Nair K P, Taly A B, Arunodaya G R, Rao S, Murali T
Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
Clin Auton Res. 1998 Aug;8(4):207-11. doi: 10.1007/BF02267783.
Autonomic dysfunctions cause significant morbidity and mortality among patients with spinal cord disorders. Sympathetic skin response (SSR), a simple, noninvasive electrophysiological technique, may be useful for assessing sympathetic functions in patients with myelopathies. Our aim was to study SSR in patients with myelopathy and correlate it with clinical features, severity of the impairment, somatosensory evoked potentials. and outcome. Thirty patients (15 men, 15 women) 12 to 60 years old with myelopathies of different etiology were studied. Subjects with clinical, electrophysiologic, or radiologic evidence of lesions outside the spinal cord were excluded. Somatosensory evoked potentials (SSEP) were recorded from scalp with median nerve stimulation at the wrist and posterior tibial nerve below the medial malleolus. The SSR was recorded from palm and sole after stimulating the supraorbital nerve at forehead, median nerve at wrist, and posterior tibial nerve below medial malleolus. The SSR was considered abnormal when absent. The sites of the lesions in these patients were cervical (13), thoracic (16), and lumbar (1). The lesion was clinically complete in six patients. Good motor recovery was noted in 16 subjects. SSR was absent from sole in 25 and palm in 10 patients from all three sites of stimulation. In addition, three patients also had absent SSR from palm on posterior tibial nerve (PTN) stimulation. SSEP was absent from median (N19) in three and posterior tibial (N39) in 20 patients. Among 10 patients with absent SSR from palm, only three had a good outcome. Presence of SSR from palm to PTN stimulation correlated with sparing of bladder sensations and good outcome. However, absent SSR from sole did not correlate with clinical features, bladder dysfunction, or outcome. Sympathetic skin response is frequently abnormal in patients with myelopathies. Spinal afferent and efferent tracts for SSR are different and may be affected individually. The afferent pathways are closely related to tracts conveying bladder sensation. Preserved palmar SSR on PTN stimulation may suggest good motor outcome. SSR may be a valuable adjunct in evaluating patients with myelopathies.
自主神经功能障碍在脊髓疾病患者中会导致显著的发病率和死亡率。交感皮肤反应（SSR）是一种简单、无创的电生理技术，可能有助于评估脊髓病患者的交感神经功能。我们的目的是研究脊髓病患者的SSR，并将其与临床特征、损伤严重程度、体感诱发电位及预后相关联。对30例年龄在12至60岁、患有不同病因脊髓病的患者（15名男性，15名女性）进行了研究。排除有脊髓外病变的临床、电生理或影像学证据的受试者。通过刺激腕部正中神经和内踝下方的胫后神经，从头皮记录体感诱发电位（SSEP）。在刺激前额眶上神经、腕部正中神经和内踝下方的胫后神经后，从手掌和脚底记录SSR。SSR缺失时被认为异常。这些患者的病变部位为颈椎（13例）、胸椎（16例）和腰椎（1例）。6例患者临床损伤完全。16名受试者有良好的运动恢复。在所有三个刺激部位，25例患者脚底的SSR缺失，10例患者手掌的SSR缺失。此外，3例患者在胫后神经（PTN）刺激时手掌的SSR也缺失。3例患者正中神经（N19）的SSEP缺失，20例患者胫后神经（N39）的SSEP缺失。在10例手掌SSR缺失的患者中，只有3例预后良好。从手掌到PTN刺激时SSR的存在与膀胱感觉保留和良好预后相关。然而，脚底SSR缺失与临床特征、膀胱功能障碍或预后无关。脊髓病患者的交感皮肤反应经常异常。SSR的脊髓传入和传出通路不同，可能会受到个别影响。传入通路与传递膀胱感觉的神经束密切相关。PTN刺激时保留手掌SSR可能提示良好的运动预后。SSR可能是评估脊髓病患者的有价值辅助手段。
