长程视频脑电监测在下丘脑错构瘤诊断治疗中的应用(附5例报告)

目的探讨长程视频脑电监测在下丘脑错构瘤诊断治疗中的应用意义。方法回顾性分析5例下丘脑错构瘤长程视频脑电(VEEG)特征,VEEG结合磁共振成像(MRI)、发作间期正电子发射计算机断层扫描(PET)检查诊断定位。结果发作间期清醒平静状态脑电图表现:双侧波形均呈不对称表现,双侧存在广泛单发性棘慢波或者双侧广泛不规则θ或δ波,一侧波幅优势,主要为一侧额叶优势,2例左侧优势,3例右侧优势,优势侧别同MRI显示的错构瘤侧别一致;睡眠期脑电图表现:存在基本睡眠标志波形与睡眠周期,间有较多量棘慢波或多棘慢波,存在形式同间期清醒平静状态;5例均捕获临床发作过程,共计13次,其中痴笑发作8次、痴笑发作继发全身强直阵挛5次,发作期脑电图表现:3例为去同步化低电压数秒后EEG混合肌电干扰,2例以肌电伪差为主。MRI结果:下丘脑脚间池处部位可见占位性改变,位于左侧半球2例、右侧半球3例。PET结果:MRI所提示的占位性改变区域均显示低代谢。5例均手术彻底去除错构瘤,随访5例患者术后均无痴笑发作或继发全身强直阵挛。结论长程视频脑电监测结合MRI及PET检查对下丘脑错构瘤诊断定位准确性高,手术治疗下丘脑错构瘤是最佳选择。     

31例青少年肌阵挛性癫痫临床表现脑电图特点及误诊分析

目的 回顾性分析31例青少年肌阵挛性癫痫(JME)患者的临床、脑电图特点及误诊原因.方法 收集2008年9月～2011年1月在我院癫痫诊治中心诊治的31例JME患者,对其临床表现、脑电图改变及药物治疗疗效进行总结性分析.结果 31例患者表现单纯肌阵挛发作者12例;肌阵挛伴全身强直-阵挛发作者15例;肌阵挛伴失神发作者4例.长程录像脑电图检查,24例患者于监测过程中出现肌阵挛发作,脑电见与发作同步的对称性、泛化性多棘慢波、棘慢波爆发.既往就诊中诊断为全身强直-阵挛发作者17例,抽动症者8例,部分性发作者4例,正常者2例.依据发作类型给予治疗后肌阵挛症状1w内消失者13人;2w内消失者11人;1个月内消失者6人,每月内均有3～4次肌阵挛发作者1人.继发的全身强直-阵挛性发作,半年内消失者20例;1年内消失者11例.结论 青少年肌阵挛性癫痫,以短暂的、无节律性、不规则的肌阵挛抽动为特点,由于症状不典型容易造成误诊,长程录像脑电图检查,附加闪光刺激、睡眠剥夺等诱发试验,提高阳性诊断率,对症治疗效果好.     

癫痫伴肌阵挛-失张力发作的临床及脑电图特征分析

目的探讨癫痫伴肌阵挛-失张力发作(epilepsy with myoclonic-atonic seizures,EMAS)的临床及视频脑电图特点,以提高对该病的认识。方法对2017年12月-2018年12月吉林大学白求恩第一医院小儿神经科收治的6例EMAS患儿临床及脑电特征进行回顾性分析。结果 6例EMAS患儿中,男5例,女1例;发病前智力运动发育正常,影像学正常。发病年龄2岁2个月～6岁,确诊时间2个月～1年6个月。6例患儿至少有肌阵挛、肌阵挛-失张力、失张力发作、不典型失神发作中两种发作形式。其中4例在上述发作前或后出现强直-阵挛发作,1例在病程晚期有强直发作。6例患儿中5例背景活动正常; 1例背景活动偏慢。6例患儿的脑电图在清醒期及睡眠期均出现广泛性2～4 Hz棘慢波、多棘慢波不规则或节律性发放,睡眠期放电有时类似高度失律,均无局灶性发作。所有患儿影像学检查均正常。6例患儿均给予正规抗癫痫药物治疗,其中2例治疗反应良好,4例治疗无效后给予甲基强的松龙治疗,其中3例有效缓解,1例虽然没有发作仍有大量放电。结论 EMAS好发于学龄前期儿童,癫痫发作类型主要包括肌阵挛、失张力或肌阵挛-失张力发作,但不典型失神等,脑电图主要为广泛性棘慢波、多棘慢波发放,治疗以抗癫痫药物和激素治疗为主,预后相对较好。     

额叶癫痫的临床特点及脑电图分析

目的探讨额叶癫痫的临床特点及脑电图改变。方法抽取2011-06—2013-06在我院就诊的60例额叶癫痫患者为研究对象,分析患者的临床特点及脑电图改变情况。结果临床发作次数共148次,每例患者平均发作2.5次,其中100次为睡眠期间发作,48次为清醒期间发作;发作主要表现为全身强直阵挛、发声发作及偏转性强直等。额叶癫痫脑电图主要特点为放电部位以额区为主49例(81.67%),主要发作频率为偶发/阵法54例(90.00%),常见的节律为阵发性棘(尖)波或棘(尖)慢波38例(63.33%)。结论对于额叶癫痫,主要的临床特点为全身强直阵挛、发声发作及偏转性强直,且在夜间发作较为常见,脑电图的主要形式为额区偶发/阵发性棘(尖)波或棘(尖)慢波。     

Dandy-Walker综合征临床分析

该文回顾性分析了6例Dandy-Walker综合征的病例资料,包括临床表现及MRI表现。在这6例Dandy-Walker综合征患者中,男4例,女2例,平均年龄12.7岁,平均病程55个月。6例均有头痛,痫性发作5例,其中4例以白天发作全身强直-阵挛发作或复杂部分性发作继发全身强直-阵挛发作,另一例夜间睡眠时发作为强直-阵挛。6例患者智力发育均落后于同龄人,且均有小脑性共济失调症状。MRI表现为后颅窝囊性扩大与不同程度扩大的四脑室相通、脑室积水及小脑蚓部的缺如或发育不良、胼胝体发育不良、巨脑回等。     

儿童肌阵挛癫(癎)临床和录像脑电图分析

目的:探讨儿童肌阵挛癫(癎)患儿的临床、脑电图(EEG)和治疗特点.方法:对35例肌阵挛癫(癎)患儿的临床表现、录像脑电图(V-EEG)及抗癫(癎)药物的治疗效果进行回顾性分析.结果:35例均有肌阵挛发作,以肌阵挛为唯一的发作形式9例,其它26例合并强直阵挛发作、强直发作、部分性发作等发作类型.30例患儿EEG可见全导...     

脑血管病继发癫86例临床分析

目的探讨脑血管病继发癫发作的临床特征、脑电图特点,可能的病理机制、药物治疗及其预后转归。方法对我院神经内科近3a脑血管病继发癫发作86例患者临床资料进行回顾性分析。结果 86例患者中脑出血41例(47.7%),脑梗死27例(31.4%),蛛网膜下腔出血18例(20.9%),全面强直—阵挛发作46例(53.49%),部分运动性发作继发全面强直—阵挛发作20例(23.26%),部分运动性发作17例(19.77%),癫持续状态3例(3.49%)。脑电图异常74例。结论出血性脑血管病癫发生率较高,以全面性强直阵挛发作为主,动态脑电图对治疗和判断预后有很大帮助。经抗癫药物治疗,随访1a,75例无再发作,2例死亡。有9例需长期服抗癫药。患者一般预后良好。     

失神癫痫最佳治疗方案的探讨

本文总结近几年用丙戊酸钠治疗典型失神癫痫或合并全身强直-阵挛癫痫,并提出我们认为最佳的治疗方案。 方法与资料 一、病例选择 按国际癫痫发作与癫痫分类的诊断标准,临床上有典型的失神发作,清醒或睡眠脑电图上有3Hz弥漫性双侧对称棘-慢波发放者才归入本组。典型失神癫痫组男18例,女28例,就诊时年龄4.4～     

脑血管病继发癫痫86例临床分析

目的探讨脑血管病继发癫痫发作的临床特征、脑电图特点，可能的病理机制、药物治疗及其预后转归。方法对我院神经内科近3a脑血管病继发癫痢发作86例患者临床资料进行回顾性分析。结果86例患者中脑出血41例（47．7％），脑梗死27例（31．4％），蛛网膜下腔出血18例（20．9％），全面强直一阵挛发作46例（53．49％），部分运动性发作继发全面强直一阵挛发作20例（23．26％），部分运动性发作17例（19．77％），癫痢持续状态3例（3．49％）。脑电图异常74例。结论出血性脑血管病癫痫发生率较高，以全面性强直阵挛发作为主，动态脑电图对治疗和判断预后有很大帮助。经抗癫痢药物治疗，随访1a，75例无再发作，2例死亡。有9例需长期服抗癫痫药。患者一般预后良好。     

病毒性脑炎急性期继发性全身性强直-阵挛发作的危险因素分析

目的探讨病毒性脑炎急性期继发性全身性强直-阵挛发作的危险因素。方法资料完整的急性病毒性脑炎患者374例,其中,病例组继发性全身性强直-阵挛发作组72例,对照组(无抽搐发作组)259例,系同期住院患者;病例组和对照组采用统一的调查表,用MicrosoftAccess2002建立数据库,共52个主项内容,部分主项有下属分项;对研究资料先进行单因素分析,然后进行多因素非条件Logistic回归模型分析。结果经分析筛选出大脑皮质损害、多灶性损害、脑电图异常、昏迷、颅内压升高等5个因素为脑炎后继发癫痫间的独立危险因素。结论病毒性脑炎后急性期强直-阵挛发作的发生主要与大脑皮质损害关系密切,昏迷、颅内压升高可促发脑炎后强直-阵挛发作。     

Videotape recording in psychiatry and psychopharmacology : REVIEW AND PRESENTATION OF A NEW METHOD

After a review of publications concerning the use of television in psychiatry a new method of audiovisual evaluation of psychotropic drugs is demonstrated: SAPE (Standardized Audiovisual Psychiatric Evaluation). The procedure requires a pre-treatment and post-treatment videotaped interview with each patient (15 min). These interviews are later rated and scored by 10 to 20 or more raters (using a Symptom Check List). Data are evaluated by a fully automated computer program in four steps. The main advantages of the method are: 1) Uniform homogeneous information available to all participating raters. 2) Reduced number of patients and shorter duration of trial. 3) Participation of as many raters as desired. 4) Better comparability and standardization than with usual methods. 5) Inter-rater and intra-rater reliability tests for every study possible. 6) Stabilized baseline values for each symptom. 7) Homogeneity of raters’assessments resulting from the increased number of raters participating. 8) Improved basis and conditions for the use of parametric statistical evaluation techniques. 9) Homogeneity of the rater evaluation for each subsequent control. 10) A statistical assessment of the homogeneity of a study as a whole is possible. 11) Double-blind method only for treating doctor (not video-rating), the nurses and patients but not for the television interviewer and raters (if contact with ward and patients is avoided).     

alpha-Bungarotoxin aggregates on radioiodination with chloramine-T but not with iodogen

The presence of polymer(s) of radioiodinated bungarotoxin (Bgt) in preparations iodinated with chloramine-T or with iodogen, was investigated by chromatography on Sephadex-G50. In addition to a monomeric peak (P2), chloramine-T preparations showed a high content of polymeric forms (16-43%) eluting in the void volume (P1), present only to the extent of 1-3% in iodogen preparations. In purified [125I]Bgt prepared by the iodogen method, the content of P1 increased on treatment with chloramine-T, in the absence of radioiodine. The nonspecific binding of [125I]Bgt to DE-81 filter discs was high in the case of chloramine-T preparations and proportional to the content of P1 in each batch. Purified P1 (polymer) but not P2 (monomer) showed a concentration-dependent high degree of binding to DE-81 discs.     

Antidepressant drugs in anergic schizophrenia. A double-blind cross-over study with maprotiline and placebo

Seventeen out of 20 inactive and emotionally withdrawn schizophrenic patients under long-term neuroleptic treatment completed a double-blind cross-over investigation of the possible activating effect of maprotiline, a relatively specific noradrenaline-reuptake inhibitor, compared with that of placebo. Each treatment phase lasted 8 weeks. No significant differences with respect to either the level of activity or schizophrenic symptoms were found between maprotiline (mean dose 138 mg/day) and placebo. Maprotiline provoked a slight psychotic exacerbation in one patient and sedation in another, four patients developed orthostatic hypotension, and two patients had an epileptic seizure. In the light of this and other studies, it must be concluded that antidepressant drugs do not represent any therapeutic advance in the treatment of inactive schizophrenic patients receiving neuroleptics.     

Immunohistochemical study with an anti-myelin serum a marker for all glial cells except ‘dark’ oligodendrocytes

The usefulness of an anti-myelin antiserum as a possible marker for glial cells and related structures was investigated using rat brain. As expected, the myelin fibers were heavily stained but the neuronal cells and their processes were unreactive. The oligodendrocytes, identified on electron microscopy, revealed labelling of only the light and medium types, but not the dark cells. These results indicate that the suggested morphological classification of oligodendrocytes may be based on varying amounts of myelin antigen synthesis. Astrocytes from all areas, Golgi epithelial cells, Bergmann fibers and some subependymal cells also reacted with this anti-myelin antiserum but the staining was abolished completely by preabsorption with kidney powder. In contrast, the myelin fibers and the light and medium oligodendrocytes could still be labelled. We conclude that this anti-myelin antiserum should prove useful in studies of oligodendrocytes in the central nervous system.     

Erythrocyte COMT-activity in patients with affective disorders

COMT enzyme characteristics (K_m, V, ratio of meta/paramethylation) were determined in the red blood cells of 20 patients with endogenous depression, in 20 healthy controls matched as to age and sex, as well as in 10 patients with mania, and 10 patients with neurotic depression. Assessment was done twice, i.e. before and after remission in patients with endogenous depression and in the manic patients. If male and female patients are considered together there was no statistical difference between the COMT charateristics of these patients groups, either before or after remission. Only the bipolar patients showed a higher COMT-activity (V) than their individually matched controls. If, however, only the female patients are taken into consideration, COMT-activity of the patients with endogenous depression vs. controls is significantly increased by 60%. This difference can be demonstrated also after remission (“free interval”) though statistical significance is reached only for the unipolar group. Further in vitro experiments indicate that antidepressant drugs do not possess a relevant influence on COMT-activity. Ranking the mean COMT-values leads to the following order: matched controls < neurotic depression < unipolar depression < biopolar depression, which would be in good agreement with theoretical expectations based on the amine hypothesis of depression. Compared with normal male subjects COMT-activity of female controls is significantly lower. On the other hand, the female patients with endogenous depression show a significantly higher enzyme activity than the corresponding male patients.     

Psychopharmacological activity of anaphylatoxin C3a in rat hypothalamus

C3a anaphylatoxin injected into the perifornical hypothalamic region of sated rats increased the eating response to norepinephrine and the drinking response to carbamyl choline but had no effect on food or water intake in sated, saline control animals. This potentiation of drug-stimulated intakes was reversible by intrahypothalamic injection of catecholamine receptor antagonists haloperidol and phentolamine. We propose that C3a acts as a catecholamine agonist in the central nervous system. The results suggest that C3a may play a role in mediating the neuropsychiatric manifestations associated with immune complex formation or deposition in the central nervous system.     

Paranoid states of middle life:FAMILIAL OCCURRENCE AND RELATIONSHIP TO SCHIZOPHRENIA

Paranoid states beginning in middle life were selected from a case register. A search among the sibs of those probands uncovered no paranoid states and schizophrenia was no more common than in the general population. The implications for the asteiology of paranoid states and for the relationship between these and schizophrenia are discussed.     

Studies on the prolactin response induced by electroconvulsive therapy in schizophrenics

Electroconvulsive therapy (ECT) and simulated ECT (SECT)-induced prolactin response has been studied in 14 schizophrenic males. Cortisol, growth hormone, and thyroid stimulating hormone (TSH) changes have been measured simultaneously. The prolactin rise was significantly higher after ECT than after SECT. Cortisol increase after ECT did not exceed significantly the elevation after SECT. Changes in growth hormone and TSH concentrations were inconsistent and non-significant. On the basis of the results it may be assumed that ECT-induced prolactin response is a consequence of specific transmitter changes in the CNS and not a result of stress reaction or generalized neuronal discharge. ECT-induced prolactin response was negligible in two cases. Both patients were chronically hospitalized schizophrenics resistant to therapy. Whether the prolactin response or its absence is of predictive value with respect to prognosis or effect of ECT remains to be seen.     

Incidence and prevalence of treated mental disorders: HEALTH CARE PLANNING IN A SMALL-TOWN-RURAL REGION OF UPPER BAVARIA

An analysis of those to be cared for and those destined to provide the care is necessary, in order to develop an effective system of mental health care. Such an analysis is given here for a rural-small-town region of Upper Bavaria with 424,000 residents. The treated incidence and prevalence are presented according to sex, age and diagnosis. The morbidity rates for patients from communities of various sizes and distances from the institution of treatment are discussed as an example of ecological analysis. The future planning for the research area should be based on varied community-centred possibilities for psychiatric care.     

Socio-demographic correlates of schizophrenia,affective psychoses and neuroses in a clinic in India

Of a total of 5,343 patients seen during four calendar years at the adult psychiatric outpatients’clinic of a teaching hospital in India, patients with schizophrenia, affective psychoses and neuroses were compared with one another regarding distribution of socio-demographic variables. Women with an urban background and higher socio-economic status were proportionately more numerous amongst neurotics. Schizophrenics were youngest and more often single. Patients with affective psychoses were older, usually married, had the lowest educational level and most often a rural background, and were from relatively lower socio-economic strata. Also the Sikh religion and Jat caste were significantly more preponderant amongst affective psychotics. This finding is consistent with the reported distribution of ABO blood groups in affective psychotics and in Jat Sikhs, and suggests a genetic basis for the greater representation of Jats and Sikhs amongst affective psychotics.