正电子发射断层扫描与视频脑电图在难治性癫痫致痫灶的术前定位研究

<正>对药物难治性癫痫常进行癫痫外科术前评估,如能准确定位的局灶性癫痫考虑手术治疗,否则继续进行药物治疗或其他疗法。目前,术前致痫灶定位的方法是结合临床发作症状学、各种脑电图检查、神经影像学及脑磁图(MEG)等结果综合评估定位,术前准确的癫痫灶定位和大脑功能区评价与手术方式的选择及疗效密切相关。视频脑     

发作期脑电图在癫痫术前定位中的应用

对药物难以控制发作的难治性癫痫患者，依靠患者症状以及辅助检查正确定位致痫（epileptogenic zone）后行外科治疗，可使30—85％的患者达到癫痫无发作口1。现代癫痫病学家采用多种诊断工具，如临床症状分析、电生理描记、功能性检查以及神经影像学技术等，以寻找致痫区的位置和范围。     

儿童典型失神发作的脑电图分析

儿童典型失神发作是特发性全身性癫痫的一种非惊厥性的癫痫发作.癫痫发作是脑内神经元阵发性异常超同步化电活动的临床表现,这种异常活动可通过脑电图记录,为探讨脑电图在典型失神发作中的诊断价值,本文对16例患者进行回顾性分析.1资料与方法1.1 -般资料 收集我院2008年3月至201 1年3月16例典型失神发作患者,男9例,女7例,年龄6～14岁,平均7.2岁,均无智障,检查前均未治疗过.     

癫痫宁片治疗难治性癫痫临床分析

目的观察癫痫宁片添加治疗难治性癫痫的疗效。方法35例难治性癫痫，强直一阵挛发作6例，复杂部分性发作12例，部分性发作继发全身发作17例．在应用传统抗癫痫药物的基础上加用癫痫宁片治疗，进行自身对照的开放性研究。结果癫痛宁片添加治疗难治性癫痫总的疗效发作减少≥50％，占22例(64％)。其中发作减少≥75％，11例(31％)，发作消失4例(11．4％)，无明显不良反应，耐受性良好。结论癫痫宁片添加治疗对难治性强直发作，复杂部分发作、部分性发作继发全身性发作具有良好疗效，不良反应少。     

《儿童癫痫诊治新进展学习班》通知

由首都医科大学宣武医院癫痫中心举办的儿童癫痫诊治新进展学习班拟定于2013年10月23至27日在首都医科大学宣武医院进行。本次学习班邀请了王玉平、邹丽萍、姜玉武、刘晓燕、方芳教授等国际神经内科和小儿神经内科专家授课。主要内容包括癫痫发作分类、儿童癫痫药物治疗新进展、癫痫性脑病特点、癫痫相关基因研究、儿童癫痫的手术治疗、脑磁图在儿童癫痫诊断中应用及癫痫诊疗中电生理新技术等。报名条件：从事癫痫内科、癫痫外科、神经电生理并具有一定经验的医（技）师,限额50名。     

难治性癫痫对合并脑卒中后遗症的影响

目的观察难治性癫痫对卒中后遗症的影响。方法选择脑卒中后难治性癫痫患者26例,其中全身强直-阵挛发作11例,部分性发作15例。对比观察癫痫发作前、后患者脑CT、神经功能缺损程度及记忆商数的变化。结果发现继发全身性发作患者癫痫发作后记忆商数明显下降,继发部分性癫痫发作患者神经功能缺损程度长时间持续恶化,但癫痫发作后患者脑CT检查无明显变化。结论部分性癫痫发作加重了患者原发的神经功能缺陷,全身强直-阵挛发作能够加重患者记忆障碍。     

脑功能区胚胎发育不良性神经上皮肿瘤的外科治疗

目的探讨脑功能区胚胎发育不良性神经上皮肿瘤(DNT)的临床表现及手术治疗特点。方法对2006年-2010年治疗5例位于脑功能区的DNT患者的临床症状、影像学及电生理特点、手术技巧进行回顾性分析。结果 5例DNT均表现有与部位相关的癫痫发作,MRI具有特征性表现,脑电图检查表现为部位相关局灶性异常。5例均行术中脑电监测,行显微镜下肿瘤切除。结论DNT手术目的是治疗癫痫,显微切除肿瘤效果良好,术中脑电描记有指导切除肿瘤的意义。     

加用拉莫三嗪治疗成人难治性部分性癫痫的疗效观察

目的:观察加用拉莫三嗪治疗难治性部分性癫痫的效果。方法:连续性收集2007-2010年在我院就诊的62例难治性部分性癫痫患者,均为连续正规治疗2年以上仍频繁发作的患者,原服用抗癫痫药药量不变,加用拉莫三嗪口服。采用开放性试验的方法观察6个月,评价拉莫三嗪对难治性部分性癫痫的发作控制率、脑电图改善情况、不良反应和安全性。结果:加用拉莫三嗪治疗难治性部分性癫痫,有效率82.3%,24.2%的患者发作完全控制。治疗前后的肝、肾、血、尿等实验室检查及心电图无明显变化,偶有患者出现轻度副作用,但不影响结果。结论:加用拉莫三嗪治疗难治性部分性癫痫疗效确切,副作用轻。     

MRI、SPECT在外科治疗儿童颞叶癫痫中的作用

随着ＭＲＩ、ＳＰＥＣＴ等影像技术的发展 ,儿童难治性癫痫的外科治疗正逐步普及。现就ＭＲＩ、ＳＰＥＣＴ在我院治疗儿童颞叶癫痫的应用报告如下。临床资料一、对象　 1990～ 1998年在我院手术治疗的儿童难治性颞叶癫痫患儿 ,根据临床表现、头皮脑电图(3次以上 )和影像学检查诊断 ,并经术中脑电图检查及病理学检查证实。本组 2 6例 ,男 16例 ,女 10例 ;手术时平均年龄 11± 2 4 0岁 ,癫痫发作平均年龄为 6± 3 2 4岁。患者术后随访 1年以上 ,手术效果按Ｗｙｌｅｒｅｔａｌ分级评价 ,完全不发作 18例 ,大部分好转 8例。二、方法　ＭＲＩ检…     

难治性癫痫手术治疗53例分析

目前 ,外科手术已成为难治性癫痫的主要治疗手段 ,而术前术中致痫灶的精确定位及据不同发作类型选择术式是手术成功的关键。本文报道 1998年 5月至 2 0 0 2年 5月 5 3例难治性癫痫手术患者 ,分析如下。1　资料与方法1.1　临床资料 :男性 3 2例 ,女性 2 1例 ,年龄 11～ 3 8岁 ;病程 4～ 3 4a,平均病程 13 .5 a;发作类型 :全身强直—阵挛发作 18例 ,复杂部分发作 16例 ,简单部分发作 15例 ,其他 4例 ;发作次数 :每日 3～ 4次至每月数次不等 ,均经系统抗癫痫药物治疗无效。1.2　术前致痫灶定位 :1电生理检查 :普通脑电图 ( EEG)加蝶骨电极及…     

Zonisamide: review of its use in epilepsy therapy

Zonisamide is an antiepileptic drug used as adjunctive therapy for refractory partial seizures in adults. Because of the multiple mechanisms of action, it shows a broad spectrum of anticonvulsant activity and has been effective in several types of seizures, including partial and generalized seizures, tonic-clonic seizures and absence seizures in patients unresponsive to other anticonvulsants. Myoclonic epilepsy, Lennox-Gastaut syndrome and infantile spasms have also been treated effectively with zonisamide. Recent clinical studies have demonstrated additional potential for therapeutic use in neuropathic pain, bipolar disorder, migraine, obesity, eating disorders and Parkinson's disease. Despite adverse events, zonisamide is relatively safe and well tolerated in patients, and shows low discontinuation rate. It has a good pharmacokinetic profile and a low drug interaction potential. Zonisamide is considered as a drug that effectively reduces the frequency of partial seizures.     

加巴喷丁胶囊添加治疗癫痫的临床疗效和安全性

目的 :评价国产加巴喷丁的临床疗效和安全性。方法 :采用多中心、双盲、安慰剂对照、平行试验方法观察加巴喷丁添加治疗癫痫部分性发作(PS)和泛化性全身强直 阵挛发作 (SGTCS) 2 4wk。分 2组 :加巴喷丁组 (原基础抗癫痫药 +加巴喷丁胶囊 90 0mg·d- 1) 110例 ,对照组 (原基础抗癫痫药 +安慰剂 ) 10 8例。结果 :加巴喷丁组总有效率5 2 .7% (5 8/ 110 ) ,对照组 31.5 % (34/ 10 8) ,2组比较 ,P <0 .0 1;2组基线期发作次数≥ 4次 (2 8d)病人的疗效比较 ,P <0 .0 5 ;不同发作类型的疗效比较SGTCS >复杂部分性发作 (CPS) >简单部分性发作(SPS) (P <0 .0 1) ;2组痫样放电减少≥ 2 5 %的疗效比较 ,P <0 .0 5。2组不良反应发生率比较差异无显著性 (P >0 .0 5 )。结论 :国产加巴喷丁添加治疗对控制癫痫PS和SGTCS是有效而安全的。     

Treatment of idiopathic generalized epilepsy - a review of the evidence

INTRODUCTION: Epilepsy is stratified into idiopathic partial, symptomatic partial, idiopathic generalized (IGE) and symptomatic generalized epilepsies. AREAS COVERED: The epidemiology and clinical characteristics of IGE are reviewed in this paper. Clinically, IGE is characterized by the occurrence of any of the following three seizure types: absence seizures, myoclonic seizures and primarily generalized tonic-clonic seizures. To assess the presence of evidence-based data on the treatment of IGE, the literature was extensively reviewed for studies evaluating the treatment of IGE with various antiepileptic drugs. These studies were stratified into four classes based on recently described criteria. Class I studies were considered as providing evidence of the efficacy of the drug in patients with IGE. Finally, suggestions to evaluate the efficacy of a study drug in patients with IGE are presented. EXPERT OPINION: Based on the reviewed data, there is strong evidence-based data to support the use of valproate and ethosuximide for the treatment of childhood absence seizures; for the use of topiramate as monotherapy or adjunctive therapy for patients with primarily generalized tonic-clonic seizures; for the use of adjunctive therapy with lamotrigine for the treatment of primarily generalized tonic-clonic seizures; and for the use of levetiracetam as adjunctive therapy for the treatment of myoclonic or primarily generalized tonic-clonic seizures. To evaluate a new drug as a potential treatment for patients with IGE requires a rational methodology, discussed in this review.     

Treatment of idiopathic generalized epilepsy – a review of the evidence

Introduction: Epilepsy is stratified into idiopathic partial, symptomatic partial, idiopathic generalized (IGE) and symptomatic generalized epilepsies.

Areas covered: The epidemiology and clinical characteristics of IGE are reviewed in this paper. Clinically, IGE is characterized by the occurrence of any of the following three seizure types: absence seizures, myoclonic seizures and primarily generalized tonic-clonic seizures. To assess the presence of evidence-based data on the treatment of IGE, the literature was extensively reviewed for studies evaluating the treatment of IGE with various antiepileptic drugs. These studies were stratified into four classes based on recently described criteria. Class I studies were considered as providing evidence of the efficacy of the drug in patients with IGE. Finally, suggestions to evaluate the efficacy of a study drug in patients with IGE are presented.

Expert opinion: Based on the reviewed data, there is strong evidence-based data to support the use of valproate and ethosuximide for the treatment of childhood absence seizures; for the use of topiramate as monotherapy or adjunctive therapy for patients with primarily generalized tonic-clonic seizures; for the use of adjunctive therapy with lamotrigine for the treatment of primarily generalized tonic-clonic seizures; and for the use of levetiracetam as adjunctive therapy for the treatment of myoclonic or primarily generalized tonic-clonic seizures. To evaluate a new drug as a potential treatment for patients with IGE requires a rational methodology, discussed in this review.     

老年癫痫41例临床特点分析

目的研究老年癫痫的临床特点。方法回顾性分析大连医科大学附属第一医院癫痫门诊41例老年癫痫患者的临床资料。结果 41例患者70.7%为部分性发作,29.3%为全面性强直阵挛发作。病因分析：63.4%为脑血管病,9.8%为脑肿瘤,7.3%为代谢性疾病,14.6%病因不明。41例均为单药治疗,其中61.0%发作完全控制,有效率87.9%。结论老年癫痫多为继发性癫痫,病因明确,发作类型以部分性发作为主,抗癫痫药物单药治疗效果好。     

单唾液酸四己糖神经节苷脂钠治疗脑外伤癫痫疗效分析

目的评价用单唾液酸四己糖神经节苷脂钠(神经节苷脂)联合高压氧及常规抗癫痫药物综合与单纯高压氧及常规抗癫痫药物治疗脑外伤癫痫的疗效。方法常规抗癫痫药物联合高压氧治疗脑外伤癫痫为对照组(73例),对照组基础上加用神经节苷脂静脉点滴为治疗组(77例),观察临床症状和脑电图。结果与对照组相比:试验组神经节苷脂给药越早,疗效指标改变越好。多个不同的发作类型,疗程结束的脑电图显示均有显著改善,其中以单纯部分性发作类型及全面性发作类型患者尤为明显。结论神经节苷脂联合高压氧综合治疗脑外伤癫痫是一种有效的治疗手段。     

Valproate: past,present, and future

Preclinical studies have been carried out during the past four decades to investigate the different mechanisms of action of valproate (VPA). The mechanisms of VPA which seem to be of clinical importance include increased GABAergic activity, reduction in excitatory neurotransmission, and modification of monoamines. These mechanisms are discussed in relation to the various clinical uses of the drug. VPA is widely used as an antiepileptic drug with a broad spectrum of activity. In patients, VPA possesses efficacy in the treatment of various epileptic seizures such as absence, myoclonic, and generalized tonic-clonic seizures. It is also effective in the treatment of partial seizures with or without secondary generalization and acutely in status epilepticus. The pharmacokinetic aspects of VPA and the frequent drug interactions between VPA and other drugs are discussed. The available methods for the determination of VPA in body fluids are briefly evaluated. At present, investigations and clinical trials are carried out and evaluated to explore the new indications for VPA in other conditions such as in psychiatric disorders, migraine and neuropathic pain. Furthermore, the toxicity of VPA, both regarding commonly occurring side effects and potential idiosyncratic reactions are described. Derivatives of VPA with improved efficacy and tolerability are in development.     

拉莫三嗪单药治疗新诊断小儿局限性癫痫41例疗效观察

目的：探讨拉莫三嗪单药对局限性发作癫痫患儿治疗效果及不良反应。方法首次确诊为部分性发作癫痫患儿41例加用拉莫三嗪治疗12个月,治疗前后分别观察治疗效果及不良反应。结果拉莫三嗪单药治疗41例患儿12个月,总有效率为92.68%,其中完全控制率为80.49%,有效控制率为12.20%,无效控制率为4.88%,不良反应率为9.51%。结论拉莫三嗪是治疗局限性发作癫痫患儿疗效确切、安全性好、可单药使用的药物。     

脑血管病继发癫痫120例临床分析

目的回顾性分析120例脑血管病继发癫痫患者的临床资料,为相关的临床实践提供参考。方法所有患者的临床资料均录入Epidata3.0数据库,然后导入SPSS14.0进行频数分析。结果脑血管病后继发癫痫的发病率为9.15%,癫痫发生的时间主要集中在脑卒中发生后的6个月内;癫痫发作的类型主要为单纯部分性发作和全身强直阵挛发作;病变部位主要分布在脑叶区,其次为额顶基底节区;经治疗后116例患者的癫痫病情被控制。结论脑血管病后癫痫大多较易控制,抗癫痫药物在类别、剂量的选择原则上应强调个体化,不能千篇一律。     

丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫的临床对比

目的 观察丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫的临床效果.方法 选取本院收治的儿童癫痫患者127例,根据癫痫类型分为部分发作型(PS)组(52例)、部分发作继发全面发作(SGS)组(37例)、全面性发作(GS)组(28例)和Lennox Gastaut综合征(LGS)组(10例).所有患者均给予丙戊酸钠联合拉莫三嗪治疗,观察各组临床治疗效果.结果 SGS组完全控制率为35.14％,明显高于其他3组(P＜ 0.05);LGS组全控制率最低,为0.00％.SGS组治疗总有效率为64.86％,明显高于其他3组(P＜0.05);LGS组治疗总有效率最低,为30.00％.与治疗前比较,各组发作频次均有不同程度减少,差异均有统计学意义(P＜0.05).结论 丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫均有不同程度的效果,均能够显著减少患儿癫痫发作次数,其中以SGS疗效最为明显.