卒中后癫痫发作和卒中后癫痫

卒中可导致偏瘫、失语和认知损害,还会并发癫痫发作甚至癫痫.近年来,有关卒中后癫痫发作和卒中后癫痫的研究越来越多,但主要集中在危险因素方面.文章对卒中后癫痫发作和卒中后癫痫的危险因素、发病机制和治疗进行了综述.     

缺血性卒中后癫痫发作复发和耐药的预测因素

目的：探讨缺血性卒中后癫痫发作复发和耐药性的预测因素。方法回顾性纳入连续的缺血性卒中后首次癫痫发作患者的临床资料,计算癫痫发作复发率及耐药发生率,应用生存分析及 Cox 比例风险模型分析癫痫发作复发和耐药的预测因素。结果共纳入74例连续的缺血性卒中后首次癫痫发作患者,男性45例,女性29例,年龄（66.64±11.50）岁;早发性癫痫发作患者26例,迟发性癫痫发作患者48例。迟发性癫痫发作[优势比（odds ratio, OR）2.56,95％可信区间（confidence interval, CI）1.11~5.88;P =0.027]和部分性发作（OR 3.68,95％ CI 1.29~10.48;P =0.015）是缺血性卒中后癫痫发作复发的预测因素;早发性癫痫发作是耐药性的独立预测因素（OR 6.20,95％ CI 2.04~18.84;P =0.001）。结论迟发性癫痫发作和部分性发作患者易复发,早发性癫痫发作患者易产生耐药性。     

常用新型抗癫痫药物对癫痫患儿认知功能的影响

癫痫是小儿时期常见的神经系统慢性疾病。有研究报道大多数癫痫患儿的认知发育正常,但从总体来看,癫痫患儿的认知水平低于正常儿童。癫痫的认知功能损害主要表现为对外部信息的整合能力下降,其与癫痫发作类型、癫痫发病年龄、癫痫病程、癫痫发作频率、癫痫持续时间、病灶部位、癫痫的基础疾病／病因及社会心理等因素相关。一直以来,癫痫治疗最重要的目的都是控制癫痫发作,目前大量实验研究表明,新型抗癫痫药物通过神经传递、离子通道、第二信使以及其他环节进行调节控制癫痫发作,从而改善癫痫的认知损害,提高患者的生活质量,但也在某些方面影响患儿的认知功能。     

初始单药长期疗效对癫痫患者撤药后复发的预测价值

目的 探讨初始抗癫痫药物(AED)单药治疗的长期疗效对癫痫患者撤药后复发的预测价值,并分析与复发相关的临床因素.方法 收集获得3年及以上无发作后开始撤药的癫痫患者171例,根据撤药前获得长期无发作的药物治疗方案,分为初始单药组(110例)与调整药物组(61例).比较两组患者撤药后的复发率,并分析两组患者出现不同结局相关...     

颅骨成形术后癫痫发作的临床研究

目的分析颅骨成形术后癫痫发作的发生率、相关因素和预防性应用抗癫痫药物(AED)的临床效果。方法选择行颅骨成形术患者107例,分析术后癫痫发作、AED预防性使用及术后早期癫痫发作者术后住院日及晚期癫痫发作情况。结果术后早期癫痫发作17例(15.9%),晚期癫痫发作19例(17.8%)。自体颅骨成形术后早期癫痫发作发生率低于钛网成形术(P<0.05)。术后未使用AED患者早期癫痫发作发生率为23.5%,术后使用AED发生率为2.6%(P<0.01)。术后出现早期癫痫发作患者术后平均住院日和晚期癫痫发作发生率明显高于术后未出现早期癫痫发作患者(P<0.01)。结论颅骨修补术后早期和晚期癫痫发作发生率高,早期癫痫发作可导致平均住院日延长,并增加晚期癫痫发作的风险。预防使用AED可以显著减少术后早期癫痫发作的发生。     

正规抗癫痫治疗与老年癫痫患者抑郁情绪的相关性研究

目的观察抗癫痫药物规范化治疗后,老年患者抑郁状态的变化。方法选择2011年1月1日~12月31日在台州市第一人民医院就诊的初诊或未曾规范化治疗的≥65岁的癫痫患者45例,男性19例,女性26例,收集患者基本资料及汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分,根据HAMD评分分为抑郁组14例,非抑郁组31例,患者进行规范化抗癫痫治疗,随访2年,再次评定HAMD评分,并收集相关资料。结果抑郁组患者治疗前HAMD评分[(21.14±3.66)分vs(12.19±3.00)分]及癫痫发作频率[(2.39±0.96)次/月vs(1.39±0.68)次/月]均明显高于非抑郁组(P=0.00)。2年正规用药后,抑郁组HAMD评分高于非抑郁组[(18.00±3.26)分vs(12.09±2.68)分,P=0.00],2组癫痫发作频率无显著差异[(0.05±0.12)次/月vs(0.07±0.18)次/月,P=0.73],抑郁组8例HAMD评分下降为正常(P0.05),6例仍抑郁患者HAMD评分较治疗前下降,但无明显差异(P0.05)。Spearman相关分析显示,治疗前HAMD评分及治疗前癫痫发作频率与抑郁改善呈正相关(r=0.77、0.55,P=0.00)。结论正规抗癫痫治疗能良好控制癫痫发作情况,并明显改善患者抑郁情绪,帮助恢复社会功能。治疗前癫痫发作越频繁,抑郁程度越重患者改善越明显。     

首次自发性痫性发作后复发危险因素分析

为探讨首次自发性痫性发作后复发的危险因素 ,帮助临床制定首次痫性发作患者的个体化治疗方案。我们对 1 5 0例首诊患者 (包括 66例首次痫性发作患者 )进行了前瞻性研究 ,并分析首次痫性发作后复发的危险性及相关影响因素。1　资料与方法1 .1　临床资料　选择 1 998年 1 0月至 2 0 0 1年 6月间来我院首诊的自发性痫性发作患者 1 5 0例 ,男 86例 ,女 64例 ;平均年龄 ( 1 0 .2± 7.8)岁。症状性发作34例 ,特发性发作 1 1 6例 ;有热性惊厥史 8例 ,新生儿惊厥史 4例 ,癫痫家族史 5例。其中 66例为首次痫性发作后即来就诊 ,84例曾有两次或多次痫…     

脑电图在抗癫痫药物治疗中应用的研究进展

癫痫是一组由大脑神经元异常放电所引起的、以短暂中枢神经系统功能异常为特征的慢性脑部疾病。大脑皮层神经元过度放电是各种癫痫发作的病理基础。这种异常电活动可通过头皮脑电图或颅内脑电图记录到。因此,脑电图在癫痫的诊断和指导治疗中具有重要作用。动态脑电图以其高阳性率及     

耐药性部分性发作癫痫抗癫痫药物治疗观察及影响因素分析

目的探讨耐药性部分性发作癫痫患者继续使用抗癫痫药物(AEDs)治疗的效果及影响药物疗效的危险因素。方法耐药性部分性发作癫痫患者97例,所有患者继续使用AEDs治疗,观察至少2 a,根据观察期内是否达到至少1 a无发作将其分为缓解组和失败组,采用单因素和多因素Logistic回归分析探讨影响ADEs治疗效果的危险因素。结果 97例患者中,18例达到缓解(其中12例复发),79例始终未达到缓解(失败)。单因素Logistic回归分析显示,治疗前发作频率≥4次/月(OR=3.973,95%CI 1.202～13.136,P=0.024)、治疗失败药物数量≥4种(OR=3.269,95%CI 1.063～10.047,P=0.039)与ADEs治疗失败相关;多因素Logistic回归分析未显示AEDs治疗失败的预测因素。结论耐药性部分性发作癫痫患者继续使用AEDs治疗,仍然有一定几率获得发作缓解,缓解后复发几率较高;治疗前发作频率≥4次/月、治疗失败药物数量≥4种与患者AEDs治疗效果不佳有关。     

Influence of normal versus slow antiepileptic drugs withdrawal on seizure recurrence in patients with epilepsy

Objective To explore the influence of normal and slow antiepileptic drugs(AEDs) withdrawal on recurrence of epilepsy. Methods Epileptic patients with seizure-free more than 2 years were recruited to the study. They were first divided into normal     

Neuropsychological effects of epilepsy and antiepileptic drugs

Epilepsy and its treatment can have deleterious cognitive and behavioural consequences. Affected individuals have a higher prevalence of neuropsychological dysfunction than the general population because of complex interactions among several multifaceted and overlapping influences--for example, underlying neuropathologies, ictal and interictal neuronal discharges, a plethora of antiepileptic drugs, and numerous psychosocial issues. Research into the clinical relevance of these factors has been dogged by a range of methodological pitfalls including lack of standardisation of neuropsychological tests, small numbers and multiple testing, and statistical failure to appreciate differential effects of interactive elements in individual patients. Although antiepileptic drugs can impair neuropsychological functioning, their positive effect on seizure control might improve cognition and behaviour. Each person should be assessed individually with respect to factors unique to his or her seizure disorder and its treatment.     

Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy

OBJECTIVES: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs). DESIGN: Retrospective administrative database analysis. SETTING: All outpatient facilities within the Department of Veterans Affairs (VA). PARTICIPANTS: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N=21,435). MEASUREMENTS: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset. RESULTS: Approximately 17% of patients received phenobarbital and 54% phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (chi2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations. CONCLUSION: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.     

Choosing an antiepileptic. Selecting drugs for older patients with epilepsy

After age 65, the incidence of epilepsy increases rapidly. Approximately 1.5% of Medicare recipients and 10% of nursing home residents are being treated with antiepileptic drugs (AEDs). The most commonly used AED is phenytoin, a first generation agent. Appropriate drug selection in this population is complicated by the fact that multiple comorbidity is commonplace. Most older patients receive a number of drugs in addition to AEDs. The average nursing home patient receives six additional medications. Age-related issues affecting the choice of an AED include changes in protein binding, decreases in hepatic and renal clearance, and alterations in gastrointestinal absorption. AEDs that do not have drug-drug interactions, are not metabolized by the liver, and are readily absorbed may be better suited for the elderly. This paper reviews the present knowledge base and attempts to develop a more rational approach to AED selection for the elderly.     

Delayed multifocal recurrent stress-induced cardiomyopathy after antidepressants withdrawal

Stress-induced cardiomyopathy is an acute disease characterized by a large left ventricular apical dyskinesia (“apical ballooning”), triggered by intense emotional or physical stress, acute illnesses or, rarely, by alcohol or opiates withdrawal. Connection to stress and apical asynergy suggest a catecholamine-mediated pathogenesis.     

抗癫痫药物的毒副作用

癫痫患者需要长期服药治疗甚至终生服药、合并用药.抗癫痫药(AEDs)已证实对全身多系统均有一定的影响,在使用过程中易产生各种毒副作用,应受到临床医生的关注.本文从AEDs对皮肤结缔组织、心血管系统、消化系统、血液系统、神经系统、内分泌、代谢的不良反应,对认知功能的影响以及致畸、加重癫痫发作等方面,就其毒副作用进行综述.     

Advances in antiepileptic drug treatments. A rational basis for selecting drugs for older patients with epilepsy

Incidence of epilepsy increases rapidly after age 65; recent studies indicate that approximately 10% of nursing home residents are being treated with antiepileptic drugs (AEDs). Almost all are being treated with first generation AEDs. The average nursing home patient receives six medications, has age-related changes in protein binding, decreases in hepatic and renal clearance, and may have alterations in gastrointestinal absorption. AEDs that do not have drug-drug interactions, are not metabolized by the liver, and are readily absorbed may offer benefits in this population. New studies are demonstrating that the first generation AEDs have a number of shortcomings for treating older patients, whereas some of the newer AEDs may overcome these limitations. This paper reviews the present knowledge base and compares properties of the first generation AEDs with newer agents to develop a more rational approach for drug selection in older adults.     

Transient hyperthyroidism after withdrawal of antithyroid drugs in patients with Graves' disease

The development of silent thyroiditis in patients with a history of Graves' disease is common, especially in the postpartum period. We describe herein patients with Graves' disease who developed transient hyperthyroidism but not silent thyroiditis after withdrawal of antithyroid drug (ATD). If such patients are diagnosed as recurrence of Graves' disease, they may receive ATD or radioiodine therapy unnecessarily. We investigated the characteristics of these patients to prevent unnecessary therapy. We retrospectively studied 22 patients with Graves' disease who showed transient thyrotoxicosis after withdrawal of ATD. Two of 22 patients were male and the mean ages (+/- SD) were 33.7 +/- 12.6 yr. We observed these patients for 28.5 +/- 12.8 (mean +/- SD; range 12-53) months after transient thyrotoxicosis, and measured TSH, FT4, and TSH binding inhibitor immunoglobulin in sera. Radioiodine uptake was measured in 6 of them. The radioiodine uptake in the 4 patients was not suppressed (27.5%, 28.0%, 32.7%, 38.1%). These uptake levels indicate that their thyrotoxicosis was not caused by silent thyroiditis. Most of the 22 patients became euthyroid within 6 months. This study suggests a new therapeutic option as follows: in the case of young patients with mild thyrotoxicosis after withdrawal of ATD, physicians should follow them up for one month without medication unless they have unbearable symptoms or complications.