Descending spinal cord evoked potentials in cervical spondylotic myelopathy: characteristic waveform changes seen at the lesion site.
Descending spinal cord evoked potentials in cervical spondylotic myelopathy: characteristic waveform changes seen at the lesion site.
复制标题
脊髓型颈椎病的脊髓下降诱发电位：病变部位可见特征性波形变化。
DOI：
10.1016/j.clinph.2013.06.183
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发表时间：
2014
影响因子：
4.7
通讯作者：
Kimura J.
中科院分区：
文献类型：
--
作者：
Tadokoro N;Tani T;Ikeuchi M;Takemasa R;Kida K;Ikemoto T;Ushida T;Taniguchi S;Kimura J.
目的报道脊髓上行诱发电位（A-SCEP）对脊髓压迫症的定位诊断结果：单极记录电极置于脊髓旁，双极刺激电极置于腰段硬膜外间隙。负峰大小的突然减小伴随着初始正峰在短段上的增大，作为局灶性传导阻滞的有力证据。A-SCEP在定位最大脊髓受累水平方面是MRI的有用补充，特别是在多个水平的临床无症状脊髓压迫的老年患者中（Tani等人，1999年，2002年）。然而，A-SCEP记录的局限性是排除了对比传导阻滞更靠近嘴侧的节段的评价。经颅电刺激（TES）后的下行脊髓诱发电位（D-SCEP）的评估，如果添加到A-SCEP研究，可能会避免这个问题。皮质脊髓束轴突的下行截击终止于脊髓的各个水平，与脊髓运动神经元或中间神经元形成突触。这反过来又会导致到达尾侧记录部位的运动齐射的逐渐下降，导致D-SCEP的减少比从生理时间分散预测的更大，其中记录的电位随着刺激电极和拾取电极之间的距离增加而振幅变小且持续时间变长。为了进一步阐明这一关系，我们研究了单节段脊髓受压时D-SCEP的波形变化。特别是，我们希望确定在识别局灶性传导异常时，A-SCEP和D-SCEP分析是否具有相同的波形变化原理。
Purpose We reported the results of level diagnosis in compressive myelopathy using ascending spinal cord evoked potentials (A-SCEP): monopolar recording electrode placed near the spinal cord and bipolar stimulating electrode inserted in the lumbar epidural space. An abrupt reduction in size of the negative peak accompanied by an augmentation of the initial-positive peak over a short segment serves as strong evidence of a focal conduction block. A-SCEP were a useful addition to MRI in terms of localizing the level of maximal cord involvement, particularly in elderly patients with clinically silent cord compression at multiple levels (Tani et al., 1999, 2002). However, a limitation of A-SCEP recordings is that evaluation of segments more rostral than the conduction block are precluded. An assessment of descending spinal cord evoked potentials (D-SCEPs) after transcranial electrical stimulation (TES) of the brain, if added to A-SCEP studies, may circumvent this problem. Descending volleys in corticospinal tract axons terminate at various levels of the cord to synapse with spinal motoneurons or interneurons. This, in turn, would cause a progressive decline of motor volleys reaching the caudal recording sites, resulting in a greater diminution of the D-SCEPs than predicted from physiological temporal dispersion where the recorded potentials become smaller in amplitude and longer in duration with increasing distance between stimulating and pickup electrodes. To further clarify this relationship, we have studied waveform changes of the D-SCEP associated with single-level cord compression. In particular, we wished to determine if the same principles of waveform changes hold for analyses of A-SCEP and D-SCEP in identifying focal conduction abnormalities.