Phrenic neuropathies (PN) are an important cause of dyspnoea, orthopnoea and hypercapnic respiratory failure. However, there is no agreement on the nosology of this disorder. The aim of this cohort study was to analyze the author’s and published PN patients and compare them with other immune-mediated focal neuropathies to determine the most appropriate nomenclature and classification of the disorder. All patients with PN referred to the author from March 2004 to March 2013 were included. In addition, to identify previously published patients with PN, a PubMed search was done. The demographic and clinical characteristics of both series were then compared with the published series of neuralgic amyotrophy (NA) patients. Of 19 PN patients from the author’s series, 11 % fulfilled the criteria for definite and 58 % for probable NA; while in 58 previous patients, the values were 16 and 48 %, respectively. PN and NA both have a male preponderance and a frequent history of preceding events, but PN occur in an older population and more often in diabetics, are less commonly associated with pain, and have a less complete recovery. Although demonstrating some similarities with NA, the high proportion of isolated (particularly bilateral) PN point to a probable immune-mediated attack against some phrenic nerve-specific antigen with occasional spillover to neighboring nerves. As a consequence, idiopathic PN seems to be more appropriately regarded as a distinct entity within the spectrum of immune-mediated focal neuropathies rather than as a variant of NA.
COBISS.SI-ID: 2201260
Objective: To report diagnostic accuracy of ultrasonography (US) and compare it to standard 10-cm nerve conduction studies (NCSs), and short-segment NCSs (SSNCSs) across the elbow in the diagnosis of ulnar neuropathy at the elbow (UNE). Methods: In a broad spectrum of consecutive patients with suspected UNE a prospective and blinded study was performed. This included a clinical examination, electrodiagnostic (EDx) and US studies. In clinically definite UNE patients we compared the sensitivity of SSNCSs, of 10-cm NCSs across the elbow, and of US. The specificity was calculated in asymptomatic controls. Results: We studied 113 affected arms in 109 patients; definite UNE was diagnosed in 81, and alternative conditions in 12 arms. The sensitivity of SSNCSs was 89%, of 10-cm NCSs 83%, and of US 71%. We found the highest sensitivity of US in patients with axonal UNE (93%), followed by conduction slowing (82%) and conduction block (55%). Specificity of SSNCSs was 80%, of 10-cm NCSs 82%, and of US 82%. Conclusion: The present study found the highest diagnostic accuracy of SSNCSs (85%), followed by 10-cm NCSs (83%), and of US (77%). Significance: US is particularly useful in patients with axonal UNE, while SSNCSs in UNE with conduction block.
COBISS.SI-ID: 2644396
Study Objectives: Periodic breathing is sleep disordered breathing characterized by instability in the respiratory pattern that exhibits an oscillatory behavior. Periodic breathing is associated with increased mortality, and it is observed in a variety of situations, such as acute hypoxia, chronic heart failure, and damage to respiratory centers. The standard quantification for the diagnosis of sleep related breathing disorders is the apnea-hypopnea index (AHI), which measures the proportion of apneic/ hypopneic events during polysomnography. Determining the AHI is labor-intensive and requires the simultaneous recording of airflow and oxygen saturation. In this paper, we propose an automated, simple, and novel methodology for the detection and qualification of periodic breathing: the estimated amplitude modulation index (eAMI). Patients or Participants: Antarctic Cohort (3800 meters): 13 normal individuals. Sleep Clinic Cohort: 39 different patients suffering from diverse sleep-related pathologies. Measurements and Results: When tested in a population with high levels of periodic breathing (Antarctic Cohort), eAMI was closely correlated with AHI (r = 0.95, P ( 0.001). When tested in the clinical setting, the proposed method was able to detect portions of the signal in which subclinical periodic breathing was validated by an expert (n = 93; accuracy = 0.85). Average eAMI was also correlated with the loop gain for the combined clinical and Antarctica cohorts (r = 0.58, P ( 0.001). Conclusions: In terms of quantification and temporal resolution, the eAMI is able to estimate the strength of periodic breathing and the underlying loop gain at any given time within a record. The impaired prognosis associated with periodic breathing makes its automated detection and early diagnosis of clinical relevance.
COBISS.SI-ID: 2076588
In recent years, evidence has emerged for a bidirectional relationship between sleep and neurological and psychiatric disorders. First, sleep-wake disorders (SWDs) are very common and may be the first/main manifestation of underlying neurological and psychiatric disorders. Secondly, SWDs may represent an independent risk factor for neuropsychiatric morbidities. Thirdly, sleep-wake function (SWF) may influence the course and outcome of neurological and psychiatric disorders. This review summarizes the most important research and clinical findings in the fields of neuropsychiatric sleep and circadian research and medicine, and discusses the promise they bear for the next decade. The findings herein summarize discussions conducted in a workshop with 26 European experts in these fields, and formulate specific future priorities for clinical practice and translational research. More generally, the conclusion emerging from this workshop is the recognition of a tremendous opportunity offered by our knowledge of SWF and SWDs that has unfortunately not yet entered as an important key factor in clinical practice, particularly in Europe. Strengthening pre-graduate and postgraduate teaching, creating academic multidisciplinary sleep-wake centres and simplifying diagnostic approaches of SWDs coupled with targeted treatment strategies yield enormous clinical benefits for these diseases.
COBISS.SI-ID: 2619308
Synchronization between prefrontal (executive) and posterior (association) cortices seems a plausible mechanism for temporary maintenance of information. However, while EEG studies reported involvement of (pre)frontal midline structures in synchronization, functional neuroimaging elucidated the importance of lateral prefrontal cortex (PFC) in working memory (WM). Verbal and spatial WM rely on lateralized subsystems (phonological loop and visuospatial sketchpad, respectively), yet only trends for hemispheric dissociation of networks supporting rehearsal of verbal and spatial information were identified by EEG. As oscillatory activity is WM load dependent, we applied an individually tailored submaximal load for verbal (V) and spatial (S) task to enhance synchronization in the relevant functional networks. To map these networks, we used high-density EEG and coherence analysis. Our results imply that the synchronized activity is limited to highly specialized areas that correspond well with the areas identified by functional neuroimaging. In both V and S task, two independent networks of theta synchronization involving dorsolateral PFC of each hemisphere were revealed. In V task, left prefrontal and left parietal areas were functionally coupled in gamma frequencies. Theta synchronization thus provides the necessary interface for storage and manipulation of information, while left-lateralized gamma synchronization could represent the EEG correlate of the phonological loop.
COBISS.SI-ID: 2504108