新冠肺炎疫情下浏阳市精神疾病患者家属焦虑抑郁情况及影响因素

目的 了解新冠肺炎疫情期间精神疾病患者家属焦虑、抑郁情况及影响因素。方法 采用横断面研究，通过立意抽样和分层抽样的方法，选取2020年3月18日-28日浏阳市精神病医院门诊患者家属116名和住院患者家属111名。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和自行设计的一般资料问卷进行调查，并对数据进行单因素和多因素Logistic回归分析。结果 共回收问卷239份，其中有效问卷227份，有效问卷回收率为94.98%。检出存在焦虑症状者29人，焦虑检出率为12.78%；检出存在抑郁症状者40人，抑郁检出率为17.62%。Logistic回归分析显示，家属年龄≥60岁（OR=4.454，P=0.041）、睡眠质量评价为中等及以下（OR=17.922、153.728，P<0.01）、患者疫情期间居家休息（OR=5.597，P=0.004）是家属存在焦虑症状的危险因素；睡眠质量评价为中等及以下（OR=7.806、15.105，P<0.01）、受教育程度低（OR=0.137、0.205，P<0.05）、患者疫情期间居家休息（OR=2.868，P=0.022）是家属存在抑郁症状的危险因素。结论 新冠肺炎疫情期间精神疾病患者家属存在一定程度的焦虑、抑郁情绪。其中，年龄≥60岁、睡眠质量不佳、患者居家休息、受教育程度低是家属存在焦虑和抑郁的危险因素。     

精神专科医院危重症患者谵妄发生的危险因素：一项回顾性研究

背景 精神科危重症患者谵妄发生率较高,且影响谵妄发生的因素较多。目前针对精神专科医院危重症患者谵妄的流行病学研究有限。目的 探索精神专科医院危重症患者谵妄发生的影响因素,以指导临床对谵妄的管理。方法 回顾性收集2019年1月1日-2021年5月31日在深圳市康宁医院住院的427例危重症患者的谵妄发生情况、性别、年龄、入院前病程（指患者始发急性精神状态变化至登记入住精神专科医院的时间）、精神疾病史、认知功能障碍病史、精神活性物质使用史、镇静催眠药使用史、合并慢性病数、合并用药数以及病种类型等信息。采用单因素Logistic回归分析谵妄发生的可能危险因素,将可能的危险因素纳入多因素Logistic回归分析模型,逐步筛选出精神专科医院危重症患者谵妄发生的危险因素。结果 在427例危重症患者中,143例（33.49%）存在谵妄。多因素Logistic回归分析结果显示,使用精神活性物质所致的精神和行为障碍（OR=8.949,P<0.01）、无精神病病史（OR=4.202,P<0.01）、合并慢性病数（OR=1.249,P<0.01）、年龄（OR=1.031,P<0.01）以及入院前病程（OR=0.942,P<0.01）与谵妄发生相关。结论 在精神专科医院中,约1/3的危重症患者存在谵妄,入院前病程较短、年龄较大、合并慢性疾病数多、无精神疾病史、使用精神活性物质所致的精神和行为障碍是谵妄发生的危险因素。     

芦山地震后6年雅安市城市老年人抑郁症状检出情况及影响因素

目的 了解芦山地震后6年雅安市城市老年人抑郁症状检出率及特点,为灾难性事件后老年人群心理干预提供参考。方法 采取多阶段分层整群随机抽样方法,于2019年3月-4月选取雅安市城市老年人（年龄≥60岁）885名为研究对象,采用自制一般信息调查表收集老年人一般人口学资料、健康状况以及受灾情况,采用老年抑郁量表（GDS-30）评估其抑郁症状。采用单因素和多因素Logistic回归分析城市老年人抑郁症状的影响因素。结果 共回收有效问卷783份,有效问卷回收率为88.47%,检出存在抑郁症状者161例（20.56%）;不同性别、年龄、婚姻状况、家庭关系、家庭人均月收入、身体锻炼情况、健康状况、生活自理情况、睡眠状况、受灾程度的城市老年人抑郁症状检出率比较差异均有统计学意义（P<0.05或0.01）。Logistic回归分析显示,女性（OR=1.552,P=0.040）、家庭人均月收入2000~3000元（OR=6.982,P<0.01）、家庭人均月收入≤2000元（OR=6.857,P<0.01）、无身体锻炼情况（OR=1.693,P<0.01）、生活部分自理（OR=3.838,P<0.01）、生活不能自理（OR=8.547,P<0.01）、多病可治愈（OR=4.892,P<0.01）、久病难治（OR=5.657,P=0.031）的老年人出现抑郁症状的风险较高;相比于离异和丧偶者,已婚老年人出现抑郁症状的风险更低（OR=0.063,P<0.01）。结论 芦山地震后6年雅安市城市老年人抑郁症状检出率较高,其中女性、家庭人均月收入低、无身体锻炼情况、生活不能完全自理、健康状况差为出现抑郁症状的危险因素,已婚为保护因素。     

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。     

老年白内障患者合并抑郁状况及其自我感受负担的影响

背景 伴抑郁症状的老年白内障患者自我感受负担较重,术后视觉相关生活质量较无抑郁症状的患者更差,家庭负担更重。既往研究多认为家庭关系、视力等是导致老年白内障患者出现抑郁症状的主要因素,自我感受、合并疾病等对老年白内障患者心理状态的影响研究有限。目的 探讨老年白内障患者抑郁症状与自我感受负担和术后视觉相关生活质量的关系,分析患者抑郁症状的危险因素,对其进行针对性的心理干预提供参考。方法 连续纳入2020年7月1日—2022年12月31日在江苏省人民医院（南京医科大学第一附属医院）住院治疗的老年白内障患者104例,采用自编调查问卷收集患者基本资料,采用患者健康问卷抑郁量表（PHQ-9）、自我感受负担量表（SPBS）、25项美国国家眼科研究所视功能问卷（NEI-VFQ-25）评定患者抑郁症状、自我感受负担以及术后视觉相关生活质量水平。采用Pearson相关分析考查伴抑郁症状的老年白内障患者PHQ-9、SPBS、NEI-VFQ-25评分的相关性,采用Logistic回归分析老年白内障患者抑郁症状的影响因素。结果 共100例老年白内障患者完成有效问卷调查,检出31例（31.00%）患者存在抑郁症状。抑郁组SPBS评分高于无抑郁组（t=11.062,P<0.01）,NEI-VFQ-25评分低于无抑郁组（t=-5.235,P<0.01）。Pearson相关分析结果显示,伴抑郁症状的老年白内障患者PHQ-9评分与SPBS评分呈正相关（r=0.485,P<0.01）,与NEI-VFQ-25评分呈负相关（r=-0.440,P<0.01）。合并糖尿病（OR=1.441,P<0.01）、合并骨关节炎（OR=1.324,P<0.05）和高SPBS评分（OR=1.340,P<0.05）是老年白内障患者出现抑郁症状的危险因素。结论 老年白内障患者抑郁症状检出率较高;伴抑郁症状的老年白内障患者术后视觉相关生活质量更低;合并糖尿病、骨关节炎以及自我感受负担较重是老年白内障患者出现抑郁症状的危险因素。     

抗抑郁药临床试验受试者脱落情况及影响因素

目的 分析抗抑郁药临床试验受试者脱落情况,讨论受试者脱落的影响因素。方法 对广州医科大学附属脑科医院2013年-2020年完成的9项抗抑郁药临床试验受试者资料进行回顾性分析,采用自编调查表采集受试者人口学资料、疾病特点及试验完成情况,分析受试者的脱落情况及影响因素。结果 共入组157例,完成120例,脱落37例。脱落原因分别为：疗效差13例（35.14%）,发生不良反应12例（32.43%）,撤回知情同意书8例（21.62%）,失访4例（10.81%）。相关分析结果显示,受试者脱落与焦虑程度（r=0.224,P<0.01）和不良事件（r=0.158,P<0.05）呈正相关,与受教育程度（r=-0.209,P<0.01）和总体疗效（r=-0.545,P<0.01）呈负相关。二元Logistic回归分析结果显示,受教育程度（β=-0.611,OR=0.543,P<0.05）、就诊次数（β=-1.831,OR=0.160,P<0.01）和总体疗效（β=-2.286,OR=0.102,P<0.01）是受试者脱落的影响因素。结论 受教育程度低、首次就诊、疗效不佳、焦虑程度重以及发生不良事件是抗抑郁药临床试验受试者脱落的影响因素。     

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。     

社区精神分裂症患者代谢综合征影响因素

背景 精神分裂症患者是罹患代谢综合征的高风险人群。既往关于代谢综合征影响因素的研究主要集中于住院精神分裂症患者,对社区精神分裂症患者的研究较少。目的 探索广州市社区精神分裂症患者不同代谢综合征风险层级的影响因素,为社区精神分裂症患者代谢综合征干预提供参考。方法 于2021年11月,选取广州市精神卫生信息系统在册在管且完成2020年度健康体检的精神分裂症患者3 339例。从信息系统导出患者健康体检资料,采用《中国2型糖尿病防治指南（2020年版）》评估患者是否罹患代谢综合征。根据《精神分裂症患者代谢综合征管理的中国专家共识》,将患者分为高风险组（n=423）、临界组（n=1 524）和代谢综合征组（n=1 392）。采用多元Logistic回归分析社区精神分裂症患者罹患代谢综合征的危险因素。结果 社区精神分裂症患者代谢综合征患病率为41.69%。单因素分析显示,三组在性别（χ²=44.610）、年龄（χ²=55.992）、婚姻状况（χ²=30.755）、病程（χ²=25.913）和体质量指数（χ²=829.265）方面差异均有统计学意义（P均<0.01）。Kruskal-Wallis H检验显示,三组患者腰围（H=920.331）、收缩压（H=436.673）、舒张压（H=393.337）、空腹血糖（H=807.304）、甘油三酯（H=1 134.125）、高密度脂蛋白胆固醇（H=593.615）水平差异均有统计学意义（P均<0.01）。Logistic回归分析显示,年龄≥50岁（OR=1.761,95% CI：1.087~2.853）、超重（OR=2.418,95% CI：1.862~3.140）和肥胖（OR=57.903,95% CI：14.340~233.802）是社区精神分裂症患者成为代谢综合征临界人群的危险因素（P<0.05或0.01）;女性（OR=1.295,95% CI：1.034~1.622）、年龄40~49岁（OR=2.597,95% CI：1.582~4.263）、年龄≥50岁（OR=4.392,95% CI：2.609~7.395）、超重（OR=7.844,95% CI：6.018~10.223）和肥胖（OR=426.785,95% CI：105.724~1 722.839）是社区精神分裂症患者成为代谢综合征人群的危险因素（P<0.05或0.01）。结论 社区精神分裂症患者代谢综合征患病率较高,女性、年长、超重和肥胖是精神分裂症患者罹患代谢综合征的高风险因素。     

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。     

医学生偏头痛患者睡眠时间不足的发生率及影响因素分析

目的 调查医学生偏头痛患者睡眠时间不足的发生率及影响因素，为改善睡眠质量提供参考。方法 采用整群抽样方法，于2018年7月-2019年7月选取川北医学院在校医学生中符合《国际头痛疾病分类（第3版）》（ICHD-3）偏头痛诊断标准的546名患者为研究对象，并根据每夜睡眠时间是否>6 h分为睡眠时间充足组（n=367）与睡眠时间不足组（n=179）。收集医学生一般人口学资料及临床资料，采用匹兹堡睡眠质量指数量表（PSQI）评定睡眠情况，采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表24项版（HAMD-24）评定焦虑抑郁情况，采用视觉模拟评分法（VAS）和头痛影响测试量表（HIT-6）评定头痛严重程度及其对日常生活的影响。采用Logistic回归分析探索偏头痛患者睡眠时间不足的影响因素。结果 在546名医学生偏头痛患者中，有179人（32.78%）存在睡眠时间不足。睡眠时间不足组和睡眠时间充足组的年龄（t=2.107）、头痛频率（Z=-2.972）、焦虑状态（χ2=14.053）、抑郁状态（χ2=10.773）、PSQI评分（t=-13.247）及睡眠质量（χ2=94.754）差异均有统计学意义（P?0.05或0.01）。相关分析显示，偏头痛患者睡眠时间与年龄呈负相关（r=-0.100，P<0.01），与头痛频率、焦虑状态、抑郁状态呈正相关（r=0.135、0.169、0.139，P均<0.01）。多因素Logistic回归分析显示，年龄（OR=0.860，95% CI：0.743~0.996，P=0.045）、头痛频率（OR=1.051，95% CI：1.006~1.098，P=0.026）、抑郁状态（OR=1.712，95% CI：1.024~2.861，P=0.040）是医学生偏头痛患者睡眠时间不足的影响因素。结论 医学生偏头痛患者睡眠时间不足的发生率较高，头痛频率高和抑郁状态是其危险因素，年龄是保护因素。     

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.     

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 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.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.