多种诱发电位和MRI检查在多发性硬化诊断中的价值

目的：探讨诱发电位和磁共振成像（MRI）检查在多发性硬化（MS）诊断中的价值。方法：收集65例MS患者的临床资料、磁刺激运动诱发电位（MEP）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）、体感诱发电位（SEP）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患者的磁刺激MEP、BAEP、VEP、SEP以及MRI的异常检出率分别为78％（51／65）、51％（33／05）、80％（52／65）、71％（46／65）和85％（55／65）。4项诱发电位检查总异常检出率为88％（57／65）,与MRI检查结果比较差异无统计学意义（P〉0．05）。各种诱发电位和MRI检查均能发现临床下病灶：6例患者经MRI检查发现病灶但无相应临床症状;8例患者有临床症状而MRI检查未见相应病灶,但诱发电位检查可见异常。结论：MRI和各种诱发电位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。     

多发性硬化患者的视觉、听觉和体感诱发电位的诊断价值

目的:探讨视觉诱发电位(VEP)、听觉诱发电位(BAEP)、体感诱发电位(SEP)对多发性硬化(MS)的诊断价值。方法:对22例临床诊断为MS的患者进行VEP、BAEP、SEP检测,并与正常对照组进行比较分析。结果:22例MS患者中VEP异常15例(68.2%),BAEP异常9例(40.9%),SEP异常12例(54.5%),异常中VEP有53.3%、BAEP有44.4%、SEP有58.3%的患者,临床有相应症状。结论:VEP、BAEP、SEP的检测有助于MS诊断以及亚临床病灶的发现。     

The correlation between cerebrospinal fluid findings and evoked potentials during an acute MS attack

Clinically definite Multiple Sclerosis (MS) cases have an index greater than 0.7. Evoked potentials using geometrical patterns and click stimuli respectively and electrical stimulation of mixed nerve trunks evokes low level electrical impulses along a nerve. Prolonged latencies and changes in amplitude in these evoked potentials are thought to reflect sensory loss. This study is performed to determine whether there is a correlation between cerebrospinal fluid (CSF) findings and evoked potentials in MS during an acute MS attack. 10 male and 10 female patients' (20-55) mean (37.75) were included in to the study. They were diagnosed as definite MS with their clinical and MRI findings. During the acute attack 10 (50%) patients out of 20 had high Ig G index and one (10%) had oligoclonal band positivity. Of these 10 patients 8 (4 M, 4 F) had pathology in their evoked potentials while two had normal evoked potential findings. 8 of (80%) 10 patients whom had normal Ig G index during the acute attack had evoked potential pathology while (20%) had normal Ig G index and evoked potentials during the acute attack. Of the 8 patients which had high Ig G index and pathological evoked potential findings during acute attack were evaluated. VEP, BAEP latencies were found to be prolonged as Ig G index increased. (p < 0.05) However the same correlation can not be found with SEP parameters.     

P300等诱发电位对亚临床肝性脑病早期诊断的意义

目的:观察事件相关电位P_(300)、体感诱发电位、视觉诱发电位和脑干听觉诱发电位在亚临床肝性脑病诊断中的意义。方法:50例亚临床肝性脑病患者进行了心理测验,并做了头颅CT和视觉诱发电位、体感诱发电位、脑干听觉诱发电位和事件相关电位检查,30例正常人做为对照组。结果:亚临床肝性脑病的心理测验,韦氏法智力低下率为76％,视觉诱发电位异常率为13％,脑干听觉诱发电位异常率为20％,体感诱发电位异常率为40％,事件相关电位异常率为71％,正常对照组四种诱发电位的正常率是100％。头颅CT结果与亚临床肝性脑病无关。结论:视觉诱发电位、体感诱发电位、脑干听觉诱发电位和事件相关电位在亚临床肝性脑病中是异常的。事件相关电位更为敏感,对亚临床肝性脑病的早期诊断有重要意义。     

Vitamin B12 deficiency neurological syndromes: a clinical,MRI and electrodiagnostic study

BACKGROUND: Vegetarianism is an important cause of vitamin B12 deficiency, especially in countries like India. We managed 17 patients with neurological syndrome due to vitamin B12 deficiency in a tertiary care referral teaching hospital which caters to relatively affluent population. AIM: To evaluate neurophysiological and MRI changes in patients presenting with vitamin B12 deficiency neurological syndrome and interpret these is the light of reported autopsy findings. SETTING: Tertiary care referral teaching hospital. METHODS: Patients with vitamin B12 deficiency neurological syndrome diagnosed by low serum vitamin B12 and/or megaloblastic bone marrow were subjected to clinical evaluation and spinal MRI. The neurophysiological tests included nerve conduction studies, tibial somatosensory evoked potential (SEP), motor evoked potential (MEP) and visual evoked potential (VEP) studies. The recovery was defined on the basis of 6 months Barthel Index score into complete, partial or poor. RESULTS: There were 17 patients with vitamin B12 deficiency neurological syndrome, 3 were females and 12 lactovegetarian. The clinical syndrome was that of myelopathy in 8, myeloneuropathy in 5, dementia myelopathy in 3 and neuropathy in 1 patient. All the patients had impaired joint position and vibration sensation in the lower limbs and 4 had in upper limbs as well. Lower limbs were spastic in 13 and upper limbs in 2 patients. Spinal MRI revealed T2 hyperintensity in cervicodorsal region in 6 and cord atrophy in 3 patients. Sural nerve conduction was abnormal in 8 and peroneal conduction in 5 patients. In one patient all sensory nerve conductions were unrecordable but motor conductions were normal. Tibial SEP was abnormal in 12 out of 15 and lower limb MEP in 8 out of 12 patients. P100 latency of VEP was prolonged in 7 out of 13 patients. Right to left asymmetry was present in tibial SEP in 4 and VEP in 2 patients. At 6 months followup 2 patients improved completely, 7 partially and 3 had poor recovery. Clinical recovery correlated with MEP but not with SEP or MRI changes. CONCLUSION: The evoked potential and MRI changes in vitamin B12 deficiency neurological syndrome are consistent with focal demyelination of white matter in spinal cord and optic nerve. Myelopathic presentation is commoner and SEP is more frequently abnormal. The outcome at 6 months correlated with MEP changes.     

诱发电位对痴呆和非痴呆型帕金森病与宾斯旺格病的比较研究

目的 :探讨帕金森病 (PD)与宾斯旺格病 (BD)患者的中枢神经通路和认知功能状态。方法 :对无痴呆的PD 2 8例 (PD组 ) ,伴痴呆的PD 2 2例 (DPD组 )及BD组 18例进行①体感诱发电位 (SEP)、②视觉诱发电位 (VEP)、③脑干听觉诱发电位 (BAEP)和④事件相关电位 (ERP)检查。结果 :①SEP :PD组中 5例 (18% )异常 ,DPD组中 8例 (36 % )异常 ,BD组中 11例 (6 1% )异常 ;②VEP :PD组仅 1例 (4% )异常 ,DPD组中 4例 (18% )异常 ,BD组 3例 (17% )异常 ,经统计学处理 ,潜伏期与左右眼差值均无显著差异 ;③BAEP :PD组中 4例 (14% )异常 ,DPD组中 5例异常 (2 3% )异常 ,BD组 4例 (2 2 % )异常 ;④ERP :PD组中 5例异常 (18% ) ,DPD组 9例异常 (41% ) ,BD组 11例异常 (6 1% )。结论 :SEP和ERP阳性率最高 ,其阳性率的顺序为BD >DPD >PD ,提示三组病例的中枢神经系统功能的损害有明显区别。     

Somatosensory evoked potentials in the diagnosis of cervical spondylotic myelopathy.

Median, ulnar, radial and common peroneal nerve somatosensory evoked potentials (SEPs) were studied in 17 patients suffering from cervical spondylotic myelopathy. Median, ulnar and common peroneal nerve SEPs were abnormal in 41%, 71% and 100% of cases respectively. Abnormalities of the scalp far-field P14 evoked by upper limb stimulation correlated with joint and touch sensation impairment, but not with radiological findings. Therefore, P14 may be a reliable marker of dorsal column impairment in cervical spondylotic myelopathy. The analysis of the cervical N13 response, which was recorded using a cephalic reference electrode, did not give any further information. Common peroneal nerve SEP abnormalities were found in all our patients, but they were obviously of no value in identifying the cervical spine as the site of lesion.     

视觉、脑干听觉诱发电位对多发性硬化的诊断价值

目的 :探讨视觉诱发电位 (VEP)、听觉诱发电位 (BAEP)对多发性硬化 (MS)的诊断价值。方法 :对 30例临床诊断为MS的患者进行VEP、BAEP检测 ,并与正常对照组进行比较分析。结果 :MS患者VEP和BAEP的异常率分别为 73%和 6 0 %。异常中VEP有 6 8% ,BAEP有 78%的患者 ,临床有相应的症状 ;VEP 32 % ,BAEP 2 2 %的患者临床无相应症状。 5例MS患者在临床缓解期复查VEP、BAEP ,1例VEP、BAEP恢复正常 ,4例仍异常。结论 :VEP、BAEP检测对MS的诊断具有重要意义。     

65例颈椎型脊髓病体感诱发电位分析

目的研究颈椎型脊髓病皮质体感诱发电位（ＳＥＰ）变化。方法对６５例颈椎型脊髓病患者和２６例正常人进行正中神经和胫后神经刺激的ＳＥＰ对照研究，并对１０例患者作治疗前后对照观察。结果本组异常率为４５％，主要表现为各波替伏期和波间期（Ｎ２０—Ｐ２５，Ｐ２５—Ｎ３５，Ｐ４０—Ｎ４５）延长，且下肢的延长更加明显，部分患者出现波形分化不良。经保守治疗后６例正常，２例好转，且ＳＥＰ的好转先于临床的改善。结论ＳＥＰ对评判颈椎型脊髓病的脊髓传导功能具有重要的意义，且有助于临床预后的评价。     

重症肌无力患者视、听、体感诱发电位研究

目的：研究重症肌无力(MG)患者视觉诱发电位(VEP)、脑干听觉诱发电位(BAEP)和体感诱发电位(SEP)的变化及其与中枢神经系统(CNS)损害的关系。方法：对22例临床及重复神经电刺激(RNS)确诊的MG患者行VEP、BAEP检测，其中的18例还进行了SEP检测。结果：22例MG患者中VEP异常15例(68．2％)、BAEP异常8例(36．4％)。SEP检查18例均异常，其中上肢SEP异常8例(44．4％)，下肢SEP异常10例(55．6％)。结论：MG患者的VEP、BAEP、SEP均有不同程度异常，表明MG患者可伴有CNS损害，而VEP、BAEP、SEP可作为早期发现MG患者CNS改变的有效检测手段。     

诱发电位在多发性硬化诊断中的应用

目的：探讨诱发电位在多发性硬化诊断中的应用价值。方法：对26例多发性硬化患者进行视觉、听觉和体感诱发电位的检查并分析。结果：视觉诱发电位异常的有20例,异常率为76.9%,听觉诱发电位异常的15例,异常率为57.7%,体感诱发电位异常的13例,异常率为50.0%。三项诱发电位总的异常有23例,总的异常率88.5%。结论：联合应用视觉、听觉和体感诱发电位检测可使异常率明显提高,有助于对多发性硬化的诊断及亚临床病灶的发现。     

P300 in multiple sclerosis: a preliminary report.

The P300 component of the event-related brain potential (ERP) elicited with auditory stimuli and pattern-shift visual evoked potentials (VEPs) was obtained from 16 patients with multiple sclerosis (MS) and 16 matched control subjects. P300 latency was significantly longer and component amplitude relatively depressed in the MS patients compared to control subjects. The P100 potential of the VEP also was delayed for both full-field and half-field stimulus conditions in the patients compared to control subjects. The findings suggest that the P300 ERP may reflect the cognitive decline associated with MS.     

Neurogenic vestibular evoked potentials in the diagnosis of multiple sclerosis

OBJECTIVES: To determine the value of neurogenic vesibular evoked potential (NVESTEP) studies in comparison with other paraclinical tests in demonstrating dissemination in time and space in Multiple Sclerosis (MS) and in identifying clinically silent lesions. METHOD: All patients in whom MS was suspected but the diagnosis of MS was not possible based on the McDonald criteria were included in this study. We studied 14 patients and performed visual, brainstem auditory, somatosensory and neurogenic vestibular evoked potentials in all patients, together with MRI and CSF analysis of oligoclonal bands (OB). RESULTS: Two out of the thirteen patients could be movedfrom the category of "possible MS" to "MS" using the McDonald criteria based on an abnormal NVESTEP result. CONCLUSION: Neurogenic vestibular evoked potentials are potentially useful in identifying clinically silent lesions in patients with possible MS.     

A sensory evoked potential comparison of persons 'at risk' for Huntington's disease and hospitalized neurotic patients

Scalp-recorded sensory evoked potentials (EPs) elicited by left and right median nerve stimulation (LSEP and RSEP), checkerboard pattern flash (VEP) and acoustic click (AEP) were obtained in 22 individuals 'at risk' (AR) for Huntington's disease and 22 hospitalized neurotic patients matched for age, gender and intelligence. EPs of AR subjects were generally similar to those of the neurotic comparison group, in terms of overall configuration; however, mean amplitudes were significantly lower for ARs. While the general amplitude reduction for ARs was seen in all three modalities, the somatosensory modality yielded the most abnormal findings.     

Reconsiderations about the abnormalities of somatosensory evoked potentials in motor neuron disease

The frequency of involvement of sensory pathways in motor neuron disease (MND) remains the matter of controversy. For this reason the purpose of the present work was to test how often sensory system involvement might be detected by somatosensory evoked potentials (SEP) studies and then to verify the presence of alteration of the sensory conduction and to detect the frequency of abnormalities of somatosensory peripheral, spinal, subcortical and cortical potentials in MND. SEP were tested after median nerve stimulation at the wrist, recorded from Erb's point, Ce2, Ce7 and scalp. Pearson's correlation coefficients test and Wilcoxon rank-sum test were used for statistical analysis. 74 patients (22 women and 52 men) were examined. Mean age of patients was 54.07 +/- 11.24 years; mean duration of the disease -19.25 +/- 15.87 months. SEP were abnormal in 39 of 74 patients (about 53%) whereas the sensory NCV in median nerve was abnormal in 14 of 74 patients (19%). The most frequent pattern of abnormalities consisted of the absence or delay of cortical responses. The mean values of SEP latencies (N9, N11, N13, N20 and P25) were significantly increased in MND patients (p < 0.05) as compared with controls. The N9 and N11 latencies correlated with the duration of the disease. The results of our study (concerning a large group of MND patients) suggest that the involvement of sensory pathways is not rare in MND.     

Visual and brainstem auditory evoked potentials in hereditary motor-sensory neuropathy

Visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) were recorded in 57 children and adults with hereditary motor-sensory neuropathy (HMSN); 37 of them were diagnosed as type I (demyelinating) and 20 as type II (axonal). None of the patients presented central nervous system involvement. The results were compared with VEP and BAEP records of 12 adults with Guillain-Barré syndrome (GBS) and 40 healthy controls. Above 30% of all patients with HMSN I showed delayed latency of the VEP. These abnormalities were less expressed in HMSN II. Abnormal BAEP were observed in almost 50% of patients with HMSN I and HMSN II with nearly the same frequency in both types but more pronounced in HMSN I. The most common feature was prolongation of the I-III interpeak latency (JPL). The VEP and BAEP changes could be present simultaneously in the same patient (mainly in HMSN I) or separately. More often the abnormalities were observed in the adult patients. Normal VEP and BAEP values were present in all patients with GBS. The results strongly suggest the subclinical optical and auditory pathways involvement in HMSN patients.     

BRAIN DYSFUNCTION OF PATIENTS WITH QIGONG INDUCED MENTAL DISORDER REVEALED BY EVOKED POTENTIALS RECORDING

Objective: In order to investigate the brain function of patients with Qigong induced mental disorder (QIMD), this study was carried out. Methods: Four kinds of evoked potentials, including contingent negative variation ( CNV) , auditory evoked potentials ( AEP) , visual evoked potentials ( VEP), and so-matosensory evoked potentials (SEP), were recorded from 12 patients with Qigong induced mental disorder. Comparison of their evoked potentials with the data from some normal controls was made. Results: The results revealed that there were 3 kinds of abnormal changes in evoked potentials of patients with QIMD that is latency prolongation, amplitude increase and amplitude decrease, as compared with normal controls. Conclusion: Brain dysfunction of patients with QIMD was confirmed. Its biological mechanism needs further studying.     

How might demyelinating disorders and glaucoma modify synaptic function?

Latencies of visually evoked potentials (VEPs) tend to be abnormally long in multiple sclerosis (MS). Similar VEP delays are seen in glaucoma. Such delays could result in part from reduced intensities of synaptic inputs at post-retinal synaptic relays, and defects of axoplasmic transport might be one cause for this. The effective rate of synaptic activation of a given postsynaptic neuron can be decreased either by reducing the arrival-rate of presynaptic action potentials (e.g., by complete or partial blockage of conduction in some presynaptic axons), or by reducing the quantity of neurotransmitter released per action potential (e.g., as a consequence of presynaptic neurotransmitter depletion). It is proposed that in both glaucoma and MS, delayed VEPs may result from either or both of these mechanisms. Firstly, loss and functional impairment of optic nerve axons occurs in each disorder. Secondly, in glaucoma the increased intraocular pressure tends to block the rapid anterograde axoplasmic transport (RAAT) which brings neurotransmitter supplies to the axon terminals. This could result in neurotransmitter depletion in the lateral geniculate relay, decreased synaptic effectiveness of remaining normally-conducting optic nerve axons, and thereby increased VEP latencies. RAAT is also blocked by demyelinated lesions that have been produced experimentally by injection of diphtheria toxin. If it is impaired by the demyelinated plaques of multiple sclerosis, then VEP slowing by a similar presynaptic depletion mechanism could ensue.     

慢性肝病肝硬化的脑干诱发电位的初步研究

在我们嘉兴地区,由于曾是血吸虫病流行区,因此对血吸虫病肝纤维化及混合性肝硬化发病率高,为了解肝硬化患者与脑干诱发电位的关系,我们于1995年1月～1996年12月对100例肝硬化肝功能失代偿患者,其中还包含有32例由于肝硬化门静脉高压并发上消化道大出血的患者进行了脑干听觉诱发电位(BAEP),视觉诱发电位(VEP),体感诱发电位(SEP)进行测试,其结果BAEP阳性率为50％,VEP阳性率为18％,SEP阳性率为12％,本文检测对象年龄从21岁～82岁,平均年龄为51.5岁,所以还必须对年龄因素来进行分析,以便客观和确切的来探讨肝硬化与脑干诱发电位之间的关系。     

Evaluation of asymptomatic central neuropathy in type I diabetes mellitus

OBJECTIVES: Diabetic neuropathy is recognized as the most common clinical picture of nervous system disorders caused by diabetes mellitus (DM). Although peripheral and autonomic nervous system involvements are frequently encountered, there exists a few data about the incidence of central diabetic neuropathies. Central nervous system degeneration is a well known pathology in diabetic patients in the long term. It is possible to reveal central nervous system involvement at the early stages by using evoked potentials (EP). The aim of this study is to evaluate the auditory, visual and sensorial abnormalities in type I diabetic patients, who also have normal nerve conduction studies, with somatosensory, brainstem auditory and visual EP studies (SEP, VEP BAEP); to determine the frequency of these abnormalities and to investigate the relationship between other variables such as age, gender, duration of the diabetes and degree of the metabolic control. PATIENTS AND METHODS: A total of 36 asymptomatic type I DM children, ages ranging between 6-17 (mean age 11 +/- 3.24) taking insulin treatments were included in this study. Control group was made up of healthy children. EPs were evaluated and comparisons were made between the two groups. RESULTS: In a large group of diabetic children (47.2%), independent from parameters such as age, gender, glycemic control degree, auditory and visual deficits, retinopathy, joint movement limitation; but dependent on the peripheral SEP pathologies and disease duration there were central electrophysiological disturbances. In 13 (36.1%) of the patients SEP pathologies; in 9 (25%) of the patients VEP pathologies and in 14 (38.9%) of the patients BAEP pathologies were detected. Conclusion: Besides independent from peripheral pathologies, central nervous system involvement could also be observed in diabetic children. EP changes can be detected in asymptomatic patients that would be a predictor of future symptoms.