癫痫伴高同型半胱氨酸血症10例分析

目的:探讨癫痫伴高同型半胱氨酸血症分析。方法:回顾性分析2012年1月-12月收治的10例癫痫合并高同型半胱氨酸血症患者的临床资料。结果:10例患者临床发作形式9例以强直-痉挛大发作为主,1列以失神发作为主;3例为正常脑电图;2例患者表现为轻度异常主要是清醒时脑电背景以θ波为主;1例患者(脑出血)广泛重度异常脑电监测。结论:癫痫临床发作以强直-痉挛大发作为主,癫痫患者中合并有高同型半胱氨酸血症,HHcy的兴奋性神经毒性作用和氧化应激是促进癫痫发作的原因,Hcy水平增加有促使癫痫发作和神经退行性疾病的发生率。     

外伤后癫痫致痫灶定位和术式选择的临床观察

目的评价多种手术方法联合使用治疗外伤后癫痫的效果。方法21例患者根据术前致痫灶的初步定位和术中皮层脑电及深部电极的监测结果,分别采用以下5种不同的术式:⑴疤痕及周围皮层切除7例;⑵疤痕及周围皮层切除 多软膜下横切术(MST)8例;⑶前颞叶、杏仁核-海马切除4例;⑷神经导航下选择性杏仁核-海马切除1例;⑸胼胝体前部切开 MST 皮层热灼1例。结果术后随访3个月至10年,疗效满意的9例(42.9%),显著改善的7例(33.3%),良好的3例(14.3%),效差的1例(4.8%),无改善的1例(4.8%)。术后无死亡病例,有8例出现暂时性的功能障碍,但均在4周内恢复正常。结论多种手术方法联合治疗外伤后癫痫安全有效。     

癫痫综合干预成本-效用分析

目的 对癫痫综合十预的效果进行卫生经济学评价.方法 在河南省9个项目示范点对874例癫痫患者进行调查.以农村癫痫防治管理项目研究为依托,计算癫痫综合干预的成本,以伤残调整生命年(DALY)和质量调整生命年(QALY)为效用指标进行成本效用分析.结果 874例患者中,综合干预组(422例)人均损失8 58个DALY,获得27 95个QALY,获得1个QALY需付出的成本为2454 10元,挽救1个DALY需付出7995.40元;相对于无干预对照组(452例),综合干预组获得QALY所需成本减少,挽救1个DALY少投入21 73510元.结论 癫痫对社会、家庭、患者本人造成严重的经济损害,综合性干预可以更好地降低癫痫患者的疾病经济负担,具有较高的成本-效用收益,值得推广.     

脑卒中后癫痫47例临床研究

目的:探讨脑卒中后癫痫的临床特点,癫痫对脑卒中恢复期神经功能康复的影响。方法:回顾性分析47例脑卒中后癫痫患者的临床资料。结果:早发型癫痫27例,其中出血性脑卒中(19例),缺血血性脑卒中(8例);迟发型癫痫20例,出血性脑卒中(8例),缺血血性脑卒中(12例)。早发型癫痫患者中16例长期服用抗癫痫药,12例(75%)无发作;11例未给予抗癫痫治疗,8例(72.72%)无发作。迟发型癫痫患者中15例长期服用抗癫痫药。13例(86.67%)无发作;5例未给正规应用抗癫痫药物,2例(40%)无发作。结论:出血性卒中发生早发型癫痫的可能性大,缺血性卒中更倾向于发生迟发型癫痫。服用抗癫痫药物对早发型癫痫预后并无明显影响,但可明显改善迟发型癫痫的预后。     

热性感染相关性癫痫综合征患儿的临床及随访分析

目的探讨热性感染相关性癫痫综合征(FIRES)患儿的临床表现、脑电图及医学影像学特点。方法选择2016年8月至2019年9月,于四川大学华西第二医院诊治的5例FIRES患儿(患儿1~5)为研究对象。回顾性分析其临床病例资料,包括临床表现与实验室检查、脑电图及医学影像学检查、治疗和随访结果等。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果本研究患儿1~5的研究结果如下。①一般临床资料:年龄为4~9岁,男性与女性患儿比为2∶3,发热至首次抽搐发作间隔时间为4~7 d,入院时均处于昏迷状态,改良Glasgow昏迷评分为3~7分。②脑电图检查结果:其脑电图背景节律呈慢化、多灶性癫痫样放电。③医学影像学检查结果:其病程早期头颅影像学检查结果正常,后期均可见脑萎缩改变,在额、顶、枕叶皮质或皮质下及脑室旁白质区等部位出现异常信号影。④治疗结果:对其采取多种抗癫痫药物、激素、丙种球蛋白、血浆置换等治疗均无效;采用生酮饮食(KD)治疗1~14 d后,其抽搐发作频率降低。⑤随访结果:在随访1~6个月时,2例(患儿3、5)癫痫发作得到完全控制,1例(患儿1)癫痫发作得到明显控制,2例(患儿2、4)遗留难治性癫痫发作;除1例(患儿3)仅伴轻度学习障碍外,其余4例(患儿1~2、4~5)均存在中至重度认知障碍。结论FIRES是一种严重癫痫性脑病,多数FIRES患儿经治疗后,可遗留严重认知功能损害和难治性癫痫发作,预后差,接受药物治疗如常规抗癫痫药物、麻醉剂、免疫调节等效果不理想,KD治疗可能有助于控制癫痫发作。     

青少年肌阵挛癫痫误诊22例分析

目的 探讨青少年肌阵挛癫痫患者误诊的原因.方法 对22例青少年肌阵挛癫痫患者的误诊情况进行分析.结果 误诊为全面性强直-阵挛发作、特发性癫痫8例,误诊为儿童失神癫痫、特发性癫痫4例,误诊为复杂部分性发作2例,误诊为多动症2例,误诊为局灶性癫痫1例,误诊为单纯部分性发作1例,误诊为局灶性起源的阵挛性发作1例,误诊为热性惊厥1例,误诊为月经期癫痫1例,误诊为反射性发作1例.诊断为青少年肌阵挛癫痫后,停用卡马西平、奥卡西平、苯妥英钠,予丙戊酸钠或(和)左乙拉西坦口服,8例发作次数明显减少,4例发作时间减少,5例3个月无发作,3例6个月无发作,2例已连续1年无发作.结论 理解和掌握青少年肌阵挛癫痫的特点可以避免和减少误诊.     

动态脑电图监测结果指导癫痫患者停药的价值

目的探讨动态脑电图监测结果用以指导癫痫患者停药的价值。方法选择我院3年无癫痫发作的患者58例,采用上海诺诚8128型无线蓝牙动态16导脑电图仪进行24h脑电图监测58例3年无发作癫痫患者脑电图变化,观察其监测结果与临床症状的关系。结果 58例3年无发作的癫痫患者中,所有患者均无临床癫痫发作,动态脑电图发现痫样放电19(32.8%)例。19例痫样放电患者中,活动性痫样发作史<6个月3例、7-12个月5例、>12个月11例;单药治疗3例、2药联用3例、3药联用13例;全面性发作8例,部分性发作11例。痫样放电出现时间:睡眠状态12(63.2%)例,清醒状态6(31.6%)例,清醒与睡眠中均痫样放电1(5.3%)例,睡眠中痫样放电发生率明显高于清醒期,差异有统计学意义(P<0.05)。结论动态脑电图监测结果可以用以指导3年无发作癫痫患者是否适合停药,对癫痫患者进行脑电图检查时需要描记夜间脑电活动情况,监测时不短于一个完整睡眠周期。只有当患者临床发作停止2年以上,脑电活动完全正常时,才考虑停止抗癫痫药物治疗。     

癫痫患儿血清serotonin、leptin的水平及临床意义

目的 探讨癫痫患儿血清中血清素(serotonin)、瘦素(leptin)的水平及其临床意义。方法 选取2019年4月至2021年4月咸宁市中心医院收治的102例癫痫患儿作为研究对象,随后根据癫痫发作频率分为频发组(A组,35例)、持续状态组(B组,27例)、非频发或持续状态组(C组,40例)。另选取同期在该院体检的102例健康儿童作为对照组。分别采用酶联免疫吸附法、放射免疫法检测儿童血清serotonin、leptin水平。采用Pearson相关分析探讨血清serotonin、leptin水平与C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)的关系,同时采用ROC曲线评价血清serotonin、leptin评估癫痫的临床价值。结果 癫痫各组及对照组儿童的血清serotonin、leptin的水平差异均有统计学意义(F值分别为76.710、79.640,P<0.05);进一步比较发现,serotonin水平:对照组>C组>B组>A组;leptin水平:A组>B组>C组>对照组,差异均有统计学意义(P<0.05)。癫痫各组及对照组儿童血清CRP、IL-2、TNF-α表达水平差异均有统计学意义(F值分别为813.920、560.602、507.530,P<0.05);进一步比较发现,A组>B组>C组>对照组,差异均有统计学意义(P<0.05)。相关性分析显示,癫痫患儿血清serotonin与CRP、IL-2、TNF-α均呈负相关(r值分别为-0.534、-0.528、-0.476,P<0.05),血清leptin与CRP、IL-2、TNF-α均呈正相关(r值分别为0.425、0.433、0.457,P<0.05)。血清serotonin、leptin评估癫痫的曲线下面积(AUC)及其95%CI分别为0.819(0.759~0.879)、0.835(0.765~0.897),二者联合检测的AUC(95%CI)为0.887(0.816~0.966)。结论 癫痫患儿血清中serotonin表达水平降低,leptin水平升高,且与癫痫发作频率及预后密切相关。Serotonin和leptin水平在辅助诊断癫痫上具有一定的价值。     

湖北省农村癫痫防治管理项目效果评价

目的通过分析湖北省农村癫痫防治管理6个项目县(市)的随访管理资料,评价苯巴比妥的治疗效果。方法按照国家癫痫项目办农村癫痫防治管理项目工作手册(2013年)的要求,在湖北省6个县(市)开展农村癫痫患者筛查、诊断复核、药物治疗、病例随访和治疗质控的效果评价。2014年12月~2016年12月,6个项目县(市)共管理服用苯巴比妥治疗的患者1 649例。疗效评估以癫痫发作次数的变化作为判定标准。结果 1 649例苯巴比妥治疗的患者中,1 358例患者随访管理满12个月,其中显效患者1 019例(患者未发作或发作减少75.00%以上),占75.04%;746例患者随访管理满24个月,其中显效患者533例,占71.45%。有效控制癫痫发作的病例中,有73.01%的患者服用苯巴比妥日平均剂量在60~119 mg。共有56例患者出现1项中度或重度不良反应。退组原因排名前3位的是好转、依从性不好和迁出。疾病、原因不明和溺水是主要的死亡原因。结论湖北省农村癫痫防治管理项目的实施有效地控制了农村癫痫患者的发作,适合在农村贫困地区广泛应用。     

~(18)-FDG PET显像对癫痫患者的诊断价值

目的　探讨18F -FDGPET显像对癫痫灶定位的诊断价值。方法　 5 0例临床确诊癫痫患者行PET显像 ,空腹至少 4小时 ,测血糖值 <6 7mmol/L ,静脉注射FDG后安静休息 4 0分钟行显像 ,先透射 10分钟后二维采集 30分钟 ;图像重建成冠状面、横段面、矢状面断层图像。结果　 5 0例PET检查癫痫患者中 ,PET显像检出率为 86 % ,其中异常代谢灶 4 3例 (43/ 5 0 ,86 % ) ,低代谢灶 4 2例 (42 / 5 0 ,84 % ) ,高代谢灶 1例 (1/ 5 0 ,2 % ) ,正常 7例 (7/ 5 0 ,14 % )。结论　PET脑代谢显像对癫痫的定位诊断是一种有效方法。     

Complexity quantification of cardiac variability time series using improved sample entropy (I-SampEn)

The sample entropy (SampEn) has been widely used to quantify the complexity of RR-interval time series. It is a fact that higher complexity, and hence, entropy is associated with the RR-interval time series of healthy subjects. But, SampEn suffers from the disadvantage that it assigns higher entropy to the randomized surrogate time series as well as to certain pathological time series, which is a misleading observation. This wrong estimation of the complexity of a time series may be due to the fact that the existing SampEn technique updates the threshold value as a function of long-term standard deviation (SD) of a time series. However, time series of certain pathologies exhibits substantial variability in beat-to-beat fluctuations. So the SD of the first order difference (short term SD) of the time series should be considered while updating threshold value, to account for period-to-period variations inherited in a time series. In the present work, improved sample entropy (I-SampEn), a new methodology has been proposed in which threshold value is updated by considering the period-to-period variations of a time series. The I-SampEn technique results in assigning higher entropy value to age-matched healthy subjects than patients suffering atrial fibrillation (AF) and diabetes mellitus (DM). Our results are in agreement with the theory of reduction in complexity of RR-interval time series in patients suffering from chronic cardiovascular and non-cardiovascular diseases.     

心率变异性与高血压病动脉硬化和早期肾脏损害的相关性研究

目的 探讨心率变异性与高血压病动脉硬化和早期肾损害的相关性。 方法 对健康体检中筛选已确诊原发性高血压病164 例,进行心率变异性(HRV-SDNN)、尿微量白蛋白和臂踝脉搏波传导速度(baPWV)以及血压、BMI和血生化检查检测,并与200例健康受试者(正常对照组)进行对比分析。 结果 (1)两组在脉压差、体重指数(BMI)、低密度胆固醇(LDL)、甘油三酯(TG)、高密度脂蛋白(HDL)、血糖、血尿酸、尿微量白蛋白、baPWV和SDNN方面的比较,差异有统计学意义(均P＜0.05)。(2)SDNN与baPWV两者具有明显相关性(r=-0.72,P＜0.01)。(3)SDNN与尿微量白蛋白两者具有显著相关性(r=-0.81,P＜0.01)。 结论 心率变异性降低是高血压病动脉粥样硬化和早期肾功能损害的危险因素。通过心率变异性的分析, 对评估和预测血管病变和靶器官损害均有重要的指导意义。     

Short-term stability of resting heart rate variability: influence of position and gender

Heart rate variability (HRV) is utilized within laboratory and clinical settings as a noninvasive indicator of cardiac autonomic modulation. Past research has utilized a wide variety of resting methodologies and, as such, it is difficult to draw conclusions on the nature of HRV from different studies. Therefore, the current study aimed to assess the short-term stability of resting HRV during a 40-min resting trial and the impact of body position and gender on this short-term stability. Resting HRV was determined from 40-min trials in 3?standard positions (supine, seated, and standing) for healthy males (n = 14) and females (n = 16). Time-domain, geometric, and frequency-domain measures of resting HRV were examined during consecutive 10-min segments using a 3-way ANOVA (time?× position?× gender) and Tukeys' post-hoc tests with reproducibility assessed by intraclass correlation coefficients (ICC) and coefficients of variation. During rest, most HRV measures fluctuated over time, were greater in the supine compared to the standing position, and were greater for males compared with females. Variables that reflected primarily vagal modulations of heart rate remained stable, whereas other HRV measures varied over time. The majority of HRV variables exhibited substantial to excellent short-term reproducibility (ICC?> 0.6) with time-domain and geometric measures of HRV demonstrating greater values compared with frequency-domain parameters. Based on the current results, the recording and analysis of HRV at 0-10?min of rest was recommended as a standardized protocol for the assessment of resting HRV in any standard position for either gender during laboratory and (or) clinical settings.     

Potential of feature selection methods in heart rate variability analysis for the classification of different cardiovascular diseases

In this study heart rate variability (HRV) analysis was applied to characterize patients suffering from coronary heart disease (CHD), dilated cardiomyopathy (DCM) and patients who had survived an acute myocardial infarction (MI). On the basis of several HRV parameters, an optimal discrimination between the different kinds of cardiovascular diseases and between the diseases and healthy controls (HC) was derived by feature selection and linear classification. For each task a small favourable subset of a set of 33 potentially interesting HRV measures was selected with the intention of improving the diagnostic value and facilitating the physiological interpretation of HRV analysis. Time- and frequency-domain parameters as well as parameters from non-linear dynamics were included in the analysis. With the expectation that different diseases are characterized by different phenomena, feature selection was applied for each task separately. Using the features optimal for one task to another task can reveal a loss in performance, but it turned out that one specific parameter set (set1: normalized low frequency LF/P and a non-linear variability measure WPSUM13) was applicable for all tasks, where diseased and healthy subjects have to be distinguished, without significant reduction in performance. This set seems to be a general marker for pathologic changes in HRV and might be used for early detection of heart diseases. The classification between different heart diseases requires another parameter set (set2: meanNN and sdaNN, reflecting the steady state behaviour of the heart rate and long and short term SEAR describing the spectral composition). However, the use of set1 for the separation of different kinds of diseases, where set2 is appropriate, led to significant reduction in performance and vice versa. This observation may be important for future developments of HRV measures especially suitable for the assessment of disease severity.     

Investigation of noise exposure effect on heart rate variability parameters

This paper deals with the study of the effect of 135 min exposure to noise with intensity Leq 95 dB(A) in experimental conditions. Three experimental sessions: before, at the onset, and at the end of the noise exposure were conducted. The comparison of heart rate variability (HRV) parameters before and on the onset of the experiment showed tendency for significant decrease of the cardiointervals variability parameters: standard deviation (SD), sum of positive differences between successive cardiointervals (S), total wave energy in the cardiotachogram (S*Ns), mean difference between successive cardiointervals (V). Statistically significant increase of the mean value was found at HRV parameters related to the distribution of the cardiointervals: control adequacy parameter (IARP), equilibrium autonomic parameter (IVE), autonomous balance (IVB), homeostasis parameter (HI). At the end of the third experimental session HRV parameters were almost restored, but they did not achieve the initial values. An elevation of the sympathetic activity under noise exposure effect was found. In this aspect, the heart rate variability parameters were interpreted as a sensitive indicator for the quality of cardiac rhythm and they can be used for assessment of the functional status and the level of preserving of the adaptive reserves of the investigated persons.     

Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has been shown to increase the risk for cardiovascular diseases and death, and autonomic dysfunction (specifically, reduced heart rate variability (HRV)) is a predictor of increased cardiac risk. This study tests the hypothesis that ETS exposure reduces HRV in the general population and discusses possible pathways. METHODS: This cross-sectional study was conducted between 2001 and 2003 and is part of the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung Diseases in Adults) study. The analysis included 1218 randomly selected non-smokers aged 50 and above who participated in 24-h electrocardiogram recordings. Other examinations included an interview, investigating health status (especially respiratory and cardiovascular health and health relevant behaviours and exposure to ETS) and measurements of blood pressure, body height and weight. RESULTS: Subjects exposed to ETS at home or at work for more than 2 h/day had a difference of -15% in total power (95%CI: -26 to -3%), low frequency power (-28 to -1%), low/high frequency ratio (-26 to -3%) and -18% (-29 to -4%) in ultralow frequency power of HRV compared with subjects not exposed to ETS at home or work. We also found a 2.7% (-0.01 to 5.34%) higher heart rate during the recording in exposed subjects. CONCLUSIONS: Exposure to ETS at home and work is associated with lower HRV and with higher heart rate in an ageing population. Our findings suggest that exposure to ETS increases cardiac risk through disturbances in the autonomic nervous system.     

Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants

Physical inactivity and low resting heart rate variability (HRV) are associated with increased coronary heart disease incidence. In the Whitehall II study of civil servants aged 45-68 years (London, United Kingdom, 1997-1999), the strength of the association of moderate and vigorous activity with higher HRV was examined. Five-minute recordings of heart rate and HRV measures were obtained from 3328 participants. Calculated were time domain (standard deviation of NN intervals) and high-frequency-power measures as indicators of cardiac parasympathetic activity and low-frequency power of parasympathetic-sympathetic balance. Leisure-time physical activity (metabolic equivalent-hours per week) was categorized as moderate (>or=3-<5) and vigorous (>or=5). Moderate and vigorous physical activity were associated with higher HRV and lower heart rate. For men, linear trends of higher low-frequency power with increasing quartile of vigorous activity (304.6 (low), 329.0, 342.4, 362.5 (high); p < 0.01) and lower heart rate with increasing quartile of moderate activity (69.6 (low), 69.2, 68.9, 67.8 (high); p < 0.05) were found. These associations remained significant after adjustment for smoking and high alcohol intake. For men whose body mass index was >25 kg/m(2), vigorous activity was associated with HRV levels similar to those for normal-weight men who engaged in no vigorous activity. Vigorous activity was associated with higher HRV, representing a possible mechanism by which physical activity reduces coronary heart disease risk.     

Enhancement of Ketone Supplements-Evoked Effect on Absence Epileptic Activity by Co-Administration of Uridine in Wistar Albino Glaxo Rijswijk Rats

Both uridine and exogenous ketone supplements decreased the number of spike-wave discharges (SWDs) in a rat model of human absence epilepsy Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats. It has been suggested that alleviating influence of both uridine and ketone supplements on absence epileptic activity may be modulated by A₁ type adenosine receptors (A₁Rs). The first aim was to determine whether intraperitoneal (i.p.) administration of a specific A₁R antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX; 0.2 mg/kg) and a selective adenosine A_2A receptor antagonist (7-(2-phenylethyl)-5-amino-2-(2-furyl)-pyrazolo-[4,3-e]-1,2,4-triazolo [1,5-c]pyrimidine) (SCH 58261; 0.5 mg/kg) have a modulatory influence on i.p. 1000 mg/kg uridine-evoked effects on SWD number in WAG/Rij rats. The second aim was to assess efficacy of a sub-effective dose of uridine (i.p. 250 mg/kg) combined with beta-hydroxybutyrate salt + medium chain triglyceride (KSMCT; 2.5 g/kg, gavage) on absence epilepsy. DPCPX completely abolished the i.p. 1000 mg/kg uridine-evoked alleviating effect on SWD number whereas SCH 58261 was ineffective, confirming the A₁R mechanism. Moreover, the sub-effective dose of uridine markedly enhanced the effect of KSMCT (2.5 g/kg, gavage) on absence epileptic activity. These results demonstrate the anti-epilepsy benefits of co-administrating uridine and exogenous ketone supplements as a means to treat absence epilepsy.     

老年冠心病患者心率变异性分析

目的了解冠心病（CHD）患者的心率变异性（HRV）特点,探讨其自主神经变化的临床意义。方法测定92例CHD患者和50例健康对照者24h心率变异性的时域、频域指标,并进行比较分析。结果 CHD组24hHRV指标水平明显低于健康对照组,差异有统计学意义（P〈0.01）。结论 CHD患者HRV降低提示心血管自主神经系统功能失衡。     

Evaluation of the effect of heat exposure on the autonomic nervous system by heart rate variability and urinary catecholamines

The aim of this study was to investigate the usefulness of heart rate variability (HRV) and urinary catecholamines (CA) as objective indices of heat stress effect. We examined physiological responses, subjective symptoms, HRV and urinary CA to evaluate the effect of heat exposure on the autonomic nervous system. Six healthy male students volunteered for this study. They were exposed on different days to either a thermoneutral condition at wet bulb globe temperature (WBGT) 21 degrees C, or a heated condition at WBGT 35 degrees C for 30 min, while seated on a chair. In the thermoneutral condition, differences of all parameters between the values before and after 30 min exposure were not statistically significant. In the heated condition, heart rate, body temperature and scores for subjective symptoms (feverishness, sweating, mood, and face flushing) significantly increased after 30 min exposure (p<0.05). Also, the high frequency component (HF%) of HRV significantly decreased and the low frequency/high frequency (LF/HF) ratio of HRV significantly increased after 30 min exposure to the heated condition (p<0.05). There were no significant differences between the amounts of urinary CA before and after the 30 min exposures; however, the norepinephrine amount after 30 min exposure to the heated condition was significantly greater than that of the thermoneutral condition (p<0.05). The heat exposure (WBGT 35 degrees C) induced activation of the sympathetic nervous system and a withdrawal of the parasympathetic nervous system. These findings coincide with observed changes of heart rate, body temperature and subjective symptoms. It is suggested that HRV (HF% and LF/HF ratio) and urinary norepinephrine may be useful objective indices of heat stress; HRV seems to be more sensitive to heat stress than urinary CA.