基于瞬目反射检测的面肌痉挛患者面神经核团兴奋性机制研究

Mechanism of facial nerve nucleus excitability in patients with hemifacial spasm based on blink reflexes

目的基于面肌痉挛患者瞬目反射特征的分析,进一步验证面肌痉挛的发病机制。方法选择自2021年1月至2022年12月于贵州省人民医院神经电生理科接受神经电生理评估的63例面肌痉挛患者(面肌痉挛组)为研究对象,并以同期接受神经电生理评估的58例原发性三叉神经痛患者(三叉神经痛组)、8例面瘫后遗联带运动患者(面瘫后遗联带运动组)及20例健康志愿者(正常组)为对照。收集并比较上述受试者面神经运动传导速度、复合肌肉动作电位潜伏期及瞬目反射检测指标(包括R1潜伏期、R1波幅、R2起始潜伏期、R2波幅、R2末端潜伏期、患侧记录R2’’起始潜伏期、患侧记录R2’’波幅、患侧记录R2’’末端潜伏期)的差异;进一步依据痉挛严重程度(三星医疗中心评分系统评估)将面肌痉挛组患者分为1~4级,依据显微血管减压术中探查所见的与面神经接触的责任血管数量将面肌痉挛组患者分为1根责任血管组与2根及以上责任血管组,分析各组患者间瞬目反射检测指标增大/延长发生率的变化趋势或差异性。结果 4组受试者间面神经运动传导速度、复合肌肉动作电位潜伏期的差异均无统计学意义(P>0.05),但面肌痉挛组患者的R1波幅明显高于三叉神经痛组、面瘫后遗联带运动组,R2波幅、患侧记录R2’’波幅、R2末端潜伏期及患侧记录R2’’末端潜伏期均明显高于其余3组,差异均有统计学意义(P<0.05)。不同痉挛严重程度面肌痉挛患者间,R1波幅增大发生率、R2末端潜伏期延长发生率均随着痉挛严重程度升高而呈升高趋势,差异均有统计学意义(P<0.05)。1根责任血管组与2根及以上责任血管组患者间R1波幅增大发生率、R2波幅增大发生率、R2末端潜伏期延长发生率、患侧记录R2’’波幅增大发生率、患侧记录R2’’末端潜伏期延长发生率的差异均无统计学意义(P>0.05)。结论面肌痉挛患者的瞬目反射特征为R1波幅增高及R2末端潜伏期延长,该特征佐证了面肌痉挛发病的面神经核团兴奋性增高学说。

Objective To further elucidate the pathogenesis of hemifacial spasm by analyzing blinking reflex characteristics.Methods A total of 63 patients with hemifacial spasm(hemifacial spasm group)who underwent neuroelectrophysiological evaluation in Department of Neurological Electrophysiology,Guizhou Provincial People's Hospital from January 2021 to December 2022 were included as study subjects.Additionally,58 patients with primary trigeminal neuralgia(trigeminal neuralgia group),8 patients with post-facial paralysis associated exercise(post-facial paralysis associated exercise group),and 20 healthy volunteers(normal group)were selected as controls.Differences in facial nerve motor conduction velocity,complex muscle action potential latency,and blinking reflex characteristics including R1 latency,R1 amplitude,R2 initiation latency,R2 amplitude,R2 terminal latency,R2'initiation latency recorded on the affected side,R2'amplitude recorded on the affected side,and R2'terminal latency recorded on the affected side were collected and compared.Severity of hemifacial spasm was graded from grade 1 to grade 4 according to Samsung Medical Center scoring system;based on microvascular decompression findings regarding responsible blood vessels contacted with the facial nerve,patients were divided into one responsible blood vessel group and two or more responsible blood vessels group;trends or differences in incidences of increased/prolonged blink reflex indexes among all groups were analyzed.Results No significant difference in facial nerve motor conduction velocity or complex muscle action potential latency was noted among the 4 groups(P>0.05);the hemifacial spasm group had significantly higher R1 amplitude than the trigeminal neuralgia group and post-facial paralysis associated exercise group;additionally,the hemifacial spasm group had significantly higher R2 amplitude,R2'amplitude recorded on the affected side,R2 terminal latency,and R2'terminal latency recorded on the affected side compared with the other 3 groups(P<0.05).Among patients with varying degrees of hemifacial spasm,increased incidences of increased R1 amplitude and prolonged R2 terminal latency were noted with increased spasm degrees,enjoying significant differences(P<0.05).No significant differences in incidences of increased R1 amplitude,increased R2 amplitude,prolonged R2 terminal latency,increased R2'amplitude recorded on the affected side or prolonged R2'terminal latency recorded on the affected side were noted between one responsible blood vessel group and two or more responsible blood vessels group(P>0.05).Conclusion Increased R1 amplitude and prolonged R2 latency in patients with hemifacial spasm further substantiate the pathogenesis of hyperexcitability within facial nerve nucleus.