姜黄素对大鼠脑缺血再灌注损伤后基质金属蛋白酶MMP-2及MMP-9的影响

目的 探讨姜黄素对大鼠局灶性脑缺血再灌注损伤后的基质金属蛋白酶-9(MMP-9)及MMP-2表达及活性的影响.方法 采用线栓法制作大鼠暂时性大脑中动脉栓塞(MCAO)模型,MCAO后1h腹腔注射100mg/kg姜黄素,MCAO 2 h再灌注22h后处死动物.取患侧或对照侧端脑,提取总蛋白,采用Western blot和明胶酶谱分析方法研究MMPO及MMP-2的表达及活性.结果 Western blot和明胶酶谱分析结果均表明,姜黄素可降低脑缺血再灌注损伤所诱导的MMP-9及MMP-2蛋白的表达及其活性水平.结论 姜黄素对脑缺血再灌注损伤的保护作用机制之一可能与抑制了MMPO及MMP-2蛋白的高表达及活性增高有关.     

白藜芦醇对小鼠脑缺血再灌注损伤后MMP-9蛋白的影响

目的探讨白藜芦醇预治疗对小鼠暂时性脑缺血的脑保护作用及其对基质金属蛋白酶-9（MMP-9）表达及活性的影响。方法采用插线法制作小鼠暂时性大脑中动脉栓塞（MCAO）模型。白藜芦醇溶于20％环糊精／0．9％NaCL，50mg／kg强饲，1／d，于第7d行MCAO。MCAO2h再灌注22h取完整端脑，切成2mm冠状厚片，2％红四氮唑（TFC）染色，计算脑梗死灶的大小。分别于MCAO2h再灌注4h、10h及22h取患侧或对照侧端脑，提取总蛋白，采用Western blot和明胶酶谱分析方法研究MMP-9的表达及活性。结果白藜芦醇预治疗组MCAO2h再灌注22h时的梗死灶明显小于对照组（P〈0．01）。Western blot和明胶酶谱分析结果证明，白藜芦醇预治疗可降低脑缺血再灌注损伤所诱导的MMP-9蛋白的表达及其活性水平。结论白藜芦醇预治疗对脑缺血再灌注损伤有一定的保护作用，这可能得益于其抑制了MMP-9蛋白的高表达及活性增高。     

脑缺血/再灌注损伤时MMP-9的表达及银杏叶提取物的干预作用

目的观察银杏叶制剂对大鼠脑缺血再灌注后基质金属蛋白酶（MMPs）表达的影响，探讨其对脑缺血再灌注损伤的保护作用及其机制。方法应用明胶酶谱法（SDS—PAGE enzymograph）测各组脑组织不同时间点MMP-9的表达。结果MMP-9的动态变化：模型组缺血／再灌注6h后，大鼠缺血部位脑内可见少量的MMP-9的表达，24h明显升高，48h达高峰，3d时有所下降，5d时水平更低。假手术组的脑内未见到MMP-9的表达，24h和48h组与模型组相比有显著性差异，而银杏叶治疗组的脑内MMP-9的表达24h也明显升高，但是小于模型组，48h的峰值较模型组低，3d、5d下降。银杏叶治疗组的脑内MMP-9的表达24h和48h组与模型组相比差异有显著性。结论缺血／再灌注可引起MMP-9表达异常，并且呈动态变化；银杏叶提取物对MMP-9表达有干预作用，能够降低MMP-9的合成上调程度；其可能的作用机制为减轻脑缺血后的炎症性病理损害，减轻脑水肿，改善局部脑血液循环。     

乌司他丁对脑缺血再灌注损伤大鼠血脑屏障通透性和MMP-9活性的影响

目的 观察乌司他丁对大鼠局灶脑缺血再灌注损伤后血脑屏障(BBB)通透性和基质金属蛋白酶-9(MMP-9)活性的影响.方法 采用栓线法制备大鼠局灶性脑缺血再灌注损伤模型,腹腔注射乌司他丁,于脑缺血再灌注后6h、24h、48h、72h处死大鼠.通过测定损伤侧脑组织中伊文思蓝(EB)含鼍来观察BBB通透性的改变,用明胶酶谱法检测同侧脑部MMP-9活性变化.结果 脑缺血再灌注损伤后,大鼠EB含量增加,24h最明显;MMP-9活性明显升高,48h达高峰.乌司他丁处理组EB含量及MMP-9活性水平明显低于脑缺血再灌注组(P<0.05).结论 乌司他丁可抑制脑缺血再灌注后大鼠MMP-9的活性,减轻BBB通透性的破坏.     

亚低温对大鼠局灶性脑缺血再灌注后MMP-9表达和细胞凋亡的影响

目的 通过研究亚低温对大鼠局灶性脑缺血再灌注后基质金属蛋白酶-9(MMP-9)表达和细胞凋亡的影响,探讨亚低温脑保护的可能机制.方法 将雄性SD大鼠39只分为假手术组、常温缺血组和缺血期亚低温组.制作大脑中动脉阻塞(MCAO)模型,缺血2h再灌注48h,HE染色观察各组大鼠脑组织形态学改变;采用TTC染色法观察梗死体积;TUNEL法检测细胞凋亡;免疫组化法检测MMP-9表达.结果 亚低温减轻脑缺血组织病理学损伤,明显缩小脑梗死体积(P<0.05).常温下缺血侧脑组织可见大量TUNEL阳性细胞和MMP-9免疫阳性细胞,主要位于皮质缺血半暗带区.亚低温减少脑缺血后TUNEL阳性细胞数目(P<0.05),明显下调MMP-9蛋白表达(P<0.05).结论 亚低温可能通过下调脑缺血再灌注后MMP-9表达,抑制细胞凋亡,从而发挥确实的脑保护作用.     

氨基胍对大鼠局灶性脑缺血再灌注神经细胞损伤的影响

目的　探讨氨基胍 (AG)对脑缺血 再灌注 (IR)神经细胞损伤的影响。方法　用线栓法制作大鼠局灶性脑缺血 再灌注模型 ,动物缺血 2小时后给予腹腔注射AG 10 0mg·kg-1,取不同再灌注时间测定大鼠脑匀浆NOS活性、髓过氧化物酶 (MPO)活性和脑梗死体积。结果　再灌注后 12～ 72小时 ,AG显著降低了iNOS活性 ,且于再灌注后 2 4小时达最大抑制率。再灌注后 2 4～ 72小时 ,AG减少髓过氧化物酶 (MPO)含量。再灌注后 2 4～ 72小时 ,AG减少梗死体积。结论　AG对脑缺血 再灌注神经细胞损伤具有一定的保护作用。     

川芎嗪对大鼠前脑缺血再灌注后MMP-9的影响

目的观察大鼠前脑缺血再灌注后MMP-9的变化及川芎嗪对其表达的影响。方法用夹闭双侧颈总动脉30min的方法,制备缺血再灌注大鼠模型,应用明胶酶谱法(SDS-PAGE enzymograph)测各组脑组织不同时间点MMP-9的表达。结果假手术组各个时间段大鼠前脑组织少量表达MMP-9;缺血再灌注6h组大鼠脑组织即有MMP-9的表达,缺血再灌注24h组、48h组大鼠脑组织大量表达MMP-9;缺血再灌注3d、5d组大鼠脑组织亦可见MMP-9的表达,但较缺血再灌注24h、48h组相比MMP-9表达减少;除川芎嗪6h组不具统计学意义外,其它时间段川芎嗪治疗组与缺血再灌注组相比MMP-9含量均降低。结论脑缺血再灌注后MMP-9的表达可上调;川芎嗪对大鼠前脑缺血再灌注后对MMP-9的表达有干预作用。     

脑缺血后适应对基质金属蛋白酶-9表达的影响

目的:探讨缺血后适应对大鼠脑缺血再灌注损伤的保护作用及与MMP-9的关系。方法:应用线栓法制做大鼠脑缺血再灌注损伤模型;对大鼠脑缺血再灌注1h和48h进行神经功能评分;48h后TTC染色测定脑梗死体积和脑水肿程度;4h、8h、24h、48h后免疫组化定位定量MMP-9水平。结果:缺血后适应组大鼠脑梗死体积、水肿程度、术后神经功能评分较对照组明显改善(P<0.05),各时间点后适应组大鼠基底节区MMP-9表达较对照组显著减少(P<0.05),梗死侧皮层MMP-9表达无显著改变。结论:缺血后适应能减少脑缺血后MMP-9的表达,缩小梗死体积,减轻脑水肿程度,改善术后神经功能。MMP-9下调可能是缺血后适应脑保护的分子机制之一。     

脑脉泰对大鼠脑缺血再灌注后神经细胞凋亡和Akt,bcl-2,Bax,caspase3表达的影响

目的 研究脑脉泰对大鼠脑缺血再灌注损伤神经细胞凋亡和Akt,bcl-2, Bax,caspase3表达的影响。方法 在大鼠大脑中动脉栓塞再灌注动物模型,将60只雄性SD大鼠随机分为假手术组（sham）、脑缺血再灌注模型组（MCAO）、脑脉泰大剂量组（MCAO+脑脉泰2.24g·kg-1）、脑脉泰中剂量组（MCAO+脑脉泰1.12g·kg-1 ）,脑脉泰小剂量组（MCAO+脑脉泰0.56g·kg-1）和尼莫地平组（MCAO+nimodipine 10mg·kg-1）,每组10只大鼠。脑脉泰组在MCAO前五天开始灌胃给药,连续五天。用TUNEL法和免疫组化染色法分别检测缺血半暗带凋亡细胞和Akt,bcl-2,Bax,caspase3表达。结果 脑脉泰大剂量组和中剂量剂量组大鼠脑缺血半暗带的凋亡细胞显著减少,Akt、bcl-2 表达显著增加, caspase3 和 Bax表达减少,与MCAO模型组比较,有显著性差异（P<0.01）。结论 脑脉泰对脑缺血/再灌注损伤产生保护作用,其保护作用与促进Akt,bcl-2的表达,抑制Bax和caspasse3的表达有关。     

曲克芦丁脑蛋白水解物对大脑中动脉栓塞后大鼠神经血管单元的保护作用

目的 验证曲克芦丁脑蛋白水解物对局灶性脑缺血后神经血管单元的保护作用,探讨其保护作用的 机制。 方法 采用大脑中动脉栓塞（middle c erebral a rtery o cclusion,MCAO）制备大鼠局灶性脑缺血模型。 120只雄性SD大鼠,采用随机数字表法分成假手术（SHAM）组（n =40）、MCAO组（n =40）以及MCAO+曲 克芦丁治疗组（n =40）。MCAO+曲克芦丁治疗组于术后立即给予曲克芦丁3 ml/kg,1次/日腹腔注射 3 d。采用改良神经功能缺损评分（modified Neurological Severity Score,mNSS）分别评价栓塞后3 d、7 d、 14 d大鼠的行为改变;栓塞后3 d,采用7.0 T高分辨率磁共振的T2及动脉自旋标记（arterial spin label, ASL）序列评价梗死体积及梗死区血流变化;采用尼氏染色评价神经元存活率及形态学变化;采用 免疫荧光染色技术评价各组内皮细胞、星形胶质细胞及紧密连接标记分子表达的变化;采用蛋白质 印迹法评价各组3-硝基酪氨酸（3-nitrotyrosine,3-NT）、基质金属蛋白酶9（matrix metalloproteinase 9, MMP-9）及诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS）表达的变化。 结果 MCAO后3 d,MCAO组与SHAM组相比,ASL序列显示梗死区域血流显著减少;尼氏染色结果显示 神经元存活率降低,大量空泡形成,核固缩;免疫荧光显示内皮细胞及紧密连接标记分子减少而星 形胶质细胞增多;蛋白质印迹法结果显示iNOS、3-NT、MMP-9增多。而MCAO+曲克芦丁治疗组与MCAO组 相比,梗死区域血流显著增多,神经元存活率升高,内皮细胞、紧密连接标记分子增多,星形胶质细 胞减少,i NOS、3-NT、MMP-9减少。 结论 曲克芦丁脑蛋白水解物可以通过抑制iNOS和MMP-9的表达,减少3-NT的产生,从而对MCAO后 大鼠神经血管单元起到保护作用。     

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.     

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.     

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.