Temporal lobe epilepsy is associated with astrogliosis. Notch1 signaling can induce astrogliosis in glioma. However, it remains unknown whether Notch1 signaling is involved in the pathogenesis of epilepsy. This study investigated the presence of Notch1, hairy and enhancer of split-1, and glial fibrillary acidic protein in the temporal neocortex and hippocampus of lithium-pilocar-pine-treated rats. The presence of Notch1 and hairy and enhancer of split-1 was also explored in brain tissues of patients with intractable temporal lobe epilepsy. Quantitative electroencephalo-gram analysis and behavioral observations were used as auxiliary measures. Results revealed that the presence of Notch1, hairy and enhancer of split-1, and glial ifbrillary acidic protein were en-hanced in status epilepticus and vehicle-treated spontaneous recurrent seizures rats, but remain unchanged in the following groups:control, absence of either status epilepticus or spontaneous recurrent seizures, and zileuton-treated spontaneous recurrent seizures. Compared with patient control cases, the presences of Notch1 and hairy and enhancer of split-1 were upregulated in the temporal neocortex of patients with intractable temporal lobe epilepsy. Therefore, these results suggest that Notch1 signaling may play an important role in the onset of temporal lobe epilepsy via astrogliosis. Furthermore, zileuton may be a potential therapeutic strategy for temporal lobe epilepsy by blocking Notch1 signaling.

The automatic detection and identification of electroencephalogram waves play an important role in the prediction, diagnosis and treatment of epileptic seizures. In this study, a nonlinear dynamics index-approximate entropy and a support vector machine that has strong generalization ability were applied to classify electroencephalogram signals at epileptic interictal and ictal periods. Our aim was to verify whether approximate entropy waves can be effectively applied to the automatic real-time detection of epilepsy in the electroencephalogram, and to explore its generalization ability as a classifier trained using a nonlinear dynamics index. Four patients presenting with partial epi-leptic seizures were included in this study. They were al diagnosed with neocortex localized epi-lepsy and epileptic foci were clearly observed by electroencephalogram. The electroencephalogram data form the four involved patients were segmented and the characteristic values of each segment, that is, the approximate entropy, were extracted. The support vector machine classifier was con-structed with the approximate entropy extracted from one epileptic case, and then electroence-phalogram waves of the other three cases were classified, reaching a 93.33%accuracy rate. Our findings suggest that the use of approximate entropy al ows the automatic real-time detection of electroencephalogram data in epileptic cases. The combination of approximate entropy and support vector machines shows good generalization ability for the classification of electroencephalogram signals for epilepsy.

Temporal lobe resection is an important treatment option for epilepsy that involves removal of potentially essential brain regions. Selective amygdalohippocampectomy is a widely performed temporal lobe surgery. We suggest starting the incision for selective amygdalohippocampec-tomy at the inferior temporal gyrus based on diffusion magnetic resonance imaging (MRI) tractography. Diffusion MRI data from 20 normal participants were obtained from Parkinson’s Progression Markers Initiative (PPMI) database (www.ppmi-info.org). A tractography algorithm was applied to extract neuronal fiber information for the temporal lobe, hippocampus, and amygdala. Fiber information was analyzed in terms of the number of fibers and betweenness centrality. Distances between starting incisions and surgical target regions were also considered to explore the length of the surgical path. Middle temporal and superior temporal gyrus regions have higher connectivity values than the inferior temporal gyrus and thus are not good candi-dates for starting the incision. The distances between inferior temporal gyrus and surgical target regions were shorter than those between middle temporal gyrus and target regions. Thus, the in-ferior temporal gyrus is a good candidate for starting the incision. Starting the incision from the inferior temporal gyrus would spare the important (in terms of betweenness centrality values) middle region and shorten the distance to the target regions of the hippocampus and amygdala.

Amentoflavone is a natural biflavone compound with many biological properties, including anti-inlfammatory, antioxidative, and neuroprotective effects. We presumed that amentolfavone exerts a neuroprotective effect in epilepsy models. Prior to model establishment, mice were intragastrically administered 25 mg/kg amentoflavone for 3 consecutive days. Amentoflavone effectively prevented pilocarpine-induced epilepsy in a mouse kindling model, suppressed nu-clear factor-κB activation and expression, inhibited excessive discharge of hippocampal neurons resulting in a reduction in epileptic seizures, shortened attack time, and diminished loss and apoptosis of hippocampal neurons. Results suggested that amentolfavone protected hippocampal neurons in epilepsy micevia anti-inlfammation, antioxidation, and antiapoptosis, and then ef-fectively prevented the occurrence of seizures.

Although low-frequency repetitive transcranial magnetic simulation can potentially treat epilepsy, its underlying mechanism remains unclear. This study investigated the influence of low-frequency re-petitive transcranial magnetic simulation on changes in several nonlinear dynamic electroenceph-alographic parameters in rats with chronic epilepsy and explored the mechanism underlying repeti-tive transcranial magnetic simulation-induced antiepileptic effects. An epilepsy model was estab-lished using lithium-pilocarpine intraperitoneal injection into adult Sprague-Dawley rats, which were then treated with repetitive transcranial magnetic simulation for 7 consecutive days. Nonlinear elec-electroencephalographic parameters were obtained from the rats at 7, 14, and 28 days post-stimulation. Results showed significantly lower mean correlation-dimension and Kolmogo-rov-entropy values for stimulated rats than for non-stimulated rats. At 28 days, the complexity and point-wise correlation dimensional values were lower in stimulated rats. Low-frequency repetitive transcranial magnetic simulation has suppressive effects on electrical activity in epileptic rats, thus explaining its effectiveness in treating epilepsy.

Antiepileptic drugs are the preferred treatment approach for epileptic patients. However, informal treatment is important for intractable epilepsy. In this study, 500 epileptic patients were recruited from the General Hospital of Beijing Military Area Command of Chinese PLA during the period of October 2009 to January 2012. These involved patients that had been medical y treated for at least 1 year. Information on the initial treatment and changes to treatment regimens for each patient was col ected through questionnaires. The survey results showed that 52.3% of the epileptic patients searched for treatment after the first seizure, and the mean numbers of seizures was 12.8;59.8%of the epileptic patients were diagnosed at the first visit, and the mean onset time was 17 months after the first seizure. After diagnosis, patients were treated for an average of 20 days, and the median time was 1 day. Formal anti-epileptic drugs were selected as the first treatment regimen by 67.8%of patients, and 77.5%of these drugs were monotherapies. The mean and median numbers of seizure were respectively 36.9 and 3.0 times before the first regimen was changed. The regimen was changed within the first 6 months by 46.6% of patients, and after the first and second years of treatment, the proportions increased to 54.0%and 71.8%, respectively. In total, 78.5%of the regi-mens were changed to informal treatments. The informal treatment of epilepsy in China is common, being initiated by either patients or physicians. Enhancing epileptic treatment services in hospital, improving physicians’ professional quality, and strengthening health propaganda may promote the normalization of drug treatment of epilepsy in China.

Objective To evaluate the efficacy of electrocorticographic (ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy.
Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years (mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated.
Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I (75.00%), 5 were class II (13.89%), 2 were class III (5.56%), and 2 were class IV (5.56%), thus the total effective rate (class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes (P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes (P=0.041).
Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

Objective　To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong.Methods　Retrospective review of outpatient records.Results　1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P<0.05). Conclusion　In this local cohort of adult patients with epilepsy under specialist care, there were a considerable number of patients falling into the category of cryptogenic epilepsy. Risk factors associated with medical refractoriness are similar to previous studies.

Are there physiological and pathological convulsive thresholds in brain?

ological convulsive threshold.

外源性神经节苷脂对脑损伤的保护作用

AIM: To investigate protection function of ectogenesis ganglioside (GM1)to brain injury of epilepsy rats. METHODS: Inducing rat epilepsy model with sulfo-semicarbazide(7.5mg/kg), dynamically observe nerve growth factor (NGF) expression of epilepsy group and GM1 intervention group in Hippocampus and cerebral cortex nerve cell 24 h, 48 h, 72 h and 7 d after epileptic attack and control group after 72 h with immunohistochemistry method. At same time we observed change of nerve cell shape and structure with electron microscope techniques. RESULTS: Electron microscope showed nerve cell injury of epilepsy rats but injury relieved after GM1 intervention. CONCLUSION: GM1 play some protective function to brain injury of epilepsy rats through induced NGF expression increase.

石杉碱－甲治疗小儿语言发育迟缓

AIM:To investigate the efficacy of huperzine A in treating child language delay and its side effects.METHODS:37 children with language delay and other developmental diseases from pediatric neurology out- patient department, who did not undergo any language rehabilitation,were treated with huperzine A 50 μ g bi- daily for more 3 months and then the efficacy and side effects observed.The follow- up was arranged to record the efficacy monthly.RESULTS:37 cases of 40 had undergone the whole course and the total efficiency was 68% (25/37). Language developments of other 12 cases were not improved significantly.Other 3 children were not included in because epilepsy were observed among them.CONCLUSION:This pilot trial result suggests that huperzine A has efficacy on child language delay but should be investigated further.Huperzine A may trigger seizure of language delay patients with epilepsy.

小儿精神发育迟滞合并癫痫的治疗

Objective To investigate the effective management approaches for mental retardation plus epilepsy in children.Method Sodium valproat[15～ 60 mg/（ kg· day)] or nitrazepam[0.5～ 1 mg/（ kg· day） ] and guanmaishu containing hyoscyamine(0.0045～ 0.045 mg/（ kg· day)] as adjuvant were administered for 1.5～2 consecutive years.EEG,three dimensional Doppler ultrasonic examination of cerebral vessels were performed.Result Favorable therapeutic effect was obtained in 25 cases(48.1％ ),good effect in 12 cases(23.1％ ).Conclusion Favorable therapeutic effect of hyoscyamine in epilepsy is correlated with improved cerebral microcirculation,cortical choline receptor blocking ,reduced conduction between synapses.These factors all inhibit onset of epilepsy.

Background: Epilepsy associated with Prader-Willi syndrome (PWS) represents an early and important complication, often not clearly reported and described in the literature. Consequently, there are controversial data about the clinical characteristics of epilepsy and electroencephalographic (EEG) abnormalities found in these patients.
Data sources: Based on recent original publications, we have reviewed the different types of seizures and EEG findings in PWS patients, the response to antiepileptic treatment, and the prognosis of epilepsy.
Results: The frequency of epilepsy in PWS patients ranges from 4% to 26%. The types of seizure include generalized tonic-clonic seizures, complex partial seizures, atypical absence, staring spells, and myoclonic, tonic and hemiclonic seizures, but the most frequent type is focal epilepsy. Status epilepticus has never been reported. EEG abnormalities are not typical but variable in different patients. However, generalized and focal discharges are the most frequently reported findings. There is no evidence of relationship between the course of epilepsy and frequency, morphology and spread of EEG discharges. However, epilepsy in PWS patients is usually responsive to antiepileptic monotherapy with rapid seizure control and a good outcome.
Conclusions: The frequency of epilepsy is higher in PWS patients than in general populations and this complication can be a challenge for the clinicians of these patients. Prospective studies are needed to confirm the good long-term prognosis.

Objective: To investigate the effects of epileptic discharges in sleep of epileptic patients on sleep-breath events. Methods: Polysomnograph (PSG) and long-term video electroencephalogram (LTVEEG) were used to monitor 82 adult epileptic patients. The condition of paroxysmal events in nocturnal sleep was analyzed, and the epileptiform discharge and effects of antiepileptic drugs were explored. Results: In epileptic group, latency to persistent sleep (LPS) and REM sleep latency increased, the proportion of light sleep increased while that of deep sleep decreased, sleep efficiency reduced, nocturnal arousal times increased and apnea hyponea indexes (AHI) improved, which demonstrated significant differences by comparison to control group. Periodic leg movements (PLM) had no conspicuous differences compared with control group. There were no speciifc effects of epileptiform discharge and antiepileptic drugs on AHI and PLM indexes. Conclusion: Epileptic patients have sleep structure disorders and sleep-disordered breathing, and arousal, respiratory and leg movement events inlfuence mutually. Synchronous detection of PSG combined with LTVEEG is in favor of comprehensively analyzing the relationship between sleep structures and epilepsy-breath events.