神经传导检测在Bell麻痹预后判断中的价值

目的:探讨神经传导检测在Bell麻痹预后判断中的价值.方法:对发病10～21 d的56例Bell麻痹患者进行神经传导检测和F波检查,以随访3个月时患者的House-Brackmann分级结果来判断神经传导检测的价值.结果:预后好组和预后差组患侧面神经复合肌动作电位(CMAP)波幅分别为1.15(0.90,1.60)mV和0.20(0.13,0.40)mV,远端运动潜伏期(DML)分别为2.70(2.40,3.00)ms和3.00(2.85,3.68)ms,波幅下降比分别为(31.14±18.47)%和(79.03±13.14)%,F波出现率分别为25.00(15.00,30.00)%和5.00(0.00,15.00)%,两组比较差异有显著意义.结论:虽然神经传导检测和F波是评价面神经功能的敏感方法,但是CMAP波幅、DML并不适合作为Bell麻痹的预后判断指标,F波出现率也可能不可靠,患侧波幅下降比仍然是判断预后的较好指标.     

表面肌电生物反馈疗法对小儿Bell's麻痹面肌功能恢复的观察

目的观察表面肌电生物反馈疗法对小儿Bell's麻痹的疗效。方法选取Bell's麻痹的患者60例,随机分为对照组和治疗组。其中对照组30例,治疗组30例。对照组患者给予常规神经内科药物治疗:包括泼尼松,维生素B_1、甲钴胺等药物。治疗组患者在对照组治疗基础上加用表面肌电生物反馈治疗,应用肌电图(EMG)检测两组患者患侧面神经从茎乳孔到眼轮匝肌及口轮匝肌部位的潜伏期及波幅的变化,并于治疗前后进行H-B分级评定。结果两组患者于治疗前后患侧面神经潜伏期及波幅有显著性变化。H-B分级比较有显著提高。并且治疗组优于对照组。结论采用表面肌电生物反馈治疗能有效改善面瘫症状,改善面肌肌力,促进面神经麻痹侧面神经功能的恢复。     

神经电生理检测指标对周围性面神经麻痹的预后判断价值

目的探讨电生理检测指标评价周围性面神经麻痹患者预后的作用,为早期制定理想的治疗策略提供依据。方法对发病20 d内的109例周围性面神经麻痹患者行面神经电生理检测,经0.5~3年随访,以House-Brackmann分级评价电生理指标对预后的判断价值。结果 109例患者中,预后差组20例,预后好组89例。预后差组和预后好组电生理指标比较:1面神经传导远端潜伏期分别为(3.55±0.65)ms、(2.82±0.36)ms;2 M波波幅分别为(0.72±0.58)mV、(2.22±0.89)mV,波幅下降比值分别为(71.45±22.94)%、(25.55±20.56)%;3 F波消失率分别为85.00%(17/20例)、21.35%(19/89例),各组间比较差异有统计学意义。以F波是否能引出评价预后的准确度为79.82%,以波幅下降比值是否90%评价预后的准确度为85.32%,两种诊断方法经配对卡方检验,差异有统计学意义。结论面神经复合动作电位波幅下降比值及F波均可作为面神经麻痹预后判断的电生理指标,波幅下降比值判断预后的准确度优于F波。     

瞬目反射与面神经电图对面神经麻痹预后评估的价值

目的:探讨瞬目反射(BR)、面神经电图检测在面神经麻痹患者早期诊断和预后评估中的价值.方法:对64例面神经麻痹患者在7d内(A组)和8～15 d(B组)时分别进行BR、面神经电图检测.结果:患侧R1、R2',健侧R2’缺如者37例,其余27例患侧R1、R2',健侧R2'波潜伏期延长,异常率为100％;患侧面神经运动传导潜伏期延长,波幅降低,与健侧比较差异有显著意义(P＜0.01),发病7d内异常率为58％.结论:BR测定是诊断面神经麻痹的敏感指标,同时结合面神经电图可全面客观地评价面神经损害的程度和预后.     

瞬目反射与面神经电图对面神经麻痹预后评估的价值

目的探讨瞬目反射(Blink Reflex,BR)、面神经电图(Facial Nerve Conduction,FNC)检测在面神经麻痹患者早期诊断和预后评估的价值。方法对64例面神经麻痹患者在7d(A组)和8~15d(B组)时分别进行BR、FNC检测。结果患侧R1、R2,健侧R2’,缺如者37例,其余27例患侧R1、R2,健侧R2’波潜伏期延长,异常率为100%;患侧面神经运动传导潜伏期延长,波幅降低,与健侧比较差异有显著性(P<0.01),发病7d内异常率为57.5%。结论 BR测定是诊断面神经麻痹的敏感指标,同时结合FNC可全面客观地评价面神经损害的程度和预后。     

面神经炎治疗前后神经电生理变化的临床研究

目的观察面神经炎治疗前后神经电生理变化。方法以2013-01—2016-12在聊城市人民医院脑科医院接受治疗的84例面神经炎患者为研究对象,分别于治疗前后检测患者面神经电图和瞬目反射,并进行患侧与健侧比较。结果治疗后较治疗前House-Brackmann分级明显改善(P0.05),面肌功能评分明显升高(P0.05)。治疗前,患侧较健侧R1、R2、R2’波潜伏期均明显延长(P0.05);治疗前,患侧较健侧面神经电图潜伏期及瞬目反射R1、R2、R2’波潜伏期均明显延长(P0.05),面神经波幅明显降低(P0.05);治疗后,患侧面神经电图潜伏期及R1、R2、R2’波潜伏期较治疗前均明显缩短(P0.05),面神经波幅明显增大(P0.05),且与健侧比较无显著差异(P0.05)。结论神经电生理检测或许有助于面神经炎诊断,病情严重程度评估,并对预后判断有指导作用。     

长期应用A型肉毒毒素对面神经电生理功能的影响

目的 探讨长期应用A型肉毒毒素治疗面肌痉挛对面神经电生理功能的影响.方法 将44例面肌痉挛患者分别依据病程及接受肉毒毒素治疗的次数分为三组早期组(16例)、长期未治疗组(10例)、长期治疗组(18例).测量患者双侧面神经传导速度及复合肌肉动作电位波幅.结果 长期治疗组面神经诱发肌电图的CMAP波幅患侧较健侧显著降低,其余二组CMAP波幅及三组患者潜速率患健侧自身对比均无显著性差异.结论 长期A型肉毒毒素局部注射治疗面肌痉挛安全、疗效显著.降低治疗侧的CMAP波幅,对面神经传导速度无影响.     

49例桥小脑角区肿瘤病人术前面神经电生理的指标分析

目的探讨面神经M波和F波对桥小脑角(CPA)区肿瘤病人面神经功能评估的临床意义。方法回顾性分析49例CPA区肿瘤病人的临床资料,均采用面神经电图检测M波和F波,统计比较健侧与病侧差异。结果与健侧比较,病侧M波波幅较低(P=0.023),F波潜伏期延长且波幅下降(P 0.001),F-M潜伏期延长(P=0.001)。结论 F波、M波可以客观评价CPA区肿瘤病人的面神经功能,反映面神经近端的临床病变。     

病毒性脑炎后癫痫的预后及其影响因素

目的探讨病毒性脑炎后癫痫(PEE)的预后及其影响因素。方法对50例病毒性脑炎伴PEE患者进行随访,以从未达到1年无发作为预后差评价指标,观察其预后。收集患者的临床资料,分析影响PEE预后差的危险因素。结果预后差组患者脑炎急性期有意识障碍及脑炎急性期有痫性发作、发作次数10次的比率显著高于预后好组(均P0.01)。年龄、性别、发作类型、脑炎急性期精神障碍、脑炎急性期神经系统缺损、脑炎急性期SE、CSF细胞数增多、EEG异常、头颅CT/MRI异常与预后差无相关性(均P0.05)。多因素Logistic回归分析显示,脑炎急性期意识障碍、脑炎急性期发作是PEE患者预后差的独立危险因素(OR=7.269,95%CI:1.22~43.35,P=0.029;OR=22.893,95%CI:4.02~130.43,P=0.000)。结论脑炎急性期意识障碍、脑炎急性期痫性发作是影响PEE预后差的独立危险因素。     

血清基质金属蛋白酶-2在脑白质病变患者头颅MRI各分级中的表达水平

目的探讨血清基质金属蛋白酶-2(MMP-2)在脑白质病变(WML)患者头颅MRI各分级中的表达水平。方法选取WML患者60例为病例组和无WML患者30例为对照组。收集临床资料,并检测血清MMP-2水平。结果血清MMP-2水平在对照组分别与WMLⅠ级、WMLⅡ级、WMLⅢ级之间比较差异均有统计学意义(均P0.001);血清MMP-2水平在WMLⅠ级分别与WMLⅡ级、WMLⅢ级之间比较差异均有统计学意义(均P0.001),血清MMP-2水平在WMLⅡ级与WMLⅢ级之间比较无统计学差异(P0.05)。经有序Logistic回归分析,结果显示年龄(OR=2.144,95%CI:1.248~3.684,P=0.006)、血浆同型半胱氨酸(Hcy)水平(OR=4.432,95%CI:1.344~14.600,P=0.014)、MMP-2(OR=7.622,95%CI:4.063~14.296,P=0.001)与WML严重程度相关。结论 MMP-2可能是WML发病机制中的关键因素之一,血清MMP-2水平与WML严重程度具有相关性。     

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.