帕金森病患者PINK1 LRRK2基因单核苷酸多态性分析

目的探讨PINK1基因rs45530340位点及LRRK2基因rs1491942位点单核苷酸多态性(single nucleotide polymorphism,SNP)与淮海地区汉族人群晚发散发性帕金森病(Parkinson’s disease,PD)的相关性。方法收集152例晚发散发性PD患者和160例年龄和性别相匹配的健康对照者,入组者均来自淮海地区汉族人群。提取外周血全基因组DNA,应用聚合酶链式反应(polymerase chain reaction,PCR)技术扩增包含多态位点的目的基因片段,通过琼脂糖凝胶电泳(AGE)检测PCR产物。对PCR产物分别用DNA限制性内切酶NlalV和SmlI进行酶切,用聚丙烯酰胺凝胶电泳(PAGE)、硝酸银染色检测酶切产物,采用聚合酶链式反应-限制性片段长度多态性(restriction fragment length polymorphism,RFLP)技术分析基因型,计算所有研究对象两个SNP位点的基因型频率和等位基因频率。结果 (1)PINK1基因rs45530340位点基因型和等位基因在晚发散发性PD组和正常对照组中的分布无统计学差异(基因型:χ2=1.572,P=0.456;等位基因:χ2=1.318,P=0.251)。(2)LRRK2基因rs1491942位点基因型和等位基因在晚发散发性PD组与正常对照组中的分布差异有统计学意义(基因型:χ2=6.802,P=0.033;等位基因C:χ2=7.448,P=0.006,OR=1.571,95%CI=1.135~2.176)。结论 (1)PINK1基因rs45530340多态位点可能不是淮海地区汉族人群晚发散发性PD患者的危险因素。(2)LRRK2基因rs1491942多态位点C等位基因可能是淮海地区汉族人群晚发散发性PD患者的危险因素。     

帕金森病患者PINK1LRRK2基因单核苷酸多态性分析

目的 探讨PINK1基因rs45530340位点及LRRK2基因rs1491942位点单核苷酸多态性（single nucleotide polymorphism,SNP）与淮海地区汉族人群晚发散发性帕金森病（Parkinson＇s disease,PD）的相关性.方法 收集152例晚发散发性PD患者和160例年龄和性别相匹配的健康对照者,入组者均来自淮海地区汉族人群.提取外周血全基因组DNA,应用聚合酶链式反应（polymerase chain reaction,PCR）技术扩增包含多态位点的目的 基因片段,通过琼脂糖凝胶电泳（AGE）检测PCR产物.对PCR产物分别用DNA限制性内切酶NlalV和SmlI进行酶切,用聚丙烯酰胺凝胶电泳（PAGE）、硝酸银染色检测酶切产物,采用聚合酶链式反应-限制性片段长度多态性（restriction fragment length polymorphism,RFLP）技术分析基因型,计算所有研究对象两个SNP位点的基因型频率和等位基因频率.结果 （1）PINK1基因rs45530340位点基因型和等位基因在晚发散发性PD组和正常对照组中的分布无统计学差异（基因型：χ2=1.572,P=0.456;等位基因：χ2=1.318,P=0.251）.（2） LRRK2基因rs1491942 位点基因型和等位基因在晚发散发性PD组与正常对照组中的分布差异有统计学意义（基因型：χ2=6.802,P=0.033;等位基因C：χ2=7.448,P=0.006,OR=1.571,95%CI=1.135~2.176）.结论 （1）PINK1基因rs45530340 多态位点可能不是淮海地区汉族人群晚发散发性PD患者的危险因素.（2）LRRK2基因rs1491942多态位点C等位基因可能是淮海地区汉族人群晚发散发性PD患者的危险因素.     

Fas基因A-670G单核苷酸多态性与阿尔茨海默病的相关性分析

目的探讨中国汉族人群中Fas基因A-670G单核苷酸多态性(SNP)与阿尔茨海默病(AD)的相互关系。方法采用等位基因特异性PCR(A-S PCR)技术检测509例AD患者和561名健康对照者Fas基因A-670G位点SNP的分布,并分析各基因型与发病年龄和疾病严重程度的关系。结果AD组和对照组基因型频率(χ2=0.66,P>0.05)及等位基因频率(χ2=0.70,P>0.05)差异均无统计学意义。进一步将样本按发病年龄和性别分层其差异也未发现统计学意义(P>0.05)。而且,各基因型与发病年龄、疾病严重程度也不相关。结论中国汉族人群中Fas基因A-670G位点SNP与AD无关联。     

广西汉族人群NINJ2基因单核苷酸多态性位点rs12425791与缺血性脑卒中的关系

目的 探讨广西汉族人群NINJ2基因单核苷酸多态性(SNP)位点rs12425791与缺血性脑卒中(IS)的关系.方法 采用TaqMan MGB探针等位基因分型技术,对166例IS患者(IS组)和192名健康对照者(正常对照组)NINJ2基因SNP位点rs12425791进行基因分型,对两组基因型和等位基因频率进行比较.结果 IS组NINJ2基因SNP位点rs12425791基因型分布[G/G型103例(62.05％),G/A型54例(32.53％),A/A型9例(5.42％)]与正常对照组[G/G型112例(58.33％)、G/A型65例(33.85％)、A/A型15例(7.81％)]比较差异无统计学意义(x2=1.011,P=0.603).IS组NINJ2基因SNP位点rs12425791等位基因频率(G等位基因78.31％,A等位基因21.69％)与正常对照组(G等位基因75.26％,A等位基因24.74％)比较差异亦无统计学意义(x2=0.928,P=0.335).结论 广西汉族人群NINJ2基因SNP位点rs12425791可能与IS的发病无关.     

ABCB1基因多态性与中国汉族人群动脉粥样硬化性血栓性脑梗死的相关性研究

目的探讨ATP结合盒B亚家族成员1转运蛋白(ABCB1)基因多态性与中国汉族人群动脉粥样硬化性血栓性脑梗死(ATCI)患者的关系。方法选取392例ATCI患者(脑梗死组)和429例健康对照者(对照组),通过SNa Pshot方法对ABCB1基因的rs1128503和rs1045642位点进行SNP检测。比较两组的基因型和等位基因分布频率,分析基因型与临床表型的关系。结果脑梗死组rs1128503和rs1045642位点的基因型及等位基因分布频率与对照组比较,无统计学意义(P0.05)。女性ATCI患者的rs1128503位点TT基因型和CC基因型体重指数高于TC基因型(P=0.007,P=0.011)。女性ATCI患者的rs1045642位点CC基因型低密度脂蛋白-胆固醇水平高于CT基因型(P=0.030)。结论 ABCB1基因多态性与中国汉族人群ATCI的发病无明显相关性。rs1128503位点多态性可能与女性ATCI患者的体重指数有关,rs1045642位点多态性可能与女性ATCI患者的低密度脂蛋白-胆固醇水平有关。     

胰岛素样生长因子1、载脂蛋白酶E基因多态性与阿尔茨海默病关系的研究

目的探讨河南省汉族人群胰岛素样生长因子1(insulin like growth factor 1,IGF-1)基因rs972936位点多态性、载脂蛋白酶E(Apo E)基因多态性与阿尔茨海默病(Alzheimer’s disease,AD)之间的相关性。方法选取58例AD患者和126例年龄、性别相匹配的健康对照(ND)者为研究对象,柱层析法提取外周血基因组DNA,采用PCR和基因测序技术检测IGF-1基因rs972936位点及Apo E基因型多态分布,并进行对比分析。结果与ND组比较,AD组IGF-1基因rs972936位点3种基因型分布总体差异有统计学意义(χ~2=6.108,P=0.047),其中AD组中GG基因型的频率高于对照组(70.7%51.6%,χ~2=5.935,P=0.015),G等位基因频率明显高于健康对照组(χ~2=6.502,P=0.011);AD组Apo Eε4等位基因频率可能增加AD的患病风险(OR=2.872,95%CI 1.542~5.351)(P=0.001);Apo Eε4等位基因不影响IGF-1基因rs972936位点的基因型或等位基因的分布频率(P0.05)。结论 IGF-1基因rs972936位点多态性与河南汉族人群AD的发病可能有相关性,其中GG基因型、G等位基因可能是AD发病的独立于Apo Eε4等位基因的危险因素。Apo Eε4等位基因是散发性AD的主要危险因素。     

β2肾上腺素能受体基因多态在重症肌无力发病机制中的作用

目的 探讨β2肾上腺素能受体(β2-AR)基因16位、27位密码子遗传多态在重症肌无力(myasthenia gravis,MG)发病机制中的作用.方法 应用聚合酶链反应-限制性片段长度多态(PCR-RFLP)方法和PCR产物直接测序检测88例MG患者组和91名性别、年龄相匹配的健康对照(HC)的β2-AR基因16位点和27位点多态分布特征.结果 β2-AR基因16位点Arg/Arg、Arg/Gly和Gly/Gly基因型频率在MG组依次为44.4%、38.6%和17.0%,HC组依次为29.7%、58.2%和12.1%,两组间差异有统计学意义(X~2=6.898,P=0.032).Arg和Gly的等位基因频率在MG组分别为63.6%和36.4%,HC组为58.8%和41.2%,两组间差异无统计学意义.β2-AR基因27位点Gln/Gln、Gln/Glu和Glu/Glu基因型频率在MG组依次为77.3%、20.4%和2.3%,HC组依次为78.0%、18.7%和3.3%,两组间差异无统计学意义.Gln和Glu等位基因频率在MG组为87.5%和12.5%,HC组为87.4%和12.6%,两组间差异无统计学意义.两组的基因型多态分布均符合Hardy-Weinberg定律.结论 β2-AR 16位点基因多态可能是MG发病的独立危险凶素,27位点基因多态与MG发病无明确相关性.     

IL-17F及IL-17A基因多态性与中国四川汉族人群多发性硬化的相关性

目的探讨中国四川汉族人群中白细胞介素(interleukin,IL)-17A多态位点rs2275913及IL-17F基因多态位点rs763780与多发性硬化(multiple sclerosis,MS)发病的相关性。方法收集川北医学院附属医院神经内科就诊的MS患者126例,以176名性别年龄相匹配的健康体检者为对照,利用聚合酶链式反应-限制性片段长度多态性方法来检测rs2275913及rs763780多态位点的等位基因及基因型频率分布,并进行统计学分析。结果 MS患者IL-17F基因rs763780位点TT基因型频率(84.92%)高于健康对照组(71.01%),差异有统计学意义(校正后P=0.036)。患者T等位基因频率(92.06%)亦高于正常人(84.66%),差异有统计学意义(校正后P=0.048)。MS患者IL-17A位点rs2275913的基因型频率及等位基因频率与健康对照者相比无统计学差异(P0.05)。结论 IL-17F基因多态位点rs763780与MS相关,TT基因型及T等位基因可能是中国四川汉族人群MS发生的危险因素。IL-17A位点rs2275913同四川汉族人MS发病无相关。     

SORL1基因多态性与中国东北地区帕金森病的相关性分析

目的探究SORL1基因rs2070045位点的单核苷酸多态性与帕金森病(Parkinson disease,PD)的相关性。方法本研究纳入215名中国东北地区汉族健康人和377例PD患者。根据其发病年龄,将PD组患者再分为早发PD组(发病年龄≤50岁)和晚发PD组(发病年龄50岁),收集一般临床资料,提取外周血基因组DNA,利用MALDI-TOF-PEX技术检测SORL1基因rs2070045多态性分布情况,分析其与帕金森病的相关性。结果在PD组与对照组以及晚发PD组与对照组的比较中,SORL1基因rs2070045位点单核苷酸多态性的基因型及等位基因频率分布无统计学差异。早发PD组与对照组比较,rs2070045基因型分布有显著差异(P=0.036),而等位基因频率无显著差异。在晚发PD中G等位基因携带者的起病年龄明显低于非携带者(P=0.001),其他临床特征如性别、Hoehn-Yahr分期以及病程在携带者和非携带者间无统计学差异。结论 SORL1基因rs2070045位点的单核苷酸多态性与中国东北地区汉族早发帕金森病相关,G等位基因可能是早发PD的保护性因素。     

新疆地区维吾尔族、汉族单胺氧化酶B基因多态性与帕金森病的相关性研究

目的探讨中国新疆地区维吾尔族、汉族人群多巴胺代谢酶-单胺氧化酶B(MAO-B)基因内含子13 G/A多态性与帕金森病(PD)遗传易感性的关系,以及PD患者基因型与临床特点的关系。方法研究对象为中国新疆地区241例PD患者(PD组),其中维吾尔族95例(维吾尔族PD组)、汉族146例(汉族PD组);另选择247名健康对照者(对照组),其中维吾尔族104例、汉族143例。收集并分析PD患者临床资料;采用聚合酶链反应-限制性片段长度多态性分析法(PCR-RLFP)进行MAO-B基因多态性分析,研究基因型和等位基因频率分布情况。结果①PD组与对照组MAO-B基因G/A基因型及等位基因频率差异无统计学意义。②维吾尔族PD组和汉族PD组与对照组的基因型及等位基因频率差异无统计学意义。③男性PD组和女性PD组与相同性别对照组的基因型及等位基因频率分布差异无统计学意义。④发病年龄≤70岁PD患者与对照组基因型频率、等位基因频率差异无统计学意义;>70岁的PD患者与对照组基因型频率、等位基因频率差异有统计学意义。⑤新疆地区维吾尔族、汉族PD患者的3种基因型的临床特点差异无统计学意义。结论MAO-B基因的AA基因型与A等位基因频率增高是发病年龄>70岁新疆维吾尔族和汉族PD患者的危险因素。PD患者MAO-B基因3种基因型的临床特点无差别。     

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.