- Email: [email protected]
72. Characterization of the occlusion effect through auditory steady-state response in normal-hearing adults
Abstracts / Clinical Neurophysiology 127 (2016) e304–e321
Significance: Early diagnosis and intervention in the management of these children is important to enhance language maturation. doi:10.1016/j.clinph.2016.05.343
69. An approximation to time–frequency analysis of the Mismatch Negativity (MMN) in children with language impairment—Patricia Torres a,b, Carmelita Vela b,c, Hector Cervantes b,c, Samuel Zamora b, Gabriela Romero d, Dora Granados b (a Doctorado en Investigaciones Cerebrales-UV, Universidad Veracruzana, Mexico , b Laboratorio de Psicobiología, PsicologiaUV, Universidad Veracruzana, Mexico, c Doctorado en Ciencias Biomedicas-UV, Universidad Veracruzana, Mexico, d UAMXochimilco, Universidad Veracruzana, Mexico) Objective: To describe in time and frequency the MMN of children with language impairments. Material and methods: 12 children (6 boys, 6 girls) were selected with an average age of 5 years 5 months (SD 4 months), classified in two groups: one with language impairments (LI) and other with typical developmental (TD). EEG was recorded and the MMN was obtained with an oddball paradigm using the words/ajos/ (standard) and/ojos/ (deviant), and 60 electrodes on the Curry 7.0 XS software from Neuroscan System; frontocentral regions were analyzed (FCz, FC3, FC4) by describing the latencies and amplitudes of the MMN and the frequency band power related to standard and deviant stimuli using EEGLAB 13.5.4b. Results: The MMN was observed at 324 ms for both groups, and its late component called LDN, at 426 ms for TD and 438 ms for LI; there was a smaller amplitude of both components in children with LI. Gamma activity synchronization related to deviant stimuli was observed. Conclusions: The smaller amplitude of MMN and LDN in children with language impairment could be related with a low neuronal synchronization in word discrimination. Significance: The analysis of MMN in language impairments, shows the presence of a deficit in auditory perceptual discrimination that impedes a proper discrimination and expression of speech sounds. MMN characterization contributes to determine if the language difficulties of children are given by a dysfunctional neural substrate. The data obtained allow establishing an appropriate intervention for each case. doi:10.1016/j.clinph.2016.05.344
70. Utility of sound-field auditory steady-state response in normal-hearing adults—Alioth Guerrero-Aranda, Alejandro Torres-Fortuny, Eduardo Eimil-Suarez (Cuban Neuroscience Center, Cuba) Objective: To demonstrate the utility of the sound-field Auditory Steady State Response (ASSR) in normal-hearing adults. Methods: 19 normal-hearing adults with a mean age of 22 years were studied in sound-field conditions. Thresholds were compared between two different conditions (behavioral vs. electrophysiological audiometry) at 500, 1000, 2000 y 4000 Hz. Results: Electrophysiological thresholds were significantly higher than behavioral ones in a range of 17–25 dB. There was also, a strong correlation among thresholds form different conditions. Conclusions: Our findings suggest that behavioral thresholds can be reasonably estimated form electrophysiological thresholds at 500, 1000, 2000 y 4000 Hz in sound-field conditions; at least in normal-hearing adults.
e319
Significance: These results provide the basis for subsequent introduction into clinical practice of sound-field ASSRs. This technique could become an alternative for behaviorally difficult-to-test populations in which a sound-field audiogram is necessary, for instance, hearing aid fitting in young children. doi:10.1016/j.clinph.2016.05.345
71. Sturge–Weber syndrome + cortical dysplasia. A dual pathology case report—Areli Rosario Suarez-Roman a, Enoe CruzMartinez b, Yokary Amor Mellado-Ortiz a, Ernesto RamirezNavarrete b, Paul Shkurovich-Bialik a (a Department of Clinical Neurophsyiology, Centro Medico ABC, Mexico City, Mexico , b Neurologic Center, Centro Medico ABC, Mexico City, Mexico) Introduction: Sturge–Weber syndrome is a rare disorder that occurs with a frequency of approximately 1 per 50,000. The disease is characterized by an intracranial vascular anomaly like leptomeningeal angiomatosis. Facial cutaneous vascular malformations, seizures, and glaucoma are among the most common symptoms and signs. The clinical course is highly variable and some children experience intractable seizures, mental retardation, and recurrent strokelike episodes. Case report: We present here the case of a 11 months-old female with clinical and imaging evidence of left-side Sturge–Weber syndrome (SWS) and with clinical, image and seizure onset by electroencephalographic evidence that was most consistent with probable right-side cortical dysplasia. The patient underwent evaluation for epilepsy surgery; however he was not a surgical candidate for the dual pathology. We describe the history, physical examination, imaging, development and seizure control for eleven monthsold female with dual pathology. Conclusion: Our patient demonstrated two independent diseases not described previously in the literature. Although the incidence of seizure is high in SWS our patient have evidence of seizure onset in contralateral hemisphere. doi:10.1016/j.clinph.2016.05.346
72. Characterization of the occlusion effect through auditory steady-state response in normal-hearing adults—Alioth Guerrero-Aranda, Alejandro Torres-Fortuny, Eleina MijaresNodarse (Cuban Neuroscience Center, Cuba) Objective: This paper aims to characterize the behavior of the occlusion effect using Auditory Steady State Responses (ASSR) in order to estimate a compensating electrophysiological correction factor. Methods: The stimulus consisted of a combination of four sinusoidal carrier tones of 500, 1000, 2000 y 4000 Hz, modulated in amplitude (95% depth) at the following rates: 104.2, 107.8, 111.4 and 115 Hz; respectively. It was presented via bone conduction for each participant (32 in total) under two different conditions (occluded vs. un-occluded ear). Results: Occlusion caused a significant decrease of boneconducted ASSR thresholds at low frequencies but a significant increase at 4000 Hz. Some subjects, however, showed no occlusion effect. The electrophysiological correction factors were 12 and 8 dB HL for 500 and 1000 Hz, respectively. Conclusions: Our findings indicate that threshold variations at high frequencies need to be considered when conducting boneconduction testing with ear canal occlusion. The fact that the occlusion effect is not present in every individual may have some clinical
e320
Abstracts / Clinical Neurophysiology 127 (2016) e304–e321
implications. Our findings also suggest that correction factors recommended for behavioral testing can be applicable when using ASSRs. Significance: This research estimates correction factors based on electrophysiological measures (eCF) to compensate for an expected OE.
It is found some variations in the current causes of hearing losses when comparing the early and late periods (before and after 1990) of the screening program. Significance: This hearing screening program with Auditory Brainstem Responses (ABR) and Multiple Auditory Steady State Responses (MSSR) shows a high grade of efficiency and sensibility in programs to early detection of hearing deafness.
doi:10.1016/j.clinph.2016.05.347 doi:10.1016/j.clinph.2016.05.349
73. Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli— Lydia Baez a, Eleina Mijares b, Licer Cabrera a, Maria C. PerezAbalo b, Alejandro Torres-Fortuny b (a Neurophysiology Department, Paediatric Hospital William Soler, Havana, Cuba , b Hearing and Language Department, Cuban Neurosciences Center, Havana, Cuba) Objective: Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli. Material and methods: A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard. Results: The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (1.9) min. In 34% of babies, only one repetition of the test was needed to raising the result. Conclusions: The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments, reducing the number of positive false cases. Significance: This test permits to improve the diagnostic efficiency of auditory steady state responses.
75. Evaluation of related factors of bifid P100 wave, of visual evoked potentials—Martin Roberto Villagomez Vazquez, Abraham Arturo Gonzalez Samano, Jose Darío Ochoa Mena, Isela Valverde Luna, Luna Elvia Ramírez, Jorge Varela Blanco, Josefina Hernandez Cervantes (Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico) Objective: To evaluate factors that could be related to bifid wave of P100 in visual evoked potentials (VEP). Material and methods: Retrospective and descriptive study of 1 year, 30 patients with different diagnoses. Parameters studies were absolute latencies, morphology of the wave, replicability, amplitude, pattern (goggle or reverse), results, reference (Fz). Results: 20 female, 10 males, age 26.47 26.35 years, diagnoses: 1 premature infants, 8 with demyelinization, 5 with amaurosis, 9 delayed neurological development, 7 miscellaneous. Abnormal morphology 13, bifid wave 7, p = 0.000. Abnormal result in 7 cases without relation with wave bifid wave. Type of used pattern; 9 reverse; 21 goggle p = NS. All 30 cases referenced to Fz, amplitudes and latencies without relation with bifid wave. The abnormal result was related with premature infants p = 0.000, latency 260 21.81 ms and amplitude of 2.7 lV. Conclusions: There was no relation of the factors studied with the P100 bifid wave presence. Significance: In the present study, bifid wave does not correlate with a factor of normality or abnormality, nor conditioned with age. doi:10.1016/j.clinph.2016.05.350
doi:10.1016/j.clinph.2016.05.348
74. Screening high risk babies with Auditory Brainstem Responses and Multiple Auditory Steady State Responses—L. Baez Allende a, B. Carrillo Valdes a, M.C. Perez-Abalo b, G. Savio Lopez b, J.A. Gaya Vazquez b, L. Cabrera Rodriguez a (a Pediatric Hospital William Soler, Havana, Cuba, b Cuban Neuroscience Center, Cuba) Objective: Evaluate the results of the hearing screening program organized and applied in the ‘‘William Soler” Paediatric Hospital, targeting multiple high-risk groups. Material and methods: The children were evaluated using click Auditory Brainstem Responses (ABR with Multiple Auditory Steady State Responses (MSSR) (0.5 and 2 kHz). The possible causes of hearing impairment were examined comparatively. Results: The results shows an overall incidence of permanent hearing losses of 3,3% in the high risk population with referral rates of around 10%. The common perinatal causes of hearing losses were low birth weight; foetal suffering and the use of ototoxic drugs have remained very frequent. Conclusions: The incidence of hearing impairment and the referral rates were quite comparable to those reported in the high risk population by similar screening protocols.
76. Maturational changes of the auditory system in normal preschool children assessed by brainstem auditory evoked potentials (BAEPs)—Reyes Cuayahuitl Araceli b, Muñoz Montúfar Juan Pablo b, Galván Heredia Penélope a (a Pediatric Neurology Service, Hospital General de Zona 14 Instituto Mexicano del Seguro Social, Mexico City, Mexico , b Pediatric Neurology Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social, Mexico City, Mexico) Introduction: Absolute latencies and inter peak latencies of wave brainstem auditory evoked potentials (BAEP) changes with the maturation of the auditory pathway, which is reached between 18 and 36 months old. Objective: To describe the maturation of BAEPs in healthy preschool children. Methods: Cross-sectional study. A sample of 102 preschool children were studied with adequate neurodevelopmental, age distribution (12–23 months, 24–35 months, 36–47 months, 48–59 month and 60–71 months). The stimulation parameters were: rarefaction, click, 80 dBnHL intensity, frequency 11.1 Hz and average of 2000 stimuli. We evaluated absolute latencies for I, III and V waves and interpeak latencies I–III, III–V and I–V expressed in milliseconds (ms) and hearing threshold expressed in decibels (dB).
Significance: Early diagnosis and intervention in the management of these children is important to enhance language maturation. doi:10.1016/j.clinph.2016.05.343
69. An approximation to time–frequency analysis of the Mismatch Negativity (MMN) in children with language impairment—Patricia Torres a,b, Carmelita Vela b,c, Hector Cervantes b,c, Samuel Zamora b, Gabriela Romero d, Dora Granados b (a Doctorado en Investigaciones Cerebrales-UV, Universidad Veracruzana, Mexico , b Laboratorio de Psicobiología, PsicologiaUV, Universidad Veracruzana, Mexico, c Doctorado en Ciencias Biomedicas-UV, Universidad Veracruzana, Mexico, d UAMXochimilco, Universidad Veracruzana, Mexico) Objective: To describe in time and frequency the MMN of children with language impairments. Material and methods: 12 children (6 boys, 6 girls) were selected with an average age of 5 years 5 months (SD 4 months), classified in two groups: one with language impairments (LI) and other with typical developmental (TD). EEG was recorded and the MMN was obtained with an oddball paradigm using the words/ajos/ (standard) and/ojos/ (deviant), and 60 electrodes on the Curry 7.0 XS software from Neuroscan System; frontocentral regions were analyzed (FCz, FC3, FC4) by describing the latencies and amplitudes of the MMN and the frequency band power related to standard and deviant stimuli using EEGLAB 13.5.4b. Results: The MMN was observed at 324 ms for both groups, and its late component called LDN, at 426 ms for TD and 438 ms for LI; there was a smaller amplitude of both components in children with LI. Gamma activity synchronization related to deviant stimuli was observed. Conclusions: The smaller amplitude of MMN and LDN in children with language impairment could be related with a low neuronal synchronization in word discrimination. Significance: The analysis of MMN in language impairments, shows the presence of a deficit in auditory perceptual discrimination that impedes a proper discrimination and expression of speech sounds. MMN characterization contributes to determine if the language difficulties of children are given by a dysfunctional neural substrate. The data obtained allow establishing an appropriate intervention for each case. doi:10.1016/j.clinph.2016.05.344
70. Utility of sound-field auditory steady-state response in normal-hearing adults—Alioth Guerrero-Aranda, Alejandro Torres-Fortuny, Eduardo Eimil-Suarez (Cuban Neuroscience Center, Cuba) Objective: To demonstrate the utility of the sound-field Auditory Steady State Response (ASSR) in normal-hearing adults. Methods: 19 normal-hearing adults with a mean age of 22 years were studied in sound-field conditions. Thresholds were compared between two different conditions (behavioral vs. electrophysiological audiometry) at 500, 1000, 2000 y 4000 Hz. Results: Electrophysiological thresholds were significantly higher than behavioral ones in a range of 17–25 dB. There was also, a strong correlation among thresholds form different conditions. Conclusions: Our findings suggest that behavioral thresholds can be reasonably estimated form electrophysiological thresholds at 500, 1000, 2000 y 4000 Hz in sound-field conditions; at least in normal-hearing adults.
e319
Significance: These results provide the basis for subsequent introduction into clinical practice of sound-field ASSRs. This technique could become an alternative for behaviorally difficult-to-test populations in which a sound-field audiogram is necessary, for instance, hearing aid fitting in young children. doi:10.1016/j.clinph.2016.05.345
71. Sturge–Weber syndrome + cortical dysplasia. A dual pathology case report—Areli Rosario Suarez-Roman a, Enoe CruzMartinez b, Yokary Amor Mellado-Ortiz a, Ernesto RamirezNavarrete b, Paul Shkurovich-Bialik a (a Department of Clinical Neurophsyiology, Centro Medico ABC, Mexico City, Mexico , b Neurologic Center, Centro Medico ABC, Mexico City, Mexico) Introduction: Sturge–Weber syndrome is a rare disorder that occurs with a frequency of approximately 1 per 50,000. The disease is characterized by an intracranial vascular anomaly like leptomeningeal angiomatosis. Facial cutaneous vascular malformations, seizures, and glaucoma are among the most common symptoms and signs. The clinical course is highly variable and some children experience intractable seizures, mental retardation, and recurrent strokelike episodes. Case report: We present here the case of a 11 months-old female with clinical and imaging evidence of left-side Sturge–Weber syndrome (SWS) and with clinical, image and seizure onset by electroencephalographic evidence that was most consistent with probable right-side cortical dysplasia. The patient underwent evaluation for epilepsy surgery; however he was not a surgical candidate for the dual pathology. We describe the history, physical examination, imaging, development and seizure control for eleven monthsold female with dual pathology. Conclusion: Our patient demonstrated two independent diseases not described previously in the literature. Although the incidence of seizure is high in SWS our patient have evidence of seizure onset in contralateral hemisphere. doi:10.1016/j.clinph.2016.05.346
72. Characterization of the occlusion effect through auditory steady-state response in normal-hearing adults—Alioth Guerrero-Aranda, Alejandro Torres-Fortuny, Eleina MijaresNodarse (Cuban Neuroscience Center, Cuba) Objective: This paper aims to characterize the behavior of the occlusion effect using Auditory Steady State Responses (ASSR) in order to estimate a compensating electrophysiological correction factor. Methods: The stimulus consisted of a combination of four sinusoidal carrier tones of 500, 1000, 2000 y 4000 Hz, modulated in amplitude (95% depth) at the following rates: 104.2, 107.8, 111.4 and 115 Hz; respectively. It was presented via bone conduction for each participant (32 in total) under two different conditions (occluded vs. un-occluded ear). Results: Occlusion caused a significant decrease of boneconducted ASSR thresholds at low frequencies but a significant increase at 4000 Hz. Some subjects, however, showed no occlusion effect. The electrophysiological correction factors were 12 and 8 dB HL for 500 and 1000 Hz, respectively. Conclusions: Our findings indicate that threshold variations at high frequencies need to be considered when conducting boneconduction testing with ear canal occlusion. The fact that the occlusion effect is not present in every individual may have some clinical
e320
Abstracts / Clinical Neurophysiology 127 (2016) e304–e321
implications. Our findings also suggest that correction factors recommended for behavioral testing can be applicable when using ASSRs. Significance: This research estimates correction factors based on electrophysiological measures (eCF) to compensate for an expected OE.
It is found some variations in the current causes of hearing losses when comparing the early and late periods (before and after 1990) of the screening program. Significance: This hearing screening program with Auditory Brainstem Responses (ABR) and Multiple Auditory Steady State Responses (MSSR) shows a high grade of efficiency and sensibility in programs to early detection of hearing deafness.
doi:10.1016/j.clinph.2016.05.347 doi:10.1016/j.clinph.2016.05.349
73. Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli— Lydia Baez a, Eleina Mijares b, Licer Cabrera a, Maria C. PerezAbalo b, Alejandro Torres-Fortuny b (a Neurophysiology Department, Paediatric Hospital William Soler, Havana, Cuba , b Hearing and Language Department, Cuban Neurosciences Center, Havana, Cuba) Objective: Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli. Material and methods: A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard. Results: The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (1.9) min. In 34% of babies, only one repetition of the test was needed to raising the result. Conclusions: The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments, reducing the number of positive false cases. Significance: This test permits to improve the diagnostic efficiency of auditory steady state responses.
75. Evaluation of related factors of bifid P100 wave, of visual evoked potentials—Martin Roberto Villagomez Vazquez, Abraham Arturo Gonzalez Samano, Jose Darío Ochoa Mena, Isela Valverde Luna, Luna Elvia Ramírez, Jorge Varela Blanco, Josefina Hernandez Cervantes (Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico) Objective: To evaluate factors that could be related to bifid wave of P100 in visual evoked potentials (VEP). Material and methods: Retrospective and descriptive study of 1 year, 30 patients with different diagnoses. Parameters studies were absolute latencies, morphology of the wave, replicability, amplitude, pattern (goggle or reverse), results, reference (Fz). Results: 20 female, 10 males, age 26.47 26.35 years, diagnoses: 1 premature infants, 8 with demyelinization, 5 with amaurosis, 9 delayed neurological development, 7 miscellaneous. Abnormal morphology 13, bifid wave 7, p = 0.000. Abnormal result in 7 cases without relation with wave bifid wave. Type of used pattern; 9 reverse; 21 goggle p = NS. All 30 cases referenced to Fz, amplitudes and latencies without relation with bifid wave. The abnormal result was related with premature infants p = 0.000, latency 260 21.81 ms and amplitude of 2.7 lV. Conclusions: There was no relation of the factors studied with the P100 bifid wave presence. Significance: In the present study, bifid wave does not correlate with a factor of normality or abnormality, nor conditioned with age. doi:10.1016/j.clinph.2016.05.350
doi:10.1016/j.clinph.2016.05.348
74. Screening high risk babies with Auditory Brainstem Responses and Multiple Auditory Steady State Responses—L. Baez Allende a, B. Carrillo Valdes a, M.C. Perez-Abalo b, G. Savio Lopez b, J.A. Gaya Vazquez b, L. Cabrera Rodriguez a (a Pediatric Hospital William Soler, Havana, Cuba, b Cuban Neuroscience Center, Cuba) Objective: Evaluate the results of the hearing screening program organized and applied in the ‘‘William Soler” Paediatric Hospital, targeting multiple high-risk groups. Material and methods: The children were evaluated using click Auditory Brainstem Responses (ABR with Multiple Auditory Steady State Responses (MSSR) (0.5 and 2 kHz). The possible causes of hearing impairment were examined comparatively. Results: The results shows an overall incidence of permanent hearing losses of 3,3% in the high risk population with referral rates of around 10%. The common perinatal causes of hearing losses were low birth weight; foetal suffering and the use of ototoxic drugs have remained very frequent. Conclusions: The incidence of hearing impairment and the referral rates were quite comparable to those reported in the high risk population by similar screening protocols.
76. Maturational changes of the auditory system in normal preschool children assessed by brainstem auditory evoked potentials (BAEPs)—Reyes Cuayahuitl Araceli b, Muñoz Montúfar Juan Pablo b, Galván Heredia Penélope a (a Pediatric Neurology Service, Hospital General de Zona 14 Instituto Mexicano del Seguro Social, Mexico City, Mexico , b Pediatric Neurology Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social, Mexico City, Mexico) Introduction: Absolute latencies and inter peak latencies of wave brainstem auditory evoked potentials (BAEP) changes with the maturation of the auditory pathway, which is reached between 18 and 36 months old. Objective: To describe the maturation of BAEPs in healthy preschool children. Methods: Cross-sectional study. A sample of 102 preschool children were studied with adequate neurodevelopmental, age distribution (12–23 months, 24–35 months, 36–47 months, 48–59 month and 60–71 months). The stimulation parameters were: rarefaction, click, 80 dBnHL intensity, frequency 11.1 Hz and average of 2000 stimuli. We evaluated absolute latencies for I, III and V waves and interpeak latencies I–III, III–V and I–V expressed in milliseconds (ms) and hearing threshold expressed in decibels (dB).