趋化因子和神经病理性疼痛

神经病理性疼痛是一种常见症状,常规药物和外科治疗都难以治愈。为了研制针对这种神经病理性疼痛的新药,认识慢性疼痛的发生机制十分必要。临床观察已证实炎症通常会伴有神经病理性疼痛,而趋化因子在疼痛和炎症两方面都具有重要作用,这为寻找治疗神经病理性疼痛制剂提供了新思路。     

CCI 和 SNI 神经病理性疼痛动物模型的 认知功能研究进展

神经病理性疼痛常伴有情感和认知障碍的合并症,但其内在机制并不清楚。神经病理性 疼痛动物模型中坐骨神经慢性结扎（CCI）模型和坐骨神经分支选择性损伤（SNI）模型的行为和功能改变 与临床神经病理性疼痛症状更为相似,且可以诱发疼痛晚期神经精神障碍（焦虑样、抑郁样及认知障碍 等）,常被用于神经病理性疼痛认知功能的研究中。文章介绍两种动物模型的特点及其在神经病理性疼 痛改变认知功能研究中的应用,旨在为神经病理性改变认知功能的病理机制和干预研究提供帮助。     

神经病理性疼痛

神经病理性疼痛(NP)与糖尿病和哮喘一样为临床常见疾病,其患病率为6%~8%[1 2],严重影响患者工作和学习能力,以及生活质量。然而迄今为止,神经病理性疼痛的明确诊断与治疗对一般内科医师,甚至疼痛科或神经内科医师来说仍非易事。本刊特开辟"神经病理性疼痛"专栏,较系统地讨论其病理生理学机制、诊断策略、评价量表及治疗原则,希望能够起到"抛砖引玉"的作用,激起更多临床医师的兴趣,以利于深入开展神经病理性疼痛的     

神经病理性疼痛的发病机制研究进展

外周神经系统或中枢神经系统的损伤或功能紊乱引起的疼痛称为神经病理性疼痛。其发病率高,严重影响人们的生活质量[1]。大量动物实验表明神经病理性疼痛是由外周神经与中枢神经共同作用的结果。目前神经病理性疼痛的治疗仍然是临床上一个巨大挑战。其发病机制的阐明对寻找有效的治疗方法具有重要意义。本文就其发生机制研究进展综述如下。     

经皮穿刺射频温控热凝治疗神经病理性疼痛131例

目的探讨经皮穿刺射频温控热凝治疗神经病理性疼痛的疗效。方法对门诊及住院的顽固性神经病理性疼痛病人采用经皮穿刺半月神经节或外周神经,应用射频温控热凝毁损治疗神经病理性疼痛。结果共治疗各类神经病理性疼痛患者131例。其中三叉神经痛115例,偏头痛12例,带状疱疹后神经痛3例,开胸术后肋间神经痛1例。随访8~46个月,平均12个月。获得优良者106例(80.9%),良好21例(16.0%)。除原疼痛部位有不同程度的感觉减退外,无其他严重、永久并发症。结论采用经皮穿刺射频温控热凝治疗神经病理性疼痛操作安全,治疗效果良好,是一种微创治疗方法,具有较高临床实用价值。     

神经病理性疼痛治疗进展

目前,神经病理性疼痛(NP)的治疗进展主要表现为对传统镇痛药物作用的重新评价及微创介入治疗的广泛应用.近年来,对周围神经损伤所致病理性疼痛的分子和细胞学机制,特别是对初级感觉神经元和脊髓损伤的研究积累了丰富的资料,周围神经损伤、脊髓背根神经节(DRG)胞体损伤及背根神经损伤等动物模型的建立,为认识神经病理性疼痛的机制和筛选治疗药物提供了有力的工具.     

脑源性神经营养因子信号转导在神经病理性疼痛中的作用

神经病理性疼痛是一种常见并且严重影响人类健康的疾病,甚至可导致病人最终失去行动能力,全世界受此病困扰着达数百万人,因此成为神经科学研究的一个重要问题,但具体机制还不清楚。目前已经知道,神经病理性疼痛是由于手术等造成的神经损伤或糖尿病、带状疱疹、艾滋病,以及部分肿瘤等疾病产生的外周神经功能异常所引起,患者出现痛觉敏感的现象,对轻微的皮肤触摸产生较痛苦的感觉。目前对神经病理性疼痛的预防和治疗措施有限,因此加强在该领域的研究具有十分重要的意义。经过许多科学家的努力,最近的一系列研究表明一种神经营养因子———脑源…     

神经病理性疼痛外科治疗

由周围和(或)中枢神经系统原发性和(或)继发性损害、功能障碍或短暂性功能紊乱引起的疼痛,称为神经病理性疼痛,表现为以痛觉过敏、异常性疼痛和自发性疼痛为特点的综合征。神经病理性疼痛的外科治疗经历了较长的发展过程,在疼痛治疗中占有重要地位。本文主要对近年来关于神经病理性疼痛外科治疗研究进展,当前主要外科治疗手术技术(神经调控技术、神经损毁术及神经减压术等)进行概述。     

脊髓损伤后疼痛的临床特点分析

目的分析脊髓损伤后神经病理性疼痛的临床特点,以提高脊髓损伤疼痛诊疗水平。方法本研究回顾性分析2010年2月至2017年2月诊治的脊髓损伤患者。采用国际脊髓损伤后疼痛分类法、神经病理性疼痛量表和疼痛视觉模拟量表(VAS)对疼痛进行诊断、归类,采用t检验分析不同类型疼痛之间的差异,以P 0. 05为具有显著性统计学差异。结果本研究共纳入265例患者,213例患者存在慢性疼痛,其中246例(55. 1%)患者存在神经病理性疼痛,194例患者存在伤害感受性疼痛(73. 2%)。神经病理性疼痛和伤害感受性疼痛的平均VAS评分分别为7. 8±2. 1和5. 6±3. 1,两者存在显著性差异(P 0. 05)。结论脊髓损伤后疼痛是脊髓损伤患者常见的后遗症,神经病理性疼痛较伤害感受性疼痛程度更剧烈。     

Contribution of interleukin-1beta in neuropathic pain

炎性因子白细胞介素-1β(IL-1β)参与神经病理性疼痛的中枢和周围敏化过程,此为其特征性病理变化.IL-1β是介导中枢神经系统胶质细胞与神经元相互作用的重要炎性因子,其活化受到其他炎性因子的调控,如趋化细胞因子配体2(CCL2)和基质金属蛋白酶2、9(MMP-2、9)等.本文简要概述IL-1β在中枢性和周围性神经病理性疼痛中的主要作用机制.     

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.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.     

Introduction: Goals

Summary: Epilepsy is characterized by recurrent seizures. Many epilepsies with focal seizures as well as convulsive generalized seizures respond satisfactorily to antiepileptic drugs (AEDs) that reduce repetitive firing (e.g., phenytoin, carbamazepine, and valproate) or that augment GABA_A-mediated inhibition (e.g., phenobarbital and benzodiazepines). A number of drugs presently under development, such as NMDA receptor antagonists, loreclezole, losigamone, meth-ysticine, and dextromethorphan, are promising in acute animal models of otherwise drug-resistant convulsant activity. As a result of recent studies in both experimental models and surgically resected human epileptic brain, the prospects for development of AEDs have significantly improved. Several new AEDs recently have reached the commercial market or are in experimental or clinical trials. A comparative presentation of the standing of the new AEDs with respect to their efficacy and side effects is necessary, but still very difficult. Because initial experience with new AEDs is restricted to populations with severe drug-resistant epilepsy, the crucial question whether potential new AEDs can alter prognosis is not yet definitively answered. There is a clear need to compare the effects of standard AEDs and new AEDs in naive patients and over longer follow-up periods. Moreover, because of the strong desire to develop antiepileptic therapy that directly treats the primary etiology of a given epileptic syndrome , or modifies the neurobiological processes that cause recurrent seizures, better experimental epilepsy models for chronic epilepsy and further clinical studies are necessary to increase the knowledge on the pathophysiology of distinct epileptic syndromes. In this respect, studies on the differences between responders and nonresponders to a given AED treatment are extremely valuable.