2013年神经病学临床进展

通过回顾、分析2013年美国神经病学学会、国际抗癫痫联盟和其他学会发表和公布的诊断标准和治疗指南等,使更多的临床工作得到证据支持.<缺血性脑血管病患者围手术期抗栓药物管理指南>中试图解决在外科手术或其他医学操作中抗栓药物是否需要停用这一难题,并分别对阿司匹林、华法林和肝素进行了评估.在脑实质型囊虫病的治疗中阿苯达唑联合激素治疗得到了循证医学的支持,但是抗癫痫药物的疗效仍不明确.迟发性综合征的治疗方法多样,但疗效各异,药物治疗的证据水平不同.阿司匹林联合氯吡格雷治疗小卒中或短暂性脑缺血发作可降低脑卒中的发生率且不增加出血事件.同时他汀类药物在防治缺血性卒中/短暂性脑缺血发作中注重个体化治疗,并注意其安全性.迷走神经刺激治疗癫痫的适应证有限,疗效证据水平不高.各类初发癫痫的单药治疗有效水平各异,应慎重选择.阻塞性睡眠呼吸暂停治疗中强烈推荐进行减肥治疗,结节性硬化的诊断标准更加慎重,基因检测可单独确诊.

The main advances in neurology researches in 2013

Reviewing and analyzing the diagnostic criteria and treatment guidelines reported by American Academy of Neurology,and International League Against Epilepsy in 2013,more and more evidence supported the clinical work.The evidence-based guideline aims to deal with the periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease,and assesses aspirin,warfarin,and heparin.The indication of vagus nerve stimulation for epilepsy is limited,and the evidence level of the efficacy is low.The efficacy of antiepileptic drug as initial monotherapy for epileptic seizures is different and we should choose carefully.The patients diagnosed with obstructive sleep apnea should be encouraged to lose weight.The diagnostic criteria of tuberous sclerosis is complex,and genetic testing can be identified.Albendazole plus either dexamethasone or prednisolone should be considered for neurocysticercosis,but the efficacy of antiepileptic drugs is not clear.Many methods are probably useful in treatment of tardive syndromes,but the effects are different,and the evidence of drug treatment is diverse.Among patients with transient ischemic attack（TIA） or minor stroke who can be treated within 24 hours after the onset of symptoms,the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first 90 days and the therapy does not increase the risk of hemorrhage.In addition,individualized treatment and the safety of statins should be payed attention in the prevention of ischemic stroke or TIA.