轻度胃肠炎伴良性婴幼儿惊厥的临床治疗体会

目的了解轻度胃肠炎伴良性婴幼儿惊厥(BICE)的病因、临床特点及预后。方法 2009-06—2014-06在我院儿科住院的31例符合BIEC患儿进行病史采集,临床观察和出院后6~9个月随访。结果 31例患儿发病平均年龄19个月,秋冬季多见。83.8%患儿出现胃肠炎48h内发生惊厥,为全身性发作,发作≥2次者21例,每次持续1~3min。发作间期脑电图、头颅影像学正常,血生化、脑脊液正常。轮状病毒感染阳性率达64.51%(20例),提示BICE与轮状病毒感染密切相关。4例短期应用抗癫痫药外,其他在癫痫停止后未再应用抗癫痫药。随访21例,患儿无复发,智力运动发育正常。结论BICE多发生在秋冬季胃肠炎的早期,复发反复出现全身性发作无热惊厥,预后良好,一般无需长期服用抗癫痫药。     

轮状病毒肠炎伴良性婴幼儿惊厥血钙钠浓度的配对研究

目的探讨轮状病毒肠炎伴良性婴幼儿惊厥患儿血钙钠浓度水平。方法入选轮状病毒肠炎伴良性婴幼儿惊厥患者29例,按性别、脱水程度相同、年龄、发病时间相近进行配对选择同期入院或门诊轮状病毒肠炎无惊厥29例患者作为对照组,分别对2组病例进行血钙钠浓度检测。结果轮状病毒肠炎伴良性婴幼儿惊厥组血钙钠浓度低于对照组,差异有统计学意义(P0.05)。结论轮状病毒肠炎伴良性婴幼儿惊厥患儿有可伴有一定程度血钙钠降低,低钙和低钠可能共同参与了轮状病毒肠炎伴良性婴幼儿惊厥发作。     

婴幼儿良性惊厥32例临床分析及血清神经元特异性烯醇化酶测定

目的研究轻度胃肠炎并婴幼儿良性惊厥的临床特点及中枢神经元的损伤情况。方法收集2008-11～2010-01我院诊断轻度胃肠炎并婴幼儿良性惊厥的32例患儿作为观察组,记录患儿的胃肠炎表现及惊厥特点,随访6月以上。应用Elecsys 2010电化学发光免疫分析仪检测血清NSE水平。对照组20例,为同期我院门诊健康体检者。结果患儿胃肠炎均较轻,仅11例伴有轻度脱水,无电解质紊乱,大多惊厥频繁可成簇发作,最多者惊厥达5次,发作形式多为强直或强直阵挛,仅6例伴双目向一侧斜视。发作间期脑电图多正常,有7例见散在癫样放电,影像学检查均未见异常。该病预后良好,31例随访期间未再出现惊厥,仅1例因再次轻度胃肠炎并婴幼儿良性惊厥出现惊厥复发。观察组NSE高于正常对照组(P<0.01)。结论轻度胃肠炎并婴幼儿良性惊厥胃肠炎表现均轻微,惊厥往往成簇发作;发作间期脑电图多正常;可对神经元造成损伤;预后良好。     

短暂头痛、神经功能缺损伴脑脊液淋巴细胞增多综合征的临床随访研究

目的报道1例短暂头痛、神经功能缺损伴脑脊液淋巴细胞增多综合征(HaNDL)患者的临床、脑脊液和脑电图改变特点。方法患者,男,27岁,反复出现肢体麻木无力和头痛1 m余,有时伴随语言障碍或失认。头部MRI和头颈CTA未见异常。经食道超声心动示卵圆孔未闭。发作期和发作间期对患者进行脑电图和脑脊液检查。结果脑电图检查在发作期出现非对称性的慢波活动,发作间期慢波减少至正常。腰穿检查在发作期和间期均存在脑脊液蛋白和淋巴细胞增多,脑脊液淋巴细胞亚群分析以T淋巴细胞为主,少量B细胞及NK细胞,比例大致在正常范围。1 m余后症状好转无复发。结论 HaNDL综合征早期诊断易与脑卒中混淆。局灶性神经功能缺陷伴头痛及脑脊液淋巴细胞增多是该病的主要特点。脑电图可用于监测病情变化。     

影像学正常的癫(癎)患者的SPECT与长程EEG研究

目的:探讨影像学(CT和MR1)正常的癫(癎)病例的发作间期SPECT与脑电图(EEG)特点.方法:对100例影像学正常病例在发作间期进行SPECT显像、EEG长程监测.结果:共100例中,男57例,女43例.年龄1～54岁.病程平均3.77年.可追溯到病因者63%.全身性发作58%(全身强直阵挛发作52%),局灶性发作42%.发作间期SPECT异常100%,其中低灌注67%,高灌注30%,高-低灌注3%.异常灌注灶156个:脑区151个(97%),其中颞叶76例94个(60%).长程EEG监测正常17%,异常83%,异常者中90%有(癎)样放电.局灶性异常45%和弥漫性异常54%,EEG正常的全身性发作与局灶性发作差异明显(P＜0.01);局灶性异常中全身性发作与局灶性发作比较差异有统计学意义(P＜0.05).结论:影像学正常而发作间期SPECT异常的癫(癎)病例和EEG异常明显增高,全身性发作者各脑区均存在异常灌注灶,其中颞叶异常灌注灶占60.2%.     

皮层发育不良继发同侧偏转性癫(癎)发作1例报告

1 病例报告 患者男性,30岁,农民工.因旋转阵挛性抽搐伴意识丧失反复发作9年,3 d前复发1次,于2008年2月27日就诊.患者于21岁起反复旋转发作并阵挛性抽搐,曾在当地医院检查头颅CT与脑电图(EEG)正常.因服药疗效差,自行停药2年,近年发作频繁,每月3次左右,疲劳时易发作.无癫(癎)家族史,既往无窒息史,无头部外伤史.查体未见阳性体征.     

轻度胃肠炎伴良性婴幼儿惊厥的临床研究

回顾性分析65例急性胃肠炎合并惊厥发作患儿(轻度胃肠炎伴良性婴幼儿惊厥18例、热性惊厥15例、癫13例、病毒性脑炎6例、低钠性脑病6例、高钠性脑病3例、中毒性脑病2例和低钙惊厥2例)临床资料。主要表现为全面性强直或强直-阵挛发作,持续时间短暂,多发生在病程前2 d内,轮状病毒阳性检出率高达83.33%(15/18)。首次惊厥发作患儿肌肉注射苯巴比妥[5~10 mg(/kg·次)],住院过程中再次发作者静脉注射地西泮[0.10~0.30 mg(/kg·次)]。轻度胃肠炎伴良性婴幼儿惊厥为婴幼儿常见惊厥发作疾病,治疗以控制反复发作为原则,预后良好。     

轮状病毒感染与轻度胃肠炎并良性婴幼儿惊厥的相关性历史队列研究

目的 研究轮状病毒(RV)感染与轻度胃肠炎并良性婴幼儿惊厥的相关性.方法 将我院既往3年内收住院的轮状病毒肠炎(大便轮状病毒抗原阳性)321例设为暴露组,而非轮状病毒肠炎(大便轮状病毒抗原阴性)350例为非暴露组.观察胃肠炎症状后1周时间,统计发生惊厥的病例数,计算相对危险度(RR值)及95%可信区间并进行统计学分析.结果 暴露组中37例出现惊厥,发生率为11.53%;而非暴露组11例发生惊厥,发生率为3.14%,RR= 3.67,95%可信区间为2.0 ～ 6.72 ,χ2=17.71,P＜0.01.结论 轮状病毒感染与轻度胃肠炎并良性婴幼儿惊厥之间存在相关性.     

原发性中枢神经系统淋巴瘤2例报告并文献复习

<正>1病例报告病例1:患者男,52岁。因"发热伴头痛20d"于2015-03-12入院。20d前无明显诱因出现发热,体温最高39.2℃,伴畏寒、寒战、头痛及头晕,就诊于外院,查脑电图结果显示轻度异常;腰椎穿刺检查结果显示,颅压正常,脑脊液常规生化提示氯稍低,余指标正常;胸部CT检查未见异常。考虑"脑炎",给予抗感染治疗后无明显好转,     

良性伴海马硬化的颞叶癫临床特点分析

目的观察伴海马硬化的颞叶癫(TLE-HS)对药物治疗的反应性,分析药物反应良好的良性伴海马硬化的颞叶癫的临床特点。方法 46例颞叶癫患者经MRI证实伴海马硬化,抗癫药物治疗至少随访2年,超过发作周期无癫发作,与51例对抗癫药物耐药的患者比较人口学资料、早期突发损伤因素、癫家族史、临床症状、发作间期脑电图样放电、海马硬化侧别、药物治疗方案等特征,并采用多因素前进法Logistic回归分析筛选药物治疗反应良好的影响因素。结果良性TLE-HS组与对照组患者发病年龄(P=0.041)、病程(P=0.001)、热性惊厥史(P=0.019)、癫发作频率(P=0.001)和药物治疗方案(P=0.000)差异有统计学意义,而性别、年龄、出生史异常、脑炎史、颅脑创伤史、癫家族史、癫持续状态、认知功能障碍、精神障碍,以及发作类型、先兆、是否存在发作间期和发作间期脑电图样放电、海马硬化侧别差异均无统计学意义(P0.05);其中,热性惊厥史是药物治疗反应良好的危险因素(OR=3.405,95%CI:1.080~10.737;P=0.037),而低癫发作频率(OR=0.275,95%CI:0.100~0.758;P=0.013)和单药治疗(OR=0.135,95%CI:0.049~0.373;P=0.000)是药物治疗反应良好的保护因素。结论良性伴海马硬化的颞叶癫多于青少年后期发病,发病初期癫发作频率低,较少伴热性惊厥史,单药治疗特别是卡马西平或奥卡西平疗效较好。     

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.