Pellegrinetti A, Moscato G, Siciliano G, Bonuccelli U, Orlandi G, Maritato P, Sartucci F
Department of Neuroscience, Section of Neurology, University of Pisa, Pisa, Italy.
Int J Neurosci. 2003 Oct;113(10):1353-69. doi: 10.1080/00207450390231428.
Thirteen patients with multiple system atrophy underwent multimodality neurophysiological evaluation, including sphincteric needle electromyography (EMG), sacral reflexes, pudendal nerve terminal latency, pudendal (PSEPs) and tibialis posterior nerve somatosensory evoked potentials (TPSEPs), and perineal motor evoked potentials (PMEPs). EMG revealed denervation or neurogenic changes, with reduction in spontaneous tonic activity at rest and abnormal pudendal nerve terminal latency in 10 patients (76.9%); anal reflex was delayed in 7 patients (53.8%). TPSEPs scalp responses were clearly abnormal in 4 patients (30.7%), whereas PSEPs exhibited changes in 9 (69.2%): in 6 patients responses were delayed at lumbar level (46.2%), and in 5 over the scalp (38.4%). PMEPs showed an increase in latency with a mild prolongation of central motor conduction time (CMCT) in 2 cases (15.3%); 1 patient had prolonged latencies following both cortical and sacral stimulation, but a normal CMCT. Even if diagnostic yield is not improved using these investigations they provide evidence of multiple lesion sites other than Onuf's nucleus.
13例多系统萎缩患者接受了多模态神经生理学评估，包括括约肌针电极肌电图（EMG）、骶反射、阴部神经终末潜伏期、阴部躯体感觉诱发电位（PSEPs）和胫后神经体感诱发电位（TPSEPs）以及会阴运动诱发电位（PMEPs）。肌电图显示失神经支配或神经源性改变，10例患者（76.9%）静息时自发紧张性活动减少且阴部神经终末潜伏期异常；7例患者（53.8%）肛门反射延迟。4例患者（30.7%）的TPSEPs头皮反应明显异常，而9例患者（69.2%）的PSEPs出现改变：6例患者在腰段反应延迟（46.2%），5例在头皮水平延迟（38.4%）。2例患者（15.3%）的PMEPs潜伏期延长，中枢运动传导时间（CMCT）轻度延长；1例患者在皮层和骶部刺激后潜伏期均延长，但CMCT正常。即使使用这些检查不能提高诊断率，但它们提供了除奥努夫核以外多个病变部位的证据。
