神经系统器质性病变儿童痉挛综合征的临床和神经肌电图特点

I. A. Zorii, N. Vasylieva, I. Krychun, O. M. Nicka, I.B. Kharmanska
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摘要

时事性。中枢神经系统器质性病变(CNS)是由影响大脑的各种病理因素引起的一组神经精神疾病。小儿脑瘫(ICP)是儿童早期最常见的神经系统疾病。80%的ICP患儿患有痉挛形式,其主要症状是肌肉张力异常增加-痉挛。这种综合征可以通过神经肌电图(ENMG)检查客观化,可以对神经肌肉系统状态进行定性和定量评估。目的:探讨颅内压患儿痉挛综合征在运动障碍程度上的临床和神经肌电图特征。材料和方法。122例ICP患儿(平均年龄8岁,8±3.7岁),根据大肌肉运动功能扩展与修订分类(GMFCS E&R)结果进行分组。所有患者均行神经学检查和ENMG检查。通过对h反射和f波参数的分析,评价神经系统损伤的节段上和节段水平。痉挛形式的ICP被诊断在大多数检查的儿童。骨科病理更常见于有明显运动障碍的ICP患儿,包括马蹄外翻位和平外翻足畸形。根据ENMG参数,ICP患者表现为传导障碍,表现为М反应幅度增加,特别是在胫骨神经测试中,Нmах/Мmах比增加,Н-reflex和f波振幅增加。根据所进行的研究结果,根据大运动功能分类,ENMG参数在恶化侧的变化取决于运动活动障碍的程度。
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Clinical and electroneuromyographic peculiarities of spastic syndrome in children with organic lesions of the nervous system
Topicality. Organic lesions of the central nervous system (CNS) are a group of neuropsychiatric disorders caused by various pathological factors affecting the brain. Infantile cerebral palsy (ICP) is the most common neurological disease diagnosed in children at an early age. 80 % of children with ICP suffer from spastic forms, the main symptom of which is an abnormal increase in muscle tone – spasticity. This syndrome can be objectified by electroneuromyographic (ENMG) examination which enables qualitative and quantitative assessments of the nervousmuscular system state.Objective: to determine clinical and electroneuromyographic peculiarities of the spastic syndrome of ICP children depending on the intensity of motor disorders.Materials and methods. 122 ICP children were examined (an average age 8,8 ± 3,7 years) and distributed into groups by the results of Gross Motor Function Classification Expanded & Revised (GMFCS E&R). All the patients underwent careful neurological examination and ENMG examination. To assess suprasegmental and segmental levels of nervous system lesions, the parameters of H-reflex and F-wave were analyzed.Results. Spastic forms of ICP were diagnosed in the majority of the examined children. Orthopedic pathology was found more often among ICP children with marked motor disorders, including equinovalgus position and planovalgus foot deformity. According to ENMG parameters ICP patients presented conduction disorders manifested by increased amplitude of М response, especially in testing the tibial nerve, increased Нmах/Мmах ratio and the amplitudes of Н-reflex and F-wave.Conclusions. According to the results of the conducted study, ENMG parameters changed on the side of deterioration depending on the degree of motor activity disorders by Gross Motor Function Classification.
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