90例原发性癫痫患者睡眠呼吸障碍及其相关事件分析

目的:探讨原发性癫痫患者夜间睡眠呼吸障碍及相关事件的特点.方法:对90例原发性癫痫患者进行夜间多导睡眠图(PSG)检查.分析夜间睡眠呼吸暂停低通气指数、睡眠各期SPO2值及相关腿动事件.结果:本组病人的PSG检测结果表现为SPO2监测显示有26.67%的患者合并有睡眠呼吸暂停低通气综合症(SAHS),合并SAHS组与不合并SAHS组在年龄、体重指数、是否合并高血压病方面进行比较P均<0.05,其差异有统计学意义.两组在病程、性别、发作形式、有无痫样放电、有无周期性腿动方面比较P值均>0.05,其差异无统计学意义.SPO2仪显示癫痫患者夜间存在不同程度低氧事件,其中SPO2最低值均发生在REM期.肌电显示孤立性腿动指数增加人数为27例(占30%),周期性腿动指数增加人数为15人(占16.67%),其中因激醒事件及呼吸事件因素而导致腿动指数增加分别占一定比例,且腿动事件主要集中在NREM期.结论:原发性癫痫患者常伴有睡眠呼吸障碍及夜间低氧事件.     

Up-regulation of apelin in brain tissue of patients with epilepsy and an epileptic rat model

Prolonged epileptic seizures or SE can cause neuronal cell death. However, the exact role of neuroprotectant against brain injury during epileptic seizure needs to be further elucidated. The aim of this study was to investigate the expression of the apelin, a novel neuroprotective peptide, in brain tissues of the patients with temporal lobe epilepsy (TLE) and experimental rats using immunohistochemistry, immunofluorescence and Western blotting analysis and to discuss the possible role of apelin in TLE. Thirty temporal neocortical tissue samples from the patients with drug-refractory TLE underwent surgical therapy and nine histologically normal temporal lobes tissues as controls were used in our study. Fifty-six Sprague-Dawley rats were randomly divided into seven groups, including one control group and six groups with epilepsy induced by lithium-pilocarpine. Hippocampus and adjacent cortex were taken from the controls and epileptic rats at 1, 3, 7, 14, 30, and 60 days after onset of seizures. Apelin was mainly expressed in the neurons of TLE patients and controls, and was significantly increased in TLE patients compared with the controls. Apelin was also expressed in the neurons of experimental and control rats, it was gradually increased in the experimental rat post-seizure and reached a stable high level in chronic epileptic phase. Our results demonstrated that the increased expression of apelin in the brain may be involved in human TLE.     

Effect of diazepam on the epileptic activity of rats with experimental photogenic epilepsy]

Chronic experiments were conducted on rats. A study was made of the effect of diazepam (in a dose of 4 mg/kg of body weight) on the specific and nonspecific mechanisms of experimentally-induced photogenic epilepsy developing as a result of tetanus toxin injection into the lateral geniculate body (LGB) and formation in this nucleus of a pathologically enhanced excitation generator (PEEG). Diazepam in the mentioned dose had a relatively weak effect on the extent of pathological enhancement of the sensory visual signal in the LGB under conditions of PEEG formation aided detection of focal interictal discharges in this nucleus, and completely inhibited generalized epileptic activity in experimental animals in the course of one hour.     

Unilateral epilepsy and the asymmetry of postepileptic sleep

In the paper the analysis is given of "penicillin" epilepsy in animals (cats) in conditions of different forms of deafferentation of one of the halves of the fore brain. It is shown, that in conditions of combined section of one half of the operculum of the midbrain and commissural systems of the endbrain, diencephalon and midbrain, under large doses of penicillin, unilateral convulsive activity is recorded in summate electrical activity of one of the brain halves at the side of the midbrain lesion. After the completion of unilateral organization of the epileptic process an asymmetrical sleep takes place: at the side, at which epileptiform activity was recorded, a more deep phase of the sleep appears than in the opposite brain half.     

Evaluation of an oral function promotion programme for the independent elderly in Japan

Objectives: The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. Background: Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. Materials and methods: The subjects were independent elderly females (mean age: 74.6 ± 6.3) recruited from senior citizens’ centres in Tokyo. The intervention group (n = 79) received a 3‐month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. Results: In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter‐clockwise circular motion and side‐to‐side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. Conclusion: An oral function promotion programme was effective in improving the oral health status and oral function of an independent elderly population.     

Control of motoneuron function and muscle tone during REM sleep, REM sleep behavior disorder and cataplexy/narcolepsy

REM sleep triggers a potent suppression of postural muscle tone - i.e., REM atonia. However, motor control during REM sleep is paradoxical because overall brain activity is maximal, but motor output is minimal. The skeletal motor system remains quiescent during REM sleep because somatic motoneurons are powerfully inactivated. Determining the mechanisms triggering loss of motoneuron function during REM sleep is important because breakdown in REM sleep motor control underlies sleep disorders such as REM sleep behavior disorder (RBD) and cataplexy/narcolepsy. For example, RBD is characterized by dramatic REM motor activation resulting in dream enactment and subsequent patient injury. In contrast, cataplexy a pathognomonic symptom of narcolepsy - is caused by the involuntary onset of REM-like atonia during wakefulness. This review highlights recent work from my laboratory that examines how motoneuron function is lost during normal REM sleep and it also identifies potential biochemical mechanisms underlying abnormal motor control in both RBD and cataplexy. First, I show that both GABAB and GABAA/glycine mediated inhibition of motoneurons is required for generating REM atonia. Next, I show that impaired GABA and glycine neurotransmission triggers the cardinal features of RBD in a transgenic mouse model. Last, I show that loss of an excitatory noradrenergic drive onto motoneurons is, at least in part, responsible for the loss of postural muscle tone during cataplexy in narcoleptic mice. Together, this research indicates that multiple transmitters systems are responsible for regulating postural muscle tone during REM sleep, RBD and cataplexy.     

Load compensation as a function of state during sleep onset

Ventilation decreases and airway resistanceincreases with the loss of electroencephalogram alpha activity at sleeponset. The aim of this study was to determine whether reflexive load compensation is lost immediately on the loss of alpha activity. Sixhealthy male subjects were studied under two conditions (load andcontrol-no load), in three states (continuous alpha, continuous theta,and immediately after a transition from alpha to theta), and in twophases (early and late sleep onset). Ventilation and respiratory timingwere measured. A comparison of loaded with control conditions indicatedthat loading had no effect on inspiratory minute ventilation duringcontinuous alpha (differential effect of 0.00 l/min) and only a small,nonsignificant effect in theta immediately after phase2 transitions (0.31 l/min), indicating a preservationof load compensation at these times. However, there were significantdecreases in inspiratory minute ventilation on loaded trials duringcontinuous theta in phase 2 (0.77 l/min) and phase 3 (1.15 l/min) andduring theta immediately after a transition in phase3 (0.87 l/min), indicating a lack of reflexive loadcompensation. The results indicate that, because reflex load compensation is state dependent, state-related changes in airway resistance contribute to state-related changes in ventilation duringsleep onset. However, this effect was slightly delayed with transitionsinto theta early in sleep.

     

Neural reapportionment: an hypothesis to account for the function of sleep

Sleep is a ubiquitous component of animal life, and prolonged sleep deprivation is fatal in both vertebrates and invertebrates. The physiologic function of sleep, however, is not known. We propose here that sleep provides a period of time necessary to reapportion resources within neurons and neural systems that become sub-optimally distributed during active waking. Three specific examples of such reapportionment during sleep are suggested: (1) the return of the neurotransmitter, glutamate, to synaptic vesicles at presynaptic sites most active during waking, (2) the intracellular movement of mitochondria from neuronal processes to the cells soma where mitochondrial replication can occur, and (3) the readjustment of the level and distribution of neurotransmitters within the brainstem modulatory systems and elsewhere that must function in an integrated fashion during waking. Experimental approaches that might be utilized to test these hypotheses are suggested.     

On the function of sleep.

It is proposed that sleep serves the function of maintaining immobility in animals at times when immobility is an optimum behavioural survival strategem. Sleep is of great evolutionary age and is always carefully tailored to the life-style of each animal; abundant in some species and absent from others. The survival advantages conferred on an animal by the power of sleep to schedule behaviour effectively may justify its existence and persistence in the evolution of species.     

Two types of "spike-wave" discharges in the electrocorticogram of WAG/Rij rats, the genetic model of absence epilepsy

WAG/Rij rats were injected with apomorphine (0.5 mg/kg, i.p.), an agonist of D2 receptors. Two types of spike-wave discharges (generalized and local) were found in the baseline ECoG of the intact and injected rats. Injections of apomorphine led to a suppression of the generalized (type 1) for about 30 minutes and a 8-10-fold increase in the local spike-wave discharges (type 2) within 4-6 minutes. Since it has been shown earlier that haloperidol, which acts on dopamine receptors oppositely to apomorphine, enhance the generalized spike-wave activity and suppress the local discharges. Thus, the different pharmacological characteristics of the two types of spike-wave activity suggest the controlling role of the dopaminergic system in the processes of spike-wave generation.     

GABAergic neuron deficit as an idiopathic generalized epilepsy mechanism: the role of BRD2 haploinsufficiency in juvenile myoclonic epilepsy

Idiopathic generalized epilepsy (IGE) syndromes represent about 30% of all epilepsies. They have strong, but elusive, genetic components and sex-specific seizure expression. Multiple linkage and population association studies have connected the bromodomain-containing gene BRD2 to forms of IGE. In mice, a null mutation at the homologous Brd2 locus results in embryonic lethality while heterozygous Brd2+/- mice are viable and overtly normal. However, using the flurothyl model, we now show, that compared to the Brd2+/+ littermates, Brd2+/- males have a decreased clonic, and females a decreased tonic-clonic, seizure threshold. Additionally, long-term EEG/video recordings captured spontaneous seizures in three out of five recorded Brd2+/- female mice. Anatomical analysis of specific regions of the brain further revealed significant differences in Brd2+/- vs +/+ mice. Specifically, there were decreases in the numbers of GABAergic (parvalbumin- or GAD67-immunopositive) neurons along the basal ganglia pathway, i.e., in the neocortex and striatum of Brd2+/- mice, compared to Brd2+/+ mice. There were also fewer GABAergic neurons in the substantia nigra reticulata (SNR), yet there was a minor, possibly compensatory increase in the GABA producing enzyme GAD67 in these SNR cells. Further, GAD67 expression in the superior colliculus and ventral medial thalamic nucleus, the main SNR outputs, was significantly decreased in Brd2+/- mice, further supporting GABA downregulation. Our data show that the non-channel-encoding, developmentally critical Brd2 gene is associated with i) sex-specific increases in seizure susceptibility, ii) the development of spontaneous seizures, and iii) seizure-related anatomical changes in the GABA system, supporting BRD2's involvement in human IGE.     

Pump function of the heart as an optimal control problem

In order to model the pump function of the heart the left ventricle is represented as an elastic thick-walled cylinder contracting symmetrically. The acceleration is included in the mathematical formalism describing the contraction of the myocardium and optimal control theory is used to solve the differential equation of motion of the cylindrical wall in such a way as to minimize a given performance index. Application of the equations to experimental data published in the literature is discussed. The mathematical formalism presents a new way to study the time variation of the volume ejected from the left ventricle. Methods to quantify the pump function of the heart are suggested.     

Effect of the delta sleep peptide on epileptic activity in the cerebral cortex of rats and cats

In free behaviour experiments on rats it has been shown that the intraperitoneal injection of delta sleep-inducing peptide (DSIP) (100 micrograms/kg) suppressed penicillin-induced relatively moderate epileptic foci which generated spike potentials as well as severe foci with ictal epileptic discharges. In the experiments on cats it was shown that intravenous DSIP injection (100 micrograms/kg) suppressed strychnine-induced epileptic focus and complexes of epileptic foci.     

Stimulus-induced transitions between spike-wave discharges and spindles with the modulation of thalamic reticular nucleus

It is believed that thalamic reticular nucleus (TRN) controls spindles and spike-wave discharges (SWD) in seizure or sleeping processes. The dynamical mechanisms of spatiotemporal evolutions between these two types of activity, however, are not well understood. In light of this, we first use a single-compartment thalamocortical neural field model to investigate the effects of TRN on occurrence of SWD and its transition. Results show that the increasing inhibition from TRN to specific relay nuclei (SRN) can lead to the transition of system from SWD to slow-wave oscillation. Specially, it is shown that stimulations applied in the cortical neuronal populations can also initiate the SWD and slow-wave oscillation from the resting states under the typical inhibitory intensity from TRN to SRN. Then, we expand into a 3-compartment coupled thalamocortical model network in linear and circular structures, respectively, to explore the spatiotemporal evolutions of wave states in different compartments. The main results are: (i) for the open-ended model network, SWD induced by stimulus in the first compartment can be transformed into sleep-like slow UP-DOWN and spindle states as it propagates into the downstream compartments; (ii) for the close-ended model network, weak stimulations performed in the first compartment can result in the consistent experimentally observed spindle oscillations in all three compartments; in contrast, stronger periodic single-pulse stimulations applied in the first compartment can induce periodic transitions between SWD and spindle oscillations. Detailed investigations reveal that multi-attractor coexistence mechanism composed of SWD, spindles and background state underlies these state evolutions. What’s more, in order to demonstrate the state evolution stability with respect to the topological structures of neural network, we further expand the 3-compartment coupled network into 10-compartment coupled one, with linear and circular structures, and nearest-neighbor (NN) coupled network as well as its realization of small-world (SW) topology via random rewiring, respectively. Interestingly, for the cases of linear and circular connetivities, qualitatively similar results were obtained in addition to the more irregularity of firings. However, SWD can be eventually transformed into the consistent low-amplitude oscillations for both NN and SW networks. In particular, SWD evolves into the slow spindling oscillations and background tonic oscillations within the NN and SW network, respectively. Our modeling and simulation studies highlight the effect of network topology in the evolutions of SWD and spindling oscillations, which provides new insights into the mechanisms of cortical seizures development.