癫痫患者血清和脑脊液神经元特异性烯醇化酶的测定

目的 探讨癫痫发作对脑神经元的损伤。方法 应用酶联免疫反应法动态测定癫痫发作后患者血清和脑脊液（CSF）中神经元特异性烯醇化酶（NSE）的含量。结果 癫痫组血清和CSF中NSE含量在发作后明显升高，血清NSE水平在发作后第1天最高，1周左右开始下降，2周左右降至正常；抽搐发作及频繁发作时，血清和CSF中NSE升高更明显。结论 癫痫发作引起血清和CSF中NSE水平的升高；癫痫发作导致神经元损伤，抽搐发作及频繁发作时神经元损伤更严重。     

不同发作类型癫痫患儿血清神经元特异性烯醇化酶水平研究

目的探讨不同发作类型癫痫患儿血清神经元特异性烯醇化酶水平变化与脑损害之间的关系。方法按照1981年国际抗癫痂联盟制定的癫痫发作类型分类标准,共明确诊断190例癫痫患儿（强直．阵挛发作41例、强直性发作34例、阵挛性发作22例、肌阵挛发作12例、无张力性发作17例、失神发作22例、单纯部分性发作21例及复杂部分性发作21例）,于癫痫发作72h内施行长程视频脑电图观察和血清神经元特异性烯醇化酶检测。结果不同发作类型癫痫患儿血清神经元特异性烯醇化酶水平均高于正常对照组（P=0．000）,其中以肌阵挛发作组[（32．42±6．62）ng／m1]水平最高,除与强直一阵挛发作组（P=0．062）外,与其他各发作类型之间差异均有统计学意义（P=0．000）;而其他各类型之间差异无统计学意义（均P〉0．05）。秩相关分析显示,癫痫患儿血清神经元特异性烯醇化酶水平与长程视频脑电图异常程度呈正相关（rs=0．613,P=0．000）。结论癫痫发作后血清神经元特异性烯醇化酶水平即升高,提示癫痫发作对患儿脑组织有一定损害;而且癫痫放电对神经元损害越严重、血清神经元特异性烯醇化酶水平升高越明显,不同发作类型中以肌阵挛发作、强直一阵挛发作患儿血清神经元特异性烯醇化酶水平最高,提示这两种发作类型对脑组织的损害高于其他类型。     

癫痫持续状态患者血清神经元特异性烯醇化酶的变化

目的 研究癫痫强直一阵挛持续状态和复杂部分持续状态患者血清神经元特异性烯醇化酶(NSE)水平变化。方法 运用酶联免疫双抗法测定癫痫持续状态患者(包括强直一阵挛持续状态14例和复杂部分发作持续状态10例)发作后不同时段血清中NSE水平，并与健康对照组及癫痫对照组比较。结果 发作后2d两组癫痫持续状态患者血清NSE水平均升高，发作后3dNSE水平开始降低，发作后7d强直一阵挛组NSE恢复正常，而复杂部分发作组NSE水平仍高于对照组。结论 癫痫持续状态，尤其是复杂部分发作持续状态可造成脑神经元损伤，需紧急处理。     

不同发作类型癫痫患儿血清神经元特异性烯醇化酶水平研究

目的探讨不同发作类型癫癎患儿血清神经元特异性烯醇化酶水平变化与脑损害之间的关系。方法按照1981年国际抗癫癎联盟制定的癫癎发作类型分类标准,共明确诊断190例癫癎患儿（强直-阵挛发作41例、强直性发作34例、阵挛性发作22例、肌阵挛发作12例、无张力性发作17例、失神发作22例、单纯部分性发作21例及复杂部分性发作21例）,于癫癎发作72 h内施行长程视频脑电图观察和血清神经元特异性烯醇化酶检测。结果不同发作类型癫癎患儿血清神经元特异性烯醇化酶水平均高于正常对照组（P=0.000）,其中以肌阵挛发作组[（32.42±6.62）ng/ml]水平最高,除与强直-阵挛发作组（P=0.062）外,与其他各发作类型之间差异均有统计学意义（P=0.000）;而其他各类型之间差异无统计学意义（均P>0.05）。秩相关分析显示,癫癎患儿血清神经元特异性烯醇化酶水平与长程视频脑电图异常程度呈正相关（r₁=0.613,P=0.000）。结论癫癎发作后血清神经元特异性烯醇化酶水平即升高,提示癫癎发作对患儿脑组织有一定损害;而且癫癎放电对神经元损害越严重、血清神经元特异性烯醇化酶水平升高越明显,不同发作类型中以肌阵挛发作、强直-阵挛发作患儿血清神经元特异性烯醇化酶水平最高,提示这两种发作类型对脑组织的损害高于其他类型。     

神经元特异性烯醇化酶与急性颅脑创伤患者预后关系研究

目的探讨急性颅脑创伤患者血清和脑脊液神经元特异性烯醇化酶表达变化与病情严重程度和预后关系。方法共89例急性颅脑创伤患者根据入院时Glasgow昏迷量表(GCS)评分分为轻型、中型、重型和特重型颅脑创伤组,于伤后12 h内分别检测血清(89例)和脑脊液(18例)神经元特异性烯醇化酶表达水平,Spearman秩相关分析评价其与颅脑创伤程度和预后的相关性。结果与对照组相比,颅脑创伤各组患者血清神经元特异性烯醇化酶表达水平升高(均P0.05),且特重型组和重型组高于中型组和轻型组(均P0.05)。脑挫裂伤患者血清神经元特异性烯醇化酶表达水平高于弥漫性轴索损伤(P=0.025)、硬膜下血肿(P=0.031)和硬膜外血肿患者(P=0.021)。血清神经元特异性烯醇化酶表达水平与GCS评分(rs=-0.327,P=0.024)和Glasgow预后分级评分(rs=-0.252,P=0.049)均呈负相关关系。特重型和重型颅脑创伤患者脑脊液神经元特异性烯醇化酶表达水平均高于血清(P=0.039,0.031)。结论神经元特异性烯醇化酶表达变化可以作为辅助评价急性颅脑创伤程度、分型诊断和判断预后的实验室指标,且脑脊液神经元特异性烯醇化酶水平较血清更敏感。     

神经元特异性烯醇化酶变化在癫痫发作中的意义

神经元特异性烯醇化酶(NSE)是神经元损伤的特异性标志。测定NSE对神经系统疾病的诊断、严重程度估计、预后判断及治疗指导等方面具有重要意义。本文对NSE的性质、在癫痫持续状态及癫痫发作后的变化和意义、机理及研究前景作一综述。     

癫痫持续状态患者的血清特异性神经元烯醇酶

特异性神经元烯醇酶(NSE)是一种易测定、可靠的高特异性体内神经元损伤的标志,仅在神经元和神经外胚层组织中发现。本文首次对癫痫持续状 态患者的血清NSE(s—NSE)做了前瞻性研究。 19名患者进入研究,符合癫痫持续状态的诊断,在患者发病后入院时及第2、3天和第7天各抽5ml血,离心后冷冻,在—20℃贮存,采用放射免疫技术测定NSE。另取18名正常人和13名慢性癫痫而无癫痫持续状态病史者作为对照组,比较各组的s—NSE水平。在抽血时做了格拉斯哥(Glasgow)昏迷评分和结局评分。出院前或在1周时做了格拉斯哥结局评分。     

癫痫患者血清、脑脊液神经元特异性烯醇化酶的测定及意义

目的探讨癫痫患者疴性发作后对神经元和血脑屏障的损伤。方法采用酶联免疫法测定癫痫患者在痢性发作后2d内血清和脑脊液（CSF）中神经元特异性烯醇化酶（NSE）的含量，与非神经系统疾病的神经症对照组对比分析。结果患者组CSF中NSE较对照组升高，差异有统计学意义；但血清中NSE含量与对照组差异无统计学意义。结论癫痫患者癫痫发作后脑脊液中NSE升高，提示疴性发作对中枢神经的神经元有损伤；而血中NSE正常，提示血脑屏障正常。     

偏头痛患者58例血清神经元特异性烯醇酶测定及其临床意义

神经元特异性烯醇酶(NSE)是主要存在于大脑神经元和神经内分泌细胞内并参与酵解的特异性酶。脑神经元损伤后，NSE从细胞内溢入脑脊液和血液中。由于脑胶质细胞和其他神经组织均不含NSE，故NSE是检测脑内神经元损伤的客观指标。我们采用ELISA法检测58例偏头痛患者血清NSE，以探讨偏头痛发作期患者血清NSE水平及其对脑     

血清神经元特异性烯醇化酶在癫癎患者中的应用价值

目的 探讨癫痫患者发作后不同时间神经元特异性烯醇化酶（NSE）的动态变化。方法 采用放射免疫法测定20例癫痫患者发作后48h内、2-4d、5-7d血清中NSE水平，并与22例正常健康体检者进行对照。结果 癫痫患者发作48h内及2～4d血清NSE水平与对照组比较有显著性差异（t=4．31，2．57；P〈0．01，0．05）。结论 癫痫发作后血清NSE水平升高可能与脑神经元损害有关。     

首发精神分裂症患者血液中神经元特异性烯醇化酶和髓鞘碱性蛋白的改变

目的 通过测定首发精神分裂症患者髓鞘碱性蛋白(MBP)和神经元特异性烯醇化酶(NSE),探讨是否有神经系统损伤。方法 选择88例首发精神分裂症患者(患者组)和30例对照(对照组)测定血液中MBP和NSE,采用双抗体夹心酶标免疫分析法检测。并在入组第1天及第8周后分别评定阳性和阴性症状量表(PANSS)量表。结果 患者组MBP[(7.9±4.5)μg/L]和NSE[(19.4±6.9)μg/L]含量明显高于对照组[(4.3±0.4)μg/L,(8.0±2.8)μg/L],t:12.70,P<0.01;t=7.20,P<0.01。患者组MBP和NSE与PANSS总分减分率呈负相关(r=-0.236,P=0.025:r=-0.298,P=0.005)。结论 精神分裂症患者可能存在神经系统损伤,且受损程度可能与疗效有关。     

癫(癎)患者血清、脑脊液神经元特异性烯醇化酶的测定及意义

目的探讨癫癎患者癎性发作后对神经元和血脑屏障的损伤。方法采用酶联免疫法测定癫癎患者在癎性发作后2d内血清和脑脊液(CSF)中神经元特异性烯醇化酶(NSE)的含量,与非神经系统疾病的神经症对照组对比分析。结果患者组CSF中NSE较对照组升高,差异有统计学意义;但血清中NSE含量与对照组差异无统计学意义。结论癫癎患者癫癎发作后脑脊液中NSE升高,提示癎性发作对中枢神经的神经元有损伤;而血中NSE正常,提示血脑屏障正常。     

Serum prolactin response to repetitive epileptic seizures

We measured postictal prolactin (PRL) levels during repetitive seizures in 14 patients (10 men and 4 women) suffering from epilepsy with focal and/or secondarily generalized seizures. Between two and six seizures occurred per patient (mean 2.7). The interveral between seizures was 15 min and 8 h 40 min (mean 3 h 32 min). Five of the 14 patients showed a marked postictal PRL rise after each seizure (i.e. concentrations above 700 U/ml for women, 500 U/ml for men). In the remaining 9 patients there was no detectable rise in PRL. A decrease in PRL did not occur in any of the 14 patients. In those patients who had shown a marked PRL increase after the first seizure, the PRL continued to rise in subsequent seizures. Unlike previous investigations, these results show that repetitive epileptic seizures are not necessarily followed by a decrease in postical PRL levels. A decrease in PRL response is known to occur if there is progression to status epilepticus.     

癫痫患者神经元特异性烯醇化酶和胰岛素样 生长因子1的变化及临床意义

目的观察癫痫发作3 d内患者血清神经元特异性烯醇化酶(NSE)和胰岛素样生长因子1(IGF-1)浓度的变化及其临床意义。方法选取63例特发性癫痫患者作为病例组,以37例年龄及性别相匹配的体检健康者作对照组。采用ECLIA、ELISA测定血清NSE和IGF-1的浓度。结果病例组血清NSE和IGF-1浓度与对照组比较明显升高,差异有统计学意义(P<0.05)。血清NSE和IGF-1ROC曲线下面积分别为0.767和0.663。癫痫患者血清NSE和IGF-1浓度之间存在相关性(r=0.379,P<0.01)。结论血清NSE、IGF-1浓度在痫性发作后3 d内升高,提示其可作为判断痫性发作后早期脑损伤及机体早期启动神经保护的生化指标,具一定临床应用价值。癫痫患者血清NSE和IGF-1浓度之间存在相关性,提示它们可能共同参与了癫痫的发病过程。     

Diffusion-weighted magnetic resonance imaging in patients with partial status epilepticus

Purpose:   Diffusion-weighted magnetic resonance imaging (DWI) is used to detect changes in the distribution of water molecules in regions affected by various pathologies. Like other conditions, ictal epileptic activity, such as status epilepticus (SE), can cause regional vasogenic/cytotoxic edema that reflects hemodynamic and metabolic changes. This study describes the electroclinical and neuroimaging findings in 10 patients with partial SE whose DWI evaluation disclosed periictal changes related to sustained epileptic activity.
Patients and Methods:   In this retrospective study we selected 10 patients with partial SE of different etiologies (six acute symptomatic SE; four with previous epilepsy and concomitant precipitating factors) who underwent video-EEG (electroencephalography) monitoring and a DWI study during the periictal phase. We analyzed ictal electroclinical features and DWI changes in the acute phase and during the follow-up period.
Results:   DWI images revealed significant signal alterations in different brain regions depending on the location of ictal activity. DWI changes were highly concordant with the electroclinical findings in all 10 patients. As the SE resolved and the clinical conditions improved, DWI follow-up showed that the signal alterations gradually disappeared, thereby documenting their close relationship with ictal activity.
Conclusions:   This study confirms the usefulness of DWI imaging in clinical practice for a more accurate definition of the hemodynamic/metabolic changes occurring during sustained epileptic activity.     

Use of levetiracetam in hospitalized patients

PURPOSE: The objective of the study was to analyze the short-term efficacy and safety of levetiracetam (LEV) to treat repetitive seizures in hospitalized patients. METHODS: During admission to a tertiary hospital, we retrospectively identified patients with repetitive seizures who were treated for the first time with LEV during a hospital stay. LEV was considered effective if seizure cessation or >75% seizure reduction occurred in the 24 h after starting LEV (compared with the previous 48 h), requiring no further antiepileptic drug (AED) treatment. RESULTS: Thirty patients (12 men, 18 women) were included. Mean age was 59.7 years. Most frequent seizure type was focal motor in 12 (40%) of 30 patients. Most frequent etiology was stroke: nine (30%) of 30 patients. Relevant medical conditions included atrial fibrillation (three) and hepatic disease (three). Concomitant medications included oral anticoagulants (seven), corticosteroids (two), and chemotherapy (two). Four patients received LEV as the only AED. Six patients with focal SE and 20 (66.6%) patients with clusters of seizures but not in SE received LEV as add-on treatment after lack of response to first-line AEDs. Mean LEV dose during first day was 1,119 mg. Mean daily maintenance dose was 1,724 mg. LEV was effective in 24 (80%) patients, all four patients who received it as the only AED, four of six patients with focal SE, and 16 of 20 patients with clusters of seizures. Three (10%) elderly patients with seizures secondary to stroke and chronic obstructive pulmonary disease (COPD) reported moderate/severe somnolence and dizziness, leading to treatment discontinuation in one. On discharge, 20 (66.7%) patients continued on LEV, nine (30%) as the only AED. CONCLUSIONS: LEV is effective and safe to treat repetitive seizures in hospitalized patients, including patients in focal SE.