氟哌噻吨美利曲辛联合舍曲林对青年卒中后抑郁患者抑郁及对神经功能康复的影响

目的 探讨氟哌噻吨美利曲辛联合舍曲林对青年卒中后抑郁患者抑郁及神经功能康复的影响.方法 将我院住院治疗的118例青年卒中后抑郁患者按照随机数字表法分为对照组与观察组,给予对照组患者舍曲林口服,观察组患者接受氟哌噻吨美利曲辛联合舍曲林治疗.采用汉密尔顿抑郁量表（HAMD）、改良Barthel指数及FMA运动功能量表评估患者抑郁状况、日常生活能力（ADL）及肢体运动功能.结果 治疗后4周观察组治疗有效率显著高于对照组（96.7% vs 74.1%,P〈0.05）;治疗后2周及4周,观察组HAMD评分显著低于对照组（P〈0.05）;观察组改良Barthel指数及FMA评分显著高于对照组,差异具有统计学意义（P〈0.05）.结论 氟哌噻吨美利曲辛联合舍曲林治疗青年卒中后抑郁,可显著改善患者抑郁状态,促进神经功能的康复.     

老年人脑卒中后抑郁的临床研究

目的:探讨老年人脑卒中后抑郁(PSD)的临床特征和西酞普兰的疗效。方法:65岁以上首次发作的老年脑卒中患者230例,于卒中15天后进行日常生活能力(ADL)、汉密尔顿抑郁量表(HAMD)、简明智能量表(MMSE)评估,对伴有卒中后抑郁的患者给予西酞普兰治疗,3个月后随访,并与对照组比较。结果:经随访评估合并PSD患者90例,占39.1%;PSD的发生率与卒中类型无关;脑叶和左侧半球与PSD发生具有相关趋势(OR>1,P=0.10);抑郁组与无抑郁组患者ADL及MMSE评分比较差异有显著性意义(P<0.05);经抗抑郁治疗后,西酞普兰组患者的抑郁症状逐渐好转,HAMD及ADL评分明显改善。结论:PSD的发生率高达39.1%;PSD对ADL和MMSE可产生明显影响;西酞普兰治疗PSD有良好疗效。     

舍曲林联合经颅磁刺激对急性脑梗死后患者神经缺损的影响

目的：探讨对首发脑梗死患者早期应用舍曲林联合经颅磁刺激是否利于神经功能缺损状态的改善,并减少卒中后抑郁的发生。方法将200例首发急性脑卒中患者随机分为对照组、舍曲林组、经颅磁刺激（TMS）组、舍曲林＋ TMS组,对照组为空白对照,4组均接受抗血小板聚集、调脂、改善循环、脑保护等常规治疗,分别应用NIHH评分、ADL评分、汉密顿抑郁量表（HAMD）评价患者入院时、发病12周后神经功能缺损状态、日常生活能力、抑郁状态。结果发病12周后NIHH、ADL、HAMD评分,对照组与舍曲林组、TMS组、舍曲林＋ TMS组间差异均有统计学意义（P＜0·05）,舍曲林组、TMS组与舍曲林＋ TMS组间差异有统计学意义（P＜0·05）。结论舍曲林、TMS均可改善患者的神经功能缺损症状,减少卒中后抑郁的发生,二者联合作用优于单个作用。     

舍曲林治疗脑卒中后抑郁的临床观察

目的 观察舍曲林治疗脑卒中后抑郁(PSD)的疗效与安全性.方法 将84例PSD患者随机分成2组,研究组42例,应用舍曲林治疗;对照组42例,应用阿米替林治疗;疗程均为6周.采用Hamilton抑郁量表(HAMD)、临床疗效总评病情严重程度量表(CGI-SI)评定临床疗效,副反应量表(TESS)评定药物的不良反应.结果 2组总体疗效相当(P＞0.05),但舍曲林起效快,不良反应较轻.结论 舍曲林治疗脑卒中后抑郁疗效显著,不良反应少,安全性高.     

高压氧联合舍曲林治疗脑卒中后抑郁的疗效观察

目的观察高压氧联合舍曲林治疗脑卒中后抑郁患者的疗效及对日常生活能力、生存质量的影响。方法将入组的的72例患者随机分为治疗组和对照组,每组36例。治疗组采用高压氧联合舍曲林治疗,对照组单用舍曲林治疗。2组患者在治疗前后分别进行HAMD、ADL及WHOQOL-BREF量表评定。结果 2组患者HAMD、ADL及WHOQOL-BREF各指标评分与治疗前相比,差异均有统计学意义(P<0.01);而治疗组比对照组变化更明显,差异有统计学意义(P<0.01,P<0.05)。结论高压氧联合舍曲林治疗能改善脑卒中后抑郁患者的抑郁症状还能提高其日常生活能力及生存质量。     

舍曲林治疗老年人群脑卒中后抑郁的疗效观察

目的观察舍曲林治疗老年人群卒中后抑郁的疗效。方法将100例老年脑卒中后抑郁患者随机分为2组,实验组51例口服盐酸舍曲林片;对照组49例应用三环类抗抑郁药阿米替林片。2组均3个月为1疗程。分别在治疗前及治疗3个月后应用汉密尔顿抑郁量表(hamilton rating scale for depression,HAMD)评分评估抑郁改善情况,采用TESS不良反应量表(treatment emergent symptom scale,TESS)评估不良反应事件,应用NIHSS量表(national institute of health stroke scale)评估患者神经功能缺损恢复情况。结果治疗3个月后,实验组汉密尔顿抑郁量表评分、TESS不良反应量表评分和NIHSS评分均较对照组明显降低,差异有统计学意义(P<0.05)。结论舍曲林治疗老年人群脑卒中后抑郁疗效确切,且不良反应较小,总体评价安全有效。     

舍曲林与氟西汀治疗老年脑梗死后抑郁的对照研究

目的对比舍曲林与氟西汀治疗老年脑梗死后抑郁的疗效及安全性。方法将脑梗死后抑郁患者随机分为2组,分别口服舍曲林和氟西汀,疗程12周。采用汉密尔顿抑郁量表(HAMD)评定疗效,抗抑郁剂副反应量表(SERS)评价安全性,巴氏指数(BI)评定日常生活能力(ADL)。结果舍曲林和氟西汀治疗后HAMD评分均明显下降、BI显著升高,且随着治疗时间的延长变化更显著(P<0.001),但2组相比均无明显差异(P>0.05)。舍曲林组不良反应发生率明显低于氟西汀组(P<0.05)。结论舍曲林和氟西汀在改善老年脑梗死后抑郁和日常生活能力方面疗效相当,但舍曲林安全性更好。     

舍曲林联合坦度螺酮治疗卒中后抑郁伴焦虑老年患者的疗效

目的研究舍曲林联合坦度螺酮治疗卒中后老年抑郁及焦虑的临床效果及安全性。方法选取2014-01—2015-01我科收治的卒中后抑郁伴焦虑的老年患者80例,按随机数字表法分为实验组和对照组各40例。实验组给予舍曲林联合坦度螺酮治疗,对照组仅给予舍曲林治疗。记录并分析患者用药前后的焦虑自评量表SAS评分、抑郁自评量表SDS评分及不良反应TESS评分。结果 (1)治疗2周后实验组SAS评分(37.35±5.7)分,优于对照组的(44.19±6 24)分,差异具有统计学意义(P0.05)。(2)实验组SDS评分(41.21±6.74)分,优于对照组的(48.44±6.03)分,差异具有统计学意义(P0.05)。(3)2组不良发应发生率及各种不良反应差异均无统计学意义(P0.05)。结论舍曲林联合坦度螺酮治疗卒中后老年抑郁及焦虑的临床效果确切且安全性高,总值得临床进一步深入研究和推广。     

舍曲林联合针刺治疗老年抑郁症的效果观察

目的探讨舍曲林联合针刺治疗老年抑郁症的临床疗效。方法按随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)抑郁发作诊断标准的70例老年抑郁症患者分为研究组(舍曲林联合针刺治疗)和对照组(舍曲林治疗),治疗8周,采用汉密尔顿抑郁量表17项版(HAMD-17)、副反应量表(TESS)分别评定疗效和不良反应。结果 8周治疗后,研究组和对照组有效率差异无统计学意义(94.28%vs.88.57%,P0.05),治疗第1、2周末两组HAMD-17评分差异均有统计学意义[(15.25±2.36)分vs.(19.17±2.67)分,(13.25±2.36)分vs.(16.37±2.66)分,P均0.05]。两组TESS评分差异无统计学意义[(2.88±1.23)分vs.(4.97±2.69)分,P0.05]。结论舍曲林联合针刺治疗与单用舍曲林治疗对老年抑郁症均有效,但前者的早期症状改善更明显,副反应更少。     

舍曲林治疗脑卒中后抑郁疗效观察

目的观察舍曲林治疗脑卒中后抑郁症(PSD)的疗效及对神经功能缺损的改善情况。方法 56例入选患者经知情同意后分为舍曲林组(干预组)30例和对照组26例,前者予舍曲林口服治疗,疗程8周;后者予心理疏导治疗,其他治疗两组基本相同。于治疗前后采用汉密尔顿抑郁量表(HAMD)和美国国立卫生研究院卒中量表(NIHSS)对抑郁症和神经功能缺损进行评分,并记录药物不良反应。结果治疗后两组PSD总有效率分别为92.86%和57.69%,差异非常显著(P<0.01);两组NIHSS均减小,以干预组更明显,组内比较及组间比较差异均有统计学意义(P<0.05),1例过敏未完成观察,其他不良反应轻微。结论 PSD患者舍曲林能很好控制抑郁症状,改善缺损的神经功能,减少后遗症,值得应用。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。