Lyme neuroborreliosis presenting with urinary retention and spastic paraparesis.

Progressive myelopathy, urinary retention and gait problems are rare presenting features of Lyme neuroborreliosis. A 30-year-old man had 11 months of urinary retention and 3 months of spastic paraparesis. MR scans of the brain and the spinal cord showed leptomeningeal thickening with contrast enhancement. Cerebrospinal fluid showed mononuclear pleocytosis, decreased glucose, increased protein and chemokine ligand 13, with intrathecal Borrelia-specific IgM and IgG antibodies. He received 14 days of intravenous ceftriaxone followed by 14 days of oral doxycycline. Despite improvement at 6 months, he still had severe gait problems. Urinary retention in otherwise healthy people needs investigation, and Lyme neuroborreliosis is a rare cause.

Out-of-hospital multimodal seizure detection: a pilot study.

Background: Out-of-hospital seizure detection aims to provide clinicians and patients with objective seizure documentation in efforts to improve the clinical management of epilepsy. In-patient studies have found that combining different modalities helps improve the seizure detection accuracy. In this study, the objective was to evaluate the viability of out-of-hospital seizure detection using wearable ECG, accelerometry and behind-the-ear electroencephalography (EEG). Furthermore, we examined the signal quality of out-of-hospital EEG recordings. Methods: Seventeen patients were monitored for up to 5 days. A support vector machine based seizure detection algorithm was applied using both in-patient seizures and out-of-hospital electrographic seizures in one patient. To assess the content of noise in the EEG signal, we compared the root-mean-square (RMS) of the recordings to a reference threshold derived from manually categorised segments of EEG recordings. Results: In total 1427 hours of continuous EEG was recorded. In one patient, we identified 15 electrographic focal impaired awareness seizures with a motor component. After training our algorithm on in-patient data, we found a sensitivity of 91% and a false alarm rate (FAR) of 18/24 hours for the detection of out-of-hospital seizures using a combination of EEG and ECG recordings. We estimated that 30.1% of the recorded EEG signal was physiological EEG, with an RMS value within the reference threshold. Conclusion: We found that detection of out-of-hospital focal impaired awareness seizures with a motor component is possible and that applying multiple modalities improves the diagnostic accuracy compared with unimodal EEG. However, significant challenges remain regarding a high FAR and that only 30.1% of the EEG data represented usable signal.

Systematic Review of EEG Coherence in Alzheimer's Disease.

BACKGROUND: Magnitude-squared coherence (MSCOH) is an electroencephalography (EEG) measure of functional connectivity. MSCOH has been widely applied to investigate pathological changes in patients with Alzheimer's disease (AD). However, significant heterogeneity exists between the studies using MSOCH. OBJECTIVE: We systematically reviewed the literature on MSCOH changes in AD as compared to healthy controls to investigate the clinical utility of MSCOH as a marker of AD. METHODS: We searched PubMed, Embase, and Scopus to identify studies reporting EEG MSCOH used in patients with AD. The identified studies were independently screened by two researchers and the data was extracted, which included cognitive scores, preprocessing steps, and changes in MSCOH across frequency bands. RESULTS: A total of 35 studies investigating changes in MSCOH in patients with AD were included in the review. Alpha coherence was significantly decreased in patients with AD in 24 out of 34 studies. Differences in other frequency bands were less consistent. Some studies showed that MSCOH may serve as a diagnostic marker of AD. CONCLUSION: Reduced alpha MSCOH is present in patients with AD and MSCOH may serve as a diagnostic marker. However, studies validating MSCOH as a diagnostic marker are needed.

Corticomuscular coherence in the acute and subacute phase after stroke.

OBJECTIVE: Stroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke. METHODS: We examined 19 patients with clinically diagnosed stroke and 18 controls. The patients had unilateral mild to moderate weakness of the hand. Each patient attended two sessions at approximately 3days (acute) and 38days post stroke (subacute). Task-related changes in the communication between motor cortex and muscles were evaluated from coupling in the frequency domain between EEG and EMG during movement of the paretic hand. RESULTS: Corticomuscular coherence (CMC) and intermuscular coherence (IMC) were reduced in patients as compared to controls. Paretic hand motor performance improved within 4-6weeks after stroke, but no change was observed in CMC or IMC. CONCLUSIONS: CMC and IMC were reduced in patients in the early phase after stroke. However, changes in coherence do not appear to be an efficient marker for early recovery of hand function following stroke. SIGNIFICANCE: This is the first study to demonstrate sustained reduced coherence in acute and subacute stroke.