The Electroencephalogram Patterns In Patients With Status Epilepticus In Department of Neurology Dr. Soetomo General Hospital Surabaya

Status epileptikus (SE) merupakan kegawatan neurologis akibat kegagalan terminasi dari bangkitan dan juga hipereksitasi neuron sehingga menyebabkan bangkitan yang abnormal atau berkepanjangan. Mortalitas terkait SE terus mengalami peningkatan, terutama pada populasi geriatri. Hal ini menyebabkan SE menjadi penyakit dengan biaya pengobatan yang besar khususnya di negara-negara terbelakang dan berkembang. Pemahaman terkait elektroensefalogram (EEG) pada SE dapat membantu dalam penentuan diagnosis secara akurat dan pemberian terapi secara tepat. Penelitian ini bertujuan untuk mengetahui gambaran EEG pasien SE di Departemen Neurologi RSUD Dr. Soetomo. Penelitian dilakukan secara observasional deskriptif dengan desain studi potong lintang menggunakan data sekunder dari rekam medis pasien dengan diagnosis SE pada periode Januari 2016 – Desember 2019. Data pasien yang lengkap kemudian dilakukan analisis berdasarkan usia, jenis kelamin, etiologi, komorbid, tipe bangkitan, onset terjadinya SE, jarak waktu antara onset dengan pelaksanaan EEG, keadaan klinis, dan gambaran EEG. Hasil: Sebagian besar pasien SE dalam penelitian ini berjenis kelamin laki-laki dengan kelompok usia >1-10 tahun, diikuti kelompok usia >19-60 tahun. Etiologi SE terbanyak adalah meningoensefalitis, diikuti oleh epilepsi dan stroke. Populasi anak dan geriatri lebih rentan terhadap infeksi yang dapat menyebabkan SE, terutama di negara berkembang. Sebagian besar pasien tidak memiliki komorbid lain dan menjalani pemeriksaan EEG dalam waktu 3-<7 hari setelah bangkitan terakhir, dengan onset general sebagai onset SE yang dominan. SE konvulsif adalah jenis SE yang paling banyak dengan bangkitan general tonik-klonik sebagai manifestasi motorik terbanyak. Temuan EEG yang terbanyak adalah interiktal general diikuti oleh interiktal fokal. Sharp/spike wave dan continuous slow activity merupakan gambaran pelepasan epileptiform dan non-epileptiform terbanyak secara berurutan.

Congenital hydrocephalus in three sheep: Clinical, electroencephalographic and pathological features

The clinical, electroencephalographic and neuro-pathological features of three cases (cases 1, 2 and 3) of congenital hydrocephalus in sheep were described. The observed neurological signs reflected damage in the telencephalon and brain stem. The electroencephalogram performed in case 1 and case 2 showed different patterns: symmetric and synchronous high-voltage slow-activity in case 1, and low-voltage slow-activity in case 2. By the post-mortem examination, in all the animals, dilatation of the ventricular system, especially of the lateral ventricles, associated with a glial reaction surrounding the dilated ventricles was observed. Only in case 3, a monolateral meningeal thickening at the left cerebellopontine angle seemed to be responsible for the obstructive hydrocephalus. In the other two brains (case 1 and 2), no potential anatomical cause for the hydrocephalus were detected, even if, in case 2, a compensatory form was not excluded due to the moderate hypoplasia of the cerebrum and the presence of the non-suppurative inflammation. The results of this work provide a contribution to the EEG characterisation in ovine hydrocephalus cases; nevertheless further multidisciplinary studies of a larger number of sheep could permit to better characterise the EEG pattern in ovine hydrocephalus cases.

Kleine-levin syndrome (kls)-a review

Kleine-Levin Syndrome is a rare sleep disease characterized by relapsing episodes of hypersomnia interconnected with behavioral and cognitive disorders along with hyperphagia and hypersexuality. This disease occurs more often in young male adolescents. The diagnosis was clinical, primarily based on the nosologic distinction of non-identical forms of recurrent hypersomnia. The brief duration of KLS varies from 7 days to 2 months and the people affected are completely asymptomatic between episodes but during episodes, electroencephalography shows diffuse or local slow activity. Investigations for KLS comprise of medical history, magnetic resonance imaging, polysomnography, 24- hours time profile of growth hormone, melatonin, TSH, and cortisol. The Pathophysiology of this sleeping beauty syndrome is based on Neuropathological examinations, cerebrospinal fluid hypocretin-1 monitoring, clinical patterns, and neuroimaging. Imaging of brain function reveals the hypoactivity in thalamic and hypothalamic regions and imaging along with the cognitive capacity evaluation gives insights into neurobiological mechanisms of KLS. No effective treatment, as well as indefinite pathology, has been identified even though the illness is having clearly defined clinical features but some medications like stimulants and mood stabilizers can be beneficial in the treatment of severe cases.

Long Time Constant May Endorses Sharp Waves and Spikes Than Sharp Transients in Scalp Electroencephalography: A Comparison of Both After-Slow Among Different Time Constant and High-Frequency Activity Analysis

Objective: To clarify whether long time constant (TC) is useful for detecting the after-slow activity of epileptiform discharges (EDs): sharp waves and spikes and for differentiating EDs from sharp transients (Sts).Methods: We employed 68 after-slow activities preceded by 32 EDs (26 sharp waves and six spikes) and 36 Sts from 52 patients with partial and generalized epilepsy (22 men, 30 women; mean age 39.08 ± 13.13 years) defined by visual inspection. High-frequency activity (HFA) associated with the apical component of EDs and Sts was also investigated to endorse two groups. After separating nine Sts that were labeled by visual inspection but did not fulfill the amplitude criteria for after-slow of Sts, 59 activities (32 EDs and 27 Sts) were analyzed about the total area of after-slow under three TCs (long: 2 s; conventional: 0.3 s; and short: 0.1 s).Results: Compared to Sts, HFA was found significantly more with the apical component of EDs (p &lt; 0.05). The total area of after-slow in all 32 EDs under TC 2 s was significantly larger than those under TC 0.3 s and 0.1 s (p &lt; 0.001). Conversely, no significant differences were observed in the same parameter of 27 Sts among the three different TCs. Regarding separated nine Sts, the total area of after-slow showed a similar tendency to that of 27 Sts under three different TCs.Significance: These results suggest that long TC could be useful for selectively endorsing after-slow of EDs and differentiating EDs from Sts. These findings are concordant with the results of the HFA analysis. Visual inspection is also equally good as the total area of after-slow analysis.

No association between alcohol consumption and pancreatic cancer even among individuals genetically susceptible to the carcinogenicity of alcohol

Inconsistent results have been reported for the association between alcohol use and pancreatic cancer, particularly at low levels of alcohol consumption. Individuals genetically susceptible to the carcinogenic effect of alcohol might have higher pancreatic cancer risk after drinking alcohol. The current study investigated the association between alcohol use and pancreatic cancer with 419 pancreatic cancer cases and 963 controls recruited by a hospital-based case–control study in Taiwan. Gene-environment interaction between alcohol use and polymorphisms of two ethanol-metabolizing genes, ADH1B and ALDH2, on pancreatic risk was evaluated. Our results showed no significant association between alcohol drinking and an increased pancreatic cancer risk, even at high levels of alcohol consumption. Even among those genetically susceptible to the carcinogenic effect of alcohol (carriers of ADH1B*2/*2(fast activity) combined with ALDH2*1/*2(slow activity) or ALDH2*2/*2(almost non-functional)), no significant association between alcohol use and pancreatic cancer was observed. Overall, our results suggested that alcohol drinking is not a significant contributor to the occurrence of pancreatic cancer in Taiwan.

A unifying mechanism governing inter-brain neural relationship during social interactions

A key goal of social neuroscience is to understand the relationship between the neural activity of socially interacting individuals. Decades of research have focused on a single aspect of that relationship: the similarity in neural activity across brains. Here we instead asked how neural activity differs between brains, and how that difference evolves alongside activity patterns shared between brains. Applying this framework to pairs of bats engaged in spontaneous social interactions revealed two complementary phenomena characterizing the inter-brain neural relationship: fast “inter-brain catch-up” unfolding in parallel with slow activity covariation across brains. A model reproduced these observations, generated multiple predictions that we confirmed using experimental data, and provided testable hypotheses for studying the inter-brain relationship in larger social groups. Together, the data and model suggest a parsimonious computational mechanism—opposite feedback to neural activity components reflecting interbrain difference and similarity—that unifies diverse aspects of the inter-brain neural relationship.

Regulation of REM Sleep by Inhibitory Neurons in the Dorsomedial Medulla

ABSTRACTThe two major stages of mammalian sleep – rapid eye movement sleep (REMs) and non-REM sleep (NREMs) – are characterized by distinct brain rhythms ranging from millisecond to minute-long (infraslow) oscillations. The mechanisms controlling transitions between sleep stages and how they are synchronized with infraslow rhythms remain poorly understood. Using opto- and chemogenetic manipulation, we show that GABAergic neurons in the dorsomedial medulla (dmM) promote the initiation and maintenance of REMs, in part through their projections to the dorsal and median raphe nuclei. Fiber photometry revealed that dmM GABAergic neurons are strongly activated during REMs. During NREMs, their activity fluctuated in close synchrony with infraslow oscillations in the spindle band of the electroencephalogram, and the phase of this rhythm modulated the latency of optogenetically induced REMs episodes. Thus, dmM inhibitory neurons powerfully promote REMs, and their slow activity fluctuations may coordinate transitions from NREMs to REMs with infraslow brain rhythms.

Learning to detect the onset of slow activity after a generalized tonic–clonic seizure

Background Sudden death in epilepsy (SUDEP) is a rare disease in US, however, they account for 8–17% of deaths in people with epilepsy. This disease involves complicated physiological patterns and it is still not clear what are the physio-/bio-makers that can be used as an indicator to predict SUDEP so that care providers can intervene and treat patients in a timely manner. For this sake, UTHealth School of Biomedical Informatics (SBMI) organized a machine learning Hackathon to call for advanced solutions https://sbmi.uth.edu/hackathon/archive/sept19.htm. Methods In recent years, deep learning has become state of the art for many domains with large amounts data. Although healthcare has accumulated a lot of data, they are often not abundant enough for subpopulation studies where deep learning could be beneficial. Taking these limitations into account, we present a framework to apply deep learning to the detection of the onset of slow activity after a generalized tonic–clonic seizure, as well as other EEG signal detection problems exhibiting data paucity. Results We conducted ten training runs for our full method and seven model variants, statistically demonstrating the impact of each technique used in our framework with a high degree of confidence. Conclusions Our findings point toward deep learning being a viable method for detection of the onset of slow activity provided approperiate regularization is performed.