- Email: [email protected]
Quantified EEG in the sleep evaluation of insomniacs
5OP
Society Proceedings
to verify whether these signs are always related to sympathetic ocular impairment exclusively or whether other systems may be involved as wel]. Five migraine patients (MP) with ptosis only during headache attacks were compared with a control group of 10 normal subjects and 2 patients with Claude Bernard Horner syndrome (CBH). Sympathetic skin responses @SR) from hands and forehead, electromyographic examination from orbicularis oculi muscles, pretarsal and orbital portions, blink reflex (BR) and BR recovery cycle were recorded. The relevant findings were: presence of SSR in MPs and its absente in CBH at the affected side; involuntary muscle activation, particularly in orbicularis oculi pretarsal portion, and an early BR recovery cycle only in MPs, at the symptomatic side, during headache. The role of abnormal excitability in the peripheral and centra1 nerveus system in MPs is discussed. 41. Lamotrigine use in partial and generalized epilepsy: preliminary clinical and electrographic results. - 0. Mecarelli, M.R. de Feo, D. Del Priore, T. Cantelmi and G.F. Ricci (1 Neurolkiopatologia, Dip. Scienze Neurologiche, Università “La Sapienza,” Rome) Lamotrigine (LTD) is an interesting new anticonvulsant drug with few side effects, used as add-on therapy for the treatment of partial and generalized seizures as wel1 as of Lennox-Gastaut syndrome. We report preliminary results obtained using LTG as add-on therapy in 16 patients, aged 6-73 years (mean age = 28.9 years), affected by epileptic partial (6 cases) or generalized (10 cases) manifestations refractory to other antiepileptic drugs. In the pretrial period the seizure frequency was of at least 2 episodes/month. The LTG dose varied from 50 to 400 mg/kg. Minimum follow-up was 3 months, maximum 12 months. One patient was withdrawn after 15 days of therapy because of the appearance of rash. LTG therapy caused complete disappearance of seizures in 4 patients (27%); a reduction > 50% in 5 (33%) and no substantial modifications in 6 (40%). A good correlation between clinical and EEG features was observed in the majority of the patients: generally, the reduction or the disappearance of the seizures paralleled with a reduction or disappearance of the electrographic abnormalities, while no remarkable EEG variations were noticed in patients without clinical modifications. The incidence of side effects was very low, consisting of rash (2 cases), dizziness (1 case) and hyperexcitability (1 case). study 42. Monomelic atrophy (MA): clinical and electrophysiological of 6 cases. - R. Nucciotti ‘, V. Palma b, L. Santoro b and G. Caruso b (‘Department of Neurology, “Clinica del Lavoro” Foundation, Campoli (BN), and b Department of Clinical Neurophysiology, Naples) We describe 6 patients with monomelic atrophy (MA): in 3 patients muscular atrophy was confined to one hand and in 3 to one lower limb. Age onset was 24-42 years. In 4 patients muscle atrophy progressed for 1-2 years, then remained stationary for 3-9 years. In the other 2 patients muscle atrophy extended to the contralateral hand, and then slowly worsened, without involving other muscles, during the following 10-11 years. MRI, SSEPs, motor cortex stimulation, H reflex, F wave and sensory and motor conduction velocities along the median, ulnar, peroneal and tibial nerves were normal. Evoked potential amplitude was reduced in atrophic muscles. Standard EMG showed signs of diffuse chronic denervation, even in clinically unaffected muscles. The titer of serum anti-GMl antibodies was normal. In conclusion, we suggest sequentia] clinical and electrophysiological tests to reach a correct diagnosis of MA. A remarkable diagnostic criterion is the absente of focal conduction blocks.
symptomatic epilepsy (mainly the Lennox-Gastaut syndrome and myoclonic epilepsies) has been reported in a number of international studies. Several infantile cases were studied but the data available at present do not yet allow a precise identification of the type of infantile epilepsy in which lamotrigine is most effective. Therefore, we started an open study (follow-up 6 months) in which lamotrigine was given as add-on to a group of 7 children (1 female, 6 malesl with drug-resistant symptomatic myoclonic epilepsy. Only subjects with grade 5 resistance according to Schmidt’s criteria entered the study. Their ages ranged from 2.6 to 16.9 years (mean age 8.61. The 2 youngest children were immediately withdrawn from the trial because of the onset of widespread maculopapular rash. In another patient lamotrigine was discontinued because of lack of efficacy. The other 4 children (mean age 10.8) had only 1 seizure per day, al1 other seizures being completely suppressed with a dose of 75-300 mg/day. In al1 cases LTG was combined with sodium valproate; myoclonic relapses arose while trying to slowly discontinue the latter. This led to the administration of the initial dose of sodium valproate. 44. Atypical benign partial epilepsy of childhood (ABPEC): a novel therapeutic strategy. - A. Pelliccia, 1. Lacapra, E. Piazza and F. Pisani (Sezione Studio e Terapia della Convulsività ed Epilessia in Età Evolutiva del CIPSMS) After the original description of Aicardi and Chevrie, only Deonna and Ziegler have reported a series of children with myoclonic-astatic seizures and electroclinical patterns consistent with atypical benign partial epilepsy of childhood (ABPEC). In spite of the consistency of its clinical features ABPEC has not yet been widely recognized and therefore not yet included in the 1985 and 1989 ILAE Classifications. In the last 4 years, out of a group of 253 patients with benign partial epilepsy we were able to identify a group of 10 cases of ABPEC (6 males and 4 females). In 5 cases a family history of seizure disorder was reported. The age of seizure onset was 2.4-7 years and in 4 cases epilepsy was preceded by simple febrile convulsions. In al1 cases a significant improvement in clinical symptomatology was obtained with the administration of sodium valproate or clobazam, whereas only the combination with acetazolantide resulted in a full remission of EEG abnormalities. 45. Quantified EEG in the sleep evaluation of insomniacs. - G. Schiavi, L. Nobili, M. Gabarra, V. Balestra ’ and F. Ferrillo (Sleep Disorder Centre, Department of Motor Science, University of Genoa, Genoa, and ’ Department of Endocrinology and Science of Metabolism, University of Genoa, Genoa) The interplay between homeostatic and ultradian processes determines the cyclic structure of sleep. EEG spectra1 analysis techniques allow the study of these features, The effect of the homeostatic process is rejected by the exponential declining trend, as a function of time, of the delta band power density. The ultradian process causes EEG desynchronization and it can be detected as the periodic gathering of theta and slow alpha band power density. The neural mechanisms underlying insomnia are stil1 unknown. However, a derangement of homeostatic and ultradian processes has been hypothesized. We studied 50 insomniac patients. The distribution curves of delta band power density in each NREM sleep cycle during the whole night have been determined and a procedure of cluster analysis was applied. Four different groups, characterized by different tempora1 distribution of delta activity curves, were identified. The differences between the patterns of the distribution curves led to suppose different underlying physiopathological mechanisms for each group.
43. Benefit of sodhtm valproate-lamotrigine combination in the treatment of drug-resistant infantile myoclonic epilepsies. - A. Pelliccia and M.C. Tini (Sez. Epilessia, CIPSMS, Univ. “La Sapienza,” Rome)
46. Arousal oscillations in NREM parasomnias: role of cyclic alternating pattern (CAP). - M. Zucconi, A. Oldani, L. FeriniStrambi, M. Zamboni, V. Castronovo, F. Milani and S. Smirne (Sleep Disorder Center, Dept. of Neurology, State University and IRCCS, Hosp. San Raffaele, Milan)
Abhough lamotrigine (LTG) has not yet been included in the Italian pharmaceutical panel, the benefit of its administration in generalized
Some of NREM parasomnias, such as sleepwalking (SW), sleep terror (ST) and, in some aspects, sleep enuresis (SE), are considered “arousal
Society Proceedings
to verify whether these signs are always related to sympathetic ocular impairment exclusively or whether other systems may be involved as wel]. Five migraine patients (MP) with ptosis only during headache attacks were compared with a control group of 10 normal subjects and 2 patients with Claude Bernard Horner syndrome (CBH). Sympathetic skin responses @SR) from hands and forehead, electromyographic examination from orbicularis oculi muscles, pretarsal and orbital portions, blink reflex (BR) and BR recovery cycle were recorded. The relevant findings were: presence of SSR in MPs and its absente in CBH at the affected side; involuntary muscle activation, particularly in orbicularis oculi pretarsal portion, and an early BR recovery cycle only in MPs, at the symptomatic side, during headache. The role of abnormal excitability in the peripheral and centra1 nerveus system in MPs is discussed. 41. Lamotrigine use in partial and generalized epilepsy: preliminary clinical and electrographic results. - 0. Mecarelli, M.R. de Feo, D. Del Priore, T. Cantelmi and G.F. Ricci (1 Neurolkiopatologia, Dip. Scienze Neurologiche, Università “La Sapienza,” Rome) Lamotrigine (LTD) is an interesting new anticonvulsant drug with few side effects, used as add-on therapy for the treatment of partial and generalized seizures as wel1 as of Lennox-Gastaut syndrome. We report preliminary results obtained using LTG as add-on therapy in 16 patients, aged 6-73 years (mean age = 28.9 years), affected by epileptic partial (6 cases) or generalized (10 cases) manifestations refractory to other antiepileptic drugs. In the pretrial period the seizure frequency was of at least 2 episodes/month. The LTG dose varied from 50 to 400 mg/kg. Minimum follow-up was 3 months, maximum 12 months. One patient was withdrawn after 15 days of therapy because of the appearance of rash. LTG therapy caused complete disappearance of seizures in 4 patients (27%); a reduction > 50% in 5 (33%) and no substantial modifications in 6 (40%). A good correlation between clinical and EEG features was observed in the majority of the patients: generally, the reduction or the disappearance of the seizures paralleled with a reduction or disappearance of the electrographic abnormalities, while no remarkable EEG variations were noticed in patients without clinical modifications. The incidence of side effects was very low, consisting of rash (2 cases), dizziness (1 case) and hyperexcitability (1 case). study 42. Monomelic atrophy (MA): clinical and electrophysiological of 6 cases. - R. Nucciotti ‘, V. Palma b, L. Santoro b and G. Caruso b (‘Department of Neurology, “Clinica del Lavoro” Foundation, Campoli (BN), and b Department of Clinical Neurophysiology, Naples) We describe 6 patients with monomelic atrophy (MA): in 3 patients muscular atrophy was confined to one hand and in 3 to one lower limb. Age onset was 24-42 years. In 4 patients muscle atrophy progressed for 1-2 years, then remained stationary for 3-9 years. In the other 2 patients muscle atrophy extended to the contralateral hand, and then slowly worsened, without involving other muscles, during the following 10-11 years. MRI, SSEPs, motor cortex stimulation, H reflex, F wave and sensory and motor conduction velocities along the median, ulnar, peroneal and tibial nerves were normal. Evoked potential amplitude was reduced in atrophic muscles. Standard EMG showed signs of diffuse chronic denervation, even in clinically unaffected muscles. The titer of serum anti-GMl antibodies was normal. In conclusion, we suggest sequentia] clinical and electrophysiological tests to reach a correct diagnosis of MA. A remarkable diagnostic criterion is the absente of focal conduction blocks.
symptomatic epilepsy (mainly the Lennox-Gastaut syndrome and myoclonic epilepsies) has been reported in a number of international studies. Several infantile cases were studied but the data available at present do not yet allow a precise identification of the type of infantile epilepsy in which lamotrigine is most effective. Therefore, we started an open study (follow-up 6 months) in which lamotrigine was given as add-on to a group of 7 children (1 female, 6 malesl with drug-resistant symptomatic myoclonic epilepsy. Only subjects with grade 5 resistance according to Schmidt’s criteria entered the study. Their ages ranged from 2.6 to 16.9 years (mean age 8.61. The 2 youngest children were immediately withdrawn from the trial because of the onset of widespread maculopapular rash. In another patient lamotrigine was discontinued because of lack of efficacy. The other 4 children (mean age 10.8) had only 1 seizure per day, al1 other seizures being completely suppressed with a dose of 75-300 mg/day. In al1 cases LTG was combined with sodium valproate; myoclonic relapses arose while trying to slowly discontinue the latter. This led to the administration of the initial dose of sodium valproate. 44. Atypical benign partial epilepsy of childhood (ABPEC): a novel therapeutic strategy. - A. Pelliccia, 1. Lacapra, E. Piazza and F. Pisani (Sezione Studio e Terapia della Convulsività ed Epilessia in Età Evolutiva del CIPSMS) After the original description of Aicardi and Chevrie, only Deonna and Ziegler have reported a series of children with myoclonic-astatic seizures and electroclinical patterns consistent with atypical benign partial epilepsy of childhood (ABPEC). In spite of the consistency of its clinical features ABPEC has not yet been widely recognized and therefore not yet included in the 1985 and 1989 ILAE Classifications. In the last 4 years, out of a group of 253 patients with benign partial epilepsy we were able to identify a group of 10 cases of ABPEC (6 males and 4 females). In 5 cases a family history of seizure disorder was reported. The age of seizure onset was 2.4-7 years and in 4 cases epilepsy was preceded by simple febrile convulsions. In al1 cases a significant improvement in clinical symptomatology was obtained with the administration of sodium valproate or clobazam, whereas only the combination with acetazolantide resulted in a full remission of EEG abnormalities. 45. Quantified EEG in the sleep evaluation of insomniacs. - G. Schiavi, L. Nobili, M. Gabarra, V. Balestra ’ and F. Ferrillo (Sleep Disorder Centre, Department of Motor Science, University of Genoa, Genoa, and ’ Department of Endocrinology and Science of Metabolism, University of Genoa, Genoa) The interplay between homeostatic and ultradian processes determines the cyclic structure of sleep. EEG spectra1 analysis techniques allow the study of these features, The effect of the homeostatic process is rejected by the exponential declining trend, as a function of time, of the delta band power density. The ultradian process causes EEG desynchronization and it can be detected as the periodic gathering of theta and slow alpha band power density. The neural mechanisms underlying insomnia are stil1 unknown. However, a derangement of homeostatic and ultradian processes has been hypothesized. We studied 50 insomniac patients. The distribution curves of delta band power density in each NREM sleep cycle during the whole night have been determined and a procedure of cluster analysis was applied. Four different groups, characterized by different tempora1 distribution of delta activity curves, were identified. The differences between the patterns of the distribution curves led to suppose different underlying physiopathological mechanisms for each group.
43. Benefit of sodhtm valproate-lamotrigine combination in the treatment of drug-resistant infantile myoclonic epilepsies. - A. Pelliccia and M.C. Tini (Sez. Epilessia, CIPSMS, Univ. “La Sapienza,” Rome)
46. Arousal oscillations in NREM parasomnias: role of cyclic alternating pattern (CAP). - M. Zucconi, A. Oldani, L. FeriniStrambi, M. Zamboni, V. Castronovo, F. Milani and S. Smirne (Sleep Disorder Center, Dept. of Neurology, State University and IRCCS, Hosp. San Raffaele, Milan)
Abhough lamotrigine (LTG) has not yet been included in the Italian pharmaceutical panel, the benefit of its administration in generalized
Some of NREM parasomnias, such as sleepwalking (SW), sleep terror (ST) and, in some aspects, sleep enuresis (SE), are considered “arousal