Brainstem Auditory and Somatosensory Evoked Potential Study in Amphetamine Abusers

安非他命濫用者其腦幹聽覺及體感覺誘發電位之研究

潘昭雄(Chau-Hsiung Pan) ； 李正淳(Cheng-Chun Lee) ； 陳順勝(Shun-Sheng Chen)

《Mid-Taiwan Journal of Medicine》 4卷4期 (1999/12) Pp. 241-248

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

摘要

近年來安非他命在台灣藥物濫用的情況十分令人憂慮，安非他命的藥理特性與其他的擬交感神經胺類似，對中樞神經系統有相當大的刺激作用。有關安非他命濫用者的誘發電位在過去其少有研究報告，因此我們擬定安非他命濫用者的多重誘發電位（含腦幹聽覺及體感覺誘發電位）研究以評估安非他命對中樞神經系統的影響。本研究中共收集了19位安非他命濫用者，這些濫用者都經尿液檢查呈陽性反應，而且距離最後一次使用之時間在多天以內才納入本研究中。另有17位年齡及身高相近之正常志願者作為對照組。這兩組受測者都接受腦幹聽覺誘發電位及正中神經，排神經之體感覺誘發電位檢查。在腦幹聽覺誘發電位方面，安非他命濫用者右邊之I，II，III，IV，V波潛時與左邊第III，IV波潛時，I-III波間潛時，比之對照組有顯著的延長（p＜0.05）。在正中神經體感覺誘發電位方面，安非他命濫用者兩側之N10，N13，N20波潛時都比對照組有意義的延長（p＜0.05），但是所有的波間潛時（即中樞傳導時間）則無顯著的差異。在排神經體感覺誘發電位方面，安非他命濫用者兩側的N22，P40波潛時與對照組比較呈有意義的延長（p ＜0.05），而波間潛時也是沒有顯著的差異。本研究顯示安非他命濫用者之腦幹聽覺誘發電位及體感覺誘發電位在末稍傳導時間大多呈顯著的延長，但在中樞傳導時間則幾乎都沒有顯著的延長，這表示安非他命對周圍神經有電氣生理學可偵測之變化，而中樞神經系統則無。至於中樞傳導時間沒有顯著的延長，作者推測其可能性有三，其一是安非他命左旋，右旋同質異構物的因素，第二點是安非他命以吸入之方法可能在劑量方面不夠大，最後一點則是在臨床上無法在安非他命吸入後，儘快的對濫用者進行誘發電位的檢查。在尿毒症和糖尿病患者之電氣生理學研究常有左右不對稱之現象，而本研究中安非他命濫用者之左右兩邊也呈不對稱之現象，例如右邊之第I，II，V波潛時比左邊延長。

關鍵字

安非他命 ； 腦幹聽覺誘發電位 ； 體感覺誘發電位

並列摘要

Amphetamine is a potent sympathomimetic amine and has a strong stimulatory effect on the central nervous system (CNS). The CNS effects of amphetamine may include neuronal degeneration, axonal degeneration, disruptive effect on polyribosomes and neuronal protein synthesis, altered gene transcription (affect mRNA amounts), and alternations in several proteins (posttranscriptional effects) to induce tolerance. Only a few studies of evoked potentials of amphetamine abusers have been conducted. We developed a multimodal potential study of amphetamine abusers to evaluate the amphetamine effects on the human CNS. Nineteen amphetamine abusers were studied. They all had urine tests positive for amphetamine use within the previous 5 days. Seventeen healthy volunteers, adjusted for age and sex, were recruited for the control group. Brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs) from the median and the tibial nerves were obtained from these amphetamine abusers and healthy volunteers. The BAEPs of amphetamine abusers showed significantly prolonged peak latencies of waves I, III and V on the right side as well as wave III on the left side (p＜0.05). Interpeak latency (IPL) of I-III on the left side was also significantly prolonged (p ＜0.05). The median nerve SEPs study revealed a significant latency prolongation of bilateral waves N10, N13 and N20 (p＜0.05), but no significant prolongation in central conduction time (IPL). In the tibial nerve SEPs, the prolongation of conduction was demonstrated in bilateral waves N22 and P40 (p＜0.05). However, the central conduction time was not significantly prolonged as compared with healthy volunteers. This study reveals that amphetamine abuse had a significant effect on the peripheral nervous system (PNS), but only a small electrophysiological effect on the CNS (just one prolongation of central conduction time of BAEPs in amphetamine abusers). These strong electrophysiological PNS effects and very weak CNS effects of amphetamines may be due to the tolerance effect, timing of axonal degeneration, or racemic amphetamine isomers (the levo-isomer and the dextro-isomer) used. Other explanations such as the quantity of the amount of amphetamine inhaled may not be substantial, as well as the late recording of evoked potential.

並列關鍵字

amphetamine ； brainstem auditory evoked potential (BAEP) ； somatosensory evoked potential (SEP)