愈痫灵颗粒对癫痫患者(GTCS)认知功能障碍及生活质量的影响
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摘要
[目的]观察愈痫灵颗粒对癫痫患者认知功能障碍及生活质量的影响。
     [方法]选择符合诊断和纳入标准的病例61例,按照Doll's临床随机表法分为治疗组(YXLG组)30例、对照组(VPA组)31例;治疗组给予愈痫灵颗粒,对照组给予丙戊酸钠治疗,疗程3个月,以事件相关电位(P300)、《韦克斯勒成人智力量表中国修订本,WAIS-RC》、癫痫患者生活质量调查问卷-31及癫痫积分评估61例癫痫患者(GTCS)治疗前后P300潜伏期及波幅、智商、生活质量及癫痫发作控制情况,探讨愈痫灵颗粒有改善患者认知功能障碍和生活质量的影响。
     [结果]①事件相关电位(P300):癫痫患者P300潜伏期明显延长(P<0.01),提示癫痫患者存在认识功能障碍;愈癫痫灵颗粒能改善癫痫患者的认知功能障碍(P<0.01),丙戊酸纳不能改善癫痫患者认知功能障碍(P>0.05)。②智力测试:愈癫痫灵颗粒有改善癫痫患者智商的作用(P<0.01),丙戊酸纳组治疗后癫痫患者智商降低(P<0.05),提示愈癫痫灵颗粒可提高癫痫患者智商,丙戊酸纳不能改善癫痫患者智商。③癫痫患者生活质量量表:愈痫灵颗粒组及丙戊酸纳组患者生活总积分明显提高(P<0.01),愈癫痫灵颗粒与丙戊酸钠改善癫痫患者生活质量作用优于丙戊酸钠组(P<0.05)。④癫痫积分:治疗和对照组治疗后两组癫痫计分积分均有明显降低(P<0.01),组间比较差异无统计学意义(P>0.05),提示愈癫痫灵颗粒与丙戊酸钠均可有效控制癫痫发作且二者疗效相当;
     [结论]①与正常成人相比较,癫痫患者P300潜伏期延长,FIQ低于正常,癫痫患者存在认知功能障碍。②愈痫灵颗粒可以改善癫痫患者的认知功能障碍。③愈痫灵颗粒可改善癫痫患者生活质量,且疗效优于丙戊酸钠。
[Objective] To observe influence of Yuxianling Granula on cogntive dysfunction and quality of life in patients with epilepsy (GTCS)
     [Method] Choose 61 available cases according to the diagnosis, and divide them into two groups under the Doll's clinical random table method. One group is the treatment group (YXLG group), and the other is comparative group (VPA group), YXLG group has 30 cases, VPA group has 31 cases. The treatment group uses Yuxianling Gran-ula, and the comparative group uses VPA. Both Courses of the treatments are there months Observing separately influence of Yuxianling Granula on P300 latency、FIQ and quality of life in patients with epilepsy (GTCS),try to exploring that Yuxianling Granula have the effect of improving Cognitive dysfunction and Qualityof Life.
     [Results] 1 Compared with the Normal group, the P300 latency and ampfily epilepsy,two group has greet sense in statistics (P<0.01).The comparative in the group:the P300 latency epilepsy of before and the after has greet sense in statistics (P<0.01), the YXLG group clinical effect better than the comparative group.The comparative between the groups:after three months treatment, two group has sense in statistics (P<0.05).The comparative in the group and the comparative between the groups after three months treatment,the P300 ampilfy has no sense in statistics (P>0.05).2 The FIQ of IQ the comparative in the group:the FIQ of IQ of before and the after has greet sense in statistics (P<0.01).3 QOLIE-31 the comparative in the group:the table of QOLIE-31 of YXLG group before and the after has greet sense in statistics (P<0.01). the table of QOLIE-31 of VAP group before and the after has sense in statistics (P<0.05) the compa-rative between the groups:after three months treatment, the table of QOLIE-31 of life of the two group has no sense in statistics (P<0.01), two group clinical effect has no different. The comparative betw-een the groups:after three months treatment, the table of intractable epilepsy of life of the two group has no sense in statistics (P>0.05), two group clinical effect has no different. The comparative between the groups:after three months treatment, the table of intractable epilepsy of life of the two group has sense in statistics (P<0.05), the effect YXLG group on Cognitive dysfunction better than the VPA group.4 The table of intractable epilepsy the comparative in the group:the table of intractable epilepsy of before and the after has greet sense in statistics (P<0.01)
     [Conclusion] 1 Compared with the Normal group, the P300 latency and ampfily epilepsy of Patients with epilepsy exist cognitive dys-function; 2 YXLG can improve cognitive dysfunction in patients with epilepsy 3 YXLG can improve quality of life in patients with epilepsy,and the effect YXLG group on Cognitive dysfunction better than the VPA group.
引文
[1]ILAE Commission Report The epidemiology of the epilepsies:future directions Epilepsia 1997.38(5):614-618.
    [2]解孔.癫痫病学[M],第一版北京:人民卫生出版社,1995:245-254.
    [3]Mac TL,Tran D S,Quet F,et al.Epidemiology,aetiology,and clinical manage-ment of epilepsy in Asia a systematic review[J].Lancet Neurol,2007,6:533~543.
    [4]吴逊.抗癫痫药可以导致发作频率增加.中华神经科杂志.2001;34(3):162.
    [5]Chen R C,Sai S Y,Chang Y C, et al.Seizure frequency affects event-related potentials(P300)in epilepsy[J].JClin Neurosci,2001,8(5):442~446.
    [6]孙伟,王薇薇,吴逊.妥泰引起严重认知障碍[J].中国康复理论与践,2005,11(5):402~403.
    [7]洪震,黄茂盛,王蓓.癫痫患者的认知功能状况分析[J].临床神经理杂志,2002,13:88~90.
    [8]刘娟,高丽.儿童癫痫认知障碍研究进展[J].实用诊断与治疗杂志,2008,(1):45~48.
    [9]张渺,刘南平,杨丽.癫痫儿童事件相关电位P300与认知学习能力的相关分析[J].宁夏医学院学报,2008,30(1):28-30.
    [10]Leung LS,Boon KA,Kaibara T,Innis NK.Radial maze performance following hippocampal kindling. Behav Brain Res,1990,40(2):119~129.
    [11]陈湛惜,陈文荣,莫仕文.情感障碍对癫痫患者认知障碍影响的事件相关电位研究[J].中国实用神经疾病杂志,2009,12(15):1-4.
    [12]林玳.抗癫痫药物的几个安全性问题[J].中国药业,2008,18(6):62-63.
    [13]索军芳,王浙东,吉永春,等.丙戊酸钠单药治疗首诊癫痫患儿的P300短期变化分析[J].医学研究与教育,2009,26(3):29-30,35.
    [14]Lee S,Sziklas V,Andermann F,et Al.The effect of adjunctive topiramate on cognitive function in patients with epilepsy[J].Epilepsia,2003,44(3):339~347.
    [15]王净净,李振光,邓元江,等.愈痫灵方抗癫痫作用临床研究[J].中国医师杂志,2001,3(11):821-823.
    [16]王净净,邓元江,顾星,等.治痫灵对实验性癫痫大鼠的作用[J].湖南中医学院学报1999,19(4):12-14.
    [17]王净净,李振光,钟艳,等.愈痫灵颗粒剂对癫痫大鼠脑组织氨基酸神经递质含量的影[J].中医药学刊,2002,20(3):308-310.
    [18]任晓琳,梁平,刘雪琴.癫痫患者生活质量量表-31中文版的翻译及修订[J].解放军护理杂志,2003,(04):99-101.
    [19]李智雄,尹烨,谢静涛,等.愈痫灵颗粒对戊四氮致痫大鼠海马CA3区超微结构与认知功能障碍的影响[J].湖南中医药大学学报,2009,29(3)17~20.
    [19]刘雪琴,任晓琳,周谷兰,等.癫痫患者生活质量-31量表的信度和效度[J].中华神经医学杂志,2003,2(2):106-9.
    [20]Besag FM. Childhood epilepsy in relation to mental handicap and behavioural disorders[J].J Child Psychol Psychiatry,2002,43(1):103~131.
    [20]陈子怡,周列民,孙星海,等.癫痫患者的认知功能损害及其独立危险因素分析[J].中国神经精神疾病志.2006,32(2):146-149.
    [21]Elger CE,Helmstaedter C,Kurthen M.chronic epilepsy and cognition[J]. Lancet Neurol,2004,3(11):663.
    [22]Gulgonen S,Demirbilek V,Korkmaz B,et al.Neuropsychological functions in idiopathic occipital lobe epilepsy[J]. Epilepsia,2000,41(4):405~411.
    [23]Culhane-Shelburne K,Chapieski L,Hiscock M,et al.Executive functions in children with frontal and temporal lobe epilepsy[J]. J Int Neuropsychol Soc,2002,14(5):623~32.
    [24]Bergin PS,Thompson PJ,Baxendale SA,et al.Remote memory in epilepsy [J].Epilepsia,2000,41(2):231~298.
    [25]朱丹彤,杨晓苏,金丽娟.颞叶癫痫与认知功能[J].现代康复,2001,5(12):54-55.
    [26]Feasey-Truger KJ,Kargl L,ten Bruggencate G. Differential effects of dentate kindling on working and reference spatial memory in the rat[J]. Neurosci Lett, 1993,151(1):25~28.
    [27]Chen Y,Chow J.Lee I.Comparison the cognitive effect of antiepilepticdrugs in seizure-free children with epilepsy before and after drug with drawal[J]. Epilepsy Res,2001,44(1):65~70.
    [28]Jones J E, Herman B P,Bany JJ,et al.Rates and risk factors for suicide suicidal ideation,and suicide attempts In chronic EPileps.EPilePsyBehavl,2003,4:531~533.
    [29]Choi-kwon,Chung C,Kim H Et al.Faetors affectting the quality of life in Patients with ePilePsy inSeoul,South Korea.Acta Neurol Seand,200308(6):428-434.
    [30]车春晖,黄品华,郑安.癫痈患者生活质量的研究.中国神经精神疾病杂志,2005,31(3):185-187.
    [31]黑川彻.癫病患者的生活质量.日本医学介绍,1998,19(9):411-413.
    [32]Cramer J A Quality of life assessment in clinical practice.Neurology 1999;53(5 suppl2):S49-52.
    [33]Kang HC.Eun BL.Wu Lee C,et al. The effects on cognitive function and beha-viorral problems of topiramate compared to carbamazepine as monotherapy for children with benign rolandic epilepsy. Epilepsia JT-Epilepsia,2007,48(9): 1716-1723.
    [34]Gomer B, Wagner K,Frings L,et al. The influence of anti-epileptic drugs on cognition:a comparison of levetiracetam with topiramate. Epilepsy Behav JT-Epilepsy & behavior:E&B,2007,10(3):486-94.
    [35]Brown ES,Frol AB,Khan DA,et al. Impact of levetiracetam on mood and cognition during prednisone therapy. Eur Psychiatry JT-European psychiatry the journal of the Association of European Psychiatrists,2007,22(7):448-52.
    [36]Meador KJ. Cognitive and memory effects of the new antiepileptic drugs. Epilepsy Res JT-Epilepsy research,2006,68(1):63-7.
    [37]贺娟,马师蕾.反复惊厥和大剂量抗痫药对大鼠海马pCREB的影响及草果知母汤的干预作用[J].中国中西医结合杂志,2007,27(9):819-821.
    [38]裴林,李佃贵,娄燕,等.调肝解毒方对慢性癫痫大鼠学习记忆及海马组织环磷酸腺苷反应元件结合蛋白表达的影响[J].中医杂志,2007,48(3):265.
    [39]李振光,王净净.从瘀治痫理论基础及机理的研究摄要[J].中医药学刊,2001,19(4):323~324.
    [40]李进安,朱百科,王净净.癫痫认知功能障碍的中医病因病机探析[J].中医药导报,2007,13(3):12-14.
    [41]朱百科,王净净.单味中药抗痫作用的实验研究进展[J].中医药导报,2008,14(7):110~112.
    [42]朱百科.王净净,单昧中药抗痫作用的实验研究进展,湖南中医药报,2008,14(7):13-14.
    [43]樊双义,谌小维,樊宏孝,等.冰片对长时连续作业大鼠觉醒能力及认知功能的影响[J].药物不良反应杂志,2006,8(2):101-103.
    [44]李树蕾,杨立彬,黄艳智,等.中药石菖蒲及其主要成分α-细辛醚对癫痫幼鼠惊厥行为及脑电图的影响[J].吉林大学学报(医学版),2006,32(1):74~76.
    [45]马艳喜,角建瓴,刘承宜,等.石菖蒲水提取液及挥发油对淀粉样p蛋白25-35二级结构的影响[J].中国病理生理杂志,2007,23(2):352-355.
    [46]彭延古,李露丹,雷田,等.僵蚕抗凝成分对血小板聚集的抑制效应[J].血栓与止血学,2007,13(2):78-79.
    [47]韩琳,汤道权.α-细辛脑的抗惊厥、抗癫痫作用研究[J].井冈山医专学报2009,16(6):9-10,15.
    [48]李天富,罗玉敏,吕传真.杏仁核注射KA诱导的边缘叶发作致海马神经元凋亡及黄芩苷干预研究[J].中国神经科学杂志,2003,19(6)395-400.
    [1]Mac TL,Tran DS,Quet F,et al.Epidemiology, aetiology, and clinical management of epilepsy in Asia:a systematic review[J].Lancet Neurol,2007,6:533~543.
    [2]张渺,刘南平,杨丽.癫痫儿童事件相关电位P300与认知学习能力的相关分析[J].宁夏医学院学报,2008,30(1):28-30.
    [3]王凌霄,苗玲.癫痫患者认知功能障碍45例临床分析[J].上海交通大学学报(医学版),2007,27(10):1261-1264.
    [4]刘娟,高丽.儿童癫痫认知障碍研究进展[J].实用诊断与治疗杂志,2008,(1):45-48.
    [5]张渺,刘南平,杨丽,等.癫痫儿童事件相关电位P300与认知学习能力的相关分析[J].宁夏医学院学报,2008,30(1):28-30.
    [6]王湘庆,郎森阳,毛燕玲,等.癫痫患者认知功能损害及其影响因素分析[J].卒中与神经疾病,2006,13(5):273.
    [7]王湘庆,郎森阳,陆虹,等.癫痫患者磁共振弥散张量成像及其与智能损害的关系[J].中华神经科杂志,2007,40(1):31-35.
    [8]朱百科,李智雄,王净净,等.愈痫灵颗粒对戊四氮致痫大鼠水迷宫成绩的影响[J].临床神经电生理学杂志,2010,19(1):826-828.
    [9]杨娟,黄祖春,脑诱发电位在癫痫方面的研究进展.实用医学杂志,2007,23(15):2292~2294.
    [10]Sutton S, Braren M, Zubin J, et al. Evoked-potential correlates of stimulus uncertainty[J]. Science,1965,150(700):1187~1188.
    [11]Steven J.Luck著,范思陆,丁玉珑,曲折,等译.事件相关电位基础[M].第1版.上海:华东师范大学出版社,2009:33-35.
    [12]魏景汉,罗跃嘉.认知事件相关脑电位教程[M].第1版.北京:经济日报出版社,2002:204-212.
    [13]姚静,王-洪明,舒放,等.事件相关电位P300与认知功能测定的相关性[J].中国神经精神疾病杂志,2005,31(1):66-67.
    [14]Tandon OP,Duhan P.Event-related evoked potential responses in epileptic patients[J].Indian J Physiol Pharmacol,2000,44(4):461~466.
    [15]车春晖,黄华品,郑安.癫痼患者听觉事件相关电位的改变和影响因素[J].福建医科大学学报,2006,40(3):295-297.
    [16]Gokcay A,Celebisoy N,Gokcay F,et al. Cognitivfunctions evaluated by P300 and visual and auditory number assays in children with childhood epilepsy with occipital paroxysms (cEOP) [J]. Seizure,2006,15(1):22~27.
    [17]Nicolai J,Aldenkamp AP,Arends J,et al.Cognitive and behavioral effects of nocturnal epilepticform discharges in children with benign childhood epilepsy with centrotemporal spikes[J].Epilepsy Behavior,2006,8(1):66~70.
    [18]Van Boqaert P,Aeby A,De Borchqrave V,et al.The epileptic syndromes with continuous spikes and waves during slow sleep:definition and management guidelines[J].Actr Neurol Belg,2006,106(2):52~60.
    [19]Tremmel L,Hohmann M,Schmidt MH,et al.Do subclinical epilcptiform discharges really affect short-term memory in children?[J].z Kinder Juqendpsychiatr Psychother,2006,34(2):139~148.
    [20]李丽君.癫痫儿童事件相关电位P300检测报告.临床神经电生理学杂志,2006,15(6):345-346.
    [21]Celebisoy N,Kisabay A,Gokcay F,et al. Evaluating cognitive functions with visual and auditory number assays and P300 in children with epilepsy[J].Brain Dev,2005,27(4):253~258.
    [22]Chen RC,Tsai S Y,Chang YC,et al.Seizure frequency affects event-related potentials(P300)in epilepsy[J]J Clin Neurosci,2001,8(5):442~446.
    [23]孙伟,王薇薇,吴逊.妥泰引起严重认知障碍[J].中国康复理论与实践,2005,11 (5):402~403.
    [24]Turkdogan D,Us O,Akyuz GI.Visual and auditory event related potentials in epileptic children:a comparison with normal and abnormal MRI findings[J].Brain Dev,2003,25(6):396~400.
    [25]陈湛惜,陈文荣,莫仕文.情感障碍对癫痫患者认知障碍影响的事件相关电位研究[J].中国实用神经疾病杂志,2009,12(15):1-4.
    [26]周铃,陶爱华.癫痫患者听觉事件相关电位的检测报告[J].临床神经电生理学杂志,2006,15(3):160.
    [27]Sclysal A,Atakli D,Atay T,et al.Auditory eventrelated potentials(P300)in partial and generalized epileptic patients[J].Seizure,1999,8(2):107~110.
    [28]Caravaglios G,Natale E,Ferraro G,etal.Auditory event-related potentials(P300)in epileptic patients[J].Neurophysiol Clin,2001,31(2):121~ 129.
    [29]Wambacq I,Abubakr A.Auditory event-related Potentials(P300)in the identification of psychogenic non-epileptic seizures [J]. Epilepsy Behav,2004,5(4):503~508.
    [30]Abubakr A, Wambacq L.The localizing value of auditory eventrelated potentials (P300) in patients with medically intractable temporal lobe epilepsy[J].Epileps, Behay,2007,4(6):692~701.
    [31]陈湛惜,陈逢俭,王志海,等.癫痫患者情感障碍和认知功能障碍的关系及其影响因素的研究[J].医学研究杂志,2008,37(8):37-41.
    [32]Kutas M,Hillyard Reading senseless sentences:brain potentials reflect semantic incongruity[J].Scienee,1980,207(4427):203~205.
    [33]潘灏,罗跃嘉.事件相关电位与癫痫患者的认知功能[J].立体定向和功能性神经外科杂志,2008,21(5):316-319.
    [34]Kutas M, Iragui V. The N400 in a semantic categorization task across 6 decade[J]. Electroencephalogr ClinNeurophysiol,2008,8(5):456~471.
    [35]Olichney JM,Riggins BR,Hillert DG,et al.Reduced sensitivity of the N400 and late positive component to semantic congruity and word repetition in left temporal lobe epilepsy[J].Clin Electroencephalogr,2002,33(3):111~118.
    [36]Miyamoto T,Katayama JI,Kohsaka M,et al.Disturbance of semantic processing in temporal lobe epilepsy demonstrated with scalp ERPs[J].Seizure,2006,9(8):572~579.
    [37]Grunwald T,Lehnertz K,Pezer N,et al.Prediction of postoperative seizure control by hippocampal event-related potentials[J].Epilepsia,1999,40(3):303~306.
    [38]陈兴时,唐云翔,肖泽,等.首发精神分裂症患者N400神经发生源的研究[J].上海交通大学学报(医学版),2009,29(11):1351-1354.
    [39]陈显光,何文贞,林兰.癫痫患者事件相关电位N400的研究[J].现代医药卫,2007,23(12):1744-1745.
    [40]陈璇,周曙,刘忆星,等.30例脑梗死患者的事件相关电位N400变化[J].广东医学,2009,30(9):1271-1273.
    [41]陈兴时,张明岛,陈冲,等.46例正常成人事件相关脑电位N400实验研究[J].神经病学与神经康复学杂志,2007,4(3):156-159.
    [42]张载福,陈兴时.事件相关脑电位研究新进展——N400[J].现代电生理学杂志,2008第15(4):241-250.
    [43]肖爱娇,庄剑青.年龄和性别对伴随负电位的影响[J].临床神经电生理学杂志,2009,18(1):37-40.
    [44]Walter WG, Cooper R, Aldridge VJ, et al. Contingent negative variation: an electric sign of sensorimotor association and expentancy in the human brain[J].Nature,1964,203:380~384.
    [45]魏景汉,罗跃嘉.认知事件相关脑电位教程[M].第1版.北京:经济日报出版社,2002:8-29.
    [46]Hamano T,Luders HO,Ikeda A,et al.The cortical generators of the contingent negative variation in humans:a study with subdural electrodes[J].Electroencephalogr Clin Neurophysiol,1997,104(3):257~268.
    [47]Vein AM,Vorob'eva OV. A neurophysiologieal model ofthe "paroxysmal brain" (cerebral mechanisms in the genesis of paroxysmal states)[J].Vestn Ross Akad Med Nauk,1998,(8):32~36.
    [48]张志杰,尹华站,黄希庭.时间知觉和关联负变化[J].心理科学进展,2007,15(2):308~312.
    [49]Bender S, Weisbrod M, Resch F, et al.Stereotyped topography of different elevatedcontingent negative variation com ponents in children with migraine without aura points towards a subcortical dysfunction[J].Pain,2007,127:221~233.
    [50]Naatanen R,Gaillard AW,M antysalo S.Early selective attention effect on evoked potential reinterpreted[J].Acta Psyehol(Amst),1978,42(4):313~329.
    [51]李玲,郑健.事件相关电位某些成分在神经精神疾病中的临床研究及应用[J].临床神经电生理学杂志,2007,16(5):304-308.
    [52]Kane NM,Butler SR,Sim pson T.Com a outcome predictionusing event-related potentials:P3 and mismatch negativity[J].Audiol Neurotol,2000,5:186~191.
    [53]Gene-Cos N,Pottinger R,Barrett G,et al.A comparative study of mismatch negativity(MN)in epilepsy and non-epileptic seizures[J].Epileptic Disord,2005,7(4):363~372.
    [54]Lin YY, Hsiao FJ, Shih YH, et al. Plastic Phase-locking and Magnetic MismatchResponse to Auditory Deviants in Temporal Lobe Epilepsy[J].Cereb Cortex,2007,17(11):2516~2525.
    [55]Honbolygo F,Csepe V,Fekeshazy A,et al.Co nverging evidences on language impairment in Landau—Kleffner Syndrome revealed by behavioral and brain activity measures:a case study [J].Clin Neurophysiol,2006,117(2):295~305.

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