伴颅周肌筋膜触痛点的头痛患者神经心理和肌电生理临床特点

Clinical features of neuropsychology and electrophysiology in headache patinets with myofascial trigger points

目的观察伴颅周肌筋膜触痛点(MTrPs)的头痛患者神经心理和肌电生理的临床特点。方法对伴有MTrPs的发作性头痛患者17例和慢性头痛患者16例,正常对照15例,采用MMSE、匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿焦虑量表14项(HAMA)和汉密尔顿抑郁量表24项(HAMD)评估受试者神经心理学状态;并对MTrPs所在颅周肌行针电极肌腹插入检查(EMG),记录和分析其肌电活动。结果与正常对照相比,发作性头痛组及慢性头痛组PSQI、HAMA、HAMD评分的差异有统计学意义(均P<0.05);慢性头痛组和发作性头痛组MMSE、PSQI、HAMA和HAMD评分的差异无统计学意义。发作性头痛组EMG异常率为94.1%,慢性头痛组EMG异常率为75.0%,正常对照EMG均为正常;EMG异常表现为不同程度的自发性电活动。结论头痛患者常伴有一定程度的睡眠障碍和焦虑抑郁。伴MTrPs的发作性和慢性头痛患者均存在相当比率的肌电改变,表现为不同程度的自发性电活动。MTrPs的出现提示头痛出现新的诱因和机制,如能及时发现和诊断,可以帮助正确处理头痛。

Objective To study the clinical characteristics of headache patients with pericranial myofascial trigger points（MTrPs）,to explore the possible pathogenesis of MTrPs,and find its possible electrical biomarkers.Methods A series of neuropsychological test scale including MMSE,the Pittsburgh sleep quality index（PSQI）,Hamilton anxiety scale（HAMA） and Hamilton anxiety scale（HAMD） were evaluated among 33 headache patients with MTrPs and 15 normal controls,the needle electromyography（EMG） inspection were performed in the subjects with MTrPs,recorded and analyzed the abnormal electrical activitiy of muscles where MTrPs were. Results Compared with the normal control group,PSQI,HAMA and HMAD scores of paroxysmal headache and chronic headache group was significantly increased（all P 〈 0. 05）,but there was no statistical difference in MMSE between three groubs. There were no significant difference in three tests scores between two headache groups. The results of abnormal EMG rates in MTrPs showed that 94. 1% in paroxysmal headache patients while 75. 0% in chronic groups,the electrical characteristics were presented with different levels of spontaneous electrical activity. Conclusions Headache patients often have certain rate of sleep disorders and affective disorders. The significant proportion of abnormal EMG changes in MTrPs are observerd in the two headache groups,showed spontaneous electrical activity in different degree. It can concluded that the emerging of MTrPs abnormal electrical activity hint the new cause and mechanisms in headache. To be timely detected and diagnosised,it can help for the treatment.