老年脑卒中患者并发抑郁的影响因素分析

目的 探讨老年脑卒中患者并发抑郁的影响因素,为其临床诊治提供参考。方法 选取天津市安定医院2020年1月～2022年1月收治的48例老年脑卒中后抑郁患者作为研究对象,另外选取同期来我院门急诊就诊,诊断老年脑卒中且未抑郁患者72人作为对照组。所有患者均应用老年抑郁量表（GDS-15）、NIH卒中量表（NIH Stroke Scale,NIHSS）、生活能力量表（Activity of Daily Living Scale,ADL）进行评估以及进行血清学和影像学检查。采用Spearman秩相关分析GDS评分与NIHSS和ADL评分的相关性;采用二元Logistic回归分析老年脑卒中患者并发抑郁的影响因素。结果老年脑卒中后抑郁患者病变部位不同于非抑郁患者,血清C反应蛋白水平和皮质醇水平均高于非抑郁患者,差异有统计学意义（P<0.05）;抑郁患者NIHSS评分更高,ADL评分更低,差异有统计学意义（P<0.05）;随抑郁程度增加,患者NIHSS评分更高,ADL评分越低,差异具有统计学意义;GDS评分与NIHSS评分呈正相关,与ADL评分呈负相关,差异具有统计学意义（P<0.0...     

日常生活移动训练在脑卒中偏瘫患者中的应用

目的 探讨日常生活移动训练对脑卒中后偏瘫患者神经功能、肢体功能与日常活动能力的影响。方法 选择2018-05—2019-05郑州大学第一附属医院收治的脑卒中后偏瘫患者160例,按照随机数字表法对上述患者进行随机分组,其中研究组80例,对照组80例。对照组采取常规康复训练,研究组在此基础上采取日常生活移动训练。对比2组患者干预前与干预3个月时神经功能[美国国立卫生研究院卒中量表(NIHSS)]、肢体功能[肢体运动功能量表(FMA)]、日常活动能力[日常生活活动能力(BI)指数]评分情况,以及2组的护理满意度。结果 (1)2组干预后NIHSS评分均低于干预前(P0.01),其中研究组NIHSS评分低于对照组(P0.01)。(2)2组干预后FMA评分均高于干预前(P0.01),其中研究组FMA评分高于对照组(P0.01)。(3)干预后2组BI分值高于干预前(P0.01),其中研究组分值高于对照组(P0.01)。(4)研究组患者对于本次护理服务的总满意率为98.75%高于对照组90.00%(P0.05)。结论 日常生活移动训练能够有效改善脑卒中后偏瘫患者的神经功能,值得临床应用。     

心理干预对老年脑卒中患者神经功能缺损和幸福感的影响

目的观察心理干预对老年脑卒中患者神经功能缺损症状和幸福感的影响。方法回顾性分析2013年1～6月在我院治疗的120例老年脑卒中患者,随机分为两组,对照组（60例）采用脑血管药物进行常规治疗和日常功能训练,研究组（60例）在对照组的基础上联合采用心理干预进行治疗,比较治疗前和治疗后第1、2、4个月的Barthel指数评估量表评分、美国国立卫生研究院卒中量表（NIHSS）评分、总体幸福感量表（GWB）评分。结果治疗后两组患者的Barthel指数各时点评分与治疗前比较均明显升高（P〈0.05）;治疗后第2、4个月,研究组Barthel指数评分显著高于对照组（P〈0.01）。治疗后两组患者各时点NIHSS评分与治疗前比较均明显降低（P〈0.05）;治疗后第2、4个月,研究组NIHSS评分显著低于对照组（P〈0.05）。研究组患者治疗后各时点GWB评分与治疗前比较均明显升高（P〈0.05）;对照组患者治疗后第2、4个月GWB评分与治疗前比较均明显升高（P〈0.05）;治疗后第2、4个月,研究组GWB评分显著高于对照组（P〈0.01）。结论心理干预能有效提升老年脑卒中患者幸福感,降低其神经功能缺损症状,提高日常生活能力,值得进一步推广应用。     

肺康复在缺血性脑卒中早期康复中的价值

目的:探讨肺康复在缺血性脑卒中患者早期康复中的疗效。方法:招募2016年1月—2017年1月符合病例选择标准的20例缺血性脑卒中患者,随机分为对照组(10例)和肺康复组(10例)。肺康复组在常规康复治疗基础上联合肺康复,对照组仅接受常规康复治疗,疗程均为4周。比较2组患者干预前后的生活质量、抑郁情绪、最大吸气压(maximum inspiratory pressure,PImax)、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分和肌力引出率。结果:干预后,肺康复组的生理功能、生理疼痛、活力、社会功能和精神健康评分均显著高于对照组(P 0.05),但生理职能、总体健康和情感职能评分的差异无统计学意义(P 0.05)。干预后,肺康复组的汉密尔顿抑郁量表评分显著低于对照组(P 0.05)。干预后,肺康复组的PImax显著高于对照组(P 0.05),但NIHSS评分无显著差异(P0.05)。肺康复组和对照组干预后的肌力引出率均显著高于干预前(P 0.05)。结论:肺康复可以改善缺血性脑卒中患者的生活质量、抑郁情绪和呼吸功能,对运动功能的改善也显示出积极的作用。     

运动想象疗法在脑卒中偏瘫患者康复训练中的效果

目的 分析运动想象疗在脑卒中偏瘫患者康复训练中的效果.方法 前瞻性纳入117例脑卒中偏瘫患者,采用随机数字表法随机分为2组,对照组采取神经内科常规康复训练,研究组在对照组基础上采用运动想象疗法.采用简化Fugl-Meyer运动评分评估患者运动功能,改良Barthel指数评估患者生活活动能力.结果 干预后研究组上肢运动功...     

经颅磁刺激治疗脑梗死的临床疗效观察

目的 观察经颅磁刺激（transcranial magnetic stimulation,TMS）对脑梗死患者的临床疗效。方法 符合病例入选标准的脑梗死患者60例,随机分为试验组及对照组,每组各30例,试验组及对照组均给予常规药物治疗,试验组在常规治疗基础上给予TMS治疗,疗程10 d,比较治疗前后患者的运动功能（Fugl-Meyer评分）、Barthel指数（Barthel index,BI）以及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分。结果 NIHSS评分：试验组由治疗前的6.57±2.66减少到治疗后4.01±2.83,对照组由6.29±3.00减少到5.10±2.43;Barthel指数：试验组由治疗前47.33±14.31增加到治疗后60.83±18.53,对照组由45.50±13.91增加到53.67±15.97;Fugl-Meyer评分：试验组由治疗前38.20±24.01增加到治疗后58.40±29.57,对照组由37.53±23.8增加到49.60±29.77,治疗前两组3项评分差异均无统计学意义,治疗后3项评分差异均有统计学意义（P分别为0.008、0.004和0.008）。结论 TMS对脑梗死患者肢体功能恢复有一定疗效,能提高患者的日常生活能力。     

心理治疗和功能锻炼对脑梗死患者的效果

目的 分析心理治疗联合功能锻炼对脑梗死患者心理状态的影响。方法 研究对象来源于本院2018年3月～2021年3月住院的92例脑梗死患者,根据随机数字表法分组（每组n=46）,对照组给予常规治疗,观察组在对照组基础上给予心理治疗联合功能锻炼,对比两组焦虑自评量表（Self-Rating Anxiety Scale,SAS）评分、抑郁自评量表（Self-rating depression scale,SDS）评分、神经功能缺损程度评分（NIHSS）评分、Fugl-Meyer肢体运动功能评分表（Fugl-Meyer assessment of motor function,FAM）评分、匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）评分、患者满意度。结果 观察组治疗后SAS评分、 SDS评分、NIHSS评分、PSQI评分均低于对照组,观察组治疗后FAM评分高于对照组,观察组患者满意度（95.65%）高于对照组（69.57%）,差异具有统计学意义（P<0.05）。结论 心理治疗联合功能锻炼可有效减轻脑梗死患者焦虑、抑郁等不良情绪以及神经功能受...     

早期精准化运动在急性缺血性脑卒中偏瘫患者运动康复中的作用

目的 探讨早期精准化运动在急性缺血性脑卒中偏瘫患者运动康复中的应用效果。方法纳入56例2020-07—2022-06张家口市第一医院神经内科收治的急性缺血性脑卒中偏瘫患者,采用随机数字表法分为对照组和试验组各28例。对照组采取早期常规运动干预措施,试验组采用早期精准化运动干预,2组均连续干预3个月,随访6个月。比较2组干预前、随访6个月时运动功能、生活能力,干预前、干预后3个月、随访6个月时神经功能、希望水平,干预前、干预后3个月的炎症指标及随访期间的并发症。结果 与干预前比较,随访6个月时2组患者Fugl-Meyer运动功能评分(FMA)、功能性步行量表(FAC)、Berg平衡量表(BBS)、改良Barthel指数评分升高,试验组高于对照组(P<0.05)。与干预前比较,干预后3个月、随访6个月时2组患者美国国立卫生研究院卒中量表(NIHSS)评分呈降低趋势,试验组干预后3个月、随访6个月时NIHSS评分低于对照组(P<0.05);2组患者Herth希望量表(HHI)评分呈升高趋势,试验组干预后3个月、随访6个月时HHI评分高于对照组(P<0.05)。与干预前比较,...     

音乐联合运动疗法对脑卒中患者运动功能和情绪的影响

目的 探讨音乐联合运动疗法对脑卒中患者运动功能及不良情绪的影响。方法 本研究对象为我院2021年7月～2022年2月100例脑卒中患者,利用数字表法随机分为观察组与对照组。对照组采用常规运动疗法进行康复训练;观察组采用音乐联合运动疗法,两组患者均连续干预3个月。干预前后采用美国国立卫生研究院卒中量表（NIHSS）、改良Barthel指数评分量表（MBI）、Berg平衡量表（BBS）、肢体运动功能量表Fugel-Meyer(FMA)分别评价患者神经功能、生活能力、平衡功能以及步行功能;采用焦虑自评量表（SAS）、抑郁自评量表（SDS）评价患者焦虑、抑郁情绪。结果两组患者干预后NIHSS评分均降低,干预后观察组显著低于对照组（P<0.05）;两组患者干预后MBI评分、BBS评分、FMA评分显著升高,干预后观察组3项评分显著高于对照组（P<0.05）;两组患者干预后SDS评分、SAS评分均降低,干预后观察组显著低于对照组（P<0.05）。结论 音乐联合运动疗法能够显著提升脑卒中患者神经功能、运动功能等的康复效果,并缓解焦虑、抑郁等不良情绪。     

脑卒中患者家庭康复护理干预及效果观察

目的 探讨脑卒中偏瘫患者家庭康复护理的效果.方法 选择治疗好转出院的80例脑卒中偏瘫患者随机分为干预组和对照组,对照组给予药物治疗和常规健康指导,而干预组则增加了对病人及家属进行家庭康复护理指导和定期随访,干预前后用Fugl-Meyer量表(FMA)评定运动功能,用Barthel指数评定日常生活能力(ADL).结果 6个月后干预组FMA及ADL改善程度与对照组比较差异有统计学意义(P＜0.01),而干预组神经功能缺损程度较对照组显著降低(P＜0.01).结论 家庭康复护理干预可明显改善脑卒中偏瘫患者的运动功能和日常生活能力,降低神经功能缺损程度.     

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.     

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.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.