丁基苯酞对神经系统疾病的作用及机制

丁基苯酞对多种神经系统疾病，如脑缺血、脑外伤、记忆障碍、惊厥等有治疗作用。本文就其作用机制做一概述。     

巴氯酚口服对脑卒中偏瘫所致肌肉痉挛之缓解作用观察

目的探讨巴氯酚对脑卒中痉挛性偏瘫患者肢体痉挛状态的缓解作用。方法将均为首次发病的脑卒中痉挛性偏瘫患者100例按住院的先后顺序,随机分为治疗组和对照组各50例。其中对照组采用综合康复治疗方法 ,包括抗痉挛体位摆放、被动关节活动、持续牵张运动、手法按摩、肢体空气压力治疗、站立训练、健康教育等。治疗组在上述康复治疗的基础上采用口服巴氯酚治疗。两组均于治疗前和治疗后45d对肌张力进行评分。采用改良巴氏指数(MBI)评定日常生活活动能力(ADL)。结果经过治疗,两组患者肌张力较治疗前均有明显降低(P0.05),生活自理能力较治疗前有明显提高(P0.01),且治疗组疗效明显优于对照组(P0.05)。结论巴氯酚联合康复疗法对脑卒中所致偏瘫肌痉挛有显著的改善作用。     

咪哒唑仑对罗哌卡因致惊厥作用的影响

目的从致惊厥的行为学、安全性角度探讨咪哒唑仑对罗哌卡因致惊厥作用的影响。方法皮下注射咪哒唑仑20min后,腹腔注射罗哌卡因,观察小鼠惊厥潜伏期、持续时间、未惊厥率及其死亡率：并按序贯法分析咪哒唑仑对罗哌卡因致惊厥半数有效量（ED50）和半数致死量（LD50）的影响。结果0．5、1．0mg／kg咪哒唑仑可显著延长罗哌卡因致小鼠惊厥潜伏期（P〈0．05。P〈0．01）,显著缩短惊厥持续期（P〈0．01）,减少惊厥发生率和死亡率;且本试验剂量咪哒唑仑（0．2、1．0mg／mL与5．0、7．5mg／mL）可分别增大罗哌卡因致惊厥ED50和LD50。结论咪哒唑仑可缓解罗哌卡因的致惊厥作用,结果对临床联合用药有一定的参考意义。     

Genetic analysis of PRRT2 for benign infantile epilepsy,infantile convulsions with choreoathetosis syndrome,and benign convulsions with mild gastroenteritis

Purpose: PRRT2 mutations were recently identified in benign familial infantile epilepsy (BFIE) and infantile convulsions with paroxysmal choreoathetosis (ICCA) but no abnormalities have so far been identified in their phenotypically similar seizure disorder of benign convulsions with mild gastroenteritis (CwG), while mutations in KCNQ2 and KCNQ3 have been recognized in benign familial neonatal epilepsy (BFNE). The aim of this study was to identify PRRT2 mutations in infantile convulsions in Asian families with BFIE and ICCA, CwG and BFNE. Methods: We recruited 26 unrelated Japanese affected with either BFIE or non-familial benign infantile seizures and their families, including three families with ICCA. A total of 17 Japanese and Taiwanese with CwG, 50 Japanese with BFNE and 96 healthy volunteers were also recruited. Mutations of PRRT2 were sought using direct sequencing. Results: Heterozygous truncation mutation (c.649dupC) was identified in 15 of 26 individuals with benign infantile epilepsy (52.1%). All three families of ICCA harbored the same mutation (100%). Another novel mutation (c.1012+2dupT) was found in the proband of a family with BFIE. However, no PRRT2 mutation was found in either CwG or BFNE. Conclusions: The results confirm that c.649dupC, a truncating mutation of PRRT2, is a hotspot mutation resulting in BFIE or ICCA regardless of the ethnic background. In contrast, PRRT2 mutations do not seem to be associated with CwG or BFNE. Screening for PRRT2 mutation might be useful in early-stage differentiation of BFIE from CwG.     

The family attitudes towards febrile convulsions

Giving adequate information about febrile convulsion and its prognosis would be helpful in alleviating parental stress, and would contribute to decrease in the morbidity of febrile convulsion. In this study, the knowledge level of parents on taking body temperature, and decreasing high fever, their attitudes during febrile convulsion and the impact of febrile convulsion on parents are evaluated. One hundred seventy-four parents of 132 children with FC were enrolled in the study. Twenty-seven per cent of parents had no thermometer at home, 32.8% of them did not know how to take a temperature, 72.2% of them did not know the minimum range of increased body temperature, and 69.5% of them did not know how to decrease the increased body temperature. Thirty-six percent of parents recognised the convulsions when their children suffered from them, the others assumed the convulsion were fainting spells (6.9%), near death state (38.5%) and suffocation (18.4%). Thirty-six per cent of parents brought their children to the hospital without doing anything themselves. Most parents (91.4%) had a fear of a recurrence of febrile convulsion in their children. Seventy-four per cent of parents complained of insomia, 24.3% parents had dyspeptic symptoms even 14 parents had weight loss due to dyspepsia.     

四位新安医家惊风创见探析

惊风是儿科常见的危急重症,常常危害小儿生命,孙一奎、程杏轩、许豫和、王君萃四位新安医家对惊风理论研究和临床治疗多有建树,率先提出"惊风非惊"之说,革除惊风妄名之弊,指明惊风之误,痛斥滥药之非,创立"小儿烧针法"。新安医家不泥前贤旧说,阐述理论新知的学术创新精神,正是对"发群贤未有之论,破千古未决之疑"古老传统的继承与发扬。     

静脉应用阿米卡星和庆大霉素致骨骼肌强直痉挛各1例

例1,男,30岁。因＂呕吐腹泻5h＂就诊于一社区门诊,诊断为胃肠炎,应用阿米卡星500万U静脉滴注（静滴）,静滴完毕后约1h,在输用维生素C及维生素B6过程中突然出现面部、四肢骨胳肌强直收缩伴剧烈疼痛,难以忍受,故由＂120＂车接入我科。查体：T 37℃,P 82次/min,R 20次/min,BP165/90mmHg（1mmHg=0.133kPa）,发育正常,营养中等,神志清楚,语言欠清,抬入病房,查体合作。     

热惊厥幼龄大鼠脑内Prolactin蛋白及Zinc transporter 1 mRNA表达

目的 探讨热应激(Heat stress,HS)和热惊厥(Febrile convulsions,FC)对脑内催乳素蛋白(Prolactin,PRL)和锌离子转运体1(Zinc transporter 1,ZnT1)表达的影响,探讨FC的神经免疫学机制.方法 实验在浙江大学附属邵逸夫医院中心实验室进行.采用热水浴诱导FC模型.21 d龄雄性sD大鼠随机分为正常对照组(8只)和热应激组(28只),28只热应激处理大鼠中15只达到5级(设为热性惊厥组,FC),10只未出现惊厥(设为单纯热应激组,HS),3只达到2级惊厥,弃用.应用免疫组织化学技术对HS和FC大鼠PRL免疫反应性在不同脑区的表达进行分析,原位杂交检测ZnT1表达.各组阳性细胞数采用方差分析进行统计.结果 ①对照组大脑皮层偶见零星表达,着色淡且无定位分布特征.HS组PRL-IR阳性细胞在大脑皮层PIR、Ent和Rs区免疫染色较深,PRH、PAR和Fr区染色较浅;另外PRL-IR阳性细胞还分布于丘脑中线一带;而FC组则于大脑皮层、海马、杏仁核、丘脑及下丘脑见大量PRL-IR阳性细胞,呈弥漫性分布,无明显核团分布特征.②HS和FC两组大脑皮层各区PRL-IR阳性细胞数均明显高于对照组(P<0.01).FC组大鼠大脑皮层PIR、Ent、RS区PRL-1R阳性细胞数与HS组大鼠差异无统计学意义(F值分别为688.9、744.3、0.56,P>0.05),PRH和PAR区FC组明显高于HS组(F值分别为2.68、1.48,P<0.01).③FC组海马区域可见明显ZnT1 mRNA表达,而HS组和对照组无明显表达.结论 ①PfuL在HS组和FC组大脑皮层各区明显表达,而FC组在海马和杏仁核等前脑结构内亦有明显表达,表明PRL不仅与热应激的中枢调控有关,也参与海马等前脑结构对惊厥活动的中枢调控机制.②FC组海马ZnT1 mRNA明显表达提示FC组海马区域存在异常增高的锌离子转运.     

Unidirectional interaction between flurothyl seizures and amygdala kindling

In this report, the interaction between flurothyl convulsions and electrical kindling of the amygdala was investigated. Three flurothyl convulsions decreased the afterdischarge threshold of the amygdala and enhanced the rate of development of electrical kindling without affecting the intensity of postictal refractoriness. On the other hand, 3 generalized kindled convulsions did not alter the flurothyl convulsive threshold. The data suggest that the influence of generalized convulsions on future seizure susceptibility may depend on the agents used to induce the convulsions.