甲基强的松龙治疗实验性变态反应性脑脊髓炎的作用机制

目的:研究细胞因子、T细胞凋亡和淋巴细胞增殖在实验性变态反应性脑脊髓炎(EAE)形成中的作用及甲基强的松龙(MP)治疗EAE的作用机制。方法:采用人脑纯化的髓鞘碱性蛋白(MBP)与完全福氏佐剂免疫Lewis大鼠,建立EAE动物模型。用双抗体夹心ELISA法检测各组大鼠血清中IL-10、TNF-α、IFN-γ的含量:流式细胞仪检测外周血T细胞凋亡;3H-TdR释放法检测外周血淋巴细胞转化率。结果:与对照组比较,EAE组的外周血IFN-γ、TNF-α水平明显增高,IL-10水平明显降低,MP治疗后IFN-γ和TNF-α水平下降,IL-10浓度上调。MP还诱导外周血T细胞凋亡和抑制MBP致敏淋巴细胞增殖并呈剂量依赖性。结论:应用人MBP成功建立EAE大鼠模型,MP可能通过调节Th细胞因子格局、促进Th2细胞因子分泌、抑制MBP致敏淋巴细胞增殖及外周血T细胞凋亡而发挥治疗多发性硬化的作用。     

二甲双胍通过调节Treg细胞反应治疗实验性自身免疫性脑脊髓炎

目的给予实验性自身免疫性脑脊髓炎(EAE)小鼠应用二甲双胍(MET)干预性治疗。观察MET对EAE小鼠发病情况及体内Treg细胞反应的作用。方法将雌性C57BL/6小鼠随机分为正常对照组、EAE模型组和MET治疗组,采用髓鞘少突胶质细胞糖蛋白MOG35-55免疫小鼠建立EAE模型。自身免疫后第1天开始,按100mg·kg~(-1)·d~(-1)给予MET治疗组腹腔注射。正常对照组及EAE模型组小鼠给予等量的生理盐水每日腹腔注射作为对照。应用Knoz评分观察小鼠的神经功能评分,流式细胞学检测方法检测小鼠脾细胞中Treg细胞比例,ELISA方法检测脾细胞培养上清及血清中IL-10、TGF-β含量。qPCR方法检测小鼠脾及脊髓中Treg细胞转录因子Foxp3 mRNA表达水平。结果与EAE模型组相比,MET治疗组发病程度减轻(P0.01);脾细胞中Treg细胞比例增高(P0.01),脾细胞培养上清及血清中IL-10、TGF-β含量增加(P0.01);脾组织中Foxp3mRNA表达水平升高(P0.01);脊髓组织中Foxp3mRNA表达水平升高(P0.01)。结论 MET通过提高外周免疫器官及中枢神经系统的Treg细胞数量,增加抑制炎症因子的表达而达到对EAE模型小鼠的保护作用。     

白介素-12家族与实验性自身免疫性脑脊髓炎的研究进展

实验性自身免疫性脑脊髓炎(EAE)是自身反应性CD4+T细胞,即辅助性T细胞(Th细胞)介导的自身免疫性中枢神经系统脱髓鞘性炎症,在EAE的发病中,Th细胞分泌的细胞因子起了重要的调节作用。白介素-12(IL-12)家族由IL-12和最近发现的白介素-23(IL-23)、白介素-27(IL-27)组成,是一类结构相似、具有共价结合的杂化双链的细胞因子,在细胞免疫尤其是Th1型炎症反应中,起重要的调节作用。本文综合论述了IL-12家族各成员与EAE的关系的研究,揭示了各因子在EAE发生发展中的作用。     

TNF-α及IL-8在EAE免疫学发病机理中的作用

目的　探讨 TNF-α及 IL - 8在实验性变态反应性脑脊髓炎 (EAE)免疫学发病机理中的作用。方法　自牛脑提取的髓鞘碱性蛋白 (MBP)加福氏完全佐剂 (CFA )免疫豚鼠 ,建立 EAE模型。同时采用生物活性测定法检测了 EAE模型的 TNF- α水平 ,采用双抗体夹心法酶联免疫吸附实验检测了 EAE模型的 IL- 8水平。结果　 EAE组的 TNF- α及 IL- 8水平均明显高于正常对照组。结论　 TNF- α及 IL- 8在 EAE免疫学发病机制中具有重要作用 ,验证了细胞因子 (CK)是 EAE致病的重要分子基础。为深入研究多发性硬化 (MS)的发病机理及探索新的有效治疗途径提供了理论依据。     

淋巴细胞亚群及炎症因子与自身免疫性脑炎的相关性

目的 探讨外周血淋巴细胞亚群及炎症因子与自身免疫性脑炎的相关性.方法 收集自身免疫性脑炎患者静脉血,流式细胞技术检测自身免疫性脑炎患者治疗前后各淋巴细胞亚群百分比,流式免疫荧光发光法检测相关细胞因子,改良Rankin量表(mRS)评估一线免疫治疗前后的评分.结果 自身免疫性脑炎患者免疫治疗前CD8+T细胞(r=0.77...     

TNF-α及工IL-8在EAE免疫学发病机理中的作用

目的探讨TNF-α及IL-8在实验性变态反应性脑脊髓炎(EAE)免疫学发病机理中的作用.方法自牛脑提取的髓鞘碱性蛋白(MBP)加福氏完全佐剂(CFA)免疫豚鼠,建立EAE模型.同时采用生物活性测定法检测了EAE模型的TNF-α水平,采用双抗体夹心法酶联免疫吸附实验检测了EAE模型的IL-8水平.结果EAE组的TNF-α及IL-8水平均明显高于正常对照组.结论TNF-α及IL-8在EAE免疫学发病机制中具有重要作用,验证了细胞因子(CK)是EAE致病的重要分子基础.为深入研究多发性硬化(MS)的发病机理及探索新的有效治疗途径提供了理论依据.     

经腹腔诱导免疫耐受抑制EAE的实验研究

目的 通过建立实验性自身免疫性脑脊髓炎（EAE）动物模型。研究经腹腔诱导免疫耐受的方法及机制。方法 腹腔内注射可溶性髓鞘碱性蛋白（MBP）或转输可溶性MBP致敏的腹腔抗原提呈细胞（MBP-APC），观察各组动物EAE的发病情况，检测各组动物迟发型超敏反应（DTH）和淋巴细胞体外增殖应答。结果 腹腔内注射MBP及MBP-APC的动物发病率明显低于EAE组。临床症状减轻，由MBP引起的DTH和体外特异的MBP淋巴细胞增殖反应也明显降低。结论 腹腔注射MBP或MBP-APC可引起黏膜耐受，抑制EAE的发生。     

载脂蛋白E拟肽对EAE小鼠的髓鞘和轴突损伤的影响

目的探讨载脂蛋白E(ApoE)拟肽对实验性自身免疫性脑脊髓炎(EAE)小鼠中枢神经系统髓鞘脱失和轴突损伤的影响。方法以髓鞘少突胶质细胞糖蛋白多肽(MOG35-55)为抗原建立EAE模型。将40只雌性C57BL/6J小鼠随机分为4组,即正常组、EAE组、正常治疗组和EAE治疗组,两个治疗组皮下注射ApoE拟肽。免疫组化法检测髓鞘碱性蛋白(MBP)和神经丝轻链(NF-L)的表达。结果 EAE治疗组中脑和脊髓的MBP和NF-L的表达均高于EAE组(P<0.05)。结论 ApoE拟肽可能对EAE的髓鞘和轴突的损伤有保护作用。     

阿托伐他汀对实验性变态反应性脑脊髓炎T辅助细胞功能的影响

目的探讨阿托伐他汀对实验性变态反应性脑脊髓炎(EAE)豚鼠T辅助细胞功能的影响,探讨阿托伐他汀对EAE发病保护作用的免疫调节机制。方法皮下注射粗制碱性髓鞘蛋白(MBP)建立EAE模型。40只豚鼠分成4组:正常对照组、EAE对照组、EAE低剂量组和EAE高剂量组,每组10只,雌雄各半。ELISA法测定EAE发病高峰期外周血单个核细胞培养上清液的细胞因子INF-γ、IL-4水平。结果EAE对照组IL-4浓度低于正常对照组(P<0.01),EAE高、低剂量组IL-4浓度高于EAE对照组(P<0.01),EAE高剂量组IL-4浓度比EAE低剂量组高(P<0.01)。EAE对照组IFN-γ浓度高于正常对照组(P<0.01),EAE高、低剂量组IFN-γ浓度低于EAE对照组(P<0.01),EAE高剂量IFN-γ浓度比EAE低剂量组低(P<0.01)。结论EAE豚鼠存在Th1细胞的过度活化、Th2细胞分泌活性降低;阿托伐他汀能具有抑制Th1细胞活性、提高Th2细胞分泌能力,具有调节Th1/Th2失衡作用。     

二甲双胍抑制Th17细胞反应对实验性自身免疫性脑脊髓炎小鼠保护作用

目的探讨实验性自身免疫性脑脊髓炎(EAE)小鼠应用二甲双胍(MET)干预,观察MET对EAE小鼠发病情况、神经功能评分的影响及其对小鼠体内Th17细胞反应的作用。方法以MOG35-55免疫雌性C57BL/6小鼠建立EAE模型。随机分成对照组、EAE组和MET治疗组,比较不同组小鼠神经功能评分。在发病高峰期,比较小鼠脊髓中炎性细胞浸润程度,脾细胞中Th17细胞比例,脾细胞培养上清及血清中IL-17A含量以及小鼠脾及脊髓中IL-17A、RORγt mRNA转录水平。结果与EAE组相比,MET治疗组发病率减低(P0.05),疾病严重程度减轻(P0.01);脾细胞中Th17细胞比例降低(P0.01),脾细胞培养上清及血清中IL-17A含量减少(P0.01);脾及脊髓组织中IL-17A、RORγt mRNA转录水平均降低(P0.01)。结论 MET通过抑制外周免疫器官及中枢神经系统的Th17细胞反应而对EAE小鼠起到保护作用。     

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.     

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.     

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.     

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.     

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.     

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.