依达拉奉治疗急性脑梗死76例临床分析

目的 观察依达拉奉治疗急性脑梗死的临床疗效.方法 选择76例急性脑梗死患者,随机分为治疗组42例,对照组34例,2组均给予缺血性脑血管病常规治疗,治疗组同时给予依达拉奉30mg静滴,2次/d,14d为一个疗程.治疗前,治疗后7d、14d、21d分别进行一次神经功能缺损评分、欧洲卒中量表评分、Barthel生活质量评分,观察治疗效果.结果 治疗21d后治疗组总有效率95.24%,对照组总有效率79.41%,2组之间疗效有显著差异(P<0.05).结论 依达拉奉治疗急性脑梗死安全有效,值得临床应用.     

脑心通胶囊治疗急性脑梗死的疗效观察

目的 观察脑心通胶囊治疗急性脑梗死的临床疗效.方法 将98例急性脑梗死的患者随机分为治疗组和对照组.对照组49例给予肠溶阿司匹林抗血小板聚集、脑保护、抗自由基等常规治疗;治疗组49例给予上述常规治疗的同时加用脑心通胶囊4粒,3次/d,共30d.结果 治疗组神经功能缺损评分程度与对照组相比有显著差异(P＜0.05).结论 脑心通胶囊对急性脑梗死的治疗疗效明显.     

依达拉奉治疗急性脑梗死临床观察

目的 观察依达拉奉治疗急性脑梗死的有效性和安全性.方法 采用随机、双盲、安慰剂对照试验,选择发病48h内急性脑梗死患者 102 例,随机为为依达拉奉治疗组 52例,对照组 50 例.治疗组给予依达拉奉 30mg静滴,2次/d,共14d,2组同时给予疏血通、阿司匹林.治疗前后定期对患者进行欧洲卒中评分(ESS),日常生活活动能力(ADL)评定和常规检查,以治疗第7、14、21天 ESS增分率与第 90天 ADL增分率作为主要疗效判断标准.结果 21d 治疗组与对照组增分率分别为(58.8±16.2)%、(25.1±11.7)%,2组对比差异有统计学意义(P＜0.01),90d治疗组与对照组增分率分别为(72.5±19.8)%、(46.1±28.6)%,2组相比差异有统计学意义(P＜0.01),治疗组无明显不良反应.结论 依达拉奉治疗脑梗死安全有效.     

rHu-EPO用于急性脑梗死患者的疗效分析

目的探讨重组人促红细胞生成素(rH uE PO)治疗急性脑梗死患者的疗效。方法急性脑梗死患者362例分为两组。对照组(175例)按急性脑梗死临床路径的规范给予常规治疗;rH u-EPO组(187例)在常规治疗的基础上加用rH u-EPO 3000IU/次,每周3次,疗程4 w。治疗前和治疗后7 d、14 d和28 d,ELISA法检测患者血清神经元特异性烯醇化酶(NSE)和S100B蛋白水平;治疗前和治疗后7 d、14 d和28 d行临床神经功能缺陷评分。结果经rH u-EPO治疗7 d、14 d和28 d后,患者血清NSE和S100B水平均显著低于对照组(P<0.05)。急性脑梗死后7 d、14 d和28 d,rH u-EPO组临床神经功能缺陷评分均显著低于对照组(P<0.05)。结论 rH u-EPO治疗能显著降低患者血清血清NSE和S100B水平,改善急性脑梗死患者的神经系统预后。     

依达拉奉治疗急性脑梗死60例疗效观察

目的 观察依达拉奉治疗急性脑梗死的疗效.方法 120例急性脑梗死患者随机分为治疗组和对照组,治疗组60例在对照组常规内科治疗基础上,加用依达拉奉注射液30 mg,加入生理盐水250 mL静滴,2次/d,连续应用14 d.结果 治疗组与对照组比较,总有效率分别为95.00%、83.33%,经统计学处理差异有统计学意义(P...     

神经节苷脂治疗急性脑梗死的疗效观察

目的 探讨神经节苷脂治疗急性脑梗死的临床疗效.方法 将60例急性脑梗死患者随机分为观察组和对照组各30例,2组均给予常规治疗的基础上,对照组给予胞二磷胆碱治疗,观察组给予神经节苷脂治疗.结果 观察组总有效率100%,对照组总有效率60%,观察组疗效优于对照组,2组比较差异具有统计学意义 (P<0.05).结论 神经节苷脂治疗急性脑梗死疗效显著,且安全性好,值得临床推广应用.     

依达拉奉治疗急性脑梗死的疗效及对自由基含量的影响

目的 观察依达拉奉治疗急性脑梗死的临床疗效及对自由基含量的影响.方法 将71例急性脑梗死患者随机分为治疗组35例和对照组36例.两组均给予常规治疗,在此摹础上对照组给予复方丹参注射液静脉滴注,1次/d,连用14 d.治疗组给予依达拉奉注射液静脉滴注.2次/d,连用14 d.观察两组临床疗效,并在治疗前及治疗后进行血清超氧化物歧化酶(superoxide dis-mutase,SoD)活性和丙二醛(m10ndiadehyde,MDA)水平的检测.结果 治疗后7、14、21 d的EsS(European stroke 8cale)比较,差异有统计学意义(p<0.05),治疗组均显著优于对照组.治疗组的显效率为48.6%,对照组的显效率为22.2%,两者比较有统计学差异(P<0.05).治疗组的总有效率为88.6%,也显著优于对照组(63.9%)(P<0.05).在治疗后治疗组的SOD活性显著提高,MDA水平明显降低,与对照组比较有显著统计学差异(P<0.01).结论 依达拉奉能有效清除自由基,改善急性脑梗死患者的神经功能.     

尿激酶超早期静脉溶栓治疗急性脑梗死20例疗效观察

目的 观察应用尿激酶超早期静脉溶栓治疗急性脑梗死的有效性和安全性.方法 治疗组20例,尿激酶100万～150万 U溶于生理盐水100 mL中静滴,30 min内滴完;对照组20例给予常规治疗,分别在溶栓前、溶栓后1 d、7 d和14 d通过神经功能缺损评分评价疗效.结果 2组治疗后1 d、7 d和14 d的神经功能缺损评分比较差异有统计学意义(P＜0.05);治疗组总有效率为90%,对照组总有效率为75%,2组比较差异有统计学意义(P＜0.05);2组均无致死性出血和药物过敏反应.结论 应用尿激酶超早期静脉溶栓治疗急性脑梗死安全、有效.     

降低脑梗死急性期空腹高血糖对神经功能的影响

目的探讨脑梗死急性期空腹高血糖时相变化及降低脑梗死急性期空腹高血糖对神经功能的影响.方法74例入选的急性脑梗死空腹高血糖患者分为诺和灵(RI)治疗组及非RI治疗组各37例、另选正常血糖急性脑梗死患者32例,并动态测定空腹血糖值、神经功能缺损评分及近期疗效.结果(1)脑梗死急性期病程越短,血糖浓度越高,病情越重,RI明显缩短应激性空腹高血糖的持续时间;(2)RI治疗组神经功能恢复快且明显,治愈率高(89.2%),非RI治疗组及正常血糖组治愈率分别为43 2%和62.5%,有显著差异(P均＜0.01).结论RI明显地降低脑梗死急性期空腹高血糖持续时间,且对脑梗死急性期空腹高血糖患者的治疗作用明显.     

通心络胶囊治疗急性脑梗死的疗效观察

目的观察通心络胶囊对急性脑梗死的疗效。方法急性脑梗死患者150例随机分为对照组和治疗组,对照组常规治疗给予银杏叶注射液、肠溶阿司匹林等,治疗组在常规治疗的基础上加服通心络胶囊,评估2组治疗后15d,30d和90d的疗效。结果治疗组神经功能缺损程度的恢复和生活自理能力明显好于对照组,统计学处理P<0.05。结论通心络胶囊治疗急性脑梗死效果较好,应用越早,疗效越好。     

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.     

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.     

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.