Sec In Patients Research Articles

Abstract 16877: Role Of Short Term Atrial Fibrillation in Different Stroke Entities

Introduction: Stroke including ESUS is one of the most common causes of disability and death in the world. Atrial fibrillation (AF) of more than 30 sec is considered as reason for cardioembolic stroke. Hypothesis: Nevertheless, shorter periods of AF might also be a possible risk factor. Methods: We determined periods of AF of 0-14 sec, AF 15-30sec and AF> 30 sec in patients with different stroke entities. We analysed all ischemic strokes and transient ischemic attacks at the Stroke Unit in Siegen over 6 months. All stroke patients were prospectively ECG monitored over a minimum of 24h and characterized for the different AF periods. Results: A number of 714 patients over 6 months were hospitalized suffering a stroke. Among them 163 (30.8%) had a cryptogenic Stroke, including 98 (19%) ESUS patients. Furthermore, 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. Manifest atrial fibrillation (>30s) showed a prevalence within our stroke population of 23%. Whereas 15% had an AF episode of 15-29 s and 16% presented AF episode of 0-14 s. Among cardioembolic infarcts, 45% had manifest atrial fibrillation (>30 s), 20% had an atrial fibrillation episode of 15-29 s, and 22% showed an atrial fibrillation episode of 0-14 s. Taken together, more than 90% of cardioembolic infarcts show an episode of atrial fibrillation of any duration. An AF episode of 15-29 s or 0-14 s is also found in almost 35% of ESUS patients;similar to cryptogenic infarcts. In 22% of TIA patients manifest atrial fibrillation has been detected. 7% of TIA patients showed one or more episodes of AF of 15-29 s and 10% an episode of 0-14 s. Among the atherosclerotic infarcts, the proportion of AF >30 s is significantly lower at 12%, however the percentage of AF for 15-29 s was 14. Conclusions: In our study, AF showed the largest ratio with 48% among cardioembolic infarcts. Since a manifest AF is an exclusion criterion for ESUS, none suffered from manifest AF. However, it is striking that 15% had an AF episode of 15-29 s and 18% had an AF episode of 0-15 s. Possibly, the definition of AF has to be adjusted or at least advanced rhythm monitoring should be provided. This should be investigated in future prospective studies.

Retracted: The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation.

[This retracts the article DOI: 10.1155/2022/8679511.].

Association of spontaneous echo contrast with Systemic Immune Inflammation Index in patients with mitral stenosis

ObjectiveSpontaneous echo contrast (SEC) is the appearance of swirling, smoke-like echoes in the left atrium (LA) and is accepted as an independent predictor of thromboembolic risk. There is an established relationship between the inflammatory state and the prothrombotic state. Therefore, we investigated the relationship between the Systemic Immune Inflammation Index (SII), a new inflammation parameter introduced recently, and SEC in patients with mitral stenosis (MS). Material and methodsA total of 262 patients who underwent percutaneous mitral valvuloplasty (PMBV) for MS were included in this study. The patients were divided into two groups: patients with MS complicated by SEC and patients with MS without SEC, based on whether SEC occurred in the LA. ResultsThere were 79 patients (mean age 47.1 ± 6.6, 30.3% male gender) in the SEC (+) group, while there were 183 patients (mean age 46.4 ± 8.6, 29.5% male gender) in the SEC (-) group. In multivariate analysis, high levels of SII were an independent risk factor for SEC in patients with MS (OR: 1.001, 95% confidence interval (CI): 1.000-1.001, p<0.001) together with high levels of C-reactive protein (OR: 1.145, 95% CI: 1.027-1.277, p=0.014). The receiver operating characteristics (ROC) curve analysis showed that at a cutoff value of 547.6 for SII to predict SEC with 74.6% sensitivity and 77.6% specificity (area under ROC curve=0.736 (95% CI: 0.668-0.805), p<0.001). ConclusionOur study showed that the SII levels were independently associated with SEC in patients with MS.

Movement Disorders P-MD001. Evaluation of gait in spinocerebellar ataxia type 12 (SCA-12)

Introduction . SCA12 an autosomal dominant ataxia, is characterized by tremor in hands at onset followed by gait ataxia and other cortical features during the course of illness. The aim of the study was to identify and quantify spatiotemporal parameters of gait in a group of SCA12 patients and to compare it with healthy subjects. Methods . Genetically confirmed SCA12 patients (n = 25) with mean age of 55.7 ± 10.2 years and age matched healthy individuals (n = 25) with 55.2 ± 10.1 years were studied. A walkway system (by Teckscan, USA) was used to evaluate spatiotemporal parameters of gait in both groups. All the participants were instructed to walk bare foot within comfortable normal speed on sensor plates of walkway system for 30 seconds. The two sampled t test was used with the level of significance p value <0.05. Results . All spatial and temporal parameter mean values were significantly different from the control group, except for single support time and swing time. Most significant findings in spatial and temporal parameters concerned stride length (106.8 ± 7.4cm in control group vs 79.0 ± 19.4 cm in patients, p = 0.000), step width (7.8 ± 1.7 cm in control group vs 13.8 ± 2.8 cm in patients, p = 0.000), double support time (0.35 ± 0.6 sec in control group vs 0.61 ± 0.30 sec in patients, p=0.005) and gait velocity (83.5 ± 14.5 cm/sec in control group vs 48.86 ± 21.6 cm/s in patients, p = 0.000). Ten patients with normal gait had mean duration of illness 4.4 ± 1.2 year and mean CAG repeat number 55.7 ± 5.4. Mean duration of illness and mean CAG repeat number of 15 patients having abnormal gait was 6.8 ± 5.4 years and 53.8 ± 7.3. Conclusion . Gait ataxia in SCA12 patients was a late feature and developed after around 5 years of illness. Gait showed significant reduction in stride length, step length, gait velocity with mark increase in step width and double support time.

Association of left atrial deformation indices with left atrial appendage thrombus in patients with non valvular atrial fibrillation

AimAssessment of the value of left atrial deformation indices for prediction of left atrial appendage functioning patients with non-valvular atrial fibrillation. MethodThe study included 250 patients with non-valvular atrial fibrillation and normal left atrial dimension. Trans-thoracic and trans-esophageal echocardiography were performed. Patients were divided into two groups; patients with LAA thrombus (group I) and patients without LAA thrombus (group II), a correlation between trans-esophageal and trans-thoracic data was analyzed. ResultsGroup I included110 patients (44%) and Group II 140 patients (56%). By TDI mean LA strain and strain rate were lower in group I (21.89 ± 7.75% vs 35.14 ± 9.28%; p < 0.001) and (1.15/sec, IQR 0.12–3/sec versus 2.1/sec, IQR 0.21–3/sec, p < 0.001) respectively. By speckle tracking PALS and strain rate were lower in group I (24.79 ± 7.78% vs 37.63 ± 8.64%; p value < 0.001) and (0.95 ± 0.32/sec. Vs 1.27 ± 0.32/sec p, value < 0.001) respectively. By TEE; group I had lower LAA EF (39.2 ± 13.55% vs 53.86 ± 12.7%); p < 0.001, and lower LAA emptying velocity (17.53 cm/s, IQR 9.54–77.4 vs 63.5 cm/s, IQR 7.89–86.4; p < 0.001). There was a good correlation between LA TDI and speckle tracking PALS and PALSR and LAA EF% and velocity p < 0.001. TDI and PALS and PALSR were found to be significant predictors for LAA thrombus (P < 0.05) with good sensitivity and specificity. ConclusionLeft atrium deformation indices are predictors of LAA thrombus or SEC in patients with non-valvular AF with accepted sensitivity and specificity.

P279 Guselkumab was more effective than secukinumab in patients with plaque psoriasis and the subset of patients with self-reported PsA in the randomised, double-blind, head-to-head comparison study ECLIPSE over 1 year

Abstract Background Guselkumab (GUS, an antibody against IL-23) and secukinumab (SEC, an antibody against IL-17A) are both approved for the treatment of psoriasis (PsO). Up to 30% of patients with PsO may have psoriatic arthritis (PsA). The ECLIPSE study compared efficacy and safety of GUS vs SEC in patients with plaque PsO. Post hoc analyses examined outcomes in the subgroup of patients with self-reported PsA. Methods ECLIPSE was a randomised, double-blind trial of adults with moderate-to-severe plaque PsO who received GUS 100 mg at Week (W)0, W4, then every 8 weeks, or SEC 300 mg at W0, W1, W2, W3, and W4, then every 4 weeks, both through W44. The primary endpoint was the proportion of patients achieving ≥90% improvement compared to baseline in the Psoriasis Area and Severity Index (PASI) score at W48. Cochran-Mantel Haenszel chi-square testing stratified by investigator was used to compare treatment-group responses. Results Overall, treatment groups [GUS (n = 534), SEC (n = 514)] were comparable at baseline: weight 89 kg, 24% body surface area PsO, and Investigator Global Assessment (IGA) moderate (76%) or severe (24%). These characteristics were similar to those of subgroups with self-reported PsA [GUS (n = 97), SEC (n = 79)]. In the overall population, the primary endpoint of PASI 90 response at W48 was achieved by 84.5% of GUS vs 70.0% of SEC patients (treatment difference 14.2 [95% CI = 9.6%, 18.8%], P &amp;lt; 0.001). Among patients with PsA, the primary endpoint of PASI 90 response at W48 was achieved by 82.5% of GUS vs 63.3% of SEC patients (treatment difference 19.2% [95% CI = 5.0%, 33.4%]). Beyond Week 20, in both the overall study population and the PsA subpopulation, GUS-treated patients maintained the PASI 90 response while SEC-treated patients had a reduction in response through W48. In the overall population, results of the first major secondary endpoint (proportion of patients with a PASI 75 response at both W12 and W48) showed non-inferiority of GUS vs SEC (GUS-84.6% vs SEC-80.2% of patients, p &amp;lt; 0.001), but superiority was not demonstrated (p = 0.062). Adverse events (AEs) observed in the overall population and PsA subgroup were generally consistent with the established safety profiles for GUS and SEC. Conclusion In the subset of patients with self-reported PsA in the ECLIPSE study, GUS demonstrated better maintenance of response and higher efficacy at approximately one year compared with SEC in the treatment of moderate to severe plaque PsO. These findings were consistent with those for the overall study population of patients with plaque PsO. AEs observed were generally consistent with the established safety profiles for GUS and SEC. Disclosures J.F. Merola: Other; J.M. has been a study investigator for Janssen. S. Li: Other; S.L. is a Janssen employee. M. Hsu: Other; M.H. is a Janssen employee. C. Karyekar: Other; C.K. is a Janssen employee. P.C. Gorecki: Other; P.G. is a Janssen employee. S. Flavin: Other; S.F. is a Janssen employee. B. Randazzo: Other; B.R. is a Janssen employee. L.C. Coates: Other; L.C. has been a study investigator for Janssen.

Implication of d-dimer in rheumatic severe mitral stenosis – A tertiary centre study

BackgroundIn rheumatic mitral stenosis (MS), left atrial (LA) thrombus and LA spontaneous echo contrast (LA SEC) reflect hypercoagulability. The study focuses on whether D-dimer levels predict the existence of LA thrombus and SEC in patients with severe MS. Methods95 consecutive patients with severe MS referred for transesophageal echocardiogram (TEE) between July 2011 and March 2012 to evaluate LA thrombus prior to balloon mitral valvotomy (BMV) were included in the study. D-Dimer levels in these patients were observed. ResultsOut of the 95 patients, 15 (15.8%) had LA thrombus and 52 patients had LA SEC (54.7%). Any correlation between D-Dimer levels and existence (or non-existence) of LA thrombus was not noticed from the receiver operating characteristics (ROC) curve with an area of .535. For patients with LA SEC, the D-Dimer levels were found to be considerably higher (776 ± 866 μg/L vs. 294 ± 331 μg/L, p = .001). An ideal cut-off level of 393 μg/L for diagnosing LA SEC was illustrated by the ROC curve with a sensitivity of 63.4%, specificity of 83.72%, positive predictive value of 82.5% and a negative predictive value of 65.45%. ConclusionsD-dimer levels were not representative of the presence or absence of LA thrombus in patients with severe MS. Nonetheless, this study demonstrated the substantial link between D-Dimer level and LA SEC. If a D-Dimer level of 400 μg/L or higher is taken as positive, it has high specificity and positive predictive value for diagnosing LA SEC.

Characteristics of Block and Post-Operative Analgesia of Low Dose Intrathecal Fentanyl and Midazolam Combined With Hyperbaric 0.5% Bupivacaine in Patients Undergoing Lower Limb Orthopaedic Surgeries

Aim: To investigate characteristics of block and post-operative analgesia of low dose intrathecal Fentanyl and Midazolam combined with hyperbaric 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgeries. Material and method: Selected consented 60 patients scheduled for orthopaedic surgeries under subarachnoid blockade were randomized into two comparable equal groups of 30 patients each i.e. Group A(Sub arachnoid block with addition of 25 μg (0.5 ml available preservative free) fentanyl to 3ml of 0.5% Bupivacaine hydrochloride (hyperbaric) and Group B: (Sub arachnoid block with addition of 1 mg (0.2 ml preservative free) midazolam (+ 0.3 ml normal saline) to 3ml of 0.5% Bupivacaine hydrochloride (hyperbaric).The motor block of the lower extremities was evaluated bilaterally by modified Bromage scale (0-3). Duration of sensory analgesia was taken from onset of spinal anesthesia to time of administration of first rescue analgesic, reflected on visual analogue scale (VAS). Results: The mean time required to achieve Complete Sensory blockade was 142.77±8.73 sec in patients of Group A and 138.57±7.65 sec in patients of Group B.Sedation score was recorded every 30 min for 90 mins (using Ramsay sedation score) considering the time of study drug given as zero in both groups.The mean sedation score at 30 mins in patients of Group A was 2.10±0.31 and in patients of Group B it was 2.27±0.45. Conclusion: It can be concluded that intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not available or contraindicated.

LO37: Routine application of defibrillation pads and time to first shock in prehospital STEMI complicated by cardiac arrest

Introduction: ST-segment elevation myocardial infarction (STEMI) remains a significant cause of morbidity and mortality in North America, with recent studies suggesting that between 4 to 11% of patients diagnosed with STEMI suffer an out-of-hospital-cardiac arrest (OHCA). Previously published research has shown that shorter time to initial defibrillation in patients with VF/VT OHCA increases functional survival. The purpose of this study is to assess whether the routine application of defibrillation pads in STEMI decreases the time to initial defibrillation in those who suffer OHCA. Methods: Ambulance call records (ACR) for patients diagnosed with STEMI in Middlesex-London in the prehospital setting from Jan 1, 2012 to Jun 30, 2016 were reviewed. Patients were included in the study if they were 18 years of age or older with a confirmed diagnosis of STEMI and suffered an OHCA with an initial shockable rhythm (VF or VT) while in paramedic care. The pre-pad protocol (routine application of defibrillation pads in STEMI patients) was implemented by Middlesex-London EMS in July 2014. If inclusion criteria were met, ACRs were reviewed to determine whether the pre-pad protocol was implemented and to extract the time to initial defibrillation and relevant demographic and event features. Associated hospital charts were reviewed to evaluate inpatient event features and survival. T-test was used to assess the difference between mean times to defibrillation. Results: 446 patients were diagnosed with prehospital STEMI. Of those, 11 patients experienced a paramedic witnessed cardiac arrest. Four of the 11 had defibrillation pads applied upon diagnosis of STEMI. In patients who received pre-pad application, the mean time to initial defibrillation was 17.71 sec, compared to 72.71 sec in patients who had pads applied following arrest (MD 54.97 sec CI 22.69 to 87.24 sec). All patients treated with the pre-pad protocol survived to discharge from hospital, while one patient in the routine care group died in the ED. Conclusion: Routine application of defibrillation pads decreases the time to initial defibrillation in STEMI patients who suffer OHCA. Larger studies are required to evaluate whether this decreased time to defibrillation translates into mortality benefit in this subset of patients who experience OHCA.

Tissue Factor and Cancer Procoagulant as Predictors of Thrombosis or Progression in Cancer Patients.

Background: Two procoagulant factors are associated with the tumor cell: tissue factor (TF) and cancer procoagulant (CP). The activation of the coagulation system can cause thrombosis and it has also been involved in the development of metastasis.Aims: 1- to establish the relationship between the presence and the levels of both procoagulants and the development of thrombosis or disease progression. 2- to analyse if the treatment with chemotherapy increases the levels of TF or CP.Methods: Patients with recent diagnosis of cancer were included in this prospective study. TF and CP determinations were done at diagnosis, at three months after chemotherapy, and at either event of progression or thrombosis. TF evaluation was done through ELISA test (normal value 159 pg/ml) and CP evaluation by a coagulometric method (Gordon et al, Thromb Res 1989; 56:431–40). In the last test negative values indicate high CP activity. Statistical analysis of the data was performed by two-tailed Fisher exact test and Mann-Withney/Wilcoxon test.Results: 31 patients, 61% female sex, age median 54 years. Digestive cancer 49%, breast 32%, genitourinary 13%, lung 2%. Stages of the disease were: early (I and II) 48% and advanced (III and IV) 52%. Median follow-up was 11.6 months. High levels of TF and CP at diagnosis were seen in 48% and 84% respectively. No patients developed thrombosis. Nine patients had disease progression (29%) and 4 (13%) died. Eigthy eight percent patients of this last group had advanced stages of the disease. The type of tumor more frequently associated with the event was digestive cancer (45%) and genitourinary cancer (33%). TF and CP values were increased by 40% and 50% respectively during chemotherapy treatment. Level of CP at diagnosis predicted progression (-26 sec versus -8 sec in patients with and without progression p 0.006) and also mortality (-34 sec versus -10 sec p0.003). TF at diagnosis predicted neither progression nor mortality. All patients who had progressive disease showed increased levels of TF (388 pg/ml vs 217 pg/ml p0.002) and CP (-63 sec vs -23 sec p.006) with respect to the values at diagnosis.Conclusions: Higher levels of CP at diagnosis are associated with a greater frequency of progression and mortality. No patients developed thrombosis. TF and CP levels were increased at the time of progression with respect to the values obtained at diagnosis. Chemotherapy increases the values of both procoagulants. A larger follow-up and a large number of patients could clarify the role of these procoagulants in the development of disease progression (metastasis).

Dynamic contrast‐enhanced MRI of the pancreas: Initial results in healthy volunteers and patients with chronic pancreatitis

To characterize pancreatic perfusion in volunteers and patients with chronic pancreatitis (CP) by dynamic contrast-enhanced (DCE) MRI. Pancreatic enhancement after bolus injection of Gd-DTPA with a three-dimensional ultrafast partial-Fourier radiofrequency (RF) spoiled gradient-echo (GE) acquisition was examined prospectively. An acquisition volume of the pancreatic parenchyma was obtained every 4.2 seconds during a single breath-hold in 31 volunteers and 19 patients with CP. We calculated the wash-in rate and a newly defined parameter, the "time-to-inflow deceleration" (TID). A statistical analysis of the differences between both groups was performed with the use of Student's t-test. Significant differences in the TID and wash-in rate were found for the head and body of the pancreas: the TID was 22.4 sec +/- 4.4 sec and 23.5 sec +/- 6.1 sec in the pancreatic head and body of the healthy volunteers, and 29.8 sec +/- 8.6 sec and 29.4 sec +/- 3.8 sec in patients with CP. The wash-in rate was 96 +/- 37 sec(-1) and 101 +/- 27 sec(-1) in controls, and 62 +/- 17 sec(-1) and 75 +/- 27 sec(-1) in CP. CP can be identified by semiquantitative changes on DCE-MRI. Whether DCE-MRI of the pancreas can be used to detect early CP remains to be validated.

Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity.

The aim of our study was to determine if hepatic perfusion parameters measured with CT change in relation to disease severity in patients with chronic liver disease. Dynamic contrast-enhanced single-section CT scans of the liver were obtained in 40 individuals who included six control subjects, 16 patients with noncirrhotic chronic liver disease, and 18 patients with cirrhosis. Hepatic, aortic, and portal venous time-density curves were fitted to a dual-input one-compartment model to calculate the liver perfusion, arterial fraction, distribution volume, and mean transit time. Liver perfusion decreased in patients with cirrhosis (67 +/- 23 mL. min(-1). 100 mL(-1) versus 108 +/- 34 mL. min(-1). 100 mL(-1) in control subjects [p = 0.009] and 98 +/- 36 mL. min(-1). 100 mL(-1) in patients with noncirrhotic chronic liver disease [p = 0.003]), and the arterial fraction and the mean transit time increased (41 +/- 27% and 51 +/- 79 sec versus 17 +/- 16% and 16 +/- 5 sec in control subjects, and 19 +/- 6% and 17 +/- 8 sec in patients with noncirrhotic chronic liver disease [p < 0.05]). A significant correlation was seen between these three perfusion parameters and the severity of chronic liver disease based on clinical and biologic data (p < 0.001). No significant change in distribution volume was observed. Hepatic perfusion parameters measured with CT were significantly altered in cirrhosis and correlated with the severity of chronic liver disease.

Superficial tension of blood and urine in diabetic nephropathy

Dynamic surface tension (ST) of the blood serum and urine was studied in patients with diabetic nephropathy by the method of maximal pressure in a vesicle using MPT2 computer tensiometer (LAUDA, Germany). The angle of the slope of blood tensiogram curve increased and urinary ST decreased at t = 1 sec in patients with type I diabetics in comparison with those with type II condition. The development of the nephrotic syndrome and chronic renal insufficiency was associated with decrease of ST in the range of short (t = 0.01 sec) and medium (t = 1 sec) times of surface life and of the equilibrium (static) ST (at t -&gt; go/. The parameters of interphase tensiometry correlated with the content of protein and lipid surfactants in biological fluids.

ＴＣＤを用いた血流速度とＩＡ‐ＤＳＡを用いた脳循環時間測定によるクモ膜下出血後脳血管れん縮の比較検討

TCD findings used for evaluating vasospasm (VSP) due to ruptured aneurysm are controversial. To clarify these TCD findings, intra-arterial DSA (IA-DSA) was applied to study morphological changes and to measure cerebral circulation time (CCT) . Forty-six patients with ruptured aneurysms treated by neck clipping at the acute stage were investigated. Clinical grade and CT findings were estimated using the Hunt and Hess classification and Fisher's classification, respectively. Mean flow velocity (MFV) in the M1 segment was measured by TCD. IA-DSA was performed on the day 7-13 day. Angiographic VSP was categorized by Fisher's classification. CCT was defined by the time difference between the two peak optical density curves recorded by IA-DSA at the carotid artery (C3-4) and the ascending vein. Mean CCT was 3.7 sec in patients without VSP and 4.3 sec in those with slight to moderate VSP, which were significantly different from mean CCT, 6.2 sec, in patients with severe VSP. MFV in patients with no, slight to moderate, and severe VSP was 82, 104 and 124 cm/sec, respectively, none of the differences being significant. Additionally, patients with diffuse VSP extending from the M2 to peripheral sites showed increased CCT values and an unchanged MFV value. These findings suggest that use of the MFV at the M1 segement for estimating the severity of diffuse peripheral VSP is problematic.

Rapid induction sequence with vecuronium: should we intubate after 60 or 90 seconds?

The purpose of the study was to determine intubating conditions after administration of either succinylcholine or vecuronium in a rapid induction sequence. Patients received either succinylcholine 1.5 mg.kg-1 (Groups I and II) after d-tubocurarine 0.05 mg.kg-1 four minutes earlier, or vecuronium (Groups III and IV) in an initial dose of 0.01 mg.kg-1 followed four minutes later by 0.1 mg.kg-1. In Groups I and III an apnoeic delay of one minute was allowed before intubation whereas in Groups II and IV the delay was 90 sec. There was no significant difference in intubating conditions between Groups I and IV. Intubating conditions in Group III (vecuronium-delay of one minute) were statistically worse than in any of the three other groups. A delay of 90 sec after succinylcholine improved intubating conditions in male patients. Considering that intubating conditions obtained after 90 sec in patients given a priming sequence with vecuronium (Group IV) were not different from those obtained 60 sec after succinylcholine (Group I), the authors conclude that vecuronium is an acceptable alternative for rapid tracheal intubation. In the doses used in this study, intubating conditions 60 sec after vecuronium were unacceptable for rapid induction of anaesthesia.

Readiness potentials recorded from the scalp and depth leads.

Readiness potentials on voluntary hand movements were recorded from the scalp (C3, C4), premotor cortex, subcortical white matter and VL nucleus of the thalamus. Subjects were healthy right-handed men and patients with involuntary movement disorders. We obtained a slow negative shift of brain electrical potentials from the scalp and cortex preceding voluntary hand movements. The mean time interval between the onset of the readiness potential and the onset of motor activity (mean T) was 0.8 sec on right hand movements and 1.0 sec on left hand movements in healthy men. In cases with parkinsonism, the mean T value was 1.4 sec in patients with akinesia, 1.1 sec in those without akinesia. The amplitude of readiness potentials was higher in the scalp contralateral to the hand movement. The readiness potentials recorded from the VL nucleus and white matter were reversed in polarity from those of scalp and cortex. Simultaneous recordings from cortex and VL nucleus showed early onset of readiness potentials from the cortex by approximately 0.1 sec compared with the VL nucleus.