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Biomedical subjects

L Parrino

Publications and source records attributed to L Parrino.

48 records · Page 3Linked to original sources
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

Seizures triggered by blinking when beginning to speak.

A patient had seizures triggered by spontaneous blinking associated with the act of beginning to speak. Diffuse paroxysmal discharges in the EEG appeared when the patient was blinking in darkness or in bright light. Closing the eyes voluntarily, on command, or as a reflex reaction produced this response very infrequently. During intermittent photic stimulation the epileptic discharges were accompanied by myoclonic jerks. The act of beginning to speak was linked with spontaneous blinking and EEG changes and was accompanied consistently by seizures. These were characterized by a peculiar stuttering and an absencelike impairment of consciousness. Seizures have been controlled well using clonazepam and valproic acid.

Blinking↗
PubMedDate not supplied

Activation of partial seizures with motor signs during cyclic alternating pattern in human sleep.

Both interictal and ictal EEG phenomena are commonly activated by functional instability. The different non-REM sleep stages comprise long-lasting periods of cyclic alternating pattern (CAP) in which arousal fluctuates between 'A phases' of greater arousal and 'B phases' of less arousal, and periods in which vigilance maintains a tonic stability (non-CAP). Previous studies have revealed that phase A induces a marked enhancement of generalized EEG paroxysms, a minor though significant activation of focal lesional bursts, but no effect on rolandic functional spikes. Conversely, phase B exerts an inhibitory modulation, especially on bilateral interictal phenomena. Because of the opposite influence of phase A and phase B also on muscle tone, we assessed the amount and distribution of nocturnal partial motor seizures in 6 subjects affected by focal epilepsy. The polysomnograms included 45 motor seizures, 43 of which occurred during non-REM sleep. Nocturnal fits were significantly more frequent in stages 1 and 3 (P less than 0.0001). Among the non-REM seizures, 42 appeared in CAP (P less than 0.0001) and always in phase A. The transient arousal and the concomitant muscle tone activation expressed by phase A of CAP is likely to support the motor components of nocturnal seizures. Sleep analysis in terms of CAP and non-CAP provides a better understanding of the continuum from subclinical EEG paroxysms to clinical manifestations and of the relations between vigilance and seizure disorders.

Adolescent↗
PubMedDate not supplied

Confusional states with periodic lateralized epileptiform discharges (PLEDs): a peculiar epileptic syndrome in the elderly.

The histories of seven patients over the age of 60 years are reported. They all suffered from recurrent and prolonged episodes of confusional state associated with psychic and neurologic manifestations. All episodes were accompanied by the occurrence of periodic lateralized epileptiform discharges (PLEDs) on the EEG, which became normal when the ictal episodes subsided either spontaneously or after administration of diazepam i.v. Although PLEDs may correspond to severe hemispheric lesions, serial computed tomography (CT) scan and laboratory investigations detected significant abnormalities in only one case, that of a patient with a progressive dementing outcome. In the other six patients, follow-up neuropsychological controls indicated moderate impairment of higher cortical functions according to the hemisphere involved by PLEDs. Administration of carbamazepine (CBZ) proved rather effective in preventing the recurrence of the ictal episodes. For its clinical, EEG, and prognostic features, this condition may represent a peculiar nonconvulsive status epilepticus in the elderly.

Aged↗
PubMedDate not supplied

Modulation of generalized spike-and-wave discharges during sleep by cyclic alternating pattern.

Because arousal plays a critical role in activation of epileptic phenomena, we analyzed the behavior of interictal generalized spike-and-waves (S-W) during the two recently identified modalities of arousal control during NREM sleep: (a) the cyclic alternating pattern (CAP), expressed by successive biphasic (phase A and phase B) fluctuations of arousal; and (b) non-CAP (NCAP), characterized by prolonged stable periods of EEG and arousal level. Within the single NREM stages, phase A consists of clusters of phasic events associated with transient arousal activation, whereas phase B is represented by the periodic reappearance of the EEG background and reflects a rebound inhibitory condition. The polysomnograms of 10 subjects with a wide age range and affected by primary generalized epilepsy displayed significant differences (all at p less than 0.01) between the spike indexes (S-W/min) of CAP (2.9) and NCAP (1.3), of phase A (7.4) and phase B (0.3), and of NCAP and phase B. For distribution of S-W, a significant prevalence of EEG paroxysms was detected during CAP as compared with NCAP (68 vs. 32%, p less than 0.001), and 93% of all the interictal bursts that occurred in CAP occurred in phase A (p less than 0.001). Our data stress the arousal-dependent influence of CAP and NCAP on modulation of generalized epileptic mechanisms during sleep.

Adolescent↗
PubMedDate not supplied

Discriminatory effect of cyclic alternating pattern in focal lesional and benign rolandic interictal spikes during sleep.

Twenty epileptic patients (10 male and 10 female) were polygraphically recorded during nocturnal sleep. Ten subjects, with a wide age range, were affected by focal lesional epilepsy, and 10 were children affected by benign epilepsy with rolandic spikes (BERS). In five cases a bihemispheric expression of the focal lesional bursts emerged occasionally during the night recordings. The behavior of interictal electroencephalographic (EEG) paroxysms were analyzed with respect to the two arousal states of non-rapid-eye-movement (REM) sleep: (a) the cyclic alternating pattern (CAP), expressed by biphasic EEG periodic activities and related to long-lasting fluctuations between greater (phase A) and lesser (phase B) arousal levels; and (b) the non-CAP (NCAP), manifested by EEG stationarities that reflect a sustained relative stability of arousal. The CAP/NCAP modality affected the spiking activity and distribution of the focal lesional EEG paroxysms, which appeared enhanced during CAP and which were mostly collected in phase A. The even more powerful influence of CAP and especially phase A on the secondary bisynchronous bursts suggests a crucial integration among thalamocortical circuits, arousal modulation, and epileptic generalization mechanisms. Conversely, in the BERS recordings no significant differences emerged throughout CAP and NCAP. The intense activity of the rolandic foci induced by sleep as such could be explained on the basis of the greater dependence of these functional cortical EEG abnormalities on the degree of synchronization during sleep.

Adolescent↗
PubMedDate not supplied

Effects of generalized interictal EEG discharges on sleep stability: assessment by means of cyclic alternating pattern.

Generalized interictal EEG discharges are influenced by a biphasic (phase A and B) modality of arousal control during non-rapid eye movement (REM) sleep termed cyclic alternating pattern (CAP). Each phase A and the following phase B compose a CAP cycle. The percentage ratio of total CAP time to total non-REM sleep time is the CAP rate, a sleep parameter that measures the instability and fragmentation of sleep. Since CAP exerts a powerful influence on generalized interictal EEG discharges during sleep, the polysomnograms of seven epileptic patients affected by a clinically active form of primary generalized epilepsy were matched with those of seven healthy volunteers of the same age and sex to assess the influence of interictal discharges on sleep organization. No remarkable differences emerged when the traditional polysomnographic parameters were compared between the two groups. However, the epileptic patients showed significantly higher CAP rate values (52.7 vs. 34.6%; p less than 0.003), indicating a greater arousal instability in the sleep records of these subjects. Within the epileptic group, the CAP cycles that included at least one interictal paroxysm were significantly longer than those without EEG discharges (31.2 vs. 25.4 s; p less than 0.007). The selective lengthening of CAP cycles is likely due to an exaggeration of the natural activating power of phase A when coupled with EEG paroxysms and an intensification of the inhibitory properties of the following phase B. The dynamic relationships and differences between spindles in animals, k-complexes, and slow-wave bursts in humans may have a functional linkage with epileptic phenomena during sleep.

Adolescent↗
PubMedDate not supplied

Morphologic and functional features of cyclic alternating pattern (CAP) sequences in normal NREM sleep.

The Cyclic Alternating Pattern (CAP) is an EEG biphasic periodic activity of normal NREM sleep, generally organized in sequences of two or more cycles and correlated to long-lasting fluctuations in the level of arousal. The remaining NREM sleep is characterized by prolonged stationary activities or non-CAP (NCAP). Criteria for the detection of morphology and reactivity of CAP and NCAP segments are defined in the sleep recordings of 10 healthy young adults. Standard sleep variables and CAP rates, referred to the ratio of CAP time to Total NREM sleep time (CAPR/NREM) and to each NREM sleep stage, were scored for statistical inferences and correlations. CAPR/NREM may be considered an additional non-redundant sleep variable which determines the measure of arousal instability during NREM sleep. The relationship between CAP and the biphasic behavior of microarousals is discussed.

Acoustic Stimulation↗
PubMedDate not supplied

Effect of hypnotic drugs on sleep architecture.

It is widely accepted that the conventional polysomnographic parameters (macrostructure of sleep) supply only rough information for clinical purposes. In particular, they often appear inadequate to support a diagnosis of insomnia or the effectiveness of a hypnotic compound. In the past years, attention has been focused on the microstructure of sleep, and especially on the periodic distribution of arousal-related phasic events known as Cyclic Alternating Pattern (CAP). This microstructural rhythm is not only a physiological component of normal NREM sleep, but it also appears highly sensitive in the detection of disturbing factors and drug manipulation. Regardless of the specific context, CAP always translates a condition of arousal instability during sleep. Accordingly, the higher the amount of CAP, the poorer the subjective quality of sleep. In young adults, the physiological amount of CAP Rate (percentage ratio of CAP time to NREM sleep time) ranges around 25%, while CAP Rate rises to 55% when sleep is perturbed by continuous white noise (situational insomnia). The analysis of CAP Rate within this framework of situational insomnia is recommended for evaluating the effects of hypnotic drugs under controlled experimental conditions. Therapeutical doses of zolpidem preserve the regular course of sleep both at the macro- and at the microstructural level, when sleep is recorded under basal conditions. In contrast, during acoustic perturbation, zolpidem reduces the pathological amounts of arousal instability by lowering the values of CAP Rate to 38%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗