我国农村社区癫痫有效控制方案的推广性试验

目的 探索适用于我国农村地区癫痫患的有效治疗方法,并进一步验证其推广应用价值。方法 在山西晋城泽州县及河南焦作市武陟县两个农村社区人群中选定全身强直－阵挛型发作的活动性癫痫患376人（山西185例,河南191例）。由经过短期培训的乡村医生按照规定方案使用苯巴比妥单药治疗、管理病人,并观察疗效、患的依从性及药物不良反应。结果 治疗观察1年的效果表明,服药7－12个月期间与入组前半年的情况比较,有45．9％的患未再发作,发作频度减少＞75％占15％,两项合计显效率为60．9％。在规定剂量内无明显副作用。结论 本研究再次证明,该方案适合在我国广大农村地区进一步推广应用,可使约半数癫痫患受益。     

吉林省部分农村地区癫痫流行病学调查

目的通过对吉林省部分农村地区癫痫流行病学调查,掌握吉林省农村地区癫痫的发病率,患病率、死亡率以及治疗缺口情况。方法 (1)选择吉林省3个县为目标县,由吉林大学第一医院神经内科癫痫课题组对当地县级神经内科医生及乡镇医院内科医生进行培训;(2)由当地乡镇医院医生对管区内癫痫患者进行筛查,并由县级医院神经内科医生复查;(3)统计学处理。结果 (1)发病率与患病率:吉林省活动性癫痫患病率大约为3.94‰,总发病率约为每年每10万人口22.55人;(2)患者性别构成:男女比例大约为1.13∶1;(3)年龄构成:患者的年龄多集中在10~60岁之间,以20~50岁患者居多,发病年龄高峰在0~10岁之间;(4)发作类型:全面强直阵挛发作为主要的发作类型;(5)死亡率:死亡率约为0.89%;(6)治疗缺口62.7%。结论吉林省农村地区活动性癫痫发病率及患病率低于以往国内调查的结果,治疗缺口大,提示在农村地区加强癫痫宣教具有重要意义。     

在癫痫患者的管理中使用结构磁共振成像的建议:国际抗癫痫神经影像专题工作组的共识报告

结构磁共振成像(MRI)对癫痫的诊断和治疗至关重要,尤其是考虑行癫痫外科治疗时。尽管以前已有一些关于癫痫MRI的建议及指南,但在世界范围内,结构MRI的方法不尽相同,无法充分发挥MRI新技术进步的优势造福癫痫患者。因此,国际抗癫痫联盟诊断方法委员会委托2013-2017年神经影像专题工作组制定了一套建议,以解决以下问题:①MRI检查的目标患者;②癫痫MRI检查方案的最低要求是什么;③如何评估MRI图像;④如何优化病灶的检出。这些建议针对癫痫中心的临床医生和综合性/地区性医院神经科医生制订。工作组赞同在新发的全面性和局灶性癫痫中行常规的结构成像,并在需要进行详细评估时,描述病灶的范围。工作组确定了一组以三维采集为核心、统一的癫痫结构神经成像序列-HARNESS-MRI方案。由于这些序列在大多数MR扫描仪上都可用,与临床环境和国家/地区无关,因此HARNESS-MRI方案可推广使用。工作组还赞同使用计算机辅助图像后处理技术,客观显示个体化大脑的解剖结构和病理情况。本报告通过对MRI全面、深入地讨论,强调这种非侵入性检查在癫痫患者管理中的独特作用。     

河南焦作市武陟县农村人群癫痫流行病学调查

目的 :调查了解我国农村地区癫痫的患病率及治疗缺口 ,为开展防治工作提供依据。方法 :河南省焦作市武陟县作为调查点 ,采用随机整群抽样方法确定调查人群 ,由经过统一培训的医生入户调查。调查人数为 12 45 7人。凡初筛调查时确诊或可疑的癫痫患者 ,均经神经科医生再次访查确诊。结果 :调查确诊 5 9例癫痫患者 ,患病率为 4 7‰。活动性癫痫患病率为 3 5‰ ,年发病率32 1/ 10万人口。全部患者中有 2 5 4%未治疗 ,47 5 %患者治疗不正规。活动性癫痫的治疗缺口为 32 5 %。结论 :本次调查农村地区癫痫患病率与以往报道接近 ,约有 2 / 3患者没有得到正确治疗 ,应尽快制订合理的干预对策     

牡丹江农村地区癫痫患者用药情况调查

目的：调查牡丹江农村地区癫痫患的用药情况，为开展防治工作提供根据。方法：在东宁县采用随机整群抽样方法调查10151人，由经统一培训的医生入户调查，最终由神经科医师确诊。结果：初发年龄、性别、发作持续时间及发作类型及用药无明显相关性，而年发作次数是决定用药的关键因素。结论：近年农村地区癫痫病人的治疗观念虽有一定转变，但仍处于一种无序状态，亟待改进。     

河南焦作市武陟县农村人群癫痫流行病学调查

目的：调查了解我国农村地区癫痫的患病率及治疗缺口，为开展防治工作提供依据。方法：河南省焦作市武陟县作为调查点，采用随机整群抽样方法确定调查人群，由经过统一培训的医生入户调查。调查人数为12457人。凡初筛调查时确诊或可疑的癫痫患者，均经神经科医生再次访查确诊。结果：调查确诊59例癫痫患者，患病率为4．7‰。活动性癫痫患病率为3．5‰，年发病率32．1／10万人口。全部患者中有25．4％未治疗，47．5％患者治疗不正规。活动性癫痫的治疗缺口为32．5％。结论：本次调查农村地区癫痫患病率与以往报道接近，约有2／3患者没有得到正确治疗，应尽快制订合理的干预对策。     

我国五市城乡癫痫流行病学对比分析

癫痫迄今在国际上还缺乏一致公认的定义和分类,因此在方法学上难于相互比较。本文根据国内1983年和1985年先后在长沙等五城市及哈尔滨等21省(市)农村进行的大规模神经流行病学调查结果进行对比分析,现报告如下。 材料与方法 按照地理位置,选定长沙、成都、广州、哈尔滨、银川五城市为城市组,在相距20公里的乡村为农村组。两地区各随机选择含有一万余名自然社区人群为研究样本,共计城市人群:54144人,农村人群58518人。具有该地区正式城市或农村户口居民为调查对象。调查方式每两人一组,均经过统一的技术培训,并有神经科医生参加,进行逐户家访,实查率城市、农村     

书讯

《癫痫外科手术技术》由美国滨州大学Gordon H.Baltuch医生和加拿大蒙特利尔大学Jean-Guy Villemure医生主编,北京三博脑科医院栾国明、周健医生主译。该书详细介绍了手术计划设计,选择脑皮质切除术和术中应用各类技术以及创新的方法,如神经调控技术和神经放射技术,对了解癫痫外科最新前沿治疗方法和癫痫患者的手术管理策略具有重要的指导意义。     

书讯

《癫痫外科手术技术》由美国滨州大学Gordon H.Baltuch医生和加拿大蒙特利尔大学Jean-Guy Villemure医生主编,北京三博脑科医院栾国明、周健医生主译。该书详细介绍了手术计划设计,选择脑皮质切除术和术中应用各类技术以及创新的方法,如神经调控技术和神经放射技术,对了解癫痫外科最新前沿治疗方法和癫痫患者的手术管理策略具有重要的指导意义。     

免疫组织化学标记物在难治性癫痫病理诊断中的应用

<正> 癫痫是由大脑神经元异常放电引起的以短暂性中枢神经系统(CNS)功能失常为特征的慢性脑部疾病。长期正规抗癫痫药物治疗被认为是控制癫痫发作的最佳治疗方案,但约30%的患者经多种抗癫痫药物正规治疗并达最大治疗剂量后仍不能有效控制发作,最终发展成为难治性癫痫。近年来,随着功能神经外科的发展,手术治疗逐渐成为难治性癫痫的首选治疗方式,因而正确的病理诊断成为进一步治疗的关键。此文作者结合自己工作经验体会,介绍一组在难治性癫痫相关脑组织病变     

A report on a feasibility test of "community control of epilepsy" proposed by WHO

According to a protocol proposed by the Division of Mental Health, WHO, a feasibility test for "Community Control of Epilepsy" was carried out in rural areas of Beijing and Sichuan. This project means to detect, control and follow-up patients with generalized tonic-clonic seizures using primary health care workers 40 patients were chosen to be administrated phenobarbital and divided randomly into two groups. 20 in community "A" treated by primary health care workers who were trained by a three-day course, 20 in community "B" treated by neurologists. Patients in both communities were compliant and the curative effects were no difference between the two groups. The primary health care workers could master the fixed method and manage patients conveniently. This present study revealed that the "Community Control of Epilepsy" is a feasible project in the rural areas of China.     

An evaluation of the impact of health worker and patient education on the care and compliance of patients with epilepsy in Zimbabwe

PURPOSE: The use of primary health care personnel to identify cases of epilepsy and initiate simple treatment protocols has been advocated as a solution to the numeric inadequacy and uneven distribution of medical manpower available for the management of epilepsy in developing countries. This study sought to evaluate the effectiveness of primary health care nurses in the diagnosis and management of epilepsy, as well as the impact of patient-information pamphlets on drug compliance and clinic attendance of patients with epilepsy. METHODS: Primary health care workers from 24 clinics in the Zvimba district in Zimbabwe attended a workshop to improving their knowledge in the diagnosis and management of generalized tonic-clonic seizures. Half of these clinics (experimental group) subsequently received patient-information pamphlets for distribution to patients and relatives, whereas the other half (control group) did not. Frequency of clinic attendance, mean seizure frequencies, and mean serum levels of phenobarbitone were compared at baseline and at 6 months after intervention in patients within each group, and at 6 months after intervention between both groups. RESULTS: Community health worker education led to a 74% increase in patient recruitment as well as a marked improvement in patient drug compliance over the 6-month study period. The use of patient-information pamphlets led to a marked reduction in patient default from clinic follow-up, but did not appear to influence drug compliance or seizure frequency. CONCLUSIONS: The benefits of these simple and inexpensive interventions make a strong case for their widespread implementation for improved epilepsy care not only in Zimbabwe, but also in other developing countries.     

Ego functions in epilepsy

Two groups of epilepsy patients (28 patients with temporal lobe epilepsy and 15 patients with primary generalized epilepsy) entered a study of personality traits related to epilepsy, based on a modification of Bellak's semistructured interview for assessment of ego strength. Two groups of subjects served as controls: 15 patients with a non-neurological but relapsing disorder, psoriasis, and 15 healthy volunteers. Compared with the group of healthy volunteers, a decreased adaptive level of ego functioning was found in the epilepsy groups, regardless of seizure types and EEG findings, and, to a lesser extent, compared with the psoriasis group. Areas of ego functioning most affected were "reality testing", "cognitive functioning", "integrative functioning" and "regulation and control of drives". Patients with more than one type of seizure were the most affected, as were patients who were younger than 15 years when the disease began. The number of anticonvulsants administered did not influence the results. No difference on adaptive level of ego functioning was found between the group with primary generalized epilepsy and the group with temporal lobe epilepsy. Similarly, the temporal lobe epilepsy group with predominantly right-sided and left-sided EEG changes, respectively, showed similar adaptive levels of ego functioning.     

Sleep spindle abnormalities in children with generalized spike-wave discharges

This study investigated sleep and sleep spindle parameters in children with primary generalized spike-and-wave discharges (untreated primary generalized group, nine patients; treated primary generalized group, six patients) and compared these with an age- and sex-matched nonepileptic control group (n = 47). In the untreated primary generalized group, stage 2 onset was significantly shorter, with less spindles in stage 2. In the last stage 2 period of the night, significantly less fast frequency spindles were observed, indicating abnormal dynamics of sleep architecture. In the treated group, sleep patterns were comparable to that of the control group. The data indicate sleep architecture dysfunctions in children with generalized spike-and-wave discharges. These dysfunctions could account for the frequently encountered sleep problems in children with primary generalized epilepsy.     

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force

The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long‐Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.     

Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures

Illness perceptions of health care professionals are likely to affect patient care. This study describes the illness perceptions of two groups of health care staff toward epilepsy and psychogenic nonepileptic seizures (PNES). Sixty-one health care professionals (30 emergency care [EC] and 31 neuroscience ward [NW] staff) who regularly see patients with seizures completed the adapted Illness Perception Questionnaire-Revised (IPQ-R) and the Symptom Attribution Question for epilepsy and PNES. Respondents reported a poorer understanding of PNES than of epilepsy (P<0.001), thought epilepsy was a more chronic condition (P=0.001/P<0.001) and that patients with PNES had more "personal control" of their seizures (P=0.014/P<0.001). Staff from both departments identified psychological causes as most important for PNES (P<0.001). EC staff also attributed PNES to behavioral issues or alcohol. The Illness Perception Questionnaire-Revised and Symptom Attribution Question demonstrated important differences in attitudes of health care staff toward epilepsy and PNES. The findings illustrate why some patients with PNES have traumatic encounters with health care professionals.     

Dental status and oral health of patients with epilepsy: an epidemiologic study

PURPOSE: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients. METHODS: We first set up four "dental" subgroups of epilepsy patients, based on the types of seizures, seizure frequency, and mental state. One hundred one patients underwent a survey concerning their dental, medical, and epilepsy histories, followed by a dental examination. Indexes quantifying oral hygiene, the number and condition of the remaining teeth, periodontium, and the degree of prosthetic treatment were measured. An age-matched control group of general (nonepilepsy) population underwent an identical dental examination. Statistical comparison was performed between the patient and the control groups and between subgroups of epilepsy patients. RESULTS: In almost all aspects of oral health and dental status, patients with epilepsy showed a significantly worse condition compared with the control group. Comparison of the subgroups of epilepsy patients revealed that the most severe findings concern patients who have poorly controlled epilepsy, especially those who have frequent generalized tonic-clonic seizures. CONCLUSIONS: The observed difference probably results from a combination of factors such as the effect of the seizures themselves, socioeconomic conditions, and the negative attitude of dentists. We recommend that the planning of dental treatment of such patients should start with the assessment of their disease and determination of the "dental" subgroup to which they belong. For each subgroup, specific recommendations for interventions are given.     

Pathway to care of epilepsy patients: Exploratory study from an urban slum in Northern India

Introduction:

Epilepsy is a chronic neurological disorder with major psychosocial correlates. Most epilepsy patients in developing countries are untreated or inadequately treated. It is essential to understand the pathway, to care taken by epilepsy patients in a community, to be able to target appropriate services to them.

Materials and Methods:

A community based study was conducted on all epilepsy patients in an urban slum in Northern India to study their pathways to care. A list of persons suffering from epilepsy was generated by house to house visits, snowballing, and key informant contacts. In-depth interview and Medical Record Review were used to document their pathway to care.

Results:

Thirteen of the twenty two patients had contacted a health-care provider for their first episode. The most common first link of care for the patients was secondary level Government hospitals. The next common was private practitioners, followed by Tertiary Care Hospitals, and registered medical practitioners. Eleven out of twenty two patients had to contact a Tertiary Level Center for seeking care. The number of health-care facilities consulted before arriving at their latest point of care ranged from 0 to 5. Traditional or faith healers were consulted at some point of time for cure.

Conclusion:

There is a need to focus on strengthening and capacity building of the primary care settings for managing epilepsy to enable their better utilization. This shall prevent unnecessary referrals and hence the load on the already burdened higher facilities.     

Community leader education to increase epilepsy attendance at clinics in Epworth, Zimbabwe

OBJECTIVE: To determine whether educating community leaders about epilepsy would lead to an increase in epilepsy cases being diagnosed and treated at primary health centers. METHODS: This was a single-arm cohort study performed in Epworth, a periurban township outside Harare, Zimbabwe. The subjects were Epworth community leaders (Local Board members, teachers, nurses, police officers, traditional healers, prophets). Educational workshops were given on epilepsy, its cause, and its management, and the number of new epilepsy cases on local primary health clinic registers 6 months after the workshops was measured. RESULTS: Six new cases were recorded, all among patients previously diagnosed with epilepsy. This was a significant increase (p = 0.02) compared with the null hypothesis. CONCLUSION: Although there was a significant increase in new cases, these did not represent newly diagnosed patients. Significant prejudice within the community may still prevent identified patients with epilepsy from seeking treatment. Alternative methods must be sought to increase the awareness of epilepsy within low-income communities and to reach "hidden" people with epilepsy.