Department of Pediatric Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Pediatr Neurol. 2012 Oct;47(4):270-8. doi: 10.1016/j.pediatrneurol.2012.06.010.
We aimed to disentangle the proportional contributions of upper and lower motor neuron dysfunction to motor impairment in children with spina bifida. We enrolled 42 children (mean age, 11.2 years; standard deviation, 2.8 years) with spina bifida and 36 control children (mean age, 11.4 years; standard deviation, 2.6 years). Motor impairment was graded to severity scales in children with spina bifida. We recorded motor evoked potentials after transcranial and lumbosacral magnetic stimulation and compound muscle action potentials after electric nerve stimulation. Regarding lower motor neuron function, severely impaired children with spina bifida demonstrated smaller compound muscle action potential areas and lumbosacral motor evoked potential areas than control children; mildly impaired children hardly differed from control children. Compound muscle action potential latencies and lumbosacral motor evoked potential latencies did not differ between children with spina bifida and control children. Regarding upper motor neuron function, children with spina bifida demonstrated smaller transcranial motor evoked potential areas and longer central motor conduction times than control children. The smallest motor evoked potential areas and longest central motor conduction times were observed in severely impaired children. In children with spina bifida, the contribution of upper motor neuron dysfunction to motor impairment is more considerable than expected from clinical neurologic examination.
我们旨在厘清上运动神经元和下运动神经元功能障碍对脊膜膨出患儿运动障碍的相对贡献。我们纳入了 42 名脊膜膨出患儿（平均年龄 11.2 岁，标准差 2.8 岁）和 36 名对照儿童（平均年龄 11.4 岁，标准差 2.6 岁）。脊膜膨出患儿的运动障碍按严重程度分级。我们记录了经颅和腰骶部磁刺激后的运动诱发电位和电神经刺激后的复合肌肉动作电位。在下运动神经元功能方面，严重受损的脊膜膨出患儿的复合肌肉动作电位面积和腰骶部运动诱发电位面积明显小于对照组儿童；轻度受损的患儿与对照组儿童几乎没有差异。复合肌肉动作电位潜伏期和腰骶部运动诱发电位潜伏期在脊膜膨出患儿和对照组儿童之间无差异。在上运动神经元功能方面，脊膜膨出患儿的经颅运动诱发电位面积明显小于对照组儿童，且中枢运动传导时间明显延长。严重受损的患儿的运动诱发电位面积最小，中枢运动传导时间最长。在脊膜膨出患儿中，上运动神经元功能障碍对运动障碍的贡献比临床神经检查所预期的更为显著。
