生物钟基因隐花色素-1与精神分裂症核心家系的单体型相对风险分析

目的探讨精神分裂症与生物钟基因隐花色素-1(Cryptochrome-1,Cry1)的关系。方法检测100个精神分裂症核心家系的Cry1基因上的rs2300448-rs1921135和rs1056560三个多态性位点,并进行单体型相对风险分析(HHRR)。结果HHRR结果显示,rs2300448多态性由父母传递给患病子女的等位基因(G/A)频率差异有统计学意义(P<0.05),等位基因G优先传递给患病子女;而rs1056560和rs1921135的等位基因传递频率差异无统计学意义(P>0.05)。结论Cry1基因可能与中国汉族精神分裂症相关联。     

文拉法辛临床疗效与γ-氨基丁酸β2受体基因的相关分析

目的 探索γ-氨基丁酸β2受体(GABRB2)基因多态性与五羟色胺-去甲肾上腺素重吸收抑制剂(Serotonin and Norepinephrine Reuptake Inhibitor,SNRI)文拉法辛抗抑郁疗效差异的相关性.方法 对151例抑郁症患者采用文拉法辛治疗6周,以治疗后17项汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)总分≤7为临床痊愈.检测5号染色体上的GABRB2基因的29个标签单核苷酸多态性(Single Nucleotide Polymorphisms,SNP)位点.运用Plink 1.07和Haploview 4.2软件进行29个SNP位点及其构成的单倍型与药物疗效的相关分析.结果 GABRB2基因的rs10071312 和 rs4426954位点的等位基因频率在痊愈组和非痊愈组之间的差异有统计学意义(均P=0.02),rs10071312位点的A等位基因携带者的治疗痊愈率高于G等位基因携带者(OR=4.43),而rs4426954位点的A等位基因携带者的治疗痊愈率低于G等位基因携带者(OR=0.44).有3种单倍型在痊愈组和非痊愈组之间的分布差异有统计学意义,分别是A-A-A-A-G-A (rs7724146-rs10051667-rs2964773-rs12153421-rs2962402-rs4426954,P=0.01),A-A-A-G-A(rs10051667-rs2964773-rs12153421-rs2962402-rs442695,P=0.02)和A-A-A-G-A-G (rs10051667-rs2964773-rs12153421-rs2962402-rs4426954-rs3816596,P=0.03).结论 GABRB2基因多态性可能与文拉法辛治疗的个体化差异有关联.     

GluR-6和GABRG2基因多态性与精神分裂症患者精神症状的关系

目的探讨谷氨酸受体6基因（GluR6）和γ－氨基丁酸γ2受体基因（GABRG2）基因多态性与精神分裂症患者精神症状的关系。方法以聚合酶链式反应－限制性片段长度多态性（PCR--RFLP）方法对600名研究对象的GluR6基因rs2227283（G／A碱基改变）和GABRG2基因rs211014（T／G碱基改变）单核苷酸多态性（SNP）进行检测。同时采用阳性与阴性症状量表（PANSS）、修订版外显攻击量表（MOAS）以及自制的一般情况调查表对研究组和对照组1的研究对象进行测查。使用SPSS13．0对数据进行统计分析。结果（1）GluR6基因的rs2227283位点等位基因分布与精神分裂症的阳性症状被害妄想相关（F=4．641,P=0．032）;（2）rs2227283等位基因A与兴奋、情绪退缩、关注身体健康以及不合作等阴性症状相关联（P〈0．05）,rs211014等位基因G与幻觉行为、兴奋、自罪感、动作迟缓以及不寻常思维内容等阳性症状相关（P〈0．05）。结论GluR6基因rs2227283位点多态性可能与攻击行为及阴性症状有关联,GABRG2基因rs211014位点多态性可能与攻击行为及阳性症状有关联。     

α7-烟碱样乙酰胆碱受体基因多态性与精神分裂症的关联研究

目的 研究α7-熘碱样乙酰胆碱受体基因rs1042724多态性与精神分裂症的相关性。方法运用聚合酶链反应扩增及单核苷酸多态性的分子生物学技术，对符合精神分裂症诊断标准的98个先证者及其父母组成的核心家系，测定α7-烟碱样乙酰胆碱受体基因分型，进行精神分裂症的α7-烟碱样乙酰胆碱受体基因多态性的关联分析和传递不平衡（TDT）检验。结果TDT检验结果提示α7-烟碱样乙酰胆碱受体基因等位基因与精神分裂症之间的相关性（McNemarX^2=4．21，P〈0．05），且等位基因T携带者，其精神分裂症的易患性是C携带者的1．31倍（RR=1．31,X^2（RR）=3．96，P〈0．05）。结论 提示α7-烟碱样乙酰胆碱受体基因rs1042724与精神分裂症相关联。     

三磷酸腺苷结合盒转运子A1基因多态性与散发性阿尔茨海默病的关系

目的 探讨三磷酸腺苷结合盒转运子A1（ATP—binding cassette transporter 1，ABCA1）基因第6外显子D→A（R219K）多态性位点与散发性阿尔茨海默病（sporadic Alzheimer disease，SAD）易患性的关系。方法 采用病例．对照研究方法，利用聚合酶链反应．限制性片段长度多态性（PCR—RFLP）技术对168例SAD患者和215名健康对照的ABCA1基因多态性进行检测，比较不同基因型与阿尔茨海默病（AD）发病风险之间的关系。结果 SAD组ABCA1基因第6外显子G—A多态位点A等位基因频率明显低于对照组（37．8％ vs 48．1％，）（X^2=8．204，P=0．004）；SAD组AA基因型频率也明显低于对照组（14．3％ vs 22．8％，）（X^2=8．230，P=0．016）。Logistic回归分析表明，校正年龄、性别和ApoEe4等位基因的影响后，携带A等位基因者（G／A＋A／A基因型）比携带GG基因型者AD发病风险降低43．0％（OR 0．57，95％CI 0．36—0．91，P=0．019），而AA纯合子比携带GG基因型者AD发病风险降低60．0％（OR 0．40，95％ CI 0．21—0．77，P：0．006）。结论 ABCA1基因第6外显子D—A多态性与SAD相关，携带A等位基因或者AA基因型对SAD发病可能有一定的保护作用。     

精神分裂症患者多巴胺D1受体基因多态性与抗精神病药疗效的关系

目的:探讨精神分裂症患者多巴胺D1受体(DRD1)基因多态性与抗精神病药疗效的关系.方法:300例精神分裂症患者分别给予氯丙嗪(n=78)、利培酮(n=90)、氯氮平(n=132)单一治疗8周;以阳性与阴性症状量表(PANSS)评定疗效;以SNaPshot单核苷酸多态性(SNP)技术检测DRD1基因rs265981、rs4532、rs686和rs265976多态性. 结果:氯氮平总疗效有效组与无效组相比,rs265981基因型T/T、T/C、C/C及等位基因T、C的分布差异有统计学意义(x2=7.101,P=0.029;x2 =4.011,P=0.045);rs265976基因型A/A、A/C、C/C的分布差异有统计学意义(x2=7.124,P=0.028),但其等位基因A、C的分布差异无统计学意义(x2=3.54,P =0.06).氯丙嗪改善阳性症状有效组与无效组相比,rs686等位基因A、G的分布差异有统计学意义(x2=4.427,P=0.035),但其基因型A/A、A/G、G/G的分布差异无统计学意义(x2=3.842,P=0.146).氯氮平改善阴性症状有效组与无效组相比,rs265976基因型A/A、A/C、C/C的分布差异有统计学意义(x2 =5.999,P=0.05),而其等位基因A、C的分布差异无统计学意义(x2=1.051,P=0.305). 结论:DRD1基因rs265981、rs686和rs265976多态性可能对抗精神病药治疗精神分裂症的临床疗效有着重要影响.     

乙酰辅酶A:胆固醇乙酰转移酶基因单核苷酸多态性与散发性阿尔茨海默病的相关性研究

目的 此实验旨在探讨ACAT1的基因甾醇氧-乙酰转移酶（sterol O-acyltransferase． SOAT1）的单核苷酸多态性位点rs1044925与散发性AD（SAD）是否具有相关性。方法 在中国北方汉族人群中收集了SAD107例．以及性别和年龄与之相匹配的同一地区健康对照者118例．采用聚合酶链反应-限制性片段长度多态性（PCR—RFLP）方法检测了SOAT1多态性位点rs1044925的基因型以及载脂蛋白E（Apolipoprotein E，APOE）的基因型。结果 rs1044925位点在SAD组的基因型（AA．AC．CC）频率分别为82．2％。16．8％，1．0％，在对照组的基因型频率分别为81．4％．17．8％，0．8％．两组间基因型频率差异无显著性（P=1．000，χ^2=0．030，OR=0．863．95％CI=0．478～1．857）。SAD组等位基因（A．C）频率分别为90．7％、9．3％，对照组等位基因频率分别为90．3％、9．7％，两组间等位基因频率差异亦无显著性（P=1．000．χ^2=0．021，OR=0．885，95％CI=0．508～1．774）。当数据用ApoEε4分层后．rs1044925位点基因型频率和等位基因频率两组间差异仍无显著性（P〉0．05）。结论 研究表明在中国北方汉族人群中ACAT1的基因SOAT1多态性位点rs1044925与SAD无相关性，SOAT1可能不是SAD的遗传易感基因。     

精神分裂症与染色体22q11的连锁不平衡研究

目的 探讨染色体22q11泛有素融合降解1型蛋白基因(UFD1L)和腭心面综合征缺失的核定位信号基因(NLVCF)多态性与精神分裂症的关系。方法 在138例吉林省汉族精神分裂症患者及其健康父母双亲的核心家系中，以聚合酶链反应(PCR)和限制性片段长度多态(RFLP)方法对UFDlL基因rs1547931(G／C碱基改变)和NLVCF基因rs1473109(C／T碱基改变)单核苷酸多态性(SNPs)进行检测。应用基于家系的连锁不平衡方法，包括单体型相对风险分析(HRR)，传递不平衡检验(TDT)及Transmit双位点单体型分析，分析基因型数据。结果 (1)HRR显示UFDlL基因rs1547931与精神分裂症有关联(χ^2=4．260，ν=1，P=0．039)，NLVCF基因rs1473109与精神分裂症无关联；(2)TDT显示UFDlL基因rs1547931与精神分裂症有连锁和关联(χ^2=5．333，ν=1，P=0．021)，NLVCF基因rs1473109与精神分裂症无连锁及关联；(3)Transmit双位点单体型分析显示rs1547931-rs1473109单体型与精神分裂症有关联(χ^2=9．723，ν=3，P=0．021)，rs1547931(C)-rs1473109(T)单体型与精神分裂症呈负相关(χ^2=6．607，ν=1，P=0．01)。结论 精神分裂症患者UFD1L基因本身或其附近的基因可能与精神分裂症的易感性相关。     

硫氧还原蛋白结合蛋白基因多态性与精神分裂症的关联分析

目的探索硫氧还原蛋白结合蛋白（TXNIP）基因与精神分裂症的关联关系。方法以182个精神分裂症核心家系为研究对象，应用聚合酶链反应和限制性片段长度多态性技术（PCR-RFLP）对TXNIP基因标签单核苷酸多态性（htSNP）rs9245进行基因分型；使用传递不平衡（TDT）、基于单体型的单体型相对危险度分析（HHRR）检测TXNIP基因与精神分裂症之间的关联关系。结果①患者组、父母组htSNP rs9245位点各基因型的分布均符合Hardy-Weinberg平衡法则（矿值分别为0．68，0．02，df=1，P〉0．05）；②单体型相对风险分析（HHRR）显示htSNP rs9245位点等位基因在患者组和父母组的频数分布为χ^2=3．42，P=0．064；③传递不平衡检验（TDT）分析显示，杂合子父母传递给受累子女与非传递等位基因频率分布为χ^2=3．40，P=0．065，虽然差异未达到显著性，但接近边缘显著性。结论本研究虽未发现TXNIP基因htSNP rs9245与精神分裂症的发生存在关联，但不能排除两者的阳性关联，尚需选择更多SNP及扩大样本量进一步分析。     

BDNF基因多态性与精神分裂症发病及临床症状的 相关性

目的 探讨BDNF基因rs2030324和rs11030101多态性与精神分裂症发病及临床症状的关 系。方法 于2017年1月—2018年1月由齐齐哈尔市精神卫生中心招募200例精神分裂症患者（病例组） 及200 例健康对照（对照组）纳入研究。每位研究对象抽取5 ml 静脉血提取基因组DNA，对rs2030324 和 rs11030101 两个位点上下游500 bp 的序列设计引物，进行PCR 扩增，比较rs2030324 和rs11030101 两个 位点在两组人群中的基因频率分布及基因型分布。对病例组采用阳性与阴性症状量表（PANSS）评估临 床症状，分析PANSS 评分与不同基因型的相关性。结果 病例组和对照组在rs2030324 和rs11030101 两个位点基因频率分布和基因型分布均具有统计学意义（P＜ 0.05）。该两个位点的A 等位基因，都是 精神分裂症的易感基因，OR 值=1.532、1.391；95%CI=1.154～2.034、1.027～1.883。rs11030101 位点AT 基因型的患者与PANSS 阴性症状评分相关，AT基因型的患者阴性症状评分最高。结论 BDNF 基因 rs2030324、rs11030101 位点多态性与汉族人群精神分裂症的发病具有相关性，该两个位点的等位基因 A 均可能是精神分裂症发病的易感等位基因。rs11030101 位点多态性可能影响精神分裂症的临床表现。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.