痉挛性斜颈中感觉诡计的临床特征以及感觉诡计与空间辨别觉关系的探究
发布时间：2018-08-13 21:18
【摘要】：背景： 痉挛性斜颈(cervical dystonia, CD)是局灶性肌张力障碍的常见类型,主要临床表现为颈部肌肉的异常收缩导致了头颈部的姿势异常和／或运动增多。而感觉诡计(sensory trick, ST)现象是其经典的临床特征之一。感觉诡计是指患者可以通过一些特定的动作,暂时减轻斜颈的姿势和运动异常。根据感觉诡计是否需要用力,可将其分为“经典型”感觉诡计(classical sensory trick, CST)和“用力型”感觉诡计(forcible sensory trick, FST)。感觉诡计的方向与头偏转的方向之间是否有关仍存在争议。感觉诡计的有效程度、作用时间长短究竟与哪些因素相关；CST与FST的作用机制是否相同；FST是否仅仅通过对抗异常运动发挥作用；这些问题都没有定论。感觉诡计的机制仍是不解之谜。除感觉诡计现象外,还有许多证据表明局灶性肌张力障碍的患者存在感觉系统的异常,如时间辨别觉与空间辨别觉的异常。这些异常与感觉诡计的有效性之间是否相关也尚无定论。 目的： 本研究通过调查痉挛性斜颈患者中感觉诡计的临床特征及其相关因素,着重对比“经典型”感觉诡计与“用力型”感觉诡计,结合感觉诡计与空间辨别觉之间关系的研究,探究感觉诡计的作用机制。 方法： 对北京协和医院神经科运动障碍专病门诊的痉挛性斜颈患者进行标准问卷调查与临床评估,具体包括患者的一般情况、起病年龄、病程长短、病情加重缓解因素和感觉诡计详细情况。使用TSUI评分评估患者的斜颈严重程度。 使用J.V.P Domes套件测定痉挛性斜颈患者与健康受试者的触觉空间辨别觉阈值(Spatial Discrimination Threshold,SDT)。对比健康受试者、感觉诡计使症状完全缓解的CD患者、感觉诡计使症状部分缓解的CD患者以及感觉诡计无效的CD患者之间的SDT是否不同。 所有数据均录入SPSS22.0中进行统计分析。 结果： 在纳入研究的240名痉挛性斜颈患者中,有75%的患者在接受调查时存在感觉诡计。感觉诡计常见的形式较为多样,多数表现为手触摸头颈部的某一部位。一个患者可有多种感觉诡计。多数患者认为感觉诡计对症状的缓解不如肉毒毒素。与FST组相比,CST组的患者年龄较小、起病年龄较小、病程较短、TSUI评分较低,且CST组的患者感觉诡计效果更好、持续时间更长(p0.05), CST组患者的感觉诡计有效程度和持续时间均与TSUI评分相关(p0.05)。FST组患者中,多数患者(55.5%)为头偏转同侧的感觉诡计更为有效。但CST组与FST组均有部分患者双侧感觉诡计有效程度相等(分别为39.2%和11.1%),CST组双双侧感觉诡计有效程度相等的患者比例更高(p0.05)。靠近不触摸、想象、双手伸直上举这3个动作在FST组的患者中有效率均显著低于CST组患者(p0.05)。健康受试者与CD患者之间以及感觉诡计效果不同的CD患者之间未发现SDT存在显著性差异(p0.05)。 结论： 绝大多数痉挛性斜颈的患者在病程中会出现感觉诡计。与FST的患者相比,CST的患者斜颈程度较轻,感觉诡计更为有效,持续的时间也更长。FST并非单纯通过对抗异常运动来缓解症状,但与CST相比,FST更依赖于触觉刺激。感觉诡计的机制十分复杂,它的作用可能分为两个阶段：①使头从姿势异常恢复到正位,②维持头部的正常姿势。FST与CST的不同之处可能在于,在斜颈程度较重的患者中,需要施加力量即使用FST使头恢复到正位。而在维持头部位置正常的过程中,FST与CST的机制是类似的。除了触觉刺激外,本体感觉刺激、运动觉刺激、温度觉刺激、视觉听觉刺激甚至想象感觉诡计均可使某些肌张力障碍的患者症状减轻。感觉诡计可能是通过多种感觉刺激的整合,改变了大脑皮层的激活模式,降低了异常的皮层内易化,从而使症状暂时缓解。感觉诡计对肌张力障碍的治疗有一定的指导意义,但仍需要进一步的研究以证实。
[Abstract]:Background:
Spastic torticollis (CD) is a common type of focal dystonia. The main clinical manifestation is abnormal contraction of cervical muscles, which results in abnormal head and neck posture and/or increased movement. Sensory trick (ST) is one of the classical clinical features of CD. Sensory trick refers to the ability of a patient to pass through a single sensory trick. Certain movements temporarily relieve the posture and movement abnormalities of the torticollis. According to whether sensory cunning requires exertion, it can be divided into classical sensory trick (CST) and forcible sensory trick (FST). Whether the direction of sensory cunning is related to the direction of head deflection remains. There are controversies about the effectiveness and duration of sensory cunning; whether CST and FST work in the same way; whether FST only works against abnormal movements; and whether these questions are not conclusive. There are sensory abnormalities in patients with focal dystonia, such as temporal and spatial abnormalities. Whether these abnormalities are related to the effectiveness of sensory cunning is not conclusive.
Objective:
By investigating the clinical features and related factors of sensory cunning in patients with spastic torticollis, this study compared the classical sensory cunning with the forced sensory cunning, and explored the mechanism of sensory cunning combined with the relationship between sensory cunning and spatial discrimination.
Method:
Standard questionnaire survey and clinical evaluation were conducted on the patients with spastic torticollis in the neurological department of Peking Union Medical College Hospital, including general condition, age of onset, duration of illness, remission factors of aggravation and sensory trickery.
Spatial Discrimination Threshold (SDT) was measured in spastic torticollis patients and healthy volunteers using the J.V.P Domes suite. Compared with healthy volunteers, the SDT between CD patients with complete remission of symptoms by sensory cunning, CD patients with partial remission of symptoms by sensory cunning and CD patients with ineffective sensory cunning were It's not different.
All data were entered in SPSS22.0 for statistical analysis.
Result:
Of the 240 patients with spastic torticollis included in the study, 75% had sensory cunning at the time of the study. Sensory cunning was more common in a variety of forms, mostly by touching a part of the head and neck. One patient could have multiple sensory cunning. Most patients thought sensory cunning was less effective than botulinum toxin in relieving symptoms. Compared with group T, CST patients were younger, younger onset age, shorter course of disease, lower TSUI score, and CST patients felt better trickery effect, longer duration (p0.05). The efficacy and duration of sensory trickery in CST patients were correlated with TSUI score (p0.05). Most patients (55.5%) in FST group were head deflection ipsilateral. Sensory cunning was more effective. However, some patients in CST and FST groups had the same degree of efficacy in bilateral sensory cunning (39.2% and 11.1% respectively). The proportion of patients in CST group with the same degree of efficacy in bilateral sensory cunning was higher (p0.05). The efficiency of the three movements in FST group was significantly lower than that in CST group. There was no significant difference in SDT between healthy subjects and CD patients or between CD patients with different sensory cunning effects (p0.05).
Conclusion:
The vast majority of patients with spastic torticollis develop sensory cunning during the course of their illness. CST patients have less torticollis, more effective sensory cunning, and longer duration than FST patients. FST does not relieve symptoms simply by confronting abnormal movements, but is more dependent on tactile stimuli than CST. The difference between FST and CST may be that, in patients with severe torticollis, a force is needed to restore the head to its normal position, while in the process of maintaining normal head position, FST and CST are required. In addition to tactile stimuli, proprioceptive stimuli, motor stimuli, thermosensory stimuli, visual and auditory stimuli, and even imaginative sensory cunning can alleviate symptoms in some patients with dystonia. Sensory cunning may change the activation pattern of the cerebral cortex and reduce abnormal cortex through the integration of multiple sensory stimuli. Sensory cunning has a guiding role in the treatment of dystonia, but further research is needed to confirm it.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R746
本文编号：2182215
[Abstract]:Background:
Spastic torticollis (CD) is a common type of focal dystonia. The main clinical manifestation is abnormal contraction of cervical muscles, which results in abnormal head and neck posture and/or increased movement. Sensory trick (ST) is one of the classical clinical features of CD. Sensory trick refers to the ability of a patient to pass through a single sensory trick. Certain movements temporarily relieve the posture and movement abnormalities of the torticollis. According to whether sensory cunning requires exertion, it can be divided into classical sensory trick (CST) and forcible sensory trick (FST). Whether the direction of sensory cunning is related to the direction of head deflection remains. There are controversies about the effectiveness and duration of sensory cunning; whether CST and FST work in the same way; whether FST only works against abnormal movements; and whether these questions are not conclusive. There are sensory abnormalities in patients with focal dystonia, such as temporal and spatial abnormalities. Whether these abnormalities are related to the effectiveness of sensory cunning is not conclusive.
Objective:
By investigating the clinical features and related factors of sensory cunning in patients with spastic torticollis, this study compared the classical sensory cunning with the forced sensory cunning, and explored the mechanism of sensory cunning combined with the relationship between sensory cunning and spatial discrimination.
Method:
Standard questionnaire survey and clinical evaluation were conducted on the patients with spastic torticollis in the neurological department of Peking Union Medical College Hospital, including general condition, age of onset, duration of illness, remission factors of aggravation and sensory trickery.
Spatial Discrimination Threshold (SDT) was measured in spastic torticollis patients and healthy volunteers using the J.V.P Domes suite. Compared with healthy volunteers, the SDT between CD patients with complete remission of symptoms by sensory cunning, CD patients with partial remission of symptoms by sensory cunning and CD patients with ineffective sensory cunning were It's not different.
All data were entered in SPSS22.0 for statistical analysis.
Result:
Of the 240 patients with spastic torticollis included in the study, 75% had sensory cunning at the time of the study. Sensory cunning was more common in a variety of forms, mostly by touching a part of the head and neck. One patient could have multiple sensory cunning. Most patients thought sensory cunning was less effective than botulinum toxin in relieving symptoms. Compared with group T, CST patients were younger, younger onset age, shorter course of disease, lower TSUI score, and CST patients felt better trickery effect, longer duration (p0.05). The efficacy and duration of sensory trickery in CST patients were correlated with TSUI score (p0.05). Most patients (55.5%) in FST group were head deflection ipsilateral. Sensory cunning was more effective. However, some patients in CST and FST groups had the same degree of efficacy in bilateral sensory cunning (39.2% and 11.1% respectively). The proportion of patients in CST group with the same degree of efficacy in bilateral sensory cunning was higher (p0.05). The efficiency of the three movements in FST group was significantly lower than that in CST group. There was no significant difference in SDT between healthy subjects and CD patients or between CD patients with different sensory cunning effects (p0.05).
Conclusion:
The vast majority of patients with spastic torticollis develop sensory cunning during the course of their illness. CST patients have less torticollis, more effective sensory cunning, and longer duration than FST patients. FST does not relieve symptoms simply by confronting abnormal movements, but is more dependent on tactile stimuli than CST. The difference between FST and CST may be that, in patients with severe torticollis, a force is needed to restore the head to its normal position, while in the process of maintaining normal head position, FST and CST are required. In addition to tactile stimuli, proprioceptive stimuli, motor stimuli, thermosensory stimuli, visual and auditory stimuli, and even imaginative sensory cunning can alleviate symptoms in some patients with dystonia. Sensory cunning may change the activation pattern of the cerebral cortex and reduce abnormal cortex through the integration of multiple sensory stimuli. Sensory cunning has a guiding role in the treatment of dystonia, but further research is needed to confirm it.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R746
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