Toward a better understanding of the pathophysiology of OCD SSRI responders: QEEG source localization.

OBJECTIVE: To demonstrate the utility of three-dimensional source localization of the scalp-recorded electroencephalogram (EEG) for the identification of the most probable underlying brain dysfunction in patients with obsessive-compulsive disorder (OCD). METHOD: Eyes-closed resting EEG data was recorded from the scalp locations of the International 10/20 System. Variable resolution electromagnetic tomography (VARETA) was applied to artifact-free EEG data. This mathematical algorithm estimates the source generators of EEG recorded from the scalp. RESULTS: An excess in the alpha range was found with sources in the corpus striatum, in the orbito-frontal and temporo-frontal regions in untreated OCD patients. This abnormality was seen to decrease following successful treatment with paroxetine. CONCLUSION: The VARETA findings of an activation/deactivation pattern in cortical and subcortical structures in paroxetine-responsive patients are in good accordance with data obtained in previously published positron emission tomography studies related to current hypotheses of a thalamo-striatal-frontal feedback loop being relevant for understanding the pathophysiology of OCD.

The Patient State Index as an indicator of the level of hypnosis under general anaesthesia.

BACKGROUND: This retrospective study describes the performance of the Patient State Index (PSI), under standard clinical practice conditions. The PSI is comprised of quantitative features of the EEG (QEEG) that display clear differences between hypnotic states, but consistency across anaesthetic agents within the state. METHODS: The PSI was constructed from a systematic investigation of a database containing QEEG extracted from the analyses of continuous 19 channel EEG recordings obtained in 176 surgical patients. Induction was accomplished with etomidate, propofol, or thiopental. Anaesthesia was maintained by isoflurane, desflurane, or sevoflurane, total i.v. anaesthesia using propofol, or nitrous oxide/narcotics. It was hypothesized that a multivariate algorithm based on such measures of brain state, would vary significantly with changes in hypnotic state. RESULTS: Highly significant differences were found between mean PSI values obtained during the different anaesthetic states selected for study. The relationship between level of awareness and PSI value at different stages of anaesthetic delivery was also evaluated. Regression analysis for prediction of arousal level using PSI was found to be highly significant for the combination of all anaesthetics, and for the individual anaesthetics. CONCLUSIONS: The PSI, based upon derived features of brain electrical activity in the anterior/posterior dimension, significantly co-varies with changes in state under general anaesthesia and can significantly predict the level of arousal in varying stages of anaesthetic delivery.

Prediction of treatment outcome in cocaine dependent males using quantitative EEG.

This study investigates the existence of outcome related neurophysiological subtypes within a population of abstinent cocaine dependent adults. We have previously reported and replicated the existence of a distinctive quantitative EEG (QEEG) profile in such a population, and demonstrated the persistence of this pattern at one and six month follow-up evaluations. This profile is characterized by significant deficits of absolute and relative delta and theta power, and excess of relative alpha power, as compared with age expected normal values. Abnormalities were greater in anterior than posterior regions, and disturbances in interhemispheric relationships were also observed. In the current study, 35 adult males with DSM-III-R cocaine dependence, were evaluated while residents of a drug-free residential therapeutic community, 5-15 days after last use of crack cocaine. Using multivariate cluster analysis, two neurophysiological subtypes were identified from the baseline QEEGs; Cluster 1 characterized by significant deficits of delta and theta activity, significant excess of alpha activity and more normal amounts of beta activity (alpha CLUS) and Cluster 2 characterized by deficits of delta, more normal amounts of theta and anterior excess of alpha and beta activity beta CLUS). No significant relationships were found between QEEG subtype membership and length of exposure to cocaine, time since last use of cocaine or any demographic characteristics. Further, no significant relationships were found between the commonly reported comorbid clinical features of depression and anxiety and subtype membership. However, a significant relationship was found between QEEG subtype membership and length of stay in treatment, with members of the alpha CLUS retained in treatment significantly longer than members of the beta CLUS.

Quantitative electroencephalographic characteristics of crack cocaine dependence.

This study replicates preliminary findings reporting a quantitative electroencephalographic (QEEG) profile of crack cocaine dependence in abstinence. All subjects (n = 52) met criteria for DMS-III-R cocaine dependence (in the form of crack), and were residing in a drug-free therapeutic community. Baseline QEEG evaluations were conducted at intake (5-10 days after last use of crack, and at follow-up (1 month after last reported use). Previous findings of significant excess of relative alpha power and deficit of absolute and relative delta and theta power were replicated in this expanded group. Abnormalities were greater in anterior than posterior regions, and disturbances in interhemispheric relationships were also observed. Further, QEEG showed little change in the interval between the first and second evaluations. This QEEG profile may reflect persistent alterations in neurotransmission as a possible consequence of chronic cocaine exposure.

[Permanent constriction of the jaws in children: 3 cases with extra-articular etiology]. / Les constrictions permanentes des mâchoires de l'enfant. Trois cas d'étiologie extra-articulaire.

Three cases of permanent constriction of the jaw are reported. One was a sequela after a noma, the second occurred in a child with arthrogryposis and the third was an inborn malformation. Each case raised specific problems for diagnosis and treatment. Mechanicotherapy is essential postoperatively and requires a specific electric apparatus to mobilize the joint.

Sensitivity and specificity of QEEG in children with attention deficit or specific developmental learning disorders.

The sensitivity and specificity of QEEG-based discriminant functions were evaluated in populations of children diagnosed with specific developmental learning disorders and those with attention deficit disorders. Both populations of children could be distinguished from each other, and from the normal population, with high levels of accuracy. Pretreatment QEEG could be utilized to distinguish ADD/ADHD children who responded to dextroamphetamine from those who responded to methylphenidate, again with high levels of accuracy. This paper provides a replication of all presented discriminant functions, and should provide the research basis for the generalized utilization of QEEG in the initial evaluation of children with learning and/or attention disorders.

The diagnostic utility of dermatomal evoked potentials.

A study was completed to evaluate the diagnostic utility of dermatomal evoked potentials (EPs) for identifying single and multiple sensory nerve root compromise. We examined the clinical records of 37 patients referred for neck and lower back pain with particular attention paid to presenting clinical symptoms, magnetic resonance (MR) imaging results, and cervical and/or lumbar dermatomal EP results. The primary object of this study was to determine whether or not dermatomal EPs provided useful diagnostic information about nerve root function that would supplement the structural information provided by the MR imaging. We evaluated an outpatient population presenting with neck and lower back pain. These patients had detailed clinical evaluations, MR images, and EP evaluations, each done by independent sources. EP studies included mixed nerve EPs (ulnar and median or tibial nerve), and either C6 and C8 or L4, L5, and S1 dermatomal EPs for cervical and lumbar disorders, respectively. Mixed nerve and dermatomal EPs provided reliable information about nerve root function that corresponded to clinical symptoms more closely than did the MR findings. Specifically, these EPs often provided additional information about lateralized nerve root dysfunction beyond that given by the MR imaging. In some cases, EPs identified disturbances in nerve root function in the absence of MR-imaging-identified structural abnormality.

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization.

Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

Measurement of spinal cord ischemia during operations upon the thoracic aorta: initial clinical experience.

Paraplegia has been an unpredictable, devasting complication following operations upon the thoracoabdominal aorta for over 30 years. The frequency ranges from 0.5% with operations for coarctation to as high as 15% following surgery for thoracoabdominal aneurysms. Both uncertainty and controversy exist about the value of different protective methods during aortic crossclamping (AXC): heparinized shunts, partial bypass, and reimplantation of intercostal arteries. This report describes the authors' initial clinical experience with a highly sensitive indicator of spinal cord ischemia, somatosensory evoked potentials (SEP) in an attempt to prevent paraplegia associated with surgical procedures on the thoracoabdominal aorta. Seven consecutive patients (one coarctation, five thoracic aneurysms, one thoracoabdominal aneurysm) underwent continuous operative monitoring of SEP. Cortical response to simultaneous electrical stimulation (20 mAmps, 0.6 mSec., 2.3 cps) of both the right and left posterior tibial nerves was recorded before, during, and after AXC, and following operation. When ischemic changes were detected by SEP, increasing distal circulation by different maneuvers (heparinized shunt, femoral-femoral bypass, reimplantation of intercostal arteries) reversed these changes. In two patients with thoracic aneurysms, ischemic changes appeared within three minutes after AXC and all potentials disappeared in nine minutes. Rapid insertion of a graft (AXC 28 and 37 minutes) resulted in SEP return 40 minutes following restoration of flow. These changes were prevented by a heparinized shunt in two patients, femoral/femoral bypass in one, and T8-T9 intercostal reimplantation in one. No SEP changes occurred in the patient with coarctation. No postoperative neurologic complications occurred. Continuous operative monitoring of SEP has exciting possibilities for preventing paraplegia. It is simple, highly sensitive, and seems to provide a precise measurement of adequacy of circulation to the spinal cord.

Somatosensory evoked potentials during Harrington instrumentation for scoliosis.

The somatosensory evoked potential can be obtained in the anesthetized patient during corrective surgery on the spine. The techniques of anesthesia and somatosensory evoked potential recordings described herein were utilized in fifty-five patients during surgical correction of scoliosis with Harrington instrumentation and spine fusion. No detectable complications were encountered and no neurological morbidity ensued in our series. This method may prove to be of significant value when potential injury to the spinal cord may be encountered during correction of spinal deformities.