帕罗西汀联合白脉软膏治疗慢性紧张型头痛的临床疗效

目的:观察帕罗西汀联合白脉软膏治疗慢性紧张型头痛(CTH)的临床疗效。方法:CTH患者60例,随机分为给予帕罗西汀联合安慰剂软膏治疗的对照组和给予帕罗西汀联合白脉软膏治疗的观察组各30例,疗程8周。比较治疗前后患者外感受抑制实验(ESP)的第二潜伏期(ESP2)、时限及肌电频率、波幅变化,评价头痛程度、焦虑抑郁情绪及生活质量。结果:治疗后2组EPS2潜伏期明显缩短,时限明显延长(P<0.05),观察组较对照组更明显(P<0.05)。对照组肌电频率和波幅改变不明显(P>0.05),观察组肌电频率和波幅明显降低(P<0.05)。2组头痛程度、焦虑抑郁情绪评分明显低于治疗前,生活质量评分明显高于治疗前(P<0.05),观察组较对照组更明显(P<0.05)。结论:帕罗西汀联合白脉软膏治疗CTH疗效优于单用帕罗西汀。     

偏头痛患者事件相关诱发电位的特点

目的:通过测定偏头痛患者早期认知功能障碍的指标P300听觉事件相关诱发电位,分析偏头痛患者的认知功能特点。方法:选择2005-01/12在北京大学人民医院神经内科门诊就诊的偏头痛患者56例,同时选取在本院门诊就诊及进行体检的52名健康人作为正常对照组,均自愿参加观察。采用肌电诱发电位仪检测以上两组观察对象的听觉事件相关诱发电位P300,记录波型中P300的潜伏期和波幅。偏头痛组患者均行头颅MRI检查,观察有无异常。记录患者平均头痛发作频率、持续时间、头痛强度和头痛发作史,分析以上指标与听觉事件相关诱发电位P300潜伏期和波幅的相关性。结果:偏头痛组56例患者及正常对照组52名健康人全部进入结果分析,无脱落。①两组观察对象听觉事件相关电位P300的潜伏期和波幅比较:偏头痛组患者P300的潜伏期显著长于正常对照组眼(328.66±33.06,315.73±25.19)ms(t=-2.296,P<0.05)演,波幅显著低于正常对照组眼(11.17±2.05,11.99±1.71)μV(t=2.275,P<0.05)演。②偏头痛组头部MRI检查正常与异常患者听觉事件相关电位P300的潜伏期和波幅比较:56例偏头痛患者中25例异常,表现为皮质下脑白质病变,设为MRI检查异常组;其余31例设为MRI检查正常组。MRI检查异常组患者P300的潜伏期显著长于MRI检查正常组眼(349.88±17.07,311.55±33.06)ms(t=-5.597,P<0.01)演,波幅显著低于MRI检查正常组眼(9.61±1.08,12.42±2.05)μV(t=7.355,P<0.01)演。③偏头痛患者病程与听觉事件相关电位P300的潜伏期呈正相关(P<0.01),与波幅呈负相关(P<0.01)。结论:偏头痛患者存在脑认知功能障碍,且认知障碍程度与病程长短有关,病程越长,程度越重。偏头痛患者可出现脑白质区病变,此病变加重了认知功能障碍。     

电刺激正中神经引发手肌反射对中枢神经病损的评定意义

目的:探讨手肌反射引发HR',LLR在中枢神经病损时的变化,揭示其作为诊断和康复评定的价值。方法:对45例确诊为脑血管意外偏瘫患者进行电刺激偏瘫手腕部正中神经,引发手肌(大鱼际肌)反射模式,测定HR',LLR的潜伏期、时限、波幅和分化的情况,与健手作对照,半年后再进行复查对照。结果:偏瘫手与健手HR'的潜伏期、时限、波幅和分化差异均无显著性(P>0.05);偏瘫手LLR潜伏期延长,波幅降低,与健手对比差异均有非常显著性(P<0.01)。结论:电刺激正中神经引发手肌反射LLR的潜伏期、波幅和分化情况均能反映中枢神经的功能状态,并可作为中枢神经病损康复评定的客观定量指标。     

310例紧张型头痛患者临床特点分析

目的:探讨紧张型头痛患者的临床特点。方法:回顾性分析解放军总医院国际头痛中心2011年10月到2012年1月就诊的紧张型头痛患者的临床资料。调查内容包括头痛患者的人口学特点、临床特点、伴随症状、触发因素、合并症等。结果:310例紧张型头痛患者中,频发性紧张型头痛139例,偶发性紧张型头痛73例,慢性紧张型头痛86例,可能的紧张型头痛12例,男女比例为1:1.38;平均年龄为41.7±13.8岁。患者来源于城市多于农村,高学历者多于低学历者。疼痛部位为单侧105例(33.87%)、双侧157例(50.65%)、全头34例(10.97%)、部位不定14例(4.51%);好发部位依次为枕部(50.65%),其次为颞部(48.39%),顶部(35.48%),额部(31.61%);疼痛性质为胀痛145例(46.77%)、钝痛79例(25.48%)、紧箍感39例(12.59%)、搏动感47例(15.16%);无伴随症状195例,有伴随症状115例,包括恶心、畏声、畏光等;疼痛程度大多为中度(VAS 4⁶分)176人(56.77%);诱发因素依次睡眠缺乏115例(37.10%),劳累89例(28.71%),紧张或情绪变化66例(21.29%),天气变化21例(6.77%),饮酒8例(2.58%)。慢性紧张型头痛有33例(38.4%)合并药物过量性头痛。结论:紧张型头痛临床表现多种多样,应提高对该疾病的认识,以期早期正确诊断和合理治疗。     

星状神经节阻滞联合亚甲蓝帽状腱膜下注射治疗慢性紧张型头痛

目的:观察星状神经节阻滞联合亚甲蓝帽状腱膜下注射治疗慢性紧张型头痛的疗效。方法:60例患者随机分为A、B两组,每组30例。A组(治疗组)先行星状神经节阻滞,再于患者枕外隆凸处、双侧耳颞区、前额区亚甲蓝帽状腱膜下注射。每周一次,4次为一疗程。B组(对照组),盐酸氟西汀和盐酸乙哌立松及布洛芬缓释胶囊口服用药,连续服药4周。动态观察治疗前后患者头痛发作程度、频率、持续时间的变化,并对各组治疗效果及并发症进行比较,头痛程度采用视觉模拟评分(visual analogue scale,VAS)表示。结果:两组患者治疗后,头痛频率、持续时间和头痛程度都有缓解,A组优于B组。A组治疗后优良率(86.7%)高于B组(53.3%)。结论:星状神经节阻滞联合亚甲蓝帽状腱膜下注射是治疗慢性紧张型头痛的一种有效方法。     

一种紧张型头痛动物模型的建立与评价

目的:评价大鼠双侧半棘肌注射三磷酸腺苷(adenosine triphosphate,ATP)建立紧张型头痛动物模型的可行性。方法 :将37只大鼠分为3组,麻醉大鼠暴露双侧半棘肌后,假手术组(n=8)给予针头刺入不注射药物;对照组(n=16)注射生理盐水(20μl/min,持续1 min),ATP组(n=13)注射ATP(20μl/min,持续1 min)。给予舌肌电刺激并在二腹肌记录张颌反射(jaw-opening reflex,JOR),测定JOR出现的阈值、潜伏期。结果 :与注射前相比,注射后假手术组和对照组疼痛阈值无差异(P>0.05),注射后ATP组疼痛阈值减低(P<0.05)。注射后ATP组疼痛阈值低于假手术组和对照组疼痛阈值(P<0.05)。3组注射前后疼痛潜伏期均未出现显著性变化(P>0.05)。结论 :ATP模型模拟紧张型头痛颈部肌筋膜伤害性传入增强发病机制,科学可靠,简单易于复制。     

血管内皮生长因子联合内皮抑素在2型糖尿病肾病患者诊断中的价值分析

目的探讨血管内皮生长因子(VEGF)联合内皮抑素(ES)在2型糖尿病肾病诊断中的价值。方法该院2012年4月至2014年9月收治的30例糖尿病患者和60例糖尿病肾病患者按照患者病情分为无肾病组(30例)、肾病组(低蛋白尿组30例和高蛋白尿组30例)。比较无肾病组、低蛋白尿组、高蛋白尿组患者的VEGF和ES水平,并进行相关分析。结果无肾病组、低蛋白尿组、高蛋白尿组患者VEGF和ES水平进行比较,差异有统计学意义(P0.05),低蛋白尿组和高蛋白尿组的VEGF和ES均比无肾病组高(P0.05),且高蛋白尿组VEGF和ES水平高于低蛋白尿组(P0.05);进行回归性分析结果显示,VEGF和ES与2型糖尿病肾病相关;VEGF和ES与患者的肾小球滤过率和清蛋白呈负相关,与患者的24h尿液中微量清蛋白和视网膜病变呈正相关。结论血浆内VEGF和ES在2型糖尿病不同临床分期有不同程度的升高,对糖尿病患者进行VEGF和ES检测可以及时发现并发肾病的危险。     

多发性肌炎、皮肌炎患者的肌电图研究

目的探讨肌电图（EMG）、神经传导速度（NCV）的检测对提高多发性肌炎、皮肌炎的诊断价值。方法对30例多发性肌炎、皮肌炎患者肌电图检查中自发电活动,MUP时限、波幅及多相波,最大随意收缩时的募集形式,以及NCV检查进行分析。结果30例中25例EMG示肌原性损害,同时有5例出现NCV的轻度减慢（16．6％）、3例（10．0％）NCV远端潜伏期延长。结论EMG、NCV测定是诊断多发性肌炎和皮肌炎的有价值的电生理检测方法。     

脉冲射频对早期神经根型颈椎病疼痛的疗效观察

目的:观察脉冲射频对早期神经根型颈椎病疼痛的疗效。方法:神经根型颈椎病患者49例,随机分为2组,观察组24例采用脉冲射频治疗,对照组25例采用牵引针灸治疗。检测治疗结束后第1天、第30天的视觉模拟评分(VAS)和情绪评分(ES)。结果:2组患者在治疗结束后第1天和第30天VAS评分及ES评分均较治疗前显著降低(P0.05),且各时间点观察组VAS评分及ES评分均低于对照组(P0.05)。结论:脉冲射频对早期神经根型颈椎病疼痛疗效确切,可以用于治疗早期神经根型颈椎病疼痛患者。     

Kennedy Ⅰ类牙列缺损修复前后咀嚼肌肌电变化分析

目的探讨KennedyⅠ类牙列缺损患者修复前、后不同时期咀嚼肌肌电变化规律。方法双侧游离端牙列缺损患者34例,分别于修复前、初戴义齿及修复后1、3、6个月,在下颌姿势位和牙尖交错位最大紧咬时分别进行双侧咬肌、颞肌前束、胸锁乳突肌、二腹肌前腹的肌电检测,记录并计算其肌电幅值和不对称指数。结果下颌姿势位时,义齿初戴和修复后1个月时患者双侧咬肌、颞肌前束肌电幅值大于修复前(P0.05),修复后3、6个月时双侧咬肌、颞肌前束肌电幅值与修复前比较差异无统计学意义(P0.05),义齿初戴及修复后1、3、6个月时双侧二腹肌前腹肌电幅值大于修复前(P0.05),双侧胸锁乳突肌肌电幅值与修复前比较差异无统计学意义(P0.05),义齿初戴及修复后1、3、6个月时患者咬肌、颞肌前束不对称指数明显小于修复前(P0.05),二腹肌前腹和胸锁乳突肌不对称指数与修复前比较差异无统计学意义(P0.05);牙尖交错位最大紧咬时,义齿初戴及修复后1、3、6个月时双侧咬肌、颞肌前束、二腹肌前腹、胸锁乳突肌肌电幅值均高于修复前(P0.05),义齿初戴及修复后3、6个月时咬肌、颞肌前束不对称指数低于修复前(P0.05),修复后1个月时咬肌、颞肌前束不对称指数与修复前比较差异无统计学意义(P0.05),义齿初戴及修复后1、3、6个月时胸锁乳突肌不对称指数小于修复前(P0.05),二腹肌前腹不对称指数与修复前比较差异无统计学意义(P0.05)。结论 KennedyⅠ类牙列缺损患者义齿修复后咀嚼肌功能得到明显改善,时间需≥3个月。     

Exteroceptive suppression patterns of masseter and temporalis muscles in central and peripheral headache disorders

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.     

Exteroceptive suppression of the masseter, temporalis and trapezius muscles produced by mental nerve stimulation in patients with chronic headaches

Exteroceptive suppression of the masseter, temporalis and trapezius muscles, produced by mental nerve stimulation, was studied in 46 patients with chronic headaches. The background contracting electromyographic activity prior to stimulation showed no difference between normal subjects and patients with any type of headache. In patients with chronic tension-type headache associated with a disorder of the pericranial muscles, the duration and degree of exteroceptive suppression were lower when compared with normal subjects. A low degree of exteroceptive suppression was observed also in patients suffering from migraine without aura, although exteroceptive suppression in patients suffering from migraine with aura and cluster headache was the same as that in normal subjects. A low degree of exteroceptive suppression may play a role not only in chronic tension-type headache associated with a disorder of the pericranial muscles, but also in migraine without aura.     

Recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity in migraine and tension-type headache

Brain stem interneuronal excitability can be assessed by recording the recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity. Abnormal endogenous pain control mechanisms due to disturbed brain stem interneuronal activity have been implicated in the pathogenesis of tension-type headaches. The blink reflex, exteroceptive suppression of temporalis muscle activity, and the recovery curve of both the R2 component of the blink reflex and the ES2 component of the exteroceptive suppression of the temporalis muscle activity were studied in 20 patients with migraine without aura, 32 patients with tension-type headache, and 20 normal controls. In our study, the blink reflex was elicited by stimulation of the supraorbital nerve; the exteroceptive suppression of the temporalis muscle activity was elicited by applying electrical shocks to the labial commissure, both on the lower and upper sides. The recovery cycle was established by delivering paired shocks at different interstimulus intervals. Comparisons were made between normal control subjects, patients with migraine without aura, and patients with tension-type headache. The latency of R1, R2, and R2', the amplitude and size of the R2 and R2' components of the blink reflex, the latency and duration of the ES1 and ES2 components, and the recovery curve of the ES2 component of the temporalis muscle activity did not differ between groups. However, the recovery curve of the R2 component of the blink reflex diminished in patients with tension-type headache compared with the other groups. Our findings indicate reduced excitability of the brain stem interneurons in patients with tension-type headache.     

Exteroceptive suppression of masseter muscle activity in juvenile migraineurs

The second exteroceptive suppression period (ES2) of masseter or temporalis muscle activity may be reduced in adults with chronic tension-type headache. In adults with migraine, ES2 was found normal or tended to be protracted. To date, no studies on exteroceptive suppression in children and adolescents with headaches have been published. We investigated the exteroceptive suppression of masseter muscle activity in 14 migraineurs and 19 controls between 6 and 18 years of age. It was elicited by electrical stimulation at the labial commissure. No differences were found regarding the first suppression period, but ES2 was significantly longer in the migraine group than in controls. The results of the migraine group suggest overactivity of the interneurons of the reflex loop due to impaired inhibitory control from superior antinociceptive systems already at the beginning of this headache disorder.     

Acetylsalicylic acid activates antinociceptive brain-stem reflex activity in headache patients and in healthy subjects.

The exteroceptive suppression (ES) of electrical activity in the temporal muscle is an inhibitory antinociceptive brain-stem reflex. We investigated whether aspirin can significantly modulate latencies or durations of the early (ES1) and late (ES2) exteroceptive suppression periods of electrical activity in the temporal muscle. Participating in the randomized double-blind crossover study were 20 patients with migraine without aura, 20 patients with tension-type headache, and 20 healthy subjects. ES1 and ES2 elicited by an electrical stimulus of 20 mA lasting 0.2 msec were recorded during maximal voluntary contraction of the mastication muscles before and 30 min after medication. In a randomized and double-blind fashion half of the subjects were given 1200 mg of aspirin in the form of an effervescent solution and the other half were given an identically tasting solution without aspirin. One week later the experiment was repeated with the substances exchanged in crossover fashion. The administration of placebo as well as aspirin caused a highly significant increase in ES1 duration (P less than or equal to 0.001). While aspirin caused a highly significant increase in ES2 duration (P less than or equal to 0.001) the taking of placebo showed no significant effect on ES2 duration. In giving aspirin as opposed to the placebo, there was a significant interaction between groups and drug effect on the latency of ES1; whereas in migraine patients and in patients with tension-type headache the latency of ES1 was reduced by administration of aspirin, it was increased in healthy subjects (P less than or equal to 0.05). Neither aspirin nor placebo significantly varied the ES2 latency.(ABSTRACT TRUNCATED AT 250 WORDS)     

Exteroceptive Silent Periods of Temporalis Muscle Activity: Correlation with Neuropsychological Findings

SYNOPSIS
The latency and duration of the early (ES 1) and late (ES 2) exteroceptive silent period of temporalis muscle activity were determined in 51 neurological patients. We investigated whether these electrophysiologicalparameters correlated with neuropsychological variables of the patients using standardized scores for personality index, state of well-being and physical symptoms. There were no correlations between personality traits and the electrophysiological parameters, while we found significant correlations between the duration of ES 2 and momentary psychological and physical well-being variables. Moreover, the score of the momentary well-being item 'general feeling of well-being' was demonstrated to moderate significantly the ES 2 duration (P = 0.018). Therefore, neuropsychological factors prove to be of great relevance to the exteroceptive silent periods of temporalis muscle activity.     

Modulation of exteroceptive suppression periods in human jaw-closing muscles by local and remote experimental muscle pain.

The exteroceptive suppression periods (ES) in human jaw-closing muscles can be conditioned by a wide range of somatosensory stimuli and cognitive states. The aim of this study was to examine the effects of tonic experimental jaw-muscle pain versus remote muscle pain on the short-latency (ES1) and long-latency (ES2) reflex in the jaw-closing muscles. Twelve healthy subjects participated in the first experiment with jaw-muscle pain. In random order 5% hypertonic or 0.9% isotonic saline was infused into the left masseter muscle for 15 min. The pain intensity was scored continuously by the subjects on a 10-cm visual analogue scale (VAS). Electromyographic (EMG) activity was recorded bilaterally from the masseter and temporalis muscles during the pre-infusion, early phase of infusion (from 120 to 480 s), late phase of infusion (from 540 to 900 s) and post-infusion. An electrical stimulus was delivered to the skin above the left mental nerve (ipsilateral to the painful muscle) to evoke the ES in the contracting jaw-closing muscles. Ten healthy subjects participated in experiment 2 which was as identical to experiment 1 except that the electrical stimulus was delivered to the right mental nerve (contralateral to the painful muscle). Nine healthy subjects participated experiment 3 where remote muscle pain was induced in the left tibialis anterior muscle. In experiment 1 painful infusion of hypertonic saline caused a significantly later onset latency of ES2 in the left masseter muscle during the late phase of infusion compared to pre-infusion values (P < 0.05). The duration of ES2 in the same muscle was significantly shorter during the late infusion phase compared to pre- and post-infusion values (P < 0.05) and the degree of suppression was significantly reduced during the early infusion compared to the pre-infusion values (P < 0.05). Isotonic saline did not influence the ES1 or ES2. In experiment 2, similar significant inhibitory changes were found in the ES2 on the painful side. In experiment 3, no significant effects on ES1 and ES2 were observed during painful infusion of hypertonic saline into the leg muscle. These results indicate that the effects of tonic jaw-muscle pain on ES2 can be distinguished from a generalized effect of muscle pain. Furthermore, there seems to be a differential and lateralized effect of jaw-muscle pain on the brain stem reflex circuits involved in the generation of ES1 and ES2 probably through a presynaptic mechanism.     

Exteroceptive suppression of temporalis muscle activity: methodological and physiological aspects

In recent years studies of the suppression of EMG activity in temporalis muscle induced by stimulation in the trigeminal territory have opened new perspectives in headache research. The various methods that have been used in different laboratories are reviewed and some of the physiological modulations of temporalis exteroceptive suppression are described. Among different methods of recording, averaging 10 full-wave rectified EMG responses produces results with acceptable variability and discomfort. In order to obtain maximal responses the intensity of the stimulation should reach at least 20 mA. To avoid habituation of the second temporalis exteroceptive suppression period (ES2), the stimulation frequency has to be at O.1 Hz or below. The level of voluntary contraction is not a critical variable as long as it reaches 50% of maximum. Some physiological variations of temporalis suppression are well documented. In females, ES2 is shorter during menstruation than at mid-cycle and correlated with the estradiolprogesterone ratio in plasma. Conditioning temporalis ES2, by a preceding peripheral stimulus markedly reduces its duration, which is partly reversible by naloxone. Various pharmacological agents are able to modify temporalis ES2: its duration is increased by 5-HT₁ antagonists, but decreased by 5-HT uptake blockers; contradictory results have been obtained with acetylsalicylic acid. These results suggest that inhibitory brain-stem interneurons mediating temporalis ES2 are inhibited by serotonergic afferents, probably from the raphe magnus nucleus, and that the latter receives an excitatory input from the periaqueductal gray matter and other limbic structures, in part via opioid receptors.     

Effects of Tizanidine Administration on Exteroceptive Suppression of the Temporalis Muscle in Patients with Chronic Tension-Type Headache

SYNOPSIS
The aim of this study was to clarify the changes of inhibitory interneuronal activity in patients with chronic tension-type headache with disorder of pericranial muscle after treatment, and the pharmacological mechanisms of tizanidine- an alpha2 adrenergic agonist. The effects of tizanidine on exteroceptive suppression (ES) of the temporalis muscle were examined in eighteen patients with chronic tension-type headache with disorder of pericranial muscles, before and two weeks after the administration of tizanidine. The left mental nerve was stimulated, under the maximal voluntary contraction of the temporalis muscles. Two types of stimulation were used: weak stimulation with four times the sensory threshold, and strong stimulation with 10 times the sensory threshold. The rectified electromyographic activity was recorded from the right temporalis muscle. ES2 produced by four times the sensory threshold was lengthened after tizanidine administration. This fact suggests that tizanidine improves the inhibitory function in the central nervous system, and then relieves headache. However, ES produced by 10 times the sensory threshold did not change. This suggests that the effect of tizanidine may be relatively mild. The interneurones mediating ES2 may be modified by the alpha2 agonist.     

Exteroceptive silent period of temporalis muscle in menstrual headaches

The second exteroceptive silent period (ES2) of temporalis muscle was recorded on days 1 and 15 of the menstrual cycle in 17 women, 9 of whom suffered regularly from tension-type headaches during menstruation. Mean duration of temporalis ES2 was significantly shorter on day 1 of the cycle than on day 15. This difference was due to a marked menstrual reduction of ES2 in the headache subgroup. A positive correlation was found between ES2 durations and oestradiol/progesterone ratios. We hypothesize that the variations of ES2 during the ovarian cycle result from the modulatory effects of oestrogens on descending aminergic pathways that control excitability of inhibitory brainstem interneurons mediating exteroceptive suppression of jaw-closing motoneurons.