传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响

目的 评价传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响。方法 102例临床新确诊的成年癫痫患者被随机分为两组：一组予以传统抗癫痫药物单药系统治疗(AEDs组)，另一组予以妥泰单药治疗(TPM组)。1个月后比较两组的发作频率和不良反应。并用QOLIE-30表对这102例癫痫患者进行生活质量评定。结果 TPM组的发作频率和不良反应均明显低于AEDs组，而生活质量总分明显高于AEDs组，尤其在前五项的评分中更加明显。结论 TPM能提高癫痫患者的生活质量，其改善生活质量的作用主要是通过控制发作和减轻不良反应实现的。     

抗癫癎药物对癫癎发作后状态影响研究进展

癫癎发作后状态(PIS)是癫癎发作结束后患者的综合临床表现。PIS与癫癎患者持续的认知功能变化,抗癫癎药物(AEDs)的选择及长期保留率有关,并影响患者生活质量。新、老AEDs对PIS的冶疗效果至今未被明确阐述。目前,AEDs对PIS的疗效已被引起重视,并逐步纳入AEDs总体评价指标。本文对此进行综述。     

传统抗癫疒间药物与托吡酯对成年癫疒间患者生活质量影响的对比研究

目的 探讨传统抗癫癎药物(AEDs)与托吡酯(TPM)对成年癫癎患者生活质量(QOL)的影响。方法 102例临床确诊的成年癫癎患者随机分为AEDs组和TPM组,井用QOL IE-30表对102例癫癎患者和62名正常人(对照组)进行评定。结果 AEDs组较对照组QOL明显降低(P<0.05),表现惧怕发作,对日常生活不满意,情绪差,精力不足,认知功能下降,对长期服用抗癫癎药物的顾虑较多,社交、工作受限等;而TPM组的QOL虽然低于对照组(P<0.05),但在前5项的评分中明显高于AEDs组(P<0.05)。TPM组的发作频率明显低于AEDs组(P<0.05)。发作频率对癫癎患者QOL的影响较大,癫癎发作越频繁,QOL越差。结论 成年癫癎患者的QOL较正常人显著降低,TPM能提高癫癎患者的QOL,其改善QOL的作用主要是通过控制发作实现的。因此,合适的药物控制癎性发作是提高癫癎患者QOL的关键。     

重症肌无力伴发癫的临床研究

目的:探讨重症肌无力(MG)伴癫(EP)的发生率、机制与临床治疗。方法:回顾分析2000至2010年250例MG患者中EP的发生率。将8例MG伴发EP患者设为MG+EP组,242例不伴发EP的MG患者设为MG-EP组和200名正常体检者设为正常对照组。分析8例MG+EP组患者的临床治疗及实验检查结果。结果:250例MG患者中有8例(3.2%)有EP发作,其中MGⅡa型2例,MGⅡb型4例,MGⅢ型1例,MGⅣ型1例。癫发作类型:全身性强直-阵挛发作4例,复杂部分性发作4例,单纯部分性发作1例。脑脊液中IgG,MG+EP组明显高于MG-EP组及正常对照组(P<0.05),后两组组间差异无统计学意义(P>0.05),3组间血清中IgG差异无统计学意义(P>0.05)。MG+EP脑脊液检出抗乙酰胆碱受体抗体(AChR-Ab)。患者出现EP,单用抗癫药物(AEDs)治疗效果欠佳,EP发作在MG症状加重时频率增加,减轻时发作缓解,死亡2例。结论:①EP发作与MG的病情严重程度有关,与MG全身型可能相关;②MG+EP发作与脑脊液中IgG增高可能有关;③MG与EP相关的机制可能与脑内存在AChR-Ab有关。单用AEDs治疗效果欠佳,应同时加强MG的治疗。     

晚期糖基化终末产物受体与癫痫炎症机制相关性的研究

<正>癫痫是一种慢性疾病,反复发作和无端癫痫发作严重影响患者的生活质量。经典的抗癫痫药物(anti-epileptic drugs,AEDs)可以有效控制70%的患者的癫痫发作,但是它们都没有显示出预防或延缓癫痫发展的令人信服的效果~([1])。由于目前可用的AEDs主要是对症的,可以阻断癫痫发作,但     

CYP基因多态性与抗癫痫药物代谢相关性的研究进展

癫痫( epilepsy,EP)是一种常见的神经系统疾患,已成为重要的公共卫生问题[1].目前癫痫治疗仍以抗癫痫药物(antiepileptic drugs,AEDs)控制发作为主,通过规范的诊疗,大多数患者可以控制发作.但在癫痫的临床治疗过程中,作者发现AEDs的代谢存在较大的个体差异,即使患者发作类型相同,应用相同剂量的同种AEDs治疗,其血药浓度与疗效也相差甚远,有的患者用到最大耐受剂量时,仍不能控制发作,而有的患者应用常规剂量,就会出现严重的药物副作用.单核苷酸多态性(single nucleotide polymorphism,SNPs)是指同一物种不同个体基因组DNA等位基因序列存在差别的现象.诸多研究表明[2-5]:细胞色素P450( cytochrome P450,CYP)基因SNPs是影响多种AEDs代谢的重要因素,特别是CYP2C9与CYP2C19基因突变后会引起多种AEDs血药浓度升高,如苯妥英( phenytoin,PHT)、苯巴比妥(phenobarbital,PB)、丙戊酸(valproic acid,VPA)等,说明CYP基因SNPs影响多种AEDs的代谢,是导致AEDs个体代谢差异的重要原因.基于不同个体的特定基因型选择合适的药物剂量,以求达到临床个体化治疗的目的.本文将从与AEDs代谢相关的CYP基因SNPs及其对AEDs代谢的影响等几个方面做一综述.     

抗癫痫药与骨健康

现已明确癫痫患者可因发作跌倒，特别是抗癫痫药（AEDs）通过对维生素D、甲状旁腺素等影响而对骨代谢产生不良影响作用，使患者骨折危险性增加2倍以上。临床上应对长期服用AEDs的患者进行骨矿密度等监测，适当活动、补充维生素D、钙剂可改善患者骨健康，降低骨折发生率。     

抗癫痫药物对女性癫痫患者内分泌激素的影响

女性具有的生理特点及在社会中所承担的特殊角色给女性癫痫患者带来了更多需要特别关注的问题,尤其是内分泌问题。与正常女性相比癫痫患者更容易出现内分泌紊乱。现在的研究认为癫痫患者内分泌的变化与患者的癫痫发作类型、抗癫痫药物（AEDs）的使用均有密切联系。本文主要阐述AEDs对女性癫痫患者内分泌激素的影响,为临床上诊治女性癫痫患者和药物选择提供理论基础。     

精神分裂症和双相情感障碍住院患者家属的生活质量及社会支持状况

目的：探讨精神分裂症和双相情感障碍（躁狂发作或抑郁发作及混合发作）住院患者家属生活质量及社会支持状况。方法以精神分裂症和双相情感障碍住院患者的家属为研究对象,进行一般调查表（自制）、简明健康调查量表（SF－36）、社会支持评定量表（SSRS）等检测,并对结果进行统计分析。结果（1）精神分裂症和双相情感障碍住院患者家属生活质量的各项指标均低于全国平均水平,差异有统计学意义（P ＜0．01）。（2）精神分裂症和双相情感障碍住院患者家属社会支持总分与全国常模比较,差异无统计学意义（P ＞0．05）;患者家属文化程度越高,获得的社会支持情况越好,但差异无统计学意义（P ＞0．05）;双相情感障碍患者家人获得的社会支持状况好于精神分裂症患者家属,差异有统计学意义（ P＝0．049）。结论精神分裂症和双相情感障碍住院患者家属的生活质量令人担忧,这可能与疾病的特点有关。     

难治性癫(癎)的早期判断

难治性癫痫（intractable epilepsy，IE）是指经系统正规地应用2种以上抗癫痫药物（AEDs）治疗，且药物在体内达到有效浓度，并至少观察2年，发作仍然得不到有效控制。据统计30％癫痫患者经药物治疗后难以得到有效的控制，最终发展为IE。这些患者长期承受着由癫痫发作可能引起的各种并发症的巨大风险和长期无效AEDs治疗带来不必要的药物不良反应和经济损失。     

承德地区中青年癫痫患者规范诊疗前后的对比

目的对比分析中青年癫痫患者接受规范诊疗前后的现状,为在临床进一步推广其诊疗规程提供依据。方法采用方便抽样的方法,选取2008年8月～2010年12月来我院神经内科诊治的160例癫痫患者为研究对象,采用自身对照法分析患者诊疗前后癫痫发作频率、生活质量、肝功、家庭年收入等指标。结果由表1可知,在规范治疗前后患者的发作频率、个人年收入、治疗费用比较差异均有统计学意义（P〈0．01）,而且肝功正常的比例（97．5％）在规范治疗后也有了显著改善,差异有统计学意义（P〈0．01）。规范治疗前癫痫患者生活质量评分平均为（43．55±11．37）分,治疗后平均为（82．59±4．34）分,治疗前后比较差异有统计学意义（t=-41．92,P〈0．01）。结论规范诊疗对有效控制中青年癫痫患者的病情,提高其生活质量有至关重要的意义。     

心理干预对癫患者生活质量影响的研究

目的调查癫患者的生活质量,评价心理干预对癫患者生活质量的影响。方法对60例符合入选标准的癫患者和正常对照者60例,进行癫患者生活质量量表-31(QOLIE-31中文版)评估,并对癫患者进行心理干预,干预后6个月再次进行癫患者生活质量量表-31评估。结果癫组较对照组生活质量明显降低(P<0.01)。心理干预治疗后,癫组生活质量评分明显增高(P<0.05)。结论癫患者生活质量明显下降,只有加强包括药物治疗、心理治疗在内的综合治疗,才能真正提高癫患者的生活质量。     

The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study

PURPOSE: Cognitive deficits are one of the major limiting factors in the everyday life functioning of patients with focal seizures. Although cognitive rehabilitation methods have been successfully applied to patients with other central nervous system (CNS) lesions, these methods have not yet been evaluated in cognitively impaired patients with epilepsy. The present study evaluated the effectiveness of two commonly used methods for attention deficits: (a) the Retraining Method, aimed at retraining impaired cognitive functions; and (b) the Compensation Method, aimed at teaching compensatory strategies while taking neuronal loss for granted. METHODS: Fifty adult outpatients with focal seizures and attention impairments receiving carbamazepine (CBZ) monotherapy were randomly assigned to the Retraining Method, the Compensation Method, or to a waiting-list control group. Established and self-reported neuropsychological outcomes and self-reported quality of life of these groups were evaluated at pretraining, posttraining, and at a 6-month follow-up measurement point and were completed by 44 patients. RESULTS: Neuropsychological outcomes related to training, self-reported neuropsychological outcomes, and quality of life at the 6-month follow-up measurement point improved both in the Retraining Method group (n = 19) and the Compensation Method group (n = 17) relative to the waiting-list control group (n = 8). The Compensation Method was more effective in improving self-reported neuropsychological outcomes and quality of life, especially for patients with less education. The patients with active epilepsy benefited more from both methods than did the seizure-free patients. CONCLUSIONS: These data show that cognitive rehabilitation programs are effective for patients with focal seizures and attention deficits and should, therefore, be incorporated into comprehensive care programs.     

Overview and Perspectives of Employment in People with Epilepsy

Summary:  Even though it is now the viewpoint of the majority of professionals working in epilepsy care that most people with epilepsy should and can perform on the labor market as does anybody else, research tells a different story. Most figures concerning employment rates of people with epilepsy indicate that they do not perform as well on the labor market as others do. Although both research figures and research groups vary, generally unemployment rates are higher for people with epilepsy than for the general population. Early studies showed that the situation for people with epilepsy was rather grim. Later studies showed similar outcomes. Unemployment rates vary between groups and countries. Research shows that being employed is an important ingredient of the quality of life of people with epilepsy. The World Health Organization also recognizes the importance of employment as a part of social health, and therefore, improving the quality of life. It is important to know the perspectives on the labor market for people with epilepsy and what the possible problems are. I describe a Dutch research project and give an overview of the findings concerning the employment and consequent employability of people with epilepsy and questions pertaining to employment and epilepsy. Possible interventions [i.e., public education and employment programs for people with epilepsy with the aim to improve the (re)integration of people with epilepsy into the labor market, thus improving the quality of life of (potential) employees with epilepsy], are described extensively.     

Epilepsy stigma: Moving from a global problem to global solutions

Stigma and exclusion are common features of epilepsy in both the developed and developing countries and a major contributor to the burden associated with the condition. Reducing the stigma of epilepsy is key to reducing its impact and so improving quality of life. The social consequences of having epilepsy can be enormous, be it that they vary from country to country, based on cultural differences and economic circumstances. The most significant problems people with epilepsy encounter in daily life often are not related to the severity of the condition, but stem from concepts of epilepsy held by the general public.In this paper, I review the history of epilepsy and consider how different historical and cultural understandings of epilepsy have determined the experience of stigma for those affected by it. I consider how this history of stigma impacts on the position of people with epilepsy today, many of whom may still experience serious limitations to their enjoyment of economic, social and cultural rights and have many unmet needs in the areas of civil rights, education, employment, residential and community services, and access to appropriate health care. Finally, I will discuss some current initiatives aimed at addressed the issue of epilepsy stigma worldwide, which offer hope of an end to the social exclusion and prejudice which people with epilepsy have endured for so long.     

Research implications of the Institute of Medicine Report,Epilepsy Across the Spectrum: Promoting Health and Understanding

In March 2012 the Institute of Medicine (IOM) released the report, Epilepsy Across The Spectrum: Promoting Health and Understanding. This report examined the public health dimensions of the epilepsies with a focus on the following four areas: public health surveillance and data collection and integration; population and public health research; health policy, health care, and human services; and education for providers, people with epilepsy and their families, and the public. The report provided recommendations and research priorities for future work in the field of epilepsy that relate to increasing the power of data on epilepsy; prevention of epilepsy; improving health care for people with epilepsy; improving health professional education about epilepsy; improving quality of life for people with epilepsy; improving education about epilepsy for people with epilepsy and families; and raising public awareness about epilepsy. For this article, the authors selected one research priority from each of the major chapter themes in the IOM report: expanding and improving the quality of epidemiologic surveillance in epilepsy; developing improved interventions for people with epilepsy and depression; expanding early identification/screening for learning impairments in children with epilepsy; evaluating and promoting effective innovative teaching strategies; accelerating research on the identification of risk factors and interventions that increase employment and improve quality of life for people with epilepsy and their families; assessing the information needs of people with epilepsy and their families associated with epilepsy‐related risks, specifically sudden unexpected death in epilepsy; and developing and conducting surveys to capture trends in knowledge, awareness, attitudes, and beliefs about epilepsy over time and in specific population subgroups. For each research priority selected, examples of research are provided that will advance the field of epilepsy and improve the lives of people with epilepsy. The IOM report has many other research priorities for researchers to consider developing to advance the field of epilepsy and better the lives of people with epilepsy.     

Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional,correlational study

PurposeThe purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan.MethodsA cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy—31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support.ResultsScores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001–100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life.SignificanceOur study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.     

癫痫患者生活质量影响因素分析

目的 调查和分析影响癫痫患者生活质量的相关因素,为采取相应措施提高癫痫患者的生活质量提供理论依据.方法 选择自2007年7月至2008年12月在广州医学院第二附属医院癫痫中心就诊的门诊及住院癫痫患者65例,采用癫痫患者生活质量表-31(中文版)对患者进行问卷调查,以患者的年龄、性别、文化程度、发作类型、病程、认知功能、用药依从性、发作担忧作为自变量,以生活质量表-31(中文版)中相关评分作为应变量,多元线性回归分析应变量和自变量之间的线性关系.结果 文化程度、病程可以影响癫痫患者的记忆力(标准化回归系数分别为0.380、0.264);年龄可以影响患者的社会活动(标准化回归系数为-0.303);性别影响患者的发作(标准化回归系数为0.332).结论 影响癫痫患者生活质量的因素是年龄、性别、病程、文化程度等,且病程与文化程度影响最大.     

Sleep disturbances, socioeconomic status, and seizure control as main predictors of quality of life in epilepsy

Improving quality of life is the most important goal for patients with epilepsy. To recognize the factors associated with quality of life in patients with epilepsy in Mexico, we performed a cross-sectional survey using the Quality of Life in Epilepsy 31 (QOLIE-31) inventory to assess the quality of life of 401 adult patients with epilepsy at the National Institute of Neurology and Neurosurgery of Mexico. Clinical and demographical data were collected. Multiple regression was used to determine which factors affected quality of life in our patients. The variables that most strongly predicted a lower QOLIE-31 total score after multiple regression were sleep disorders (P<0.001), socioeconomic status (P<0.001), female gender (P=0.002), and high seizure frequency (P=0.001). In our study, neither depression nor time of evolution of epilepsy had significant influence on QOLIE-31 scores.     

The effect of self-management training on health-related quality of life in patients with epilepsy

PurposeEpilepsy is the most common chronic neurological disease after headache. Health-related quality of life in patients with epilepsy is disturbed by psychosocial factors, seizures, and treatment side effects. This study was conducted to determine the effect of a self-management training program on quality of life in patients with epilepsy.MethodsIn this controlled clinical trial, 60 patients with epilepsy going to Zanjan Neurology Clinic were examined. The samples were selected using convenience sampling and divided randomly into the case group (30 people) and control group (30 people) using the table of random numbers. Four training sessions on the nature of epilepsy and self-managementwere run for the case group. All the patients completed an inventory for quality of life twice: before and one month after the intervention. The data were analyzed using the chi-square test, independent t-test, and paired t-test.ResultsThere was no statistically significant difference between the two groups before the intervention in terms of personal specifications and scores and dimensions of the quality of life. One month after the intervention, a statistically significant difference was observed between the two groups in terms of the scores and dimensions of quality of life that indicated improved quality of life in the case group (P < 0.001).ConclusionThe self-management training program improved the quality of life in patients with epilepsy. The present findings highlight that psychosocial variables can have incremental significance over biomedical variables in the health-related quality of life of patients with epilepsy.