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PubMed2002

Sleep disorders in Parkinson's disease: epidemiology and management.

Sleep problems are an under-emphasised cause of disability in Parkinson's disease (PD) and may be seen independently of PD, associated with primary PD pathology, or as a result of antiparkinsonian medications. Common sleep disorders include excessive daytime sleepiness, rapid eye movement (REM) sleep behaviour disorder, night-time wakefulness and restless legs syndrome. A number of strategies may be used to improve sleep cycle disturbances, and often these interventions do not require pharmacological manipulation. Restoring traditional mealtimes and scheduling activities during predicted periods of sleepiness may help alleviate daytime somnolence; the use of controlled-release levodopa preparations or administration of a catechol-O-methyl transferase (COMT) inhibitor with levodopa at bedtime may reduce periods of night-time wakefulness. Administration of clonazepam at bedtime may assist with REM sleep behaviour disorder but, because this agent can result in daytime somnolence, experimentation with dosage times is recommended. Sleep attacks are described as a sudden, unavoidable transition from wakefulness to sleep and, although rare, have been described with pramipexole, ropinirole and other dopamine agonists. Although the condition has yet to be recognised by the International Association of Sleep Disorders, patients with PD who report rapid sleep onset should be evaluated for the possibility of sleep attacks. If sleep attacks are suspected, it is reasonable to strongly caution patients regarding potentially risk-associated activities such as driving, and to consider careful withdrawal of dopaminergic therapy.

Antiparkinson Agents↗
PubMed2000

Circadian rhythm sleep disorders.

"Night owls" and "morning larks" are descriptive terms used to characterize individuals who go to sleep or awaken differently than most individuals. Many of these individuals have a primary circadian sleep dysrhythmia. Identification and proper treatment of a specific condition can markedly improve their quality of life. Secondary circadian dysrhythmias are very common. Nearly everyone at some time in his or her life experiences jet lag or shift work sleep disorder, two conditions in which we ignore our biologic rhythms. The impact of these conditions on performance and judgment can be tempered by certain pharmacologic and nonpharmacologic strategies. A better understanding of both primary and secondary circadian rhythm sleep disorders will be valuable to the primary care physician, leading to earlier diagnosis and improved treatment of patients with these conditions.

Circadian Rhythm↗
PubMed2003

[Comparison of answers to a sleep questionnaire of middle-age adults in Warsaw].

In 1997 we evaluated answers to a sleep questionnaire in a representative sample of 1186 persons of adult population of Warsaw. In the year 2000 we sent the same questionnaire to all persons who participated in the 1997 investigations. 676 (57%) subjects responded. There were 53% males and 47% females in the studied group. Their mean age was 56.6 +/- 8 years. There was no difference in age and sex between responders and non-responders. The standardized questionnaire contained questions assessing the following items: snoring, excessive daytime sleepiness, apnoeas observed by the sleep partner, sleep time and sleep latency. During a 3-year follow-up mean sleep time on working days did not change and remained 7.1 +/- 1.1 h. However, the subjects slept significantly shorter time at weekends, 8.1 +/- 1.3 and 7.9 +/- 1.3 h respectively (p < 0.001). There was a decrease in percentage of snorers from 81% to 75% and increase in BMI from 27 +/- 4.5 to 29 +/- 5 kg/m2. The daytime sleepiness was reduced from 7.9 +/- 4.5 to 6.4 +/- 3.9 points (p < 0.001).

Circadian Rhythm↗
PubMedDate not supplied

[Prevalence of asthma in Cuban adolescents by different clinical criteria].

BACKGROUND: Despite of the knowledge about asthma, its diagnosis is clinical and its prevalence depends on the case criterion. Several methodologies have been applied to determine its prevalence; the International Study of Asthma and Allergies in Childhood (ISAAC) is the newest, although some inconsistencies have been attributed to their results. OBJECTIVE: To estimate the prevalence of asthma according to five diagnostic criteria and according to respiratory symptoms in order to contribute to improve the diagnosis quality. MATERIAL AND METHODS: Data of the first phase of the ISAAC study made at the Centro Cubano Playa-Marianao in 2003 were collected. Three thousand twenty-six children of 13 to 14 years of age answered a survey, and prevalence of established criteria was estimated; confidence intervals were used to compare them. Estimations were presented with 95% of confidence; the chi square test and the odds ratio were applied for prevalence rates by gender. RESULTS: When comparing all the prevalences among different criteria, those corresponding to criteria I and II were statistically significant. Criterion I was the least discriminatory and criterion V had the highest power to discriminate. Criterion III offered an intermediate value of prevalence, with a proper level to discern. The first three criteria had higher prevalences in women, with statistically significant values among genders (p = 0.002, p = 0.045 and p = 0.008, respectively). CONCLUSIONS: Using a criterion that could include several symptoms, especially in low income-countries, where hospitals do not have current and expensive diagnostic methods, would be useful and would contribute to diminish the diagnostic error.

Adolescent↗
PubMedDate not supplied

[Increased accumulated incidence of allergic rhinitis in adolescents of Morelia, Michoacán, and its relation to satisfaction of vital and affective needs].

OBJECTIVE: To determine the incidence (preliminary) of allergic rhinitis in a population-based sample of adolescents and its relation on how they meet basic and affective need satisfaction. MATERIAL AND METHODS: We used ISAAC survey to assess rhinitis-related symptoms in a population-based sample of adolescents from Morelia, Michoacán, Mexico. Some items were added to the survey to evaluate how they meet basic and affective needs. Random sample included 1,333 adolescents aged 11-16 years from several schools of Morelia, Michoacán. Allergic rhinitis impact on basic and affective need satisfaction was assessed. Relative risk (RR) and 95% confidence interval (CI) were estimated. RESULTS AND DISCUSSION: Until 2003, such disease was diagnosed in 12% of cases; however, the number went up after the survey: rhinitis-related symptoms were seen in 46% of those polled, of which prevalence, sensitivity and specificity rates were 27, 90, 70%, respectively. More symptoms were reported from July through December. Sixty percent of adolescents with allergic rhinitis reported sleep disturbances, with adverse effects on bed rest period (RR 2.64) [1.01-6.94]. Well-balanced diet was seen in 62% of adolescents with such disease (RR 1.56) [1.34-1.79]. Sixty-seven percent of such teenagers said that the disease does no interfere with their performance in school (RR 1.41) [0.61-3.24] and 22% felt unaccepted (RR 1.8) [0.795-16.63]. CONCLUSIONS: The estimation of incidence of allergic rhinitis found in this study is higher than in other reports. Basic and affective need satisfaction was affected; thus, implementation of psychotherapy within a multi-disciplinary approach is required.

Adolescent↗
PubMed2005

Tonic status epilepticus in patients with idiopathic generalized epilepsy.

RATIONALE: Tonic status epilepticus (TSE) in patients with idiopathic generalized epilepsy (IGE) is not well recognized. The objective of this study is to report episodes of TSE in patients with IGE. METHODS: We retrospectively reviewed the clinical and EEG evaluation of three IGE patients who presented TSE. RESULTS: The three patients had mainly clinical features of IGE, but had developed, in addition, focal discharges, diffuse EEG abnormalities and some focal or diffuse neuropsychological dysfunction. The tonic attacks eventually responded to treatment, but were not completely controlled in any of the patients. DISCUSSION: The continuum between IGE and secondary generalized epilepsy is demonstrated in these patients. Most of their clinical and EEG features are however, in keeping with an idiopathic generalized epileptic process with additional focal and diffuse components. Recognition of the significance of TSE in such patients has important therapeutic and prognostic implications. [Published with video sequences].

Adult↗
PubMed2005

Ictal video-polysomnography and EEG spectral analysis in a child with severe Panayiotopoulos syndrome.

OBJECTIVE: To describe the ictal polysomnographic features of a patient with Panayiotopoulos syndrome, a peculiar epileptic syndrome characterized by infrequent, often single, prolonged, nocturnal, focal seizures comprising an unusual constellation of autonomic symptoms (malaise, nausea, pallor, tachycardia, vomiting) and unilateral deviation of the eyes at the onset of seizures. These clinical, ictal manifestations are rarely followed by post-ictal headache. In the literature, there is little information on the ictal EEG characteristics of Panayiotopoulos syndrome and, in particular, on certain autonomic manifestations, such as tachycardia, as the sole ictal phenomena at the onset of seizures. METHODS AND RESULTS: One, all-night videopolysomnography, during which one seizure was recorded. Video-EEG data were evaluated visually and by means of quantitative spectral analysis. The spectral analysis of the recorded seizure showed a complex ictal pattern of cortical involvement with focal onset in the right occipital area followed by the recruitment of widespread extra-occipital cortical regions. CONCLUSIONS: This is the first such analysis of this peculiar epileptic condition. Most of the symptoms were consistent with a diagnosis of severe Panayiotopoulos syndrome, although the patient also presented "atypical findings": a relatively high frequency of seizures, post-ictal headache, no spontaneous remission of seizures with age, and late onset of visual hallucinations; this last finding is more frequent in "Gastaut-type childhood occipital epilepsy", in which onset typically occurs later than in Panayiotopoulos syndrome. [Published with video sequences].

Anticonvulsants↗
PubMed2005

Late-onset, "Gastaut type", childhood occipital epilepsy: an unusual evolution.

We report on two girls and one boy with clinical and electroencephalographic features of late-onset childhood epilepsy with occipital paroxysms of the "Gastaut type", showing an unusual evolution. Neurological examination and brain imaging were normal in all three. At the age of 7.5 years, eight years and ten years respectively, the three children presented with episodes of visual symptoms when awake, and in one of them, the seizures were occasionally followed by oculocephalic deviation. The interictal EEG showed bilateral occipital spike-wave activated by eye closing. In two patients, the occipital seizures had been immediately followed by typical absences, since onset; in the other patient, five months after onset. The ictal EEG showed irregular bilateral occipital spike-wave discharges during the visual symptoms, followed by generalized spike-wave activity during the typical absences. The typical absences were activated by hyperventilation; the EEG did not show continuous spikes and waves during slow sleep. These three patients, with typical electroclinical features of "Gastaut type", childhood occipital epilepsy, demonstrated an evolution which, to our knowledge, has not been previously described. We investigated whether this unusual, age-dependent evolution was due to secondary bilateral synchrony or if these electroclinical features represent two types of idiopathic epileptic syndromes in the same patients.

Age of Onset↗