Spectral entropy indicates electrophysiological and hemodynamic changes in drug-resistant epilepsy - A multimodal MREG study.

OBJECTIVE: Epilepsy causes measurable irregularity over a range of brain signal frequencies, as well as autonomic nervous system functions that modulate heart and respiratory rate variability. Imaging dynamic neuronal signals utilizing simultaneously acquired ultra-fast 10 Hz magnetic resonance encephalography (MREG), direct current electroencephalography (DC-EEG), and near-infrared spectroscopy (NIRS) can provide a more comprehensive picture of human brain function. Spectral entropy (SE) is a nonlinear method to summarize signal power irregularity over measured frequencies. SE was used as a joint measure to study whether spectral signal irregularity over a range of brain signal frequencies based on synchronous multimodal brain signals could provide new insights in the neural underpinnings of epileptiform activity. METHODS: Ten patients with focal drug-resistant epilepsy (DRE) and ten healthy controls (HC) were scanned with 10 Hz MREG sequence in combination with EEG, NIRS (measuring oxygenated, deoxygenated, and total hemoglobin: HbO, Hb, and HbT, respectively), and cardiorespiratory signals. After pre-processing, voxelwise SEMREG was estimated from MREG data. Different neurophysiological and physiological subfrequency band signals were further estimated from MREG, DC-EEG, and NIRS: fullband (0-5 Hz, FB), near FB (0.08-5 Hz, NFB), brain pulsations in very-low (0.009-0.08 Hz, VLFP), respiratory (0.12-0.4 Hz, RFP), and cardiac (0.7-1.6 Hz, CFP) frequency bands. Global dynamic fluctuations in MREG and NIRS were analyzed in windows of 2 min with 50% overlap. RESULTS: Right thalamus, cingulate gyrus, inferior frontal gyrus, and frontal pole showed significantly higher SEMREG in DRE patients compared to HC. In DRE patients, SE of cortical Hb was significantly reduced in FB (p = .045), NFB (p = .017), and CFP (p = .038), while both HbO and HbT were significantly reduced in RFP (p = .038, p = .045, respectively). Dynamic SE of HbT was reduced in DRE patients in RFP during minutes 2 to 6. Fitting to the frontal MREG and NIRS results, DRE patients showed a significant increase in SEEEG in FB in fronto-central and parieto-occipital regions, in VLFP in parieto-central region, accompanied with a significant decrease in RFP in frontal pole and parietal and occipital (O2, Oz) regions. CONCLUSION: This is the first study to show altered spectral entropy from synchronous MREG, EEG, and NIRS in DRE patients. Higher SEMREG in DRE patients in anterior cingulate gyrus together with SEEEG and SENIRS results in 0.12-0.4 Hz can be linked to altered parasympathetic function and respiratory pulsations in the brain. Higher SEMREG in thalamus in DRE patients is connected to disturbances in anatomical and functional connections in epilepsy. Findings suggest that spectral irregularity of both electrophysiological and hemodynamic signals are altered in specific way depending on the physiological frequency range.

Consequences of synovectomy of the knee joint: clinical, histopathological, and enzymatic changes and changes in 2 components of complement.

The state of 36 knee joints of 32 rheumatic patients was evaluated after surgical synovectomy, the follow-up period varying from 2 to 39 months. Synovitis was suspected by arthroscopy in 67% and verified histologically in 52%, although in a milder form than at the time of synovectomy. The regenerated synovial tissue was less permeable to serum proteins and contained lower activities of lysosomal enzymes than the excised synovial tissue. Although the number of leucocytes decreased in the joint fluid after synovectomy, the activities of lysosomal enzymes were lowered only slightly, and there was no change in the amount of C3 and C4 components of complement pathway.

The cold foot symptom in sciatica. A clinical and thermographic study.

A thermographic study on admission of 174 hospital patients with sciatica revealed a significant correlation between decreased temperature of the distal part of the affected limb and the probability of spinal nerve root compression. The highest order of preponderance for "coldness" was related to the group of patients whose symptoms were confirmed surgically as those of a herniated disc. The follow-up thermograms of 30 patients, on the average 29,4 months postoperatively showed correlation between normalization of the temperature and the relief of symptoms. Opinions regarding the neurophysiological mechanism of peripheral vasomotor control are controversial and the findings give rise to discussion of its complex pattern. Hypothetically derangement of anterograde axoplasmic transport of vasodilatory peptide macromolecules to the skin vessels may be involved.