癫(癎)患者认知功能损害及其影响因素分析

目的采用神经心理学方法研究癫患者认知功能受损情况及其影响因素。方法对67例癫患者和63例年龄、性别、学历、文化背景与癫患者相匹配的健康志愿者进行韦氏成人智力量表(WAIS)检测。结果癫患者的FIQ较对照组显著减低,有40%的癫患者智商低于正常,存在认知功能损害。颞叶癫、部分性发作、发作频率和文化程度对FIQ值有显著性意义。结论癫患者确实存在认知功能障碍,且颞叶癫痫间患者认知功能受损更为明显。     

癫(癎)患者认知功能影响因素的研究

目的:研究癫患者认知功能的影响因素。方法:对166例癫患者进行认知评定。认知评定工具:听觉词语测验、逻辑记忆测验、数字符号转换测验、Stoop字色干扰测验、连线测验、言语流畅性测验、Rey-Osterrieth复杂图片测验及Boston命名测验。影响因素与认知功能评分之间采用一元线性相关及多元逐步回归分析。结果:患者年龄、性别、文化程度、起病年龄、病程、发作频率、发作持续时间、全身强直阵挛发作(GTCS)、复杂部分性发作(CPS)及抗癫药物数量与患者的认知功能有相关性。结论:癫患者的起病年龄与其认知损害成正比,病程越长对癫患者的认知损害越明显,原发或继发全身性强直阵挛发作与言语功能损害、复杂部分性发作与言语记忆损害之间的关系密切,用药种类与记忆、注意力以及精神运动能力的损害有关。     

影响癫患者认知功能障碍的有关因素分析

癫是一组疾病和综合征,以在病程中反复发作性的大脑神经元过度放电所致暂时性中枢神经系统功能失常,可表现为运动、感觉、意识、行为、自主神经等不同程度障碍,灶部位最常见于脑皮质下的神经核团、脑皮质及脑干网状结构,大多数患者的智商和正常人一样,但有部分癫患者存在认知功能障碍,经回顾分析我院住院的121例癫患者,有认知功能障碍41例,其结果分析如下。     

急性脑血管病继发癫的临床特点及预后分析

目的探讨急性脑血管病继发癫的临床特点及预后。方法选取2011-06—2012-06我院诊治的80例急性脑血管病继发癫患者,给予相应抗癫治疗,对其临床资料进行回顾性分析。结果 80例急性脑血管病继发癫患者中,30例患者经过对原发病治疗,其癫症状得到有效控制;47例抗癫药物治疗后,症状得到控制;3例患者由于原发疾病恶化而死亡。脑出血继发癫以早期发作多见,脑梗死继发癫以晚期发作多见。病灶位于皮层范围的脑血管病患者继发癫的发生率明显较高。早期继发癫以强直-阵挛发作型为主,而晚期继发癫以单纯部分发作型为主。结论了解脑血管病与继发癫之间的关系,对于疾病的治疗和患者的预后有重要临床意义。     

女性与青少年癫

癫是常见的神经系统疾病,全球发病率和患病率呈逐渐上升趋势。女性和青少年癫患者是占相当患病比例的特殊群体,具有性别或年龄相关的疾病特点及诊断与治疗要点,如女性患者面临的生育问题、青少年患者面临的发育问题,均导致二者在抗癫药物选择、治疗策略制定、疾病预后评价等方面存在特殊性,准确把握女性和青少年癫的诊断与治疗要点,对有效控制癫发作、降低癫相关并发症风险和减少药物不良反应具有重要意义。     

蒙特利尔认知评估量表在癫认知功能障碍患者中的应用价值

目的分析蒙特利尔认知评估(MoCA)量表筛查癫患者认知功能障碍的应用价值。方法使用简明精神状态检查(MMSE)量表筛查出认知功能正常的120例癫患者,再行MoCA量表评分。依据MoCA量表评分结果将120例癫患者分为①认知功能正常(NC)组:MoCA量表评分≥26分;②认知功能损害(CI)组:MoCA量表评分<26分。比较两组癫患者MoCA量表各项分数的差异及认知功能改变的特点,应用单因素及多元Logistic回归分析认知功能损害的影响因素。结果①120例患者中50例(41.7%)MoCA量表评分<26分;②CI组MoCA量表各条目得分均低于NC组,差异有统计学意义(P<0.05);③Logistic回归分析结果显示,受教育年限是认知功能损害的影响因素(OR=1.34,95%C1:1.05~1.70,P<0.05)。结论 MMSE正常癫患者中仍存在相当比例MoCA量表评分异常的患者。建议使用MoCA量表测试癫患者的认知功能水平。     

左乙拉西坦治疗癫伴认知功能障碍患儿疗效观察

目的分析左乙拉西坦治疗癫伴认知功能障碍患儿的临床疗效。方法选择在本院接受治疗的癫伴认知功能障碍患儿作为研究对象,分别给予常规治疗及左乙拉西坦治疗,比较2组患儿的认知功能、脑电活动情况及生活质量评分等差异。结果观察组总有效率(66.67%)、MMES评分(25.47±4.83)、无认知功能障碍(83.33%)、躯体功能(76.87±7.16)、心理功能(59.32±5.34)、社会功能(58.76±2.16)、总体生活质量(82.34±8.21)评分均明显高于对照组(P<0.05);癫样放电(15%)、α波(18.21±3.36)、β波(10.32±2.25)、δ(12.36±2.25)、θ波(20.32±3.24)数目均明显少于对照组(P<0.05)。结论左乙拉西坦可有效改善癫伴认知功能障碍患儿的认知功能,减少异常脑电活动,提高生活质量。     

癫猝死的相关研究新进展

癫是一种脑部疾病,其特点是脑部有持续存在癫反复发作的易感性,以及因癫发作所引起的神经生化、认知、心理和社会后果。癫患者的早逝风险较同年龄普通人群高。癫猝死(SUDEP)是癫患者早逝风险增加的重要原因。文中就SUDEP的定义、发生率、发病机制、危险因素以及预防措施做综述。     

神经刺激治疗癫的临床应用

癫是多种病因导致的具有发作性症状的脑病,是常见的神经系统疾病,我国的患病率大约为7‰,因此,估计全国应有900万的癫病人。癫的治疗包括了药物、手术及心理等综合治疗。对于那些药物及外科手术难以控制的顽固性癫患者,神经刺激是一项很有发展前景的治疗技术。在过去的30年中,通过电刺激神经系统的不同部位,来控制癫的发作,已经在临床被应用,并取得了不同程度的临床效果。神经刺激治疗癫的方法很多,其中主要包括迷走神经刺激和脑深部核团刺激等。1迷走神经刺激(VNS)早在20世纪30年代,人们就认识到了迷走神经刺激可以引起脑电…     

多烯磷脂酰胆碱对癫患者认知功能的影响

目的观察多烯磷脂酰胆碱治疗癫患者认知功能的临床疗效。方法选取2011-02—2013-02我院收治的50例癫患者,按数字法随机分为观察组和对照组各25例。对照组给予卡马西平,观察组给予多烯磷脂酰胆碱,比较2组患者认知功能情况。结果观察组蒙特利尔认知评分及MMSE评分均显著优于对照组,差异有统计学意义(P<0.05)。结论应用多烯磷脂酰胆碱治疗癫,可促进患者认知功能的恢复。     

白介素-1和白介素-6与癫痫及其认知功能障碍的关系

癫痫作为一种严重危害人类健康的常见病,省30％-40％癫痫患者存在不同程度的认知障碍。近年来,对癫痫患者认知功能改变的研究与干预工作受到广泛重视,但其机制仍不清楚。研究证实白介素-1（IL-1）和白介素-6（IL-6）参与认知功能。癫痫发作后引起脑组织和血液IL-1和IL-6水平升高,可能与癫痫后认知功能损害有关。本文就IL-1和IL-6与癫痫及其认知功能障碍的关系进行综述。     

癫痫患者的认知功能评估及其影响因素研究

目的评估癫痫患者的认知功能,探索影响癫痫患者认知功能的相关因素。方法将2013年1月-2015年1月在三台县人民医院就诊的符合国际抗癫痫联盟(ILAE)1981年癫痫发作分类及1989年癫痫综合征分类标准的癫痫患者48例作为研究组,选取同期在该院的45例健康体检者为对照组。采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评价两组的认知功能,采用自制调查表收集患者的病历资料,并分析影响癫痫患者认知功能的相关因素。结果研究组MoCA总评分低于对照组[(19.34±7.22)分vs.(28.61±6.89)分],差异有统计学意义(P0.01),MoCA各项目评分研究组低于对照组,差异均有统计学意义(P0.01)。发病年龄、病程长短、发作频率、发作持续时间、发作类型及用药情况对患者的认知功能影响显著(P均0.05)。结论癫痫患者存在认知功能障碍,其认知功能损害与发病年龄、病程长短、发作频率、发作持续时间、发作类型及用药情况有关。     

癫(癎)患者认知功能障碍及其影响因素的分析

目的 探讨癫(癎)患者认知功能障碍及其影响因素.方法 采用韦氏儿童智力量表及成人智力量表对125例癫(癎)患者的认知功能进行测定,并分析年龄、发作类型、癫(癎)综合征类型、病因、发作频率、严重程度、脑电图改变、服用药物及家族史等因素对其的影响.结果 癫(癎)患者认知功能障碍发生率为18.4%,儿童(27.8%)高于成人(14.6%).癫(癎)组儿童和成人患者总智商(F7Q)、操作智商(PIQ)和言语智商(VIQ)、言语理解因子(VCF)、知觉组织因子(POF)和记忆/注意不分心因子(MF)显著低于相应的正常对照组(均P<0.01).多因素回归分析显示,发作程度越严重、服用药物的数量越多,智商越低,全面发作对智商的影响最明显.结论 癫(癎)患者存在明显的认知功能障碍,发作严重程度、服药数量,发作形式是影响其认知功能的独立危险因素.     

Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force,Diagnostic Methods Commission, 2013–2017

The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new‐onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth of scope of neuropsychological assessment, this report demonstrates the pivotal role played by this noninvasive and minimally resource intensive investigation in the care of people with epilepsy.     

Funktionelle Magnetresonanztomographie von Ged?chtnisfunktionen

Chronic epilepsy is frequently accompanied by cognitive deficits. Temporal lobe epilepsy (TLE) as well as resection surgery on the temporal lobe may affect cognitive function, in particular verbal and visual memory but also working memory. Epilepsy arising from the brain??s temporal lobe can be controlled surgically in up to 70% of patients. The goals of epilepsy surgery are to remove the brain areas generating the seizures without causing or aggravating memory dysfunction. This requires accurate localization of areas responsible for memory function (eloquent cortex). Functional magnetic resonance imaging (fMRI) is increasingly being used to lateralize and localize brain areas involved in memory processes and shows promise for predicting the effects of temporal lobe resection on memory function, especially when combined with other structural as well as functional imaging methods.     

桥本脑病二例

目的探讨桥本脑病的临床特点及其治疗方法。方法分析我院收治的2例桥本脑病患者的临床资料。结果两例患者分别以认知功能障碍及癫痫为首发症状,脑脊液检测、脑电图、头颅核磁共振检查未见特异性改变,但是血液甲状腺过氧化物酶抗体(TPOAb)明显增高,例1患者甲状腺功能正常,例2患者有甲亢。2例患者均对皮质类固醇激素敏感。结论临床上有以认知功能障碍、癫痫等症状为突出表现者,须考虑桥本脑病的可能。     

Is there an association between subjective and objective measures of cognitive function in patients with affective disorders?

Background: Patients with affective disorders experience cognitive dysfunction in addition to their affective symptoms. The relationship between subjectively experienced and objectively measured cognitive function is controversial with several studies reporting no correlation between subjective and objective deficits. Aims: To investigate whether there is a correlation between subjectively reported and objectively measured cognitive function in patients with affective disorders, and whether subjective complaints predict objectively measured dysfunction. Methods: The study included 45 participants; 15 with bipolar disorder (BD), 15 with unipolar disorder (UD) and 15 healthy individuals. Participants’ subjectively experienced cognitive function and objective cognitive function were assessed with the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the Screen for Cognitive Impairment in Psychiatry (SCIP), respectively. Patients were rated for affective symptoms with Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results: Patients demonstrated subjective and objective cognitive dysfunction relative to controls (P-values ≤ 0.01) but there were no differences between patient groups (P > 0.1). We found no correlation between subjectively experienced and objectively measured cognitive dysfunction in BD (P = 0.7), and a non-significant trend towards a correlation in UD (P = 0.06), which disappeared when controlling for gender (P = 0.1). Conclusion: Our results suggest that it is not necessarily patients who have cognitive complaints that are most impaired. If confirmed in a larger sample, our findings suggest that neuropsychological assessment is warranted to elucidate the potential role of cognitive dysfunction in patients’ everyday lives and to inform treatment strategies targeting these difficulties.     

Interictal perceptual function in epilepsy

Epilepsy can affect perception. Ictal perceptual experiences are common, but interictal perceptual function may also be affected. This article reviews the English-language literature on interictal perceptual disturbances in epilepsy. Although most studies report impaired perceptual ability, heightened sensitivity has also been described. There is a compelling, though not absolute, correlation between affected sensory modality and underlying epilepsy syndrome. Olfaction is clearly affected in temporal lobe epilepsy, while visual information processing is disturbed in occipital lobe epilepsy. The cause of interictal perceptual dysfunction is unknown, but propagating epileptiform discharges may play a role. The presence of specific perceptual disturbances in focal epilepsy syndromes is consistent with the view that epilepsy is a network disease, with the potential to affect neural circuits distant from the seizure focus. The use of thoughtfully selected psychophysical perceptual tasks may provide additional insight into the cognitive impact of different epilepsy syndromes and of ablative epilepsy surgery.     

Register zur Thalamusstimulation bei Epilepsiepatienten

Deep brain stimulation (DBS) is a new treatment option for pharmacorefractory epilepsy patients. Due to the positive experiences gained with DBS for movement disorders such as Parkinson’s disease, Tremor und dystonia, approval for epilepsy patients was accompanied by great expectations. The success of DBS is measured by the aspects of efficacy and tolerability, as with other forms of epilepsy treatment. In addition to clinical studies such data are also currently being collated in the form of registers. Results on the long-term observation of durable seizure control are expected from the Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE) study. Furthermore, the register of the German-Austrian “Arbeitskreis Tiefe Hirnstimulation bei Epilepsien” (working group on deep brain stimulation in epilepsy) is attempting to collect data on possible psychiatric and cognitive side effects whereas the European Medtronic Registry for Epilepsy (MORE) of the company Medtronic is focusing on responder and optimal stimulation parameters.