P物质对大鼠三叉神经节神经元H+-门控电流的调制

目的 探讨P物质(SP)对大鼠三叉神经节(TG)神经元膜H+-门控电流的调制作用及其机制.方法 急性分离TG神经元,通过排管快速换液装置行胞外给药,电极内灌药行胞内透析后,采用全细胞膜片钳技术记录神经元膜H+-门控电流.结果 依照我们在背根神经节(DRG)神经元分类的方式,同样可将TG神经元H+-门控电流也分为四型,即T-型、S-型、B-型、O-型;共加SP和H+能浓度依赖性增强S-型H+-门控电流,SP受体拮抗剂GR82334不能阻断此作用;共加SP和H+能增强B-型H+-门控电流,GR82334和胞内透析GDP-β-S能阻断SP对B-型H+-门控电流的这一增强作用,而预加SP则抑制B-型H+-门控电流,并以短暂成分尤为明显,此抑制效应不能被GR82334阻断.结论 SP对H+-门控电流的调制依ASIC亚基组成不同,其作用机制有所不同:S-型H+-门控电流的ASIC分子膜外结构上可能存在SP的别构位点.     

酸敏感离子通道在PC12细胞中的表达

目的：检测酸敏感离子通道（ASICs）在PC12细胞中的表达情况。方法：采用RT-PCR、Westernblot以及单细胞膜片钳记录方法检测ASICs在培养的PC12细胞中的表达情况。结果：PC12细胞中有ASICs蛋白的表达,且ASICs的6个亚基：ASIC1a,ASIC1b,ASIC2a,ASIC2b,ASIC3,ASIC4均有表达,给予酸诱导能产生电流。结论：PC12细胞上存在ASICs电流,且能被ASICs阻断剂阿米洛利所阻断,这为研究ASICs在神经退行性疾病中的作用提供了较为理想的细胞模型。     

大鼠背根神经节神经元S-型与O-型H+-门控离子通道外向电流研究

目的 在前期工作的基础上,从药理学敏感性的角度出发,初步探讨S-型与O-型H+-门控离子通道外向电流的离子成分及其药理学特性.方法 采用全细胞膜片钳技术记录急性分离的大鼠背根神经节神经元H+-门控离子通道电流,测定S-型与O-型离子通道外向电流的药理学特性,分析其成分组成.结果 高浓度的胞外K+、CsC1、BaCl2、4-氨基吡啶(4-AP)、四乙基溴化铵(TEABr)、CdCl2、阿米洛利等抑制S-型与O-型H+-门控离子通道外向电流,而Ca2+络合剂EGTA和高浓度的胞外Ca2+则增强该外向电流;胞外Na+浓度的变化对该外向电流无明显影响.结论 S-型和O-型H+-门控离子通道电流的外向电流离子成分可能为钙依赖性钾电流.     

快速老化小鼠海马神经元电压门控离子通道特点

目的：观察快速老化小鼠（Senescence-accelerated mouse,SAM)海马神经元的基本离子通道特点，并对抗快速老化亚系（SAM－resistance/1,SAMR1)与快速老化亚系（SAM－prone/8,SMAP8)的基本离子通道特点进行了比较，探讨了离子通道变化在衰老中的可能角度，方法：应用全细胞记录方式，观察并比较原代培养SAMR1和SAMP8海马神经元的电压门控离子通道及膜参数。结果：原代培养SAMR1和SAMP8海马神经元电压门控Na^2 通道电流（INa)和电压门控延迟整流K^ 通道电流（IK）的电学特点和幅度基本一致。SAMP8的电压门控Ca^2 通道电流（ICa)和瞬时外向K^ 通道电流（IA）的幅值则大于相同培养天数的SAMR1。经膜电容校正所得的ICa电流密度也表现出增大的变化规律。结论：SAMP8与SAMR1神经元间IA和ICa的差异可能与其神经系统变异而产生的学习记忆功能下降有关。     

酸感受离子通道及钠氢泵基因表达在痫性发作中的作用研究

目的探讨酸感受离子通道（ASICs）、钠氢泵（NHE）基因表达及其在痫性发作中的作用。方法联合运用脑电图及逆转录PCR方法,检测正常大鼠,匹鲁卡品致痫大鼠,阿米洛利海马ASIC1a,ASIC3及NHErnRNA表达。结果痫性发作1h即可观察到ASIC1a,ASIC3及NHEmRNA表达较正常大鼠增加,差异具统计学意义（P〈0．01）;痫性发作大鼠给予阿米洛利后,与对照组（痫性发作1h组）相比,ASIC1a,ASIC3mRNA表达差异有统计学意义（P〈0．01）,NHEmRNA表达差异无统计学意义（P〉0．05）。结论痫性发作可致ASIC1a,ASIC3基因表达增加,抑制AslC1a,ASIC3基因可减弱痫性发作,而与时NHE的作用无关。     

酸性环境介导皮质神经元损伤及阻断酸敏感离子通道1α的神经保护作用

目的 探讨脑梗死模型中酸性环境能否介导皮质神经元损伤及阻断酸敏感离子通道1α（acidsensing ion channels1α，ASIC1α）的神经保护作用。方法 制作缺氧细胞模型、脑梗死动物模型，检测ASIC1α阻断剂对乳酸脱氢酸（lactate dehydrogenase，LDH）释放率、大鼠行为学、脑梗死体积以及ASIC1蛋白表达的影响。结果 酸性环境可以损伤皮质神经元，加重缺氧对细胞的毒性作用，经侧脑室注射ASIC1α阻断剂可以改善脑梗死大鼠的行为学改变，梗死体积明显减小（P〈0.05）；随梗死时间延长，缺血半暗带ASIC1表达增加，在缺血后24h表达量较明显。结论 酸性环境导致皮质神经元损伤，其损伤机制与缺血后神经元ASIC1α开放以及表达增加有关；阻断ASIC1α具有神经保护作用。     

酸敏感离子通道2a对缺血预处理诱导大鼠海马缺血耐受的作用

目的探讨脑缺血时的组织病理学变化及酸敏感离子通道2a（ASIC2a）在缺血预处理诱导的脑缺血模型耐受中的作用。方法取成年雄性SD大鼠160只,随机分为假手术组、预缺血组、缺血组、缺血预处理组共4组。行焦油紫染色观察各组大鼠海马CAI区存活神经元密度,TUNEL染色观察大鼠海马CA1区神经元凋亡情况,RT—PCR和Western blotting检测ASIC2a在大鼠海马CAl区mRNA和蛋白表达情况。结果缺血预处理能够显著减少大鼠海马CA1区锥体神经元的死亡和凋亡,PC＋Isch组和Isch组相比具有显著性差异（P〈0．01）。全脑缺血能够上调ASIC2a在大鼠海马CA1区mRNA和蛋白表达,在24h达到高峰,而缺血预处理进一步上调ASIC2a表达,呈进行性上升,在24h和72h时相点,PC＋Isch组和Isch组相比具有显著性差异（P〈0．01）。结论在脑缺血耐受中,缺血预处理对第二次致死性缺血表现出保护作用。在这个过程中,大鼠海马CA1区ASIC2a基因和蛋白表达上调发挥了重要的保护作用。     

酸敏感离子通道调控机制的研究进展

酸敏感离子通道（Acid-sensing ion channels,ASICs）是一类由细胞外酸直接激活的阳离子通道,广泛分布于中枢及外周系统,参与痛觉、触觉、酸味觉形成,在突触可塑性、学习记忆功能、炎症及脑缺血等病理生理过程中发挥重要作用。因此对ASICs的功能性调控的研究有着重要的意义。研究表明ASICs的功能可受如金属离子、神经肽、蛋白酶等多种因素所调控,通过对这些调控机制的研究有利于为临床治疗寻找新的药理学靶点。     

一种改良的精确分析酸敏感性离子通道特性的优化记录方法

目的 用一种改良的灌流方法研究和再次证实HEK 293细胞内源性酸敏感性离子通道的生物物理和药理学特性.方法 使用全细胞膜片钳技术,将记录细胞与玻片分离,并使细胞位于输液管前,呈漂浮状态,以记录在低pH值外液中,HEK293细胞的酸敏感性1a型离子通道的电流.结果 使用细胞漂浮方法,pH 5.0的细胞外液诱发的酸敏感性1a型离子通道电流足传统细胞附着法诱发的两倍.在两种不同的方法下,通道电流达到峰值的时间分别是(21±5)ms和(270±25)ms,失活的时间常数分别是(496±23)ms和(2284±120)ms.细胞漂流法也明显增强amiloride对酸敏感性1a型离子通道的阻断效能.两种方法具有相似的pH激活的EC50(分别为6.6±0.6,6.6±0.7).结论 酸敏感性1a型离子通道的激活需要细胞外液快速的交换.通过细胞漂浮的方法,我们再次证明了酸敏感性1a型离子通道电流的存在,更精确地分析了HEK 293细胞内源性酸敏感型离子通道的生物物理和药理学特性.这一改良的方法能够用于研究所有的酸敏感型离子通道和需要快速细胞外液交换的配体门控通道.     

离子通道变异与癫痫病

离子通道是神经系统和其它可兴奋组织(肌肉和腺体)产生兴奋和行使功能活动的核心基本物质之一。因编码离子通道基因的突变所导致的各类先天性疾病被称之为通道病因学。临床上常见的先天性癫痫综合征多属于通道病。先天性癫痫占癫痫人群的40％，常见的有以下几种：由N型乙酰胆碱受体CHRNA4或CHRNB亚基突变所致的常染色体显性夜间额叶癫痫：因电压门控钾通道KCNQ2和KCNQ3缺陷所致的良性家族性新生儿惊厥；因电压门控钠通道SCN1B．SCN1A和SCN2A亚基以及GABA受体GABRG2亚基突变诱发的高热抽搐全身型癫痫叠加综合征：南电压门控氯通道(C1C2突变)和GABAA受体或亚基突变所致的几种特发性全身性癫痫：此外，近来还发现了与电压门控钾通道KCNA1有关的另一种与1型共济失调伴发的局限性癫痫。研究分析先天性癫痫家系基因遗传谱及其突变通道的电生理特性，有利于更深入地认识和了解先天性癫痫的通道突变发病机制．制定新的抗癫痫策略，开发针对性抗癫痫新药。本文将对先天性癫痫的通道病因学研究进展作一简要梳理。     

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.