Yokota T, Matsunaga T, Okiyama R, Hirose K, Tanabe H, Furukawa T, Tsukagoshi H
Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
Brain. 1991 Jun;114 ( Pt 3):1381-94. doi: 10.1093/brain/114.3.1381.
In 28 patients with definite multiple sclerosis (MS) and 21 patients with a functionally complete transection of the spinal cord sympathetic skin responses (SSR) from both the palms and soles were studied. In the patients with a complete transection at T3 or 4, SSRs were impaired in the palms as well as the soles, and most patients with a transection at T11 or T12 had normal SSRs in the soles. These findings indicate that the central pathway mediating the SSR descends to the upper thoracic cord where connections are made with the sympathetic distribution to the palms, and then to the lower thoracic cord to reach the sympathetic outflow to the soles. This is compatible with the anatomical knowledge of the sympathetic system. Of the MS patients, 75% had abnormal SSR results. The SSR for the soles was more sensitive than that for the palms. The incidence of SSR abnormality was as high as those of somatosensory evoked potential (SEP) (79%) and visual evoked potential (VEP) (75%) abnormalities. Of the patients with normal SEPs 14% had impaired SSRs and 21% had abnormal SSR with normal VEPs. When the results of these 3 tests were combined, the abnormality increased to 100%. From our study, the SSR probably reflects not only postganglionic sympathetic activity but also preganglionic function. The SSR is therefore useful in evaluating myelopathy, providing information different from that given by assessment of the somatic nervous system. Since the SSR detected a few MS lesions which were not demonstrated by other evoked potentials, it is potentially a new tool for the detection of MS lesions in addition to conventional evoked potential studies.
对28例确诊为多发性硬化症（MS）的患者和21例脊髓功能完全横断的患者进行了手掌和脚底交感神经皮肤反应（SSR）的研究。在T3或T4水平完全横断的患者中，手掌和脚底的SSR均受损，而大多数在T11或T12水平横断的患者脚底SSR正常。这些发现表明，介导SSR的中枢通路下行至胸段脊髓上部，在此与支配手掌的交感神经建立联系，然后至胸段脊髓下部，以到达支配脚底的交感神经传出纤维。这与交感神经系统的解剖学知识相符。在MS患者中，75%的患者SSR结果异常。脚底的SSR比手掌的更敏感。SSR异常的发生率与体感诱发电位（SEP）（79%）和视觉诱发电位（VEP）（75%）异常的发生率一样高。在SEP正常的患者中，14%的患者SSR受损，21%的患者VEP正常但SSR异常。当将这三项检查的结果综合起来时，异常率增至100%。根据我们的研究，SSR可能不仅反映节后交感神经活动，还反映节前功能。因此，SSR在评估脊髓病方面很有用，可提供与躯体神经系统评估不同的信息。由于SSR检测到了一些其他诱发电位未显示的MS病变，除了传统的诱发电位研究外，它可能是检测MS病变的一种新工具。
