短暂性癫痫性遗忘的临床和电生理研究(附6例报告)

目的探讨短暂性癫痫性遗忘(TEA)的临床和电生理特点。方法对本院脑电监测中心收治的6例TEA患者的临床和电生理特点进行研究。结果 6例患者,女性4例,男性2例,年龄34~74岁。除有癫痫性遗忘发作外,还伴有自动症、部分继发全面强直阵挛发作(s GTCS)、"愣神"等其他癫痫发作形式,5例患者的脑电图均为颞导(单侧或双侧)痫样放电,1例正常。其中5例均给予抗癫痫药物治疗,随访1 y,3例无临床发作,2例偶有发作。结论 TEA常常被误诊或漏诊,尽管大多数颞叶癫痫为难治性癫痫,我们的研究提示伴有TEA的颞叶癫痫对抗癫痫药物反应良好。     

Epileptic auras: phenomenology and neurophysiology

This review discusses the phenomenology, neurophysiology, and localization of epileptic auras with particular emphasis on how auras can manifest as part of an epileptic network. Epileptic auras, as the first clinical symptom of a seizure, may lead us to infer the site of seizure onset. At the same time, auras can also be a result of activation or alteration in an epileptic network. They can be highly specific or ill‐defined in symptomatology. They occur as a result of limited seizure activation, allowing access of the neural signal to the conscious brain. An understanding of epileptic auras offers a window into understanding fundamental brain functions, and helps the clinician at the bedside to make appropriate diagnostic and therapeutic choices.     

戊四氮点燃猫癫痫形成过程中行为和脑电的动态研究

目的:观察戊四氮点燃猫癫癎形成过程中行为和脑电特征。方法:用低于急性致惊厥剂量的戊四氮(PIZ,25 mg·kg~1)给成年雄性猫每日肌肉注射,观察脑电活动和行为特征。结果:1周后,猫出现发作性面部抽搐,脑电为不对称近额部的散发性棘波,基本节律存在;2周后出现节律性点头,脑电为双侧对称性广泛的散发性棘慢波;16 d后出现发作性四肢强直,脑电活动背景节律变慢,棘慢波呈现阵发性;20 d后出现持续半小时以上的全面性强直阵挛发作,脑电活动为较多不规则的θ和δ波,棘慢波持续时间明显延长。结论:PTZ点燃猫癫癎形成过程中,其行为和脑电阶段性变化明显,与人类癫癎的局灶性继发全面性发作癫癎表现相似。     

Developmental and epileptic encephalopathies: recognition and approaches to care

The term “developmental and epileptic encephalopathy” (DEE) refers to when cognitive functions are influenced by both seizure and interictal epileptiform activity and the neurobiological process behind the epilepsy. Many DEEs are related to gene variants and the onset is typically during early childhood. In this setting, neurocognition, whilst not improved by seizure control, may benefit from some precision therapies. In patients with non‐progressive diseases with cognitive impairment and co‐existing epilepsy, in whom the epileptiform activity does not affect or has minimal effect on function, the term “developmental encephalopathy” (DE) can be used. In contrast, for those patients with direct impact on cognition due to epileptic or epileptiform activity, the term “epileptic encephalopathy” (EE) is preferred, as most can revert to their normal or near normal baseline cognitive state with appropriate intervention. These children need aggressive treatment. Clinicians must tailor care towards individual needs and realistic expectations for each affected person; those with DE are unlikely to gain from aggressive antiseizure medication whilst those with EE will gain. Patients with DEE might benefit from a precision medicine approach in order to reduce the overall burden of epilepsy.     

Critical volume of rat cortex and extracellular threshold concentration for a pentylenetetrazol-induced epileptic focus

The initiation of focal interictal epileptiform activity (FIEA) has been shown to depend on the activation of a sufficiently large volume of brain tissue. We estimated the size of this ‘critical volume' for the convulsant pentylenetetrazol (PTZ) by analyzing the diffusion following its microinjection into rat motor cortex. PTZ concentration was monitored 100–200 μm away from the injection site with a PTZ-sensitive microelectrode. Diffusion analysis in 0.3% agar yielded the free diffusion coefficient D (8.50±0.15×10⁻⁶ cm²·s⁻¹ at 37°C, median±S.E.M.). In brain tissue, diffusion was modified by extracellular volume fraction (α), tortuosity (λ=(D/ADC)^1/2; ADC=apparent diffusion coefficient) and non-specific uptake (k′). Using a value of 0.2 for α from previous studies, we found values of λ=1.61±0.01, k′=3.37±0.15×10⁻³ s⁻¹ and an injected volume U of 5.16±0.45×10⁻¹⁰ l for pulses without FIEA, and λ=1.95±0.06, k′=6.24±1.73×10⁻³ s⁻¹ and U=7.40±0.66×10⁻¹⁰ l for pulses with FIEA. From the calculated concentration distribution of PTZ during FIEA we estimated a threshold concentration of about 1.77 mM PTZ and a volume with a radius of about 219 μm in which this concentration had to be exceeded. Since this critical volume was comparable in size to foci elicited by penicillin or electric stimuli in previous studies, it is concluded that it is determined by intrinsic tissue properties rather than by the convulsive agent being used. © 1997 Elsevier Science B.V. All rights reserved.     

氟桂利嗪对癫痫鼠痫性发作和脑电活动的影响

目的研究氟桂利嗪对青霉素致癎大鼠癎性发作和脑电活动的影响.方法用60只Wistar大鼠分4组,即对照组及氟桂利嗪10、20、40 mg·kg-1组,2 h后对照组和各实验组给同样剂量青毒素300 万U·kg-1腹腔注射,观察大鼠行为表现及EEG改变.结果氟桂利嗪能明显降低青霉素致癎大鼠癎性发作程度,明显缩短癎性发作持续时间,显著延长癎性发作的潜伏期,明显提高存活率;明显延长大脑皮质、海马癎性放电潜伏期,缩短其持续时间,明显减少癎性放电的数量.结论氟桂利嗪对青霉素致癎大鼠的癎性行为和大脑皮质、海马的癎性电活动均有抑制作用.     

Taurine- and penicillin-induced epileptic activity

The present study has been performed to investigate the effect of i.v. administration of taurine on the electrical activity of the epileptogenic focus induced by penicillin applied to the right sensory motor cortex of adult rats. Taurine (100 mg/kg body weight) was administered 15, 30, 60, and 120 min before the application of penicillin. The EEG was unipolarly recorded by means of electrodes applied to the pia. Taurine caused a decrease of the frequency as well as the spike amplitude of epileptic discharge. The spread of epileptogenic foci to the opposite hemisphere was retarded when compared to that of control animals. The maximal antiepileptic effect of taurine was observed when the amino acid was administered 30-60 min previous to penicillin. It is suggested that high concentrations of taurine in the brain might be necessary to inhibit the epileptic activity.     

Is Ihara's genetically epileptic rat an adequate model for studying human temporal lobe epilepsy? Verification of suitability from the clinical and pathomorphological perspectives

We developed a novel epileptic mutant with spontaneous generalized tonic clonic convulsions, Ihara's genetically epileptic rat (IGER). Judging from the characteristics of the symptomatology, electroencephalographic correlates, and neuropathological findings, this epileptic mutant can be expected to be a useful model for studying human temporal lobe epilepsy (TLE). Verification of the suit-ability of IGER as a model for human TLE was carried out from the clinical and pathomorphological perspectives. IGER basically meets the first and the second criteria for an animal model, that is, similarity of symptomatology of the disease in the animal model and humans, and similarity of pathomorphological changes in the lesions of the model and humans. Causative similarity, the third criterion, re-mains to be established for IGER and human TLE. Judging from the first and second criteria, IGER seems to be a useful tool for studying human TLE.     

联合应用多种术式治疗致痫灶较广泛的原发性顽固性癫痫

目的探讨在三维痫灶精确定位诊疗计划系统定位下,联合应用多种术式治疗致痫灶较广泛的原发性顽固性癫痫的方法。方法对138例经影像学检查及三维痫灶精确定位诊疗计划系统精确定位后,联合应用多种术式治疗的致痫灶较广泛的原发性顽固性癫痫患者的临床资料、手术方案、手术效果进行分析总结。结果所有病例随访1年以上,随访疗效评估效果达到良好以上的占71.7%,总有效率达到92.0%,术后神经功能良好,无明显后遗症。结论经三维痫灶精确定位诊疗计划系统精确定位痫灶后,恰当选用多种术式联合治疗致痫灶较广泛的原发性顽固性癫痫疗效较好。     

100例癫痫患者脑电图与磁共振分析

目的:观察脑电图和头颅MRI在确诊癫痫及其病因诊治方面的应用,探讨痫性放电与结构异常之间的关系。方法:选100例癫痫患者,均作REEG、AEEG、头颅CT和MRI检查。比较四种检查方法的阳性率和异常病灶的分布。应用卡方检验,比较痫性放电与结构异常之间的关系。结果;REEG痫性放电35例(35%),AEEG76例(76%),比REEG多提供了41%的异常信息。CT发现颅内异常25例(25%),MRI发现异常58例(58%)。在EEG单侧局灶放电的53例中,MRI异常42例,18例双侧半球放电中,MRI异常5例,经x2检验,局灶痫性放电者MRI异常率显著高于双侧半球痫性放电者(P<0.01);MRI正常的42例患者中EEG痫性放电26例,异常率为61.9%,MRI发现结构异常的58例患者中,EEG异常放电50例,异常率为86.2%,经x2检验发现MRI结构异常患者,痫性放电出现率高(P<0.01)。结沦:AEEG是确诊癫痫、指导治疗的有利依据;MRI可作为癫痫患者病因诊断的首选影像检查。痫性放电与结构异常有一定关系。     

Painful unilateral epileptic seizure

Two rare cases with focal, paroxysmal pain as the initial manifestation of partial epilepsy have been reported. The pain attacks subsided after treatment with anti-epileptic drugs.     

Cerebral embolism and epileptic seizures — the role of the embolic source

Objectives – To study the clinical outcome of patients with epileptic seizures due to ischemic stroke (IS) of cardiac or artery-to-artery embolism. Methods – Seizures due to IS of cardiac or artery-to-artery embolism are differentiated by clinical, neuroimaging and cardiovascular test data. Results – From 174 cases with supratentorial IS, 13 patients suffered from epileptic seizures due to cardiac embolism, 11 patients due to artery-to-artery embolism. The patients with cardiac IS showed an equal sex distribution and EEG abnormalities in 6 patients, the initial seizure occurred on average after 222 days (SD, ±69 days). Among the 11 patients with artery-to-artery embolic IS, there were 9 males and 2 females and EEG abnormalities in 10 patients. The initial seizure occurred on average after 447 days (SD, ±177 days). Conclusion – In seizures due to artery-to-artery embolism, there is a male preponderance and a higher incidence of EEG abnormalities, symptomatic seizures appear later compared to IS due to cardiac embolism.     

66例癫痫性精神障碍的临床分析

目的:探讨癫痫性精神障碍的临床表现及治疗。方法:对66例癫痫性精神障碍患者临床资料进行回顾性研究。结果:癫痫性精神障碍症状以类精神分裂症为主,经卡马西平合并氟哌啶醇治疗痊愈59.10%,显著24.24%,好转13.63%,无效3.03%。结论:癫痫性精神障碍时癫痫发作减少,规范治疗癫痫性精神障碍效果显著。     

Neuroethological approach to frontolimbic epileptic seizures and parasomnias: The same central pattern generators for the same behaviours

The aim of this report is not to make a differential diagnosis between epileptic nocturnal seizures and non-epileptic sleep-related movement disorders, or parasomnias. On the contrary, our goal is to emphasize the commonly shared semiological features of some epileptic seizures and parasomnias. Such similar features might be explained by the activation of the same neuronal networks (so-called ‘central pattern generators’ or CPG). These produce the stereotypical rhythmic motor sequences - in other words, behaviours - that are adaptive and species-specific (such as eating/alimentary, attractive/aversive, locomotor and nesting habits). CPG are located at the subcortical level (mainly in the brain stem and spinal cord) and, in humans, are under the control of the phylogenetically more recent neomammalian neocortical structures, according to a simplified Jacksonian model. Based on video-polygraphic recordings of sleep-related epileptic seizures and non-epileptic events (parasomnias), we have documented how a transient “neomammalian brain” dysfunction - whether epileptic or not - can ‘release’ (disinhibition?) the CPG responsible for involuntary motor behaviours. Thus, in both epileptic seizures and parasomnias, we can observe: (a) oroalimentary automatisms, bruxism and biting; (b) ambulatory behaviours, ranging from the classical bimanual-bipedal activity of ‘frontal’ hypermotor seizures, epileptic and non-epileptic wanderings, and somnambulism to periodic leg movements (PLM), alternating leg muscle activation (ALMA) and restless legs syndrome (RLS); and (c) various sleep-related events such as ictal fear, sleep terrors, nightmares and violent behaviour.     

非瓣膜心房纤颤相关性脑卒中患者早发性癫痫发作的发生率以及危险因素分析

目的探讨非瓣膜心房纤颤(房颤)相关性脑卒中患者早发性癫痫发作的发生率以及危险因素。方法对2008~2015年陕西省14家三级医院的病例资料进行多中心性、回顾性研究。依据卒中后1周是否出现癫痫发作,将患者分为早发性癫痫发作组和对照组,通过单因素和多因素Logistic回归分析筛选出影响非瓣膜房颤相关性脑卒中患者早发性癫痫发作的危险因素。结果共纳入1077例非瓣膜房颤相关性脑卒中病例,男540例,女537例,年龄34~94岁,中位数73岁。发生卒中后早发性癫痫发作共21例(1.95%)。多因素Logistic回归显示两组NIHSS评分(95%CI:1.642~9.701,P=0.002)、既往脑卒中病史(95%CI:2.631~15.593,P0.01)差异有统计学意义。ROC曲线分析显示,曲线下面积为0.762,灵敏度61.9%,特异度81.0%,预测准确率71.5%。结论严重的卒中神经功能缺损、既往脑卒中病史是非瓣膜房颤相关性脑卒中患者早发性癫痫发作的重要危险因素。