多发性硬化周围神经病变的电生理评价

目的研究多发性硬化(MS)患者的周围神经病变，并评价神经电生理技术的应用价值。方法采用神经传导速度(NCV)技术检测MS患者周围神经的运动传导速度(MCV)、感觉传导速度(SCV)及其潜伏期；采用运动诱发电位(MEP)检测正中神经和胫神经的潜伏期；采用F波检测正中神经的出现率和传导速度。结果MS患者NCV均不同程度地减慢，MCV的异常率高于SCV，NCV结果提示轴突损害比脱髓鞘显著。MEP测得肘点和腰4点的潜伏期延长，提示正中神经远端和腰骶神经根功能的损害。部分患者F波的出现率降低．提示周围神经根功能异常。结论MS患者存在周围神经病变；综合运用电生理技术可以全面地评价MS周围神经功能。     

吉兰-巴雷综合征患者的神经电生理特点

目的 探讨吉兰-巴雷综合征(GBS)患者的神经电生理特点.方法 对20例吉兰-巴雷综合征患者进行肌电图(EMG)、运动神经传导速度(MCV)、F波及感觉神经传导速度(SCV)检测,共检测160条运动神经、120条感觉神经及60块肌肉,并对结果进行分析.结果 上、下肢神经远端潜伏期延长占54.4%,MCV减慢占68.8%,F波异常占95.0%,SCV减慢占70.8%,EMG提示神经源性损害占70.0%.结论 GBS为广泛的周围神经损害,存在以脱髓鞘为主伴有轴索变性的神经电生理改变.神经电生理检测对GBS的诊断具有极为重要的诊断价值.     

帕金森病患者周围神经损害的特点

目的探讨帕金森病(PD)患者周围神经损害的特点。方法将32例PD患者根据H-Y分级标准分为轻度组(17例)和重度组(15例),分别进行神经电生理检查,包括四肢感觉和运动神经传导速度(SCV、MCV)及潜伏期(LP)、波幅(Amp)、F波LP及出现率、H反射LP;并与对照组(30例)比较。结果 (1)与对照组比较,PD轻度组和重度组SCV及MCV LP明显延长,Amp明显降低,下肢SCV及MCV明显减慢;F波及H反射的LP明显延长,F波出现率明显降低(均P<0.05);(2)与PD轻度组比较,PD重度组下肢SCV明显减慢,SCV及MCV的Amp明显降低,F波LP明显延长,出现率明显降低(均P<0.05)。结论 PD患者周围神经损害下肢重于上肢,感觉神经损害重于运动神经,并与病情有关。     

神经型布氏杆菌病周围神经损害的临床与电生理研究

目的研究神经型布氏杆菌病周围神经损害的临床特征,探讨电生理对其的诊断价值。方法对32例神经型布氏杆菌病周围神经损害患者(病例组)和32名性别及年龄与病例组匹配的正常对照组进行神经电生理检查,并对所得检查结果进行统计学分析。结果病例组与对照组在运动末梢潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound motor active potentials,CMAP)波幅、运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经动作电位潜伏期(sensory nerve action potential latency,SL)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensory nerve conduction velocity,SCV)方面的比较,差异均有统计学意义(P0.05)。电生理检查提示上下肢周围神经损害,感觉神经及运动神经均受累,其中感觉神经占55.47%,运动神经占16.80%,上肢以正中神经(64条)最多见,下肢以腓肠神经(16条)最多见。四肢运动神经256条中43条传导速度减慢,占16.80%,四肢感觉神经256条中142条传导速度减慢,占55.47%,SCV较MCV改变明显,上肢病变重于下肢。结论神经电生理检查为神经型布氏杆菌病周围神经损害的临床诊断提供了客观依据。     

脊髓小脑性共济失调3型无症状基因携带者与患者周围神经传导特征北大核心CSCD

目的探讨脊髓小脑性共济失调3型(spinocerebellar ataxia type 3,SCA3)无症状基因携带者与患者周围神经传导异常特征,寻找与SCA3疾病严重程度及病程相关的电生理指标。方法对确诊的20例无症状基因携带者(preclinical carriers of spinocerebellar ataxias type 3,PreSCA3)、39例SCA3患者及32名健康对照者进行周围神经传导(nerve conductive study,NCS)检测,比较各组间的神经传导异常,分析各电生理参数与共济失调等级量表(scale for the assessment and rating of ataxia,SARA)总分及病程的相关性。结果PreSCA3感觉神经传导异常发生率为20%,并且PreSCA3组尺神经、胫神经、腓肠神经SNAP波幅及尺神经MCV显著低于健康对照组(P<0.05)。SCA3患者NCS异常发生率为69.2%,以感觉神经传导异常为主(53.8%),主要表现为混合性损害(48.1%)。与健康对照组相比,SCA3患者所有检测神经SNAP波幅、SCV及腓总神经CMAP波幅、尺神经MCV显著降低(P<0.05)。此外,正中、尺、胫、腓总及腓肠神经SNAP波幅、SCV与SARA总分及病程呈负相关(P<0.05)。结论部分PreSCA3已存在周围神经损害,主要累及感觉神经。SCA3患者NCS检查异常率高,主要表现为混合性损害为主的感觉性周围神经病。SNAP波幅、SCV可能作为监测疾病发生发展的潜在生物学标记物。     

200例2型糖尿病患者神经传导速度检测分析

目的:探讨2型糖尿病(DM)患者周围神经病变的客观神经电生理特点。方法:分别对200例DM患者,其中有周围神经损害临床表现组(DM-I)100例和无周围神经损害临床表现组(DM-Ⅱ)100例,与50例正常成人进行运动神经传导速度(MCV)、感觉神经传导速度(SCV)、复合肌肉动作电位(CMAP)、感觉神经动作电位(SNAP)进行测定。结果:两组患者所测的MCV、SCV、CMAP、SNAP与正常对照组比较有显著差异,而DM-I组与DM-II所测的MCV、SCW、CMAP、SNAP比较亦有显著差异,下肢神经的4个参数总异常率高于上肢。结论:(1)神经传导速度的检测有助于糖尿病周围神经病的早期诊断。(2)DM并发周围神经损害在临床症状出现之前已有神经传导速度的改变。(3)下肢神经的总异常率高于上肢。     

小儿有机磷中毒致周围神经损害的电生理研究

目的探讨小儿有机磷中毒致周围神经损害对电生理的影响,为预防有机磷中毒造成周围神经损害提供理论依据。方法选择2010-01—2014-12收治的100例有机磷中毒患儿为研究对象,行常规肌电图(EMG)及神经传导速度(NCV)测定。结果 (1)静息状态下纤颤发生率为30.8%,正向电位发生率为31.8%;轻收缩时运动单位电位时限延长、波幅增高、多相波增多发生率分别为22.8%、23.0%、20.8%;重收缩时募集形式单纯相占38.2%,混合相为44.3%,干扰相为17.5%,均表现为周围神经损害。(2)MCV异常率为24.3%,SCV异常率为31.3%,与正常参考值比较,MCV、SCV明显减慢,且差异具有统计学意义(P0.05)。结论电生理检查可为有机磷中毒患儿所致的周围神经损伤情况提供重要的统计依据,为临床诊断、鉴别提供评判指标,具有重要的临床判断价值。     

急性河豚毒素中毒患者神经电生理的研究

目的 研究急性河豚毒素（TTX）中毒患者神经电生理的改变。方法 检测58例TTX中毒患者的肌电图，运动神经传导速度（MCV），感觉神经传导速度（SCV），F波，H反射和体感诱发电位（SEP）。结果 22例TTX中毒患者（37．9％）肌电图以多相不规则波为主，MCV，SCV均有减慢，以SCV减慢最为显著，MCV远端动作电位潜伏期明显延长，神经传导速度（NCV）的异常率比纤颤，正尖波检出率高，F反应，H反射异常提示部分TTX中毒累及神经根；SEP的异常率达56．9％。结论 TTX中毒可伴有中枢神经的损害。神经电生理检测可用来动态观察其神经系统损害程序，病程，范围，亦是TTX中毒时早期检查的重要手段之一。     

糖尿病性多发性神经病神经传导异常与临床评分相关性分析

目的分析糖尿病性多发性神经病患者神经电生理改变及其与临床评分的相关性。方法回顾性分析36例中日友好医院内分泌科住院的2型糖尿病性多发性神经病患者神经电生理异常特点并统计分析其与密歇根量表评分之间的相关性。结果本研究入组的36例糖尿病性多发性神经病患者中,周围神经传导检查下肢重于上肢(100%vs 83. 3%),感觉传导异常比运动传导异常多见(100%vs 83. 3%),以下肢感觉传导感觉神经动作电位(SNAP)波幅下降最为常见(36/36,100%);运动神经传导异常则以运动传导速度(MCV)减慢相对常见(30/36,83. 3%),复合肌肉动作电位(CMAP)波幅下降及运动传导远端潜伏期(DML)延长相对少见(11. 1%,5. 6%);神经损害电生理评分与密歇根量表评分之间具有显著相关(P 0. 01)。结论感觉传导波幅下降及轻度的运动传导速度减慢为常见的糖尿病性多发性神经病电生理改变特点;神经传导异常评分与密歇根量表评分具有显著相关,可用于疾病严重程度随访。     

不同电生理检测方法对糖尿病患者胫神经损害诊断价值的比较

目的比较不同的神经电生理检测方法对糖尿病患者胫神经损害的诊断价值。方法应用EMG仪对63例确诊2型糖尿病患者进行单侧胫神经运动传导速度(MCV)及感觉传导速度(SCV)、F波及H反射检测,比较四者的诊断阳性率。结果本组63例糖尿病患者胫神经四种检查方法阳性率从高到低依次为H反射(76.19%)、F波(53.97%)、SCV(36.51%)、MCV(17.46%)(均P0.05)。本组中43例无周围神经临床症状和体征的糖尿病患者胫神经四种检查方法阳性率从高到低依次为H反射(76.74%)、F波(55.81%)、SCV(32.56%)、MCV(13.95%)(均P0.05)。本组63例糖尿病患者中反映神经远端传导功能的神经传导速度总异常率为44.44%(28/63),而反映神经近端传导功能的H反射与F波总异常率为80.95%(51/63),二者比较差异有统计学意义(χ~2=17.952,P0.01)。结论四种不同的电生理检测方法可以较全面反映胫神经远近端的损害,糖尿病患者胫神经损害不仅仅限于远端,其近端亦容易受损。四种检测方法中H反射阳性率更高,可以更早发现胫神经的亚临床病变。     

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.