小脑顶核电刺激对急性脑梗死患者血清神经元特异性稀醇化酶和S100的影响

目的 观察小脑顶核电刺激(FNS)对急性脑梗死患者血清神经元特异性稀醇化酶(NSE)和S100的影响，探讨该治疗的康复疗效。方法 60例急性脑梗死的患者随机分为电刺激小脑治疗组(FNS组，30例)和常规治疗对照组(30例)，分别观察其治疗前后患者血清NSE和S100水平的动态变化及神经功能缺损评分情况。结果 FNS组与对照组治疗前神经功能缺损评分及血清NSE、S100水平无显著差异(P＞0．05)，治疗后两组患者血清NSE、S100水平和神经功能缺损评分均有下降，但FNS组下降更显著，差异有显著性(P＜0．01)。结论 小脑顶核电刺激可降低急性脑梗死患者血清NSE、S100水平，有利于促进神经功能恢复。     

亚低温对大面积脑梗死病人临床疗效及血清NSE、S-100蛋白的影响

目的　观察亚低温(MHT)技术治疗急性大面积脑梗死的临床疗效和对血清神经元特异性烯醇化酶(NSE)、S-100蛋白的影响。方法　将收治的 68 例急性大面积脑梗死病人随机份如治疗组合对照组各34例,治疗组在药物治疗脑梗死的同时加用 MHT治疗技术,在治疗前、治疗后 3 d、7 d、14 d进行神经功能缺损评分及NSE、S-100蛋白含量的测定。结果　在治疗后7 d、14 d治疗组神经功能缺损评分较对照组降低(P <0.05),在治疗后 3 d、7 d、14 d治疗组血清 NSE、S-100 蛋白含量明显降低(P <0.01)。结论　MHT治疗技术可改善急性大面积脑梗死病人神经功能、对神经细胞有较好的保护作用。     

氯吡格雷对急性脑梗死患者血清高敏感C反应蛋白的影响

目的 通过观察急性脑梗死患者使用氯吡格雷前后血清高敏感C反应蛋白(high sensitive C-reactionprotein,hs-CRP)水平的变化,并与对照组比较,探讨氯吡格雷在急性脑梗死患者治疗中的抗炎症作用.方法选择200例急性脑梗死患者随机分为治疗组和对照组各100例,治疗组给予氯吡格雷75mg/d口服,其它用药同对照组;对照组每日静脉滴注三七总苷(商品名:血寒通)注射液0.4g/d;应用放射免疫比浊法检测治疗前、治疗后7d、14d的血清hs.CRP水平变化,并对神经功能缺损进行标准评分.结果两组hs-CRP水平在梗死后7d最高,随后逐渐降低.治疗组在治疗前、治疗后14d血清hs-CRP水平和治疗前、治疗后7d的神经功能缺损总分与对照组患者比较差异无统计学意义(P>0.05);治疗后7d治疗组hs-CRP水平低于对照组(P<0.05),14d治疗组神经功能缺损总分与对照组比较差异有统计学意义(P<0.01).结论氯吡格雷在急性脑梗死患者的治疗中可以降低患者血清hs-CRP水平,有利于减轻炎症反应,改善脑梗死部位缺血缺氧和缺损神经功能.     

超早期脑梗死患者介入溶栓治疗的效果观察

目的观察介入溶栓治疗超早期脑梗死患者的临床效果。方法选取2017-06—2019-01南阳市中心医院超早期脑梗死患者82例,按照治疗方案不同分为研究组(n=41)和对照组(n=41)。对照组采用静脉溶栓治疗,研究组采用动脉介入溶栓治疗。比较2组疗效、并发症发生情况,以及治疗前、治疗7 d后神经功能指标[血清星形胶质源性蛋白(S100B)、神经元特异性烯醇化酶(NSE)]、氧化应激指标[血清8-异前列腺素F2α(8-iso-PGF2α)、丙二醛(MDA)],治疗前与治疗14 d、28 d后美国国立卫生研究院卒中量表(NIHSS)评分。结果研究组总有效率92.68%(38/41),高于对照组的75.61%(31/41)(P0.05);治疗7 d后,2组血清S100B、NSE、8-iso-PGF2α、MDA水平均降低,研究组低于对照组(P0.05);治疗14 d、28 d后研究组NIHSS评分低于对照组(P0.05);2组脑出血、尿血、皮肤黏膜出血、黑便、再闭塞发生率比较差异无统计学意义(P0.05)。结论介入溶栓治疗超早期脑梗死,可通过调节机体神经功能损伤相关因子水平、抑制机体氧化应激反应途径,改善患者神经功能损伤程度,疗效显著。     

血清S100B蛋白水平与急性出血性脑梗死的关系研究

目的检测出血性脑梗死患者血清S100B蛋白水平动态变化,探讨S100B蛋白与出血性脑梗死的关系。方法应用酶联免疫双抗体夹心法(enzyme linked immunosorbent assay,ELISA)测定60例急性出血性脑梗死患者发病后24 h内,第3、5、7、14 d血清S100B蛋白水平,并与大面积脑梗死组、正常对照组进行对比。结果出血性脑梗死患者血清S100B蛋白水平在发病后24 h内开始升高,第3 d达到高峰,之后开始下降,出血性脑梗死患者发病后24 h内,第3、5、7、14 d的血清S100B蛋白水平均显著高于正常对照组(P0.05),也高于大面积脑梗死组(P0.05)。结论血清S100B蛋白水平早期升高可作为预测急性脑梗死患者继发出血的参考指标。     

丁苯酞治疗急性脑梗死患者的临床疗效及对血清NSE、S-100B蛋白的影响

目的观察丁苯酞软胶囊(NBP)治疗急性脑梗死的临床疗效和对血清神经元特异性烯醇化酶(NSE)、S-100B蛋白的影响。方法将收治的80例急性脑梗死病人随机分为对照组和治疗组,各40例。对照组给予银杏叶提取物注射液20mL静滴,1次/d;阿司匹林100mg口服,1次/d,疗程2周。治疗组在对照组的基础上给予NBP 200mg/次口服,3次/d,疗程2周。分别于治疗前、治疗后3d、7d、14d进行神经功能缺损评分及血清NSE、S-100B蛋白含量的测定。结果与对照组比较,治疗组在治疗后7d、14d神经功能缺损评分较对照组降低(P<0.01),治疗后3d、7d、14d血清NSE、S-100B蛋白含量明显下降(P<0.05)。结论丁苯酞软胶囊可以保护神经细胞,改善急性脑梗死病人的神经功能。     

丁苯酞对急性脑梗死患者血清NSE S-100β及氧化标记物的影响

目的观察丁苯酞注射液对急性脑梗死患者神经功能、预后及血清神经元特异性烯醇化酶(NSE)、S-100β蛋白、丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法将60例急性脑梗死患者随机分为丁苯酞组和对照组各30例。2组均给予常规治疗,丁苯酞组在此基础上给予丁苯酞注射液静滴,2次/d。于治疗前、治疗后7d和14d检测2组患者血清NSE、S-100β、MDA和SOD的水平变化,并比较2组治疗前后美国国立卫生研究院卒中量表评分(NIHSS)和2组3个月后改良Rankin量表(modified Rankin Scale,mRS)评分变化。结果丁苯酞组在治疗后7d和14d,血清NSE、S-100β和MDA水平均较对照组明显降低(P0.05),血清SOD水平较对照组明显升高。丁苯酞组在治疗后7d和14d,NIHSS评分较对照组明显降低,差异有统计学意义(P0.05);3个月后,丁苯酞组mRS评分较对照组明显降低,差异有统计学意义(P0.05)。结论丁苯酞注射液可降低急性脑梗死患者血清NSE、S-100β和MDA水平,提高血清SOD水平,有助于神经功能恢复,改善患者预后。     

局部亚低温对重症脑梗死患者血清NSE的影响

目的 探讨局部亚低温对重症脑梗死患者血清神经元特异性烯醇化酶(NSE)水平的影响.方法 84例重症脑梗死患者分为治疗组和对照组各42 例,对照组采用常规治疗,亚低温组在此基础上进行局部亚低温治疗,两组患者均在治疗前和治疗后第3 、7、14 d测定血清NSE 水平,并在治疗后14 d进行临床疗效的判定.结果 亚低温组第7 d和第14 d的NSE明显低于对照组(P<0.05).亚低温组治疗14 d后临床疗效明显高于对照组(P<0.05) 结论亚低温治疗可降低重症脑梗死患者血清NSE 水平,改善重症脑梗死患者的预后.     

急性脑卒中患者血清神经元特异性烯醇化酶、S-100B蛋白、髓鞘碱性蛋白水平的变化

目的探讨急性脑卒中患者血清神经元特异性烯醇化酶(NSE)、S-100B蛋白、髓鞘碱性蛋白(MBP)水平变化及其临床意义。方法回顾性对照分析发病在48 h内的45例急性脑卒中患者(其中脑梗死组19例,脑出血组15例,短暂性脑缺血发作组11例)血清NSE、S-100B蛋白、MBP水平变化及其与脑梗死、脑出血患者神经功能缺损程度的相关性。结果脑梗死组和脑出血组患者血清NSE、S-100B蛋白、MBP水平均较对照组有不同程度增高(P<0.05),而短暂性脑缺血发作组与正常对照组比较均无明显变化。脑梗死组和脑出血组患者中神经功能缺损较重的中重型亚组患者血清NSE、S-100B蛋白、MBP水平较轻型亚组水平高(P<0.05)。结论血清NSE、S-100B蛋白、MBP水平可作为急性脑卒中患者病情判断、预后评估的指标之一,对早期脑梗死与短暂性脑缺血发作也有鉴别诊断价值,尤其适用于无法进行影像学检查的脑卒中患者。     

不同剂量甘露醇治疗急性大面积脑梗死病人其血清神经元特异性烯醇酶的变化

目的 探讨应用不同剂量甘露醇治疗急性大面积脑梗死病人时对其血清神经元特异性烯醇酶(NSE)的影响。方法 将急性大面积脑梗死病人分成两组,分别给予小剂量和常规剂量甘露醇治疗,均于发病后1、3、7、14d测定其血清NSE的浓度,比较两组病人同天内的测量值有无差别,并与正常健康人相对照。结果 两组病人起病后第1、3、7d血清NSE浓度较对照组显著升高(P<0.05),第3d最高,第14d NSE浓度与对照组比较无统计学意义(P>O.05)。两组间第1、3、7、14d NSE浓度分别比较均无显著性差异(P>0.05)。结论 急性大面积脑梗死病人应用小剂量甘露醇与应用常规剂量甘露醇治疗时,对于血清中NSE的变化具有一致的影响结果。     

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.     

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.