Objective To explore the risk factors of carotid artery atherosclerotic plaque in ischemic stroke patients. Methods One hundred and forty-eight patients with ischemic stoke were allocated into two groups by ultrasonographic testing (80 with plaque and 68 without plaque). The carotid artery acoustic densitometry (IMT), blood pressure, blood glucose , blood lipid, fibriongen (FIB), c-reactive protein (CRP) were tested. First, single variable analysis was conducted and then multivariate non-condition stepwise logistic model analysis was conducted. Results Carotid IMT, age , total cholesterol (TC), low density lipoprotein (LDL)-CH, FIB, CRP level and the incidence of hypertension and diabetes were significantly higher in ischemic stroke patients with carotid artery plaques than patients without plaques (P≤0.05); Multiple logistic regression analysis showed the most important risk factors of plaques were CRP (OR=3.546, P=0.035) and FIB (OR=1.074, P=0.012) level. Conclusion The main risk factors of carotid atherosclerosis plaque are almost the same as atherosclerosis, such as age , hypertension ,diabetes, hyperlipidemia , high FIB and CRP level and increase in carotid IMT. CRP and FIB may play a crucial role in the development of carotid artery atherosclerosis plaque.
ObjectiveAnalysis prophylactic anti-epileptic drugs (AEDs) therapy in patients with brain tumor-related epilepsy (BTE) to observe whether seizures occurance, frequency will decrease, and the adverse reactions risk assessment of the patient's after using AEDs in 3 months and 12 month. MethodsRetrospective analysis of the cases and follow-up data of patients with the diagnosis of brain tumors in the Second Affiliated Hospital of Chongqing Medical University in June 2011 to February 2015. Through the strict inclusion criteria and exclusion criteria review, the sixty-eight standard patients were divided into two groups:treatment group (44 cases) and control group (24 cases), and compared in the incidence of epilepsy and seizure frequency two groups of patients, and observe the adverse reactions after using AEDs. And analyzed the outcome of patients with brain tumors at 3 months and 2 months. ResultsThrough at least 1 year follow up, compared the data of patients in the two groups with seizure incidence at 3 months and with seizures frequency≥3 times at 12 months, the difference was statistically significant (P < 0.05).In the treatment group, however, 7 patients experienced mild adverse reactions, such as dizziness, fatigue, nausea and vomiting, mild white blood cell reduction, mild liver damage, menstrual cycle changes, mental and behavioral abnormalities, etc.A patient discontinued due to mental disorder, and a patient change AEDs due to menstrual cycle change. All patients had no serious adverse reactions. Conclusions①prophylactic use of AEDs can significantly reduce the incidence of seizures at 3 months; ②Although prophylactic use of AEDs did not reduce the incidence of seizures at 12 months, but can reduce the frequency of seizures; ③The risk of adverse reactions of prophylactic use of AEDs in patients with BTE is relatively low.
ObjectiveTo investigate the classification of seizures, etiology,EEG examination, treatment and prognosis of senile epilepsy. MethodsThe clinical data of 92 senile epileptsy patients in the Second Affiliated Hospital Of Chongqing Medical University from January 2012 to September 2015 were retrospectively analyzed. ResultsFrom the selected sample,15 cases suffered from SPS(16.3%),22 cases suffered from CPS(23.9%),40 cases suffered from GTCS(43.5%),4 cases suffered from partial seizures with secondary generalization(4.3%),11 cases suffered from both partial seizures and generalized seizures(12.0%).The common causes include cerebrovascular disease (57.6%),intracranial tumors (10.9%), degenerative brain diseases (7.6%) and so on.The abnormal ratio of REEG and AEEG was 87.1% and 91.7% respectively.The ratio of typical epileptiform activity in the REEG and AEEG was 22.6% and 70.8% respectively.82 cases(89.1%) were treated with AED,but only 69 cases had been taking orally AED among the patients treated with AED.57 cases(82.6%) were on monotherapy.55 cases (67.1%) were controlled effectively with drug treatment,11 cases (13.4%) were ineffective and 16 patients (19.5%) died. Advanced age was the important cause of death. Age was positively correlated with the fatality rate.9 cases(10.9%) appeared side effect,the frequency of sleepiness was the highest among all the adverse reactions. ConclusionThe majority of senile epilepsy suffer from symptomatic epilepsy.The main cause is cerebrovascular disease,the generalized tonic-clonic seizures constituted a high proprotion in the sample.The ratio of typical epileptic discharge in the REEG was low from senile patients with epilepsy,we recommend the AEEG examination in the senile patients suspected with epilepsy. AED has excellent therapeutic effects in senile epileptics,and a few patients appeared light adverse reactions.
ObjectiveTo investigate the clinical symptom and risk factors of diabetic seizures. MethodsThe clinical data of 44 patients with diabetes related seizures were analyzed with the clinical classification, blood glucose, Na+, Plasma Osmotic Pressure, HbA1c, EEG, brain MR, and the antiepileptic drugs. Results① Diabetic hyperglycemia (DH) related seizures: among the 28 patients, 17 cases were male patients, 11 cases were female patients. The mean age was 51.3 years old. Simple partial seizure without secondary generalized seizures (12/28, 42.8%) was the most common, 8 patients (8/28, 28.6%) showed complex partial seizure, 8 patients (8/28, 28.6%) showed no obvious focal origin generalized tonic-closure seizures. Patients with poor glycemic control (HbA1c > 9%) had significantly higher risk of generalized seizures (46.7% vs. 7.7 %, P < 0.05) (P < 0.05). ② Diabetic ketoa-cidosis or hypertonic state associated seizures: among the 7 patients, 6 cases were male patients, 1case was female patients. The mean age was 45.7 years old, 2 patients (2/7, 28.6%) had generalized tonic-clonic seizure, 2 patients (2/7, 28.6%) showed status epilepticus, 2 patients (2/7, 28.6%) showed local motor seizure, 1 patient (1/7, 14.2%) showed Jackson seizure. ③ Diabetic hypoglycemia related seizures: among the 9 patients, 7 cases were male patients, 2 cases were female patients. The mean age was 45.3 years old.5 patients showed generalized tonic-clonic seizure (5/9, 55.6%), 3 patients had complex partial seizure (3/9, 33.3%), 1 patients had generalized tonic-closure seizures (1/9, 11.1%). ConclusionSimple partial seizure is the most common in patients with diabetic hyperglycemia related seizures; so as to diabetic hypoglycemia and keto-acidosis, generalized seizures are relatively common. HbA1c can be an important risk factor of seizures for patients with hyperglycemia.
Epilepsy is a heterogeneous disease with a very complex etiological mechanism, characterized by recurrent and unpredictable abnormal neuronal discharge. Epilepsy patients mainly rely on oral antiseizure medication (ASMs) the for treatment and control of disease progression. However, about 30% patients are resistance to ASMs, leading to the inability to alleviate and cure seizures, which gradually evolve into refractory epilepsy. The most common type of intractable epilepsy is temporal lobe epilepsy. Therefore, in-depth exploration of the causes and molecular mechanisms of seizures is the key to find new methods for treating refractory epilepsy. Mitochondria are important organelles within cells, providing abundant energy to neurons and continuously driving their activity. Neurons rely on mitochondria for complex neurotransmitter transmission, synaptic plasticity processes, and the establishment of membrane excitability. The process by which the autophagy system degrades and metabolizes damaged mitochondria through lysosomes is called mitophagy. Mitophagy is a specific autophagic pathway that maintains cellular structure and function. Mitochondrial dysfunction can produce harmful reactive oxygen species, damage cell proteins and DNA, or trigger programmed cell death. Mitophagy helps maintain mitochondrial quality control and quantity regulation in various cell types, and is closely related to the occurrence and development of epilepsy. The imbalance of mitophagy regulation is one of the causes of abnormal neuronal discharge and epileptic seizures. Understanding its related mechanisms is crucial for the treatment and control of the progression of epilepsy in patients.
ObjectiveTo analyze the prognosis factors in status epilepticus and confirm the external validity of the Status Epilepticus Severity Score (STESS) prediction functions for outcome in patients with statusepilepticus. MethodsRetrospectively, collecting prognosis factors in status epilepticus of 50 patients. These factors include gender, age, SE aetiology, seizure type at SE onset, history of prior seizures or epilepsy, level of consciousness, duration of SE, albumin and infection. Using STESS score to evaluate the prognosis of patients, then evaluate the effectiveness of the STESS score. Results1. Single factor analysis:age,history of prior seizures or epilepsy, level of consciousness and infection were prognosis factors in status epilepticus (P<0.05). Gender, SE aetiology, seizure type at SE onset and albumin were not prognosis factors (P>0.05). Multivariablelogistic regression models selected two factors:duration of SE (OR3.645), level of consciousness (OR2.877). 2. 28 status epilepticus patient in the STESS 0-2 group were all alive. 10 status epilepticus patients in the STESS 3-6 group were died (45.4%), 12 patient were alive (54.6%). There were significant differences among the prognostic of patienst in different groups (P<0.01). The receiver operating characteristic curve for prediction of death by the STESS Score had an area under the curve of 0.92. The optimal cut-off point is 3. ConclusionAge, history of prior seizures or epilepsy, level of consciousness, duration of SE and infection were prognosis factors in status epilepticus. Level of consciousness and duration of SE were the directly related factors of the prognosis of status epilepticus. STESS score performed reasonable prognositic role on our patients with status epilepticus.
ObjectiveTo explore the prognostic factors for seizure control in focal cortical dysplasia(FCD)by analyzing the clinical features of FCD patients. MethodsWe conducted a follow-up study of patients, who were confirmed FCD by pathology after resective surgery,in Epileptic Center, Guangdong Sanjiu Brain Hospital, From January 1, 2014 to December 31, 2014. All patients were followed at least 6 months,they were divided into seizure control group(Engel class I) and seizure group(Engel classⅡ-class Ⅳ) according to surgical outcomes. Clinical features,auxiliary examinations and pathological classification were compared between two groups. Results102 patients were included, male 65 cases (63.7%), female 37 cases (36.3%), onset age 0.01~45 years old, average (10.3±8.26) years old, surgery age (3~47) years old, average (21.21±8.9) years old, all had seizure onset. 83 (81.4%) patients in seizure control group, 19 (18.6%) patients in seizure group. There are 14.5% of the patients' onset ages are younger than 3 years old, 59.8% preoperative electroencephalogram recording a diffusion epileptiform discharge, 32.5% orientation of magnetic resonance imaging (MRI) and electroencephalography (EEG) is inconsistent, 49.4% postoperative electroencephalogram (EEG) reveal an epileptiform discharge, 45.2% of the patients had intellectual disability, 36.1% had an absence of a lesion on MRI, in seizure control group. However,in seizure group they respectively 36.8%, 72.2%, 89.5%, 68.4%,94.1%, 89.5%. Patients in seizure control group got an average scores of (89.4±18.53) in performance intelligence quotient (PIQ)test, while, seizure group 65.80±15.71.There has a statistical significance between two groups. ConclusionPostoperative seizure outcome was favorable in patients with FCD, onset ages younger 3 years old, intellectual disability,getting a lower scores in PIQ test, preoperative electroencephalogram recording a diffusion epileptic discharge, inconsistent orientation of MRI and EEG, and postoperative EEG reveal an epileptiform discharge may be predictive for the postoperative outcome.