Panizza M E, Hallett M, Nilsson J
Division of Intramural Research, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD 20892.
Neurology. 1989 Jan;39(1):85-9. doi: 10.1212/wnl.39.1.85.
We studied inhibition of median nerve H-reflex produced by radial nerve stimulation in both arms of 14 patients with hand cramps and 15 normal volunteers. Median nerve stimulation was delivered 1 and 0.5 msec before and 0, 0.5, 1, 2, 10, 20, 30, 50, 75, 100, 200, 500, and 1,000 msec after radial nerve stimulation. Recordings were from surface electrodes positioned over flexor carpi radialis. We identified three periods of attenuation of median nerve H-reflex amplitude in the control group. When radial nerve conditioning stimuli were delivered simultaneously, 10 and 75 msec before median nerve test stimuli, H-reflex amplitude diminished to 47%, 61%, and 69%. In the patient group we also found three periods of attenuation at the same delays, but the amount of attenuation was significantly less than in controls. Dividing the patients into two groups, dystonic hand cramp and simple hand cramp, both showed less inhibition than the control group, but the abnormality was greater in the dystonic cramp group. This test is the first to demonstrate physiologic disturbance in patients with hand cramps.
我们研究了14例手部痉挛患者和15名正常志愿者双臂中，桡神经刺激对正中神经H反射的抑制作用。在桡神经刺激前1毫秒和0.5毫秒以及后0、0.5、1、2、10、20、30、50、75、100、200、500和1000毫秒给予正中神经刺激。记录来自置于桡侧腕屈肌上方的表面电极。我们在对照组中确定了正中神经H反射波幅衰减的三个时期。当在正中神经测试刺激前同时给予桡神经条件刺激，分别为10毫秒和75毫秒时，H反射波幅分别降至47%、61%和69%。在患者组中，我们也在相同的延迟时间发现了三个衰减时期，但衰减量明显少于对照组。将患者分为两组，即张力障碍性手部痉挛组和单纯性手部痉挛组，两组的抑制作用均小于对照组，但在张力障碍性痉挛组中异常更为明显。该测试首次证明了手部痉挛患者存在生理紊乱。
