穴位推拿结合抗痉挛技术对脑卒中后上肢肌痉挛改善的疗效观察

目的观察穴位推拿结合抗痉挛技术对脑卒中后上肢肌痉挛的改善情况。方法 40例脑卒中后上肢肌痉挛的患者随机分成治疗组(穴位推拿与抗痉挛技术组)和对照组(抗痉挛技术组),在治疗前和治疗后第12周运用改良的Ashworth肌痉挛量表(MAS)和Fugl-meyer(FMA)的上肢主动运动功能积分进行上肢肌痉挛和运动功能的评定。结果 2组患者治疗后MAS和FMA评分与治疗前比较,差异有统计学意义(P<0.05)。治疗组与对照组治疗后MAS和FMA评分比较,差异有统计学意义(P<0.05)。结论 2组均能改善上肢肌痉挛和运动功能,但穴位推拿结合抗痉挛技术在改善上肢肌痉挛和运动功能方面又优于单纯抗痉挛技术。     

镜像疗法对偏瘫患者上肢功能康复疗效的观察

目的 观察镜像疗法对卒中后偏瘫患者上肢功能康复的疗效。方法 选择30例入选卒中后8周内偏瘫患者随机分为两组：镜像疗法组和对照组,分别于治疗前及治疗后4周采用Fugl-Meyer运动评价（Fugl-Meyer motor assessment,FMA）（上肢部分）,上肢运动研究测试（the action research arm test,ARAT）、运动功能评估量表（motor assessment scale,MAS）对上肢运动功能进行评分,同时评定患者的视觉模拟评分（visual analogue scale/score,VAS）、痉挛程度以及改良Barthel指数,以观察镜像疗法对偏瘫患者上肢功能康复的疗效。结果 治疗4周后,两组上肢运动能力FMA评分、ARAT评分、MAS评分、改良Barthel指数均较治疗前提高（P＜0.01）;治疗组FMA评分、ARAT评分高于对照组（P＜0.05）,两组间MAS评分、改良Barthel指数提高,但差别无统计学意义（P＞0.05）。治疗组VAS评分较治疗前有下降（P＜0.05）,但对照组治疗前后,VAS评分差异无统计学意义（P＞0.05）,治疗后两组间的VAS差异有统计学意义（P＜0.05）。两组治疗前后及治疗后组间痉挛改善差异无统计学意义（P＞0.05）。结论 镜像疗法能提高偏瘫患者的上肢运动功能,且能减轻患者偏瘫上肢的疼痛,但对患者日常生活活动能力（activity of daily living scale,ADL）及患肢痉挛程度的改善无明显影响。     

三级康复训练对脑出血后上肢运动功能的改善情况

目的 探讨三级康复训练对脑出血后上肢运动功能的改善情况。方法 采用随机、对照与双盲研究方法选择本院2013年2月-2017年1月收治的脑出血患者220例,以随机方法将患者分为对照组和观察组,均为110例,对于对照组患者开展常规康复训练,而对于观察组患者,不仅开展常规康复训练,同时还给予三级康复训练,记录上肢运动功能改善情况。结果 康复后观察组与对照组的上肢运动功能评分分别为(49.44±5.69)和(43.49±6.14)分,都高于康复前的(36.23±6.19)和(37.10±5.69)分(P<0.05),且康复后观察组的评分高于对照组(P<0.05); 在肩手综合征的发生率方面观察组为0.9%,而对照组为10.9%,观察组低于对照组(P<0.05); 观察组康复期间的生活作息、正规服药、复诊随访、均衡饮食、康复训练依从性评分高于对照组(P<0.05); 康复后观察组的活力、总体健康、躯体疼痛等方面评分显著高于对照组(P<0.05)。结论 三级康复训练在脑出血患者中的应用能改善患者上肢运动功能状况,降低发生肩手综合征的概率,提升患者康复的依从性,进而提升患者的生活质量。     

不同病程康复介入对脑损伤后足下垂的疗效观察

目的 探讨颅脑损伤不同时期介入康复治疗对患者足下垂的疗效影响.方法 对54例颅脑损伤患者根据康复治疗介入的时间(＜1个月、1～3个月、3～6个月、＞6个月),将患者分为4组,于治疗前及治疗1个月后评定患肢的被动踝背屈角度(ROM)及腓肠肌痉挛程度(MAS).结果 康复治疗介入时间＜1个月、1～3个月组的患者ROM和MAS均有显著提高(P＜0.01).3～6个月组的患者,仍有统计学意义(P＜0.05).＞6个月组的患者ROM和MAS均无显著改善(P＞0.05).结论 系统正规的康复治疗有利于不同时期康复患者,早期康复对足下垂的改善有重要意义.     

电子生物反馈联合康复机器人对脑卒中上肢功能恢复的作用观察

目的观察电子生物反馈疗法联合上肢康复机器人治疗对脑卒中后偏瘫上肢运动功能的临床效果。方法将60例脑卒中后上肢瘫痪患者采用随机对照的方法分为治疗组和试验组各30例,治疗组采用常规康复治疗措施(作业疗法和手功能训练),结合电子生物反馈疗法,2次/d,30 min/次,12次/周,共6周。试验组在常规康复治疗基础上应用上肢康复机器人进行治疗,同时联合电子生物反馈疗法,2次/d,20 min/次,12次/周,共6周。治疗前及治疗后2组采用Fugl-Mayer运动功能量表上肢部分评定(FMA-UE)、Carroll上肢功能评定(UEFT)以及改良Barthel指数(MBI)评价2组患者上肢功能及日常生活活动能力。结果治疗后2组FMA-UE、UEFT、MBI与治疗前比较差异均有统计学意义(P0.05)。试验组效果较治疗组更显著(P0.05)。结论电子生物反馈疗法联合上肢康复机器人对脑卒中上肢运动功能障碍的改善及日常生活活动能力的提高效果优于常规康复治疗。     

抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的作用

目的探讨抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的临床效果。方法将40例脑卒中后上肢痉挛的患者随机分为两组,对照组进行常规的康复训练,治疗组在常规康复训练的基础上加用抗痉挛治疗仪进行治疗;分别采用上肢改良Ashworth量表(MAS)、疼痛视觉模拟评分法(VAS)及简化Fugl-Meyer运动功能评定量表(FMA)上肢部分对两组患者治疗前及治疗30d后上肢痉挛程度、疼痛程度及上肢运动功能的变化进行比较。结果治疗前两组MAS分级,VAS评分及FMA评分比较,差异均无统计学意义(P0.05)。治疗后两组MAS分级及VAS评分显著低于治疗前(P0.05),且治疗组降低程度更加显著;两组FMA评分均有显著提高,且治疗组提高程度优于对照组。结论抗痉挛治疗仪能有效降低脑卒中患者肱二头肌痉挛程度,并能缓解疼痛,提高其运动功能。     

精神分裂症患者出院后心理康复指导的意义

目的　探讨心理康复指导对精神分裂症患者出院后康复的意义。方法　对 12 0例出院的精神分裂症患者随机分成干预组 6 0例和对照组 6 0例 ,两组均接受抗精神药物的维持治疗 ,在此基础上干预组进行心理康复指导 ,而对照组仅限于一般情况的介绍 ,于干预前和干预后 6个月、一年对二组进行简明精神病量表(BPRS)、日常生活能力量表 (ADL)、功能大体评定量表 (GAF)、社会功能缺陷筛选量表 (SDSS)评定。结果　干预后 6个月BPRS、GAF、ADL评分分别为 2 1.4± 4 .5 ,79.0± 18.4和 19.6± 4 .8,对照组分别为 2 3.5±5 .1,6 8.0± 16 .8和 2 1.7± 5 .5 ,两组各项评分差异有显著性 ,干预组 12个月后BPRS、GAF、ADL、SDSS评分分别为 16 .3± 3.4 ,82 .0± 113.4 ,4 .1± 2 .2和 14 .5± 5 .5 ,对照组分别为 19.7± 8.2 ,5 8.0± 14 .7,6 .7±2 .8和 18.7± 5 .5 ,两组各项评分差异均有显著性 ,1年内干预组 8例 (13.3% )复发 ,对照组 2 1例 (3.5 % )复发 ,有差异显著性 (P <0 .0 1)。结论　心理康复指导能降低精神分裂症患者的复发率 ,有利于社会功能的康复     

运动康复对中风偏瘫患者及家属进行同步指导的效果观察

目的分析并探讨对中风偏瘫患者及家属进行同步运动康复指导的临床效果。方法选取2010-01—2014-08在我院接受治疗的中风偏瘫患者94例,随机分为观察组与对照组,每组47例。2组患者均给予常规的支持治疗和运动康复指导,观察组则同时对家属进行康复指导。结果治疗12周后,2组ADL各项评分均比治疗前有显著提高,且治疗后观察组各项评分明显高于对照组,差异有统计学意义(P0.05)。治疗前观察组MAS评分为(7.5±3.1)分,治疗后2周为(21.3±6.7)分,治疗4周为(34.6±8.9)分;治疗前对照组MAS评分为(7.7±3.3)分,治疗后2周为(20.3±6.6)分,治疗4周为(25.7±7.7)分。2组患者MAS评分在治疗前和治疗2周时差异无统计学意义(P0.05)。治疗4周及以后观察组MAS评分明显高于对照组,差异具有统计学意义(P0.05)。结论对中风偏瘫患者及家属进行同步运动康复指导对于患者健康恢复有重要作用,值得推广。     

重复经颅磁刺激联合生物反馈对脑卒中上肢运动功能的康复评价

目的探讨重复经颅磁刺激(rTMS)联合生物反馈对脑卒中患者上肢运动功能的康复效果。方法选取脑卒中患者120例,随机分为观察组和对照组各60例,2组患者均给予常规药物及康复治疗,观察组在常规康复的基础上给予rTMS和生物反馈治疗。颅磁刺激联合生物治疗前应用加拿大功能神经功能量表(CNS)、Fugl-Meyer运动功能量表(FMA)和改良Barthel指数(MBI)对2组患者的上肢运动功能以及日常生活活动能力进行评定;经4周治疗后再进行效果评价。结果治疗后4周观察组CNS、MBI、FMA评分均高于对照组,差异具有统计学意义(P0.05)。结论 rTMS联合生物反馈康复训练可改善脑卒中患者的上肢运动功能,有效地提高患者的生活质量。     

经颅磁刺激对脑梗死患者上肢功能康复效果的评估价值

目的探讨经颅磁刺激(TMS)对脑梗死患者上肢功能康复效果的评估价值。方法选择2012年1月至2015年6月间我院收治的92例脑梗死患者,根据患者病灶侧脑区TMS检查结果的不同分为两组,其中对照组45例患者的运动诱发电位波幅小于50uV,观察组47例患者的运动诱发电位波幅高于或等于50uV。2组患者均给予相同的药物及康复训练。分别比较两组患者治疗前、治疗4周后和治疗8周后的患侧脑区运动诱发电位皮质潜伏期(CL)、中枢运动传导时间(CMCT),同时采用Barthel指数量表(BI)评分评定日常生活能力以及FuglMeyer运动功能量表(FMA)评定上肢运动功能恢复情况,并进行相关性分析。结果两组患者治疗后上肢FMA以及BI评分较治疗前明显提高(P0.05);治疗8周时观察组患者上肢FMA评分以及BI评分均显著优于对照组水平(P0.05)。治疗后两组患者CL及CMCT均逐渐缩短(P0.05);治疗8周时观察组患者CL及CMCT水平均显著优于对照组(P0.05)。直线相关分析显示患者患肢CL和CMCT与FMA以及BI评分呈正相关(P0.05)。结论经颅磁刺激检测具有安全方便的特点,可有效预测脑梗死患者肢运动功能恢复情况,对科学制订康复干预方案具有重要作用。     

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.