巴曲酶治疗高龄急性脑梗死患者的疗效观察

目的观察巴曲酶治疗高龄(≥75岁)急性(6~48h)脑梗死的疗效及安全性。方法将80例急性脑梗死患者分为≥75岁的高龄组和<75岁的对照组各40例。入院当日巴曲酶10BU加入0.9%氯化钠注射液100ml中1h静滴完毕,第3d与第5d均给巴曲酶5BU加入0.9%氯化钠注射液100ml中1h静滴完毕。同时辅于脑保护,改善脑供血等治疗。对治疗前后患者的神经功能缺损进行评定。结果2组患者临床症状均明显改善,2组之间无明显差异(P>0.05),治疗后并发症不随年龄增加而增多。结论≥75岁的高龄急性脑梗死患者应积极进行降纤治疗,年龄不应作为高龄急性脑梗死患者是否进行降纤治疗的标准。     

巴曲酶注射液治疗高龄老年人急性脑梗死的临床观察

目的　观察巴曲酶注射液治疗高龄老年人急性脑梗死的临床疗效及其安全性。方法　将≥ 80岁的高龄老年急性脑梗死患者 12 7例随机分成治疗组 (6 7例 )与对照组 (6 0例 )。两组均采用胞二磷胆碱注射液静滴作为基础治疗。治疗组同时加用巴曲酶注射液 (10BU ,5BU ,5BU)静滴 ,隔日 1次 ,共 3次 ;用药前后进行神经功能缺损评分 (ESS)、血液流变学测定 ;并观察其不良反应。结果　治疗组起效快 ,第 2天ESS分值即较用药前显著提高 ,治疗 11天后疗效明显优于对照组 (P <0 .0 5 ) ,血黏度及纤维蛋白原较治疗前显著降低 (均P <0 .0 1) ;且无明显不良反应。结论　巴曲酶注射液治疗高龄老年人急性脑梗死疗效好 ,且较安全     

个体化调整巴曲酶剂量治疗脑梗死的疗效观察

目的　探讨个体化调整巴曲酶剂量治疗脑梗死的疗效。方法　将440例脑梗死患者随机分为个体化剂量组和常规剂量组(各220例),个体化剂量组根据每例患者的病程、病情和疗效及凝血纤溶系统检验的结果,个体化调整巴曲酶的用量和时间,每例巴曲酶用量在10~50BU,平均35BU;时间3 ~10d,平均6. 8d。常规治疗组采用5d隔日3次疗法,即首次10BU,隔日5BU两次。在治疗后14d评定临床疗效和观察凝血纤溶系统变化。结果　个体化剂量组显效率72. 3%,总有效率94 .5%,常规剂量组显效率54 1%,总有效率85 .0%,两组比较差异有显著性(均P<0. 05);个体化剂量组治疗后血纤维蛋白原浓度下降、D 二聚体浓度上升,与常规剂量组比较差异有显著性(均P<0. 01)。结论　依据脑梗死患者的个体差异性调整巴曲酶的用量和用药时间,可提高巴曲酶治疗脑梗死的临床疗效。     

依达拉奉联合巴曲酶治疗进展性脑梗死疗效观察

目的 观察依达拉奉联合巴曲酶治疗进展性脑梗死的临床疗效及安全性.方法 选择发病72h内的进展性脑梗死患者76例,随机分为联合组和巴曲酶组,2组均采用巴曲酶注射液(10BU、5BU、5BU)静滴,隔日1次,共3次;联合组加用依达拉奉注射液30mg静滴,2次/d,共14d.2组病人分别在治疗前后进行神经功能缺损评分(NDS),并进行比较.结果 联合组临床显效率(68.42%)明显优于巴曲酶组(42.11%),2组均无明显不良反应.结论 依达拉奉联合巴曲酶治疗进展性脑梗死安全有效.     

巴曲酶联合依达拉奉治疗急性脑梗死疗效及安全性

目的 观察巴曲酶联合依达拉奉对急性脑梗死的临床疗效及安全性.方法 选择本院75例急性脑梗死患者为观察对象,符合国家脑血管病诊断标准,并经CT或磁共振成像(MRI)证实,除外禁忌证.按入院顺序随机分为依达拉奉组(A组)、巴曲酶组(B组)和依达拉奉+巴曲酶联用组(C组)各25例.在急性脑梗死常规治疗基础上,A组依达拉奉30 mg加生理盐水100 mL静滴,2次/d,疗程14 d;B组巴曲酶,第1天生理盐水100 mL+巴曲酶10 BU静滴,第3天和第5天分别以生理盐水100 mL+巴曲酶5 BU静滴,半小时内滴完.共三次20 BU.C组依达拉奉、巴曲酶,剂量及用法同A、B组.3周后观察神经功能缺损评分情况,按缺损分值的减少判定疗效.用药期间监测肝肾功能、出凝血时间,观察并记录药物不良反应.结果 治疗后 A、B、C 3组总有效率分别为84%、80%和92%.各组治疗前后自身比较差异均有统计学意义(P＜0.05),组间比较,A、B 2组间无显著差异(P＞0.05),C组则明显优于A、B组(P＜0.05).病人顺应性良好,无严重不良反应.结论 巴曲酶联用依达拉奉治疗急性脑梗死疗效肯定,安全性好.     

巴曲酶突击连续给药治疗急性脑梗死临床疗效分析

巴曲酶(东菱精纯克栓酶)在我国治疗急性脑梗死已多年,有关巴曲酶在治疗急性脑梗死中的溶栓、降纤及脑保护等方面的作用已有多篇报道.既往在使用巴曲酶治疗急性脑梗死时多采用首次10U,隔日5U,总量20U的给药方法.为了探讨巴曲酶在不同剂量不同疗程时治疗急性脑梗死的有效性和安全性,我们于2000年开始对发病在24h内的急性脑梗死患者采用连续3次给药,每次巴曲酶10U的治疗方法,取得了较好的治疗效果.     

巴曲梅突击连续给药治疗急性脑梗死临床疗效分析

巴曲酶 (东菱精纯克栓酶 )在我国治疗急性脑梗死已多年 ,有关巴曲酶在治疗急性脑梗死中的溶栓、降纤及脑保护等方面的作用已有多篇报道。既往在使用巴曲酶治疗急性脑梗死时多采用首次 10 U,隔日 5 U,总量 2 0 U的给药方法。为了探讨巴曲酶在不同剂量不同疗程时治疗急性脑梗死的有效性和安全性 ,我们于 2 0 0 0年开始对发病在 2 4 h内的急性脑梗死患者采用连续 3次给药 ,每次巴曲酶 10 U的治疗方法 ,取得了较好的治疗效果。1　材料与方法1.1　一般资料1.1.1　分组　共 180例脑梗死患者 ,均为 2 0 0 0～ 2 0 0 1年期间住院患者。随机分为 3…     

巴曲酶注射液治疗发病72h后急性脑梗死的研究

目的 比较巴曲酶注射液对发病72h～5d(试验组)与发病6～72h(对照组)急性脑梗死的治疗作用及其安全性.方法 对两组60例患者应用巴曲酶注射液静脉滴注隔日1次,共3次.首次为10BU,另两次各为5BU.用药前、治疗后2h、12h±20min、24h±20min、3d、7d、14d、1个月及3个月时进行NIHSS评分,在1个月和3个月时进行简易智能量表(mini-mental state examination,MMSE)、Barthel指数(Barthel Index,BI)、改良的 Rankin量表(Modified Rankin Scales,MRS)和安全性评价.结果 试验组神经功能恢复在用药后2h NIHSS评分即开始改善,对照组在用药后12h开始改善;两组在其他各时间点均较用药前显著改善.试验组在用药后3个月的BI、MMSE评价比用药后1个月时有显著进步.两组均无不良事件发生.结论 巴曲酶注射液对发病72h～5d急性脑梗死的治疗安全、有效.     

依达拉奉和巴曲酶联合治疗急性进展型脑梗死的疗效观察

目的 观察依达拉奉和巴曲酶联合治疗急性进展型脑梗死的疗效.方法 将80例急性进展型脑梗死患者随机分为联合治疗组和对照组各40例.联合治疗组使用依达拉奉30 mg静脉滴注,每天2次,连用10 d;同时在第1 d、3 d、5 d静脉滴注巴曲酶,剂量分别是10 BU、5 BU、5 BU.对照组则单用巴曲酶,用法同联合治疗组.两组治疗前后均进行神经功能缺损程度评分(NDS)及凝血指标检查.结果 联合治疗组的总有效率(95%)明显高于对照组(75%)(P＜0.05).治疗后两组的血纤维蛋白原水平均明显降低(均P＜0.05),血小板数、出凝血时间、凝血酶原时间差异无统计学意义.联合治疗组有1例出现皮下出血.结论 依达拉奉联合巴曲酶治疗急性进展型脑梗死效果显著,无明显不良反应.     

小剂量巴曲酶治疗高龄老人急性脑梗死的疗效观察

本文观察了急性脑梗死32例高龄老人,平均81岁,用小剂量马曲酶5BU,隔日1次静滴,(1支/次,4次1个疗程,不良反应轻,致残率低,无明显出血.其主要机制可能为小剂量巴曲酶缓慢持久降纤使血液始终处于低纤维蛋白原水平,而产生了持久降纤改善微循环,避免了首次10BU而引起再出血的风险.因此,对伴有高纤维蛋白原血症的高龄急性脑梗死患者,给予小剂量巴曲酶降纤,疗效肯定、安全,出血风险小.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.