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Vasomotor sympathetic reflex assessment with Doppler sonography
Society
stereotypical crunching of the teeth during sleep stages I, 2. or during REM sleep, frequently associated with malocclusion or stress. Sleep talking is often observed in normal children. Rhythmic movement disorders such as head banging or body rocking occur just prior to sleep onset and may persist into light sleep without arousal signs in the EEG. When particularly intense, skull callus formation may ensue. REM twitches are little erratic muscle quivers occurring in otherwise flaccid distal limb and face muscles. In REM sleep behaviour disorder the muscle atonia is reduced, resulting in arm waving, reaching gestures, punching or kicking, or rapid ambulatory collision with furniture. This disorder is associated with stroke, degenerative diseases, multiple sclerosis, or alcoholism.
18.
Hypnogenic paroxysmal dystonia fiker, G. Kriimer (Ziirich)
- I.W. Mothersill,
P. Hil-
Hypnogenic paroxysmal dystonia (HPD) are rarely reported complex motor attacks occurring abruptly during sleep, especially NREM sleep. The existence of HPD as a distinct nosological entity has been the cause of much discussion. Many authors consider these nocturnal motor attacks to be frontal lobe epileptic seizures and indeed many patients reported have, in addition to their nocturnal attacks, seizures of obvious epileptic origin or epileptiform activity in the inter-ictal EEG. One of the main points in the debate as to the existence or nonexistence of HPD has been the ictal EEG. The lack of ictal changes, apart from a massive desynchronisation, has been used as one of the main arguments for a non-epileptic nature of these attacks. However this argument alone seems not to be valid as the same findings can be seen in surface EEG during frontal lobe epileptic seizures. We present a 21 year old female patient with nocturnal motor attacks with bizarre tonic posturing. The ictal EEG showed neither arousal nor desynchronisation but instead changes typical for parasomnias occurring during slow wave sleep. We will compare the ictal EEG of this patient to other HPD from the literature and to a patient with clear parasomnia
19.
Stimulus artifact elimination with a device connected to standard electrophysiology equipment - A.C. Nirkko, K.M. RSsler (Bern)
Stimulus artifacts can considerably disturb the electrical recording of biological responses to magnetic and high-voltage electric stimulation. Published effective methods for artifact reduction cannot be used with unaltered standard EMG hardware. A new method of signal conditioning effectively removes stimulus artifacts. It can be implemented as a simple electronic device lo be attached to the input of existing unmodified equipment. This allows continued use of advanced hardand software of standard commercial EMG units. Artifacts can be rejected to such an extent that measurement of the sensory antidromic response in fingers is possible with magnetic stimulation in the palm of the hand, and measurement of transcortical responses to magnetic stimulation become possible. In routine clinical electrophysiology, it has proved to be useful in the measurement of motor evoked potentials: Removing common artifacts from high-voltage lumbar and cervical stimulation as well as removing occasional far range artifacts from magnetic cortex stimulation improves the accuracy of latency measurements, which are in some cases not possible at all without artifact suppression.
20.
Vasomotor sonography
sympathetic reflex assessment with - A.C. Nirkko, K.M. RSsler (Bern)
Doppler
The possibilities of neurophysiological assessment of autonomous nervous function are limited. Measurements of the cutaneous (sudo-
proceedings
31P
motor) sympathetic reflex and of the heartbeat variation (cardiac autonomous innervation) are established in clinical practice. We developed a method to additionally assess the vasomotor system using Doppler sonography of peripheral arteries. The response to single, irregularly timed electrical stimuli of nerves was recorded with Doppler sonography of the radial and tibia1 arteries, together with simultaneous recordings of galvanic skin responses. In all healthy volunteers, the cutaneous response occurred with a latency of around 1.5 s, followed by a sharp decrease in Doppler blood flow velocity in the peripheral arteries with a latency of 2-3 s, reaching a minimum after 5-8 s. In patients with plexopathies, both responses were absent in the affected limb. In some patients, the vasomotor reflex response was dissociated. Thus, assessment of the vasomotor response, using conventional Doppler sonographic equipment, can contribute additional information in the evaluation of diseases with involvement of the peripheral or central autonomous nervous system.
21.
Conspicuous EEG-patterns in 9 patients with neuronal migration disorders - G.P. Ramelli, F. Donati, F. Vassella (Bern)
Neuronal migration disorders (NMD) are malformations which affect development of the cerebral cortex during the first trimenon of pregnancy. Patients with NMD are often microcephalic, severely retarded and show intractable epileptic seizures. We studied 9 children with NMD. All patients had extensive EEG and neuroradiologic examination. Three children had lissencephaly type 1. 5 a pachygyria and one a hemimegalencephaly. All 3 children with lissencephaly are severely retarded, one of these patients suffered from infantile spasms, and another shows partial motor and secondary generalized seizures. The EEG in all the lissencephaly patients shows generalized, nonreactive, fast activity (8-18/s) and high amplitude (>lOO~V). The 5 children with pachygyria are mildly to moderately retarded; 4 have partial motor and secondary generalized seizures. In all these children the EEG shows a high amplitude on the side of cortical dysplasia. The child with hemimegalencephaly is mildly retarded with partial motor seizures with secondary generalization. The EEG shows a continuous epileptiform activity consisting of sharp and slow-wave complex. High amplitude EEG activity was observed in 8/9 children with cortical dysplasia. This finding is not specific but can suggest the diagnosis of NMD.
22.
Assessment multaneous Wada test Schroth, H.
of language dominance in patients: bilateral transcranial Doppler sonography compared - F. Rihs, C. Gutbrod, M. Sturzenegger, Mattle (Bern/Rheinfelden)
sito G.
Previous work shows, that bilateral (‘stereo’) transcranial Doppler sonography (sTCD) may identify cognitive hemispheric dominance in healthy subjects. Confirmation by the invasive Wada test is necessary. At the same time, the sTCD examination needs validation in patients. sTCD and Wada test were performed in 9 patients. sTCD only was performed in 3 patients with favourable course of aphasia. With sTCD, hemispheric dominance was determined based on the hemispheric blood flow velocity shift for language and visuospatial tasks. In 6 patients, both tests indicated the same side of language dominance (5 left, one bilateral). In one patient, sTCD indicated right, and the Wada test bilateral dominance. In two patients, Wada tests were not interpretable due to somnolence, but TCD indicated bilateral and right dominance in one patient each. In all patients with remitted aphasia sTCD language dominance was identical with the side of the lesion. sTCD assessment of hemispheric language dominance correlates well with interpretable Wada tests and clinical evidence for hemispheric dominance. sTCD might become a complementary tool for the assessment of cognitive hemispheric dominance, particularly in patients who should not undergo Wada test.
stereotypical crunching of the teeth during sleep stages I, 2. or during REM sleep, frequently associated with malocclusion or stress. Sleep talking is often observed in normal children. Rhythmic movement disorders such as head banging or body rocking occur just prior to sleep onset and may persist into light sleep without arousal signs in the EEG. When particularly intense, skull callus formation may ensue. REM twitches are little erratic muscle quivers occurring in otherwise flaccid distal limb and face muscles. In REM sleep behaviour disorder the muscle atonia is reduced, resulting in arm waving, reaching gestures, punching or kicking, or rapid ambulatory collision with furniture. This disorder is associated with stroke, degenerative diseases, multiple sclerosis, or alcoholism.
18.
Hypnogenic paroxysmal dystonia fiker, G. Kriimer (Ziirich)
- I.W. Mothersill,
P. Hil-
Hypnogenic paroxysmal dystonia (HPD) are rarely reported complex motor attacks occurring abruptly during sleep, especially NREM sleep. The existence of HPD as a distinct nosological entity has been the cause of much discussion. Many authors consider these nocturnal motor attacks to be frontal lobe epileptic seizures and indeed many patients reported have, in addition to their nocturnal attacks, seizures of obvious epileptic origin or epileptiform activity in the inter-ictal EEG. One of the main points in the debate as to the existence or nonexistence of HPD has been the ictal EEG. The lack of ictal changes, apart from a massive desynchronisation, has been used as one of the main arguments for a non-epileptic nature of these attacks. However this argument alone seems not to be valid as the same findings can be seen in surface EEG during frontal lobe epileptic seizures. We present a 21 year old female patient with nocturnal motor attacks with bizarre tonic posturing. The ictal EEG showed neither arousal nor desynchronisation but instead changes typical for parasomnias occurring during slow wave sleep. We will compare the ictal EEG of this patient to other HPD from the literature and to a patient with clear parasomnia
19.
Stimulus artifact elimination with a device connected to standard electrophysiology equipment - A.C. Nirkko, K.M. RSsler (Bern)
Stimulus artifacts can considerably disturb the electrical recording of biological responses to magnetic and high-voltage electric stimulation. Published effective methods for artifact reduction cannot be used with unaltered standard EMG hardware. A new method of signal conditioning effectively removes stimulus artifacts. It can be implemented as a simple electronic device lo be attached to the input of existing unmodified equipment. This allows continued use of advanced hardand software of standard commercial EMG units. Artifacts can be rejected to such an extent that measurement of the sensory antidromic response in fingers is possible with magnetic stimulation in the palm of the hand, and measurement of transcortical responses to magnetic stimulation become possible. In routine clinical electrophysiology, it has proved to be useful in the measurement of motor evoked potentials: Removing common artifacts from high-voltage lumbar and cervical stimulation as well as removing occasional far range artifacts from magnetic cortex stimulation improves the accuracy of latency measurements, which are in some cases not possible at all without artifact suppression.
20.
Vasomotor sonography
sympathetic reflex assessment with - A.C. Nirkko, K.M. RSsler (Bern)
Doppler
The possibilities of neurophysiological assessment of autonomous nervous function are limited. Measurements of the cutaneous (sudo-
proceedings
31P
motor) sympathetic reflex and of the heartbeat variation (cardiac autonomous innervation) are established in clinical practice. We developed a method to additionally assess the vasomotor system using Doppler sonography of peripheral arteries. The response to single, irregularly timed electrical stimuli of nerves was recorded with Doppler sonography of the radial and tibia1 arteries, together with simultaneous recordings of galvanic skin responses. In all healthy volunteers, the cutaneous response occurred with a latency of around 1.5 s, followed by a sharp decrease in Doppler blood flow velocity in the peripheral arteries with a latency of 2-3 s, reaching a minimum after 5-8 s. In patients with plexopathies, both responses were absent in the affected limb. In some patients, the vasomotor reflex response was dissociated. Thus, assessment of the vasomotor response, using conventional Doppler sonographic equipment, can contribute additional information in the evaluation of diseases with involvement of the peripheral or central autonomous nervous system.
21.
Conspicuous EEG-patterns in 9 patients with neuronal migration disorders - G.P. Ramelli, F. Donati, F. Vassella (Bern)
Neuronal migration disorders (NMD) are malformations which affect development of the cerebral cortex during the first trimenon of pregnancy. Patients with NMD are often microcephalic, severely retarded and show intractable epileptic seizures. We studied 9 children with NMD. All patients had extensive EEG and neuroradiologic examination. Three children had lissencephaly type 1. 5 a pachygyria and one a hemimegalencephaly. All 3 children with lissencephaly are severely retarded, one of these patients suffered from infantile spasms, and another shows partial motor and secondary generalized seizures. The EEG in all the lissencephaly patients shows generalized, nonreactive, fast activity (8-18/s) and high amplitude (>lOO~V). The 5 children with pachygyria are mildly to moderately retarded; 4 have partial motor and secondary generalized seizures. In all these children the EEG shows a high amplitude on the side of cortical dysplasia. The child with hemimegalencephaly is mildly retarded with partial motor seizures with secondary generalization. The EEG shows a continuous epileptiform activity consisting of sharp and slow-wave complex. High amplitude EEG activity was observed in 8/9 children with cortical dysplasia. This finding is not specific but can suggest the diagnosis of NMD.
22.
Assessment multaneous Wada test Schroth, H.
of language dominance in patients: bilateral transcranial Doppler sonography compared - F. Rihs, C. Gutbrod, M. Sturzenegger, Mattle (Bern/Rheinfelden)
sito G.
Previous work shows, that bilateral (‘stereo’) transcranial Doppler sonography (sTCD) may identify cognitive hemispheric dominance in healthy subjects. Confirmation by the invasive Wada test is necessary. At the same time, the sTCD examination needs validation in patients. sTCD and Wada test were performed in 9 patients. sTCD only was performed in 3 patients with favourable course of aphasia. With sTCD, hemispheric dominance was determined based on the hemispheric blood flow velocity shift for language and visuospatial tasks. In 6 patients, both tests indicated the same side of language dominance (5 left, one bilateral). In one patient, sTCD indicated right, and the Wada test bilateral dominance. In two patients, Wada tests were not interpretable due to somnolence, but TCD indicated bilateral and right dominance in one patient each. In all patients with remitted aphasia sTCD language dominance was identical with the side of the lesion. sTCD assessment of hemispheric language dominance correlates well with interpretable Wada tests and clinical evidence for hemispheric dominance. sTCD might become a complementary tool for the assessment of cognitive hemispheric dominance, particularly in patients who should not undergo Wada test.