妥泰治疗242例症状性癫痫的疗效分析

目的：了解新型抗癫痫药妥泰对症状性癫痼的疗效。方法：病人用药前4周，填写发作日志，记录发作次数，随后单用或添加治疗，随访4个月至3年。以用药后每4周的发作次数与用药前基线比较，减少75％为有效，发作停止1年者为发作停止，以评价其药物疗效。结果：在对242例症状性癫痫的研究中发现妥泰治疗由于肿瘤引起的癫痫的发作停止率为61％，有效率为74％；头伤后癫痫的发作停止率为34．6％，有效率为55．70．4；脑血管病所致癫痫的发作停止率为81．2％，有效率为90．6％；炎症后癫痫的发作停止率为52％，有效率为54．5％；发育障碍性癫痫的发作停止率为50％，有效率为64％；寄生虫所致癫痼的有效率为87．5％；糖尿病性癫痫的有效率为81．8％。结论：妥泰对症状性癫痫也是有效的，其中对慢性肿瘤、头伤、糖尿病等所致的癫痫可能具有更大的优势。     

癫(癎)患儿服用妥泰后交感神经皮肤反应研究

目的：利用交感神经皮肤反应（SSR）探讨妥泰对癫癎儿童自主神经功能的影响。方法：对59例服用妥泰后出现自主神经功能障碍的癫癎患儿进行研究，分别测量服药前后SSR波幅和潜伏期。结果：服妥泰后癫癎患儿SSR波幅降低和潜伏期延长，与服妥泰前比较差异有显著意义。结论：妥泰对癫癎患儿自主神经功能的影响能够通过SSR反映出来。     

妥泰单药治疗癫癎疗效观察

妥泰(Topiramate,TPM)是一种新型广谱抗癫痫药,自1999年在国内上市以来,广泛应用于各类癫痫的治疗,取得了满意疗效,尤其是单药治疗效果得到了一致的结论。我科于2002年9月设置独立的癫痫门诊,现将应用妥泰单药治疗癫痫的结果分析报道如下。     

症状性癫癎的影像学检查

一、癫癎的定义 2005国际抗癫癎联盟（1LAE）对癫癎的定义做了修订,其推荐的定义为：癫癎是—种脑部疾患,其特点是持续存在能产生癫癎发作的脑部持久性改变,并出现相应的神经生物学、认知、心理学以及社会学等方面的后果。二、癫癎的常见病因（一）原发性癫癎：又称特发性或隐原性癫癎,其真正的原因不明,虽经现代各种诊查手段检查仍不能明确。（二）继发性癫癎：又称症状性癫癎,     

癫(癎)及癫(癎)性精神障碍患者的精神症状分析

目的:探讨癫(癎)及癫(癎)合并精神障碍的诊断治疗,并对其精神症状分析,进一步提高诊断的准确性并降低治疗风险.方法:对123例癫(癎)病人随访跟踪,采用病人自身对照方法,对其进行心理评估;对癫(癎)性精神障碍患者进行双重治疗,观察其症状变化.结果:症状和药物引起的癫(癎)性精神障碍病人自杀意念明显增高,使治疗风险加大.结论:仔细观察癫(癎)及癫(癎)性精神障碍病人的治疗效果和精神状况,合理用药,及早给予心理干预使临床治疗的风险降低.     

颞叶癫癎的症状学及其定位意义

颞叶癫(癎)是最常见的癫(癎)综合征之一,它的症状表现多种多样.癫(癎)的定位对于确定治疗方案和评估预后有重要意义.但临床上对于不同症状的认识及其诊断和定位价值存在疑问,因此本文综述了颞叶癫(癎)的常见临床表现及其对于责任灶的定位意义,以供同道参考.     

癫痫患儿服用妥泰后交感神经皮肤反应研究

目的:利用交感神经皮肤反应(SSR)探讨妥泰对癫癎儿童自主神经功能的影响。方法:对59例服用妥泰后出现自主神经功能障碍的癫痫患儿进行研究,分别测量服药前后SSR波幅和潜伏期。结果:服妥泰后癫癎患儿SSR波幅降低和潜伏期延长,与服妥泰前比较差异有显著意义。结论:妥泰对癫癎患儿自主神经功能的影响能够通过SSR反映出来。     

非癫(癎)性发作的临床与脑电图分析

非癫癎性发作(NES)与癫癎性发作(ES)都是临床阵发性发作,可能是或不是癫癎发作。虽然临床上表现为反复的发作,但不伴同步的异常脑电活动,即称为NES。现将我院78例NES的临床和脑电图(EEG)分析如下。1临床资料本组病例为我院2002年5月至2006年3月门诊及住院有发作性症状并经长程同步录像脑电图     

司法鉴定癫癎性精神障碍者的脑电图分析

目的:探讨经司法机关鉴定为癫性精神障碍者的脑电图特点及案件类型与精神障碍者的关系。方法:对113例司法机关提供的癫性精神障碍者的脑电图资料进行分析。结果:脑电图异常40例,异常率为35·4%。有34例表现为广泛异常,6例为局限性异常,经临床医学诊断为人格改变和智力障碍的患者脑电图异常率高,且大部分为广泛异常,经司法机关鉴定为伤害罪、纵火罪和杀人罪的异常率较其他犯罪类型高。结论:癫性精神障碍者的脑电图有其特征性改变,与精神障碍的类型有关,与案件类型无关。     

司法鉴定为癫癎性精神障碍者的脑电图分析

目的：探讨经司法精神病鉴定为癫癎性精神病障碍者的脑电图（ＥＥＧ） 改变特点,及与精神障碍表现、临床发作类型、案件类型的关系。方法：对５２ 例经司法精神病鉴定为癫癎性精神障碍患者的ＥＥＧ 资料进行回顾性分析。结果：常规ＥＥＧ 异常率为５８ ％ 。广泛异常２２ 例,其中轻度１１ 例,中度９例,重度２ 例;局灶性异常８ 例。智能障碍、人格改变并智能障碍异常率均较高,且大多为广泛异常。伤害罪、抢劫罪、纵火罪、杀人罪及被奸淫案异常率比其他案件类型高。结论：癫癎性精神障碍ＥＥＧ 有其特征性改变,与其病因、发作频次、精神障碍表现和临床发作类型有关,但与案件类型无关。     

托吡酯对癫癎患者脑电活动的影响

目的 :观察癫患者应用托吡酯单药治疗后 ,脑电背景活动及发作间歇期样放电的变化。方法 :对 42例癫患者给予托吡酯单药治疗 ,比较用药前和用药后 3个月时的脑电背景活动和发作间期样放电的变化及其与临床疗效的关系。结果 :用药 3个月时EEG的θ频段相对功率显著增加(P <0 0 5 ) ,α频段、δ频段、β频段相对功率改变不大 ;4例发作间期的样放电消失 ,6例明显减少 ,但样放电的改变与临床疗效无明显相关性 (P >0 0 5 )。结论 :托吡酯可使脑电背景活动中θ频段相对功率显著增加 ,发作间期的样放电减少 ,但样放电的改变与临床疗效无关     

托吡酯加添治疗难治性癫(癎)的临床研究

目的:观察托吡酯(TPM)对难治性癫的疗效和不良反应。方法:对114例难治性癫患者加用TPM治疗,观察控制癫发作效果。结果:TPM加添治疗总有效率为63.2%,儿童组有效率为62.5%,成人组为63.6%,对各型难治性癫均有效。TPM加添治疗起效时间在4～8周达高峰,有效率为43.4%。副作用发生率为25.4%,均较轻。结论:TPM加添治疗难治性癫疗效较好,是一种广谱、安全、耐受性好的新型抗癫药。     

托吡酯单药治疗40例小儿癫Xian疗效分析

目的：观察托吡酯（商品名妥泰,TPM）单药治疗小儿不同类型癫Xian发作的疗效及不良反应。方法：单独应用TPM治疗40例临床诊断的小儿癫Xian患者（部分性发作13例,Lennox-Gastaut 综合征13例,West综合征11例,青少年肌阵挛3例）,治疗前后进行自身对照的开放性研究。平均治疗6个月,记录癫Xian发作频率变化及副作用。结果：本组40例中发作减少≥50％为82％,发作消失47％,其中部分性发作、Lennox-Gastaut综合征、West综合征发作消失分别为61％、46％、27％,发作减少50％者分别为92％、69．3％及82％。青少年肌阵挛3例,发作减少≥75％为3例,其中2例发作消失。不良反应为纳差12．5％,嗜睡5％,无汗症10％。结论：TPM单药治疗小儿部分发作性癫Xian、Lennox-Gastaut综合征、West综合征及青少年肌阵挛性癫Xian有效,与同期TPM添加治疗组疗效相仿,不良反应少于添加治疗组。     

Evoked motor response thresholds during transcranial magnetic stimulation in patients with symptomatic partial epilepsy

Transcranial magnetic stimulation (TMS) occupies a leading position among noninvasive neurophysiological methods used for evaluating the balance of processes of cortical inhibition and excitation. The aim of the present work was to assess motor cortical excitability in symptomatic partial epilepsy using TMS in relation to the effects of antiepileptic treatment. A total of 31 patients were studied. A decrease in the motor response threshold was seen in a group consisting of untreated patients, with changes in cortical excitability during seizures. Treated patients showed no difference as compared with healthy subjects. The shorter the interval between a seizure and TMS, the smaller the evoked motor response threshold. The low threshold seen in patients with symptomatic partial epilepsy showed a significant correlation with clinical signs of neuromuscular excitability. The data obtained here provide evidence of changes in the functional state of the cortex and, thus, the motor response threshold, in patients with epilepsy. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Supplement, Epilepsiya, No. 1, pp. 75–78, 2006.     

病毒性脑炎后遗癫痫的致痢灶定位及射频热凝疗效

目的：总结用视频脑电图（V-EEG）监测病毒性脑炎后遗癫痫患者,以立体脑电辅助定位为基本依据进行机器人辅助立体定向作射频热凝毁损治疗的结果。方法：采用V-EEG监测病毒性脑炎症状体征稳定后6个月以上的药物难治性癫痫患者22例（其中因病史与无创检查矛盾,采用立体定位脑电监测1例）。结果：①22例患者都能在VEEG监测中发现痫样放电,分布均为两个脑区或以上（100％）（其中1例行立体脑电监测定位）;②22例患者接受机器人辅助立体定向射频热凝毁损颞叶内侧结构或内囊前肢,随访6～36个月（平均15．4个月）,发现癫痫发作消失（继续服术前药物情况下）1例（4．5％）,极少或几乎消失（每6个月发作不超过1次）1例（4．5％）,值得的改善（发作较术前减少90％或以上）0例,不值得的改善或无效20例（91％）;③22例患者中16例行立体定向术后3d内发生低热症状（72．7％）。结论：绝大多数病毒性脑炎后遗癫痫患者致痫灶不是很局限的,难以明确定位,因而射频热凝疗效较差。     

Attention changes in epilepsy patients following 3-month topiramate or valproate treatment revealed by event-related potential

The present study was designed to reveal changes of cognitive processes in epilepsy (EP) patients with Topiramate (TPM) or Valproate (VPA) treatment using Wechsler Adult Intelligence Scale (WAIS-CR) and event-related potential (ERP). Thirty untreated epilepsy patients were randomly divided into two groups receiving TPM or VPA, respectively. Fifteen healthy volunteers were included as controls. All the patients were examined by WAIS-CR and ERP before and 3 months after drug treatment. Controls were examined by ERP at the time recruited into the study and 3 months later. Unfamiliar grey-scale photographs of faces (front view) were used as stimuli. ERP were recorded at the same time. Mean Intelligence Quotient (IQ) in TPM group decreased after the 3-month treatment (90.40 vs. 81.00, P < 0.05). One component of ERP-P300 was smaller in epilepsy patients than controls (P < 0.05), but remained unchanged after TPM or VPA treatment (P > 0.05). A delayed and smaller N270 was detected in patients compared to controls (P < 0.05). After 3 months TPM treatment, it decreased further compared to before treatment (P < 0.05). N170 was lower in patient groups, and it became lower after TPM treatment than before. Our results demonstrate that in all epilepsy patients with mild cognitive impairment ERP changes were found. TPM affected the cognitive functions in epilepsy patients reflected by the decreased full-scale intelligence quotient (FIQ). The imperative effects of TPM on visual perception function reflected by N170 were more obvious than that of VPA. Attention reflected by N270 was impaired after TPM treatment.     

Modafinil treatment in patients with seasonal affective disorder/winter depression: an open-label pilot study

BACKGROUND: Hypersomnia is a cardinal symptom of seasonal affective disorder/winter depression. This open-label pilot study assessed modafinil, a novel wake-promoting agent, as treatment for seasonal affective disorder/winter depression. METHODS: Total daily modafinil dose was 100 mg (all patients week 1), and 100 mg or 200 mg split dose (weeks 2-8). Efficacy assessments (weeks 1, 2, 5, and 8) included the Structured Interview Guide for the Hamilton Depression (HAM-D) Rating Scale, Seasonal Affective Disorder Version (SIGH-SAD), Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression of Change (CGI-C), Fatigue Severity Scale (FSS), and Epworth Sleepiness Scale (ESS). RESULTS: Thirteen patients (11 women; mean age, 41 years) were enrolled, 12 were evaluable for efficacy (100 mg dose, five patients; 200 mg dose, seven patients), and nine completed treatment. Modafinil significantly improved winter depression as shown by reductions from baseline in mean SIGH-SAD at week 1 (P<0.01) through week 8 (P<0.001 weeks 2-8) and MADRS total scores from week 2 through week 8 (P<0.01 for all). At week 8, mean SIGH-SAD total score was 17.1 (versus 37.2 at baseline, P<0.001), and mean MADRS total score was 13.3 (versus 26.9 at baseline, P<0.01). Modafinil significantly improved overall clinical condition at all time points (P<0.001). The response rate was 67% on the SIGH-SAD (29 item), HAM-D (21 item), and MADRS, and 100% on eight atypical SIGH-SAD items. Modafinil significantly reduced fatigue (FSS) and improved wakefulness (ESS) from weeks 2 through 8 (P<0.01). Modafinil was well tolerated. LIMITATIONS: This was an open-label, single site study. CONCLUSIONS: Modafinil may be an effective and well-tolerated treatment in patients with seasonal affective disorder/winter depression.     

颞叶癫痫患者语言相关功能区的fMRI研究

目的：通过功能磁共振成像（fMRI）检查,了解颞叶癫痫（TLE）患者语言相关功能区的分布,初步探讨影响其不典型分布的因素,评价fMRI对癫痫患者进行无创语言功能定位检查的临床可操作性。方法：健康对照组和成人发病的左、右一侧性TLE患者组各6例,均为右利手。所有受试者进行动词产生任务fMRI检查,以按键记录受试者的反应。使用统计参数图2（statisticalparametricmap-ping2,SPM2）对fMRI的图像进行个体和组分析。结果：所有受试者顺利完成任务,fMRI的结果显示左侧组较对照组有明显差异,语言激活出现不典型化表现,优势侧有向右侧转移的趋势,其偏侧化指数（1ateralityindex,LI）与病程呈相对的负相关。结论：左侧TLE患者的语言功能区出现不典型分布,偏侧化程度可能与病程有关。fMRI检查评价语言功能相关区结果基本可靠,受试者耐受性好,具有一定的临床可操作性。