接触性热痛诱发电位检测方法的建立

目的 建立接触性热痛诱发电位(CHEP)的检测方法,估测介导此诱发电位的外周神经传导速度.方法 受试者取卧位,应用CHEP刺激器,于两个强度水平(49.5℃和54.5℃)应用可调节脉冲,刺激部位为鱼际肌、手背、前臂的掌侧面.受试者在每次刺激后,按照视觉模拟评分标准对刺激强度分级.以Keypoint仪器记录,记录点为Cz和Pz.测定刺激强度和疼痛分级的关系、诱发电位的主要成分及外周神经传导速度.结果 刺激强度和疼痛分级的关系为:49.5℃和54.5℃刺激鱼际肌皮肤,疼痛分级分别为(3.2±0.3)、(4.4±0.5)级;54.5℃刺激手背和前臂掌侧面皮肤,疼痛分级分别为(6.3±0.8)、(7.2±0.5)级.于记录点记录到3个主要成分:Cz/N550、Cz/P750和Pz/P1000.介导此诱发电位的外周神经传导速度分别为(12.9±7.5)、(1.7±0.4)m/s,分别与Aδ纤维和C纤维的传导速度相对应.结论 CHEP能较为稳定、可靠地引出,介导此诱发电位的外周神经为Aδ纤维和C纤维.     

接触性热痛诱发电位在亚急性联合变性诊断中的应用

目的 应用接触性热痛诱发电位(CHEPs)技术研究亚急性脊髓联合变性(SCD)患者痛觉传导通路变化特点,探讨CHEPs在SCD中的应用价值,为其电生理诊断提供依据.方法 选取确诊型SCD患者20例和健康人34名,应用CHEPs刺激器,刺激水平为51℃,对C_7部位、上肢前臂掌侧前1/3处、下肢内踝及腰部进行刺激,记录点为Cz,记录诱发电位主要成分的潜伏期和波幅.分析周围神经Aδ纤维传导速度和中枢N波峰潜伏期、N-P波波幅,同时进行躯体感觉诱发电位(SEP)及感觉传导速度(SCV)测定并与CHEPs进行比较.结果 (1)健康对照组予以51℃刺激,CHEPs的引出率为100%.(2)患者组中存在痛温觉减退者,视觉模拟评分[VAS,上肢6.4(5.3～8.9)分,下肢5.7(2.8～8.8)分]低于健康对照组[上肢7.6(6.4～9.2)分,下肢6.9(5.7～9.1)分,Z=3.478、3.909,P＜0.01].(3)患者组上肢A8纤维传导速度(CV)为(9.77±4.28)m/s,下肢Aδ纤维CV为(8.19±0.91)m/s,与健康对照组[(12.87±1.40)m/s]比较,差异具有统计学意义(t=3.142、14.864,P＜0.01).患者组中上肢Aδ纤维CV减慢13例(65%),正中神经SCV减慢4例(20%);下肢Aδ纤维CV减慢19例(85%),胫神经SCV减慢12例(60%),A5纤维CV异常率高于SCV.(4)患者组下肢CHEPs异常者16例,而SEP异常者18例,两组间比较差异无统计学意义.结论 CHEPs能发现SCD痛觉传导通路异常部位和程度,较SCV敏感,可以作为辅助SCD电生理诊断的方便、客观的方法.     

多发性硬化的诱发电位特点

目的分析多发性硬化(multiple sclerosis,MS)模式翻转视觉诱发电位(pattern reversal evoked po-tential,PRVEP)、脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)和体感诱发电位(somatosenso-ry evoked potential,SEP)等三种诱发电位(evoked potential,EP)的临床特点。方法对83例确诊MS患者进行回顾性分析,根据有无相应临床症状、病程及功能残障程度对EP进行分层研究,探讨其变化规律。结果三种EP的异常率在有临床症状组〔PRVEP、BAEP及下肢短潜伏期体感诱发电位(SLSEP)异常率分别为88.00%、66.67%、100%〕与无临床症状组(PRVEP、BAEP及下肢SLSEP异常率分别为60.61%、31.71%、79.63%)间比较均存在统计学差异(均P<0.05)。PRVEP的峰潜伏期(PL)延长及侧间峰潜伏期差值(ILD)增加的异常率之和与病程呈正相关(r=1.0,P<0.05);病程在20年以内时BAEP异常率与病程呈正相关(r=1.0,P<0.05);SLSEP下肢未引出率与病程呈正相关(r=1.0,P<0.05)。PRVEP异常率与EDSS分值呈正相关(r=1.7,P<0.01);SLSEP上肢异常率及下肢未引出率也与EDSS分值呈正相关(分别r=1.8,P<0.01;r=1.6,P<0.01)。结论三种EP的异常率与有无相应临床症状相关,且与病程及功能残障程度在一定范围内呈正相关。     

磁共振成像和诱发电位在多发性硬化诊断中的价值

目的　探讨磁共振成像 (MRI)和诱发电位在诊断多发性硬化中的价值。方法　运用病例统计方法 ,计算头颅MRI、视觉诱发电位以及听觉诱发电位等在多发性硬化患者中的异常率 ,并分析、比较异常率之间的差别。结果　MRI异常率为 83 5 8% (5 6/67) ,视觉诱发电位为 64 18% (4 9/ 67) ,听觉诱发电位为 73 1% (4 3 / 67) ,并且均能发现多发性硬化的亚临床病灶 ;两项或三项联合检查的异常率较其单项检查的异常率增高 ,并有统计学意义。结论　MRI和诱发电位检查有助于临床确诊MS ,联合应用可使其敏感性提高。     

诱发电位和MRI检查在多发性硬化诊断中的价值

目的探讨诱发电位(EPs)和MRI检查在多发性硬化(MS)诊断中的价值。方法收集69例MS患者的临床资料、视觉诱发电位、体感诱发电位、脑干听觉诱发电位、磁刺激运动诱发电位以及MRI结果,比较不同检测方法对其临床诊断的价值。结果 MS患者的视觉诱发电位、体感诱发电位、听觉诱发电位、运动诱发电位以及MRI的异常检出率分别为69.57%(48/69)、50.72%(35/69)、55.07%(38/69)、42.03%(29/69)、78.26%(54/69)。4项诱发电位检查总异常检出率为86.96%(60/69),与MRI检查结果比较差异无统计学意义(P=0.178)。EPs和MRI检查均能发现临床下病灶:14例患者经MRI检查发现病灶但无相应临床症状;15例患者有临床症状而MRI检查未见相应病灶,但EPs检查可见异常。结论 MRI和EPs检查具有相互补充作用,结合临床合理选择使用此两种检查有助于提高MS诊断的敏感性。     

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。     

视觉诱发电位对多发性硬化的诊断意义

目的：探讨视觉诱发电位在多发性硬化中的诊断价值。方法：应用棋盘格翻转方式分别对３２例健康人和２０例多发性硬化患者进行视觉诱发电位检测，将测量结果进行比较，结果：视觉诱发电位的异常率为９０％，Ｐ１００峰潜伏期与对照组相比有显著性差异（Ｐ＜０．０１）。结论：视觉诱发电位对多发性硬化患者的早期诊断、病情程度判断和预后评估方面具有一定的价值。     

视觉诱发电位对多发性硬化的诊断价值

目的进一步认识视觉诱发电位(VEP)在多发性硬化(MS)中的使用价值。方法分析25例临床诊断为MS的VEP检测结果。结果25例MS患者的VEP异常率为72％,异常者中伴视觉症状者占44％;不伴相应视觉症状者占56％;伴脊髓损害者占78％。结论VEP检查对MS的诊断具有重要意义。     

The utility of multimodal evoked potentials in multiple sclerosis prognostication

The ability to predict disability development in multiple sclerosis (MS) is limited. While abnormalities of evoked potentials (EP) have been associated with disability, the prognosticating utility of EP in MS remains to be fully elucidated. The present study assessed the utility of multimodal EP as a prognostic biomarker of disability in a cohort of clinically heterogeneous MS patients. Median and tibial nerve somatosensory, visual, and brainstem auditory EP were performed at initial assessment on 63 MS patients (53 relapsing–remitting and 10 secondary progressive) who were followed for an average of 2 years. A combined EP score (CEPS) was calculated consisting of the total number of abnormal EP tests, and was correlated with the Expanded Disability Status Scale (EDSS) at baseline and follow-up. There was a significant correlation between multimodal EP and baseline and follow-up EDSS. Specifically, tibial nerve P37 latencies correlated with EDSS (R_BASELINE = 0.49, p < 0.01; R_FOLLOW-UP = 0.47, p < 0.01), as did the median nerve N13 (R_BASELINE = 0.40, p < 0.01; R_FOLLOW-UP = 0.35, p < 0.05) and N20 latencies (R_BASELINE = 0.43, p < 0.01; R_FOLLOW-UP = 0.47, p < 0.01), and P100 full-field (R_BASELINE = 0.50, p < 0.001; R_FOLLOW-UP = 0.45, p < 0.001) and central field latencies (R_BASELINE = 0.60, p < 0.001; R_FOLLOW-UP = 0.50, p < 0.001). In addition, there was a significant correlation between the CEPS with baseline (R = 0.65, p < 0.001) and follow-up (R = 0.57, p < 0.01) EDSS. In contrast, white matter disease burden, as measured by T2 lesion load, exhibited a weaker correlation with EDSS (R_BASELINE = 0.28, p < 0.05). In conclusion, these findings suggest that abnormalities of EP, as quantified by the novel CEPS, may be a useful biomarker for prognosticating clinical disability in MS, and may aid in the quantification of MS disease severity and in guiding therapeutic decisions.     

多发性硬化患者前庭诱发肌源性电位的临床意义

目的研究多发性硬化(multiple sclerosis,MS)患者前庭诱发肌源性电位(vestibularevoked myogenic potentials,VEMPs)各参量的变化及临床意义,比较VEMPs与核磁共振、脑干听觉诱发电位对MS病变的检测能力。方法采用双耳短声刺激记录37例MS患者(有脑干症状21例、无脑干症状16例)和20名健康对照的VEMPs的潜伏期和振幅值,计算双侧在13ms左右出现的正波(p13)波幅潜伏期差值(Δp13)和振幅比(SR)。37例MS患者均做核磁共振成像,其中33例记录脑干听觉诱发电位。结果有脑干症状组和对照组相比,p13潜伏期显著延长[左侧为(13.84±2.57)ms和(12.20±1.10)ms,P<0.05;右侧为(14.69±2.96)ms和(12.10±2.60)ms,P<0.01],Δp13显著增大(1.63±1.82和1.00±1.44,P<0.01),而无脑干症状组差异无统计学意义。两组MS患者的p13-n23(在23ms左右出现的负波)振幅值与对照组相比均降低[左侧分别为(149.98±52.2)、(175.51±49.22)、(272.80±165.81)μV;右侧分别为(156.88±97.04)、(167.74±57.32)、(257.50±138.49)μV,P均<0.05],扩展的残疾功能量表评分与振幅有相关性(左侧r=0.45,右侧r=0.46,P均<0.05)。VEMPs与核磁共振相比,对病灶的检出率低(分别为33%与100%,P<0.05),与脑干听觉诱发电位相比差异无统计学意义。结论p13潜伏期及Δp13可作为判定MS前庭脊髓通路脱髓鞘的参考指标。VEMPs作为辅助诊断MS的一项新的诱发电位,对脑干病灶的诊断有一定临床参考意义。     

多发性硬化患者头颅磁共振、诱发电位和IgG指数的对比研究

报道43例多发性硬化(MS)患者头颅磁共振成像(MRI)、诱发电位(EP)和IgG指数(IgGIndex)的对比研究结果。发现MRI的检测异常率为81.4％,而VEP仅53.7％、BAEP47.5％、IgGIndex57.5％。MRI在显示空间脱髓鞘方面是最敏感的方法,但VEP、BAEP只要有一项异常即判断为EP异常则其异常率高达79.5％,接近MRI。作者认为三者同时检查可以提高诊断的准确性。     

痛觉诱发电位示肌萎缩侧索硬化患者痛觉通路正常

目的 研究肌萎缩侧索硬化患者痛觉诱发电位的特点,评估其痛觉通路的传导.方法 肌萎缩侧索硬化患者60例,取卧位,应用接触性热痛诱发电位刺激器,直径27 mm(面积573 mm2),加热速度70℃/s.于54.5℃应用可调节脉冲,刺激部位为手背、前臂的掌侧面、第7颈椎棘突处(C7).记录仪器:Keypoint.net仪器.记录点为Cz和Pz.同时进行躯体感觉诱发电位检测,记录其波形及潜伏期.并对60名健康对照者进行相应研究.结果 肌萎缩侧索硬化患者接触性热痛诱发电位波形无异常,潜伏期分别为:手背刺激(561.2±28.6)ms,前臂掌侧刺激(540.1±39.2)ms,C7刺激(512.7±31.4)ms,与健康对照组[(558.7±30.2)、(536.6±23.5)、(501.8±26.0)ms]比较差异均无统计学意义(t=4.23、4.51、3.74,P＞0.05).其躯体感觉诱发电位各波潜伏期、波间期均正常.结论 肌萎缩侧索硬化患者接触性热痛诱发电位正常,提示其痛觉通路正常.     

Serial studies of evoked potentials and circulating lymphocyte subsets for multiple sclerosis: attempts to monitor progress

Summary A concurrent change in evoked potential measurements and quantitation of circulating T-suppressor (CD8) lymphocyte subpopulations might indicate increased subclinical disease activity. Eight untreated patients with clinically definite multiple sclerosis were monitored monthly for changes in the numbers of cells positive for CD8 markers, and hence in the ratio of CD4: CD8 positive cells. Such changes were found not to be associated with changes in evoked potentials or clinical status.     

Right/left differences of median nerve evoked scalp potentials in multiple sclerosis

Summary Scalp potentials evoked by electrical stimulation of the median nerve at the wrist were examined in multiple sclerosis patients and healthy controls. The latencies of the first negative peak (about 18 ms latency) of the response to right and to left-sided stimulation were compared. Forty-eight of 60 measured latency differences in 15 suspected or certain MS patients were more than 3 standard deviations beyond the average difference in controls (arbitrary norm limit), whereas none of the 56 results of the 14 controls was in that range. Fifteen of 24 latency differences in 6 patients without anamnestic or clinical sensory disturbances in the arms were above the limit. On the other hand, conduction velocity between wrist, neck and scalp did not differentiate controls from patients.We suggest using latency differences of the early components of right and left median nerve-evoked scalp potentials as a mean for the early detection of functional disturbances in multiple sclerosis.Supported in part by Schweiz. Multiple-Sklerose-Gesellschaft (Jubiläumsstiftung der Schweiz. Lebens- und Rentenversicherung), Swiss National Science Foundation, and Stiftung Wiss. Forschung, Zürich     

Fever and evoked potentials in multiple sclerosis

Summary The somatosensory evoked potentials (SEPs) and visual evoked potentials (VEPs) were studied in 19 patients with multiple sclerosis; 17 controls were studied during fever (38.0°–39.7°C) and 2–3 days following return to normal temperature. The latencies of components N₂₀ and P₁₁₄ were measured and specified as abnormal when their value exceeded the standard deviation of the controls by 2.5 times. The corresponding criterion for the evaluation of the amplitude of components N₂₀ and P₁₁₄ was a reduction in amplitude of more than 50%. In the controls fever did not cause significant changes in evoked potentials. On the other hand, patients with multiple sclerosis showed abnormalities in evoked potentials during fever in a greater number of recordings (26 of SEPs and 33 of VEBs) than after return to normal temperature (19 and 27 respectively). In addition, the average latency of components N₂₀ and P₁₁₄ was clearly greater in the patients during fever (N₂₀=29.5±5.2 ms and P₁₁₄=143±18.1 ms) than after return to normal temperature (N₂₀=6.6±3.5 ms and P₁₁₄=134±16 ms). The amplitude of components N₂₀ and P₁₁₄ in patients during fever was clearly smaller than after return to normal temperature. These differences were statistically significant. Finally, in two patients, a decrease was found, during fever, in the conduction velocity of the peripheral somatosensory pathway from the median nerve to the wrist at Erb's point.

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Zusammenfassung Wir studierten die somatosensorisch evozierten Potentiale (SSEP) sowie die visuell evozierten Potentiale (VEP) bei 19 Patienten mit Multipler Sklerose und 17 Kontrollpersonen. Die somatosensorisch und visuell evozierten Potentiale wurden in beiden Gruppen unter dem Einfluß von Fieber als auch zwei bis drei Tage nach dem Abklingen des Fiebers untersucht.Die Latenzzeit der Komponenten N₂₀ und P₁₁₄ wurde als pathologisch bewertet, wenn ihre Werte 2,5 Standardabweichungen über dem Mittelwert von Normalpersonen lagen.Der entsprechende Maßstab für die Bewertung der Höhe der Komponenten N₂₀ und P₁₁₄ war eine Höheminderung über 50%.Wir fanden, daß Fieber bei den Kontrollpersonen keinen wesentlichen Einfluß auf SSEP und VEP hatte. Bei den MS-Patienten haben wir wesentlich mehr Abnormitäten der SSEP und VEP während des Fiebers (26 SSEP und 33 VEP) als nach dem Abklingen des Fiebers (19 SSEP und 27 VEP).Darüber hinaus war der Mittelwert der Latenzzeit der Komponenten N₂₀ und P₁₁₄ bei den MS-Patienten während des Fiebers höher (N₂₀=29,5±5,2 ms; P₁₁₄=143±18,1 ms) als nach dessen Abklingen (N₂₀=26,6±3,5 ms; P₁₁₄=134±16,8 ms).Abgesehen davon war die Höhe der Komponenten N₂₀ und P₁₁₄ während des Fiebers wesentlich kleiner als nach dem Abklingen des Fiebers.Diese Unterschiede sind statistisch signifikant.Ferner fanden wir während des Fiebers bei zwei Patienten eine Verminderung der Erregungsleitungsgeschwindigkeit im N. medianus zwischen Handgelenk und Erbschen Punkt.

     

Evoked potentials for evaluation of multiple sclerosis

The role of evoked potentials (EP) in the assessment of multiple sclerosis (MS) has changed over the last decade. This is largely due to progress in imaging techniques. But while MRI has a greater diagnostic sensitivity, EP remain a useful diagnostic tool in many clinical situations. Moreover, recent studies demonstrate the utility of EP for monitoring and predicting the course of the disease in patient groups, although not yet in individuals. For these purposes, EP show better results than conventional MRI. In the near future, new developments in electrophysiology, immunology and imaging may allow to differentiate between different subtypes of MS early in the course, and consequently to tailor therapeutic measures more precisely to the individual patients.