瞬目反射正常值测定及临床应用价值

目的：研究瞬目反射（ＨＲ）的正常值及其临床应用价值。方法：采用Ｋｅｙｐｏｉｎｔ神经电生理仪,表面电极刺激眶上神经,在同测眼轮匝肌记录出Ｒ１波和Ｒ２＇波,在对测眼轮匝肌记录出Ｒ２＇波。对３０例健康成人和５６例患者（主要包括面神经,三叉神经痛,脑干损伤以及脑出血）进行ＢＲ检测。结果：正常组ＢＲ各潜伏期平均值分别是Ｒ２为１０．７ｍｓ,Ｒ２和Ｒ２＇为３０．８ｍｓ、３０．６ｍｓ,患者组根据损伤部位分为传入型     

瞬目反射应用的研究进展

瞬目反射应用的研究进展卢祖能汤晓芙瞬目反射（ＢＲ）是众多的脑干反射的一种。电刺激所诱发的ＢＲ可进行定量分析，这样就可用来评价疾病状态、为临床诊断提供客观信息。对ＢＲ最早的文献记载可追朔到１９世纪末期。Ｏｖｅｒｅｎｄ（１８９６）首先描述了ＢＲ：当轻叩前...     

脑卒中对瞬目反射的影响

目的 :探讨脑干以上节段的病变对瞬目反射 ( BR)的影响。方法 :共 3 0例脑卒中患者作了 BR检测。于眶上切迹处以方波脉冲电流刺激眶上神经。双侧下眼轮匝肌分别记录 ,刺激同侧所记录的两个波为 R1 、R2 ,刺激的对侧所记录到的一个波为 R'2 。结果 :( 1 ) BR2例正常、2 8例异常。 ( 2 )在这 2 8例 56侧中 BR各成分的异常率分别为 R1 :4 8.2 % ( 2 7/56)、R2 :69.6% ( 3 9/56)、R'2 :57.1 % ( 3 3 /56)。 ( 3 )两个或以上的 BR成分缺如者 9例 ,其中 5例有神志的改变、2例有失语、2例神志清楚。结论 :大脑半球病变对 BR总的影响是抑制性的。 BR的异常与病人的神志状况及有否失语密切相关 ,而与病变部位、是否有中枢性面瘫、偏瘫、面部感觉障碍以及检测的时间间隔均关系不大。     

帕金森病患者瞬目反射分析

目的 通过观察帕金森病患者的瞬目反射,为帕金森病患者的诊断及分期治疗提供客观依据.方法 对帕金森病患者及对照组行瞬目反射检查,早期帕金森病组与中晚期帕金森病组瞬目反射结果.结果 帕金森病组和对照组比较,帕金森病组瞬目反射R2波潜伏期较对照组延长(P<0.01);中晚期帕金森病组较早期帕金森病组瞬目反射R2波潜伏期延长(...     

瞬目反射与面神经麻痹的早期诊断

面神经麻痹是神经科临床常见病．表现为一侧额纹消失．不能皱额、蹙眉，同侧眼不能闭合或闭合不全，鼻唇沟变浅．口角下垂，示齿时口角偏向健侧。其病因不同、病变部位不同而有不同的临床表现。本科自去年起将瞬目反射（BR）广泛应用于面神经麻痹诊断中．现将其应用价值做一总结性评价。     

脑梗死对瞬目反射的影响

目的探讨不同部位脑梗死对瞬目反射(blink reflex,BR)的影响。方法77例脑梗死患者分为基底节组、脑干组、大脑皮质组进行BR检测,比较不同病变部位的R1、R2和R2′之间有无差异。结果各病变组病侧与健侧R1、R2和R2′潜伏期较对照组均延长,有显著性差异。大脑皮质组之病侧与健侧R2、R2′均较基底节组明显延长,存在显著性差异。结论无论是大脑皮质、基底节或脑干的病变均会导致BR的异常,BR可作为了解脑梗死病变后神经传导通路是否受损的客观指标。     

瞬目反射应用的研究进展

瞬目反射应用的研究进展卢祖能汤晓芙４．为评价某些疾病状态提供电生理依据４．３半侧面肌痉挛（ＨＦＳ）［２，５，２６］。ＨＦＳ也可显示有联带运动的临床和电生理依据。眼轮匝肌以外的面肌记录到了ＢＲ表明：①面神经核的过度兴奋（ｈｙｐｅｒｅｘｃｉｔａｂｉｌｉｔ...     

瞬目反射在糖尿病患者中的应用

３０例糖尿病患者的瞬目反射结果显示，糖尿病组左右两侧Ｒ１、Ｒ２、Ｒ２各反应波潜伏期均值比较无显著差异，将两侧值平均后与正常人比较，各反应波潜伏期有不同程度的延长，以Ｒ２和Ｒ２延显著，且各波波幅均值低于下沉人。表明糖尿病民生中枢神经系统损害可影响脑干，受损部位以桥脑为主。     

瞬目反射R1波对面神经麻痹诊断价值的研究

对３４例面神经麻醉痹患者进行Ｒ１波、Ｍ波及ＥＭＧ检测综合分析，可客观地评价面神经损害程度及部位是在茎乳孔内或外。结果表明Ｒ１波、Ｍ波是定位诊断的敏感指标，Ｒ１波传导时间延长对茎乳孔内病变有较高诊断价值。面神经麻痹患者Ｒ１波消失经１个月未恢复者提示预后不良。     

瞬目反射对贝尔氏面瘫早期诊断及预后评估的价值

目的探讨瞬目反射(BR)在贝尔氏面瘫患者早期诊断及预后评估的价值。方法于病后1m对45例贝尔氏面瘫患者进行神经电图(ENoG)检测,并根据检测结果分成轻、中、重度3组;分别于病后3～5d、1m和3m对3组患者进行BR检测。结果病后3～5d的BR检测异常率为100%;病后3～5d、1m和3m的BR检测结果比较,提示R1和R2潜伏期差异在3组之间有显著意义(P<0.01)。结论BR不仅是早期诊断贝尔氏面瘫的客观和敏感指标,而且能早期客观判断面神经损害的预后。     

Pathway of the blink reflex in the brainstem of the cat: Interneurons between the trigeminal nuclei and the facial nucleus

Blink reflex responses evoked by electrical stimulation of the supraorbital nerve were examined using cats and the pathway of the blink reflex in the brainstem was elucidated. Both early response (ER) and late response (LR) were mediated by the main sensory trigeminal nucleus and the spinal trigeminal nucleus. However, a lesion of the main sensory trigeminal nucleus had less effect on the blink reflex than a lesion of the spinal trigeminal nucleus. The ER was mediated not only by the shorter disynaptic pathway of 3 neurons through the trigeminal nerve, the trigeminal nuclei and the facial nucleus but also by a polysynaptic pathway of 4 neurons. The interneurons were located between the trigeminal nuclei and the facial nucleus. Some of these interneurons participated in the production of both ER and LR. The area of the brainstem responsible for ER and LR of the blink reflex was the reticular formation from the rostral part of the medulla to the pons except the medial area around the median sulcus. The LR interneurons were distributed more widely than the ER interneurons.     

微血管减压术治疗原发性三叉神经痛

目的综合评价三叉神经微血管减压术治疗原发性三叉神经痛的近远期疗效及手术风险。方法回顾性分析三叉神经微血管减压术治疗的原发性三叉神经痛25例患者临床资料。手术采用乙状窦后入路,术中分离血管神经后用Teflon补片分隔。结果术中发现24例有血管压迫,18例为小脑上动脉压迫,1例为基底动脉,3例为小脑前下动脉,1例为岩静脉压迫,1例为小脑上动脉和岩静脉压迫,另1例未发现血管压迫。结论三叉神经显微血管减压术临床适应证广泛,对神经损伤小,临床疗效满意,但手术风险不容忽视。     

Values of blink reflex and electroneurography in diagnosis of facial paralysis

BACKGROUND: The electrophysiological test was mainly achieved by the reaction of nerve fiber to electrical stimulus, usually expressed by the amplitude and latency. Blink reflex and electroneurography (ENOG) are widely applied in facial paralysis, the amplitude would step down, and the latency would prolong when the facial nerve was injured. OBJECTIVE: To compare the value of blink reflex and ENOG in the diagnosis of facial paralysis (Bell's palsy). DESIGN: A controlled trial. SETTINGS: Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People's Hospital. PARTICIPANTS: The patients who had finished the tests of blink reflex (n =207) and ENOG (n =205) were selected from the Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People's Hospital from September 2001 to July 2003. After treatment for 4 weeks, the patients finished tests of blink reflex (n =207) and ENOG (n =205) were randomly divided into primary treatment group (n =68, 69), acupuncture group (n =71, 66) and comprehensive treatment group (n =68, 70), respectively. Approval was obtained from the ethic committee of hospital. METHODS: Patients in the primary treatment group and acupuncture group were treated with western medicine, acupuncture and moxibustion alone respectively, and those in the comprehensive treatment group were treated with acupuncture and moxibustion based on western medicine. The whole period of treatment was 4 weeks. The tests of blink reflex and ENOG were carried out using Japanese light and electricity MEB-2200 electromyogram/induced potential instrument for once before and after treatment respectively. The normal value of the latency period of wave R1 was within 13 ms, and the difference was 1–1.2 ms between the left and right sides. MAIN OUTCOME MEASURES: The latency of wave R1 of blink reflect and the latency and wave amplitude of ENOG on the affected and healthy sides before and after treatment were observed. RESULTS: Totally 207 and 205 patients received tests of blink reflex and ENOG, but 17 and 16 cases respectively did not finish the second measurement, finally 190 and 189 cases were involved in the analysis of results. The latencies of wave R1 on the affected side after treatment were significantly longer than those before treatment (t =–6.253, P < 0.01); The latencies of wave R1 on the normal side were in the normal range before and after treatment; The latencies of wave R1 before treatment on the affected side was significantly longer than that on the normal side (t =–5.896, P < 0.01), but there were no significant differences between the affected and normal sides after treatment (P > 0.05). It was indicated that the latencies of wave R1 on the affected side had restored normally, and the blink reflex was improved obviously after treatment. The latency of ENOG on the affected side before treatment was significantly prolonged as compared with that on the normal side (t =2.247, P < 0.01); After treatment, the difference between the affected and normal side became smaller, but remarkable significance still existed (t =10.810, P < 0.01). In spite of the obvious improvement of affected side before and after treatment, there were still significant differences (t =–8.110, P < 0.05). The wave amplitude on the affected side was decreased after treatment, which was not significantly different from that before treatment (P >0.05). CONCLUSION: After treatment of facial paralysis, blink reflect was greatly improved, there was an obvious hysteresis in the latency of ENOG. Therefore, blink reflect was better than ENOG in the early diagnosis, while ENOG was suitable for evaluating the prognosis. The ENOG examination was better than blink reflex at middle and late period.     

Topodiagnostic value of blink reflex R1 changes: a digital postprocessing MRI correlation study

The aim of the study was to investigate the relation of the blink reflex R1 arc to known anatomical brainstem structures. Acute vascular brainstem lesions as identified by magnetic resonance imaging (MRI) of patients with isolated R1 pathology were superimposed into a stereotactic anatomical atlas using a new method of digital postprocessing. Isolated acute brainstem lesions were documented by diffusion-weighted MRI in 12 of 24 patients with unilateral R1 pathology. The lesions were located in the ipsilateral mid- to lower pons. In three patients only, the lesion had partial contact with the principal sensory nucleus of the trigeminal nerve (PSN) on at least one level. In two patients, the lesion involved the medial longitudinal fasciculus. Most lesions were located medially and ventrally to the PSN on transverse slices. Our results underline the high localizing value of changes in the R1 component of the blink reflex in patients with ipsilateral pontine functional deficits. Although available physiological evidence suggests that the R1 component of the blink reflex traverses an oligosynaptic pathway, this MRI study does not support the view that synaptic transmission in the PSN subserves R1. The reflex arc probably descends more medially and ventrally on its course to the facial nucleus.     

微血管减压术治疗原发性典型与不典型三叉神经痛对比研究

目的探讨原发性典型与不典型三叉神经痛微血管减压术治疗的临床效果。方法选择原发性典型与不典型三叉神经痛患者各40例,在全身麻醉气管插管下完成微血管减压术,比较2组术中所见血管压迫来源、压迫程度及血管压迫位置。结果典型三叉神经痛组压迫血管来源为单纯动脉占85.0%,显著高于非典型三叉神经痛组的57.5%(P0.05);来源为动静脉混合占15.0%,显著低于非典型三叉神经痛组的42.5%(P0.05);典型三叉神经痛组血管与神经位置接触者显著高于非典型三叉神经痛者(P0.05),术中发生三叉神经出现萎缩者比例显著少于非典型三叉神经痛者(P0.05),典型三叉神经痛者其压迫血管在近端者显著多于非典型三叉神经痛者(P0.05),压迫血管在远端者显著少于非典型三叉神经痛者(P0.05)。结论原发性三叉神经痛实施血管减压术,术前鉴定其发病特点,在预测其压迫血管类型、位置及其与神经的关系具有一定临床价值。     

原发性三叉神经痛的磁共振扫描对比研究

目的探讨磁共振对三又神经痛的诊断价值。方法采用3D—FFE序列扫描三叉神经痛60例,患、健侧进行对比,术中进行验证。再与患者配偶60例进行对比。结果磁共振显示研究组患侧明显压迫51例,可疑接触3例,无接触6例,健侧明显压迫14例,可疑接触4例,无接触42例,术中证实患侧都存在明确压迫,其中动脉性压迫57例,静脉性压迫3例。对照组明显压迫15例,可疑接触5例,无接触40例。结论磁共振3D—FFE序列扫描对有三叉神经痛有较高的诊断价值,但对静脉性压迫易漏诊。     

Impaired long-term potentiation-like plasticity of the trigeminal blink reflex circuit in Parkinson's disease.

We investigated the hypothesis that Parkinsons's disease (PD) is associated with abnormal plasticity of the neuronal circuits mediating blink reflex. We induced long-term potentiation (LTP)-like plasticity in trigeminal wide dynamic range neurons of the blink reflex circuit by pairing an high-frequency train of electrical stimuli over the right supraorbital nerve (SO) coincident with the R2 response elicited by a preceding SO stimulus. The facilitation of the R2 response after the induction protocol was markedly decreased in patients relative to controls. Treatment with dopaminergic drugs normalized the LTP-like plasticity of the R2 response. We conclude that nigrostriatal denervation disrupts LTP-like plasticity in the trigeminal reflex circuit.     

精神分裂症瞬目反射诱发电位研究

目的:探讨精神分裂症患者瞬目反射特征性变化。方法:对48例精神分裂症患者及41例正常对照组运用KEYPOINT2000型肌电诱发电位仪进行BR检测。结果:精神分裂症患者的左侧R2、R2′潜伏期以及右侧R2、R2′,潜伏期指标显著高于对照组(P<0.05或P<0.01),左右R1潜伏期指标两组无差异。精神分裂症患者组和对照组左右两侧R1、R2、R2′波幅指标无差异。19例精神分裂症患者治疗前后的左右两侧R1、R2、R2′潜伏期及波幅均无显著性差异。结论:精神分裂症患者可能存在脑干功能如脊髓束核、网状结构的异常改变,瞬目反射可为精神分裂症诊断提供有益补充。     

原发性三叉神经痛特征性MRI序列检查的临床应用

目的探讨磁共振断层血管成像(MRTA)不同成像序列在诊断三叉神经痛血管神经压迫的价值。方法回顾分析128例原发性三叉神经痛病人的临床资料,全部行微血管减压术(MVD)。术前均行MRTA检查,运用三维时间飞跃成像序列(3D-TOF)、超快平衡场回波序列(B-TFE)、T1高分辨率各向同性容积激发序列(THRIVE)及最大密度投影法(MIP)重建,观察血管神经走行关系,并与术中所见进行对比。结果 MRTA检查共发现责任血管115例,三叉神经无血管压迫13例;术中观察发现责任血管122例,三叉神经无血管压迫6例。MRTA检查与术中观察情况一致121例(95%)。本组治愈106例,显效15例,有效5例,无效2例。结论 MRTA检查对发现原发性三叉神经痛的责任血管与神经关系具有重要价值,3D-TOF、B-TFE、THRIVE及MIP序列扫描可显示责任血管,并具有较高的准确性,对术前评估和指导手术具有重要意义。