脑血管病后癫痫的临床特点分析

目的 本文旨在通过对28例中老年人脑血管病后癫痫临床特点的研究,提高中老年脑血管病人的生存质量。方法 对342例脑血管疾病病例中28例继发性癫痫的患者的临床资料进行回顾性分析。结果 按发病时间,卒中后癫痫发作分为两型,早发型癫痫发作(卒中后两周内发生)16例(5.17％),迟发型癫痫发作(卒中2周以后发生),卒中急性期患者癫痫发病率明显高于卒中恢复期。发作形式以全面强直-阵挛性发作最多15例(53.6％),其次为单纯部分运动性发作9例(32.1％)。早发型癫痫多以全面强直-阵挛性发作(大发作)的形式出现,迟发型癫痫多为部分性发作。头 部CT及MRI结果显示病变部位在顶叶最多见9例(32.1％)。卒中后癫痫的发生率与病灶部位(皮质/皮质下)有显著差异性(P<0.05),与卒中类型无明显差异(P<0.05)。结论 早发型癫痫发作形式多为全面强直--阵挛性发作,迟发型癫痫其发作形式多为部分性发作。     

脑卒中后癫痫160例临床分析

目的 探讨脑卒中后癫痫的临床特征及发病机制。方法 对1860例脑卒中患中的160例继发癫痫的临床资料进行回顾性分析。结果 卒中后癫痫总发生率为8．6％，其中早发型癫痫占64％，迟发型癫痫占36％。早发型癫痫多见于脑出血，而迟发型癫痫多见于脑梗死。卒中后癫痫的发生率因病灶部位(皮质／皮质下)的不同存在显性差异。皮质病灶中,位于额叶、颞叶、顶叶好发癫痫。皮质下区病灶在基底节、内囊易发生癫痫。结论 脑卒中后癫痫以早发型为多,早期癫痫多见于脑出血,而迟发型癫痫多见于脑梗死。病灶位于皮质发生癫痫的危险性高,皮质下结构在癫痫活动的调节中也起着重要的作用。     

脑卒中后癫癎57例临床分析

目的 探讨脑卒中后癫痫的临床特点.方法对885例脑卒中患者中57例继发性癫痫间患者的临床资料进行回顾性分析.结果脑卒中后癫痫 间的发生率为6.44%,男女发病无性别差异（P＞0.05）,其中早发性癫痫间占64.91%,发作类型以简单部分发作（simple partial seizures,SPS）为主,迟发性癫痫间占35.09%,发作类型以全面性强直阵挛发作（generalized tonic-clonic seizures,GTCS）为主,皮质病灶较皮质下病灶发生癫痫间的机率高.结论脑卒中是继发性癫痫 间的最常见原因,以早发性多见,为改善患者预后,应合理选用抗癫痫间药,积极控制发作,提高患者生活质量.     

脑卒中与癫(癎)的临床分析

目的探讨卒中后癫痈的临床表现、特点及发病机制。方法对1060例脑卒中病例中102例继发性癫痫患者的临床资料进行回顾性分析研究。结果卒中后癫痫发生率为10％，早期癫痫发作6．04％，晚期癫痫发作3．96％。卒中后癫痫的发生率与病灶部位（皮质下／皮质）差异有统计学意义（P〈0．05），与卒中类型无明显差异。结论脑卒中是癫痫发作的重要病因，皮质病变更易导致癫痫发作。积极控制发作可改善预后。     

卒中后癫痫的临床特点和抗癫痫药物治疗转归

目的探讨不同类型脑卒中后癫痫的临床特点及抗癫痫药物(AEDs)治疗转归及痫性发作的再发诱因,旨在指导脑卒中后癫痫的临床防治。方法收集我院神经内科及癫痫专科门诊就诊的卒中后癫痫患者77例并随访观察,根据入组患者卒中后首次痫性发作的时间分组,分为早发性癫痫组(脑卒中后≤2 w发作者)32例和晚发性癫痫组(脑卒中后>2 w发作者)45例。分析两组患者卒中部位、痫性发作类型、脑电图特点、抗癫痫药治疗及痫性发作的再发诱因。结果 (1)卒中后癫痫相关的常见脑部病变部位依次为皮质、皮质下、丘脑等。(2)早发性癫痫以部分性发作为主,占53.1%;晚发性癫痫以全面强直阵挛发作(包括可能的部分继发全面性发作)为主,占71.1%。(3)早发性癫痫组与晚发性癫痫组比较,长程视频脑电图(VEEG)和常规脑电图(REEG)异常波检出率和痫样放电波检出率的差异无统计学意义(P>0.05);两种脑电图痫样放电波检出率的比较,VEEG的检出率高于REEG(χ2=8.376,P<0.05),异常波检出率的比较差异无统计学意义(P>0.05)。(4)早发性癫痫组经AEDs治疗后发作控制的无发作率及有效率均高于晚发性癫痫组(P<0.05)。(5)再次发作有诱因者占65.5%(主要为发热、服药不规律、不良生活习惯、情绪因素),无诱因者占34.5%。结论皮质、皮质下卒中及发作间期脑电图有痫样放电的患者应警惕痫性发作及反复发作,首次发作后再次发作的患者,应考虑规律服用抗癫痫药物治疗,并尽量避免再发诱因。     

脑卒中后继发癫痫发作的临床分析

目的：探讨脑卒中与其继发癫痫发作的关系。方法：对769例脑卒中患者继发癫痫发作的发病率,发作时间、类型、病变部位肢治疗预后进行分析。结果：脑卒中后继发癫痫发作以蛛网膜下隙出血及脑栓塞概率较大。早期发作者中,以脑栓塞和蛛网膜下隙出血为主;迟发性发作者中,以腑血栓形成和脑出血为主。病变部位在皮质的患者腩卒中后癫痫发作发病率较高。结论：脑卒中是老年人癫痫发作的重要原因之一,癫痂发作的发病率与病灶性质、部位有明显相关性,由于发病机制不同,早发性癫痫发作较易控制,迟发性癫痫发作多需要长期服用抗癫痫药物。     

老年缺血性脑卒中继发癫痫的临床特征

目的探讨老年缺血性脑卒中继发癫痫的临床特征。方法选择2010-07—2013-07在我院接受治疗的172例老年脑卒中患者为研究对象,分析老年缺血性脑卒中继发癫痫的临床特征。结果 172例老年缺血性脑卒中患者中,86例继发癫痫患者为观察组,发作类型表现多样,多为全身强直阵挛发作:其中早发性癫痫26.7%,迟发性癫痫73.3%;皮质病灶继发癫痫77.9%,皮质下病灶继发癫痫22.1%;与未继发癫痫患者(对照组)比较,病灶部位和受累半球均存在显著性差异(P0.05)。结论老年缺血性脑卒中继发癫痫多发生在脑卒中发生后半年内,主要病灶部位为大脑皮质,临床表现多样,应用抗癫痫治疗效果较好。     

卒中后早发性痫性发作28例临床病例特点分析

目的 探讨卒中后早发性痫性发作的发生率、临床特点、治疗及预后。 方法 回顾性分析2012年1月～2013年2月我院神经内科全部急性卒中住院的患者资料,对其中卒中后早发性痫性发作患者的临床资料进行总结。 结果 研究期间共有1973例住院急性卒中患者,其中有28例出现早发性痫性发作,发生率为1.4%;在脑梗死患者中发病率为1.1%（20/1785）,脑出血患者中发病率为3.7%（8/188）,两者差异具显著性（P＜0.001）;男性发病率为1.7%（20/1149）,女性发病率为1.0%（8/824）,性别差异无显著性。发作类型均为部分性或全面性强直-阵挛发作;病灶在脑皮质的13例（46.4%）,皮质下6例（21.4%）,皮质、皮质下均累及的9例（32.2%）,皮质卒中更易引起卒中后早发性痫性发作,差异有显著性（P=0.01）。 结论 不同性别间发生卒中后早发性痫性发作无明显差异性,出血性卒中比缺血性卒中更易导致卒中后早发性痫性发作,皮质卒中比皮质下卒中更易引起卒中后早发性痫性发作。     

脑卒中与癫(癎)的临床分析

目的 探讨卒中后癫(癎)的临床表现、特点及发病机制.方法 对1060例脑卒中病例中102例继发性癫(癎)患者的临床资料进行回顾性分析研究.结果 卒中后癫(癎)发生率为10%,早期癫(癎)发作6.04%,晚期癫(癎)发作3.96%.卒中后癫(癎)的发生率与病灶部位(皮质下/皮质)差异有统计学意义(P＜0.05),与卒中类型无明显差异.结论 脑卒中是癫(癎)发作的重要病因,皮质病变更易导致癫(癎)发作.积极控制发作可改善预后.     

大面积脑梗死后继发性癫痫的临床及脑电图特点

目的研究大面积脑梗死后继发性癫痫的临床及脑电图特点。方法回顾性分析41例大面积脑梗死继发癫痫患者的临床资料及脑电图结果。结果大面积脑梗死合并癫痫发作发病率为26.1%,早发性癫痫占总发病数65.9%(27/41),迟发性癫痫占35.1%(14/41),早发性癫痫患者中全面性发作占66.7%,迟发性癫痫患者中部分性发作占78.6%,95.1%(39/41)大面积脑梗死并继发性癫痫患者脑电图异常。结论大面积脑梗死更容易合并癫痫发作,且早发性癫痫患者和迟发性癫痫患者发作类型特点不同。脑电图检查可帮助定位,预测病情及观察治疗效果。     

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.     

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.     

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.     

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.     

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.     

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.