抑郁障碍的多导睡眠图监测研究

目的 探讨抑郁障碍患者睡眠生理的变化.方法 应用日本1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图等技术,对19例抑郁障碍患者的多导睡眠图(PSG)进行整夜监测,并与21名正常受试者对照.结果 抑郁障碍组PSG主要指标表现为REM睡眠潜伏期(RL)前移,正常组(84±11)min,抑郁障碍组(61±19)min(P＜0.01);睡眠维持率(SMT)下降(正常组(99±3)%,抑郁障碍组(90±5)%,P＜0.01),第二阶段睡眠降低(正常组(56±4)%,抑郁障碍组(45±17)%,P＜0.05)及REM4个睡眠参数存在变异.结论 抑郁障碍患者具有PSG多项睡眠脑电指标的改变.其中REM睡眠潜伏期前移是本病的特点.     

发作性睡病患者行 PSG和MSLT监测的护理

目的：探讨发作性睡病临床主要表现,以及诊断中常用的标准多导睡眠监测（polysomnography ,PSG）和多次睡眠潜伏试验（multiple sleep latency test ,MSLT）的应用和监测方法。方法回顾分析2012‐07—2014‐03到我科监测治疗的26例发作性睡病患者的临床资料。结果26例均顺利完成监测,其中21例夜间PSG检查中睡眠潜伏期＜10 min;14例快动眼睡眠（REM）始于入睡后＜20 min;白天MSLT中,26例平均睡眠潜伏期＜5 min ,入睡开始阶段出现REM（ROREMPs）≥2次的26例。结论护理人员在对患者进行监测的过程中,应采取适合的心理疏导方式,以消除患者的不良情绪,合理的心理疏导能提高检测结果的准确率,将对发作性睡病的诊断起非常重要的作用。     

多次睡眠潜伏期试验的检测方法及临床应用进展

应用多导睡眠仪（PSG）进行多次睡眠潜伏期试验（MSLT）是客观评价日间思睡严重程度的 标准工具。分析多次试验的睡眠次数、平均睡眠潜伏期以及快速眼动（REM）睡眠出现的潜伏期与次数， 能将思睡的严重程度用睡眠潜伏期的长短显示出来，更具有客观性和可重复性。目前MSLT在临床已 广泛用于发作性睡病的诊断，特发性睡眠增多和阻塞性睡眠呼吸暂停综合征等日间思睡的严重程度评 估，以及精神振奋剂等药物的疗效评估。现对MSLT的具体检测方法及临床应用作一综述。     

发作性睡病和阻塞性睡眠呼吸暂停综合征患者多次睡眠潜伏期试验对照研究

为了解发作性睡病与阻塞性睡眠呼吸暂停综合征(OSAS)的异同，采用多次睡眠潜伏期试验(MSLT)和多导睡眠图(PSG)进行对照研究。     

24例成人发作性睡病伴快速眼动睡眠期行为异常患者临床及多导睡眠图分析

目的探讨发作性睡病(Narcolepsy)合并快速眼动睡眠期行为异常(REM sleep behavior disorder,RBD)患者的临床及多导睡眠图特征,为临床诊断提供客观依据。方法收集本院24例临床诊断为发作性睡病同时合并RBD患者,行多导睡眠监测(polysomnography,PSG)及多次睡眠潜伏期试验(multiple sleep latency test,MSLT),对其临床症状及电生理检查结果进行统计分析。结果临床症状:本组24例均存在白天不能控制的过度嗜睡(100%);临床症状表现形式有睡眠相关性幻觉、睡眠瘫痪、猝倒发作、夜间睡眠中打鼾、憋醒、夜间睡眠中拍打同床人、梦境扮演经历。PSG分析:24例患者中24例N1期睡眠时间增加(100%);18例N2期睡眠时间减少(75%);18例N3期睡眠时间减少或消失(75%);12例REM睡眠时间延长(50%);9例(37.5%)存在呼吸暂停-低通气情况(AHI5次/时);15例(62.5%)存在周期性肢体运动(PMLS指数15次/时);24例伴随下颌肌电持续或间断增高(100%);12例伴随出现肢体或颜面部异常活动(50%)。MSLT分析:24例平均睡眠潜伏时间均小于8 min同时大于或等于两次REM起始睡眠(100%)。结论成人发作性睡病患者常合并睡眠呼吸暂停-低通气综合征,继发性嗜睡症状需与发作性睡病相鉴别;发作性睡病者常合并RBD,异常动作并非每夜都发生,但PSG可发现微小的异常动作或肌电活动,帮助疾病诊断;发作性睡病常合并周期性肢体运动,且分布在REM睡眠期较多时,需注意是否同时存在RBD可能。     

32例儿童发作性睡病临床特征分析

目的 加强对儿童发作性睡病临床特征及诊断方法的认识. 方法 回顾性分析自2008年9月至2011年9月北京市儿童医院神经科和解放军总医院儿童医学中心收治的32例发作性睡病患儿资料,同时对相关文献进行回顾分析. 结果 32例发作性睡病患儿均有日间不可抗拒的入睡发作,26例(81.3％)存在猝倒发作,11例(34.4％)存在睡眠幻觉,仅2例(6.25％)存在睡眠瘫痪表现.患儿多以日间睡眠增多为起病症状,大多数患儿有夜间睡眠紊乱、易激惹的临床表现,性格改变、食欲及体重增加、青春期提前也是常见的临床症状.多次小睡睡眠潜伏期试验(MSLT)检查在患儿中阳性率较低,可能与患儿年龄小、病程短等因素有关. 结论 不可抗拒的入睡发作、猝倒发作是中国儿童发作性睡病典型的临床表现,结合多导睡眠图和MSLT可明确诊断.     

帕金森病患者的睡眠异常

目的研究帕金森病患者睡眠障碍发生及其特点和影响因素。方法收集患者病史资料并应用多导睡眠仪对10例帕金森病患者及5名健康对照进行多导睡眠监测。受试者分为3组:对照组、帕金森病Hoehn-Yahr(H&Y)Ⅰ级组及帕金森病H&YⅡ~Ⅳ级组。每组均包括男性3例,女性2例。结果3组年龄分别为(54·4±5·7)岁、(57·6±14·5)岁、(58·2±10·7)岁,年龄之间的差异无统计学意义(F=0·232,P=0·794)。对照组浅慢波睡眠时间为(70·6±7·8)min,而H&YⅠ级组患者浅慢波睡眠时间为(81·4±6·1)min,显著高于对照组(P=0·008);对照组睡眠效率为75·6%±12·8%,快动眼睡眠(REM)潜伏期为(116±48)min,浅慢波睡眠所占比例为70·6%±7·8%,REM所占比例为14·8%±5·5%,总睡眠时间为(372·8±53·4)min,而H&YⅡ~Ⅳ级组患者睡眠效率43·6%±16·0%(P=0·003)、REM所占比例7·3%±6·1%(P=0·003)及总睡眠时间(244·3±103·2)min(P=0·006)均显著低于对照组,REM睡眠潜伏期(281±86)min(P=0·000)及浅慢波睡眠时间(85·3±7·9)min(P=0·000)显著高于对照组。经相关分析,睡眠潜伏期、浅慢波睡眠时间与疾病病程存在显著正相关(r分别为0·889、0·492;P值分别为0·000、0·006),而睡眠效率、深慢波睡眠时间及总睡眠时间与疾病病程有显著负相关(r分别为-0·626、-0·723、-0·728;P值均为0·000)。结论研究结果显示,帕金森病患者在患病早期已经存在夜间睡眠时间减少、睡眠效率下降、睡眠潜伏期延长及睡眠结构的改变等异常,而且有随疾病进展而加重的趋势。     

失眠症的整夜多导睡眠图监测

目的探索建立失眠症的多导睡眠图(PSG)模式.方法应用日本Nihon Kohden公司的Neurofax-1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图技术,对39例失眠症患者和33名正常对照者进行PSG全夜监测.结果与正常组相比,失眠症组的PSG表现为睡眠总时间减少(正常组464.1±22.9分,失眠症组359.7±31.5分,P＜0.01),睡眠潜伏期延迟(正常组19.9±9.8分,失眠症组31.5±18.4分,P＜0.01),醒觉次数多(正常组1.4±0.7次,失眠症组4.9±2.1次,P＜0.01),睡眠效率低(正常组94.6±5.1%,失眠症组84.7±8.3%,P＜0.01),第一阶段睡眠增加(正常组9.1±1.9%,失眠症组27.9±17.9%,P＜0.01),第二阶段睡眠下降(正常组56.2±4.7%,失眠症组45.9±17.7%,P＜0.01),第3,4阶段睡眠降低(正常组16.7±4.9%,失眠症组9.1±5.1%,P＜0.01),REM睡眠潜伏期缩短(正常组87.8±11.7分,失眠症组53.8±19.7分,P＜0.01).此外,失眠症组有8例(N=8/39,20.5%)的睡眠潜伏期和睡眠效率综合分析正常,但患者主诉"无睡眠感",有"主观性失眠"存在.结论失眠症患者PSG存在睡眠进程、睡眠结构和REM值的变化.睡眠潜伏期延迟和慢波睡眠S1增加具有更高的临床价值.本组研究还发现失眠症患者中有一部分对象可能属于"主观性失眠".     

首发抑郁症患者多导睡眠图的对照研究

目的 观察自然夜间多导睡眠图(PSG)对首发抑郁症患者的诊断价值.方法 应用日本1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图等技术,对24例首发抑郁症患者的多导睡眠图(PSG)进行整夜监测,并与21名正常受试者对照.结果 首发抑郁症患者组PSG主要指标表现为REM睡眠潜伏期(RL)前移[正常组(81±11)min,首发抑郁症患者组(62±19)min,P<0.01];睡眠维持率(SMT)下降[正常组(98±5)%,首发抑郁症患者组(87±8)%,P<0.01],第二阶段睡眠降低[正常组(57±5)%,首发抑郁症患者组(43±12)%,P<0.01]及REM 3个睡眠参数有改变.结论 REM睡眠潜伏期前移是首发抑郁症的特点.     

抑郁症患者的Quisi试验研究

目的　探讨Quisi在抑郁症辅助诊断中的价值。方法　应用德国Quisi仪 ,对 2 4例抑郁症患者 (抑郁症组 )的睡眠脑电进行 2次全夜测试 ,并与 2 1名正常受试者 (正常对照组 )进行对照。结果　 (1)抑郁症组在第 1夜的各项指标中 ,仅总记录时间短于第 2夜 [分别为 (478 1± 2 7 4 )min和(499 5± 2 5 7)min ;P <0 0 1]。 (2 )抑郁症组与正常对照组比较 ,睡眠潜伏期长 [分别为 (34 5± 17 9)min和 (2 3 9± 17 4 )min ;P <0 0 5 ],觉醒时间长 [分别为 (39 8± 2 1 9)min和 (19 3± 14 9)min],睡眠效率低 [分别为 (83 7± 6 9) %和 (93 3± 5 1) % ],睡眠维持率低 [分别为 (88 8± 9 1) %和 (99 8±4 9) % ],REM睡眠潜伏期短 [分别为 (6 9 9± 16 3)min和 (88 6± 15 9)min],第二阶段百分比高 [分别为 (5 5 3± 11 9) %和 (47 5± 7 8) % ;P <0 0 5 ],第三阶段百分比高 [分别为 (8 9± 6 9) %和 (14 1±6 1) % ],REM睡眠百分比低 [分别为 (10 1± 5 9) %和 (16 9± 5 1) % ],伪迹百分比高 [分别为 (3 9±1 3) %和 (1 9± 0 8) % ],P <0 0 5或P <0 0 1。结论　Quisi适合于全夜监测。在缺乏相关设备的基层医院 ,Quisi技术可用于对抑郁症的检测。     

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.