目的 評估國際抗癲癇聯盟（ILAE）耐藥癲癇定義專家共識在發展中國家、發展中地區應用的可行性及應用中存在的問題。 方法 2010年12月9日－2011年2月18日，連續登記癲癇專科門診患者409例。共納入183例患者，根據ILAE耐藥癲癇新定義對每位納入患者癲癇分類進行評估。 結果 耐藥癲癇患者18例（8.7%），臨床治愈患者29例（14.1%），不能判斷為159例（77.2%）。入組患者共涉及癲癇藥物治療方案321項。根據ILAE定義步驟一分類為不確定的治療方案共有199項（62.00%），其中數量最多的為服藥劑量＜50% WHO限定日劑量有157例（78.89%）。 結論 由于治療劑量未能夠達到國際統一標準，大量患者分類不明確，使得該共識應用面臨巨大挑戰，但目前為止該共識對于發展中地區耐藥癲癇治療有很強的指導促進意義，對未來耐藥癲癇的早期識別有非常大的應用潛力。
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 summarize the clinical features of and prognosis factors for spontaneous intracranial hypotension (SIH). MethodsWe continuously registered hospitalized patients diagnosed with SIH from December 1st, 2010 to February 1st, 2014. Etiology information and clinical features were collected at the first day of admission. Routine blood test and lumbar puncture were done as soon as possible. Every patient got position and fluid infusion therapy. During the one-week follow-up, headache level was evaluated with Visual Analogue Scale (VAS). ResultsThere were 110 patients included, and among them, 39(35.5%) were male and 71(64.55%) were female. The age of onset was between 17 and 91 years old with a mean onset age of (42.0±12.4). Besides postural headache, common signs were nausea (68 cases, 61.8%), vomiting (63 cases, 57.3%), dizziness (40 cases, 36.4%), neck pain (27 cases, 24.5%), and tinnitus (23 cases, 20.9%). VAS at baseline was (7.46±0.86), and at the last follow-up, VAS was (3.45±2.17), with an average improvement of 53.75%. Patients with ANA marker positive had better prognosis. ConclusionSIH can accompany serious brain stem and cerebellum signs, and even meningeal irritation. Cerebrospinal fluid (CSF) changes are similar to virus infection with negative serum virus screening. If CSF leak cannot be found on imaging, patients can improve through fluid infusion therapy and postural treatment.