A型肉毒毒素局部注射对远隔部位F波影响的临床研究

目的观察A型肉毒毒素局部注射后远隔部位F波改变，揭示对脊髓运动神经元兴奋性的影响，探讨其机制。方法选取29例原发性痉挛性斜颈患者，应用A型肉毒毒素进行颈部肌肉注射治疗，检测和比较注射前、注射后1周和12-16周尺神经及胫神经F波的潜伏期及出现率。结果痉挛性斜颈患者A型肉毒毒素局部注射后1周及12～16周，尺神经及胫神经M波波幅、潜伏期和神经传导速度与注射前差异无统计学意义；局部注射后1周，尺神经及胫神经F波潜伏期较注射前显著延长（P〈0．05），出现率差异无统计学意义；注射后12～16周，尺神经及胫神经F波潜伏期及出现率与注射前差异无统计学意义；胫神经和尺神经F波潜伏期变化值（注射前后差值）差异元统计学意义，与A型肉毒毒素注射剂量元明显相关性。结论A型肉毒毒素局部注射存在“远隔效应”，远隔部位F波潜伏期显著延长，脊髓运动神经元兴奋性显著降低。注射部位距离及剂量不起决定作用，其发生机制复杂，可能有多因素参与。     

局部注射A型肉毒毒素后远隔部位运动神经元功能状态的改变

背景注射A型肉毒毒素后,不仅影响注射局部神经肌肉接头的功能,也可导致远隔部位的改变;F波由运动神经元逆向兴奋引起,故有可能间接评价运动神经元的功能状态.目的探讨局部注射A型肉毒毒素后远隔部位F波改变及其可能机制.设计以运动障碍性疾病患者为研究对象的自身对照观察性研究.单位一所大学医院神经科门诊.对象2002-09/2003-07就诊于武汉大学人民医院神经科门诊的未接受过A型肉毒毒素局部注射治疗的运动障碍性疾病患者26例,其中19例为偏侧面肌痉挛、5例为Meige综合征、2例为痉挛性斜颈.干预对26例患者行A型肉毒毒素注射,并在注射前、注射后1周及注射后12～24周,分别检测其尺神经及胫神经F波.主要观察指标注射A型肉毒毒素前、后F波最短潜伏期、平均潜伏期、负峰波幅、时限、出现率和弥散时值;M波潜伏期及波幅变化.结果注射1周后3例共5条尺神经未引出肯定波形.与注射前比较,尺、胫神经F波平均潜伏期及尺神经F波时限在注射后1周显著延长,且这种改变与注射剂量无关;注射后12～24周上述两参数与注射前比较,差异均无显著性意义.结论F波平均潜伏期和时限为评价A型肉毒毒素远隔效应的敏感指标;A型肉毒毒素的远隔效应似与注射部位的距离有关,而与注射剂量无关.     

局部注射A型肉毒毒素后远隔部位运动神经元功能状态的改变

背景：注射A型肉毒毒素后，不仅影响注射局部神经肌肉接头的功能，也可导致远隔部位的改变；F波由运动神经元逆向兴奋引起，故有可能间接评价运动神经元的功能状态。目的：探讨局部注射A型肉毒毒素后远隔部位F波改变及其可能机制。设计：以运动障碍性疾病患为研究对象的自身对照观察性研究。单位：一所大学医院神经科门诊。对象：2002-09／2003-07就诊于武汉大学人民医院神经科门诊的未接受过A型肉毒毒素局部注射治疗的运动障碍性疾病患26例，其中19例为偏侧面肌痉挛、5例为Meige综合征、2例为痉挛性斜颈。干预：对26例患行A型肉毒毒素注射，并在注射前、注射后1周及注射后12～24周，分别检测其尺神经及胫神经F波。主要观察指标：注射A型肉毒毒素前、后F波最短潜伏期、平均潜伏期、负峰波幅、时限、出现率和弥散时值；M波潜伏期及波幅变化。结果：注射1周后3例共5条尺神经未引出肯定波形。与注射前比较，尺、胫神经F波平均潜伏期及尺神经F波时限在注射后1周显延长，且这种改变与注射剂量无关；注射后12～24周上述两参数与注射前比较，差异均无显性意义。结论：F波平均潜伏期和时限为评价A型肉毒毒素远隔效应的敏感指标；A型肉毒毒素的远隔效应似与注射部位的距离有关，而与注射剂量无关。     

F波在糖尿病周围神经病诊断中的应用

目的：研究F波在糖尿病周围神经病（DPN）早期诊断中的应用。方法：检测53例DPN病人和32例正常人的胫神经F波最短潜伏期、时限、波幅。结果：糖尿病周围神经病患者53例，其中轻型36例，F波时限异常33例、最短潜伏期延长21例，重型17例，F波时限异常4例、最短潜伏期延长12例。结论：F波可以作为糖尿病周围神经病早期诊断的敏感指标。     

A型肉毒毒素对脑卒中患者胫神经F波和步行能力的影响

目的 探讨小腿三头肌局部A型肉毒毒素(BTX-A)注射对脑卒中患者胫神经F波和步行能力的影响.方法 选择20例脑卒中偏瘫下肢痉挛患者,按患者意愿和治疗方式的不同分为实验组和对照组,每组10例.所有患者均接受为期4周的步行训练、平衡训练、肌力训练等常规康复治疗;在康复治疗前,实验组在电刺激引导下接受患侧下肢腓肠肌和比目鱼肌BTX-A注射治疗,总剂量300 IU,BTX-A注射只进行1次.选择患侧下肢胫神经行F波检测,使用改良式Ashworth量表评定肌张力,起立步行测试和10 m自由步行测试评价患者步行能力,并进行统计学分析比较.结果 ①治疗前,实验组和对照组的胫神经F波波幅分别为(387.8±48.7)μV和(375.6±56.6)μV,2组的F/M值分别为(31.4±5.6)％和(28.6±5.4)％,2组间差异均无统计学意义(P＞0.05);实验组患者治疗2周后的胫神经F波波幅和F/M值均较治疗前明显降低(P＜0.05),而对照组下降不明显(P＞0.05);治疗2周后和治疗4周后,2组间同时间点的比较,差异有统计学意义(P＜0.05).②治疗前,实验组与对照组患者小腿三头肌肌张力评分分别为(3.76±0.67)分和(3.86±0.54)分,2组间差异无统计学意义(P＞0.05);治疗4周后,实验组患者小腿三头肌肌张力评分为(1.87±0.87)分,较治疗前明显下降(P＜0.05),而对照组患者小腿三头肌肌张力评分为(3.36±0.87)分,较治疗前略有下降(P＞0.05),但2组间同时间点比较,差异有统计学意义(P＜0.05).③治疗前,实验组和对照组的TUG测试时间分别为(45.6 ±7.5)s和(46.4±8.9)s,2组患者10 m自由步行测试时间分别为(44.6±8.4)s和(43.8 ±9.1)s,组间差异无统计学意义(P＞0.05);治疗4周后,实验组患者的TUG和10 m自由步行测试时间分别为(24.1±10.3)s和(24.5±9.8)s,较治疗前明显减少(P＜0.05),而对照组减少不明显(P＞0.05);治疗4周后,实验组患者的TUG和10 m自由步行测试时间与对照组同时间点比较,差异有统计学意义(P＜0.05).结论 下肢局部注射肉毒毒素(BTX)可降低相应脊髓节段运动神经元的F波波幅,BTX注射结合康复训练治疗可以显著提高患者的步行能力.     

三维曲度牵引治疗神经根型颈椎病的肌电图分析

目的:观察三维曲度牵引治疗对神经根型颈椎病患者肌电图F波传导速度及潜伏期的影响。方法:将96例神经根型颈椎病患者按随机分为2组各48例。研究组给予颈椎三维曲度牵引仪进行三维曲度牵引治疗,对照组给予颌枕带牵引治疗。比较2组患者治疗前后正中神经和尺神经F波传导速度及潜伏期。结果:2组治疗后正中神经和尺神经的F波传导速度均较治疗前加快(均P0.05),且F波的潜伏期均缩短(均P0.05),治疗后研究组正中神经和尺神经的F波传导速度及潜伏期较对照组改变更加显著(均P0.05)。结论:三维曲度牵引治疗神经根型颈椎病疗效优于颌枕带牵引,是一种值得推广的治疗方法。     

肯定型肌萎缩性侧索硬化症的运动神经传导速度和F波改变特点及其影响因素

目的 观察肯定型肌萎缩性侧索硬化症(definite amyotrophic lateral sclerosis，DALS)的运动神经传导速度(motor neuron conduction velocity，MCV)和F波改变特点，以及病情和病程对MCV和F波的影响。方法 对46例肯定型ALS患者和正常对照组的：MCV和F波进行测定。结果 患者组正中神经、尺神经、胫神经和腓深神经的末端运动潜伏期(distal motor latency，DML)明显延长。F波的出现率、近端段／中枢潜伏期和左右往返脊髓的近端段／中枢潜伏期的差值与对照组比较差异均有显著性意义。患者重度组4条神经的DML显著延长，MCV明显减慢和波幅明显降低，重度组正中神经和尺神经的DML、MCV和波幅与轻度组比较差异也有显著性意义。随访患者组3年，其运动神经传导速度和F波检查结果经配对方差检验，差异均有显著性意义。结论 MCV和F波可作为ALS电生理诊断的一项有价值的检查,其异常程度与病情和病程有关。     

F波在评定糖尿病周围神经病变中的价值(英文)

目的探讨F波在糖尿病周围神经病(diabeticperipheralneu-ropathy,DPN)中的诊断价值。方法测定106例糖尿病(diabetesmel-litus,DM)患者和75名正常人下肢F波最短潜伏期、时限、波幅和面积,以及M波波幅和面积。结果无神经病变的DM患者30例,F波时限增宽8例,F波最短潜伏期延长4例,F/M波面积增大2例。有神经病变的DM患者76例,F波最短潜伏期均延长;F/M波波幅和F/M波面积增大;F波时限在轻型DPN患者中增宽,在重型DPN患者中未见明显异常。正常人F波最短潜伏期上限(Y)与腿长(X)的函数关系为Y=12.3+48.8X2。结论F波可作为早期诊断DPN的敏感指标,并可发现亚临床DPN。DPN患者的近、远端神经节段均可受累,近端神经损害可早于并重于远端神经。     

青少年特发性脊柱侧凸症神经传导速度的变化

目的:探讨青少年特发性脊柱侧凸症(AIS)的外周神经传导功能及特点。方法:纳入AIS患者16例,进行神经传导检测。结果:AIS患者治疗前的正中神经、尺神经、胫神经、腓总神经动作电位潜伏期、波幅、近端神经电位F波引出率、H/M比率与正常值相比均有神经营养障碍改变,差异有统计学意义(P<0.05)。结论:神经传导检查可明显提高AIS患者周围神经损伤的早期诊断率。     

F波在评定糖尿病周围神经病变中的价值

目的 探讨F波在糖尿病周围神经病（diabetic peripheral neu-rupathy,DPN)中的诊断价值。方法 测定106例糖尿病（diabetes mel-litus,DM）患和75名正常人下肢F波最短潜伏期、时限、波幅和面积，以及M波波幅和面积。结果 无神经病变的DM患30例，F波时限增宽8例，F波最短潜伏期延长4例，F/M波面积增大2例。有神经病变的DM患76例，F波最短潜伏期均延长；F/M波波幅和F/M波面积增大；F波时限在轻型DPN患中增宽，在重型DPN患中未见明显异常。正常人F波最短潜伏期上限（Y）与腿长（X）的函数关系为Y=12.3-48.8X^2。结论 F波可作为早期诊断DPN的敏感指标，并可发现亚临床DPN。DPN患的近、远端神经节段均可受累，近端神经损害可早于并重于远端神经。     

Repeatability of Nerve conduction Measurements using Automation

Objective

To quantify nerve conduction study (NCS) reproducibility utilizing an automated NCS system (NC-stat^®, NeuroMetrix, Inc.).

Method

Healthy volunteers without neuropathic symptoms participated in the study. Their median, ulnar, peroneal, and tibial nerves were tested twice (7 days apart) by the same technician with an NC-stat^® instrument. Pre-fabricated electrode arrays specific to each nerve were used. Both motor responses (compound motor action potential [CMAP] and F-waves –all nerves) and sensory responses (sensory nerve action potentials [SNAP] –median and ulnar nerves only) were recorded following supramaximal stimuli. Automated algorithms determined all NCS parameters: distal motor latency (DML), mean F-wave latency (FWL), distal sensory latency (DSL), CMAP amplitude, and SNAP amplitude. Latency was adjusted for skin temperature deviation from reference. Pearson correlation coefficient (CC), intraclass correlation coefficient (ICC), coefficient of variance (CoV), and relative intertrial variation (RIV) were calculated.

Results

Fifteen subjects participated in either upper or lower extremity studies with nine participating in both. With the exception of CMAP amplitude, all parameters had CoV less than 0.06. Upper extremity amplitude parameters had CCs greater than 0.85. CCs for latencies were greater than 0.80 except for the median nerve FWL (CC = 0.69). For lower extremity nerves, ICCs were highest for mean FWL (>0.90), followed by DML (>0.82) and then CMAP (peroneal 0.33, tibial 0.73). The 10th to 90th RIV percentiles were bounded by ±7% for F-wave latencies;?±9% for all DSLs; and?±11% for DML (except peroneal at 15%).

Conclusions

The reproducibility of NCS parameters obtained with an automated NCS instrument compared favorably with traditional electromyography laboratories. F-wave latencies had the highest repeatability, followed by DML, DSL, SNAP and CMAP amplitude. Given their high reproducibility, automated NCS instrument may encourage wider utilization of NCS in clinical and research applications.     

彩超水囊引导下A型肉毒毒素注射治疗面肌痉挛的临床疗效

目的:探讨彩超水囊引导下肉毒毒素注射治疗面肌痉挛的疗效。方法:面肌痉挛患者96例,随机分为A、B组各48例,A组给予口服药物6个月,B组给予彩超水囊引导下局部注射A型肉毒毒素(BTX-A)。治疗前后分别采用Cohen、Acbert痉挛强度分级评估疗效,观察2组疗效、持续时间、显效率和治疗前后肌痉挛强度及变化情况。结果:A组治疗后肌痉挛强度变化无统计学差异,B组治疗后肌痉挛强度变化有显著性差异(P<0.01),且显效率高于A组(P<0.01)。结论:彩超水囊引导下BTX-A注射治疗能显著降低面肌痉挛的肌张力,且安全、简单易行。     

Gait improvement by low-dose botulinum toxin A injection treatment of the lower limbs in subacute stroke patients

[Purpose] Lower-limb spasticity after stroke may be associated with worse functional outcome. Our study aim was to establish whether a low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients can improve spasticity, gait, and daily living abilities. [Subjects] Twenty-three subacute stroke patients were randomly allocated to BTX-A treatment group (11 patients) and control group (12 patients). [Methods] In the BTX-A treatment group patients, 200 units BTX-A was injected into the triceps surae (150 iu) and posterior tibial (50 iu) by electrical stimulation-guided. The patients in the control group received the same volume of placebo solution into the same injection locations. Gait analysis (step length, cadence, speed), the 6-min walking test, Fugl-Meyer Assessment (FMA) of the lower limbs, modified Ashworth scale assess (MAS) assessment of the lower limbs, surface electromyography (sEMG), and modified Barthel index (MBI) assessment were performed before and at 4,8 weeks after treatment. [Results] We found that the FMA of the low limbs and MBI were significantly improved in both groups. The gait analysis, FMA, and MBI results in the BTX-A treatment group were better than those in the control group. MAS and surface electromyography (sEMG) showed better improvement of spasticity in the treatment group. [Conclusion] Early low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients into the lower-limb may improve gait, spasticity, and daily living abilities.Key words: Botulinum toxin A, Stroke, Spasticity     

超声引导联合电刺激定位注射肉毒毒素治疗脑卒中后上肢痉挛

目的评价超声引导联合电刺激定位注射肉毒毒素(BTX-A)治疗脑卒中后上肢肌痉挛的效果。方法选择脑卒中上肢痉挛患者23例,在超声引导联合电刺激定位引导下,多点注射法将BTX-A注入靶肌。注射后进行常规康复训练。注射前、注射后1、2、4、12周分别采用改良Ashworth评分、腕指关节主动活动度测量、Fug1-Meyer评估表对上肢部分进行疗效评价。结果注射BTX-A后,患者肌张力、腕指关节主动活动度、Fug1-Meyer评估表上肢部分评分均较注射前明显改善(P均<0.05)。结论超声引导联合电刺激定位注射BTX-A治疗脑卒中后上肢肌痉挛,定位准确,治疗效果明显。     

磁刺激对脊髓前角细胞兴奋性的影响

背景F波是末梢神经接受最大电刺激,从肌肉诱发出来的后期合成活动电位之一,是脊髓运动神经元突触后电位的反映,对F波的研究已经被作为衡量脊髓运动神经元兴奋性的一种手段.但F波具有低波幅和出现不稳定的特点,如何使F波的出现更加稳定和明显且又不影响F波的最短潜伏期是神经电生理研究的方向.目的了解枕骨粗隆处磁刺激对F波的影响,更进一步了解人类中枢神经系统对脊髓前角运动细胞兴奋性的影响.设计自身对照实验.单位广西医科大学第一附属医院神经内科,日本熊本机能医院.对象选择2000-03/2001-03日本熊本机能医院的工作人员13名,男6名,女7名,年龄20～54岁,均排除神经系统疾病史,体内无植入金属体.方法枕骨粗隆上或稍低处使用8字形磁刺激头进行磁刺激,右腕关节尺神经上进行电刺激,在右手的第一骨间肌记录肌电活动,每一个受试者均分别记录磁刺激前、磁刺激后间隔30,50,100和300 ms时电刺激的F波,每一个实验条件下记录10个F波.主要观察指标①M波的波幅.②F波平均波幅与M波波幅比.③F波最大波幅与M波波幅比.④F波最小潜伏期.⑤F波平均持续时间.⑥F波出现频率(F 波波幅≥0.05 mV).结果13名健康自愿者的实验数据均进入结果分析.磁-电刺激间隔50 ms时F波平均持续时间出现极显著性延长[(8.39±1.59),(6.75±1.62)ms,P＜0.001];F平均/M波幅出现极显著性升高[1.73±1.20,0.87±0.78,P＜0.001];F最大/M波幅出现显著性升高[4.07±2.59,2.19±1.76,P＜0.05];F波出现频率出现极显著性升高[(80.77±22.89),(61.82±23.16)%,P＜0.001];在磁-电刺激间隔100 ms亦出现显著性升高(P＜0.05).在整个实验过程中,任何实验条件下都没有观察到F波最短潜伏期有显著性改变(P＞0.05).结论枕骨粗隆处磁刺激明显改变了脊髓前角细胞兴奋性,表现为当枕骨粗隆处施行的磁刺激和腕关节处尺神经电刺激间隔一定的时间时,F波波幅增高,时程延长.同时还发现无论在任何实验条件下,F波最短潜伏期都没有明显的变化.     

Averaged axillary F-loop latency of median and ulnar nerves

Axillary F-loop latencies (AFLL) were measured on median and ulnar nerves of 54 normal volunteers. The median and ulnar nerves were stimulated at the wrist and at the axilla 25cm distal to the sternal notch. The compound muscle action potentials were recorded from thenar and hypothenar muscles. Averaged tracings from 32 consecutive stimuli at the wrist were obtained. The averaged F-wave latencies were measured to the peak (Fwp) of the averaged F-wave. The M-wave latencies from wrist and axilla stimulation were measured to the onset of the wave (Mw and Ma, respectively). The averaged AFLL (a-AFLL) was calculated as (Fwp + Mw)-2 Ma. The average values of a-AFLL were 14.12 +/- 0.88msec for median nerve, and 13.97 +/- 0.90msec for ulnar nerve. There was no significant difference between male and female subjects, nor between the right and left sides. Seven subjects with EMG evidence of C8 or C8 to T1 radiculopathy, although manifesting normal AFLL gauged by the regular method (ie, measured to the onset of the shortest F-wave latency among eight tracings), had significantly longer "averaged AFLL" in both median and ulnar nerves of the affected side than the a-AFLL obtained from the normal side. It is concluded that the a-AFLL is a more sensitive measure than the "regular AFLL" in the assessment of proximal nerve lesion (especially C8 or C8 to T1 radiculopathy).     

Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

Several clinical trials suggest that botulinum toxin type-A (BTX-A) may be an effective treatment option for patients with chronic tension-type headache (CTTH); however, controversy remains as to how the botulinum toxin optimally should be used for treating headache and which patient's profile fits this treatment. The objective of this study was to evaluate the efficacy and tolerability of BTX-A for the prophylactic treatment of CCTH in Egyptian patients. This was a randomized, single-blind, placebo-controlled study of BTX-A for the treatment of patients aged 25–50 years old with CCTH. Following a 30-day screening, headache parameters and severity assessed by the standard visual analogue scale (VAS), and the 25-item Henry Ford Hospital Headache Disability Inventory (HDI) were recorded as a baseline. Then, injection was done with either BTX-A or with saline by a combination of two methods for detecting injection sites (the fixed-site approach and follow-the-pain approach). Our study showed significant improvement after 1 month of BTX-A injection regarding headache days/month, severity measured by VAS and HDI in headache severity. There was significant reduction of prophylactic medications, and there were minor complications, but these reversed spontaneously without further treatment. BTX-A was an effective and well-tolerated prophylactic treatment in Egyptian patients with CCTH.     

A型肉毒素局部注射对脑卒中后痉挛性上肢功能障碍的影响

目的评估A型肉毒毒素(BTX-A)局部注射对脑卒中后痉挛性腕及手功能障碍的影响。方法 36例患者于治疗前及治疗后1周、4周、8周和12周应用改良Ashworth量表(MAS)、Carroll上肢功能试验(UEFT)、肢体静息位置、疼痛视觉模拟评分(VAS)、改良Barthel指数(MBI)、上肢3个运动任务(清洗偏瘫侧的手掌、剪患侧手指甲、将患侧的手臂伸进袖子)中遇到的困难进行评估。结果治疗后,MAS、VAS、UEFT评分和3个上肢任务完成情况均有改善(P<0.05),改善于注射后1周出现,并至少维持12周。MBI与治疗前比较无显著性差异(P>0.05)。结论 BTX-A局部注射可以改善脑卒中后痉挛性上肢功能障碍,减轻疼痛。