Autoantibodies to glutamic acid decarboxylase in palatal myoclonus and epilepsy.

We report the presence of serum autoantibodies directed against glutamic acid decarboxylase in a patient with epilepsy and palatal myoclonus not associated with brain lesions. Glutamic acid decarboxylase antibody reactivity was dependent on the presence of carboxy-terminal amino acids, similar to that reported in patients with stiff-man syndrome. Marked reduction in the frequency of epileptic attacks and improvement in palatal myoclonus occurred when benzodiazepine was administered and phenytoin was gradually tapered. Testing for anti-glutamic acid decarboxylase antibodies may be indicated in patients with palatal myoclonus and with convulsive disorders refractory to therapy.

Spectral analysis of heart rate variability signal and respiration in diabetic subjects.

The paper deals with methods of processing ECG and respiration signals which aim at detecting parameters whose values may be correlated to normal and diabetic subjects with or without cardiovascular autonomic neuropathy (CAN). Beat-to-beat R-R duration values of the ECG and discrete series of respiration are obtained from original signals using a recognition algorithm. Power spectrum analysis (autospectra, cross-spectra and coherence via autoregressive modelling) is carried out on segments of about 200 consecutive cardiac cycles. Spectral parameters of the R-R variability signal are obtained as follows: total power, powers of low-frequency (LF) and high-frequency (HF) components, power of the signal which is (or is not) coherent with respiration, in absolute or in percentage values. The experimental protocol considers 40 diabetic patients (21 of whom have diabetic neuropathy) and 14 normals in three different conditions: resting, standing and controlled respiration. The developed spectral parameters seem sensitive enough to differentiate between normal and pathological subjects. These parameters may constitute a quantitative means to be added to the classical diabetic tests for the diagnosis of cardiovascular autonomic neuropathy.

Reproducibility of cardiovascular autonomic tests in diabetics with and without autonomic dysfunction and in normal controls.

The present study evaluates the reproducibility of five cardiovascular reflex tests, deep breathing (DB), Valsalva maneuver (VM), sustained hand-grip (SHG), postural hypotension (PH) and lying to standing (LS) in normal subjects and in insulin dependent (type I) diabetic patients. The study was carried out in 10 normal subjects, in 10 diabetics with autonomic neuropathy and in 10 diabetics without autonomic neuropathy. The five cardiovascular reflex tests were performed five times on five consecutive days by the same investigator and in identical basal conditions. The intraindividual variability of DB, LS and VM was significantly reduced in diabetics with autonomic neuropathy compared with normal controls, but there was no difference between diabetics without neuropathy and normal controls. The intraindividual variability of PH was significantly increased in diabetics with autonomic neuropathy compared with diabetics without autonomic neuropathy and with normal controls. There was no difference among the three groups in the reproducibility of SHG. In normal subjects the intraindividual variability only exceptionally produced a shift from normal to abnormal values or vice versa; in diabetics with autonomic neuropathy this shift was more frequent.