Postural Tone Research Articles

Alternating hemiplegia of childhood

We reviewed the etiologic aspects, clinical symptoms, complementary studies, differential diagnosis and treatment of alternating hemiplegia of childhood (AHC). AHC is an uncommon illness of uncertain pathophysiology that provokes crisis of transient hemiplegia affecting one hemibody or occasionally both at the same time. Clinical symptoms of AHC usually begin before the age of 18 months and in some cases may present in the neonatal period. Clinical symptoms include abnormal ocular movements such as nystagmus and dystonic or tonic posturing. Hemiplegic attacks are not associated with alteration of consciousness. Hemiplegia may disappear after arousal and may reappear 10 to 20 minutes after arousal in children with AHC. The diagnosis of AHC is clinically made, and most of the clinically used diagnostic tests result in negative. The treatment of AHC includes flunarizine. It is necessary to suspect this diagnosis to identify patients with AHC.

Valproic acid-induced pancreatitis in a physically and mentally challenged child

An 11-year-old child with spastic cerebral palsy, microcephaly, mental retardation and epilepsy presented with a short history of abnormal tonic posturing, irritability and poor feeding. A presumptive diagnosis of seizure relapse was made and treatment instituted along without improvement. Investigation revealed elevated laboratory markers of pancreatitis, which together with the clinical picture and evidence of pancreatic inflammation on computed tomography abdomen, led to the diagnosis of acute pancreatitis secondary to valproic acid. Symptoms of pancreatitis subsided promptly with discontinuation of valproate and supportive treatment. The clinical features of pancreatitis can easily be misinterpreted in neurologically impaired children and its diagnosis requires a high index of suspicion.

1-A-D-25. Ictal limb posturing differs between seizures arising from temporal lobe and supplementary motor area: A video-EEG study

Focal seizures arising from the temporal lobe (TL seizures) resemble those from supplementary motor area (SMA) with resepct to ictal dystonic and/or tonic posturing. The aim of this study is to clarify the symptomatic difference and then underlying mechanism between TL- and SMA seizures by careful observation of ictal posturing. Among patients with partial epilepsy who performed long-term video-EEG monitoring from 1992 to 2014, we employed 13 patients with TL seizures showing discrete dystonic posture and 12 patients with SMA seizures showing clear abnormal tonic posture. We reviewed the posturing and the movement direction of the shoulder, elbow and wrist joints of both seizures. As the results, shoulder adduction was observed significantly more in TL seizures than SMA seizures ( p p

Mirroring patients – or not. A study of general practitioners and psychiatrists and their interactions with patients with depression

For mentalization theorists, implicit mentalization is a key component of all forms of therapy. However, it has been difficult to grasp and to describe precisely how implicit mentalization works. It is said to take place partly by mirroring others in posture, facial expression and vocal tone. Based on studies of imitative behaviour within linguistics and psychology, we argue that interactional mirroring is an important aspect of displaying implicit mentalization. We aimed to explore if, and in that case how, mirroring is displayed by general practitioners (GPs) and psychiatrists in consultations with patients with depression. We wanted to see how implicit mentalizing unfolds in physician–patient interactions. Consultations were video-recorded and analysed within the framework of conversation analysis. GPs and psychiatrists differed substantially in their propensity to mirror body movements and verbal and acoustic features of speech. GPs mirrored their patients more than psychiatrists in all modalities and were more flexible in their interactional behaviour. Psychiatrists seemed more static, regardless of the emotionality displayed by patients. Implicitly mirroring and attuning to patients could signify enactment of implicit mentalization, according to how it is described by mentalization theorists. We discuss reasons for the differences between GPs and psychiatrists, and their implications.

Hemodynamic measurements for evaluating vasovagal syncope in the emergency department.

Syncope is a sudden and transient loss of consciousness and postural tone, with spontaneous recovery without medical intervention. It accounts for 1.0% to 1.5% of emergency department (ED) visits and up to 6% of hospital admissions. Vasovagal syncope may be the cause of syncope in 21% to 40% of cases. A 53-year-old Chinese woman was brought to the ED by ambulance after a near-syncope episode while performing gentle morning exercises. She was hypotensive and bradycardic in the ambulance. Upon arrival at the ED, her blood pressure was 89/61 mmHg. The use of a Doppler cardiac output monitor readily demonstrated that the patient’s systemic vascular resistance was reduced, with cardiac output at the lower limit of the normal range. These hemodynamic data were useful in supporting the diagnosis of vasovagal syncope; they helped in the risk stratification of our patient with syncope, and guided the management and subsequent disposition decision.

Diagnostic utility of carotid artery duplex ultrasonography in the evaluation of syncope: a good test ordered for the wrong reason

Syncope refers to a transient loss of consciousness and postural tone secondary to cerebral hypoperfusion. Guidelines recommend against neurovascular testing in cases of syncope without neurologic symptoms; however, many pursue carotid artery duplex ultrasonography (CUS) due to the prognostic implications of identified cerebrovascular disease. Our objective was to determine the diagnostic utility of CUS in the evaluation of syncope and the identification of new or severe atherosclerosis with the potential to change patient management. We reviewed records of 569 patients with CUS ordered for the primary indication of syncope through an accredited vascular laboratory at an academic, urban medical centre. Findings on CUS, patient demographic, clinical and laboratory information, and medications within 6 months of the CUS exam were reviewed. Bivariate relationships between key medical history characteristics and atherosclerosis status (known vs. new disease) were examined. Among 495 patients with complete information, cerebrovascular findings could potentially explain syncope in 2% (10 patients). Optimization of cardiovascular risk factors would benefit patients with known (56.6%) and new atherosclerosis (33.5%) with suboptimal lipid control, (LDL > 70 in 42.2 and 34.9% respectively; LDL > 100 in 15.7 and 20.4%), and those not on high-intensity statin therapy (80 and 87.5%) or antiplatelet medications (13.2 and 50.6%). CUS is a low-yield diagnostic test in the evaluation of syncope, but it is useful in the diagnosis of atherosclerosis and identification of subjects who would benefit from optimal medical therapy.

Lighten Up

Background. Parkinson’s disease (PD) is associated with stooped postural alignment, increased postural sway, and reduced mobility. The Alexander Technique (AT) is a mindfulness-based approach to improving posture and mobility by reducing muscular interference while maintaining upward intentions. Evidence suggests that AT can reduce disability associated with PD, but a mechanism for this effect has not yet been established. Objective. We investigated whether AT-based instructions reduce axial rigidity and increase upright postural alignment, and whether these instructions have different effects on postural alignment, axial rigidity, postural sway, and mobility than effort-based instructions regarding posture. Method. Twenty subjects with PD practiced 2 sets of instructions and then attempted to implement both approaches (as well as a relaxed control condition) during quiet standing and step initiation. The “Lighten Up” instructions relied on AT principles of reducing excess tension while encouraging length. The “Pull Up” instructions relied on popular concepts of effortful posture correction. We measured kinematics, resistance to axial rotation, and ground reaction forces. Results. Both sets of experimental instructions led to increases in upright postural alignment relative to the control condition. Only the Lighten Up instructions led to reduced postural sway, reduced axial postural tone, greater modifiability of tone, and a smoother center of pressure trajectory during step initiation, possibly indicating greater movement efficiency. Conclusion. Mindful movement approaches such as AT may benefit balance and mobility in subjects with PD by acutely facilitating increased upright postural alignment while decreasing rigidity.

Vasovagal syncope in humans and protective reactions in animals.

Vasovagal syncope (VVS) is not known to occur in animals, although other similar reflex responses are common. This review examines the possible relation of these latter presumably protective reflexes in animals to VVS in humans. The goal is to provide practitioners, and ultimately their patients, a meaningful understanding of the origins and appropriate management of this unpredictable affliction. This report utilized review of computer databases (e.g. PubMed) addressing VVS pathophysiology and origins, spontaneous transient loss of consciousness in animals, and comparative physiology. We also examined articles cited in the publications obtained by computer search and others suggested by colleagues. Articles were chosen based on those providing original observations and/or suggestions of novel mechanisms. In animals self-preservation is directed towards protection of the body through an escalation of behaviours depending on severity and proximity to danger. In humans self-preservation is directed not only to protection of the body, but also to protection of the brain's functional integrity. By virtue of loss of postural tone, the faint causes the body to assume a gravitationally neutral position, thereby offering a better chance of restoring brain blood supply and preserving brain function. Vasovagal syncope may seem to be a disadvantageous evolutionary adaptation. However, it is a reversible condition, that while exposing risk of injury and embarrassment, ultimately favours brain self-preservation in potentially threatening circumstances.

APPROACH TO SYNCOPE IN EMERGENCY DEPARTMENT

ABSTRACT Syncope, with the absence of postural tone, a sudden and transient loss of consciousness is characterized by full and often rapid spontaneous recovery. Most of the potential causes of syncope are benign and self-limiting. However, Syncope can be life-threatening causes. Approximately one third of patients during episodes of syncope cause injuries and can be psychologically devastating for patients with recurrent syncope. History, physical examination, and electrocardiogram can be detected an underlying cause in about 50 to 80% of patients. Despite detailed diagnostic tests, reason of syncope is undetectable in 18-41% of patients with syncope. This article is based on the problems of diagnostic approach to syncope in emergency department.

Soft tissue changes after a combined lefort I and anterior maxillary osteotomy: A clinical and cephalometric study

Background: Orthognathic Surgery is indicated in severe skeletal disharmony on the best means of improving functional facial esthetic. Assessment of the facial harmony in relation to soft tissue contour the thickness of the tissues, the lip length to postural tone plays an important role. This article aims determining the changes of the soft tissue profile cephalometrically after maxillary osteotomy. Material and Methods: The entire concept of orthognathic surgery involves the identification of the hard and soft tissue deformity by clinical examination, cephalometric radiographs, models and photographs. This study is to assist the pre and post-operative soft tissue changes clinically including width of the nasal bone and upper incisor exposure of rest and cephalometrically including nasolabial angle, facial convexity, lip protuberance and inter-labial gap by using Rickets E Line, Steiner's S Line, Merrifield's Z Angle and Holdaway Soft Tissue Analysis. Results: There is significant dramatic improvement in the soft tissue profile cephalometrically after maxillary osteotomy. Conclusion: The conclusion of the study is that there is a change in the soft tissue in relation to the hard tissue movement, and also the stability of the soft tissue profile was established by rigid fixation of bony segments.

Neuropeptides and peptide hormones in syncope and orthostatic intolerance.

Syncope and orthostatic intolerance (OI) are common clinical syndromes often requiring medical attention. The former is defined as transient loss of consciousness and postural tone due to self-limited cerebral hypoperfusion, while the latter consists of inappropriate cardiovascular responses to upright posture such as occur with orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome. The most frequent causes of syncope and OI are conditions that temporarily disrupt essential moment-to-moment interaction between the autonomic nervous system and cardiovascular system. In this regard, many neuropeptides (NPs) or peptide hormones (PH) exert cardioactive effects that might contribute to the pathophysiology of certain forms of syncope or OI. To date, the principal peptides that have been studied in this context are: atrial and B-type-neuropeptides, adrenomedullin, endothelin-1 (ET-1), galanin, and vasopressin. While definitive conclusions cannot yet be drawn, the intrinsic vasoconstrictor ET-1 appears to be elevated in OH, presumably to compensate for vasodilation and hypotension of other etiologies. As such elevated ET-1 may become a marker for OH. Further, elevated NT-proBNP may play a role in causing vasodilation and hypotension in some forms of OH of previously unknown cause, and may be a marker in other patients of a cardiovascular cause of syncope and OI. In the end, the study of the role of NPs and PHs in syncope and OI syndromes is at an early stage, and considerable further future effort is needed.

Brief asymmetric tonic posturing with diffuse low-voltage fast activity in seizures arising from the mesial parietal region

Seizures originating from the parietal lobe can demonstrate variable semiology. Our aim was to describe the electroclinical features of seizures originating from the mesial parietal lobe. We identified four patients through the Comprehensive Epilepsy Program at our institution, who had strong evidence of a mesial parietal source for their epilepsy, including a mesial parietal structural lesion. Patients had very frequent brief seizures despite anticonvulsants, each lasting 10-30s, with rapid return of awareness post-event. Clinically attacks were bland, or showed asymmetric tonic posturing, often with partially preserved awareness. Ictal EEG showed diffuse low voltage fast activity. Seizures arising from the precuneus, in the mesial parietal lobe, appear to have a recognizable electroclinical phenotype. Although the clinical and EEG features might have been considered 'non-localizing', there is a striking similarity across patients. The precuneus is a key component of the default mode network (DMN), important for internal reflective thinking. Deactivation of this region has been found to be a prominent feature of generalized spike and wave epileptiform activity. The seizure semiology of these patients presumably reflects activation of this region, and ictal propagation along intrinsically connected components of the DMN.

Role of sympathetic nerve activity in the process of fainting.

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery, and the process of syncope progression is here described with two types of sympathetic change. Simultaneous recordings of microneurographically-recorded muscle sympathetic nerve activity (MSNA) and continuous and noninvasive blood pressure measurement has disclosed what is going on during the course of syncope progression. For vasovagal or neurally mediated syncope, three stages are identified in the course of syncope onset, oscillation, imbalance, and catastrophe phases. Vasovagal syncope is characterized by sympathoexcitation, followed by vagal overcoming via the Bezold-Jarisch reflex. Orthostatic syncope is caused by response failure or a lack of sympathetic nerve activity to the orthostatic challenge, followed by fluid shift and subsequent low cerebral perfusion. Four causes are considered for the compensatory failure that triggers orthostatic syncope: hypovolemia, increased pooling in the lower body, failure to activate sympathetic activity, and failure of vasoconstriction against sympathetic vasoconstrictive stimulation. Many pathophysiological conditions have been described from the perspectives of (1) exaggerated sympathoexcitation and (2) failure to activate the sympathetic nerve. We conclude that the sympathetic nervous system can control cardiovascular function, and its failure results in syncope; however, responses of the system obtained by microneurographically-recorded MSNA would determine the pathophysiology of the onset and progression of syncope, explaining the treatment effect that could be achieved by the analysis of this mechanism.

Looking for complexity in quantitative semiology of frontal and temporal lobe seizures using neuroethology and graph theory

Epileptic syndromes and seizures are the expression of complex brain systems. Because no analysis of complexity has been applied to epileptic seizure semiology, our goal was to apply neuroethology and graph analysis to the study of the complexity of behavioral manifestations of epileptic seizures in human frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). We analyzed the video recordings of 120 seizures of 18 patients with FLE and 28 seizures of 28 patients with TLE. All patients were seizure-free >1year after surgery (Engel Class I). All patients' behavioral sequences were analyzed by means of a glossary containing all behaviors and analyzed for neuroethology (Ethomatic software). The same series were used for graph analysis (CYTOSCAPE®). Behaviors, displayed as nodes, were connected by edges to other nodes according to their temporal sequence of appearance.Using neuroethology analysis, we confirmed data in the literature such as in FLE: brief/frequent seizures, complex motor behaviors, head and eye version, unilateral/bilateral tonic posturing, speech arrest, vocalization, and rapid postictal recovery and in the case of TLE: presence of epigastric aura, lateralized dystonias, impairment of consciousness/speech during ictal and postictal periods, and development of secondary generalization.Using graph analysis metrics of FLE and TLE confirmed data from flowcharts. However, because of the algorithms we used, they highlighted more powerfully the connectivity and complex associations among behaviors in a quite selective manner, depending on the origin of the seizures. The algorithms we used are commonly employed to track brain connectivity from EEG and MRI sources, which makes our study very promising for future studies of complexity in this field.This article is part of a Special Issue entitled “NEWroscience 2013”.

Neural network underlying ictal pouting (“chapeau de gendarme”) in frontal lobe epilepsy

In order to determine the anatomical neural network underlying ictal pouting (IP), with the mouth turned down like a “chapeau de gendarme”, in frontal lobe epilepsy (FLE), we reviewed the video-EEG recordings of 36 patients with FLE who became seizure-free after surgery. We selected the cases presenting IP, defined as a symmetrical and sustained (>5s) lowering of labial commissures with contraction of chin, mimicking an expression of fear, disgust, or menace. Ictal pouting was identified in 11 patients (8 males; 16–48years old). We analyzed the clinical semiology, imaging, and electrophysiological data associated with IP, including FDG-PET in 10 and SEEG in 9 cases. In 37 analyzed seizures (2–7/patient), IP was an early symptom, occurring during the first 10s in 9 cases. The main associated features consisted of fear, anguish, vegetative disturbances, behavioral disorders (sudden agitation, insults, and fighting), tonic posturing, and complex motor activities. The epileptogenic zone assessed by SEEG involved the mesial frontal areas, especially the anterior cingulate cortex (ACC) in 8 patients, whereas lateral frontal onset with an early spread to the ACC was seen in the other patient. Ictal pouting associated with emotional changes and hypermotor behavior had high localizing value for rostroventral “affective” ACC, whereas less intense facial expressions were related to the dorsal “cognitive” ACC. Fluorodeoxyglucose positron emission tomography demonstrated the involvement of both the ACC and lateral cortex including the anterior insula in all cases. We propose that IP is sustained by reciprocal mesial and lateral frontal interactions involved in emotional and cognitive processes, in which the ACC plays a pivotal role.

Feasibility of pulse presence and pulse strength assessment during head-up tilt table testing using an accelerometer located at the carotid artery.

Neurally mediated syncope (NMS) is a disorder of the autonomic regulation of postural tone, which is characterized by hypotension and/or bradycardia, resulting in cerebral hypo-perfusion and finally in a sudden loss of consciousness. Prediction of an impending NMS requires detection of pulse presence to derive heart rate (HR) as well as to assess the pulse strength (PS) related to systolic blood pressure (SBP) preferably from a single body location only. This paper analyses the basic feasibility of using a single accelerometer positioned above the common carotid artery to assess pulse strength and pulse rate towards NMS prediction. A physical model has been investigated to gain insights into expected signal morphologies and potential feature candidates vs. hemodynamic parameters such as SBP, pulse pressure (PP) and PR relevant for NMS detection. Model results are compared with first measurements obtained in a head-up tilt table test (HUTT) from a patient during impending syncope. We show that an accelerometer positioned at the carotid artery is a potential approach offering a valuable tool in syncope management.

Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome.

Orthostatic intolerance is the inability to tolerate the upright posture and is relieved by recumbence. It most commonly affects young women and has a major impact on quality of life and psychosocial well-being. Several forms of orthostatic intolerance have been described. The most common one is the recurrent vasovagal syncope (VVS) phenotype which presents as a transient and abrupt loss of consciousness and postural tone that is followed by rapid recovery. Another common type of orthostatic intolerance is the postural orthostatic tachycardia syndrome (POTS) which is characterized by an excessive rise in heart rate upon standing and is associated with symptoms of presyncope such as light-headedness, fatigue, palpitations, and nausea. Maintenance of arterial pressure under condition of reduced central blood volume during the orthostasis is accomplished in large part through sympathetic efferent nerve traffic to the peripheral vasculature. Therefore sympathetic nervous system (SNS) dysfunction is high on the list of possible contributors to the pathophysiology of orthostatic intolerance. Investigations into the role of the SNS in orthostatic intolerance have yielded mixed results. This review outlines the current knowledge of the function of the SNS in both VVS and POTS.

P97: Frontal lobe epilepsy versus NREM sleep parasomnia: clinical and EEG characteristics

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S75 ization as focal or generalized, as presentation was mixed. The convulsions seldom qualified as simple generalized tonic-clonic. Nearly half of our patients had generalized convulsive seizures followed by postictal EEG suppression, a possible biomarker for sudden unexpected death in epilepsy. P97 Frontal lobe epilepsy versus NREM sleep parasomnia: clinical and EEG characteristics P. Meritam1,2, M. Lauritzen1,3, B. Wanscher1, P. Jennum1,4, K. Benedek1 1Glostrup Hospital, Clinical Neurophysiology, Glostrup, Copenhagen, Denmark; 2Danish Epilepsy Center, Clinical Neurophysiology, Dianalund, Denmark; 3Copenhagen University, Neuroscience and Pharmacology, Copenhagen, Denmark; 4Copenhagen University, Copenhagen, Denmark Background: Nocturnal paroxysmal events may be characterized clinically, and by video EEG and video polysomnographic recordings, but even when applied rigorously it is often difficult to distinguish between frontal lobe epilepsy (FLE) and NREM parasomnia (NREM-P). Aim of study: To assess the value of high frequency EEG synchronization during pre-ictal state in order to differentiate between FLE and NREM-P. Methods: We analyzed the clinical features as well as macroscopic EEG and polysomnografic recordings of 12 patients with frontal lobe epilepsy and 12 patients with NREM parasomnia. Short time Fast Fourrier Transformation (FFT), spectral data analysis as well as spectral coherences were evaluated among all electrodes at 1-10 seconds prior to the nocturnal episode in both patient groups. Results: Evaluation of clinical features of frontal lobe seizures and NREM parasomnia events showed significant differences between the two groups. FLE seizures had shorter duration (<2 min), higher frequency per night (mean 9.75±3.9) as well as per month (mean 22.75±8) as compared to NREM-P events (mean 4.33±3.9 and 15.6±12.6 respectively). The semiology of FLE seizures were more stereotyped (p<0.0001) than NREM-P attacks with higher incidence of dystonic or tonic posturing and abrupt offset with recollection (p=0.011) of the event. In comparison, the semiology of NREMP events was heterogenous, with a more gradual offset and with the patient often going back to sleep and having only a vague or no recollection of the event. Our results were consistent with a higher positive FLEP scale in FLE (mean 5.42±2.3) as compared to NREM-P (mean −2.65±3.6). No abnormal rhythmic activity was observed in the macroscopic EEG recordings of most patients (FLE 58% n=7, NREM-P 92% n=11). In contrast, FFT analysis of the EEG signal showed remarkable increases of phase coherence in the high frequency beta and gamma range, mainly occurring around the frontal areas in patients with FLE prior to seizures. This was not observed in patients with NREM sleep parasomnia patients. Conclusion: The clinical features of FLE and NREM sleep parasomnia differ importantly. In addition EEG signal analysis with focus on the highfrequence EEG bands is a useful tool in distinguishing between nocturnal events. Glossary: FLE, frontal lobe epilepsy; REM, rapid eye movement; NREM, non-REM; EEG, electroencephalopraphy; FLEP scale, frontal lobe epilepsy and parasomnia scale. P98 Methionine-enriched diet increases susceptibility of rats to epilepsy: the role of sodium-potassium pump D. Hrncic1, A. Rasic-Markovic1, M. Colovic2, D. Krstic3, R. Obrenovic4, Z. Grubac1, V. Susic5, D. Macut4, D. Djuric1, O. Stanojlovic1 1Belgrade University Faculty of Medicine, Institute of Medical Physiology “Richard Burian”, Lab of Neurophysiology, Belgrade, Serbia; 2Institute for Nuclear Sciences “Vinca”, Belgrade, Serbia; 3Belgrade University Faculty of Medicine, Department of Medical Chemistry, Belgrade, Serbia; 4Clinical Center of Serbia, Belgrade, Serbia; 5Serbian Academy of Sciences and Arts, Belgrade,

P98: Methionine-enriched diet increases susceptibility of rats to epilepsy: the role of sodium-potassium pump

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S75 ization as focal or generalized, as presentation was mixed. The convulsions seldom qualified as simple generalized tonic-clonic. Nearly half of our patients had generalized convulsive seizures followed by postictal EEG suppression, a possible biomarker for sudden unexpected death in epilepsy. P97 Frontal lobe epilepsy versus NREM sleep parasomnia: clinical and EEG characteristics P. Meritam1,2, M. Lauritzen1,3, B. Wanscher1, P. Jennum1,4, K. Benedek1 1Glostrup Hospital, Clinical Neurophysiology, Glostrup, Copenhagen, Denmark; 2Danish Epilepsy Center, Clinical Neurophysiology, Dianalund, Denmark; 3Copenhagen University, Neuroscience and Pharmacology, Copenhagen, Denmark; 4Copenhagen University, Copenhagen, Denmark Background: Nocturnal paroxysmal events may be characterized clinically, and by video EEG and video polysomnographic recordings, but even when applied rigorously it is often difficult to distinguish between frontal lobe epilepsy (FLE) and NREM parasomnia (NREM-P). Aim of study: To assess the value of high frequency EEG synchronization during pre-ictal state in order to differentiate between FLE and NREM-P. Methods: We analyzed the clinical features as well as macroscopic EEG and polysomnografic recordings of 12 patients with frontal lobe epilepsy and 12 patients with NREM parasomnia. Short time Fast Fourrier Transformation (FFT), spectral data analysis as well as spectral coherences were evaluated among all electrodes at 1-10 seconds prior to the nocturnal episode in both patient groups. Results: Evaluation of clinical features of frontal lobe seizures and NREM parasomnia events showed significant differences between the two groups. FLE seizures had shorter duration (<2 min), higher frequency per night (mean 9.75±3.9) as well as per month (mean 22.75±8) as compared to NREM-P events (mean 4.33±3.9 and 15.6±12.6 respectively). The semiology of FLE seizures were more stereotyped (p<0.0001) than NREM-P attacks with higher incidence of dystonic or tonic posturing and abrupt offset with recollection (p=0.011) of the event. In comparison, the semiology of NREMP events was heterogenous, with a more gradual offset and with the patient often going back to sleep and having only a vague or no recollection of the event. Our results were consistent with a higher positive FLEP scale in FLE (mean 5.42±2.3) as compared to NREM-P (mean −2.65±3.6). No abnormal rhythmic activity was observed in the macroscopic EEG recordings of most patients (FLE 58% n=7, NREM-P 92% n=11). In contrast, FFT analysis of the EEG signal showed remarkable increases of phase coherence in the high frequency beta and gamma range, mainly occurring around the frontal areas in patients with FLE prior to seizures. This was not observed in patients with NREM sleep parasomnia patients. Conclusion: The clinical features of FLE and NREM sleep parasomnia differ importantly. In addition EEG signal analysis with focus on the highfrequence EEG bands is a useful tool in distinguishing between nocturnal events. Glossary: FLE, frontal lobe epilepsy; REM, rapid eye movement; NREM, non-REM; EEG, electroencephalopraphy; FLEP scale, frontal lobe epilepsy and parasomnia scale. P98 Methionine-enriched diet increases susceptibility of rats to epilepsy: the role of sodium-potassium pump D. Hrncic1, A. Rasic-Markovic1, M. Colovic2, D. Krstic3, R. Obrenovic4, Z. Grubac1, V. Susic5, D. Macut4, D. Djuric1, O. Stanojlovic1 1Belgrade University Faculty of Medicine, Institute of Medical Physiology “Richard Burian”, Lab of Neurophysiology, Belgrade, Serbia; 2Institute for Nuclear Sciences “Vinca”, Belgrade, Serbia; 3Belgrade University Faculty of Medicine, Department of Medical Chemistry, Belgrade, Serbia; 4Clinical Center of Serbia, Belgrade, Serbia; 5Serbian Academy of Sciences and Arts, Belgrade,

Revisión de los fundamentos teóricos de la gimnasia abdominal hipopresiva

Abdominal hypopressive gymnastics (AHG) is a means towards toning the abdominal muscles, muscles of the pelvic floor, and spine stabilizing musculature. As a differentiating trait, it is claimed that the practice of this method's moves does not cause intraabdominal pressure to increase.The objective of this study is to assess the validity of AHG's theoretical basis and to present arguments for its practice. A literature review is also presented.Discrepancies were found within the following theoretical grounds of AHG: (i)AHG causes stimulation of the expiratory area, and inhibition of the inspiratory area. (ii)AHG causes stimulation of the pneumotaxic center. (iii)Through AHG, postural relaxation of the diaphragm is achieved. (iv)The supraspinal respiratory centers regulate postural tension of the respiratory musculature. (v)Executing phasic abdominal exercises causes a decrease in postural muscle tone. (vi)In order to prevent stress urinary incontinence, training of typei fibers in the pelvic floor must be emphasized.