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117. Changes in cyclic alternating pattern in children with sleep disordered breathing before and after treatment
Society Proceedings / Clinical Neurophysiology 120 (2009) e147–e180
expressions altered during maturation, however, the frequency of interictal FO remains stable from the neonates. doi:10.1016/j.clinph.2009.02.119
114. A case of polyneuropathy with hypertrophic spinal radiculopathy mimicking neurofibromatosis—Takashi Kasahara, Mitsuhiko Kodama, Nagako Gima, Yuji Koyama, Kozo Hanayama, Minoru Toyokura, Yoshihisa Masakado (Tokai University School of Medicine, Kanagawa, Japan) This report illustrate a case of polyneuropathy masquerading as neurofibromatosis due to multifocal enlargements of spinal nerve roots. The patient complained of numbness and pain of the hands and leg weakness from six years later at age 67, but could gait with cane independently and draw picture with intention tremor. Magnetic resonance imaging (MRI) T2 weighted image through cervical spine demonstrated C6-7 spinal cord compression bilaterally by cervical root tumors like neurofibromatosis and enlargements of spinal nerve roots and brachial, lumbosacral plexus of nerves. Nerve conduction studies were almost no evoked response but median nerve which demonstrated prolonged distal latency and reduced compound muscle action potential with temporal dispersion, suggesting a diagnosis of demyelinating neuropathy. Somatosensory evoked potential of the median nerve revealed prolonged latency, and motor evoked potentials obtained from abductor pollicis brevis, and abductor digiti minimi by transcranial magnetic stimulation have prolonged latency and temporal dispersion. Sural nerve biopsies showed segmental demyelination, remyelination, lymphocyte infiltration and onion-bulb formation, suggesting chronic inflammatory demyelinating polyneuropathy. The patient did not have family history and reject furthermore genetic study, we could not deny the possibility of hereditary hypertrophic neuropathy like Charcot– Marie–Tooth disease. doi:10.1016/j.clinph.2009.02.120
115. Phantom limb in the painful brain—Masahiko Sumitani, Satoru Miyauchi, Yoshitsugu Yamada (The University of Tokyo Hospital, Tokyo, Japan) After amputation, most patients experience a phenomenon known as a phantom limb. Further, following lesions in somatosensory pathways, deafferentation pain (e.g., phantom limb pain) often occurs. Patients report that the pain is of a complex nature. Anecdotal evidence has suggested that mirror visual feedback (MVF) can alleviate the pain, so we examined the effect of MVF to treat deafferentation pain and categorized subjective descriptors of the pain into skin surface-mediated pain and deep tissue-mediated pain (deeppain). After MVF, the deep-pain descriptors by the patients decreased significantly. The pain amelioration and the decrease of deep-pain descriptors were linked to the emergence of willed visuomotor imagery of the affected limb, suggesting that MVF seems to compensate for insufficient somatosensory input from the deafferentated limb and/or phantom limb. The analgesic effect of MVF treatment does depend on the qualities of the pain. With better understanding of the nature of the pain, treatment strategy that produces proper visuomotor imagery could be useful for deafferentation pain. doi:10.1016/j.clinph.2009.02.121
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116. Anterior prefrontal activity associated with pleasant and unpleasant emotions: A study with event-related near-infrared spectroscopy—Yoko Hoshi 1, Jinghua Huang 1, Shunji Kohri 1, Yoshinobu Iguchi 1, Masayuki Naya 2, Takahiro Okamoto 3, Shuji Ono 3 (1 Tokyo Institute of Psychiatry, Tokyo, Japan, 2 Frontier Core-technology Laboratories, Fuji Film Co., Kaisei, Japan, 3 Software Development Center, Fuji Film Co., Kaisei, Japan) Although a considerable amount of evidence showing that the prefrontal cortex (PFC) plays a key role in various aspects of emotion has been accumulated, the role of the frontopolar cortex in the processing of emotion is still controversial. To address this issue, we employed event-related near-infrared spectroscopy to examine rCBF changes directly related to emotions but not to cognitive operations in the anterior frontal region of healthy adults during viewing affective pictures. Changes in oxygenated hemoglobin (oxy-Hb) for a 6s-picture presentation period (early change) and for a 14s-resting period (late change) were analyzed in an event-related design and a block design, respectively. The event-related analysis showed that very unpleasant emotion was accompanied by an increase in oxy-Hb in the bilateral ventrolateral PFCs, while very pleasant emotion was accompanied by a decrease in oxy-Hb in the left dorsolateral PFC. The block design analysis demonstrated widespread increases in oxy-Hb during an unpleasant condition in comparison with a pleasant condition in more than half of the subjects. These findings suggest that the frontopolar cortex is less likely the primary site where visual stimuli-induced emotions are processed, but mainly recruited in cognitive operations that occur following visual stimuli and/or elicited emotions. doi:10.1016/j.clinph.2009.02.122
117. Changes in cyclic alternating pattern in children with sleep disordered breathing before and after treatment—Kumi KatoNishimura, Gaoyahan, Hideko Sugita, Ikuko Mohri, Mitsutaka Taniguchi, Masako Taniike (Osaka University Graduate School of Medicine, Osaka, Japan) NREM sleep microstructure was evaluated by cyclic alternating pattern (CAP) in seven children (mean age 6.17 ± 0.58 years, 4 males and 3 females) with obstructive sleep apnea syndrome (OSAS). They underwent repeated overnight polysomnographic recording in the sleep laboratory before and after adenotonsillectomy (A/T) in the mean interval of 10.4 ± 8.4 months. The scoring of sleep stage and CAP was manually performed according to the atlas of Rechtschaffen & Kales or CAP. After A/T, OSAS were completely cured in all subjects: snore disappeared and obstructive apnea hypopnea index (OAHI), mean of which had been 22.5 ± 17.9, was reduced to <1. After treatment, CAP rate and A2 subtype tended to increase, in particular, CAP rate in Stage1, A2 (%) and A2 index were significantly increased. The physiological mechanism and significance of CAP still remain to be clarified. Our data suggests that the consensus regarding CAP rate as a parameter of NREM instability does not necessarily hold in children. To the contrary, our data was compatible with adult ones suggesting that A1 subtype represents the brain’s attempt to preserve sleep. This is first report documenting the change of CAP in children before and after complete cure of OSAS. doi:10.1016/j.clinph.2009.02.123
expressions altered during maturation, however, the frequency of interictal FO remains stable from the neonates. doi:10.1016/j.clinph.2009.02.119
114. A case of polyneuropathy with hypertrophic spinal radiculopathy mimicking neurofibromatosis—Takashi Kasahara, Mitsuhiko Kodama, Nagako Gima, Yuji Koyama, Kozo Hanayama, Minoru Toyokura, Yoshihisa Masakado (Tokai University School of Medicine, Kanagawa, Japan) This report illustrate a case of polyneuropathy masquerading as neurofibromatosis due to multifocal enlargements of spinal nerve roots. The patient complained of numbness and pain of the hands and leg weakness from six years later at age 67, but could gait with cane independently and draw picture with intention tremor. Magnetic resonance imaging (MRI) T2 weighted image through cervical spine demonstrated C6-7 spinal cord compression bilaterally by cervical root tumors like neurofibromatosis and enlargements of spinal nerve roots and brachial, lumbosacral plexus of nerves. Nerve conduction studies were almost no evoked response but median nerve which demonstrated prolonged distal latency and reduced compound muscle action potential with temporal dispersion, suggesting a diagnosis of demyelinating neuropathy. Somatosensory evoked potential of the median nerve revealed prolonged latency, and motor evoked potentials obtained from abductor pollicis brevis, and abductor digiti minimi by transcranial magnetic stimulation have prolonged latency and temporal dispersion. Sural nerve biopsies showed segmental demyelination, remyelination, lymphocyte infiltration and onion-bulb formation, suggesting chronic inflammatory demyelinating polyneuropathy. The patient did not have family history and reject furthermore genetic study, we could not deny the possibility of hereditary hypertrophic neuropathy like Charcot– Marie–Tooth disease. doi:10.1016/j.clinph.2009.02.120
115. Phantom limb in the painful brain—Masahiko Sumitani, Satoru Miyauchi, Yoshitsugu Yamada (The University of Tokyo Hospital, Tokyo, Japan) After amputation, most patients experience a phenomenon known as a phantom limb. Further, following lesions in somatosensory pathways, deafferentation pain (e.g., phantom limb pain) often occurs. Patients report that the pain is of a complex nature. Anecdotal evidence has suggested that mirror visual feedback (MVF) can alleviate the pain, so we examined the effect of MVF to treat deafferentation pain and categorized subjective descriptors of the pain into skin surface-mediated pain and deep tissue-mediated pain (deeppain). After MVF, the deep-pain descriptors by the patients decreased significantly. The pain amelioration and the decrease of deep-pain descriptors were linked to the emergence of willed visuomotor imagery of the affected limb, suggesting that MVF seems to compensate for insufficient somatosensory input from the deafferentated limb and/or phantom limb. The analgesic effect of MVF treatment does depend on the qualities of the pain. With better understanding of the nature of the pain, treatment strategy that produces proper visuomotor imagery could be useful for deafferentation pain. doi:10.1016/j.clinph.2009.02.121
e173
116. Anterior prefrontal activity associated with pleasant and unpleasant emotions: A study with event-related near-infrared spectroscopy—Yoko Hoshi 1, Jinghua Huang 1, Shunji Kohri 1, Yoshinobu Iguchi 1, Masayuki Naya 2, Takahiro Okamoto 3, Shuji Ono 3 (1 Tokyo Institute of Psychiatry, Tokyo, Japan, 2 Frontier Core-technology Laboratories, Fuji Film Co., Kaisei, Japan, 3 Software Development Center, Fuji Film Co., Kaisei, Japan) Although a considerable amount of evidence showing that the prefrontal cortex (PFC) plays a key role in various aspects of emotion has been accumulated, the role of the frontopolar cortex in the processing of emotion is still controversial. To address this issue, we employed event-related near-infrared spectroscopy to examine rCBF changes directly related to emotions but not to cognitive operations in the anterior frontal region of healthy adults during viewing affective pictures. Changes in oxygenated hemoglobin (oxy-Hb) for a 6s-picture presentation period (early change) and for a 14s-resting period (late change) were analyzed in an event-related design and a block design, respectively. The event-related analysis showed that very unpleasant emotion was accompanied by an increase in oxy-Hb in the bilateral ventrolateral PFCs, while very pleasant emotion was accompanied by a decrease in oxy-Hb in the left dorsolateral PFC. The block design analysis demonstrated widespread increases in oxy-Hb during an unpleasant condition in comparison with a pleasant condition in more than half of the subjects. These findings suggest that the frontopolar cortex is less likely the primary site where visual stimuli-induced emotions are processed, but mainly recruited in cognitive operations that occur following visual stimuli and/or elicited emotions. doi:10.1016/j.clinph.2009.02.122
117. Changes in cyclic alternating pattern in children with sleep disordered breathing before and after treatment—Kumi KatoNishimura, Gaoyahan, Hideko Sugita, Ikuko Mohri, Mitsutaka Taniguchi, Masako Taniike (Osaka University Graduate School of Medicine, Osaka, Japan) NREM sleep microstructure was evaluated by cyclic alternating pattern (CAP) in seven children (mean age 6.17 ± 0.58 years, 4 males and 3 females) with obstructive sleep apnea syndrome (OSAS). They underwent repeated overnight polysomnographic recording in the sleep laboratory before and after adenotonsillectomy (A/T) in the mean interval of 10.4 ± 8.4 months. The scoring of sleep stage and CAP was manually performed according to the atlas of Rechtschaffen & Kales or CAP. After A/T, OSAS were completely cured in all subjects: snore disappeared and obstructive apnea hypopnea index (OAHI), mean of which had been 22.5 ± 17.9, was reduced to <1. After treatment, CAP rate and A2 subtype tended to increase, in particular, CAP rate in Stage1, A2 (%) and A2 index were significantly increased. The physiological mechanism and significance of CAP still remain to be clarified. Our data suggests that the consensus regarding CAP rate as a parameter of NREM instability does not necessarily hold in children. To the contrary, our data was compatible with adult ones suggesting that A1 subtype represents the brain’s attempt to preserve sleep. This is first report documenting the change of CAP in children before and after complete cure of OSAS. doi:10.1016/j.clinph.2009.02.123