月经性偏头痛患者静息态功能磁共振研究

目的采用静息态功能磁共振成像(rf MRI)技术描述月经性偏头痛患者发作间期的脑功能改变,探索其可能的病理生理学机制。方法对10例发作间期的月经性偏头痛患者和10例受教育程度、年龄相匹配的健康对照行rf MRI扫描,计算低频振幅(ALFF),采用双样本t检验得到差异的脑区。结果偏头痛组左侧额叶ALFF值较对照组显著增强(P<0.05);偏头痛组双侧枕叶、双侧丘脑ALFF值较对照组明显减弱(P<0.05)。结论月经性偏头痛患者在头痛发作间期仍然存在皮质及皮质下脑区功能异常。     

偏头痛性眩晕的临床特点初步分析

目的 初步了解偏头痛性眩晕(migrainous vertigo,MV)患者的临床特点.方法 回顾性分析上海仁济医院神经内科头痛门诊2006年1月至2007年1月159例连续偏头痛患者登记资料,共30例在偏头痛发作过程中伴有眩晕,成功电话随访17例,对其眩晕的临床特点进行分析,并与无眩晕偏头痛患者进行比较.结果 眩晕的首发年龄均晚于头痛,平均间隔为6.1年.眩晕发作可于头痛发作之前、之后或在头痛期间出现.其中12例患者在头痛间歇期也存在反复发作性眩晕.每次眩晕发作一般不超过24 h.多数患者发作不规则,频率自数天1次至数月1次不等,劳累及天气变化是最常见的诱发因素.伴或不伴眩晕的偏头痛患者,人口学及偏头痛发作特征方面无统计学差异.结论 偏头痛性眩晕有其特征性临床表现,但与不伴眩晕的偏头痛患者相比,其他临床表现方面相似.其内在机制有待进一步研究.     

偏头痛性眩晕与基底型偏头痛(附9例临床分析)

目的分析9例偏头痛伴眩晕/头晕患者的临床及实验室检查结果,探讨头痛与眩晕/头晕的关系,以利正确诊治。方法作者医院收治的偏头痛伴眩晕/头晕患者9例,对所有患者均详细收集病史,并进行神经系统查体以及前庭功能、听力检查和头颅CT/MRI等实验室检查,以除外中枢性和耳源性眩晕。结果 9例偏头痛伴眩晕/头晕患者中,基底型偏头痛2例,无先兆偏头痛3例,偏头痛性眩晕(migrainous vertigo,MV)6例(其中2例为无先兆偏头痛发作数年后和50岁后转变为MV)。本组6例MV患者中,眩晕/头晕在头痛发作前数秒钟～1h内发生3例,在头痛发作后发生1例,与头痛同时发生1例,另1例偏头痛患者其头痛与眩晕从未同时发作过,为偏头痛等位征。结论 MV是不同于基底型偏头痛的头痛伴眩晕综合征,二者易与梅尼埃病、良性复发性位置性眩晕、后循环缺血(posterior circulation ischemia,PCI)等周围性和中枢性眩晕混淆或并存,临床应注意鉴别。     

偏瘫型偏头痛1例报道

偏瘫型偏头痛为偏头痛的一种特殊类型,临床较少见,报道不多,现报告1例如下. 1 病例资料 患者,女性,38岁,农民,因"发作性恶心呕吐伴肢体活动障碍3年余加重10余日"入院.     

颈性偏头痛85例临床分析

近年随着颈椎病发病率的增高 ,颈性偏头痛临床并不少见。颈性偏头痛表现为一侧发作性头痛 ,并在剧烈头痛时出现恶心、呕吐 ,而酷似一般偏头痛 ,但两者治疗方法不同。现将我院近 3年来神经科门诊收治的 85例颈性偏头痛报告如下。1　临床资料1.1　一般资料　颈性偏头痛患者 85例 ,男 45例 ,女 40例 ,平均发病年龄 46 .2± 1.3岁 (36～ 5 5岁 ) ,病史 15天～ 8年 ,平均 17.4个月。1.2　发作因素　看书、俯案工作过久 2 5例 (2 9.4% ) ;劳累、睡眠不足 2 7例 (31.8% ) ;精神情绪因素 16例 (18.8% ) ;原因不明 17例 (2 0 .0 % )。1.3　临床表现　…     

月经性偏头痛与女性激素关系的研究

本文采用放射免疫法测定42例月经性偏头痛发作期(Ⅰ组)和38例间歇期(Ⅱ组)患者血清雌二醇(E_2)、孕酮(p)及泌乳素(PRL)的含量,并以20例非月经性偏头痛发作期(Ⅲ组)及25例正常人(Ⅳ组)作为对照。结果表明,Ⅰ组与Ⅱ、Ⅲ、Ⅳ组对比,血清E_2浓度均明显下降(P<0.01),而Ⅱ组E_2明显回升到正常范围。各组的P浓度比较均无显著差异(P>0.05)。PRL在Ⅰ、Ⅱ组均增高,仅Ⅰ组与Ⅳ组比较有显著差异(P<0.05)。本文重点讨论了女性激素尤其是雌二醇撤退对诱发月经性偏头痛所起的作用。     

偏头痛患者前庭诱发肌源性电位的临床应用

目的 通过前庭诱发肌源性电位评价偏头痛患者的前庭功能、球囊.脑干.颈肌反射通路状态,并探讨其临床价值.方法 应用前庭诱发肌源性电位检测39 例偏头痛患者的前庭功能,并根据有无先兆发作、性别和有无偏头痛家族史,比较不同亚组偏头痛患者前庭诱发肌源性电位的差异性.结果 39 例偏头痛患者中13 例前庭诱发肌源性电位检测异常,异常率约为33.33%,但P13 波和N23 波潜伏期均于正常值范围.不同亚组比较,有偏头痛家族史患者前庭诱发肌源性电位检测异常率显著高于无家族史者(χ2 = 6.635,P = 0.001);而有无先兆发作和性别等亚组之间差异无统计学意义(χ2 = 0.014,P = 0.906;χ2 = 0.017,P = 0.897).结论 偏头痛患者前庭功能存在亚临床损害,主要表现为双侧球囊.脑干.颈肌反射通路不对称性,有偏头痛家族史患者更容易出现异常改变.前庭诱发肌源性电位检查可以作为偏头痛患者预防性治疗药物选择的一项依据.     

儿童偏头痛与复杂性发作

曾有人提出过偏头痛与癫痫发作的关系,但较少注意到在发作类型方面二者之间的关系。本文报道19例儿童具有偏头痛并伴有复杂性症状学的部分性发作(复杂性发作)的患者,以阐明二者间的关系。 19例中,男7例,女12例,平均发病年龄10.5岁(6～15)岁,偏头痛的平均发病年龄7岁(3～15岁),癫痫发作的平均年龄为10岁(3～12岁),6例患者痫性发作先于偏头痛(6个月至9年),19例中普通型偏头痛者14例,普通型兼基底动脉型1例,普通型兼典型性者1例,偏瘫型1型,典型性偏头痛2例。复杂性发作中,精神运动性发作者3例,情感障碍性发作3例,精神感觉性发作6例,复合性发作3例,认识障碍性发作5例。在11名患者中,发作伴随猝倒、尿失禁、局灶性运动性发作或全身     

偏头痛与癫癎共病的临床特点

目的 探讨偏头痛与癫癎共病的临床特点.方法 回顾性分析67例偏头痛患者的临床资料.结果 67例偏头痛患者中有癫癎发作6例,其中为局灶性发作2例,全面性发作4例;脑电图有疒间样放电57例,其中6例癫癎患者还有暴发性节律.6例偏头痛和癫癎共病患者经丙戊酸钠治疗后偏头痛和癫癎发作均得到控制;脑电图恢复正常.结论 偏头痛与癫癎存在共病现象,丙戊酸钠治疗的疗效好.     

循证指南更新:成人发作性偏头痛预防的药物治疗

目的 提供偏头痛预防治疗的指南更新推荐,所提出的临床问题是什么样的药物治疗可有效预防偏头痛发作?方法作者对1999年6月-2009年5月间发表的研究使用结构式的评价程序来分类不同(美国可获得)药物对偏头痛预防的效果.结果 和推荐作者评价了284篇摘要,最后对29篇包含Ⅰ类或Ⅱ类证据的文章进行综述.双丙戊酸、丙戊酸钠、托吡酯、美托洛尔、普萘洛尔和噻吗洛尔能有效预防偏头痛,应该用于偏头痛患者以减少发作频率及程度(A级证据).夫罗曲坦可有效预防月经性偏头痛(A级证据).拉莫三嗪对偏头痛预防无效(A级证据).     

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.