30例BECT的临床分析及疗效观察

目的对小儿良性癫痫（BECT）患儿进行诊断、治疗及疗效监测。方法对30例BECT患儿的临床资料和视频脑电图进行分析,给予得理多治疗及血药浓度监测。结果30例患儿发病均与睡眠密切相关。发作间期脑电图均有一侧或双侧中央、顶区和（或）中、后颞区棘波或棘慢复合波发放,其中有19例用得理多可控制临床发作。结论伴有中央颞区棘波的小儿良性癫痫临床发作和睡眠密切相关,以学龄儿为多见。95%病例对得理多反应良好,单药即可控制发作。     

儿童睡眠癫痫电持续状态的临床与脑电图变化

目的探讨儿童睡眠癫痫电持续状态(ESES)临床和脑电图变化。方法收集2009年6月至2011年8月本院诊断ESES的患儿31例,分析其临床资料。结果 21例患儿单药控制临床发作疗效欠佳,丙戊酸钠联合用药治疗反应良好,首发年龄越小,则发作和EEG异常的持续时间越长。药物及激素治疗效果越差。13例(42%)予甲泼龙冲击治疗,9例(69%)在甲泼尼龙冲击疗程结束后癫痫发作控制,或发作减少50%以上,3例(23%)发作无改善。5例(38%)神经心理损伤及运动倒退情况明显好转,2例(15%)好转半年后再次出现神经心理倒退,6例(46%)较治疗前无变化。结论甲泼尼龙对ESES临床治疗疗效不一。对于消除中央区-颞区电持续续状态效果明显,但对特发性枕区癫痫伴ESES现象及年龄<2岁癫痫患儿疗效欠佳。     

动态脑电图在癫痫诊断中的价值

目的探讨动态脑电图监测（AEEG）即24h脑电图监测在癫瘸诊断中的应用价值。方法对252例临床诊断为癫瘸的患者行AEEG监测,对发作间期清醒与睡眠脑电图瘸样放电的检出率进行比较。结果252例患者中,共检出瘸样放电191例,单独出现在清醒期者17例,单独出现在睡眠期者80例,清醒及睡眠均出现者94例,清醒期共出现111例（占58．1％）,睡眠期共出现174例（占91．1％）,两者比较差异有统计学意义（P〈0．01）。瘸样放电主要出现于NREM睡眠I-Ⅱ期。结论睡眠期癌样放电检出率明显高于觉醒期,AEEG有助于癫瘸的诊断,这点,对临床不能排除癫瘸发作而常规脑电图无阳性发现的患者更有价值。     

The effect of frusemide, mexiletine, (+)-propranolol and three benzodiazepine drugs on interictal spike discharges in the electroencephalograms of epileptic patients

1 The effects of single intravenous doses of diazepam, clonazepam, lorazepam, frusemide, mexiletine and (+)-propranolol on the frequency of electroencephalographic (EEG) interictal spike discharges were assessed in three double-blind placebo-controlled trials in fourteen epileptic patients.

2 Diazepam (5 mg) produced a significant mean decrease of spike discharges to about one third of the control frequency. The effect developed rapidly and persisted for the duration of the study (up to 25 min after injection). A larger dose (10 mg) failed to produce a further reduction in the frequency of the spike discharges.

3 Clonazepam (0.5 mg), frusemide (40 mg) and lorazepam (2 mg) appeared to be as effective as diazepam in reducing spike discharges, although the effect of the latter drug seemed to develop with some delay.

4 Mexiletine (100 mg) and (+)-propranolol (50 mg) did not reduce paroxysmal EEG discharges, their effects being not significantly different from that of saline.

5 EEG spike counting after intravenous administration of single test-doses appeared to be both a simple and promising technique for the rapid preliminary evaluation of the clinical efficacy of new anti-epileptic drugs.

     

136例小儿癫痫的睡眠脑电图分析

目的探讨睡眠EEG对癫痫的诊断价值、优点及诊断中的注意事项。方法分析应用日本光电4418型EEG仪监测136例癫痫患者睡眠EEG。结果136例,正常28例(20,6％),非特异性异常12例(8．8％),痫样放电96例(70．6％)。结论睡眠EEG可反映睡眠结构和异常放电的发作情况;同时EEG可观察临床发作的全过程及发作时EEG的演变过程,能更明确局限性癫痫诊断及定位,也可为全身性发作者寻找致痫灶。     

A new frontier in epilepsy: novel antiepileptogenic drugs

Epilepsy is a hetergenous syndrome characterized by recurrently and repeatedly occurring seizures. Although able to inhibit the epileptic seizures, the currently available antiepileptic drugs (AEDs) have no effects on epileptogenesis. Such AEDs should be classified as drugs against ictogenesis, which are transient events in ion and/or receptor-gated channels related with triggering to evoke seizures. Epileptogenesis involves long-term and histological/biochemical/physiological alterations formed in brain structures over a long period, ranging from months to years. This review focuses on the effects of AEDs on epileptogenesis and novel candidates of antiepileptogenic drugs using a genetically defined epilepsy model animal, the spontaneous epileptic rat (SER).     

咪达唑仑治疗儿童癫痫持续状态及惊厥频繁发作的临床研究

目的研究咪达唑仑持续静脉滴注治疗癫痫持续状态[SE,包括难治性癫痫(R SE)]及频繁惊厥发作(FCS)的临床疗效,同时探讨其安全有效剂量及副作用。方法选取收入院的SE及FCS患儿205例为观察对象,随机分为两组,治疗组103例,给予咪达唑仑持续静脉滴注;对照组102例,应用传统的一线抗癫痫药(AED s)治疗。同时将两组疗效进行对照研究,观察治疗组的最大、最小用药剂量,副反应,51例患儿进行脑电图监测。结果治疗组疗效明显高于对照组(P<0.01),治疗组的咪达唑仑安全有效剂量为1￣8μg.kg-1.m in-1,在治疗剂量下未见明显副作用,37例痫样放电随着临床发作的终止消失,14例随着发作次数的减少而减少。结论持续静脉滴注咪达唑仑治疗SE及FCS安全、可靠、有效,且常规一线AEDs治疗无效后该药仍有效,故该药可推荐为治疗癫痫持续状态及频繁惊厥发作的最佳选择。     

小儿非癫痫性发作临床分析

目的　对小儿时期的各种非癫痫性发作进行分析。方法　对 3 2例疑似非癫痫性发作的患儿进行临床分析 ,同时进行录像脑电图或 2 4h动态脑电图监测。结果　 3 2例患儿发作期及发作间期脑电图均无异常放电 ,证实为非癫痫性发作 ,以生理性发作最多 (16例 ,占 5 0 % ) ,其平均年龄最小 (3 .5岁 )。结论　儿童时期存在多种形式的非癫痫性发作 ,以生理性发作最多 ,且非癫痫性发作易被误诊为癫痫及其他疾病 ,采用动态脑电图监测对诊断及鉴别诊断均有指导意义     

Effect of lamotrigine on EEG paroxysmal abnormalities and background activity: a computerized analysis

1 Little information is available about the action of lamotrigine (LTG) on EEG paroxysmal abnormalities and background activity. On the contrary, several clinical trials have shown the therapeutic efficacy of the drug in preventing partial and generalized seizures.
2 We performed computerized EEG monitoring in 21 patients suffering from focal and generalized epilepsy before and 4 months after addition of LTG. The anticonvulsant modified the EEG ictal events by reducing their frequency and duration. A statistically significant decrease of the interictal spikes was observed. The decrease involved mainly the spreading component of the interictal events leading to a better spatial definition of the epileptic focus.
3 In the presence of LTG, generalized tonic-clonic attacks were completely controlled, whereas partial seizures were decreased.
4 The EEG background activity was not modified by the addition of the drug.
5 Our findings suggest a specific role for LTG in the generation and propagation processes of epileptiform activity without interfering with the EEG background activity.     

NMDA receptor-mediated long-term alterations in epileptiform activity in experimental chronic epilepsy

When epileptiform activity is acutely induced in vitro, transient partial blockade of N-methyl-d-aspartic acid (NMDA) receptor-mediated calcium influx leads to selective long-term depotentiation of the synapses involved in the epileptic activity as well as a reduction in the probability of further epileptiform activity. If such selective depotentiation occurred within foci of epileptic activity in vivo, the corresponding long-term reduction in seizure probability could form the basis for a novel treatment of epilepsy. Continuous radiotelemetric EEG monitoring demonstrated modest acute anticonvulsant effects but no long-term reductions in the probability of spontaneous seizures after transient partial blockade of NMDA receptors (NMDAR) during ictal and interictal activity in the kainate animal model of chronic epilepsy. In vitro, depotentiation was induced when NMDAR were partially blocked during epileptiform activity in hippocampal slices from control animals, but not in slices from chronically epileptic rats. However in slices from epileptic animals, depotentiation during epileptiform activity was induced by partial block of NMDAR using NR2B- but not NR2A-selective antagonists. These results suggest that chronic epileptic activity is associated with changes in NMDA receptor-mediated signaling that is reflected in the pharmacology of activity- and NMDA receptor-dependent depotentiation.     

Management of focal-onset seizures: an update on drug treatment

Focal-onset seizures are manifestations of abnormal epileptic firing of brain cells in a localised area or areas of the brain. The diagnosis of focal-onset seizures initially entails an EEG, a detailed history from the patient and eyewitnesses, as well as computer tomographic or, preferably, magnetic resonance imaging scans. Video EEG to record ictal events may be necessary to establish the correct diagnosis.Focal seizures are classified according to the International Classification of Epileptic Seizures and International Classification of Epilepsies and Epilepsy Syndromes. It is important to try to decide how the seizure event fits into this system in order to successfully evaluate and optimise treatment, as well as to give detailed information to the patient about their seizures and prognosis.Once the decision to treat the seizures has been made, the physician must choose which medication is the most appropriate to begin with. Carbamazepine, phenytoin or valproic acid (sodium valproate) are often rated as first-line drugs, but factors such as adverse-effect profiles, age, possibility of pregnancy, and concomitant diseases and medication also need to be considered. Most of the newer antiepileptic drugs (AEDs) appear to have good efficacy and better tolerability than the older agents, but evidence to support their superiority is scarce and has led to conflicting advice in several guidelines. Among the newer AEDs, lamotrigine, gabapentin, topiramate and oxcarbazepine have obtained monotherapy indication in many countries. The higher costs of the newer AEDs may inhibit their wider use, especially in poorer countries.     

Effects of antiepileptic drugs on sleep structure : are all drugs equal?

Good-quality sleep is an important and frequently overlooked component of general health, but it is particularly essential to patients with epilepsy. Their sleep can be affected by seizures, concurrent sleep disorders and seizure treatment. Worsening sleep can result not only in poor daytime functioning but also potentially in worsening epilepsy. The effects of antiepileptic drugs (AEDs) on sleep are of particular concern. Some agents have detrimental effects on sleep, particularly benzodiazepines and barbiturates but also phenytoin and, possibly, carbamazepine. Others, especially gabapentin, seem to actually improve sleep quality. Much research in this area is confounded by the effects of seizures and concurrent conditions on sleep, making it difficult to isolate the direct effects of AEDs on sleep. But because AEDs have independent effects on sleep quality, the choice of an appropriate agent not only determines whether seizures are completely controlled but also whether the patient performs optimally on a daily basis.     

Impaired memory following repeated pentylenetetrazol treatments in kindled mice

Epilepsy is characterized by recurrent seizures, which are caused by excessive discharges from cerebral neurons. Currently, antiepileptic drugs that possess sodium channel blocking activities and also mediate GABA-ergic systems are primarily used to prevent epileptic seizure. However, approximately 40% of patients with epilepsy suffer from interictal psychiatric comorbidities in clinical practice. Furthermore, it is unclear whether epilepsy is associated with psychic function. The aim of the present study was to clarify the effects of kindling-induced epileptic seizures on psychic functioning using behavioral pharmacological tests. Pentylenetetrazol (PTZ)-kindled mice demonstrated no significant differences in locomotor activity and muscle relaxation compared with na?ve mice. PTZ-kindled mice also demonstrated cognitive impairment in the objective location test, but no significant effects of PTZ-kindling were observed in the Y-maze test. These findings suggested that PTZ-kindling impairs reference memory, but not working memory. These results suggest that, with respect to their psychic functioning, PTZ-kindled mice have specific characteristics.     

癫(癎)儿童事件相关电位与认知障碍的研究

目的 观察癫(癎)儿童事件相关电位(ERP P300)和认知障碍,为其临床干预提供试验依据.方法 联合应用ERP P300与学习障碍筛查量表(PRS)对85例癫(癎)儿童和63例健康儿童进行检测,并对2组数据进行统计学比较.结果 癫(癎)儿童PRS量表总分、言语得分、非言语得分及ERP P300潜伏期、波幅与正常儿童相比,差异均有统计学意义(P<0.01或P<0.05).癫(癎)儿童有(癎)样放电组较无(癎)样放电组ERP P300潜伏期明显延长,PRS总分、非言语得分明显降低[(350±48)ms 比(334±44)ms,(69±11)分比(76±15)分,(44±7)分比(49±10)分,均P<0.05].结论 癫(癎)儿童认知情况受影响,ERP P300潜伏期明显延长,波幅降低;认知受损情况及ERP P300的异常程度与(癎)样放电关系密切.癫(癎)的治疗应控制发作与控制(癎)样放电并重.

Abstract：

Objective To observe the event-related potential(ERP P300) and learning status of epileptic children, in order to provide the experimental basis for clinic intervention. Methods ERP P300 and the pupil rating scale revised screening for learning disabilities (PRS) were done separately in 85 children with epilepsy. Also compare the statistic data between the two groups. Results The latency of ERP P300 in children with epilepsy showed significantly longer than that in the controls (P < 0.01). The total score, the verbal score and the nonverbal score of PRS in children with epilepsy showed significantly lower than those in the controls ( P < 0. 01). The ERP P300 latency, the total score and the nonverbal score of epileptic children with epileptiform electroencephalographic discharges showed significant difference from those in children without epileptiform discharge ( P < 0. 05 ). Conclusions The latency of ERP P300 is significantly delayed and the amplitude of ERP P300 is significantly decreased in children with epilepsy. The condition of damage of their cognitive and learning fuction and the abnormal degree of their ERP P300 is closely related to epitiform discharges.     

Epileptogenic activity induced by teicoplanin and effects of some antiepileptics in mice

The present study was undertaken to clarify the epileptogenic activity induced by intracerebroventricular injection (i.c.v.) of methicillin-resistant Staphylococcus aureus (MRSA) antibiotics in mice. Teicoplanin (200 mug, i.c.v.) caused dose-related behavioral seizures such as head twitch and forelimb clonus. At the same time, the drug caused electroencephalographic (EEG) seizures characterized by spike-and-wave complex and a continuous spike with high amplitude. At a high dose (500 mug, i.c.v.), the drug caused a severe clonic convulsion followed by continuous spike and spike-and-wave complex on EEG. On the other hand, vancomycin caused no or almost no epileptogenic activity in both behavior and on EEG. Diazepam and sodium valproate dose-dependently antagonized epileptic seizures in behavior and on EEG induced by teicoplanin (500 mug, i.c.v.). In contrast, carbamazepine and ethosuximide caused no significant changes in both behavioral and EEG seizures induced by teicoplanin. From these findings, it can be concluded that teicoplanin may cause potent epileptogenic activity different from vancomycin when used clinically at extremely high doses. In addition, it may be that teicoplanin-induced seizure is closely related with the gamma-amino butyric acid (GABA)-ergic mechanism.     

Treatment strategies after a single seizure : rationale for immediate versus deferred treatment

What is the rationale for the treatment of an epileptic seizure? More specifically, should a first seizure be treated as soon as it is diagnosed or should one defer treatment until a second seizure occurs? Several studies indicate that the risk of a second (unprovoked) seizure is <50%, but studies vary in methodology and most have reviewed outcome in children only. Also, many patients were maintained on antiepileptic drugs (AEDs) during these studies, meaning that the risk for seizure recurrence was perhaps underestimated compared with the risk if untreated. Most neurologists recommend waiting for a second seizure in order to avoid complications of medications that might prove to be unnecessary. Several large studies show that delaying treatment until a second seizure occurs does not worsen the course of epilepsy or likelihood of eventual seizure control. Seizures attributable to an acute illness ('acute symptomatic', provoked seizures) usually resolve with treatment of the underlying illness and thus long-term AEDs are often unwarranted. Nevertheless, seizures arising in certain circumstances are more likely to recur and there are special considerations for patients with strokes, tumours, infections and dementia, and also after head injury or neurosurgery. Patient preferences with regard to risk and benefit also enter into the decision on whether to initiate AED treatment after a single seizure.     

小儿热性惊厥100例的脑电图及临床研究分析

目的：探讨小儿热性惊厥患儿脑电图的相关影响因素、疾病的相关临床特征,为临床合理有效的诊断治疗提供较为可靠的参考依据。方法：对本院100例小儿热性惊厥6个月～7岁患儿病情发作后的脑电图等临床相关资料予以回顾性的分析总结,同时就疾病的相关临床特征予以探讨。结果：小儿热性惊厥发作时持续时间、发作的具体年龄及发作次数均和脑电图异常情况的发生率有着密切的相关性。结论：小儿热性惊厥发作持续时间、发作年龄及发作次数等是小儿热性惊厥发作后脑电图异常表现的主要相关性因素,在对小儿热性惊厥患儿予以临床治疗时要仔细分析相关因素,及时有效地予以对症治疗,最大程度地提高患儿的生活质量。     

The effect of vigabatrin on central nervous system oxygen toxicity in rats.

The toxicity of hyperbaric oxygen in the central nervous system is expressed by clinical and electroencephalographic (EEG) manifestations resembling those of generalized tonic-clonic seizures. In the search for drugs effective against these seizures, we tested vigabatrin, an irreversible inhibitor of GABA (gamma-aminobutyric acid) transaminase. Five different doses of vigabatrin (ranging from 50 to 500 mg/kg) or vehicle were injected i.p. in rats implanted with cortical electrodes, 4 h prior to exposure to 5 ATA (0.5 MPa) oxygen. EEG and spectral analysis of the background EEG activity were monitored for the different dosages of the drug. The duration of the latent period before the appearance of electrical discharges in the EEG was used as an index of oxygen toxicity. The protective effect of vigabatrin was dose-related, and complete protection against hyperoxic-induced discharges was at 180 mg/kg. The protective effect lasted 24 h and decreased gradually disappearing completely on the third day. An increase in the low frequency bands of the EEG and a decrease in the faster activity were correlated with the vigabatrin dosage injected. Our results suggest that vigabatrin has the potential of being a useful drug in the treatment and prevention of oxygen-induced seizures during hyperbaric oxygen therapy.     

应用不同抗癫痫药治疗儿童癫痫与肥胖的关系

目的　了解应用不同抗癫痫药 (AEDs)所导致癫痫患儿肥胖的情况。方法　根据患儿服用的不同AEDs,将 6 6例癫痫病人分为丙戊酸钠治疗组和非丙戊酸钠治疗组两组 ,对其体重 (Wt)及身高 (H)从服用AEDs开始进行为期 6个月的观察 ,观察肥胖指标 (BMI)的变化情况。结果　丙戊酸钠治疗组从治疗后 3个月开始出现肥胖 ,到治疗后 6个月时 ,男、女性的肥胖指标才有统计学的差异 ;丙戊酸钠治疗组的肥胖指标与非丙戊酸钠治疗组的统计学差异 ,也是从治疗后 3个月开始。结论　应用丙戊酸钠后可导致癫痫病人出现肥胖 ,其肥胖发生的时间一般在开始应用此药治疗后 3个月 ,因此 ,临床上应用丙戊酸钠时 ,要注意导致癫痫病人出现肥胖的问题。     

脑性瘫痪儿童睡眠脑电图检查的临床意义

目的 探讨脑性瘫痪(CP)儿童睡眠脑电图检查的临床意义。方法 采用部分剥夺睡眠法对57例年龄4～48个月的足月CP儿进行睡眠脑电图描记。结果 53例EEG异常(93.0％),主要异常为睡眠纺锤波缺失(80.7％),见于各型CP,3个月时即可检出;两半球脑波明显不对称占22.8％,主要见于偏瘫以及存在左右差的双瘫型CP;痫样放电占19.5％,见于合并癫痫发作者。结论 睡眠EEG检查有助于CP早期诊断、分型、合并癫痫的诊断,可作为高危儿随访及早期CP患儿常规评价内容。