한국 정상 아동과 뇌성마비 아동의 운동신경 전도속도에 관한 연구

Abstract

[한글]

[영문]

The purpose of this investigation was to attempt to establish a set of motor nerve conduction velocities for the peripheral nerves in normal children in Korea and then compare it with a set of velocities measured in cerebral palsied children in order to show whether or not disorders of the central nervous system produce significant changes in motor conductivity of the peripheral nervous system.

In this study, one hundred normal children and one hundred cerebral palsied children were examined. Ages ranged from 5 to 14 years. Through a routine physical examination which included complete blood count, fasting blood sugar and urinalysis, children with a history of peripheral neuropathy, diabetes, peripheral vascular disease or prolonged isoniazid therapy were excluded. In an atmosphere of controlled temperature and humidity, skin temperature was measured in each case over the forearm and hand and over the lower leg and foot. This was followed by measurement of motor nerve conduction velocity of median and peroneal nerves. All studies were carried out by the same examiner.

(1) Motor nerve conduction velocities in normal children.

Motor nerve conduction velocity of median nerve was 57.6±4.6 m/sec(Mean±S.D.); 57.0±4.7(Male), 58.2±4.6(Female). Motor nerve conduction velocity of peroneal nerve was 51.2±4.3 m/sec(Mean±S.D.); 50.7±4.7(Male), 51.7±3.8(Female).

(2) Motor nerve conduction velocities according to age groups in normal children.

Statistical analysis of each age group shows that there does not appear to be any significant difference from ages 5 to 14 yearn in this study.

(3) Motor nerve conduction velocities according to sex in normal children.

Statistical analysis of each sex shows that there does not appear to be any significant difference according to sex in this study.

(4) Motor nerve conduction velocities in cerebral palsied children.

Motor nerve conduction velocity of median nerve was 53.7±5.0 m/sec (Mean±S.D.): 53.6±5.0 (Male), 53.8±4.9 (Female).

Motor nerve conduction velocity of peroneal nerve was 47.8±4.9 m/sec (Mean±S.D.); 48.0±5.0 (Male), 47.6±4.8 (Female).

(5) Difference in motor nerve conduction velocities between normal and cerebral palsied children.

In the median nerve the mean difference between both groups of children was 3.9 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

In the peroneal nerve the mean difference between both groups of children was 3.4 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

(6) Skin temperature differences between normal and cerebral palsied children.

Skin temperature over the median nerve of the forearm was 34.0±0.04℃ (Mean±S.E.) in normal children and 33.1±0.08 in cerebral palsied children. The mean difference between both groups of children was 0.9 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

Skin temperature over the abductor pollicis brevis muscle of the hand was 34.8±0.07 in normal children and 33.7±0.1 in cerebral palsied children. The mean difference between both groups of children was 1.1 showing that there appears to be

a significant decrease in cerebral palsied children (p value <0.01).

Skin temperature over the peroneal nerve of lower leg was 32.5±0.04 in normal children and 30.7±0.15 in cerebral palsied children. The mean difference between both groups of children was 1.8 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

Skin temperature over the extensor digitorum brevis muscle of the foot was 31.9±0.08 in normal children and 29.3±0.18 in cerebral palsied children. The mean difference between both groups of children was 2.6 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

(7) Differences in distal latency between normal and cerebral palsied children.

Distal latency of the median nerve was 2.5±0.02 msec (Mean±S.E.) in normal children and 2.3±0.02 in cerebral palsied children. The mean difference between broth groups of children was 0.2 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

Distal latency of the peroneal nerve was 3.7±0.05 in normal children and 3.0±0.05 in cerebral palsied children. The mean difference between both groups of children was 0.7 showing that there appears to be a significant decrease in cerebral palsied children (p value <0.01).

(8) Differences in amplitude between normal and cerebral palsied children.

The amplitude of muscle response with the median nerve electrical stimulation at the wrist was 9.2±0.4 mV (Mean±S.E.) in normal children and 9.4±0.3 in cerebral palsied children. The mean difference of 0.2 was not statistically significant (0.6< p <0.8).

The amplitude of muscle response with the median nerve electrical stimulation below the elbow was 8.2±0.3 in normal children and 9.3±0.3 in cerebral palsied children. The mean difference of 1.1 was statistically significant (p value <0.01).

The amplitude of muscle response with the peroneal nerve electrical stimulation at the ankle was 5.5±0.2 in normal children and 7.9±0.3 in cerebral palsied children. The mean difference of 2.4 was statistically significant (p value <0.01).

The amplitude of muscle response with the peroneal nerve electrical stimulation at the knee was 5.3±0.2 in normal children and 7.4±0.3 in cerebral palsied children. The mean difference of 2.1 was statistically significant (p value <0.01).

(9) Correlation of motor nerve conduction velocity and skin temperature.

The correlation coefficient between the motor nerve conduction velocity of median nerve and the forearm skin temperature over the median nerve was 0.04 in normal children and 0.05 in cerebral palsied children. The confidence interval at 95% confidence level was -0.12 to +0.18 in normal children and -0.1 to +0.19 in cerebral palsied children. The correlation coefficient between the motor nerve conduction velocity of peroneal nerve and the lower leg skin temperature over the peroneal nerve was 0.25 in normal children and -0.03 in cerebral palsied children. The confidence interval at 95% confidence level was +0.13 to +0.37 in normal children and -0.17 to +0.12 in cerebral palsied children.

(10) Correlation of distal latency and skin temperature.

The correlation coefficient between the distal latency of the median nerve and the skin temperature over the abductor pollicis brevis muscle was -0.04 in normal children and -0.03 in cerebral palsied children. The confidence interval at 95% confidence level was -1.7 to -0.12 in normal children and -0.17 to +0.12 in cerebral palsied children. The correlation coefficient between the distal latency of the peroneal nerve and the skin temperature over the extensor digitorum brevis muscle was 0.00 in normal children and -0,25 in cerebral palsied children. The confidence interval at 95% confidence level was -0.37 to -0.12 in cerebral palsied children.

The results of this study may be summarized as follows:

(1) There was no significant difference between the sexes in motor nerve conduction velocity in normal children.

(2) There was no significant difference in motor nerve conduction velocities in normal children between the ages of 5 to 14 years.

(3) The motor nerve conduction velocities of cerebral palsied children were significantly decreased compared with those of normal children.

(4) The skin temperature of cerebral palsied children was significantly lower than that of normal children.

(5) The distal latency of cerebral palsied children was significantly decreased compared with that of normal children.

(6) The amplitudes of muscle response in cerebral palsied children were significantly higher than those of normal children except the amplitude of muscle response with the median nerve stimulation at the wrist which showed no significant difference.

(7) There was no linear correlation between lower skin temperature and the decrease of motor nerve conduction velocity nor between lower skin temperature and the decrease of distal latency in this study. Therefore I think that cerebral palsied children can be said to have some reduction in the conductivity of the peripheral nervous system or final common pathway.