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。     

The persistence of erroneous familiarity in an epileptic male: challenging perceptual theories of déjà vu activation

We report the case of a 39-year-old, temporal lobe epileptic male, MH. Prior to complex partial seizure, experienced up to three times a day, MH often experiences an aura experienced as a persistent sensation of déjà vu. Data-driven theories of déjà vu formation suggest that partial familiarity for the perceived stimulus is responsible for the sensation. Consequently, diverting attention away from this stimulus should cause the sensation to dissipate. MH, whose sensations of déjà vu persist long enough for him to shift his perceptual focus a number of times during the experience, spontaneously reports that these shifts make no difference to the sensation experienced. This novel observation challenges data-driven theories of déjà vu formation which have been used to explain the occurrence of déjà vu in those with temporal lobe epilepsy and the general population. Clearly, in epilepsy, erratic neuronal firing is the likely contributor, and in this paper we postulate that such brain firing causes higher-order erroneous 'cognitive feelings'. We tentatively extend this account to the general population. Rather than being a reaction to familiar elements in perceptual stimuli, déjà vu is likely to be the result of a cognitive feeling borne of the erroneous activation of neural familiarity circuits such as the parahippocampal gyrus, persisting as long as this activation persists.     

A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures

Objective: We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures.

Methods: Individuals were randomised to write about potentially ‘therapeutic’ topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions.

Results: Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the ‘therapeutic’ condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures.

Conclusions: A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.     

Forensic neuropsychiatric aspects of epilepsy

Epilepsy may be associated with automatisms that are classed as ‘insane ‘as they are deemed to have originated within the mind. ‘Sane automatism’ is said to occur from external factors, such as physical trauma, while ‘insane automatism’ is said to be innate to the individual experiencing them. To claim automatism within the context of a criminal matter requires a detailed evaluation of the behavior demonstrated and a questioning of the volitional and purposeful nature of this behavior. It is insufficient to rely upon past behavior in association with these seizures to justify the defense of automatism within a specific event. Epilepsy is often considered to be associated with an increase in violence. Proper epidemiological research, both in long-term, large population control studies and hospital-based studies, has suggested that epilepsy, per se, is not associated with an increase in violence when compared to the population at large and controlled for other familial and environmental factors.     

Spoken Language Outcomes after Hemispherectomy: Factoring in Etiology

We analyzed postsurgery linguistic outcomes of 43 hemispherectomy patients operated on at UCLA. We rated spoken language (Spoken Language Rank, SLR) on a scale from 0 (no language) to 6 (mature grammar) and examined the effects of side of resection/damage, age at surgery/seizure onset, seizure control postsurgery, and etiology on language development. Etiology was defined as developmental (cortical dysplasia and prenatal stroke) and acquired pathology (Rasmussen's encephalitis and postnatal stroke). We found that clinical variables were predictive of language outcomes only when they were considered within distinct etiology groups. Specifically, children with developmental etiologies had lower SLRs than those with acquired pathologies (p =.0006); age factors correlated positively with higher SLRs only for children with acquired etiologies (p =.0006); right-sided resections led to higher SLRs only for the acquired group (p =.0008); and postsurgery seizure control correlated positively with SLR only for those with developmental etiologies (p =.0047). We argue that the variables considered are not independent predictors of spoken language outcome posthemispherectomy but should be viewed instead as characteristics of etiology.     

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...     

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。     

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。     

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。