The EEG in acute ischaemic cerebrovascular disease

The electroencephalogram (EEG) is a neurophysiological technique with high temporal resolution and sensibility in the evaluation of brain function in real time. Besides this, EEG is the gold standard for the identification of epileptogenesis and ictogenesis biomarkers. Epileptic seizures and Cerebrovascular disease are two of the most frequent neurological disorders imposing important mutual challenges. Furthermore, in recent years, stroke care has evolved remarkably and, facing a new paradigm of acute standard of care (centred on multidisciplinary Stroke Units), epileptic seizures (as stroke complications) deserve to be rethought. The EEG is an essential neurophysiological exam in the evaluation of patients with epileptic seizures, status epilepticus and/or epilepsy, both for diagnosis and classification, as well as for the establishment of a correct treatment or outcome prediction. Furthermore, EEG has been previously used in cerebrovascular disease with different purposes. However, its clinical usefulness in the differential diagnosis of transient neurological symptoms, specifically in the differentiation between a transient ischaemic attack and some epileptic seizures, and also in the diagnosis or prediction of post-stroke seizures or in post-stroke prognosis prediction, remains uncertain. In this work, we aim to use the clinical model of acute ischaemic cerebrovascular disease to study the value of EEG in the differential diagnosis of transient neurological symptoms, in the diagnosis and prediction of post-stroke seizures and epilepsy, as well as to analyse if electroencephalographic abnormalities and/or epileptic seizures are independent predictors of an anterior circulation ischaemic stroke outcome. Furthermore, since the gold standard of acute stroke care (namely intravenous alteplase treatment) is associated with a reduction of mortality and incapacity of treated patients with possible consequences in post-stroke seizure frequency, but a pro-convulsive and an epileptogenic effect of alteplase has also been described, we aim to test the hypothesis that ischaemic stroke patients treated with intravenous alteplase have a different frequency of epileptic (clinic and/or electroencephalographic) manifestations compared to non-treated patients. Different research methodologies were used in this thesis. A systematic review and meta-analysis of observational studies was performed to evaluate both the frequency of post-stroke (ictal and interictal) epileptiform activity in the EEG, and the quality of studies about this subject. Furthermore, different types of observational studies (including clinical case report, case series and cohort studies) were completed to answer relevant clinical questions. We performed a prospective longitudinal study of possible transient ischaemic attacks (TIA) patients evaluated at a tertiary centre during 36 months, with 1-3 months follow-up and also of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for one year. In both studies, patients underwent standardized clinical, diagnostic and neurophysiological assessment. A short duration (≤60 minutes) video-EEG protocol with an extended montage including 64 EEG, two electrooculogram, one electrocardiogram and at least one electromyogram channel was established. Different electroencephalographic investigation technics including visual, back-average and quantitative analysis were used in the clinical workup of patients with possible and definite, transient and established, cerebrovascular disease as tools for the differential diagnosis and for brain functional assessment, concerning not only epileptic manifestations detection and prediction but also to search for predictors of ischaemic stroke functional outcome and vital prognosis. Although epileptic seizures were the most frequent defined final diagnosis (n=13; 16.3%) in our series of 80 patients with difficult-to-diagnose transient neurological symptoms, visual inspection of EEG supported this diagnosis only in 7.5% (n=6) of patients with possible TIA. Moreover, the majority (n=6; 53.8%) of patients with the final diagnosis of epileptic seizures did not have interictal epileptiform activity in an early EEG. Furthermore, early focal slow wave activity, the most frequent EEG abnormality in this patient’s series, did not distinguished between TIA and seizure patients. Our systematic review and random-effects meta-analysis showed that the pooled frequency of post-stroke ictal and interictal epileptiform activity was 7% (95%CI: 3%-12%) and 8% (95%CI: 4%-13%) respectively. Only 2 out of 17 included studies (11.7%) attained the maximum quality score. Moreover, no study exclusively enrolled ischaemic stroke patients, highlighting the need for higher quality studies in the evaluation of epileptiform activity frequency in this type of cerebrovascular disease. Furthermore, due to detection bias, it was not possible to correlate clinical and electrographic seizures. In our prospective cohort of 151 anterior circulation acute stroke patients, we identified different post-stroke, clinical and electroencephalographic, epileptic manifestations including 22.7% (5/22) of acute symptomatic seizures that were exclusively electrographic and therefore could not otherwise be recognised. Furthermore, only EEG back-average analysis allowed the diagnosis of cortical myoclonus during intravenous alteplase perfusion in one clinical vignette included in this work and the recognition of epilepsia partialis continua as a chronic complication of this stroke type in 1.7% of patients. This original work also showed that studied clinical and EEG epileptic manifestations were not significantly different between intravenous alteplase treated and non-treated patients. This thesis work established which abnormalities of an early EEG after acute stroke (background activity asymmetry and the presence of interictal epileptiform activity) are independent predictors of epilepsy in the year after (even when adjusted for clinical and imaging stroke severity). Besides this, early (within the first 72h) post-stroke EEG features, extracted from visual (background activity diffuse slowing and asymmetry) and quantitative (such as delta-theta to alpha-beta ratio and alfa relative power) analysis were recognized as independent predictors of death or functional dependency, at hospital discharge and at 12 months after stroke. Furthermore, outcome models that incorporate delta-theta to alpha-beta ratio or alpha relative power were better than models based exclusively on clinical and imaging-related ischaemic stroke severity at hospital admission. Additionally, post-stroke acute symptomatic seizures and epilepsy were independently associated to death and to an unfavourable outcome 1 year after an acute anterior circulation ischaemic stroke, respectively. Globally, these research projects have shown the value of EEG in the current paradigm of stroke patient’s care. Furthermore, they expand the knowledge both about the EEG role as a complementary neurophysiological tool in general Neurology and about different aspects of the diagnosis and outcome of two of the most prevalent neurological disorders, Cerebrovascular Diseases and Epilepsy, in particular. Beyond the value of specific results, with this work several other research questions about EEG and seizures in ischaemic cerebrovascular disease emerge. Therefore, new possibilities of future research, ideally multicentric, clinical or translational arise

Men and women with chronic insomnia disorder and OSAS : different responses to CPAP

Objective: To evaluate the response to CPAP in patients with chronic insomnia disorder (CID) with OSAS in an unselected patient population including all OSAS severity groups. As a secondary objective, we also wanted to evaluate the differences between patients that improve insomnia symptoms with CPAP and patients that do not improve, specifically evaluating possible gender differences. Methods: Retrospective study of patients with a diagnosis of OSAS treated with CPAP and CID at the first clinical visit, selected from a database of an outpatient sleep clinic of University Hospital. Results: From a database of total of 827 patient, 90 patients were identified with OSAS and CID (53.3% women). Middle / moderate OSAS was diagnosed in 68.9% and severe OSA in 31.1%. Most patients (61.1%) improved insomnia symptoms after CPAP therapy. In the responders group, 58.2% had initial insomnia, 63.6% middle insomnia and 12.7% late insomnia. Responders to CPAP were more frequently women (women 61.8%, men 38.2%, p = 0.035) and there was no other difference between responders and non-responders. On subgroup analysis, this difference was significant only in severe OSAS (women 88.9%, men 31.6%, p = 0.013). Conclusion: In most patients with CID and OSA, there is a consistent reduction of insomnia symptoms with the CPAP use. This factor emphasizes the importance of performing PSG in CID. Insomnia in men with severe OSAS responds less frequently to CPAP suggesting that in these cases the insomnia phenotype is less dependent on the respiratory symptoms.info:eu-repo/semantics/publishedVersio

End of OSLER test sessions in Parkinson’s disease do not correspond to true sleep onset: results from an exploratory study

Copyright © 2015 Neutel, Peralta, Pires, Bentes and Ferreira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.The aim of the present study was to evaluate the correlation between the end of an Oxford sleep resistance (OSLER) test session and a neurophysiological marker of sleep onset in Parkinson's disease (PD) patients. Single center study was conducted in PD patients with excessive daytime sleepiness [Epworth sleepiness scale (ESS) >9]. The OSLER test was conducted with a concomitant electroencephalography (EEG), electromyography (mentalis), right and left electroculogram, and video monitoring. Neurophysiological (NP) sleep onset was defined according to AASM criteria (2005). Five PD patients with mean ESS of 14 (10-16) were included. OSLER test duration was shorter than 40 min in all patients (mean duration 20 min and 39 s). No patient fulfilled neurophysiological criteria to sleep onset at the time of OSLER test termination. In 13 OSLER sessions that ended before 40 min, eight had microsleeps in the last 30 s before the end of the test. NP monitoring showed signs of sleepiness in all patients. In PD patients, the early termination of an OSLER test session may not correspond to NP criteria of sleep onset. However, in all PD patients with abnormal OSLER results, there were EEG signs of sleepiness, which do not exclude the potential utility of OSLER test to evaluate the risk of falling asleep.info:eu-repo/semantics/publishedVersio

Dream recall frequency and content in patients with temporal lobe epilepsy

Purpose: To evaluate morning dream recall frequency and content in patients with temporal lobe epilepsy (TLE). Methods: Fifty-two patients with pharmacoresistant TLE submitted to a written dream diary during five consecutive days and continuous video–electroencephalographic (video-EEG) monitoring. A matched control group of 41 healthy subjects completed the same diary at home. The number of recalled dreams (including long dreams) and nonrecalled dream mentation were collected, and the Dream Recall Rate (DRR) was calculated. Hall and Van de Castle dream content analysis was performed. Key Findings: Greater than 70% of patients with TLE (37 of 52) recall their dreams, but DRR rate in these patients is lower than in controls (p £ 0.001). Dream recall does not appear to be influenced by the presence of neuropsychological deficits nor seizure frequency. In dreams descriptions, TLE patients (vs. controls) have a higher percentage of familiarity in settings and fewer dreams with at least one success. Significance: Onirical activity of patients with TLE is different from that of healthy subjects. Our results support the role of mesial and neocortical temporal structures in dream experience. The selective activation of dysfunctional mesial structures may be responsible for some of the observed variability. However, dream content changes can also mirror social and psychological comorbidities of patients with epilepsy.info:eu-repo/semantics/publishedVersio

Políticas públicas para a população LGBT: uma análise das produções realizada de 2011 a 2020

In this article we analyze public policies for LGBT, we aimed to present a brief review of literature about public policies for LGBT from 2011 to 2020. This research was qualitative, with an exploratory base, focused on the State of the Question. The survey was bibliographic  in two database with descriptors "LGBT" and "public policies", the results identified twelve products which were grouped into four categories after content analysis: 1) public policies and citizenship, 2) public policies and health, 3) public policies and security and 4) public policies and education. The discussions pointed to the need of promoting public policies for LGBT, as well as difficulties in the process of legitimization and implementation of public policies for LGBT, to promoting the empowerment to face inequalities.Nesse artigo são analisadas as políticas públicas existentes voltadas para a população LGBT. Teve como objetivo apresentar uma breve revisão de literatura sobre as políticas públicas direcionadas para a população LGBT de 2011 a 2020.A pesquisa teve caráter qualitativo, de base exploratória, focado no estado da questão, com levantamento bibliográfico em duas bases de dados, com os descritores "LGBT" e "políticas públicas”. Os resultados identificaram doze produtos, que foram agrupados em quatro categorias 1) políticas públicas e cidadania, 2) políticas públicas e saúde, 3) políticas públicas e segurança e 4) políticas públicas e educação. As discussões apontaram para a relevância do fomento às políticas públicas para população LGBT, bem como dificuldades no processo de legitimação e execução destas, objetivando o fomento ao protagonismo para o enfrentamento das desigualdade

Semi-pelagic Longline and Trammel Net Elasmobranch Catches in Southern Portugal: Catch Composition, Catch Rates and Discards

In Portugal, elasmobranch landings have decreased substantially in recent years. In this work, elasmobranch catches in semi-pelagic longlines (1997 and 1998) were compared with those in trammel nets (2000) in the Algarve, southern Portugal areas. In the semi-pelagic longline fi shery, 7 elasmobranch species represented 33.4% (2 185 specimens) of the total fi sh catches. Among the elasmobranch species, the most abundant were Galeus melastomus (63.3%), Etmopterus pusillus (21.7%) and Scyliorhinus canicula (14.2%). Most of these elasmobranchs were discarded (68.3% in total). In the trammel net fi shery, 16 different elasmobranch species represented 4.3% (597 specimens) of total fi sh catches and the most important species were Raja undulata (43.6%) and S. canicula (10.2%). The majority of the elasmobranchs caught in trammel nets had commercial value, and only 5.4% were discarded. In both fi sheries, intra-specifi c catch rates varied with depth. Length-frequency distributions for the only species with relatively high catches in both fi sheries, S. canicula, showed that, in general, trammel nets catch larger specimens and in a narrower length range than do longlines.info:eu-repo/semantics/publishedVersio

Dream recall frequency and content in patients with temporal lobe epilepsy

Purpose: To evaluate morning dream recall frequency and content in patients with temporal lobe epilepsy (TLE). Methods: Fifty-two patients with pharmacoresistant TLE submitted to a written dream diary during five consecutive days and continuous video–electroencephalographic (video-EEG) monitoring. A matched control group of 41 healthy subjects completed the same diary at home. The number of recalled dreams (including long dreams) and nonrecalled dream mentation were collected, and the Dream Recall Rate (DRR) was calculated. Hall and Van de Castle dream content analysis was performed. Key Findings: Greater than 70% of patients with TLE (37 of 52) recall their dreams, but DRR rate in these patients is lower than in controls (p £ 0.001). Dream recall does not appear to be influenced by the presence of neuropsychological deficits nor seizure frequency. In dreams descriptions, TLE patients (vs. controls) have a higher percentage of familiarity in settings and fewer dreams with at least one success. Significance: Onirical activity of patients with TLE is different from that of healthy subjects. Our results support the role of mesial and neocortical temporal structures in dream experience. The selective activation of dysfunctional mesial structures may be responsible for some of the observed variability. However, dream content changes can also mirror social and psychological comorbidities of patients with epilepsy

Fungal endophytic community associated with guarana (Paullinia cupana var. Sorbilis): diversity driver by genotypes in the centre of origin

Guarana plant is a native of the Amazon region. Due to its high amount of caffeine and tannins, the seed has medicinal and stimulating properties. The guarana industry has grown exponentially in recent years; however, little information is available about associated mycobiota, particularly endophytic fungi. The present study aimed to compare the distribution and diversity of endophytic fungi associated with the leaves and seeds of anthracnose-resistant and susceptible guarana plants produced in Maués and Manaus, Amazonas State, Brazil. A total of 7514 endophytic fungi were isolated on Potato Dextrose Agar, Sabouraud and Czapek media, and grouped into 77 morphological groups. Overall, fungal communities in guarana leaves and seeds were mainly composed by Colletotrichum and Fusarium genera, but also by Chondrostereum, Clonostachys, Curvularia, Hypomontagnella, Lentinus, Neopestalotiopsis, Nigrospora, Peroneutypa, Phyllosticta, Simplicillium and Tinctoporellus. Obtained results indicate that some members of Colletotrichum and Fusarium genera may have experienced dysbiosis during the guarana domestication process, suggesting that some individuals may behave as latent pathogens. The susceptible guarana genotype cultivated in Manaus presented higher fungal diversity. The relative abundance of taxa and diversity among samples suggests that communities are structured by genotype and geographic location. This is the first report of mycobiota in both guarana leaves and seeds.This research was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior(CAPES) project Pró-Amazônia n◦3287/13. C.S. (Carla Santos) and N.L. were supported by FCT under the scopeof the strategic funding of UIDB/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004)funded by the European Regional Development Fund under the scope of Norte2020 - Programa OperacionalRegional do Norte. C.S. (Cledir Santos) was supported by the Universidad de La Frontera (Temuco, Chile) withpartial funding from the Project PIA19-0001.info:eu-repo/semantics/publishedVersio