Epilepsy is one of the most common neurological diseases, and symptomatic epilepsy patients are the main group of epilepsy patients, and their etiologies mainly include structural, infectious, metabolic and autoimmune, and the seizures caused by each etiology may have different degrees of impact on the quality of life of patients. The purpose of this article is to review the research on the quality of life of patients with symptomatic epilepsy caused by structural and infectious etiologies, including cerebrovascular diseases, neurodegenerative diseases, brain tumors, traumatic brain injuries and neurocysticercosis, in order to help clinicians understand the quality of life of patients with symptomatic epilepsy and benefit patients in clinical practice.
ObjectiveTo investigate the role of amygdala volume index(AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy (mTLE), including clinical features, etiologies and surgical outcome.
MethodsThirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations, video-electroencephalogram (VEEG) and magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI, which were measured with region of interest (ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue.
ResultsAmong the 35 patients, there is a strong correlation between AVI on the lesion side and age of onset (R =-0.389, P = 0.019) as well as age of surgery (R =-0.357, P = 0.032). No obvious relation can be seen between AVI and gender, history of febrile convulsion, duration of epilepsy, secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up, thirty patients (80.5%) reached seizure-free, AVI on the lesion side is nota predictor of surgical failure (P > 0.05).
ConclusionAVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover, a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.
ObjectiveDetermine the effect of Semen ziziphi spinosae decoction combined Sodium valproate (VPA) sustained-release tablets on treating patients with Post-traumatic epilepsy (PTE).Methods30 patients are chosen among the patients who were hospitalised in Epilepsy Department of Kunshan Traditional Chinese Medicine Hospital from Jan 2017 to Jan 2019. The age ranges from 31 to 75, averaging at (42.5±13.5) years old, and composed of 16 male samples and 14 female, randomly divided into experimental group (Semen ziziphi spinosae decoction combined VPA, n=15) and control group (VPA, n=15). In general, imaging data and EEG data are collected. Regular follow-up is also carried out for these 30 patients. The results are analysed to determine the effect of treatment.ResultsAfter 9-months treatment of Semen ziziphi spinosae decoction combined VPA, morbidity of experiment group is significantly lower than that of the control group. It is also found that the differenes of imaging data and EEG data of patients were of no statistical significance.ConclusionIt is demonstrated that Semen ziziphi spinosae decoction combined VPA has superior performance in treating patients with PTE. The efficiency of Semen ziziphi spinosae decoction combined VPS in treating PTE is 93.3%, higher than the 80% of VPA. It can serve as reference for clinical diagnosis and treatment.
ObjectiveTo characterize the dynamic expression of Robo3 in the rat model of temporal lobe epilepsy(TLE), and assess the potential contribution of Robo3 to epileptogenesis.
MethodsMale Sprague-Dawley (SD) rats were randomly divided into the control group (n=6) and the experimental groups (n=30, 6 per group). The experimental groups were injected intraperitoneally (i.p.) with an aqueous solution of lithium-pilocarpine, and sacrificed at different time points (1, 7, 14, 30 and 60 days) following the seizure. The control group was i.p. with 0.9% sodium chloride instead of pilocarpine. Quantitative real-time PCR were used to detected the mRNA expression of Robo3 and Western bolt were used to detected the protein expression of Robo3.
ResultsQuantitative real-time PCR showed that the expression of Robo3 were significantly lower in the rat temporal lobe tissues of the latent and the chronic period group as compared with the controls(P < 0.05), but no significant differences were identified between the acute period group and the controls(P > 0.05). Western blot showed that the protein expression of Robo3 were significantly lower in the rat temporal lobe tissues of the latent and the chronic period group as compared with the controls(P < 0.05), no significant differences were identified between the acute period group and the controls(P > 0.05).
ConclusionsRobo3 may be involved in the pathogenesis of temporal lobe epilepsy.
Objective
To study the clinical efficacy of topiramate combined with carbamazepine combined with phenytoin in elderly seizures.
Methods
A total of 105 elderly patients with epilepsy were enrolled in this study from August 2014 to July 2016 in Fuzhou Chinese and Western Medicine Hospital. The patients were aged 61 to 80 years. There were 42 males and 63 females with epilepsy. The course were 1 to 5 years; 55 cases were partial onset, 50 cases were systemic attack. According to the different treatment methods, the patients were divided into A, B, C three groups, each group were 35 patients. Group A was daily treated with 4 to 8 mg/kg topiramate; Group B was treated with 0.3 g carbamazepine combined with 250 to 300 mg phenytoin per day. Group C was daily treated with 4 to 8 mg/kg topiramate and 0.3 g carbamazepine combined with 250 to 300 mg phenytoin. The total effective rate, the incidence of adverse reactions, the number of seizures before and after treatment were compared among the three groups.
Results
The total effective rate of group C was higher than that of group A and B, and the difference was statistically significant (P<0.05). There were no significant differences in the number of epileptic seizures between the three groups before treatment (P>0.05). The number of seizures in group C was significantly lower than that in group A and B (P<0.05).
Conclusions
The treatment of topical epilepsy patients with topiramate and carbamazepine combined with phenytoin can significantly improve the total effective rate of treatment, protect the safety of medication, reduce the number of patients with epilepsy, so that patients can quickly return to normal life. It would be worthy for clinical promotion and use.
ObjectiveTo investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.MethodsA total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response (VER) group and the non-VER group according to their occurrence or absence. Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation (PRFT) in patients with functional epilepsy, and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT. Bootstrap method was used for internal verification. C-index, correction curve and ROC curve were used to evaluate the prediction ability of the model.ResultsLogistic regression analysis showed that age [OR=0.235, 95%CI (0.564, 3.076)], preoperative fugl-meyer score [OR=4.356, 95%CI (1.537, 6.621)], depression [OR=0.995, 95%CI (1.068, 7.404)], and lesion range [OR=1.512, 95%CI (0.073, 3.453)] were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG (P<0.05), and were highly correlated with the occurrence of VER in PRFT. Based on the above six indicators, a SEEG-guided colograph model of VER risk in PRFT was established, and the model was validated internally. The results showed that the C-index of the modeling set and validation set were 0.779 [95%CI (0.689, 0.869)] and 0.782 [95%CI (0.692, 0.872)], respectively. The calibration curves of the two groups fit well with the standard curves. The areas under the ROC curve (AUC) of the two groups were 0.779 and 0.782 respectively, which proved that the model had good prediction accuracy.ConclusionFor patients with functional epilepsy requiring seeg-guided PRFT therapy, age, preoperative Fugl-meyer score, depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER, and early intervention measures should be taken to reduce and reduce the incidence, which has good clinical application value.
ObjectiveTo summarize clinical electrophysiological features and efficacy of some of Anti-epileptic drugs(AEDs) of Juvenile myoclonic epilepsy (JME).
MethodsClinical electrophysiological information of 101 outpatients with JME observed at Xuanwu Hospital from Jul. 2001 to Sep. 2014 was retrospectively analyzed, including the seizure types, trigger factors, electroencephalogram. We followed some of these patients and compared the efficacy between different AEDs. Result According to different seizure types, there are four subtypes: Myoclonus (MJ) only 11.88%, MJ+generalized tonic-clonic seizure(GTCS) 75.24%, MJ+GTCS+Absence(Abs) 11.88%, MJ+Abs 1.00%. Patients with typical ictal generalized poly-spike and waves (PSW) or spike and waves (SW) or spikes account for 96.80%. And 75.00% of patients have no MJ and 91.80% have no GTCS with valproic acid monotherapy. 65.00% and 88.24% of patients were seizure free of MJ and GTCS recpectively. But the difference of efficacy between these two drugs have no statistically significance. Sleep deprivation was the primary trigger factors, accounting for 16.83%.
ConclusionJME has clinical heterogeinety, clinicians should fully understand the whole condition of JME individual, including their clinical manifestation, EEG features, reaction to AEDs, trigger factors, habitual patterns and so on, in order to help making individualized therapy.
ObjectiveTo investigate the status and prognosis effect of surgical operation for Temporal lobe epilepsy.MethodsRetrospective analyses were performed on 24 patients with intractable temporal lobe epilepsy who were treated by surgery in Zibo Changguo Hospital and had complete clinical and follow-up data, during the period from April 2011 to June 2014. Among them, 14 were male and 10 were female, 16 to 44 years old, the average age was (24.40±6.26) years old, and the average course of disease was (12.50±8.42) years old. The clinical characteristics and prognosis of the patients were analyzed.ResultsAll 24 patients had hippocampal sclerosis and underwent "anterior temporal lobe and medial temporal structural resection". Patients were followed up for 5~7 years, the postoperative epileptic seizure of the patient reached grade Engel Ⅰ in 20 cases (83.3%), grade Engel Ⅱ in 2 cases (8.3%) and grade Engel Ⅳ in 2 cases (8.3%).ConclusionHippocampal sclerosis and cortical dysplasia were common in 24 patients, and the operation controlling intractable epilepsy was better. In order to improve the prognosis of patients, surgical treatment should be carried out as soon as possible.
ObjectiveTo compare the efficacy and safety of perampanel (PER) and oxcarbazepine (OXC) monotherapy in the treatment of newly diagnosed focal epilepsy in adults. Methods A total of 62 adult patients with focal epilepsy, aged 18~79 years old, with an average age of (40.53±16.69) years, were enrolled from Qingyuan People’s Hospital between August 2021 and October 2022 and randomly divided into PER group and OXC groups. Both groups were followed up for 12 months and assessed for seizure free rate, effective rate, drug retention rate, and adverse reactions at 3, 6, and 12th months. ResultsThe results showed that the seizure free rate, effective rate, and drug retention rate in the PER group were 62.5%, 71.9% and 87.5% at 3 months, respectively, and 53.1%, 65.6% and 75.0% at 6 months respectively. In the OXC group, the seizure free rate, effective rate, and drug retention rate were 70.0%, 86.7%, and 93.3% at 3 months, respectively, and 66.7%, 73.3% and 83.3% at 6 months, respectively. At 12 months, the seizure free rate, effective rate and retention rate of the PER group were 43.8%, 46.9%, and 53.1%, respectively; The seizure free rate, effective rate, and retention rate of OXC group were 66.7%, 66.7%, and 70.0%, respectively. The incidence of adverse reactions in the PER group and OXC group was 15.6% and 16.7%, respectively. The most common adverse reactions in both groups were dizziness and drowsiness, with no serious adverse events. ConclusionPER and OXC monotherapy demonstrated similar efficacy and safety in the treatment of newly diagnosed adult focal epilepsy, and both drugs can be used as safe and effective treatment options.
The present study is to explore the change process and distribution of phosphorylated DARPP-32 (p-DARPP-32) in rat brain including cortex, hippocampus and striatum and to further deduce whether p-DARPP-32 was possibly involved in epilepsy induced by repetitive low doses of pentylenetetrazol (PTZ). PTZ-induced epilepsy model in rat was established with 30 male SD rats randomly divided into 6 groups, control group and five trial groups [PTZ 1 h,PTZ 6 h,PTZ 24 h,PTZ 48 h and PTZ 72 h respectively, after onset of status epilepticus (SE)]. Immunohistochemistry and immunofluorescence double-labeling were used to detect the temporal time change and distribution of p-DARPP-32 expression and to analyze the coexpression of DARPP-32 and p-DARPP-32 in rat brain after the onset of PTZ-induced generalized SE. The results showed that there was a temporal time change of p-DARPP-32 expression in rat brain after the onset of SE. The number of p-DARPP-32-positive cells increased significantly and reached the peaks at the ends of 1 hour and 6 hours after the onset of SE, but decreased at the end of 24 hours. The moderate to strong p-DARPP-32-immunopositive neurons were observed in cortex, hippocampus and striatum, and located in cell cytoplasm and cell nucleus. Further immunofluorescence double-labeling revealed that denser colocalization of p-DARPP-32 and DARPP-32 in the neurons existed in the area mentioned above. Therefore, PTZ-induced SE may cause phosphorylation of DARPP-32 in rat brain. The temporal time change and distribution of p-DARPP-32 suggest that phosphorylation of DARPP-32 may be involved in PTZ-induced epilepsy in rat brain including cortex, hippocampus and striatum, and p-DARPP-32 may play a central role in the onset of SE.
