多梗塞性痴呆病人血浆内皮素和红细胞变形能力的研究

观察３６例多梗塞性痴呆和２０例非痴呆病人血浆内皮素含量和红细胞变形能力，并与２５例健康对照组比较。结果：（１）痴呆组和非痴呆组血浆内皮素含量均明显高于对照组（Ｐ＜０．００１；＜０．０１）；（２）两组红细胞变形能力均明显低于对照组（Ｐ＜０．００１；＜０．０５），而痴呆组又明显低于非痴呆组（Ｐ＜０．０５）。认为：血浆内皮素增高和红细胞变形能力下降与痴呆的形成和发展有关。     

癫痫患者血清中抗脑组织抗体的检测

补体结合试验对１１３例癫痫患者及６０例对照血清中抗脑组织抗体（ａｎｔｉ－ｅｎｃｅｐｈａｌｉｃａｎｔｉｂｏｄｙ，ＡＥＡｂ）进行检测，结果：１．癫痫患者ＡＥＡｂ阳性率为４２．２８％，明显高于对照组阳性率８．３３％（Ｐ＜０．０１）。２．原发性癫痫与继发性癫痫之间ＡＥＡｂ阳性率未见差异；ＡＥＡｂ阳性率与年龄、性别、是否用抗痫药亦无明显关系（Ｐ＞０．０５）。３．ＡＥＡｂ阳性率与癫痫病程长短有关（Ｐ＜０．０５）；与脑电图是否异常、用药效果、发作类型有关（Ｐ＜０．０１）     

癫痫患儿血清丙二醛及维生素E水平测定

以本文测定４５例癫痫患儿（其中发作期患儿２０例，控制期患儿２５例）血清丙二醛及维生素Ｅ，并与４０例正常小儿进行对照。结果显示癫痫控制期患儿与对照组间丙二醛及维生素Ｅ值接近；癫痫发作期患儿与对照组比较，维生素Ｅ值明显下降（Ｐ＜０．０５），丙二醛呈上升趋势。此结果提示脂质过氧化可能参与了癫痫的病理过程。     

海洛因滥用与尿液过氧化脂质的关系

检测配对设计的３８例海洛因滥用者和３８例健康对照者尿液过氧化脂质（Ｕ－ＬＰＯ）含量的结果表明，与对照组之值相比较，海洛因滥用者组的Ｕ－ＬＰＯ平均含量显著升高（Ｐ＜０．０１），海洛因滥用者的Ｕ－ＬＰＯ含量随其尿液吗啡含量及滥用海洛因史的增加而升高，并均呈直线正相关（ｒ＝０．７８５５，Ｐ＜０．００１；ｒ＝０．６６７４，Ｐ＜０．００１）；提示海洛因滥用者体内的脂质过氧化反应呈现病理性加剧。     

癫痫患者的红细胞免疫粘附功能的初步研究

本文用Ｃ（３ｂ）受体花环试验及ＩＣ花环试验分别测定了５０例正常人及５０例癫痫患者的红细胞Ｃ（３ｂ）受体花环率及ＩＣ花环率。结果提示癫痫患者Ｃ（３ｂ）受体花环率（８．４６±３．９８％）明显低于正常对照组（１３．９２±４．３２％）（Ｐ＜０．００１），ＩＣ花环率（５．２２±２．５９％）稍低于正常对照组（５．９０±１．６７％）（Ｐ＜０．０５）。表明癫痫患者的红细胞免疫粘附功能是低下的。文章还对影响正常人及癫痫患者红细胞免疫粘附功能的因素进行了讨论。     

海洛因滥用与尿液过氧化脂质的关系

检测配对设计的３８例海洛因滥用者和３８例健康对照者尿液过氧化脂质（Ｕ－ＬＰＯ）含量的结果表明，与对照组之值相比较，海洛因滥用者组的ｕ－ＬＰＯ平均含量显著升高（Ｐ＜０．００１），海洛因滥用者的Ｕ－ＬＰＯ含量随其尿液吗啡含量及滥用海洛因史的增加而升高，并均呈直线正相关（ｒ＝０．７８５５，Ｐ＜０．００１，ｒ＝０．６６７４，ｐ＜０．００１）；提示海洛因滥用者体内的脂质过氧化反应呈现病理性加剧。     

磁环穴位内植治疗癫痫临床研究

为探讨磁环穴位内植治疗癫痫的疗效，将１５１例癫痫病人随机分为磁穴组（５８例），磁穴药物组（５１例），对照组（４２例）进行治疗对照研究。结果显示，磁穴组显效率明显高于对照组（Ｐ〈０．０５），磁穴药物组比对照组总有效率显著提高（Ｐ〈０．０５），其显效率更高（Ｐ〈０．０１），磁穴药物组效率明显高于磁穴组（Ｐ〈０．０５）。提示磁环穴 内植对癫痫的治疗具有较好的疗效，常用抗癫痫药物配合磁环穴位内植治疗癫痫具     

癫痫患者红细胞免疫功能观察

检测５０名正常人和４２例癫痫患者红细胞Ｃ３ｂ（ＲＢＣ－Ｃ３ｂ）受体花环率和红细胞免疫复合物（ＲＢＣ－Ｉｃ）花环率。结果：癫痫患者ＲＢＣ－Ｃ３ｂ受体花环率较对照组明显低于健康对照组（Ｐ＜０．０１）。而ＲＢＣ－Ｉｃ花环率较对照组明显增高（Ｐ＞０．０５）；而且根据脑电图结果“病因、发作类型和性别进行了分组研究。表明癫痫的发作与红细胞免疫功能有关。提示在癫痫治疗中可应用先疫增强剂。     

脑血栓患者红细胞膜脂质代谢改变的相关性研究

本文对３０例脑血栓患者红细胞膜（ＲＢＣｍ）及血浆总胆固醇（Ｔ－ｃｈ）、载脂蛋白（ＡＰＯ）Ａ１、Ｂ１００进行了测试分析，并同５５名健康人作对照比较，结果显示：脑血栓患者ＲＢＣｍ上Ｔ－ｃｈ、ＡＰＯＡ１含量明显高于健康组（Ｐ＜０．０１），ＡＰＯＢ１００的含量明显低于健康人（Ｐ＜０．０５）；血浆中ＡＰＯＡ１明显低于健康组（Ｐ＜０．０１），ＡＰＯＢ１００、Ｔ－ｃｈ明显高于健康组（Ｐ＜０．０１）。直线相关分析显示ＲＢＣｍ脂质成份改变与血浆脂蛋白水平有明显相关性。结果表明脑血栓患者脂质代谢紊乱与ＲＢＣｍ脂质成分改变密切相关。     

内皮素和自由基在脑缺血中的相互作用

本文在建立兔ＭＣＡＯ模型的基础上，用放免法测脑组织和血浆中内皮素（ＥＴ）的含量，同时用ＴＢＡ法测定脑组织中过氧化脂质（ＬＰＯ）含量。兔３６只，随机分三组，对照组（假手术），脑缺血后４ｈ，２４ｈ组，每组１２只。结果发现脑缺血后ＥＴ和ＬＰＯ之间呈明显的正相关（Ｐ＜０．００１），且随缺血后时间的延长而递增（Ｐ＜０．０１），用相关回归分析发现，脑组织ＥＴ和ＬＰＯ均显著高于对照组（Ｐ＜０．０５），结果说明脑     

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.     

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.     

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.     

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.     

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.