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find Keyword "痫性发作" 19 results
  • 诊断心因性非癫痫性发作的最低要求:阶梯式程序

    为了给心因性非癫痫性发作(Psychogenic nonepilepticseizures,PNES)建立一个清晰的诊断标准,由癫痫、精神病学、神经心理学、神经精神医学领域的医生和研究者们组成的一个国际共识团体竭诚合作。由于作为金标准的视频脑电图并不是全世界每个中心都有,或者是每例患者都进行了该检查,该团体为非癫痫性发作的诊断阐释了一种阶梯式程序。该团体通过使用一致的文献回顾,评价了关键的诊断方法,包括:病史,脑电图,动态脑电图,视频脑电图/监测,神经生理、神经内分泌、神经影像、神经心理检查,催眠疗法,谈话分析。根据病史,被目击的事件,和检查结果(包括视频脑电图),将诊断确定性分层,包括可能的,很可能的,临床确立的,和记录的诊断。国际抗癫痫联盟非癫痫性发作协作组报告的目标与希望在于提高PNES的诊断过程和诊断的确定性,以更好地管理癫痫和非癫痫性发作的患者。

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  • Elevated C-reactive protein levels are associated with a higher risk of post-stroke seizures

    ObjectiveThis study aims to examine the possible association between C-reactive protein (CRP) concentration and post-stroke seizures. MethodsPatients with a first-ever ischemic stroke and no history of epilepsy before stroke who admitted to Western China Hospital were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset. After a mean follow-up period of 2.5 years, a follow-up assessment was performed to identify post-stroke epilepsy. Logistic regression and Cox regression analyses were used to assess the relationship between CRP levels and post-stroke early-onset seizures or post-stroke epilepsy. ResultsAmong the 1, 116 patients included in our study, 36 (3.2%) patients had post-stroke early-onset seizures and 65 (5.8%) patients had post-stroke epilepsy. Elevated CRP levels were associated with a higher risk of post-stroke early-onset seizures (51.4±49.2 vs 15.9±12.9, P=0.023). This correlation was persisted even after adjusting for potential confounders[OR=1.008, 95%CI (1.003, 1.018); P=0.003]. No association was observed between CRP levels and post-stroke epilepsy. ConclusionsElevated CRP levels may be associated with higher risk of post-stroke seizures. However, because of the observational nature of the study, more studies are needed to confirm the results.

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  • 新型抗癫痫药物在控制孕期痫性发作的效能

    评估新型抗癫痫药物(AEDs)——拉莫三嗪、托吡酯与左乙拉西坦在患者妊娠期中控制痫性发作的效能。分析在澳大利亚登记数据库中应用AEDs控制痫性发作的癫痫患者中1 534例次患者妊娠的数据。在澳大利亚癫痫登记的数据中,接受单种AED治疗的1 111例次妊娠的患者中,妊娠期使用左乙拉西坦控制发作的患者的痫性发作控制率与服用传统AEDs如卡马西平、丙戊酸的发作控制率相近;优于拉莫三嗪、托吡酯在孕期的发作控制率。左乙拉西坦作为控制癫痫患者的妊娠期发作的药物有应用前景。

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  • 癫痫共患偏头痛的研究进展

    癫痫和偏头痛有很多相同的临床表现,偏头痛可出现在癫痫发作间期、发作前、发作时和发作后,使癫痫和偏头痛在有时难以鉴别。部分抗癫痫药物可应用于偏头痛治疗。这些均表明癫痫和偏头痛之间的共病关系。癫痫和偏头痛的基础研究也表明皮质扩散抑制可能是两者之间共病的基础。目前关于癫痫伴偏头痛有不同的国际分类,由于偏头痛可以是癫痫的唯一症状,有学者建议设立一种新的分类,命名为发作性癫痫性头痛。现将从流行病学、发病机制、临床特征、国际分类,以及治疗等方面对癫痫共患偏头痛作一综述。

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  • Clinical Value of Video-electroencephalograph for Non-epileptic Seizures Disease in Children

    ObjectiveTo explore the clinical value of video-electroencephalograph (VEEG) for non-epileptic seizures disease in children. MethodsThe clinical data of 58 children with non-epileptic seizures (NES) diagnosed by VEEG from October 2010 to November 2012 were retrospectively analyzed. ResultsIn 50 out of 58 patients in the process of monitoring,the NES clinical onset was found while no synchronized epileptiform discharges was observed;in five patients with NES combined with epilepsy,no epileptiform discharges was found by VEEG at the clinical onset of NES;there were 3 patients with epileptiform discharges without seizures,who had no history of epilepsy,but non-synchronized clinical nonparoxysmal epileptiform discharges was found by VEEG monitoring. ConclusionVEEG is an effective diagnosis method for NES and seizures in children,which could be regarded as the gold standard for NES diagnosis.

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  • Efficacy of low to moderate doses of levetiracetam as initial monotherapy in adult patients with partial epilepsy

    Objective To explore the efficacy of low to moderate doses of levetiracetam in adult patients with newly diagnosed partial epilepsy and possible predictors for poor treatment response. Methods We retrospectively analyzed the clinical data of patients treated in West China Hospital from March 2011 to December 2015 whose clinical data were input into the Epilepsy database. Patients with newly diagnosed partial epilepsy and whose initial anti-epileptic drug was levetiracetam were screened out for this study. Their clinical data, especially responses to the treatment of levetiracetam were reviewed. Results Ninety-six patients were included in this study. Seventy-one of them achieved seizure-free for a complete year after initial treatment of levetiracetam. Forty-eight patients (50.0%) achieved seizure-free with levetiracetam monotherapy; 23 patients (24.0%) achieved seizure-free for one year with levetiracetam combination therapy. Sixty-nine (97.2%) of the 71 patients achieved seizure-free with low to moderate doses of levetiracetam (500 to 1 500 mg/day), with or without combination of other antiepileptic drugs. High baseline seizure frequency before initial therapy was an independent predictor of poor levetiracetam response in this multivariate logistic regression mode (P=0.019). Conclusions Low to moderate levetiracetam is both effective and well tolerated in newly diagnosed partial epilepsy patients. High baseline seizure frequency before initial therapy is an independent predictor of poor levetiracetam response.

    Release date:2017-05-18 01:09 Export PDF Favorites Scan
  • 脑血管疾病继发癫痫:实验回顾和临床危险因素的荟萃分析

    癫痫发作可能发生在刚刚卒中发生以后或在很久以后。此外,癫痫也常发生在患有脑白质疏松的患者。尽管卒中后早期痫性发作被广泛研究,卒中后癫痫(Post-stroke epilepsy,PSE)和与脑白质疏松相关癫痫(Epilepsy associated with leukoaraiosis,EAL)研究较少。文章目的是回顾PSE和EAL相关病理生理学,预后和治疗情况。并进行了广泛的文献检索,以筛选关于PSE和EAL的动物实验和临床文章。同时,还对纳入研究中PSE和EAL发生的风险因素进行了系统的回顾分析。PSE是由于瘢痕组织内和其附近神经元兴奋性增加引起的。白质改变在EAL中的作用尚待阐明。荟萃分析显示皮质受累[ OR=3.71,95% CI (2.34, 5.90),P < 0.001],脑出血[ OR=2.41,95% CI (1.57, 3.70),P < 0.001]和早期痫性发作[ OR=4.43,95% CI (2.36, 8.32),P < 0.001]显著增加PSE发生风险。关于EAL,没有前瞻性、基于人群的研究评估不同变量对癫痫发作风险的影响。关于PSE治疗的研究相对有限。PSE药物控制效果通常良好。有关危险因素、预后和EAL治疗的资料较缺乏。PSE的病理生理学和危险因素是明确的,但在EAL中仍需进一步阐明。PSE和EAL的治疗依赖于临床医生的判断,并应在个人基础上进行调控。

    Release date:2017-05-24 05:46 Export PDF Favorites Scan
  • 作后血氨水平作为惊厥性癫痫发作的生物标志物:一项前瞻性研究

    有报道指出全面性惊厥性癫痫发作(Generalized convulsive seizures,GCS)后出现短暂性高血氨症(Transient hyperammonemia,THA),没有足够的证据证实与癫痫的关系。文章的目的是确定发作后THA是否可以区分不同类型的发作,如使用视频脑电图(VEEG)监测确认脑电变化。在前瞻性队列中,筛选了所有进入癫痫监测单元并同意接受研究的成年患者(> 18岁)。血氨的基础值以及在发作(所有患者)的60 min内、发作后24 h(只要有可能)的血氨水平均被检测。根据VEEG,将患者进行分组,分别为GCS、心因性惊厥性非痫性发作(Psychogenic nonepileptic seizures with convulsions,PNES-C)或局灶性癫痫发作(Focal seizures,FS)。使用描述性统计和参数/非参数方法分析数据。纳入患者78例,13例为GCS、8例为FS、9例为PNES-C。这些组在性别(P=0.04) 和血氨基础值(P=0.02) 方面是不同的,但年龄无差异。三组之间发作后血氨水平较血氨基础值的变化差异有统计学意义(P=0.004)。区分GCS与其他组差异的发作后血氨水平ROC曲线下面积为0.88[95%CI (0.69, 0.96)],表明检测血氨水平是一种很好的用来区分GCS与其他发作的试验。血氨水平≥80μmol/L可以准确为80%的患者分类(灵敏度53.9%,特异性100%)。VEEG监测为THA与GCS癫痫发作之间的关联提供了客观证据,并为今后关于确定发作后血氨水平作为GCS的廉价诊断试验作用的研究奠定了基础。

    Release date:2017-07-26 04:06 Export PDF Favorites Scan
  • 癫痫、痫性发作、体育锻炼和运动:ILAE 运动与癫痫工作组的报告

    癫痫患者(People with epilepsy,PWEs)通常被建议不要参与体育运动和锻炼,主要是因为恐惧、过度保护,以及对与此类活动有关的具体利益和风险的无知。现有证据表明,体育锻炼和积极参与体育运动除了有广泛的身体及心理社会效益外,可能会有利于癫痫的控制。国际抗癫痫协会(ILAE)运动与癫痫工作组共同提出的这一共识提供了 PWEs 参与体育活动的一般性指导意见,并提出了不同运动的医疗健康证明的发放建议。如果发生痫性发作,运动会根据潜在的伤害或死亡风险分为三类:第一类,没有重大额外风险的运动;第二类,对 PWEs 有适度风险的运动,但不承担风险;第三类,具有重大风险的运动。在提供 PWEs 是否可以参与具体活动的建议时,应考虑的因素包括体育类型、癫痫发生概率、癫痫类型和严重程度、癫痫的促发因素、平常痫性发作的时间,以及患者接受一定程度风险的态度。由于获得了额外数据,运动与癫痫工作小组将此文件视为一项不断更新的工作。

    Release date:2018-01-20 10:51 Export PDF Favorites Scan
  • 心因性非癫痫性发作的诊断和鉴别诊断

    心因性非癫痫性发作(Psychogenic non-epileptic seizures,PNES)是转换障碍疾病最常见的临床表现之一,其临床症状和癫痫发作(Epileptic seizure,ES)十分相似,但发作时没有异常的脑电活动。在日常临床工作中,PNES 常被误诊为癫痫,并给予不恰当的治疗,给患者带来极其不利的后果,且有增加死亡率的风险。因此,早期明确诊断是治疗 PNES 的关键。回顾近年文献,对 PNES 的诊断方法及与其他疾病的鉴别诊断方法进行综述,以期尽早对 PNES 明确诊断,给予恰当的治疗。

    Release date:2018-01-20 10:51 Export PDF Favorites Scan
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