运动神经元病的神经电生理诊断方法探讨

目的：探讨运动神经元病（MND）诊断中神经电生理检测方法及特点。方法：对22例MND病人常规进行运动神经、感觉神经传导检测（NCS），侧重肌电图（EMG）检测四肢肌肉（特别是远端肌）及舌肌、胸锁乳突肌、T10椎旁肌，观察所检肌肉静息、轻收缩、重收缩时的变化。结果：NCS检测运动神经102条，感觉神经90条均在正常范围。EMG检测肌肉243块均表现为广泛性神经原性损害，其中：186块（22例）可见失神经电位（纤颤电位、正尖波），162块（15例）见束颤电位，144块（18例）见高波幅（≥5mV）、宽时限的巨大电位，128块（17例）重收缩时见募集电位减弱为高波幅的单纯相。EMG舌肌检测阳性率为82％；胸锁乳突肌检测阳性率为52％；T10椎旁肌检测阳性率为75％。结论：神经电生理检测指标在MND诊断中十分必要，其中EMG是诊断MND最重要的检测手段，EMG广泛性神经原性损害是MND特征性改变。束颤电位、巨大电位是诊断MND的常用指标。舌肌、胸锁乳突肌和椎旁肌在MND的诊断中具有特异性，是有价值的检查方法，舌肌和胸锁乳突肌作为必选检测肌肉可以提高诊断阳性率。舌肌与胸锁乳突肌EMG的结合诊断价值更高。

Investigation of Electroneurophysiological diagnosis method in patients with motor neuron disease

Objective：To investigate the characteristics and examination methods of electroneurophysiology in patients with motor neuron disease（MND）. Methods：Twenty-two patients with MND were detected in the conduction of motor and sensory nerves and the limb muscle（especially the distal muscle）, tongue, sternocleidomastoid and T10 paraspinal muscles with EMG. There muscle changes relaxation or the slight and grievous shrinks were observed. Results.. Nerve conduction study（NCS） showed that 102 motor nerves and 90 sensory nerves were all in normal range. Electromyography（EMG）indicated that extensive neurogenie damages were found in 243 muscles, which had been examined, of which the denervation potential（such as fibrillation potential and positive sharp wave） displayed in 186 muscles （77 %） of 22 patients the fasciculation potential was in 162 muscles（67 %） of 15 patients, moreover, and 144 muscles（59 %） of 18 patients Huge potential with high amp litude（≥ 5 mV）and long duration were in, Recruitment potential decreased to incomplete interference pattern with high amplitude during maximal voluntary contraction in 128 muscles（53 % ）of 17 patients. The positive testing rates of tongue, sternocleidomastoid and T10 paraspinal muscles were 82 %,52 % and 75 % respectively. Conclusion： The electroneurophysiological index in MND diaghosis is very necessary and the most important is EMG. Extensive neurogenie damage is the characteristic change of MND and the normal index to diagnose MND is fasciculation potential detection and huge potential detection . The dection of tongue, sternocleidomastoid muscles and paraspinal muscles are considered as worthwhile methods and can be used widely in MND diagnosis. The conbined detetion of tongue and sternocleidomastoid can increase the positove testing rate and has greater value in EMG agnosis.