再发脑出血的临床研究

目的探讨再发脑出血的临床特点和危险因素。方法回顾性分析54例再发脑出血患者的临床资料,并与同期住院的首发脑出血患者进行比较。结果54例患者62次再发,再发间隔时间为(3.7±3.5)年,34.4%在1年以内再发。再发类型以基底节-基底节最多见,其次为基底节-丘脑和基底节-脑叶,多在对侧再发,很少在同一部位再发。与首发患者相比,再发脑出血患者多有高血压病,病程较长且控制不良。多变量logistic分析显示高血压病程与再发脑出血正相关,首次发病年龄与再发脑出血负相关。结论脑出血后3年以内再发危险性较大,积极控制高血压有助于防止脑出血再发。     

复发性脑出血相关因素临床分析

目的探讨脑出血后复发性出血的相关危险因素、临床特点及预后。方法回顾性总结1994～2003年间我院收治的152例复发性脑出血患者的临床资料,并与同期住院的首发脑出血患者对照研究。结果复发性脑出血患者多有高血压病,病程长且控制不良,并与糖尿病、高血脂、既往有缺血性卒中史等有关。复发出血的部位多在原出血部位的对侧,以基底节出血最多见。复发出血的间隔时间多为1～4年。复发出血预后差。结论脑出血后4年内复发率较高,积极有效控制高血压和其它因素,可以预防脑出血复发,改善预后。     

复发性脑出血相关因素临床分析

目的探讨脑出血后复发性出血的相关危险因素、临床特点及预后。方法回顾性总结1994，2003年间我院收治的152例复发性脑出血患者的临床资料，并与同期住院的首发脑出血患者对照研究。结果复发性脑出血患者多有高血压病，病程长且控制不良，并与糖尿病、高血脂、既往有缺血性卒中史等有关。复发出血的部位多在原出血部位的对侧，以基底节出血最多见。复发出血的间隔时间多为1—4年。复发出血预后差。结论脑出血后4年内复发率较高，积极有效控制高血压和其它因素，可以预防脑出血复发，改善顸后。     

36例复发性高血压脑出血临床分析

目的探讨高血压脑出血复发的临床特点及发病相关因素,以寻找有效的预防措施。方法对我院1998-01—2011-12收治的36例复发性高血压脑出血患者临床资料进行分析。结果复发性高血压脑出血以基底节-基底节型最多见,好发于首次出血的对侧,首次高血压脑出血后未能坚持控制好血压,尤其是波动性高血压是导致复发出血的重要因素,合并糖尿病患者血糖未良好控制也使脑出血复发的机会增加。结论复发性高血压脑出血预防的关键是坚持控制好血压,并有效控制血糖。     

原发性脑出血复发的临床分析

目的 探讨脑出血复发的频率、出血部位、复发时间及导致复发的危险因素.方法 对2005-01～2008-12在我科住院的1200例脑出血患者中68例复发出血患者的临床资料进行统计学分析.结果 复发性脑出血以基底节-基底节型最多见,好发于首次出血的对侧,高血压的有效控制与否与脑出血的复发密切相关,并与糖尿病、高脂血症有关.结论 积极有效控制高血压可以预防脑出血的复发.     

复发性脑出血103例临床分析

目的 探讨复发性脑出血的临床特点和发病机制。方法 对我院经CT证实的住院脑出血病人3200例中有复发性脑出血103例患者,分析其临床表现并探讨其可能的发病机制。结果 100例为2次出血,3例为3次出血,脑出血复发率为3．2％,2次出血者以基底节－基底节型最多（60％）,3次出血者3例均同时有基底节出血。61．2％再出血病灶位于首次出血的对侧,2例出血间隔时间大多在1年内（40．7％）,基底节－基底节型预后较差。结论 复发性脑出血有其特殊的临床表现,高血压控制不良可增加再出血的危险;基底节－基底节型出血原因多考虑高血压,而脑叶－脑叶型出血很可能与淀粉样脑血管病有关。     

复发性脑出血40例临床相关因素分析

目的 通过对40例复发性脑出血的发病率、出血部位、易发等相关因素进行综合分析，阐述复发性脑出血的临床特点，并提出相应的预防措施。方法 对1995年5月～2004年7月在徐州医学院附属医院神经内科及江苏省盐业公司总医院内科住院的40例再发脑出血病例进行分析。结果 40例再发性脑出血占本院同期脑出血例幸存的7％。有高血压病史31例(77．5％)；第1次出血到第2次出血时间以半年到2年内复发率最高(67．5％)；复发时间最短6个月，最长达5年。再出血发生于对侧占85．5％，同侧占15％。结论 复发性脑出血病灶大多在首发病灶的对侧，病死、病残率高，且再发与高血压关系密切，任何引起血压波动的原因都可能导致脑出血的再发，控制血压是防止再发性脑出血发生的关键。     

中西医结合治疗急性多灶性脑出血11例报告

目的 :探讨急性多灶性脑出血 (AMCH)的中西医结合治疗。方法 :对 11例急性多灶性脑出血患者进行临床资料分析。结果 :AMCH占同期脑出血患者 2 1% ,主要原因为高血压 ( 6 6 % ) ,出血以基底节 ( 5 4% )和脑叶 ( 2 9% )多见 ,临床表现复杂多样 ,中西医结合治疗效果更为理想。结论 :本病发病率低 ,但病死率高 ,高血压为主要基础 ,头颅CT有助于诊断 ,中西医结合治疗较好     

高血压性脑出血复发出血相关因素分析

目的：探讨高血压性脑出血首次出血后复发出血的相关因素和复发出血部位的变化以及临床预后。方法：以6年间计276例入院接受治疗的高血压性脑出血患者为研究对象，根据有无复发出血进行分组别、分部位、分因素研究。结果：高血压性脑出血复发出血与高血压的有效控制与否密切相关，并与糖尿病、高血脂及既往有缺血性卒中史有关。复发出血部位多在原出血病灶的对侧。复发出血预后差。结论：有效控制血压和其它因素的影响，可以预防出血复发，改善预后。     

急性多灶性脑出血21例临床分析

目的 探讨急性多灶性脑出血（AMCH）的病因、发病机理和临床特征。方法对21例急性多灶性脑出血患者临床资料进行分析。结果AMCH占同期脑出血患者的2．4％。主要病因为高血压。出血以基底节和脑叶多见。临床表现复杂多样。结论本病发病率低，但死亡率高，高血压为主要病因。头颅CT有助于诊断。     

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.     

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.     

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.     

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.     

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.     

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.