[肌萎缩侧索硬化症患者多点刺激与递增刺激的比较]

[Comparison of multiple point stimulation and incremental stimulation in patients with amyotrophic lateral sclerosis].

作者信息

Xu Ying-sheng, Zheng Ju-yang, Zhang Shuo, Song Hong-song, Zhang Jun, Fan Dong-sheng

机构信息

Department of Neurology, Peking University Third Hospital, Beijing, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Nov 24;89(43):3051-4.

PMID:20137632

Abstract

OBJECTIVE

To compare two common techniques for motor unit number estimation (MUNE), multiple point stimulation and incremental stimulation to determine which is preferable in patients with amyotrophic lateral sclerosis (ALS).

METHODS

Surface recorded motor unit action potentials of median nerve or thenar muscle were measured in 60 ALS patients and 60 controls. The maximal baseline to negative peak compound muscle action potential (CMAP) amplitude was recorded. For multiple point stimulation, the stimuli sites included the skin of wrist, 6 cm above the wrist, elbow and 6 cm above the elbow. Individual motor unit responses were obtained by moving the stimulating electrode and isolating threshold responses with distinct morphologies. Then, with finely graded stimulus intensity at one point, 3 steps in a CMAP were investigated. 10 - 12 different single motor unit action potentials (SMUPs) were recorded. For incremental stimulation, stimulus intensity was slowly increased from subthreshold levels until a small all-or-none response was evoked. The intensity was slowly increased until the response increased in a quantal fashion. This process was repeated for a total of 10 increments. Individual motor unit amplitudes were obtained by subtracting amplitudes of each response from that of prior response. Both techniques were performed twice, electrodes changed and results averaged.

RESULTS

For controls, MUNE was 228 +/- 30 for multiple point stimulation and 198 +/- 26 for incremental stimulation. Test-retest correlation coefficients and coefficients of variation for mean of two MUNE were 0.88 - 0.91 and 13.20% - 15.24% for multiple point stimulation, 0.86 and 13.30% - 15.65% for incremental stimulation. For ALS patients, MUNE was 64 +/- 6 and 59 +/- 7 respectively.

CONCLUSION

Both MUNE methods are similarly reproducible and are equally effective at documenting progression of a lower motor neuron disorder in ALS patients.

摘要

目的

比较两种常用的运动单位数量估计（MUNE）技术，即多点刺激和递增刺激，以确定哪种技术更适用于肌萎缩侧索硬化症（ALS）患者。

方法

对60例ALS患者和60例对照者测量正中神经或鱼际肌的表面记录运动单位动作电位。记录最大基线至负峰复合肌肉动作电位（CMAP）幅度。对于多点刺激，刺激部位包括腕部皮肤、腕部上方6 cm处、肘部及肘部上方6 cm处。通过移动刺激电极并分离具有不同形态的阈下反应来获得单个运动单位反应。然后，在一点处以精细分级的刺激强度，研究CMAP中的3个步骤。记录10 - 12个不同的单个运动单位动作电位（SMUPs）。对于递增刺激，刺激强度从阈下水平缓慢增加，直到诱发一个小的全或无反应。强度缓慢增加，直到反应以量子方式增加。此过程总共重复10次递增。通过将每个反应的幅度从前一个反应的幅度中减去来获得单个运动单位幅度。两种技术均进行两次，更换电极并将结果取平均值。