中青年人脑梗死的病因探讨

目的：探讨中青年人脑梗死的病因，方法：回顾性总结了６１例中青年人脑梗死的病因，结果：发现９３％的患者能查到病因，且动脉粥样硬化是中青年人脑梗死最常见的病因之一（２４％），非动脉硬化性血管病亦是中青年人脑梗死的常见原因，少见的原因有动静脉畸形、心源性疾病、凝血障碍、结缔组织疾病、外伤、手术后，腹泻、乙型肝炎后等。结论：中青年人脑梗死的病因复杂，ＤＳＡ、ＭＲＡ等相关的检索实属必要，大多数病人，通过详细     

中青年急性脑梗死患者血尿酸水平的相关研究

目的：观察中青年急性脑梗死患者血尿酸水平,研究尿酸与中青年急性脑梗死患者病情严重程度的关系及对预后的影响。方法详细采集纳入的350例中青年急性脑梗死的临床资料,检测血尿酸、低密度脂蛋白、高密度脂蛋白及同型半胱氨酸水平,并进行NIHSS评分及mRS评分,分析血尿酸与急性脑梗死患者入院时病情严重程度及90 d预后的关系。结果中青年急性脑梗死患者血尿酸水平比正常人高（ P＜0.05）;中青年急性脑梗死患者的血尿酸水平与入院时病情严重程度无明显相关性（P＝0.357）;血尿酸水平与中青年急性脑梗死患者的预后呈正相关（OR＝1.012,P＝0.026）。结论中青年急性脑梗死患者血尿酸水平高;血尿酸水平不影响中青年急性脑梗死患者发病时的病情严重程度,高尿酸影响中青年急性脑梗死患者的预后。     

中青年脑梗死75例分析

我科1997～2001年共收治脑梗死患者986例，其中45岁以下脑梗死患者75例，结合文献复习，以进一步探讨中青年脑梗死的病因及临床特点。     

经颅多普勒检测中青年缺血性脑血管病临床研究

目的 分析中青年人缺血性脑血管病TCD特点.方法 对75例中青年缺血性脑卒中患者TCD结果进行回顾性分析.结果 75例患者中,异常54例,异常率72.0%.大面积脑梗死患者血管异常率明显高于小面积脑梗死和腔隙性脑梗死(P<0.05).结论 TCD检测对于中青年缺血性脑血管病的早期筛查诊断具有重要的临床价值.     

中青年急性脑梗死患者糖代谢特点分析

血糖水平的升高是急性脑梗死患者伴随的一种并发症,原因不明确,其中大部分人可诊断为糖尿病。彭春霞等[1]通过临床数据分析发现,血糖代谢异常率在50岁以上急性脑梗死患者中较高,高达65%以上。但血糖代谢在45岁以下中青年急性脑梗死患者中的情况如何,至今还少有报道。为进一步了解中青年急性脑梗死患者糖代谢的情况,我院对66例中青年急性脑梗死患者的血糖代谢情况进行分析和探讨,现将结果报告如下。     

中青年脑梗死119例临床分析

脑梗死是老年高发病之一,但近几年中青年脑梗死的报道逐渐增多,其致残率极高,极大的降低了患者的生存质量.为了减少中青年脑梗死的发生,有效的预防尤为重要.为此我们对近几年住院患者进行回顾分析,以探讨中青年脑梗死的特点.     

中青年脑梗死患者危险因素Logistic分析

目的研究中青年脑梗死患者发病相关危险因素。方法回顾分析我院近3a脑梗死病例,依据病史、检验和影像学资料以了解致病危险因素。结果纳入107例中青年脑梗死患者(≤60岁)为观察组,125例同期老年脑梗死患者(60岁)为对照组,经χ2检验,2组高尿酸血症、吸烟、喝酒差异有统计学意义(P0.05);Logistic回归结果显示,高尿酸血症、吸烟、喝酒是独立危险因素(P0.05)。结论中青年脑梗死致病危险因素较多,其中高尿酸血症、吸烟、喝酒是独立危险因素。     

中青年脑梗死患者危险因素临床分析

目的研究中青年脑梗死患者危险因素,为脑梗死的预防提供依据。方法对43例中青年脑梗死住院患者危险因素进行回顾性分析,并与54例老年脑梗死患者作对比研究。结果中青年脑梗死患者吸烟、酗酒、超重、吸毒和家族史阳性发生率高于老年组(P0.05或P0.01),而非瓣膜性房颤低于老年组(P0.01)。2组高血压、糖尿病的差异无统计学意义。中青年组HDL-C、ApoA1水平显著低于老年组(P0.05),2组GLU、UA、TC、TG、LDL-C、ApoB和Lp(a)的差异无统计学意义。结论中青年人群应注意饮食合理,戒除不良嗜好,加强体育锻炼,控制体质量,早期防治高血压和糖尿病,以减少脑梗死的发病率。     

青中年脑梗死与颈动脉粥样硬化的关系

目的 研究中青年脑梗死与颈动脉粥样硬化的关系.方法 应用彩色多普勒超声仪对中青年脑梗死患者 66 例、36例非脑血管病患者和正常体检者(对照组)行颈部血管超声检查.检测血管壁的厚度和斑块的大小及厚度,观察颈动脉粥样硬化斑块的数目及部位,计算斑块积分及血管狭窄程度.结果 中青年脑梗死患者颈动脉内膜增厚,动脉粥样硬化斑块的发生率明显高于对照组,斑块积分为轻中度的颈动脉粥样硬化,颈动脉血管多为轻中度狭窄.结论 颈动脉粥样硬化与青中年脑梗死关系密切,颈动脉超声检查对脑梗死的发生有极好的预测价值.     

血尿酸(UA)与中青年脑梗死的相关性分析

目的探讨血尿酸UA与中青年脑梗死的关系。方法采用日立7170S全自动分析仪以酶比色法测定尿酸。结果 80例中青年急性脑梗死患者的血尿酸值与对照组在统计学上有显著性差异(P<0.01),不稳定斑块组血尿酸高于稳定斑块组,有显著性差异(P<0.01)。结论血尿酸是中青年脑梗死的重要相关因素,尿酸水平的高低可作为评判颈动脉粥样硬化斑块稳定性的指标之一。     

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.     

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.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.