AMT法对接受长期药物治疗癫痫病人的倦睡评价

用一种新构建的脑电图检查方法在控制条件下探讨长期接受抗Ｊｉａｎ药治疗是否削弱了癫Ｊｉａｎ病人维持觉醒的能力。发现接受抗Ｊｉａｎ治疗的病人平均总倦睡时间为１０１ｓ，两个对照组均≤１２ｓ。该时间与测量方法无关。     

抗癫药物对妊娠癫癎患者子代的致畸风险

目的:旨在评估抗癫癎药物(AEDs)对妊娠癫癎患者子代出现先天畸形的风险。方法:对妊娠癫癎患者采用登记和随访研究,分析其孕期AEDs用药情况、癫癎发作、妊娠结局及子代出现畸形的风险。结果:入选105例妊娠癫癎患者。服用AEDs患者79/105例(75.2%),未服用AEDs患者26/105例(24.8%)。单药治疗60/79例(75.9%),其中1/60例(1.7%)流产;患者子代中2/60例(3.3%)先天性畸形(1例服用卡马西平,出现先天性心脏动脉导管未闭;1例服用拉莫三嗪,出现无胚心)。联合用药19/79例(24.1%),子代无先天畸形出现。未服用AEDs患者中有2/26例(7.7%)流产,其余患者子代未出现先天畸形。结论:妊娠癫癎孕妇多数于孕期仍服用AEDs,且以单药治疗居多;使用AEDs(分别为卡马西平和拉莫三嗪)患者子代出现2例先天性畸形;丙戊酸钠易致畸但仍在妊娠癫癎中经常使用,本研究中服用丙戊酸钠孕妇未出现子代先天性畸形。     

奥卡西平治疗癫癎的临床分析

目的　评价奥卡西平 (oxcarbazepine ,OXC)的安全性和疗效。方法　对 47例癫病人采取单用和加用OXC治疗 ,其中2 5例未经治疗 ,2 2例用一线药物治疗无效。 6例随访 4个月 ,41例随访 6个月。结果　①应用OXC后 2、4、6个月发作频率均明显减少 (P <0 .0 1)。②单用组发作消失者为 3 2 .0 % ,合用组为 9.1% (P <0 .0 1)。③不同发作类型的疗效相似。④维持量与疗效无关。⑤9例 (19.1% )出现较轻的副反应 ,除 1例需停药外 ,另 8例均自行消失。结论　OXC单用或合用对各类型发作均有较好的疗效 ,副反应少且程度低 ,耐受性好。     

抗癫癎药物致癎作用的临床观察

目的研究抗癫癎药物(AEDs)的致癎作用及对其的预防和治疗.方法总结32例AEDs致癫癎发作加重患者的临床资料.结果32例中以服用卡马西平最多(19.12%)、次之为巴比妥类药物(15%)、苯妥英钠(14.5%)、合并用药(14.29%)、苯二氮( )类(8.69%)、丙戊酸钠(2.78%).32例经停药并合理选择其他抗癫癎药物及减少药物剂量治疗,27例有效,5例无效.结论AEDs能致癫癎发作加重,应合理选择抗癫癎药物.     

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。     

长期抗痫药治疗对癫痫病人维持觉醒能力的影响

目的： 探讨长期抗痫药治疗是否削弱了癫痫病人维持觉醒的能力。方法： 用一种新构建的脑电图检查方法, 在控制条件下测量非刺激时间内病人维持觉醒的能力。并进行听力反应时间、精神状态全貌和标准睡眠评分测定。测量方法相互比较。结果： 接受抗痫药治疗的病人平均总倦睡时间为１０１ 秒, 两个对照组均≤１２ 秒 （Ｐ＜ ０．００１）。该时间与测量方法无关。未治疗的癫痫病人尽管脑电图缺乏倦睡时间, 但更多地抱怨无精打采。结论： 长期抗痫药治疗削弱了癫痫病人维持觉醒的能力, 病人对服药后对倦睡的抱怨可能不精确地说明了该问题。     

耐药性颞叶癫癎的研究进展

1耐药性癫?的概述
　　癫?是多种原因所致的慢性脑部疾病,其特征为脑部神经元异常过度放电引发身体某一部分或整个肢体非自主性抽搐,有时伴有意识丧失和尿便失禁。世界卫生组织的数据表明,全球约有5000万癫?患者［1］,而我国就有癫?患者900万人,且每年新增癫?患者40万人［2］。癫?在卫生保健需求、过早死亡以及丧失工作生产力方面给社会经济带来严重的负担。     

无影像学病灶顽固性癫癎病人的手术治疗

目的探讨脑MRI与CT为阴性的顽固性癎癫病人的手术治疗及术前评估时应注意的问题。方法回顾性分析MRI及CT为阴性表现的22例癫癎手术病人的资料,按照Engel疗效分级标准,将其效果分为满意组(10例)与非满意组(12例),对两组的术前检查情况进行对比。结果手术后整体满意率为45%。发作间期头皮EEG癫癎波局限在单一脑叶者,满意组中多于非满意组;颅内电极发作期脑电图局限性起源者,满意组中多于非满意组;单光子发射断层显像(SPECT)报告结果与手术部位关系各指标比较,两组无显著性差异;单脑叶切除术者,满意组中多于非满意组。结论MRI为阴性的癫癎手术效果不如病灶性癫癎。术前头皮视频脑电图(VEEG)发作间期性波局限在单一脑叶者治疗效果优于非局限者。手术前评估除重视各项非侵袭性检查外,颅内电极检查往往是不可缺少的。发作间期SPECT目前还不能做为一项决定性的定位手段。多脑叶切除手术效果不优于单脑叶切除,手术的关键是致灶的彻底切除。     

53种抗癫癎中成药的成分分析

目的：检测部分抗癫痫中成药中是否含有西药抗癫痫药物的成分。方法：用高效液相色谱法测定53种抗癫痫中成药中是否含有苯巴比妥、苯妥英钠、卡马西平和丙戊酸钠。结果：83.01%中成药中测出含有苯巴比妥、苯妥英钠、卡马西平和丙戊酸。结论：市场上大量未标明含有抗癫痫西药成分的中成药,严重影响癫痫用药安全。     

抗精神病药所致癫癎

对我院住院患者中抗精神病药致癫疒间者进行分析。1一般资料为1991年至2005年在我院住院精神疾病患者1 523例,其中抗精神病药致癫疒间37例;男26例,女11例;年龄15~46岁,平均(25·0±7·4)岁;既住有癫疒间发作史2例,脑炎病史4例,颅脑外伤6例。服用氯氮平22例,平均剂量425 mg/d,平     

Assessment of Drowsiness in Epilepsy Patients Receiving Chronic Antiepileptic Drug Therapy

Drowsiness is a common complaint among patients with epilepsy taking antiepileptic drugs (AEDs) and may be of particular importance because of the potential effects on cognitive abilities. We used a novel EEG-based measure (the Awake Maintenance Task, AMT) to determine objectively whether patients on chronic, stable AED therapy had impaired ability to maintain wakefulness. Thirty patients receiving AEDs [carbamazepine (CBZ), phenytoin (PHT), phenobarbital (PB), valproate (VPA)] were compared to 35 healthy controls, 12 seizure patients not taking AEDs, and 16 patients with multiple sclerosis. A structured EEG recording was conducted under controlled conditions, and subjects were tested to determine their ability to maintain wakefulness during a 6-min unstimulated trial. Testing also included Digit Symbol, auditory reaction time, and subjective measures of fatigue or sleepiness [Profile of Mood States (POMS), Stanford Sleepiness Scale (SSS)]. Patients receiving AEDs had a mean total drowsiness score of 101 s compared with ≤ 12 s for each of the three control groups (p < 0.001). One third of the AED-treated patients had >120 s of drowsiness, in contrast to only 1 of 63 controls (p < 0.001). Among patients receiving AEDs, objective EEG drowsiness did not correlate with AED levels or performance measures. Untreated seizure patients had significantly greater complaints of lack of vigor despite a near absence of objective drowsiness on the AMT. These results suggest that epilepsy patients receiving chronic AED therapy have impaired ability to maintain wakefulness. Patient self-reports of AED-related sleepiness may not accurately represent this problem.     

Outcome After Discontinuation of Antiepileptic Drug Therapy in Children with Epilepsy

We studied recurrence risks and predictive factors of relapse after antiepileptic drug (AED) discontinuation in a prospective analysis of 425 children with epilepsy who had not had a seizure for at least 2 years (follow-up after withdrawal 1.6-12 years, mean 8 years). Factors closely related by multivariate analysis to relapse were neurologic abnormalities, mental retardation, seizure type (infantile spasms, absence seizures), and appearance or persistence of EEG abnormalities during the course of the illness and before discontinuation. When multivariate analysis was performed to evaluate outcome of patients with a first relapse (isolated vs. multiple relapses), the variables closely related to a poor prognosis were etiologic factors, first relapse characterized by more than one seizure in a 24-h period, seizure-free period less than 4 years, unchanged seizure type at first relapse, more than one AED for seizure control, and abnormal EEG before the first relapse. In itself, resumption of therapy did not influence outcome. At the study cutoff point, 88% of patients with relapse were again seizure-free. We conclude that AEDs can safely be discontinued if predictive factors are considered to individualize the risk of relapse for each patient.     

Therapy for Neurobehavioral Disorders in Epilepsy

Summary:  Neurobehavioral disorders commonly affect patients with epilepsy. In addition to the behavioral changes during and immediately after seizures, the epileptogenic disorder of function often extends further into the postictal and interictal period. Cognitive impairments commonly affect attention, memory, mental speed, and language, as well as executive and social functions. Reducing seizure frequency and the antiepileptic drug burden can reduce these problems. Attentional deficits may respond to therapies for attention-deficit/hyperactivity disorder, but apart from patients with this comorbid disorder, their efficacy is unproven in other epilepsy patients. No effective therapies are established for other cognitive problems, but pragmatic, compensatory strategies can be helpful. Behavioral disorders include fatigue, depression, anxiety, and psychosis. Many of these disorders usually respond well to pharmacotherapy, which can be supplemented by psychotherapy. Cognitive and behavioral disorders can be the greatest cause of morbidity and impaired quality of life, often overshadowing seizures. Yet these problems often go unrecognized and, even when identified, are often undertreated or untreated.     

Response to Antiepileptic Drug Therapy: Winners and Losers

Summary:  Recent evidence suggests that the vast majority of people with epilepsy will respond to their first or second treatment regimen or will be refractory de novo. Two patients with symptomatic epilepsy secondary to underlying cortical dysplasias are presented to illustrate these different scenarios. Clinical observations can provide insights to the processes underlying pharmacoresistance.     

Assessment of CNS effects of antiepileptic drugs by using quantitative EEG measures

PURPOSE: Antiepileptic drugs (AEDs) can be associated with adverse neurologic effects including cognitive dysfunction. Objective methods for recognizing AED effects on the brain could be valuable for long-term management. We compared quantitative EEG measures and cognitive tests in a group of patients beginning or ending AED therapy. METHODS: Subjects included 20 patients beginning AED therapy (AEDon), 12 patients stopping AED therapy (AEDoff), 33 patient controls receiving stable AED therapy (AEDco), and 73 healthy controls (Nco). All subjects underwent structured EEG recording and a cognitive test battery before change in AED dose and again 12-16 weeks later, >or=4 weeks after the last dose change. Four occipital EEG measures (peak frequency, median frequency, relative theta and delta power) were analyzed. Cognitive test changes were scored by using test-retest regression equations based on the Nco subjects. Wilcoxon tests were used for two-group comparisons. RESULTS: AEDons had a significant decrease, and AEDoffs, a significant increase in the peak frequency of the EEG rhythm, as compared with controls. Results for median frequency and theta power were similar. Change in the EEG peak frequency correlated with an aggregate cognitive change measure (r2= 0.71; p < 0.001), individual cognitive measures, and subjective complaints. Of the combined AEDon/AEDoff patients, 58% exceeded the 95% confidence interval for test-retest change in EEG peak frequency. CONCLUSIONS: Quantitative measures derived from the occipital EEG are sensitive to AEDs and correlate with AED-related cognitive effects and subjective complaints. Although this correlation does not indicate a direct relation, quantified EEG may be a practical measure of AED impact on the brain.     

Reappraisal of Polytherapy in Epilepsy: A Critical Review of Drug Load and Adverse Effects

Summary: Purpose: We reviewed the literature to determine whether an analysis of published data could clarify the relationship between antiepileptic drug (AED) polytherapy and adverse affects (AE). We highlight the problems encountered. Methods: We made a Medline-search for articles published between 1974 and 1994 reporting the number of AE and doses or serum levels of every AED, per patient or treatment group, and used the PDD/DDD ratio to calculate AED load per patient from doses or the OSL/AToxL ratio to do so from serum levels of individual drugs. The PDD/DDD is the sum of ratios of the actual prescribed daily doses divided by the published average therapeutic dose of each drug. The OSL/AToxL is the sum of each observed serum level divided by its average toxic level. Results: We retrieved 118 trial reports. Most had to be excluded because of incomplete reporting of concomitant medication or AE. The data of the 15 articles selected for further analysis indicate a relationship between drug load and number of AE. We noted no relationship between the number of AEDs administered and AE. In add-on studies, the difference in neurotoxicity between the active and placebo arm may be obscured if the relative increase in drug load is small, as exemplified by the study of McGuire et al. (35). Conclusions: Articles reporting add-on trials of new AEDs generally do not provide detailed information about the basic medication to which the new AED is added, which makes calculation of total drug load impossible. Furthermore, often only frequency of AE is reported, not severity or development of tolerance, making it difficult to judge the impact of AE. However, despite the paucity of available information, we present some evidence that toxicity in AED polytherapy may be related to total drug load, rather than to the number of drugs administered. Therefore, the present trend to reject polytherapy for fear of increased toxicity is not warranted, which removes one of the objections to initiating specific research to prove or disprove the value of AED combinations as long as the drug load is appropriate.     

Paradoxical Normalization in Childhood Epilepsy

Summary: We report 5 children aged 2·5 to 9 years with refractory epilepsy who, in the wake of a change in anti-epileptic drug (AED) regimen, developed paradoxical normalization (PN). Their acute psychiatric symptoms were associated with abrupt seizure cessation and normalization of the EEG. The latency periods between first seizure and advent of psychosis ranged from 1·9 to 7·0 years. Behavioral manifestations were schizophrenialike psychosis in 1, autistic withdrawal in 3, and organic mental syndrome not otherwise specified in 1. PN has heretofore been reported only in adolescents and adults after prolonged periods of poorly controlled seizures. The hypothesized precipitating factors relate to drug-induced changes in neurotransmitter systems.