低频电刺激丘脑网状核对杏仁核点燃大鼠模型海马谷氨酸和γ氨基丁酸的影响

<正>我国癫癎患病率为0.9‰～4.8‰,25%～30%的癫癎患者为难治性癫癎。脑深部电刺激(DBS)作为一种新的治疗手段,已经受到广泛的关注。近年来,出现用丘脑网状核(TRN)作为靶点进行电刺激或电毁损来抑制癫癎发作,取得了一定疗效。但目前尚不清楚电刺激TRN是否通过调节海马谷氨酸(Glu)与γ氨基丁酸(GABA)的动态平衡而实     

褪黑素对匹罗卡品致癫癎大鼠海马神经发生和突触重建的影响

目的探讨褪黑素(Mel)在匹罗卡品(PILO)致癫癎犬鼠模型中的抗癫癎作用机制。方法将45只Wistar大鼠按癫癎持续状态(SE)后6 h,14、28天分为PILO组(1 5只),PILO+Mel组(15只)和对照组(15只),采用PILO诱导大鼠慢性颞叶癫癎模型,用5溴-2-脱氧尿嘧啶核苷标记增殖细胞,Timms染色评价苔藓纤维发芽(MFS)等技术,动态观察MeI对癫癎大鼠海马神经发生和MFS的影响及其与反复自发性癫癎发作(SRS)发生的关系。结果与对照组比较,PILO组大鼠SE后6 h,14、28天细胞数明显增加,差异有统计学意义(P<0.01);与PILO组比较,PILO+Mel组大鼠在SE后6 h,14、28天,细胞数量明显减少(P<0.05),28天SRS数量明显减少,差异有统计学意义(P<0.05)。与PILO+Mel组比较,PILO组大鼠SE后14天,Timms染色密度开始增强,28天密度明显增强,差异有统计学意义(P<0.05)。结论Mel对SRS的预防作用可能与其对癫癎诱导的神经发生和MFS的抑制作用有关。     

人参皂甙Rd对匹罗卡品致癎大鼠模型中netrin-1表达及神经元凋亡的影响

目的探讨人参皂甙Rd(GSRd)对大鼠癫癎持续状态后齿状回netrin-1表达及海马神经元凋亡的影响。方法健康Wistar大鼠30只,随机分为颞叶癫癎组、GSRd组和对照组,每组10只。氯化锂-匹罗卡品建立大鼠颞叶癫癎模型,采用免疫组织化学法及TUNEL法观察颞叶癫癎组、GSRd组和对照组齿状回netrin-1蛋白表达及海马神经元凋亡细胞数情况。结果与对照组比较,颞叶癫癎组大鼠30 d齿状回netrin 1蛋白表达明显增高,海马CA3区TUNEL阳性细胞数在癫癎持续状态后7 d明显增高,差异有统计学意义(P<0.05);与颞叶癫癎组比较,GSRd组大鼠30 d齿状回nctrin l蛋白表达明显降低,海马CA3区TUNEL阳性细胞数在癫癎持续状态后7 d明显降低,差异有统计学意义(P<0.05)。结论 GSRd可能通过下调netrin 1的表达,并使神经元凋亡数目减少,从而发挥对神经元的保护作用。     

颞叶癫(癎)的临床特征和脑电图分析

目的分析和总结颞叶癫癎的临床、脑电图特征。方法对2004年6月至2006年1月于首都医科大学北京天坛医院癫癎中心门诊和病房确诊为颞叶癫癎的145例患者的临床、脑电图和神经影像学资料进行分析。结果患者的发作类型包括简单和复杂部分性发作以及全面强直阵挛发作,以复杂部分性发作最常见。病因分析显示,45例病灶性颞叶癫癎的病因依次为脑血管病、颅内感染、脑外伤等,100例非病灶性颞叶癫癎中,海马硬化29例。脑电图显示颞区癫癎样放电。结论颞叶癫癎是一组临床常见、病因复杂、表现多样的癫癎综合征。正确诊断、规范化治疗是提高其疗效的关键。     

老年性癫癎的临床特征和脑电图分析

目的分析和总结老年性癫癎的临床特征、脑电图特点及临床意义。方法对92例60岁后发病的老年性癫癎患者的临床、脑电图及神经影像学资料等进行分析。结果 92例患者中,复杂部分性发作是最常见的发作类型。82例为症状性癫癎,10例为隐源性癫癎。脑血管病、脑肿瘤、代谢中毒性疾病、颅内感染、脑外伤等是常见病因。脑电图异常以局灶性慢波最常见。56例随访患者中,47例发作控制良好。结论老年人群是癫癎的高发人群,正确认识临床特征和脑电图特点是诊断治疗的关键。     

脑梗死继发癫癎的研究进展

<正>随着人口的老龄化,脑卒中及脑卒中后癫癎发作呈现出逐渐增加的趋势。脑卒中及其相关的癫癎已逐渐成为严重的神经系统疾病之一,引起了人们越来越多的关注。脑卒中被认为是老年期癫癎的最常见原因,占年龄≥60岁老年人新发癫癎的35%以上,脑卒中和癫癎的共同存在,不仅加重了患者的神经系统损害,而且会导致焦虑、抑郁,影响预后。目前,有关脑卒中,特别是对脑梗死后癫癎发病率、危险因素、发病机制、发作类型、诊断、治疗等认识方面,仍然存在很多争议。为进一步提高我们对上述问题的了解,现就相关内容综述如下。1脑梗死继发癫癎发作的发病率脑梗死后继发性癫癎发作的发病率,既往报道存在着较     

老人癫癎发作的病因和类型

以老人癫癎发作为课题,已作过一些研究,但极大多数限于神经内科和神经外科。有关其病因的诊断标准,随检查深度和所使用的方法而各异。从研究的报道看,脑血管疾病最多,脑内肿瘤约占10～15％,尽管各组间有所不同,但其中原因不明的占相当大部分。Vercelletto等(1970)在原因不明的病人中随访34例,发现在10多年时间内极少数人死于中风;在大多数病人中所进行的治疗能有效地控制癫癎发作。     

依托咪酯在大鼠最大电休克和戊四氮模型中的抗惊厥作用

目的研究依托咪酯在最大电休克(maximal electroshock seizure,MES)和戊四氮(metrazol seizure test,MST)惊厥实验中的抗惊厥作用。方法复制160只Wistar大鼠MES和MST模型,MES实验大鼠80只随机分为4组,分别为依托咪酯10 mg/kg组(E10组)、5 mg/kg组(E5组)、2.5 mg/kg组(E2.5组)和对照1组,每组20只。MST实验大鼠80只随机分为4组,分别为依托咪酯10 mg/kg组(E10组)、5 mg/kg组(E5组)、2.5 mg/kg组(E2.5组)和对照2组,每组20只。观察MES中大鼠的惊厥发生率、死亡率和强直持续期,MST中惊厥潜伏期、惊厥数和死亡数,并记录每只大鼠的发作强度。发作24 h后,灌注固定后取脑,常规HE染色及Nissl染色。结果在MES中,与对照1组比较,E2.5组可缩短强直持续期(P<0.05),对惊厥发生率无明显影响,E5组可同时缩短强直持续期(P<0.01)降低惊厥发生率,E10组可完全拮抗大鼠电惊厥的发生。在MST中,与对照2组比较,依托咪酯各组仍具明显抗惊厥作用,其抗惊厥作用具有剂量依赖性,用量越大,大鼠惊厥发生强度越小。结论依托咪酯在动物模型观察中,具有对抗癫癎发作的作用,有希望成为临床治疗癫癎发作的药物。     

一例英国儿童脑内的犬弓蛔虫幼虫

弓蛔虫是猫和狗常见的寄生线虫。以往曾有5例人脑感染犬弓蛔虫的报道。其中1例是脑弓蛔虫癫癎发作后死亡。本文系非意外损伤而死亡的脑犬弓蛔虫病例。患儿2岁半,为出生于德国的英国女孩。据称,因为该孩有非意外性损害的再发史,故常由于患儿剧哭而“激怒”。既往无癫癎发作史。家庭养有一只供玩尝的大狗。尸体解剖发现,有多处体部挫伤。唇系带破裂。颅内有双侧硬脑     

脑动静脉畸形的介入治疗进展

<正> 脑动静脉畸形(arteriovenous malformation,AVM)是一种胚胎时期脑血管发育异常所形成的先天性血管畸形,发病率为0.01%～0.5%,多表现为脑内出血、癫癎发作等,常发生于青少年。因其能引起神经系统多种功能障碍,尤其是大量脑内出血后引发5%～10%病死率和30%～50%致残率,严重威胁人类健康。近20年来,随着显微神经外科技术     

Waves and stimulus-modulated dynamics in an oscillating olfactory network.

The temporal dynamics of electrical activity in an olfactory organ, the procerebral lobe of the terrestrial mollusc Limax maximus, is studied. The lobe exhibits intrinsic oscillations in its field potential. Intracellular recordings show that the lobe contains two classes of neurons, both with activity phase-locked to the oscillation. Neurons in one class produce periodic bursts of spikes while those in the other class fire infrequently but receive strong, periodic inhibition whose onset coincides with the burst. The large-scale activity of these neurons is imaged in preparations stained with voltage-sensitive dyes. We observe waves of electrical activity that span the width of the lobe and travel its full length along a longitudinal axis. Simultaneous optical and intracellular recordings show that the form of the wave reflects the electrical activity of both classes of neurons. The application of natural odor stimuli causes the electrical activity along the lobe to transiently switch from the state with propagating waves to one with spatially uniform oscillations. The behavioral and computational relevance of this change in global timing is discussed.     

Communication between neocortex and hippocampus during sleep in rodents

Both neocortical and hippocampal networks organize the firing patterns of their neurons by prominent oscillations during sleep, but the functional role of these rhythms is not well understood. Here, we show a robust correlation of neuronal discharges between the somatosensory cortex and hippocampus on both slow and fine time scales in the mouse and rat. Neuronal bursts in deep cortical layers, associated with sleep spindles and delta waves/slow rhythm, effectively triggered hippocampal discharges related to fast (ripple) oscillations. We hypothesize that oscillation-mediated temporal links coordinate specific information transfer between neocortical and hippocampal cell assemblies. Such a neocortical-hippocampal interplay may be important for memory consolidation.     

Epilepsy and takotsubo cardiomyopathy: a case report

A 60-year-old woman with a history of symptomatic seizures secondary to a subarachnoid hemorrhage was admitted to hospital because of a generalized seizure. The following day, her electrocardiogram showed negative T waves in II, III, (a)V(F), and V(2-6), and the echocardiogram showed an impaired left ventricular ejection fraction with ventricular apical akinesia. Head magnetic resonance imaging showed no acute brain injury, but single photon emission computed tomography (SPECT) showed hyperperfusion which affected the left temporal cortex in particular. Hyperactivity of the temporal lobe might cause autonomic nervous system dysfunction and might be related to takotsubo cardiomyopathy.     

手术治疗顽固性颞叶癫痫(附23例报告)

目的探讨颞叶癫痫手术适应证与术式选择。方法根据发作类型和表现、发作间期EEG及头颅MRI扫描，选择顽固性颞叶癫痫综合征23例进行手术治疗，其中单侧海马硬化16例。行前颞叶切除术7例，经颞中回侧脑室入路与经侧裂侧脑室入路选择性杏仁核海马切除术分别4、5例；蛛网膜囊肿2例仅行囊肿壁切除术；颞中回后部胶质瘤1例先行病灶切除术，术后因癫痫仍发作于术后第5天再次行前颞叶切除术；颞叶内侧肿瘤4例行肿瘤切除术加前颞叶切除术。术后随访3～22月。结果16例海马硬化中，2例术后1周内分别出现1次和2次强直阵挛发作．服卡马西平后未再发作，3例术后6～8个月的随访期内共发作1、3、3次，余11例未发作。蛛网膜囊肿者术后发作次数减少90％，颞叶肿瘤除1例术后第6天出现强直阵挛发作1次外未出现发作。结论在筛选颞叶癫痫手术适应证时，应注意癫痫发作形式和MRI表现，根椐病因选择术式。     

Relation between oxidative metabolism and slow rhythmic potentials in mammalian intestinal muscle.

Intact muscle layers separated from the small intestine of the cat were mounted in a specially designed chamber to measure electrical slow waves and NADH fluorescence simultaneously. Cooling the muscle to 17 degrees eliminated slow waves and simultaneously increased the level of fluorescence. Likewise, superfusing the muscle with a N2-bubbled glucose-free Krebs solution decreased the amplitude of slow waves and concomitantly increased fluorescence emission. In both cases, return to normal conditions reversed the effects on both slow waves and fluorescence. When signals were averaged over 30-70 slow waves, a pattern emerged with the fluorescence oscillations in phase with the electric oscillations. The NADH:NAD+ ratio reached a maximum at the most depolarized point of the slow waves and a minimum at the most polarized point between slow waves. This indicates maximum ATP utilization during the repolarization process. The correlation between redox oscillations and electrical slow wave generation is associated with cell metabolism.     

Source modeling sleep slow waves

Slow waves are the most prominent electroencephalographic (EEG) feature of sleep. These waves arise from the synchronization of slow oscillations in the membrane potentials of millions of neurons. Scalp-level studies have indicated that slow waves are not instantaneous events, but rather they travel across the brain. Previous studies of EEG slow waves were limited by the poor spatial resolution of EEGs and by the difficulty of relating scalp potentials to the activity of the underlying cortex. Here we use high-density EEG (hd-EEG) source modeling to show that individual spontaneous slow waves have distinct cortical origins, propagate uniquely across the cortex, and involve unique subsets of cortical structures. However, when the waves are examined en masse, we find that there are diffuse hot spots of slow wave origins centered on the lateral sulci. Furthermore, slow wave propagation along the anterior−posterior axis of the brain is largely mediated by a cingulate highway. As a group, slow waves are associated with large currents in the medial frontal gyrus, the middle frontal gyrus, the inferior frontal gyrus, the anterior cingulate, the precuneus, and the posterior cingulate. These areas overlap with the major connectional backbone of the cortex and with many parts of the default network.     

原发性进行性失语的磁共振研究(附一例病例分析)

目的报道1例原发性进行性失语患者的脑内影像学特点,以探讨原发性进行性失语患者常见的病变部位,脑内血流量、代谢及语言功能区之间联系纤维的变化。方法利用西门子3.0T磁共振仪对1例确诊失语类型为感觉性失语的原发性进行性失语患者进行(1)常规磁共振;(2)磁共振灌注成像;(3)磁共振波谱分析;(4)磁共振扩散张量成像分析。结果常规磁共振成像显示左侧额叶及颞叶萎缩,功能磁共振显示左侧颞叶和额叶前部代谢较对侧明显减低,左侧颞极及额前部的血流量较对侧减低;左侧皮质脊髓束部分各向异性值及追踪到的纤维束较对侧减少,Broca区与Wernicke区之间的联系纤维与对侧相比减少。结论原发性进行性失语病变的部位主要在左侧颞叶、额叶,与对侧相应区域对比呈现低灌注、低代谢状态,Broca区与Wernicke联系纤维减少。     

Spontaneous neural activity during human slow wave sleep

Slow wave sleep (SWS) is associated with spontaneous brain oscillations that are thought to participate in sleep homeostasis and to support the processing of information related to the experiences of the previous awake period. At the cellular level, during SWS, a slow oscillation (<1 Hz) synchronizes firing patterns in large neuronal populations and is reflected on electroencephalography (EEG) recordings as large-amplitude, low-frequency waves. By using simultaneous EEG and event-related functional magnetic resonance imaging (fMRI), we characterized the transient changes in brain activity consistently associated with slow waves (>140 μV) and delta waves (75–140 μV) during SWS in 14 non-sleep-deprived normal human volunteers. Significant increases in activity were associated with these waves in several cortical areas, including the inferior frontal, medial prefrontal, precuneus, and posterior cingulate areas. Compared with baseline activity, slow waves are associated with significant activity in the parahippocampal gyrus, cerebellum, and brainstem, whereas delta waves are related to frontal responses. No decrease in activity was observed. This study demonstrates that SWS is not a state of brain quiescence, but rather is an active state during which brain activity is consistently synchronized to the slow oscillation in specific cerebral regions. The partial overlap between the response pattern related to SWS waves and the waking default mode network is consistent with the fascinating hypothesis that brain responses synchronized by the slow oscillation restore microwake-like activity patterns that facilitate neuronal interactions.     

五羟色胺含量在丹参改善颞叶缺血大鼠记忆障碍中的变化

目的 探讨五羟色胺(5-HT)含量在丹参改善单侧颞叶缺血性损害大鼠空间记忆障碍中的变化。方法采用立体定向光化学技术选择性地导致大鼠左侧颞叶皮层缺血,术前30min及术后第3天分别给丹参组大鼠腹腔注射丹参10g／kg体重,用Morris水迷宫及图像自动监视系统监测大鼠行为。然后取脑组织进行病理观察及5-HT免疫组化分析：结果经丹参治疗,颞叶缺血性损害大鼠的空间记忆障碍得到显改善,颞叶缺血性损害显减轻,缺血灶内5-HT表达明显减少。结论在丹参改善单侧颞叶缺血大鼠空间记忆障碍中,5-HT起一定作用。     

颞叶癫痫中的过度运动性发作(附2例报告)

目的过度运动性发作常见于额叶癫痫,总结我中心病例,探讨颞叶癫痫表现为过度运动性发作时的临床决策。方法回顾2007～2009年进行手术治疗的颞叶癫痫患者,对所有患者的术前评估资料包括病史、MRI、头皮视频脑电图、PET和颅内脑电记录进行回顾性分析。根据Luders的描述对过度运动性发作进行识别。结果 102例患者中有2例表现为典型的过度运动性发作,尽管症状学提示额叶起源,但是头皮脑电图均提示颞叶为发作起始区,1例进行颅内电极监测,另1例因为MRI的阳性发现而直接进行手术切除。2例患者进行了前颞叶切除术,术后2 a以上无发作。结论过度运动性发作发作偶尔可见于颞叶癫痫,如果其头皮EEG结果与影像学检查一致,则手术治疗效果比较理想。