多系统萎缩44例的临床与神经电生理特点分析

目的 探讨临床和神经电生理检查对于多系统萎缩(MSA)的诊断价值。方法 对44例MSA患者分组分析其临床特点、肌电图(EMG)、神经传导速度(NCV)、躯体感觉诱发电位(SEP)、运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)及视觉诱发电位(VEP)。并比较临床表现和电生理检查结果在各组间的差异。结果 本组患者以自主神经功能障碍和小脑生共济失调的异常率最高(88．6％)。帕金森综合征出现率在各组间差异有显著意义(P值分别为0．027、0．007、0．025)，卧立位血压异常在拟诊组和可能组间差异有显著意义(76．5％、18．2％)。EMG和NCV的异常率为38．1％，各组间出现率有不同。各种诱发电位的异常出现率在分组比较中无显著性差异。结论 仅凭临床表现无法对：MSA进行分组。各项神经电生理检查中以BAEP的阳性率最高。EMG和NCV结果在各组之间的差异提示该项检查对于MSA的分组可能有一定的帮助。     

亚急性联合变性的神经电生理研究

目的:探讨神经电生理检查在亚急性联合变性(SCD)早期诊断及疾病预后判定中的意义.方法:选取35例SCD患者,分别进行脊髓MRI、胫后神经体感诱发电位(SEP)、正中神经SEP、视觉诱发电位(VEP)和神经传导速度(NCV)检查,比较上述检查阳性率的差异,探讨不同检查的诊断敏感性及其对应神经结构受累的时序差别.结果:本组30例SCD患者接受脊髓MRI检查,其中有12例(40％)发现异常,35例接受胫后神经SEP、正中神经SEP、VEP、NCV检查,分别有32例(91％)、23例(66％)、7例(20％)和15例(43％)发现异常.PT-SEP与脊髓MRI的阳性率存在显著差异(P＜0.05),PT-SEP、MN-SEP、VEP、NCV的阳性率也存在显著差异(P＜0.05).结论:①神经电生理检查在SCD的诊断过程中具有较高的敏感性,对SCD的早期诊断具有重要的临床意义;②神经电生理检查可以反映SCD神经结构受累的范围及时序,对SCD的疾病预后判定有一定帮助.     

脊髓亚急性联合变性临床特点研究

目的研究脊髓亚急性联合变性(SCD)的临床、电生理及MRI特点,评价电生理及MRI在该病诊断中的价值。方法回顾性收集56例临床确诊SCD患者的临床资料,其中52例行血清维生素B12及叶酸水平测定,31例行血清同型半胱氨酸(Hcy)水平测定,56例均行针极肌电图、胫神经体感诱发电位(SEP)检查,其中29例行视觉诱发电位(VEP)及22例听觉诱发电位(BAEP)检查,51例根据临床定位行MRI检查。结果 52例中35例血清维生素B12水平、14例叶酸水平低于正常范围;31例中12例血清Hcy水平高于正常范围。56例肌电图检查结果均正常;56例中运动神经传导异常51根(45例),感觉神经传导异常90根(56例),胫神经SEP异常83侧(56例);29例中VEP结果异常22侧(12例),BAEP结果异常9侧(7例)。51例中23例可见脊髓不同范围长T2信号,8例可见单纯后索长T2信号,8例可见后索合并侧索长T2信号。结论诊断SCD应综合临床表现及实验室检查结果,神经电生理及MRI检查对判断SCD病变部位及评价治疗前后病情变化具有一定价值。     

13例神经肌炎的临床及肌电图研究

目的:探讨神经肌炎的临床特点以及肌电图(EMG)、神经传导速度(NCV)的诊断价值。方法:分析13例神经肌炎临床表现、EMG、NCV结果。结果:13例患者均以肌肉受累为主要临床表现;11例并发有神经病变的症状及体征。13例患者NCV均有异常。所检测的104根神经NCV异常率为57.7%。F波异常率为26.9%。11例针极EMG呈神经源性与肌源性混合损害,2例呈神经源性损害。结论:EMG、NCV是有价值的电生理诊断方法。确诊神经肌炎需结合临床表现和EMG结果。     

癫痫患者的脑诱发电位表现

为160例癫痫患者进行了SEP、BAEP和VEP检查,参照本实验室正常参数标准,把波消失,峰潜伏期延长(>2.5SD)和波幅降低(>2.5SD)做为异常,本组SEP、BAEP、VEP的异常率分别为38.67％、28.28％和21.88％。其中59例SEP、BAEP和VEP同时检查的异常率为52.54％,139例SEP和BAEP同时检查的异常率为48.92％,60例SEP和VEP同时检查的异常率为38.33％,62例BAEP和VEP同时检查的异常率为33.87％,表明SEP较为敏感,BAEP和VEP次之。对本病进行多项诱发电位检查,可进一步提高阳性率。     

脑震荡患者的视觉、听觉和体感诱发电位研究

目的 :探讨脑震荡患者脑功能改变及其客观诊断依据。方法 :对 30例急性期脑震荡患者进行视觉诱发电位 ( VEP)、脑干听觉诱发电位 ( BAEP)及体感诱发电位 ( SEP)检测 ,并与年龄、身高匹配的健康者对比。结果 :VEP、BAEP及 SEP异常率分别为 30 %、6 6 .7%、5 4 .5 %。结论 :脑震荡患者存在脑干、大脑半球功能受损及视通路机能障碍 ,脑诱发电位对脑震荡的诊断有一定价值。     

糖尿病周围神经病肌电图临床分析

目的 :探讨糖尿病并发周围神经病的肌电图特点、诊断价值。方法 :采用NDI 2 0 0型肌电诱发电位仪检测糖尿病周围神经病人 5 0例 ,与 3 5例正常人肌电图对照 ,统计分析。结果 :观察组NCV检查 2 60条神经异常率 80 %。正中神经、尺神经、腓总神经、腓肠神经全部受累 ,下肢比上肢重 ,感觉神经异常率高于运动神经。可见纤颤电位、正相波以及增大的波幅和时限。对照组NCV检查周围神经无异常。结论 :NCV和EMG能敏感地评价糖尿病周围神经受损程度。     

糖尿病周围神经病肌电图临床分析

目的：探讨糖尿病并发周围神经病的肌电图特点、诊断价值。方法：采用NDI－200型肌电诱发电位仪检测糖尿病周围神经病人50例，与35例正常人肌电图对照，统计分析。结果：观察组NCV检查260条神经异常率80％。正中神经、尺神经、腓总神经、腌肠神经全部受累，下肢比上肢重，感觉神经异常率高于运动神经。可见纤颤电位、正相波以及增大的波幅和时限。对照组NCV检查周围神经无异常。结论：NCV和EMG能敏感地评价糖尿病周围神经受损程度。     

多发性硬化的MRI、神经电生理和脑脊液特征分析及其诊断价值评价

目的分析61例多发性硬化(MS)患者临床和辅助检查的改变探讨各项指标诊断价值.方法回顾性总结分析61例MS患者的临床特点以及磁共振成像(MRI)、视觉诱发电位(VEP)、体感诱发电位(SEP)、脑干听觉诱发电位(BAEP)和脑脊液寡克隆区带(OB)检查结果.结果MRI检查异常率达92.31%,VEP、SEP、BAEP的异常率分别为73.17%,66.67%,35.56%,而3项诱发电位总的异常率为92%,OB检查阳性率为90.1%.结论头颅MRI和诱发电位、OB联合检测结合临床可大大提高MS诊断的阳性率.     

MRI和EMG、NCV检查在脊髓病变的应用价值分析

对76例常见脊髓病病人的主要临床资料和磁共振（MRI）、肌电图（EMG）、神经传导速度（NCV）检查结果回顾性分析，认为MRI对脊髓有形态学上改变者异常检测率高，并有其特异的影像学表现。EMG、NCV对变性，遗传性疾病的异常检测率高，MRI和EMG、NCV与临床诊断符合率分别为84．3％和90．7％，二者结合对辅助临床诊断提供了有利依据。     

多发性硬化患者的MRI及多种诱发电位研究

目的探讨磁共振成像(MRI)和诱发电位(EPs)在诊断多发性硬化中的价值。方法对68例多发性硬化患者的头颅MRI、脑干听觉诱发电位、视觉诱发电位以及体感诱发电位等指标进行回顾性分析和比较。结果多发性硬化患者的头颅MRI、脑干听觉诱发电位、视觉诱发电位以及体感诱发电位的异常率分别为91.2%(62/68)、80.9%(55/68)、82.4%(56/68)和77.9%(53/68),且均发现多发性硬化的亚临床病灶;两项或多项联合检查的异常率较单项检查的异常率增高,差异有统计学意义(P<0.01)。结论头颅MRI和诱发电位检查有助于临床早期确诊多发性硬化,联合应用可使其敏感性提高。     

Neurophysiologic and intellectual evaluation of beta-thalassemia patients

In order to detect involvement of the central and peripheral nervous system in beta-thalassemic patients, 32 children and young adults (mean age 14.5 +/- 6.4 years) participated in a systematic neurophysiologic and intellectual prospective study. All patients were in a regular transfusion program, receiving subcutaneous desferrioxamine chelation and maintaining a mean serum ferritin level of 2,101.56 +/- 986.32 ng/ml. Study patients underwent neurophysiologic evaluation consisting of brainstem auditory, visual and somatosensory evoked potential examination (BAEP, VEP, SEP) as well as motor and sensory nerve conduction velocity studies (MCV, SCV). Additionally, the verbal, performance and total IQ were assessed in patients under 16 years of age using the Weschler Intelligence Scale for Children (WISC-III). The incidence of abnormal BAEP, VEP, SEP and NCVs was 0, 3.12, 3.12 and 18.75%, respectively, findings comparative to or better than previously reported. On the contrary, the prevalence of abnormal total IQ score was considerably high (36.4%), not correlating, however, to any of the parameters assessed (age, sex, ferritin level, BAEP, VEP, SEP, NCV). Factors associated with chronic illness, rather than the disease per se, could play a potential role in the development of cognitive dysfunction in beta-thalassemia patients.     

Evoked potential abnormalities in the various inherited ataxias

Visual (VEP), brainstem auditory (BAEP), and somatosensory (SEP) evoked potential tests were performed in 45 patients representing ten types of inherited disorders in which ataxia was the most prominent symptom. Comparable VEP abnormalities were present among all types of patients. Normal BAEP tests were recorded in most patients except those with olivopontocerebellar atrophy. SEP results were often more severely abnormal in patients with Friedreich's ataxia. The observations emphasize the similarity in expression of different metabolic-degenerative disorders. When these tests are used clinically, certain features of evoked potentials (especially left-right symmetry) are typical of the inherited ataxias as a group. Few distinguishing features differentiate the individual disorders.     

Brain-stem auditory evoked potentials in multiple sclerosis: the relation to VEP,SEP and CSF immunoglobulins

Summary One hundred patients with multiple sclerosis (MS) were analysed retrospectively with respect to investigations of brain-stem auditory evoked potentials (BAEP), pattern reversal visual evoked potentials (VEP), somatosensory evoked potentials (SEP), and cerebrospinal fluid immunoglobulins (CSF-IG). BAEP were abnormal in 42% of those with normal VEP and SEP examinations, and in 38% of patients with normal CSF-IG. The chance of obtaining at least one abnormal EP was lower in patients with normal CSF-IG than in patients with abnormal CSF. When a dispersion ratio was included in the criteria for BAEP abnormality, the sensitivity increased compared with conventional BAEP criteria. We recommend that BAEP should still be included in the EP test battery for patients with suspected MS.     

单纯脑白质疏松症与皮质下动脉硬化性脑病的临床对比研究

目的探讨单纯脑白质疏松症(LA)和皮质下动脉硬化性脑病(BD)的临床表现、影像学及脑诱发电位的改变特征。方法(1)调查114例单纯脑白质疏松症患(LA组)和41例皮质下动脉硬化性脑病患(BD组)的发病危险因素和临床表现。(2)两组患均行CT检查，并按照脑白质异常程度分为3型。(3)LA组74例患，BD组35例患行MRI检查，根据T2WI显示的脑室周围高信号分为5型。(4)两组分别选择部分伴有高血压的患进行躯体感觉诱发电位(SEP)、脑干听觉诱发电位(BAEP)和视觉诱发电位(VEP)检查。结果(1)LA组患的危险因素呈多样化，无神经局灶体征，临床表现仅为轻度记忆力减退、步态不稳。CT显示脑白质异常以1型为主，占70．2％(80／114)；MRI脑白质异常也同样以1型为主，占71．6％(53／74)，均无脑室扩大。电生理学检查显示，SEP异常率为83．7％(36／43)，其中轻度60．5％，中度23．2％；BAEP异常率为62．8％(27／43)，潜伏期和峰间期延长；VEP异常率为53．5％(23／43)，各波潜伏期延长，均无波形消失。(2)BD组患危险因素以高血压为主(95．1％)，临床表现以神经局灶体征、明显认知功能障碍和卒中样发作为主。CT分型以3型多见，为73．2％(30／41)；MRI检查显示3型为54．3％(19／35)，4型45．7％(16／35)，41例患均有双侧脑室对称性扩大。电生理学检查显示，SEP异常率为96．7％(29／30)，其中轻度6．7％，中度46．7％，重度43．3％；BAEP异常率86．7％(26／30)，潜伏期和峰间期进一步延长，部分伴有Ⅲ、Ⅴ波缺失；VEP异常率为83．3％(25／30)，各波潜伏期进一步延长，部分P2单侧波形消失。结论单纯脑白质疏松症无特征性临床表现，诊断主要以影像学1型脑白质异常为依据；诱发电位表现为各波潜伏期延长，无波形完全缺失。皮质下动脉硬化性脑病的危险因素为高血压，临床有较明显的认知功能障碍，常见卒中样发作等特征，影像学检查CT显示3型脑白质异常，MRI显示3型或4型为诊断依据；诱发电位呈现各波潜伏期进一步延长并伴有部分波形完全缺失。     

Multimodal evoked potentials in neuro-Behçet: a longitudinal study of two cases

Two neuro-Behçet patients have been studied, over a period of several months, by means of peroneal and median somatosensory- (SEP), brainstem auditory- (BAEP), and visual- (VEP) evoked potentials. In both patients, peroneal SEP showed evidence of a pathological reduction in the central conduction velocity without a related deep sensation impairment, while VEP changes were consistent with the visual disorders. Conversely, BAEP and median SEP findings did not show disease-related abnormalities. The observed anomalies were detectable irrespective of the clinical phase of the disease. Thus, evoked potential assessment is useful in providing objective evidence for evaluating and monitoring CNS damage in neuro-Behçet's syndrome.     

Brain stem auditory and visual evoked potentials in multiple sclerosis

The diagnostic value of the checkerboard pattern-reversal visual evoked potential (VEP) and the random, low rate stimulated brain stem auditory evoked potential (BAEP) was compared in 99 patients with established or suspected multiple sclerosis (MS). In normal subjects examined by both techniques no abnormal recordings were found. In 49 patients with definite MS an incidence of abnormality was found in 100% of VEP and in 84% of BAEP recordings. In 50 patients with probable or possible MS an abnormal VEP was found in 70% and an abnormal BAEP in 50%. When the two examinations were combined, the diagnostic yield increased to 100 and 80%, respectively. 22 patients had only spinal symptoms; in these the VEP gave 73%, the BAEP 55% and the combination 82% abnormalities. The combination of the two techniques was found useful for demonstrating demyelinating lesions in the central nervous system, the diagnostic value being greatest when these lesions were clinically silent.     

Visual, early auditory and somatosensory evoked potentials in multiple sclerosis (917 cases)

Visual (VEP), brainstem auditory (BAEP) and somatosensory (SEP) evoked potentials were recorded over a 6 year period in 917 patients with or suspected of multiple sclerosis according to Mc Alpine's criteria. Evoked potentials provided information of diagnostic relevance in detecting clinically unsuspected lesions (spatial dissemination). They also gave valuable informations in patients with atypical or borderline clinical features. When abnormal, VEP indicated clinically silent lesions in 45.1 p. 100 of patients with definite MS, 66 p. 100 of those with probable MS and 78 p. 100 of the possible MS. Less than 15 p. 100 of SEP and/or BAEP abnormalities were found in 83 patients with a simple or recurring retrobulbar optic neuritis. Thirteen patients with acute transverse myelopathy and no prior history of neurological disease were studied. All had normal visual and brainstem auditory evoked potentials. Abnormal VEPs helped to the clinical assessment of 88 patients with progressive spastic paraparesis 46,6 p. 100 of whom had abnormal VEPs demonstrating disseminated lesions and 36,1 p. 100 had abnormal BAEPs. The frequency of the various types of VEP, BAEP and SEP abnormalities was studied as well as their course on repeated recordings. Results of multivariate analysis are given. It was found that the longer the time interval between the first MS relapse and the evoked potential recording, the higher the incidence of abnormalities. The incidence of evoked potentials abnormalities was lower in patients with normal CSF and higher in patients with inflammatory CSF. The abnormalities were more frequent when patients had clinical evidence of lesions of the sensory pathways explored by the tests.     

卡马西平对诱发电位的影响及意义

目的研究长期口服卡马西平治疗癫对诱发电位的影响,并讨论其意义。方法选择尚未治疗的癫病人31例作为试验组;以性别、年龄与癫组相匹配的健康正常人26例作为对照组。两组先分别做脑干听觉诱发电位(BAEP)、事件相关电位P300、视觉诱发电位(VEP)和体感诱发电位(SEP),之后癫组开始卡马西平治疗,服药一年后再作上述各项检查。结果癫组病人治疗前各项电生理学指标与正常对照组相比无显著性差异;癫组卡马西平治疗后各项电生理指标与治疗前相比BAEP各波、P300以及VEP的P100波潜伏期均显著延长;SEP的潜伏期无显著变化。结论神经电生理学检查可以早期发现长期服用卡马西平导致的亚临床毒性。