食物不耐受与抽动症的相关性研究

目的 对抽动症患儿进行食物不耐受检测,了解患儿食物过敏情况,并分析食物不耐受与抽动症的相关性。方法 采用回顾性分析的方法,收集 2016年1月-2017年10月于武汉大学人民医院小儿神经科门诊及病房就诊的符合条件的抽动症患儿61例,其中男39例,女22例,对照组为在武汉大学人民医院体检的4岁以上的无抽动障碍的儿童50例,其中男28例,女22例。采用ELISA半定量间接法检测两组儿童血清中14种食物过敏原的特异性抗体IgG,并做对比分析。结果 对两组儿童进行食物不耐受检测,61例抽动症患儿中60例结果阳性,阳性率达98.4％;50例健康儿童中39例结果阳性,阳性率78.0 %,差异有统计学意义(P＜0.01)。抽动症患儿对多种食物不耐受的程度较健康儿童高(1种食物不耐受:23.0%vs.34.0%;2种:24.6%vs.38.0%;3种:34.4%vs.6.0%;4种:16.4%vs.0%,P＜0.01)。两组儿童不耐受的食物主要是鸡蛋和牛奶,但抽动症患儿不耐受的程度较健康儿童组严重(即IgG为+++: 36.7% vs. 19.7%,P＜0.001)。 结论 食物不耐受检测可作为抽动症患儿寻找食物过敏原的一个有效途径,并可指导抽动症患儿的饮食,促进儿童健康成长。     

多发性抽动症的临床与脑电图特征分析

目的：探讨多发性抽动症（tourette syndrome,TS）的临床及脑电图（EEG）特征。方法：对164例多发性抽动症患儿的临床及脑电图资料进行回顾性分析。结果：EEG异常36例,异常率22％,其中32例表现为枕区基本节律慢化,α波指数减少,α波调节调幅不良,阵发高幅θ节律等非特异性异常。另4例表现为典型的癫痫样放电。结论：部分TS患儿有EEG的异常改变,且EEG的异常与病程的长短及严重程度存在一定的对应关系,EEG可作为评估病变严重程度的客观依据之一。     

柴胡龙骨牡蛎汤应用体会

柴胡加龙骨牡蛎汤于和解寓有通阳和表,泻热清里,重镇安神之义,方药合拍,是身心疾病对证施治之良剂,临床用其治疗郁证-阴道抽搐症,多动秽语综合征,失眠症,心神经官能症--惊悸,均取得佳效,另外还用其治疗产后抑郁症、癫痫、厥证、慢惊风等病证。     

开四关治疗痰火内扰型小儿抽动秽语综合征临床观察

目的：观察毫针刺四关穴治疗痰火内扰型小儿抽动秽语综合征(PTS)的临床疗效。方法：选取48例痰火内扰型PTS患者随机分为试验组与对照组(每组24例),对照组采用西药常规治疗,试验组在此基础上采用针刺开四关法治疗。此两组针对运动性抽动和发声性抽动分别进行评估,得出耶鲁抽动症整体严重度量表的评估得分,使之和临床疗效有进一步的比较分析。结果：试验组总有效率为95.83%,对照组58.33%,试验组疗效优于对照组(P<0.05),试验组缓解发声性和运动性抽动症状的效果优于对照组(P＜0.05)。结论：开四关法毫针刺治疗PTS疗效确切,对发声性抽动的改善明显,操作简单,安全性高,值得临床推广。     

Immunopathogenic mechanisms in tourette syndrome: A critical review

Tourette syndrome (TS) has a multifactorial etiology, in which genetic, environmental, immunological and hormonal factors interact to establish vulnerability. This review: (i) summarizes research exploring the exposure of TS patients to immune‐activating environmental factors, and (ii) focuses on recent findings supporting a role of the innate and adaptive immune systems in the pathogenesis of TS and related disorders. A higher exposure prior to disease onset to group A β‐haemolytic streptococcal (GABHS) infections in children with tics and obsessive‐compulsive (OC) symptoms has been documented, although their influence upon the course of disease remains uncertain. Increased activation of immune responses in TS is suggested by changes in gene expression profiles of peripheral immune cells, relative frequency of lymphocyte subpopulations, and synthesis of immune effector molecules. Increased activity of cell‐mediated mechanisms is suggested by the increased expression of genes controlling natural killer and cytotoxic T cells, increased plasma levels of some pro‐inflammatory cytokines which correlate with disease severity, and increased synthesis of antineuronal antibodies. Important methodological differences might account for some inconsistency among results of studies addressing autoantibodies in TS. Finally, a general predisposition to autoimmune responses in TS patients is indicated by the reduced frequency of regulatory T cells, which induce tolerance towards self‐antigens. Although the pathogenic role of immune activation in TS has not been definitively proven, a pathophysiological model is proposed to explain the possible effect of immunity upon dopamine transmission regulation and the generation of tics. © 2009 Movement Disorder Society     

伴与不伴多动的Tourette综合症脑电图对比分析

目的:探讨伴与不伴注意缺陷多动障碍(ADHD)的Tourette综合症(TS)之间的脑电图变化差异。方法:对65例患儿进行常规EEG描记研究分析。采用Conners父母用症状问卷(PSQ)、Conners多动指数(CNS)及中国儿童韦氏智力测定量表(C-WISC)进行评定。结果:伴ADHD的TS患儿EEG异常率显著高于单纯TS,主要表现为慢波异常以及癫癎样波。结论:TS在神经生理学上存在异质性。TS与ADHA之间在解剖生理及生化上的关联有待进一步探讨。     

针灸治疗多发性抽动症研究述评

目的：对针灸治疗多发性抽动症的应用进行述评。方法：对近10 a来针灸治疗多发性抽动症的文献资料进行综述。结果：针灸治疗多发性抽动症已取得较大进展,具有疗效好、不良反应小等特点,针灸治疗多发性抽动症的确能取得满意疗效,但仍有不足之处。结论：针灸治疗多发性抽动症疗效显著,具有广阔的发展前景。     

Tic disorders in childhood

Despite our familiarity with tic disorders, their management remains challenging. The difficulty seldom relates to the diagnosis, which is usually based on the history, but rather in dealing with the impact of the tics and multiple comorbidities. The child and family must be educated and must be taught how to facilitate a positive attitude among others who come in contact with the patient. Knowledge and acceptance of the tics by other family members, peers, teachers, and coaches often become central to the child's well-being. Although many children can be managed without pharmacotherapy, medications are often central to achieving success. The goals of therapy and the appropriate choice of medication must be individualized. We are frequently challenged not only by the wide array of medication choices available but also by the decision of which symptom to treat first. The tics, despite being flamboyant, are often viewed by the child and family as less disabling than co-occurring conditions, such as attention-deficit hyperactivity disorder, obsessive-compulsiveness, or rage. Even when tics are the major issue, patients must define their goals for therapy. It is unreasonable to expect a complete resolution of tics and safety usually rules in favor of better tolerated but potentially less efficacious therapies. Developing strategies to minimize the lifelong impact of the multiple components of Tourette syndrome is an essential aspect of the care of these patients.