三七总皂苷对急性脑梗死患者血清sICAM-1的影响

目的观察不同的药物治疗对急性脑梗死患者血清可溶性细胞间黏附分子-1(sICAM-1)的影响。方法84例患者分为治疗组44例和对照组40例,治疗组应用三七总皂苷,对照组应用维脑路通,采用双抗体酶联免疫吸附法(ELISA)分析。结果2组患者治疗后血清sICAM-1含量均降低,治疗组下降更显著。结论三七总皂苷对急性脑梗死患者血清中异常升高的sI-CAM-1有明显降低作用,其疗效优于对照组,差异有统计学意义(P<0.05)。     

三七总皂苷对急性脑梗死患者血清NSE水平及功能恢复的影响

目的观察三七总皂苷对急性脑梗死(ACI)患者血清神经元特异性烯醇化酶(NSE)水平及神经功能缺损程度评分的影响。方法将100例ACI患者随机分为2组,对照组50例给予常规治疗,观察组50例在对照组基础上加用三七总皂苷注射液,比较2组临床疗效及治疗前后的血清NSE水平和神经功能缺损程度评分。结果观察组临床总有效率显著高于对照组(P0.05),治疗后的血清NSE水平、神经功能缺损程度评分改善程度均显著优于对照组(P0.05)。结论三七总皂苷治疗ACI疗效明显,对促进神经功能缺损恢复有一定价值。     

三七总皂苷注射液治疗急性脑梗死临床观察

目的评价三七总皂苷注射液治疗急性脑梗死的疗效及不良反应。方法对照组给予复方丹参注射液16 mL静滴,1次/d,疗程2周;治疗组应用三七总皂苷注射液0.175 g静滴,1次/d,疗程2周。结果三七总皂苷注射液治疗急性脑梗死有效率明显高于对照组。结论三七总皂苷注射液治疗急性脑梗死安全、疗效好、无不良反应。     

奥扎格雷钠对急性脑梗死患者血清IL-6和sICAM-1的影响

目的 探讨奥扎格雷钠对急性脑梗死(ACI)患者血清白介素-6(IL-6)和可溶性细胞间黏附分子-1(sICAM-1)的影响.方法 80例ACI患者随机分为治疗组和对照组.2组均给予常规治疗,治疗组加用奥扎格雷钠治疗,对照组加用维脑路通,采用双抗体酶联免疫吸附法(ELISA)分析.结果 2组治疗后血清IL-6和sICAM-1水平均降低,治疗组下降更明显.结论 血清sICAM-1及IL-6水平升高可能是脑梗死发病的危险因素,奥扎格雷钠对急性脑梗死患者血清中异常升高的IL-6和sICAM-1有降低作用.     

银杏叶提取物对银性脑梗死患者细胞间粘附分子—1的影响

目的：对比观察银杏叶提取物（杏丁注射液）与复方丹参注射液对急性脑梗死患者可溶性细胞间粘附分子-1(sICAM-1)的影响。方法：43例急性脑梗死患者随机分为实验组（n=22,每日静脉滴注杏丁20ml，连续14d）和对照组（n=21，每日静脉滴注复方丹参注射液250ml，连续14d），动态监测治疗前后血液中sICAM-1的水平变化。结果：两组sICAM-1治疗前无显著性差异（P＞0．05），治疗后第7d，14d实验组明显低于对照组（P＜0．05）；且两组患者治疗后均低于治疗前（P＜0．05或P＜0．01）。结论：银杏叶提取物（杏丁注射液）在降低急性脑梗死患者血液sICAM-1的水平方面明显优于复方丹参注射液。     

急性脑梗死血清可溶性细胞间粘附分子的变化及意义

目的为了解急性脑梗死患者血清可溶性细胞间粘附分子（sICAM-1)的变化及临床意义。方法采用双抗体夹心ELSA法测定了68例脑梗死患者血清sICAM-1,并与31例TIA患者和30例正常人对照比较。结果脑梗死患者24小时内血清sICAM-1水平明显高于TIA和正常对照组(P<0.01)。大梗死灶组血清sICAM明显高于中梗死灶组和小梗死灶组。脑梗死患者血清sICAM-1水平在脑梗死发生24小时至7天呈现上升趋势,7至14天呈下降趋势。结论sICAM-1与急性脑梗死密切相关,参与了缺血后脑组织损伤的病理过程。实验证明,急性脑梗死早期大量白细胞聚集阻塞微血管,穿越内皮细胞进入组织,使局灶区组织受损。此时白细胞聚集与sICAM-1表达增强密切相关。     

三七总皂苷对急性重型颅脑损伤患者血清NSE和MBP含量的影响

目的观察三七总皂苷（PNS）对急性重型颅脑损伤患者血清神经元特异性烯醇化酶（NSE）和碱性髓鞘蛋白（MBP）含量的影响，为PNS用于临床颅脑损伤的治疗提供更充分的依据。方法按标准选取急性重型颅脑损伤患者82例，随机分成对照组和治疗组。对照组行常规治疗，治疗组在常规治疗的基础上加用PNS治疗。治疗前和治疗后不同时间点分别测患者血清NSE和MBP的浓度，并行格拉斯哥昏迷评分（GCS），3个月后行格拉斯哥预后分级（GOS），然后对所得资料进行统计学分析。结果治疗后治疗组血清NSE和MBP含量低于对照组，GCS和GOS高于对照组，差异均有显著性意义（P〈0．05）。结论PNS能降低急性重型颅脑桶伤患者血清NSE和MBP的会量．有明理治疗技某．     

胶梗死患者血清sICAM—1含量的研究

目的 研究脑梗死（CI）患者血清可溶性细胞间粘附分子（sICAM-1）浓度的变化及其鉴意义。方法 采用双抗体ELISA法测定100例CI患者不同病程血清中sICAM-1的含量，并与30例正常人对照。结果 CI患者急性期血清sICAM-1浓度明显高于对照组（P＜0．01），在发病后7天内明显升高，7－14天内逐渐下降，21天后逐渐恢复正常。大梗死灶组患者血清sICAM-1的浓度明显高于中梗死灶组和小梗死灶组。CI合并糖尿病患者血清sICAM-1浓度明显高于无合并糖尿病患者。结论 sICAM-1与CI的发生，发展密切相关，深入研究CI后血清sICAM-1含量的变化有重要的临床价值。     

大剂量三七总皂甙治疗急性脑梗死的疗效观察

目的 观察大剂量三七总皂甙治疗急性脑梗死患者的疗效。方法 对１９８例急性脑梗死患者随机分为两组;（１）三七总皂甙治疗组１０３例;（２）对照组９５例。比较两组疗效。结果 三七总甙组基本痊愈２４例（２３．３％）,总显效率５１．５％,总有效率９４．２％,明显高于对照组（７．３％,３２．６％,６８．３％）（Ｐ〈０．０１）。三七总甙治疗后血液流变学改善也较对照组非常明显（Ｐ〈０．０１）,且未见明显副作用。结     

丁咯地尔治疗急性脑梗死80例疗效观察

目的：探讨丁咯地尔治疗急性脑梗死患者的效果。方法：选择发病6－72h的急性脑梗死患者，对其中80例急性脑梗死患者应用丁咯地尔针剂（赛莱乐），剂量200mg加入生理盐水500ml中静滴，每日1次，连续14天为1疗程；并对另外80例急性脑梗死患者应用低分子右旋糖酐500ml加复方丹参16ml静滴，每日1次，连用14天为对照，两组治疗前后测定血液流变学指标，并对比研究其疗效。结果：治疗组基本痊愈47例（58．8％），显著进步24例（30％），总显效（基本痊愈＋显著进步）71例（88．8％）；对照组基本痊愈14例（17．5％），显著进步12例（15％），总显效（基本痊愈＋显著进步）26例（32．5％）。治疗组的疗效明显优于对照组（P＜0．01），血液流变学改变，与治疗前比较也有显著改善（P＜0．01），CT检查显示治疗组病灶亦有明显改善，治疗组优于对照组。结论：丁咯地尔治疗急性脑梗死患者效果显著，且无毒副作用。     

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.     

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.     

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.     

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.