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Objective:To explore the relationship between objective cognitive function and subjective memory in patients with epilepsy and the mediating effect of depression and anxiety.Methods:A total of 123 patients with epilepsy were included, and their basic information and clinical data were collected. The quality of life in epilepsy inventory-89 memory subscale, Beck depression inventory Ⅱ, Beck anxiety scale and repeatable battery for the assessment of neuropsychological status were used to evaluate the subjective memory, depression, anxiety and objective cognitive function of patients with epilepsy. SPSS 25.0 software was used for bivariate correlation analysis and multiple regression analysis, and PROCESS V3.5 macro program was used for Bootstrap mediating effect test.Results:(1)Correlation analysis showed that the objective cognitive function score of patients with epilepsy was negatively correlated with depression score ( r=-0.392, P<0.01) and anxiety score ( r=-0.310, P<0.01), while positively correlated with subjective memory score ( r=0.388, P<0.01). Subjective memory score was significantly negatively correlated with depression score ( r=-0.436, P<0.01) and anxiety score ( r=-0.395, P<0.01). (2)The mediating effects analysis showed that objective cognitive function of patients with epilepsy could affect the subjective memory through the mediating effects of depression and anxiety indirectly. The mediating effect accounted for 33.87% and 17.93% of the total effects respectively. Conclusion:Objective cognitive function, depression and anxiety are closely related to subjective memory in patients with epilepsy. Depression and anxiety play a mediating role between objective cognitive function and subjective memory in patients with epilepsy.
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Temporal lobe epilepsy is the most common refractory focal epilepsy and most patients have significant cognitive dysfunction. Not only can seizures cause cognitive impairment, but also many antiepileptic drugs can have adverse effects on cognition. So, it is very important to choose appropriate antiepileptic drugs for the prognosis of temporal lobe epilepsy patients. At present, some studies suggest that levetiracetam (LEV) can improve the cognitive function of temporal lobe epilepsy. However, the effect and mechanism of cognitive dysfunction in temporal lobe epilepsy is not yet fully understood, so this review will focus on the effects of LEV on the cognitive dysfunction of temporal lobe epilepsy.
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OBJECTIVE：To observe therapuetic effica cy of oxcarbazepine combined with levetiracetam in the treatment of cognitive dysfunction in adult patients with temporal lobe epilepsy. METHODS ：According to inclusion and exclusion criteria ，83 adult patients with temporal lobe epilepsy were collected from neurology department of the First Affiliated Hospital of Kunming Medical University during January 2018 to October 2019，and then divided into control group （39 cases）and observation group （44 cases）. Control group was given Oxcarbazepine tablet with initial dose of 8-10 mg/（kg·d），morning and night ，increased by 5-10 mg/（kg·d）each week according to patient ’s condition ，the maximal dose was 45 mg/（kg·d），lasting for 3 months with the lowest effective treatment dose. Based on treatment of control group ，observation group was additionally given Levetiracetam tablet with initial dose of 5-10 mg/（kg·d），morning and night ，increased by 5-10 mg/（kg·d）each week according to the severity of disease，the total dose was not more than 2 000 mg/d，lasting for 3 months with the lowest effective treatment dose. The event-related potential P 300 at Pz site in 2 groups was measured before and after treatment （including the incubation period of N 1， P2，N2 and P 3 waves，amplitude of P 3 wave）. Webster ’s Adult Intelligence Scale [WAIS-RC ，including verbal IQ （VIQ）， performance IQ （PIQ），full scale IQ （FIQ）scores] and Clinical Memory Scale [CMS ，converting to memory quotient （MQ） score] were adopted. The occurrence of ADR was recorded. RESULTS ：Totally 5 patients of control group and 7 patients of observation group fell off. Finally ，a total of 71 patients participated in the entire study （34 cases in control group and 37 cases in observation group ）. Before treatment ，there was no statistical significance in P 300 at Pz site ，WAIS-RC and CMS between 2 groups （P＞0.05）. Compared with before treatment ，incubation period of N 2 and P 3 waves was shortenedsignificantly in 2 groups，and amplitude of P 3 wave wasincreased significantly after treatment （P＜0.05）；VIQ，FIQ and MQ scores were increased significantly （P＜0.05）. The incubation pe riod of P 2 wave was shortened significantly，and PIQ score was increased significantly in observation group （P＜ 0.05）. Compared with control group ，the shortening degree of incubation period of P 2，P3 waves，rising degree of amplitude of P 3 wave and rising degree of VIQ ，PIQ，FIQ，MQ scores were more bigger after treatment in observation （P＜0.05）. In the control group，there was 1 case of slight rash ，1 case of conscious asthenia ；in the observation group ，there was 1 case of nausea and vomiting，1 case of conscious asthenia ，and 1 case of emotional instability ；no serious ADR was found in 2 groups. CONCLUSIONS：Oxcarbazepine combined with levetiracetam can improve cognitive dysfunction in adult patients with temporal lobe epilepsy ，and the treatment effect is significantly better than oxcarbazepine monotherapy.
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Objective To investigate the distribution of divalent metal transporter 1 (DMT1) in the cerebellum of APP/PS1 transgenic mouse. Methods Immunohistochemistry, immunofluorescence, and confocal laser scanning microscopy were used to analyze the relationship between DMTl and amyloid beta (Aβ) and their distribution in senile plaques. Western blotting was used to analyze DMT1 protein level in the APP/PS1 transgenic mouse cerebellum. Results DMTl and Aβ were mainly located in the amyloid plaques, which were predominately located in the molecular layer of the cerebellar cortex of the transgenic mouse. Only a few plaques could be seen in the Purkinje cell layer and granular layer. Confocal laser microscopy revealed the DMTl and Aβ were co-localized in senile plaques. Conclusion The abundant expression of DMTl protein suggests that DMTl and the divalent metal ions that it transports might be involved in the formation of Aβ senile plaques and other pathological processes in the cerebellum in Alzheimer' s disease.
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Objective To report surgical outcomes of managing comminuted fractures of the inferior patellar pole with separate vertical wiring plus anchor suture fixation.Methods From January 2010 to January 2015,37 patients with comminuted fractures of the inferior patellar pole were treated with separate vertical wiring and anchor suture fixation.They were 15 men and 22 women,from 32 to 76 years of age (average,55.1 years).The intervals from fracture to surgery ranged from 2 to 3 days (average,2.1 days).According to the AO classification,all the fractures were type 34-A1.The visual analogue scale (VAS) scores,ranges of motion (ROM) of the knee,Bostman scores and postoperative complications were recorded at 6 weeks,3,6 and 12 months and the final follow-up postoperatively.Results The follow-up time for the 37 patients averaged 16 months (range,from 12 to 23 months).The fracture union time averaged 10 weeks after surgery (range,from 8 to 13 weeks).At postoperative 6 weeks,3,6 and 12 months and the final follow-up,respectively,the average VAS scores were 2.5,1.1,0.3,0.2 and 0.2 points,the average ranges of motion 109.5°,123.7°,128.6°,129.1° and 132.5°,and the average Bostman scores 23.7,26.9,29.1,29.4 and 29.6 points.No patient reported delayed union,nonunion,loss of reduction,wire breakage,wound problem or irritation from the implant.Conclusion Separate vertical wiring combined with anchor suture fixation is a useful technique for comminuted fractures of the inferior patellar pole,for it is easy to perform,allows early functional exercise and leads to fine curative outcomes.
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Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.