人类颞叶皮层与视、听信息加工:Ⅱ.左颞叶癫痫病人的脑事件相关电位

记录7名左颞叶癫痫病人和9名正常人在四种实验条件下的事件相关电位：（1）听觉脑子诱发电位,（2）红色闪光刺激,（3）陌生人嗓音识别,（4）陌生人面孔识别。实验结果发现,两组被试在视觉信息加工中无差异,在嗓音识别中病人的N150和P300波潜伏期大于正常人,表明其复杂听觉认知功能受到影响．红色闪光刺激和噪音识别条件下,病人的P100波幅大于正常人,说明病人对强刺激的物理强度有较高的反应水平,不易习惯化。     

人类颞叶皮层与视、听信息加工:Ⅰ、神经心理模型和左颞叶癫痫病人的认知功能

对37名被试的18项神经心理测验结果进行因素分析后得到4个主要因素:知觉组织、感觉注意、记忆和知觉运动。对比组t 考验发现左颞叶瘢痫病人的节律跟随和说话人识别测验得分明显低于普通外科病人,说明左颞叶癫痫病可能影响听觉运动和非言语复杂听觉信息加工的能力。     

Anterior Temporal Lobectomy,Hippocampal Sclerosis,and Memory: Recent Neuropsychological Findings

Anterior temporal lobectomy (ATL) is an effective and increasingly utilized treatment for nonlesional, intractable mesial temporal lobe epilepsy. However, this surgery results in domain-specific neuropsychological morbidity for a subset of patients. Within the past decade, multidisciplinary studies have revealed that left ATL patients without significant sclerosis in the resected hippocampus are most at risk for a substantial postacute decline in the ability to encode new verbal information. These patients are also at risk for a significant decrement in confrontation naming and other retrieval-based language abilities. The memory deficit is not attributable to this disruption of language. A relationship between hippocampal sclerosis (HS) status and memory performance has not been identified consistently in right ATL patients, but investigation of new visuospatial measures continues. The influence of variables other than HS on neuropsychological outcome is also discussed.     

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。     

Utility of the Behavior Rating Inventory of Executive Function – Preschool version (BRIEF-P) in young children with epilepsy

Executive functioning deficits are prominent in children with epilepsy. Although instruments, such as the Behavior Rating Inventory of Executive Function (BRIEF), are useful in detecting executive dysfunction in school-age children with epilepsy, little data are available for younger children. The present study evaluates the ability of the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) to detect executive dysfunction in preschool-age children with epilepsy. Parents of 51 clinically referred children with epilepsy (age: M = 1.99 years, SD = 1.29 years, range = 2–5 years) completed the BRIEF-P. Using a cutoff t score of ≥65 as the threshold for impairment, the BRIEF-P’s ability to detect executive dysfunction within this clinical population was established. Additionally, correlational analyses were used to assess the relations between epilepsy severity factors and BRIEF-P indices. Epilepsy severity variables that were significantly related to BRIEF-P indices were entered into a linear regression model to explore their predictive ability. Emergent metacognition (emergent metacognition index [EMI]; 59%) and the global executive composite (43%) were the most frequently elevated indices. The most commonly elevated subscales were working memory (65%), inhibition (37%), and planning/organization (35%). Age of seizure onset, seizure frequency, and number of antiepileptic drugs were not significantly correlated with BRIEF-P indices. However, children with lower intellectual ability were rated as having greater executive dysfunction, specifically with EMI (r = ?.30). Still, intellectual functioning only accounted for a small percentage (9%) of the variance in EMI scores. The current pilot study demonstrates that the BRIEF-P shows promise in identifying executive dysfunction in preschool-age children with epilepsy.     

Diagnosis by Documentary: Professional Responsibilities in Informal Encounters

Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional–patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such “informal” encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the “social contract” model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large.     

关于提高癫痫正确诊断率的思考

癫痫是神经系统常见疾病之一,临床上常有误诊误治现象.无论是癫痫的诊断,还是治疗药物的选择,都给临床医生的哲学思维提出了很高的要求.因此临床医生不仅要注重积累自己的专业知识,而且要努力提高自己的哲学修养.     

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.     

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。