Friday, 13 December 2019

Road map for TMS and schizophrenia project in Iceland

Reykjavík University, Iceland

by Ovidiu C. Banea

On June 2018 a project dedicated to schizophrenia patients with auditory verbal hallucinations and their treatment with trans-cranial magnetic stimulation started in Iceland. 
The perfect coordination between researchers from Kleppur Psychiatric Hospital, Biomedical and Neural Engineering Institute at Reykjavík University, School of Business - Department of Psychology, National Institute of Neurological Disorders and Stroke (NINDS) Bethesda, United States and Clinical Neurophysiology Unit from National University Hospital - Landspítali Iceland made possible the recruitment and treatment of 12 patients with consequent analyses with multi-metric approach.
Measurements of the brain activity was performed before and after the treatment with P50, N100-P300 complex, resting state and auditory motor-task with 256 High Density-EEG recordings, cortical silent period and psychometric scales.
The team could organize and present their methodology, results and preliminary data in 14 original works during several local and international meetings in France, Japan, Poland, Portugal and Austria (see all works here).

On 13th of December we met at Reykjavik University and we discussed the detailed of the most important aspects of the AVH-TMS Icelandic Clinical trial - publishing the results in a peer review international journals. Two teams were formed, one at Reykjavik University and one at University National Hospital. The first team will process event related potential results at BNE and the second team will put together all data obtained at Fossvogur Landspítali and at Kleppur Psychiatric Hospital. By the end of January 2020 the process structure and software analyses will start.

Friday, 1 November 2019

Assessment of the lower limb weakness and suspected amyotrophic lateral sclerosis

A patient with suspected motor neuron disease (MND or ALS) was assessed with TMS in our Unit in Iceland here. There were no signs of EMG criteria. We further investigated with TMS and it seems that there is a lower spinal level delay of the central motor conduction.

Tuesday, 27 August 2019

Muscle fibers, I ran the 42 km Reykjavik Marathon without specific training

Why did I run the 42 km Reykjavík Marathon on 24th of August 2019 ?

by Ovidiu C. Banea, MD
Clinical Neurophysiology and Sports Medicine specialist

The simple answer to the question from the title would be: I ran the marathon because my colleague, Eysteinn Ívarsson told me on Friday 23rd of August 2019 at 4:00 pm that he cannot come on Saturday to help me with a sleep video-polysomnography because he has to run the marathon and he will be tired in the evening. And yes, this was enough to rise my curiosity and look to internet and find information just before the weekend of marathon started. It was 6:45 pm when I was looking for a parking place at Laugardalsholl Sport Center. 10 minutes were enough to register myself and to get my registration package to my first 42 km marathon.

Please note that this report is just a simple story and you should consult a doctor before you run a marathon. Twelve runners died at the end of their 42 km only at London Marathon since this started in 1981 (here) and 50 died worldwide after the first Marathon runner, a soldier named Philippides  died in Athens after the run of 42 km to announce the Battle of Marathon victory. Before this, he had other runs of 240 km to Sparta and back and he fought in the morning with the Persians, this being probably  the reason of the exhaustion which lead  to his dead after the 42 km run. Now, ultramarathons of 50, 100 km or other distances are organized in mountain terrain, desert or ice environment.

If you are one of the pupils who remained between the lasts when your sport teacher asked you to run 3 kilometers surrounding your school it might be that you are like me or I am like you and that in some of our muscles the predominant fibers are the slow twitch muscle fibers or Type 1 (ST).  
ST muscle fibers are more efficient at using oxygen to generate more ATP fuel for continuous, extended muscle contractions over a long time, firing more slowly than fast twitch fibers and can go for a long time before they fatigue. Slow twitch fibers are great at helping athletes run marathons and bicycle for hours (here). 

Why did I run the #ReykjavikMarathon 2019 ?

In my childhood I did swimming for few years, then equitation, and I have been training weekly with 5-8 km running through forest near my city of Sibiu while I was Mountain Rescue Team member. 
I climbed mountains like Retezat, Rodna, Caliman, Ceahlau, Bugegi, Fagaras in Romania, Certascan Peak in Pyrenees Mountains or Uhuru Peak (5895 m) in Kilimanjaro, Tanzania. I am traveling to Romania each year in Danube delta and almost every year I walk from Letea village to Periprava village and back around 24-28 km depending on how many sent dunes I cross or if the floods period worsens the pass through the wild forest. The last "walk" of 5 km in Danube delta was on June 2019. On the 2nd of August 2019 with two Romanian friends and 5 Icelanders we helped Icelandic authorities from 1:30 am to 6:30 am to keep alive 9 pilot whales after they stranded at Garður, near Keflavik airport, wearing cubes of water. This was my last physical effort before the race of 42 km. So, am I considering myself physically trained to run a marathon? Not to run, no. Then why did I run a Marathon? Psychologically I had my challenges in the past. I did not run, I just walked, I went to the Marathon to walk, so I used the run-walk strategy and my target was 6 hours. Every trained marathon man or woman is doing the race in 4 hours. I finished my race after 6 hours and 36 minutes.

What did I do to succeed?

In the evening, before the race I went to an Icelandic geothermal pool in Reykjavik where there is a powerful hydro-massage pot. There I used the moving water to train my peripheral lower limbs proprioception, the GTOs from both ankles and both knees for more than 5 minutes each but also I let the water to press on the hamstrings, quadriceps and triceps surae muscles for a while, thinking that my muscles spindles are also in need "to move" and trigger the gamma motor co-activation the second day. I went then to the cold pot where I usually go for 2-3 minutes. Before I left, I measured my weight, it was 87 Kg.  At ten a´clock I was buying at Hagkaup two raw eco energy bars, 450-600g of Icelandic code which I ate with 3 eggs at home. I also drank 1 liter carrot juice when I left the store (I was thirsty after the pool) before the fish meal and half liter isotonic when I went to sleep.
In the morning, 70 minutes before the race I drank 2 bottles of 250 ml isotonic Aquarius and ate 1 Icelandic 500g blueberries Skyr (yogurt), 4 biscuits and 2 apples. During the race I have been drinking 4 x 500 ml isotonic water by filling my bottle at drinking stations. Sometimes, I had 2 glasses of water. In total, during the day before and during the race I consumed 4,5 - 5 liters liquids (During the race 2,5 L). There is a risk if one drinks to much to suffer of hyponatremia which causes collapse and other side effects which may be irreversible and fatal.

The race: I started the running-walking at 8:40 am and I was feeling the anaerobic-aerobic change after 8-10 minutes, 10 km being achieved at 1:24 minutes after the start. The right shoe was pressing over the anterior tarsal region, so I had to release the cordon. The 21 km were passed at exactly 3 hours. I didn´t look to the watch I was just following and enjoying the race analyzing other runners. My first attack of soreness started bilaterally at quadriceps then also at gastrocnemians. I was thinking that there is no possible that the pain is due to muscle elongation or fibrilar rupture because the bilaterality, so I stopped to stretch 2 times. I did not feel tired at all. When the second pain attack occurred I was at 26 km from start. At that moment I started to walk lateral and sometimes backwards. It was the time when I ate the two energy bars and when I reduced the intensity of walk. After 20 minutes of slow walk I was able to run again. Every 5 km I was eating 1 or two Phoenix dactylifera, commonly known as date or date palm (döðlur, in Icelandic). After 30 km the physical senses and soreness stabilized there was no more need to stretch. I was arriving to the city together with Japanese and Taiwan people but also with few older ladies from USA. When I was crossing near "Penninn Eymundsson Skólavörðustíg" people clapped their hands and encouraged us. We were seeing the 40 km sign. From this moment there was question of records-breaking. I left the group and I have been running again. After one kilometer I was seeing Harpa, I was running-walking like in the morning. My video and Marathon Photos VIDEO with me.

I arrived at the finish line at 3:20 pm 40 minutes before the organizers quit the stands and closed the race.

I was having diffused pain in my legs. I sat for 20-30 minutes, then I went to my car and directly to the Icelandic pool where I moved slowly the legs. I went again to the cold pot, this time only for 1 minute and I had the water only over the legs. I was 87 Kg. I did not use any pain-killer or ibuprofen until Sunday morning when I used the first of two. The medication might mask other signs of serious injuries or chest pain. Today after 48 hours from the race I can walk much better than exactly after the marathon. The soreness or muscle contraction I feel it at both gluteal regions. 

27th of August 2019

Monday, 8 April 2019


Possible evidence of human ability to detect Earth's magnetic field found HERE.
First Journal Club Meeting at Reykjavik, Iceland

We talk about the 6th human sense, MAGNETO-RECEPTION IN HUMANS

Thursday, 24 January 2019

D wave IONM in Iceland. Third case: Meningocele

IONM for medular herniation at T5 level Use of D-wave 


Ovidiu C. Banea, Halldór Skúlasson, Ingvar H. Ólafsson, Aron D. Jónasson and Eysteinn Ívarsson

52 y.o. with meningocele.


MEP with direct cortical stimulation (560 V to the left and 890 V to the right) with train of five from C1-C2 and C3-C4 to:
- Right EDC, APB, TA, AH
- Left APB, TA, AH
SSEP were performed from lower tibialis nerve and recorded to FpZ-Cz´ and from median nerves to Fpz-C3´ and Fpz-C4´. Both were controlled at popliteal fossa level (TN) and spinal C7 (TN and MN).
D wave was obtained rotral and caudal to the defect with D-wave electrodes after stimulation at 1Hz continuously (199V)
TOF was used from rioght median nerve to right APB.  was 100-99% during the entire surgery.
EEG was analized from C4´-Fpz and Fpz-C3´channels.

At the beginning of the surgery MEP was obtained in the upper limbs and left lower limb muscles. Right AH muscle was very difficult to elicit with 890 V, while TA in the right side was not obtained. At the end of the surgery the MEP were similar with those obtained at the beginning.

SSEP showed normal latencies during all the procedure. At the middle of the surgery, SSEP from right TN decreased 10-20% in amplitude. Rapidly we confirmed the decreased TA when asked the anaesthesiologist. After 5 minutes the SSEP recovered baseline values.

D-Wave was unchanged during all the spine manipulations and the defect corrective procedures.

The IONM was successful and all modalities showed normal evolution. We do not expect sensory or motor new neurological deficits.

Technical data:
-Surgery duration 4,5 hours.
-Material: 11 subdermal needle paired electrodes, 4 monopolar subdermal needle electrodes, 2 D-wave electrodes, 8 Cork-screw electrodes, 1 ground electrode.

Neurophysiology Plus Iceland © 2019

Meningocele at T5 level.

 After surgery.
 SSEP upper and lower limbs

 MEP in lower limbs

 D wave: left rostral and right caudal
D wave: upper trace rostral, lower trace caudal. Latency 5-6 ms and amplitude 8uV.
The reference electrode was placed between two electrodes. (phase reversed peak).
It would be useful to reference both electrodes to a proximal sub-dermal well inserted electrode.

Monday, 13 August 2018

VAFO project Iceland, QEEG, P50, P300 recordings

On 11th of August 2018 VAFO project started officially with the first healthy subject data acquirement in the Icelandic Center for Neurophysiology, Department of Biomedical Engineering, Reykjavik University.

Valerio Gargiulo, Fabio Barollo, Eysteinn Ívarsson and Martin Freiler

Dr Sigurjón Stefánsson gave us important insights on methodology of P50 and P300. 
Continuous averaging is still a desired EEG system option to avoid artifacts during recordings.