深板层角膜移植与穿透性角膜移植视力恢复的差异

背景：角膜移植可主要分为以恢复角膜透明性和提高视力为主要原因的光学性角膜移植和以修补及重建角膜完整性为主要原因的治疗性或结构性角膜移植。 目的：对比分析深板层角膜移植与穿透性角膜移植成功率和降低并发症发生率的临床效果。 方法：分析深板层角膜移植和穿透性角膜移植患者43例43眼,26例26眼行深板层角膜移植,17例17眼行穿透性角膜移植,供体角膜均来自死亡后的捐献,24 h内4 ℃湿房保存,移植后用药常规抗炎抗排斥反应,随访3~37个月,观察两组移植前后的裸眼视力和矫正视力,对比疗效、排斥反应、并发症。 结果与结论：与移植前比较,两组患者移植后裸眼视力和矫正视力均有提高(P < 0.05)。深板层角膜移植后并发症为后弹力膜穿孔1例,移植排斥反应2例,穿透性角膜移植后青光眼1例,虹膜前粘连1例,排斥反应4例。深板层角膜移植可以减少排斥反应的发生率和并发症,移植后视力恢复与穿透性角膜移植无明显差异,但建议内皮功能正常的角膜基质病变可尽量选择深板层角膜移植。 关键词：深板层角膜移植;穿透性角膜移植;角膜移植;修补;重建;内皮细胞     

丙泊酚对大鼠肾缺血再灌注损伤细胞凋亡信号通路的影响

背景：角膜移植后40%~60%的患者发生了角膜新生血管,移植后的角膜新生血管加速了角膜免疫排斥反应的发生。抑制角膜移植后的角膜新生血管有利于延长植片的存活时间,提高角膜移植手术的成功率。 目的: 探讨强力霉素对角膜移植后角膜新生血管的抑制作用。 设计、时间及单位：随机对照,动物实验观察,于2007-03/08在中山大学中山眼科中心(眼科学国家重点实验室,2006DA105054)完成。 材料：健康清洁级SD大鼠48只作为角膜移植受体,Wistar大鼠24只作为供体,受体眼为右眼,供体眼为双眼。CD31-PE荧光抗体由美国Sigma公司提供,VEGF ELISA试剂盒由美国RapidBio公司提供。 方法: 建立大鼠同种异体角膜移植模型,48只受体鼠随机分为2组：盐水对照组和强力霉素用药组,24只/组。术前20 min 以1%阿托品滴眼液散瞳,植片直径为2.75 mm,植床直径为2.5 mm。术后盐水对照组右眼结膜囊内滴用生理眼水,3次/d;强力霉素用药组右眼结膜囊内滴用1%强力霉素眼药水,3次/d;直至术后30 d。 主要观察指标：全角膜免疫荧光法检测角膜移植后角膜新生血管的发展,ELISA动态检测角膜组织中VEGF蛋白的表达。 结果:①强力霉素用药组植片存活(20.67± 3.01) d,比盐水对照组(9.67±2.73) d明显延长(P < 0.01)。②角膜移植后3,7,14 d盐水对照组新生血管面积相对百分比分别为(4.00±1.00)%,(14.33±4.04)%, (31.33± 3.51)%;强力霉素用药组新生血管面积相对百分比分别为(1.67±1.15)%,(4.67±1.53)%,(18.33±1.53)%。其中7,14 d时两组比较差异显著(P < 0.05)。③角膜移植后强力霉素用药组血管内皮生长因子蛋白水平均低于盐水对照组(P < 0.01)。角膜移植后3,7,14 d,盐水对照组血管内皮生长因子蛋白水平为(541.00±75.44),(960.00±90.14),(976.00± 130.41) ng/g; 强力霉素用药组为(115.33± 9.29),(239.00±41.62),(361.00±65.20) ng/g,各时间段比较差异显著(P < 0.05)。 结论: 强力霉素能抑制角膜移植后角膜新生血管的生长,延长植片的生存时间。     

羟基喜树碱抑制大鼠角膜移植免疫排斥反应：与环孢素A的比较

背景：近期研究表明羟基喜树碱在一些器官移植过程中具有免疫抑制作用,但在角膜移植中的免疫抑制作用却未见报道。 目的：观察羟基喜树碱对大鼠穿透性角膜移植术后免疫排斥反应的影响,并与经典抗排斥药环孢素A进行比较。 方法：18只成年雌性Wistar大鼠为供体,36只成年雄性SD大鼠为受体,建立大鼠穿透性角膜移植动物模型。受体大鼠随机分为3组,羟基喜树碱组、环孢素A组和对照组,每组12只。羟基喜树碱组和环孢素A组分别在术后腹腔注射羟基喜树碱2.0 mg/(kg•d)和环孢素A 10 mg/(kg•d),连续用药12 d。对角膜植片进行临床观察,以混浊、水肿和新生血管3 项指标作为临床评估标准,记录角膜植片存活时间。 结果与结论：羟基喜树碱组、环孢素A组和对照组角膜植片的存活时间分别为(21±2),(19±2)和(11±2) d,各用药组与对照组比较角膜植片存活时间显著延长(P < 0.01),羟基喜树碱组比环孢素A组植片存活时间明显延长(P < 0.05)。实验结果提示羟基喜树碱能对大鼠穿透性角膜移植术后免疫排斥反应具有明显的抑制作用,可延长植片存活时间,抑制新生血管,其作用优于环孢素A。 关键词：角膜移植;大鼠;免疫排斥;羟基喜树碱;免疫抑制剂     

神经再生素对实验性急性高眼压兔眼视网膜神经节细胞的保护：与脑源性神经营养因子的作用相似？

【摘要】 目的 探讨中药提取物神经再生素（Nerve Regeneration Factor,NRF）对实验性急性高眼压（Hyper-intraocular pressure , HIOP）兔眼视网膜神经节细胞（RGCs）的保护作用。方法 16只健康中华大耳白兔随机等分为实验组（NRF）组和空白对照（PBS）组,前房灌注法建立右眼实验性急性HIOP模型,左眼作为正常对照。于灌注前、灌注后4、7d ,NRF组和PBS组右眼玻璃体腔内分别注射NRF 4.5μg或等量0.1M 磷酸缓冲液（PBS）。实验兔第14d安乐致死。实验兔致死前48h以辣根过氧化物酶（HRP）逆向标记双眼RGCs,视网膜铺片后以3,3',5,5'-四甲基联苯胺（TMB）法呈色,计数下半视网膜距视盘边缘2、4、6mm处的RGCs密度。结果 距视盘边缘2、4、6mm处,正常对照组的RGCs密度为(1 621±407)、(762±235)、(366±125)个/mm2;NRF组的RGCs密度为(1 268±378)、(699±253)、(284±104)个/mm2,距视盘边缘2、6mm处,NRF组与正常对照组RGCs密度的差异有非常显著意义（P均<0.01）;PBS组的RGCs密度为(1 002±410)、(627±211)、(264±107)个/mm2,与正常对照组RGCs密度的差异均有非常显著意义（P均<0.01）;距视盘边缘2mm处,NRF组与PBS组的RGCs密度的差异有显著意义（P<0.05）。结论 神经再生素可提高实验性急性高眼压兔眼RGCs的存活率,对RGCs具有保护作用。     

骨桥蛋白与高血压性脑出血脑组织水肿程度和神经功能损伤及临床预后的相关性分析

目的 观察高血压性脑出血（HICH）患者骨桥蛋白（OPN）的表达及其与脑组织水肿程 度、神经功能损伤及临床预后之间的关系。方法 收集临沂市人民医院神经内科监护室自 2017 年 4 月 至 2018 年 11 月收治的 HICH 患者 17 例为观察组，通过立体定向软通道颅内血肿清除术取其血肿液， 并同时抽取患者外周血。测量观察组脑组织出血量、水肿量，并评估术前格拉斯哥昏迷量表（GCS）评 分、美国国立卫生研究院卒中量表（NIHSS）评分，术后 3 个月改良 Rankin 量表（mRS）评分。收集临沂 市人民医院 14 例健康体检者为对照组，取其空腹外周血。利用酶联免疫吸附剂测定（ELISA）法检测 观察组血肿液、外周血和健康对照组外周血 OPN 水平，分析 OPN 表达水平与患者脑水肿程度、神经功 能损伤及临床预后之间的关系。结果 观察组患者血肿液中 OPN 水平高于患者外周血［（2 653.48± 1 460.64）μg/L 比（1 313.00±950.89）μg/L］，差异有统计学意义（t=4.752，P＜ 0.001）。观察组患者外 周血 OPN 水平与对照组外周血［（1 313.00±950.89）μg/L 比（923.44±284.73）μg/L］差异无统计学意 义（t=1.475，P=0.151）。轻中度、重度神经功能障碍组血肿液 OPN 水平分别为（1 708.87±1 227.78）、 （3 716.16±846.08）μg/L，差异有统计学意义（t=3.872，P=0.002）。轻、中、重度意识障碍组血肿液OPN水平 差异有统计学意义［（1 378.30±626.26）μg/L 比（1 798.04±1 518.76）μg/L 比（3 507.14±1 000.53）μg/L； F=4.987，P=0.023］。少量、大量脑水肿组血肿液 OPN 水平差异有统计学意义［（1 418.08±851.40）μg/L 比（3 751.61±865.90）μg/L，t=5.590，P＜ 0.001］。预后良好、预后不良组血肿液 OPN 水平差异有统计学 意义［（2 006.46±994.69）μg/L 比（3 882.90±482.28）μg/L；t=4.232，P=0.001］。血肿液 OPN 浓度与水肿 量（r=0.616，P=0.008）、发病时 GCS 评分（r=0.491，P=0.045）、发病时 NIHSS 评分（r=0.491，P=0.046）、术后 3 个月 mRS 评分（r=0.581，P=0.029）均呈正相关。结论 OPN 与 HICH 患者病情严重程度及预后具有相 关性，血肿液中 OPN 水平越高，病情越重，预后越差。     

5000/高氧液对大鼠肝移植的保护作用研究

目的 探讨高氧液对大鼠肝移植的保护作用。方法 40只SPF级Wistar 大鼠,随机分成2组,实验组实验高氧液灌注,对照组使用普通林格液灌注,比较两组灌注末、术后第1天、7天透明质酸、转氨酶、CD8+CD28-T细胞的变化,比较两组术后肝组织病理急性排斥评分。结果 术前两组无统计学差异,术后实验组透明质酸（87.9±6.3;65.4±5.1）、转氨酶（130.3±20.8;87.44±7.2）低于对照组（351.4±53.9;105.5±49.6）、（283.9±24.7;111.7±27.7）,CD8+CD28-T细胞（11.84±0.73; 14.76±0.62）高于对照组（6.22±0.2; 8.66±0.29）,（p<0.05）结论高氧液可减轻缺血再灌注损伤,对大鼠肝移植有一定的保护作用。     

高危角膜移植后免疫排斥反应与颈淋巴结切除****☆

背景：颈淋巴结是角膜的引流区淋巴结。角膜移植后，抗原提呈细胞随着房水经由脉络膜巩膜外途径引流至颈淋巴结而诱发角膜免疫排斥反应。 目的:观察在碱烧伤的角膜植床上行角膜移植后的免疫排斥反应现象，认识颈淋巴结切除抑制角膜移植后免疫排斥的效应。 设计：随机对照动物实验。 单位：中山大学中山眼科中心。 材料：实验于2005-05/2007-02在中山大学中山眼科中心完成（眼科学国家重点试验室。实验室编号2006DA105054）。选用SD大鼠104只, Wistar大鼠40只,均为雄性，鼠龄1~2个月，均由中山大学实验动物中心提供。实验所用的白细胞介素2 和干扰素γ ELISA试剂盒由美国Biource International公司提供。实验过程对动物的处置符合在眼科研究使用动物的ARVO声明。 方法:以SD鼠为受体，Wistar鼠为供体，所有受体大鼠均行同种异体角膜移植。受体鼠被随机分为4组：正常对照组:行正常角膜移植；B组为颈淋巴结切除组：正常大鼠切除双侧颈淋巴结；碱烧伤后角膜移植组：角膜碱烧伤后21 d时行角膜移植；碱烧伤后角膜移植合并颈淋巴结切除组：角膜碱烧伤后立即行双侧颈淋巴结切除，21 d后再行角膜移植；每组20只。应用ELISA法检测角膜移植后各组植片中干扰素γ、白细胞介素-2蛋白的表达，记录角膜排斥反应发生的时间并比较各组植片平均存活时间。其余24只受体鼠用于在裂隙灯下及组织切片后显微镜下观察碱烧伤后角膜炎症及新生血管的动态变化。 结果: ①病理组织学：正常角膜无炎症及新生血管。碱烧伤后3天时，角膜基质中存在着大量的炎症细胞浸润。3周末时无明显的炎症征象，但角膜新生血管达到高峰。碱烧伤后8周时，角膜新生血管已完全消退。②植片平均存活时间: 正常对照组、颈淋巴结切除组、碱烧伤后角膜移植组、碱烧伤后角膜移植合并颈淋巴结切除组分别为（10.40±1.14），（46.30±9.46），（7.00±1.58）和（15.00±3.39）d；颈淋巴结切除组较正常对照组明显延长(P < 0.05)，而碱烧伤后角膜移植合并颈淋巴结切除组较碱烧伤后角膜移植组明显延长,差异具有显著性意义 (P < 0.05)。③移植后角膜中干扰素γ及白细胞介素2蛋白的表达：角膜移植后颈淋巴结切除组植片中无干扰素γ及白细胞介素2蛋白的表达。在角膜移植后3，7，10，14 d，碱烧伤后角膜移植合并颈淋巴结切除组干扰素γ和白细胞介素-2的表达均明显下降，与碱烧伤后角膜移植组比较，差异有显著性意义（P < 0.05）。 结论:颈淋巴结切除能有效抑制正常及碱烧伤后角膜移植术后的免疫排斥反应。     

着色聚甲基丙烯酸甲酯人工晶体在白内障及角膜移植三联术中的应用

目的：目前在白内障摘除人工晶状体置入角膜移植三联术中对人工晶体的选择在不断改进。在小切口非超声乳化白内障摘除、人工晶体置入联合角膜移植三联术中置入着色聚甲基丙烯酸甲酯人工晶体并评价其对视力的改善效果。 方法：由第一作者以“着色人工晶体,穿透性角膜移植,白内障,联合术”为检索词,在中国期刊全文数据库(CNKI：2003/2007)中进行文献检索,语言设定为中文。以“PMMA intraocular lens,cataract extraction,corneal transplantation”为检索词,在Medline database(1974/2004)数据库中进行文献检索,语言设定为英文。选择主题内容与白内障及角膜移植三联术中着色聚甲基丙烯酸甲酯人工晶体置入联系紧密的文章,排除Meta分析、与主题无关的文章及重复性研究。共纳入11篇文章,针对病例进一步归纳总结。 结果：作者结合上述文献利用着色聚甲基丙烯酸甲酯人工晶体置入治疗外伤或各种眼病引起的角膜白斑合并白内障病例21例(21眼),随访时间10个月。92%患者着色聚甲基丙烯酸甲酯人工晶体置入后裸眼视力比置入前提高,置入后2周视力在4.7以上有9例占42.9%,4.5以上有10例占47.6%,视力为4.0有2例占9.5%。置入后7~14 d,21眼角膜植片全为透明。置入后10个月植片完全透明16例,植片呈半透明3例,角膜重度混浊并需再次行穿透性角膜移植2例。 结论：针对病例并结合文献得出结论,穿透性角膜移植联合白内障摘除、人工晶体置入三联术中置入着色聚甲基丙烯酸甲酯人工晶体,可以一次性解决眼前段屈光间质混浊。与传统联合术相比,三联术减少了术后并发症,使患者快速恢复术后视力,安全性高。 关键词：聚甲基丙烯酸甲酯;着色人工晶体;穿透性角膜移植;白内障;联合术 doi:10.3969/j.issn.1673-8225.2010.03.038     

穿透性角膜移植治疗高危真菌性角膜溃疡51例

背景：单纯药物治疗高危真菌性角膜溃疡效果不佳，目前穿透性角膜移植已是挽救眼球和视力的主要手段。 目的：观察穿透性角膜移植治疗高危真菌性角膜溃疡的随访结果。 设计、时间及地点：回顾性病例分析，于2000-01/2007-01在青岛大学医学院附属医院眼科完成。 对象：选择在青岛大学医学院附属医院行穿透性角膜移植的高危真菌性角膜溃疡患者51例(51眼)，其中12例穿孔，前房积脓35例，移植前合并白内障8例，合并青光眼5例。 方法：移植前给予抗真菌联合抗细菌治疗，51例患者均在入院4 d内完成了穿透性角膜移植，移植后局部和全身给予抗炎和抗真菌药物治疗，随访6~24个月。 主要观察指标：观察移植后视力变化和真菌复发、植片排斥、继发性青光眼、并发性白内障等并发症的发生情况。 结果：①51例患者中18例随访6~12个月，25例随访13~18个月，8例随访19~24个月。②49例患者(占96.1%)成功地保存了眼球，48例(占94.1%)患者视力有不同程度提高。③移植后6例患者(占11.8%)真菌复发，其中4例药物治疗后治愈，2例摘除眼球；18例患者(占35.3%)植片发生排斥，其中13例经抗排斥治疗植片转为透明，5例因药物治疗无效而行二次穿透性角膜移植；4例患者(占7.84%)植片发生溃疡，其中3例治愈，1例因合并角膜内皮功能失代偿而行再次穿透性角膜移植；7例患者(占13.7%)继发青光眼，眼压均得到成功控制；6例患者(占11.8%)发生并发性白内障，其中3例行白内障摘除。其余患者移植后随访期间眼部情况稳定，植片保持透明。最终随访时，45例患者(占88.2%)角膜植片透明。 结论：对于保守治疗无效的高危真菌性角膜溃疡患者，穿透性角膜移植是挽救眼球和视力的有效方法。     

自体骨髓单个核细胞移植治疗老年冠状动脉粥样硬化性心脏病的临床观察

2003-06/2007-11河南省人民医院心内科收治的老年心肌梗死患者76例，行骨髓干细胞移植患者46例，男34例，女12例，除常规治疗外，将骨髓单个核细胞悬液在冠状动脉造影时经导管注入冠状动脉内；未行骨髓干细胞移植患者30例为对照组，男22例，女8例，仅采用常规治疗。随访1年，经胸超声心动图显示，骨髓干细胞移植组和对照组左室射血分数分别由治疗前（43.1±5.6）%、（44.9±7.5）%增加到（54.8±4.6）%、（50.1±7.1）%；骨髓干细胞移植组和对照组脑钠肽水平由治疗前（696±102）、（680±93）ng/L 下降至（303±89）、（396±88）ng/L；单光子放射计算机断层显像术显示，骨髓干细胞移植组和对照组心肌灌注缺损面积分别由（25.8±8.5）%、（26.2±6.4）%降低至（14.8±4.6）%、（20.4±7.3）%。骨髓干细胞移植组在移植过程中和移植后均无并发症发生。表明经皮冠状动脉内移植骨髓干细胞治疗老年心肌梗死患者安全可行，移植后能改善左室收缩功能及心肌血流灌注。     

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”.