甲状腺机能障碍患者的体感诱发电位

应用电子计算机迭加平均技术,记录了24名甲状腺机能亢进症(甲亢)、4名甲状腺机能减退症(甲减)患者和32名正常受试者的正中神经体感诱发电位(SEPs)。在24名甲亢患者中F_(?)峰值潜伏期延长者12例,N_(13)-N_(20)传导时间缩短者2例;4例甲减患者中,Ep峰值潜伏期延长者3例,N_(20)峰值潜伏期延长者1例,N_(13)-N_(20)传导时间延长者1例。结果表明,甲状腺机能异常者不仅可出现外周神经传导功能障碍,而且也可能出现中枢传导功能的异常。     

MEP、NCV、FW在突眼性甲状腺肿中的应用

目的:了解突眼性甲状腺肿患者感觉传入神经以及运动传出通路(包括运动中枢、脊髓、神经根和远、近端周围神经)的功能状态。方法:对44例突眼性甲状腺肿患者采用表面电极法常规顺向检测正中神经和胫后神经共88条神经感觉传导速度(SCV)、运动末端潜伏期(DL)及波幅,F波(FW)潜伏期及出现率。并在88条尺神经和腓总神经从中枢至外周传出通路不同部位予以磁刺激,分别在小指展肌和胫前肌记录复合肌肉动作电位,分别测定各段潜伏期和中枢运动传导时间(CMCT)。结果:88条正中神经和胫后神经中有16条(18%)SCV减慢或波幅降低,12条(14%)ML延长或波幅降低。4条FW潜伏期延长,4条FW出现率降低。88条尺神经和腓总神经运动诱发电位(MEP)检查中有34条(39%)波幅降低,各节段潜伏期和CMCT均未见异常。结论:NCV、FW、MEP联合检测对判断突眼性甲状腺肿是否合并神经病变具有较重要作用。     

糖尿病性周围神经病神经传导速度的电生理研究

目的:探讨糖尿病性周围神经病的电生理改变特征。方法:对58例临床确诊的Ⅱ型糖尿病(NIDDM)患者和25例健康对照组进行正中神经和腓总神经运动神经传导检测,对刺激所诱发的复合肌肉动作电位进行分析。结果:两组对比,糖尿病组中MCV减慢(72.41%),DPL延长(56.89%),波幅降低(34.48%),时限延长(53.45%),有显著性差异(P<0.01)。结论:检测和分析正中神经、腓总神经的运动神经传导和复合肌肉动作电位有助于了解糖尿病性远端神经病变的电生理改变,有助于DPN早期诊断和鉴别诊断。     

二硫化碳慢性中毒90例临床及神经传导研究

目的:二硫化碳(CS2)是亲神经毒物,中毒主要表现为神经系统受损.长期接触低浓度CS2者,可发生周围神经病或亚临床周围神经病.对90例CS2中毒患者进行神经传导电生理检测以探讨其周围神经功能损害情况.方法:检测正中神经、尺神经、胫后神经、腓总神经的末端运动传导潜伏期(DML) 、神经末端复合肌动作电位波幅植(dCMAPA)、感觉传导速度( SCV)、感觉动作电位波幅值(SNAPA)、 F波传导速度(F CV)、 F波出现率等.结果:尺神经、腓总神经、胫后神经、正中神经的神经传导异常率分别为52%、48%、44%、41%.上下肢未见明显差别.运动神经传导异常率为31%,F波异常率为24%,感觉神经传导异常率为13%、只检出感觉神经异常者仅7%.不同神经传导检测各项目异常率分别为DML 30%、dCMAPA 9%、SCV 13%、SNAPA 13%、F CV 10% 及F波出现率19%.结论:CS2引起的中毒性神经病以运动神经远端轴索损害为主,少数会有感觉神经的异常.电生理损害主要为DML延长.     

神经肌电图在腕管综合征患者中的应用价值

目的 探讨神经肌电图在腕管综合征(CTS)患者中的诊断应用价值。方法 收集2021年9月至2023年2月在桂林医学院附属医院门诊就诊的患者55例,性别不限,根据临床表现初步诊断为CTS,病程3 d～3年,对其进行肌电图检查,记录正中神经支配拇指、示指感觉纤维的波幅和传导速度、运动传导潜伏期、波幅和传导速度,尺神经的运动及感觉传导,正中神经和尺神经的环指差值,观察肌肉静息状态下有无自发电位。结果 被检的110条正中神经中,有105条(95.4%)正中神经/尺神经环指感觉电位潜伏期差值≥0.4 ms,有104条(94.5%)感觉传导速度减慢,有66条(60%)神经运动传导潜伏期延长,有28条(25.4%)感觉传导波幅降低,有13条(11.8%)神经运动动作电位波幅降低。被检的110块拇短展肌中针极肌电图异常有13块(11.8%),其中有8块出现自发电位(纤颤电位、正锐波),有10块出现运动单位时限延长。尺神经的神经传导及小指展肌等肌肉的针极肌电图结果均正常。55例患者中,8例为轻度异常,26例为中度异常,21例为重度异常。结论 对临床初步诊断CTS的患者进行神经肌电图检查可以提供正中神经受...     

糖尿病性神经病变的SEP临床研究

目的：探讨SEP与MCV、SCV检测在糖尿病伴有周围神经症状中的诊断应用价值。方法：对61例糖尿病伴有神经症状施行了胫神经感觉诱发电位(SEP)，腓总神经运动传导速度(MCV)，正中神经感觉传导速度(SCV)，并进行了比较分析。结果：总异常率为75．41％。SEP异常率最高(65．57％)；SCV次之(50．82％)；MCV最低(26．23％)。大多数(80％)SCV减慢患均有SEP延长，而1／3SCV正常的病人，SEP潜伏期是延长的。结论：SEP与SCV、MCV合并检测对糖尿病患神经系统损害程度的判断是有益的。     

腓骨肌萎缩症患者的临床与神经电生理特征分析

目的:探讨腓骨肌萎缩症(Charcot-Marie-Tooth disease,CMT)的临床与神经电生理特征;方法:应用肌电图仪检测和分析21例腓骨肌萎缩症患者的电生理特征,包括肌电图和运动、感觉神经传导速度;分析电生理特征与临床之间的关系;结果:16例患者肌电图出现纤颤电位和(或)正锐波,17例患者运动单位(MUP)时限延长。11例腓总神经、13例胫神经运动传导速度(MCV)未引出,1例正中神经、2例尺神经MCV未引出,3例正中神经、2例尺神经MCV正常,其余均有不同程度减慢;15例腓肠神经感觉神经传导速度(SCV)未引出,3例正中神经、6例尺神经SCV未引出,7例正中神经、5例尺神经SCV正常,其余均有不同程度减慢。结论:CMT患者的神经电生理特征大多数呈神经原性损害,运动和感觉神经传导速度有不同程度的受累,下肢的神经病变重于上肢,临床表现结合神经肌电图检查有助于CMT的确诊。     

糖尿病周围神经病变患者电生理特点及相关危险因素

目的 探讨2型糖尿病患者周围神经病变的电生理特点以及疾病相关危险因素。方法 选取2021年11月至2022年3月在无锡市人民医院就诊的210例2型糖尿病患者,根据周围神经临床症状、体征将患者分为有症状组(108例)和无症状组(102例)。通过测定单侧肢体的正中神经、尺神经、腓总神经的运动传导速度(MNCV)、复合肌肉动作电位(CMAP)波幅、运动远端潜伏期(DML)以及正中神经、尺神经、腓浅神经的感觉传导速度(SNCV)、感觉神经动作电位(SNAP)波幅,分析两组患者电生理特点以及糖尿病周围神经病变(DPN)的危险因素。结果 有症状组的年龄大于无症状组,病程长于无症状组,空腹血糖、餐后2 h血糖比无症状组高,有症状组的舒张压比无症状组高,差异均具有统计学意义(P<0.05)。有症状组正中神经、尺神经和腓总神经MNCV均较无症状组减慢(P<0.01),正中神经、尺神经的DML较无症状组延长(P<0.01),波幅较无症状组降低(P=0.05)。有症状组正中神经、尺神经和腓浅神经SNCV均较无症状组减慢,波幅较无症状组降低(P均<0.05)。logistic单因素回归...     

长期服用苯妥英钠的癫癎患者神经电生理观察

目的:观察长期服用苯妥英钠的癫患者周围神经损害。方法:应用丹迪Neuromatic2000M型肌电仪,对37例患者进行正中神经和胫后神经的神经传导(NCV),F波和H反射的检测,同时观察肌肉的针极肌电图(EMG)。结果:癫组与对照组比较正中神经感觉速度(P<0·05),波幅(P<0·05),dML(P<0·05),F波出现率(P<0·01),胫后神经感觉波幅(P<0·05),dML(P<0·01),F波潜伏时(P<0·01)。EMG检测未发现损害。结论:长期服用苯妥英钠的癫患者可发生周围神经损害,表现为(1)感觉运动神经均有损害;(2)脱髓鞘及轴索损害都会发生,轴突损害符合远端轴突病;(3)神经损害远近端都有发生;(4)上下肢神经轴突均有损害,以下肢的轴突损害为重。     

腕管综合征患者的临床与神经电生理研究

目的：观察神经电生理检测对腕管综合征(CTS)的诊断价值。方法：对腕管综合征的临床特征及病因进行了分析，并作神经传导速度(NCV)和肌电图检测和分析。结果：40条患病神经中8条正中神经诱发波形消失，32条正中神经感觉潜伏期延长、波幅降低或(和)感觉神经传导速度减慢。25例患者伴有30条正中神经运动末梢潜伏期延长或(和)动作电位波幅降低。22块正中神经支配肌有去神经电位。结论：神经电生理检查在腕管综合征的诊断与鉴别诊断中有重要意义。     

Cortical and subcortical SEPs following posterior tibial nerve stimulation

Summary Intra-operative cortical and subcortical SEPs from the cerebral convexity and from the inter-hemispheric fissure were recorded following posterior tibial nerve (PTN) stimulation. Cortical and subcortical SEPs from the cerebral convexity after contra-lateral PTN stimulation consisted of N38 and P46, and their polarity reversed when the ipsi-lateral site was stimulated. On the other hand, cortical SEPs from the inter-hemispheric fissure always showed P38 and N46, whether the right or the left PTN was stimulated. Cortical and subcortical SEPs from the inter-hemispheric fissure showed clear cut polarity reversals. These findings provide good evidence for the existence of a tangential dipole oriented perpendicular to the inter-hemispheric fissure in the foot sensory area of the primary sensory cortex. SEPs recorded from the superficial part of the inter-hemispheric fissure showed smaller amplitudes and longer latencies than those of SEPs from the deeper regions. These findings suggest the existence of another dipole responsible for the generation of SEPs after PTN stimulation.     

Nerve conduction changes during lower limb lengthening. Somatosensory evoked potentials (SEPs) and F-wave results

The effect of lower limb lengthening on nerve conduction was investigated in 5 achondroplastic subjects who underwent callotasis on a "cross-over" basis. Somatosensory evoked potentials (SEPs) and F waves from the posterior tibial nerve (PTN) were studied preoperatively and then after removal of the axial fixators. SEPs at the end of lengthening showed that both the latency of the plexus potential (P9) and, albeit to a lesser extent, the interpeak time between the plexus and the spinal cord (N15) potentials were significantly increased. The central conduction time (N15-P33) and the amplitude of the scalp responses were not modified. The latencies of the F waves were much longer at the end of bone distraction than in basal conditions. The increases in both PTN SEPs and F-wave latencies are consistent with a slowing of conduction The extent of these latency shifts correlated closely with the degree of limb lengthening. We calculated that, on average, each cm of lengthening could produce 0.21 msec and 0.22 msec delays respectively, suggesting a similar effect of the stretching on both sensory and motor fibers. Our findings indicated that the damage could be widely distributed along the whole length of the nerve, affecting both the peripheral (trunk) and proximal (plexus and root) segments. The electrophysiological changes were not associated with any persistent clinical complaint.     

Neurophysiological investigation of cervical spondylosis

The difficulties in diagnosing spinal cord lesions due to the cervical spondylosis is well-known in clinical neurology. In order to investigate the contribution of various neurophysiological examinations in the diagnosis in cervical spondylosis, we examined 70 patients suffering from cervical spondylosis, with peripheral nerve conduction studies, F-wave from the upper limb and electromyography from the corresponding muscles, as well as somatosensory evoked potentials (SEPs) from upper and lower limbs. Patients were separated into four groups: 20 patients had cervical spondylosis symptoms only; 15 patients had symptoms and signs of spinal root involvement; 15 patients had symptoms and signs of myelopathy; and 20 patients had symptoms and signs of both myelopathy and spinal root involvement. A group of 20 normal controls was also studied. In all groups of patients SEPs were the most sensitive electrophysiological study. Low-amplitude N13 and increased conduction time of N9-N13 and central conduction N13-N19 and LP-P27 were the most common finding in SSEP testing. SEPs were affected in many cases without CT-MRI findings of spinal cord pressure. From the above findings, SEPs proved to be the most sensitive diagnostic investigation in cervical spondylosis.     

Central sensory motor pathways are less affected than peripheral in chronic renal failure

In chronic renal failure, peripheral neuropathy although is well recognised but there are only a few studies on the evaluation of central sensory pathways and none on central motor pathways. This study is aimed at the evaluation of peripheral and central sensory motor pathways. In this prospective hospital based study, 19 patients with chronic renal failure on regular hemodialysis were included. They were subjected to detailed clinical evaluation and blood urea nitrogen, serum creatinine, serum protein, haemoglobin and vasculitic profile were carried out in all the patients. Peroneal motor conduction, sural sensory conduction, tibial somatosensory evoked potential (SEP) and motor evoked potential to tibialis anterior (CMCT-TA) were carried out in all the patients and the results correlated with clinical and biochemical parameters. The mean age of the patients was 34.6 y and 1 of them was female. The duration of renal failure ranged between 0.3 and 5 years. Nerve conduction studies were abnormal in 12 patients of whom sural nerve conduction was abnormal in 10 and peroneal in 8 patients. Central conduction, motor or sensory or both were abnormal in 5 patients. Central motor conduction time to tibialis anterior was marginally prolonged in 3 patients and tibial SEPs were recordable in 2 and prolonged in 1 patient. The central and peripheral conduction did not correlate with duration of illness, serum creatinine and hemoglobin levels. It is concluded that central pathways are less frequently and less severely affected than the peripheral in chronic renal failure.     

Comparative study of evoked potentials in multiple sclerosis and neuro-Beh?et's syndrome

We studied somatosensory evoked potentials (SEPs) and brainstem auditory evoked potentials (BAEPs) in Japanese patients with multiple sclerosis (MS) and those with neuro-Behcet's disease (NB). Abnormal cortical P37 of posterior tibial nerve SEPs or cervical N13 of median nerve SEPs were more frequently found in the MS patients than in the NB patients. On the other hand, prolongation of the central conduction time of median nerve SEPs or abnormal BAEPs were more common in NB than in MS. The present data showed that lesions were mainly present in the spinal cord in MS and in the brainstem in NB. SEPs and BAEPs were considered of great value for detecting the involvement of the central nervous system in MS and NB and distinguishing between these diseases.     

Cortical somatosensory evoked potentials. II. Effects of excision of somatosensory or motor cortex in humans and monkeys

1. To clarify the generators of human short-latency somatosensory evoked potentials (SEPs) thought to arise in sensorimotor cortex, we studied the effects on SEPs of surgical excision of somatosensory or motor cortex in humans and monkeys. 2. Normal median nerve SEPs (P20-N30, N20-P30, and P25-N35) were recorded from the cortical surface of a patient (G13) undergoing a cortical excision for relief of focal seizures. All SEPs were abolished both acutely and chronically after excision of the hand area of somatosensory cortex. Similarly, excision of the hand area of somatosensory cortex abolished corresponding SEPs (P10-N20, N10-P20, and P12-N25) in monkeys. Excision of the crown of monkey somatosensory cortex abolished P12-N25 while leaving P10-N20 and N10-P20 relatively unaffected. 3. After excision of the hand area of motor cortex, all SEPs were present when recorded from the cortical surface of a patient (W1) undergoing a cortical excision for relief of focal seizures. Similarly, all SEPs were present in monkeys after excision of the hand area of motor cortex. 4. Although all SEPs were present after excision of motor cortex in monkeys, variable changes were observed in SEPs after the excisions. However, these changes were not larger than the changes observed after excision of parietal cortex posterior to somatosensory cortex. We concluded that the changes were not specific to motor cortex excision. 5. These results support two major conclusions. 1) Median nerve SEPs recorded from sensorimotor cortex are produced by generators in two adjacent regions of somatosensory cortex: a tangentially oriented generator in area 3b, which produces P20-N30 (human) and P10-N20 (monkey) [recorded anterior to the central sulcus (CS)] and N20-P30 (human) and N10-P20 (monkey) posterior to the CS; and a radially oriented generator in area 1, which produces P25-N35 (human) and P12-N25 (monkey) recorded from the postcentral gyrus near the CS. 2) Motor cortex makes little or no contribution to these potentials.     

股外侧皮神经损害患者的SEP检测

目的:观察股外侧皮神经(LFCN)损害患者的体感诱发电位(SEP)变化。方法:对35例 LCNT损害的患者进行SEP检测,并以健侧肢体作为对照组。结果:35例LFCN损害患者中异常29例 (82％),表现为P40或(和)P60潜伏期延长11例(37％)、波幅降低9例(31％),两者兼有7例(24％), P40、P60未引出2例(6％),与健侧肢体对照比较差异有显著意义。结论:LFCN受损后神经传导冲动 减弱,SEP潜伏期延长或(和)波幅降低,因而认为SEP是检测LFCN损害的一种敏感而有效的方法。     

A thalamic component of the cervical evoked potential in man

Somatosensory evoked potentials (SEPs) were recorded simultaneously from scalp and neck locations following median nerve stimulation. By subtracting the latency of the major negative peak of the cervical SEP (N13) from that of the primary cortical response (N20), the central somatosensory conduction time was calculated (5.9 ms). On the descending slope of the cervical SEP was superimposed a positive potential of probable thalamic origin (P17). By subtracting the latency of N13 from that of P17 and P17 from that of N20 respectively, the transit time for the afferent volley both within the brainstem (3.9 ms) and the thalamo-cortical radiation (2.0 ms) was obtained.     

Transmission times from cutaneous and mixed nerves of lower limbs.

In each of 10 normal subjects, P28 and N31 far-field components as well as the cortical N37 and P40 waves were identified for both Sural (SN) and Posterior Tibial nerve (PTN) stimulation at the ankle. Peripheral conduction velocity along the popliteal fossa-L3 segment and spinal transmission velocity over the L3-Cv2 segment did not differ significantly for the two nerves. The average latencies of N37 and P40 to stimulation of PTN were 2.55 and 3.65 msec shorter than corresponding latencies from SN. If we consider the P28-N37 and P28-P40 intervals as central transmission times, only the former approaches upper limb CCT values closely enough to support the analogy between median nerve N20 and PTN N37. At the intracranial level, the P28-N37 inter-peak latency was significantly shorter for PTN than SN. The P28 component is generally attributed to lemniscal activity. Thus, the discrepancy in afferent transmission times from the leg's mixed and sensory nerves would appear to take place at a level that is supralemniscal but subcortical.