EEG Test Research Articles

Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system.

There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having a history of epilepsy or seizure(s) prior to EEG testing was predictive of epileptiform findings. This has important implications for triaging EEG testing in this population.

TIMES REQUIRED FOR EACH STEP OF BRAIN DEATH DONOR MANAGEMENT

Background: Delayed brain death determination or prolonged time period for donor management cause increasing number of donor death, or withdrawal of family’s consent for donation, and increasing the expenditure of intensive care expenses. In order to prepare a plan to minimize the donation failure by understanding the times required for each step of organ donation is urgent. Methods: From January 2016 to December 2018, we reviewed KODA statistical data of reported potential brain death and investigated the time intervals that take to complete each process of brain death management. Organ donation procedures were divided into five steps. The first step started from the end of the first brain death examination to the end of the second examination, the second step was from finishing the second brain death examination until we got the flat EEG, the third stage was from finishing EEG test to the declaration of brain death by brain death committee, and the fourth stage was from end of committee to entrance to operating room and the fifth step was from the operating room entrance to the completion of organ procurement. Results: During the study period, 1,633 cases of potential brain death were managed for organ donation, and we analyzed 1,594 cases excluding donors under age six. The average time spent on organ donation procedure was 33 hours and 16 minutes. The time required for each step was 11 hours 28 minutes for step1, 5 hours 15 minutes for step2, 5 hours 58 minutes for step3, 6 hours 38 minutes for step4 and 3 hours 42 minutes for step5. Among the analyzed cases, 119 cases spent more than 48 hours from step 1 to 4, and 63 cases those included holidays in the donation process took an average of 71 hours and 5 minutes. Ninety three cases were discontinued during the donation procedure and their causes of interruption were poor organ quality 15 cases, patient death in 15, failure in brain death judgement in 13 and withdrawal of donation consent in six. About time of interruption of donation procedures, 45 cases were stopped at step 1 and 2, and the total times spent for step 1 and 2 was 16 hours and 43 minutes which accounting for half of all brain death donation procedures. In particular, the first step took 11 hours and 28 minutes on average, almost twice as long as the 6 hour legal inspection interval. The third step took an average of six hours, which is unnecessary in foreign countries where there is no brain death judgment committee. Conclusion: Brain death determination procedures should be accurate but not unnecessarily delayed. Among the measures to reduce the time required, improvement of the execution of the first and second brain death examinations which repeat the same test, improvement of delay of the EEG examination to obtain flat wave, and careful approach for abolishing the brain death judgment committee are necessary. Delayed brain death organ donation procedure caused by lack of manpower especially during holidays and night time need a government level policy revision and social consensus.

Evaluation of state and trait anxiety levels of parents and children before electroencephalography procedures: A prospective study from a tertiary epilepsy center

BackgroundInadequate or misinformation about electroencephalography (EEG) and epilepsy may lead to anxiety in children and their parents. The purpose of this study was to make a simultaneous evaluation of the anxiety levels of children and parents before EEG procedures and to make a brief assessment of their knowledge about EEG. Methods and materialsChildren aged between 8 and 18 years who were referred for EEG tests at Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey and their parents were included in the study, prospectively. Data were collected through Personal Information Forms; an EEG questionnaire form, which questioned the knowledge of the participants about EEG; the Spielberger's State–Trait Anxiety Inventory (STAI) to determine anxiety levels of the parents; and the State–Trait Anxiety Inventory for Children-State form (STAIC) to determine the anxiety levels of the children. The following parameters were collected in a database: demographic data about children and parents (sex, age), indication of suspected diagnosis on EEG request (i.e., the referral diagnosis), history of epilepsy, number of EEG recordings, and results of previous EEG recordings. The state and trait anxiety test results of the children were compared between the girls and boys, between age groups, and their parents' results in terms of both trait and state anxiety in terms of EEG, sex, ages, educational levels, and working. ResultsEighty-five children (mean age: 13.25 ± 3.02 years) and 85 parents (mean age: 41.16 ± 7.65 years) were included in the study. The children's mean trait anxiety score was 32.51 ± 8.09, and the mean state anxiety score was 34.97 ± 7.62. Half of the children who had a trait anxiety score of ≤30 points had increased state anxiety levels because they received more than 30 points in the state anxiety evaluation score. No significant differences were found between the boys and girls in terms of the state and trait anxiety scores (p > 0.05). The parents' mean trait anxiety score was 39.16 ± 7.74, and the mean state anxiety score was 42.74 ± 6.22. Forty (47%) parents were found to have trait anxiety, and 52 (61.2%) parents had state anxiety before the EEG. The trait anxiety score of the mothers was statistically significantly higher than that of the fathers (p < 0.01). The investigation of the knowledge level of both parents and children about EEG demonstrated some misunderstandings or points of insufficiency. ConclusionThe present study revealed that both parents and children had insufficient knowledge about EEG, and the procedure caused anxiety for both the parents and children. When EEG procedures are requested, parents and children should be given brief information about EEG and epilepsy. We think that in this way, the knowledge of both parents and children about this issue may be increased and their anxiety may be decreased.

RESEARCH ON CHARACTERISTICS OF CLINICAL, EEG AND CRANIAL CT SCAN IMAGES IN EPILEPSY PATIENTS FROM 1-12 MONTHS AT VIETNAM NATIONAL CHILDREN’S HOSPITAL

Objectives: Classify seizures and EEG characteristics, magnetic resonance lesions in children with epilepsy from 1 to 12 months of age.&#x0D; Materials and methods: 83 pediatric patients were diagnosed epilepsy. Asking or observing to classify seizures were used. An EEG test in the resting state was done to identify normal or seizure wave. CT scan image 1.5 Tesla was done to identify brain damage.&#x0D; Results: The generalized seizures accounted for 43.4%, of which tonic-clonic type accounted for the highest rate of 21.7%. Focalized seizures accounted for 54.2%, of which the simple focalized seizure accounted for the highest rate of 37.3%. EEG has typical seizure waves accounted for 61.4%. The lesions on magnetic resonance were detected as 40.9%, of which 14.5% were congenital brain structure lesions.&#x0D; Conclusion: The clinical manifestations of seizures in children from 1 to 12 months of age are diverse. The rate of recording of typical seizure waves in the resting state is low. The rate of epilepsy in children from 1 to 12 months with brain damage is relatively high.&#x0D;

How are results of EEG activation procedures associated with patient perception of seizure provocative factors? A single-center cross-sectional pilot study

PurposeThe purpose of this study was to examine the relationship between subjectively perceived seizure provocative factors or inhibitors and objectively recorded changes in epileptiform activity (EA) during EEG activation procedures. Material and methodsConsenting epilepsy patients (≥18 years old) were asked to complete a questionnaire by indicating whether items on a list provoke, inhibit or have no effect on their seizures. A scalp EEG was recorded afterwards to evaluate baseline epileptiform activity and its change (increase/decrease in frequency) during a set of activation procedures. These included hyperventilation, intermittent photic stimulation (IPS), eye-closing/eye-opening, tasks of reading aloud in a native and a foreign language, solving a Rubik’s cube and crossing-out letters. We used correlation and multiple regression analysis to search for associations between the sum of self-reported provocative/inhibiting items and changes in EA. ResultsOf the 90 patients recruited 75 (83.3%) indicated at least one seizure provocative factor. Sleep deprivation, emotional stress, negative emotions and alcohol use were most frequently selected as provoking seizures. Positive feelings, focused thinking, mental calculation and exercising were the most predominant seizure inhibitors. EEG data revealed a weak, but statistically significant correlation with the sum of items in distinct questionnaire groups (0.20 ≤ Spearman’s ρ ≤ 0.39). Sensory stimuli (olfactory, gustatory, auditory and visual), cognitive phenomena (thoughts and feelings) and substance use were found to be significantly correlated with EEG results by being self-reported as both provoking and inhibiting seizures. A statistically significant relationship was also found between the increase in EA while reading aloud in a native language and the number of physiological states (sleep deprivation, stress etc.) indicated as provoking seizures (Spearman’s ρ = 0.320, P = 0.005). A suitable stepwise multiple regression model was feasible for this finding (F(3, 71) = 7.396, P < 0.001, adjusted R squared = 0.206) with the additional inclusion of EA change during IPS and epilepsy type as explanatory variables. ConclusionOur pilot study indicates that there is a previously non-explored association between patients’ self-perception of seizure provocative/inhibiting factors and objectively recorded changes in epileptiform activity during activation EEGs. Distinct EEG tests might be useful in activating ictogenic networks that are sensitive to indirect influence by hormonal, emotional or diurnally variable factors.

Is autism driven by epilepsy in infants with Tuberous Sclerosis Complex?

ObjectiveTo evaluate the relationship between age at seizure onset and neurodevelopmental outcome at age 24 months in infants with TSC, as well as the effect on neurodevelopmental outcome of early versus conventional treatment of epileptic seizures with vigabatrin (80–150 mg/kg/day).MethodsInfants with TSC, aged ≤4 months and without previous seizures were enrolled in a prospective study and closely followed with monthly video EEG and serial standardized neurodevelopmental testing (Bayley Scales of Infant Development and Autism Diagnostic Observation Schedule).ResultsEighty infants were enrolled. At the age of 24 months testing identified risk of Autism Spectrum Disorder (ASD) in 24/80 children (30.0%), and developmental delay (DD) in 26/80 (32.5%). Children with epilepsy (51/80; 63.8%) had a higher risk of ASD (P = 0.02) and DD (P = 0.001). Overall, no child presented with moderate or severe DD at 24 months (developmental quotient < 55). In 20% of children abnormal developmental trajectories were detected before the onset of seizures. Furthermore, 21% of all children with risk of ASD at 24 months had not developed seizures at that timepoint. There was no significant difference between early and conventional treatment with respect to rate of risk of ASD (P = 0.8) or DD (P = 0.9) at 24 months.InterpretationThis study confirms a relationship between epilepsy and risk of ASD/DD. However, in this combined randomized/open label study, early treatment with vigabatrin did not alter the risk of ASD or DD at age 2 years.

Unique Medium Chain Triglyceride Product Rapidly Enhances Brain Function: A Pilot Investigational Study

PURPOSE: Medium Chain Triglyceride (MCT) compounds are purported to increase brain energy based upon the relationship between MCT products and ketone production, especially for older individuals or those on low-carbohydrate diets. Little evidence exists that MCT products positively affect brain function, short-term. In this pilot study, Intervention Group (IG )subjects were tested prior to ingestion of a proprietary MCT product, and then 90 minutes later using the same electro-encephalographic (EEG) device and compared to a control group (CG). METHODS: Eight (8) IG volunteers, aged 49-68 years old, (male = 5, female =3) were compared to three (3) CG volunteers, aged 48 to 68 years old, (male = 3). Study subjects completed standard EEG testing prior to ingestion of the compound, and 90 minutes after consuming the compound or placebo. Testing consisted of a P300 audio reaction time test and two visual decision making/reaction tests. RESULTS: The IG increased brain function as measured with evoke potentials, time to task and graphic representations compared to the control group. The decrease for the IG in the audio reaction time test was 340 milliseconds to 314 milliseconds. In addition, the tens of millivolt (μV) activation during the auditory reaction time test increased from 7.5 μV to 12.9 μV, indicating increased brain functional activity. The CG showed essentially no voltage changes. The IG decreased times in the first trail making test from 94 to 57 seconds, and decreased time to complete the second trail making test from 113 to 93 seconds. Descriptive statistics revealed the measures for the IG had statistical significance (P<0.5) for the second trail making test and strong positive trends for all other parameters. Topographic brain maps from the test revealed a representative picture of the changes from taking the supplement. CONCLUSIONS: In this pilot study, consumption of a proprietary MCT combination produced marked enhancement in brain activity 90 minutes after ingestion with significant increases in relation to topographical brain maps. Further investigation is warranted to determine optimal ingestion conditions and time to effect for this and similar products across various populations. EEG measurements show promise as assessment biomarkers for the effects of nutritional supplements on brain function.

Random Forest-based Algorithm for Sleep Spindle Detection in Infant EEG.

Sleep spindles are associated with normal brain development, memory consolidation and infant sleep-dependent brain plasticity and can be used by clinicians in the assessment of brain development in infants. Sleep spindles can be detected in EEG, however, identifying sleep spindles in EEG recordings manually is very time-consuming and typically requires highly trained experts. Research on the automatic detection of sleep spindles in infant EEGs has been limited to-date. In this study, we present a novel supervised machine learning-based algorithm to detect sleep spindles in infant EEG recordings. EEGs collected from 141 ex-term born infants and 6 ex-preterm born infants, recorded at 4 months of age (adjusted), were used to train and test the algorithm. Sleep spindles were annotated by experienced clinical physiologists as the gold standard. The dataset was split into training (81 ex-term), validation (30 ex-term), and testing (30 ex-term + 6 ex-preterm) set. 15 features were selected for input into a random forest algorithm. Sleep spindles were detected in the ex-term infant EEG test set with 92.1% sensitivity and 95.2% specificity. For ex-preterm born infants, the sensitivity and specificity were 80.3% and 91.8% respectively. The proposed algorithm has the potential to assist researchers and clinicians in the automated analysis of sleep spindles in infant EEG.

Decoding Brain Patterns for Colored and Grayscale Images using Multivariate Pattern Analysis

Taxonomy of human brain activity is a complicated rather challenging procedure. Due to its multifaceted aspects, including experiment design, stimuli selection and presentation of images other than feature extraction and selection techniques, foster its challenging nature. Although, researchers have focused various methods to create taxonomy of human brain activity, however use of multivariate pattern analysis (MVPA) for image recognition to catalog the human brain activities is scarce. Moreover, experiment design is a complex procedure and selection of image type, color and order is challenging too. Thus, this research bridge the gap by using MVPA to create taxonomy of human brain activity for different categories of images, both colored and gray scale. In this regard, experiment is conducted through EEG testing technique, with feature extraction, selection and classification approaches to collect data from prequalified criteria of 25 graduates of University Technology PETRONAS (UTP). These participants are shown both colored and gray scale images to record accuracy and reaction time. The results showed that colored images produces better end result in terms of accuracy and response time using wavelet transform, t-test and support vector machine. This research resulted that MVPA is a better approach for the analysis of EEG data as more useful information can be extracted from the brain using colored images. This research discusses a detail behavior of human brain based on the color and gray scale images for the specific and unique task. This research contributes to further improve the decoding of human brain with increased accuracy. Besides, such experiment settings can be implemented and contribute to other areas of medical, military, business, lie detection and many others.

A Preliminary Study of the Effects of Attentive Music Listening on Cochlear Implant Users' Speech Perception, Quality of Life, and Behavioral and Objective Measures of Frequency Change Detection.

IntroductionMost cochlear implant (CI) users have difficulty in listening tasks that rely strongly on perception of frequency changes (e.g., speech perception in noise, musical melody perception, etc.). Some previous studies using behavioral or subjective assessments have shown that short-term music training can benefit CI users’ perception of music and speech. Electroencephalographic (EEG) recordings may reveal the neural basis for music training benefits in CI users.ObjectiveTo examine the effects of short-term music training on CI hearing outcomes using a comprehensive test battery of subjective evaluation, behavioral tests, and EEG measures.DesignTwelve adult CI users were recruited for a home-based music training program that focused on attentive listening to music genres and materials that have an emphasis on melody. The participants used a music streaming program (i.e., Pandora) downloaded onto personal electronic devices for training. The participants attentively listened to music through a direct audio cable or through Bluetooth streaming. The training schedule was 40 min/session/day, 5 days/week, for either 4 or 8 weeks. The pre-training and post-training tests included: hearing thresholds, Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire, psychoacoustic tests of frequency change detection threshold (FCDT), speech recognition tests (CNC words, AzBio sentences, and QuickSIN), and EEG responses to tones that contained different magnitudes of frequency changes.ResultsAll participants except one finished the 4- or 8-week training, resulting in a dropout rate of 8.33%. Eleven participants performed all tests except for two who did not participate in EEG tests. Results showed a significant improvement in the FCDTs as well as performance on CNC and QuickSIN after training (p < 0.05), but no significant improvement in SSQ scores (p > 0.05). Results of the EEG tests showed larger post-training cortical auditory evoked potentials (CAEPs) in seven of the nine participants, suggesting a better cortical processing of both stimulus onset and within-stimulus frequency changes.ConclusionThese preliminary data suggest that extensive, focused music listening can improve frequency perception and speech perception in CI users. Further studies that include a larger sample size and control groups are warranted to determine the efficacy of short-term music training in CI users.

Epileptic Seizure Detection in EEGs by Using Random Tree Forest, Naïve Bayes and KNN Classification

Epilepsy is a disease that attacks the nerves. To detect epilepsy, it is necessary to analyze the results of an EEG test. In this study, we compared the naive bayes, random tree forest and K-nearest neighbor (KNN) classification algorithms to detect epilepsy. The raw EEG data were pre-processed before doing feature extraction. Then, we have done the training in three algorithms: KNN Classification, naïve bayes classification and random tree forest. The last step was validation of the trained machine learning. Comparing those three classifiers, we calculated accuracy, sensitivity, specificity, and precision. The best trained classifier is KNN classifier (accuracy: 92.7%), rather than random tree forest (accuracy: 86.6%) and naïve bayes classifier (accuracy: 55.6%). Seen from precision performance, KNN Classification also gives the best precision (82.5%) rather than Naïve Bayes classification (25.3%) and random tree forest (68.2%). But, for the sensitivity, Naïve Bayes classification is the best with 80.3% sensitivity, compare to KNN 73.2% and random tree forest (42.2%). For specificity, KNN classification gives 96.7% specificity, then random tree forest 95.9% and Naïve bayes 50.4%. The training time of naïve bayes was 0.166030 sec, while training time of random tree forest was 2.4094sec and KNN was the slower in training that was 4.789 sec. Therefore, KNN Classification gives better performance than naïve bayes and random tree forest classification.

Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers

RationaleCue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood.ObjectivesThe present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues.MethodsHeavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants’ event-related and motor readiness potentials as they were preparing to respond.ResultsIn the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block.ConclusionsAfter a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.

Stroke identification using a portable EEG device – A pilot study

Changes in EEG patterns during stroke are almost immediate; however, a full EEG test takes time and requires highly qualified staff. In this study, we examined whether a short recording using a portable EEG device can differentiate between a stroke and control group. EEG samples were collected from patients with an acute ischemic stroke event. The control group comprised healthy volunteers. EEG recordings were recorded using a portable brain wave sensor device. The Revised Brain Symmetry Index (rsBSI) was used to quantify the symmetry of spectral power between the two hemispheres. The investigation group included 33 patients (ages 46-96, mean age 72 years, 66% male) who were diagnosed with ischemic stroke. The control group included 25 healthy individuals. Scores for the rsBSI of non-stroke patients (M=0.1686, SD=0.10) differed significantly from those of ischemic stroke patients (P<0.05, M=0.363, SD=0.25). A statistically significant difference was observed between a group of stroke patients and a matched group of healthy controls with a short recording using a portable EEG device.

Vagus Nerve Stimulator implantation in a pregnant woman with drug resistant epilepsy

The aim is to present a case of successful implantation of Vagus Nerve Stimulator (VNS) in a woman with drug resistant epilepsy (DRE) during pregnancy. It is the first case of VNS implantation in the Russian Federation. The implantation, follow-up, and programming were carried out in the Bekhterev National Research Medical Centre of Psychiatry and Neurology, Saint-Petersburg. Material and method . Female patient, 28 y.o., was diagnosed with DRE more than 11 years ago. The course of her epilepsy deteriorated during pregnancy despite of the appropriate antiepileptic treatment. The EEG, MRI, and laboratory tests did not reveal any focal brain lesion that could necessitate surgical resection. After multidisciplinary consultations, no contraindications to VNS procedure were found. Results . The VNS system was implanted in this patient when she was 18-week-pregnant. The procedure resulted in a seizure reduction and allowed the patient to preserve her pregnancy and deliver a healthy child. Conclusion s. VNS Therapy® is safe and effective for the treatment of DRE. This successful case of VNS implantation in pregnancy opens new venues for the treatment of DRE in this group of patients. The authors declare the absence of conflict of interest with respect to this publication. All authors contributed equally to this article.

Early Detection of Temporal Lobe Epilepsy: Identification of Novel Candidate Genes and Potential Biomarkers Using Integrative Genomics Analysis

Currently afflicting more than 50 million people worldwide, epilepsy is the spectrum disorder characterizing seizures that occur without other plausible medical explanations. Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. Current clinical methods; including MRI scans, EEG tests, and doctor visits; can take upwards of several months to confirm a TLE diagnosis; during this time, patients may experience additional seizures and are at an increased risk for other psychiatric disorders. The purpose of this study is to identify candidate genetic biomarkers to facilitate the earlier detection and diagnosis of TLE through gene-based testing (e.g., genomic heatmap analysis or genetic and/or microarray testing). It was hypothesized that potential biomarkers could be identified by analyzing genes that are normally significantly overexpressed in the temporal lobe relative to the gray matter. Statistical and functional analysis was performed on significantly overexpressed genes (≥3.000 fold change) in the gene expression profiles of four donors without epilepsy. The experimental-evidence-based STRING protein interactions analysis showed associations between genes found in DAVID keyword search and other genes facilitating network interconnectivity. After evaluation of the genes’ STRING enriched functions, changes in the expression of the genes CAMK2A, NPY, DLG4, MEF2C, and MAPK7 were concluded to be potential biomarkers for TLE, confirming the original hypothesis. Specifically, the identification of MEF2C and MAPK7 for this purpose is relatively novel in the fields of bioinformatics and neurogenetics. Future work includes investigating the utility of the candidate genes in real-world gene-based diagnostic methods.

Tibetan medicine Ru-yi-Zhen-bao Pills exhibits anti-migraine effect through mediating PAG anti-nociceptive channel.

Migraine is a disabling neurovascular disorder, which increases risk of cardiovascular events and is a social burden worldwide. The present first-line anti-migraine medications can cause overwhelming side-effects, of which one includes the onset of cardiovascular disease. As one of the marketed Tibetan drugs, Ru-yi-Zhen-bao Pills (RYZBP) have been clinically used to treat cardiovascular disorders and as anti-migraine medication. However, there is currently no research exploring the anti-migraine actions of RYZBP. The current research was designed to assess the anti-migraine roles of RYZBP and explore the underlying mechanisms in a nitroglycerin (NTG)-induced migraine rat model trial. 120 rats were randomly divided into the following six groups of 20 rats each: normal control group, model control group, positive control group, and RYZBP high/medium/low-dose groups (Ru-yi-Zhen-bao Pills; TH 1.00 g/kg, TM 0.50 g/kg and TL 0.25 g/kg). All rats were administered intragastrically for 7 consecutive days, which were subcutaneously injected with the NTG (10mg/kg) after the last gavage (except in the normal control group). 3min after NTG treatment, 30 rats (5 rats from each group) were anesthetized and devoted to electroencephalogram(EEG) testing, which was used to evaluate the analgesic effect of RYZBP. One hour after NTG treatment, the rest of the 90 rats (15 rats from each group) were anesthetized and midbrain tissue sample was dissected. The dissection was then washed with physiological saline and collected. The histopathological changes in the periaqueductal gray(PAG) of 5 tissue samples were determined by aematoxylin-eosin (H&E) staining, as well as an estimation of substance P (SP) and neurokinin 1 receptor (NK1R) expression through immunohistochemically staining(IHC). Another 5 midbrain preparations were carried out to evaluate calcitonin gene-related peptide (CGRP), proenkephalin (PENK), SP, and cholecystokinin (CCK) expressions by real-time quantitative polymerase chain reaction (RT-qPCR). The rest of the 5 brainstem tissues were then used to measure CCK, CGRP, and opioid peptide receptor (DORR) levels by western blotting(WB). In the EEG test, RYZBP (TM 0.50 g / kg) treatment transformed the EEG pain-wave of the NTG-induced migraine model rats in different time period. In the mechanism assay, compared with the model control group, RYZBP pretreatment reduced inflammatory cell infiltration, fibrosis and vacuolation of neuronal cells of PAG tissue seen by HE staining. IHC experiments further showed that RYZBPTM up-regulated SP expression levels and enhanced NK1R levels in the NTG-induced migraine rats (P<0.05). Therapeutic administration of RYZBP also increased PENK mRNA expression and DORR protein level. Both RT-qPCR and western blotting trials indicated that RYZBP treatment significantly decreased CCK and CGRP expression levels (P<0.01 or P<0.05) in the NTG-induced migraine rats. RYZBP has the potential to be an effective anti-migraine treatment through suppressing the EEG pain-wave, increasing the levels of SP, PENK, DORR and reducing expression of CCK and CGRP. Mediating the PAG anti-nociceptive channel and inhibiting central sensitization were the two potential mechanisms, which offers further evidence for clinical therapy.

Intranasal oxytocin enhances EEG mu rhythm desynchronization during execution and observation of social action: An exploratory study

Intranasal administration of oxytocin (OT) has been found to facilitate prosocial behaviors, emotion recognition and cooperation between individuals. Recent electroencephalography (EEG) investigations have reported enhanced mu rhythm (alpha: 8–13 Hz; beta: 15–25 Hz) desynchronization during the observation of biological motion and stimuli probing social synchrony after the administration of intranasal OT. This hormone may therefore target a network of cortical circuits involved in higher cognitive functions, including the mirror neuron system (MNS). Here, in a double-blind, placebo-controlled, between-subjects exploratory study, we investigated whether intranasal OT modulates the cortical activity from sensorimotor areas during the observation and the execution of social and non-social grasping actions. Participants underwent EEG testing after receiving a single dose (24 IU) of either intranasal OT or placebo. Results revealed an enhancement of alpha - but not beta - desynchronization during observation and execution of social grasps, especially over central and parietal electrodes, in participants who received OT (OT group). No differences between the social and non-social condition were found in the control group (CTRL group). Moreover, we found a significant difference over the cortical central-parietal region between the OT and CTRL group only within the social condition. These results suggest a possible action of intranasal OT on sensorimotor circuits involved in social perception and action understanding, which might contribute to facilitate the prosocial effects typically reported by behavioral studies.

Demographic and clinical factors associated with routine outpatient electroencephalography (EEG) findings at king Abdulaziz University Hospital in Jeddah, Saudi Arabia

Routine EEG is the most commonly used EEG. It is limited by its short duration and difficulty capturing sleep. To improve its yield, hyperventilation, photic stimulation, and sleep deprivation are applied. Moreover, specific factors have been found to predict abnormal findings in a few studies. We aimed to further investigate the effect of more factors on routine EEG findings. We gathered routine outpatient EEG records between 2015 and 2018 from the EEG department and reviewed the demographic and clinical data from patients' files. Patients ≥18-year-old were included. We collected demographics, the indications of EEG tests, co-morbidities, anti-epileptic medications (AEDs) use, and detailed EEG reading records. We included 503 records, 58.6% of females, with a mean age of 39 ± 17 years. Of the recorded EEG's, 41.6% were abnormal, 13.4% of them had epileptiform discharges, 88.5% slowing. Half of epileptic patients had abnormal findings, 20.9% of them who were on ≥1 AED had epileptiform discharges (p < .05). Diabetes mellitus and AED use with stroke were associated with slowing, specifically with use of one AED (p < .05). AED combinations including levetiracetam were associated with all mentioned findings (p < .05). Seizure-related indications were associated with epileptiform discharges as opposed to other indications (p < .05). Using logistic regression, stroke and use of carbamazepine were predictors of abnormal EEG, while use of ≥1 AED predicted epileptiform discharges. Stroke also predicted the abnormal slowing. To improve the yield of routine EEG, priority can be given to epileptics, diabetics with stroke, those on AEDs, and those with indications more typical of seizures or brain lesions.

204 Clinicoradiological Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation (CAA-ri) - a Non-Invasive Approach to Diagnosis and Management

Abstract Background Cerebral Amyloid Angiopathy (CAA) is an age-related disorder characterised by deposition of beta-amyloid protein in the walls of small and medium cortical vessels leading to increased risk of intracranial bleeding. CAA-Related Inflammation (CAA-ri) is an under recognised subtype of CAA potentially responsive to immunosuppression and traditionally diagnosed by invasive brain biopsy. CAA-ri is associated with rapid cognitive decline but shows reversibility for some when treated with immunosuppression. We present the case of an 82 year old lady who presented with first seizure, a history of notable cognitive change and neuroimaging consistent with probable CAA-ri. Methods Validated clinicoradiological diagnostic criteria for CAA-ri were applied to MRI T2 FLAIR and SWI sequences. CSF, APOE genotyping, EEG and cognitive testing were performed. Interdisciplinary perspectives were sought from Neurology, Neurosurgery and Infectious Diseases colleagues. Consensus opinion opposed brain biopsy on strength of imaging evidence and pulsed intravenous steroid treatment was initiated. BP, anti-convulsant and bone protection were optimised and anti-thrombotics avoided. Repeat imaging and cognitive testing were repeated after four months. Results MRI T2-FLAIR revealed an asymmetric multifocal distribution of cortical and subcortical white matter hyperintensities (WMH) with leptomeningeal enhancement while SWI showed extensive multifocal microhaemorrhages with confluent haemorrhage in the right frontal and temporal regions. EEG demonstrated right frontal theta slowing and absence of epileptiform activity. CSF analysis reported raised protein at 53mg/dl. Normal WCC. Formal cognitive testing with ACEIII revealed a score of 79/100. EPOA was advised. Conclusion Clinicoradiological diagnosis of CAA-ri permits early initiation of immunosuppressive therapy and avoids invasive brain biopsy. In the absence of clinical suspicion and blood sensitive imaging sequences CAA-ri may be misdiagnosed as Acute Ischaemic Stroke or TIA where the addition of anti-thrombotic therapy could cause harm while early medical management offers potential reversibility.

The association of quantitative EEG and MRI in Creutzfeldt-Jakob Disease.

Previous studies showed concordance between the typical Periodic Sharp Wave Complex (PSWC) activity in EEG of Creutzfeldt-Jakob Disease (CJD) patients and the MRI findings, while the concordance with slow activity in EEG is less established. The aim of this study was to better characterize the association between MRI findings and EEG changes using quantitative EEG (qEEG) analysis. The demographics, clinical features, and the MRI findings of 12 familial E200K patients with CJD were gathered. EEG test was done and reviewed for the typical PSWC and for the non-specific slow activity. A possible association between the MRI findings and the EEG activity was examined. Then, EEG was analyzed using qEEG tool, and the association between the qEEG finding and the MRI was examined. Twelve patients were included in the study (67% women). Cortical MRI lesions finding were seen in 6/12 (50%) of the patients, and deep gray mater lesions were seen in 8/12 patients (67%). EEG showed the classic PSWC in 6/12 (50%) of the patients where slow activity was seen in 10/12 (83%). Slow activity and cortical MRI findings were associated in only 2/6 (33%) where deep gray matter findings and the slow activity had concordance of 4/8 (50%). qEEG analysis improved this concordance between slow activity and cortical findings to 3/6 (50%) and with the deep gray matter findings to 5/8 (63%). Quantitative EEG analysis modesty but not significantly, improves the association of EEG slow activity in familial E200K CJD patients with MRI findings.