Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome

Primary headache disorders, including migraine, are some of the most common neurological disorders presenting to hospital. Episodic syndromes that may be associated with migraine, including recurrent gastrointestinal disturbances such as abdominal migraine and cyclic vomiting, often pre-date or co-occur with the onset of migraine in a child who is at risk of developing the headache condition. The purpose of this review is to evaluate the two most common episodic syndromes, abdominal migraine and cyclic vomiting syndrome, including their pathophysiology, common presentations, and diagnostic criteria. Differential diagnosis and “red flag” features are outlined, and an approach to diagnostic work-up is offered. Finally, we provide an evidence-based review of management options and long-term prognosis. Future research should include randomized trials for the acute and preventive treatment of these disorders, as well as research as to whether early intervention can prevent progression to migraine and/or mitigate migraine severity.     

Pharmacokinetic Profiles and Temporal Changes in Quantitative EEG after Imipramine Administrations

Abstract: A study of the relationship between pharmacokinetic profiles and temporal changes in quantitative EEG following imipramine administrations showed that a single dose of imipramine administered by different routes decreased the alpha-power spectra of healthy subjects. The EEG changes were time-related and their latent period and duration depended not on the plasma levels, but on the pharmacokinetic parameters. These effects were produced by imipramine without the influence of its desmethylated product, desipramine. Also, both single and multiple doses after oral or intramuscular imipramine administrations to depressive patients led to two types of EEG responses, with Type 1 patientsexhibiting fast improvement of their symptoms. Therefore, chronologically-recorded quantitative EEG should be useful in judging the clinical prognosis of depressive patients after the imipramine treatment. At a steady state, however, neither the EEG recording nor theevaluation of the plasma level is adequate for the judgment.     

Cyclic Vomiting Syndrome in Infants and Children: A Clinical Follow-Up Study

BackgroundCyclic vomiting syndrome is characterized by recurrent vomiting that is associated with increased adrenocorticotropic hormone and antidiuretic hormone levels during cyclic vomiting syndrome attacks. However, both prognosis and treatment remain unclear. We therefore evaluated the clinical features, prognosis, and effectiveness of the prophylaxis of cyclic vomiting syndrome as well as the relationship between symptoms and adrenocorticotropic hormone/antidiuretic hormone levels.MethodsWe included 31 patients with cyclic vomiting syndrome who were admitted to Teikyo University between 1996 and 2008. All patients were diagnosed with cyclic vomiting syndrome based on the criteria of the second edition of the International Headache Classification. The patients (25 of 31) were followed until 2013.ResultsThe median overall duration of the disorder was 66 (3-179) months. Follow-up was completed for 25 patients with cyclic vomiting syndrome, of whom 44% (n = 11) developed migraine. Valproic acid, valproic acid with phenobarbital, phenobarbital, and amitriptyline were effective in nine, four, three, and one patients, respectively. Abnormally high adrenocorticotropic hormone (n = 17) and antidiuretic hormone (n = 18) levels were found among the 25 patients for whom follow-up data were available. The following correlations were significant: attack duration and adrenocorticotropic hormone levels (correlation coefficient: 0.5153, P = 0.0084) and attack duration and antidiuretic hormone levels (correlation coefficient: 0.5666, P = 0.0031). Antidiuretic hormone levels in patients with bilious vomiting were higher than in those without bilious vomiting (P = 0.048).ConclusionsMost patients with cyclic vomiting syndrome recovered completely and benefited from prophylactic therapy, although half of them developed migraines.     

Reversible encephalopathy induced by cefoperazone: a case report monitored with EEG

In patients with an impaired state of consciousness, EEG is fundamental, a correct neurological work-up. Cephalosporins have been identified as a case of triphasic waves’ (TW) reversible encephalopathy. We report a case of an acute reversible encephalopathy with TWs during treatment with cefoperazone. We report the occurrence and regression of a confusional state with TWs encephalopathy at EEG after the administration of cefoperazone for urinary tract infection in a patient admitted for syncope. In conclusion, cefoperazone should be considered as a cause of toxic encephalopathy with EEG TWs, when there is a temporal relationship with its administration; EEG monitoring is useful in the neurological follow-up.     

Quantitative Comparison of Cell Loss and Thiopental-Induced EEG Changes in Human Epileptic Hippocampus

Thiopental-induced EEG beta activity recorded from mesial and lateral temporal lobe sites was analyzed both visually and by computer in 30 patients with complex partial seizures. All patients later received anterior temporal lobectomy. Volumetric cell densities and percentage of principal cell loss relative to normal controls were determined in several different areas of each resected temporal lobe. The percentage of drug-induced beta activity was then compared with the percentage of cell loss by (a) making precise topographic correlations between induced beta and cell loss, (b) relating the overall degree of left/right beta asymmetry to cell loss averaged over wide regions, and (c) comparing the likelihood of left/right beta asymmetries in patients with and without extreme cell loss. The results obtained were consistently negative and were unaffected by whether EEG data were analyzed by computer or visual inspection. These results indicate that the well-known loss of drug-induced beta activity found in epileptogenic regions is not an indicator of the degree of cell loss or sclerosis. The underlying focal dysfunction measured by EEG beta activity remains unknown, and factors such as focal hypoperfusion, hypometabolism, and the microanatomic features of the cells remaining in the focus should be investigated.     

Quantitative EEG Evidence of Increased Alpha Peak Frequency in Children with Precocious Reading Ability

ABSTRACT

Background. EEG research with specific clinical populations (e.g., Alzheimer's and mentally disabled) has confirmed that reduced alpha peak frequency often is associated with impaired cognitive functioning. However, research with high-functioning populations does not exist, and increased peak frequency in alpha has only been hypothesized to relate to advanced brain maturation.

Methods. This study compared peak frequency in the alpha band (8.0 to 12.0 Hz) of children with precocious reading ability to that of control groups. The experimental group consisted of 15 early readers (ER). One comparison sample included 15 age-level matched (ALM) children, similar to the ER group in terms of cognitive functioning and age, but reading at grade level. A second comparison group, composed of 15 reading-level matched (RLM) children, had intelligence and reading level scores equivalent to the ER group, but was 2.5 years older. Using Lexicor NeuroSearch-24 equipment and v151 software, quantitative EEG (QEEG) data on each participant were obtained from 19 scalp electrode sites.

Results. As hypothesized, peak frequency in alpha differentiated the groups. Specifically, the ER group had significantly higher alpha peak frequency than the ALM group at 16 of the 19 electrode sites examined. The differences were consistent across all brain regions, as the mean alpha peak frequency at each site was between 9.0 and 9.3 Hz for members of the ER group and between 8.6 and 8.8 Hz for members of the ALM group. Peak frequency in alpha did not differ significantly between the ER and RLM sample.

Conclusions. Peak frequency in the alpha band is associated with precocious reading ability, and may be an indicator of advanced brain maturation.     

Quantitative EEG patterns following unilateral stroke: a study in chronic stage

The aim of this study was to investigate the EEG power spectra obtained during rest and mental processing in chronic stroke patients. Seventeen patients with stabilized unilateral cerebral ischemia, grouped according to the side of lesion, underwent quantitative EEG recordings during rest and attentive/cognitive tasks. EEG spectral values were compared with those of 11 healthy subjects. Patients displayed different EEG patterns from controls, under rest condition: patients with left hemispheric lesion were characterized by a preserved alpha and beta band "reactivity," with a lack of significant changes in slow band components. In patients with right hemisphere lesion, no significant changes of the slow and fast band activities were evident during each task. These findings indicate that different EEG patterns of activation characterize stroke patients with left and right hemispheric damage.     

EEG during pedaling: Evidence for cortical control of locomotor tasks

ObjectiveThis study characterized the brain electrical activity during pedaling, a locomotor-like task, in humans. We postulated that phasic brain activity would be associated with active pedaling, consistent with a cortical role in locomotor tasks.MethodsSixty four channels of electroencephalogram (EEG) and 10 channels of electromyogram (EMG) data were recorded from 10 neurologically-intact volunteers while they performed active and passive (no effort) pedaling on a custom-designed stationary bicycle. Ensemble averaged waveforms, 2 dimensional topographic maps and amplitude of the β (13–35 Hz) frequency band were analyzed and compared between active and passive trials.ResultsThe peak-to-peak amplitude (peak positive–peak negative) of the EEG waveform recorded at the Cz electrode was higher in the passive than the active trials (p < 0.01). β-band oscillations in electrodes overlying the leg representation area of the cortex were significantly desynchronized during active compared to the passive pedaling (p < 0.01). A significant negative correlation was observed between the average EEG waveform for active trials and the composite EMG (summated EMG from both limbs for each muscle) of the rectus femoris (r = ?0.77, p < 0.01) the medial hamstrings (r = ?0.85, p < 0.01) and the tibialis anterior (r = ?0.70, p < 0.01) muscles.ConclusionsThese results demonstrated that substantial sensorimotor processing occurs in the brain during pedaling in humans. Further, cortical activity seemed to be greatest during recruitment of the muscles critical for transitioning the legs from flexion to extension and vice versa.SignificanceThis is the first study demonstrating the feasibility of EEG recording during pedaling, and owing to similarities between pedaling and bipedal walking, may provide valuable insight into brain activity during locomotion in humans.     

Post-infectious Opsoclonus and Reversible Magnetic Resonance Imaging Changes: A Case Report and Review of the Literatures

Purpose: Opsoclonus is a rare neurological disorder in adult. The etiology of opsoclonus includes parainfectious, paraneoplastic, toxic, and metabolic disorders. We reported an old female with post-infectious opsoclonus who had a benign clinical course and reversible brain MRI lesions, and its review of the literature. Case Report: A 67-year-old woman presented with opsoclonus and truncal ataxia for two weeks. The magnetic resonance imaging (MRI) showed the hyperintensity lesions in bilateral medial thalamus, hypothalamus, and tegmentum of pons on Fluid-attenuated inversion recovery (FLAIR) imaging. Investigations of neoplasm and autoimmune disorders showed negative findings. Clinical symptoms subsided in two-week duration and MRI abnormalities also disappeared one month later. Conclusion: A benign clinical course and reversible MRI lesions could be found in the patients with postinfectious opsoclonus such as our case. However, detailed investigations and long-term follow-up are needed to exclude paraneoplastic or other systemic and immunological disorders.     

Quantitative EEG for Early and Differential Diagnosis of Bipolar Disorders: a Comprehensive Review of the Literature

This paper is aimed to review the applications and potentials of QEEG in early diagnosis of bipolar disorders as well as its diagnostic efficacy for differential diagnosis against other cognitive abnormalities with the same clinical symptoms. The databases of PubMed (1990–2016), EMBASE (1990–2016), Web of Sciences (1990–2016), and Google Scholar (1980–2016) were searched using the search terms of “quantitative electroencephalogram” or “QEEG”, “bipolar disorders”, “early diagnosis”, and “differential diagnosis”. selected for further evaluations. The evidence indicates diagnostic efficacy of QEEG for early diagnosis of bipolar disorders (BDs). Controlled clinical studies have indicated that QEEG extracted measures may have the same diagnostic value for early and differential diagnosis of BDs as these conventional assessments.     

EEG fitting: a new method for numerical analysis of EEG

A new method for numerical analysis of EEG is described. It consists of fitting the EEG with orthogonal polynomials in several steps to separate the different frequencies contained in the original recording (high-frequency noise, beta, sigma, alpha, theta, delta, low-frequency noise). The original EEG is separated into 5 different signals with cutoff frequencies at 40, 18, 4 and 0.6 Hz. The activity in these signals is classified into the usual EEG bands by zero-crossing. The results are given as integrated values over 1 s in the different EEG bands, or wave by wave, each wave being described by its time of occurrence, amplitude and duration. This method is designed for accurate amplitude measurement in the frequency bands of EEG, particularly for application in psychiatry and psychophysiology.     

Continuous Quantitative Electroencephalogram (EEG) Monitoring for Early Detection of Brain Herniation in Large Hemispheric Infarction (LHI): A Case Report

BackgroundComputer-assisted electroencephalography (EEG) systems may improve the likelihood of detecting abnormal EEGs in adult patients with severe disease.Case presentationWe implemented long-range EEG monitoring in a patient with large hemispheric infarction (LHI) and explored its real-time changes in reflecting the patient's brain function. The bands of Alpha, Beta, Delta, Theta, DAR (Delta/Alpha), DTABR (Delta+Theta/Alpha+Beta), and brain symmetry index (BSI) were calculated as a ratio of total power. The test results showed that this patient presents a progressive worsening trend and developed brain herniation. The sigh at the electrophysiological level of brain herniation could be seen 6 h in advance based on the quantitative EEG (QEEG) parameters test. We calculated QEEG at both C3 and C4, electrode locations simultaneously, and the results showed that the trend of QEEG at both electrodes was consistent with the global, affected, and unaffected side.ConclusionsQEEG parameters can reflect the trend of LHI patients in real-time and may predict the occurrence of LHI brain herniation. For LHI patients, monitoring with fewer EEG electrodes can be tried to predict the changes in conditions.     

Quantitative EEG and dynamic susceptibility contrast MRI in Alzheimer's disease: a correlative study.

OBJECTIVE: To investigate the relationship between the electroencephalographic (EEG) power spectra features obtained by quantitative EEG (qEEG) and the hemodynamic parameters detected by dynamic susceptibility contrast-enhanced MR imaging (DSC MRI) in patients with Alzheimer's disease (AD). METHODS: Fourteen patients with probable AD and 15 elderly healthy controls were included in the study. All subjects underwent both EEG recording in a rest condition and perfusion MRI. Three EEG scalp areas were defined (anterior, central and posterior) and power spectra values were obtained from each scalp area. Relative values of temporoparietal and sensorimotor regional cerebral blood volume (rCBV) were measured bilaterally and successively averaged to obtain a total perfusion index. The brain atrophy index was calculated and used as a covariate to rCBV. Correlation analysis was performed between EEG variables and hemodynamic-morphological parameters. RESULTS: qEEG power spectra of AD patients were characterized by an increase in mean relative power of theta (4-7.75 Hz) associated with a decrease in alpha (8-12.75 Hz) frequency bands with a topographic distribution over the central and posterior EEG scalp regions, when compared with controls; beta (13-31 Hz) frequency band also displayed a significant decrease over the anterior and posterior EEG scalp regions of AD patients with respect to controls. The DSC MRI revealed a bilateral reduction in the temporoparietal and sensorimotor rCBV with respect to controls. Correlation analysis showed that the total level of hypoperfusion selectively correlates with the EEG power spectra in theta and alpha frequency bands distributed over anterior/central and central region, respectively. Within AD patients, the lower the level of hypoperfusion, the higher the content of EEG power spectra in theta frequency band, and the lower the level of hypoperfusion, the lower the content of EEG power spectra in alpha band. CONCLUSIONS: The combined qEEG and DSC MRI technology unveiled a selective correlation between neurophysiological and hemodynamical patterns in AD patients. Further investigations will ascertain the relevance of this multi-modal approach in the heterogeneous clinical context of AD.     

Evidence of a faster posterior dominant EEG rhythm in children with autism

Multiple electroencephalography (EEG) abnormalities have been associated with autism. In the course of clinical work, we have observed a posterior dominant EEG rhythm at higher frequency in children with autism. To test this observation, 56 EEG tracings of children with autism were compared to the EEGs of age-matched controls. Children with autism showed a posterior dominant EEG rhythm (PDR) of 9.00 Hz versus 8.60 Hz for controls (p = 0.014). This difference was greater at younger ages. Neural correlates of an increased alpha frequency are unclear. This may represent pathology in cortical-thalamic circuits, default mode network, dorsal attention network and/or occipital visual networks. Examination of changes in these circuits in autism may be a worthwhile area for future research.