FMRI activation in language areas correlates with verb generation performance in children

Functional MRI mapping of language areas in children frequently employs a covert verb generation task. Because responses are not monitored, the relationship between fMRI activation and task performance is unknown. We compared fMRI activation during covert and overt verb generation to performance during the overt task. 15 children, ages 11-13 years, listened to concrete nouns and responded with related verbs covertly and overtly. A clustered fMRI acquisition allowed for recording of overt responses without motion artifacts. Region of interest analysis was also performed in areas that exhibited correlation between activation and performance during overt verb generation in left inferior frontal and left superior temporal gyri (along with their right hemisphere homologues). Regression analysis determined that during both covert and overt generation, left hemisphere regions showed positive correlations with average counts of verbs generated during the overt task. These results suggest that increased verb generation performance leads to increased activation. In addition, overt performance may be used as an estimator of covert performance.     

Cortical pattern of complex but not simple movements is affected in writer's cramp: a parametric event-related fMRI study

ObjectivePatients with writer’s cramp (WC) were studied for differences in cortical activation during movements likely to induce WC (complex movements) and movements which rarely lead to dystonia (simple movements).MethodsEleven WC patients (10 F, 1 M, mean age 41.5 ± (SD)7.2 years) and eleven age matched controls were examined for Blood oxygenation-level dependent (BOLD) 1.5 T fMRI. The complex task consisted of writing a single letter or random drawing using an especially adapted joystick with the line of trajectory visualized or hidden. The simple task consisted of self-initiated fingers flexion/extension using the affected hand.ResultsUnlike the controls, WC patients performing complex movements exhibited a lower BOLD signal in the primary sensorimotor cortex and in the posterior parietal cortex bilaterally. A hypoactivation was also observed in the right secondary somatosensory area, in the right anterior insula and in the left premotor cortex (p < 0.05 corrected). No significant inter-group differences were found for simple movements.ConclusionsAlthough WC patients’ complex movements during fMRI were never associated with dystonic cramp, they exhibited an abnormally low cortical activity. This phenomenon was not observed in simple movements and was unrelated to the character of handwriting or to visual feedback.SignificanceOur results support the dualistic behavior in the sensorimotor system in WC.     

Effect of systemic kynurenine on cortical spreading depression and its modulation by sex hormones in rat

BackgroundThe aura symptoms in migraine are most likely due to cortical spreading depression (CSD). CSD is favored by NMDA receptor activation and increased cortical excitability. The latter probably explains why migraine with aura may appear when estrogen levels are high, like during pregnancy. Kynurenic acid, a derivative of tryptophan metabolism, is an endogenous NMDA receptor antagonist whose cerebral concentrations can be augmented by systemic administration of its precursor l-kynurenine.ObjectiveTo determine if exogenous administration of l-kynurenine is able to influence KCl-induced CSD in rat, if the effect is sex-dependent and if it differs in females between the phases of the estrous cycle.MethodsAdult Sprague–Dawley rats (n = 8/group) received intraperitoneal (i.p.) injections of l-kynurenine (L-KYN, 300 mg/kg), L-KYN combined with probenecid (L-KYN + PROB) that increases cortical concentration of KYNA by blocking its excretion from the central nervous system, probenecid alone (PROB, 200 mg/kg) or NaCl. Cortical kynurenic acid concentrations were determined by HPLC (n = 7). Thirty minutes after the injections, CSDs were elicited by application of 1 M KCl over the occipital cortex and recorded by DC electrocorticogram. In NaCl and L-KYN groups, supplementary females were added and CSD frequency was analyzed respective to the phases of the estrous cycle determined by vaginal smears.ResultsIn both sexes, PROB, L-KYN and L-KYN + PROB increased cortical kynurenic acid level. PROB, L-KYN and L-KYN + PROB with increasing potency decreased CSD frequency in female rats, while in males such an effect was significant only for L-KYN + PROB. The inhibitory effect of L-KYN on CSD frequency in females was most potent in diestrus.Conclusionl-Kynurenine administration suppresses CSD, most likely by increasing kynurenic acid levels in the cortex. Females are more sensitive to this suppressive effect of l-kynurenine than males. These results emphasize the role of sex hormones in migraine and open interesting novel perspectives for its preventive treatment.     

Levodopa-induced striatal activation in Parkinson's disease: A functional MRI study

ObjectiveTo assess the effect of a single levodopa dose (200 mg levodopa, 50 mg carbidopa = sdLD) on cortical and subcortical motor-circuit activation during bimanual grip force in patients with Parkinson's disease (PD).Patients and methodsWe studied 12 right-handed patients with PD (Hoehn–Yahr stages I–II) after a period of at least 12 h without medication (OFF state) and a second time 1 h after oral administration of sdLD (ON state) using functional magnetic resonance imaging (fMRI). Blood-oxygenation-level-dependency (BOLD) fMRI was measured while participants underwent two unilateral and two bimanual grip force movements with a defined movement amplitude and force (10 N) in a block design. 12 age matched healthy subjects were studied as controls (without administration of sdLD).ResultsBimanual grip force tasks activated a specific pattern of cortical and subcortical structures in all patients during the OFF state and after levodopa administration with statistically significant differences in putamen and thalamus comparing the OFF and ON condition. In contrast, no such significant changes were observed in cortical structures. Between-group analysis revealed higher putaminal activity in controls compared to OFF state in bimanual tasks, while these differences disappeared after administration of levodopa.ConclusionsOur results indicate that the putamen and thalamus are the regions within the cortico-subcortical motor-circuit with most prominent response to levodopa. In our study, cortical motor areas did not respond to levodopa as one could have expected from previous studies. These findings contribute to the increasing evidence that an extended model of the underlying pathophysiology of motor dysfunctions in PD is warranted.     

Hypertension and sleep apnea-hypopnea syndrome: changes in echocardiographic abnormalities depending on the presence of hypertension and treatment with CPAP

IntroductionSleep apnea–hypopnea syndrome (SAHS) is an emerging disease with high prevalence. There is controversy as to whether cardiac abnormalities are due to the disease itself or to the arterial hypertension frequently associated with this disease.ObjectivesTo analyze echocardiographic abnormalities in a population of SAHS patients depending on the presence or absence of hypertension at the time of diagnosis and after six months of treatment with continuous positive airway pressure (CPAP).MethodsWe studied 85 consecutive patients diagnosed with SAHS who required treatment with CPAP (Hypertensive: 43, nonhypertensive: 42). We performed a baseline echocardiogram after six months of treatment. We analyzed morphological (wall thickness, diameters, ejection fraction) and functional (peak E- and A-wave velocities, deceleration time, Tei index) parameters of the left and right ventricles.ResultsHypertensive patients were older and had higher blood pressure values, but there were no differences between groups in other clinical parameters. The hypertensive group had greater septal thickness (hypertensive: 12.1 ± 2.3; nonhypertensive: 10.8 ± 2.1 mm; p = 0.01). There were also differences in impairment of left (hypertensiveHT: 92.9%, nonhypertensive: 65%, p = 0.002) and right (hypertensive: 74.4%, nonhypertensive: 42.1%, p = 0.006) ventricular filling.After six months of treatment, an improvement of the myocardial performance index was noted in nonhypertensive patients (baseline Tei: 0.55 ± 0.1 vs. 6-month Tei: 0.49 ± 0.1; p = 0.01), whereas no significant change was observed in hypertensive patients.ConclusionsCardiac abnormalities in SAHS patients are increased in the presence of associated hypertension. Treatment with CPAP for six months improves cardiac abnormalities in nonhypertensive patients but not in hypertensive patients.     

The relationship between psychotic-like experiences and sleep disturbances in adolescents

ObjectiveWe investigated the relationships between sleep disturbances and psychotic-like experiences (PLEs) among adolescents.MethodsA total of 8530 students (grades 7–11) were recruited in the Republic of Korea, and 7172 students who completed all of the relevant questionnaires participated in the current study. The survey included the Eppendorf Schizophrenia Inventory (ESI), the Youth Psychosis At Risk Questionnaire (Y-PARQ), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale and questionnaires about sleep disturbances (insomnia, cataplexy and snoring).ResultsSubjects with insomnia, excessive daytime somnolence (EDS), or probable cataplexy had higher ESI and Y-PARQ scores after controlling for age, sex and BDI scores (all p < 0.001). Insomnia (OR = 4.40), EDS (OR = 3.84) and probable cataplexy (OR = 2.97) predicted clinical high risk of psychosis. Insomnia, EDS and probable cataplexy remained as significant predictors of clinical high risk for psychosis, even after controlling for depressive symptoms or when analyses were confined to non-depressive adolescents.ConclusionsInsomnia and EDS were found to predict PLEs in adolescents, independent of depression. Our findings suggest that adolescents complaining of insomnia or sleepiness may require further assessment regarding potential risk of psychosis.     

Blink reflex prepulse inhibition and excitability recovery: Influence of age and sex

ObjectiveAge and sex affect various reflexes in healthy humans. Their respective influence on prepulse inhibition (PPI) of the trigeminofacial blink reflex (BR) and BR excitability recovery has not as yet been investigated in detail.MethodsWe studied the trigeminofacial BR bilaterally in 62 healthy volunteers (31 males, age 41.0 ± 13.2 years, mean ± SD, 31 females, 39.2 ± 11.7 years) following right supraorbital nerve stimulation. Single sweeps were recorded either alone (n = 8) or conditioned by a prepulse applied 100 ms earlier to the dominant index finger though ring electrodes (n = 8). Latency and amplitude of the ipsilateral R1 component, as well as latency and area-under-the-curve of the ipsilateral R2 and contralateral R2c components were measured in single traces and then averaged per subject. BR excitability recovery was established bilaterally following right supraorbital nerve stimulation with paired pulses. Six responses were averaged on-line per interstimulus interval (ISI 160, 300, and 500 ms).ResultsUnconditioned BR did not differ significantly between males and females, but R2 and R2c latencies increased with age. Prepulse stimulation caused significant facilitation of R1 (latency and amplitude), and inhibition of R2 and R2c (latency and area), irrespective of age. PPI of R2 and R2c area was significantly more pronounced in men. BR excitability recovery was significantly influenced by age, but not by sex. Multiple regression showed inverse correlation of age with conditioned R2 and R2c area at ISI 300 ms and 500 ms (P < 0.01 each), indicating reduced excitability recovery. No parameter showed significant interaction of age × sex.ConclusionThese data indicate less pronounced PPI of the trigeminofacial BR in females, concurring with previous reports of sex differences in protective reflexes, but also suggesting less rigorous filtering of information flow to the brain in females. Reduced BR excitability to paired-pulse stimulation may counteract age-related disinhibition of brainstem interneuronal circuitry.SignificanceThe present findings allow new insight into human brainstem physiology.     

Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction

ObjectiveType D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity × social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable.MethodsParticipants were 192 MI patients (138 males, 54 females, mean age 66.0 years) who provided demographic and clinical information, and completed measures of Type D one-week post-MI. Three months later, 131 of these MI patients completed measures of disability and quality of life.ResultsUsing regression analyses, adjusted for demographic and clinical data, Type D emerged as a significant predictor of disability and quality of life in MI patients, when analysed using the traditional categorical approach. However, Type D did not predict disability and quality of life when it was analysed using the interaction of negative affectivity and social inhibition. Negative affect emerged as a significant predictor of both disability (β=.433, t(130) = 3.53, p < .01), and quality of life (β= ? .624, t(130) = ? 5.68, p < .001).ConclusionsThe results suggest that Type D is not associated with short-term psychosocial outcome in MI patients, after controlling for its constituent elements. However, negative affect was significantly associated with both disability and quality of life. Future research should conceptualise Type D as the interaction between negative affectivity and social inhibition, rather than as a typology.     

Could formant frequencies of snore signals be an alternative means for the diagnosis of obstructive sleep apnea?

ObjectiveTo study the feasibility of using acoustic signatures in snore signals for the diagnosis of obstructive sleep apnea (OSA).MethodsSnoring sounds of 30 apneic snorers (24 males; 6 females; apnea–hypopnea index, AHI = 46.9 ± 25.7 events/h) and 10 benign snorers (6 males; 4 females; AHI = 4.6 ± 3.4 events/h) were captured in a sleep laboratory. The recorded snore signals were preprocessed to remove noise, and subsequently, modeled using a linear predictive coding (LPC) technique. Formant frequencies (F1, F2, and F3) were extracted from the LPC spectrum for analysis. The accuracy of this approach was assessed using receiver operating characteristic curves and notched box plots. The relationship between AHI and F1 was further explored via regression analysis.ResultsQuantitative differences in formant frequencies between apneic and benign snores are found in same- or both-gender snorers. Apneic snores exhibit higher formant frequencies than benign snores, especially F1, which can be related to the pathology of OSA. This study yields a sensitivity of 88%, a specificity of 82%, and a threshold value of F1 = 470 Hz that best differentiate apneic snorers from benign snorers (both gender combined).ConclusionAcoustic signatures in snore signals carry information for OSA diagnosis, and snore-based analysis might potentially be a non-invasive and inexpensive diagnostic approach for mass screening of OSA.     

Biogenetic temperament and character in insomnia and depression

ObjectiveWe compared the biogenetic temperaments and characters of primary insomnia patients, major depressive disorder (MDD) patients with insomnia, MDD patients without insomnia, and normal controls.MethodsA total of 417 participants were recruited from a community and a psychiatric clinic in South Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire: 1) normal controls (n = 314), 2) primary insomnia (n = 33), 3) MDD without insomnia (n = 30), and 4) MDD with insomnia (n = 40). All participants were requested to complete the Temperament and Character Inventory.ResultsThere were significant between-group differences in harm avoidance (HA)(F = 32.96, p < 0.001), reward dependence (RD)(F = 5.21, p < 0.01), self-directedness (SD)(F = 24.72, p < 0.001) and cooperativeness (CO)(F = 15.75, p < 0.001), after controlling for age and gender. Subjects with primary insomnia showed higher HA and lower SD than normal control, but lower HA and higher SD than MDD patients with insomnia. CO was lower in MDD patients, but not in subjects with primary insomnia. Lower RD was found only in MDD patients with insomnia.ConclusionThe current study suggests that high HA and low SD were related to primary insomnia, although these patterns were more prominent in patients with MDD.     

Pseudohypacusis in childhood and adolescence is associated with increased gray matter volume in the medial frontal gyrus and superior temporal gyrus

Pseudohypacusis is a somatoform disorder characterized by hearing loss with discrepancies between pure-tone audiometry and auditory brainstem response (ABR), but the underlying neuronal mechanisms remain unclear. Using voxel-based morphometry (VBM) with magnetic resonance (MR) imaging for 14 unmedicated, right-handed patients and 35 healthy control subjects, we investigated whether functional hearing loss was associated with discernible changes of brain morphology. Group differences in gray matter volume (GMV) were assessed using high-resolution, T1-weighted, volumetric MR imaging datasets (3T Trio scanner; Siemens AG) and analyzed with covariant factors of age, sex, socioeconomic status (SES), and total GMV, which was increased by 27.9% in the left medial frontal gyrus (MFG) (Brodmann area 10) (p = .001, corrected cluster level) and by 14.4% in the right superior temporal gyrus (STG) and the adjacent middle temporal gyrus (MTG) (BA42 to 21) (p = .009, corrected cluster level) in patients with pseudohypacusis. The GMV in the right STG (BA42) and verbal intelligence quotient (IQ) were correlated significantly with the Wechsler Intelligence Scale for Children – Third Edition (WISC-III) (ß = ?.57, p < .0001) and level of SES (ß = ?.55, p < .0001). The present findings suggest that the development of the auditory association cortex involved in language processing is affected, causing insufficient pruning during brain development. We therefore assert that differences in the neuroanatomical substrate of pseudohypacusis subjects result from a developmental disorder in auditory processing.     

Sex differences in seizure types and symptoms

BackgroundDespite the increasing interest in sex differences in disease manifestations and responses to treatment, very few data are available on sex differences in seizure types and semiology. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, multi-institutional, collaborative study that aims to create a comprehensive repository of detailed clinical information and DNA samples from a large cohort of people with epilepsy. We used this well-characterized cohort to explore differences in seizure types as well as focal seizure symptoms between males and females.MethodsWe reviewed the EPGP database and identified individuals with generalized epilepsy of unknown etiology (GE) (n = 760; female: 446, male: 314), nonacquired focal epilepsy (NAFE) (n = 476; female: 245, male: 231), or both (n = 64; female: 33, male: 31). Demographic data along with characterization of seizure type and focal seizure semiologies were examined.ResultsIn GE, males reported atonic seizures more frequently than females (6.5% vs. 1.7%; p < 0.001). No differences were observed in other generalized seizure types. In NAFE, no sex differences were seen for seizure types with or without alteration of consciousness or progression to secondary generalization. Autonomic (16.4% vs. 26.6%; p = 0.005), psychic (26.7% vs. 40.3%; p = 0.001), and visual (10.3% vs. 19.9%; p = 0.002) symptoms were more frequently reported in females than males. Specifically, of psychic symptoms, more females than males endorsed déjà vu (p = 0.001) but not forced thoughts, derealization/depersonalization, jamais vu, or fear. With corrections for multiple comparisons, there were no significant differences in aphasic, motor, somatosensory, gustatory, olfactory, auditory, vertiginous, or ictal headache symptoms between sexes.ConclusionsSignificant differences between the sexes were observed in the reporting of atonic seizures, which were more common in males with GE, and for autonomic, visual, and psychic symptoms associated with NAFE, which were more common in females.     

Long-term outcomes and predictors of chronic insomnia: a prospective study in Hong Kong Chinese adults

ObjectivesWe aimed to determine the longitudinal course and outcome of chronic insomnia in a five-year prospective study in Hong Kong Chinese adults.MethodsTwo thousand three hundred and sixteen middle-aged adults (53.3% females, 46.3 ± 5.1 years old at follow-up) were recruited at baseline and follow-up. Participants were divided into three groups: non-insomnia, insomnia symptoms, and insomnia syndrome (insomnia symptoms plus daytime symptoms). Upper airway inflammatory diseases, mental problems, and medical problems were additionally assessed at follow up.ResultsThe incidence of insomnia (symptoms and syndrome) was 5.9%. The persistence rate of insomnia syndrome was 42.7% for insomnia syndrome and 28.2% for insomnia symptoms. New incidence of insomnia was associated with younger age, unemployment, and daytime symptoms, while persistence of insomnia was associated with female sex, lower education level, and daytime symptoms at the baseline (p < 0.05). Baseline insomnia syndrome was significantly associated with upper airway inflammatory diseases (including asthma and laryngopharyngitis; adjusted OR = 1.97–17.9), mental problems, and medical conditions (including arthritis, psychiatric disorders, chronic pain, and gastroesophageal reflux disease; AOR = 2.29–3.77), whereas baseline insomnia symptoms were associated with poor mental health (AOR = 2.43), psychiatric disorders (AOR = 2.39), and chronic pain (AOR = 2.95).ConclusionsChronic insomnia is a common problem with considerable persistence and incidence rates among middle-aged Chinese adults. Insomnia syndrome has a higher persistence rate with more mental and medical comorbidities when compared with insomnia symptoms without daytime consequences.     

Clinically-oriented monitoring of acute effects of methylphenidate on cerebral hemodynamics in ADHD children using fNIRS

ObjectiveAttention Deficit Hyperactivity Disorder (ADHD), a common developmental syndrome with inattention, hyperactivity, and impulsivity, is typically treated with the psychostimulant drug, methylphenidate (MPH). We explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to search for a clinically implementable biological marker for the acute MPH effect on ADHD children.MethodsFollowing an MPH washout period, twelve ADHD children performed a go/no-go task before and 1.5 h after MPH intake. fNIRS was used to monitor the lateral prefrontal cortical hemodynamics of ADHD children performing a go/no-go task.ResultsThere was no significant activation in the lateral prefrontal cortices examined before MPH intake. However, after MPH intake, significant MPH-elicited activation (oxygenated hemoglobin signal increase) was detected in the right lateral prefrontal cortex (LPFC) implicated with response inhibition functions. There was a large significant correlation between increases in task performance and activation in the right LPFC.ConclusionsThe improved cognitive performance was associated with activation in the right LPFC, which might serve as a biological marker to monitor the effect of MPH in ADHD children.SignificanceMPH-effect assessment in ADHD children using fNIRS can be performed within a 3 h stay at a hospital during a single visit, and thus may be integrated into clinical practice.     

Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes

ObjectiveTo investigate the cross-sectional association between COPD severity and disturbed sleep and the longitudinal association between disturbed sleep and poor health outcomes.MethodsNinety eight adults with spirometrically-confirmed COPD were recruited through population-based, random-digit telephone dialing. Sleep disturbance was evaluated using a 4-item scale assessing insomnia symptoms as: difficulty falling asleep, nocturnal awakening, morning tiredness, and sleep duration adequacy. COPD severity was quantified by: FEV₁ and COPD Severity Score, which incorporates COPD symptoms, requirement for COPD medications and oxygen, and hospital-based utilization. Subjects were assessed one year after baseline to determine longitudinal COPD exacerbations and emergency utilization and were followed for a median 2.4 years to assess all-cause mortality.ResultsSleep disturbance was cross-sectionally associated with cough, dyspnea, and COPD Severity Score, but not FEV₁. In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR = 4.7; p = 0.018) and respiratory-related emergency utilization (OR = 11.5; p = 0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR = 5.0; p = 0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV₁ and COPD Severity Score.ConclusionsDisturbed sleep is cross-sectionally associated with worse COPD and is longitudinally predictive of COPD exacerbations, emergency health care utilization, and mortality.     

Scalp- and sLORETA-derived loudness dependence of auditory evoked potentials (LDAEPs) in unmedicated depressed males and females and healthy controls

ObjectiveAs major depressive disorder (MDD) is associated with altered 5-HT activity, we probed intensity-dependent auditory evoked potentials (AEPs) and loudness dependence of the AEP (LDAEP) slopes, shown pre-clinically to be inversely related to 5-HT activity, in MDD.MethodsAEPs and LDAEP slopes were measured in MDD (N = 50; 27 females) and controls (N = 43; 23 females). Correlations between scalp AEPs/LDAEPs and low-resolution electromagnetic tomography (sLORETA)-derived indices were assessed.ResultsSmaller scalp intensity-dependent N1 and N1/P2 amplitudes in MDD versus control males and longer P2 latencies in MDD versus control females were found; no LDAEP group differences existed. Females had greater scalp AEPs, steeper N1 and N1/P2 scalp LDAEPs as well as greater intensity-dependent primary auditory cortex activation during the N1 than males. Scalp LDAEPs correlated weak-moderately with sLORETA counterparts. P2 LDAEP-sLORETA correlated negatively with MADRS scores. Female P2 and N1/P2 LDAEP-sLORETA correlated negatively with HAMD-17 and MADRS scores.ConclusionsMDD was not associated with altered LDAEPs. Impaired processing or potentiated inhibition of auditory stimuli was found in MDD males; longer processing existed in MDD females. Inverse relationships between LDAEPs and clinical scores may be related to treatment history, personality and/or MDD features.SignificanceMDD was not associated with an altered LDAEP, though subtle AEPs alterations were noted in MDD.     

Age of onset in idiopathic (genetic) generalized epilepsies: clinical and EEG findings in various age groups

PurposeThe prevalence and differences of idiopathic (genetic) generalized epilepsies (IGEs) with atypical age of onset compared to classical IGEs is a matter of debate. We tried to determine the clinical and EEG characteristics of IGEs in various age groups.MethodsAll patients with a clinical diagnosis of IGE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2011. We subdivided the patients into four different age groups: 4 years of age and under, 5–11 years, 12–17 years, and finally, 18 years and above, at the time of their epilepsy onset. Syndromic diagnosis, sex ratio, seizure types and EEG findings were compared. Statistical analyses were performed using Pearson Chi square test.Results2190 patients with epilepsy were registered. 442 patients (20.2%) were diagnosed as having IGEs. Age of seizure onset was 12.4 ± 6.9 years. The peak age of onset had a bimodal appearance. Sixty-seven patients (15.2%) were four years and under at the time of the onset of their disease, 112 persons (25.3%) were 5–11 years, 197 people (44.6%) were 12–17 years of age, and 66 patients (14.9%) had 18 years and above at the onset of their epilepsy. The sex ratio was significantly different between patients in group one compared to groups three and four. All expected seizure types (i.e., generalized tonic–clonic, absence or myoclonic seizures) and all expected EEG abnormalities were observed among all age groups, despite some differences in their prevalence.ConclusionAlthough IGE syndromes are often age dependent and most of them appear within the first two decades of life, adult-onset IGE is not rare. Presentation of IGEs could be different in various age groups, but these differences do not offer pathognomonic or characteristic features at any age.     

Extended retention intervals can help to bridge the gap between subjective and objective memory impairment

PurposeDespite their excellent clinical validity, objective measures of memory often do not reflect self-perceived memory impairment. This discordance has mostly been attributed to depressed mood. Alternatively, a lack of ecological validity due to the rather short standard retention intervals of 20–60 min may be responsible for this discordance. Therefore, we explored the value of extended retention intervals in regard to subjective memory deficits.MethodsOur prospective study was based on 73 patients with epilepsy. In addition to the standard 30-min retention interval of a verbal learning and memory test (VLMT) patients were randomized to either a free delayed recall after 1 week or after 4 weeks. Mood was assessed by the Beck Depression Inventory (BDI).ResultsForty-four patients (60%) reported self-perceived memory deficits, whereas objective verbal memory impairment was present in 26 patients (36%). Concordance between subjective and objective memory performance was observed in 53% of the patients. Multivariate analyses identified memory performance after 4 weeks and self-rated mood as determinants of subjective memory impairment. Self-perceived memory impairment correlated with the number of remembered words after 4 weeks (r = ?0.361, p = 0.030) and the BDI total score (r = 0.332, p = 0.004) but neither with recall performance after 30 min nor after 1 week.ConclusionSubjective memory appears to follow a different time scale than routine memory testing. Thus, the introduction of longer retention intervals may enhance the ecological validity of standard memory tests. Furthermore, the findings again underscore that controlling for mood is mandatory when dealing with subjective memory complaints.     

Blink reflexes in chronic tension-type headache patients and healthy controls

ObjectiveTo use the R2 component of nociceptive-specific blink reflex (nBR) to probe the trigeminal nociceptive system and compare chronic tension-type headache (CTTH) patients and healthy controls.MethodsThirty patients with CTTH and 30 age- and sex-matched healthy control subjects were included. nBR were evoked by painful electrical pulses (0.5 ms duration), delivered by a concentric electrode placed on the left lower forehead close to the supraorbital foramen. The EMG activity in the orbicularis oculi muscles was recorded bilaterally. The electrical stimulus intensities to evoke individual sensory threshold (Is) and pin-prick pain sensation (Ip) were assessed. A fixed stimulation intensity of 1.5× Ip was used to evoke the nBR. The perceived pain intensity of the electrical stimulus (I_BR) was assessed by the subjects on a 0–10 cm visual analogue scale (VAS).ResultsIs did not differ between CTTH patients and controls (P = 0.687) but were lower in females than in males (P = 0.020). CTTH patients had higher scores on I_BR than controls (P = 0.026). ANOVA showed significantly higher pre-stimulus EMG values in CTTH patients on the left (stimulated) side (P < 0.001), whereas there were no differences between males and females (P > 0.168). There were no significant differences in the absolute values of the nBR, however CTTH patients had significantly lower values of the normalized root mean square (RMS) (P = 0.035) and area under the curve (AUC) (P = 0.042) of the nBR on the left side compared with control subjects with no sex-related differences (P > 0.070). The onset latencies and duration were not significantly different between CTTH and control subjects or between female and male subjects (P > 0.270). There was no significant correlation between any of the BR parameters (RMS, AUC) and clinical characteristics of CTTH (headache intensity and duration) (P > 0.163).ConclusionsThe results of the present study did not detect a significantly different blink reflex response in CTTH patients, but suggested that painful electrical stimulation was associated with consistent increases in eye muscle activity on the same side.SignificanceThese findings add further information to central nociceptive pathways in CTTH patients.     

The role of proprioception in the consolidation of ipsilateral 1Hz-rTMS effects on motor performance

ObjectivesThe aim of the present work is to investigate whether the longlasting effect of the ipsilateral primary motor cortex (ipsiM1) 1 Hz-repetitive transcranial magnetic stimulation (1 Hz-rTMS) on motor performance can be modulated by subsequent engagement of the sensorimotor system through muscle vibration.MethodsTwenty-one subjects were divided into three groups: MOVEMENT group performed the 1 min-finger opposition task before (PRE), immediately after (POST0), 15 min (POST15) and 30 min after (POST30) the 1 Hz-rTMS on ipsiM1; the REST and VIBRATION groups performed the finger opposition task only at PRE and POST30. However, in the VIBRATION group at POST0 and POST15 the right flexor carpi radialis (FCR) was vibrated for 1 min. Motor performance was recorded at PRE and POST30.ResultsThe MOVEMENT and VIBRATION groups showed at POST30 similar and significant changes in motor performance. A decrease in movement time and an increase in touch duration with no change in the ability to follow the metronome cue were observed. Motor performance did not change in the REST group at POST30.ConclusionsThese findings suggest that vibration of FCR can interact with rTMS cortical effects in a similar way to the voluntary movement.SignificanceMuscle vibration might be used in a rehabilitative setting to consolidate rTMS effects in patients with sensory pathways preserved.