Developmental changes in the human sleep EEG during early adolescence

STUDY OBJECTIVES

To use time-frequency analysis to characterize developmental changes in the human sleep electroencephalogram (EEG) across early adolescence.

DESIGN

Sleep EEG was recorded when children were 9/10 years old and 1 to 3 years later after sleeping at home on a fixed schedule for at least one week.

SETTING

A 4-bed sleep laboratory.

PARTICIPANTS

Fourteen (5 girls) healthy children ages 9/10 (mean = 10.13, SD = +/- 0.51) years at initial and 11 to 13 (mean = 12.28, SD = +/- 0.62) years at follow-up.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

All-night polysomnography was performed at each assessment and sleep stages were scored with Rechtschaffen and Kales criteria. Slow wave sleep minutes decreased from the initial to the follow-up session by 29%, while minutes of stage 2 increased by 17%. NREM and REM sleep EEG spectra from two central and two occipital leads were examined for developmental changes. All-night analyses showed a significant decrease of EEG power from the initial to follow-up session across a range of frequencies during NREM and REM sleep. This decline occurred across leads and states in the delta/theta bands (3.8 - 7 Hz). Time-frequency analyses indicated that this effect was consistent across the night. The decline in power with age was most pronounced in the left central and right occipital leads. The frequency of greatest power in the sigma band (11 - 16 Hz) was significantly higher at follow-up.

CONCLUSIONS

This longitudinal analysis highlights asymmetrical frequency-specific declines in sleep EEG spectral power with early adolescent maturation, which may reflect early signs of the cortical synaptic pruning in the healthy adolescent.

Cognitive Deficits during Status Epilepticus and Time Course of Recovery: A Case Report

We describe a young woman with progressive cognitive and neurological deficits during a parietal lobe status epilepticus (SE). Ictal FDG-PET showed left parietal lobe hypermetabolism and frontal lobe hypometabolism with concomitant EEG slowing. Cognitive and neurological deficits fully reversed more than 1 year after seizure remission, and were associated with normalization of FDG-PET and EEG. Our findings suggest that ictal hypometabolism and EEG delta activity at a distance from the epileptic focus were seizure-related phenomena, possibly representing inhibition in seizure propagation pathways, which could be responsible for the epileptic encephalopathy.

Different neuronal networks are associated with spikes and slow activity in hypsarrhythmia

PURPOSE

West syndrome is a severe epileptic encephalopathy of infancy characterized by a poor developmental outcome and hypsarrhythmia. The pathogenesis of hypsarrhythmia is insufficiently understood.

METHODS

We investigated eight patients with infantile spasms and hypsarrhythmia (group I) and 8 children with complex partial seizures (group II) using simultaneous recordings of electroencephalogram (EEG) and functional MRI. Hemodynamic responses to epileptiform discharges and slow wave activity (EEG delta power) were analyzed separately.

RESULTS

In group I (mean age, 7.82 +/- 2.87 months), interictal spikes within the hypsarrhythmia were associated with positive blood oxygenation level-dependent (BOLD) changes in the cerebral cortex (especially occipital areas). This was comparable with cortical positive BOLD responses in group II (mean age, 20.75 +/- 12.52 months). Slow wave activity in group I correlated significantly with BOLD signal in voxels, which were localized in brainstem, thalamus, as well as different cortical areas. There was no association between BOLD effect and EEG delta power in group II. Moreover, as revealed by group analysis, group I differed from group II according to correlations between BOLD signal and slow wave activity in putamen and brainstem.

CONCLUSIONS

This study demonstrates that multifocal interictal spikes and high-amplitude slow wave activity within the hypsarrhythmia are associated with the activation of different neuronal networks. Although spikes caused a cortical activation pattern similar to that in focal epilepsies, slow wave activity produced a hypsarrhythmia-specific activation in cortex and subcortical structures such as brainstem, thalamus, and putamen.

Characteristic Distribution of Interictal Brain Electrical Activity in Idiopathic Generalized Epilepsy

PURPOSE

To demonstrate the anatomic localization of the cortical sources of the interictal EEG activity in human idiopathic generalized epilepsy (IGE).

METHODS

Multiple cortical and hippocampal sources of the interictal spontaneous EEG activity were investigated by low-resolution electromagnetic tomography in 15 untreated IGE patients and in 15 healthy controls. EEG activity (current density) in four frequency bands (delta: 1.5-3.5 Hz, theta: 3.5-7.5 Hz, alpha: 7.5-12.5 Hz, beta: 12.5-25.0 Hz) was computed for 2,397 voxels. Voxel-by-voxel group comparison was done between the patient and the control group. Voxels with p < 0.01 differences (between the two groups) were correlated with cortical anatomy.

RESULTS

Areas of significantly increased or decreased activity were characterized by their anatomical extension and the frequency bands involved. Five areas of bilaterally increased activity were found: rostral part of the prefrontal cortex (delta, theta); posterior part of the insula (delta); hippocampus and mediobasal temporal cortex (all frequency bands); medial parietooccipital cortex (theta, alpha, beta); dorsal and polar parts of the occipital cortex (alpha). Bilaterally decreased delta, theta, alpha activity was found in the majority of the frontal and anterior parietal cortex on the lateral surface, and in parts of the medial surface of the hemispheres. The area of decreased beta activity was less extensive. The right lateral and laterobasal temporal cortex showed decreased delta, theta, alpha, and beta activity, while its left counterpart only showed decreased delta and alpha activity in a limited part of this area.

CONCLUSIONS

(1) Pathological interictal EEG activity is not evenly distributed across the cortex in IGE. The prefrontal area of increased activity corresponds to the area that is essential in the buildup of the ictal spike-wave paroxysms (absence seizures). The existence of the posterior "center of gravity" of increased EEG activity in IGE was confirmed. The frontal area of decreased activity might be related to the cognitive deficit described in IGE patients. (2) Increased activity in a lot of ontogenetically older areas (including the hippocampi) and decreased activity in the majority of the isocortex is a peculiar pattern that argues for a developmental hypothesis for IGE.

Clinical Correlates of Occipital Intermittent Rhythmic Delta Activity (OIRDA) in Children

PURPOSE

The clinical significance of occipital intermittent rhythmic delta activity (OIRDA) on the electroencephalogram has not been fully established. Recent studies suggest that this pattern occurs almost exclusively in children and is probably of epileptic origin in most cases. We sought to characterize the electrographic features and clinical correlates of occipital intermittent rhythmic delta activity.

METHODS

A review of 697 consecutive pediatric electroencephalograms detected occipital intermittent rhythmic delta activity in 24 studies. Mean patient age was 7.96 years.

RESULTS

Recent convulsions and absence seizures constituted the main indications for the study. Concomitant, independent epileptiform activity was noted in half of the cases. This activity was focal in all but one case. Conversely, in most cases of absence seizures, epileptiform activity intermixed with occipital intermittent rhythmic delta activity. Furthermore, the frequency of the occipital rhythmic discharges in studies of children with absences was generally faster (3-4 Hz) than in localization-related epilepsy (2-3 Hz). Most patients were awake when occipital intermittent rhythmic delta activity occurred. Chronic encephalopathy was seen in one child only. Analysis of neuroimaging studies in eight cases revealed no structural pathology associated with occipital intermittent rhythmic delta activity.

CONCLUSIONS

Occipital intermittent rhythmic delta activity is probably an epileptiform pattern, although it is noted occasionally in encephalopathic children. Its electrographic characteristics appear to differ between localization-related epilepsy and primary generalized epilepsy, particularly absence seizures.

Lithium-induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy?

Lithium therapy can cause a confusional state by direct toxicity, precipitation of nonconvulsive status epilepticus, or by interplay with other neuroleptic medications to produce neuroleptic malignant syndrome or serotonin syndrome. These conditions resemble each other clinically, but EEG may help differentiate among them. We reviewed the EEG patterns with triphasic waves or rhythmic delta activity in lithium toxic patients and discuss clinical and EEG differentiation among syndromes. Lithium toxicity poses significant diagnostic challenges from EEG and clinical perspectives.

Occurrence of a Prolonged Nonepileptic Motor Status after a Febrile Seizure

PURPOSE

Febrile seizures are very common events in the pediatric population, and this disorder could be inherited. A previous article on nonepileptic status after a febrile seizure was published by Japanese authors. They described convulsive manifestations after a febrile seizure with an EEG counterpart characterized by delta activity and rhythmic theta discharges. We report two cases of nonepileptic prolonged motor status occurring after a simple febrile seizure, erroneously diagnosed as an epileptic status.

METHODS

An EEG was obtained during the episode in both of the children; for one of them, we performed a video-EEG recording.

RESULTS

In both children, this state was characterized by tonic, vibratory posture, and fluctuation of consciousness. The face was not involved, eyes were closed, and the children were not cyanotic. Ictal EEG showed alternating and mixed theta-delta activity. This activity appeared to be rhythmic in some periods. Clinical and EEG features did not change after administration of benzodiazepine.

CONCLUSIONS

We believe this uncommon condition to be a nonepileptic phenomenon, occurring after a simple febrile seizure, with favorable prognosis.

Beta and Gamma Range EEG Power-Spectrum Correlation with Spiking Discharges in DBA/2J Mice Absence Model: Role of GABAB Receptors

PURPOSE

To describe the correlations between spiking pattern and EEG power spectrum frequency in DBA/2J mice, a model for murine absence seizures, after gamma-aminobutyric acid (GABA)(B) modulation.

METHODS

The animals were first tested with the GABA(B) agonist l-baclofen followed by the GABA(B) antagonist SCH 50911. Moreover, digital EEGs recorded under experimental conditions were processed at baseline and 10 and 20 min after l-baclofen injection. This procedure was followed by injection of the GABA(B) antagonist SCH50911 and by an additional EEG evaluation at 10 and 20 min from drug administration. The power spectra analysis of signals was obtained for delta (0.5-3 Hz), theta (3.5-7.5 Hz), alpha (8-12 Hz), beta (13-20 Hz), and gamma (21-50 Hz) frequencies.

RESULTS

The spiking pattern and power spectrum of beta activity was increased by <or=80% after administration of 5 mg/kg l-baclofen, whereas gamma power frequency decreased to the same extent. After administration of 50 mg/kg SCH 50911, spiking activity and beta power frequencies were markedly reduced (>80%), whereas gamma power increased (correlation, 0.92; p < 0.001). The remaining frequency bands were unaffected.

CONCLUSIONS

This study confirms the potential of GABA(B) antagonists in contrasting seizure absence in rodent models and suggests the application of drugs with a similar mechanism in humans. In addition, because GABA(B) antagonists not only contrast seizure in rodent models of absence but also improve "cognitive" performance, it could be hypothesized that gamma increase, correlated with optimized cortical binding during coherent percepts, may produce potential cognition-enhancing effects.

Correlation of Severity of FDG-PET Hypometabolism and Interictal Regional Delta Slowing in Temporal Lobe Epilepsy

PURPOSE

We investigated the association of severity of hypometabolism detected by positron emission tomography (PET) with [(18)F]fluorodeoxyglucose (FDG) and persistence of interictal EEG focal slowing in patients with refractory temporal lobe epilepsy.

METHODS

Eighty temporal lobes of 40 consecutive patients with intractable temporal lobe epilepsy (mean age, 43.5 years) were studied. All patients underwent video-EEG monitoring, magnetic resonance imaging (MRI), and FDG-PET. Patients with either normal MRI or with unilateral mesial temporal sclerosis, but no other structural abnormality, were included. Interictal EEG delta slowing was graded as none, infrequent (one episode or less/hour), intermediate (more than one episode/hour), or continuous. PET hypometabolism was graded as none, mild, moderate, or severe.

RESULTS

The severity of temporal lobe hypometabolism with PET was significantly correlated with the amount of delta activity in the interictal EEG, independent of MRI findings (Spearman r = 0.46; p < 0.0005).

CONCLUSIONS

This observation suggests related underlying pathophysiologic mechanisms for metabolic and electrical dysfunction in temporal lobe epilepsy.

Homeostatic sleep response to naps is similar in normal elderly and young adults

Delta homeostatic regulation can be challenged by reducing delta need with daytime naps and measuring delta in post-nap sleep. We previously demonstrated that, after a late afternoon nap, young adults reduce the amount of delta in post-nap sleep by the amount in the nap. We compared homeostatic responses of 19 young adults (mean age 22.4 years) and 19 normal elderly subjects (mean age 71.4 years). Each participated in four separate 2-day sessions that consisted of a baseline night, a nap, and post-nap sleep. Nap times were 0900, 1200, 1500 and 1800 h. The 1800 h nap contained the largest amount of delta and produced the largest reduction in post-nap delta. The young and elderly groups respectively produced 28 and 24% of baseline delta in the 1800 h nap. Both groups showed equivalent delta regulation, reducing post-nap delta by 28 and 25%, respectively. In both age groups, the decrease in post-nap delta resulted from a reduced rate of delta production (power/min) and reduced non-rapid eye movement (NREM) sleep duration. Period-amplitude analysis showed that the reduction in power/min resulted from decreases in delta wave amplitude and incidence. None of the responses to nap challenges differed significantly across age groups nor were there gender differences or age by gender interactions. These results show that delta homeostatic responses to naps in the elderly parallel those of young subjects. REM sleep showed no homeostatic reductions following naps in either group. We believe that the striking differences in the delta and REM responses point to different biological roles of the two kinds of sleep.

Interictal Temporal Delta Activity in Temporal Lobe Epilepsy: Correlations with Pathology and Outcome

PURPOSE

To determine the characteristics and the clinical significance of focal slow activity and its association with focal epileptogenesis in patients with temporal lobe epilepsy (TLE).

METHODS

We analyzed the interictal EEGs of 141 patients who had temporal lobe resections for intractable focal seizures and correlated the findings with pathologic changes and outcome. The pathologic changes were categorized into medial temporal sclerosis, tumors, and nonspecific changes.

RESULTS

Lateralized slow activity was found in 66% of the patients, and it was mainly temporal, of delta frequency and irregular morphology. None of its characteristics, including quantity and reactivity to eye opening, was substrate specific. It was highly concordant with temporal spiking (60%), without any difference across the three groups, but provided additional information in 19 (15%) patients who had no lateralizing spikes. The effect of sleep also was similar in all three groups and included transition of slow waves into spikes. Lateralized slow activity to the side of the operation was significantly associated with favorable outcome only in the group with nonspecific pathology (p = 0.008), regardless of the presence, laterality, or topography of spikes.

CONCLUSIONS

Our findings suggest that in patients with TLE whose brain magnetic resonance imaging (MRI) is either normal or suggestive of medial temporal sclerosis, interictal temporal slow activity has a lateralizing value similar to that of temporal spiking. Its association with a favorable outcome in patients with nonspecific pathology also suggests that candidates with lateralizing temporal delta and normal MRI should not be barred from further preoperative assessment.

Rapid eye movement density shows trends across REM periods but is uncorrelated with NREM delta in young and elderly human subjects

Saccade-like eye movements are the most prominent phasic component of rapid eye movement (REM) sleep. Eye movement density (EMD) appears to be negatively related to sleep depth. Thus, EMD is depressed by sleep deprivation. We sought to determine in 19 young normal (YN) and 19 elderly normal (EN) subjects: (a) whether EMD is correlated with delta EEG in baseline sleep; (b) whether EMD is increased by daytime naps; and (c) whether EMD patterns across sleep cycles differ in the two age groups. Subjects participated in four separate 2-day recording sessions, each consisting of a baseline night, a daytime nap, and post nap night. EMD was measured as 0.3-2 Hz integrated amplitude (IA)/20 s stage REM. EMD was not correlated with rate of non rapid eye movement (NREM) delta production (power/min) in the baseline sleep of either group. Changes in EMD and delta power/min on post nap nights also were uncorrelated. These data indicate that very strong changes in sleep depth (state) are required to overcome the individual stability (traits) of NREM delta and eye movement density. ANOVA for EMD across REM periods 1-4 showed a significant cycle effect and a significant age x cycle interaction. These effects were mainly due to YNs having depressed EMD in the first REM period, likely due to the low arousal level early in sleep in these subjects. Compared with waking saccades the saccade eye movements of REM sleep have received little investigation. Further study of these movements could shed new light on neurophysiology of REM sleep. Such studies might also be clinically useful because the density of these movements appears to be related to depression and (independently) to cognitive function in individuals with brain impairment.

Clinical correlation of occipital intermittent rhythmic delta activity

Frontal intermittent rhythmic delta activity is associated with encephalopathy, and temporal intermittent delta activity is associated with epilepsy, but the importance of OIRDA (OIRDA) is less well defined. The authors reviewed retrospectively EEGs and medical records of 77 patients with OIRDA to determine whether they had epilepsy, acute encephalopathy, or another diagnosis. They compared the incidence of epilepsy in this population with a control group of 77 patients referred for EEG, matched for age, gender, and year of EEG. OIRDA was most commonly generalized, high amplitude, saw toothed, and reactive to eye opening, and with mean frequency of 2.89 +/- 0.50 Hz. Mean age was 8.1 +/- 4.5 years. Seventy-six of 77 patients were <or= 18 years old. Seizures were present in 69 OIRDA patients but only 41 control subjects (P < 0.0001). OIRDA compared with control subjects had more patients with GTCs (34 vs. 10; P < 0.0001) and absence seizures (25 vs. 6; P < 0.0001), but an equal number had partial seizures (30 vs. 27). Only one OIRDA patient had acute encephalopathy. OIRDA patients with seizures were younger (7.6 +/- 4.7 years vs. 12 +/- 6.9 years; P < 0.01) and more likely to evolve to spike-wave activity compared with OIRDA patients without seizures. OIRDA is present almost exclusively in children and is associated with epilepsy but not acute encephalopathy. OIRDA has clinical importance distinctly different from frontal intermittent rhythmic delta activity.

Clinical and radiologic correlates of frontal intermittent rhythmic delta activity

To assess the clinical and radiologic correlates of frontal intermittent rhythmic delta activity (FIRDA), the authors reviewed the hospital charts of patients whose EEGs depicted this EEG finding, and recorded their past medical and neurologic history, the reason for hospital admission, and their neurologic status both on admission and during EEG recordings. Laboratory results on admission and concomitant to the EEG recording, computed tomography, or MRI findings during hospital admission were also reviewed. Sixty-eight patients were assessed. The gender ratio was 1:1; mean age was 56 years. Chronic disease occurred in 78% of patients, including hypertension (34%), diabetes (32%), and renal failure (18%). On admission, renal failure (n = 34) and hyperglycemia (n = 22) were most prominent. The majority of patients had at least one abnormal laboratory result. Thirty-eight of 51 patients in whom the level of consciousness was stated during EEG were described as awake. More than half of 58 patients whose EEG background activity was stipulated demonstrated diffuse slowing, mostly in the theta range. MRI was abnormal in 15 of 17 patients. Intrahemispheric lesions, particularly ischemic and hemorrhagic, were most common (n = 10), followed by basal ganglia lacunae (n = 4). Computed tomography was abnormal in 29 of 44 patients. Hemispheric pathology, diffuse or localized, occurred in 22 patients. Frontal intermittent rhythmic delta activity is associated with mild to moderate encephalopathy and is detected principally in awake patients. Most patients in this series had chronic systemic illness. Old ischemic structural brain lesions may predispose some patients to develop FIRDA during acute metabolic derangement, such as uremia and hyperglycemia. Frontal intermittent rhythmic delta activity was not associated with EEG epileptiform activity. Deep midline lesions, posterior fossa tumors, and hydrocephalus were not detected in this series of patients with FIRDA.

Topographic quantitative EEG response to acute caffeine withdrawal: a comprehensive analysis of multiple quantitative variables

Most previous studies of the neurophysiological effects of caffeine have focused on the effects of caffeine ingestion, and few studies have examined the effects of caffeine withdrawal. This open study evaluated the quantitative EEG (QEEG) changes occurring during a 4-day period of abstinence in subjects who habitually consume 300 mg or more of caffeine daily. Thirteen subjects underwent QEEG studies during their usual caffeine consumption (baseline) and on days 1, 2, and 4 of a 4-day period of caffeine abstinence. Ten of the subjects underwent a second QEEG on day 4 that consisted of a period of recording after reinstitution of caffeine. A comprehensive analysis of multiple quantitative variables was performed for each study during the abstinence period and compared to the variables obtained at baseline for each subject. Changes occurring during caffeine abstinence included: 1) increases in theta absolute power over all cortical areas, 2) increases in delta absolute power over the frontal cortex, 3) decreases in the mean frequency of both the alpha and beta rhythm, 4) increase in theta relative power and decrease in beta relative power, and 5) significant changes in interhemispheric coherence. Most of these changes tended to return to pre-abstinence baseline levels rapidly after resumption of caffeine consumption. The caffeine withdrawal state affects a number of neurophysiological variables. Further investigation of the neurophysiological aspects of caffeine withdrawal using placebo controlled double blind assessment methods is warranted.

Relationship between electroencephalogram slow-wave magnitude and heart rate variability during sleep in humans

To explore whether depth of sleep is related to changes in autonomic control, continuous power-spectral analysis of the electroencephalogram (EEG) and heart rate variability (HRV) was performed in ten normal subjects during nocturnal sleep. Quiet sleep (QS) was associated with an increase in high-frequency power (HF) of HRV (0.15-0.4 Hz) but a decrease in low-frequency power (LF) (0.04-0.15 Hz) to HF ratio (LF/HF) compared with awakening. During QS, LF/HF was significantly and negatively correlated with delta power of EEG (0.5-4.0 Hz), whereas mean R-R interval and HF were not. We conclude that during QS, cardiac sympathetic regulation is negatively related to the depth of sleep, although vagal regulation is not. Our methodology offers a quantitative analysis to study the interaction between cerebral cortical and autonomic functions.

Distinguishing subtypes of temporal lobe epilepsy with background hippocampal activity

PURPOSE

Two subtypes of temporal lobe epilepsy (TLE) can be defined through clinical observations and analysis of hippocampal tissue resected during surgical procedures for intractable TLE: (a) mesial temporal sclerosis (MTS), which is characterized by extensive changes to the hippocampus and good surgical outcome; and (b) paradoxical temporal lobe epilepsy (PTLE), which is characterized by minimal cell loss and comparatively poorer surgical outcome. Patients in both subtypes have seizures that appear to begin in the medial temporal lobe, but documented differences in substrate and outcome between these subtypes has defined a need to distinguish MTS and PTLE patients before surgery. This report describes a retrospective study to investigate the feasibility of doing so during intracranial monitoring.

METHODS

Background EEG epochs, 5 min in duration, were recorded from the anterior hippocampus in 14 (10 MTS and four PTLE) patients with consistent localization of seizure onset to medial temporal structures. The power spectral density (PSD) of the EEG epochs was calculated by a Fourier spectral estimator, and the total signal power and power of the delta, theta, alpha, beta, and gamma frequency bands were submitted to group-to-group comparison.

RESULTS

Spectral peaks were observed in the delta band in all PSD estimates and in the theta band in nine of 14 (seven MTS, two PTLE) estimates. The MTS and PTLE subtypes could be distinguished by the total signal power and delta band power. These power measurements were greater in the PTLE subtype.

CONCLUSIONS

Both delta and theta spectral components are present in hippocampal background EEGs recorded from patients with TLE. The results indicate that group differences exist in spectral measures of background hippocampal signals recorded from MTS and PTLE subtypes. This suggests both that substrate differences in cellular composition and connectivity are reflected in hippocampal background EEGs and that spectral measurements of these signals may hold promise for tests to identify the group membership of individual patients.

Lateralized postictal EEG delta predicts the side of seizure surgery in temporal lobe epilepsy

PURPOSE

The concordance of lateralized EEG postictal polymorphic delta activity (PPDA) to the side of seizure origin in temporal lobe epilepsy (TLE) has received limited study. Our objective was to study the lateralizing value of PPDA in patients with documented TLE.

METHODS

A cohort of consecutive adults with TLE, detailed presurgical evaluation before temporal lobectomy, and minimal follow-up of 2 years were included. One author masked the ictal rhythm of presurgical EEGs and randomly presented 20 s of preictal and the postictal EEG to two electroencephalographers who were blind to all clinical data. They independently assigned PPDA to one of three categories: not present, bilateral, or lateralized (defined as newly appearing or an amplitude >50% of the preictal record).

RESULTS

Eighty seizures from 29 patients were studied. Fifteen patients had a left, and 14 had a right temporal lobectomy. Twenty-three patients were seizure free or substantially improved (defined as simple partial or nocturnal seizures only). Lateralized PPDA was present in 64% of all EEGs and at least one record from 22 (76%) patients. Lateralized PPDA, when present, was concordant with the side of surgery in 96% of the EEGs.

CONCLUSIONS

Lateralized PPDA is highly predictive of the side of ultimate temporal lobectomy, and by inference the side of seizure origin.

Temporal characteristics of delta activity during NREM sleep in depressed outpatients and healthy adults: group and sex effects

STUDY OBJECTIVES

The primary aim was to evaluate group and sex differences in delta activity across non-rapid eye movement (NREM) sleep in depressed patients and healthy controls.

DESIGN

Repeated-measures ANOVA contrasted delta power, amplitude and incidence in the first three NREM periods (stages 2, 3, and 4) of sleep. The time course of delta activity was evaluated with exponential regressions. Age effects on delta were evaluated with linear regression analysis.

SETTING

Two consecutive nights were spent in the laboratory, the first of which served as adaptation.

PATIENTS OR PARTICIPANTS

Twenty-two (9 men, 13 women) symptomatic, but unmedicated, outpatients with major depressive disorder (MDD) and 23 healthy controls (15 men, 8 women) participated in the study.

MEASUREMENTS AND RESULTS

Delta power and amplitude showed significant group by sex interactions. Men with MDD showed lower power and amplitude in NREM sleep compared to women with MDD, but did not differ significantly from controls. However, the time course of delta power and amplitude was significantly different in men with MDD, with lower accumulation and slower dissipation across NREM sleep than all other groups. Women with MDD showed no evidence of lower delta power and amplitude or an abnormal time course compared to control women or men. Age had a differential influence on delta activity between the groups, with little age-related change in delta activity in the depressed groups.

CONCLUSIONS

It was concluded that slow-wave sleep deficiencies may be characteristic of men, but not women, with MDD. It was also concluded that the influence of age on delta activity varied as a function of both psychiatric status and sex.

EEG background delta activity in temporal lobe epilepsy: correlation with volumetric and spectroscopic imaging

PURPOSE

With quantitative electroencephalogram (EEG) and neuroimaging methods, we examined delta activity, atrophy, and neuronal-axonal dysfunction of the cerebral gray and white matter in patients with intractable temporal lobe epilepsy (TLE). Based on evidence that lesions of the white matter result in EEG delta activity, we postulated that background abnormalities in patients with TLE are related to changes of the temporal lobe white matter.

METHODS

We measured interictal delta activity in 34 TLE patients and 10 controls. Spike-free and artifact-free EEG samples were selected by visual inspection. A spectral analysis was used to compute the energy in the delta frequency band. We compared the results of the spectral analysis to magnetic resonance imaging- (MRI) based volumes of the temporal lobe white and gray matter, the hippocampus and the amygdala; and N-acetyl aspartate (NAA) in the lateral and posterior temporal lobe by using proton magnetic resonance spectroscopic imaging (1H-MRSI). The degree of correlation between delta activity and the neuroimaging measurements was assessed by using the Pearson correlation coefficient (r). An analysis of variance (ANOVA) was used to examine the influence of the seizure-focus lateralization on the delta activity and the neuroimaging parameters.

RESULTS

There was no significant difference in the amount of delta activity in the temporal lobe between the controls and patients. We found no correlation between delta activity and the neuroimaging measures (p>0.05). The ANOVA showed significant differences between the patients and controls for the volume of the gray and white matter of the temporal lobe and for the NAA in the lateral and posterior temporal lobe (p<0.002).

CONCLUSIONS

The interictal background delta activity was not explained by reduced volume of the temporal lobe white matter, gray matter, or by abnormalities seen in 1H-MRSI.

Dynamics underlying rhythmic and non-rhythmic variants of abnormal, waking delta activity

OBJECT

We applied a new test, nonlinear cross prediction (NLCP), to investigate whether or polymorphic delta activity (PDA) and frontal intermittent rhythmic delta activity (FIRDA) reflect linear or nonlinear brain dynamics. Furthermore realistic models were constructed to explain the dynamical properties of PDA and FIRDA.

METHODS

Forty-nine EEG time series with FIRDA and 40 time series with PDA were studied with the NLCP algorithm. This characterizes a time series in terms of its predictability, amplitude asymmetry, and time asymmetry, with the latter two measures reflecting nonlinearity. Parameters of an EEG model proposed by Lopes da Silva were adjusted to obtain time series resembling PDA and FIRDA.

RESULTS

FIRDA was more predictable than PDA. Most PDA segments could not be distinguished from linearly filtered noise. In contrast, FIRDA activity showed strong evidence of nonlinear dynamics. These dynamical properties of PDA and FIRDA could be reproduced by the Lopes da Silva model. PDA and FIRDA reflect a point attractor and a limit cycle attractor, respectively, perturbed by dynamical noise.

CONCLUSION

Experimental analysis and modeling of the data suggest that PDA and FIRDA reflect fundamentally different types of brain dynamics. While PDA is filtered noise, reflecting low-level, random input to cortical networks, FIRDA may reflect limit-cycle oscillations due to increased excitation.

Interictal spiking increases with sleep depth in temporal lobe epilepsy

PURPOSE

To test the hypothesis that deepening sleep activates focal interictal epileptiform discharges (IEDs), we performed EEG-polysomnography in 21 subjects with medically refractory temporal lobe epilepsy.

METHODS

At the time of study, subjects were seizure-free for > or =24 h and were taking stable doses of antiepileptic medications (AEDs). Sleep depth was measured by log delta power (LDP). Visual sleep scoring and visual detection of IEDs also were performed. Logistic-regression analyses of IED occurrence in relation to LDP were carried out for two groups of subjects, nine with frequent IEDs (group 1) and 12 with rare IEDs (group 2).

RESULTS

The LDP differentiated visually scored non-rapid eye movement (NREM) sleep stages (p = 0.0001). The IEDs were most frequent in NREM stages 3/4 and least frequent in REM sleep. Within NREM sleep, in both groups, IEDs were more frequent at higher levels of LDP (p < 0.05). In group 1, after accounting for the level of LDP, IEDs were more frequent (a) on the ascending limb of LDP and with more rapid increases in LDP (p = 0.007), (b) in NREM than in REM sleep (p = 0.002), and (c) closer to sleep onset (p < 0.0001). Fewer than 1% of IEDs occurred within 10 s of an EEG arousal.

CONCLUSIONS

Processes underlying the deepening of NREM sleep, including progressive hyperpolarization in thalamocortical projection neurons, may contribute to IED activation in partial epilepsy. Time from sleep onset and NREM versus REM sleep also influence IED occurrence.

A novel method of time series analysis, and an application to the study of human sleep electroencephalogram

A new mathematical method was developed to analyze time series. Applications of this method to the delta component of all-night sleep electroencephalogram (EEG) revealed new variations with double-rapid eye movement (REM)-sleep interval. The proposed method entails repeated application of the least squares spectrum. First, the conventional least squares spectrum calculation is applied to the time series. Using the parameters of the peak components in the obtained spectrum, an intermediate time series is reconstructed. The residual time series is made by subtracting the intermediate time series from the previous time series. Next, the least squares calculation is again applied to the residual time series. These procedures are repeated until the component cannot be detected. We named this new method the Repeated Least Squares Spectrum for the Residual (RLSSR). The remarkably similar time series pattern to the original time series can be reconstructed using the obtained parameters of all components. The EEG was recorded during all-night sleep on five consecutive nights in five healthy adults, by a total of 25 recordings. The variations of the height of successive 1-min delta components in the EEG were analyzed. In addition, two autocorrelograms were made for two time series patterns. These were reconstructed from two specific sets of the components obtained by the proposed analysis method. These autocorrelograms demonstrated a long-span variation with near double-REM-sleep interval in not a few records. Based on these data, it appears that the delta component of sleep EEG does not always demonstrate a simple gradually decreasing trend.

Rasmussen's syndrome: longitudinal EEG study from the first seizure to epilepsia partialis continua

PURPOSE

The aim of our work was to describe the initial electroencephalographic characteristics of Rasmussen's syndrome (RS).

METHODS

We performed repeated EEG recordings in an 11-year 5-month-old girl affected by RS, as demonstrated through the progressive evolution of the illness. All EEGs were carried out in polygraphy and videorecordered, both in waking and in sleep.

RESULTS

In our opinion, our patient's EEG picture is absolutely unusual in childhood partial epilepsy form without any neuroradiologic perturbation. Delta focal activity persistence in such a clinical context should be considered an RS sign, among the possible causes.

CONCLUSIONS

We are not aware of any early-stage RS EEG description. We think that the initial RS EEG picture is so unusual as to suggest such pathology. We hope that analogous reports can confirm our belief.

EEG delta activity: an indicator of attention to internal processing during performance of mental tasks

In previous papers we proposed that an increase in delta EEG activity during mental tasks might be related to an increase in subjects' attention to internal processing. In this paper we have made a narrow band analysis to detect those EEG frequencies that change selectively during the performance of a mental task that requires attention to internal processing. Two different experiments were performed: (1) a difficult mental calculation task and a control stimulus with the same physical characteristics as the arithmetical symbols were presented in random order; (2) the Sternberg paradigm for the analysis of short term memory using a memory set of 5 or 3 digits was also presented in random order. Referential recordings to linked ears were obtained in all leads of the 10/20 system. In the first experiment, the increase of power from 1.56 to 5.46 Hz was observed only during the performance of the task and not during the control condition. In the Sternberg paradigm, the increase of power from 1.56 to 3.90 Hz was greater during the difficult than during the easy condition. These results support our hypothesis that an increase in delta activity may be related to attention to internal processing during the performance of a mental task.

[The dynamics of the dominant alpha-rhythm frequency in the perception and reproduction of time intervals]

Dependence of the dominant alpha frequency on the processes of perception and subsequent reproduction of time intervals by rhythmic hand pressing was analysed. Two groups of subjects were separated, which demonstrated either an increase (I) or a decrease (II) in the dominant alpha frequency after the transition from perception to reproduction. In the I group 83% of the subjects reproduced time intervals with a delay. In the II group reproduction in advance was observed in 75% of the subjects. The dynamics of the dominant alpha frequency probably reflects formation of the optimal functional state underlying the individual level of activation and properties of the higher nervous activity in the subjects from both groups.

Possibilities of classification of topographically distributed neurophysiological multi-channel data

Progress in quantifying states of cerebral function and in the further development of automated EEG processing demands the application of suitable methods for the reduction of neurophysiological multi-channel data as well as their automatic classification. The method used here for reducing multi-channel data was to gain distributions of parametric descriptors from EEG data from computer-aided topographic electroencephalometry (CATEEM), for example the relative and absolute band power in the frequency bands delta, theta, alpha 1, alpha 2, beta 1, beta 2, total power, median and mode frequency, and other parameters. These values were subjected to cluster analysis. The classification of EEG parameters was carried out by means of discrimination analysis and neural networks. The practicability of both procedures was demonstrated in the reduction and classification of EEG data in the context of a normed study involving 104 healthy adults. These data have been used as the basis for a new evaluation study of 60 additional intraoperative EEG recordings obtained with CATEEM. In that newly started study, the effects of sedative and anaesthetic drugs on EEG behavior and psychophysiologic behavior remain to be investigated.

Measuring the dissimilarity between EEG recordings through a non-linear dynamical system approach

A new measure of dissimilarity between two EEG segments is proposed. It is derived from the application of the mathematical concept of distance between series of one-step predictions according to the estimated non-linear autoregressive functions. The non-linear autoregressive estimation is performed by non-parametric regression using kernel estimators. The possibility of applying this measure for automatic classification of EEG segments is explored. For this purpose multidimensional scaling and cluster analyses are applied on the basis of the calculated dissimilarity measures. In particular, its application to different EEG segments with delta activity and also with alpha waves reveals high agreement with visual classification by EEG specialists.

Automatic detection of K-complexes: validation in normals and dysthymic patients

A model-based automatic K-complex (Kc) detector was applied to all-night single-channel sleep electroencephalographic (EEG) recordings from normal and dysthymic patients. The performance of the detector was analyzed in the two groups, and the differences obtained were discussed. The results showed that the detection rate of Kc in the normal group was around 92% through all stages of non-rapid eye movement (NREM) sleep, but with high numbers of "false" positives in stage 4 NREM, which reached 57%. In the dysthymic patients "true" detection included 85% of the Kc, but the percentage of "false" positives dropped to 25% in stage 4 NREM. Most of the "false" detections in the normal group were due to sharp delta activity during slow wave sleep (SWS). The results in the patient group were expected, because sleep in dysthymics showed a reduction in SWS when compared to normals. The behavior and automatic artifact rejection mechanisms of the detector are briefly presented. The model-based Kc detector performed significantly better than other automatic detectors described in the literature; it was found to be a useful tool for routine sleep EEG studies.

[A comparative analysis of the change in the EEG spectral characteristics of rats during the activation and suppression of the catecholaminergic systems]

To find EEG-markers of catecholaminergic activation shifts EEG power spectra of white rats were computed before and after intraperitoneal injections of propranolol, metaproterenol, haloperidol, amantadine, or isotonic sodium chloride solution. Differential spectral characteristics were undergone to factor analysis and discriminant analysis. Factors with similar structure for both catecholaminergic systems were revealed in EEG-reactions to mutually antagonistic injections and relatively specific factors as well. The leading factor of adrenotropic injections described the augmentation of the spectral power in the range of 9-16 Hz induced by propranolol and its reduction by metaproternol. Similar factor was also revealed in reactions to dopaminotropic injections with the smaller value of discriminant function coefficient. One more common feature of EEG-reactions to catecholaminergic disturbances was found to consist of the reciprocal narrow-band shifts in the theta- and delta-diapasons. The leading factor for the recognition of dopaminotropic disturbances described the increase of EEG power in the band of 19-30 Hz at activation and its reduction at suppression of the transmitter system.