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find Author "林卫红" 19 results
  • 癫痫持续状态研究进展

    从国内外研究现状出发, 对癫痫持续状态(Status epilepticus, SE)的定义、流行病学和病因、发病机制、分类、诊断评估、治疗及预后等进行了全面阐述。有关SE定义的历史变迁, 从理论性定义到实用性定义均给出了明确界定, 其中实用性定义为适应人们对SE病理生理机制的进一步理解和满足临床容易操作需要不断更新。国际抗癫痫联盟(ILAE)已对强直-阵挛SE、复杂部分发作SE和失神SE实用性定义给出了明确规定。并对SE的流行病学及病因进行了探讨, 多种神经系统及全身性病理生理改变可导致SE, 发作自我维持与自我终止的平衡破坏是SE发生的必要条件, 发作导致神经系统兴奋性和抑制性系统失衡, 后者反过来又促进发作持续。有关SE分类一直备受关注, 几经变迁, 最新方案重新按惊厥性和非惊厥性分为两大类。诊断需依靠脑电图监测, 尤其非惊厥类型, 典型癫痫发作且持续时间足够长, 可无需脑电图监测证据。神经影像及实验室检查有助于发现病因。SE为神经科急症, 尽早控制发作, 并应与详细的病史采集同时进行, 院前积极给药明显增加SE控制率, 咪达唑仑和苯二氮卓类为首选药物。对难治性SE及早应用麻醉药物, 可减少并发症及死亡率, 提高控制率

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  • Investigation on the status of newly diagnosed adult epilepsy in the General Hospitals of Jilin Province

    ObjectiveTo investigate the status of newly diagnosed adult epilepsy in the General Hospital of Jilin Province, in order to improve the prevention and treatment of epilepsy. MethodsTo collect the clinical data of newly diagnosed adult epilepsy from October 2016 to February 2017, and to follow up 6 months. ResultsA total of 81 patients were included. At the last clinic visit, 73 cases origined from focal, 74 cases were positive in EEG examination, 56 cases were unknown etiology, 12 cases had hippocampal sclerosis, 48 cases were mildly declined cognitive function, and 30 cases were poor compliance. ConclusionThe newly diagnosed epilepsy were focal origin, delayed treatment, mildly declined cognitive function and poor compliance.

    Release date:2017-09-26 05:09 Export PDF Favorites Scan
  • A study on the changes of serum monoamine neurotransmitters and myocardial enzymes in patients with refractory epilepsy

    Objectives To investigate the changes of serum monoamine neurotransmitters and myocardial enzymes in patients with refractory epilepsy (RE), and the possible effects on the cardiovascular system, which would contribute to provide help and guidance to the early warming and prevention to the sudden unexpected death in epilepsy (SUDEP). Methods We collected sixty patients with RE who admitted to Neurological department of First Hospital of Jilin University from December 2015 to December 2016. According to the exclusion criteria, we selected thirty-two patients into the study. The study included 21 males and 11 females patients. Epinephrine (EPI), norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), creatine kinase isoenzyme (CKMB), lactate dehydrogenase (LDH) and hydroxybutyrate dehydrogenase (HBDH) were measured in peri-ictal period and the interictal period in the patients. All the data were analyzed by SPSS17.0 statistical software. Results ① Thirty two patients were eligiblefor this study and the maleto female ratio is 21:11; The age ranged from 15 to 85 years old, with the average age of 50.9±17.6 years old. Twelve (37.5%) were older than 60 years old and 20 (62.5%) were under 60 years old. The epilepsy history ranged from 1 year to 14 years, with an average of 3.75±3.12 years; ② Comparing the levels of monoamine neurotransmitters in peri-ictal period and the interictal period in the patients with RE, we found that the level of EPI and LDH was significantly lower than that in interictal period, while the levels of NE and DA were significantly increased; ③ The results showed that EPI, NE and DA levels in patients under 60 were higher than over 60; ④ Patients were divided into four groups according to the etiology of the disease: idiopathic epilepsy group (10 cases, 31.25%), post-encephalitic epilepsy group (7 cases, 21.88%), post-stroke epilepsy group (9 cases, 28.12%) and epilepsy after brain injury group (6 cases, 18.75%). The results showed that the levels of EPI, NE and DA in the post-strokeepilepsy group were significantly lower than those in the other three groups. The level of CKMB in the idiopathic epilepsy group was higher than that in post-stroke epilepsy and epilepsy induced by brain injury patients. Conclusions RE patients have a higher level of serum NE and DA interictal period, suggesting that seizures may increase sympathetic nervous excitability. The patients under 60 years-old with RE release more catecholamines than young patients, suggesting that the latterwith intractable epilepsy may have higher sympathetic nerve excitability. And it may be associated with the higher incidence of SUDEP in young patients. Post-stroke epilepsyrelease less catecholamine than others, suggesting that the sympathetic nervous excitability is relatively low, and it may have relatively little damage to heart.

    Release date:2018-01-20 10:51 Export PDF Favorites Scan
  • 常染色体显性遗传夜间额叶癫痫的基因学研究现状

    常染色体显性遗传夜间额叶癫痫(Autosomal dominant nocturnal frontal lobe epilepsy,ADNFLE)首先由 Lugaresi 等描述,是第一个发现致病基因的癫痫综合征。迄今为止,已鉴定出的可能致病基因有CHRNA4、CHRNB2、CHRNA2、KCNT1、DEPDC5、CRH、CABP4,外显率 70%~80%,但已发现的基因仅能解释部分患者的病因,不同种族仍具有较大的遗传异质性。文章回顾了 ADNFLE 近几年的流行病学、临床体征、致病基因研究及基因测序技术等,为已发现的致病基因提供解释,并为未来寻找新的基因提供方向。

    Release date:2019-03-21 11:04 Export PDF Favorites Scan
  • Comparison of clinical manifestation between occipital lobe epilepsy and temporal lobe epilepsy and their influences on emotion and cognition in adults

    ObjectivesTo compare the clinical features and the effects on cognition, emotion, and prognosis of antiepileptic drugs (AEDs) between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE).MethodsWe collected the clinical data of the patients with OLE and TLE from the Department of Neurology, the First Hospital of Jilin University from January 2016 to May 2018. We measured the patients with Mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital span, Auditory verbal memory test (AVMT), Generalized anxiety disorder (GAD-7), Patient health questionnaire-9 (PHQ-9) and Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (c-NDDI-E) and followed up for 1 year.Results① After 1 year’s follow-up, the frequency of the two groups decreased compared with the first visit (Z=3.734, P=0.000) and the extent was similar (Z=−0.290, P=0.772). In group OLE, occipital aura was 45.9% (17 cases) and temporal aura was 37.8% (14 cases). In TLE group, temporal aura was 49.3% (33 cases) and occipital aura 7.5% (5 cases). In OLE group, post-seizure headache was found in 17 cases (45.9%), which was more than the 15 cases (22.4%) in TLE group (χ2=6.210, P=0.013). ② 30 cases (81.1%) in OLE group interictal discharge involved lobes outside occipitotemporal lobe, 4 of which had a wide-lead-involved discharge, and 19 cases (28.4%) in TLE group involved lobes outside temporal lobe, and there was a significant difference between the two groups (χ2=26.592, P=0.000). ③ There was no significant difference in the score of MOCA and AVMT in the group of OLE-A and OLE-B, either the group of TLE-A and TLE-B. The score of AVMT in group OLE-A was higher than that in group TLE-A (t=3.193, P=0.002), and that in group OLE-B was higher than that in group TLE-B (t=2.264, P=0.029). There was no significant difference in GAD-7, PHQ-9, and c-NDDI-E (P>0.05). After follow-up for 1 year, the scores were compared with its initial scales. The score of GAD-7 (Z=−2.561, P=0.010), PHQ-9 (Z=−2.053, P=0.040) and c-NDDI-E (Z=−2.493, P=0.013) all decreased. The score of GAD-7 (r=0.281, P=0.021) and c-NDDI-E (r=0.456, P=0.000) have a positive correlation with the frequency of seizure. Therapeutic effect: In OLE group, the efficiency of carbamazepine or oxcarbazepine group was 58.82% and of levetiracetam group was 83.33%. in TLE group, the efficiency of carbamazepine or oxcarbazepine was 72.50% and of levetiracetam group was 70.00%. There was no significant difference between group OLE and group TLE in the curative effect of carbamazepine or oxcarbazepine group (χ2=1.033, P=0.310) or levetiracetam group (χ2=0.356, P=0.551). After 1 year’s follow-up, the frequency of OLE group was 0.00 (0.000, 2.750) times per month, and the TLE group was 0.00 (0.000, 1.500) times per month. There was no significant difference between the two groups (Z=−0.226, P=0.822). At the follow-up, the frequency of seizure in the two groups was lower than that at the first visit (P=0.000). The frequency of seizure in TLE group was similar to that in OLE group (=−0.648, P=0.517). After 1 year, 5 patients (13.51%) in OLE group were newly diagnosed as refractory epilepsy and 6 patients (9.00%) in TLE group There was no significant difference in the rate of the newly diagnosed refractory epilepsy between the two groups (2=0.524, P=0.469).ConclusionOccipital aura and post-seizure headache are specific to OLE, which can be used as one of the basis for diagnosis of OLE. Epileptiform discharge in OLE is more likely to spread out in multiple cerebral lobes, while epileptiform discharge in TLE is confined to temporal lobe and the area near it. The cognitive impairment in OLE or TLE is not related to the duration of the disease. The degree of depression is positively correlated with the frequency of seizure. The responses to AEDs of OLE and TLE are similar.

    Release date:2020-01-09 08:49 Export PDF Favorites Scan
  • 癫痫的免疫性病因研究进展

    国际抗癫痫联盟(ILAE)于 2017 年提出了癫痫的六大病因,其中免疫性病因是目前研究的热点。系统性自身免疫性疾病、神经系统自身免疫性疾病、自身免疫性脑炎(Autoimmune encephalitis,AE)与癫痫的关系均十分密切。其中,AE 与癫痫的关系尤为复杂。从癫痫的概念及AE的特点出发,ILAE 提出了“继发于自身免疫性脑炎的急性症状性发作”及“自身免疫相关癫痫”这两个概念,可以更好地从发病机制及临床特点来认识 AE 与癫痫的关系,为后续的研究理清了思路。

    Release date:2021-01-07 02:57 Export PDF Favorites Scan
  • 成人癫痫患者共患躯体疾病的抗癫痫药物选择

    癫痫共患躯体疾病现象普遍,在治疗方面尚无指南或专家共识。文章在检索癫痫共患病、各脏器疾病与癫痫发作、癫痫的药物治疗等方面文献之后,对癫痫共患躯体疾病的抗癫痫药物选择进行讨论,并按照躯体疾病的分类进行综述,旨在为解决癫痫共患躯体疾病可能遇到的临床实际问题提供参考,指导临床用药。

    Release date:2018-07-18 02:17 Export PDF Favorites Scan
  • Clinical features of post-stroke epilepsy

    Objective To observe the clinical characteristics and influencing factors of post-stroke epilepsy. Methods Our research wasaretrospective study, the data came from the information of patients diagnosed with post-stroke epilepsy from our hospital on October 2000 to December 2014 withatotal of 160 cases. With the general collection of clinical data, including gender, past history, clinical manifestations, laboratory examinations and treatment informations. Results The shortest time of post-stroke seizures were occur immediately, the longest was 15 years after the stroke. Peak onset is as early as onset of stroke immediately, late-onset seizures after stroke peaks between 6 months to 1.5 years. 59 patients occurred early epileptic seizures, partial seizures were the most common, accounting for 47.46%; 101 patients occurred late epilepsy, generalized tonic-clonic seizures were the most common, accounting for 56.44%. 25% of patients wereasingle-site lesions, the most common site was temporal lobe; 75% of patients were multifocal lesions. Most were located in the temporal lobe, frontal lobe and the basal ganglia. 42 cases of patients performed EEG, 30 patients (71.43%) of the EEG abnormalities, including 22 cases (73.33%) recurrent epileptic seizures; 12 cases (28.57%) patients with an edge or normal EEG, including 3 cases (25%) relapsed. 54.38% patients with drug therapy to single-agent therapy, two patients with refractory epilepsy to be combination therapy. Conclusions This group of post stroke epilepsy patients were more common as late-onset epilepsy, early onset of stroke peaks is the first day, and delayed the onset of the peak after stroke is within 6 months to 18 months. Lesions in the cortex:alarge area and multiple lesions were risk factors for post-stroke epilepsy, cortical damage to the temporal lobe is most prevalent. 71.43% of patients may have abnormal EEG, EEG abnormalities have higher relapse rate in patients with epilepsy.

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  • Analysis of autoimmune encephalitis seizure types and EEG characteristics

    ObjectiveThe purpose of this study was to investigate the autoimmune encephalitis (AE) seizure types and EEG characteristics and the value of diagnosis. MethodsFifteen AE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from November 2012 to July 2014. Data from their clinical manifestations, seizure types, EEG characteristics and laboratory investigation were analyzed. ResultA total of 15 patients, 5 males and 10 females, aged 19-75 years were included. Eight cases of anti-NMDA receptor encephalitis, five cases of LGI1 receptor encephalitis and two cases of anti-Hu antibody encephalitis were diagnosed clinically.①Anti-NMDA receptor encephalitis:seven patients had seizures, which inclued complex partial seizure, generalized tonic-clonic seizure, simple partial seizure and status epilepticus.Three patients had extreme delta brush.②LGI1 receptor encephalitis:two cases had seizures, while four cases with FBDS. Sharp and slow waves with irregular delta waves appeared in bilateral temporal areas in EEG of three cases, while one case showed clinical seizure. Two cases detected "limb shaking and others" attack, but the corresponding EEG showed no abnormalities.③Anti-Hu antibody encephalitis:one case showed seizures, the EEG showed a lot of sharp and slow waves with irregular delta waves in bilateral temporal areas, while one case showed sharp and slow waves. ConclusionAnti-NMDA receptor encephalitis can present with various types of seizures and non-convulsive status epilepticus, interictal extreme delta brush is more specific. It has important value. LGI1 receptor encephalitis is characterized by FBDS, it has important clinical significance.Anti-Hu antibody encephalitis lesions diffuse distribution, clinical manifestations are different. It may be associated with seizures, seizure types are not-specific.It may have slow waves or sharp and slow waves.

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  • Mechanism of mTOR signaling pathway in intractable epilepsy

    ObjectiveTo observe the expressions of p-mTOR, p-S6K1 and p-4EBP1 in the human brain with refractory epilepsy and to explore the role of mTOR signaling pathway in intractable epilepsy. MethodsCollecting the brain tissues of 24 patients with refractory epilepsy for surgical treatment from March 2010 to July 2011 as experimental group in hospitalized Epilepsy Center at the First Hospital of Jilin University, Changchun City. Collecting temporal lobe or frontal lobe brain tissue from 6 autopsy of patients who had emergency surgery for neurosurgery brain tranma during the same period. Using immunohistochemistry to observe the expression of p-mTOR, p-S6K1, p-4EBP1 in the two groups of brain tissues, and analyzed statistically. Results① p-mTOR, p-S6K1 and p-4EBP1 were expressed in both neurons and glial cells of experimental and control groups. P-mTOR, p-S6K1, p-4EBP1 positive cells of experimental group was significantly higher than the control group(P<0.01). The expression level of p-mTOR, p-S6K1, p-4EBP1 in the brain tissues of patients with different seizure frequency and with different duration:the expression level of p-mTOR, p-S6K1, p-4EBP1 in the brain tissues of patients in the group of epilepsy 10 years and more than 10 years were significantly higher than the group of epilepsy fewer than 10 years and the difference was statistically significant (P<0.05). ② The structural changes of brain tissues were observed under the optical microscope and electron microscope. Under the optical microscope:the distribution of nerve cells were uneven, the nucleus was vacuolated, the cytoplasm was less and gliosis. Under the transmission electron microscope:the number of neurons was reduced, nuclear condensation, the heterochromatin was increased, the nucleolus were dissymmetry and the nuclear membrane was breakage, also see neurons became psychotic, cell body became smaller, astrocyte cell membrane became edema, chromatin was dissymmetry, some mitochondrial were swelling and transparent, and others were vacuolated, the mitochondrial crista was in disorder. ③ p-mTOR, p-S6K1 and p-4EBP1 are expressed in the cerebral vascular of the brain in both experimental and control groups.In the experimental group, the expression is high concentration.In the control group, the expression is scattered in a small amount. Conclusionsp-mTOR, p-S6K1 and p-4EBP1 are widely expressed in neurons and glial cells with refractory epilepsy, which was significantly increased compared with control group. The expression of p-mTOR, p-S6K1and p-4EBP1 is related to frequency of epileptic seizures and course.

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