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Consciousness in non-responsive patients: fMRI and EEG data
Abstracts of SAN Meeting / Neuroscience Letters 500S (2011) e1–e54
estimated using wrist actigraphy and sleep log data collected for 7 consecutive 24-h periods. Neuropsychological assessment included tests of attention, working memory, verbal fluency, planning and decision making. Results: The mean insomnia history was 122,13 ± 89,43 months long. 90% of the insomniacs complained of difficulty falling asleep, 63,3% of maintaining sleep and 70% of early morning awakening and non-restorative sleep. No statistical differences were found in tests of excessive daytime sleepiness (EDS), while insomniacs reported more fatigue symptoms. Significant differences were observed in tests of sustained attention, the phonological loop and visuospatial sketchpad. Moreover, insomniacs had significantly lower performance in tasks of maintenance, codification and manipulation of information, inhibition of habitual but inappropriate responses and in one test during the dual task paradigm. Regarding fluency, insomniacs generated fewer words in the third task of both letter and category cues in verbal fluency tasks, whereas they generated more unacceptable designs in the design fluency task. Conclusion: Our chronic insomniacs suffered from multiple sleep difficulties, experienced fatigue and general discomfort, but no EDS symptoms were present. Even young insomniacs present subtle neuropsychological deficiencies in fluency, owing to sustained attention deficits, and working memory, especially regarding the central executive. doi:10.1016/j.neulet.2011.05.174 Consciousness in non-responsive patients: fMRI and EEG data Efthymios Angelakis 1 , Nikos Andreadis 1 , Evangelia Liouta 1 , Theofanis Flaskas 1 , Dimitris Verganelakis 2 , Damianos Sakas 1 1 Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis,” Department of Neurosurgery, University of Athens, Greece 2 Encephalos-Euromedica Diagnostic Medical Center, Greece Objectives: Is there a way to assess consciousness in apparently non-responsive patients? The present study attempts to address this question by measuring hemodynamic and electrical brain activity. Methods: fMRI and EEG was recorded during verbal stimulation with motor commands (“move your hand”) vs. non-motor commands, separately for each hand, in patients with persistent vegetative state (PVS, 10 patients), or minimally conscious state (MCS, 2 patients), and in 8 healthy controls. Results: Group analysis of 8 healthy volunteers showed significant fMRI activations in contralateral primary motor cortex, supplementary motor area, pre-motor cortex, and ipsilateral cerebellum. Patients with MCS showed partial similar activations. Patients with PVS showed sporadic activations. A common pattern of EEG responses appeared in healthy volunteers, mostly in interelectrode coherence of the 10–12 Hz frequency. Patient data are under analysis. Conclusions: fMRI and EEG measures of brain activity may help assess consciousness in apparently non-responsive patients. This procedure may help selection of patients for further treatment with electrical brain stimulation. doi:10.1016/j.neulet.2011.05.175
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Antiretroviral CNS penetration effectiveness rank is associated with HIV-related peripheral sensory polyneuropathy and intraepidermal nerve fiber density Elias Skopelitis 1 , Athanasios Kontos 1 , Panayiotis Kokotis 2 , Kyriaki Aroni 3 , George Panayiotakopoulos 4 , Kyriaki Panagiotopoulou 1 , Theodore Kordossis 1 1 Laikon General Hospital, Greece 2 Aeginiteion Neurology Hospital, Greece 3 University of Athens, School of Medicine, Dept. of Pathology, Greece 4 University of Patras, Greece Objectives: A method for quantifying penetration of antiretroviral (ARV) drugs was devised and validated in the CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) study, providing a rank of combination drug regimens by algorithmically combining the individual drug rankings. The CNS penetration-effectiveness (CPE) rank was associated with CSF VL. Patients treated with regimens having lower CPE ranks showed more residual CSF viral replication than those treated with higher CPE ranks. The present study aimed to investigate whether the CPE rank was also associated with the degree of peripheral sensory polyneuropathy (PSPN). Methods: A total of 102 consecutive HIV patients from an outpatient clinic were studied with clinical examination, electrophysiology, and intraepidermal nerve fiber density (IENFD) for the presence of PSPN. The HIV status, surrogate markers and antiretroviral history was recorded and the CPE rank of the current ARV regimen was calculated. Statistical analysis was executed using SPSS 15.0 Results: Almost 16% presented with symptomatic PSPN and another 36% demonstrated subclinical PSPN, recognized by means of electrophysiology and IENFD determination. IENFD was associated with more advanced HIV disease, lower nadir CD4 count, and exposure to NRTIs. The median CPE rank for the patient population was 1.5 (range 0–3). The CPE rank did not differ in patients with or without PSPN. Using the cutoff value of CPE = 2 the regimen was characterized as CNS effective or not effective. Patients under not CNS effective regimen had lower values of IENFD (3.36 ± 1.75 vs 6.02 ± 2.47, p = 0.02). IENFD correlated with the CPE rank values (r = 0.31, p = 0.045). Conclusions: The use of ARV therapy capable of penetrating into the CNS was associated with worse IENFD, a measure of small fiber neuropathy, even though patients with and without peripheral sensory polyneuropathy diagnosis did not differ in respect of CPE rank of their ARV regimen. doi:10.1016/j.neulet.2011.05.176 Method of the EEG operant conditioning for the children with learning disabilities Paulis Butlers Riga Stradins University, Latvia Introduction: EEG operant conditioning (neurofeedback) has been developed and used as a form of integrative therapy particularly for children with learning disabilities. This method is based on the neuronal conditioning of specific cerebral EEG activity. Materials and methods: More than 240 EEG records were analysed from Cz, C3 and C4 scalp areas of 12 children (8–12 years old) with learning disabilities during 20 sessions of neurofeedback training. A standard protocol of sensorimotor SMR frequency band (12–15 Hz) enhancing with concurrent reduction of theta (3–6 Hz) activity was applied. 2-Chanel EEG module 2E (BrainMaster Technologies, Inc.) with standard software was used. Linear (Pearson) correlation analysis of the power of different EEG frequency bands
estimated using wrist actigraphy and sleep log data collected for 7 consecutive 24-h periods. Neuropsychological assessment included tests of attention, working memory, verbal fluency, planning and decision making. Results: The mean insomnia history was 122,13 ± 89,43 months long. 90% of the insomniacs complained of difficulty falling asleep, 63,3% of maintaining sleep and 70% of early morning awakening and non-restorative sleep. No statistical differences were found in tests of excessive daytime sleepiness (EDS), while insomniacs reported more fatigue symptoms. Significant differences were observed in tests of sustained attention, the phonological loop and visuospatial sketchpad. Moreover, insomniacs had significantly lower performance in tasks of maintenance, codification and manipulation of information, inhibition of habitual but inappropriate responses and in one test during the dual task paradigm. Regarding fluency, insomniacs generated fewer words in the third task of both letter and category cues in verbal fluency tasks, whereas they generated more unacceptable designs in the design fluency task. Conclusion: Our chronic insomniacs suffered from multiple sleep difficulties, experienced fatigue and general discomfort, but no EDS symptoms were present. Even young insomniacs present subtle neuropsychological deficiencies in fluency, owing to sustained attention deficits, and working memory, especially regarding the central executive. doi:10.1016/j.neulet.2011.05.174 Consciousness in non-responsive patients: fMRI and EEG data Efthymios Angelakis 1 , Nikos Andreadis 1 , Evangelia Liouta 1 , Theofanis Flaskas 1 , Dimitris Verganelakis 2 , Damianos Sakas 1 1 Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis,” Department of Neurosurgery, University of Athens, Greece 2 Encephalos-Euromedica Diagnostic Medical Center, Greece Objectives: Is there a way to assess consciousness in apparently non-responsive patients? The present study attempts to address this question by measuring hemodynamic and electrical brain activity. Methods: fMRI and EEG was recorded during verbal stimulation with motor commands (“move your hand”) vs. non-motor commands, separately for each hand, in patients with persistent vegetative state (PVS, 10 patients), or minimally conscious state (MCS, 2 patients), and in 8 healthy controls. Results: Group analysis of 8 healthy volunteers showed significant fMRI activations in contralateral primary motor cortex, supplementary motor area, pre-motor cortex, and ipsilateral cerebellum. Patients with MCS showed partial similar activations. Patients with PVS showed sporadic activations. A common pattern of EEG responses appeared in healthy volunteers, mostly in interelectrode coherence of the 10–12 Hz frequency. Patient data are under analysis. Conclusions: fMRI and EEG measures of brain activity may help assess consciousness in apparently non-responsive patients. This procedure may help selection of patients for further treatment with electrical brain stimulation. doi:10.1016/j.neulet.2011.05.175
e37
Antiretroviral CNS penetration effectiveness rank is associated with HIV-related peripheral sensory polyneuropathy and intraepidermal nerve fiber density Elias Skopelitis 1 , Athanasios Kontos 1 , Panayiotis Kokotis 2 , Kyriaki Aroni 3 , George Panayiotakopoulos 4 , Kyriaki Panagiotopoulou 1 , Theodore Kordossis 1 1 Laikon General Hospital, Greece 2 Aeginiteion Neurology Hospital, Greece 3 University of Athens, School of Medicine, Dept. of Pathology, Greece 4 University of Patras, Greece Objectives: A method for quantifying penetration of antiretroviral (ARV) drugs was devised and validated in the CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) study, providing a rank of combination drug regimens by algorithmically combining the individual drug rankings. The CNS penetration-effectiveness (CPE) rank was associated with CSF VL. Patients treated with regimens having lower CPE ranks showed more residual CSF viral replication than those treated with higher CPE ranks. The present study aimed to investigate whether the CPE rank was also associated with the degree of peripheral sensory polyneuropathy (PSPN). Methods: A total of 102 consecutive HIV patients from an outpatient clinic were studied with clinical examination, electrophysiology, and intraepidermal nerve fiber density (IENFD) for the presence of PSPN. The HIV status, surrogate markers and antiretroviral history was recorded and the CPE rank of the current ARV regimen was calculated. Statistical analysis was executed using SPSS 15.0 Results: Almost 16% presented with symptomatic PSPN and another 36% demonstrated subclinical PSPN, recognized by means of electrophysiology and IENFD determination. IENFD was associated with more advanced HIV disease, lower nadir CD4 count, and exposure to NRTIs. The median CPE rank for the patient population was 1.5 (range 0–3). The CPE rank did not differ in patients with or without PSPN. Using the cutoff value of CPE = 2 the regimen was characterized as CNS effective or not effective. Patients under not CNS effective regimen had lower values of IENFD (3.36 ± 1.75 vs 6.02 ± 2.47, p = 0.02). IENFD correlated with the CPE rank values (r = 0.31, p = 0.045). Conclusions: The use of ARV therapy capable of penetrating into the CNS was associated with worse IENFD, a measure of small fiber neuropathy, even though patients with and without peripheral sensory polyneuropathy diagnosis did not differ in respect of CPE rank of their ARV regimen. doi:10.1016/j.neulet.2011.05.176 Method of the EEG operant conditioning for the children with learning disabilities Paulis Butlers Riga Stradins University, Latvia Introduction: EEG operant conditioning (neurofeedback) has been developed and used as a form of integrative therapy particularly for children with learning disabilities. This method is based on the neuronal conditioning of specific cerebral EEG activity. Materials and methods: More than 240 EEG records were analysed from Cz, C3 and C4 scalp areas of 12 children (8–12 years old) with learning disabilities during 20 sessions of neurofeedback training. A standard protocol of sensorimotor SMR frequency band (12–15 Hz) enhancing with concurrent reduction of theta (3–6 Hz) activity was applied. 2-Chanel EEG module 2E (BrainMaster Technologies, Inc.) with standard software was used. Linear (Pearson) correlation analysis of the power of different EEG frequency bands