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Background: Temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) is a surgically treatable epileptic syndrome. While the core of pre-surgical evaluations rely on video-EEG, recent studies question the necessity of recorded seizures denying a possible role of ictal EEG in surgical decision. This study aims to retrospectively assess the prognostic value of EEG ictal patterns in TLE-HS, in order to identify which patients need further investigations before offering surgery. Methods: We included TLE-HS patients who underwent surgery with at least one captured seizure during non-invasive pre-surgical video-EEG recordings. They were classified in "mesial" and "lateral/mixed", according to the ictal EEG patterns, defined by the frequency of the discharge (mesial ≥ 5 Hz, lateral < 5 Hz). Seizure outcome was assessed by Engel's Class. Statistical analyses were performed to evaluate associations between EEG patterns and post-surgical outcomes. Results: Sixty-nine exhibited a mesial pattern, forty- two displayed lateral/mixed patterns. Mesial pattern group had a significantly higher rate of postsurgical seizure freedom (82.7% vs. 28.6%). Gender, age of onset, age at surgery, duration of epilepsy, seizure frequency, and lateralization did not influence the outcome. Mesial pattern significantly correlated with favorable outcomes (p < 0.001), suggesting its potential predictive value. Conclusion: This retrospective study proposes ictal EEG patterns as possible predictors of postoperative prognosis in TLE-HS. A mesial pattern correlates with better outcomes, indicating a potentially more circumscribed epileptogenic zone. Patients with lateral/mixed patterns may benefit from additional investigations to delineate the epileptogenic zone. Further studies are warranted to validate and extend these findings. [ABSTRACT FROM AUTHOR]

Bidirectional relationship between sleep disturbances and affective disorders is increasingly recognised, but its underlying mechanisms are far from clear, and there is a scarcity of studies that report on sleep disturbances in recurrent depressive disorder (RDD) and bipolar affective disorder (BPAD). To address this, we conducted a retrospective study of polysomnographic and clinical records of patients presenting to a tertiary sleep disorders clinic with affective disorders. Sixty-three BPAD patients (32 female; mean age ± S.D.: 41.8 ± 12.4 years) and 126 age- and gender-matched RDD patients (62 female; 41.5 ± 12.8) were studied. Whilst no significant differences were observed in sleep macrostructure parameters between BPAD and RDD patients, major differences were observed in comorbid sleep and physical disorders, both of which were higher in BPAD patients. Two most prevalent sleep disorders, namely obstructive sleep apnoea (OSA) (BPAD 50.8.0% vs RDD 29.3%, P = 0.006) and insomnia (BPAD 34.9% vs RDD 15.0%, P = 0.005) were found to be strongly linked with BPAD. In summary, in our tertiary sleep clinic cohort, no overt differences in the sleep macrostructure between BPAD and RDD patients were demonstrated. However, OSA and insomnia, two most prevalent sleep disorders, were found significantly more prevalent in patients with BPAD, by comparison to RDD patients. Also, BPAD patients presented with significantly more severe OSA, and with higher overall physical co-morbidity. Thus, our findings suggest an unmet/hidden need for earlier diagnosis of those with BPAD. [ABSTRACT FROM AUTHOR]

To evaluate sleep disorders and daytime drowsiness in a cohort of patients affected by anorexia nervosa and their impact on health-related quality of life. We evaluated patients affected by restricting-type of anorexia nervosa (AN-R) and healthy controls by the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Beck Depression Index. We also used the Short-Form Health Survey (SF-36) questionnaire to assess the quality of life in both AN-R and controls. Twenty-eight out of 34 AN-R patients (82.3%) in contrast with ten out of 34 healthy subjects (29.4%) had a pathological PSQI score compared to HC (p < 0.0001). The overall PSQI score (p < 0.001), sleep quality (p < 0.001), sleep duration (p = 0.02), sleep efficiency (p = 0.002), sleep disturbances (p = 0.03) and daytime dysfunction (p = 0.004) were significantly higher in AN-R than in controls. SF36 showed significantly reduced scores of standardized physical components (p = 0.01) and standardized mental components (p < 0.001), physical function (p < 0.001), physical role (p < 0.001) and general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001) emotional role (p = 0.001) and mental health (p < 0.001) in AN-R. We found a significant correlation between the PSQI score and both the physical role (r = − 0.35, p = 0.03) and level of education (r = 0.38, p = 0.02). Our data showed reduced overall sleep quality without excessive daytime sleepiness in AN-R. Sleep quality correlated significantly with quality of life (physical role) and level of education. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy treatment during pregnancy is still challenging. The study is aimed at comparing the efficacy and safety of carbamazepine (CBZ), lamotrigine (LTG) and levetiracetam (LEV) monotherapies during pregnancy in women with focal (FE) or generalized (GE) epilepsy. Methods: A multicentre retrospective study was conducted to evaluate seizures frequency and seizure freedom (SF) rate during 3 months before pregnancy, each trimester of gestation and post-partum period in women on monotherapy with CBZ, LTG and LEV. Results: Fifty-seven pregnancies (45 FE, 12 GE) on monotherapy (29 CBZ, 11 LTG, 17 LEV) were included. A significant reduction of seizure frequency was found in the first trimester of pregnancy as compared with that one before pregnancy (p = 0.004), more evident in GE (p = 0.003) and in LEV group (p = 0.004). The SF rate significantly increased in the first trimester in comparison to that one before pregnancy and persisted in the post-partum period in the whole sample (p < 0.001) and in women on LEV (p = 0.004). Besides, 88.57% of SF women before pregnancy remained unchanged during gestation and the post-partum period. One major heart malformation in CBZ and no major malformations in LTG and LEV groups were found. Conclusions: A better clinical outcome during pregnancy emerged since the first trimester in comparison to the before-pregnancy period, mostly evident in women with GE and LEV therapy, reinforcing the hypothesis of a protective role of pregnancy versus seizures. SF before pregnancy represents a significant predictive factor of good clinical outcome during gestation and the post-partum period. Compared to CBZ, LTG and LEV showed a better safety profile. [ABSTRACT FROM AUTHOR]

Excessive daytime sleepiness (EDS) and fatigue are some of the most frequent symptoms in neurological diseases and could impact on quality of life by increasing the risk of accidents and generally affecting daily life activities. In this review, we will examine the variety of causes responsible for EDS in neurological diseases, including nocturnal sleep alterations, CNS pathological abnormalities with alterations in arousal and/or REM regulation systems, circadian rhythms disorders, drugs, and comorbid psychiatric or primary sleep disorders. Among neurological diseases, epilepsy, dementia, Parkinson disease, multiple sclerosis, and myotonic dystrophies represented a model for these interactions between EDS and neurological diseases. A complete diagnostic workup in neurological patients with EDS should be undertaken since EDS can worsen many different aspects such as psychiatric symptoms, cognitive deficit, and in some cases, the severity of the neurological disease per se. Moreover, quality of life and risk of accidents are dependent on EDS. An individualized approach to this symptom in neurological patients should be considered with a focus on modifiable causes such as SDB, psychiatric comorbidities, and drugs. When considering EDS and fatigue in neurological diseases, close attention to lifestyle and sleep hygiene is advisable. A critical review of ongoing pharmacological therapy should not be overlooked. Possible diagnosis and treatment of SDB should be always considered. [ABSTRACT FROM AUTHOR]

Purpose: Sleep-related breathing disorders (SRBD) have been associated with adverse cardiovascular events and prognosis. Some modern pacemakers (PMK) and implantable cardioverter defibrillators (ICD) are equipped with thoracic impedance monitoring systems which allow detecting fluctuations in tidal volume occurring in SRBD. This study aimed at assessing the accuracy of a novel transthoracic impedance-based PMK/ICD sensor for automatic detection of SRBD.Methods: We prospectively enrolled 31 consecutive patients scheduled for implantation of a PMK or an ICD with sleep respiratory disturbances monitoring capability. The results of unattended home nocturnal recordings expressed as apnea/hypopnea index (AHI) were compared with the respiratory disturbance index (RDI) stored in the cardiac device memory at the time polygraphy was performed.Results: Among the 31 enrolled patients (20 men, mean age 70 ± 8 years), a comparison between the data from polygraphy and cardiac device was feasible in 29 patients. According to the results of home nocturnal recording, a severe SRBD was observed in 7/29 (24.1%) patients. On the basis of receiver-operating characteristic curve analysis of RDI values, the optimal RDI cutoff value to identify severe SRBD was 47 episodes/h (sensitivity 100%, specificity 100%). Bland-Altman agreement analysis of AHI-RDI revealed a bias between measurements of - 11 episodes/h, with limits of agreement - 38 to 15 episodes/h.Conclusions: In the present study, the novel transthoracic impedance-based monitoring system ApneaScanTM appeared effective in screening PMK and ICD patients for SRBD. [ABSTRACT FROM AUTHOR]

Rasmussen's encephalitis (RE) is a rare immune-mediated condition characterized by drug-resistant focal epilepsy, progressive neurological, and cognitive deficits associated to unilateral hemispheric atrophy. The onset is typically reported in childhood, although adult cases (A-RE) have been described. While surgical strategies in childhood RE are well defined, little is known about usefulness of epilepsy surgery in A-RE patients. We describe clinical features, surgical approach, and outcome of five A-RE patients who underwent epilepsy surgery, and we review the literature with regard to surgical A-RE cases. We retrospectively studied five A-RE patients aged 21-38 years (mean age 22.8 years) who were followed after surgery for a period ranging from to 1 to 6 years. Demographic, electroclinical, and neuroimaging data were systematically reviewed. Four out of five subjects underwent invasive EEG monitoring to define epileptogenic zone. Epilepsy outcome was defined according to Engel's classification. Surgery consisted of frontal corticectomy in three patients, temporal lobectomy in one, combined temporal lobectomy plus insular, and frontobasal corticectomy in the remaining case. No permanent neurological deficits were observed after surgery. At the last follow-up observation, one patient was seizure-free, two subjects experienced rare disabling seizures, another had moderate seizure reduction, and one had no clinical improvement. Our experience, although limited to few cases, suggests that resective surgery in A-RE may play a role in the context of multidisciplinary therapeutical approach of this severe condition. Since the lack of specific data about surgical options, this topic seems to deserve further investigations and more targeted studies. [ABSTRACT FROM AUTHOR]

Daytime somnolence and sleep-wake cycle disturbances are commonly encountered symptoms in Frontotemporal Dementia (FTD). Orexin-A (Hypocretin-1) is a hypothalamic neuropeptide regulating the sleep-wake rhythm. We investigated the cerebrospinal-fluid (CSF) orexin levels in a population of FTD patients and evaluated whether there is a relationship between daytime somnolence and CSF orexin concentrations. CSF orexin levels were measured in a sample of FTD patients ( n = 11) compared to a population of non-demented controls ( n = 13) similar for age and sex. Moreover, CSF orexin concentrations were correlated with daytime somnolence investigated by means of the Epworth Sleepiness Scale (ESS) in both FTD patients and controls. FTD patients showed CSF orexin concentrations (164.3 ± 66.45 vs 170.81 ± 42.73 pg/mL) and ESS scores (7.45 ± 4.36 vs 3.84 ± 1.82) not different from controls. However, three FTD patients showed pathological daytime sleepiness (ESS > 10) coupled with the lowest CSF orexin levels. In addition, we found a significant negative correlation between CSF orexin levels and ESS scores in the FTD population ( R = −0.91; p < 0.0001), which was not evident in the control group ( R = 0.16; p > 0.05). This is the first study investigating CSF orexin concentrations in FTD. We did not find differences in CSF orexin concentrations between FTD patients and controls. However, a significant negative correlation between daytime somnolence and CSF orexin levels was evident in FTD patients. Moreover, we have found that pathological daytime somnolence was evident in those FTD patients with the lowest CSF orexin levels. Based on these findings, we argued that lower orexin levels may be permissive for increased daytime somnolence in FTD. [ABSTRACT FROM AUTHOR]

No data are available regarding the occurrence of sleep disorders in spinal and bulbar muscular atrophy (SBMA). We investigated the sleep-wake cycle in SBMA patients compared with healthy subjects. Nine SBMA outpatients and nine age-matched and sex-matched healthy controls were evaluated. Subjective quality of sleep was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). The Epworth Sleepiness Scale was used in order to evaluate excessive daytime sleepiness. All participants underwent a 48-h polysomnography followed by the multiple sleep latency test. Time in bed, total sleep time and sleep efficiency were significantly lower in SBMA than controls. Furthermore, the apnea-hypopnea index (AHI) was significantly higher in SBMA than controls. Obstructive sleep apnea (OSA: AHI >5/h) was evident in 6/9 patients (66.6 %). REM sleep without atonia was evident in three patients also affected by OSA and higher AHI in REM; 2/9 (22.2 %) SBMA patients showed periodic limb movements in sleep. The global PSQI score was higher in SBMA versus controls. Sleep quality in SBMA is poorer than in controls. OSA is the most common sleep disorder in SBMA. The sleep impairment could be induced both by OSA or/and the neurodegenerative processes involving crucial areas regulating the sleep-wake cycle. [ABSTRACT FROM AUTHOR]

To investigatethe sleep-wake cycle and theeffects of cabergoline monotherapyin a homogenous group of de novoParkinson’s Disease (PD) patientswithout confounding comorbidfactors. Twelve de novo patients affected byidiopathic PD underwent twoambulatory polysomnographic (APSG)monitoring sessions. The firstwas performed at baseline, and thesecond recording one-month afterstable treatment with cabergolinemonotherapy. Subjective daytimesleepiness was evaluated by meansof the Epworth Sleepiness Scale.Data obtained in PD patients atbaseline were compared with thoseobtained in 12 age- and sexmatchedhealthy subjects. Diurnal sleep parameters did notshow significant differencesbetween controls and PD patientsat baseline. In PD patients, nosignificant changes in diurnal sleepwere observed between baselineand cabergoline treatment. Regardingnocturnal sleep, patients atbaseline showed a significantlylower sleep efficiency and a significantlyhigher Wakefulness AfterSleep Onset than controls. Withrespect to baseline, a significantincrease in REM latency and asignificant reduction in REM sleepwere observed during cabergolinetreatment. In the earlystage of PD, the neurodegenerativeprocess does not seem to be directlyresponsible for daytimesomnolence, but it may be directlyinvolved in the alteration of nocturnalsleep. Cabergoline monotherapydoes not affect daytimesleep propensity and, despite clinicalimprovement, it may have negativeeffects on REM sleep. [ABSTRACT FROM AUTHOR]

Few studies focused on the effects of cabergoline on sleep-wake cycle in PD. Twelve patients affected by PD treated with levodopa as monotherapy underwent two 24-hour ambulatory polysomnographic (A-PSG) sessions twice: in baseline condition (levodopa as monotherapy) and after addition of cabergoline. In each condition, a subjective evaluation of sleep quality and daytime sleepiness was obtained by means of Parkinson’s disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale. The statistical analysis of sleep parameters revealed a significant increase of sleep efficiency and slow wave sleep under cabergoline. The PDSS total score showed a significant improvement of overall sleep quality after cabergoline. No significant changes in daytime sleepiness were observed. No patient referred and/or showed sleep attacks before and after addition of cabergoline. We hypothesize that the long-lasting effect of cabergoline may improve the objective quality of nocturnal sleep in PD patients complaining nocturnal motor disability without inducing daytime sleepiness. [ABSTRACT FROM AUTHOR]

Purpose of Review: To update the current knowledge concerning sleep complaints and breathing disorders in myotonic dystrophy type 2 (DM2) and to better understand if sleep and breathing symptoms may add a further clinical definition of DM2.Recent Findings: Although DM2 has been poorly evaluated, the most relevant sleep disorders are sleep-disordered breathing (SDB) (37.5-66.7%) and restless legs syndrome (RLS) (50-60%). Excessive daytime somnolence (EDS) is not consistent with SDB, and a large percentage of patients with sleep complaints (58-69%) report pain. In addition, respiratory dysfunctions are reported in 6 to 15% of DM2 patients, albeit few data are available regarding pulmonary restriction, hypoventilation, and non-invasive ventilation (NIV).Summary: SDB, RLS, and pain may contribute to sleep fragmentation and EDS in DM2. In addition, few studies report hypoventilation and pulmonary restriction, although there are no studies at all on NIV, except for limited clinical experiences. These findings suggest performing a careful pulmonary examination and NIV when required. Furthermore, sleep studies and respiratory evaluation should be recommended if OSA or respiratory muscle dysfunctions are suspected. A large polysomnographic study should be performed to clarify the link between sleep disorders, pain, and sleep disruption in DM2. [ABSTRACT FROM AUTHOR]

Purpose of Review: To update current knowledge regarding sleep disturbances and myotonic dystrophies so as to better understand if sleep symptoms may help in the early recognition of the two genetic subtypes: myotonic dystrophy type 1 (DM1) and myotonic dystrophy type 2 (DM2).Recent Findings: Sleep-disordered breathing (SDB), restless legs syndrome, periodic limb movements in sleep, hypersomnia, and REM sleep dysregulation are frequently described in DM1 patients. SDB does not always explain hypersomnia, but a central dysregulation of sleep-wake modulation is reported mainly in DM1. Sleep apnea, restless legs syndrome, and REM sleep without atonia have been reported in single case reports and small case series of DM2.Summary: DM2 is less prevalent and more recently described than DM1, with a milder phenotype than DM1. The most frequent sleep disorders in DM1 are hypersomnia, SDB, periodic limb movements, and a narcoleptic-like phenotype, whereas restless legs syndrome, SDB, and REM sleep without atonia seem to be the most frequent sleep disorders in DM2. Comparative sleep studies are strongly required to delineate the sleep phenotype of myotonic dystrophies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on topiramate-induced restless legs syndrome.