妥泰单药治疗全身强直—阵挛性发作癫痫34例的疗效观察

目的 研究妥泰单药治疗全身强直－阵挛性发作癫痫的疗效和耐受性。方法 对34例全身强直－阵挛性发作患者予以妥泰单药治疗24周,以治疗前3月的平均每月癫痫发作频率与治疗后9－24周平均每月癫痫发作频率进行比较,观察其脑电图的改变和药物耐受性。结果 单药治疗24周后有20例（58．9％）癫痫发作频率较治疗前减少75％以上,其中9例（26．5％）在观察期间停止发作,8例（23．5％）发作频率减少74％－50％,总有效率为82．4％;治疗后脑电图有明显改善者占56．5％,与治疗前比较有显著性差异（P＜0．001）;无明显不良反应。结论 妥泰单药治疗全身强直－阵挛性发作的总有效率与丙戊酸钠、苯妥英钠相近,治疗后脑电图有显著性改善,有良好耐受性。为全身强直－阵挛性发作单药治疗的有效药物之一。     

埋藏式颅内电极在癫痫外科中应用

癫痫手术治疗前精确定位 ,可提高手术效果 ,现将我院应用埋藏式颅内电极 ,对 19例顽固性癫痫定位 ,总结分析如下。一、资料与方法自 1993年 9月至 1998年 2月 ,对 19例癫痫患者采用埋藏式颅内电极 ,进行术前痫灶定位应用 ,其中男 11例 ,女 8例 ,平均年龄 2 4 ( 14～ 4 2岁 ) ,病程平均 11年 ( 4～ 17年 ) ,均有抗癫药物治疗不能控制癫痫发作。临床发作形式 :全身强直 -阵挛性发作7例 ,失神伴全身强直 -阵挛性发作 3例 ,部分性发作发展至全身性发作 4例 ,复杂部分性发作 5例。全部病例均行多次头皮 -蝶骨ＥＥＧ检查 ,部分行剥夺睡眠或长程Ｅ…     

50例脑囊虫病伴发癫痫临床分析

目的 探讨脑囊虫病伴发癫痫的临床特征及发生机制。方法 对70例脑囊虫病患者中50例并发癫痫者的发作形式，影像学表现等进行回顾性分析。结果 本组71.4%(50/70)的脑囊虫病患者并发癫痫，发作形式分别为；全身强直-阵挛性发作25例（50.0%)。单纯部分性发作10例（20.0%)，复杂部分性发作7例（14.0%)，失神发作2例（4.0%)，癫痫持续状态1例（2.0%)。两种或两种以上形式发作5例（10.0%)；影像学主要表现为脑实质内单个或多个散在低密度或高密度以及钙化等圆形或卵圆形病灶或异常信号，结论 癫痫发作是脑囊虫病患者最主要的临床表现。发作形式的多样性及易转换性可能是本病的特征之一。癫痫发作与虫体的生活状态以及囊虫蜕变死亡时释放大量抗原和毒素引起机体变态反应性脑水肿有关。     

视频脑电图在假性癫痫发作诊断中的价值

假性癫痫发作系指在各种诱因下 (情绪原因为主 )出现的类似癫痫发作的非癫痫发作 ,常易误诊。现将我院经视频脑电图监测诊断的 16例假性癫痫发作患者进行回顾性分析 ,并与 16例癫痫患者比较 ,探讨视频脑电图鉴别假性癫痫的价值。资料和方法 :16例假性癫痫发作患者 ,男 4例 ,女 12例 ,年龄 2 1～ 6 5岁 ,平均 42岁 ,均为视频脑电图检查前临床诊断为癫痫的患者。临床分型 :全身强直 阵挛性发作 11例 ,复杂部分性发作 3例 ,单纯部分性发作 2例。病程 1ｄ至 2 0年。同时选择临床确诊且视频脑电图监测到发作的 16例患者 ,男 9例 ,女 7例 ,年龄 1…     

8例家族性皮质肌阵挛震颤性癫痫临床特点分析

目的分析家族性皮质肌阵挛震颤性癫痫(FCMTE)的临床特点。方法对8例FCMTE患者的临床资料进行回顾性分析,总结家系的临床特点、遗传特征。结果 8例FCMTE患者,连续3代发病,男女均受累,均30岁以后起病,先后出现震颤、全面强直-阵挛发作。其中,5例伴头痛,6例有肢体震颤,4例有情绪焦虑,1例有共济失调症状。8例均于30岁以后癫痫发作,呈强直-阵挛发作。4例刺激左右正中神经记录的躯体感觉诱发电位(SEPs)可见巨大电位,未见C-反射。结论 FCMTE呈常染色体显性遗传,均发生于成人,表现为四肢末端细微震颤、强直-阵挛性癫痫发作,光刺激、情绪激动或惊吓时可诱发。服抗癫痫药有效,服用β受体阻滞剂或饮酒无效,为非进展性病程。神经电生理检查提示肌阵挛或震颤来源于大脑皮质。     

颅内CT钙化与癫痫及其手术治疗

我院从 1983年 4月至 1999年 3月期间 ,收治颅脑ＣＴ扫描证实钙化病灶的癫痫病人 ,共 2 6例 ,经行手术治疗效果满意 ,现将结果报告如下 :临床资料一、一般资料 :本组 2 6例 ,男、女各 13例。年龄5～ 4 0岁 ,平均 19岁 ,15岁以下者 7例 ,16岁以上者 19例。癫痫病程 7天至 2 0年 ,平均 7年 ,其中 1年以内者 5例 ,1年 1例 ,2年以上 5例 ,5年以上 15例。癫痫发作类型 :局限 (部分 )发作至强直—阵挛性发作 9例 ,复杂部分发作至强直—阵挛性发作 5例 ,复杂部分性发作 2例 ,强直—阵挛性发作 10例。癫痫发作频率 :“失神样”发作患者 ,每日多达 80…     

海马硬化与癫痫的因果关系探讨

为了探讨海马硬化与癫痫的因果关系，选用Ｗｉｓｔａｒ大鼠以马桑内酯肌肉注射，制成全身强直－阵挛性发作的癫痫动物模型，并于点燃后连续用药，分别引起Ⅳ级以上抽搐发作２０和４０次。同时建立生理盐水和安定对照组，后者于注射马桑内酯前注射安定，以避免抽搐。并对海马ＣＡ１区进行病理形态学观察。结果显示，马桑内酯注射组与安定组大鼠海马ＣＡ１区有明显的病理改变，锥体细胞变性坏死，神经胶质细胞水肿变性，突触结构异常。抽搐４０次组病理变化重于抽搐２０次组，后者又重于安定组。生理盐水组未见上述改变。结果提示，马桑内酯可引起大鼠海马ＣＡ１区神经元损伤，既使无抽搐发作时也可造成这种损伤。反复严重的抽搐发作又可进一步加重海马ＣＡ１区的病损，抽搐次数越多，损伤越重。海马硬化可能是抽搐反复发作造成的结果。     

妥泰治疗小儿癫癎28例疗效观察

我们于2000-01～2002-01对28例癫痫患儿使用妥泰治疗，观察如下。 1 资料与方法 1．1临床资料本组患儿男17例，女11例，年龄3个月～14岁，病程半个月～7年。癫痫发作类型参照抗癫痫协会于1981年制定的分类方案，其中单纯部分性发作5例，复杂部分性发作3例，强直-阵挛性发作7例，阵挛性发作11例，婴儿痉挛症1例，Lennox-Gastaut综合征1例。     

儿童癫痫发作后肺水肿

作者报告2例儿童癫痫全身强直阵挛性发作后出现急性肺水肿。例1:9岁男孩,全身强直阵挛性发作5分钟,随后呼吸窘迫、咯粉红色泡沫痰。查:神志清,体温37℃,脉搏136次/分,呼吸38次/分,血压128/64mmHg。两肺底呼吸音弱,吸气末弥漫性啰音。心脏无杂音及奔马律,肝不大,外周无水肿。WBC19800,电解质正常,动脉血气:PO_251mmHg、PCO_235mmHg、PH7.38,心电图窦性心动过速,X线胸片双侧弥漫性肺泡浸润,心脏大小正常。静脉注射苯妥因钠、速尿,限制液体,给氧。36小时内血气迅速改善,48小时后胸片肺水肿消失。此后7个月,在8小时内4次短暂发作后又出现肺水肿,用面罩持续正压给氧及利尿剂治疗。例2:8岁男孩,出生11个月左侧大脑中动脉卒中,此后有局限性发作伴全身发作,用苯妥因钠、酰胺咪嗪及苯巴比妥控制不佳。一次全身强直性发作后呼吸     

阿尔茨海默病伴发癫痫的研究

目的：探讨阿尔茨海默病伴发癫痫的临床特征。方法：对45例老年型阿尔茨海默病(AD)与47例健康老人进行对照分析。结果：AD有7例伴发癫痫。AD伴发疯痛的患者年龄明显较不伴发癫痫者为轻。AD伴发癫痫的类型均为全身强直—阵挛性发作，药物较易控制。结论：AD可能伴有癫痫发作，对有发作者应予抗癫痫治疗。     

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.