多发性硬化42例临床分析

目的 探讨多发性硬化(MS)的临床特点、诊断和治疗.方法 分析42例多发性硬化患者的一般资料、病变部位、主要症状、重要辅助检查及其治疗方法和效果.结果 42例MS患者中青壮年女性多见,以急性、亚急性起病为主,首发症状以肢体无力最常见,病变部位以脊髓和视神经最常见,实验室检查以脑脊液蛋白水平和IgG指数增高常见.MRI异常率高达85.96%.结论 MS是一种临床表现复杂、累及中枢神经系统白质,多部位、多时相的自身免疫性疾病.根据临床特点、神经电生理、脑脊液免疫学及磁共振成像检查能提高临床确诊率,激素治疗对大多数病人有效.     

105例多发性硬化临床特点及治疗分析

目的 探讨多发性硬化的临床发病特点及临床治疗疗效.方法 从2005-01至2010-10月间收治的多发性硬化患者105例为研究对象.结果 105例患者中以20-40岁女性多见,以急性、亚急性起病,以肢体无力为首发症状最常见,病变部位多以脑和脊髓多见,脑脊液蛋白升高、IgG增高及寡克隆区带阳性常见,核磁共振较计算机断层扫...     

26例多发性硬化患者的临床与鉴别诊断

目的 分析26例临床确诊的多发性硬化(multiple sclerosis，MS)患者的临床资料。方法 回顾性总结临床确诊MS患者的临床表现、实验室检查以及影像学表现。结果 26例MS患者最常见的临床症状为肢体无力和感觉异常，其次为肌肉痉挛性疼痛、视力障碍、尿便异常、共济失调，个别患者可有周围神经改变。实验室检查示：脑脊液蛋白水平和IgG量增高最常见。磁共振(MRI)异常率高达90．9％。结论 MS是一种临床表现复杂、累及中枢神经系统白质多部位、病程表现多时相的自身免疫性疾病。但临床有周围神经症状及MRI发现皮层病灶也并非是排除MS的绝对标准。在诊断MS时，尤其对于单病灶或多病灶、单时相病程患者应从临床和影像学方面注意与脑梗死、脊髓疾病相鉴别。     

65例多发性硬化患者的临床分析

目的总结多发性硬化(MS)患者的临床特点(精神情感障碍)以及脑脊液、诱发电位、影像学改变进行分析。方法回顾分析65例MS患者的有关临床和实验室资料。结果65例中,男17例,女48例;年龄16~68岁,平均(36.5±14.1)岁,男女比为1∶2.8。MS首发及常见症状为感觉异常、肢体无力、视力减退及括约肌功能障碍,病变部位以脊髓受累最多见,部分患者存在精神情感障碍。结论出现感觉异常有助于MS早期诊断,诱发电位及MRI有助于发现亚临床病变;括约肌功能异常多见,可能与脊髓受累较多有关;MS患者的精神情感应受人们关注。     

多发性硬化临床特征分析及治疗

目的 探讨多发性硬化(multiple sclerosis,MS) 的临床特征及治疗方法.方法 回顾分析42例MS患者的临床资料.结果 MS 好发于青年女性(29例),常见症状为肢体无力(29例)、视力障碍(22例)和感觉障碍(21例).病变累及大脑半球30例,视神经28例,脊髓23例,脑干9例,小脑4例,所有病例MRI检查均有阳性改变,CSF检查IgG鞘内合成率阳性16例,寡克隆区带阳性19例,抗髓鞘碱性蛋白(MBP)抗体阳性15例.视觉诱发电位(VEP)异常28例,脑干听觉诱发电位(BAEP)阳性16例,体感诱发电位(SEP)异常20例,急性期甲强龙冲击治疗患者临床症状均有改善,缓慢激素减量及小剂量激素长期维持治疗,随访至2008-01仅有7例复发.结论 结合临床特点、MRI、脑脊液免疫学、诱发电位检查能明显提高临床确诊率.急性期甲强龙冲击治疗可改善临床症状,缩短急性期病程,缓慢激素减量及小剂量激素长期维持可能有助于降低复发率.     

多发性硬化118例临床分析

目的探讨多发性硬化(MS)的临床特征及MRI、视觉诱发电位(VEP)、脑干听觉诱发电位(BAEP)、脑脊液(CSF)检查在诊断中的价值。方法从流行病学、首发症状、起病形式、病程、累积部位、各项辅助检查情况等方面对作者医院1998—2004年收住的118例MS患者进行回顾性分析。结果118例MS患者中,临床确诊68例,实验室支持确诊21例,临床可能29例;男、女比为1.46∶1;平均首发年龄:男(31.1±13.5)岁,女(34.9±10.5)岁;起病形式:急性37.0%,亚急性40.0%,慢性23.0%;病程:复发-缓解型占67.0%;首发症状:肢体无力58例,肢体麻木34例,视力障碍29例。累及部位:视神经80例,脊髓72例,脑干61例,大脑半球50例,小脑26例。MRI:行MRI检查82例,阳性67例,其中累及脊髓32例,脑室旁34例(占MRI检查阳性者的50.7%)。VEP:异常但无症状体征者占47.0%;BAEP:异常但无症状体征者占81.5%。CSF:24 h鞘内合成率阳性占81.6%,寡克隆区带阳性占23.0%。结论MS多无明显诱因,多以急性或亚急性起病,复发率高,首发症状以肢体无力多见,脊髓、视神经易受累,MRI检查阳性者中半数左右大脑白质有异常信号,VEP、BAEP检查可发现许多视神经及脑干亚临床病灶,CSF 24 h鞘内合成率阳性者较多,可提示病变的炎性本质。     

脊髓型多发性硬化超高场强3.0T MR诊断分析

多发性硬化(multiple sclerosis,MS)是以中枢神经系统白质脱髓鞘病变为特征的自身免疫性疾病,临床表现复杂多样,症状与病程不一,仅以脊髓病灶为主引起临床症状和体征者,称之为脊髓型多发性硬化(spinal cord of multiple sclerosis,SMS)[1].MS的诊断以往主要是依据临床表现辅以实验室检查,自MR问世以来,其对MS的敏感性越来越受到临床重视,目前超高场强3.0T MR被认为是MS最有价值的影像学检查方法.本文收集26例经3.0T MR检查和临床确诊的病例进行分析,旨在提高对脊髓型MS的诊断水平.     

多发性硬化413例患者的临床表现特点

目的 总结多发性硬化(MS)患者的临床特点。方法 用临床病例分析统计方法，对413例MS患者的发病规律和临床特点进行归纳、分析。结果 MS好发于青壮年，以急性和亚急性起病为主；首发症状以视力障碍(128例，31．O％)最常见；肢体无力(325例)、感觉障碍(246例)、视力障碍(243例)是MS患者最常见的症状，Lhermitte征较多见；发作性症状多见，以痛性痉挛发作和癫疴发作常见；可合并周围神经系统损害；临床定位以脊髓(256例)和视神经(244例)受累最多见。结论本组MS临床特点不同于西方人。     

多发性硬化从临床可能到确诊的影响因素

多发性硬化 (multiplesclerosis,MS)最常见的临床类型是复发缓解型 ,但确诊必须等待第二次甚至更多次发作 ,这对患者治疗时机的选择带来一定困难 ,因此有必要了解MS首次发作至确诊的时间和影响因素。1　资料1 1　病例选择 :所有患者为 1986年 7月至 2 0 0 2年 12月期间曾在我科就诊的MS患者 ,可能MS和确诊MS按McDonald等人制定的诊断标准[1 ] 。资料相对完整者的 72例MS患者进入研究。1 2　临床症状的分类和辅助检查异常的标准 :临床表现按症状分为视力损害、肢体无力、感觉异常、大小便障碍、共济失调、认知功能障碍和脑干功能异常 7…     

多发性硬化的临床与磁共振成像

目的 :对 4 6例多发性硬化 (multiple sclerosis,MS)患者进行临床与磁共振成像 (MRI)分析 ,从而进一步探讨其常见症状、体征、首发症状及 MRI检查的诊断价值。方法 :总结 4 6例多发性硬化的临床特点 ;结合文献复习对MS的 MRI及头颅 CT扫描所见进行讨论。结果 :MRI可发现 MS早期病变 ,及早作出诊断 ,且明显优于头颅 CT扫描。结论 :MS最常见的发病部位是侧脑室周围白质、视神经、脊髓和脑干。MS诊断的金标准仍然是临床 ,MRI作为MS的辅助诊断是最有效的手段     

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.     

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.     

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.     

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.     

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.     

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.