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Biomedical subjects

M G Terzano

Publications and source records attributed to M G Terzano.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of EEG cyclic alternating pattern during sleep in insomniacs and controls under placebo and acute treatment with zolpidem.

In nonrapid eye movement (NREM) sleep, electroencephalographic cyclic alternating patterns (CAPS) express the organized complexity of arousal-related phasic events. As a translation of sustained instability of the arousal level, CAPS increase under perturbation and decrease under sleep-promoting conditions. After adaptation to the sleep lab, 18 subjects (12 with persistent psychophysiological insomnia and 6 without sleep complaints), all aged 40-60 years, underwent a random sequence of two nonconsecutive nocturnal recordings, one under placebo and one under an imidazopyridine hypnotic agent (zolpidem). The choice of this drug was oriented by its capability to warrant, at the selected dose of 10 mg, a physiological profile of sleep. Polysomnographic parameters and self-report of sleep quality by means of visual analogue scale (VAS) were assessed by analysis of variance followed by a Scheffé test when F statistics were significant. The placebo nights of controls showed a significantly longer duration of total sleep time (+60 minutes) compared with the placebo nights of insomniacs. However, no relevant differences emerged from the other traditional polysomnographic variables. Conversely, CAP rate (CAP time x 100/NREM sleep time) showed highly sensitive and consistent modifications. Under placebo, CAP rate was significantly higher among insomniacs compared with controls (62.2% vs. 38.5%). Under medication, CAP rate dropped to 26.8% in insomniacs, whereas it was only moderately reduced in controls (31%). CAP rate values paralleled the self-rating estimation of sleep quality, but the VAS means differed significantly only among insomniacs where a sharp average fall from 45 mm (placebo nights) to 15 mm (zolpidem nights) could be detected. Our findings suggest that CAP rate in sleep analysis can represent a useful tool for the diagnosis of insomnia and for gaining insight into the therapeutic efficacy of hypnotic-sedative drugs.

Adult↗
PubMed1990

Modifications of sleep structure induced by increasing levels of acoustic perturbation in normal subjects.

In each non-REM (NREM) sleep stage, the aggregation of the arousal-related phasic events permits identification of periods of arousal fluctuation (cyclic alternating pattern or CAP) and periods of long-lasting arousal stability (non-CAP or NCAP). As the ratio CAP time to NREM sleep time (CAP/NREM) measures the instability of arousal during sleep, any perturbing event determines an increase of CAP/NREM. On the basis of these premises, 6 healthy volunteers underwent 5 sleep recordings at increasing intensities of sound pressure level (basal condition followed by continuous white noise at 45 dBA, 55 dBA, 65 dBA and 75 dBA, respectively). Besides a remarkable enhancement of CAP/NREM (P less than 0.00001), acoustic perturbation induced a significant linear increase of waking time after sleep onset, stage 2, NREM sleep, stage shifts and a significant linear decrease of stage 4, deep sleep, REM sleep and total sleep time. At each step of environmental disturbance, the values of the CAP ratio were consistent with the gradual changes of sleep organization. Although the Multiple Sleep Latency Test was unremarkable during the day following the sleep recording, CAP/NREM was significantly correlated with the personal evaluation of sleep quality (P less than 0.01). Through this model of transient situational insomnia it was possible to outline different degrees of subjective complaint depending on 3 ranges of CAP/NREM. A crucial role of CAP in the pathophysiological mechanisms of clinical insomnia is hypothesized.

Adult↗
PubMed1990

Modifications of cyclic alternating pattern in sleep apnea syndrome.

Within non-rapid eye movement sleep, two complementary modalities of arousal organization may be identified: (1) the cyclic alternating pattern (CAP), correlated with successive upward (phase A) and downward (phase B) fluctuations of arousal and arousal-related vegetative functions, and (2) non-CAP, corresponding to a relative stability of arousal and vegetative activities. In a 62-year-old overweight and heavily snoring man, complaining of excessive daytime sleepiness, three consecutive polysomnograms displayed a highly frequent occurrence of nocturnal apneas (apnea index: 15), mostly obstructive and mixed, limited to non-rapid eye movement sleep stages 1 and 2. The apneic episodes, that never occurred during non-CAP, exclusively appeared during the inhibitory phase B of CAP, whereas the following breathing resumption was mainly induced by an activating phase A pattern. The crucial effect of arousal instability on respiratory control is emphasized.

Adult↗
PubMed1988

The cyclic alternating pattern sequences in the dynamic organization of sleep.

The cyclic alternating pattern (CAP) is a physiological component of normal NREM sleep, functionally correlated with long-lasting arousal oscillations. This EEG periodic activity, organized in sequences of two or more decasecond cycles, is detectable also in coma and in other neurologic disorders, appearing as a general modality of arousal organization. Within NREM sleep, the fluctuations of CAP alternate with sustained homogeneous EEG patterns, characterized by a greater stability of arousal and called non-CAP (NCAP). In 20 sleep records of 10 healthy young adults we analysed the chronological relationship between CAP and 3 fundamental states of arousal: wakefulness, NREM sleep, REM sleep. Sleep onset and sleep recoveries after nocturnal awakenings were closely linked to CAP sequences, indicating a functional linkage between cyclic fluctuations of arousal and the beginning of any sleep behavioural state. On the basis of their temporal relationship with CAP sequences, the waking to sleep and the waking transitions appeared a symmetrical events in the organization of arousal, whereas the NREM to REM transitions and the REM to NREM transitions occurred as asymmetrical events. Moreover, almost 50% of all NREM stage changes were accompanied by CAP sequences. The EEG and dynamic features of CAP sequences show morphological and behavioural analogies with some phasic phenomena (i.e., phase d'activation transitoire or micro-arousals) and EEG patterns reported in the literature (e.g., tracé alternant; phase transitionnelles; tracé intermittent). Our data suggest a functional correlation between the control mechanisms of CAP and the organization of sleep.

Acoustic Stimulation↗
PubMed1988

Variations of cyclic alternating pattern rate and homeostasis of sleep organization: a controlled study on the effects of white noise and zolpidem.

The Cyclic Alternating Pattern (CAP) is a physiologic structure of normal non-REM (NREM) sleep, functionally correlated to long-lasting arousal instability. In 12 healthy volunteers, a continuous 45 dB (A) white noise induced no remarkable changes on the standard sleep parameters. However, compared to the baseline conditions, the acoustic perturbation determined a significant increase of the Cyclic Alternating Pattern Rate (CAPR), that measures the amount of CAP during sleep. Ten mg of zolpidem, a novel imidazopyridine hypnotic compound, did not modify the structure of unperturbed sleep, but induced a highly significant reduction of the increased values of CAP Rate due to white noise. The homeostatic function of CAP is stressed. CAPR appears to be a highly sensitive indicator of environmental modification during sleep.

Adult↗
PubMed1988

[Cyclic alternating pattern. A new approach to the pharmacology of sleep disorders].

The Cyclic Alternating Pattern (CAP) is an intrinsic component of normal NREM sleep. This periodic activity is organized in biphasic 40-sec cycles clustered in sequences. CAP sequences are functionally correlated to long lasting arousal instability. CAP is induced by endogenous stimuli (change in sleep stage, body movements) but it is considerably increased by exogenous impulses (noise). CAP rate (CAPR) is a novel polysomnographic variable that measures the amount of CAP during sleep, and it may be calculated for total sleep time and total NREM sleep. We demonstrated that all-night exposure to a 45 dB(A) white noise induced a significant CAPR increase, correlated with impaired sleep quality, even without changes in sleep architecture. We hypothesized that administration of an hypnotic should attenuate this CAPR rise. This hypothesis was verified in a double-blind placebo study, in which 12 healthy young adults received zolpidem, a new imidazopyridine hypnotic. During the noise perturbed nights, zolpidem clearly demonstrated a protective effect on CAPR (mainly during slow wave sleep) and on sleep quality. CAPR appears to be a sensitive indicator of sleep quality, and the cumulative distribution of CAPR throughout the night represents a new method to evaluate the effects of an hypnotic in sleep.

Adult↗
PubMed1987

Acute confusional migraine: clinical and electroencephalographic aspects.

Twelve patients with episodes of acute confusional migraine (ACM) are reported. Prolonged agitation and mental confusion characterized the headache attacks, occurring mostly among adolescents. The ictal EEG showed diffuse, slow abnormalities and a peculiar pattern known as FIRDA (frontal intermittent rhythmic delta activity). Neuroradiologic examinations and laboratory tests were unremarkable. After the acute stage, EEG gradually tended to show normalization. Apart from the noticeable similarities to the "juvenile head trauma syndrome", the authors assume that ACM represents a peculiar clinical form among the different types of migraine associated with disorders of higher mental functions.

Acute Disease↗
PubMed1986

Acute confusional migraine attacks resolved by sleep: lack of significant abnormalities in post-ictal polysomnograms.

We observed acute confusional migraine (ACM) attacks in two adolescents, and in both cases the episodes ended when the patients fell asleep spontaneously. Laboratory and neuroradiologic examinations were unremarkable. The post-ictal polysomnograms displayed a regular quality and duration of the physiologic components of sleep. Random posterior slow waves occurred only during the nocturnal awakenings and REM periods. The observation that sleep may resolve migraine attacks is emphasized. ACM is characterized by peculiar and relatively quickly reversible clinical manifestations and EEG abnormalities. The lack of significant abnormalities in post-ictal polysomnograms corresponds to a functional integrity of the brainstem structures involved in the global organization of sleep and may represent a useful laboratory feature in the diagnosis of ACM.

Acute Disease↗
PubMed1985

The cyclic alternating pattern as a physiologic component of normal NREM sleep.

The cyclic alternating pattern (CAP) is a long-lasting periodic activity consisting of two alternate electroencephalogram (EEG) patterns. This variation in EEG is closely related to fluctuations in the level of arousal that characterize two different functional states in the arousal control mechanism. We studied 20 sleep records of 10 healthy subjects to see if CAP appears under physiologic conditions. During NREM sleep, CAP corresponded to a periodic succession of spontaneous phasic phenomena recurring within every stage, i.e., intermittent alpha rhythm, K-complex sequences, and reactive slow wave sequences. The following analyses were performed. Each EEG specific alternating pattern, defined as a cycle, was subdivided into two phases depending on the arousal response to stimulation. Average cycle length, average duration of each phase, and average ratio phase/cycle were calculated. CAP rate defined as (CAP time/Sleep time) was calculated for total sleep time (TST), (Cap time/TST); for NREM sleep, (CAP time/Total NREM); and for each NREM sleep stage. CAP is the EEG translation of the reorganization of the sleeping brain challenged by the modification of environmental conditions.

Acoustic Stimulation↗
PubMed1983

The effect of amantadine on arousal and EEG patterns in Creutzfeldt-Jakob disease.

In recent years, Creutzfeldt-Jakob disease (CJD) has been supposed to be of viral origin, and amantadine hydrochloride has been suggested as therapy because of its proved antiviral action. We studied nine patients with CJD (confirmed at autopsy in seven). Four were treated with amantadine hydrochloride, in dosages ranging from 3.5 to 15 mg/kg/day for an average period of 32 days. The clinical evolution of their disease was compared with that in five patients receiving only supportive maintenance therapy. The length of survival from the onset of clinical care did not differ significantly between the two groups. Nevertheless, a transient improvement in wakefulness and mentation was observed in three patients treated with amantadine, and EEG changes were observed in two, consisting above all of a reduction in the slow-wave activity and the periodic discharges (PDs). Amantadine administered intravenously did not induce any short-term changes in the PDs or the cyclic alternating pattern.

Aged↗
PubMed1983

Lithium carbonate in cluster headache: assessment of its short- and long-term therapeutic efficacy.

The short- and long-term effects of administration of lithium carbonate in cluster headache (CH) have been investigated. Of the 90 patients treated (78 males and 12 females), 68 had episodic CH and 22 had the chronic form of the disease. The doses used were almost always 900 mg/day. Eleven of the 22 patients with chronic CH showed a definite, constant improvement both short and long term. In 7 of the 22 patients, lithium treatment provided excellent results initially but was later followed by some transient worsening; in the remaining 4 only partial benefits were observed initially and treatment proved still less effective after a few months. The effects of cessation of lithium administration after at least five months of continuous treatment were studied in 9 cases. In 6 of them the attacks re-appeared immediately, whereas in 3 the attacks occurred again only after free intervals of four to six months. Of the 68 patients with episodic CH, 26 proved highly responsive to treatment, 26 only partially responsive, and 16 refractory. In 3 cases, after one to three years of continuous treatment, euthyroid goitre developed, which disappeared after the drug was discontinued.

Adolescent↗
PubMed1983

[Autoscopic occipital seizures and occipital poroencephalic lesion: considerations on a case].

Autoscopy is an hallucinatory phenomenon during which the subject see his own image. It may be caused by organic processes like migraine, vascular diseases, tumoral lesions, and exceptionally by epileptic seizure. The case of 15 years old boy is reported, affected by hemianopia, surgically treated squint, who presented occipital epileptic seizures consisting of autoscopic hallucinations, leftward conjugate eye deviation, followed by a typical major seizures. A right parieto-occipital epileptic focus was a constant finding on EEG. On CT a poroencephalic cyst in the corresponding cerebral region could be demonstrated.

Adolescent↗