Cortical Spreading Depression and Migraine

Cortical spreading depression, a slowly propagating wave of transient neuronal and glial depolarization, is widely accepted as the electrophysiologic substrate of migraine aura and a trigger for headache. Recent clinical and experimental evidence reinforces the putative role of cortical spreading depression in migraine pathophysiology. Imaging studies in migraineurs demonstrated hemodynamic changes consistent with cortical spreading depression during aura, whereas recent animal studies helped unravel pathophysiologic aspects such as the triggering mechanisms, genetic and hormonal modulation, and potential therapeutic targets. Here, we provide an overview of recent advances in our understanding of migraine pathophysiology and treatment.     

癫(癎)与抑郁

癫患者在癫发作间期,抑郁症发作很常见。病因学主要归纳为强制正常化现象、抗癫药物、偏侧化假说和个人心理因素影响等4方面;癫合并抑郁与神经递质如5-羟色胺(5-HT)、去甲肾上腺素、γ-氨基丁酸和谷氨酸等有关;癫患者抑郁的检测。临床医生应重视抑郁症的治疗,并从抗癫药物和5-HT再摄取抑制剂(selective serotonin reuptake inhibitors,SSRIs)等药物中归纳出一些主要药物的功效。本文主要针对癫合并抑郁的病因、发病机制、检测方法及治疗等研究进展作介绍。     

外伤性癫痫治疗的临床探讨

目的探讨外伤性癫痫的高危因素、临床特征、预防及治疗方法等。方法我科自2000年1月到2006年3月收治86例外伤性癫痫患者,均常规给予抗癫痫药物治疗,其中手术治疗21例。手术患者采取致痫灶切除术6例,致痫灶切除 多处软膜下横切术(MST)/热灼术11例,前颞叶、杏仁核-海马切除2例,选择性杏仁核-海马切除1例,胼胝体切开 MST 皮层热灼1例。结果随访6～58月,65例保守治疗者中,28例在服药治疗两年以上后逐步减药直至停药,未见癫痫明显发作;其余患者仍继续口服药物治疗,8例仍时有发作。21例手术治疗患者,术后癫痫控制满意9例(42.7%),显著改善8例(38.1%),良好2例(9.6%),效果较差1例(4.8%),无改善1例(4.8%)。无手术死亡及永久性并发症发生。结论外伤性癫痫的预防首先应去除诱因,对有高发风险者可予以预防性抗癫痫药物治疗。准确的术前评估、术中ECoG监测、多种术式的联合应用可提高外伤后癫痫患者的手术疗效。     

Fatigue and Depression in Epilepsy

Fatigue is commonly reported as an adverse effect of antiepileptic drugs. In other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy.     

Prevalence, Classification, and Severity of Epilepsy and Epileptic Syndromes in Children

Summary: Purpose: To determine the point prevalence of active childhood epilepsy in a defined area and evaluate the usefulness of ILAE classification of seizures, and epilepsies/syndromes with special interest in severe epilepsies. Methods: By using the latest ILAE International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989), we determined the age- and sex-specific prevalence rates of epilepsy, type of seizures, epilepsies, and recognizable epileptic syndromes, as well as the proportion of severe cases in each seizure/epilepsy/syndrome category in all children 0–15 years of age from a geographically defined area in Finland. All medical records, neurophysiological recordings and available clinical data were reviewed retrospectively. Results: Point prevalence of active epilepsy on December 12, 1992 was 3.94 per 1,000. According to ICESDCE, we were able to classify 96% of seizures and 90% of epilepsies and syndromes. Generalized seizure and epilepsy/syndrome types were more prevalent in children 0–6 years of age and partial/ localization-related in children 6–15 years of age. Epilepsy was intractable in 17% of all cases and correlated significantly with symptomatic etiology and early onset of epilepsy, as well as with additional neuroimpairments. Conclusions: A considerable number of cases fell into the nonspecific categories of ICE, which limits the value of present epilepsy/syndrome classification in terms of prognosis, prediction, and indication for special investigations in individual cases. A number of intractable cases was relatively low, indicating good prognosis in many childhood epilepsies, especially when additional neuroimpairments are absent.     

Learned Helplessness, Attributional Style, and Depression in Epilepsy

Summary: Purpose: We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy.
Methods: Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self-report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies-Depression scale (CES-D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale.
Results: Attributional style was significantly associated with increased self-reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance].
Conclusions: The results indicate that the concepts of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.     

Chaos, Balance, and Development: Thoughts on Selected Childhood Epilepsy Syndromes

Summary: Age-specific epilepsy syndromes raise important questions about developmental susceptibility to seizures and epileptogenesis and about the effect of seizures on function. The diagnosis and treatment of these syndromes has been enhanced by the use of modern science and technology. Epidemiologic studies have changed our approach to febrile convulsions. This developmental seizure disorder is benign and self-limited. We have been forced to think carefully about threshold, therapy, and whether other seizures in childhood may be equally benign. This framework of developmental specificity can also be applied to West syndrome, especially with respect to neurophysiology, neurochemistry, neuroimaging, and epidemiology–the types of seizures, clustering, variations associated with sleep, PET scans, and therapy. Rasmussen's syndrome and other unilateral developmental epilepsies are progressive but remain confined to a single hemisphere. However, they usually are devastating to global neurologic function. They are models for examining the impact of epilepsy in one pathologic hemisphere on the function of the entire brain. Current therapy for this condition is hemispherectomy. Recovery of function after this major surgery is striking and provides clues to brain organization. The analysis of these three syndromes provides windows on the dynamic, changing central nervous system of the child and may lead to better understanding and therapy for other seizure disorders.