最终版-神经系统常见疾病及用药.ppt

乙酰胆碱受体 * 目前对于癫痫的治疗强调单药治疗的原则，70%-80%左右的癫痫患者可以通过单药治疗控制发作。如果一种一线药物已达最大可耐受剂量仍然不能控制发作，可加用另一种一线或二线药物，至发作控制或最大可耐受剂量后逐渐减掉原有的药物，转换为单药。从较小的剂量开始，缓慢加量直至发作控制或最大可耐受剂量。 * * Slide 9: The cholinergic deficit in AD underlies the clinical symptomatology Acetylcholine (ACh) is needed in sufficient amounts for maintaining proper neurotransmission. Reduction in ACh is the most predominant neurotransmitter deficit found in AD. The progressive loss of ACh available for neurotransmission has been correlated with the cognitive deficits found in AD patients (Perry et al.,1978). These findings have led to the formulation of the cholinergic hypothesis of AD (Bartus et al., 1982), which proposes that the cognitive deficits of AD are related to the observed decrease in central cholinergic activity and that increasing intrasynaptic ACh could enhance cognitive function and clinical well being. Furthermore, cholinergic deficits in the limbic and paralimbic structures may contribute to the development of certain behavioural abnormalities seen in AD (Cummings and Back, 1998). * In this test, the patient is asked to draw a clock face depicting a specified time: in this example, 2:45. The drawing is then rated on a scale of 10 to 1, with 10 being an accurate and well-organized depiction and 1 being an incoherent or uninterpretable scribbling. Two studies found clock drawing to be highly correlated with several independent global measures of dementia severity. It is also very well accepted by patients. Although clearly not diagnostic, clock drawing affords a convenient screening tool when sophisticated neuropsychologic testing is not available. It is especially helpful in the primary care setting in identifying patients who may require further cognitive assessment. In assessing the drawings, the clinician should apply the following criteria: Normal: The hands are in the correct position in a score of 10. Mild impairment: Compared with an accurate rendering of a clock showing a time of 2:45, er