老年抑郁症患者的脑正电子发射体层摄影术显像分析

目的 探讨老年抑郁症患者脑^18氟-脱氧葡萄糖（18^F-FDG）正电子发射体层摄影术（PET）显像的特点。方法 分别对6例老年抑郁症患者（GD组）及10名健康体检者（对照组）进行脑^18 F-FDGPET显像，按年龄、简易智力状态检查量表总分和性别构成配对，用统计参数图第2版软件比较两组间脑局部葡萄糖代谢的差别。结果 GD组较对照组在双侧尾状核、额下回、颞上回、额中回，右侧核外、额上回、舌回和左侧扣带回、中央前回等脑区局部葡萄糖代谢减低（均P〈0．005）。GD组无局部脑葡萄糖代谢增加的脑区。结论 老年抑郁症患者存在基底节区、前额叶、颞叶和边缘系统的局部葡萄糖代谢下降。     

抑郁症患者脑葡萄糖代谢研究的系统评价北大核心CSCD

目的 通过Meta分析和系统评价了解抑郁症患者不同脑区的葡萄糖代谢水平的改变。方法 参考Cochrane协作网工作手册检索PubMed、Web of Science、EMbase、Cochrane Library及中文科技期刊数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据资源系统,检索时间为1982年1月1日至2014年4月8日。检索词包括：depression,depressive,PET,position emission tomography,氟代脱氧葡萄糖（18F-Fluorodeoxyglucose,FDG）,抑郁,正电子发射体层摄影术等,使用截词符提高查全率;手工检索了2013年10月到2014年4月精神科相关杂志及氟代脱氧葡萄糖相关文章的参考文献。运用SDM（signed differential mapping）软件进行基于体素的Meta分析（P≤0.005,阈值范围〉10）。纳入研究的MNI坐标统一转换为Talairach坐标,SDM软件重建脑区差异图后进行汇总分析。结果 共有10项研究符合纳入标准,包括188例抑郁症患者和169名健康对照者,各项研究间无异质性（P〉0.05）。SDM分析显示,抑郁症患者在右侧额下回眶部[布罗德曼分区（BA）47]和盖部（BA44）、右侧直回（BA11）、右侧额上回背侧（BA10）、右侧扣带中部/扣带旁回、左侧颞上回和左侧额中回眶部（BA47）存在脑葡萄糖代谢减低,双侧丘脑、右侧角回（BA48）和左侧中央前回（BA6）代谢增高。结论 抑郁症患者存在额颞叶-边缘系统活动降低及双侧丘脑活动增强的异常改变。     

~(18)F-FDG PET显像观察特发性快眼动睡眠期行为障碍患者脑葡萄糖代谢特点的研究

目的探讨~(18)F-FDG PET显像观察特发性快眼动睡眠期行为障碍(iRBD)患者脑葡萄糖代谢改变和iRBD脑葡萄糖代谢改变与病程间的相关性。方法纳入多导睡眠监测(PSG)确诊的iRBD患者20例(iRBD组)和年龄、性别匹配的健康对照者19例(对照组)。两组均行~(18)F-FDG PET脑显像。基于自动解剖标记模板将大脑划分为90个左右对称的脑区,计算各脑区葡萄糖代谢半定量值。对iRBD组和对照组各脑区葡萄糖代谢半定量值进行独立样本t检验;并对iRBD组脑葡萄糖代谢改变与病程行Pearson相关分析。结果 (1)与对照组比较,iRBD组的双侧背外侧额上回、双侧眶部额上回、双侧眶部额中回、双侧海马、双侧海马旁回、双侧杏仁核、左侧眶部额下回、左侧岛叶、左侧内侧与旁扣带脑回、左侧中央旁小叶、左侧苍白球的葡萄糖代谢半定量值均增高(P0.05);双侧距状裂周围皮质、双侧楔叶、双侧舌回、双侧枕上回、双侧枕中回、双侧枕下回、双侧角回、双侧颞上回、双侧颞中回、右侧颞横回的葡萄糖代谢半定量值均降低(P0.05)。Pearson相关分析结果,iRBD组双侧杏仁核、双侧颞上回、右侧楔叶、右侧枕上回、右侧颞横回、左侧海马、左侧颞中回的葡萄糖代谢半定量值与病程呈正相关(P0.05);而双侧眶部额上回、双侧眶部额中回、左侧中央旁小叶、左侧眶部额下回、左侧内侧和旁扣带回、右侧背外侧额上回、右侧海马旁回的葡萄糖代谢半定量值与病程呈负相关(P0.05)。结论 iRBD患者脑内存在疾病相关的葡萄糖代谢水平改变,有助于客观评估iRBD病情的变化。     

轻度认知障碍及阿尔茨海默病脑葡萄糖代谢改变的统计参数图的PET研究

目的应用氟脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET)探讨阿尔茨海默病(AD)、遗忘型轻度认知障碍(aMCI)患者脑部葡萄糖代谢改变的特点。方法对27例轻度AD患者(AD组)、10例aMCI患者(aMCI组)和21例年龄匹配正常老年志愿者(对照组)行18F-FDG PET成像,对扫描获得的18F-FDG PET图像进行预处理后应用统计参数图(SPM8)对脑葡萄糖代谢进行基于体素水平的组间t检验的统计学分析。结果①与对照组比较,AD组脑葡萄糖代谢减低的脑区包括后扣带回(BA23、31)及楔前叶(BA19)、双侧顶叶(BA40)、双侧颞叶(BA20、21、22、37)、双侧额叶(BA6、9、10)等(P<0.001,未校正,K≥50像素);②AD组与aMCI组比较,脑葡萄糖代谢相对减低的脑区包括后扣带回(BA23、31)及楔前叶(BA19)、颞顶叶(BA40、20、21、22、39)及额叶(BA6、8、9)等(P<0.001,未校正,K≥50体素);③AD组和aMCI组葡萄糖减低的体素数目(12 413个)要少于AD组和对照组的体素数目(17 592个);④aMCI组葡萄糖代谢与对照组比较,仅右侧枕叶的舌回(BA17)减低(P<0.05,未校正)。结论 SPM8可用于诊断和区分AD患者的脑葡萄糖代谢模式。     

阿尔茨海默病脑白质葡萄糖代谢异常分析

目的探讨阿尔茨海默病(AD)脑白质葡萄糖代谢异常的意义。方法纳入33例符合美国精神障碍诊断与统计手册-第四版(DSM-IV)AD诊断标准的患者和健康对照20名,进行脑正电子发射断层成像(PET)检查。应用SPM软件对PET图像进行分析。结果①与健康对照相比,AD患者有广泛的白质葡萄糖代谢减低,减低较为明显的区域有右侧额叶皮质下白质、左侧额叶上中回皮质下白质(P<0.001);另外,AD患者左侧额叶内侧回皮质下白质、左侧枕叶楔回皮质下白质葡萄糖代谢增强(P<0.001);②与不伴有精神行为症状(BPS)的AD患者(16例)相比,伴有BPS的AD患者(17例)在左右枕叶中回、右侧枕叶楔回、右侧顶下小叶、左侧颞叶梭形回、左侧额叶内侧回等脑区的皮质下白质葡萄糖代谢增强(P<0.001);而左右额叶中央旁回、右侧额叶上回和中回、左侧颞叶上回等脑区的皮质下白质葡萄糖代谢减低(P<0.001)。结论AD有广泛的白质脑葡萄糖代谢异常,有无BPS的AD白质代谢异常不同。     

正常人安静和催眠状态下脑葡萄糖代谢的自身对照研究

目的 研究健康正常人催眠静息状态和清醒安静状态下脑内葡萄糖代谢的差异,初步探索催眠状态的神经生理基础。方法 正常人在清醒安静状态下行^18F—FDG PET扫描。隔日后,采用凝视法将受试者诱导进入催眠状态,再次行^18F—FDG PET扫描。两种状态皆应采用3D模式进行PET脑显像,应用SPM分析对催眠静息状态和清醒安静状态^18F—FDG PET图像进行组间体元统计,统计所得到的一系列数值构成了统计参数地图（SPM）。比较催眠静息状态和清醒安静状态脑局部糖代谢的变化,根据变化差异显著（P〈0．001）区域的Talariach坐标值确定其部位。结果 SPM分析显示催眠静息状态较清醒安静状态右侧枕叶（BA17,18）、左侧枕叶（BA17,18）、左侧顶叶（BA40,）、左侧颞上回（BA22）、右侧尾状核、右侧小脑后叶、右侧额叶（BA6）、左侧额中回（BA8,9）和右侧丘脑葡萄糖代谢明显降低（P〈0．001）。结论 催眠静息状态脑葡萄糖代谢不同于清醒安静状态,催眠静息状态存在神经生理基础。     

抑郁症患者对正性面部表情功能识别

目的：利用任务态功能核磁共振成像技术,初步探讨抗抑郁治疗对正性情绪识别脑区功能的影响。方法：检测19例抑郁症患者治疗前和治疗10周后在识别正性及中性面部表情视频时的激活脑区,并与19例匹配的健康者对照比较。结果：与正常对照组相比,治疗前抑郁症患者左右颞上回（BA39）、左后扣带回（BA23）、右后扣带回（BA30）、左丘脑、右岛叶（BA13）等脑区激活显著降低;治疗后患者左颞上回（BA39）、右颞上回（BA22）、左颞中回（BA37）、左右海马旁回（BA30）、右后扣带回（BA29）、右梭状回（BA36）、左额中回（BA8）、右额下回（BA47）、左顶下小叶（BA40）、右岛叶（BA13）等脑区激活较治疗前增强;但与正常组相比,左颞上回（BA22）、左额中回（BA10）、左梭状回（BA20）、左楔叶（BA19）、右顶上小叶（BA7）、右岛叶（BA13）等脑区激活仍存在一定程度的降低。结论：经抗抑郁治疗,抑郁症患者正性情绪识别脑区功能较治疗前有所改善,但与正常对照组相比,仍存在一定程度的功能损害。进一步证实了积极有效的抗抑郁治疗能够部分逆转正性情绪相关脑区损害。     

NF1患者大脑活动特征的PET-CT研究

目的采用正电子发射断层扫描/X射线计算机断层成像（PET-CT）检测Ⅰ型神经纤维瘤病（NF1）成年患者大脑代谢活动特征变化情况，探讨该疾病稳定状态下的特异脑活动异常情况。 方法利用PET-CT技术，结合脑内葡萄糖代谢特征分析方法，对自2018年1月至7月就诊于首都医科大学附属北京天坛医院神经外科的11例病情稳定的NF1患者（NF1组）和10例健康对照组进行全脑数据分析，运用基于Matlab的SPM软件比较NF1组与健康对照组在全脑水平上大脑各区域活动的变化。 结果NF1组与健康对照组在额叶、颞叶等区域存在不同的代谢特征。全脑分析结果显示NF1在右侧颞上回后部、中央区、额上回、额中回，双侧的颞叶内侧面、顶叶视觉区等脑区出现了与健康对照组不同的脑代谢表现，特别是在双侧丘脑区域出现了显著异常，差异具有统计学意义（P<0.05），主要表现为双侧丘脑区域的葡萄糖摄取减低，提示该区域的脑活动减弱。 结论非中枢系统病变或疾病自身基因突变引起大脑的功能代谢变化，可能为NF1患者的一项重要临床特征，也将为该类疾病以及具有同类型脑部疾病患者的康复及治疗提供前瞻指导。     

阿尔茨海默病脑区葡萄糖代谢研究

目的:探讨阿尔茨海默病(AD)患者部分脑区葡萄糖代谢增强的原因及意义. 方法:符合美国精神障碍诊断和统计手册第4版(DSM-4)诊断标准的AD患者33例(AD组),其中17例伴有痴呆精神行为症状(BPSD),16例不伴有BPSD;以20名健康人作对照(对照组).两组均进行一般资料、简易智能状态(MMSE)、日常生活能力及Hachinski缺血指数量表测定,并进行脑正电子发射断层成像(PET)检查;应用SPM2000软件对两组PET图像进行基于像素的比较. 结果:与对照组相比,AD患者左侧额叶内侧回皮质下白质,左侧枕叶楔回灰质(Brodmann 17区)及皮质下白质,右侧小脑扁桃体等脑区葡萄糖代谢显著增强(P<0.001);与不伴有BPSD的AD患者相比,伴有BPSD的AD患者额叶、顶枕叶及颞叶下部等脑区的葡萄糖代谢显著减低(P<0.001),而枕叶、小脑等脑区的代谢显著增强(P<0.001). 结论:无论是否伴有BPSD的AD患者,其脑葡萄糖代谢均有弥漫性减低,但部分脑区呈代谢增强,增强区域主要位于旧皮质,次级运动及感知觉中枢,局部皮质下白质等.AD患者大脑新皮质代谢及高级功能容易受损,而旧皮质及皮质下结构的代谢及功能出现代偿性增强,与BPSD相一致.     

汉语单字词音、义加工的脑激活模式

目的：研究汉字音、义加工的脑机制。方法：采用汉字单字词为实验材料，通过功能磁共振成像扫描执行语音和语义两种认知任务的脑区。结果：语音任务激活的脑区有，左侧顶叶下部和颞上回(BA 40／39／22，BA：Brodmann Area，即布鲁德曼分区，下同)，左侧枕中回(BA18／19)，右侧枕下回(BA18／19)，以及左中央前回(BA6)。语义任务激活的脑区有，左侧顶叶下部(BA40／39)和左侧颞上回(BA22)，左侧额下回(BA10／47)，右侧额中回和额上回(BA10／11)，以及左侧额中回(BA11)。语义任务减去语音任务激活的脑区有，左侧额下回(BA47)，左侧海马(BA36)和右侧海马旁回(BA36)。语音任务减去语义任务没有发现任何脑区的显著激活。结论：在语义任务中与语音有关的脑区得到激活；而在语音任务中与语义有关的脑区没有激活。     

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.