Kjeld Andersen

Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study.

ObjectivesMyofascial pain syndromes due to trigger points (TrPs) are clinical entities, but more evidence is needed to evaluate TrP palpation. Chronic tension-type headache (CTTH) is the most prevalent chronic headache with high socioeconomic costs. The primary aim was to study whether TrP palpation can distinguish patients with headache patients from healthy controls. DesignDouble-blinded, controlled design. PatientsTwenty patients with the diagnosis of CTTH, and 20 healthy age-matched and sex-matched control participants. ResultsTrP palpation revealed more TrPs in patients (N=17) versus controls (N=6) (P=0.0005). Referred pain was also more frequent in patients (N=17) versus controls (N=9) (P=0.04). Further, TrP palpation also identified a higher pain intensity than at a control point (CtP) in both groups (P=0.0001). Pain intensity at TrPs in patients was higher than in controls (P=0.0010), and CtPs were also more tender in patients than in controls (P=0.0167). For spontaneous electromyographic activity no difference between TrPs versus CtPs within or between groups could be detected. ConclusionsThese findings suggest that active TrPs are much more frequent in CTTH than in controls and the number and pain intensity of TrPs may be used to distinguish between the 2 groups. Spontaneous electromyographic activity could not be demonstrated, and the underlying biology of TrPs is still unclear.

Standardized computer-based organized reporting of EEG: SCORE.

The electroencephalography (EEG) signal has a high complexity, and the process of extracting clinically relevant features is achieved by visual analysis of the recordings. The interobserver agreement in EEG interpretation is only moderate. This is partly due to the method of reporting the findings in free‐text format. The purpose of our endeavor was to create a computer‐based system for EEG assessment and reporting, where the physicians would construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena (for video‐EEG recordings). A working group of EEG experts took part in consensus workshops in Dianalund, Denmark, in 2010 and 2011. The faculty was approved by the Commission on European Affairs of the International League Against Epilepsy (ILAE). The working group produced a consensus proposal that went through a pan‐European review process, organized by the European Chapter of the International Federation of Clinical Neurophysiology. The Standardised Computer‐based Organised Reporting of EEG (SCORE) software was constructed based on the terms and features of the consensus statement and it was tested in the clinical practice. The main elements of SCORE are the following: personal data of the patient, referral data, recording conditions, modulators, background activity, drowsiness and sleep, interictal findings, “episodes” (clinical or subclinical events), physiologic patterns, patterns of uncertain significance, artifacts, polygraphic channels, and diagnostic significance. The following specific aspects of the neonatal EEGs are scored: alertness, temporal organization, and spatial organization. For each EEG finding, relevant features are scored using predefined terms. Definitions are provided for all EEG terms and features. SCORE can potentially improve the quality of EEG assessment and reporting; it will help incorporate the results of computer‐assisted analysis into the report, it will make possible the build‐up of a multinational database, and it will help in training young neurophysiologists.

Multiple mononeuropathy following cocaine abuse.

A 31-year-old man with acute-onset of left-sided weakness following the sniffing of cocaine was admitted with rhabdomyolysis. Neurophysiological studies showed axonal degeneration in 4/10 sensory and 3/8 motor nerves, and conduction block outside the typical compression-sites in 3/8 motor nerves. The findings are consistent with a diagnosis of multiple mononeuropathy. Ischaemia due to vasoconstriction is currently believed to be the cause of muscle necrosis following cocaine abuse and we hypothesise that it also explains the neuropathy in this case.

W8.2 SCORE: an overview of the software

W8.2 SCORE: an overview of the software H. Aurlien1, S. Beniczky2, A. Fuglsang-Frederiksen3, A. Martinsda-Silva4, E. Trinka5, G. Visser6, G. Rubboli7, H. Hjalgrim2, H. Stefan8, I. Rosén9, J. Zarubova10, J. Dobesberger5, J. Alving2, K.V. Andersen11, M. Fabricius11, M.D. Atkins2, M. Neufeld12, P. Plouin13, P. Marusic10, R. Lees14, R. Pressler15, R. Hopfengärtner8, J.C. Brøgger2, R. Mameniskiene16, W. van Emde Boas17, P. Wolf2 1Department of Neurology, University of Bergen, Norway, 2Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark, 3Department of Clinical Neurophysiology, University of Aarhus, Denmark, 4Neurological Department, University of Porto, Portugal, 5Department of Neurology, Paracelsus Medical University, Salzburg, Austria, 6Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, 7Department of Neurological Sciences, University of Bologna, Italy, 8University Hospital Erlangen, Epilepsy Center, Neurological Clinic, Erlangen, Germany, 9Department of Clinical Neurophysiology, University of Lund, Sweden, 10Neurology Department, Charles University, Prague, Czech Republic, 11Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark, 12EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel, 13Clinical Neurophysiology Department, Hôpital Saint-Vincent de Paul, Paris, France, 14Department of Clinical Neurophysiology, Helsinki University, Finland, 15Great Ormond Street Hospital for Children, NHS Trust, London, England, UK, 16Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Lithuania, 17Dutch Epilepsy Clinics Foundation, S.E.I.N., Heemstede, The Netherlands

W8.3 SCORE: background activity, sleep and non-ictal findings

W8.2 SCORE: an overview of the software H. Aurlien1, S. Beniczky2, A. Fuglsang-Frederiksen3, A. Martinsda-Silva4, E. Trinka5, G. Visser6, G. Rubboli7, H. Hjalgrim2, H. Stefan8, I. Rosen9, J. Zarubova10, J. Dobesberger5, J. Alving2, K.V. Andersen11, M. Fabricius11, M.D. Atkins2, M. Neufeld12, P. Plouin13, P. Marusic10, R. Lees14, R. Pressler15, R. Hopfengartner8, J.C. Brogger2, R. Mameniskiene16, W. van Emde Boas17, P. Wolf2 1Department of Neurology, University of Bergen, Norway, 2Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark, 3Department of Clinical Neurophysiology, University of Aarhus, Denmark, 4Neurological Department, University of Porto, Portugal, 5Department of Neurology, Paracelsus Medical University, Salzburg, Austria, 6Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, 7Department of Neurological Sciences, University of Bologna, Italy, 8University Hospital Erlangen, Epilepsy Center, Neurological Clinic, Erlangen, Germany, 9Department of Clinical Neurophysiology, University of Lund, Sweden, 10Neurology Department, Charles University, Prague, Czech Republic, 11Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark, 12EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel, 13Clinical Neurophysiology Department, Hopital Saint-Vincent de Paul, Paris, France, 14Department of Clinical Neurophysiology, Helsinki University, Finland, 15Great Ormond Street Hospital for Children, NHS Trust, London, England, UK, 16Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Lithuania, 17Dutch Epilepsy Clinics Foundation, S.E.I.N., Heemstede, The Netherlands

W8.5 SCORE: normal variants, artefacts, polygraphic channels and interpretation

R. Pressler1, S. Beniczky2, H. Aurlien3, A. Fuglsang-Frederiksen4, A. Martins-da-Silva5, E. Trinka6, G. Visser7, G. Rubboli8, H. Hjalgrim2, H. Stefan9, I. Rosén10, J.C. Brøgger3, J. Zarubova11, J. Dobesberger6, J. Alving2, K.V. Andersen12, M. Fabricius12, M.D. Atkins2, M. Neufeld13, P. Plouin14, P. Wolf2, P. Marusic11, R. Lees15, R. Mameniskiene16, R. Hopfengärtner9, W. van Emde Boas17 1Great Ormond Street Hospital for Children, NHS Trust, London, England, UK, 2Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark, 3Department of Neurology, University of Bergen, Norway, 4Department of Clinical Neurophysiology, University of Aarhus, Denmark, 5Neurological Department, University of Porto, Portugal, 6Department of Neurology, Paracelsus Medical University, Salzburg, Austria, 7Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, 8Department of Neurological Sciences, University of Bologna, Italy, 9University Hospital Erlangen, Epilepsy Center, Neurological Clinic, Erlangen, Germany, 10Department of Clinical Neurophysiology, University of Lund, Sweden, 11Neurology Department, Charles University, Prague, Czech Republic, 12Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark, 13Department of Neurology, Tel-Aviv Sourasky Medical Center, Israel, 14Clinical Neurophysiology Department, Hôpital Saint-Vincent de Paul, Paris, France, 15Department of Clinical Neurophysiology, Helsinki University, Finland, 16Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Lithuania, 17Dutch Epilepsy Clinics Foundation, S.E.I.N., Heemstede, The Netherlands

W8.1 SCORE: ictal findings

N400 component of linguistic ERPs. It represents the cerebral response to a semantic violation and its amplitude is larger to incongruous words than to congruous words within the semantic context (Kutas e Hillyard 1984; Friederici A 1997; Kutas M et al 2000). The N400 amplitude is a very sensitive marker of semantic processing demands in MCI and may be considered a reliable tool in the early detection of incipient Alzheimer’s disease (AD) (Olichney JM et al 2002, 2006, 2008). Objective: To evaluate semantic processing deficits in patients with MCI by using the N400 wave. Patients and Methods: We studied 15 MCI patients and 15 elderly normal controls using a simple word-pair reading paradigm. Semantically congruous (60%) and semantically incongruous (40%) adjective-pairs were selected according to the frequency of word-use, cloze probability and length-word. A number of 30 channel ERPs were recorded in patients and controls. A selective neuropsychological battery was administered to assess general cognitive status, shortand long-term verbal memory, episodic memory, constructional praxia. Results: No significant differences between the N400 amplitude to incongruous words and congruous words were found in 12/15 of MCI patients. Significant lower N400 amplitude to incongruous words were recorded between MCI patients and control group. No significant correlations emerged between N400 amplitude with age and depression. Conclusions: Abnormal N400 amplitude represents a useful electrophysiological index to evaluate semantic memory deficits in MCI patients. Longitudinal studies are needed to assess the predictive value of N400 on the progression from MCI to AD.