左乙拉西坦和丙戊酸钠对青少年肌阵挛癫痫单药治疗的疗效比较

目的比较左乙拉西坦(levetiracitam,LEV)和丙戊酸钠(sodium valproate,VPA)对青少年肌阵挛癫痫(Juvenile Myoclonic Epilepsy,JME)单药治疗的疗效。方法选取60例青少年肌阵挛癫痫患者,随机分为2组,每组30例,分别给予左乙拉西坦和丙戊酸钠单药治疗,比较治疗后2组肌阵挛发作(myoclonic seizure,MS)、全面性强直阵挛发作(generalized tonic-clonic seizure,GTCS)和脑电图(electroencephalogram,EEG)改善情况。结果 (1)肌阵挛发作改善情况:左乙拉西坦组总有效率为79.31%,丙戊酸钠组总有效率为85.71%(χ2=0.049,P0.05);(2)全面性强直阵挛发作改善情况:左乙拉西坦组总有效率为89.65%,丙戊酸钠组有效率为82.14%(χ2=0.669,P0.05);(3)脑电图改善情况:左乙拉西坦组总有效率为72.41%,丙戊酸钠组总有效率为75.00%(χ2=0.049,P0.05);(4)不良反应:左乙拉西坦组不良反应发生率为6.90%,丙戊酸钠组为25.00%(χ2=6.02,P0.05)。结论青少年肌阵挛癫痫是一种需要长期治疗甚至终生治疗的疾病,故选择治疗药物时不仅需要考虑疗效,长期服用药物的毒副作用也不容忽视。左乙拉西坦和丙戊酸钠对青少年肌阵挛癫痫单药治疗有相同的疗效,且左乙拉西坦不良反应发生率较丙戊酸钠小(P0.05),故左乙拉西坦可作为治疗青少年肌阵挛癫痫的首选一线药物。     

67例青少年肌阵挛临床与VEEG的局灶性特征分析

目的总结青少年肌阵挛癫痫(juvenile myoclonic epilepsy,JME)的临床与VEEG的局灶性特征。方法回顾性分析厦门大学附属中山医院就诊的67例JME患者临床症状与24小时长程视频脑电图的局灶性特征。结果 67例患者中,11.94%的肌阵挛发作(MJ)存在一侧或不对称肌阵挛抽动,13.11%的全面强直-阵挛发作(CTCS)出现不对称体征;24 h VEEG监测到的发作中,46.80%的MJ及66.67%的GTCS出现不对称或及局灶症状;发作间期的不对称及局灶性EEG占44.7%。局灶性EEG的棘波、棘慢波最常出现在额区。31例患者服药后复查VEEG,不对称及局灶EEG比例增加至64.52%。结论 JME有高度的临床异质性,临床医生应警惕其临床及EEG的局灶性特征,避免误诊。     

青少年肌阵挛癫痫和睡眠肌阵挛的比较研究

目的比较分析青少年肌阵挛癫痫(JME)和睡眠肌阵挛(SM)的临床和脑电图(EEG)特点.方法对20例JME患者和25例SM进行分析.结果JME多见于青春期发病,有遗传性,男女无差别,常在清醒时表现为双侧单一或反复的不规则无节律的肌阵挛发作,无意识障碍,可伴全身强直阵挛性发作(GTCS),少有失神,易被剥夺睡眠和闪光诱发,EEG示快而弥漫的不规则棘慢波和多棘慢波复合;SM可见于各年龄组,在入睡不久出现肢体或手指不自主、无规律地抽动一下,双侧不同时出现,发作频率和动作幅度不等,EEG监测在肢体抖动时,亦无异常放电.结论JME是一种遗传性、与年龄相关的以肌阵挛发作为主的癫痫综合征,其预后好;SM是一种无需治疗的生理现象.     

奥卡西平 拉莫三嗪 左乙拉西坦对癫痫患者脑电图的影响

目的探讨抗癫痫新药奥卡西平(OXC)、拉莫三嗪(LGT)、左乙拉西坦(LEV)对癫痫患者脑电图的影响。方法对单用奥卡西平、拉莫三嗪、左乙拉西坦的癫痫患儿作服药前及服药后动态脑电图比较。结果奥卡西平、拉莫三嗪、左乙拉西坦均可使癫痫患儿脑电图痫性活动减少,但拉莫三嗪、左乙拉西坦优于奥卡西平;奥卡西平组易发生背景波减慢,α活动减少,θ、δ增多,但拉莫三嗪、左乙拉西坦影响较小。结论拉莫三嗪、左乙拉西坦对脑电图不良影响较小,有利于控制痫性活动,更易达到停药标准。     

癫痫住院患者抗癫痫药物和病因及发作形式的回顾性研究

目的了解癫痫住院患者病因、发作形式及抗癫痫药使用情况。方法收集癫痫住院患者5563例,分析其病因、发作形式及抗癫痫药物的种类、数量及使用频度。结果病因不明(40.80%),脑外伤(13.64%)、海马硬化(11.52%)、脑卒中(5.24%)、神经系统感染(4.98%)、围生期损害(5.28%)等为常见病因,发作形式以部分性发作最常见(45.43%),抗癫痫药物以传统药物卡马西平和丙戊酸为主,卡马西平和丙戊酸平均使用率分别为36.88%和30.80%,新型抗癫痫药物拉莫三嗪和左乙拉西坦使用频度呈上升趋势,拉莫三嗪从16.16%上升到28.44%,左乙拉西坦从0.61%上升到20.87%,奥卡西平和托吡酯的使用频度变化不明显,分别稳定在15.07%和9.42%左右。结论癫痫病因复杂,发作形式多样,抗癫痫药物种类繁多,新型抗癫痫药物在临床中越来越多的被使用。     

卡马西平与托吡酯联合左乙拉西坦治疗创伤性难治性癫痫临床研究

目的探讨托吡酯、卡马西平及左乙拉西坦联合治疗创伤性难治性癫痫患者的疗效及对其认知功能的影响。方法选取2014-01—2016-06平煤神马医疗集团总医院收治的74例难治性癫痫患者,依据建档顺序分为2组,各37例。对照组采用卡马西平联合托吡酯治疗,研究组联合采用卡马西平、托吡酯及左乙拉西坦治疗;2组均持续治疗4个月。统计对比2组临床疗效、入院时及疗程结束后认知功能评分(MoCA)及癫痫发作次数。结果研究组总有效率89.19%(33例)高于对照组70.27%(26例),差异有统计学意义(P0.05);治疗前2组癫痫发作次数及MoCA评分比较,差异无统计学意义(P0.05),治疗后研究组癫痫发作次数少于对照组,MoCA评分高于对照组,差异有统计学意义(P0.05)。结论托吡酯联合卡马西平及左乙拉西坦治疗创伤性难治性癫痫效果显著,可有效减少癫痫发作次数,提高患者认知功能。     

抗癫癎药物对儿童临床下癎性电持续状态及认知功能的影响

目的：探讨抗癫?药物（AED）对临床发作已控制,但脑电图（EEG）上仍存在癫?性电持续状态ESES患者的认知功能的影响。方法：收集2013年3月～2015年11月本院门诊、住院治疗的儿童癫?患者,用日本光电9000型长程录像脑电图（V‐EEG）监测到的16例临床下ESES患者,临床无发作均超过半年,随访观察,调整治疗方案前后均再进行神经心理学评估和V‐EEG监测。结果：16例应用卡马西平（CBZ）、奥卡西平（OXC）临床发作均已得到控制,V‐EEG提示仍存在ESES现象,神经心理学评估均存在不同程度的认知功能障碍,治疗方案调整为丙戊酸钠／丙戊酸镁、左乙拉西坦／托吡酯,3个月后复查V‐EEG提示ESES消失,脑功能状态得到改善（P＜0．05）。结论：AED的治疗目的,不仅要控制临床发作,也要控制临床下?样放电,特别是ESES现象。     

睡眠中失神发作的儿童失神癫痫的临床特点(附1例报告)

目的 探讨睡眠中失神发作的儿童失神癫痫(CAE)的临床特征.方法 回顾性分析1例睡眠中失神发作的CAE患儿的临床资料.结果 本例患儿以反复愣神为主要表现,同时伴有睡眠中突然睁眼、茫然无视及轻微眨眼等症状,同期视频EEG均为全导广泛性3 Hz棘慢波阵发.空腹CSF检查及头颅MRI正常.先后给予丙戊酸、拉莫三嗪及左乙拉西坦...     

青少年癫痫的治疗进展

癫痫是一组由大脑神经元异常放电所引起的短暂中枢神经系统功能失常性慢性脑部疾病,是常见的中枢神经系统疾病。癫痫的治疗主要包括病因治疗、药物治疗、心理治疗等。本文将就以下几个方面进行综述,并着重通过药物的机制、适用类型及不良反应等方面探讨拉莫三嗪、左乙拉西坦、奥卡西平、托吡酯、丙戊酸钠、卡马西平等抗癫痫药物在青少年癫痫治疗中的应用,分析青少年癫痫的治疗进展。     

前额叶完全孤立术治疗复发性癫一例

<正>患者女性,17岁。因反复失神发作伴肢体抽搐14年,于2013年3月11日入院。患者3岁时开始出现癫发作,表现为易受惊吓、右眼睑跳动或突然抱人等症状,7~8次/d,外院诊断为"结节性硬化症继发癫",予托吡酯(妥泰)、卡马西平、丙戊酸钠(德巴金)、奥卡西平、左乙拉西坦和氯硝西泮等抗癫药物治疗无效。12岁时于外院行左侧额叶致灶切除术,术后癫发作频率未减少且出现精神异常、人格改变和游走等症状,为求进一步治疗收入我院。入院后体格检查:生长发育正常,检查不     

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.