The prevalence and clinical features of fibromyalgia in Chinese hospital patients with primary headache: The survey of fibromyalgia comorbid with headache.

OBJECTIVE: The aims were to explore the prevalence and clinical features of fibromyalgia in Chinese hospital patients with primary headache. BACKGROUND: Studies done in non-Chinese populations suggest that around one-third of patients with primary headache have fibromyalgia, but data from mainland China are limited. Investigations into the prevalence and clinical features of fibromyalgia in Chinese patients with primary headache would improve our understanding of these two complex disease areas and help guide future clinical practice. METHODS: This cross-sectional study included adults with primary headache treated at 23 Chinese hospitals from September 2020 to May 2021. Fibromyalgia was diagnosed using the modified 2010 American College of Rheumatology criteria. Mood and insomnia were evaluated employing the Hospital Anxiety and Depression Scale and the Insomnia Severity Index. RESULTS: A total of 2782 participants were analyzed. The fibromyalgia prevalence was 6.0% (166/2782; 95% confidence interval: 5.1%, 6.8%). Compared to primary headache patients without combined fibromyalgia, patients with primary headache combined with fibromyalgia were more likely to be older (47.8 vs. 41.7 years), women (83.7% [139/166] vs. 72.8% [1904/2616]), less educated (65.1% [108/166] vs. 45.2% [1183/2616]), and with longer-duration headache (10.0 vs. 8.0 years). Such patients were more likely to exhibit comorbid depression (34.3% [57/166] vs. 9.9% [260/2616]), anxiety (16.3% [27/166] vs. 2.7% [70/2612]), and insomnia (58.4% [97/166] vs. 17.1% [447/2616]). Fibromyalgia was more prevalent in those with chronic (rather than episodic) migraine (11.1% [46/414] vs. 4.4% [72/1653], p < 0.001) and chronic (rather than episodic) tension-type headache (11.5% [27/235] vs. 4.6% [19/409], p = 0.001). Most fibromyalgia pain was in the shoulders, neck, and upper back. CONCLUSIONS: The prevalence of fibromyalgia in mainland Chinese patients with primary headache was 6.0%. Fibromyalgia was more common in those with chronic rather than episodic headache. The most common sites of fibromyalgia pain were the neck, shoulders, and back.

Exploration of cortical inhibition and habituation in insomnia: Based on CNV and EEG.

OBJECTIVE: Cognitive dysfunction with abnormal cortical inhibition and habituation has frequently been found in patients with insomnia. And the so-called contingent negative variation (CNV) and EEG power spectral density (FFT) may be the best choice to explore the underlining pathophysiology. METHODS: We used polysomnography (PSG) to record such objective PSG parameters. The amplitudes, latencies, areas of different CNV components such as oCNV, iCNV and tCNV, PINV have been selected and analyzed. Behavioral data such as manual reaction time (RT) has been analyzed. Spectral analysis was performed with fast Fourier transformation (FFT) on all channels to make a spectral analyses of EEG datas. RESULTS: The A-latency located in CZ or PZ were statistically longer in insomnia group than control group, the iCNV-latency located in insomnia group were statistically shorter than control group. The iCNV-amplitude located in insomnia group was lower than control group. The oCNV-amplitude or the tCNV-amplitude located in insomnia group was higher than control group. The oCNV-square, tCNV-square, or PINV-square located in insomnia group were significant larger than control group. ß1 or ß2 activity distributed in bilateral hemisphere were significantly increased in insomnia group than control group with different distributions. DISCUSSION: Our study revealed varied attentional and information processing in insomnia patients. Above all, we made a hypothesis with ceiling theory: Frontal lobe play an important role in maintaining cognitive processing, which needs much more energy consumption and leads to decreased fast EEG activity in frontal cortex, which contributes to reduced cortical inhibition, represented as abnormal CNV.

Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China.

BACKGROUND: Headache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists. METHODS: In the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021. RESULTS: The study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of "Nervous headache" was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study. CONCLUSIONS: While there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future.

Clinical manifestations and polysomnography-based analysis in nine cases of probable sporadic Creutzfeldt-Jakob disease.

PURPOSE: To summarize the clinical characteristics of patients with sporadic Creutzfeldt-Jakob disease (sCJD), analyze its sleep disorder characteristics using polysomnography (PSG), and compare sleep disturbances with those of fatal familial insomnia (FFI). PATIENTS AND METHODS: We retrospectively reviewed the sleep disturbances; cerebrospinal fluid (CSF) protein 14-3-3 (CSF-14-3-3 protein); prion protein gene, PRNP; magnetic resonance imaging; and electroencephalogram (EEG) of nine sCJD patients RESULTS: Of the nine sCJD patients, six were positive for CSF-14-3-3 protein. In the eight patients who completed diffusion-weighted imaging, seven showed cortical "ribbons sign" and two showed high signal in the basal ganglia. All nine patients had an EEG, which showed an increase in background slow waves; moreover, four showed typical periodic sharp wave complexes. The codon diversity at position 129, 219 of nine patients were MM, EE. Almost all nine patients had sleep disturbances such as insomnia, hypersomnia, and periodic limb movement disorder (PLMD). Five patients completed PSG, which demonstrated severe sleep structure disorder, prolonged total waking time, significantly reduced sleep efficiency, and absent rapid eye movement in some severe patients. CONCLUSION: Sleep disturbances are common in sCJD patients, manifested as insomnia, lethargy, and PLMD. The sCJD patients often demonstrate severe sleep structure disorder through PSG, which is similar to patients with FFI.

Roles of motor and cortical activity in sleep rebound in rat.

Sleep pressure that builds up gradually during the extended wakefulness results in sleep rebound. Several lines of evidence, however, suggest that wake per se may not be sufficient to drive sleep rebound and that rapid eye movement (REM) and non-rapid eye movement (NREM) sleep rebound may be differentially regulated. In this study, we investigated the relative contribution of brain versus physical activities in REM and NREM sleep rebound by four sets of experiments. First, we forced locomotion in rats in a rotating wheel for 4 hr and examined subsequent sleep rebound. Second, we exposed the rats lacking homeostatic sleep response after prolonged quiet wakefulness and arousal brain activity induced by chemoactivation of parabrachial nucleus to the same rotating wheel paradigm and tested if physical activity could rescue the sleep homeostasis. Third, we varied motor activity levels while concurrently inhibiting the cortical activity by administering ketamine or xylazine (motor inhibitor), or ketamine + xylazine mixture and investigated if motor activity in the absence of activated cortex can cause NREM sleep rebound. Fourth and finally, we manipulated cortical activity by administering ketamine (that induced active wakefulness and waking brain) alone or in combination with atropine (that selectively inhibits the cortex) and studied if cortical inhibition irrespective of motor activity levels can block REM sleep rebound. Our results demonstrate that motor activity but not cortical activity determines NREM sleep rebound whereas cortical activity but not motor activity determines REM sleep rebound.

Different EPHX1 methylation levels in promoter area between carbamazepine-resistant epilepsy group and carbamazepine-sensitive epilepsy group in Chinese population.

BACKGROUND: Epigenetics underlying refractory epilepsy is poorly understood. DNA methylation may affect gene expression in epilepsy patients without affecting DNA sequences. Herein, we investigated the association between Carbamazepine-resistant (CBZ-resistant) epilepsy and EPHX1 methylation in a northern Han Chinese population, and conducted an analysis of clinical risk factors for CBZ-resistant epilepsy. METHODS: Seventy-five northern Han Chinese patients participated in this research. 25 cases were CBZ-resistant epilepsy, 25 cases were CBZ-sensitive epilepsy and the remaining 25 cases were controls. Using a CpG searcher was to make a prediction of CpG islands; bisulfite sequencing PCR (BSP) was applied to test the methylation of EPHX1. We then did statistical analysis between clinical parameters and EPHX1 methylation. RESULTS: There was no difference between CBZ-resistant patients, CBZ-sensitive patients and healthy controls in matched age and gender. However, a significant difference of methylation levels located in NC_000001.11 (225,806,929.....225807108) of the EPHX1 promoter was found in CBZ-resistant patients, which was much higher than CBZ-sensitive and controls. Additionally, there was a significant positive correlation between seizure frequency, disease course and EPHX1 methylation in CBZ-resistant group. CONCLUSION: Methylation levels in EPHX1 promoter associated with CBZ-resistant epilepsy significantly. EPHX1 methylation may be the potential marker for CBZ resistance prior to the CBZ therapy and potential target for treatments.

The Detection of the Negative Effects of Interictal Epileptiform Discharges on Cognition: An Event-Related Potential Study.

Evidence from a neuropsychological test revealed that interictal epileptiform discharges (IEDs) may have significant impact on cognitive performance. Sometimes, neuropsychological tests may not be sensitive to detection of mild cognitive changes. We applied P300 and mismatch negativity (MMN) to detect mild cognitive changes caused by small amount of IEDs. Sixty-seven adult epilepsy patients and participants were divided into six groups according to different IEDs index. The patients with IED index greater than 7.5% showed longer latency and lower amplitude in the test of P300 and MMN than patients with IED index less than 7.5%, which indicated mild impaired cognitive function. The negative effect of IED index greater than 10% on cognitive has been found by neuropsychological test, whereas the mild negative effect of IED index greater than 7.5% has only been found by P300 and MMN. So, P300 and MMN may be more sensitive than neuropsychological tests to detect mild cognitive impairment caused by IEDs.

Tonic Seizure as a Different Seizure Type Presented in Autoimmune Epilepsy Caused by Systemic Lupus Erythematosus.

The diagnosis of autoimmune epilepsy is often challenging, and may be misdiagnosed as epileptic disorders or viral encephalitis. Autoimmune epilepsy has a strong association with other autoimmune diseases, especially systemic lupus erythematosus (SLE). In addition, autoimmune epilepsy was reported to present with complex partial seizure (CPS), simple partial seizure (SPS), and secondarily generalized tonic-clonic seizure (sGTCS). In our case, we present a different seizure type of tonic seizure in autoimmune epilepsy caused by SLE, which has not been reported, and it will provide with a new understanding of autoimmune epilepsy. A 17-year-old Chinese girl was diagnosed as having SLE for 1 month but with no epilepsy history. After this admission, she presented with different seizure types. Then EEG, magnetic resonance imaging, and lumbar puncture were performed. We have found generalized tonic seizure and excluded CNS infection and lupus encephalopathy. After antiepileptic therapy, no improvement has been found in seizure control. According to the previous history, clinical manifestation, and relevant examinations, we have made a clinical diagnosis of autoimmune epilepsy (tonic seizure) and SLE has been confirmed again by the immunological test. After the hormonotherapy, anti-inflammatory, and anti-tuberculosis therapy, the tonic seizure decreased significantly, and patient's consciousness improved. Autoimmune epilepsy should call the attentions of the clinicians, especially when the patient presented with SLE. Tonic seizure has not been described in autoimmune epilepsy before, which was different from other seizures reported, such as SPS, CPS, and sGTCS, and may bring a new insight into the autoimmune epilepsy.

Cognitive Impairment and Personality Traits in Epilepsy: Characterization and Risk Factor Analysis.

Cognitive impairment and personality disorders are severe comorbidities commonly observed in patients with epilepsy, and together they decrease the quality of patients' life. This study aimed to evaluate cognitive function and personality traits in patients with epilepsy with the Wechsler Adult Intelligence Scale-Chinese revised and Eysenck Personality Questionnaire and investigate the underlying influencing factors. Compared with the control group, our results showed that patients with epilepsy were presented with significant cognitive impairment and particular personality traits. Epileptic seizure-related factors including earlier age of onset, longer duration of epileptic history, and higher seizure frequency were significantly associated with the observed defects in cognition and personality traits. In addition, the temporal lobe was more likely to affect cognition and personality, and the left hemisphere was closely related to verbal intelligence quotient, which needs to be the focus of future research. These results will be instrumental for guiding the treatment of epilepsy.

Clapping-surpressed focal spikes in EEG may be unique for the patients with rett syndrome : a case report.

BACKGROUND: Rett syndrome is a severe neurodevelopmental disorder that primarily affects females. Typical features include a loss of purposeful hand skills, development of hand stereotypies, loss of spoken language, gait abnormalities, and acquired microcephaly. However, Rett syndrome hasn't been recognized by clinical doctors at the early stage. So we need to find some special characters. CASE PRESENTATION: We reported a Chinese case of Rett syndrome, exhibiting continuous centrotemporal spikes in EEG with paroxysmal suppression by hand stereotypies (hand clapping). The child, female, 4 years old, presented with a significant regression in her spoken language skills, hand stereotypies (hand clapping and hand wringing), a wider based gait with difficulties in balance, repeated abnormal behaviors (bruxism and head banging). With her clinical-history, Rett syndrome was suspected and genetic testing with mutation in MECP2 confirmed the diagnosis. Her EEG showed slow acticity in background and revealed a specific feature that continuous centrotemporal spikes can be suppressed by the repeated hand clapping. And when the hand stopped, the spikes reoccured again. CONCLUSIONS: This unique EEG signature has rarely been reported, which will expand the spectrum of EEG abnormalities in Rett syndrome.

Dementia with Lewy bodies versus nonconvulsive status epilepticus in the diagnosis of a patient with cognitive dysfunction, complex visual hallucinations and periodic abnormal waves in EEG: a case report.

BACKGROUND: The diagnosis of dementia with Lewy bodies (DLB) is often challenging in elderly individuals, not only for its various clinical features, sometimes, but also for its rare changes of periodic synchronous discharges (PSD) in electroencephalogram ( EEG). So, we reported one case of DLB and gave a detailed analysis. CASE PRESENTATION: A Chinese patient (Female, 56 years old) presented with progressive cognitive decline and complex visual hallucinations. Several days after admission, she gradually showed focal myoclonic jerks. Mini-Mental State Examination (MMSE) score was 19/30, EEG revealed PSD, Cerebrospinal fluid and 14-3-3 brain protein was negative, Magnetic resonance imaging (MRI) showed diffuse atrophy. To differentiate the PSD derived from DLB or from late-onset Absence Status Epilepticus, we have given the treatment with intravenous valproate (1200 mg/24 h) and diazepam 20 mg under the EEG monitor, a clinical improvement was absent and PSD in EEG did not disappear. Two weeks later, the patient showed akinetic-rigid syndrome and PSD in EEG persisted for a long time. According to her history and therapy, a clinical diagnosis of DLB has been made, but no autopsy for confirmation, and in the following visit, she has a poor prognosis. CONCLUSION: PSD in EEG may occasionally be recorded in neurodegenerative disorders such as AD, DLB other than CJD or NCSE. Hence it should not dissuade clinicians from the diagnosis of DLB where the clinical and neuropsychological findings were consistent with suggested diagnostic criteria for DLB.

Pontine parabrachial nucleus-basal forebrain circuitry regulating cortical and hippocampal arousal.

INTRODUCTION: The basal forebrain (BF) and the medial septum (MS) respectively drive neuronal activity of cerebral cortex and hippocampus (HPC) in sleep-wake cycle. Our previous studies of lesions and neuronal circuit tracing have shown that the pontine parabrachial nucleus (PB) projections to the BF and MS may be a key circuit for cortical and HPC arousal. AIMS: This study aims to demonstrate that PB projections to the BF and MS activate the cerebral cortex and HPC. RESULTS: By using chemogenetic stimulation of the BF, the PB-BF and the PB-MS pathway combined with electroencephalogram (EEG) Fast Fourier Transformation (FFT) analysis in rats, we demonstrated that chemogenetic stimulation of the BF or PB neurons projecting to the BF activated the cerebral cortex while chemogenetic stimulation of the MS or PB neurons projecting to the MS activated HPC activity, in sleep and wake state. These stimulations did not significantly alter sleep-wake amounts. CONCLUSIONS: Our results support that PB projections to the BF and MS specifically regulating cortical and HPC activity.

A Semi-Supervised Multi-Scale Arbitrary Dilated Convolution Neural Network for Pediatric Sleep Staging.

Sleep staging is essential for assessing sleep quality and diagnosing sleep disorders. However, sleep staging is a labor-intensive process, making it arduous to obtain large quantities of high-quality labeled data for automatic sleep staging. Meanwhile, most of the research on automatic sleep staging pays little attention to pediatric sleep staging. To address these challenges, we propose a semi-supervised multi-scale arbitrary dilated convolution neural network (SMADNet) for pediatric sleep staging using the scalogram with a high height-to-width ratio generated by the continuous wavelet transform (CWT) as input. To extract more extended time dimensional feature representations and adapt to scalograms with a high height-to-width ratio in SMADNet, we introduce a multi-scale arbitrary dilation convolution block (MADBlock) based on our proposed arbitrary dilated convolution (ADConv). Finally, we also utilize semi-supervised learning as the training scheme for our network in order to alleviate the reliance on labeled data. Our proposed model has achieved performance comparable to state-of-the-art supervised learning methods with 30% labels. Our model is tested on a private pediatric dataset and achieved 79% accuracy, 72% kappa, and 75% MF1. Therefore, our model demonstrates a powerful feature extraction capability and has achieved performance comparable to state-of-the-art supervised learning methods with a small number of labels.

ECGAN-Assisted ResT-Net Based on Fuzziness for OSA Detection.

OBJECTIVE: Growing attention has been paid recently to electrocardiogram (ECG) based obstructive sleep apnea (OSA) detection, with some progresses been made on this topic. However, the lack of data, low data quality, and incomplete data labeling hinder the application of deep learning to OSA detection, which in turn affects the overall generalization capacity of the network. METHODS: To address these issues, we propose the ResT-ECGAN framework. It uses a one-dimensional generative adversarial network (ECGAN) for sample generation, and integrates it into ResT-Net for OSA detection. ECGAN filters the generated ECG signals by incorporating the concept of fuzziness, effectively increasing the amount of high-quality data. ResT-Net not only alleviates the problems caused by deepening the network but also utilizes multi-head attention mechanisms to parallelize sequence processing and extract more valuable OSA detection features by leveraging contextual information. RESULTS: Through extensive experiments, we verify that ECGAN can effectively improve the OSA detection performance of ResT-Net. Using only ResT-Net for detection, the accuracy on the Apnea-ECG and private databases is 0.885 and 0.837, respectively. By adding ECGAN-generated data augmentation, the accuracy is increased to 0.893 and 0.848, respectively. CONCLUSION AND SIGNIFICANCE: Comparing with the state-of-the-art deep learning methods, our method outperforms them in terms of accuracy. This study provides a new approach and solution to improve OSA detection in situations with limited labeled samples.

Association between Body Mass Index and Medication-Overuse Headache among Individuals with Migraine: A Cross-Sectional Study.

INTRODUCTION: Medication-overuse headache (MOH) is a secondary chronic headache disorder that occurs in individuals with a pre-existing primary headache disorder, particularly migraine disorder. Obesity is often combined with chronic daily headaches and is considered a risk factor for the transformation of episodic headaches into chronic headaches. However, the association between obesity and MOH among individuals with migraine has rarely been studied. The present study explored the association between body mass index (BMI) and MOH in people living with migraine. METHODS: This cross-sectional study is a secondary analysis of data from the Survey of Fibromyalgia Comorbidity with Headache study. Migraine and MOH were diagnosed using the criteria of the International Classification of Headache Disorders, 3rd Edition. BMI (kg/m2) is calculated by dividing the weight (kg) by the square of the height (m). Multivariable logistic regression analysis was used to evaluate the association between BMI and MOH. RESULTS: A total of 2,251 individuals with migraine were included, of whom 8.7% (195/2,251) had a concomitant MOH. Multivariable logistic regression analysis, adjusted for age, sex, education level, headache duration, pain intensity, headache family history, chronic migraine, depression, anxiety, insomnia, and fibromyalgia, demonstrated there was an association between BMI (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.11; p = 0.031) and MOH. The results remained when the BMI was transformed into a category. Compared to individuals with Q2 (18.5 kg/m2 ≤ BMI ≤23.9 kg/m2), those with Q4 (BMI ≥28 kg/m2) had an adjusted OR for MOH of 1.81 (95% CI, 1.04-3.17; p = 0.037). In the subgroup analyses, BMI was associated with MOH among aged more than 50 years (OR, 1.13; 95%, 1.03-1.24), less than high school (OR, 1.08; 95%, 1.01-1.15), without depression (OR, 1.06; 95%, 1.01-1.12), and without anxiety (OR, 1.06; 95%, 1.01-1.12). An association between BMI and MOH was found in a sensitivity analysis that BMI was classified into four categories according to the World Health Organization guidelines. CONCLUSION: In this cross-sectional study, BMI was associated with MOH in Chinese individuals with migraine.

The association between oxcarbazepine-induced maculopapular eruption and HLA-B alleles in a northern Han Chinese population.

BACKGROUND: We investigated the association between oxcarbazepine (OXC)-induced maculopapular eruption (MPE) and HLA-B alleles in a northern Han Chinese population, and conducted an analysis of clinical risk factors for OXC-MPE. METHODS: Forty-two northern Han Chinese patients who had been treated with OXC in Changchun, China were genotyped. Among them were 14 cases with OXC-induced MPE; the remaining 28 were OXC-tolerant. The HLA-B allele frequencies of the normal control group were found in the Allele Frequency Net Database. Polymerase chain reaction-sequence specific primer( PCR-SSP )was used for HLA-B*1502 testing and direct sequencing for four-digit genotype determination. RESULTS: Four-digit allele sequencing showed that there was no statistically significant difference in the frequency of the HLA-B*1502 allele between the OXC-MPE and OXC-tolerant controls (3.6% versus 7.5%, OR = 0.38, 95% CI = 0.04-3.40, P = 0.65), as well as between OXC-MPE and normal controls (3.6% versus 2.4%, OR = 1.54, 95% CI = 0.20-11.73, P = 0.49). However, a significant difference in the frequency of HLA-B*3802 alleles was found between the MPE group and normal controls (10.7% versus 1.9%, OR = 6.329, 95% CI = 1.783-22.460, P = 0.018). There was no significant difference in terms of age, gender, or final OXC dose between the OXC-MPE and OXC-tolerant groups. CONCLUSIONS: There was no significant association between OXC-MPE and HLA-B*1502 in the northern Han Chinese population in our study. Instead, HLA-B*3802 was found to be a potential risk factor for OXC-MPE.

Cognitive correlates of interictal epileptiform discharges in adult patients with epilepsy in China.

OBJECTIVE: Learning difficulties or cognitive impairment has been observed in many patients with epilepsy. Evidence from neurophysiologic and functional neuroimaging suggests that epileptic seizures and/or epileptiform activity can be the dominant factors inhibiting specific brain areas. However, most previous studies were focused on cognitive performance in children. In this study, we analyzed a new cohort of adult patients with frequent interictal epileptiform discharges (IEDs). METHODS: Data from 67 adult patients with epilepsy were reviewed. Electroencephalography (EEG)-video recording and cognitive testing were performed, and the IED index was estimated as a percentage assigned to one of four categories (<1%, 1-10%, 10-50%, and >50%) during either wakefulness or sleep. Correlations of cognitive test results and clinical characteristics of IED categories were analyzed. The effects of the frequency, duration, location, and sleep-wake cycles of IEDs on cognition (intelligence and memory capacity) were analyzed. RESULTS: Patients with an IED index >10% showed impaired performance on the Chinese Wechsler Adult Intelligence Scale (WAIS-RC) and the Chinese Wechsler Memory Scale (WMS). This effect was detected independently from other IED frequencies and other IED-related variables, such as duration, distribution, and location. The impact of waking or sleeping IEDs was of equal importance in contributing to impaired WAIS-RC and WMS performance. CONCLUSION: An IED frequency of more than 10% in both waking and sleeping EEGs is associated with impaired cognitive performance in adult patients. However, whether patients with a high IED frequency but low seizure frequency will benefit from antiepileptic treatment should be examined in future studies.

GAC-SleepNet: A dual-structured sleep staging method based on graph structure and Euclidean structure.

Sleep staging is a precondition for the diagnosis and treatment of sleep disorders. However, how to fully exploit the relationship between spatial features of the brain and sleep stages is an important task. Many current classical algorithms only extract the characteristic information of the brain in the Euclidean space without considering other spatial structures. In this study, a sleep staging network named GAC-SleepNet is designed. GAC-SleepNet uses the characteristic information in the dual structure of the graph structure and the Euclidean structure for the classification of sleep stages. In the graph structure, this study uses a graph convolutional neural network to learn the deep features of each sleep stage and converts the features in the topological structure into feature vectors by a multilayer perceptron. In the Euclidean structure, this study uses convolutional neural networks to learn the temporal features of sleep information and combine attention mechanism to portray the connection between different sleep periods and EEG signals, while enhancing the description of global features to avoid local optima. In this study, the performance of the proposed network is evaluated on two public datasets. The experimental results show that the dual spatial structure captures more adequate and comprehensive information about sleep features and shows advancement in terms of different evaluation metrics.

Exploring the cortical habituation in migraine patients based on contingent negative variation.

Introduction: Cognitive dysfunction has frequently been found in patients with migraine. The so-called contingent negative variation (CNV) and EEG power spectral densities may be the best choices to explore the underlining pathophysiology, such as cortical inhibition and habituation. Methods: Thirty migraine patients without aura and healthy controls matched for sex, age, and education were recruited separately for CNV recording. The amplitudes, latencies, and squares of different CNV components, such as oCNV, iCNV, tCNV, and PINV, were selected and analyzed. Behavioral data, such as manual reaction time (RT), were analyzed. We used the Person correlation coefficient R to analyze different ERP components in relation to clinical characteristics. A multiple regression analysis was conducted for the migraine group. Spectral analysis of EEG data from all channels using the fast Fourier transform (FFT). Results: The migraine group had longer A-latency, C-latency, and iCNV-latency than the control group. The migraine group had higher iCNV-amplitude, oCNV-amplitude, and tCNV-amplitude than the control group, especially those located in the occipital area. The iCNV-square, oCNV-square, tCNV-square, or PINV-square in the migraine group was significantly larger than the control group. Different correlations were found between clinical characteristics and ERP components. The delta or theta activity in the migraine group was statistically lower than in the control group. Discussion: Our study has revealed that migraine attacks may influence responsivity, pre-activation, habituation, and cortical inhibition not only on the behavioral level but also on the electrophysiological level. Abnormal changes in cortical habituation and inhibition can be interpreted as CNV components. Additionally, analyses have revealed correlations between CNV components and various factors, including age, the clinical course of the condition, attack frequency, pain intensity, and duration. Thus, repetitive migraine attacks can lead to a reduction in cortical inhibition and subsequent impairment in executive function.

Habenula regulates cardiovascular activities in the insula cortex in a rat model of epilepsy.

BACKGROUND: Epilepsy has a high mortality rate due to sudden death, which is poorly understood. However, recent research has indicated that it may be associated with fatal arrhythmia, which occurs commonly in insular epilepsy. OBJECTIVE: To examine the effects of the habenular nucleus on cardiovascular activities in a rat model of insular epilepsy. METHODS: Adult rats (n = 32) were divided into four groups: Group A (normal control); Group B (insular epilepsy); Group C (habenular nuclei injury alone); and Group D (bilateral habenular nuclei injury one week prior to the insular epilepsy). A rat model of epilepsy was made in the right insula by microinjection of kainic acid (KA, 0.3 µL). Behavioral activities were observed according to Racine scales. The habenular nuclei were injured by direct current electric shock. Heart rate, blood pressure, and plasma norepinephrine were measured in the four groups under quite conditions or during seizure. RESULTS: We found that the rats in Group B have significantly higher heart rate, blood pressure, and plasma norepinephrine than those in Group A or Group D during seizure; however, there was no difference in blood pressure, heart rate, or plasma norepinephrine between Groups A and C. Moreover, the rats in the Group D had a significant lower blood pressure when compared with those in the Group C; however, no difference was observed in the heart rate and norepinephrine during seizure. CONCLUSION: The insula cortex has close association with cardiovascular activities in rats from our insula epilepsy model. The habenular nuclei can regulate cardiovascular activities during insular epilepsy.