缬沙坦对肾性高血压大鼠模型脑缺血-再灌注后细胞凋亡的影响

目的通过观察血管紧张素Ⅱ受体阻断药缬沙坦对肾性高血压大鼠模型脑缺血。再灌注后神经功能缺损程度和神经元凋亡的影响．探讨血管紧张素Ⅱ受体阻断药的神经保护机制。方法采用Wistar雄性大鼠建立肾性高血压模型，随机分为缬沙坦大剂量组（12mg／kg）、小剂量组（6mg／kg）和缺血-再灌注组．分别于脑缺血2h-再灌注1h和脑缺血2h-再灌注24h时进行神经功能缺损程度评分，并采用TUNEL法和免疫组织化学方法检测海马组织缺血后细胞凋亡发生情况．以及Bcl-2蛋白和Bax蛋白表达水平的变化。结果缬沙坦大剂量组和小剂餐组大鼠的神经功能缺损程度评分低于缺血-再灌注组（P=0．047，0．043），Bcl-2阳性细胞数目高于缺血-再灌注组（均P=0．000），Bax阳性细胞数目低于缺血-再灌注组（均P=0．000）．且神经元凋亡数目明显减少（均P=0．000）：缬沙坦大剂量组Bcl-2阳性细胞数目明显高于小剂量组（P=0．000）．Bax阳性细胞数目明显低于小剂量组（P=0．000）。神经元凋亡数目较小剂量组明显减少（P=0．000）。结论血管紧张素Ⅱ受体阻断药缬沙坦具有明显改善肾性高血压大鼠模型局灶性脑缺血后神经功能缺损程度、减少神经元凋亡、上调脑组织Bcl-2蛋白及抑制Bax蛋白表达水平的作用．对脑缺血-再灌注损伤后的脑组织有一定的保护作用。     

自由基清除剂预处理对大鼠脑缺血再灌注损伤后脑组织细胞凋亡及其相关蛋白表达的影响

目的探讨自由基清除剂依达拉奉预处理对大鼠脑缺血再灌注损伤后神经细胞凋亡及其相关蛋白Bcl-2、Bax、热休克蛋白70(HSP70)表达的影响。方法将45只雄性SD大鼠随机分为假手术组、对照组、依达拉奉预处理组,每组15只。采用线栓法制作大鼠缺血2h再灌注24h模型。预处理组大鼠建模前12h腹腔注射依达拉奉(3mg/kg),对照组给予等容量生理盐水。再灌注24h后断头取脑,应用免疫组织化学法检测Bcl-2、Bax、HSP70蛋白表达,末端脱氧核糖核酸转移酶介导的原位缺口末端标记法检测凋亡细胞。结果依达拉奉预处理组和对照组大鼠缺血周围脑组织中凋亡细胞和Bcl-2、Bax及HSP70阳性细胞数比假手术组均明显增加(P<0.01);与对照组比较,其凋亡细胞和Bax阳性细胞数均明显减少(P<0.01),而Bcl-2和HSP70阳性细胞数明显增加(P<0.01)。结论细胞凋亡在缺血再灌注损伤中起着重要作用;依达拉奉可能通过上调Bcl-2、HSP70蛋白表达、下调Bax蛋白表达减轻大鼠脑缺血再灌注后的细胞凋亡,增加脑缺血再灌注损伤耐受性,从而起到神经保护作用。     

帕瑞昔布对脑缺血损伤大鼠神经保护作用的研究

目的评价线粒体ATP敏感性钾离子通道(mitoKATP)对帕瑞昔布减轻大鼠脑缺血再灌注损伤的影响。方法成年健康雄性SD大鼠100只,体质量280~330g,随机分成5组(n=20只):假手术组(S组)、脑缺血再灌注组(I/R组)、帕瑞昔布组(P组)、5-羟葵酸组(5-HD组)和5-羟葵酸+帕瑞昔布组(5-HD+P组)。采用改良线栓法阻塞右侧颈总动脉2h恢复灌注的方法制备大鼠脑缺血再灌注损伤模型。P组在缺血前15min和再灌注12h经静脉注射帕瑞昔布,4mg/kg。5-HD组在缺血前1h经静脉注射5-HD,30mg/kg。5-HD+P组在缺血前1h经静脉注射5-HD,30mg/kg,余操作同P组。S组和I/R组给予等容量生理盐水。各组于再灌注24h时,行神经功能缺陷评分后处死取脑,检测SOD、MDA、Bcl-2及Bax蛋白表达水平。结果与S组相比,其余各组大鼠神经功能缺陷评分、MDA水平及Bax蛋白表达升高,SOD水平及Bcl-2蛋白表达降低(P0.05);与I/R组相比,P组大鼠神经功能缺陷评分、MDA水平及Bax蛋白表达降低,SOD水平及Bcl-2蛋白表达升高(P0.05);与P组相比,5-HD+P组大鼠神经功能缺陷评分、MDA水平及Bax蛋白表达升高,SOD水平及Bcl-2蛋白表达降低(P0.05)。结论mitoKATP通道参与了帕瑞昔布减轻大鼠脑缺血再灌注损伤的过程。     

大鼠局灶性脑缺血再灌注后海马Bcl-2、Bax蛋白的表达

目的 探讨大鼠局灶性脑缺血再灌注后Bcl-2、Bax蛋白在海马表达的变化.方法 线栓法制作大鼠局灶性脑缺血再灌注模型,应用免疫组化染色检测Bcl-2、Bax蛋白表达,应用TUNEL法检测海马区细胞凋亡.结果 缺血再灌注2h后海马神经元Bcl-2、Bax蛋白开始表达,Bcl-2蛋白12h达高峰,Bax蛋白12h～24h达高峰,之后开始下降.再灌注2h后海马凋亡细胞开始表达,随着再灌注时间的延长,其表达不断增加.Bcl-2/ Bax的比率在再灌注开始时升高,再灌注12h达高峰,随后开始下降.结论 凋亡是脑缺血再灌注损伤的重要形式之一,Bcl-2/ Bax的改变与缺血再灌注后海马的神经元存亡有关,缺血再灌注可导致海马神经元凋亡.     

骨髓基质细胞源神经干细胞对大鼠局灶性脑缺血神经细胞凋亡及相关蛋白表达的动态影响

目的探讨骨髓基质细胞源神经干细胞对大鼠局灶性脑缺血神经细胞凋亡及相关蛋白表达的影响。方法建立大鼠大脑中动脉缺血再灌注模型。32只健康Sprague-Dawley(SD)大鼠分为假手术组、缺血对照组、缺血骨髓基质细胞移植组和缺血骨髓基质细胞源神经干细胞移植组。分别在移植后7d和14d行脑灌注固定取材,应用免疫组化染色及原位细胞凋亡检测脑组织Bcl-2、Bax蛋白表达及凋亡细胞数。结果缺血移植组各时点的凋亡细胞数均少于缺血对照组(P<0.01),缺血移植14d组凋亡细胞数明显少于缺血移植7d组(P<0.01),骨髓基质细胞源神经干细胞移植组凋亡细胞明显少于骨髓基质细胞移植组(P<0.05)。缺血移植组Bcl-2表达显著高于缺血对照组(P<0.01)。缺血移植组Bax蛋白表达明显低于缺血对照组(P<0.01)。结论骨髓基质细胞源神经干细胞可能通过上调Bcl-2蛋白表达,下调Bax蛋白表达,对脑缺血再灌注损伤起保护作用。     

大鼠全脑缺血再灌注损伤后调控基因Bcl-2、Bax的表达及与细胞凋亡的关系

目的:本研究旨在探讨Bcl-2及Bax蛋白在大鼠全脑缺血再灌注损伤中的变化及与细胞凋亡的关系。方法:雄性Wistar大鼠56只,随机分为假手术组、缺血15分钟再灌注1、6、12、24、48、72小时组。采用大鼠四条血管阻断方法制备大鼠全脑缺血再灌注模型。采用TUNEL法观察不同再灌注时间组海马CAl区细胞凋亡的变化。采用免疫组化法观察Bcl-2及Bax蛋白表达水平的变化。结果:脑缺血损伤后随再灌注时间延长凋亡细胞逐渐增多,至再灌注48小时达到高峰,72小时后减少。Bcl-2表达至再灌注12小时达高峰,再灌注24~72小时组逐渐减弱。Bax表达至48小时达高峰,再灌注72小时减少。结论:Bcl-2于再灌注早期表达增强,Bax于再灌注中期表达增强,Bcl-2/Bax比例失衡可能是大鼠全脑缺血再灌注后神经细胞凋亡的机制之一。     

局灶性脑缺血再灌注大鼠海马CA1区神经元凋亡研究

目的 观察大鼠局灶性脑缺血再灌注(ischemia reperfusion,I/R)损伤后海马CA1区神经元凋亡、TUNEL阳性细胞变化,以及凋亡相关蛋白Bcl-2与Bax蛋白的表达情况.方法 将健康雄性SD (Sprague-Dawley)大鼠随机分为假手术组和I/R组,每组再分为缺血再灌注后3、6、12、24、48、72 h亚组.应用免疫组化方法检测再灌注后不同时间点大鼠海马CA1区神经元凋亡基因Bcl-2和Bax蛋白的表达及Bcl-2/Bax比值变化,采用原位细胞凋亡检测(TUNEL)技术检测凋亡阳性细胞数.结果 各组非缺血侧相应区域神经元胞质中Bcl-2均有微弱表达.I/R组缺血侧海马CA1区于再灌注3 h开始出现Bcl-2和Bax蛋白微弱表达,随再灌注时间延长神经元内Bcl-2表达逐渐增强,再灌注24 h后Bcl-2表达达高峰,假手术组与I/R组比较差异有统计学意义(P<0.05).结论 I/R损伤后海马CA1区神经元不仅存在变性坏死,还存在明显的细胞凋亡且细胞凋亡在大鼠I/R损伤中发挥重要作用;I/R可诱导海马CA1区细胞凋亡基因Bcl-2和Bax蛋白表达,且其表达呈一定规律.     

脑脉泰对大鼠脑缺血再灌注后神经细胞凋亡和Akt，bcl-2，Bax和caspase3表达的影响

目的研究脑脉泰对大鼠脑缺血再灌注损伤神经细胞凋亡和Akt、bcl-2、Bax、caspase3表达的影响。方法采用大鼠大脑中动脉栓塞再灌注动物模型,将雄性SD大鼠随机分为假手术组（sham）、脑缺血再灌注模型组（MCAO）、脑脉泰大剂量组（MCAO＋脑脉泰2．24g／kg）、脑脉泰中剂量组（MCAO＋脑脉泰1．12g／kg）、脑脉泰小剂量组（MCAO＋脑脉泰0．56g／kg）,每组10只大鼠。脑脉泰组在MCAO前5天开始灌胃给药,连续5d。用TUNEL法和免疫组化染色法分别检测缺血半暗带凋亡细胞和Akt、bcl-2、Bax和caspase3表达。结果脑脉泰大剂量组和中剂量组大鼠脑缺血半暗带的凋亡细胞显著减少（P〈0．01）,Akt、bcl-2表达显著增加,caspase3和Bax表达减少,与MCAO模型组比较,有显著性差异（分别为P〈0．05和P〈0．01）。结论脑脉泰对脑缺血／再灌注损伤有保护作用,其保护作用与促进Akt和bcl-2的表达,抑制Bax和caspasse3的表达有关。     

自由基清除剂联合钙离子拮抗剂对脑缺血神经元凋亡的影响

【摘要】 目的 观察自由基清除剂联合钙离子拮抗剂对大鼠脑缺血半暗带神经元凋亡及B细胞淋巴瘤/白血病-2（B cell lymphoma/leukemia-2,Bcl-2）和Bcl-2相关X蛋白（Bcl-2 associated X protein,Bax）表达的影响。 方法 线栓法制备大鼠大脑中动脉缺血再灌注模型,随机分为假手术组、对照组和干预组,干预组又分为自由基组、钙离子组及联合干预组。对照组及各干预组根据缺血再灌注时间分为再灌注6 h、24 h、48 h、72 h及5 d组,每组各16只大鼠。对照组大鼠每日腹腔注射3 mg/kg生理盐水及灌胃给服12 mg/kg淀粉,自由基组大鼠每日腹腔注射3 mg/kg依达拉奉,钙离子组大鼠每日灌胃给服12 mg/kg尼莫地平,联合干预组大鼠每日腹腔注射3 mg/kg依达拉奉及灌胃给服12 mg/kg尼莫地平。观察各组大鼠缺血侧脑梗死面积、缺血半暗带Bcl-2、Bax蛋白表达及神经元凋亡的变化。 结果 缺血再灌注后6 h,各干预组与对照组比较,大鼠缺血侧脑梗死面积、脑缺血半暗带神经元凋亡及凋亡相关Bcl-2、Bax蛋白表达差异无显著性（P均>0.05）;缺血再灌注后48 h、72 h和5 d,与同时间段对照组比较,各干预组大鼠脑缺血半暗带区Bcl-2蛋白表达增强,Bax蛋白表达降低,凋亡神经元数减少,梗死区面积缩小,差异有显著性（P均＜0.05）;与自由基组及钙离子组比较,联合干预组大鼠上述指标改变更显著,差异有显著性（P均＜0.001）;自由基组与钙离子组组间比较,上述各指标差异无显著性（P均>0.05）。 结论 在脑缺血再灌注损伤中,联合应用自由基清除剂和钙离子拮抗剂对缺血半暗带神经元具有较好的协同保护作用。     

缺血预处理上调TROY表达诱导大鼠局灶性脑缺血耐受

目的研究缺血预处理（IPC）对局灶性脑缺血的保护作用以及对TNFRSF expressed on the mouse embryo（TROY）表达的影响。方法33只雄性成年SD大鼠，随机分为预处理6h组（IVC-6组，11只）、预处理72h组（IPC-72组，11只）和缺血组（CI组，11只）。利用线栓法建立大脑中动脉栓塞（MCAO）致局灶性脑缺血模型。MCAO 10min作为IPC,IPC-6和IPC-72组分别在IPC后6h和72h制作短暂性局灶性脑缺血模型。再灌注24h后，对所有动物行神经功能缺损评分（NDS），并处死大鼠取脑，应用2％TTC染色测定梗死容积、TUNEL染色研究细胞凋亡情况和免疫组化观察TROY表达变化。结果与CI组比较，IPC-72组显著改善局灶性脑缺血24h后大鼠神经功能损害[两组评分分别为2（1．5-3），1（0—2）]，减少脑梗死容积[（299．33±70．98）mm^3，（69．25±47．66）mm^3]，抑制细胞凋亡和增强TROY的表达（阳性细胞数分别为42±11，87±17）（P〈0．01）。结论IPC对其后局灶性脑缺血有明显的保护作用．能诱导脑缺血耐受，可能与TROY表达上调相关。     

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.