症状性枕叶癫(癎)术前致(癎)灶评估及疗效分析

目的:探讨36例症状性枕叶癫(癎)的术前评估和3年以上的随访结果.方法:采用长程视频脑电图(V-EEG)监测结合皮层脑电图(EEG)定位的方法,对症状性枕叶癫(癎)患者行术前评估方法,结合病理结果和手术疗效进行回顾性分析.结果:在36例症状性枕叶癫(癎)患者中,29例(81％)依据长程V-EEG和MRI等无创检查不能精确定位致(痫)灶,需应用颅内电极记录定位.对所有术后患者随访3年以上,Engel分级:Ⅰ级21例(58％);Ⅱ级8例(22％);Ⅲ级4例(11％);Ⅳ级:3例(9％).结论:症状性枕叶癫(癎)的临床特点包括:具有视觉先兆、枕叶区域异常EEG及影像学改变的症状性枕叶癫(癎)患者,结合V-EEG和皮层EEG监测,手术切除致(痫)灶能获得良好手术效果,特别是致(痫)灶病理为神经节胶质细胞瘤和胚胎发育不良性神经上皮肿瘤预后良好.     

磁共振波谱对原发性癫痫患者海马病变的诊断价值

目的 探讨磁共振波谱(MRS)对原发性癫痫患者海马病变的诊断价值.方法 对38例原发性癫痫患者(癫痫组)和30例健康志愿者(正常对照组进行EEG、MRI和MRS检查.采用MRS检测双侧海马N-乙酰天门冬氨酸(NAA)、肌酸复合物(Cr)和胆碱复合物(Cho)的水平.结果 正常对照组EEG、MRI、MRS检查均无异常.癫痫组EEG检查发现痫样放电30例(78.9％);MRI检查发现海马异常15例(39.5％),其中双侧异常10例、单侧异常5例;MRS检查发现海马异常35例(92.1％),其中双侧异常30例、单侧异常5例.癫痫组病侧海马Cho/Cr和Cho/NAA显著高于对侧海马及正常对照组(均P＜ 0.001),NAA/(Cho+Cr)显著低于对侧海马及正常对照组(均P＜0.001).癫痫组病侧海马头部的NAA/(Cho+ Cr)明显低于体部及尾部(均P＜0.001).结论 MRS可提高原发性癫痫患者海马病变的检出率,且可显示海马的生化改变,对原发性癫痫具有很高的诊断价值.     

药物难治性癫痫MRI表现与脑电图及病理对照研究

目的 探讨药物难治性癫痫发作间期MRI与脑电图(EEG)在致痫灶定位中的相关性以及MRI表现的病理学基础.方法 对40例药物难治性癫痫患者术前行传统MRI及视频EEG检查,并对其中25例颞叶癫痫患者行弥散加权像扫描.手术方式包括标准颞前叶切除术、选择性海马杏仁核切除术及致痫灶切除术等,对切除的脑组织进行病理学检查.结果 33例患者传统MRI检查结果显示的异常包括:海马硬化(16例)、脑发育不良(5例)、颞极蛛网膜囊肿(3例)、颅内肿瘤(3例)、脑软化灶(2例)、脉络膜裂囊肿(2例)、脑软化合并颞极蛛网膜囊肿(1例)和小脑萎缩(1例).发作间期颞叶癫痫患者发作侧海马表观弥散系数(apparent diffusion coefficient,ADC)值[(102.1±4.7)×10-5 cm2/s]较对侧[(84.6±5.9)×10-5 cm2/s]明显升高(t=12.7,P<0.01).所有癫痫患者发作间期EEG均呈异常改变.24例患者传统MRI检查所示病变区与发作间期EEG定位的致痫灶部位一致,4例患者传统MRI检查显示正常而其发作侧海马ADC值却较对侧增高.结论 传统MRI与ADC同时用于评价致痫灶优于任一单独应用者,如结合EEG将更有助于对癫痫的术前评价.     

氯化锂-毛果芸香碱致(痫)大鼠海马髓鞘及少突胶质细胞系变化初步研究

目的 研究氯化锂-毛果芸香碱致(痫)大鼠不同时期海马髓鞘损伤及少突胶质细胞系变化.方法 健康成年雄性SD大鼠建立氯化锂-毛果芸香碱慢性癫(痫)模型,分为对照组、急性期组(致(痫)后24 h内)、潜伏期组(致(痫)后2周内)、慢性期组(致(痫)后2个月),各组(均n=4).采用伊文思蓝法检测各组大鼠海马血脑屏障(BBB)通透性改变;免疫荧光染色法检测海马神经元数目、髓鞘碱性蛋白(MBP)表达水平、2',3'-环核苷酸3'-磷酸二酯酶(CNPase)阳性成熟少突胶质细胞数目、未成熟少突胶质细胞标记物(04)表达水平、硫酸软骨素蛋白多糖(NG2)阳性少突胶质祖细胞数目.结果 大鼠致(痫)后,急性期组、潜伏期组和慢性期组大鼠海马各区域BBB通透性均较对照组增加(P＜0.05),以急性期组增加最为显著.各组大鼠海马不同区域NeuN阳性神经元数目均较对照组显著下降(P＜0.05).潜伏期组和慢性期组海马各区域MBP表达水平及CNPase阳性细胞数目均显著低于对照组(P＜0.05);各组海马CA1、Hilus区O4表达水平及NG2阳性细胞数目均较对照组显著增加(P＜0.05),以潜伏期组增加最为明显.结论 氯化锂-毛果芸香碱致(痫)大鼠海马区BBB通透性增加,未成熟少突胶质细胞和少突胶质祖细胞免疫荧光表达上调,髓鞘及成熟少突胶质细胞存在一定程度损伤.     

L-PGDS在匹罗卡品诱导癫(痫)大鼠海马组织中的表达及作用

目的:探讨脂质运载蛋白型前列腺素D合成酶(Lipocalin-type prostaglandin D syn-thase,L-PGDS)在匹罗卡品诱导的癫(痫)大鼠海马脑组织中的表达变化及意义.方法:35只SD雄性大鼠随机分成对照组和模型组,模型组依据观察时间点不同又分成建模后id、3d、7d、14 d、30 d和60d6个亚组,每组各5只大鼠.模型组大鼠用氯化锂-匹罗卡品诱导癫(痫)持续状态后,用蛋白免疫印迹检测大鼠海马组织内L-PGDS蛋白表达水平,并用免疫荧光双标技术对L-PGDS进行海马区细胞定位.结果:大鼠癫(痫)持续状态后第1天,海马组织内L-PGDS蛋白表达水平较对照组有所升高,随着时间的延长,L-PGDS蛋白表达水平逐渐升高,与对照组比较差异有统计学意义(P＜0.05).免疫荧光双标检测发现L-PGDS主要表达于神经元的树突和星型胶质细胞的胞质胞浆中.结论:L-PGDS在癫(痫)模型中表达异常升高,可能参与了癫(痫)的发生发展过程,有望成为临床癫(痫)诊断的一个分子标志物和新的抗癫(痫)药物治疗的靶点.     

杏仁核电点燃癫(痫)模型与氯化锂-匹罗卡品大鼠癫(痫)模型的对比研究

目的:探讨不同类型癫(痫)大鼠在急性期和慢性期反复自发性发作时、发作前后脑电图(EEG)相应指标改变以及行为学改变.方法:选取雄性SD大鼠40只,随机分为A、B、C、D4组.A组10只为杏仁核电点燃癫(痫)模型(不作电刺激)对照组;B组:10只,为制作杏仁核电刺激点燃癫(痫)模型组;C组:10只,氯化锂-匹罗卡品癫(痫)模型(只注生理盐水)对照组;D组:10只,制作氯化锂-匹罗卡品癫(痫)模型组.结果:D组慢性期发作时EEG频率与急性期频率相比差异有统计学意义(P＜0.05),与B组各时期相比差异有统计学意义(P＜0.05);D组慢性期发作后3 min发作频率与B组急性期相比差异有统计学意义(P＜0.05);A组与C组在频率、波幅方面比较差异无统计学意义(P＞0.05).结论:B、D两种不同类型的癫(痫)大鼠不同时期EEG和行为学都会发生相应的改变.     

额叶癫(痫)与颞叶癫(痫)的临床与电生理对比分析

目的:对比分析额叶癫(痫)、颞叶癫(痫)发作期临床及脑电图表现.方法:统计2011～2012年视频脑电图(V-EEG)监测中发作的额叶癫(痫)和颞叶癫(痫)各30例,进行病因、影像学以及发作间期、发作期脑电图(EEG)和临床表现对比分析.结果:额叶癫(痫)、颞叶癫(痫)在发作间期、发作期的EEG及临床表现均有各自典型特征,如额叶癫(痫)各年龄段均有发作,颞叶癫(痫)主要集中于成人,额叶癫(痫)发作间期EEG诊断意义不大,额叶癫(痫)发作间期EEG具有一定病灶提示价值,发作期颞叶癫(痫)有先兆者居多且多数为口及消化系统自动症,而额叶癫(痫)多为过度动作,动作夸张且易出现姿势性扭转强直等.结论:V-EEG监测对于具有发作期的额叶癫(痫)、颞叶癫(痫)的诊断具有重要价值.     

丰富环境促进颞叶癫(痫)大鼠神经发生及其机制的研究

目的 探讨丰富环境对颞叶癫(痫)大鼠齿状回新生细胞分化和存活的影响及其相关分子机制.方法 成年Wistar 大鼠随机分为4组:假手术组、丰富环境+假手术组、癫(痫)组、丰富环境+癫(痫)组,各组均n=15.大鼠侧脑室注射海人酸制作颞叶癫(痫)模型.丰富环境干预30 d后,应用免疫荧光技术观察大鼠海马齿状回的新生细胞分化和存活情况,用Western blot方法检测各组海马脑源性神经营养因子(BDNF)、cAMP应答元件结合蛋白(pCREB)、蛋白激酶A(PKA)表达水平.结果 丰富环境+假手术组、丰富环境+癫(痫)组齿状回新生细胞标记物(BrdU)和新生成熟神经细胞标记物(BrdU/NeuN)阳性细胞数分别多于假手术组、癫(痫)组(P＜0.05),而新生星形胶质细胞BrdU/GFAP阳性细胞数无统计学意义,并且丰富环境+假手术组、丰富环境+癫(痫)组海马BDNF和pCREB蛋白表达水平分别高于假手术组、癫(痫)组(P＜o.05),而PKA蛋白表达水平无增高.结论 丰富环境可能通过增强pCREB/BDNF通路促进成年颞叶癫(痫)大鼠海马齿状回的神经发生.     

生天南星对匹罗卡品癫(痫)模型鼠GABA能神经元的影响

目的:探讨生天南星对匹罗卡品癫(痫)模型鼠γ-氨基丁酸(GABA)表达的影响.方法:选取50只健康SD大鼠,采用腹腔注射氯化锂125 mg后予腹腔注射匹罗卡品150mg/kg,建立癫(痫)大鼠模型,获得Ⅲ级以上发作后,作为造模成功;癫(痫)造模成功后随机分成5组(癫闻模型组、丙戊酸钠治疗组、生天南星低剂量治疗组、生天南星中剂量治疗组、生天南星高剂量治疗组)给药4周后,麻醉处理后留取大鼠海马标本.采用免疫组织化学法,检测各组大鼠海马区GABA能神经元.结果:除空白对照组无癫(痫)样发作外,其余各组都出现Racine分级中的Ⅲ-V级(痫)样发作表现.丙戊酸钠治疗组、治疗各剂量生天南星治疗组GABA表达上调,与模型组比较,差异有显著意义(P＜0.01).结论:生天南星对氯化锂-匹罗卡品癫(痫)模型大鼠海马区内抑制性细胞GABA神经元有明显的上调作用,从而起到抑制神经元兴奋,抑制癫(痫)样过度放电、缓解癫(痫)症状的作用.     

拉莫三嗪治疗卒中后癫(癎)的疗效观察

目的 探讨拉莫三嗪治疗卒中后癫(痫)的临床效果和预后.方法 60例卒中后癫(痢)患者随机分为观察组30例和对照组30例,对照组采用丙戊酸钠治疗,观察组口服拉莫三嗪,比较2组癫(痫)复发情况.结果 观察组癫(痫)发作率13.3％,对照组发作率36.7％,2组比较差异有统计学意义(P＜0.05).结论 拉莫三嗪治疗卒中后癫(痫)效果较满意,且无明显不良反应,值得临床推广.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Origins of the sympathetic innervation of the cervical end of the uterus in the rat

A retrograde neuronal tracer (Fast Blue) was injected in the cervical end of the uterine horn of virgin rats. The majority of the retrogradely labeled post-ganglionic sympathetic neurons were found in the sympathetic chain (74%). The superior mesenteric ganglia, inferior mesenteric ganglia and suprarenal ganglia accounted for 22, 3 and <1%, respectively. The distribution of neurons in the sympathetic chain labeled from the uterus resembles that described for other pelvic organs.     

Topographical organization of the motoneuron pools that innervate the muscles of the pinna of the cat

The topographical organization of the 22 motoneuron pools that innervate the pinna muscles of the cat was examined by injecting the B-subunit of cholera toxin conjugated to horseradish peroxidase into individual muscles. All 22 pools are found in the facial nucleus, organized as rostro-caudally oriented columns, and arranged according to the action of the muscles they innervate. Pools innervating muscles that pull the pinna dorsally are located in the dorsal two thirds of the medio-dorsal subdivision, and those innervating muscles that pull the pinna ventrally are located in the ventral one half of the nucleus. Motoneurons innervating muscles that pull the pinna cranially are located laterally, those that pull the pinna caudally are located medio-ventrally, and those that change the shape of the pinna are located along the entire dorso-ventral extent in the center of the medio-dorsal subdivision. This topographical layout is consistent with the somatotopic organization of the entire facial nucleus as demonstrated in a variety of species. © 1995 Wiley-Liss, Inc.     

Histochemical methods for the further characterisation of the tumourettes of the posterior lobe of the pituitary

Summary The granular cell tumourettes of the posterior lobe of the pituitary possess neuraminic acid containing carbohydrate. After removal of neuraminic acid with neuraminidase and exposure to FITC (Fluorescein isothiocyanate) labelled peanut agglutinin (Arachis hypogaea) (PNA), intracellular receptor structures could be demonstrated. The significance of the findings is discussed.