Video-EEG epilepsian diagnostiikassa - milloin ja miksi?

Aivosähkötoimintaa mittaava EEG on epilepsian spesifinen tutkimus. Video-EEG:llä (V-EEG) tarkoitetaan EEG:n ja videokuvan samanaikaista tallennusta. Valtaosa epilepsiapotilaista joudutaan diagnosoimaan ilman V-EEG:tä, varsinkin jos kohtauksia on esiintynyt vain muutama. Kohtausten toistuessa tavoite on päästä kohtauksenaikaiseen V-EEG-rekisteröintiin. V-EEG:n käyttöaiheista tärkein on epilepsian diagnostiikka ja erotusdiagnostiikka. V-EEG:llä pystytään erottamaan epileptiset kohtaukset esimerkiksi sydänperäisistä kohtauksista, liikehäiriöistä ja toiminnallisista kohtauksista. Keskeisiä kliinisiä käyttöaiheita ovat epilepsioiden tarkempi luokittelu, hoitovasteen arviointi ja epilepsialeikkausta edeltävä kohtauspesäkkeen paikannus. V-EEG voidaan rekisteröidä kaikenikäisiltä. Tutkimuksen kesto vaihtelee kliinisen tarpeen mukaan muutamista tunneista useaan vuorokauteen. V-EEG:stä hyötyvät kaikki tutkimukseen ohjatut potilaat, vaikka vain osa etenee esimerkiksi epilepsian kirurgiseen hoitoon. English summary: Video-EEG in epilepsy diagnostics - when and why? Video-EEG (V-EEG) refers to the recording of video picture simultaneously with EEG. A major part of epilepsy patients have to be diagnosed without V-EEG. For a patient having recurrent seizures, the aim is to accomplish V-EEG recording during a seizure. Of the indications of V-EEG, the most important one is diagnosis and differential diagnosis of epilepsy. V-EEG is able to differentiate epileptic seizures from cardiogenic seizures, motor disorders or functional seizures, for example. Essential clinical indications include a more exact classification of epilepsies, evaluation of therapeutic response, and localization of the seizure focus prior to epilepsy surgery

Self-Applied Electrode Set Provides a Clinically Feasible Solution Enabling EEG Recording in Home Sleep Apnea Testing

Home sleep apnea testing (HSAT) without electroencephalography (EEG) recording is increasingly used as an alternative to in-laboratory polysomnography for the diagnosis of obstructive sleep apnea (OSA). However, without EEG, electrooculography (EOG), and chin electromyography (EMG) recordings, the OSA severity may be significantly underestimated. Although several ambulatory EEG systems have been recently introduced, no patient-applied systems including EEG, EOG, and chin EMG suitable for home polysomnography are currently in clinical use. We have recently developed and pre-clinically tested a self-applied ambulatory electrode set (AES), consisting of frontal EEG, EOG, and EMG, in subjects with possible sleep bruxism. Now, in this clinical feasibility study, we investigated the signal scorability and usability of the AES as a self-administered sleep assessment approach supplementing the conventional HSAT device. We also investigated how the diagnostic parameters and OSA severity changed when utilizing the AES. Thirty-eight patients (61 % male, 25-78 years) with a clinical suspicion of OSA conducted a single-night, self-administered HSAT with a portable polysomnography device (Nox A1, Nox Medical, Reykjavik, Iceland) supplemented with AES. Only one AES recording failed. The use of AES signals in data analysis significantly affected the median apnea-hypopnea index (AHI), increasing it from 9.4 to 12.7 events/h (p < 0.001) compared to the conventional HSAT. Also, in eight patients, the OSA severity class changed to one class worse. Perceived ease of use was well in line with that previously found among healthy volunteers. These results suggest that the AES provides an easy, clinically feasible solution to record EEG as a part of conventional HSAT.Peer reviewe

Success Rate and Technical Quality of Home Polysomnography With Self-Applicable Electrode Set in Subjects With Possible Sleep Bruxism

Using sleep laboratory polysomnography (PSG) is restricted for the diagnosis of only the most severe sleep disorders due to its low availability and high cost. Home PSG is more affordable, but applying conventional electroencephalography (EEG) electrodes increases its overall complexity and lowers the availability. Simple, self-administered single-channel EEG monitors on the other hand suffer from poor reliability. In this study, we aimed to quantify the reliability of self-administrated home PSG recordings conducted with a newly designed ambulatory electrode set (AES) that enables multichannel EEG, electrooculography, electromyography, and electrocardiography recordings. We assessed the sleep study success rate and technical quality of the recordings performed in subjects with possible sleep bruxism (SB). Thirty-two females and five males aged 39.6 +/- 11.6 years (mean +/- SD) with self-reported SB were recruited in the study. Self-administrated home PSG recordings with two AES designs were conducted (n = 19 and 21). The technical quality of the recordings was graded based on the proportion of interpretable data. Technical failure rate for AES (both designs) was 5% and SB was scorable for 96.9% of all recorded data. Only one recording failed due to mistakes in self-applying the AES. We found that the proportion of good quality self-administrated EEG recordings is significantly higher when multiple channels are used compared to using a single channel. Sleep study success rates and proportion of recordings with high quality interpretable data from EEG channels of AES were comparable to that of conventional home PSG. Self-applicable AES has potential to become a reliable tool for widely available home PSG.Peer reviewe

Mitochondrial respiratory dysfunction due to the conversion of substituted cathinones to methylbenzamides in SH-SY5Y cells

The increased use of cathinone-type designer drugs, known as legal highs, has led to concerns about their potential neurotoxicity due to their similarity to methamphetamine (METH). Therefore, closer investigations of their toxic effects are needed. We investigated the effects of the cathinones 4-methylmethcathinone (4-MMC) and 3,4-methylenedioxymethcathinone (MDMC) and the amphetamine METH on cytotoxicity and mitochondrial respiration in SH-SY5Y neuroblastoma cells. We also investigated the contribution of reactive species, dopamine, Bcl-2 and tumor necrosis factor alpha(TNF alpha) on toxicity. Finally, we investigated the effect of cathinone breakdown products using ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry and studied their involvement in toxicity. We observed dose-dependent increases in cytotoxicity and decreases in mitochondrial respiration following treatment with all cathinones and amphetamines. Glutathione depletion increases amphetamine, but not cathinone toxicity. Bcl-2 and TNF alpha pathways are involved in toxicity but dopamine levels are not. We also show that cathinones, but not amphetamines, spontaneously produce reactive species and cytotoxic methylbenzamide breakdown products when in aqueous solution. These results provide an important first insight into the mechanisms of cathinone cytotoxicity and pave the way for further studies on cathinone toxicity in vivo.Peer reviewe

Deep Learning Enables Accurate Automatic Sleep Staging Based on Ambulatory Forehead EEG

We have previously developed an ambulatory electrode set (AES) for the measurement of electroencephalography (EEG), electrooculography (EOG), and electromyography (EMG). The AES has been proven to be suitable for manual sleep staging and self-application in in-home polysomnography (PSG). To further facilitate the diagnostics of various sleep disorders, this study aimed to utilize a deep learning-based automated sleep staging approach for EEG signals acquired with the AES. The present neural network architecture comprises a combination of convolutional and recurrent neural networks previously shown to achieve excellent sleep scoring accuracy with a single standard EEG channel (F4-M1). In this study, the model was re-trained and tested with 135 EEG signals recorded with AES. The recordings were conducted for subjects suspected of sleep apnea or sleep bruxism. The performance of the deep learning model was evaluated with 10-fold cross-validation using manual scoring of the AES signals as a reference. The accuracy of the neural network sleep staging was 79.7% (kappa = 0.729) for five sleep stages (W, N1, N2, N3, and R), 84.1% (kappa = 0.773) for four sleep stages (W, light sleep, deep sleep, R), and 89.1% (kappa = 0.801) for three sleep stages (W, NREM, R). The utilized neural network was able to accurately determine sleep stages based on EEG channels measured with the AES. The accuracy is comparable to the inter-scorer agreement of standard EEG scorings between international sleep centers. The automatic AES-based sleep staging could potentially improve the availability of PSG studies by facilitating the arrangement of self-administrated in-home PSGs.Peer reviewe

New Insights into Alzheimer's Disease Progression: A Combined TMS and Structural MRI Study

BACKGROUND: Combination of structural and functional data of the human brain can provide detailed information of neurodegenerative diseases and the influence of the disease on various local cortical areas. METHODOLOGY AND PRINCIPAL FINDINGS: To examine the relationship between structure and function of the brain the cortical thickness based on structural magnetic resonance images and motor cortex excitability assessed with transcranial magnetic stimulation were correlated in Alzheimer's disease (AD) and mild cognitive impairment (MCI) patients as well as in age-matched healthy controls. Motor cortex excitability correlated negatively with cortical thickness on the sensorimotor cortex, the precuneus and the cuneus but the strength of the correlation varied between the study groups. On the sensorimotor cortex the correlation was significant only in MCI subjects. On the precuneus and cuneus the correlation was significant both in AD and MCI subjects. In healthy controls the motor cortex excitability did not correlate with the cortical thickness. CONCLUSIONS: In healthy subjects the motor cortex excitability is not dependent on the cortical thickness, whereas in neurodegenerative diseases the cortical thinning is related to weaker cortical excitability, especially on the precuneus and cuneus. However, in AD subjects there seems to be a protective mechanism of hyperexcitability on the sensorimotor cortex counteracting the prominent loss of cortical volume since the motor cortex excitability did not correlate with the cortical thickness. Such protective mechanism was not found on the precuneus or cuneus nor in the MCI subjects. Therefore, our results indicate that the progression of the disease proceeds with different dynamics in the structure and function of neuronal circuits from normal conditions via MCI to AD

Increase in body mass index decreases duration of apneas and hypopneas in obstructive sleep apnea

BACKGROUND: Obesity is one of the most prominent risk factors for obstructive sleep apnea (OSA). Weight loss decreases the number of shorter respiratory events

Simulation of required CPAP usage to normalize AHI in obstructive sleep apnea patients

Obstructive sleep apnea (OSA) is a highly prevalent disease with severe health consequences. The severity of OSA is estimated with apnea-hypopnea-index (AHI). OSA is often treated with continuous positive airway pressure (CPAP). The aim of the current work was to create a numerical simulator showing benefits of different levels of usage of CPAP treatment. 226 male OSA patients were evaluated. CPAP treatment was simulated in 5 min intervals starting from the beginning of the night and continuing until the end. The cutoff point where AHI reached normal level o

Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea-hypopnea index

Sleep apnea-hypopnea syndrome (SAHS) causes impairment of daytime functions and increases risk of cardiovascular diseases. Apnea-hypopnea index (AHI), currently used for the estimation of the severity of SAHS, does not contain information on the morphology or duration aspects of the breathing cessations and related oxygen desaturations. Longer breathing cessations and deeper desaturations may have more severe consequences than shorter and shallower ones. To address these issues, novel parameters containing information on the duration and morphology of breathing cessations and oxygen desaturations were calculated and evaluated on 160 male patients (40 patients in normal, mild, moderate and severe AHI severity categories). Obstruction and desaturation duration parameters consist of sum of event durations normalized with the total analysed time. Desaturation severity is a sum of desaturation event areas normalized with total analysed time and obstruction severity parameter is a sum of the products of apnea and hypopnea durations and related desaturation areas normalized with total analysed time. The median follow-up time of the patients was 183 months (range 154-215 months). The 40 patients in each category were further divided into subgroups A and B with lowest and highest novel parameter values, respectively. AHI showed no differences between the subgroups. Mortality was increased in subgroups B compared to subgroups A. The correlation of the novel parameters with AHI was only moderate and the parameter values were partially overlapping between the AHI severity categories. This suggests that patients with similar AHI may in fact suffer from SAHS of very different severity. Thus, the present results suggest that the novel parameters could bring new insight to the individual estimation of the severity of SAHS

Evaluation of a novel ambulatory device for screening of sleep apnea

The gold standard for diagnosis of obstructive sleep apnea (OSA) is the sleep laboratory polysomnography, which is technically demanding, labor-intensive, and time-consuming. Thus, screening of large undiagnosed population for OSA may be cost efficient only by means of ambulatory devices suitable for home recordings. The aim of our study was to evaluate the diagnostic and technical reliability of a novel ambulatory device (APV2, Remote Analysis Oy) introduced for sleep apnea diagnostics. APV2 records breathing movements, nasal and oral air flow, position, snore, blood oxygen saturation, and heart rate. The evaluation was done by comparing 10 simultaneous polygraphic recordings with APV2 and with commonly used clinical reference instrumentation (Embla, Embla Co.) at a sleep laboratory. Furthermore, the technical reliability of measurements was evaluated by analyzing the fraction of clinical APV2 and Embletta (Embla Co.) home recordings (n = 149 and n = 169, respectively) that were technically of diagnostically unacceptable quality. Similar diagnostic sensitivity in detecting OSA was found with the APV2 compared to the simultaneous reference recording with the Embla. Apnea-hypopnea indices and oxygen desaturation indices, recorded with APV2 and Embla, were closely correlated (r = 0.996-0.997, p < 0.0001). The quality of 90.0% of home recordings with APV2 was technically perfect and 96.0% of recordings were of diagnostically acceptable quality. As a comparison, the clinical evaluation of a widely used ambulatory polygraphy device (Embletta) showed that 77.2% of home recordings were technically perfect and 80.8% of recordings were diagnostically acceptable. In conclusion, the novel device was found clinically applicable, technically reliable, and sensitive for the diagnostics of OSA