颅内电极脑电图发作前期脑电活动特点在癫发作定位中的作用

目的分析颅内电极脑电图发作前期脑电活动特点,探讨其与不同发作起源部位及术后病理的关系,为癫定位诊断提供依据。方法回顾性分析19例症状性难治性癫病人的临床资料,根据颅内电极记录的发作起始部位不同,将病人分颞叶外癫(n=11)和颞叶癫(n=8)。分析两组发作前期脑电的放电类型以及病理结果。结果颞叶外癫病人发作前期脑电多表现为周期样节律性快活动,颞叶癫发作前期均表现为周期样多棘/棘-慢波放电。两组病人发作前期脑电活动的放电类型存在统计学差异(χ~2=40.358,P0.01)。术后病理结果显示局灶性脑皮质发育不良(focal cortical dysplasia,FCD)不同亚型之间的发作前期脑电活动存在统计学差异(χ~2=25.050,P0.01)。结论起源于颞叶外的癫,发作前期脑电活动多表现为周期样节律性快活动,病理分型以FCDⅡ型多见。而起源于颞叶的癫,发作前期则以周期样多棘/棘-慢波放电为主要放电表现,病理分型多见于FCDⅠ型。     

动态脑电图在进展性卒中早期诊断的临床应用

目的探讨动态脑电图监测对进展性卒中早期诊断的临床应用价值。方法 160例急性缺血性卒中患者,根据病情进展与否分为进展组(53例)和非进展组(107例),回顾分析患者入院24 h内的动态脑电图监测和头部CT检查资料,比较两组患者脑电图异常检出率,以及进展组患者动态脑电图与CT阳性一致性。结果进展组患者动态脑电图异常检出率为88.68%(47/53),与非进展组[64.49%(69/107)]比较差异具有统计学意义(X~2=10.405,P=0.001);发病24 h内CT检查阳性率为67.92%(36/53),其中58.49%(31/53)患者两种检查均发现病灶,两种方法阳性率比较差异有统计学意义(X~2=4.762,P=0.027)。进展组脑电图呈重度异常者4例(大面积脑梗死3例、脑干梗死1例),入院第2天昏迷;中度异常者20例,均为前循环梗死;轻度异常者23例(前循环梗死19例、后循环梗死4例);正常脑电图6例,均无意识障碍。结论进展性卒中患者动态脑电图监测异常检出率较高,尤其在发病早期其阳性率明显高于头部CT检查。动态脑电图异常程度与病变程度和部位有关,对急性进展性卒中患者的早期诊断具有一定参考价值。     

229例癫癎无发作2年以上患者的脑电图特点及影响因素

目的探讨癫癎无发作2年以上的患者抗癫癎药(AEDs)撤药前脑电图异常(样放电)的可能影响因素。方法根据入组标准共筛选229例癫癎控制、达到无发作2年以上患者,收集相关临床资料并进行统计学分析。结果在229例患者中,脑电图持续异常者为48例(21.0%)。多因素分析发现首次发作后脑电图出现异常放电(P=0.000,OR=9.07,95%CI:3.39-24.28)以及多药联合治疗(P=0.019,OR=2.70,95%CI:1.17-6.17)是脑电图持续异常(样放电)的相关危险因素。结论癫癎首次发作后脑电图异常(样放电)、AEDs多药联合治疗是癫癎发作控制患者的脑电图持续异常(样放电)的危险因素,撤药应慎重。     

首发脑梗死患者卒中后抑郁的临床特征及与病灶相关性分析

目的分析首发脑梗死患者卒中后抑郁临床特征及其和病灶的相关性。方法选取2014年12月至2016年12月期间在我院就诊的首发脑梗死卒中患者68例,根据是否伴有抑郁分为:伴抑郁21例,为观察组,不伴抑郁47例,为对照组,观察两组患者临床特征,并分析脑梗死卒中后抑郁和病灶部位、病灶大小相关性。结果两组患者左侧大脑半球的比较发现:皮质下及额叶梗死率存在显著性差异(P0.05),而右侧大脑半球梗死发生率未见统计学差异(P0.05);观察组梗死灶直径≥3.6cm患者所占比例明显高于对照组,差异有统计学意义(P0.05);观察组中病灶直径≥3.6cm的患者重度抑郁发生率明显高于直径3.6cm的患者(P0.05)。结论首发脑梗死卒中后抑郁患者的梗死灶常见于左侧大脑半球,且卒中后抑郁病情的严重程度和梗死灶直径的大小相关。     

动态脑电图在癫诊断中的应用价值

目的 探讨动态脑电图在癫癎诊断中的应用价值.方法 记录169例临床拟诊癫癎患者的24h脑电活动,与常规脑电图检查进行对比.结果 动态脑电图癎样放电率(62.72%)及总异常率(86.98%)与常规脑电图比较差异有统计学意义(P均<0.01).睡眠期癎样放电率明显高于清醒期.结论 24h动态脑电图可提高癎样放电的检出率,对癫癎的诊断有重要应用价值.     

动态脑电图在进展性卒中早期诊断的临床应用

目的探讨动态脑电图监测对进展性卒中早期诊断的临床应用价值。方法160例急性缺血性卒中患者,根据病情进展与否分为进展组（53例）和非进展组（107例）,回顾分析患者入院24h内的动态脑电图监测和决部CT检查资料,比较两组患者脑电图异常检出率,以及进展组患者动态脑电图与CT阳性一致性。结果进展组患者动态脑电图异常检出率为88．68％（47／53）,与非进展组[64．49％（69／107）]比较差异具有统计学意义（X2=10．405,P=0．001）;发病24h内CT检查阳性率为67．92％（36／53）,其中58．49％（31／53）患者两种检查均发现病灶,两种方法阳性率比较差异有统计学意义（x2=4．762,P=0．027）。进展组脑电图呈重度异常者4例（大面积脑梗死3例、脑干梗死1例）,人院第2天昏迷;中度异常者20例,均为前循环梗死;轻度异常者23例（前循环梗死19例、后循环梗死4例）;正常脑电图6例,均无意识障碍。结论进展性卒中患者动态脑电图监测异常检出率较高,尤其在发病早期其阳性率明显高于头部CT检查。动态脑电图异常程度与病变程度和部位有关,对急性进展性卒中患者的早期诊断具有一定参考价值。     

缺血性卒中伴发癫(癎)的危险因素分析

目的 探讨缺血性卒中伴发癫(癎)的危险因素,以加强早期预防并改善预后.方法 根据斯堪地那维亚卒中评分(SSS)对101例发病<24 h的缺血性卒中伴发癫(癎)患者进行神经功能缺损程度评价,同时记录患者性别,年龄,既往史(高血压、冠心病、心房纤颤、2型糖尿病、高脂血症),电解质(血清钾、钠、氯),发病状态(安静、活动),缺血性卒中亚型(动脉粥样硬化性血栓性脑梗死、脑栓塞、腔隙性梗死),脑梗死后渗血,病灶部位(脑叶、基底节区),受累大脑半球侧别(左侧、右侧、双侧),脑萎缩及脑白质脱髓鞘病变等临床资料,分别进行单因素分析和多因素非条件Logistic回归分析.结果 单因素分析显示,与单纯缺血性卒中患者相比,缺血性卒中伴发癫(癎)者缺血性卒中亚型(脑栓塞)、脑梗死后渗血、病灶部位(脑叶,其中额叶所占比例达48.72%)、受累大脑半球侧别(右侧),以及神经功能缺损程度(SSS评分<30分)均存在明显差异(均P≤0.05);而性别、年龄、既往史、电解质指标、发病时状态、脑萎缩程度、脑白质脱髓鞘病变等因素,两组差异无统计学意义(均P>0.05).多因素非条件Logistic回归分析表明,脑栓塞(OR=0.152,95%CI:0.065～0.496;P=0.011)、脑梗死后渗血(OR=0.105,95%CI:0.020～0.549;P=0.008)、脑叶皮质受累(OR=0.099,95%CI:0.044～0.225;P=0.000)、SSS评分<30分(OR=0.145,95% CI:0.062～0.337;P=0.000)等因素为缺血性卒中伴发癫(癎)的主要危险因素,而右侧大脑半球受累(OR=0.638,95%CI:0.311～1.308;P=0.220)则不增加缺血性卒中伴发癫(癎)的风险.结论 具有脑栓塞、脑梗死后渗血、病灶位于脑叶(特别是额叶)、SSS评分<30分等因素的缺血性卒中患者易伴发癫(癎).     

头晕 记忆力减退1年 加重伴癫发作 精神行为异常19天

<正>病历摘要患者男性,50岁。主因头晕、记忆力减退1年,加重伴癫发作和精神行为异常19 d,于2014年11月25日入院。患者1年余前开始出现间断性头晕,发作时注意力不集中,不伴恶心、呕吐,记忆力逐渐减退、反应迟钝,时有提笔忘字。入院前19 d,突发意识障碍、双眼上翻、四肢抽搐,持续10 min后自行缓解。外院头部CT显示额颞叶梗死灶;脑电图呈现广泛异常,以右侧大脑半球明显,可见周期性三相波。考虑缺血性卒中、癫,予神经营养药物和抗癫药物     

长程视频脑电监测对癫的诊断价值

目的评价长程视频脑电图对癫等发作性疾病的诊断价值,提高癫及癫综合征的诊断。方法对在本院神经内科癫中心门诊及住院患者中首次以发作性疾病就诊的患者进行不同时程的视频脑电图监测,对其临床资料进行回顾性分析。结果 24 h组视频脑电监测对癫异常脑波放电的阳性检出率较高(76.9%),8 h组最低(30.1%),15 h组介于两者之间(55.4%),在24 h组1920例患者中有1476例有异常放电,287例记录到临床同步发作,其中153例明确癫发作类型,153例中96例进一步明确为癫综合征,使对癫的分型及癫综合征的分类更加明了细化。结论 24 h视频脑电监测能够显著提高癫患者的诊断率及异常脑波的检出率,有效地降低了假阴性率并且在癫的鉴别诊断、分型及癫综合症的诊断方面有重要的临床意义,同时对其他发作性疾病的鉴别提供了可靠的的临床依据。     

缺血性脑卒中后血管性痴呆的MRI特征研究

目的研究急性缺血性脑卒中后血管性痴呆的MRI特点,探讨急性缺血性脑卒中与血管性痴呆的相关性,为指导临床治疗提供帮助。方法选取124例缺血性脑卒中患者,检查后发现血管性痴呆的缺血性脑卒中患者(实验组)66例,非血管性痴呆患者(对照组)58例。经头颅MRI检查后,比较2组患者的脑梗死发生部位、数目、大小。结果 2组患者的年龄、饮酒和吸烟时间、并发高血压、心脏病几率相比差异无统计学意义(P0.05)。但实验组患者的病程较长、患糖尿病几率以及卒中次数明显高于对照组(P0.05)。对照组患者的语言即刻记忆、时间定向、语言复述、言语表达和图形描述等评分与实验组相比差异无统计学意义(P0.05)。但实验组注意和计算、短程记忆评分明显低于对照组(P0.05)。对照组患者中小梗死较为常见,实验组患者梗死部位主要发生在额叶和丘脑,以大梗死发病较多,明显高于对照组(P0.05)。结论额叶、丘脑等是缺血性脑卒中后血管性痴呆的主要梗死部位以大中梗死较为常见,与年龄、卒中次数等密切相关。     

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.