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find Author "秦家明" 7 results
  • 癫痫与精神障碍

    癫痫患者的精神障碍患病率高于普通人群。目前尚无诊断标准,其诊断需要结合国际抗癫痫联盟推荐的癫痫诊断标准和精神疾病诊断与统计手册。癫痫患者出现精神障碍,根据精神障碍与癫痫的关系,可以分为以下三种类型:癫痫合并精神分裂症、癫痫特有的精神障碍以及抗癫痫药物诱发精神障碍。三种类别的精神障碍临床表现、病程、治疗原则以及预后均各有迥异,需要在临床诊治过程中进行鉴别。但是至今相关的研究报道仍然不多,相关的临床问题尚未引起注意得到关注,期待更多的临床研究,提供更多的循证医学证据。

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  • Risks of seizure recurrence from antiepileptic drug withdrawal among seizure-free patients for more than three years

    ObjectiveTo determine the outcome of antiepileptic drugs (AEDs) withdrawal in patients who had been seizure-free for more than two years. MethodsPatients with epilepsy who had been seizure-free for at least two years and decided to stop AEDs therapy gradually were checked on every two months for seizure relapse. The inclusion criteria were:①diagnosis of epilepsy, defined as at least two unprovoked seizures at least 24 hours apart; ②patients remained seizure-free for at least 24 consecutive months during AEDs therapy; ③patients expressed a desire to discontinue AEDs therapy gradually and agreed to return for regular follow-ups; and④electroencephalogram (EEG) showed no epileptic discharge. The time to a seizure relapse and predictive factors were analyzed by survival methods, including sex; age at seizure onset; number of episodes; seizure-free period before AEDs withdrawal; duration of follow-up after AEDs withdrawal; AEDs tapering off period (taper period); results from brain MRI; EEG before seizure-free; EEG before drug withdrawal; seizure type (classified as generalized, partial, or multiple types based on history); the number of AEDs administered for long-term seizure control. A log-rank test was used for univariate analysis, and a Cox proportional hazard model was used for multivariate analysis. ResultsSixty-eight patients (39 male, 29 female) were admithed. The relapsed rate was 23.5%. Univariate analysis and multivariate Cox regression analysis indicated that multiple AEDs, hippocampal sclerosis and withdrawal time were significantly correlated with seizure recurrence and those were significant independent predictive factors, with hazard ratio were 0.861, 2.223 and 2.137 respectively. ConclusionsThe relapsed rate in our study was similar to other studies. Distinguishing variables, such as multiple AEDs, hippocampal sclerosis and withdrawal time, need to be considered when decide to withdraw. Therefore, our recommendation is that after two years of being seizure-free, patients could consider withdrawal unless they are hippocampal sclerosis patients.

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  • HCN single nucleotide polymorphism and genetic susceptibility of medial temporal lobe epilepsy

    ObjectiveThrough Sequenom iPEX system analyzed the genetic susceptibility in patients with Medial temporal lobe epilepsy (MTLE) which screening hyperpolarization-activated cyclic nucleotide gated channel (HCN) subunit HCN1 and HCN2 single nucleotide polymorphism blood samples. MethodsPatients with epilepsy who were diagnosed MTLE in our epileptic clinic from December 2013 to April 2016 were included in this study, total 143 cases. Healthy volunteers who received annual physical checkups were recruited to serve as controls total 120 cases. The group enter criterion according to a 2004 ILAE report mainly:①12~55 years old; ②attack forms:partial onset seizures or secondary tonic-closure-clonus attack, a common onset symptoms such as stomach gas rise feeling, sense of deja vu, automatism etc.; ③with or without febrile convulsions history; ④EEG displayed unilateral or bilateral temporal spike, sharp slow wave, or their spines slow-wave sample such as epilepsy wave; ⑤head MRI displayed hippocampal sclerosis. Exclusion criteria:①tumors; ②head MRI display focal cortical dysplasia (FCD). Using sequenom iPLEX technology platform to detect all the object of study of gene polymorphism sites total ten sites. All statistical tests were conducted using SPSS version 16.0. Resultsall sites fulfilled Hardy-Weinberg genetic balance. The results showed that HCN1 rs17344896 C/T, rs6451973 A/G and HCN2 rs12977194 A/G three polypeptide sites associated with MTLE, with statistical differences(P < 0.05). ConclusionHCN1 and HCN2 genetic suscepibility is one of possible mechanism of MTLE.

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  • Construction of rat model with phenytoin-resistant mesial temporal lobe epilepsy

    Objectives The purpose of this study is to verify the phenytoin-resistant mesial temporal lobe epilepsy (MTLE) induced by Li-pilocarpine and screened by antiepilepsy drug (AEDs). Methods The rats with MTLE were induced by Li-pilocarpine, which were screened by effect of phenytoin treatment monitored by vedio-EEG. The living microdialysis technology was used for verification of drug concentration in brain of drug-resistant and drug-responsive rat model, and the P-glycoprotein expression was detected by immunohistochemical method. Results Sixteen rats with chronic MTLE were successfully induced in total 30 rats, among which, 6 drug-resistant rats with MTLE were screened. The brain/plasma ratio of area under the curve in drug-resistant rats was significantly lower than that of drug-responsive rats (0.15±0.03 vs. 0.28±0.05, P<0.05). In addition, the P-glycoprotein expression in brain of drug-responsive rats was obviously higher than that of drug-responsive rats (P<0.05). Conclusions The low concentration of phenytoin in drug-resistant rat model with MTLE was verified that might be related to the over-expressed P-glycoprotein in brain.

    Release date:2019-01-19 08:54 Export PDF Favorites Scan
  • Effects of verapamil for phenytoin distribution in rat model with mesial temporal lobe epilepsy

    ObjectiveIn order to evaluate that whether the P-glycoprotein-inhibitor verapamil (VPM) could effect the distribution of antiepileptic drug phenytoin (PHT) in a rat model of mesial temporal lobe epilepsy (MTLE).MethodsThe rat models of MTLE were induced by li-pilocarpine and were randomly divided into two groups (PHT group and VPM+PHT treatment group) to compare the PHT distribution in brain, liver and kidney. Brain dialysate samples were collected by microdialysis technology. And the analysis of samples for PHT concentration was performed by high performance liquid chromatography (HPLC). The comparisons were carried out by t test (or Wilcoxon test).ResultsIn VPM+PHT treatment group, 4 out of 9 rats were dead within 30 minutes after drug administration. The significantly decreased area under the curve (AUC) ratio of brain/plasma in VPM+PHT group was 0.11±0.06 when compared with PHT group 0.21±0.02 (t=3.237, P=0.025), while there were no significant differences in ratios of liver/plasma [PHT (1.12±0.37) vs. VPM+PHT (0.99±0.27), Z=−0.490, P=0.624] and kidney/plasma [PHT (0.74±0.16) vs. VPM+PHT (0.49±0.26), t=1.872, P=0.103] between two groups.ConclusionsThe P-glycoprotein-inhibitor VPM significantly decreased PHT level in brain of rat with MTLE.

    Release date:2019-05-21 08:51 Export PDF Favorites Scan
  • 超极化激活环核苷酸门控通道在颞叶癫痫的研究新进展

    超极化激活环核苷酸门控通道(Hyperpolarizationactivated cyclic nucleotide gatedchannel,HCN)属于电压门控型离子通道,迄今为止发现有四个亚型:HCN1~HCN4。HCN 通道的激活依赖于膜的超级化,在膜电位低于静息电位时,HCN 通道被激活,产生局部紧张性电流,导致持续的钠内流,使细胞膜发生去极化。该通道分布在人体的分布并不一致,主要在神经系统和心脏中表达。目前研究表明,HCN 通道既参与所在组织的正常生理功能,如睡眠和觉醒、学习和记忆、视觉和疼痛感知、神经元起搏、树突整合等,也与多种中枢神经系统疾病及所在组织的病理状态密切相关,如神经病理性疼痛、学习记忆障碍、药物成瘾和颞叶癫痫,特别是在伴海马硬化性内侧颞叶癫痫中。癫痫作为神经系统最常见的神经疾病之一,癫痫因其病因错综复杂,病理改变亦多样性,至今尚未能完全了解其全部发病机制。目前有大量的文献报道 HCN 与癫痫,特别是颞叶癫痫的发生发展有密切关系。因此本文就 HCN 通道的结构特征、分布、功能、调控及其在颞叶癫痫发生过程中的新研究进展进行综述。

    Release date:2020-03-20 08:06 Export PDF Favorites Scan
  • 基因启动子甲基化在癫痫的研究进展

    DNA 甲基化是人类发现最早的表观遗传学修饰之一,具有多种调控功能,参与机体发育过程中干细胞生长、细胞增殖、器官发育、衰老和肿瘤发生等多个生物学过程,而且在突触重塑、神经细胞分化等神经生物过程中也具有重要作用。近年来,越来越多的研究表明 DNA 甲基化修饰与癫痫的发病机制密切相关,特别是基因启动子的甲基化改变逐渐受到关注。文章主要对表观遗传中基因启动子区的甲基化在癫痫发生发展中的研究进展进行综述。

    Release date:2020-09-04 03:06 Export PDF Favorites Scan
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