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Bos M.J.,Stichting Epilepsie Instellingen Nederland
Nederlands tijdschrift voor geneeskunde | Year: 2011

Behavioural episodes of staring in children are difficult to distinguish from epileptic seizures, especially in children with developmental disorders such as ADHD, autism spectrum disorders and intellectual disabilities. We discuss two patients with staring episodes who were using anti-epileptic drugs. In both patients, EEG with video monitoring showed that the staring was non-epileptic. The first is an 8-year-old boy, who developed severe motor problems and ataxia during treatment with valproate. His staring episodes were behavioural, caused by his intellectual disability, and the motor problems resolved after discontinuation of valproate. The second patient is a 10-year-old boy with known autism, ADHD and infantile seizures, who developed staring for which he was using valproate. Again, video-EEG monitoring during staring showed no abnormalities and in this case the staring was caused by his intellectual disability and autism. We discuss the differential diagnosis of staring episodes in children with developmental disorders and present the pitfalls of the diagnostic process.

Op Vollenbroek R.J.G.B.,Spectrum | De Weerd A.W.,Stichting Epilepsie Instellingen Nederland
Nederlands Tijdschrift voor Geneeskunde | Year: 2013

Introduction: There are many different types of sleep disorders. The majority of sleep related breathing disorders can be assigned to sleep apnea syndrome. Nocturnal choking sensation is a symptom with different causes. When sleep apnea syndrome is excluded sleep choking syndrome, nocturnal laryngeal spasm, esophagal reflux or insular epilepsy must be considered. Case description: We present two cases with similar choking sensation during the night. The first is a female patient with almost every night choking sensations. A sleep apnea syndrome was allready excluded and she was referred to our clinic for sleep disorders. Polysomnographic findings showed awakenings from deep sleep accompanied with panic and no signs of breathing disorder. Sleep choking syndrome was diagnosed and she was treated with clonazepam and referred to a psychologist. After several weeks she had no choking events anymore. The second patient is a male with also almost every night choking events. His events are accompanied with motor signs. Initially he was diagnosed with nocturnal epilepsy and he was treated with anti-epileptic drugs but the choking events still occurred. At that time he was referred to our clinic. During a nocturnal EEG registration he had a choking event. During such an events patient is short of breath, has excessive salivation and he is fully concious. There were no epileptic discharges visible on the EEG during the event. Sleep choking syndrome became more likely and the anti-epileptic drugs were tapered. After a while episodes of choking sensation became more frequent. He was admitted to our ward for observation. The events were more severe and at that time also acompanied with rithmic jerks of the left arm and leg. The diagnosis went back to epilepsy and because of the semiology it fitted the diagnosis of insular epilepsy. Conclusion: Nocturnal choking sensation is a terrifying symptom for the patient and the diagnostic approach can be challenging. Nocturnal laryngospasm, insular epilepsy and nocturnal gastro-esophageal reflux can have similar symptoms as sleep choking syndrome. A thorough patient history and observation of the nocturnal event, sometimes supported by video-EEG findings and examination by an ENT-physician can give the clue to the right diagnosis. This kind of nocturnal symptoms is best analyzed in a clinic specialized for both epilepsy and sleep disorders.

Van Houdt P.J.,Epilepsy Center Kempenhaeghe | Van Houdt P.J.,VU University Amsterdam | Ossenblok P.P.W.,Kempenhaeghe | Boon P.A.J.M.,Epilepsy Center Kempenhaeghe | And 4 more authors.
Human Brain Mapping | Year: 2010

EEG correlated functional MRI (EEG-fMRI) allows the delineation of the areas corresponding to spontaneous brain activity, such as epileptiform spikes or alpha rhythm. A major problem of fMRI analysis in general is that spurious correlations may occur because fMRI signals are not only correlated with the phenomena of interest, but also with physiological processes, like cardiac and respiratory functions. The aim of this study was to reduce the number of falsely detected activated areas by taking the variation in physiological functioning into account in the general linear model (GLM). We used the photoplethysmogram (PPG), since this signal is based on a linear combination of oxy- and deoxyhemoglobin in the arterial blood, which is also the basis of fMRI. We derived a regressor from the variation in pulse height (VIPH) of PPG and added this regressor to the GLM. When this regressor was used as predictor it appeared that VIPH explained a large part of the variance of fMRI signals acquired from five epilepsy patients and thirteen healthy volunteers. As a confounder VIPH reduced the number of activated voxels by 30% for the healthy volunteers, when studying the generators of the alpha rhythm. Although for the patients the number of activated voxels either decreased or increased, the identification of the epileptogenic zone was substantially enhanced in one out of five patients, whereas for the other patients the effects were smaller. In conclusion, applying VIPH as a confounder diminishes physiological noise and allows a more reliable interpretation of fMRI results. © 2009 Wiley-Liss, Inc.

Grune F.,Erasmus MC | Kazmaier S.,University of Gottingen | Stolker R.J.,Erasmus MC | Visser G.H.,Stichting Epilepsie Instellingen Nederland | Weyland A.,University of Oldenburg
Journal of Cerebral Blood Flow and Metabolism | Year: 2015

In addition to cerebrovascular resistance (CVR) zero flow pressure (ZFP), effective cerebral perfusion pressure (CPPe) and the resistance area product (RAP) are supplemental determinants of cerebral blood flow (CBF). Until now, the interrelationship of PaCO2 -induced changes in CBF, CVR, CPPe, ZFP, and RAP is not fully understood. In a controlled crossover trial, we investigated 10 anesthetized patients aiming at PaCO2 levels of 30, 37, 43, and 50 mm Hg. Cerebral blood flow was measured with a modified Kety-Schmidt-technique. Zero flow pressure and RAP was estimated by linear regression analysis of pressure-flow velocity relationships of the middle cerebral artery. Effective cerebral perfusion pressure was calculated as the difference between mean arterial pressure and ZFP, CVR as the ratio CPPe/CBF. Statistical analysis was performed by one-way RM-ANOVA. When comparing hypocapnia with hypercapnia, CBF showed a significant exponential reduction by 55% and mean V MCA by 41%. Effective cerebral perfusion pressure linearly decreased by 17% while ZFP increased from 14 to 29 mm Hg. Cerebrovascular resistance increased by 96% and RAP by 39%; despite these concordant changes in mean CVR and Doppler-derived RAP correlation between these variables was weak (r=0.43). In conclusion, under general anesthesia hypocapnia-induced reduction in CBF is caused by both an increase in CVR and a decrease in CPPe, as a consequence of an increase in ZFP. © 2015 ISCBFM All rights reserved.

Koppert M.,Stichting Epilepsie Instellingen Nederland | Kalitzin S.,Stichting Epilepsie Instellingen Nederland | Velis D.,Stichting Epilepsie Instellingen Nederland | Velis D.,University of Amsterdam | And 3 more authors.
International Journal of Neural Systems | Year: 2014

In this study, we investigate the correspondence between dynamic patterns of behavior in two types of computational models of neuronal activity. The first model type is the realistic neuronal model; the second model type is the phenomenological or analytical model. In the simplest model set-up of two interconnected units, we define a parameter space for both types of systems where their behavior is similar. Next we expand the analytical model to two sets of 90 fully interconnected units with some overlap, which can display multi-stable behavior. This system can be in three classes of states: (i) a class consisting of a single resting state, where all units of a set are in steady state, (ii) a class consisting of multiple preserving states, where subsets of the units of a set participate in limit cycle, and (iii) a class consisting of a single saturated state, where all units of a set are recruited in a global limit cycle. In the third and final part of the work, we demonstrate that phase synchronization of units can be detected by a single output unit. © 2014 World Scientific Publishing Company.

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