长春西汀治疗椎基底动脉供血不足性眩晕38 例疗效观察

目的 探讨长春西汀注射液治疗椎基底动脉供血不足性眩晕的疗效.方法 将76例椎基底动脉供血不足性眩晕的患者分为2组,治疗组用长春西汀注射液40 mg/d 生理盐水250ml静滴 ,而对照组用复方丹参注射液20ml/d 生理盐水250ml静滴,共用14d.结果 治疗组与对照组有效率差异有统计学意义(P＜0.01);治疗后椎基底动脉血流动力学明显改善(P＜0.05).结论 长春西汀注射液治疗椎基底动脉供血不足性眩晕疗效显著,且不良反应少、复发率低,值得推广使用.     

盐酸丁咯地尔治疗椎基底动脉供血不足的疗效观察

应用丁咯地尔共7d。结果床应用。目的观察丁咯地尔治疗椎基底动脉供血不足的疗效。方法选择椎基底动脉供血不足性眩晕患者102例，治疗组0．1g加入盐酸培他啶500ml中静滴，1次／d，共7d。对照组用复方丹参10ml加入盐酸培他啶500ml中静滴，1次／d，治疗组疗效明显高于对照组（P〈0．05）。结论丁咯地尔治疗椎基底动脉供血不足起效快，效果好，疗程短，值得临床应用。     

盐酸丁咯地尔联合血栓通治疗椎基底动脉供血不足疗效观察

目的 观察盐酸丁咯地尔联合血栓通治疗椎基底动脉供血不足(VBI)的临床疗效.方法 随机将87例病人分为治疗组(45例)和对照组(42例),治疗组应用盐取丁咯地尔注射液100 mg加入生理盐水250 mL中静滴,1次/d,血栓通冻干粉针450 mg加入5%葡萄糖250 mL中静滴,1次/d;对照组应用复方丹参注射液250 mL静滴,1次/d;2组均连用10 d,其余常规治疗相同.结果 治疗组痊愈26例,有效18例,总有效率98%;对照组痊愈15例,有效24例,总有效率93%,治疗组疗效优于对照组(P＜0.05).结论 盐酸丁咯地尔联合血栓通治疗椎基底动脉供血不足有良好的临床疗效,可以临床广泛应用.     

马来酸桂哌齐特治疗椎基底动脉供血不足疗效观察

目的观察马来酸桂哌齐特治疗椎基底动脉供血不足的疗效。方法将70例椎基底动脉供血不足患者随机分为治疗组(38例)和对照组(32例),治疗组使用马来酸桂哌齐特注射液320mg加入生理盐水250ml中静滴,1次/d,14d为一个疗程;对照组使用丹参粉针400mg加入生理盐水250ml中静滴,1次/d,14d为一个疗程,观察临床疗效。结果治疗组总有效率明显好于对照组,2组差异有显著性(P0.05)。结论马来酸桂哌齐特治疗椎基底动脉供血不足的疗效显著。     

丁咯地尔联合氯吡格雷治疗椎基底动脉供血不足临床观察

目的 观察丁咯地尔联合氯吡格雷治疗椎基底动脉供血不足病人的临床疗效.方法 将60例椎基底动脉供血不足病人随机分为治疗组和对照组.治疗组给予丁咯地尔注射液静滴,口服国产氯吡格雷(泰嘉);对照组给予曲可芦丁注射液静滴,口服肠溶阿司匹林,疗程14d.分别观察2组治疗前后临床疗效.结果 治疗组总有效率93.3%,对照组有效率66.7%.2组比较差异有统计学意义(P＜0.05).结论 丁咯地尔联合氯吡格雷治疗椎基地动脉供血不足疗效显著.     

低分子肝素治疗椎基底动脉供血不足的疗效观察

目的 观察低分子肝素治疗椎基底动脉供血不足疗效及不良反应。方法 选择椎基底动脉供血不足患者35例,应用低分子肝素钙针4100IUAxa腹壁皮下注射,2次/d,7d-疗程。对照组35例,应用丹参注射液20ml溶于5％葡萄糖250ml静滴,1次/d,7d为一疗程。结果 治疗组与对照组总有效率比较,有显著性差异(P<0.05)。结论低分子肝素能有效治疗椎基底动脉供血不足     

赛莱乐在椎基底动脉供血不足中的应用

目的：观察赛莱乐治疗以眩晕为主要症状的椎基底动脉供血不足疗效及副作用。方法：选择椎基底动脉供血不足患者45例，应用赛莱乐（盐酸丁咯地尔）200mg溶于生理盐水200ml静滴，10天一疗程。对照组40例，应用丹参注射液20ml溶于5％葡萄糖200ml静滴，10天一疗程。结果：治疗组有效率明显高于对照组（P＜0．01）。结论：赛莱乐能迅速有效地控制椎基底动脉供血不足所致的眩晕症状。     

马来酸桂哌齐特注射液治疗椎基底动脉供血不足疗效观察

目的 观察马来酸桂哌齐特治疗椎基底动脉供血不足的疗效.方法 将94例患者随机分为2组,治疗组48例应用马来酸桂哌齐特320mg加入5%葡萄糖250ml或生理盐水250ml静滴,1次/d,14d为1个疗程.对照组46例,用脉络宁注射液20ml加入盐酸倍他司丁500ml静滴,1次/d,14d为1个疗程.比较2组疗效.结果 治疗组起效快,总有效率95.58%,对照组起效慢,总有效率86.96%,2组比较差异有统计学意义(P<0.01).结论 马来酸桂哌齐特可明显改善脑供血,是治疗椎基底动脉供血不足的有效药物.     

疏血通治疗椎基底动脉供血不足性眩晕

目的观察疏血通治疗椎基底动脉供血不足的效果。方法82例椎基底供血不足患者分为治疗组42例和对照组40例。在常规治疗的基础上,以静滴疏血通为治疗组,静滴血栓通为对照组进行比较。观察治疗效果及TCD检测椎动脉和基底动脉血流速度的改善情况。结果治疗组痊愈率、临床总有效率优于对照组。且治疗组椎动脉、基底动脉血流速度改善较对照组有明显差异。结论疏血通治疗椎基底动脉供血不足疗效较血栓通疗效显著。     

盐酸法舒地尔注射液治疗椎基底动脉供血不足疗效观察

目的观察盐酸法舒地尔注射液治疗椎基底动脉供血不足的临床疗效和安全性。方法选取我院收治符合入选标准的106例椎基底动脉供血不足患者,分成实验组和对照组。实验组每日给予羟乙基淀粉250mL静滴,1次/d,法舒地尔注射液30mg静滴,2次/d;对照组每日给予羟乙基淀粉250mL静滴,1次/d,丁咯地尔注射液0.2g静滴,1次/d。辅以对症支持治疗,疗程均为14d,观察临床疗效及不良反应。结果与治疗前比较,实验组椎动脉和基底动脉血流速度均有明显加快,治疗前后差异具有统计学意义(P<0.05);与对照组比较,实验组治疗有效率无统计学意义(P>0.05)。结论单一应用盐酸法舒地尔注射液治疗椎基底动脉供血不足效果显著,无严重不良反应发生。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

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.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

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.     

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.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.