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Song J, Westover MB, Zhang R. A neural mass model for disturbance of alpha rhythm in the minimal hepatic encephalopathy. Mol Cell Neurosci 2024; 128:103918. [PMID: 38296121 DOI: 10.1016/j.mcn.2024.103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/13/2024] Open
Abstract
One of the early markers of minimal hepatic encephalopathy (MHE) is the disruption of alpha rhythm observed in electroencephalogram (EEG) signals. However, the underlying mechanisms responsible for this occurrence remain poorly understood. To address this gap, we develop a novel biophysical model MHE-AWD-NCM, encompassing the communication dynamics between a cortical neuron population (CNP) and an astrocyte population (AP), aimed at investigating the relationship between alpha wave disturbance (AWD) and mechanistical principles, specifically concerning astrocyte-neuronal communication in the context of MHE. In addition, we introduce the concepts of peak power density and peak frequency within the alpha band as quantitative measures of AWD. Our model faithfully reproduces the characteristic EEG phenomenology during MHE and shows how impairments of communication between CNP and AP could promote AWD. The results suggest that the disruptions in feedback neurotransmission from AP to CNP, along with the inhibition of GABA uptake by AP from the extracellular space, contribute to the observed AWD. Moreover, we found that the variation of external excitatory stimuli on CNP may play a key role in AWD in MHE. Finally, the sensitivity analysis is also performed to assess the relative significance of above factors in influencing AWD. Our findings align with the physiological observations and provide a more comprehensive understanding of the complex interplay of astrocyte-neuronal communication that underlies the AWD observed in MHE, which potentially may help to explore the targeted therapeutic interventions for the early stage of hepatic encephalopathy.
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Affiliation(s)
- Jiangling Song
- The Medical Big Data Research Center, Northwest University, Xi'an, China
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Rui Zhang
- The Medical Big Data Research Center, Northwest University, Xi'an, China.
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Lei L, Li Y, Xu H, Zhang Q, Wu J, Zhao S, Zhang X, Xu M, Zhang S. Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study. BMC Psychiatry 2023; 23:925. [PMID: 38082396 PMCID: PMC10712132 DOI: 10.1186/s12888-023-05406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Delirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes. METHODS This observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization. RESULTS The incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05). CONCLUSIONS Delirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.
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Affiliation(s)
- Lei Lei
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yi Li
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Huilin Xu
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Qin Zhang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiacai Wu
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shoujv Zhao
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaochao Zhang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Min Xu
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shuai Zhang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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Kaplan PW, Gélisse P, Sutter R. An EEG Voyage in Search of Triphasic Waves-The Sirens and Corsairs on the Encephalopathy/EEG Horizon: A Survey of Triphasic Waves. J Clin Neurophysiol 2021; 38:348-358. [PMID: 34155177 DOI: 10.1097/wnp.0000000000000725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SUMMARY Generalized periodic discharges with triphasic wave (TW) morphology, long referred to as TWs, are typical of many toxic, metabolic, infectious, and cerebral structural problems, often in concert. Identifying TWs has been challenging for the electroencephalographer and clinician, as has been their cause, significance, prognosis, and treatment. This review highlights the many different patterns of TWs with commentary on their various causes and etiologies, characteristics, different morbidities, differentiation from nonconvulsive status epilepticus, and their prognosis. The articles in this Journal of Clinical Neurophysiology special issue on TWs will review the many challenges the clinician face when TWs are sighted.
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Affiliation(s)
- Peter W Kaplan
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A
| | - Philippe Gélisse
- Department of Neurology, Epilepsy Unit Montpellier, Montpellier, France
| | - Raoul Sutter
- Intensive Care Units and Department of Neurology, University Hospital Basel, Basel, Switzerland; and
- University of Basel, Basel, Switzerland
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Kural MA, Fabricius M, Christensen J, Kaplan PW, Beniczky S. Triphasic Waves Are Generated by Widespread Bilateral Cortical Networks. J Clin Neurophysiol 2021; 38:415-419. [PMID: 32852286 DOI: 10.1097/wnp.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Triphasic waves (TWs) have been observed in the EEG recorded in patients with various types of encephalopathy, yet their genesis and significance is still debated. The aim of this study was to elucidate the localization of the cortical generators of TWs using EEG source imaging. METHODS In 20 consecutive patients who had encephalopathy with TWs, EEG source imaging of the first negative and the positive phases of the TW was performed. Three different approaches were used: equivalent current dipoles, a distributed source model, and a recently described spatial filtration method for visualizing EEG in source space. RESULTS Equivalent current dipole models failed to provide valid solutions. The distributed source model and the spatial filtration method suggested that TWs were generated by large, bilateral cortical networks, invariably involving the anterior frontal and the temporo-polar areas. CONCLUSIONS Source imaging localized TWs to anterior frontal and temporo-frontal structures. Involvement of these regions is consistent with the typical pathophysiological changes of altered consciousness and cognitive changes observed in patients with TW encephalopathy.
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Affiliation(s)
- Mustafa Aykut Kural
- Departments of Clinical Neurophysiology and
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Fabricius
- Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Christensen
- Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.; and
| | - Sándor Beniczky
- Departments of Clinical Neurophysiology and
- Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark
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Ligtenstein S, Song J, Jin J, Sun H, Paixao L, Zafar S, Westover MB. Do Triphasic Waves and Nonconvulsive Status Epilepticus Arise From Similar Mechanisms? A Computational Model. J Clin Neurophysiol 2021; 38:366-375. [PMID: 34155185 PMCID: PMC8429048 DOI: 10.1097/wnp.0000000000000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Triphasic waves arising in patients with toxic metabolic encephalopathy (TME) are often considered different from generalized periodic discharges (GPDs) in patients with generalized nonconvulsive status epilepticus (GNCSE). The primary objective of this study was to investigate whether a common mechanism can explain key aspects of both triphasic waves in TME and GPDs in GNCSE. METHOD A neural mass model was used for the simulation of EEG patterns in patients with acute hepatic encephalopathy, a common etiology of TME. Increased neuronal excitability and impaired synaptic transmission because of elevated ammonia levels in acute hepatic encephalopathy patients were used to explain how triphasic waves and GNCSE arise. The effect of gamma-aminobutyric acid-ergic drugs on epileptiform activity, simulated with a prolonged duration of the inhibitory postsynaptic potential, was also studied. RESULTS The simulations show that a model that includes increased neuronal excitability and impaired synaptic transmission can account for both the emergence of GPDs and GNCSE and their suppression by gamma-aminobutyric acid-ergic drugs. CONCLUSIONS The results of this study add to evidence from other studies calling into question the dichotomy between triphasic waves in TME and GPDs in GNCSE and support the hypothesis that all GPDs, including those arising in TME patients, occur via a common mechanism.
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Affiliation(s)
- Sophie Ligtenstein
- Department of Technical Medicine, Department of Applied Mathematics, University of Twente
| | | | - Jin Jin
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston MA
| | - Sahar Zafar
- Department of Neurology, Massachusetts General Hospital, Boston MA
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Abstract
PURPOSE Triphasic waves (TWs) have been associated with a host of medication toxicities, and cefepime has emerged recently as a frequently encountered offending agent. This investigation aims to evaluate cefepime-induced encephalopathy and to report the associated clinical, EEG expression with TWs, and the radiologic findings. METHODS A retrospective multicenter observational study examining adult patients with cefepime-induced encephalopathy with generalized periodic discharges on either routine or continuous EEG between January 2014 and January 2020. Clinical, electrographic, and radiologic data were collected. Patients in whom cefepime was not the sole causative factor for their encephalopathy were excluded. RESULTS Twenty-seven patients with cefepime-induced encephalopathy marked by generalized periodic discharges with triphasic morphology were identified at both centers, whereas no patients were presenting with generalized periodic discharges without TWs. Patients had a median age of 63 years (interquartile range, 56-73). Fifty-six percent of the cohort (15 patients) were <65 years of age. Eighteen patients (67%) had either acute or chronic kidney impairment (either acute kidney injury or chronic kidney disease or both), whereas 81% had preexisting white matter disease on brain imaging. Of these, 14 patients (51%) were classified as either moderate or severe. In the majority of the patients, TWs were either state-dependent or stimulus-sensitive, and in one third of them presented only as stimulus-induced pattern. All patients improved with discontinuation of cefepime. CONCLUSIONS Cefepime toxicity should be considered in the differential diagnosis in encephalopathic patients with TWs. The presence of preexisting white matter disease in these patients should heighten the degree of suspicion, especially in younger patients and patients without renal dysfunction.
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Kang Y, Liu R, Mao X. Aperiodic stochastic resonance in neural information processing with Gaussian colored noise. Cogn Neurodyn 2020; 15:517-532. [PMID: 34040675 DOI: 10.1007/s11571-020-09632-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/22/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this paper is to explore the phenomenon of aperiodic stochastic resonance in neural systems with colored noise. For nonlinear dynamical systems driven by Gaussian colored noise, we prove that the stochastic sample trajectory can converge to the corresponding deterministic trajectory as noise intensity tends to zero in mean square, under global and local Lipschitz conditions, respectively. Then, following forbidden interval theorem we predict the phenomenon of aperiodic stochastic resonance in bistable and excitable neural systems. Two neuron models are further used to verify the theoretical prediction. Moreover, we disclose the phenomenon of aperiodic stochastic resonance induced by correlation time and this finding suggests that adjusting noise correlation might be a biologically more plausible mechanism in neural signal processing.
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Affiliation(s)
- Yanmei Kang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049 China
| | - Ruonan Liu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049 China
| | - Xuerong Mao
- Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XT Scotland, UK
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