阿尔茨海默病的事件相关电位P300研究

目的　探讨阿尔茨海默病 (AD)P3 0 0 的特点以及P3 0 0 与简易智力状况检查 (MMSE)评分的相关性。方法　对 32例AD患者和 30名健康老年人应用NicoletBravo脑诱发电位仪进行事件相关电位P3 0 0 检测 ;同时用MMSE进行认知功能评估。结果　 (1)AD组MMSE评分 [(16 5 2± 2 17)分 ]低于正常对照组 [(2 6 5 7± 1 4 3)分 ,P <0 0 1]。 (2 )AD组与正常对照组相比 ,靶刺激中的P2 、N2 、P3 潜伏期长 ,P2 、P3 波幅低 ;非靶刺激P2 波幅低 (P <0 0 5～ 0 0 1) ;AD组Cz、Pz、Fz各点间的P3 0 0 指标相比 ,差异均无显著性 (P >0 0 5 )。 (3)AD组P3 0 0 靶刺激中的P2 、P3 波潜伏期与MMSE分值呈负相关 (P <0 0 5～ 0 0 1)。结论　AD患者的P3 0 0 有多指标变异 ,且与其认知功能缺损的程度有关。     

急性脑梗死患者事件相关电位及其与认知功能的相关性

目的分析脑梗死患者的事件相关电位与认知障碍的关系。方法应用简易精神状态检查量表(MMSE)和相关事件电位(ERP)的检测,分析脑梗死患者的认知功能变化与P300的关系。结果脑梗死组MMSE评分低于正常对照组(P<0.01),P300潜伏期高于正常对照组,振幅低于正常对照组(P<0.05)。脑梗死组P300潜伏期与年龄(r=0.477,P<0.05)成正相关,与学历(r=-0.516,P<0.05)、MMSE(r=-0.549,P<0.05)、功能独立性评定量表(FIM)认知项呈负相关(r=-0.584,P<0.01),而与抑郁、性别、神经功能缺损评分、MBI、既往史评分、伴发病评分等因素不相关。结论听觉P300潜伏期可以客观反映急性脑梗死患者的认知功能障碍。     

糖尿病患者认知功能障碍及其相关因素的分析

目的　探讨 2型糖尿病 (DM)患者的认知功能改变 ,评价 2型DM认知功能障碍的敏感指标及相关危险因素。方法　对 10 0例 2型DM患者和 4 0名健康对照者进行简易智能精神状态检查表 (MMSE)和韦氏记忆量表 (WMS R)评定及事件相关电位 (ERP)测定 ,分析其认知功能、P3 0 0 波的潜伏期 (P3 PL)与病程、治疗状况和糖化血红蛋白 (GhbA1)的关系。结果　 2型DM组MMSE和WMS R评分均低于对照组 (P <0 0 1,P <0 0 5 ) ,N2 PL和P3 PL较对照组均显著延长 (P <0 0 0 1) ,且与MMSE和WMS R呈负相关 (r =- 0 5 13,P <0 0 1;r =- 0 898,P <0 0 0 1)。病程≥ 10年组患者的P3 PL长于病程 5～ 10年组 ,后者又长于病程≤ 5年组 ;未治疗和未进行正规治疗的患者P3 PL长于正规降糖治疗者 (P <0 0 1) ;GhbA1与P3 PL呈正相关 (r=0 718,P <0 0 0 1)。结论　 2型糖尿病患者存在明显的认知功能障碍 ,ERP和其他量表一样能反映认知功能损害的程度 ;2型DM的病程、治疗以及血糖控制状况均与认知功能显著相关。     

帕金森病患者的认知电位研究

目的 :研究帕金森病 (PD)患者认知功能损害。方法 :选取PD患者进行临床痴呆评分与简易智能测定 ,按照其结果将PD患者分为认知障碍组与认知正常组 ,分别进行事件相关电位检测 ,进行比较。结果 :PD认知正常组较正常对照组N2 、P3潜伏期延长 ,PD认知障碍组较PD认知正常组P3潜伏期延长。PD患者P3潜伏期与MMSE呈负相关 (r=- 0 41 5)。结论 :PD患者P3潜伏期延长 ,P3、MMSE均可反映PD患者的认知状况     

Binswanger病、脑白质疏松症及其合并脑梗死患者的认知功能障碍

目的　探讨Binswanger病 (BD)、脑白质疏松症 (LA)及LA合并脑梗死 (LA +CI)患者的认知功能障碍程度及其临床意义。方法　采用简易精神状态量表 (MMSE)和临床记忆量表 (CMS)检查BD(33例 )、LA(2 7例 )、LA +CI(31例 )患者及健康对照者 (30名 )的认知功能状态 ,并比较其障碍的程度。结果　 (1)BD组、LA组、LA +CI组MMSE及CMS评分均明显低于对照组 (P <0 0 5～ 0 0 1)。 (2 )BD组、LA +CI组MMSE及CMS评分均明显低于LA组 (P <0 0 5～ 0 0 1)。 (3)LA组轻度认知功能障碍 2 1例 (77 8% ) ;BD组中度认知功能障碍 8例 (2 4 2 % ) ,痴呆 2 5例 (75 .8% ) ;LA +CI组中度认知功能障碍 6例 (19 4 % ) ,痴呆 2 4例 (77 4 % )。结论LA大多有轻度认知功能障碍 ,而BD和LA +CI多为中度认知功能障碍和痴呆。认知功能障碍的程度是临床诊断BD、LA的参考指标。     

神经心理测试及P300对皮质下缺血性脑血管病伴认知功能障碍患者评估研究

目的研究神经心理测试及听觉事件相关电位(event related potential,ERP)P300在皮质下缺血性脑血管病(subcortical ischemic vascular disease,SIVD)伴不同程度认知功能障碍的临床应用价值。方法 92例SIVD患者,其中血管性无痴呆型认知损害(vascular cognitive impairment no dementia,VCIND)45例,血管性痴呆(vascular dementia,VaD)47例,同时选取45例未发生脑梗死及认知功能障碍的正常人作为对照组。分别对2组患者住院治疗前及正常对照组进行神经心理测试认知评估量表MMSE、MoCA评分和听觉事件相关电位P300检测。结果入院治疗前,VCIND组、VaD组简易精神状态检查(MMSE)和蒙特利尔认知评估量表(MoCA)评分均较正常组偏低(P0.05),VCIND组较VaD组偏低(P0.05),P300检测:与正常对照组潜伏期(318.689±16.123)ms相比,VCIND组患者潜伏期(360.667±16.082)ms,VaD组患者潜伏期(420.333±21.149)ms,各组间听觉事件相关电位P300潜伏期差异均有统计学意义(P0.05)。结论 SIVD患者存在认知功能损害,以执行功能障碍为主,ERP-P300测试能客观反映VCIND患者早期认知功能障碍,P300潜伏期与MMSE及MoCA有相关性,有利于VCIND早期的诊断。     

特发性震颤患者认知功能的特点

目的探讨特发性震颤(ET)患者认知功能的特点。方法用MMSE、韦氏智力量表(WAIS-R)、韦氏记忆量表(WMS-R)、事件相关电位等对25例ET患者(ET组)及22名健康对照者(对照组)的认知功能进行评估,并进行比较分析。结果 ET组WAIS-R评分的操作量表分、WMS-R评分的量表分、视觉再生及视觉再认评分显著低于对照组(均P0.05)。ET组Cz和Pz记录点事件相关电位的N2潜伏期和P3潜伏期较对照组明显延长(均P0.05)。Cz记录点N2潜伏期与MMSE、图片排列评分呈负相关(r=-0.494,P=0.027;r=-0.594,P=0.004),Pz记录点N2潜伏期与图片排列评分呈负相关(r=-0.575,P=0.005)。结论 ET患者存在认知功能障碍,主要表现为记忆力、操作能力以及信息处理速度方面。     

高频重复经颅磁刺激对酒依赖患者认知功能的影响

目的:探讨高频重复经颅磁刺激(r TMS)治疗对酒依赖患者认知功能的影响。方法:75例酒依赖患者随机分为研究组(38例)和对照组(37例),均给予两组常规戒酒治疗;在此基础上给予研究组r TMS(10Hz)辅助治疗4周,对照组给予伪刺激。分别在治疗前后应用简易精神状态检查(MMSE)进行认知功能评分,应用诱发电位仪进行事件相关电位(ERP)检测。结果:①治疗后两组MMSE总分及各因子分均较治疗前明显提高,且研究组MMSE总分、时间定向、地点定向、注意和计算及短程记忆评分明显高于对照组(P 0. 05或P 0. 01);②治疗后两组ERP的N2、P3潜伏期较治疗前缩短,P3波幅较治疗前升高(P 0. 05或P 0. 01),与对照组相比,研究组改善更显著(P均0. 05);③治疗后患者MMSE总分与N2潜伏期呈负相关(r=-0. 385,P=0. 003),与P3波幅呈正相关(r=0. 224,P=0. 028)。结论:高频r TMS辅助治疗对酒依赖患者认知功能的改善有显著增效作用。     

无症状脑梗死患者认知功能障碍及抑郁与事件相关电位变化的关系

目的探讨无症状脑梗死(SBI)患者认知功能障碍及抑郁与事件相关电位(ERP)变化的关系。方法对68例SBI患者采用汉密尔顿抑郁(HAMD)量表、简易精神状态检查(MMSE)量表及ERP检查,并与55例非脑梗死患者(对照组)进行比较。结果SBI组中,31例(45.6%)HAMD≥17分(抑郁亚组),37例(54.4%)HAMD<17分(非抑郁亚组)。SBI组MMSE评分(17.1±1.8)较对照组(25.2±1.6)显著降低,认知功能障碍发生率(52.9%vs 12.7%)显著增高(均P<0.05);与对照组相比,SBI组P3潜伏期显著延长,波幅显著降低(均P<0.05)。SBI组中,抑郁亚组MMSE评分(14.9±1.2)较非抑郁亚组(21.6±2.6)显著降低,认知功能障碍发生率(93.6%vs 21.6%)显著增高,P3潜伏期明显延长和波幅明显降低(均P<0.05)。SBI抑郁亚组MMSE评分与P3潜伏期负相关,与波幅正相关(r=-0.537,r=0.529;均P<0.05)。结论SBI患者存在认知功能障碍,伴抑郁症状者认知功能障碍更显著。ERP检查可早期发现SBI患者的认知功能障碍及抑郁。     

后循环TIA患者临床认知功能与P300相关性研究

目的探讨后循环(posterior circulation,PI)-短暂性脑缺血发作(transient ischemic attack,TIA)患者大脑认知功能的临床表现,了解PI-TIA患者大脑认知功能状态。方法选择2011年7月-2012年8月在新疆石河子市人民医院神经内科住院的PI-TIA患者30例,对照组50例。两组患者使用简易精神状态量表(MMSE)、蒙特利尔认知评估中文版(M0CA)和事件相关电位P300(ERP/P300)进行认知功能评定。结果 PI-TIA组MoCA和MMSE评分较对照组减低(P 0. 01); P300潜伏期较对照组延长(P 0. 01)。PI-TIA组MoCA子项目中执行功能/视空间、命名、记忆评分较对照组低(P 0. 01,0. 05)。PI-TIA组MMSE子项目时间定向力、语言即刻记忆、计算能力、短程记忆、语言表达、图形描画评分较对照组低(P 0. 01,0. 05)。MMSE和MoCA正相关(r=0. 811,P 0. 01)。MMSE和P300潜伏期负相关(r=-0. 745,P 0. 01)。结论 PI-TIA患者存在一定的认知功能损害。MoCA和P300潜伏期可识别PI-TIA患者早期认知功能损害。     

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.     

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.     

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.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.