人参皂苷Rg1诱导骨髓间充质干细胞分化为神经样细胞的作用

目的研究人参皂苷Rg1在体外能否诱导Wistar大鼠骨髓间充质干细胞分化为神经元样细胞。方法通过贴壁法分离大鼠骨髓间充质干细胞,体外培养扩增,人参皂苷Rg1诱导分化,光镜下观察细胞形态,免疫细胞化学检测神经元特异性烯醇化酶（NSE）和神经胶质纤维酸性蛋白（GFAP）的表达,RT-PCR检测细胞NGF mRNA的表达。结果大鼠骨髓间充质干细胞可通过贴壁法成功分离并可以在体外大量扩增。人参皂苷Rg1诱导72h后,部分骨髓间充质干细胞（35．57％±3．59％）转变为神经元样细胞,免疫细胞化学染色NSE呈阳性,分化的神经元样细胞可能表达NGF mRNA。结论人参皂苷Rg1可以在体外诱导大鼠骨髓间充质干细胞分化为神经元样细胞,并且可能表达NGF mRNA。     

无血清神经培养基体外培养大鼠骨髓源性神经干细胞

背景：传统的胚胎来源和脑来源的神经干细胞由于取材困难,并受伦理道德的约束,应用受到极大限制。 目的：拟利用无血清神经培养基体外培养大鼠骨髓源性神经干细胞。 方法：抽取大鼠股骨和胫骨的骨髓,采用全骨髓培养及贴壁筛选法分离培养骨髓间充质干细胞,流式细胞仪检测细胞周期及细胞免疫表型,油红O染色及茜素红染色鉴定其成骨、成脂能力。取传至4~6代的大鼠骨髓间充质干细胞,加入含表皮生长因子、碱性成纤维生长因子、B27的DMEM/F12无血清神经培养基进行诱导,采用免疫荧光染色及流式细胞仪予以鉴定。 结果与结论：P5骨髓间充质干细胞(91.5±3.1)%处于G1期,高表达CD90及CD29,不表达CD45及CD34,成脂诱导后在胞质中可见桔红色脂滴,成骨诱导后可见黑色矿化结节。骨髓源性神经干细胞巢蛋白免疫荧光染色呈阳性,流式细胞仪检测其阳性率为(97.2±1.1)%,NSE,β-Tubulin,GFAP及MAP-2抗原免疫荧光染色均呈阳性表达。表明在无血清神经培养基中加入特定生长因子,骨髓间充质干细胞可诱导为神经干细胞;在体外适当条件下,骨髓源性神经干细胞具有增殖和分化为神经元、星形胶质细胞及少突胶质细胞的能力。     

川芎嗪联合创伤性脑组织匀浆液诱导骨髓间充质干细胞向神经样细胞分化

背景：川芎嗪和创伤性脑组织匀浆液均可诱导骨髓间充质干细胞向神经样细胞分化。 目的：探讨川芎嗪与创伤性脑组织匀浆液诱导骨髓间充质干细胞向神经样细胞分化的联合效应。 方法：分离培养Wistar大鼠骨髓间充质干细胞后分为4组,加入不同的诱导培养基分别干预：空白对照组、川芎嗪诱导组、创伤性脑匀浆液诱导组和川芎嗪联合创伤性脑匀浆液诱导组。诱导后采用倒差显微镜观察细胞形态变化,并统计不同时段四组细胞分化率。分别取部分细胞进行神经元特异性烯醇化酶染色,胶质纤维酸性蛋白免疫细胞化学与免疫荧光细胞化学双标检测。 结果与结论：川芎嗪及受损大鼠脑匀浆液上清液可诱导大鼠骨髓间充质干细胞向神经元样细胞分化,随诱导时间的延长,诱导分化率越高,具有较重要的应用价值,而神经元特异性烯醇化酶与胶质纤维酸性蛋白在其分化信号中起重要作用。     

辛伐他汀对高糖高脂诱导人骨髓间充质干细胞凋亡的影响

背景：研究表明,他汀类药物能够促进骨髓间充质干细胞的增殖与黏附能力,抑制高糖高脂培养下骨髓间充质干细胞的凋亡。 目的：观察辛伐他汀对高糖高脂诱导条件下人骨髓间充质干细胞凋亡的影响。 方法：将0.001,0.01,0.1,1.0 μmol/L辛伐他汀分别与高糖高脂诱导条件下人骨髓间充质干细胞培养48 h,以正常培养骨髓间充质干细胞及高糖高脂诱导条件下培养的骨髓间充质干细胞为对照。倒置显微镜下观察细胞形态,MTT法比较不同浓度辛伐他汀对高糖高脂环境下骨髓间充质干细胞存活率的影响,应用流式细胞术检测细胞凋亡,加入PI3K/Akt信号转导通路抑制剂LY294002后辛伐他汀对骨髓间充质干细胞凋亡的影响。 结果与结论：与高糖高脂诱导组比较,辛伐他汀0.01,0.1,1.0 µmol/L组骨髓间充质干细胞存活率均升高(P < 0.01),其中辛伐他汀浓度在0.1 μmol/L时骨髓间充质干细胞存活率升高最显著(P < 0.01);同时流式细胞仪检测结果显示,辛伐他汀0.01,0.1,1.0 µmol/L组细胞凋亡率下降(P < 0.01),其中0.1 µmol/L组凋亡率下降最显著(P < 0.01)。0.1 µmol/L辛伐他汀对骨髓间充质干细胞的影响可被LY294002阻断。说明辛伐他汀能抑制高糖高脂诱导条件下骨髓间充质干细胞的凋亡,其机制可能与PI3K/Akt信号途径有关。     

小胶质细胞活化刺激骨髓间充质干细胞释放胶质细胞源性神经营养因子保护多巴胺能神经元的实验☆

背景：目前尚未见骨髓间充质干细胞对活化的小胶质细胞特异性反应的报道，且有关骨髓间充质干细胞在特定微环境下如何维持多巴胺能神经元的存活也缺乏相应的实验证据。 目的：观察骨髓间充质干细胞在活化的小胶质细胞刺激下保护多巴胺能神经元存活的作用。 方法：取Wistar大鼠，贴壁法分离培养骨髓间充质干细胞，体外培养并活化小胶质细胞，酶消化法培养中脑多巴胺能神经元。实验分为5组：骨髓间充质干细胞组；小胶质细胞组；脂多糖+小胶质细胞组；骨髓间充质干细胞+脂多糖+小胶质细胞组；分别取各实验组的培养上清，对中脑多巴胺神经元进行培养。单纯多巴胺能神经元组采用体积分数为10%胎牛血清+DMEM/F12进行培养。采用免疫荧光技术检测不同微环境对多巴胺能神经元存活的影响及不同微环境对骨髓间充质干细胞释放胶质细胞源性神经营养因子的影响。 结果与结论：含有骨髓间充质干细胞的实验组胶质细胞源性神经营养因子的释放量均较相应的对照组高。酪氨酸羟化酶免疫荧光染色结果发现，单纯多巴胺能神经元组神经元的存活率为15%；小胶质细胞组多巴胺能神经元的存活率为10%；骨髓间充质干细胞组多巴胺能神经元的存活率为35%；脂多糖+小胶质细胞组多巴胺能神经元的存活率为5%；而骨髓间充质干细胞+脂多糖+小胶质细胞组多巴胺能神经元的存活率达到了28%，高于除骨髓间充质干细胞组外的其他各组(P < 0.05)。此外体外培养多巴胺能神经元存活率随培养时间延长下降，但含有骨髓间充质干细胞实验组的多巴胺能神经元存活率明显高于相应对照组。提示小胶质细胞活化刺激骨髓间充质干细胞上调胶质细胞源性神经营养因子表达，使得多巴胺能神经元免受毒素的损害，抑制了多巴胺能神经元的延迟性死亡。     

鼠脑C6胶质瘤细胞上清液诱导人骨髓间充质干细胞向神经元样细胞的分化

目的：观察人骨髓间充质干细胞经鼠脑C6胶质瘤细胞上清液诱导后向神经元样细胞方向的分化情况。 方法：取肝素抗凝人骨髓血，Percoll梯度法体外分离培养骨髓间充质干细胞，胰酶消化后传代扩增。取第4~6代骨髓间充质干细胞，当细胞达90%融合时，按2×103/孔接种于24孔板内，第2天分为两组，诱导组用含有50% C6胶质瘤细胞上清液的完全培养基（含体积分数为0.1胎牛血清的L-DMEM培养基）诱导，每隔2 d换液1次；对照组单纯加入完全培养基进行培养。诱导后3 d，两组细胞采用S-P法进行免疫细胞化学染色，检测神经元特异性标志物的表达。 结果：诱导24 h后，诱导组多数骨髓间充质干细胞表现出典型的神经元样外观，对照组细胞形态无明显变化。诱导3 d后，诱导组神经元烯醇化酶阳性细胞率显著高于对照组（P < 0.01）；诱导组神经丝蛋白阳性细胞率为（44.2±2.4）%，对照组为阴性；两组胶质纤维酸性蛋白均呈阴性表达。 结论：鼠脑C6胶质瘤细胞上清液可成功诱导人骨髓间充质干细胞向神经元样细胞分化。     

细胞因子联合纹状体条件培养液定向诱导间充质干细胞体外分化为多巴胺能神经元

背景：在众多体外诱导间充质干细胞向多巴胺能神经元的诱导分化研究中，诱导阳性率仍不理想。 目的：实验应用碱性成纤维细胞生长因子、表皮生长因子和纹状体条件培养液定向诱导大鼠骨髓间充质干细胞分化为多巴胺能神经元，拟探讨提高诱导阳性率的方法。 设计、时间及地点：以细胞为对象的对照观察细胞学实验，于2006-07/2007-12在山东大学齐鲁儿童医院和山东大学第二医院血液实验室完成。 材料：健康成年Wistar大鼠用于骨髓间充质干细胞的分离，新生Wistar大鼠用于纹状体条件培养液的制备。 方法：采用贴壁法分离纯化健康成年Wistar大鼠骨髓间充质干细胞进行传代培养。取出生24 h内新生Wistar大鼠，完整剥离其大脑组织制备纹状体条件培养液。取体外培养的第5代间充质干细胞，用含碱性成纤维细胞生长因子和表皮生长因子的预诱导液进行预诱导，24 h后去除预诱导液，换用纹状体条件培养液进行诱导。 主要观察指标：倒置显微镜下观察细胞形态变化，并应用细胞免疫化学技术检测细胞内神经元特异烯醇化酶和酪氨酸羟化酶表达。 结果：大鼠骨髓间充质干细胞经碱性成纤维细胞生长因子、表皮生长因子和纹状体条件培养液诱导后细胞胞体逐渐回缩成团，形成梭形，部分细胞可见突起伸出，类似神经元。细胞免疫化学检测，诱导后细胞神经元特异烯醇化酶阳性表达率为( 72.70±14.81)%，酪氨酸羟化酶阳性表达率为(34.50±15.93)%。 结论：应用碱性成纤维细胞生长因子、表皮生长因子联合纹状体条件培养液诱导分化体系，获得了高比例的神经元，其中包括较多的多巴胺能神经元。     

丹参诱导大鼠骨髓间充质干细胞分化为神经元样细胞中的钙离子检测

目的 检测大鼠骨髓间充质干细胞经丹参注射液诱导分化的神经元样细胞内钙离子浓度,以期为骨髓间充质干细胞应用于神经系统疾病的治疗提供理论依据.方法 从成年大鼠骨髓中获取骨髓间充质干细胞,体外扩增培养,经碱性成纤维生长因子预诱导后施加10mL/L丹参注射液于骨髓间充质干细胞培养液中.运用免疫荧光检测神经元特异性核蛋白(NeuN)在诱导后细胞与经新生大鼠海马获取的体外培养海马神经元中的表达.激光共聚焦技术检测诱导后的细胞内钙离子浓度.并与原代培养海马神经元内的钙离子浓度进行比较.结果 大鼠骨髓间充质干细胞经碱性成纤维生长因子和丹参注射液处理后,可表达NeuN,并具有神经元样的表型.诱导分化的神经元样细胞内钙离子浓度为984.75±79.51,原代培养海马神经元内钙离子浓度为769.42±60.93,两者比较差异无统计学意义(P>0.05).结论 丹参注射液诱导骨髓间充质干细胞分化的神经元样细胞具有神经元的某些特征.     

川芎嗪诱导大鼠骨髓间充质干细胞分化为神经元样细胞：最佳诱导剂量筛选☆

背景：目前用于体外诱导骨髓间充质干细胞向神经元样细胞分化的诱导剂众多,但多数化学诱导剂具有毒性不适合用于人体。 目的：观察中药川芎嗪对大鼠骨髓间充质干细胞分化为神经元样细胞的影响,并寻找川芎嗪诱导分化的最佳浓度。 方法：SD大鼠麻醉后无菌条件下取出股骨和胫骨,离心后弃上清液,加入含体积分数为15%胎牛血清的L-DMEM培养基重新悬浮细胞并转入培养瓶培养传代,用免疫细胞化学方法检测第5代骨髓间充质干细胞CD44、CD45的表达;取含1.00,1.25,1.50 g/L 3种剂量盐酸川芎嗪注射液的无血清L-DMEM培养基对体外培养的第5代骨髓间充质干细胞进行诱导。倒置相差显微镜下观察细胞形态变化,免疫细胞化学方法检测已诱导细胞巢蛋白、神经元特异性烯醇化酶和胶质纤维酸性蛋白的表达,比较3种剂量盐酸川芎嗪注射液诱导神经元样细胞抗原表达率。 结果与结论：①原代细胞接种3 d后多数细胞贴壁,传代后细胞贴壁速度和增殖更快,第5代基本纯化为骨髓间充质干细胞,细胞呈放射状或漩涡状排列。②第5代骨髓间充质干细胞(98.02±0.81)%CD44表达阳性,CD45表达阴性。③诱导后细胞出现类似神经元细胞样形态;免疫细胞化学方法检测显示多数细胞巢蛋白、神经元特异性烯醇化酶阳性表达,1.25 g/L浓度组细胞的神经元特异性烯醇化酶阳性表达率最高。提示川芎嗪可诱导骨髓间充质干细胞分化为神经元样细胞,1.25 g/L为最适诱导剂量。     

创伤性脑组织匀浆对大鼠骨髓间充质干细胞分化为神经元样细胞的影响

目的：骨髓间充质干细胞在脑组织匀浆诱导环境下可以转化为神经元样细胞，损伤脑组织匀浆的骨髓间充质干细胞培养液中，不仅有脑组织中提取的生长因子，而且有骨髓间充质干细胞分泌的多种生长因子，共同刺激骨髓间充质干细胞向神经元样细胞的分化。实验观察了创伤后24 h和正常脑组织匀浆诱导大鼠骨髓间充质干细胞向神经元样细胞分化的差别。 方法：实验于2007-03/08在河北医科大学解剖教研室细胞培养中心完成。①实验材料：体质量100~150 g的健康SD大鼠由河北医科大学实验动物中心提供，4~6周龄,清洁级。实验过程中对动物处置符合动物伦理学标准。②实验方法：取1只 SD大鼠，麻醉后分离股骨和胫骨，用培养基冲洗骨髓腔，离心弃上清液，加入含体积分数为0.10胎牛血清的L-DMEM培养基重悬，接种于培养瓶培养并传代，于倒置显微镜下观察细胞形态。采用Gruncr改良法制作中度脑损伤大鼠模型，取伤后 24 h和正常大鼠脑组织匀浆，对体外培养的第3代骨髓间充质干细胞进行诱导。③实验评估：在倒置显微镜下观察细胞形态学变化，并应用免疫细胞化学技术检测细胞内神经元特异性烯醇化酶的表达，比较创伤后和正常脑组织匀浆两组诱导率差别。 结果：骨髓间充质干细胞经创伤性脑组织匀浆培养基诱导24 h后，细胞的胞体变大，36 h后部分细胞分化，回缩成圆形或梭形，48 h后部分细胞可见两个或多个突起伸出，类似神经元。免疫细胞化学技术检测显示，创伤性脑组织匀浆培养基诱导组神经元特异性烯醇化酶阳性表达为（54.28±6.03）%，正常脑组织匀浆诱导分化率较前者低，神经元特异性烯醇化酶阳性表达为（32.76±3.25）%，细胞生长状态略差。 结论：脑组织匀浆可诱导大鼠骨髓间充质干细胞向神经元样细胞分化，创伤性脑组织匀浆可明显促进其分化。     

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.     

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.     

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.