神经节苷脂GM1对大鼠脑液压伤后行为和记忆的影响

目的:探讨大鼠脑液压伤后GM1与学习记忆、脑内一氧化氮、突触素和细胞凋亡的关系.方法:液压损伤法建立大鼠脑损伤模型,随机分为治疗组、损伤组和对照组.观察伤后学习记忆改变,检测一氧化氮合酶(NOS)、一氧化氮(NO)、突触素和海马、皮质及基底节区细胞凋亡指数.结果:治疗组学习记忆成绩高于损伤组,NOS、NO明显降低,治疗组海马CA1区突触素显著增多,皮质、海马和基底节的凋亡细胞数明显减少.结论:GM1能减少海马和皮质细胞凋亡,可能有利于促进脑损伤后神经行为和记忆的恢复.     

神经节苷脂GMl对大鼠脑液压伤后行为和记忆的影响

目的探讨大鼠脑液压伤后GM1与学习记忆、脑内一氧化氮、突触素和细胞凋亡的关系.方法液压损伤法建立大鼠脑损伤模型,随机分为治疗组、损伤组和对照组.观察伤后学习记忆改变,检测一氧化氮合酶(NOS)、一氧化氮(NO)、突触素和海马、皮质及基底节区细胞凋亡指数.结果治疗组学习记忆成绩高于损伤组,NOS、NO明显降低,治疗组海马CA1区突触素显著增多,皮质、海马和基底节的凋亡细胞数明显减少.结论GM1能减少海马和皮质细胞凋亡,可能有利于促进脑损伤后神经行为和记忆的恢复.     

一氧化氮合酶及其抑制剂与脑缺血

一氧化氮合酶(NOS)在脑缺血中具有双重作用,nNOS介导缺血早期神经元损伤,iNOS介导缺血晚期神经元损伤,eNOS则介导神经保护作用。对NOS抑制剂,尤其是选择性nNOS和iNOS抑制剂的研究,无疑将为缺血性脑损伤的治疗提供新途径。     

重症肌无力患者IgG对大鼠脑内NOS不同时间表达的影响

目的观察重症肌无力(myasthenia gravis,MG)患者IgG(AchRab)对大鼠脑内一氧化氮合酶(NOS)表达的影响,探讨NOS在MG中造成中枢神经系统损害的机制.方法将AchRab IgG或健康人的IgG注入大鼠侧脑室,1次/d,连续4次.免疫组化方法观察不同时间点大鼠脑皮质、海马及杏仁核神经元型一氧化氮合酶(nNOS)和诱导型一氧化氮合酶(iNOS)的表达变化.结果侧脑室注射后1周实验组大鼠皮质、海马神经元nNOS表达量明显减少,后2周实验组皮质、海马神经元nNOS表达下降更为明显,同时杏仁核神经元nNOS表达量也减少;实验组及对照组脑内细胞均未见iNOS表达.结论AchRab侧脑室内注射可引起大鼠皮质、海马及杏仁核神经元nNOS表达量减少,且2周内这种减少效应随时间延长而增强,但未能诱导脑内细胞iNOS表达,提示AchRab尚可通过抑制大鼠中枢神经系统nNOS表达,降低脑内正常的一氧化氮浓度,减弱一氧化氮对脑组织的保护作用,增加神经元的易损性.     

刺五加皂甙对大鼠血管性痴呆防治作用的研究

目的探讨刺五加皂甙对血管性痴呆(VD)模型大鼠学习记忆等认知功能的改善和对海马CA1区神经元的保护作用.方法SD大鼠随机分为正常组、(VD)模型组、刺五加皂甙组,采用4-血管阻断改良法制备VD大鼠模型,各组作避暗回避试验和跳台试验等行为学测试,Nissl染色.结果行为学测试表明刺五加皂甙能明显改善(VD)模型大鼠学习记忆等认知功能,形态学结果表明刺五加能减轻海马CA1区神经元丢失.结论刺五加皂甙能减轻海马脑缺血缺氧后神经元损害,从而改善(VD)模型大鼠学习记忆功能.     

丁苯酞对慢性脑缺血大鼠海马iNOS及MG表达的影响

目的观察丁苯酞对慢性脑缺血大鼠海马区诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)、小胶质细胞(microglia,MG)表达的影响,探讨丁苯酞脑保护作用机制。方法 48只雄性SD大鼠随机分为4组:正常大鼠组为A组,假模型组为B组,模型组为C组,丁苯酞干预组为D组。行双侧大鼠颈总动脉永久结扎的方法制作大鼠慢性脑缺血模型。丁苯酞干预组在慢性脑缺血模型成功后给予丁苯酞软胶囊0.2g·kg~(-1)治疗12周,采用Y迷宫测定各组大鼠学习记忆能力,免疫组化染色测定iNOS及OX42(小胶质细胞的标志)表达,特异性尼氏染色方法测定海马CA1区神经元。结果 A、B组大鼠学习记忆能力正常,海马区iNOS、OX42少量表达,神经元数目正常。C、D组大鼠学习记忆能力下降,海马区iNOS、OX42表达增多,神经元数目减少。与C组相比,D组大鼠学习记忆能力明显增加(P0.01),海马区iNOS、OX42表达减少(P0.01),神经元数目增加(P0.01)。结论丁苯酞可减少慢性脑缺血大鼠海马区iNOS、OX42表达,减少MG的过度激活,减少海马区神经元坏死,提高大鼠的学习记忆能力,具有脑保护作用。     

颅脑损伤后局部组织一氧化氮合酶表达的实验研究

目的研究一氧化氮合酶(nitricoxidesynthase,NOS)基因在实验性大鼠颅脑创伤后局部组织中表达.方法应用免疫组化技术和高清晰度彩色病理图像分析系统,对大鼠脑组织神经细胞中诱导型一氧化氮合酶(iNOS)的表达进行了检测.结果颅脑创伤后大鼠局部及周围神经细胞中有NOS阳性产物表达并具时程特点,伤后2h平均积分光密度(ODI)较0.5h升高不显著(P0.05),伤后6h、12h、24hODI较0.5h升高非常显著(P<0.01).结论在急性脑损伤后的病理过程中,脑组织中诱导型一氧化氮合酶被大量合成,可能是造成机体一氧化氮(Nitricoxide,NO)升高的直接原因.     

脑室内注射乙酰胆碱受体抗体IgG对大鼠神经元凋亡及一氧化氮合酶表达的影响

目的研究乙酰胆碱受体抗体(AchRab)对大鼠脑内神经元的损害及一氧化氮合酶(NOS)在损害中所起的作用，探讨重症肌无力(MG)中枢神经系统损害的机制。方法将AchRab IgG或健康人的IgG注入大鼠侧脑室。HE染色、TUNEL法检测细胞凋亡；免疫组化方法观察大鼠皮质、海马及杏仁核神经元型一氧化氮合酶(nNOS)和诱导型一氧化氮合酶(iNOS)表达变化。结果2周后实验组皮质、海马及杏仁核凋亡细胞明显增多，对照组仅见少量凋亡。实验组皮质、海马及杏仁核nNOS神经元数目明显减少。实验组及对照组脑内细胞均来见iNOS表达。结论AchRab脑内注射可诱导神经元凋亡；损伤皮质。海马及杏仁核nNOS神经元；但未能诱导脑内细胞iNOS表达。神经元凋亡损害参与了AchRab对中枢神经损害的机制；nNOS神经元的减少，可能与MG认知功能障碍有密切关系；而神经元的损伤可能与NO的毒性作用无关。     

一氧化氮合酶抑制剂对脊髓损伤后运动功能的影响

目的观察诱导型和神经型一氧化氮合酶(iNOS,nNOS)抑制剂对大鼠脊髓损伤(SCI)后运动功能的影响和机理。方法大鼠脊髓压迫伤后分别给予iNOS和nNOS抑制剂—氨基胍(AG)和7-硝基吲唑(7-NI)进行治疗,24h后用分光光度法测定组织中一氧化氮(NO)含量和一氧化氮合酶(NOS)活性,72h后用流式细胞仪检测神经细胞凋亡情况,4周后用电生理和动物行为学等指标评价运动功能的恢复情况。结果AG和7-NI均可以抑制组织中的NO含量,并使NOS活性下降,同时降低神经细胞的凋亡比率,对运动功能的恢复前者优于后者。结论脊髓损伤后应用NOS抑制剂可以使伤后运动功能得到改善,AG的作用似乎更明显,提示iNOS活性变化可能对脊髓损伤的恢复更具决定作用。     

腺病毒介导BDNF基因转移对大鼠创伤性脑损伤后iNOS表达及细胞凋亡的影响

研究重组腺病毒介导的脑源性神经营养因子（brain derived neurotrophic factor,BDNF)基因转移对创伤性脑损伤（TBI）后诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS)表达及细胞凋亡的影响。将重组腺病毒载体4μl注入承受单侧大脑皮质重锤打击的大鼠海马,对照组注射病毒缓冲液。伤后3h及1,3,7,14d利用免疫组化单标／双标染色。原位杂交／组化染色及DNA末端原位标记等方法,检测伤侧大脑皮质和海马各多区iNOS、BDNF及凋亡相关信号表达的改变。与对照组相比,同伤组大脑皮质及海马各区iNOS阳性细胞于伤后3h开始显著增多,7d达高峰。多数iNOS阳性细胞同时呈现凋亡相关蛋白阳性反应或TUNEL阳性反应,但很少同时表达BDNF mRNA。注射病毒载体组后3,7d,海马CA1区和DH区表达iNOS、凋亡相关蛋白的细胞及凋亡细胞显著减少（P均＜0．01）,而表达BDNF mRNA的神经元显著增多。提示,TBI诱导海马细胞表达iNOS及诱导海马细胞凋亡;腺病毒介导的BDNF基因转移通过抑制iNOS表达、增加BDNF表达及减少细胞凋亡的机制保护海马神经元。     

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.