颈交感神经节阻滞治疗偏头痛及其对交感神经皮肤反应的影响

目的探讨颈交感神经节阻滞治疗偏头痛的疗效及其对交感神经皮肤反应的影响。方法颈交感神经节阻滞受用颈6横突法，每日1次，两侧交替阻滞，共7次；应用神经电生理测定36例偏头痛患者治疗前后和30例健康人交感神经皮肤反应（SSR）。结果偏头痛患者经颈交感神经节阻滞后头痛次数减少、头痛时间缩短、程度减轻，与治疗前比较有显著性差异（P〈0．01）。偏头痛患者交感神经皮肤反应的潜伏期均明显长于对照组（P〈0．01），而波幅显著低于对照组（P〈0．01）；颈交感神经节阻滞后偏头痛患者交感神经皮肤反应恢复正常。结论颈交感神经节阻滞治疗偏头痛具有良好的疗效，并能改善偏头痛患者的自主神经功能（ANS）。     

慢性紧张型头痛患者的抑郁和交感神经皮肤反应相关性的研究

目的探讨慢性紧张型头痛(CTTH)患者抑郁和交感神经皮肤反应(SSR)相关性。方法选取神经内科就诊、符合入组的CTTH患者54例,对照组为同期健康体检者40例,两组均行汉密顿抑郁量表(HAMD)和SSR检测。结果 CTTH患者轻度抑郁(HAMD8¹7分)26例,占48.15%;中、重度抑郁(HAMD>17分)10例,占18.52%。与对照组比较,轻度和中、重度抑郁患者SSR潜伏期均延长(p<0.01),而波幅均降低(p<0.01);无抑郁的CTTH患者SSR潜伏期亦显著长于对照组(p<0.05),而波幅显著低于对照组(p<0.05);中、重度抑郁患者较轻度抑郁患者SSR潜伏期延长(p<0.01),波幅降低(p<0.01)。结论 CTTH患者抑郁发生率高,CTTH患者存在皮肤交感神经兴奋性减低,伴发抑郁重者变化更为明显,SSR检测为CTTH的诊断和治疗可提供一定的参考价值。     

某部驻岛官兵睡眠状况自评量表评定分析

目的探讨抑郁症患者交感神经皮肤反应(SSR)的特点及其与焦虑抑郁严重程度的相关性。方法对32例首发抑郁症、19例复发抑郁症和27例正常对照组分别检测SSR潜伏期和波幅。结果首发抑郁症和复发性抑郁症患者的双侧上下肢SSR波潜伏期和波幅与正常组相比,差异均无统计学意义(P>0.05),但复发性抑郁症的左上肢SSR波潜伏期显著长于首发稀有症(P=0.034);抑郁症的双侧上下肢SSR波潜伏期和波幅与HAMD、HAMA的评分,其差异均无统计学意义(P>0.05)。结论 SSR可能并不能敏感地反映抑郁症的自主神经功能损害症状,因而其临床应用价值也尚不能肯定。     

交感神经皮肤反应诊断慢性乙醇中毒自主神经病变

目的 :早期发现慢性乙醇 (酒精 )中毒者自主神经病变。方法 :对 48例慢性乙醇中毒患者进行交感神经皮肤反应 (SSR)的检测 ,并与 50例正常人进行对比分析。结果 :慢性乙醇中毒组SSR潜伏期显著延长 (P <0 0 1 ) ,下肢波幅明显减低 (P <0 0 5) ,患者的饮酒年限、饮酒量与SSR呈正相关。结论 :交感神经皮肤反应可作为评价乙醇中毒自主神经功能障碍的客观电生理指标     

皮肤交感反应在糖尿病周围神经病早期诊断中的价值

目的　探讨皮肤交感反应 (SSR)与糖尿病自主神经系统交感神经病变的关系 ,为糖尿病自主神经系统病变的早期诊断提供客观依据。方法　对 80例糖尿病患者及 30名健康人四肢进行SSR测定 ,对两组SSR各波潜伏期及波幅的均值行t检验。结果　两组SSR的起始潜伏期、N波、P波潜伏期比较差异有显著意义 (P <0 0 0 1) ;N波波幅、P波波幅差异无显著意义 (P >0 0 5 )。健康对照组全部可引出SSR ,而糖尿病组仅 2例患者四肢可正常引出SSR ,78例 (97 5 % )患者至少有一肢SSR潜伏期异常。结论　SSR为糖尿病性自主神经系统交感神经病变的早期诊断提供了新的方法和客观依据 ,可发现糖尿病自主神经系统交感神经纤维的早期病变。     

偏头痛患者脑血流动力学TCD检测

应用经颅多普勒超声（TranscranialDoppleUltrasonography，TCD）对118例偏头痛病人发作间歇期，发作期脑血流动力学变化进行检测，并做CO2反应性和血管杂音测定。结果表明：发作间歇期，偏头痛组平均血流速度（MFV）、血管杂音出现机率显著高于对照组；脉动指数（PI）显著低于对照组，CO2反应性偏头痛组显著增强。而发作期普通型偏头痛与典型偏头痛有显著差异。普通组MFV显著低于间歇期、血管杂音减弱，典型组MFV显著高于间歇期，血管杂音增强，PI无明显变化。     

抑郁症患者的交感神经皮肤反应探讨

目的探讨交感神经皮肤反应(SSR)对抑郁症患者的临床价值。方法对45例抑郁症患者治疗前后和43例正常健康者分别进行SSR测定和汉密尔顿抑郁量表(HAMD)评定,并加以比较。结果抑郁症组治疗前SSR测定的异常率为84.4%(38/45),而治疗后异常率为13.3%(6/45)。治疗前SSR测定波潜伏期及波幅值较治疗后及对照组分别延长和降低,差异有统计学意义(P<0.01);治疗后抑郁症组HAMD评定分值较治疗前降低,差异有统计学意义(P<0.01)。相关分析结果表明,抑郁症患者SSR波潜伏期与HAMD分值呈显著正相关(P<0.01),其波幅与HAMD分值呈显著负相关(P<0.01)。结论交感神经皮肤反应测定可作为判定抑郁症患者自主神经功能的参考指标应用于临床。     

2型糖尿病患者交感神经皮肤反应及F波的研究

目的:探讨交感神经皮肤反应(SSR)及F波在2型糖尿病周围神经病中的诊断价值。对64例2型糖尿病患者进行交感神经皮肤反应(SSR)及F波检测,并与40例正常人进行对比分析。结果:患者组上下肢SSR的潜伏期及波幅,F波的平均潜伏期,F波时限及F波出现率均较对照组有显著性差异,SSR异常率为42.2％,F波的异常率为37.5％,SSR及F波导常与患者的病程相关,而与血糖水平无关。结论:SSR及F波可作为评价2型糖尿患者自主神经及周围运动纤维近端损害的客观指标。     

帕金森病与多系统萎缩患者交感神经皮肤反应电位的比较研究

目的探讨帕金森病和多系统萎缩患者交感神经皮肤反应电位所显示的自主神经功能障碍的差异性,以为二者鉴别诊断提供临床依据。方法采用MEB-9200K型肌电诱发电位仪分别对受试者进行交感神经皮肤反应电位检测,以波形潜伏期〉x＋2．50）s、波幅低于均值的50％或未引出波形作为异常标准,分析帕金森病与多系统萎缩患者交感神经皮肤反应电位异常特征和病程等之间的相关性。结果与正常对照组受试者相比,帕金森病组和多系统萎缩组患者交感神经皮肤反应电位检测显示四肢潜伏期延长、波幅降低（P〈0．05）,但帕金森病组与多系统萎缩组之间差异无统计学意义（均P〉0．05）;其中多系统萎缩组交感神经皮肤反应电位总异常率（P=0．018）和双侧异常率（P=0．035）均高于帕金森病组。帕金森病组病程≤3年者交感神经皮肤反应电位异常率与病程〉3年者比较,差异具有统计学意义（P=0．033）;多系统萎缩组病程≤3年患者交感神经皮肤反应电位异常率与病程〉3年者比较,差异无统计学意义（P=0．285）。结论多系统萎缩患者交感神经皮肤反应电位异常出现早,且多呈双侧改变,表明其自主神经功能障碍更严重、更广泛。     

卒中后抑郁患者的交感神经皮肤反应与事件相关电位对照研究

目的探讨交感神经皮肤反应(SSR)与事件相关电位(ERP)对卒中后抑郁患者的诊断价值。方法对55例卒中后抑郁患者和52例正常健康者分别进行了SSR和ERP测定,并将结果加以比较。结果卒中后抑郁组中SSR和ERP测定中的P300成分异常率分别为87.3%(48/55)和83.6%(46/55),两者异常吻合率为76.4%(42/55)。卒中后抑郁组SSR测定结果中,SSR潜伏期和波幅值较对照组延长和降低,其差异具有显著性(P<0.01),ERP测定中N2、P3波潜伏期和P3波幅较对照组分别延长和降低,存在显著性差异(P<0.01)。其中N2、P3波潜伏期与SSR测定中潜伏期以及波幅与波幅之间呈正相关(r=0.29~0.36,P<0.01),而两者潜伏期与波幅之间呈负相关(r=-0.32~-0.33,P<0.01)。结论交感神经皮肤反应和事件相关电位测定可作为卒中后抑郁患者的诊断指标应用于临床。     

Autonomic dysfunction in Parkinson's disease assessed by sympathetic skin response: a prospective clinical and neurophysiological trial on 50 patients

To verify possible dysfunction of sympathetic skin activity in Parkinson's disease (PD), we studied the electrically evoked sympathetic skin responses (SSR) bilaterally at hands and feet in a group of 50 PD patients and in normal subjects. SSR was present in all patients. Nevertheless, significant differences in the latency and amplitude values were noted. In the group of patients prolongation of latency as well as the reduction of SSR amplitude correlates with age. The longer the disease the more SSR abnormalities could be found. Gender, type of clinical manifestation of PD or medication had no statistically significant effects. However, motor symptom asymmetries evaluated separately for each body side correlated well with interside asymmetries of SSR.     

Evaluation of sympathetic skin response in Parkinson's disease

There is no clear definition on the role of sympathetic skin response (SSR) in the evaluation of patients with Parkinson's disease (PD). We recorded the SSR of the palms of 64 controls and 46 patients with PD to electrical stimulation of the median nerve at the wrist. We analyzed onset latency and peak-to-peak amplitude. A study of parasympathetic function (R–R interval analysis) was also undertaken. We found that patients with PD had more absent SSRs than controls. The mean amplitude of the SSR was significantly reduced in both lower and upper limbs of PD patients in comparison with control subjects (p<0.001). The onset latency was longer in the lower limbs of these patients in respect to the control group (p<0.003). There was a significant inverse correlation between SSR amplitudes and age, severity and late onset of the disease. There was no association of these parameters with dysautonomic symptoms or R–R interval variation. In conclusion, there is a significant association between altered SSR and PD and an inverse correlation in this group of patients between SSR values and older age, greater severity and later onset of disease. Therefore, the study of SSR may provide valuable information on cholinergic sympathetic function in patients with PD.     

Dysfunction of the pupillary light reflex following migraine headache

Using pupillometry and sympathetic skin responses we compared the changes in local and systemic autonomic function within one week of a migraine attack. We investigated whether the measurement of the pupillary light reflex provides further information on the pathophysiology of migraine. Forty-two migraine patients and forty-two healthy age-matched controls were included. The parameters that were measured were the amplitude of the pupillary light reflex, the pupil size at the beginning of the measurement, the latency, the velocity of constriction and the velocity at the end of the dilatation. The average pupil size was 6.43 mm in the migraine group and 6.7 mm in the control group (p < 0.01). Reduced velocity of constriction and smaller amplitude of constriction in migraine patients within two days of an attack were signs of a parasympathetic dysfunction (p < 0.05). The sympathetic skin response did not differ significantly between migraine sufferers and controls. These findings indicate that both parasympathetic and sympathetic nerves supplying the eye are involved in migraine headache presumably due to effects on the pericarotid sympathetic fibers and involvement of trigeminal-parasympathetic reflexes. Received: 24 July 2001, Accepted: 16 July 2002 Correspondence to K. Schepelmann, M. D.     

Sympathetic skin response in patients with myasthenia gravis★ A comparative analysis

BACKGROUND: The examination of sympathetic skin response is an important index for assessing the autonomic nerve function, and patients with myasthenia gravis are always accompanied by dysautonomia. Therefore, it will be important to know whether sympathetic skin response can be used as the index for the clinical evaluation of myasthenia gravis. OBJECTIVE: To investigate the diagnostic value of sympathetic skin response in the damage of autonomic nerve function of patients with myasthenia gravis. DESIGN: A case-controlled comparative observation. SETTING: Department of Neurology and Room of Nerve Electromyogram, the Affiliated Hospital of North Sichuan Medical College. PARTICIPANTS: Thirty outpatients or inpatients with myasthenia gravis were selected from the Department of Neurology, the Affiliated Hospital of North Sichuan Medical College from May 2006 to May 2007, including 9 males and 21 females, aged 8–72 years with a mean age of (28±5) years old. They were all accorded with the diagnostic standards of myasthenia gravis, accompanied by different severity of autonomic nerve symptoms, including poor skin nutrition, sweating of hands and feet, pyknocardia, persistent hypotension, abdominal pain, constipation, etc. They all had not taken any drug affecting the autonomic nerve function before the examination. Informed consents were obtained from all the patients. Meanwhile, 30 healthy physical examinees were enrolled as the normal control group, including 10 males and 20 females, aged 10–75 years with a mean age of (31±5) years old. Approval was obtained from the hospital ethic committee. METHODS: After admission, the patients were examined with sympathetic skin response using DANTEC keypoint 2.0 electromyography evoked potential apparatus (Danmark). The changes of the latency and wave amplitude of sympathetic skin response were observed. The subjects in the normal control group were examined with the same methods at physical examination. Abnormality was judged by the disappearance of wave form, latency longer than that in the normal control group by Mean±2.5SD, or wave amplitude lower than the average value in the normal control group by 50%. MAIN OUTCOME MEASURES: The results of the latency and wave amplitude of sympathetic skin response were compared between the patients with myasthenia gravis and normal controls. RESULTS: All the 30 patients with myasthenia gravis and 30 healthy physical examinees were involved in the final analysis of results. There were no significant differences between the left and right upper and lower limbs in both the myasthenia gravis group and normal control group (P > 0.05). In the myasthenia gravis group, the abnormal rate of sympathetic skin response was 37% (11/30), the latency was prolonged and the wave amplitude was decreased as compared with those in the normal control group, and there were significant differences (P < 0.01). CONCLUSION: Sympathetic skin response can be used as an electrophysiological index for judging the damages of autonomic nerve function in patients with myasthenia gravis.     

Sympathetic skin response and cardiovascular autonomic function tests in Parkinson's disease and multiple system atrophy with autonomic failure.

The relationship between sympathetic skin response (SSR) and cardiovascular autonomic function tests (CVTs) was investigated in 15 patients with idiopathic Parkinson's disease (PD), 15 patients with clinical evidence of multiple system atrophy (MSA) with autonomic failure, and in 15 healthy control subjects. SSR was elicited by electrical stimulation of the right and left median nerves and simultaneously recorded on the palms of both hands. CVTs included the following sympathetic and parasympathetic tests: orthostatism, head-up tilt, cold pressor test, deep breathing, Valsalva maneuver, and hyperventilation. The SSR was normal in all patients with PD and control subjects but was abnormal or absent in all patients with MSA. For patients with MSA, SSR latency was significantly longer and amplitude was significantly smaller than that of patients with PD and control subjects. For patients with PD, SSR did not differ from that of control subjects. In these patients, SSR latency was significantly longer and SSR amplitude was smaller when the side with more marked motor symptoms was stimulated, both ipsilaterally and contralaterally to the side of stimulation. A statistically significant difference in SSR latencies and amplitudes was found between patients with PD and control subjects only when motor asymmetries were considered. CVTs showed severe sympathetic and parasympathetic hypofunction in patients with MSA, but not in patients with PD or control subjects. No correlation was found between SSR and CVTs that assess sympathetic function in patients and control subjects. SSR is indicated as an additional test for the evaluation of sympathetic degeneration in patients with MSA.     

Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor and neurological function.

The sympathetic skin response (SSR) at the foot to a deep inspiration was measured in 68 randomly selected diabetic patients and 46 age matched normal subjects and compared with other quantitative measures of neurological and sudomotor function. SSR was obtained in all but three diabetic patients. The upper limit of normal for the onset latency was 2202 ms and the lower limit for the amplitude of the first wave 92 microV. Ten diabetic patients had measurable but prolonged latencies, and 11 had measurable but low amplitudes. There were no significant associations between latency, height, and age, but in insulin dependent patients there was a significant diminution of response amplitude with increasing duration of diabetes. Latency was weakly associated with Marstock thermal thresholds, respiratory RR variation, and common peroneal nerve conduction velocity. SSR amplitude was associated with the density of pilocarpine activatable sweatspots in the same region of the foot. Patients with abnormal latencies were significantly older and had reduced thermal sensation than those with normal latencies. Median coefficients of variation for repeat testing in diabetic patients were 9% for latency and 13% for amplitude. The test is objective and reproducible, but latency measurements reflect conduction in a long multineuronal pathway and are not purely a measure of peripheral C fibre function; amplitude measurements reflect the density of spontaneously activable sweat glands and are therefore a valid measure of peripheral sympathetic activity, though they depend more on temperature than do latencies (mean change over the range 32-34 degrees C; 8.5% degrees C for amplitude, -2.5%/degrees C for latency).     

2型糖尿病患者交感皮肤反应分析

目的探讨交感皮肤反应(SSR)对检测2型糖尿病(T2DM)患者交感神经功能损害的诊断价值。方法选择本院收治的60例2型糖尿病患者进行交感皮肤反应检测,并与40例健康人进行对比。结果60例糖尿病患者交感皮肤反应与对照组比较,起始潜伏时差异有统计学意义(P<0.05),而波幅上下肢差异无统计学意义。结论SSR可以作为评价糖尿病患者交感神经功能的一个显著指标。     

Sympathetic skin response in carpal tunnel syndrome.

OBJECTIVES: Sudomotor efferent nerve fiber function was studied in carpal tunnel syndrome (CTS). METHODS: Bilateral median and ulnar sympathetic skin response (SSR) were recorded by sternal stimulation in 22 bilateral and 9 unilateral patients and compared with 21 healthy volunteers. RESULTS: There was no significant difference between median and ulnar nerve SSR latency, amplitude or area. The median nerve SSR was not different from that of the controls. The median-to-ulnar ratios of SSR parameters were not different in patients and controls. However, the median-to-ulnar ratios of SSR amplitude and area were lower than normal in 3 out of 7 patients with normal nerve conduction whereas this abnormality was found in only 4 out of 46 patients with abnormal nerve conduction. CONCLUSIONS: Normal SSR results, even in patients with complaints related to sudomotor sympathetic dysfunction, indicate that the SSR does not seem to be a sensitive diagnostic method in CTS.