Heart rate analysis differentiates dialeptic complex partial temporal lobe seizures from auras and non-epileptic seizures.

The distinction of non-epileptic from epileptic events is difficult even for experienced neurologists. We retrospectively evaluated 59 dialeptic events from 27 patients admitted for video EEG monitoring to check whether heart rate (HR) analysis could help in differentiating dialeptic complex partial temporal lobe seizures (TLS) from dialeptic simple partial TLS, and non-epileptic dialeptic events. Baseline HR was increased in the simple partial TLS in comparison to complex partial TLS and non-epileptic groups (p<0.05). HR increase accompanied each individual dialeptic complex partial TLS (100% of the events, p<0.05) bur HR returned to baseline in the post-ictal phase. Ictal HR was not altered in the non-epileptic or simple partial TLS groups. Our findings suggest that ictal centrally mediated tachycardia is characteristic of dialeptic TLS (both tachycardia and bradycardia have been reported during TLS). This finding may be used as a criterion to distinguish dialeptic complex partial TLS from simple partial and non-epileptic dialeptic events.

Levodopa enhances immobility induced by spinal cord electromagnetic stimulation in rats.

BACKGROUND: The repetitive ElectroMagnetic Stimulation (rEMS) is an innocuous method applied to modulate neurocircuits in real-time to study the physiology of the central nervous system and treat neuropsychiatric conditions. Preliminary data suggest that spinal rEMS induces behavioral changes in awake rats. However, the mechanisms behind this phenomenon remain largely unknown. METHODS: Twenty-five male Wistar rats were divided into five subgroups of five animals each: one subgroup was drug-free, two subgroups received Levodopa+Benserazide 250+25mg/kg for two or seven days, and the remaining two subgroups received Haloperidol 0.1 or 0.3mg/kg for two days. The animals were restrained during sham rEMS (day 1) followed by real rEMS of the cervicothoracic region at a different day (day 2 or 7, depending on subgroup). Four behavioral parameters were quantified: Walking, Climbing, Grooming, and Cornering. RESULTS: rEMS reduced Walking and increased Cornering duration when applied over the cervicothoracic region of drug-free animals. A pretreatment with Levodopa+Benserazide for two or seven days induced an additional decrease in Walking after rEMS. This reduction was maximum after the treatment for seven days and associated with extinction of Climbing and increase in Cornering. A pretreatment with Haloperidol 0.1mg/kg reduced Grooming after rEMS, but did not prevent the reduction in Walking. CONCLUSIONS: Cervicothoracic rEMS induced complex immobility responses that are in part modulated by dopaminergic pathways in rats. Further studies are necessary to determine the specific mechanisms involved.

Clinical and Electrodiagnostic Findings in Patients with Peripheral Neuropathy and Inflammatory Bowel Disease.

BACKGROUND: Several neurological diseases, especially different types of peripheral neuropathy (PN) are common in inflammatory bowel disease (IBD). METHODS: We prospectively evaluated the presence of PN in 121 patients with IBD (51 with Crohn's disease [CD] and 70 with ulcerative colitis [UC]) and 50 controls (gastritis and dyspepsia) over 3.5 years. RESULTS: A total of 15 patients (12.4%) with small-fiber neuropathy and IBD (7 CD and 8 UC) and 24 patients (19.8%) with large-fiber PN (12 CD and 12 UC) were diagnosed. Small-fiber neuropathy affected 6% and large-fiber PN affected 4% of the control patients. Patients with CD with PN were older, had more metabolic complications and more severe motor involvement than patients with UC with PN. Carpal tunnel syndrome was more common in patients with UC. Sural and median sensory nerves were the most commonly and severely affected sensory responses. Tibial, peroneal, median, and ulnar compound muscle action potential amplitudes were also significantly decreased in patients with CD and UC. In general, sensory and motor amplitudes were a more sensitive marker for PN in patients with IBD than conduction velocities. CONCLUSIONS: In summary, PN is common in patients with IBD. It may be primarily related to IBD, phenotypically modified by metabolic complications. Its phenotype is diverse (most commonly small to predominantly axonal sensory large-fiber), but usually more severe in CD. It also includes ataxic and demyelinating forms. Results from our 10-year follow-up will elucidate the PN clinical course and the real impact of the comorbidities and new therapies.

Development and validation of the Intrinsic Religiousness Inventory (IRI).

OBJECTIVE: The role of religious involvement in mental health has been increasingly investigated in psychiatric research; however, there is a shortage of scales on religiousness in Portuguese. The present study aimed to develop and validate a brief instrument to assess intrinsic religiosity (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples. METHOD: The initial version was based on literature review and experts' suggestions. University students (sample 1; n = 323) and psychiatric patients (sample 2; n = 102) completed the Duke Religiosity Index (DUREL), the IRI, an instrument of spirituality measurement (WHOQOL-SRPB), as well as measurements of anxiety and depressive symptoms. RESULTS: The IRI showed adequate internal consistence reliability in sample 1 (Cronbach's α = 0.96; 95% CI; 0.95-0.97) and sample 2 (α = 0.96; 95% CI; 0.95-0.97). The IRI main component analyses indicated a single factor, which explained 73.7% and 74.9% of variance in samples 1 and 2, respectively. Strong correlations between IRI and intrinsic subscale of the DUREL were observed (Spearman's r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p < 0.001). The IRI showed good test-retest reliability (intraclass correlation coefficients > 0.70). CONCLUSION: These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

Movement-induced heart rate changes in epileptic and non-epileptic seizures.

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20% heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

Sildenafil inhibits duodenal contractility via activation of the NO-K+ channel pathway.

Phosphodiesterase type-5 (PDE5) specifically cleaves cyclic guanosine monophosphate (cGMP), a key intracellular secondary messenger. The PDE5 inhibitor sildenafil is a well-known vasodilator that also has gastrointestinal myorelaxant properties. In the present study, we further investigated sildenafil-induced myorelaxation in rat isolated duodenum, assessing its interaction with nitric oxide (NO) synthase and K(+) channel opening. The spontaneous contractions of duodenal strips were reversibly inhibited by sildenafil (0.1-300 microM) in a concentration-dependent manner [mean (95% confidence interval); EC(50) = 6.8 (2.7-17.3) microM]. The sildenafil-induced myorelaxation was significantly decreased by the NO synthase inhibitor N-nitro-L-arginine methyl ester [increasing the EC(50) value to 41.9 (26.1-67.3) microM]. Sodium nitroprusside or forskolin pretreatments enhanced the sildenafil-induced myorelaxation. In isolated strips pretreated with BaCl(2) (0.2 mM), 4-aminopyridine (4-AP, 3 mM), or glybenclamide (1 microM), the sildenafil-induced EC(50) value was significantly increased to 32.8 (19.1-56.4), 27.1 (15.2-48.3) and 20.1 (16.4-24.7) microM, respectively. Minoxidil (50 microM) or diazoxide (100 microM) also significantly attenuated the sildenafil-induced potency. In conclusion, the NO synthase/cyclic nucleotide pathway activation is involved in sildenafil-induced inhibition of spontaneous duodenal contractions. Its pharmacological action seems to be influenced by K(+) channel opening, especially the voltage-sensitive ones, being inhibited by 4-AP and K(ATP) channels, sensitive to glybenclamide.

Development and validation of the Intrinsic Religiousness Inventory (IRI) / Desenvolvimento e validação do Inventário de Religiosidade Intrínseca (IRI)

OBJECTIVE: The role of religious involvement in mental health has been increasingly investigated in psychiatric research; however, there is a shortage of scales on religiousness in Portuguese. The present study aimed to develop and validate a brief instrument to assess intrinsic religiosity (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples. METHOD: The initial version was based on literature review and experts' suggestions. University students (sample 1; n = 323) and psychiatric patients (sample 2; n = 102) completed the Duke Religiosity Index (DUREL), the IRI, an instrument of spirituality measurement (WHOQOL-SRPB), as well as measurements of anxiety and depressive symptoms. RESULTS: The IRI showed adequate internal consistence reliability in sample 1 (Cronbach's α = 0.96; 95 percent CI; 0.95-0.97) and sample 2 (α = 0.96; 95 percent CI; 0.95-0.97). The IRI main component analyses indicated a single factor, which explained 73.7 percent and 74.9 percent of variance in samples 1 and 2, respectively. Strong correlations between IRI and intrinsic subscale of the DUREL were observed (Spearman's r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p < 0.001). The IRI showed good test-retest reliability (intraclass correlation coefficients > 0.70). CONCLUSION: These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

OBJETIVO: O papel da religiosidade em saúde mental vem sendo objeto de intensa investigação. Estudos devem ser executados em diferentes locais e culturas. O presente estudo objetiva desenvolver e validar um instrumento breve para mensurar religiosidade intrínseca (Inventário de Religiosidade Intrínseca - IRI) em duas amostras brasileiras. MÉTODO: A versão inicial foi baseada na revisão de literatura e em sugestões de especialistas. Estudantes universitários (amostra 1; n = 323) e pacientes psiquiátricos (amostra 2; n = 102) preencheram o Índice de Religiosidade de Duke (DUREL), o IRI, uma medida de espiritualidade (WHOQOL-SRPB), bem como medidas de sintomas ansiosos e depressivos. RESULTADOS: O IRI apresentou consistência interna adequada nas amostras 1 (α de Cronbach = 0,96; IC 95 por cento; 0,95-0,97) e 2 (α = 0,96; IC 95 por cento; 0,95-0,97). Análises de componentes principais indicaram um único fator que explicou 73,7 por cento e 74,9 por cento da variância nas amostras 1 e 2, respectivamente. Foram observadas fortes correlações entre o IRI e a subescala de religiosidade intrínseca da DUREL (r de Spearman de 0,87 a 0,73 nas amostras 1 e 2, respectivamente, p < 0,001). O IRI apresentou boa validade teste-reteste (coeficientes de correlação intraclasse > 0,70). CONCLUSÃO: Os dados indicam que o IRI é um instrumento válido e pode contribuir para estudar religiosidade intrínseca em amostras brasileiras.

Movement-induced heart rate changes in epileptic and non-epileptic seizures / Alterações da frequência cardíaca induzidas pelo movimento em crises epilépticas e não-epilépticas

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20 percent heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

Alterações da frequência cardíaca são comuns em crises epilépticas e não-epilépticas. Estudos prévios não avaliaram adequadamente a contribuição da atividade motora nas alterações da frequência cardíaca, e as crises não foram estudadas durante monitoração prolongada. No presente estudo avaliamos retrospectivamente 143 crises de 76 pacientes admitidos para monitoração com vídeo-EEG no Hospital da Universidade de Saint Louis. As crises foram classificadas de acordo com o grau de atividade motora (severa, moderada e leve/ausente) em: epiléptica grave (EG, N=17), não-epiléptica grave (NEG, N=6), epiléptica moderada (EM, N=28), não epiléptica moderada (NEM, N=11), epiléptica leve (EL, N=35), não-epiléptica leve (NEL, N=33), e aura, N=13. A frequência cardíaca aumentou no período ictal nas crises epilépticas graves, não epilépticas graves, epilépticas moderadas, epilépticas leves (p<0,05). A frequência cardíaca apresentou tendência a retornar aos níveis basais durante o período pós ictal nas crises não epilépticas graves, mas não nas crises epilépticas graves. As auras apresentaram frequência cardíaca basal aumentada. Um limiar de 20 por cento no aumento da frequência cardíaca pode diferenciar eventos epilépticos moderados de eventos epilépticos leves com duração maior que 30 segundos. Em crises epilépticas com atividade motora leve ou ausente, a magnitude do aumento da frequência cardíaca é proporcional à duração do evento. A análise da frequência cardíaca em crises com diferentes quantidades de movimento na fase ictal podem ajudar na diferenciação de crises epilépticas de não epilépticas.

Bilateral nephrectomy delays gastric emptying of a liquid meal in awake rats.

AIMS: This study evaluates the effect of bilateral nephrectomy on the gastric emptying of a liquid meal. METHODS: Male rats were submitted under anesthesia to cervical vessels cannulation and bilateral lumbar incision, followed or not by nephrectomy. Next day, they were gavage fed (1.5 mL) with phenol red (0.5gmL(-1)) in 5% glucose solution and sacrificed 0,10, 20,30 or 45 min later. A blood sample was obtained for biochemical analysis while gastric dye retention was determined by spectrophotometry. Data (mean +/- SEM) were compared by ANOVA and Student-Newman-Keuls tests. RESULTS: Gastric emptying values from nephrectomy group at 10,20,30 and 45 min were lower (P < 0.05) than those of sham-operated animals (22.0 +/- 4.0 vs. 38.9 +/- 6.1%, 34.1 +/- 1.4 vs. 66.9 +/- 1.3%, 45.5 +/- 6.1 vs. 64.9 +/- 5.4% and 59.7 +/- 2.4 vs. 81.5 +/- 4.0%, respectively). Mean arterial pressure, blood volume, serum osmolarity, urea, creatinine and potassium values were higher (P < 0.05) in nephrectomy group than in sham-operated animals (143.3 +/- 2.7 vs. 100.5 +/- 4.1 mmHg, 15.7 +/- 0.9 vs. 8.9 +/- 1.1 mL 100 g(-1), 344.0 +/- 10.8 vs. 299.4 +/- 1.3 mOsm KgH2O(-1), 344.0 +/- 33.7 vs. 47.0 +/- 2.8mg dL(-1), 3.6 +/- 0.3 vs. 1.1 +/- 0.1 mg dL(-1), 6.4 +/- 0.7 vs. 3.7 +/- 0.2 mEq L(-1), respectively). The plasmatic Na+ values did not change (139.3 +/- 2.0 in sham-operation vs. 123.0 +/- 7.5 mEq L(-1) in nephrectomy). CONCLUSION: Acute loss of kidney function markedly delays the gastric emptying rates, which could be involved in gastrointestinal dysmotility complaints seen after renal failure.

Heart rate analysis differentiates dialeptic complex partial temporal lobe seizures from auras and non-epileptic seizures

The distinction of non-epileptic from epileptic events is difficult even for experienced neurologists. We retrospectively evaluated 59 dialeptic events from 27 patients admitted for video EEG monitoring to check whether heart rate (HR) analysis could help in differentiating dialeptic complex partial temporal lobe seizures (TLS) from dialeptic simple partial TLS, and non-epileptic dialeptic events. Baseline HR was increased in the simple partial TLS in comparison to complex partial TLS and non-epileptic groups (p<0.05). HR increase accompanied each individual dialeptic complex partial TLS (100 percent of the events, p<0.05) bur HR returned to baseline in the post-ictal phase. Ictal HR was not altered in the non-epileptic or simple partial TLS groups. Our findings suggest that ictal centrally mediated tachycardia is characteristic of dialeptic TLS (both tachycardia and bradycardia have been reported during TLS). This finding may be used as a criterion to distinguish dialeptic complex partial TLS from simple partial and non-epileptic dialeptic events.

A distinção entre eventos não epilépticos de epilépticos é difícil mesmo para neurologistas experientes. Analisamos 59 eventos dialéticos de 27 pacientes internados para monitorização por video-EEG para checar se a análise da frequência cardíaca (FC) poderia auxiliar na diferenciação de crises dialépticas parciais complexas de crises dialépticas parciais simples e eventos dialépticos não epilépticos. A freqüência cardíaca basal estava aumentada nos pacientes com crises parciais simples em comparação com o período basal dos grupos parcial complexa e não epiléptico (p<0,05). Houve aumento da freqüência cardíaca em cada crise dialéptica parcial complexa (100 por cento dos eventos, p<0,05), mas a FC retornou aos níveis basais na fase pós-ictal. A FC ictal não foi alterada nos grupos de crises não epiléticas e nos pacientes com crises parciais simples. Nossos achados sugerem que a taquicardia ictal com mediação central é característica de crises parciais complexas dialépticas (tanto taquicardia quanto bradicardia têm sido relatados durante crises temporais parciais complexas). Tal achado poderá ser utilizado como critério para diferenciar crises dialépticas parciais complexas de crises dialépticas parciais simples e eventos dialépticos não epilépticos.