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1.
目的 探讨以过度运动为主要发作症状的颞叶癫痫患者的临床与电生理特点。方法 回顾性分析广东三九脑科医院经立体定向脑电图(SEEG)证实的,以过度运动为主要发作症状的10例颞叶癫痫患者的临床资料;分析其症状学及脑电图特点。结果 本组患者中,以颞叶内侧结构起始的患者7例,以颞叶新皮层起始的患者2例,以颞叶内外侧同步起始的患者1例。其中9例患者有发作前兆;所有患者均在过度运动发作的同时,伴有不同程度的自动运动(轻微的咂嘴、抿嘴、嘟嘴、手的摸索)和发作起始对侧肢体的肌张力障碍。SEEG均以周期性节律性棘-慢波→低波幅快活动为发作起始图形;脑电图起始至出现过度运动或自动运动的时间平均为65 s。结论 以过度运动为主要发作症状的颞叶癫痫,其致痫区可以是颞叶内侧结构或颞叶新皮层。以过度运动为主要发作症状学,伴先兆、自动运动和对侧肢体的肌张力障碍,提示为颞叶起源的癫痫;先兆和自动症是颞叶癫痫与额叶癫痫鉴别的要点,可与额叶癫痫相鉴别。颞叶癫痫出现过度运动可能是同时或先后激活了额叶的腹内侧网络和颞岛网络所致。  相似文献   

2.
正背景惊吓性发作是由突然不可预知的刺激诱发的癫痫发作。诱发因素主要是突然的声音刺激,本体感觉和少数的视觉刺激也可能诱发发作。"惊吓"为受到出乎意料的突然刺激的结果,作为一种诱发因素,是刺激和发作的链接。2001年国际癫痫分类方案中将惊吓性癫痫列为反射性癫痫的一种综合征。大多数患有该综合征的患者有症状性癫痫。病因学、脑结构异常、临床发作类型和脑电图(EEG)特征往往存在很大的变化。惊吓性癫痫相对少见,其相关研究主要为个案报告。Tibussek等最近报道了22例惊吓性癫痫患者的症状学和电生理特征。本文对11例惊吓性癫痫患者的临床特征及电生理特征进行总结。  相似文献   

3.
脑皮层电刺激对功能区和癫痫发作起始区的确定作用   总被引:2,自引:1,他引:1  
目的评估皮层电刺激功能区的确定的可靠性和对癫痫发作起始区的辅助定位作用。方法19名患者,在最怀疑的区域进行颅内电极置入,条状电极和格子电极均采用。颅内电极置入后,手术后关闭手术切口,患者返回脑电监测室进行1~2周的长程视频颅内脑电监测,期间对患者的发作间期和发作期脑电图进行分析和进行脑皮层电刺激功能区测定。皮层电刺激方式本临床实验采用的脑皮层电刺激参数是50Hz,0.2ms电脉冲刺激。结果脑皮层功能区测定19例患者中,发作起源区与重要的皮质功能区(运动、感觉、语言、视觉)范围紧邻或有重叠的有7例。脑皮层电刺激癫痫发作诱发19名患者中,18名患者人为通过颅内电极电刺激诱发出患者的发作先兆或发作,诱发脑皮质位置均包含皮层脑电记录所确定的癫痫发作起始区,电刺激诱发先兆或发作的可重复率为94.7%。手术并发症1例患者发生永久性局限视野缺损(术后7个月复查仍未改善),缺损为左上视野区;1例患者电极埋藏术后出现一过性失语,2天后该症状缓解,切除术后未发生失语;1例患者术后3天内反应时有“星星闪光”样视幻觉,后未经特殊处理,自愈。所有其他患者经过检查,术后无神经功能和神经心理损害发生。结论皮层电刺激确定的神经功能区可靠性好,是避免手术并发症的保证,同时电刺激对癫痫发作起始区的确定有良好的辅助作用。  相似文献   

4.
目的:了解门诊癫患者正规服药情况及其影响因素.方法:应用自编癫患者遵医服药行为调查表,对本院门诊的癫痫患者及病情介绍人进行问卷调查统计.结果:184例癫痫患者中遵医嘱服药率为55.4%,全身强直-阵挛发作患者遵医服药率最高占58.9%,最低为失神发作,采用非条件Logistic回归进行分析显示发作类型、服药种类、服药效果、家庭照顾、经济水平及对医嘱清楚程度等与遵医服药率有关.结论:台州市门诊癫患者遵医服药率较低.影响遵医服药的因素是多方面的.  相似文献   

5.
目的探究我国西北地区症状性癫痫的临床特点及预后危险因素。方法回顾性分析216例症状性癫痫的临床特点,并依据治疗后发作控制情况分为有效组与无效组,采用Logistic回归分析影响症状性癫痫预后的相关因素。结果 20岁以下起病者162例(75.0%),部分性发作152例(70.4%);病因中以脑发育异常(23.6%)、脑外伤(15.7%)、围产期损伤(12.0%)、颅内感染(11.6%)、海马硬化(9.3%)居多;并且脑发育异常、围产期损伤、颅内感染主要发生于10岁以下的患者,脑血管病和脑外伤则为30岁以上患者的主要病因;与基础期相比69.0%的患者疾病控制情况良好,其中28.2%患者6个月以上无发作,23.6%患者发作减少≥75%,17.1%患者发作减少50%~75%;剩余31.0%患者则发作减少50%或是无明显改善。患病时间、口服抗癫痫药种类、服药依从性在有效组与无效组间有显著差异(P0.05)。进一步的Logistic回归分析显示,患病时间长可能为西北地区症状性癫痫预后不良的危险因素(比值比=1.048,95%置信区间:1.009~1.091)。结论我国西北地区症状性癫痫患者发病年龄小,脑发育异常为主,患病时间长为其预后不良的危险因素;早期诊断和正规的抗癫痫治疗对于改善预后有重要意义。  相似文献   

6.
氯氮平与癫痫发作   总被引:3,自引:0,他引:3  
氯氮平治疗对目前通用的精神药物不能耐受的难治性精神分裂症有效,且极少引起锥体外系副作用及迟发性运动障碍。但据报道,该药除能引起1%~2%的粒细胞缺乏症外,还能引起较其它抗精神药物较高的癫痫发作,且与服药剂量有关,当服药量为600~900mg/日时,癫痫发病率为5%;服药量300~599mg/日时,发病率为3%~4%;服药量低于300mg/日时,发病率为1%~2%。本文报道了4例服用氯氮平治疗量或低于治疗量引起癫痫发作的病例,并介绍解  相似文献   

7.
作者对6例精神药物所致癫痫发作进行临床分析,发现多发生于用药早期,增量、减量均可诱发,经及时处理,预后较好。提出了避免或减少癫痫发作的建议。  相似文献   

8.
目的探讨伴随癫痫的颅内疾病病人在高压氧治疗时的安全防护方法。方法回顾性分析2008年7月至2015年12月行高压氧治疗的127例伴随癫痫的颅内疾病的临床资料,在进舱前、氧舱内和出舱后进行安全护理。结果 127例中,安全进行高压氧治疗79例;有癫痫发作先兆,调整治疗时间避免在舱内发作26例;在舱内癫痫发作中断治疗5例;在舱内癫痫发作经处理后继续治疗17例。结论伴随癫痫的颅内疾病病人高压氧治疗前充分准备,认真评估病情,预防诱发因素,制定个性化治疗方案,在高压氧舱内密切观察和应急处理癫痫发作是安全治疗成功的关键。  相似文献   

9.
通常认为癫痫发作是自发的,但许多研究发现癫痫发作与患者所处环境、自身生理和心理因素存在一定关联。与反射性癫痫的诱发因素不同,这些诱因多是非特异、不明显、多因素共同作用的。虽然癫痫发作的诱因广泛存在,但对其研究较少,国内无相关研究;同时也是临床研究难点,因为临床上很难确定癫痫发作和诱发因素之间的确切关系,不同患者,特别是不同种族的患者,其诱发因素也不尽相同,同一患者可伴有多种诱发因素,很难确定哪种诱因起主要作用,这些均是临床研究的瓶颈。另一方面,癫痫患者及其家属极为关注癫痫的诱发因素,这成为困扰患者及临床医生的难题。然而,了解癫痫发作的诱因不仅有助于预防、减少癫痫发作,也有助于阐明癫痫的病理生理机制,从而更加有效地控制癫痫发作。文章对癫痫发作诱因的研究现状进行综述,以供临床医生参考及进一步研究。  相似文献   

10.
目的:分析反射性癫痫患者的临床特征和辅助检查,随访患者判断预后。方法:回顾性研究我院癫痫门诊1999年1月~2006年6月就诊的反射性癫痫患者37例。结果:麻将、扑克诱发者16例,电脑游戏、电视诱发者13例,麻将、扑克、电脑游戏、电视均能诱发者4例,象棋诱发者1例,狗叫、电话等刺耳声音诱发者1例,进餐诱发1例,阅读诱发1例;对33例随访研究显示;6例仍有发作。结论:反射性癫痫患者应避免诱发因素,必要时抗癫痫药物治疗,其预后较好。  相似文献   

11.
PURPOSE: To assess subjective seizure anticipation in patients with focal and generalized epilepsy. METHODS: Five hundred consecutively recruited out-patients (251 male, 249 female, mean age 38.1 year) from three German tertiary epilepsy referral centres filled out questionnaires regarding subjective anticipation of seizures by at least 30 min and to timing and semiologic characteristics of their premonitory symptoms versus those of ictal phenomena. Patients were not regarded as having prodromi if the semiology of symptoms reported long before a seizure was identical to auras. RESULTS: 6.2% of patients reported that they were able to anticipate seizures. Premonitory symptoms were classified as stereotyped in all but one patient. An intraindividual semiologic analysis showed that the majority of these patients had symptoms, which were distinct from ictal experiences during auras. Seizure anticipation was reported both by patients with focal and idiopathic generalized epilepsy. The median estimated time interval between occurrence of premonitory symptoms and seizure onset was 90 min. CONCLUSIONS: This study gives evidence that both patients with focal and idiopathic generalized epilepsy may subjectively anticipate the occurrence of epileptic seizures. Premonitory symptoms are distinct from auras in terms of semiology and time of occurrence. The lower percentage of patients regarded as having premonitory symptoms as compared to some earlier reports may be related to stricter criteria and to the exclusion of auras, which could directly evolve into seizures, and other ictal events. Premonitory symptoms occur at similar periods prior to seizures as anticipatory EEG-changes have been reported using methods from time series analysis.  相似文献   

12.
OBJECTIVE: To determine incidence of and risk factors for sudden unexpected death in epilepsy (SUDEP). METHODS: Three epilepsy centers enrolled 4,578 patients and prospectively followed these patients for 16,463 patient-years. The cohort was screened for death annually. Deaths were investigated to determine whether SUDEP occurred. Potential risk factors were compared in SUDEP cases and in controls enrolled contemporaneously at the same center. RESULTS: Incidence of SUDEP was 1.21/1,000 patient-years and was higher among women (1.45/1,000) than men (0.98/1,000). SUDEP accounted for 18% of all deaths. Occurrence of tonic-clonic seizures, treatment with more than two anticonvulsant medications, and full-scale IQ less than 70 were independent risk factors for SUDEP. The number of tonic-clonic seizures was a risk factor only in women. The presence of cerebral structural lesions and use of psychotropic drugs at the last visit were not risk factors for SUDEP in this cohort. Subtherapeutic anticonvulsant levels at the last visit were equally common in the two groups. No particular anticonvulsant appeared to be associated with SUDEP. CONCLUSIONS: These results support the idea that tonic-clonic seizures are an important proximate cause of SUDEP. This information creates a risk profile for SUDEP that may help direct preventative efforts.  相似文献   

13.
2005年住院精神疾病患者药物治疗时点调查   总被引:17,自引:1,他引:16  
目的:了解住院精神疾病患者精神药物的应用情况及其演变。方法:采用一日法对上海精神卫生中心679例住院精神疾病患者的精神药物应用状况进行调查,将其结果与2004年和2002相比较。结果:精神药物的使用频度发生了显著变化;新型精神药物的使用正在逐渐增多;精神药物的使用剂量基本都在安全范围之内。结论:精神药物应用的多样性已是一种趋势。  相似文献   

14.
精神病院住院患者并发乙型肝炎28例临床分析   总被引:10,自引:0,他引:10  
28例精神疾病合并乙型肝炎的患者与同期无精神疾病的乙型肝炎病人作比较,其临床表现、体征与肝损害程度有较大差异,且疗效差,表明精神疾病患者罹患乙型肝炎较一般肝炎患者为重。提出在精神病院应重视合并存在的躯体疾病。  相似文献   

15.
Sang-Ahm Lee  Young-Joo No 《Seizure》2005,14(2):100-105
Many patients with epilepsy have warning symptoms prior to seizure onset, and some of these individuals report the ability to abort or prevent these seizures. We investigated the clinical characteristics of perceived self-control of seizures in 174 patients with uncontrolled partial epilepsy. The warning symptoms were categorized as premonitory (prodrome) and as initial symptoms of simple partial seizure onset, depending on the relationship between the warning events and the ensuing seizures. About 50% of the patients with simple partial seizure onset and about 70% of those with prodrome or premonitory symptoms reported that they could abort or prevent their seizures by various self-developed techniques. Patients who attempted to abort or prevent their seizures reported success rates as high as 80%. The proportion of patients with secondary generalized seizures was significantly lower in patients who tried to abort their seizures than in those who did not (p<0.05). The ability to prevent seizures was significantly higher in patients with brain lesions on MRI than in those without lesions (p<0.05). These results suggest that spontaneously developed methods are helpful in controlling seizures in some patients with uncontrolled partial epilepsy and that the potential success of self-control methods may be influenced by structural abnormalities on brain MRI.  相似文献   

16.
This paper presents the usage of psychotropic drugs by all general inpatients of a Boston teaching and referral hospital on a randomly chosen weekday. Of all surveyed inpatients, 42.8% were receiving at least one psychotropic medication. Sleep medications were the most frequently prescribed class of psychotropic drugs and flurazepam was the most commonly prescribed of all drugs. Phenothiazine and neuroleptics were given to control agitation, pain, or nausea, rather than psychosis. Antidepressants were prescribed without notated justification in the medical record, and if given for depression, were underdosed. Diazepam was the most frequently prescribed antianxiety drug and was the most frequently prescribed psychotropic drug after flurazepam. Psychotropic drug polypharmacy was common, with the average patient receiving seven different drugs. Remedial approaches to this widespread problem are recommended.  相似文献   

17.
OBJECTIVES: To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients. METHODS: 425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient. RESULTS: Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used. CONCLUSION: Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.  相似文献   

18.
ObjectiveTo explore which patient characteristics are associated in naturalistic conditions with the lifetime use of homeopathic treatment for psychiatric symptoms.MethodLifetime use of psychotropic treatment was explored in a sample of 36,785 persons, participating in the Mental Health Survey in the General Population. Characteristics associated with use of homeopathic treatments, associated or not with conventional psychotropic drugs, were explored using multivariate analyses.ResultsUse of homeopathic treatment for psychiatric symptoms was reported by 1.3% of persons. Younger age, female gender and high educational level were associated with use of homeopathy. Half of homeopathy users presented at least one Mini International Neuropsychiatric Interview (MINI) diagnosis, most frequently anxiety disorders. Their diagnostic profile was similar to that of persons reporting use of anxiolytics or hypnotics. Compared to persons with no lifetime use of psychotropic drugs, persons using homeopathy were more likely to present with a diagnosis of mood disorder or anxiety disorder. Compared to those using conventional psychotropic drugs, they presented less frequently with psychiatric disorders, with the exception of anxiety disorders.ConclusionHomeopathic treatment for psychiatric symptoms appears to be used mainly to reduce anxiety symptoms in the general population.  相似文献   

19.
20.
精神分裂症阴性症状与抑郁的相关性   总被引:2,自引:0,他引:2  
目的:探讨精神分裂症阴性症状与抑郁的关系。方法:对符合CCMD-2-4诊断标准的精神分裂症50例住院患者的症状,为阳性症状和阴性症状量表(PANSS)进行评定,并对阴性症状和抑郁症状作多因素相关分析。结果:因子中N7与G6正相关,N1、N3、N4、N6与抑郁总分负相关,N5、N7、减分与G6减分正相关。结论:阴性症状部分因子与抑郁相关,但并非继发于抑郁。  相似文献   

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