基于连接性构筑图谱的岛叶-岛盖癫痫发作症状学亚组

岛叶-岛盖癫痫发作的特点是多样性的症状学表现,这与岛叶参与多种功能和广泛的连接有关。文章旨在确定其症状学亚组,并将它们与基于连接性构筑进行分区的岛叶-岛盖亚区相联系。回顾性收集来自3个癫痫中心37例立体定向脑电图(SEEG)检查确定的岛叶-岛盖癫痫发作的一组大样本量患者资料。基于解剖和功能连接的新的脑网络组图谱(Brainnetome atlas,BNA)被用于分割岛叶-岛盖皮质。仔细阅览症状学和SEEG的变化并进行量化,用主成分分析和聚类分析将症状学特征与岛叶-岛盖亚区相关联。基于BNA沿前腹侧-后背侧轴确定了4个主要的症状学亚组:第1组特征是上腹感觉和或协调性姿势性运动行为,伴有或不伴有恐惧或愤怒,涉及前腹侧岛叶和颞叶内侧结构;第2组特征是听觉及对称性近端肌或轴肌强直,涉及后腹侧的颞盖;第3组特征是口面部和喉部症状,涉及岛叶-岛盖的中间区;第4组特征是躯体感觉,继之出现非协调性姿势性运动行为和双侧非对称性强直,涉及后背侧岛叶-岛盖并传播至额叶内侧面。前腹部的癫痫发作主要表现为边缘系统症状学,而更靠后背侧的症状学主要涉及感觉运动系统。主观症状具有特殊的组别区分意义。可根据临床症状学对岛叶-岛盖癫痫发作进行分类,并将其与连接性构筑亚区相关联,它们沿前腹侧-后背侧轴排列,这与细胞构筑的梯度而非岛叶的沟回解剖相一致。这为岛叶-岛盖癫痫的鉴别诊断和术前定位提供了新思路,同时也强调了在确定复杂症状学模式的神经相关性时考虑连接性构筑的重要性。     

癫痫患者先兆症状的临床定位意义

目的 探讨癫痫患者先兆症状的临床定位意义。方法 31例癫痫患者按照有无先兆分为有先兆组(n=19)和无先兆组（n=12）,采用独立样本t检验比较两组之间的发病年龄差异有无统计学意义。采用x2检验比较两组之间患者的头颅MRI的异常率及手术有效率差异有无统计学意义。结果 有先兆组的19例患者,分别为精神症状、自主神经症状、躯体感觉、视觉、听觉、头晕共6种先兆,术后先兆症状均消失,以上6种先兆可分别定位于颞叶、颞叶、对侧顶叶或颞叶、枕叶或颞叶、对侧颞叶、颞顶叶。两组间患者的首次发病年龄差异、头颅MRI的异常率差异均无统计学意义。有先兆组和无先兆组患者的手术有效率（分别为15/19和5/12）差异有统计学意义(x2=4.456,P=0.035)。结论 先兆具有一定的定位意义,可以协助判断致痫灶的起源部位,指导外科手术治疗。     

局灶性癫痫继发性强直-阵挛阶段中非对称性强直的临床特征

目的分析局灶性癫痫继发强直-阵挛阶段非对称性强直的临床症状学特点。方法 28例患者54次非对称性强直发作,观察两种非对称性强直姿势—M2e和(或)"4"字征,分析其定侧意义、时间相关性及演变特点。结果 (1)100%(33/33)M2e出现在致痫区对侧,56%(19/34)"4"字征伸直侧位于致痫灶对侧;(2)定侧正确与错误的"4"字征出现时间及持续时间比较(30.3s vs 50.6s,4.6s vs 15.7s),后者差异具有显著性;(3)M2e转变为定侧正确与定侧错误"4"字征的时间分别为7.5s和15.4s,差异具有显著性。结论局灶性癫痫中M2e具有定侧意义,而"4"字征在颞叶癫痫中具有较好的定侧价值。     

额颞叶癫痫有定位价值的发作性症状

癫痫发作性症状不仅对癫痫的诊断也对确定癫痫在大脑的起源区有非常重要的意义。对手术后发作消失的病人分析其术前发作性症状与手术切除部位的关系可以确定其定侧价值。额、颞叶癫痫有定侧价值的发作性症状可分为三类:①高度定侧意义:一侧阵挛、扭转、不对称性强直姿势、一侧鬼脸、发作后轻瘫、发作终止不对称;②一般定侧意义:一侧肌张力障碍性姿势、一侧强直姿势、一侧手自动症;③定侧意义不肯定:早期头转动、一侧眨眼、发作后擦鼻子、发声。而口咽自动症、过度运动自动症、发笑、发作后咳嗽、自主神经症状等则无定侧意义。     

岛叶癫痫的诊断及治疗

岛叶解剖结构及生理功能都非常复杂,与岛叶相连的多个皮质区域参与到岛叶起始或扩散到岛叶的局灶性癫痫发作中,所以岛叶癫痫发作症状常与其他脑叶癫痫相混淆。研究发现岛叶癫痫的主要症状学特点为咽喉不适伴抓颈姿势、口周区感觉异常、发音困难或构音障碍、以局灶躯体运动表现结束。颅内电极埋藏是临床诊断隐源性岛叶癫痫的重要手段。对病灶性岛叶癫痫,手术切除岛叶病灶可获得满意的癫痫控制效果,而隐源性岛叶癫痫患者行岛叶皮层切除术或射频消融术的效果仍需进一步证实。本文拟对岛叶解剖,岛叶癫痫症状学、检查评估及手术治疗等方面的进展作一综述。     

经SEEG证实以过度运动为发作症状的颞叶癫痫分析

目的 探讨以过度运动为主要发作症状的颞叶癫痫患者的临床与电生理特点。方法 回顾性分析广东三九脑科医院经立体定向脑电图(SEEG)证实的,以过度运动为主要发作症状的10例颞叶癫痫患者的临床资料;分析其症状学及脑电图特点。结果 本组患者中,以颞叶内侧结构起始的患者7例,以颞叶新皮层起始的患者2例,以颞叶内外侧同步起始的患者1例。其中9例患者有发作前兆;所有患者均在过度运动发作的同时,伴有不同程度的自动运动(轻微的咂嘴、抿嘴、嘟嘴、手的摸索)和发作起始对侧肢体的肌张力障碍。SEEG均以周期性节律性棘-慢波→低波幅快活动为发作起始图形;脑电图起始至出现过度运动或自动运动的时间平均为65 s。结论 以过度运动为主要发作症状的颞叶癫痫,其致痫区可以是颞叶内侧结构或颞叶新皮层。以过度运动为主要发作症状学,伴先兆、自动运动和对侧肢体的肌张力障碍,提示为颞叶起源的癫痫;先兆和自动症是颞叶癫痫与额叶癫痫鉴别的要点,可与额叶癫痫相鉴别。颞叶癫痫出现过度运动可能是同时或先后激活了额叶的腹内侧网络和颞岛网络所致。     

眶额区癫痫——有待深入研究的癫痫类型

眶额区位于双侧额叶下方前颅凹中,嗅束将直回与其他脑回分开。眶额区本身在各脑回间,以及与额叶凸面及内侧面,颞叶有广泛的联系。眶额区起源的癫痫少见。发作开始均先出现动作停止、无反应及茫然,而后根据扩布的不同出现:嗅觉异常、过度运动、头眼偏向同侧或对侧、重复动作等运动症状、自主神经症状,还可以有难以确定的感觉异常、发笑、似曾相识、视幻觉、自动症。根据临床症状可以分为额叶型、颞叶型及额颞叶型。头皮脑电图很难提供有定位价值的异常,常为额颞叶甚至双侧额颞叶异常。深部电极尤其是立体脑电图有定侧定位价值。眶额区癫痫几乎均为药物难治性癫痫,应以外科治疗为主。     

起源于颞后-枕交界区癫痫的电-临床研究

目的：探讨神经影像学、电生理及症状学在起源于颞后-枕交界区癫痫患者术前评估中的价值。方法回顾性分析2010年1月至2012年12月清华大学玉泉医院神经外科五病区经颅内电极证实发作起源于颞后-枕交界区的7例癫痫患者,术后随访1年以上无发作,分析其头颅MRI、电生理及发作症状学特点及定侧、定位信息。结果（1）头颅MRI：3例患者致痫区同侧颞枕交界区、枕叶或颞顶枕交界区病灶,2例患者致痫区同侧海马硬化,2例阴性。（2）间歇期放电脑区：2例为致痫区同侧后头部,3例为累及额、颞及后头部等多脑区,其中致痫区同侧颞区著1例,致痫区同侧后头部著2例;2例为致痫区同侧半球弥漫性,颞区著1例,后头部著1例。（3）发作期脑电图：3例为致痫区同侧后头部起始;4例为弥漫性起始,致痫区同侧后头部著2例,致痫区同侧颞区著1例,同侧半球著1例。（4）发作症状学：6例患者视觉先兆,1例患者有头部先兆;5例患者有自动症发作,6例患者对侧肢体强直／强直-阵挛,其中4例患者既有自动症发作又有强直发作。结论与头颅MRI相比,间歇期VEEG、发作期VEEG及症状学提供了更多的定侧、定位信息,特别是症状学先兆及体征的定侧及定位信息更大。而头颅MRI在一定程度上可造成误导,往往出现致痫灶同侧颞叶内侧结构的信号异常。     

鉴别额叶癫痫及颞叶癫痫的临床症状学提示

目的:比较额叶癫痫(FLE)及颞叶癫痫(TLE)的临床症状学区别。方法:纳入2005年10月至2007年3月我院癫痫中心门诊临床诊断为额叶癫痫患者190名,颞叶癫痫患者257名。纳入病例满足发作间期脑电图至少一次具有局限于额叶或颞叶的放电或发作期脑电图明确提示额或颞叶起源;排除所有发作间期脑电图正常、存在多灶或定位不清的脑电异常及影像学检查具有额或颞叶以外的局灶损害者。由两位不知道患者脑电图和影像学结果的临床医生单独分析患者发作情况(先兆、复杂部分发作(CPS)、继发全面强直阵挛发作(SGTC))。用χ2检验统计数据。结果:提示颞叶癫痫最有意义的先兆是经验现象和胃气上升感(P<0.01)。情感表现在TLE中更常见(P<0.05)。口咽自动症与手部自动症是颞叶癫痫患者的典型CPS表现(P<0.01)。而躯体自动症,偏转性强直-肢体与头眼及SGTC、姿势性强直,局部阵挛发作,发作时伴随出声、植物神经症状是额叶癫痫患者的典型CPS表现(P<0.01)。发笑、震颤症状在二类中均可出现,以额叶居多(P<0.05)。言语终止,自言自语,单纯凝视发作对于二者的鉴别意义不大。额叶癫痫组具有两种以上CPS发作的病例更多(P<0.01)。结论:额叶癫痫与颞叶癫痫的症状学特征是不同的,对于临床诊断有重要价值。     

双侧强直发作的局灶相关性癫痫的电-临床症状学分析

目的分析具有双侧强直发作的局灶相关性癫痫的电-临床症状学特点。方法分析发作期脑电图(EEG)、双侧肢体强直发作特点及可靠的伴随症状(正确预测率80%)-偏转、单侧面肌强直、单侧阵挛、单侧肢体感觉异常、M2e、"4"字征。结果 24例患者81次发作,依据致痫区部位分为旁矢状面皮质癫痫组和外侧面皮质癫痫组。(1)81次发作中48次(59.3%)发作期头皮EEG具有侧向性征象,其中20次(24.7%)具有定位征象;(2)旁矢状面皮质癫痫组双侧强直出现时间为6.8s,外侧面皮质癫痫组为13s(P=0.031),双侧强直持续时间分别为13.1s和16.5s(P=0.078),前者差异具有显著性;(3)依据可靠的伴随症状,外侧面皮质癫痫组正确定侧率高于旁矢状面皮质癫痫组(72.5%vs 43.3%P=0.016),差异有统计学意义。结论局灶相关性癫痫双侧强直出现早、持续时间短特点,提示致痫区(EZ)位于或近辅助感觉运动区(SSMA)。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高，而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

广西农村壮族妇女精神分裂症患者生活质量状况调查

目的研究农村壮族妇女精神分裂症患者的生活质量及影响因素。方法前瞻性的队列研究。采用随机分层抽样法分为农村壮族妇女精神分裂症组、农村汉族妇女精神分裂症组、农村正常妇女对照组,应用“世界卫生组织生存质量测定报告”(WHOQOL-100)及PANSS量表调查其生活质量和疾病的严重程度。结果农村壮族妇女精神分裂症患者生活质量明显低于农村汉族妇女精神分裂症患者,影响其生活质量的相关因素是生活环境及精神支柱/个人信仰。结论经济贫困、环境条件、缺乏有效的医疗服务和社会保障是农村壮族妇女精神分裂症患者生活质量低的关键。因此,建立农村壮族社区精神卫生服务网络势在必行。