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.
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.
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.
Objective The purpose of this study was to explore the expressions of EPO-R, JAK2 and STAT-5 in the human brain with refractory epilepsy and the role in neural apotosis. Methods Collecting the brain tissue of 24 patients with intractable epilepsy (as experimental group) who were hospitalized and underwent surgery in the Epilepsy Center of the First Hospital Jilin University between March 2010 to July 2011 and 6 cases of accidental or unnatural death immediately following autopsy (as control group) as required by law during the same term. Immunohistochemical was performed to observe the expression of EPO-R, JAK2 and STAT-5 in brain tissue and statistical analysis was performed. Results ① EPO-R, JAK2 and STAT-5 were expressed in both experimental and control groups. In experimental group, the positive-cell number were 41.05±2.40, 50.21±2.50 and 60.18±2.84 under light microscope (400×). While in control group, the positive-cell number were 23.00±0.49, 27.00±0.88 and 25.93±0.33. There were significant differences between the 2 groups (P<0.001). ② There were the pathologic and ultrastructural changes in the human brain with refractory epilepsy. Under the optical microscope, we can observe that the distribution of neurons was uneven and immature neurons were visible. We can see that the nuclei were vacuolar, less cytoplasm, dark staining, hyalomitome acidophilic body, and the neurons became triangular due to degeneration. The proliferation and hyperemia appeared in small vascular and glial cells. Under the transmission electron microscope we observed degeneration and necrosis of the nerve cells, nuclear karyopyknosis, nucleolis dyssymmetry and karyolemma breakage and even dissolution. The mitochondria and astrocytes were swelling. We also saw that part of the mitochondrial cristae was abnormal. Conclusion ① We found neuronal apotosis in the human brain with refractory epilepsy. ② The expression of EPO-R, JAK2 and STAT-5 in intractable epilepsy was significantly increased in neurons and glial cells compared with the control group. The high expression of EPO-R, JAK2 and STAT-5 is unrelated with course and frequency of epileptic seizures. ③ The pathway of EPO-R/JAK2/STAT-5 may be involved in the pathophysiological processes of neural protective effect of endogenous EPO against brain injury induced by epileptic seizures.
ObjectAimed to describe the clinical characteristics of the patients with interictal schizophrenia-like psychoses of epilepsy (SLPE), so as to improve the identification, diagnosis and treatment.MethodsWe collected the cases from January 2017 to December 2019 that diagnosed as "epileptic psychosis/organic mental disorders/brain damage and functional disorders and somatic diseases caused by other mental disorders/organic delusions (schizophrenia-like) disorders" in the medical record system of the Sixth Hospital of Changchun. The discharge records were re-diagnosed by two experienced epilepsy specialists and psychiatrists respectively. Retrospective statistical analysis was performed on the cases identified as SLPE.ResultsA total of 45 patients were diagnosed as SLPE (male: female=1:1.4). The onset age of epilepsy and mental symptoms was (16.4±12.5) years and (35.3±13.4) years respectively. The duration of mental symptoms after first seizure was (18.9±13.4) years. 7 patients (15.6%) were not treated with AEDs, and 26 patients (57.8%) were treated with first generation AEDs. 8 patients (17.8%) had no seizures within 1 year before the onset of mental symptoms, and 28 patients (62.2%) had frequent seizures, even status epilepticus or clustered seizures. 2 patients (4.4%) had generalized tonic-clonic seizure, only 4 patients (8.9%) showed focal impaired awareness seizure, and 39 patients (86.7%) had focal to bilateral tonic-clonic seizure.The PANSS positive symptom score, PANSS negative symptom score and BPRS score were (15.1±4.4), (17.7±4.6) and (44.7±8.4) respectively.ConclusionThere were some features of epilepsy in SLPE, such as early onset age, frequent seizure (some patients were seizure-free), focal epilepsy, and poor AEDs treatment compliance. The onset age of mental symptoms in SLPE was later than Schizophrenia and long duration after first seizure. The PANSS scale showed that the mental symptoms of patients with SLPE were similar to those of patients with schizophrenia, and both positive and negative symptoms existed.