- Email: [email protected]
29. Impaired VEP after photostress in migraine patients between attacks
Society Proceedings / Clinical Neurophysiology 126 (2015) e1–e28
tion with integrated NMUS-EMG facilitates pediatric neuromuscular diagnosis, improving spatial resolution with limited costs and invasivness. doi:10.1016/j.clinph.2014.10.044
26. A newborn with transient giant sep revealed during a seizure by an integrated neurophysiological monitoring—S. Lori, E. Molesti, S. Gabbanini, M. Bastianelli, G. Bertini, C. Dani (Firenze, Italy) The role of ElectroEncephaloGraphy (EEG) and SomatosensoryEvoked-Potentials (SEP) in Neonatal as well as Adult-ICU is validated. To evaluate brain-functions in newborns with high risk of encephalic damage we also proposed an Integrated Multiparametric-Neurophysiological-Assessment (IMNA) simultaneously recording VEEG, CFM, Density-Spectral-Analisys and SEPs. We describe the case of a term-newborn (Apgar- Index 6–9, pH 7,03) in which an 1-h-IMNA was performed at 24 h from birth, to best define the encephalic damage. Results:An early encephalic ultrasound study showed only poor evidences. During IMNA baby incidentally presented short episodes of tonic–clonic motions of left arm. These clinical signs were associated with short right emispheric EEG hypovoltages while the cascade-SEPs monitoring showed a sudden transient change in voltage: right giant SEPs traces simultaneous to seizures. After phenobarbital administration seizures stopped and the right SEPs traces return to normality. An early encephalic MRI showed a right parietal ischemic lesion and also a right extracerebral hemorrhagic injury. The latest one appeared reduced in a further MRI. No further seizures were reported. 1 h-IMNA monitoring, especially cascade-SEPs, is a useful tool to perform an early evaluation and assess prognosis of neonatal hypoxic brain damage; it also allows to correlate neurophysiological parameters? trends to clinical events. doi:10.1016/j.clinph.2014.10.045
27. Prognostic role of spectral analysis of the EEG in premature infants—M. Sole, E. Cainelli, A. Cappellari, P.S. Bisiacchi, A. Suppiej (Padova, Italy) Brain maturation at early stages may be assessed by changes in spectral power frequencies of electroencephalogram (EEG) (Scher et al., 1997), but their predictive value for later outcome remains poorly understood. The aim of this study is to correlate neonatal spectral power values with developmental scores obtained at one year in infants born premature. EEG was recorded on twenty infants (23–34 weeks) at 35 post-conceptional weeks. In order to minimize handling, one bipolar channel (C3-C4) was recorded. Data were transformed into frequency domain using a Fast Fourier Transformation algorithm and divided in delta (0.5–4 Hz), theta (4–8 Hz), alpha (8–13 Hz) and beta (13–30 Hz) bands. As infants attained 12 months corrected age they underwent the Griffiths Mental Development Scales. Relative spectral power values recorded in the neonatal period were correlated with developmental scores. Relational skills and personal self autonomies sub-scale score correlated negatively with delta (r = .60, p = .01) and positively with beta (r = .64, p = .007) and alpha (r = .63, p = .006) power values. Data on minor impairments in premature infants indicate a great incidence of psychiatric disorders later in life (Bhutta et al., 2002); the association of neonatal spectral power values with Griffith’s scores suggests a possible prognostic role of EEG spectral analysis in neonates born prematurely. doi:10.1016/j.clinph.2014.10.046
e7
28. Monitoring in neonatal hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: Comparison of multichannel, two-channel and amplitude integrated EEGs—E. Toffoli, F. Scarabel, M. Agatiello, A. Suppiej (Padova, Italy) This study aimed to compare seizure detection by means of multichannel standard EEG with two simplified monitoring methods (amplitude integrated-aEEG and two-channel C3-C4-EEG), in neonatal hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia, since in this aetiology of neonatal seizures the issue has not yet been specifically addressed. Blind identification of seizure activity by three independent researchers was done on 100 h of multichannel EEG, C3-C4-channels EEG and aEEG traces obtained from 11 different neonates. 147 seizures were detected by multichannel EEG inspection; 75% of seizures were detected by aEEG, 97% by two- channel EEG. Furthermore, 10 sequences of paroxysmal activity on C3-C4 channels EEG and 12 notches on aEEG were mistakenly classified as seizures. One patient with HIE complicated by stroke had 4 occipital seizures: none was recognized on aEEG, only 1/4 with forward diffusion was recognized by two-channel EEG. In the subgroup of neonatal seizures occurring in HIE undergoing hypothermic treatment two-channel EEG performed better, as seizure detector, than aEEG; both methods showed false positives. Multichannel EEG had an added value especially in identification of seizures outside the parasagittal sites suggesting occurrence of stroke. doi:10.1016/j.clinph.2014.10.047
29. Impaired VEP after photostress in migraine patients between attacks—G. Coppola, D. Di Lenola, M. Bracaglia, G. Di Ciaccia, C. Di Lorenzo, M. Serrao, V. Parisi, F. Pierelli (Roma, Italy) Subtle impaired macular vision was observed among different psychophysical experimental tasks in migraine. Here we studied visual evoked potential (VEP) after photostress (PS) representing an objective index of the dynamic properties of macular performance after exposure to intense light stimulation. We recorded VEPs in basal condition and after PS in 43 migraineurs patients (19 with and 24 without aura) and 14 healthy volunteers (HV). We compared P100 implicit time and N75-P100 amplitude of baseline VEP with those collected every 20 s up to 200 s after PS. In HV, N75-P100 amplitude significantly decreased 20 s after PS, and recovered subsequently. There was no effect in the migraine groups. In fact, the percentage reduction in N75-P100 amplitude observed at 20s after photostress in MO and MA patients were lower than in HV (MO vs HV P < 0.05, MA vs HV P < 0.05). In migraine, the percentage of amplitude change at 20 s was negatively correlated with number of days since the last migraine attack (r = 0.525, p = 0.02). We documented altered recovery after PS under the influence of imminent attack. Whether present VEP findings are related to the ictal/interictal migraineur susceptibility to abnormal sensory perception, such as visual discomfort, remains to be determined. doi:10.1016/j.clinph.2014.10.048
30. Vestibular evoked myogenic potentials in healthy subjects: C-VEMPs and O-VEMPs standard recording—R. Del Colle, M. Turazzini, S. Olivato, L. Bevacqua, A. Polo (Legnago, VR, Italy) Vestibular-evoked myogenic potentials (VEMPs) have been recorded from tonically contracted neck muscles by acoustic and galvanic stimulation or forehead tap (cervical VEMPs, c-VEMPs). VEMPs can also be recorded from extraocular muscles, using the same stimuli. (ocular VEMPs, o-VEMPs). The aim of our study was
tion with integrated NMUS-EMG facilitates pediatric neuromuscular diagnosis, improving spatial resolution with limited costs and invasivness. doi:10.1016/j.clinph.2014.10.044
26. A newborn with transient giant sep revealed during a seizure by an integrated neurophysiological monitoring—S. Lori, E. Molesti, S. Gabbanini, M. Bastianelli, G. Bertini, C. Dani (Firenze, Italy) The role of ElectroEncephaloGraphy (EEG) and SomatosensoryEvoked-Potentials (SEP) in Neonatal as well as Adult-ICU is validated. To evaluate brain-functions in newborns with high risk of encephalic damage we also proposed an Integrated Multiparametric-Neurophysiological-Assessment (IMNA) simultaneously recording VEEG, CFM, Density-Spectral-Analisys and SEPs. We describe the case of a term-newborn (Apgar- Index 6–9, pH 7,03) in which an 1-h-IMNA was performed at 24 h from birth, to best define the encephalic damage. Results:An early encephalic ultrasound study showed only poor evidences. During IMNA baby incidentally presented short episodes of tonic–clonic motions of left arm. These clinical signs were associated with short right emispheric EEG hypovoltages while the cascade-SEPs monitoring showed a sudden transient change in voltage: right giant SEPs traces simultaneous to seizures. After phenobarbital administration seizures stopped and the right SEPs traces return to normality. An early encephalic MRI showed a right parietal ischemic lesion and also a right extracerebral hemorrhagic injury. The latest one appeared reduced in a further MRI. No further seizures were reported. 1 h-IMNA monitoring, especially cascade-SEPs, is a useful tool to perform an early evaluation and assess prognosis of neonatal hypoxic brain damage; it also allows to correlate neurophysiological parameters? trends to clinical events. doi:10.1016/j.clinph.2014.10.045
27. Prognostic role of spectral analysis of the EEG in premature infants—M. Sole, E. Cainelli, A. Cappellari, P.S. Bisiacchi, A. Suppiej (Padova, Italy) Brain maturation at early stages may be assessed by changes in spectral power frequencies of electroencephalogram (EEG) (Scher et al., 1997), but their predictive value for later outcome remains poorly understood. The aim of this study is to correlate neonatal spectral power values with developmental scores obtained at one year in infants born premature. EEG was recorded on twenty infants (23–34 weeks) at 35 post-conceptional weeks. In order to minimize handling, one bipolar channel (C3-C4) was recorded. Data were transformed into frequency domain using a Fast Fourier Transformation algorithm and divided in delta (0.5–4 Hz), theta (4–8 Hz), alpha (8–13 Hz) and beta (13–30 Hz) bands. As infants attained 12 months corrected age they underwent the Griffiths Mental Development Scales. Relative spectral power values recorded in the neonatal period were correlated with developmental scores. Relational skills and personal self autonomies sub-scale score correlated negatively with delta (r = .60, p = .01) and positively with beta (r = .64, p = .007) and alpha (r = .63, p = .006) power values. Data on minor impairments in premature infants indicate a great incidence of psychiatric disorders later in life (Bhutta et al., 2002); the association of neonatal spectral power values with Griffith’s scores suggests a possible prognostic role of EEG spectral analysis in neonates born prematurely. doi:10.1016/j.clinph.2014.10.046
e7
28. Monitoring in neonatal hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: Comparison of multichannel, two-channel and amplitude integrated EEGs—E. Toffoli, F. Scarabel, M. Agatiello, A. Suppiej (Padova, Italy) This study aimed to compare seizure detection by means of multichannel standard EEG with two simplified monitoring methods (amplitude integrated-aEEG and two-channel C3-C4-EEG), in neonatal hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia, since in this aetiology of neonatal seizures the issue has not yet been specifically addressed. Blind identification of seizure activity by three independent researchers was done on 100 h of multichannel EEG, C3-C4-channels EEG and aEEG traces obtained from 11 different neonates. 147 seizures were detected by multichannel EEG inspection; 75% of seizures were detected by aEEG, 97% by two- channel EEG. Furthermore, 10 sequences of paroxysmal activity on C3-C4 channels EEG and 12 notches on aEEG were mistakenly classified as seizures. One patient with HIE complicated by stroke had 4 occipital seizures: none was recognized on aEEG, only 1/4 with forward diffusion was recognized by two-channel EEG. In the subgroup of neonatal seizures occurring in HIE undergoing hypothermic treatment two-channel EEG performed better, as seizure detector, than aEEG; both methods showed false positives. Multichannel EEG had an added value especially in identification of seizures outside the parasagittal sites suggesting occurrence of stroke. doi:10.1016/j.clinph.2014.10.047
29. Impaired VEP after photostress in migraine patients between attacks—G. Coppola, D. Di Lenola, M. Bracaglia, G. Di Ciaccia, C. Di Lorenzo, M. Serrao, V. Parisi, F. Pierelli (Roma, Italy) Subtle impaired macular vision was observed among different psychophysical experimental tasks in migraine. Here we studied visual evoked potential (VEP) after photostress (PS) representing an objective index of the dynamic properties of macular performance after exposure to intense light stimulation. We recorded VEPs in basal condition and after PS in 43 migraineurs patients (19 with and 24 without aura) and 14 healthy volunteers (HV). We compared P100 implicit time and N75-P100 amplitude of baseline VEP with those collected every 20 s up to 200 s after PS. In HV, N75-P100 amplitude significantly decreased 20 s after PS, and recovered subsequently. There was no effect in the migraine groups. In fact, the percentage reduction in N75-P100 amplitude observed at 20s after photostress in MO and MA patients were lower than in HV (MO vs HV P < 0.05, MA vs HV P < 0.05). In migraine, the percentage of amplitude change at 20 s was negatively correlated with number of days since the last migraine attack (r = 0.525, p = 0.02). We documented altered recovery after PS under the influence of imminent attack. Whether present VEP findings are related to the ictal/interictal migraineur susceptibility to abnormal sensory perception, such as visual discomfort, remains to be determined. doi:10.1016/j.clinph.2014.10.048
30. Vestibular evoked myogenic potentials in healthy subjects: C-VEMPs and O-VEMPs standard recording—R. Del Colle, M. Turazzini, S. Olivato, L. Bevacqua, A. Polo (Legnago, VR, Italy) Vestibular-evoked myogenic potentials (VEMPs) have been recorded from tonically contracted neck muscles by acoustic and galvanic stimulation or forehead tap (cervical VEMPs, c-VEMPs). VEMPs can also be recorded from extraocular muscles, using the same stimuli. (ocular VEMPs, o-VEMPs). The aim of our study was