多塞平加氟桂利嗪治疗难治性功能性消化不良

目的 :观察多塞平加氟桂利嗪治疗难治性功能性消化不良 (FD)的疗效。方法 :应用随机开放性的自身交叉对照试验 ,6 3例病人分为AB组和BA组 ,轮替给予A方案和B方案先后治疗各 4wk。A方案给多塞平 12 .5mg ,po ,bid +2 5mg ,po ,qn ;氟桂利嗪 5mg ,po ,qn。B方案给西沙必利 5mg ,po ,tid ;雷尼替丁 0 .3g ,po ,qn。A和B方案间隔 3wk执行 ,2组病人在A和B方案均完成后 ,相同方案的症状评分结果合并 ,再比较症状改善情况及有效率。结果 :治疗后 2方案的症状积分下降均有非常显著意义 (P <0 .0 1) ;2方案间比较 ,A方案症状积分非常显著低于B方案 (P <0 .0 1) ,症状总积分减分率达有效者 ,A方案 75 % ,非常显著高于B方案 4 4% (P <0 .0 1)。结论 :多塞平加氟桂利嗪是治疗难治性FD的有效方案。     

Anticonvulsant properties of flunarizine on reflex and generalized models of epilepsy

The anticonvulsant activity of 1-bis(4-fluorophenyl)methyl-4-(3-phenyl-2-propenyl)-piperazine, flunarizine, was studied after intraperitoneal administration in DBA/2 mice (seizures induced by sound), intravenous administration in Papio papio (myoclonus induced by photic stimulation) and oral administration in Wistar rats (seizures induced by cefazolin). Protection against sound-induced seizures was observed after intraperitoneal administration of flunarizine (5-40 mg/kg). The ED50 for suppression of tonic, clonic and wild running phases of sound-induced seizures was 3.3, 9.8 and 17.5 mg/kg, respectively. This protective action was significantly reduced by pretreatment with aminophylline (50 mg/kg, i.p.). In photosensitive baboons flunarizine (0.5-1.0 mg/kg, i.v.) provided partial protection against myoclonic responses to stroboscopic stimulation. After flunarizine (2 mg/kg, i.v.) this protection lasted for more than 5 hr (and was complete at 2-3 hr). Cefazolin-induced seizures in rats were prevented by administration of flunarizine (20-40 mg/kg, orally). The ED50 for the suppression of tonic and clonic seizures evoked by subsequent intravenous administration of cefazolin was 25 mg/kg. The protective effects of flunarizine (40 mg/kg, orally) were maximal after 3-6 hr and were maintained for 16-24 hr. Behavioural effects of flunarizine included signs of sedation in both mice and rats. Tolerance to the antiepileptic effects of flunarizine was not seen after chronic treatment in rats. The role of purinergic receptors and of calcium entry blockade in the anticonvulsant action of flunarizine requires further study.     

Effects of flunarizine on rat cerebral cortex

Flunarizine was tested using a single dose (40 mg/kg IP) and multiple doses (30 mg/kg PO presurgery) in 200–250 g male Wistar rats, using physiological measures related to the rapid ionic shift seen in cerebral cortex following a sudden insult. The threshold for initiation of a spreading depression was increased by flunarizine treatment only in rats in which the cortex had previously been injured. The time to rapid ionic shift after cardiac arrest (global ischemia) was increased by both flunarizine and phenytoin. Other measures tested showed no difference in normal cortex under flunarizine treatment. Flunarizine appears to have little or no effect on normal cortical tissure, but rather seems to exert a therapeutic effect on injured cortical tissue. Flunarizine may be a useful agent in the management of cerebral trauma.     

难治性癫(癎)患者基本认知能力分析

目的 分析手术前难治性癫(癎)患者基本认知能力,为合理制定治疗方案提供参考依据.方法 对46例手术前难治性癫(癎)患者使用《基本认知能力测验》软件进行测评,测试结果进行统计学分析.结果 与常模组相比,难治性癫(癎)患者的认知功能广泛受损,包括数字鉴别[(10.0±5.0)分比(12.0±4.0)分]、汉字快速比较[(8.6±4.8)分比(12.0±4.0)分]、心算效率[(7.4±3.4)分比(12.0±4.0)分]、汉字旋转[(4.8±2.1)分比(12.0±4.0)分]、数字工作记忆[(8.6±3.6)分比(12.0 ±4.0)分]和双字词再认[(10.0±3.5)分比(12.0±4.0)分]、无意义图形再认[(7.1±4.3)分比(12.0±4.0)分],差异均具有统计学意义(均P＜0.01).结论 难治性癫(癎)病患者的基本认知能力明显低于常模组.重视难治性癫(癎)患者基本认知能力状况,对评估手术疗效、患者愈后和提高患者生活质量具有重要意义.     

难治性癫(癎)患者临床症状自评90项量表测评结果分析

目的 了解难治性癫(癎)患者的心理健康状况.方法 对40例初中以上文化水平,无智力缺陷的成人患者,使用临床症状自评90项(SCL-90)量表进行测量,测定结果 进行统计学分析.结果 40例患者测评结果:总分最高分227分,最低分103分,平均(159.63±35.04)分,其中躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等因子分均高于中国成人常模,差异均有统计学意义(P＜0.05或P＜0.01).结论 难治性癫(癎)患者心理健康水平明显低于普通人群,在积极手术治疗的同时应关注该群体存在的心理健康问题,对提高疗效及患者的生活质量有重要意义.

Abstract：

Objective To study the mental health in the patients with intractable epilepsy. Methods Totally 40 adult patients with middle school level or above, no mental deficiency, were tested with symptom checklist 90 scale. Results The patients with intractable epilepsy associated with different degrees of mental problems including somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety and hostility. The factor scores of refractory epilepsy were higher than those of normal adult. The differences were significant (P＜ 0.05). Conclusion The intractable epilepsy patient's psychological health is significantly lower than the normal people.     

Pharmacokinetics of nafimidone in patients with chronic intractable epilepsy

Nafimidone is a new antiepileptic drug which may be effective in partial onset seizures. We studied the pharmacokinetics of nafimidone and its metabolite, nafimidone alcohol, in 12 patients already taking phenytoin and/or carbamazepine. The half-life of nafimidone was 1.34 +/- 0.48 hours after a 100mg single dose and 1.69 +/- 0.91 hours after a 300mg single dose. However, the half-life of nafimidone alcohol increased from 2.84 +/- 0.72 hours after a 100mg single dose to 4.22 +/- 1.09 hours after a 300mg single dose (p less than 0.02). The clearance of nafimidone was 43.56 +/- 22.11 L/h/kg after a 100mg single dose and 35.51 +/- 28.93 L/h/kg after the 300mg single dose. The respective apparent volumes of distribution of nafimidone after single 100 and 300mg doses were 80.78 +/- 46.11 L/kg and 71.01 +/- 36.86 L/kg. After short term (9 to 10 weeks) and long term (127 to 152 weeks) maintenance therapy on nafimidone 600mg per day the half-life of nafimidone alcohol was 2.23 +/- 0.36 hours and 2.16 +/- 0.60 hours, respectively. No nafimidone could be detected in urine but from 4 to 7% of the daily nafimidone dose was recovered as nafimidone alcohol. Thus, it appears that over 90% of the administered dose of nafimidone is metabolised by pathways other than glucuronidation of nafimidone alcohol and urinary excretion.     

Effects of flunarizine on spontaneous synaptic currents in rat neocortex

Flunarizine, a non-selective blocker of voltage-dependent Ca²⁺ and Na⁺ channels, is clinically effective against several neurological disorders, including epilepsy, migraine, and alternating hemiplegia of childhood. We examined the effects of flunarizine on spontaneous post-synaptic currents in acute brain slices maintained in vitro using patch-clamp electrophysiology. Flunarizine significantly attenuated the amplitude of spontaneous currents in pyramidal neurons from juvenile rat neocortex. Flunarizine had no effect on miniature spontaneous events recorded in the presence of tetrodotoxin, a blocker of voltage-dependent sodium channels. In high (9 mM) extracellular potassium, flunarizine reduced the amplitude and frequency of the spontaneous currents. Additionally, dimethyl sulfoxide, the solvent used in our experiments, reduced the amplitude of spontaneous currents, but only in high extracellular potassium. Our data suggest that the clinical activity of flunarizine may in part be a consequence of reducing spontaneous synaptic currents in the neocortex, especially under conditions of heightened neuronal activity.     

甘露醇、能量合剂联合抗癫痫药治疗发作频繁的小儿难治性癫痫的疗效

目的：有效缓解小儿难治性癫痫发病症状,临床探究在使用抗癫痫药治疗同时加以甘露醇、能量合剂的效果。方法：选取我院2014年7月～2015年8月96例经诊断为难治性癫痫入院治疗的小儿患者,分为单一组、联合组,按挂号单双数进行分配,每组48例。单一组仅使用抗癫痫药,联合组在单一组用药基础上加用能量合剂以及甘露醇,观察两组疗效以及治疗前后发病次数。结果：联合组临床有效率高达91.7%,单一组仅为79.2%,联合组较单一组疗效好,P<0.05;治疗前两组癫痫发病次数差异无统计学意义, P>0.05,治疗后两组发病次数均有明显减少,联合组较单一组发病次数少,P<0.05。结论：临床在治疗小儿难治性癫痫时在使用抗癫痫药同时加以甘露醇、能量合剂辅助治疗,患儿发病次数减少,恢复情况好,疗效高。     

A phase I clinical trial of dextromethorphan in intractable partial epilepsy

We conducted an open-label pilot study of dextromethorphan (DM) in intractable partial epilepsy with the following objectives: a preliminary evaluation of the drug's safety and efficacy in the epileptic patient and a definition of a concentration range which can be safely achieved in future studies. Sixteen patients with drug-resistant, localization-related epilepsies entered the trial. After an 8-week baseline period, DM was added to the existing antiepileptic drugs at a dose of 40 and 50 mg every 6 h (160 and 200 mg/day). Each treatment period lasted 8 weeks. Seizure control improved after administration of DM, especially in the group of intermediate and slow metabolizers. Two patients, however, experienced increased seizure frequency and withdrew from the study. Adverse effects during DM administration were mild and transient. DM was well tolerated even in patients with high plasma levels of the drug (up to 15020 ng/dl). Our results indicate that DM is safe and effective in the treatment of comedicated patients with intractable partial epilepsies.     

生酮饮食对难治性癫痫患儿情绪和社会行为的影响

目的 了解生酮饮食(ketogenic diet,KD)对难治性癫痫患儿情绪和社会行为的影响。方法 采用前瞻性病例对照研究,对66例难治性癫痫患儿,在告知相关生酮治疗疗效和不良反应后由家长选择入组,加用生酮饮食治疗的35例为生酮组,继续单用抗癫痫药物治疗的31例为对照组。研究启动前对两组患儿进行情绪和社会行为评估,生酮饮食治疗启动后,分别在第3、6、12个月再进行情绪和社会行为的评估,将评分结果转化成T分进行分析,比较生酮组和对照组之间,以及生酮组自身治疗前后患儿情绪和社会行为的改变情况。结果 生酮组生酮饮食治疗后第3、6、12个月,患儿的问题维度(忧郁、焦虑、冲动性、攻击性)较对照组明显下降(P<0.05);能力维度(注意力、依从性、模仿)较对照组有明显提高(P<0.05),其中在治疗初3个月改善最为明显。结论 生酮饮食能明显改善难治性癫痫患儿的情绪和社会行为,较为安全。     

伊来西胺添加治疗难治性癫痫的效果分析

目的观察伊来西胺添加治疗难治性癫痫的疗效与安全性。方法选择本院76例难治性癫痫患者,保持原药不变,添加伊来西胺治疗,随访3～18个月,观察其疗效及不良反应。结果伊来西胺添加治疗难治性癫痫的总有效率为69．7％,对部分性发作和全面性发作均有效,且无明差异,不良反应发生率为23．7％,无严重不良反应。结论伊来西胺治疗难治性癫痫效果较好,安全性高,患者耐受性好,可用于儿童及成人难治性癫痫的添加治疗。     

拉科酰胺对难治性癫痫患者认知功能和生活质量的影响

目的探讨拉科酰胺作为抗癫痫辅助用药对难治性癫痫患者认知功能和生活质量的影响。方法收集2013年6月至2015年6月我院年龄18~75岁的80例难治性癫痫患者,随机分为辅以拉科酰胺干预组(干预组)及安慰剂对照组(对照组),并对患者进行10个月随访。干预前后对患者认知功能及生活质量进行评估。结果干预组10个月后的MMSE(Mini-mental state examination,简易精神状态检查)评分及WCST(Wisconsin Card Sorting Test,威斯康辛卡片分类测验)结果均优于对照组,差异有统计学意义(P<0.05)。干预组治疗后患者QOLIE-31总分、对发作的担忧、认知功能及综合生活质量评分均较治疗前增高(P<0.05),且高于对照组(P<0.05)。结论拉科酰胺不引起癫痫患者认知功能减退,且能改善患者主诉的生活质量。     

癫痫的药物治疗

<正> 癫痫药物治疗看似简单,实际上并非如此。癫痫病人之间病因、症状有很大差别,他们大脑受损害的部位和程度各不相同,这些因素导致预后各不相同。人类有丰富的精神心理活动,病后的反应也千差万别,这些都会影响治疗效果。因此药物治疗应个体化,没有一个适用于所有病人的用药模式。     

几种新癫痫药分别联合丙戊酸钠治疗难治性癫痫的对比

目的：探讨部分难治性癫痫（RE）在添加拉莫三嗪（LTG）或奥卡西平（OXC）或托吡酯（TPM）联合丙戊酸钠（VPA）治疗的临床疗效。方法累积收集2009年1月~2014年1月符合标准的212例难治性部分性癫痫患者,对照治疗3个月前癫痫发作频度,并对治疗2年结束后的疗效、不良反应（ADR）及安全性和脑电图进行自身分析对比。结果患者应用LTG或OXC或TPM联合VPA治疗RE 2年结束后,患者发作频率均比用药前明显减少,患者治疗结束后的总有效率分别为89%、88.5%、78.1%, ADR的发生率分别为9.6%、19.2%、21.9%,脑电图总的好转率分别为89.9%、78.5%、76.9%。结论 LTG或OXC或TPM联合VPA治疗RE患者的疗效确切,耐受性好,安全性高, ADR轻。     

多药耐药机制与难治性癫痫关系的研究进展

难治性癫痫是多年来困扰临床医生的常见问题，其重要特征是大部分患者对许多抗癫痫药物抵抗，尽管这些药物有不同作用机制，说明这种现象可能由非特异性机制所介导。本文对难治性癫痫近年来有关多药耐药现象进行综述。