儿童良性中央-颞棘波型癫痫随访研究

目的：探讨儿童良性中央－颞棘波型癫痫的预后。方法；对１３８例儿童良笥中央－颞棘波型癫痫进行了２～１２年的随防研究。结果：抗癫痫药物均能控制临床发作，智商和社会行为不受影响，其中１１３例（８２％）终止抗癫痫药物２～１２年临床无发作，脑电图均恢复正常。结论：脑电图睡眠诱发试验可以提高本病诊断阳性率。经抗癫痫药物治疗，临床无发作，脑电图正常我年后可以停药。     

糖尿病性癫痫10例临床分析

现将本院所见的糖尿病性癫痫９例报告如下。１临床资料１．１年龄与性别男６例,女４例,年龄４４－７８岁,平均６１．２岁。１．２病史与病程有糖尿病病史者１０例,有典型“三多一少”者８例,糖尿病症状不典型者２例;糖尿病病史１０～１２年者２例,２－５年者３例,半～１年者４例;癫痫症状发生在糖尿病症状之后者８例,癫痫发作时检查发现糖尿病２例。其中合并高血压５例,冠心病２例,周围及植物神经病变３例。１．３癫痫诱因和前驱症状诱因中,糖尿病加重者４例,感染２例,自行停用胰岛素１例,静滴低分子右旋糖酐（未加胰岛素）…     

日间睡眠脑电图在癫痫诊断中的应用

目的：探讨睡眠脑电图（ＥＥＧ）在癫痫诊断中的价值及适应症。方法：过去１０年间５２２例患有癫痫及各种发作性疾患病人的睡眠及清醒ＥＥＧ进行研究。结果：ＥＥＧ有异常爆发活动（ＰＡ）者２１７例，ＰＡ只在睡眠中出现者９６例，痫样放电的检出率由清醒的２３．２％提高到４１．６％。１５例病人通过发作间期或发作期的睡眠ＥＥＧ显示的ＰＡ，进一步明确癫痫发作类型。在９７例有中央－－颞棘波的儿童良性部分性癫痫中，５０例（     

24小时动态脑电图癔病诱发试验对癔病与癫痫的鉴别诊断价值

目的寻找鉴别癔病性发作与癫痫发作的有效方法。方法对９６例发作性疾病患者进行２４小时动态脑电图监测及癔病诱发试验（ＡＥＥＧ－ＨＰＴ）研究。结果难治性癫痫疑伴癔病组（１８例）、癔病或癫痫发作诊断不定组（３６例）、癫痫组（１８例）、癔病组（２４例）４组中癔病诱发试验阳性率分别为７７．８％、６６．７％、５．６％、９１．７％；记录到非诱发下自发发作（癫痫或癔病）分别为３、７、３、１例；记录到发作间期癫痫性放电分别为１６、１８、１７、２例。９６．０％的患者明确诊断。结论ＡＥＥＧ－ＨＰＴ是鉴别癔病与癫痫发作的有效方法之一。     

单、双相躁狂发作临床特点的比较结果

作者对单、双相躁狂发作者临床特点进行了比较分析,现将结果报道如下。１　资　　料本文单相躁狂发作３６例（下称研究组）,双相躁狂发作３８例（下称对照组）。２　结　　果２－１　家族史　研究组中有阳性家族史者６例（１６－７％）,其中,Ⅰ级２例、Ⅱ级３例、Ⅲ级１例。对照组１０例（２６－３％）,其中,Ⅰ级９例,Ⅲ级１例。Ⅰ级亲属精神病阳性率研究组低于对照组（χ２＝４－４３,Ｐ＜０－０５）。２－２　起病形式　急性（≤２周）、亚急性（＞２周、≤３个月）、慢性（＞３个月）［１］。研究组分别１９例、９例、８例;对照…     

添加拉莫三嗪治疗难治性癫痫

采用保持原用抗病药物及剂量不变，添加拉莫三嗪（LTG）治疗161例难治性痛痛患者。以治疗前3个月的发作次数为基础，与治疗期间3个月内发作次数比较，结果显示：添加LTG后癫痫发作完全控制者12例，占7．45％；明显好转者69例，占42．8％。其中全身强直-阵挛发作者疗效最佳，其明显好转者为48．52％，部分性发作者中明显好转者为44％。Lennox－Gastaut综合征8例，明显好转者50％。该药副作用小，减量或停药后症状消失。     

38例儿童颞叶癫痫脑电图分析

目的 探讨儿童颞叶癫痫的脑电图特征，方法 分析３８例颞叶癫痫患儿发作间歇期的脑电图资料。结果 尖波棘波，棘慢波综合３６例（９４．７％）能定位于颞区的３３例（８４．８％）大多表现为非同步灶性阵发（６３．２％）结论儿童颞叶癫痫患者间歇期脑电图国明显的特征是颞区的阵发，高电位尖波，棘波。     

静脉用德巴金在癫痫手术后早期应用(摘要)

从１９９７年７月～１９９８年５月，我们在癫痫手术后早期静脉用德巴金（ＶＰＡ）１０例，取得了较好的效果。其中男８例，女２例。平均年龄１９．２岁（１１～２８）。平均病程１０．２年（４～１８）。强直—阵挛性发作８例；失神发作２例。１０例均经正规抗癫痫治疗，...     

世界卫生组织-全球抗癫痫运动中国农村癫痫示范项目结束后四年随访结果

目的了解全球抗癫痫运动中国农村抗癫痫示范项目终止后4年曾接受苯巴比妥治疗的癫痫患者的远期治疗效果及转归,以为我国农村癫痫患者的防治和管理提供参考依据。方法2008年7—12月由经过培训的乡卫生院医师采用问卷与访谈相结合的形式入户调查,对原示范项目6省（市）共8个县经苯巴比妥治疗管理的2455例惊厥型癫痫患者进行随访。结果接受苯巴比妥治疗的2455例患者中共随访到1780例,其中939例（52．75％）继续服药,无发作和发作减少超过50％（有效）的患者于项目终止后的12、24、36和48个月时所占比例分别为66．77％（627／939）、68．37％（642／939）、71．35％（670／939）和73．06％（686／939）;841例（47．25％）停药患者中244例（29．01％）无发作、320例（38．05％）仍然发作但已停药、277例（32．94％）改用其他类型抗癫痫药物。对939例继续服用苯巴比妥与841例停药的癫痫患者进行疗效比较,继续服药者的远期疗效优于停药者（x2=12．423,P=0．002）。停药原因分别为发作停止（244例,29．01％）、改用其他抗癫痫药物（277例,32．94％）、未提供免费药物或无钱买药（93例,11．06％）、治疗效果欠佳（92例,10．94％）、当地买不到苯巴比妥（54例,6．42％）等。至2008年随访结束时共有206例患者死亡,标化死亡比达19．10;其中意外事故死亡为59例（28．64％）,其次为脑血管病30例（14．56％）、癫痫持续状态窒息死亡28例（13．59％）。结论“全球抗癫痫运动”中国农村癫痫示范项目开展成功,远期治疗效果良好,值得进一步推广。癫痫人群死亡率高,尤其是意外事故死亡率高,值得引起注意。     

酒精中毒伴儿童头痛型癫痫30例临床观察

我们科１９９６年１月－１９９９年１０月共收治３０ 例儿童酒精中毒伴发头痛型癫痫,现就其诊治体会报告如下。１临床资料１．１一般资料３０例中,昏迷９例,抽搐１０例,伴有头痛、呕吐及抽搐者１１例。３均无颅脑损伤及颅内感染等病史,无饮劣酒史,男２８例,女２例,年龄４－６岁２例,７－１０岁１４例,１０－１５岁１４例,学生２６例９约占８６．７％）,学前儿童４例（１３．４３％）,干部子女１３例（４３．３％）,工人子女１１例（３６．６％）,农民子女６例（２０％）。 凡是因饮酒过量造成昏迷伴有抽搐、呕吐者均静脉输液…     

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.     

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.     

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.     

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.