Xu Ying-Sheng, Zheng Ju-Yang, Zhang Shuo, Fan Dong-Sheng
Department of Neurology, Peking University Third Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2012 Feb 21;92(7):456-9. doi: 10.3760/cma.j.issn.00376-2491-2012.07.007.
To detect the conduction block (CB) between nerve root and Erb's point by triple stimulation technique (TST) in patients with multifocal motor neuropathy (MMN).
The subjects were recruited from Peking University Third Hospital during the period of April 2010 to April 2011. Twelve MMN patients, 30 healthy subjects, 30 patients with cubital tunnel syndrome and 30 patients with amyotrophic lateral sclerosis (ALS) underwent TST along with clinical assessments and nerve conduction studies. TST combined transcranial magnetic stimulation (TMS) of motor cortex with peripheral collision studies. The results were expressed by the TST amplitude ratio. And the conduction block was judged by TST amplitude ratio or the amplitude ratio of compound muscle action potential (CMAP).
The TST amplitude ratio of healthy volunteers was 93.0% ± 2.7%. And it was 42.3% ± 7.1% in patients with MMN indicating a proximal CB. There were 47 CBs in distal segments by routine nerve conduction study. Compared with the baseline levels, the patients with definite MMN increased (χ(2) = 6.31, P < 0.05). The TST amplitude ratio (30.5% ± 4.8%) of those with ALS indicated the lesion of pyramid tract (t = 2.43, P < 0.05). And the TST amplitude ratio (92.2% ± 2.6%) of those with cubital tunnel syndrome was normal (t = 0.68, P > 0.05) while the nerve conduction velocity of cubital tunnel syndrome patients (below elbow-above elbow) was slower ((23.6 ± 3.5) m/s) (t = 2.00, P < 0.05).
TST may be used to detect proximal CB and facilitate the diagnosis of MMN.
采用三重刺激技术（TST）检测多灶性运动神经病（MMN）患者神经根与臂丛神经点之间的传导阻滞（CB）。
研究对象于2010年4月至2011年4月期间招募自北京大学第三医院。12例MMN患者、30例健康受试者、30例肘管综合征患者和30例肌萎缩侧索硬化症（ALS）患者接受了TST检查以及临床评估和神经传导研究。TST结合运动皮层的经颅磁刺激（TMS）与外周碰撞研究。结果以TST振幅比表示。并通过TST振幅比或复合肌肉动作电位（CMAP）的振幅比判断传导阻滞。
健康志愿者的TST振幅比为93.0%±2.7%。MMN患者为42.3%±7.1%，提示近端CB。常规神经传导研究显示远端节段有47处CB。与基线水平相比，确诊MMN患者的CB增加（χ(2)=6.31，P<0.05）。ALS患者的TST振幅比（30.5%±4.8%）提示锥体束病变（t=2.43，P<0.05）。肘管综合征患者的TST振幅比（92.2%±2.6%）正常（t= .68，P>0.05），而肘管综合征患者的神经传导速度（肘下-肘上）较慢（(23.6±3.5)m/s）（t=2.00，P<0.05）。
TST可用于检测近端CB并有助于MMN的诊断。
