PB15. Neurophysiological biomarker for the clinical development of tuberous sclerosis [Abstract]

Aim To investigate the neuronal networks in children with tuberous sclerosis complex (TS) undergoing treatment with Everolimus. Methods Sleep and wake electroencephalography (EEG) before and one year after the start of the treatment with Everolimus were investigated in 13 patients with TS. To investigate functional and effective connectivity within the network generating the delta and theta activity in the background sleep and wake EEG, the methods of dynamic imaging of coherent sources (DICS) and renormalized partial directed coherence (RPDC) were applied. Results Sources before the treatment. Independent of location of the tubera and severity of epilepsy, delta activity in the background EEG pattern in patients with TS was associated with the sources in the medial prefrontal cortex, the supplementary motor area and the putamen during sleep. Theta waves during sleep were associated with sources in the prefrontal cortex, sensory cortex, hippocampus and the thalamus. The sources of delta frequency during wakefulness were identified at the posterior parietal cortex, the parahippocampal gyrus and the Broca area. Sources at theta frequency were found at the sensorymotor cortex, the prefrontal cortex, the primary visual cortex and the thalamus at awake state. Sources after the treatment. The sources one year after the start of the therapy, for both delta and delta frequencies were located in the same areas as before, however with a significantly weaker strength of coherence. The RPDC analysis at baseline showed strong bidirectional connections between described sources. The RPDC analyses after the one year of treatment showed significantly weaker unidirectional connections within the described network. At the follow up patients were grouped in two groups; group 1: five patients with >50% reduction of seizures and spike wave index, group 2: eight patients with <50% reduction of seizures and spike wave index. Interestingly, at follow up patients from the group 1 had decreased values in absolute power of the sources, coherence values and strength of connections. Whereas, patients from the group 2 had increased values in all above mentioned parameters. Conclusion The current study described the neuronal network in children with severe epilepsies due to TS. Regardless of the locations of the tubera the DICS analyses showed a complex network of cortical and subcortical sources with strong bidirectional connections. The described network was significantly weaker after one year under the treatment with Everolimus and appears to be characteristic for the children with TS and severe epilepsy

Multimodal alterations of directed connectivity profiles in patients with attention-deficit/hyperactivity disorders

Functional and effective connectivity measures for tracking brain region interactions that have been investigated using both electroencephalography (EEG) and magnetoencephalography (MEG) bringing up new insights into clinical research. However, the differences between these connectivity methods, especially at the source level, have not yet been systematically studied. The dynamic characterization of coherent sources and temporal partial directed coherence, as measures of functional and effective connectivity, were applied to multimodal resting EEG and MEG data obtained from 11 young patients (mean age 13.2 ± 1.5 years) with attention-deficit/hyperactivity disorder (ADHD) and age-matched healthy subjects. Additionally, machine-learning algorithms were applied to the extracted connectivity features to identify biomarkers differentiating the two groups. An altered thalamo-cortical connectivity profile was attested in patients with ADHD who showed solely information outflow from cortical regions in comparison to healthy controls who exhibited bidirectional interregional connectivity in alpha, beta, and gamma frequency bands. We achieved an accuracy of 98% by combining features from all five studied frequency bands. Our findings suggest that both types of connectivity as extracted from EEG or MEG are sensitive methods to investigate neuronal network features in neuropsychiatric disorders. The connectivity features investigated here can be further tested as biomarkers of ADHD

SUPPLY CHAIN MANAGEMENT AS A CONTEMPORARY DOMAIN FOR ORGANISED RETAILING -INVESTIGATION IN SELECTED RETAILING ORGANISATION IN CHENNAI

ABSTRACT -Supply chain management‖ can be viewed as both an emergent field of practice and an emerging academic domain. Neither perspective is fully mature but each has considerable promise. The future progress of each will be enhanced and indeed is ultimately dependent upon the other. Hence, the purpose of this paper is to take stock of developments in theory and practice to date and to identify barriers and possibilities. Moreover, given the off-remarked acknowledgement of the crucial importance of the behavioral and people dimension but the relative neglect of this in any substantive form, we give special attention to this aspect. Supply chain management is ultimately about influencing behavior in particular directions and in particular ways. The underlying logics, drivers, enablers and barriers merit and require close attention

Evaluation of Morphological Patterns of Anemia In Children.

It Is An Axiomatic Truth That The Children Of Today Are Citizens Of Tomorrow And Upon Them Depend The Weal And Welfare Of The Community. In A Country Like India, Children Fall An Easy Prey To Anemia As Majority Of Them Remain Ill-Fed, Ill-Clothed And Undernourished Due To Poverty And Ignorance. If Not Detected At The Earliest Point Of Time, This Disease Which Is Draconian Will Spread It’s Tentacles So Widely As To Impair Or Endanger The Very Physical Condition Of The Children. Anemia Is Not A Disease But Only A Manifestation Of The Underlying Disease. Root Cause Of Anemia May Be A Trivial Problem Like Iron Deficiency Anemia, And Vit B12 Or Folic Acid Deficiency Or It May Be The First Indication Of An Ominous Disorder Like Leukemia Or Aplastic Anemia. Management Of Pediatric Patients Depends Not Only On The Hematologist But Also On The Automated Cell Counters Which Give A Precise Measurement Of Hematological Parameters. In This Study I Have Evaluated The Clinical And Hematological Profile Of Pediatric Patients Coming To Pediatric Dept, Govt Rajaji Hospital Who Are Found To Be Anemic. The Morphological Findings Are Correlated With Results Of The Automated Cell Counters. Peripheral Smear Study, Automated Hemogram And Reticulocyte Count Done In All Children. Serum Iron Studies, Bone Marrow Examination Direct Coomb’s Test, Hb Electrophoresis Done In Children With Resistant Anemia

Wavelet-based bracketing, time–frequency beta burst detection: new insights in Parkinson's disease

Studies have shown that beta band activity is not tonically elevated but comprises exaggerated phasic bursts of varying durations and magnitudes, for Parkinson’s disease (PD) patients. Current methods for detecting beta bursts target a single frequency peak in beta band, potentially ignoring bursts in the wider beta band. In this study, we propose a new robust framework for beta burst identification across wide frequency ranges. Chronic local field potential at-rest recordings were obtained from seven PD patients implanted with Medtronic SenSight™ deep brain stimulation (DBS) electrodes. The proposed method uses wavelet decomposition to compute the time–frequency spectrum and identifies bursts spanning multiple frequency bins by thresholding, offering an additional burst measure, ∆f, that captures the width of a burst in the frequency domain. Analysis included calculating burst duration, magnitude, and ∆f and evaluating the distribution and likelihood of bursts between the low beta (13–20 Hz) and high beta (21–35 Hz). Finally, the results of the analysis were correlated to motor impairment (MDS-UPDRS III) med off scores. We found that low beta bursts with longer durations and larger width in the frequency domain (∆f) were positively correlated, while high beta bursts with longer durations and larger ∆f were negatively correlated with motor impairment. The proposed method, finding clear differences between bursting behavior in high and low beta bands, has clearly demonstrated the importance of considering wide frequency bands for beta burst behavior with implications for closed-loop DBS paradigms

Effects of ON and OFF subthalamic nucleus-DBS on prefrontal cortex activation during a cognitive task: an fNIRS study

Subthalamic nucleus (STN) deep brain stimulation (DBS) therapy is an effective treatment for the appendicular motor symptoms of Parkinson’s disease (PD). The STN contains multiple segregated circuits subserving motor, cognitive and mood functions through distinct connectivity to cortical regions. Therefore, we examined prefrontal cortical (PFC) effects of “ON” and “OFF” STN-DBS on executive function (Go/NoGo) using functional near-infrared spectroscopy (fNIRS). Methods Out of 8 PD STN-DBS patients, we present here preliminary analysis of a male (62y) PD patient with bilateral STN-DBS (unipolar, 180Hz, 3.5V). The patient was tested after 12h withdrawal of dopamine medications in both an “OFF” and “ON” DBS session separated by 30min. The subject performed a computerised GoNoGo task with 3 alternating Go/NoGo blocks of 30s duration (20 trials/block) interspersed with 30s rest. Reaction time (RT) and accuracy (omission-Om and commission-Cm errors) results were the average of the 3 Go/NoGo blocks. During performance of the Go/NoGo blocks, changes in oxygenated (O2Hb) and deoxygenated (HHb) haemoglobin concentrations were measured by a fNIRS system (Oxymon MkIII, Artinis Medical Systems) covering the bilateral PFC regions. Results/Discussion Clinical motor performance (UPDRSIII) improved from OFF (31) to ON (20). RT during Go and NoGo was ∼40ms faster in OFF (460 and 364ms) than ON (516 and 407ms). Furthermore, the NoGo condition increased misses (Om) in ON (7%) than OFF (0%); while false alarms (Cm) were similarly increased in ON (27%) and OFF (30%). The Go and NoGo conditions increased bilateral PFC activation (i.e., increase in O2Hb and decrease in HHb). However, there was a general decrease in PFC activation in OFF relative to ON, and this was more obvious in Go than NoGo (see Fig. 1) Conclusion These preliminary results indicate that STN-DBS modulates neurovascular responses in the bilateral PFC that are associated with response inhibition

Gait ataxia in essential tremor is differentially modulated by thalamic stimulation

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