三种抗癫痫药对癫痫患者脑电图的背景影响比较研究

目的：研究对比三种抗癫痫药（苯妥因钠、丙戊酸钠、卡马西平）对癫痫患者脑电图的背景影响。方法：选取我院于2009年3月至2011年2月收治的60例癫痫患者,随机分为苯妥因钠（PHT）、卡马西平（CBZ）和丙戊酸钠（SVP）组各20例,动态观察各组患者于治疗期间痫样波放电的频度和EEG背景的变化。结果：EEG痫样波放电的抑制率以SVP最为明显,而CBZ在EEG背景活动影响方面均比其他两组显著。结论：三种药物对癫痫波放电的抑制顺序是SVP〉PHT〉CBZ,SVP组明显优于其他两组。     

常用抗癫痫药对癫痫患者血同型半胱氨酸的影响

目的:观察常用抗癫痫药对癫痫患者血同型半胱氨酸、叶酸、维生素B12浓度的影响。方法:比较45例服用单药治疗的癫痫患者(服用卡马西平11例,服用拉莫三嗪12例,服用奥卡西平9例,服用丙戊酸13例)血同型半胱氨酸、叶酸、维生素B12浓度的差异。结果:癫痫患者血同型半胱氨酸均高于正常,而叶酸和维生素B12均在正常范围内;服用拉莫三嗪的患者其血中同型半胱氨酸低于服用丙戊酸、卡马西平和奥卡西平的患者;服用卡马西平的患者血中叶酸高于服用拉莫三嗪、丙戊酸的患者(P<0.05);维生素B12在各用药组间无统计学差异。结论:长期服用抗癫痫药物可引起血中同型半胱氨酸的升高,而高同型半胱氨酸血症可增加心脑血管疾病的危险,故癫痫患者应常规给予补充叶酸、维生素B12,以使血同型半胱氨酸水平恢复正常。     

内磁疗法治疗癫痫初探与脑电图分析

为探讨磁环穴位内植治疗癫痫的疗效,将151例癫痫病人随机分为磁穴组（58例）,磁穴药物组（51例）对照组（42例）进行治疗对照组研究与脑电图分析,结果显示,磁穴组显效率明显高于对照组（P＜0．05）;磁穴药物组对照组总有效率显提高（P＜0．05）,其显效率更高（P＜0．01）;磁穴药物组显效率明显高于磁穴组（P＜0．05）,脑电图磁穴药物组与对照组有效率（P＜0．05）。提示磁环穴位内植用于癫痫的治疗具有较好的疗效,且安全可靠,常用抗癫痫药物配合磁环穴位内植治疗癫痫具有协同作用,可明显提高其治疗效果。     

益生菌联合常规药物对难治性癫痫患儿的疗效及对脑电图的影响CSCD

目的 探讨益生菌联合常规药物对难治性癫痫患儿的治疗效果及对患儿脑电图的影响,为该类患儿的治疗提供参考。方法 选取2020年1月至2022年5月我院收治的104例难治性癫痫患儿作为研究对象,按照随机数表法分为对照组和联合组。对照组患儿采用常规药物治疗,联合组在对照组的基础上联用益生菌治疗。对比两组患儿治疗前后癫痫发作频率、脑电图情况、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、神经递质[γ-氨基丁酸(GABA)、5-羟色胺(5-HT)]水平及治疗后的临床疗效和用药安全性。结果 治疗前两组患儿癫痫发作频率、脑电图各频段相对功率以及IL-6、TNF-α、GABA和5-HT水平差异均无统计学意义(均P>0.05)。治疗后两组患儿癫痫发作频率、脑电图θ频段相对功率及IL-6、TNF-α水平均降低,且联合组患儿以上指标水平均低于对照组(均P<0.05)。治疗后两组患儿GABA和5-HT水平均升高,且联合组的GABA和5-HT水平高于对照组(均P<0.05)。两组患儿临床疗效分布差异有统计学意义,联合组总有效率高于对照组(94.23%vs 80.77%,P<0.05)。治疗期间两组患儿的不良反应发生率对比差异无统计学意义(P>0.05)。结论 对难治性癫痫患儿采用益生菌联合常规药物治疗能有效降低其癫痫发作频率,改善脑电图相应频段的相对功率,减轻炎症反应,抑制异常兴奋,且疗效显著,安全性高。     

视频脑电图鉴别诊断癫痫患者睡眠障碍、认知障碍的临床价值研究

目的:探讨视频脑电图诊断癫痫患者睡眠障碍、认知障碍的临床价值。方法:选取2014年1月~2016年12月在我院神经内科进行诊治的癫痫患者236例作为癫痫组,另选取同期的健康患者家属或者其他健康体检者236例作为正常对照组,对两组进行视频脑电图联合睡眠参数分析;并对癫痫组视频脑电图联合认知参数进行分析。结果:癫痫组睡眠Ⅰ~Ⅱ期时间显著长于正常对照组且具有统计学差异(P=0.000),睡眠Ⅲ~Ⅳ期时间显著短于正常对照组且具有统计学差异(P=0.000),睡眠时相转换频率、觉醒指数均显著高于正常对照组且均具有统计学差异(P=0.000);清醒期、睡眠期不同痫样放电指数(IED)的WAIS-RC IQ和WMS-RC MQ均具有统计学差异(P0.05),10%IED≤50%者的WAIS-RC IQ和WMS-RC MQ均显著低于1%IED≤10%者且均具有统计学差异(P0.05),IED 10%可能是痫样放电影响患者认知功能的最低阈值。结论:视频脑电图在癫痫患者睡眠障碍、认知障碍识别中具有重要的临床价值。     

视频脑电图与常规脑电图在癫痫患儿诊断和定位中的应用价值对比研究

目的:比较视频脑电图(VEEG)与常规脑电图(REEG)在癫痫患儿诊断和定位中的应用价值,为癫痫诊断提供依据。方法:对2014年1月~2016年12月间本院收治的有临床症状拟诊断为癫痫的102例患儿的临床资料进行回顾性分析,比较VEEG与REEG两种方法痫样放电检出率、临床发作检出率、睡眠期检出率以及痫灶定位中的诊断价值。结果:102例患儿中,VEEG检测到痫样放电80例,痫样放电检出率为78.43%,REEG检测到痫样放电42例,痫样放电检出率为41.18%,VEEG痫样放电检出率显著高于REEG(P0.05)。VEEG临床发作检出率为48.75%,显著高于REEG临床发作检出率的14.29%(P0.05)。VEEG检测出睡眠期痫样放电检出率为46.25%,高于觉醒期痫样放电检出率的12.50%(P0.05)。VEEG睡眠期各电图时相痫样放电检出率比较,组间差异均有统计学意义(均P0.05)。根据VEEG确定39例癫痫患儿痫样放电起源部位为额区9例、颞区10例、额颞区9例、枕区4例、中央区4例、颞枕后区3例。结论:VEEG对癫痫患儿的脑部痫样放电检出率和临床发作检出率均明显优于REEG,同时定位诊断效果更优,值得临床推广应用。     

复杂性热性惊厥脑电图特征与癫痫发生的相关性

目的：探讨复杂性热性惊厥脑电图特征与癫痫发生的相关性。方法：2012年3 月到2014 年5 月选择在我院诊治为复杂性热 性惊厥的呼吸道感染患儿86 例作为观察组,同期选择在我院诊治的非热性惊厥的呼吸道感染患儿86 例作为对照组,两组都进 行脑电图监测与认知功能判定,对癫痫发生情况进行判定与分析。结果：观察组的言语智商、行为智商与总智商评分都明显低于 对照组(P<0.05)。观察组的癫痫发生率为9.3 %,脑电图异常率为8.1 %;而对照组的癫痫发生率为1.2 %,脑电图异常率为2.3 %, 对比差异都有统计学意义(P<0.05)。在观察组患儿中,Spearman 相关性分析显示脑电图异常与癫痫发生存在明显正向相关性(r=0. 349,P<0.05)。结论：复杂性热性惊厥伴随有脑电图异常,与癫痫发生存在明显正向相关性,损害患儿的认知功能。     

临床抗癫痫新药治疗的动物实验

目的:对比临床较常用的几种抗癫痫新药与传统抗癫痫药苯妥英钠长期单药治疗慢性颞叶癫痫大鼠的疗效与安全性。方法:用海仁酸制成慢性颞叶癫痫的大鼠模型,临床常用维持剂量的苯妥因钠、奥卡西平、拉莫三嗪、妥泰根据成人剂量换算为大鼠剂量分别为37．50mg/Kg、125mg/Kg、28．13mg/Kg、15．63mg/Kg。每日灌胃,连续90天后,观察并比较各用药组大鼠脑电功率谱,学习记忆能力,血液常规,肝功能的变化情况。结果:90天后,与造模组相比,苯妥因钠、奥卡西平、拉莫三嗪、妥泰各组脑电活动均改善,其中以拉莫三嗪组最明显。水迷宫测试中:奥卡西平组较好;各用药组对造血、肝功能的影响与造模组及正常对照组相比无统计学意义。结论:对于慢性颞叶癫痫大鼠,拉莫三嗪改善脑电最明显,奥卡西平明显改善认知功能,疗效优于妥泰和苯妥英钠。     

Effects of Antiepileptic Drug Monotherapy on One-Carbon Metabolism and DNA Methylation in Patients with Epilepsy

Purpose

The aim of this study was to compare the serum levels of one-carbon metabolism (OCM) nutrients (e.g., folate, homocysteine and vitamin B12) and peripheral blood DNA methylation in epileptic patients under treatment with antiepileptic drugs (AEDs) and in healthy controls.

Methods

In this cross-sectional study, 60 patients with epilepsy who were receiving valproate (VPA) (n = 30) or lamotrigine (LTG) (n = 30) monotherapy were enrolled. Thirty age and sex matched healthy subjects served as the controls. Serum concentrations of OCM nutrients and peripheral blood DNA methylation status were measured.

Results

Compared to the control group, the VPA group had higher serum levels of homocysteine (p<0.05). No difference in homocysteine concentration was observed in the LTG group. Patients receiving VPA or LTG had significantly lower serum folate levels in comparison with controls (p<0.001). The level of methylation of long interspersed nucleotide element-1 (LINE-1) in peripheral blood was not significantly different between the AED monotherapy group and healthy controls. A difference in the methylation levels of methylenetetrahydrofolate reductase (MTHFR) amplicon was observed between AED-treated patients with epilepsy and controls (p<0.01). A positive correlation between serum folate levels and peripheral blood MTHFR amplicon methylation status was also observed (r = 0.25, p = 0.023).

Conclusion

Our findings suggest that the effects of AED monotherapy on OCM may induce specific regions of DNA hypomethylation.     

Neurodevelopmental Effects of Antiepileptic Drugs

Increasing evidence suggests that exposure to certain antiepileptic drugs (AEDs) during critical periods of development may induce transient or long-lasting neurodevelopmental deficits across cognitive, motor and behavioral domains. The developing nervous system may endure prolonged chronic exposure to AEDs during pregnancy (in utero) or during childhood, which can lead to neurodevelopmental defects such as congenital neural tube defects, lower IQ, language deficits, autism and ADHD. To date, valproate is the most widely recognized AED to significantly negatively affect neurodevelopment, and demonstrates greater adverse effects than any other AEDs that have been assessed. Although some AEDs appear to have low risk (i.e., lamotrigine, levetiracetam), other AEDs have been implicated in a variety of studies detailed below, and many AEDs have not been adequately assessed. The purpose of this review article is to summarize our current understanding of the neurodevelopmental effects of AEDs.

     

Antiepileptic Drugs Prevent Changes Induced by Pilocarpine Model of Epilepsy in Brain Ecto-Nucleotidases

Ecto-nucleotidases, one of the main mechanisms involved in the control of adenosine levels in the synaptic cleft, have shown increased activities after the pilocarpine model of epilepsy. Here we have investigated the effect of the antiepileptic drugs (AEDs) on ecto-nucleotidase activities from hippocampal and cerebral cortical synaptosomes of rats at seven days after the induction of the pilocarpine model. Expression of these enzymes were investigated as well. Our results have demonstrated that phenytoin (50 mg/kg) and carbamazepine (30 mg/kg) were able to prevent the increase in ecto-nucleotidase activities elicited by pilocarpine in brain synaptosomes. However, sodium valproate (at 100 mg/kg) was only able to avoid the increase on ATP and ADP hydrolysis in hippocampal synaptosomes. Increase on ATP hydrolysis in hippocampal synaptosomes was also prevented by sodium valproate at 286 mg/kg, which corresponds to ED50 for pilocarpine model. NTPDase1, NTPDase2, NTPDase3, and ecto-5′-nucleotidase expressions were not affected by pilocarpine in cerebral cortex. However, expressions of NTPDase2, NTPDase3, and ecto-5′-nucleotidase were increased by pilocarpine in hippocampus. Our results have indicated that previous treatment with AEDs was able to prevent the increase in hippocampal ecto-nucleotidases of pilocarpine-treated rats. These findings have shown that anticonvulsant drugs can modulate plastic events related to the increase of nucleotidase expression and activities in pilocarpine-treated rats.     

拉莫三嗪治疗部分性发作癫痫患者的疗效及对认知功能及生活质量的影响

目的:探讨拉莫三嗪对部分性发作癫痫患者的疗效及对认知功能及生活质量的影响。方法:选择2012年6月到2013年12月在我院接收治疗的部分性发作癫痫患者60例,按随机数字表法随机分为对照组(n=30)和治疗组(n=30);对照组患者给予卡马西平进行治疗,治疗组患者给予拉莫三嗪进行治疗。治疗20周后,对比两组患者的治疗效果、认知功能及生活质量。结果:治疗组患者的无发作率和总有效率分别为20.00%和80.00%,均显著高于对照组的6.67%和53.33%(P0.05);治疗后治疗组患者认知功能总评分明显高于对照组,(P0.05);治疗后治疗组患者各项生活质量评分均明显高于对照组(均P0.05)。结论:拉莫三嗪对部分性发作癫痫患者有显著疗效,能够有效控制癫痫发作,对改善患者认知功能及生活质量有重要作用。     

Effects of Antiepileptic Drugs on Antioxidant and Oxidant Molecular Pathways: Focus on Trace Elements

Current reports on trace elements, oxidative stress, and the effect of antiepileptic drugs are poor and controversial. We aimed to review effects of most common used antiepileptics on antioxidant, trace element, calcium ion (Ca²⁺) influx, and oxidant systems in human and experimental animal models. Observations of lower blood or tissue antioxidant levels in epileptic patients and animals compared to controls in recent publications may commonly support the proposed crucial role of antioxidants in the pathogenesis of epilepsy. Effects of old and new antiepileptics on reactive oxygen species (ROS) production in epilepsy are controversial. The old antiepileptic drugs like valproic acid, phenytoin, and carbamazepine induced ROS overproduction, while new epileptic drugs (e.g., topiramate and zonisamide) induced scavenger effects on over production of ROS in human and animals. Antioxidant trace element levels such as selenium, copper, and zinc were generally low in the blood of epileptic patients, indicating trace element deficiencies in the pathogenesis of epilepsy. Recent papers indicate that selenium with/without topiramate administration in human and animals decreased seizure levels, although antioxidant values were increased. Recent studies also reported that sustained depolarization of mitochondrial membranes, enhanced ROS production and Ca²⁺ influx may be modulated by topiramate. In conclusion, there is a large number of recent studies about the role of antioxidants or neuroprotectants in clinical and experimental models of epilepsy. New antiepileptic drugs are more prone to restore antioxidant redox systems in brain and neurons.     

不同药物治疗频发室早的临床疗效观察

目的:观察不同药物治疗频发室早患者的临床疗效和安全性.方法:入选69例频发室早患者,随机分为三组,给予不同药物治疗,分别为倍他乐克组(21例),给予口服酒石酸美托洛尔;美西律组(22例),给予口服美西律片;倍他乐克+美西律+稳心颗粒组即联合治疗组(26例),给予口服酒石酸美托洛尔,加服美西律片和稳心颗粒,治疗后观察患者的动态心电图,比较不同药物治疗频发室旱的疗效及不良反应的发生情况.结果:治疗2周后,联合治疗组的有效率显著高于倍他乐克组和美心律组(42.3％ vs23.8％,42.3％ vs 27.3％,P＜0.05);治疗4周后,联合治疗组有效率高达88.4％,显著高于倍他乐克(42.8％)和美西律组(50％),(P＜0.05),三组治疗过程中均无严重不良反应和并发症发生.结论:倍他乐克联合美西律和稳心颗粒治疗频发室早疗效较单一药物治疗疗效更好,且不增加不良反应.