中药组方联合盐酸帕罗西汀治疗老年脑卒中后抑郁的近期疗效观察

目的探索中药组方联合盐酸帕罗西汀治疗老年脑卒中后抑郁的近期疗效。方法选取2015年5月—2017年5月就诊于清河县中心医院神经内科162例老年脑卒中后抑郁患者,随机分为对照组和治疗组,对照组给予盐酸帕罗西汀治疗,治疗组给予中药组方联合盐酸帕罗西汀治疗,观察两组治疗后汉密尔顿抑郁量表17项(HAMD-17)、日常生活能力量表(ADL)、抑郁缓解情况及不良反应。结果治疗后治疗组HAMD-17和ADL评分均较对照组低(tHAMD-17=11.571,tADL=2.601,P<0.05);治疗组抑郁缓解总有效率高于对照组(χ2=8.783,P=0.003),不良反应低于对照组(t=18.734,P<0.05)。结论中药组方联合盐酸帕罗西汀可有效改善老年脑卒中后抑郁症状,提高患者日常生活能力,值得临床推广应用。     

米那普仑治疗老年卒中后抑郁的临床疗效

目的 探讨米那普仑对比舍曲林治疗老年卒中后抑郁症的临床疗效和不良反应。方法 选取2018年1月～2019年6月我院收治的48 例诊断为脑卒中后抑郁的老年患者,随机分为两组,研究组使用米那普仑,对照组使用舍曲林,治疗8 周,采用汉密尔顿抑郁量表（HAMD）和神经功能缺损量表（CSS）、匹兹堡睡眠质量指数量表（PSQI）、副反应量表（TESS）评定临床疗效、睡眠质量指数和不良反应。结果 研究组和对照组治疗老年脑卒中后抑郁的HAMD、CSS、PSQI 评分无显著性差异,总有效率分别为88.0%和91.3%,差异无统计学意义（P＞0.05）;副反应量表显示研究组与对照组均未出现严重不良反应,两组间无统计学差异（P＞0.05）。结论 米那普仑有利于老年脑卒中后抑郁患者改善抑郁症状,促进神经功能康复,提高生活能力,是一种安全有效、副反应少的抗老年卒中后抑郁药。     

Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series

ABSTRACT

Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.     

谷氨酸能系统障碍与卒中后抑郁

近年来,大量研究表明谷氨酸能系统障碍可能与卒中后抑郁（PSD）的发病机制密切相关。本文主要从外周血小板功能障碍、海马神经元再生及重塑障碍两方面阐述谷氨酸能系统障碍在PSD病理生理机制中发挥的作用。     

卒中亚急性期抑郁与急性期血浆同型半胱氨酸水平的相关性研究

目的 研究卒中亚急性期发生的卒中后抑郁（post-stroke depression,PSD）与卒中急性期血浆同型半胱氨酸（homocysteine,Hcy）水平的相关性。
方法 连续收集2010年4月～2011年7月北京航天总医院神经内科住院的198例缺血性卒中患者,根据《中国精神疾病分类方案与诊断标准》第3版（Chinese Classification and Diagnostic Criteria of Mental Disorders-3,CCMD-3）进行PSD的诊断,根据诊断结果分为PSD组102例和卒中后无抑郁组（对照组）96例。由固定的、经过培训的心理咨询师对PSD患者进行汉密尔顿抑郁量表17项（Hamilton Rating Scale for Depression-17,HRSD-17）评定,根据评定结果分为轻度、中度、重度抑郁组。采用微量荧光偏振免疫分析法于入院次日对所有患者进行血浆Hcy水平测定,比较两组患者血浆Hcy水平,并与PSD进行相关分析。
结果 PSD组102例患者有高同型半胱氨酸血症（hyperhomocysteinemia,HHcy）68例（66.7%）,对照组有12例（12.5%）,PSD组HHcy阳性检出率较对照组差异具有显著性（χ2=17.29,P＜0.001）。经非条件Logistic回归分析PSD的危险因素,显示血浆Hcy水平与PSD有相关性[优势比（odds ratio,OR）=1.946,P<0.001,95%可信区间（confidence interval,CI）1.10～1.22]。
结论 卒中急性期血浆Hcy水平与卒中亚急性期抑郁有相关性。     

Modified constraint-induced therapy for children with hemiplegic cerebral palsy: A feasibility study

Purpose: To determine the feasibility of family-focused, modified constraint-induced therapy with children with hemiplegic cerebral palsy and test study procedures in preparation for a randomized controlled trial.

Design: Prospective pre–post feasibility study.

Methods and procedures: Ten children (median age: 3 years 6 months) were assessed at baseline, at completion of intervention and at 6 months post-baseline. Intervention consisted of a mitt worn on the unaffected hand for 2?hours per day for 8 weeks. Targeted adjunct therapy was provided during the time the mitt was worn. Primary assessments included the Canadian Occupational Performance Measure, Goal Attainment Scaling, Assisting Hand Assessment and the Melbourne Assessment of Unilateral Upper Limb Function.

Outcomes: Modified constraint-induced therapy as implemented in this study was acceptable to participants. Over the intervention period, participants experienced improvements in the performance of important daily activities as determined by the primary outcome measures.

Conclusions: Modified constraint-induced therapy which targets participant-identified goals and which is family-focused warrants further investigation utilizing randomized trial methodology.

Propósito: Determinar la viabilidad de la terapia modificada de inducción de restricción enfocada en la familia en niños con parálisis cerebral hemipléjica, y evaluar procedimientos de estudio en la preparación de una prueba controlada aleatorizada. Diseño: Estudio prospectivo pre-post viabilidad. Métodos y procedimientos: Se evaluaron a diez niños (edades medias: 3años 6 meses) en una etapa inicial, al completar el tratamiento y a los seis meses después de la evaluación inicial. La intervención consistió del uso de un guante en la mano no afectada durante 2 horas al día por 8 semanas. La terapia adjunta fue proporcionada durante el periodo de tiempo en que el guante fue usado. Los instrumentos de evaluación primaria incluyeron: Canadian Occupational Performance Measure, Goal Attainment Scaling, Assisting Hand Assessment y the Melbourne Assessment of Unilateral Upper Limb Function. Resultados: La terapia de inducción de restricción modificada fue aceptada por los participantes de la forma en que fue implementada en este estudio. Los participantes experimentaron mejoría en el desempaño de las actividades de la vida diaria durante el periodo de tratamiento, siendo determinado esto por los resultados de las mediciones primarias. Conclusiones: El hecho de que las terapias de inducción de restricción modificada tengan como objetivo metas identificadas por los pacientes y un enfoque familiar, sienta precedente para la realización de investigaciones futuras que utilicen una metodología de pruebas aleatorizadas. Palabras clave: Terapia de inducción restringida modificada, parálisis cerebral, función del miembro superior, pediátrica, enfocado en la familia, hemiplejia     

Antidepressant-like effects of paeoniflorin on post-stroke depression in a rat model

ABSTRACT

Background: Post-stroke depression (PSD) is one of the most prevalent emotional disorders after stroke and often results in poor outcomes. However, the underlying physiopathologic mechanism and effective treatment of PSD remain poorly elucidated.

Objective: To investigate whether paeoniflorin has antidepressant-like activity in a rat model of PSD.

Methods: Rats were randomly divided into four groups: sham-operated control (Sham), PSD, paeoniflorin (with PSD) and fluoxetine group(with PSD). PSD was developed by the right middle cerebral artery occlusion followed 21 days chronic unpredictable mild stress combined (CUMS) with raised alone. Tests of sucrose preference and open field were used to assess the depression-like behavior. Neurological function was evaluated by neurological deficit score and beam balance test. Expression of phosphorylated CREB (p-CREB) and brain-derived neurotrophic factor (BDNF) in the CA1 region of the hippocampal complex was evaluated by western blot and immunofluorescence.

Results: Te depressive-like behaviors markedly improved after paeoniflorin and fluoxetine treatment. Furthermore, paeoniflorin treatment significantly increased BDNF and p-CREB expression in the CA1 region.

Conclusions: Observed results suggested that paeoniflorin could ameliorate the symptoms and improve the functional capability of PSD rats, similar to the effect of fluoxetine.

Abbreviations: PSD: post-stroke depression; CUMS: chronic unpredictable mild stress stimulation; MCAO: middle cerebral artery occlusion; OFT: open field test; SPT: sucrose preference test, NDS: neurological deficit score, BBT: beam balance test; BDNF: brain-derived neurotrophic factor protein; p-CREB: phosphorylated Cyclic-AMP responsive element binding protein     

Error-based training and emergent awareness in anosognosia for hemiplegia

Residual forms of awareness have recently been demonstrated in subjects affected by anosognosia for hemiplegia, but their potential effects in recovery of awareness remain to date unexplored. Emergent awareness refers to a specific facet of motor unawareness in which anosognosic subjects recognise their motor deficits only when they have been requested to perform an action and they realise their errors. Four participants in the chronic phase after a stroke with anosognosia for hemiplegia were recruited. They took part in an “error-full” or “analysis of error-based” rehabilitative training programme. They were asked to attempt to execute specific actions, analyse their own strategies and errors and discuss the reasons for their failures. Pre- and post-training and follow-up assessments showed that motor unawareness improved in all four patients. These results indicate that unsuccessful action attempts with concomitant error analysis may facilitate the recovery of emergent awareness and, sometimes, of more general aspects of awareness.     

针刺治疗脑卒中后痉挛性瘫痪疗效比较的系统评价与Meta分析

目的:系统评价针刺治疗脑卒中后痉挛性瘫痪的疗效。方法:电子检索国内外数据库中针刺治疗脑卒中后痉挛性瘫痪的随机对照试验(Randomized Controlled Trial,RCT),并由两名评价者按照Cochrane Handboo5.1.0中的方法独立进行文献筛选和质量评估,运用Rev Man5.3软件进行数据统计和Meta分析。结果:最终纳入15个RCT,共包括940例患者。Meta分析显示:(1)有效率:试验组高于对照组,有统计学意义[OR=1.88,95%CI(1.35,2.61)];(2)MAS评分:针刺(综合)组疗效优于康复组,有统计学意义[WMD=-0.58,95%CI(-0.77,-0.39)];(3)FMA评分:试验组疗效优于对照组,有统计学意义[WMD=10.90,95%CI(8.69,13.11)]。结论:针刺治疗脑卒中后痉挛性瘫痪有一定的疗效,在与康复结合时更能凸显优势。但是由于纳入文献研究质量不足,目前不能对其疗效得出肯定性结论,需要以更多高质量的多中心随机对照试验进一步证实。     

重复经颅磁刺激联合盐酸帕罗西汀对卒中后抑郁症患者治疗效果观察

目的 探讨重复经颅磁刺激(rTMS)联合盐酸帕罗西汀对卒中后抑郁症(PSD)患者HAMD评分及血清神经肽Y(NPY)、促肾上腺皮质激素释放因子(CRF)、脑源性神经营养因子(BDNF)水平变化的影响。 方法 选取郑州大学第二附属医院2014年11月至2017年2月PSD患者68例,随机数字表法分组,各34例。对照组采用盐酸帕罗西汀,观察组采用盐酸帕罗西汀+rTMS,两组均持续治疗2个月。入院时及治疗结束后统计对比两组抑郁评分(HAMD、MARDS、SDS)、血清NPY、BDNF、CRF水平、临床疗效及不良反应发生率。 结果 ①两组治疗后MARDS、HAMD及SDS分值低于治疗前,且观察组较对照组低(P＜0.05);②两组治疗有效率比较,观察组94.12%(32/34)较对照组64.71%(22/34)高(P＜0.05);③两组治疗后血清CRF水平低于治疗前,BDNF及NPY水平高于治疗前,且观察组各指标优于对照组(P＜0.05);④两组不良反应发生率比较,观察组14.71%(5/34)与对照组8.82%(3/34)间差异无统计学意义(P＞0.05)。 结论 联合采用盐酸帕罗西汀及rTMS治疗卒中后抑郁症效果显著,可有效改善血清NPY、BDNF、CRF水平,降低HAMD评分,减轻患者抑郁程度,提高治疗效果,且不会增加不良反应发生风险,具有安全性。