ObjectiveTo investigate the effect of electroacupuncture on the apoptosis of hippocampal neurons in C57BL/6J mice with status epilepticus by observing the changes of hippocampal subtle neuron pathology and apoptosis.MethodsMale C57BL/6J mice were used to prepare epileptic status models of lithium-pilocarpine mice, and then 7-day electroacupuncture stimulation (Baihui, Fengfu) were given to the mice model. Open field experiment and new object recognition experiment were performed to observe the changes of cognitive abilities. The pathological changes of hippocampal neurons were detected by HE staining. Hippocampal apoptosis protein (Caspase-3) and microtubule-associated protein (MAP-2) were detected by immunohistochemistry. Effect of electroacupuncture on apoptosis of hippocampal neurons in C57BL/6J mice with status epilepticus were recorded.Results① Compared with the control group, the vertical movement, modification times, and number of crossings of the model group all decreased significantly (P<0.000 1,P<0.000 1,P<0.000 1), and their cognitive ability decreased significantly (P<0.01). Compared with the model group, vertical movements, modification times, and number of crossings were increased in the electroacupuncture (EA) group (P<0.01,P<0.05,P<0.05), and the cognitive ability of new objects was increased (P<0.01). ② HE staining showed that the model group had significant damage to the hippocampal neurons of mice, and the cells swelled, nuclear collapsed and vacuoles appeared. In the EA group, the injury of hippocampal neurons was alleviated, and cell edema and vacuolization were alleviated. ③ Immunohistochemistry showed that compared with the control group, the IOD of the Caspase-3 positive cells in the hippocampus of the model group increased significantly (P<0.000 1), and the IOD of the MAP-2 positive cells decreased significantly (P<0.01); Compared with the electroacupuncture, the IOD of the Caspase-3 positive cells in the hippocampus of the mice decreased (P<0.05), and the IOD of the MAP-2 positive cells increased (P<0.05).ConclusionsElectroacupuncture can improve the pathological changes of hippocampal neurons in C57BL/6J mice with status epilepticus, promote cytoskeletal repair, reduce neuronal apoptosis in hippocampus, and antagonize the damage of hippocampal neurons induced by status epilepticus.
Objectives Retrospective analysis of the Tibetan convulsive status epilepticus (CSE) for the aetiology, prognosis and its influencing factors in Tibet area. Methods Through electronic patient record, making “epilepsy”, “status epilepticus ”, “epileptic seizure” as keywords, convulsive status epilepticus patients in the People’s Hospital of Tibet Autonomous Region hospitalized from January 2015 to December 2020 were retrospectively observed, gathering their clinical data and aided examinations furthermore, and the prognoses were returned by telephone, meanwhile the functional status of those patients was assessed by the modified rankin scale. and the causes differ in gender, age, out-of-hospital antiepileptic treatment, family history of epilepsy and history of epilepsy were analyzed. The prognostic factors were analyzed by logistic regression. Results A total of 2 254 hospitalized patients with epilepsy were retrieved, including 331 CSE patients aged 14~84 years, 219 males and 112 females. There were 36 lost calls, 62 CSE deaths (21.01%), and 4 adverse outcomes (non-death)(1.7%).There were statistically significant differences in etiology of CSE in different ages and history of epilepsy (P<0.05), but there were no statistically significant differences in gender, out-of-hospital antiepileptic treatment, progression of refractory status epilepticus and family history of epilepsy. Cerebrovascular disease was the main cause of CSE in people aged 45 and over (54 cases), while the main cause of CSE in people aged under 45 was unknown (104 cases).Among the patients with previous history of epilepsy, the highest proportion was unknown cause [117 cases (48.8%)]; Among patients without a history of epilepsy, cerebrovascular disease [34 cases (37.4)] was the most common cause of CSE. Multivariate logistic regression analysis of prognostic factors of CSE showed that gender, age, GCS and electrolyte disorder had statistically significant effects on the death of CSE patients (P<0.05), while altitude and their duration and other factors had no statistically significant effects on the death of CSE patients (P>0.05). ConclusionsCerebrovascular disease is the leading cause of CSE in people aged 45 and over. Male, advanced age, low GCS score at discharge, and electrolyte disorder were risk factors.
ObjectiveTo observe the dynamic changes of neuroglobin (NGB) expression in hippocampus after status epilepticus(SE) in rats, and to explore the role of NGB in epileptic seizures.Methods40 healthy male Sprague Dawley rats were randomly divided into two group according to random number table method:control group (n=5) and epilepsy model group(n=35).Epilepsy model group according to observation time was divided into:0h, 1h, 3h, 12h, 24h, 10d and 30d.Intraperitoneal injection Lithium-pilocarpine (20 mg/kg~127 mg/kg, Li-PC) to establish the rat model of SE.Observe the behavioral changes in rats with epilepsy.Nissl staining was used to detect the neuronal damage in hippocampus. Streptavidin-biotin-peroxidase complex immunohistochemical method was used to detect the expression level of NGB in hippocampus;ResultsAfter SE, the neurons in hippocampus were severely damaged with the progress of epileptic seizures, the number of surviving neurons in CA1, CA3 regions showed a near linear decline.Among them, the number of surviving neurons in (12h, 24h, 10d, 30d)CA1, (0h, 12h, 24h, 10d, 30d)CA3 and(12h, 24h, 10d, 30d) DG area were significantly lower than that of the control group (P < 0.05).The expression level of NGB in CA1, CA3 and DG region of hippocampus were increased after SE, and both of CA1 and DG were reached peak in 24h after SE, but was still higher than the control group.And the CA3 area showed a continue rising trend.Among them, CA1(24h, 10d, 30d), CA3(24h, 10d, 30d) and DG(12h, 24h, 10d, 30d) were higher than that of control group significantly (P < 0.05).In addition, it was found that there was a positive correlation between the number of surviving neurons in CA3 area and the expression level of NGB (R=0.306, P=0.011).ConclusionUp-regulation of NGB expression in hippocampus after status epilepticus, and was positively correlated with the number of neurons in the CA3 area, suggesting that up regulation of NGB expression may be a compensatory protective mechanism of ischemic injury induced by seizures, and participate in the protection of epilepsy related neuronal damage.
ObjectiveTo systematically review the efficacy and safety of second-line medications for status epilepticus (SE). MethodsThe Cochrane Library, PubMed, EMbase, CNKI, CBM, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of second-line medications for SE from inception to May, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed using Stata 15.1 software and R 4.1.0 software. ResultsA total of 23 RCTs were included and 4 regimens were involved: levetiracetam (LEV), phenytoin/fosphenytoin (PHT), valproate (VPA), and phenobarbital (PHB). The results of network meta-analysis showed SE control rate validity sorting to be PHB>LEV>VPA>PHT, the epilepsy recurrence rate in 24 hour validity sorting to be VPA>PHB>LEV>PHT, those requiring further antiepileptic drug treatment rate validity sorting to be LEV>PHT>VPA, and drug safety security sorting to be VPA>LEV>PHT>PHB. Subgroup analysis showed PHB was optimal for SE control in children and adults, VPA had the optimal effect on other efficacy indicators in children, LEV was the safest in children and elderly patients, and VPA was the safest in adults. ConclusionsCurrent evidence suggests that PHB is the optimal for SE control, however, the safety is unsatisfactory; VPA and LEV have their own advantages in the treatment of SE, and their safety is satisfactory. VPA is recommended for adult patients, and LEV is recommended for children and elderly patients.
【摘要】 目的 探讨癫痫持续状态引起的脑部异常MRI表现的特点。 方法 回顾分析2004年—2007年5例患者由癫痫持续状态引起的脑部异常MRI表现，患者均在发作后72 h内行头颅MRI检查，常规进行了T2WI、T1WI、液体衰减反转恢复序列、弥散加权成像（diffusion-weighted imaging，DWI），同时进行了磁共振血管造影（magnetic resonance angiography，MRA）及增强扫描。 结果 5例患者均由部分性发作泛发为全面性强直-阵挛发作，均在发作后行MRI时出现明显单侧大脑半球异常表现，且与部分性发作侧相对应，在T2WI上均表现为局部皮层肿胀，呈高信号，其中3例DWI上出现皮层高信号，病灶不按脑血管分布。4例在MRA上出现病灶同侧大脑中动脉血管较对侧明显增多。5例行增强扫描后均见病灶侧脑膜明显强化。5例患者临床发作后均遗留有与MRI异常病灶相应的临床神经功能缺失。其中3例病情稳定后复查MRI，发现异常病灶及MRA完全恢复正常。 结论 癫痫持续状态引起脑部异常MRI表现特点：①常局限于大脑皮层的T2WI、DWI高信号，且病灶不按血管分布区分布；②MRA提示单侧脑血管增多；③增强扫描见单侧脑膜强化。大部分病灶可逆。这些特点可用来区别是癫痫引起的异常病灶还是脑部的致痫灶。【Abstract】 Objective To summarize the characteristics of abnormal MRI findings of brain caused by status epilepticus. Methods We retrospectively analyzed the abnormal MRI findings of brain in five patients with status epilepticus from 2004 to 2007. All of them received MRI examination within 72 hours after seizures, including the routine examination of T2WI, T1WI, FLAIR and diffusion-weighted imaging (DWI). Meanwhile, MRA and enhancement scanning were carried out. Three of them were reexamined with MRI after the disease came into a stable condition. Results All the five patients transferred from partial seizures initially to generalized tonic clonic seizures, and obvious abnormal MRI findings were detected at the unilateral cerebral hemisphere, corresponding to the side of partial seizures. They appeared regional swelling of cortex with high signal in T2WI, and three cases were found with cortex high signals in DWI, which were not distributed according to cerebral vessels. In four cases, we found that the branches of the middle cerebral artery increased markedly than the contralateral branches on the ipsilateral lesions in MRA. Enhancement scanning also showed that the meninges at the side of the lesion was strengthened significantly in five cases. The loss of neurological functions corresponding to abnormal lesions in MR remained after seizures in five cases among whom three patients recovered completely in terms of their abnormal focuses and MRA findings after their diseases came into a stable condition. Conclusions The features of abnormal brain MRI findings caused by status epilepticus are: ① High signals in T2WI and DWI are confined to the cortex, and the focuses are not distributed according to cerebral vessels; ② MRA shows that unilateral cerebral vessels increases in number; ③ Strengthened unilateral meninges can be observed in enhanced scanning and most of lesions are reversible. According the characteristics, we can distinguish the abnormal lesions caused by epilepsy from focuses in the brain causing epilepsy.
ObjectiveTo summarize the clinical phenotype, electrophysiological characteristics, imaging characteristics, surgical treatment and prognosis of Rasmussen encephalitis (RE), so as to deepen the understanding of the disease. MethodsThe clinical data of patients with RE who underwent surgical therapy from October 2014 to October 2019 at Children's Epilepsy Center in Peking University First Hospital were retrospectively reviewed. Demographic characteristics, seizure forms, electroencephalogram (EEG), cranial nuclear magnetic resonance (MRI), operative methods as well as surgical outcomes evaluated by Engel classification during follow-up of the subjects were collected and analyzed. ResultsTotally 21 pediatric patients were enrolled, including 8 males and 13 females. The age at onset was (5.0±2.0) years old, the age at the time of surgery was (6.9±2.7) years old, and the disease duration at the time of surgery was (1.7±1.3) years. Twenty (20/21, 95.2%) patients had focal motor seizures, and 10 (10/21, 47.6%) patients had 2 or 3 forms of focal motor seizures. Fifteen patients (15/21, 71.4%) had epilepsia partialis continua (EPC), which occurred (0.7±0.6) years after the onset. All patients had hemiplegia, which appeared at (0.9±0.6) years after the onset. All patients showed a slow rhythm at their affected hemispheres during the EEG monitoring and 4 of them also showed slow rhythm at the contralateral hemispheres as the disease progressed. All patients had epileptiform discharges at the involved hemisphere, and 6 patients also had independent epileptiform discharges on the contralateral side. All 21 patients underwent hemispheric disconnection. The duration of follow-up was 2 to 7 years, and all patients achieved Engel class I after the surgery. The neurological dysfunction recovered to varying degrees during the postoperative period. ConclusionRE mostly occurs around the school age. Focal motor seizures are the main manifestations and the most common onset symptoms. With the progress of the disease, the condition of patients worsened gradually. The EEG of patients was mainly characterized by broad slow wave and spike wave in the affected hemisphere. Some patients can also have bilateral involvement, which was obviously asymmetrical. Through surgical treatment, the patients all achieved good results in terms of seizures and development.
Objective To investigate the diagnosis and treatment of status epilepticus in hospitals of different levels and the knowledge of status epilepticus in clinical physicians, in order to better guide clinical education in the future. Methods From August 2014 to August 2015, a questionnaire was designed and used to investigate the general situation of the hospital, the diagnosis of status epilepticus and the clinical practice among trainee doctors and students in the epilepsy training class in the Neurological Intensive Care Unit and the Department of Neurology of West China Hospital, Sichuan University. The results of the investigation were statistically analyzed. Results Ninety questionnaires were distributed, and all the questionnaires were retrieved with validity. The number of investigated physicians was 42 (46.7%) from the Department of Neurology, 6 (6.7%) from the Department of Neurosurgery, 30 (33.3%) from the Intensive Care Unit and 12 (13.3%) from other departments. Twenty-seven (30.0%) physicians were from class Ⅲ grade A hospitals, 31 (34.4%) from class Ⅲ grade B hospitals, and 32 (35.6%) from class Ⅱ grade A hospitals. All the class Ⅲ hospitals and 53.1% of class Ⅱ hospitals had electroencephalograph monitoring facilities. The proportion of status epilepticus patients ranged from 0.5% to 10.0% in different hospitals. There were great differences in the identification and treatment of convulsive status epilepticus among different hospitals. Conclusions Status epilepticus is a common emergency. Questionnaire survey is an effective means to reflect the difference in identifying and treating the emergency among different departments and hospitals. It can guide clinical education and promote the identification and treatment of the emergency more accurately in doctors of all levels.
ObjectiveTo investigate the etiology of patients with convulsive status epilepticus (CSE).MethodsBy taking epilepsy, seizure, status epilepticus, and epileptic seizure as keywords, the clinical data of epilepsy patients hospitalized in the First People’s Hospital of Longquanyi District of Chengdu and the People’s Hospital of Leshan from January, 2012 to December, 2017 were retrospectively collected from a retrieval system for electronic patient records. The collected CSE cases were screened by trained epilepsy specialists in strict accordance with inclusion criteria and exclusion criteria. The etiology of CSE, and the pathogenetic distinctions among patients with different ages, sexes, educational levels, places of residence, and histories of epilepsy were analyzed based on medical histories and accessory examinations. The prognostic factors for epilepsy were determined using logistic regression analysis.ResultsIn this study, a total of 852 hospitalized epilepsy cases were retrieved, among which 104 cases were CSE cases aged between 18 and 86, including 75 males and 29 females. There were 13 CSE deaths (12.5%). There were significant differences in the pathogeneses among CSE patients with different ages and histories of epilepsy (χ2=52.396, 18.354; P<0.05). However, no significant difference in CSE pathogeneses was observed among patients with different sexes, educational levels, or places of residence (P>0.05). Drug withdrawal or dose reduction was the leading cause of CSE in patients with a history of epilepsy (n=28, 57.1%), while cerebrovascular diseases (n=19, 34.5%) were common causes among those without a history. Among patients aged over 65, cerebrovascular diseases (n=17, 43.6%) were determined as the major causes of CSE, while for those aged under 65, drug withdrawal or dose reduction was the main pathogeny (n=20, 30.8%). Results obtained from multivariate logistic regression analysis on the prognostic factors for epilepsy showed that the duration of epileptic seizure significantly influenced the prognosis of patients [odds ratio=1.299, 95% confidence interval (1.074, 1.571), P=0.007], while there were no significant correlations between other factors and epilepsy prognosis (P>0.05).ConclusionsCerebrovascular diseases are the leading causes of geriatric CSE. Irregular medication of epilepsy patients is a prominent avoidable trigger for CSE.