注意缺陷多动障碍患儿事件相关电位N400研究

目的:探讨注意缺陷多动障碍(ADHD)患儿汉语句子结尾词匹配和非匹配语言时相关电位(ERP)N400的变化。方法:应用ERP仪,采用汉语正常句子结尾词匹配与非匹配的范式,对35例ADHD患儿(ADHD组)和41名正常儿童(正常对照组)进行视觉诱发电位N400检测。结果:在Cz脑区匹配及非匹配条件下,ADHD组N400潜伏期[(384±45)ms,(436±35)ms]比正常对照组[(348±32)ms,(399±29)ms]显著延迟(P均0.01);波幅ADHD组[(4.2±4.5)μV,(7.5±5.1)μV]显著低于正常对照组[(7.6±5.0)μV,(12.4±6.5)μV](P均0.01)。结论:ADHD患儿N400异常,N400检测可能成为判断注意缺陷多动障碍的客观指标。     

首发精神分裂症患者康复过程中事件相关脑电位N400随访

目的研究首发精神分裂症患者的N400变异与临床症状和康复的关系。方法对58例精神分裂症首发患者和62名健康成人作了N400检测。并用阳性和阴性症状量表(PANSS)评定患者精神症状。患者组于治疗6月、15月时进行N400随访。结果 (1)与健康成人相比,患者组服药前的N400潜伏期和波幅在Cz、Pz、Fz、C3、C45个脑区明显延迟于对照组和波幅下降。(2)N400潜伏期延迟和波幅下降与阳性症状分和PANSS总分呈负相关。(3)患者组在治疗后的6月、15月随访时,N400潜伏期和波幅有显著性差异(N400潜伏期,非匹配:治疗前446±35ms,治疗6月440±37ms,治疗15月414±31ms,F值=9.72,P<0.01。N400波幅,匹配:治疗前5.2±4.6μV,治疗6月5.7±4.8μV,治疗15月7.3±5.0μV,F值=2.06,P>0.05。非匹配:治疗前8.5±5.9μV,治疗6月10.1±5.0μV,治疗15月11.9±7.0μV,F值=3.697,P<0.05)。结论 N400对精神分裂症的疗效具有一定的预测作用。随访显示精神分裂症的语言及认识缺陷症状是渐进性过程,随着疗程或治疗发生相应变化。     

血管性认知功能障碍患者的事件相关电位分析

目的观察血管性认知功能障碍患者的事件相关电位特性。方法以非认知功能障碍正常对照组、非痴呆型血管认知功能障碍组和血管性痴呆组进行19通道的事件相关电位分析,自动记录反应时间和反应按键的正误,应用重复测量方差分析和配对检验进行比较。结果血管性痴呆组的反应时间(F=54.18,P<0.001)和按键正确率(F=40.23,P<0.001)较正常对照组、非痴呆型血管认知功能障碍组有显著差异,正常对照组的行为绩效反应时间[(325.16±69.39)ms]、正确率[(97.5±1.6)%]优于非痴呆型血管认知功能障碍组[(384.58±76.25)ms,(88.2±8.9)%]和血管性痴呆组[(472.65±89.30)ms,(57.8±7.8)%],后2组行为绩效比较亦存在显著性差异。ERP提示非痴呆型血管认知功能障碍和血管性痴呆的P300、N400潜伏期较正常对照组明显延长,3组潜伏期及波幅比较差异有统计学意义(P<0.05)。结论事件相关电位的P300、N400成分作为一种客观、量化的电生理指标,可用于早期识别脑卒中血管性认知功能障,为非痴呆型血管认知功能障碍的诊断和评估预后提供了重要的客观辅助手段。     

正常成人汉语句子识别的事件相关脑电位N400实验研究

目的探讨正常成人汉语句子结尾词匹配和非匹配事件相关脑电位（ERP）N400的特点。方法应用ERP仪,对58名19～63岁正常成人右利手受试者,进行汉语正常句子结尾词（匹配）与句子结尾歧义词（非匹配）N400的实验研究。结果正常成人中央区（Cz）、前额区（Fz）及顶区（Pz）脑区汉语句子结尾词匹配的N400平均潜伏期为364ms,平均波幅为8.9μV;非匹配的N400的平均潜伏期为409ms,平均波幅为12.9μV。正常成人各脑区匹配与非匹配的汉语句子结尾词的N400潜伏期、波幅比较有统计学差异。结论正常成人汉语句子识别的N400稳定、可靠;非匹配的汉语句子结尾词的N400潜伏期长,波幅高。     

神经性厌食的事件相关电位P300的实验研究

目的研究神经性厌食（AN）患者的事件相关电位P300特点。方法应用Nicolet Bravo脑电生理仪,采用纯音＂Oddball＂刺激诱发模式,对43例AN患者和34名健康对照进行认知性电位P300检测。结果 AN组P300中靶P3的潜伏期[（297.8±29.3）ms]长于健康对照组[（285.6±19.7）ms],差异有统计学意义（t=2.19,P=0.03）;AN组靶P3波幅为（6.5±3.4）μV,低于健康对照组（9.8±3.2）μV,差异有统计学意义（t=4.33,P〈0.01）。2组的靶P2、靶N2及非靶P2的潜伏期、波幅均无统计学差异。结论 AN患者的P300靶P3潜伏期延长、波幅降低。     

草酸艾司西酞普兰对抑郁症患者事件相关电位P300的影响

目的:探讨草酸艾司西酞普兰对抑郁症患者的事件相关电位P300影响。方法:随机将年龄在18～65岁之间符合中国精神障碍分类与诊断标准第3版抑郁症诊断标准患者30例作为研究组,选择30例性别年龄健康者作为对照组。研究组予草酸艾司西酞普兰治疗。两组分别予听觉P300检测,比较P300潜伏期及波幅的差异。结果:研究组Fz、Pz点潜伏期分别为(319±23)ms、(315±20)ms均比对照组分别为(300±22)ms、(299±21)ms延长,研究组Fz、Cz、Pz点分别为(2.5±1.8)μV、(2.6±2.4)μV、(2.5±3.3)μV波幅均比对照组分别为(3.8±2.0)μV、(3.7±1.9)μV、(4.1±3.0)μV降低(P<0.05或P<0.01)。治疗8周后,研究组Fz、Pz点潜伏期分别为(301±19)ms、(305±19)ms]明显缩短,Fz、Cz、Pz点分别为(3.5±1.8)μV、(3.7±2.1)μV、(3.6±3.5)μV波幅明显升高(P<0.05)。结论:抑郁症患者存在P300异常,草酸艾司西酞普兰具有改善这种异常现象的作用。     

躯体形式障碍患者认知功能的事件相关电位P300研究

目的 探讨躯体形式障碍患者认知功能的事件相关电位P300特征.方法 随机将年龄在18～65岁之间符合CCMD-3躯体形式障碍诊断标准患者30例作为实验组,选择30例性别年龄相匹配的健康者作为对照组.各组分别予听觉P300检测,比较P300潜伏期及波幅的差异.结果 实验组PZ点潜伏期[(308±21)ms],均比对照组[(298±22)ms]延长,实验组FZ、CZ、PZ、OZ点[分别为(2.4±1.6)μV、(2.6±2.3)μV、(2.6±3.3)μV、(2.4±1.9)μV]波幅比对照组[分别为(3.9±2.1)μV、(3.8±1.9)μV、(4.2±3.4)μV、(3.7±2.0)μV]降低(P<0.05及0.01).结论 躯体形式障碍患者存在认知功能障碍.     

血管性抑郁患者关联性负变的临床研究

目的 观察抑郁症各亚型患者事件相关电位关联性负变的特征,从神经电生理角度探讨血管性抑郁发生可能的病理生理机制.方法 应用意大利EB-NEURO事件相关电位工作站,对19例血管性抑郁患者、13例非血管性抑郁患者和16名年龄匹配的正常对照检测关联性负变成分的潜伏期、波幅和面积.结果 [1]与正常对照相比,血管性抑郁患者关联性负变波形欠规则.[2]血管性抑郁患者组的关联性负变潜伏期A较正常对照组明显延长[(519.68±41.59)ms、(307.50±28.02)ms],命令信号前期待波(EW)平均波幅均较正常对照和非血管性抑郁患者组明显降低[(6.23±1.39)μV、(16.13±2.66)μV、(8.92±1.99)μV]、EW面积也分别较后两组明显减少[(7592.06±628.58)、(20016.7±1005.37)、(10592.54±718.84)],上述差异均有统计学意义(P＜0.05).结论 血管性抑郁患者关联性负变异常的特征提示脑血管病变既影响情感调节通路,又影响了注意等认知神经环路.     

酒依赖相关精神障碍患者的脑干听觉反应及P300异常变化

目的探讨酒依赖患者脑干听觉反应(ABR)及P300的特点.方法以click短声、听觉靶刺激和非靶刺激为诱发事件,检测26例男性酒依赖患者及31名男性正常人的ABR和事件相关电位P300.结果 (1)ABR与对照组比较,酒依赖组波Ⅱ～波Ⅶ的绝对潜伏期长,波Ⅱ～波Ⅴ的绝对波幅低,差异均有显著性和非常显著性(P<0.05或P<0.01);(2)P300在靶刺激中,酒依赖组的P2和P3潜伏期[分别为(187±26)ms和(319±27)ms]长于对照组[分别为(171±21)ms和(302±16)ms],P2和P3波幅[分别为(3.9±2.3)μV和(3.5±3.1)μV]低于对照组[分别为(6.0±2.1)μV和(8.2±4.1)μV];在非靶刺激中,酒依赖组的N1潜伏期[(108±14)ms]长于对照组[(98±12)ms];差异有显著性和非常显著性(P<0.05或P<0.01).结论长期大量饮酒不仅损害脑干功能,同时损害皮层认知功能.     

强迫症患者的失匹配负波研究

目的 探讨强迫症患者失匹配负波(MMN)的特点.方法 应用美国Nicolet Bravo脑诱发电位仪,对27例强迫症患者和33名正常成人进行了MMN检测.结果 与正常对照组相比,强迫症患者MMN潜伏期延迟(正常组(191±23)ms,强迫症组(208±25)ms,t=2.793,P＜0.01),同时波幅降低(正常组(8.9±1.7)μV,强迫症组(5.4±1.9)μV,t=6.24, P＜0.01).结论 被动事件相关电位MMN可反映强迫症患者自动加工过程.失匹配负波在评价强迫症脑功能失常上可能是有用的指标.     

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.