Lower Motor Neuron Changes Related to Upper Motor Neuron Lesion: Evidence from Electrophysiological Study in Patients with Hemiplegia

上運動神經元病變導致下運動神經元之變化：偏癱病患神經傳導及肌電圖之驗證

羅瑞寬(Sui-Foon Lo) ； 林千琳(Chien-Lin Lin) ； 孟乃欣(Nai-Hsin Meng) ； 梁秋伴(Chau-Peng Leong) ； 周碩彬(Shuo-Bin Jou) ； 周立偉(Li-Wei Chou) ； 高木榮(Mu-Jung Kao)

《Mid-Taiwan Journal of Medicine》 4卷4期 (1999/12) Pp. 229-234

https://doi.org/10.6558/MTJM.1999.4(4).2

摘要

以往的研究指出腦中風可能導致下運動神經元（lower motor neuron）之退化現象（transynaptic degeneration）。但過去之文獻對偏癱病人患肢之神經傳導及肌電圖發現頗具爭議。故此吾人研究比較偏癱病人患側肢體與健側肢體的電氣生理檢查，藉以了解其兩側差異之特性。本研究選擇住院或於門診接受復健治療之腦中風患者（經病史或理學檢查懷疑有周邊神經病變者，則排除之），共有29名（男性22名，女性7名，平均年齡61.8±10.9歲），檢查其兩側正中神經、尺神經、腔神經、排神經之神經傳導，並進行患、側上下肢肌電圖檢查。以paired t-test比較患側與健側檢查所得數據。在神經傳導方面，患側上肢正中神經及尺神經之近端及遠端複合肌肉電位波（compound motor action potential）之波幅（amplitude）都較健側低（p＜0.01）。患側下肢脛神經之運動神經傳導速度較健側為慢（p＜0.0多）。接受肌電圖檢查之患者共28名，其中12人（43%）於脛骨前肌出現自發性電位。（9人有fibrillation，6人有positive waves）；15人（54%）於外展拇短肌出現自發性電位（11人有fibrillation，10人有positive waves）；10人（36%）同時於外展拇短肌及脛骨前肌出現自發性電位，卡方檢定顯示有統計上之意義。本研究結果支持上運動神經元病變導致下運動神經元退化現象之可能性。

關鍵字

肌電圖 ； 偏癱 ； 下運動神經元 ； 神經傳導速度 ； 上運動神經元

並列摘要

The purposes of our study were to evaluate whether patients with upper motor neuron lesion have functional changes in lower motor neurons, as reflected on nerve conduction velocity (NCV) study and electromyography (EMG), and to investigate the significance of the changes. Twenty-nine patients with hemiplegia due to cerebrovascular accident were included. The patients' ages ranged from 43 to 80 years (average, 61.8±10.9yr). Patients with history or physical findings of peripheral nerve involvement were excluded. Nerve conduction studies of median nerve and ulnar nerve in upper extremities, and tibial nerve and peroneal nerve in the lower extremities, were performed. EMG studies of abductor pollicis brevis and tibialis anterior of the patients with hemiplegia were also carried out. Our nerve conduction studies revealed a significant decreasing in compound motor action potential (CMAP) amplitude of the median and ulnar nerves (p＜0.01), and a significant decreasing in NCV of tibial motor nerve on the hemiplegic side (p＜0.05). EMG examination revealed spontaneous activities in 54% of the hand muscles and 43% of the leg muscles studied on the hemiplegic side. Spontaneous activities tended to occur simultaneously in the upper and lower limb muscles (p＜0.05). Our study supports the hypothesis that there are functional changes in the lower motor neurons as a result of an upper motor neuronal lesion.

並列關鍵字

electromyography ； hemiplegia ； lower motor neuron ； nerve conduction velocity ； upper motor neuron