ObjectiveThe aim of this study was to investigate the pathogenesis of AED-induced SJS/TEN across the spectrum of HLA-A, -B and -DRB1 alleles, and to explore the different clinical characteristics of patients with and without the HLA-B*15:02 allele in the SJS/TEN group. MethodsA total of twenty-three patients exhibiting AED-induced SJS/TEN (16 CBZ-SJS/TEN, seven LTG-SJS/TEN) and fifty-two patients who exhibited tolerance to AEDs were recruited. High-resolution HLA genotyping was performed to estimate the prevalence of the HLA-A, -B and -DRB1 alleles for each subject. Patients in the SJS/TEN group were further divided to positive HLA-B*15:02 allele group and negative HLA-B*15:02 allele group depending on whether carrying the HLA-B*15:02 allele, and the clinical feathers were compared between the two groups. ResultsNine of twenty-three patients (39%) in the SJS/TEN group were male, and the mean age of this group was 32 (8-68) years old. Twenty-eight of fifty-four (54%) patients in the tolerant group were male, and the mean age of the tolerant group was 28 (9-64) years old.Fourteen subjects in the SJS/TEN group carried the HLA-B*15:02 allele, whereas only four subjects (7.7%) in the AED-tolerant group carried this allele; the carrier rate of HLA-B*15:02 was significantly different between the groups (P<0.001). Among the fourteen patients who carried the HLA-B*15:02 allele in the SJS/TEN group, composing the positive HLA-B*15:02 allele group, eight patients (57.1%) were female, whereas six of nine patients in the negative HLA-B*15:02 allele group were female. The difference of the gender didn't have statistical significance between the two groups, nor did the other clinical characteristics, including mean age, the dosage of the AEDs, the interval from the drug administration to the onset of the SJS/TEN, fever, allergic history, abnormal MRI and abnormal EEG results. ConclusionsThe pathogenesis of AED-induced SJS/TEN is a complex process, which may involve one or more alleles. The HLA-B*15:02 allele may be a genetic susceptibility factor of the AED-induced SJS/TEN. However, we didn't find significant difference of the clinical characteristics of SJS/TEN between the patients with and without the HLA-B*15:02 allele. Notably, further studies using larger samples are required to confirm these conclusions.
ObjectiveTo reveal impairments in the perceptual networks in tuberous sclerosis complex (TSC) with epilepsy by functional connectivity MRI (fcMRI). MethodsThe fcMRI-based independent component analysis (ICA) was used to measure the resting state functional connectivity in nine TSC patients with epilepsy recruited from June 2010 to June 2012 and perceptual networks including the sensorimotor network (SMN), visual network (VN), and auditory network (AN) were investigated. The correlation between Z values in regions of interest (ROIs) and age of seizure onset or duration of epilepsy were analyzed. ResultsCompared with the controls, the TSC patients with epilepsy presented decreased functional connectivity in primary visual cortex within the VN networks and there were no increased connectivity. Increased connectivity in left middle temporal gyrus and inferior temporal gyrus was found and decreased connectivity was detected in right inferior frontal gyrus within AN networks. Decreased connectivity was detected at the right inferior frontal gyrus and the increase in connectivity was found in right thalamus within SMN netwoks. No significant correlations were found between Z values in ROIs including the primary visual cortex within the VN, right thalamus and inferior frontal gyrus within SMN, left temporal lobe and right inferior frontal gyrus within AN and the duration of the disease or the age of onset. ConclusionFhere is altered (both increased and decreased) functional connectivity in the perceptual networks of TSC patients with epilepsy. The decreased functional connectivity may reflect the dysfunction of correlative perceptual networks in TSC patients, and the increased functional connectivity may indicate the compensatory mechanism or reorganization of cortical networks. Our fcMRI study may contribute to the understanding of neuropathophysiological mechanisms underlying perceptual impairments in TSC patients with epilepsy.
ObjectiveTo study the cytokine changes in the cerebrospinal fluid (CSF) of mesial temporal lobe epilepsy (MTLE) patients, and the mechanism of the development of hippocampal sclerosis. MethodsFifty MTLE patients who sought treatment from January 2013 to March 2014 were included in the study. Clinical features were investigated. All CSF samples of the 59 patients along with 19 samples of the control group were tested for 12 common cytokines using a chemokine magnetic bead panel. Data were statistically analyzed. ResultsClinical features showed no significant difference between hippocampal sclerosis and non-hippocampal sclerosis patients. Interleukin (IL)-1 receptor antagonist (RA), IL-4 and IL-9 expression decreased, and tumor necrosis factor (TNF)-α, IL-3 and IL-5 expression increased. Up-regulation of TNF-α was significantly different between hippocampal sclerosis and non-hippocampal sclerosis patients. ConclusionIL-1RA, IL-3, IL-4, IL-5 and IL-9 changes may be non-specific seizure-related cytokine regulation. TNF-α is associated with hippocampal sclerosis pathology. TNF-α is a possible pathological element in hippocampal sclerosis development.
ObjectiveTo investigate the role of somatostatin in gastrointestinal function after operation for treatment of abdominal injury patients. MethodsSixty patients with abdominal trauma were divided into somatostatin in treatment group (n=30) and the conventional treatment control group (n=30). The amount of gastrointestinal decompression drainage, bowel sounds recovery time, exhaust time, defecation time, and the levels of serum C reactive protein, TNF-α, IL-6, and IL-8 after operation in two groups were observed. ResultsSomatostatin treatment group recovery time of bowel sounds, exhaust time, and defecation time were earlier than the control group, hospitalization time shortened, and the amount of gastrointestinal decompression drainage reduced (P < 0.05), The levels of serum C reactive protein, TNF-α, IL-6 and IL-8 of somatostatin treatment group were lower than those in control group (P < 0.05), and the magnitude of decline above index in the somatostatin treatment group were greater than that in the control group (P < 0.05). ConclusionSomatostatin can promote the recovery of gastrointestinal function in patients after operation in abdominal injury.
ObjectiveTo evaluate the effect of the timing of surgery on treating refractory epilepsy caused by cavernomas. Method63 patients with refractory epilepsy caused by intracranial supratentorial cavernomas were retrospectively analyzed on the duration of epilepsy, epileptogenesis sitations, and epileptic seizure types. After resection surgeries of cavernomas, the surgical outcomes were compared between the patients with shorter duration of seizures and the longer ones. ResultThe durations of epilepsy were beteen 3 months and 25 years, median 4.5 years. The temporal epilepsies were 43, frontal 12, parietal 3, occipital 1, cingulate gyrus 1, and multiple lobe 3. The overall ILAE class 1 outcome was 71.4% in 63 patients at 2-year-followup, and ILAE class 1 and 2 outcome was 81.6%. The seizure free rate in the group with epilepsy duration shorter than 5 years was 92.1%, better than the 56.0% in the group with epilepsy duration longer than 5 years. ConclusionOnce the diagnosis of medical refractory epilepsy caused by cavernoma was confirmed, the early surgical operation should be considered seriously.
ObjectiveTo investigate the quality of life of family caregivers of patients with Alzheimer's disease (AD) and to explore the related factors. MethodsTwenty family caregivers of patients with Alzheimer's disease were surveyed with short form 36 health survey questionnaire between October 2013 and August 2014. ResultsThe subjects who were over 60 years old had lower scores in the dimensions of physical functioning, role limitations due to physical problem and role limitations due to emotional problem than those below 60 years old. Female subjects scored better than male subjects in the dimension of vitality. The sons and daughters had higher scores than the wives and husbands in the dimensions of physical functioning, role limitations due to physical problem and role limitations due to emotional problem. The subjects whose patients had medical insurance scored better than those whose patients with no insurance. The differences above were all statistically significant. The scores of caregivers with senior middle school edudation or above were higher than the caregivers with lower education level in the dimensions of mental health, vitality and general health perceptions. ConclusionThe quality of life of the family members of AD patients is obviously affected by many factors. It is very important to implement planned, targeted, reasonable and effective interventions to enhance the quality of life of these people.
ObjectivesTo evaluate the efficacy and safety of lacosamide (200mg/d and 400mg/d)when added to 1 to 3 antiepileptic drugs (AEDs) in adults with uncontrolled partial-onset seizures. MethodsDuring this multicenter, double-blind, placebo-controlled trial, patients were randomized to placebo or lacosamide 200 or 400mg/day after an 8-week baseline period. Lacosamide was titrated in weekly increments to target dose over 4 weeks and maintained for 12 weeks followed by 12 weeks for withdrawal. The reductions of seizure frequence during maintain period and proportion of ≥50% reduction of seizures frequence were analysed. Besides,adverse effects were also recorded. ResultsFive hundred fourty patients were randomized, 515 patients completed the trial (Full analysis set, FAS), including 394 were per-protocol set (PPS). The reduction of seizure frequence during maintain period every 4 weeks among 200mg/d,400mg/d group and placebo group were 26.35%,40.12%,21.69%(P=0.000 5) and 25.61%,46.86%,23.06%(P<0.000 1), respectively in FAS and PPS. The proportion of ≥50% reduction of seizures frequence among three groups were 29.82%,38.15%,22.49%(P=0.006 8) and 27.94%,42.37%,22.86%(P=0.002 3), respectively in FAS and PPS. The incidences of adverse events were 5.84%, 36.11%, 19.55% among three groups. Compared with each other, there was statistic significance between 400mg/d and placebo groups. ConclusionIn this trial, adjunctive lacosamide significantly reduced seizure frequency in patients with uncontrolled partial-onset seizures. Along with favorable pharmacokinetic and tolerability profiles, these results support further development of lacosamide as an AED.