卒中后痫性发作

卒中后痫性发作常见，根据其发生时问分为早发性和迟发性痫性发作，前者与卒中后病理生理学改变有关，后者与胶质细胞增生有关。卒中后痢性发作与卒中类型、病因、病灶部位和大小及神经功能缺损情况等有关。临床上，大部分卒中后痢性发作表现为部分性发作或部分性发作继发全面性发作，部分患者发展为癫痫持续状态。根据卒中病史、痢性发作临床表现、脑电图和神经影像学，卒中后痫性发作的诊断一般并不困难，但需与其他发作性疾病鉴别。卒中后反复痫性发作者应予抗癫痫药物治疗，同时还应注意药物之间的相互作用，无需预防性用药。其与预后的关系尚存争议。     

首次自发性痫性发作后复发危险因素分析

为探讨首次自发性痫性发作后复发的危险因素 ,帮助临床制定首次痫性发作患者的个体化治疗方案。我们对 1 5 0例首诊患者 (包括 66例首次痫性发作患者 )进行了前瞻性研究 ,并分析首次痫性发作后复发的危险性及相关影响因素。1　资料与方法1 .1　临床资料　选择 1 998年 1 0月至 2 0 0 1年 6月间来我院首诊的自发性痫性发作患者 1 5 0例 ,男 86例 ,女 64例 ;平均年龄 ( 1 0 .2± 7.8)岁。症状性发作34例 ,特发性发作 1 1 6例 ;有热性惊厥史 8例 ,新生儿惊厥史 4例 ,癫痫家族史 5例。其中 66例为首次痫性发作后即来就诊 ,84例曾有两次或多次痫…     

癫痫性精神症状发作的鉴别诊断

与其他脑部疾病一样癫痫亦常合并精神症状。按其与癫痫发作之间的时间关系分为发作期、围发作期及发作间期精神障碍。癫痫发作期精神障碍具有癫痫发作的典型特征，如刻板性、多无诱因、突然开始、持续时间短暂(＜3分钟)、突然终止。复杂部分性发作时伴有意识改变，可以是非常轻微的意识模糊和混乱。可有凝视、运动或口自动症。     

肝性腹水与非肝性腹水的鉴别诊断

肝性腹水与非肝性腹水的鉴别诊断周平张木森腹水是临床上常见的体征之一，病因较复杂。尽管约８０％的原因系肝实质性疾病和肝硬化所致〔１〕。但腹水分析仍然是临床上的难题之一。传统的渗出液和漏出液检查，虽然有一定的价值，但对于肝性与非肝性腹水的鉴别诊断并不敏感...     

首次自发性痫性发作后复发危险性分析探讨

目的探讨首次自发性痫性发作后复发的危险性及潜在危险因素。方法选择1998-10～2007-06间于神经内科和小儿科首诊就诊的首次痫性发作病人66例,随访2年,记录有无再次复发,应用Kaplan-Meier乘积限法估算复发率,针对66例首次痫性发作患者,应用Cox比例风险模型的单因素和多因素分析来探讨分析影响首次痫性发作后复发的潜在危险因素。结果 66例首次痫性发作患者2年中复发36例,累积复发率为54.55%。Cox单因素和多因素分析表明,首次痫性发作后,症状性发作复发的危险性较大;另外EEG异常、首次发作出现在睡眠状态中、首次发作持续时间较长等亦是复发的危险因素,而3～12岁间出现的首次痫性发作复发率较低。结论首次痫性发作的某些临床特点可以帮助判断其复发危险性。     

通过发作频率、EEG和药物的疗效预测非痫性发作

非痫性发作（NES）在癫痫中心约占患者数的20％，发病率为1．4～3．0／10万人口，许多患者多年未能明确诊断，且常用多种癫痫药物治疗。NES诊断的金标准是录像脑电图（V-EEG）监测，本研究用V-EEG进行确诊来评价发作频率、有无EEG癫痫样放电和药物疗效三标准在预测NES的有效性：     

老年人短暂性脑缺血发作与非惊厥性癫痫的鉴别诊断

目的探讨老年人短暂性脑缺血发作(TIA)与非惊厥性癫痫的鉴别诊断。方法回顾性分析56例有反复发作性局限性神经功能障碍特点临床症状的老年患者的视频脑电图及经颅多普勒超声(TCD)、头颅磁共振血管造影(MRA)影像资料。结果 38例(67.9%)患者视频监测脑电图异常,监测到临床发作26例,伴随临床发作同步背景脑电图表现为癫痫样病理波发放为主6例(15.8%),表现为局灶性慢波为主20例(52.6%)。12例(31.6%)不伴临床发作患者脑电图以局灶性慢波为主。视频监测脑电图正常18例(32.1%)。56例患者入院时诊断为TIA,实际上至少6例为癫痫,误诊率大于10.7%。TCD异常52例(92.9%)。MRA显示,颅内大血管狭窄48例(85.7%)。结论老年人TIA与非惊厥性癫痫的临床症状相似,忽视癫痫的排查,容易造成非惊厥性癫痫的漏诊、误诊,对这类患者视频脑电监测应作为常规检查手段。     

假性发作及其与癫痫的鉴别

假性发作为一极易与癫痫混淆的发作性疾病。近年来，国外学者着眼于二者的鉴别，对假性发作进行了多方面研究，在临床表现，心理特征，辅助检查，诊治及预后方面有了较深入的认识。本文就此作一综述。     

慢性咳嗽的鉴别诊断

慢性咳嗽是指8周以上的持续或反复发作性咳嗽,是临床常见症状,病因众多。目前,临床上常见且受到重视的主要是以下几种疾病：[第一段]     

视频脑电图在小儿非癫痫性发作中的诊断价值

小儿非癫痫性发作是指不伴有同步异常脑电改变的短暂反复临床发作 ,如各种器质性病变引起的发作性症状、功能性病变引起的发作性症状、生理事件、心因性发作等 ,其中以后三种情况最常见 [1,2 ]。近年来 ,许多家长由于对其独生子女过分关注 ,常将小儿的一些非癫痫性发作症状视为癫痫性发作 ,有时临床医生对其难以判断 ,因此造成误诊误治。近年来 ,视频脑电图的应用为鉴别非癫痫性发作和癫痫发作提供了可靠的依据 [2 ]。 2 0 0 2年 6月以来 ,我们对临床表现类似癫痫性发作的 1 96例患儿进行了视频脑电图检查 ,均排除小儿非癫痫性发作。1　资料…     

Syncope and epileptic seizures

Syncope is one of the most common symptoms leading to hospital admission. Thereby syncope can be induced by several diseases. It is crucial to detect underlying structural heart disease or high grade arrhythmias, as these are associated with an increased mortality. The careful history and physical examination can often give sufficient evidence to evaluate the origin of syncope. Additional examinations should only be applied selectively. In patients with structural heart disease the specific treatment should be initiated, in patients with cardiac arrhythmias the implantation of a pacemaker or ICD might be indicated. The most common neurally-mediated and orthostatic syncopes can often be treated successfully by physical training. Beside syncope epilepsy might be responsible for a transient loss of consciousness. Again careful history taking helps to differentiate between these two entities.     

Ginkgo biloba precipitating epileptic seizures

BACKGROUND: The herbal remedy Ginkgo biloba is promoted as a treatment for a variety of ailments including memory loss and dementia, poor concentration and mood, glaucoma, 'cerebral insufficiency' and 'peripheral circulatory disturbances'. It is gaining worldwide popularity, particularly as a potential treatment for dementia. CASE REPORTS: Two patients with well-controlled epilepsy presented with recurrent seizures within 2 weeks of commencing extract of Ginkgo biloba. The herbal remedy was discontinued and both patients are seizure-free several months later. DISCUSSION: Ginkgo biloba may have precipitated seizures in these two patients. This and other potential adverse effects should be highlighted on the packaging of the drug.     

Peripheral glucose metabolism is altered by epileptic seizures

The aim of the present study was to investigate the status of jejunal absorption and peripheral metabolism of glucose in Wistar Audiogenic Rats (WAR), a genetic model of epilepsy, after seizures induced by intensive sound exposure. The jejunal loop of rats was isolated and infused (0.5 mL min⁻¹) with Tyrode solution containing twice the normal concentrations of glucose, sodium, and potassium. Samples were taken at 5 or 10-min intervals over a 40-min period. At the end of the experiment, samples of liver and gastrocnemius muscle were taken to measure the levels of glycogen, glucose-6-phosphate, fructose-6-phosphate and glucose transporter-4 (GLUT4). Hepatic glucose-6-phosphate increased in WAR submitted to audiogenic seizure (21.90 ± 3.08) as compared to non-susceptible Wistar rats (8.12 ± 0.87) and to WAR not submitted to audiogenic stimulation (5.17 ± 0.97). In addition, an increase in hepatic fructose-6-phosphate, an intermediate metabolite of the glycolytic pathway, was observed in WAR submitted to audiogenic seizure (5.98 ± 0.99) compared to non-susceptible Wistar rats (2.38 ± 0.53). According to the present results, jejunal absorption of glucose was not changed by seizures. However, generalized tonic–clonic seizures produced by sound stimulation resulted in a decrease in muscle glycogen content. In addition, our results demonstrated that the concentration of GLUT4 in the gastrocnemius muscle of WAR was 1.6-fold higher than that observed in resistant rats and that the audiogenic stimulus led to decreased concentration of this receptor in the muscle of WAR animals.