Suzuki T, Saitoh E, Tani M, Nabeta R, Daikuya S, Hirose H, Wakayama I, Fujiwara T
Research Center of Neurological Diseases, Kansai College of Oriental Medicine.
Electromyogr Clin Neurophysiol. 2002 Mar;42(2):67-70.
We experienced H-reflex may be evoked with supramaximal stimulation in patients with cerebrovascular disease (CVD). In this study, we investigated the relationship between the characteristic appearances of H-reflex and F-wave with increased stimulus intensity and neurological signs. We examined the H-reflex and F-wave of the affected arm with increased stimulus intensity during muscle relaxation in 31 patients (17 males and 14 females) with hemiparesis caused by CVD. Mean patient age was 56.0 (range 30-82) years. 30 healthy subjects, mean age of 56.2 (range 28-80) were investigated using the same method as controlled group. H-reflex and F-wave with increased stimulus intensity after the median nerve stimulation at the wrist were recorded from the opponence pollicis muscle on the affected side in patients with CVD or right arm in the healthy subjects. Appearance patterns of the H-reflex and F-wave with increased stimulus intensity was separated into four types. Type 1: F-wave appeared with increased stimulus intensity, but there was no H-reflex. Type 2: H-reflex and F-wave both appeared with increased stimulus intensity, but the F-wave followed disappearance of the H-reflex with increased stimulus intensity. Type 3: H-reflex and F-wave both appeared with increased stimulus intensity, but the F-wave appeared during the H-reflex with increased stimulus intensity. Type 4: Only the H-reflex appeared with increased stimulus intensity, but there was no F-wave. Neurological findings including muscle tone and tendon reflex were also evaluated. Findings on muscle tone and tendon reflex were classified into increased (markedly, moderately and slightly), normal and decreased. Results were analyzed as follows; 1) The characteristic appearances of H-reflex and F-wave in the healthy subjects and 2) The relationship between characteristic appearances of waves with increased stimulus intensity and neurological signs in patients with CVD. 1) Pattern of the H-reflex and F-wave with increased stimulus intensity in all healthy subjects were type 1. 2) Patterns of the H-reflex and F-wave with increased stimulus intensity in patients with markedly increased muscle tone and tendon reflex were almost always type 4. Those with moderately increased signs in this parameter demonstrated type 2 or 3. Those with slightly increased signs in this parameter demonstrated type 1 or 2. Those with normal or decreased signs were type 1. These findings suggest that the characteristic appearances of the H-reflex and F-wave was influenced by grade of neurological signs.
在脑血管疾病（CVD）患者中，我们发现用超强刺激可能诱发H反射。在本研究中，我们调查了随着刺激强度增加，H反射和F波的特征表现与神经体征之间的关系。我们对31例由CVD导致偏瘫的患者（17例男性和14例女性）在肌肉放松状态下，随着刺激强度增加检查其患侧手臂的H反射和F波。患者平均年龄为56.0岁（范围30 - 82岁）。30名健康受试者，平均年龄56.2岁（范围28 - 80岁），采用相同方法作为对照组进行研究。在CVD患者的患侧拇对掌肌或健康受试者的右侧手臂记录腕部正中神经刺激后随着刺激强度增加的H反射和F波。随着刺激强度增加，H反射和F波的表现模式分为四种类型。类型1：随着刺激强度增加F波出现，但无H反射。类型2：随着刺激强度增加H反射和F波均出现，但随着刺激强度增加F波在H反射消失后出现。类型3：随着刺激强度增加H反射和F波均出现，但随着刺激强度增加F波在H反射期间出现。类型4：随着刺激强度增加仅出现H反射，但无F波。还评估了包括肌张力和腱反射在内的神经学表现。肌张力和腱反射的表现分为增强（明显、中度和轻度）、正常和减弱。结果分析如下：1）健康受试者中H反射和F波的特征表现；2）CVD患者中随着刺激强度增加波的特征表现与神经体征之间的关系。1）所有健康受试者随着刺激强度增加H反射和F波的模式均为类型1。2）肌张力和腱反射明显增强的患者随着刺激强度增加H反射和F波的模式几乎总是类型4。该参数体征中度增加的患者表现为类型2或3。该参数体征轻度增加的患者表现为类型1或2。体征正常或减弱的患者为类型1。这些发现表明H反射和F波的特征表现受神经体征分级的影响。
