卒中后抑郁患者的认知功能、自主神经功能及血浆单胺类神经递质水平的相关性

目的探讨卒中后抑郁(PSD)患者认知功能、自主神经功能与血浆单胺类神经递质水平的相关性。方法对33例PSD患者(PSD组)和33名健康对照者(正常对照组)进行事件相关电位(ERP)、交感神经皮肤反应(SSR)和血浆单胺类神经递质水平的测定;对检测结果进行Pearson多元相关分析。结果与正常对照组比较,PSD组ERP(P300、N400、CNV及MMN)、SSR各波潜伏期明显延长(均P<0.01),波幅明显下降(均P<0.01);血浆单胺类神经递质水平明显降低(均P<0.01)。PSD组各项指标间均具有相关性(P<0.05～0.01)。结论PSD患者血浆单胺类神经递质水平降低与其认知功能及自主神经功能障碍相关。     

卒中后抑郁单胺类递质与睡眠的研究

目的 探讨卒中后抑郁患者单胺类递质和睡眠结构的变化,以及二者的关系.方法 对46例卒中后抑郁患者和30例正常人进行血浆单胺类递质的测定以及多导睡眠图描记,将所得结果进行分析.结果 卒中后抑郁患者血浆中多巴胺、去甲肾上腺素、5-羟色胺、5-羟吲哚乙酸、高香草酸含量均显著低于对照组(P＜0.05);卒中后抑郁组与对照组相比,睡眠潜伏期及S1(%)时间延长,s3 S4(%)、REM、REM时间及潜伏期缩短,差异均有显著性(P＜0.05或P＜0.01);卒中后抑郁患者血浆NE、5-HT与REM、REM latency(%)均呈正相关(P＜0.05或P＜0.01).结论 卒中后抑郁存在单胺类神经递质及睡眠结构的改变,且睡眠障碍与单胺类神经递质变化有关.     

密闭舱室内亚致死性爆炸伤大鼠额叶皮质及血浆内单胺类神经递质的变化对大鼠旷场行为的影响

目的: 观察密闭舱室内亚致死剂量爆炸伤大鼠额叶皮质及血浆内单胺神经递质的变化对大鼠旷场行为的影响.方法:采用密闭舱室内亚致死剂量爆炸伤的大鼠模型,高效液相色谱电化学法分析大鼠血浆、额叶皮质内5-羟色胺(5-HT),多巴胺(DA),肾上腺素(E).去甲肾上腺素(NE)含量的变化,用旷场行为观察箱观察大鼠旷场行为.结果: 舱内亚致死剂量爆炸伤大鼠额叶皮质内NE,E含量较对照组明显升高(P<0.05),DA含量明显降低(P<0.05),5-HT的含量在爆炸后48 h达高峰,随后出现下降,密闭舱室内亚致死剂量爆炸后大鼠旷场行为较对照组明显减少(P<0.05).结论: 舱内爆炸后大鼠的兴奋性明显下降;大鼠旷场行为与舱内爆炸后额叶皮质E浓度呈负相关(r=-0.987,P<0.05),与5-HT浓度呈正相关(r=0.952,P<0.05),大鼠旷场行为与血浆内E浓度呈正相关(r=0.979,P<0.05),而与5一HT的浓度成负相关(r=-0.958,P<0.05).     

伴攻击行为的男性精神分裂症患者听觉事件相关电位与探索性眼动研究

目的 研究有攻击行为的男性精神分裂症患者听觉事件相关电位与探索性眼动的特征.方法 纳入63例有攻击行为的精神分裂症住院患者为研究组,无暴力攻击行为的精神分裂症住院患者75例为对照组,进行听觉事件相关电位(ERP)和探索性眼动(EEM)检测,比较两组间的差异.结果 与对照组相比,研究组EEM凝视点数(NEF)和反应探索评分值(RSS)低于对照组,差异有统计学意义(P<0.01);ERP中N2、P3波潜伏期均延长和P3波幅降低,差异有统计学意义(P(0.01);ERP的靶P3波潜伏期显著延长(P<0.05),提示研究组的认知信息加工过程速度减慢.研究组N2、P3波潜伏期与NEF、R5S呈负相关(r为-0.29～-0.36,P均小于0.01),P3波幅与NEF、RSS呈正相关(r为0.32～0.33,P均小于0.01).结论 有攻击行为的精神分裂症患者的ERP和EEM均有异常并相关,他们可能作为攻击行为的预测指标.     

脑卒中后抑郁患者检测SEP与血浆5-羟色胺的临床意义

目的探讨脑卒中后抑郁(post-stroke depression,PSD)患者体感诱发电位(somatosensory evoked potential,SEP)与血浆5-羟色胺(5-hydroxytryptamine,5-HT)水平的变化及其相关性,为脑卒中后抑郁的诊断及预后提供科学依据。方法单纯脑卒中组(n=19)、脑卒中后抑郁组(n=17),采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)判断抑郁程度,另设正常对照组(n=12),检测3组体感诱发电位N9、N13、N20的潜伏期及波幅;检测各组血浆5-HT含量,比较分析3组体感诱发电位和血浆5-HT含量。结果脑卒中患者、脑卒中后抑郁患者正中神经测定N20的潜伏期及波幅异常率较正常人高(P0.05);脑卒中后抑郁组血浆中5-HT含量明显低于正常对照组或脑卒中组,差异显著均有统计学意义(P0.05);脑卒中后抑郁患者HAMD评分与N20潜伏期呈正相关、与N20波幅呈负相关,N9波幅、N9潜伏期、N13波幅、N13潜伏期、N20波幅无相关;脑卒中后抑郁组HAMD评分与血浆中5-HT含量呈负相关。结论脑卒中后抑郁患者血浆中5-HT含量明显低于正常人或脑卒中患者,并且脑卒中后抑郁患者及脑卒中患者正中神经测定N20波幅及潜伏期异常率明显高于正常组。因此,检测脑卒中患者的SEP中N20波幅、潜伏期及血浆5-HT水平,将对脑卒中后抑郁的诊断及预后具有很好的临床意义。     

利培酮与氟哌啶醇治疗儿童抽动障碍的效果及安全性对比分析

目的对比应用利培酮与氟哌啶醇治疗儿童抽动障碍的效果与安全性。方法将我院85例儿童抽动障碍患者采用随机数字表法分组,对照组42例给予氟哌啶醇口服治疗,观察组43例给予利培酮口服治疗,对比两组患者治疗后单胺类神经递质水平变化、症状变化、疗效及不良反应。结果两组患者治疗后NE、DA水平均明显升高,5-HT水平及YGTSS评分显著降低,观察组治疗2、4、8周TESS评分均低于对照组,治疗2周末YGTSS评分高于对照组(P0.05);观察组NE、DA、5-HT水平、总有效率及治疗4、8周末YGTSS评分与对照组相比无统计学意义(P0.05)。结论利培酮与氟哌啶醇均能够有效调节儿童抽动障碍患者单胺类神经递质水平,改善症状体征,利培酮起效慢,但不良反应少。     

无抽搐电休克对精神分裂症和抑郁症患者P300及血浆神经递质影响的研究

目的 探讨无抽搐电休克(MECT)对精神分裂症和抑郁症患者P300及血浆神经递质的影响.方法 本研究共入组的15例患者,将其分为所有患者组,精神分裂症组和抑郁症组;在MECT治疗前后分别完成P300和血5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NE)检测,比较治疗前后三组患者P300和血浆神经递质的变化.结果 所有患者组P2、N2、P3波幅治疗后分别为(16.79±18.31,25.32±18.58,24.33±18.676)高于治疗前分别为(5.05±3.72,9.88±9.78,11.299±9.849),差异具有统计学意义(P＜0.05);而在精神分裂症组和抑郁症组N2波幅治疗后分别为(32.847±21.563,16.54±9.224)均高于治疗前分别为(13.72±12.14,5.40±2.77),差异具有统计学意义(P＜0.05).血浆神经递质在所有患者组以及精神分裂症组和抑郁症组治疗前后的差异均无统计学意义.结论 MECT对患者N2、P3波幅有一定程度的改善,但对血浆神经递质的影响不大.     

临床下(癎)样放电对数学认知功能的影响

目的探讨临床下样放电对数学认知功能的影响。方法对11例经丙戊酸钠治疗后临床发作控制、但仍有频繁的临床下伴中央-颞区棘波的良性癫(BECTS)患儿(BECTS组)和11名正常儿童(正常对照组)进行以数学运算为刺激的事件相关电位(ERP)检测,并对检测结果进行比较分析。结果与正常对照组比较,BECTS组各导联P3潜伏期明显延长(均P<0.01),波幅明显降低(均P<0.05)。结论频繁的临床下癫样放电可能是造成BECTS儿童数学认知功能障碍的因素之一。     

帕金森病外科治疗的综合评价与相关基础研究

目的通过综合研究对帕金森病(PD)外科治疗的价值和疗效进行全面评价。方法采用医学心理学测验(WAISRC)、临床记忆量表(MMPI)、神经生理学检测(听觉P300地形图)、神经电生理学(体感诱发电位SEP)和神经生化检查的脑脊液中多巴胺(DA)、5羟色胺(5HT)、去甲肾上腺素(NE)及其代谢产物)等对手术前后患者进行综合研究,并设对照组。结果手术前后智能和精神症状无显著性差异(P>0.05);手术后SEP的N20波峰潜伏期较术前缩短,统计学处理有差异(P左<0.005,P右<0.05),手术侧较非手术侧峰潜伏期缩短(P<0.05)。伴发抑郁患者组CSF中单胺类神经递质5HT的代谢产物5羟吲哚乙酸(5HIAA)和NE的代谢产物3甲氧基4羟基苯乙二醇(MHPG)低于对照组(P<0.01),患者组DA、高香草酸(HVA),5HT,5HIAA、NE、MPHG低于正常对照组(P<0.001),手术组上述各项均高于手术前组(P<0.001);结论手术不会加重智能和精神障碍;听觉P300地形图可作为诊断和疗效判定的客观指标之一;帕金森病及伴发抑郁症状均具有相应生化病理学基础。     

军人失眠症患者探究性眼动与事件相关电位研究

目的:探讨探究性眼动(EEM)和事件相关电位(ERP)对军人失眠症患者认知功能评估的临床价值.方法:采用EEM和ERP对某三级甲等部队医院心理科收治的48例失眠症官兵(研究组)和随机抽取某部50名官兵(对照组)进行测定,并将结果进行比较.结果:①军人失眠症患者EEM凝视点数(NEF)、反应探索评分(RSS)及D值与对照组相比,差异有统计学意义(P＜0.01);②军人失眠症患者ERP测定,N2、P3波潜伏期较对照组延长,P3波幅较对照组降低,两者比较差异均有显著性意义(P＜0.01);③相关分析显示,研究组N2、P3波潜伏期与NEF、RSS呈负相关(r=-0.19～-0.42,P＜0.05或0.01),与D值呈正相关(r=0.30,0.48,P＜0.01);P3波幅与NEF、RSS呈正相关(r=0.38,0.51,P＜0.01),与D值呈负相关(r=-0.32,P＜0.01).结论:EEM和ERP测定具有良好的一致性,可作为判断失眠症患者认知功能的重要指标.     

N1 and P300 abnormalities in patients with schizophrenia, epilepsy, and epilepsy with schizophrenialike features.

BACKGROUND: The scalp-recorded N1 and P300 components of the event-related brain potential (ERP) are commonly reduced in patients with schizophrenia but not in patients with epilepsy. Epilepsy patients with interictal chronic schizophrenialike features (EPI-SZ) provide a comparison group for determining whether the ERP amplitude abnormalities seen in schizophrenic patients are associated with shared clinical features of EPI-SZ and schizophrenic patients or overlapping pathophysiologies, or are specific to a distinct schizophrenia etiology. METHODS: Patients with schizophrenia (n = 24) were compared with normal control subjects (n = 32) and patients with epilepsy syndromes on visual and auditory oddball ERP paradigms. Epilepsy patients included those with chronic interictal schizophrenialike features (n = 6) and those without (n = 16). RESULTS: Auditory P300 amplitude was reduced in both schizophrenic and EPI-SZ patients, whose positive or negative symptoms did not differ. In contrast, N1 amplitude was reduced only in schizophrenic patients. Delays in both N1 and P300 were associated with epilepsy patients and EPI-SZ but not schizophrenic patients. CONCLUSIONS: The schizophrenialike symptoms in epilepsy probably represent a phenocopy of schizophrenia with common clinical features and some common pathophysiologies but distinct etiologies. P300 amplitude appears to be sensitive to schizophrenialike features, regardless of whether they occur in the context of schizophrenia or epilepsy. N1 amplitude reduction appears to be specific to schizophrenia, suggesting its sensitivity to the distinct etiology of schizophrenia.     

Hair zinc and copper concentration in patients with epilepsy

The concentration of zinc and copper in the hair of 55 patients with epilepsy was determined. The hair copper levels in patients with epilepsy were significantly lower than those in the normal control group (P less than 0.001). The hair zinc levels in female patients were significantly lower than those in the normal control group (P less than 0.05). In the following patients: (1) with generalized seizure, (2) with the disease course 0-5 years, (3) EEG showed heavy or middle abnormality, (4) had epileptic attacks within one year before the sample was taken, the zinc levels were also significantly lower compared with controls (P less than 0.05). Antiepileptic drugs had more effect on hair zinc than on copper. The increase in the hair zinc and copper and zinc: copper ratio seems to show the efficiency of drugs.     

Auditory event-related potentials (P300) in partial and generalized epileptic patients.

We evaluated the P300 components of event-related potentials (ERP) in 64 cryptogenic partial epilepsy (CPE) patients, and 52 idiopathic generalized epilepsy (IGE) patients as well as in their age-matched control groups. The P200, N200 and P300 latencies recorded from Cz were significantly longer in CPE patients compared with those of their control group (P = 0.0371, P = 0.0092 and P = 0.0405, respectively). The P200 and N200 latencies recorded from Fz were significantly longer than in their control group (P = 0.0448 and P = 0.0107) while the prolongation in the P300 latencies was not found to be statistically significant (P = 0.0733). All latencies were longer in IGE patients, and the amplitudes of the N200/P300 components of ERP were lower in both epileptic groups compared with their control groups, but these differences were not significant. The prolongation of the P300 latencies was not correlated with the type or serum level of antiepileptic drug or seizure control. Our findings suggest that the prolongation of the P300 latency of ERP is related to the type of epilepsy.     

Homocysteine levels in epileptic children receiving antiepileptic drugs

The aim of this study is to investigate the homocysteine, folic acid, and vitamin B(12) levels in epileptic children receiving antiepileptic drugs. A total of 25 children with idiopathic epilepsy (8 valproate, 11 carbamazepine, and 6 oxcarbazepine) and 10 healthy children were included in the study. The mean homocysteine, folic acid, and vitamin B(12) levels in the study group were 7.57 +/- 3.78 micromol/L (normal = 5-15 micromol/L), 10.19 +/- 4.05 ng/mL (normal = 3.0-17 ng/mL), and 428.20 +/- 256.12 pg/mL (normal = 193-983 pg/mL), respectively. The differences between the mean plasma homocysteine, folic acid, and vitamin B(12) levels of the study and control groups were not significant (P = .522; P = .855; P = .798, respectively). However, plasma homocysteine levels were higher than the normal cutoff point accepted for childhood in 4 (16%) of the study patients. Out of these 4 children, 3 were from the carbamazepine group and 1 was from the valproate group. Although the number of the study patients is limited, the authors recommend assessment of plasma homocysteine, serum vitamin B(12), and folic acid levels in children receiving enzyme-inducing antiepileptic drugs.     

CYP2C19基因型对丙戊酸及其与苯妥英联合用药时血药浓度影响

目的探讨细胞色素P450 2C19(CYP2C19)基因对丙戊酸(VPA)血药浓度,以及VPA和苯妥英(PHT)联合应用时对其VPA血药浓度的影响.方法应用变性高效液相(DHPLC)技术对CYP2C19两个常见的等位基因突变进行了分析;应用荧光偏振免疫法(FPIA)测定口服抗癫痫药物患者的血药浓度.结果81例癫痫患者中CYP2C19外显子4(*3)和外显子5(*2)位点均为野生型(*1/*1)的发生率为37.0%,CYP2C19*2和CYP2C19*3的等位基因频率分别为31.5%和3.7%.单一应用VPA时,弱代谢患者较正常代谢患者的VPA血药浓度有所升高(P＜0.05).联合应用PHT和VPA可使VPA血药浓度显著降低(P＜0.01),CYP2C19正常代谢患者VPA血药浓度降低尤为明显(P＜0.01);在VPA与PHT联合用药过程中,约半数CYP2C19正常代谢患者VPA血药浓度不能达到治疗血药浓度.结论CYP2C19基因多态性影响VPA的血药浓度变化,在联合应用PHT时对VPA血药浓度的影响尤为明显,从而影响抗癫痫的临床疗效.     

事件相关电位对血管性痴呆的早期诊断价值

目的　探讨事件相关电位 (ERP)对血管性痴呆 (VD)的早期诊断价值。方法　对 10 8例缺血性脑血管病 (ICVD)及其危险因素患者进行听觉ERP和心理量表测试。结果　不同类型的ICVD及其危险因素患者ERP的N2 和P3 峰潜伏期 (PL)均较对照组显著延长 (P <0 .0 5 ) ,而且P3 PL与心理量表成绩呈显著负相关 (P <0 .0 5 ) ;P3 PL对VD诊断的敏感性和特异性分别为 81.3%和 80 .4 %。结论　ERP可以作为客观评价认知障碍敏感而简便的电生理学指标 ,动态观察ERP(P3 PL)的变化有助于VD的早期诊断。     

Reduced sensitivity of the N400 and late positive component to semantic congruity and word repetition in left temporal lobe epilepsy.

We studied 14 patients with well-characterized refractory temporal lobe epilepsy (TLE), 7 with right temporal lobe epilepsy (RTE) and 7 with left temporal lobe epilepsy (LTE), on a word repetition ERP experiment. Much prior literature supports the view that patients with left TLE are more likely to develop verbal memory deficits, often attributable to left hippocampal sclerosis. Our main objectives were to test if abnormalities of the N400 or Late Positive Component (LPC, P600) were associated with a left temporal seizure focus, or left temporal lobe dysfunction. A minimum of 19 channels of EEG/EOG data were collected while subjects performed a semantic categorization task. Auditory category statements were followed by a visual target word, which were 50% "congruous" (category exemplars) and 50% "incongruous" (non-category exemplars) with the preceding semantic context. These auditory-visual pairings were repeated pseudo-randomly at time intervals ranging from approximately 10-140 seconds later. The ERP data were submitted to repeated-measures ANOVAs, which showed the RTE group had generally normal effects of word repetition on the LPC and the N400. Also, the N400 component was larger to incongruous than congruous new words, as is normally the case. In contrast, the LTE group did not have statistically significant effects of either word repetition or congruity on their ERPs (N400 or LPC), suggesting that this ERP semantic categorization paradigm is sensitive to left temporal lobe dysfunction. Further studies are ongoing to determine if these ERP abnormalities predict hippocampal sclerosis on histopathology, or outcome after anterior temporal lobectomy.     

Limbic P3 potentials, seizure localization, and surgical pathology in temporal lobe epilepsy

Limbic P3 event-related potentials were recorded from mesial temporal electrodes implanted for presurgical investigation in 70 patients with intractable focal seizures. In 46 (81%) of 57 patients with unilateral temporal lobe epilepsy, the limbic P3 potential was absent or rudimentary ipsilateral to the seizure focus and a robust P3 potential was always elicited from the nonepileptogenic temporal lobe. Bilateral P3 potentials were recorded in 6 patients (10%) with unilateral temporal lobe epilepsy. In the remaining 5 patients in the group with unilateral temporal lobe epilepsy, results showed P3 bilaterally absent (2 patients), P3 present in a unilateral investigation (1 patient), P3 absent contralateral to the seizure focus (1 patient), and technically unsatisfactory recordings (1 patient). Bilaterally absent P3 potentials were noted in 2 patients with bilateral temporal lobe epilepsy. In 6 patients with technically adequate P3 studies and extratemporal seizures, bilaterally present P3 potentials were noted. Sensitivity and specificity of P3 absence as a predictor of an epileptogenic temporal lobe were 87% and 95%, respectively. Tissue specimens of the hippocampus were available in 22 patients (43%). Thirteen hippocampi showed sclerosis, all of which were associated with unilaterally absent P3 potentials. Nine hippocampi were normal (5 patients with the P3 absent, 4 with P3 present). Sensitivity and specificity of an absent limbic P3 as a function of hippocampal pathological findings were 100% and 44%, respectively. Absent limbic P3 potentials in temporal lobe epilepsy thus indicate structural or functional hippocampal abnormality and may add important information in presurgical evaluation with depth electrodes of patients who have temporal lobe epilepsy.     

The role of event related potentials in evaluation of subclinical cognitive dysfunction in epileptic patients

BACKGROUND/AIM: Cognitive dysfunction in epileptic patients may develop due to the neurophysiological changes related to seizures or antiepileptic drugs. The aim of this study was to evaluate the cognitive dysfunction in epileptic patients under antiepileptic drug therapy by the aid of event related potentials. METHOD: P300 latencies were obtained from Fz, Cz and Pz electrod positions from both epileptic patients (n=40) and age and sex matched control group (n=40). Epileptic patients were classified either idiopathic primary generalized (IPGE) (n=9) or secondary generalized epilepsy (SGE) (n=31) based on the ILAE classification. The effect of epilepsy type, treatment types (monotherapy/polytherapy), daily dosages and serum levels of antiepileptic drugs, age at onset and EEG abnormalities on P300 latencies were studied. RESULTS: P300 latencies were longer in the epileptics when compared to controls (P < 0.05). Besides, our results pointed out that P300 latencies were longer in IPGE when compared to SGE (P < 0.05). No statistically significant difference was determined between ERP parameters neither in monotherapy nor in polytherapy groups (p > 0.05). Antiepileptic drug subgroups revealed variable effects on ERP latencies. CONCLUSION: We believe P300 latencies may have an important role in the evaluation of subclinical cognitive dysfunction in epileptic patients treated with antiepileptic drugs.     

Antiepileptic drugs and the significance of event-related potentials.

The authors compared cognitive changes in epilepsy patients with or without antiepileptic drugs using event-related potential (ERP) N270 and P300. The patients were divided into three groups according to treatment type: carbamazepine, valproate acid (VPA), or no treatment. One control group composed of healthy subjects was included. The Mini-Mental State Examination detected no clinical dementia in all subjects. A modified Sternberg paradigm was used as a task when an ERP was recorded. When a stimulus was different from the memorized item (conflict condition), N270 was elicited in both controls and patients. All the three patient groups showed a delayed and smaller N270 than the control group. P300 was elicited when a stimulus was the same one as the memorized item (match condition), and its amplitude decreased in the VPA group. P300 latency did not differ among the four groups. ERP (N270 and P300) was abnormal in patients with epilepsy. These results indicate that antiepileptic drugs, especially VPA, might enhance the impairment of cognitive processing. N270 is more sensitive than P300 in the early detection of minor cognitive impairment in epileptics.