Créac'h C, Convers P, Robert F, Antoine J-C, Camdessanche J-P
Service de neurologie, CHU Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France.
Rev Neurol (Paris). 2011 Jan;167(1):40-5. doi: 10.1016/j.neurol.2010.08.011. Epub 2010 Dec 28.
Standard neurophysiological techniques evaluate exclusively large myelinated fibers, but are not useful to explore sensory small fibers. Quantitative sensory tests have been developed to explore the thermal nociceptive function but this exploration is only subjective. Laser evoked potentials (LEPs) represent a noninvasive and objective test to explore thermal and nociceptive pathways. The clinical interest of LEPs have been assessed recently in the diagnosis of small fibers sensory neuropathies. In routine, the determination of detection and nociceptive thresholds, the analysis of N2P2 latencies and amplitudes enable demonstration of a dysfunction of A delta nerve fibers, to quantify these lesions and to determine whether the neuropathies are length-dependent or not. The LEP amplitude is negatively correlated to deafferentation. The interest of LEPs remained to be studied compared to skin biopsy.
标准神经生理学技术仅评估有髓大纤维,对探索感觉小纤维并无用处。定量感觉测试已被开发用于探索热痛觉功能,但这种探索只是主观的。激光诱发电位(LEP)是一种用于探索热觉和痛觉通路的非侵入性客观测试。最近已评估了LEP在小纤维感觉神经病诊断中的临床价值。在常规检查中,检测和痛觉阈值的测定、N2P2潜伏期和波幅的分析能够证实Aδ神经纤维功能障碍,量化这些病变,并确定神经病是否与长度相关。LEP波幅与去传入作用呈负相关。与皮肤活检相比,LEP的价值仍有待研究。