CLINICAL AND ELECTROPHYSIOLOGICAL INDICATORS OF ACUTE AND EARLY RECOVERY PERIODS OF CEREBRAL STROKE

В остром и раннем восстановительном периодах церебрального инсульта взаимосвязь между биоэлектрической активностью головного мозга и клинической картиной заболевания представляют значительный научный и практический интерес. В данной статье, представлены результаты исследования клинико-неврологических и электроэнцефалографических показателей, в остром и раннем восстановительном периодах церебрального инсульта, 67 больных в возрасте от 43 до 78 лет. Показано, что у больных в остром и раннем восстановительном периодах церебрального инсульта на фоне двигательных и речевых расстройств, наблюдались легкие и умеренные когнитивные нарушения, а также тревожно-депрессивные проявления. Головная боль, соответствующая критериям головной боли напряжения отмечалась у 61,1% больных. Биоэлектрическая активность головного мозга характеризовалась выраженной дельта и тета активностью, а также единичными острыми волнами, спайками, преимущественно в пораженном полушарии головного мозга, межполушарной асимметрией, повышением мощности спектров в сторону преобладания медленных волн. Показатели индекса когерентности по всем отведениям были снижены, что свидетельствует о нарушении функциональных межполушарных взаимосвязей. Более значительное повышение индекса когерентности в дельта и тета диапазонах у пациентов, перенесших геморрагический инсульт, может указывать на более грубые межполушарные нарушения, в сравнении с ишемическим инсультом. In the acute and early recovery periods of cerebral stroke, the correlation between bioelectrical activity of the brain and the clinical picture of the disease is of considerable scientific and practical interest. This article presents the results of a study of clinical, neurological and electroencephalographic parameters, in the acute and early recovery periods of cerebral stroke, in 67 patients aged from 43 to 78. Mild and moderate cognitive impairment as well as anxiety and depressive manifestations were shown among patients in the acute and early recovery periods of cerebral stroke amid the motor and speech disorders. Headache meeting the criteria of tension headache was reported among 61,1% of patients. The bioelectrical activity of the brain was characterised by marked delta and theta activity as well as single sharp waves, commissures mainly in the affected cerebral hemisphere, interhemispheric asymmetry and by increase in the spectrum power towards the predominance of slow waves. The coherence index scores were decreased on all directions, indicating impaired functional interhemispheric connectivity. A greater increase in coherence index in the delta and theta bands among haemorrhagic stroke patients may indicate more severe interhemispheric disturbances compared to ischaemic stroke.

Encephalitis, a Rare Manifestation of Human Herpesvirus 7 Infection

Human herpesvirus 7 (HHV-7) infection typically occurs in childhood and is frequently asymptomatic. Some clinical manifestations include fever and exanthem subitum. There have been rare reports of invasion of HHV-7 into the central nervous system. Here we report a case of encephalitis associated with HHV-7. A 16-year-old girl presented with headache, vomiting, disorientation, and psychomotor agitation. Glasgow Coma Scale on arrival was 9. Cerebrospinal fluid tested positive for HHV-7. Electroencephalogram showed intermittent slowing and rare sharp waves in the left frontal region. She recovered well after appropriate treatment for encephalitis.This case added to the few existing reports of encephalitis due to HHV-7. Physicians should be aware of this rare neurological manifestation of HHV-7 for prompt management. Similar cases should be reported to further our knowledge about this virus and its role in neurological disease.

Children’s Neurological Status Epilepticus and Poor Prognostic Factors through Electroencephalogram Image under Composite Domain Analysis Algorithm

This study aimed to analyze the application of composite domain analysis algorithm for electroencephalogram (EEG) images of children with epilepsy and to investigate the risk factors related to poor prognosis. 70 children with neurological epilepsy admitted to the hospital were selected as the research objects. Besides, the EEG of the children during the intermittent and seizure phases of epilepsy were collected, so as to establish a composite domain analysis algorithm model. Then, the model was applied in EEG analysis. The clinical disease type and prognosis of children were statistically analyzed, and the risk factors that affected the prognosis of children were investigated. The results showed that the EEG signal values of the detail coefficients (d51 and d52) and the approximate coefficient (c5) during the epileptic seizure period were higher markedly than the signal values of the epileptic intermittent period; the EEG signal of the epileptic intermittent period was a transient waveform, which appeared as sharp waves or spikes. The EEG signal of epileptic seizures was continuous, with a composite waveform of sharp waves and spikes, and the change amplitude of the wavelet envelope spectrum during epileptic seizures was also higher hugely than that of intermittent epilepsy. The accurate identification rate, specificity, and sensitivity of EEG analysis with the composite domain algorithm were higher than those without the algorithm. Among the five types of epileptic seizures in children, the proportion of systemic tonic-clonic status was the largest, and the proportion of myoclonic status was equal to that of complex partial epileptic status, both of which were relatively small. The proportion of children with a better prognosis was 75.71% (53/70), which was higher than those with a poor prognosis 24.29% (17/70). Abnormal imaging examination (odds ratio (OR) = 3.823 and 95% confidence interval (CI) = 1.643–8.897); seizure duration greater than 1 hour (OR = 1.855 and 95% CI = 1.076–3.199); C-reactive protein (CRP) (OR = 5.089 and 95% CI = 1.507–17.187); and abnormal blood glucose (OR = 3.077, 95%CI = 1.640–5.773) were all independent risk factors for poor prognosis (all P < 0.05 ). The composite domain analysis algorithm was helpful for clinicians to find the difference in the EEG signals between the epileptic seizure period and the epileptic intermittent period in a short time, thereby improving the doctor’s analysis of the results, which could reflect its marked superiority. In addition, abnormal imaging examinations, convulsion duration greater than 1 hour, CRP, and abnormal blood glucose were independent risk factors for poor prognosis in children. Therefore, the invasion of related risk factors could be reduced clinically by prognostic review with medical advice, attention to food safety and hygiene, and improvement of children’s immunity.

Encephalopathy With Alternating Hemispheric MRI Abnormalities

A 21-year-old woman with a long-standing history of migraine sought care at her local provider for a 1-week history of confusion and mixing up her words. She then had a witnessed seizure, with dyscognitive features and secondary generalization. On hospitalization, electroencephalography demonstrated left temporal theta slowing and sharp waves. Magnetic resonance imaging showed patchy T2-signal abnormality, nonenhancing, in the left temporal region (only a report was available). Thyroid peroxidase antibodies were increased at 271 IU/mL. A diagnosis of an autoimmune encephalopathy was made, and the patient was treated with phenytoin, levetiracetam, and high-dose corticosteroids, followed by a slow oral prednisone taper. The patient improved cognitively but had considerable emotional lability and an increase in headache frequency and severity and, thus, sought a second opinion. Blood was drawn for genetic testing. The patient died in her sleep a short time later, most likely in the context of sudden unexplained death in epilepsy. Her genetic testing results became available 1 month later, which showed findings consistent with MELAS syndrome: heteroplasmic sequence variation m.3243A>G (tRNA Leu) and homoplasmic rare variant m.2294A>G (16S rRNA). Encephalopathy or encephalitis of subacute onset with fluctuating course is not unique to autoimmune encephalitis. Common acquired metabolic disorders must be considered and excluded in all cases, such as deficiencies of vitamin B12 and folate, hypothyroidism, sepsis, and central nervous system–active medications.

Electroencephalography: Evaluation of Neurologic Disorders

Electroencephalography (EEG) is a useful diagnostic and prognostic tool for evaluation of patients with epilepsy, encephalopathy, focal lesions, coma, or brain death. The 3 main types of epileptiform discharges are spikes, sharp waves, and spike-and-wave discharges. Spikes have a steep ascent and descent and are brief (duration ≤70 milliseconds). Sharp waves, in contrast, are longer (70-200 milliseconds). Spike-and-wave discharges consist of a spike followed by an after-coming slow wave. All the discharges may occur singly or in trains, and any may be present in either focal epilepsy or generalized epilepsy.

Electroencephalography: Basic Concepts

Electroencephalography (EEG) is a useful diagnostic and prognostic tool for evaluation of patients with epilepsy, encephalopathy, focal lesions, coma, or brain death. The 3 main types of epileptiform discharges are spikes, sharp waves, and spike-and-wave discharges. Spikes have a steep ascent and descent and are brief (duration ≤70 milliseconds). Sharp waves, in contrast, are longer (70-200 milliseconds). Spike-and-wave discharges consist of a spike followed by an after-coming slow wave. All the discharges may occur singly or in trains, and any may be present in either focal epilepsy or generalized epilepsy.

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.

Electroencephalography Patterns in Children with First Unprovoked Seizure

Background First unprovoked seizure (FUS) is a neurological health problem that occurs in an estimated 2% of children aged 16 years or younger. Electroencephalography (EEG) is an electrophysiological technique to record electrical activities arising from the brain; this technique can be used to evaluate patients with suspected seizures, epilepsy, and unusual concomitants. The objective of this study is to describe the EEG patterns in children with FUS and the factors associated with these EEG results. Method A retrospective analytic study was conducted in the Neuropaediatric Clinic, Dr Soetomo General Academic Hospital. The medical record data were obtained from January 2018 to December 2019. Children aged one month to 18 years with FUS and their complete EEG records were included. Descriptive statistics and the chi-square test with Cochran's Q test and Mantel–Haenszel tests were used for statistical calculations. Results One hundred participants enrolled the study. The majority (54%) showed abnormal EEG, which was dominated by epileptiform discharges (68.5%) consisting of benign epileptiform with centro-temporal spikes (BECTS), focal and generalized sharp waves, focal and generalized spikes, and EEG seizures. Factors associated with abnormal EEG results were children aged ≥ 5 years (p = 0.07, OR = 3.093, 95% CI = 1.361–7.030), focal seizure type (p = 0.021, OR = 6.286, 95% CI = 1.327–29,779), and long seizure duration ≥ 5 minutes (p < 0.001, OR = 8.333, 95% CI = 3.029–22.929). Conclusion Children with abnormal EEG were at risk for recurrent seizures. Over 50% of children with FUS had abnormal EEG results. In the present study, abnormal EEG results were frequently found in children with FUS, especially in older children (≥ 5 years old), those with focal seizures, and those with long seizure durations (≥ 5 minutes).

Effects of River-Ice Breakup on Sediment Transport and Implications to Stream Environments: A Review

During the breakup of river ice covers, a greater potential for erosion occurs due to rising discharge and moving ice and the highly dynamic waves that form upon ice-jam release. Consequently, suspended-sediment concentrations can increase sharply and peak before the arrival of the peak flow. Large spikes in sediment concentrations occasionally occur during the passage of sharp waves resulting from releases of upstream ice jams and the ensuing ice runs. This is important, as river form and function (both geomorphologic and ecological) depend upon sediment erosion and deposition. Yet, sediment monitoring programs often overlook the higher suspended-sediment concentrations and loads that occur during the breakup period owing to data-collection difficulties in the presence of moving ice and ice jams. In this review paper, we introduce basics of river sediment erosion and transport and of relevant phenomena that occur during the breakup of river ice. Datasets of varying volume and detail on measured and inferred suspended-sediment concentrations during the breakup period on different rivers are reviewed and compared. Possible effects of river characteristics on seasonal sediment supply are discussed, and the implications of increased sediment supply are reviewed based on seasonal comparisons. The paper also reviews the environmental significance of increased sediment supply both on water quality and ecosystem functionality.

Multiple ictal onset patterns underlie seizure generation in seizure-free patients with temporal lobe epilepsy surgery: an SEEG study

Purpose Seizure originates from different pathological substrate; however, the same pathologies may have distinct mechanisms underlying seizure generation. We aimed to improve the understanding of such mechanisms in patients with temporal lobe epilepsy (TLE) by investigating the stereoelectroencephalography (SEEG) ictal onset patterns (IOPs). Methods We analyzed data from a cohort of 19 consecutive patients explored by SEEG and had 1–3-year seizure-freedom following temporal lobe resection. Results Six IOPs were identified. They were low voltage fast activity (LVFA) (36.5%), rhythmic spikes or spike-waves at low frequency and with high amplitude (34.1%), runs of spikes (10.6%), rhythmic sharp waves (8.2%), low frequency high amplitude repetitive spiking (LFRS) (7.1%), and delta activity (3.5%). All six patterns were found in patients with mesial temporal onset and only two patterns were found in patients with temporal neocortical onset. The most prevalent patterns for patients with mesial temporal onset were rhythmic spikes or spike-waves, followed by LVFA with a mean discharge rate 74 Hz. For patients with temporal neocortical onset, the most prevalent IOP pattern was LVFA with a mean discharge rate 35 Hz, followed by runs of spikes. Compared with Lateral TLE (LTLE), the duration between the onset of the IOPs to the onset of the symptom was longer for patients with MTLE (Mesial TLE) (MTLE:55.7 ± 50.6 s vs LTLE:19.5 ± 16.4 s). Conclusion Multiple IOPs underlie seizure generation in patients with TLE. However, the mesial and lateral temporal lobes share distinct IOPs.