Romanian journal of neurology and psychiatry = Revue roumaine de neurologie et psychiatrie最新文献

The present study has selected 125 cases with psychomotor attacks (sometimes secondarily generalized). Polysomnographic recordings were carried out for a continuous period of eight hours. All this time, the patients have been observed by video-monitorization on a closed infrared circuit screen. The diagnostic procedure was supported by several computerized EEG mappings (CEM) according to a model achieved by us, transcribing the primary data which were obtained by Hjorth's NSD parameters (activity and ability) from the Siemens-Elema Mingograph to a microcomputer. In many cases, we have employed an interface which had been envisaged by us for analog-digital conversion of amplitudes and frequencies from the Mingograph to the microcomputer. Sleep organization anomalies were found: increase of the percentages of light slow-wave sleep (LSWS) and of REM sleep and reduction of the percentages of deep slow-wave sleep (DSWS). The temporal foci appeared with the greatest frequency and with a clear-cut evidence during LSWS, especially in REM sleep and in the transitional states of SWS to REM sleep and from REM sleep to wakefulness. Our researches supplemented with CEM, demonstrate a peculiar activation of the temporal foci during REM sleep, during the states of LSWS and during the transitional states, showing that many psychomotor attacks appear predominantly during these sleep states and that many cases initially clinically misinterpreted as grand mal seizures are, in fact, focal temporal epilepsies secondarily generalized.

The study included 203 epileptic absences: 1. Simple; (30 cases); 2. Myoclonic petit mal absences (62 cases); 3. Amyotonic-akinetic absences (41 cases); 4. Temporal lobe absences (62 cases); 5. "Hybrid" absences in Lennox-Gastaud disease (13 children). This paper presents only the myoclonic petit mal absences (57 cases). Correlations of the clinical, EEG and polysomnographic data were found by several methods: a. The patients were video-monitored on an infrared closed-circuit TV screen: b. The Hjorth's NSD parameters were computed on a Siemens-Elema Mingograph; c. The EEG graphoelements were morphologically analyzed every second throughout the discharges, by means of an original technique; d. Computerized EEG mappings (CEM) were performed for various periods, also including the sequential ones, second by second, all along the epileptic discharges; e. 8 hours of continuous polysomnographic recordings. The peculiar electroclinical features of the five types of absences have been emphasized. Regarding the myoclonic petit mal absences, the discharges of polyspikes and waves manifested an evident increase in the number and duration within the LSWS stages and during the transition from the wakefulness state to sleep and from the LSWS to the wakefulness, and a transformation in slow polyspikes and waves complexes during the stages III and IV. The CEM were always asymmetrical during sleep and the maximal amplitudes were seen on the anterior and posterior temporal regions. In all the REM stages, the polyspikes and waves disappeared.

The subacute subdural hematoma (SASDH) is an entity which is still to be analyzed because the attention of the clinicians was directed towards the acute subdural hematoma (ASDH) and to the chronic subdural hematoma (CSDH). A series of 69 patients with SASDH was studied outlining the particularities of the affection. A trauma caused the hematoma but it was a milder one. The associated cerebral lesions were generally produced by concussion (34%) and cerebral dilacerations represented only 8.4%. Clinical symptoms were obvious between the third and the fourteenth day after trauma due to the cerebral compression. The consciousness was moderately impaired. The patients with GCS < 8 represented 18.9%. The neurological picture stated with time allowed a programmed paraclinical investigation: a. radiography of the skull revealed cranial fractures in 10.1%; b. carotid arteriography showed a lentiform aspect of the avascular space; c. CT presented variable densities (isodensity--3%, hypodensity--14.5%, and hyperdensity--27.5%) depending on the length of the interval between trauma and admission. The operation evacuated the liquid blood collection through a widened burr hole. Death during operation was 17.4% and 79.8% survived.

The present paper reports biochemical and neurophysiological investigations in ten cases with restless leg syndrome. Other neuropsychiatric affections and factors which could generate the symptomatology of restless legs syndrome were not included. The EEG recordings demonstrated evident reticular neuronal hypersynchrony generated by hyperpnoea (sinusoidal slow waves). The classical EEG investigations pointed out neuromuscular hyperexcitability, but some modifications of the functional parameters of the neuromuscular excitability and conductibility (signs of neuropathy) were also noticed. In all the cases, continuous 8-hour polysomnographic recordings and monitorization on infrared TV screen were performed. Investigations reported: important disorders of sleep organization, agitated sleep with frequent periods of nocturnal awakenings, increase of the durations and percentages of light slow-wave sleep (LSWS) and rapid and frequent changes of various stages of LSWS, a decrease of duration and percentage of DSWS, a decrease of duration and percentage of REM sleep (as in other parasomnias caused by magnesium deficiency) and nocturnal EEG anomalies (long discharges of sinusoidal slow waves, of sharp waves and of sharp slow waves appearing in the LSWS stages with the disappearance in the REM sleep).

Clinical and polysomnographical investigations have been performed in 35 patients with REM narcolepsy (group 1), comparatively with 45 patients suffering from symptomatic hypersomnia in NREM sleep (group 2). The polysomnographical recordings have been made by: a) continuous recording covering 24 h; b) submission of the subjects to the "Maintenance of wakefulness tests" (MWT). In 20 narcoleptics and in 12 normal subjects, computerized EEG mappings were performed in wakefulness and in different sleep stages. In the narcoleptic patients, the association of the sleep attacks with other symptoms of Gélineau's disease has been noticed. The 24 h continuous polysomnographical recordings pointed out relevant differences between the first and the second group: the patients with REM narcolepsy (Gélineau's disease) presented increased quantities and percentages of REM sleep and manifested several periods wish sleep-onset REM. Comparatively, the patients with NREM hypersomnias slept predominantly in NREM sleep, and presented normal percentages of REM sleep and also manifested sleep-onset NREM periods. One found great differences between the two groups by the MWT, that is, in the first group the mean values of REM sleep were greater, the REM latency and the sleep latency were very short and one assisted to many sleep-onset REM. The cortical EEG mappings were ampler and slower on the right posterior temporal and occipital regions (especially during the REM sleep) either in normal or in narcoleptic patients. These results suggest the consistency of some previous data regarding the differentiation of the true REM narcolepsy (as an independent entity) from the various frequent NREM hypersomnias.

The effect of general hypothermia was investigated in 15 unanesthetized cats. The animals were immobilized with Flaxedil and maintained on mechanical respiration. An epileptogenic focus was induced by stereo-tactical injection of penicillin to the right hippocampus. Cooling of the body was followed by a marked decrease of the amplitude and frequency of the penicillin spikes. The antiepileptic effect of general hypothermia was not dependent on brain stem section as suggested by previous investigations. Seizures generated by a hippocampic penicillin focus were more resistant to hypothermia than discharges produced by penicillin applied to the visual cortex.

The phenotypic indicators of genomic imprinting were applied to the familial psychopathology data collected through the family history method about 886 adult relatives of 65 manic-depressive probands directly investigated. The probands and their relatives were diagnosed according to DSM-III/DSM-III-R criteria. A first analysis of the age at onset of the BP illness by affective status of the probands' parents suggested that the BP disorder begins about 8 years earlier in the probands whose father was affectively ill (13.84% cases) than in the probands whose mother was affectively ill (24.6% cases) (t = -3.29, P < .004). When controlling this result for the effect of the probands' sex, its statistical significance decreased. The severity of the BP illness seemed also to be influenced by the affective status of the probands' father but only when assessing the probands' illness severity over a long time period and taking into account their psychosocial functioning; the number of manic and depressive hospitalized and non-hospitalized episodes as a single measure of the BP disorder severity as well as the morbidity risk in the first degree relatives of the probands did not significantly differentiate the patients whose disorder was transmitted by the father/paternal side as compared with the patients who inherited the BP disorder from the mother/maternal side.