冰片对脑膜炎患者血-脑脊液屏障影响的初步临床观察

细菌性脑膜炎是一种常见的颅内感染性疾病，由于血-脑脊液屏障（BBB）可限制抗生素进入脑脊液，常可导致其疗效不佳。目前有研究显示冰片能可促进某些物质通过BBB。此文观察1例细菌性脑膜炎患者使用冰片后对注射用盐酸头孢吡肟（商品名马斯平）透过BBB的影响。     

甘松治疗戊四氮致大鼠的实验性研究

目的观察甘松对戊四氮致大鼠的疗效。方法将50只Wistar大鼠随机分为5组,每组各10只,分别为正常对照组、模型组、甘松治疗组、丙戊酸钠治疗组和甘松合并丙戊酸钠治疗组;采用腹腔注射戊四氮制作建立癫模型;观察各组大鼠行为学及脑电图、NSE(神经元特异性烯醇化酶)浓度变化。结果与模型组比较,甘松治疗组、丙戊酸钠治疗组、甘松合并丙戊酸钠组可明显减轻大鼠样发作程度,减少发作频率和持续时间,改善大鼠皮层脑电图,降低脑脊液神经元特异性烯醇化酶浓度,其中以甘松合并丙戊酸钠组最为明显。结论甘松对戊四氮致大鼠具有一定的抗癫及脑保护作用,与丙戊酸钠联用有协同作用。     

抗癫痫药治疗躁狂发作的对照研究

目的 比较托吡酯和丙戊酸钠缓释片治疗双相障碍躁狂发作的疗效和安全性.方法 将符合CCMD-3双相情感障碍躁狂发作标准的90例患者,随机分为托吡酯与奎硫平组、丙戊酸钠缓释片与奎硫平两组,进行为期8周的治疗,用BRMS躁狂量表评定疗效,药物副反应量表评定副反应.结果 托吡酯组有效率为84.4%,丙戊酸纳缓释片组有效率为88.8%,两组间差异无统计学意义（χ2=0.39,P＞0.05）.治疗2周时托吡酯组与丙戊酸纳缓释片组减分率比较上差异有统计学意义.结论 托吡酯治疗双相情感障碍躁狂发作的疗效与丙戊酸钠缓释片相当,不良反应可耐受,可长期使用.     

丙戊酸钠与多西环素治疗脊髓炎大鼠的行为学评分及对小胶质细胞、单核细胞及中性粒细胞水平的差异比较分析

目的 分析丙戊酸钠与多西环素治疗脊髓炎大鼠的行为学评分及对小胶质细胞、单核细胞及中性粒细胞水平的差异.方法 构建致敏抗原诱导敏感实验动物诱发T细胞介导的反应性脊髓炎模型,并将大鼠分为模型组、丙戊酸钠组、多西环素组及空白对照组;模型组及空白对照组采用0.9％氯化钠注射液干预,丙戊酸钠组及多西环素组分别采用丙戊酸钠和多西环...     

长期应用托吡酯、丙戊酸钠对于血脂水平的影响

目的 观察长期应用托吡酯、丙戊酸钠单药治疗对癫痫患者血脂水平的影响。 方法 连续入组长期单药应用丙戊酸钠控制良好的癫痫患者28例、单药应用托吡酯控制良好的癫痫患者30例,并选取健康对照60例,观察各组间血脂代谢指标的差异。 结果 丙戊酸钠组血清脂蛋白（a）水平显著高于托吡酯组（P<0.001）及健康对照组（P=0.003）,而总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯水平较其他两组无明显差异。托吡酯组的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、脂蛋白（a）、甘油三酯水平较对照组均未有显著差异。 结论 长期单药应用丙戊酸钠有可能增加癫痫患者脂蛋白（a）的水平,而长期单药应用托吡酯对于血脂水平影响并不明显。     

托吡酯联合丙戊酸钠治疗小儿癫痫临床观察

目的分析托吡酯联合丙戊酸钠治疗小儿癫痫的临床效果及对血清细胞因子水平的影响。方法选取2014-03—2016-11在解放军第152中心医院接受治疗的癫痫患儿180例,随机分为观察组(n=90)与对照组(n=90)。2组均给予托吡酯治疗,观察组同时联合丙戊酸钠治疗。结果观察组有效率92.22%,对照组为82.22%。观察组有效率明显高于对照组(P0.05)。2组治疗后NSE、Hcy、IGF-1水平均有显著改善,观察组改善更加明显,差异有统计学意义(P0.05)。2组治疗后IL-2、IL-6、TNF?α水平均有显著改善,观察组改善更加明显,差异有统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗小儿癫痫的临床效果显著,安全性高,且有利于改善血清细胞因子水平。     

托吡酯和丙戊酸钠预防偏头痛发作的对比研究

目的对比研究托吡酯和丙戊酸钠预防偏头痛发作的疗效及安全性。方法采用前瞻性的方法，随机将偏头痛患者分为两组：（1）托吡酯组（74例），采用托吡酯，第1周每日25mg开始，每周日递增25nlg，最高剂量增至每日100mg，分早晚两次口服；（2）丙戊酸钠组（72例），采用丙戊酸钠每日400mg，分早晚两次口服，最高剂量增至每日600mg。丽组服药持续3个月。观察两组患者治疗前后的头痛发作频率、头痛发作天数和疼痛程度，并进行对比。头痛程度采用0～10分评分法，观察时间为13周，此期间患者记录头痛日记。结果发作频率：托吡酯组从每月7．01次减少至1．89次（P〈0．001），丙戊酸钠组从每月6．87次减少至1．91次（P〈0．001），两组之间差异无统计学意义（P〉0．05）；头痛发作天数：托吡酯组从7．28d减少至1．89d（P〈0．001），丙戊酸钠组从7．09d减少至2．40d（P〈0．001），两组差异无统计学意义（P〉0．05）；头痛程度：托吡酯组从8．05分减轻至2．02分（P〈0．001），丙戊酸钠组从7．56分减轻至3．62分（P〈0．001），两组之间差异有统计学意义（P〈0．05）。托吡酯最常见的不良反应为肢体麻木、头晕、乏力和食欲减退，丙戊酸钠的不良反应为恶心、呕吐、血白细胞降低、转氨酶升高。结论托吡酯和丙戊酸钠均能有效预防偏头痛发作，但在减轻头痛程度方面，托吡酯比丙戊酸钠效果更好。     

比阿培南联合腰穿治疗开颅术后颅内感染的疗效及安全性分析

目的分析比阿培南联合腰穿治疗神经外科开颅术后颅内感染患者的疗效及安全性。方法将40例神经外科开颅术后颅内感染患者分为治疗组和对照组各20例。治疗组使用比阿培南联合腰穿治疗,对照组使用头孢吡肟联合腰穿治疗,分别观察2组治疗前后体温(T)、白细胞总数(WBC)、脑脊液有核细胞数(TC-BF)、脑脊液葡萄糖(GLU)、脑脊液总蛋白(TPC3)、药物不良反应及实验室检查结果。结果治疗组总有效率95.0%(19/20),对照组为85.0%(17/20);2组治疗后体温均有明显改变,血液及脑脊液相关指标(WBC、TC-BF、GLU、TPC3)治疗前后均有显著改善(P0.05),但治疗组临床有效治疗时间优于对照组(P0.05);2组治疗前后药物不良反应及实验室检查结果差异有统计学意义(P0.05)。结论比阿培南联合腰穿治疗神经外科开颅术后颅内感染患者可显著改善患者的血液及脑脊液指标,比头孢吡肟联合腰穿治疗时间明显缩短,不良反应少。     

托吡酯添加治疗婴儿痉挛症36例疗效观察

目的 观察托吡酯添加治疗婴儿痉挛症的疗效。方法 选择近4年来首次确诊婴儿痉挛症的患儿，应用丙戊酸钠单药治疗36例为对照组，添加托吡酯治疗36例为治疗组．两组比较。结果 托吡酯添加组有较高显效率，对婴儿痉挛症的发作有效率优于对照组。结论 托吡酯添加治疗婴儿痉挛能较好地控制其发作，具有良好的安全性。     

托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性

目的探讨托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性。方法选取80例癫痫患儿,随机分为对照组和联合组各40例,对照组给予托吡酯单药治疗,联合组在对照组用药基础上加用丙戊酸钠治疗。观察2组疗效及不良反应发生情况。结果治疗3个月时联合组治疗总有效率95.00%高于对照组80.00%(P0.05),治疗6个月时2组治疗总有效率分别为97.50%、87.50%,差异无统计学意义(P0.05);治疗3、6个月时2组癫痫发作月均频率明显低于治疗前(P0.01),治疗6个月癫痫发作月均频率明显低于治疗3个月(P0.01),治疗3、6个月时联合组癫痫发作月均频率明显低于对照组(P0.01);对照组不良反应发生率10.00%,联合组为15.00%,差异无统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗儿童癫痫可在短期内减少癫痫发作频率,未明显增加不良反应发生率,耐受性较好。     

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.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

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.