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P148 Fortuitous discovery of epileptiform discharges in children during a multiple sleep latency tests (MLST)
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Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
was normal (average 113 minutes). Wake time during sleep period was recorded mean time 60 minutes. There is no significantly difference on NonREM sleep. The mean score of apnea-hypopnea index was 9/hour and limb movement index was 6/hour. Awakining after sleep index found 8/hour. 6 of 11 patients diagnosed as obstructive sleep apne syndrome. Our data suggest that the weight gain effect of valproic acid may develop respiratuary disorder.
P146 Sleep architecture in patients with complex partial seizures Martin Markov, Pencho Kolev St Naum Hospital in Neurology and Psychiatry Sofia Bulgaria Purpose: To investigate the macro and microstructure of night sleep in patients with epilepsy syndromes who have complex partial seizures with/without second tonic-clonic generalization. Methods: We performed neurological examination, EEG and full night polysomnography in 16 patients with epilepsy with complex partial seizures (8 without and 8 with second secondary generalized tonic clonic seizures) and in 8 sex- and age-matched healthy controls, to compare different polysomnographic parameters of sleep architecture Results: We found that both group of people with epilepsy had lower sleep efficiency and londer total recorded time of sleep compared to the healthy controls. The percentage of stage 1 of NREM sleep was increased an the percantage of slow wave sleep was dicreased in patients with epilepsy, more in the group with secondary generalization. Also in both epilepsy groups we found longer REM sleep latency (longer in the group without generalization) and significantly more stage shifts than in normal controls. We also found higher numbers of CAPs (cyclic alternating pattern) in both groups of patients with epilepsy, and they were significantly higher in the group that had second tonic clonic seizures. Conclusion: Epilepsy and complex partial seizures affect both sleep macro- and microstructure. The second generalization with tonic clonic seizures has also an impairing effect on sleep quality. The worse quality of sleep in patients with epilepsy compared to healthy subjects can lead to symptoms as daytime sleepiness, lower working capacity and can worsen their quality of life.
P147 Multicenter study about agreement between CPAP titration by polisomnography and by predictive formula in SAHS patients Jesus Escriba 1 , Jose Maria Tenias 2 , Teresa Canet 3 , Blanca Hoyo 4 , Elena Lopez 4 , Susana Casaña 1 , Juan Moliner 1 1 doctor Peset University Hospital, Clinical Neurophysiology Department; 2 lluis Alcanyis Hospital, Preventive Medicine Department; 3 virgen De Los Lirios Hospital, Clinical Neurophysiology Department; 4 lluis Alcanyis Hospital, Clinical Neurophysiology Department Introduction: Miljeteig & Hofstein designed a predictive formula in 1993 in order to determine the initial CPAP pressure in SAHS Canadian patients and this method has been widely used for titrating CPAP, without previous scientific validation, in our environment. Purpose: Analyse the concordance between CPAP titration by polisomnography (gold-standard technique) and by the Miljeteig and Hofstein’s predictive formula in a multicenter population. Methods: 830 patients from 3 different hospitals from Region of Valencia, Spain (Doctor Peset University Hospital [HPV], Lluis Alcanyis Hospital [HLX] and Verge dels Lliris Hospital [HVA]) were analysed after a complete data collection. Agreement beyond chance between both methods was judged by Lin’s coefficient (Rho) Results: The average CPAP titration by polisomnography ranges from 7.4 (HVA) to 10.9 (HLX) cm H2 0. We found a slight agreement in HPV (Rho= 0.102 IC95% -0.13 a 0.33) and HLX (Rho= 0.19 IC95% 0.14 a 0.24) and moderate in HVA (Rho= 0.45 IC95% 0.32 a 0.59). Conclusion: The Miljeteig & Hofstein’s predictive formula does not show a good concordance in our sample. According to these results, we rather recommend CPAP titration by polisomnography in SAHS patients until more
studies would be able to prove if there is another alternative method of titration with enough scientific evidence to replace the polisomnography.
P148 Fortuitous discovery of epileptiform discharges in children during a multiple sleep latency tests (MLST) Max Grosclaude, Albert Beschet, Luis Garcia-Larrea Centre Hospitalier de Valence, Valence, France Background: The MLST is routinely used to measure the ability to fall asleep in adult and children. Some reports indicate that routine EEG monitoring, polysomnography or EEG-controlled MSLT would not be necessary for routine diagnosis and screening of hypersomnia with clear phenotype (e.g. narcolepsy). Methods: We review 50 consecutive MSLT over a period of 2 years for excessive sleepiness in search of qualitative EEG abnormalities. Results: Among the 50 tests, we found 2 young patients (11 and 12 years-old) who had been addressed because of morning sleepiness at school, in whom the EEG demonstrated epileptiform generalised discharges. None had experienced epileptic seizures, both had excessive sleepiness. In one case the excessive daytime sleepiness was dramatically improved by antiepileptic therapy. Conclusion: These 2 cases represent 4% of the series, and illustrate the value and interest of EEG recording in the evaluation of hypersomnia. They further stress the importance of human visual analysis (versus automated analysis) of MSLT-EEG traces from hypersomniac patients, performed by a clinician proficient in clinical neurophysiology. Other methods of sleepiness evaluation (automatic computer analysis, Osler’s test, cognitive evoked potential) are of interest, but open to criticism in the light of our present results.
Peripheral nervous syatem & polyneuropathies P149 Effect of L-carnitine on diabetic neuropathy and ventricular dispersion in patients with diabetes mellitus Hizir Ulvi, Recep Aygül, Recep Demir Atatürk University, Medical Faculty, Department of Neurology*, Erzurum Objectives: Diabetes is a common cause of polyneuropathy. Cardiac arrhythmias and markedly increased mortality rate have been demonstrated in patients with diabetic neuropathy. We investigated the efficacy and tolerability of L-carnitine (LC) in the treatment of diabetic neuropathy and ventricular dispersion, mainly by evaluating the effects of treatment on electrophysiological parameters. Material and methods: We recruited 30 patients with type I or type II diabetes (mean age: 60±9 years, range: 36-75; 18 males, 12 females) meeting clinical and neurophysiological criteria for diabetic neuropathy. All of the patients were given LC 2gr/day for 10 months. Blood glucose regulation was maintained by diet, oral antidiabetic or insulin. To determine the nerve functions electrophysiological by superficial electrode distal latency, amplitude, nerve conduction velocity in median and ulnar nerves in the upper extremities and peroneal, tibial and sural nerves in the lower extremities and F response in motor nerves were studied and resting 12-lead electrocardiograms were recorded for measurement of QTd, corrected QTd (QTcd), JT dispersion (JTd) and corrected JT dispersion (JTcd). Results: After 10 months of treatment, median, ulnar and tibial nerves’ motor nerve conduction velocities (p<0.05) and M-wave amplitudes (p<0.01) increased, and distal latancies and the F-wave latancies (p<0.05) decreased; ulnar, sural and median sensory nerve action potentials amplitudes (p<0.01), and nerve conduction velocities (p<0.05) increased, distal latancies (p<0.05) decreased; QTd, QTcd, JTd, and JTcd (p<0.05) decreased significantly when compared to basal values. The greatest changes in sensory nerve action potential amplitude and ventricular dispersion parameters were observed in the sensory sural nerve and QTcd, respectively. LC was well tolerated over the study period. Conclusion: LC well tolerated by diabetic patients may improve peripheral neuropathy and ventricular dispersion and may be useful in preventing the increased incidence of arrhythmias and sudden death observed in such
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131
was normal (average 113 minutes). Wake time during sleep period was recorded mean time 60 minutes. There is no significantly difference on NonREM sleep. The mean score of apnea-hypopnea index was 9/hour and limb movement index was 6/hour. Awakining after sleep index found 8/hour. 6 of 11 patients diagnosed as obstructive sleep apne syndrome. Our data suggest that the weight gain effect of valproic acid may develop respiratuary disorder.
P146 Sleep architecture in patients with complex partial seizures Martin Markov, Pencho Kolev St Naum Hospital in Neurology and Psychiatry Sofia Bulgaria Purpose: To investigate the macro and microstructure of night sleep in patients with epilepsy syndromes who have complex partial seizures with/without second tonic-clonic generalization. Methods: We performed neurological examination, EEG and full night polysomnography in 16 patients with epilepsy with complex partial seizures (8 without and 8 with second secondary generalized tonic clonic seizures) and in 8 sex- and age-matched healthy controls, to compare different polysomnographic parameters of sleep architecture Results: We found that both group of people with epilepsy had lower sleep efficiency and londer total recorded time of sleep compared to the healthy controls. The percentage of stage 1 of NREM sleep was increased an the percantage of slow wave sleep was dicreased in patients with epilepsy, more in the group with secondary generalization. Also in both epilepsy groups we found longer REM sleep latency (longer in the group without generalization) and significantly more stage shifts than in normal controls. We also found higher numbers of CAPs (cyclic alternating pattern) in both groups of patients with epilepsy, and they were significantly higher in the group that had second tonic clonic seizures. Conclusion: Epilepsy and complex partial seizures affect both sleep macro- and microstructure. The second generalization with tonic clonic seizures has also an impairing effect on sleep quality. The worse quality of sleep in patients with epilepsy compared to healthy subjects can lead to symptoms as daytime sleepiness, lower working capacity and can worsen their quality of life.
P147 Multicenter study about agreement between CPAP titration by polisomnography and by predictive formula in SAHS patients Jesus Escriba 1 , Jose Maria Tenias 2 , Teresa Canet 3 , Blanca Hoyo 4 , Elena Lopez 4 , Susana Casaña 1 , Juan Moliner 1 1 doctor Peset University Hospital, Clinical Neurophysiology Department; 2 lluis Alcanyis Hospital, Preventive Medicine Department; 3 virgen De Los Lirios Hospital, Clinical Neurophysiology Department; 4 lluis Alcanyis Hospital, Clinical Neurophysiology Department Introduction: Miljeteig & Hofstein designed a predictive formula in 1993 in order to determine the initial CPAP pressure in SAHS Canadian patients and this method has been widely used for titrating CPAP, without previous scientific validation, in our environment. Purpose: Analyse the concordance between CPAP titration by polisomnography (gold-standard technique) and by the Miljeteig and Hofstein’s predictive formula in a multicenter population. Methods: 830 patients from 3 different hospitals from Region of Valencia, Spain (Doctor Peset University Hospital [HPV], Lluis Alcanyis Hospital [HLX] and Verge dels Lliris Hospital [HVA]) were analysed after a complete data collection. Agreement beyond chance between both methods was judged by Lin’s coefficient (Rho) Results: The average CPAP titration by polisomnography ranges from 7.4 (HVA) to 10.9 (HLX) cm H2 0. We found a slight agreement in HPV (Rho= 0.102 IC95% -0.13 a 0.33) and HLX (Rho= 0.19 IC95% 0.14 a 0.24) and moderate in HVA (Rho= 0.45 IC95% 0.32 a 0.59). Conclusion: The Miljeteig & Hofstein’s predictive formula does not show a good concordance in our sample. According to these results, we rather recommend CPAP titration by polisomnography in SAHS patients until more
studies would be able to prove if there is another alternative method of titration with enough scientific evidence to replace the polisomnography.
P148 Fortuitous discovery of epileptiform discharges in children during a multiple sleep latency tests (MLST) Max Grosclaude, Albert Beschet, Luis Garcia-Larrea Centre Hospitalier de Valence, Valence, France Background: The MLST is routinely used to measure the ability to fall asleep in adult and children. Some reports indicate that routine EEG monitoring, polysomnography or EEG-controlled MSLT would not be necessary for routine diagnosis and screening of hypersomnia with clear phenotype (e.g. narcolepsy). Methods: We review 50 consecutive MSLT over a period of 2 years for excessive sleepiness in search of qualitative EEG abnormalities. Results: Among the 50 tests, we found 2 young patients (11 and 12 years-old) who had been addressed because of morning sleepiness at school, in whom the EEG demonstrated epileptiform generalised discharges. None had experienced epileptic seizures, both had excessive sleepiness. In one case the excessive daytime sleepiness was dramatically improved by antiepileptic therapy. Conclusion: These 2 cases represent 4% of the series, and illustrate the value and interest of EEG recording in the evaluation of hypersomnia. They further stress the importance of human visual analysis (versus automated analysis) of MSLT-EEG traces from hypersomniac patients, performed by a clinician proficient in clinical neurophysiology. Other methods of sleepiness evaluation (automatic computer analysis, Osler’s test, cognitive evoked potential) are of interest, but open to criticism in the light of our present results.
Peripheral nervous syatem & polyneuropathies P149 Effect of L-carnitine on diabetic neuropathy and ventricular dispersion in patients with diabetes mellitus Hizir Ulvi, Recep Aygül, Recep Demir Atatürk University, Medical Faculty, Department of Neurology*, Erzurum Objectives: Diabetes is a common cause of polyneuropathy. Cardiac arrhythmias and markedly increased mortality rate have been demonstrated in patients with diabetic neuropathy. We investigated the efficacy and tolerability of L-carnitine (LC) in the treatment of diabetic neuropathy and ventricular dispersion, mainly by evaluating the effects of treatment on electrophysiological parameters. Material and methods: We recruited 30 patients with type I or type II diabetes (mean age: 60±9 years, range: 36-75; 18 males, 12 females) meeting clinical and neurophysiological criteria for diabetic neuropathy. All of the patients were given LC 2gr/day for 10 months. Blood glucose regulation was maintained by diet, oral antidiabetic or insulin. To determine the nerve functions electrophysiological by superficial electrode distal latency, amplitude, nerve conduction velocity in median and ulnar nerves in the upper extremities and peroneal, tibial and sural nerves in the lower extremities and F response in motor nerves were studied and resting 12-lead electrocardiograms were recorded for measurement of QTd, corrected QTd (QTcd), JT dispersion (JTd) and corrected JT dispersion (JTcd). Results: After 10 months of treatment, median, ulnar and tibial nerves’ motor nerve conduction velocities (p<0.05) and M-wave amplitudes (p<0.01) increased, and distal latancies and the F-wave latancies (p<0.05) decreased; ulnar, sural and median sensory nerve action potentials amplitudes (p<0.01), and nerve conduction velocities (p<0.05) increased, distal latancies (p<0.05) decreased; QTd, QTcd, JTd, and JTcd (p<0.05) decreased significantly when compared to basal values. The greatest changes in sensory nerve action potential amplitude and ventricular dispersion parameters were observed in the sensory sural nerve and QTcd, respectively. LC was well tolerated over the study period. Conclusion: LC well tolerated by diabetic patients may improve peripheral neuropathy and ventricular dispersion and may be useful in preventing the increased incidence of arrhythmias and sudden death observed in such