癫痫预测方法的分析与研究

癫痫预测目的有两个:从技术的层面去理解癫痫发作的机理,并对癫痫发作进行测量和改善,探索引发癫痫发作的周期性及先兆;开发出可靠的"癫痫发作前预警及治疗装置".癫痫预测的主要研究方法有:频域分析方法;时序分析方法;智能系统工程方法;非线性动力学方法.目前,越来越多的研究集中在非线性动力学的方法上,且来自多种方法的很多证据证明癫痫可以预测.     

癫痫预测面临问题的分析与展望

癫痫是神经科常见疾病,具有反复发作和难以治愈的特征。对癫痫发作的预测可以使医护人员或患者提前采取有效措施来降低或避免癫痫发作所带来的损伤。从20世纪90年代至今,癫痫预测算法得到了长足发展,同时也面临着如算法精确度、数据处理方式、预测能力有限等方面的问题。本文对上述问题进行了整理阐述,并对癫痫预测算法的发展趋势做了进一步分析。     

新生儿癫痫与脑发育的关系

患有癫痈的新生儿在成年期癫痫发作、智能障碍和行为问题的发生率明显增高。新生儿癫痈远期危害的确切机制尚不明确。癫痫发作对成熟脑和发育脑的影响具有差异性,新生儿期癫痈发作可能通过干扰脑的正常发育,引起神经系统发育障碍。本文对新生儿癫痫与脑发育研究中亟待解决的问题作一初步探讨。     

脑电图判读对癫痫诊断和治疗的影响

脑电图(EEG)是癫痫诊断中最重要的实验室检查方法,对确定癫痫类型,合理选择抗癫痫药物发挥了重要作用。但由于EEG操作不规范,对EEG结果不适当或错误的判读和解释,以及临床医生缺乏对EEG临床应用的理解,导致将很多非癫痫性事件误诊为癫痫,或对已经长期控制发作的癫痫病人过度治疗,由此带来一系列的医疗和社会问题。这些现象在国内外均普遍存在,应引起相关学科的高度重视。应强调规范的EEG记录,提高对EEG的判读水平,并对神经科、儿科或癫痫专科医生进行必有的EEG培训,以更好的发挥EEG在癫痫诊治中的作用。     

脑电图判读对癫痫诊断和治疗的影响

脑电图(EEG)是癫痫诊断中最重要的实验室检查方法,对确定癫痫类型,合理选择抗癫痫药物发挥了重要作用.但由于EEG操作不规范,对EEG结果不适当或错误的判读和解释,以及临床医生缺乏对EEG临床应用的理解,导致将很多非癫痫性事件误诊为癫痫,或对已经长期控制发作的癫痫病人过度治疗,由此带来一系列的医疗和社会问题.这些现象在国内外均普遍存在,应引起相关学科的高度重视.应强调规范的EEG记录,提高对EEG的判读水平,并对神经科、儿科或癫痫专科医生进行必有的EEG培训,以更好的发挥EEG在癫痫诊治中的作用.     

自由基在癫痫发生及其治疗中的研究现状与进展

癫痫是一组包括许多不同症状的综合征,其主要特征是对反复出现的无明显诱因的发作的易感性。无论动物实验还是临床观察均表明癫痫时伴有活跃的自由基反应,自由基与癫痫的发生发展有着密切的联系。清除自由基,阻断自由基反应无疑为癫痫的治疗开辟了新的途径。本文就自由基在癫痫发生及其治疗中的研究现状与进展作一概述。目前应用自由基清除剂治疗癫痫尚处于临床试验阶段,但我们可以预见,进一步探索癫痫发生的自由基病理机制,开发有效清除自由基的药物具有广阔的前景,并将为人类最终战胜癫痫提供有力的帮助。     

自由基在癫痫发生及其治疗中的研究现状与进展

癫痫是一组包括许多不同症状的综合征,其主要特征是对反复出现的无明显诱因的发作的易感性.无论动物实验还是临床观察均表明癫痫时伴有活跃的自由基反应,自由基与癫痫的发生发展有着密切的联系.清除自由基,阻断自由基反应无疑为癫痫的治疗开辟了新的途径.本文就自由基在癫痫发生及其治疗中的研究现状与进展作一概述.目前应用自由基清除剂治疗癫痫尚处于临床试验阶段,但我们可以预见,进一步探索癫痫发生的自由基病理机制,开发有效清除自由基的药物具有广阔的前景,并将为人类最终战胜癫痫提供有力的帮助.     

右旋柠烯对幼鼠颞叶癫痫海马星形胶质细胞的影响

探讨右旋柠烯（D-L）对癫痫幼鼠海马星形胶质细胞胶质原纤维酸性蛋白（GFAP）的影响。利用尼氏染色及免疫组化技术观察匹罗卡品致癫痫的幼鼠经药物（左乙拉西坦、丙戊酸钠、D-L）治疗后星形胶质细胞形态学变化和GFAP的表达。尼氏染色显示药物治疗后幼鼠海马胶质神经元脱失较未治疗的幼鼠明显减轻;海马GFAP免疫阳性细胞数在药物治疗后的幼鼠较未治疗幼鼠明显减少（P〈O．05）。幼鼠癫痫发作可能与海马星形胶质细胞增生有关,D-L对发育期大鼠颞叶癫痫星形胶质细胞的增生及GFAP的表达似有抑制作用,推测D-L可能具有抗癫痫作用。     

癫痫儿童的智力结构及适应行为特点的初步研究

探讨癫痫儿童的智力结构及适应行为特点并进行相关因素分析。应用中国-韦氏儿童智力测验量表及儿童适应行为评定量表,进行智力测验及适应行为评定。结果癫痫儿童易出现智力及适应行为能力的缺陷,对于癫痫儿童的临床治疗,除积极控制癫痫发作外,应注重认知功能的保护,其中言语智力的开发及训练应给予特别关注,同时,也应注意社会心理因素对儿...     

成年癫痫患者伴发抑郁焦虑情绪及相关因素研究

50％成年癫痫患者伴发抑郁、焦虑情绪,影响了患者的疗效及生活质量,本文分别采用汉密尔顿抑郁、焦虑量表（HAMD、HAMA）、生活事件量表（LES）,对成年癫痫患者及正常人的抑郁、焦虑情绪及相关影响因素进行对照研究,探讨癫痫患者伴发抑郁焦虑情绪的比例、临床特征及主要影响因素,以期为临床医生的临床决策提供循证医学证据,从而全面提高癫痫患者的生活质量。     

Neonatal seizures: early-onset seizure syndromes and their consequences for development

The determination of the developmental consequences of seizure syndromes in the neonate is based upon a number of factors which include: understanding of the clinical and electroencephalographic (EEG) features of neonatal seizures; current theories of the mechanisms by which neonatal seizures are generated; a current classification of neonatal seizures; potential etiologic and risk factors for seizures; and therapies. In addition, different seizure types, mechanisms of generation and etiologies of cerebral dysfunction may vary with conceptional age of the infant. There are a few distinct neonatal epileptic syndromes, which are rare, have been well described: benign neonatal convulsions; benign neonatal familial convulsions; early myoclonic encephalopathy and early infantile epileptic encephalopathy. The prognosis for the first two is relatively good while the outcome for the other two with encephalopathy is catastrophic. However, the majority of neonatal seizures occur as acute, reactive events in association with a wide range of etiologic factors. These etiologic factors, as well as those of the more traditionally defined syndromes, are the main determinants of eventual developmental outcome of neonates who experience seizures. Although experimental data suggests that some epileptic seizures eventually may have physiological, histological, metabolic, or behavioral consequences, there is yet direct evidence in humans to suggest that the occurrence of seizures themselves in the neonate is the main determinant of long-term outcome.     

Anticipating seizure: pre-reflective experience at the center of neuro-phenomenology

The purpose of this paper is to show through the concrete example of epileptic seizure anticipation how neuro-dynamic analysis (using new mathematical tools to detect the dynamic structure of the neuro-electric activity of the brain) and "pheno-dynamic" analysis (using new interview techniques to detect the pre-reflective dynamic micro-structure of the corresponding subjective experience) may guide and determine each other. We will show that this dynamic approach to epileptic seizure makes it possible to consolidate the foundations of a cognitive non pharmacological therapy of epilepsy. We will also show through this example how the neuro-phenomenological co-determination could shed new light on the difficult problem of the "gap" which separates subjective experience from neurophysiological activity.     

Operant conditioning of epileptic neurons in monkeys and its theoretical application to EEG operant conditioning in humans

This paper reviews a series of previous reports which summarize the physiology of chronic experimental epileptic foci in monkeys. It is shown that such monkeys can be trained to bidirectionally control the firing rates of normal and epileptic neurons which comprise the epileptic focus. As a result of this acquired operant performance, the monkeys show both a decrease in clinical seizures as well as a decrease in single unit epileptic activity. The EEC correlate of this change in single unit epileptic actvity is generalized EEG desynchronization. The conclusion from these data would indicate epileptic neurons can be operantly controlled and this control is not correlated with any specific EEG pattern. This brings to question the specificity of the SMR in EEG biofeedback paradigms which treat human epilepsy. This author feels that the result from such biofeedback studies are the result of the patient learning to manipulate electrical events within the CNS pathways through which the seizure propagates and is not contingent upon specific EEG frequencies.     

Operant conditioning of the EEG in two patients with epilepsy: Methodologic and clinical considerations

Methodologic and clinical considerations are discussed in sensorimotor rhythm (SMR) biofeedback research on two dissimilar but severe epileptic males. The first case, an akinetic epileptic who prior to feedback training experienced 80–100 clinical seizures every 10 hours, showed considerable seizure reduction after 6 months of SMR and epileptiform training. A number of methodologic and instrumentation advances were pioneered with the akinetic patient: (1) development of and ultra-sharp band-pass filter; (2) use of epileptiform inhibit and feed-back circuitry; (3) use of monetary rewards as additional incentive; (4) use of correlational analysis for evaluation of acquisition in the major dependent variables and; (5) use of noncontingent feedback and rein-forcement as control techniques. The second case, a psychomotor epileptic, also showed therapeutic benefit from SMR training. Clinical information regarding the effect of anticonvulsant medications on the course and therapeutic outcome of SMR training are described. In conjunction with operant conditioning of 12 Hz activity, corresponding changes for other EEG parameters are examined.     

Factors Involved in Learning Problems and Educational Delay in Children with Epilepsy

Educational delay was assessed in a group of children with epilepsy and co-morbid learning problems, and compared with a matched group of children with learning problems, but without epilepsy. In addition, delay in the academic skills reading/spelling and arithmetic was compared for the two groups. Moreover, the differential contribution for the development of learning problems of each of the following epileptic factors was inspected: type of epilepsy, seizure type, seizure frequency and type of AED-treatment. The ‘Groninger School Onderzoek’ (G.S.O.) was used to yield an objective measurement of school achievement. The first 24 children with a reconfirmed diagnosis of epilepsy and with co-morbid learning problems who were referred to our outpatient department for ‘epilepsy and learning disabilities’ were included in the study. Each child was matched to a control subject (children with learning problems, but without epilepsy). Matching was carried out for the potential confounding factors age, school-type, school-grade and intelligence. The measure for school achievement showed no significant differences between the two groups with a delay in both groups of approximately a half year. Also, no statistically significant difference was found with respect to achievement on the academic skills reading/spelling and arithmetic. The impact of several epileptic factors on the measurement of school achievement were analyzed. The analysis of type of epilepsy showed significant lower school achievement scores for the patients with idiopathic generalized epilepsy compared to the patients with localisation-related epilepsy. Further evaluation of this result shows that most of the patients, classified as idiopathic generalized epilepsy have a recent onset epilepsy, a high seizure frequency and are not yet satisfactorily controlled with antiepileptic therapy. The key factor contributing to learning problems in children with epilepsy is an ‘uncontrolled’ epilepsy, i.e., an epilepsy with high seizure frequency.     

Epileptic seizures in multiple sclerosis

Starting from informations in the literature, the authors deals with eight own cases, suffering from clinically certain multiple sclerosis and showing, as a further sign, epileptic seizures. Compared to the total of patients, these eight cases represent 1.78 p.c. of all patients treated for multiple sclerosis in this clinic. The features of seizures, frequency and dynamics of occurrence are referred to. The authors point out that it is necessary to differential between epileptic seizures and non-epileptic attacks, and they draw attention to the fact that here are difficulties with regard to differential diagnosis if epileptic seizure appears as a initial symptom of multiple sclerosis.     

Neural network applications in consumer behavior

This article introduces the concepts and terminology of artificial neural networks. The approach is demonstrated on data that represent a domain of interest to the consumer psychologist. ANNs are mathematical models that are commonly used in business applications to model relationships between variables. A key strength of ANNs is their flexibility, i.e. their ability to easily accommodate linear and non-linear relationships without any a priori functional form specification. They can easily be used to study topics of interest to consumer psychologists such as persuasion, influence, segmentation etc and can offer distinct advantages over traditional statistical techniques such as ANOVA and regression. We demonstrate the application of ANNs in three different areas: regression, non-linear principal component analysis and classification.     

Massively multiplayer online role-playing game-induced seizures: a neglected health problem in Internet addiction.

As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing psychosocial problem. However, epileptic seizure, another out-of-the-ordinary health problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games -- Massively Multiplayer Online Role-Playing Games (MMORPGs) -- were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game-induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the software. While the prevalence of MMORPG-induced seizures remains unknown, it may exceed our expectations and impact our society. Not only for clinical neurologists but also for the primary physicians, educators, sociologists, and global online game publishers, there should be an awareness of this special form of reflex seizures in order to provide an appropriate health warning to MMORPG players.     

Removal of epileptically compromised tissue in the frontal cortex restores oculomotor selection in the antisaccade task

The frontal cortex is heavily involved in oculomotor selection. Here, we investigated the neural correlates of eye movement selection during an antisaccade task in a young epileptic patient in whom the seizure focus included the frontal cortex and affected its function. Before resection surgery, the patient had difficulty in performing correct antisaccades towards the visual field contralateral to the seizure focus. Because the FEF is the only area in the human frontal cortex that is known to have a lateralized oculomotor function in the antisaccade task, this behavioural imbalance between the two visual fields suggests a disruption of FEF functioning by the nearby seizure focus. Electrocorticographic recordings at the seizure focus indeed showed that the seizure focus interfered with correct antisaccade performance. These results were in line with fMRI recordings revealing less task-related frontal activity for the hemisphere of the seizure focus, possibly reflecting diminished top-down engagement of the oculomotor system. Two months after removal of the compromised tissue, the seizures had disappeared, and antisaccade performance was the same for both visual hemifields. We conclude that a seizure focus in the frontal cortex can induce a dysfunction in the selection of eye movements, which is resolved after removal of interfering tissue.     

EEG feedback training in the treatment of epilepsy: Some questions and some answers

A basic question in EEG feedback training of epileptic patients is whether the decrease in seizures is specifically due to the training or to other factors. Questions may also be raised as to what EEG changes are involved. Preliminary results in five patients suggest that seizure reductions can occur with training which are not due to placebo or nonspecific effects or to changes in medication compliance. These changes occurred rapidly during EEG-contingent feedback training but not when feedback was random in relation to the EEG. Reliable changes in the EEG were also observed, but the question of which mechanism accounts for these results has yet to be answered.