表皮内电诱发电位对检测退行性颈椎病敏感，提示其脊髓丘脑传播。

Intra-epidermal electrically evoked potentials are sensitive to detect degenerative cervical myelopathy suggesting their spinothalamic propagation.

机构信息

Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.

出版信息

Clin Neurophysiol. 2024 Nov;167:229-238. doi: 10.1016/j.clinph.2024.09.015. Epub 2024 Sep 19.

DOI:10.1016/j.clinph.2024.09.015

PMID:39368346

Abstract

OBJECTIVE

Degenerative cervical myelopathy (DCM) is a centromedullary spinal cord disorder mainly affecting crossing fibers. While contact heat evoked potentials (CHEPs) are sensitive in detecting DCM by testing spinothalamic integrity, somatosensory evoked potentials (dSSEPs) show unaffected dorsal column conduction. Intra-epidermal electrically evoked potentials (IEEPs) have unknown spinal propagation after noxious stimulation. We investigated (1) the spinothalamic tract propagation and (2) the discriminative power in detecting spinal pathology of IEEPs compared to CHEPs and dSSEPs in DCM.

METHODS

DCM was diagnosed by neurological examination regarding stenosis (MRI). Stimulation of C6, C8, and T4 dermatomes yielded dSSEPs, CHEPs, and IEEPs. (1) Spinal propagation was assessed through concordant or discordant responses, and (2) discriminative power was determined using receiver operating characteristic curves (ROC).

RESULTS

Twenty-seven patients (8F, 56 ± 12yrs) with DCM were analyzed and compared to age-matched healthy controls. IEEPs were abnormal in 43-54%, CHEPs in 37-69%, and dSSEPs in 4-12%. IEEPs showed high concordance with abnormalities of CHEPs (62-69%). ROC analyses showed good discriminative power of CHEPs and IEEPs contrary to dSSEPs.

CONCLUSIONS

The concordance of abnormal responses of CHEPs and IEEPs contrary to dSSEPs suggests spinothalamic propagation of IEEPs.

SIGNIFICANCE

Minimal differences between CHEPs and IEEPs suggest complementary potential by the combined testing of spinothalamic tract integrity.

摘要

目的

退行性颈髓病（DCM）是一种主要影响交叉纤维的中央髓质脊髓疾病。虽然接触热诱发电位（CHEPs）通过测试脊髓丘脑束的完整性对 DCM 的检测较为敏感，但体感诱发电位（dSSEPs）显示背柱传导不受影响。有害刺激后，表皮内电诱发电位（IEEPs）的脊髓传播尚不清楚。我们研究了（1）IEEPs 的脊髓投射，以及（2）与 CHEPs 和 dSSEPs 相比，在 DCM 中检测脊髓病变的鉴别能力。

方法

通过神经学检查评估狭窄（MRI）来诊断 DCM。刺激 C6、C8 和 T4 皮区可产生 dSSEPs、CHEPs 和 IEEPs。（1）通过一致或不一致的反应评估脊髓投射，（2）使用接收者操作特征曲线（ROC）确定鉴别能力。

结果

分析了 27 例（8 例女性，56±12 岁）DCM 患者，并与年龄匹配的健康对照组进行比较。IEEPs 异常率为 43-54%，CHEPs 为 37-69%，dSSEPs 为 4-12%。IEEPs 与 CHEPs 的异常表现高度一致（62-69%）。ROC 分析显示 CHEPs 和 IEEPs 具有良好的鉴别能力，而 dSSEPs 则较差。