滥用酒精与抗氧化剂关系的研究

目的探讨滥用酒精与抗氧化剂的关系。方法用分光光度比色分析法检测１９４例４０岁男性滥用酒精者和５０例４０岁男性无饮酒史健康者血浆维生素Ｃ（Ｐ－ＶＣ）、维生素Ｅ（Ｐ－ＶＥ）、β－胡萝卜素（Ｐ－β－ＣＡＲ）含量，在Ｃｏｍｐａｑ５８６／１６６微机上用ＳＰＳＳ／７．０和Ｓｔａｔｉｓｔｉｃａ／５．０统计软件包分析处理。结果滥用酒精组及各滥用酒精史组和各滥用酒精量组的Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ平均含量均显著降低（Ｐ＜０．０５～０．０１），滥用酒精者的Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ值均随滥用酒精史延长和滥用酒精量增加而逐渐降低（Ｐ＜０．０１）。结论滥用酒精者体内的氧化和抗氧化平衡严重失调，氧自由基反应病理性加剧。     

血管性帕金森综合征患者血浆β—内啡肽的变化及其临床意义

目的探讨血管性帕金森综合征（ＶＰ）患者血浆β－内啡肽（β－ＥＰ）的变化及其临床意义。方法采用放射免疫法（ＲＩＡ）检测４２全例ＶＰ、３５例帕金森病（ＰＤ）、３０例多发性脑梗死（ＭＣＩ）患者及３０名正常对照者血浆β－ＥＰ含量并对照分析。结果①ＶＰ与ＰＤ组血浆β－ＥＰ含量较ＭＣＩ及正常对照组明显降低（Ｐ〈０．０５）。②ＶＰ组血浆β－ＥＰ含量降低不如ＰＤ组明显,但差别不明显（Ｐ〉０．０５）。③高龄、病情重     

帕金森病血抗氧化系统的变化及临床意义

探讨帕金森病（ＰＤ）患者体内抗氧化系统水平及其在ＰＤ发病中的可能作用。方法观测了７０例ＰＤ患者和７０例正常人的血浆维生素Ｃ、Ｅ浓度（Ｐ－ＶＣ，Ｐ－ＶＥ），血浆及红细胞膜超氧化物歧化酶（Ｐ－ＳＯＤ，Ｅ－ＳＯＤ）活性，血浆及红细胞过氧化脂质（Ｐ－ＬＰＯ，Ｅ－ＬＰＯ）水平的变化。结果与正常对照组相比，ＰＤ患者的Ｐ－ＶＣ、Ｐ－ＶＥ浓度及Ｐ－ＳＯＤ、Ｅ－ＳＯＤ活性均明显降低，而Ｐ－ＬＰＯ、Ｅ－ＬＰＯ水平则显著增高。并且Ｐ－ＶＣ、Ｐ－ＶＥ、Ｅ－ＳＯＤ水平与ＰＤ患者的病情和病程呈负相关。结论提示ＰＤ患者可能存在血抗氧化系统缺陷而使内源性氧自由基堆积，导致黑质神经元退变     

小儿病毒性脑炎患者内皮素—1含量的研究

采用放射免疫均相竟争法，测定５６例急性病毒性脑炎（ＡＶＥ）患儿的血浆和脑脊液（ＣＳＦ）中内皮素－１（ＥＴ－１）含量。结果发现，ＡＶＥ急性期患儿血浆ＥＴ－１含量明显高于疾病对照组和正常对照组（Ｐ＜０．０１），急性期血浆和ＣＳＦ中ＥＴ－１含量高于恢复期（Ｐ＜０．０１），血浆与ＣＳＦ中ＥＴ－１含量呈正相关（ｒ＝０．８５８，Ｐ＜０．００１），病情严重、抽搐频繁、ＥＥＧ和脑ＣＴ或ＭＲＩ显示病变部位广泛者，血浆和ＣＳＦ中ＥＴ－１含量增高更为显著。认为ＥＴ－１是一种新的内源性致病因子，在ＡＶＥ病程发展与转归中起重要作用。     

多发梗塞性痴呆患者血浆和脑脊液中若干神经肽含量的变化

用放射免疫法测定了３０例多发梗塞性痴呆（ＭＩＤ）、３５例无痴呆多发脑梗塞患者（ＭＣＩ）及３０名健康人的血浆生长抑素（ＳＳ）、精氨酸加压素（ＡＶＰ）及β－内啡肽（β－ＥＰ）含量，同时测定了部分ＭＩＤ和ＭＣＩ患者脑脊液（ＣＳＦ）中ＳＳ、ＡＶＰ、β－ＥＰ含量。发现ＭＩＤ患者血浆ＳＳ、ＡＶＰ含量比ＭＣＩ组和健康对照组均降低（Ｐ＜０．０５），且随痴呆程度的加重，其含量有递减趋势。而血浆中β－ＥＰ在这三组间差异无显著性意义（Ｐ＞０．０５）。ＭＩＤ组ＣＳＦ中ＳＳ、β－ＥＰ含量低于ＭＣＩ组（Ｐ＜０．０５），而ＣＳＦ中ＡＶＰ含量在两组间无差异（Ｐ＞０．０５），ＣＳＦ中ＡＶＰ含量与痴呆的关系有待进一步研究。     

内皮素一氧化氮在蛛网膜下腔出血后脑血管痉挛中的动态变化

目的：探讨内皮素（ＥＴ－１）和一氧化氮（ＮＯ）代谢产物在蛛网膜下腔出血（ＳＡＨ）后症状性脑血管痉挛（ＳＣＶＳ）发生机制中的作用。方法：建立兔的症状性脑血管痉挛模型,观察ＳＡＨ后不同时间血浆和脑脊液（ＣＳＦ）中ＥＴ－１和ＮＯ代谢产物含量变化。结果：ＳＡＨ后第４天和第７天血浆和ＣＳＦ中ＥＴ－１含量均显著升高（Ｐ〈０．０１）。且以ＳＡＨ后第４天为著。ＳＡＨ后第４天和第７天血浆和ＣＳＦ中ＮＯ代谢产物含量也明显升高（Ｐ〈０．０１）,但二者之间无显著性差异（Ｐ〉０．０５）。结论：ＳＡＨ后血浆和ＣＳＦ中ＥＴ－１和ＮＯ代谢产物含量增加在ＳＣＶＳ发生机制中起重要作用。     

氧化、脂质过氧化与脑梗死关系的探讨

目的:探讨一氧化氮、氧化、脂质过氧化与脑梗死的关系。方法:检测了１４６例急性脑梗死患者(ＣＩ)和１００例健康志愿者(ＨＶ)血浆中的一氧化氮(Ｐ－ＮＯ)、维生素Ｃ(Ｐ－ＶＣ)、维生素Ｅ(Ｐ－ＶＥ)、β－胡萝卜素(Ｐ－β－ＣＡＲ)和过氧化脂质(Ｐ－ＬＰＯ)含量及红细胞中的超氧化物歧化酶(Ｅ－ＳＯＤ)、过氧化氢酶(Ｅ－ＣＡＴ)、谷胱甘肽过氧化物酶(Ｅ－ＧＳＨ－Ｐｘ)活性和过氧化脂质(Ｅ－ＬＰＯ)含量并作分析比较;同时,检测了其中４４例患者治疗前后的上述生化指标,并作分析比较。结果:与ＨＶ组比较,ＣＩ组的Ｐ－ＮＯ、Ｐ－ＬＰＯ、Ｅ－ＬＰＯ平均值均显著升高(Ｐ＜０．００１),Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ、Ｅ－ＳＯＤ、Ｅ－ＣＡＴ、Ｅ－ＧＳＨ－Ｐｘ平均值均显著降低(Ｐ＜０．００１);与治疗前比较,治疗后的Ｐ－ＮＯ、Ｐ－ＬＰＯ、Ｅ－ＬＰＯ平均值均显著降低(Ｐ＜０．００１),Ｐ－ＶＣ、Ｐ－ＶＥ、Ｐ－β－ＣＡＲ、Ｅ－ＳＯＤ、Ｅ－ＣＡＴ、Ｅ－ＧＳＨ－Ｐｘ平均值均显著升高(Ｐ＜０．００１)。结论:脑梗死患者体内ＮＯ代谢异常,一系列自由基连锁反应病理性加剧,氧化抗氧化平衡严重失调,ＮＯ、氧化和脂质过氧化损伤加剧。     

对海洛因依赖者血浆精氨酸加压素浓度的检测结果

目的 探讨海洛因依赖者及其血浆精氨酸加压素（ＡＶＰ）浓度间的关系。方法 采用放射免疫法测定１５例（病例组）海洛因依赖患者及１８例正常人（对照组）的血浆ＡＶＰ浓度。结果 病例组务血浆ＡＶＰ浓度较对照组低,两组差异有非常显著性（ｔ＝２６．３９,Ｐ〈０．０１）。结论 结果提示,病例组的ＡＶＰ功能低下,且滥用时间越长,ＡＶＰ浓度下降越明显。     

脑梗塞患者血浆和脑脊液中内皮素-1、降钙素基因相关肽含量的研究

用放免法检测４０例脑梗塞患者脑脊液和不同病期血浆中内皮素－１（ＥＴ－１）、降钙素基因相关肽（ＣＧＲＰ）的含量并与对照组比较。结果：脑梗塞患者脑脊液中ＥＴ－１含量无明显改变（Ｐ＞０．０５），ＣＧＲＰ含量显著降低（Ｐ＜０．０１）。发病２周内血浆ＥＴ－１含量明显高于对照组（Ｐ＜０．０５），而发病４周内ＣＧＲＰ值却显著低于对照组（Ｐ＜０．０１）。患者是否伴高血压、神经功能缺损轻重、梗塞灶大小对血浆ＥＴ－１和ＣＧＲＰ含量均无明显影响。     

脑梗塞患者血浆和脑脊液中内皮素—1,降钙素基因相关肽含量…

用放免法检测４０例脑梗塞患者脑脊液和不同病期血浆中内皮素－１（ＥＴ－１）、降钙素基因相关肽（ＣＧＲＰ）的含量并与对照组比较。结果：脑梗塞患者脑脊液中ＥＴ－１含量无明显改变（Ｐ〉０．０５），ＣＧＲＰ含量显著降低（Ｐ〈０．０１）。发病２周内血浆ＥＴ－１含量明显高于对照组（Ｐ〈０．０５），而发病４周内ＣＧＲＰ值却显著低于对照组（Ｐ〈０．０１）。患者是否伴高血压、神经功能缺损轻重、梗塞灶大小对血浆ＥＴ－１     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.