Two Cases of Citalopram Induced Awake Bruxism / 대한정신약물학회지

Bruxism has been defined as an oral parafunctional activity characterized by clenching, bracing, gnashing and grinding of teeth while asleep and or awake. While bruxism has been associated with a number of neurological diseases, it has been mostly highlighted following drug medication. We report 2 female patients of awake bruxism after citalopram medication. The bruxism in these patients was completely or significantly improved after cessation of citalopram. We discuss the pathophyisological mechanism of bruxsm associated with selective serotonin reuptake inhibitors (SSRIs). These cases highlight that bruxism can occur in response to citalopram, as do in other SSRIs.

EEG Coherence in Alzheimer's Disease

BACKGROUND: EEG coherence can be used to evaluate the functional cortical connections and to get information about the synchronization of the regional cortical activity. We studied EEG coherence in patients affected by clinically probable Alzheimer's disease (AD) in order to quantify the modifications in the cortico-cortical or cortico-subcortical connections. METHODS: The EEGs were recorded in 62 AD patients and in 30 normal age-matched subjects from 16 electrodes with linked-ears reference. Spectral parameters and coherence were calculated by a multichannel autoregressive model using 20 artifact-free 2-sec epoch in normal controls and AD patients. RESULTS: In AD patients, alpha coherence in frontal field and theta, alpha interhemispheric coherence was significantly decreased, whereas alpha, beta coherence in posterior field was significantly increased. Some electrodes in the anterior field showed significant negative correlation with MMSE, whereas other electrodes in the posterior field showed significant positive correlation with MMSE. CONCLUSIONS: This study suggests that coherence is a useful tool for understanding electrophysiologic change of AD and for correlating with the severity of cognitive dysfunction. And these coherence changes can be interpreted as the effects of neuronal loss and neocortical disconnection.

Pharmacological Treatments of Behavioral Symptoms in Dementia

Behavioral symptoms are well-recognized concomitants of the progression of dementia. These symptoms include agitation, aggression, anxiety, depression, disinhibition, delusions, hallucination, and sleep disturbance. Because these symptoms are a major source of impaired quality of life for patients and their caregivers, appropriate pharmacological management of them may reduce the burden of caregivers and postpone institutionalization. Furthermore, behavioral symptoms may be more amenable to pharmacological intervention than cognitive symptoms. For that reason, detailed evaluation and appropriate treatment are the mainstay in the management of dementia patients. In this article, we reviewed symptomatology and psychopharmacology for behavioral symptoms of dementia.

Two Cases of Stroke with False Lateralization in EEG Mapping

In recent days quantitative electroencephalography (QEEG) has grown rapidly and QEEG techniques and EEG mapping have shown localizing functional imaging. We report two cases of falsely lateralized EEG mapping in stroke patients. Both cases had right hemispheric stroke, but presented bilateral clinical symptoms. Contrary to structural imaging, EEG mapping displayed left hemispheric dysfunction and SPECT displayed bilateral perfusion Aegects. These findings suggest that false lateralization of EEG mapping in unilateral stroke patients may show bilateral cerebral dysfunction not detected in conventional imaging technique.

Neuropsychological Differentiation between Alzheimer's Disease and Vascular Dementia

BACKGROUND: Neuropsychological Differentiation between Alzheimer's disease and vascular dementia has been controversial. The aim of this study was to detect neuropsychological differences between Alzheimer's disease (AD) and vascular dementia (VD). METHODS: Twenty one patients who met the criteria for probable AD according to the National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and 22 patients who met criteria for probable VD according to the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), were included in this study. These two dementia groups were matched for age, sex, education, Mini-Mental State Examination score, and severities of dementia. All patients underwent the Seoul Neuropsychological Screening Battery (SNSB). RESULTS: Patients with VD showed greater deficits in verbal fluency (P<.05) than AD patients. However, AD patients, compared with VD patients, showed greater deficits in verbal memory functions including the 3 words recall task. Otherwise, no significant between-group differences were found in task results. CONCLUSIONS: Neuropsychologically, patients with VD differ from patients with AD only in a few cognitive domains. (J Korean Neurol Assoc 19(2):143~148, 2001)

Neuropsychological Differentiation between Alzheimer's Disease and Vascular Dementia

BACKGROUND: Neuropsychological Differentiation between Alzheimer's disease and vascular dementia has been controversial. The aim of this study was to detect neuropsychological differences between Alzheimer's disease (AD) and vascular dementia (VD). METHODS: Twenty one patients who met the criteria for probable AD according to the National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and 22 patients who met criteria for probable VD according to the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), were included in this study. These two dementia groups were matched for age, sex, education, Mini-Mental State Examination score, and severities of dementia. All patients underwent the Seoul Neuropsychological Screening Battery (SNSB). RESULTS: Patients with VD showed greater deficits in verbal fluency (P<.05) than AD patients. However, AD patients, compared with VD patients, showed greater deficits in verbal memory functions including the 3 words recall task. Otherwise, no significant between-group differences were found in task results. CONCLUSIONS: Neuropsychologically, patients with VD differ from patients with AD only in a few cognitive domains. (J Korean Neurol Assoc 19(2):143~148, 2001)

Usefulness of Quantified-EEG in Alzheimer's Disease

BACKGROUND: The conventional electroencephalography (EEG) is commonly used as an aid in the diagnosis of Alzhiemer's disease (AD). Recently developed quantitative electroencephalography (qEEG) provides data that are not achievable by conventional EEG. Nevertheless, the clinical reliability and usefulness of spectral analysis and topographic mapping is still a matter of controversy in the diagnosis of Alzheimer's disease. The aim of this study was to compare the topographical quantitative EEG (qEEG) changes between elderly controls and AD patients. METHODS: We analyzed the absolute, relative spectra power and occipital peak frequency taken from 16 derivations by averaging twenty-2-sec epoch in elderly controls and AD patients. After logarithmic transformations of absolute and relative power, a statistical test was done and occipital peak frequency was compared with each other. RESULTS: (1) Compared with normal controls, AD patients had a significantly lower alpha and beta spectra power as well as a significant higher delta spectra power. (2) In AD patients, the peak frequency in occipital lead had a significantly lower frequency than that of elderly controls. (3) Korean Mini-Mental State Examination(K-MMSE) scores were closely related in delta and alpha band power in nearly all electric leads. (4) Compared to absolute power, relative power was a more sensitive tools in detecting changes of EEG in AD patients. CONCLUSIONS: This study suggests that qEEG is a useful tool for detecting the electroencephalographic changes of AD, and correlated with the severity of cognitive dysfunction. Moreover, absolute and relative spectra power is complementary in the clinical utility of qEEG.