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背景:运动神经元病的最早及好发部位为颈膨大,随病情发展,最早累及邻近的上部颈段及延髓区,三叉神经-颈反射受累较早。目的:建立三叉神经-颈反射的肌电检测方法,分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。设计:病例-对照观察。单位:北京大学第三医院神经内科电生理检查室。对象:北京大学第三医院2002/2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙ElEscorial会议诊断标准。方法:受检测者取仰卧位,头部轻度抬高。使胸锁乳突肌轻度收缩。刺激一侧眶下神经,于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag/Agcl表面电极。主要观察指标:正/负波潜伏期(P20/N30),波幅比率的平方根,即A值。结果:刺激对照者一侧的眶下神经,可于双侧胸锁乳突肌引出正/负波。运动神经元病组7例正常(23.3%),8例未引出(26.7%),11例潜伏期延长(36.7%),4例双侧反射超常不对称(13.3%)。运动神经元病组三叉神经-颈反射正波/负波的峰潜伏期(P20/N30)明显高于正常对照组,差异有显著性。波幅比的平方根(峰值与刺激前波幅比值的平方根即A值)明显低于正常对照组,差异有显著性。结论:三叉神经-颈反射能够可靠测定,可作为颈-球区病变的一种辅助检查手段,有助于运动神经元病的早期诊断。
Background: The earliest and most frequent site of motor neuron disease is neck enlargement. As the disease progresses, the earliest involvement of the upper cervical and medullary regions is earlier than that of the trigeminal nerve-neck reflex. OBJECTIVE: To establish a method for the detection of trigeminal nerve-neck reflexes and to analyze the diagnostic value of trigeminal nerve-neck reflex in the damage of the spondylolisthesis of motor neurons. Design: Case-control observation. Unit: Peking University Third Hospital Department of Neurology electrophysiology examination room. PARTICIPANTS: 30 patients with amyotrophic lateral sclerosis and 70 healthy volunteers were enrolled in the Department of Motor Neuron Disease, Peking University Third Hospital 2002/2005. Patients with motor neuron disease meet the diagnostic criteria of the El Escorial conference in Spain. Methods: Subjects were supine position, head slightly elevated. Mild sternocleidomastoid muscle contraction. Stimulation of one side of the infraorbital nerve in the bilateral sternocleidomastoid record peak latency and amplitude. The test instrument used is Keypoint EMG. The electrodes used are Ag / Agcl surface electrodes. MAIN OUTCOME MEASURES: Positive / negative latencies (P20 / N30), square root of amplitude ratio, ie, A value. RESULTS: The infraorbital nerve on the side of the stimulus control led to positive / negative waves on bilateral sternocleidomastoid muscle. Seven cases of motor neuron disease group were normal (23.3%), 8 cases were not induced (26.7%), 11 cases were prolonged (36.7%) and 4 cases were bilateral asymmetric asymmetry (13.3%). Motor neuron disease group trigeminal nerve - neck reflex positive / negative peak latency (P20 / N30) was significantly higher than the normal control group, the difference was significant. The square root of the amplitude ratio (the square root of the ratio between the peak value and the amplitude before stimulation) was significantly lower than that of the normal control group, the difference was significant. CONCLUSION: Trigeminal nerve-neck reflex can be reliably measured and can be used as an auxiliary examination for cervical-ball lesions, which is helpful for the early diagnosis of motor neuron disease.