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P92. Electroencephalographic patterns in different types of status epilepticus – Association with specific syndromes and prognostic significance
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Society Proceedings / Clinical Neurophysiology 126 (2015) e63–e170
well as at night during sleep and led to arousal. Ictal electrographic abnormalities were not observed. Interictal EEG showed focal slowing right (fronto-) temporal with periodical enclosed 1–1, 5/s sharpand sharp-slow-waves for max. 20 s. The patient was tested for antibodies to LGI1 component of the VGKC (voltage-gated potassium channel) complex. Anti-LGI1 antibodies were identified in serum and cerebrospinal fluid (CSF). The routine CSF examination (cell counts, glucose and protein) was unremarkable. Further investigations demonstrated moderate hyponatremia (127 mmol/l in serum). Brain MRI showed unilateral temporomesial T2 signal intensity on the right side. Cognitive impairments were not detected. FBCDS frequency was significantly reduced after immunotherapy with corticosteroids. In contrast, antiepileptic treatment with levetiracetam as first-line therapy was ineffective. Conclusion: Based on our case report and other case studies (Maramattom et al., 2013), FBCDS can be a rare differential diagnosis of falls without loss of awareness. The leg ictal dystonia is not to be confused with drop attacks with backward falls (Irani et al., 2011). The timely immunotherapy with corticosteroids can lead to freedom from seizures(Irani et al., 2013). References Irani et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol 2011;69(5):892–900. Irani et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. Brain 2013;136(10):3151–62. Maramattom et al. Facio-brachio-crural dystonic episodes and drop attacks due to leucine rich glioma inactivated 1 encephalitis in two elderly Indian women. Ann Indian Acad Neurol 2013;16(4):590–2. doi:10.1016/j.clinph.2015.04.241
P92. Electroencephalographic patterns in different types of status epilepticus – Association with specific syndromes and prognostic significance—J. Rösche, K. Rantsch, U. Walter, M. Wittstock, R. Benecke (Universitätsmedizin Rostock, Klinik für Neurologie und Polipklinik, Rostock, Germany) Objective: It was planned to investigate, whether certain electroencephalographic patterns obtained during the treatment of a status epilepticus (SE) were associated with a particular subtype of SE. Methods: In a retrospective databank analysis all treatment episodes of a SE between January 1st 2000 and December 31st 2009 in the department of Neurology of the Universitätsmedizin Rostock were identified. The first EEG of each treatment episode, in which an EEG was recorded, was evaluated. Statistical tests (i.e. chi-square-test and Student t-test) were performed in order to find out whether there is an association of a certain EEG pattern with a particular subtype of SE or whether some EEG patterns signify a worse outcome than others. Results: In 35 treatment episodes of a SE at least one EEG was obtained during the actual treatment. There was no association of a certain EEG pattern with a particular subtype of SE. Periodic epileptiform discharges were seen more often in Nonlimbic complex partial status epilepticus and Cases of coma due to acute brain injury with epileptiform EEG changes than in Nonconvulsive status epilepticus (NCSE) in the postictal phase of tonic–clonic seizures. These results are at variance with the published literature, where the frequent occurrence of periodic epileptiform discharges in NCSE in the postictal phase of tonic-clonic seizures is reported. Background slowing with a frequency in the theta-range or lower was associated
with disability to perform the activities of daily life without any help. On discharge patients with periodic epileptic discharges were more disabled than those without this pattern. Conclusion: The concept of different substypes of NCSE needs further evaluation especially with regard to its therapeutic relevance. In adults EEG patterns specific for a particular subtype of SE are rare. doi:10.1016/j.clinph.2015.04.242
P93. Ictal SPECT in patients with REM sleep behavior disorder—G. Mayer a, H. Stefan b, T. Kuwert c, M. Bitterlich a (a Hephata Klinik, Neurologie, Schwalmstadt, Germany, b Universität Erlangen, Neurologie, Erlangen, Germany, c Universität Erlangen, Nuklear Medizin, Erlangen, Germany) Introduction: Patients with idiopathic REM sleep behavior disorder (iRBD) have the same phenotype as those with Parkinson and RBD (PD + RBD) and narcolepsy and RBD (nRBD). Little is known if different types of RBD share the same pathways during their nocturnal activities. The aim of the study was to compare ictal SPECT of different types of RBD. Methods: Recording was performed as 22 channel video-EEG polysomnography using an IT- Med system l. Ictal and interictal subtraction SPECT was performed after using a semiautomatic SPECT injection device permitting immediate intravenous application of the radioligand ECD with a latency <10 s between onset of clinical event and injection. Patients were injected with 898 MBq Tc-99 m ECD (NeuroLite, Bristol-Myers Squibb). Injection was done when REM sleep lasted > or 10 epochs and complex behavior in REM sleep > 10 epochs. Ictal and interictal reconstructed datasets were subtracted pixelwise from each other, the difference images were coregistered to MRI images. Patients: 2 iRBD, 2 with nRBD. 1 iRBD patient had converted to Parkinson’s disease (Hoehn & Yahr 4). Patients fulfilled RBD criteria according to the International Classification of Sleep Disorders 2 (2005). All patients gave their written consent. The study was approved by the Ethical Committee of the Chamber of Physicians of the state of Hessen/Germany. Results: All patients independent of their RBD type displayed a similar pattern of activation in the ictal SPECT. The activation included the premotor areas bilaterally, the interhemispheric cleft, the periaqueductal area, the dorsal and ventral pons and the anterior part of the cerebellum. Conclusion: The ictal pathway of RBD is the same in iRBD, PD + RBD and nRBD. doi:10.1016/j.clinph.2015.04.243
P94. Effects of non-invasive ventilation on sleep and nocturnal ventilation in patients with amyotrophic lateral sclerosis—I. Brenscheidt, P. Young, C. Glatz, M. Boentert (Universitätsklinikum Münster, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Münster, Germany) Introduction: The majority of patients with amyotrophic lateral sclerosis (ALS) develop chronic ventilatory failure which substantially adds to disease burden and massively affects prognosis. Both quality of life and life expectancy can be influenced by non-invasive ventilation (NIV). Initiation of NIV is indicated in case of sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness. Since nocturnal hypercapnia and sleep apnea substantially reduce sleep quality we investigated the
Society Proceedings / Clinical Neurophysiology 126 (2015) e63–e170
well as at night during sleep and led to arousal. Ictal electrographic abnormalities were not observed. Interictal EEG showed focal slowing right (fronto-) temporal with periodical enclosed 1–1, 5/s sharpand sharp-slow-waves for max. 20 s. The patient was tested for antibodies to LGI1 component of the VGKC (voltage-gated potassium channel) complex. Anti-LGI1 antibodies were identified in serum and cerebrospinal fluid (CSF). The routine CSF examination (cell counts, glucose and protein) was unremarkable. Further investigations demonstrated moderate hyponatremia (127 mmol/l in serum). Brain MRI showed unilateral temporomesial T2 signal intensity on the right side. Cognitive impairments were not detected. FBCDS frequency was significantly reduced after immunotherapy with corticosteroids. In contrast, antiepileptic treatment with levetiracetam as first-line therapy was ineffective. Conclusion: Based on our case report and other case studies (Maramattom et al., 2013), FBCDS can be a rare differential diagnosis of falls without loss of awareness. The leg ictal dystonia is not to be confused with drop attacks with backward falls (Irani et al., 2011). The timely immunotherapy with corticosteroids can lead to freedom from seizures(Irani et al., 2013). References Irani et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol 2011;69(5):892–900. Irani et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. Brain 2013;136(10):3151–62. Maramattom et al. Facio-brachio-crural dystonic episodes and drop attacks due to leucine rich glioma inactivated 1 encephalitis in two elderly Indian women. Ann Indian Acad Neurol 2013;16(4):590–2. doi:10.1016/j.clinph.2015.04.241
P92. Electroencephalographic patterns in different types of status epilepticus – Association with specific syndromes and prognostic significance—J. Rösche, K. Rantsch, U. Walter, M. Wittstock, R. Benecke (Universitätsmedizin Rostock, Klinik für Neurologie und Polipklinik, Rostock, Germany) Objective: It was planned to investigate, whether certain electroencephalographic patterns obtained during the treatment of a status epilepticus (SE) were associated with a particular subtype of SE. Methods: In a retrospective databank analysis all treatment episodes of a SE between January 1st 2000 and December 31st 2009 in the department of Neurology of the Universitätsmedizin Rostock were identified. The first EEG of each treatment episode, in which an EEG was recorded, was evaluated. Statistical tests (i.e. chi-square-test and Student t-test) were performed in order to find out whether there is an association of a certain EEG pattern with a particular subtype of SE or whether some EEG patterns signify a worse outcome than others. Results: In 35 treatment episodes of a SE at least one EEG was obtained during the actual treatment. There was no association of a certain EEG pattern with a particular subtype of SE. Periodic epileptiform discharges were seen more often in Nonlimbic complex partial status epilepticus and Cases of coma due to acute brain injury with epileptiform EEG changes than in Nonconvulsive status epilepticus (NCSE) in the postictal phase of tonic–clonic seizures. These results are at variance with the published literature, where the frequent occurrence of periodic epileptiform discharges in NCSE in the postictal phase of tonic-clonic seizures is reported. Background slowing with a frequency in the theta-range or lower was associated
with disability to perform the activities of daily life without any help. On discharge patients with periodic epileptic discharges were more disabled than those without this pattern. Conclusion: The concept of different substypes of NCSE needs further evaluation especially with regard to its therapeutic relevance. In adults EEG patterns specific for a particular subtype of SE are rare. doi:10.1016/j.clinph.2015.04.242
P93. Ictal SPECT in patients with REM sleep behavior disorder—G. Mayer a, H. Stefan b, T. Kuwert c, M. Bitterlich a (a Hephata Klinik, Neurologie, Schwalmstadt, Germany, b Universität Erlangen, Neurologie, Erlangen, Germany, c Universität Erlangen, Nuklear Medizin, Erlangen, Germany) Introduction: Patients with idiopathic REM sleep behavior disorder (iRBD) have the same phenotype as those with Parkinson and RBD (PD + RBD) and narcolepsy and RBD (nRBD). Little is known if different types of RBD share the same pathways during their nocturnal activities. The aim of the study was to compare ictal SPECT of different types of RBD. Methods: Recording was performed as 22 channel video-EEG polysomnography using an IT- Med system l. Ictal and interictal subtraction SPECT was performed after using a semiautomatic SPECT injection device permitting immediate intravenous application of the radioligand ECD with a latency <10 s between onset of clinical event and injection. Patients were injected with 898 MBq Tc-99 m ECD (NeuroLite, Bristol-Myers Squibb). Injection was done when REM sleep lasted > or 10 epochs and complex behavior in REM sleep > 10 epochs. Ictal and interictal reconstructed datasets were subtracted pixelwise from each other, the difference images were coregistered to MRI images. Patients: 2 iRBD, 2 with nRBD. 1 iRBD patient had converted to Parkinson’s disease (Hoehn & Yahr 4). Patients fulfilled RBD criteria according to the International Classification of Sleep Disorders 2 (2005). All patients gave their written consent. The study was approved by the Ethical Committee of the Chamber of Physicians of the state of Hessen/Germany. Results: All patients independent of their RBD type displayed a similar pattern of activation in the ictal SPECT. The activation included the premotor areas bilaterally, the interhemispheric cleft, the periaqueductal area, the dorsal and ventral pons and the anterior part of the cerebellum. Conclusion: The ictal pathway of RBD is the same in iRBD, PD + RBD and nRBD. doi:10.1016/j.clinph.2015.04.243
P94. Effects of non-invasive ventilation on sleep and nocturnal ventilation in patients with amyotrophic lateral sclerosis—I. Brenscheidt, P. Young, C. Glatz, M. Boentert (Universitätsklinikum Münster, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Münster, Germany) Introduction: The majority of patients with amyotrophic lateral sclerosis (ALS) develop chronic ventilatory failure which substantially adds to disease burden and massively affects prognosis. Both quality of life and life expectancy can be influenced by non-invasive ventilation (NIV). Initiation of NIV is indicated in case of sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness. Since nocturnal hypercapnia and sleep apnea substantially reduce sleep quality we investigated the