创伤后应激障碍患者陈述性记忆损害与岛叶关系的磁共振成像研究

目的 利用功能磁共振成像(fMRI)技术,探讨在创伤后应激障碍(PTSD)患者的陈述性记忆损害中是否存在岛叶结构及功能异常.方法 应用基于体素的形态测量学和汉字编码任务,对12例PTSD患者(PTSD组)和12名正常对照者(对照组)进行脑结构和fMRI扫描,比较两组间岛叶结构及功能的差异.结果 (1)FTSD患者双侧岛叶的灰质密度(右侧岛叶x=34,y=4,x=6,t=4.44;左侧岛叶x=-36,y=2,z=0;t=4.64)低于对照组;(2)在编码作业时,左侧岛叶的激活程度(x=-40,y=-20,z=14)亦低于对照组(P均<0.05).结论 PTSD患者的岛叶存在结构损害,并在陈述性记忆作业中呈现功能异常,提示岛叶结构的损害可能与PTSD的陈述性记忆损害有关.     

抑郁症首次发病患者脑白质的弥散张量成像研究

目的 探讨抑郁症首次发病（以下简称首发）患者全脑白质纤维的完整性是否受到损害。方法 对14例未接受过治疗的首发抑郁症患者（抑郁症组）和14名与抑郁症组按性别、年龄匹配的正常人（正常人组）进行全脑弥散张量成像扫描，使用以像素为基础的分析方法比较两组各向异性分数（FA）。结果 抑郁症组的右侧额中回（x=36，y=49．x=10；t=4．89，像素集合=258）、左侧枕颞外侧回（x=-42，y=-56，z=-1；t=5．00，像素集合=96）、右侧顶叶的角回（x=24，y=-47，z=41；t=5．23，像素集合=120）和深部（x=42，y=-65，z=27；t=4．56，像素集合=76）白质FA值低于正常人（未校正，P〈0．001），上述FA值差异有统计学意义的区域与抑郁症组的症状严重程度（BDI和HAMD评分）以及病程之间无显著相关性。未发现抑郁症组比正常人组FA值高的脑区。结论 白质病变在抑郁症发病早期即已存在，其完整性的损害可能破坏了调节心境的神经环路。     

部分性发作癫痫患者静息状态功能磁共振默认模式网络的功能连接改变

目的 应用静息状态功能磁共振成像(fMRI)探讨部分性发作癫痫患者静息状态下的脑功能改变.方法 对60例部分性发作癫痫患者(患者组)和60名性别、年龄和教育程度匹配的健康对照者(对照组),使用3.0T磁共振采集两组的静息状态下fMRI数据,采用功能连接方法分析计算脑区的默认模式网络的功能连接,利用SPM5软件分析比较患者组和对照组脑功能的差异.结果 患者组的默认模式网络的功能连接主要包括左侧楔前叶/后扣带回和角回、扣带回;对照组的功能连接主要包括左侧楔前叶/后扣带回和右侧角回,双侧内侧额叶和颞叶;患者组的左侧顶下小叶[坐标值(x,y,z):-57,-39,48;t=4.90,P＜0.01]、左侧缘上回[坐标值(x,y,z):-63,- 48,33;t=4.25,P＜0.01]、左侧海马旁回[坐标值(x,y,z):-30,-6,-21;t =4.05,P＜0.01]、左侧颞上回[坐标值(x,y,z):-48,-39,6;t=3.72,P＜0.01],左侧钩回[坐标值(x,y,z):-24,6,- 36;=4.56,P＜0.01]及右侧钩回[坐标值(x,y,z):33,-15,- 36;t=4.00,P＜0.01]的默认模式网络功能连接较对照组降低;未发现功能连接升高的脑区.结论 部分性发作癫痫患者静息状态下脑区的功能连接改变,可能是部分性发作癫痫潜在的病理生理机制.静息状态fMRI能发现常规MRI正常的癫痫患者的广泛脑功能异常,是一种无创的研究癫痫患者脑功能的有效方法.     

基于体素的形态学测量的创伤后应激障碍患者脑结构变化研究

目的探讨交通事故致创伤后应激障碍(PTSD)患者的脑结构形态学改变。方法选择46例经历交通事故后自2021年1月至2022年6月就诊于广东省第二人民医院心理精神科的PTSD患者(PTSD组)以及同期招募的49例性别、年龄相匹配的正常健康者(对照组)为研究对象。所有受试者均行全脑MRI 3D-T1WI结构像扫描, 并应用基于体素的形态学测量(VBM)方法分析2组受试者间脑区灰质体积的差异, 并对PTSD组较对照组有差异的脑区灰质体积与其临床用创伤后应激障碍诊断量表(CAPS)、创伤后应激障碍自评量表(PCL-C)及汉密尔顿抑郁量表(HAMD)评分进行相关性分析。结果与对照组相比, PTSD组左侧海马、左侧中央后回及右侧额上回灰质体积明显缩小, 差异均有统计学意义(P<0.001, GRF校正), 未发现较对照组灰质体积增加的脑区。PTSD组患者的左侧中央后回灰质体积与其CAPS评分呈负相关关系(r=-0.443, P=0.002), 其余有差异的脑区灰质体积与CAPS、PCL-C及HAMD评分间均无相关性(P>0.05)。结论交通事故致PTSD患者存在左侧海马、左侧中央后回及...     

矿难后急性重性创伤后应激障碍症状激发和创伤有关短期记忆提取的功能性磁共振成像研究

目的 探讨急性重性创伤后应激障碍(post traumatic stress disorder,PTSD)患者的脑功能及执行记忆功能时的脑反应.方法 采用功能磁共振成像技术,对经历矿难的10例急性重性PTSD患者(PTSD组)和7例非PTSD对照(非PTSD组)执行症状激发任务,并首次采用1项创伤有关的短期记忆提取任务进行记忆功能的测定.结果 症状激发试验中,PTSD组负性图片相比中性图片,左侧后扣带回、双侧尾状核和右侧丘脑等脑区激活增强,右侧扣带回和双侧额中回激活下降;PTSD组相比非PTSD组,右侧前扣带回、左侧额下回、双侧额中回及双侧颞中回等脑区激活下降,左侧海马旁回激活增高.短期记忆提取任务中,PTSD组负性图片相比中性图片,右侧后扣带回和双侧海马存在明显激活;PTSD组相比非PTSD组,右侧额下回、右侧额中回、左侧枕中回等脑区激活下降.记忆提取任务相比症状激发任务,PTSD组右侧海马旁回激活下降.结论 急性重性PTSD患者在急性期已存在部分脑区激活的下降以及记忆功能的减退.     

急性创伤后应激障碍患者脑结构的磁共振研究

目的探讨单一、高强度持续刺激所致急性创伤后应激障碍(PTSD)患者早期脑部结构的变化。方法采用基于像素的形态学方法(VBM)研究受试者脑部结构变化。研究对象包括10名急性PTSD患者,10名未患PTSD的矿难幸存者,并对其PTSD症状积分(CAPS)与感兴趣区灰质密度进行相关性分析。结果与对照组相比,急性PTSD患者左侧海马前部、海马旁回和双侧距状裂皮质纹状区的灰质体积明显下降;而其白质体积未见明显变化。双侧距状裂及左侧海马灰质密度与CAPS积分存在显著负相关。结论本研究结果显示早期急性PTSD患者边缘系统的灰质体积明显减小,PTSD患者症状的严重程度与距状裂皮质纹状区和海马区的灰质密度相关。     

精神分裂症早期的脑白质和灰质信号强度下降

目的分析精神分裂症早期阶段脑灰质和脑白质结构的变化。方法对25例早期阶段(病程小于6个月)的首发未用药的精神分裂症患者和28名正常对照的脑部进行磁共振T1加权成像,所得图像以统计参数图软件包进行预处理,再对两组脑灰质密度和白质信号强度进行t检验。结果患者组左侧岛叶区(x=34,y=18,z=-2,体素集合数=163)、左枕叶(x=14,y=-66,z=14,体素集合数=76)、右侧额叶(x=46,y=44,z=8,体素集合数=74)白质信号强度较正常对照组降低(t=-3.78,P=0.007;t=-3.36,P=0.02;t=3.26,P=0.03);右侧枕叶(x=10,y=-84,z=8,体素集合数=64)脑灰质信号强度比正常对照组降低(t=3.12,P=0.03)。结论精神分裂症早期阶段即存在脑实质结构异常,以白质为著。     

青少年非自杀性自伤患者静息态功能磁共振研究北大核心CSCD

目的探讨非自杀性自伤(non-suicidal self-injury,NSSI)青少年静息态功能磁共振成像下脑功能特征。方法采用病例对照研究设计,纳入NSSI青少年患者23例(NSSI组)与健康青少年18名(healthy control,HC组),进行静息态功能MRI扫描,分析NSSI组与HC组低频振幅(amplitude of low frequency fluctuation,ALFF)有差异的脑区,以差异脑区为种子点计算全脑功能连接(functional connectivity,FC),并分析NSSI组差异脑区的ALFF值与青少年非自杀性自伤行为评定问卷及汉密尔顿抑郁量表评分相关性。结果与HC组比较,NSSI组ALFF升高的脑区包括双侧杏仁核(x=-27,y=3,z=-24,t=2.492,P<0.05,FDR校正;x=27,y=3,z=-12,t=2.746,P<0.05,FDR校正)、右侧背外侧额上回(x=15,y=21,z=45,t=4.051,P<0.05,FDR校正)。以双侧杏仁核作为种子点分别计算全脑FC,与HC组比较,NSSI组左侧杏仁核与右侧前扣带回(t=3.352,P<0.05,FDR校正)、左侧前扣带回(t=2.843,P<0.05,FDR校正)、右侧丘脑(t=3.026,P<0.05,FDR校正)、左侧丘脑(t=2.352,P<0.05,FDR校正)FC强度增高,与左侧眶部额上回(t=-2.181,P<0.05,FDR校正)、左侧眶部额中回(t=-3.378,P<0.05,FDR校正)FC强度减低。NSSI组左侧杏仁核ALFF值与汉密尔顿抑郁量表评分呈正相关(r=0.627,P=0.004)。结论NSSI青少年静息态下多个脑区存在神经元异常活动,左侧杏仁核与多个脑区的FC存在异常,这可能是NSSI神经病理发病机制。     

脑梗死后运动性失语的发生机制:基于局部一致性的静息态功能MRl研究

目的:应用静息态功能MRl的基于局部一致性(regional homogeneity,ReHo)技术,探讨脑梗死后运动性失语的早期恢复发生机制。方法:选取脑梗死后运动性失语症患者10例作为失语组,同期无失语患者10例作为对照组,均行静息态fMRl检查。应用SPM8软件和DPARSF软件对数据进行处理,利用REST进行2样本t检验。结果:与对照组相比,失语组患者ReHO高于对照组的脑区有左侧小脑(脑成像坐标系MNl:x=-27,y=-60,z=-18;t=3.33)、左枕叶(脑成像坐标系MNl:x=-45,y=-69,z=15;t=5.26)和右侧颞叶(脑成像坐标系MNl:x=51,y=-51,z=9;t=7.49)。失语组患者ReHO低于对照组的脑区有左侧前额叶内侧回(脑成像坐标系MNl:x=-24,y=75,z=3;t=-3.75)、左额上回和左额中回(脑成像坐标系MNl:x=-36,y=9,z=66;t=-4.44)、左角回(脑成像坐标系MNl:x=-66,y=-60,z=42;t=-2.67)、左顶叶(脑成像坐标系MNl:x=-57,y=-84,z=48;t=-3.23)、左侧顶...     

抑郁症患者岛叶-皮质静息态功能连接的观察北大核心CSCD

目的探讨未服药抑郁症患者静息态岛叶功能连接特征。方法选取50例未服药的抑郁症患者(抑郁症组)和51名健康对照者(对照组)进行静息态fMRI(rs-fMRI)扫描,对rs-fMRI数据进行常规预处理并基于岛叶分区为双侧岛叶前部、双侧岛叶中部、双侧岛叶后部6个种子点进行全脑功能连接分析,采用双样本t检验比较2组间脑功能连接值的差异,经过不依赖阈值集群增强(threshold-free cluster enhancement,TFCE)的多重比较校正,并将差异有统计学意义脑区的功能连接值与HAMD24评分等临床变量进行相关分析。结果与对照组相比,抑郁症组左侧岛叶前部与双侧前扣带回之间功能连接减低(t=-4.83,P<0.05,TFCE校正),左侧岛叶前部与左侧额中回、双侧后扣带回/楔前叶之间功能连接增强(t=4.08、4.42,均P<0.05,TFCE校正)。左侧岛叶前部与双侧前扣带回(r=-0.125,P=0.387)、左侧额中回(r=0.149,P=0.302)、双侧后扣带回/楔前叶(r=-0.207,P=0.148)的功能连接值与HMAD24评分无相关性。结论抑郁症患者可能存在左侧岛叶前部与边缘系统、额叶皮质功能连接异常,包括岛叶-前扣带回连接减弱,岛叶-额叶、岛叶-后扣带回/楔前叶连接增高。     

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.     

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.     

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.