Wang Yue, Wang Han, Cui Li-Ying
Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.
Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
J Clin Neurophysiol. 2019 Mar;36(2):87-92. doi: 10.1097/WNP.0000000000000520.
To identify upper motor neuron (UMN) dysfunction using the triple stimulation technique (TST) in amyotrophic lateral sclerosis (ALS).
Fifty ALS and 42 non-ALS patients were examined clinically, using conventional transcranial magnetic stimulation and TST.
For ALS patients presenting with UMN in tested limb, the TST amplitude ratio was abnormal in 25 of 28 patients (89.3%). For ALS patients without UMN signs, 6 of 22 patients (27.3%) had an abnormal TST ratio. When clinical signs were not present, both abnormal resting motor threshold and TST indicated a UMN involvement. In non-ALS patients with central motor conduction disorders, the percentage of patients with an abnormal TST was higher for those presenting with clinical UMN signs (9/12, 75.0%) than for those without these signs (1/8, 12.5%).
Triple stimulation technique appears to be an accurate, early measure for detecting clinical and subclinical UMN abnormalities in ALS. Triple stimulation technique could also be useful to investigate central motor conduction abnormalities in other disorders.
运用三重刺激技术（TST）识别肌萎缩侧索硬化症（ALS）中的上运动神经元（UMN）功能障碍。
对50例ALS患者和42例非ALS患者进行临床检查，采用传统经颅磁刺激和TST。
对于受试肢体存在UMN的ALS患者，28例患者中有25例（89.3%）的TST振幅比异常。对于无UMN体征的ALS患者，22例患者中有6例（27.3%）的TST比率异常。当不存在临床体征时，静息运动阈值异常和TST异常均提示UMN受累。在患有中枢运动传导障碍的非ALS患者中，出现临床UMN体征的患者TST异常的百分比（9/12，75.0%）高于无这些体征的患者（1/8，12.5%）。
三重刺激技术似乎是检测ALS临床和亚临床UMN异常的一种准确、早期的方法。三重刺激技术也可能有助于研究其他疾病中的中枢运动传导异常。
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