Petersen Jens A, Spiess Martina, Curt Armin, Weidner Norbert, Rupp Rüdiger, Abel Rainer, Schubert Martin
1 University Hospital Zurich, Zurich, Switzerland.
2 University of Zurich, Zurich, Switzerland.
Neurorehabil Neural Repair. 2017 May;31(5):432-441. doi: 10.1177/1545968316688796. Epub 2017 Jan 27.
The course of central and peripheral motor recovery after cervical spinal cord injury (SCI) may be investigated by electrophysiological measures. The goal of this study was to compare the 2 over the first year after injury in relation to motor gains.
Compound motor action potentials (CMAPs), motor-evoked potentials (MEPs), and F-waves were recorded from the abductor digiti minimi and CMAP and F-waves from abductor hallucis muscles in 305 patients at about 15 days, 1 month, 3 months, 6 months, and 12 months following an acute traumatic SCI.
The MEP amplitudes and F-wave persistences were lower with more severe sensorimotor impairment. They steadily increased in most subgroups within 6 months after SCI. The amplitude of the CMAPs was low for the first 3 months in the most severely affected participants. This was also found for CMAPs from tibial nerve originating well below the cervical lesion level. Improvement in neurophysiological parameters correlated with improved upper extremity motor scores.
The results point to a systematic interrelation of corticospinal transmission, spinal motoneuron excitability, and its axon function, respectively. Electrophysiological correlates of neural excitability show distinct spatial and temporal interrelations within central and peripheral motor pathways following acute cervical SCI. A strong secondary deterioration within the peripheral motor system with incomplete or no recovery depends on anatomical distance caudal to lesion and on lesion severity. Electrophysiological assessments may increase the sensitivity of interventional studies in addition to clinical measures.
可通过电生理手段研究颈脊髓损伤（SCI）后中枢和外周运动功能的恢复过程。本研究的目的是比较损伤后第一年中两者与运动功能改善情况的关系。
在305例急性创伤性SCI患者伤后约15天、1个月、3个月、6个月和12个月时，记录小指展肌的复合肌肉动作电位（CMAP）、运动诱发电位（MEP）和F波，以及拇展肌的CMAP和F波。
感觉运动功能障碍越严重，MEP波幅和F波出现率越低。在SCI后6个月内，大多数亚组的这些指标稳步上升。在受影响最严重的参与者中，CMAP波幅在最初3个月较低。起源于颈髓损伤平面以下的胫神经CMAP也有同样情况。神经生理参数的改善与上肢运动评分的提高相关。
结果分别表明皮质脊髓传导、脊髓运动神经元兴奋性及其轴突功能之间存在系统的相互关系。神经兴奋性的电生理相关指标在急性颈髓损伤后的中枢和外周运动通路中呈现出明显的时空相互关系。外周运动系统存在严重的继发性恶化且恢复不完全或无恢复，这取决于损伤平面以下的解剖距离和损伤严重程度。除临床测量外，电生理评估可能会提高干预性研究的敏感性。
