松果体区肿瘤的伽玛刀治疗

使用立体定向伽玛刀治疗松果体区肿瘤３３例，肿瘤直径（Ｘ＋Ｙ＋Ｚ／３）１０．０～４５．５ｍｍ；平均２３．５ｍｍ；体积０．４～３５．４ｃｍ３，平均１２．１ｃｍ３；肿瘤边缘剂量１４～２０Ｇｙ，平均１５．２±１．７Ｇｙ；中心剂量２５．０～４２．８Ｇｙ，平均３７．３±６．９Ｇｙ；影像定位仪为１．５ＴＭＲ。随访３～１２个月。初步结果表明：病人的临床症状体证明显好转，９个月后肿瘤生长控制率，即治疗有效率为９６．２％，显效率９２．３％，无严重并发症发生。提示γ－刀可作为松果体区肿瘤的有效治疗方法。     

伽玛刀在松果体区肿瘤治疗中的应用

的探讨伽玛刀对松果体区肿瘤治疗的有效性。方法２５例共３１个病灶,治疗前肿瘤平均体积为５４ｃｍ３（００９２～２９３ｃｍ３）;ＫＰＳ平均为７９２３分（５０～１００分）;射点数１～８个（平均４２个）;周边剂量１０～２２５Ｇｙ（平均１４８６Ｇｙ）;周边剂量曲线３０％～９０％（平均４３９％）;中心剂量１４４４～５６２５Ｇｙ（平均３６１８Ｇｙ）。结果１９个月内有１４例获得随访,平均随访期为５５个月,治疗后平均肿瘤体积缩小至４４ｃｍ３（０～２６７ｃｍ３）。治疗后肿瘤体积缩小者临床症状有明显好转或改善,ＫＰＳ平均为８６９２分（５０～１００分）。结论定位诊断明确的松果体区占位病变,如果其体积在伽玛刀治疗的允许范围内,首选伽玛刀治疗是明智的,可获得良好的预后。     

复发胶质瘤伽玛刀治疗的初步报告

对４８例经手术治疗、术后放疗和（或）化疗后复发的胶质瘤进行了伽玛刀治疗，肿瘤直径１１．３～６９．８ｍｍ，平均３５ｍｍ；肿瘤中心剂量２２～５５Ｇｙ，平均３２Ｇｙ；肿瘤周边剂量１１～２０Ｇｙ，平均１５Ｇｙ；照射的等中心数１～１５个，平均７个。获得随访４０例，随访时间９～２２个月，平均１４个月。至最后一次随访时，１６例死亡，１２例病情恶化，３例症状好转，９例病情无加重。４０例的存活时间２～２２个月，平均１０．９个月。肿瘤体积小治疗效果好，体积大效果差。     

鼠脑胶质瘤近距离放疗的实验研究

目的：探讨铱１９２间质放疗,不同剂量分割对实验性鼠脑胶质瘤的影响。方法：选用种植胶质瘤１７只ＳＤ鼠进行０～１０００ｃＧｙ／２次／天的分割剂量放疗,比较１５０～３００ｃＧｙ组和５００～１０００ｃＧｙ组放疗过程中的影像变化。模式特征和生存期。结果：５００～１０００ｃＧｙ组瘤体出现中央坏死率为１００％（４／４）,１５０～３００ｃＧｙ组为２２．２％（２／９）,两组相比Ｐ〈０．０５。治疗中瘤体中央无坏死组（     

垂体腺瘤的伽玛刀治疗

目的：评估伽玛刀（γ－刀）手术对垂体腺瘤的治疗效果。方法：对２９２例垂体腺瘤患者,用１．５Ｔ磁共振和γ－ｐｌａｎ计算机联网定位,Ｌｅｋｓｅｌ伽玛刀实施放射外科手术。肿瘤直径３．８～５１．１ｍｍ,平均１６．３ｍｍ,处方剂量９～３５Ｇｙ,平均２１．６Ｇｙ。结果：本组获随访２０４例（１２～３４个月,平均２１个月）,肿瘤消失３９例（１９．１％）,缩小１５６例（７６．４％）;激素值恢复正常１４例（１１．８％）,较术前下降９４例（７９．６％）;临床症状改善１９０例（９３．１％）,９例症状加重,３例肿瘤增大,２例开颅手术,１例死亡。结论：γ－刀是治疗垂体腺瘤安全、有效的一种方法,但要严格掌握适应证,对Ⅲ级以上肿瘤应首选手术治疗,γ－刀治疗后有可能加重垂体功能低下或诱发垂体危象。     

伽玛刀治疗颅内疾病3094例临床报告

目的： 探讨立体定向放射手术（伽玛刀） 对颅内疾病的疗效。方法： 用１．５Ｔｅｓｌａ 磁共振仪和γ－ ｐｌａｎ 计算机联网定位, γ－ ｐｌａｎ４．０ 版剂量规划系统作治疗方案设计, 剂量规划, 对３０９４ 例不同类型的颅内疾病包括肿瘤、血管畸形及功能性疾病等实施立体定向放射外科治疗, 病种达２０ 余种,年龄１．１～８６ 岁,周边剂量９～７５Ｇｙ,中心剂量１８～１５０Ｇｙ,等剂量曲线３０％ ～９０％ ,靶点数１～１２ 个。结果： 随访１０～４７ 个月, 统计结果表明： 伽玛刀疗效是确切的。对脑动静脉畸形, 随防一年半以上, 完全闭塞率可达４４．６％ , 体积越小, 周边照射剂量越大, 闭塞率越高。对颅内肿瘤的生长控制率, 良性肿瘤≥８０．０％ , 恶性肿瘤≥６６．７％ ,对功能性疾病的治疗有效率, 帕金森病为８５．２％ , 三叉神经痛为７６．９％ 。结论： 伽玛刀是治疗颅内疾病又一种可选择方法。治疗技术良好, 指征掌握严格, 可提高疗效, 降低并发症。     

分次立体定向放射治疗颅内肿瘤132例分析

目的：探讨立体定向分次放射治疗颅内肿瘤１３２例临床结果。方程：利用ＧＴＣ重定位头架和Ｘ刀治疗１３２例。本组病人共治疗３～１０次,３～１０Ｇｙ／次。每次间隔１～３天。结果：１３２例病,经８～３６个月（平均１４个月）随访。其中显效３１例（２３．５％）,有效８０例（６０．０％）,无效２１例（１５．９％）,出现并发症６例（４．５％）。结论：立体定向放射治疗可治疗体积较大和位于重要解剖部位的肿瘤。它不同于一般外放疗,它的治疗次数虽少而剂量大。增加ＳＲＴ治疗颅内肿瘤具有重要意义。     

脑转移瘤的立体定向放射手术：附272例临床报告

目的探讨立体定向放射手术（伽玛刀）治疗脑转移瘤的临床疗效。方法对２７２例脑转移瘤病人,用１．５Ｔｅｓｌａ磁共振仪和Ｇａｍｍａ－Ｐｌａｎ计算机联网定位,Ｌｅｋｓｅｌｌ伽玛刀实施放射手术,其中单发１５６例,多发１１６例;男１８１例,女９１例,年龄１８－８６岁,平均５８岁。肿瘤直径３．５－５０．１ｍｍ;周边剂量１０－３５Ｇｙ,平均１８．８Ｇｙ,中心剂量２７－７０Ｇｙ,平均４６Ｇｙ;靶点数１－１１个,平均     

立体定向放射外科治疗脑转移瘤

目的：探讨脑转移瘤的立体定向放射治疗的方法,临床结果。方法：采用单纯ＳＲＳ治疗颅内转移瘤３３例,ＳＲＳ＋ＷＢＲＴ治疗４２例,３１例行单纯全脑放疗。单纯ＳＲＳ治疗的剂量为１４～２２Ｇｙ／单次,ＳＲＳ＋ＷＢＲＴ则在单次ＳＲＳ后在行全脑放疗３０～４０（ｙ）３～４周,单纯ＷＢＲＴ治疗剂量４０～５０Ｇｙ／４～５周。结果：经２～３年随访,ＳＲＳ组３３例ＰＲ＋ＣＲ局部控制率８７．８％,一年生存率７５．８％,两年生存率４５．５％;ＳＲＳ＋ＷＢＲＴ组４１例,ＣＲ＋ＰＲ９２．９％,一年生存率８８．１％,两年生存率４７．６％;两组对照无显著差异（Ｐ〉０．１０）,但无对照有显著差异（Ｐ〈０．０５）,ＷＢＲＴ组３１例,ＣＲ＋ＰＲ８７．１％,两年生存率２５．８％,与ＳＲＳ＋ＷＢＲＴ组对照无显著差异（Ｐ〉０．１０）,瘤生存率分别为４８．４％     

立体定向伽玛刀治疗垂体腺瘤56例报告

目的：探讨伽玛刀对垂体腺瘤的疗效。方法：５６例垂体瘤患者实施立体定向伽玛刀治疗，肿瘤直径４～３４．２ｍｍ（平均１５．６ｍｍ），肿瘤照射野覆盖平均为６７％，瘤周边剂量平均为２４Ｇｙ。结果：５１例随访３～２１个月（平均１１个月），临床症状改善３６例（７０．６％），激素水平恢复正常或下降１９／２５例（７６％），肿瘤缩小２５／４７例（５３％），仅３例肿瘤增大。结论：认为伽玛刀手术简便、安全，是治疗垂体腺瘤（尤其是微小功能性腺瘤）的又一有效方法。     

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.