脑干三叉神经诱发电位研究进展

脑干三叉神经诱发电位 (BTEP)是反应皮层下三叉神经感觉通路传导功能的客观指标。近年来 ,BTEP在疾病诊断、昏迷预后评定及手术监护等领域日益显现出重要性 ,成为又一研究热点。本文就近年来BTEP的研究进展作一综述。     

脑干血管病的脑干三叉神经诱发电位的研究

目的：探讨脑干血管病的脑干三叉神经诱发电位（BTEP）改变及其临床价值。方法：对28例脑干脑血管（出血12例,梗死16例）进行BTEP检测,同时检测干听觉诱发电位（BAEP）,并结合临床资料进行分析。结果：28例脑干血管病患者BTEP正常7例、异常21例（75％）,其中双侧异常13例、单侧异常8例,异常BTEP主要表现为T3、T5波形消失、波幅低下,或峰潜伏期延长,T1－T3、T1－T5波同期延长,BTEP的变化与病情相关,,且较BAEP更灵敏。结论：BTEP可作为评价脑干血管病引起的脑干细胞损伤的可靠电生理学方法。     

脑干三叉神经诱发电位的特征及临床应用研究

目的　探讨正常人脑干三叉神经诱发电位 (BTEP)的波形特征及三叉神经系统病变时BTEP的变化。方法　对 3 0名正常成人进行BTEP检测 ,确定正常值标准 ,并与 2 5例确诊为三叉神经系统病变患者的BTEP检查结果进行比较。结果　 3 0名正常人均记录到清晰、稳定的BTEP反应波。病例组 2 5例中BTEP异常 14例 ( 5 6% ) ,其中双侧异常 6例。 9例有面部感觉障碍者中 8例BTEP异常 ,16例无面部感觉障碍者 6例异常。 5例经脑外科手术证实的脑桥小脑角肿瘤患者 4例异常。 7例行射频治疗者 ,手术前后BTEP无明显变化。周围性病变时 ,BTEP主要表现为T1、T2 波消失或潜伏期延长 ,T1～T3波波间潜伏期差值 (IPLD)延长。中枢性病变时T3、T5波消失或低波幅 ,T1～T5、T2 ～T5波IPLD延长。结论　用无伤害性刺激在正常人可引导出稳定的BTEP反应波。三叉神经系统周围神经和脑干中枢部分病变时 ,BTEP变化明显。BTEP为评价三叉神经周围结构和脑干中枢神经通路功能 ,提供了一个新的、可靠的电生理学方法。     

脑干三叉神经诱发电位对三叉神经根部分切断术的临床应用研究

目的 评价脑干三叉神经诱发电位对三叉神经痛病人三叉神经根切断术的临床应用价值.方法 作者研究了36例经术前MRTA及术中探查除外神经血管接触的三叉神经痛病人,在三叉神经感觉根大部切断术过程中,通过术前、中、后记录BTEP以监测三叉神经传导功能;测定BTEP潜伏期及波幅参量的变化指导手术的进程.结果 36例病人患侧BTEP潜伏期延长、波幅降低,提示三叉神经痛患者三叉神经传导功能损害,术中待BTEP呈一直线后,不再继续切断神经根,术后疼痛均缓解,未遗三叉运动功能障碍.结论 脑干三叉神经诱发电位可以指导选择性三叉神经根切断术并防止三叉神经眼支损害的发生.     

脑干三叉神经诱发电位的刺激方法研究

目的 :研究适于术中监护的脑干三叉神经诱发电位 (BTEP)诱发方法。方法 :分别采用两种方法引导BTEP :①表面电极直接刺激下唇 ;②针状电极穿刺眶下孔直接刺激眶下神经 ,并比较其优、缺点。结果 :针状电极刺激引导出稳定的BTEP波形 ;BTEP包含3个主要波 :W1、W2 和W3 。W1为正波 ,潜伏期 0 79～ 0 85ms ;W2 为负波 ,潜伏期 1 72～ 1 80ms ;W3 为负波 ,潜伏期 2 60～ 2 65ms。结论 :针状电极刺激较表面电极刺激引导BTEP的电位记录效果为好     

家兔脑干三叉神经诱发电位监测方法的研究

目的建立稳定可靠的家兔脑干三叉神经诱发电位的监测方法。方法 20只家兔随机分为两组,每组各10只。两组均使用针形刺激电极,一组穿刺鼻唇沟(穿刺鼻唇沟组),另一组穿刺眶下孔(穿刺眶下孔组),均以Cz-Cv7导联记录家兔三叉神经诱发电位。结果两组刺激阈值和最大刺激强度均无明显差别;穿刺眶下孔组三叉神经诱发电位波形检出率明显高于穿刺鼻唇沟组(χ2=6.6667,P0.01),但刺激产生的肌电伪迹较明显。结论穿刺眶下孔直接刺激眶下神经能够较恒定地监测出三叉神经诱发电位,尽管伪迹较明显,但不影响对波形特征的判断,应用价值较大。     

脑干三叉诱发电位研究进展

脑干三叉诱发电位 (BTEP)是用电生理学方法客观、定量评价三叉神经周围和脑干中枢结构的传导功能的一种方法。本文综述BTEP的检测技术 ,主要电位的神经起源和临床应用研究进展     

脑干三叉神经诱发电位对三叉神经痛微血管减压术的应用研究

目的 评价三叉神经痛微血管减压术前、后三叉神经的传导功能变化，探讨脑干三叉神经诱发电位对三叉神经痛微血管减压术的指导及其对手术预后的评估，探讨微血管减压术的可能机制。方法 14例经术前核磁共振斜矢状位成像证实有神经血管压迫的三叉神经痛的病人，在微血管减压过程中，通过术前、中、后记录早期头皮诱发电位监测三叉神经传导功能。结果 所有病例的术前头皮诱发电位均呈潜伏期延长与波幅降低的改变，显示三叉神经根部的传导功能损害。脑干三叉神经诱发电位证实微血管减压术后，14例病人三叉神经传导功能迅速恢复，术后疼痛均缓解。结论 微血管减压术后三叉神经痛的改善，常与神经生理学数值恢复正常有关，提示神经传导功能的恢复。微血管减压术后电生理参数值的迅速恢复及疼痛缓解，证明这两种现象与髓鞘再生无关。脑干三叉神经诱发电位预测微血管减压术的效果是可靠的。     

50例正常人脑干三叉神经诱发电位分析

目的：探讨无伤害性刺激脑干三叉 电位（ＢＴＥＰ）的检测方法和波形特征。方法：对５０名健康志愿者进行上唇电脉冲刺激,用远场记录法在头皮上记录刺激后１０ｍｓ内出现的反应波,寻找最适宜的刺激和记录参数。部分被试者同时进行脑干听觉诱发电侠（ＢＡＥＰ）和正中神经短潜伏期体感诱发电位检测。结果：５０例正常人均记录到满意的ＢＴＥＰ反应波,其峰潜伏期,波间期值与文献资料近似。     

脑干听觉诱发电位监护在脑干肿瘤手术中的应用研究

目的研究脑干及相应颅神经功能损伤时较敏感的电生理指标,为脑干肿瘤手术提供精确、准确和安全的术中监测手段。方法对18例脑干肿瘤病人,用同一进口监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)连续实时监护,测定手术操作对这些指标的影响。结果脑干肿瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)及Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期(IPL)明显延长(P<0.01),Ⅴ波波幅明显降低(P<0.01),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论BAEP的Ⅴ波潜伏期延长和波幅下降是术中敏感的电生理指标,对其进行监护可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免病人手术后神经功能损伤。     

Auditory evoked potentials recorded intracranially from the brain stem in man

Auditory evoked potentials were recorded in patients undergoing neurosurgical operations to manage cranial nerve dysfunctions. Recordings were made intra-operatively from the distal portion of the eighth nerve, from the entrance of the eighth nerve into the brain stem, and from a site overlying the superior olivary complex (rostral and medial to the entrance of the eighth nerve). The potentials at the three different loci showed characteristic differences: the responses recorded at the entrance of the eighth nerve into the brain stem showed three peaks about 1 ms apart. The earliest peaks had longer latencies than did those recorded at a distal locus on the eighth nerve, which is consistent with what we know about propagation of nerve impulses in the auditory nerve. The responses recorded on the brain stem, rostral-medial to the eighth nerve, also showed three peaks but the amplitude of the third peak was greater than those of the other two. It is assumed that the first peak originates in the auditory nerve, the second peak in the cochlear nucleus, and the third peak in the lateral superior olive. The latencies of these peaks match the latencies of peaks II, III, and IV of scalp-recorded brain stem evoked potentials.     

Localizing brain stem lesions with brain stem auditory evoked potentials

Based on a survey of brain stem auditory evoked potentials (BAEPs) in animals and humans with localized brain stem lesions compared to the recognizability of BAEP components in normal materials, it was concluded that BAEP examination might localize lesions to a high or low level and diffusely within the brain stem. In 155 patients with multiple sclerosis, vascular disorders or other lesions from a neurological department, the involvement of the brain stem was clinically estimated to be negative, situated at a high or low level or diffuse. Correlation between location of the lesions assessed by clinical versus BAEP examination showed correspondence between negative and diffusely abnormal findings, but not with regard to levels within the brain stem. CT-scanning similarly failed to localize lesions to various levels. This was probably due to poorly circumscribed or widespread lesions. The main value of BAEP in neurological patients was to establish clinically silent lesions, especially in patients with multiple sclerosis and only spinal signs.     

Evaluation and graduation of brain stem auditory evoked potentials in patients with neurological diseases

Based on normative data from 40 subjects, criteria for evaluating brain stem auditory evoked potentials have been elaborated. This system contained six grades from normal to diffusely abnormal, and was used in evaluating recordings from 142 patients, including 38 patients with definite and 48 with probable and possible multiple sclerosis, 18 patients with brain stem infarctions, six patients with other organic brain stem lesions, six patients with a postcommotional syndrome and 26 patients without any brain stem involvement. A statistically significant difference was found between normal persons and patients without evidence of brain stem lesions versus patients with such evidence, as well as between subgroups of slightly and severely affected patients. The system was found useful as a way of describing recordings, in company groups of patients and in a follow up of a few patients.     

Usefulness of trigeminal somatosensory evoked potentials to detect subclinical trigeminal impairment in multiple sclerosis patients

Trigeminal somatosensory evoked potentials (TSEPs) by surface electric pulse stimulation were recorded in 30 normal subjects and in 70 multiple sclerosis (MS) patients, 13 of whom presenting clinical trigeminal impairment. We observed significant prolongation of all TSEPs parameters in MS group. TSEPs were abnormal in 45 patients (64.3%). Clinical and neurophysiological data agreed in 36 patients (51%) on 84 sides (60%). TSEPs were able to detect clinically silent lesions 54 times. TSEPs recording proves to be an additional useful test in MS multimodal evoked potential protocols.     

Variations of brain stem auditory evoked potentials correlated to duration and severity of multiple sclerosis

A total of 158 recordings of brain stem auditory evoked potentials (BAEPs) were obtained in 121 patients with multiple sclerosis. A statistically significant increased incidence of abnormality and diffusely abnormal recordings was found with increasing duration and severity of symptoms. Alterations in follow-up recordings might reflect changes in the clinical state, but also occurred in clinically stable patients. These findings suggested that transition from normality of BAEPs might occur either by successive disappearance of the later waves or by uniformly decreasing amplitudes of all the waves to diffusely abnormal recordings. It was concluded that the main value of BAEP recording in patients with multiple sclerosis was to indicate clinically silent lesions, and its value in monitoring the clinical condition of the individual patient was dubious.     

Brain stem auditory and visual evoked potentials in multiple sclerosis

The diagnostic value of the checkerboard pattern-reversal visual evoked potential (VEP) and the random, low rate stimulated brain stem auditory evoked potential (BAEP) was compared in 99 patients with established or suspected multiple sclerosis (MS). In normal subjects examined by both techniques no abnormal recordings were found. In 49 patients with definite MS an incidence of abnormality was found in 100% of VEP and in 84% of BAEP recordings. In 50 patients with probable or possible MS an abnormal VEP was found in 70% and an abnormal BAEP in 50%. When the two examinations were combined, the diagnostic yield increased to 100 and 80%, respectively. 22 patients had only spinal symptoms; in these the VEP gave 73%, the BAEP 55% and the combination 82% abnormalities. The combination of the two techniques was found useful for demonstrating demyelinating lesions in the central nervous system, the diagnostic value being greatest when these lesions were clinically silent.     

Depression and anxiety as a single disorder: evidence from brain stem auditory evoked potentials

Anxiety and depression are often interlinked as demonstrated by clinical, epidemiological, psychopharmacological and even genetic studies. However, robust biochemical and electrophysiological evidence for linkage or separation of mood and anxiety disorders is scarce. Brain stem auditory evoked potentials (BASEP) can easily and non-invasivly be measured in psychiatric patients and reflect neurophysiological processes in the brain stem. The aim of the present study was to evaluate BASEP in drug-free patients suffering from panic disorder or major depression and to compare these to healthy controls. Patients (n = 26; panic = 16, depression = 10) were diagnosed according to Diagnostic and Statistical Manual (DSM)-III-R criteria assessed by the Hamilton Anxiety and Hamilton Depression Scales, and all underwent 3 weeks of medications washout. All subjects (n = 36) completed the study. N3 latency was decreased in the patient group (P < 0.05), N3-5 interval was lengthened (P < 0.05), the N3 latency correlated with anxiety scores and depression scores correlated with the N3 and N5 latency periods. In conclusion, our small sample demonstrated shared electrophysiological variables in panic disorder and depression, further supporting the concept of spectrum disorder.