NREM Parasomnias: An Important Comorbidity in Epilepsy Patients of Pediatric Age

Objectives: We here aimed to investigate our pediatric group of patients to reveal the comorbidity of epilepsy and non-rapid eye movement (NREM) parasomnias and their clinical and polysomnographic characteristics.Methods: We retrospectively investigated all patients at the age of 18 or younger internalized within the last two years patients for a full night polysomnographic evaluation in our Sleep and Wake Disorders Unit. The diagnosis of epilepsy was made on the basis of clinical findings and electroencephalography findings; and the diagnosis of NREM parasomnia was made according to the International Classification of Sleep Disorders.Results: A total of 29 male (67.4%) and 14 female (32.6%) patients were investigated. Nineteen (44.2%) out of 43 patients were diagnosed as epilepsy. Nine (47.4%) of the patients with epilepsy also had delta-alpha paroxysms (DAP) and partial wakefulness during sleep – which are the characteristics polysomnographic features of NREM parasomnias.Conclusion: We observed a high comorbidity of epilepsy and NREM parasomnia in pediatric group of patients investigated in our sleepcenter. The arousal parasomnias are increasingly being reported to be more common in patients with epilepsy, probably due to shared commonphysiopathological mechanism characterized by pathological arousals originating in abnormal thalamo-cortical circuits produced by the central pattern generators

A Case Report of Rathke’s Pouch Diagnosed in a Patient Presenting with Excessive Daytime Sleepiness

Narcolepsy is a sleep disorder classified among central hypersomnias and, is characterized mainly by excessive daytime sleepiness. In its pathophysiology, the deficiency of hypocretin produced from hypothalamus was demonstrated, and suggested to be secondary to autoimmune process. Narcolepsy usually presents as a primary disorder, but may be observed following intracranial tumors, multiple sclerosis, encephalitis, head trauma or infections/vaccines. In this case report a narcolepsy patient diagnosed with Rathke’s pouch tumor, who was complaining of excessive daytime sleepiness was presented

Long-term outcomes in patients with West syndrome: An outpatient clinical study

AbstractPurposeNearly half of all patients with seizure onset in the first year of life suffer from West syndrome (WS). The prognosis of epilepsy and psychosocial outcomes in children with WS are variable. This study was performed to examine the factors influencing the outcome of this patient population.MethodsA total of 109 patients with WS followed up regularly for at least 3 years were included in the study. Relevant clinical, laboratory, and imaging data were collected.ResultsThe male/female ratio was 65/44 (59.6%/40.4%). The mean age at onset of infantile spasm (IS) was 6±6 (1–36) months. With regard to neuro-developmental and social conditions during the final evaluation, 29.4% of the patients were socially dependent on caregivers, 61.8% needed assistance, and 8.8% were normal. Among the patients, 5.9% were free of epilepsy and antiepileptic drugs (AED) for at least 2 years, 49.0% had no seizures with AEDs, and 45.1% had uncontrollable seizures. Parameters with significant negative effects on the long-term outcomes included symptomatic etiology, presence of developmental retardation before the onset of IS, persistence of active epilepsy, and male gender.ConclusionIn this study, 37 (33.9%) patients had severe consequences as a result of WS. The majority of the rest could cope with daily life with varying degrees of assistance. Eight percent of the patients had a normal development. These results draw attention to the two-thirds of patients with WS who have the chance of an acceptable quality of life (QoL) with early diagnosis and therapeutic measures

Excessive Fragmentary Myoclonus: Case Report

Excessive fragmentary myoclonus is defined as a “normal variant” under the subgroup of sleep related movement disorders. It has no known clinical consequences. Here a 72 year-old man, in whom polysomnography recordings revealed continuous excessive fragmentary myoclonus during wakefulness and sleep was presented and it was aimed to emphasize this benign clinical table which is not to be defined as a disease but a normal variant. It is of great importance especially for clinicians scoring polysomnography to be aware of this normal variant in order for differential diagnosis of sleep related movement disorders

Exitus Secondary to Respiratory Arest in a Patient with Obstructive Sleep Apnea During Polysomnographic Investigation

Obstructive sleep apnea syndrome (OSAS) has severe, life-threatening complications such as hypertension, stoke, ischemic heart disease or rhythm problems. A 40-year old woman was referred to our sleep laboratory due to witnessed apnea during her hospitalization in endocrinology yard because of hypertension, hipophyseal microadenoma and Cushing syndrome. Her past medical history revealed that she had snoring, sweating at night, tiredness in morning and excessive daytime sleepiness for the last 10 years. In polysomnography investigation, we observed continuous obstructive hypopneas during NREM sleep stage with an index of 60 (times per an hour). As she started to have REM sleep stage, she had a central apnea lasting for 100 seconds, followed by bradicardia and cardiac arrest; the patient was lost in spite of urgent intervention. Here we aimed to attract attention of physicians from all disciplines to OSAS, which is a neurological life-threatening condition but all complications could be removed by non-invasive mechanical ventilation therapy. Especially in the presence of hypertension, obesity and cardiac disorders, OSAS should be questioned in detailed and be treated immediately. Otherwise, delay in diagnosis and treatment would result in lethal consequences, as in the patient reported here

The Influence of the Treatment of Obstructive Sleep Apnea Syndrome on Depression, Anxiety, and Quality of Life

Introduction: Psychiatric diseases may co-exist with obstructive sleep apnea syndrome (OSAS). We examined the presence of this comorbidity on the quality of life and sexual life, and the beneficial effects of OSAS treatment. Materials and Methods: A total of 79 consecutive patients newly admitted to the Sleep Disorders Unit were investigated with a psychiatric interview and whole-night polysomnography. DSM-IV-TR criteria were used and the Beck Depression and Anxiety Scales (BDS and BAS), the 36-item Short Form health survey (SF-36), and the Arizona Sexual Experiences Scale (ASEX) were administered. After one month of treatment with non-invasive mechanical ventilation, all investigations were repeated. Results: Of 48 patients with OSAS, major depression was present in 13 patients (27%), anxiety disorders in 3 patients (6.2%), and major depression and anxiety disorders were both present in 11 patients (22.9%). Following one month of OSAS treatment, major depression was observed in 5 patients (10.4%), anxiety disorder in 1 patient (2.0%), and both major depression and anxiety disorder (p=0.001) were found in 9 patients (18.7%). After treatment, significant improvements were detected in both BDS (p=0.001) and BAS scores (p=0.002). There was no significant difference in ASEX scores (p=0.165). Comparison of SF36 sub-scales scores before and after OSAS treatment demonstrated significant improvements in quality of life measures. The significance was more pronounced in patients with severe OSAS. Discussion: It is of great importance to keep in mind the comorbidity of OSAS and psychiatric diseases such as drug resistant depression and anxiety disorders, as treatment of OSAS provides a marked benefit in depression, anxiety, and also in quality of life

Evaluation of Sleep Quality in Pregnancy According to Trimesters and Investigation of Related Factors

Objective:Pregnancy causes changes in the duration and quality of sleep. Insomnia, insufficient sleep time, and symptoms associated with restless legs syndrome/Willis-Ekbom disease (RLS/WED) are frequently described during pregnancy. We aimed to evaluate the deterioration in sleep quality during pregnancy according to trimesters and to examine the effect of RLS/WEH and its correlation with clinical and biochemical markers.Materials and Methods:Hundred pregnant women were included in the study prospectively and consecutively. Pregnant women were evaluated to determine their clinical characteristics, including demographic data, habits, and medical backgrounds by using a questionnaire. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), disease duration, severity, triggering factors, and family history for RLS/WEH were recorded. Complete blood count, fasting blood glucose, kidney function tests, ferritin, iron and iron binding capacity were also analyzed.Results:The mean age was 28.8±6.0 years. PSQI values were significantly higher in the third trimester (p=0.044), and ESS values were similar between trimesters (p=0.524). RLS/WEH was detected in 34% of the pregnant women; there was no difference between trimesters (p=0.188). The PSQI score was significantly higher in RLS/WEH patients (p=0.013). There was no significant difference in clinical and biochemical parameters between pregnant women with and without subjective poor sleep quality at night (PSQI >5 points).Conclusion:It is shown that night sleep quality is deteriorated in pregnant women, especially in the last trimester. The fact that the frequency of RLS/WEH is not different in pregnant women with poor sleep quality suggests the existence of other factors underlying poor sleep quality

In Case Sleep Related Bruxism is Resistant to Treatment…

The diagnosis of sleep-related bruxism is easily established clinically. When there is no identifiable underlying cause, it is classified as primary or idiopathic. However, secondary-symptomatic-forms are much more commonly observed and should therefore be questioned. In this case report, a 17 year-old boy was presented who admitted to our Sleep and Disorders Unit complaining of bruxism in his sleep but diagnosed as having secondary sleep related bruxism associated with arousals secondary to periodic leg movements in sleep. Especially in cases resistant to treatment, secondary conditions and possible underlying sleep disorders should be well-questioned and polysomnography should be performed even it is not necessary for the clinical diagnosis of sleep related bruxism

Relationship Between Sleep-related Violence and NREM Parasomnia: A Case Report

Parasomnia constitutes an important group among the situations that can lead to sleep-related violence scene. Parasomnia attacks are characterized by complex motor behaviors of various degrees, violent behaviors may result in life-threatening and rarely lethal conditions for patients and their relatives. Here is presented a patient with right temporoparietal bone fracture, pneumocephalus and hemotympanum in right ear due to head trauma during a parasomnia attack. The diagnosis could be made by a detailed history taking and polysomnography only after many other investigations. In this context, we aimed to emphasize that not only nocturnal epilepsies, especially frontal lobe epilepsies, but also parasomnia attacks should be kept in mind in differential diagnosis of sleep-related violence

Objective assessment of bradykinesia in Parkinson’s disease using evolutionary algorithms: clinical validation

Background: There is an urgent need for developing objective, effective and convenient measurements to help clinicians accurately identify bradykinesia. The purpose of this study is to evaluate the accuracy of an objective approach assessing bradykinesia in finger tapping (FT) that uses evolutionary algorithms (EAs) and explore whether it can be used to identify early stage Parkinson’s disease (PD). Methods: One hundred and seven PD, 41 essential tremor (ET) patients and 49 normal controls (NC) were recruited. Participants performed a standard FT task with two electromagnetic tracking sensors attached to the thumb and index finger. Readings from the sensors were transmitted to a tablet computer and subsequently analyzed by using EAs. The output from the device (referred to as "PD-Monitor") scaled from − 1 to +1 (where higher scores indicate greater severity of bradykinesia). Meanwhile, the bradykinesia was rated clinically using the Movement Disorder Society- Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) FT item. Results: With an increasing MDS-UPDRS FT score, the PD-Monitor score from the same hand side increased correspondingly. PD-Monitor score correlated well with MDS-UPDRS FT score (right side: r = 0.819, P = 0.000; left side: r = 0.783, P = 0.000). Moreover, PD-Monitor scores in 97 PD patients with MDS-UPDRS FT bradykinesia and each PD subgroup (FT bradykinesia scored from 1 to 3) were all higher than that in NC. Receiver operating characteristic (ROC) curves revealed that PD-Monitor FT scores could detect different severity of bradykinesia with high accuracy (≥89.7%) in the right dominant hand. Furthermore, PD-Monitor scores could discriminate early stage PD from NC, with area under the ROC curve greater than or equal to 0.899. Additionally, ET without bradykinesia could be differentiated from PD by PD-Monitor scores. A positive correlation of PD-Monitor scores with modified Hoehn and Yahr stage was found in the left hand sides. Conclusions: Our study demonstrated that a simple to use device employing classifiers derived from EAs could not only be used to accurately measure different severity of bradykinesia in PD, but also had the potential to differentiate early stage PD from normality