偏头痛的神经心理和神经电生理对比研究
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摘要
目的：探讨偏头痛患者的神经心理及电生理改变，对比研究偏头痛间歇期、发作期的神经心理和神经电生理的变化特点，寻找敏感指标，揭示神经心理和神经电生理之间的相关性。方法：对72例偏头痛发作期及间歇期患者，18例其他头痛患者及25例健康对照进行神经心理检查，包括成套H-R神经心理量表、韦氏成人智力量表简式四合一测验、临床记忆量表甲套检测表，并同期进行TCD、BAEP、BEAM、P_(300)检查的对比及相关研究。结果：偏头痛患者在连线甲时间、连线乙时间、语音测验、右手敲击、触摸三项测验、范畴测验，木块图测验、指向记忆、联想记忆、图象记忆测验的粗分及MQ较健康组差；偏头痛患者中发作期组在连线乙时间、范畴测验、触摸总时间、触摸记形测验成绩明显差于发作间歇期组；偏头痛患者TCD检查发现有多根血管的血流动力学异常，其中以MCA、VA、BA的Vm增高为主要表现；BAEP检查发现患者的Ⅲ波、Ⅳ波、Ⅴ波的PL值较健康对照组明显延长，Ⅰ-Ⅴ、Ⅲ-Ⅴ的IPL比健康对照组延长；BEAM检查发现多个部位δ、θ频段的功率值增高，α频段的功率值则表现为降低；P_(300)检查发现Fz、Cz、Pz点的N_2、P_3波峰潜伏期明显延长，波幅则在Cz、Pz点的P_3波有缩短。神经心理和神经电生理的对比研究发现，偏头痛患者FIQ、MQ与P_(300)的波幅呈正相关、与潜伏期呈负相关，IQ均与BAEP双侧Ⅲ-Ⅴ、右侧Ⅰ-Ⅴ的峰间值呈负相关，PIQ、FIQ与Ⅴ波峰潜值也呈负相关；DQ与P_3潜伏期呈正相关关系；P_3波潜伏期与触摸记形、触摸记位负相关，P_3波幅与木块图测验、图画排列测验正相关。结论：偏头痛患者可以出现多项神经心理测验及TCD、BAEP、BEAM、P_(300)的异常，通过神经心理测验与电生理检查结合的比较研究，发现连线乙次数、触摸记位、椎动脉的血流速度、BAEP的Ⅴ波峰潜值为偏头痛脑机能改变的重要指标，可客观的判断偏头痛患者的高级神经功能改变，全面的反映患者脑机能变化。
Objective:To investigest the disorder of neuropsychological function and neurophysiological inspection in migraineurs, and to compare the trait of neuropsychological function and electroneurophysiological examination ,and we can find sensitive and special index between interictal and ictal in migraine. Then we can open out the correlation between neuropsychological examination and electroneurophysiological Inspection.
Methods: 72 migraineurs ,18 patients of another type headache and 25 controls were studied..the people were inspected neuropsychological examination, contain Halstead-Reitan neuropsychological battery ( HRB ) ,the simple Wechsler adult intelligence scale (WAIS) and clinical memory scale.The part of patients were also examinaed Transcranial Doppler sonography (TCD) brainstem auditory evoked potentials (BAEP),brain electrical activity mapping(BEAM). event-related potentials (P300) in the same term. Then we can use the date to have the comparative and correlative study.
Results: There have significantly performance change between the patients and the comtrols in many neuropsychological battery contain trail making test,the right finger tapping test,the tactual performance test,the speech-sound perception test,the category test,block design,direction memory,associated memory,picture memory and Memory quotient(MQ),the same as in the interictal and ictal of migraineurs on trail making test,the tactual performance test,the category test.Through TCD,we can find the change of blood speed,and the most obvious variation exist the higher blood flow velictoy at middle cerebral artery (MCA), vertebral artery(VA).basiliar artery(BA) .There have prolonger potentials latency of III, IV, V waves in migraine of BAEP to compare with the controls.The interpeak latency of I -V. III- V were also prolonged in migraine.The power in deta and theta of BEAM in migraineurs were
increase,but the power of alpha was decrease. The migraineurs appear abnormal in Migraine patients differente significantly from control subjects on several parameters, longer latencies (Fz, Cz, Pz) of N2.P3 waves and lower amplitudes(Cz, Pz ) of P3 was found in patients. Through the comparison of neuropsychological inspection and electroneurophysiological examination ,we can find there have positive correlation between full Intelligence quotient(FIQ),MQ and amplitude of P3oo,negative correlation between FIQ,MQ and latencies of P300. The interpeak latency of I -V, III-Vand potentials latency of V waves have negative relationship with IQ, but the defection quotient(DQ) and latencies of P300 are positeive correlation.We found the correlatio between amplitude of P300 and the tactual performance test,latencies of P300 and block design,picture arragement.
Conclusion:There abnormality of several neuropsychological battery and the examination of TCD, BAEP, BEAM, P300 were showed in migraineurs. The sensitive index of evaluating the cerebral function in migraineurs are performance of trail making test,the tactual performance test,the velocity of VA, potentials latency of V wave. The combination of neuropsychological examination and electroneurophysiological inspection, can objectively estimate the change of the migraineurs' advanced neurological function and comprehensively reflect the transformation of migraineurs' brain.
Objective:To investigest the disorder of neuropsychological function and neurophysiological inspection in migraineurs, and to compare the trait of neuropsychological function and electroneurophysiological examination ,and we can find sensitive and special index between interictal and ictal in migraine. Then we can open out the correlation between neuropsychological examination and electroneurophysiological Inspection.
Methods: 72 migraineurs ,18 patients of another type headache and 25 controls were studied..the people were inspected neuropsychological examination, contain Halstead-Reitan neuropsychological battery ( HRB ) ,the simple Wechsler adult intelligence scale (WAIS) and clinical memory scale.The part of patients were also examinaed Transcranial Doppler sonography (TCD) brainstem auditory evoked potentials (BAEP),brain electrical activity mapping(BEAM). event-related potentials (P300) in the same term. Then we can use the date to have the comparative and correlative study.
Results: There have significantly performance change between the patients and the comtrols in many neuropsychological battery contain trail making test,the right finger tapping test,the tactual performance test,the speech-sound perception test,the category test,block design,direction memory,associated memory,picture memory and Memory quotient(MQ),the same as in the interictal and ictal of migraineurs on trail making test,the tactual performance test,the category test.Through TCD,we can find the change of blood speed,and the most obvious variation exist the higher blood flow velictoy at middle cerebral artery (MCA), vertebral artery(VA).basiliar artery(BA) .There have prolonger potentials latency of III, IV, V waves in migraine of BAEP to compare with the controls.The interpeak latency of I -V. III- V were also prolonged in migraine.The power in deta and theta of BEAM in migraineurs were
increase,but the power of alpha was decrease. The migraineurs appear abnormal in Migraine patients differente significantly from control subjects on several parameters, longer latencies (Fz, Cz, Pz) of N2.P3 waves and lower amplitudes(Cz, Pz ) of P3 was found in patients. Through the comparison of neuropsychological inspection and electroneurophysiological examination ,we can find there have positive correlation between full Intelligence quotient(FIQ),MQ and amplitude of P3oo,negative correlation between FIQ,MQ and latencies of P300. The interpeak latency of I -V, III-Vand potentials latency of V waves have negative relationship with IQ, but the defection quotient(DQ) and latencies of P300 are positeive correlation.We found the correlatio between amplitude of P300 and the tactual performance test,latencies of P300 and block design,picture arragement.
Conclusion:There abnormality of several neuropsychological battery and the examination of TCD, BAEP, BEAM, P300 were showed in migraineurs. The sensitive index of evaluating the cerebral function in migraineurs are performance of trail making test,the tactual performance test,the velocity of VA, potentials latency of V wave. The combination of neuropsychological examination and electroneurophysiological inspection, can objectively estimate the change of the migraineurs' advanced neurological function and comprehensively reflect the transformation of migraineurs' brain.
引文
1 FraLe-Pira,-F;Zappala,-G;Giuffrida,-S.et al.Memory disturbances in migraine with and without aura:a strategry problem? Cephalalgia,2000 Jun;20(5):475-8
2 Framer,-K;Cady,-R;Bleiberg,-J,etal.A pilot study to measure cognitive efficiency during migraine.Headache.2000 Sep;40(8):657-61
3 艾清龙，王荪．偏头痛的神经及高级神经功能障碍．国外医学神经病学神经外学，1988(6)：288-290
4 王素珍，唐俊英，丁铭臣等，偏头痛患者的定量脑电图研究．中华神经病学杂志．1996，29(1)：49-52
5 何小峡、陈芷若．经颅多普勒在偏头痛中的应用．国外医学内科学分册．1997，24(6)：259-261
6 La-spina-I;Calloni-MV;Porazzi-D.Transcranial Doppler monitoring of a migraine with aura attack from prodromal phase to the nd.Headache. 1994.Nov-Doc;34(10): 539-6.
7 Chernyshev,-O-Y;Vein, A-M;Mathew,-N-T;etal.Blood flow velocity and pulsatility index differences in patiences with unilateral migraine. Headache.2001 Jul-Aug;41 (7):704-9
8 艾清龙，王荪，蒲道学．偏头痛病人的神经心理研究．中华神经精神科杂志．1992，25(2)：92-95
9 Calandre,-E-P,Bembibre,-J;Arnedo,-M-L;Cognitive disturbances and cerebral blood flow abnormalities in migraine patients:their relationship with the clinical manifestion of the illness. C ephalalgia. 2002. May;22(4) :291-302
10 Jensen K,etal Classec Migraine: approspectire reports of symptoms. Acta Neurol scand ;1986,73:359;
11 Hooker WD etal. Neuropsychologic alterations in classic and common migraing.Arch Neurol 1986,43:709;
12 Headache Classification Connittee of international Headache Society classification and diagnostic critera for headache disorders, cranial neuralgias and facial pain, cephalagia. 1988,8:1-96.
13 孙增华，杨玉金．偏头痛诊断、疗效评定标准意见．中风与神经疾病杂志 1995
12(2)：110；
14 谭郁玲，临床脑电图与脑电地形图学，人民卫生出版社 1999年2月第一版：49，330
15 Farmer, etal. Sumatriptan nasal spray and cognitive function during migraine: results of an open-label study. Headache. 2001 Apr; 41 (4): 377-84
16 Jelicic, etal. Does migraine headache affect cognitive function in the elderly? Report from the Maastricht Aging Study (MAAS). Headache. 2000 Oct; 40(9): 715-9
17 Meyer, Reversible cognitive decline accompanies migraine and cluster headaches. Headache. 2000 Sep; 40(8): 638-46
18 erti,etal.Event-related potentians in posttraumtic headache.Headache 2001;41(6):579-85
19 Scher P,Bauer H,Baum K,etal.Alternate finger tapping test in patients with migraine.Acta Neurol Scand 1997;96:392-396
20 Spierings,Pathogenesis of the migraine attack. Clin-J-Pain.2003 Jul-Aug; 19(4 )255-62
21 Koker, etal.The new pathogenesis of migraine.Pain Clinical Updates,2001,9:1-4
22 牛永华，张铁山，(衤羔)敏．偏头痛的超声多普勒研究，中国医学影像技术 2002：18(4)311-313，
23 Chernyshev, -O-Y, ETAL. Blood flow velocity and pulsatility index differences in patients with unilaterial migraine.Headache.2001 Jul-AUG;41(7):704-709
24 李金凤，毛善平，段申汉．20例偏头痛患者TCD分析，卒中与神经疾病，2001：8(4)243-244，
25 e-Benedittis,-G, etal. CBF change during headache-free periodes and spontaneous/induced attacks in migraine with and without aura:a TCD and SPECT comparison study.J-Neurosurg-Sci. 1999;Jun; 141-6;discussion 146-7
26 Drake MF, etal.Visual and auditory evoked potentials in migraine. Electromyogr Clin Neuropsyiol, 1999,39;98-100
27 雷革胜，井晓荣，刘思扬等，偏头痛间歇期经颅多谱勒超声、脑干诱发电位及瞬目反射改变，中国临床康复 2002，6(18)：2740-2741
28 Kochar,-K,etal. Visual evoked potential & brainstem auditory evoked potentials in acute & after the attack of migraine. Electromyogr-Clin-Neurophysiol. 2002. Apr-May;42(3): 175-9,
29 陈伦斌，刘乃河．偏头痛患者的定量脑电图研究．广东医学，2000，21(7)：581-582
30 de-Tommas,-M;Scriruicchio,-V;Guido,-M, etal.EEG spectral analysis in migraine without aura attacks. Cephalalgia. 1998 Jul-Aug; 18(6):324-8
31 Wang,-w, etal.Cognitive function in migraine without aura between attacks:a psychophysiological approach using the "oddball" paradigm. Neurophysiol-Clin. 1995; 25(1):3-11
32 Legrain,-V, etal.Clinical and pathophysiological contribution of event-related potentials used to study migraine headache. Rev-Neurol-(Paris). 2001 Apr; 157(4): 365-75;
33 Wang, etal.Interictal potentiation of passive "oddball"auditory event-related potentials in migraine.Cephalalgia. 1998,Jun; 18(5):261-5;discussion 241;
34 朱榆红，张丽华、张德芳．偏头痛患者的事件相关电位P300研究，中华医学研究杂志，2004：4(4)：295-297
35 Mcgarry-Robats PA.Event-ralated potentials (ERP) correlates of performance of intelligencetests. Intelligence, 1997,16:385-397,
36 姚静，孙学礼，刘涛生等，健康成人事件相关电位与神经心理学测验的相关性研究，中华精神科杂志，2003，36(3)：167-170
37 Polich J.P300 in clinical application:meaning, method and measurement.Am J EEG Technol, 1997,31:211-219
38 傅求真，井晓荣，罗宇．偏头痛患者的性格、情感与认知功能改变．第四军队大学学报，2003：24(14)：1307-1310．
2 Framer,-K;Cady,-R;Bleiberg,-J,etal.A pilot study to measure cognitive efficiency during migraine.Headache.2000 Sep;40(8):657-61
3 艾清龙，王荪．偏头痛的神经及高级神经功能障碍．国外医学神经病学神经外学，1988(6)：288-290
4 王素珍，唐俊英，丁铭臣等，偏头痛患者的定量脑电图研究．中华神经病学杂志．1996，29(1)：49-52
5 何小峡、陈芷若．经颅多普勒在偏头痛中的应用．国外医学内科学分册．1997，24(6)：259-261
6 La-spina-I;Calloni-MV;Porazzi-D.Transcranial Doppler monitoring of a migraine with aura attack from prodromal phase to the nd.Headache. 1994.Nov-Doc;34(10): 539-6.
7 Chernyshev,-O-Y;Vein, A-M;Mathew,-N-T;etal.Blood flow velocity and pulsatility index differences in patiences with unilateral migraine. Headache.2001 Jul-Aug;41 (7):704-9
8 艾清龙，王荪，蒲道学．偏头痛病人的神经心理研究．中华神经精神科杂志．1992，25(2)：92-95
9 Calandre,-E-P,Bembibre,-J;Arnedo,-M-L;Cognitive disturbances and cerebral blood flow abnormalities in migraine patients:their relationship with the clinical manifestion of the illness. C ephalalgia. 2002. May;22(4) :291-302
10 Jensen K,etal Classec Migraine: approspectire reports of symptoms. Acta Neurol scand ;1986,73:359;
11 Hooker WD etal. Neuropsychologic alterations in classic and common migraing.Arch Neurol 1986,43:709;
12 Headache Classification Connittee of international Headache Society classification and diagnostic critera for headache disorders, cranial neuralgias and facial pain, cephalagia. 1988,8:1-96.
13 孙增华，杨玉金．偏头痛诊断、疗效评定标准意见．中风与神经疾病杂志 1995
12(2)：110；
14 谭郁玲，临床脑电图与脑电地形图学，人民卫生出版社 1999年2月第一版：49，330
15 Farmer, etal. Sumatriptan nasal spray and cognitive function during migraine: results of an open-label study. Headache. 2001 Apr; 41 (4): 377-84
16 Jelicic, etal. Does migraine headache affect cognitive function in the elderly? Report from the Maastricht Aging Study (MAAS). Headache. 2000 Oct; 40(9): 715-9
17 Meyer, Reversible cognitive decline accompanies migraine and cluster headaches. Headache. 2000 Sep; 40(8): 638-46
18 erti,etal.Event-related potentians in posttraumtic headache.Headache 2001;41(6):579-85
19 Scher P,Bauer H,Baum K,etal.Alternate finger tapping test in patients with migraine.Acta Neurol Scand 1997;96:392-396
20 Spierings,Pathogenesis of the migraine attack. Clin-J-Pain.2003 Jul-Aug; 19(4 )255-62
21 Koker, etal.The new pathogenesis of migraine.Pain Clinical Updates,2001,9:1-4
22 牛永华，张铁山，(衤羔)敏．偏头痛的超声多普勒研究，中国医学影像技术 2002：18(4)311-313，
23 Chernyshev, -O-Y, ETAL. Blood flow velocity and pulsatility index differences in patients with unilaterial migraine.Headache.2001 Jul-AUG;41(7):704-709
24 李金凤，毛善平，段申汉．20例偏头痛患者TCD分析，卒中与神经疾病，2001：8(4)243-244，
25 e-Benedittis,-G, etal. CBF change during headache-free periodes and spontaneous/induced attacks in migraine with and without aura:a TCD and SPECT comparison study.J-Neurosurg-Sci. 1999;Jun; 141-6;discussion 146-7
26 Drake MF, etal.Visual and auditory evoked potentials in migraine. Electromyogr Clin Neuropsyiol, 1999,39;98-100
27 雷革胜，井晓荣，刘思扬等，偏头痛间歇期经颅多谱勒超声、脑干诱发电位及瞬目反射改变，中国临床康复 2002，6(18)：2740-2741
28 Kochar,-K,etal. Visual evoked potential & brainstem auditory evoked potentials in acute & after the attack of migraine. Electromyogr-Clin-Neurophysiol. 2002. Apr-May;42(3): 175-9,
29 陈伦斌，刘乃河．偏头痛患者的定量脑电图研究．广东医学，2000，21(7)：581-582
30 de-Tommas,-M;Scriruicchio,-V;Guido,-M, etal.EEG spectral analysis in migraine without aura attacks. Cephalalgia. 1998 Jul-Aug; 18(6):324-8
31 Wang,-w, etal.Cognitive function in migraine without aura between attacks:a psychophysiological approach using the "oddball" paradigm. Neurophysiol-Clin. 1995; 25(1):3-11
32 Legrain,-V, etal.Clinical and pathophysiological contribution of event-related potentials used to study migraine headache. Rev-Neurol-(Paris). 2001 Apr; 157(4): 365-75;
33 Wang, etal.Interictal potentiation of passive "oddball"auditory event-related potentials in migraine.Cephalalgia. 1998,Jun; 18(5):261-5;discussion 241;
34 朱榆红，张丽华、张德芳．偏头痛患者的事件相关电位P300研究，中华医学研究杂志，2004：4(4)：295-297
35 Mcgarry-Robats PA.Event-ralated potentials (ERP) correlates of performance of intelligencetests. Intelligence, 1997,16:385-397,
36 姚静，孙学礼，刘涛生等，健康成人事件相关电位与神经心理学测验的相关性研究，中华精神科杂志，2003，36(3)：167-170
37 Polich J.P300 in clinical application:meaning, method and measurement.Am J EEG Technol, 1997,31:211-219
38 傅求真，井晓荣，罗宇．偏头痛患者的性格、情感与认知功能改变．第四军队大学学报，2003：24(14)：1307-1310．