认知功能损害是癫的不良后果之一。影响癫认知功能的因素很多,其中抗癫药物（AED）作为癫治疗的主要手段，它对认知功能的影响备受临床医生关注。我们采用随机对照、单药治疗的方法探讨新诊断成人部分性癫患者在用药前额叶相关认知功能的改变及AED对其影响，以便在控制癫发作的同时尽可能减少AED对认知功能的影响。

Purpose: To quantify changes in ictal seizure semiology during rapid withdrawal of carbamazepine (CBZ) and valproate (VPA) from a monoregimen in presurgical evaluation. Methods: Therapeutic intensive seizure analysis (TISA) with video-EEG monitoring was used in 33 patients with armacoresistant partial epilepsy undergoing complete withdrawal of CBZ (20 patients) or VPA (13 patients) from a monoregimen. Monitoring phases included a 3-day baseline phase, a 3-day rapid antiepileptic drug (AED) withdrawal phase, and another 3-day AED-free phase with AEDs in subtherapeutic levels. Seizure variables as complete processes and their various elements (ictal signs) were analyzed, including duration (seconds), intensity (on a scale of 0 to 3), frequency (number per 3 days), and total duration of seizures and ictal signs in 3 days (seconds). The localization of seizure patterns on ictal EEG recording (EEG seizure onset) and the first appearing clinical ictal phenomena (initial ictal signs) were recorded. Results: A total of 188 seizures in the CBZ group and 57 seizures in the VPA group were investigated. Compared with the baseline phase, the CBZ group showed increases in duration, frequency of seizures, various ictal signs, and secondarily generalized tonic and clonic signs during the following two phases. Significantly increased values of the VPA group were observed in seizure duration and frequency of hypermotoric phenomena during the AED-free phase. More patients in the CBZ group had secondarily generalized clonic signs during the AED-free phase. EEG seizure onset and initial ictal signs showed no obvious changes between study phases. Conclusions: Withdrawal of CBZ is followed more quickly by an increase of seizure frequency and severity than is the case for VPA withdrawal. Both CBZ and VPA withdrawal influences seizure propagation rather than the seizure-onset characteristics, which speaks in favor of its use in presurgical evaluation.

耐药性癫约占癫患者的30%，耐药癫动物模型是研究其耐药机制和探讨治疗方法的重要工具。马桑内酯（coriarialactone, CL）是从植物马桑中提取的一种致物质,对动物反复肌注阈下剂量的CL可以建立化学点燃模型，并具有一定的耐药性[1]。P-糖蛋白（P-glycorprotein,P-gp）和多药耐药相关蛋白1（multidrugresistance-associatedprotein1,MRP1）是近年在耐药性癫患者脑组织中发现的两种与耐药性产生相关的膜蛋白[2,3]。我们通过建立大鼠CL点燃模型,观察其对卡马西平（carbamazopine, CBZ）、丙戊酸钠（valproate, VPA）及托吡酯（topiramate, TMP）等抗癫药物（AED）的治疗反应和大鼠脑部P-gp和MRP1的表达，探讨该模型的耐药性及其可能机制。

目的探讨代谢性谷氨酸受体1α（MGLUR1α）在马桑内酯（CL）点燃致癫模型大鼠脑组织不同区域表达的差异。方法　35只雄性SD大鼠随机分为对照组（n=5,大鼠予1.0ml/kg生理盐水肌注）和3个不同剂量CL点燃致癫模型组（分别予0.75、1.0、1.25ml/kg马桑内酯提取液肌注）。分别对点燃、未点燃、对照组大鼠行皮层脑电图描记、取脑组织作HE和MGLUR1α的免疫组化染色,观察MGLUR1α在脑组织不同区域的表达。结果点燃组大鼠在肌注马桑内酯后产生了1～5级的痫性发作，与皮层脑电图的表现相一致。MGLUR1α在点燃组大鼠海马以及海马以外的颞叶皮质的表达较之未点燃和对照组增强（P<0.05），这种表达的增强在神经元与神经胶质细胞间未发现有明显的差异。结论MGLUR1α在点燃大鼠海马和海马以外的颞叶皮质的表达较之未点燃和对照组增强，可能参与了癫痫的发生。

目的观察丙戊酸钠、托吡酯诱导癫患者体重及血清瘦素水平的变化。方法40例女性癫患者按年龄、体重指数分层匹配进入丙戊酸钠、托吡酯治疗组,每组20例。在治疗前及治疗3个月后分别测定身高、体重及早晨空腹血清瘦素水平。结果9例经丙戊酸钠治疗者体重增加（≥4kg），血清瘦素水平[（13.2±3.6）ng/ml]高于治疗前[（7.4±3.0）ng/ml,P<0.01]；6例托吡酯治疗者体重减轻（≥4kg），血清瘦素水平[（3.7±1.8）ng/ml]低于治疗前[（7.4±2.6）ng/ml,P<0.01]。结论经丙戊酸钠治疗体重增加者出现瘦素抵抗，经托吡酯治疗体重减轻者血清瘦素水平降低。