Commentary: Integrating electrodermal biofeedback into pharmacologic treatment of grand mal seizures

Thirty percent of patients with epilepsy experience seizures despite optimal anticonvulsant drug treatment. Stress is frequently identified by patients with epilepsy as a precipitant of seizures (Spector et al., 2000; Ferlisi and Shorvon, 2014). Patients also often report using countermeasures to control the seizure onset. These are typically spontaneous and individualized such as increasing arousal by walking, breathing, standing, focusing attention, changing way of thinking, and more rarely inducing relaxation (Lee and No, 2005; Hether et al., 2013). In parallel, behavioral and psychological interventions, complementing conventional therapeutic methods for the management of epileptic seizures, have gained greater clinical attention over the past decade. Among these, Biofeedback (BFK) represents a noninvasive biobehavioral treatment that enables a patient to gain volitional control over a specific physiological process. BFK has already shown its value when applied to patients with epilepsy (Sterman and Friar, 1972; Rockstroh et al., 1993; Nagai et al., 2004a; Nagai, 2011; Micoulaud-Franchi et al., 2014a,b). Scrimali et al. (2015) have rightly pointed out the potential usefulness of electrodermal biofeedback in the management of refractory epilepsy. In a single case study, they report an effect of electrodermal activity (EDA) relaxation biofeedback in reducing seizures in a patient treated for 2 years. This case study supports the necessity to expand clinical armamentarium for treatment-resistant patients with few alternatives

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study

Study objectivesThe prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study.MethodsEligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up.ResultsEnrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy.ConclusionSEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway

L’horizon de la phénoménologie expérientielle : les formes incandescentes de la présence humaine

I) Introduction : la phénoménologie expérientielle Depuis la plus haute Antiquité, et dans plusieurs continents, les philosophes, les religieux, les sages, les mystiques mais aussi d’autres humains n’ayant que la prétention de moins mal comprendre ce qu’il en est de leur vie mentale, posent un regard réflexif sur le contenu et l’organisation de la vie de l’esprit. En Occident, une étape décisive fut franchie par Husserl, quand il prit le parti d’une analyse systématique et scientifique des vé..

J Clin Sleep Med

Non-24-hour sleep-wake disorder is 1 of several chronic circadian rhythm sleep-wake disorders. It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects patients who are sight-impaired, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. This case report discusses non-24-hour sleep-wake disorder in a sighted young man who complained of alternating severe insomnia and excessive sleepiness, with a sleep agenda and actigraphic data showing a daily delay of approximately 2 hours. A novel therapy by total sleep deprivation followed by a combination of morning light therapy and nocturnal melatonin administration was efficient in stopping his free-running sleep-wake pattern both immediately and in the long term. The treatment combination for 6 months resulted in stable circadian entrainment to a 24-hour cycle. Compliance with chronotherapy was maintained over the course of follow-up

Non-REM Sleep Characteristics Predict Early Cognitive Impairment in an Aging Population

Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults.Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night.Results: Twenty-nine patients (8 males, age = 71 ± 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P < 0.05), theta power (OR 0.018, P < 0.01), sigma power (OR 0.033, P < 0.05), and spindle maximal amplitude (OR 0.002, P < 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment (P < 0.05).Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults

Design and Preliminary Study of a Neurofeedback Protocol to reduce Drowsiness

International audienceNeuroFeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory)[4]. Many NF approaches have been studied to improve attentional abilities, notably for Attention Deficit Hy-peractivity Disorder [1, 2]. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose a complete EEG-NF solution to train users to self-regulate an EEG marker of drowsiness. This marker is based on a ratio of beta over theta/alpha power in Cz electrode. In addition to this EEG marker of drowsiness, we also carefully selected and designed the duration, the sequencing, the objective evaluation metrics and the visual and audio feedback to use in for each NF session. Preliminary study with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects are expected to begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. The implementation of this NF solution is available for free 1 , with the OpenViBE platform [3], under the AGPL-3.0 license

Conception et étude préliminaire d'un protocole de neurofeedback visant à autoréguler un marqueur EEG de la somnolence

International audienceNeurofeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory). Many NF approaches have been studied to improve atten-tional abilities, notably for attention deficit hyper activity disorder. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose an EEG-NF solution to train users to self-regulate an EEG marker of drowsiness, and evaluate it with a preliminary study. Results with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects should begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. This NF solution implementation is available for free, with the OpenViBE platform, under the AGPL-3.0 license.Le neurofeedback (NF) consiste à utiliser des mesures électroencéphalographiques (EEG) pour aider les utilisateurs à effectuer un apprentissage cognitif en utilisant des informations provenant de leur propre activité cérébrale, au moyen d'un retour sensoriel en temps réel (visuel ou auditif, par exemple). De nombreuses approches du NF ont été étudiées pour améliorer les capacités d'attention, notamment pour le trouble d'hyperactivité avec déficit de l'attention. Cependant, à notre connaissance, aucune solution de NF n'a été proposée pour réduire spécifiquement la somnolence. Ainsi, nous proposons une solution de NF-EEG pour former les utilisateurs à l’autorégulation d’un marqueur EEG de la somnolence et l’évaluer avec une étude préliminaire. Les résultats, avec cinq sujets sains, ont montré que trois d'entre eux pourraient apprendre à autoréguler ce marqueur EEG avec un nombre relativement court de séances de NF (jusqu'à 8 séances de 40 min). Les essais cliniques sur des sujets privés de sommeil devraient commencer en 2019 pour étudier les avantages cognitifs et cliniques possibles de cette autorégulation. Cette mise en œuvre de la solution de NF est disponible gratuitement, avec la plateforme OpenViBE, sous la licence AGPL-3.0

Mise en place d’une solution de Neurofeedback pour lutter contre la somnolence diurne excessive.

International audienc

Sleep Med

Circadian system contributes to the regulation of inflammatory processes, but the role of circadian misalignment as a risk factor for contracting Covid-19 has up to now been poorly studied. The aim of this study was to explore the relationship between circadian misalignment (chronic disturbance of the circadian system) and the risk of Covid-19 infection in a population of subjects suspected of contact or infection with SARS-CoV-2. Cross-sectional single-center study conducted during a period without lockdown in winter 2021. Recruitment took place in a Covid-19 outpatient testing center. Subjects between 18 and 45 years old were included whether they were symptomatic or not, healthcare workers or not, in contact with a Covid-19 case or not. To determine social jetlag, a proxy of circadian misalignment, they were asked about their usual sleep-wake behaviors. Usual sleep duration and sleep-wake timing were explored on workdays and free days. Social jetlag was defined as at least 2 h shift of circadian alignment (defined as the difference between mid-sleep on workdays and mid-sleep on free days, mid-sleep as the median between bedtime and rise time). One thousand fourteen subjects were included (sampling rate: 10.8%, 39% men, mean age 28 ± 8) with 56 subjects positive for Covid-19 (positivity rate: 5.5%). Usual mean sleep duration was equivalent in both groups (7h47 versus 7h49, p = 0.733). Social jetlag greater than 2 h comprised 33.3% of subjects in the Covid-19 group versus 20.6% in the control group (p = 0.026). After adjustment on age, gender, BMI and work schedules, subjects presenting with social jetlag greater than 2 h had a 2.07-fold higher likelihood to test positive than subjects who had identical sleep-wake timing on workdays and free days (OR = 2.07, 95%CI = [1.12-3.80], p = 0.024). Circadian misalignment not only is present in subjects infected by Covid-19 but could also be responsible for a higher likelihood of being infected. The chronobiological impact on the immune system or a higher likelihood of being exposed to social contacts during nocturnal activities could explain our findings, which need to be confirmed in a future large cohort study. Regular sleep-wake timing could ultimately become a target for preventing Covid-19 infection