A型肉毒毒素對(duì)原發(fā)性眼瞼痙攣中樞感覺傳導(dǎo)通路影響的研究
發(fā)布時(shí)間：2018-08-09 17:18
【摘要】：背景： 眼瞼痙攣（BSP）是一種局灶型肌張力障礙，以原發(fā)性多見。通常認(rèn)為原發(fā)性眼瞼痙攣是由于遺傳易感因素以及眼的運(yùn)動(dòng)感覺輸入在中樞神經(jīng)系統(tǒng)整合功能障礙導(dǎo)致的。A型肉毒毒素（BTX-A）是眼瞼痙攣的首選治療。研究表明BTX-A改善眼瞼痙攣運(yùn)動(dòng)癥狀，不僅通過其外周作用，還可能存在一定的中樞作用。但是目前國(guó)內(nèi)外對(duì)BTX-A中樞作用的研究較少，并且多為BTX-A對(duì)中樞運(yùn)動(dòng)神經(jīng)元的影響。三叉神經(jīng)體感誘發(fā)電位（TSEP）是通過電脈沖刺激三叉神經(jīng)末梢，在三叉神經(jīng)感覺傳導(dǎo)通路多個(gè)神經(jīng)元聚集區(qū)記錄誘發(fā)電位的波幅，在一定程度上反映口周感覺傳導(dǎo)通路功能變化。輔助運(yùn)動(dòng)區(qū)（SAM）同時(shí)接受感覺和運(yùn)動(dòng)神經(jīng)元投射，可以代表部分感覺運(yùn)動(dòng)整合的過程。在TSEP中加入代表輔助運(yùn)動(dòng)皮層的F5/F6位點(diǎn)，可以在觀察感覺通路變化的同時(shí)，也觀察部分的感覺運(yùn)動(dòng)整合過程的改變。 目的： 將皮層多點(diǎn)記錄的三叉神經(jīng)體感誘發(fā)電位應(yīng)用于眼瞼痙攣研究，對(duì)比BSP患者與正常受試者三叉神經(jīng)感覺通路興奮性變化，及BTX-A注射前后運(yùn)動(dòng)癥狀改善同時(shí)，感覺通路興奮性的改變和感覺運(yùn)動(dòng)整合的變化。 方法： 皮層多點(diǎn)記錄的TSEP研究：14例正常對(duì)照（I），14例確診為原發(fā)性眼瞼痙攣的患者BTX-A注射前（II），，注射后一個(gè)月（III），分別行皮層多點(diǎn)記錄的TSEP檢測(cè)，兩兩比較，分析C(5,6) N13-P19、P19-N30峰間期， N13/P19、N19/N30峰峰幅度測(cè)值變化情況，以及F(5,6) N13’-P19’、P19’-N30’峰間期，N13’/P19’、P19’/N30’峰峰幅度變化。 結(jié)果： BTX-A注射后，BSP患者JRS量表評(píng)分顯著低于BTX-A注射前，差異有統(tǒng)計(jì)學(xué)意義（P0.05），14例患者平均BIDS評(píng)分為0.73±0.02。 皮層多點(diǎn)記錄的三叉神經(jīng)體感誘發(fā)電位研究：三組間C(5,6)位點(diǎn)記錄，N13-P19、P19-N30峰間期差異無統(tǒng)計(jì)學(xué)意義（P0.05）。II N13-P19、P19-N30峰峰幅度高于I，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。II N13/P19、P19/N30峰峰幅度顯著高于III，差異有統(tǒng)計(jì)學(xué)意義（P0.01）。I與III各波峰峰幅度比較，N13-P19、P19-N30峰峰幅度差異無統(tǒng)計(jì)學(xué)意義（P0.05）； 三組間F(5,6)位點(diǎn)記錄，N13’-P19’、P19’-N30’峰間期差異無統(tǒng)計(jì)學(xué)意義（P0.05）。II N13’-P19’、P19’-N30’峰峰幅度高于I，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。II N13’/P19’、P19’/N30’峰峰幅度顯著高于III，差異有統(tǒng)計(jì)學(xué)意義（P0.01）。I與III各波峰峰幅度比較，N13’-P19’、P19’-N30’峰峰幅度差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論： 1、A型肉毒毒素注射治療可顯著改善原發(fā)性眼瞼痙攣臨床癥狀。 2、A型肉毒毒素注射后，原發(fā)性眼瞼痙攣患者三叉神經(jīng)感覺傳導(dǎo)通路興奮性降低。 3、A型肉毒毒素注射后，原發(fā)性眼瞼痙攣患者皮質(zhì)下至輔助運(yùn)動(dòng)皮層通路興奮性降低。
[Abstract]:Background: blepharospasm (BSP) is a focal dystonia. It is generally believed that primary blepharospasm is the first choice of treatment for blepharospasm due to genetic susceptibility factors and motor sensory input in the central nervous system due to the dysfunction of the integration of the. A botulinum toxin (BTX-A) is the first treatment of blepharospasm. The study shows that BTX-A improves palpebral spasticity, not only through its peripheral effect, but also by central effect. However, there are few studies on the central role of BTX-A at home and abroad, and most of them are the effects of BTX-A on central motor neurons. Trigeminal somatosensory evoked potentials (TSEP) are recorded by electrical pulse stimulation of trigeminal nerve endings, and the amplitude of evoked potentials is recorded in many neuronal areas of the trigeminal sensory conduction pathway, which to some extent reflects the functional changes of the peroral sensory conduction pathway. Both sensory and motor neuronal projections are accepted in the auxiliary motor region (SAM), which can represent the process of sensory and motor integration. The addition of F5/F6 site which represents the auxiliary motor cortex in TSEP can not only observe the changes of sensory pathway, but also observe the changes of sensory motor integration process. Objective: to compare the excitability of trigeminal nerve sensory pathway in patients with BSP and normal subjects, and the improvement of motor symptoms before and after BTX-A injection by applying the multipoint recorded trigeminal nerve somatosensory evoked potential (SEP) in the study of blepharospasm. Changes in sensory pathway excitability and sensory motor integration. Methods: a TSEP study of cortical multipoint recording was performed in 14 patients with primary blepharospasm diagnosed as a normal control group. The TSEP of multipoint cortical records was detected one month before BTX-A injection with (II), in 14 normal controls, and the results were compared with each other. The variation of the amplitude of C _ (5N _ 6) N _ (13) P _ (19) N _ (19) N _ (30) and N _ (13 / P _ (19) N _ (19) N _ (30) peaks, and the amplitude of F _ (5 ~ (6) N _ (13) ~ (-P _ (19) P _ (19) ~ (-N) ~ (30') P _ (19) ~ (19) N ~ (30') peak were analyzed. Results: the score of JRS scale after BTX-A injection was significantly lower than that before BTX-A injection, and the difference was statistically significant (P0.05). The average BIDS score of 14 patients was 0.73 鹵0.02. The study of Trigeminal somatosensory evoked potentials recorded at multiple points in the Cortex: there was no significant difference between the three groups in the interpeak interval of N13-P19P19P19-N30 (P0.05). The amplitude of the peak of P19-N30 was higher than that of I.The difference was statistically significant (P0.05) .II N13P19P19P19N30 peak amplitude was significantly higher than that of IIIs, and the difference was significant (P0.05). There was no significant difference between the peak amplitude of N13-P19 and P19-N30 between III and I (P0.01) I (P0.05). There was no significant difference between the three groups in the interpeak interval between the F _ (5N _ 6) locus and the P _ (19) -N _ (30') (P0.05). II. II, N _ (13) ~ (-P _ (19), P _ (19) -N _ (30) 'was higher than I (P 0.05), the difference was statistically significant (P0.05) .II, N _ (13) P _ (19) P _ (19) P _ (19) P ~ (19) / N _ (30') was significantly higher than that of I (P < 0.05). The difference was statistically significant (P0.01). There was no significant difference between the peak amplitude of N13 ~ + -P19 ~ (19) and P19 ~ (19) -N _ (30') between I and III (P0.05). Conclusion: 1Botulinum toxin A injection can significantly improve the clinical symptoms of primary blepharospasm. The excitability of trigeminal sensory conduction pathway was decreased in patients with primary blepharospasm, and the excitability of subcortical to auxiliary motor cortex was decreased after botulinum toxin type A injection in patients with primary blepharospasm.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R777.1
[Abstract]:Background: blepharospasm (BSP) is a focal dystonia. It is generally believed that primary blepharospasm is the first choice of treatment for blepharospasm due to genetic susceptibility factors and motor sensory input in the central nervous system due to the dysfunction of the integration of the. A botulinum toxin (BTX-A) is the first treatment of blepharospasm. The study shows that BTX-A improves palpebral spasticity, not only through its peripheral effect, but also by central effect. However, there are few studies on the central role of BTX-A at home and abroad, and most of them are the effects of BTX-A on central motor neurons. Trigeminal somatosensory evoked potentials (TSEP) are recorded by electrical pulse stimulation of trigeminal nerve endings, and the amplitude of evoked potentials is recorded in many neuronal areas of the trigeminal sensory conduction pathway, which to some extent reflects the functional changes of the peroral sensory conduction pathway. Both sensory and motor neuronal projections are accepted in the auxiliary motor region (SAM), which can represent the process of sensory and motor integration. The addition of F5/F6 site which represents the auxiliary motor cortex in TSEP can not only observe the changes of sensory pathway, but also observe the changes of sensory motor integration process. Objective: to compare the excitability of trigeminal nerve sensory pathway in patients with BSP and normal subjects, and the improvement of motor symptoms before and after BTX-A injection by applying the multipoint recorded trigeminal nerve somatosensory evoked potential (SEP) in the study of blepharospasm. Changes in sensory pathway excitability and sensory motor integration. Methods: a TSEP study of cortical multipoint recording was performed in 14 patients with primary blepharospasm diagnosed as a normal control group. The TSEP of multipoint cortical records was detected one month before BTX-A injection with (II), in 14 normal controls, and the results were compared with each other. The variation of the amplitude of C _ (5N _ 6) N _ (13) P _ (19) N _ (19) N _ (30) and N _ (13 / P _ (19) N _ (19) N _ (30) peaks, and the amplitude of F _ (5 ~ (6) N _ (13) ~ (-P _ (19) P _ (19) ~ (-N) ~ (30') P _ (19) ~ (19) N ~ (30') peak were analyzed. Results: the score of JRS scale after BTX-A injection was significantly lower than that before BTX-A injection, and the difference was statistically significant (P0.05). The average BIDS score of 14 patients was 0.73 鹵0.02. The study of Trigeminal somatosensory evoked potentials recorded at multiple points in the Cortex: there was no significant difference between the three groups in the interpeak interval of N13-P19P19P19-N30 (P0.05). The amplitude of the peak of P19-N30 was higher than that of I.The difference was statistically significant (P0.05) .II N13P19P19P19N30 peak amplitude was significantly higher than that of IIIs, and the difference was significant (P0.05). There was no significant difference between the peak amplitude of N13-P19 and P19-N30 between III and I (P0.01) I (P0.05). There was no significant difference between the three groups in the interpeak interval between the F _ (5N _ 6) locus and the P _ (19) -N _ (30') (P0.05). II. II, N _ (13) ~ (-P _ (19), P _ (19) -N _ (30) 'was higher than I (P 0.05), the difference was statistically significant (P0.05) .II, N _ (13) P _ (19) P _ (19) P _ (19) P ~ (19) / N _ (30') was significantly higher than that of I (P < 0.05). The difference was statistically significant (P0.01). There was no significant difference between the peak amplitude of N13 ~ + -P19 ~ (19) and P19 ~ (19) -N _ (30') between I and III (P0.05). Conclusion: 1Botulinum toxin A injection can significantly improve the clinical symptoms of primary blepharospasm. The excitability of trigeminal sensory conduction pathway was decreased in patients with primary blepharospasm, and the excitability of subcortical to auxiliary motor cortex was decreased after botulinum toxin type A injection in patients with primary blepharospasm.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R777.1
【共引文獻(xiàn)】
相關(guān)期刊論文 前10條
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