520例儿童癫痫与高热惊厥的关系分析

目的 分析癫痫患儿与伴高热惊厥史的临床特点，探讨高热惊厥脑损伤及其与颞叶癫痫的关系。方法 对1990～2001年在本院儿科就诊的520例癫痫患儿进行回顾性分析，包括首发年龄、家族史、持续时间、癫痫发作类型、神经影像学及脑电图改变等。结果 125例(24％)患儿有前期高热惊厥史。伴高热惊厥史的急儿癫痫发作早且易出现癫痫持续状态，与无高热惊厥史的患儿相比，伴高热惊厥史的患儿强直一阵挛发作较多，复杂部分性发作较少。387例患儿曾行影像学检查，4例提示有海马硬化均无高热惊厥史。在伴高热惊厥史的癫痫患儿中脑电图局灶起源的异常放电显低于无高热惊厥史的癫痫患儿。有6．4％(8／125)伴高热惊厥史的癫痫患儿和8．4％(33／395)无高热惊厥史的癫痫患儿脑电图表现为单纯颞叶异常放电，二组相比无明显差异。结论 在癫痫患儿中，高热惊厥可能伴有脑损伤，且可能与后期的癫痫发生有关，伴高热惊厥史不一定发展为颞叶癫痫。     

振幅整合脑电图在新生儿脑损伤中的应用价值

目的探讨新生儿脑损伤诊断中振幅整合脑电图的价值。方法选取2014-08—2015-08我院新生儿重症监护病房收治的156例脑损伤高危新生儿,按出生时是否出现窒息症状分为A组(出现窒息症状,n=70)、B组(未出现窒息症状,n=86)。所有患儿均在出生后3~24h内实施振幅整合脑电图检测,分析振幅整合脑电图检查结果与缺氧缺血性脑病及脑损伤严重程度的相关性。结果 A组54例(77.1%)确诊为新生儿缺氧缺血性脑病,振幅整合脑电图总异常率为57.1%(40/70),新生儿缺氧缺血性脑病振幅整合脑电图异常率为74.1%(40/54),高于无新生儿缺氧缺血性脑病,差异有统计学意义(P0.05),新生儿缺氧缺血性脑病与振幅整合脑电图异常率有一定的相关性。B组40例(46.5%)患儿确诊为新生儿脑损伤,振幅整合脑电图总异常率44.2%(38/86),新生儿脑损伤振幅整合脑电图异常率为90.0%(36/40),明显高于非脑损伤患儿,差异有统计学意义(P0.05),新生儿脑损伤与振幅整合脑电图异常率有一定的相关性。轻度、中度、重度新生儿缺氧缺血性脑病振幅整合脑电图异常率分别为61.8%(21/34)、93.8%(15/16)、100.0%(4/4),且随着临床分度的增加,异常率明显提升。结论振幅整合脑电图异常率与新生儿脑损伤有密切的关系,且新生儿缺氧缺血性脑病临床分度与振幅整合脑电图异常程度密切相关。     

Dravet综合征临床和脑电图特征及演变过程

目的 分析Dravet综合征的临床和脑电图特征及演变过程,以改善对本病的早期诊断与合理治疗.方法 分析50例Dravet综合征儿童各种发作类型的起病年龄、诱因、各年龄段发作特征及其与脑电图演变过程的关系.结果 患儿平均起病年龄(5.5±1.9)个月,病程中持续存在热敏感现象.早期以全面性、一侧性或局灶性惊厥发作为主,以后出现肌阵挛、失神等多种发作类型.出现肌阵挛发作的平均年龄(M50)为16个月,13例(26%)无肌阵挛发作.患儿1岁以内脑电图36例次(76%)正常,在1～2岁期间尽管临床出现多种形式发作,但脑电图异常放电出现率仅在50%左右.3岁以后脑电图背景和异常放电出现率均在90%以上.5/18例(28%)有光敏性反应伴肌阵挛发作.结论 Dravet综合征病程早期脑电图与临床发作呈现不平行的进展过程,2岁之前常表现为临床发作严重而脑电图异常率较低.3岁以后各种脑电图异常特征逐渐充分表现.认识Dravet综合征这种临床和脑电图特征有助于早期做出临床诊断,筛选进行SCN1A基因检测的病例.     

小儿高热惊厥临床特点分析

目的探讨小儿高热惊厥的临床特点。方法临床观察130例高热惊厥患儿,给予治疗,统计分析脑电图异常与发病年龄、发病次数、发病持续时间的关系。结果发病年龄与脑电图异常的关系显示,1周岁以下异常率10%,1～3周岁间异常率21.74%,3岁以上异常率55.56%;发病次数与脑电图异常的关系显示,发病1次的异常率11.43%,发病2次的异常率25.00%,发病3次及以上的异常率70.00%;发病持续时间与脑电图异常的关系显示,发病<30min异常率20.83%,发病>30min异常率47.06%。结论高热惊厥患儿的发病年龄、发病次数及发病持续时间均与脑电图出现异常的频率呈正相关,发病年龄越大、发病次数越多、发病持续时间越长,脑电图出现异常的频率就越大。     

高热惊厥患儿的预后及危险因素分析

目的分析高热惊厥(febrile convulsion,FC)患儿的预后情况,探讨相关危险因素。方法随机选取75例高热惊厥患儿为研究对象,搜集所有入组患者的临床、随访及问卷调查资料,对可能影响高热惊厥患儿预后的因素,如性别、初发年龄、持续时间、发作次数、脑电图、家族史进行回顾分析。结果 75例患儿中,62例(82.67%)预后良好,余13例(17.33%)预后不良。高热惊厥初发年龄、持续时间、发作次数、脑电图、家族史与患儿预后存在相关性(P0.05);性别与患儿预后无相关性(P0.05)。多因素Logistic回归分析显示,初发年龄1岁、持续时间≥10min、发作次数≥3次患儿预后不良的可能性大,其风险比(OR)值分别为1.59、5.46、3.97。结论高热惊厥患儿多预后良好,初发年龄1岁、持续时间≥10min、发作次数≥3次是影响高热惊厥患儿预后的独立危险因素。     

颞叶癫痫术后脑电图转归的影响因素与疗效分析

目的分析颞叶癫痫手术后脑电图不同转归的影响因素及与疗效的关系。方法回顾性分析124例行手术治疗的颞叶癫痫患者术后脑电图,根据脑电图的转归将病例分为两组,A组为术后脑电图正常;B组为术后脑电图仍存在癫痫样放电,并分析不同脑电图转归与癫痫病程、首发年龄、术前脑电图痫样放电分布范围及术后疗效的关系。结果 A组占70.97%(88/124),B组占29.03%(36/124),两组患者术前癫痫病程及首发年龄间无统计学差异(P均0.05),B组患者术前脑电图异常分布较A组广泛(55.56%vs.25.00%,P0.01)。A组术后无发作率为92.05%(81/88),B组无发作率为61.11%(22/36),两组间有统计学差异(P0.01)。结论颞叶癫痫术前异常脑电图分布范围影响术后脑电图转归,术后复查脑电图仍有异常者其术后总体疗效要差,提示更需要加强患者的药物巩固治疗。     

过敏性紫癜对脑电图的影响

目的 探讨过敏性紫癜对脑电图的影响.方法 对53例过敏性紫癜患者的脑电图相关资料进行回顾分析,观察5种不同的类型在3个不同的临床阶段的脑电图变化,比较该病的初发和复发对脑电图的影响.结果 脑电图的总异常率为67.92%.53例患者中有15.09%出现了样活动的变化.急性期脑电图异常率是67.92%,缓解期脑电图异常率是56.60%,恢复期脑电图异常率是24.54%.急性期36例异常脑电图中16例(44.44%)为HSP初发者,有20例(55.55%)为HSP复发者;缓解期30例异常脑电图中13例(43.33%)为HSP初发者,有17例(56.66%)为HSP复发者;在恢复期的13例异常脑电图中4例(30.76%)为HSP初发者,9例(69.23%)为HSP复发者.结论 ①异常脑电图可以出现在不同类型的HSP中.②症状越严重,异常脑电图的程度也越严重.③样变化在HSP患者的异常脑电图中是常有的情况,值得进一步随访.④异常脑电图与HSP复发有密切的联系.⑤脑电图检查对HSP的脑损伤和预后的判别是一个有用的监测.     

302例癫痫患者病因分析

本文302例癫痫病人,30岁以前发病最多,占81.3％,以婴幼儿发病较多,占44.7％,男性多于女性,男女之比为1.1∶1。本组有52.65％患者可找到癫痫的可能病因:颅内炎症(即脑炎、结核性、散发性等),脑部肿瘤,产伤,脑外伤,高热惊厥,遗传史,中毒及脑血管病等,仍有47.35％的患者原因不明。本组仅发现51例有家族遗传史。286例进行脑电图检查,其中有162例脑电图异常,124例脑电图正常。脑电图异常在遗传及高热惊厥方面表现较为突出,发现高热惊厥和癫痫在遗传上可能有一定联系。     

118例小儿热性惊厥的临床与动态脑电图分析

为探讨24小时脑电图（AEEG）监测对小儿热性惊厥的诊断意义,对118例热性惊厥患儿进行24小时动态脑电监测。结果,AEEG总异常率为40．7％,痫样波检出率6．8％。年龄≤2岁与＞2岁组、体温＞38．5℃组与≤38.5℃、首发组与反复发作组比较,后AEEG异常率明显高于前（P＜0．05－0．01）。提示,发作次数越多AEEG异常率越高。对AEEG异常和有痫样放电的患儿均应给以抗癫痫药物治疗。     

aEEG在窒息新生儿早期脑损伤与预后预测中的应用及其临床意义

目的 探讨窒息新生儿采用振幅整合脑电图(aEEG)进行早期脑损伤与预后预测的实际价值及临床意义。方法 选取2015年5月-2018年4月就诊于本院的60例缺血缺氧性脑损伤新生儿开展研究,根据窒息程度将其分为轻度窒息组(42例)和重度窒息组(18例),另选同期健康新生儿共40例作为对照组,使用aEEG对所有新生儿进行监测,同时根据aEEG监测表现将所有新生儿分为aEEG轻度异常组、重度异常组和正常组,分析aEEG在评估窒息新生儿早期脑损伤与预后中的应用价值。结果 不同组新生儿aEEG异常率比较差异显著,重度窒息组明显高于轻度窒息组和对照组,其中对照组aEEG异常率最低(P<0.05); 随访1年后发现,3组新生儿身长和体质量比较无明显差异(P>0.05),但重度异常组头围明显低于轻度异常组和正常组(P<0.05); 正常组MDI、PDI评分均高于轻度和重度异常组(P<0.05),重度异常组癫痫发生率显著高于轻度异常组和正常组(P<0.05); 正常组各项运动功能发育评分均高于轻度和重度异常组,其中重度异常组最低(P<0.05)。结论 缺血缺氧性脑损伤新生儿aEEG监测能作为评估早期脑损伤程度的参考依据,还能有效预测患儿远期发育状况。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -