拉莫三嗪治疗卒中后癫的疗效观察

目的探讨拉莫三嗪治疗卒中后癫的临床效果和预后。方法 60例卒中后癫患者随机分为观察组30例和对照组30例,对照组采用丙戊酸钠治疗,观察组口服拉莫三嗪,比较2组癫复发情况。结果观察组癫发作率13.3%,对照组发作率36.7%,2组比较差异有统计学意义（P〈0.05）。结论拉莫三嗪治疗卒中后癫效果较满意,且无明显不良反应,值得临床推广。     

比较奥卡西平或拉莫三嗪联合丙戊酸钠治疗脑外伤术后癫疒间复发疗效

目的探讨丙戊酸钠治疗脑外伤术后癫疒间复发后,添加奥卡西平或拉莫三嗪联合治疗外伤性癫疒间效果。方法以治疗前3个月癫疒间发作频度为对照,对治疗12个月后的疗效、不良反应及安全性进行自身对比观察。结果应用奥卡西平或拉莫三嗪联合丙戊酸钠治疗12个月后,患者发作频率均较用药前明显减少;发作频率减少≥50%的患者分别为89.2%和89.7%,用药前后差异无统计学意义(P<0.05);奥卡西平或拉莫三嗪联合丙戊酸钠两组间差无明显统计学意义(P>0.05)。奥卡西平联合丙戊酸钠不良反应的发生率为19.3%,拉莫三嗪联合丙戊酸钠不良反应的发生率为9.1%,差异显著(P<0.05)。结论奥卡西平或拉莫三嗪联合丙戊酸钠治疗外伤性癫疒间复发疗效确切,副作用拉莫三嗪组明显低于奥卡西平组。     

拉莫三嗪治疗青少年肌阵挛癫有效性和安全性的系统评价

目的系统评价拉莫三嗪单药治疗青少年肌阵挛癫的有效性和安全性。方法以juvenile myoclonic epilepsy、idiopathic generalized epilepsies、lamotrigine、antiepileptic drugs、random等英文词汇计算机检索1980年1月1日-2017年12月31日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)和Cochrane图书馆等数据库关于拉莫三嗪单药治疗青少年肌阵挛癫的临床指南、系统评价(包括Meta分析)、随机对照临床试验、病例对照研究、回顾性队列研究、病例观察研究等,采用Jadad量表、Cochrane系统评价手册和RevMan 5.3统计软件进行文献质量评价和Meta分析。结果共获得英文文献1220篇,经剔除重复和不符合纳入标准者,最终纳入6篇高质量(Jadad评分≥4分)文献共314例青少年肌阵挛癫患者(拉莫三嗪单药治疗组166例,丙戊酸钠单药治疗组148例),包括4项随机对照临床试验和2项病例观察研究。Meta分析结果显示,拉莫三嗪单药治疗组药物不良反应发生率低于丙戊酸钠单药治疗组(RR=0.540,95%CI:0.320～0.910;P=0.020),而癫发作频率减少50%比例组间差异无统计学意义(RR=1.200,95%CI:0.870～1.650;P=0.260)。结论拉莫三嗪对青少年肌阵挛癫安全、有效,且疗效与丙戊酸钠相当、耐受性较好、不良反应较少,是青少年肌阵挛癫的首选药物,特别是女性患者尤其适用。但与其他抗癫药物联合应用的疗效尚待更高质量的临床研究证实。     

丙戊酸钠对癫痫患儿血糖及血清胰岛素的影响

目的通过检测服用丙戊酸钠癫患儿血糖及血清胰岛素水平,观察丙戊酸钠对癫患儿血糖及血清胰岛素的影响。方法采用葡萄糖氧化酶法测定葡萄糖浓度,采用放射免疫分析法测定胰岛素浓度。结果丙戊酸钠治疗3个月、6个月时癫患儿的血清胰岛素、胰岛素抵抗指数较治疗前均明显增高(P<0.05),治疗3个月时和6个月时相比差异无统计学意义(P>0.05),但血糖无明显变化(P>0.05)。结论丙戊酸钠不引起癫患儿血糖明显变化,但血清胰岛素明显增加。     

拉莫三嗪治疗卒中后癫(癎)的疗效观察

目的 探讨拉莫三嗪治疗卒中后癫(痫)的临床效果和预后.方法 60例卒中后癫(痢)患者随机分为观察组30例和对照组30例,对照组采用丙戊酸钠治疗,观察组口服拉莫三嗪,比较2组癫(痫)复发情况.结果 观察组癫(痫)发作率13.3％,对照组发作率36.7％,2组比较差异有统计学意义(P＜0.05).结论 拉莫三嗪治疗卒中后癫(痫)效果较满意,且无明显不良反应,值得临床推广.     

丙戊酸钠、托吡酯诱导癫癎患者体重及血清瘦素水平的变化

目的观察丙戊酸钠、托吡酯诱导癫癎患者体重及血清瘦素水平的变化。方法40例女性癫癎患者按年龄、体重指数分层匹配进入丙戊酸钠、托吡酯治疗组,每组20例。在治疗前及治疗3个月后分别测定身高、体重及早晨空腹血清瘦素水平。结果9例经丙戊酸钠治疗者体重增加(≥4kg),血清瘦素水平[(13.2±3.6)ng/ml]高于治疗前[(7.4±3.0)ng/ml,P<0.01];6例托吡酯治疗者体重减轻(≥4kg),血清瘦素水平[(3.7±1.8)ng/ml]低于治疗前[(7.4±2.6)ng/ml,P<0·01]。结论经丙戊酸钠治疗体重增加者出现瘦素抵抗,经托吡酯治疗体重减轻者血清瘦素水平降低。     

育龄期女性癫痫患者抗癫痫药物使用的情况

目的探讨育龄期女性癫痫患者的抗癫痫药物使用情况。方法回顾性分析478例育龄期女性患者的药物使用情况。结果 478例患者中,332例患者使用单药治疗,其中133例(40.06%)使用拉莫三嗪,62例(18.67%)使用卡马西平,60例(18.07%)使用丙戊酸钠。96例(20.08%)两药联用,其中36例(32.73%)使用拉莫三嗪+丙戊酸钠。24例(5.02%)使用≥3种药物治疗。26例(5.44%)使用其他药物治疗。结论育龄期女性癫痫患者主要采用单药治疗,以拉莫三嗪为主。单药治疗效果不佳的患者中,以两药联用多见,以拉莫三嗪+丙戊酸钠为主。     

拉莫三嗪对癫(癎)患者血清甲状腺激素水平的影响

目的 观察拉莫三嗪对癫(癎)患者血清甲状腺激素水平的影响.方法 用化学发光分析法检测51例癫(癎)患者(癫(癎)组)拉莫三嗪治疗前及治疗后3个月、6个月、12个月的血清甲状腺激素水平,并与43名正常对照者进行比较.结果 癫(癎)组患者治疗前血清甲状腺激素水平与正常对照组比较,差异均无统计学意义;拉莫三嗪治疗后3个月、6个月、12个月的甲状腺激素水平与治疗前及正常对照组比较,差异亦均无统计学意义.结论 拉莫三嗪对癫(癎)患者的甲状腺激素水平没有明显影响,安全性好.     

甘松治疗戊四氮致大鼠的实验性研究

目的观察甘松对戊四氮致大鼠的疗效。方法将50只Wistar大鼠随机分为5组,每组各10只,分别为正常对照组、模型组、甘松治疗组、丙戊酸钠治疗组和甘松合并丙戊酸钠治疗组;采用腹腔注射戊四氮制作建立癫模型;观察各组大鼠行为学及脑电图、NSE(神经元特异性烯醇化酶)浓度变化。结果与模型组比较,甘松治疗组、丙戊酸钠治疗组、甘松合并丙戊酸钠组可明显减轻大鼠样发作程度,减少发作频率和持续时间,改善大鼠皮层脑电图,降低脑脊液神经元特异性烯醇化酶浓度,其中以甘松合并丙戊酸钠组最为明显。结论甘松对戊四氮致大鼠具有一定的抗癫及脑保护作用,与丙戊酸钠联用有协同作用。     

丙戊酸钠和苯巴比妥对癫患儿尿β_2-微球蛋白的影响

目的研究丙戊酸钠和苯巴比妥对癫患儿肾小管功能的影响。方法观察60例癫患儿,分别予丙戊酸钠及苯巴比妥单药治疗6个月,测定服药前后尿β2-微球蛋白的变化。结果丙戊酸钠组治疗前尿β2-MG为(0.27±0.04)mg/L,治疗后为(0.31±0.06)mg/L,t=2.60,P<0.01。苯巴比妥组治疗前后相比较,差别无显著性。结论丙戊酸钠对癫患儿肾小管功能有一定程度的损伤。     

Adipokines during early abstinence of crack cocaine in dependent women reporting childhood maltreatment

Childhood maltreatment has been associated with addiction and immune dysregulation, although neurobiological substrates underlying this association remain largely unknown. The aim of the study was to compare plasma levels of adipokines during early abstinence in crack cocaine dependent women with (CM+) and without history of childhood maltreatment (CM−). One hundred four crack cocaine female users were followed for 20 days in a detoxification inpatient treatment unit. Plasma levels of adiponectin, resistin and leptin were assessed every 7 days during 3 weeks of follow-up. The Childhood Trauma Questionnaire (CTQ) retrospectively assessed childhood maltreatment history. A healthy control group was included to provide adipokines reference values (HC). All crack users increased leptin plasma levels during early abstinence despite concentrations remained lower in comparison with non-users group. Crack users reporting childhood maltreatment exhibited a significant reduction in plasma levels of adiponectin and resistin when compared to CM− group. In addition, only CM− participants increased plasma levels of adiponectin during detoxification. This is the first study evaluating adipokines during crack cocaine abstinence. Our results suggest a modulator effect of childhood maltreatment on inflammatory status in treatment-seeking crack cocaine dependents during early abstinence.     

Increased levels of adipokines in bipolar disorder

Bipolar disorder (BD) is associated with considerable higher chronic medical comorbidities, overweight and obesity. Adipokines are adipocyte-derived secretory factors which have functions in immune response and seem to be associated with both BD and overweight. The aim of this study was to evaluate the plasma levels of adipokines (adiponectin, resistin and leptin) and TNF-α and its receptors (sTNFR1 and sTNFR2) in BD overweight patients in comparison with overweight controls. Thirty euthymic BD type-I patients and thirty controls matched by age, gender and body-mass index (BMI) were assessed by Mini-International Neuropsychiatric Interview, Young Mania and Hamilton Depression rating scales (YMRS and HDRS, respectively). Plasma levels of adiponectin, resistin, leptin, TNF-α and its soluble receptors were measured by ELISA. BD patients presented increased plasma levels of adiponectin (p < 0.001), leptin (p < 0.001) and sTNFR1 (p = 0.01). Plasma levels of adipokines were not correlated neither with clinical parameters nor TNF-α, sTNFR1 and sTNFR2 plasma levels. This study provides further support to the hypothesis of the immune/inflammatory imbalance in BD.     

Adipocytokines and ghrelin level of bipolar patients from manic episode to euthymic episode

Purpose: Obesity and metabolic syndrome (MeS) are more frequently observed in bipolar patients than the general population. This may result from the differences of adipocytokines and ghrelin levels in bipolar disorder.

Material and methods: We evaluated the leptin, adiponectin, resistin and ghrelin levels in bipolar patients (n?=?30) in manic episode and in a control group (n?=?30). After treatment, the same patients were evaluated again during the euthymic episode. We also measured the insulin, glucose, insulin resistance (HOMA), trygliceride (TG), total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) in relation to the (MeS).

Results: When controlling for age, BMI and glucose, leptin levels were higher in the bipolar disorder manic episode group (BD-ME) and bipolar euthymic episode group (BD-EE) than the control group; resistin levels were higher in the BD-ME compared to the control group and it had a positive correlation with Young Mania Rating Scale (YMRS). After treatment, ghrelin levels were higher in the BD-EE compared to the BD-ME group. There was no difference among the groups with respect to adiponectin.

Conclusions: The present results point that high leptin, resistin and ghrelin levels may be involved in the early pathophysiological process which can lead to later obesity and MeS in patients with bipolar disorder.     

Higher androgens and weight gain with valproate compared with lamotrigine for epilepsy

BACKGROUND: Valproate is used widely for the treatment of epilepsy but has been associated with hyperandrogenism, hyperinsulinemia, and dyslipidemia. The mechanism for these associations is unknown, but they have been hypothesized to be secondary to valproate-associated weight gain. This study was conducted to test the hypothesis that the antiepileptic drug lamotrigine, which also has a broad spectrum of anti-seizure efficacy, would not be associated with endocrine abnormalities and would not cause weight gain. OBJECTIVE AND METHODS: This open-label, cross-sectional study compared (1) endocrine and lipid measures during the early follicular phase of the menstrual cycle; (2) prevalence of menstrual disorders (from patient diaries recorded over three cycles); and (3) body weight of women with epilepsy on lamotrigine monotherapy (n=119) with those on valproate monotherapy (n=103) for <5 years. RESULTS: Mean total serum testosterone and androstenedione levels were higher (P<0.02) in the valproate group compared with the lamotrigine group. More lamotrigine patients (87%) than valproate patients (77%) reported regular menstrual cycles at the Screening Visit. The prevalence of anovulation did not differ between lamotrigine and valproate. Mean HDL cholesterol levels were higher (P<0.01) with lamotrigine compared with valproate as were LDL and total cholesterol levels (P<0.05). Mean total insulin levels did not significantly differ between the groups. Whereas mean body weight in lamotrigine patients did not differ between the time lamotrigine treatment was initiated and the Study Visit, mean weight in valproate patients increased by 3.7 kg. CONCLUSIONS: Compared with lamotrigine monotherapy, valproate monotherapy was associated with weight gain and higher androgen levels in women with epilepsy. These data suggest that the hyperandrogenism observed in some women using valproate for epilepsy may be secondary to drug therapy. Lamotrigine monotherapy may be more appropriate than valproate for women in whom reproductive endocrine or metabolic abnormalities are potential concerns, i.e. women with concerns about weight gain, diabetes, hirsutism, polycystic ovary syndrome, menstrual dysfunction or infertility.     

Hail and Farewell: Gratitude for Service Past and Future

We investigated the mechanism of topiramate-related appetite loss and exposed its relationship to body weight, body mass index, body fat index, and serum insulin, lipid, leptin, neuropeptide-Y, cortisol, ghrelin, and adiponectin levels. Twenty children with epilepsy were evaluated at baseline and months 3 and 6 of treatment. Their body fat index, leptin, and neuropeptide-Y levels significantly decreased at month 3, whereas significant decreases occurred in body weight, body mass index, body fat index, neuropeptide-Y, cholesterol, and cortisol levels of patients at month 6 compared with baseline. Weight loss during topiramate treatment was attributed to loss of appetite and reduced food intake caused by reductions in neuropeptide-Y. To the best of our knowledge, this study is the first to describe reductions in neuropeptide-Y with topiramate use in humans.     

Effects of major adipokines and the −420 C > G resistin gene polymorphism on the long-term outcome of patients with acute ischemic stroke

Abstract

Aim: The association between adiponectin, leptin, and resistin and the long-term outcome of ischemic stroke are controversial. We aimed to evaluate this relationship.

Methods: We prospectively studied 83 patients consecutively hospitalized for acute ischemic stroke (38.6% males, age 79.7?±?6.3?years). Serum adiponectin, leptin, and resistin levels and the ?420C?>?G polymorphism of the resistin gene were determined at admission. Stroke severity at admission was evaluated with the National Institutes of Health Stroke Scale (NIHSS). One year after discharge, functional status, incidence of cardiovascular events and all-cause mortality were recorded. Functional status was evaluated with the modified Rankin scale (mRS).

Results: Patients with the G allele had lower mRS (p?<?.05) and patients with adverse outcome had higher serum resistin levels (p?<?.05). The only independent predictor of adverse outcome was mRS at discharge (risk ratio (RR) 2.78, 95% confidence interval (CI) 1.54–5.00; p?<?.001). Higher adiponectin levels were an independent predictor of cardiovascular morbidity (RR 1.07, 95% CI 1.01–1.14; p?<?.05). Patients who died had higher serum adiponectin levels than those who survived (p?<?.05). The only independent predictor of all-cause mortality was NIHSS at admission (RR 1.19, 95% CI 1.04–1.35; p?<?.01).

Conclusions: In patients with acute ischemic stroke, the G allele of the ?420C?>?G polymorphism of the resistin gene promoter is more frequent in those with a more favorable functional outcome at one year after discharge. Patients with higher serum resistin levels appear to have worse long-term functional outcome, while higher serum adiponectin levels are associated with higher incidence of cardiovascular events.     

Effects of Sodium Valproate Combined with Lamotrigine on Quality of Life and Serum Inflammatory Factors in Patients with Poststroke Secondary Epilepsy

BackgroundWe sought to explore the effects of sodium valproate combined with lamotrigine on quality of life and serum inflammatory factors in patients with poststroke secondary epilepsy.MethodsA total of 145 patients with post-stroke secondary epilepsy admitted to our hospital from January 2017 to June 2018 were collected: 76 treated with sodium valproate combined with lamotrigine (study group) and 69 patients treated with sodium valproate alone (control group). The levels of serum high-mobility group protein B1, matrix metalloproteinase 9, and interleukin 6 were detected before and after treatment, and the therapeutic efficacy and adverse reactions were compared between the 2 groups.ResultsThe total effective rate of the study group was higher than that of the control group. Both groups decreased in epileptiform discharges or in the number of involved leads after treatment, with the results of the study group being lower than those of the control group. The quality of life scores in both groups was increased after treatment, albeit the scores of the study group were higher than those of the control group. In terms of the levels of serum inflammatory factors, the 2 groups were reduced after treatment; the levels of the study group were lower than those of the control group. Regarding the incidence of adverse reactions, no significant difference was seen between the 2 groups.ConclusionsSodium valproate combined with lamotrigine has better clinical efficacy and higher safety in the treatment of poststroke secondary epilepsy and is able to reduce the expression levels of serum inflammatory factors.     

Serum insulin and leptin levels in valproate-associated obesity

PURPOSE: Weight gain is an important adverse effect of valproate (VPA) therapy, and it is associated with hyperinsulinemia and hyperandrogenism in women with epilepsy. Leptin is considered a signaling factor regulating body weight and energy metabolism. In human subjects, obesity is in general associated with elevated serum leptin levels, suggesting decreased sensitivity to leptin. The present study aimed at evaluating the role of insulin and leptin in VPA-related obesity. METHODS: Body mass index (BMI) was calculated, and serum insulin and leptin levels were measured in 81 patients with epilepsy taking VPA and in 51 healthy control subjects. RESULTS: Forty (49%) of the patients taking VPA and 25 (49%) of the control subjects were obese. The mean insulin levels were higher in VPA-treated patients than in the control subjects despite similar BMI values, when all subjects were included in the comparison. Both obese male and female patients taking VPA had higher serum insulin levels than the respective control subjects with similar BMI values. Serum insulin levels also were higher in lean male and lean female patients compared with the lean control subjects of same sex. Serum leptin levels did not differ between the VPA-treated patients and the control subjects. CONCLUSIONS: Both obese and lean patients taking VPA for epilepsy have hyperinsulinemia, suggesting development of insulin resistance. This may be one of the factors leading to weight gain during VPA treatment. However, the results of the present study do not suggest an independent role for leptin in the pathogenesis of VPA-related obesity.     

丙戊酸联合拉莫三嗪治疗不同类型癫痫患者的疗效及对细胞因子的影响

目的探讨丙戊酸联合拉莫三嗪治疗不同类型癫痫患者的疗效及对细胞因子的影响。方法选择2018年10月至2019年10月孟州市人民医院收治的78例癫痫患者作为研究对象,根据癫痫类型将患者分为部分性发作组(PS组)33例、全面性发作组(GS组)26例、继发全面性发作组(SGS组)19例,利用丙戊酸联合拉莫三嗪对入组的癫痫患者进行治疗,比较3组患者治疗的有效率及细胞因子水平。结果治疗后PS组、GS组、SGS组的治疗有效率分别为79%(26/33)、88%(23/26)和79%(15/19),3组比较及组间比较差异均未见统计学意义(P>0.05)。3组在治疗后血清白介素-2(IL-2)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平均显著低于治疗前(P<0.05);治疗后3个组血清IL-6、TNF-α和IL-2水平比较差异均未见统计学意义(P>0.05)。PS组、GS组、SGS组不良反应发生率分别为6%(2/33)、8%(2/26)和5%(1/19),差异均未见统计学意义(P>0.05)。结论丙戊酸联合拉莫三嗪在不同类型的癫痫患者治疗中均取得满意成效,血清炎症因子均得到显著改善。     

脑梗死患者血清脂联素、瘦素、CRP、IL-6与颈动脉内中膜厚度相关性研究

目的研究脑梗死患者血清脂联素、瘦素、炎性因子(C-反应蛋白,CRP;白介素-6,IL-6)与颈动脉内中膜厚度(IMT)的相关性,探讨血清脂联素、瘦素、CRP、IL-6在脑梗死发生发展过程中的作用。方法以96例脑梗死患者为梗死组,50例健康志愿者为正常对照组。用酶联免疫吸附法(ELISA)分别测定血清脂联素,瘦素及CRP、IL-6水平;测量IMT值,梗死组分为IMT<1.0 mm和IMT≥1.0 mm两亚组;同时梗死组进一步按脑梗死程度分为轻型、中型、重型亚组,用酶联免疫吸附法(ELISA)分别测定CRP、IL-6和血清脂联素、瘦素水平;分别测量颈动脉内中膜厚度(IMT)值。结果脑梗死组中,血清脂联素,瘦素及炎性因子含量分别与正常对照组相比较,差异具有统计学意义(p<0.05);脑梗死组中IMT≥1.0 mm者与IMT<1.0 mm者相比较,差异有统计学意义(p<0.05);脑梗死组中,随梗死程度变化,IMT与血清脂联素、瘦素、CRP、IL-6间,异有统计学意义(p<0.05),IMT与血清瘦素、CRP、IL-6呈明显正相关(r=0.52,p<0.01;r=0.48,p<0.01;r=0.50,p<0.01),脑梗死患者IMT与血清脂联素含量呈明显负相关(r=-0.848,p<0.01)。结论脑梗死患者IMT增厚,血清脂联素降低,瘦素、CRP、IL-6升高,脑梗死患者IMT与血清脂联素、瘦素、CRP、IL-6含量具有明显相关性。