Frederic A. Gibbs

Extreme Spindles: Correlation of Electroencephalographic Sleep Pattern with Mental Retardation

An electroencephalographic abnormality is described which is relatively common among children below 12 years of age who are mentally retarded. This pattern consists of exaggerated sleep spindles, which are of higher voltage and more continuously present than in normal persons, and it correlates specifically with mental retardation and not with epilepsy or cerebral palsy.

The electroencephalogram in phenylpyruvic oligophrenia

Abstract Electroencephalographic studies in the waking and sleeping state of 19 patients with phenylpyruvic amentia reveals that waking activity in these patients is usually abnormal; it is of high voltage, slightly fast, slightly slow, or a mixture of fast and slow; seizure discharges of the petit mal type are common. Eleven patients showed seizure activity in the waking state and 18 had seizure activity during sleep. Thus the electroencephalogram confirms the clinical observation that epileptic disorder is a common complication in phenylpyruvic amentia. The occurence of 3/sec. spike and wave discharges of the petit mal type in more than one-third of the present group of patients with phenylpyruvic amentia is noteworthy because this pattern is rare in other types of symptomatic epilepsy. It suggests that there is some causal relation between the metabolic disorder which is present in phenylpyruvic amentia and the wave and spike pattern. The most consitent abnormality was a lack of well formed sleep patterns. Biparietal humps and spindles were either absent or poorly developed. Sleep activity was profoundly disorganized. In two cases mitten patterns were present. These findings suggested a pathological process with a strong epileptic component, causing a profound disturbance of both cortical and thalamic function.

Effect on the electrical activity of the brain of intra-arterially and intra-cerebrally injected convulsant and sedative drugs (Metrazol and Nembutal)

Abstract In 27 cats seizure discharges were produced by unilateral intracarotid injection of Metrazol or by injection of Metrazol into the vertebral arteries or into the substance of the brain. Intracarotid Metrazol produces a seizure discharge which commonly appears bilaterally and synchronously with little or no difference between the form of the spikes in the primary (metrazolized) and the secondary (non-metrazolized) hemisphere. Bilateral synchronicity is not necessarily a sign of a thalamic origin. If interhemispheric spread is normal, bilaterally synchronous discharges are likely to occur whenever a large portion of one hemisphere is affected by an epileptogenic disturbance. The spread of the seizure discharge can be restricted and confined to the primarily involved (metrazolized) hemisphere by locally or generally applied Nembutal. The alterations in wave form that occur when spread is restricted are in accord with those previously described by Curtis (1940) and discussed in detail by Gibbs and Hayne (1948). It is believed that Nembutal may be used to differentiate between the primary and the secondary discharge in cases with widely spreading seizure activity and that it can be used to localize a focus in some cases where a focus might not otherwise be evident. Metrazol injected into the vertebral artery produces a generalized seizure discharge which closely resembles that produced by unilateral intracarotid injection, suggesting that closely comparable types of seizure discharges can originate from the cortex and from the thalamus. Petit mal-like discharges were easily produced when Metrazol was injected into one common carotid artery; they were rarely produced when the injection was made into a vertebral artery. This suggests that the thalamus is not necessarily the primary cite of discharges of the petit mal type.

How Much Do Sleep Recordings Contribute to the Detection of Seizure Activity

For the past 28 years my wife and I have been recording EEGs both awake and asleep. We started doing this because we found that although focal and diffuse slowing usually disappear in sleep, seizure discharges usually become more numerous and certain types of seizure discharges appear in sleep that are almost never seen awake. It was in 1944 also, that my wife and I became exclusive monopolarists. For the previous 10 years we had used both bipolar and common reference leads. We had become increasingly aware that both montages showed the same thing and that the monopolar view gave a simpler picture. With monopolar recording, voltages were higher, wave forms more consistent and electrical sign was immediately obvious. Among patients with clinically diagnosable epilepsy, approximately one third show seizure activity in the awake recording, but in sleep and drowsiness, 80-90 per cent show seizure activity (1). We have reviewed our case material, collected since 1944, to see how great a contribution sleep recordings make to the detection of various types of seizure discharges. The young lady shown in Fig. 1 is our research assistant. She helped get together all our cases that had an anterior temporal focus of seizure activity. This focus is called a psychomotor type of focus because it is commonly associated with trance-like attacks and confusional episodes. The data concerning each case was put onto a McBee marginal punchcard and the cards were sorted to see how many cases had anterior temporal spiking awake only, how many asleep only and how

Electroencephalographic Study of Criminals

Many people who have thought seriously about criminality have concluded that it is commonly a symptom of disordered higher central nervous functions. In certain cases criminal acts, dangerous a n.l aggressive behavior, compulsiveness and deficient impulse control (sometimes resulting in murder), are unquestionably manifestations of disease processes in the brain. That this is a fact is recognized not only by physicians and other qualified experts, but also by the courts. With the advent of electroencephalography, a technique became available that makes it possible to identify epileptic disorder objectively. Seizure discharges can be demonstrated in 80% of epileptics, and in a lower but significant percentage of the supposedly normal population. However, in order to detect epilepsy in this high a percentage of epileptics, it is necessary to record the electroencephalogram both awake and asleep (1). If recordings are made without sleep, only 30% of clinically diagnosable epileptics have seizure activity in their electroencephalograms (2), An abnormal sleep pattern has been identified that correlates with psychosis (3-7), The pattern looks like a slow spike and wave discharge; it appears during fairly deep sleep and shows best in the fronto-parietal areas (Fig 2), In outline it resembles the thumb and hand of a childs mitten and for this reason it has been called the mitten pattern. It is more common among epileptics with psychosis (42%) than in any other broad diagnostic category, but it does not correlate with epilepsy. It occurs in 37% of schizophreniC8 and in 22% of patients with manicdepressive psychosis (4), Struve and Becka (7) have reported that mittens are much more common among reactive (74%) than among process schizophrenics (10%). In the former the onset of the psychosis is sudden, usually in early adult life and the prernorbid personality is relatively normal. In the latter the onset is insidious with psychotic symptoms occurring in mid to late adolescence with extremely poor social and sexual adjustments. In the early years of electroencephalography, a study of 451 criminals (of whom 79 were murderers), revealed no significant differences between the criminals and a matching group of controlled subjects (8). However, all these recordings were made awake only, because at that time the val ue of sleep recordings was not recognized. Dennis Hill was the first to point out a relationship between temporal lobe disorder and anti-social behavior (9). He reported that slow activity in the temporal lobe (particularly in the post-temporal area) is common among persons with aggressive behavior. Somewhat later the relationship between seizure activity in the anterior-temporal area and episodic psychotic behavior was reported (10) (11). Until 1953 the main emphasis had been on dangerous, anti social behavior among adults and its possible relationship to electroencephalographic abnormality, but in

“Flat” electroencephalograms in physiological decortication and hemispherectomy (recordings awake and asleep)

Abstract Four patients with severe bilateral cortical damage were chosen for study because they had bilateral flat (almost isoelectric) electroencephalograms. In two of these patients the damage was presumably due to an anesthesia accident, in one to encephalitis and in one to severe prolonged hypo-glycemia. Two cases on whom hemispherectomies were performed were chosen for study because they showed post-surgically a flattening of activity on the operated side while the unoperated side retained a normal voltage. In all these cases sleep produced no significant change in the flat electroencephalogram; sleep was distinguised in the flat EEG only by dropping out of superimposed muscle potentials. In cases where a relatively isoelectric state is the result of destruction or absence of cortical tissue the same extreme hypopotentia continues in sleep.

Tumor Sites in Cases of Brain Tumor with Mitten Patterns in the Electroencephalogram

A letter from Ilmar Sulg in Helsingborg asked an interesting question, “What is the incidence of mitten patterns among persons with brain tumors?” As those familiar with our previous work know, mitten patterns (Fig. l ) , occur in moderately deep sleep in approximately 1.3 percent of a random sample of adult control subjects (1) (2) and in a much higher percentage of psychotic patients (Fig. 2) , the highest incidence being among psychotic epileptics (42 percent). Struve and his colleagues (3, 4, 5) have shown that mittens are far more common among the reactive type of schizophrenics (33-73 percent) than among the process type (7 percent) and recently these authors have pointed out that mittens are almost never found in persons below 14 years of age (6). Obviously age is a controlling factor and Sulg’s question cannot be answered without specifying the age range to which the percentage incidence of patients with brain tumors and mittens applies. A series of 261 consecutive cases of brain tumor with sleep recordings, all patients being over 14 years of age, yielded 20 cases with mitten patterns, i.e., 7.7 percent, which is an incidence approximately 6 times greater than in a random sample of control subjects of the same age (1.3) percent) (1) (2 ) . This suggests that brain tumors can produce mitten patterns (since a casual relation between mittens and brain tumors seems illogical), A second question naturally follows Sulg’s first question, “Where were the brain tumors located that were associated with mitten patterns?” The answer is set forth in Table 1 Tumors in certain locations are common and in other locations rare, and Figure 3 shows the percentage of cases with a tumor in a given location that were associated with mittens.

Der gegenwärtige Stand der klinischen Elektrencephalographie

Der Kliniker hat im E E G ein wirkungsvolles Mittel, einige der schwierigsten Probleme bei Nervenund Geisteskrankheiten anzugehen. Es ist Aufgabe dieses Beriehtes, einige neuere Fortschritte und eigene Ergebnisse zusammenzufassen und zu zeigen, wie man das E E G bei praktisch-klinisehen Untersuchungen verwenden kann. Zun/ichst soll ehrend der Pioniere auf diesem Gebiet gedacht werden. Wie bekannt, war es ttA~S B~.RG~ 1, der 1929 den Weg wies. Er zeigte, dal~ das E E G beim Menschen iiberraschend einfach zu registrieren ist, und was noch wesentlicher war, dal~ es mit dem Alter, mit der Aufmerksamkeit und mit Zust~tnden ver/~nderten Bewul~tseins und bei verschiedenen Erkrankungen Unterschiede aufweist. F I s c n ~ 2 hat zuzuerst im Tierversueh nachgewiesen, dad abnorme corticale Potentiale bei Krgmpfen auftreten. TO~c.wIEs s Verdienst war es, den ersten brauchbaren Tintenschreiber zu entwickeln; GI~ASS t hat d~nn entspreehende gute Elektrencephalographen fiber die ganze Weir verbreitet. Die Beitrage yon KO~S~t~LLE~ 5, ADRIAN 6, G~EY WALTE:R 7, BI~EME:R 8, JASPER 9 U. a. ~~ haben allen friihen Untersuchern Grundlagen und Ausriehtung gegeben. In den letzten 20 Jahren ist praktisch jeder normale und abnorme Zustand des Zentralnervensystems bei Mensehen und Tieren im E E G untersucht worden. Zehntausende M/~nner, Frauen und Kinder wurden in mehrfacher Registrierung untersucht. Vie]e 1000 Meilen Registrierungen wurden ausgewertet und mit versehiedenen klinischen Symptomen in Beziehung gesetzt. Diese Arbeit hat die EEG-Diagnose auf eine sonde statistisehe Basis gestellt*. Es ist jedoch noch mehr erreicht

Clinical Significance of 14 and 6 Per Second Positive Spikes in the Electroencephalograms of Patients Over 29 Years of Age

Fourteen and 6 per second positive spikes are so common in the electroencephalograms of school-age children that many electroencephalographers have concluded that they are normal. They have been reported as occurring in 15-50 percent of control subjects 4-19 years of age (1-6). Among asymptomatic adults over 29 years of age this pattern is rare; the incidence was only 0.3 percent in 344 control subjects over 29 years of age (6 ) . We thought it would be of interest to study the clinical correlates of 14 and 6 per second positive spikes in this older age group. Among 3,452 consecutive patients over 29 years of age who were referred to our private office for electroencephalographic study, 207, or 6 percent had 14 and 6 per second positive spikes (Table 1 ) . This percentage is not large, but if 14 and 6 per second positive spiking is normal for mature adults, it seems strange that it occurred 20 times more often among patients than among control subjects. Among our patients over 29 years of age, there were 46 who had sustained head traumas but had no symptoms; of these asympto-

The Electronencephalograms of Three Brothers with Progressive Familial Myoclonic Epilepsy (Unverricht's Disease)

A distinctive, abnormal, electroencephalographic pattern (Figs. 1-3) was encountered in three brothers who were referred for study by the late Dr. Meyer Perlstein. The oldest of the three, M-2, was 19 years of age when examined. His gestation and birth had been uncomplicated but he began to have convulsive seizures in early childhood. They were both major and minor in type. Their frequency and severity increased and he had a progressive loss of intellectual power. Ataxia and myoclonic jerkings developed. Attempts at preventing the patient’s seizures with various anticonvulsant drugs were largely unsuccessful. Formal schooling was abandoned at age 14 and he was sent to a nursing home at the age of 17. On examination, the patient was found to be oriented as to time and place and; though dull, not extremely retarded. His neurological examination was complicated by frequent bilateral myoclonic jerks. His voice was nasal and he had a marked dysarthria. The musculature of all extremities showed atrophy and there was a beginning contracture of the legs. Deep tendon reflexes were hyperactive and there was a bilateral sustained ankle clonus and a questionable positive Babinski sign on the right. Laboratory studies were non-contributory except for evidence of a urinary tract infection. Aminoaciduria and riborsuria had been reported by another hospital three years ago, but this could not be confirmed at the University of Illinois Hospitals. This patient’s electroencephalogram was exceedingly abnormal awake and asleep (Fig. 1), with very frequent short bursts of high voltage 3-4 per second slow waves, many of which had sharp positive deflections, and between the slow waves there were often single or multiple negative spikes of high voltage. The 16 year old brother, M-3, was also the product of normal gestation and delivery, but for some unknown reason, he required two minutes of resuscitation. He sat at 6 months, walked at 11 months and talked at 19 months. However, his speech was so defective that he was given speech therapy in the first and second grades. At 10-11 years of age, this child‘s mother noticed that his eyelids were twitching; the twitching or jerking progressed to involve the muscles of the face and later of the extremities. The first major motor seizure occurred at the age of 12 years, and at this time the myoclonic jerking became more severe. The patient’s school work, which had always been inferior, deteriorated so much that his reading became poorer than when he was in second grade. He was placed in a school for handicapped children. His personality changed; he became irritable and ill-tempered. On examination, this patient gave the impression of being dull but not severely retarded. Many myoclonic jerks were noted during the examination. There were no true cerebellar signs. Speech was slow, deliberate, and slightly slurred. There were no weaknesses or sensory deficits. Deep tendon reflexes were brisk and symmetrical. There were no pathological reflexes. Laboratory studies were all negative except for a glucose tolerance test which showed that the patient was mildly diabetic. The electroencephalogram awake and asleep was very abnormal with essentially the same abnormalities as those of the patient’s older brother but less marked. There were fairly frequent short runs of high voltage 3 but more often 4 per second slow waves which were in-