偏头痛患者基于体素形态学与功能连接分析

目的 探讨偏头痛患者脑结构、脑功能、认知和情绪的变化情况。方法 采集33例偏头痛患者(偏头痛组)及27例相匹配的健康对照者(健康对照组)的高分辨T₁结构相及静息态功能相数据,利用基于体素的形态学(VBM)方法分析偏头痛患者大脑灰质体积变化,继而利用静息态功能连接分析技术分析有结构变化的脑区与大脑其他区域功能连接的差异,结果采用GRF校正(体素水平P<0.001,簇水平P<0.05)。采用蒙特利尔认知评估量表(MoCA)及情绪量表[焦虑自评表(SAS)及抑郁自评量表(SDS)]评估偏头痛患者认知功能及焦虑、抑郁水平。分析偏头痛患者脑灰质体积变化与临床变量及量表评分的相关关系。结果 与健康对照组比较,偏头痛组SAS、SDS评分显著升高,MoCA评分显著降低(均P<0.05)。与健康对照组比较,偏头痛组左侧枕中回及左侧距状裂周围皮质灰质体积显著增大(GRF校正,体素水平P<0.001,簇水平P<0.05),偏头痛组左侧枕中回与多个脑区功能连接减弱,包括双侧脑岛、双侧颞上回、右侧缘上回、右侧中央后回、右侧额下回等脑区(GRF校正,体素水平P&...     

静息态功能磁共振在血管性轻度认知障碍研究中的 应用进展

血管性认知障碍作为脑血管病致残结果之一，其发病率仅次于AD，成为与年龄相关的认 知障碍和痴呆的第二大原因。目前血管性痴呆尚无有效的治疗措施，而血管性轻度认知障碍（VaMCI） 作为血管性痴呆的早期阶段被认为是临床上治疗、预防痴呆的关键时期，也是当今血管性认知障碍研 究的热点。近年来静息态功能磁共振成像技术的快速发展及其在认知领域的广泛应用使我们更加深入 的了解VaMCI 患者在神经结构、功能、代谢等方面的变化，为早期诊断、评估疾病严重程度及治疗效果 带来了新的希望。将静息态功能磁共振用于该病并将其与神经心理学评估结合用来诊断VaMCI将会成 为未来的趋势。     

长期住院男性精神分裂症患者的认知功能与事件相关电位P300的相关性

目的 探讨长期住院的男性精神分裂症患者认知功能的变化与事件相关电位P300的关系.方法入组长期住院男性精神分裂症患者82例和健康对照52人.采用美国Nicolet Viking Quste诱发电位仪记录事件相关电位P300的潜伏期和波幅.采用动物命名测验、范畴流畅性测验、数字划消测验、连线测验(TMT-A、TMT-B)、Stroop测验(单词、颜色、色词干扰测验)、木块图测验、WMS-Ⅲ空间广度测验评估认知功能.结果患者组各项认知功能测验成绩与对照组之间差异均有统计学意义(P<0.01).患者组事件相关电位P300潜伏期较对照组明显延长(t=22.990,P<0.01),波幅较对照组明显降低(t=-9.699,P<0.01).患者组事件相关电位P300潜伏期与数字划消测验及TMT-A呈正相关(r=0.481,P<0.01;r=0.245,P<0.05).事件相关电位P300波幅与数字划消测验呈负相关(r=-0.338,P<0.01).结论长期住院男性精神分裂症患者虽处于稳定期,但仍存在认知功能的损害.事件相关电位P300的潜伏期和波幅可能是精神分裂症认知功能的电生理指标,并与患者的认知量表评估结果之间存在相关性.     

癫痫患者事件相关电位(P300)与认知功能相关性研究

目的：探讨癫痫患者事件相关电位特征及其在反映认知功能上的价值。方法：利用事件相关电位、韦氏成人智力量表和记忆量表对５０例成人癫痫患者认知功能进行电生理学和心理学评估,３０例年龄、性别及文化程度相匹配的健康成人作对照。结果：病人组Ｐ３潜伏 长,智商、记忆商明显降低,Ｐ３潜伏期与患者总智商、言语智商、操作智商和记忆商呈显著负相关,其中相关性最密切的是言语智商和记忆商。结论：Ｐ３潜伏期在一定和程序上能够     

偏头痛与静息态脑功能连接研究

目的本文研究采用静息态功能磁共振成像(rfMRI)技术描述偏头痛患者静息态脑功能连接改变,为探索偏头痛的发病机制提供影像学资料。方法收集16例偏头痛患者与16例健康对照,采集rfMRI成像,计算低频振幅,找出感兴趣区做功能连接进行统计分析。结果偏头痛患者左侧岛叶、左侧额下回低频振幅显著低于对照组,右侧视觉皮质低频振幅显著高于对照组;以左侧额下回、右侧枕中回为感兴趣区,发现左侧额下回与脑干之间的功能连接增强,与双侧枕叶之间的功能连接减弱;右侧枕中回与双侧楔前叶延伸至扣带回中部区域之间的功能连接增强,与双侧中央前回、双侧缘上回、双侧颞上回及双侧额下回之间的功能连接减弱。结论偏头痛患者无头痛发作时神经元活动强度改变,大脑功能连接异常,这导致大脑整合信息过程改变,并与偏头痛发病相关。     

92例偏头痛患者的听觉事件相关电位分析

本文报告2003-03～2005-02对92例偏头痛患者的听觉事件相关电位(ERP)检查,以了解偏头痛患者是否有认知功能改变.报告如下.     

帕金森病认知功能与事件相关电位P300

帕金森病(PD)可并发认知功能障碍已为大家所公认。有关本病的神经心理学研究,国内早有报道,但对本病认知功能的电生理学研究,报道甚少。由于量表测试费时,而且依赖于主试者的主观解释,较难客观评价认知功能。对PD患者进行听觉事件相关电位(ERP)和改良长谷川智能量表(HDS)检测,旨在探讨事件相关电位P_(300)对PD患者认知功能障碍的临床诊断价值。     

首发抑郁症的患者静息态脑网络度中心度与认知功能研究

目的 基于体素的度中心度方法(DC)分析探讨首发抑郁症患者静息态脑网络节点中心地位的特点及其认知功能损害的神经影像学机制.方法 纳入2013年5月至2019年3月武汉大学人民医院收治的首发抑郁症患者及同期招募健康对照各30例进行静息态磁共振扫描,并行数字符号测试、数字广度测试及语言流畅性测试.对静息态磁共振数据进行常规...     

听觉事件相关电位对意识障碍患者预后评估的研究进展

意识障碍预后的有效评估对临床决策和医疗资源分配至关重要。行为学量表是目前最为常用的评估手段,但其主观性强、误诊率高。事件相关电位,尤其是长潜伏期事件相关电位逐渐被应用于意识水平的评估。本文主要综述听觉事件相关电位不同成分在意识障碍预后评估中的应用价值。     

慢性精神分裂症患者认知功能及静息态脑功能局部一致性研究

目的 探讨慢性稳定期精神分裂症患者静息态脑功能局部一致性（ReHo）的改变及其与认知功能损害之间的相关性。方法 选取20例慢性精神分裂症患者（患者组）和19名健康志愿者（对照组）,采用神经心理状态评定量表（RBANS）评估两组被试的认知功能,并行静息态功能磁共振（rs-fMRI）扫描获取ReHo值,采用t检验比较组间差异,并分析ReHo值与RBANS的相关性。结果患者组在视觉空间/结构、言语功能、注意及总分均显著低于对照组（P]<0.05或P<0.001）。与对照组相比,患者组在双侧中央后回、舌回及右侧颞下回ReHo值显著降低（P均<0.05）;患者组右侧颞下回ReHo值与PANSS总分及阳性症状分均呈正相关（P均<0.05）,与言语功能呈负相关（P<0.05）。结论 在静息状态下,慢性精神分裂症患者双侧中央后回、舌回及右侧颞下回同步一致性活动减低,ReHo改变可能与慢性精神分裂症认知损害有相关性。     

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.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.