Made available in DSpace on 2014-08-26T17:31:43Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 69589.pdf: 12544721 bytes, checksum: e242b76c9cdf8b6c04d9e749f41a5d1f (MD5) / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / As mucopolisacaridoses (MPS) são doenças geneticamente determinadas, causadas pela deficiência de enzimas lisossômicas, o que leva ao acúmulo de glicosaminoglicanos (GAGs) universalmente. As mielopatias cervicais ao nível da junção craniocervical são uma complicação frequente, grave e multifatorial das MPS. Este trabalho teve como principal objetivo o estudo das vias sensitivas e motoras centrais (cordão posterior e trato córtico-espinhal) em topografia medular cervical nos pacientes com mucopolissacaridoses (MPS), utilizando os potenciais evocados somatossensitivos e motores. Como objetivos específicos, a avaliação dos pacientes com MPS em fases distintas da doença, a demonstração da existência de comprometimento da condução nervosa nos trajetos das vias medulares na topografia já mencionada e o destaque do papel dos testes neurofisiológicos (funcionais) no diagnóstico, acompanhamento e na tomada de decisões terapêuticas nos pacientes com MPS. Foi realizado um estudo transversal, de uma série de casos, tendo como metodologia a revisão de prontuários, no Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Foram incluídos os pacientes com o diagnóstico de MPS, sem restrições quanto à idade, aos subtipos da doença ou ao fato de estarem ou não sob tratamento específico e excluídos aqueles pacientes com lesões graves do sistema nervoso central que impedissem a realização dos testes propostos. Os dados colhidos referiram-se à idade dos pacientes, o tipo de MPS, os achados do exame neurológico, os resultados dos estudos de imagem (ressonância magnética) da coluna cervical e os parâmetros neurofisiológicos encontrados nos potenciais evocados somatossensitivos (PESS) e motores (PEM), que incluiram as latências das ondas (N9, N13 e N20 nos PESS de membros superiores e N21 e P37 nos PESS de membros inferiores), os tempos de condução central (N20 – N13 e P37 – N21) e o tempo de condução motora central (nos PEM de membros superiores e inferiores). Foram analisados resultados de cinquenta e oito exames de potenciais evocados somatossensitivos e motores, realizados em vinte e oito pacientes com MPS. Todos os exames foram anormais, com alterações mais graves nos exames de PEM. / Mucopolysaccharidosis (MPS) are inherited metabolic diseases caused by deficiency of lysosomal enzymes leading to progressive accumulation of glycosaminoglycans (GAGs) in nearly all cell types, tissues and organs. Cervical myelopathy at the cranio-cervical junction is a frequent, severe and multifactorial complication of MPS. The first objective of the present study is the evaluation os the function of central neural pathways (brain stem and spinal cord posterior columns and corticospinal tract in patients with MPS using somatosensory evoked potentials (SEP) and motor evoked potentials (MEP). The secondary objectives are the evaluation of the patients in different periods of disease, the diagnostic of the lesions in cervical spinal cord and the remark of the role of these neurophysiological tests in diagnostic, follow-up and therapeutic decisions. This cross-sectional study included all patients with MPS of Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, despite age, type of disease, enzyme replacement therapy or not, except the patients with severe central nervous system lesions in whom the neurophysiological evaluation became impossible. Data included the age of patients, type of disease, the findings in neurological examination, magnetic resonance imaging of cervical spinal cord and the neurophysiological parameters [the latencies of N9, N13 and N20 waveforms, central conduction time (upper limbs SEP), the latencies of N21 and P37 waveforms, central conduction time (lower limbs SEP), central motor conduction time (upper and lower limbs MEP)].Twenty-eight patients were enrolled and fifty-eigth tests (SEP and MEP, upper and lower limbs) were performed in these patients. All tests were abnormal with most severe functional impairment in MEP tests.

No description available.

Intraoperative neurophysiologic monitoring is an integral part of spinal surgeries and involves the recording of somatosensory evoked potentials (SSEP). However, clinical application of IONM still requires anywhere between 200 to 2000 trials to obtain an SSEP signal, which is excessive and introduces a significant delay during surgery to detect a possible neurological damage. The aim of this study is to develop a means to obtain the SSEP using a much less, twelve number of recordings. The preliminary step involved was to distinguish the SSEP with the ongoing brain activity. We first establish that the brain activity is indeed quasi-stationary whereas an SSEP is expected to be identical every time a trial is recorded. An algorithm was developed using Chebychev time windowing for preconditioning of SSEP trials to retain the morphological characteristics of somatosensory evoked potentials (SSEP). This preconditioning was followed by the application of a principal component analysis (PCA)-based algorithm utilizing quasi-stationarity of EEG on 12 preconditioned trials. A unique Walsh transform operation was then used to identify the position of the SSEP event. An alarm is raised when there is a 10% time in latency deviation and/or 50% peak-to-peak amplitude deviation, as per the clinical requirements. The algorithm shows consistency in the results in monitoring SSEP in up to 6-hour surgical procedures even under this significantly reduced number of trials. In this study, the analysis was performed on the data recorded in 29 patients undergoing surgery during which the posterior tibial nerve was stimulated and SSEP response was recorded from scalp. This method is shown empirically to be more clinically viable than present day approaches. In all 29 cases, the algorithm takes 4sec to extract an SSEP signal, as compared to conventional methods, which take several minutes. The monitoring process using the algorithm was successful and proved conclusive under the clinical constraints throughout the different surgical procedures with an accuracy of 91.5%. Higher accuracy and faster execution time, observed in the present study, in determining the SSEP signals provide a much improved and effective neurophysiological monitoring process.

Bakgrund- Sensorisk evoked potentials (SEP) är en neurofysiologisk undersökningsmetod som används för att monitorera svarspotentialer från kroppens sensoriska nervsystem efter en sensorisk stimulering. Registreringen av sensorisk evoked potentials sker med små elektriska stimuleringar över en perifer sensorisk nerv och registreras från tre olika registreringskanaler som benämns N9 över plexus brachialis, N13 Erb’s punkt och N20 för det primär sensoriska cortexområdet. Metod- I denna studie bearbetas data från 20 registreringar för N20-kanalen. Med registreringen av den klinisk använda standardmontaget C3’-Fz som används vid Karolinska universitetssjukhuset, som jämförs mot nya registreringsmontagen C3’-CPz, CP3-Fz CP3-CPz. Stimulering skedde unilateralt över höger nervus medianus på handledsnivå. Syftet med studien var att ta reda på om det fanns någon statistisk signifikant skillnad mellan standardmontaget C3’-Fz mot de alternativa montagen med avseende på amplitud, duration och latenstid mellan två registreringsomgångar. Den statistiska analysen genomfördes med Wilcoxsons teckenranktest för differenserna av registreringsomgångarna i amplitud, duration och latenstid. Spearmans rangkorrelationstest användes för att visa sambandet mellan standardmontaget och de nya registreringsmontagen i amplitud. Resultat- Resultatet visade ingen statistisk signifikant skillnad mellan standardmontaget mot de alternativa montagen för differenserna av amplitud, duration och latenstid mellan de två registringsomgångarna. Korrelationen för amplituderna visade att montaget CP3-Fz hade en starkare grad av samband mot standardmontaget C3’-Fz jämfört med registreringsmontagen C3’-CPz och CP3-CPz. Slutsats- Slutsatsen av denna studie är att det inte fanns någon statistisk signifikant skillnad i differenserna för amplitud, duration och latenstiderna vid jämförelse av standardmontaget mot de nya alternativa montagen. Dock visade montage CP3-Fz på ett starkare samband mot den klinisk använda C3-Fz jämfört med resterande montage med avseende på amplituden. / Background-Sensory evoked potentials (SEP) are a neurophysiological examination method used to monitor electrical response potentials from the body’s sensory nervous system. The registration follows three recording channels throughout the sensory pathway as N9 over plexus brachialis, N13 over cervical vertebrae mentioned as Erb’ point and N20 represented for the primary somatosensory cortex area. Method- In this study data was collected from 20 registrations for N20 channel. Registration for this study measured the clinical used cortical registration montage at Karolinska university hospital C3’-Fz against new registration montages C3'-CPz, CP3-Fz and CP3-CPz, with stimulation on the right median nerve at wrist level unilateral. The purpose of the study was to see if there exists any significant difference between the standard montage C3’-Fz against the new alternative registration montages in regard to amplitude, duration and latency after two registration rounds. Wilcoxson’s singed rank test were used to compare the difference in amplitude, duration and latency between registration rounds. Spearman’s correlation test were used to show the correlation between the standard montage and the new registration montages in amplitude. Result-The result showed no statistical significant difference between the standard montage and the new alternative montages in amplitude, duration and latency for the two registration rounds. The correlation showed registration montage CP3-Fz with a greater correlation towards the standard montage C3’-Fz compared to registration montages C3’-CPz and CP3-CPz in amplitude. Conclusions- This study showed no significant difference in amplitude, duration and latency when it compared the standard montage C3’-Fz against the new alternative montages. The correlation in amplitude showed montage Cp3-Fz with a stronger correlation towards the clinical used registration montage compared to the other new alternative montages.

Based on contemporary theoretical knowledge in this prospective study we outline the relationship between a chosen surgical approach (anterior or posterior approach) as it relates to the localization of spinal cord lesion (anterior or posterior spinal pathways) assessed by the use of evoked potentials (SEP, MEP) and the effect of this approach on the postoperative state of patients with cervical spondylotic myelopathy. Furthermore we evaluate clinical outcome of these patients according to several aspects of their MRI and X-ray findings. The study, from 2006 to 2010, comprised 65 patients with clinical signs of cervical myelopathy. These patients had been indicated for surgery, which subsequently was performed by using either the front (anterior - a) or back (posterior - p) approach. The patients were assessed using Nurick and mJOA scores before surgery, then at 12 months, and finally 24 months after surgery. In addition, they were preoperatively examined with a battery of evoked potentials (EP) - somatosensory evoked potential (SEP) and motor evoked potential (MEP) tests. Based on EP, principal spinal cord disability was determined: A - anterior (maximum changes in MEP), P - posterior - maximum change in SEP). The entire group was, on the basis of EP partitioning and the surgical approach used, divided...

Η σύγχρονη μελέτη της κεντρικής και αυτόνομης δραστηριότητας θεωρούνται χρήσιμες στην ανάδειξη της σχέσης των δύο συστημάτων και της φυγόκεντρου ανατροφοδότησης των περιφερικών αλλαγών. Στην εργασία αυτή διερευνώνται οι πιθανές σχέσεις μεταξύ κεντρικών και αυτόνομων απαντήσεων σε σωματαισθητικούς ερεθισμούς. Η ηλεκτροδερμική δραστηριότητα (ΗΔΑ) είναι δείκτης της αυτόνομης δραστηριότητας. Προκλητά δυναμικά και ΗΔΑ καταγράφονταν ταυτόχρονα έπειτα από μια σειρά ερεθισμών του μέσου νεύρου ,με τρείς διαφορετικές εντάσεις, σε έξι φυσιολογικά άτομα. Η χαμηλότερη ένταση ερεθισμού ρυθμίζονταν έτσι ώστε να μη γίνεται αντιληπτή από το άτομα. Τα επάρματα P40, P100, N200 και P300 των προκλητών δυναμικών εξήχθησαν από το καταγεγραμμένο σήμα. Μελετήσαμε το πλάτος και τον λανθάνοντα χρόνο και διερευνήσαμε την πιθανή συσχέτιση των μεγεθών αυτών της ΗΔΑ. Χρησιμοποιήσαμε την συνηθισμένη μέθοδο της μεσοποίησης (average), καθώς και την προσέγγιση των μοναδιαίων απαντήσεων, εξάγωντας τις απαντήσεις με την χρήση χωρικού φίλτρου. Το συμπαθητικό νευρικό σύστημα φαινόταν να απαντά ακόμα και σε ερεθισμούς μη αντιληπτούς από το υποκείμενο. Η φλοιική επεξεργασία των αντιληπτών και μη ερεθισμάτων όπως αποτυπώνονταν με τα επάρματα των προκλητών δυναμικών, φαίνεται να είναι όμοια και στις δύο περιπτώσεις κατά τη διάρκεια των πρώτων 40ms έπειτα από τον ερεθισμό, ενώ τα μακρά κύματα ήταν απόνατ στους μη αντιληπτούς ερεθισμούς. Τα πλάτη της ΗΔΑ και του P300 με την προσέγγιση των μοναδιαίων απαντήσεων παρουσίαζαν μια σημαντική θετική συσχέτιση. / Concurrent studies of central and autonomic activity are considered useful in elucidating the relationship between the two systems and indicating the centripetal feedback of peripheral changes. The SSR (sympathetic skin response) is one index of autonomic arousal. In our study we examine the possible relationships between central and autonomic responses to somatosensory stimuli. EPs (evoked potentials) and SSRs were simultaneously recorded during a series of electrical stimuli of median nerve in six normal adults using three different intensities of stimuli. The weakest of them was unperceived by subject. The P40, P100, N200 and P300 waves of EPs were extracted and their latencies and amplitudes were analysed in order to find correlations with those of the SSRs. We used the conventional method of signal averaging and the single trial (ST) approach, as the EP waves were subtracted by spatial filtering. Interestingly, sympathetic nervous system seemed to react even to stimuli unperceived by the subject. The cortical processing of consciously perceived and unperceived somatosensory stimuli as it was expressed by the evoked potentials seems to be identical during the first 40ms after the stimulus onset while later waves were absent for unperceived stimuli. SSR and P300 amplitude at the ST level had a positive correlation.

Bien que la douleur soit une expérience subjective universelle, la façon de la percevoir et de l’interpréter est modulée par une multitude de facteurs. Plusieurs interventions cognitives se sont montrées efficaces pour réduire la douleur dans des conditions cliniques et expérimentales. Cette thèse s’intéressera particulièrement aux mécanismes psychophysiologiques impliqués dans les stratégies de modulation volontaire de la douleur. Ces stratégies sont intéressantes puisqu’elles encouragent une prise en charge par l’individu, lui permettant de jouer un rôle actif dans la régulation de sa douleur. La première étude s’intéresse à l’efficacité du biofeedback comme moyen de modulation volontaire de la douleur. Il s’agissait de déterminer si le fait de présenter une rétroaction de l’amplitude du réflex RIII (évoqué par une stimulation électrique du nerf sural) au cours d’un entraînement de plusieurs essais permettrait au participant d’adopter des stratégies de modulation de la douleur et d’activer volontairement des mécanismes de contrôle descendant de la douleur. De façon à évaluer spécifiquement les changements induits par le biofeedback, la modulation du réflexe RIII et de la douleur était comparée dans trois groupes (biofeedback valide, faux biofeedback et groupe contrôle sans rétroaction). Dans les trois groupes, il était suggéré aux participants d’utiliser des stratégies cognitives de modulation de la douleur (attention, modulation de la respiration, réévaluation cognitive et imagerie mentale) afin d’augmenter ou de diminuer leur réflexe RIII comparativement à leur niveau de base. Les résultats de notre étude indiquent que les participants des 3 groupes ont réussi à moduler leur réflexe RIII (p<0,001) ainsi que leurs évaluations de douleur (p<0,001) (intensité et désagrément). Les résultats de notre étude montrent que l’entraînement au biofeedback n’était pas nécessaire pour obtenir une modulation du réflexe RIII et de la douleur, ce qui suggère que l’utilisation de stratégies cognitives pourrait être suffisante pour déclencher des mécanismes de contrôle de la douleur. La deuxième étude découle de la première et s’intéressait à l’influence de la fréquence et de la phase respiratoire sur la nociception spinale, l’activité cérébrale et la perception de douleur. Le contrôle volontaire de la respiration est un moyen commun de régulation des émotions et est fréquemment utilisé en combinaison avec d’autres techniques (ex. : relaxation, méditation) dans le but de réguler la douleur. Les participants étaient invités à synchroniser leur respiration à des indices sonores indiquant le moment de l’inspiration et de l’expiration. Trois patrons de respiration étaient proposés (respiration à 0,1Hz avec une inspiration de 4 secondes, respiration à 0,1Hz avec une inspiration de 2 secondes et respiration à 0,2Hz avec une inspiration de 2 secondes. La moitié des stimulations étaient données durant l’inspiration et l’autre moitié durant l’expiration. Afin d’évaluer l’effet de ces manipulations, l’amplitude du RIII, l’évaluation subjective d’intensité de la douleur et de l’anxiété suscitée par le choc en plus des potentiels évoqués étaient mesurés. Les résultats de cette étude démontrent que les évaluations d’intensité de la douleur n’étaient pas affectées par le patron respiratoire (p=0,3), mais étaient statistiquement plus basses durant l’inspiration comparativement à l’expiration (p=0,02). Un effet de phase (p=0,03) était également observé sur les potentiels évoqués durant la condition de respiration à 0,1hHz avec une inspiration de 2 secondes comparativement au patron de respiration de 0,2Hz. Paradoxalement, l’amplitude du réflexe RIII était augmenté durant l’inspiration (p=0,02) comparativement à l’expiration. Ces résultats montrent que la manipulation de la fréquence et de la phase respiratoires (par une synchronisation imposée) a un effet marginal sur les évaluations de douleur et sur l’activité cérébrale et spinale évoquée par une stimulation électrique (douleur aigüe). Cela suggère que d’autres mécanismes contribuent aux effets analgésiques observés dans la relaxation et la méditation. Plus largement, nos résultats font état de la nécessité d’études plus approfondies avec une méthodologie plus rigoureuse afin de contrôler les effets non spécifiques aux traitements évalués. Une meilleure connaissance des mécanismes sous-tendant chaque stratégie permettrait de mieux cibler les clientèles susceptibles d’y répondre et de mieux considérer le ratio coût bénéfice de chaque traitement. / Although pain is a universal subjective expérience, the way of perceiving and interpreting it is modulated by multiple factors. Several cognitive interventions have proven effective in reducing pain in clinical and experimental conditions. This thesis will focus particularly on psychophysiological mechanisms involved in voluntary strategies of pain modulation. These strategies are relevant because they encourage an individual who suffers from pain conditions, to play an active role in the regulation of pain. The first study examines the effectiveness of biofeedback as a means of voluntary modulation of pain. This allows to determine whether to provide feedback to the amplitude of the RIII-reflex (evoked by electrical stimulation of the sural nerve) during a training induces the participant to adopt strategies for pain modulation and voluntarily activate descending inhibitory control mechanisms of pain. In order to specifically evaluate the changes induced by biofeedback, RIII reflex modulation and pain was compared in three groups (valid biofeedback, sham biofeedback and control group without feedback). In all three groups, participants were encouraged to use cognitive strategies of pain (attention, modulation of breathing, mental imagery and cognitive reappraisal) to increase or decrease their RIII reflex compared to their baseline. The results of our study indicate that the three groups were able to modulate their RIII reflex (p<0.001) as well as their pain évaluation (p<0.001) (intensity and unpleasantness). Biofeedback training was not required to obtain a modulation of the RIII-reflex and pain, suggesting that the use of these strategies may be sufficient to trigger mechanisms of pain control. The second study was interested in the influence of respiratory frequency and phase on spinal nociception, brain activity and perception of pain. Voluntary control of breathing is a common means of regulating emotions, and is frequently used in combination with other techniques (eg, relaxation, meditation) in order to regulate pain. Participants were asked to synchronize their breathing on the cues indicating the time of inspiration and expiration. Three breathing patterns were proposed (breathing at 0.1 Hz with 4 seconds inspiration, breathing at 0.1 Hz with 2 seconds inspiration and breathing at 0.2 Hz with 2 seconds inspiration). Half of stimuli were given during inspiration and the other half during expiration. To assess the effect of these manipulations, the amplitude of the RIII, the subjective evaluation of pain intensity and anxiety elicited by the shock and evoked potentials were measured. The results of this study demonstrate that pain intensity was not affected by the respiratory pattern (p = 0.3), but was statistically lower during inspiration compared to expiration (p = 0.02). A phase effect (p = 0.03) was also observed on evoked potentials during the breathing pattern 0.1 Hz with 2 seconds inspiration compared to the breathing pattern at 0.2 Hz. However, the amplitude of the RIII reflex was increased during inspiration (p = 0.02) compared to expiration. These results show that the manipulation of phase and frequency with paced respiration has a marginal effect on pain and anxiety ratings, as well as on brain activity and spinal nociception evoked by painful electrical stimulation. This suggests that other mechanisms contribute to the analgesic effects of relaxation and meditation. More broadly, our results indicate the need for further studies with more rigorous methodology to control for nonspecific treatment effects evaluated. A better understanding of the mechanisms underlying each strategy would allow a better selection of the treatment as a function of individual differences and cost-benefit ratio associated to each treatment.

Les informations sensorielles peuvent être atténuées de la périphérie jusqu'au cortex durant le mouvement. Notre hypothèse est que l'information somatosensorielle serait facilitée durant la planification du pas où il serait inopportun de supprimer ces informations cruciales. Nous avons enregistré les potentiels somatosensoriels (SEPs) évoqués par vibration bilatérale des muscles des chevilles afin de stimuler la proprioception.Les résultats montrent que la composante évoquée corticale précoce restait inchangée mais une composante tardive négative était significativement augmentée durant la planification du pas.Pour tester si cette facilitation proprioceptive était due aux contraintes d'équilibre, la même expérience fut effectuée en microgravité où cette facilitation disparut, malgré la restauration d'un cadre de référence spatial.Cette facilitation tardive survint pendant l'imagerie motrice kinesthésique d'un pas planifié, démontrant que l'imagerie mentale intègrerait les contraintes d'équilibre et posturales requises pour la tâche, ceci étant confirmé par la disparition de cette facilitation lors de la planification du pas imaginé en microgravité.Ceci démontre au niveau neurophysiologique, une modulation de la transmission des afférences sensorielles selon leur pertinence pour planifier un mouvement. Cette facilitation résulterait de mécanismes prédictifs reliés à l'importance de contrôler l'équilibre du corps avant l'initiation du pas, car ce processus survint durant la planification d'un pas exécuté ou imaginé. Il serait basé sur un modèle interne de l'action impliquant des lois physiques du mouvement (1-g modèle) car cette facilitation fut supprimée en microgravité. / Sensory inputs can be attenuated from the periphery to the cortex during voluntary movements. Our hypothesis is that the somatosensory information could be facilitated during the planning of a step. It would appear dysfunctional to suppress somatosensory information, which is considered to be of the utmost importance for gait planning. We recorded somatosensory potentials (SEPs) evoked by bilateral ankle vibration to stimulate proprioception. Results showed that cortical early evoked component remained unchanged but a negative late component was significantly increased during step planning. To determine whether this facilitation of proprioceptive inputs was related to gravitational equilibrium constraints, we performed the same experiment in microgravity. In the absence of equilibrium constraints, both components did not significantly differ between the static and stepping conditions, despite the restoration of a body in space reference frame.This late facilitation occurred during kinesthetic motor imagery of a planned step, suggesting that mental imagery would integrate postura and balance constraints required for the task, as it was confirmed byt the lack of this facilitation during the planning of an imagined step in microgravity.These observations provide neurophysiological evidence that the brain exerts a dynamic control over the transmission of the afferent signal according to their current relevance during movement preparation.These processes should be based on internal model of action involving the physical laws of motion (1g-model) as this sensory facilitation was suppressed in microgravity when planning motor imagery.

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Abstract Several anaesthetics are able to induce a burst-suppression (B-S) pattern in the electroencephalogram (EEG) during deep levels of anaesthesia. A burst-suppression pattern consists of alternating high amplitude bursts and periods of suppressed background activity. All monitors measuring the adequacy of anaesthesia recognize the EEG B-S as one criterion. A better understanding of EEG burst-suppression is important in understanding the mechanisms of anaesthesia. The aim of the study was to acquire a more comprehensive understanding of the function of neural pathways during deep anaesthesia. The thesis is comprised of four prospective clinical studies with EEG recordings from 64 patients, and of one experimental study of a porcine model of epilepsy with EEG registrations together with BOLD fMRI during isoflurane anaesthesia (II). In study I, somatosensory cortical evoked responses to median nerve stimulation were studied under sevoflurane anaesthesia at EEG B-S levels. In study III, The EEGs of three Parkinson`s patients were observed to describe the characteristics of B-S during propofol anaesthesia using scalp electrodes and depth electrodes in the subthalamic nucleus. In study IV, EEG topography was observed in 20 healthy children under anaesthesia mask induction with sevoflurane. Twenty male patients were randomized to either controlled hyperventilation or spontaneous breathing groups for anaesthesia mask induction with sevoflurane in study V. EEG alterations in relation to haemodynamic responses were examined in studies IV and V. Somatosensory information reached the cortex even during deep anaesthesia at EEG burst-suppression level. Further processing of these impulses in the cortex was suppressed. The EEG slow wave oscillations were synchronous over the entire cerebral cortex, while spindles and sharp waves were produced by the sensorimotor cortex. The development of focal epileptic activity could be detected as a BOLD signal increase, which preceded the EEG spike activity. The epileptogenic property of sevoflurane used at high concentrations especially during hyperventilation but also during spontaneous breathing together with heart rate increase, was confirmed in healthy children and male. Spike- and polyspike waveforms concentrated in a multifocal manner frontocentrally. / Tiivistelmä Useat anestesia-aineet pystyvät aiheuttamaan aivosähkökäyrän (EEG) purskevaimentuman syvän anestesian aikana. Purskevaimentuma koostuu EEG:n suuriamplitudisten purskeiden sekä vaimentuneen taustatoiminnan vaihtelusta. Kaikkien anestesian syvyyttä mittaavien valvontalaitteiden toiminta perustuu osaltaan EEG:n purskevaimentuman tunnistamiseen. Tämän ilmiön parempi tunteminen on tärkeää anestesiamekanismien ymmärtämiseksi. Tutkimuksen päämääränä oli saada kattavampi käsitys hermoratojen toiminnasta syvässä anestesiassa. Väitöskirjatyö koostuu neljästä prospektiivisesta yhteensä 64 potilaan EEG-rekisteröinnit sisältävästä tutkimuksesta sekä yhdestä kokeellisen epilepsiatutkimuksen koe-eläintyöstä, jossa porsailla käytettiin isofluraanianestesiassa sekä EEG-rekisteröintejä sekä että magneettikuvantamista (fMRI) samanaikaisesti (II). Ensimmäisessä osatyössä tutkittiin keskihermon stimulaation aiheuttamia somatosensorisia herätepotentiaaleja aivokuorella EEG:n purskevaimentumatasolla sevofluraanianestesian aikana. Kolmannessa osatyössä selvitettiin propofolianestesian aiheuttamaa EEG:n purskevaimentumaa kolmelta Parkinsonin tautia sairastavalta potilaalta käyttäen sekä pintaelektrodien että subtalamisen aivotumakkeen syväelektrodien rekisteröintejä. Neljännessä osatyössä tutkittiin EEG:n topografiaa 20:llä terveeellä lapsella indusoimalla anestesia sevofluraanilla. Kaksikymmentä miespotilasta nukutettiin sevofluraanilla ja heidät satunnaistettiin joko kontrolloidun hyperventilaation tai spontaanin hengityksen ryhmiin osatyössä V. EEG-muutoksia sekä niiden yhteyttä verenkiertovasteisiin selviteltiin molemmissa osatöissä IV ja V. Omasta kehosta tuleviin tuntoärsykkeisiin liittyvä somatosensorinen informaatio saavutti aivokuoren myös syvässä EEG:n purskevaimentumatasoisessa anestesiassa. Impulssien jatkokäsittely aivokuorella oli kuitenkin estynyt. EEG:n hidasaaltotoiminta oli synkronista koko aivokuoren alueella, sen sijaan unisukkulat ja terävät aallot paikantuivat sensorimotoriselle aivokuorelle. Paikallisen epileptisen toiminnan kehittyminen oli mahdollista havaita jo ennen piikikkäiden EEG:n aaltomuotojen ilmaantumista edeltävänä BOLD-ilmiöön liittyvänä aivoverenkierron lisääntymisenä. Sevofluraanin epileptogeenisyys varmistui erityisesti hyperventilaation, mutta myös spontaanin hengityksen yhteydessä ja näihin liittyi sykkeen nousu sekä terveillä lapsilla että miehillä. Piikkejä ja monipiikkejä käsittävien aaltomuotojen keskittymistä esiintyi otsalohkon keskialueilla.