张家口市气象因素变化与急性脑卒中疾病的相关性研究

目的 探讨张家口市气象因素变化与急性脑卒中疾病的相关性。方法 收集2018年2月至2020年6月在该院神经内科住院的1 426例患者资料进行回顾性分析。收集患者人口学特征、生活方式、入院时季节及入院时气候信息。根据患者入住医院病因是否为脑卒中将其分为2组,已确诊患有脑卒中疾病者为脑卒中组,其他疾病患者为非脑卒中组。比较2组患者上述各因素,并采用多因素Logistic回归分析判断各因素对脑卒中发病的综合作用。结果 调查的1 426例患者中共有327例(22.92%)为脑卒中患者,多因素Logistic回归分析结果显示,患者年龄增长(OR=1.474,95%CI=1.073~2.025)、有吸烟史(OR=1.493,95%CI=1.033~2.159 )、有饮酒史(OR=1.530,95%CI=1.094~2.139)、秋季(OR=1.418,95%CI=1.006~1.998)、冬季(OR=1.464,95%CI=1.035~2.071)、月平均气温下降(OR=1.486,95%CI=1.016~2.173)、月平均气压升高(OR=1.442,95%CI=1.009~2.060)为脑卒中发病的危险因素(P<0.05)。结论 张家口市脑卒中患者在秋、冬季节高发,月平均气温下降及月平均气压升高为张家口市脑卒中患者发病的危险因素,另外年龄、吸烟史、饮酒史也与脑卒中的发生密切相关。     

酒精使用障碍严重程度的影响因素及风险预测模型构建

背景 酒精使用障碍（AUD）是常见的慢性复发性精神疾病,对于重度AUD,需早期快速识别并及时妥善处理,以避免不可逆的伤害发生。目前,对AUD严重程度的评估主要基于临床医师对患者的精神检查,关于AUD严重程度影响因素及预测模型的研究有限。目的 分析AUD患者疾病严重程度的影响因素,构建风险预测模型,为评估AUD患者的疾病严重程度提供参考。方法 回顾性选取2017年1月1日—2022年12月31日南宁市第五人民医院收治的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）AUD诊断标准的1 358例首次住院患者为研究对象,收集其基本资料,根据疾病严重程度分为轻中度组（n=330）和重度组（n=1 028）。按7∶3将患者分为训练集和测试集,在训练集样本中构建Logistic回归模型,在测试集样本中采用受试者工作特征（ROC）曲线分析该模型对AUD严重程度的预测价值。结果 与轻中度组相比,重度组居住地在城市（χ²=7.804）、农民（χ²=17.991）、饮酒频率高于1~2次/天（χ²=35.267）的比例更高,初次饮酒年龄更大（t=-3.858）,合并躯体疾病数量更多（Z=-22.782）,γ-谷氨酰胺转移酶（χ²=259.940）和总胆红素异常（χ²=148.552）的比例更高（P均<0.01）。在训练集中进行的Logistic分析结果表明,农民（OR=2.024,95% CI：1.352~3.029）、初次饮酒年龄较大（OR=1.075,95% CI：1.025~1.129）、用餐时间外也饮酒（OR=3.988,95% CI：2.408~6.606）、总胆红素水平异常（OR=1.034,95% CI：1.000~1.069）、合并更多的躯体疾病（OR=4.386,95% CI：2.636~7.298）是AUD更严重的危险因素。该模型在测试集中的ROC曲线下面积（AUC）为0.906。结论 在精神专科医院中,农民、初次饮酒年龄较大、用餐时间外也饮酒、总胆红素水平异常、合并更多的躯体疾病可能是重度AUD的危险因素。     

产前抑郁风险预测简易模型的构建与验证

背景 近年来,孕妇心理问题已成为我国重要的公共卫生问题,抑郁是孕期最常见心理问题,目前研究多集中在产前抑郁的治疗方面,缺少产前抑郁风险预测模型的构建。目的 建立产前抑郁风险预测简易模型,为预防孕妇抑郁提供参考。方法 于2021年5月-2022年2月,连续选取在南充市三所医院就诊的803名孕妇为研究对象。采用自制问卷收集孕妇的社会人口学信息、产科与医学信息、心理信息,采用抑郁自评量表（SDS）评定其抑郁症状。按照8∶2有放回地、随机将研究对象分为模型组（n=635）和检验组（n=168）,采用二元Logistic回归分析孕妇抑郁的危险因素,构建预测模型,采用ROC曲线对预测模型的价值进行验证。结果 ①产前无伴侣陪伴（β=-0.692,OR=0.501,95% CI：0.289~0.868）、末次月经期情绪低落（β=-1.510,OR=0.221,95% CI：0.074~0.656）、末次月经期情绪紧张（β=-1.082,OR=0.339,95% CI：0.135~0.853）、婆媳关系不满意（β=-1.228,OR=0.293,95% CI：0.141~0.609）以及婆媳关系一般（β=-0.831,OR=0.436,95% CI：0.260~0.730）是孕妇产前抑郁的危险因素（P<0.05或0.01）。②模型组ROC曲线下面积（AUC）为0.698,95% CI：0.646~0.749,约登指数最大为0.357,灵敏度为0.606,特异度为0.751;检验组AUC=0.672,95% CI：0.576~0.767,约登指数最大值为0.263,灵敏度为0.556,特异度为0.707。结论 本研究构建的产前抑郁风险预测简易模型具有较好的判别效度。     

血小板相关参数对胶质瘤患者预后的影响

目的 探讨术前血小板相关参数对胶质瘤患者肿瘤复发的预测作用。方法 分析联勤保障部队第九〇九医院2015—2017年收治的93例胶质瘤患者临床病理资料,根据随访期间肿瘤是否复发分为无复发组（n=52）和复发组（n=41）,分析血小板相关参数与胶质瘤分级的相关性,采用ROC曲线分析血小板计数（PLT）、血小板体积分布宽度（PDW）、血小板压积(PCT)、平均血小板体积（MPV）、平均血小板体积/血小板计数（MPV/PLT）对肿瘤复发的预测作用,多因素Cox分析肿瘤复发的影响因素,采用Kaplan-Meier曲线分析这些因素对肿瘤复发的影响。结果 胶质瘤Ⅲ、Ⅳ级患者PLT、PCT、高于胶质瘤Ⅰ、Ⅱ级患者（t=-2.388、-2.335,均P<0.05）;胶质瘤Ⅲ、Ⅳ级患者中MPV、MPV/PLT低于胶质瘤Ⅰ、Ⅱ级患者（均P<0.05）;无复发组患者PLT和PCT低于复发组（均P<0.05）;无复发组患者MPV和MPV/PLT高于复发组（均P<0.05）;PLT的ROC曲线下面积（UAC）为0.630（95%CI=0.517~0.743,P=0.032）,阈值为216×10⁹/L;MPV的UAC为0.633（95%CI=0.518~0.747,P=0.029）,阈值为8.65 fL;MPV/PLT的UAC为0.731（95%CI=0.626~0.835,P<0.001）,阈值为0.040;多因素分析结果发现,肿瘤分级（Ⅲ、Ⅳ）、MPV≤8.65 fL、MPV/PLT≤0.040是术后肿瘤复发的危险因素（95%CI分别为1.778~3.530、1.730~4.450、1.811~6.067,均P<0.05）;肿瘤分级（Ⅲ、Ⅳ）预测术后肿瘤复发曲线下面积为0.679（95%CI=0.569~0.789,P=0.003）。Kaplan-Meier曲线分析显示,MPV≤8.65 fL患者术后3年复发率高于MPV>8.65 fL患者（Long Rank=10.990,P=0.001）;MPV/PLT≤0.040患者术后3年复发率高于MPV/PLT>0.040患者（Long Rank=6.289,P=0.012）。结论 胶质瘤患者术前MPV和MPV/PLT与术后肿瘤复发有关,可以用于肿瘤预后预测,具有一定临床意义。 [国际神经病学神经外科学杂志, 2023, 50(4): 29-33]     

抗精神病药物对精神分裂症患者血尿酸水平影响的Meta分析

目的 探讨抗精神病药物对精神分裂症患者血尿酸水平的影响,明确抗精神病药物抗氧化性,为精神分裂症的治疗提供循证参考。方法 采用主题词+自由词的方式,计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,纳入抗精神病药物对精神分裂症患者血尿酸水平影响的对照研究。采用RevMan 5.4进行Meta分析。结果 纳入中英文文献共15篇,包括9种抗精神病药、1 434例精神分裂症患者。Meta分析结果显示,奥氮平（MD=14.01,95% CI：2.39~21.62,P<0.05）和氯丙嗪（MD=51.36,95% CI：42.15~60.57,P<0.05）可升高精神分裂症患者血尿酸水平,利培酮、阿立哌唑、氯氮平、氟哌啶醇、喹硫平和齐拉西酮对精神分裂症患者血尿酸水平的影响均无统计学意义（P均>0.05）。结论 不同种类的抗精神病药对精神分裂症患者血尿酸水平的影响不同,其中奥氮平和氯丙嗪可升高精神分裂症患者血尿酸水平,尚未发现其他抗精神病药物对患者血尿酸水平的影响。     

网络认知行为治疗对癌症患者心理痛苦、抑郁、焦虑和生活质量影响的Meta分析

背景 网络认知行为治疗（ICBT）越来越多地应用于缓解癌症患者的焦虑抑郁情绪,但目前尚无ICBT对癌症患者焦虑、抑郁、心理痛苦以及生活质量影响的荟萃分析。目的 运用系统评价的方法,探讨ICBT对缓解癌症患者心理痛苦、抑郁、焦虑症状以及提高生活质量的效果。方法 于2022年3月28日,以PubMed、PsycINFO、Embase、Cochrane Library、Web of Science、中国知网、维普、万方、中国生物医学文献数据库为数据源,系统收集关于癌症患者心理痛苦、抑郁、焦虑、生活质量、且以ICBT为治疗手段的随机对照试验（RCT）。评价纳入文献的偏倚风险后,采用Stata 17.0进行Meta分析。结果 共纳入12项RCT,包括1 686例患者。Meta分析结果显示,与对照组接受的干预措施相比,ICBT有助于缓解癌症患者的心理痛苦（SMD=-0.547,95% CI：-1.090~-0.145,P<0.01）,但对抑郁（SMD=-0.652,95% CI：-1.734~0.002,P=0.051）、焦虑（SMD=-1.045,95% CI：-3.656~0.101,P=0.088）以及生活质量（SMD=0.234,95% CI：-0.064~0.449,P=0.112）的改善效果不明显。ICBT组脱落率高于对照组（OR=1.795,95% CI：1.358~2.374,P<0.01）。结论 ICBT对癌症患者的心理痛苦有一定的缓解作用,但对抑郁和焦虑症状以及生活质量的改善不明显。     

老年急性缺血性脑卒中患者颈动脉斑块检出率及其与脑卒中复发的相关性

目的 应用多普勒彩色超声诊断仪评估老年急性缺血性脑卒中（AIS）患者颈动脉斑块检出情况,总结斑块发生的高危因素,并分析其与AIS复发的相关性。方法 以2020年1月至2020年6月于常州市第一人民医院神经内科和老年医学科住院的首次发生AIS,并且72 h内入院的老年患者236例为研究对象。依据颈动脉超声检查结果分为颈动脉斑块组（199例）和无颈动脉斑块组（37例）。收集并分析2组患者的临床资料及随访1.5年后脑卒中复发情况。结果 老年AIS患者颈动脉斑块检出率为84.3%。60~69岁、70~79岁及≥80岁患者颈动脉斑块检出率分别为74.7%、86.9%、96.0%,随着年龄增长颈动脉斑块检出率逐渐增加。颈动脉斑块组女性、高血压史和糖尿病史的比例明显高于无斑块组（均P<0.05）。颈动脉斑块组与无颈动脉斑块组脑卒中复发事件发生率比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄（OR=1.070,95%CI：1.02~1.122,P=0.005）、糖尿病史（OR=2.262,95%CI：1.055~4.850,P=0.036）、颈动脉斑块（OR=8.128,95%CI：1.077~61.348,P=0.042）是AIS复发的独立影响因素。结论 老年AIS患者颈动脉斑块检出率高。年龄、性别、高血压史、糖尿病史是颈动脉粥样硬化的危险因素。年龄、糖尿病史、颈动脉斑块与脑卒中复发事件发生相关。     

郑州市严重精神障碍患者服药依从性的影响因素

目的 调查郑州市严重精神障碍患者服药依从情况并分析其影响因素,为制定严重精神障碍防治措施提供参考。方法 于2021年3月-6月,采用分层多阶段整群抽样方法,从国家严重精神障碍信息系统中郑州市所有在册患者中选取342人为研究对象。采用自编问卷收集患者一般人口学资料,并调查其服药情况及影响因素,比较服药依从组与服药不依从组服药影响因素的差异,采用Logistic回归分析探讨服药依从性的影响因素。结果 共320例患者纳入最终分析,其中服药依从者245人（76.56%）。服药依从组与服药不依从组在居住地、职业以及门诊慢性病报销办理情况方面差异均有统计学意义（χ²=14.015、7.502、13.106,P<0.05或0.01）。服药影响因素问卷评分方面,两组自知力缺失、病耻感以及药物相关因素因子评分差异均有统计学意义（Z=7.588、2.379、2.893,P<0.05或0.01）。已办理门诊慢性病报销是服药依从的保护因素（OR=2.727,95% CI：1.320~5.634,P<0.01）,居住地为农村（OR=0.465,95% CI：0.221~0.977,P<0.05）和自知力缺失（OR=0.398,95% CI：0.286~0.553,P<0.01）是服药依从的危险因素。结论 郑州市严重精神障碍患者服药依从比例较高,门诊慢性病报销办理、患者自知力缺失以及居住地可能是患者服药依从性的影响因素。     

淀粉样脑血管病相关脑出血患者血肿增大的影响因素

目的 分析淀粉样脑血管病（CAA）相关脑出血患者住院期间血肿增大的影响因素。方法 分析2016年7月—2023年7月江南大学附属医院收治于神经外科、神经内科、急诊科符合CAA纳入标准的患者242例，将其分为血肿增大组48例和血肿无增大组194例，对影响血肿增大的因素进行Logistic分析。结果 Logistic分析显示高龄（OR：1.064，95%CI：1.018-1.113，P=0.006）、高收缩压（OR：1.063，95%CI：1.015-1.113，P=0.009）、使用三七类药物（OR：5.078，95%CI：2.191-11.766，P＜0.001）、高血钙水平（OR：0.033，95%CI：0.005-0.202，P=0.033）是CAA相关脑出血患者住院期间血肿增大的影响因素。结论 CAA相关脑出血患者血肿增大的影响因素中高龄、高收缩压、使用三七类药物为危险因素，高血钙水平为保护因素。     

早发和晚发型强迫症住院患者临床特征及发病年龄的影响因素

背景 强迫症病因复杂且临床表现异质性高,不同年龄段起病的强迫症患者在临床症状及病因学上存在差异,目前针对早发型和晚发型强迫症住院患者的研究有限。目的 探讨早发型和晚发型住院强迫症患者临床特征的差异及影响强迫症发病年龄的因素,为强迫症患者的早期筛查及治疗提供参考。方法 收集2012年3月-2023年3月在南京医科大学附属脑科医院住院治疗的540例强迫症患者的病历资料。以起病年龄18岁为界,将患者分为早发组（n=310）和晚发组（n=230）,比较两组患者人口学资料及临床症状的差异。使用二元Logistic回归分析影响强迫症患者发病年龄的因素。结果 人口学资料方面,早发组和晚发组的性别、婚姻状况、精神疾病家族史、共病精神疾病、工作情况、受教育程度、强迫症状种类差异均有统计学意义（χ²=22.302、170.556、9.224、13.624、242.277、59.791、7.231,P均<0.05或0.01）,两组起病年龄、住院时年龄差异有统计学意义（Z=-19.915、16.831,P均<0.01）;临床症状方面,早发组强迫思维（χ²=11.998,P<0.05）、排序类（χ²=7.731,P<0.05）、仪式化类症状（χ²=7.714,P<0.05）比例高于晚发组,检查类（χ²=8.204,P<0.05）及清洗类（χ²=7.506,P<0.05）症状比例低于晚发组。共病神经发育障碍、共病情感障碍、有精神分裂症家族史、有情感障碍家族史是影响强迫症患者发病年龄的独立危险因素（OR=19.587、1.830、3.065、4.431,P均<0.05）,其中共病神经发育障碍是影响强迫症患者发病年龄的核心因素,女性是早发患者的保护因素（OR=0.417,P<0.01）。结论 早发和晚发型强迫症住院患者在人口学资料及临床症状上存在差异,共病神经发育障碍是影响强迫症住院患者起病年龄的核心危险因素。     

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.     

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 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.