新型抗癫痫药物对认知功能的影响

以往研究发现几乎所有的抗癫痫药物对认知功能都产生直接或间接的影响.本文简要综述了新型抗癫痫药物对认知功能影响,结果显示:总体上拉莫三嗪和奥卡西平对健康志愿者和癫痫患者的认知有好的作用;但奥卡西平证据不如拉莫三嗪;托吡酯可引起认知损害,对注意力有影响,对语义功能和语言有特殊的影响;癫痫儿童认知损害和学习能力受阻必然影响学习成绩,而其中部分原因要归因于长期的抗癫痫药物治疗.     

影响耐药性部分性发作癫痫抗癫痫药物疗效的危险因素分析

癫痫是一种常见的慢性疾病,对人体的危害较大,尤其是耐药性部分性发作癫痫[1]。耐药性部分性发作癫痫属于应用两种或更多种恰当的抗癫痫药物,给予合理、足量的治疗（无论是单一抑或联合用药）后,治疗均失败的癫痫类型。临床上对耐药性部分性发作癫痫患者进行治疗的时候,做好相关高危因素的分析后[2]继续给予抗癫痫药物治疗,仍然可以得到缓解。     

抗癫痫药物在哺乳期癫痫女性中的合理应用及研究进展

癫痫是神经系统的一种常见慢性病,确诊患者通常需持续3～5年规律服用抗癫痫药(AEDs).生育期女性的癫痫患病率高达0.3％～0.5％,为控制癫痫发作,一些患者在哺乳期也需坚持服用AEDs.母乳是婴儿最理想的天然食物,但几乎所有AEDs均能通过乳汁进入婴儿体内,对其健康存在潜在的危害.因此,患者服用AEDs是否能哺乳,各种类型AEDs对婴儿的影响,哺乳期AEDs的选择等一系列问题都是医生和患者面临的棘手难题.本文从传统和新型AEDs的母体代谢及乳汁排泄率、AEDs在婴儿体内的代谢及影响因素、AEDs对婴儿的影响三方面进行综述,以期指导哺乳期癫痫女性更加合理地选择AEDs,从而最大限度降低或避免AEDs对婴儿的不良影响.     

尼莫地平对卡马西平药物代谢动力学影响

采用荧光偏振免疫分析法，按自身对照法在六只家兔身上，对卡马西平单用及与尼莫地平合用中卡马西平浓度变化进行观测，结果表明，合用尼莫地平后卡马西平药物动力学模型稍有改变，而单用与合用卡马西平，其半衰期（T1/2)，药时曲线下面积（AUC），消除率（CL），表 布容积（Vd)，峰浓度（Cmax)差异无统计学意义（P＞0．05）。     

结构MRI对青少年癫痫脑皮质厚度的研究进展

青少年癫痫发病率高,发作形式多样,对病人大脑皮质、认知能力的发育有较大影响。研究青少年癫痫大脑皮质厚度的变化对该病的早期诊断和治疗至关重要。大脑皮质厚度是癫痫诊断和治疗的重要生物特征指标,可为癫痫脑组织形态和病理特征研究提供依据。就结构MRI对青少年癫痫病人的大脑皮质厚度变化的检测及大脑皮质厚度与病程、临床症状和抗癫痫药的关系等方面的研究进展予以综述。     

311例癫痫患者血药浓度监测的回顾性分析

目的 回顾性分析4种常用抗癫痫药的血药浓度监测情况,以利指导合理用药。方法采用HPLC法测定苯巴比妥、苯妥英钠、卡马西平和丙戊酸钠4种常用抗癫痫药物的血药浓度。结果监测311例次达有效治疗血药浓度,儿童组为45．95％,成人组为44．23％;低于有效血药浓度的儿童组为40．15％,成人组为30．77％;高于有效血药浓度的儿童组为13．90％,成人组为25．00％;两组比较无显著差异。!lll-~血药浓度监测结果是指导临床用药的依据之一,血药浓度不在治疗窗内的原因具多元化,应全面综合分析监测结果。     

原发性肝癌患者长期生存的影响因素分析

目的 对明确诊断为原发性肝癌并存活5年以上的患者,探讨影响其长期生存的相关因素及介入治疗对患者长期生存的作用.方法 对2001年1月至2010年1月以来就诊生存时间长于5年的原发性肝癌患者相关资料及治疗经过进行分析,探讨其长期生存的相关因素.结果 随访的452例原发性肝癌患者中43例存活5年以上.其中年龄、肝硬化的程度、肝内肿瘤的大小、肝内肿瘤的数量、门静脉有无受侵对患者的长期生存具有统计学意义(P＜0.01).结论 原发性肝癌患者的年龄、肝硬化的程度、肿瘤的数量、门静脉有无受侵、术后复发选择的治疗方式对患者的长期生存起着显著作用.     

抗癫痫药物的治疗监测评价及进展

癫痫是最常见的神经系统疾病之一,据统计,我国约有超过900万癫痫患者,患病率为4.4‰～5‰.其中75%患者在正规治疗后,病情得到了很好的控制,还有25%的患者,因为个体用药或医源性原因,控制并不理想,影响生存质量[1].     

长期应用非洛地平对原发性高血压患者血管内皮功能的影响

目的观察长期应用非洛地平对原发性高血压患者血管内皮功能的影响。方法60例轻-中度原发性高血压患者给予非洛地平口服治疗24周。采用高分辨率血管外超声法检测治疗前后肱动脉内皮依赖性血管舒张功能。结果非洛地平治疗24周后,原发性高血压患者的收缩压[(122.8±11.7)mmHg]及舒张压[(76.4±8.2)mmHg]均较治疗前[收缩压:(160.4±14.8)mmHg,舒张压:(96.2±10.1)mmHg]显著降低(均P<0.01);治疗后肱动脉内径的基础值[(4.98±0.41)mm]及血流介导的内皮依赖性舒张功能[(6.21±1.28)%]均较治疗前[(分别为(4.02±0.50)mm和(4.91±1.03)%]明显改善(均P<0.01)。结论非洛地平能够在有效降压的同时显著改善原发性高血压患者肱动脉内皮依赖性舒张功能。     

卡马西平对丙戊酸稳态血药浓度及药物动力学的影响

目的　观察兔灌服卡马西平前后对稳态时丙戊酸血药浓度及药代动力学参数的影响。方法　实验分为两期 ,Ⅰ期 :7只兔单独灌服丙戊酸 ,连续给药 4d至稳态后定时采血 ;Ⅱ期 :合用卡马西平与丙戊酸 7d。给药剂量丙戊酸为 30mg·kg-1 ·d-1 ,卡马西平为 4 0mg·kg-1 ·d-1 。采用荧光偏振免疫分析法测定丙戊酸血药浓度。对两期药代动力学参数进行统计分析。结果　合并用药后 (Ⅱ期 )峰值时间内VPA血药浓度 (0 .5 ,1 .0h)比单独应用VPA(Ⅰ期 )的浓度显著升高 ,二者有显著性差异 (P <0 .0 1 ,P <0 .0 5 )。其余时间点的血药浓度值尽管有变化 ,但无统计学意义。合并用药后VPA的消除半衰期 (T1 / 2 β　 )低于单用者 ,二者有显著性差异 (P <0 .0 5 )。合并用药后血浓度达峰时间提前 ,但与单用药比较差异无统计学意义 ,其它药动学参数无显著性差异。结论　CBZ可以使VPA的峰浓度显著升高 ,而使其T1 / 2　缩短 ,二药合用时应注意监测VPA的血药浓度 ,及时调整给药剂量。     

Effect of seizure on hippocampus in mesial temporal lobe epilepsy and neocortical epilepsy: an MRS study

This study was performed to evaluate the effect of seizures on the bilateral hippocampus in mesial temporal lobe epilepsy (mTLE) and neocortical epilepsy by single voxel proton magnetic resonance spectroscopy (MRS). Forty-one patients with mTLE having unilateral hippocampal sclerosis and 43 patients with a neocortical epilepsy who underwent subsequent epilepsy surgery were recruited. Ninety-five percent confidence intervals of N-acetyl aspartate/choline (NAA/Cho) and NAA/creatine (NAA/Cr) ratios in 20 healthy control subjects were used as threshold values to determine abnormal NAA/Cho and NAA/Cr. NAA/Cho and NAA/Cr were significantly lower in the ipsilateral hippocampus of mTLE and neocortical epilepsy. Using asymmetry indices for patients with bilaterally abnormal ratios of NAA/Cho and NAA/Cr in addition to using unilateral abnormal ratio, the seizure focus was correctly lateralized in 65.9% of patients with mTLE and 48.8% of neocortical epilepsy patients. Bilateral NAA/Cho abnormality was significantly related to a poor surgical outcome in mTLE. No significant relationship was found between the results of NAA/Cho or NAA/Cr and surgical outcome in neocortical epilepsy. The mean contralateral NAA/Cr ratio of the hippocampus in mTLE was significantly lower in patients with a history of secondary generalized tonic-clonic seizure (SGTCS) than in those without. Our results demonstrate effects of seizures on the hippocampi in neocortical epilepsy and the relation between SGTCS and NAA/Cr of the contralateral hippocampus in mTLE. This proves the presence of a seizure effect on the hippocampus in neocortical epilepsy as well as in mTLE.     

Homocarnosine and the measurement of neuronal pH in patients with epilepsy

Homocarnosine is a dipeptide of gamma-aminobutyric acid (GABA) and histidine found uniquely in the brain, most likely in a subclass of GABAergic neurons. By comparison of spectra from the occipital lobe of patients receiving a homocarnosine elevation drug to normal subjects we have assigned two elevated resonances in the short TE ¹H MRS spectrum to homocarnosine. These resonances are partially resolved at 7.05 and 8.02 ppm in a short TE spectrum at 2.1 T when macromolecule resonances are removed by subtraction of a spectrum in which the metabolite resonances are nulled by inversion recovery. The chemical shift of both of these resonances is sensitive to pH_i. By comparison with a titration curve the pH_i was calculated from the downfield resonance to be 7.06 in the patient group which is similar to values reported using the P_i resonance. Based on the in vivo results and theoretical considerations the potential sensitivity for using nonelevated homocarnosine to measure pH is similar to that of P_i under physiological conditions.     

EEG-fMRI using z-shimming in patients with temporal lobe epilepsy

PURPOSE: To use z-shimming, a technique that reduces signal loss due to susceptibility artifacts that can result in reduced or absent activation in electroencephalography (EEG) functional MRI (fMRI) sessions in patients with temporal lobe epilepsy (TLE), to determine whether it would result in an increased ability to detect significant regions of blood oxygenation level-dependent (BOLD) signal change. MATERIALS AND METHODS: Eight patients with TL EEG spikes underwent an EEG-fMRI scanning session using z-shimming. The signal intensities in the z-shimmed images were compared with those in the standard images. BOLD activation maps were created from the two sets of images using the timings of the spikes observed on the EEG. RESULTS: The mean signal increase in the TLs as a result of z-shimming was 45.9%+/-4.5%. The percentage of TL voxels above a brain intensity threshold rose from 66.1%+/-7.6% to 77.6%+/-5.7%. This appreciable increase in signal did not lead to any significant differences in the statistical maps created with the two sets of functional images. CONCLUSION: The results suggest that loss of signal is not the limiting factor for the detection of spike-related BOLD signal changes in patients with TLE activity.     

大黄合剂对癫痫患者长时程视频脑电定量监测的影响

目的:定量分析大黄对癫痫患者视频脑电监测(video-EEG)的影响。方法:对36例应用大黄治疗后癫痫患者,和31例对照组癫痫患者进行视频脑电图(V-EEG)定量分析。结果:大黄组与对照组主频、θ、δ相对功率值有显著性差异(P<0.05),大黄组治疗后与对照组比较主频大部分前移、θ、δ相对功率明显下降。结论:长程视频脑电定量监测大黄对中枢兴奋性具有抑制作用。     

原发性癫痫90例睡眠结构及脑电事件分析

目的探讨原发性癫痫患者睡眠结构及脑电事件特点。方法对90例符合原发性癫痫诊断标准的患者进行多导睡眠图(PSG)检查,分析患者的睡眠结构、夜间激醒事件及异常脑电事件。结果本组病人PSG睡眠结构特点表现为患者睡眠阶段的转换增加,睡眠片断及睡眠效率减低,睡眠质量低下,结构紊乱。REM期比例减少例数76例(占84.44%),REM潜伏期增加例数70例(占77.78%),Ⅰ+Ⅱ期比例增加例数64例(占71.11%),Ⅲ+Ⅳ比例减少例数44例(占48.89%),入睡潜伏期增加例数为41例(占45.56%)。整夜激醒次数为(103.20±131.76)次,激醒次数增多者占88.89%。睡眠脑电图(EEG)监测结果显示有异常放电者占38.30%,尤其以浅睡期发放显著。结论原发性癫痫患者存在睡眠结构紊乱。     

颅脑外伤后晚发型癫痫患者认知损害和磁共振弥散张量研究

目的分析颅脑外伤后晚发型癫痫患者的临床特点、认知功能及弥散张量成像技术在显示脑损害中的作用。方法对1999年6月-2007年8月在解放军总医院癫痫门诊就诊的175例颅脑外伤后晚发型癫痫患者,将其分为有明确病灶组和无明确病灶组,并对其临床资料进行分析;再取其中37例癫痫患者作为癫痫组,39例健康人作为正常对照组,对癫痫组和正常对照组进行认知功能检查,并对癫痫组患者中的13例进行磁共振弥散张量(DTI)检查。结果颅脑外伤后晚发型癫痫患者中有明确病灶组和无明确病灶组患者单纯部分发作或复杂部分发作的发作频率均显著高于部分继发全面性发作,差异具有统计学意义(P<0.01),而比较两组间各发作类型的发作频率,差异无统计学意义(P>0.05)。颅脑外伤后晚发型癫痫组患者VIQ、PIQ、FIQ得分均明显低于对照组(P<0.01),差异具有统计学意义。癫痫组1min之内说出的蔬菜、动物、水果及总均数均明显低于正常对照组;数字广度、数字符号得分明显低于正常对照组;癫痫组较对照组Stroop试验反应时明显延长(P<0.01)。DTI研究可见在T2加权像病灶中心部位呈长T2信号,MD值明显增高、FA值明显减低。病灶周边T2加权像看似正常的白质(NAWM),其MD值高于、FA值低于对侧相应白质区域(P<0.05)。结论颅脑外伤后晚发型癫痫患者存在广泛的认知功能损害,DTI成像能发现脑白质早期病变,尤其是能够显示T2加权像看似正常白质的细微病理改变。     

Temporal lobe epilepsy with varying severity: MRI study of 222 patients

MRI was performed in 222 consecutive adult patients with temporal lobe epilepsy of varying severity from January 1991 to May 1993. The diagnosis of hippocampal sclerosis was established visually by three independent observers. The accuracy of visual assessment of hippocampal asymmetry was compared with volumetric measurements. Neuropathological correlations were obtained in 63 patients with refractory seizures. Temporal lobe abnormalities were observed in 180 patients (81 %) as follows: hippocampal sclerosis in 122 (55 %); developmental abnormalities in 16 (7.2 %); tumours in 15 (6.8 %); scars in 11 (5 %); cavernous angiomas in 10 (4.5 %); miscellaneous lesions in 6. MRI was normal or showed unrelated changes in 42 patients (19 %). Visual assessment correctly lateralised hippocampal sclerosis in 79 of the 84 patients measured (94 %). Temporal lobectomy confirmed the MRI data (side and aetiology) in all 63 operated patients. Patients with normal MRI had an older age of seizure onset and were more often drug-responsive than patients with hippocampal sclerosis. MRI showed temporal lobe abnormalities in 81 % of epileptic patients with varying severity with good neuropathological correlation. Patients with normal MRI had a less severe form of the disease. Received: 19 August 1996 Accepted: 13 November 1996     

选择性海马切除对难治性癫痫患者个性改变的影响

目的：研究选择性海马切除术后难治性癫痫患者个性特征的变化。方法：回顾性分析52例癫痫患者在选择性海马切除术前、术后1年行艾森克个性问卷（EPQ）测评,观察相应测量指标变化。结果：52例选择性海马切除患者术后EPQ中精神质（P）、内外向（E）、神经质（N）分值较术前下降（P〈0.05）;23例行左侧海马切除患者术后P、E、N分值也较术前下降（P〈0.05）,而29例行右侧海马切除者术前术后1年P、E、N分值无明显差异（P〉0.05）;Engle分级Ⅰ～Ⅱ级患者术后P、E、N分值均较术前有明显差异（P〈0.05）,Ⅲ～Ⅳ级患者术后P、E、N无明显改变（P〉0.05）。结论：一侧选择性海马切除术后患者个性可能发生改变,且左侧较右侧影响较大,术后1年内症状控制优良者较控制差或无效者个性变化大。