运动神经元病和帕金森病的经颅磁刺激运动诱发电位分析与疾病分型和病程的相关性研究

Correlation Study of TMS-MEP Analysis with Disease Type And Course in Motor Neurone Disease and Parkinson's Disease

目的探讨运动神经元病和帕金森病的经颅磁刺激运动诱发电位(TMS-MEP),分析与疾病分型和病程的相关性。方法共收集2020年7月至2024年3月在安徽中医药大学神经病学研究所附属医院住院的运动神经元病(MND)患者20例(MND组),帕金森病(PD)患者12例(PD组),以及同期健康体检者10名(正常对照组),均行经颅磁刺激TMS-MEP检查,并收集临床资料。比较3组受试者MEP波幅、MEP潜伏期以及MEP波形参数,采用Pearson相关性分析MEP波幅、MEP潜伏期参数与病程的相关性。结果肌萎缩侧索硬化(ALS)患者首发症状以上肢无力、下肢无力为主,而PD患者首发症状以上肢、下肢抖动僵硬为主。ALS组、PD组、对照组的MEP潜伏期、MEP波幅差异有统计学意义,其中PD组MEP潜伏期相较对照组无差异(P>0.05),而明显低于ALS组(P<0.05)。PD组MEP波幅低于对照组,高于对ALS组(P<0.05)。ALS和PD患者的MEP波形存在差异(P<0.05),其中ALS组患者以2级为主,而PD患者以1级为主。Pearson相关性分析显示,ALS患者MEP潜伏期与病程呈正相关性(r=0.539,P<0.05),PD患者MEP波幅与病程呈负相关性(r=-0.438,P<0.05)。结论TMS-MEP检查可有效评估PD、ALS。ALS患者MEP潜伏期明显增加,波幅明显减低,病程越长则MEP潜伏期越长;PD患者MEP潜伏期较健康人群无明显变化,而波幅略有降低,病程越长MEP波幅降低越明显。

Objective To investigate the correlation between Transcranial magnetic stimulation motor evoked potential(TMS-MEP)and disease types and course evoked in motor neurone disease and Parkinson's disease.Methods A total of 20 patients with motor neuron disease(MND)admitted to the Affiliated Hospital of Institute of Neurology,Anhui University of Chinese Medicine from July 2020 to March 2024(MND group),12 patients with Parkinson's disease(PD group),and 10 healthy physical examination subjects(normal control group)during the same period were collected.Transcranial magnetic stimulation TMS-MEP was performed and clinical data were collected.MEP amplitude,MEP latency and MEP waveform parameters of the three groups were compared,and the correlation between MEP amplitude,MEP latency parameters and disease course was analyzed by Pearson correlation.Results Among the enrolled patients,the first symptoms of amyotrophic lateral sclerosis patients were mainly upper limb weakness and lower limb weakness,while the first symptoms of PD patients were mainly upper limb and lower limb jitter stiffness.The MEP latency and MEP amplitude of ALS group,PD group and control group had statistical significance,and the MEP latency of PD group had no significant difference compared with the control group(P>0.05),but was significantly lower than that of ALS group.MEP amplitude in PD group was lower than that in control group,but higher than that in ALS group(P<0.05).There were significant differences in MEP waveform between ALS and PD patients(P<0.05),among which grade 2 was dominant in ALS patients and grade 1 was dominant in PD patients.Pearson correlation analysis showed that the latency of MEP in ALS patients was positively correlated with the course of the disease(r=0.539,P<0.05).MEP amplitude in PD patients was negatively correlated with the course of disease(r=-0.438,P<0.05).Conclusions TMS-MEP test can effectively evaluate PD and ALS.The latency period of MEP in ALS patients is significantly increased,and the amplitude is significantly reduced.The longer the course of disease,the longer the latency period of MEP.The latency period of MEP in PD patients has no significant change compared with healthy people,but the amplitude of MEP is slightly reduced,and the longer the course of disease,the more obvious the decrease of MEP amplitude.