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1.
Neurodiagn J ; 60(3): 195-207, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33006508

RESUMO

Since 1995, ASET has periodically published updates to recommendations for best practices in infection prevention for Neurodiagnostic technologists. The latest installment was accepted in December 2019 for publication in Volume 60, Issue 1, before we had much knowledge or understanding about the SARS-CoV-2, the virus that causes COVID-19. This Technical Tips article is presented as an addendum to the 2020 update and includes important information about infection prevention measures specific to procedure protocols when working with patients positive or under investigation for a highly infectious disease, and when working with patients in general during the current pandemic. All Neurodiagnostic technologists who have direct patient care are responsible for ensuring the use of best practices to prevent the spread of infection.


Assuntos
Infecções por Coronavirus/prevenção & controle , Eletroencefalografia/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pessoal Técnico de Saúde , Betacoronavirus , Técnicas de Diagnóstico Neurológico/instrumentação , Desinfecção/métodos , Eletroencefalografia/instrumentação , Contaminação de Equipamentos , Humanos , Polissonografia/instrumentação , Polissonografia/métodos
2.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012721

RESUMO

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Assuntos
Antipsicóticos/efeitos adversos , Betacoronavirus , Clozapina/efeitos adversos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Psicóticos/tratamento farmacológico , Estado Epiléptico/etiologia , Clozapina/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Estado Epiléptico/fisiopatologia
3.
Nat Commun ; 11(1): 4683, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943621

RESUMO

Wearable dry electrodes are needed for long-term biopotential recordings but are limited by their imperfect compliance with the skin, especially during body movements and sweat secretions, resulting in high interfacial impedance and motion artifacts. Herein, we report an intrinsically conductive polymer dry electrode with excellent self-adhesiveness, stretchability, and conductivity. It shows much lower skin-contact impedance and noise in static and dynamic measurement than the current dry electrodes and standard gel electrodes, enabling to acquire high-quality electrocardiogram (ECG), electromyogram (EMG) and electroencephalogram (EEG) signals in various conditions such as dry and wet skin and during body movement. Hence, this dry electrode can be used for long-term healthcare monitoring in complex daily conditions. We further investigated the capabilities of this electrode in a clinical setting and realized its ability to detect the arrhythmia features of atrial fibrillation accurately, and quantify muscle activity during deep tendon reflex testing and contraction against resistance.


Assuntos
Condutividade Elétrica , Epiderme , Monitorização Fisiológica/instrumentação , Movimento (Física) , Pele , Artefatos , Impedância Elétrica , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrodos , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Eletromiografia/instrumentação , Eletromiografia/métodos , Desenho de Equipamento , Humanos , Monitorização Fisiológica/métodos , Polímeros/química , Sorbitol
4.
PLoS One ; 15(8): e0238221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866181

RESUMO

After perceiving cognitive conflicts or errors, children as well as adults adjust their performance in terms of reaction time slowing on subsequent actions, resulting in the so called post-conflict slowing and post-error slowing, respectively. The development of these phenomena has been studied separately and with different methods yielding inconsistent findings. We aimed to assess the temporal dynamics of these two slowing phenomena within a single behavioral task. To do so, 9-13-year-old children and young adults performed a Simon task in which every fifth trial was incongruent and thus induced cognitive conflict and, frequently, also errors. We compared the reaction times on four trials following a conflict or an error. Both age groups slowed down after conflicts and did so even more strongly after errors. Disproportionally high reaction times on the first post-error trial were followed by a steady flattening of the slowing. Generally, children slowed down more than adults. In addition to highlighting the phenomenal and developmental robustness of post-conflict and post-error slowing these findings strongly suggest increasingly efficient performance adjustment through fine-tuning of cognitive control in the course of development.


Assuntos
Cognição/fisiologia , Desempenho Psicomotor/fisiologia , Adaptação Psicológica/fisiologia , Adolescente , Adulto , Criança , Conflito Psicológico , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Tempo de Reação/fisiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 99(36): e22052, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899066

RESUMO

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ±â€Š11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/terapia , Corpo Caloso/patologia , Músculos Paraespinais/diagnóstico por imagem , Adulto , Encefalopatias/sangue , Encefalopatias/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/metabolismo , Líquido Cefalorraquidiano/fisiologia , Pressão do Líquido Cefalorraquidiano , Eletroencefalografia/métodos , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Músculos Paraespinais/patologia , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/etiologia , Sódio/sangue , Síndrome , Resultado do Tratamento , Vertigem/tratamento farmacológico , Vertigem/etiologia
6.
Lancet Child Adolesc Health ; 4(10): 740-749, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32861271

RESUMO

BACKGROUND: Despite the availability of continuous conventional electroencephalography (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical practice. Algorithms for decision support in the recognition of neonatal seizures could improve detection. We aimed to assess the diagnostic accuracy of an automated seizure detection algorithm called Algorithm for Neonatal Seizure Recognition (ANSeR). METHODS: This multicentre, randomised, two-arm, parallel, controlled trial was done in eight neonatal centres across Ireland, the Netherlands, Sweden, and the UK. Neonates with a corrected gestational age between 36 and 44 weeks with, or at significant risk of, seizures requiring EEG monitoring, received cEEG plus ANSeR linked to the EEG monitor displaying a seizure probability trend in real time (algorithm group) or cEEG monitoring alone (non-algorithm group). The primary outcome was diagnostic accuracy (sensitivity, specificity, and false detection rate) of health-care professionals to identify neonates with electrographic seizures and seizure hours with and without the support of the ANSeR algorithm. Neonates with data on the outcome of interest were included in the analysis. This study is registered with ClinicalTrials.gov, NCT02431780. FINDINGS: Between Feb 13, 2015, and Feb 7, 2017, 132 neonates were randomly assigned to the algorithm group and 132 to the non-algorithm group. Six neonates were excluded (four from the algorithm group and two from the non-algorithm group). Electrographic seizures were present in 32 (25·0%) of 128 neonates in the algorithm group and 38 (29·2%) of 130 neonates in the non-algorithm group. For recognition of neonates with electrographic seizures, sensitivity was 81·3% (95% CI 66·7-93·3) in the algorithm group and 89·5% (78·4-97·5) in the non-algorithm group; specificity was 84·4% (95% CI 76·9-91·0) in the algorithm group and 89·1% (82·5-94·7) in the non-algorithm group; and the false detection rate was 36·6% (95% CI 22·7-52·1) in the algorithm group and 22·7% (11·6-35·9) in the non-algorithm group. We identified 659 h in which seizures occurred (seizure hours): 268 h in the algorithm versus 391 h in the non-algorithm group. The percentage of seizure hours correctly identified was higher in the algorithm group than in the non-algorithm group (177 [66·0%; 95% CI 53·8-77·3] of 268 h vs 177 [45·3%; 34·5-58·3] of 391 h; difference 20·8% [3·6-37·1]). No significant differences were seen in the percentage of neonates with seizures given at least one inappropriate antiseizure medication (37·5% [95% CI 25·0 to 56·3] vs 31·6% [21·1 to 47·4]; difference 5·9% [-14·0 to 26·3]). INTERPRETATION: ANSeR, a machine-learning algorithm, is safe and able to accurately detect neonatal seizures. Although the algorithm did not enhance identification of individual neonates with seizures beyond conventional EEG, recognition of seizure hours was improved with use of ANSeR. The benefit might be greater in less experienced centres, but further study is required. FUNDING: Wellcome Trust, Science Foundation Ireland, and Nihon Kohden.


Assuntos
Algoritmos , Eletroencefalografia/métodos , Aprendizado de Máquina/estatística & dados numéricos , Monitorização Fisiológica/métodos , Convulsões/diagnóstico , Eletroencefalografia/normas , Humanos , Lactente , Terapia Intensiva Neonatal , Irlanda , Monitorização Fisiológica/normas , Países Baixos , Convulsões/prevenção & controle , Suécia , Reino Unido
7.
Med. intensiva (Madr., Ed. impr.) ; 44(5): 301-309, jun.-jul. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193190

RESUMO

La monitorización es crucial en el cuidado del paciente crítico. Detecta disfunciones orgánicas y provee orientación en el abordaje terapéutico. Los intensivistas monitorizan habitualmente la función de varios sistemas orgánicos y el cerebro no es la excepción. La monitorización EEG continuo es una vía no invasiva e ininterrumpida para valorar la actividad eléctrica cortical con aceptable resolución espacial y excelente resolución temporal. La efectividad diagnóstica del estado epiléptico no convulsivo como causa de compromiso de la consciencia no explicable por otras causas se ha incrementado con el empleo del EEG continuo; sin embargo, no es la única indicación para valorar la actividad eléctrica cortical cerebral. Este manuscrito intenta resumir las indicaciones, modos de empleo y metodología para el empleo del monitoreo electroencefalográfico continuo en la unidad de cuidados intensivos con la finalidad que el intensivista se familiarice con el mismo


Monitoring is a crucial part of the care of the critically ill patient. It detects organ dysfunction and provides guidance on the therapeutic approach. Intensivists closely monitor the function of various organ systems, and the brain is no exception. Continuous EEG monitoring is a noninvasive and uninterrupted way of assessing cerebral cortical activity with good spatial and excellent temporal resolution. The diagnostic effectiveness of non-convulsive status epilepticus as a cause of unexplained consciousness disorder has increased the use of continuous EEG monitoring in the neurocritical care setting. However, non-convulsive status epilepticus is not the only indication for the assessment of cerebral cortical activity. This study summarizes the indications, usage and methodology of continuous EEG monitoring in the intensive care unit, with the aim of allowing practitioners to become familiarized the technique


Assuntos
Humanos , Eletroencefalografia/métodos , Cuidados Críticos , Isquemia Encefálica/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Ondas Encefálicas/efeitos da radiação , Isquemia Encefálica/fisiopatologia , Sedação Profunda , Morte Encefálica/diagnóstico por imagem
9.
Neurology ; 95(6): e637-e642, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32636329

RESUMO

OBJECTIVE: To study neural networks involved in hyperkinetic seizures (HKS) using ictal SPECT. METHODS: We retrospectively identified 18 patients with HKS evaluated at the Cleveland Clinic between 2005 and 2015 with video-EEG monitoring and ictal SPECT. Semiology was confirmed by the consensus of 2 epileptologists' independent reviews and classified as type 1, 2, or 3 HKS. SPECT data were analyzed by 2 independent physicians using a z score of 1.5. Ictal hyperperfusion patterns for each group were analyzed visually and with SPM. Spatial normalization to Montreal Neurological Institute space for each patient's data was performed, followed by flipping of data from patients with left-sided ictal onset to the right side. Finally, an average z score map for each group was calculated. RESULTS: Visual analysis and SPM identified different patterns of ictal hyperperfusion in the 3 subtypes of HKS. Type 1 seizures showed hyperperfusion in a more anteriorly located network involving the anterior insula, orbitofrontal cortex, cingulate, and anterior perisylvian region and rostral midbrain. Type 2 seizures were associated with hyperperfusion in a more caudally located network involving the orbitofrontal cortex, cingulate (middle and posterior), basal ganglia, thalami, and cerebellum. Type 3 seizures showed a mixed pattern of SPECT hyperperfusion involving the temporal pole and anterior perisylvian region. CONCLUSIONS: Each of the 3 different semiologic subtypes of HKS is associated with distinct patterns of hyperperfusion, providing further insight into the neural networks involved. This knowledge may inform placement of invasive EEG electrodes in patients with HKS semiology undergoing presurgical evaluation.


Assuntos
Epilepsia Motora Parcial/diagnóstico por imagem , Hipercinese/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adolescente , Adulto , Mapeamento Encefálico , Circulação Cerebrovascular , Criança , Dominância Cerebral , Eletroencefalografia/métodos , Epilepsia Motora Parcial/classificação , Epilepsia Motora Parcial/fisiopatologia , Feminino , Humanos , Hipercinese/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Gravação em Vídeo/métodos , Adulto Jovem
10.
Br J Anaesth ; 125(3): 291-297, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32682555

RESUMO

BACKGROUND: Cardiac surgery has one of the highest incidences of intraoperative awareness. The periods of initiation and discontinuation of cardiopulmonary bypass could be high-risk periods. Certain frontal EEG patterns might plausibly occur with unintended intraoperative awareness. This study sought to quantify the incidence of these pre-specified patterns during cardiac surgery. METHODS: Two-channel bihemispheric frontal EEG was recorded in 1072 patients undergoing cardiac surgery as part of a prospective observational study. Spectrograms were created, and mean theta (4-7 Hz) power and peak alpha (7-17 Hz) frequency were measured in patients under general anaesthesia with isoflurane. Emergence-like EEG activity in the spectrogram during surgery was classified as an alpha peak frequency increase by 2 Hz or more, and a theta power decrease by 5 dB or more in comparison with the median pre-bypass values. RESULTS: Data from 1002 patients were available for analysis. Fifty-five of those patients (5.5%) showed emergence-like EEG activity at least once during surgery with a median duration of 13.2 min. These patients were younger (median age, 59 vs 67 yr; P<0.001) and the median end-tidal isoflurane concentration before cardiopulmonary bypass was higher (0.82 vs 0.75 minimum alveolar concentration [MAC]; P=0.013). There was no significant difference between those with or without emergence-like EEG activity in sex, lowest core temperature, or duration of surgery. Forty-six of these EEG changes (84%) occurred within a 1 h time window centred on separation from cardiopulmonary bypass. CONCLUSION: The findings of this study suggest that approximately one in 20 patients undergoing cardiac surgery with a volatile anaesthetic agent have a sustained EEG pattern while surgery is ongoing that is often seen with emergence from general anaesthesia. Monitoring the frontal EEG during cardiopulmonary bypass may identify these events and potentially reduce the incidence of unintended awareness. CLINICAL TRIAL REGISTRATION: NCT02976584.


Assuntos
Anestesia Geral/métodos , Encéfalo/fisiologia , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Eletroencefalografia/métodos , Consciência no Peroperatório/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Período de Recuperação da Anestesia , Encéfalo/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
11.
PLoS One ; 15(7): e0235309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614860

RESUMO

Recent researches revealed that the EEG component caused by the flickering visual stimulus, which is called steady-state visually evoked potential (SSVEP), might be a potential index for object recognition. This study examined whether SSVEP reflects different states during object recognition. In one trial, a binary image (BI), which is difficult to recognize, was followed by a grayscale image (GI) of the same object as the answer. Both BI and GI were presented in a flickering manner at a frequency of 7.5 Hz. Participants were first asked to answer whether they could recognize BI. Then, after GI was shown, participants were requested to answer whether they recognized it. We analyzed the evoked and induced component of SSVEPs from the two recognition conditions. As a result, the SSVEPs to BI were significantly larger than that to GI. In addition, induced component to GI after the BI was unrecognized was smaller than after the BI was recognized. The present data provide evidence that SSVEPs reflect a transition of cognitive state to ambiguous figures is reflected.


Assuntos
Eletroencefalografia/métodos , Potenciais Evocados Visuais , Reconhecimento Visual de Modelos/fisiologia , Estimulação Luminosa/métodos , Córtex Visual/fisiologia , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
14.
Br J Anaesth ; 125(1): 55-66, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499013

RESUMO

BACKGROUND: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium. METHODS: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate. RESULTS: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2=0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001). CONCLUSIONS: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium. CLINICAL TRIAL REGISTRATION: NCT03124303, NCT02926417.


Assuntos
Encéfalo/fisiopatologia , Delírio/diagnóstico , Delírio/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Citocinas/sangue , Delírio/sangue , Imagem de Tensor de Difusão/métodos , Eletroencefalografia/métodos , Humanos , Complicações Pós-Operatórias/sangue
15.
Ideggyogy Sz ; 73(05-06): 177-184, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579307

RESUMO

Background and purpose: We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Methods: Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. Results: In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet-ween 2005 and 2018, with various clinical presentations. Conclusion: CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.


Assuntos
Encéfalo/diagnóstico por imagem , Síndrome de Creutzfeldt-Jakob/diagnóstico , Eletroencefalografia/métodos , Líquido Cefalorraquidiano , Disfunção Cognitiva/etiologia , Síndrome de Creutzfeldt-Jakob/líquido cefalorraquidiano , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética/métodos , Turquia
16.
PLoS One ; 15(6): e0232381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584818

RESUMO

Alphaviruses such as Venezuelan equine encephalitis virus (VEEV) and Eastern equine encephalitis virus (EEEV) are arboviruses that can cause severe zoonotic disease in humans. Both VEEV and EEEV are highly infectious when aerosolized and can be used as biological weapons. Vaccines and therapeutics are urgently needed, but efficacy determination requires animal models. The cynomolgus macaque (Macaca fascicularis) provides a relevant model of human disease, but questions remain whether vaccines or therapeutics can mitigate CNS infection or disease in this model. The documentation of alphavirus encephalitis in animals relies on traditional physiological biomarkers and behavioral/neurological observations by veterinary staff; quantitative measurements such as electroencephalography (EEG) and intracranial pressure (ICP) can recapitulate underlying encephalitic processes. We detail a telemetry implantation method suitable for continuous monitoring of both EEG and ICP in awake macaques, as well as methods for collection and analysis of such data. We sought to evaluate whether changes in EEG/ICP suggestive of CNS penetration by virus would be seen after aerosol exposure of naïve macaques to VEEV IC INH9813 or EEEV V105 strains compared to mock-infection in a cohort of twelve adult cynomolgus macaques. Data collection ran continuously from at least four days preceding aerosol exposure and up to 50 days thereafter. EEG signals were processed into frequency spectrum bands (delta: [0.4 - 4Hz); theta: [4 - 8Hz); alpha: [8-12Hz); beta: [12-30] Hz) and assessed for viral encephalitis-associated changes against robust background circadian variation while ICP data was assessed for signal fidelity, circadian variability, and for meaningful differences during encephalitis. Results indicated differences in delta, alpha, and beta band magnitude in infected macaques, disrupted circadian rhythm, and proportional increases in ICP in response to alphavirus infection. This novel enhancement of the cynomolgus macaque model offers utility for timely determination of onset, severity, and resolution of encephalitic disease and for the evaluation of vaccine and therapeutic candidates.


Assuntos
Infecções por Alphavirus/patologia , Encéfalo/fisiologia , Encefalite Viral/patologia , Pressão Intracraniana/fisiologia , Alphavirus/isolamento & purificação , Alphavirus/patogenicidade , Infecções por Alphavirus/metabolismo , Animais , Biomarcadores/metabolismo , Ritmo Circadiano , Modelos Animais de Doenças , Eletroencefalografia/métodos , Encefalite Viral/metabolismo , Feminino , Macaca , Masculino , Índice de Gravidade de Doença , Telemetria
17.
Nat Commun ; 11(1): 3089, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32555168

RESUMO

Electroencephalogram microstates are recurrent scalp potential configurations that remain stable for around 90 ms. The dynamics of two of the four canonical classes of microstates, commonly labeled as C and D, have been suggested as a potential endophenotype for schizophrenia. For endophenotypes, unaffected relatives of patients must show abnormalities compared to controls. Here, we examined microstate dynamics in resting-state recordings of unaffected siblings of patients with schizophrenia, patients with schizophrenia, healthy controls, and patients with first episodes of psychosis (FEP). Patients with schizophrenia and their siblings showed increased presence of microstate class C and decreased presence of microstate class D compared to controls. No difference was found between FEP and chronic patients. Our findings suggest that the dynamics of microstate classes C and D are a candidate endophenotype for schizophrenia.


Assuntos
Eletroencefalografia/métodos , Esquizofrenia/patologia , Endofenótipos , Feminino , Humanos , Masculino , Transtornos Psicóticos/patologia
19.
Neurol Sci ; 41(8): 1999-2004, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32588368

RESUMO

OBJECTIVE: During the Covid-19 pandemic, government restrictions limited health care to urgent needs. Neurophysiology centers had to suddenly reschedule their activities, with a lack of specific recommendations about electroencephalography (EEG) execution. During the pandemic phase 1, we launched an online survey to understand the flaws and strengths of the EEG management in Italy at the time of Covid-19 pandemic. METHODS: A 45-item online survey (published from April 16 to 30, 2020), endorsed by the Italian Society of Clinical Neurophysiology (SINC), the Italian League Against epilepsy (LICE), and the Italian Association of Neurophysiology technologists (AITN), collected EEG management data (EEG's number and type, indications, personnel and patients safety, devices' sanification) during the Covid-19 pandemic. RESULTS: We received responses from 206 centers. The number of EEGs performed was reduced by 76 ± 20%, and several types of specific EEG (video-EEG, ambulatory-EEG, LTM, polysomnography) were reduced at a minimum. Half of the centers performed inpatient EEGs only for urgencies. Repetitive seizures, encephalitis, and non-convulsive status epilepticus were the most common indications. Covid-19-positive patients received less EEG than negative ones (p < 0.0001). EEG requests came mainly not only from neurologists (n = 176) but also from general practitioners (n = 40), emergentists (n = 79), intensivists (n = 72), and other specialists (n = 53). Those centers which continued performing outpatient EEG examinations were instructed to perform the EEG after a Covid-19-related symptom screening for patients and using personal protective equipment (PPE) through all the procedure. Inpatient EEGs were performed using FFP2/FFP3 masks by neurophysiology technologists in only 50% of cases. Patients executed hyperventilation only for real clinical needs, but often (56%) with a mask. CONCLUSIONS: Italian neurophysiology centers strongly adhered to government restrictions of lockdown. Some issues emerged, ranging from the evaluation of a proper indication for EEG, technical procedures of EEG recording, and protection of neurophysiology technicians.


Assuntos
Infecções por Coronavirus , Eletroencefalografia , Neurofisiologia , Pandemias , Pneumonia Viral , Quarentena , Betacoronavirus , Eletroencefalografia/métodos , Eletroencefalografia/normas , Eletroencefalografia/estatística & dados numéricos , Humanos , Itália , Neurofisiologia/métodos , Neurofisiologia/normas , Neurofisiologia/estatística & dados numéricos , Equipamento de Proteção Individual/normas , Inquéritos e Questionários
20.
Neurology ; 95(4): e335-e341, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32482841

RESUMO

OBJECTIVE: To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA). METHODS: Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge. Clinical examination included brainstem reflexes and motor activity. EEG was assessed for best background continuity, reactivity, presence of epileptiform activity, and burst suppression with identical bursts (BSIB). MRI was examined for presence of diffusion restriction or fluid-attenuated inversion recovery changes consistent with anoxic brain injury. A prediction model was developed using optimal combination of variables. RESULTS: Among 78 patients, 11 (14.1%) recovered at discharge and 6 (7.7%) had good outcome (Cerebral Performance Category < 3) at 3 months. Patients who followed commands were more likely to have pupillary and corneal reflexes, flexion or better motor response, EEG continuity and reactivity, no BSIB, and no anoxic injury on MRI. The combined EEG/MRI variable of continuous background and no anoxic changes on MRI was associated with coma recovery at hospital discharge with sensitivity 91% (95% confidence interval [CI], 0.59-1.00), specificity 99% (95% CI, 0.92-1.00), positive predictive value 91% (95% CI, 0.59-1.00), and negative predictive value 99% (95% CI, 0.92-1.00). CONCLUSIONS: EEG and MRI are complementary and identify both good and poor outcome in patients with PAM with high accuracy. An MRI should be considered in patients with myoclonus showing continuous or reactive EEGs.


Assuntos
Eletroencefalografia/métodos , Parada Cardíaca/complicações , Imagem por Ressonância Magnética/métodos , Mioclonia/diagnóstico por imagem , Mioclonia/etiologia , Adulto , Idoso , Feminino , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mioclonia/fisiopatologia , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos
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