血液透析相关性癫痫样发作临床研究

目的：探讨血液透析（血透）相关性癫痫样发作（HAS）的危险因素、临床特点以及防治措施。方法：回顾性分析总结1995年6月至2005年6月534例血透患者中15例有HAS病史的血透患者的临床资料。结果：HAS发病率为2．80％（15／534），发作类型为肌阵挛发作（9例，60．00％）、强直阵挛发作（3例，20．00％）、癫痫持续状态（2例，13．33％）、单纯部分发作（1例，6．67％）。危险因素贫血和促红细胞生成素（EPO）使用存在于14例患者中，其余的因素如高血压、电解质异常、药物使用存在率不高。地西泮治疗有效，复发率低。结论：贫血和EPO使用是HAS．发作的危险因素，肌阵挛发作是HAS的主要类型，地西泮治疗有效。     

癫(癎)患者抑郁障碍发生率及相关因素调查

目的：探讨癫痫患者抑郁发生率和相关危险因素。方法：运用自制问卷对患者的个人及家庭一般情况进行调查记录，采用Zung抑郁自评量表对104例癫痫患者进行筛选、抑郁评定，并对不同因素对癫痫患者抑郁发病率的影响进行比较。结果：104例癫痫患者中有55例52．9％合并有抑郁症状，其中37例（35．6%）有严重抑郁，8例（17．3％）为中、轻度抑郁。复杂性部分发作患者抑郁的患病率为73．5％，明显高于强制-阵挛发作的42．8％，两者差别有统计学意义（P〈O．01）。结论：癫痫患者的抑郁是严重的医疗和社会问题其发生与癫痫发作的类型，频率病程和社会家庭的支持有关。     

胰岛素瘤低血糖发作误诊癫(癎)2例

1 临床资料 患者1,男,54岁,因"反复抽搐伴意识丧失10 a,智力减退6个月"就诊.10 a前患者无诱因突然出现意识丧失、抽搐,大汗,小便失禁,约10 min后抽搐停止,1h左右意识清醒,醒后对发作过程无记忆.此后上述症状反复发作,多于晚上饮酒后或劳累后发作.曾多次至当地医院就诊行脑电图检查(检查结果不详),诊断为癫(癎),长期间断服用中西药(具体用药、用法不详),仍每月发作3～8次.6个月来患者逐渐出现反应迟钝、智力减退,遂至本院就诊,以癫(癎)收住院.入院神经系统检查:神志清晰,言语流利,记忆力、计算力均差,定向力正常,余神经系统检查无异常.血、尿常规、血糖及生化指标及心电图未见异常.头颅MRI检查示轻度脑萎缩.     

拉莫三嗪添加治疗儿童难治性癫(癎)临床研究

目的 探讨添加拉莫三嗪治疗儿童难治性癫(癎)的疗效和安全性.方法 选择符合儿童难治性癫(癎)诊断标准的患儿37例,原抗癫(癎)药物种类和剂量不变,加用拉莫三嗪,从小剂量开始:原治疗中未用丙戊酸(VPA)的患儿加用拉莫三嗪0.5～1 mg/(kg·d),分早晚2次服,每2周增加0.5～1 mg/(kg·d),直至发作停止或不能耐受为止,最大剂量15 mg/(kg·d);用VPA者开始0.2 mg/(kg·d),分早晚2次服,每2周增加0.2 mg/(kg·d),逐渐增加剂量,最大量5 mg/(kg·d).结果 评价时间1～2年,平均1年4个月.37例患儿经拉莫三嗪治疗后,3例因皮疹停药,1年药物总保留率91.9%,有效率为73,5%,其中完全控制23.5%,显效29.4%,有效20.6%,无效26.4%.不良反应发生率为13.5%,其中3例为皮疹,均为同时应用VPA者.结论 添加拉莫三嗪治疗儿童多种发作难治性癫(癎)疗效满意,特别是与丙戊酸合用疗效更好;拉莫三嗪为广谱抗癫(癎)药,对难治性癫(癎)的临床疗效确切,副作用小.     

癫(癎)模型研究概况

癫(癎) (epilepsy)是最常见的神经系统疾病之一,其患病率在一般人口中为5人/千人.根据世界卫生组织的定义,癫(癎)是由先天或后天不同因素所引起的慢性脑疾病,其特征是反复性惊厥发作,伴随不同的临床和脑电图表现.     

癫(癎)合并非癫(癎)性发作21例漏诊分析

癫(癎)的本质是脑神经元的异常放电,而非癫(癎)性发作(non-epileptic seizure,NES)是指一组临床症状类似于癫(癎)发作的发作性疾病,其发生与脑部电生理紊乱无关,而由于生理或心理功能障碍所致,发作时不伴脑电图(癎)样放电[1].临床上二者极易混淆,当二者并存时更易引起误诊或漏诊.现回顾性分析我院2001年6月～2005年12月确诊为癫(癎)合并NES的21例资料,以探讨临床和脑电图特点,避免漏诊.     

儿童癫(癎)综合治疗依从性影响因素调查

目的 调查和分析儿童癫(癎)综合治疗依从性的影响因素,为相应的临床干预提供依据.方法 对244例进行癫(癎)治疗的患儿中因依从性不好未综合治疗影响疗效的114例进行问卷调查,统计并分析患儿依从性差的原因.结果 114例(占治疗总例数的46.72％)因依从性不佳而中断用药或非规范治疗,影响因素依次为怀疑医生诊断51例、占44.74％,担心药物副作用40例、占35.09％,对疗效不满意35例、占30.70％,嫌治疗烦琐和漫长32例、占28.07％,心理因素14例、占12.28％,经济原因12例、占10.53％.结论 儿童癫(癎)综合治疗的依从性受到专业技术、社会和经济等多种因素的影响.因此,应积极采取综合的干预措施以提高患儿治疗的依从性.     

额叶癫(癎)发作的临床表现及脑电图特征

目的:探讨额叶癫痢发作的临床表现与脑电图特征.方法:对36例额叶癫癎发作患者临床表现及脑电图特征进行同步分析.结果:额叶癫癎发作频繁而短暂,以睡眠中发作为主.常见发作形式为复杂部分性发作,主要表现为过度运动、偏转性强直、姿势性强直、发声及重复语言,额叶失神等.常规脑电图检查阳性率30.6%.长时间视频监测阳性率91.7%.绪论:额叶癫癎发作是-组以运动症状为主的癫癎综合征,临床表现复杂多样,长程视频监测为无创性诊断额叶癫癎发作最佳方法.     

额叶癫(癎)的临床及脑电图特点

目的 分析和总结额叶癫(癎)的临床及脑电图特点.方法对80例确诊为额叶癫(癎)患者的临床和脑电图资料进行分析.结果①额叶癫(癎)发作形式:单纯部分性发作、复杂部分性发作及继发全身泛化.发作特点:发作时间短、运动突出,为强直性或姿势性,发作后意识障碍轻或无,发作频、夜间增多;②发作间期脑电图:额部导联的棘波或尖波,一侧或双侧多时性尖波或慢波;发作期脑电图:额部爆发性节律,很快同步化.结论额叶癫(癎)是一组较为特征性的癫(癎)综合征.     

癫(癎)发作间期脑动脉血流速度的变化研究

目的:了解癫(癎)患者脑血流速度的变化特点.方法:采用经颅超声多普勒,对43例癫(癎)病患者(观察组)发作间期和48例正常对照者(对照组)的脑动脉平均血流速度进行观察.结果:观察组中脑动脉平均血流速度12例正常,4例双侧增快,8例减慢,19例表现为双侧血流速度不对称,脑动脉平均血流速度异常发生率为72.09%(31/43).对照组中,脑动脉平均血流速度33例正常,8例双侧增快,4例双侧减慢,3例表现为双侧血流速度不对称,异常率31.25%(15/48),两组异常率相比有统计学意义(P＜0.01).结论:癫(癎)发作间期脑动脉血流速度存在异常改变,其异常改变的主要形式为双侧血流速度不对称和脑动脉平均血流速度减慢.     

以癫痫发作为首发症状的自身免疫性脑炎8例临床分析

目的:分析以癫痫发作为首发症状的自身免疫性脑炎的临床资料。方法:回顾性分析以癫痫发作为首发症状的自身免疫性脑炎8例患者的临床表现、实验室检测结果、影像学检查、脑电图特点、治疗结果及随访记录,并结合文献讨论。结果:8例患者中,抗NMDAR脑炎5例,抗GABAR脑炎2例,抗LGI1脑炎1例;男6例,女2例;发病年龄18～66岁,平均50岁;均以癫痫发作为首发症状,均有反应迟钝、近记忆力下降的症状,其中出现精神行为异常3例,言语障碍1例,顽固性低钠血症1例;均有≥1种的癫痫发作形式,脑电图异常6例;头颅MRI检查异常4例。结论:对于以癫痫发作为首发症状的自身免疫性脑炎患者,早期免疫治疗及抗癫痫治疗,对于控制症状、改善预后具有重要意义。     

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Abstract

Objective. The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence. Methods. A multidisciplinary panel was chosen based on expertise in pediatric emergency medicine, prehospital medicine, and/or evidence-based guideline development. The panel followed the National Prehospital EBG Model using the GRADE methodology to formulate questions, retrieve evidence, appraise the evidence, and formulate recommendations. The panel members initially searched the literature in 2009 and updated their searches in 2012. The panel finalized a draft of a patient care algorithm in 2012 that was presented to stakeholder organizations to gather feedback for necessary revisions. Results. Five strong and ten weak recommendations emerged from the process; all but one was supported by low or very low quality evidence. The panel sought to ensure that the recommendations promoted timely seizure cessation while avoiding respiratory depression and seizure recurrence. The panel recommended that all patients in an active seizure have capillary blood glucose checked and be treated with intravenous (IV) dextrose or intramuscular (IM) glucagon if <60 mg/dL (3 mmol/L). The panel also recommended that non-IV routes (buccal, IM, or intranasal) of benzodiazepines (0.2 mg/kg) be used as first-line therapy for status epilepticus, rather than the rectal route. Conclusions. Using GRADE methodology, we have developed a pediatric seizure guideline that emphasizes the role of capillary blood glucometry and the use of buccal, IM, or intranasal benzodiazepines over IV or rectal routes. Future research is needed to compare the effectiveness and safety of these medication routes.     

New-Onset Seizure in Patient Medicated With Bupropion for Smoking Cessation: A Case Report

BackgroundBupropion is a pharmacologic agent approved by the U.S. Food and Drug Administration as an antidepressant and to support smoking cessation. Because reduction of seizure threshold is a rare but serious side effect of bupropion, its use in patients with a known history of seizures is contraindicated. We report a patient without seizure risk factors who presented to the emergency department (ED) with new-onset seizures secondary to bupropion use.Case ReportA 66-year-old female presented to the ED by emergency medical services with altered mental status. She was determined to be postictal after a witnessed new-onset seizure 4 days after starting bupropion for smoking cessation. She had no personal or family history of seizure disorders, although her medication list raised suspicion that recent discontinuation of alprazolam may have contributed to a reduced seizure threshold.Why Should an Emergency Physician Be Aware of This?New-onset seizures secondary to bupropion use are less likely in patients with no personal or family history of seizure disorders. Emergency medicine clinicians should be aware, however, of the seizure risk associated with bupropion regardless of personal risk factors. Discontinuation of bupropion should be considered if determined to be a contributor to seizures.     

Lacosamide Overdose: A Case of QRS Prolongation and Seizure

BackgroundLacosamide is a third-generation antiepileptic drug. Its likely mechanism of action is via neuronal sodium channel blockade, via a unique manner compared with other antiepileptic drugs that block sodium channels. A paucity of information exists regarding lacosamide overdosage. Lacosamide overdosage is thought to cause QRS prolongation and seizures, due to its effect of sodium channel blockade. The potential efficacy of sodium bicarbonate to reverse the effects of lacosamide has not been well studied. Furthermore, prior reports of lacosamide toxicity have occurred in the setting of concomitant polypharmacy. Thus, the isolated toxic effects of the drug have not been well elucidated.Case ReportWe report a case of a suspected, single-ingestion overdose on lacosamide. The patient developed signs of cardiotoxicity and seizure.Why Should an Emergency Physician Be Aware of This?After lacosamide overdosage, the emergency physician must be capable of acute management of subsequent lacosamide toxicity. Understanding the mechanisms of action causing toxicity due to this drug can help the clinician to anticipate the interventions that may be needed or useful to treat this potentially toxic ingestion.     

62例糖尿病足患者危险因素分析

目的探讨2型糖尿病足患者的临床特征及危险因素。方法回顾性分析62例2型糖尿病足患者的资料，包括年龄、性别，病程、空腹血糖、糖化血红蛋白、血红蛋白、肾小球滤过率、清蛋白、血脂、肌电图、双下肢动脉彩色多普勒超声检查等，并与60例无糖尿病足的2型糖尿病患者进行对比分析。结果两组患者的年龄、性别、血红蛋白、清蛋白，以及肌电图和动脉多普勒超声检查结果差异有显著性意义（P〈0．05），而病程、空腹血糖、糖化血红蛋白，肾小球滤过率、血脂等指标差异无显著性意义（P〉0．05）。结论高龄，男性、周围神经病变，周围血管病变是2型糖尿病足的危险因素，患者多合并贫血、低清蛋白血症。     

老年多器官功能衰竭1605例的临床分析

目的 探讨老年多器官功能衰竭(MOFE)患的早期护理干预措施。方法 应用回顾性调查法分析l605例MOFE患的发病危险因素和临床特征。结果 99％的MOFE患发病前有1种以上的基础疾病，50％以上的MOFE患发病前有2～3种疾病，最多的患有9种疾病；MOFE的发病诱因以感染最为多见，其中肺部感染最多(73．1％)，且首发衰竭的器官以肺居首位。结论 为降低MOFE的发生率和死亡率，应积极预防多基础疾病老年患的肺部感染，防止呼吸衰竭的发生。     

九例住院患者急性栓塞事件原因分析

目的:探讨导致住院期间发生急性栓塞性疾病的各种因素。方法:以回顾性调查的方式,分析近2.5年来发生于住院期间的急性栓塞性事件的相关因素及发生机制。结果:高龄、房颤(房扑)、高血压、糖尿病、高血脂、慢性心衰、既往血栓栓塞性疾病、慢阻肺、肿瘤、长时间卧床、急性疾病状况等是导致住院期间发生急性栓塞事件的常见因素。结论:对于存在栓子形成高危因素的住院患者加强监测,主动采取预防措施,将有助于改善预后。     

42例缺血性卒中后癫痫发作危险因素探讨

目的：研究缺血性卒中患者继发早期癫痫发作和晚期癫痫发作的发病率、发作类型及缺血性卒中继发癫痫发作的临床危险因素。方法：分析山西省人民医院近3年来首发缺血性卒中的408例患者的年龄、性别、入院时意识、糖尿病、高血压、心源性疾病和卒中部位等的临床特征,随访6~12个月,其中缺血性卒中后继发癫痫发作患者42例,未继发癫痫发作患者366例。缺血性卒中后癫痫发作的患者依据癫痫发作的发生时间分为早期癫痫发作组（18例）和晚期癫痫发作组（24例）。分析缺血性卒中后早期癫痫发作和晚期癫痫发作的发病率、发作类型以及缺血性卒中后发生继发癫痫发作的临床危险因素。结果：缺血性卒中后癫痫发作的发病率为10.3%（42/408）,其中早期癫痫发作的发病率为4.4%（18/408）;晚期癫痫发作的发病率为5.9%（24/408）。早期癫痫发作的50.0%（9/18）为全面性强直-阵挛发作,晚期癫痫发作的58.3%（14/24）为单纯部分性发作。缺血性卒中后癫痫发作组与非癫痫发作组的临床特征经统计学比较,两组间心源性脑栓塞病例的发生率和累及皮质梗死的发生率比较差异有显著性（P〈0.05）。结论：缺血性卒中后早期癫痫发作以全面性发作为主,晚期癫痫发作以单纯部分性发作为主;心源性脑栓塞和累及皮质梗死是缺血性卒中后癫痫发生的危险因素。     

Seizure During Hyperbaric Oxygen Therapy for Carbon Monoxide Toxicity: A Case Series and Five-year Experience

Background: Hyperbaric oxygen (HBO) therapy is recommended to reduce the delayed neurologic sequelae resulting from carbon monoxide (CO) toxicity. Although HBO is generally well tolerated, there exists a risk of seizure in all patients that may be increased in patients with predisposing factors including: fever, hypothermia, prior seizure, or brain injury. Case Report: We present two cases of patients without known risk factors who experienced seizures associated with HBO therapy during treatment for CO toxicity. Conclusion: This facility's 5-year experience and a review of the germane literature are also presented to elucidate the risk factors and incidence of seizures in patients treated with HBO for CO toxicity.