论著

运动诱发电位用于鉴别诊断原发性帕金森病和多系统萎缩的临床研究

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  • 上海交通大学医学院附属瑞金医院神经内科 神经病学研究所,上海 200025

收稿日期: 2018-05-16

  网络出版日期: 2018-08-25

基金资助

上海市教育委员会高峰-高原项目-研究型医师计划(20172001); 国家临床重点专科资助项目(国卫办医函[2013]544号)

Motor evoked potentials for the differential diagnosis of idiopathic Parkinson's disease and multiple system atrophy

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  • Department of Neurology and Neuroscience Institute, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2018-05-16

  Online published: 2018-08-25

摘要

目的:研究原发性帕金森病(Parkinson′s disease, PD)与多系统萎缩(multiple system atrophy,MSA)患者间的运动诱发电位(Motor evoked potentials,MEP)差异,探索其在两者鉴别诊断中的价值。方法:对12例MSA患者和12例性别、年龄匹配的初诊未服药原发性PD患者进行单脉冲经颅磁刺激-MEP检查,比较2组患者的MEP指标,通过绘制受试者工作特征曲线选取适用于鉴别诊断的指标。结果:运动阈值、MEP波幅和中枢运动传导时间(central motor conduction time, CMCT)在MSA与初诊原发性PD患者间差异无统计学意义(P>0.05),而MEP波形在2组间的差异存在统计学意义(P<0.05);MSA患者的MEP时长较初诊PD患者存在延长的趋势,但差异尚无统计学意义(P>0.05)。结论:对MEP波形评级和MEP时长的检测有助于MSA与原发性PD间的鉴别诊断。

本文引用格式

邹扬, 崔海伦, 胡勇博, 高颖, 张月琪, 陈生弟, 王刚 . 运动诱发电位用于鉴别诊断原发性帕金森病和多系统萎缩的临床研究[J]. 诊断学理论与实践, 2018 , 17(04) : 409 -413 . DOI: 10.16150/j.1671-2870.2018.04.010

Abstract

Objective: To investigate the difference in motor evoked potentials (MEP) between idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA), analyze its value for the differential diagnosis of PD and MSA. Methods: Single-pulse transcranial magnetic stimulation (sTMS)-MEP examination was performed in 12 patients with MSA and 12 sex and age matched idiopathic PD patients. MEP parameters were compared between the two groups of patients. Receiver operating characteristic curve was used to screen the parameters suitable for differential diagnosis. Results: The differences of motor threshold, MEP amplitude and central motor conduction time (CMCT) between idiopathic PD and MSA patients were not statistically significant(P>0.05). The waveform of MEP differed significantly between idiopathic PD and MSA patients (P<0.01). The MEP duration showed a trend of prolonging in MSA patients than in idiopathic PD patients, but was not statistically significant (P>0.05). Conclusions: Both duration and waveform of MEP may help the differential diagnosis of MSA from idiopathic PD.

参考文献

[1] Stefanova N, Bücke P, Duerr S, et al.Multiple system atrophy: an update[J]. Lancet Neurol,2009,8(12):1172-1178.
[2] Wenning GK, Geser F, Krismer F, et al.The natural history of multiple system atrophy: a prospective European cohort study[J]. Lancet Neurol,2013,12(3):264-274.
[3] Barker AT, Jalinous R, Freeston IL.Non-invasive magnetic stimulation of human motor cortex[J]. Lancet,1985, 1(8437):1106-1107.
[4] Abbruzzese G, Marchese R, Trompetto C.Sensory and motor evoked potentials in multiple system atrophy: a comparative study with Parkinson's disease[J]. Mov Disord,1997,12(3):315-321.
[5] Marchese R, Trompetto C, Buccolieri A, et al.Abnorma-lities of motor cortical excitability are not correlated with clinical features in atypical parkinsonism[J]. Mov Disord,2000,15(6):1210-1214.
[6] Postuma RB, Berg D, Stern M, et al.MDS clinical diagnostic criteria for Parkinson's disease[J]. Mov Disord,2015,30(12):1591-1601.
[7] Gilman S, Wenning GK, Low PA, et al.Second consensus statement on the diagnosis of multiple system atrophy[J]. Neurology,2008,71(9):670-676.
[8] Ogura T, Takeshita H, Hase H, et al.Evaluation of descending spinal cord tracts in patients with thoracic cord lesions using motor evoked potentials recorded from the paravertebral and lower limb muscles[J]. J Spinal Disord Tech,2003,16(2):163-170.
[9] Nakamae T, Tanaka N, Nakanishi K, et al.Quantitative assessment of myelopathy patients using motor evoked potentials produced by transcranial magnetic stimulation[J]. Eur Spine J,2010,19(5):685-690.
[10] 谢红雯, 刘树山, 吴承远, 等. 急性脊髓损伤时经颅磁刺激运动诱发电位监测的实验研究[J]. 中华外科杂志,2004,42(13):787-791.
[11] Kawashima S, Ueki Y, Mima T, et al.Differences in dopaminergic modulation to motor cortical plasticity between Parkinson's disease and multiple system atrophy[J]. PLoS One,2013,8(5):e62515.
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