Society Proceedings / Clinical Neurophysiology 123 (2012) e77–e86
the upper body part, rarely the lower limbs. Regardless of the myoc-
lonus, dystonia in MD is mild and focal, without tendency to gener-
alize. Typical disease onset is usually in the childhood. Certain
neurological conditions with myoclonus as a prominent feature,
such are progressive myoclonic epilepsies, may cause a trouble in
MD differential diagnosis.
Methods and patients: We report three MD children with aver-
age disease onset at the age of 6 years followed up for around
10 years. Myoclonus was a leading clinical sign in all. Two out of
three patients presented with mild focal dystonia, only one patient
manifested severe generalized dystonia.
Results: EEG and SSEP were normal in all, while genetic analyses
confirmed MD disorder.
Conclusions: Although genetics has a main role for MD final
diagnosis, EEG and SSEP must be included in all myoclonic dysorders
diagnostic evaluation. While abnormal EEG and giant SSEP point to
the above mentioned epileptic syndromes, normal SSEP and EEG fin-
digs are electrophysiologic hallmarks of MD.
doi:10.1016/j.clinph.2011.11.065
26. Causes of low serum levels of antiepileptic drugs in children—
M. Radovanović, S. Obradović (Pediatric Clinic, Clinical Center
Kragujevac, Serbia)
The serum level of antiepileptic drug is defined as therapeutic
range for a single antiepileptic drug.
Purpose: Purpose of this study is to examine the causes of low
serum levels of antiepileptic drugs in children.
Methods: A group of respondents: 69 children, age from 2 to
16 years, with epilepsy, treated with valproate or carbamazepine,
or both drugs, with verified low serum levels of antiepileptic drugs,
which are monitored on an outpatient basis. Control group: 22 chil-
dren of the same age, with all of the above who were followed during
hospitalization at the clinic.
Results: The causes of low serum levels of antiepileptic drugs
were 68% poor compliance, 10% the interaction of antiepileptic
drugs, 9% sudden increase in body mass, 7% anemia, 3% metabo-
lism autoinduction of carbamazepine, 2% enterocolitis, 1%, celiac
disease.
Conclusions: Despite the fact the compliance is poor as the most
common cause of low serum levels of antiepileptic drugs, it is neces-
sary to set the doubt to another causes, to correct antiepileptic drug
levels and achieve optimal seizure control.
doi:10.1016/j.clinph.2011.11.066
27. Characteristics of psychomotor development in children
with West syndrome of different aetiology—S. Purić, D. Nikolić,
N. Dimitrijević, D. Bogićević, I. Milovanović (University Children’s
Clinic, Belgrade, Serbia)
West syndrome (WS) is age-related epileptic encephalopathy,
most frequent in first year of life. WS is characterized with typical
clinical features: infantile spasms, pathognomonic electroencephalo-
graphic pattern (hypsarrhythmia) and stagnation/or deterioration in
psychomotor development (PMD).
Purpose: Aim of the study was to determine characteristics of
psychomotor development in children with different types of WS.
Methods: Study comprised 65 patients, age 6–30 months with
diagnosed WS. Patients were divided into three groups according
to aetiology and all had PMD assessed initially and during two year
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e83
follow up. Psychological testing was performed in all patients using
Brunet-Lezine test and developmental quotient (DQ) was assessed.
Results: PMD follow-up results at 12 and 24 months were best in
patients with idiopathic form of WS. Worst results for PMD were in
group with symptomatic WS. This was in accordance with results of
psychological testing at 12 and 24 months. Best average score (93.0–
93.9) had patients with idiopathic form, those with cryptogenic form
had score of 46.8–51.9 and with symptomatic 43.9–50.9.
Conclusions: Improvement in PMD after 12, and 24 months of
therapy was associated with better DQ. All patients had improve-
ment in PMD at two year follow-up.
doi:10.1016/j.clinph.2011.11.067
28. Complexity changes of sEMG in TMS and PAS protocols: Is it
better to apply the factors of chaos?—M. Čukić, M. Ljubisavljević,
N. Jorgovanović (Applied Physics Laboratory, Faculty of Elec-
tronical Engineering, University of Nis, Serbia, FMHS, UAE Uni-
versity, UAE, Department for Automatics, Faculty of Technical
Sciences, University Novi Sad, Serbia)
The aim of this study was to determine what would be the better
characterisation of accompanying EMG in protocols of TMS and
Paired associative stimulation (PAS), with the same target muscle
(FDI), by using different factors. Subject were 17 healthy volunteers
(8 for TMS, 9 for PAS), in both protocols were changing the level of
muscle voluntary control (mild, medium, strong), and also the inten-
sity of stimulation. For every combination of stimulus intensity and
level of contraction, a series of stimuli was presented; for every
frame two epochs of signal were sampled and analysed: 3s before
the presentation of stimulus, and after MEP+SP. On those series three
factors were calculated: Fractal dimension (FD), Median spectral fre-
quency (MDF) and Mean spectral frequency (MNF). By comparing
the series of mean values of calculated factors, we have found that
only those from TMS protocol showed significance, and in all three
cases were falling (for FD from 72 series in 61, MDF from 53 in 61,
MNF from 63 in 50). No interaction between factors were found.
We concluded that this finding of complexity change of sEMG was
in accordance with previous findings, showing that TMS induce syn-
chronization of induced bursts, and that FD is better than spectral
factors in this characterization.
doi:10.1016/j.clinph.2011.11.068
29. Subclinical cervical spondylotic myelopathy – Early detection
of long tract pathways involvement—S. Stanković a, N.V. Ilić b, T.V.
Ilić a (a Military Medical Academy, Belgrade, Serbia, b Department
of Physical Medicine and Rehabilitation, Clinical Center, Belgrade,
Serbia)
Objective: Functional assessment of subclinical involvement of
long tract spinal pathways among patients with degenerative dis-
eases of the cervical spine aiming to provide early detection of cer-
vical spondylotic myelopathy (CSM) through neurophysiological
evaluation.
Methods: We have tested 21 patients (48.24 ± 1.11 years) with
clinical presentation of cervical spondyloarthrosis, without reliable
clinical and neuroradiological signs of myelopathy. Besides conven-
tional neurophysiological tests (SSEP, MEP, EMNeG) performed in
each patient, we evaluated the implementation of the central motor
time (CVMP) depending on the head position in maximal ante- or
retroflexion (dynamic tests).