目的 评估国际抗癫痫联盟（ILAE）耐药癫痫定义专家共识在发展中国家、发展中地区应用的可行性及应用中存在的问题。 方法 2010年12月9日－2011年2月18日，连续登记癫痫专科门诊患者409例。共纳入183例患者，根据ILAE耐药癫痫新定义对每位纳入患者癫痫分类进行评估。 结果 耐药癫痫患者18例（8.7%），临床治愈患者29例（14.1%），不能判断为159例（77.2%）。入组患者共涉及癫痫药物治疗方案321项。根据ILAE定义步骤一分类为不确定的治疗方案共有199项（62.00%），其中数量最多的为服药剂量＜50% WHO限定日剂量有157例（78.89%）。 结论 由于治疗剂量未能够达到国际统一标准，大量患者分类不明确，使得该共识应用面临巨大挑战，但目前为止该共识对于发展中地区耐药癫痫治疗有很强的指导促进意义，对未来耐药癫痫的早期识别有非常大的应用潜力。
ObjectiveTo summarize the clinical features of and prognosis factors for spontaneous intracranial hypotension (SIH). MethodsWe continuously registered hospitalized patients diagnosed with SIH from December 1st, 2010 to February 1st, 2014. Etiology information and clinical features were collected at the first day of admission. Routine blood test and lumbar puncture were done as soon as possible. Every patient got position and fluid infusion therapy. During the one-week follow-up, headache level was evaluated with Visual Analogue Scale (VAS). ResultsThere were 110 patients included, and among them, 39(35.5%) were male and 71(64.55%) were female. The age of onset was between 17 and 91 years old with a mean onset age of (42.0±12.4). Besides postural headache, common signs were nausea (68 cases, 61.8%), vomiting (63 cases, 57.3%), dizziness (40 cases, 36.4%), neck pain (27 cases, 24.5%), and tinnitus (23 cases, 20.9%). VAS at baseline was (7.46±0.86), and at the last follow-up, VAS was (3.45±2.17), with an average improvement of 53.75%. Patients with ANA marker positive had better prognosis. ConclusionSIH can accompany serious brain stem and cerebellum signs, and even meningeal irritation. Cerebrospinal fluid (CSF) changes are similar to virus infection with negative serum virus screening. If CSF leak cannot be found on imaging, patients can improve through fluid infusion therapy and postural treatment.
Objective To investigate the diagnosis and treatment of status epilepticus in hospitals of different levels and the knowledge of status epilepticus in clinical physicians, in order to better guide clinical education in the future. Methods From August 2014 to August 2015, a questionnaire was designed and used to investigate the general situation of the hospital, the diagnosis of status epilepticus and the clinical practice among trainee doctors and students in the epilepsy training class in the Neurological Intensive Care Unit and the Department of Neurology of West China Hospital, Sichuan University. The results of the investigation were statistically analyzed. Results Ninety questionnaires were distributed, and all the questionnaires were retrieved with validity. The number of investigated physicians was 42 (46.7%) from the Department of Neurology, 6 (6.7%) from the Department of Neurosurgery, 30 (33.3%) from the Intensive Care Unit and 12 (13.3%) from other departments. Twenty-seven (30.0%) physicians were from class Ⅲ grade A hospitals, 31 (34.4%) from class Ⅲ grade B hospitals, and 32 (35.6%) from class Ⅱ grade A hospitals. All the class Ⅲ hospitals and 53.1% of class Ⅱ hospitals had electroencephalograph monitoring facilities. The proportion of status epilepticus patients ranged from 0.5% to 10.0% in different hospitals. There were great differences in the identification and treatment of convulsive status epilepticus among different hospitals. Conclusions Status epilepticus is a common emergency. Questionnaire survey is an effective means to reflect the difference in identifying and treating the emergency among different departments and hospitals. It can guide clinical education and promote the identification and treatment of the emergency more accurately in doctors of all levels.
ObjectiveTo summarize the experience of earthquake rescue with the help of wise information technology.MethodsThe Jiuzhaigou earthquake of magnitude 7.0 occurred at 21:19 on August 8th 2017. Three hours and 38 minutes after the earthquake, a triad model of remote consultation, mobile video consultation and mobile text consultation was established to assist the earthquake rescue based on the mobile on-line medical consultation application and telemedicine center in West China Hospital. Patients classification, primary diagnosis, psychological counseling, victims searching were done by this novel rescue model.ResultWithin 72 hours after the earthquake, there were 114 doctors taking part in the earthquake rescue, including 4 remote consultations (hospital to hospital), 7 video consultations (doctor to victim), 487 mobile text consultations (doctor to victim), and 32 cases of which were highly relative to earthquake rescue, including one case of positioning for victim-searching.ConclusionThe triad model of earhquake rescue which was first initiated by West China Hospital played an important role in assisting earthquake rescue and achieved good results.