- Email: [email protected]
Video-EEG monitoring in epileptic children with visually induced seizures
94.
Cortical and retinal responses to chromatic and luminance stimuli in optic neuritis. - F. Sartucci, L. Murri, V. Porciattia (Department of Clinical Neurophysiology, Institute of Neurology. ‘Institute of Neurophysiology, C.N.R, Pisa, Italy)
Color vision disturbances in optic neuritis (ON) have been often reported with psychophysical methods; only a few studies have been performed using electrophysiological techniques and chromatic stimuli. The aim of this study was to compare chromatic and luminance visual involvement in ON in the course of multiple sclerosis (MS). Stimuli were alternating gratings of low spatial frequency, modulated in either pure chromatic (equi-luminant red-green) or luminance (yellowblack) contrast; both steady-state (2-24 Hz) and transient PER& and VEPs were recorded. On average, luminance VEPs showed little latency (about 10 ms) delay; chromatic VEPs exhibited larger amplitude loss and latency prolongation (about 30 ms). PERGs were also reduced in amplitude more for chromatic than for luminance stimuli, without any evident delay. In conclusion, our electrophysiological data prove a higher degree of impairment using color contrast stimuli, suggesting a prevalent impairment of the parve-cellular system in MS. 95.
Oscillating magnetic fields change in an opposite way painthresholds and pain-related evoked potentials. - F. Sartucci, L. Bonftglio, C. Del Seppiaa, P. Luschia, S. Ghioneb, M. Szucsb, L. Murri, F. Papia (Department of Clinical Neurophysiology, Institute of Neurology. aDepartment of Animal Behavior and of Human. bInstitute of Clinical Physiology, C.N.R., Pisa, Italy)
It is well known that oscillating magnetic fields (MFs) modify stress-induced analgesia. Hitherto, to test these effects in man only psychophysical methods (pain-threshold) have been employed. In this study, MF effects have been assessed in 10 normal subjects (6 females and 4 males; age range 26115 years), both with psychophysical (tactile and pain thresholds) and electrophysiological (pain-related evoked potentials, PEPS) methods. During two independent experimental sessions, they have been submitted to effective (ON) and shame (OFF) MFs, in a random way. Following OFF condition, tactile and pain thresholds showed a significant increase (stress induced hypoalgesia due to the experimental method itself). After ON condition, both thresholds were decreased; on the contrary, a significant N150 and P250 waves amplitude loss has been detected, not correlated with psychophysical data. In conclusion, MFs change in an opposite way to perception thresholds and PEPS, as a possible consequence of an independent effect on the nociceptive system and electroencephalographical activity. 96.
Motor involvement in Charcot-Marie-tooth disease type I): electrophysiological findings. - F. Sartucci, gliocco (Institute of Neurology, Department of Clinical physiology, University of Pisa, Italy)
(HMSN L. SaNeuro-
Motor involvement in Charcot-Marie-tooth disease (HMSN type I) has been extensively investigated in peripheral limb nerves; little 1s known on cranial and deep nerves and doubt exists about pyramidal tract impairment. Nineteen patients with HMSN type I (6 males, 13 females; mean age 35.5 +- 18.5 years) were investigated. Motor nerve conduction velocity was highly reduced; sensory potentials were absent both from upper and lower extremities in all patients. Electromyography revealed evidence of denervation and loss of motor units, with giant potentials. M responses following facial nerve stimulation and RI component latency of blink reflex showed increased latencies in all, as well as dinphrngmatic responses by phrenic nerve stimulation. Following trnnscranial magnetic stimulation, peripheral and indirect central motor conduction times were abnormal in 89.5% and 42.1% from upper limbs and in 84.2% and 36.8% from lower limbs. respectively. These
results prove an evident systemic demyelinating and. in some cases, upper motomeurons. 97.
involvement
of lower
Subacute peripheral neuropathy in hereditary coproporphyria and diabetes mellitus. - F. Morello, R. Gennaro”, D. Borreggineb, A. Franciosi (aService of Neurology and Anaesthetics. bArzignano Department of Medicine, Valdagno)
We describe the case of a 59 year old retired man who was suffering behavior disturbances and diabetes. He came to our observation for progressive proximal weakness of upper limbs and, less important, limbs with left foot drop. Electrodiagnostic examination revealed acute neuropathy with axonal degeneration, reinnervation and mild demyelination. Porphyry was suspected after 4 days and was confirmed by urinary testing. Cerebrospinal fluid was normal. The patient died after 5 months, tetraplegic with respiratory failure because of complications. Hereditary coproporphyria is rare and often asymptomatic. Hepatic porphyria (intermittent porphyria, variegate porphyria and hereditary coproporphyria) cause the same neurologic complications. Porphyric neuropathy is of real diagnostic difficulty at the first manifestation of the illness. Therapy by means of glucose infusions was difficult in our patient, who was already hyperglycemic. Hematin is not available in the Italian market. 98.
Visual evoked potential and neurological development in infants of diabetic mothers. - M. Brinciotti, M. Matricardi, A. Domenici, A. Napolia, A. Sahhatinia, F. Falluccaa, G. Porro (Dipartimento di Scienze Neurologiche e Psichiatriche deWEtA Evolutiva. aCattedra di Diabetologia, II a Clinica Medica, Univ. ‘La Sapienza’, Roma)
Visual evoked potentials (VEP) were recorded at 1 and 3 months of age in 27 infants (I4 males, 13 females) of diabetic mothers. Latencies and amplitudes of Nl, P2, and N2 components were compared with normal values (22 healthy infants). Moreover, values were compared with psychomotor development (Brunet-Lezine = BL) and with some clinical and metabolic risk factors. Results and conclusions. Significant increase of N2 latency was noted in infants of diabetic mothers compared with controls (300.0 t 44 ms versus 267.3 + 49; ANOVA, P 0.0456). Negative correlation coefficients (Spearman test) were found between VEP components and BL scores; P2 correlated with total developmental quotient (r -0.412060; P 0.040680), language (r 0.419706; P 0.036739) and posture (r -0.441 189; P 0.027267), whereas N I component correlated with language subtest (I -0.429460; P 0.03170). Significant positive relations were noted between Nl. P2, and N2 latencies and some risk factors of pregnancy (maternal glycaemia, number of hypoglycaemic episodes) and perinatal period (Apgar at lth). These preliminary observations suggest the usefulness of VEP in evaluating infants of diabetic mothers. 99.
Video-EEG monitoring in epileptic children with visually induced seizures. - M. Brinciotti, A. Angelini, F. Crocioni, M. Matricardi, G. Mattivi (Dipartinaento di Scienze Neurologiche e Psichiatriche dell’EtB Evolutiva, Univ. ‘La Sapienza’, Roma)
Epileptic children may experience seizures induced by visual stimuli (television, computer. video-gamea, sunlight, etc). The ajrn of the study was to evaluate clinical and EEG correlates of visually induced seizures m 21 epileptic children (7 males, 14 females, age 416 years. mean age = 10 years) with a history of visually induced seizures. Video-EEG monitoring was performed, with informed consent of parents, during a standardized procedure of visual stimulations; specific provocative factors (video-games, reading, etc.) were also used in appropriate cases. Results and conclusions: 21 seizures (8 simple partial, 3 absences, 10 generalized myoclonics) were recorded in 9 cases; 5 attacks were spontaneous and 16 provoked by intermittent light (8) or pattern stimulation (8). Provocative factors were noted in 8 patients (3
Society pattern, 3 ILS, 2 both). Non-epileptic manifestations (tics) were found in 2 cases; epileptic versus non-epileptic manifestations were correctly diagnosed in one case of Rett syndrome with complex and stereotyped fast movements. Video-EEG monitoring during standard visual stimulations appears to be effective in evaluation children with visually induced seizures. 100.
Nenrophysiological studies in patients with focal dystonia. - I,. Manfredia, M. Panizzab, P. Garavagliaa, J. Nilsonb (Division of Neurology, Valdnce Hospital, Como. bLaboratory of Clinical Nenrophysiology, Fondazione Clinica del Lavoro, IRCCS, Neuromuscular Rehabilitation Center of Caste1 Goffredo
(MN), Italy) We studied IO patients with movement disorders (4 Writer’s cramp, 2 spasmodic torticollis, I blefarospasm, and 3 facial spasms), with a battery of neurophysiological tests, including long latency reflexes, somatosensory and motor evoked potentials, and silent periods evoked by peripheral electrical and transcranial magnetic stimulation. Results were compared to studies from a group of healthy controls. The short and long latency reflexes were determined bilaterally by stimulation of the median nerve recording from abductor pollicis brevis (APB), and were normal in all patients. The somatosensory and motor evoked potentials, and the peripheral silent period recorded from APB were normal as well. The central silent period was evoked by transcranial magnetic stimulation, at 20% above motor threshold, recording from APB, and the mean duration in dystonic patients was 92.5 r 37.4 ms, a statistically significant (P = 0.03) reduction compared to controls (114.3 f 25.4 ms). The reduction in duration of the central silent period was not homogeneous in the different movement disorders, but was specially pronounced in spasmodic torticollis. 101.
A prognostic value of multimodal evoked potentials study in patients with apallic syndrome. - L. Margar?, V. Monitillob, G. Franchinob, T. Gasparroa, S. Calabreseb, R. Santostasia, M. Megnac, G. MegnaC (aI Neurological Clinic, University of Bari. “Clinica del Lavoro’ Foundation, I.R.C.C.S., Medical Centre of Rehabilitation, Cassano Mnrge (Bari), Division of Neurology. CDepartment of Physical Medicine and Rehabilitation, University of Bari)
A perspective neurophysiological study was performed in 8 subjects with apallic syndrome. The clinical pattern was evaluated with the Glasgow Outcome Scale at 4, 7 and 10 months from pathological event. Neurophyisiological investigations including brainstem auditory evoked potentials (BAEPs), median nerve somatosensory evoked potentials (MN-SEPs) and motor evoked potentials (MEPs) to transcranial magnetic stimulation were carried out within 4 months and follow-up at 7 months. BAEPs were normal in all patients at first control and at follow-up except for 1 case in which monolateral absence of all waves was due to a peripheral lesion. SEPs were normal only in I case in which clinical situation evolved to severe disability, while in the remaining patients SEPs revealed different degrees of alterations. At follow up SEPs recordings showed an improvement in 3 patients, 2 of them evolved to severe disability and I to moderate disability. MEPs recorded only in 4 patients were normal in 3 cases while in I the motor response to the thenar muscle was absent only on one side. These findings remained unchanged at follow-up. Our study suggests that SEPs could have a prognostic value for clinical evolution in apallic patients. At present it is not possible to make any considerations about MEPs due to the few cases examined. 102.
Requesting for EMG examination: from whom and how? - W. Neri, C. Gnidi, G.P. Galletti, A. Patnelli (Dept. of Nenrol. Forli) From
1990 to 1394 we performed
6587
EMG
examinations.
SO99
Proceedings
13P
(86.5%) were sent by general practitioners (35.8%) and specialists (64.2%) in orthopaedics and physiotherapy (53.6%), neurology (18. I%), internal medicine (9.3%). neurosurgery (7%), others (12%). 63.4% of the patients had EMG abnormalities, 35.6% were normal. Among the latter 32.4% showed signs and symptoms of probable neurological disease while the remaining 67.6% did not. 6% of the requests were without clinical indications or symptoms, 27% presented suspected carpal tunnel syndrome, 17.8% suspected radicolopathy and 5.2% other suspected disease. In conclusion: (I) demand for EMG comes mostly from specialized non-neurologists, (2) indications and limits of EMG are not clear to practitioners, (3) nearly two-thirds of normal EMG are of little or no clinical use, (4) our code of conduct and laboratory organization prevent us from selecting patienns beforehand. 103.
99mTc-HMPAO SPET in the diagnosis of brain death: preliminary report. - E. Facto, F. Bnia, F. Baratto, M. Gregianina, P. Zncchettaa, S. Cesaro, G.P. Giron (Lab. Nenrofisiologia, 1st. di Anestesiolgia e Rianimazione. aIst. di Medicina Nucleare Univ. Padova)
Eight patients, ranging between the age of I 1 and 60 years. comatose following severe head injury (6 cases), subarachnoidal hemorrhage (1 case) and brain tumor (1 case) were submitted to 99mTcHMPAO SPET. Six of them were already brain dead at the moment of SPET, while the remaining two underwent SPET twice, when in preterminal conditions and after the onset of BD. The SPET was able to confirm BD in all patients, with an outstanding picture showing an empty skull. One case tested in preterminal conditions had a large brain stem contusion on CT scan, the absence of all brain stem reflexes and only wave I on ABR recording; the EEG showed the persistence of diffuse slowwave activity, while the SPET showed a diffuse brain perfusion, with some interhemispheric asymmetry. The second SPET performed 2 days later, after the onset of brain death, clearly showed the picture of an empty skull. In the other preterminal patient, studied during barbiturate coma, both SPET, ABR and SEP were able to exclude BD; the same tests, performed 4 days later, were able to diagnose BD. The EEG and clinical examination, performed after withdrawal of barbiturate. confirmed the diagnosis. Our results, although based on a limited sample, confirm the reliability of SPET in the diagnosis of BD: this investigation. manageable and non-invasive, if most helpful when factors capnble of affecting EEG and clinical data are present. 104.
The diagnosis of brain death: role of short latency evoked potentials. - E. Facto, F. Baratto, M. Munari, A.U. Behr, A. Lanzillotta, L. Zanardi, G.P. Giron (Lab. Neurofisiologia, 1st. Anestesiologia e Rianimazione, Univ. Padova)
Fifty-seven patients, ranging between I I and 70 years, were submitted to evoked potentials recordings: ABRs were tested in 54 cases, while SEPs from median nerve with non-cephalic reference were tested in 43 cases. All patients were brain dead according to the Italian criteria. The causes of coma were head injury (31 cases), cerebrovascular disorders (26 cases), brain tumors (after surgery, 2 cases). postanoxic coma (2 cases). ABRs were absent in 42 cases (77.8%). only wave I was present in IO (I 8.5%). while waves I through V were present in 2 patients (3.7%). SEPs showed preserved cervical components N9-N I3 in 41 cases (95.3%). while in two cases (4.7%) both Nl I-N13 and farfield PI I -PI 3 were absent. Among patients with present N 13, 17 cases (41.4%) showed no components followmg PI I, 24 (58.5%) had preserved PI3 with absent PI4 Nl8. while one case (2.3%) had completely normal SEP; in the latter ABRs were normal as well. ABRs and SEPs confirmed brain death in 41 patients, but were able ro exclude it in 2 cases: however. both of them died within 2 days from the time of recording. Our results confirm the usefulness of ABRs and SEPs in the diagnosis of brain death; being capable of exploring brain stem pathways which cannot be clinically explored in comatose patients, they should be routinely used in the confirmation of brain sItem death.
Cortical and retinal responses to chromatic and luminance stimuli in optic neuritis. - F. Sartucci, L. Murri, V. Porciattia (Department of Clinical Neurophysiology, Institute of Neurology. ‘Institute of Neurophysiology, C.N.R, Pisa, Italy)
Color vision disturbances in optic neuritis (ON) have been often reported with psychophysical methods; only a few studies have been performed using electrophysiological techniques and chromatic stimuli. The aim of this study was to compare chromatic and luminance visual involvement in ON in the course of multiple sclerosis (MS). Stimuli were alternating gratings of low spatial frequency, modulated in either pure chromatic (equi-luminant red-green) or luminance (yellowblack) contrast; both steady-state (2-24 Hz) and transient PER& and VEPs were recorded. On average, luminance VEPs showed little latency (about 10 ms) delay; chromatic VEPs exhibited larger amplitude loss and latency prolongation (about 30 ms). PERGs were also reduced in amplitude more for chromatic than for luminance stimuli, without any evident delay. In conclusion, our electrophysiological data prove a higher degree of impairment using color contrast stimuli, suggesting a prevalent impairment of the parve-cellular system in MS. 95.
Oscillating magnetic fields change in an opposite way painthresholds and pain-related evoked potentials. - F. Sartucci, L. Bonftglio, C. Del Seppiaa, P. Luschia, S. Ghioneb, M. Szucsb, L. Murri, F. Papia (Department of Clinical Neurophysiology, Institute of Neurology. aDepartment of Animal Behavior and of Human. bInstitute of Clinical Physiology, C.N.R., Pisa, Italy)
It is well known that oscillating magnetic fields (MFs) modify stress-induced analgesia. Hitherto, to test these effects in man only psychophysical methods (pain-threshold) have been employed. In this study, MF effects have been assessed in 10 normal subjects (6 females and 4 males; age range 26115 years), both with psychophysical (tactile and pain thresholds) and electrophysiological (pain-related evoked potentials, PEPS) methods. During two independent experimental sessions, they have been submitted to effective (ON) and shame (OFF) MFs, in a random way. Following OFF condition, tactile and pain thresholds showed a significant increase (stress induced hypoalgesia due to the experimental method itself). After ON condition, both thresholds were decreased; on the contrary, a significant N150 and P250 waves amplitude loss has been detected, not correlated with psychophysical data. In conclusion, MFs change in an opposite way to perception thresholds and PEPS, as a possible consequence of an independent effect on the nociceptive system and electroencephalographical activity. 96.
Motor involvement in Charcot-Marie-tooth disease type I): electrophysiological findings. - F. Sartucci, gliocco (Institute of Neurology, Department of Clinical physiology, University of Pisa, Italy)
(HMSN L. SaNeuro-
Motor involvement in Charcot-Marie-tooth disease (HMSN type I) has been extensively investigated in peripheral limb nerves; little 1s known on cranial and deep nerves and doubt exists about pyramidal tract impairment. Nineteen patients with HMSN type I (6 males, 13 females; mean age 35.5 +- 18.5 years) were investigated. Motor nerve conduction velocity was highly reduced; sensory potentials were absent both from upper and lower extremities in all patients. Electromyography revealed evidence of denervation and loss of motor units, with giant potentials. M responses following facial nerve stimulation and RI component latency of blink reflex showed increased latencies in all, as well as dinphrngmatic responses by phrenic nerve stimulation. Following trnnscranial magnetic stimulation, peripheral and indirect central motor conduction times were abnormal in 89.5% and 42.1% from upper limbs and in 84.2% and 36.8% from lower limbs. respectively. These
results prove an evident systemic demyelinating and. in some cases, upper motomeurons. 97.
involvement
of lower
Subacute peripheral neuropathy in hereditary coproporphyria and diabetes mellitus. - F. Morello, R. Gennaro”, D. Borreggineb, A. Franciosi (aService of Neurology and Anaesthetics. bArzignano Department of Medicine, Valdagno)
We describe the case of a 59 year old retired man who was suffering behavior disturbances and diabetes. He came to our observation for progressive proximal weakness of upper limbs and, less important, limbs with left foot drop. Electrodiagnostic examination revealed acute neuropathy with axonal degeneration, reinnervation and mild demyelination. Porphyry was suspected after 4 days and was confirmed by urinary testing. Cerebrospinal fluid was normal. The patient died after 5 months, tetraplegic with respiratory failure because of complications. Hereditary coproporphyria is rare and often asymptomatic. Hepatic porphyria (intermittent porphyria, variegate porphyria and hereditary coproporphyria) cause the same neurologic complications. Porphyric neuropathy is of real diagnostic difficulty at the first manifestation of the illness. Therapy by means of glucose infusions was difficult in our patient, who was already hyperglycemic. Hematin is not available in the Italian market. 98.
Visual evoked potential and neurological development in infants of diabetic mothers. - M. Brinciotti, M. Matricardi, A. Domenici, A. Napolia, A. Sahhatinia, F. Falluccaa, G. Porro (Dipartimento di Scienze Neurologiche e Psichiatriche deWEtA Evolutiva. aCattedra di Diabetologia, II a Clinica Medica, Univ. ‘La Sapienza’, Roma)
Visual evoked potentials (VEP) were recorded at 1 and 3 months of age in 27 infants (I4 males, 13 females) of diabetic mothers. Latencies and amplitudes of Nl, P2, and N2 components were compared with normal values (22 healthy infants). Moreover, values were compared with psychomotor development (Brunet-Lezine = BL) and with some clinical and metabolic risk factors. Results and conclusions. Significant increase of N2 latency was noted in infants of diabetic mothers compared with controls (300.0 t 44 ms versus 267.3 + 49; ANOVA, P 0.0456). Negative correlation coefficients (Spearman test) were found between VEP components and BL scores; P2 correlated with total developmental quotient (r -0.412060; P 0.040680), language (r 0.419706; P 0.036739) and posture (r -0.441 189; P 0.027267), whereas N I component correlated with language subtest (I -0.429460; P 0.03170). Significant positive relations were noted between Nl. P2, and N2 latencies and some risk factors of pregnancy (maternal glycaemia, number of hypoglycaemic episodes) and perinatal period (Apgar at lth). These preliminary observations suggest the usefulness of VEP in evaluating infants of diabetic mothers. 99.
Video-EEG monitoring in epileptic children with visually induced seizures. - M. Brinciotti, A. Angelini, F. Crocioni, M. Matricardi, G. Mattivi (Dipartinaento di Scienze Neurologiche e Psichiatriche dell’EtB Evolutiva, Univ. ‘La Sapienza’, Roma)
Epileptic children may experience seizures induced by visual stimuli (television, computer. video-gamea, sunlight, etc). The ajrn of the study was to evaluate clinical and EEG correlates of visually induced seizures m 21 epileptic children (7 males, 14 females, age 416 years. mean age = 10 years) with a history of visually induced seizures. Video-EEG monitoring was performed, with informed consent of parents, during a standardized procedure of visual stimulations; specific provocative factors (video-games, reading, etc.) were also used in appropriate cases. Results and conclusions: 21 seizures (8 simple partial, 3 absences, 10 generalized myoclonics) were recorded in 9 cases; 5 attacks were spontaneous and 16 provoked by intermittent light (8) or pattern stimulation (8). Provocative factors were noted in 8 patients (3
Society pattern, 3 ILS, 2 both). Non-epileptic manifestations (tics) were found in 2 cases; epileptic versus non-epileptic manifestations were correctly diagnosed in one case of Rett syndrome with complex and stereotyped fast movements. Video-EEG monitoring during standard visual stimulations appears to be effective in evaluation children with visually induced seizures. 100.
Nenrophysiological studies in patients with focal dystonia. - I,. Manfredia, M. Panizzab, P. Garavagliaa, J. Nilsonb (Division of Neurology, Valdnce Hospital, Como. bLaboratory of Clinical Nenrophysiology, Fondazione Clinica del Lavoro, IRCCS, Neuromuscular Rehabilitation Center of Caste1 Goffredo
(MN), Italy) We studied IO patients with movement disorders (4 Writer’s cramp, 2 spasmodic torticollis, I blefarospasm, and 3 facial spasms), with a battery of neurophysiological tests, including long latency reflexes, somatosensory and motor evoked potentials, and silent periods evoked by peripheral electrical and transcranial magnetic stimulation. Results were compared to studies from a group of healthy controls. The short and long latency reflexes were determined bilaterally by stimulation of the median nerve recording from abductor pollicis brevis (APB), and were normal in all patients. The somatosensory and motor evoked potentials, and the peripheral silent period recorded from APB were normal as well. The central silent period was evoked by transcranial magnetic stimulation, at 20% above motor threshold, recording from APB, and the mean duration in dystonic patients was 92.5 r 37.4 ms, a statistically significant (P = 0.03) reduction compared to controls (114.3 f 25.4 ms). The reduction in duration of the central silent period was not homogeneous in the different movement disorders, but was specially pronounced in spasmodic torticollis. 101.
A prognostic value of multimodal evoked potentials study in patients with apallic syndrome. - L. Margar?, V. Monitillob, G. Franchinob, T. Gasparroa, S. Calabreseb, R. Santostasia, M. Megnac, G. MegnaC (aI Neurological Clinic, University of Bari. “Clinica del Lavoro’ Foundation, I.R.C.C.S., Medical Centre of Rehabilitation, Cassano Mnrge (Bari), Division of Neurology. CDepartment of Physical Medicine and Rehabilitation, University of Bari)
A perspective neurophysiological study was performed in 8 subjects with apallic syndrome. The clinical pattern was evaluated with the Glasgow Outcome Scale at 4, 7 and 10 months from pathological event. Neurophyisiological investigations including brainstem auditory evoked potentials (BAEPs), median nerve somatosensory evoked potentials (MN-SEPs) and motor evoked potentials (MEPs) to transcranial magnetic stimulation were carried out within 4 months and follow-up at 7 months. BAEPs were normal in all patients at first control and at follow-up except for 1 case in which monolateral absence of all waves was due to a peripheral lesion. SEPs were normal only in I case in which clinical situation evolved to severe disability, while in the remaining patients SEPs revealed different degrees of alterations. At follow up SEPs recordings showed an improvement in 3 patients, 2 of them evolved to severe disability and I to moderate disability. MEPs recorded only in 4 patients were normal in 3 cases while in I the motor response to the thenar muscle was absent only on one side. These findings remained unchanged at follow-up. Our study suggests that SEPs could have a prognostic value for clinical evolution in apallic patients. At present it is not possible to make any considerations about MEPs due to the few cases examined. 102.
Requesting for EMG examination: from whom and how? - W. Neri, C. Gnidi, G.P. Galletti, A. Patnelli (Dept. of Nenrol. Forli) From
1990 to 1394 we performed
6587
EMG
examinations.
SO99
Proceedings
13P
(86.5%) were sent by general practitioners (35.8%) and specialists (64.2%) in orthopaedics and physiotherapy (53.6%), neurology (18. I%), internal medicine (9.3%). neurosurgery (7%), others (12%). 63.4% of the patients had EMG abnormalities, 35.6% were normal. Among the latter 32.4% showed signs and symptoms of probable neurological disease while the remaining 67.6% did not. 6% of the requests were without clinical indications or symptoms, 27% presented suspected carpal tunnel syndrome, 17.8% suspected radicolopathy and 5.2% other suspected disease. In conclusion: (I) demand for EMG comes mostly from specialized non-neurologists, (2) indications and limits of EMG are not clear to practitioners, (3) nearly two-thirds of normal EMG are of little or no clinical use, (4) our code of conduct and laboratory organization prevent us from selecting patienns beforehand. 103.
99mTc-HMPAO SPET in the diagnosis of brain death: preliminary report. - E. Facto, F. Bnia, F. Baratto, M. Gregianina, P. Zncchettaa, S. Cesaro, G.P. Giron (Lab. Nenrofisiologia, 1st. di Anestesiolgia e Rianimazione. aIst. di Medicina Nucleare Univ. Padova)
Eight patients, ranging between the age of I 1 and 60 years. comatose following severe head injury (6 cases), subarachnoidal hemorrhage (1 case) and brain tumor (1 case) were submitted to 99mTcHMPAO SPET. Six of them were already brain dead at the moment of SPET, while the remaining two underwent SPET twice, when in preterminal conditions and after the onset of BD. The SPET was able to confirm BD in all patients, with an outstanding picture showing an empty skull. One case tested in preterminal conditions had a large brain stem contusion on CT scan, the absence of all brain stem reflexes and only wave I on ABR recording; the EEG showed the persistence of diffuse slowwave activity, while the SPET showed a diffuse brain perfusion, with some interhemispheric asymmetry. The second SPET performed 2 days later, after the onset of brain death, clearly showed the picture of an empty skull. In the other preterminal patient, studied during barbiturate coma, both SPET, ABR and SEP were able to exclude BD; the same tests, performed 4 days later, were able to diagnose BD. The EEG and clinical examination, performed after withdrawal of barbiturate. confirmed the diagnosis. Our results, although based on a limited sample, confirm the reliability of SPET in the diagnosis of BD: this investigation. manageable and non-invasive, if most helpful when factors capnble of affecting EEG and clinical data are present. 104.
The diagnosis of brain death: role of short latency evoked potentials. - E. Facto, F. Baratto, M. Munari, A.U. Behr, A. Lanzillotta, L. Zanardi, G.P. Giron (Lab. Neurofisiologia, 1st. Anestesiologia e Rianimazione, Univ. Padova)
Fifty-seven patients, ranging between I I and 70 years, were submitted to evoked potentials recordings: ABRs were tested in 54 cases, while SEPs from median nerve with non-cephalic reference were tested in 43 cases. All patients were brain dead according to the Italian criteria. The causes of coma were head injury (31 cases), cerebrovascular disorders (26 cases), brain tumors (after surgery, 2 cases). postanoxic coma (2 cases). ABRs were absent in 42 cases (77.8%). only wave I was present in IO (I 8.5%). while waves I through V were present in 2 patients (3.7%). SEPs showed preserved cervical components N9-N I3 in 41 cases (95.3%). while in two cases (4.7%) both Nl I-N13 and farfield PI I -PI 3 were absent. Among patients with present N 13, 17 cases (41.4%) showed no components followmg PI I, 24 (58.5%) had preserved PI3 with absent PI4 Nl8. while one case (2.3%) had completely normal SEP; in the latter ABRs were normal as well. ABRs and SEPs confirmed brain death in 41 patients, but were able ro exclude it in 2 cases: however. both of them died within 2 days from the time of recording. Our results confirm the usefulness of ABRs and SEPs in the diagnosis of brain death; being capable of exploring brain stem pathways which cannot be clinically explored in comatose patients, they should be routinely used in the confirmation of brain sItem death.