ABSTRACT: In response to a request by Barr Laboratories to market their “emergency contraceptive” Plan B across the counter, the Food and Drug Administration (FDA) held a public hearing. Objections to the proposal included: (1) A considerable increase in tubal pregnancies following ingestion of Plan B was found in U.K., prompting a warning to physicians. Lack of medical supervision when provid
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Doi:10.1016/j.clinph.2004.08.019Clinical Neurophysiology 115 (2004) e1–e4 Annual Meeting of the Swiss Society of Clinical Neurophysiology, Basel, Schweizerische Gesellschaft fu¨r klinische Neurophysiologie/Socie´te´ Deficits of fine motor function in individuals at risk for with normal spatial memory, indicating a lesion in the left schizophrenia (confounding factors) – U. Gschwandtner, temporal region. The MRI confirmed this assumption and V. Semenin, M. Pflu¨ger, S. Borgwardt, A. Riecher-Ro¨ssler showed a tumor in the left medio-temporal region. The (Department of Psychiatry, University Hospital Basel, histological diagnosis was a benign xanthoastrocytoma. After resection of the tumor, the EEG and the verbal memory were Objective: Fine motor function deficits as risk factor for beginning psychosis were investigated with a computerised Discussion: EEG is one of the most used procedures to fine motor function testbattery and compared with healthy localize brain lesions in symptomatic seizures. Our case report demonstrates that rarely the neuropsychological dysfunctions are Methods: 44 individuals at risk for schizophrenia and 42 more sensitive to localize brain lesions. Therefore, a standar- healthy, age- and sex-matched controls were examined with the dized inclusion of neuropsychological examination in the computerised testbattery “Motorische Leistungsserie” (Schuh- fried, 1997). The tested factors were: dexterity, precision, tremor, velocity (arm/hand and wrist/fingers). The influences of age, sex,educational level, medication and cannabis use were statisticallycontrolled as confounding factors by multivariate analysis ofcovariance.
Changing autonomic moods by repeatedly listening to Results: Significant differences between individuals at risk EEG-based auditive patterns – B. Fricker (Zurich, for schizophrenia and controls were found in all above quotedfactors but remained significant after control of confounding factors only in the factors tremor (p!0.01) and dexterity (p! Auditive patterns (such as music) not only have an emotional influence on people, they also have a direct effect Conclusion: We detected fine motor function impairment in on the autonomic nervous system. Music can restore people’s individuals at risk for schizophrenia in all parameters measured by sense of well-being after a day of stress. Likewise, the impact the fine motor function testbattery. Nevertheless, with exception of of acoustic rituals for cult uses or the soothing effect of the factors tremor and dexterity, these impairments must be children’s songs and the autonomic reactions to acoustically conditioned reflexes all provide us with a number of clues tothis phenomenon. There has been a great deal of research doneon the eminent role that hearing plays from the mean age ofgestation, and people’s sense of hearing maintains this Symptomatic partial seizure: is EEG or neuropsychology capability to activate the autonomic nervous system throughout the best procedure to localize the lesion? – P. Weber, S. Jourdan, J. Lu¨tschg (Department of Neuropediatrics, This talk describes an audiocerebral method of regulation Childen’s Hospital, University of Basel, Switzerland) that works with sound patterns that can be calculated based Objective: Besides clinical symptoms EEG is one of the most upon people’s basic individual EEG activity. After intensive used procedures to localize brain lesion, frequently supplemented regular listening, we can effortlessly achieve autonomic by neuroimaging and neuropsychological examinations.
reactions while bringing about a permanent change in mood.
Case report: We report on a right-handed 7 year old girl Tests have shown a significant improvement in effects arising presenting with absence-like seizures and dysfunction in word from the person’s individual EEG as compared with random generation. The neurological examination was normal. The EEG synthetic sequences of sounds without differentiation. Finally, showed a hypersynchronic activity fronto-temporally and fronto- this method of autonomic patient self-influencing has a high parietally right-sided more than left-sided. The neuropsycholo- degree of therapy compliance without having any hazardous gical examination demonstrated a dysfunction of verbal memory Swiss Society of Clinical Neurophysiology / Clinical Neurophysiology 115 (2004) e1–e4 Pathological EEG-patterns in individuals at risk for Time-related change of amygdala response to emotional psychosis and in patients with a first episode of pychosis auditory stimulation in patients with emotional dysregula- (Basle FEPSY Study) – U. Gschwandtnera, V. Semenina, tion: a functional magnetic resonance study in borderline M. Pflu¨gera, A. Riecher-Ro¨sslera, P. Fuhrb (aDepartment personality disorder – G. Dammanna, F. Di Salleb, of Psychiatry; bDepartment of Neurology, University F. Espositoc, A. Luethid, E. Seifritza,e (aPsychiatric University Hospital, University of Basel, Switzerland; Objective: To investigate whether individuals at risk (IR) and bDivision of Neuroradiology, University of Naples Federico patients with a first episode (FE) of psychosis have EEG II, Italy; cSecond Division of Neurology, Second University of Naples, Italy; dFriedrich Miescher Institute, Basel, Methods: 73 patients (42 IR, 31 FE) from an early recognition Switzerland; eUniversity Hospital of Clinical, Psychiatry, clinic for psychosis and 29 healthy controls (HC) were investi- gated. The at risk state of the patients was assessed with a screening Borderline Personality Disorder (BPD) is associated with instrument for beginning of psychosis. The transition to psychosis altered emotional regulation. Functional magnetic resonance was evaluated by the Brief Psychiatric Rating Scale (BPRS). EEG imaging (fMRI) evidence suggests an involvement of the amygdala recording was done with 16 channels using the 10/20 system. The and associated circuits. Here we used event-related fMRI and neurologist, blinded to the subject’s group, analyzed visually the emotional auditory stimuli in a group of BPD patients and normal EEG for the presence of generalized or focal slowing and control subjects. The temporal structure of the blood-oxygen level epileptiform discharges. Statistical analysis was done with chi- dependent (BOLD) signal response was analyzed using single trial- by-trial analysis. Averaged across the entire experimental sessions, Results: IR showed more pathological EEG patterns (35.7%) as we found significantly greater BOLD signal response in the compared to the FE (29%) and as compared to HC (13.7%). In both amygdala of BPD patients than in the controls. The BPD patients groups of patients the combined pathological EEG patterns showed a uniform level of response, whereas the controls showed (slowing and epileptiform discharges) were predominant (IR rapid habituation to the stimuli. Our data support existing evidence 14.2%, FE 19.3%). Neurological standard examination was of altered amygdala responsiveness to emotional stimuli and suggest that disturbances in physiological habituation processes are Conclusion: IR, and less so FE, show a remarkable number of EEG abnormalities. Some psychiatric patients fulfilling the criteriafor being at risk or for having a first episode of psychosis maysuffer from subtle organic brain disease.
Recent technical advances of ambulatory EEG increase itsclinical I.W. Mothersill, Th. Grunwald, G. Kra¨mer (Swiss Predictive value of sleep EEG markers in long-term course of depression – M. Hatzinger, S. Brand, U. Hemmeter, Ambulatory EEG (AEEG) fills the diagnostic gap between B. Annen, E. Holsboer-Trachsler (Psychiatric University routine EEG and cost-intensive, continuous EEG/Video monitor- ing in the evaluation of seizure disorders. Recent technological The predictive value of altered sleep regulation for long- advances in portable recorders and storage media allow a term course of depression is unclear. Thus, the present continuous, uninterrupted recording of all of the 21 channels of study aimed to identify sleep EEG markers that may havepredictive value for the long-term outcome. In order to the 10–20 electrode system for more than 24 hours with a quality characterize related pathophysiological mechanisms, hypothala- mic–pituitary–adrenocortical (HPA) system function was We evaluated AEEG recordings of the first 240 patients investigated with this method using Trackitw recorders and In fifteen patients with depression, HPA system assessments Profilew review software. The average duration of the recording using the DEX/CRH test and sleep EEG studies were was 2.4 days (range 4–304 hours). The most frequent clinical conducted during a controlled antidepressant treatment study questions asked were those concerning verification and classifi- (TS) and during a follow-up (FU) investigation 2 to 10 years cation of seizures (57.1%) and the evaluation of interictal EEG activity (41.7%). These questions could be answered in 75.4% of Unfavorable sleep EEG measures during the TS were all patients. The number of investigations increased by 128% significantly associated with the previous course of depression compared to the previous 8-channel cassette recording. Critical and with the prospective outcome until FU, as reflected by the success factors for the clinical use of AEEG are discussed.
number of episodes. Moreover, the identified sleep EEG The technical improvements of ambulatory recorders and markers correlated significantly with the amount of HPA review software can answer clinical questions that were previously obtainable by inpatient EEG-/video long-term monitoring alone We conclude that sleep EEG markers and HPA system and widen its use in the differential diagnosis and therapeutic regulation may predict the long-term course of depression.
Swiss Society of Clinical Neurophysiology / Clinical Neurophysiology 115 (2004) e1–e4 High resolution electric neuroimaging for epileptic focus followed carefully. Regarding the need for anticonvulsant therapy localization – G. Lantza, C.M. Michela, L. Spinellia,b, clinical symptoms are most important.
R. Grave de Peraltaa, T. Landisb, M. Seeckc (aFunctionalBrain Mapping Laboratory, bDepartment of Neurology,University Hospital Geneva, Switzerland, cLaboratory ofPresurgical Epilepsy Evaluation, University Hospitals of Contribution of short term frequency-dependent plas- ticity to seizure generation and spread – S. Ru¨egga, The purpose of the study was to evaluate the feasibility, clinical M. Kaplanb, M.A. Dichterb (aDepartment of Neurology, yield, and localization precision of high-resolution EEG source University of Basel, bUniversity of Pennsylvania, imaging of interictal epileptic activity. Forty-four consecutive patients with focal epileptic seizures, who underwent a compre- Neurons in the mammalian cortex fire in short, high frequency hensive presurgical epilepsy evaluation, were subjected to a bursts or trains during interictal epileptiform discharges and fire in 128-channel EEG recording. A standardized source imaging longer, high frequency trains during ictal activity. The nature of the procedure constrained to the individual gray matter was applied responses in neurons that are synaptically coupled to these neurons, to the averaged spikes of each patient.
however, is not well characterized. Our laboratory has been In 32 of the patients a focal epileptogenic region was identified analyzing the nature of synaptic responses in both excitatory and during the presurgical workup, and in 30 of these patients (93.7%), inhibitory circuits in response to repetitive firing of the presynaptic the 128-channel EEG source imaging correctly localized this area.
neuron in order to understand the mechanisms by which seizures In cases where imprecise localizations were obtained, this could be may develop and spread throughout the brain. Whole-cell patch- explained by simplifications of the recordings and analysis clamp experiments in monosynaptically connected pairs of procedure, which had been accepted for the benefit of speed and neurons were performed in dissociated hippocampal neuronal standardization. In 24 patients cortical resections had been low-density cultures. Despite reduction in neurotransmitter release performed, and in these cases the sublobar precision of the 128- with repetitive activation of excitatory synapses, small excitatory channel EEG source imaging could be evaluated by calculating the circuits demonstrate dramatic facilitation of synaptic transmission.
distance from the source maximum to the resected area. This This is mediated by both, AMPA and NMDA receptor-mediated analysis revealed zero distance in 19 cases (79%).
currents. Such powerful short term synaptic facilitation can In conclusion, high-resolution interictal EEG source imaging is clearly play an important role in the development and spread of a valuable non-invasive functional neuroimaging technique. The speed, ease, flexibility, and low cost of this technique warrant itsuse in clinical practice.
Brain areas for “atoms of thought”: mental imageryversus abstract thinking – D. Lehmann, T. Koenig,B. Henggeler, W. Strik, K. Kochi, M. Koukou, EEG characteristics in Rett syndrome – S. Jourdan Moser, R.D. Pascual Marqui (Psychiatric University Hospitals J. Lu¨tschg (Department of Neuropediatrics, Childen’s Hospital, University of Basel, Switzerland) EEG- and ERP-data can be parsed into microstates, i.e. epochs Clinical manifestations and typical sequence of stages of Rett (!100 ms) of quasi-stable potential distribution maps (“atoms of syndrome (RS) are well-known. 60–70% of patients develop thought”). In Experiment 1, subjects were prompted to report “what epilepsia. The EEG pattern is invariably abnormal during the was on your mind”. In these spontaneous mentations, two classes can course of RS. Characteristic EEG patterns have been described and be distinguished, visual imagery and abstract thought (e.g. “apple” suggest a typical developmental pattern. They have been correlated vs. “theory”). The last EEG-microstate before prompting was with the clinical staging. The aim of this study was to examine the marked as visual imagery or abstract. In Experiment 2, subjects read correlation between clinical and EEG stages.
visually imaginable and abstract words (1/s); after a “?”, they We compared clinical manifestations and EEG recordings from repeated last word. The ERP-microstate 286–354 ms poststimulus 9 classic cases. Patient age varied between 1 1/4 and 32 years, thus showed different potential maps for the 2 word classes. EEG and all four clinical stages were included.
ERP potential maps were analyzed into LORETA tomographic EEG patterns correlate only partially with clinical stages and images. In both experiments, visual conditions showed maximal show great variability. Some typical manifestations (apneic pauses, activation right-posterior, abstract conditions left-anterior: common episodic laughing, hand movements) can appear as fits without for both experiments, activation for abstract was in Brodmann 38, 47 being of epileptic origin. Epileptogenic activity in the EEG is left (orbito-frontal) and for visual in Brodmann 20, 36, 37 right (inf.
commonly present without clinical seizures. Conversely there are temporal). In both experiments, subjects did not know that imagery patients with clinical seizures without epileptic discharges in their vs. abstract mentation was studied, but had to remember the last spontaneous mentation or presented word. Activation of brain areas There are characteristic EEG findings in RS without being thus occurred automatically without tasks to imagine or formulate, diagnostic. EEG patterns correlate only partially with the clinical and identical areas were active regardless whether mentations were stages. To not overestimate or under-recognize seizures in patients started by exterior (word display) or internal, spontaneous events with RS, the clinical history as well as the EEG pattern have to be Swiss Society of Clinical Neurophysiology / Clinical Neurophysiology 115 (2004) e1–e4 Electroencephalographic findings in a juvenile patient immunoglobulins (IVIG). He experienced one transient ischemic with steroid-responsive encephalopathy associated with attack during IVIG administration and he underwent cardiac autoimmune (Hashimoto) thyroiditis – Th. Schmitt- bypass surgery for coronary heart disease. Within subsequent years, the frequency of IVIG administration steadily increased from once per month to once per week. This frequency remained Hashimoto’s encephalopathy, a rare disorder with subacute unchanged despite additional immunomodulatory and -suppressive onset of psychiatric symptoms and focal or generalized seizures, is therapy with interferon-beta and cyclophosphamide. However, one associated with laboratory evidence of autoimmune thyroiditis and yearly course of the anti-CD20 chimeric antibody rituximab may precede symptoms of thyroid disease. The rare descriptions of proved effective by extending the interval of IVIG administration EEG emphasise rhythmic slowing of background activity with from 7 to 12 days, i.e. by the reduction of IVIG by 43%. The drug was well tolerated and the patient remained stable since four years.
A 14-year old patient presented with generalized seizures and a Rituximab may become an alternative, complementary, and pre-existing hyperactivity/attention-deficit disorder, presumed to IVIG sparing drug in patients with MMN.
be aggravated by puberty. His EEG initially showed paroxysmalfrontal high amplitude 2.5–3/sec spike and poly-spike/slow-wave-activity indicative of atypical absences, generalized spike/slow-waves and a less dominant rhythmic slowing of backgroundactivity frontally. Behaviour worsened and seizures reoccurred Cerebral hemodynamic changes to cognitive tasks in despite anticonvulsant treatment. EEG deteriorated, showing a children with attention deficit disorder measured by near peculiar periodic rhythmic high voltage 1.5–2/sec activity in both infrared spectroscopy – P. Weber, H. Fahnenstich, parieto-occiptal regions with interspersed spikes and poly-spikes.
Cranial MRI was normal. Further work-up revealed elevated TSH-, J. Lu¨tschg (Department of Neuropediatrics, Childen’s Hospital, University of Basel, Switzerland) 4-concentrations and elevated anti-thyroxine-peroxidase antibodies (TPO) indicative of auto-immune thyroiditis. Clinical Objective: To evaluate the hemodynamic changes in both symptoms and EEG-abnormalities rapidly resolved with steroid prefrontal regions induced by a cognitive task in children with a developmental attention deficit disorder using the near-infrared Hashimoto’s encephalopathy may present as primary seizure disorder accompanied by EEG alterations mimicking idiopathic Method: 11 boys with a mean age of 10.4 (G1.2) years generalized epilepsy. Periodic posterior rhythmic spike/slow- meeting the DSM-IV criteria of ADD/ADHD and were compared waves should raise the suspicion of this encephalopathy.
with 9 age- and sex-matched healthy controls (HC). Using a trail- Deterioration of EEG led to diagnosis; EEG was the most useful making test designed to connect numbers from 1–90 in four sets, marker of CNS-involvement in this probably underdiagnosed changes in oxygenated (O2Hb) and deoxygenated (HHB) hemo- globin, tissue oxygenation index (TOI) and cerebral blood volume(CBV) were measured by NIRS.
Results: During the first test set, designed as a short attention task, the children with ADD/ADHD showed a significant increase Rituximab stabilizes multifocal motor neuropathy in a in O2Hb and CBV, but only the controls showed also an increase in patient progressively less responsive to intravenous HHB in the left prefrontal region. TOI increased only in the immunoglobulins – S.J. Ru¨egg, P. Fuhr, A.J. Steck (Department of Neurology, University Hospital of Basel, Conclusions: NIRS is a sensitive tool for measuring differences in hemodynamic changes between boys with ADD/ADHD and We report on 71 year-old patient with GM-1-antibody negative normal controls. The HC showed lateralized oxygen consumption multifocal motor neuropathy (MMN). Twenty years ago, he was in the left prefrontal cortex during an extended attention task, first diagnosed with lower motor neuron disease, but in 1995, the whereas the patients showed an imbalance between oxygenated diagnosis of MMN was established according to electrophysio- and deoxygenated hemoglobin during short and extended attention logical and clinical criteria. He initially responded well to i/v
SHSSR Diabetes Oral and Non-Insulin Injectable Medication Overview Revision 5.17.2013 References OnlineTM, Pediatric Lexi-Drugs OnlineTM , Hudson, Ohio: Lexi-Comp, Inc.; Facts & Comparisons. Facts & Comparisons Web site. http://online.factsandcomparisons.com.ezproxy.samford.edu/. Clinical Pharmacology Web site. http://cpip.gsm.com.ezproxy.samford.edu/. Pharmacist’s Letter. Drugs