- 期刊
中樞運動神經誘發電位在預測中風病人運動功能恢復上所佔之角色
Prediction of Motor Recovery Following a Stroke Using Motor Evoked Potential
摘要
本研究共收集79例腦血管阻塞併半身偏癱的病人，利用磁波刺激(electromagnetic stimulation)大腦運動皮質(motor cortex)，比較所誘發的運動神經電位(motor evoked potential, MEP)的潛期(latency)及波幅大小。並在6個月後追蹤中風病人，做詳細的臨床神經學檢查，利用Brunnstrom staging評估患側肢體的運動功能進步情形，同時利用Functional Independence Measure(FIM)評估患者日常生活自我照顧的能力。結果發現中風病人其患側的運動神經誘發電位若出現，不管其電位的潛期較長或振波較小，其患側之運動機能大多較未出現運動神經電位的病人好。臨床上運動機能較好的23例中，只有1例(4.3%)運動神經電位波不出現，反之，在56例運動機能較差的病人中，有48例(86%)未出現運動神經電位波。另一方面觀察運動神經誘發電位在不同部位腦血管病變的差異情形，並與中風6個月後的運動機能及臨床功能作相關性之比較分析。中風部位只在大腦皮質處的10例中，只有1例(10%)不出現運動神經誘發電位波。反之，在27例中風部位含括整個中腦動脈大片地區者，有26例(96%)不出現運動神經電位波。在6個月後的追蹤測試評估，發現早期運動神經電位波出現者，其將來整體運動功能亦較好。
並列摘要
Electromagnetic stimulation of the motor cortex to produce motor evoked potentials (MEP) recorded from the surface electromyogram in skeletal muscleis a painless, safe and non-invasive means of evaluating the descending motor pathway function in humans. Seventy nine ischemic stroke patients with hemiplegia or hemiparesis participated as the control group(in this study. Electromagnetic stimulation was performed to identify the correlation between MEP findings and clinical motor functional status as well as findings of CT scans. In addition, the motor status of the hemiplegic limb was evaluated by using Brunnstrom staging and the functional status of the stroke patient was evaluated by using Functional Independence Measure (FIM). According to those results, cortical MEP findings in stroke patients correlated well with both the motor function status clinically and the brain lesion radiologically. In the twenty seven cases with infarction involving total middle cerebral artery territory (cortical and subcortical areas), the cortical MEP was absent in twenty six (96%). Among the ten cases with infarction only involving the cortical area, the cortical MEP was absent in one (10%) case. Among the fifty six cases with poor motor status, absence of MEP waveform was found in forty eight (86%). In the other twenty three cases who had a better motor status, only one (4.3%) failed to detect MEP waveform. Above findings suggested the potential role of MEP as a predictor of motor recovery following a stroke.
延伸閱讀
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