Ictal EEG Non-linear And High Order Spectral Analysis Methods In Electroconvulsive Therapy And Its Clinical Utility.

Introduction: Analysis of ictal electroencephalogram (EEG) during electroconvulsive therapy (ECT) early in the course provides information to predict clinical outcome. Previous studies used visual, power spectral and non linear methods to analyze EEG. EEG signals are non stationary, non linear, non Gaussian and chaotic in nature. Such signals can be better characterized by non linear and higher order spectrum analysis. However there is scarcity of data assessing such measurers in predicting clinical outcome. We conducted nonlinear and high order spectrum analyses of ictal EEG recorded during ECT and correlated the measures with clinical outcome. Methods: Schizophrenia patients receiving ECT were assessed using the brief psychiatric rating scale (BPRS) before and 2 weeks after the start of ECT. EEG was recorded during seizure from left frontal-pole (FP1) channel. In 26 patients, completely artifact-free EEG was available. Approximate entropy (ApEn), Sample entropy (SamEn), Hurst exponent (H), Bispectrum entropy (HOS.En), correlation dimension (CD) and Largest Lyapunov exponent (LLE) were computed for EEG from the earliest ECT session (2nd or 3rd). Results: HOS.En emerged as a significant measure which predicted outcome at two weeks (HOS En1: r = - 0.434; p = 0.027 & En2: r = -0.414; 0.036) other measures, viz., ApEn (r = -0.001; p = 0.995), SampEn (r = - 0.152; p = 0.458), H (r = 0.123; p = 0.549), CD (r = 0.119; p = 0.563) and LLE (r = -0.293; p = 0.146) did not predict the outcome. Conclusion: In patients with schizophrenia receiving ECT higher bispectrum entropy of ictal EEG early in the ECT course predicts better clinical outcome at the end of two weeks. None of the other non linear measures evaluated in the study predicted clinical outcome.

Bilateral Facial Nerve Palsy Following Trauma: A Rare Case Report.

Bilateral facial paralysis occurs due to basilar skull fracture which involves temporal bone. It might be is rare. Unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Proper clinical history and thorough physical exam are needed for a diagnosis. To confirm high-resolution computed tomography scan and electrodiagnostic tests should be done which will help to make the final diagnosis of bilateral facial nerve palsy. It will also help in the early detection of the case and intervention may be important for optimal functional recovery. We have reported a 28-year-old male who received a blow to the left side of his face due to road traffic accident.

Spigelian Hernia with Homolateral Direct Inguinal Hernia: A Rare Case Report.

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominal muscle medially and the semilunar line laterally. There is a common misconception that they protrude below the arcuate line owing to deficiency of the posterior rectus sheath at that level, but in fact, the defect is almost always above the arcuate line. These are interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often unnoticeable swelling. Spigelian hernias are usually small, and therefore, the risk of strangulation is high. Most occur on the right side (4-7th decade of life).