- Email: [email protected]
B-7. Electrodiagnostic criteria for ALD: Current state and perspectives
Abstracts / Clinical Neurophysiology 129 (2018) e17–e43
physical or mental disorders. I will also review a recent topic that deep NREM sleep with delta EEG activity is an active brain process, in which memory and skills acquired during wakefulness are consolidated and made to be ready for use. In addition, such delta EEG activity during sleep is more strongly induced in those cortical areas where intensive task is loaded during wakefulness. Finally, I will consider how the above processes are controlled by the network between the thalamus and the cortex, with special reference to its relation to conventional sleep EEG patterns such as K-complex, spindle or sleep delta waves. doi:10.1016/j.clinph.2018.02.014
B-7. Electrodiagnostic criteria for ALD: Current state and perspectives—Satoshi Kuwabara (Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan) The diagnosis of amyotrophic lateral sclerosis (ALS) requires (1) evidence for extensive upper and lower motor neuron dysfunction, (2) progressive course, and (3) exclusion of other causes of motor neuronal loss. So far, a number of diagnostic criteria for ALS have been proposed, such as El Escorial (1990), revised El Escorial (1998), Awaji (2008), and updated Awaji (2015). According to the frequent revision/proposal criteria, electrodiagnostic criteria for ALS are somewhat confusing. In these criteria, the body motor system are divided into 4 regions; cranial, cervical, thoracic, and lumbosacral, and evidence for upper and lower motor neuron signs in the two or more regions are required for the diagnosis of ‘‘probable” ALS. This lecture reviews a history, current status, and perspectives for ALS electrogiagnosis. The diagnostic sensitivity latest version, the updated Awaji criteria is reported to be 73% in a recent systematic review. doi:10.1016/j.clinph.2018.02.015
B-9. Quantitative evaluation of motor function and its clinical application—Shinji Kakei (Movement Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan) A classic hypothesis for motor control assumes that the predictive controller (PC) and the feedback controller (FBC) work in parallel. Nevertheless, dissociation of outputs from the two controllers has never been possible, preventing evaluation of motor functions in movement disorders. Here we demonstrate a new method to separate outputs from PC and FBC. Subjects performed a tracking movement to pursue a slowly moving target, while we recorded movement with a manipulandum or a Kinect v2 sensor. We identified three components of tracking movement that were separable with FFT and identified in terms of their function. The primary, a lower frequency component (<0.5 Hz) continuously reproduced the target motion in a predictive manner. The second, an intermediate frequency component (0.5–3.0 Hz) represented intermittent corrections of position errors in a feedback manner. These results confirmed that the two components were generated from separate controllers. Furthermore, we identified the third, an even higher frequency component (>3.0 Hz), which showed characteristic increases in patients with Parkinson’s disease or stroke. Each of the three components provides unique parameters to quantify motor function of patients with movement disorders. Our new method provides a new framework to characterize movement disorders. doi:10.1016/j.clinph.2018.02.016
e19
B-10. Electrodiagnostic studies in entrapment neuropathy— Mitsuhiko Kodama (Department of Rehabilitation Medicine, Tokai University School of Medicine, Kanagawa, Japan) Electrodiagnosis of entrapment neuropathy at the upper limb is important to determine the treatment procedure. The median sensory nerve conduction studies and median nerve motor nerve distal latency have conventionally been performed for the diagnosis of carpal tunnel syndrome (CTS), but their sensitivities are not always sufficient. As a result of our research in 104 hands with CTS symptoms, both the ring finger test and second lumbrical–interossei comparison test had especially high sensitivity (92%), and this result supports the practice parameters recommended by the Japanese Society of Neurological Therapeutics. Exact localization of the lesion by electrodiagnosis in patients with ulnar neuropathy at the elbow (UNE) is often difficult because other disorders may mimic its symptoms (e.g., cervical lesion, brachial plexopathy, and Guyon’s canal syndrome). In one of our studies, sensitivity of the ulnar nerve motor nerve conduction velocity across the elbow lacked accuracy (54%). Meanwhile, the short-segment incremental study had the highest sensitivity (82%), maintaining high specificity (95%). In extreme UNEs, the combination of sensory nerve conduction studies evoked from the dorsal ulnar cutaneous branch and the medial antebrachial cutaneous nerve may be helpful in the exclusion of other disorders. doi:10.1016/j.clinph.2018.02.017
B-11. Application of EEG-based brain computer interface to movement and sensory disorders—Tetsuo Ota (Department of Physical Medicine & Rehabilitation Asahikawa Medical University Hospital, Asahikawa, Japan) Objective: To examine the effect of the EEG-based brain computer interface (BCI) training for patients with stroke, writer’s cramp and neuropathic pain. Method: Using the EEG recorded with Ag/AgCl electrodes placed at C3 and C4, as designated according to the International 10/20 system, we gave real time visual feedback to the patients with PC monitor which is placed in front of them. Participants were required to imagine the affected wrist extending in stroke and neuropathic pain patients. Patients with writer’s cramp were requested to relax their wrist flexor while extending their wrist. If these tasks were able to have an effect to the affected sensory motor cortex, we can see the change of patient’s sensory motor rhythm, for example what is called event-related desynchronization (ERD). While practicing this biofeedback system, patients made an effort to control their affected side EEG activity representing the ERD in stroke and neuropathic pain patients, and diminishing the event-related synchronization (ERS) in writer’s cramp patients. Results: After several months BCI training, some patients with stroke and neuropathic pain were able to change their EEG activity easily to have the ERD and after the 6 months training one writer’s cramp patient was able to diminish the ERS resulted in good performance. Moreover we could also confirm this change in stroke patients representing the sensory motor cortex activity by recording the functional MRI. Implications/Impact on Rehabilitation: The results suggest that this type of EEG-based brain computer interface training is useful method to improve some kinds of movement and sensory disorders. doi:10.1016/j.clinph.2018.02.018
physical or mental disorders. I will also review a recent topic that deep NREM sleep with delta EEG activity is an active brain process, in which memory and skills acquired during wakefulness are consolidated and made to be ready for use. In addition, such delta EEG activity during sleep is more strongly induced in those cortical areas where intensive task is loaded during wakefulness. Finally, I will consider how the above processes are controlled by the network between the thalamus and the cortex, with special reference to its relation to conventional sleep EEG patterns such as K-complex, spindle or sleep delta waves. doi:10.1016/j.clinph.2018.02.014
B-7. Electrodiagnostic criteria for ALD: Current state and perspectives—Satoshi Kuwabara (Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan) The diagnosis of amyotrophic lateral sclerosis (ALS) requires (1) evidence for extensive upper and lower motor neuron dysfunction, (2) progressive course, and (3) exclusion of other causes of motor neuronal loss. So far, a number of diagnostic criteria for ALS have been proposed, such as El Escorial (1990), revised El Escorial (1998), Awaji (2008), and updated Awaji (2015). According to the frequent revision/proposal criteria, electrodiagnostic criteria for ALS are somewhat confusing. In these criteria, the body motor system are divided into 4 regions; cranial, cervical, thoracic, and lumbosacral, and evidence for upper and lower motor neuron signs in the two or more regions are required for the diagnosis of ‘‘probable” ALS. This lecture reviews a history, current status, and perspectives for ALS electrogiagnosis. The diagnostic sensitivity latest version, the updated Awaji criteria is reported to be 73% in a recent systematic review. doi:10.1016/j.clinph.2018.02.015
B-9. Quantitative evaluation of motor function and its clinical application—Shinji Kakei (Movement Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan) A classic hypothesis for motor control assumes that the predictive controller (PC) and the feedback controller (FBC) work in parallel. Nevertheless, dissociation of outputs from the two controllers has never been possible, preventing evaluation of motor functions in movement disorders. Here we demonstrate a new method to separate outputs from PC and FBC. Subjects performed a tracking movement to pursue a slowly moving target, while we recorded movement with a manipulandum or a Kinect v2 sensor. We identified three components of tracking movement that were separable with FFT and identified in terms of their function. The primary, a lower frequency component (<0.5 Hz) continuously reproduced the target motion in a predictive manner. The second, an intermediate frequency component (0.5–3.0 Hz) represented intermittent corrections of position errors in a feedback manner. These results confirmed that the two components were generated from separate controllers. Furthermore, we identified the third, an even higher frequency component (>3.0 Hz), which showed characteristic increases in patients with Parkinson’s disease or stroke. Each of the three components provides unique parameters to quantify motor function of patients with movement disorders. Our new method provides a new framework to characterize movement disorders. doi:10.1016/j.clinph.2018.02.016
e19
B-10. Electrodiagnostic studies in entrapment neuropathy— Mitsuhiko Kodama (Department of Rehabilitation Medicine, Tokai University School of Medicine, Kanagawa, Japan) Electrodiagnosis of entrapment neuropathy at the upper limb is important to determine the treatment procedure. The median sensory nerve conduction studies and median nerve motor nerve distal latency have conventionally been performed for the diagnosis of carpal tunnel syndrome (CTS), but their sensitivities are not always sufficient. As a result of our research in 104 hands with CTS symptoms, both the ring finger test and second lumbrical–interossei comparison test had especially high sensitivity (92%), and this result supports the practice parameters recommended by the Japanese Society of Neurological Therapeutics. Exact localization of the lesion by electrodiagnosis in patients with ulnar neuropathy at the elbow (UNE) is often difficult because other disorders may mimic its symptoms (e.g., cervical lesion, brachial plexopathy, and Guyon’s canal syndrome). In one of our studies, sensitivity of the ulnar nerve motor nerve conduction velocity across the elbow lacked accuracy (54%). Meanwhile, the short-segment incremental study had the highest sensitivity (82%), maintaining high specificity (95%). In extreme UNEs, the combination of sensory nerve conduction studies evoked from the dorsal ulnar cutaneous branch and the medial antebrachial cutaneous nerve may be helpful in the exclusion of other disorders. doi:10.1016/j.clinph.2018.02.017
B-11. Application of EEG-based brain computer interface to movement and sensory disorders—Tetsuo Ota (Department of Physical Medicine & Rehabilitation Asahikawa Medical University Hospital, Asahikawa, Japan) Objective: To examine the effect of the EEG-based brain computer interface (BCI) training for patients with stroke, writer’s cramp and neuropathic pain. Method: Using the EEG recorded with Ag/AgCl electrodes placed at C3 and C4, as designated according to the International 10/20 system, we gave real time visual feedback to the patients with PC monitor which is placed in front of them. Participants were required to imagine the affected wrist extending in stroke and neuropathic pain patients. Patients with writer’s cramp were requested to relax their wrist flexor while extending their wrist. If these tasks were able to have an effect to the affected sensory motor cortex, we can see the change of patient’s sensory motor rhythm, for example what is called event-related desynchronization (ERD). While practicing this biofeedback system, patients made an effort to control their affected side EEG activity representing the ERD in stroke and neuropathic pain patients, and diminishing the event-related synchronization (ERS) in writer’s cramp patients. Results: After several months BCI training, some patients with stroke and neuropathic pain were able to change their EEG activity easily to have the ERD and after the 6 months training one writer’s cramp patient was able to diminish the ERS resulted in good performance. Moreover we could also confirm this change in stroke patients representing the sensory motor cortex activity by recording the functional MRI. Implications/Impact on Rehabilitation: The results suggest that this type of EEG-based brain computer interface training is useful method to improve some kinds of movement and sensory disorders. doi:10.1016/j.clinph.2018.02.018