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首页> 外文期刊>Brain: A journal of neurology >Criteria for conduction block based on computer simulation studies of nerve conduction with human data obtained in the forearm segment of the median nerve
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Criteria for conduction block based on computer simulation studies of nerve conduction with human data obtained in the forearm segment of the median nerve

机译：基于计算机仿真研究的传导阻滞标准，该神经传导利用在正中神经前臂节中获得的人体数据进行

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The finding of conduction block (CB) on nerve conduction studies supports the diagnosis of potentially treatable immune-mediated neuropathies. CB in a number of axons may result in reduction of the compound muscle action potential (CMAP) on proximal versus distal stimulation (decrement). Decrement may also result from increased temporal dispersion (TD) as this leads to desynchronization and phase cancellation of the motor unit action potentials (MUAPs) out of which the CMAP is built up; polyphasia of MUAPs possibly yields additional decrement. To prove the occurrence of CB, decrement has to be larger than can be explained by increased TD or increased phase cancellation. This was established previously by simulations using MUAPs recorded in rats assuming maximal TD. Unfortunately, criteria based on human data and criteria for nerves with limited TD are not available. In the present study, criteria for CB were derived using simulations with thenar surface recorded MUAPs affected by collateral reinnervation that were obtained in patients with lower motor neurone disease (LMND). The effect of TD on decrement was determined for a wide range of TDs in the forearm segment of the median nerve and the segment distal to this. Our criteria for CB were based on area decrement because this was less influenced by TD and more by CB than amplitude decrement. The maximal area decrement in the forearm segment increased as TD in the forearm segment increased but decreased as TD in the distal segment increased. This suggests that, when desynchronization and phase cancellation occur in the distal segment due to TD, less phase cancellation and, therefore, less decrement can occur due to TD in the forearm. The finding that duration prolongation on proximal versus distal stimulation reflected TD within the forearm segment and that distal duration reflected TD in the distal segment allowed proposal of a more flexible set of criteria for forearm segments when TD in the forearm segment is limited or TD in the distal segment is pronounced. A separate investigation showed that the maximal TD in chronic inflammatory demyelinating polyneuropathy was within the range of our simulations, indicating that these were realistic. Our criteria were validated retrospectively in patients with multifocal motor neuropathy and patients with LMND. In the forearm segment of the median nerve, our criteria were more sensitive and equally specific for CB as compared with criteria for CB based on the study using rats. Our criteria have to be evaluated prospectively.
机译：在神经传导研究中发现传导阻滞（CB）支持诊断可能治疗的免疫介导的神经病。许多轴突中的CB可能会导致近端刺激与远端刺激（减量）的复合肌肉动作电位（CMAP）降低。减小还可能是由于时间分散（TD）增加而引起的，因为这会导致建立CMAP的电机单元动作电位（MUAP）失步和相位抵消; MUAP的多相性可能会导致额外的减少。为了证明CB的出现，减小的幅度必须大于TD增大或相位抵消增大所能解释的范围。这是通过使用假定最大TD的大鼠中记录的MUAP通过模拟建立的。不幸的是，尚无基于人类数据的标准和TD受限的神经的标准。在本研究中，CB的标准是通过使用模拟的方法得出的，该模拟的方法是在下运动神经元疾病（LMND）患者中获得受旁侧神经支配的经narnar表面记录的MUAP。对于正中神经的前臂节段及其远端节段中的大范围的TD，确定了TD对递减的影响。我们的CB标准基于面积递减，因为与幅度递减相比，它受TD的影响较小，而受CB的影响更大。前臂节段的最大面积减少量随前臂节段的TD的增加而增加，但随着远端节段的TD的增加而减小。这表明，当由于TD而在远端节段发生失步和相抵消时，由于前臂中的TD引起的相抵消减少，因此减少的幅度也较小。当前臂节段中的TD受限制或前臂节段中的TD受限制时，近端刺激与远端刺激的持续时间延长反映了前臂节段中的TD，而远端持续时间反映了远端节段中的TD的发现，允许为前臂节段提出一套更为灵活的标准。远端节段明显。另一项调查显示，慢性炎症性脱髓鞘性多发性神经病的最大TD在我们的模拟范围内，表明这些是现实的。我们的标准在多灶性运动神经病患者和LMND患者中进行了回顾性验证。根据对大鼠的研究，与正中神经的标准相比，在正中神经的前臂节中，我们对中神经的标准更为敏感且具有相同的特异性。我们的标准必须进行前瞻性评估。

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