New-onset narcolepsy with cataplexy in a geriatric patient.
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Age Factors↗
Biomedical subjects
Hrayr P Attarian
Publications and source records attributed to Hrayr P Attarian.
Correlation of severity of FDG-PET hypometabolism and interictal regional delta slowing in temporal lobe epilepsy.
PURPOSE: We investigated the association of severity of hypometabolism detected by positron emission tomography (PET) with [(18)F]fluorodeoxyglucose (FDG) and persistence of interictal EEG focal slowing in patients with refractory temporal lobe epilepsy. METHODS: Eighty temporal lobes of 40 consecutive patients with intractable temporal lobe epilepsy (mean age, 43.5 years) were studied. All patients underwent video-EEG monitoring, magnetic resonance imaging (MRI), and FDG-PET. Patients with either normal MRI or with unilateral mesial temporal sclerosis, but no other structural abnormality, were included. Interictal EEG delta slowing was graded as none, infrequent (one episode or less/hour), intermediate (more than one episode/hour), or continuous. PET hypometabolism was graded as none, mild, moderate, or severe. RESULTS: The severity of temporal lobe hypometabolism with PET was significantly correlated with the amount of delta activity in the interictal EEG, independent of MRI findings (Spearman r = 0.46; p < 0.0005). CONCLUSIONS: This observation suggests related underlying pathophysiologic mechanisms for metabolic and electrical dysfunction in temporal lobe epilepsy.
Adult↗
The relationship of sleep disturbances and fatigue in multiple sclerosis.
BACKGROUND: Fatigue is experienced by most patients with multiple sclerosis (MS) and often is profoundly debilitating. No large-scale studies to our knowledge have examined circadian rhythm abnormalities in MS patients or the relationship of fatigue to circadian rhythms. OBJECTIVE: To determine if patients with MS and fatigue have sleep disturbances or circadian rhythm abnormalities associated with fatigue. DESIGN: Case-control study. SETTING: Washington University School of Medicine, St Louis, Mo. PATIENTS: Fifteen patients with MS and fatigue were compared with 15 patients with MS without fatigue and 15 age- and sex-matched, healthy controls. MAIN OUTCOME MEASURES: Sleep disturbances and circadian rhythm abnormalities were quantitated by actigraphy, fatigue by the Fatigue Descriptive Scale, and excessive sleepiness by the Epworth Sleepiness scale (ESS). RESULTS: Of the 15 fatigued patients with MS, 2 had delayed sleep phase, 10 had disrupted sleep, and 3 had normal sleep. One of the 15 nonfatigued MS patients had irregular sleep cycles, 2 others had disrupted sleep, and 12 had normal sleep. All 15 of the healthy controls had normal sleep. Nine patients with MS and fatigue scored 10 or higher on the ESS, suggesting excessive daytime sleepiness. Only 2 patients with MS without fatigue scored higher than 10 on the ESS. None of the healthy controls were fatigued, and 14 were not excessively sleepy. A relationship was found between fatigue and abnormal sleep cycles or disrupted sleep (Fisher exact test, P =.003). There was also a relationship between subjective excessive daytime sleepiness and fatigue in MS patients (P =.02). CONCLUSION: There is a significant correlation between fatigue in MS patients and disrupted sleep or abnormal sleep cycles.
Adult↗
Reverse sleep state misperception.
A 71-year-old woman with a 3-year history of excessive daytime sleepiness and an increased need for sleep did not feel restored upon awakening and had daytime fatigue despite a full night's sleep. She was evaluated with polysomnography (PSG). She significantly underestimated her sleep latency and awake time after sleep onset. The following morning, she stated that she had slept all night, when in fact she had extremely poor sleep efficiency and prolonged sleep latency. Another PSG and a two-week long actigraphy confirmed her misperception. Therefore, she perceived physiologic wakefulness, by PSG and actiraphy criteria, as subjective sleep, in direct contrast to 'conventional' sleep state misperception, in which patients usually present with a complaint of insomnia but have normal sleep quality and duration by PSG criteria. This patient may have a previously undescribed variation of sleep state misperception that the authors have tentatively named 'reverse' sleep state misperception.
Aged↗
Levetiracetam reduces spike-wave density and duration during continuous EEG monitoring in patients with idiopathic generalized epilepsy.
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Action Potentials↗
Sleep epilepsy.
BACKGROUND: Seizures during sleep have been recognized for centuries, and it is well known that both sleep and lack of sleep can influence the occurrence of ictal and interictal events. Sleep epilepsy refers to the subset of epilepsy in which seizures occur exclusively or predominantly during sleep. Primary generalized, secondarily generalized, and focal partial epilepsy syndromes can all manifest as sleep epilepsy. The spread of polysomnography has increased our ability to accurately diagnose sleep epilepsy and facilitated the discovery of an autosomal dominant sleep epilepsy. REVIEW SUMMARY: This review summarizes the epidemiology of sleep epilepsy and reviews a number of epilepsies that can manifest as sleep epilepsy as well as some nonepileptic sleep disorders from which sleep epilepsy must be differentiated.
Diagnosis, Differential↗
When to suspect obstructive sleep apnea syndrome. Symptoms may be subtle, but treatment is straightforward.
OSAS is a serious, prevalent condition that has significant mortality and morbidity when untreated. It is easy to diagnose and treat. Treatment improves quality of life and prevents associated morbidity or death. Response to treatment is high. The goal is to keep the airway open during sleep, leading to improved sleep, better oxygenation, and enhanced day-time alertness. The treatment of choice is CPAP, although bilevel positive airway pressure devices may be used in patients unable to tolerate CPAP. Many surgical treatments have proved effective. Drug therapy may be useful. Weight loss and training to avoid the supine sleeping position are helpful for some patients.
Humans↗