Transcript Diapositivo 1

Dissociated States in Fibromyalgia
T.F.Oliveira1,2,4, L.Ferreira2,3, Teresa Paiva2,4 and J. Miguel Sanches1
1Institute for Systems and Robotics / Instituto Superior Técnico, Lisboa, Portugal
2Centro de Electroencefalografia e Neurofisiologia Clínica, Lisboa, Portugal
3Laboratório EEG Sono (CHLN -HSM)
4Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
Background
Abstract
 Fibromyalgia (FMS) is a chronic syndrome of widespread pain and
fatigue;
 Here, it is hypothesized, that this disorder is explained by the
Dissociated States (DS) concept.
 Objectives:
- to identify sleep DS, both in NREM and REM
- to provide data for sleep electroencephalogram (EEG) mapping
abnormalities both in specific sleep stages and across sleep
stages (this analysis will be performed by computing sleep EEG
mapping in the conventional frequency of bands - , , 1, 2, 
and ).
FMS is a disorder of unknown aetiology which occurs in 3-4% of the general population, 8090% are females (ACR).
FMS patients suffer from severe fatigue, sleep disturbances, morning stiffness, cognitive
problems, affective disturbances, multiorgan dysfunctions and other symptoms (anxiety,
depression, sensory hypersensitivity).
Alternatively, FMS is a psycho-neuro-endocrine-immune disorder, so it has an organic basis.
However the biological markers are still not found. Clinical assessment of FMS brings to
light the inconsistency between the severity of complaints and the lack of explanatory
biological markers, which in our opinion can be explained by a central nervous system
(CNS) dysfunction, via DS, and must be investigated.
Considering this, we hypothesize as a basic general mechanism, the concept of DS,
which can take several forms.
Methods
•
12 FMS patients + 12 healthy controls
•
Ages 30 to 58 years
•
Nocturnal polysomnography (PSG) at
sleep laboratory (19 EEG channels +
conventional PSG data)
Dissociated States (DS)
A DS is a state that gathers characteristics from two functional
states that shouldn’t coexist. A clear example of that is alpha-delta
sleep pattern. The presence of alpha rhythm pattern is typical from
awake disappearing at sleep onset, while delta EEG patterns are
characteristic of sleep. In FMS these two features coexist
reflecting a “sleeping-awake” state.
What is common?
REM Sleep
NREM Sleep
Spindles
transitory activity bursts, observed in
Rapid eye movement
Saw-tooth like waves
with muscular atonia
(e.g. theta rhythm) – normally
associated to rapid eye
movements
central electrodes (12-15 Hz)
REM Mioclonies
sudden and very brief muscle
contractions
Alpha activity
Alpha activity
(8 - 13 Hz)
Caracteristic from awakeful states
K-complexes
transitory events observed in central electrodes
which last between 0,5 and 2 seconds
What are we looking for?
1. REM events occurring during NREM
1.2. Rapid eye movements
1.3. Mioclonies
2. NREM events occurring during REM
2.1. Spindles
3. Alpha activity in REM and NREM
2.2. K- complexes
1.2. Saw tooth like waves
Funded by: FCT PRAXISXXI/BD/36746/2007 & FCT PTDC/SAU-BEB/104948/2008
RecPad2010 - 16th edition of the Portuguese Conference on Pattern Recognition, UTAD University, Vila Real city, October 29th