边缘性癫癎和边缘性癫癎状态的临床特点

目的 探讨边缘性癫癎(LE)和边缘性癫癎状态(LSE)的临床特点.方法 回顾分析2例LE和1例LSE患者的临床资料.结果 2例LE癫癎患者均为青年期发病,表现为发作性意识障碍、紧张、恐惧及各种形式的自动症和自主神经症状.脑电图呈现一侧或双侧颞区疒间样放电.头颅MRI示1例左侧海马硬化,1例右颞叶内侧钙化灶.1例LSE患者系中年男性,表现发作性意识障碍、言行紊乱和精神症状,每次发作持续半小时以上;脑电图呈现双侧额叶、颞叶θ波或δ波;头颅MRI示:左颞叶前部蛛网膜囊肿.3例经用卡马西平或奥卡西平治疗发作得到控制.结论 LE和LSE的临床特点是发作性自动症、自主神经和精神症状,与颞叶内侧海马及杏仁核损害有关.     

癫癎共患病研究进展

癫癎是多种原因导致的脑神经元高度同步化异常放电的临床综合征,某些疾病易与癫癎共存于同一个体中,不同疾病之间难分主次、相互影响,称为癫癎共患病。其中以偏头痛、焦虑、抑郁、精神分裂症、注意力缺陷多动障碍、睡眠障碍、认知损害、心理障碍、线粒体脑肌病等较为常见,癫癎患者年龄、性别、发病年龄、病程、家族史、抗癫癎药物数量、发作控制情况等与共患病种类、数量,以及严重程度密切相关。癫癎共患病在临床上较易误诊,可影响抗癫癎药物的治疗效果与患者预后,降低患者生活质量。因此,积极探讨癫癎与共患病的内在关系、充分认识癫癎共患病的临床特点,探索对癫癎与共患病协同治疗的适宜原则与措施,才能够最大程度地提高抗癫癎药物的治疗效果,改善预后,提高患者生活质量。     

脑卒中后癫癎的临床特点

脑卒中后继发癫癎是脑血管病的常见并发症,我院自1994-01～2004-01收治经CT证实的脑卒中住院患者1250例,其中105例继发癫癎,现对其临床资料进行分析,以探讨其临床特点和发病机制.     

男性与癫癎

从癫癎发病及抗癫癎药物(AEDs)与男性激素、性功能、生殖、发育等问题的关系以及对男性癫癎病人性功能障碍的诊断及治疗等角度作一综述.     

女性与癫癎

从女性卵巢类固醇激素对癫的影响,癫和抗癫药物对女性的影响,以及女性癫病人妊娠阶段的治疗等角度作一综述.     

引发癫癎之脑膜瘤的临床病理特点

探索脑膜瘤引发癫癎的可能机制.以26例手术切除标本的病理观察与临床对比分析.结果:瘤体>5cm者对瘤周脑组织呈挤压性损害,<5cm者则以侵犯性损害为主.两者对脑组织的损害有程度上的差别,但无本质区分.主要为:神经细胞变性、脱鞘、软化及胶质增生等.提示:肿瘤使瘤周脑组织受损,导致局部神经网络重建,“短路”形成;局部血管增多,微循环及体液发生改变;以及肿瘤位于情感运动区三因素是致(疒间)灶形成的组织构筑学和病理生理学基础.手术时应切除瘤周部分脑组织,以期将致(疒间)灶一并切除,以减少癫(疒间)再发可能.     

抗癫癎药物致癎作用的临床观察

目的研究抗癫癎药物(AEDs)的致癎作用及对其的预防和治疗.方法总结32例AEDs致癫癎发作加重患者的临床资料.结果32例中以服用卡马西平最多(19.12%)、次之为巴比妥类药物(15%)、苯妥英钠(14.5%)、合并用药(14.29%)、苯二氮( )类(8.69%)、丙戊酸钠(2.78%).32例经停药并合理选择其他抗癫癎药物及减少药物剂量治疗,27例有效,5例无效.结论AEDs能致癫癎发作加重,应合理选择抗癫癎药物.     

儿童非癫癎发作与癫癎发作

介绍儿童非癫癎发作的病因,以及非癫癎发作与癫癎发作的鉴别。     

脑卒中后癫癎的临床分析

目的探讨脑卒中继发癫癎的临床特点.方法回顾分析682例脑卒中患者继发癫癎72例临床资料.结果脑卒中后继发癫癎的发生率是10.5%,与脑卒中的病灶部位有明显相关,皮质病灶显著高于皮质下病灶(P＜0.01),卒中早期型癫癎较迟发型癫癎的发生率明显增高(P＜0.05).结论早发型癫癎经积极治疗原发病症状较易控制,迟发型癫癎需正规长期服用抗癫癎药.     

奥卡西平治疗癫癎的临床分析

目的　评价奥卡西平 (oxcarbazepine ,OXC)的安全性和疗效。方法　对 47例癫病人采取单用和加用OXC治疗 ,其中2 5例未经治疗 ,2 2例用一线药物治疗无效。 6例随访 4个月 ,41例随访 6个月。结果　①应用OXC后 2、4、6个月发作频率均明显减少 (P <0 .0 1)。②单用组发作消失者为 3 2 .0 % ,合用组为 9.1% (P <0 .0 1)。③不同发作类型的疗效相似。④维持量与疗效无关。⑤9例 (19.1% )出现较轻的副反应 ,除 1例需停药外 ,另 8例均自行消失。结论　OXC单用或合用对各类型发作均有较好的疗效 ,副反应少且程度低 ,耐受性好。     

癫痫共患偏头痛的研究进展

癫痫与偏头痛是两种神经科常见的慢性发作性疾病,癫痫为慢性发作性神经功能障碍,由神经细胞超同步异常放电引起,持续时间一般不超过半小时。偏头痛是一种慢性神经血管性疾病,其特征是发作性,多为中至重度偏侧搏动性头痛,可伴有自主神经系统功能障碍如恶心呕吐,畏光畏声等;两者在临床表现有许多相似之处,都具有反复性,发作性,短暂性神经功能缺损等临床特点。二者共患会增加诊断及治疗方面的难度。本文将从流行病学、发病机制、临床特点、诊断及分类、治疗各个方面进行综述。     

Clinical features of transformed migraine

Most daily headache patients seen in specialized clinics present a past history of migraine. Some authors refer to it as transformed migraine and emphasize its milder intensity and clinical characteristics different from migraine. The aim of this study was to evaluate the clinical presentation of the daily headache in patients with prior history of migraine. We studied retrospectively 215 patients. We observed that a significant percentage of the patients presenting the so-called transformed migraine, reported frontal and/or temporal bilateral pain and had pressure or tightening pain, which is a characteristic of chronic tension-type headache. It emphasizes the loss or changing of the standard migraine features. The pulsatile pain quality remained as an important feature, specially for those with intermittent typical migraine attacks.     

Clinical and personality features of allodynic migraine

Cutaneous allodynia (CA) is a frequent complaint during migraine attacks, recently associated with migraine transformation as well as psychiatric comorbidities. The aim of our study was to define the clinical features of allodynic migraineurs, in particular, the relationship between CA and personality profile. Between October 2008 and December 2009, 410 migraineurs admitted for the first time to our Headache Center underwent Allodynia Symptom Checklist, MIgraine DIsability Assessment Scale (MIDAS) and psychometric tests [Tridimensional Personality Questionnaire (TPQ), Toronto Alexithymia Scale, State and Trait Anxiety Inventory (STAI Y 1-2), and Beck Depression Inventory (BDI)]. Allodynia was present in 63% of cases, mostly in females. In CA patients, an association with female sex, chronic migraine, higher values of MIDAS, BDI, harm avoidance (HA, a TPQ dimension) and STAI Y-2 was found. Interestingly, CA appears to be associated with depression and a particular personality profile characterized by higher values of HA, suggesting an involvement of the serotonergic system in the development of CA in migraine. In conclusion, CA is associated with progression of migraine and it could be a marker of psychiatric comorbidities, in particular, depression and anxious trait.

     

Clinical features of episodic migraine and transformed migraine: a comparative study

Transformed migraine (TM) is one of the most frequent types of chronic daily headache. Eighty patients: 40 with episodic migraine (EM) and 40 with TM with ages ranging from 18 to 60 years old were studied. Females were the majority. At first examination, the mean age was similar in both groups. The initial age of migraine attacks was significantly smaller in the TM group. Time history of episodic attacks was similar in both groups. In the EM group, the headache was predominantly located on only one side of the head; whereas in the TM group, on more than one side. There was variation in the character of pain and intensity in the TM group. Nocturnal awakening with headache, aura and family history did not show significant association with EM or TM. The TM was distinguished from the EM in relation to the frequency, location and pain intensity of the headache. Patients with early migraine headache onset may exhibit a further risk of developing TM.     

Clinical features and comorbidity of mood fluctuations in Parkinson's disease

Parkinson's disease (PD) patients commonly develop fluctuations in their motor responses to levodopa within several years of initiation of treatment; some also develop nonmotor fluctuations. The authors performed a case-control study comparing the frequency of comorbid symptoms in 70 PD patients who experienced clinically apparent mood changes during their motor "on" or "off" states with two control groups with no mood fluctuations. Mood fluctuators had significantly younger age at onset and longer disease duration and were significantly more likely to have dementia, psychosis, clinical depression, and motor complications. This association remained after removing effects of age and disease duration.     

Psychiatric comorbidity in epilepsy

Many studies on psychiatric comorbidity in epilepsy have been performed using many different patient groups and diagnostic instruments. This methodological heterogeneity complicates comparison of the findings. In this article, psychiatric disorders in epilepsy are reviewed from the perspective of the DSM classification system. The empirical findings of axis I clinical disorders and axis II personality disorders are described separately. Furthermore, the existence and specificity of conditions such as interictal dysphoric disorder, interictal behavior syndrome, and psychosis of epilepsy are discussed. From the many studies that have been performed on this topic it can be learned that there is a need for well-controlled studies using representative patient groups and valid and standardized diagnostic instruments. So far, the majority of the studies have concerned axis I disorders; relatively little research has been performed on axis II personality disorders. More research on personality disorders, as well as on the relative contributions of the different (brain- and non-brain-related) factors to the relationship between epilepsy and psychiatric disorders, is recommended.     

The psychiatric comorbidity of epilepsy

Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.     

Clinical features of neocoritcal temporal lobe epilepsy

Few Studies have examined the clinical features of neocortical temporal lobe epilepsy (NTLE) in carefully selected patients. We reviewed records from 21 patients wtih NTLE, defined by intracranial electroencephal9ogram (EEG), who have been seizure free for 1 year or more following temporal lobectomy. The mean age of onset at the time of first seizure was 14 years (range, 1–41 years). Febrile seizures were reported in only 2 patients (9.5%). In contrast to prior mesial temporal lobe epilepsy (MTLE) studies, seizure-free intervals between the initial cerebral insult or first seizure and habitual seizures were uncommon. Possible or known risk factors for epilepsy were reported in 13 of 21 patients (62%). Fifteen (71%) patients reproted auras, with experiential phenomena being the most common type. Magnetic resonance imaging was normal or nospecific in 15 patients, revealed mild hippocampal atrophy in 2, tumors in 2, and resonance imaging was normal or nospecifc in 15 patients, revealed mild hippocampal atrophy in 2, tumors in 2, and heterotopic gray matter and hippocampal atrophy in 1, and cortical dysgensis in 1. Neuropsychological testing showed deficits consistent with the seizure focus in 13 patients (62%), and Wada test showed ipsilateral memory deficits in 10 (48%). The most common behavioral manifestatin was a motionless stare at ictal onset (48%). In contrast to prior studies of MTLE, only 1 NTLE patient had frequent independent, contralateral temporal lobe epileptiform spikes on scalp EEG.     

偏头痛患者药物过度使用性头痛的相关因素及临床特点

目的探讨偏头痛患者药物过度使用性头痛的相关因素,并总结其临床特点。方法选取我院神经内科于2012-08—2014-08收治的60例药物过度使用性头痛患者以及60例非药物过度使用性头痛患者作为研究对象,对比观察2组患者的视觉模拟评分及偏头痛致残程度评分。结果观察组年龄、病程明显高于对照组(P0.01),有家族史患者明显多于对照组(P0.05)。观察组VAS评分及MIDAS总分明显高于对照组,差异具有统计学意义(P0.01)。观察组停药后61.67%的患者出现戒断症状,包括易激惹、近事遗忘、注意力分散、睡眠障碍、抑郁、焦虑、坐立不安、心悸、呕吐、恶心等,给予积极对症治疗于3~14d内消失。结论偏头痛患者药物过度使用性头痛的相关因素主要有年龄、病程及家族史等,头痛程度以及致残程度较高,停用药物后极易引起戒断症状。