Neuropathy and primary headaches affect different subgroups of inflammatory bowel disease patients.

BACKGROUND: Peripheral neuropathies (PN) and primary headaches (PH) are common comorbidities in inflammatory bowel disease (IBD) patients. We aimed to evaluate whether PN and PH affect the same subgroups of IBD patients. METHODS: Since 2004, we established a cohort study to evaluate neurological diseases in IBD patients. Over 2 years, all consecutive (N = 155) IBD patients (either Crohn's disease (CD) or ulcerative colitis (UC) were evaluated for the presence of PN and PH. PH were also evaluated in dyspeptic patients (N = 84) and IBD relatives (controls, N = 101). After neurological evaluation, symptomatic patients underwent skin wrinkling test to evaluate small fiber function and/or electromyography. RESULTS: Headaches and migraine were more prevalent in IBD than control patients: 52.3 and 34.2% vs. 40.6 and 20.8% (P < 0.05). Migraine was 2.6 times more common in CD patients than controls (CI = 1.34-5.129) and 8.6 times (13.3 times in the CD group) more common in men with IBD (P < 0.05). Headache and migraine were also more common in dyspeptic patients (P < 0.05). Chi-square, univariate, and multivariate regression analysis did not disclose any association between PN, headache, or PH (P > 0.05). Multivariate regression analysis disclosed that headaches were more prevalent in women, co-existing psychiatric disease, IBD, CD, and UC. After age, gender distribution, and prevalence of hypertension and psychiatric diseases were matched among the groups, there were still differences in the prevalence of headaches and migraine among IBD, CD, and UC versus control patients. CONCLUSION: In summary, PH and PN are common in IBD and do not affect the same subgroups of patients.

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.

Two patients with co-morbid myasthenia gravis in a Brazilian cohort of inflammatory bowel disease.

Co-morbid auto-immune disorders may affect 0.2% of the population. We present the clinical and electrodiagnostic findings of 2 patients with inflammatory bowel disease and myasthenia gravis from a Brazilian cohort of 218 inflammatory bowel disease patients. Patient 1: A 40year-old man was diagnosed with ulcerative colitis at age 37 and underwent total colectomy 3years later. After prednisone was tapered, he experienced a clinical relapse and was diagnosed with Crohn's disease. He then developed quadriparesis, bilateral ptosis, dysphagia and dysarthria. Patient 2: A 41year-old woman (diagnosed with ulcerative colitis and primary sclerosing cholangitis at age 35) developed speech impairment and ptosis. On both patients, symptoms quickly progressed over few weeks. Myasthenia gravis was diagnosed and confirmed by abnormal repetitive nerve stimulation and elevated anti-acetylcholine receptor antibody titers. Pyridostigmine and prednisone successfully treated both patients. Myasthenia gravis prevalence over 9years was 0.9%. Myasthenia gravis clinical course was not significantly modified by inflammatory bowel disease relapses and should be suspected with new onset weakness.

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.

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.

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.

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.