多导睡眠图导向下Quisi检测法的建立及其在失眠症中的应用

目的在多导睡眠图引导下建立Quisi快速检测法,并探讨Quisi在失眠症诊断中的价值.方法对39例失眠症患者和33名正常受试者同时作Quisi和多导睡眠图(PSG)检测.并以日本SEEG-1518K为检测标准,与德国Quisi进行比较研究.结果 (1)在33名正常对照组中,除暂停、伪迹和第3、第4阶段4项睡眠参数Quisi和PSG两工具不能比较外,其他12项指标比较差异均无显著性(P＞0.05).39例失眠症组Quisi和PSG两工具比较见相同结果.(2)在多导睡眠图导向下,失眠症组与正常对照组Quisi比较,主要见实际睡眠时间减少[分别为361.0±29.4 min和462.9±21.2 min,P＜0.01],睡眠潜伏期长[分别为33.3±17.9 min和20.2±9.6 min,P＜0.01],醒觉时间长[分别为38.0±15.9 min和18.9±5.7 min,P＜0.01],睡眠效率低[分别为84.3±9.1 min和95.0±4.9 min,P＜0.01],第一阶段睡眠百分比高[分别为26.4±15.5 min和9.0±1.8 min,P＜0.01],第三阶段睡眠百分比低[分别为6.2±3.9 min和10.9±3.7 min,P＜0.01]和伪迹百分比高[分别为7.5±2.1 min和2.8±1.1 min,P＜0.01].结论 Quisi检测失眠症作用与PSG相似,在心理咨询、外出巡诊和家庭病床上有应用前途.运用Quisi技术评估失眠症患者的睡眠生理学异常,更为快速简便和客观科学.     

阻滞性抑郁症的睡眠脑电图特征

目的　探索阻滞性抑郁症的睡眠脑电图特征。方法　对 8例阻滞性抑郁症、10例非阻滞性抑郁症和 10例正常对照者检测睡眠脑电图。结果　阻滞性抑郁症的REM密度 (2 17± 4 2 6 )比非阻滞性抑郁症的 (188± 111)倾向为高 (P >0 0 5 ) ,比正常对照组的 (12 4± 18 5 )显著为高 (P <0 0 5 )。结论　REM密度可作为阻滞性抑郁症的一个状态指标     

三唑仑对失眠症患者睡眠脑电的影响

目的应用多导睡眠图(PSG)探讨三唑仑对失眠症患者睡眠脑电活动的影响.方法对28例失眠症患者连续进行4夜PSG描记,其中第3、4晚上睡前予0.5mg三唑仑,观察用药后PSG的变化.正常对照组33名,作2夜适应和基础PSG监测.结果失眠症患者服用三唑仑后夜间PSG显示睡眠效率提高[基线睡眠值(86±9)%,第3晚服药后(91±8)%,第4晚服药后(92±4)%,F值6.143,P＜0.01],觉醒时间减少[同前,(39±17)min,(29±8)min,(23±7)min,F值13.211,P＜0.01],S1减少[同前,(31±18)%,(23±11)%,(16±6)%,F值9.707,P＜0.01],S2增加[同前,(45±17)%,(59±18)%,(60±6)%,F值10.104,P＜0.01],睡眠潜伏期缩短[同前,(35±18)min,(28±17)min,(21±11)min,t值4.947,P＜0.05].结论短半衰期催眠药三唑仑不仅能改善患者对睡眠的主观评价,还对夜间睡眠脑电有影响.     

帕金森病患者的睡眠异常

目的研究帕金森病患者睡眠障碍发生及其特点和影响因素。方法收集患者病史资料并应用多导睡眠仪对10例帕金森病患者及5名健康对照进行多导睡眠监测。受试者分为3组:对照组、帕金森病Hoehn-Yahr(H&Y)Ⅰ级组及帕金森病H&YⅡ~Ⅳ级组。每组均包括男性3例,女性2例。结果3组年龄分别为(54·4±5·7)岁、(57·6±14·5)岁、(58·2±10·7)岁,年龄之间的差异无统计学意义(F=0·232,P=0·794)。对照组浅慢波睡眠时间为(70·6±7·8)min,而H&YⅠ级组患者浅慢波睡眠时间为(81·4±6·1)min,显著高于对照组(P=0·008);对照组睡眠效率为75·6%±12·8%,快动眼睡眠(REM)潜伏期为(116±48)min,浅慢波睡眠所占比例为70·6%±7·8%,REM所占比例为14·8%±5·5%,总睡眠时间为(372·8±53·4)min,而H&YⅡ~Ⅳ级组患者睡眠效率43·6%±16·0%(P=0·003)、REM所占比例7·3%±6·1%(P=0·003)及总睡眠时间(244·3±103·2)min(P=0·006)均显著低于对照组,REM睡眠潜伏期(281±86)min(P=0·000)及浅慢波睡眠时间(85·3±7·9)min(P=0·000)显著高于对照组。经相关分析,睡眠潜伏期、浅慢波睡眠时间与疾病病程存在显著正相关(r分别为0·889、0·492;P值分别为0·000、0·006),而睡眠效率、深慢波睡眠时间及总睡眠时间与疾病病程有显著负相关(r分别为-0·626、-0·723、-0·728;P值均为0·000)。结论研究结果显示,帕金森病患者在患病早期已经存在夜间睡眠时间减少、睡眠效率下降、睡眠潜伏期延长及睡眠结构的改变等异常,而且有随疾病进展而加重的趋势。     

发作性睡病的临床特征与多次睡眠潜伏期试验对照研究

目的:探讨多次睡眠潜伏期试验(MSLT)对发作性睡病的诊断价值。方法:总结3 6例发作性睡病患者的临床特征,并进行白天5次MSLT和整夜多导睡眠图(PSG)描记,分析平均睡眠潜伏期(sleeplatency ,SL)、睡眠初次出现REM (sleeponsetrapideyemovementperiods ,SOREMP)次数及夜间睡眠相关参数和3 4名正常对照组进行比较。结果:3 6例均有白日过度嗜睡(10 0 % ) ,2 5例伴猝倒(69.44 .% ) ,16例伴入睡前幻觉(4 4 .44 % ) ,8例伴睡眠瘫痪(2 2 .2 2 % ) ,7例典型的睡眠四联征(19.44 % )。白天5次MSLT显示:2 8例发作性睡病患者SL <5min +SOREMP≥2次(77.78% ) ,SL(4 .12±2 .0 4)缩短和SOREMP≥2 (3 .2 8±0 .67)次,与正常对照组相比有显著性差异(P <0 .0 1)。整夜PSG结果显示:发作性睡病组总睡眠时间(3 3 5 .82±3 4.0 9)min、REM潜伏期缩短(17.19±7.14 )min ,和正常对照组相比有显著性差异(P <0 .0 1)。结论:发作性睡病具有睡眠潜伏期缩短和REM睡眠提前的特征,MSLT对发作性睡病的诊断和鉴别诊断具有重要价值。     

抑郁症患者可乐定快速眼运动睡眠抑制试验的对照研究

目的探讨重性抑郁症患者α2-肾上腺能受体功能状况。方法对15例重性抑郁症患者（抑郁症组）和15名正常人（正常对照组）分别进行多导睡眠脑电图检查。在第1个快速眼运动（REM）睡眠周期结束10min内,向所有被试者静脉注射可乐定（剂量按2mg/kg体重计算,并稀释于9ml生理盐水中）,比较两组的睡眠情况。结果可乐定注射前,抑郁症组的REM比例［（26.8±5.6）%］、REM次数［（6.8±1.2）次］及REM时间［（120.6±25.1）min］较正常对照组增加［分别为（19.2±3.3）%、（4.9±0.8）次、（78.8±14.4）min;P<0.05］,REM潜伏期缩短［（64.1±27.0）min,对照组为（96.1±27.0）min］;可乐定注射后,对两组非快速眼运动睡眠几乎无影响,而抑郁症组和对照组的REM比例［分别为（21.3±4.8）%和（13.6±2.7）%］、次数［分别为（5.3±1.2）次和（3.8±0.6）次］、时间［（101.0±24.0）min和（61.0±10.3）min］分别较注射前减少（P<0.05）,抑郁症组第1次和第2次REM间隔时间的差值小于正常对照组（P<0.01）;而两组REM潜伏期注射前后的差异均无显著性。提示抑郁症患者REM睡眠的可乐定反映较正常对照组迟钝。结论重性抑郁症患者可能存在α2-肾上腺能受体功能低下。     

抑郁症的早醒与睡眠脑电图的关系

目的探索伴和不伴早醒的抑郁症病人睡眠脑电图特征。方法对10例伴早醒的抑郁症(早醒组)、8例不伴早醒的抑郁症(非早醒组)和10例对照组进行睡眠脑电图检查。结果(1)早醒组的醒起时间比对照组显著为长(11.8±8.5:3.1±2.8,P<0.05);(2)非早醒组的运动觉醒时间比对照组显著为短(3.1±1.4:6.8±3.1,P<0.05);(3)早醒和非早醒组的睡眠总时间比对照组显著为短(331.7±25.6和333.9±52.7比386.7±41.3,P均<0.05);REM强度比对照组显著为强(28.7±8.8和32.8±19.5比19.4±3.7,P均<0.05)。结论(1)抑郁症的早醒可能与精神运动性阻滞相关联;(2)不伴早醒的抑郁症可能由慢波睡眠向快波睡眠的转相增快;(3)抑郁症病人的总睡眠时间减少和REM睡眠强度增加。     

情感性精神障碍感觉性诱发电位变异与自杀行为史的关联性研究

目的　探讨情感性精神障碍患者感觉性诱发电位 (SEP)变异与自杀行为史的关系及其临床意义。方法　应用美国尼高力公司Spirit脑诱发电位仪 ,检测 39例抑郁症 (抑郁症组 )患者、2 2例躁狂症 (躁狂症组 )患者和 33名正常对照者 (对照组 )的视觉诱发电位 (VEP)、听觉诱发电位 (AEP)和体感诱发电位 (SSEP) ,并对两患者组中有无自杀史者的测定结果进行比较。结果　 (1 )抑郁症组在VEP中的P2 潜伏期 [有自杀史者为 (2 1 1± 2 1 )ms,无自杀史者为 (2 0 9± 1 7)ms]长于正常对照组 [(1 94±1 9)ms;P <0 0 1和P <0 0 5]。 (2 )抑郁症组和躁狂症组SEP主成分的波幅均低于对照组。 (3)在VEP中 ,抑郁症组中有自杀史者的P3波幅 [(2 7± 1 8) μV]低于无自杀史者 [(5 5± 2 3) μV] ;躁狂症组中有自杀史者的P2 波幅 [(2 9± 1 8) μV]低于无自杀史者 [(5 5± 2 3) μV] ;在AEP中 ,躁狂症组中有自杀史者的P2 波幅 [(3 7± 1 9) μV]低于无自杀史者 [(5 1± 2 3) μV] ,差异有显著性和非常显著性 (P <0 0 5和P <0 0 1 )。结论　感觉性诱发电位是辅助评价自杀倾向的客观方法之一     

分裂样障碍患者的脑磁共振成像分析

目的　探讨分裂样障碍患者与正常对照者脑形态的差异。方法　采用三维磁共振成像技术测量64例(男女各32例)分裂样障碍患者和64名(男女各32名)对照组的脑形态,径线测量采用秋野等方法。结果　(1)两组男性比较:与对照组比较,患者组右侧颞叶长径小[ ( 63 4±1 5 )mm],海马角大[ (38 7±1 7)°];左侧海马长径小[ (39 4±0 7)mm],海马角大[ (38 6±1 5)°],均P<0 05。两侧半球比较,患者组右侧半球长径( 159 5±2 1 )mm、顶枕叶长径( 54 4±1 3 )mm均小于左侧[分别为(160 7±2 3)mm和(55 8±1 1)mm],而右侧半球横径[ ( 71 1±1 0 )mm]、颞叶长径[ (63 4±1 5)mm]和海马长径[ (40 7±0 8 )mm]则大于左侧[分别为( 69 8±1 0 )mm、( 62 0±1 2)mm、(39 4±0 7)mm;P<0 05]。(2)两组女性比较:患者组右侧半球高径[ (106 9±1 5)mm]、颞叶长径[ (61 6±1 2)mm]、顶枕叶长径[ (50 8±1 3)mm]和海马长径[ ( 39 9±0 8 )mm]均小于对照组[分别为(109 0±1 4)mm、(62 0±1 1)mm、(51 5±1 1)mm、(41 3±0 9)mm;均P<0 05]。两侧半球比较,患者组右侧额极长径[ ( 34 9±0 9 )mm]、额叶长径[ ( 60 7±0 9 )mm]和颞叶长径[ (61 6±1 2)mm]均大于左侧[分别为(33 6±0 8)mm、(59 6±0 8)mm、(59 9±1 3)mm],顶枕叶长径[ (50 8±1     

电针与氟西汀治疗抑郁症疗效的对照研究

目的　对比电针与氟西汀治疗抑郁症的疗效。方法　将 95例抑郁症患者随机分为电针组 ( 31例 )、氟西汀组 ( 32例 )及安慰剂组 ( 32例 )。电针组采用智能电针仪治疗 ,用抗抑郁波型 ,以毫针针刺百会、印堂穴 ,强度 2～ 3V ,4 5min/次 ,1次 /d ,每周 5次 ,同时服安慰剂 ;氟西汀组予氟西汀胶囊 2 0mg/d ,并接受模拟电针 ;安慰剂组用安慰剂并接受模拟电针 ;疗程 6周。于治疗前及治疗中每 2周评定 1次汉密尔顿抑郁量表 (HAMD)、Asberg抗抑郁药副作用量表、抑郁自评量表 (SDS)、临床总体印象量表 (CGI)。结果　治疗第 6周末 ,电针组的HAMD总分 [( 10 19± 5 88)分 ]低于安慰剂组[( 13 88± 8 2 9)分 ;P <0 0 5 ],SDS评分 [( 5 3 0 2± 9 6 7)分 ]亦低于安慰剂组 [( 6 0 0 0± 12 89)分 ;P <0 0 5 ];安慰剂组CGI中的病情严重程度 [( 3 16± 1 32 )分 ]重于电针组 [( 2 4 2± 1 0 3)分 ]和氟西汀组[( 2 5 6± 1 13)分 ;P <0 0 5 ],总体进步分 [( 2 84± 1 2 7)分 ]低于电针组 [( 2 10± 0 94 )分 ;P <0 0 1]和氟西汀组 [( 2 2 5± 1 0 8)分 ;P <0 0 5 ];电针组与氟西汀组各项评分的差异均无显著性。三组Asberg量表评分差异无显著性。结论　电针与氟西汀治疗重性抑郁症的疗效基本相同     

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.