Gutmann L
Department of Neurology, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, USA.
Muscle Nerve. 1996 Jul;19(7):811-8. doi: 10.1002/(SICI)1097-4598(199607)19:7<811::AID-MUS1>3.0.CO;2-C.
Muscle hypertrophy occurs uncommonly in several neurogenic disorders including neuropathies, radiculopathies, spinal muscular atrophy, and post-polio syndrome. Its pathogenesis varies in different circumstances. In the presence of generalized myokymia and neuromyotonia (Isaacs' syndrome), symmetrical hypertrophy appears to be the result of continuous spontaneous electrical stimulation of myofibers and, in some cases, results in type 1 myofiber preponderance. Focal hypertrophy occurring with radiculopathies and mononeuropathies was associated with complex repetitive discharges (CRDs) in approximately half the cases. CRDs may play a role in the pathogenesis of myofiber hypertrophy by continuous myofiber stimulation, but in some cases, with and without CRDs, myofiber hypertrophy may be related to mechanical events. Muscle enlargement seen in old polio appears to involve a significant degree of pseudohypertrophy, although some myofiber hypertrophy occurs. The symmetrical occurrence of hypertrophy in genetically determined disorders, such as spinal muscular atrophy, and hereditary motor and sensory neuropathy types 1 and 2 may have both a genetic and a mechanical basis in addition to pseudohypertrophy in some cases.
肌肉肥大在包括神经病变、神经根病、脊髓性肌萎缩症和小儿麻痹后遗症在内的几种神经源性疾病中并不常见。其发病机制在不同情况下有所不同。在存在全身性肌束颤搐和神经性肌强直（艾萨克斯综合征）的情况下，对称性肥大似乎是肌纤维持续自发电刺激的结果，在某些情况下，会导致1型肌纤维占优势。在神经根病和单神经病中出现的局灶性肥大，约半数病例与复合重复放电（CRDs）有关。CRDs可能通过持续刺激肌纤维在肌纤维肥大的发病机制中起作用，但在某些情况下，无论有无CRDs，肌纤维肥大可能与机械性事件有关。在陈旧性小儿麻痹症中看到的肌肉增大似乎涉及相当程度的假性肥大，尽管也会出现一些肌纤维肥大。在遗传性疾病中，如脊髓性肌萎缩症以及遗传性运动和感觉神经病1型和2型中，肥大的对称性出现除了在某些情况下存在假性肥大外，可能还具有遗传和机械基础。
