癫痫患者的脑诱发电位表现

为160例癫痫患者进行了SEP、BAEP和VEP检查,参照本实验室正常参数标准,把波消失,峰潜伏期延长(>2.5SD)和波幅降低(>2.5SD)做为异常,本组SEP、BAEP、VEP的异常率分别为38.67％、28.28％和21.88％。其中59例SEP、BAEP和VEP同时检查的异常率为52.54％,139例SEP和BAEP同时检查的异常率为48.92％,60例SEP和VEP同时检查的异常率为38.33％,62例BAEP和VEP同时检查的异常率为33.87％,表明SEP较为敏感,BAEP和VEP次之。对本病进行多项诱发电位检查,可进一步提高阳性率。     

多发性硬化35例临床、诱发电位及磁共振成像分析

目的　探讨多发性硬化 (MS)的临床特点以及诱发电位 (EP)、磁共振成像 (MRI)对MS的诊断价值。方法　分析 35例MS患者的临床表现及视觉诱发电位 (VEP)、体感诱发电位 (SEP)、脑干听觉诱发电位 (BAEP)和MRI的检查结果。结果　MS多见于青壮年 ,女性多见 ,呈急性或亚急性起病 ,视神经、脊髓、脑干受累多见 ,病程多缓解复发。VEP、SEP、BAEP、头颅MRI、脊髓MRI检查的异常率分别为 81.5 %、76 .2 %、5 2 %、77.8%、87.5 %。结论　MS的诊断主要依靠临床 ,EP和MRI检查对MS患者临床病灶的确定和亚临床病灶的发现均具有较高的敏感性 ,二者结合应用可显著提高MS的诊断正确率     

多发性硬化的MRI、神经电生理和脑脊液特征分析及其诊断价值评价

目的分析61例多发性硬化(MS)患者临床和辅助检查的改变探讨各项指标诊断价值.方法回顾性总结分析61例MS患者的临床特点以及磁共振成像(MRI)、视觉诱发电位(VEP)、体感诱发电位(SEP)、脑干听觉诱发电位(BAEP)和脑脊液寡克隆区带(OB)检查结果.结果MRI检查异常率达92.31%,VEP、SEP、BAEP的异常率分别为73.17%,66.67%,35.56%,而3项诱发电位总的异常率为92%,OB检查阳性率为90.1%.结论头颅MRI和诱发电位、OB联合检测结合临床可大大提高MS诊断的阳性率.     

椎基底动脉TIA患者BAEP、VEP、TCD的结果分析

目的 探讨BAEP、VEP、TCD对诊断椎基底动脉TIA的意义.方法 取2002-04～2004-06在我院临床上诊断为TIA的98例患者进行BAEP、VEP、TCD试验,并与正常值相比较.结果 BAEP的异常率为62.2%,TCD的异常率为83.7%,VEP的异常7%.结论 BAEP、TCD检查对TIA患者诊断提供很好的帮助,而VEP的临床意义较小.     

CT、核磁共振、诱发电位对多发性硬化的临床诊断价值

目的探讨CT、核磁共振（MRI）、诱发电位检查在多发性硬化（MS）临床诊断中的应用价值。方法对60例MS患者CT、核磁共振（MRI）、诱发电位检查结果与临床对比分析、结果MRI检查异常率最高．为85．1％，CT为41．7％．VEP为60％，SSEP为54．2％，BAEP为45．8％。如同时进行两项以上诱发电位检查．只要一项异常即判断为诱发电位异常，其异常率可达81．4％、结论CT、MRI、诱发电位检查结合应用可提高MS诊断的准确性。     

39例多系统萎缩的神经电生理特点分析

目的:观察多系统萎缩(MSA)患者神经电生理改变,探讨神经电生理对MSA的诊断价值。方法:22例行肢体骨骼肌肌电图(EMG)和神经传导速度(NCV)检测,39例均行肛门括约肌肌电图(EAS-EMG)检测,35例行脑干听觉诱发电位(BAEP)检测,26例行下肢体感诱发电位(SEP)检测,10例行视觉诱发电位(VEP)检测。电生理检查结果与本科检查室正常值比较。结果:肢体骨骼肌EMG和NCV的异常率为36．4％,肛门括约肌EMG异常率为89。7％,均呈神经源性受损表现;诱发电位的异常出现率分别为:BAEP(57．1％)、SEP(34．1％)、VEP(21．4％)。结论:神经电生理检测对于MSA的早期诊断有一定的帮助,可提高诊断的准确性。     

单纯脑白质疏松症与皮质下动脉硬化性脑病的临床对比研究

目的探讨单纯脑白质疏松症(LA)和皮质下动脉硬化性脑病(BD)的临床表现、影像学及脑诱发电位的改变特征。方法(1)调查114例单纯脑白质疏松症患(LA组)和41例皮质下动脉硬化性脑病患(BD组)的发病危险因素和临床表现。(2)两组患均行CT检查，并按照脑白质异常程度分为3型。(3)LA组74例患，BD组35例患行MRI检查，根据T2WI显示的脑室周围高信号分为5型。(4)两组分别选择部分伴有高血压的患进行躯体感觉诱发电位(SEP)、脑干听觉诱发电位(BAEP)和视觉诱发电位(VEP)检查。结果(1)LA组患的危险因素呈多样化，无神经局灶体征，临床表现仅为轻度记忆力减退、步态不稳。CT显示脑白质异常以1型为主，占70．2％(80／114)；MRI脑白质异常也同样以1型为主，占71．6％(53／74)，均无脑室扩大。电生理学检查显示，SEP异常率为83．7％(36／43)，其中轻度60．5％，中度23．2％；BAEP异常率为62．8％(27／43)，潜伏期和峰间期延长；VEP异常率为53．5％(23／43)，各波潜伏期延长，均无波形消失。(2)BD组患危险因素以高血压为主(95．1％)，临床表现以神经局灶体征、明显认知功能障碍和卒中样发作为主。CT分型以3型多见，为73．2％(30／41)；MRI检查显示3型为54．3％(19／35)，4型45．7％(16／35)，41例患均有双侧脑室对称性扩大。电生理学检查显示，SEP异常率为96．7％(29／30)，其中轻度6．7％，中度46．7％，重度43．3％；BAEP异常率86．7％(26／30)，潜伏期和峰间期进一步延长，部分伴有Ⅲ、Ⅴ波缺失；VEP异常率为83．3％(25／30)，各波潜伏期进一步延长，部分P2单侧波形消失。结论单纯脑白质疏松症无特征性临床表现，诊断主要以影像学1型脑白质异常为依据；诱发电位表现为各波潜伏期延长，无波形完全缺失。皮质下动脉硬化性脑病的危险因素为高血压，临床有较明显的认知功能障碍，常见卒中样发作等特征，影像学检查CT显示3型脑白质异常，MRI显示3型或4型为诊断依据；诱发电位呈现各波潜伏期进一步延长并伴有部分波形完全缺失。     

TCD、BAEP、MRI对椎基底动脉供血不足的诊断价值

目的　探讨椎基底动脉供血不足 (VBI)可靠的辅助诊断方法。方法　对临床确诊的VBI 115例患者同时进行了经颅多普勒 (TCD)、脑干听觉诱发电位 (BAEP)、脑颅核磁共振 (MRI)检查。结果　TCD异常率为 82 2 %,BAEP异常率为 72 1%,MRI异常率为 2 6 1%。结论　TCD、BAEP异常率高可为VBI早期诊断提供客观依据 ,TCD应作为首选的监测手段 ,也证明了VBI患者在形态学无明显改变时MRI除与VBI的鉴别诊断外 ,不应作为VBI的常规检查。     

多发性硬化诊断的进展

近年CSF中出现寡克隆带,CSF,IgG,IgM,增多以及视觉诱发电位(VEP),体感诱发电位(SEP),脑干听觉诱发电位(BAEP),MRI及CT等异常皆有助于多发性硬化(MS)的诊断,其中以ACSF寡克隆带,CSF,IgG,IgM,MRI及VEP异常更有助于MS诊断。但这些皆不比个别神经系统体征更有特异性。此外尚叙述孤立的视神经炎及急性播散性脑脊髓炎(ADEM)与MS的鉴别。     

多发性硬化118例临床分析

目的探讨多发性硬化(MS)的临床特征及MRI、视觉诱发电位(VEP)、脑干听觉诱发电位(BAEP)、脑脊液(CSF)检查在诊断中的价值。方法从流行病学、首发症状、起病形式、病程、累积部位、各项辅助检查情况等方面对作者医院1998—2004年收住的118例MS患者进行回顾性分析。结果118例MS患者中,临床确诊68例,实验室支持确诊21例,临床可能29例;男、女比为1.46∶1;平均首发年龄:男(31.1±13.5)岁,女(34.9±10.5)岁;起病形式:急性37.0%,亚急性40.0%,慢性23.0%;病程:复发-缓解型占67.0%;首发症状:肢体无力58例,肢体麻木34例,视力障碍29例。累及部位:视神经80例,脊髓72例,脑干61例,大脑半球50例,小脑26例。MRI:行MRI检查82例,阳性67例,其中累及脊髓32例,脑室旁34例(占MRI检查阳性者的50.7%)。VEP:异常但无症状体征者占47.0%;BAEP:异常但无症状体征者占81.5%。CSF:24 h鞘内合成率阳性占81.6%,寡克隆区带阳性占23.0%。结论MS多无明显诱因,多以急性或亚急性起病,复发率高,首发症状以肢体无力多见,脊髓、视神经易受累,MRI检查阳性者中半数左右大脑白质有异常信号,VEP、BAEP检查可发现许多视神经及脑干亚临床病灶,CSF 24 h鞘内合成率阳性者较多,可提示病变的炎性本质。     

Multiple sclerosis. Magnetic resonance imaging, evoked potentials and cerebrospinal fluid analysis

We have studied 27 patients with multiple sclerosis (22 definite, 5 probable) by magnetic resonance imaging (MRI), visual evoked potentials (VEPs), brainstem auditory evoked potentials (BAEPs), and oligoclonal bands (OBs) in cerebrospinal fluid (CSF), MRI was altered in 92.5% of the cases, the presence of OBs in CSF was revealed in 73.1% of the examined patients, the frequency of evoked potentials (EPs) alteration was VEPs = 59.3% and BAEPs = 29.6%, at least one of the two EPs occurred positive in 66.6% of the cases. Our data confirm the more sensitive value of MRI compared with OBs and EPs studies in assessing MS, and stress the utility of the combined use of these tests.     

The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis.

In a prospective study, we evaluated the technique of magnetically evoked motor potentials (MEP) in the diagnosis of multiple sclerosis (MS). We consecutively included 68 patients with symptoms or signs compatible with a demyelinative CNS affection. We subjected all patients to CSF analysis, MRI studies of the brain and brainstem, visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP), and somatosensory evoked potentials (SSEP). We then used the results to categorize the patients according to the Poser criteria of multiple sclerosis. Blinded from the results of the above investigations, one of the authors made MEP recordings from three muscles in the upper limbs and two in the lower limbs in all 68 patients. Forty patients received an MS diagnosis, and in these, MRI was positive in 88%, MEP in 83%, VEP in 67%, SSEP in 63%, and BAEP in 42%. As to the diagnosis of MS, the reliability of a prolonged central motor conduction time (CMCT) was 0.83 (0.73 to 0.93), while the reliability of a normal CMCT was 0.75 (0.61 to 0.98). The information gained by MRI was best supplemented by VEP. Of the neurophysiologic tests, the MEP was in closest agreement with the MRI with a concordance of 85%.     

Trimodal evoked potentials compared with magnetic resonance imaging in the diagnosis of multiple sclerosis

Twenty-three patients with the clinical diagnosis of possible multiple sclerosis (MS) were tested with magnetic resonance imaging (MRI) and trimodal evoked potentials. Fourteen patients showed abnormalities on both MRI scans and at least one evoked potential modality (65%). Four patients had normal MRI scans but at least one abnormality on evoked potential testing (17%). One patient had normal triple evoked potentials with an abnormal MRI result. Four patients had normal results on both MRI and triple evoked potential testing; two of these patients were later found to have immunologic abnormalities in the cerebrospinal fluid consistent with the diagnosis of MS. Combined evoked potential testing was found to have a higher sensitivity than MRI in confirming a diagnosis of MS. Three patients with the clinical diagnosis of definite MS were also tested. All these patients showed abnormalities on evoked potential testing, although one patient had a normal MRI result. Of all 26 patients who were studied, 17 showed abnormal MRI results and 21 showed at least one abnormality on evoked potential testing.     

Use of evoked potentials for diagnosis of multiple sclerosis

The author discusses visual evoked potentials, brain stem auditory evoked potentials, somatosensory evoked potentials, motor evoked potentials, and MRI for the diagnosis of MS. Most patients with MS will eventually have an MRI scan. However, certain specific questions regarding function and anatomic regions are better studied with evoked potentials, especially those of optic nerve, brain stem, and spinal cord.     

Sensory (VEP, BAEP, SEP) and motor-evoked potentials, liquoral and magnetic resonance findings in multiple sclerosis

In order to define the most suitable instrumental protocol for the diagnosis of multiple sclerosis (MS), 41 patients with definite (D = 14), probable (P = 14) and suspected (S = 13) MS were examined with CSF immunology, brain MRI and multimodal evoked potentials. The central motor tracts were also tested. The following alteration rates were found: MRI = 78%, CSF = 63.6%, VEP = 70.0%, median nerve SEP = 50%, peroneal nerve SEP = 68.0%, BAEPs = 35.7%, motor-evoked potentials (MEPs) = 74.0%. Altogether, EPs were abnormal in 90% of cases. Normal MRI with altered EPs were found in 22% of cases, whilst a normal EP battery with defective CSF or MRI findings were found in 7%. Twenty-six out of 27 patients with P or S forms were reclassified into a D one when considering EPs and MRI features.     

Magnetic resonance imaging in patients with multiple sclerosis and spinal cord involvement: 28 cases

In patients with clinically isolated spinal disease, magnetic resonance imaging (MRI) provides a non-invasive method of detecting surgically treatable causes and is also useful in detecting asymptomatic brain lesions where the cord syndrome is due to multiple sclerosis (MS). We report the findings of spinal and brain MRI in 28 patients with spinal cord disorder due to MS. It was possible to detect intrinsic plaques reliably in the majority of patients (60.7%) with clinical findings of spinal cord MS. The results of MRI are compared with the clinical status and with cerebrospinal fluid findings and evoked potentials.     

A retrospective study of multiple sclerosis in Siriraj Hospital, Bankok, Thailand

OBJECTIVE: To determine the demographic and clinical data of Thai multiple sclerosis (MS) patients. METHODS: A retrospective study of 72 patients attending the MS clinic at Siriraj Hospital, Mahidol University, Thailand between January 1997 and June 2004. RESULTS: Fifty-eight patients (81%) were classified as clinically definite MS, 5 (7%) as Devic's syndrome, and 9 (13%) as possible MS. There were 62 females (86%) and 10 males (14%). Age at onset was 33 +/- 12 years with a mean relapse rate of 1.2 +/- 1.0 attacks per annum. None had a family history of MS. Visual impairment (53%) was the most common manifestation. Only 16% had classic (western) form of MS. Positive oligoclonal bands were found in 21%, visual evoked potentials with a typical delayed latency in 28%. MRI brain lesions compatible with McDonald's criteria were seen in only 24%, and spinal MRI brain longer than 2 vertebral bodies in 62%. The mean Kurtzke's Expanded Disability Status Scale (EDSS) was 3.0. CONCLUSIONS: Thai MS patients had much more female occurrence, no family history, common optico-spinal form, long spinal MRI lesions and low positive CSF oligoclonal bands.     

MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT

We compared the diagnostic capabilities of MRI to CT, evoked potentials (EP), and CSF oligoclonal banding analysis in a prospective evaluation of 200 patients with suspected multiple sclerosis (MS). MRI was the best method for demonstrating dissemination in space. An abnormal appropriate EP in monosymptomatic disease was usually supported by MRI and CSF analysis as being predictive of MS as a clinical diagnosis. A normal appropriate EP study was not satisfactory because MRI and CSF analysis often did not support a diagnosis of non-MS. When there is agreement between three of these paraclinical studies, the diagnosis of MS is probably unequivocal. For use in research studies, laboratory-supported definite MS (LSDMS) could be diagnosed in 85 patients of the total 200 (42.5%), in 19/38 (50%) of optic neuritis (ON) patients, and in 24/52 (46%) of chronic progressive myelopathy (CPM) patients. MRI was 100% successful in identifying patients who qualified for LSDMS in the ON and CPM groups. In a short follow-up (less than 1 year), 19/200 (10%) went on to develop clinically definite MS (CDMS), and MRI predicted that diagnosis in 18/19 (95%). Only long-term follow-up will show how well these studies and the category of LSDMS predict the development of CDMS. The clinical diagnosis of MS (CDMS), even though only 95% accurate, must remain the gold standard.     

Magnetic resonance imaging in multiple sclerosis: investigation of brain and spinal cord lesions

Magnetic resonance imaging (MRI) of the brain was performed on forty-five patients with multiple sclerosis (MS), using T1-weighted inversion recovery and T2-weighted spin echo images, and the results were compared with X-ray computed tomography (CT). Some of the 45 MS patients were also examined by neurophysiological studies (visual evoked potentials and auditory brainstem responses) to compare with the brain MRI findings. MRI showed demyelinating plaques of the brain in 20 (74%) of 27 patients with brain symptoms, 11 (61%) of 18 patients without symptoms and 31 (69%) of all 45 patients. In 27 patients with brain symptoms, MRI was able to detect brain lesions in 6 (86%) of 7 acute stage patients and 14 (70%) of 20 non-acute stage patients. Furthermore, MRI was able to detect brain lesions in 21 (70%) of 30 clinically definite MS patients and 10 (67%) of 15 clinically probable MS patients. X-ray CT was performed on all 45 patients and was able to detect brain lesions in 9 (33%) of 27 patients with brain symptoms and 1 (6%) of 18 patients without symptoms. Visual evoked potentials were evaluated in 31 patients, and showed abnormalities in 1 (11%) of 9 patients without symptoms of optic neuritis and 100% of 22 patients with symptoms. Auditory brainstem responses were evaluated in 19 patients, and showed abnormalities in 1 (11%) of 9 patients without brainstem symptoms and 3 (30%) of 10 patients with symptoms. MRI of the brain was markedly superior to X-ray CT, visual evoked potentials and auditory brainstem responses in detecting clinically unsuspected lesions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence

BACKGROUND: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnostic investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assessments and persistent neurologic symptoms. METHODS: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. RESULTS: All 143 patients had normal initial examinations, brain MRI scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervical cord, n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.9%), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. CONCLUSIONS: PATIENTS: and clinicians may be reassured that persistent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.