Magnano Immacolata, Pes Giovanni Mario, Pilurzi Giovanna, Cabboi Maria Paola, Ginatempo Francesca, Giaconi Elena, Tolu Eusebio, Achene Antonio, Salis Antonio, Rothwell John C, Conti Maurizio, Deriu Franca
Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
Department of Biomedical Sciences, University of Sassari, Italy.
Clin Neurophysiol. 2014 Nov;125(11):2286-2296. doi: 10.1016/j.clinph.2014.03.016. Epub 2014 Mar 25.
To investigate vestibulo-masseteric (VMR), acoustic-masseteric (AMR), vestibulo-collic (VCR) and trigemino-collic (TCR) reflexes in patients with multiple sclerosis (MS); to relate abnormalities of brainstem reflexes (BSRs) to multimodal evoked potentials (EPs), clinical and Magnetic Resonance Imaging (MRI) findings.
Click-evoked VMR, AMR and VCR were recorded from active masseter and sternocleidomastoid muscles, respectively; TCR was recorded from active sternocleidomastoid muscles, following electrical stimulation of the infraorbital nerve. EPs and MRI were performed with standard techniques.
Frequencies of abnormal BSRs were: VMR 62.1%, AMR 55.1%, VCR 25.9%, TCR 58.6%. Brainstem dysfunction was identified by these tests, combined into a four-reflex battery, in 86.9% of cases, by EPs in 82.7%, MRI in 71.7% and clinical examination in 37.7% of cases. The sensitivity of paired BSRs/EPs (93.3%) was significantly higher than combined MRI/clinical testing (70%) in patients with disease duration ⩽6.4years. BSR alterations significantly correlated with clinical, EP and MRI findings.
The four-BSR battery effectively increases the performance of standard EPs in early detection of brainstem impairment, otherwise undetected by clinical examination and neuroimaging.
Multiple BSR assessment usefully supplements conventional testing and monitoring of brainstem function in MS, especially in newly diagnosed patients.
研究多发性硬化症（MS）患者的前庭-咬肌反射（VMR）、听觉-咬肌反射（AMR）、前庭-颈反射（VCR）和三叉神经-颈反射（TCR）；将脑干反射（BSR）异常与多模式诱发电位（EP）、临床及磁共振成像（MRI）结果相关联。
分别从主动收缩的咬肌和胸锁乳突肌记录点击诱发的VMR、AMR和VCR；在眶下神经电刺激后，从主动收缩的胸锁乳突肌记录TCR。采用标准技术进行EP和MRI检查。
异常BSR的发生率分别为：VMR 62.1%，AMR 55.1%，VCR 25.9%，TCR 58.6%。通过将这四项反射组合成一个反射组进行检测，在86.9%的病例中发现脑干功能障碍，通过EP检测出的比例为82.7%，MRI为71.7%，临床检查为37.7%。在病程≤6.4年的患者中，配对的BSR/EP的敏感性（93.3%）显著高于MRI/临床联合检测（70%）。BSR改变与临床、EP和MRI结果显著相关。
四项BSR组合能有效提高标准EP在早期检测脑干损伤方面的性能，而脑干损伤在临床检查和神经影像学检查中可能无法被发现。
多项BSR评估对MS患者脑干功能的传统检测和监测有有益补充，尤其是在新诊断患者中。
