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IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2024-12-21 DOI:10.1111/ene.70001

Paulina Simonne Scheuren, Markus Hupp, Nikolai Pfender, Maryam Seif, Carl Moritz Zipser, Florian Wanivenhaus, José Miguel Spirig, Michael Betz, Patrick Freund, Martin Schubert, Mazda Farshad, Armin Curt, Michèle Hubli, Jan Rosner

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引用次数: 0

摘要

背景磁共振成像可提示退行性颈椎病（DCM）中的脊髓压迫和结构性病变，但不能显示脊髓通路的功能障碍。我们的目的是评估接触热诱发电位（CHEPs）在核磁共振成像之外的价值，并假设异常的接触热诱发电位在 DCM 中可能与核磁共振成像病变无关，并且与动态机械性脊髓应力有关。方法对 DCM 患者进行神经系统检查，包括节段感觉（针刺、轻触）和运动测试。评估 T2 加权磁共振成像（T2 阳性/阴性）是否存在高强度信号。相位对比核磁共振成像用于评估脊髓运动，作为动态机械应力的指标。在刺激 C6、C8 和 T4 皮节（仅 CHEPs）后记录皮节体感诱发电位和 CHEPs，以评估脊髓完整性。结果在 138 名参与研究的患者中（年龄 56 ± 13 岁），35%（48 人）表现为 T2 阳性 DCM，65%（90 人）表现为 T2 阴性 DCM。T2 阳性 DCM（C6:41%；C8:32%；T4:24%）和 T2 阴性 DCM（C6:35%；C8:54%；T4:26%）中均存在 CHEPs 异常。C6 和 C8 的多节段 CHEP 异常与脊髓运动增加（p = 0.030；ϵ2 = 0.072）、上肢针刺减少（p = 0.046；ϵ2 = 0.063）和运动评分降低（p = 0.005；ϵ2 = 0.108）有关。结论 CHEPs 揭示了独立于结构性 T2 阳性病变的脊髓损伤的独特模式，这些模式与脊髓运动测量相关。因此，除了核磁共振成像外，CHEPs 对脊髓完整性的诊断提供了宝贵的补充见解。这对于初发脊髓病尤其重要，可为早期诊断提供依据，并在出现明确的脊髓病变之前及时采取干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Contact heat evoked potentials reveal distinct patterns of spinal cord impairment in degenerative cervical myelopathy beyond MRI lesions

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Contact heat evoked potentials reveal distinct patterns of spinal cord impairment in degenerative cervical myelopathy beyond MRI lesions

Background

Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.

Methods

Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing. The presence or absence of hyperintense signal on T2-weighted MRI (T2-positive/negative) was assessed. Phase-contrast MRI was used to assess spinal cord motion as an indicator of dynamic mechanical stress. Dermatomal somatosensory evoked potentials and CHEPs were recorded after stimulation of dermatomes C6, C8, and T4 (CHEPs only) to assess spinal cord integrity.

Results

Of 138 individuals included in this study (age 56 ± 13 years), 35% (N = 48) presented with T2-positive and 65% (N = 90) presented with T2-negative DCM. Abnormal CHEPs were present in T2-positive DCM (C6:41%; C8:32%; T4:24%) and T2-negative DCM (C6:35%; C8:54%; T4:26%). Multisegmental CHEP abnormalities at C6 and C8 were related to increased spinal cord motion (p = 0.030; ϵ² = 0.072), and reduced upper extremity pinprick (p = 0.046; ϵ² = 0.063) and motor scores (p = 0.005; ϵ² = 0.108).

Conclusions

CHEPs revealed distinct patterns of spinal cord impairment independent of structural T2-positive lesions, which were associated with measures of cord motion. CHEPs thus provide valuable complementary diagnostic insights into spinal cord integrity beyond MRI. This is especially important in incipient myelopathy to inform early diagnosis and timely interventions before the development of definite cord lesions.

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).