奥拉西坦联合神经节苷脂治疗血管性痴呆疗效观察

目的评价奥拉西坦（ORC商品名倍清星）联合单唾液酸四己糖神经节苷脂（GM-1,商品名澳甘）治疗血管性痴呆（VD的临床疗效。方法本研究将112例血管性痴呆患者分为治疗组58例及对照组54例,所有患者均给于抗血小板、改善循环、对症支持治疗,治疗组给予奥拉西坦注射液4g,加入0.9%氯化钠注射液100mL,1次/d,神经节苷脂注射液100mg,加入0.9%氯化钠注射液250mL,1次/d,连续用药3周,分别于用药前及用药后,采用简易精神状态（MMSE）量表进行评价。结果 2组患者MMSE治疗后比治疗前均有提高（P〈0.05）,治疗组明显优于对照组（P〈0.05）,治疗过程中未发现明显不良反应。结论奥拉西坦联合单唾液酸四己糖神经节苷脂治疗血管性痴呆效果好,不良反应少。     

长春西汀联合脑蛋白水解物治疗血管性痴呆的疗效观察

目的观察长春西汀注射液联合脑蛋白水解物治疗血管性痴呆(VD)的临床疗效。方法 128例血管性痴呆患者随机分为2组,观察组和对照组各64例。治疗前和治疗后1个月进行简易智能检查(MMSE)和日常生活能力量表(ADL)评分,并进行对比分析。结果 2组治疗后MMSE和ADL评分均有明显改善(P0.05),观察组改善情况优于对照组(P0.05)。结论长春西汀注射液联合脑蛋白水解物治疗能明显改善血管性痴呆患者的认知功能和生活能力,疗效优于单纯脑蛋白水解物治疗,且安全性高。     

石杉碱甲联合尼莫地平治疗轻中度血管性痴呆的疗效观察

目的观察石杉碱甲联合尼莫地平治疗轻中度血管性痴呆的疗效及安全性。方法 80例血管性痴呆患者随机分为治疗组40例和对照组40例,在常规治疗基础上,对照组口服尼莫地平+吡拉西坦;治疗组口服尼莫地平+石杉碱甲。2组均治疗6个月。检测2组患者治疗前后MMSE、ADL、HDS-R评分及药物不良反应。结果治疗6个月后,2组患者的MMSE、ADL、HDS-R评分比治疗前均明显升高,差异有统计学意义(P<0.01或P<0.05);而治疗组MMSE、ADL、HDS-R评分改善更显著(P<0.01)。2组均未发生严重不良反应。结论石杉碱甲联合尼莫地平治疗轻中度血管性痴呆疗效显著优于吡拉西坦联合尼莫地平,安全性相同。     

丁苯酚软胶囊联合奥拉西坦注射液对血管性痴呆病人认知功能的影响及安全性分析

目的探讨丁苯酚软胶囊联合奥拉西坦注射液对血管性痴呆患者认知功能的影响及安全性。方法选取血管性痴呆患者80例,随机分为2组,每组40例,对照组采用奥拉西坦注射液治疗,研究组在使用奥拉西坦注射液治疗的基础上联合丁苯酚软胶囊治疗,2组均连续治疗1个月,治疗前后采用简易智能状态量表(MMSE)和日常生活能力量表(ADL)评价临床疗效,并观察不良反应发生情况。结果研究组治疗后MMSE评分明显增加,ADL总分显著下降,治疗前后比较差异具有统计学意义(P0.05),且研究组治疗后的MMSE评分明显高于对照组,ADL总分明显低于对照组(P0.05);2组在治疗过程均未出现明显不良反应。结论丁苯酚软胶囊联合奥拉西坦注射液治疗血管性痴呆的疗效确切,无明显不良反应,能明显提高病人的认知功能和生活质量,值得应用。     

石杉碱甲与尼莫地平治疗轻中度血管性痴呆的疗效及安全性评价

目的评价石杉碱甲联合尼莫地平治疗轻中度血管性痴呆的疗效及安全性。方法 160例血管性痴呆患者随机分为治疗组80例和对照组80例,在常规治疗基础上,对照组口服尼莫地平+吡拉西坦;治疗组口服尼莫地平+石杉碱甲。2组均治疗6个月。检测2组患者治疗前后MMSE、ADL、HDS-R评分及药物的不良反应。结果治疗6个月后,2组患者的MMSE、ADL、HDS-R评分比治疗前均明显升高,差异有统计学意义(P<0.01或P<0.05);而治疗组患者的MMSE、ADL、HDS-R评分改善更显著(P<0.01)。2组均未发生严重的不良反应。结论石杉碱甲联合尼莫地平治疗轻中度血管性痴呆疗效显著优于吡拉西坦联合尼莫地平,安全性相同。     

奥拉西坦联合丁苯酞治疗血管性痴呆40例疗效观察

目的探讨奥拉西坦联合丁苯酞治疗血管性痴呆的临床效果。方法选择我院2008-10—2010-10血管性痴呆患者80例,随机分为观察组和对照组。2组患者均控制血压、血糖、调脂等对症治疗。观察组患者给予奥拉西坦联合丁苯酞软胶囊治疗,奥拉西坦注射液4g加入生理盐水注射液250mL中静滴,1次/d;同时服用丁苯酞软胶囊0.2g,3次/d;对照组给予奥拉西坦注射液4g加入生理盐水注射液250mL中静滴,1次/d。1个月为1个疗程,2组患者均治疗1个疗程。2组患者在治疗前和治疗后分别采用简易智力状态量表（MMSE）、日常生活活动能力量表（ADL）进行评分。结果观察组治疗前MMSE、ADL和对照组治疗前比较,差异无统计学意义（P〉0.05）;观察组治疗后MMSE、ADL分别与对照组治疗后比较,差异有统计学意义（P〈0.05）。结论奥拉西坦联合丁苯酞能够显著提高血管性痴呆患者认知功能,提高日常生活活动能力,临床效果显著,值得借鉴。     

天智颗粒联合奥拉西坦治疗轻中度血管性痴呆临床观察

目的研究天智颗粒联合奥拉西坦治疗轻中度血管性痴呆的临床疗效和安全性。方法将80例轻中度血管性痴呆患者随机分为2组,治疗组40例用天智颗粒联合奥拉西坦治疗;对照组40例用同等量奥拉西坦治疗,疗程60 d。治疗前后进行简易智力状态量表(MMSE)和日常生活能力量表(ADL)评定。结果 2组患者治疗后的MMSE和ADL评分较治疗前差异均有统计学意义(P<0.05);组间比较,治疗组评分改善明显优于对照组,无明显不良反应。结论天智颗粒联合奥拉西坦治疗轻中度血管性痴呆安全有效。     

单唾液酸四已糖神经节苷脂联合康复治疗对老年脑梗死患者的疗效

目的观察单唾液酸四己糖神经节苷脂联合康复治疗对老年脑梗死的临床效果。方法 118例老年脑梗死患者随机分为对照组和观察组,2组均给予常规对症支持治疗+康复治疗。对照组在常规治疗的基础上加用胞二磷胆碱治疗,观察组在常规治疗的基础上加用单唾液酸四己糖神经节苷脂治疗。观察2组治疗前后肢体功能恢复情况,生活质量改善情况及TNF-α、IL-6、CRP改善情况。结果 2组治疗后FMA积分均显著优于治疗前,观察组改善效果更显著。2组治疗后ADL评分均显著优于治疗前,观察组改善效果更显著。2组治疗后TNF-α、IL-6、CRP水平均较治疗前下降,观察组降低更显著。结论单唾液酸四己糖神经节苷脂联合康复治疗脑梗死疗效显著,值得临床推广应用。     

神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍的疗效分析

目的观察神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍的临床疗效,为临床治疗提供理论依据。方法选取2011-06—2014-06我院收治的颅脑损伤后存在认知功能障碍患者98例,将其分为观察组与对照组,每组49例。对照组给予神经节苷脂治疗,观察组在对照组基础上给予高压氧治疗。对2组患者临床疗效进行观察与比较。结果观察组总有效率83.7%高于对照组的61.2%,差异有统计学意义(P0.05);2组治疗前MMSE评分及Barthel评分比较差异均无统计学意义(P0.05);与治疗前比较,治疗后2组MMSE评分及Barthel评分均明显提高,差异均具有统计学意义(P0.05);与对照组比较,观察组治疗后MMSE评分及Barthel评分改善情况更显著,差异有统计学意义(P0.05)。结论神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍具有显著临床疗效,能使患者认知功能及日常生活活动能力有效改善,值得临床进一步推广应用。     

奥拉西坦＋尼莫同治疗血管性痴呆的疗效分析

目的观察奥拉西坦联合尼莫同治疗血管性痴呆的临床疗效。方法将83例血管性痴呆患者随机分为治疗组和对照组;治疗组42例,对照组41例;治疗组应用奥拉西坦4 g＋0.9%NaCI溶液250 ml,静滴,1次/d,尼莫同30 mg口服,3次/d,12周为1个疗程;对照组给予胞磷胆碱0.75 g＋0.9%NaCI溶液250ml,1次/d,静滴,脑复康0.8 g,口服,3次/d,12周为1个疗程。治疗前、后分别测定Folstein简易精神状态检查量表（MMSE）和日常生活活动量表（ADL）。结果 2组治疗前后MMSE评分和ADL评分差异显著（P〈0.01）;2组治疗后MMSE评分及ADL评分差异显著（P〈0.01）。结论奥拉西坦联合尼莫同治疗血管性痴呆安全有效。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.