Search

In the present study the influence of the level of consciousness on spatial organization of the cortical functional activity in human psychic processes was investigated. For regulation of the level of consciousness models were used of hypnotic analgesia, automatization of intellectual actions and mental activity in hypnotic state. Evaluation of the mosaic of the cortical activity was made by parameters of spatial synchronization of the potentials with topographic mapping of crosscorrelation, spectral and coherent-phasic EEG characteristics. The obtained data allow to conclude about special role of the frontal areas of the left hemisphere in the process of realization of information. It has been shown that one of the main functions in neurophysiological structure of consciousness is the selection of signals according to dominating motivation. The frontal areas of the left hemisphere control the degree of inclusion of foci of increased activity, specific and non-specific for each type of activity, and possibly, regulate the way of transformation of the information.

Modification is proposed of the method of "pair presentations with transfer" for the purpose of studying of some forms of animals complex behaviour in chronic experiment. The experiments were conducted on cats in the apparatus, the limited size of which make possible simultaneous recording of electrophysiological characteristics of the brain activity. On the basis of experimental data it is postulated that "reflex to relation" is one of the most complex reflexes of the animal including, alongside with conditioned component, elements of non-automatized behaviour. The proposed method can be used in neurophysiological, electrophysiological and neuropharmacological experiments on animals.

The ictal clinical manifestations of 40 patients with frontal lobe epilepsy who became and remained seizure free after selective removal of the parasagittal or anterolaterodorsal convexities were studied. Seizures arising from the parasagittal region were characterized by a high incidence of somatosensory auras (60%) and by tonic and/or clonic motor behavior (100%) and never exhibited automatisms. Conversely, the anterolaterodorsal convexity group never showed somatosensory auras but often had warnings more typical of temporal lobe seizures, only displayed partial motor seizure activity in half the cases, and included a relatively high incidence of automatisms (30%). These clinical differences may be useful in the localization of frontal lobe epileptogenic foci. The manifestations of anterolaterodorsal convexity seizures may reflect frequent spread to the temporal lobe, whereas parasagittal convexity seizures often show initial ictal behavior, in keeping with seizure activity in that region. Early ictal unilateral head turning without other motor manifestations was seen in 3 of 10 patients in the parasagittal convexity group and in 9 of 30 patients in the anterolaterodorsal convexity group. In 11 of these 12 cases, the head turning was contralateral to the surgical removal.

Amphetamine-induced stereotyped behavior is a nonsteady oscillatory process. In its structure waves with 2-3, 4-5 and 10-15 minute periods may be distinguished. In some animals (30%) after chronic amphetamine administration the stereotyped behavior was attenuated with reorganization of its rhythmical pattern but in other cases (35%) stereotype on the contrary increased. Tolerance developed in the animals which had initially the more pronounced stereotype with the predomination of short-period (2-3 min) waves on the chronogram. These animals demonstrated low locomotor activity in the opened field, greater immobility in the forced swimming test and better relearning in Y-maze.

A new theory of the cerebellum work is presented. It explains all the experimental data now accumulated.

Seventeen patients had type I complex partial seizures (CPS) with three consecutive phases: initial motionless staring, oral-alimentary automatisms, and reactive quasipurposeful movements during impaired consciousness. Fifteen patients had stereoelectroencephalography. Focal or regional 8- to 20-Hz low-voltage epileptiform paroxysms in either hippocampus (10 patients), amygdala (1 patient), or both (1 patient) preceded initial motionless staring. Focal sphenoidal or nasopharyngeal ictal paroxysms preceded seizures in three other patients who underwent lobectomy. All 15 patients are seizure-free 2 to 11 years after temporal lobectomy. Type I CPS are most commonly of hippocampal origin.

Characteristics of rapid eye movements (saccades) in babies (six babies of 1-8 months age) recorded by electrooculography method in paradoxical phase of sleep are analyzed in comparison with analogous data in adults during sleep and in alertness in various conditions of eye movements recording. Coincidence of distribution curves of intersaccadic intervals and amplitudes of saccades in babies and adults is revealed. It is also found that the most frequently met intervals (in the range up to 1 s) in sleep and wakefulness are of comparable values 71.5-90.5%. On the basis of the obtained data the suggestion is made about automation of saccades, forming the base of saccadic activity and manifested in babies and adults during sleep and also in wakefulness, against the background of which other kinds of oculomotor activity are realized. Automation of saccades is formed in early ontogenesis.

It has been demonstrated that at early stages of postnatal development of rats, corticospinal effects interact with spinal automatism. Epicortical stimulation at a frequency 0.5-1/s causes the onset of periodic motor activity during the first week of postnatal life; at later stages the same stimulation evokes periodically changing (with respect to their intensity) motor responses which follow the rhythm of stimulation. It is suggested that autogenic periodic processes in the spinal cord manifest themselves not only in periodic motor excitation, but in periodic changes of excitability as well.

The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalographic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.

To study the characteristics of the interhemispherical interaction, tachistoscopic unilateral presentation of verbal stimuli (letters) was used. Three groups of patients were examined: 27 schizophrenic patients with symptoms of an emotional-volitional defect; 23 with the syndrome of psychic automatism in the framework of schizophrenia, and 20 mentally normal subjects. Subjects from different groups presented significant differences in the nature of recognition of stimuli addressed to the right or left hemisphere. These differences are considered from the standpoint of impairment of the interhemispherical interaction in schizophrenia, which is in agreement with the existing model ideas about the visual recognition through the combined work of both brain hemispheres and relative functional specialization of each of them. To explain a possible link of the defect of the interhemispherical interaction and psychopathological symptomatology in schizophrenia, a hypothesis is advanced according to which this defect leads to changes in the time structure of reflection serving as a form of correlation between the immediately percepted things and the past experience of the patients.

Videotape analysis of 163 complex partial seizures in 40 patients showed that the mean duration of the attack was 128 seconds. Automatisms occurred in 159 seizures (97%) and involved more than the face and arms in 132 (80%). Most automatisms were simple, stereotypic, or aimless movements. Postural tone increased in 24 seizures and decreased in 62. Clonic movements of the eyelids occurred in 19 attacks, and clonic movements of the extremities in 4. Only nine patients reported auras. Distinct ictal and postictal phases could be distinguished in 132 seizures (80%); in these, the mean ictal duration was 54 seconds and the mean postictal duration 89 seconds. Videotape analysis provides objective criteria by which complex partial seizures may be differentiated from other seizure types.

In an effort to establish correlations between abnormal behaviors characteristic of schizophrenia and simultaneous cerebral electrical activity, EEGs and electro-oculograms (EOGs) were continuously recorded for 2 to 24 hours by radiotelemetry from 40 patients with schizophrenia and 12 normal control subjects. Trained observers recorded specific behavior patterns permitting visual and computer analysis of EEG during hallucinations, stereotypy, catatonia, psychomotor blocking, and other characteristic manifestations of schizophrenia. Electroencephalographic abnormalities consisting of focal slow or spike activity over either temporal region were found in nearly half of the patients so recorded. In contrast to the EEG during ictal episodes of epilepsy, the abnormal wave forms of schizophrenic patients seldom coincided with episodes of blocking, stereotypy, or other abnormal behaviors. Increased extraocular activity or blinking were recorded in a majority of patients, but were not consistently associated with the abnormal behavior or perceptual events.

A 25-year-old man presented with seizures characterized by unconsciousness, automatic behavior, and myoclonic jerks lasting 0.5 to 8 sec. Videotape analysis of 300 simultaneously recorded electroencephalographic and clinical attacks revealed 8- to 9-Hz 150 to 200 muV sharp waves beginning in both medial temporal areas during eyelid flutters. When discharges spread diffusely on both sides and lasted 2 to 3 sec, 20 degrees forward flexion of the head, unconsciousness, pupil dilation, and staring became evident. Asymmetrical myoclonic jerks invariably appeared. When paroxysms were greater than 3 sec, automatisms and tonic posturing occurred. The electroencephalographic and clinical seizures appeared during the awake and relaxed states, i.e., with normal alpha rhythm. They were suppressed during physical and mental activities and during sleep, i.e., in the absence of alpha rhythm. Our studies suggest that these seizures associated with diffuse electroencephalographic alpha-like activities are subcortical in origin and should be tested in their responsivity to alpha suppressants and inducers.

Among 1.000 absences registered in the electroencephalogram 373 were associated with automatisms. These 373 absences were ascribed to 3 groups with different clinical symptoms according to different timing of the automatisms. In the first two groups automatisms prevail in the motor picture, whereas in the third group of absences adversive movements and/or rhythmic myoclonias were predominant motor elements. The occurrence of automatisms after spike wave potentials confirms, that the true absence may last longer than is expressed by the electroencephalogram (E.E.G.). Similar conditions are known for the behaviour of the autonomous reflexes during the absence. The accordance of clinical and reflex myographical phenomena during the absence suggests a common pathophysiological origin.

The initial facial expressions of 195 complex partial seizures of 98 patients with temporal lobe epilepsy were reviewed in relation to the laterality and focality of electroencephalographic (EEG) seizure origin. A neutral expression was observed most often (71) followed in frequency by expressions of disgust (13), happiness (7) and sadness (7). There was no expression of anger, surprise and fear. No correlation was found between the type of facial expression and the side of seizure origin. However, among 27 patients examined by means of intracranial EEG recordings, it was evident that a disgust expression occurred with oro-alimentary automatisms at the beginning of mesial temporal lobe seizures, whereas a happy one occurred without oro-alimentary automatisms at the beginning of lateral temporal lobe seizures. Although the facial expressions were not always related to the concurrent ictal emotion, it appeared that the majority of the patients with the disgust expression had autonomic features, while those of the happy/sad expression had psychic/sensory ones. It was concluded that (1) a disgust expression occurs as an indirect consequence of "crude sensation," while a happy/sad expression occurs as a direct consequence of "elaborate mental state" (Jackson) and (2) facial expressions must be reviewed in relation to focality rather than laterality in temporal lobe seizures.

The effect of a new anti-arrhythmic drug etacysin was studied in various forms of dog Purkinje's fibres automativity: normal and abnormal arising at a late stage of experimental myocardial infarction (24 hrs after coronary artery ligation) and induced by ions Ba2+. An average 57% decrease in the frequency of automaticity of normal Purkinje's fibres due to steepening the slope of slow diastolic depolarization and almost complete depression of an abnormal one was observed for the drug concentrations 5 X 10(-7) and 10(-6) g/ml. Reduced automaticity was also related to decreased slow diastolic depolarization. Maximal values of diastolic potential were found unchanged.

Three new cases of automatisms occurring during frontal lobe epileptic seizures are reported. If these cases are added to those already published and adequately described in the literature, a total of 12 cases is obtained. An attempt is made to elucidate the clinical characteristics of automatisms encountered during frontal lobe seizures. This kind of automatism would seem to be clinically distinguishable from other types.

A possible relationship between epilepsy and violence has been debated for over a century. The debate has taken on new importance because of the increasing use of the "epilepsy defense" in criminal cases. In this review the following issues are addressed: (1) Is epilepsy more common among violent criminals and patients? (2) Is violence more common among epileptics? (3) Can directed violence or aggression occur as part of an epileptic seizure? (4) What medical and legal criteria should be used to determine whether a specific violent crime was the result of an epileptic seizure? Answers to these questions may be summarized as follows. (1) There is a two- to fourfold greater prevalence of epilepsy in prisoners than in control populations, but the prevalence is similar to the prevalence in other lower socioeconomic populations from which most prisoners come. There is no greater prevalence of epilepsy in persons convicted of violent crimes than in other prisoners matched as controls. (2) There is no evidence that violence is more common among epileptics than among non-epileptics, and no evidence that violence is more common in patients with temporal lobe epilepsy than in those with other types of epilepsy. (3) Ictal violence is rare, and when it does occur usually takes the form of "resistive violence" as the result of physical restraint at the end of a seizure, while the patient is still confused. Violence early in a seizure is extremely rare, stereotyped, and never supported by consecutive series of purposeful movements. (4) Five criteria should be used to determine if a specific violent act was the result of an epileptic seizure: a. the diagnosis of epilepsy should be established by a neurologist with special competence in epilepsy; b. the presence of epileptic automatisms should be documented by the case history and closed-circuit TV-EEG; c. aggression during epileptic automatisms should be documented on closed-circuit TV-EEG; d. the aggressive act should be characteristic of the patient's habitual seizures; and e. a clinical judgment should be made by the neurologist as to the possibility that the violent act was part of a seizure.

A 16-year-old physically and mentally retarded male developed a complete Klüver-Bucy syndrome similar to that demonstrated in animal experiments and characterized by so-called psychic blindness, oral tendencies, hypermetamorphosis, emotional disturbance, and hypersexuality after severe brain trauma with loss of consciousness and a transitory hemiplegia. In addition, transitory oral and grasp reflexes were observed. Despite the severity of the clinical symptoms, the patient was able to realize and report on his subjective experience of the reflex and on the instinct-motivated behavior associated with the Klüver-Bucy syndrome. In the case described, two basic behavior patterns could be differentiated, each influencing drive and the abnormally increased sexuality. The first phase of the illness was dominated by relatively constant automatic reactions. These had the character of pre-determined instinctive behavior and were more or less emotionally neutral. In the second phase of the illness, the instinctive behavior became less evident and the patient was able to respond more normally to his sensory-motor impulses. Also, emotional experience such as frustration, pleasure, and displeasure regained their meaning for the patient.

The electrographic and clinical behavioural manifestations of 96 temporal lobe seizures are reviewed from recordings in 19 patients who were submitted to stereotaxic depth electrode implantation in temporal and frontal lobes. Focal onset in hippocampus was recorded in 40% of the seizures. Sixty percent of temporal lobe seizures exhibited a regional seizure onset but in two-thirds of these ictal changes were restricted to amygdaloid and hippocampal structures. Thus, in approximately 80% of seizures, the onset of ictal EEG changes resided in the mesial temporal structures. The main behavioral manifestations observed during seizure discharge restricted to one temporal lobe included warning (67%), motionless stare (24%), automatism (22%), and head-body turning (24%). The predominant ictal behavioural manifestations observed during seizure spread to contralateral temporal and extratemporal structures included warning (3%), motionless stare (36%), automatism (77%), and head-body turning (81%). The direction of head turning did not provide reliable lateralization as to the side of seizure onset.

Tonic postural changes of the upper limb accompanied by epileptic parietal lobe discharges are not well known. The authors report 3 such cases. In the 3 patients, a total of 18 spontaneous seizures were recorded, 12 by telemetry, from either scalp electrodes or stereotactically implanted electrodes. Of these 18 seizures, 14 included tonic postural changes of the upper limb accompanied by a contralateral parietal discharge. Combining these 3 cases with the 4 such cases in the literature, the authors found that the clinical pattern consisted of a tonic postural change in one upper limb associated with automatisms of the opposite upper limb. It was also found that the same patient might have automatisms involving the upper limb in some seizures and upper limb postural changes in other seizures, both accompanied by the same electrical discharge. It is concluded that tonic postural changes and automatisms in the upper limb may be interchangeable.