针电极记录面神经F波及相关参数在偏侧面肌痉挛中的应用

The value of needle electrode recording facial nerve F wave and its related parameters in hemifacial spasm

目的建立针电极记录面神经F波各参数正常参考值,为临床评估偏侧面肌痉挛(hemifacial spasm,HFS)提供电生理依据。方法对22例HFS患者及36名健康对照组进行双侧面神经F波检测。该方法以下颌缘支刺激、针电极颏肌记录,同时获取复合肌肉动作电位(compound muscle action potentials,CAMP或M波)及F波。比较HFS组与健康对照组F波及相关参数的差异,并探讨HFS组F波参数与痉挛程度评分(Cohen Grading)的相关性。结果健康对照组,F波的潜伏期、出现率、时程及F波与M波的波幅比(ration of F-wave amplitude and M-wave amplitude,F/M)左右两侧及性别间无统计学差异,F波最小潜伏期(minimal latency of Fwave,Fmin)及平均潜伏期(mean latency of F-wave,Fmean)与头围呈正相关(Fmin r=0.449,P=0.013;Fmean r=0.391,P=0.033),但未发现其与年龄或身高相关。HFS组痉挛侧的F波平均时程(duration of F-wave,Fdura)较非痉挛侧(13.1 ms vs.9.5 ms,P<0.01)及健康对照组(13.1 ms vs.9.7 ms,P<0.001)延长,痉挛侧F/M较非痉挛侧(6.9%vs.3.8%,P<0.001)及健康对照组(6.9%vs.3.7%,P<0.001)增加。痉挛侧F/M与Cohen评分呈正相关(r=0.538,P=0.001)。结论运用针电极可在颏肌记录到清晰的面神经F波,在HFS患者中可见痉挛侧延长的Fdura和增高的F/M,F/M可为临床评价HFS患者痉挛程度提供客观依据。

Objective To optimize the method to elicit the facial nerve F wave and to establish its reference values and its related parameters, in order to provide an electrophysiological basis for facial nerve assessment in patients with hemifacial spasm(HFS). Methods Thirty-six healthy volunteers and 22 patients with HFS underwent this project.Compound muscle action potentials(CAMP, or M waves) and F waves were elicited by stimulating the marginal mandibular branch of the facial nerve and recorded with needle electrodes placed in the mentalis muscle. The association between F parameters and Cohen Grading of the HFS patients were analyzed. Results There were no significant differences in F parameters between men and women or between the two sides in control subjects. Minimal latency of F wave(Fmin) and mean latency of F wave(Fmean) had positive correlations with head circumference(Fmin r=0.449, P=0.013;Fmean r=0.391, P=0.033), but had no correlations with age nor height. Patients with HFS had prolonged duration of F wave(Fdura) in spasm side, compared with normal side(13.1 ms vs. 9.5 ms, P<0.01) and healthy subjects(13.1 ms vs. 9.7 ms, P<0.001), and increased ratio of F-wave amplitude and M-wave amplitude(F/M) in spasm side, compared with normal side(6.9% vs. 3.8%, P <0.001) and healthy subjects(6.9% vs. 3.7%, P <0.001). F/M exhibited a positive correlation with Cohen Grading(r =0.538, P =0.001). Conclusion A clear facial nerve F wave can be achieved by stimulating the marginal mandibular branch of the facial nerve, which provides an objective basis for evaluation of the facial nerve function in HFS patients with increased F/M and prolonged Fdura.