补体C3基因rs7951位点多态性与重症肌无力的相关性研究

目的 探索补体C3基因rs7951位点多态性与重症肌无力(MC)的易感性和严重程度的相关性.方法 纳入475例MG患者和487例健康对照组,采用SNPscanTM多重SNP分型技术对C3基因rs7951位点进行基因分型,比较等位基因和基因型频率在MG组及各亚组(性别、发病年龄、胸腺情况、首发受累范围以及最严重时的Osserman分型和Osterhuis评分)间的分布.结果 rs7951位点检测到CC、CT、TT3种基因型,MG组T等位基因(118/950,12.4％)高于对照组(92/974,9.4％),差异有统计学意义(P=0.036,OR=1.360,95％ CI 1.019～1.815).分别在共显性、隐性、显性和加性模型下分析MG组与对照组的基因型频率,发现基因型差异(与CC相比)在显性模型(P =0.044,OR=1.38,95％CI1.01 ～1.89)和加性模型(P=0.037,OR =1.36,95％CI 1.02 ～ 1.82)下有统计学意义.除了在15 ～50岁MG亚组与对照组之间,rs7951位点的基因型在其他各MG亚组分布频率的差异无统计学意义.结论 补体C3基因rs7951T等位基因可能与MG易感性相关.     

BST1基因多态性与中国人群帕金森病发病风险的相关性研究

目的明确BST1基因rs4698412、rs11931532位点的单核苷酸多态性(SNPs)与中国人群帕金森病(PD)发病风险的关系。方法采用病例-对照研究方法,收集江苏地区168例PD患者(PD组)及196例健康对照者(对照组),应用基质辅助激光解吸附电离飞行时间质谱技术对PD患者进行基因型测序,探讨BST1基因rs4698412、rs11931532位点的SNPs与PD发病风险的关系。结果 PD组BST1基因rs4698412位点A等位基因频率与对照组比较,差异有统计学意义(OR=1.38,95%CI:1.02~1.86,P=0.037),PD组AA+AG基因型频率与对照组比较,差异有统计学意义(OR=1.75,95%CI:1.13~2.71,P=0.011)。分层分析结果示早发型PD组AA+AG基因型分布与对照组比较,差异有显著统计学意义(OR=3.12,95%CI:1.23~7.99,P=0.013)。结论 BST1基因rs4698412位点的SNPs与中国人群PD发病有关,A等位基因可能是早发型PD的危险因素。     

CLU基因多态性与新疆哈萨克族及汉族阿尔茨海默病的相关性研究

目的探讨聚集素(clusterin,CLU)基因rs11136000位点及rs9331888位点多态性与新疆哈萨克族(简称哈族)及汉族散发性阿尔茨海默病(Alzheimer’s disease,SAD)相关性。方法运用病例对照研究,采用Kas P PCR技术和基因测序法测定CLU rs11136000及rs9331888位点的基因型及等位基因。结果 (1) CLU基因rs11136000位点基因型及等位基因分布在SAD及正常对照组差异有统计学意义(P 0. 05)。哈族SAD组CLU基因rs11136000位点T等位基因及TT基因型频率显著低于对照组(χ~2=8. 809,P=0. 003;χ~2=8. 242,P=0. 016)。携带T等位基因者(TT+TG基因型)相比携带GG基因型者AD发病风险降低63. 9%(OR=0. 361,P=0. 007)。汉族SAD CLU基因rs11136000位点基因型及等位基因与对照组之间差异均无统计学意义(P 0. 05)。(2) CLU rs9331888位点等位基因(C、G)及基因型(CC、CG、GG)频率差异无统计学意义(P 0. 05)。(3) rs9331888、rs11136000两位点存在连锁不平衡(D’=0. 764),单体型分析显示有C-C、C-G、T-G 3种单体型,频率分布差异无统计学意义(P 0. 05)。结论 CLU基因rs11136000位点多态性与新疆哈族AD发生可能有关,携带T等位基因对降低AD发病可能有一定的保护作用; CLU基因9331888位点可能与新疆SAD的发生无相关性。     

载脂蛋白E基因单核苷酸多态性与癫痫耐药的相关性研究

目的探讨汉族人群中载脂蛋白E(apolipoprotein E,Apo E)基因2个单核苷酸多态(single nucleotidepolymorphism,SNPs)位点与癫痫耐药的相关性。方法选取2011年5月-2014年5月期间于我院神经内科癫痫专科门诊患者317例,其中耐药性癫痫患者(耐药组)142例,非耐药性癫痫患者(非耐药组)175例。对入组患者抽取外周静脉血并提取全基因组DNA,对Apo E基因的rs7412与rs769450位点进行基因分型,比较癫痫耐药组与非耐药组患者等位基因频率、基因型频率及位点间连锁不平衡差异。结果与非耐药组比较,耐药组rs769450位点GG基因型(OR=2.041,95%CI 1.195~3.457,P=0.010)和G等位基因(1.619,95%CI 1.191~2.196,P=0.002)的频率较高;两组的rs7412位点在基因型和等位基因频率分布上无明显差异;耐药组rs769450位点GG基因型(OR=2.041,95%CI 1.196~3.557,P=0.011)和G等位基因(OR=1.639,95%CI 1.181~2.185),P=0.003)较高,差异具有统计学意义。通过SHEsis平台对两位点进行连锁不平衡分析,提示rs7412和rs769450位点间不存在连锁不平衡(D’=0.073)。结论 Apo E rs769450 GG基因型及G等位基因在汉族人群中可能与癫痫耐药相关。     

乙酰辅酶A:胆固醇乙酰转移酶基因单核苷酸多态性与散发性阿尔茨海默病的相关性研究

目的 此实验旨在探讨ACAT1的基因甾醇氧-乙酰转移酶（sterol O-acyltransferase． SOAT1）的单核苷酸多态性位点rs1044925与散发性AD（SAD）是否具有相关性。方法 在中国北方汉族人群中收集了SAD107例．以及性别和年龄与之相匹配的同一地区健康对照者118例．采用聚合酶链反应-限制性片段长度多态性（PCR—RFLP）方法检测了SOAT1多态性位点rs1044925的基因型以及载脂蛋白E（Apolipoprotein E，APOE）的基因型。结果 rs1044925位点在SAD组的基因型（AA．AC．CC）频率分别为82．2％。16．8％，1．0％，在对照组的基因型频率分别为81．4％．17．8％，0．8％．两组间基因型频率差异无显著性（P=1．000，χ^2=0．030，OR=0．863．95％CI=0．478～1．857）。SAD组等位基因（A．C）频率分别为90．7％、9．3％，对照组等位基因频率分别为90．3％、9．7％，两组间等位基因频率差异亦无显著性（P=1．000．χ^2=0．021，OR=0．885，95％CI=0．508～1．774）。当数据用ApoEε4分层后．rs1044925位点基因型频率和等位基因频率两组间差异仍无显著性（P〉0．05）。结论 研究表明在中国北方汉族人群中ACAT1的基因SOAT1多态性位点rs1044925与SAD无相关性，SOAT1可能不是SAD的遗传易感基因。     

广东汉族人群缝隙连接蛋白37基因多态性与动脉粥样硬化性脑梗死的关系

目的探讨广东汉族人群缝隙连接蛋白37(Cx37)基因多态性与动脉粥样硬化性脑梗死的关系。方法应用SNaPshot技术,检测250例动脉粥样硬化性脑梗死患者(病例组)和200例健康人(对照组)的Cx37基因rs1764391多态位点的基因型和等位基因频率。结果病例组与对照组Cx37基因的多态位点rs1764391的基因型分布无统计学意义(P=0.217);病例组的T等位基因频率高于对照组(22.4%vs 17.7%,P=0.085);病例组中,TT+CT基因型(T等位基因携带者)的颈总动脉内膜-中膜厚度大于CC基因型,差异有统计学意义(P=0.032)。结论广东汉族人群Cx37基因的多态位点rs1764391与动脉粥样硬化性脑梗死无关,T等位基因增加颈总动脉内膜-中膜厚度。     

环指蛋白213基因多态性与中国汉族成人型烟雾病遗传易患性的相关性

目的 探讨环指蛋白213(RNF213)基因rs112735431和rs138130613两位点多态性与中国汉族成人型烟雾病的遗传易患性的关系.方法 从南京卒中注册系统中提取2010年12月至2011年10月经脑血管造影明确诊断的64例成年型烟雾病患者,同时选取96名性别和年龄与烟雾病患者相匹配的健康人作为对照.通过改进的多重连接酶检测反应技术分析RNF213基因rs112735431和rs138130613位点的多态性,对各位点基因型、等位基因型频率进行比较分析.结果 病例组中rs112735431位点GA+AA基因型频率为10.94％(7/64)、GG基因型频率为89.06％(57/64),等位基因A频率为6.25％ (8/128)、等位基因G频率为93.75％ (120/128)；对照组分别为1.04％(1/96)、98.96％(95/96),0.52％ (1/192)、99.48％ (191/192),两组间差异具有统计学意义(OR=11.67,95％ CI 1.40 ～97.28,P =0.007;OR=12.73,95％ CI 1.57 ～ 103.09,P=0.003).rs138130613位点的基因型和等位基因频率在两组间差异无统计学意义.结论 RNF213基因rs112735431位点的多态性可能是中国汉族成人型烟雾病患者的易患因子.     

L型钙离子通道α1C亚基基因多态性与精神分裂症的相关性

目的探讨L型钙离子通道α1C亚基(calcium channel,voltage-dependent,L type,alpha 1C subunit,CACNA1C)基因多态性与精神分裂症的关系。方法纳入118例精神分裂症患者及122名对照,采用变性高效液相色谱法对其CACNA1C基因rs10848683、rs2238032、rs2299661位点进行基因分型,通过病历资料收集患者感知觉障碍、思维障碍、情感障碍和行为障碍等临床表现,采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评估患者症状。结果 rs2238032和rs2299661位点基因型和等位基因在患者组与对照组间分布有统计学差异(均P0.05),而rs10848683位点基因型和等位基因分布在组间无统计学差异(P0.05)。rs2238032位点TT基因型(OR=0.394)和rs2299661位点CG(OR=0.326)与精神分裂症的患病风险有关联(均P0.05)。rs10848683位点各基因型患者行为障碍分布有统计学差异(P0.05);rs2238032各基因型患者思维障碍、情感障碍和PANSS得分有统计学差异(均P0.05);rs2299661各基因型患者感知觉障碍、PANSS得分有统计学差异(均P0.05)。单体型分析示,CTC(OR=1.811)、CTG(OR=0.432)和TGC(OR=1.771)与精神分裂症关联有统计学意义(P0.05)。结论 CACNA1C基因多态性与精神分裂症及其临床表现有关联。     

白细胞介素23受体基因单核苷酸多态性与中国南方汉族人群多发性硬化的相关性

目的 探讨白细胞介素23受体(IL23R)基因单核苷酸多态性(SNPs)与中国南方汉族人群多发性硬化(MS)的相关性.方法 选取IL23R基因3个SNPs位点(rs2201841、rs10889677、rs7517847),采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测178例MS患者和221名健康对照者IL23R基因的多态性,分析其与MS的相关性,并采用SHEsis软件进行连锁不平衡和单倍型分析.结果 IL23R基因rs2201841[TT、TC、CC 3种基因型在病例组为5.7％(10/175)、45.7％(80/175)、48.6％(85/175),在对照组为7.4％ (16/217)、41.0％ (89/217)、51.6％ (112/217);x2=1.08,P=0.58]、rs10889677[AA、AC、CC 3种基因型在病例组为52.0％(89/171)、42.7％(73/171)、5.3％(9/171),在对照组为57.7％(123/213)、36.2％(77/213)、6.1％(13/213);x2=1.71,P=0.43]、rs7517847位点[GG、GT、TT3种基因型在病例组为16.9％(29/172)、51.7％(89/172)、31.4％(54/172),在对照组为14.4％(31/215)、49.3％(106/215)、36.3％ (78/215);x2=1.15,P=0.56]各基因型与等位基因频率分布在两组之间差异均无统计学意义;MS患者SNPs位点各基因型之间首次发病年龄、病程及扩展残疾状态评分比较差异均无统计学意义.IL23R基因rs2201841和rs10889677位点存在连锁不平衡关系(D’=0.614,r2=0.327),进一步分析发现各单倍体频率分布在病例组和对照组之间差异均无统计学意义.结论 在中国南方汉族人群中,IL23R基因3个单核苷酸位点(rs2201841、rs10889677、rs7517847)多态性与MS之间无相关性.     

Reelin基因单核苷酸多态性与汉族儿童孤独症的关联分析

目的探讨Reelin基因单核苷酸多态性与汉族儿童孤独症的关系。方法收集232例汉族孤独症患者和283名汉族正常对照,其中有165个孤独症核心家系(患者及其父母),采用实时荧光定量聚合酶链反应方法检测Reelin基因上4个单核苷酸多态位点(rs736707、rs2229864、rs362691、rs2073559),进行病例-对照关联分析及以核心家系为基础的传递不平衡检验(TDT)。结果患者组和对照组之间Reelin基因的4个多态位点的等位基因及基因型频率的差异均无统计学意义(P0.05),rs736707-rs2229864位点的TC单体型频率在两组间的差异有统计学意义(2=4.31,P=0.04),但经置换检验校正后差异无统计学意义(P=0.19);TDT分析未发现在亲代和子代间4个多态位点的等位基因及单体型的显著不平衡传递(P0.05)。结论本研究未发现Reelin基因与汉族儿童孤独症存在关联。     

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.     

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.     

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.     

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.