河南省农村地区癫痫防治管理项目效果分析

目的对河南省召陵区农村地区癫痫防治管理项目效果进行分析。方法对部分农村符合标准的惊厥性癫痫患者采取一定措施进行管理、随访,并用苯巴比妥进行规范化免费治疗,分析治疗管理率、退出治疗原因、治疗剂量及治疗效果。结果管理率为52.60%,退组45例,死亡4例,服药剂量以90 mg/d及120 mg/d为主,治疗显效66.01%,有效26.12%。结论农村地区癫痫防治管理项目的实施,提高了各级级卫生人员癫痫防治水平,使癫痫病患者得到规范化治疗,减轻患者的痛苦与经济负担。     

癫痫并发偏头痛患者临床特点分析

目的分析癫痫并发偏头痛患者的临床特点。方法选取我院2014-11—2015-11收治的88例癫痫患者为研究对象,其中48例癫痫并发偏头痛患者为观察组,40例单纯癫痫患者为对照组,回顾性分析2组临床材料。结果观察组女性比例(70.83%)显著高于对照组(47.5%),差异有统计学意义(P0.05);观察组平均癫痫病程、癫痫发作频率均显著高于对照组,差异有统计学意义(P0.05)。结论癫痫与偏头痛可能存在相互联系及作用,偏头痛可能加重癫痫严重程度,给癫痫治疗带来负面效果。     

小儿难治性癫痫早期外科治疗探讨

长期反复发作的难治性癫痫可严重影响患者的生活质量,尤其是处于发育阶段的小儿患者,可导致患者智力低下和精神衰退,影响正常的生长发育。随着临床诊疗技术的进步,癫痫患者的早期外科治疗已得到广泛的认同。成人患者已有完善的手术标准作为其治疗指导,而目前对于小儿难治性癫痫的认识及早期手术治疗尚处于探索阶段。本文主要就小儿难治性癫痫早期外科治疗的必要性及术后疗效进行探讨。     

成年癫痫患者与正常人相比的烙印感

目的评估成年癫痫患者与正常人相比的社会烙印感。方法本研究是基于医院调查的横断面研究。我们采用了立意抽样,样本包括212例成人,其中106例诊断患有癫痫病,另外106例正常人作为对照组。在评估中使用了社会人口统计学及癫痫社会烙印感等级表。使用基于Windows系统的社会科学统计学工具包(SPPS16.0)版做统计学分析。结果多数患者是男性,多数患者来自农村。癫痫患者组与对照组相比在月收入方面有显著差异。癫痫患者组的社会烙印感高于对照组,有显著差异。结论癫痫患者的社会烙印感高于正常人群,癫痫患者的收入少于正常人群。对患者和正常人群进行有关癫痫病的宣传教育,应纳入癫痫病的治疗当中,以减少社会的歧视、降低癫痫患者社会烙印感,提高癫痫患者生活质量。     

神经刺激技术在药物难治性癫痫中的治疗进展

癫痫是一种反复发作的慢性神经系统疾病,绝大多数(约70%)可通过使用抗癫痫药物控制发作,但仍有部分患者难以通过药物治疗控制,即难治性癫痫。通常,采用手术切除癫痫病灶进行治疗,但临床上仍有诸多难治性癫痫患者由于多种原因无法进行手术。对于这部分患者可选择神经刺激术进行治疗。神经刺激术的种类较多,具有相对靶向性、可调节性及持续性的特点。目前,主要用于治疗疼痛、运动障碍、震颤、癫痫等多种疾病。本文对神经刺激术治疗癫痫的相关研究进行综述。     

癫痫的影像诊断进展

癫痫患者约占世界人口的1%～2%.现代神经影像学检查对于癫痫的诊断和治疗具有重要的价值.直到1987年,海马硬化仅能由病理做出诊断.现在MRI在活体上就能识别本病.现代神经影像学检查也大大地促进了对癫痫的基础病理生理学过程的了解,可以提供有关癫痫病变精确的解剖定位和代谢信息并有助于对某些癫痫病变进行恰当的分类.     

神经外科住院总医师的培养与管理

住院总医师制度是医院人才培养和医院管理的重要环节。一般情况下,住院总医师除了负责患者的日常管理外,还承担着会诊、患者出入院管理、针对低年住院医师或实习医师的教学等工作”,对于神经外科,住院总医师阶段还要完成从辅助上级医师到自己独立诊疗的过程,达到能独立进行手术,特别是应对急诊手术的能力。     

抗癫痫药物对癫痫患者骨密度的影响

目的分析抗癫痫药物对癫痫患者骨密度的影响。方法以我院诊治的120例癫痫患者为研究对象,均接受抗癫痫药物治疗至少半年,通过超声法测定所有患者骨密度,根据骨密度结果分为骨密度正常组与骨密度异常组,比较2组癫痫病程、发作类型、抗癫痫用药(种类、用药数量)、治疗时间等情况,分析癫痫患者骨密度异常的相关因素。结果 120例患者中骨密度异常70例,正常50例。骨密度异常组GTCS、抗癫痫用药10a、多药使用比率分别为78.6%、55.7%、64.3%,均显著高于骨密度正常组的62.0%、28.0%、40.0%,差异有统计学意义(P0.05)。Logistic回归分析显示,癫痫发作类型、抗癫痫用药时间、用药数量为癫痫患者骨密度异常的独立危险因素。结论抗癫痫药物对癫痫患者骨密度均有一定的影响,临床需积极控制癫痫发作,特别是GTCS,建议尽可能选择单药治疗,最大限度缩短用药疗程,以有效预防骨密度异常。     

癫痫共患病筛查工具的中国专家共识

癫痫患者中常见多种神经精神共患病,癫痫与共患病均会严重影响患者的生活质量,两者共患会加重癫痫发作,对于癫痫患儿还会影响其生长发育,临床中应予以重视。为推动我国临床医师对癫痫共患病的规范化诊治,中国抗癫痫协会共患病专委会组织专家讨论,结合国内外现有的量表和研究证据,就癫痫共患病的早期筛查制作筛查工具进行总结,以便于临床医师,尤其是广大基层医院对癫痫共患病进行早期筛查,提高癫痫共患病诊断率。     

医师-药师联合门诊会诊癫痫患者467例

目的对医师-药师联合门诊就诊癫痫患者的发作类型、病因及用药情况进行现况调查,为抗癫痫药物合理化应用提供参考。方法收集天坛医院医师-药师联合门诊就诊的癫痫患者467例,对其一般人口学资料、病程、发作类型、病因、应用抗癫痫药物状况等进行统计分析。结果 467例患者,男性263例(56.3%),女性204例(43.7%);年龄14～90岁,平均年龄(35.21±15.32)岁;病程2w～40年,中位数为6年(四分位间距2～15);发作类型:全面性强直-阵挛发作274例(58.7%),局灶性发作65例(13.9%),局灶+全面发作116例(24.8%),未知发作类型12例(2.6%)。癫痫病因依次为脑血管病61例、颅脑创伤46例、海马病变46例、颅内感染41例,脑发育不良25例、脑肿瘤19例、围产期脑损伤17例等;有明确家族史者为14例,青少年肌阵挛(JME)13例,原因不明172例。癫痫单药治疗者240例(51.4%);2药联合治疗114例(24.4%);3种以上29例(6.2%),未服药者81例(17.3%),不规律服药者70例(14.99%)。规律服抗癫痫药物保持1年以上无发作者104例,占22.3%。出现各种不良反应频次97次,其中肝酶升高、血白细胞减少,体质量增加及震颤排列靠前。结论针对癫痫患者建立的联合门诊诊疗模式很有必要,可以为患者提供更优化的药物治疗方案。本研究为将来癫痫患者的门诊就诊模式的发展提供参考。     

A Bayesian tool for epilepsy diagnosis in the resource-poor world: Development and early validation

PurposeThe epilepsy treatment gap in resource-poor countries is so large that existing numbers of doctors are unlikely to be able to close it. Other health workers are likely to be needed but they will need help. The diagnosis of an attack as epileptic or not is an essential step in the management of epilepsy. It should be possible to devise a tool to give the probability of episodes being epileptic based on a Bayesian analysis of the results of history taking.MethodWe asked about the nature of episodes in patients referred to epilepsy camps in Nepal. Answers were then compared to the final clinical diagnosis of epilepsy and the likelihood ratio (LR) of the episode being epileptic obtained for each answer. The most informative LRs, tested sequentially, formed the basis for a tool which was validated in a different Nepalese population.ResultsData was obtained from 67 patients. The pre-test probability of having epilepsy was 0.76. Answers to 11 questions with the most informative LRs were then combined into a tool. This was tested on 14 different patients. Post-test probability scores in those with epilepsy ranged from 0.88 to 1 and for those with non-epilepsy from 0.07 to 0.42.ConclusionIt is possible to devise a tool based on simple clinical information using Bayesian principles. Initial validation suggests that this has the potential to enable health workers to diagnose episodes as epileptic or not. This now needs to be tested in different populations. The tool is easily converted to a mobile phone app.     

儿童难治性癫痫的长期治疗

治疗癫痫患者的最终目标是摆脱癫痫发作,但有些癫痫患儿可能需要终身治疗,尤其是难治性癫痫患儿更加现实的目标是降低具有致残性发作类型的发作频率。长期发作会影响患儿社会活动、心理、认知等功能,因此对这些患儿的长期管理需要儿科和神经内科医师,以及社会工作者联合给予终身关爱。在治疗过程中,临床医师应定期评价患儿病情,注意预防和控制抗癫痫药物的不良反应,监测抗癫痼药物相关不良事件;为难治性癫痫患儿选择最佳治疗方案,在收益与风险之间达到平衡,提高患儿生活质量。     

Primary care doctors' management behavior with respect to epilepsy in Kerala, southern India

Although a majority of persons with epilepsy in developing countries are diagnosed, treated, and followed up by primary care doctors, few efforts have been made to examine their understanding with respect to epilepsy management. Through a questionnaire survey, we gathered information about the epilepsy management behavior of 500 primary care doctors distributed across the south Indian state of Kerala. Very few of them ever had diagnosed focal seizures, and the majority of them overutilize EEGs, prescribe continuous antiepileptic drug (AED) prophylaxis for febrile convulsions, use relatively expensive AEDs often in combination and in suboptimal doses, and did not know about alternate management options for AED-resistant epilepsies. A substantial proportion of the current large treatment gap in epilepsy in developing countries could be minimized by educating the primary care physicians about the diagnosis of epileptic seizures, cost-effective AED treatment, and need-based referral for specialized care.     

湖南省岳阳市癫痫患者的治疗情况及需求现状

目的通过对143例癫痫患者诊治情况的调查分析,为探索有效的癫痫治疗和管理模式提供依据。方法对湖南岳阳城市及农村地区癫痫患者进行问卷调查,内容包括一般情况、诊治情况、癫痫发作情况、癫痫知晓情况及治疗依从性。结果 143例癫痫患者多为轻壮年,多数在10岁以前发病,63.6%的为活动性癫痫患者,54.6%的患者呈中高发作频率,63.4%的癫痫发作类型为继发性全身强直-阵挛性发作,90%以上的患者未得到合理的治疗;癫痫患者及家属癫痫知晓率为40.2%。结论本地区癫痫患者不合理治疗的现状令人堪忧;癫痫患者及家属癫痫知晓率低;需加强健康教育,加强癫痫知识培训,以正规抗痫痫治疗,控制癫痫发作。     

Patients' Experiences of and Satisfaction with Care for Their Epilepsy

Summary: Purpose: To determine condition-specific satisfaction with care, we studied patients'experience of general practitioner (primary physician) and hospital clinic care for their epilepsy and their views about the provision of information concerning the management of their condition. Methods: A postal questionnaire was sent to an unselected, community-based population of patients with epilepsy. In addition to clinical and demographic details and previously validated scales of psychosocial well-being, the instrument contained a series of questions about patients'experiences and views of the care they received for epilepsy from both general practice and the hospital services. Results: Doctors'interpersonal skills were the most influential factors affecting both patient satisfaction overall and the likelihood that doctors might discuss with patients certain clinical and social issues surrounding the management of the patient's condition. A sizable proportion of patients reported that they received insufficient information, about epilepsy, both from hospital doctors and general practitioners. Conclusions: Patients with epilepsy place great importance on having a doctor who is approachable, communicative, and knowledgeable and on receiving adequate information about their condition. Clinicians may need to be made more aware of the importance of accessibility and sensitivity to the nonclinical needs of their patients. Such easily implemented changes in the delivery of care would improve services in the United Kingdom for people with epilepsy.     

Behavioral intervention as an add-on therapy in epilepsy: Designing a clinical trial

Many patients with epilepsy continue to experience seizures despite taking medication, and stress is a commonly reported trigger for seizures in these individuals. Therefore, a behavioral therapy proven to be effective in epilepsy could be a valuable adjunct to current pharmacotherapy. The challenges in testing such a behavioral intervention for epilepsy are numerous, including lack of consensus about sham designs, maintaining the blind, and powering the study absent known effect sizes. Herein, we present the design of a randomized, controlled, double-blind trial of progressive muscle relaxation as an add-on therapy for refractory epilepsy. Progressive muscle relaxation, which involves the tensing and releasing of muscle groups one at a time, is a well-established technique that relaxes the body and mind, reduces stress, and may improve seizure control. Study design issues discussed may provide insights that will inform future behavioral research in epilepsy.     

Simplification of antiepileptic pharmacotherapy: from the viewpoint of rational management for epilepsy

Rational management for epilepsy was investigated mainly from the viewpoint of antiepileptic pharmacotherapy. At first, diagnoses were reviewed by the ILAE classification for epilepsies and epileptic syndromes in 603 patients who visited a newly-established outpatient clinic for epilepsy and problems concerning the diagnosis of epilepsy were pointed out. Then, habitual pharmacotherapy in the past was assessed critically in cases where details of treatment before hospital attendance could be known. Further, the results of prospectively conducted simplification of pharmacotherapy where the appropriate choice of drugs and dosage were taken into account were reported. Furthermore, questions about the conventional criteria for drug effect evaluation were described and new criteria through which the influence on the daily life was also evaluated were presented. Finally, from the standpoint of comprehensive treatment, the system of rational management was discussed.