难治性癫痫手术预后因素分析

目的 探讨性别、诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、年龄、初次发病年龄、病程、发作持续时间、发作频率、总手术时间、颅内手术时间、术中失血量等15种因素与难治性癫痫患者手术治疗后癫痫发作控制情况的关系。方法 分析359例难治性癫痫患者的临床资料、手术方案和术后随访资料。结果 本组所有病例随访1年以上．术后效果满意率为94．15％。单因素分析提示：诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、初次发病年龄、病程、发作频率等因素与术后效果有显著性关系，性另q、年龄、发作持续时间、总手术时间、颅内手术时间、术中失血量等因素与术后效果无显著性关系。Logistic回归分析发现：有诱因、全身性发作、睡眠中好发、初次发病年龄轻、病程长可能为术后癫痫控制效果不满意的独立危险因素。结论 手术治疗难治性癫痫多可获得满意的效果。无发作诱因、部分性发作、无先兆、颞叶癫痫、单脑叶癫痫患者手术效果更好，睡眠中多发作、初次发病年龄轻、病程长、发作频率高者手术效果相对不满意。颞叶癫痫、单脑叶癫痫、儿童癫痫应成为外科治疗的重点。所有难治性癫痫一旦诊断成立、定位明确、可以手术，皆宜及早手术治疗。     

颞叶低级别胶质瘤继发顽固性癫痫的外科治疗

目的探讨颞叶低级别胶质瘤继发顽固性癫痫患者的临床特点、术前评估及外科治疗效果。方法对31例颞叶低级别胶质瘤继发顽固性癫痫患者术前进行MRI、视频脑电图（VEEG）、发作间期正电子发射断层扫描（PET）检查,综合分析检查结果,制定相应手术方案。术中行皮层脑电描记（ECoG）,术后对切除组织进行病理检查,并对患者进行术后随访。结果29例（93．5％）患者术后癫痫发作完全或部分缓解,2例（6．5％）患者无明显缓解。结论对于颞叶低级别胶质瘤继发顽固性癫痫的患者．术前进行综合评估,同时切除病灶及致痫灶是控制癫痫发作、改善预后的有效手段。     

难治性癫痫手术效果评判时限

目的 总结分析难治性癫痫手术效果,以及手术后效果趋于稳定的时限。方法 对120例难治性癫痫手术患者进行长期追踪随访,并依照Engel分级对患者术后效果进行分类;比较患者术后半年,1年和远期（1年半以上）随访疗效,观察术后达到EngelⅠ-Ⅱ疗效比例的变化。结果 120例难治性癫痫手术患者中,术后半年随访发现：61％术后无癫痫再发,18％术后仅有先兆发作,7％偶有痫性发作（半年中小于2次）,痫性发作明显减少（痫性发作减少大于80％）为5％,手术效果不明显（痫性发作减少小于20％）占9％;术后1年随访发现：无癫痫再发为45％,术后仅有先兆为12％,术后偶有痫性发作为12％（1年中小于3次）,痫性发作明显减少为13％,手术效果不明显为18％。最近的随访结果如下（随访1．5～3年,平均1．8年）：无癫痫再发占43％,仅有先兆占13％,术后偶有痫性发作占14％,痫性发作明显减少占13％,手术效果不明显占17％。半年期随访预后和1年期随访预后中达到EngelⅠ-Ⅱ的比例有明显差异（组间差异有统计学意义,P〈0．05）,1年期随访预后与长期随访预后中达到EngelⅠ-Ⅱ的比例无明显差异（组间差异无统计学意义,P〉0．05）。结论 药物难治性癫痫术后半年期随访评判疗效不可靠,而1年期疗效预示术后长期效果。     

不同病程颞叶癫痫术后疗效及相关性分析

目的探讨不同病程颞叶癫痫患者术后疗效有无差异及手术疗效与病程有无相关关系。方法回顾性分析2002年1月-2011年1月在泸州医学院附属成都三六三医院神经外科接受手术治疗的颞叶癫痫患者183例,根据Engel分级评估分析不同病程患者术后疗效有无差异以及手术疗效与病程有无相关关系。结果早期手术治疗组术后无癫痫发作率占78．9％;中期手术治疗组术后无癫痫发作率占67．9％;晚期手术治疗组术后无癫痫发作率占58．6％。早期手术治疗组术后无癫痫发作率高于中期手术治疗组和晚期手术组,疗效差异有统计学意义（P〈0．05）;颞叶癫痫病程与术后疗效存在负相关关系（r=-0．213,P=0．002）,即病程越长,疗效越差。结论早期手术干预可能更加有利于控制癫痫发作,提高患者生存质量。     

颞叶占位性病变伴癫痫患者的脑电图特征及手术疗效

目的探讨颞叶占位性病变伴癫痫患者的脑电图癫痫样放电的分布特征及手术疗效。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料,其中囊性占位7例,海绵状血管瘤6例,胶质瘤16例,其他病变2例;均行病变完全切除术,大部分包括前颞叶及内侧结构切除。结果术前癫痫发作间期脑电图癫痫样波分布与病变位置关系：仅出现在病变侧颞叶12例（38．7％）,超出病变侧颞叶14例（45．2％）,完全不在病变侧颞叶3例（9．7％）;脑电图正常2例（6．4％）。监测中出现癫痫发作的17例患者中,病变侧颞叶起源12例（70．6％）,双侧颞叶起源1例（5．9％）,对侧颞叶起源1例（5．9％）,不确定起源位置3例（17．6％）。术后随访12～56个月,平均28个月,按Engel分级,Ⅰ级25例,Ⅱ级2例,Ⅲ级2例;失随访2例。结论颞叶占位性病变伴癫痫患者发作间期癫痫样波不仅仅局限于同侧颞叶,发作期脑电与病变有很好的相关性,该类患者应尽早手术切除治疗,可取得很好的疗效。     

颞叶癫痫的术前评估

术前评估对颞叶癫痫是极其重要的，首先对发作症状分析判断是否符合颞叶癫痫复杂部分发作的表现，通过脑电图相关检查确定颢叶异常放电部位结合MRI检查确定颞叶海马异常的病理生理变化，对不能明确者可以通过核医学检查颞叶的异常代谢。最后通过神经心理检查确定要切除颞叶的功能预测手术可能带来的后果。不同检查方式有不吲的敏感性和特异性，对于不同的患者应根据已知结果有选择性进行进一步的检查。总之，目的就是要确定颞叶癫痫的病灶部位，并预测手术后疗效，以及可能的术后并发症。     

小儿颞叶癫痫的临床表现及脑电图分析

目的 探讨小儿颞叶癫痫的临床特征及脑电图特点。方法收集16例颞叶癫痫患儿,对其发作的临床特点及脑电图资料进行分析,对比难治性癫痫的脑电图变化规律。结果患儿的癫痫发作形式主要表现为单纯部分性发作、复杂部分性发作、继发全面性发作。单纯部分发作频率高而持续时间短,复杂部分发作持续时间长但发作频率低并常见发作后朦胧状态。颞叶癫痫的脑电图特点：背景正常者约占62．5％（10／16）;背景异常约占37．5％（6／16）;异常放电及部位：颞叶棘波或慢波放电,表现为单侧或双侧同步或不同步放电。结论小儿颞叶癫痫是一组部分性症状性癫痫综合征,多表现为复杂部分发作,临床发作及同步脑电图特点可为临床诊治提供帮助。     

颞叶低级别肿瘤并顽固性癫痫的外科治疗策略

目的：分析颞叶低级别肿瘤并癫痫的临床特点,并探讨其手术治疗策略。方法回顾2013年1月至2014年1月27例颞叶低级别肿瘤并癫痫患者的临床资料,分析其临床特点、手术切除策略及术后疗效。结果全组病变部位分布于颞叶外侧、颞叶内侧、颞叶底面、颞后等各个区域,少数累及到颞叶以外脑区。发作首发症状分别为精神体验先兆、植物神经先兆、视幻觉、愣神、失语、自动运动、复杂运动甚至全面性强直发作等。27例中,病变手术全切除5例,扩大切除20例,次全切除2例。全组病例术后无严重并发症。发作控制：所有患者术后随访1年以上,仅1例次全切除者为EngelⅡ级,其余26例（96．3％）均为EngelⅠ级。结论颞叶低级别肿瘤并顽固性癫痫视病变部位及所累及致痫网络的不同而发作首症状表现各异;对颞叶低级别肿瘤并顽固性癫痫,应行严谨的术前评估致痫区与肿瘤的关系,周密设计切除计划,在保障安全前提下尽可能全切肿瘤以及充分切除致痫区,必要时结合神经导航、术中唤醒皮层电刺激功能区定位或颅内电极等技术;手术后发作控制效果佳。     

海马硬化的儿童合并颞叶内侧癫痫手术预后影响因素分析

目的分析不同因素对海马硬化的儿童合并颞叶内侧癫痫手术预后的影响。方法对我院行外科治疗的54例海马硬化合并颞叶内侧癫痫患儿进行回顾分析,探讨术式选择、性别、起病年龄、病程、术前发作频率、MRI表现、病理检查结果及术后近期癫痫发作情况等各因素对手术预后的影响,手术效果采用Engel分级标准衡量。结果前颞叶切除术明显优于经侧裂选择性海马杏仁核切除术(P0.05);性别、起病年龄、手术前发病频率、病理是否合并有新皮层结构异常、术后近期是否有癫样放电及先兆发作等因素均对手术预后影响不大(P均0.05);而病程长短、头颅MRI检查是否合并皮层异常及术后近期是否出现癫痫发作则对预后影响较大(P均0.05)。结论术式的选择、病程的长短、影像学上能发现除海马硬化以外的皮层异常信号及术后近期癫痫发作情况是合并海马硬化的儿童颞叶内侧癫痫手术预后的影响因素,值得更深入的研究。     

颞叶癫痫的术前评估

术前评估对颞叶癫痫是极其重要的,首先对发作症状分析判断是否符合颞叶癫痫复杂部分发作的表现,通过脑电图相关检查确定颞叶异常放电部位结合MRI检查确定颞叶海马异常的病理生理变化,对不能明确者可以通过核医学检查颞叶的异常代谢。最后通过神经心理检查确定要切除颞叶的功能预测手术可能带来的后果。不同检查方式有不同的敏感性和特异性,对于不同的患者应根据已知结果有选择性进行进一步的检查。总之,目的就是要确定颞叶癫痫的病灶部位,并预测手术后疗效,以及可能的术后并发症。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.