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S106 Polysomnographic ascertainment of sleep-related alterations of breathing control and pattern
Abstracts / Clinical Neurophysiology 128 (2017) e178–e303
was also treated chronically with paroxetine (0 or 20 mg/kg/daily) from a pre-symptomatic age. EEG/EMG was recorded after acute treatments, at the end of chronic treatment period, and two weeks after chronic treatment stopped. Results: All drugs supressed REM sleep in both genotypes. R6/2 mice treated acutely with zolpidem and amitriptyline, but not paroxetine, showed suppression of abnormal low-gamma (25– 45 Hz) EEG oscillations. However, chronic treatment with paroxetine prevented the development of abnormal gamma oscillations in R6/2 mice, an effect that persisted for at least two weeks after treatment stopped. Discussion/Conclusions: We demonstrate that the pathophysiological changes seen in sleep and EEG are not ‘hard-wired’ in HD brain and can be prevented or reversed by drugs. Furthermore, sleep and EEG measures proved to be valuable tools for assessing the therapeutic potential of treatment options for HD. Significance: Since the abnormal sleep-EEG changes are likely to be correlates of altered brain function in HD, correcting these abnormalities might also be reflected in improvements in HD symptoms other than sleep and sleep-dependent brain oscillations. Keywords: Huntington’s disease, REM sleep, Gamma power, Theta oscillation, Biomarker doi:10.1016/j.clinph.2017.07.116
S106 Polysomnographic ascertainment of sleep-related alterations of breathing control and pattern—János Juhász (SRH Zentralklinikum Suhl, Innere Medizin III, Pneumologie, Beatmungs- und Schlafmedizin, Suhl, Germany) Under healthy condition, when awake, the breathing process is built up of regular, constant and repeated sequences of inhalation and exhalation. The volume and frequency of breathing is under control of a negative feedback system that keeps the partial pressure of arterial oxygen and carbon dioxide at constant level. In awake man, breathing is dependent on 3 different control systems. The behavioral control is intentional and arises from the cortex of the forebrain and corticospinal tract. The metabolic (autonom) control of breathing originates from the medulla oblongata as well as from the ventrolateral spinal tract. The metabolic control maintains the acidbase balance and O2-homeostasis. The third control level is the wakefulness stimulus, which affects breathing during wakefulness through the reticular activating system, independent of human intention. During sleep, these control systems undergo substantial alterations. The mechanism of alveolar ventilation/hypoventilation is complex, in which the changes of the central control of breathing play a prominent role. In this process, the outfall of the intentional influence of breathing through diminished vigilance level, furthermore, the inhibition of the reticular activating system during transitional sleep lead to disappearance of the cortical control mechanisms and to reduced mechanical and metabolic control of breathing. All these changes are the physiological background for the characteristic breathing pattern and also for the development of pathological breathing forms during sleep that can be visualised during polysomnography. Keywords: Control of breathing, Breathing pattern, Sleep, Polysomnography doi:10.1016/j.clinph.2017.07.117
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S107 Polysomnography in parasomnias—Anna Szucs (National Institute of Clinical Neurosciences, Budapest, Department of Neurology, Budapest, Hungary) Parasomnias make up an important group of sleep disorders affecting children, adults and seniors; where sleep-related cognitive, affective and autonomic changes mysteriously interlace with personality-traits and daytime impressions of the affected person. The specific genetic and neuro-pathological features of parasomnias make them model-conditions of distorted sleep regulation, hopefully enlightening unknown links and mechanisms. The two apparently disjunct groups are non-REM and REM sleep parasomnias - the eminent representatives being sleep walking and REM sleep behaviour disorder. The two types show distinctive polysomnographic and clinical features; and at the same time, seem to peculiarly overlap e.g. in the form of violent parasomnias. Although the differential is generally straight-forward, some of the parasomnias may pose a hard differential-diagnostic issue against sleep related epilepsies or psychogenic conditions; resolved by the analysis of semiological and polysomnigraphic characteristics. I want to show the typical polysomnographic and clinical features of the two main groups detailing some of their known mechanisms as well. Keywords: REM parasomnias, RBD, Sleep walking, Violent somnambulism doi:10.1016/j.clinph.2017.07.118
Symposium XVI. – Robotic hand prosthesis and phantom limb pain S108 Restoration of somatosensory feedback and bidirectional real-time control of a prosthetic hand using peripheral nervous system signals—Giuseppe Granata (Università Cattolica del Sacro Cuore, Department of Neuroscience, Rome, Italy) Objectives: Over the past years, implanted neural interfaces for the peripheral nervous system have shown a remarkable potential as tools to restore the bidirectional communication between the hand prosthesis and the nerves in the residuum. In particular, intraneural electrodes have been used to restore several features of the sense of touch. The aim of the paper is to clarify the clinical impact of this approach on upper limb amputees. Methods: In order to address these questions, we report the experience with three trans-radial amputees who received an implant of TIME electrodes in their median and ulnar nerves. Several tests were performed to verify the usability by the participants of the sensory feedback and to understand whether they can exploit it during more complex and ecological tasks improving their sensory-motor control abilities by using a bidirectional hand prosthesis. Results: We were able to elicit meaningful phantom hand sensations in all participants for all the duration of the clinical trial. The subjects were able to carry out three different levels of grasping force, recognition of shape, consistence and object location with quite good performance during the study showing the long-term usability of the TIMEs. Two participants started wearing all the electronics for control and stimulation in a backpack to use the bidirectional prosthesis outside the laboratory. This allowed us to assess the usability of current technologies in a less controlled and real-life environment.
was also treated chronically with paroxetine (0 or 20 mg/kg/daily) from a pre-symptomatic age. EEG/EMG was recorded after acute treatments, at the end of chronic treatment period, and two weeks after chronic treatment stopped. Results: All drugs supressed REM sleep in both genotypes. R6/2 mice treated acutely with zolpidem and amitriptyline, but not paroxetine, showed suppression of abnormal low-gamma (25– 45 Hz) EEG oscillations. However, chronic treatment with paroxetine prevented the development of abnormal gamma oscillations in R6/2 mice, an effect that persisted for at least two weeks after treatment stopped. Discussion/Conclusions: We demonstrate that the pathophysiological changes seen in sleep and EEG are not ‘hard-wired’ in HD brain and can be prevented or reversed by drugs. Furthermore, sleep and EEG measures proved to be valuable tools for assessing the therapeutic potential of treatment options for HD. Significance: Since the abnormal sleep-EEG changes are likely to be correlates of altered brain function in HD, correcting these abnormalities might also be reflected in improvements in HD symptoms other than sleep and sleep-dependent brain oscillations. Keywords: Huntington’s disease, REM sleep, Gamma power, Theta oscillation, Biomarker doi:10.1016/j.clinph.2017.07.116
S106 Polysomnographic ascertainment of sleep-related alterations of breathing control and pattern—János Juhász (SRH Zentralklinikum Suhl, Innere Medizin III, Pneumologie, Beatmungs- und Schlafmedizin, Suhl, Germany) Under healthy condition, when awake, the breathing process is built up of regular, constant and repeated sequences of inhalation and exhalation. The volume and frequency of breathing is under control of a negative feedback system that keeps the partial pressure of arterial oxygen and carbon dioxide at constant level. In awake man, breathing is dependent on 3 different control systems. The behavioral control is intentional and arises from the cortex of the forebrain and corticospinal tract. The metabolic (autonom) control of breathing originates from the medulla oblongata as well as from the ventrolateral spinal tract. The metabolic control maintains the acidbase balance and O2-homeostasis. The third control level is the wakefulness stimulus, which affects breathing during wakefulness through the reticular activating system, independent of human intention. During sleep, these control systems undergo substantial alterations. The mechanism of alveolar ventilation/hypoventilation is complex, in which the changes of the central control of breathing play a prominent role. In this process, the outfall of the intentional influence of breathing through diminished vigilance level, furthermore, the inhibition of the reticular activating system during transitional sleep lead to disappearance of the cortical control mechanisms and to reduced mechanical and metabolic control of breathing. All these changes are the physiological background for the characteristic breathing pattern and also for the development of pathological breathing forms during sleep that can be visualised during polysomnography. Keywords: Control of breathing, Breathing pattern, Sleep, Polysomnography doi:10.1016/j.clinph.2017.07.117
e213
S107 Polysomnography in parasomnias—Anna Szucs (National Institute of Clinical Neurosciences, Budapest, Department of Neurology, Budapest, Hungary) Parasomnias make up an important group of sleep disorders affecting children, adults and seniors; where sleep-related cognitive, affective and autonomic changes mysteriously interlace with personality-traits and daytime impressions of the affected person. The specific genetic and neuro-pathological features of parasomnias make them model-conditions of distorted sleep regulation, hopefully enlightening unknown links and mechanisms. The two apparently disjunct groups are non-REM and REM sleep parasomnias - the eminent representatives being sleep walking and REM sleep behaviour disorder. The two types show distinctive polysomnographic and clinical features; and at the same time, seem to peculiarly overlap e.g. in the form of violent parasomnias. Although the differential is generally straight-forward, some of the parasomnias may pose a hard differential-diagnostic issue against sleep related epilepsies or psychogenic conditions; resolved by the analysis of semiological and polysomnigraphic characteristics. I want to show the typical polysomnographic and clinical features of the two main groups detailing some of their known mechanisms as well. Keywords: REM parasomnias, RBD, Sleep walking, Violent somnambulism doi:10.1016/j.clinph.2017.07.118
Symposium XVI. – Robotic hand prosthesis and phantom limb pain S108 Restoration of somatosensory feedback and bidirectional real-time control of a prosthetic hand using peripheral nervous system signals—Giuseppe Granata (Università Cattolica del Sacro Cuore, Department of Neuroscience, Rome, Italy) Objectives: Over the past years, implanted neural interfaces for the peripheral nervous system have shown a remarkable potential as tools to restore the bidirectional communication between the hand prosthesis and the nerves in the residuum. In particular, intraneural electrodes have been used to restore several features of the sense of touch. The aim of the paper is to clarify the clinical impact of this approach on upper limb amputees. Methods: In order to address these questions, we report the experience with three trans-radial amputees who received an implant of TIME electrodes in their median and ulnar nerves. Several tests were performed to verify the usability by the participants of the sensory feedback and to understand whether they can exploit it during more complex and ecological tasks improving their sensory-motor control abilities by using a bidirectional hand prosthesis. Results: We were able to elicit meaningful phantom hand sensations in all participants for all the duration of the clinical trial. The subjects were able to carry out three different levels of grasping force, recognition of shape, consistence and object location with quite good performance during the study showing the long-term usability of the TIMEs. Two participants started wearing all the electronics for control and stimulation in a backpack to use the bidirectional prosthesis outside the laboratory. This allowed us to assess the usability of current technologies in a less controlled and real-life environment.