急性脑卒中患者睡眠障碍的异质性研究

目的：探讨急性脑卒中患者睡眠障碍的临床异质性。方法采用匹兹堡睡眠质量指数量表（PSQI）对168例急性脑卒中患者与98例正常对照者的睡眠状况进行测评分析,同时采用 Barthel 指数（BI）与美国国立卫生研究院卒中量表（NIHSS）分别评价脑卒中患者的日常生活活动能力与神经功能缺损程度。结果脑卒中组睡眠障碍发生率（45.83%）明显高于对照组（16.32%%）（P 〈0.001）;脑卒中组 PSQI 总分以及睡眠质量、入睡时间、睡眠障碍、催眠药物、日间功能障碍五因子得分均明显高于对照组（P 〈0.05）：年龄〈50岁脑卒中组 PSQI 总分明显高于其它年龄组;脑卒中患者睡眠障碍的发生与年龄、性别、Barthel 指数及神经功能缺损程度有关。结论急性脑卒中患者存在显著的睡眠障碍,年龄〈50岁伴神经功能缺损的女性脑卒中患者更明显,而且不同脑卒中患者 PSQI 各因子方面存在明显的临床异质性。     

急性脑卒中患者睡眠障碍的发病特点与治疗

目的研究急性脑卒中患者睡眠障碍发病特点及治疗措施。方法以我院2013-01—2015-01收治的100例急性脑卒中患者为研究组,选择同期行健康体检的60例正常人群为对照组,通过匹兹堡睡眠质量指数量表(PSQI)对2组人员睡眠状况进行评价,统计2组睡眠障碍发生率,同时观察急性脑卒中患者睡眠障碍表现及治疗效果。结果研究组PSQI总分明显高于对照组,差异有统计学意义(P0.01)。研究组睡眠障碍发生率46.00%,显著高于对照组的15.00%,差异有统计学意义(P0.01)。急性脑卒中伴睡眠障碍患者以白天睡眠6h以上(52.17%)、夜间不寐(30.43%)为主要症状,以大脑皮质下卒中为最常见发生部位。急性脑卒中伴睡眠障碍患者治疗后神经功能缺损评分为(14.18±1.32)分,显著低于不伴睡眠障碍患者的(17.19±3.63)分,差异有统计学意义(P0.01)。睡眠障碍治疗总有效率93.48%。结论急性脑卒中患者相对正常人群易发生睡眠障碍,症状为白天嗜睡、夜间不寐等,且大脑皮层下卒中易出现睡眠障碍。另外给予药物联合心理辅导干预能显著改善睡眠障碍症状,疗效明确。     

脑卒中后睡眠障碍患者血清NSE IL-1β及5-HT水平的变化及意义

目的探讨脑卒中后睡眠障碍患者血清神经元特异性烯醇化酶(NSE)、白细胞介素-1β(IL-1β)及5-羟色胺(5-HT)水平的变化及意义。方法选取200例脑卒中患者为研究对象,根据匹斯堡睡眠质量指数(PSQI)评分分为睡眠障碍组(SD组,PSQI评分7~14分)和无睡眠障碍组(non-SD组,PSQI评分15~21分)。对比2组血清NSE、IL-1β、5-HT水平,探讨血清NSE、IL-1β、5-HT表达情况与脑卒中后睡眠障碍的关系。结果200例脑卒中患者中出现睡眠障碍56例,发生率为28.00%。SD组患者血清NSE、IL-1β水平及NIHSS评分均显著高于non-SD组(t=7.880、9.405、5.814,P<0.05),而SD组血清5-HT水平低于non-SD组(t=8.789,P<0.05)。随着睡眠障碍程度的加重,患者血清NSE、IL-1β水平明显升高(t=4.184、3.774,P<0.05),而血清5-HT水平降低(t=3.167,P<0.05)。睡眠障碍患者血清NSE、IL-1β水平与PSQI评分呈显著正相关(r=0.341、0.363,P<0.05),而血清5-HT水平与PSQI评分呈负相关(r=0.438,P<0.05)。Logistic回归分析显示,NIHSS评分高(OR=1.367,95%CI 1.018~1.835,P<0.05)、血清NSE(OR=1.386,95%CI 1.120~1.716,P<0.05)与IL-1β(OR=1.149,95%CI 1.063~1.243,P<0.05)高表达及血清5-HT(OR=0.770,95%CI 0.667~0.889,P<0.05)低表达是脑卒中后睡眠障碍的危险因素(P<0.05)。结论脑卒中后睡眠障碍的发生率较高,神经递质分泌失调和炎症反应是导致脑卒中后睡眠障碍的重要原因。     

脑卒中后睡眠障碍的临床相关因素研究

目的研究脑卒中后睡眠障碍的相关因素,为临床诊断和防治提供依据。方法采用美国国立卫生院神经功能缺损评分(NIHSS)和阿森斯失眠量表(AIS)对61例住院脑卒中患者进行测评。结果睡眠障碍组与非睡眠障碍组性别、平均年龄、卒中部位比较无差别;但各年龄段中,<50岁发生4例,50～60岁发生6例,61～70岁发生8例,>70岁发生8例(P<0.05)。睡眠障碍组在既往病史、卒中性质、神经功能缺损程度与非睡眠障碍组比较差异有统计学意义。结论脑卒中后患者睡眠障碍较为常见,其与性别、卒中部位无相关性,但与年龄、既往病史(高血压、糖尿病、冠心病)、卒中性质及神经功能缺损程度有关。脑卒中后睡眠障碍的发生与诸多因素有关,及时发现其相关因素并积极预防、治疗,有利于加快脑卒中后患者机体康复及改善患者睡眠质量。     

音乐电针治疗与磁疗对脑卒中后睡眠障碍的影响

目的探究音乐电针治疗与磁疗对脑卒中后睡眠障碍患者的影响。方法随机选取2012-03—2014-10来我院接受治疗的50例脑卒中患者为研究对象,根据入院时间先后将患者分为观察组和对照组,观察组采用音乐电针治疗,对照组采用电磁疗法治疗,对比2组PSQI评分和临床治疗效果。结果观察组平均PSQI评分为(3.51±1.42)分,对照组为(9.25±2.73)分,对照组平均入睡时间相对较长,2组比较差异有统计学意义(P0.05)。观察组总有效率92.31%,对照组为66.67%,观察组临床有效率明显高于对照组,差异有统计学意义(u=2.3116,P=0.020 8)。对照组接受治疗后仍有16.67%的患者出现重度睡眠障碍,而观察组无重度睡眠障碍患者,2组比较差异有统计学意义(P0.05)。经治疗后,观察组神经功能重度缺损2例(7.69%),对照组重度缺损9例(37.50%),2组比较差异有统计学意义(P0.05)。结论音乐电针疗法治疗脑卒中后发生睡眠障碍的患者临床疗效较好,安全性高,对体质较差的老年人也同样适用,患者PSQI评分低,睡眠质量较好,睡眠时间明显增加,失眠现象得到改善,有利于患者恢复健康,提高生活质量,值得临床应用。     

脑卒中患者的睡眠障碍及其相关因素分析

目的探讨脑卒中患者睡眠障碍的情况及其影响因素。方法选择526例脑卒中急性期住院病人,采用匹兹堡睡眠质量指数问卷(PSQI)、神经功能缺损程度评分(NDS)、症状自评量表(SCL-90)、日常生活能力量表(ADL)进行调查。结果在526例脑卒中患者中,睡眠障碍患者(PSQI总分>7分者)341例(64.8%)。睡眠障碍患者与非睡眠障碍患者在性别、年龄、SCL-90、NDS和ADL评分方面比较,差异均有统计学意义(P<0.05或P<0.01)。多元逐步回归分析显示,睡眠障碍与患者的性别、年龄、精神状态、神经功能缺损程度、日常生活能力、脑卒中的部位及病变范围大小密切相关。结论脑卒中患者睡眠障碍的发生率较高,要改善脑卒中后的睡眠障碍,除了防止脑卒中外,还需要患者自身有良好的心理状态,改善睡眠有助于患者神经功能缺损的康复和生存质量的提高。     

氟哌噻吨美利曲辛片与高压氧治疗脑卒中后睡眠障碍

目的观察氟哌噻吨美利曲辛片与高压氧治疗脑卒中后睡眠障碍患者的效果。方法选取脑卒中后睡眠障碍患者86例,随机分为研究组和对照组,每组43例。对照组采用氟哌噻吨美利曲辛片治疗,研究组在氟哌噻吨美利曲辛片基础上加用高压氧治疗,比较2组患者AIS评分、睡眠率、NIHSS评分、有效率以及不良反应。结果治疗后研究组患者AIS评分显著低于对照组(P0.01),睡眠率显著高于对照组(P0.05),NIHSS评分显著低于对照组(P0.01),治疗有效率显著高于对照组(P0.05)。2组不良反应差异无统计学意义(P0.05)。结论氟哌噻吨美利曲辛片与高压氧治疗脑卒中后患者睡眠障碍的效果确切,具有临床应用价值。     

缺血性脑卒中后16周患者抑郁发生以及严重程度的随访研究

目的研究脑卒中后患者抑郁(PSD)发生状况以及严重程度的演变规律。方法选取连续收治的符合入组标准的48例缺血性脑卒中住院患者进行16周随访研究,于脑卒中后1周行神经功能缺损量表(NIHSS)、Barthel指数(BI)、社会支持评定量表(SSRS)评估患者神经功能缺损程度、日常生活活动能力以及社会支持情况。脑卒中后1、2、4、8、12和16周分别行汉密尔顿抑郁量表(HAMDS)评估患者抑郁情况,根据不同时间点的HAMDS评分动态判定患者是否为PSD,并据此分为PSD组和非PSD组。结果脑卒中后2周PSD发生率(52.1%)达峰值,之后呈下降趋势。PSD患者第2周HAMD评分达峰值平均(15.14±4.28)分,之后逐渐下降,第16周降至(10.00±2.20)分。脑卒中后1周PSD (HAMDS评分≥8分)组为24例(50%),脑卒中后1周PSD组NIHSS评分显著高于非PSD组,BI指数、SSRS评分显著低于非PSD组,差异均有统计学意义(均P0.05);HAMDS评分与NIHSS评分呈正相关,与BI、SSRS评分呈负相关(P0.05)。结论经16周随访发现,PSD发生状况及严重程度呈动态变化过程;PSD的发生与神经功能缺损、日常生活活动能力、社会支持有密切关系。     

强化心理疏导结合个体化睡眠干预对脑卒中后睡眠障碍患者的效果

目的分析强化心理疏导结合个体化睡眠干预对脑卒中后睡眠障碍(Sleep Disturbance After Stroke,PSSD)患者的效果。方法选取本院2019年1月～2019年12月住院治疗的60例PSSD患者,以单盲随机抽样法分组(每组病例30例),对照组采纳传统护理,观察组在对照组基础上采纳强化心理疏导结合个体化睡眠干预,两组均在护理2周后评价护理效果,对比两组HAMA评分、HAMD评分、NIHSS评分、PSQI评分、护理满意度。结果观察组护理后HAMA评分、HAMD评分、NIHSS评分、PSQI评分均低于对照组,观察组护理满意度(93.33%)高于对照组(70.00%)(P0.05)。结论强化心理疏导结合个体化睡眠干预可有效减轻PSSD患者不良情绪及神经功能受损程度,提高睡眠质量与患者满意度。     

阻塞性睡眠呼吸暂停低通气综合征对脑梗死患者预后的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对急性脑梗死(ACI)患者预后的影响。方法根据多导睡眠图将110例ACI患者分为观察组(67例)与对照组(43例),观察组合并OSAHS,对照组未合并OSAHS。再根据呼吸暂停通气指数(AHI)将观察组分为3个亚组:A组38例,为轻度OSAHS;B组18例,为中度OSAHS;C组11例,为重度OSAHS。结果治疗前2组美国国立卫生研究院卒中量表(NIHSS)评分、巴塞尔指数(BI)、改良Rankin量表(mRS)评分相比差异无统计学意义(P0.05);治疗1个月、3个月、6个月后,观察组NIHSS评分、mRS评分均高于对照组,BI均低于对照组(P0.05)。治疗前、治疗1个月、3个月、6个月后,A组NHISS评分、mRS评分均显著低于B组与C组,BI均显著高于B组与C组(P0.05)。治疗前,B组与C组NIHSS评分、BI、mRS评分相比差异无统计学意义(P0.05);治疗1个月后、3个月后、6个月后,B组NHISS评分、mRS评分均显著低于C组,BI均显著高于C组(P0.05)。结论 OSAHS可影响ACI患者神经功能缺损、日常生活能力、残障程度的恢复,且影响程度与OSAHS严重度有关。     

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.