大鼠GLUT3基因重组腺病毒载体的构建及鉴定

目的构建携带大鼠葡萄糖转运体3（GLUT3）基因的复制缺陷型重组腺病毒载体，为研究GLUT3的生物学功能提供工具。方法采用逆转录-聚合酶链反应（RT-PCR）的方法获取大鼠GLUT3基因全长cDNA片段，将其克隆至穿梭质粒pShuttle中构建穿梭质粒pShuttle-GLUT3，经酶切后与线性化的腺病毒骨架质粒pAdeno-X体外连接并转化大肠杆菌DH5α，构建重组腺病毒质粒pAd-GLUT3，酶切线性化重组腺病毒质粒后转染293细胞包装成重组病毒颗粒，重组腺病毒在293细胞中反复扩增数代后，分别用聚合酶链反应（PCR）及免疫印记法（western blot）的方法从基因和蛋白表达水平鉴定重组的腺病毒。结果经DNA测序和PCR分析显示GLUT3 cDNA序列正确。成功筛选出重组腺病毒质粒pAd-GLUT3后在HEK293细胞中成功包装出重组病毒，包装后冻融细胞行PCR及western blot检测表明重组腺病毒包装成功。结论本研究成功构建了携带大鼠GLUT3基因的复制缺陷型重组腺病毒载体。     

人骨形态发生蛋白2和人成纤维细胞生长因子2双基因共表达腺病毒载体的构建及鉴定

背景：内部核糖体进入位点序列载体能将上下游基因共同转录,故通过此载体可使连接在一起的人骨形态发生蛋白2和人成纤维细胞生长因子2同时高表达,可为骨缺损的治疗提供新方法。 目的：实验通过引入内部核糖体进入位点序列,采用基于attLXattR的λ噬茵体位点特异性重组系统的GatewayTM技术构建带有人骨形态发生蛋白2和人成纤维细胞生长因子2双基因重组腺病毒载体并进行鉴定。 方法：用聚合酶链反应方法扩增人骨形态发生蛋白2和人成纤维细胞生长因子2目的基因,将两个基因亚克隆至pIRES2-EGFP载体中,构建phBMP2-IRES-hFGF2载体,通过BP反应将hBMP2-IRES-hFGF2重组到载体pDONR221中,再通过LR反应将其转移到腺病毒载体pAd/CMV/V5-DEST中,线性化后转染293细胞进行包装获得重组腺病毒Ad-hBMP2-IRES-hFGF2。 结果与结论：phBMP2-IRES-hFGF2经酶切及测序鉴定正确,带hBMP2-IRES-hFGF2的载体在293细胞中包装成功,获得成熟的病毒颗粒,病毒滴度为2.82×1010 ifu/mL,证实成功构建了带有人骨形态发生蛋白2和人成纤维细胞生长因子2双基因重组腺病毒载体。     

人骨形成蛋白2真核表达载体的构建和体外表达

背景：骨形态发生蛋白2(bone morphogenetic protein 2,BMP-2) 是已知的所有生长因子中对骨的形成作用最强的生长因子，被认为是最具有前途的骨诱导物质。 目的：构建人骨形成蛋白2真核表达载体并观察其体外表达情况。 设计、时间及地点：自身对照实验，于2005-07/2006-05在华中科技大学同济医学院分子生物中心实验室完成。 材料：pcDNA3.1(+)载体由华中科技大学同济医学院左石博士惠赠；成骨肉瘤组织由华中科技大学同济医学院附属协和医院骨科提供。 方法：从人成骨肉瘤细胞中提取细胞总RNA，利用反转录-聚合酶链反应方法扩增获得人BMP-2基因cDNA，将基因片断重组到pGEM-T质粒中构建pGEM-T- hBMP-2重组质粒载体，转化到大肠杆菌DH5α后筛选阳性克隆，利用限制性酶切和DNA序列分析鉴定重组质粒。分别用RcoRI和NotI双酶切pGEM-T- hBMP-2质粒和pcDNA3.1真核表达载体，将克隆载体中人骨形成蛋白2基因重组到pcDNA3.1真核表达载体，提取质粒作酶切电泳、聚合酶链反应鉴定及DNA测序后，用脂质体体外转染小鼠骨髓基质细胞，反转录-聚合酶链反应检测BMP-2的表达。 主要观察指标：①人骨肉瘤细胞总RNA 反转录-聚合酶链反应结果。②重组质粒pGEM-T-hBMP-2 和pcDNA3.1-hBMP-2的构建和酶切鉴定。③BMP-2在小鼠骨髓基质细胞内的表达。 结果：人骨肉瘤细胞总RNA经反转录-聚合酶链反应扩增后，获得1.2 kb条带。经酶切电泳、聚合酶链反应鉴定及DNA测序证实实验成功克隆BMP-2基因，重组质粒pcDNA3.1- hBMP-2构建正确;该重组质粒能在体外培养的小鼠骨髓基质细胞中有效表达BMP-2。 结论：实验成功克隆人骨形成蛋白2基因并构建了此基因的真核表达载体。     

以海马神经元为靶细胞Ad-Easy系统快速构建携带PTEN基因的重组腺病毒表达载体

摘要：目的：应用Ad-Easy腺病毒载体系统快速构建携带PTEN (Phosphatase and tensin homolog deleted on chromosome ten)基因的重组腺病毒表达载体,为应用基因技术研究PTEN对缺血性脑损伤后的神经保护作用奠定基础。方法：采用RT-PCR法从大鼠海马神经元扩增获得目的基因PTEN, 克隆入pAdTrack-CMV穿梭质粒（含绿色荧光蛋白（Green fluorescence protein,GFP）基因）形成转移载体pAdTrack-CMV-PTEN,将其在大肠杆菌BJ5183内与腺病毒骨架质粒pAdEasy-1同源重组;重组子酶切鉴定正确后转染HEK293细胞,PCR分析鉴定扩增情况及Western blot检测受腺病毒感染的海马神经元内PTEN蛋白的表达。结果：荧光显微镜检测到受腺病毒感染的HEK293细胞表达GFP,出现明显的细胞病变效应（Cytopathic effect,CPE）,经3轮扩增得到了病毒所需滴度。PTEN蛋白在受感染腺病毒神经元内表达显著增强。结论：利用Ad-Easy系统成功快速的构建了携带PTEN基因的腺病毒表达载体,为研究基因治疗缺血性脑损伤奠定了基础。     

重组腺病毒载体Ad5-hBDNF-EGFP的构建与鉴定*☆

背景：基因治疗是目前脊髓损伤治疗的方向，目的基因和载体是基因治疗的关键。 目的：构建携带增强型绿色荧光蛋白基因(Enhanced green fluorescence protein, EGFP)标志人脑源性神经营养因子(human brain-derived neurotrophic factor，hBDNF)基因重组腺病毒载体。 设计、时间及地点：单一样本观察，实验于2007-09/2008-06在福建医科大学附属第一医院完成。 材料：感受态大肠杆菌DH-5α购自美国Stratagene公司；pDC316-hBDNF、载体质粒pDC316-mCMV-EGFP、腺病毒骨架质粒pBHGlox_E1,3Cre、腺病毒包装系统AdMax和包装细胞株293购自加拿大Mixcrobix-Biosystems公司。 方法：以pDC316-hBDNF为模板，聚合酶链反应扩增酶切获得hBDNF基因片段，连接到带有EGFP标记基因的载体质粒pDC316-mCMV-EGFP上，构建穿梭质粒pDC316-hBDNF-mCMV-EGFP。利用AdMax包装系统，穿梭质粒与骨架质粒pBHGlox_E1，3Cre共转染293包装细胞, 同源重组产生复制缺陷型重组腺病毒载体Ad5-hBDNF-EGFP，反复感染293细胞扩增病毒后，离子交换法纯化病毒，并测定病毒颗粒数及滴度。 主要观察指标：①hBDNF基因原始质粒聚合酶链反应鉴定。②穿梭质粒pDC316-hBDNF-mCMV-EGFP的构建及鉴定。③重组腺病毒Ad5-hBDNF-EGFP的包装、扩增及纯化。④毒种目的基因的聚合酶链反应鉴定。⑤纯化病毒的滴度测定结果。 结果：经聚合酶链反应鉴定、限制性酶切分析及序列测定，证明已正确构建重组穿梭质粒pDC316-hBDNF-mCMV-EGFP和重组腺病毒载体Ad5-hBDNF-EGFP；扩增纯化后，测得重组腺病毒颗粒数为2.4×1011VP / mL，A260/A280值约为2.0，滴度为0.8×1010 CCID50/ mL。 结论：已成功构建重组腺病毒载体Ad5-hBDNF-EGFP，为hBDNF基因功能及基因治疗的进一步研究奠定实验基础。     

甲胎蛋白特异性小干扰RNA重组腺病毒载体的构建

背景：RNA干扰技术的应用，关键在于能够采用1个有效的基因转移系统将小干扰RNA转入至靶细胞，目前广泛应用的是构建小干扰RNA表达载体。 目的：利用AdMax腺病毒载体系统构建表达人甲胎蛋白-小干扰RNA的腺病毒载体。 设计、时间及地点：开放性实验，于2007-03/10在山东大学附属济南市中心医院中心实验室完成。 材料：穿梭质粒pDC316-EGFP-U6为本元正阳基因技术公司产品；AdMax KitD试剂盒与低代数HEK293细胞为Microbix Biosystems Inc.（Canada）公司产品。 方法：选择针对甲胎蛋白 mRNA的特异性小干扰RNA靶序列，设计合成为相应的双链DNA，并将其与酶切线性化的pDC316-EGFP-U6载体片段连接，构建好的穿梭质粒pDC316-EGFP-U6-AFP-siRNA和腺病毒骨架质粒pBHGlox_E1,3Cre共转染HEK293细胞，同源重组产生重组腺病毒。 主要观察指标：对重组腺病毒进行聚合酶链反应鉴定及扩增、纯化、滴度测定。 结果：构建的穿梭质粒载体经聚合酶链反应鉴定和测序分析，证实与设计一致。重组腺病毒Ad-AFP-siRNA经聚合酶链反应和绿色荧光蛋白表达检测证实构建成功，测定滴度为1.4×109 nfu/L。 结论：实验成功构建了Ad-EGFP-U6-AFP-siRNA重组腺病毒。     

构建人HCN4基因重组腺病毒载体及其对大鼠骨髓间充质干细胞的感染效率

背景：超极化激活及环化核苷酸门控阳离子通道(hyperpolarization-activated cyclic nucleotide-gated cation channel, HCN)基因由于具有不增加诱发心律失常的风险、能够接受自主神经系统调节等优势,成为目前最受关注的生物起搏备选基因。 目的：构建携带人HCN4基因的重组腺病毒载体,并测定其对大鼠骨髓间充质干细胞的感染效率。 设计、时间及地点：细胞-基因学体外实验,于2008-02/09在中山大学附属第二医院林百欣实验中心完成。 材料：SD大鼠10只,由中山大学实验动物中心提供。携带目的基因人HCN4 cDNA的质粒pcDNA3.1-HCN4、人胚肾293细胞、大肠杆菌DH5α由中山大学附属第二医院林百欣实验中心保存。腺病毒穿梭质粒pShuttle-CMV、骨架质粒pAdxsi购自北京诺赛基因组研究中心有限公司。 方法：质粒pcDNA3.1-HCN4用Hind Ⅲ+Xba Ⅰ双酶切后回收HCN4片段,亚克隆至pShuttle-CMV中,得到重组穿梭质粒;I-Ceu Ⅰ+I-Sce Ⅰ双酶切处理pShuttle-CMV-HCN4,回收CMV-HCN4片段,亚克隆至腺病毒骨架载体pAdxsi,得到重组腺病毒质粒;重组腺病毒质粒酶切线性化后,应用脂质体法转染293细胞进行包装扩增,得到重组腺病毒AdHCN4;应用AdHCN4转染大鼠骨髓间充质干细胞。 主要观察指标：重组腺病毒质粒载体的鉴定,重组腺病毒的鉴定及滴度测定,重组腺病毒的感染效率。 结果：构建的重组穿梭质粒pShuttle-CMV-HCN4用Hind Ⅲ+Xho Ⅰ双酶切,得到大小为3 600 bp(HCN4)和5 100 bp (pShuttle-CMV)两个片段,DNA测序结果证实人HCN4基因的全长序列已正确插入到pShuttle-CMV穿梭质粒中;重组腺病毒质粒pAdxsi-CMV-HCN4用XhoⅠ酶切得到7个片段,而作为对照的空腺病毒质粒只得到6个片段;重组腺病毒质粒在293细胞中包装后产生的重组腺病毒对293细胞有致病作用;重组腺病毒AdHCN4 PCR鉴定可见657 bp的阳性扩增条带;经多次重复感染后,病毒滴度检测达2.5×1011PFU/mL。成功转染AdHCN4的大鼠骨髓间充质干细胞可表达绿色荧光蛋白,当病毒感染复数值为800,转染效率最高,达90%。 结论：实验成功构建携带人HCN4基因的重组腺病毒载体,并可在体外有效转染大鼠骨髓间充质干细胞。     

应用AdEasy腺病毒载体系统构建鼠白细胞介素10基因重组腺病毒★

目的：AdEasy系统可在原核细胞E.coli BJ5183中完成穿梭质粒与骨架质粒之间的高效同源重组，经抗生素培养板筛选重组体，然后转染293细胞获得重组病毒，极大简化了载体的构建过程。实验利用AdEasy腺病毒载体系统构建鼠白细胞介素10基因重组腺病毒。 方法：实验于2006-08/2007-05在青岛大学医学院病毒学实验室完成。①实验材料：清洁级SD大鼠5只，实验过程中对动物的处置符合动物伦理学标准。腺病毒穿梭质粒pAdTrack-CMV，骨架质粒pAdeasy-1，大肠杆菌BJ5183和DH10B，人胚肾293细胞均由青岛大学医学院微生物教研室罗兵教授惠赠。②实验方法：从脂多糖刺激培养的大鼠脾细胞中提取细胞总RNA，应用反转录多聚酶链反应技术扩增白细胞介素10 cDNA，定向亚克隆至pAdtrack-CMV中构建腺病毒穿梭质粒pAdtrack-CMV-IL-10，酶切线性化后转化到含腺病毒骨架质粒pAdEasy的BJ5183大肠杆菌中，获得重组腺病毒质粒pAd-IL-10，Lipofectamin包装转染293细胞，获得重组腺病毒vAd-IL-10，荧光显微镜下观察绿色荧光蛋白的表达。将293细胞接种于96孔板中，每孔1×104个细胞，浓缩后的病毒贮存液按不同比例稀释加至培养板中，测定重组腺病毒滴度。用重组腺病毒vAd-IL-10感染293细胞3 d后，以TRIzol一步法提取细胞总RNA，所获RNA加入DNaseⅠ消化处理可能污染的DNA后，PCR产物行琼脂糖电泳检测白细胞介素10 mRNA的表达。 结果：①重组腺病毒的包装及滴度测定：经限制性内切酶转染293细胞16 h后，荧光显微镜观察到细胞中有GFP荧光，可间接反映目的基因的表达。将病毒上清反复感染293细胞扩增重组腺病毒，通常传至第4~5代于接种病毒后24~48 h，几乎可观察到所有细胞出现荧光，此时收获病毒，重组病毒命名为vAd-IL-10。vAd-IL-10滴度为5.5×108 pfu/mL，vAd-GFP滴度为9.0×108 pfu/mL。②目的基因RT-PCR产物的鉴定：提取重组腺病毒感染293细胞总RNA，RT-PCR扩增后琼脂糖电泳显示特异性580 bp预计大小的片段，表明该重组腺病毒可在293细胞中有效转录。 结论：利用AdEasy腺病毒载体系统成功构建了携带白细胞介素10基因的重组腺病毒载体，并制备出高滴度的重组腺病毒vAd-IL-10，可在293细胞中有效转录。     

血管内皮生长因子121和骨形态蛋白2双基因共表达重组腺病毒载体的构建及鉴定

背景：人血管内皮生长因子121和骨形态蛋白2在激素性股骨头坏死骨缺损中均具有成血管成骨作用,目前国内在以人血管内皮生长因子121和骨形态蛋白2基因联合治疗激素性股骨头坏死方面少有报道。 目的：构建人血管内皮生长因子121与人骨形态发生蛋白2双基因腺病毒穿梭质粒。 方法：将质粒pShuttle-CMV-VEGF121-IRES-hrGFP-1经Kpn Ⅰ/Xba Ⅰ酶切后,将BMP2片段定向连入pShuttle-CMV- VEGF121-IRES,构建可同时表达2个目的基因重组质粒pShuttle-CMV-V EGF121-IRES-BMP2,注入H5a细胞扩增,铺板,筛选阳性菌落,提取质粒,进行酶切分析及序列测定。将已构建确认正确的腺病毒质粒,经BJ5183-AD-1电转感受态细胞进行电穿孔后,铺板,筛选阳性菌落,提取质粒,进行酶切分析,PCR检测和序列分析。 结果与结论：酶切分析及核酸序列测定证实重组质粒构建正确,提示实验成功构建了血管内皮生长121及骨形态蛋白2双基因共表达重组腺病毒载体。     

大鼠黏结蛋白聚糖1基因重组腺病毒载体的构建及感染效率☆

背景：重组腺病毒质粒的构建方法主要有体外连接法和同源重组法。同源重组法有操作复杂、耗时长、效率低、纯化难的缺点。体外连接法又不可避免非特异性的基因重组及基因突变。 目的：应用改良体外连接法构建携带黏结蛋白聚糖1基因的重组腺病毒载体，测定其在心肌成纤维细胞中的感染效率。 设计、时间及地点：单一样本实验，于2007-08/2008-02在中山大学附属第二医院林百欣实验中心完成。 材料：穿梭载体pShuttle-CMV（含绿色荧光报告基因）和腺病毒骨架质粒pAdxsi购自诺赛基因组研究中心有限公司。 方法：核苷酸序列鉴定pCMV-Sport6.1-Sdc1质粒；用KpnⅠ + XhoⅠ从质粒pCMV-Sport6.1-Sdc1切出黏结蛋白聚糖1基因片段，亚克隆至pShuttle-CMV中，形成重组穿梭质粒。用I-CeuI + I-SceI双酶切出重组穿梭质粒中CMV-Sdc1片段，亚克隆至腺病毒基因组质粒中，得到重组腺病毒质粒。将重组腺病毒质粒转染293细胞包装获得重组腺病毒AdCMVSdc1，转化体外培养的心肌成纤维细胞。 主要观察指标：用DNA测序、酶切及聚合酶链反应法鉴定重组质粒和病毒，并测定重组腺病毒的滴度和感染效率。 结果：①核苷酸序列分析表明，pCMV-Sport6.1-Sdc1质粒正确携带大鼠黏结蛋白聚糖1 cDNA；黏结蛋白聚糖1基因被克隆于载体pShuttle-CMV上，以KpnⅠ + XhoⅠ双酶切可回收3 kb的克隆片段和5.1 kb的载体片段；重组腺病毒质粒用XhoⅠ酶切得到7个片段而空载体仅得到6个片段。②重组腺病毒质粒在293细胞中包装后产生的重组腺病毒对293细胞有致病作用；提取病毒DNA行聚合酶链反应鉴定可扩增出1.13 kb的特异性片段；用病毒上清多次重复感染293细胞扩增重组腺病毒后，病毒滴度检测达2.0×1011 PFU/mL。③用纯化浓缩后的重组腺病毒以感染复数为100感染心肌成纤维细胞，24 h后所有细胞均表达绿色荧光。 结论：成功构建了携带大鼠黏结蛋白聚糖1基因的重组腺病毒载体，经纯化浓缩后具有较高的滴度，能有效转染心肌成纤维细胞。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

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.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

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.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.