- Email: [email protected]
111. Prognostic value of brain mapping in the functional recovery of patients with cerebrovascular ischemic disease
e126
Society Proceedings / Clinical Neurophysiology 119 (2008) e99–e164
performance. There was volume in frontal structures a finders decrease, which contrasts with the poor performance of the aMCI group in tests of executive functions. This suggests that volume lost per se does not explain the executive deficit. The episodic memory’s performance in aMCI subjects had a positive correlation with the volume of bilateral temporal structures, including the hippocampus and with the volume of frontal structures in the left hemisphere.
ders. Neonates with inactive and paroxistic layouts showed an unfavorable evolution. It is concluded that neonatal polysomnography was a good indicator of the functional status of the central nervous system in the neonatal period. The results of the EEG, together with the degree of the asphyxia and the evolution of these patients were related. doi:10.1016/j.clinph.2008.04.125
doi:10.1016/j.clinph.2008.04.123
108. Nocturnal polysomnographic studies in a children’s sample with Attention Deficit Hyperactivity Disorder, hyperactivity-type—Y. Alfonsode Armas, A. Alvarez Amador, T. Virue´s Alba, M.C. Rodrı´guez Bowra (Cuba) This paper aimed at describing the sleep disorders found by nocturnal polysomnographic study (PSG) in children with Attention Deficit Hyperactivity Disorder (ADHD) with hyperactivityimpulsivity-type (ADHD/H). We studied 10 children (1 female, 9 males; mean age: 9, 30) who met the DSM-IV criteria of ADHD/H. They were evaluated by a nocturnal polysomnographic study and neurological exploration. All studies were abnormal: 7 (70%) of the children presented periodic movement legs syndrome (PMLS). The sleep architecture of 8 (80%) children with ADHD showed an increase in the percentage of phase III and consequently decreases of phase II of slow sleep. The REM latencies were increased in 7 (70%) of the studied children, whereas the REM percentage was reduced in 5 (50%). Epileptiform-type paroxysms were observed in 40% of the children who presented symptoms of ADHD/H and in 4 (40%) of them parasomnias were demonstrated. The increase of phase III may be related to disorders in noradrenaline and dopamine transmission present in children who suffer from ADHD. Some children with ADHD can have a region of the brain with intense epileptic activity, which does not trigger epileptic seizures but gives rise to behavioral disorders. doi:10.1016/j.clinph.2008.04.124
109. Value of the neonatal polysomnography in newborns with severe asphyxia at birth—Y. Expo´sito Ferna´ndez, M. Contreras Ca´rdenas (Cuba) The objective of this paper was to assess the utility of neonatal Polysomnnography in newborns with severe asphyxia at birth. The usefulness of neonatal polysomnography was evaluated in 73 newborns with severe asphyxia at birth, born at the ‘‘Ame´rica Arias” Gynecologic and Obstetric Hospital, from May 2002 to December 2006. Polysomnographic studies were carried out in the first week of the baby’s life taking under consideration the presence or absence of hypoxic-ischemic encephalopathy. The correlation between neurophysiological and neurological examinations and the follow-up EEG records were analyzed. Kappa index was used to measure the level of agreement among variables. We found a significant correlation between the electroencephalographic results and the degree of asphyxia: i.e. the more severe the asphyxia the more frequent and severe the EEG disor-
110. Value of the neonatal polysomnography in newborns with less than 1500 g of weight—Y. Expo´sito Ferna´ndez, M. Contreras Ca´rdenas (Cuba) The objective of this paper was to assess neonatal Polysomnnography (PSG) in low weight newborns. Neonatal polysomnography was assessed in 66 infants with less than 1500 g of weight at birth and born at ‘‘Ame´rica Arias” Gynecologic and Obstetric Hospital from May 2002 to December 2006. These PSGs were repeated every three months. Neurological evaluations and fontanel ultrasonograms were performed on the day of the PSG studies. The relationship between the PSG results and the causes of neonatal mortality was determined. The PSG in newborns with weight inferior to 1500 g was normal in 83.6%, with slight to moderate disorders in11.5% and with severe disorders in 4.9%. The neurological exam was normal in 77% and abnormal in 11.5%: 7 suspicious cases and 7 pathological cases. A significant relationship was found between the follow-up polysomnographic studies and pathological lesions in dead infants with very low weight at birth. Our results demonstrate that PSG helps to identify subclinical elements in this high risk group. Therefore, PSG could be considered a good indicator of the functional status of the central nervous system and could have prognostic value in high risk groups of infants. doi:10.1016/j.clinph.2008.04.126
111. Prognostic value of brain mapping in the functional recovery of patients with cerebrovascular ischemic disease— F. Torres, I. Delgado, A. Montoya (Cuba) The objective of this study was to establish a functional prognosis of recovery based on the mapping of the brain electric activity in patients with ischemic ictus. A longitudinal, prospective and descriptive study was undertaken at the Juan Bruno Zayas Hospital. A total of 22 patients (mean age: 57.2 years) with atherotrombotic ischemic stroke were studied. Neurophysiological evaluations were made at the seventh day after the ictus. Functional evaluations (Barthel index) were taken at the third and sixth months following ictus. The electrophysiologic brain mapping showed pathological slow activity (theta, delta) and decreased physiologic beta and alpha rhythms activity in cortical ipsilateral and contralateral regions of the ischemic focus. The magnitude of these disorders was closely correlated with the functional recovery. The absence or increase of the energy in the alpha frequency band, associated with the significant increment of energy (magnitude z) in the slow frequency bands constitutes an index of good rehabilitative prognosis. In contrast, the decrement of energy in the alpha band, associated with the increment of
Society Proceedings / Clinical Neurophysiology 119 (2008) e99–e164
energy of the theta and delta bands of global type, constitute an index of unfavorable rehabilitative prognosis. Brain mapping can thus contribute to establishing a prognosis of rehabilitation in patients affected by stroke. doi:10.1016/j.clinph.2008.04.127
112. Clinical and electrophysiological study of a KleineLevin case—M. Roma´n (Cuba) This work describes the clinical, psychiatric, and neurophysiological evaluations performed on a patient with Kleine-Levin syndrome from 8 to 18 years. The patient suffered from recurrent crises of hypersomnia, hyperphagia, and auditory and visual hallucinations. These crises occurred every 1–4 weeks and lasted for 7–15 days, eventually disappearing without any treatment. These disorders started after an infectious tonsillitis, with intense and persistent fever. Their intensity and frequency progressively diminished as the patient was getting older and finally disappeared. The following evaluations were all normal: psychometric, pedagogic, neurological, imaging, immunologic, CAT, magnetic resonance and cognitive event related-potential P-300. Quantitative EEG showed a slow, diffuse, and global activity which was present during the crises and the period between them. The most affected bands were theta (increased) and alpha (reduced). At early stages of the disease, paroxysmal activity in frontal and posterior regions was also found, which disappeared in later stages. These findings were interpreted as a disorder of the regulation of the electrical activity at the cortical level. This patient was diagnosed as an atypical Kleine-Levin syndrome, since it arose at an infrequent age and gender. doi:10.1016/j.clinph.2008.04.128
113. Differential diagnosis by polisomnographic (PSG) studies between epilepsy & narcolepsy: Follow up of a ´ lvarez, A. A ´ lvarez, R. patient—T. Virue´s Alba, L. A Rodrı´guez, Y. Alfonso, J.M. Antelo (Cuba) A 23 years old patient with symptomatic focal epilepsy since she was 5 years old was studied by PSG study and Multiple Sleep Latency Test (MSLT) performed in a Medicid_4 (24 channels) with Dream Hunter software. During the initial study there was abnormal sleep architecture, due to a Sleep Onset in REM (SOREM) and decrease of sleep efficiency (92%). During the nocturnal sleep there were no clinical or electrical seizures, only isolated paroxysmal activity. There was presence of REM sleep in the four MSLT records performed on the patient. The mean latency was 3 min. Subsequently, there was a remarkable improvement in the nocturnal sleep architecture. The REM latency was 102 min (normal) without fragmentation. The efficiency of sleep was 98%. There was no REM sleep and the mean latency of sleep onset was 16.25 min. Narcolepsy was diagnosed in a patient with a complex clinical picture. PSG and MSLT were crucial in order to arrive to a correct diagnosis. The follow up study confirmed the accuracy of the PSG differential diagnosis. doi:10.1016/j.clinph.2008.04.129
e127
114. Cerebral monitoring of blood flow by means of transcranial doppler during cardiac surgery—A. Recase´n Linares, A. Lamas Avila (Cuba) Neurological dysfunctions are common adverse effects of cardiac surgery. This paper aimed to evaluate the changes of brain blood flow (BBF) that occur at different stages of cardiothoracic surgery. Transcranial doppler of the right median artery was monitored in 20 patients with congenital heart disorders during five stages of cardiac surgery: (1) Before surgery, (2) Anesthetic post-induction, (3) Aortic clamping, (4) Aortic unclamping, (4) Stop of cardiopulmonary bypass and (5) Post surgery. The systolic speed was decreased from stages 1 to 5. The diastolic speed also showed the same pattern but with a lower decrement. During anesthetic induction, both speeds were reduced in all patients. Only 40% of the patients concluded the surgery with diminished average speed. Patients with mitral valve disorders did not suffer significant changes during surgery. Patients with aortic and double valve diseases showed a significant improvement of BBF after surgery. Twenty percent of the patients with congenital cardiopathies experienced a BBF reduction at the end of the surgery. These results suggest that transcranial doppler is useful to follow up the changes of BBF that occur during heart surgery and hence could be used to reduce the incidence of neurological disorders associated to these procedures. doi:10.1016/j.clinph.2008.04.130
115. Descriptive evaluation of 100 polysomnograms for suspected Obstructive Sleep Apnea Syndrome: New sleep Disorders Unit at the Hospital de Carabineros (HOSCAR)—E. Benavides, D. Florea, I. Avendan˜o, A. Montero (Cuba) The Obstructive Sleep Apnea/Hypoapnea Syndrome (OSA) is a disorder associated to intermittent and repetitive airway obstruction during sleep. Eighty-nine patients (75 men, 14 women, mean age 46) with excessive daytime sleepiness, snoring and apnea episodes were admitted at HOSCAR for one-night basal polysomnogram (PSG) (71), CPAP titration (11) and split night study (18). The patients reached an average value of 12.2 (0–23) in the Epworth Sleepness Scale. 97% of the evaluated patients had an abnormal PSG, 70% corresponded to OSA with average AHI 42.6/h (5.3– 109), ID90 18.3%, microawakening index 35.1/h. From this group, 48% of patients had a severe OSA, in which CPAP use was indicated, with seven patients (19%) actually using it. We can conclude that the sample evaluated at the Sleep Disorders Clinic at HOSCAR had a high clinical suspicion rate for OSA, which correlated with the data obtained from the PSG. One problem for these patients is the difficulties to buy nasal CPAP. Thus, this fact should be considered for further public health policies, in order to offer patients the best treatment available, along with follow-up and associated risk factors intervention. doi:10.1016/j.clinph.2008.04.131
116. Basal ganglia cortical information processing and its dependence on dopamine—M. Belluscio, M.G. Murer, L.A. Riquelme (Argentina)
Society Proceedings / Clinical Neurophysiology 119 (2008) e99–e164
performance. There was volume in frontal structures a finders decrease, which contrasts with the poor performance of the aMCI group in tests of executive functions. This suggests that volume lost per se does not explain the executive deficit. The episodic memory’s performance in aMCI subjects had a positive correlation with the volume of bilateral temporal structures, including the hippocampus and with the volume of frontal structures in the left hemisphere.
ders. Neonates with inactive and paroxistic layouts showed an unfavorable evolution. It is concluded that neonatal polysomnography was a good indicator of the functional status of the central nervous system in the neonatal period. The results of the EEG, together with the degree of the asphyxia and the evolution of these patients were related. doi:10.1016/j.clinph.2008.04.125
doi:10.1016/j.clinph.2008.04.123
108. Nocturnal polysomnographic studies in a children’s sample with Attention Deficit Hyperactivity Disorder, hyperactivity-type—Y. Alfonsode Armas, A. Alvarez Amador, T. Virue´s Alba, M.C. Rodrı´guez Bowra (Cuba) This paper aimed at describing the sleep disorders found by nocturnal polysomnographic study (PSG) in children with Attention Deficit Hyperactivity Disorder (ADHD) with hyperactivityimpulsivity-type (ADHD/H). We studied 10 children (1 female, 9 males; mean age: 9, 30) who met the DSM-IV criteria of ADHD/H. They were evaluated by a nocturnal polysomnographic study and neurological exploration. All studies were abnormal: 7 (70%) of the children presented periodic movement legs syndrome (PMLS). The sleep architecture of 8 (80%) children with ADHD showed an increase in the percentage of phase III and consequently decreases of phase II of slow sleep. The REM latencies were increased in 7 (70%) of the studied children, whereas the REM percentage was reduced in 5 (50%). Epileptiform-type paroxysms were observed in 40% of the children who presented symptoms of ADHD/H and in 4 (40%) of them parasomnias were demonstrated. The increase of phase III may be related to disorders in noradrenaline and dopamine transmission present in children who suffer from ADHD. Some children with ADHD can have a region of the brain with intense epileptic activity, which does not trigger epileptic seizures but gives rise to behavioral disorders. doi:10.1016/j.clinph.2008.04.124
109. Value of the neonatal polysomnography in newborns with severe asphyxia at birth—Y. Expo´sito Ferna´ndez, M. Contreras Ca´rdenas (Cuba) The objective of this paper was to assess the utility of neonatal Polysomnnography in newborns with severe asphyxia at birth. The usefulness of neonatal polysomnography was evaluated in 73 newborns with severe asphyxia at birth, born at the ‘‘Ame´rica Arias” Gynecologic and Obstetric Hospital, from May 2002 to December 2006. Polysomnographic studies were carried out in the first week of the baby’s life taking under consideration the presence or absence of hypoxic-ischemic encephalopathy. The correlation between neurophysiological and neurological examinations and the follow-up EEG records were analyzed. Kappa index was used to measure the level of agreement among variables. We found a significant correlation between the electroencephalographic results and the degree of asphyxia: i.e. the more severe the asphyxia the more frequent and severe the EEG disor-
110. Value of the neonatal polysomnography in newborns with less than 1500 g of weight—Y. Expo´sito Ferna´ndez, M. Contreras Ca´rdenas (Cuba) The objective of this paper was to assess neonatal Polysomnnography (PSG) in low weight newborns. Neonatal polysomnography was assessed in 66 infants with less than 1500 g of weight at birth and born at ‘‘Ame´rica Arias” Gynecologic and Obstetric Hospital from May 2002 to December 2006. These PSGs were repeated every three months. Neurological evaluations and fontanel ultrasonograms were performed on the day of the PSG studies. The relationship between the PSG results and the causes of neonatal mortality was determined. The PSG in newborns with weight inferior to 1500 g was normal in 83.6%, with slight to moderate disorders in11.5% and with severe disorders in 4.9%. The neurological exam was normal in 77% and abnormal in 11.5%: 7 suspicious cases and 7 pathological cases. A significant relationship was found between the follow-up polysomnographic studies and pathological lesions in dead infants with very low weight at birth. Our results demonstrate that PSG helps to identify subclinical elements in this high risk group. Therefore, PSG could be considered a good indicator of the functional status of the central nervous system and could have prognostic value in high risk groups of infants. doi:10.1016/j.clinph.2008.04.126
111. Prognostic value of brain mapping in the functional recovery of patients with cerebrovascular ischemic disease— F. Torres, I. Delgado, A. Montoya (Cuba) The objective of this study was to establish a functional prognosis of recovery based on the mapping of the brain electric activity in patients with ischemic ictus. A longitudinal, prospective and descriptive study was undertaken at the Juan Bruno Zayas Hospital. A total of 22 patients (mean age: 57.2 years) with atherotrombotic ischemic stroke were studied. Neurophysiological evaluations were made at the seventh day after the ictus. Functional evaluations (Barthel index) were taken at the third and sixth months following ictus. The electrophysiologic brain mapping showed pathological slow activity (theta, delta) and decreased physiologic beta and alpha rhythms activity in cortical ipsilateral and contralateral regions of the ischemic focus. The magnitude of these disorders was closely correlated with the functional recovery. The absence or increase of the energy in the alpha frequency band, associated with the significant increment of energy (magnitude z) in the slow frequency bands constitutes an index of good rehabilitative prognosis. In contrast, the decrement of energy in the alpha band, associated with the increment of
Society Proceedings / Clinical Neurophysiology 119 (2008) e99–e164
energy of the theta and delta bands of global type, constitute an index of unfavorable rehabilitative prognosis. Brain mapping can thus contribute to establishing a prognosis of rehabilitation in patients affected by stroke. doi:10.1016/j.clinph.2008.04.127
112. Clinical and electrophysiological study of a KleineLevin case—M. Roma´n (Cuba) This work describes the clinical, psychiatric, and neurophysiological evaluations performed on a patient with Kleine-Levin syndrome from 8 to 18 years. The patient suffered from recurrent crises of hypersomnia, hyperphagia, and auditory and visual hallucinations. These crises occurred every 1–4 weeks and lasted for 7–15 days, eventually disappearing without any treatment. These disorders started after an infectious tonsillitis, with intense and persistent fever. Their intensity and frequency progressively diminished as the patient was getting older and finally disappeared. The following evaluations were all normal: psychometric, pedagogic, neurological, imaging, immunologic, CAT, magnetic resonance and cognitive event related-potential P-300. Quantitative EEG showed a slow, diffuse, and global activity which was present during the crises and the period between them. The most affected bands were theta (increased) and alpha (reduced). At early stages of the disease, paroxysmal activity in frontal and posterior regions was also found, which disappeared in later stages. These findings were interpreted as a disorder of the regulation of the electrical activity at the cortical level. This patient was diagnosed as an atypical Kleine-Levin syndrome, since it arose at an infrequent age and gender. doi:10.1016/j.clinph.2008.04.128
113. Differential diagnosis by polisomnographic (PSG) studies between epilepsy & narcolepsy: Follow up of a ´ lvarez, A. A ´ lvarez, R. patient—T. Virue´s Alba, L. A Rodrı´guez, Y. Alfonso, J.M. Antelo (Cuba) A 23 years old patient with symptomatic focal epilepsy since she was 5 years old was studied by PSG study and Multiple Sleep Latency Test (MSLT) performed in a Medicid_4 (24 channels) with Dream Hunter software. During the initial study there was abnormal sleep architecture, due to a Sleep Onset in REM (SOREM) and decrease of sleep efficiency (92%). During the nocturnal sleep there were no clinical or electrical seizures, only isolated paroxysmal activity. There was presence of REM sleep in the four MSLT records performed on the patient. The mean latency was 3 min. Subsequently, there was a remarkable improvement in the nocturnal sleep architecture. The REM latency was 102 min (normal) without fragmentation. The efficiency of sleep was 98%. There was no REM sleep and the mean latency of sleep onset was 16.25 min. Narcolepsy was diagnosed in a patient with a complex clinical picture. PSG and MSLT were crucial in order to arrive to a correct diagnosis. The follow up study confirmed the accuracy of the PSG differential diagnosis. doi:10.1016/j.clinph.2008.04.129
e127
114. Cerebral monitoring of blood flow by means of transcranial doppler during cardiac surgery—A. Recase´n Linares, A. Lamas Avila (Cuba) Neurological dysfunctions are common adverse effects of cardiac surgery. This paper aimed to evaluate the changes of brain blood flow (BBF) that occur at different stages of cardiothoracic surgery. Transcranial doppler of the right median artery was monitored in 20 patients with congenital heart disorders during five stages of cardiac surgery: (1) Before surgery, (2) Anesthetic post-induction, (3) Aortic clamping, (4) Aortic unclamping, (4) Stop of cardiopulmonary bypass and (5) Post surgery. The systolic speed was decreased from stages 1 to 5. The diastolic speed also showed the same pattern but with a lower decrement. During anesthetic induction, both speeds were reduced in all patients. Only 40% of the patients concluded the surgery with diminished average speed. Patients with mitral valve disorders did not suffer significant changes during surgery. Patients with aortic and double valve diseases showed a significant improvement of BBF after surgery. Twenty percent of the patients with congenital cardiopathies experienced a BBF reduction at the end of the surgery. These results suggest that transcranial doppler is useful to follow up the changes of BBF that occur during heart surgery and hence could be used to reduce the incidence of neurological disorders associated to these procedures. doi:10.1016/j.clinph.2008.04.130
115. Descriptive evaluation of 100 polysomnograms for suspected Obstructive Sleep Apnea Syndrome: New sleep Disorders Unit at the Hospital de Carabineros (HOSCAR)—E. Benavides, D. Florea, I. Avendan˜o, A. Montero (Cuba) The Obstructive Sleep Apnea/Hypoapnea Syndrome (OSA) is a disorder associated to intermittent and repetitive airway obstruction during sleep. Eighty-nine patients (75 men, 14 women, mean age 46) with excessive daytime sleepiness, snoring and apnea episodes were admitted at HOSCAR for one-night basal polysomnogram (PSG) (71), CPAP titration (11) and split night study (18). The patients reached an average value of 12.2 (0–23) in the Epworth Sleepness Scale. 97% of the evaluated patients had an abnormal PSG, 70% corresponded to OSA with average AHI 42.6/h (5.3– 109), ID90 18.3%, microawakening index 35.1/h. From this group, 48% of patients had a severe OSA, in which CPAP use was indicated, with seven patients (19%) actually using it. We can conclude that the sample evaluated at the Sleep Disorders Clinic at HOSCAR had a high clinical suspicion rate for OSA, which correlated with the data obtained from the PSG. One problem for these patients is the difficulties to buy nasal CPAP. Thus, this fact should be considered for further public health policies, in order to offer patients the best treatment available, along with follow-up and associated risk factors intervention. doi:10.1016/j.clinph.2008.04.131
116. Basal ganglia cortical information processing and its dependence on dopamine—M. Belluscio, M.G. Murer, L.A. Riquelme (Argentina)