THE MECHANISM OF CEREBRAL EVOKED POTENTIALS BY REPETITIVE MAGNETIC STIMULATION OF GASTROCNEMIUS MUSCLE IN DUCHENNE MUSCULAR DYSTROPHY

INTRODUCTION The magnetic stimulation technique is a new electrophysiological test developed in 1980s, with its initial purpose in the measurement of motor conduction in central nerve system. Since 1990s, some researchers have found that the evoked cerebral potentials could be recorded in scalp when magnetically stimulating spinal roots and peripheral nerves, which did not differ in la tency from potentials evoked by electrical stimulation (1－ 5). Furthermore, longer latency and lower amp…     

面神经ENoG和EMP检查在面肌麻痹诊断及预后方面的应用

Electroneurography (ENoG), an objective electrophysiologic measurement of compound muscle action potentials (CMAPs), is used to assess the integrity of a peripheral motor nerve. This method has been used for many years. In our study using an electrophysiologic instrument (Medelec MS6), the stimulating electrode was placed over the facial nerve anterior to the tip of the mastoid process and was manipulated to obtain the maximum CMAPs amplitude from the frontal muscle. With 30 normal subjects and 20 patients with facial nerve palsy, the results showed that the latencies and amplitudes were different between the two groups. Motor evoked potential (MEP) is a new method. Ipsilateral facial muscles are excited by magnetic stimulation over the scalp when the coil is placed over the parieto-occipital region. Using a magnetic stimulator and EMG instrument (1500C4 DISA), CMAPs from the orbicularis oris and frontal muscle were measured. In 30 normal subjects, the CMAPs were similar in form but of longer latency than those obtained with electrical stimulation (ENoG). In 20 patients with lateral facial nerve palsy due to Bell's palsy, Hunt's syndrome or trauma, the latencies on the lesion sides were apparently longer and the amplitudes much lower than in the normals. Our studies suggest that magnetic stimulation will detect facial nerves in the region inside the temporal bone where they cannot be touched by electrical stimulation from in front of mastoid process. The use of both ENoG and MEP methods together allows for accurate measurement of proximal facial nerve conduction and also provides some quantitative measurement: thus, we can detect conduction block or axonal degeneration early.(ABSTRACT TRUNCATED AT 250 WORDS)     

面神经ENoG和MEP检查在面肌麻痹诊断及预后方面的应用

应用面神经电图(ENoG)和面神经运动诱发电位(MEP),对60名正常人(ENoG30名,MEP30名)和40例面肌麻痹患者(ENoG20例,MEP20例)的测试结果表明:①ENoG是1种客观的电生理诊断技术,能较准确地反映面神经纤维状态,对诊断和判断预后有指导意义。但在面肌麻痹早期,仅靠此项检查来判断预后不够,还需结合其它电生理检查。②MEP是1种新的测试方法,能通过颅骨刺激到颅内近端面神经,对了解近端面神经状态大有帮助。初步研究表明,该技术安全、可靠,诱发电位重复性好,正常人与患者间差异显著。③两种方法结合使用,有助于早期了解病变的性质和程度,较全面地了解面神经的完整性,对判断预后,拟定治疗方案有重要意义。     

26例臂丛神经损伤的神经肌电图分析

目的：探讨神经肌电图在臂丛受损诊断及定位中的作用。方法：对２６例臂丛受损者采用表面电极法沿神经走行的不同部位顺向检测正中神经、尺神经、桡神经、肌皮神经、腋神经共９１条神经的感觉及运动传导速度（或末端潜伏期）、Ｆ波;并用同心圆针电极观察拇短展肌、小指展肌、指总伸肌、肱二头肌、三角肌、冈上肌、冈下肌共１１４块肌肉的病理自发电位及募集形式。结果：９１条运动神经在不同节段收集共有６４条异常（７０．３％）;     

Evoked spinal cord potentials monitored at thoracoabdominal region after trans-intercostal stimulation

To investigate the feasibility of a novel recording method for trans-intercostal evoked spinal cord potentials (Tic-ESCPs) and the properties of the waveforms, the potentials were recorded and analyzed in an animal model. In two beagle dogs, Tic-ESCPs were recorded at the left twelfth intercostal to fourth lumbar nerves following stimulation at the left eleventh intercostal nerve, either with or without the use of a muscle relaxant. The amplitude and latency of the Tic-ESCP waves were then measured and compared with those of conventional transcranial spinal motor evoked potentials (MEPs). Tic-ESCPs could be obtained at any nerve, with or without the use of a muscle relaxant. The Tic-ESCP waveform was clear and simple, consisting of a small positive (P1) wave and a subsequent large negative (N1) wave. As the site of recording moved farther from the stimulation site, the N1 amplitudes were reduced and the P1 latency was prolonged. Under muscle relaxation, the N1 amplitudes were reduced, and the P1 latencies were shorter. As compared with MEPs, Tic-ESCPs could be evoked by a weaker stimulus, the N1 amplitude was smaller, and the P1 latency was shorter. Tic-ESCP recording was feasible either with or without the use of a muscle relaxant. The Tic-ESCPs showed simple and clear waveforms with smaller stimulations. Therefore, Tic-ESCPs may be useful for intraoperative spinal cord monitoring.     

失交感神经支配对周围神经再生影响的实验研究

目的观察失交感神经支配对周围神经损伤后再生的影响。方法切除大鼠一侧颈中交感神经节,切断并吻合双侧正中神经。于手术后1、2、4、8周,分别检测双侧趾浅屈肌复合动作电位(CMAP)、正中神经感觉神经活动电位(SNAP)、吻合口以远的有髓纤维计数和超微结构观察,趾浅屈肌最大肌收缩力及其肌肉湿重等指标,对上述指标进行双侧比较。结果各组动物实验侧的各项指标(19.9μV±2.7μV、11.8mV±1.7mV)均低于对照侧(25.1μV±1.8μV、18.0μV±1.0μV)(均P<0·05)。超微结构观察结果与实验检测指标相符。结论去交感神经支配不利于周围神经损伤后再生,周围神经营养血管的基础紧张被消除导致神经失营养可能是重要原因。交感神经对失神经支配的骨骼肌可能具有营养和保护作用。     

乳化七氟烷选择性阻滞外周神经对骨骼肌松弛作用的研究

目的 探索七氟烷松弛骨骼肌作用的位点是否位于外周神经。方法 健康新西兰大白兔36只,随机分配到乳化七氟烷低浓度组〔4 mL/（kg·h）〕、中浓度组〔6 mL/（kg·h）〕、高浓度组〔10 mL/（kg·h）〕及脂肪乳对照组〔以10 mL/（kg·h）的速率泵入30%脂肪乳〕,每组9只。选择性麻醉下肢外周神经、神经-肌肉接头及骨骼肌肌纤维;模型建立成功后,比较麻醉前后所测得胫骨前肌静息张力和肌肉收缩力的变化。结果 七氟烷低、中、高浓度组七氟烷分压在股静脉与颈内静脉之间的差异均具有统计学意义（ P<0.05）。七氟烷低、中浓度组的胫骨前肌的静息张力几乎没有发生改变,给予电流刺激时测得的单收缩力和强直收缩力与麻醉前的基础值差异也无统计学意义。高浓度组麻醉后兔胫骨前肌的单收缩力、强直收缩力有所减弱（ P<0.05）。结论 成功建立选择性外周神经阻滞模型。中、低浓度七氟烷松弛骨骼肌的作用位点不在外周神经,可能在脊髓或更高级别的中枢。     

Effects of Repeated Injection of Local Anesthetic on Sciatic Nerve Blocks Response

Localanestheticperipheralorepiduralblocksinhumansorratsproducetachyphylaxis .Previousstud ieshaveshownthattachyphylaxistolocalanestheticnerveblockiscloselyrelatedtohyperalgesia .Drugsknowntopreventhyperalgesiaatspinalsitesuchasnitricoxidesynthesisinhibit…     

神经根磁刺激H反射对糖尿病神经根病的诊断作用

目的探讨糖尿病神经根病的诊断及其发病频度。方法经磁刺激骶１神经根以及窝胫神经,比目鱼肌记录二种Ｈ反射,并常规检测胫神经远端感觉、运动神经传导。正常组胫神经８０条,糖尿病组胫神经８２条。用多元回归分析。结果正常人骶１Ｈ反射Ｈ－Ｍ波峰间期（ＨＭＩ）与身高、年龄呈显著正相关;８２条糖尿病胫神经中４０．２％、５３．７％有骶１Ｈ反射ＨＭＩ和波幅,５４．９％、４６．３％有窝磁刺激胫神经Ｈ反射潜伏期和波幅,４０．２％、４０．２％远端感觉传导速度和波幅分别大于或小于９５％正常范围。结论与远端神经病变相比较,糖尿病神经根病和近段神经病具有相当高的发病频度,糖尿病神经病多为广泛多发性周围神经病变     

实验性轴索型古兰-巴雷综合征电生理学研究

目的探讨轴索型古兰-巴雷综合征(GBS)兔模型腓总神经电生理学方面的改变.方法对注射脂多糖(LPS)后发病兔3只、未发病兔3只和对照组8只兔进行腓总神经运动传导速度、复合肌肉运动电位、F波潜伏期测定,并进行胫前肌肌电图检查.结果发病兔腓总神经运动传导速度为48.3 m/s±2.9 m/s,未发病兔为47.4 m/s±2.5 m/s,对照组为51.6 m/s±7.6 m/s,差异有显著意义(P>0.05).3只发病兔腓总神经运动传导速度、F波潜伏期均正常,复合肌肉电位明显降低.发病兔胫前肌肌电图可见正相尖波和纤颤电位.结论发病兔腓总神经电生理学检查结果符合轴索型GBS病人的电生理学表现,表明电生理学对轴索型GBS的诊断具有特殊作用.     

朝鲜族正常人下肢神经传导检查中检测A波的意义

[目的]对朝鲜族正常人下肢神经传导检测结果进行分析,并探讨出现A波的意义.[方法]检测34例延边朝鲜族正常人腓、胫神经的复合肌肉动作电位(CMAP)及迟延电位F波,观察A波与神经传导各参数及生活习惯的内在联系.[结果]腓神经A波出现率高于胫神经,A波阳性腓神经与阴性相比,远端潜伏期延长,CMAP波幅低下,F波最短潜伏期延长.A波阳性胫神经与阴性相比,远端潜伏期无明显变化.[结论]朝鲜族正常人腓神经A波出现率较高,究其原因认为可能与该民族的生活习惯有相关性.     

胫神经缩窄术在治疗脑瘫下肢痉挛肢体中的应用

目的探讨胫神经缩窄术在治疗脑瘫下肢痉挛肢体及矫正内翻马蹄足中的应用及手术效果。方法 2006年9月～2008年12月对27例脑瘫患儿53肢下肢痉挛肢体行胫神经缩窄术,单侧1例,双侧26例。术前详细检查、明确病因,对下肢挛缩肌肉及神经支配进行详细分析。术中以神经电刺激对运动神经肌肉支配进行定位。手术显微镜下行胫神经缩窄术。结果共行胫神经缩窄术27例（53肢）。所有患者随访6个月～1年3个月,平均10.3个月。术后手术肢体功能全部改善。踝关节增加15～50度背屈,改善率96%。内翻足19例,16例足改善,改善率84.2%。27例患儿术后足底位置正常（足底完全着地）11例（40.8%）,基本正常（与地面夹角小于10度或足底外侧3分之2以上着地）13例（48.1%）,尚不正常3例（11.1%）。随访期间下肢肢体随意运动功能改善22例（81%）,其中显著改善7例（26%）。术后下肢肢体无感觉障碍。3例（11%）肌力不同程度下降,康复训练后肌力均有恢复和增强。结论胫神经缩窄术可有效矫正治疗脑瘫下肢痉挛性瘫痪及内翻马蹄足,改善脑瘫下肢运动障碍。     

含神经生长因子壳聚糖神经导管修复大鼠坐骨神经10mm缺损

目的:研究京尼平交联的含神经生长因子的壳聚糖神经导管修复大鼠周围神经缺损的可行性。方法:利用含神经生长因子的壳聚糖神经导管桥接修复大鼠坐骨神经10mm缺损为实验组共5只,缺损组对照共5只。术后6个月行电生理学检测,并对再生神经组织和靶肌行形态学观察。结果:术后6个月,实验组术侧均能记录到复合肌动作电位,而缺损组术侧均未能记录到复合肌动作电位。抗NF-200免疫组化染色显示,实验组再生神经中段再生轴突分布密集。肌肉三色染色显示,实验组腓肠肌无明显萎缩,亦未见明显增生的胶原纤维;缺损组腓肠肌明显萎缩,同时可见大量胶原纤维增生。结论:术后6个月,京尼平交联含神经生长因子壳聚糖神经导管,能较好修复大鼠坐骨神经10mm缺损,实现靶肌神经功能的重支配。     

EXCITATORY CONNECTIONS BETWEEN SPINAL MOTONEURONS IN THE ADULT RAT

Objectives. Dendro-dendritic and dendro-somatic projections are common between spinal motoneurons. We attempted to clarify whether there are functional connections through these projections. Methods. Motoneurons were antidromically stimulated by the muscle nerve and recorded intracellularly to examine the direct interaction between them, after the related dorsal roots had been cut. Results. Excitatory connections, demonstrated by depolarizing potentials in response to muscle nerve stimulation,were found between motoneurons innervating the same muscle or synergistic muscles, but never between motoneurons in-nervating antagonistic muscles. These potentials were finely graded in response to a series of increasing stimuli and resistant to high frequency (50Hz) stimulation. Conclusions. These results indicate that excitatory connections, with certain specificity of spatial and temporal distribu-tion, occur in the spinal motoneurons. It is also suggested that electrical coupling should be involved in these connections and this mechanism should improve the excitability of the motoneurons in the same column.     

副肿瘤性周围神经病的神经电生理特点

目的 研究副肿瘤性周围神经病 (paraneoplastic peripheral neuropathy, PPN) 的神经电生理特点.方法回顾性分析2000年1月至2017年6月昆明医科大学第一附属医院神经内科住院的29例副肿瘤性周围神经病患者上下肢运动、感觉神经电生理特点.测定指标包括: (1) 正中神经、尺神经、胫神经、腓总神经运动神经传导速度、末端运动潜伏期、复合肌肉动作电位波幅; (2) 正中神经、尺神经、胫神经、腓浅神经感觉神经传导速度、感觉神经动作电位波幅; (3) 正中神经、胫神经F波.结果 (1) 副肿瘤性周围神经病患者上下肢感觉运动神经均受损, 波幅总异常率高于神经传导速度总异常率 (P<0.05) , 感觉神经动作电位波幅异常率高于运动神经复合肌肉动作电位波幅异常率 (P<0.05) , 运动神经传导速度与感觉神经传导速度异常率比较, 无统计学差异 (P>0.05) ; (2) 神经传导检测下肢异常率高于上肢 (P<0.05) ; (3) F波异常率低于神经传导检测异常率 (P<0.05) .结论 副肿瘤性周围神经病神经电生理表现为感觉运动神经病多见, 远端损害重, 下肢比上肢损害明显, 以感觉神经轴突损害为主, 运动和感觉神经脱髓鞘程度相似.分析周围神经病的神经电生理特点能为早期诊断提供客观依据.     

兔缺血后肢静脉动脉化后远端形态学及微循环的改变

目的研究静脉动脉化对兔后肢缺血形态学及微循环的影响。方法制备兔单侧后肢缺血动物模型 ,在此基础上即刻行股浅动脉近侧端与伴行股浅静脉的端侧吻合 ,完成缺血 动静脉转流模型。于实验的第 1周、第4周时 ,分别取缺血组、缺血 动静脉转流组术肢远端的腓肠肌及胫神经组织作光、电镜观察 ,并于术前、术后 4周采集转流组的股动脉、股深静脉血做血气分析。结果缺血组术肢可见跛行 ,肢体坏死 ,动物 1周后死亡。光、电镜观察显示 :转流组术后 1周肌肉、神经组织变性坏死 ;术后 4周肌肉、神经组织出现修复性改变。血气分析显示 :术前灌注动脉血和回流静脉血与术后 4周血液比较无显著性差异 (P >0 .0 5 )。结论分期静脉动脉化可使缺血肢体的组织营养、微循环得到有效改善     

选择性下肢周围神经切断术的应用解剖

目的 为下肢选择性周围神经切断术提供神经应用解剖学基础。方法 通过5例10条尸体的大体解剖和20例39条活体的坐骨神经各亚束的解剖，明确手术操作入路及其各层面的坐骨神经各亚束分布规律。结果 坐骨神经在股上部发出肌支至大收肌、半腱肌、半膜肌和股二头肌，其在臀肌下纵切口处的分布规律由内向外依次为半腱肌＋大收肌支、股二头肌长头支、半膜肌支、股二头肌短头支；胫神经在Guo窝部发出肌支到小腿三头肌和胫骨后肌，其分布规律由内向外依次为腓肠肌内侧头支、腓肠肌外侧头支、比目鱼肌远支、胫骨后肌支和比目鱼肌近支。结论 坐骨神经和胫神经内部神经束分布规律较为恒定，下肢选择性周围神经切断术可行性高，采用臀肌下纵切口和Guo窝部切口即可完成。     

H反射、F波和神经传导速度在早期诊断格林-巴利综合征中的作用

目的:分析比较H反射、F波(FW)和神经传导速度(NCV)在早期诊断格林-巴利综合征以及判断预后中三者的作用和灵敏度。方法:对44例格林-巴利综合征患者采用表面电极法常规顺向检测正中神经、尺神经、胫后神经、腓总神经和腓肠神经共141条感觉神经传导速度(SCV)及波幅、133条运动末端潜伏期(ML)及波幅;85条FW潜伏期及出现率、44条H波(HW)潜伏期及出现率。结果:共有107条神经SCV减慢或波幅降低;113条ML延长或波幅降低。55条FW潜伏期延长或出现率降低;31条HW潜伏期延长或消失。H反射、FW和NCV分别反映了神经远、近端功能状态,其检测异常程度与病情严重程度呈正相关。结论:H反射、FW和NCV在早期诊断格林-巴利综合征及了解神经远、近端受损程度从而客观评价相应病情及估价预后中具有重要作用。     

神经肌电图对坐骨神经损伤的术中应用

目的　探讨神经肌电技术在坐骨神经损伤的术中应用价值。方法　对 2 4例患者共 2 4根腓总神经和19根胫神经损伤进行术中电生理功能评价 ,研究与术前电生理诊断间差异 ,并作预后随访分析。结果　术中与术前的电生理诊断结果间存在差异。术中损伤近端存在复合肌肉动作电位 (compoundmuscleactionpotential,CMAP)和远端存在躯体感觉诱发电位 (somatosensoryevokedpotential,SEP)的损伤神经总体恢复较好。手术前后比较 ,胫神经预后较腓总神经好。结论　术中神经电生理检测能完善术前对神经受损程度的诊断 ,术中能检测到SEP和CMAP的损伤神经 ,术后能达到较好的恢复     

电刺激大鼠前列腺所致腰骶神经的电生理变化的实验研究

目的电生理方法探讨前列腺疼痛产生的神经机制.方法电刺激大鼠前列腺,记录腰骶神经的反射性的动作电位和肛门外括约肌的肌电变化.结果电刺激大鼠前列腺后,在同侧生殖股神经、髂腹股沟神经、髂腹下神经和股外侧皮神经记录到动作电位,肛门外括约肌记录到较为的恒定的复合肌肉动作电位.结论前列腺受刺激后可通过脊髓反射引起腰骶传出神经的动作电位,引起会阴、盆底肌肉的收缩而产生疼痛.