Electrogastrography for diagnosis of early-stage Parkinson's disease

IntroductionPatients with Parkinson's disease (PD) often present with gastric symptoms. Electrogastrography (EGG) can noninvasively assess gastric electric activity and may be useful for early PD diagnosis. The present study aimed to compare the efficacy of EGG in early PD diagnosis with those of ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and odor stick identification test –Japanese version (OSIT-J).MethodsThirty-seven untreated PD patients (mean age ± SD, 66 ± 8years; disease duration < 3 years) and 20 healthy control subjects (68 ± 6.9 years) were recruited. EGG and OSIT-J were performed in both groups, and MIBG scintigraphy in the PD group. EGG parameters were assessed in the preprandial and early and late postprandial segments using power spectrum analysis.ResultsIrregular EGG waves were observed in PD patients. The preprandial instability coefficient of dominant frequency (ICDF), an index of EGG irregularity, in PD patients (9.5% [6.3%]) was higher than that in controls (3.9% [3.9%], p = 0.00005). The OSIT-J score was also lower in PD patients (4.6 [3.3]) than in controls (7.7 [3.3], p = 0.006). In receiver operating characteristics analyses, the areas under the curves of preprandial ICDF and OSIT-J were 0.83 and 0.72, respectively. The sensitivities of preprandial ICDF and MIBG (delayed-phase) scintigraphy were 73% and 70%, respectively.ConclusionsEarly and untreated PD patients showed irregular EGG waves and high ICDF. EGG showed better accuracy than the olfactory test for early PD diagnosis and similar sensitivity to MIBG scintigraphy.     

Intracranial hemorrhage in hypothermic low-birth-weight neonates

We studied periventricular/intraventricular type intracranial hemorrhage (ICH) by cranial ultrasonography in 82 low-birth-weight (LBW) newborn infants with admission hypothermia against the gestational-age-matched 82 normothermic neonates. The incidence of ICH was higher in the hypothermic infants during the 1st week of life (34/82 vs 20/82, P<0.02). Although the distribution of individual grades of ICH was not significantly different between the groups, the first ultrasound scan showed higher incidence of major ICH (grades 3 and 4) in the hypothermic infants. Most of the minor ICH (grades 1 and 2) after the first ultrasound appeared in infants who were small for their gestational age. Our data do not support the contention that admission hypothermia can precipitate the development of IVH in LBW infants. However, the detection of admission hypothermia in a LBW neonate should make one suspect the possibility of ICH and regard it as a manifestation of the severity of ICH rather than the cause. Most likely, this close relationship between hypothermia and neonatal ICH originates from perinatal asphyxia and the cumulative adverse effects of asphyxia-related events.     

脑干听觉诱发电位在新生儿黄疸患儿中的应用

目的通过脑干听觉诱发电位(BAEP)检测,研究血清胆红素水平对新生儿黄疸患儿听力及脑干功能影响,及早产与足月黄疸患儿BAEP变化。方法297例新生儿黄疸患儿按血清胆红素(SB)水平分为5组,比较各组新生儿BAEP异常率。297例新生儿黄疸患儿按足月与早产分为2组,比较2组新生儿BAEP异常率。结果各组患儿BAEP异常率随血清胆红素水平增高而增高(P<0.01),早产儿BAEP异常率显著高于足月儿(P<0.01)。结论新生儿黄疸患儿血清胆红素水平越高,对BAEP影响越大,血清胆红素对早产儿影响更大。对新生儿进行BAEP检测,能及早发现听力及脑干功能异常,有利于早期干预。     

High-resolution electroencephalography and source localization in neonates

Although Electroencephalography (EEG) source localization is being widely used in adults, this promising technique has not yet been applied to newborns because of technical difficulties, such as lack of data concerning the newborn skull conductivity, thickness, and homogeneity. Using a new type of EEG headcap molded on each baby's head, we aimed to determine whether this technique could be adapted to neonates, and to evaluate the importance of these technical difficulties. We carried out EEG source reconstruction of the recordings of five neonates using dipole fit algorithm. We used four different head models for each neonate, obtained from individual MRI scans: normal skull thickness and conductivity of 0.0042 S/m; normal thickness and conductivity of 0.33 S/m; increased thickness and conductivity of 0.0042 S/m; and normal thickness and conductivity with a modeled bregma fontanel. Dipole locations were consistent with MRI and clinical data. The mean difference between the dipole locations in the 0.0042 and the 0.33 S/m skull layer models was 11.6 +/- 2.5 mm, with an average 29.7% decrease in magnitude for the 0.33 S/m model but no significant changes for the dipoles orientation. Skull layer thickness had a large influence on magnitude, but no significant effect on position and orientation. The mean difference between the dipole locations induced by the modeled fontanel was 2.0 +/- 2.1 mm, with an average 2.1% increase in magnitude. Our results show that EEG source localization is feasible in neonates. With further development, the technique may prove useful for neurological evaluation of neonates.     

新生儿脊髓拴系综合征的显微外科治疗(附48例分析)

目的探讨新生儿脊髓拴系综合征(TCS)的临床特征及显微手术操作要点。方法回顾性分析48例新生儿TCS的临床资料,包括症状、体征、辅助检查结果。术中均采用显微镜进行外科手术治疗,并随访其临床症状的改善程度。结果本组病儿随访疗效良好。6例双下肢及双足不对称中病人中,恢复正常4例,改善2例。4例大小便失禁病人中能自主控制大小便2例,症状略改善2例。3例马蹄内翻足由骨科矫形治疗后均痊愈,2例双下肢轻瘫病人肌力略改善。余病儿术后大小便均正常,双下肢活动好。结论新生儿TCS均由先天因素引起,早期手术可避免日后出现神经功能障碍。     

Haemostatic profile of healthy premature small for gestational age neonates

Background

The pathogenetic profile of premature Small for Gestational Age (SGA) neonates is strongly related to their haemostatic equilibrium, which is inadequately understood.

Objective

To evaluate coagulation and fibrinolysis in premature SGA neonates before intervening with Vitamin K administration.

Study design

We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born prematurely [gestational age (G.A.) < 37 weeks]. Study population consisted of 139 preterm newborns, 68 of whom were SGA (25 males and 43 females), while 71 were AGA (37 males and 34 females) that consisted the control group. Blood samples were obtained within 30 minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test and the Mann-Whitney U test were used to compare the differences between the values of haemostatic parameters.

Results

Premature SGA infants presented significantly lower levels of fibrinogen (p < 0.029) and higher levels of VIIIc factor, APCR, tPA and PAI-1 (p < 0.041, 0.017, 0.021 and 0.019 respectively). The two groups had similar demographic characteristics (except from birth weight), without significant differences in the values of other haemostatic parameters.

Conclusions

Despite the statistically significant differentiation in the levels of fibrinogen, VIIIc factor, APCR, tPA and PAI-1, the rest of haemostatic parameters have similar values between SGA and AGA preterms.     

Electrogastrography abnormality in eating disorders

Eating disorders are common psychiatric disorders in young women. The aim of the present study was to evaluate the gastric electrical activity of patients with eating disorders and its relation to their symptoms. The electrogastrography (EGG) was performed before and after a water load test for outpatients with eating disorders (n = 36; 14 anorexia nervosa, 14 bulimia nervosa, eight eating disorder not otherwise specified) and healthy women (n = 19). A structured interview (Eating Disorder Examination) was used to assess clinical symptoms. The percentage of normal gastric myoelectrical power was significantly smaller in the eating disorder patients (44.5% vs 74.2%; P < 0.05), while the percentage of bradygastric power was significantly greater, both before and after the water load test compared with the control subjects (30.4% vs 10.4%; P < 0.05). In addition, moderate correlation was found between the duration of illness and the percentage of bradygastria (P < 0.05). In conclusion, it is suggested that longstanding abnormal eating in patients with eating disorders may induce disturbances to gastric motor function, resulting in their abnormal, eating-related behavior, and form a symptomatic vicious circle. The EGG may be a promising method for determining the pathophysiology of eating disorders and for developing effective therapeutic approaches.     

Heparin clearance and ex vivo recovery in newborn piglets and adult pigs

The newborn infant requires more heparin per kg body weight than the adult to achieve similar heparin plasma levels. Possible mechanisms include altered heparin pharmacokinetics and/or a decreased expression of anticoagulant activity of heparin in newborn plasma because of low levels of antithrombin III (AT-III). We measured the pharmacokinetics and the anticoagulant activity of heparin in the pig (AT-III level:100%), in the piglet (levels of AT-III: 50% of adult) and the piglet given exogenous porcine AT-III. All pigs were bolused with ¹²⁵I-heparin (25 or 100 units/kg) and blood samples collected for the measurement of ¹²⁵I-radioactivity, and antifactor Xa activity. The half-life of ¹²⁵I-heparin was dose-dependent and similar in pigs and piglets; however, the volume of distribution was greater in the newborn resulting in an increased total clearance compared to the pig. The anti-factor Xa activity disappeared earlier in the piglet than in the pig. Both the kinetics and the absolute recovery of anti-factor Xa activity were normalized to pig values (after correction for different volumes of distribution) when the piglets were infused with exogenous AT-III. Thus apparent heparin resistance of the newborn is due to both an increased volume of distribution and the low AT-III level which limits the measurement of the anticoagulant activity of heparin in conventional anti-factor Xa assays.     

Electrogastrography in patients with Parkinson's disease

BACKGROUND: Impaired gastrointestinal motility in Parkinson's disease may affect absorption of levodopa and contribute to the disabling response fluctuations (RF). In this study gastric myoelectric activity was recorded with electrogastrography in patients with PD and correlated with the duration, severity and the presence of RF. METHOD: Electrogastrography (EGG) was performed in 36 patients with PD of which 22 were men. The mean age was 67 years (48-81), mean duration of disease was 7.07 years (1-20), and mean duration of treatment with levodopa was 5.07 years (1-20). Gastric dysrhythmia was diagnosed when either preprandial or postprandial dysrhythmia for more than 30% of the recording period was detected. RESULTS: The EGG was abnormal in 24 of 36 patients. Significant association was found between preprandial dysrhythmia and duration of disease (P=0.002); duration of levodopa treatment (P=0.003), severity of 86RF (P=0.001), but not with age (P=0.076). Out of 18 patients with RF, 17 had at least one pattern of dysrhythmia. In 11 out of the 18 patients without RF, the EGG was normal while the remaining seven had at least one pattern of dysrhythmia. CONCLUSION: Abnormal EGG was quite common in this group of patients with PD, particularly in those with RF. The most common pattern of abnormality was preprandial dysrhythmia, which was positively associated with disease duration and length of levodopa treatment. Although frequently asymptomatic, preprandial dysrhythmia leading to impaired gastric emptying may contribute to irregular absorption of levodopa from the small intestine and contribute to disabling response fluctuations.     

Haemostatic profile of full-term, healthy, small for gestational age neonates

Background

Small for Gestational Age (SGA) neonates often appear with haemostatic alterations, principally due to hepatic dysfunction that results from chronic intrauterine hypoxia. Polycythaemia and thrombocytopenia are common findings in this neonatal population.

Study design

We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born full term [gestational age (G.A.) > 37 weeks]. Study population consisted of 188 healthy newborns, 90 of whom were SGA (62 females and 28 males), while the rest were the control group (44 females and 54 males). Blood samples were obtained within 30 minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test was used to compare the differences between the values of haemostatic parameters.

Results

Statistical analysis revealed a significant prolongation in PT, INR, elevated levels of tPA (p < 0.015, 0.01 and 0.002 respectively) and a decrease in the values of XII and free protein S (p < 0.045 and 0.007 respectively) in SGA full term neonates. The two groups had similar demographic characteristics (except birth weight), without significant differences in the values of other haemostatic parameters.

Conclusions

Despite of statistically significant differences in PT, INR, values of tPA, XII and free protein S, levels of haemostatic factors range within laboratory references for healthy full term newborns. These findings were not accompanied with clinical manifestations of altered haemostasis.     

Congenital brain tumors in Japan (ISPN Cooperative Study): specific clinical features in neonates

The authors present specific clinical features of brain tumors occurring in immature brain in comparison with those of older infants and children. Twenty-six neonatal brain tumors, which accounted for 11.3% of 231 brain tumors diagnosed in the 1st year of life collected in a cooperative study in Japan, were analyzed. Although astrocytomas were invariably common tumors in each age group, comprising 25.0% for all pediatric brain tumors, teratomas were the most common type of neonatal brain tumors and accounted for 33.4% in this age group. Location of tumors in the immature brain was more striking, involving the posterior fossa region less commonly, as in 11.1% in neonatal, 29.5% in infantile, and 41.4% in all pediatric age groups. Surgical intervention was performed in 97.4% of the infantile and 79.1% of the neonatal cases, but total or subtotal resection of the mass was achieved only in 58.9% in the infants and 73.7% in the neonates. There was more strict limitation in performing the adjuvant therapies in the immature age groups. Radiation therapy and chemotherapy were given only in 32.0% and 27.6%, respectively, in the neonatal cases. The prognosis was extremely poor in the immature cases: 1-year, 5-year, and 10-year survivial rates were 59.3%, 26.1%, 11.5% in the infants, and 43.5%, 23.8%, 7.1% in the neonates, respectively. Of the neonates, 76% and of the infants 73.1% were retarded. The present study delineates the characteristic clinical features of tumors involving immature brain and emphasized that establishment of more specific therapeutic modalities is urgent.     

脑干听觉诱发电位在新生儿缺氧缺血性脑病中的应用价值

目的了解脑干听觉诱发电位对评价新生儿缺氧缺血性脑病预后的临床应用价值。方法对67例缺氧缺血性脑病患儿进行脑干听觉诱发电位检测、临床分度及头部CT检查并进行比较,对其中41例脑干听觉诱发电位异常者进行早期干预,随访至1岁,观察脑干听觉诱发电位异常患儿的智力发育情况及预后。结果67例缺氧缺血性脑病患儿脑干听觉诱发电位异常率为61.19%(41/67),分别与临床和CT分度相关(χ2=21.660,35.288;均P=0.000);轻、中、重度缺氧缺血性患儿脑干听觉诱发电位差异主要表现为Ⅴ波异常(χ2=20.659,27.171;均P=0.000)。脑干听觉诱发电位与头部CT检查比较,其灵敏度为80.00%(40/50),特异度94.12%(16/17),阳性诊断符合率为83.58%(56/67)。经早期干预治疗随访1年后仅23.68%(9/38)患儿脑干听觉诱发电位检测呈现异常,主要以Ⅴ波异常为主;DQ值异常者31.58%(12/38),其中9例脑干听觉诱发电位异常,临床分度均为重度。结论脑干听觉诱发电位是一种无创、经济、灵敏度高、可重复性强的检测方法,可作为缺氧缺血性脑病患者病情判断和预后评估的重要指标。     

Associations of gestational age and birth anthropometric indicators with brain white matter maturation in full‐term neonates

Newborn assessments, including gestational age (GA) and anthropometric measurements (birth weight, crown‐heel length, head circumference) are routinely performed in pediatric settings, being used as important indicators in assessing neonatal development. Close associations of these birth indicators with later cognitive abilities were also reported. However, specific associations of these indicators with white matter (WM) development during the neonatal period remain unclear, as well as the extent to which they influence WM maturation. To address this issue, 51 full‐term neonates (GA range, 37–42 weeks) with no abnormalities on MRI were retrospectively recruited. Specific correlations between birth indicators and WM maturation, quantified by diffusion tensor imaging (DTI)‐metrics (fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity), were identified by using DTI tract‐based spatial statistics and automated fiber‐tract quantification. Our findings suggest that (a) higher GA, birth weight, and crown‐heel length may indicate greater WM maturation in full‐term neonates, while head circumference presented weak correlation with WM maturation during early newborn period; (b) among the four indicators examined, GA was the one most associated with WM maturation. We believe that this study advances our knowledge of specific correlations between birth indicators and neonatal brain development and provides a valuable reference for future neonatal studies.     

新生儿缺氧缺血性脑病临床与神经病理研究

目的研究新生儿缺氧缺血性脑病(HIE)的临床特点和神经病理改变。方法回顾性分析52例死亡HIE患儿的临床特点,目视和光镜观察脑组织病理变化。结果所有患儿均为异常分娩,宫内窘迫占53．8％,产时窒息占38．5％,足月儿多发．占60％．临床表现多样,惊厥发生率高达75％,且多在生后48h之内发生。88％脑组织重量增加,25％超过正常均值加一个标准差,12％低于正常均值;均有不同程度脑水肿,神经细胞肿胀、变性及坏死,部分伴有颅内出血及软化灶形成;脑缺氧缺血易感区与胎龄有关,足月儿以皮质层状坏死为主,早产儿多为室管膜下-脑室内出血;宫内窘迫的足月小样儿脑损害程度更重;蛛网膜下腔出血(SAH)发生率高达63％,且以渗出性出血为主。结论研究HIE的临床与神经病理联系有助于揭示HIE发病机制及指导治疗。     

20Electrogastrography is of limited value in the diagnosis of motility disorders

Background:  Electrogastrography (EGG) is a technique for recording gastric myoelectric activity. Conflicting results were obtained in previous studies when EGG was applied in motility disorders of the stomach associated with various systemic diseases.
Aim:  To investigate whether the underlying diagnosis could be predicted from EGG parameters.
Material and methods:  This is a retrospective analysis of patients with motility disorders who underwent EGG as part of their clinical work-up. A single bipolar channel measured the EGG. The ability of EGG to identify diagnostic groups was tested by comparing 21 EGG parameters for each diagnostic group or symptom against all other patients in the sample.
Results:  A total of 151 patients, 125 (83%) females, and mean age 45 ± 14 years were analysed. There were 52 patients with irritable bowel syndrome (IBS), 22 with enteric dysmotility, 26 with slow transit constipation (STC), 11 with chronic intestinal pseudo-obstruction (CIP), 13 with gastroparesis or functional dyspepsia, three post-surgical, and 24 patients with other diagnoses. In general, the discriminatory power of EGG for underlying motility disorder was low. Only those with STC showed a reasonable number of differences in EGG parameters compared to all other groups (Table). Patients with IBS had lower fasting and postprandial variability of the dominant frequency (DF) and a higher percentage of postprandial time with normogastric DF.
Conclusion:  The ability of EGG to identify motility disorders as well as symptoms in general was poor. EGG findings in patients with STC require validation.
 

     

19.

Behavioral-state development and sleep-state differentiation during early ontogenesis     

Emilie Bourel-Ponchel  Danièle Hasaerts  Marie-Josèphe Challamel  Marie-Dominique Lamblin 《Clinical neurophysiology》2021,51(1):89-98

     

20.

Myoelectrical Activity of the Stomach in Gastric Ulcer Patients: An Electrogastrographic Study     

Han Geldof  Evert J. van der  Schee    ré J. P. M. Smout  Joop P. van de  Merwe  Mark van  Blankenstein Jan L. Grashuis 《Neurogastroenterology and motility》1989,1(2):122-130

This study of gastric ulcer patients examined whether characteristic abnormalities in the fasting and postprandial gastric myoelectrical activity could be discerned electrogastrographically and whether these abnormalities, if present, were related to ulcer characteristics and complaints of nausea and vomiting. A total of 61 recordings were made in 31 gastric ulcer patients, both at the time of diagnosis and after ulcer healing, and these were compared to 52 recordings made in 52 control subjects. Several types of abnormal gastric myoelectrical activity were found in patients with an active ulcer: 1) instability of both the fasting and postprandial gastric frequency; 2) absence of the normal postprandial amplitude increase in the electrogastrogram; 3) waveform changes in the electrogastrographic signal in both the fasting and postprandial states; and 4) tachygastrias. These abnormalities were predominantly found in ulcer patients with symptoms of nausea and vomiting. They disappeared with ulcer healing and resolution of nausea and vomiting. These findings indicate that the abnormalities in gastric myoelectrical activity found in gastric ulcer patients are not merely due to the presence of the ulcer itself, but are associated with the presence of nausea and vomiting.     

Myoelectrical Activity of the Stomach in Gastric Ulcer Patients: An Electrogastrographic Study

This study of gastric ulcer patients examined whether characteristic abnormalities in the fasting and postprandial gastric myoelectrical activity could be discerned electrogastrographically and whether these abnormalities, if present, were related to ulcer characteristics and complaints of nausea and vomiting. A total of 61 recordings were made in 31 gastric ulcer patients, both at the time of diagnosis and after ulcer healing, and these were compared to 52 recordings made in 52 control subjects. Several types of abnormal gastric myoelectrical activity were found in patients with an active ulcer: 1) instability of both the fasting and postprandial gastric frequency; 2) absence of the normal postprandial amplitude increase in the electrogastrogram; 3) waveform changes in the electrogastrographic signal in both the fasting and postprandial states; and 4) tachygastrias. These abnormalities were predominantly found in ulcer patients with symptoms of nausea and vomiting. They disappeared with ulcer healing and resolution of nausea and vomiting. These findings indicate that the abnormalities in gastric myoelectrical activity found in gastric ulcer patients are not merely due to the presence of the ulcer itself, but are associated with the presence of nausea and vomiting.