视觉诱发电位在视神经病变中的诊断价值

采用四种不同空间频率的图形视觉诱发电位（VEP）对视神经病变（包括外伤性视神经病变、视神经炎、缺血性视神经病变、视神经萎缩）患者进行检查,并与正常对照组比较。结果显示：①视神经病变组P100波振幅、潜伏期改变有非常显著性差异（P＜0．05）。②视神经病变组内各疾病的P100波振幅改变无显著差异（P＞0．05）,而视神经炎患者的潜伏期明显延长（P＜0．05）。③视神经病变组的病程与P100波潜伏期呈正相关,与振幅无关。④视神经病变组的视力与P100波振呈正相关。提示VEP对视神经病变诊断有重要价值,采用多种空间频率刺激可增加VEP的敏感性。     

The preventive effect of aldose reductase inhibition on diabetic optic neuropathy in the BB/W-rat

Summary A polyol-pathway-related mechanism has been invoked in the pathogenesis of murine and human diabetic peripheral neuropathy in which progressive axonal atrophy and axo-glial dysjunction constitute the cardinal structural abnormalities. We have previously reported similar neuroanatomical changes in the optic nerve of 6-month diabetic BB/W-rats. In the present study we demonstrate progression of axonal atrophy and axo-glial dysjunction in the optic nerve in 12-month diabetic BB/W-rats. These structural lesions showed highly significant correlations with the associated prolongation of the latencies of the visual evoked potentials, suggesting that axo-glial dysjunction and axonal atrophy are major determinants for impaired optic nerve function. As in peripheral nerve, the polyol-pathway is present in the optic nerve and is activated by hyperglycaemia and galactosaemia. In this study we further examined the treatment effect of the aldose reductase inhibitor ponalrestat, given from 3 weeks of diabetes and continued throughout the study protocol. This regimen resulted in complete prevention of axo-glial dysjunction, and had a significant ameliorating effect on visual evoked potential latencies, but had no effect on optic nerve axonal atrophy. This latter finding differs from the effect of aldose reductase inhibition on diabetic peripheral nerve and suggests that axonal atrophy of central nerve tracts in diabetes may be the consequence of other metabolic abnormalities or alternatively the present regimen was insufficient to protect central axons from the effects of an increased activity of the polyol pathway.     

Brainstem auditory and visual evoked potentials in Type 1 (insulin-dependent) diabetic patients

Summary Brainstem auditory evoked potentials and pattern shift visual evoked potentials were measured in 34 Type 1 (insulin-dependent) diabetic patients with long-standing disease and in 43 control subjects. Thirty-two percent of diabetic patients had abnormal brainstem auditory evoked potentials and 15% had abnormal visual evoked potentials. These abnormalities were not related to duration of diabetes, diabetic control or individual diabetic complications (retinopathy, nephropathy, peripheral or autonomic neuropathy). The aetiology of the abnormalities must remain a subject for speculation. The findings of this study are consistent with a central diabetic neuropathy involving the brainstem in long-standing diabetic patients.     

巨幼细胞性贫血患者的视觉诱发电位检测

目的：探讨图形视觉诱发电位在早期发现巨幼细胞性贫血对视路损害的应用价值。方法：分别选择31例无特殊眼病的巨幼细胞性贫血的患者作为研究对象,以及27例正常体检者作为对照组,进行图像视觉诱发电位检查。并同时行外周血中血红蛋白和血清维生素B12与叶酸浓度。结果：患者组外周血中血红蛋白和血清维生素B12浓度同对照组比较明显下降（P〈0．01）。患者组血清叶酸浓度与对照组比较差异无统计学意义（P〉0．05）。与对照组比较患者组的图形诱发电位P100潜伏期延长,振幅降低（P〈0．01）,同样N75潜伏期也延长。但是,N75振幅在患者组与正常组之间比较差异尤统计学意义（P〉0．05）。结论：图形视觉诱发电位能早期发现巨幼细胞性贫血患者视神经系统的异常,作为一种临床榆测方法有一定的府用意义．     

Effects of hyperglycaemia on visual evoked potentials in insulin-dependent diabetic patients

Multimodality evoked potentials frequently reveal subclinical involvement of the central nervous system in patients with insulin-dependent diabetes mellitus. We devised this study to evaluate the possible effects of acute hyperglycaemia on visual evoked potential (VEP) parameters in type 1 diabetic patients. A hyperglycaemic clamp (250 mg/dl for 180 min) was performed in ten patients. Monocular pattern reversal VEPs (check size 15, contrast 50%) were recorded before, and every 30 min after the start of the clamp. Basal VEP latencies and amplitudes were normal bilaterally in nine patients. No significant changes in pattern reversal and flash VEP parameters were observed after the induction or during the clamp period. None of the neurophysiological parameters evaluated during the test was related to the duration of the disease, the basal VEP latency or amplitude or the presence of retinopathy. Our data suggest that the neurophysiological abnormalities detected in insulin-dependent diabetic patients are due to structural involvement of the central nervous pathways and not to functional damage induced by acute short-term hyperglycaemia.     

Cranial optic nerve involvements in patients with severe COPD

OBJECTIVE: The relationship between neuropathy and increased morbidity in patients with COPD is clear, but few studies have assessed cranial neuropathies, especially optic nerve involvement, in COPD patients. We evaluated peripheral involvement of the optic nerve and determined factors influencing this condition in patients with severe COPD. METHODOLOGY: Twenty-eight patients, mean age 59.4 +/- 9.4 years, diagnosed with severe stable COPD according to the GOLD criteria, and 20 age- and gender-matched healthy individuals, mean age 55.6 +/- 8.5 years, were included in the study. All subjects underwent visual evoked potential (VEP) assessment together with detailed clinical and laboratory examination to exclude concurrent risk factors for neuropathy. RESULTS: VEP assessment showed significant abnormalities in COPD patients (82.1%) (commonly amplitude abnormalities) when compared with healthy controls. CONCLUSIONS: The optic nerve is often involved in patients with severe COPD, possibly as part of a polyneuropathy, and this is related to acidosis, hypercarbia and airway obstruction, independent of disease duration, smoking and age. These results should be taken into consideration when determining management strategies for these patients.     

Long-term suppression of postprandial hyperglycaemia with acarbose retards the development of neuropathies in the BB/W-rat

Summary The effect of the -glucosidase inhibitor acarbose on postprandial hyperglycaemia was explored in the spontaneously diabetic BB/W-rat. Acarbose-treatment (5 mg·kg body weight^–1·day^–1) of diabetic BB/W-rats maintained on small doses of insulin, was associated with a 40% reduction in the 24-h glucose area compared to non-treated diabetic rats. Over a 4 month treatment period this reduction in cumulative hyperglycaemia resulted in a complete prevention of autonomic polyneuropathy as indicated by R-BAR values. The development of somatic polyneuropathy in the BB/W-rat was significantly attenuated by acarbose treatment with a partial prevention of the characteristic nerve conduction velocity slowing during the first 3 months of diabetes, but no longer at 4 months. Characteristic structural abnormalities associated with diabetes in this model, such as axonal atrophy and axo-glial dysjunction, were significantly but only partially prevented in rats treated with acarbose for a diabetes duration of 4 months. These data suggest that postprandial lowering of hyperglycaemia resulting in a decrease in cumulative hyperglycaemia retards the development of diabetic polyneuropathies in the BB/W-rat.     

调节性内斜视弱视儿童多焦视诱发电位的研究

目的探讨内斜视弱视眼多焦视诱发电位（mfVEP）的特征性改变。方法对30例4～8岁调节性内斜视弱视儿童行mfVEP检测,并与同年龄正常儿童进行比较。结果内斜视弱视眼各环N1、P1波振幅密度值降低、峰潜时延长．在中心区存在显著性差异;鼻颞侧反应峰潜时存在差异。各组上半视网膜N1、P1波较下方振幅密度降低、峰潜时延长,存在统计学差异。结论内斜视弱视眼在中央及鼻侧区域视功能下降明显。     

多层螺旋CT灌注成像、彩色脑电地形图、视觉诱发电位及其地形图在急性脑梗死诊断中的对比研究

目的　比较多层螺旋CT灌注成像 (multisliceCT perfusionimaging ,MSCTPI)、彩色脑电地形图 (colorbrainatlas,CBA)、视觉诱发电位及其地形图 (visualevokedpotentialmapping ,VEP M )在急性脑梗死诊断中的价值。方法　 2 0 0 0 - 0 8～ 2 0 0 3- 0 8河北医科大学附属第四医院神经内科对 2 7例临床诊断为急性脑梗死的患者 ,行常规CT平扫后分别进行MSCTPI、CBA、VEP M检查。结果　MSCTPI表现为与临床症状相对应的灌注缺损区 ;CBA表现为在Scale为 32时 ,病变区δ、θ频带出现局限性高功率阴影 ;VEP M表现为在曲线图中P10 0的潜伏期延长、病变侧波幅降低 ,其地形图功率值分布表现为病变部功率值较对应部位明显降低 ,分布不对称。结论　MSCTPI、CBA、VEP M联合应用 ,可弥补三种检查方法各自的不足 ,进一步提高急性脑梗死的诊断率。     

心理测验、视觉诱发电位检测亚临床肝性脑病的价值

探讨心理测验、视觉诱发电位检测在亚临床肝性脑病 (SHE)诊断中的意义。对 4 5例肝硬化患者及 30例正常人进行数字连接试验 (NCT) ,视觉诱发电位 (VEP)检测。研究其在亚临床肝性脑病诊断中的应用价值。肝硬化组NCT异常占 5 6 % (2 5 / 4 5 ) ,VEP异常占 4 9% (2 2 / 4 5 ) ,NCT和 (或 )VEP异常占 71% (32 / 4 5 ) ,两者均异常 33% (15 /4 5 ) ;对照组NCT异常占 30 % (9/ 30 ) ,VEP异常占 2 7% (8/ 30 )。两组比较差异有显著性意义 (P <0 0 5 )。NCT和VEP可用于诊断SHE ,联合检测可提高SHE检出率 ,对预防肝性脑病的发生有重要意义     

补肾活血中药干预下髓核移植接触神经根致大鼠诱发电位及神经显微结构的改变

目的探索补肾活血中药干预下,髓核移植接触神经根对大鼠诱发电位及神经显微结构的影响。方法 40只SD大鼠随机分成4组,A组取大鼠自体皮下筋膜脂肪无压迫下放置在L4-5神经根周围,滴加0.05ml生理盐水。B、C、D组取大鼠自体髓核组织,无压迫下放置在L4-5神经根周围,并分别滴加0.05ml生理盐水、中药(1.2g生药/ml)、地塞米松(1mg/ml)。分别在术前、术后检测大鼠术侧诱发电位。术后3d检测大鼠术侧诱发电位并处死大鼠,进行神经根的病理切片观察。结果感觉诱发电位:B、C组潜伏期延长,与A组比较有显著差异(P<0.01);D组与A组相比无显著差异。运动诱发电位:B、C组潜伏期延长,B组与A组比较有显著差异(P<0.05),C、D组与A组比较无显著差异。术前各组感觉及运动诱发电位波幅无显著差异,术后各组也无显著差异。神经显微结构观察:A、D组少量炎性细胞浸润;B组急性炎性反应,神经外膜水肿、大量炎性细胞浸润,髓鞘水肿;C组呈炎性反应,但不如B组明显。结论髓核接触神经根后可以引起急性炎症性表现,损伤神经传导功能,补肾活血中药可以抑制神经根及周围的急性炎性反应,减少神经损伤。     

肌萎缩侧索硬化患者膈肌运动诱发电位

目的 初步探讨膈股运动诱发电位（DMEP）在肌萎缩侧索硬化（ALS）患者的应用及特点。方法 以表面电极在肋间隙处记录37例ALS患者及31例正常对照者经颅及经项磁刺激时产生的膈肌复合肌肉动作电位潜伏期和波幅,并计算中枢运动传导时间（CMCT）。22例ALS患者同时接受了用力肺活量百分比（％FVC）测定。结果 ALS患者较对照者颈及皮层潜伏期延长,颈及皮层波幅对数降低,CMCT延长,皮层潜伏期、皮层波幅对数、CMCT均与锥体束受累相关;皮层潜伏期和CMCT与临床呼吸困难相关,颈潜伏期与％FVC相关。结论 CMCT、颈及皮层潜伏期是DMEP参数中反映ALS患者呼吸功能障碍的敏感指标。CMCT反映ALS患者与呼吸功能相关的皮质脊髓束功能,CMCT与颈潜伏期结合有助于全面准确地揭示ALS患者呼吸受累的本质。     

Protective effects of cerebrolysin in a rat model of optic nerve crush

To investigate the effects of cerebrolysin (Cbl) on optic nerves (ON) and retinal ganglion cells (RGC) in a rat model of ON crush. Rats received intravitreal injection of Cbl (n = 20), intra-ON injection of Cbl (n = 20), intraperitoneal injection (IPI) of Cbl (n = 20), or phosphate buffered saline (PBS; n = 20) every day for 2 weeks after ON crush injury. At 3 weeks post-trauma, RGC density was counted by retrograde labeling with FluoroGold and visual function was assessed by flash visual-evoked potentials. Activities of microglia after insults were quantified by immunohistochemical analysis of the presence of ED1 in the optic nerve. At 3 weeks postcrush, the densities of RGCs in the Cbl-IVI group (1125 ± 166/mm²) and in the Cbl-IPI treatment group (1328 ± 119/mm²) were significantly higher than those in the PBS group (641 ± 214/mm²). The flash visual-evoked potential measurements showed that latency of the P1 wave was significantly shorter in the Cbl-IVI- and Cbl-IPI-treated groups (105 ± 4 ms and 118 ± 26 ms, respectively) than in the PBS-treated group (170 ± 20 ms). However, only Cbl IPI treatment resulted in a significant decrease in the number of ED1-positive cells at the lesion sites of the ON (5 ± 2 cells/vs. 30 ± 4 cells/high-power field in control eyes). Treatment with intra-ON injection of Cbl was harmful to the optic nerve in the crush model. Systemic administration of Cbl had neuroprotective effects on RGC survival and visual function in the optic nerve crush model.     

肾功能衰竭患者脑干听觉诱发电位的监测

对３１例老年肾功能患者肾功能和脑干听觉诱发电位（ＢＡＥＰ）监测，并动态检测１１例血液透析（血透）患者治疗前后ＢＡＥＰ变化。结果表明：老年肾功衰竭患者ＢＡＥＰ中Ｉ、Ⅲ、Ｖ主波潜伏期（ＰＬ）、Ｉ～Ⅲ、Ｉ～Ｖ峰间潜伏期较对照组均明显延长（Ｐ＜０．０５～０．０１），且其诱发电位异常与血尿素氮、肌酐呈正相关。１１例血透患者平均透析６．２个月，透析前后同体比较，血透后Ⅲ、Ｖ主波潜伏期和Ｉ～Ⅲ、Ｉ～Ｖ峰间潜伏期均较透析前明显缩短（Ｐ＜０．０５～０．０１）。提示脑干听觉诱发电位监测可作为病情及疗效判断指标，有助于该病神经系统异常的早期诊断。     

Comparison of 2-wall versus 3-wall orbital decompression against dysthyroid optic neuropathy in visual function: A retrospective study in a Chinese population

To compare visual function of 2-wall (medial and lateral) versus 3-wall (medial, lateral, and inferior) orbital decompression in patients with dysthyroid optic neuropathy (DON).A total of 52 eyes of 37 patients underwent orbital decompression for DON between 2013 and 2019 were retrospectively reviewed. Two- or 3-wall decompression was performed in 31 eyes of 23 patients and 21 eyes of 14 patients, respectively. We examined best-corrected visual acuity (BCVA), visual field mean deviation (MD) and pattern standard deviation (PSD), pattern-reversed visual evoked potential (PVEP) for P100 latency and amplitude at 60 and 15 arcmin stimulation checkerboard size, as well as proptosis using Hertel exophthalmometry.Whether 2-wall or 3-wall decompression, all parameters of visual function were improved after surgery (all P < .05). The improvement in BCVA, MD, and PSD was not statistically significant between groups (all P > .05). Proptosis reduction was higher after 3-wall decompression (P = .011). Mean increase in P100 amplitude after 3-wall decompression was statistically higher than that of after 2-wall decompression at 60 and 15 arcmin (P = .045 and .020, respectively), while the mean decrease in P100 latency was similar between the groups (P = .821 and .655, respectively). Six patients (66.67%) had persistent postoperative diplopia and 1 patient (20%) had new-onset diplopia in 3-wall decompression group, which were higher than in 2-wall decompression group (46.15% persistent postoperative diplopia and no new-onset diplopia).Both 2-wall and 3-wall decompression can effectively improve visual function of patients with DON. Three-wall decompression provides better improvement in P100 amplitude and proptosis, however new-onset diplopia is more common with this surgical technique.     

C-peptide improves neuropathy in type 1 diabetic BB/Wor-rats

BACKGROUND: The spontaneously diabetic BB/Wor-rat is a close model of human type 1 diabetes and develops diabetic polyneuropathy (DPN) similar to that seen in type 1 patients. Here we examine the therapeutic effects of C-peptide, delivered as continuous infusion or once daily subcutaneous injections on established DPN. METHODS: Diabetic rats were treated from four to seven months duration of diabetes with full continuous replacement dose of rat C-peptide via (a) osmopumps (OS), (b) full replacement dose (HSC) or (c) one-third of full replacement dose (LSC) by once daily injections. RESULTS: Diabetic rats treated with OS showed improvements in motor nerve conduction velocity (p < 0.001), sural nerve myelinated fibre number (p < 0.005), size (p < 0.05), axonal area (p < 0.001), regeneration (p < 0.001) and overall neuropathy score (p < 0.001). The progressive decline in sensory nerve conduction velocity was fully prevented. The frequencies of Wallerian degeneration were decreased (p < 0.005). HSC-treated rats showed prevention of further progression of DPN (p < 0.001), whereas LSC-treated rats showed a milder progression of DPN (p < 0.001) compared to untreated rats as assessed by neuropathy score. CONCLUSION: We conclude that (1) C-peptide is effective in the treatment of established DPN, (2) its effect is dose-dependent and (3) replacement by continuous infusion is the most effective administration of C-peptide.     

Evaluation of central nervous conduction by visual evoked potentials in insulin-dependent diabetic children. metabolic and clinical correlations

Summary Peripheral neuropathy is a well-known complication of diabetes, but few data are available on central lesions. Visual evoked potentials (VEPs) seem a reliable and feasible technique for detecting a conduction delay in the central nervous, system. Seventy-one insulin-dependent type 1 diabetic children (mean age 15±3 years) and 33 controls were investigated for central neuropathy. We used a pattern of reversal stimulation with television display of a checker board pattern (15 min and 30 min check size). The latencies of the positive peak (P100 wave) were significantly lengthened in 17 patients (27%) but no correlation was found between VEPs and age, duration of diabetes, insulin requirement and HbA₁ level. A negative correlation was found between VEPs and peripheral nervous conduction velocity. VEPs measurement seems a simple and reliable technique for detecting early alterations in CNS function in diabetics. Our data suggest that central and peripheral nervous alterations progress simultaneously.     

Impaired retrograde axonal transport from a nerve crush in streptozotocin diabetic rats

Summary The axonal transport of proteins in crushed nerves of streptozotocin (40 mg/kg) diabetic rats was investigated 4 weeks after induction of diabetes. ³⁵S-methionine was used as a marker for protein and ³H-fucose as a marker for glycoprotein. The precursors were injected into the fifth lumbar spinal ganglion and the accumulation of TCA-insoluble activity proximal and distal to a sciatic nerve ligature was measured at different time intervals after application of a crush. The start of accumulation distal to the ligature was delayed by 1 hour for proteins as well as for glycoproteins. Furthermore, the total amount of accumulated protein after 19 h was decreased by 18% while the decrease was 21% for glycoprotein. By insulin treatment the differences could both be prevented and reversed after 3 days of normoglycaemia. These findings demonstrate an impaired response to a nerve crush and might be the explanation for the regenerative abnormalities of peripheral nerves in diabetes.     

The effect of myo-inositol treatment on basement membrane thickening in the BB/W-rat retina.

A polyol-pathway related perturbation of myo-inositol metabolism has been invoked in the pathogenesis of diabetic complications, including retinal microvasculopathy. Previous studies have demonstrated a beneficiary effect of aldose reductase inhibition on basement membrane thickening of retinal microvessels in diabetic animals. In the present study we demonstrate a significant but partial effect on basement membrane thickening following myo-inositol supplementation. Qualitative structural changes, such as nodular swellings, fibrillar changes and basement membrane projections were not effected by myo-inositol supplementation, suggesting that although abnormal myo-inositol tissue levels may play a role in basement membrane thickening, other factors may be of primary pathogenetic importance.     

C-peptide prevents and improves chronic Type I diabetic polyneuropathy in the BB/Wor rat

Aims/hypothesis. Insulin and C-peptide exert neuroprotective effects and are deficient in Type I (insulin-dependent) diabetes mellitus but not in Type II (non-insulin-dependent) diabetes mellitus. These studies were designed to test the preventive and interventional effects of C-peptide replacement on diabetic polyneuropathy in the Type I diabetic BB/Wor rat. Methods. Diabetic BB/Wor rats were replaced with rat C-peptide from onset of diabetes and between 5 and 8 months of diabetes. They were examined at 2 and 8 months and compared to non-C-peptide replaced BB/Wor rats, Type II diabetic (non-C-peptide deficient) BB/Z rats and non-diabetic control rats. Animals were monitored as to hyperglycaemia and nerve conduction velocity (NCV). Acute changes such as neural Na⁺/K⁺-ATPase and paranodal swelling were examined at 2 months, morphometric and teased fiber analyses were done at 8 months. Results. C-peptide replacement for 2 months in Type I diabetic rats prevented the acute NCV defect by 59 % (p < 0.005), the neural Na⁺/K⁺-ATPase defect by 55 % (p < 0.001) and acute paranodal swelling by 61 % (p < 0.001). Eight months of C-peptide replacement prevented the chronic nerve conduction defect by 71 % (p < 0.001) and totally prevented axoglial dysjunction (p < 0.001) and paranodal demyelination (p < 0.001). C-peptide treatment from 5 to 8 months showed a 13 % (p < 0.05) improvement in NCV, a 33 % (p < 0.05) improvement in axoglial dysjunction, normalization (p < 0.001) of paranodal demyelination, repair of axonal degeneration (p < 0.01), and a fourfold (p < 0.001) increase in nerve fibre regeneration. Conclusion/interpretation. C-peptide replacement of Type I BB/Wor-rats partially prevents acute and chronic metabolic, functional and structural changes that separate Type I diabetic polyneuropathy from its Type II counterpart suggesting that C-peptide deficiency plays a pathogenetic role in Type I diabetic polyneuropathy. [Diabetologia (2001) 44: 889–897]