保定市重性抑郁障碍流行病学调查

目的：了解保定市重性抑郁障碍的患病率、人口学特征和社会生活功能状况。方法：采用多阶段分层整群抽样方法随机抽取≥18岁的人群10073人，以一般键康问卷12项（GHQ-12）为筛选工具，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版（SCID-I／P）为调查诊断工具。用功能大体评定量表（GAF）评价功能状况。结果：重性抑郁障碍的终生患病率为4．19％（95％CI：3．78％～4．60％）；时点患病率为2．64％（95％CI：2．31％～2．97％）。时点患病率女性3．26％明显高于男性2．00％（u=3．73，P〈0．01）；农村2．84％明显高于城市1．40％（u=2．76，P〈0．01）；50～69岁年龄段患病率较高；单次发作60．80％，复发39．20％；GAF平均为（50．74±6．73）分，社会和生活功能受损明显。结论：重性抑郁障碍的患病率相对较高，严重影响患者的社会生活功能。     

河北省精神障碍的现况调查

目的了解河北省≥18岁人群各类精神障碍的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18岁人群，共24000名，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查患者版进行调查，用DSM，Ⅳ对各类精神障碍进行诊断。结果（1）患病率：20716人完成调查，精神障碍的时点患病率为162．43‰[95％可信区间（95％CI）为15．8％-16．7％]，排在前三位的是重性抑郁障碍（27．01‰）、未特定的焦虑障碍（25．09‰）和心境恶劣障碍（23．12‰）；终生患病率为185．12‰（95％CI为18．0％～19．0％），排在前三位的是重性抑郁障碍（47．47‰）、酒精依赖性和滥用性障碍（38．62‰）和未特定抑郁障碍（25．51‰）。（2）时点患病率：女性（167．95‰）高于男性（156．95‰），农村（165．63‰）高于城市（144．31‰），均P〈0．05～0．01；并随年龄的增长而不断上升，其中30～49岁为137．17‰～156．71‰，50-≥70岁为201．44‰～285．41‰。结论河北省精神疾病的患病率较高，其中女性和农村的患病率高；重性抑郁障碍是省内患病率最高的精神疾病。     

江西省抑郁症患病率的流行病学调查

目的 调查江西省抑郁症的患病率。方法 资料来自江西省11个地市的样本，年龄≥15岁的城区和农村常住居民，共15939人。使用复合性国际诊断交谈检查和专门设计的社会人口学调查表，采用国际疾病分类第10版精神与行为障碍分类中的诊断标准。结果 (1)11个地市抑郁症时点患病率为0．95％，总患病率为1．15％[95％的可信区间(CI)=0．91-1．49]。其中抑郁发作的时点患病率为0．35％，总患病率为0．51％；恶劣心境的时点患病率为0．60％，总患病率为0．65％。(2)年龄45—54岁[相对危险度(RR)=2．09]、女性(RR=1．91)、离婚或丧偶(RR=2．09)、文盲(RR=2．43)或低收入(RR=2．73)与抑郁症明显相关，而有无固定的职业、地区的不同、经济区域的不同对抑郁症的总患病率没有明显的关联。女性患抑郁症的相对危险度是男性的1．91倍。结论 抑郁症是一种患病率较高的精神障碍。年龄45—54岁、女性、离婚或丧偶、文盲或低收入，与抑郁症明显相关。     

去甲肾上腺素转运体单核苷酸T-182C和G1287A多态性与抑郁症关联研究的Meta分析

目的用Meta分析方法系统评价去甲肾上腺素转运体的两个单核苷酸T-182C和G1287A的多态性和抑郁症的关联。方法收集1999年1月～2009年7月间国内外公开发表的关于去甲肾上腺素转运体的两个单核苷酸T-182C和（或）G1287A的多态性和抑郁症的关联的文献，对纳入文献进行评估后，采用异质性检验（齐性检验）、统计合并效应量（加权合并，计算效应尺度及95％的置信区间）并进行统计推断，敏感性分析和采用“倒漏斗图”了解潜在的发表偏倚。结果T-182C的多态性和抑郁症的关联的文献共有8篇（包过本人的一项研究），病例组1405例，对照组1345例；G1287A的多态性和抑郁症的关联的文献共有8篇（包过本人的一项研究），病例组2204例，对照组2010例。Meta分析结果显示，T-182C和抑郁症没有关联（ORTVC＝0．99，95％CI＝0．81～1．22，P＝0．96；ORTTVCC＝1．02，95％CI=0．59～1．74，P＝0．96）；Meta分析结果显示，G1287A和抑郁症没有关联（ORGVA＝0．96，95％CI＝0．84～1．10，P＝0．55；ORGGVSAA＝0．98，95％CI＝0．71～1．35，P＝0．90）。结论没有发现T－182C和G1287A和抑郁症存在关联的证据。     

淋巴细胞特异性酪氨酸蛋白激酶基因多态性与阿尔茨海默病的相关性研究

目的探讨淋巴细胞特并性酪氨酸蛋白激酶（LCK）基因多态性、载脂蛋白E（apoE）基因多态性和阿尔茨海默病（AD）的相关性。方法用TaqMan—PCR法检测单核苷酸多态性（SNP），对380例日本人AD患者[包括327例迟发型AD（LOAD）与53例早发型AD（EOAD）]和380例非痴呆对照纽中。观察LCK基因及apoE基因的多态性分布，并分析其与AD的相关性。结果（1）LCK基因＋6424A/G多态位点的G／G基因型息AD风险为非G／G型的1．41倍（95％CI=1．06～1．87），患LOAD风险为1．37倍（95％CI=1．02～1．85）；（2）apoEε4基因携带者患AD风险为非apoEε4基因携带者的5．11倍（95％CI=3．63～7．19）；（3）排除apoE基因型对AD风险的影响后，G／G基因型患AD风险为非G／G型的1．66倍（95％CI=1．16～2．38），患LOAD风险为1．64倍（95％CI=1．12～2．40），同时风险等位基因G与AD（P〈0．05）和LOAD（P〈0．05）具有相关性。结论LCK基因＋6424A／G多态位点与AD风险的增加呈正性相关性，apoEε4增加了AD的发病风险，LCK是独立于APOE基因的又一新的风险基因。     

重度颈动脉狭窄患者介入或药物治疗效果的长期随访

目的研究重度颈动脉狭窄患者的预后及其影响因素，前瞻性评价介入治疗或药物治疗的效果。方法103例脑卒中或TIA合并重度颈动脉狭窄患者意向性分组，分为介入组与药物治疗组。前者40例择期给予脑血管内支架置入术，后者63例给予抗血小板药物治疗。随访主要终点为发病2年时功能预后（mRS评定）；次要终点为血管事件（发病1、2年或2年以上）的发生率。结果两组的基线资料（性别、年龄、病史、收缩压、血脂、NIHSS、mRS）差异无统计学意义。在随访2年时，Logistic回归表明选择介入治疗是功能预后不良（mRS 3-6分）的独立保护性因素（RR=0．13，P=0．001，95％CI 0．036-0．460）。在发病1年和2年时血管事件发生率差异有统计学意义，介入组的血管事件发生率低于药物组（1年时，介入组：药物治疗组=12．5％：42．9％，OR 0．19，95％CI 0．07-0．55，P=0．001；2年时，介入组：药物治疗组=17．5％：47．6％，OR 0．23，95％CI 0．09-0．60，P=0．002）。进一步随访（随访时间2年以上）发现，两组血管事件发生的中位数时间分别为55个月和54个月，Kaplan-Meier分析结果提示差异无统计学意义。Cox回归提示选择介入治疗或药物治疗不是血管事件发生的独立影响因素（RR=1．063，95％CI 0．40～2．83，P=0．900）。结论对于重度颈动脉狭窄患者，介入治疗较单纯药物治疗能获得较好的功能预后；介入治疗能减少脑卒中或TIA发病后1年或2年时血管事件的发生；但是随访2年以上时，介入治疗未能减少血管事件发生。     

北京市抑郁症的患病率调查

目的掌握北京市常住人口中抑郁症的患病率及其特征。方法以复合性国际诊断交谈检查核心本1．0版为主要调查工具，按多阶段分层系统随机抽样原则，对北京市18个区县≥15岁人口5926人进行抑郁症的现况调查。结果（1）时点患病率为3．31％（196例），终生患病率为6．87％（407例）。（2）时点和终生患病率中，均为女性（分别为4．40％和8．46％）高于男性（2．45％和5．01％），年龄≥55岁者高，农村（4．19％和7．98％）高于城市（2．50％和6．07％），文盲（6．02％和10．87％）和小学文化程度者（5．42％和10．64％）高，再婚（9．52％和28．57％）、离婚（6．15％和13．85％）和丧偶者（5．43％和11．27％）高，不在业者（3．96％和7．95％）、月收入≤300元者（5．52％和9．13％）及有家庭暴力者（6．51％和15．38％）高，均P〈0．01～0．05。结论抑郁症是一种患病率较高的常见精神障碍，预防控制抑郁症应成为我国医疗卫生工作的重点之一。     

纵览AAN2039：卒中

发生率一项以白种人为参照、在西班牙裔及非裔美国人群中进行的卒中研究（SHARP）显示，该人群总卒中发生率为168例/10万人（95％CI 118～224）。其中，非裔与白人发生比为2．0（95％CI 1．8～2．0），而西班牙裔与白人发生比为0．84（95％CI 0．75～0．87）。出血性卒中[脑出血与动脉瘤性蛛网膜下腔出血（SAH）]在非裔（26％）及西班牙裔（25％）中较白人（16％）更多见。     

二十碳五烯酸预防动脉瘤性蛛网膜下腔出血后脑血管痉挛的meta分析

目的系统评价二十碳五烯酸（EPA）预防动脉瘤性蛛网膜下腔出血（aSAH）后脑血管痉挛（cvs）的临床疗效。方法计算机检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、维普数据库等收集EPA治疗aSAH后CVS的临床对照试验，评价纳入研究的质量、提取数据，采用RevMan5．0分析数据。结果共纳入3个研究，307例病人。Meta分析结果显示：EPA降低总症状性脑血管痉挛（SCVS）发生率[相对危险度（RR）=0．46，95％可信区间（CI）为0．29—0．72，P=0．0006]、持续性SCVS发生率（RR=0．13，95％CI为0．04—0．46，P=0．002）、血管痉挛性脑梗死发生率（RR=0．27，95％CI为0．14～0．51，P〈0．0001），但并不改善30d改良Rankin量表（mRS）评分（RR=1．15，95％CI为0．98～1．33，P=0．08）、180dmRS评分（RR=1．03，95％CI为0．91～1．16，P=0．65）。结论EPA可预防aSAH后CVS，但其远期疗效仍需进一步研究。     

河北省抑郁症的流行病学调查

目的:了解河北省抑郁症的患病率和分布特点。方法:采用多阶段分层整群抽样方法随机抽取≥18周岁的人群16 088名,用扩展的一般健康问卷(GHQ-12)将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准(DSM-Ⅳ),以美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查患者版(SCID-I/P)对调查对象进行抑郁症的诊断。心理、社会及职业功能评定采用大体功能评定量表(GAF)。结果:14 408人完成调查,抑郁症的终生患病率为0.62%(95%CI=0.46%～0.78%),时点患病率为0.54%(95%CI=0.39%～0.69%)。时点患病率:女性高于男性(P<0.01);30～39岁、40～49岁、50～59岁患病率较高。Logistic回归分析结果:女性、分居/离婚、低收入增加抑郁症的患病危险性。心理、社会及职业功能受损程度:重度57.41%,中度35.19%,无或轻度7.41%。抑郁症的精神科门诊就诊率为35.56%,住院率28.89%。结论:抑郁症是一类患病率较高的精神障碍,在女性及30～59岁中更常见,严重影响患者的心理、社会及职业功能,精神卫生服务利用率低。     

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.     

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.     

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.     

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.     

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.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.