以妄想为主的男性精神分裂症患者脑局部一致性的功能磁共振研究

目的：探讨男性偏执型精神分裂症患者在静息状态下是否存在脑功能活动异常及其区域。方法：采用病例一对照研究方法,对20例以妄想为主的男性精神分裂症患者（患者组）和20名性别、年龄、受教育程度相匹配的正常对照者（正常对照组）进行功能磁共振成像（fMRI）扫描,分析静息状态下各脑区的局部一致性（regionalhomogeneity,ReHo）的差异。结果：设P〈0．05、体素范围（k值）≥85,与正常对照组比较,患者组双侧额上回、双侧颞中回、左额中回、左中央前回、左小脑脚和右扣带回局部一致性（ReHo值）减低,右颞上回和左颞下回ReHo值增高,而左梭状回ReHo值既有增高也有减低。结论：以妄想为主的男性精神分裂症患者在静息状态下可能存在广泛分布的脑区功能异常。     

首发抑郁症患者静息态MRI脑局部一致性的改变

目的 利用静息态MRI 技术去探索首发抑郁症患者特异脑区的脑功能改变。方法 对符 合抑郁症诊断标准的20 例患者及20 名健康志愿者进行静息态MRI检查，使用静息态MRI局部一致性 （ReHo）分析方法，比较抑郁症组与对照组ReHo 值，发现特异性增高或减低的脑区。结果 抑郁症组 对比对照组，ReHo 增高的脑区有小脑后叶、颞下回、枕中回、舌回、中央后回、中央前回、额上回、顶 叶等；ReHo 降低的脑区有边缘叶、海马旁回、壳核、丘脑、豆状核、额下回、额中回、楔前叶、扣带回等。 结论 静息态MRI 的ReHo 分析方法可能发现抑郁症异常的脑区，为抑郁症发病机制的探索提供帮助。     

首发抑郁障碍患者及抑郁易感者静息态脑功能磁共振的研究

目的:探讨首发抑郁障碍患者及抑郁易感者静息态下脑功能,探索抑郁症发病及抑郁易感的病理生理学机制。方法:采用静息态功能磁共振成像技术(rs-fMRI)对23例首发未服药抑郁障碍患者、26例抑郁易感者和15例健康志愿者行rs-fMRI扫描,应用局部一致性分析方法(ReHo)比较各组间的差异脑区。结果:相对正常组,患者组右额上回、双侧前扣带回ReHo值升高,右壳核、小脑后叶及颞上回ReHo值降低;易感组左壳核及右前扣带回ReHo值升高,左舌回、额上回及右颞上回ReHo值降低。相对患者组,易感组右壳核、小脑后叶、颞上回及扣带回ReHo值升高,左楔前叶及额上回ReHo值降低(P均0.05)。结论:抑郁障碍是一个涉及多脑区、多系统的疾病;这些异常脑区可能是抑郁易感的病理脑区。     

抑郁症首次发病患者静息态脑功能局部一致性的研究

目的 利用功能磁共振(fMRI)和局部一致性(regional homogeneity,ReHo)探讨抑郁症首次发病(以下简称首发)患者在静息态脑功能是否存在异常及异常部位.方法 对34例符合美国精神疾病诊断与统计手册第4版诊断标准的首发抑郁症患者(抑郁症组)和34名性别、年龄、文化程度匹配的健康志愿者(对照组)进行静息态fMRI扫描.结果 抑郁症组静息态脑血氧水平依赖信号的ReHo高于对照组的脑区有左侧额叶眶回、顶下小叶、颞上回,右侧额内侧回、顶下小叶、小脑后叶;低于对照组的脑区有左颞下回、右颞上同和胼胝体、双侧后扣带回(P＜0.005,K≥10).结论首发抑郁症患者在静息态存在多个腩区功能活动的异常,并可能和抑郁症的病理机制有关.     

抑郁症与正常人静息态脑功能变化对照研究

目的:利用功能磁共振成像(functional magnetic resonance imaging,fMRI)技术,研究静息状态下重性抑郁症患者经抗抑郁药治疗前后脑局部一致性变化的特点. 方法:20例重性抑郁症患者(抑郁症组),以20名在性别、年龄、受教育年限均与之相匹配的健康人作为对照(对照组),在抗抑郁治疗前和治疗10周进行静息状态fMRI扫描. 结果:与治疗前比较,抑郁症组治疗后大脑左侧黑质、左额中回(BA9,BA10)、左额内侧回(BA10)、左颞中回(BA21)、右额中回(BA11)、右额内侧回(BA25)、右额下回(BA45)及右颞上回(BA38)局部一致性减低.与对照组比较,抑郁症组治疗前双侧楔前叶(BA7)局部一致性增高,而治疗后右前扣带回腹侧(BA31)、右额下回(BA46)、右额内侧回(BAIO)及左海马旁回(BA36)局部一致性减低. 结论:静息状态下抑郁症患者存在部分脑功能异常,经抗抑郁治疗后可逆转.     

抑郁症患者静息状态的功能磁共振成像研究

目的 了解在静息状态下抑郁症患者脑区的局部一致性特点.方法 采用功能磁共振成像(fMRI)技术,检测静息状态下27例抑郁症患者(患者组)和性别、年龄、受教育程度均与患者相匹配的27名正常人(对照组)的脑功能活动,并对两组进行比较.利用局部一致性方法 分析fMRI数据,用SPM2软件进行配对t检验(P＜0.005).结果 与对照组相比,患者组双侧额中回、右额下回、右颞上回、左前扣带回、右后扣带回、右岛叶、双侧豆状核、双侧屏状核、左尾状核局部一致性显著增高(P＜0.005,未校正,体素值＞10);未显示脑区有明显的局部一致性减低.结论 抑郁症患者神经环路脑区局部在静息状态下具有很高的一致性,其局部一致性的增高可能参与了抑郁症的代偿机制.     

青少年广泛性焦虑障碍患者静息态功能磁共振成像研究

目的:运用局部一致性(ReHo)方法研究首发青少年广泛性焦虑障碍患者的局部自发性脑活动. 方法:对19例首发青少年广泛性焦虑障碍患者及14名年龄、性别与其相匹配的正常对照进行静息态脑功能磁共振成像扫描,通过计算每个给定体素与其最邻近的26个体素之间的肯德尔和谐系数(KCC)来获得全脑的局部一致性(ReHo)图,利用双样本t检验分析两组受试者静息态下局部一致性的差异. 结果:与正常对照相比,青少年广泛性焦虑障碍患者局部一致性降低的脑区包括双侧额中回、枕中回,左侧额上回、颞下回、前扣带回及右侧顶下回、枕下回(P ＜0.005,未校正);局部一致性增高的脑区包括:右侧楔前叶、角回及左侧枕上回(P ＜0.005,未校正). 结论:青少年广泛性焦虑障碍患者静息态脑功能局部一致性存在异常.     

基于ReHo方法的精神分裂症患者攻击行为的静息态fMRI研究

目的 通过相关脑区结构与功能的对照研究,探讨精神分裂症患者暴力攻击行为的神经认知障碍基础.方法 对有、无攻击行为的精神分裂症患者和健康对照三组人群各21例进行静息状态下脑功能性磁共振成像（fMRI）,运用局域一致性（ReHo）分析方法进行数据分析处理,比较三组之间的差异.结果 与健康对照组相比,精神分裂症非攻击组在左侧额叶、中央前回、中央后回、两侧丘脑、右侧脑岛等脑区的局部一致性存在异常;而精神分裂症攻击组除表现上述脑区局部一致性异常,还表现出两侧前扣带回、左侧海马旁回等边缘系统脑区局部一致性的异常.结论 额叶、丘脑、中央前回、中央后回及脑岛等脑区的异常可能与精神分裂症症状以及攻击行为均有关,而边缘系统等脑区的异常可能与精神分裂症的攻击行为存在特异性联系.     

伴非自杀性自伤的抑郁发作患者静息态功能磁共振局部一致性特征的研究

目的:旨在探讨伴非自杀性自伤(non-suicidal self-injury,NSSI)重性抑郁发作患者静息态下局部脑区神经活动的一致性(regional homogeneity,ReHo)特征。方法:招募51例伴NSSI和61例不伴NSSI的重性抑郁发作患者,同时招募84名健康对照。将3组受试进行3.0T静息态功能磁共振扫描,计算全脑ReHo值,对3组受试进行单因素方差分析,在有显著差异脑区的基础上采用事后t检验,使用Alphasim矫正进行多重比较矫正。结果:3组ReHo指标的单因素方差分析发现左额下回眶部、左壳核、右颞上回、右额叶上中回、左枕叶上部、左扣带回中部、左顶上小叶、左额上回差异有统计学意义(P均0.01,Alphasim矫正)。伴NSSI的抑郁发作患者较不伴NSSI的抑郁发作患者左壳核、左额上回ReHo值降低(P均0.01,Alphasim矫正)。结论:伴NSSI抑郁发作患者在基础状态下执行控制相关脑区如左壳核、左额上回、左扣带回局部脑功能存在异常。     

早发性抑郁障碍患者静息态磁共振局部一致性研究

目的:探讨早发性抑郁障碍患者静息态下特征性脑功能改变与疾病严重程度的关系。方法:应用静息态功能磁共振(fMRI)中局部一致性数据分析法,选择20例早发抑郁障碍患者和性别、年龄、受教育年限相匹配的20名健康对照,分别给予fMRI扫描,应用双样本t检验对比病例组与对照组的ReHo图像,将存在差异性脑区的ReHo均值与汉密尔顿抑郁量表(HAMD-17)总分做相关性分析,观察其临床严重程度与差异性脑区活动的特征。结果:病例组左侧枕中回、左侧额中回、左侧额上回、右侧楔前叶、右侧扣带回的ReHo值随HAMD-17评分增加而逐渐增强;左侧距状裂、右侧缘上回、左侧中央前回区域随HAMD-17评分增加而逐渐减弱,相关有统计学意义(P均0.05)。结论:早发性抑郁障碍患者在前额叶、扣带回、边缘系统及部分枕、顶叶脑区自发活动的改变可能与抑郁障碍严重程度密切相关。     

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”.