基于小波变换的婴儿痉挛症脑干听觉诱发电位近似熵分析

采用多尺度小波变换计算脑干听觉诱发电位近似熵的方法,对比婴儿痉挛症患儿与正常幼儿的近似熵值,按照脑干听觉诱发电位成份波对应的解剖位置,分段、分尺度计算并统计近似熵值,从神经信息传递角度探讨阻碍婴儿痉挛症患儿智能发育的原因.采集12例正常儿童和13例婴儿痉挛症患儿的脑干听觉诱发电位,将它们进行60尺度小波分解,分段、分尺度计算各尺度近似熵值.发现婴儿痉挛症组患儿脑干听觉诱发电位中代表脑干活动的3～7 ms段的分尺度近似熵明显高于正常组(P＜0.01),小尺度上表现尤为显著.结果表明婴儿痉挛症患儿脑干传导通路不畅通,其中的随机成份增多,阻碍信息在脑干的传递,进而影响患儿大脑皮层的发育.     

听觉诱发脑电小波分量的混沌研究——婴儿痉挛症认知功能障碍的机制探讨

通过对婴幼儿期难治性癫痫———婴儿痉挛症(infantile spasms, IS)听觉诱发脑电细貌混沌特性的研究,探讨与IS相伴的认知功能障碍的发生机制。研究方法是分别记录IS组及正常对照组对象的听觉诱发脑电,经Mexihat连续小波变换后,分别计算信号各尺度小波分量的相关维数。结果表明IS组与正常对照组的各小波分量相关维数的差别主要表现在小波的第3尺度分量上(频带范围是32~64 Hz,主要为γ频带范围),在这个尺度上正常组相关维数明显低于IS组(P<0.05)。相关维数的降低意味着大脑活动自由度的减少,表明大脑的各单元耦合加强。因为正常组脑干内信息传递通道完好,使得大脑各个单元之间的信息耦合较强; IS组则由于脑干功能的异常,存在神经信息传递障碍,进而影响到脑干及其与大脑各个局部之间的信息耦合。小波第3尺度处于较高频率范围(γ频带范围),而在大脑皮层上的基频信号与听觉调频信号经加工后所产生的神经信号正在这一频率范围,且这一信号与大脑高级认知功能密切相关。因此,IS患者γ频带细貌信号的相关维数高于正常值,能够解释IS认知功能发生障碍的原因。     

用子波变换的能量最大准则分析婴儿痉挛症脑干诱发电位

借鉴流体力学中用子波变换识别湍流相干结构的能量最大准则,解释婴儿痉挛症发病的三联征,尤其想说明智能迟滞的原因.从电生理的角度来说明,为什么脑干是婴儿痉挛症的责任病灶——这个生化及病理已经做出的推测.研究发现婴儿痉挛症患儿的脑干通道对外界刺激的反应能力和信息的传递能力与正常儿童有明显差异,借用能量最大准则在湍流中的解释,认为是因为信息传导阻滞引起患儿智能发育的迟滞,并试着提出评价最理想治疗效果的标准.     

婴儿痉挛症脑干信息传导障碍的混沌学研究

婴儿痉挛症（Infantile Spasms,IS）是婴幼儿难治性癫痫。IS的发病机理至今也不清楚,目前比较一致的假说是：脑干是IS的责任结构,但该假说不能用神经生理学的传统方法来证实。从信息学的角度,婴儿弃挛症的发病机制可能是源自脑干神经信息传递障碍的脑干功能失调,为了证实这一论点,用可以反遇脑干传导功能的听觉诱发响应的相关维数,来评估脑干神经信息传导不同的功能状态,经过对IS患者、颞叶癫痫患者和健康人三个组的结果比较分析,表明IS患者脑干听觉诱发响应的相关维数明显低下,而颞叶癫痫患者该相关维数在颞叶病灶处最低。以上结果,证实了IS患者脑干神经信息传导功能障碍的存在。     

促红细胞生成素对脑损伤早产儿NBNA评分、肝肾功能以及脑干听觉诱发电位的影响

目的:探讨促红细胞生成素(EPO)对脑损伤早产儿新生儿神经行为测定(NBNA)评分、肝肾功能以及脑干听觉诱发电位的影响。方法:选取2015年2月~2018年7月期间我院收治的脑损伤早产儿117例,将上述研究对象根据随机数字表法将其分为对照组(n=58)和观察组(n=59),对照组患儿给予常规对症治疗,观察组在对照组的基础上联合EPO治疗,比较两组NBNA评分、肝肾功能以及脑干听觉诱发电位,记录两组患儿治疗期间并发症发生情况。结果:观察组纠正胎龄40周时NBNA评分高于对照组(P<0.05)。两组患儿治疗后峰间期(Ⅰ~Ⅲ波、Ⅲ~Ⅳ波、Ⅰ~Ⅳ波)、潜伏期(Ⅰ波、Ⅲ波、Ⅳ波)均较治疗前降低,且观察组低于对照组(P<0.05)。两组患儿治疗前、后尿素氮(BUN)、肌酐(Cr)、血清谷丙转氨酶(SGPT)、总胆红素(TBIL)比较差异均无统计学意义(P>0.05)。两组患儿动脉导管未闭、新生儿败血症发生率比较差异无统计学意义(P>0.05),而观察组支气管肺发育不良、颅内出血、脑干听觉诱发电位异常等发生率低于对照组(P<0.05)。结论:EPO对脑损伤早产儿具有一定的神经保护作用,能够有效保护受损神经细胞与听觉神经通路,降低脑损伤并发症的发生率,且不影响患儿的肝肾功能。     

用独立分量分析和小波变换提取听觉诱发电位晚成分的强度变化

诱发电位的提取通常依靠相干平均方法,需要进行多次的重复刺激,实验时间较长.随着实验时间的增加,受试者生理因素及环境因素的变化,会影响诱发电位的正常形态(波形、强度和相位).利用独立分量分析和小波变换方法,通过时域信息和空域信息的综合应用,可成功提取到听觉诱发电位晚成分的强度在实验过程中的变化,对由于实验时间增加对晚成分的影响做出定量评价.结果表明,在10 min左右的实验过程中,听觉诱发电位晚成分的幅度会下降约40%.     

用独立分量分析和小波变换方法研究实验过程中脑诱发电位信号强度的变化

诱发电位的提取通常依靠相干平均方法,需要进行多次的重复刺激,实验时间较长。随着实验时间的增加,受试者生理因素及环境因素的变化,会影响诱发电位的正常形态(波形、强度和相位)。利用独立分量分析和小波变换方法,通过时域信息和空域信息的综合应用,可成功提取到听觉诱发电位晚成分的强度在实验过程中的变化,对由于实验时间增加对晚成分的影响做出定量评价。结果表明,在10min左右的实验过程中,听觉诱发电位晚成分的幅度会下降约40％。     

一种改进的近似熵——样品熵及其在颞叶癫痫患者脑电信号分析中的应用

采用了近似熵(approximately entropy,ApEn)和它的改进算法,即样品熵(sample entropy,SampEn)分析了8位颞叶癫痫患者和10位健康人员的短程脑电信号。在计算过程中使用了两种滑动窗口和5个不同的过滤标准r。结果显示颞叶癫痫患者组脑电信号的熵值显著低于健康组,而且患者癫痫病灶所在的脑半球的复杂度远远小于非癫痫病灶的脑半球。小的滑动窗口能更多地反映与癫痫发作相关的细节。对于1秒的滑动窗口,过滤标准r不能小于时间序列标准差的0．15％;而对于4秒的滑动窗口,则过滤标准r不能小于时间序列标准差的10％。研究结果表明,在短程脑电信号的非线性分析中,样品熵是一种比近似熵更为可靠的非线性分析方法。颞叶癫痫患者脑电信号的熵值低于健康人员,这可能表明脑电活动的非线性程度的降低是由于神经信号在大脑内的传递受到了阻碍或者损坏,使得神经信号成了相对孤立的信息源。     

橄榄桥脑小脑萎缩患者的脑干听觉诱发电位及其与桥脑体积的相关性

目的:观察橄榄桥脑小脑萎缩(OPCA)脑干听觉诱发电位各波、波间潜伏期的变化,并分析这些变化与桥脑体积/后颅窝体积比值(PV/PFV)的相关性。方法:利用丹麦KeypointEMG/EP电生理仪测定OPCA组、对照组脑干听觉诱发电位Ⅰ、Ⅲ、Ⅴ波潜伏期(PL),Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间潜伏期(IPL)并采用1.5TMR3DVolumeRender-ing软件行桥脑体积(PV)、小脑体积(CV)、后颅窝体积(PFV)磁共振测量,算出PV/PFV、CV/PFV、PV/CV值。结果:与对照组相比,OPCA组Ⅲ波PL、Ⅰ-ⅢIPL明显延长(P<0.05),Ⅲ-ⅤIPL明显缩短(P<0.05);OPCA组PV/PFV值明显减少(P<0.01);Ⅲ-ⅤIPL与PV/PFV呈正相关(r=0.83,P<0.01)。结论:OPCA患者脑干听觉诱发电位Ⅲ波PL、Ⅰ-ⅢIPL延长,Ⅲ-ⅤIPL缩短,Ⅲ-ⅤIPL随着桥脑体积的变小而缩短。     

13例SCN2A 基因突变相关儿童神经系统疾病表型分析

摘要 目的：总结并分析SCN2A基因突变引起的儿童神经系统疾病相关表型谱特点。方法：采用回顾性研究,收集2018年6月至2021年6月在上海交通大学医学院附属上海儿童医学中心神经内科诊治的患儿,并经二代基因测序检测,纳入SCN2A基因突变者,研究并总结患儿神经系统临床表型特点。结果：共纳入13例SCN2A突变患儿,包括新生突变9例和遗传性突变4例。其中11例患儿伴有癫痫发作,发作年龄为1日龄~1岁11月龄,4例在新生儿期起病 （36%）,1~3 月龄起病2例（18%）,4~12月龄起病2例（18%）,1岁后起病3例（27%）;发作类型中强直阵挛发作、痉挛发作、局灶性发作均各有4例（36%）,阵挛发作1例（9%）。另有2例无癫痫发作的患儿,1例表现为全面性发育迟缓,另一例表现为发育迟缓合并孤独症谱系疾病。11例癫痫患儿中,丛集性发作患儿10例。遗传性突变4例患儿中2例智力、运动发育正常;9例新生突变的患儿中8例伴有运动、智力发育落后,1例发育正常。11例癫痫患儿表型中良性家族性新生儿癫痫1例,新生儿惊厥2例,婴儿痉挛症2例,不能分类的早发性癫痫性脑病3例,儿童期起病的癫痫性脑病2例,热厥附加症1例。结论：SCN2A基因突变引起的儿童神经系统疾病以癫痫表现居多、癫痫表型谱广,少数表现为不伴癫痫发作的发育迟缓和孤独症谱系疾病。     

Disruption of the serine/threonine kinase 9 gene causes severe X-linked infantile spasms and mental retardation

X-linked West syndrome, also called "X-linked infantile spasms" (ISSX), is characterized by early-onset generalized seizures, hypsarrhythmia, and mental retardation. Recently, we have shown that the majority of the X-linked families with infantile spasms carry mutations in the aristaless-related homeobox gene (ARX), which maps to the Xp21.3-p22.1 interval, and that the clinical picture in these patients can vary from mild mental retardation to severe ISSX with additional neurological abnormalities. Here, we report a study of two severely affected female patients with apparently de novo balanced X;autosome translocations, both disrupting the serine-threonine kinase 9 (STK9) gene, which maps distal to ARX in the Xp22.3 region. We show that STK9 is subject to X-inactivation in normal female somatic cells and is functionally absent in the two patients, because of preferential inactivation of the normal X. Disruption of the same gene in two unrelated patients who have identical phenotypes (consisting of early-onset severe infantile spasms, profound global developmental arrest, hypsarrhythmia, and severe mental retardation) strongly suggests that lack of functional STK9 protein causes severe ISSX and that STK9 is a second X-chromosomal locus for this disorder.     

Chronic ACTH treatment: influence on 5-HT2 receptors and behavioral supersensitivity induced by 5,7-dihydroxytryptamine lesions

The capacity of the serotonin (5-HT) precursor 5-HIP to induce the ACTH-responsive myoclonic-convulsive disorder infantile spasms in patients with Down's syndrome has been cited as evidence for altered serotonergic neurotransmission in infantile spasms. Since there is no animal model of infantile spasms, the suitability of behavioral supersensitivity (myoclonus) evoked by 5-HTP in rats with 5,7-dihydroxytryptamine (DHT) lesions as a model was tested by determining the effect of chronic treatment with ACTH (40 IU/kg) on 5-HTP-evoked myoclonus. In rats treated with DHT as adults, ACTH administration did not alter the "serotonergic behaviors," such as myoclonus, induced by 30 mg/kg 5-hydroxytryptophan (5-HTP), but induced a small significant increase in Bmax of neocortical 5-HT2 sites of the DHT group, with no change in rats without lesions. In rats treated with DHT as neonates, there was also no significant difference in behaviors evoked by several doses of 5-HTP. These data suggest that ACTH minimally modifies the effects on 5-HT receptors of DHT lesions, but the intracisternal DHT model is not a suitable model for infantile spasms because chronic ACTH was not antimyoclonic.     

The recovery of the reactivity of the auditory system in the dolphin Tursiops truncatus to paired acoustic stimuli with different spectra]

Recovery cycles of the auditory brainstem responses were studied in the bottle-nosed dolphin, Tursiops truncatus, using paired acoustic clicks. The recovery time was longer if both clicks had identical spectra (50% recovery at 0.9 ms), as compared with that of different spectra (50% recovery at 0.35 ms). These results can explain a different recovery time of evoked responses after an artificial sound and after own locating one.     

De novo trisomy 20p characterized by array comparative genomic hybridization: Report of a novel case and review of the literature

We report on a boy with speech delay, mental retardation, motor clumsiness, hyperactivity, dysmorphic facial features, brachytelephalangy and short stature. Electrocardiogram, echocardiography, renal ultrasound, electroencephalogram, fundoscopic exam and auditory brainstem responses were all normal. Brain magnetic resonance imaging showed a left temporal arachnoid cyst and a small pineal gland cyst.     

Infantile spasms in children with Down syndrome

Down syndrome (DS) is the most common genetic cause of mental retardation. It is estimated that 5-13% of persons affected by DS have seizures. Infantile spasms are the most common type of seizures and usually are well controlled with steroids and antiepileptic drugs. We present 11 children at the age of 3 years and 4 months to 10 years and 7 months with DS and infantile spasms, treated at Children's Hospital Zagreb from January 2000 until July 2009. Infantile spasms began at the age of 5 to 10.5 months in 10 children, in one child at the age of 16 months. Only one child had perinatal risk factors for the development of IS. Changes in EEG correlated to hypsarrhythmia. Infantile spasms were treated initially with antiepileptic drugs, most often with valproic acid. Treatment was inefficient in 10/11 patients. After application of ACTH, infantile spasms stopped between 7 and 15 days in 6 patients, until 28th day in 4 patients. Hypsarrhythmia vanished in all children. During follow-up period (2 years and 7 months to 9 years and 5 months) none of the children developed another type of seizures. No major epileptogenic changes were registered in EEG. Antiepileptic therapy was discontinued in 4 children (aged 4 years and 2 months to 5 years). In this group is the boy who died of heart failure. Infantile spasms associated with DS are categorized into symptomatic group. The existence of cerebral pathology and delayed psycho-motor development precedes occurrence of seizures. It is possible to achieve good control of seizures and disappearance of hypsarrhythmia with application of ACTH and antiepileptic drugs.     

Reduced respiratory-related evoked activity in subjects with obstructive sleep apnea syndrome.

Midlatency respiratory-related evoked potentials were measured during wakefulness by using a 60-electrode array placed over the cortical region of the scalp. We studied the responses evoked by 200-ms pressure pulses at -5 and -10 cmH(2)O applied at inspiratory onset and during control tests (no pressure applied) in 14 subjects with obstructive sleep apnea syndrome (OSAS) and 18 normal subjects. Wavelet decomposition was used to smooth and dissect the respiratory-related evoked potentials in frequency and time in 8 frequency bands. After denoising, selected wavelet scales were used to reconstruct the respiratory-related evoked potentials, which were quantified by using global field power estimates. The time course of the global field power activity in OSAS subjects compared with normal subjects was significantly depressed in the period 55-70 ms poststimulus onset, a time when afferent traffic from upper airway receptors arrives in normal subjects. The reduced evoked response in subjects with OSAS suggests that these subjects receive less afferent input from upper airway mechanoreceptors. This may reflect reduced sensitivity of mechanoreceptors or reduced mechanoreceptor stimulation due to decreased upper airway compliance during wakefulness in OSAS.