底蜕膜间充质干细胞分化为多巴胺能样神经元

目的 探讨人胎盘底蜕膜间充质干细胞体外向多巴胺能样神经元分化的潜能,并优化诱导方案.方法 体外分离培养底蜕膜间充质干细胞,用表皮生长因子(EGF)+人碱性成纤维细胞生长因子(bFGF)+ B27添加剂和人音猬因子(SHH)+成纤维细胞生长因子8(FGF8)+forskolin+脑源性神经营养因子(BDNF)分两个阶段对其进行诱导;免疫细胞化学先后检测干细胞标记nestin和CD133、成熟神经元标记神经元特异性烯醇化酶(NSE)、神经胶质细胞标记胶质原纤维酸性蛋白(GFAP)、多巴胺能神经元标记酪氨酸羟化酶(TH)的表达;Western blot验证诱导后TH蛋白的表达;高效液相色谱-电化学检测诱导前后多巴胺的分泌.结果 经第一阶段诱导后,细胞形成漂浮生长的神经球,nestin和CD133均呈阳性表达;第二阶段诱导后,出现明显的神经元样形态,NSE、GFAP和TH均阳性表达,Western blot也显示TH蛋白的表达,多巴胺分泌量相比诱导前明显增加(P＜0.001).结论 底蜕膜间充质干细胞体外可分化为多巴胺能样神经元,可能成为帕金森病干细胞移植治疗新的种子细胞来源.     

人羊膜上皮细胞分泌神经营养因子诱导人脐血间充质干细胞向神经元样细胞的分化：可能性验证**★

背景：课题组前期实验已证实人羊膜上皮细胞条件培养液可以诱导人脐血间充质干细胞分化为多巴胺能神经元样细胞，在此过程中人羊膜上皮细胞分泌的神经营养因子及其受体可能起到了重要作用。 目的：探讨人羊膜上皮细胞分泌的神经营养因子对人脐血间充质干细胞神经分化的作用。 方法：将P1代人脐血间充质干细胞按2×108 L-1密度接种，分为3组：对照组加入HG-DMEM培养基；诱导组加入人羊膜上皮细胞条件培养液；阻断剂组预先加入阻断剂K252a工作液，36 ℃孵育40 min后更换为羊膜上皮细胞条件培养液。免疫荧光化学检测诱导后人脐血间充质干细胞神经元特异性烯醇化酶及多巴胺转运体的表达，实时定量PCR法检测诱导后人脐血间充质干细胞中神经元特异性烯醇化酶、多巴胺转运体及酪氨酸羟化酶的表达。 结果与结论：人羊膜上清中有神经生长因子和脑源性神经营养因子的表达，且P1代人脐血间充质干细胞表达神经营养因子高黏附性受体Trka及Trkb。诱导48 h后与对照组比较，诱导组及阻断剂组神经元特异性烯醇化酶、多巴胺转运体阳性细胞数均明显增加(P < 0.05)，且诱导组阳性细胞数最多(P < 0.05)。诱导组、阻断剂组神经元特异性烯醇化酶、多巴胺转运体及酪氨酸羟化酶mRNA含量均显著高于对照组(P < 0.01)，且诱导组各基因mRNA含量明显高于阻断剂组(P < 0.01)。结果证实人羊膜上皮细胞分泌的神经营养因子对人脐血间充质干细胞的神经分化有重要作用，其促神经分化作用是通过酪氨酸激酶受体介导的。     

人骨髓间充质干细胞诱导向多巴胺能神经元的分化

背景：体内外研究发现人骨髓间充质干细胞分化为神经元的比率都明显低于胶质细胞,并且这为数不多的神经元会逐渐死亡,而最终存活的细胞中神经元的数量更少。 目的：观察人骨髓间充质干细胞体外诱导分化为多巴胺能神经元的潜能。 方法：分离纯化和扩增人骨髓间充质干细胞,在体外先用碱性成纤维细胞生长因子和表皮细胞生长因子进行预诱导后,以胶质细胞源性神经营养因子和血管紧张素Ⅱ联合诱导人骨髓间充质干细胞向神经元和多巴胺能神经元分化。观察分化过程中细胞的形态变化,利用免疫组织化学检测神经元和多巴胺能神经元特异性标志物的表达情况。 结果与结论：人骨髓间充质干细胞经诱导后的细胞呈现双极、多极和锥形的典型神经元细胞的形态,明显表达抗人神经巢蛋白[(55.7±4.3)%]和神经元特异性烯醇化酶[(78.2±6.7)%],而且大部分人骨髓间充质干细胞表达酪氨酸羟化酶[(48.5±5.6)%],不表达神经胶质细胞标记物胶质纤维酸性蛋白。提示在适宜的条件下,人骨髓间充质干细胞可分化成神经元和多巴胺能神经元样细胞。     

音速波状蛋白促进骨髓间充质干细胞向多巴胺能神经元分化

目的探讨音速波状蛋白（Shh）促进人骨髓间充质干细胞（MSCs）体外定向分化为多巴胺能神经元样细胞的作用。方法体外分离、扩增和鉴定人骨髓MSCs。采用不同诱导方案诱导MSCs向神经元和多巴胺能神经元样细胞定向转化后,进行抗神经巢蛋白（Nestin）、神经元特异烯醇化酶（NSE）、神经胶质纤维酸性蛋白（GFAP）、酪氨酸羟化酶（TH）和多巴胺转运体（DAT）等免疫细胞化学染色,并计算阳性细胞百分率。结果实验组诱导后MSCs能分化为具有典型神经元形态的细胞,可见NSE、Nestin、GFAP、TH和DAT等神经细胞标志表达;对照组MSCs细胞形态无明显变化,上述特异性标志物表达均为阴性。实验2组（诱导方案含Shh）与1组（诱导方案不含Shh）的NSE、Nestin、GFAP阳性细胞百分率的差异无统计学意义,但实验2组TH和DAT阳性细胞百分率明显高于实验1组,差异具有统计学意义（P〈0.05）。结论Shh可促进MSCs分化为多巴胺能神经元样细胞。     

人骨髓间充质干细胞向多巴胺神经元分化的体外研究

目的探讨人骨髓间充质干细胞(hMSC)向神经元和多巴胺神经元分化的潜能。方法分离和纯化hMSCs;在体外以WHI-P131预处理和碱性成纤维细胞生长因子预诱导后,全反式维甲酸和胶质细胞源性神经营养因子联合诱导hMSCs向神经元和多巴胺神经元分化。光镜下观察其分化过程中hMSCs的形态变化,免疫组化检测诱导前后细胞是否表达神经元和多巴胺能神经元标志蛋白。结果诱导后的hMSCs能分化成为具有典型神经元形态的细胞,并明显表达抗人神经巢蛋白(nestin)[(54.2±3.7)%]和神经元特异性烯醇化酶(NSE)[(77.0±5.7)%],低表达胶质纤维酸性蛋白(GFAP)[(8.8±2.4)%];对照组细胞这些表达均为阴性;而且相当部分hMSCs表达酪氨酸羟化酶(TH)[(36.5±15.8)%]和多巴胺转运体(DAT)[(26.0±14.2)%]。结论在适当条件下,hMSCs可分化成为神经元样细胞和多巴胺神经元样细胞。     

Nurr1对小胶质细胞联合神经干细胞共培养促进神经干细胞向多巴胺神经元分化作用研究

目的探讨联合过表达核受体相关因子1(Nurr1)基因的小胶质细胞(MG)和神经干细胞(NSC)共培养对神经干细胞向多巴胺神经元分化的影响。方法原代培养SD大鼠神经干细胞和小胶质细胞,并过表达Nurr1基因。CCK-8法检测Nurr1过表达对神经干细胞以及小胶质细胞活率的影响。Transwell系统共培养神经干细胞和小胶质细胞,实验分为NSC组、NSC+MG组和N(NSC+MG)组。ELISA检测共培养后第3天、第6天和第9天各组脑源性神经营养因子(BDNF)、血小板源性神经营养因子(PDNF)和胶质细胞源性神经营养因子(GDNF)表达变化;RT-PCR和Western Blot检测各组第9天酪氨酸羟化酶(TH)、多巴胺转运蛋白(DAT)DAT和Nurr1的表达变化;细胞免疫荧光鉴定神经干细胞的分化,并对TH和DAT阳性细胞计数,计算各组神经干细胞向多巴胺神经元的分化效率。结果原代培养小胶质细胞以及神经干细胞并成功过表达Nurr1基因。CCK-8法检测结果表明,Nurr1过表达对神经干细胞以及小胶质细胞活率无明显影响。ELISA检测结果表明,N(NSC+MG)组在不同时间点神经营养因子(BDNF、PDNF和GDNF)表达量明显高于其他各组(P0.05)。RT-PCR和Westen Blot检测结果表明,N(NSC+MG)组TH、DAT和Nurr1的表达水平明显高于其他各组(P0.05)。细胞免疫荧光鉴定结果表明,N(NSC+MG)组TH阳性细胞率明显高于其他各组(P0.05)。结论Nurr1基因可促进神经干细胞和小胶质细胞共培养系统神经营养因子的分泌。过表达Nurr1基因的神经干细胞和小胶质细胞共培养可促进神经干细胞向多巴胺神经元的分化。     

GFP-Nurr1基因修饰神经干细胞的建立及过表达Nurr1对神经干细胞向多巴胺神经元分化的影响

目的利用慢病毒载体建立GFP-Nurr1基因修饰的原代神经干细胞(NSCs)模型并观察Nurr1过表达后NSCs向多巴胺神经元的分化影响。方法利用基因重组构建pLenO-DCE-Nurr1慢病毒载体,用慢病毒转染第三代NSCs,转染72 h后荧光检测转染效果;设置空白对照组、空载体组及DCE-Nurr1组,分别用Western blot及PCR检测Nurr1的表达差异;并将转染后的NSCs分化培养7 d后分别用免疫细胞化学检测、Western blot及PCR检测酪氨酸羟化酶(TH)的表达。结果慢病毒转染NSCs 72 h后,转染率可达90%,与对照组相比DCE-Nurr1组高表达Nurr1。经慢病毒载体感染后的NSCs仍具备分化潜能,分化培养后发现DCE-Nurr1组分化的神经细胞中TH阳性细胞分化率90.60%,对照组为21.2%。结论慢病毒载体可高效转染NSCs过表达Nurr1;Nurr1基因过表达可以促进中脑腹侧来源NSCs向TH阳性多巴胺能神经元方向分化。     

外源性Ang Ⅱ诱导神经干细胞向多巴胺能神经元分化的研究

目的在体外成功分离培养并扩增神经干细胞（NSCs）的基础上,研究外源性血管紧张素Ⅱ（Ang Ⅱ）对NSCs向多巴胺（DA）能神经元分化的影响。方法（1）分离培养新生1d SD大鼠脑组织NSCs,免疫细胞学方法测定NSCs特异性标志物神经上皮干细胞蛋白（Nestin）表达及其分化为神经元、神经胶质细胞的能力;（2）按培养液中Ang Ⅱ的浓度不同,分5个浓度（100、200、400、600、800nmol/L）对第二代NSCs进行诱导分化。10d后采用免疫细胞学方法检测DA能神经元标志物酪氨酸羟化酶（TH）和神经胶质细胞标志物胶质纤维酸性蛋白（GFAP）的表达,半定量RT-PCR（SQ-PCR）测定分化细胞中TH mRNA的相对表达量。结果外源性Ang Ⅱ诱导提高NSCs向TH阳性细胞分化的比率,TH mRNA相对表达量亦增加,以Ang Ⅱ浓度为400nmol/L及600nmol/L的诱导效果最明显,TH阳性细胞率分别为10.77%和11.34%,TH mRNA相对表达量分别为（0.4023±0.0515）和（0.3971±0.0319）,两组间比较无统计学意义（P〉0.05）;其中400nmol/L Ang Ⅱ组分化细胞中GFAP阳性细胞率高于对照组,有统计学意义（P〈0.05）。结论外源性AngⅡ促进NSCs向DA能神经元分化,在400～600nmol/L浓度范围内AngⅡ的诱导效能更显著;AngⅡ促进NSCs向DA能神经元分化的机制可能与同时促进星型胶质细胞（AS）分化有关。     

骨髓间充质干细胞分化为神经元样细胞后电生理特性的改变

背景：目前体外实验对骨髓间充质干细胞来源的神经元样细胞的研究多集中于形态学层面和神经标志物方面,对分化后的电生理功能研究较少。 目的：观察脑源性神经营养因子/碱性成纤维细胞生长因子/全反式维甲酸诱导Wistar大鼠骨髓间充质干细胞分化为神经元样细胞后电生理特性的变化。 设计、时间及地点：细胞学体外培养,对比观察,于2005-06/2007-10在天津市环湖医院细胞室和南开大学生命科学院完成。 材料：6周龄雄性Wistar大鼠3只,体质量160 g左右。 方法：贴壁培养法体外分离纯化间充质干细胞,用脑源性神经营养因子/碱性成纤维细胞生长因子/全反式维甲酸联合诱导间充质干细胞向神经元样细胞分化。诱导前和诱导3 d后分别用膜片钳技术检测细胞膜电流。 主要观察指标：流式细胞仪检测间充质干细胞表型;倒置显微镜观察诱导分化前后细胞形态变化;免疫细胞化学鉴定神经元特异性烯醇化酶的表达,以及全细胞电流测定结果。 结果：①流式细胞仪检测结果显示,CD90阳性率(99±3)%,CD31阳性率(3.4±0.8)%,CD34阳性率(0.3±0.1)%。说明这一细胞群大部分处于未分化的干细胞状态,其纯度可达95%。②光镜下可见未经诱导的间充质干细胞多为扁平形带突起的细胞,似纤维样细胞,诱导3 d后出现神经元样细胞。③免疫细胞化学结果显示,诱导前间充质干细胞的神经元特异性烯醇化酶呈弱阳性,诱导后呈强阳性。诱导72 h时分化率为(24.01±3.76)%。④诱导组神经元样细胞外向电流峰值及最大外向电流密度高于对照组(P < 0.05),但未发现内向钠电流。 结论：脑源性神经营养因子/碱性成纤维细胞生长因子/全反式维甲酸诱导方法可以诱导间充质干细胞向神经元方向分化,虽未发现具有成熟神经元电生理功能,但有向成熟神经元分化的趋势。     

人骨髓间充质干细胞体外定向诱导分化为神经元样细胞

背景：文献报道体外诱导骨髓间充质细胞定向分化为神经元样细胞多应用神经生长因子类多肽制剂,选择纯化学诱导剂尚不多见。 目的：建立人骨髓间充质干细胞分离培养体系,体外定向诱导人骨髓间充质干细胞分化为神经元样细胞。 方法：密度梯度离心、贴壁培养法和消化时间控制相结合分离纯化人骨髓间充质干细胞并鉴定,采用β-巯基乙醇和二甲基亚砜诱导分化为神经元样细胞,观察细胞形态,通过尼氏染色、NSE和NF-200免疫细胞化学染色对已分化的神经元样细胞进行鉴定和分化率分析。 结果与结论：分离得到的骨髓间充质干细胞为成纤维样细胞,可见多个核仁,β-巯基乙醇和二甲基亚砜诱导后,间充质干细胞分化为神经元样细胞,伸出较长轴突样和树突样突起且有分支,诱导后的神经元样细胞胞质中存在着深蓝色颗粒状的尼氏小体,NSE、NF-200免疫荧光细胞化学染色均呈阳性,阳性率分别为(85.6±6.7)%和(73.2±5.6)%。结果证实采用密度梯度离心、贴壁培养法和消化时间控制相结合能够成功分离和培养人骨髓间充质干细胞,人骨髓间充质干细胞能够在诱导剂β-巯基乙醇和二甲基亚砜的诱导下体外诱导分化为神经元样细胞。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.