Fang Jia, Cui Liying, Liu Mingsheng, Guan Yuzhou, Li Xiaoguang, Li Dawei, Cui Bo, Shen Dongchao, Ding Qingyun
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China; Neuroscience Center, Chinese Academy of Medical SciencesBeijing, China.
Front Hum Neurosci. 2016 Mar 7;10:99. doi: 10.3389/fnhum.2016.00099. eCollection 2016.
This study aimed to determine differences in spinal motoneuron dysfunction between the abductor pollicis brevis (APB) and the abductor digiti minimi (ADM) in amyotrophic lateral sclerosis (ALS) patients based on studying F-waves. Forty ALS patients and 20 normal controls (NCs) underwent motor nerve conduction studies on both median and ulnar nerves, including F-waves elicited by 100 electrical stimuli. The F-wave persistence (P < 0.05), index repeating neuron (RN; P < 0.001), and index repeater F-waves (Freps; P < 0.001) significantly differed between the APB and the ADM in the NC participants. For the hands of the ALS patients that lacked detectable wasting or weakness and exhibited either no or mild impairment of discrete finger movements, significantly reduced F-wave persistence (P < 0.001), increased index RN (P < 0.001), and increased index Freps (P < 0.001) were observed in APB in comparison with the normal participants, with relatively normal ADM F-wave parameters. For the hands of ALS patients that exhibited wasting and weakness, the mean F-wave amplitude (P < 0.05), the F/M amplitude ratio (P < 0.05), F-wave persistence (P < 0.001), index RN (P < 0.05), and index Freps (P < 0.05) significantly differed between APB and ADM. The differences in the dysfunction of motoneurons innervating APB and ADM are unique manifestations in ALS patients. The F-wave persistence (P = 0.002), index RN (P < 0.001), and index Freps (P < 0.001) in the APB seemed to differentiate ALS from the NCs more robustly than the ADM/APB Compound muscle action potential (CMAP) amplitude ratio. Thus, F-waves may reveal subclinical alterations in anterior horn cells, and may potentially help to distinguish ALS from mimic disorders.
本研究旨在通过对F波的研究，确定肌萎缩侧索硬化症（ALS）患者拇短展肌（APB）和小指展肌（ADM）之间脊髓运动神经元功能障碍的差异。40例ALS患者和20例正常对照（NC）接受了正中神经和尺神经的运动神经传导研究，包括由100次电刺激引出的F波。在NC参与者中，APB和ADM之间的F波持续时间（P < 0.05）、指数重复神经元（RN；P < 0.001）和指数重复F波（Freps；P < 0.001）存在显著差异。对于ALS患者中未发现肌肉萎缩或无力且离散手指运动无或仅有轻度受损的手部，与正常参与者相比，APB的F波持续时间显著降低（P < 0.001）、指数RN增加（P < 0.001）、指数Freps增加（P < 0.001），而ADM的F波参数相对正常。对于表现出肌肉萎缩和无力的ALS患者的手部，APB和ADM之间的平均F波振幅（P < 0.05）、F/M振幅比（P < 0.05）、F波持续时间（P < 0.001）、指数RN（P < 0.05）和指数Freps（P < 0.05）存在显著差异。支配APB和ADM的运动神经元功能障碍的差异是ALS患者的独特表现。APB中的F波持续时间（P = 0.002）、指数RN（P < 0.001）和指数Freps（P < 0.001）似乎比ADM/APB复合肌肉动作电位（CMAP）振幅比更能有力地区分ALS和NC。因此，F波可能揭示前角细胞的亚临床改变，并可能有助于将ALS与模仿疾病区分开来。
