Sleep-wake disturbances in sporadic Creutzfeldt-Jakob disease.

BACKGROUND: The prevalence and characteristics of sleep-wake disturbances in sporadic Creutzfeldt-Jakob disease (sCJD) are poorly understood. METHODS: Seven consecutive patients with definite sCJD underwent a systematic assessment of sleep-wake disturbances, including clinical history, video-polysomnography, and actigraphy. Extent and distribution of neurodegeneration was estimated by brain autopsy in six patients. Western blot analyses enabling classification and quantification of the protease-resistant isoform of the prion protein, PrPSc, in thalamus and occipital cortex was available in four patients. RESULTS: Sleep-wake symptoms were observed in all patients, and were prominent in four of them. All patients had severe sleep EEG abnormalities with loss of sleep spindles, very low sleep efficiency, and virtual absence of REM sleep. The correlation between different methods to assess sleep-wake functions (history, polysomnography, actigraphy, videography) was generally poor. Brain autopsy revealed prominent changes in cortical areas, but only mild changes in the thalamus. No mutation of the PRNP gene was found. CONCLUSIONS: This study demonstrates in sporadic Creutzfeldt-Jakob disease, first, the existence of sleep-wake disturbances similar to those reported in fatal familial insomnia in the absence of prominent and isolated thalamic neuronal loss, and second, the need of a multimodal approach for the unambiguous assessment of sleep-wake functions in these patients.

Brain sources of EEG gamma frequency during volitionally meditation-induced, altered states of consciousness, and experience of the self.

Multichannel EEG of an advanced meditator was recorded during four different, repeated meditations. Locations of intracerebral source gravity centers as well as Low Resolution Electromagnetic Tomography (LORETA) functional images of the EEG 'gamma' (35-44 Hz) frequency band activity differed significantly between meditations. Thus, during volitionally self-initiated, altered states of consciousness that were associated with different subjective meditation states, different brain neuronal populations were active. The brain areas predominantly involved during the self-induced meditation states aiming at visualization (right posterior) and verbalization (left central) agreed with known brain functional neuroanatomy. The brain areas involved in the self-induced, meditational dissolution and reconstitution of the experience of the self (right fronto-temporal) are discussed in the context of neural substrates implicated in normal self-representation and reality testing, as well as in depersonalization disorders and detachment from self after brain lesions.

Effects of medial thalamotomy and pallido-thalamic tractotomy on sleep and waking EEG in pain and Parkinsonian patients.

OBJECTIVES: Investigation of sleep and sleep EEG before and after stereotactic neurosurgery. METHODS: All-night polysomnographic recordings were obtained in 3 neurogenic pain patients and 3 parkinsonian patients. One subject of each group was recorded in addition 3 months after surgery. Stereotactic operations were performed in the medial thalamus and on the pallido-thalamic tract to relieve neurogenic pain and parkinsonian symptoms, respectively. RESULTS: Sleep efficiency was little affected by the surgical intervention in neurogenic pain patients and a dramatic reduction in REM sleep occurred, which had recovered in the subject recorded after 3 months. After the surgery parkinsonian patients showed an increase in total sleep time and in sleep efficiency, and a decrease in REM sleep latency. Sleep efficiency remained elevated in the 3 months follow-up. Medial thalamotomy abolished spindle frequency activity (SFA) in the power and coherence spectra in non-REM sleep stage 2 systematically. Pallido-thalamic tractotomy attenuated SFA only to varying degrees. After 3 months SFA had reemerged. The alpha peak of the waking EEG was shifted to lower frequencies after surgery in 5 of 6 patients and had reverted to the original frequency 3 months later. CONCLUSIONS: Medial thalamotomy or pallido-thalamic tractotomy had acute and reversible effects on the EEG and long-term deleterious side effects of stereotactic surgery on sleep and sleep EEG are improbable. The results provide further evidence for the involvement of the human thalamus in the generation of sleep spindles.

Spindle frequency activity in the sleep EEG: individual differences and topographic distribution.

The brain topography of EEG power spectra in the frequency range of sleep spindles was investigated in 34 sleep recordings from 20 healthy young men. Referential (F3-A2, C3-A2, P3-A2 and O1-A2) and bipolar derivations (F3-C3, C3-P3 and P3-O1) along the anteroposterior axis were used. Sleep spindles gave rise to a distinct peak in the EEG power spectrum. The distribution of the peak frequencies pooled over subjects and derivations showed a bimodal pattern with modes at 11.5 and 13.0 Hz, and a trough at 12.25 Hz. The large inter-subject variation in peak frequency (range: 1.25 Hz) contrasted with the small intra-subject variation between derivations, non-REM sleep episodes and different nights. In some individuals and/or some derivations, only a single spindle peak was present. The topographic distributions from referential and bipolar recordings showed differences. The power showed a declining trend over consecutive non-REM sleep episodes in the low range of spindle frequency activity and a rising trend in the high range. The functional and topographic heterogeneity of sleep spindles in conjunction with the intra-subject stability of their frequency are important characteristics for the analysis of sleep regulation on the basis of the EEG.

Low-frequency (< 1 Hz) oscillations in the human sleep electroencephalogram.

Low-frequency (< 1 Hz) oscillations in intracellular recordings from cortical neurons were first reported in the anaesthetized cat and then also during natural sleep. The slow sequences of hyperpolarization and depolarization were reflected by slow oscillations in the electroencephalogram. The aim of the present study was to examine whether comparable low-frequency components are present in the human sleep electroencephalogram. All-night sleep recordings from eight healthy young men were subjected to spectral analysis in which the low-frequency attenuation of the amplifier was compensated. During sleep stages with a predominance of slow waves and in the first two episodes of non-rapid-eye-movement sleep, the mean power spectrum showed a peak at 0.7-0.8 Hz (range 0.55-0.95 Hz). The typical decline in delta activity from the first to the second non-rapid-eye-movement sleep episode was not present at frequencies below 2 Hz. To detect very low frequency components in the pattern of slow waves and sleep spindles, a new time series was computed from the mean voltage of successive 0.5 s epochs of the low-pass (< 4.5 Hz) or band-pass (12-15 Hz) filtered electroencephalogram. Spectral analysis revealed a periodicity of 20-30 s in the prevalence of slow waves and a periodicity of 4 s in the occurrence of activity in the spindle frequency range. The results demonstrate that distinct components below 1 Hz are also present in the human sleep electroencephalogram spectrum. The differences in the dynamics between the component with a mean peak value at 0.7-0.8 Hz and delta waves above 2 Hz is in accordance with results from animal experiments.

Brain topography of the human sleep EEG: antero-posterior shifts of spectral power.

To investigate the brain topography of the human sleep EEG along the antero-posterior axis, spectra (0.25-25 Hz; 1 Hz bins) were computed from all-night EEG recordings (n = 20 subjects) obtained from an anterior F3-C3) and a posterior (P3-O1) derivation. State-dependent and frequency-dependent topographic differences were observed. In non-rapid eye movement (REM) sleep, power in the anterior derivation was higher than in the posterior derivation in the 2 Hz bin, and lower in the 4-10 Hz bins. In REM sleep, a posterior dominance was present in most bins below 18 Hz. The 2-6 Hz bins exhibited an antero-posterior shift of power over consecutive non-REM sleep episodes. Consistent shifts of power were also present within non-REM sleep episodes. The results suggest that anterior and posterior cortical regions may be differently involved in the sleep process.

Simulation of human sleep: ultradian dynamics of electroencephalographic slow-wave activity.

The typical declining trend of electroencephalographic (EEG) slow-wave activity (SWA) within a sleep period is represented in the two-process model of sleep regulation by an exponentially decaying process (Process S). The model has been further elaborated to simulate not only the global changes of SWA, but also the dynamics within non-rapid-eye-movement (non-REM) sleep episodes. In this new model, the initial intraepisodic buildup of SWA is determined by the combined action of an exponentially increasing process and a saturation process, whereas its fall at the end of an episode is due to an exponentially decreasing process. The global declining trend of SWA over consecutive episodes results from the monotonic decay of the intraepisodic saturation level. In contrast to Process S in the two-process model, this decay is not represented by an exponential function, but is proportional to the momentary level of SWA. REM sleep episodes are triggered by an external function. The model allows one to simulate the ultradian pattern of SWA for baseline nights as well as changes induced by a prolonged waking period, a daytime nap, a partial slow-wave sleep deprivation, or an antidepressant drug.