儿童颞叶中内侧硬化所致颞叶癫痫的MRI研究

目的 对儿童颢叶癫痫进行前瞻性MRI研究分析。探讨儿童颢叶癫痫的MRI表现特征。方法 对127例临床和脑电图检查诊断为颢叶癫痫的儿童进行MRI多序列成像．分析研究颞叶的形态结构、信号并判断海马有无萎缩性改变。结果 127例颢叶癫痫患儿中，9例(7．1％)海马有萎缩性改变，且在T2加权成像和液体率减恢复(F1AIR)成像上呈高信号。9例中，6例伴有海马受累同侧颞叶信号异常；3例伴有同侧颞叶皮层结构不良；1例伴有同侧颞叶萎缩。结论 颞叶中内侧硬化是儿童颢叶癫痫的一个相对少见原因，受累侧海马MRI表现为萎缩和信号异常，同时常伴海马外颞叶结构受累。     

惊厥性癫痫持续状态患儿相关指标及头颅磁共振成像价值的研究进展

惊厥性癫痫持续状态是儿童时期常见的急危重症之一,其发病机制与肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)有着密切的联系.惊厥性癫痫持续状态常伴有颅脑损伤,导致头颅磁共振成像(MRI)改变.本研究对TNF-α、NSE、S100B及头颅MRI在儿童惊厥性癫痫持续状态中价值的研...     

核磁共振弥散成像在癫痫中的应用进展

弥散加权成像和弥散张量成像是一种新的成像技术,可以反应活体组织细微结构和功能改变,能通过测量弥散系数(ADC)和各向异性分数(FA),反应常规核磁共振(MR)所不能提供的癫痫病灶的异常。本文综述MR弥散成像的基本原理、在癫痫患者的功能应用研究进展及在抗癫痫药物中的应用。     

磁共振弥散张量成像在内侧颞叶癫痫中的应用进展

内侧颞叶癫痫(mTLE)是最常见的难治性癫痫类型.磁共振弥散张量成像能提供mTLE患者脑组织微观结构变化的定性、定量信息,有助于对颞叶癫痫病理生理机制理解,并可用于颞叶癫痫脑网络结构的研究.本文对磁共振弥散张量成像在mTLE中的应用进展作一综述.     

儿童癫痫大发作132例智力障碍分析

目的 探索儿童癫痫大发作的智力障碍程度和结构特点。方法 选取驻马店市计划生育病残儿医学鉴定132例城市儿童癫痫大发作患儿，采用中国修订韦氏儿童智力量表(C—WISC)进行智商测验，对智力障碍程度和智力结构特点进行分析，并和对照组98例驻马店市某小学6～14岁的学生进行比较。结果 两组低智商发生率差异有极显著性意义(χ^2=151．56，P&;lt;0．005)；两组言语智商、操作智商和总智经t检验，差异均极显著(t=17．496，23．974，P均&;lt;0．001)。132例儿童癫痫大发作的智力障碍发生率高达81．8％(108／132)，各分测验年龄量表分的均分与正常儿童均分(10)相比均超过了一个标准差(3)，其中图片排列(3．1&;#177;3．8)、木块图(3．2&;#177;3．3)和分类测验(3．4&;#177;4．1)三项分测验量表分超过了两个标准差(6)。结论 儿童癫痫大发作是导致儿童智力障碍的重要因素，所致智力障碍的结构特点是在全面智力受损的同时，上述三项分测验所负荷的智力因素受损更明显。     

癫痫儿童智力水平和结构与临床特征的相关性研究

目的 评估癫痫儿童的智力水平和结构,探讨临床特征因素对癫痫儿童智力水平的影响.方法 选用中国修订韦氏儿童智力量表中的相似性、数字广度、木块图和编码测验对53例癫痫儿童和54例正常儿童进行测查及对比分析,多因素分析方法探讨癫痫儿童智力水平与临床特征因素的关系.结果 病例组儿童智力水平在正常范围内,但总智商及相似性、数字广度、木块图、编码测验得分均低于对照组(109.97±10.72)分vs(118.89±9.05)分,(13.21±2.51)分vs(14.39±2.45)分,(11.04±2.83)分vs (12.56±2.23)分、(10.47±2.77)分vs(12.61±2.54)分,(10.45±3.15)分vs(13.33±2.97)分(P＜0.05或＜0.01);继发全面性发作、全面性发作、脑电图癫痫样放电范围、发作持续时间及用药数量是智商下降的危险因素.结论 癫痫儿童智力水平和结构存在一定程度的损害,发作类型、脑电图癫痫样放电范围、发作持续时间及用药数量是影响癫痫儿童智力水平和结构的主要临床特征因素.     

儿童视频脑电图监测对癫癎的诊断价值

目的 探讨视频脑电图(VEEG)监测对儿童发作性癫痫的诊断及鉴别诊断的临床价值。方法 临床诊断为癫痫及疑为癫痫、不疑癫痫或其他发作性疾病的726例患儿进行4-24hVEEG监测。并对其脑电波形及临床发作情况进行分析。结果 VEEG异常542例(74．66％)，其中非特异性异常117例(16．12％)，痫样放电425例(58．54％)。726例中505例行常规脑电图检测，非特异性异常91例(18．02％)，痫样放电42例(8．32％)。两者相比有显著差异。726例、VEEC监测后明确诊断非癫痫187例，癫痫493例。结论 VEEG对儿童癫痫诊断、分型、定位及与非癫痫发作性疾病的鉴别有重要价值．更能发现特殊的类型，有利于研究和发现癫痫发作的生理机制和诱因。     

儿童癫痫大发作132例智力障碍分析

目的探索儿童癫痫大发作的智力障碍程度和结构特点。方法选取驻马店市计划生育病残儿医学鉴定132例城市儿童癫痫大发作患儿,采用中国修订韦氏儿童智力量表(C-WISC)进行智商测验,对智力障碍程度和智力结构特点进行分析,并和对照组98例驻马店市某小学6～14岁的学生进行比较。结果两组低智商发生率差异有极显著性意义(χ2=151.56,P<0.005);两组言语智商、操作智商和总智经t检验,差异均极显著(t=17.496,23.974,P均<0.001)。132例儿童癫痫大发作的智力障碍发生率高达81.8%(108/132),各分测验年龄量表分的均分与正常儿童均分(10)相比均超过了一个标准差(3),其中图片排列(3.1±3.8)、木块图(3.2±3.3)和分类测验(3.4±4.1)三项分测验量表分超过了两个标准差(6)。结论儿童癫痫大发作是导致儿童智力障碍的重要因素,所致智力障碍的结构特点是在全面智力受损的同时,上述三项分测验所负荷的智力因素受损更明显。     

儿童特有癫痫

癫痫在儿童中发病率相当高 ,婴儿患癫痫较成人多 10倍 ,5岁以下儿童 5 %可有癫痫发生。著名癫痫学者冯应琨教授 70年代的资料显示 ,协和医院癫痫门诊中有 1/ 3癫痫患者为儿童 ,国外儿童癫痫患者约占癫痫患者的半数 (Ｋｏｏｉ,1971) ,在癫痫患者总数中 ,儿童与青壮年患者占绝大多数 ,90 %癫痫发生于儿童及青春期。1　什么是儿童特有癫痫儿童特有癫痫是指首发只限于儿童及少年期的癫痫 ,可分为良性及非良性癫痫两大类。良性癫痫症状大多在青春期前缓解或中止 ,很少或不延续到成人阶段 ,这些可称为良性儿童癫痫综合征 (ｂｅｎｉｇｎｃｈｉｌｄ…     

儿童失神性癫痫的低频振幅-功能连接密度失耦合

目的 采用多指标静息态功能磁共振成像（resting-state functional magnetic resonance imaging, rs-fMRI）技术,观察儿童失神性癫痫（childhood absence epilepsy, CAE）的低频振幅（amplitude of low frequency fluctuation, ALFF）及功能连接密度（functional connectivity density, FCD）改变的模式及关系,探讨其临床及病理生理机制。材料与方法 回顾性分析2010年2月至2020年9月就诊于中国人民解放军东部战区总医院的37例CAE患者（CAE患者组）以及50名健康对照者（健康对照组）的rs-fMRI扫描及临床资料。计算每个受试者ALFF、FCD及ALFF-FCD值;采用两样本t检验比较两组受试者各影像指标的改变模式,并使用Pearson相关分析计算差异脑区间两影像指标的关系;基于体素方式计算差异显著脑区的ALFF-FCD差值,并与疾病病程进行Pearson相关分析。结果 相比健康对照组,CAE患者组表现为特异脑区ALFF和FCD两指标反...     

Impaired attention and network connectivity in childhood absence epilepsy

Patients with childhood absence epilepsy (CAE) often demonstrate impaired interictal attention, even with control of their seizures. No previous study has investigated the brain networks involved in this impairment. We used the continuous performance task (CPT) of attentional vigilance and the repetitive tapping task (RTT), a control motor task, to examine interictal attention in 26 children with CAE and 22 matched healthy controls. Each subject underwent simultaneous 3T functional magnetic resonance imaging-electroencephalography (fMRI-EEG) and CPT/RTT testing. Areas of activation on fMRI during the CPT task were correlated with behavioral performance and used as seed regions for resting functional connectivity analysis. All behavioral measures reflecting inattention were significantly higher in patients. Correlation analysis revealed that impairment on all measures of inattention on the CPT task was associated with decreased medial frontal cortex (MFC) activation during CPT. In addition, analysis of resting functional connectivity revealed an overall decrease within an 'attention network' in patients relative to controls. Patients demonstrated significantly impaired connectivity between the right anterior insula/frontal operculum (In/FO) and MFC relative to controls. Our results suggest that there is impaired function in an attention network comprising anterior In/FO and MFC in patients with CAE. These findings provide an anatomical and functional basis for impaired interictal attention in CAE, which may allow the development of improved treatments targeted at these networks.     

婴幼儿颅脑创伤后外部性脑积水的危险因素

目的 分析婴幼儿颅脑损伤后外部性脑积水(EH)的危险因素.方法 回顾性分析我院2004年3月至2009年4月收治的178例颅脑损伤婴幼儿患者的临床资料,对婴幼儿脑损伤后EH的相关临床因素进行单因素和Logistic回归分析.结果 单因素分析结果 显示:年龄、伤后GCS评分、昏迷时间、脑挫裂伤、蛛网膜下腔出血和继发癫痫均是婴幼儿EH的危险因素(P均<0.05),性别、是否合并创伤性湿肺和甘露醇的使用剂量与EH相关性较小(P均>0.05),婴幼儿颅脑损伤后EH的发生率为14%(25/178),年龄(OR=0.5743)、伤后昏迷时间(OR=3.0628)、伤后GCS评分(OR=1.5628)、蛛网膜下腔出血(OR+3.7093)、脑挫裂伤(OR=4.7892)和外伤后癫痫(OR=2.9976)均是婴幼儿EH的危险因素(P均<0.05).结论 患儿≤2岁、伤后GCS评分低、昏迷时间长、有脑挫裂伤、蛛网膜下腔出血和合并癫痫发作可以增加婴幼儿颅脑损伤后EH危险性,此研究可为婴幼儿颅脑损伤后EH的预防提供参考.

Abstract：

Objective To analyze the risk factors for the external hydrocephalus (EH) after traumatic brain injury in the infants. Methods The clinical data of 178 cases of infants and young children with traumatic brain injury from March 2004 to April 2009 were retrospectively analyzed. Univariate and logistic regression analysis were performed to identify the clinical risk factors for EH after traumatic brain injury. Results By univariate regression analysis, age, GCS score after trauma, coma duration, brain contusion, subarachnoid hemorrhage and epilepsy were risk factors for external hydrocephalus in the infants and young children (Ps < 0.05). Gender,traumatic wet lung and usage of mannitol were less relevant to EH (Ps >0. 05). The incidence of EH after traumatic brain injury in the infants and young children was 14% (25/178 ). Age ( OR = 0.5743 ) , coma duration after trauma (OR =3.0628) ,subarachnoid hemorrhage (OR =3.7093),brain contusion(OR = 4.7892) and post-trauma epilepsy (OR =2. 9976) were risk factors for EH (Ps < 0. 05). Conclusion Younger than 2 years old, low GCS score, long coma duration, brain contusion, subarachnoid hemorrhage and epilepsy would increase the risk of EH after traumatic brain injury in the infants and young children. This study provides information for the prevention of EH after traumatic brain injury in the infants and young children.     

癫痫患儿不同时期脑脊液和血液中一氧化氮与氨基酸含量的变化

目的通过对癫痫患儿不同时间点脑脊液和血液中一氧化氮(NO)代谢产物NO2-与氨基酸水平的检测,阐明NO在小儿癫痫发病中的作用及临床意义。方法分别采用硝酸还原酶法、高效液相色谱(HPLC)法,检测癫痫发作后不同时间点脑脊液和血液中NO 与氨基酸的含量。结果在惊厥发作后30 min、60 min、120 min,NO2-含量明显增高(P<0.01),而在惊厥发作后180min,NO2-含量渐降至正常(P>0.05)。在惊厥发作后30 min,谷氨酸(Glu)升高(P<0.05),而在惊厥发作后期,Glu 的含量明显升高(P<0.01);甘氨酸(Gly)含量在癫痫发作各组逐渐下降(P<0.05)。结论NO是内源性致痫物质,参与惊厥的点燃过程以及癫痫后期的氧化应激性脑损害过程。癫痫发作与中枢神经系统兴奋性氨基酸与抑制性氨基酸神经递质的平衡失调密切相关。兴奋性氨基酸的毒性作用是造成脑损害的主要原因之一。     

A practical approach to uncomplicated seizures in children

Uncomplicated seizures and epilepsy are common in infants and children. Family physicians should be aware of certain epilepsy syndromes that occur in children, such as febrile seizures, benign focal epilepsy of childhood, complex partial epilepsy, juvenile myoclonic epilepsy and video game-related epilepsy. Not all uncomplicated childhood seizures require neuroimaging or treatment. Febrile seizures, rolandic seizures and video game-related seizures are childhood epileptic syndromes that are typically not associated with brain structural lesions on computed tomography or magnetic resonance imaging, and are often not treated with anticonvulsant drugs. Juvenile myoclonic epilepsy does not require neuroimaging but does require treatment because of a high rate of recurrent seizures. Complex partial epilepsy often requires both neuroimaging and treatment. Although seizures are diagnosed primarily on clinical grounds, all children with a possible seizure (except febrile seizures) should have an electroencephalogram. Interictal EEGs may be normal. Computed tomography has demonstrated abnormalities in 7 to 19 percent of children with new-onset seizures. The yield of magnetic resonance imaging for specific childhood seizure types is not known, but it is the preferred modality of neuroimaging for many clinical presentations. Most children's seizures treated with anticonvulsants are controlled by the first drug selected. The value of "therapeutic' serum drug levels is questionable in the management of uncomplicated childhood seizures.     

局灶性癫痫儿童/青少年患者脑结构-功能连接耦合特征

目的 观察局灶性癫痫儿童/青少年患者大脑结构连接与功能连接的耦合特征。方法 纳入50例局灶性癫痫儿童/青少年患者（癫痫组）和42名健康儿童/青少年（对照组）,比较组间智力测试评分。采集全脑高分辨T1结构像,行弥散张量成像和静息态血氧水平依赖扫描,分别构建结构连接网络和功能连接网络,比较组间有效连接边数量和结构-功能耦合系数的差异。采用Pearson相关或Spearman秩相关系数描述癫痫组耦合系数与临床资料的相关性。结果 癫痫组语言智商、总智商、结构-功能耦合系数及有效连接边数量均显著低于对照组（P均<0.05）。癫痫组耦合系数与首次发作年龄、语言智商、操作智商及总智商间均呈正相关（P均<0.05）。结论 局灶性癫痫儿童/青少年患者脑结构-功能连接发生解耦合,且与癫痫首次发作年龄及智商相关。     

CT检查在小儿癫痫诊断中的价值

目的：研究CT检查对小儿癫痫的价值。方法：回顾性分析资料完整、临床均以癫痫为首发症状的患儿2000例CT表现、癫痫原因及CT检查与癫痫发作形式的关系。结果：CT正常88例。异常112例，其中脑萎缩31例，颅内感染性病变25例，先天疾患20例，脑积水8例，脑内缺血性改变8例，脑肿瘤6例，双侧基底节区钙化灶5例，小儿脑瘫5例，蛛网膜囊肿2例，2例新生儿缺血缺氧性脑病。结论：颅内感染性病变是癫痫患儿最常见的病因；CT检查对症状性癫痫患儿具有重要价值。     

A case report of cerebral air embolism after esophagogastroduodenoscopy: diagnosis and management in the emergency department

Background

Esophagogastroduodenoscopy (EGD) is a rare cause of cerebral air embolism (CAE). To our knowledge, there are only eight previously reported such cases in the history of the procedure.

Objective

To identify clinical causes of CAE that can present to the emergency department (ED) and to understand the appropriate management of CAE.

Case Report

A 71-year-old man presented with new-onset left-sided hemiparesis and dysarthria 2 h after undergoing an outpatient EGD. The patient was diagnosed with CAE in the ED after undergoing a computed tomography scan of the brain without contrast.

Conclusion

The diagnosis of CAE is based on a thorough history and obtaining urgent radiographic imaging of the brain. The definitive treatment of CAE involves hyperbaric oxygen.     

50例热性惊厥继发癫痫的危险因素分析

目的:探讨小儿热性惊厥后继发癫痫的危险因素。方法:对50例有热性惊厥病史的癫痫患者的临床资料进行回顾性分析。结果:有热性惊厥的50例癫痫患者中,由热性惊厥转变为癫痫有多种危险因素,其中前五位依次是:1岁内起病的热性惊厥;反复复发5次以上的热性惊厥;有围产期脑损伤;一级亲属中有热性惊厥或癫痫病史;反复出现热性惊厥时体温有下降趋势者。结论:热性惊厥后继发癫痫与多种危险因素有关,因此,对于热性惊厥有转变成癫痫的危险因素的患者应早期进行预防性治疗,以减少癫痫的发生率。     

体外反搏治疗小儿难治性癫痫远期疗效观察

目的探讨体外反搏术治疗小儿难治性癫痫的远期疗效。方法对9例难治性癫痫患儿在原用抗癫痫药物(AEDs)不变的基础上,辅佐体外反搏治疗,每次持续60 min,每10天为1个疗程,共6个疗程。观察体外反搏治疗前后发作频率的改变及远期随访疗效、不良反应,以及对脑电生理及癫痫灶局部脑血流的影响。结果体外反搏治疗组治疗后癫痫发作明显减少,治疗组9例患儿跟踪随访2年,其中5例未见癫痫发作,2例癫痫发作明显减少,1例无效;对照组1例未见癫痫发作,2例癫痫发作次数减少,5例无效。体外反搏治疗后脑血流灌注好转率达77.8%,痫性放电现象明显减少,转阴率55.6%。两组疗效比较,差异具有统计学意义(P<0.01)。结论体外反搏治疗小儿难治性癫痫疗效肯定,远期疗效显著。     

Local Brain Functional Activity Following Early Deprivation: A Study of Postinstitutionalized Romanian Orphans

Early global deprivation of institutionalized children may result in persistent specific cognitive and behavioral deficits. In order to examine brain dysfunction underlying these deficits, we have applied positron emission tomography using 2-deoxy-2-[(18)F]fluoro-D-glucose in 10 children (6 males, 4 females, mean age 8.8 years) adopted from Romanian orphanages. Using statistical parametric mapping (SPM), the pattern of brain glucose metabolism in the orphans was compared to the patterns obtained from two control groups: (i) a group of 17 normal adults (9 males, 8 females, mean age 27.6 years) and (ii) a group of 7 children (5 males and 2 females, mean age 10.7 years) with medically refractory focal epilepsy, but normal glucose metabolism pattern in the contralateral hemisphere. Consistent with previous studies of children adopted from Romanian orphanages, neuropsychological assessment of Romanian orphans in the present study showed mild neurocognitive impairment, impulsivity, and attention and social deficits. Comparing the normalized glucose metabolic rates to those of normal adults, the Romanian orphans showed significantly decreased metabolism bilaterally in the orbital frontal gyrus, the infralimbic prefrontal cortex, the medial temporal structures (amygdala and head of hippocampus), the lateral temporal cortex, and the brain stem. These findings were confirmed using a region-of-interest approach. SPM analysis showed significantly decreased glucose metabolism in the same brain regions comparing the orphans to the nonepileptic hemisphere of the childhood epilepsy controls. Dysfunction of these brain regions may result from the stress of early global deprivation and may be involved in the long-term cognitive and behavioral deficits displayed by some Romanian orphans.