帕金森病患者立体定向手术前后脑脊液单胺类递质含量的改变

目的　研究帕金森病 (PD)患者脑立体定向手术前后脑脊液 (CSF)中单胺类递质含量的变化。方法测定 2 6例原发性PD患者 (PD组 )脑立体定向术前、后CSF中多巴胺 (DA)、5 羟色胺 (5 HT)、去甲肾上腺素 (NE)及其代谢产物高香草酸 (HVA)、5 羟吲哚乙酸 (5 HIAA)、3 甲氧基 4羟基苯乙二醇 (MHPG)的含量 ,另外测定 2 5例外科疾病腰麻手术患者 (对照组 )CSF中HVA、5 HIAA、MHPG含量。结果　PD组CSF中HVA、5 HIAA、MHPG含量明显低于对照组 (P <0 0 0 1、P <0 0 5、P <0 0 0 1) ;手术后组的CSF中DA、HVA ,、5 HT、5 HIAA、NE、MHPG含量明显高于手术前组 (其中DA、HVA、5 HT、5 HIAA和NE均P <0 0 0 1;MHPGP <0 0 5 )。结论　PD患者CSF单胺类神经递质代谢产物含量明显降低 ,脑立体定向术可提高PD患者脑部单胺类神经递质及其代谢产物的含量 ,其发生机制可能与DA能神经元的保护作用有关     

帕金森病伴发抑郁的神经递质改变

目的探讨帕金森病伴发抑郁的神经递质改变.方法用抑郁自评量表(CESD)和汗密尔顿抑郁量表(HAMD)评出帕金森病伴发抑郁患者33例,其中轻度抑郁24例,重度抑郁9例;另取阑尾炎、腹股沟疝、内、外混合痔等25例为对照组.应用日本岛津6A高效液相色谱仪,岛津电化学检测器对两组患者进行了脑脊液(CSF)中单胺类神经递质代谢产物5-羟吲哚已酸(5-HIAA)和3-甲氧-4羟苯乙二醇(MHPG)的含量测定.并进行统计处理.结果两组均数用近似法t检验,(两总体方差不齐)以-x±S表示,结果显示患者组中的5-HIAA和MHPG含量均低于对照组,差异有非常显著性.结论本组通过测定5-HT的代谢产物5-HIAA和NA的代谢产物MHPG,证实了PD伴发患者抑郁的患者其CSF中5-HIAA和MHPG含量显著减少,抑郁症状被认为与5-HT和(或)NA的缺乏有关.本文显示PD伴发抑郁有其生化病理基础.     

帕金森病外科治疗的综合评价与相关基础研究

目的通过综合研究对帕金森病(PD)外科治疗的价值和疗效进行全面评价。方法采用医学心理学测验(WAISRC)、临床记忆量表(MMPI)、神经生理学检测(听觉P300地形图)、神经电生理学(体感诱发电位SEP)和神经生化检查的脑脊液中多巴胺(DA)、5羟色胺(5HT)、去甲肾上腺素(NE)及其代谢产物)等对手术前后患者进行综合研究,并设对照组。结果手术前后智能和精神症状无显著性差异(P>0.05);手术后SEP的N20波峰潜伏期较术前缩短,统计学处理有差异(P左<0.005,P右<0.05),手术侧较非手术侧峰潜伏期缩短(P<0.05)。伴发抑郁患者组CSF中单胺类神经递质5HT的代谢产物5羟吲哚乙酸(5HIAA)和NE的代谢产物3甲氧基4羟基苯乙二醇(MHPG)低于对照组(P<0.01),患者组DA、高香草酸(HVA),5HT,5HIAA、NE、MPHG低于正常对照组(P<0.001),手术组上述各项均高于手术前组(P<0.001);结论手术不会加重智能和精神障碍;听觉P300地形图可作为诊断和疗效判定的客观指标之一;帕金森病及伴发抑郁症状均具有相应生化病理学基础。     

抑郁症与血浆中单胺类神经递质代谢产物

目的 检测抑郁症患血浆中单胺递质代谢产物在抗抑郁治疗前后的差异，探讨抑郁症及抗抑郁治疗与血浆中单胺递质代谢产物浓度的相关性。方法 用高效液相色谱法对40例抑郁症患治疗前后血浆中单胺递质代谢产物的浓度进行测定，用汉密尔顿抑郁量表评定抑郁症患的临床疗效。结果 抑郁症患血浆中单胺递质代谢产物5－HIAA、MHPG、HVA的浓度均显低于正常对照组，P＜0．05。经过4周住院治疗显效，HAMD分显下降，患血浆中5－HIAA、MHPG含量与治疗前比较明显升高，有显差异，P＜0．05；但HVA没有明显变化。结论 外周的单胺递质代谢产物可反映脑中单胺类神经递质的状态，血浆中单胺递质的变化可作为抑郁症及疗效评定的一个重要参考指标。     

抑郁症患者血浆白细胞介素与单胺代谢产物的研究

目的：探讨抑郁症患抗抑郁症治疗前后的细胞免疫及单胺类神经递质代谢产物的改变。方法：采用酶联免疫吸附法和高效液相电化学检测法，对40例抑郁症患在治疗前和抗抑郁药治疗4周后的血浆细胞因子白介素2（IL－2）和白介素6（IL－6），以及单胺代谢产物5－羟吲哚乙酸（5－HIAA）、3-甲基－4－羟－苯乙二醇（MHPG）和高香草酸（HVA）的浓度进行测定，并以20名健康人作为对照组。结果：（1）抑郁症组治疗前血浆IL－2、IL－6浓度明显高于正常对照组（P＜0．01），经过4周抗抑郁剂治疗后，随着病情显好转IL－2、IL－6较治疗前显降低（P＜0．01）；（2）抑郁症组治疗前血浆T－HIAA、MHPG、HVA浓度显低于正常对照组（P＜0．05），治疗后5－HIAA、MHPG明显高于治疗前（P＜0．05）；（3）治疗前后血浆5－HIAA的差值与治疗前后IL－2、IL－6的差值均呈显的负相关（P＜0．05）。结论：（1）抑郁症患可能伴有免疫激活和炎症反应。（2）抑郁症患存在中枢5－HT和NE功能低下。（3）IL－2、IL－6可影响中枢的5－HT活动。     

无先兆偏头痛患者血浆及血小板5-HT、5-HIAA含量的变化

目的　了解 5 -羟色胺 (5 - HT)、5 -羟吲哚乙酸 (5 - HIAA)在无先兆偏头痛发病中的作用。方法　用荧光分光光度法检测 2 0例无先兆偏头痛患者 (病例组 )和 2 3名正常人 (对照组 )血浆及血小板 5 - HT、5 - HI-AA的含量。结果　病例组发作期血浆 5 - HT含量低于对照组 (P<0 .0 5 ) ,而 5 - HIAA高于对照组 (P<0 .0 5 ) ;间歇期血浆 5 - HT高于发作期 (P<0 .0 5 ) ,而 5 - HIAA含量低于发作期 (P<0 .0 5 )。发作期血小板 5 - HT含量显著高于间歇期和对照组 (P<0 .0 1) ,而 5 - HIAA含量显著低于间歇期和对照组 (P<0 .0 1)。病例组 (含发作期和间歇期 )血小板 5 - HT含量高于对照组 (P<0 .0 5 ) ,而 5 - HIAA含量显著低于对照组 (P<0 .0 5 )。结论　无先兆偏头痛患者不同时期其血浆和血小板 5 - HT、5 - HIAA含量发生不同变化     

精神分裂症的中枢单胺递质代谢研究

目的：比较精神分裂症治疗前后中枢5－羟色胺（5－HT）,高香草酸（HVA）,4－羟基苯乙二醇（MHPG）,5－羟吲哚醋酸（5－HIAA）相互作用的差异。方法：应用高效液相色谱（HPLC）对40例首发后经8周治疗的精神分裂症患者脑脊液5－HT,HVA,MHPG,5－HIAA进行检测,并以比值作为相互作用的指标。结果：精神分裂症组HVA／MHPG,5－HTAA／5－HT比值较对照组明显降低。治疗后HVA／MHPG比值两组间差异消失,而HVA／5－HIAA组间差异仍有显著性。结论：以阳性症状为主的精神分裂症存在5－HIAA／5－HT的降低及多巴胺和去甲肾上腺素相互作用的异常。     

抑郁症患者自杀与脑脊液单胺代谢产物的关系

目的：探讨抑郁症患者自杀与脑脊液单胺代谢产物之间的关系。方法：应用高效液相色谱法，测定24例抑郁症患者(自杀组10例，无自杀组14例)及25例对照组5-羟色胺(5-HT)代谢产物5-羟吲哚乙酸(5-HIAA)，去甲肾上腺素(NE)代谢产物3-甲基-4-羟苯乙二醇(MHPG)及多巴胺(DA)代谢产物高香草酸(HVA)的浓度。结果：抑郁症自杀组5-HIAA浓度显著低于对照组，男性自杀组5-HIAA浓度、HVA浓度和HVA／MHPG比值均显著低于男性对照组，女性则无显著差异：结论：抑郁症患者自杀可能与5-HT和DA功能低下以及DA和NE之间的关系改变有关。     

帕金森病伴发抑郁患者血小板5-羟色胺浓度的对照研究

目的 了解5-羟色胺(5-HT)在帕金森病(PD)伴发抑郁症状中的作用.方法 采用高效液相色谱法,分别测定60例PD患者(伴发抑郁症状31例)和48 例正常对照者的血小板5-HT含量.结果 51. 7 %的PD患者伴发抑郁症状,PD组5-HT浓度较正常组显著下降,伴发抑郁组PD患者血小板5-HT浓度较未伴发抑郁组亦显著降低.结论 本文研究结果支持5- HT 代谢异常在PD患者中起重要作用的理论,纠正血小板5-HT浓度异常可能会促进PD患者神经功能康复.     

无先兆偏头痛患者血单胺类递质变化的研究

目的 了解5－羟色胺（5－TH）、5－羟吲哚乙酸（5－HIAA）、多巴胺（DA）、去甲肾上腺素（NE）在无先兆偏头痛发病中的作用。方法 用荧光分光光度法检测35例无先兆偏头痛患者（发作期16例、间歇期19例）和23例正常人血浆及血小板5－HT、5－HIAA、DA、NE含量。结果 无先兆偏头痛患者发作期组血浆5－HT含量低于对照组（P＜0.05),而5－HIAA含量高于对照组（P＜0.01）;间歇期组5－HT含量高于发作期组,而5－HIAA含量低于发作期组（P＜0.01）;发作期组血浆DA、NE含量均低于对照组（P＜0.01）间歇期组血浆DA与发作期组相比亦有显著性差异（P＜0.01）。无先兆偏头痛患者发作期组血小板5－HT含量高于对照组和间歇期组,而5－HIAA含量低于对照组和间歇期组（P＜0.01）;而发作期组血小板NE含量高于对照组和间歇期组（P＜0.01）;DA含量则低于对照组和间歇期组（P＜0.01）。结论 单胺类递质对偏头痛的发生可能有重要意义。     

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.