Frontal Intermittent Delta Activity Research Articles

Electroencephalography and somatosensory evoked potentials in Covid-19 patients. Experience in recording and using telemedicine technologies to analyze results

A new coronavirus COVID-19 has led to the development of a global pandemic. It is characterized by a high risk of developing pneumonia and multiple organ failure along with its capability to influence the central nervous system. The main methods of instrumental assessment of the functional state of the brain are electroencephalography (EEG) and somatosensory evoked potentials (SEPs), which have been routinely used with patients in critical care units.We recorded the EEGs and short-latency SEPs of 31 COVID-19 patients, all were treated at the N. V. Sklifosovsky Research Institute of Emergency Care in 2020. The combined data was used to analyse the following outcome.We detected abnormal EEGs in 23 COVID-19 patients (74 %). Seven (30.4 %) patients showed EEGs consisting of diffuse non-specific slowing, 4 patients had lateralized hemispheric slowing (17.4 %) and one patient (4,3 %) had frontal intermittent delta activity (FIRDA). Three (13 %) patients in comas had “burst-suppression» pattern, three (13 %) had isoelectric EEGs and two (8,7 %) had areactive alpha rhythm, regarded as an electrographic manifestation of alpha coma. Two patients had evidence of epileptiform discharges (9 %), triphasic waves were presented in one patient (4.3 %).EEG and SEPs with the median nerve stimulation in COVID-19 patients do not reveal specific changes, nevertheless they are informative instrumental methods for assessing the functional state of the brain to identify biomarkers of epileptic seizures and to prognosticate survival and recovery in comatose patients.

Ifosfamide-induced encephalopathy: the EEG with frontal intermittent delta activity, and rapid resolution with methylene blue: A case report

BackgroundEncephalopathy is an established side effect of the chemotherapeutic agent, ifosfamide, occurring in 10–30% of cases. The EEG commonly shows non-specific features of encephalopathy, and rarely shows frontal intermittent rhythmic delta activity (FIRDA).Case presentationThis is a case report of a 71 year old woman with pleomorphic sarcoma, who developed ifosfamide-induced encephalopathy with her second dose of ifosfamide. It shows the characteristic EEG findings that have been described previously with ifosfamide-induced encephalopathy and additionally the unusual and rare finding of FIRDA. This was followed up by a further EEG showing resolution of the encephalopathy, after administration of methylene blue, coinciding with rapid and complete resolution of her symptoms.ConclusionThe rapid resolution of the encephalopathy on the EEG after administration of methylene blue adds further evidence to its effectiveness as a treatment for the disorder.

Encephalitis Associated with COVID-19 Infection in an 11-Year-Old Child

Neurological complications associated with COVID-19 infection are not well understood in children or adults. An adult with acute necrotizing encephalitis associated with COVID-191Yeh E.A. Collins A. Cohen M.E. et al.Detection of coronavirus in the central nervous system of a child with acute disseminated encephalomyelitis.Pediatrics. 2004; 113: e73-e76Crossref PubMed Scopus (219) Google Scholar and a child with acute disseminated encephalomyelitis and non-COVID coronavirus2Poyiadji N. Shahin G. Noujaim D. et al.COVID-19-associated acute necrotizing encephalopathy: CT and MRI features.Radiology. 2020; : 201187Crossref PubMed Scopus (927) Google Scholar have been reported. The infection is typically mild in children, and no neurological complications were reported in the 171 children from Wuhan Children’s Hospital.3Lu X. Zhang L. Du H. et al.SARS-CoV-2 infection in children.N Engl J Med. 2020; 382: 1663-1665Crossref PubMed Scopus (1578) Google Scholar In preliminary data from US cases, headache was the only neurological symptom.4CDC COVID-19 Response TeamCoronavirus disease 2019 in children – United States, February 12-April 2, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 422-426Crossref PubMed Scopus (0) Google Scholar We describe an 11-year-old previously well child who presented with status epilepticus requiring four anticonvulsant medications and cerebrospinal fluid evidence for encephalitis (921 red cells, 16 white cells, 8% neutrophils [normal 0% to 6%] with protein of 97 [normal: 40 to 170 mg/dL], and glucose of 92 [normal: 20 to 100 mg/dL]). He had a two-day history of generalized weakness without respiratory symptoms or fever at home; emergency room temperature was 102.7°F. Head computed tomography was negative. Electroencephalography revealed frontal intermittent delta activity. Nasopharyngeal swab was positive for COVID-19 as well as rhinovirus/enterovirus but the latter was absent in cerebrospinal fluid polymerase chain reaction. Recovery without treatment was complete in six days. We believe this is the first child reported with COVID-19 viral encephalitis, and the condition was reversible. How coronavirus affects the brain is not known. This child’s findings suggest that direct brain infection may be possible. An autoimmune process may also be possible. The acuteness of our patient’s neurological manifestations coupled with the occurrence of fever and generalized systemic weakness mitigates against a postinfectious process. Because the virus binds the surface spike protein to the human angiotensin-converting enzyme 2 receptor (ACE-2) and ACE-2 is present in the brain vascular endothelium, a vascular process with clotting and infarction may also be possible, although this was not the mechanism in our patient.5Clerkin K.J. Fried J.A. Raikhelkar J. et al.Coronavirus disease 19 (Covid-19) and cardiovascular disease.Circulation. 2020; 141: 1648-1655Crossref PubMed Scopus (964) Google Scholar, 6Zhang Y. Xiao M. Zhang S. et al.Coagulopathy and antiphospholipid antibodies in patients with Covid-19.N Engl J Med. 2020; 382: e38Crossref PubMed Scopus (1408) Google Scholar, 7Jiang T. Gao L. Lu J. et al.ACE2-Ang-(1-7)-Mas axis in brain: a potential target for prevention and treatment of ischemic stroke.Curr Neuropharm. 2013; 11: 209-217Crossref PubMed Scopus (91) Google Scholar Although preliminary, we recommend screening children presenting with encephalitis for COVID-19 as infected patients require special precautions to prevent further spread.

EEG Findings in Diffuse Lewy Body Disease and Parkinson´S Disease with Dementia

Objectives: Electroencephalography can still reveal a variety of focal abnormalities in different neurological diseases. EEG could represent an easy and economical tool to differentiate parkinsonisms when compare to neuroradiological studies. We want to report the EEG findings in a serie of diffuse lewy body disease and demented Parkinson´s disease patients of our unit of movement disorders, in a prospective and open label study. Methods: 30 consecutive subjects were enrolled, 10 patients with criteria for diffuse lewy body disease, 10 patients with criteria for Parkinson’s disease (demented) and 10 normal subjects. The MMSE, the GDS/FAST staging scale, the UPDRS and the Schwab and England scales and NPI-Q scale were administered. A 36-channel video-QEEG recording and Spectral EEG analysis were determined in patients and subjects. Results: Diffuse lewy body disease patients showed a mean of occipital frequency of 7.7 ± 0.3 Hz (P: 0.04), 70% of them showed temporal lobe amplitude’s asymmetries (P: 0.04) and 90% showed a Frontal Intermittent Delta Activity (P: 0.02). Parkinson’s disease patients showed a mean of occipital frequency of 8.8 ± 0.8 Hz, 20% of them showed temporal lobe asymmetries and 10% showed Frontal Intermittent Delta Activity. Frontal Intermittent Delta Activity and temporal lobe amplitude’s asymmetries in Diffuse lewy body disease patients were statistically significant compared to the normal subjects, while the Parkinson’s disease patients showed no statistical differences from normal subjects. Conclusions: Electroencephalographic findings in Diffuse Lewy Body Disease patients could represent an electrophysiological marker that might aid in distinguishing Diffuse Lewy body disease patients from Parkinson’s disease patients, further studies are needed to validate our results

Prolonged daytime dissociative nrem3 sleep state in hypersomnolence with kleine levin symptomatology, a case report

Introduction We present a case of recurrent hypersomnolence. A diagnostic approach was performed. Materials and methods Medical evaluation by neurologist, ENT-surgeon, Maxillofacial surgeon, orthodontist and expert in sleep medicine and epilepsy. Results History: 7 weeks: stenosis pylori, 10th year: head injury; 41: Narcolepsy? HLADQ2 DQ8: neg.; negative effect of modafinil and sodium-oxybate; 41 years: IGM: Monoclonal Gammopathy of Undertermined Significance (MGUS). Symptoms: staring at childhood. At 42 years: 3 days a week hypersomnolence during daytime: sleeps from 12 am to 4 pm, a feeling of unreality, works at home on automatic pilot, has no recollection of what he has done for several hours. In this period he is highly emotional and irritated, is sexually hyper aroused and has changed eating habits, with vomiting, automatic behaviour during eating, dysbasia and atonic jerks during defecation. Neurology: no abnormalities. Polysomnography: daytime sleep 1:30–4 p.m.: deep sleep with steep sws during 40 min. Nighttime sleep 0–6.30 am; SE = 91%; awakenings 24; nrem3 = 111 min (30%); rem = 66 min (18.4%); apnea-hypopnea-index = 18.3/h. MSLT: SL = 4.1 min, no sorem. Two days EEG and video monitoring: at start and next morning a normal background EEG. At 0 pm headache, double vision, faster speaking, followed by automatic behaviour for 3 h in the late afternoon, without recollection. EEG: frontal intermittent delta activity, changing into diffuse slowing in EEG to 1–2/s. and frontal regions zeta waves 1–3 s. Magnetic resonance imaging: no abnormalities in gray and white matter. CSF fluid: Hypocretine-1: 362 ng/l (range 224–653); liquor ery: 0. 0 × 106/l;leu,5.0 × 106/l; gluc 3.3; total protein 0.51 g/l; virology: DNA HSV-1, HSV-2 and VZV: neg. Hormonal axis: GH:5.4 mU/l; TSH:1.88 mU/l; Cortisol; 8 a.m.:411; 4 p.m:157 nmol/l; ACTH:3.3 pmol/l; Testosteron: 13.4 nmol/l; Vit D: 30 nmol/l. Blood sample; BSE 4 mm/h; CRP Conclusion Diagnosis: Kleine–Levin syndrome, OSAS. No epilepsy. Treatment of OSAS with MRA was started and Vit D supplied. Therapy of KLS stabilizing deep and REM sleep during nighttime with Valproate 300–150 mg, zopiclon 7.5 mg; clonazepam 1 mg an; Mirtazapine 18 mgr an, followed by stimulating daytime vigilance with methylphenidate 10 mg 4 dd. Nighttime sleep improved to 7 h, daytime nap lessened to 2 h, dissociative deep sleep state in afternoon to 1/2 h. Conclusion: This case suggests a possible auto-immune mediation. Acknowledgements To the co-workers of the Department of Clinical Neurophysiology, Epilepsy and Sleep Centre SEIN Zwolle.

Clinical and imaging correlates of EEG patterns in hospitalized patients with encephalopathy

To identify the relationship between pathologic electroencephalographic (EEG) patterns, clinical and neuroradiological abnormalities, and outcome in hospitalized patients with acute encephalopathy. This 5-year cohort study was performed at an academic tertiary care center. EEGs in 154 patients with altered mental status were classified according to five predefined patterns: Isolated continuous slowing of background activity (theta, theta/delta, and delta activity) and patterns with slowing background activity with episodic transients [i.e., triphasic waves (TWs) or frontal intermittent delta activity (FIRDA)]. Clinical characteristics, blood tests and neuroimaging were compared among groups. Associations between EEG patterns and structural and non-structural abnormalities were calculated. Glasgow Outcome Score >3 at discharge was defined as favorable and 1–3 as unfavorable outcome. In multivariable analyses, theta was associated with brain atrophy (OR 2.6, p = 0.020), theta/delta with intracerebral hemorrhages (OR 6.8, p = 0.005), FIRDA with past cerebrovascular accidents (OR 2.7, p = 0.004), TWs with liver or multi-organ failure (OR 6, p = 0.004; OR 4, p = 0.039), and delta activity with alcohol/drug abuse with or without intoxication, and HIV infection (OR 3.8, p = 0.003; OR 9, p = 0.004). TWs were associated with death (OR 4.5, p = 0.005); theta/delta with unfavorable outcomes (OR 2.5, p = 0.033), while patients with FIRDA had favorable outcomes (OR 4.8, p = 0.004). In encephalopathic patients, well-defined EEG patterns are associated with specific pathological conditions and outcomes, suggesting that mechanistic hypotheses underlie these abnormal EEG patterns. To clarify the respective contributions of non-structural and structural abnormalities to encephalopathy reflected in specific EEG patterns, prospective studies using continuous EEG monitoring during the acute onset of encephalopathy are needed.

Reversible Carbamazapine Encephalopathy With Frontal Intermittent Rhythmic Delta Activity

Reversible Carbamazapine Encephalopathy With Frontal Intermittent Rhythmic Delta Activity

Reversible Carbamazapine Encephalopathy With Frontal Intermittent Rhythmic Delta Activity

Reversible Carbamazapine Encephalopathy With Frontal Intermittent Rhythmic Delta Activity

Frontal intermittent delta activity in schizophrenic patients receiving antipsychotic drugs.

FIRDA was found in 14 EEGs recorded from 338 schizophrenic patients receiving antipsychotic drugs, although they showed no FIRDA in the baseline EEG. The daily dose of antipsychotic drugs when FIRDA was found was larger than when FIRDA disappeared. FIRDA was assumed to be induced by relatively high doses of antipsychotic drugs. Thus, the effect of antipsychotic drugs should be added to the list of differential diagnoses associated with FIRDA. FIRDA did not correlate with the baseline psychopathology of schizophrenic patients. Patients without FIRDA tended to respond poorly to antipsychotic drugs in terms of negative symptoms. Improvement of positive symptoms in FIRDA patients was not as remarkable as in patients without FIRDA.