盐酸丁咯地尔注射液治疗缺血性脑血管病的临床观察

目的：评价国产盐酸丁咯地尔注射液治疗缺血性脑的疗效和安全性。方法：采用随机、对照和开放的试验设计。结果：盐酸丁咯地尔可显著改善缺血性脑血管病患者的自觉症状和降低神经功能缺损评分（P＜0．01），生活不能自理者由原来的29．2％下降为12．5％，与进口盐酸丁咯地尔相比差异无显著性（P＞0．05），不良反应发生率8．3％，结论：国产盐酸丁咯地尔注射液对改善缺血性脑血管病所致的运动功能障碍和提高生活能力有较好疗效，副作用少，与进口盐酸丁咯地尔注射液疗效相当。     

低分子肝素治疗急性缺血性脑血管病的临床观察

目的 观察低分子肝素治疗急性缺血性脑血管病的疗效。方法 通过分别使用低分子肝素及复方丹参注射液，随机开放性对200例急性缺血性脑血管病患者进行治疗，并比较两组的疗效。结果 低分子肝素组基本治愈率＋显效率79％，总有效率93％；对照组基本治愈率＋显效率59％，总有效率76％。低分子肝素治疗急性缺血性脑血管病的基本治愈率＋显效率以及总有效率明显高于对照组，两组比较差异有显著性（P＜0．01）。结论 低分子肝素治疗急性缺血性脑血管病疗效好，副作用小，安全可靠。     

2型糖尿病并发脑梗死诊治分析

目的观察2型糖尿病并发脑梗死患者的治疗效果及预后。方法对我科收治的48例2型糖尿病合并脑梗死住院患者的诊治情况进行归纳分析。结果经积极的治疗,大部分患者症状和体征基本消失,生活可自理,瘫痪肢体肌力在1级以上41例;症状和体征无明显改善,瘫痪肢体肌力在1级以下5例;死亡2例,1例为大脑半球大面积梗死,1例为恶性心律失常。结论 2型糖尿病并发脑梗死是多种因素共同作用的结果,临床上应积极控制血糖、血压、血脂等危险因素,合理膳食,改善生活习惯,提高生活质量,降低脑梗死的发生率、致残率、病死率。     

小剂量盐酸苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍临床分析

目的探讨小剂量苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍的临床疗效,以提高患者生活质量。方法对本科2005年至2012年收治的186例脑血管病假性延髓麻痹患者分为治疗组96例和对照组90例,遵照按脑卒中指南常规用药,治疗组在对照组治疗的基础上加用小剂量苯海索辅助治疗,治疗前后对患者进行标准吞咽功能评估(SSA)和洼田氏饮水试验评定。结果治疗组患者应用小剂量苯海索辅助治疗后有明显疗效,与对照组疗效差异有统计学意义(p<0.05)。结论小剂量苯海索辅助治疗能够更大程度的提高患者的吞咽功能,能改善患者的进食状况,提高患者的生活质量。     

缺血性脑卒中康复锻炼的效果观察

目的探讨康复锻炼对缺血性脑卒中患者的临床疗效及预后的影响。方法我院诊治的80例缺血性脑卒中患者,随机分为对照组（神经内科常规治疗和常规处理）和观察组（对照组基础上,进行早期肢体功能锻炼）,每组各40例,对2组患者Barthel指数评分和肌力进行检测,并进行比较。结果 与治疗前相比,治疗后2组患者Barthel指数评分都明显升高（P〈0.05）;治疗后与对照组（44.68±11.84）相比,观察组Barthel指数评分（64.24±12.14）明显升高（P〈0.05）。与治疗前肌力相比,治疗后观察组患者肌力明显升高（P〈0.05）;与治疗后对照组的上、下肢肌力〉Ⅱ级（47.5%和45.0%）相比,观察组上、下肢肌力〉Ⅱ级所占比例（82.5%和85.0%）明显升高（P〈0.05）。结论 脑卒中患者早期给予康复功能锻炼可明显促进患者的功能恢复,值得临床推广。     

东菱克栓酶治疗30例缺血性脑血管病的疗效观察

东菱克栓酶治疗３０例缺血性脑血管病的疗效观察刘毅金兴中裴少芳我们用东菱克栓酶治疗３０例缺血性脑血管病患者，并用５％低分子右旋糖酐加丹参静脉滴注治疗作为对照，现报道如下。一、临床资料：根据病史、体征，结合ＣＴ或ＭＲＩ确诊的６０例住院病例，随机分为东菱克...     

中青年人高血压脑出血的超早期手术治疗(附17例报告)

报告31～40岁中青年人高血压脑出血17例的超早期手术治疗。均在发病后7小时内手术。结果7例肢体、语言未遗留后遗症,6例肌力恢复至4级,生活能自理,3例肌力恢复至2～3级,生活需人照顾,死亡1例。超早期手术治疗,可在血肿压迫脑组织发生一系列病理改变之前清除血肿,解除脑受压,降低了死亡率(5.8％)和术后功能障碍。     

低能量He-Ne激光血管内照射治疗脑血管病360例报告

我院近一年来采用低能量Ｈｅ—Ｎｅ激光血管内照射治疗脑血管病３６０例，疗效满意，现报告如下：１临床资料 ３６０例脑血管病患者中男２００例，女１６０例，年龄最小２２岁，最大８６岁。脑梗死３１２例（其中脑Ａ炎８例），脑出血恢复期４８例。急性期（１５ ｄ内）２１６例。恢复期（１６ ｄ以上）１４４例。发病至入院时间最短 ５ ｈ，最长 ６年，轻偏瘫（肌力ＩＶ级以上）１３２例，中度偏瘫（肌力Ｉ－ＩＩ级）１６０例，重度偏瘫（肌力０级）６８例，合并高血压３０６例，低血压２３例，糖尿病１２６例，冠心病１０８例，心律失常７…     

高同型半胱氨酸血症对急性脑梗死短期预后的影响

目的探讨高同型半胱氨酸血症(HHcy)与急性脑梗死患者短期预后之间的关系。方法测定165例急性脑梗死患者空腹血浆Hcy浓度,将患者分为HHcy组和非HHcy组,并在其入院时和治疗14d后进行改良Rankin量表(MRS)评分。结果入院时非HHcy组和HHcy组患者MRS评分中生活自理(MRS评分≤2分)人数和不能自理(MRS评分≥3分)人数的百分比之间无统计学差异(P>0.05),经相同药物治疗14d后,非HHcy组患者中生活自理人数的百分比较HHcy组患者显著升高(P<0.01),不能自理人数的百分比较HHcy组患者显著降低(P<0.01),非HHcy组患者中生活不能自理得到改善人数的百分比较HHcy组患者也显著升高(P<0.01)。结论HHcy组急性脑梗死患者的短期预后比非HHcy组差,降低HHcy对于缺血性脑血管病具有重要的预防和治疗意义。     

中西医结合治疗缺血性脑卒中50例疗效分析

缺血性脑血管病是临床上比较常见的脑血管病之一,发病率呈逐年增高趋势,如不及时治疗,致残率和致死率较高,可遗留偏瘫、失语等后遗症,严重影响患者生活质量,给家庭和社会增加负担。我院2012-09—2013-02采用中西医结合治疗缺血性脑卒中患者50例,疗效显著,现报告如下。1资料与方法1.1一般资料选取2012-09—2013-02我院收治缺血性脑卒中患者100例,均符合1995年全国第4届脑血管病学术     

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.     

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.     

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.     

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.     

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.     

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.