Epidemiologic survey of multiple sclerosis in Mures County, Romania.

The present paper filed 129 clinically defined cases of multiple sclerosis (MS) (the prevalence day on December 31, 1986) in Mures County (Transylvania) out of a total population of 615,032 inhabitants, assessing the prevalence rate (20.97/100000) and a predominance of women (F/M = 1.34/1). Incidence (during the last 10 years: 0.86/100000), mortality (0.34/100000), lethality (0.033%) and death (1.83%) rates were also obtained.

Computerized electroencephalographic, polysomnographic, transcranial ultrasound and morphopathological research in vertebro-basilar strokes.

This paper contains a clinical, classical electroencephalographic and computerized electroencephalographic (by original methods) study of 271 cases with vertebro-basilar strokes, all the cases being verified by transcranial Doppler ultrasound investigations and some of the patients by morphopathological studies. In the first part, the standard EEG modifications in relation with the clinical pictures and with the affected arterial field are presented. In the second part, the aspects of the computerized EEG recordings with the carrying out of the cortical EEG mappings which have brought important contributions in setting down the topography of the infarctions are discussed. The third part presents the results of the polysomnographic recordings of the 70 selected cases with ischaemic vertebro-basilar attacks without disorders of consciousness (32 cases), with attacks accompanied by symptomatic hypersomnias (13 cases), with ischaemic attacks accompanied by insomnia (5 cases) and with ischaemic attacks with disorders of consciousness (20 cases). The opinion of the authors on the possible relations between the disturbances of the vigilance, the perturbations of the polysomnographic organization of sleep-wakefulness cycles (with the realisation of some interesting competitive dysfunctions between the three states of vigilance) and the electrographic anomalies are discussed.

Clinical, polysomnographic and computerized electroencephalographic research in temporal lobe epilepsies.

The present study has selected 125 cases with psychomotor attacks (sometimes secondarily generalized). Polysomnographic recordings were carried out for a continuous period of eight hours. All this time, the patients have been observed by video-monitorization on a closed infrared circuit screen. The diagnostic procedure was supported by several computerized EEG mappings (CEM) according to a model achieved by us, transcribing the primary data which were obtained by Hjorth's NSD parameters (activity and ability) from the Siemens-Elema Mingograph to a microcomputer. In many cases, we have employed an interface which had been envisaged by us for analog-digital conversion of amplitudes and frequencies from the Mingograph to the microcomputer. Sleep organization anomalies were found: increase of the percentages of light slow-wave sleep (LSWS) and of REM sleep and reduction of the percentages of deep slow-wave sleep (DSWS). The temporal foci appeared with the greatest frequency and with a clear-cut evidence during LSWS, especially in REM sleep and in the transitional states of SWS to REM sleep and from REM sleep to wakefulness. Our researches supplemented with CEM, demonstrate a peculiar activation of the temporal foci during REM sleep, during the states of LSWS and during the transitional states, showing that many psychomotor attacks appear predominantly during these sleep states and that many cases initially clinically misinterpreted as grand mal seizures are, in fact, focal temporal epilepsies secondarily generalized.

Clinical, EEG, electromyographic and polysomnographic studies in restless legs syndrome caused by magnesium deficiency.

The present paper reports biochemical and neurophysiological investigations in ten cases with restless leg syndrome. Other neuropsychiatric affections and factors which could generate the symptomatology of restless legs syndrome were not included. The EEG recordings demonstrated evident reticular neuronal hypersynchrony generated by hyperpnoea (sinusoidal slow waves). The classical EEG investigations pointed out neuromuscular hyperexcitability, but some modifications of the functional parameters of the neuromuscular excitability and conductibility (signs of neuropathy) were also noticed. In all the cases, continuous 8-hour polysomnographic recordings and monitorization on infrared TV screen were performed. Investigations reported: important disorders of sleep organization, agitated sleep with frequent periods of nocturnal awakenings, increase of the durations and percentages of light slow-wave sleep (LSWS) and rapid and frequent changes of various stages of LSWS, a decrease of duration and percentage of DSWS, a decrease of duration and percentage of REM sleep (as in other parasomnias caused by magnesium deficiency) and nocturnal EEG anomalies (long discharges of sinusoidal slow waves, of sharp waves and of sharp slow waves appearing in the LSWS stages with the disappearance in the REM sleep).

Polysomnographic and computerized electroencephalographic studies in myoclonic petit mal epilepsies.

The study included 203 epileptic absences: 1. Simple; (30 cases); 2. Myoclonic petit mal absences (62 cases); 3. Amyotonic-akinetic absences (41 cases); 4. Temporal lobe absences (62 cases); 5. "Hybrid" absences in Lennox-Gastaud disease (13 children). This paper presents only the myoclonic petit mal absences (57 cases). Correlations of the clinical, EEG and polysomnographic data were found by several methods: a. The patients were video-monitored on an infrared closed-circuit TV screen: b. The Hjorth's NSD parameters were computed on a Siemens-Elema Mingograph; c. The EEG graphoelements were morphologically analyzed every second throughout the discharges, by means of an original technique; d. Computerized EEG mappings (CEM) were performed for various periods, also including the sequential ones, second by second, all along the epileptic discharges; e. 8 hours of continuous polysomnographic recordings. The peculiar electroclinical features of the five types of absences have been emphasized. Regarding the myoclonic petit mal absences, the discharges of polyspikes and waves manifested an evident increase in the number and duration within the LSWS stages and during the transition from the wakefulness state to sleep and from the LSWS to the wakefulness, and a transformation in slow polyspikes and waves complexes during the stages III and IV. The CEM were always asymmetrical during sleep and the maximal amplitudes were seen on the anterior and posterior temporal regions. In all the REM stages, the polyspikes and waves disappeared.

REM narcolepsy, clinical polysomnographic and computerized electroencephalographic studies.

Clinical and polysomnographical investigations have been performed in 35 patients with REM narcolepsy (group 1), comparatively with 45 patients suffering from symptomatic hypersomnia in NREM sleep (group 2). The polysomnographical recordings have been made by: a) continuous recording covering 24 h; b) submission of the subjects to the "Maintenance of wakefulness tests" (MWT). In 20 narcoleptics and in 12 normal subjects, computerized EEG mappings were performed in wakefulness and in different sleep stages. In the narcoleptic patients, the association of the sleep attacks with other symptoms of Gélineau's disease has been noticed. The 24 h continuous polysomnographical recordings pointed out relevant differences between the first and the second group: the patients with REM narcolepsy (Gélineau's disease) presented increased quantities and percentages of REM sleep and manifested several periods wish sleep-onset REM. Comparatively, the patients with NREM hypersomnias slept predominantly in NREM sleep, and presented normal percentages of REM sleep and also manifested sleep-onset NREM periods. One found great differences between the two groups by the MWT, that is, in the first group the mean values of REM sleep were greater, the REM latency and the sleep latency were very short and one assisted to many sleep-onset REM. The cortical EEG mappings were ampler and slower on the right posterior temporal and occipital regions (especially during the REM sleep) either in normal or in narcoleptic patients. These results suggest the consistency of some previous data regarding the differentiation of the true REM narcolepsy (as an independent entity) from the various frequent NREM hypersomnias.

Electroclinical correlations in temporal lobe epilepsy.

2,698 epileptic patients were studied, 2,019 cases (64.3%) presenting temporal lobe epileptic attacks. Besides the routine EEG recordings and the corroboration of the clinical data with the meticulous observations by video monitoring on a closed circuit TV-screen (the patients being observe in a specially arranged room, provided with infra-red cameras), the diagnostic procedure was supported in all cases by several computerized EEG mappings, according to a model achieved by us, transcribing the primary data obtained by Hjorth's NSD parameters from the Siemens-Elema Mingograph to a Romanian M-118 microprocessor. In many cases we utilized an interface--built by us--for analog-digital conversion which allowed the direct introduction and conversion of amplitudes and frequencies from the Mingograph to the micro-computer. These were isolated to analyse the following electroclinical forms: 1. temporal absences: 360 cases (17.8%); 2. psychomotor attacks: 439 cases (21.7%) 3. psychosensory attacks: 77 cases (3.8%); 4. attacks with cognitive symptomatology: 260 cases (12.8%); 5. crises with ideative-affective symptomatology: 76 cases (3.8%); 6. vegetative attacks: 51 cases (2.5%); 7. akinetic attacks: 89 cases (4.4%); 8. focal temporal attacks secondarily generalized: 667 cases (33.0%). In 112 patients with nocturnal attacks, polysomnographic recordings were performed with sequential computerized EEG mappings during the various stages of sleep (concomitantly with the infrared video-TV monitoring).

Polysomnographical researches in patients with temporal lobe epilepsy.

One hundred and twelve patients with temporal lobe epilepsy were studied. Continuous polysomnographical recordings were performed for eight hours, the patients being video-monitored all the time. These researches, completed with computerized EEG cortical mappings demonstrated a peculiar activation of the temporal foci during REM phases and during some stages of LSWS.

Clinical, computerized EEG and polysomnographical studies in some myoclonic syndromes.

Forty-two patients with myoclonic manifestations (especially during subacute sclerosing panencephalitis (SSPE)) were studied. The multidimensional investigations pointed out that myoclonias produce several EEG and polysomnographical perturbations: 1. Sleep disorganization; 2. Appearance of the myoclonic jerks in wakefulness (especially) and in some sleep stages; 3. Some electroclinical discordances; 4. A great variability of the myoclonias during some sleep stages; 5. EEG cortical mappings showed individual variabilities of Radermecker complexes.

Lipoproteinlipase activity in multiple sclerosis and other neurologic diseases.

Taking into account the disturbances of lipid metabolism occurring in patients with demyelinating diseases, an expected finding was their increased basal lipolytic activity. We investigated 135 cases divided into 4 categories: 1. MS; 2. inflammatory diseases of the CNS; 3. cerebrovascular diseases and other diseases without any CNS organic involvements; 4. a group of absolutely healthy controls (blood donors). High values of plasmatic lipolytic activity were found in multiple sclerosis patients as compared with the other groups. They were probably due to the effect of a disturbance with an influence upon the basal lipoproteinlipase activity too. This influence is likely to refer to the stages of the process by which heparin releases lipoprotein-lipase from the capillary endothelium. Significant correlations between the clinical evolution of the disease and the values of lipolytic activity were pointed out. Measurement of this activity is a useful biochemical test in the diagnosis of multiple sclerosis.

Relationships between the degree and topography of the atherosclerotic lesions of the extracranial carotid axis with the clinical form of ischaemic attack, evaluated by duplex methodology.

Carotid echotomography (CET) in the duplex system was made in 118 patients with atherosclerotic lesions of various degree (insignificant stenoses--ISS; significant stenoses--SS and thromboses) of the extracranial carotid axis. The atherosclerotic lesions were localized mainly at the level of the carotid bifurcation (CB) and/or at the level of the carotid sinus. The clinical form of the ischaemic attack was better correlated with the extension of atherosclerotic lesions in the extracranial carotid axis than with the severity of these lesions.

Parasomnias (non-epileptic nocturnal episodic manifestations) in patients with magnesium deficiency.

Twenty seven patients with parasomnias (night terrors, nocturnal motor automatisms, nocturnal verbal automatisms and sometimes with bruxisms) associated with magnesium deficiency were selected. In all of them marked hypomagnesemia, clinical, EEG and EMG signs of spasmophilic syndromes were found. The 8 hours polysomnographical recordings of all cases (monitored in a system with infra-red video-TV cameras) showed severe sleep disorders and EEG nocturnal abnormalities occurring in the SWS (especially in the I b, II and III stages) with disappearance in the REM sleep. The authors suggest that these clinical and polysomnographic anomalies may be the expression of the brain damage caused by magnesium deficiency or of the clinical electrographic manifestations of the reticulate neuronal hypersynchrony exacerbated by sleep.

Spectral analysis of Doppler signal in the prophylaxis of ischemic cerebrovascular accidents in extra- and/or intracranial carotid and vertebral systems.

Using continuous-wave spectral analysis of Doppler signal (SADS) and/or pulsed-wave transcranial Doppler ultrasonography (TCD-US) we examined 263 patients with ischemic cerebrovascular diseases (ICVD) symptoms in the carotid and vertebrobasilar (V-B) systems. The degree of stenosis was established by taking into consideration the parameters of the spectrum of frequency (systolic peak velocity--SV; end-diastolic velocity--DV); the ratio between SV of internal carotid artery (ICA) and common carotid artery (CCA); the ratio between DV of ICA and CCA as well as the value of the spectral broadening (SB) index. The diminution of DV in CCA with increased values of Pourcelot's circulatory resistance index (RP) and spectral broadening index (SB) as compared with the controlateral part, but with apparent increase (over 3.5 kHz) of SV in ICA was constantly observed in significant stenoses of extracranial ICA. Our observations have pointed out that when proximal ICA occlusion is being formed slowly and progressively, ECA (whose increased circulatory resistance under normal conditions reflects diminished diastolic velocities) gradually takes over the hemodynamic characteristics of ICA which is expressed by increased DV, approximating DV and ICA. This situation may give rise to erroneous interpretations.

[Nocturnal bruxism. Contributions to the detection and assessment of involvement in the craniomandibular pain dysfunction syndrome]. / Bruxismul nocturn. Contributii la depistarea si aprecierea afectiunii in cadrul sindromului disfunctional dureros cranio-mandibular (S.D.D.C.M.).

The authors review the most updated information concerning the etiopathogenesis of nocturnal bruxism, stressing the co. destructive role of psychosomatic factors and of traumatogenic ones, of the type of premature dental contacts, and of occluding interferences, with evident direct implications in the buccal cavity and at a distance, giving rise to hypnic masticatory automatism, with painful hypercontraction of the masticatory muscles, and stress exerted on the temporomandibular articulations. On the basis of original studies of the interdisciplinary type (prosthetic gnathology and neurophysiology), with the aid of polygraphic investigations during sleep carried out in subjects with nocturnal bruxism it was possible to demonstrate that this oral parafunction may determine sleep disturbances at a central level which makes necessary a complex stomatologic and neuropsychiatric medical therapy.

Polysomnographic and computerized waking-sleep research in epileptic petit mal absences.

The authors carried out 8 hours of continuous night polysomnographic recordings in 40 selected cases with various forms of absences. In all these patients, the computerized electroencephalographic mappings were performed according to several methods achieved by the authors. The nocturnal electrographic abnormalities, the morphological patterns of the epileptic discharges during different sleep stages and the cortical computerized cartography were comparatively analysed in the five groups of patients: 1) genuine (pure, classical or simple) petit mal (PM) absences: 8 cases; 2) myoclonic PM absences: 10 cases; 3) amyotonic-akinetic PM absences: 6 cases; 4) "false" temporal epileptic absences: 10 cases; 5) "hybrid" (or "bastard") PM absences in 6 cases with Lennox-Gastaut disease.

Computerized electroencephalographic mapping in hypomagnesian spasmophilic syndromes.

Out of 397 patients presenting hypomagnesaemia there were selected for this study only 107 cases with neurotic and neuromuscular clinical picture (sometimes with short and simple loss of consciousness) without any sign of organic cerebral lesion. The dosing of the seric and erythrocytic magnesium was performed by means of a colorimetric method of Mann and Yoe, modified by the authors. In all the cases, the EEG and EMG changes were studied by simultaneous recording of the EEG and EMG before, during and after hyperpnoea. In these 107 selected cases (divided into three groups: children, adolescents and adults) the computerized electroencephalographic maps (CEM) were carried out by an original method, transcribing the primary data of Hjorth's NSD parameters (Amplitudes and Frequencies) into a Romanian M-118 microcomputer, by a technique with analog-digital conversion. The CEM (in white-black and in colour cartography) were performed for various epochs, including the sequential ones (second by second, all along the EEG discharges during and after hyperpnoea). By these methods, we analyzed the dynamic fluctuation and temporo-spatial cortical distribution of the sinusoidal slow waves generated by the reticulate neuronal hypersynchrony. The CEM showed some differences in the three groups of hypomagnesemic syndromes selected.