Magistris M R, Soichot P
Unité d'Electroneuromyographie et des affections neuromusculaires, Hôpital Universitaire de Genève, Suisse.
Rev Med Liege. 2004;59 Suppl 1:208-18.
Neuropathy may be difficult to distinguish from neuronopathy, on both motor and sensory sides. A number of disorders that present with characteristic electro-clinical features are readily recognized. Except for those, distinction of the lesions that concern the peripheral nerve cell or the axon may require support of clinical, electrophysiological and other ancillary tests. Distinction between motor neuropathy and neuronopathy can be based on the abnormalities of nerve conduction and on the signs that relate to the reinnervation process. Signs of terminal axonal reinnervation, such as motor axon reflex, may be observed in axonal neuronopathies, whereas only collateral reinnervation occurs in motor neuronopathies. Sensory axonopathies are usually characterized by clinical and electrophysiological findings that are axon length-dependent, by the course of the disorder that is most often chronic, and by possible reversibility. Sensory neuronopathies are usually subacute and induce clinical deficits that are more or less widespread to the whole body surface rather than distal. Follow-up studies disclose limited or absent recovery. A better knowledge of the structural differences of motor and sensory neurons and axons will improve our understanding and lead to the development of specific tests. Meanwhile, although some parameters and techniques should still be improved, electrophysiological and additional tests are useful to detect and to distinguish the peripheral nerve disorders that affect the nerve cell bodies and their axons.
在运动和感觉方面,神经病变可能难以与神经元病变相区分。许多具有特征性电临床特征的疾病很容易识别。除此之外,区分涉及周围神经细胞或轴突的病变可能需要临床、电生理和其他辅助检查的支持。运动神经病变和神经元病变之间的区分可以基于神经传导异常以及与神经再支配过程相关的体征。在轴索性神经元病变中可能会观察到终末轴突再支配的体征,如运动轴突反射,而在运动神经元病变中仅发生侧支再支配。感觉轴索性神经病通常具有临床和电生理表现,这些表现与轴突长度有关,病程通常为慢性,且可能具有可逆性。感觉神经元病通常为亚急性,会导致或多或少遍布全身表面而非远端的临床缺陷。随访研究显示恢复有限或无恢复。更好地了解运动和感觉神经元及轴突的结构差异将增进我们的理解,并促使开发特定的检测方法。同时,尽管一些参数和技术仍需改进,但电生理和其他检查对于检测和区分影响神经细胞体及其轴突的周围神经疾病很有用。