癫痫猝死研究进展

癫痫猝死(SUDEP)的发病机制及危险因素的研究可以帮助我们更好的认识和预防SUDEP.目前关于SUDEP发病机制可能有:心律失常、自主神经功能异常、癫痫发作相关性呼吸衰竭以及发作后大脑电活动广泛抑制等.发病风险包括:男性病人、年轻患者、慢性癫痫、频繁癫痫发作、多种抗癫痫药物的应用及夜间癫痫发作等.本文就SUDEP研究进展作一综述,以期降低癫痫患者的猝死率.     

体育运动对癫痫猝死症的影响：并非单纯运动

癫痫猝死（sudden unexpected deathin epilepsy，SUDEP）是癫痫患者最重要的直接与癫痫相关的死亡原因。其潜在病理机制尚未阐明，但癫痫发作时和发作间期的心律失常，电解质紊乱，致心律失常药物或癫痫电活动通过自主神经系统向心脏的传导，很可能与SUDEP的发病机理有关。引人注意的是，临床和实验数据都显示体力活动可以降低癫痫发作频率，并促进癫痫患者的心血管健康。基于上述情况，本文综述了体育锻炼可能预防SUDEP发生的相关文献内容。     

体育运动对癫痫猝死症的影响：并非单纯运动

癫痫猝死(sudden unexpected death in epilepsy,SUDEP)是癫痫患者最蓖要的直接与癫痫相关的死亡原因.其潜在病理机制尚未阐明,但癫痫发作时和发作间期的心律失常,电解质紊乱,致心律失常药物或癫痫电活动通过自主神经系统向心脏的传导,很可能与SUDEP的发病机理有关.引人注意的足,临床和实验数据都显示体力活动可以降低癫痫发作频率,并促进癫痫患者的心血管健康.基于上述情况,本文综述了体育锻炼可能预防SUDEP发生的相关文献内容.     

癫痫猝死的研究进展

癫痫患者可在没有任何结构性病理改变的情况下发生猝死，大多数癫痫猝死（SUDEP）可能与癫痫发作有关。其发生率在癫痫患者群体中为〈1／1000人年，难治性癫痫组其猝苑发生率达1／250人年。潜在危险因素包括癫痫发作未得到控制、治疗和监护不当等因素。其发病机制与呼吸和循环方面的异常有关，通过有效的监护可改善其呼吸状况。快速和过缓性心律失常，停搏在癫痫发作时并不少见，其基因易感性与SUDEP的潜在关系有待进一步深入研究。     

癫痫猝死研究进展

近年来的研究发现癫痫猝死(SUDEP)可能有以下危险因素:①癫痫发作控制不佳;②发作后脑电图全导电抑制和围发作期心电图改变;③合并某些遗传代谢性疾病或存在代谢障碍;④和长QT间期综合征相关的离子通道基因发生变异;⑤外部气温偏低及月相的变化。全面了解SUDEP的危险因素及发病机制可为临床癫痫患者的诊治提供强有力的指导和帮助。     

癫痫猝死的研究进展

癫痫猝死(sudden unexpected death in epilepsy,SUDEP)是癫痫患者突然发生的无法解释的死亡,一般认为大部分SUDEP与癫痫发作有关.其发病机制仍不明确,现对SUDEP的相关文献进行系统综述,旨在提高对该现象的认识并促进其研究.     

癫痫性猝死之管见

<正>癫痫性猝死（sudden unexpected death in epilepsy,SUDEP）是癫痫患者整体死亡风险较普通人群显著增高的重要原因，由SUDEP所致的癫痫性死亡已成为重大公共卫生问题。笔者检索国内文献发现，目前关于SUDEP的报道甚少，有关SUDEP命名不一，如“癫痫不明原因猝死”、“癫痫患者突然意外死亡”、“癫痫猝死”等。随着长程视频脑电监测的普及、基因检测技术及分子水平尸检的开展等，人们对SUDEP有了进一步认识，有必要再次探讨SUDEP的科学定义和解读，这对未来研究SUDEP具有重要意义。癫痫性猝死的概念由Nashef于1997首次提出。为了方便临床应用，2012年再次对其重新修订。     

迷走神经刺激术治疗药物难治性癫痫伴发抑郁的研究进展

正癫痫是一种慢性反复发作性疾病,其病程及治疗时间均较长,其中约有30%的患者在经过2~3年以上口服抗癫痫药物的正规治疗后仍不能有效的控制住癫痫发作,这种药物难治性的癫痫患者在长时间发病期间极易造成精神心理障碍,其中最常见的就是抑郁症。癫痫合并抑郁后会增加致痫性,加速疾病进程,而癫痫的反复发作又会使抑郁症逐渐加重,造成恶性循环。迷走神经刺激术(vagus nerve stimulation,VNS)作为一种治疗药物难治性癫痫的新     

难治性癫痫的MRI改变探讨

目的 探讨磁共振成像(MRI)对难治性癫痫患者病因诊断的价值及其对治疗的指导作用。方法 分析212例难治性癫痫患者的临床和MRI资料。结果 (1)212例难治性癫痫患者中，118例MRI有改变，异常发现阳性率为55．7％(118／212)，揭示的病因共7种，其中以脑软化、脑发育异常多见；(2)不同发作类型的MRI改变阳性率不同；(3)不同发作类型的MRI改变所揭示的病因不同；(4)不同年龄组难治性癫痫患者MRI改变所揭示的病因不同。结论 头颅MRI扫描对难治性癫痫的病因诊断有重要意义，可为难治性癫痫确定治疗方向和选择治疗方法提供可靠依据，对判断难治性癫痫的预后有一定的指导意义。     

癫痫猝死的危险因素及预防

<正> 癫痫患者的死亡率是健康人群的2～5倍。癫痫猝死(sudden unexpected death in epilepsy,SUDEP)是癫痫最常见的直接死因,常发生于慢性癫痫患者。1 SUDEP 的诊断及发生率 SUDEP是突然的     

Paediatric epilepsy surgery in the posterior cortex: a study of 62 cases

Past surgical series have emphasized the diagnostic complexity of posterior cortex epilepsy. Available data are sparse, especially in children, and most published series report a high number of surgical failures and post‐operative neurological deficits. In this article, we present a paediatric cohort of 62 children who underwent surgery for drug resistant posterior cortex epilepsy before the age of 16 years with a mean post‐operative follow‐up of 6.94 years (range: 2–16). Mean age at epilepsy onset was 3.2 years and 28 children (45%) had onset before 1 year of age. The mean age at surgery was 7.9 years (range: 1–16). Daily seizures were present in 63% of children. MRI was positive in 58 cases (93.5%) and invasive stereo‐EEG was judged mandatory in 24/62 (39%) of patients. Surgery was confined to the parietal lobe in 11 children, the occipital lobe in 8, the occipito‐parietal region in four, the occipito‐temporal region in 18, and involved both the temporal and parietal lobes in the remaining 21. Following surgery, 53 subjects (85.5%) remained seizure‐free and among those who underwent a SEEG procedure, 75% achieved seizure freedom. Focal cortical dysplasia was the most frequent histopathological diagnosis (50%), followed by tumoural (24%) and gliotic lesions (14.5%). An older age at epilepsy onset, the presence of a rather restricted epileptogenic area, and a complete resection of the epileptogenic zone were predictive of a favourable surgical outcome. These results demonstrate that a good surgical outcome is possible in children with drug resistant posterior cortex epilepsy. Accurate analysis of the chronology of ictal semiology and electrophysiological features, viewed in the context of the complete electroclinical pattern, provides a topographical orientation for posterior cortex epilepsy and, together with the presence of a lesion detectable on imaging, may improve the rate of surgical success of posterior cortex epilepsy at paediatric age.     

MicroRNAs and target genes in epileptogenesis

Epilepsy is a chronic brain dysfunction. Current antiepileptic medicines cannot prevent epileptogenesis. Increasing data have shown that microRNAs (miRNAs) are selectively altered within the epileptic hippocampi of experimental models and human tissues, and these alterations affect the genes that control epileptogenesis. Furthermore, manipulation of miRNAs in animal models can modify epileptogenesis. As a result, miRNAs have been proposed as promising targets for treating epilepsy. We searched PubMed using the terms “microRNAs/miRNAs AND epilepsy”, “microRNAs/miRNAs AND epileptogenesis”, and “microRNAs/miRNAs AND seizure”. We selected the articles in which the relationship between miRNAs and target gene(s) was validated and manipulation of miRNAs in in vivo epilepsy models modified epileptogenesis during the chronic phase via gene regulation. A total of 13 miRNAs were found in the present review. Based on the current analysis of miRNAs and their target gene(s), each miRNA has limitations as a potential epilepsy target. Importantly, miR-211 or miR-128 transgenic mice displayed seizures. These findings highlight new developments for epileptogenesis prevention. Developing novel strategies to modify epileptogenesis will be effective in curing epilepsy patients. This article provides an overview of the clinical application of miRNAs as novel targets for epilepsy.     

Ictal EEG patterns in epilepsy with centro-temporal spikes

Purpose: To describe the EEG pattern of seizures in patients with benign childhood epilepsy with centro-temporal spikes (BCECTS). Methods: The clinical and EEG data of 701 BCECTS patients with at least a 3 years follow-up were reviewed from 10 epilepsy centers. Results: Thirty-four seizures were recorded in 30 patients. Four different ictal EEG patterns (A-D) were identified. The most frequent (pattern A) was characterized by low voltage activity of fast rhythmic spikes, increasing in amplitude and decreasing in frequency, and occurred in 14 children. Pattern B (six patients) was constituted by a discharge of spikes intermixed with sharp waves increasing in frequency and amplitude. Pattern C (seven children) consisted of monomorphic theta which progressively formed a discharge increasing in amplitude and decreasing in frequency. Pattern D (5 children) was characterized by a initial focal depression of the electrical activity, followed by one of the three above described patterns. In 21 out of 28 children, the initial ictal pattern, altered from one pattern to another one. No clinical or EEG feature was predictive of a specific ictal pattern. Discussion: We failed to identify a unique ictal EEG pattern in our patients with BCECTS. The occurrence of per-ictal features, e.g., initial EEG depression or post-ictal slowing, is common and should not be interpreted with prejudice. Alteration of ictal EEG pattern from one to another is not in conflict with the diagnosis of BCECTS.     

Intraoperative electrocorticography in epilepsy surgery: useful or not?

Intraoperative electrocorticography (ECoG) has been traditionally used in the surgical management of medically refractory partial epilepsies to identify the location and limits of the epileptogenic area, to guide the extent of resection, and to assess its completeness. Although in clinical use for many years, the basic questions regarding indications and limitations of this method has remained unanswered. ECoG plays a major role in tailored temporal lobectomies, whereas, it serves no practical purpose in standard resection of medial temporal lobe epilepsy (TLE) with magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS). Residual hippocampal spikes, unaltered by resection, correlate with a greater proportion of seizure recurrence. Intraoperative hippocampal ECoG can allow sparing of functionally important hippocampus, thus minimising postoperative memory decline. ECoG eminently aids removal of developmental malformations of brain, and most importantly, the excision of highly epileptogenic cortical dysplasias (CDs) for deciding the extent of resection for best seizure control. The ECoG can be a valuable tool during multiple subpial transections (MST).     

Big data in epilepsy: Clinical and research considerations. Report from the Epilepsy Big Data Task Force of the International League Against Epilepsy

Epilepsy is a heterogeneous condition with disparate etiologies and phenotypic and genotypic characteristics. Clinical and research aspects are accordingly varied, ranging from epidemiological to molecular, spanning clinical trials and outcomes, gene and drug discovery, imaging, electroencephalography, pathology, epilepsy surgery, digital technologies, and numerous others. Epilepsy data are collected in the terabytes and petabytes, pushing the limits of current capabilities. Modern computing firepower and advances in machine and deep learning, pioneered in other diseases, open up exciting possibilities for epilepsy too. However, without carefully designed approaches to acquiring, standardizing, curating, and making available such data, there is a risk of failure. Thus, careful construction of relevant ontologies, with intimate stakeholder inputs, provides the requisite scaffolding for more ambitious big data undertakings, such as an epilepsy data commons. In this review, we assess the clinical and research epilepsy landscapes in the big data arena, current challenges, and future directions, and make the case for a systematic approach to epilepsy big data.