Objective: To compare the effects of intravenous methylprednisolone (IVMP) in patients with relapsing-remitting (RR-MS), secondary progressive (SP-MS), and primary progressive multiple sclerosis (PP-MS). Methods: Clin...Objective: To compare the effects of intravenous methylprednisolone (IVMP) in patients with relapsing-remitting (RR-MS), secondary progressive (SP-MS), and primary progressive multiple sclerosis (PP-MS). Methods: Clinical and neurophysiological follow up was undertaken in 24 RR-MS, eight SP-MS, and nine PP-MS patients receiving Solu-Medrol 500 mg/d over five days for exacerbations involving the motor system. Motor evoked potentials (MEPs) were used to measure central motor conduction time (CMCT) and the triple stimulation technique (TST) was applied to assess conduction deficits. The TST allows accurate quantification of the number of conducting central motor neurones, expressed by the TST amplitude ratio. Results: There was a significant increase in TST amplitude ratio in RR-MS (p < 0.001) and SP-MS patients (p < 0.02) at day 5, paralleling an increase in muscle force. TST amplitude ratio and muscle force remained stable at two months. In PP-MS, TST amplitude ratio and muscle force did not change. CMCT did not change significantly in any of the three groups. Conclusions: In RR-MS and SP-MS, IVMP is followed by a prompt increase in conducting central motor neurones paralleled by improvement in muscle force, which most probably reflects partial resolution of central conduction block. The lack of similar clinical and neurophysiol ogical changes in PP-MS corroborates previous clinical reports on limited IVMP efficacy in this patient group and points to pathophysiological differences underlying exacerbations in PP-MS.展开更多
文摘Objective: To compare the effects of intravenous methylprednisolone (IVMP) in patients with relapsing-remitting (RR-MS), secondary progressive (SP-MS), and primary progressive multiple sclerosis (PP-MS). Methods: Clinical and neurophysiological follow up was undertaken in 24 RR-MS, eight SP-MS, and nine PP-MS patients receiving Solu-Medrol 500 mg/d over five days for exacerbations involving the motor system. Motor evoked potentials (MEPs) were used to measure central motor conduction time (CMCT) and the triple stimulation technique (TST) was applied to assess conduction deficits. The TST allows accurate quantification of the number of conducting central motor neurones, expressed by the TST amplitude ratio. Results: There was a significant increase in TST amplitude ratio in RR-MS (p < 0.001) and SP-MS patients (p < 0.02) at day 5, paralleling an increase in muscle force. TST amplitude ratio and muscle force remained stable at two months. In PP-MS, TST amplitude ratio and muscle force did not change. CMCT did not change significantly in any of the three groups. Conclusions: In RR-MS and SP-MS, IVMP is followed by a prompt increase in conducting central motor neurones paralleled by improvement in muscle force, which most probably reflects partial resolution of central conduction block. The lack of similar clinical and neurophysiol ogical changes in PP-MS corroborates previous clinical reports on limited IVMP efficacy in this patient group and points to pathophysiological differences underlying exacerbations in PP-MS.
文摘目的 探讨中医针灸辅助现代康复治疗脑梗死患者的疗效观察。方法 选取2018年1月—2022年2月期间张家港市中医医院收治的100例脑梗死患者,按随机数字表法分为对照组与试验组,每组各50例。两组患者均给予脑梗死基础治疗,病情稳定后开展康复训练,在此基础上,对照组给予低频重复经颅磁刺激,试验组给予中医针灸辅助重复经颅磁刺激,均治疗4周。观察比较两组患者临床疗效、中医证候疗效及治疗前后肢体运动功能(Fugl-Meyer Assessment, FMA)、运动诱发电位(Motor evoked potential, MEP)波幅、潜伏期、中枢运动传导时间(Central motor conduction time, CMCT)、神经功能评分[美国国立卫生院卒中量表(National Institutes of Health Stroke Scale, NIHSS)]、自理能力(Self-care ability in daily life, ADL)变化。结果 治疗后试验组临床疗效总有效率95.92%(47/49)优于对照组83.33%(40/48),差异有统计学意义(P<0.05)。治疗后试验组中医证候疗效总有效率91.84%(45/49)优于对照组72.92%(35/48),差异有统计学意义(P<0.05)。治疗后两组患者FMA上、下肢评分及总分均较治疗前升高,差异有统计学意义(P<0.05),且试验组FMA上、下肢评分及总分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者MEP波幅、潜伏期及CMCT均较治疗前改善,差异有统计学意义(P<0.05),且试验组优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NIHSS评分及ADL评分均较治疗前降低,差异有统计学意义(P<0.05),且试验组低于对照组,差异有统计学意义(P<0.05)。结论 中医针灸辅助现代康复技术治疗脑梗死效果显著,有利于改善患者肢体运动功能、MEP、CMCT、神经功能及生活自理能力。
