Cilostazol as adjunctive therapy in treatment of children with autism spectrum disorders: a double-blind and placebo-controlled randomized trial.

We aimed to evaluate cilostazol therapeutic effects on aberrant behaviors of autism spectrum disorder (ASD) children and its safety profile in a double-blind, randomized clinical trial. Sixty-six children with confirmed ASD were allocated to receive either daily 50-mg cilostazol (increased to 100 mg/day after 2 weeks) or matched placebo in addition to risperidone. The Aberrant Behavior Checklist-Community Edition (ABC-C) scale and a checklist of probable adverse effects were used to assess the behavioral outcomes and safety profile at weeks 0, 5, and 10 of the study. Sixty-one participants, with comparable baseline characteristics, completed the trial. Unlike other ABC-C subscales, repeated-measures analysis showed significant effect for time × treatment interaction in the hyperactivity subscale ( P = 0.047; partial eta squared = 0.06). We used the median value for the baseline score hyperactivity subscale [median (interquartile range) = 31 (24-37)] to stratify participants to higher hyperactivity and lower hyperactivity subgroups and found that only participants with higher hyperactivity benefit from cilostazol adjunctive therapy ( P = 0.028; partial eta squared = 0.14). Cilostazol could be considered as a safe agent with beneficial effects on hyperactivity in children with ASD and higher levels of hyperactivity.

Proximal coronary sinus pacing induced prolonged asystole.

BACKGROUND: Atrioventricular node (AVN) is an interatrial septum structure located at the apex of triangle of Koch that modulates the transmission of impulses from atria to the ventricles. Vagally mediated AVN block with high frequency stimulation (HFS) was investigated in a few animal and human studies, but prolonged ventricular asystole that was induced by a low frequency proximal coronary sinus (CS) overdrive pacing has rarely been reported. CASE REPORT: A 40-year-old man was admitted in our hospital for evaluation of syncope and palpitation. He presented with prolonged ventricular asystole by proximal CS pacing during electrophysiological study (EPS). CONCLUSION: There is no comprehensive clinical study to investigate the association of vasovagal syncope with vagally mediated atrioventricular block (AVB) which is induced by posteroseptal area stimulation. Radiofrequency catheter ablation of ganglionated plexi (GP) located close to sinus node and AVN was reported to eliminate the vagal efferent output during vasovagal syncope as a new treatment strategy.

Abnormalities of Alpha Activity in Frontocentral Region of the Brain as a Biomarker to Diagnose Adolescents With Bipolar Disorder.

Objectives. To investigate brain abnormalities in adolescents with new-onset bipolar disorder (BD) during acute hypomanic and depressive episodes using electroencephalogram (EEG) analysis and to derive a computer-based method for diagnosis of the disorder. Methods. EEG spectral power and entropy of 21 adolescents with BD (included 11 patients in the hypomanic episode and 10 patients in the depressive episode) and 18 healthy adolescents were compared. Moreover, using significant differences and K-nearest-neighbors (KNN) classifier, it was attempted to distinguish the BD adolescents from normal ones. Results. The BD adolescents had higher values of spectral power in all frequency bands, particularly in the frontocentral, mid-temporal, and right parietal regions. Also, spectral entropy had significantly increased in delta, alpha, and gamma frequency bands for BD. A high accuracy of 95.8% was achieved by all significant differences in the alpha band in discriminating adolescents with BD. The depressive state showed higher values of spectral power and entropy in low-frequency bands (delta and theta) compared to the hypomanic state. Conclusion. Based on BD symptoms, especially inattention, increased alpha power is a rational finding which is associated with thalamus dysfunction. Thus, it seems that EEG alpha oscillation is the main source of abnormality in BD. Furthermore, EEG slowing in the depressive episode is related to inhibition of electrical activity and reduced cognitive functions.

Cortical Alpha Activity in Schizoaffective Patients.

Objective: Electrophysiological studies have identified abnormal oscillatory activities in the cerebral cortex in schizophrenia and mood disorders. Biological and pathophysiological evidence suggests specific deficits in serotonin (5-HT) receptor function in schizoaffective disorder (SA), a clinical syndrome with characteristics of both schizophrenia and bipolar disorder. This study investigated alpha oscillations in patients with SA. Method: Electroencephalography was used to measure ongoing and evoked alpha oscillations in 38 adults meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for SA, and in 39 healthy controls. Results: Spontaneous alpha power of the participants with SA was significantly lower than that of healthy participants [F (1, 75) = 8.81, P < 0.01]. Evoked alpha activity was also decreased in SA compared to controls [F (1, 75) = 5.67, P = 0.025]. Conclusion: A strong reduction of alpha power in the posterior regions may reflect abnormality in the thalamocortical circuits. It is shown that hypoxia and reduced cerebral blood flow is associated with reduced alpha activity among different regions of the brain. Therefore, it can be concluded that greatly decreased alpha activity, particularly in centro-parietal and occipital regions, is related to SA symptoms such as hallucinations.

Electroencephalogram complexity analysis in children with attention-deficit/hyperactivity disorder during a visual cognitive task.

OBJECTIVE: The aim of this study was to investigate electroencephalogram (EEG) dynamics using complexity analysis in children with attention-deficit/hyperactivity disorder (ADHD) compared with healthy control children when performing a cognitive task. METHOD: Thirty 7-12-year-old children meeting Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for ADHD and 30 healthy control children underwent an EEG evaluation during a cognitive task, and Lempel-Ziv complexity (LZC) values were computed. There were no significant differences between ADHD and control groups on age and gender. RESULTS: The mean LZC of the ADHD children was significantly larger than healthy children over the right anterior and right posterior regions during the cognitive performance. In the ADHD group, complexity of the right hemisphere was higher than that of the left hemisphere, but the complexity of the left hemisphere was higher than that of the right hemisphere in the normal group. CONCLUSION: Although fronto-striatal dysfunction is considered conclusive evidence for the pathophysiology of ADHD, our arithmetic mental task has provided evidence of structural and functional changes in the posterior regions and probably cerebellum in ADHD.

EEG classification of adolescents with type I and type II of bipolar disorder.

Bipolar disorder (BD) is a severe psychiatric disorder and has two common types: type I and type II. Early diagnosis of the subtypes is very challenging particularly in adolescence. In this study, 38 adolescents are participated including 18 patients with BD I and 20 patients with BD II. The electroencephalogram signal is recorded by 19 electrodes in open eyes at resting state. After preprocessing, the state of the art methods from various domains are implemented to provide a good feature set for classifying the two groups. In order to improve the classification accuracy, four different feature selection methods named mutual information maximization (MIM), conditional mutual information maximization (CMIM), fast correlation based filter (FCBF), and double input symmetrical relevance (DISR) are applied to select the most informative features. Multilayer perceptron (MLP) neural network with a hidden layer containing five neurons is used for classification with and without applying the feature selection methods. The accuracy of 82.68, 86.33, 89.67, 84.61, and 91.83 % were observed using entire extracted features and selected features using MIM, CMIM, FCBF, and DISR methods by MLP, respectively. Therefore, the proposed method can be used in clinical setting for more validation.

Characteristics of Alpha Band Frequency in Adolescents with Bipolar II Disorder: A Resting-State QEEG Study.

OBJECTIVE: The aim of this study was to compare the QEEG of adolescents affected by bipolar II disorder with age and gender matched healthy controls, and to extract the characteristics of the alpha frequency band to better understand this disorder. METHODS: Twenty one adolescents affected by acute episodes of bipolar II disorder (BMD II), both hypomanic and depressive episodes, were selected via convenience sampling based on DSM IV criteria and child and adolescent psychiatrist diagnosis. Eleven patients were going through a hypomanic episode and 10 patients were going through a depression episode. Of the participants, 18 who were matched with the patient group participated in this study as a normal group. Any major comorbidities and intellectual disabilities were excluded through applying K-SADS-PL and Raven's IQ test for all the patients and the healthy participants. Electroencephalogram signals were obtained according to 10-20 international system by 21 electrodes from participants in open and closed eyes in a resting state. We selected 40 seconds length segments from each recorded EEG signals that had minimal noise and artifacts. Power spectrum density (PSD) was estimated for each segment and extracted alpha band frequency. We used only referential (unipolar) montage for comparison. Eventually, data were analyzed by independent Mann-Whitney test and independent t test. RESULTS: We observed significant differences in the alpha frequency band in some brain regions. Alpha power increased in the fronto-central region and right parietal lobe in the patients (P < 0.05). In the patients with BMD II, entropy of alpha oscillations was larger than the normal participants in the central region and in the F3, F4 and P4 channels. Also, there were differences in the variance of alpha oscillations in these regions between the two groups (P < 0.05). In the occipital lobe, alpha wave had different skewness between the two groups (P < 0.05). CONCLUSION: Thalamus as a generator and modulator of at least a part of alpha oscillations may be involved in this disorder and hence this explains the major symptoms like distractibility and inattention in both hypomanic and depressive episodes of bipolar II disorder.

Quantitative electroencephalogram (QEEG) Spectrum Analysis of Patients with Schizoaffective Disorder Compared to Normal Subjects.

OBJECTIVE: The aim of this study was to achieve a better understanding of schizoaffective disorder. Therefore, we obtained electroencephalogram (EEG) signals from patients with schizoaffective disorder and analyzed them in comparison to normal subjects. METHOD: Forty patients with schizoaffective disorder and 40 normal subjects were selected randomly and their electroencephalogram signals were recorded based on 10-20 international system by 23 electrodes in open- and closed-eyes while they were sitting on a chair comfortably. After preprocessing for noise removal and artifact reduction, we took 60- second segments from each recorded signals. Then, the absolute and relative powers of these segments were evaluated in all channels and in 4 frequency bands (i.e., delta, theta, alpha and beta waves). Finally, Data were analyzed by independent t-test using SPSS software. RESULTS: A significant decrease in relative power in the alpha band, a significant decrease in power spectra in the alpha band and a significant increase in power spectra in the beta band were found in patients compared to normal subjects (P < 0.05). The predominant wave in the centro-parietal region was the beta wave in patients, but it was the alpha band in normal subjects (P = 0.048). Also, the predominant wave of the occipital region in patients was the delta wave, while it was the alpha wave in normal subjects (P = 0.038). CONCLUSION: Considering the findings, particularly based on the significant decrease of the alpha waves in schizoaffective patients, it can be concluded that schizoaffective disorder can be seen in schizophrenia spectrum.