重复经颅磁刺激或无抽搐电休克治疗联合抗抑郁药物对重度抑郁障碍的疗效和安全性

背景 重度抑郁障碍是致残性最强的精神疾病之一,目前对该病的治疗多采用药物联合物理治疗和心理治疗,关于物理治疗之间的对照研究较少,药物联合物理治疗的对照研究更少。目的 探讨重复经颅磁刺激（rTMS）和无抽搐电休克治疗（MECT）分别联合抗抑郁药物对重度抑郁障碍的疗效和安全性,以期为重度抑郁障碍患者提供更优的治疗方案。方法 连续选取2019年1月1日—2023年4月30日在山东省戴庄医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）诊断标准的重度抑郁障碍患者（n=335）。入院后,患者根据病情接受MECT联合药物治疗（n=141）或rTMS联合药物治疗（n=194）。于基线期及治疗第1、2、3、4周末,采用汉密尔顿抑郁量表24项版（HAMD-24）评定抑郁症状,阅读患者病程记录,了解不良反应发生情况。结果 两组HAMD-24评分的时间效应有统计学意义（F=3.081,P=0.042）,组间效应无统计学意义（F=1.023,P=0.313）,时间与组间的交互效应无统计学意义（F=1.642,P=0.191）。治疗后各时点,两组显效率及痊愈率比较,差异均无统计学意义（P均>0.05）。在整个治疗过程中,MECT联合药物组中,有58人（41.13%）出现近记忆力受损,74人（52.48%）出现头痛或颈部肌肉痛;rTMS联合药物组中,27人（13.92%）出现头痛或头皮不适。结论 rTMS联合抗抑郁药物与MECT联合抗抑郁药物治疗重度抑郁障碍的效果相当,rTMS联合抗抑郁药物的安全性更高。     

团体认知行为治疗对广泛性焦虑障碍的临床疗效及其对患者执行功能的影响

背景 广泛性焦虑障碍（GAD）患者常存在执行功能损害。团体认知行为治疗（CBT）有助于改善GAD患者的负性情绪,但对执行功能的改善效果尚不明确。目的 探讨团体CBT对GAD患者焦虑症状和执行功能的影响,以期为GAD患者的康复治疗提供参考。方法 连续选取2021年3月—2022年8月在十堰市太和医院睡眠心身医学中心住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）中GAD诊断标准的80例患者为研究对象,采用随机数字表法分为研究组（n=40）和对照组（n=40）。两组均接受药物治疗及疾病健康教育,研究组在此基础上接受为期6周、每周1次、每次60~90 min的团体CBT。分别于治疗前和治疗6周后使用汉密尔顿焦虑量表（HAMA）评定焦虑症状,使用额叶功能评定量表（FAB）评定执行功能。结果 重复测量方差分析结果显示,两组HAMA评分的时间效应有统计学意义（F=1 870.320,P<0.01）,组间效应以及时间与组间的交互效应无统计学意义（F=1.254、0.293,P均>0.05）。两组FAB评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=311.190、4.399、7.021,P<0.05或0.01）。进一步分析结果显示,治疗后,两组FAB评分均高于治疗前（t=200.569、115.401,P均<0.01）,且研究组FBA评分高于对照组（t=-3.211,P<0.01）。结论 团体CBT联合药物治疗可能有助于降低GAD患者焦虑水平,改善其执行功能。     

氟西汀联合舒肝解郁胶囊治疗抑郁症的效果及对患者心率变异性的影响

背景 抑郁症可能导致患者存在较高的自杀风险,严重影响患者和家属的生活质量,给社会带来较大负担。虽然西药中的抗抑郁药疗效确切,但单一使用对抑郁症状改善相对局限,且联用两种抗抑郁药可能增加不良反应。中成药与西药合理配伍使用可能起到相辅相成的效果,且中成药安全性较高。目的 探讨氟西汀联合舒肝解郁胶囊治疗抑郁症的效果,比较氟西汀联合舒肝解郁胶囊与单用氟西汀的疗效、安全性以及对患者心率变异性影响的差异,为抑郁症患者的临床用药提供参考。方法 收集2015年12月-2016年6月在新乡医学院第二附属医院门诊就诊和住院治疗的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）抑郁症诊断标准的64例患者为研究对象,采用随机数字表法分为联合用药组和氟西汀组各32例。两组均接受氟西汀治疗,联合用药组在此基础上联用舒肝解郁胶囊。治疗前,两组均接受汉密尔顿抑郁量表24项版（HAMD-24）和汉密尔顿焦虑量表（HAMA）评定以及心率变异性（HRV）分析,并于治疗第2、4、6周末接受HAMD-24和副反应量表（TESS）评定,治疗第6周末再次进行HRV分析。结果 最终共60例抑郁症患者完成研究,联合用药组和氟西汀组各30例。治疗第2、4、6周末,联合用药组HAMD-24评分均低于氟西汀组,差异均有统计学意义（t=-2.677、-3.960、-4.432,P<0.05或0.01）。与治疗前相比,联合用药组在治疗第6周末24小时平均正常RR间期标准差（SDNN）、标化低频功率（nLF）以及标化高频功率（nHF）均较高（t=-73.970、-31.878、-38.721,P均<0.01）,而低频功率与高频功率之比（LF/HF）较低（t=3.525,P<0.01）。治疗第6周末,联合治疗组总有效率高于氟西汀组,差异有统计学意义（86.67% vs. 70.00%,χ²=18.764,P<0.01）。治疗第2、4、6周末,两组不良反应发生例数差异均无统计学意义（P均>0.05）。结论 与单用氟西汀相比,舒肝解郁胶囊联合氟西汀对抑郁症的临床疗效和改善患者心率变异性方面可能更好,且不增加不良反应。     

青少年抑郁障碍患者与双相情感障碍患者睡眠特征及其对自杀风险的影响

目的 比较青少年抑郁障碍患者和双相情感障碍患者睡眠结构特征的差异,探讨睡眠指标等因素对患者自杀风险的影响。方法 回顾性查阅广州医科大学附属脑科医院2019年1月1日-2021年6月30日符合《国际疾病分类（第10版）》（ICD-10）诊断标准的抑郁障碍（n=97）和双相情感障碍（n=52）住院青少年患者病历资料,收集患者的年龄、性别、体质量指数（BMI）、精神科诊断、自杀风险评估量表（NGASR）评分及多导睡眠监测（PSG）结果。根据NGASR评分结果,将患者分为两组：0~5分为自杀低风险组（n=32）,>5分为自杀高风险组（n=117）。以既往文献中80例正常青少年的PSG数据作为对照组资料。建立多元线性回归模型探讨青少年情感障碍患者自杀风险的影响因素。结果 自杀高风险组睡眠效率和N2期睡眠占比均低于自杀低风险组（Z=-2.138、-2.520,P均<0.05）。抑郁组总睡眠时间、N2期睡眠时间以及REM期睡眠时间均少于双相组（t=-2.822、-3.087、-2.277,P<0.05或0.01）;抑郁组和双相组REM期睡眠占比均低于对照组（t=-2.369、-2.069,P均<0.05）。线性回归分析显示,青少年情感障碍患者自杀风险的影响因素包括N1期睡眠时间（β=0.019,P<0.05）、性别（男性vs.女性,β=-4.051,P<0.01）以及诊断（双相情感障碍vs.抑郁障碍,β=-1.429,P<0.05）。结论 与青少年双相情感障碍患者相比,青少年抑郁障碍患者存在睡眠连续性差、浅睡眠更少的特点。N1期睡眠时间、女性以及诊断为抑郁障碍是青少年情感障碍患者自杀的影响因素。     

伴中重度阻塞性睡眠呼吸暂停低通气综合征的抑郁症患者多导睡眠监测特点

目的 探讨伴中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的抑郁症患者多导睡眠监测（PSG）特点。方法 回顾性分析2017年12月-2019年10月在苏州市广济医院睡眠医学中心完成整夜多导睡眠监测（PSG）的门诊和住院患者以及健康体检人群,从中筛选出四组被试,分别为伴中重度OSAHS的抑郁症患者（n=31）、不伴OSAHS的抑郁症患者（n=79）、中重度OSAHS患者（n=96）和正常对照组（n=32）。比较四组被试睡眠进程相关指标（总睡眠时间、睡眠潜伏期、觉醒次数）和睡眠结构相关指标（N1、N2、N3期及REM期占总睡眠时间的比例,REM潜伏期、REM期持续时间）以及睡眠呼吸相关指标（氧减指数）等参数。结果 睡眠进程方面,四组被试总睡眠时间、睡眠潜伏期和觉醒次数差异均有统计学意义（F=2.874、3.959、12.291,P<0.05或0.01）。睡眠结构方面,四组被试N2期、N3期占总睡眠时间比例差异均有统计学意义（F=13.885、48.013,P均<0.01）;四组被试REM潜伏期、REM期持续时间、REM期占总睡眠时间比例差异均有统计学意义（F=41.492、11.827、10.552,P均<0.01）。睡眠呼吸相关指标方面,四组被试氧减指数差异有统计学意义（F=170.585,P<0.05）。结论 伴中重度OSAHS的抑郁症患者存在严重的睡眠进程和结构紊乱,同时伴有更频繁和更严重的呼吸相关事件。     

伴失眠的抑郁症患者睡眠认知特征及其对睡眠质量的影响

目的 了解伴失眠的抑郁症患者对睡眠的信念与态度，并探讨其对睡眠质量的影响。方法 纳入在首都医科大学附属北京安定医院就诊、符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）诊断标准的伴失眠的抑郁症患者（n=61）和原发性失眠患者（n=62）为研究对象，并招募健康对照组（n=64）。三组被试均接受睡眠功能失调信念和态度量表（DBAS）及匹兹堡睡眠质量指数量表（PSQI）评定，伴失眠的抑郁症患者同时接受汉密尔顿抑郁量表17项版（HAMD-17）评定。采用协方差分析比较三组被试PSQI和DBAS评分。采用多元线性回归分析探讨伴失眠的抑郁症患者PSQI评分的影响因素。结果 伴失眠的抑郁症组和原发性失眠组PSQI评分均高于对照组（t=18.932、18.610，P均<0.01），两组DBAS评分均低于对照组（t=-5.561、-5.791，P均<0.01）。以伴失眠的抑郁症患者PSQI评分作为因变量，建立的多元线性回归方程具有统计学意义（F=14.095，R²=0.327，P<0.05），DBAS中对睡眠的预测与控制因子和年龄是患者睡眠质量的影响因素（B=-0.100、-0.279，P<0.05或0.01）。结论 伴失眠的抑郁症患者比正常人存在更多的睡眠相关负性认知，且不良认知可能是其睡眠质量的影响因素。     

青少年抑郁发作患者自杀行为态度及其相关因素

背景 青少年人群对自杀的态度与其自杀行为高度相关,既往关于自杀态度及其相关因素的研究多聚焦于学校样本,对青少年抑郁发作患者相关临床样本的研究不足。目的 分析青少年抑郁发作患者对自杀行为的态度及相关因素,为这一群体的自杀干预提供参考。方法 连续选取2021年5月-2022年7月芜湖市第四人民医院门诊及住院部符合《国际疾病分类（第10版）》（ICD-10）抑郁发作诊断标准的青少年患者共100例。采用自编一般情况调查问卷收集患者人口学资料,采用汉密尔顿抑郁量表17项版（HAMD-17）、自杀态度问卷（QSA）、父母教养方式评价量表（EMBU）以及网络成瘾量表（IAT）分别评定患者的抑郁症状、自杀态度、父母教养方式和网络成瘾情况。采用Spearman和Pearson相关分析探讨患者QSA中对自杀行为的态度因子评分与一般情况和HAMD-17评分、EMBU评分及IAT评分的相关性。采用多元线性回归分析考查自杀行为的态度的危险因素,绘制ROC曲线评估各因素预测对自杀行为的态度的有效性。结果 青少年抑郁发作患者QSA对自杀行为的态度因子评分与对自杀者的态度因子、对安乐死的态度因子、母亲情感温暖与理解因子评分均呈正相关（r=0.210~0.485,P<0.05或0.01）,与父亲受教育程度、近6个月自杀行为、HAMD-17评分、IAT评分、父亲惩罚与严厉、父亲过分干涉、父亲拒绝与否认、父亲过度保护、母亲过分干涉与保护、母亲拒绝与否认、母亲惩罚与严厉因子评分均呈负相关（r=-0.571~-0.290,P<0.05或0.01）。多元线性回归分析显示,QSA对自杀者的态度因子（β=0.198,P<0.01）和对安乐死的态度因子（β=0.302,P<0.01）可正向预测对自杀行为的态度,父亲受教育程度（β=-0.180,P=0.043）、HAMD-17评分（β=-0.366,P<0.01）以及IAT评分（β=-0.191,P=0.030）可负向预测对自杀行为的态度。各因素之间预测效能比较差异均无统计学意义（Z=-1.289~0.092,P均>0.05）。结论 网络成瘾、抑郁严重程度、对自杀者的态度、对安乐死的态度和父亲受教育程度可能影响青少年抑郁发作患者对自杀行为的态度。     

江门市中学生非自杀性自伤行为的流行病学特征及影响因素分析

目的 了解江门市中学生非自杀性自伤（NSSI）行为的流行病学特征及影响因素。方法 于2020年11月-12月,采用分层随机抽样法,抽取江门市1 220名中学生为研究对象。采用自编调查问卷、中学生应对方式量表、Olweus儿童欺负问卷初中版（BVQ）、青少年社会支持量表及流调中心用抑郁量表（CES-D）进行评定。运用二元Logistic回归分析探讨中学生NSSI行为的影响因素。结果 共检出204名（16.72%）中学生曾有过NSSI行为,其中男生67人、女生137人。NSSI组与非NSSI组在性别、学段、住校情况、同伴关系及学习成绩上差异均有统计学意义（χ²=22.162、7.247、6.541、45.787、25.097,P<0.05或0.01）。与非NSSI组相比,NSSI组CES-D评分（t=-14.240）和BVQ评分（t=-5.952）更高,青少年社会支持量表评分更低（t=9.238）,中学生应对方式量表问题应对分量表评分更低（t=7.148）,情绪应对分量表评分更高（t=-7.038）,受校园欺凌、语言欺凌和关系欺凌检出率更高（χ²=34.215,29.785,16.465）,差异均有统计学意义（P均<0.01）。二元Logistic回归分析结果显示,抑郁（OR=1.090,P<0.01）及受校园欺凌（OR=1.492,P<0.05）进入回归模型。结论 江门市中学生NSSI形势严峻,抑郁及受校园欺凌是其发生NSSI行为的危险因素。     

新冠肺炎疫情复学后高中生心理健康状况调查

目的 了解新冠肺炎疫情复学后高中生的心理健康状况，为其心理干预提供参考。方法 采用分层抽样，以山东省某中学的149名高中生为研究对象，通过症状自评量表（SCL-90）对其进行心理健康状况评估。结果 SCL-90评定结果显示，总评分异常（总评分≥160分）者共57人（38.26%），阳性项目数异常（阳性项目数≥43项）者共45人（30.20%）。不同性别的高中生SCL-90恐怖因子评分差异有统计学意义（t=-2.139，P=0.034）。不同年级的高中生SCL-90总评分（F=3.262，P=0.041）、焦虑因子（F=4.045，P=0.020）、敌对因子（F=3.598，P=0.030）、精神病性症状因子（F=3.573，P=0.031）评分差异均有统计学意义。两两比较显示，高三年级组与高一年级组SCL-90总评分（t=2.618，P=0.01）、强迫症状因子（t=2.067，P=0.041）、抑郁因子（t=2.513，P=0.013）、焦虑因子（t=2.960，P<0.01）、敌对因子（t=2.910，P<0.01）、精神病性因子（t=2.608，P=0.01）、其他因子（t=2.131，P=0.035）评分差异均有统计学意义。结论 新冠肺炎疫情对高中生的心理健康状况有影响，需要关注女生的恐惧情绪，高年级学生更容易受影响，主要与疫情对学习的影响有关。     

正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响

背景 术后认知功能障碍（POCD）是术后常见的并发症之一,老年患者发病率较高。POCD对患者术后康复影响较大。目的 探讨正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响,为降低老年患者POCD发生风险、改善睡眠质量提供参考。方法 采用简单随机抽样法,选取2022年3月—2023年3月在绵阳市第三人民医院接受非全身麻醉手术的78例老年患者为研究对象,采用随机数字表法分为研究组和对照组各39例。两组均接受常规治疗及护理,研究组此基础上接受正念疗法干预。于术前1天以及术后第1、3、5天,采用简易精神状态量表（MMSE）评定患者的认知功能,于术前1天及术后第3天采用匹兹堡睡眠质量指数量表（PSQI）评定患者的睡眠质量。结果 两组MMSE评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=78.251、197.071、371.915,P均<0.05）。进一步分析显示,术后第1、3、5天,研究组MMSE评分均高于对照组,差异均有统计学意义（t=-3.579、-1.764、-0.253,P均<0.05）。术后第1、3、5天,研究组POCD发生率均低于对照组,差异均有统计学意义（χ²=2.631、3.471、5.135,P均<0.05）。术后第3天,研究组PSQI总评分低于对照组（P<0.05）,且研究组PSQI总评分、睡眠潜伏期、主观睡眠质量、日间功能障碍以及催眠药物使用因子评分均低于术前（F=43.175、12.594、11.092、4.579、3.514,P均<0.01）。结论 正念疗法可能有助于降低老年患者非全身麻醉术POCD的发生率,并改善其睡眠质量。     

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.     

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 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.     

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.