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Assessment of awareness in patients with severe brain injury remains subjective, although patients with even limited awareness (e.g. minimal conscious state, MCS) have different prognoses and treatment than those in vegetative state (VS). Recently, task appropriate differential regional activation in VS has been reported using fMRI during mental imagery.Demonstration of conscious awareness in reproducible differential EEG source localization images in a VS patient reflecting requested mental imagery was performed.A VS patient (with re-test) and a normal control were requested to imagine singing and to mentally perform serial subtraction, while EEG was recorded. QEEG source localization was performed to identify regions of brain activation in response to tasks.Replicable distinctive activation of brain areas appropriate for each task was seen in the VS patient and control. Frequency spectra shifted to beta, with significant source activation in regions including the bilateral anterior cingulate, insula, left caudate and dorsolateral pre-frontal cortex to singing and the putamen, insula, left pre-frontal cortex and right temporal gyrus to subtraction by 7's.Results from this single case suggests the potential utility of QEEG source localization images to detect awareness in patients clinically diagnosed as being in VS. This indicates the possibility that EEG may serve as an important adjunct to the assessment of awareness in patients with disorders of consciousness in the clinical setting.

Objective: This research sought neurobiological features common to psychotic states displayed by patients with different clinical diagnoses. Method: Cluster analysis with quantitative electroencephalographic (QEEG) variables was used to subtype drug-naive, non-medicated, and medicated schizophrenic, depressed and alcoholic patients with psychotic symptoms, from the USA and Germany. QEEG source localization brain images were computed for each cluster. Results: Psychotic patients with schizophrenia, depression and alcoholism, and drug- naive schizophrenic patients, were distributed among six clusters. QEEG images revealed one set of brain regions differentially upregulated in each cluster and another group of structures downregulated in the same way in every cluster. Conclusion: Subtypes previously found among 94 schizophrenic patients were replicated in a sample of 390 non-schizophrenic as well as schizophrenic psychotics, and displayed common neurobiological abnormalities. Collaborative longitudinal studies using these economical methods might improve differential understanding and treatment of patients based upon these features rather than clinical symptoms.

Background: Accumulating evidence suggests repetitive transcranial magnetic stimulation (rTMS) may be beneficial in ameliorating cognitive deficits in Alzheimer's disease (AD). Methods: AD patients received four high-frequency rTMS sessions over the bilateral dorsolateral prefrontal cortex (DLPFC) over two weeks. Structured cognitive assessments were administered at baseline, at 2 weeks after completion of rTMS, and at 4 weeks post treatment. At these same times, tolerant patients underwent functional magnetic resonance imaging (fMRI) while performing structured motor and cognitive tasks. We also reviewed literature regarding the effects of rTMS on cognitive function in AD. Results: A total of 12 patients were enrolled, eight of whom tolerated the fMRI. Improvement was seen in Boston Diagnostic Aphasia Examination tests of verbal and non-verbal agility 4 weeks post-treatment. The fMRI analysis showed trends for increased activation during cognitive performance tasks immediately after and at 4 weeks post-treatment. Our literature review revealed several double-blind, sham-controlled studies, all showing sustained improvement in cognition of AD patients with rTMS. Conclusions: There was improvement in aspects of language after four rTMS treatments, sustained a month after treatment cessation. Our results are consistent with other studies and standardization of treatment protocols using functional imaging may be of benefit.

There is now more information to assimilate in clinical psychopharmacology and newer ways to acquire this information. Educational materials should be designed for and targeted to meet the diverse needs of such groups as medical students, psychiatry residents, clinical practitioners, industry and federal scientists, and clinical research organizations. As a starting point, the authors developed, in 1997, a model curriculum for psychopharmacology residency programs. The curriculum consists of 1) overview, 2) learning and educational objectives, 3) what and how to teach, 4) how to evaluate, 5) how to organize a psychopharmacology program, and 6) an investigative psychiatry curriculum. There are 31 lecture outlines and hard copies of 1,500 slides, comprising basic and advanced courses. A 1-year follow-up evaluation of users’ experience found that 62% rated the curriculum, to varying degrees, as improving the teaching of psychopharmacology in their programs.

Objective: To assess whether 1) repetitive transcranial magnetic stimulation (rTMS) can ameliorate aphasia in Alzheimer9s disease (AD) patients and 2) whether there are changes in activation patterns in relevant cortical areas using functional brain imaging subsequent to rTMS. Background Among the earliest manifestations of AD are deficits in language that significantly impair patients9 quality of life. Currently approved agents for slowing progression of AD do not target aphasia. Studies have demonstrated beneficial effects of rTMS in improving cognition and language deficits in patients with neurological disorders. rTMS may be a potential therapeutic tool to help improve aphasia in AD patients. Design/Methods: Eleven AD patients with aphasia underwent 4 sessions of rTMS applied to the dorsolateral prefrontal cortex at a frequency of 10-15 Hz over two weeks. They underwent standardized cognitive tests at baseline, immediately after completing the course of rTMS, and 4-weeks after the last rTMS treatment. All patients underwent concomitant functional MRI (fMRI) scans at the time of the tests while performing cognitive paradigms in the scanner. Results: All patients completed the cognitive portions of the study. Three patients could not tolerate imaging and therefore did not complete the imaging portion of the study. There was improvement in verbal and non-verbal agility on testing that was seen 4-weeks post-treatment relative to baseline (p Conclusions: These preliminary results suggest that rTMS may serve as an effective adjunctive treatment for aphasia found in AD patients. Further research using control stimulation is needed. Disclosure: Dr. Devi has nothing to disclose. Dr. Levine has nothing to disclose. Dr. Voss has nothing to disclose. Dr. de Boisblanc has nothing to disclose. Dr. Heier has nothing to disclose. Dr. Halper has nothing to disclose.

Antigen-antibody complexes prepared from rat IgGa inhibited the binding of rat IgE by rat basophilic leukemia cells, but failed to inhibit IgE binding to small membrane particles from such cells. Monomeric IgGa could not be shown to bind to the cells in direct studies and failed to inhibit IgE binding. The results can be rationalized on the basis of a weak intrinsic affinity of IgGa for the receptor for IgE which is amplified by extensive multipoint attachement.

The Ia alloantigens as measures of different alleles of loci in the major histocompatibility complex were determined in patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). The Ia specificities of reagents used were defined by their pattern of reaction with lymphoblastoid lines derived from normal donors homozygous for HLA-D determinants. The reagent specificities included those associated with a single Dw type as well as those reacting with a single specificity shared by several Dw types. Patients with RA had a marked elevation in the frequency of alloantigens detected by reagent sera that recognize various determinants shared by cell lines from HLA-Dw4, Dw7, or Dw10 individuals (Ia 4-7-10). The frequency of mixed lymphocyte culture alleles Dw4 and Dw10 was found to be increased; however this elevation did not approach the higher frequency for the serologically determined antigens of the Ia 4-7-10 group. In contrast, patients with SLE had an increased frequency of reactions with the reagent alloantisera defined by reactions with either HLA-Dw2 or Dw3 positive cell lines. The data suggest that immunogenetic factors are relevant to both groups of patients, but that these are entirely distinct for each disease.

The design of neurorehabilitation therapy to treat subjects with altered consciousness provides opportunities and challenges to professionals involved with the care for these severely ill patients. While there is an increased interest in determining methods to restore consciousness in these patients, the process is complex and challenging, due in part to the diverse aetiology of these states of consciousness, and also to the intricate cerebral connectivity involved in their treatment. The present case study examines a patient who showed signs of emergence from the vegetative state after neurorehabilitation using The Combined Method Therapy (CMT). In this case, neurorehabilitation therapy was applied simultaneously with pharmacological treatment, stimulation, and neuroimaging techniques to help adjust drug dosage. The results of this study suggest that this combined approach to treatment promoted connectivity among posterior and anterior cortical regions aiding emergence from the vegetative state.