小儿颞叶癫癎的临床表现及脑电图分析

目的 探讨小儿颞叶癫癎的临床特征及脑电图特点.方法 收集16例颞叶癫癎患儿,对其发作的临床特点及脑电图资料进行分析,对比难治性癫癎的脑电图变化规律.结果 患儿的癫癎发作形式主要表现为单纯部分性发作、复杂部分性发作、继发全面性发作.单纯部分发作频率高而持续时间短,复杂部分发作持续时间长但发作频率低并常见发作后朦胧状态.颞叶癫癎的脑电图特点:背景正常者约占62.5%(10/16);背景异常约占37.5%(6/16);异常放电及部位:颞叶棘波或慢波放电,表现为单侧或双侧同步或不同步放电.结论 小儿颞叶癫癎是一组部分性症状性癫癎综合征,多表现为复杂部分发作,临床发作及同步脑电图特点可为临床诊治提供帮助.     

脑电图与经颅多普勒在脑梗死后癫(癎)患者中的应用价值

目的探讨脑电图与经颅多普勒在脑梗死后癫癎中的应用价值。方法对48例脑梗死后癫癎患者行脑电图及经颅多普勒检查。结果48例患者中,脑电图异常44例,异常率91.7%,主要表现为慢波增多,出现棘波、尖波及棘慢波、尖慢波等;经颅多普勒异常42例,异常率85.7%,主要表现为频谱形态异常及血流增快及减慢等。结论脑电图是脑细胞功能的最直接反映,对预测癫癎发作及病情变化有重要价值。经颅多普勒可反映脑血管功能情况,出现脑供血不足、脑组织缺血缺氧时可致癫癎发作。     

慢波睡眠中伴有持续性棘-慢波癫(癎)的现代观点

国际抗癫(癎)联盟的癫(癎)新定义认为,癫(癎)发作是一种临床现象,是由神经元高度同步化异常放电所导致的,能被患者或他人察觉到的功能紊乱,表现为被临床工作者认同的症状和体征.仅有脑电图(癎)样放电而没有临床发作者不能诊断为癫(癎),但慢波睡眠中伴有连续棘一慢波的癫(癎)(ESS)是唯一被国际抗癫(癎)联盟认同,脑电图上有明显(癎)样放电,但不一定有临床发作的新的癫(癎)综合征.由于其在2001年才被认同,因而近年来围绕着这种特殊癫(癎)综合征的基本要素进行了广泛的研究.     

17例弈棋相关性癫(癎)发作临床特点分析

目的:分析与弈棋相关的癫(癎)发作患者的临床特征.方法:选取2012年1月～2015年12月上海交通大学医学院附属新华医院神经内科癫(癎)数据库中与弈棋相关的癫(癎)发作患者17例进行随访,收集患者的人口学资料、起病年龄、癫(癎)发作类型、发作频率、影像学资料以及脑电图资料等,并对患者数据进行统计学分析.结果:17例患者均表现为与弈棋相关的癫(癎)发作,其中12例为棋奕性癫(癎),2例单次发作,3例为继发性癫(癎)弈棋相关性发作.2例棋奕性癫(癎)患者的动态脑电图提示(痫)样放电,2例继发性癫(癎)弈棋相关性发作患者的动态脑电图亦发现异常放电.行为学干预有助于预防再次发作,而抗癫(癎)药物(AED)并无特异疗效.结论:出现弈棋相关性癫(癎)发作的患者首先需明确病因.继发性癫(癎)弈棋相关性发作可考虑AED治疗;反射性癫(癎)行为学干预有助于预防再次发作,AED治疗非首选.     

颞叶癫(癎)发作期临床表现及脑电图特点分析

目的 探讨颞叶癫(癎)患者发作期临床特征、脑电图特点及其临床意义.方法 对14例患者的46次发作的临床特点及脑电图进行分析.结果 46次发作中,16次为单纯部分性发作,30次为复杂部分性发作,2次继发全面性发作,单纯部分发作频率高而持续时间短,复杂部分发作持续时间长但发作频率低并常见发作后朦胧状态.发作时脑电图表现以中高波幅慢波起始最多见,10例患者可以得到定侧.4例患者通过分析临床表现及脑电图改变定侧后进行手术,术后癫(癎)完全控制.结论 颞叶癫(癎)是一组部分性症状性癫(癎)综合症,多表现为复杂部分发作,临床医生通过监测到临床发作可以更好明确诊断.同时,临床发作及同步脑电图改变可以为术前评估提供很大帮助.     

一组特殊的良性儿童部分性癫(癎)的临床和脑电图特征

目的 分析一组特殊的良性儿童部分性癫(癎)的临床特征,探讨其病理生理机制.方法 对在我院癫(癎)中心门诊就诊的儿童部分性癫(癎)进行随访观察,纳入符合良性部分性癫(癎)诊断者,排除能够分类的其他类型,分析患者的临床和脑电图特征.结果 入组的44例患者中,38.6%(17/44)的患儿每天均有发作,额叶失神、偏转是最常见的发作症状,觉醒脑电图有局灶、多灶、全面性棘慢波爆发3种表现,且以额部为著;睡眠时双侧同步化.截止随访日,88.6%(39/44)完全无发作,22.7%(10/44)脑电图完全恢复正常.结论 有一组特殊的良性儿童部分性癫(癎),可能是起源于额叶.     

癫(癎)失神发作50例脑电图分析

目的通过50例癫(癎)失神发作患儿的脑电图分析,探讨脑电图在临床脑功能评价中的应用.方法采用日本光电4418型脑电图仪,对癫(癎)失神发作患儿进行检查.结果正常2例,异常48例,异常率96%.结论3Hz棘慢波综合为癫(癎)失神发作所特有波形,适当延长过度换气描记时间及做睡眠诱发试验可提高EEG阳性率.     

癫(癎)发作同步记录脑电图非典型癫(癎)样病理波发放的临床意义

目的 观察癫(癎)发作时棘、尖样波群以外有别于背景波的θ、δ波在癫(癎)诊断中的价值,正确认识癫(癎)发作同步记录脑电图未见到尖、棘样典型病理波发放的临床意义.方法 对2000-01～2007-01我院收治的具有(癎)样发作患者203例的录像监测脑电图(video-EEG)进行回顾性分析.结果 脑电图正常16例(7.5%),临床发作与典型癫(癎)样病理波同步发放者157例(77.3%),临床发作与非典型癫(癎)样病理波同步发放者30例(15.2%),发作间歇期有癫(癎)样波发放者56例,发作间歇期可见不典型癫(癎)样波发放者36例.结论 正确识别棘、尖波群以外有别于背景波的癫(癎)样波的演变过程及规律,可提高癫(癎)的准确诊断率.     

头痛间隙期伴癎性放电15例患儿的脑电图分析

目的:分析以"发作性头痛"为主诉的患儿其脑电图癎性放电部位的分布特点。方法:收集中国医科大学附属第一医院儿科门诊101例以"发作性头痛"为主诉的患儿,行脑电图检查。其中15例患儿脑电图中显示癎性放电,对癎性放电的出现部位进行分析。结果:15例患儿中有12例患儿脑电图中的癎性放电表现为散在性棘慢波,且颞叶出现率最高,为65.5%;2例患儿脑电图中的癎性放电表现为全部导联周期性及阵发性棘慢波;1例患儿脑电图中的癎性放电表现为双侧顶枕导联阵发性棘慢波。结论:头痛患者行脑电图检查十分必要,儿童患者的头痛症状应引起临床医生的重视。     

癫(癎)与可疑癫(癎)临床发作时的动态脑电图分析

目的探讨癫(癎)与可疑癫(癎)临床发作时的动态脑电图(AEEG)的变化特征.方法本文对316例癫(癎)临床发作时的动态脑电图进行分析.结果临床发作时癫(癎)组162例中,AEEG监测结果正常为49例(30.25%),异常为113例(69.75%);在临床诊断可疑癫(癎)的154例中,AEEG监测结果正常为110例(71.43%),异常44例(28.57%).癫(癎)组与可疑癫(癎)组临床发作时癫(癎)样波的发放有非常显著性差异(x2=53.56,P＜0.001).结论AEEG因大大增加了描记时间而使EEG阳性率明显提高,临床发作与同步的AEEG痫样波的发放对癫(癎)的诊断非常重要.尤其对许多非(癎)性发作性疾病与癫(癎)发作的鉴别诊断更有重要意义.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.