Frontal lobe epilepsy presented as ictal aggression

Abstract Aggressive behaviour is rarely observed as an ictal semiology. Ictal aggression can occur in lesions of frontal and limbic structures. In limbic structure lesions, the main mechanism of aggressive behaviour is hyperactivity; whereas frontal lesions may cause aggressive behaviour with an indirect mechanism in which the suppression on limbic system is lost. Here we present a patient with ictal aggression. In this case a right frontoparietal epileptiform focus was detected during the postictal period. Magnetic resonance imaging showed cortical dysplasia on the right inferior frontal gyrus. The seizures disappeared completely after pharmacological treatment.     

Atypical presentation of NREM arousal parasomnia with repetitive episodes

The case report describes a distinct variant of non-REM (Rapid Eye Movement) arousal parasomnia, sleepwalking type, featuring repetitive abrupt arousals, mostly from slow-wave sleep, and various automatisms and semi-purposeful behaviours. The frequency of events and distribution throughout the night presented as a continuous status of parasomnia (' status parasomnicus '). The patient responded well to treatment typically administered for adult NREM parasomnias, and after careful review of the clinical presentation, objective findings and treatment outcome, sleep-related epilepsy was ruled out in favour of parasomnia.     

海人酸致大鼠海马结构GABA_B受体亚单位表达的研究

目的:探讨海人酸诱导大鼠颞叶癫(EP)发作后2种γ-氨基丁酸(GABA)受体亚单位GABABR亚单位1a(GBR1a)和GABABR亚单位2(GBR2)在EP发生、发展中的作用。方法:运用原位杂交及免疫组化法,检测EP发作后GABABR亚单位mRNA及蛋白在海马的表达。结果:致早期CA1和CA3区2种亚单位mRNA表达持续低下后逐渐增加,DG区则暂时性下降后很快回升;而免疫反应早期却未见明显改变,随后CA1和CA3区表达处于低水平,DG区和颞叶皮质表达下降后很快恢复。结论:致后2种GABAB受体亚单位基因和蛋白表达上调为颞叶EP的内源性自我保护机制。     

肥大肝叶内胆管结石的处理

目的探讨在肝肥大-萎缩征中肥大肝叶内胆管结石的处理方法。方法回顾性分析我科1990年6月～2004年12月收治的103例肥大肝叶内胆管结石病人的临床资料，总结其手术治疗的原则和方法。结果全体病例均经手术治愈，术后残石率17．5％，效果优良率83．7％。结论肥大肝叶内的胆管结石，手术难度大，应根据病情选择手术方式，既要遵循肝胆管结石的治疗原则，又要保护赖以生存的肥大肝叶（段）。     

Evaluating therapeutic outcome in epileptic patients using the changes of interval and duration

BACKGROUND: Seizure frequency is in abnormal distribution, and it is not enough to express the trend of concentration using means, and its median loses a lot of information, thus it lacks of a standard for evaluating the therapeutic effects based on seizure frequency. OBJECTIVE: To establish a method for evaluating the therapeutic effects on anti-epileptic drugs using changes of interval and duration of seizure. DESIGN: A prospective cohort study. SETTING: Zhumadian Psychiatric Hospital. PARTICIPANTS: Outpatients and inpatients suffering from epilepsy attending firstly visited Zhumadian Psychiatric Hospital from June 2001 to June 2002 were enrolled. They were diagnosed as epileptic according to the International Classification of Epileptic Seizure by International League Against Epilepsy (1981) based on the clinical history, physical examination, and investigations. The interval time was no more than 6 months. Informed consent was obtained from all the subjects, and the study was approved by the hospital ethical committee. METHODS: ① For the first visit and each follow-up, the following data were recorded, including general demographic information, seizure type, the date and time of ictus, the duration of ictus, and inducement or situation related, according to which the following indexes could be calculated, including seizure styles, interval, duration, cluster frequency and cluster duration. The information from the first review was noted as annals A. The second interview was taken at the end of the evaluating period; the information from the second review was noted as annals B. The third interview was taken within two weeks after the second one; the information from the third review was noted as annals C. The annals B or the annals C were respectively compared with the annals A in the light of the same types or the same styles of the same patient. Summation of the scores of interval change and duration change of the same type or the same style and 5 of basic score was the score of a corresponding seizure type or a corresponding style of one patient. In order to test its reliability and validity, the score of change of frequency or duration plus 5 scores respectively was the score of frequency or duration. ② Reliability and validity were tested by calculating corresponding correlation coefficient with SPSS 11.0. ROC curve was used for developing diagnostic criterion of predicting therapeutic effects with SPSS 11.0. MAIN OUTCOME MEASURES: ① Reliability and validity; ② Diagnostic criterion for predicting therapeutic effects one year later. RESULTS: Totally 28 patients were involved in the final analysis of results. ① Reliability and validity were high: rinter-rater=0.98, rtest-retest=0.99, rconstruct validity=0.83. ② A total score > 6 was the optimal diagnostic criteria for predicting therapeutic effects one year later, in other words, a patient who scored more than 6 at the evaluating period may be seizure-free one year later. CONCLUSION: It is a potential tool for evaluating epileptic therapeutic outcome, and it can be diffusely used in interrelated fields after being further validated.     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.     

中风后癫痫的临床研究

本文报告３６例中风后癫痫发作的临床和ＣＴ资料。通过回顾性病历复习和随访发现，中风后癫痫的发生率占同期住院中风患者的５．２６％，以蛛网膜下腔出血和脑栓塞发生癫痫比率最高，分别为１５％和１２．５％。癫痫发作与ＣＴ所见病灶分布密切相关，皮质病灶较皮质下病灶更易发生病病。癫痫发作可发生于中风后任何时期，但早期癫痫以出血性中风多见，而迟发性癫痫则更多见于脑梗塞患者。     

Approach through the temporal horn of the lateral ventricle for clipping of large dorsal type basilar bifurcation aneurysms

Summary The authors describe an approach through the temporal horn of the lateral ventricle which proved to be useful for clipping of a large dorsal type basilar bifurcation aneurysms. It facilitates the preservation of the perforating arteries behind the aneurysm, because it gives sufficient working space to move the aneurysm dome. Furthermore this approach avoids many of the disadvantages of other approaches, especially the risk of iatrogenic injuries of the Sylvian or Labe's vein.