轻度低温对脑缺血再灌注后细胞凋亡的影响

观察轻度低温对脑缺血再灌注后细胞凋亡的影响。方法：沙鼠４０只,随机分假手术组、缺血组和轻度低温（３２－３３℃）２ｈ组、６ｈ组、１２ｈ组共５组。夹闭双侧颈总动脉２０ｍｉｎ再灌注７２ｈ观察细胞凋亡。结果：ＦＣＭ显示缺血组海马区凋亡细胞９．３％,轻度低温２ｈ、６ｈ、１２ｈ组分别４．６％、２．６％、１．７％、。     

大鼠局灶性脑缺血再灌注损伤组织病理及超微结构研究

一、材料和方法Ｗ’ｉｓｔａｌ雄性大鼠３６只，体重２７０－３２０９．随机分为缺血１小时再灌注７２／Ｊ’时（Ａ．组）．缺血２小时再灌注７２小时（入组）．缺血３小时再灌注７２小时（Ａ。组），缺血４小时再灌注７２小时（＼组），单纯持续缺血４小时（Ｂ组Ｘ所有大鼠均按Ｋｏｉｚｕｎｕ方法栓塞右侧大脑中动脉：将单股尼龙线的头端０ｓｃｍ热膨胀并打磨后，经颈外动脉，颈总动脉．颈内动脉进人大脑中动脉起始部位．造成栓塞，于栓塞不同时间拔出尼龙线，形成缺血后再灌注。术后大鼠置单箱饲养观察。７２小时后断头取脑，以视交叉为中…     

大鼠脑缺血再灌流后海马区一氧化氮合酶活性的变化

目的：观察鼠全脑缺血再灌流后海马区ＮＯＳ活性的变化。方法：采用大鼠４血管关闭方法制作全脑缺血再灌流模型。实验动物分为假手术组、缺血１０ｍｉｎ组、再灌注１、２、３ｄ组。测定脑缺血再灌流后海马区ＮＯＳ活性的变化。结果：全脑缺血曹澡注后海马组织ＮＯＳ活性被激活上调。结论：ＮＯ可能参与了海马ＣＡ１区迟发性神经元死亡（ＤＮＤ）的发生。     

脑缺血选择性海马CA1区神经元损害的实验研究

采用Ｐｕｌｓｉｎｅｌｉ－Ｂｒｉｅｒｌｅｙ４血管阻塞脑缺血模型观察了大鼠全脑缺血２０ｍｉｎ再灌流８ｈ，ｃ－ｆｏｓ基因表达及再灌流７ｄ海马ＣＡ１区迟发性神经元损害。在缺血再灌流早期（８ｈ）海马ＣＡ１区极少ｃ－ｆｏｓ表达，而齿状回、海马ＣＡ３区、杏仁核大量ｃ－ｆｏｓ表达。缺血再灌流晚期（７ｄ）镀银染色显示海马ＣＡ１区神经元及其突触终末带呈黑色溃变相，而齿状回、海马ＣＡ３区、杏仁核呈金黄色正常相。相邻切片ＨＥ染色示缺血组海马ＣＡ１区核完整的锥体细胞数（５±２．６个／２００μｍ）与对照组（４０±２．９个／μｍ）比较差异有显著意义（Ｐ＜０．０１）。脑缺血诱导的ｃ－ｆｏｓ基因表达对于缺血易损海马ＣＡ１区迟发性神经元坏死可能起直接的调控作用。     

E—选择素对局灶缺血性脑皮质血流的影响

目的探讨Ｅ－选择素对局灶缺血性脑皮质血流的影响。方法用Ｅ－ｓｅｌｅｃｔｉｎＬｅｃｔｉｎＤｏ－ｍａｉｎ（以下Ｅ－选择素）Ｎ－末端２３－３０氨基酸残基合成的寡肽（Ｏｌｉｇｏｐｅｐｔｉｄｅ）１０ｍｇ／ｋｇ，或伪Ｅ－ｓｅｌｅｃｔｉｎ或等量生理盐水，在ＳＨＲ（自发高血压性大鼠）ＭＣＡ／ＣＣＡ（大脑中动脉／颈总动脉）闭塞２ｈ后ＣＣＡ再灌注的模型中，静脉内缓慢注入，用激光多普勒血流测定仪从ＳＨＲ缺血前１０ｍｉｎ起至ＭＣＡ／ＣＣＡ闭塞２ｈ、ＣＣＡ再灌注后３０ｍｉｎ止，在大脑皮质背侧测定脑血流的变化。结果生理盐水组、伪Ｅ－选择素和Ｅ－选择素组的局部脑血流分别是２３％、２９％和５４％，有统计学意义（Ｐ＜０．０５）。结论Ｅ－选择素能够有效地增加ＳＨＲ缺血再灌注后脑皮质的血流     

缺血及再灌流时不同脑区磷脂酶A2活性的变化及作用探讨

本文利用大鼠４血管阻断法（４ＶＯ）建立脑缺血再灌模型，分别检测假手术组，缺血１５ｍｉｎ组，缺血１５ｍｉｎ后再灌流１ｈ，６ｈ，２４ｈ，７２ｈ和１６８ｈ各组不同脑区的磷脂酶Ａ２（ＰＬＡ２）活性变化。发现海马和皮质下脑皮ＰＬＡ２活性在再灌流早期显著升高，但随再灌流时间延长其活性反而低于假手术组；而皮质区ＰＬＡ２活性在再灌流早期虽然也升高，但很快接近假手术组，表明ＰＬＡ２活性改变有着区域性差别，参与并影响     

急性缺血性大鼠脑乳酸含量变化的实验观察

本研究通过四血管闭塞的非禁食动物脑缺血模型，旨在观察缺血再灌流不同时期大鼠脑乳酸含量的变化。结果再灌流１小时和再灌流２小时后大鼠脑乳酸含量无差异（Ｐ＞０．２）。提示再灌流后第一小时是脑乳酸产生的关键时期，这与此期出现的皮层神经元膜结构的病理改变密切相关。     

脑缺血再灌流［~3H］—三磷酸肌醇放射活性及突触体游离Ca~（2＋）的变化

本文研究了大鼠脑缺血再灌流时［３Ｈ］—三磷酸肌醇（［３Ｈ］－ＩＰ３）放射活性及突触体游离Ｃａ２＋（［Ｃａ２＋］ｉ）的变化，并用苯甲基磺酰氟化物（ＰＭＳＦ）治疗，观察其对［３Ｈ］－ＩＰ３放射活性及突触体［Ｃａ２＋］ｉ的影响。结果：脑缺血１ｍｉｎ［３Ｈ］－ＩＰ３放射活性非常显著地增高。缺血２０ｍｉｎ、缺血２０ｍｉｎ再灌流１ｈ、６ｈ、２ｄ［３Ｈ］－ＩＰ３放射活性非常显著地降低。缺血２０ｍｉｎ突触体［Ｃａ２＋］ｉ非常显著地增高，至再灌流６ｈ达到最高水平。应用ＰＭＳＦ治疗能显著地抑制突触体［Ｃａ２＋］ｉ的升高。     

脑缺血及再灌流期间生物膜磷脂代谢特点

本文利用大白鼠４血管结扎法建立脑缺血再灌流模型，同时制备脑组织线粒体和微粒体组织，检测假手术组，缺血１５ｍｉｎ，再灌１ｈ和３ｄ各组生物膜主要磷脂的含量变化，发现再灌流时磷脂代谢变化比缺血期幅度大，并且线粒体主要组成磷脂和微粒体主要组成磷脂代谢变化规律并不一致，证明磷脂代谢异常导致了生物膜功能丧失，造成了神经元的损伤。     

脑缺血再灌注[^3H]——三磷酸肌醇放射活性及突触体游离C …

本文研究了大鼠脑缺血再灌流时［＾３Ｈ］－三磷酸肌醇［＾３Ｈ］－ＩＰ３）放射活性及突触体游离Ｃａ＾２＋（［Ｃａ＾２＋］ｉ）的变化，并用苯甲基磺酰氟化物（ＰＭＳＦ）治疗，观察其对［＾３Ｈ］－ＩＰ３放射活性及突触体［Ｃａ＾２＋］ｉ的影响。结果：脑缺血１ｍｉｎ［＾３Ｈ］－ＩＰ３放射活性非常显著地增高。缺血２０ｍｉｎ、缺血２０ｍｉｎ再灌注１ｈ、６ｈ、２ｄ［＾３Ｈ］－ＩＰ３放射活性非常显著地降低。缺血２０ｍ，     

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.