神经系统表现为主的肉毒杆菌中毒三例

目的探讨肉毒杆菌中毒的神经系统表现。方法分析3例肉毒杆菌中毒患者的临床资料。结果 3例患者病前均食用变质酸豆酱,以眼肌无力为首发症状。2例(例1,例2)患者出现呼吸困难,经注射A型、B型肉毒抗毒素、机械辅助呼吸后症状好转。3例患者经2年随访均无后遗症及复发。结论肉毒杆菌中毒主要表现为眼部、口咽部麻痹、四肢对称性驰缓性瘫痪等症状,严重者出现呼吸衰竭。早期诊断、尽早、足量使用肉毒抗毒素是救治的关键。     

医源性肉毒毒素中毒(附3例报告及文献复习)

目的报告医源性肉毒毒素中毒相关的严重不良事件。方法总结分析3例医源性肉毒毒素中毒患者的临床表现特征、治疗和预后等临床资料,并结合文献复习进行讨论。结果 3例女性患者均为美容而局部注射肉毒毒素,于注射后数天内出现吞咽困难、呼吸费力、双眼睑显著下垂、视物模糊、头晕、全身无力等症状。患者入院后经支持治疗后症状缓解,3个月后随访恢复良好。结论应用肉毒毒素治疗或美容可引发严重不良事件。临床医生应熟知治疗肌肉的解剖学和肉毒毒素的药理学特征以避免发生严重不良事件。     

中国新疆维吾尔自治区67例肉毒中毒患者临床分析

目的评估中国新疆维吾尔自治区肉毒中毒患者的流行病学和临床特点、预后和相关因素, 以及接受抗毒素治疗后发生不良反应的人群特点。方法回顾性收录自2017年1月至2021年12月于新疆医科大学第二附属医院出院的肉毒中毒患者临床信息。分析肉毒中毒患者流行病学和常见症状/体征;以是否发生院内感染、机械通气为终点分析上述变量的组间差异, 进行分组和组间比较;对比抗毒素治疗后发生与未发生不良反应的人群特点, 进行分组并对比组间差异。结果共纳入67例肉毒中毒患者, 发病时间最常见于1—3月份(32例, 47.8%);62例(92.5%)患者为汉族;发病率最高区域为阿克苏地区(15例, 22.4%);肉毒中毒患者常见症状/体征包括乏力58例(86.6%), 饮水呛咳/吞咽困难48例(71.6%), 头晕42例(62.7%), 眼睑下垂/睁眼费力42例(62.7%), 视物模糊41例(61.2%), 肢体无力35例(52.2%)等。共有15例(15/67, 22.4%)发生院内感染。与未发生院内感染组(n=52)相比, 院内感染组(n=15)严重程度更重(重度比例分别为0/52比5/15, χ2=19.7...     

美容局部注射A型肉毒毒素后全身无力临床分析(附三例报道)

目的分析局部注射A型肉毒毒素致全身无力的临床表现及实验室检查特点,并初步探讨其发病机制。方法对作者医院2007—2009年收治的3例因美容局部注射A型肉毒毒素后出现全身无力患者的临床特点和电生理检查资料进行回顾性分析,并行相关文献复习。结果 3例患者于美容局部注射A型肉毒毒素后2～7 d后出现眼外肌麻痹、双侧周围性面瘫、延髓麻痹、四肢无力等全身肌无力症状,电生理检查结果显示除存在神经肌肉接头功能异常外,还出现周围神经源性或肌源性损害的表现。临床症状多在4周左右开始好转,半年左右完全恢复正常。其中1例进行毒素效价检测显示实际效力相当于标示剂量的6倍。结论美容局部注射A型肉毒毒素中毒往往与药品剂量过大有关。提高对其临床表现、电生理特点以及发病机制的认识有利于对其进行诊断和治疗。     

B型肉毒杆菌中毒7例

Ｂ型肉毒杆菌中毒７例张秀明，赵会颖，穆海宏肉毒中毒是由肉毒杆菌外毒素所致的中毒性疾病，临床以神经系统症状为主要表现．我院于１９９６年５月收治一家族自入自制臭豆腐后集体发病，经石家庄市防疫的作肉毒梭菌中和实验检出“Ｂ型肉毒毒素”．一家７人年龄最大６６岁...     

创伤性肉毒中毒(颅脑损伤并发肉毒中毒的首例报告)

报告1例由于头皮撕裂伤感染肉毒杆菌引起的创伤性肉毒中毒,伤后11天出现全身无力、视物模糊、上睑下垂、咽下困难、呼吸肌麻痹等肉毒中毒的临床症状。伤口分泌物检出A型肉毒毒素和肉毒杆菌,血清中也检出A型肉毒毒素。经用肉毒抗毒素、人工呼吸机和创口局部积极治疗,挽救了病人的生命。结合复习文献,讨论本病的诊断要点、治疗原则和预防措施,并指出本例可能系颅脑损伤并发肉毒中毒的首例报告。     

肉毒中毒的神经系统表现

为了减少对肉毒中毒 (ｂｏｔｕｌｉｎ)的误诊 ,我们将1991～ 1995年 12月收治两起 15例肉毒中毒的神经系统表现总结如下 :一般资料　第一起 8例 ,均食用自制臭豆腐 ,第二起 7例 ,均食用自制豆豉 ,家庭中未食者未发生中毒症状 ,潜伏期 6ｈ～ 3ｄ ,既往身体健康。其中男性 7例 ,女性 8例 ,年龄 10～ 70岁 ,平均 30岁。神经系统表现　头晕起病者 13例 ;视物模糊、复视者 15例 ;构音困难 10例 ;四肢无力 15例 ;瞳孔散大、对光反射减弱或消失者 7例 ;7例发病始均能以眼球示意并非真正昏迷 ;吞咽困难、饮水呛咳 10例 ;肱二头肌反射减弱或消失、跟…     

A型肉毒杆菌中毒致肌无力症4例临床分析

肉毒杆菌中毒导致肌无力症临床罕见,我院2009年7月收治4例本病患者,现分析如下. 1 临床资料本组男3例,女1例;年龄39～69岁,平均55岁;病程6～10 d.平均7 d.4例患者同生食自制的豆酱后,逐渐出现四肢无力、双眼睑下垂、声音嘶哑、吞咽困难;2例出现视物模糊、眼球活动受限、咳痰和抬头无力;2例出现气短,其中年龄最大的患者出现阵发性呼吸困难、排尿排便障碍.本组患者既往均健康,近期无感染、发热及接触农药史.     

A型肉毒毒素治疗口下颌肌张力障碍

目的观察A型肉毒毒素治疗口下颌肌张力障碍(OMD)患者的临床效果。方法对19例口下颌肌张力障碍患者进行临床分析,依据患者临床特点,将A型肉毒毒素注射到患者一侧或双侧咀嚼肌、颞肌及翼外肌,并根据肌肉收缩力量大小、肌肉体积及患者体重调整剂量。结果 68.4%的患者功能改善评分≥3分,疗效平均维持8～12周(有效范围2～28周)。4例患者注射后有轻度咀嚼无力,2～3周恢复。1例混合型患者注射后出现轻度鼻音,持续13天后症状消失。所有患者未出现其它严重副作用。结论 A型肉毒毒素对于口下颌肌张力障碍的治疗是有效、安全的。熟悉本病的临床特点及分型,选择正确的靶肌肉及注射适宜剂量的肉毒毒素是治疗本病的关键。     

抢救肉毒中毒3例临床分析

肉毒中毒起病急、进展快 ,诊断和抢救不及时 ,往往造成死亡。其特有的神经麻痹症状 ,病初不易认识 ,易造成误诊误治。我院收治 3例做如下分析 :1　临床资料1 1　一般资料　患者母亲自制霉豆腐全家人均食用。 12岁女儿吃的较多 ,首先于次日发病 ,出现头昏、头痛、全身无力、视物模糊 ,曾在当地医院诊为“感冒” ,给予对症治疗不见好转 ,而来我院就治。入院后患者病情逐渐加重 ,除上述症状外 ,出现吞咽困难、呛食、呛咳 ,不能进食、咳嗽无力、呼吸困难 ,在救治其女儿同时 ,15岁儿子以类似症状来院就诊。患者父母亲也都同时有头痛、头昏、视物…     

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.