48例肘管综合征临床分析

目的 探讨肘管综合征(CuTS)患者的临床及神经电生理特点.方法 总结46例CuTS患者患侧(患者组)与健侧(对照组)相关的临床及神经电生理资料进行分析比较. 结果尺神经运动传导速度肘上-肘下段为(33.56±8.61) m/s,动作电位潜伏期较对照组延长,波幅降低,感觉神经传导速度为(37.34±8.57) m/s,感觉电位潜伏期较对照组延长,波幅降低,其间的差异均有统计学意义(P＜0.05).患者组1例未引出运动诱发的动作电位波形,4例未引出感觉诱发的动作电位波形.结论 肘管综合征应早诊断、早治疗;而神经电生理检测为诊断肘管综合征的可靠手段,可早期确诊及准确定位尺神经受损部位及损伤程度.     

神经电生理检测在肘管综合征中的应用

目的:探讨神经电生理检测在肘管综合征(CuTS)中的临床应用价值.方法:总结86例(88侧)CuTS患者(患者组)的临床神经电生理资料,并与30例(60侧)正常人(对照组)相关的电生理数据进行分析比较.结果:患者组共有19侧肢体在尺神经运动传导检测时未引出波形,有36侧肢体在尺神经感觉传导检测时未引出波形.尺神经运动传导速度肘上至肘下段为(34.56±6.27) m/s,复合肌肉动作电位潜伏期较对照组延长、波幅降低,感觉神经传导速度为(40.72±6.54)m/s,与对照组比较,差异均有极显著意义(P＜0.01).结论:神经电生理检测为诊断CuTS的可靠手段,可早期确诊及精确定位尺神经受损的部位及损伤程度.为提高其敏感性及定位的准确性,在电生理检查方法上还需进一步探讨.     

糖尿病性多发性神经病神经传导异常与临床评分相关性分析

目的分析糖尿病性多发性神经病患者神经电生理改变及其与临床评分的相关性。方法回顾性分析36例中日友好医院内分泌科住院的2型糖尿病性多发性神经病患者神经电生理异常特点并统计分析其与密歇根量表评分之间的相关性。结果本研究入组的36例糖尿病性多发性神经病患者中,周围神经传导检查下肢重于上肢(100%vs 83. 3%),感觉传导异常比运动传导异常多见(100%vs 83. 3%),以下肢感觉传导感觉神经动作电位(SNAP)波幅下降最为常见(36/36,100%);运动神经传导异常则以运动传导速度(MCV)减慢相对常见(30/36,83. 3%),复合肌肉动作电位(CMAP)波幅下降及运动传导远端潜伏期(DML)延长相对少见(11. 1%,5. 6%);神经损害电生理评分与密歇根量表评分之间具有显著相关(P 0. 01)。结论感觉传导波幅下降及轻度的运动传导速度减慢为常见的糖尿病性多发性神经病电生理改变特点;神经传导异常评分与密歇根量表评分具有显著相关,可用于疾病严重程度随访。     

婴儿型脊肌萎缩症的神经电生理特点

目的探讨婴儿型脊肌萎缩症(SMA)的神经电生理特征。方法采用肌电/诱发电位仪对27例SAM患儿进行神经传导速度测定,每例进行至少6块肌肉的EMG检查,分析检查结果。结果婴儿型SMA正中神经复合肌肉动作电位(CMAP)波幅显著下降,尺神经与腓总神经的CMAP波幅明显下降,伴有尺神经运动传导速度的轻度减慢;所记录感觉神经传导未见明显异常。EMG提示神经源性损伤。结论婴儿型SMA典型临床症状为进行性加重的对称性肌肉无力和萎缩,特异性的神经电生理表现为本病的诊断提供重要的依据。     

平山病的神经电生理学研究

目的 探讨平山病的神经电生理学特点及其与肌萎缩侧索硬化、多灶性运动神经病的鉴别诊断.方法 分别对平山病(26例)、肌萎缩侧索硬化(30例)和多灶性运动神经病(16例)患者进行运动和感觉传导速度、肌电图及交感皮肤反应等神经电生理学检查.运动传导速度采用由远端至近端分段刺激,记录复合肌肉动作电位的波幅、时限、面积及波形的变化,并判断是否存在神经传导阻滞;肌电图检查记录脑区肌肉(双侧胸锁乳突肌),颈区肌肉(拇短展肌、小指展肌、第一骨问肌、肱二头肌),胸区肌肉(T10椎旁肌、腹直肌)和腰骶区肌肉(胫骨前肌)的肌电活动.比较3组患者神经电生理学特点的差异性.结果 平山病组患者均无神经传导阻滞,肌电图检查显示颈区肌肉呈神经源性损害;肌萎缩侧索硬化组患者亦无神经传导阻滞,肌电图检查显示脑区、颈区、胸区和腰骶区肌肉均呈神经源性损害;多灶性运动神经病组患者均存在神经传导阻滞,肌电图检查颈区和腰骶区肌肉呈神经源性损害.平山病组患者神经传导阻滞的发生率与多灶性运动神经病组比较,差异有统计学意义(x2=42.000,P=0.000);平山病组患者神经源性损害的发生率与肌萎缩侧索硬化组比较,差异亦有统计学意义(x2=56.000,P=0.000).结论 平山病组患者运动和感觉传导速度均无异常,无神经传导阻滞,但肌电图检查显示颈区肌肉呈神经源性损害.     

36例手足口病合并急性弛缓性麻痹患儿的肌电图分析

目的:探讨神经电生理检查在手足口病(HFMD)合并急性迟缓性麻痹(AFP)患儿的特点及应用价值.方法:对36例手足口病合并急性迟缓性麻痹患儿进行运动神经传导速度(MCV)、感觉神经传导速度(SCV)、F波及肌电图(EMG)检查,共检测176条运动神经、88条感觉神经、98条神经的F波及285块肌肉,并对结果进行分析.结果:运动神经传导异常率为52.8%,其中运动传导波幅下降占81%,未引出反应波者为15%,MCV减慢或潜伏期延长者为4%,感觉传导异常率为6%,F波异常率为10%,EMG出现自发电位者为28.4%,出现高大运动单位电位(MUP)者为48.1%,募集相减少63.9%.结论:HFMD合并AFP患儿有神经原性损害,以轴突损害电生理改变为主,多累及近端神经,以运动神经受累为主.神经电生理检查对HFMD合并AFP患儿的诊断治疗及判断预后有重要价值.     

多发性硬化周围神经病变的电生理评价

目的研究多发性硬化(MS)患者的周围神经病变，并评价神经电生理技术的应用价值。方法采用神经传导速度(NCV)技术检测MS患者周围神经的运动传导速度(MCV)、感觉传导速度(SCV)及其潜伏期；采用运动诱发电位(MEP)检测正中神经和胫神经的潜伏期；采用F波检测正中神经的出现率和传导速度。结果MS患者NCV均不同程度地减慢，MCV的异常率高于SCV，NCV结果提示轴突损害比脱髓鞘显著。MEP测得肘点和腰4点的潜伏期延长，提示正中神经远端和腰骶神经根功能的损害。部分患者F波的出现率降低．提示周围神经根功能异常。结论MS患者存在周围神经病变；综合运用电生理技术可以全面地评价MS周围神经功能。     

神经型布氏杆菌病周围神经损害的临床与电生理研究

目的研究神经型布氏杆菌病周围神经损害的临床特征,探讨电生理对其的诊断价值。方法对32例神经型布氏杆菌病周围神经损害患者(病例组)和32名性别及年龄与病例组匹配的正常对照组进行神经电生理检查,并对所得检查结果进行统计学分析。结果病例组与对照组在运动末梢潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound motor active potentials,CMAP)波幅、运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经动作电位潜伏期(sensory nerve action potential latency,SL)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensory nerve conduction velocity,SCV)方面的比较,差异均有统计学意义(P0.05)。电生理检查提示上下肢周围神经损害,感觉神经及运动神经均受累,其中感觉神经占55.47%,运动神经占16.80%,上肢以正中神经(64条)最多见,下肢以腓肠神经(16条)最多见。四肢运动神经256条中43条传导速度减慢,占16.80%,四肢感觉神经256条中142条传导速度减慢,占55.47%,SCV较MCV改变明显,上肢病变重于下肢。结论神经电生理检查为神经型布氏杆菌病周围神经损害的临床诊断提供了客观依据。     

吉兰-巴雷综合征患者的神经电生理特点

目的 探讨吉兰-巴雷综合征(GBS)患者的神经电生理特点.方法 对20例吉兰-巴雷综合征患者进行肌电图(EMG)、运动神经传导速度(MCV)、F波及感觉神经传导速度(SCV)检测,共检测160条运动神经、120条感觉神经及60块肌肉,并对结果进行分析.结果 上、下肢神经远端潜伏期延长占54.4%,MCV减慢占68.8%,F波异常占95.0%,SCV减慢占70.8%,EMG提示神经源性损害占70.0%.结论 GBS为广泛的周围神经损害,存在以脱髓鞘为主伴有轴索变性的神经电生理改变.神经电生理检测对GBS的诊断具有极为重要的诊断价值.     

神经电生理检查对足下垂鉴别诊断的临床意义

目的：探讨足下垂病因及神经电生理检查对其鉴别诊断的临床意义。方法：对66例足下垂患者进行神经电生理检查。结果：腓总神经复合肌肉动作电位（CMAP）波幅降低30例,传导阻滞6例,CMAP缺如29例,异常65例,达99％;腓总神经损伤17例,坐骨神经损伤8例,腰骶神经根病41例。结论：腰骶神经根病、坐骨神经损伤、腓总神经嵌压均可导致足下垂,神经电生理检查对确定神经受损部位、损害程度及评价预后有重要价值。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.