帕金森病嗅觉障碍研究进展

帕金森病以静止性震颤、行动迟缓、肌张力增高为主要运动症状,同时伴有嗅觉减退、便秘、认知障碍、RBD、精神症状、焦虑、抑郁、淡漠、自主神经功能障碍等多种非运动症状。嗅觉障碍是帕金森病常见的非运动症状之一,可早于运动症状数年出现。因此,筛查嗅觉障碍可能有助于早期发现并诊断帕金森病。本文就帕金森病嗅觉障碍的病理生理、危险因素、与其他症状的关系、检查方法及治疗等方面的研究进展做一综述。     

帕金森病前驱期非运动症状的相关研究进展

正帕金森病是常见的神经退行性病变,早期诊断及干预可以有效改善帕金森病患者的预后。2015年国际运动障碍学会强调了帕金森病前驱期的重要性,在帕金森病前驱期中患者已经出现中枢或周围神经病理性改变,患者可表现为不同程度的非运动症状和体征,但有限的运动症状仍不足以作出帕金森病的诊断。了解目前帕金森病前驱期非运动症状的特点及可能的生物标记物,将有助于临床医生更早的甄别可疑的帕金森病患者,而本文就近期国内外帕金森病前驱期主要的非运动症状(嗅觉减退、睡眠障碍、认知功能下降、神经精神症状及自主神经功能障碍)特点及可能发生机制的相关文章进行分类叙述,旨在提高临床医生对帕金森病前驱期非运动症状的关注及加强相关临床回顾性或前瞻性研究。     

帕金森病患者嗅觉减退的相关因素分析

目的 探讨帕金森病患者嗅觉减退的发生率以及相关因素。方法 收集463例帕金森病(PD)患者基本信息,并通过量表系统性评估运动及非运动症状, PD非运动量表“是否有嗅觉减退”项回答“是”者纳入嗅觉减退组,回答“否”者纳入非嗅觉减退组。结果 帕金森病患者嗅觉减退发生率为33.9%,86%的患者嗅觉减退出现在运动症状之前,并且与性别、年龄、起病年龄、运动症状、疾病严重程度无明显关系。伴有嗅觉减退患者的情绪障碍如焦虑、抑郁、淡漠较重,并且睡眠和认知功能较差。高质量的睡眠及吸烟是PD嗅觉减退的保护因素,淡漠是危险因素。结论 合并嗅觉减退患者可能合并更加严重的情绪、睡眠及认知障碍。     

帕金森病患者嗅觉减退的危险因素分析

目的分析引起帕金森病患者嗅觉减退的相关因素。方法选取我院收治的180例帕金森病患者的临床资料,通过帕金森评分量表系统评估患者运动、非运动症状,并通过非运动症状问卷对患者进行分组,比较一般资料并对量表评估结果进行统计学分析。结果 PD患者性别、年龄、病程等一般资料与发生嗅觉减退无明显联系(P0.05),吸烟史及高质量睡眠是保护因素,淡漠是危险因素(P0.05)。结论 PD伴嗅觉减退患者易出现抑郁、焦虑等情绪障碍,其中吸烟及高质量睡眠是出现嗅觉减退的保护因素,淡漠可能是危险因素。     

帕金森病嗅觉障碍研究进展

帕金森病（Parkinsondisease，PD）的主要临床特征为运动症状，但近年来其非运动性症状日益收到重视。嗅觉功能障碍是PD主要的非运动症状之一。据统计，90％的PD患者运动症状出现前表现有不同程度嗅觉功能减退或完全性嗅觉丧失。     

经颅超声评价帕金森病伴发抑郁的研究进展

正帕金森病(Parkinson’s disease,PD)是一种以静止性震颤、肌强直、运动迟缓、姿势平衡障碍等运动症状以及以包括抑郁、焦虑、睡眠障碍、精神症状等非运动症状为主要特征的神经系统变性疾病,目前帕金森病诊断主要依据是患者的临床症状、体征以及对左旋多巴等治疗的反应性,尤其在发病早期尚缺乏特异的生物学诊断指标。相对于运动症状而言,目前认为非运动症状对帕金森病患者的生活质量影响更大,其中抑郁是帕金森病的常见的非运动症状之一,约40%～     

帕金森病疼痛机制研究进展

帕金森病是中老年人群常见的神经变性病,临床表现主要包括运动症状和非运动症状,疼痛是常见的非运动症状,因影响患者生活质量而倍受关注。然而目前关于帕金森病疼痛的发病机制仍不明确,尚待进一步研究。本文拟就可能的帕金森病疼痛发病机制进行阐述。     

盐酸普拉克索改善帕金森病非运动症状疗效观察

目的观察盐酸普拉克索对帕金森病非运动症状的疗效。方法随机观察,46例接受普拉克索治疗的伴有非运动症状的原发性帕金森病患者,分别在服药剂量稳定不变后4周,评估用药前后患者非运动症状的变化。结果普拉克索治疗后帕金森病伴发的抑郁、疼痛、下肢痉挛、不宁腿综合征和睡眠障碍明显改善(P<0.05);而流涎、便秘、排尿障碍、性功能障碍、肢体发冷、认知障碍和嗅觉障碍等症状,用药前后没有发生明显变化(P>0.05);普拉克索治疗部分患者出现口干、头晕、体位性低血压、幻觉、嗜睡等不良反应。结论普拉克索能减轻部分帕金森病患者的非运动症状如抑郁、疼痛和双下肢不适等,但也可能加重某些帕金森病的非运动症状如口干、头晕和幻觉等。     

帕金森病抑郁的研究进展

<正>帕金森病主要的运动症状包括静止性震颤、僵直、运动迟缓和姿势平衡障碍,严重影响患者的运动功能。近年来的临床研究得出结论,与运动症状相比,帕金森病伴发的非运动症状是降低患者生活质量更为主要的原因。抑郁是帕金森病非常常见的非运动症状之一,严重影响患者情绪和生活。但是在临床工作中,帕金森病患者的抑郁却很少被诊断,更难以做到规范有效地治疗。本文综述了帕金森病并发抑郁的可能机制,临床特点和评估以及综合治疗等内容。     

帕金森病患者便秘的研究进展

帕金森病(Parkinson disease,PD)是一种中老年常见的神经变性病,慢性致残率高。疾病早期除了典型运动症状,患者还诉嗅觉减退、睡眠障碍、抑郁和便秘等非运动症状(non-motor symptoms,NMS)。临床中随着抗帕金森药物的应用,NMS成为影响患者生活质量的主要因素[1],而便秘是临床常见、发生率很高的     

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.     

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.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.     

Introduction: Goals

Summary: Epilepsy is characterized by recurrent seizures. Many epilepsies with focal seizures as well as convulsive generalized seizures respond satisfactorily to antiepileptic drugs (AEDs) that reduce repetitive firing (e.g., phenytoin, carbamazepine, and valproate) or that augment GABA_A-mediated inhibition (e.g., phenobarbital and benzodiazepines). A number of drugs presently under development, such as NMDA receptor antagonists, loreclezole, losigamone, meth-ysticine, and dextromethorphan, are promising in acute animal models of otherwise drug-resistant convulsant activity. As a result of recent studies in both experimental models and surgically resected human epileptic brain, the prospects for development of AEDs have significantly improved. Several new AEDs recently have reached the commercial market or are in experimental or clinical trials. A comparative presentation of the standing of the new AEDs with respect to their efficacy and side effects is necessary, but still very difficult. Because initial experience with new AEDs is restricted to populations with severe drug-resistant epilepsy, the crucial question whether potential new AEDs can alter prognosis is not yet definitively answered. There is a clear need to compare the effects of standard AEDs and new AEDs in naive patients and over longer follow-up periods. Moreover, because of the strong desire to develop antiepileptic therapy that directly treats the primary etiology of a given epileptic syndrome , or modifies the neurobiological processes that cause recurrent seizures, better experimental epilepsy models for chronic epilepsy and further clinical studies are necessary to increase the knowledge on the pathophysiology of distinct epileptic syndromes. In this respect, studies on the differences between responders and nonresponders to a given AED treatment are extremely valuable.