[Effect of interactive scalp acupuncture on upper limb function in patients with hemiplegia after stroke].

OBJECTIVE: To explore the clinical effect of interactive scalp acupuncture combined with task-oriented mirror therapy on hemiplegia after stroke. METHODS: A total of 86 patients with hemiplegia after stroke were randomly divided into an observation group (43 cases, 2 cases dropped out) and a control group (43 cases, 2 cases dropped out). Both groups received routine treatment and rehabilitation treatment for stroke. The control group was treated with task-oriented mirror therapy, 40 min each time, once a day, 6 days a week. The observation group was treated with interactive scalp acupuncture at ipsilateral upper 1/5 and 2/5 of the parietal and temporal anterior oblique line and upper 1/5 and 2/5 of the parietal and temporal posterior oblique line on the basis of the treatment as the control group, 45 min each time, once a day, 6 days a week. Both groups were treated for 4 weeks. Before and after treatment and in follow-up of 8 weeks after treatment completion, the Fugl-Meyer assessment (FMA) score, modified Ashworth scale (MAS) score, shoulder abduction angle, wrist dorsiflexion angle and N20 latency and amplitude of somatosensory evoked potential were compared between the two groups. RESULTS: After treatment and in follow-up, the FMA scores were increased (P<0.01), the MAS scores were decreased (P<0.01) compared with those before treatment in the two groups; the FMA scores in the observation group were higher than those in the control group (P<0.01), the MAS scores were lower than those in the control group (P<0.01). After treatment and in follow-up, the shoulder abduction angle and wrist dorsiflexion angle was increased (P<0.01), the N20 latency was shortened and amplitude was increased (P<0.01) compared with that before treatment in both groups; the shoulder abduction angle and wrist dorsiflexion angle in the observation group was greater than that in the control group (P<0.01), the N20 latency was shorter than that in the control group (P<0.01), and the N20 amplitude was higher than that in the control group (P<0.01). CONCLUSION: Interactive scalp acupuncture combined with task-oriented mirror therapy can improve upper limb function in patients with hemiplegia after stroke, and reduce the muscular tone of the affected limb.

Localizing hidden Interictal Epileptiform Discharges with simultaneous intracerebral and scalp high-density EEG recordings.

BACKGROUND: Scalp EEG is one of the main tools in the clinical evaluation of epilepsy. In some cases intracranial Interictal Epileptiform Discharges (IEDs) are not visible from the scalp. Recent studies have shown the feasibility of revealing them in the EEG if their timings are extracted from simultaneous intracranial recordings, but their potential for the localization of the epileptogenic zone is not yet well defined. NEW METHOD: We recorded simultaneous high-density EEG (HD-EEG) and stereo-electroencephalography (SEEG) during interictal periods in 8 patients affected by drug-resistant focal epilepsy. We identified IEDs in the SEEG and systematically analyzed the time-locked signals on the EEG by means of evoked potentials, topographical analysis and Electrical Source Imaging (ESI). The dataset has been standardized and is being publicly shared. RESULTS: Our results showed that IEDs that were not clearly visible at single-trials could be uncovered by averaging, in line with previous reports. They also showed that their topographical voltage distributions matched the position of the SEEG electrode where IEDs had been identified, and that ESI techniques can reconstruct it with an accuracy of ∼2 cm. Finally, the present dataset provides a reference to test the accuracy of different methods and parameters. COMPARISON WITH EXISTING METHODS: Our study is the first to systematically compare ESI methods on simultaneously recorded IEDs, and to share a public resource with in-vivo data for their evaluation. CONCLUSIONS: Simultaneous HD-EEG and SEEG recordings can unveil hidden IEDs whose origins can be reconstructed using topographical and ESI analyses, but results depend on the selected methods and parameters.

Using scalp EEG to predict seizure recurrence and electrical status epilepticus in children with idiopathic focal epilepsy.

PURPOSE: Some individuals with idiopathic focal epilepsy (IFE) experience recurring seizures accompanied by the evolution of electrical status epilepticus during sleep (ESES). Here, we aimed to develop a predictor for the early detection of seizure recurrence with ESES in children with IFE using resting state electroencephalogram (EEG) data. METHODS: The study group included 15 IFE patients who developed seizure recurrence with ESES. There were 17 children in the control group who did not experience seizure recurrence with ESES during at least 2-year follow-up. We used the degree value of the partial directed coherence (PDC) from the EEG data to predict seizure recurrence with ESES via 6 machine learning (ML) algorithms. RESULTS: Among the models, the Xgboost Classifier (XGBC) model achieved the highest specificity of 0.90, and a remarkable sensitivity and accuracy of 0.80 and 0.85, respectively. The CATC showed balanced performance with a specificity of 0.85, sensitivity of 0.73, and an accuracy of 0.80, with an AUC equal to 0.78. For both of these models, F4, Fz and T4 were the overlaps of the top 4 features. CONCLUSIONS: Considering its high classification accuracy, the XGBC model is an effective and quantitative tool for predicting seizure recurrence with ESES evolution in IFE patients. We developed an ML-based tool for predicting the development of IFE using resting state EEG data. This could facilitate the diagnosis and treatment of patients with IFE.

Mathematical Simulation and Numerical Computation of the Temperature Profiles in the Peripherals of Human Brain during the Tepid Sponge Treatment to Fever.

BACKGROUND: Fever is one of the frequently occurring diseases in human beings, and the body is said to have befallen in fever if the arterial or internal body temperature rises to 38°C. The patient who suffers from fever is either given paracetamol or tepid sponging or both. OBJECTIVE: This paper is aimed at studying the effects of the tepid sponge in normalizing the high temperature of the human body during fever. Among the various available methods for tepid sponging, the impact of holding a cool wet cloth on the forehead for reducing the fever is analyzed and pictured graphically. METHOD: For analyzing the effects of tepid sponge on the temperature distribution of the domain consisting of scalp, skull, and cerebrospinal fluid (CSF), a cool wet cloth is brought in contact with the skin allowing the heat to transfer from the brain to the wet cloth through these layers. The heat transfer in living biological tissues is different from ordinary heat transfer in other nonliving materials. Therefore, a model based on the bioheat equation has been constructed. The model has been solved by numerical methods for both steady- and unsteady-state cases. The domain, which consists of the scalp, skull, and CSF layers of the human head, has been discretized into four equal parts along the axes of the three-dimensional coordinate system. The forward difference and forward time centered space approximations were employed for numerical temperature distribution results at the nodal points. RESULTS: The effects of tepid sponge in reducing the body temperature with fever at 38°C, 39.5°C, and 41°C have been numerically calculated, and the results were pictured graphically. For transient cases, the corresponding calculations have been carried out at times t = 2 minutes, 4 minutes, and 6 minutes. CONCLUSION: Among all the available remedies to fever, tepid sponging has shown a significant effect in controlling fever.

Automated electrical source imaging with scalp EEG to define the insular irritative zone: Comparison with simultaneous intracranial EEG.

OBJECTIVE: To evaluate the accuracy of automatedinterictallow-density electrical source imaging (LD-ESI) to define the insular irritative zone (IZ) by comparing the simultaneous interictal ESI localization with the SEEG interictal activity. METHODS: Long-term simultaneous scalp electroencephalography (EEG) and stereo-EEG (SEEG) with at least one depth electrode exploring the operculo-insular region(s) were analyzed. Automated interictal ESI was performed on the scalp EEG using standardized low-resolution brain electromagnetic tomography (sLORETA) and individual head models. A two-step analysis was performed: i) sublobar concordance betweencluster-based ESI localization and SEEG-based IZ; ii) time-locked ESI-/SEEG analysis. Diagnostic accuracy values were calculated using SEEG as reference standard. Subgroup analysis wascarried out, based onthe involvement of insular contacts in the seizure onset and patterns of insular interictal activity. RESULTS: Thirty patients were included in the study. ESI showed an overall accuracy of 53% (C.I. 29-76%). Sensitivity and specificity were calculated as 53% (C.I. 29-76%), 55% (C.I. 23-83%) respectively. Higher accuracy was found in patients with frequent and dominant interictal insular spikes. CONCLUSIONS: LD-ESI defines with good accuracy the insular implication in the IZ, which is not possible with classical interictalscalpEEG interpretation. SIGNIFICANCE: Automated LD-ESI may be a valuable additional tool to characterize the epileptogenic zone in epilepsies with suspected insular involvement.

Impaired awareness in mesial temporal lobe epilepsy: Network analysis of foramen ovale and scalp EEG.

OBJECTIVE: We use co-registration of foramen-ovale and scalp-EEG to investigate network alterations in temporal-lobe epilepsy during focal seizures without (aura) or with impairment of awareness (SIA). METHODS: One aura and one SIA were selected from six patients. Temporal dynamic among 4 epochs, as well as the differences between aura and SIA, were analyzed through partial directed coherence and graph theory-based indices of centrality. RESULTS: Regarding the auras temporal evolution, fronto-parietal (FP) regions showed decreased connectivity with respect to the interictal period, in both epileptogenic (EH) and non-epileptogenic hemisphere (nEH). During SIAs, temporal dynamic showed more changes than auras: centrality of mesial temporal (mT) regions changes during all conditions, and nEH FP centrality showed the same dynamic trend of the aura (decreased centrality), until the last epoch, close to the impaired awareness, when showed increased centrality. Comparing SIA with aura, in proximity of impaired awareness, increased centrality was found in all the regions, except in nEH mT. CONCLUSIONS: Our findings suggested that the impairment of awareness is related to network alterations occurring first in neocortical regions and when awareness is still retained. SIGNIFICANCE: The analysis of 'hub' alteration can represent a suitable biomarker for scalp EEG-based prediction of awareness impairment.

Oxidative stress and its impact on skin, scalp and hair.

Oxidative stress is an unbalanced condition in which the tissues of the body are not sufficiently able to counteract either exogenous or endogenous sources of reactive oxygen species. Oxidative stress is strongly associated with ageing, both local and systemic, as well as a wide range of local health conditions. This review focuses on the oxidative stress data known for skin, scalp and hair. This oxidative stress may be the 'currency' by which an unhealthy scalp leads to deleterious consequences to the hair. The ramifications of this scalp oxidative stress to normal hair elongation, retention and replacement are discussed.

Le stress oxydatif est une condition déséquilibrée dans laquelle les tissus du corps ne sont pas suffisamment capables de contrer la source exogène ou endogène d'espèces réactives de l'oxygène. Le stress oxydatif est fortement associé au vieillissement, à la fois local et systémique, ainsi qu'à un large éventail de problèmes de santé locaux. Cette revue se concentre sur les données de stress oxydatif connues pour la peau, le cuir chevelu et les cheveux. Ce stress oxydatif peut être la « devise ¼ par laquelle un cuir chevelu malsain entraîne des conséquences délétères pour les cheveux. Les ramifications de ce stress oxydatif du cuir chevelu sur l'allongement, la rétention et le remplacement normaux des cheveux sont discutées.

Scalp Biophysical Characteristics in Males with Androgenetic Alopecia: A Comparative Study with Healthy Controls.

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss in men. Its prevalence increases with advancing age. Characteristics of hair loss in male AGA reveal the possibility of different biophysical and physiological profiles between androgen-sensitive (vertex) and androgen-insensitive (occipital) scalps. However, these variations have not been well investigated. OBJECTIVE: We aimed to evaluate and compare scalp biophysical and physiological characteristics in male AGA patients and healthy controls. METHODS: Scalp biophysiological profiles were evaluated by non-invasive measuring techniques, including skin surface lipids (SSL), transepidermal water loss (TEWL), and stratum corneum hydration (SCH) on both vertex and occipital areas. Values were compared between scalp areas and study groups. Participants with AGA were further categorized based on disease severity (Hamilton-Norwood classification) for subgroup analyses. Correlation coefficients were evaluated to determine the effects of AGA severity and age on each functional parameter. RESULTS: Participants were 31 AGA subjects and 31 healthy controls. The vertex scalp of AGA patients had significantly higher SSL (p = 0.03) and lower SCH (p = 0.02) compared to the occipital scalp. TEWL was not significantly different (p = 0.31). AGA group SSL showed a positive correlation with severity of hair loss (r = 0.61, p = 0.03). When compared to controls, the AGA group vertex scalp had significantly higher SSL (p = 0.03) and lower TEWL (p < 0.001). The occipital area showed no statistically significant differences. CONCLUSION: Male AGA presents with different biophysical and physiological characteristics in androgen-sensitive and androgen-insensitive areas, and with further differences from controls. These findings could direct further research and aid in the development of optimal hair and scalp treatments to improve scalp functional profiles in particular patients.

Role of scalp health in achieving optimal hair growth and retention.

We have conducted a thorough review of the literature to assess the evidence for supporting a cause-and-effect linkage between scalp condition and resultant hair condition. Over 20 epidemiological studies have been published covering a wide range of abnormal scalp conditions in which consequent impacts to the hair have been documented. A treatment study was conducted to demonstrate not only that impaired scalp condition led to impaired hair quality but that the impacts to hair are reversible upon normalization of the scalp condition. A proposed explanation involves the impact of scalp oxidative stress, which is part of the etiology of these scalp conditions as well as normal aging, in interfering with the normal keratinization of the pre-emergent hair cuticle. This perturbed cuticle impedes normal fiber anchorage and emerges more brittle and fragile than normal cuticle leading to accelerated physical degradation, mirroring the effects of chronological aging of the hair fiber. The consequences of the rapid cuticle degradation result in hair that is more vulnerable to mechanical insults and compromised overall quality.

Nous avons mené un examen approfondi de la littérature médicale pour évaluer les preuves étayant un lien de cause à effet entre l'état du cuir chevelu et celui des cheveux. Plus de 20 études épidémiologiques ont été publiées, couvrant un large éventail d'affections du cuir chevelu pour lesquelles des impacts conséquents sur les cheveux ont été documentés. Une étude de traitement a été menée pour démontrer non seulement qu'une altération du cuir chevelu entraînait une altération de la qualité des cheveux, mais aussi que les impacts sur les cheveux étaient réversibles après normalisation de l'état du cuir chevelu. Une explication proposée inclut l'impact du stress oxydatif sur le cuir chevelu, qui fait partie de l'étiologie de ces affections du cuir chevelu ainsi que du vieillissement normal, en interférant avec la kératinisation normale de la cuticule du cheveu à son point d'émergence. Cette cuticule perturbée gêne l'ancrage normal des fibres et fait émerger des cuticules plus fragiles et friables que la normale, entraînant une dégradation physique accélérée, reflet des effets du vieillissement chronologique des fibres capillaires. La dégradation rapide de la cuticule rend les cheveux plus vulnérables aux agressions mécaniques et compromet leur qualité globale.

High-Density EEG in Current Clinical Practice and Opportunities for the Future.

SUMMARY: High-density EEG (HD-EEG) recordings use a higher spatial sampling of scalp electrodes than a standard 10-20 low-density EEG montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. Despite these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, using different recording techniques and software, where HD-EEG provided information above and beyond the standard low-density EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: case 1-lateralize falsely generalized interictal epileptiform discharges; case 2-improve localization of falsely generalized epileptic spasms; cases 3 and 4-improve localization of interictal epileptiform discharges in anatomic regions below the circumferential limit of standard low-density EEG coverage; case 5-improve noninvasive localization of the seizure onset zone in lesional epilepsy; cases 6 and 7-improve localization of the seizure onset zone to guide invasive investigation near eloquent cortex; case 8-identify epileptic fast oscillations; and case 9-map language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.

Altered Functional Connectivity after Epileptic Seizure Revealed by Scalp EEG.

Epileptic seizures are considered to be a brain network dysfunction, and chronic recurrent seizures can cause severe brain damage. However, the functional brain network underlying recurrent epileptic seizures is still left unveiled. This study is aimed at exploring the differences in a related brain activity before and after chronic repetitive seizures by investigating the power spectral density (PSD), fuzzy entropy, and functional connectivity in epileptic patients. The PSD analysis revealed differences between the two states at local area, showing postseizure energy accumulation. Besides, the fuzzy entropies of preseizure in the frontal, central, and temporal regions are higher than that of postseizure. Additionally, attenuated long-range connectivity and enhanced local connectivity were also found. Moreover, significant correlations were found between network metrics (i.e., characteristic path length and clustering coefficient) and individual seizure number. The PSD, fuzzy entropy, and network analysis may indicate that the brain is gradually impaired along with the occurrence of epilepsy, and the accumulated effect of brain impairment is observed in individuals with consecutive epileptic bursts. The findings of this study may provide helpful insights into understanding the network mechanism underlying chronic recurrent epilepsy.

Scalp-acupuncture for patients with hemiplegic paralysis of acute ischaemic stroke: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the efficacy of scalp-acupuncture on subjects with hemiplegic paralysis of acute ischaemic stroke (AIS). METHODS: One hundred and twenty patients with hemiplegic paralysis of 1 to 7 d post stroke, aged 40 to 75 years, were randomly allocated to receive either standard care (control group) or standard care plus 30 min of scalp-acupuncture applied to the bilateral anterior oblique line of the vertex-temporal (MS6) for 14 d (6 d/week) (trial group). The outcome measures included the National Institutes of Health Stroke scale (NIHSS) for neurological deficits, the Fugl-Meyer assessment (FMA) for limb impairment, and Barthel index (BI) for activities of daily living before and after intervention. The manual muscle test (MMT) was assessed at pre-intervention, at the first post-intervention immediately, and at the 14th day after intervention commencement. Measurements were recorded by a blinded investigator at different time points after initiating the intervention. RESULTS: The trial group had a greater increase in MMT (P < 0.05), FMA, and BI scores (P < 0.01), and a greater decrease in NIHSS scores (P < 0.01) from pre-intervention to post-intervention, and the control group had a greater increase in MMT scores (P < 0.05), and a greater decrease in NIHSS scores(P < 0.01) from pre-intervention to post-intervention. The improvement in MMT (P < 0.01), FMA, BI (P < 0.05), and NIHSS (P < 0.01) scores in the trial group was superior to that of the control group. Meanwhile, scalp-acupuncture intervention had an immediate effect on myodynamia of patients with hemiplegic paralysis after acute ischaemic stroke in this randomized controlled trial. CONCLUSION: The early scalp-acupuncture intervention after stroke effectively increased myodynamia of the affected limbs, improved neurological deficit degrees, and daily living ability.

Scalp EEG interictal high frequency oscillations as an objective biomarker of infantile spasms.

OBJECTIVE: To investigate the diagnostic utility of high frequency oscillations (HFOs) via scalp electroencephalogram (EEG) in infantile spasms. METHODS: We retrospectively analyzed interictal slow-wave sleep EEGs sampled at 2,000 Hz recorded from 30 consecutive patients who were suspected of having infantile spasms. We measured the rate of HFOs (80-500 Hz) and the strength of the cross-frequency coupling between HFOs and slow-wave activity (SWA) at 3-4 Hz and 0.5-1 Hz as quantified with modulation indices (MIs). RESULTS: Twenty-three patients (77%) exhibited active spasms during the overnight EEG recording. Although the HFOs were detected in all children, increased HFO rate and MIs correlated with the presence of active spasms (p < 0.001 by HFO rate; p < 0.01 by MIs at 3-4 Hz; p = 0.02 by MIs at 0.5-1 Hz). The presence of active spasms was predicted by the logistic regression models incorporating HFO-related metrics (AUC: 0.80-0.98) better than that incorporating hypsarrhythmia (AUC: 0.61). The predictive performance of the best model remained favorable (87.5% accuracy) after a cross-validation procedure. CONCLUSIONS: Increased rate of HFOs and coupling between HFOs and SWA are associated with active epileptic spasms. SIGNIFICANCE: Scalp-recorded HFOs may serve as an objective EEG biomarker for active epileptic spasms.

Detection of interictal epileptiform discharges: A comparison of on-scalp MEG and conventional MEG measurements.

OBJECTIVE: Conventional MEG provides an unsurpassed ability to, non-invasively, detect epileptic activity. However, highly resolved information on small neuronal populations required in epilepsy diagnostics is lost and can be detected only intracranially. Next-generation on-scalp magnetencephalography (MEG) sensors aim to retrieve information unavailable to conventional non-invasive brain imaging techniques. To evaluate the benefits of on-scalp MEG in epilepsy, we performed the first-ever such measurement on an epilepsy patient. METHODS: Conducted as a benchmarking study focusing on interictal epileptiform discharge (IED) detectability, an on-scalp high-temperature superconducting quantum interference device magnetometer (high-Tc SQUID) system was compared to a conventional, low-temperature SQUID system. Co-registration of electroencephalopraphy (EEG) was performed. A novel machine learning-based IED-detection algorithm was developed to aid identification of on-scalp MEG unique IEDs. RESULTS: Conventional MEG contained 24 IEDs. On-scalp MEG revealed 47 IEDs (16 co-registered by EEG, 31 unique to the on-scalp MEG recording). CONCLUSION: Our results indicate that on-scalp MEG might capture IEDs not seen by other non-invasive modalities. SIGNIFICANCE: On-scalp MEG has the potential of improving non-invasive epilepsy evaluation.

Treatment of scalp defects with a combination of trephination and platelet-rich plasma.

In cases of complete scalp loss where the calvarium is exposed and reconstruction cannot be achieved using replantation, or local or far flaps, using trephination to create holes to the depth of the spongeous layer followed by grafting once granulation has covered all defects is an important reconstruction alternative. However, growth of the granulation after trephination and waiting for the entire defect to be covered is a slow process. Since the introduction of platelet-rich plasma (PRP), several researchers have investigated the efficacy of different bone healing and grafting procedures. We present a case with full-thickness partial scalp defect in which we support the development of granulation through holes drilled to the spongeous layer by trephination with PRP.

Getting under the skin of hair aging: the impact of the hair follicle environment.

Like the skin, our hair shows striking changes with age, producing hairs with altered diameter, lustre and texture. The biology of hair aging has focused predominately on various aspects of the hair cycle, follicle size and the fibre produced, but surprisingly the impact of the aging scalp dermal environment on the hair follicle and fibre has been generally overlooked. Hair loss affects both sexes with incidence increasing with age. In men, male pattern-balding (androgenetic alopecia) is driven by androgens and follows a specific pattern of frontotemporal and vertex regression. Women also experience female pattern hair loss (FPHL), presenting as more general, diffuse hair thinning. Hair thinning in women is commonly associated with the menopause, corresponding with other age-related changes in skin. The rapidly growing hair follicle undergoes continued renewal throughout the life span of an individual, where it is exposed to a substantial number of extrinsic and intrinsic stressors. As the hair follicle sits deep within the dermis with its bulb residing in the hypodermis, detrimental age-related changes in the surrounding scalp skin may likely disrupt the hair follicle machinery. The impacts of these changes are unknown, but evidence suggests that scalp skin aging and hair follicle aging go hand-in-hand. Herein, we summarize the evidence that the age-related changes observed in sun-exposed human skin also occur in scalp skin and that these changes are likely to play a contributing role in the aging hair phenotype.

Multiple Aplasia Cutis Congenita Lesions of the Scalp: A Case Study.

Aplasia cutis congenita (ACC) is a rare condition that presents at birth as an absence of skin that does not usually involve underlying structures. Occurring in 3/10,000 live births, ACC is evenly distributed between males and females; the risk of ACC increases to 7 percent in consanguineous marriages. Up to 86 percent of lesions are found on the scalp in the midline vertex position. Lesions can also be found on the trunk and limbs, as with Adams-Oliver syndrome or accompanying epidermolysis bullosa. ACC is associated with chromosomal abnormalities and 35-50 percent of the time with trisomy 13 (Patau syndrome). This case study presents an infant with multiple ACC lesions of the scalp. The pathophysiology, treatment, potential long-term complications, and nursing considerations are discussed.