焦虑症患者的听觉事件相关电位P300研究

目的探讨焦虑症听觉事件相关电位P300的特点.方法收集符合中国精神病分类方案第2版(CCMD-2-R)焦虑症诊断标准的30例患者(焦虑症组)以及30名正常人(正常对照组),应用美国Nicolet Spirit脑诱发电位仪,采用"听觉靶-非靶刺激序列"为诱发事件,完成听觉P300检测.结果焦虑症组与正常对照组的P300波形均清晰可辨.(1)靶刺激在Fz、Cz 2个电极位置,焦虑症组靶N2潜伏期[分别为(282.7±34.6)ms和(277.9±22.6)ms]较正常对照组[分别为(263.3±18.9)ms和(259.5±13.8)ms]明显延长(P<0.01);焦虑症组靶P3波幅[分别为(3.1±1.2)μV和(3.1±1.4)μV]较正常对照组[分别为(6.4±2.4)μV和(6.2±2.0)μV]明显降低(P<0.01);在Fz、Cz 2个电极位置,尽管焦虑症组靶P3潜伏期也较正常对照组延长,但差异无统计学意义(P>0.05).(2)非靶刺激在Fz点,焦虑症组非靶P2波幅[(2.3±1.3)μV]较正常对照组[(3.4± 1.0)μV]明显降低(P<0.01).结论 P300为反映焦虑症认知功能障碍的客观生理指标,P300中靶N2潜伏期、靶P3波幅有可能成为焦虑症诊断的一个辅助指标,值得进一步跟踪观察.     

军人创伤后应激障碍患者脑诱发电位的3种变异

目的:探讨军人创伤后应激障碍(post-traumaticstressdisorder,PTSD)患者3种脑诱发电位(brainevokedpotential,BEP)的变异。方法:应用美国NicoletBravo型脑诱发电位仪,采用光、声刺激和Click短声刺激,检测75例PTSD患者(研究组)和46名健康军人(对照组)的视觉诱发电位(visualevokedpotential,VEP)、听觉诱发电位(auditoryevokedpotential,AEP)和脑干听觉反应(auditorybrainstemresponse,ABR)。结果:①VEP:Cz脑区的P2波幅研究组低于对照组犤(4.4±4.1)和(9.0±5.2)μV,t=5.40,P<0.01犦,Pz脑区的P3波幅研究组低于对照组犤(5.1±4.0)和(8.1±4.5)μV,t=3.82,P<0.01犦。②AEP:Oz脑区的P3潜伏期研究组长于对照组犤(330.2±30.7)和(298.1±27.4)ms,t=5.81,P<0.01犦,Cz脑区的P2波幅研究组低于对照组犤(2.8±1.7)和(4.5±1.8)μV,t=5.22,P<0.01犦,Cz脑区的P3波幅研究组高于对照组犤(4.2±2.1)和(2.2±1.0)μV,t=6.05,P<0.01犦。③ABR:Pz脑区的波Ⅴ绝对潜伏期研究组长于对照组犤(5.8±0.3)和(5.4±0.2)ms,t=8.01,P<0.01犦,Oz脑区的波Ⅴ绝对潜伏期研究组短于对照组犤(6.4±0.3)和(6.9±0.3)ms,t=8.90,P<0.01犦。Pz脑区的波Ⅳ绝对波幅研究组低于对照组犤(0.24±0.12)和(0.40±0.10)μV,t=7.57,P<0.01犦,Oz脑区的波Ⅱ绝     

事件相关电位P300评估阿尔茨海默病患者认知功能障碍程度以及对老年精神分裂症的鉴别作用

目的:探讨阿尔茨海默病与老年精神分裂症患者P300的差异及P300在阿尔茨海默病患者认知功能障碍严重程度判断中的价值。方法:采用电生理技术检测2000-12/2003-12山东省精神卫生中心住院及门诊阿尔茨海默病患者38例及老年精神分裂症患者40例的P300。应用简明精神状态量表评定阿尔茨海默病患者的认知功能。结果:阿尔茨海默病患者P300检测结果中在Fz犤(402.50±3.77)ms犦、Cz犤(425.81±1.90)ms犦和Pz犤(366.31±1.61)ms犦3点P300潜伏期与老年精神分裂症患者相比均明显延长,差异有显著性(t=4.23,2.79,4.56;P均<0.01);在Fz犤(5.05±0.65)μV犦、Cz犤(3.93±0.56μV犦和Pz犤(7.97±0.73)μV犦3点波幅明显减低,与老年精神分裂症患者比较,差异有显著性(t=4.02,3.75,2.85;P均<0.01)。阿尔茨海默病患者P300在Fz,Cz及Pz3点潜伏期与简明精神状态量表分数显著负相关(r=-0.78,-0.76,-0.77,P均<0.01);在Fz,Cz及Pz3点波幅与简明精神状态量表分数显著正相关(r=0.77,0.78,0.75;P均<0.01)。结论:阿尔茨海默病患者P300在Fz、Cz与Pz3点潜伏期延长及波峰减低的现象与老年精神分裂症患者的差异以及与简明精神状态量表分数的关系,有助于对阿尔茨海默病患者认知功能受损程度的判断。     

事件相关电位P300评估阿尔茨海默病患者认知功能障碍程度以及对老年精神分裂症的鉴别作用

目的：探讨阿尔茨海默病与老年精神分裂症患者P300的差异及P300在阿尔茨海默病患者认知功能障碍严重程度判断中的价值。方法：采用电生理技术检测2000-12／2003-12山东省精神卫生中心住院及门诊阿尔茨海默病患者38例及老年精神分裂症患者40例的P300。应用简明精神状态量表评定阿尔茨海默病患者的认知功能。结果：阿尔茨海默病患者P300检测结果中在Fz[(402．50&;#177;3．77)ms]、Cz[(425．81&;#177;1．90)ms]和Pz[(366．31&;#177;1．61)ms]3点P300潜伏期与老年精神分裂症患者相比均明显延长，差异有显著性(t=4．23，2．79．4．56；P均&;lt;0．01)；在Fz[(5．05&;#177;0．65)μV]、Cz[(3．93&;#177;0．56μV]和Pz[(7．97&;#177;0．73)μV]3点波幅明显减低，与老年精神分裂症患者比较，差异有显著性(t=4．02，3．75，2．85；P均&;lt;0．01)。阿尔茨海默病患者P300在Fz，Cz及Pz3点潜伏期与简明精神状态量表分数显著负相关(r=-0．78，-0．76，-0．77．P均&;lt;0．01)；在Fz，Cz及Pz3点波幅与简明精神状态量表分数显著正相关(r=0．77，0．78，0．75；P均&;lt;0．01)。结论：阿尔茨海默病患者P300在Fz、Cz与Pz3点潜伏期延长及波峰减低的现象与老年精神分裂症患者的差异以及与简明精神状态量表分数的关系，有助于对阿尔茨海默病患者认知功能受损程度的判断。     

注意缺陷障碍与精神发育迟滞及品行障碍患儿诱发电位的比较

目的探讨注意缺陷障碍(ADHD)、精神发育迟滞(MR)及品行障碍(CD)患儿诱发电位指标变异的意义。方法收集37例ADHD(ADHD组)、24例MR(MR组)、22例CD(CD组)患儿及30例正常儿童(NC组),应用美国Nicolet Spirit脑电生理仪以及光、声刺激,完成视觉诱发电位(VEP)和听觉诱发电位(AEP)检查。结果ADHD组、MR组、CD组及NC组在VEP潜伏期N1、P2(Oz脑区),波幅P2、P3(Cz脑区)和波幅P3(Oz脑区)上差异有统计学意义(P<0.05～0.01)。在AEP上,潜伏期N2(Pz脑区)、P3(Oz脑区)以及波幅N1、P2(Pz脑区)和波幅N1(Oz脑区)上差异也有统计学意义(P<0.05～0.01)。与NC组相比[NC组Oz脑区VEP-N1潜伏期(107±22)ms,Pz脑区AEP-N2(219±28)ms],MR组无论是VEP还是AEP均表现为潜伏期延迟[MR组Oz脑区VEP-N1潜伏期(129±29)ms,Pz脑区AEP-N2(244±27)ms,P<0.05～0.01和波幅下降];ADHD组VEP潜伏期P2前移[Oz脑区VEP/P2NC组(188±28)ms,ADHD组(167±30)ms,P<0.01]、AEP/N2、P3延迟,波幅VEP降低,AEP/N1和P2波幅升高[Oz脑区/N1NC组(4.5±1.9)μV,ADHD组(6.3±3.4)μV;Pz脑区/P2NC组(2.3±1.2)μV,ADHD组(4.2±2.2)μV,P均<0.01],CD组变化程度介于ADHD组和MR组之间。结论MR患儿的诱发电位主成份延迟,波幅降低;而ADHD患儿若干主成份前移,波幅增高的现象值得进一步观察。     

事件相关电位对短暂性脑缺血发作患者认知功能的评估

目的:对短暂性脑缺血发作患者的事件相关电位进行研究,以发现短暂性脑缺血发作是否对患者的认知功能有影响。方法:2002-12/2003-12解放军北京军区总医院干部病房收治短暂性脑缺血发作患者28例,年龄42～81岁;年龄、性别及受教育程度匹配的对照组28例。应用经典的Oddball刺激模式,对所有受试者进行P300的测试。结果:病例组P300的潜伏期较对照组延长犤Fz:(363.6±39.2)ms,Cz:(355.0±41.5)ms,Pz:(357.0±42.0)ms,P<0.01犦,波幅降低犤Fz:(3.0±1.7)μV,Cz:(2.8±1.6)μV,Pz:(3.3±1.5)μV,P<0.05犦。结论:短暂性脑缺血发作对患者的认知功能是有一定影响的。     

事件相关电位对短暂性脑缺血发作患者认知功能的评估

目的：对短暂性脑缺血发作患者的事件相关电位进行研究，以发现短暂性脑缺血发作是否对患者的认知功能有影响。方法：2002—12／2003—12解放军北京军区总医院干部病房收治短暂性脑缺血发作患者28例，年龄42～81岁；年龄、性别及受教育程度匹配的对照组28例。应用经典的Oddball刺激模式，对所有受试者进行P300的测试。结果：病例组P300的潜伏期较对照组延长[Fz：(363．6&;#177;39．2)ms，Cz：(355．0&;#177;41．5)ms，Pz：(357．0&;#177;42．0)ms，P&;lt;0．01]，波幅降低]Fz：(3．0&;#177;1．7)μV，Cz：(2．8&;#177;1．6)μV，Pz：(3．3&;#177;1．5)μV，P&;lt;0．05]。结论：短暂性脑缺血发作对患者的认知功能是有一定影响的。     

注意缺陷多动障碍、精神发育迟滞及品行障碍患儿的脑干听觉反应临床研究

目的　探讨注意缺陷多动障碍 (ADHD)患儿在脑干听觉反应 (ABR)检测中的特点。方法　应用美国NicoletSpirit脑电生理仪及Click短声刺激 ,测查 3 7例ADHD、2 4例精神发育迟滞 (MR)、2 2例品行障碍(CD)和 3 0名正常儿童 (NC)的ABR。结果　ADHD组、MR组、CD组及NC组在绝对潜伏期波Ⅲ、波Ⅴ (Fz脑区 ) ,波Ⅲ (Pz脑区 ) ,绝对波幅波Ⅲ (Fz脑区 ) ,波Ⅴ (Pz脑区 )上差异有显著性意义 (P <0 .0 5～ 0 .0 1)。在Fz脑区 ,波Ⅴ绝对潜伏期上与NC组相比 ,ADHD组、MR组和CD组均延迟 (P <0 .0 1) ;进一步分析MR又延迟于ADHD组和CD组。在Pz脑区上 ,ADHD组和MR组波Ⅲ绝对潜伏期均前移。绝对波幅上不论是波Ⅲ还是波Ⅴ ,ADHD组、MR组和CD组均低于NC组 (P <0 .0 1) ,进一步分析 ,在Pz脑区上 ,ADHD组和MR组波Ⅴ绝对波幅又明显低于CD组 (P <0 .0 1)。结论　ABR对临床辅助诊断ADHD和MR有参考价值     

阴性、阳性精神分裂症事件相关电位P300的比较及其与临床症状关系的探讨

目的 探讨事件相关电位P300与阴性、阳性精神分裂症异质性的关系。方法对首次发作未用药或复发但停药半年以上的36例阴性精神分裂症、35例阳性精神分裂症进行阳性、阴性临床症状量表（PANSS）评定和Fz、Cz、Pz位点事件相关电位P300各指标检测，对36例正常对照也同样进行P300各指标的检测。结果 （1）与正常对照组相比，阴性精神分裂症组Fz、Cz、Pz三点靶刺激P3波幅降低（P〈0．01），Cz、Pz位点靶刺激P3潜伏期延长（P〈0．01），P2-N2峰间潜伏期延长（P〈0．05～0．01），P2点P2-N2峰间波幅增高（P〈0．05），Cz点N2-P3峰间波幅降低（P〈0．01），非靶刺激P2波幅降低（P〈0．01），而阳性精神分裂症组Fz、Cz、Pz三点靶刺激P3波幅降低（P〈0．05～0．01），P2-N2峰间波幅增高（P〈0．05～0．01），F，、C。位点靶刺激P，潜伏期延长（P〈0．05），P2-N2峰间潜伏期延长（P〈0．05～0．01），N2-P3峰间波幅降低（P〈0．05），阴性与阳性精神分裂症组相比，F2点P3波幅有降低趋势（P=0．05）。（2）阴性精神分裂症组内Fz、Cz、Pz三点P2-N2峰间潜伏期与抑郁分成正相关（r=0．500，0．370，0．429，P〈0．05～0．01），C2点非靶刺激P2波幅与抑郁分成负相关（r=-0．361，P〈0．05）；阳性精神分裂症组内Fz点靶刺激P3潜伏期、非靶刺激P2潜伏期与偏执分成正相关（r=0．344，0．381，P〈0．05）。结论提示两组患者脑电异常有不同的脑功能异常基础。     

军人创伤后应激障碍患者脑诱发电位的3种变异

目的：探讨军人创伤后应激障碍(post-traumatic stress disorder，PTSD)患者3种脑诱发电位(brain evoked potential，BEP)的变异。方法：应用美国Nicolet Bravo型脑诱发电位仪，采用光、声刺激和Click短声刺激，检测75例PTSD患者(研究组)和46名健康军人(对照组)的视觉诱发电位(visualevokedpotential，VEP)、听觉诱发电位(auditory evoked potential,AEP)和脑干听觉反应(auditory brainstem response,ABR)。结果：①VEP：Cz脑区的P2波幅研究组低于对照组[(4．4&;#177;4.1)和(9.0&;#177;5.2)μV，t=5．40，P&;lt;0.01]，Pz脑区的P3波幅研究组低于对照组[(5．1&;#177;4.0)和(8.1&;#177;4.5)μV，t=3.82，P&;lt;0．01]。②AEP：Oz脑区的P，潜伏期研究组长于对照组[(330．2&;#177;30.7)和(298．1&;#177;27.4)ms，t=5.81，P&;lt;0．01]，Cz脑区的P2波幅研究组低于对照组[(2.8&;#177;1．7)和(4.5&;#177;1.8)μV，t=5、22，P&;lt;0．01]，Cz脑区的P3波幅研究组高于对照组[(4.2&;#177;2.1)和(2.2&;#177;1.0)μV，t=6.05，P&;lt;0．01]。③ABR：Pz脑区的波V绝对潜伏期研究组长于对照组[(5.8&;#177;0.3)和(5．4&;#177;0．2)ms，t=8．01，P&;lt;0.01]，Oz脑区的波V绝对潜伏期研究组短于对照组[(6．4&;#177;0.3)和(6．9&;#177;0．3)ms，t=8．90，P&;lt;0.01]。Pz脑区的波Ⅳ绝对波幅研究组低于对照组[(0.24&;#177;0.12)和(0．40&;#177;0.10)μV，t=7．57，P&;lt;0．01]，Oz脑区的波Ⅱ绝对波幅研究组低于对照组[(0．38&;#177;0.11)和(0．51&;#177;0.12)μV，t=6．10，P&;lt;0.01]。结论：BEP的变异特点可作为PTSD辅助诊断的一个脑电生理学标志。     

神经电生理监测的影响因素

神经电生理监测因其可以监测术中神经损伤,改善患者预后的优点广泛应用于神经外科、脊柱外科、甲状腺外科手术等。与此同时神经电生理监测受到包括麻醉药物、体温、手术体位等多种因素的影响。众多影响因素制约了神经电生理监测,了解、掌握并规避影响因素,对提高神经电生理监测指导临床操作的可信度至关重要。     

脊髓损伤实验动物模型评价：诱发电位的应用与研究进展

背景：随着工业社会的发展和交通的发达,脊髓损伤的发病率也逐年升高。脊髓损伤的辅助检查手段除了影像学以外,神经电生理技术的应用也越来越广泛。其中诱发电位因其准确率高、操作简便应用较多。目的：综述躯体感觉诱发电位及运动诱发电位在兔脊髓损伤中的应用情况。方法：通过检索中国知网、PubMed数据库,输入“脊髓损伤,诱发电位,动物模型,Spinal cord injury,evoked potential,animal model”等关键词进行检索,最终纳入文章33篇进入结果分析。结果与结论：详细阐述了体感诱发电位与运动诱发电位在动物实验中的操作方法、波形分析、应用价值、影响因素及诱发电位与动物预后功能评价。其中体感诱发电位是反应脊髓后索功能的很好指标,操作简便,对检测患者感觉功能的变化有很好的指导作用。运动诱发电位能为各种脊髓疾病提供敏感而精确的诊断,尤其在患者治疗和康复期间可作为重要的评估手段。而两者连用效果更精确。     

多模式脑诱发电位对早期帕金森病的诊断价值

目的探讨多模式脑诱发电位对早期未治疗帕金森病（Parkinson’s disease,PD）的诊断价值。方法未经治疗的早期PD患者33例（PD组）和同期体检健康者31例（对照组）,2组分别进行视觉诱发电位、脑干听觉诱发电位、短潜伏期躯体感觉诱发电位和瞬目反射的综合测试,并进行2组间比较。结果PD组视觉诱发电位的P100潜伏期、脑干听觉诱发电位的V波潜伏期及Ⅲ-V波峰间潜伏期、I～V波峰间潜伏期和瞬目反射的R2波及R2’波潜伏期均较对照组明显延长,差异有统计学意义（P〈0．01）;2组短潜伏期躯体感觉诱发电位各波潜伏期差异均无统计学意义（P〉0．05）。结论PD早期存在视觉传导通路和脑干传导通路损害,对PD患者进行多模式脑诱发电位检测有助于疾病早期诊断。     

Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.     

Eliminating diathermy-induced artifacts during intraoperative monitoring of somatosensory-evoked potentials: A hardware solution

Somatosensory-evoked potentials (SEPs) recorded intraoperatively are often contaminated by artifacts arising from unipolar diathermy. This increases variability in serial SEP recordings and decreases the reliability of SEPs for intraoperative monitoring. Rejection of single sweeps on the basis of a voltage criterion can only partially prevent the inclusion of sweeps containing artifacts. We describe a low-cost hardware system that will halt SEP acquisition automatically before diathermy becomes active. Activation of the diathermy switch will halt SEP acquisition by sending a digital inhibit signal to the evoked potential machine via a fiberoptic cable. A timer delays the activation of the diathermy until the last sweep has been completed. To allow the electroencephalographic amplifiers to recover from any overload condition resulting from the high-voltage/high-frequency input during diathermy, acquisition is resumed only after a user-selectable time interval. The system was evaluated in 50 patients. It effectively interrupted SEP acquisition each time diathermy was used. By eliminating diathermy noise from the averaged waveforms, the system will allow evoked potential monitoring even during periods of intensive use of diathermy.     

体感诱发电位和脑干听觉诱发电位联合瞬目反射在脑干梗死预后评估中的价值

目的评价体感诱发电位（BAEP）、脑干听觉诱发电位（SEP）联合瞬目反射（BR）对脑干梗死预后评估中的作用。方法64例梗死患者,根据格拉斯哥Glasgow（GCS）评分,分为重症组（GCS≤8分）和非重症组（GCS〉8分）。根据CANT分级标准将脑干BAEP及SEP分为I、II、III3级,将BR分为正常者和异常者,分别比较重症组与非重组诱发电位的表现,并比较不同级别诱发电位与预后的关系。结果重症组死亡患者所占比例42．86％,明显高于非重症组的19．44％。BAEP、SEP表现为Ⅲ级者死亡率分别为57．69％、58．82％,明显高于I、II、III级患者;BR异常者死亡率48．38％,明显高于BR正常者。结论BAEP、SEP、BR能评价脑干梗死患者的脑功能,并能预测预后。     

Intraoperative monitoring of brainstem auditory evoked potentials following emergency evacuation of a cerebellar vascular malformation

This case report highlights the use and value of monitoring the auditory brainstem response during emergency neurosurgery. The prompt on-line changes in the auditory brainstem response after evacuation of a cerebellar arteriovenous malformation provided objective evidence of improved brainstem function, which aided in the management of this patient's disorder.     

Habituation of visual and intensity dependence of auditory evoked cortical potentials tends to normalize just before and during the migraine attack

Between attacks, migraine with (MO) or without aura (MA) patients show deficient habituation of pattern-reversal visual evoked potentials (PR-VEP) and a strong intensity dependence of auditory evoked cortical potentials (IDAP). Clinical observations of migraine prodromes and previously published electrophysiological studies suggest that cortical information processing may vary in close temporal relationship to the attack. We studied PR-VEP and IDAP just before (11 MO pts), during (23 MO, 3 MA), 1 day following (27 MO, 1 MA) and 2 days following (14 MO) a migraine attack. The results were compared with a large group of MO patients recorded at a distance of at least 3 days from an attack (n = 66 for IDAP; n = 39 for VEP). Patients recorded the day before the attack had on average an habituation of -13.6+/-20.5% (mean +/- SD) between the 5th and 1st block of 100 averaged VEP responses and a flat (0.38+/-1.06 microV/10 dB) amplitude-stimulus intensity function (ASF) slope of the auditory evoked cortical potential. Both values were significantly different from those obtained in the attack interval (P=0.003; P=0.020). During the attack, VEP habituation was less pronounced (-0.17+/-26.2%) and ASF slopes remained flat (0.32+/-1.44 microV/10 dB; P=0.002 compared to interval). During the 2 days following the attack, VEP habituation was replaced by potentiation (+0.09+/-29.1% the 1st day; 19.5+/-45.7% the 2nd day) and ASF slopes increased markedly (0.87+/-1.39 and 1.14+/-1.12 microV/10 dB). The normalization of evoked cortical responses just before and during the attack, might reflect an increase in the cortical preactivation level due to enhanced activity in raphe-cortical serotonergic pathways.     

Pattern-Reversal Visual Evoked Potentials in Migraineurs With or Without Visual Aura

To determine the possible electrophysiologic changes in migraineurs with or without visual aura, we investigatedpattern-reversal visual evoked potentials in 39 patients. We compared the mean P100 latency and amplitude of 16patients with aura, 23 patients without aura, and 17 age- and sex-matched normal subjects. There were no significantdifferences between groups. There was no correlation between age and the parameters in any group. However, in 7 of23 patients without aura, the P100 latency was longer than the mean control value + 2 SD. The mean disease duration inthis subgroup was significantly longer than the means of the remaining 16 patients without aura or the patients with aura(P<0.05 for each). This suggests the possibility that P100 latency prolongation is a consequence, but not an entitycaused by the pathogenetic mechanism of the disease from the beginning.