血脂与缺血性脑血管病的关系

目的探讨血脂与缺血性脑血管病的关系。方法选取佛山市第一人民医院2000~2004年缺血性脑血管病(Ischemic cerebral vascular disease,ICVD)患者共1430例为1组,以我院同时期保健科随机选取的400名健康体检人群为对照组,记录血脂情况,进行对照分析。结果血TC、TG和LDL-C水平ICVD组明显高于健康体检人群,差异有统计学意义。结论佛山地区血脂异常是ICVD的一个重要因素。     

血脂、颈动脉粥样硬化与缺血性脑血管病的关系

目的：探讨血脂、颈动脉粥样硬化与缺血性脑血管病的关系。方法：2001年6月-2004年12月在佛山市第一人民医院诊治的缺血性脑血管病患者为病例组，共1583例，其中男性902例（57．0％），女性681例（43．0％），年龄38～89岁，平均（60．02±10．35）岁；同时期保健科随机选取的400名健康体检人群作为对照组。将动脉粥样硬化斑块分为稳定型和不稳定型。记录血脂和颈动脉粥样硬化情况并进行对比分析。结果：Logistic回归分析表明，颈动脉斑块与年龄、高血压史和胆固醇水平有显著相关性。有高血压、糖尿病、血浆低密度脂蛋白-胆固醇（LDL-C）水平增高和吸烟史的患者，颈动脉狭窄发生率显著增高。病例组总胆固醇、三酰甘油和LDL-C与对照组有显著差异。缺血性脑血管病患者颈动脉粥样硬化发生率显著高于普通人群。结论：血脂异常和颈动脉粥样硬化是缺血性脑血管病的重要因素。     

血管紧张素原基因T704C多态性及血脂水平与动脉硬化性脑梗死的相关性研究

目的探讨血管紧张素原∽G7）基因T704C多态性与血脂水平及动脉硬化性脑梗死（ACI）的关系。方法2206为离退休职工为研究对象,进行体格检查和问卷调查,资料完整者l990名入选,其中男性1289名、女性701名。1990名中共检出ACl患者170例（男性132例,女性38例）为ACI组;余1820名无ACT者（男性1155例,女性665例）为对照组。采用PCR-RFLP方法检测AGT基因T704C基因型,采用全自动生化分析仪测定血脂等生化项目。结果ACI组性别、年龄、平均收缩压、平均舒张压、体重指数、血糖与对照组比较,两组问差异有统计学意义（P〈O．05）;调查人群中,携带AGT基因CC基因型的人群中,ACI患病率高干携带TT、TC基因型者（P〈0．05）;且携带C等位基因的人群ACI患病率高于携带T等位基因的人群（P〈0．05）;两组间血脂水平比较,对照组携带TC、CC基因型者高密度脂蛋白水平高于ACI组（P〈0．05）;携带CC基因型者三酰甘油水平明显低于ACI组（P〈0．05）。结论AGT基因T704C多态性及血脂水平与ACI相关。     

新疆石河子城区血管性痴呆和老年性痴呆的流行病学调查

目的探讨新疆石河子城区老年人血管性痴呆及老年性痴呆的发病情况。方法于1995年1～3月对石河子城区50岁以上老年人群进行随机抽样调查。共调查6个住宅小区计2687人，其中尼佳1380人，女性1307人。结果发现血管性痴呆的患病率为1．38％（37／2687），老年性痴呆患病率为0．41％（11／2687），老年性痴呆无性别及职业差异。血管性痴呆男性患病率（1．88％，26／1380）明显高于女性（0．84％，11／1307）（x2=4．6310，P＜0．05），无职业差异。随年龄增长，两种痴呆患病率均有明显增加，且两者均有显著性意义（P＜0．01）。调查结果还表明，无论哪种痴呆，文化程度低的人群患病率高。结论降低痴呆的重要措施是提高人群的教育、文化水平。     

河北省精神障碍的现况调查

目的了解河北省≥18岁人群各类精神障碍的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18岁人群，共24000名，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查患者版进行调查，用DSM，Ⅳ对各类精神障碍进行诊断。结果（1）患病率：20716人完成调查，精神障碍的时点患病率为162．43‰[95％可信区间（95％CI）为15．8％-16．7％]，排在前三位的是重性抑郁障碍（27．01‰）、未特定的焦虑障碍（25．09‰）和心境恶劣障碍（23．12‰）；终生患病率为185．12‰（95％CI为18．0％～19．0％），排在前三位的是重性抑郁障碍（47．47‰）、酒精依赖性和滥用性障碍（38．62‰）和未特定抑郁障碍（25．51‰）。（2）时点患病率：女性（167．95‰）高于男性（156．95‰），农村（165．63‰）高于城市（144．31‰），均P〈0．05～0．01；并随年龄的增长而不断上升，其中30～49岁为137．17‰～156．71‰，50-≥70岁为201．44‰～285．41‰。结论河北省精神疾病的患病率较高，其中女性和农村的患病率高；重性抑郁障碍是省内患病率最高的精神疾病。     

保定市特殊恐怖症的流行病学调查

目的探讨保定市民特殊恐怖症的患病率和分布特点。方法2004年10月～2005年3月采用多阶段分层整群抽样方法随机抽取18周岁及以上的人群10073例,用扩展的一般健康问卷（GHQ—12）将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准（DSM—Ⅳ）,以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版对调查对象进行特殊恐怖症的诊断。结果9021例完成调查,特殊恐怖症的终生患病率为0．74％,时点患病率为0．68％;各类型的终生及时点患病率分别为：动物型0．38％、0．36％,自然环境型0．31％、0．27％,其他型0．07％、0．03％;血液-注射-损伤型的终生和时点患病率均为0．09％,情景型仅终生患病率为0．01％。女性时点患病率高于男性;农村时点患病率高于城市;30-39岁的患病率最高,18～19岁的患病率最低。特殊恐怖症的精神科就诊率为2．5％。结论特殊恐怖症常见于年轻的女性,各类型患病率不同,且就诊率低。     

广州市城乡65岁及其以上人群痴呆患病率调查

目的调查广州市城乡≥65岁人群痴呆的患病率。方法采用分层随机整群抽样方法对广州市城乡人群进行抽样，用筛查和确诊两阶段法进行调查，实查14个居委会、2个村委会中≥65岁人群共3780人。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆，阿尔茨海默病（AD）诊断采用美国神经病学、语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的标准。结果（1）查出痴呆患者182例，粗患病率为4．81％；其中AD128例（3．39％），血管性痴呆（VD）44例（1．16％）；经2000年广州市人口年龄构成进行标化，痴呆、AD和VD患病率分别为4．54％、3．17％和1．11％。（2）女性痴呆患者134例，粗患病率（5．98％）高于男性（48例，3．12％；P〈0．001），经年龄标化患病率分别为6．03％和2．74％。（3）痴呆患病率随年龄增长急剧上升。结论广州地区年龄≥65岁老人的痴呆患病率为4．81％，AD患病率高于VD。老年期痴呆患病率随年龄的增长而急剧升高。     

河北省承德地区精神疾病流行病学调查

目的：了解河北省承德地区18岁及以上人群各类精神疾病的时点患病率和分布特点。方法：2004年10月至2004年11月采用多阶段分层整群随机抽样方法，抽取≥18岁者为调查对象。用一般健康问卷（CHQ-12）将调查对象分为高、中、低危险组，以美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）轴Ⅰ用定式临床检查患者版进行调查，用DSM-Ⅳ对精神障碍进行诊断。结果：3025人完成调查，精神疾病总时点患病率为177．19‰，终生患病率为216．86‰。除精神发育迟滞和痴呆外，各类精神疾病时点患病率为175．86‰，终生患病率为215．54‰。时点患病率农村为（176．65‰），城市为（180．08‰）；女性（182．05‰）高于男性（171．94‰）。重性抑郁障碍患病率最高（51.57‰）。结论：本调查基本掌握了河北省承德地区18岁及以上人群各类精神障碍的患病水平和分布特点。     

精神分裂症患者伴发代谢综合征的患病率调查

目的调查国内精神分裂症患者中代谢综合征的患病率及分析可能的相关影响因素。方法对住院的精神分裂症患者进行问卷调查和实验室测定，代谢综合征的诊断标准采用2004年中华医学会糖尿病分会代谢综合征标准。结果符合入组条件者共完成602例。精神分裂症患者中代谢综合征患病率为35．5％。与代谢综合征患病风险相关的危险因素包括年龄、性别、抗精神病药物种类及精神分裂症的病程（P〈0．05）。Logistic回归分析结果显示，女性精神分裂症患者罹患代谢综合征的相对危险度明显高于男性。年龄的相对危险度为12．27（95％CI2．238-32．557）。抗精神病药物种类与代谢综合征的患病风险有关（P=0．047〈0．05）。结论与普通人群相比，精神分裂症患者具有较高的代谢综合征发病风险，可能的危险因素包括女性、高龄、病程长及服用氯氮平药物等。     

保定市酒精滥用和酒精依赖的流行病学调查

目的了解保定市酒精滥用和酒精依赖的患病率和分布特点。方法2004年10月至2005年3月采用多阶段分层整群抽样方法随机抽取≥18周岁的人群,共10073名,用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组,采用美国精神障碍诊断标准（DSM-Ⅳ）,以美国精神障碍诊断与统计手册-第四版（DSM-Ⅳ）轴Ⅰ障碍定式临床检查病人版对调查对象进行酒精滥用及酒精依赖的诊断。心理、社会及职业功能采用大体功能量表（GAF）评定。结果9021人完成调查。酒精滥用：终生患病率为27.49‰,时点患病率为10.37‰;时点患病率：男性（20.01‰）明显高于女性（0.69‰）（P〈0.01）,农村（11.44‰）明显高于城市（2.76‰）（P〈0.01）,18-59岁患病率较高;心理、社会及职业功能无或轻度91.67%、中度2.38%、重度5.95%。酒精依赖：终生患病率为14.25‰、时点患病率为10.47‰;时点患病率：男性（20.69‰）明显高于女性（0.22‰）（P〈0.01）;20-69岁患病率较高;心理、社会及职业功能无或轻度68.68%、中度27.71%、重度3.61%。酒精滥用和酒精依赖均与心境障碍和焦虑障碍共病常见。结论酒精滥用和酒精依赖是常见的精神障碍,在男性及中青年人群中患病率高,已成为严重的社会公共卫生问题。     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

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 and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

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.