甲强龙、电针联合AECs移植治疗脊髓损伤的实验研究

目的 探讨甲强龙、电针与羊膜上皮细胞(amniotic epithelial cell,AECs)移植联合治疗,对脊髓损伤(spinal cord injury,SCl)大鼠下肢运动功能的影响.方法 将60只成年雌性Wistar大鼠随机分成5组,每组12只.A组(SCI损伤对照):做SCI手术,不进行治疗;B组(甲强龙治疗):SCI后,用大量甲强龙药物冲击治疗,共3d;C组(MP+电针):B组基础上,SCI后4h,行华佗夹脊穴电针治疗;D组(MP+电针+AEC):C组基础上,SCI后第7天,在脊髓损伤处移植大鼠AECs;E组(假手术):只打开椎板,暴露脊髓,不造成SCI.各组定期行为学观察(BBB评分),术后30d行5-HT免疫荧光组织化学观察和神经电生理检测.结果 5-HT染色:D组损伤区可见大量有序的5-HT阳性神经纤维,与E组最接近;BBB评分:D组恢复最为明显,与其它治疗组比较差异显著;MEP检测:D组峰-峰值显著增加,潜伏期明显缩短,差异有统计学意义(P<0.01).结论 甲强龙、电针与AECs联合治疗脊髓损伤极大的促进了5-羟色胺能神经纤维的再生,对SCI大鼠后肢运动功能的恢复有明显的促进作用.     

胎鼠神经干细胞局部注射移植大鼠高位脊髓损伤缺损处：体感及运动诱发电位与后肢运动功能评价

背景：如何促进脊髓损伤后的神经再生和功能恢复始终是医学界一大难题,胚胎神经干细胞有利于神经元的存活,并能促进轴突再生。 目的：观察胚胎鼠神经干细胞局部注射移植治疗高位脊髓损伤大鼠的可行性,以神经电生理及后肢运动功能评分评价其效果。 设计、时间及地点：细胞学体内实验,于2007-06/2008-06在哈尔滨医科大学动物实验中心完成。 材料：健康成年雌性SD大鼠40只,随机分为生理盐水组、细胞移植组,20只/组。另取孕14 d的SD大鼠5只用于制备胚胎神经干细胞。 方法：生理盐水组、细胞移植组大鼠均建立高位脊髓损伤模型,取双侧第8~10对肋间神经各2 cm,交叉植入脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质),细胞移植组局部注射鼠胚胎神经干细胞2×106个,生理盐水组局部注射等量无菌生理盐水。 主要观察指标：通过体感诱发电位和运动诱发电位的检测,观察神经电生理恢复情况;通过BDA顺行神经示踪,观察运动传导束恢复情况;BBB后肢运动功能评分结果。 结果：细胞移植组大鼠体感诱发电位及运动诱发电位的潜伏期、波幅明显优于生理盐水组(P < 0.01);细胞移植组大鼠在损伤区有较多BDA标记阳性神经纤维通过,而生理盐水组未见BDA标记阳性神经纤维;细胞移植组大鼠BBB后肢运动功能评分较生理盐水组明显提高(P < 0.01)。 结论：胎鼠神经干细胞局部注射可以较好地恢复高位脊髓损伤后的神经电生理及后肢运动功能。     

骨髓间充质干细胞立体定向移植治疗大鼠脊髓损伤*

摘要 背景：传统观念认为,神经组织损伤后几乎不能再生,以往对SCI的治疗缺乏有效手段,致使本病致残率高,疗效差。干细胞治疗关键在于移植具有再生能力的干细胞,通过多种作用机制,可以重建中枢神经系统的结构和功能,近年来引起了广泛的关注。 目的：探讨立体定向移植骨髓间充质干细胞（MSCs）对大鼠脊髓损伤修复的影响并探讨其机制 设计、时间及地点：随机对照动物实验,于2007-10/2008-6在天津市环湖医院完成。 材料：1月龄SD大鼠20只,用于制备骨髓间充质干细胞;健康成年Wistar大鼠45只,雌性、同系,体质量280±20 g。将动物随机分为对照组、假手术组与移植组,每组各15只。 方法：密度梯度离心法结合贴壁筛选法分离骨髓间充质干细胞,经流式细胞仪鉴定为MSCs。以动脉瘤夹夹闭法制备大鼠脊髓损伤（SCI）模型,在SCI大鼠致伤后第7天,通过立体定向途径移植MSCs到移植组大鼠脊髓损伤中心,移植等量生理盐水至假手术组大鼠脊髓损伤中心,对照组大鼠不做处理。 主要观察指标：SCI大鼠损伤前及损伤后第7天、14天、30天、60天、90天的BBB评分;损伤后第90天处死大鼠,观察其脊髓组织中有无BrdU阳性细胞、Brdu+NSE、Brdu+GFAP、Brdu+bFGF、Brdu+BDNF免疫组化双染阳性细胞并观察NSE、GFAP、bFGF、BDNF单染阳性细胞。 结果： ①BBB评分发现,MSCs移植组大鼠BBB后肢功能评分恢复优于对照组（p<0.05）;假手术组BBB评分在损伤后30天内恢复速度慢于对照组（p<0.05）,至第90天与对照组比较无显著差异（P>0.05）;②免疫组织化学染色发现,移植组大鼠脊髓内在损伤中心及头、尾端距离脊髓损伤中心1cm处均可见BrdU染色阳性细胞及Brdu+NSE、Brdu+GFAP、Brdu+bFGF、Brdu+BDNF免疫组化双染阳性细胞。移植组NSE、GFAP、bFGF、BDNF单染阳性细胞数明显高于对照组和假手术组（p<0.05）。 结论： MSCs移植可以促进SCI大鼠的神经功能的恢复,其机制可能与移植细胞分化为神经元样和神经胶质细胞样细胞,并分泌或促进宿主分泌神经营养因子有关。 关键词 脊髓损伤 骨髓间充质干细胞 立体定向 细胞移植     

大鼠脊髓完全性损伤模型的建立

背景：建立有效的完全性脊髓损伤动物模型是深入研究脊髓损伤的前提,只有建立标准的、可重复性高的实验动物模型才能择优选出治疗脊髓损伤的可行方案。 目的：实验拟建立一种稳定的大鼠完全性脊髓损伤动物模型。 设计、时间及地点：对照观察动物实验,于2007-11/2008-10在石河子大学药学院动物试验中心完成。 材料：30只健康Wistar大鼠随机分成假手术组6只、实验组24只。 方法：显露实验组大鼠T8~T12棘突及椎板,切除T9~10棘突及椎板,暴露相应脊髓段作为损伤区,采用大鼠脑定位仪自主设计改良Allen模型打击装置,予15 g×20 cm=2.94×10-2N 重力打击大鼠T10节段脊髓,动物模型保证硬脊膜完整。假手术组仅同法暴露相应脊髓段,但不做打击。 主要观察指标：造模后2,4,8周以斜板试验及BBB评分观察大鼠双后肢运动功能,以苏木精-伊红染色观察大鼠脊髓组织的变化。 结果：假手术组大鼠苏醒后能站立行走,斜板试验角度均大于70°,BBB评分21分,脊髓结构正常。实验组大鼠造模后双下肢全瘫,2只大鼠表现为痉挛性瘫痪,5只大鼠表现出不同程度的自残现象。造模后2,4,8周斜板试验角度均小于30°,BBB评分均少于10分,随时间延长,部分大鼠可见后肢刺激性反射,但无主动性功能活动,局部脊髓结构破坏严重。 结论：以2.94×10-2N 重力打击大鼠脊髓可保证硬脊膜的完整,并获得稳定的完全性脊髓损伤动物模型。     

人胚神经干细胞条件化培养基促进脊髓损伤大鼠皮质脊髓束再生

目的 研究神经干细胞条件化培养基对脊髓损伤大鼠（SCI）皮质脊髓束（CST）再生的促进作用。方法 成年雌性Wistar大鼠30只随机分为两组，神经干细胞条件化培养基治疗组和培养基对照组各15只，所有大鼠于T11水平横切脊髓。治疗组15只大鼠从固定在大鼠皮下Ommaya囊内注入神经干细胞条件化培养基，每周1次，每次注入5μl，对照组从Ommaya囊内注入同等量未培养过干细胞的培养基。利用Basso-Beattie—Bresnahan（BBB）评分客观评价后肢运动功能的恢复，检测生物素葡聚糖胺（Biotin dextran amine，BDA）示踪标记CST的再生，检测损伤部位远端的突触素表达情况。结果 所有大鼠在脊髓损伤后出现下肢截瘫，神经干细胞条件化培养基治疗组的大鼠表现为后肢运动功能的逐渐恢复，BDA标记的再生的轴突穿过了损伤处到达了脊髓的远端；对照组仅表现为轻微的组织和功能变化。治疗组大鼠脊髓在脊髓损伤处远端的神经元和BDA标记的轴突位置有突触素表达，对照组没有突触素表达。结论 神经干细胞条件化培养基可以促进SCI大鼠CST的再生以及CST和神经元之间的解剖学重建；神经于细胞治疗SCI可能通过支持治疗而非替代治疗。     

BDNF-GFP转染神经干细胞修复大鼠脊髓损伤：发挥干细胞与神经因子的双重效应？

摘要 背景：神经干细胞移植入大鼠脊髓损伤模型可以促进功能恢复,基因治疗已被广泛用于治疗脊髓损伤。 目的：确定BDNF-GFP转染后神经干细胞移植对大鼠脊髓损伤的修复效果。 设计,时间和背景：本实验是在中国医科大学基础医学院发育生物学实验室与2009年5月至2010年1月完成。 材料：10只新生Wistar大鼠和88只2-3个月大,雌雄不限的Wistar大鼠。 方法：以携带BDNF-GFP基因的腺病毒转染神经干细胞。88只Wistar大鼠中假手术组8只, 80只大鼠制成T9左侧横断模型,并随机分成四组：BDNF和GFP修饰的神经干细胞移植组,GFP修饰的神经干细胞移植组;单纯神经干细胞移植组和模型组。在各神经干细胞移植组,脊髓损伤后向横断处显微注射等体积细胞,模型组在相同的部位注射等体积的PBS。 主要观察指标： BBB评分检测脊髓损伤模型运动功能恢复情况;制备脊髓损伤模型2周后取材,免疫组化评估BDNF-GFP转染的神经干细胞移植后的细胞学特点;制备脊髓损伤模型2、4、6、8周Real-time PCR检测脊髓横断处BDNF表达情况。 结果： BDNF-GFP转染后神经干细胞在脊髓半切模型中存活并表达BDNF和GFP,移植该细胞后的大鼠体内高表达具有生物活性的BDNF,且脊髓损伤动物运动功能较对照组明显恢复。 结论：移植BDNF-GFP转染后神经干细胞可能是一种修复脊髓损伤的有效的方法。 关键词：神经干细胞,脑源性神经营养因子;绿色荧光蛋白;脊髓损伤;移植。     

5000/自体骨髓干细胞动员移植与手术移植治疗脊髓损伤的实验研究

探讨自体骨髓干细胞( bone marrow stem cells, BMSC)动员移植与手术移植治疗脊髓损伤（spinal cord injury，SCI）的疗效和机制。方法：选用10周龄健康SD大鼠90只，雌雄各半，建模前注射5-溴2-脱氧尿嘧啶核苷 (Bromodeoxyuridine,Brdu) 50mg/kg/d×3天后抽取自体骨髓，体外分离自体BMSC；NYU(New York University，NYU) Impactor制作SCI模型，随机分为对照组、动员移植组、手术移植组各30只。动员移植组应用重组粒细胞刺激因子（granulocyte-colony stimulating factor,G-CSF）皮下注射，20mg/kg/d×7天；手术移植组为损伤局部移植0.3ml（1×107个/ml）BMSC,各组均从术前三天开始，连续10天腹腔注射Brdu 50mg/kg/d。采用Basso-Beattie-Bresnahan（BBB）评分检测大鼠后肢的运动功能；体感诱发电位（somatoseneory evoked potential,SEP）和运动诱发电位（motor evoke potential,MEP）检测脊髓上、下行神经传导通路，判断SCI和恢复程度；病理和免疫组化观察脊髓损伤组织细胞结构变化及Brdu、GFAP和NSE分布表达。结果：BBB评分1周以后动员移植组和手术移植组分别较对照组比较差异有统计学意义（p＜0.05）,SEP、MEP潜伏期和波幅2周后动员移植组和手术移植组较对照组比较差异有统计学意义，组织病理学显示动员移植组和手术移植组较对照组有更少的空洞、坏死及GFAP阳性胶质瘢痕组织，较多的Brdu阳性细胞和NSE阳性细胞。结论：自体BMSCs动员移植和手术移植两种方法均能明显减轻SCI的程度，促进损伤后的脊髓功能的恢复，二者对比，前者更为方便、无创，实用性强，更有可能抓住有限的治疗时机，因而应用前景可能更好。     

米诺环素对大鼠脊髓挤压伤后运动功能恢复的影响

目的探讨米诺环素对大鼠脊髓挤压伤后运动功能恢复的影响。方法成年Sprague-Dawley(SD)大鼠36只,分为空白对照组:只打开脊柱椎板,不损伤脊髓;米诺环素治疗组:制作脊髓挤压伤模型,腹腔注射米诺环素;盐水对照组:制作脊髓挤压伤模型,腹腔注射等剂量的生理盐水。于脊髓挤压伤后第3天取大鼠脊髓标本,进行组织水肿、损伤面积的测量,并行组织切片,进行细胞凋亡Caspase-3染色,观察细胞凋亡情况。同时于各个时间点进行大鼠后肢运动功能评分(basso-beattie-bresnahan,BBB评分)。结果与生理盐水组比较,米诺环素治疗组损伤面积更小,细胞凋亡数量更少,组织水肿更轻,运动功能恢复更好。结论米诺环素可以促进大鼠脊髓挤压伤后运动功能的恢复。     

接受嗅鞘细胞移植脊髓损伤大鼠电生理及后肢功能变化

背景：研究证实嗅鞘细胞有利于神经元存活,并可促进轴突再生。 目的：探讨嗅鞘细胞移植治疗大鼠脊髓损伤的效果。 方法：健康成年雌性SD大鼠40只,随机分为盐水对照组、细胞移植组,20只/组。另取10只SD大鼠用于嗅鞘细胞的分离培养。盐水对照组、细胞移植组大鼠均建立脊髓损伤模型,取双侧第8~10对肋间神经各2 cm,交叉植入脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质),细胞移植组局部注射嗅鞘细胞2×106个,盐水对照组局部注射等量无菌生理盐水。通过体感诱发电位和运动诱发电位的检测,观察神经电生理恢复情况;BBB后肢运动功能评分结果;通过BDA顺行神经示踪,观察运动传导束恢复情况。 结果与结论：细胞移植组大鼠体感诱发电位及运动诱发电位的潜伏期、波幅明显优于盐水对照组(P < 0.01);细胞移植组大鼠BBB后肢运动功能评分较生理盐水组明显提高(P < 0.01);细胞移植组脊髓损伤区有较多BDA标记阳性神经纤维通过,其数量明显多于盐水对照组(P < 0.01)。证实局部注射嗅鞘细胞可以较好地恢复大鼠脊髓损伤后的神经电生理及后肢运动功能。     

咯利普兰对大鼠脊髓损伤后保护作用及其机制

目的探讨咯利普兰对大鼠脊髓损伤(SCI)后的保护作用及其可能机制。方法将84只SD大鼠随机分为三组:假手术组(n=4)、损伤组(n=40)和治疗组(n=40)。大鼠SCI模型采用纽约大学脊髓重物坠落伤模型。治疗组伤后即刻腹腔内注射咯利普兰,剂量为0.5 mg(/kg.d),2次/d,连续3d。损伤前后对损伤组和治疗组大鼠进行开放场地试验(BBB)评估大鼠脊髓功能。免疫组化染色分析三组大鼠损伤前后脊髓兴奋性氨基酸转运蛋白4(EAAT4)表达情况。结果损伤组和治疗组伤后即刻大鼠BBB评分均为0,处于完全瘫痪状态;然后BBB评分逐渐增高;伤后42、56和64d,治疗组BBB评分明显高于损伤组(P<0.01)。假手术组脊髓组织形态正常,EAAT4表达较少;脊髓损伤1周后,损伤中央出现较大空洞,EAAT4表达明显升高;而治疗组,组织空洞缩小,EAAT4表达较损伤组明显增加。结论咯利普兰有助于大鼠脊髓损伤后功能恢复,其机制可能与增加EAAT4表达有关。     

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.     

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.     

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.     

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.     

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.     

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.