Idiopathic partial thrombosis is associated with cycling and the presence of a fibrous web on MRI

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How the brain attunes to sentence processing: Relating behavior, structure, and function

Publication date: 1 April 2016
Source:NeuroImage, Volume 129
Author(s): Anja Fengler, Lars Meyer, Angela D. Friederici
Unlike other aspects of language comprehension, the ability to process complex sentences develops rather late in life. Brain maturation as well as verbal working memory (vWM) expansion have been discussed as possible reasons. To determine the factors contributing to this functional development, we assessed three aspects in different age-groups (5–6years, 7–8years, and adults): first, functional brain activity during the processing of increasingly complex sentences; second, brain structure in language-related ROIs; and third, the behavioral comprehension performance on complex sentences and the performance on an independent vWM test. At the whole-brain level, brain functional data revealed a qualitatively similar neural network in children and adults including the left pars opercularis (PO), the left inferior parietal lobe together with the posterior superior temporal gyrus (IPL/pSTG), the supplementary motor area, and the cerebellum. While functional activation of the language-related ROIs PO and IPL/pSTG predicted sentence comprehension performance for all age-groups, only adults showed a functional selectivity in these brain regions with increased activation for more complex sentences. The attunement of both the PO and IPL/pSTG toward a functional selectivity for complex sentences is predicted by region-specific gray matter reduction while that of the IPL/pSTG is additionally predicted by vWM span. Thus, both structural brain maturation and vWM expansion provide the basis for the emergence of functional selectivity in language-related brain regions leading to more efficient sentence processing during development.



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The LDA beamformer: Optimal estimation of ERP source time series using linear discriminant analysis

Publication date: 1 April 2016
Source:NeuroImage, Volume 129
Author(s): Matthias S. Treder, Anne K. Porbadnigk, Forooz Shahbazi Avarvand, Klaus-Robert Müller, Benjamin Blankertz
We introduce a novel beamforming approach for estimating event-related potential (ERP) source time series based on regularized linear discriminant analysis (LDA). The optimization problems in LDA and linearly-constrained minimum-variance (LCMV) beamformers are formally equivalent. The approaches differ in that, in LCMV beamformers, the spatial patterns are derived from a source model, whereas in an LDA beamformer the spatial patterns are derived directly from the data (i.e., the ERP peak). Using a formal proof and MEG simulations, we show that the LDA beamformer is robust to correlated sources and offers a higher signal-to-noise ratio than the LCMV beamformer and PCA. As an application, we use EEG data from an oddball experiment to show how the LDA beamformer can be harnessed to detect single-trial ERP latencies and estimate connectivity between ERP sources. Concluding, the LDA beamformer optimally reconstructs ERP sources by maximizing the ERP signal-to-noise ratio. Hence, it is a highly suited tool for analyzing ERP source time series, particularly in EEG/MEG studies wherein a source model is not available.



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Sleep Apnea Treatment- The Canadian Experience

So, you're tired of feeling tired or hearing from your spouse about your snoring. You go to your family physician, which refers you to a Sleep Specialist. After the Sleep Study results are available you are told that you stop breathing in your sleep 30 times an hour, something that would concern most people. You are then told about lifestyle modifications that you may want to consider, and various therapeutic approaches. But the one they highly recommend, and that the government sponsored Health Plan covers is CPAP. Continuous Positive Airway Pressure, which involves blowing the appropriate level of air pressure up your nose on a continuous basis preventing your airway from collapsing during sleep. You simply breathe with and against the constant stream of air. This therapy is effective in preventing the airway from collapsing and eliminates snoring for virtually everyone. So, all is good! Until you take it home…

About 1/3 of patients take to CPAP very well, and actually become missionaries telling everyone around them how it's changed their lives. About 1/3 struggle with it daily and although they wear it to some degree, it is not all night and may not even be every night. For the remaining 1/3, you will find their CPAP stored under their bed or in their closet for a variety of reasons. Adherence studies have shown that after 6 years of prescription, 54% of patients are still wearing their CPAP. So, what happens to the other 46%?

Mostly, they remain untreated. Let's look at the reasons:

Some do not feel it worth their while to return to their Sleep Specialist because they feel that CPAP is the only option available there, and they've already tried that. So, they remain untreated.

Some return to their CPAP dispenser, which typically encourage them to try alternative masks and to stick with CPAP, explaining that it is the only worthwhile therapy, discouraging them from considering any alternatives. So, they remain untreated.

Some, ask their family physician for guidance, often being referred for an ENT consultation for palatal surgery which has a success rate of <50%, consequently, few of these procedures are performed. So, they remain untreated. This of course is no fault of the family physicians because even when they attend CE courses promoted as "Current Management of Sleep Disorders: A Comprehensive Update", all they hear about is CPAP.

Some, go to the drug store and pick up an oral appliance over the counter that states the following on the label, "FDA Approved for Mild to Moderate Sleep Apnea". Imagine that, the Regulatory Boards in Canada currently allow patients to manage their own Sleep Apnea! This of course ends up failing for a variety of reasons, so they remain untreated.

The information these patients need is this, The American Academy of Sleep Medicine AND the American Academy of Dental Sleep Medicine Joint Guidelines state that an oral appliance is an appropriate therapy for All Severities of Sleep Apnea if the patient prefers an oral appliance to CPAP. This is the current "Standard of Care".

 

 Adherence studies show us that long term oral appliance adherence ranges from 85-95% and that patients typically wear their oral appliance longer each night when compared to CPAP wear. Although oral appliances may not be as effective in reducing the apnea level in some patients, for most, the fact that patients wear them more often and for longer seems to make their overall benefit similar, current studies evaluating both Efficacy and Actual Use suggesting that they have a similar Mean Disease Alleviation as CPAP. Yet, patients often don't hear about oral appliances as a viable option or are simply misinformed about their efficacy and or side effects. So, they remain untreated.

 Adding insult to injury, 30% of patients referred for a Sleep Study simply don't go, 50% of these patients citing that they don't want to wear CPAP as their reason. Considering that 82% of them would have tested positive had they gone, this increases the number of patients with OSA needing our help to an even higher level. What happens to these additional patients? They remain untreated.

In countries like USA, France and Sweden, where government sponsored health plans cover oral appliance therapy. Many oral appliances are being delivered on a regular basis, even before trialing and or failing the use of CPAP. I guess for those countries, the answer for what happens to the other 46% is, they get an oral appliance!

But in Canada, what happens to the other 46%? Unfortunately, all too often, they remain untreated!

 

John Viviano DDS D ABDSM

 

Links to the pertaining articles…

http://ift.tt/1Pg56S2

http://ift.tt/1Q4cyDk

 

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Microelectrode recording (MER) findings during sleep-awake anesthesia using dexmedetomidine in deep brain stimulation surgery for Parkinson’s disease

Publication date: Available online 6 February 2016
Source:Clinical Neurology and Neurosurgery
Author(s): Woo-Keun Kwon, Jong Hyun Kim, Ji-Hye Lee, Byung-Gun Lim, Il-ok Lee, Seong Beom Koh, Taek Hyun Kwon
ObjectiveThe preferred choice of anesthesia for deep brain stimulation (DBS) has been local anesthesia due to the need of patients' cooperation during the procedure, and concern on the interference of sedatives on microelectrode recording (MER) results. However, local anesthesia during the whole procedure may be impossible in some patients due to uncontrolled anxiety, fear, delirium or exhaustion. Therefore, sedative drugs have been used for DBS, but findings of MER during the procedures have not been reported in detail, especially in the globus pallidus internus (GPi). We introduce our experience using 'asleep-awake' technique by dexmedetomidine (DEX) anesthesia with MER findings during DBS in idiopathic Parkinson's disease (IPD) patients.Patients and MethodsData from 14 different subcortical nuclei from 8 consecutive IPD patients whom had DBS at the GPi (6 patients) and subthalamic nucleus (STN) (2 patients) were retrospectively reviewed. We used continuous DEX and intermittent small boluses of propofol during the painful procedure ('asleep phase'), accompanied with continuous intraoperative monitorings of bispectral index (BIS) and modified observer's assessment of sedation (MOAA/S). Then sedatives were discontinued during MER recording ('awake phase'). Characteristic findings and firing rates of neurons were analyzed and compared to those from other 6 patients who underwent surgery under local anesthesia.ResultsAll patients were satisfactorily sedated using this technique without any respiratory or hemodynamic complications. Characteristics of spike activities of each nucleus were inspected and analyzed quantitatively. We could inspect changes of spike activities according to level of patients' consciousness in some cases, but the localizing value was good to decide the target in all cases. Firing rates of group whom sedatives were given during asleep phase ('sedatives') were significantly lower than those of group under local anesthesia ('no sedative'). Intraoperative length of target nuclei, postoperative imaging and postoperative changes of UPDRS III score indicated satisfactory outcome.ConclusionWe concluded that though MER findings may change during DEX-based monitored 'sleep-awake' anesthesia, it did not affect the results of target localization for the clinical purpose. However, it should be considered that use of sedatives before MER could result in changes of firing rate and pattern depending on the patient's state of consciousness.



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The value of dynamic radiographic myelography in addition to magnetic resonance imaging in detection lumbar spinal canal stenosis: a prospective study

Publication date: Available online 6 February 2016
Source:Clinical Neurology and Neurosurgery
Author(s): Martin Merkle, Gottlieb Maier, Sören Danz, Jan Kaminsky, Marcos S. Tatagiba, Nader M. Hebela, Florian Roser
ObjectiveMRI is regarded as the study of choice in the diagnosis of lumbar spinal stenosis. In some cases, the supine MRI leads to a misdiagnosis in the extent of lumbar spinal stenosis. Dynamic myelography can detect lumbar spinal stenosis in these cases of where the MRI may not be as sensitive.To compare the sensitivities of dynamic radiographic myelography and supine MRI in lumbar canal stenosis (LCS) patients and to determine whether dynamic radiographic myelography is a valuable diagnostic exam in the work-up of lumbar canal stenosis.Patients & MethodsOver two years, the imaging data of 100 consecutive patients who were suspected of having LCS were prospectively analyzed. All lumbar intervertebral segments were evaluated in each patient on sagittal MR T2-weighted images and lateral plane images by myelography using a semi-quantitative scoring system. The differences in scores for 5 motion segments under 3 conditions (supine MRI, upright sitting myelography and standing myelography with extension) were analyzed statistically.ResultsOf 100 patients with 500 analyzed intervertebral segments, 23 patients with inconclusive supine MRI results had LCS in standing myelography with extension. Compared with upright sitting myelography and supine MRI, standing myelography with extension yielded the highest score for every segment from L1/2 to L5/S1. Compared with the upright sitting myelography position, 61 more patients received a diagnosis of lumbar stenosis in the standing myelography with extension position, and 121 more stenotic segments were diagnosed. Compared with the supine MRI position, standing myelography with extension detected 64 more stenotic patients and 137 more stenotic segments.Conclusion Based on a large patient sample, dynamic myelography is a valuable diagnostic tool in detecting lumbar spinal stenosis. Patients with lumbar spinal stenosis may have inconclusive supine MRI in 23% of cases being misdiagnosed as normal. This missed rate of LCS patients with unclear supine MRI results can be avoided with dynamic myelography. The combination of supine MRI and dynamic myelography is critical in the evaluation of LCS, especially if multisegmental findings are detected.



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