延髓内脏带至杏仁核投射通路参与迷走神经刺激抑制癫痫发作的研究

目的 观察迷走神经→延髓内脏带(MVZ)→杏仁中央核的儿茶酚胺能通路是否参与了迷走神经刺激(vagus nerve stimulation,VNS)抑制癫痫的调节；是否存在由迷走神经→延髓内脏带→海马的直接投射参与抑痫。方法 将逆行追踪剂WGA—HRP注入大鼠—侧杏仁中央核或腹侧海马，48h后，给予迷走神经刺激，观察MVZ内WGA—HRP逆行标记的细胞、Fos蛋白、TH阳性神经元的表达及分布。结果 杏仁核注射组大鼠MVZ内可见HPR／Fos／TH二重标记的细胞；海马注射组MVZ内未见HRP逆标神经元，但HRP逆行标记与Fos阳性双重标记细胞出现存隔区和下丘脑室旁该。结论 提示迷走神经→延髓内脏带→杏仁中央核的投射通路直接参与VNS抑痫过程，而且与儿茶酚胺能神经元有关；迷走神经→延髓内脏带→隔区、下丘脑室旁核中继至海马的间接通路也参与了抑痫。     

大鼠延髓内脏带与下丘脑室旁核、视上核往返投射通路参与高渗调节反应的研究

目的探讨延髓内脏带(MVZ)与下丘脑室旁核(PVN)和视上核(SON)之间是否存在往返渗透压投射通路。方法通过给予大鼠饮用3%氯化钠的方法制作高渗刺激模型,并用WGA-HRP逆行追踪、抗Fos、抗酪氨酸羟化酶(TH)或加压素(VP)及胶质纤维酸性蛋白(GFAP)免疫组织化学相结合的四重标记方法,观察MVZ、PVN和SON中WGA-HRP、Fos、TH、VP和GFAP阳性分布及表达状况。结果高渗刺激后MVZ、PVN和SON内Fos阳性细胞明显增多;GFAP阳性结构也明显增多,其分布与Fos阳性细胞分布基本一致,表现为胞体肥大、突起粗长。星形胶质细胞(AST)紧密包绕在神经元周围形成神经元-AST复合体(N-ASC)。结论神经元和AST以N-ASC的形式共同参与渗透压调节反应,体内存在MVZ和SON或PVN之间往返的渗透压调节通路。     

大鼠面部和胃肠道伤害性传入信息在延髓内的汇聚——c—fos表达研究

本研究应用神经元Fos样蛋白的表达作为对伤害性传人信息反应的标志，将少量Formalin分别注入大鼠一侧面部软组织或导入胃肠道作为伤害性刺激，然后用免疫细胞化学双重标记法，显示其延髓神经元对面部和胃肠道化学伤害性信息传人的反应及其与几条酚胺递质的关系。结果表明：（1）胃肠道伤害性刺激诱导延髓内大量神经元的c-fos表达，其Fos样免疫反应（Fos-LI）神经元主要位于孤束核（NIS）、延髓腹外侧区（VLM）和最后区（AP），少数分布于NIS与VLM之间的网状结构（RF）、三叉神经旁核（PaV）；（2）面部伤害性信息传人诱导的Fos－LI神经元除大量分布在三叉神经脊束核尾侧亚核（nSpVc）浅层和PaV外．也分布于NTS、VLM和RF；(3)两种不同区域伤害性刺激所诱导的Fos表达神经元在延髓NIS和VLM的分布明显重叠，其中许多Fos—LI神经元同时呈酪氨酸羟化酶（TH）－LI．Fos/TH双重阳性神经元约占TH—LI神经元总数的50％。本结果提示延髓NTS和VLM是面部和胃肠道伤害性传入信息所汇聚的主要区域，其儿茶酚胺能神经元是所汇聚的重要成分，并讨论了它们参与面部穴位针刺对胃肠道功能调节的中枢弥漫性伤害抑制性控制（DiffuseNoxiousInhibitoryControls，DNIC）过程的可能性。     

皮下注射多聚甲醛诱导大鼠脊髓和三叉神经脊束核向延髓网状背侧亚核传入投射的fos表达

目的:研究外周伤害性刺激下大鼠脊髓和三叉神经脊束核尾侧亚核向延髓网状背侧亚核传入投射的神经元中的Fos表达.方法:采用荧光金逆行追踪及Fos免疫组化染色相结合的方法.结果:脊髓和三叉神经脊束核尾侧亚核均有神经元投射到延髓网状背侧亚核.在颈髓背角浅层,FG/Fos双标神经元分别占FG阳性神经元和Fos阳性神经元的9.3%和7.5%;在三叉神经脊束核尾侧亚核浅层,FG/Fos双标神经元分别占FG阳性神经元和Fos阳性神经元的9.5%和14.2%.结论:在颈髓背角浅层和三叉神经脊束核尾侧亚核浅层向延髓网状背侧亚核传入投射的神经元中,部分神经元可能与伤害性刺激有关.     

皮下注射多聚甲醛诱导大鼠脊髓和三叉神经脊束核向延髓网状背侧亚核传入投射的fos表达

目的：研究外周伤害性刺激下大鼠脊髓和三叉神经脊束核向延髓网状背侧亚核传入投射的神经元中的Fos表达。方法：采用荧光金逆行追踪及Fos免疫组结合的方法。结果：脊髓和三叉神经脊束核尾侧亚核均有神经元投射延髓网状背侧亚核。在颈髓背角浅层FG／Fos双标神经元占FG阳性神经元和Fos双标神经元的9．3％和7．5％；在三叉神经脊束核尾侧亚核浅层，FG／Fos双标神经元分别占FG阳性神经元和Fos双标神经元的9．5％和14．2％，结论：在颈髓背角浅层和三叉神经脊束核尾侧亚核浅层向延髓网状背侧亚核传入投射的神经元中，部分神经元可能与伤害性刺激有关。     

LPS激发大鼠前脑神经元Fos和小胶质细胞OX42表达改变

目的 探讨单次腹腔注射LPS后前脑神经元和小胶质细胞的可塑性变化和相互关系。方法 应用抗Fos、抗TH或抗OX42单一、以及抗Fos／抗TH／抗OX42三重免疫组化标记方法，观察大鼠单次腹腔注射LPS后，Fos阳性神经元、Fos／TH阳性神经元、OX42阳性小胶质细胞在脑内的表达分布及时程变化，以及Fos阳性神经元或Fos／TH阳性神经元与OX42阳性小胶质细胞之间的关系。结果：Fos阳性神经元分布在额、顶皮质，扣带回和梨状皮质，外侧隔核腹侧部，杏仁中央核，海马CA2区、CA3区、齿状回，下丘脑室旁核、视上核、下丘脑外侧区和第三脑室周围灰质等。Fos阳性神经元在注射后30min出现表达，注射后1～3h为表达高峰。反应阳性小胶质细胞首先于脑室周围灰质出现，注射后6h达到高峰，胞体变大，突起变粗，OX42呈阳性深染，密集分布于Fos阳性神经元的表达区域。下丘脑Fos／TH／OX42三重染色切片显示：由LPS激活的Fos／TH阳性神经元周围被OX42阳性细胞包绕并接触，表明神经元和小胶质细胞在对LPS刺激的反应中关系密切。结论 在外周免疫刺激下，下丘脑、扣带回、梨状皮质和海马内的神经元和小胶质细胞可能参与免疫调节。     

PS激发大鼠延髓内脏带星形胶质细胞GFAP和神经元FOS表达水平的变化

观察腹腔注射细菌内毒素 (LPS)后 ,大鼠延髓内脏带 (MVZ)星形胶质细胞胶质原纤维酸性蛋白 (GFAP)及神经元FOS表达水平随时间变化的规律及其相互关系。大鼠经LPS腹腔注射后 1,3,6,12h分别行固定取材制片。每个时间点的切片分为 3组 ,分别进行抗FOS、抗GFAP免疫组织化学染色及抗FOS/GFAP/酪氨酸羟化酶 (TH)三重免疫组织化学染色。结果表明 :①FOS反应在LPS注射后 3h达到高峰 ,阳性产物主要分布于MVZ内。②GFAP反应在注射后 1h即达到高峰 ,表现为胶质细胞肥大、数量增多。其分布与FOS基本相同。③三重染色观察到GFAP与FOS的多种聚集方式 (FOS/GFAP/TH ,FOS/GFAP ,GFAP/TH) ,FOS阳性神经元周围GFAP免疫反应产物更密集。提示星形胶质细胞对LPS起反应 ,其反应高峰的出现先于神经元     

LPS激发大鼠延髓内脏带星形胶质细胞GFAP和神经元FOS表达水平的变化

观察腹腔注射细菌内毒素（LPS）后,大鼠延髓内脏带（MVZ）星形胶质细胞胶质原纤维酸性蛋白（GFAP）及神经元FOS表达水平随时间变化的规律及其相互关系。大鼠经LPS腹腔注射后1,3,6,12h分别行固定取材制片。每个时间点的切片分为3组,分别进行抗FOS、抗GFAP免疫组织化学染色及抗FOS／GFAP／酪氨酸羟化酶（TH）三重免疫组织化学染色。结果表明：（1）FOS反应在LPS注射后3h达到高峰,阳性产物主要分布于MVZ内。（2）GFAP反应在注射后1h即达到高峰,表现为胶质细胞肥大,数量增多。其分布于FOS基本相同。（3）三重染色观察到GFAP与FOS的多种聚集方式（FOS／GFAP／TH,FOS／GFAP,GFAP／TH）,FOS阳性神经元周围GFAP免疫反应产物更密集。提示星形胶质细胞对LPS起反应,其反应高峰的出现先于神经元。     

大鼠脑干内的calbindin D—28K可能参与内脏伤害性信息传递或调控的形态学研究

为研究calbindinD 2 8K(CB)是否与内脏伤害性信息的传递或调控有关 ,应用免疫组织化学双重标记技术 ,对给予内脏伤害性刺激后大鼠脑干内表达Fos蛋白的CB免疫阳性神经元分布进行了观察。结果显示 :在孤束核 (NTS)、延髓腹外侧区 (VLM)、蓝斑 (LC)、臂旁外侧核 (LPB)、中脑导水管周围灰质腹外侧区 (vlPAG)等核团内均可见Fos/CB双标记神经元。双标记神经元分别占上述核团内Fos蛋白免疫阳性神经元数量的比例为12 .8% ,4 2 .7% ,4 8.1% ,14 .0 %和 13.9% ;占CB免疫标记阳性神经元数量的比例为 14 .3% ,2 4 .3% ,38.4 % ,6 .8%和 8.9%。研究结果提示 ,CB可能参与脑干内内脏伤害性信息的传递或调控。     

大鼠脑干内的calbindin D-28K可能参与内脏伤害性信息传递或调控的形态学研究

为研究calbindin D-28K(CB)是否与内脏伤害性信息的传递或调控有关,应用免疫组织化学双重标记技术,对给予内脏伤害性刺激后大鼠脑干内表达Fos蛋白的CB免疫阳性神经元分布进行了观察.结果显示:在孤束核(NTS)、延髓腹外侧区(VLM)、蓝斑(LC)、臂旁外侧核(LPB)、中脑导水管周围灰质腹外侧区(vlPAG)等核团内均可见Fos/CB双标记神经元.双标记神经元分别占上述核团内Fos蛋白免疫阳性神经元数量的比例为12.8%,42.7%,48.1%,14.0%和13.9%;占CB免疫标记阳性神经元数量的比例为14.3%,24.3%,38.4%,6.8%和8.9%.研究结果提示,CB可能参与脑干内内脏伤害性信息的传递或调控.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.