盐酸丁咯地尔注射液治疗缺血性脑血管病的临床观察

目的：评价国产盐酸丁咯地尔注射液治疗缺血性脑的疗效和安全性。方法：采用随机、对照和开放的试验设计。结果：盐酸丁咯地尔可显著改善缺血性脑血管病患者的自觉症状和降低神经功能缺损评分（P＜0．01），生活不能自理者由原来的29．2％下降为12．5％，与进口盐酸丁咯地尔相比差异无显著性（P＞0．05），不良反应发生率8．3％，结论：国产盐酸丁咯地尔注射液对改善缺血性脑血管病所致的运动功能障碍和提高生活能力有较好疗效，副作用少，与进口盐酸丁咯地尔注射液疗效相当。     

低分子肝素治疗急性缺血性脑血管病的临床观察

目的 观察低分子肝素治疗急性缺血性脑血管病的疗效。方法 通过分别使用低分子肝素及复方丹参注射液，随机开放性对200例急性缺血性脑血管病患者进行治疗，并比较两组的疗效。结果 低分子肝素组基本治愈率＋显效率79％，总有效率93％；对照组基本治愈率＋显效率59％，总有效率76％。低分子肝素治疗急性缺血性脑血管病的基本治愈率＋显效率以及总有效率明显高于对照组，两组比较差异有显著性（P＜0．01）。结论 低分子肝素治疗急性缺血性脑血管病疗效好，副作用小，安全可靠。     

2型糖尿病并发脑梗死诊治分析

目的观察2型糖尿病并发脑梗死患者的治疗效果及预后。方法对我科收治的48例2型糖尿病合并脑梗死住院患者的诊治情况进行归纳分析。结果经积极的治疗,大部分患者症状和体征基本消失,生活可自理,瘫痪肢体肌力在1级以上41例;症状和体征无明显改善,瘫痪肢体肌力在1级以下5例;死亡2例,1例为大脑半球大面积梗死,1例为恶性心律失常。结论 2型糖尿病并发脑梗死是多种因素共同作用的结果,临床上应积极控制血糖、血压、血脂等危险因素,合理膳食,改善生活习惯,提高生活质量,降低脑梗死的发生率、致残率、病死率。     

小剂量盐酸苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍临床分析

目的探讨小剂量苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍的临床疗效,以提高患者生活质量。方法对本科2005年至2012年收治的186例脑血管病假性延髓麻痹患者分为治疗组96例和对照组90例,遵照按脑卒中指南常规用药,治疗组在对照组治疗的基础上加用小剂量苯海索辅助治疗,治疗前后对患者进行标准吞咽功能评估(SSA)和洼田氏饮水试验评定。结果治疗组患者应用小剂量苯海索辅助治疗后有明显疗效,与对照组疗效差异有统计学意义(p<0.05)。结论小剂量苯海索辅助治疗能够更大程度的提高患者的吞咽功能,能改善患者的进食状况,提高患者的生活质量。     

缺血性脑卒中康复锻炼的效果观察

目的探讨康复锻炼对缺血性脑卒中患者的临床疗效及预后的影响。方法我院诊治的80例缺血性脑卒中患者,随机分为对照组（神经内科常规治疗和常规处理）和观察组（对照组基础上,进行早期肢体功能锻炼）,每组各40例,对2组患者Barthel指数评分和肌力进行检测,并进行比较。结果 与治疗前相比,治疗后2组患者Barthel指数评分都明显升高（P〈0.05）;治疗后与对照组（44.68±11.84）相比,观察组Barthel指数评分（64.24±12.14）明显升高（P〈0.05）。与治疗前肌力相比,治疗后观察组患者肌力明显升高（P〈0.05）;与治疗后对照组的上、下肢肌力〉Ⅱ级（47.5%和45.0%）相比,观察组上、下肢肌力〉Ⅱ级所占比例（82.5%和85.0%）明显升高（P〈0.05）。结论 脑卒中患者早期给予康复功能锻炼可明显促进患者的功能恢复,值得临床推广。     

东菱克栓酶治疗30例缺血性脑血管病的疗效观察

东菱克栓酶治疗３０例缺血性脑血管病的疗效观察刘毅金兴中裴少芳我们用东菱克栓酶治疗３０例缺血性脑血管病患者，并用５％低分子右旋糖酐加丹参静脉滴注治疗作为对照，现报道如下。一、临床资料：根据病史、体征，结合ＣＴ或ＭＲＩ确诊的６０例住院病例，随机分为东菱克...     

中青年人高血压脑出血的超早期手术治疗(附17例报告)

报告31～40岁中青年人高血压脑出血17例的超早期手术治疗。均在发病后7小时内手术。结果7例肢体、语言未遗留后遗症,6例肌力恢复至4级,生活能自理,3例肌力恢复至2～3级,生活需人照顾,死亡1例。超早期手术治疗,可在血肿压迫脑组织发生一系列病理改变之前清除血肿,解除脑受压,降低了死亡率(5.8％)和术后功能障碍。     

中西医结合治疗缺血性脑卒中50例疗效分析

缺血性脑血管病是临床上比较常见的脑血管病之一,发病率呈逐年增高趋势,如不及时治疗,致残率和致死率较高,可遗留偏瘫、失语等后遗症,严重影响患者生活质量,给家庭和社会增加负担。我院2012-09—2013-02采用中西医结合治疗缺血性脑卒中患者50例,疗效显著,现报告如下。1资料与方法1.1一般资料选取2012-09—2013-02我院收治缺血性脑卒中患者100例,均符合1995年全国第4届脑血管病学术     

高同型半胱氨酸血症对急性脑梗死短期预后的影响

目的探讨高同型半胱氨酸血症(HHcy)与急性脑梗死患者短期预后之间的关系。方法测定165例急性脑梗死患者空腹血浆Hcy浓度,将患者分为HHcy组和非HHcy组,并在其入院时和治疗14d后进行改良Rankin量表(MRS)评分。结果入院时非HHcy组和HHcy组患者MRS评分中生活自理(MRS评分≤2分)人数和不能自理(MRS评分≥3分)人数的百分比之间无统计学差异(P>0.05),经相同药物治疗14d后,非HHcy组患者中生活自理人数的百分比较HHcy组患者显著升高(P<0.01),不能自理人数的百分比较HHcy组患者显著降低(P<0.01),非HHcy组患者中生活不能自理得到改善人数的百分比较HHcy组患者也显著升高(P<0.01)。结论HHcy组急性脑梗死患者的短期预后比非HHcy组差,降低HHcy对于缺血性脑血管病具有重要的预防和治疗意义。     

低能量He-Ne激光血管内照射治疗脑血管病360例报告

我院近一年来采用低能量Ｈｅ—Ｎｅ激光血管内照射治疗脑血管病３６０例，疗效满意，现报告如下：１临床资料 ３６０例脑血管病患者中男２００例，女１６０例，年龄最小２２岁，最大８６岁。脑梗死３１２例（其中脑Ａ炎８例），脑出血恢复期４８例。急性期（１５ ｄ内）２１６例。恢复期（１６ ｄ以上）１４４例。发病至入院时间最短 ５ ｈ，最长 ６年，轻偏瘫（肌力ＩＶ级以上）１３２例，中度偏瘫（肌力Ｉ－ＩＩ级）１６０例，重度偏瘫（肌力０级）６８例，合并高血压３０６例，低血压２３例，糖尿病１２６例，冠心病１０８例，心律失常７…     

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.     

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.     

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.