ASE 2008:世界各地造成癫痫的非感染性病因越来越多


  December 19, 2008(西雅图)-神经学专家看到比以前更多的感染与寄生虫疾病,同时面临到治疗癫痫的挑战,这显然是使人困惑的用词。为了讨论这项议题,5位专家学者最近于AES 2008美国癫痫医学会(AES)第62届年会上联合发表这项议题。
  
  这个由国际对抗癫痫联盟组织的小组,提供与会代表世界各地非感染病因的总览以及给予治疗建议。
  
  【脑囊虫感染是癫痫的常见病因】
  秘鲁利马Peruana Cayetano Heredia大学的Hector Hugo医师以及知名的神经脑囊虫研究团队于这项座谈会中发表;神经脑囊虫据报是开发中国家癫痫的常见原因。Garcia医师指出,该状况的研究提供了了解癫痫机转一个独特的机会,以及之后可能改变的方向。
  
  Alberta Calgary Foothills医疗中心的资深共同主席Samuel Wiebe医师向Medscape神经学与神经外科学表示,这些状况中,大多数不只可以治疗的,还可以预防;在降低世界各地癫痫负担上有绝佳的潜力。
  
  Garcia医师建议,神经学专家应该先治疗癫痫症状,并在病患状况获得控制后考虑使用抗原虫药物;抗原虫药物应该仅用于原虫还活著时,但状况经常不是这样。
  
  另一位发表者、中国抗癫痫协会理事长Shichuo Li医师讨论到中枢神经系统感染以及对于癫痫上的角色越来越重;Li医师列举了这些感染症在国际上增加的模式以及与癫痫的整体负担有关。他来自北京大学,并且在世界卫生组织担任许多职务。
  
  【AIDS与癫痫】
  来自乌干达坎帕拉Makerere大学的Angeina Kakooza-Mwesige医师发表癫痫在AIDS与HIV上的背景;据估计,有30%罹患HIV与AIDS的病患发生癫痫。Mwesige医师表示,因为受到影响的病患很多,因此在医疗照护上的应用很大。
  
  她指出,全世界每天约有7,400件新感染病例,其中1,000件是年龄低于15岁的儿童,绝大部分在非洲,约占68%,剩下的32%则是在其它区域。
  
  她表示,治疗正在服用抗病毒药物病患的癫痫是很复杂的,且这进一步受到非洲许多地方无法取得这些药物的限制,让医师只有比较老一代的选择。
  
  Mwesige医师在会议上表示,社会经济上的意义对病患来说也是困难的;有癫痫也感染HIV的病患,同时罹患了两种令人蒙羞的状况,大部分病患会告诉他们的另一半他罹患了HIV与癫痫,但他们要同时处理这两种状况是不容易的。
  
  【疟疾与癫痫】
  来自肯尼亚Kilifi肯尼亚医学研究机构的Charles Newton教授也在这个会议上发表,他描述疟疾与癫痫之间的关系。
  
  他指出,估计有20亿人口每年暴露在疟疾之下;Newton教授表示,这是个对健康照护影响很大的问题,因为疟原虫具有可能引发癫痫的潜力,这应该被审慎看待;疟原虫是造成人类疟疾的病原虫。
  
  Wiebe医师在访谈中表示,早期诊断与治疗对于预测可能会影响神经学后遗症的人来说,也将是有益的。
  
  国家神经异常与中风临床癫痫部门主任William Theodore医师描述其它神经感染也可能在癫痫上扮演部分角色,这些神经感染包括脑膜炎与脑炎。
  
  Theodore医师列出了这些感染促进癫痫发作的机转,同时描述了定义这些机转的努力,以分子角度来看,就是这些特定病毒如何克服身体的防御机转且与标的细胞作用。
  
  世界卫生组织已经将神经感染列为主要可预防、可治疗的癫痫病因;专家们建议公共卫生措施,例如改善公共卫生、教、诊断及治疗,还有接种疫苗计画。
  
  Wiebe医师附带表示,在这个领域上的治疗指引很少。这对于神经学家来说更是困难。Wiebe医师是对抗癫痫国际联盟北美委员会的一员,且希望在AES上的这个呼吁可以唤起大家的注意。
  
  研究者表示没有相关资金上的往来。

AES 2008: Neuroinfections Growing Cause of Epilepsy Worldwide

By Allison Gandey
Medscape Medical News

December 19, 2008 (Seattle, Washington) — Neurologists are seeing more infectious and parasitic disorders than ever before, and many are facing the challenge of treating epilepsy in the context of what might appear to be mystifying symptomatology. To discuss this issue, a panel of 5 world experts presented at the recent AES 2008: the American Epilepsy Society (AES) 62nd Annual Meeting.

Cochairs Marco Medina and Samuel Wiebe in front with presenters behind ?Hector Hugo Garcia, Angelina Kakooza-Mwesige, and Charles Newton.
Cochairs Marco Medina and Samuel Wiebe in front with presenters behind ?Hector Hugo Garcia, Angelina Kakooza-Mwesige, and Charles Newton.

The group, organized by the International League Against Epilepsy, provided delegates an overview of neuroinfections around the world and offered insight on treatment.

Neurocysticerosis Leading Cause of Epilepsy

Hector Hugo Garcia, MD, from the Universidad Peruana Cayetano Heredia, in Lima, and the well-known neurocysticerosis working group in Peru, presented during the session. Neurocysticerosis is reportedly the leading cause of epilepsy in the developing world. Dr. Garcia pointed out that study of such conditions provides a unique opportunity to understand the mechanisms of epilepsy and ways they might eventually be altered.

"Many of these conditions are not only treatable, but preventable," session cochair Samuel Wiebe, MD, from the Foothills Medical Centre, in Calgary, Alberta, told Medscape Neurology & Neurosurgery. "There is great potential to reduce the burden of epilepsy around the world."

Dr. Garcia recommended that neurologists treat the symptoms of epilepsy first and consider anti-parasitic agents only after the patient is well controlled. "Anti-parasitics should only be used if the parasite is still alive," he emphasized, "and often this is not the case."

Among the other presenters was Shichuo Li, MD, president of the Chinese Association Against Epilepsy. Dr. Li is from Beijing University and has held various positions with the World Health Organization. He discussed central nervous system infections and their growing role in epilepsy. Dr. Li outlined the way these infections are increasing internationally and contributing to the global burden of epilepsy.

AIDS and Epilepsy

Angelina Kakooza-Mwesige, MD, from Makerere University, in Kampala, Uganda, presented on seizures in the context of HIV and AIDS. An estimated 30% of people with HIV or AIDS develop seizures. Dr. Mwesige said that given the number of people affected, the healthcare implications are enormous.

Worldwide, she said, there are 7400 new HIV infections a day, 1000 of these in children younger than 15 years. Most of these cases — 68% — are in Africa and the remaining 32% occur in the rest of the world.

Treating epilepsy in patients on antiretroviral agents is complex, she noted, and further complicated by the lack of access to drugs in many parts of Africa, leaving physicians with only older-generation options.

The social implications are also difficult for patients, Dr. Mwesige told the meeting. "HIV patients who also have epilepsy have 2 highly stigmatizing conditions. Most patients are more comfortable telling their loved ones they have epilepsy than HIV, but they have both to deal with and it is hard."

Malaria and Seizures

Prof. Charles Newton, from the Kenya Medical Research Institute, in Kilifi, also presented at the meeting. He described the link between malaria and epilepsy.

An estimated 2?billion people are exposed to malaria each year, he said. It is a problem with enormous healthcare implications and, given the epileptogenic potential of plasmodium falciparum, should be taken very seriously, Prof. Newton noted. Plasmodium falciparum is a cause of malaria in humans.

"Early diagnosis and treatment are important and efforts to predict who may develop neurological sequelae will also be helpful," Dr. Wiebe added during an interview.

William Theodore, MD, chief of clinical epilepsy at the National Institute of Neurological Disorders and Stroke, described other neuroinfections that can play a role in epilepsy, such as meningitis and encephalitis.

Dr. Theodore outlined the epileptogenic mechanisms of these infections and described efforts to define, on a molecular level, how certain viruses overcome the body's defense mechanism and interact with target cells.

The World Health Organization has recognized neuroinfections as the leading preventable, treatable cause of epilepsy worldwide. Experts are recommending public-health measures, such as improved sanitation, education, diagnosis and treatment, and vaccination programs.

"There are very few treatment guidelines in this area," Dr. Wiebe added. "This makes it difficult for neurologists." Dr. Wiebe is part of the North American Commission of the International League Against Epilepsy and hopes talks such as the one at the AES will raise awareness.

The researchers have disclosed no relevant financial relationships.

AES 2008: American Epilepsy Society 62nd Annual Meeting. Presented December 8, 2008.

    
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