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O78 Membrane depolarization in motor nerves of critical ill patients is related to insulin resistance
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Abstracts / Clinical Neurophysiology 128 (2017) e178–e303
O78 Membrane depolarization in motor nerves of critical ill patients is related to insulin resistance—Susanne Koch 1, Tobias Wollersheim 1, Kurt Mai 2, Kurt Haas 1, Claudia Spies 1, Steffen Weber-Carstens 1 (1 Charité Humboldt University, Anesthesiology and Intensive Care Medicine, Berlin, Germany2 Charité Humboldt University, Department of Endocrinology, Berlin, Germany) Objectives: Critical illness polyneuropathy/myopathy (CIP/CIM) features depolarization of the resting membrane potential and reduced membrane excitability in motor nerve and muscle.1–3 Since CIP/CIM shows an increased Insulin resistance,4 and Insulin is one agonist of the Na-K-pump controlling resting membrane potential,5 we like to prove if Insulin resistance is correlated with motor nerve resting membrane polarisation in critical ill patients. Methods: ICU patients were classified as ICU-control and CIM/CIP patients related to electrophysiological exam. Electrophysiological excitability studies recording the recovery-of-excitability at baseline and during Insulin clamp condition (euglycemic-hyperinsulinemic clamp) were conducted, to prove resting membrane polarization at baseline and after high dosage of Insulin (steady state).6 Insulin sensitivity Index (ISI), as marker of Insulin resistance, was calculated during steady state condition. Results: Two ICU-control and six CIM/CIP patients were enrolled. The resting membrane polarization during steady state condition was significantly correlated to ISI (R2 = 0.858; p = 0.001), where pronounced Insulin resistance correlates with pronounced membrane depolarization. Membrane repolarization after Insulin stimulation of Na-K-pump fails in CIM/CIP patients with severe Insulin resistance, compared to ICU control patients with a less severe Insulin resistance. Discussion: Resting membrane depolarization in critically ill patients is correlated to Insulin resistance, where membrane repolarization induced by Insulin seems to fail in CIM/CIP patients showing the most severe Insulin resistance,4 but not in ICU-control patients. Conclusions: Insulin resistance in critical ill patients, besides affecting glucose metabolism, also influences motor nerve dysfunction. Significance: We prove the link between muscle dysfunction and disturbed Glucose metabolism in CIM/CIP patients.
EEG is measured to calculate the evoked potentials as reactions to the stimuli. For assessment, the users had to follow predefined tasks, such as ‘‘count the stimuli you feel on your left hand”. The BCI could then determine if the users were able to follow the task. In the communication runs the users were free to decide on which kind of stimuli they want to concentrate providing YES/NO answers. Three patients and three healthy controls are assessed. Results: All six participants were able to communicate in at least in one session. All EPs of the healthy subjects showed a P300 peak. Discussion: Visual inspection of the EPs shows that the P300 was generally not the main signal that differed between targets vs. nontargets. In most patient data, the normative P300 is not apparent, still the BCI was able to distinguish the EPs of single stimuli. Conclusions: We show which evoked potentials result in successful communication and provide online results of communication tests for all participants. Significance: Results further supports the nascent consensus that BCI technology could be helpful for assessment of awareness in these patients and for communication.
Keywords: DOC, EPs, Evoked potentials, Coma assessment, Vibrotactile, EEGBCI, P300 doi:10.1016/j.clinph.2017.07.090
O80 Neurophysiological prognosis in comatose patients after cardiac arrest: The italian multicentric study (PRONECA) – preliminary data-—Riccardo Carrai 1, Antonello Grippo 1, Franco Valzania 2, Maria Lombardi 3, Eugenio Vitelli 4, Oriano Mecarelli 5, Lucia Politini 6, Chiara Minardi 7, Paolo Costa 8, Aldo Amantini 1 (1 SODc Neurofisiopatologia, Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy, 2 UO Neurologia, Neurofisiopatologia, Osp Nocsae Baggiovara, Modena, Italy, 3 UO 4 Neurologia, Medico, Empoli, Italy, UO Neurologia, Neurofisiopatologia, Pres Osp Lodi, Lodi, Italy, 5 Dipartimento di Neurologia e Psichiatria, Università La Sapienza, Rome, Italy, 6 UO Neurologia, Neuroscienze, Legnano, Italy, 7 UO Neurologia, Osp Bufalini, Cesena, Italy, 8 Neurofisiopatologia, Dipartimento Neuroscienze e Salute mentale, Osp CTO, Torino, Italy)
Keywords: Motor nerve excitability, Critical illness polyneuropathy, Membrane polarization, Insulin metabolism doi:10.1016/j.clinph.2017.07.089
O79 vibro-tactile evoked potentials (EPS) for assessment of consciousness and communication for people with disorders of consciousness—Rupert Ortner 1, Francisco Fernandes 1, Christoph Guger 1, Alexander Heilinger 1,*, Martin Walchshofer 1, Johannes Gruenwald 2 (1 G.tec medical engineering GmbH, Research & Development, Schiedlberg, Austria, 2 Guger Technologies OG, Research & Development, Schiedlberg, Austria) Objectives: The correct classification of patients in unresponsive wakefulness state (UWS) or minimally conscious state (MCS) is a challenge and misclassifications often occurre. In this publication we present a vibro-tactile EPs Brain-Computer Interface that serves for assessment of consciousness in and for communication. Methods: Patients are stimulated with two vibro-tactile tactors for consciousness assessment and three tactors for communication. The
Objective: To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) a italian multicentric study. Methods: Comatose patients after CA were included.EEG and SEPs were recorded within 12 h and at 72 h after CA. EEG was classified into ‘‘non-continuous” (low voltage, isoelectric, burst-suppression) and ‘‘continuous” (other patterns except epileptiform). SEPs were dichotomized into ‘‘bilaterally absent” (BA) and ‘‘present”. Outcome was evaluated at 6 months by GOS. ‘‘Recovery of consciousness” was considered good outcome. Results: At the moment four center took part to the study and 230 patients were included. EEG and SEPs were recorded in 92 within 12 h in 102 at 72 h. ‘‘Continuous” EEG pattern at 12 h always predicted good outcome, ‘‘non-continuous” pattern at 72 h always predicted poor outcome. BA SEPs always predicted poor outcome. Early ‘‘continuous” EEG pattern was always associated with present SEPs. Conclusion: EEG is a reliable time-dependent predictor of good outcome (within 12 h) and poor outcome (after 72 h). SEP is timeindependent predictor of poor outcome. Early ‘‘continuous” EEG and BA SEPs are never associated together.
Abstracts / Clinical Neurophysiology 128 (2017) e178–e303
O78 Membrane depolarization in motor nerves of critical ill patients is related to insulin resistance—Susanne Koch 1, Tobias Wollersheim 1, Kurt Mai 2, Kurt Haas 1, Claudia Spies 1, Steffen Weber-Carstens 1 (1 Charité Humboldt University, Anesthesiology and Intensive Care Medicine, Berlin, Germany2 Charité Humboldt University, Department of Endocrinology, Berlin, Germany) Objectives: Critical illness polyneuropathy/myopathy (CIP/CIM) features depolarization of the resting membrane potential and reduced membrane excitability in motor nerve and muscle.1–3 Since CIP/CIM shows an increased Insulin resistance,4 and Insulin is one agonist of the Na-K-pump controlling resting membrane potential,5 we like to prove if Insulin resistance is correlated with motor nerve resting membrane polarisation in critical ill patients. Methods: ICU patients were classified as ICU-control and CIM/CIP patients related to electrophysiological exam. Electrophysiological excitability studies recording the recovery-of-excitability at baseline and during Insulin clamp condition (euglycemic-hyperinsulinemic clamp) were conducted, to prove resting membrane polarization at baseline and after high dosage of Insulin (steady state).6 Insulin sensitivity Index (ISI), as marker of Insulin resistance, was calculated during steady state condition. Results: Two ICU-control and six CIM/CIP patients were enrolled. The resting membrane polarization during steady state condition was significantly correlated to ISI (R2 = 0.858; p = 0.001), where pronounced Insulin resistance correlates with pronounced membrane depolarization. Membrane repolarization after Insulin stimulation of Na-K-pump fails in CIM/CIP patients with severe Insulin resistance, compared to ICU control patients with a less severe Insulin resistance. Discussion: Resting membrane depolarization in critically ill patients is correlated to Insulin resistance, where membrane repolarization induced by Insulin seems to fail in CIM/CIP patients showing the most severe Insulin resistance,4 but not in ICU-control patients. Conclusions: Insulin resistance in critical ill patients, besides affecting glucose metabolism, also influences motor nerve dysfunction. Significance: We prove the link between muscle dysfunction and disturbed Glucose metabolism in CIM/CIP patients.
EEG is measured to calculate the evoked potentials as reactions to the stimuli. For assessment, the users had to follow predefined tasks, such as ‘‘count the stimuli you feel on your left hand”. The BCI could then determine if the users were able to follow the task. In the communication runs the users were free to decide on which kind of stimuli they want to concentrate providing YES/NO answers. Three patients and three healthy controls are assessed. Results: All six participants were able to communicate in at least in one session. All EPs of the healthy subjects showed a P300 peak. Discussion: Visual inspection of the EPs shows that the P300 was generally not the main signal that differed between targets vs. nontargets. In most patient data, the normative P300 is not apparent, still the BCI was able to distinguish the EPs of single stimuli. Conclusions: We show which evoked potentials result in successful communication and provide online results of communication tests for all participants. Significance: Results further supports the nascent consensus that BCI technology could be helpful for assessment of awareness in these patients and for communication.
Keywords: DOC, EPs, Evoked potentials, Coma assessment, Vibrotactile, EEGBCI, P300 doi:10.1016/j.clinph.2017.07.090
O80 Neurophysiological prognosis in comatose patients after cardiac arrest: The italian multicentric study (PRONECA) – preliminary data-—Riccardo Carrai 1, Antonello Grippo 1, Franco Valzania 2, Maria Lombardi 3, Eugenio Vitelli 4, Oriano Mecarelli 5, Lucia Politini 6, Chiara Minardi 7, Paolo Costa 8, Aldo Amantini 1 (1 SODc Neurofisiopatologia, Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy, 2 UO Neurologia, Neurofisiopatologia, Osp Nocsae Baggiovara, Modena, Italy, 3 UO 4 Neurologia, Medico, Empoli, Italy, UO Neurologia, Neurofisiopatologia, Pres Osp Lodi, Lodi, Italy, 5 Dipartimento di Neurologia e Psichiatria, Università La Sapienza, Rome, Italy, 6 UO Neurologia, Neuroscienze, Legnano, Italy, 7 UO Neurologia, Osp Bufalini, Cesena, Italy, 8 Neurofisiopatologia, Dipartimento Neuroscienze e Salute mentale, Osp CTO, Torino, Italy)
Keywords: Motor nerve excitability, Critical illness polyneuropathy, Membrane polarization, Insulin metabolism doi:10.1016/j.clinph.2017.07.089
O79 vibro-tactile evoked potentials (EPS) for assessment of consciousness and communication for people with disorders of consciousness—Rupert Ortner 1, Francisco Fernandes 1, Christoph Guger 1, Alexander Heilinger 1,*, Martin Walchshofer 1, Johannes Gruenwald 2 (1 G.tec medical engineering GmbH, Research & Development, Schiedlberg, Austria, 2 Guger Technologies OG, Research & Development, Schiedlberg, Austria) Objectives: The correct classification of patients in unresponsive wakefulness state (UWS) or minimally conscious state (MCS) is a challenge and misclassifications often occurre. In this publication we present a vibro-tactile EPs Brain-Computer Interface that serves for assessment of consciousness in and for communication. Methods: Patients are stimulated with two vibro-tactile tactors for consciousness assessment and three tactors for communication. The
Objective: To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) a italian multicentric study. Methods: Comatose patients after CA were included.EEG and SEPs were recorded within 12 h and at 72 h after CA. EEG was classified into ‘‘non-continuous” (low voltage, isoelectric, burst-suppression) and ‘‘continuous” (other patterns except epileptiform). SEPs were dichotomized into ‘‘bilaterally absent” (BA) and ‘‘present”. Outcome was evaluated at 6 months by GOS. ‘‘Recovery of consciousness” was considered good outcome. Results: At the moment four center took part to the study and 230 patients were included. EEG and SEPs were recorded in 92 within 12 h in 102 at 72 h. ‘‘Continuous” EEG pattern at 12 h always predicted good outcome, ‘‘non-continuous” pattern at 72 h always predicted poor outcome. BA SEPs always predicted poor outcome. Early ‘‘continuous” EEG pattern was always associated with present SEPs. Conclusion: EEG is a reliable time-dependent predictor of good outcome (within 12 h) and poor outcome (after 72 h). SEP is timeindependent predictor of poor outcome. Early ‘‘continuous” EEG and BA SEPs are never associated together.