A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效,探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射,对治疗前后的病情分级进行对比,分析治疗效果。结果71例面肌痉挛者完全缓解35例(49.3%),明显缓解34例(47.8%),无效2例(2.8%)。34例眼睑痉挛者,22例完全缓解,12例明显缓解,总有效率达98%。起效时间数小时至7d,缓解时间3～8个月,局部不良反应轻微、短暂,无全身反应及过敏反应,其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异,并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射,可有效控制眼睑痉挛及偏侧面肌痉挛,部分眼睑及面肌痉挛的病因为血管压迫。     

A型肉毒毒素治疗局限性肌肉痉挛的临床研究

目的　观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛及Meige综合征的疗效。方法　对 40例偏侧面肌痉挛、9例眼睑痉挛、1例Meige综合征进行面部肌肉局部多点注射A型肉毒毒素 ,评价其治疗效果。结果　 40例偏侧面肌痉挛者 ,完全缓解 1 5例 (38% ) ,明显缓解2 4例 (60 % ) ,1例无效 ;9例眼睑痉挛者 ,4例完全缓解 ,4例明显缓解 ,1例无效 ;1例Meige综合征部分缓解 ,总有效率达 96 %。起效时间平均 3天 ,缓解时间平均 3 5个月。局部副反应轻微、短暂 ,无全身反应及过敏反应。结论　A型肉毒毒素局部肌肉注射是治疗局限性肌肉痉挛的一种安全、有效的治疗方法。     

A型肉毒毒素治疗面肌、眼睑痉挛156例临床观察

目的 探讨A型肉毒毒素治疗面肌，眼睑痉挛及Meige综合征的疗效。方法 采用A型肉毒毒素局部注射治疗偏侧面肌痉挛102例。眼睑痉挛41例及Meige综合征13例。并使用Cohen和Albert量表进行评估。结果 症状完全缓解占51.3%。明显改善占37.8%。部分改善占10.9%。疗效平均持续约3-6个月。复发者重复注射仍有效，出现眼睑闭合不全，面肌无力，眼睑下垂共58例，均恢复。结论 局部注射A型肉毒毒素确为一种安全有效。简便易行的治疗面肌。眼睑痉挛及Meige综合征的方法。     

A型肉毒毒素治疗面肌痉挛38例疗效观察

目的：观察A型肉毒毒素治疗偏侧面肌痉挛的疗效。方法：对38例偏侧面肌痉挛进行面部肌肉多点注射A型肉毒毒素。评价其治疗效果。结果：完全缓解11例，明显缓解27例，总有效率100％。起效时间平均3d。局部反应轻微，无全身反应及过敏反应。结论：A型肉毒毒素局部肌肉注射是治疗面肌痉挛的一种安全、有效、易行的方法。     

A型肉毒毒素治疗面肌痉挛、眼睑痉挛疗效观察

目的观察A型肉毒毒素治疗面肌、眼睑痉挛的疗效。方法采用A型肉毒毒素局部注射治疗偏侧面肌痉挛51例、眼睑痉挛8例,并使用Cohen和Albert量表对疗效进行评估。结果31例(52.5%)症状完全缓解,22例(37.2%)明显改善,6例(10.1%)部分改善,疗效平均持续约9～33周,复发者重复注射仍有效。不良反应可出现眼睑闭合不全、面肌无力、眼睑下垂等共18例,均在4周内恢复。结论局部注射A型肉毒毒素确为一种安全有效的治疗面肌、眼睑痉挛的方法。     

A型肉毒毒素治疗面肌痉挛38例疗效观察

目的 :观察A型肉毒毒素治疗偏侧面肌痉挛的疗效。方法 :对 3 8例偏侧面肌痉挛进行面部肌肉多点注射A型肉毒毒素。评价其治疗效果。结果 :完全缓解 11例 ,明显缓解 2 7例 ,总有效率 10 0 %。起效时间平均 3d。局部反应轻微 ,无全身反应及过敏反应。结论 :A型肉毒毒素局部肌肉注射是治疗面肌痉挛的一种安全、有效、易行的方法。     

A型肉毒毒素治疗118例面肌痉挛的疗效观察

目的探讨面肌痉挛的病因，评估Ａ型肉毒毒素治疗面肌痉挛的疗效。方法对１１８例病人进行面部肌肉多点注射Ａ型肉毒毒素治疗，对治疗前后的病情分级进行对比，并随机抽取３６例做肌电图，１２例做核磁共振血管成像（ＭＲＡ）检查。结果Ａ型肉毒毒素有效率为９４％，半年复发率为８７％。肌电图全部显示自发性动作电位。１２例ＭＲＡ中，１１例检出有椎动脉、小脑后下动脉、小脑前下动脉的变异，并造成对面神经的压迫。结论部分面肌痉挛的病因为血管压迫。尽管Ａ型肉毒毒素的疗效多不超过半年，但仍不失为一种简单有效的治疗方法     

A型肉毒杆菌毒素治疗眼睑痉挛及面肌痉挛临床研究

应用Ａ型肉毒杆菌毒素局部注射治疗眼睑痉挛９例及面肌痉挛３３，例完全缓解者分别为６例及３１例，明显缓解者分别为３例及２例，所有病例均有效，总有效期分别为４～２０周（平均１４周）及１６～３４周（平均２２周）。局部副反应轻微、短暂，无全身反应及过敏反应，且操作简单。认为Ａ型肉毒杆菌毒素是一种安全有效的生物制剂，该方法可作为治疗眼睑痉挛及面肌痉挛的新方法．     

A型肉毒毒素治疗面肌痉挛500例临床研究

目的 探讨使用A型肉毒毒素针多点重复注射治疗面肌痉挛的临床疗效及安全性.方法 采用A型肉毒毒素局部多点重复注射治疗面肌痉挛500例,使用Cohen评分进行评估.观察疗效.结果 症状完全缓解301例（60.2％）,明显缓解者182例（36.4％）,部分缓解者15例（3.0％）,无效2例（0.4％）;总有效率99.8％.疗效持续2～7个月,复发者重复治疗仍有效,不良反应轻微.结论 局部注射A型肉毒毒素是治疗面肌痉挛一种简便、安全、有效的方法.     

A型肉毒杆菌毒素治疗眼睑及面肌痉挛

目的 探讨A型肉毒杆菌毒素(BTXA)治疗眼睑及面肌痉挛的疗效.方法 选择眼睑及面肌痉挛患者36例,根据病情用2.5U/0.1ml的A型肉毒杆菌毒素做痉挛局部皮下或肌内注射,一次剂量不超过55U, 有残存痉挛者可追加注射.结果 一次注射痉挛完全缓解26例,明显缓解6例,部分缓解4例,10例重复2～3次注射均完全缓解.结论 BTXA治疗眼睑、面部肌痉挛安全、有效.     

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”.