Long-term Effectiveness of Antiepileptic Drug Monotherapy in Partial Epileptic Patients: A 7-year Study in an Epilepsy Center in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.</p><p><b>METHODS</b>This is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.</p><p><b>RESULTS</b>A total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64-44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P = 0.006), LTG (70.79%, P = 0.001), LEV (72.54%, P = 0.005), and VPA (73.33%, P = 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).</p><p><b>CONCLUSION</b>This study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.</p>

Clinical analysis of 47 misdiagnosed cases of atypical tuberculous meningitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To improve the differential diagnosis of tuberculous meningitis (TBM) and reduced potential misdiagnosis of TBM.</p><p><b>METHODS</b>The clinical data of 47 misdiagnosed cases of TBM between January, 1994 and June, 2009 were investigated retrospectively. The clinical presentations and causes for the misdiagnoses were analyzed.</p><p><b>RESULTS</b>The 47 patients with misdiagnosed TBM included 28 male and 19 female patients with a mean age of 36.84∓16.41 years. Eight patients had an acute onset, 10 had a subacute onset, and 29 had chronic disease. The initial symptoms, in the descending order of their frequencies, included fever and headache (87.2%), anergia and dyskinesia (27.7%), cerebral nerve damage (23.4%), decreased level of consciousness (14.9%), and urinary and fecal incontinence (2%). Meningeal irritation was present in 25 cases and positive Babinksi sign was found in 19 cases. Elevated intracranial pressure occurred in 51.1% of the cases, and 16 cases showed papilloedema. Non-purulent CSF with elevated protein was found in 86.7%, decreased glucose in 50%, and decreased chlorinate in 53.3% of the cases. Eight out of 23 cases showed a positive result of PPD test. MRI identified abnormitis with meningeal enhancement in 15 cases, hydrocephalus in 7 cases and infarction in 14 cases. Tuberculoma was found in 2 cases, and spinal cord lesions were found 4 cases. All the patients received anti-tuberculosis therapy, which resulted in symptomatic improvement in 39 cases, fluctuated condition in 2 cases; 5 patients discontinued the treatment and 1 died.</p><p><b>CONCLUSION</b>Early TBM often presents with atypical features and its differential diagnosis can be difficult. CSF monitoring and careful inspection of the radiographic data can be helpful in the diagnosis of suspected cases, for which early anti-TB treatment is an important means to reduce misdiagnosis.</p>

Temperament and Self-esteem of Children Aged 8～12 / 中国康复理论与实践

@#ObjectiveTo study the level of temperament and self-esteem of children aged 8～12 in Beijing city,as well as their interaction and influenced factor.Methods203 school children aged 8～12 were assessed with Carey's temperament questionnaire(8～12:MCTQ) and The Self-Esteem Scale(SES).ResultsTemperament and self-esteem of school children aged 8～12 were associated with the parental behavior,especially with work style of their fathers.The rhythmicity was found to be negative correlated to the self-esteem scores,and the intensity of reaction was found to be positive correlated to the self-esteem scores.ConclusionParents' behavior and family environment were important to the temperament and self-esteem of school children.

Multiple system atrophy:clinical manifestations and imaging characteristics / 中华神经科杂志

Objective To analyze the clinical manifestations as well as correlation between clinical manifestations and the new neuroimage characteristics(pontine"cross sign"and"putaminal slit")for correct diagnosis of multiple system atrophy(MSA).Methods Eleven patients with MSA based on Gilman diagnostic criteria were retrospectively analyzed for clinical manifestations and brain MRI findings.Results Eleven patients were probably diagnosed as MSA,among which 8 patients were MSA-C(olivopontoeerebellar atrophy,OPCA),2 patients were MSA-P(striatonigral degeneration,SND),one patient was MSA-A(Shy- Drager syndrome,SDS).Five years after onset,MRI of MSA-A showed stage 0"cross sign"and "putaminal slit".In 8 patients with MSA-C,2 patients reached stage Ⅰ 3 years after onset,one patient reached stage Ⅱ 2 years after onset,3 patients respectively did stage Ⅲ 1 year,3 years,and 5 years after onset,2 patients reached Ⅳ stage 2 years,and 7 years after onset respectively.As for putaminal slit,all of these patients were in stage 0.One patient with MSA-P reached stage 0"cross sign"and stage Ⅰ "putaminal slit"6 years after onset;another patient showed stage Ⅳ"cross sign"and stage Ⅱ"putaminal slit"9 years after onset,which was high slit intensity on both sides,however much stronger in the fight side than in the left side.Conclusion Both"cross sign"and"putaminal slit"are neuroimage characteristics for early diagnosing MSA-C,while"putaminal slit"for MSA-P.

Clinical research on the therapeutic effects and safety of amitrine bismesylate in patients with mild vascular dementia / 中华神经科杂志

Objective To evaluate the therapeutic effects and safety of amitrine bismesylate in patients with mild vascular dementia.Methods An open multicenter self-controlled trial was carried out with 128 mild vascular dementia patients clinically diagnosed.Patients were treated with amitrine bismesylate in a dose of 2 tablets per day for 12 weeks.The neuro-psychologieal scale of MMSE,ADAS-cog,CDR, ADL were used to evaluate patients′cognitive condition before therapy and 6,12 weeks after treatment.The adverse effects,such as nausea and vertigo and so on,were monitored at the same time to evaluate the safety of this drug.Results After 3 months of treatment,the MMSE score(16.98 before therapy and 17.97 after treatment,P

Cognitive impairment in epileptic patients: neuropsychological and diffusion-tensor imaging study / 中华神经科杂志

Objective To explore the pathologic changes in the brain areas corresponding to specific cognitive function and underlying mechanism of cognitive impairment in patients with epilepsy by DTI study.Methods Forty-four Patients and 20 control subjects received the test of Wechsler Adult Intelligence Scale and the Diffusion-Tensor Imaging examination.Mean diffusivity (MD) and fractional anisotropy (FA) in the normal appearing white matter of interested area were measured.T test was employed to compare the MD and FA between patients and healthy controls,patients with normal and impaired FIQ respectively.The relationships between FIQ and DTI value were analyzed by Bivariate correlations.Results VIQ (100.52?17.63),PIQ (95.10?16.72) and FIQ (98.19?17.76) of the patients with epilepsy were significantly lower than those of health controls (VIQ,PIQ and FIQ were 109.77?13.54,108.11? 12.17 and 109.81?10.57,respectively).Significant reduction of FA in both side of posterior limb of internal capsule (P