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DIAMARK-meeting September 2008, Aalborg

DIAMARK-meeting September 2008, Aalborg. Pathogenesis and biomarkers. Motility disorders ? Mechanical structural enteropathy ? Peripheral neuropathy ? Central neuroplastic changes ? Others ? Effect of treatment???????. DIAMARK: Stimulation, endoscopy, US.

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DIAMARK-meeting September 2008, Aalborg

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  1. DIAMARK-meeting September 2008, Aalborg

  2. Pathogenesis and biomarkers • Motility disorders ? • Mechanical structural enteropathy ? • Peripheral neuropathy ? • Central neuroplastic changes ? • Others ? • Effect of treatment???????

  3. DIAMARK: Stimulation, endoscopy, US

  4. DIAMARK: Motility, histology, biomechanics ? Immunohistochemistry

  5. DIAMARK: Sensory assessment VAS resting EEG CEP and inverse modelling Coherence analysis etc 4 5 3 DNIC 2 1 Spinal EP Autonomic tests Referred pain areas

  6. Spatial resolution EEG PET MEG fMRI • Early components (<150 ms): • direct thalamo-cortical projections • pain intensity and localisation • influenced by the stimulation paradigm Temporal resolution • Late components (>150 ms): • perceptual and cognitive processing of the stimulus • modulated by external stimuli and internal factors

  7. +1.6 - 1.6 263.00 ms 66.93 ms 103.00 ms 125.44 ms 138.26 ms 212.79 ms EP´s: Topographic analysis

  8. Head model – Polhemus and MR Spatial resolution EEG PET MEG fMRI Temporal resolution

  9. Invers modelling and coherence analysis

  10. Problems in EEG analysis Model for inverse modelling Individual vs. group (BEM and FEM models, group MR template) Spinal recordings Activity beyond 150 ms (e.g. descending pain system) Etc.

  11. Previous (mainly ours) findings in DM • Histological? • Sensory: • General hyposensitivity (oesophagus, stomach, duodenum) • Increased referred pain • CEPs: • prolonged latency • decreased amplitude • non-reproducibility • Mechanical: • Increased thickness • less strecthability • Motor • dysmotility • long reflex

  12. Framework • Stimulation 4. Treatment • Pacing • Others ? 3. Biomarkers 5. Biomarkers revised 2. Assessment • Motor • (motility, scintigraphy?) • Biomechanical • (thickness, deformation, stress etc) • 3D, FEM? • Histology? • Sensory • VAS • Referred pain • EEG analysis and support vector machine • Spinal EP • CEP • Coherence • DNIC

  13. Aalborg Sahlgr Hung. Århus Diagles GMC WP 2

  14. Backup system

  15. WP 3 Aalborg Sahlgr Hung. Århus Diagles GMC • CSA, pressure, volume, layers (US) • Wall tension, stress and strain, 3D models?? • Motor activity • antroduodenal?, fluoroscopy, scintigraphy, new probe (force velocity, lenght-tension) • Sensory ratings and neurophysiology • 30 patients and 15 volunteers • Different blood sugars (outcome last experiment?)

  16. Aalborg Sahlgr Hung. Århus Diagles GMC WP 4 • Oesophagus and sigmoid colon (may be avoided, but mentioned in delivery), multimodal stimulations • 30 patients with GI symptoms and autonomic neuropathy • 30 volunteers • Different blood sugars • Subset of 15 patients QST of skin and muscles • Assessment: • VAS inclusive temporal summation • Spinal EP, referred pain to multimodal stimulation • Resting EEG, CEP (128 ch), Polhemus and MR • Inverse modelling (MUSIC, ICA, MMP) and connectivity analysis • DNIC

  17. WP 5 Aalborg Sahlgr Hung. Århus Diagles GMC • 20 patients (more according to negotiation?) without diabetic neuropathy and gastroparesis (evaluation?) + symptoms (nausea/vomiting) • Temporary gastric pacing ON/OFF. Before and after test: • Motor evaluation with scintigraphy, antroduodenal, probe (WP3) • Biomechanical evaluation (WP3) • Sensory evaluation (WP4)

  18. Working plan Ethics Committee Employees (across hospitals?) and transport Other centres (Bergen) Coordinative meetings Logistics Etc.

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