电纺丝技术制备生物活性复合纤维支架及其体外降解性

摘要 背景：聚乳酸/羟基磷灰石类复合材料支架常用的制备方法主要有冷压法、粒子沥滤法、热致相分离法等,但是在增强材料界面的结合、调节材料的降解速率、改善材料的强度等方面仍不能满足要求。 目的：制备左旋聚乳酸/羟基磷灰石复合纳米纤维支架。 方法：采用静电纺丝法制备聚乳酸/羟基磷灰石复合纳米纤维支架。以扫面电镜对纤维的结构形态进行分析,并观察其在PBS中浸泡不同时间的体外降解过程。 结果与结论：羟基磷灰石纳米粒子与聚乳酸/基体间存在化学键合,纳米粒子使纤维直径增大且表面粗糙程度增加,这种结构将有利于细胞在纤维膜上的伸展和和繁殖。羟基磷灰石的引入,抑制了聚乳酸降解过程中的自催化作用,减缓了聚乳酸的降解速度。说明电纺丝技术制备的聚乳酸/羟基磷灰石复合支架在组织工程支架材料方面具有潜在的应用前景。 关键词：电纺丝;羟基磷灰石;聚乳酸;降解性能;生物材料 doi:10.3969/j.issn.1673-8225.2011.08.010     

壳聚糖微球/纳米羟基磷灰石/聚乳酸-羟基乙酸复合支架制备及其蛋白缓释效果：与单纯纳米羟基磷灰石/聚乳酸-羟基乙酸支架、壳聚糖微球的比较

背景：骨组织工程骨构建中如何使生长因子持续高效发挥作用是影响成骨速度和质量的关键,现多以各种材料的微球或支架作为缓释载体,但缓释作用有待提高。 目的：实验拟制备壳聚糖微球,然后复合到纳米羟基磷灰石/聚乳酸-羟基乙酸支架上,形成双重缓释作用,并测量对牛血清白蛋白的释放效果。 方法：以牛血清白蛋白为模型药物,采用乳化交联法制备壳聚糖微球。将微球与纳米羟基磷灰石、聚乳酸-羟基乙酸按一定比例混合,以冰粒子为致孔剂,采用冷冻干燥法制备壳聚糖微球/纳米羟基磷灰石/聚乳酸-羟基乙酸复合支架。利用扫描电镜、激光粒度分析仪、压泵仪和力学性能测试仪检测复合支架的形态性能,考察药物在缓释支架上的体外释放规律。 结果与结论：所制备的壳聚糖微球形态良好,呈规则圆球形,粒径集中分布在20~40 μm,微球药物包封率为86.5%,载药量为0.8%,随牛血清白蛋白初始用量的增加,载药量可升高至2.6%,但包封率下降至74.1%。壳聚糖微球能均匀分布在聚乳酸-羟基乙酸支架上,形成壳聚糖微球/纳米羟基磷灰石/聚乳酸-羟基乙酸复合支架,孔径为100~400 μm,孔隙率> 80%,压缩强度为1.1~2.3 MPa,10周降解率为26.5%。单纯纳米羟基磷灰石/聚乳酸-羟基乙酸支架其牛血清白蛋白在36 h累积释放量达85%以上,壳聚糖微球其牛血清白蛋白10 d累积释放量为33.6%,复合支架其牛血清白蛋白40 d累积释放量为81.5%。结果证实包埋壳聚糖微球的纳米羟基磷灰石/聚乳酸-羟基乙酸支架其压缩强度和降解速率合适,对蛋白类药物具有良好的缓释作用,有望作为组织工程的支架材料和生长因子的缓释载体。 关键词：聚乳酸-羟基乙酸;支架;壳聚糖;缓释载体;骨修复材料,组织工程;生物材料 doi:10.3969/j.issn.1673-8225.2010.03.017     

聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的制备及体外释放***◆

背景：由聚乳酸羟基乙酸/纳米羟基磷灰石复合材料制备的微球,在体外磷酸盐缓冲液中能够持续释放药物。 目的：制备聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球,探讨纳米羟基磷灰石对复合微球的载药量、包封率和体外释放等性质的影响。 设计、时间及地点：材料学体外观察,于2009-02/2009-07在华南理工大学材料学院实验室完成。 材料：聚乳酸羟基乙酸为济南岱罡生物有限公司产品,纳米羟基磷灰石由华南理工大学特种功能材料教育部重点实验室自制,5-氟尿嘧啶为上海楷洋生物技术有限公司产品。 方法：以水溶性抗癌药物5-氟尿嘧啶作为模型药物,先用纳米羟基磷灰石吸附药物,外包裹生物相容性好且可生物降解的聚乳酸羟基乙酸,采用单乳化溶剂挥发法(S/O/W)制备聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球。对载药前后的纳米羟基磷灰石进行透射电子显微镜、扫描电子显微镜观察和FTIR分析。采用扫描电镜、激光粒度仪和紫外分光光度计对微球的理化性质及体外释药性质进行分析。 主要观察指标：纳米羟基磷灰石与5-氟尿嘧啶分子之间的相互作用,微球载药量和包封率,药物体外释放。 结果：FTIR结果表明,纳米羟基磷灰石对5-氟尿嘧啶有较强的吸附作用。聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的载药量和包封率分别为3.83%,86.78%,明显高于单纯的聚乳酸羟基乙酸-5-氟尿嘧啶微球。经过体外释放药物突释后,复合微球比单纯聚乳酸羟基乙酸微球的药物释放慢。在第27天,复合微球和单纯的聚乳酸羟基乙酸微球累积药物释率放分别为84.87%,99.87%。 结论：与单纯的聚乳酸羟基乙酸-5-氟尿嘧啶微球相比,由于纳米羟基磷灰石对5-氟尿嘧啶存在较强的吸附作用,使聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的载药量和包封率得到了较大提高,具有更好的药物缓释效果。 关键词：5-氟尿嘧啶;乳酸-羟基乙酸共聚物;纳米羟基磷灰石;复合微球;药物释放 doi:10.3969/j.issn.1673-8225.2009.47.017     

载荷角质细胞生长因子聚乳酸-羟基乙酸共聚物纳米缓释微球在组织工程皮肤构建中的应用

背景：聚乳酸-羟基乙酸共聚物具有良好的生物相容性和可降解性性。 目的：制备载荷角质细胞生长因子聚乳酸-羟基乙酸共聚物控释载药系统用于组织工程皮肤。 方法：采用乳化-溶剂挥发法、冷冻干燥法制备载有角质细胞生长因子的聚乳酸-羟基乙酸共聚物纳米微球,并构建组织工程皮肤。扫描电镜、倒置显微镜、纳米粒度分析仪、紫外分光及ELISA法对微球评价其特性。 结果与结论：纳米微球载药量为(14.05±0.56)%,包封率为(59.86±2.38)%,角质细胞生长因子活性保留率(78.26±5.63)%,体外释放30 d的累积释药率达75%以上,微球形态规则圆润。微球形态规整,在脱细胞真皮表面分布均匀,与其联接良好。毛囊干细胞群在荷载聚乳酸-羟基乙酸共聚物纳米微囊脱细胞真皮上生长活跃,细胞形态良好,并呈克隆团生长。说明实验用组织工程材料制备工艺合理,材料相容性好,可用于构建新型组织工程皮肤。     

热压-盐析法制备骨组织工程支架的工艺及性能表征**☆

背景：热压-盐析法制备聚合物组织工程支架,设备简单,成型快速,力学强度较高,但是适当的支架成型条件及材料组分对支架的性能尤为重要。 目的：观察热压-盐析法制备聚乳酸/聚己内酯/纳米羟基磷灰石复合组织工程支架中温度、时间、压力以及羟基磷灰石的加入对支架性能的影响。 设计、时间及地点：复合材料性能测试,对比观察实验,于2008-09/2009-05在同济大学材料科学与工程学院纳米与生物高分子材料研究所完成。 材料：聚乳酸、聚己内酯、羟基磷灰石均为实验室合成。 方法：采用液相共沉淀法制备纳米羟基磷灰石,借助溶剂将聚乳酸、聚己内酯、纳米羟基磷灰石和致孔剂进行共混,去除溶剂后在一定温度、压力、时间下进行热压制得聚乳酸/聚己内酯/纳米羟基磷灰石复合组织工程支架。 主要观察指标：①X射线衍射分析、透射电镜观察羟基磷灰石的相结构、形状和尺寸。②扫描电镜观察复合多孔支架的形貌。③通过表面接触角观察不同材料的亲水性。④不同热压时间、温度、压力对支架孔隙率及抗压强度的影响。⑤不同含量羟基磷灰石对支架抗压强度的影响。 结果：热压-盐析法制备的聚乳酸/聚己内酯/纳米羟基磷灰石复合组织工程支架具有连通开孔的多孔结构,孔径多分布在300~340 µm,支架的表面无结皮现象,孔隙率和抗压强度均满足骨支架的应用要求;纳米羟基磷灰石的加入提高了支架的抗压强度,但支架亲水性随其质量分数的升高而下降,纳米羟基磷灰石质量分数为4%时支架的综合性能相对较好;热压温度、时间、压力对支架的性能影响较大,支架的综合性能在热压温度65 ℃、热压压力7 MPa、热压时间3 min条件时相对较好。 结论：热压-盐析法构建的骨组织工程支架孔径、孔隙率和抗压强度均满足应用要求;热压温度、时间、压力对支架的性能影响较大;纳米羟基磷灰石的加入提高了支架的抗压强度,但对支架亲水性有影响。 关键词：多孔支架;骨组织工程;热压-盐析法;纳米羟基磷灰石;支架性能     

聚乳酸/聚羟基乙酸共聚物修复髌股关节软骨缺损

摘要 背景：传统的方法修复软骨损伤,易发生退变。聚乳酸/聚羟基乙酸共聚物具有良好的生物相容性,可根据需要调节降解速度等性能,可能在修复软骨损伤方面具有应用前景。 目的：观察以聚乳酸/聚羟基乙酸共聚物为载体修复兔关节软骨缺损的可行性。 方法：选取2月龄新西兰兔骨髓培养,诱导间充质干细胞向软骨细胞分化。第3代细胞与聚乳酸/聚羟基乙酸共聚物共培养制成聚乳酸/聚羟基乙酸共聚物-细胞复合物。建立兔髌股关节股骨髁部缺损模型,在右侧36个膝关节植入聚乳酸/聚羟基乙酸共聚物-细胞复合物,左侧18膝植入聚乳酸/聚羟基乙酸共聚物,另18膝造成缺损后留作空白对照。术后4,8,12,24,36,48周取材,行大体及组织学观察,组织学评分。 结果与结论：聚乳酸/聚羟基乙酸共聚物-细胞复合物修复大鼠缺损后,软骨细胞分布较均一,色泽与正常软骨相似,与正常软骨界限消失,表面细胞平行于关节面,深层细胞排列紊乱,细胞呈团状,基质异染广泛,软骨下骨形成及潮线恢复正常,与周围正常软骨连接良好。而单纯植入聚乳酸/聚羟基乙酸共聚物或缺损后未处理大鼠缺损边缘细胞呈团块状增生,底部为纤维组织。提示骨髓基质细胞源性软骨细胞是修复关节软骨缺损较理想的种子细胞,聚乳酸/聚羟基乙酸共聚物适合作为组织工程修复关节软骨缺损的支架材料,具有良好的应用前景。 关键词：聚乳酸/羟基乙酸共聚物;髌股关节;组织工程;骨髓基质细胞;载体材料;软骨缺损;分化 doi:10.3969/j.issn.1673-8225.2011.16.007     

静电纺丝纳米纤维膜作为骨骼肌组织工程支架材料的细胞相容性

摘要 背景：有报道以生物可降解的胶原盘或聚L-乳酸、聚羟基乙酸、聚L-乳酸/聚羟基乙酸共聚物等作为骨骼肌组织工程的支架材料,各有优缺点,不能完全满足骨骼肌组织工程的需要。 目的：探讨静电纺丝纳米纤维膜作为骨骼肌组织工程支架材料的可行性。 方法：制备7种不同组分的静电纺丝纳米纤维膜,以其浸提液为培养基培养第3代SD乳鼠成肌细胞,以含体积分数20%新生小牛血清的F12培养基培养的为对照。采用MTT法和扫描电镜检测成肌细胞在各组材料的黏附及生长情况。 结果与结论：各组分静电纺丝纳米纤维膜吸光度值与对照组间差异无显著性意义(P > 0.05)。各组分静电纺丝纳米纤维膜组成肌细胞黏附率差异有显著性意义(P < 0.05)。扫描电镜与上述结果一致。含70%聚乳酸+20%蚕丝蛋白+10%胶原组成电纺丝纳米纤维膜组可见大量成肌细胞黏附,呈梭形,两极伸展,排列规律,效果最好。其他各组细胞少,形态不规则,似衰退期成肌细胞。提示静电纺丝纳米纤维膜无细胞毒性,对成肌细胞的增殖无影响,成肌细胞能良好地黏附;以70%聚乳酸+ 20%蚕丝蛋白+10%胶原组分效果最佳。 关键词：聚乳酸;蚕丝蛋白;胶原;成肌细胞;静电纺丝技术;纳米纤维膜;组织工程 doi:10.3969/j.issn.1673-8225.2011.12.020     

聚乳酸/壳聚糖纤维复合支架的制备与性能

摘要 背景：聚乳酸/壳聚糖纤维复合支架材料既可提高支架的力学性能,又可中和聚乳酸的酸性降解产物,提高生物相容性,从而满足组织工程支架的要求。 目的：制备用于组织工程的聚乳酸/壳聚糖纤维复合支架。 方法：采用热致相分离法制备了聚乳酸/壳聚糖纤维复合支架。测定了复合支架的微观形貌、孔隙率、压缩模量、降解特性、蛋白质吸附特性。 结果与结论：复合支架具有纳米微米共存的亚微观结构。在聚乳酸纳米纤维网络中引入壳聚糖纤维,有效地增强了复合支架的压缩模量和蛋白质吸附能力,复合支架压缩模量为纯聚乳酸纳米支架的3.75倍,蛋白质吸附能力比纯聚乳酸纳米支架提高了112%。体外降解实验表明复合支架降解液的pH值随时间的下降明显变缓。提示,在聚乳酸纳米纤维网络中引入壳聚糖纤维,可有效增强支架的压缩模量,提高蛋白质吸附能力,并可有效减缓聚乳酸降解过程中pH值的下降,克服酸性产物引发的无痛性炎症问题。 关键词：聚乳酸;壳聚糖;纳米复合;增强;支架 doi:10.3969/j.issn.1673-8225.2010.42.015     

电纺丝聚乳酸、聚3羟基丁酸酯共聚4羟基丁酸酯和聚碳酸亚丙酯纳米纤维的制备及表面亲水性

背景：近年来聚乳酸、羟基磷灰石类复合材料支架具有良好的生物降解性和生物相容性而被广泛的研究,但是这类复合材料在增强材料界面的结合、调节材料的降解速率、改善材料的强度等方面仍不能满足理想的组织工程支架材料的要求。 目的：探讨电纺丝法制备纳米纤维的结构形态及表面亲水性。 方法：分别将聚乳酸、聚3羟基丁酸酯共聚4羟基丁酸酯和聚碳酸亚丙酯通过静电纺丝法制备纳米纤维膜,扫描电镜对纤维膜的结构形态进行分析,并观察在人体环境相近的磷酸盐缓冲溶液(37 ℃,pH 7.4)中浸泡不同时间的表面亲水性。 结果与结论：通过静电纺丝技术可以将聚乳酸、聚3羟基丁酸酯共聚4羟基丁酸酯和聚碳酸亚丙酯3种材料制备成微纳米纤维结构,控制制备参数可以获得不同直径的纤维,样品随着在培养液中的浸泡时间延长,总体显示出接触角比初始降低,亲水性增强。 关键词：聚乳酸;聚3羟基丁酸酯共聚4羟基丁酸酯;聚碳酸酯;电纺丝;亲水性 doi:10.3969/j.issn.1673-8225.2010.12.046     

复合壳聚糖纳米微球聚乳酸-羟基乙酸/纳米羟基磷灰石缓释载体系统对蛋白的缓释作用

背景：聚乳酸-羟基乙酸支架材料具有良好的生物相容性、无毒、可以良好的塑性,并具有一定的强度和韧性。但其降解产物为酸性,会影响局部pH值变化,不利组织生长。 目的：制备能够良好缓释蛋白类药物的复合支架。 方法：以牛血清蛋白为模型药物,以离子凝胶法制备壳聚糖微球。将微球与纳米羟基磷灰石和聚乳酸-羟基乙酸按一定比例混合,以冰粒子为致孔剂,采用粒子沥虑-冷冻干燥复合工艺制备CMs/nHA/PLGA复合缓释支架。利用扫描电镜、透射电镜、压泵仪和力学性能测试仪检测复合支架的形态和性能,并考察其在体外对蛋白类药物释放的规律。 结果与结论：制备的壳聚糖纳米微球形态良好,呈规则球形或类球形,粒径分布在220~770 nm,以380~650 nm为多。微球对药物的载药量为39.2%,包封率为68.3%,两者均与牛血清蛋白的初始量相关,载药量随牛血清蛋白初始量的增加而增加,包封率则反之。复合支架呈白色多孔状,孔径为125~355 mm,孔与孔之间联通良好,孔隙率达83.4%,压缩强度为1.4~ 2.1 MPa,10周降解率为28.6%。PLGA/nHA支架对牛血清蛋白的2 d累积释放量为85%,而壳聚糖和CMs/nHA/PLGA复合支架对牛血清蛋白的9 d累积释放量分别是为48.9%和35.7%。提示制作的壳聚糖纳米微球和CMs/nHA/PLGA支架材料对牛血清蛋白有良好的缓释作用,复合支架材料形态好,强度和降解速率合适。     

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.