利培酮合并氯丙咪嗪治疗难治性Tourette综合征对照研究

目的利培酮联用氯丙咪嗪治疗Tourette综合征(TS)的临床疗效。方法55例TS患者随机分成利培酮组(对照组)和利培酮联用氯丙咪嗪组(试验组),分别治疗8周,采用YGTSS(耶鲁综合抽动严重程度量表)于治疗前后分别进行测试。结果8周后试验组的YGTSS总分较对照组有明显的下降(P<0.05),试验组的有效率为87.51%,对照组的有效率为66.66%,差异有显著性。(χ2=9.46,P=0.023<0.05)。结论利培酮联用氯丙咪嗪治疗难治性TS疗效肯定。     

利培酮与氟哌啶醇治疗儿童抽动障碍的对照研究

目的:比较利培酮与氟哌啶醇治疗儿童抽动障碍的疗效和安全性。方法:将52例6~14岁抽动障碍患儿随机分为利培酮组和氟哌啶醇组;分别予以相应的药物治疗8周;于治疗前及治疗2、4、8周末采用耶鲁综合抽动严重程度量表(YGTSS)、治疗中出现的症状量表(TESS)评估疗效和安全性。结果:共有46例患者完成8周的治疗;治疗第2周末利培酮组(24例)YGTSS总分明显高于氟哌啶醇组(22例)[(57.71±15.45)分vs.(47.34±18.13)分],有效率明显低于氟哌啶醇组(29.17%vs.59.09%)(P均0.05);治疗第4、8周末两组间YGTSS总分和有效率差异无统计学意义;治疗第2、4、8周末利培酮组TESS分明显低于氟哌啶醇组(P均0.01)。结论:利培酮治疗儿童抽动障碍的疗效与氟哌啶醇相当;虽然起效较慢,但不良反应小,适合儿童治疗。     

利培酮口服液与氟哌啶醇治疗Tourette’s综合征的临床对照研究

目的 探讨利培酮口服液治疗Tourette's综合征(TS)的疗效、安全性和耐受性.方法 将91例Tourette's综合征患者随机分为研究组(利培酮口服液组)及对照组(氟哌啶醇组),采用耶鲁抽动症整体严重度量表(YGTSS)、治疗中需处理的不良反应症状量表(TESS)于治疗前及治疗第8、24周末对两组进行评估.结果 研究组在治疗第8周和24周末有效率分别为81.6%和86.9%,YGTSS总分分别为33.66±7.81和30.08±6.38,减分率分别为51.53±16.81和53.71±13.27,与对照组相比,有效率76.2%和84.8%、YGTSS总分35.82±9.13和32.56±9.67、减分率47.30±14.73和52.31±17.69差异均无显著性(P>0.05);治疗第8周和24周末,研究组口干、便秘、嗜睡、肌强直、静坐不能、震颤等不良反应的发生率低于对照组,差异有显著性(P<0.05).结论 利培酮口服液治疗Tourette's综合症的疗效与氟哌啶醇相当,且不良反应轻,安全性高,依从性好.     

奥氮平与利培酮治疗难治性精神分裂症的对照研究

目的 比较奥氮平与利培酮对难治性精神分裂症的疗效及安全性.方法 68例难治性精神分裂症患者按照排列表法随机分为奥氮平组[34例,(24.1±5.4)mg/d]和利培酮组[34例,(7.9±1.8)mg/d],疗程均为12周.采用阳性和阴性症状量表(PANSS)、临床总体印象量表(CGI)及治疗中需处理的不良反应症状量表(TESS),在治疗前及治疗第1,2,4,8,12周末分别评定疗效和不良反应.结果 (1)奥氮平组PANSS总分、阳性症状分、阴性症状分及一般病理分均从治疗第2周末起较治疗前下降(P<0.05～0.01);利培酮组PANSS总分、阳性症状分、一般病理分从治疗第2周末起,阴性症状分从第4周末起,较治疗前下降(P<0.05～0.01);奥氮平组从治疗第2周末起各时点PANSS总分、阴性症状分均低于利培酮组(P<0.05～0.01).(2)治疗第2周末起,2组临床总体印象量表-严重程度和改善程度(CGI-SI)总分均较治疗前下降(P<0.05～0.01);2组间各时点CGI-SI分的差异无统计学意义(P>0.05).(3)治疗第12周末,奥氮平组、利培酮组临床总有效率分别为65%、41%,差异有统计学意义(P<0.05).(4)奥氮平组、利培酮组不良反应发生率分别为53%(18/34)和59%(20/34),差异无统计学意义(P>0.05);奥氮平组体质量增加发生率高于利培酮组(P<0.05);利培酮组静坐不能、异常泌乳和(或)闭经、肌张力增高的发生率高于奥氮平组(P<0.05).结论 奥氮平对难治性精神分裂症有良好疗效,不良反应轻微.     

托吡酯与氟哌啶醇治疗Tourette综合征疗效的对照研究

目的 探讨托吡酯单一治疗Tourette综合征(TS)的疗效和安全性。方法 将53例TS患者按病例编号分为研究组(35例)和对照组(18例)。研究组予托吡酯(50-150 mg/d)治疗;对照组予氟哌啶醇(1.5-6 mg/d),共治疗24周。研究组3例脱落,对照组2例脱落。采用耶鲁抽动症整体严重度量表(YGTSS)、治疗中需处理的不良反应症状量表(TESS)于治疗前、治疗第8,24周末对两组进行评估。结果(1)治疗第8周末研究组有效率为72％,高于对照组(38％;Z=-3.284,P=0.001)。研究组YGTSS总分[(28.06±14.45)分]低于对照组[(40.00±20.90)分;P<0.05];减分率[(48.10±22.80)％]高于对照组[(33.17±31.90)％;但P>0.05]。治疗第24周末,研究组有效率为81％,高于对照组(56％;Z=-4.808,P<0.001)。研究组YGTSS总分[(24.96±16.28)分]低于对照组[(36.50±21.08)分;P<0.05];减分率[(52.90±24.49)％]高于对照组[(34.63±32.58)％;P<0.05]。(2)第8周末研究组TESS分[(2.69±3.02)分]低于对照组[(6.25±4.06)分;P<0.01];第24周末研究组TESS分[(1.69±1.79)分]低于对照组[(2.69±3.02)分;P<0.01]。结论 托吡酯能有效改善TS的运动、发声抽动和综合损伤效应,副作用相对较轻。     

经颅微电流刺激治疗难治性儿童抽动秽语综合征患者6个月临床观察

目的:评价经颅微电流刺激(CES)治疗难治性儿童抽动秽语综合征(TS)的疗效和安全性。方法:对21例TS患儿,前12周以正在服用的药物加CES,12周后逐渐撤去药物,单一CES治疗。在治疗前和治疗4周及24周采用耶鲁综合抽动严重程度量表(YGTSS)及治疗中出现的症状量表(TESS)评定其疗效和安全性。结果:治疗4周及治疗24周YGTSS总分及各因子分均显著低于疗前,(P均0.01);治疗4周及24周显效率分别为47.62%及80.95%;治疗24周不良反应显著小于疗前及治疗4周。结论:CES能安全有效地治疗难治性TS。     

难治性抽动秽语综合征的临床特点

目的探讨难治性Tourette综合征(Tourettesyndrom,TS)的临床特征。方法采用自制TS一般情况调查表、YGTSS(耶鲁综合抽动严重程度量表)、CBCL(Achenbach儿童行为量表)、WISC—CR(韦氏儿童智力量表中国修订版)对32例难治性TS(难治性组)患者和随机抽取的31例普通TS患者(普通组)分别进行测试和对照分析。结果(1)难治性TS患者在发病年龄、病前诱因、病程等方面与普通TS患者之间存在显著差异(P<0.05,P<0.01)。(2)难治性组CBCL总分显著高于普通组(P<0.01);难治性组19例6～11岁男性与普通组21例6～11岁男性CBCL测验比较,前者交往不良、强迫行为等6个行为问题因子得分显著高于后者(P<0.05,P<0.01),其CBCL总分也显著高于后者(P<0.01)。(3)在智力测验中,难治性组不仅其VIQ、PIQ、FIQ均显著低于普通组(P<0.05,P<0.01),而且在10项分测验中,算术分测验、理解分测验和译码分测验量表分均显著低于普通组。结论难治性TS具有自己的临床特征。     

利培酮与无抽搐电休克治疗难治性精神分裂症近期疗效对照研究

目的评价利培酮和无抽搐电休克对难治性精神分裂症的疗效和副反应。方法将住院的难治性精神分裂症60例,随机分为两组,分别应用利培酮和无抽搐电休克治疗,观察12周。用PANSS量表评定疗效,用TESS量表评定药物副反应。结果利培酮治疗组(在2周内逐渐停用原有抗精神病药)从治疗第6周起PAN-SS量表总分、PANSS量表一般精神病理分和阳性症状分开始下降,第8周起全面下降,各治疗时段TESS评分不大于3,观察期末评定有效率为56.67%,显效率为13.33%。MECT组(将原有抗精神病药减量至2/3-1/2)自治疗第4周起PANSS量表总分、PANSS量表一般精神病理分和阳性症状分开始下降,观察期末,有效率为63.33%,显效率为20%,但TESS评分较高。结论上述两种方法对难治性精神分裂症均有较理想治疗效果。     

利培酮早期治疗反应及治疗方案调整对精神分裂症患者疗效的影响

目的:探讨根据利培酮早期治疗反应调整治疗方案对精神分裂症患者疗效及安全性影响。方法:120例精神分裂症患者随机分为两组,两组均给予利培酮单药治疗并于2周内滴定至4～6 mg/d;对照组以此剂量维持治疗;研究组治疗第2周末阳性与阴性症状量表(PANSS)减分率20%的患者替换为奥氮平治疗(10～20 mg/d),减分率≥20%的患者继续利培酮治疗;疗程共8周。治疗前、治疗第2、4、8周末分别进行PANSS和治疗中出现的症状量表(TESS)评分。结果:研究组49例、对照组47例完成8周观察;治疗第4、8周末研究组PANSS总分、阳性症状分及治疗第8周末一般精神病理分显著低于对照组(P0.05或P0.01);阴性症状分各时间点两组间差异无统计学意义;治疗后各时间点TESS评分研究组明显低于对照组(P均0.01)。结论:根据利培酮早期治疗反应调整治疗方案能明显改善精神分裂症患者的症状,减轻不良反应。     

丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征

目的 探讨丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征(TS)的临床疗效和安全性.方法 将93例难治性TS患儿按病例编号分为试验组(58例)和对照组(35例).试验组予丙戊酸钠(400～600 mg/d或15 mg·kg-1·d-1)合并氟哌啶醇(2～6 mg/d)治疗,对照组采取常规治疗[单一或联合使用氟哌啶醇(6～16 mg/d)、泰必利(400～600 m/d)、可乐定(0.15～0.6 mg/d)、安定类药物],共治疗8周.采用YGTSS、国际TS临床信息调查表、儿童行为量表(CBCL)及副反应量表,于治疗前、治疗后第1,3,8周末对两组进行评估.结果 治疗第8周末,试验组的有效率为93%,高于对照组(80%;Z=-4.310,P<0.001);试验组YGTSS总分[(3.50±4.59)分]低于对照组[(7.86±7.03)分;P<0.01],减分率[(83.11±15.13)%]高于对照组[(63.81±27.87)%;P<0.01];试验组的CBCL评分[(11.43±5.27)分]低于对照组[(14.77±6.75)分;t=-2.139,P<0.05];治疗第1周末两组副反应差异无显著性(P>0.05);从第3周末开始试验组副反应评分[(9.26±3.15)分]低于对照组[(11.69±5.51)分;P<0.01],并持续至第8周末.结论 丙戊酸钠合并氟哌啶醇治疗难治性TS,疗效肯定,副反应相对较轻.     

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.