我国癫(癎)的诊断与治疗现状

20世纪90年代以来我国的癫痫研究有了较大的进展。流行病学调查结果显示，我国癫痫的患病率为0．70％，活动性癫痫患病率为0．46％，治疗缺口为6．48％。这些数字对规划癫痫研究的发展方向具有重要意义。如果按照0．70％估算，我国约有癫痫患者900万，其中约500万未曾接受治疗或未经过正规的治疗，这使医疗行政部门及医疗保障面临巨大的压力和挑战。     

癫(癎)术后抗癫(癎)药物的治疗模式

目的 探讨癫(癎)术后抗癫(癎)药物的应用方法及影响因素.方法 2002-2005年在我院接受了手术治疗的170例癫(癎)患者,根据不同手术时段分为3组,A组:2002年至2003年10月的病例;B组:2003年11月至2004年10月药师与临床医生一起对癫(癎)手术患者进行用药教育的病例;C组:2004年11月至2005年10月接受全程化药学服务的病例.对随访1年后各组之间的疗效、用药安全性、抗癫(癎)药应用依从性等指标进行了比较,初步探讨术后应用抗癫(癎)药的规律.结果 B组和C组在疗效(71%、81%)、用药安全性、抗癫(癎)药用药依从性等指标上均优于A组(46%),差异均有统计学意义(X2=7.08、15.50,P<0.05).结论 神经内外科医生、药师合作的个体化癫(癎)术后全程化服务是一种较新的、有效的癫(癎)术后管理模式.     

癫癎治疗的现状

癫癇以全球有３０００万,中国有６５０万患者而被列为神经科最常见病的第二位。全世界每年新发癫癇病人超过２００万,而我国则达４５万,因此成为重点关注的疾病。全社会为这种病付出的代价,包括劳动力的丧失,家属为照顾病人而丢失的工作以及治疗所付出的费用是难以估计的。更重要的是,由于根深蒂固的社会偏见和公众的歧视,给病人和家属带来了沉重的精神负担。 回顾２０世纪,癫癇治疗已取得令人瞩目的进展,故观念的更新十分必要。首先,癫癇不是以往认为的不易治疗的疾病,在美国Ｒｏｃｈｅｓｔｅｒ进行的回顾性研究显示,大部分癫…     

颞叶癫(癎)的影像诊断

结合文献从计算机体层摄影(CT)、磁共振检查(MRI)和磁共振波谱分析(MRS),以及SPECT、PET、FMRI,介绍了近年来诊断颞叶癫(癎)(TLE)的进展.CT扫描对颅内较大病变和梗塞灶的发现具有高度敏感性,尤为钙化灶的发现优于MRI.MRI常能最精细地发现颞叶癫(癎)病人的脑结构灶病变,尤其是能准确地诊断出海马硬化,在T2像或行FLAIR系列像上信号增强,阳性率可达60%～100%.MRS能测定出活体脑内代谢产物的分布,是与癫(癎)灶生物化学改变密切相关的.在TLE病人采用MRS技术,可测出NAA峰值的降低和/或Cr,Cho峰值的升高,临床上常以NAA/Cr,Cho的比值来作为TLE的定侧指标.还简述了SPECT、PET和fMRI对诊断的价值.     

癫(癎)手术治疗的(癎)灶定位

1 不同皮质区与致癎区的关系癫痢外科的目的是要完全切除致痢区,也就是要切除产生临床癫癎发作的大脑皮质.现代癫痢病学家采用各种各样的诊断工具,如临床症状分析、电生理描记、功能性检查以及神经影像学技术,从而来寻找致癎区的位置和范围.     

癫(癎)的药物治疗

癫痫最重要的治疗方法是药物治疗，即使接受外科手术治疗的患者，手术后也仍须继续服用抗癫痫药物（antiepileptic drug，AED）一段时间。药物治疗的目的在于控制癫痫的发作，同时没有或少有药物不良反应，从而改善患者的生存质量。70％～80％的癫痫患者经过正规、合理的抗癫痫药物治疗后临床发作可以获得缓解。     

癫(癎)的药物治疗

癫(癎)最重要的治疗方法是药物治疗,即使接受外科手术治疗的患者,手术后也仍须继续服用抗癫(癎)药物(antiepileptic drug,AED)一段时间.药物治疗的目的在于控制癫(癎)的发作,同时没有或少有药物不良反应,从而改善患者的生存质量.70%～80%的癫(癎)患者经过正规、合理的抗癫(癎)药物治疗后临床发作可以获得缓解[1].     

癫(癎)与抑郁

癫患者在癫发作间期,抑郁症发作很常见。病因学主要归纳为强制正常化现象、抗癫药物、偏侧化假说和个人心理因素影响等4方面;癫合并抑郁与神经递质如5-羟色胺(5-HT)、去甲肾上腺素、γ-氨基丁酸和谷氨酸等有关;癫患者抑郁的检测。临床医生应重视抑郁症的治疗,并从抗癫药物和5-HT再摄取抑制剂(selective serotonin reuptake inhibitors,SSRIs)等药物中归纳出一些主要药物的功效。本文主要针对癫合并抑郁的病因、发病机制、检测方法及治疗等研究进展作介绍。     

女性癫(癎)

癫(癎)的人群患病率约为0.5%,其中几乎一半为女性.女性癫(癎)患者(Women With Epilepsy,WWE)(癎)性发作的频率、严重程度及对患者的影响在青春期、生育期、围绝经期等不同时期各不相同.本文就WWE不同年龄时期的特点作一综述.     

病毒性脑炎的临床诊治现状及存在的问题

神经系统病毒感染性疾病或神经病毒病是病毒感染性疾病或病毒病中的一部分。病毒性脑炎是中枢神经系统病毒感染性疾病中一具有重要代表性的急性神经病毒病。本拟初探病毒性脑炎的临床相关问题，谨供参考并祈指正。     

Recent advances in the diagnosis and treatment of epilepsy

Recent advances in the diagnosis and treatment of epilepsies are discussed with special consideration of epidemiology and classification, progress in neuroimaging, electrophysiological studies using EEG and MEG, initiation of medical and surgical treatment, the role of new antiepileptic drugs and selected aspects of genetics of idiopathic epilepsies. In addition from conclusions obtained by the review of recent developments suggestions for future work in Europe are discussed. A constructive approach from multicenter studies requires homologous definitions, documentations and standardization of procedures of trials for European multicenter studies.     

Role of genetics in the diagnosis and treatment of epilepsy

Epilepsy is a heterogeneous group of multifactorial diseases, the vast majority determined by interactions between many genes and environmental factors; however, there are rare epilepsy syndromes that can be caused by a single gene mutation and are inherited according to classical mendelian genetic principles. Finding disease-causing genetic mutations in epilepsy has provided new opportunities for aiding diagnosis and developing therapies. Thus, the discovery of KCNQ2 mutations in benign familial neonatal convulsions, SCN1A mutations in severe myoclonic epilepsy of infancy and in generalized epilepsy with febrile seizures plus, and CHRA4 and CHRB2 mutations in autosomal-dominant nocturnal frontal lobe epilepsy, has led to the establishment of epilepsy as a disorder of ion channel function and, furthermore, has led to the introduction of genetic tests that are available clinically to aid in diagnosis and treatment. At the present time, clinical use of genetic testing in epilepsy is greatest in suspected cases of severe myoclonic epilepsy of infancy, generalized epilepsy with febrile seizures plus, atypical cases of benign familial neonatal convulsions and 'occult' cases of autosomal-dominant nocturnal frontal lobe epilepsy without a family history. Overall, clinical use is limited by the low number of documented disease-associated mutations and the uncertain clinical significance of many test results. Further elucidation of the relationship between gene mutations and channel function will add value to genetic testing in the future, as will better characterization of the association between gene mutations and clinical phenotypes.     

Common errors made in the diagnosis and treatment of epilepsy

Learning from one's mistakes is the best learning tool in medicine and this applies as well to epilepsy. This article is a compilation of some of the frequent mistakes that are made in the evaluation and management of patients with epilepsy. It encompasses errors in the clinical diagnosis that result in the choice of the erroneous antiepileptic drug (AED), errors in the way auxiliary tests like the electroencephalogram and magnetic resonance imaging studies are ordered, mistakes in the recognition of subclinical status epilepticus, errors in the selection of AEDs, consequences of the failure to factor in the pharmacokinetic and pharmacodynamic properties of AEDs in the choice and dosification of medication, misconceptions on the expectations of therapeutic effect of AEDs, delay in recognition of refractory epilepsy with consequent delay in a timely identification of patients whose epilepsy can be cured with surgical treatment, and mistakes in the recognition and management of comorbid psychiatric disorders. In addition to a discussion of the reasons for the errors, the article provides practical solutions.     

Panic attacks in the differential diagnosis and treatment of resistant epilepsy

The authors present four patients displaying panic disorder and a history of epileptic seizures to illustrate difficulties regarding differential diagnosis between epileptic seizures and panic attacks. The cases describe the aversive properties of epileptic seizures, the role of visual seizure-triggering stimuli as phobic cues, and the effectiveness and safety of clomipramine treatment of panic attacks as an adjunct to concurrent antiepileptic medication.     

轻度认知功能障碍的治疗现状与进展

随着对阿尔茨海默病(Alzheimer disease,AD)认识的深入,作为正常老龄化向痴呆过渡状态的轻度认知功能障碍(mild cognitive impairment,MCI)越来越受到人们的关注。对轻度认知功能障碍积极进行干预是延缓认知功能进一步衰退的有效措施,但目前关于轻度认知功能障碍干预措施的报道     

Current status of epilepsy treatment and efficacy of standard phenobarbital therapy in rural areas of Northern China

Purpose: To investigate the current status of epilepsy treatment and the efficacy and adverse effects of phenobarbital therapy in rural areas of Northern China. Methods: A total of 2192 patients diagnosed with convulsive epilepsy were recruited from seven different rural regions in Jilin Province, China to investigate the current status of epilepsy treatment, and 1379 of them were enrolled in a standard phenobarbital therapy trial. Patients were selected according to strict inclusion and exclusion criteria, and medical records for all patients were collected and analyzed before the standard treatment was started. Patients were followed up monthly, and efficacy in 1218 patients was analyzed at 1, 3, 6 and 12 months of treatment. Results: More patients had the initial seizure in juveniles than in adults, and 40.72% of the 2192 patients were not receiving any treatment before the treatment trial. The efficacy of phenobarbital increased and adverse effects decreased within the treatment period. Among the 349 patients who were followed up for 12 months from the beginning of the phenobarbital treatment, seizures were decreased by more than 75% in 71.3% of patients using a low-to-medium dose of phenobarbital. Major adverse effects of phenobarbital included mild exhaustion, drowsiness, dizziness and headache. Conclusions: Standardized long-term and regular administration of phenobarbital at a low-to-medium dose can be used as an effective, economic and safe treatment against epilepsy in rural areas.     

脑肿瘤相关性癫痫的病理诊断与手术疗效分析

目的探讨脑肿瘤相关性癫痫患者病理指标的诊断意义和外科手术治疗的临床疗效分析。方法回顾性分析自2010年1月-2012年12月之间在我院神经外科接受手术治疗的52例经各项检查确诊为脑肿瘤的患者的临床资料,根据术前是否伴发癫痫症状分为实验组和对照组,实验组行肿瘤＋致痫灶切除术,对照组行肿瘤切除术,术后均对病灶行病理学检查并对手术效果跟踪随访。结果病理学结果示：CD34在实验组中阳性表达率明显高于在对照组,差异有统计学意义（P〈0.05）;实验组癫痫控制满意（Eagle I-II级）率为81.25%,病灶全切满意率明显高于次全切及部分切除,差异有统计学意义（P〈0.05）。结论对于肿瘤相关性癫痫,CD34可以作为一项敏感诊断标记物;手术是目前最有效的治疗方法,肿瘤全切,同时将周围的致痫灶一同切除术后疗效更好。