对癫痫的认识及其外科治疗

人们对癫痫的认识及其外科治疗的发展是一个漫长而复杂的过程,经历高潮、低谷的更迭.科技进步使人们对癫痫正确认识,也使治疗手段更趋于多样化、个性化.     

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。     

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。     

癫痫的诊治与人文思想

癫痫是神经科常见的疾病之一,对于患者的学习、生活和工作均有不同程度影响。它的发病机制尚不十分清楚,主要是以药物治疗为主。在癫痫的诊断中要根据病情和患者的实际情况选择合适的检查;在癫痫的治疗中须按照最优化的医疗原则选择最佳的治疗方案。在治疗中要注意结合人文思想来提高癫痫的治疗效果。     

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.     

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。     

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。     

癫痫的诊治与人文思想

癫痫是神经科常见的疾病之一,时于患者的学习、生活和工作均有不同程度影响.它的发病机制尚不十分清楚,主要是以药物治疗为主.在癫痫的诊断中要根据病情和忠者的实际情况选择合适的检查;在癫痫的治疗中须按照最优化的医疗原则选择最佳的治疗方案.在治疗中要注意结合人文思想来提高癫痫的治疗效果.     

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。     

儿童惊厥性癫痫持续状态——难题与决策

癫痫持续状态是儿科神经系统最常见的一种急重症,其中惊厥性癫痫持续状态可能严重至危及生命,因而尤其需要准确紧急处理。准确的早期诊断、正确处理是抢救成功的关键。近年来对于癫痫持续状态的定义、分类以及程序化治疗都有很多新的认识和研究进展。本文拟从定义、分类、流行病学、临床诊治以及对发育中脑的影响方面对惊厥性癫痫持续状态进行综述,希望能帮助儿科医生在日常工作中能准确认识惊厥性癫痫持续状态,及早做出合理的临床决策,从而最终改善此症的预后。     

Neuropsychological Deficits in Childhood Epilepsy Syndromes

Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.     

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.     

Barriers to the management of patients with surgically remediable intractable epilepsy

It is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.     

Epilepsy genes: the link between molecular dysfunction and pathophysiology

Our understanding of the genetic basis of epilepsy is progressing at a rapid pace. Gene mutations causing several of the inherited epilepsies have been mapped, and several more are likely to be added in coming years. In this review, we summarize the available information on the genetic basis of human epilepsies and epilepsy syndromes, emphasizing how genetic defects may correlate with the pathophysiological mechanisms of brain hyperexcitability. Mutations leading to epilepsy have been identified in genes encoding voltage- and ligand-gated ion channels (benign familial neonatal convulsions, autosomal dominant nocturnal frontal lobe epilepsy, generalized epilepsy with febrile seizures "plus"), neurotransmitter receptors (Angelman syndrome), the molecular cascade of cellular energy production (myoclonic epilepsy with ragged red fibers), and proteins without a known role in neuronal excitability (Unverricht-Lundborg disease). Gene defects can lead to epilepsy by altering multiple and diverse aspects of neuronal function.     

Behandlung von Epilepsie bei Menschen mit Intelligenzminderung

People with intellectual disability frequently suffer from epilepsy. Management of epilepsy in this population is particularly challenging because of the different ways of communicating, cognitive impairment, changes in behavior which can be disruptive, the severity of the epilepsy syndrome, the seizure types, and the seizure frequency. Treatment of epilepsy is complicated due to the interaction of the intellectual disability and the behavior as well as behavioral changes caused by the antiepileptic drugs or the change of seizure types or frequency. This article provides the reader with a guidance for managing epilepsy in this particular population and raises important open questions.     

Understanding and management of epilepsy in a rural community in South Africa: An exploratory study

The aim of the study was to explore how people living with epilepsy in an indigenous rural South African community understood and managed their epilepsy. Six people with epilepsy were informants (male = 3, female = 3; age range = 16 to 58 years, unemployed = 5, learner = 1). They completed individual interviews on their meanings of epilepsy and also on their experiences managing the illness. The results indicated that the participants’ understanding of epilepsy is closely linked to their own experiences of the condition, as well as to cultural beliefs about seizure disorder. Moreover, they reported that the unpredictability associated with a seizure generated a greater level of distress to the participants than the fact that they had seizure disorder. The participants reported to rely on family, and both traditional and Western medicine to manage their epilepsy.     

The Relationship Between Experience and Attitudes Concerning Epilepsy1

Research indicates that epilepsy is a misunderstood and stigmatizing disorder. The present study examined whether various levels and types of experience with epilepsy are related to attitudes about the disorder. It was hypothesized that certain types of direct experience with epilepsy (e.g., knowing people with epilepsy) are related to positive attitudes about the disorder, whereas other types of direct experience (e.g., witnessing seizures) are related to negative beliefs. As predicted, data from telephone interviews with 271 subjects indicate that individuals knowing someone with epilepsy held significantly more accepting attitudes than respondents who had never known an epileptic. The findings also suggest that witnessing epileptic seizures is an emotionally charged event, and, in the absence of other types of experience, this emotional impact might have a negative effect on attitudes toward people with epilepsy. The findings from this study have implications for the development of educational programs aimed at the general public, medical personnel, and people with epilepsy.     

A Comparison of Children with Epilepsy to an Age- and IQ-Matched Control Group on the Children's Memory Scale

Past research has found that children with epilepsy exhibit decreased memory skills. In addition, some studies have found that children with epilepsy obtain significantly lower IQ scores than controls. In an effort to examine whether children with epilepsy have specific memory weaknesses versus global cognitive difficulties, the present study compared the performance of 62 children (age range = 6–16 years). Thirty-one children with epilepsy were compared to 31 age- and IQ-matched controls on the Children's Memory Scale (CMS) to determine whether differences in memory skills persist when IQ is matched. An independent t-test comparing index and scaled scores was performed. The results indicated that with the exception of the Word Pairs subtest (p < .01), children with epilepsy did not differ significantly on the CMS subtests when IQ was matched. This suggests that list-learning paradigms may be particularly sensitive to memory impairments in children with epilepsy and/or that children with epilepsy have more global cognitive impairments.     

A comparison of children with epilepsy to an age- and IQ-matched control group on the Children's Memory Scale.

Past research has found that children with epilepsy exhibit decreased memory skills. In addition, some studies have found that children with epilepsy obtain significantly lower IQ scores than controls. In an effort to examine whether children with epilepsy have specific memory weaknesses versus global cognitive difficulties, the present study compared the performance of 62 children (age range = 6-16 years). Thirty-one children with epilepsy were compared to 31 age- and IQ-matched controls on the Children's Memory Scale (CMS) to determine whether differences in memory skills persist when IQ is matched. An independent t-test comparing index and scaled scores was performed. The results indicated that with the exception of the Word Pairs subtest (p < .01), children with epilepsy did not differ significantly on the CMS subtests when IQ was matched. This suggests that list-learning paradigms may be particularly sensitive to memory impairments in children with epilepsy and/or that children with epilepsy have more global cognitive impairments.