脑肿瘤患者麻醉诱导时脑电双频指数变化

脑电双频指数(Bispectral index,BIS)监测麻醉镇静程度的研究较多用在监测非颅脑手术麻醉,但对脑肿瘤患者监测的研究甚少。本文是在常规麻醉诱导下,观察BIS在额叶与非额叶脑肿瘤患者麻醉诱导时的变化,探讨BIS在脑肿瘤手术麻醉中的临床应用价值。1 资料与方法1.1 一般资料 择期脑肿瘤手术病人54例。根据脑肿瘤生长部位,分为额叶组34例和非额叶组20例,后者包括肿瘤在颞叶11例、顶叶7例和枕叶2     

托吡酯药物定量脑电图研究的非线性分析

目的探讨托吡酯对人类脑电图复杂性的影响。方法应用药物定量脑电图的方法,用非线性分析方法对12例癫患者和16名健康人单次口服托吡酯前后脑电图的复杂度,近似熵,李氏指数,分形维数变化进行动态观察和研究。结果托吡酯对脑电图复杂性的影响表现为李氏指数先升高,再降低,再升高,升高有统计学意义(健康人双中央最大值0.44,P<0.01);分形维数和近似熵有下降趋势;复杂度健康人降低(右顶最小值0.34),患者升高(右后颞最大值0.34)。结论托吡酯对人类的脑电复杂性有影响。     

基于复杂度分析阿尔茨海默病、轻度认知功能障碍患者的脑电特点

目的 探讨阿尔茨海默病(Alzheimer's disease,AD)、轻度认知功能障碍(mildcognitive impairment,MCI)和健康老年人的脑电复杂度(Lemple-Zie complexity,LZC)特点,以及LZC值在鉴别AD、MCI以及健康老年人中的应用价值.方法 对30例AD患者、30例MCI患者及20名健康老年对照者进行安静闭目状态下的脑电监测,用Matlab自编软件计算各组不同导联及脑区的LZC值.结果 (1) AD组、MCI组、对照组全部导联平均值依次是0.396±0.036、0.470±0.051、0.523±0.055,AD组和MCI组与对照组相比均有所降低,差别有统计学意义(F=43.092,P=0.000).(2)AD组的LZC值在各导联处[(0.373±0.042) ～(0.430±0.083)]、全部导联均值、左右半球、双侧额颞区的均明显低于对照组[(0.498±0.067) ～(0.566±0.059)],差异有统计学意义(=3.602 ～ 8.747,P=0.000 ～0.010);且在双侧前中颞、双侧额区、左顶区具有较大降幅,均大于23％.(3)除导联T6外,AD组的LZC值在各导联处[(0.373±0.042) ～ (0.418±0.063)]、全部导联均值、左右半球及双侧额颞区均低于MCI组[(0.455±0.072) ～ (0.489±0.063)],差异有统计学意义(在T5导联处,t =2.038、P=0.041,其余t=4.178 ～7.424,均P=0.000).(4) MCI组的LZC值在全部导联均值、左右半球、双侧颞区、左额、双侧顶区较对照组降低,差异有统计学意义.结论 随着认知功能的降低,脑电信号复杂度值可出现同向改变,说明LZC值可在一定程度上反映大脑认知功能的变化;出现额、颞区复杂度异常的MCI患者与AD的发生存在一定程度的联系.     

三唑仑对失眠症患者睡眠脑电的影响

目的应用多导睡眠图(PSG)探讨三唑仑对失眠症患者睡眠脑电活动的影响.方法对28例失眠症患者连续进行4夜PSG描记,其中第3、4晚上睡前予0.5mg三唑仑,观察用药后PSG的变化.正常对照组33名,作2夜适应和基础PSG监测.结果失眠症患者服用三唑仑后夜间PSG显示睡眠效率提高[基线睡眠值(86±9)%,第3晚服药后(91±8)%,第4晚服药后(92±4)%,F值6.143,P＜0.01],觉醒时间减少[同前,(39±17)min,(29±8)min,(23±7)min,F值13.211,P＜0.01],S1减少[同前,(31±18)%,(23±11)%,(16±6)%,F值9.707,P＜0.01],S2增加[同前,(45±17)%,(59±18)%,(60±6)%,F值10.104,P＜0.01],睡眠潜伏期缩短[同前,(35±18)min,(28±17)min,(21±11)min,t值4.947,P＜0.05].结论短半衰期催眠药三唑仑不仅能改善患者对睡眠的主观评价,还对夜间睡眠脑电有影响.     

发作期录像脑电监测在15例难治性颞叶癫痫患者术前定位中的价值

目的 探讨发作期录像脑电监测（IVEEG）在难治性非病变性颞叶癫痫（TLE）致痫源术前定位中的价值。方法 对15例药物难治性TLE患者术前定位资料及术后随诊情况进行分析。结果 所有患者在行长时间IVEEG监测中均捕获到临床发作。在15例患者中，有13例IVEEG显示出一侧起源的局灶爆发性节律性电活动，该放电侧均与最终切除侧相一致，且有11例患者术后效果较好。结论 IVEEG监测不仅有助于明确诊断及发作类型，更为重要的是对于大多数难治性非病变性TLE患者可提供较可靠的致痫源定侧信息。     

一次量氯氮平对精神分裂症脑电活动的影响

目的：探讨氯氮平所致首发精神分裂症患者和健康成人之间脑电能量变化的差异及自身用药前后脑电能量变化。方法：对22例健康受试者和19例首发精神分裂症患者服用一次量25mg氯氮平前及后0．5、1、2、3、4、5、6、8、12、24h脑电能量变化进行单因素和两因素方差分析。结果 ：某些频段的部分导联在患者或健康人自身对照时有显著改变；有些在患者与健康人比较时有显著差异。结论；氯氮平所致健康成人与首发精神分裂症患者某些脑电能量变化有显著差异。     

卡马西平对脑电活动影响的动态观察与定量研究

目的探讨卡马西平对脑电活动的影响。方法应用定量药物脑电图（ｑｕａｎｔｉｔａｔｉｖｅｐｈａｒｍａｃｏ－ＥＥＧ，ＱＰＥＥＧ），采用功率谱分析方法，对癫痫患者和健康人单次口服卡马西平前后的脑电背景活动变化进行动态观察与定量研究，与此同时同步测定该药的血清浓度。结果随着血药浓度的升高，θ频段功率百分比逐渐增加，α２频段功率百分比逐渐降低；当血药浓度达峰值时，上述变化分别达到最高和最低。结论卡马西平的定量ＥＥＧ效应在不同频段及不同脑区存在着不均衡分布     

一次量氯氮平对首发精神分裂症患者脑电活动影响的对照研究

为探讨氯氮平所致首发精神分裂症患和健康成人之间脑电能量变化的差异及自身用药前后脑电能量变化,对22例健康受试和19例首发精神分裂症患服用一次量25mg氯氮平前及后0．5,1,2,3,4,5,6,8,12,24小时脑电能量变化进行单因素和两因素方差分析。结果,α1频段Fp1,Fp2,F3,F4,F8,3,T4,T5,T6,P3,O1导联,α2频段F4导联,α3频段C4,T4,P3,O2导联,β频段O1导联,δ频段Fp1,Fp2,F3,F4,F8,T3,C3,T5,O1,O2导联,精神分裂症患和健康成人之间比较差异具有显性（P＜0．05）。除健康成人α2频段,精神分裂症患α1频段变化不明显外,两组受试对象各频段脑电能量变化趋势基本一致,但显变化部位均有不同。提示,氯氮平致健康成人与首发精神分裂症患脑电能量变化除θ频段外,各频段两组间比较均有显性差异,两组受试对象各频段脑电能量变化趋势大致一致。     

失眠症睡眠脑电的研究进展

本综述了近年来有关失眠症患睡眠脑电图研究的新进展。     

过度换气对脑电压缩谱阵图的影响

目的：研究对过度换气（ＨＶ）对常规脑电图的压缩谱阵（ＣＳＡ）的影响。方法：对３０例正常人常规ＨＶ前、中后各１ｍｉｎ的脑电图进行ＣＳＡ分析。结果：ＨＶ前枕区主频谱峰较区为快，波幅交高。ＨＶ中谱阵主峰解体、增强、减弱或不变，整个主峰频率有左移倾，年龄越小改变越明显。结论：ＣＳＡ能充分地实时显示常规ＨＶ前后脑电变化的特点，并有新的发现。     

脑电非线性分析在认知功能研究中的应用

目的　探讨在不同认知作业状态下脑电非线性动力学特性的变化规律、脑电非线性动态分析在认知过程研究中的作用。方法　我们用关联维数 (D2 )、点关联维数 (PD2 )对 30名健康成年人四种状态下的脑电数据进行了分析 :安静闭眼、安静睁眼、闭眼心算作业和睁眼图形推理作业。结果　认知作业过程相对于安静状态 ,D2 和PD2 有明显的升高。闭眼和心算 ,睁眼和图形推理状态之间差异有显著意义 (D2 分别为 3 93和 4 33,P <0 0 1;4 4 7和 4 98,P <0 0 1)。D2 和PD2 随时间存在时高时低的现象。结论　动态的、短时程的非线性动力学分析方法 ,更适合研究认知过程中大脑功能活动的变化规律。以D2 和PD2 地形图为基础的动态分析 ,可以清晰地展示认知过程中D2 和PD2的分布情况及与认知作业相关的大脑部位活跃顺序和活跃程度的变化 ,有助于我们了解认知过程中大脑的工作机制。     

Computerized Analysis of EEG Background Activity in Epileptic Patients

Background activity was studied in 128 idiopathic epilepsy patients and 30 normal controls using EEG topography and t-statistic significance probability mapping (t-SPM). In epileptic patients, EEG background activity showed a marked increase in delta, theta, alpha 1, and beta 1, and a decrease in alpha 2 activity as compared with controls. Untreated epileptic patients had a significant increase in delta, theta, and alpha 1 as compared with controls. For epileptic patients treated with antiepileptic drugs (AEDs), the most marked slowing was observed in the polytherapy group, followed by the monotherapy group and then the untreated group. Among seizure types, patients with partial seizures (PS) tended to exhibit more slowing than patients with only generalized tonic-clonic seizures (GTC). Moreover, PS had a right-left asymmetry in alpha 2 and beta 1 activities. In a comparison of AEDs, patients receiving carbamazepine (CBZ) and phenobarbital (PB) showed no significant difference as compared with the untreated group. In contrast, patients receiving valproate (VPA) showed a decrease in slow and fast activities. EEG changes associated with each AED were different in GTC and PS. Patients receiving VPA for GTC showed a decrease in theta and beta 1 activities, but those with PS showed a decrease only in delta activity.     

Faster REM sleep EEG and worse restedness in older insomniacs with HLA DQB1*0602

HLA DQB1*0602 is found in most individuals with hypocretin-deficient narcolepsy, a disorder characterized by a severe disruption of sleep and wake. Population studies indicate that DQB1*0602 may also be associated with normal phenotypic variation of rapid eye movement (REM) sleep. Disruption of REM sleep has been linked to specific symptoms of insomnia. We here examine the relationship of sleep and DQB1*0602 in older individuals (n = 46) with primary insomnia, using objective (polysomnography, wrist actigraphy) and subjective (logs, scales) measures. DQB1*0602 positivity was similarly distributed in the older individuals with insomnia (24%) as in the general population (25%). Most sleep variables were statistically indistinguishable between DQB1*0602 positive and negative subjects except that those with the allele reported that they were significantly less well rested than those without it. When sleep efficiencies were lower than 70%, DQB1*0602 positive subjects reported being less well rested at the same sleep efficiency than those without the allele. Examination of EEG during REM sleep also revealed that DQB1*0602 positive subjects had EEG shifted towards faster frequencies compared with negative subjects. Thus, DQB1*0602 positivity is associated with both a shift in EEG power spectrum to faster frequencies during REM sleep and a diminution of restedness given the same sleep quantity.     

Effect of Long-Term Benzodiazepines for Chronic Insomnia on Cognitive Function and Waking Electroencephalography: A Case-Control Study

Objective The relationship between benzodiazepine use and cognitive decline in insomnia patients has been reported, but still conflicting. Thus, we tried to determine whether long-term exposure of benzodiazepine might be associated with changes of cognition and electroencephalography (EEG) findings in patients with chronic insomnia. Methods Insomniacs using benzodiazepines (n=29), drug-free insomniacs (n=27), and age- and sex-matched controls (n=28) were recruited. Neurocognitive function tested with Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet Neuropsychological Assessment Battery, quantitative EEG in awake state, and information of benzodiazepine usage were obtained. Results Drug-free insomniacs reported more severe symptoms than insomniacs using benzodiazepine (p<0.001). Insomniacs using benzodiazepine showed a decrease of executive function in Trail Making Test A than drug-free insomniacs and controls (0.73±0.66 vs. 1.27±0.38 vs. 1.09±0.47, p<0.001) and in categorical fluency than drug-free insomniacs (-0.01±0.99 vs. 1.26±0.97, p=0.002). However, such decrease of executive function was not proportional to daily dose or cumulative dose of benzodiazepine. The EEG was not significantly different between insomniacs using benzodiazepine and drug-free insomniacs, while EEG of insomniacs showed low relative theta power in frontal and parietal regions but high relative beta power in frontal region than that of controls. Conclusion Benzodiazepine users with chronic insomnia showed an impairment of executive function compared to drug-free insomniacs and controls although they showed relatively decreased severity of insomnia symptoms. Chronic insomniacs showed a hyper-arousal manifestation in front-parietal region of brain regardless of benzodiazepine exposure.     

Non-linear EEG analysis in children with epilepsy and electrical status epilepticus during slow-wave sleep (ESES)

OBJECTIVE: The objective of this work was to study the non-linear aspects of electroencephalography (EEG) in children with epilepsy and electrical status epilepticus during slow-wave sleep (ESES). METHODS: In this study, we recorded the sleep EEG in 5 subjects with ESES (4 males and one female, aged 6.5-10 years) who were also mentally retarded and affected by cerebral palsy (3 subjects) and hydrocephalus (two subjects). The signals were sampled at 128Hz and stored on hard disk. All the subsequent computational steps were performed on EEG epochs (4096 data points) selected from wakefulness and non-rapid eye movement (non-REM) (with ESES) or REM sleep. The dynamic properties of the EEG were assessed by means of the non-linear cross prediction (NLCP) test which uses 3 different 'model' time series in order to predict non-linearly the original data set (Pred, Ama and Tir). Pred is a measure of the predictability of the time series and Ama and Tir are measures of asymmetry, indicating non-linear structure. Moreover, the correlation dimension (D2) was estimated by means of the algorithm by for the epochs showing non-linear nature. RESULTS: The NLCP test provided evidence of significant non-linear dynamics in all epochs of non-REM sleep, when ESES was evident. Only during this stage, the possible presence of low-dimensional chaos could also be suspected (average D2=4.02; range 3.16-6.21). EEG without ESES could not be distinguished from linearly filtered noise. CONCLUSIONS: The results of the present study seem to indicate that subjects with ESES show a profound modification of their EEG dynamics with the occurrence, during sleep, of long periods characterized by non-linear dynamics and, probably, low-dimensional chaotic structure able to modify in a substantial way their brain functioning during sleep.     

Relationship between Personality and Insomnia in Panic Disorder Patients

Objective

Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients.

Methods

Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger''s Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates.

Results

There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F_1,96=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia.

Conclusion

The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.     

Independent sleep EEG slow-wave and spindle band dynamics associated with 4 weeks of continuous application of short-half-life hypnotics in healthy subjects.

OBJECTIVES: Habituation and adverse withdrawal reactions after prolonged medication with benzodiazepine (BZ) hypnotics are believed to play a role in dose escalation and the development of dependence. METHODS: In the current sleep EEG study in 43 healthy male subjects, the known property of BZ- and similar hypnotics to change the NREM sleep EEG spectrum is utilized for a detailed quantitative analysis across 4 weeks of continuous medication and a subsequent two-week withdrawal period. The BZ hypnotic triazolam and the non-BZ hypnotics zopiclone and zolpidem, differing in pharmacological properties and reported adverse effects, were examined in parallel to a placebo group. RESULTS: Reliably occurring spectral effects in the sleep stage 2 EEG were found in the 3 frequency bands 0.8-5 Hz, 5-10 Hz and 10-15 Hz. All 3 hypnotics showed the typical 'benzodiazepine signature', a 10-15 Hz increase and lower-frequency (<10 Hz) suppression relative to the preceding drug-free night. However, these effects developed differently across the first medication night, across the 4 medication weeks and after withdrawal: While the 5-10 Hz effect covaried with the blood presence of the drugs as estimated from the known plasma half-lifes, showed habituation and a rebound after withdrawal, the 10-15 Hz power increased across medication days and showed no rebound. Effects in the 0.8-5 Hz band in the first medication night correlated with the decrease of sleep efficiency at later withdrawal for triazolam and zolpidem.     

Sleep Microstructure and EEG Epileptiform Activity in Patients with Juvenile Myoclonic Epilepsy

Clinical and EEG manifestations of juvenile myoclonic epilepsy (JME) occur in a strict relationship to the sleep-wake cycle, particularly to transition phases (awakening, falling asleep, afternoon relaxation after work). JME manifestations are deactivated during sleep. Because arousal fluctuations during NREM sleep may be controlled by the same neurophysiologic mechanisms regulating awakening, we studied the relationship between the cyclic alternating pattern (CAP) and JME manifestations. All-night polysomnographic recordings of 10 JME patients were analyzed for variations of epileptiform EEG abnormalities in relation to sleep stages and to different microstructural variables (NCAP, CAP, phases A and B). CAP rates (ratio between total CAP duration and total NREM sleep duration) were also calculated. Average CAP rate was 46.70%, significantly higher than that (23%) of an age-matched control group. Macrostructural analysis showed only a trend toward a slight predominance of EEG epileptiform activity during slow wave sleep but no significant correlation between spiking rates and sleep stages. Microstructural analysis confirmed the CAP modulation of EEG epileptiform activity, with maximum appearance of epileptiform abnormalities during phase A CAP (normalized spiking rate = 4.00 +/- 0.98) and strong inhibition during phase B (0.06 +/- 00.6). Intermediate values were noted during NCAP (0.54 +/- 0.27). No correlation was noted between spiking rates during NREM sleep and CAP rates, possibly indicating that in JME patients the increased CAP rate may be partially independent of epileptiform EEG activity. Our data suggest that in JME patients CAP may be a neurophysiologic oscillator organizing expression of the epileptiform discharges independent of the tendency of the individual patient to produce epileptiform EEG discharges.     

Metabolic Consequences of Using Low-Dose Quetiapine for Insomnia in Psychiatric Patients

Quetiapine is frequently prescribed for insomnia that is comorbid with psychiatric disorders, but there has been no documentation of metabolic adverse effects associated with this practice. The objective of this study was to document changes in weight, body mass index, and waist circumference that occurred when low-dose quetiapine was used at bedtime for insomnia. The study was a retrospective chart review conducted at a community mental health center. Patients were non-elderly (19–65 years old) psychiatric patients who received quetiapine at ≤200 mg at bedtime for the explicit indication of insomnia. Forty-three patients were included in the study. Weight and BMI increased by an average of 4.9 lb. (P = 0.037) and 0.8 points (P = 0.048), respectively. Males experienced statistically significant increases in weight and BMI, and Caucasians experienced a statistically significant increase in BMI. There were no significant differences between baseline and endpoint metabolic parameters when examined by baseline BMI, age category, psychiatric diagnosis, or concomitant psychotropic medication. Despite the low doses typically used when quetiapine is prescribed for insomnia, metabolic adverse effects can occur and should be considered in the overall benefit to risk analysis. Presented as a poster at College of Psychiatric and Neurologic Pharmacists Annual Meeting, Scottsdale, AZ, Apr. 13, 2008.