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Biomedical subjects

A J Gabor

Publications and source records attributed to A J Gabor.

At least 19 recordsLinked to original sources

Automated interictal EEG spike detection using artificial neural networks.

Feed-forward, error-back-propagation artificial neural networks were applied to recognition of epileptiform patterns in the EEG. The inherent network properties of generalization and variability tolerance were effective in identifying wave forms that differed from the training patterns but still maintained 'epileptiform' spatio-temporal characteristics. The certainty of recognition was measured as a continuous function with a range of 0-1. Two levels of certainty (0.825 and 0.900) were used to indicate recognition of spikes and sharp waves (SSW). An average 94.2% (+/- 7.3) of the SSW were recognized; 20.9% (+/- 22.9) of all recognized SSW were false-positive recognitions. The time required for pattern recognition was well within the time required for digitizing the analogue data. This study provides evidence that neural network technology is, in principle, an effective pattern recognition strategy for identification of epileptiform transients in the EEG. The analysis is sufficiently rapid to be of potential value as a strategy for data reduction of long recordings stored on bulk media.

Electroencephalography

Scleroderma and central nervous system vasculitis.

We describe a patient with scleroderma (CREST syndrome) and central nervous system vasculitis. While angiography demonstrated segmental symmetrical arterial narrowing characteristic of vasculitis, results of leptomeningeal biopsy were normal. There was no evidence of systemic vasculitis, renal failure, or malignant hypertension previously thought to be required to explain central nervous system dysfunction in patients with scleroderma. Signs and symptoms attributable to vasculitis were reversible with aggressive immunosuppressive therapy.

Cerebrovascular Circulation

Electroencephalography laboratory diagnosis of prolonged QT interval.

Patients with prolongation of the QT interval are at risk for significant neurological morbidity and mortality secondary to ventricular tachyarrhythmias. These patients frequently undergo electroencephalographic (EEG) examination to evaluate episodes of loss of consciousness, which may be associated with convulsions. Electrocardiogram recording as a part of the EEG is a simple and common practice, but analysis for possible QT prolongation is not routinely performed by electroencephalographers. This is, in part, due to the fact that while calculation of the corrected QT interval is straight forward, a calculator is generally required. A nomogram that is presented simplifies determination of the corrected QT interval, facilitating diagnosis of prolongation of the QT interval in the EEG laboratory.

Adult

Orientation discrimination sensitivity of single units in cat primary visual cortex.

Responses of visual cortex (area 17) neurons to moving oriented stimuli were recorded from anesthetized cats. The variance of response (SD2) to repeated identical stimuli was directly proportional to response magnitude (R), (SD2 = C2R). The values of C were not found to differ significantly between different types of cortical cells. The relationship predicts that the coefficient of variation (SD/R) will be smallest near the peak of the tuning curve, indicating that the peak response is most reliable for detecting an orientation but not necessarily the most sensitive to a change in orientation. Tuning curves and response variability were then examined to determine the orientation at which the neuron was most sensitive to changes in stimulus orientation using signal detection theory. The discrimination index (d' = [R1-R2]/SD) for a 1 degree change in stimulus orientation was greatest along the flanks of the tuning curve. In order to generalize the experimental data, response distributions derived from a model of cells with parameters based on experimental data were examined to determine the minimal discriminable change in stimulus orientation. Changes of stimulus orientation between 0.6 and 5 deg of arc could be detected from single responses of a single cell by an optimal observer with 75% accuracy if the orientation change was centered at the most sensitive part of the tuning curve.

Action Potentials

Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin.

In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p less than 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p less than 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.

Adult

Generators of human spinal somatosensory evoked potentials.

Somatosensory evoked potentials recorded over the spine with a noncephalic reference following posterior tibial nerve stimulation have several components. (1) A stationary, synapse-dependent, negative potential (N22) occurs synchronously with a positive potential, P22, recorded ventral to the spinal cord and is localized to the lumbar region overlying the lumbar root entry zone. The N22/P22 complex is attributed to activation of interneurons in the dorsal gray of the lumbar cord. (2) A traveling negative potential with a gradually increasing latency may be recorded from the sacral to the cervical region. Its short refractory period indicates that it is not dependent on transmission across a synapse. This activity is attributed to transmission of the afferent volley through the lumbosacral plexus, roots, and the dorsal columns of the spinal cord. (3) N29, a stationary, synapse-dependent negative potential, localizes to the rostral cervical spine and is attributed to activation of the gracile nucleus relay cells. Following stimulation of the median nerve or fingers, the waveforms recorded over the cervical spine with a noncephalic reference include (1) the proximal plexus volley, a traveling negative potential reflecting transmission through the proximal brachial plexus and roots; (2) the dorsal column volley (DCV), the latency of which gradually increases from the caudal to rostral cervical region (the DCV is attributed to transmission of the afferent volley through the dorsal columns of the cervical cord); and (3) N13, a stationary negative waveform, with a long refractory period consistent with its dependence on transmission across a synapse. Experimental animal and human studies indicate that the N13 waveform is dependent on activity of at least two generator sites, namely the dorsal gray of the cervical cord and the cuneate nucleus.

Evoked Potentials, Somatosensory

Effect of movement on human spinal and subcortical somatosensory evoked potentials.

Sensory transmission in dorsal column nuclei is inhibited during voluntary movement in experimental animals. We have studied the human response by recording spine and scalp somatosensory evoked potentials. Finger movement attenuated the amplitude and duration of the cervical N13 and the scalp N18 and N20 waves. Foot movement did not alter the lumbar N22 after foot stimulation, but the scalp P38 was attenuated. N22 results solely from activation of interneurons in the dorsal gray of the cord at the root entry zone, but N13 may receive contributions from the nucleus cuneatus. Therefore, the movement-induced attenuation of N13 is attributed to decreased contribution from the nucleus cuneatus.

Action Potentials

Cervical synapse-dependent somatosensory evoked potential following posterior tibial nerve stimulation.

We have demonstrated the presence of a localized, synapse-dependent negativity (N29) recorded over the upper cervical spine after bilateral stimulation of the posterior tibial nerves at the ankle. The amplitude of N29 is maximal at the level of the second cervical spine and decreases at more rostral and caudal levels. The peak latency of N29 remains constant at all levels. N29 has a long refractory period when compared with the refractory period of the afferent volley recorded at either the sacral or thoracic level. N29 is most likely generated by activation of the nucleus gracilis by the afferent volley. The cervical N13 after median nerve stimulation probably has multiple generator sites, including the nucleus cuneatus.

Electric Stimulation

Effect of sleep on the electrographic manifestations of epilepsy.

Alterations in the level of arousal have profound predictable effects on the electrographic manifestations of epileptogenic abnormalities. The changes produced by sleep are dramatic in patients with generalized epilepsy as compared to patients with partial epilepsy. The epileptiform complexes associated with the generalized epilepsies show changes in spatial distribution, voltage, temporal sequencing, and waveform morphology. The changes are qualitatively similar in the different types of generalized seizure disorders but vary in the degree to which they are expressed in proportion to the "severity" of the seizure disorder. The presence of a generalized epileptogenic abnormality may result in alteration of K-complex waveform morphology. Multifocal spikes occurring in conjunction with bilateral synchronous discharges are frequently represented by a spatial field distribution consistent with a "horizontal dipole," during sleep especially in children.

Adult

Response covariance in cat visual cortex.

The activity of pairs of neurons in the visual cortex (area 17) of anaesthetized, paralysed cats was recorded using two independently manipulated micropipettes. The number of spikes in the evoked responses of pairs of single neurons were analyzed for response covariance. Responses of the majority of cell pairs (83%) did not covary. Covariance was restricted to closeby neurons with distances of less than 150 microns and with identical orientation and ocular dominance preference.

Analysis of Variance

The human posterior tibial somatosensory evoked potential: synapse dependent and synapse independent spinal components.

Evidence has been obtained for the existence of two separate events occurring in the human spinal cord following posterior tibial nerve (PTN) stimulation. These events can be recorded on the surface in unanesthetized individuals. The first is an ascending wave which is conducted up to the cord at constant velocity and has a relatively short refractory period consistent with a compound nerve action potential. This represents the afferent volley traversing the lumbosacral plexus and the ascending dorsal columns. A second event, the N22/P22 complex, is surface negative on the back and surface positive anteriorly; its amplitude is maximal 5-15 cm above the level of the L4 spine and its peak latency remains constant at all levels. This activity has a relatively long refractory period. These characteristics of N22/P22 indicate that it is a localized synaptically dependent event conforming to a transverse dipole with dorsal negativity and a simultaneous anterior positivity. The N22/P22 is probably generated in the dorsal grey at the root entry zone. The N22/P22 is analogous to the stationary N13/P13 recorded over the neck following median nerve stimulation.

Adult

Paroxysmal genital pain: an unusual manifestation of epilepsy.

A male patient who is now 15 years old has experienced a seizure disorder since age 9 years. The seizures were expressed as episodes of excruciating pain localized to the genital region. Appropriate anticonvulsant medication has controlled both pain and seizures.

Cerebral Cortex

Exacerbation generalized nonconvulsive seizures with ethosuximide therapy.

We describe a patient whose absence seizures increased greatly in number after the addition of ethosuximide to ongoing phenobarbital therapy. This unusual response and review of other cases in the literature suggested the possibility of some as yet underfined interaction between ethosuximide and other anticonvulsant drugs. That a particular subytpe of epilepsy may be worsened by ethosuximide therapy is also considered.

Child