van Kuijk Annette A, Pasman Jaco W, Hendricks Henk T, Schelhaas Jurgen H, Zwarts Machiel J, Geurts Alexander C
Department of Rehabilitation Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
J Clin Neurophysiol. 2007 Dec;24(6):450-5. doi: 10.1097/WNP.0b013e3181590371.
The primary goal of this study was to identify secondary functional changes in the peripheral motor units of the paretic upper extremity (UE) in patients with severe ischemic stroke and to determine how these changes develop during the first weeks after stroke. An inception cohort of 27 consecutive patients with an acute ischemic supratentorial stroke and an initial UE paralysis was compared with 10 healthy control subjects. The ulnar nerve was electrically stimulated proximal to the wrist and electromyographic recordings were obtained from the abductor digiti minimi muscle. Hemiparetic side mean values of the compound muscle action potential (CMAP) 1 and 3 weeks after stroke were compared with the nonparetic side and with CMAP values obtained from healthy control subjects. The mean CMAP amplitude in patients was significantly lower on the paretic side compared with the nonparetic side and with control subjects. Decrease in CMAP amplitude was observed in more than half of the stroke patients, sometimes as early as 4 days after stroke, and persisted in most cases. Whenever present, it was accompanied by absence of motor recovery at that specific time after stroke. Decreased CMAP amplitude in the abductor digiti minimi muscle can be seen already in the very acute phases after stroke unrelated to peripheral neuropathy, radiculopathy, or plexopathy, and it is accompanied by absence of UMN recovery. This knowledge is important for interpreting electrophysiological data in stroke patients.
本研究的主要目标是确定重度缺血性脑卒中患者患侧上肢周围运动单位的继发性功能变化，并确定这些变化在卒中后的最初几周内如何发展。将27例连续性急性幕上缺血性脑卒中且最初存在上肢麻痹的患者起始队列与10名健康对照者进行比较。在腕部近端对尺神经进行电刺激，并从小指展肌获取肌电图记录。将卒中后1周和3周时患侧的复合肌肉动作电位（CMAP）均值与非患侧以及健康对照者的CMAP值进行比较。与非患侧和对照者相比，患者患侧的CMAP平均波幅显著降低。超过半数的卒中患者出现CMAP波幅降低，有时早在卒中后4天即出现，且在大多数情况下持续存在。一旦出现，在卒中后的特定时间就会伴有运动功能未恢复。卒中后极急性期，在与周围神经病、神经根病或臂丛神经病无关的情况下，即可见小指展肌CMAP波幅降低，且伴有上运动神经元恢复缺失。这一认识对于解读卒中患者的电生理数据很重要。
