- Email: [email protected]
German EEG society
192
SOCIETY PROCEEDINGS
than in the combined scalp recording. The 14 and 6 pattern was limited to the thalamo-capsular probe and not seen in the frontal tresses. Accentuation of 14 and 6 activity was noted in 3 different contact levels: the thalamo-capsular area, the internal capsule adjacent to the putamen and an area within the white matter deep in the frontal lobe, probably close to a buried sulcus. The 14 as well as the 6/see component was demon-
strable. The deep 14 and 6 discharge showed both a positive and a negative component while unequivocal positivity was observed in the scalp leads. Our study suggests (a) a deep origin of the 14 and 6 pattern and (b) equivocal polarity in the depth with a positive as well as a negative component. (Full paper: this Journal, 1967, 22: 86-89.)
Electroenceph. clin. Neurophysiol., 1967, 22:188-192
G E R M A N EEG SOCIETY Wiesbaden, April 18, 1966
Secretary." DR. ST. KUBICKI Neurosurgical Clinic, Free University of Berlin, Berlin 19 ( Western Germany) 1. The value of longitudinal EEG studies in malimmnt tumours.-- E. MUller (Bochum). Repeated E E G examinations have been carried out in 103 patients with extracerebral tumours during a period of 2-6 months. In 45 9/0 the primary tumour was in the respiratory tract, in 27.5 % in the genito-urinary tract and then, in decreasing frequency, blastomata of the mammary glands, of the gastro-intestinal tract, the oral cavity, the throat and oesophagus as well as the male and female genital organs; 93 % of these blastomata were carcinomas. The initial EEG was definitely abnormal in half the cases and only in one third unequivocally normal. 61% of those with tumours of the respiratory tract had an abnormal initial EEG. In the course of the illness the number of abnormal E E G recordings increased. By the time of the 4th examination a normal record was found in only 13 9/00. Only 5 % of the initial EEGs remained unchanged. On the basis of these observations the E E G is held to be a good indicator of a favourable or unfavourable prognosis. The correlation between EEG and neurological findings was not close. In over half the cases a correlation between the abnormal clinical and E E G findings and the tumour could be excluded. In 9 % cerebral metastases could be demonstrated. Abnormal E E G records were also found in metacarcinomatous neuro-myopathies. Those E E G changes which are not a direct consequence of the tumour are difficult to interpret. Partly they can be explained as connected with changes due to age and cerebral circulatory lesions. A matter for discussion is how far "carcinotoxic" metabolic disturbances are or are not a factor responsible for the EEG changes, analogous to tumour cachexia. 2. On the diagnostic value of the EEG picture in hepatoportal eneephalopathy. - - H. Penin (Bonn).
Hepato-portal encephalopathy was the occasion for a comparative psycho-pathological E E G examination of the disease process in 114 patients with surgically induced
porto-caval anastomosis for cirrhosis and 142 patients with spontaneous collateral circulation of the portal vein. The only difference between operated and non-operated patients with liver disease was with regard to the frequency distribution of acute encephalopathies with a pathological EEG, while the total of all the hepato-portal encephalopathies, i.e. both acute and chronic forms, showed no marked difference from the control groups in severity or distribution in their course over more than 10 years. There is no special pathogenetic factor (Sherlock) underlying the greater number of acute encephalopathies in the operated cases, which is a consequence of the increased length of life without haemorrhage and the terminally aggravated cirrhosis of the liver during the relatively long illness; acute encephalopathy is rarely met clinically in unoperated cases because of the often fatal haemorrhages. The EEG proved to be a reliable indicator for differentiating the acute and chronic forms of hepato-portal encephalopathy, and closely paralleled the acuteness of the underlying cirrhosis. Abnormal rhythms were very frequently observed. These were grouped as alpha, theta, delta paten rhythms ( = intermittent) and continuous alpha, theta, delta aidio rhythms ( = permanent) and were distinguished from dysrhythmias and generalized changes because a different psycho-pathologic significance can be attached to the pathological monorhythm of slow brain waves than to the pathological polyrhythms. 3. On encephalopathies in liver disease. - - A. Kollmannsberger, J. Kugler and K. P. Eymer (Munich).
Of 34 patients with cirrhosis of the liver or liver dystrophy examined by us electroencephalographically and clinically during the last 2 years, 21 had indications of a l,epatic encephalopathy. In 14 patients the course of the illness could be followed electroencephalographically over a longer period. E E G abnormalities preceded the clinical manifestation of encephalopathy in 10 cases. The main
Electroenceph. clin. Neurophysiol., 1967, 22: 192-194
GERMAN EEG SOCIETY importance of the EEG control is in the early detection of cerebral involvement secondary to the complex metabolic disturbances in liver disease. This appears to be particularly important as regards therapy; for instance, protein restriction in porto-caval shunts. The surgeon who wants to carry out a shunt operation in a patient with cirrhosis and portal hypertension will hesitate to operate if the EEG already shows abnormalities. The most frequent neurological or psychic disturbances in our patients with hepatic encephalopathy were: coma (8 times), pre-coma (7 times), memory defect (7 times), depressive symptoms (4 times), twilight states (4 times), Parkinsonism (twice). We found flapping-tremor in almost all patients with acute exacerbation. The 2 patients with Parkinsonism underwent a portocaval shunt operation 1 year and 6 weeks respectively before the appearance of the neurological symptoms. To be considered as particularly unfavourable prognostic signs are: (1) a marked flattening of the EEG between groups of slow waves and (2) a marked change in the localization of the abnormalities.
4. Depth of coma and EEG changes in narcotic poisoning. St.Kubieki (Berlin). An aetiologically homogeneous disease group shows in general a good correlation between depth of coma and the EEG changes. In narcotic poisoning there is the closest agreement between the pattern of "black-outs and bursts" and the clinical picture of the vita reducta (Masshoff and Neuhaus). This concept, like the synonymous coma avec effondrement vdgJtatif of Fischgold and Mathis is to be preferred to coma ddpass~ of Mollaret, as in narcotic poisoning the condition is reversible. In coma avec effondrement vJgJtatif deterioration or improvement can best be detected in the EEG by the increase or decrease of episodes of flattening of the record. In the phase of ordinary coma the clinical neurological changes make possible a subtler determination of the depth of unconsciousness (stages 3-6 according to Bozza Marrubini (Acta neurochir. ( W i e n ) , 1964, 12" 352). During these stages of coma only continuous delta rhythms can be observed in the EEG. In "mild coma", the characteristic feature of which is motor responses to painful stimuli, longer stretches of delta activity frequently appear, which can even be evoked acoustically. During drowsiness, on the contrary, only short delta bursts of tension-activated 12-18 c/see are found. The E E G records at the onset of the intoxication are very different from those of the recovery phase, although the clinico-neurolngical pictures cannot in practice be differentiated. Before a coma avec effondrement vJgJtatif delta waves are found with superimposed tension-activated 9-12 c/see activity which is accentuated in the pre-central and temporal regions, and after the coma delta waves with or without mono- or triphasic waves. Accordingly the tension-activated 12-18 c/see activity during the going to sleep phase stands in contradistinction to delta activity during the awakening phase. The correlation of EEG patterns with definite changes in consciousness is relatively close. In fatigue, on the one hand, and in complete loss of consciousness, on the other, only the pre-centrally and temporally accentuated activity at 12-18 c/see is found. Mme. Arfel-Capdevielle also found correspondingly
193
differing clinical states of the same EEG form during anaesthesia. The EEG record and the corresponding clinical pictures are practically the same with all narcotics. A single exception is glutethimide, which gives no typical "black-outs" and in which the coma avec effondrement vdgdtatif starts straight away with the pattern of delta waves and superimposed 9-12 c/sec.
5. EEG examination in uraemic eneephaiopathy during intermittent peritoneal dialysis. - - E. Zysno, F. Diirr, H. E. Reichenmiller and H. Nieth (Tiibingen). Uraemic encephalopathy is the consequence of acute or chronic renal failure, in which it is still difficult to determine the pathogenesis of the uraemic intoxication. Urea alone cannot bring about the disturbance in cerebral function, but can lead to enzyme blocking. The neuropathological changes are also rarely specific; occasionally brain oedema is the consequence of demineralization. More recent investigations point to a significant increase in sodium and potassium in the brain, while the chloride and the intracellular fluid are clearly decreased. As therapy in chronic uraemias we favour intermittent peritoneal dialysis, which acts more gently because of the slow reduction of retained substances. As with extracorporeal haemodialysis we have also carried out an EEG control of the patients with intermittent peritoneal dialysis before and after treatment. Up till now we have reviewed 106 progress curves in 51 peritoneal dialyses. In the patients with chronic renal failure the time factor plays an important part in the EEG changes, because the brain has adjusted to the altered metabolism in a particular way. Therefore more moderate generalized changes are found in the E E G and the more slowly acting peritoneal dialysis causes only slight changes in brain potentials. Contrary to our findings in patients with extracorporeal haemodialysis we saw an improvement in 80 % of EEG records after intermittent peritoneal dialysis as compared with the initial record. Corresponding to the nature of the underlying disease this improvement was brief without influencing the ultimate prognosis. The main changes in the EEG consisted in a progressive slowing of the background activity and the paroxysmal appearance of sharp bursts of discharges resembling convulsive activity or true convulsive potentials. The occurrence of generalized convulsive discharges in the course of intermittent peritoneal dialysis usually indicated the approach of the terminal stage.
6. EEG findings in thalidomide-damaged children. - - W. Horstmann (Freiburgi.B.). Contrary to the widespread view that malformations in the thalidomide syndrome should only be looked for in mesodermaUy-derived organs, it is shown by means of EEG and neurological findings (17 patients), that exceptions are encountered, particularly in that group of thalidomide-damaged children who exhibit a visible malformation of the ears, ranging from a thickening of the auricle and a deep insertion of the ear to complete absence of the ear. Striking among these children (9) are, on the one hand, the absent or only minimal dysmyelia and, on the other, Electroenceph. clin. Neurophysiol., 1967, 22:192-194
194
SOCIETY PROCEEDINGS
in 7 patients, single or multiple, sometimes bilateral, complete or partial, absence of cranial nerves, viz., VII (7 times), VIII (5 times), VI (4 times), III (twice), II (once), X t I (once) and IX (once). The psychomotor development is slightly to moderately retarded throughout, as equally are the length, weight and bony development. In "thalidomide-children" without aural embryopathy and without loss of cranial nerves, who make up by far the majority, one would obviously expect a pathological EEG report only exceptionally (1 in 8), while in the other group a predominance of abnormal EEGs is found (8 out of 9) : fgcal dysrhythmias, spike foci or paroxysmal, generalized, irregular slow wave complexes, or polyphasic sharp discharges. Together with isolated increased pathological-anatomical findings (cerebellar aplasia, cavum septi pellucidi) the pathological EEG and cranial nerve signs allow one to infer the anomalies of the CNS in some of the thalidomide embryopathies. The close relationship to the syndrome of congenital nuclear aplasia (M/Sbius) is pointed out.
wave complexes and, at times, delta waves particularly with larger polymorphic spikes and waves on the right, which appeared often 15 msec before, more rarely also shortly after, large muscle potentials in the E M G of the left biceps. Activation by photic, acoustic and tactile stimulation, clear suppression of spikes and waves on hyperventilation. 1 year before death, on anticonvulsant medication, irregular groups or trains of spikes and waves, repeated periods without them. Patient died of pneumonia, aged 24. Histologically, typical microgyria with small convolutions, absent differentiation of cortical layers, but with fibre connections, as well as heterotopias, partly of deep subcortically localized grey matter. Microscopically no definite pathological diagnosis was made. In the dorso-medial thalamus, dentate and olive a doubtful, small and partial loss of cells. The tigroid substance in the dentate cells was powdery. No definite inclusion bodies. We could not find a similar case of cerebral malformations with myoclonus epilepsy in the literature.
7. Myoclonus epilepsy in a ease of mierogyria. - - H. D. Weigeldt, G. Ossenkopp, H. Kehler (Bremen).
8. Constellation of conditions in the manifestation of basal dysrhythmia. - - S. Kanowski and H. Kiinkel (Berlin).
This demonstration was given because of the peculiarity of the histo-pathological findings in a man with myoclonus epilepsy. Family history negative, prolonged labour, talking at 3 years. At 10 years ataxic gait after a fall from a height of 3 m without head injury. 3 months later first generalized fit, further fits at intervals of about 2 months and, finally, increasing myoclonic jerks and epileptic psychic changes. At the age of 13 years carotid angiography revealed a convoluted vessel and a right parieto-central craniotomy was carried out, which showed microgyria. 6 years on anticonvulsant therapy: no generalized fits but increasingly frequent and intense, uncoordinated, synchronous, sudden, myoclonic jerks (demonstrated by a film). At 21 years more frequent generalized attacks and paranoid delusions, explosive reactions with hitting out, insulting behaviour and spitting. On physical examination, marked struma diffusa colloides, slight generalized muscular atrophy, left spastic hemiparesis, dysdiadochokinesia, intention tremor and barely intelligible, scanning speech. The EEG 4 and 5 years before death showed irregular 12-13 c/see alpha activity up to 30/~V, diffuse theta waves, multiple spike and
Using analysis of variance 2880 patients were examined to see which factors influence the manifestation of a basal dysrhythmia. The basal dysrhythmia was described by means of typical curves. The following statistically significant results were obtained. (1) A one-sided influence of sex can be proved. The female sex is significantly more strongly predisposed to the manifestation of a basal dysrhythmia. (2) An influence of age is found, such that patients below 40 are predisposed to basal dysrhythmia to a greater degree than the more elderly. (3) Those with cerebral seizures show a higher proportion of basal dysrhythmia than t he rest of the population. (4) The facilitatory action of the female sex and the inhibitory action of greater age on the appearance of basal dysrhythmia broadly cancel each other out. (5) In neuroses and abnormal reactions to experience basal dysrhythmia is found more frequently than in the control population, but this influence is not statistically significant. Migraine sufferers and those with vasomotor conditioned headache show no greater frequency of basal dysrhythmia than the control population. (6) In patients with seizures anticonvulsant therapy has not led to a change in the frequency of basal dysrhythmia.
Electroenceph. clin. Neurophysiol., 1967, 22: 192-194
ANNOUNCEMENT ELECTROMYOGRAPHY
A n international meeting on Electromyography and Clinical Neurophysiology will be held in Glasgow, under the auspices of the Pavia Committee on Electromyo-
graphy, from June 28-July 1, 1967. Further details may be obtained from Professor J. A. Simpson, Department of Neurology, Glasgow University, Glasgow, Scotland.
Electroenceph. clin. Neuroph.vsiol., 1967, 22:194
SOCIETY PROCEEDINGS
than in the combined scalp recording. The 14 and 6 pattern was limited to the thalamo-capsular probe and not seen in the frontal tresses. Accentuation of 14 and 6 activity was noted in 3 different contact levels: the thalamo-capsular area, the internal capsule adjacent to the putamen and an area within the white matter deep in the frontal lobe, probably close to a buried sulcus. The 14 as well as the 6/see component was demon-
strable. The deep 14 and 6 discharge showed both a positive and a negative component while unequivocal positivity was observed in the scalp leads. Our study suggests (a) a deep origin of the 14 and 6 pattern and (b) equivocal polarity in the depth with a positive as well as a negative component. (Full paper: this Journal, 1967, 22: 86-89.)
Electroenceph. clin. Neurophysiol., 1967, 22:188-192
G E R M A N EEG SOCIETY Wiesbaden, April 18, 1966
Secretary." DR. ST. KUBICKI Neurosurgical Clinic, Free University of Berlin, Berlin 19 ( Western Germany) 1. The value of longitudinal EEG studies in malimmnt tumours.-- E. MUller (Bochum). Repeated E E G examinations have been carried out in 103 patients with extracerebral tumours during a period of 2-6 months. In 45 9/0 the primary tumour was in the respiratory tract, in 27.5 % in the genito-urinary tract and then, in decreasing frequency, blastomata of the mammary glands, of the gastro-intestinal tract, the oral cavity, the throat and oesophagus as well as the male and female genital organs; 93 % of these blastomata were carcinomas. The initial EEG was definitely abnormal in half the cases and only in one third unequivocally normal. 61% of those with tumours of the respiratory tract had an abnormal initial EEG. In the course of the illness the number of abnormal E E G recordings increased. By the time of the 4th examination a normal record was found in only 13 9/00. Only 5 % of the initial EEGs remained unchanged. On the basis of these observations the E E G is held to be a good indicator of a favourable or unfavourable prognosis. The correlation between EEG and neurological findings was not close. In over half the cases a correlation between the abnormal clinical and E E G findings and the tumour could be excluded. In 9 % cerebral metastases could be demonstrated. Abnormal E E G records were also found in metacarcinomatous neuro-myopathies. Those E E G changes which are not a direct consequence of the tumour are difficult to interpret. Partly they can be explained as connected with changes due to age and cerebral circulatory lesions. A matter for discussion is how far "carcinotoxic" metabolic disturbances are or are not a factor responsible for the EEG changes, analogous to tumour cachexia. 2. On the diagnostic value of the EEG picture in hepatoportal eneephalopathy. - - H. Penin (Bonn).
Hepato-portal encephalopathy was the occasion for a comparative psycho-pathological E E G examination of the disease process in 114 patients with surgically induced
porto-caval anastomosis for cirrhosis and 142 patients with spontaneous collateral circulation of the portal vein. The only difference between operated and non-operated patients with liver disease was with regard to the frequency distribution of acute encephalopathies with a pathological EEG, while the total of all the hepato-portal encephalopathies, i.e. both acute and chronic forms, showed no marked difference from the control groups in severity or distribution in their course over more than 10 years. There is no special pathogenetic factor (Sherlock) underlying the greater number of acute encephalopathies in the operated cases, which is a consequence of the increased length of life without haemorrhage and the terminally aggravated cirrhosis of the liver during the relatively long illness; acute encephalopathy is rarely met clinically in unoperated cases because of the often fatal haemorrhages. The EEG proved to be a reliable indicator for differentiating the acute and chronic forms of hepato-portal encephalopathy, and closely paralleled the acuteness of the underlying cirrhosis. Abnormal rhythms were very frequently observed. These were grouped as alpha, theta, delta paten rhythms ( = intermittent) and continuous alpha, theta, delta aidio rhythms ( = permanent) and were distinguished from dysrhythmias and generalized changes because a different psycho-pathologic significance can be attached to the pathological monorhythm of slow brain waves than to the pathological polyrhythms. 3. On encephalopathies in liver disease. - - A. Kollmannsberger, J. Kugler and K. P. Eymer (Munich).
Of 34 patients with cirrhosis of the liver or liver dystrophy examined by us electroencephalographically and clinically during the last 2 years, 21 had indications of a l,epatic encephalopathy. In 14 patients the course of the illness could be followed electroencephalographically over a longer period. E E G abnormalities preceded the clinical manifestation of encephalopathy in 10 cases. The main
Electroenceph. clin. Neurophysiol., 1967, 22: 192-194
GERMAN EEG SOCIETY importance of the EEG control is in the early detection of cerebral involvement secondary to the complex metabolic disturbances in liver disease. This appears to be particularly important as regards therapy; for instance, protein restriction in porto-caval shunts. The surgeon who wants to carry out a shunt operation in a patient with cirrhosis and portal hypertension will hesitate to operate if the EEG already shows abnormalities. The most frequent neurological or psychic disturbances in our patients with hepatic encephalopathy were: coma (8 times), pre-coma (7 times), memory defect (7 times), depressive symptoms (4 times), twilight states (4 times), Parkinsonism (twice). We found flapping-tremor in almost all patients with acute exacerbation. The 2 patients with Parkinsonism underwent a portocaval shunt operation 1 year and 6 weeks respectively before the appearance of the neurological symptoms. To be considered as particularly unfavourable prognostic signs are: (1) a marked flattening of the EEG between groups of slow waves and (2) a marked change in the localization of the abnormalities.
4. Depth of coma and EEG changes in narcotic poisoning. St.Kubieki (Berlin). An aetiologically homogeneous disease group shows in general a good correlation between depth of coma and the EEG changes. In narcotic poisoning there is the closest agreement between the pattern of "black-outs and bursts" and the clinical picture of the vita reducta (Masshoff and Neuhaus). This concept, like the synonymous coma avec effondrement vdgJtatif of Fischgold and Mathis is to be preferred to coma ddpass~ of Mollaret, as in narcotic poisoning the condition is reversible. In coma avec effondrement vJgJtatif deterioration or improvement can best be detected in the EEG by the increase or decrease of episodes of flattening of the record. In the phase of ordinary coma the clinical neurological changes make possible a subtler determination of the depth of unconsciousness (stages 3-6 according to Bozza Marrubini (Acta neurochir. ( W i e n ) , 1964, 12" 352). During these stages of coma only continuous delta rhythms can be observed in the EEG. In "mild coma", the characteristic feature of which is motor responses to painful stimuli, longer stretches of delta activity frequently appear, which can even be evoked acoustically. During drowsiness, on the contrary, only short delta bursts of tension-activated 12-18 c/see are found. The E E G records at the onset of the intoxication are very different from those of the recovery phase, although the clinico-neurolngical pictures cannot in practice be differentiated. Before a coma avec effondrement vJgJtatif delta waves are found with superimposed tension-activated 9-12 c/see activity which is accentuated in the pre-central and temporal regions, and after the coma delta waves with or without mono- or triphasic waves. Accordingly the tension-activated 12-18 c/see activity during the going to sleep phase stands in contradistinction to delta activity during the awakening phase. The correlation of EEG patterns with definite changes in consciousness is relatively close. In fatigue, on the one hand, and in complete loss of consciousness, on the other, only the pre-centrally and temporally accentuated activity at 12-18 c/see is found. Mme. Arfel-Capdevielle also found correspondingly
193
differing clinical states of the same EEG form during anaesthesia. The EEG record and the corresponding clinical pictures are practically the same with all narcotics. A single exception is glutethimide, which gives no typical "black-outs" and in which the coma avec effondrement vdgdtatif starts straight away with the pattern of delta waves and superimposed 9-12 c/sec.
5. EEG examination in uraemic eneephaiopathy during intermittent peritoneal dialysis. - - E. Zysno, F. Diirr, H. E. Reichenmiller and H. Nieth (Tiibingen). Uraemic encephalopathy is the consequence of acute or chronic renal failure, in which it is still difficult to determine the pathogenesis of the uraemic intoxication. Urea alone cannot bring about the disturbance in cerebral function, but can lead to enzyme blocking. The neuropathological changes are also rarely specific; occasionally brain oedema is the consequence of demineralization. More recent investigations point to a significant increase in sodium and potassium in the brain, while the chloride and the intracellular fluid are clearly decreased. As therapy in chronic uraemias we favour intermittent peritoneal dialysis, which acts more gently because of the slow reduction of retained substances. As with extracorporeal haemodialysis we have also carried out an EEG control of the patients with intermittent peritoneal dialysis before and after treatment. Up till now we have reviewed 106 progress curves in 51 peritoneal dialyses. In the patients with chronic renal failure the time factor plays an important part in the EEG changes, because the brain has adjusted to the altered metabolism in a particular way. Therefore more moderate generalized changes are found in the E E G and the more slowly acting peritoneal dialysis causes only slight changes in brain potentials. Contrary to our findings in patients with extracorporeal haemodialysis we saw an improvement in 80 % of EEG records after intermittent peritoneal dialysis as compared with the initial record. Corresponding to the nature of the underlying disease this improvement was brief without influencing the ultimate prognosis. The main changes in the EEG consisted in a progressive slowing of the background activity and the paroxysmal appearance of sharp bursts of discharges resembling convulsive activity or true convulsive potentials. The occurrence of generalized convulsive discharges in the course of intermittent peritoneal dialysis usually indicated the approach of the terminal stage.
6. EEG findings in thalidomide-damaged children. - - W. Horstmann (Freiburgi.B.). Contrary to the widespread view that malformations in the thalidomide syndrome should only be looked for in mesodermaUy-derived organs, it is shown by means of EEG and neurological findings (17 patients), that exceptions are encountered, particularly in that group of thalidomide-damaged children who exhibit a visible malformation of the ears, ranging from a thickening of the auricle and a deep insertion of the ear to complete absence of the ear. Striking among these children (9) are, on the one hand, the absent or only minimal dysmyelia and, on the other, Electroenceph. clin. Neurophysiol., 1967, 22:192-194
194
SOCIETY PROCEEDINGS
in 7 patients, single or multiple, sometimes bilateral, complete or partial, absence of cranial nerves, viz., VII (7 times), VIII (5 times), VI (4 times), III (twice), II (once), X t I (once) and IX (once). The psychomotor development is slightly to moderately retarded throughout, as equally are the length, weight and bony development. In "thalidomide-children" without aural embryopathy and without loss of cranial nerves, who make up by far the majority, one would obviously expect a pathological EEG report only exceptionally (1 in 8), while in the other group a predominance of abnormal EEGs is found (8 out of 9) : fgcal dysrhythmias, spike foci or paroxysmal, generalized, irregular slow wave complexes, or polyphasic sharp discharges. Together with isolated increased pathological-anatomical findings (cerebellar aplasia, cavum septi pellucidi) the pathological EEG and cranial nerve signs allow one to infer the anomalies of the CNS in some of the thalidomide embryopathies. The close relationship to the syndrome of congenital nuclear aplasia (M/Sbius) is pointed out.
wave complexes and, at times, delta waves particularly with larger polymorphic spikes and waves on the right, which appeared often 15 msec before, more rarely also shortly after, large muscle potentials in the E M G of the left biceps. Activation by photic, acoustic and tactile stimulation, clear suppression of spikes and waves on hyperventilation. 1 year before death, on anticonvulsant medication, irregular groups or trains of spikes and waves, repeated periods without them. Patient died of pneumonia, aged 24. Histologically, typical microgyria with small convolutions, absent differentiation of cortical layers, but with fibre connections, as well as heterotopias, partly of deep subcortically localized grey matter. Microscopically no definite pathological diagnosis was made. In the dorso-medial thalamus, dentate and olive a doubtful, small and partial loss of cells. The tigroid substance in the dentate cells was powdery. No definite inclusion bodies. We could not find a similar case of cerebral malformations with myoclonus epilepsy in the literature.
7. Myoclonus epilepsy in a ease of mierogyria. - - H. D. Weigeldt, G. Ossenkopp, H. Kehler (Bremen).
8. Constellation of conditions in the manifestation of basal dysrhythmia. - - S. Kanowski and H. Kiinkel (Berlin).
This demonstration was given because of the peculiarity of the histo-pathological findings in a man with myoclonus epilepsy. Family history negative, prolonged labour, talking at 3 years. At 10 years ataxic gait after a fall from a height of 3 m without head injury. 3 months later first generalized fit, further fits at intervals of about 2 months and, finally, increasing myoclonic jerks and epileptic psychic changes. At the age of 13 years carotid angiography revealed a convoluted vessel and a right parieto-central craniotomy was carried out, which showed microgyria. 6 years on anticonvulsant therapy: no generalized fits but increasingly frequent and intense, uncoordinated, synchronous, sudden, myoclonic jerks (demonstrated by a film). At 21 years more frequent generalized attacks and paranoid delusions, explosive reactions with hitting out, insulting behaviour and spitting. On physical examination, marked struma diffusa colloides, slight generalized muscular atrophy, left spastic hemiparesis, dysdiadochokinesia, intention tremor and barely intelligible, scanning speech. The EEG 4 and 5 years before death showed irregular 12-13 c/see alpha activity up to 30/~V, diffuse theta waves, multiple spike and
Using analysis of variance 2880 patients were examined to see which factors influence the manifestation of a basal dysrhythmia. The basal dysrhythmia was described by means of typical curves. The following statistically significant results were obtained. (1) A one-sided influence of sex can be proved. The female sex is significantly more strongly predisposed to the manifestation of a basal dysrhythmia. (2) An influence of age is found, such that patients below 40 are predisposed to basal dysrhythmia to a greater degree than the more elderly. (3) Those with cerebral seizures show a higher proportion of basal dysrhythmia than t he rest of the population. (4) The facilitatory action of the female sex and the inhibitory action of greater age on the appearance of basal dysrhythmia broadly cancel each other out. (5) In neuroses and abnormal reactions to experience basal dysrhythmia is found more frequently than in the control population, but this influence is not statistically significant. Migraine sufferers and those with vasomotor conditioned headache show no greater frequency of basal dysrhythmia than the control population. (6) In patients with seizures anticonvulsant therapy has not led to a change in the frequency of basal dysrhythmia.
Electroenceph. clin. Neurophysiol., 1967, 22: 192-194
ANNOUNCEMENT ELECTROMYOGRAPHY
A n international meeting on Electromyography and Clinical Neurophysiology will be held in Glasgow, under the auspices of the Pavia Committee on Electromyo-
graphy, from June 28-July 1, 1967. Further details may be obtained from Professor J. A. Simpson, Department of Neurology, Glasgow University, Glasgow, Scotland.
Electroenceph. clin. Neuroph.vsiol., 1967, 22:194