Biomedical subjects

Ivana Sartori

Publications and source records attributed to Ivana Sartori.

7 recordsLinked to original sources

PubMed2006

Relationship of epileptic discharges to arousal instability and periodic leg movements in a case of nocturnal frontal lobe epilepsy: a stereo-EEG study.

We describe the case of a patient with nocturnal frontal lobe epilepsy, presenting with periodic leg movements during sleep and complaining of excessive daytime sleepiness. With the support of intracerebral electroencephalogram recordings and the corroboration of the postoperative outcome, periodic leg movements during sleep and excessive daytime sleepiness appeared to be associated to enhanced arousal instability induced by by recurrent epileptic discharges not detectable on scalp electroencephalogram.

Adult↗

PubMed2005

Biting behavior, aggression, and seizures.

PURPOSE: To describe the semiologic features of aggressive behaviors observed in human epileptic seizures with particular reference to the act of biting a conspecific. METHODS: We analyzed the biting behavior (BB) and other aggressive gestures occurring in a group of 11 patients retrospectively selected from >1,000 patients subjected to video-EEG/SEEG monitoring for presurgical evaluation of drug-resistant seizures. RESULTS: Patients displaying BB showed (a) a male sex predominance, (b) heterogeneous etiologies and lesion locations, and (c) seizures involving the frontotemporal regions of both hemispheres. The act of biting was a rapid motor action, lasting approximately 600 ms, occurring in the context of strong emotional arousal, fear, and anger, with various bodily gestures with aggressive connotation. BB was mainly a "reflexive" behavior, in that biting acts were evoked (both during and after seizures) by actions of people in close contact with the patient. The sole intrusion of the examiner's hand in the space near the patient's face was effective in triggering BB. Rarely, self-directed or object-directed biting acts were not triggered by external stimuli. Intracranial data (SEEG) obtained in one subject showed that the amygdala/hippocampal region plus the orbitomedial prefrontal cortex had to be involved by ictal activity to observe BB. CONCLUSIONS: Anatomic and electrophysiologic data in our patients suggest that a model of dual--temporal and frontal--dysfunction could account for the occurrence of ictal/postictal BB. Behavioral data suggest also that BB and related aggressive gestures can be considered as the emergence of instinctive behaviors with an adaptative significance of defense of the peripersonal space.

Adult↗

PubMed2005

Stereoelectroencephalography in the presurgical evaluation of children with drug-resistant focal epilepsy.

OBJECT: The authors report on indications for, techniques of, and results of stereoelectroencephalography (stereo-EEG) monitoring in the presurgical evaluation of childhood drug-resistant focal epilepsy. METHODS: Thirty-five children (24 boys and 11 girls; mean age 8.8 +/- 3.9 years; mean age at seizure onset 2.1 +/- 2.2 years) underwent 37 tailored stereotactic placements of intracerebral, multilead electrodes for intensive monitoring of seizures (stereo-EEG). Two children underwent exploration twice. Investigations prior to stereo-EEG monitoring, including magnetic resonance imaging and video-EEG of the scalp, revealed variable patterns of localizing incoherence among clinical, electrophysiological, and anatomical findings in all cases. A total of 426 electrodes were implanted (mean 11.5 +/- 2.6 per procedure) according to individualized arrangements. The stereo-EEG monitoring enabled recording of 826 seizures (mean 22 +/- 45 per procedure) and mapping of critically functional areas. One untoward event consisted of intracranial breakage of an electrode. Resections of the epileptogenic zone were performed according to results of stereo-EEG recordings. They consisted of cortical removal in seven cases, removal of the lesion and epileptogenic cortex in 26 cases, and lesion removal in two cases. Transient postoperative neurological deficits were observed in 13 patients, and permanent anticipated visual field defects occurred in seven patients. According to the Engel postoperative classification of seizure outcome, 60% of cases were in Class I, 74% had significant improvement (Classes I-III), and 26% were unchanged (mean follow up 31.9 +/- 20.6 months). CONCLUSIONS: Stereoelectroencephalography monitoring is a helpful and well-tolerated technique for the definition of the epileptogenic zone in complex cases of childhood drug-resistant epilepsy. It provides essential information for safe resections that should result in excellent outcomes in a considerable number of patients.

Adolescent↗

PubMed2004

Rhythmic movement disorder and cyclic alternating pattern during sleep: a video-polysomnographic study in a 9-year-old boy.

We report on polysomnographic findings in a 9-year-old boy affected by rhythmic movement disorder. The subject's rhythmic movements were found to be intimately linked to unstable nonrapid eye movement N-REM sleep, as shown by their close association with the A phases of the cyclic alternating pattern. We examine the complex interactions between arousal mechanisms and rhythmic movements occurring during sleep.

Child↗

PubMed2004

Dopamine agonists and sleepiness in PD: review of the literature and personal findings.

BACKGROUND AND PURPOSE: This study is aimed at evaluating daytime sleepiness in a series of Parkinson's disease (PD) patients chronically treated with dopamine agonists (DAs) alone or in combination with L-Dopa. PATIENTS AND METHODS: A preliminary series of 22 non-demented, adult PD patients (mean age 68.9, 13 men and 9 women) were evaluated by means of structured sleep interview, Epworth sleepiness scale (ESS) and 24-h ambulatory polysomnography (A-PSG). RESULTS: Sleep attacks (SAs) were reported by 32% of the patients, in three of them (43%) after DA treatment was initiated (alone or in addition to L-Dopa). In two patients, both with chronic use of ropinirole, we documented NREM SAs during a continuous ambulatory polysomnography (A-PSG) performed in the patients' real-life settings. The subjects experiencing SAs showed a higher degree of daytime sleep propensity than those without SA, having higher ESS scores and a higher proportion of microsleeps and intentional naps on A-PSG. Interestingly, we found that nocturnal total sleep time is higher in PD patients with SAs than in the others. CONCLUSIONS: All in all, our data indicate that SAs are an extreme manifestation of increased daytime sleepiness. The occurrence of SAs in our series of PD patients is unlikely to depend simply on the demands of homeostatic mechanisms.

Aged↗

PubMed2003

Nocturnal frontal lobe epilepsy: intracerebral recordings of paroxysmal motor attacks with increasing complexity.

PURPOSES: To show the results of the investigation conducted with intracerebral electrodes in a patient with drug-resistant nocturnal frontal lobe epilepsy, characterized by sleep-related paroxysmal motor attacks of increasing complexity ranging from simple and brief stereotyped motor events to paroxysmal arousals and major attacks. METHODS: The patient was studied with long-term video-stereo-electroencephalographic monitoring by means of stereotactically implanted intracerebral electrodes. RESULTS: Video-stereo-electroencephalography demonstrated that minor events and paroxysmal arousals, as well as major attacks, were correlated with a discharge in the right supplementary motor area and central cingulate gyms. The increasing complexity of these sleep-related ictal motor behaviors reflected a different pattern of discharge, with a progressive spread to other frontal and extrafrontal areas in the fully developed attacks. Surgical resection of the right supplementary motor area and central cingulate gyrus was performed. In the 5 years since the operation, the patient has remained completely seizure free. CONCLUSION: This study clearly demonstrates the ictal origin of minor events in nocturnal frontal lobe epilepsy. The increasing complexity of the motor behaviors from minor to major attacks reflects different duration, amplitude, and spread of the epileptic discharge.

Adult↗

PubMed2003

Obstructive sleep apnea in a clinical series of adult epilepsy patients: frequency and features of the comorbidity.

PURPOSE: The aim of this study was to evaluate the rate and features of obstructive sleep apnea (OSA) in adult epilepsy patients. METHODS: Two hundred eighty-three adult epilepsy patients (137 men; mean age, 33 years; range, 18-70 years) were prospectively screened for OSA by means of a structured interview. Those in whom OSA was clinically suspected were monitored for a full night by using a portable device (Polymesam), and OSA was diagnosed when they had an Apnea/Hypopnea Index greater than five. RESULTS: Coexistence of OSA with epilepsy was found in 10.2% (15.4% of the male and 5.4% of the female) epilepsy patients investigated. The OSA was mild in 66.6%, moderate in 22.2%, and severe in 11.1% of the cases. The "epilepsy + OSA" patients were older, heavier, more frequently male, and sleepier (p < 0.05) than those with "epilepsy only." Furthermore, they experienced their first seizure at an older age (p < 0.05). CONCLUSIONS: Systematic investigation reveals that OSA is frequent in epilepsy patients. The major risk factors for OSA in our epilepsy patients were the same as those typically found in the general population. Of the epilepsy-related factors, older age at onset of seizures appears to be significantly related to comorbidity with OSA (p < 0.05). The presence in epilepsy patients of these features should alert the clinician to the possibility of an underlying OSA.

Adolescent↗