癫痫患者血小板活化因子,丙二醛的变化及其相关性

本文对３０例癫痫患者，分别于发作后７２小时内及发作缓解期进行血中血小板活化因子及丙二醛的检测。发现发作后７２小时内ＰＡＦ和ＭＤＡ均高于正常对照组，且两者具有相关性。发作缓解期，再者近于正常。说明这两者均参与癫痫的病理过程。     

苯巴比妥对癫痈患者血浆型PAF—AH酶活力的影响

目的检测苯巴比妥癫痫患者血浆型血小板活化因子乙酰水解酶（PAF-AH）活性，了解苯巴比妥抗癫痫治疗对免疫功能的影响。方法采用ELISA法测定16例单药PB抗癫痫治疗未发作EP患者，14例单药PB抗癫痫治疗发作患者及16例健康对照组的血浆型PAF—AH活性。结果癫痫未发作组、癫痫发作组和健康对照组血浆型PAF—AH活性分别为（15．91±1．59）、（17．66±1．46）、（15．52±1．18）nmol／（min·μl），发作组血浆型PAF—AH活性高于健康对照组（P〈0．01），未发作组与对照组无显著差异（P〉0．05）。结论单药苯巴比妥抗癫痫治疗EP患者发作后血浆型PAF-AH活性升高，可能是机体的一种自我保护措施。     

脑卒中后癫痫50例临床研究

目的探讨脑卒中后癫痫的临床特点，癫痫对脑卒中恢复期神经功能康复的影响。方法50例脑卒中后继发癫痫患者进行发作部位、类型、治疗时间及效果等分析，并按病情轻、中、重三组进行功能康复评分。结果脑卒中后癫痫发生率5．1%（50／980），其中早发癫痫72％（36／50），迟发癫痫28％（14／50）。皮层病灶继发癫痫72％（36／50），皮层下病灶继发癫痫占28％（14／50）。早发癫痫中全身发作27例．部分性发作9例，迟发癫痫中全身发作4例，部分性发作10例。癫痫组神经功能缺损评分均差于对照绀组（P〈0．05），结论脑卒中后癫痫皮层病灶多见，早发癫痫以全身发作为主，迟发癫痫以部分发作为主。脑卒中合并癫痫患者的治疗效果差于对照组，抗癫痫治疗有利于神经功能康复。     

癫痫治疗进展

公众和医务人员都普遍认为癫痫预后差。产生这种印象有两方面原因:第一,癫痫病人有多发残疾;第二,是人们对癫痫中心慢性癫痫病人进行正规研究的结果。实际上过去十年采用前瞻性,以社区为基本的调查得出的结果表明:80%新诊断的病人缓解期延长,大多数病人在治疗开始后的两年内无癫痫发作。这些研究还说明癫痫发作次数以及癫痫患者在开始治疗前的发病时间对癫痫预后起决定性作用。Gower有句名言:在癫痫发作导致再次出现癫痫的情况下,早期治疗是十分重要的。然而,如果癫痫发作没有明显诱因,复发的危险性增大。早期治疗可以防止癫痫慢性化,则应该持续用药。癫痫首次发作后的再次发作的可能性各不相同,估计为27%至71%,这可能与治疗方案有关:一般情况下,癫痫首次发作后很快又有第二次发作时才给予治疗,若诊断延误的话,只有一次癫痫发作的病人预后较好。     

癫癎持续状态的抢救与影响预后因素分析

目的探讨癫痫持续状态的抢救与影响预后因素关系。方法回顾性分析72例癫痫持续状态的抢救及预后，并分析其病因、诱因、持续时间、并发症及疗效。结果72例癫痫持续状态经积极治疗，治愈61例，治愈率84．72％，死亡8例，有3例因癫痫发作持续时间在24h者控制不良自动出院。结论癫痫持续状态的抢救及预后与病因有关，迅速选用有效药物控制癫痫发作，积极防治并发症，及时处理原发病是抢救癫痫持续状态的关键。     

西比灵辅助治疗癫痫的疗效及其对脑脊液钙含量的影响

目的 观察西比灵辅助治疗癫痫的疗效，及对脑脊液钙含量的影响。方法 将64例癫痫病人随机分为西比灵组及对照组32例。两组按不 发作类型分别应用抗癫痫药物治疗。西比灵组加西比灵每晚5mg，2周内加至每晚10mg，连服3个月。观察治疗前，后癫痫发作频率及癫痫发作后3小时，72小时脑脊液Ca^2 含量。结果 西比灵组总有效率有75％，对照组为50％，两组有显著差异（P＜0．05）。癫痫发作后3小时脑脊液Ca^2 含量明显低于健康组（P＜0．01），发作后72小时西比灵组已恢复到健康组水平（P＞0．05），而对照组仍低于健康组（P＜0．01）。结论 西比灵配合抗癫痫药物治疗，能减少癫痫患者的发作频率，并能迅速恢复癫痫病人脑脊液Ca^2 浓度。     

外源性GM1对癫痫大鼠脑损伤的保护作用

目的　探讨外源性神经节苷脂GM1对癫痫大鼠脑损伤有无保护作用。方法　采用硫代氨基脲 (7.5mg/kg)诱导大鼠癫痫发作模型 ,用免疫组化方法动态观察致痫组大鼠和GM 1干预组大鼠在癫痫发作 2 4小时、4 8小时、72小时及 7天时 ,以及正常对照组、生理盐水组大鼠 72小时时神经生长因子 (NGF)在实验大鼠海马及额叶神经细胞表达情况。同时应用电镜技术观察受损海马神经细胞形态及结构变化。结果　正常对照组和生理盐水组大鼠无癫痫发作 ,致痫组和GM1干预组大鼠有Ⅰ Ⅴ级癫痫发作。免疫组化结果显示 ,癫痫鼠在其海马、额叶有较多的NGF阳性神经细胞表达 ,而未致痫鼠偶有NGF阳性细胞表达 (P <0 .0 5 )。在致痫鼠中 ,GM1干预后NGF表达明显高于未干预组 (P <0 .0 5 ) ,且以 72小时NGF表达为最高(P <0 .0 5 )。电镜显示癫痫鼠神经细胞损伤 ,但GM1干预后损伤减轻 ,而正常对照组和生理盐水组神经细胞形态和结构正常。结论　癫痫发作可引起脑细胞损伤 ;GM1对癫痫大鼠脑损伤具有一定保护作用 ,其保护作用可能通过诱导NGF表达增多来实现。     

应用妥泰后大鼠癫痫模型血清NSE水平变化的研究

目的观察应用妥泰后发育期大鼠癫痫模型血清神经元特异性烯醇化酶(NSE)水平变化，探讨妥泰减少发育期大鼠癫痫发作引起的脑神经元损伤。方法戊四唑点燃发育期大鼠癫痫模型，随机分为正常对照组、点燃模型组、妥泰治疗组，观察大鼠血清NSE水平变化、惊厥发作频率和发作程度。结果正常对照组大鼠无惊厥发作．血清NSE水平在正常范围；癫痫模型组大鼠惊厥出现时间早，发作程度重，血清NSE水平明显高于其它两组；妥泰治疗组大鼠惊厥出现时间晚．发作程度轻，血清NSE水平略高于正常对照组而低于癫痫模型组。结论妥泰应用后血清NSE水平降低．考虑是由于其减少癫痫发作引起的神经元损伤。     

癫痫患者血清和脑脊液神经元特异性烯醇化酶的测定

目的 探讨癫痫发作对脑神经元的损伤。方法 应用酶联免疫反应法动态测定癫痫发作后患者血清和脑脊液（CSF）中神经元特异性烯醇化酶（NSE）的含量。结果 癫痫组血清和CSF中NSE含量在发作后明显升高，血清NSE水平在发作后第1天最高，1周左右开始下降，2周左右降至正常；抽搐发作及频繁发作时，血清和CSF中NSE升高更明显。结论 癫痫发作引起血清和CSF中NSE水平的升高；癫痫发作导致神经元损伤，抽搐发作及频繁发作时神经元损伤更严重。     

颅骨成形术后癫痫发作的危险因素分析

目的 探讨颅骨成形术后癫痫发作的危险因素。方法 回顾性分析2015年12月至2020年12月行颅骨成形术的72例颅骨缺损病人的临床资料。术后随访2个月,依据癫痫发作的临床表现进行术后癫痫评估。结果 72例中,20例颅骨成形术后出现癫痫发作,发生率为27.8%。即刻癫痫发作（≤24 h）6例,早期癫痫发作（24 h~2周）8例,晚期癫痫发作（>2周）6例。随访期间,未出现伤口感染、人工修补材料外露、颅内感染、术区出血、脑疝等。单因素分析显示年龄、去骨瓣减压术后继发癫痫、颅骨缺损原因和直径与颅骨成形术后癫痫发作有关（P<0.05）,多因素logistic回归分析显示颅骨缺损直径是颅骨成形术后癫痫发作的独立危险因素（P<0.05）。结论 颅骨成形术作为神经外科的基础手术之一,手术过程相对简单,但其并发症不容忽视。颅骨成形术后癫痫发作的临床影响因素较多,颅骨缺损直径越大,发生癫痫的风险越高。     

癫痫患者自由基代谢的变化及其与脑电图的关系

本文选择癫痫患者３０例，分别于发作期和缓解期作血浆总抗氧化能力（ＧＡＡ）、血浆谷胱甘肽（ＧＳＨ１）、血红蛋白谷胱甘肽（ＧＳＨ２）及血浆丙二醛（ＭＤＡ）的检测及脑电图检查。结果提示：发作期，ＭＤＡ明显高于正常。缓解期近于正常，ＭＤＡ升高者，ＥＥＧ多数异常，ＧＡＡ、ＧＳＨ的变化也具有显著意义。揭示自由基代谢参与癫痫的病理过程。     

血清神经元特异性烯醇化酶在癫癎患者中的应用价值

目的 探讨癫痫患者发作后不同时间神经元特异性烯醇化酶（NSE）的动态变化。方法 采用放射免疫法测定20例癫痫患者发作后48h内、2-4d、5-7d血清中NSE水平，并与22例正常健康体检者进行对照。结果 癫痫患者发作48h内及2～4d血清NSE水平与对照组比较有显著性差异（t=4．31，2．57；P〈0．01，0．05）。结论 癫痫发作后血清NSE水平升高可能与脑神经元损害有关。     

矢状窦、大脑镰旁脑膜瘤手术与继发性癫痫的控制及防治

目的分析继发性癫痫在矢状窦、大脑镰旁脑膜瘤中的发生机制及危害,探讨如何预防和减少肿瘤相关性癫痫的发生。方法回顾性分析自2011年3月~2016年6月我科住院手术的23例窦、镰旁脑膜瘤患者的临床资料,通过对比不同肿瘤特征的手术方法及继发性癫痫的发生情况。结果全部病例均手术治疗,其中肿瘤I级切除19例,II级切除4例。术前有癫痫发作7例,术后24小时癫痫发作1例,术后24小时~7天发生癫痫5例,2年内新增癫痫病例5例,3例部分运动性失语,4例出现对侧不同程度肢体偏瘫,卡方检验比较得出瘤周有无水肿(p=0.007)及术前有无使用抗癫痫药物(p=0.027)对术后继发性癫痫的发生具有影响。结论肿瘤相关性癫痫对窦、镰旁脑膜瘤患者术后危害极大,术前有癫痫病史的患者在围手术期应积极给予抗癫痫治疗,对于有明显瘤周水肿、术中脑挫伤、回流静脉损伤等高危患者术后应积极给予药物预防治疗。     

The role of sleep in forgetting in temporal lobe epilepsy: a pilot study

The purpose of this study was to examine how sleep impacts memory function in temporal lobe epilepsy (TLE). Patients with TLE (n=7) and control subjects (n=9) underwent training and overnight testing on (1) a motor sequence task known to undergo sleep-dependent enhancement in healthy subjects, and (2) the selective reminding test, a verbal memory task on which patients with TLE have shown impaired performance 24 hours after training. Sleep data were collected by polysomnography. Results indicate that patients with TLE display greater forgetting on the selective reminding test compared with controls over 12 hours of daytime wakefulness, but not over a similar period including a night of sleep. Slow wave sleep is correlated with overnight performance change on the selective reminding test. Patients with TLE show no deficit in sleep-dependent motor sequence task improvement. The findings provide potential insight into the pattern and pathophysiology of forgetting in TLE.     

The effect of kindled seizures on the locomotory behavior of Long-Evans rats

The incidence of attention deficit hyperactivity disorder (ADHD) is higher in children with epilepsy than in the general childhood population. The origin of the symptoms of ADHD seen in children with epilepsy is unknown. This experiment used an animal model to investigate whether seizures could be a cause of the hyperactivity sometimes associated with epilepsy. Sixteen male Long-Evans rats were implanted with electrodes, and 8 of them were kindled until generalized stage 5 seizures were elicited. Eight subjects were handled, but not kindled. The behavior of the rats in the two groups was compared in an open field test. The time spent in four behaviors was measured: exploratory behavior, immobility, eating, and grooming. Rats were tested after 5 stage 5 seizures, after 10 stage 5 seizures, after 15 stage 5 seizures, after a 2-week rest period, and after 5 more stage 5 seizures. Data were analyzed using the Mann-Whitney rank sum test. Twenty-four hours after a seizure, the kindled rats displayed a greater level of exploratory behavior than did the controls. They were not found to differ on any other measure. After a 2-week rest period, the group difference in behavior disappeared. When kindling was reinitiated, the kindled rats again showed increased exploratory behavior. The findings suggest that the increased exploratory behavior found in the kindled rats resulted from recent seizure activity. It may be that the hyperactivity seen in some children with epilepsy also results from recent seizure activity.     

颞叶癫痫神经元型钙粘素mRNA表达研究

目的研究匹罗卡品诱导的颞叶癫痫神经元型钙粘素的表达变化.方法用氯化锂加匹罗卡品诱导SD大鼠颞叶癫痫模型,特异性探针原位杂交检测神经元型钙粘素mRNA表达.结果对照组动物神经元型钙粘素mRNA在皮层和海马各区均有表达,给药后4 h和12 h神经元型钙粘素mRNA在CA1、CA3和齿状回均表达下降,24 h开始恢复,注药后3 d神经元型钙粘素mRNA表达显著高于对照组,7 d表达最高.结论神经元型钙粘素mRNA在颞叶癫痫表达呈双相变化.     

癫痫持续状态和慢性癫痫对大鼠学习记忆和情感行为的影响

目的探讨急慢性癫痫发作对大鼠认知功能的影响。方法戊四氮(PTZ)诱导大鼠癫痫持续状态(SE)和慢性癫痫(CEP),用交替电刺激Y迷宫试验、Morris水迷宫试验、抬高迷宫试验和旷场试验检测大鼠学习记忆和情感行为变化。结果SE大鼠致痫后近期水迷宫逃避潜伏期延长(P<0.05),平台象限搜寻时间百分比降低(P<0.01),穿越平台区域次数减少(P<0.05)Y迷宫选择错误总数增多(P<0.05);抬高迷宫开放臂中逃避时间延长(P<0.05),进入次数增多(P<0.05);旷场活动的格子数、站立次数及粪便颗粒数均减少(P<0.05)。远期均恢复正常。CEP大鼠致痫后近期水迷宫部分时段逃避潜伏期延长(P<0.05),远期恢复正常,Y迷宫选择错误总数近期和远期均增多(P<0.05)抬高迷宫开放臂中逃避时间和进入次数及旷场活动格子数、站立次数和粪便颗粒数与对照组相比均无明显差别(P>0.05)。结论癫痫持续状态可导致大鼠短期学习记忆功能受损和情感行为异常慢性癫痫引起的学习记忆能力降低持续时间较长,对情感行为无明显影响。交替电刺激Y迷宫在检测癫痫大鼠学习记忆功能方面可能较Morris水迷宫更灵敏。     

Impaired Platelet Binding of Fibrinogen Due to a Lower Number of GPIIB/IIIA Receptors in Polycythemia Vera

We have previously described a stimulus-specific defect in platelet aggregation in polycythaemia vera (PV) after stimulation with surface receptor dependent agonists such as platelet activating factor (PAF). In contrast, responses to phorbol myristate acetate (PMA) were normal. We now report that after PAF stimulation, using flow cytometry, the amount of fibrinogen bound to its receptor was significantly lower in PV platelets with a median MFI of 6.0 (range 4.1–17.3) compared to controls, 12.8 (range 8–21.3; n=11; p<0.01). We found no evidence of preactivation of PV platelets. Quantitative analysis of GPIIIa gave a significantly lower number of GPIIIa on resting PV platelets, 14300 subunits of GPIIIa (range 8500–15500) vs. 19800 for controls (range 13400–26800; n=12; p<0.01). Both patients and controls increased their number of receptors on the cell surface after stimulation with PAF and PMA, but the significant difference in the number of receptors per cell remained. Indirect evaluation of PAF receptor function showed that activation of CD 62 did not differ in PV and controls after PAF stimulation. Additionally, although the basal level of serotonin in platelet-rich plasma was significantly lower in PV, there was a threefold increase of the basal level after stimulation with PAF for both PV and control platelets, also indicating a normal interaction of PAF with its receptor. Although our results indicate both an impaired PAF induced aggregation in PV and a lower number of GPIIb/IIIa complexes on single platelets, whether these phenomena are related remains uncertain.     

Mirtazapine increases cortical excitability in healthy controls and epilepsy patients with major depression

BACKGROUND: Epilepsy is often complicated by depression requiring antidepressant treatment. Such treatment might be proconvulsive. OBJECTIVE: To examine the effects of the noradrenergic and specific serotonergic antidepressant mirtazapine on motor cortex excitability in epilepsy patients with depression and in healthy controls, using transcranial magnetic stimulation (TMS). METHODS: Seven clinically depressed epilepsy patients treated with anticonvulsant drugs and six healthy volunteers were studied. Before intake of mirtazapine and 24 hours afterwards (and also three weeks afterwards in the patients), the active and resting motor threshold (AMT, RMT), the size of the motor evoked potential (MEP), the cortical silent period (SP), and intracortical inhibition/facilitation and intracortical facilitatory I wave interactions were determined using single and paired pulse TMS. RESULTS: At baseline, AMT and RMT were higher (p = 0.049 and p = 0.04, respectively) and the ratio SP duration/MEP area greater in patients (p = 0.041). In patients but not in healthy subjects AMT was lower 24 hours after intake of mirtazapine (p = 0.028). Mirtazapine had no significant effect on the MEP size, duration of the SP, or the ratio of SP duration to MEP size in patients. The duration of the SP was longer (p = 0.037) but the ratio of SP duration to MEP size remained similar in healthy subjects after mirtazapine. There were no significant differences in paired pulse measures between the two groups either at baseline or after mirtazapine. CONCLUSIONS: Mirtazapine increased neuronal excitability of pyramidal tract axons in an activated state in both healthy controls and epilepsy patients with major depression.     

Circadian variation in heart-rate variability in localization-related epilepsy

PURPOSE: Case-control studies of sudden unexpected death in epilepsy (SUDEP) have reported that SUDEP is more likely to occur during sleep and thus presumably during night hours. The circadian variation of heart-rate variability (HRV) might be of relevance to this risk. We examined night versus daytime HRV in patients with newly diagnosed and refractory localization-related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio. METHODS: We used spectral analysis to assess HRV and calculated the night-time (00.00-05.00)/daytime (07.30-21.30) ratio of HRV in 14 patients with newly diagnosed localization-related epilepsy before and during carbamazepine (CBZ) treatment and in 21 patients with temporal lobe epilepsy before and after epilepsy surgery. Both groups were compared with age- and sex-matched controls. RESULTS: No significant differences were found from controls in the night/daytime ratios of HRV whether compared before or after initiation of treatment with CBZ in newly diagnosed epilepsy patients. When patients were used as their own controls, night/daytime ratios of standard deviation of RR intervals (p = 0.04) and total power (p = 0.04) were significantly lower during treatment than before. Compared with those of controls, the night/daytime ratios were lower in epilepsy surgery patients before surgery [low-frequency power (p = 0.04); high-frequency power (p = 0.04)]. Night/daytime ratios did not change significantly after surgery. Conclusions: The HRV of the patients was more affected during night-time when the risk of SUDEP seems to be highest in such patients.