前列地尔治疗脑心综合征的疗效观察

目的观察前列地尔治疗脑心综合征患者的疗效。方法选择河南省胸科医院2015-09—2016-09住院符合脑心综合征诊断标准的168例患者,随机分为观察组(84例)和对照组(84例)。2组均采用内科常规治疗,观察组采取前列地尔10μg加入0.9%氯化钠注射液100mL内静滴,bid,3周一疗程。观察2组临床疗效。结果 2组治疗后NIHSS评分显著下降,观察组较对照组明显下降(P0.05)。BI评分显著升高,观察组较对照组明显升高(P0.05)。2组心脏功能的疗效比较观察组明显高于对照组(P0.05)。结论前列地尔可以提高脑心综合征患者的疗效。     

前列地尔联合依达拉奉治疗急性脑梗死的疗效观察

目的观察前列地尔联合依达拉奉治疗急性脑梗死的疗效。方法 110例急性脑梗死患者随机分为治疗组59例和对照组51例。对照组在常规治疗基础上给予前列地尔治疗,治疗组在对照组治疗的基础上再加用依达拉奉治疗,连用2周,观察2组治疗前后神经功能缺损评分的变化,评价2组临床疗效。结果治疗组有效率明显高于对照组,差异有统计学意义(P0.05)。治疗后神经功能缺损(NIHSS)评分2组均有改善,但治疗组改善幅度明显优于对照组,差异有统计学意义(P0.05)。结论前列地尔联合依法拉奉合用治疗急性脑梗死疗效明显优于单用前列地尔。     

丁苯酞软胶囊联合前列地尔注射液治疗急性脑梗死的疗效观察

目的探讨丁苯酞软胶囊联合前列地尔治疗急性脑梗死的临床疗效。方法选择80例急性脑梗死患者为研究对象,随机分为对照组和治疗组各40例。对照组给予前列地尔治疗,治疗组在对照组的基础上口服丁苯酞软胶囊。观察2组神经功能改善情况及临床疗效。结果治疗组总有效率95.00%,明显高于对照组的77.50%(P0.05)。治疗后,2组患者神经功能缺损程度评分(NIHSS)均有明显改善(P0.05),且治疗组效果明显优于对照组(P0.05)。结论丁苯酞联合前列地尔对急性脑梗死有良好疗效,可显著改善患者NIHSS评分,提高神经功能康复,促进机体健康。     

灯盏花素联合前列地尔对脑梗死神经功能缺损及血液流变学的影响

目的探讨灯盏花素联合前列地尔对脑梗死患者神经功能及血液流变学的影响。方法收集2012-01—2014-05我院收治的脑梗死患者164例,随机分为观察组与对照组各82例。2组均予以常规治疗,对照组加用灯盏花素注射液治疗,观察组则在对照组的基础上加用前列地尔治疗。比较2组临床疗效、神经功能缺损及血液流变学指标改善情况。结果治疗后2组CSS评分均显著降低,且观察组显著低于对照组(P0.05);2组Barthel指数以及各项血液流变学指标均显著提高,且观察组显著高于对照组(P0.05);观察组总有效率为91.5%,显著高于对照组的80.5%(P0.05)。结论灯盏花素联合前列地尔治疗脑梗死可显著改善患者的神经功能缺损及血液流变学指标,疗效显著,不良反应少,值得推广应用。     

前列地尔联合依达拉奉治疗急性脑梗死的效果分析

目的：探讨应用前列地尔联合依达拉奉治疗急性脑梗死的临床效果。方法选择2010-01-2012-12收治的100例急性脑梗死患者为研究对象,随机分为对照组和实验组,对照组接受血栓通治疗,实验组接受前列地尔联合依达拉奉治疗,对比2组临床疗效。结果实验组总有效率和治疗后神经功能缺损程度均明显优于对照组,2组患者治疗效果对比差异有统计学意义（ P＜0.05）。结论急性脑梗死患者接受前列地尔联合依达拉奉治疗,有助于其临床神经功能恢复,临床应用价值较高。     

前列地尔联合舒血宁注射液治疗急性脑梗死的疗效及对血NSE及Ang-2的影响

目的观察应用前列地尔联合舒血宁治疗急性脑梗死的疗效及对血NSE及Ang-2的影响。方法选取2012-04—2014-05在我院诊治的54例急性脑梗死患者,按随机数字表法随机分为对照组和观察组各27例,对照组给予前列地尔治疗,观察组在对照组基础上给予舒血宁,观察2组疗效及血NSE及Ang-2的变化情况。结果总有效率比较观察组明显高于对照组(P0.05),观察组患者的血NSE、Ang-2水平改善程度明显高于对照组,差异有统计学意义(P0.05)。结论前列地尔联合舒血宁治疗急性脑梗死临床效果显著,能明显改善血NSE及Ang-2水平,可推广应用。     

灯盏花素联合前列地尔治疗急性脑梗死的疗效及对血液流变学的影响

目的观察灯盏花素联合前列地尔治疗急性脑梗死患者的临床疗效及对血液流变学的影响。方法 90例急性脑梗死患者按照治疗方法不同分为治疗组47例与对照组43例,对照组给予常规药物治疗,治疗组在基础上加用灯盏花素、前列地尔治疗,连续治疗14d后比较2组临床疗效及对血液流变学的影响。结果治疗组总有效率明显高于对照组（χ2=11.260,P=0.007）,治疗后全血高切、低切、红细胞比积、血浆黏度、纤维蛋白原等指标均较治疗前、同期对照组改善明显,差异具有统计学意义（P〈0.05）。结论灯盏花素联合前列地尔治疗急性脑梗死可提高治疗效果,其可能通过改变血液流变学发挥作用。     

前列地尔治疗急性脑梗死临床分析

目的观察前列地尔注射液治疗急性脑梗死的疗效和安全性。方法 50例急性脑梗死病人随机分为治疗组25例和对照组25例。对照组按急性脑梗死常规方法治疗,治疗组在常规治疗基础上加用前列地尔注射液治疗。2组病例于治疗前、治疗后进行神经功能评分按照欧洲卒中评分(ESS)标准进行评定和日常生活能力(ADL)的测定。并观察前列地尔注射液治疗期间的不良反应。结果治疗14 d后,2组ESS均较治疗前下降,差异具有显著性(均P0.05);但治疗组ESS下降水平显著低于对照组,差异具有显著性(P0.05)。治疗组治疗后ADL上升的水平显著高于对照组,具有显著差异性(P0.05)。前列地尔注射液治疗期间无明显不良反应发生。结论前列地尔注射液治疗急性脑梗死是安全有效的。     

前列地尔对脑梗死患者血清基质金属蛋白-9的调控作用

目的探讨脑梗死患者接受前列地尔治疗后的临床疗效及血清基质金属蛋白-9(MMP-9)的变化。方法收集临床首发颈内动脉系急性脑梗死患者590例,随机分为对照组及实验组各295例,对照组予以常规治疗,实验组在此基础上加用前列地尔治疗,观察治疗前后2组症状改善及MMP-9水平变化情况。结果疗程结束后2组临床表现及神经症状均得以改善,MMP-9水平下降,实验组改变明显优于对照组(P0.05),总有效率高于对照组(χ2=18.89,P0.05);MMP-9水平与NIHSS评分呈正相关(r=0.572,P0.05),与BI评分呈负相关(r=-0.423,P0.05)。结论前列地尔可显著提高脑梗死患者的临床疗效,与其促进MMP-9降低及改善神经症状的作用相关。     

脂微球前列地尔治疗急性脑梗死临床观察

目的观察脂微球前列地尔治疗脑梗死的疗效。方法将经头颅MRI或CT证实的脑梗死患者118例随机分为2组：治疗组60例,用脂微球前列地尔10μg＋生理盐水100mL静滴,1次/d;对照组58例,应用复方丹参注射液20mL＋生理盐水250mL静滴,1次/d;2组均给予阿司匹林100mg口服,1次/d,连用14d为一疗程。观察2组患者用药前及用药后第15天的神经功能缺损评分及血液流变学变化,并对2组进行比较,同时进行临床疗效比较。结果治疗组神经功能缺损评分改善情况及临床疗效均显著优于对照组（均P〈0.05）;治疗组全血比黏度、血浆比黏度、纤维蛋白原、红细胞聚集指数较治疗前显著降低（P〈0.01）,红细胞比积较治疗前显著降低（P〈0.05）;对照组较治疗前无明显变化（P〉0.05）,治疗组显著优于对照组（P〈0.05）。结论脂微球前列地尔治疗急性脑梗死疗效明显。     

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.