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Somatosensorisch evozierte Potentiale (SEP) in der Differentialdiagnose spinaler Erkrankungen

  • J. Schramm
Chapter

Zusammenfassung

Viele Rückenmarkserkrankungen, gleich ob mit oder ohne Querschnittsymptomatik, lassen sich aufgrund der Anamnese und des neurologischen Untersuchungsbefundes diagnostizieren. Neben etablierten Zusatzuntersuchungen (Liquoruntersuchung und Röntgen) sind neurophysiologische Zusatzuntersuchungen nicht immer erforderlich. Es gibt aber differentialdiagnostische Probleme, insbesondere bei der Abgrenzung der spinalen und monolokulären Verlaufsform der multiplen Sklerose, z.B. von Tumoren (Jörg 1974; Kuhlendahl u. Ischebeck 1975; Schramm et al. 1980). Die Klassifizierung langsam progredienter paraspastischer oder tetraspastischer Syndrome ist häufig prolematisch (Jörg 1977; Jörg et al. 1982; Stöhr u. Dichgans 1982; Schramm et al. 1980). Bei den hereditären degenerativen Spinalerkrankungen gibt es Krankheitsbilder, die nach der Symptomatik und dem typischen Erkran-kungsalter Überlappungen mit dem Erscheinungsbild der MS aufweisen. Die Abgrenzung seltener Krankheitsbilder (z.B. nicht disseminierte entzündliche Myeli-tiden) vom ersten Schub einer spinalen MS kann besonders schwierig sein (Ropper et al. 1982; Bird u Crill 1981). Nicht-invasive Untersuchungsmethoden sind vorzuziehen, wenn eine Raumforderung ausgeschlossen oder als außerordentlich unwahrscheinlich angenommen werden kann, da für die Diagnosestellung der MS eine Myelographie nicht nur unnötig, sondern gelegentlich auch schädlich sein kann (Riffel et al. 1982). In der Klinik ist jedoch neben der Diagnosestellung auch eine möglichst objektive Registrierung der Ausdehnung, der Schwere und des Verlaufes der Erkrankung anzustreben. Hier kommt die erweiterte neurophysiologische Technik, insbesondere die EP-Technik, zum Zuge. Frühere klinische Arbeiten (Giblin 1964; Bergamini et al. 1966) machten zum Verhältnis SEP-Befund zu Ausdehnung, Schwere und Krankheitsverlauf der Erkrankung noch keine Angaben. Dabei scheint die Überprüfung der somatosensorischen Bahnensysteme im Rückenmark mit Hilfe der SEP-Methodik vielversprechend, da die somatosensorischen Fasern das Rückenmark in seiner ganzen Länge durchqueren und ihr Eintritt in das Rückenmark seitengetrennt und entlang der kaudo-kranialen Achse etagenweise getrennt geschieht.

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