9例癫痫孕妇临床分析

目的：分析妊娠期癫痫发作对孕妇及胎儿的影响及处理。方法：分析9例癫痫孕妇的病史,记录其妊娠期间发作的变化、服抗癫痫药的情况、妊娠结局及胎儿情况。结果：妊娠期间发作频率增加者4例,无发作者2例,发作频率无改变者3例;单药治疗者3例,2例联合治疗,4例未治疗。新生儿中1例巨大儿;1例出生lmin Apgar评分为7分,余8例均为9分。结论：生育期癫痫妇女应进行孕前咨询,根据发作类型选用适宜的致畸危险性小的抗癫痫药物,以单药治疗为原则;妊娠期间定期进行血药浓度的监测并加服叶酸。     

妊娠与癫痫

癫痴是神经内科的第二大疾病,我国流行病学显示其患病率为0．5％～0．7%,全国约有病人600～700万,其中女性患病率占0．2％～0．3％,约120～210万妇女患者。因有部分女性患者的癫痫与妊娠之间会发生明显的相互影响,对该类患者的治疗更为神经科医生的一大棘手问题。本文兹就癫痫与妊娠相互影响的问题综述如下。     

难治性癫痫发生机制研究进展

目前,大约三分之一的癫痫患者对抗癫痫药物耐药。药物难治性瘢痫是指无中枢神经系统进行性疾病或占位性疾病,但临床迁延,经两年以上正规抗癫痫治疗,单独或合用主要抗癫痫药,并达到患者能耐受最大剂量且血药浓度达到有效范围,仍不能控制,且影响日常生活的癫痫发作。     

妊娠合并甲状腺机能亢进255例临床分析

目的探讨妊娠合并甲状腺机能亢进患者的围产期发病率,药物治疗剂量及规范治疗后的母婴结局。方法收集我院1995年1月～2007年12月的妊娠合并甲亢患者的临床资料255例,分为控制组153例,未控制组102例,选择同期正常妊娠315例作为对照组,控制组均在我院产科高危门诊定期产前保健,每1～1.5月监测FT4,FT3,调整抗甲状腺药物（ATD）的剂量。对妊娠合并甲亢的发生率,控制组的抗甲状腺药物剂量以及3组母儿结局进行回顾性分析。结果（1）发病率：我院近13年来妊娠合并甲亢的发病率0.26%,呈逐年上升的趋势（0.17%～0.32%）。（2）抗甲状腺药物剂量（ATD）：控制组（116例）ATD的平均剂量孕前、孕早期、孕中晚期分别为：126.27±109.92,174.58±121.42,125.21±110.77,孕前与孕早期比较,差异有统计学意义（P〈0.05=;孕早期与孕中、晚期比较,差异有统计学意义（P〈0.05）;孕前与孕中、晚期比较,差异无统计学意义（P〉0.05）。（3）母婴结局：未控制组的子痫前期、早产、胎儿生长不良、胎儿窘迫发生率与控制组比较,差异有统计学意义,控制组与正常妊娠比较,差异无统计学意义。结论妊娠合并甲亢的发病率逐年升高,孕期需及时调整抗甲状腺药物治疗量,规律治疗能明显改善母儿结局。     

抗癫痫药物或非药物治疗反射性癫痫伴异常脑电图的临床观察

目的i比较抗癫痫药物或非药物治疗反射性癫痫的临床疗效和脑电图改变。方法i将27例患者分为3组：第1组为反射性癫痫伴脑电图异常（痫样放电1～4次／24h）,未用抗癫痫药者;第2组：反射性癫痫伴脑电图异常（痫样放电1～4次／24h）,使用抗癫痫药者;第3组为反射性癫痫伴脑电图异常（痫样放电≥5次／24h）,使用抗癫痫药者。各组均需避开诱因。根据患者既往最长癫痫发作间期的3倍时间随访其癫痫发作次数和视频脑电图表现。结果：各组无1例临床加重患者,临床总有效率为63％～100％,各组之间比较差异无统计学意义。脑电图改善总有效率3个组之间有明显差异（P〈0．05）。脑电图异常（痫样放电1～4次／24h）病人用药与否脑电图改善总有效率比较差异有显著意义（P〈0．01）。结论：各组反射性癫痫预后良好,伴脑电图异常的反射性癫痫建议给予抗癫痫药治疗。     

癫痫治疗中的药物经济学研究进展

近年来,癫痫的治疗受到费用的牵制,许多国家、政府和卫生保健机构都在限制抗癫痫药物（AED）支出。目前临床上应用的AED分为三大类,老药包括苯巴比妥、苯妥英钠,经典药物包括卡马西平、丙戊酸钠,新药包括托毗酯、拉莫三嗪、奥卡西平、左乙拉西坦。老药最便宜,经典药物比老药贵4～5倍,新药又比经典药物贵4～6倍。     

肝素治疗妊娠合并子宫肌瘤变性16例临床分析

妊娠合并子宫肌瘤变性的发生率为0·5%~5·0%,且近年来有增加的趋势。因妊娠期子宫肌瘤挖除术有诸多危险性,故我院自2001年以来利用肝素进行治疗,效果满意。现报道如下。临床资料1·一般资料:本组孕妇年龄25~40岁,平均(30·45±5·29)岁。初产妇12例,经产妇3例。入院时孕周平均     

妊娠合并肝炎55例临床分析

目的分析妊娠合并肝炎患者的临床特点。方法将55例妊娠合并肝炎病例按照孕周分为早中期妊娠组及晚期妊娠组,比较重症肝炎的发生率、肝功能及转归。结果妊娠期肝炎以慢性乙型肝炎患者占绝大多数,晚期妊娠组较早中期妊娠组重型肝炎发生率高（P=0.011）,且病死率高（P=0.001）,晚期妊娠组ALT、AST、ALP均高于早中期妊娠（P〈0.05）。结论晚期妊娠合并肝炎病情重、预后差,临床上应严密观察病情变化,以减少孕产妇的病死率。     

A case series of lacosamide as adjunctive therapy in refractory sleep‐related hypermotor epilepsy (previously nocturnal frontal lobe epilepsy)

The aim of this study was to evaluate the efficacy and tolerability of open‐label lacosamide in patients with refractory sleep‐related hypermotor epilepsy. The study was a case review of eight patients with refractory sleep‐related hypermotor epilepsy treated with lacosamide. Seizure diaries compared the mean baseline seizure frequency with the most recent 3 months of follow‐up. Five (62.5%) patients were responders, defined as ≥50% reduction in seizure frequency, over a mean duration of exposure of 21.5 months. The mean maintenance dose of lacosamide was 400 mg/day. No‐one reported worsening of seizures. Lacosamide was well tolerated with initial fatigue being the main side‐effect. Lacosamide is a potentially efficacious adjunctive therapy in patients with refractory sleep‐related hypermotor epilepsy. A double‐blind placebo‐controlled study would determine its efficacy.     

Pattern of adverse events of antiepileptic drugs: results of the aESCAPE study in Poland

Introduction

The Adverse Event Scale in Patients With Epilepsy (aESCAPE) European study ({"type":"clinical-trial","attrs":{"text":"NCT00394927","term_id":"NCT00394927"}}NCT00394927) explored and analyzed adverse events (AEs) and reasons for modifying treatment in patients treated with newer and older antiepileptic drugs (AEDs) used in monotherapy or polytherapy. The present analysis concerns the results of patients recruited in Poland.

Material and methods

Multicentre, international, observational, cross-sectional study investigating AEs in patients with epilepsy (aged ≥ 4 years), on stable AED treatment with one or two AED(s) for ≥ 3 months, using standardized questionnaires completed by a physician during a single study visit.

Results

Out of 309 patients, 24.6% were treated exclusively with newer AED(s) in monotherapy or in combination, while 75.4% were treated with older AED(s) or a combination of older and newer AED(s). 60.8% were on monotherapy, and 39.9% on polytherapy. In general, 73.8% of patients reported ≥ 1 AE(s). There were no significant differences in the frequency of reported AEs in compared groups. The most common were disturbances in cognitive function (40.5%), psychological problems (36.2%), and sedation (32.7%). Some AEs were found to be more specific for particular types and treatment regimens. Changes in treatment or dose during the study visit occurred in 22.3% of the patients, mainly due to lack of efficacy (10.7%), AEs (5.2%) or absence of seizures (4.5%).

Conclusions

A detailed structured interview revealed high frequency of AEs in patients treated with AEDs. The main reasons for treatment modifications at the study visit were lack of efficacy, adverse events and absence of seizures.     

急性脑血管病继发癫(癎)的临床分析

目的:探讨急性脑血管病继发癫(癎)的临床特点、发病机制、发作类型及治疗预后.方法:对我科2006年1月～2014年1月收治的经头颅CT、MRI证实的389例急性脑血管病继发癫(癎)患者的临床资料进行分析,总结其临床特点、发病机制、发作类型、治疗及预后.结果:本组急性脑血管病继发癫(癎)的发病率为4.77％(389/8 152),癫(癎)发病率与脑血管病的类型、发病部位有关;其中以脑梗死患者、累及皮层或邻近皮层者易患,发作形式以单纯部分性运动发作的发病率较高.结论:急性脑血管病继发癫(癎)的原因主要与脑水肿有关,病灶主要位于皮层或邻近皮层者易发作,发作类型以单纯部分性运动为多,累及大脑皮层者发生癫(癎)的危险性高,预后较差.     

妊娠合并甲状腺功能亢进症55例临床分析

目的探讨妊娠合并甲状腺功能亢进症的母儿结局和临床处理。方法回顾性分析2003年1月至2007年12月在我院住院分娩的55例妊娠合并甲状腺功能亢进症患者的临床资料，将其分为病情控制组（37例）和病情未控制组（18例），并进行对照研究。结果妊娠合并甲状腺功能亢进症发生率5．4‰，病情控制组／病情未控制组妊娠糖尿病、妊娠高血压疾病、甲亢性心脏病、引产、早产、流产、小于胎龄儿、死胎发生率分别为2．7％／38．9％、0％／27．8％、0％／27．8％、0％／22．2％、2．7％／50．0％、0％／16．7％、8．1％／44，4％、0％／27，8％，病情控制组明显低于病情未控制组（P〈0．01或0．05）；无孕产妇死亡，无新生儿出生缺陷。病情未控制组患者的医疗费用显著高于病情控制组（P〈0．001）。以丙基硫氧嘧啶为主的药物治疗安全有效。结论妊娠合并甲状腺功能亢进症孕前和孕期及早发现并规范治疗，并监测以FT3、FT4为主而非TSH的甲状腺功能，维持其正常、稳定，可以有效减少母儿并发症的发生。     

Progabide as an add-on drug for epilepsy refractory to high dose antiepileptic drug therapy

In a double-blind cross-over add-on trial an average daily dose of 2100 mg progabide or placebo were given for 3 months each as adjunctive therapy to 11 patients with intractable complex partial seizures uncontrolled by a high-dose regimen of either carbamazepine, phenobarbital, phenytoin or primidone. A reduction or an increase in seizure frequency by more than 50% was seen in one patient each. Mild transient sedative side effects were observed in two patients. The plasma concentrations of the concomitant antiepileptic drugs remained unchanged. Progabide appears to be as effective as primary antiepileptic drug for adjunctive therapy in partial epilepsy refractory to previous high-dose therapy. Progabide does not seem to be the drug urgently needed for failures of standard therapy despite its few side effects.     

腹腔镜下输卵管妊娠手术治疗80例临床分析

目的 探讨腹腔镜下异位妊娠的手术方法、适应证、手术疗效及临床应用价值。方法 回顾分析确诊为输卵管妊娠、有手术指征的80例患者的腹腔镜手术情况和术后情况。结果 80例输卵管妊娠均在腹腔镜下完成，术中出血量为5-200ml，手术获得满意疗效。结论 腹腔镜手术具有创伤小、恢复快、术中出血少、住院时间短等优点，是治疗异位妊娠首选的手术方式。     

妊娠期急性脂肪肝8例临床分析

目的探讨妊娠期急性脂肪肝（AFLP）的临床特点,以利及时诊断和治疗。方法就对近1O年我院收治的8例AFLP患者的临床资料进行回顾性分析。结果8例患者中6例为初产妇,2例经产妇。以无诱因出现恶心、呕吐、进行性黄疸等消化道症状及肝功能损害为主要表现,短期内出现多脏器功能衰竭、DIC。化验检查：血清白蛋白降低、凝血酶原时间延长、纤维蛋白原降低、血清转氨酶升高、血清总胆红素、直接胆红素升高、低血糖、白细胞升高、血小板下降。8例患者均剖宫产终止妊娠,其中2例因子宫出血行全子宫切除术。孕产妇死亡2例,围产儿死亡1例。结论早期诊断、及时终止妊娠和支持治疗是提高AFLP母儿预后的关键。     

Evidence of the milder phenotypic spectrum of c.1582G>A PIGT variant: Delineation based on seven novel Polish patients

PIGT is one of over 29 glycosylphosphatidylinositol biosynthesis defect genes. Mutations cause genetically determined disorders characterized mainly by epilepsy with fever-sensitivity, central hypotonia, psychomotor delay and congenital malformations. The disease is known as multiple congenital anomalies-hypotonia-seizures syndrome 3 (MCAHS3) or glycosylphosphatidylinositol biosynthesis defect-7. Twenty-eight cases have been reported until today. We present seven novel Polish patients, all harboring 1582G>A variant in a homozygous or compound heterozygous state which seems to cause a milder phenotype of the disease.     

抗癫痫药物对热性惊厥相关癫痫患者发作控制的效果观察

目的：探讨抗癫痫药物(antiepileptic drugs,AEDs)对热性惊厥相关癫痫患者发作控制的效果。方法：选取2012年1月至2015年2月在我院治疗的热性惊厥相关癫痫患者190例,比较不同AEDs对热性惊厥相关癫痫患者发作控制的效果。结果：190例患者中共使用AEDs药物5种,分别为：丙戊酸、托吡酯、氯硝安定、苯巴比妥、左乙拉西坦。使用比例前三位的AEDs为丙戊酸、托吡酯、氯硝安定,比例分别为87.20%、64.47%和43.50%;190例患者中联合用药107例,占56.32%,单药治疗83例,占43.68%;单药治疗和联合用药对发作控制效果比较无统计学意义(P>0.05);丙戊酸、托吡酯和氯硝安定对发作改善的效果最好,明显好于苯巴比妥和左乙拉西坦,而苯巴比妥和左乙拉西坦对发作改善的效果比较差异无统计学意义(P>0.05)。结论：热性惊厥相关癫痫患者治疗应首选丙戊酸、托吡酯和氯硝安定,三种药物控制效果较好,值得临床推广使用。