癫痫与突然死亡

一般认为 ,癫痫患者死亡原因 (除自然死亡外 )主要有以下几种情况 :(1)癫痫持续状态造成的窒息及脑功能衰竭 ;(2 )癫痫发作造成的意外事故 ;(3)自杀 ;(4 )死于引起癫痫发作的原发病 ;(5 )与治疗药物有关的死亡 ,极为罕见 ;(6 )突然而不能解释的死亡 (ｓｕｄｄｅｎｕｎｅｘｐｌａｉｎｅｄｄｅａｔｈｉｎｅｐｉｌｅｐｓｙ,ＳＵＤＥＰ) ,即猝死。其中以癫痫持续状态及发作时的意外事故造成的死亡多见。有报道在癫痫死亡原因中 ,ＳＵＤＥＰ占8% ,可见突然死亡亦是癫痫死亡的一个重要原因[1] 。但是 ,癫痫的突然死亡在临床一直被忽视 ,现就ＳＵＤ…     

癫痫性猝死之管见

<正>癫痫性猝死（sudden unexpected death in epilepsy,SUDEP）是癫痫患者整体死亡风险较普通人群显著增高的重要原因，由SUDEP所致的癫痫性死亡已成为重大公共卫生问题。笔者检索国内文献发现，目前关于SUDEP的报道甚少，有关SUDEP命名不一，如“癫痫不明原因猝死”、“癫痫患者突然意外死亡”、“癫痫猝死”等。随着长程视频脑电监测的普及、基因检测技术及分子水平尸检的开展等，人们对SUDEP有了进一步认识，有必要再次探讨SUDEP的科学定义和解读，这对未来研究SUDEP具有重要意义。癫痫性猝死的概念由Nashef于1997首次提出。为了方便临床应用，2012年再次对其重新修订。     

宁夏农村地区惊厥性癫痫患者死亡原因分析

目的分析宁夏农村地区惊厥性癫痫患者可能的死亡原因,为预防癫痫患者死亡及降低癫痫死亡率提供依据。方法收集2012年1月1日~2014年12月31日宁夏农村地区癫痫示范项目区内死亡癫痫患者的临床资料,并进行回顾性分析,用Excel表格建立数据库,SPSS17.0软件统计分析,计数资料比较采用χ2检验,P0.05为差异有统计学意义。结果 3 y间,宁夏农村地区癫痫示范项目区内死亡患者共计137例。癫痫发作在死因构成中居于首位(32.8%),其次为意外死亡(26.9%)、脑血管病(11.0%)、不明原因死亡(8.0%)、呼吸系统疾病(6.5%)、循环系统疾病(5.1%)、消化系统疾病(4.3%)及自杀(2.9%);癫痫患者的死亡年龄主要分布在30~39岁之间(21.9%);以脑血管病为主要死亡原因者主要分布在60~69岁之间;以癫痫发作为死亡原因者20~69岁年龄组占86.7%;意外死亡的患者年龄分布在10~79岁之间,其中,40~59岁者占37.9%。宁夏农村地区癫痫患者年平均死亡率为1.4/10万,男性死亡率为1.7/10万,女性为1.1/10万,男、女性死亡率有显著性差异(P0.05);在神经系统疾病死因统计中,癫痫死亡率仅次于脑血管病。结论癫痫发作、意外(溺水及车祸为主)、脑血管病、不明原因死亡是宁夏农村地区癫痫示范项目区内癫痫患者死亡的主要原因。宁夏农村地区癫痫示范项目区内癫痫患者的死亡率为1.4/10万。男性癫痫患者的死亡率(1.7/10万)高于女性(1.1/10万)。     

癫痫猝死的研究进展

癫痫猝死(sudden unexpected death in epilepsy,SUDEP)是癫痫患者突然发生的无法解释的死亡,一般认为大部分SUDEP与癫痫发作有关.其发病机制仍不明确,现对SUDEP的相关文献进行系统综述,旨在提高对该现象的认识并促进其研究.     

癫痫病人原因未明的突然死亡

癫痫病人原因未明的突然死亡吴逊综述癫痫病人的寿命短，年龄匹配的死亡中位年龄为３２．５～４３．５岁，而非癫痫为６８．３～６９．３岁［２、３］。癫痫死亡率为非癫痫的１．８倍或２～３倍，标准死亡率为５．８，非癫痫为１．０［２、３，７］。发作后平均生存年龄１...     

癫癎患者不明原因突然死亡的临床和病理特征

目的 研究癫痫患者不明原因突然死亡(SUDE)的临床和病理特征。方法 对7例符合美国食品药品管理局SUDE标准的癫痫患者的临床资料和病理特征进行分析。结果 病理切片显示全部患者都存在脑水肿和肺水肿，部分患者有神经细胞数量减少和胶质细胞增多，无占位性改变，也没有发现明显的脑部损伤。其中2例在睡眠中死亡，4例死亡前有情绪激动或惊恐史，7例患者均在出现全身强直-阵挛性发作时死亡。结论 脑水肿、肺水肿、多种胶质细胞增生及神经元数量减少是SUDE的主要病理改变，但无特异性。情绪激动、发作未能有效控制和全身强直-阵挛性发作是SUDE患者重要诱因，SUDE易发生在睡眠中。     

癫痫猝死的危险因素与风险评估研究进展

癫痫是一类常见的神经系统疾病, 患者常表现出不可预测的自发性癫痫发作。癫痫猝死是癫痫最为严重的并发症之一, 也是癫痫患者过早死亡的主要原因。全身性强直阵挛发作、年龄及遗传等均为癫痫猝死的常见危险因素。文中就癫痫的流行病学、致病机制、危险因素、风险评估和预防对癫痫猝死进行综述, 以帮助临床医生更好地区分癫痫猝死与心脏猝死。     

癫痫猝死的研究进展

正癫痫猝死是癫痫患者突然发生的、意外的、有或无目击者、非外伤或溺水所致的死亡,伴或不伴癫痫发作,必须排除癫痫持续状态,尸检未发现结构性或中毒性致死因素~([1])。近年来有关癫痫猝死的研究已引起越来越多的关注,但其发病机制仍不明确。现对癫痫猝死的危险因素、发病机制、预防措施作一综述。1癫痫猝死的发生率癫痫患者的死亡率比普通人群高2~3倍,这种过高的死     

宁夏农村惊厥性癫痫患者死因分析

目的分析宁夏农村惊厥性癫痫(CE)患者的死亡原因,为早期识别高危患者、制定可行的防范措施提供依据,以降低癫痫患者的死亡风险。方法通过宁夏癫痫防治管理项目办,收集2012年1月1日~2016年1月1日宁夏农村CE患者的死亡资料,采用统一的癫痫患者死亡调查问卷对死亡信息进行调查核对,回顾性分析死亡原因。结果 4年中宁夏农村CE患者共死亡187例,死亡率约为5.2/10万。死因顺位前5位依次为损伤与中毒(25.7%)、癫痫持续状态(SE,21.4%)、癫痫猝死(SUDEP,17.1%)、脑血管病(12.8%)及心脏病(7.5%)。男、女CE患者的死因构成不同(P0.05)。其他疾病组(包括脑血管病、心脏病、恶性肿瘤、呼吸系统疾病、精神障碍、泌尿及生殖系统疾病及消化系统疾病)死亡年龄大于损伤与中毒、SUDEP以及SE组(LSD-t=5.20,P=0.000;LSD-t=4.22,P=0.000;LSD-t=6.07,P=0.000)。不同死因CE患者的死亡年龄构成不同(P0.05)、死亡地点分布不同(P0.05)。结论宁夏农村CE患者的首位死因是损伤与中毒,其次为SE和SUDEP。     

癫痫与自杀

自杀而导致死亡被为是增加癫痫患者死亡率的最重要原因之一。国外许多研究报道都表明癫痫患者的自杀率比普通人群的自杀率高几倍到二十几倍。可能导致癫痫患者自杀的危险性因素是有多方面的,本文将从5-HT、抗癫痫药及癫痫手术治疗、精神病理等方面对癫痫患者可能存在自杀危险因素进行综述,并希望在癫痫的综合治疗中对这些危险因素能加以考虑。     

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.     

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.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.