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Combining evoked potentials and EEG reactivity for coma prognosis
Abstracts/Résumés interpreted as an abnormal study that supports the diagnosis of periodic paralysis. Summary/conclusion.— McManis Test is a useful tool for evaluating patients under suspicion of periodic paralysis even though it does not distinguish between those with high, normal or low potassium levels. http://dx.doi.org/10.1016/j.neucli.2013.10.018 18
Correction of neurometabolic disturbances in epileptic brain by repetitive transcranial magnetic stimulation V. Kistsen a , V. Evstigneev a , A. Belevich b , R. Sakovich c a Belarusian Medical Academy of Postgraduate Education, Neurology and Neurosurgery Department, Belarus, Russia b Institute of traumatology, Belarus, Russia c Minsk hospital, Belarus, Russia Introduction.— Repetitive transcranial magnetic stimulation (rTMS) is a perspective method to reduce seizures at resistant epilepsy. Mechanisms of rTMS action are active researched. Objective.— The study was designed to evaluate the neurometabolic effect of single and ten sessions of low-frequency repetitive transcranial magnetic stimulation over temporal lobe of epileptogenic hemisphere. Methods.— Twenty-four patients with resistant epilepsy (mean age 28.1 ± 2.9 years) were enrolled in a prospective single-blind, randomized study [sham (n = 12) vs real (n = 12)]. RTMS (1 Hz, 20% MMI intensity of ring coil, 546 impulses) was performed during ten minutes over the temporal lobe projection with ‘‘focusing’’ over hippocampus. Hippocampal brain regions bilaterally were investigated by multi-voxel proton magnetic resonance spectroscopy (1H-MRS) before and after rTMS. Than patients has a complex therapy with rTMS course. Diffusion tensor MRI was performed for all patients. Results.— Normalization of NAA/Cho + Cr after single rTMS was registrated at 50% of patients at real rTMS group (p%3C0.05). Our results showed a significant reduction of seizure frequency after real 10 rTMS sessions that lasted for at least 3 monthes following treatment patients (p%3C0.05). These clinical changes were correlated with increases in NAA/Cho + Cr ratio in the ipsilateral hippocamp region after single rTMS session (r = 0.7, P = 0.037) and with normal tractography picture at frontal lobe with unaffected of brain commissures (r = 0.8, P = 0.009). We found a positive correlation between increases NAA/Cho + Cr ratio levels after rTMS at hippocampus and remission of epilepsy after complex therapy (r = 0.67, P = 0.05). For the sham group, there were no any significant changes in NAA/Cho + Cr ratio levels (p%3E0.1). Conclusions.— New technology of low-frequency rTMS delivered into temporal lobe leads to significant antiepileptic effect at patients with resistant epilepsy. That effect correlate with neurometabolic effect in deep brain regions and can predict course of epilepsy after complex therapy with low-intensity rTMS. http://dx.doi.org/10.1016/j.neucli.2013.10.019 19
Combining evoked potentials and EEG reactivity for coma prognosis C. Buisson , M. Duclaux , E. Hofmann , O. Reynier , D. Savarino , L. Garcia-Larrea Laboratory of neurosensory electrophysiology, Neurology Department, Regional Hospital of Valence, Drame, France
319 The assessment of coma prognosis with short-latency EPs is now part of routine examination in most university hospitals, while the combined study of short- and long-latency responses remains restricted to very few of them. Here, we review results in 71 consecutive comatose patients (62% anoxic) studied with short- and long-latency EPs combined with EEG reactivity in a non-university hospital. Were assessed — auditory I-V, Na-Pa and N100 vertex potential; — somatosensory N9, P14 and N20 responses; — and EEG reactivity to auditory and somatic stimuli. The results confirm the ominous prognosis associated with bilateral absence of cortical responses N20 and Pa, and a fortiori of brainstem responses, whatever the coma aetiology. Preservation of short-latency EPs does not have a positive predictive value, and was followed by death or PVS in one third of the cases. Conversely, presence of both short- and long-latency responses (N20 + Pa + N100) had a strong positive predictive value for awakening from coma if they were associated with a reactive EEG (85% of awakening). N100 and EEG reactivity were strongly associated; their dissociation (N100 present but non-reactive EEG) was followed in 6% of cases by a vegetative or minimally conscious state. Unilateral suppression of somatosensory N20, with preservation of all other responses was associated with sensorimotor handicap on awakening. This study underscores the prognostic usefulness of neurophysiological assessment of coma, and shows its feasibility in non-university hospitals. The 85% predictive value for awakening in patients with N100 plus reactive EEG stresses the importance of associating the two measures for improving prognosis, despite interpretative difficulties when using sedative drugs at high-doses. Quantifying EEG reactivity using spectral analysis could significantly improve its predictive value, and even replace more sophisticated and difficultto-implement measures such as MMN or P300. http://dx.doi.org/10.1016/j.neucli.2013.10.020 20
Impairment of autonomic nervous system in Parkinson’s disease and its modulation V. Izura a,c , J. Martin b,c , M.T. Herrero c Hospital Universitario Virgen de la Arrixaca, Servicios de Neurofisiologia, Universidad de Murcia, Murcia, Spain b Neurologia, Universidad de Murcia, Murcia, Spain c Clinical and Experimental Neuroscience (NiCE-CIBERNED), Universidad de Murcia, Murcia, Spain
a
Objectives.— — to study dysautonomia in patients with PD, its progression, and effect of treatment with L DOPA; — to design two simple protocols that can be used in clinical routine. Background.— PD is a multisystemic process, which affects the ANS. Degeneration in PD has a stereotyped and topographical sequence. Deposits of alpha-synuclein have been observed in central and peripheral nuclei of the ANS even in pre-symptomatic stages. Dysautonomia negatively affects the quality of life of patients. Early diagnosis will help select the most suitable treatment and help establish differential diagnosis. Methods.— Fifty healthy subjects and 50 patients suffering PD were studied. Exclusion criteria included reasons and treatments altering autonomic function. Tests were carried out in ON patients. PD patients were divided into 3 groups according time of evolution and into 2 groups according treatment: with or without L-DOPA. Hoehn %26 Yahr stage was also analyzed. To study the sympathetic function, the cutaneous-skin response (CSR) was used, and to study the parasympathetic function, heart rate variability (HRV) at rest, deep breathing (6 cycles/min), and Valsalva’s maneuver. Time
Correction of neurometabolic disturbances in epileptic brain by repetitive transcranial magnetic stimulation V. Kistsen a , V. Evstigneev a , A. Belevich b , R. Sakovich c a Belarusian Medical Academy of Postgraduate Education, Neurology and Neurosurgery Department, Belarus, Russia b Institute of traumatology, Belarus, Russia c Minsk hospital, Belarus, Russia Introduction.— Repetitive transcranial magnetic stimulation (rTMS) is a perspective method to reduce seizures at resistant epilepsy. Mechanisms of rTMS action are active researched. Objective.— The study was designed to evaluate the neurometabolic effect of single and ten sessions of low-frequency repetitive transcranial magnetic stimulation over temporal lobe of epileptogenic hemisphere. Methods.— Twenty-four patients with resistant epilepsy (mean age 28.1 ± 2.9 years) were enrolled in a prospective single-blind, randomized study [sham (n = 12) vs real (n = 12)]. RTMS (1 Hz, 20% MMI intensity of ring coil, 546 impulses) was performed during ten minutes over the temporal lobe projection with ‘‘focusing’’ over hippocampus. Hippocampal brain regions bilaterally were investigated by multi-voxel proton magnetic resonance spectroscopy (1H-MRS) before and after rTMS. Than patients has a complex therapy with rTMS course. Diffusion tensor MRI was performed for all patients. Results.— Normalization of NAA/Cho + Cr after single rTMS was registrated at 50% of patients at real rTMS group (p%3C0.05). Our results showed a significant reduction of seizure frequency after real 10 rTMS sessions that lasted for at least 3 monthes following treatment patients (p%3C0.05). These clinical changes were correlated with increases in NAA/Cho + Cr ratio in the ipsilateral hippocamp region after single rTMS session (r = 0.7, P = 0.037) and with normal tractography picture at frontal lobe with unaffected of brain commissures (r = 0.8, P = 0.009). We found a positive correlation between increases NAA/Cho + Cr ratio levels after rTMS at hippocampus and remission of epilepsy after complex therapy (r = 0.67, P = 0.05). For the sham group, there were no any significant changes in NAA/Cho + Cr ratio levels (p%3E0.1). Conclusions.— New technology of low-frequency rTMS delivered into temporal lobe leads to significant antiepileptic effect at patients with resistant epilepsy. That effect correlate with neurometabolic effect in deep brain regions and can predict course of epilepsy after complex therapy with low-intensity rTMS. http://dx.doi.org/10.1016/j.neucli.2013.10.019 19
Combining evoked potentials and EEG reactivity for coma prognosis C. Buisson , M. Duclaux , E. Hofmann , O. Reynier , D. Savarino , L. Garcia-Larrea Laboratory of neurosensory electrophysiology, Neurology Department, Regional Hospital of Valence, Drame, France
319 The assessment of coma prognosis with short-latency EPs is now part of routine examination in most university hospitals, while the combined study of short- and long-latency responses remains restricted to very few of them. Here, we review results in 71 consecutive comatose patients (62% anoxic) studied with short- and long-latency EPs combined with EEG reactivity in a non-university hospital. Were assessed — auditory I-V, Na-Pa and N100 vertex potential; — somatosensory N9, P14 and N20 responses; — and EEG reactivity to auditory and somatic stimuli. The results confirm the ominous prognosis associated with bilateral absence of cortical responses N20 and Pa, and a fortiori of brainstem responses, whatever the coma aetiology. Preservation of short-latency EPs does not have a positive predictive value, and was followed by death or PVS in one third of the cases. Conversely, presence of both short- and long-latency responses (N20 + Pa + N100) had a strong positive predictive value for awakening from coma if they were associated with a reactive EEG (85% of awakening). N100 and EEG reactivity were strongly associated; their dissociation (N100 present but non-reactive EEG) was followed in 6% of cases by a vegetative or minimally conscious state. Unilateral suppression of somatosensory N20, with preservation of all other responses was associated with sensorimotor handicap on awakening. This study underscores the prognostic usefulness of neurophysiological assessment of coma, and shows its feasibility in non-university hospitals. The 85% predictive value for awakening in patients with N100 plus reactive EEG stresses the importance of associating the two measures for improving prognosis, despite interpretative difficulties when using sedative drugs at high-doses. Quantifying EEG reactivity using spectral analysis could significantly improve its predictive value, and even replace more sophisticated and difficultto-implement measures such as MMN or P300. http://dx.doi.org/10.1016/j.neucli.2013.10.020 20
Impairment of autonomic nervous system in Parkinson’s disease and its modulation V. Izura a,c , J. Martin b,c , M.T. Herrero c Hospital Universitario Virgen de la Arrixaca, Servicios de Neurofisiologia, Universidad de Murcia, Murcia, Spain b Neurologia, Universidad de Murcia, Murcia, Spain c Clinical and Experimental Neuroscience (NiCE-CIBERNED), Universidad de Murcia, Murcia, Spain
a
Objectives.— — to study dysautonomia in patients with PD, its progression, and effect of treatment with L DOPA; — to design two simple protocols that can be used in clinical routine. Background.— PD is a multisystemic process, which affects the ANS. Degeneration in PD has a stereotyped and topographical sequence. Deposits of alpha-synuclein have been observed in central and peripheral nuclei of the ANS even in pre-symptomatic stages. Dysautonomia negatively affects the quality of life of patients. Early diagnosis will help select the most suitable treatment and help establish differential diagnosis. Methods.— Fifty healthy subjects and 50 patients suffering PD were studied. Exclusion criteria included reasons and treatments altering autonomic function. Tests were carried out in ON patients. PD patients were divided into 3 groups according time of evolution and into 2 groups according treatment: with or without L-DOPA. Hoehn %26 Yahr stage was also analyzed. To study the sympathetic function, the cutaneous-skin response (CSR) was used, and to study the parasympathetic function, heart rate variability (HRV) at rest, deep breathing (6 cycles/min), and Valsalva’s maneuver. Time