Electroencephalographic features associated with intermittent rhythmic delta activity.

OBJECTIVE: To investigate the clinical importance of intermittent rhythmic delta activity (IRDA) in terms of accompanying electrophysiological findings on EEG and their association with IRDA. METHODS: We retrospectively assessed all EEG studies recorded in our institution from 2011 to 2017. Patients with intermittent rhythmic delta activity (IRDA) in EEGs were included. Clinical data were collected from charts of the patients with IRDA. RESULTS: We identified 69 EEGs with IRDA in 58 patients from a total of 18,625 EEG recordings. The most common IRDA type was frontal IRDA (FIRDA; 55%), followed by temporal IRDA (TIRDA; 28.9%). Unilateral (UL) distribution was present in 36.8% of FIRDAs and 95% of TIRDAs. The frequency of focal epileptiform discharges (FED) was 78.5% in UL FIRDA group and 89.4% in UL TIRDA group. Among the EEGs with FEDs, in UL FIRDA group 90.9% and in UL TIRDA group 70.5% of the FEDs were ipsilateral. Concordance of focal structural brain lesions and FEDs with UL TIRDA was 30.7%, and with UL FIRDA was 50%. UL FIRDA had a 71.4% positive predictive value for ipsilateral focal epileptic focus and UL TIRDA had 63.1%. The frequency of focal structural lesions and FEDs were significantly higher in the UL FIRDA group than bilateral FIRDA group (P=0.03; P=0.01). Among the patients with focal structural lesions, ipsilateral FED association is significantly higher in the UL FIRDA group than BL FIRDA group (P=0.03). CONCLUSIONS: UL FIRDA is more likely to indicate a focal lesion and a focal epileptic focus compared to bilateral FIRDA, and it had similar characteristics to UL TIRDA. It can be considered that UL FIRDA has as good a lateralizing value for ipsilateral focal epileptic focus and focal lesion as UL TIRDA.

Prepulse modulation and recovery of trigemino-cervical reflex in normal subjects.

OBJECTIVE: In this study, we analyzed the inhibitory control on the trigemino-cervical reflex (TCR), and whether or not prepulse modulation (PPM) has an effect on TCR. Thus, we studied the PPM of TCR. We hypothesized that TCR would presumably be under the modulatory effect after the prepulse stimulus similar to blink reflex (BR). We also studied the recovery of TCR which was previously shown. METHODS: We included 13 healthy individuals. All subjects underwent recordings of TCR, TCR-PPM, and recovery of TCR. For TCR-PPM, a subthreshold stimulus to second finger 50 or 100 ms before the test stimulus was applied. For recovery of TCR, two stimuli at the infraorbital nerve were applied at 300, 500, and 800 ms interstimulus intervals (ISIs). RESULTS: There was an inhibition of bilateral late responses of TCR at the ISIs of both 50 ms and 100 ms. There was no change of latencies. Full recovery of TCR did not develop even at the ISI 800 ms. DISCUSSION: We have provided an evidence for the TCR-PPM in healthy subjects for the first time in this study. The prepulse inhibition is attributed to the functions of the pedunculopontine tegmental nucleus. Our study provides a strong indication that there are connections between pedunculopontine tegmental nucleus and trigemino-cervical circuit, which produces TCR.