3-硝基丙酸诱导继发性肌张力障碍大鼠模型的行为学研究

目的 观察3-硝基丙酸(3-NP)诱导的继发性肌张力障碍大鼠模型的行为学变化,以建立一个可靠的继发性肌张力障碍动物模型.方法 36只雄性SD大鼠按随机数字表法分为3组,每组各12只,前2组为实验组(低剂量组立体定向注射2000 nmol 3-NP至大鼠左侧尾壳核,高剂量组立体定向注射4000nmol 3-NP),第3组为对照组(注射等体积生理盐水).术后观察大鼠头部扭转和自主行为变化,平板实验观察大鼠通过时间及步幅.结果 实验组大鼠给药后开始出现姿势障碍,头部向同侧扭转,其中高剂量组扭转评分明显大于低剂量组,比较差异有统计学意义(P＜0.05).平板实验结果显示:实验组大鼠通过时间较对照组明显延长,步幅较对照组明显变小,比较差异有统计学意义(P＜0.05),且偏于木板一侧行走,症状随剂量增加而加重.对照组大鼠术后第2天基本恢复术前状态,无头部偏转,均顺利通过木板实验.结论 大鼠尾壳核注射3-NP可诱导产生稳定的继发性肌张力障碍动物模型.     

丘脑底核电刺激术治疗原发性肌张力障碍

目的观察双侧丘脑底核(STN)脑深部电刺激(DBS)治疗原发性肌张力障碍的疗效。方法回顾性分析8例接受双侧STN-DBS的原发性肌张力障碍病人的临床资料。分别在术前和术后1、3、6个月进行Burke-Fahn-Marsden肌张力障碍评分(BFMDRS)和帕金森病综合评分量表(UPDRS),计算两项评分改善率,评价治疗效果。结果 BFMDRS和UPDRS评分的改善率:术后1个月其均值分别为47%和48%,术后3个月为69%和73%,术后6个月为75%和79%。结论 STN-DBS可有效改善原发性肌张力障碍病人的症状,术后疗效稳定。STN是DBS治疗原发性肌张力障碍的理想靶点。     

颅内电极长程记录在颞叶癫痫定位中的应用

目的 探讨颅内电极长程记录在颞叶癫痫定位、定侧中的应用,评价其临床价值.方法 2006年1月至2010年10月北京天坛医院神经外科60例经颅内电极定位的颞叶癫痫患者,电极类型采用硬膜下条状、栅状以及深部电极,手术方式包括颅骨钻孔电极植入、立体定向深部电极植入和骨瓣开颅电极植入.结果 额-颞皮层电极植入34例,额-颞前-颞枕交界电极植入7例,双颞皮层电极植入7例,深部电极联合颞叶皮层电极植入7例,颞前-颞枕交界电极植入3例,条状电极联合栅状电极植入2例.手术方式包括前颞叶切除术50例,联合额叶致痫灶切除7例,联合胼胝体切开1例,颞后枕新皮层痫灶切除联合海马杏仁核切除2例.结论 颅内电极长程记录是一种有效的检查方法和重要的定位手段,可应用于无创评估方法难以定位、定侧的颞叶癫痫.     

丘脑前核电刺激对癫痫大鼠海马葡萄糖代谢的影响

Background Electrical stimulation of the anterior nucleus of the thalamus (ANT) appears to be effective against seizures. In this study, we investigated changes in glucose metabolism during high frequency stimulation of ANT in epileptic rats. Methods Three groups of rats were used: (1) a stimulation group (n = 12), (2) a sham stimulation group (n = 12) with seizures induced by stereotactic administration of kainic acid (KA), and (3) a control group (n = 12) with sham surgery. Concentric bipolar electrodes were stereotaxically implanted unilaterally in the ANT. High frequency stimulation was performed in each group except the sham stimulation group. Microdialysis probes were lowered into the CA3 region of the hippocampus unilaterally but bilaterally in the stimulation group. The concentrations of glucose, lactate and pyruvate in dialysate samples were determined by an ISCUS microdialysis analyzer. Results The extracellular concentrations of lactate and lactate/pyruvate ratio (LPR) of epileptic rats were significantly higher than in control rats. However, no significant difference in the concentration of glucose and pyruvate was found between these groups. Electrical stimulation of ANT induced decreases in lactate and LPR in the ipsilateral hippocampus (KA injected) of the stimulation group, but it did not influence the glucose metabolism in the contralateral hippocampus. Conclusions This study demonstrated that the glycolysis was inhibited in the ipsilateral hippocampus of epileptic rats during electrical ANT stimulation. These findings may provide useful information for better understanding the mechanism of ANT-DBS.     

影响双额脑挫伤临床恶化及预后的危险因素

 目的 探讨影响双额脑挫伤临床症状恶化和预后的相关危险因素。方法 回顾性研究2011-03到2013-03医院收治的双额脑挫裂伤患者,收集并分析患者年龄、性别、受伤机制,入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)、影像学表现等临床信息,分析影响临床症状恶化出现的相关危险因素;并对患者进行伤后1年随访,格拉斯哥结局量表(Glasgow outcome scale, GOS)评价临床预后并分析影响患者预后的相关因素。结果 入组患者共112例,17例出现临床恶化,预后不良者(GOS分级,Ⅰ~Ⅱ级)15例,预后良好者(GOS分级,Ⅲ~Ⅴ级)95例。患者性别(P=0.0039)、GCS评分(P=0.0063)、环池闭塞(P=0.0426)、血肿体积(P<0.0001)与临床症状恶化显著相关,年龄(P=0.0004)、GCS评分(P=0.0424)、鞍上池闭塞(P=0.0047)、血肿体积(P<0.0001)、SAH(P=0.0145)显著影响患者临床预后。结论 GCS评分及影像学表现是影响双额脑挫伤患者预后和临床症状恶化的重要评价指标。
     

迷走神经刺激术治疗顽固性癫痫初步探讨

Objective To investigate the effectiveness of vagus nerve stimulation (VNS) therapy in intractable epilepsy. Methods VNS were performed in twenty - one patients. The generator was turned on 2 weeks after operation. Stimulation parameters were adjusted gradually. The output currents adjusted from 0.25 mA, and less than 3.0 mA. Stimulative time was 30 s ON and 5 min OFF, the frequency was from 20to 30 Hz, and the pulse width was from 250 μs to 1000 μs. The patients were followed up so as to analysis the effectiveness. Results After4 - 16 months of intermittent stimulation of the vagus nerve, grade Ⅰ in 3 patients, grade Ⅱ in 7 patients, grade Ⅲ in 9 patients and grade Ⅴ in 2 patients. Among them, seizure frequency was reduced over 50% occurred in 10 patients. Conclusion VNS can reduce seizure frequency,improve the quality of life in patients with intractable epilepsy, and it is a minimal invasive surgery with few side effects.     

原发性典型与不典型三叉神经痛微血管减压术的疗效分析

目的 评价微血管减压术(MVD)对原发性典型三叉神经痛(CTN)和不典型三叉神经痛 (ATN)的治疗效果,并从病因学角度探讨产生不同术后效果的原因.方法 本文采用Barrow神经科学研究所面部疼痛评分标准,将168例原发性三叉神经痛病例疼痛水平分为Ⅰ～Ⅴ级.结果 MVD后早期,92.7%的CTN达Barrow I级;97.6%达Barrow ≥Ⅱ级;86.4%的ATN达Barrow Ⅰ级;95.5%达Barrow ≥Ⅱ级.平均随访5.2年,88.6%的CTN达Barrow ≥Ⅱ级;55.3%的ATN达Barrow ≥Ⅱ级.结论 术后早期二者治疗效果无明显差异(P=0.202).ATN可能存在血管压迫以外的起病因素或因神经轴突受损严重,造成ATN术后远期效果差,疼痛复发率高(P<0.05).     

脑深部电刺激治疗药物难治性抽动秽语综合征的疗效观察

目的探讨脑深部电刺激(DBS)治疗药物难治性抽动秽语综合征(TS)的临床疗效, 初步观察以苍白球内侧部(GPi)与以中央中核-束旁核复合体(CM-Pf)为靶点的DBS在改善抽动症状方面的差异。方法回顾性分析2006年10月至2023年1月于首都医科大学附属北京天坛医院神经外科学中心接受DBS治疗且随访时间≥12个月的40例TS患者的临床资料。其中33例为GPi-DBS组, 7例为CM-Pf-DBS组。随访术后6、12个月患者临床症状的改善情况。临床症状的主要评估指标为耶鲁综合抽动严重程度量表(YGTSS)评分, 次要评估指标为贝克抑郁量表(BDI)、汉密尔顿抑郁量表(HRDS)、医院焦虑和抑郁量表(HADS)、耶鲁布朗强迫症严重程度量表(YBOSC)评分。对比分析两组YGTSS评分的改善情况。结果 40例患者术前, 术后6、12个月的YGTSS评分分别为(63.6±14.2)分、(42.0±15.0)分、(36.1±16.9)分, 差异有统计学意义(P<0.001);术后6、12个月YGTSS评分的改善率分别为(33.7±19.0)%、(43.1±23.3)%。BDI(24例)、...     

颅内电极长程记录在癫痫外科中的应用价值

目的 探讨颅内电极长程记录在癫痫外科中的应用时机以及方法,评价其应用价值.方法 回顾性分析112例颅内电极植入患者的临床资料,包括电极类型、部位、电极植入方式以及并发症.结果 单纯硬膜下条状皮层电极植入87例,条状电极和深部电极联合植入9例,栅状电极植入13例,条状电极和栅状电极联合植入3例.左侧26例,右侧32例,双侧54例,监测时间24-192 h.脑脊液漏15例,胃肠道反应9例,脑脓肿2例,硬膜外血肿1例,术中硬膜下少量出血1例,无死亡病例.结论 颅内电极长程记录是确定癫痫致痫灶重要的定位手段,可应用于无创评估方法难以确定的致痫灶.