左右额叶肿瘤患者注意功能的研究

目的 研究左右额叶肿瘤患者的注意功能的损害和事件相关电位(event related potential,ERP)P300的有关参数的变化,了解左右额叶肿瘤对注意功能损害的特点.方法 对31例额叶肿瘤患者(左侧15例、右侧16例)及30例正常对照分别进行Stroop字色干扰实验、数字广度测验(digit span test,DST)、数字颜色连线测验(Color trail test 1,CTT)测试注意功能的神经认知心理学测验和P300检查,并对两者作相关性研究.结果 与正常对照组比较:右额叶肿瘤患者Stroop test、DST、CTT评分均低于正常组,有统计学意义.左额叶肿瘤患者的各项评分虽也低于正常组,但与正常组相比差异无统计学意义.左右两组事件相关电位的P3波潜伏期均延长,P3波幅均降低,均有有统计学意义.神经认知心理学评分与P300有相关性.结论 右侧额叶肿瘤对患者的注意功能损害更严重.P300与注意功能有相关性,但不具有特异性.     

额叶肿瘤患者认知功能和事件相关电位P300的研究

目的 探讨额叶肿瘤患者认知功能的损害和事件相关电位P300有关参数的变化特点,了解额叶在认知功能及P300产生中的作用.方法 对31例额叶肿瘤患者(左侧15例、右侧16例)及30例健康对照者分别进行Stroop字色干扰等多项认知神经心理学测试和P300检查.结果 与健康对照组相比,额叶肿瘤组认知功能各项测试指标评分均显著降低(P＜0.05),P300的N2、P3波潜伏期显著延长(P＜0.05),P3波幅显著降低(P＜0.05).进一步研究发现,右额叶肿瘤组患者的各项认知测试指标评分均显著低于健康对照组(P＜0.05),而左额叶肿瘤组只有词语流畅性指标评分显著低于健康对照组(P＜0.05);与健康对照组相比,左、右额叶肿瘤组P300的N2、P3波潜伏期均显著延长(P＜0.05),P3波幅均显著降低(P＜0.05);左、右额叶肿瘤组患者之间的P300比较则无统计学差异(p＞0.05).结论 额叶肿瘤患者认知功能有明显损害,右侧肿瘤患者的认知功能损害更严重:额叶可能与P300发生或传导有关,且左右额叶无明显的差异.     

慢性肾脏病患者的认知障碍与脑白质损伤磁共振弥散张量成像研究

目的探讨慢性肾脏病患者肾功能下降与认知障碍及脑白质损伤的关系。方法选取30例慢性肾脏病(CKD2-5期)患者和30例肾功能正常者,接受磁共振(magnetic resonance imaging,MRI)弥散张量成像(diffusion tensor imaging,DTI)检查,同时进行蒙特利尔认知评估量表(MoCA)测试。采用SPSS26.0统计软件对数据进行分析。结果CKD组较肾功能正常组双侧额叶,双侧顶叶各向异性分数(fractional anisotropy,FA)值减低,双侧额叶,左侧颞叶,左侧顶叶表观弥散系数(apparent diffusion coefficient,ADC)值升高,患者的MoCA评分随eGFR值的下降而下降。eGFR值与左侧额叶,右侧额叶,左侧颞叶,右侧顶叶FA值,左侧额叶,右侧颞叶,左侧顶叶ADC值存在显著相关性。MocA评分与左侧额叶,左侧颞叶,右侧顶叶FA值,左侧额叶,右侧颞叶ADC值存在显著相关性,差异有统计学意义(P0.05).结论患者的肾功能下降与认知功能损害及脑白质损害具有相关性。肾功能下降可能是患者脑白质病变及认知功能下降的独立危险因素。     

早发性精神分裂症患者认知功能损伤特点

目的:探究早发性精神分裂症(EOS)患者认知功能损伤的特点。方法:采用成套神经心理学量表对50例EOS患者(EOS组)和55名正常对照者(NC组)进行言语记忆、数字记忆、额叶功能、执行功能及注意力测试。结果:EOS组言语记忆、执行功能、注意的认知功能测试成绩明显低于正常对照组(P均0.01);两组间数字记忆、额叶功能测试成绩差异无统计学意义。除病程与数字连线评分正相关(r=0.639,P0.01),病程及阳性和阴性症状量表(PANSS)评分与各项测试成绩无相关。结论:EOS患者存在言语记忆、注意及执行功能受损;这种认知功能损伤是EOS的特质性改变。     

轻度认知功能障碍与脑白质弥散张量成像的相关性研究

目的通过磁共振弥散张量成像研究不同区域脑白质损害与轻度认知功能(MCI)的关系。方法纳入2015年7月至2016年2月我院的住院患者56例为研究对象,其中MCI组34例,认知功能正常组22例。所有研究对象进行一般情况检查,完成神经心理学量表检测。通过头颅磁共振弥散张量成像(DTI)检查对不同脑区白质纤维进行部分各向异性(FA)值测量。结果 MCI组患者与认知功能正常组相比,右侧额叶FA值(0.335±0.068)、左侧颞叶白质FA值(0.391±0.032)及胼胝体膝部FA值(0.658±0.053)降低,差异具有统计学意义(P0.05)。将上述FA值和MMSE、Mo CA量表中各认知域进行典型相关分析,结果显示右侧额叶白质FA值与注意与计算力呈正相关,左侧颞叶白质和胼胝体膝部FA值与记忆力呈正相关(P0.05)。结论 MCI患者注意与计算力的障碍可能与右侧额叶白质损害有关,而左侧颞叶白质及胼胝体膝部白质的损害可能导致早期的记忆障碍。DTI可能成为超早期识别与诊断MCI的新方法。     

2型糖尿病患者记忆功能及相关脑区代谢的改变

目的 探讨2型糖尿病患者记忆功能和相关脑区代谢的改变.方法 对以记忆减退为主诉的2型糖尿病患者(糖尿病组,73例)和无糖尿病患者(对照组,73例)进行简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、修订韦氏记忆量表中文版(RWMS-RC)检查.同时予左侧海马、额叶、基底节及丘脑磁共振质子波谱分析检查,采集N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌醇(mI)、肌酸复合物(Cr,Cr2)及谷氨酸复合物(CIx)峰下面积数值,并进行比较.结果 (1)糖尿病组MMSE、MoCA评分,以及MoCA中瞬时记忆及短时记忆评分明显低于对照组(P＜0.01～ 0.005);两组间WMS-RC评分差异无统计学意义.(2)与对照组相比,糖尿病组左侧海马Cr、mI峰下面积及左侧额叶Cr2峰下面积明显高于对照组(P＜0.05～0.01);左侧丘脑NAA、Cr2、Cho峰下面积明显低于对照组(均P＜0.05).两组间左侧基底节区各代谢物水平差异无统计学意义.结论 2型糖尿病损害记忆功能;与记忆功能有关的海马、额叶和丘脑存在代谢异常.     

脑小血管病患者伴发非痴呆血管性认知功能损害情况及尼莫地平疗效的研究

目的探讨脑小血管病(cerebral small vessel disease,SVD)不同亚型伴发非痴呆血管性认知功能损害的情况,评价尼莫地平对SVD的疗效。方法选择SVD患者118例,包括52例腔隙灶脑梗死(LI)和66例白质疏松(WML)患者。分别将LI组和WML组患者随机分组为治疗组(基础治疗加尼莫地平治疗)和对照组(基础治疗),进行6个月治疗。治疗前后对所有患者采用蒙特利尔认知评估量表(MoCA)、简易智能状态检查表(MMSE)、语义分类流畅测验(动物)、Stroop测验(计算错误数)、画钟试验、积木测验、数字广度顺背测验、数字符号测验、逻辑记忆亚测验和再生亚测验进行认知功能评价,并比较各组患者治疗前后认知功能评分。结果治疗前,LI组患者语义分类流畅测验(动物)、数字符号测验、逻辑记忆亚测验、视觉再生亚测验、MoCA、MMSE评分显著高于WML组患者,Stroop测验得分显著低于WML组患者。经过6个月治疗后,LI组和WML组患者中的对照组治疗前后各项认知功能评分均没有统计学差异(P>0.05)。LI组患者中治疗组MoCA、画钟试验和数字广度顺背测验得分升高,Stroop测验得分下降(均P<0.05);WML组患者中治疗组MoCA、MMSE、画钟试验、数字广度顺背测验和视觉再生亚测验得分升高,Stroop测验得分下降(均P<0.05)。结论 SVD两个亚型伴发非痴呆血管性认知功能损害情况不同,LI患者损害程度比WML患者轻。尼莫地平治疗可较好的改善患者的执行功能、视空间结构能力和注意力。     

老年脑梗死患者早期记忆障碍特点研究

目的探讨老年脑梗死患者早期记忆障碍的特点。方法前瞻性收集老年脑梗死患者76例,根据头颅MRI病灶部位分为额叶、颞叶、顶枕叶、小脑、基底节、脑干等亚组,根据病灶大小及数量分为大梗死、中梗死、小梗死、腔隙性梗死和多发性梗死等亚组;以同期健康体检者76名为健康对照。分别对脑梗死组及对照组应用蒙特利尔认知评价表(MoCA)评定认知功能,临床记忆量表(CMS)、Fuld物体记忆测验(FOM)、言语流畅性测验(RVR)评定记忆功能。结果 76例脑梗死患者中44例(57.9%)MoCA评分26分。与对照组相比,脑梗死组及其亚组额叶、颞叶、顶枕叶、基底节组MoCA评分及各项记忆功能评分下降(P0.01);脑梗死各亚组中,额叶、颞叶、顶枕叶及基底节组之间两两比较,额叶、颞叶、顶枕叶组记忆商(MQ)、FOM、RVR评分较基底节组下降(P0.05);额叶、颞叶、顶枕叶组各项记忆功能评分无明显差别(P0.05);各亚组不同病灶类型相比,额叶及颞叶梗死亚组中,中梗死组各项记忆功能评分均低于小梗死和腔隙性梗死组(P0.01),小梗死组各项记忆功能评分均低于腔隙性梗死组(P0.01);顶枕叶及基底节梗死亚组中,中梗死组各项记忆功能评分均低于小梗死组和腔隙性梗死组(P0.01),小梗死组与腔隙性梗死组比较,各项记忆功能差异无统计学意义(P0.05)。结论老年脑梗死患者早期认知功能下降发生率较高,其记忆障碍表现及记忆功能损害程度与梗死灶部位及大小有关。     

脑肿瘤患者认知功能的评测及影响因素分析

目的评测脑肿瘤患者认知功能并分析其影响因素,以期为临床脑肿瘤病变的诊疗提供借鉴。方法自2012-06以来入我院治疗的确诊为脑肿瘤病变并行手术切除的患者为研究对象,以正常人为对照组,采用MMSE、MoCA评测认知功能,并收集患者的一般情况,如年龄、性别、受教育年限,肿瘤特征,如肿瘤部位(左右大脑半球及具体位置)、肿瘤大小、病理类型及病理分级,既往史,如癲痫史等资料并进行统计学分析。结果共纳入患者322例,MoCA量表各亚项结果显示,术前脑肿瘤组各亚项评分均低于对照组,差异有统计学意义(P0.05);MMSE各亚项结果显示,术前脑肿瘤组仅延迟记忆、注意力及计算能力、语言能力方面低于对照组,差异有统计学意义(P0.05)。肿瘤位于左右大脑半球、肿瘤具体位置、肿瘤体积、有无癫痫史、病理类型等因素是脑肿瘤患者认知功能的影响因素。结论术前脑肿瘤患者认知功能障碍发生率为58.4%,表现为延迟记忆、视空间与执行能力、注意力及计算能力、命名、注意力、抽象概括、语言能力等几个方面的障碍,肿瘤位于左侧大脑半球、有癫痫史、胶质瘤、脑膜瘤,肿瘤位于额叶、额颞叶、颞叶,肿瘤越大,认知功能损害越大。     

冲动性在双相I型躁狂发作认知功能损害中的作用

目的 探讨冲动性在双相I型躁狂发作患者认知功能损害中的作用。方法 选择本院2018年7月～2020年7月100例双相I型躁狂发作患者,设为观察组,另选择100例进行心理测试的正常人群,设为对照组。采用重复性成套神经心理状态测验(RBANS)评价两组的认知功能,采用中文版Barratt-11冲动性量表(BIS-11)评价冲动性。并采用Pearson分析冲动性与认知功能的关系。结果 观察组RBANS量表中视觉广度、即刻记忆等评分均显著高于对照组(P0.05);观察组BIS-11量表中运动、无计划以及认知冲动性评分均显著高于对照组(P0.05);双相I型躁狂发作患者BIS-11量表中运动冲动性评分与RBANS量表中言语功能、注意呈负相关,无计划冲动性评分与视觉广度、注意呈负相关,认知冲动性与即刻记忆、延时记忆、注意呈负相关(P0.05)。结论 双相I型躁狂发作患者存在一定的认知功能损害,其冲动性与认知功能损害有关。     

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.     

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.     

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.     

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.