| Objective:1.In the clinical aspect,to enrich the clinical data of brain function by a retrospective study of the EEG characteristics of 500 children with TD.2.In the experiment,adopted the small animal MRI scanning system to study the volume changes of striatum and globus pallidus of TS rats induced by IDPN to explore the relationship between the changes of brain structure and the pathogenesis of TS,so as to provide further neuroimaging evidence for Jian-Pi-Zhi-Dong Decoction in anti twitch.Methods:1.Clinical research:Selected the medical records of 500 children with TD from May 2013 to December 2018 in the pediatric outpatient department of Dongfang hospital of Beijing University of Chinese Medicine,record the age of onset,age of treatment,gender,course of disease,TD type,TCM syndrome type,YGTSS score,etc.Excel 2013 and spss20.0 software were used to analyze the data.2.Experimental study:Thirty-two male SD rats were randomly divided into 4 groups according to their body weight after adaptive feeding for 1 week,which were blank control group,model group,Thiopril hydrochloride group and Jian-Pi-Zhi-Dong Decoction group,8 rats in each group.The model group,Thiopril hydrochloride group and Jian-Pi-Zhi-Dong Decoction group were intraperitoneally injected with IDPN,250 mg/kg/d,and the blank control group were intraperitoneally injected with normal saline once a day for 7 consecutive days.After successful modeling,the blank control group and model group were gavaged with normal saline(10 ml/kg/d),the Tiapride group was gavaged with tiapride hydrochloride suspension(21 mg/kg/d),and the Chinese herbal group were gavaged with Jian-Pi-Zhi-Dong Decoction(16 mg/kg/d),respectively for four weeks.Behavioral test were carried out on the first day after model establishment and on the 4 weeks after dosing.After 4 weeks administration,under the condition of continuous anesthesia with isoflurane,the rats in each group were examined by high field MR spectroscopy scanner,and T2W1 images were obtained,and the volume of striatum was analyzed by VBM.Results:1.Clinical research:?among the 500 cases included in the study,the ratio of male to female was 4.3:1,the average age of onset was(6.59±2.29)years,and the average age of treatment was(8.83±3.04)years.The course of disease was less than 1 year in 190 cases,1-3 years in 171 cases,and more than 3 years in 139 cases.The mean YGTSS score was(23.50±11.01).There were 228 children with TS,195 with TTD,and 77 with CTD.In TCM syndromes,there are 44 cases of Gankangfengdong syndrome type,1 case of Waifengyindong syndrome type,11 cases of Tanhuoraoshen syndrome type,8 cases of Pixutanju syndrome type,2 cases of Yinxufengdong syndrome type,434 cases of Pixugankang syndrome type.?The total abnormal rate of EEG was 16.8%(including abnormal EEG and boundary EEG).The boundary EEG showed irregular ? wave,poor rhythm and paroxysmal ? activity.The abnormal EEG mainly showed the increase of slow wave or ? activity,the poor formation of ?wave,the difference of ? wave adjustment and amplitude modulation,the increase of ?activity power,the suspected scattered high amplitude spike slow wave or high amplitude sharp wave,epileptiform discharge,the paroxysmal high amplitude spike slow wave or paroxysmal high amplitude slow wave.Most of the abnormal brain waves occurred in the temporal,parietal,central and anterior head regions,accounting for 41.70%,22.61%in each channel,and 4.76%in the parietal and occipital regions.? There was no significant difference in electroencephalogram(EEG)between TD children of different genders(P>0.05).? There was a certain correlation between the EEG results and the course of disease(P<0.05),that is,the longer the course of disease,the greater the possibility of abnormal EEG.? There was significant difference in EEG results of TD children with different Western Medicine Types(P<0.05).The abnormal rate of EEG in TS children was significantly higher than that in TTD children(P<0.01).? There was no difference in electroencephalogram(EEG)between TD patients with different TCM syndromes(P>0.05).? The abnormal degree of EEG was related to YGTSS score(P<0.05).Compared with other groups,the YGTSS score of normal EEG group was significantly lower than that of abnormal EEG group(P<0.01)2.Experimental study:? Compared with the model group,the score of stereotyped exercise in Jian-Pi-Zhi-Dong Decoction group decreased(P<0.05);compared with the model group and Tiapride group,the score of stereotyped exercise in Jian-Pi-Zhi-Dong Decoction group and tiapride group was no significant difference(P>0.05).? After modeling,the weight of rats in Jian-Pi-Zhi-Dong Decoction group,Tiapride hydrochloride group and model group was significantly lower than that in the blank control group(P<0.01),and there was no significant difference between the three groups(P>0.05).? After 4 weeks of gavage,there was no significant difference in the mean gray matter volume of striatum between the four groups(P>0.05).There was no significant difference in pallidoid volume between the four groups(P>0.05).There was no significant difference in caudate putamen volume between the four groups(P>0.05).Conclusion:1.Clinical research:As a means of exclusion examination,there is no need for regular reexamination of EEG in children with TD.The longer the course of disease,the more likely the abnormal EEG will appear.The more serious the convulsion is,the more likely the EEG is to be abnormal.2.Experimental study:Jian-Pi-Zhi-Dong Decoction can reduce the excitability of central nervous system in model rats.Intraperitoneal injection of IDPN can make the weight development of rats lower than that of normal rats.Jian-Pi-Zhi-Dong Decoction failed to significantly improve the striatum volume of TS rats.At present,the neuroimaging mechanism of Jian-Pi-Zhi-Dong Decoction significantly reducing the stereotypical motor score of TS rats is not clear.Some TS rats were found to have hydrocephalus on MRI,but not all the rats receiving IDPN were found to have hydrocephalus.Therefore,futher study is needed to explore the neuroimaging basis of the tic behavior of rats caused by IDPN. |
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