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Fazli B, Hosseini SA, Behnampour N, Langari A, Habibi-koolaee M. Melatonin versus chloral hydrate on sleep induction for recording electroencephalography in children: a randomized clinical trial. Ann Med Surg (Lond) 2023; 85:5478-5483. [PMID: 37915677 PMCID: PMC10617919 DOI: 10.1097/ms9.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/31/2023] [Indexed: 11/03/2023] Open
Abstract
Background Electroencephalography (EEG) plays an essential role in the diagnosis of seizures. EEG recording in children is done with partial sleep deprivation and sedative drugs. To compare the effectiveness of melatonin and chloral hydrate on sleep induction and EEG recording in children. Materials and methods In a parallel blinded randomized clinical trial study, 78 patients (6 months-5 years) were included to record EEG. Patients were randomly divided into two groups to receive melatonin (0.4 mg/kg) or chloral hydrate (0.5 ml/kg). After receiving the sedative drug, the start and duration of sedation, recovery time, side effects, and epileptiform waves in the EEG were recorded. The data was analyzed using SPSS version 16, and the significance level was determined to be less than 0.05. Results A total of 78 children, including 34 girls (43.6%) and 44 boys (56.4%) (average age of 27.15±17.15 months), were examined. Success in the induction of sedation was reported by melatonin in 36 patients (92%) and chloral hydrate in 37 patients (95%), which was similar between the two drugs (P=0.5). The start time (P=0.134) and the duration of sedation (P=0.408) were alike between the two drugs. However, compared to the chloral hydrate, the recovery time in the melatonin group was significantly shorter (P<0.001). Side effects were not seen in melatonin, while six children (15%) using chloral hydrate had mild side effects (P=0.013). Epileptiform waves in EEGs were reported to be similar and positive for melatonin in 18 children (50%) and chloral hydrate in 16 children (43%) (P=0.410). Conclusion The findings show that using melatonin in the dose prescribed in this study had similar effects to success in inducing sedation with the minimum quantity of chloral hydrate. Regardless of the start time and duration of sedation, the shorter recovery time and the absence of side effects are the advantages of using melatonin.
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Affiliation(s)
| | - Seyed-Ahmad Hosseini
- Neonatal and Children’s Health Research Center, Taleghani Medicine Educational Center
| | | | | | - Mahdi Habibi-koolaee
- Department of Health Information Technology, Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, 4918936316 Iran
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Melatonin versus Sleep Deprivation for Sleep Induction in Nap Electroencephalography: Protocol for a Prospective Randomized Crossover Trial in Children and Young Adults with Epilepsy. Metabolites 2023; 13:metabo13030383. [PMID: 36984823 PMCID: PMC10059140 DOI: 10.3390/metabo13030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Electroencephalography (EEG) continues to be a pivotal investigation in children with epilepsy, providing diagnostic evidence and supporting syndromic classification. In the pediatric population, electroencephalographic recordings are frequently performed during sleep, since this procedure reduces the number of artifacts and activates epileptiform abnormalities. To date, no shared guidelines are available for sleep induction in EEG. Among the interventions used in the clinical setting, melatonin and sleep deprivation represent the most used methods. The main purpose of this study is to test the non-inferiority of 3–5 mg melatonin versus sleep deprivation in achieving sleep in nap electroencephalography in children and young adult patients with epilepsy. To test non-inferiority, a randomized crossover trial is proposed where 30 patients will be randomized to receive 3–5 mg melatonin or sleep deprivation. Each enrolled subject will perform EEG recordings during sleep in the early afternoon for a total of 60 EEGs. In the melatonin group, the study drug will be administered a single oral dose 30 min prior to the EEG recording. In the sleep deprivation group, parents will be required to subject the child to sleep deprivation the night before registration. Urinary and salivary concentrations of melatonin and of its main metabolite 6-hydroxymelatonin will be determined by using a validated LC-MS method. The present protocol aims to offer a standardized protocol for sleep induction to be applied to EEG recordings in those of pediatric age. In addition, melatonin metabolism and elimination will be characterized and its potential interference in interictal abnormalities will be assessed.
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Peltola ME, Leitinger M, Halford JJ, Vinayan KP, Kobayashi K, Pressler RM, Mindruta I, Mayor LC, Lauronen L, Beniczky S. Routine and sleep EEG: Minimum recording standards of the International Federation of Clinical Neurophysiology and the International League Against Epilepsy. Epilepsia 2023; 64:602-618. [PMID: 36762397 PMCID: PMC10006292 DOI: 10.1111/epi.17448] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 02/11/2023]
Abstract
This article provides recommendations on the minimum standards for recording routine ("standard") and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for epilepsy-related clinical practice guidelines by the Epilepsy Guidelines Working Group. We reviewed the published evidence using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of evidence for sleep induction methods was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. A tool for Quality Assessment of Diagnostic Studies (QUADAS-2) was used to assess the risk of bias in technical and methodological studies. Where high-quality published evidence was lacking, we used modified Delphi technique to reach expert consensus. The GRADE system was used to formulate the recommendations. The quality of evidence was low or moderate. We formulated 16 consensus-based recommendations for minimum standards for recording routine and sleep EEG. The recommendations comprise the following aspects: indications, technical standards, recording duration, sleep induction, and provocative methods.
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Affiliation(s)
- Maria E Peltola
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ronit M Pressler
- Clinical Neuroscience, UCL-Great Ormond Street Institute of Child Health and Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ioana Mindruta
- Department of Neurology, University Emergency Hospital of Bucharest and University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Luis Carlos Mayor
- Department of Neurology, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Leena Lauronen
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, and Danish Epilepsy Centre, Dianalund, Denmark
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Peltola ME, Leitinger M, Halford JJ, Vinayan KP, Kobayashi K, Pressler RM, Mindruta I, Mayor LC, Lauronen L, Beniczky S. Routine and sleep EEG: Minimum recording standards of the International Federation of Clinical Neurophysiology and the International League Against Epilepsy. Clin Neurophysiol 2023; 147:108-120. [PMID: 36775678 DOI: 10.1016/j.clinph.2023.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article provides recommendations on the minimum standards for recording routine ("standard") and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for epilepsy-related clinical practice guidelines by the Epilepsy Guidelines Working Group. We reviewed the published evidence using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of evidence for sleep induction methods was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. A tool for Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the risk of bias in technical and methodological studies. Where high-quality published evidence was lacking, we used modified Delphi technique to reach expert consensus. The GRADE system was used to formulate the recommendations. The quality of evidence was low or moderate. We formulated 16 consensus-based recommendations for minimum standards for recording routine and sleep EEG. The recommendations comprise the following aspects: indications, technical standards, recording duration, sleep induction, and provocative methods.
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Affiliation(s)
- Maria E Peltola
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ronit M Pressler
- Clinical Neuroscience, UCL-Great Ormond Street Institute of Child Health and Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ioana Mindruta
- Department of Neurology, University Emergency Hospital of Bucharest and University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Luis Carlos Mayor
- Department of Neurology, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Leena Lauronen
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, and Danish Epilepsy Centre, Dianalund, Denmark
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Bonuccelli A, Santangelo A, Castelli F, Magherini G, Volpi E, Costa E, Alesci E, Massimetti G, Operto FF, Peroni DG, Orsini A. Efficacy of Liposomal Melatonin in sleep EEG in Childhood: A Double Blind Case Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:552. [PMID: 36612875 PMCID: PMC9819026 DOI: 10.3390/ijerph20010552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Electroencephalography (EEG) is pivotal in the clinical assessment of epilepsy, and sleep is known to improve the diagnostic yield of its recording. Sleep-EEG recording is generally reached by either partial deprivation or by administration of sleep-inducing agents, although it is still not achieved in a considerable percentage of patients. We conducted a double-blind placebo-controlled study, involving a hundred patients between 1 and 6 years old, randomized into two groups: Group 1 received liposomal melatonin (melatosome) whereas Group 2 received a placebo. Sleep latency (SL), defined as the time span between the onset of a well-established posterior dominant rhythm, considered as a frequency of 3 to 4 Hz, increasing to 4-5 Hz by the age of 6 months, to 5-7 Hz by 12 months, and finally to 8 Hz by 3 years, and the first EEG sleep figures detected, were measured for each patient. A significant difference in SL was observed (10.8 ± 5 vs. 18.1 ± 13.4 min, p-value = 0.002). Within each group, no differences in sleep latency were detected between genders. Furthermore, no difference in EEG abnormality detection was observed between the two groups. Our study confirmed the efficacy and safety of melatonin administration in sleep induction. Nonetheless, liposomal melatonin presents a greater bioavailability, ensuring a faster effect and allowing lower dosages. Such results, never before reported in the literature, suggest that the routine employment of melatonin might improve clinical practice in neurophysiology, reducing unsuccessful recordings.
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Affiliation(s)
- Alice Bonuccelli
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Andrea Santangelo
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Francesca Castelli
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Giulia Magherini
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elena Volpi
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elisa Costa
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elena Alesci
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Diego Giampiero Peroni
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
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Ahmed J, Patel W, Pullattayil AK, Razak A. Melatonin for non-operating room sedation in paediatric population: a systematic review and meta-analysis. Arch Dis Child 2022; 107:78-85. [PMID: 33785532 DOI: 10.1136/archdischild-2020-320592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/24/2021] [Accepted: 02/28/2021] [Indexed: 11/03/2022]
Abstract
CONTEXT The literature on melatonin as a sedative agent in children is limited. OBJECTIVE To conduct a systematic review of studies assessing the efficacy and safety of melatonin for non-operating room sedation in children. METHODS Medline, Embase, Cochrane Library and Cumulative Index to Nursing and Allied Health were searched until 9 April 2020 for studies using melatonin and reporting one of the prespecified outcomes of this review. Two authors independently assessed the eligibility, risk of bias and extracted the data. Studies with a similar study design, comparator and procedure were pooled using the fixed-effect model. RESULTS 25 studies (clinical trials=3, observational studies=9, descriptive studies=13) were included. Melatonin was used for electroencephalogram (EEG) (n=12), brainstem evoked response audiometry (n=8) and magnetic resonance imaging (MRI) (n=5). No significant differences were noted on meta-analysis of EEG studies comparing melatonin with sleep deprivation (SD) (relative risk (RR) 1.06 (95% CI 0.99 to 1.12)), melatonin with chloral hydrate (RR 0.97 (95% CI 0.89 to 1.05)) and melatonin alone with melatonin and SD combined (RR 1.03 (95% CI 0.97 to 1.10)) for successful procedure completion. However, significantly higher sedation failure was noted in melatonin alone compared with melatonin and SD combined (RR 1.55 (95% CI 1.02 to 2.33)) for EEG. Additionally, meta-analysis showed lower sleep latency for melatonin compared with SD (mean difference -10.21 (95% CI -11.53 to -8.89) for EEG. No major adverse events were reported with melatonin. CONCLUSION Although several studies were identified, and no serious safety concerns were noted, the evidence was not of high quality to establish melatonin's efficacy for non-operating room sedation in children.
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Affiliation(s)
- Javed Ahmed
- Neonatology, Hamad Medical Corporation, Doha, Qatar
| | - Waseemoddin Patel
- Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh, Al Riyadh, Saudi Arabia
| | | | - Abdul Razak
- Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh, Al Riyadh, Saudi Arabia
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Uludag İ, Demirtaş B, Şener U, Zorlu Y. Comparison of awake electroencephalography, electroencephalography after sleep deprivation, and melatonin-induced sleep electroencephalography sensitivity in the diagnosis of epilepsy in adults. NEUROL SCI NEUROPHYS 2022. [DOI: 10.4103/nsn.nsn_101_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Panda PK, Panda P, Dawman L, Sharawat IK. Systematic Review and Meta-analysis of Efficacy and Safety of Melatonin and Triclofos for Inducing Adequate Sedation for Sleep Electroencephalogram in Children. J Neurosci Rural Pract 2021; 13:3-11. [PMID: 35110915 PMCID: PMC8803531 DOI: 10.1055/s-0041-1736511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Abstract
Introduction Triclofos and melatonin are commonly used oral sedatives in children for obtaining a sleep electroencephalogram (EEG) record. There has been no systematic review till now to compare the efficacy and safety of these two medications.
Objectives The review intended to compare the efficacy of oral triclofos and melatonin in children <18 years of age for inducing adequate sedation for obtaining a sleep EEG record. We also attempted to compare the adverse effects, impact on EEG record, the yield of epileptiform abnormalities, and sleep onset latency in both groups.
Methods A systematic search was conducted on “MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, and Google Scholar” till November 30, 2020, with the following keywords/the Medical Subject Headings (MESH) terms while searching: “sleep EEG,” “electroencephalogram,” “triclofos,” “melatonin” OR “ramelteon” AND “epilepsy,” “seizure,” OR “convulsion.” ROB 2.0 and ROBINS-I tool was used to determine the risk of bias. To assess heterogeneity in studies, Higgins and Thompson's I
2 method was utilized. When I
2 was more than 50%, a random effects model was utilized and a fixed-effect model was used for other parameters. To assess the presence of publication bias, Egger's test was used.
Results For describing the efficacy of triclofos in 1,284 and melatonin in 1,532 children, we selected 16 articles. The indirect comparison between the pooled estimate of all children receiving individual medications revealed comparable efficacy in obtaining successful sleep EEG record with a single dose (90 vs. 76%, p = 0.058) and repeat dose (p = 0.054), detection of epileptiform abnormalities (p = 0.06), and sleep onset latency (p = 0.06), but more proportion of children receiving triclofos had adverse effects (p = 0.001) and duration of sleep was also higher with triclofos (p = 0.001).
Conclusion Efficacy of triclofos and melatonin are comparable in inducing sleep for recording EEG in children, although triclofos is more likely to cause adverse effects. However, the level of evidence is low for this conclusion and the weak strength of recommendation for the results of this review is likely to change in the future after completion of controlled trials exploring these two medications.
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Affiliation(s)
- Prateek K. Panda
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pragnya Panda
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar K. Sharawat
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Lalwani S, Srivastava K, Thakor B, Panda BK, Kaur H, Karmarkar S, Dhumak N, Rajadhyaksha S. Efficacy and tolerability of Melatonin vs Triclofos to achieve sleep for pediatric electroencephalography: A single blinded randomized controlled trial. Eur J Paediatr Neurol 2021; 34:14-20. [PMID: 34293628 DOI: 10.1016/j.ejpn.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare Melatonin with Triclofos for efficacy (proportion of successful EEG, need of augmentation, sleep onset latency (SOL), yield of discharges, duration of sleep, presence and grade of artifacts) and tolerability (adverse effect profile). METHODS A randomized trial was performed (block randomization). All children were advised regarding sleep deprivation, EEG technician administered the drug. EEG was labelled successful if at least 30 min of record could be obtained (sleep with or without awake state). Pediatric neurologist reported the EEG findings-sleep onset latency, epileptiform abnormalities and graded the artifacts (excess beta activity and movement artifacts if present). The parents were interviewed telephonically next day by a pediatric resident for any adverse effects. The parents, pediatric neurologist and pediatric resident were blinded for the drug given. RESULTS 228 children were randomized (114 each received Melatonin and Triclofos). Both the groups were comparable at baseline for age group and demographic data. The proportion of successful EEG was 89.4% in Melatonin and 91.2% in Triclofos. First dose was effective in 64% in Melatonin and 63.15% in Triclofos group. Augmentation dose was needed in 25.4% in Melatonin and 28% in Triclofos group. Mean total sleep duration was 80 min after Melatonin and 82.39 after Triclofos administration. Adverse effects were observed in 6.14% of Melatonin and 8.65% of Triclofos group. None of the results were statistically significant. CONCLUSION There was no significant difference between efficacy and tolerability of Melatonin and Triclofos. Melatonin can be safely used to achieve sleep for EEG in children.
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Affiliation(s)
- Siddhant Lalwani
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Kavita Srivastava
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Bina Thakor
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Bijoy Kumar Panda
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Harsimran Kaur
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Suparna Karmarkar
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Nirmala Dhumak
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
| | - Surekha Rajadhyaksha
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
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The use of melatonin for auditory brainstem response audiometry in children with comorbidities. Eur Arch Otorhinolaryngol 2021; 279:2303-2308. [PMID: 34101008 DOI: 10.1007/s00405-021-06923-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, the efficacy and feasibility of melatonin in young children with and without comorbidities, undergoing auditory brainstem response audiometry (ABR) was evaluated. The aim of this study was primarily to evaluate the use of melatonin for ABR investigations in children with comorbidities. Second, the efficacy of melatonin was evaluated based on several factors like sleep-onset latency, sleep duration, frequency of awakenings as well as adverse events. METHODS Click-induced ABR tests were performed at the outpatient clinic between January, 2018 and August, 2020. Investigations were considered successful when binaural testing was completed. A dose of melatonin depending on age, 5 mg for children younger than 6 years and 10 mg if older than 6 years, was administered after placement of electrodes. RESULTS 131 children were included in this study. 87% of all ABR investigations were performed successfully. Comorbidities such as neurodevelopmental disorders or developmental delays were present in 70% of all children. There was no significant difference in age (p = 0.36) or gender (p = 0.97) between the success and failed group. In addition, comorbidities were equally distributed between both groups. Mean sleep duration was 38 (SD 21) min and sleep-onset latency was 28 (SD 20) min No adverse events were documented. CONCLUSION Melatonin is effective for ABR examinations in infants and children with and without comorbidities. Furthermore, it allows for sequential testing in those at risk for progressive hearing loss. Clear instructions to caregivers and expertise of audiologists are a prerequisite for optimal outcomes.
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Efficiency of Melatonin as a Sedative for Auditory Brainstem Response in Children. Audiol Res 2020; 10:50-54. [PMID: 33202546 PMCID: PMC7768538 DOI: 10.3390/audiolres10020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction-Although auditory brainstem response (ABR) testing is among the most frequently used investigations in pediatric audiology and it often requires sedation or general anesthesia. In recent years, melatonin has been successfully used as an alternative way of inducing sleep, particularly in children undergoing magnetic resonance imaging (MRI) or electroencephalography (EEG). Purpose-To assess the effectiveness of orally administered melatonin as an alternative to sedation or general anesthesia during ABR testing. Method-In total, 33 children with suspected hearing loss underwent ABR tests in melatonin-induced sleep. Each patient received an initial dose of 5 mg, which was re-administered in case of failure to obtain sleep. Click-induced ABR tests were performed on both ears. Results-ABR tests were successfully performed in 72.7% of the patients. The average total length of time needed to obtain sleep and complete the ABR testing was 45 min. There was no significant difference between the patients who completed the examination and those who did not in terms of age or psychomotor development. There was a statistically significant association between receiving a maintenance dose and successful completion of the test (p < 0.001). There was also a significant connection between the degree of hearing loss and the success rate of the ABR tests (p < 0.001). Conclusions-Melatonin-induced sleep is a good and safer alternative to anesthesia to perform ABR testing in young children. It is easily administered, tolerated by the patients, and accepted by parents.
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Mantle D, Smits M, Boss M, Miedema I, van Geijlswijk I. Efficacy and safety of supplemental melatonin for delayed sleep-wake phase disorder in children: an overview. Sleep Med X 2020; 2:100022. [PMID: 33870175 PMCID: PMC8041131 DOI: 10.1016/j.sleepx.2020.100022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023] Open
Abstract
Delayed sleep–wake phase disorder (DSPD) is the most frequently occurring intrinsic circadian rhythm sleep–wake disorder, with the highest prevalence in adolescence. Melatonin is the first-choice drug treatment. However, to date melatonin (in a controlled-release formulation) is only authorised for the treatment of insomnia in children with autism or Smiths-Magenis syndrome. Concerns have been raised with respect to the safety and efficacy of melatonin for more general use in children, as melatonin has not undergone the formal safety testing required for a new drug, especially long-term safety in children. Melatonin is known to have profound effects on the reproductive systems of rodents, sheep and primates, as well as effects on the cardiovascular, immune and metabolic systems. The objective of the present article was therefore to establish the efficacy and safety of exogenous melatonin for use in children with DSPD, based on in vitro, animal model and clinical studies by reviewing the relevant literature in the Medline database using PubMed. Acute toxicity studies in rats and mice showed toxic effects only at extremely high melatonin doses (>400 mg/kg), some tens of thousands of times more than the recommended dose of 3–6 mg in a person weighing 70 kg. Longer-term administration of melatonin improved the general health and survival of ageing rats or mice. A full range of in vitro/in vivo genotoxicity tests consistently found no evidence that melatonin is genotoxic. Similarly long term administration of melatonin in rats or mice did not have carcinogenic effects, or negative effects on cardiovascular, endocrine and reproductive systems. With regard to clinical studies, in 19 randomised controlled trials comprising 841 children and adolescents with DSPD, melatonin treatment (usually of 4 weeks duration) consistently improved sleep latency by 22–60 min, without any serious adverse effects. Similarly, 17 randomised controlled trials, comprising 1374 children and adolescents, supplementing melatonin for indications other than DSPD, reported no relevant adverse effects. In addition, 4 long-term safety studies (1.0–10.8 yr) supplementing exogenous melatonin found no substantial deviation of the development of children with respect to sleep quality, puberty development and mental health scores. Finally, post-marketing data for an immediate-release melatonin formulation (Bio-melatonin), used in the UK since 2008 as an unlicensed medicine for sleep disturbance in children, recorded no adverse events to date on sales of approximately 600,000 packs, equivalent to some 35 million individual 3 mg tablet doses (MHRA yellow card adverse event recording scheme). In conclusion, evidence has been provided that melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in children, provided that it is administered at the correct time (3–5 h before endogenous melatonin starts to rise in dim light (DLMO)), and in the correct (minimal effective) dose. As the status of circadian rhythmicity may change during long-time treatment, it is recommended to stop melatonin treatment at least once a year (preferably during the summer holidays). Melatonin improves sleep onset without serious adverse effects in youths with DSPD. Change th text after the fourth bullet into: Melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in youths. Melatonin for indications other than DSPD, dose not cause relevant adverse effects. Long term melatonin treatment does not impair sleep, puberty, and mental health. Melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in youths. Melatonin should be administered at the correct time and in the minimal effective dose.
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Affiliation(s)
| | - Marcel Smits
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Myrthe Boss
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Irene Miedema
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Inge van Geijlswijk
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, and Faculty of Veterinary Medicine, Pharmacy Department Utrecht University, Utrecht, The Netherlands
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Heida EJ, Lunsing RJ, Brouwer OF, Meiners LC. Melatonin in neuropaediatric MRI: a retrospective study of efficacy in a general hospital setting. Eur J Paediatr Neurol 2020; 25:172-180. [PMID: 31753707 DOI: 10.1016/j.ejpn.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/21/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melatonin may offer a safe and cheap alternative to general anaesthesia and sedatives in neuropaediatric MRI. The purpose of our study was to evaluate its efficacy during a daily scanning programme and to assess its financial benefit. METHODS Neuro-MRI scans, performed in a general hospital setting after administration of melatonin in 64 children aged 10 months-5 years, were retrospectively reassessed by an experienced paediatric neuroradiologist, rating them as diagnostically contributing or as failed. The financial benefit was calculated. RESULTS 49/64 scans (77%) were diagnostically contributing, in 11 (22%) no movement artefact was seen in any sequence; 15/64 scans failed (23%), in 3/15 because of serious movement artefacts, in 12/15 the scan was not started. Repeat scans under general anaesthesia were performed in 17 cases (27%): in the 15 failed cases and in 2 cases initially assessed as failed, but were considered diagnostically contributing in the present study. The financial benefit at the time the scans were made was approximately 13,360 Euro. CONCLUSIONS In this retrospective study, the use of melatonin in neuropaediatric MRI, made during a daily scanning programme with a remote waiting room, was associated with a high success rate in infants and young children. A minority of scans had no movement artefacts, indicating most children were not asleep. The sleep-inducing effect of melatonin could therefore not be proven, but the high success rate may be attributed to the sedative and/or anxiolytic effect of melatonin. Only a minority of scans had to be repeated under general anesthesia, leading to a reduction of scan related costs.
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Affiliation(s)
- Elebarta Je Heida
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Radiology, Groningen, the Netherlands
| | - Roelineke J Lunsing
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Oebele F Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Linda C Meiners
- University of Groningen, University Medical Centre Groningen, Department of Radiology, Groningen, the Netherlands.
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Milovanovic M, Radivojevic V, Radosavljev-Kircanski J, Grujicic R, Toskovic O, Aleksić-Hil O, Pejovic-Milovancevic M. Epilepsy and interictal epileptiform activity in patients with autism spectrum disorders. Epilepsy Behav 2019; 92:45-52. [PMID: 30611007 DOI: 10.1016/j.yebeh.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of epilepsy and subclinical epileptiform abnormalities in children with autism spectrum disorder (ASD), and to investigate its effects on core autistic symptoms and adaptive behavior skills. METHODS Patients with diagnosis of ASD who met full criteria on Autism Diagnostic Interview-Revised (ADI-R) were included in the study. Adaptive behavior skills were assessed by Vineland Adaptive Behavior Scale-II (VABS-II). Clinical assessment for epilepsy and video electroencephalography (EEG) (v-EEG) examinations during wakefulness and/or sleep were prospectively performed in all patients. RESULTS A total of 112 patients with diagnosis of ASD of mean age 6.58 ± 3.72 were included in the study. Based on clinical and v-EEG assessments, three groups of patients were defined: 1) patients with epilepsy (n = 17; 15.2%); 2) patients with epileptiform discharges in absence of clinical seizures (n = 14; 12.5%); 3) patients without epilepsy and without epileptiform discharges (n = 81; 72.3%). There were no significant differences between three groups of patients on ADI-R subscores. Speech development was also not significantly related to epilepsy. There was a slight tendency of the VABS-II motor skills score to be higher in the group of patients with autism without clinical diagnosis of epilepsy and without subclinical epileptiform discharges (p < 0.05) in comparison with the two other groups. According to this tendency, we might claim that patients with higher scores on motor skills could have 0.88 times lower odds for having epileptiform EEG activity. CONCLUSIONS According to our results, we were not able to detect differences in the ADI-R between the three populations with ASD, all with unknown etiology. Epilepsy, as well as subclinical epileptic discharges, showed small effects on Motor Skills in patients with autism, and had no effect on adaptive behavior Communication/Socialization/Daily Living Skills.
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Affiliation(s)
- Maja Milovanovic
- Institute of Mental Health, Belgrade, Serbia; Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Oliver Toskovic
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | | | - Milica Pejovic-Milovancevic
- Institute of Mental Health, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Alix JJP, Kandler RH, Pang C, Stavroulakis T, Catania S. Sleep deprivation and melatonin for inducing sleep in paediatric electroencephalography: a prospective multicentre service evaluation. Dev Med Child Neurol 2019; 61:181-185. [PMID: 30028504 DOI: 10.1111/dmcn.13973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
AIM To compare the efficacy of the main methodologies in attaining sleep and electroencephalography (EEG) abnormalities in children with a view to producing recommendations on best practice. METHOD Fifty-one UK centres participated. Methods for sleep induction (sleep deprivation, melatonin, and combined sleep deprivation/melatonin) were compared. Data pertaining to demographics, achievement of stage II sleep, and recording characteristics (duration of study, presence of epileptiform activity in awake/sleep states) were prospectively collected for consecutive patients in November and December 2013. RESULTS Five hundred and sixty-five patients were included. Age range was 1 years to 17 years (mean 7y 10mo), 27.7 per cent had an underlying neurobehavioural condition. Stage II sleep was achieved in 69 per cent of sleep deprived studies, 77 per cent of melatonin studies, and 90 per cent of combined intervention studies (p<0.001, χ2 ). In children who slept, there was no difference between the three interventions in eliciting epileptiform discharges. In children who did not sleep, epileptiform abnormalities were seen more often than after sleep deprivation alone (p=0.02, χ2 ). Seizures were rare. INTERPRETATION Combined sleep deprivation/melatonin is more effective than either method alone in achieving sleep. The occurrence of epileptiform activity during sleep is broadly similar across the three groups. We recommend the combined intervention to induce sleep for paediatric EEG. WHAT THIS PAPER ADDS Combined sleep deprivation/melatonin is more effective in achieving sleep than either sleep deprivation or melatonin alone. Sleep latency is shorter with combined sleep deprivation/melatonin. When children do sleep, there is no difference in the occurrence of epileptiform abnormalities between different induction methods. Seizures are rare in sleep electroencephalography recordings.
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Affiliation(s)
- James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Department of Clinical Neurophysiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rosalind H Kandler
- Department of Clinical Neurophysiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Catherine Pang
- Department of Clinical Neurophysiology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Santiago Catania
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
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The role of melatonin to attain electroencephalograms in children in a sub-Saharan African setting. Seizure 2017; 51:87-94. [DOI: 10.1016/j.seizure.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022] Open
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Dirani M, Nasreddine W, Melhem J, Arabi M, Beydoun A. Efficacy of the Sequential Administration of Melatonin, Hydroxyzine, and Chloral Hydrate for Recording Sleep EEGs in Children. Clin EEG Neurosci 2017; 48:41-47. [PMID: 26755506 DOI: 10.1177/1550059415621830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022]
Abstract
Sedation of children for electroencephalography (EEG) recordings is often required. Chloral hydrate (CH) requires medical clearance and continuous monitoring. To try to reduce personnel and time resources associated with CH administration, a new sedation policy was formulated. This study included all children who underwent an EEG during a consecutive 3-month period following the implementation of the new sedation policy, which consists of the sequential administration of melatonin, hydroxyzine (if needed), and CH (if needed). The comparator group included all children with a recorded EEG during a consecutive 3-month period when the sedation policy consisted of the sole administration of CH. A total of 803 children with a mean age of 7.9 years (SD = 5.1, range = 0.5-17.7 years) were included. Sleep EEG recordings were obtained in 364 of 385 children (94.6%) using the old sedation policy and in 409 of 418 children (97.9%) using the new one. With the new sedation policy, the percentage of children requiring CH dropped from 37.1% to 6.7% (P < .001). Time to sleep onset and duration of sleep were not significantly different between the 2 policies. The new sedation policy was very well tolerated. The new sedation policy is very safe, is highly efficacious in obtaining sleep EEG recordings, and will result in substantial saving of time and personnel resources.
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Affiliation(s)
- Maya Dirani
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jawad Melhem
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Guerlain J, Paul A, Rouillon I, Parodi M, Garabedian EN, Loundon N. Efficiency of Melatonin as Compared to Pentobarbital for Audiometry Brainstem Response in Children With Associated Disorders. Am J Audiol 2016; 25:206-10. [PMID: 27598454 DOI: 10.1044/2016_aja-15-0075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/30/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Outpatient pediatric audiometry brainstem response (ABR) uses various techniques (no drug, hydroxyzine, pentobarbital, melatonin). The aim of this study was to evaluate the efficiency of melatonin as compared to pentobarbital in children with associated disorders. METHOD This was a retrospective study that took place in a tertiary care center. Eighty-three children (34 girls and 49 boys) had performed ABR under pentobarbital (GPent) or melatonin (GMel) between 2013 and 2014 and were included. All children had associated neurological or behavioral disorders or had failed a previous ABR using another technique. Success rate, defined as completed binaural investigation, delay, and duration of sleep (minutes), as well as side effects, were compared between GPent and GMel. RESULTS There were 56 patients in GMel and 27 in GPent, with a mean age at test of 3 years and 10 months (1-13 years) and 4 years and 1 month (1-14.5 years), respectively. Success rate was 76.8% and 88.8%, respectively (p > .05), sleep duration was 23 and 153 min (p < .0001), and mean delay was 35 and 54 min. No side effects have been reported. CONCLUSIONS Melatonin is a drug widely used, particularly for electroencephalogram in children. Sleep duration allowed a success rate that was comparable to pentobarbital. Melatonin seems to be an efficient alternative to pentobarbital for pediatric ABR.
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Affiliation(s)
- Joanne Guerlain
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Antoine Paul
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Isabelle Rouillon
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Marine Parodi
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Erea Noel Garabedian
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Natalie Loundon
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
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Bruni O, Alonso-Alconada D, Besag F, Biran V, Braam W, Cortese S, Moavero R, Parisi P, Smits M, Van der Heijden K, Curatolo P. Current role of melatonin in pediatric neurology: clinical recommendations. Eur J Paediatr Neurol 2015; 19:122-33. [PMID: 25553845 DOI: 10.1016/j.ejpn.2014.12.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Melatonin, an indoleamine secreted by the pineal gland, plays a key role in regulating circadian rhythm. It has chronobiotic, antioxidant, anti-inflammatory and free radical scavenging properties. METHODS A conference in Rome in 2014 aimed to establish consensus on the roles of melatonin in children and on treatment guidelines. RESULTS AND CONCLUSION The best evidence for efficacy is in sleep onset insomnia and delayed sleep phase syndrome. It is most effective when administered 3-5 h before physiological dim light melatonin onset. There is no evidence that extended-release melatonin confers advantage over immediate release. Many children with developmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder and intellectual disability have sleep disturbance and can benefit from melatonin treatment. Melatonin decreases sleep onset latency and increases total sleep time but does not decrease night awakenings. Decreased CYP 1A2 activity, genetically determined or from concomitant medication, can slow metabolism, with loss of variation in melatonin level and loss of effect. Decreasing the dose can remedy this. Animal work and limited human data suggest that melatonin does not exacerbate seizures and might decrease them. Melatonin has been used successfully in treating headache. Animal work has confirmed a neuroprotective effect of melatonin, suggesting a role in minimising neuronal damage from birth asphyxia; results from human studies are awaited. Melatonin can also be of value in the performance of sleep EEGs and as sedation for brainstem auditory evoked potential assessments. No serious adverse effects of melatonin in humans have been identified.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Daniel Alonso-Alconada
- Institute for Women's Health, University College London, London, UK; Department of Cell Biology and Histology, University of the Basque Country, Spain
| | - Frank Besag
- South Essex Partnership University NHS Foundation Trust, Bedfordshire, & Institute of Psychiatry, London, UK
| | - Valerie Biran
- Neonatal Intensive Care Unit, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Univ Paris Diderot, 75019 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, INSERM, U1141, 75019 Paris, France
| | - Wiebe Braam
- 's Heeren Loo, Department Advisium, Wekerom, The Netherlands; Governor Kremers Centre, University Maastricht, The Netherlands
| | - Samuele Cortese
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; School of Medicine, and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; New York University Child Study Center, NY, USA
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy; Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Child Neurology-Chair of Pediatrics, c/o Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Marcel Smits
- Governor Kremers Centre, University Maastricht, The Netherlands; Department of Sleep-wake Disorders and Chronobiology, Hospital Gelderse Vallei Ede, The Netherlands
| | - Kristiaan Van der Heijden
- Leiden Institute for Brain and Cognition & Institute of Education and Child Studies, Leiden University, The Netherlands
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy.
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Michel V, Mazzola L, Lemesle M, Vercueil L. Long-term EEG in adults: Sleep-deprived EEG (SDE), ambulatory EEG (Amb-EEG) and long-term video-EEG recording (LTVER). Neurophysiol Clin 2015; 45:47-64. [DOI: 10.1016/j.neucli.2014.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
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[French guidelines on electroencephalogram]. Neurophysiol Clin 2014; 44:515-612. [PMID: 25435392 DOI: 10.1016/j.neucli.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 12/11/2022] Open
Abstract
Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.
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Gustafsson G, Broström A, Ulander M, Vrethem M, Svanborg E. Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation. Clin Neurophysiol 2014; 126:1493-7. [PMID: 25453612 DOI: 10.1016/j.clinph.2014.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/22/2014] [Accepted: 10/04/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16 years old. METHODS We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made. RESULTS No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4 years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12 years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children. CONCLUSION Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect. SIGNIFICANCE Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.
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Affiliation(s)
- Greta Gustafsson
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Anders Broström
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Vrethem
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Svanborg
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Chloral hydrate, chloral hydrate--promethazine and chloral hydrate -hydroxyzine efficacy in electroencephalography sedation. Indian J Pediatr 2014; 81:541-6. [PMID: 24445981 DOI: 10.1007/s12098-013-1298-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare efficacy and safety of chloral hydrate (CH), chloral hydrate and promethazine (CH + P) and chloral hydrate and hydroxyzine (CH + H) in electroencephalography (EEG) sedation. METHODS In a parallel single-blinded randomized clinical trial, ninety 1-7 y-old uncooperative kids who were referred to Pediatric Neurology Clinic of Shahid Sadoughi University, Yazd, Iran from April through August 2012, were randomly assigned to receive 40 mg/kg of chloral hydrate or 40 mg/kg of chloral hydrate and 1 mg/kg of promethazine or 40 mg/kg of chloral hydrate and 2 mg/kg of hydroxyzine. The primary endpoint was efficacy in sufficient sedation (obtaining four Ramsay sedation score) and successful completion of EEG. Secondary endpoint was clinical adverse events. RESULTS Thirty nine girls (43.3 %) and 51 boys (56.7 %) with mean age of 3.34 ± 1.47 y were assessed. Sufficient sedation and completion of EEG were achieved in 70 % (N = 21) of chloral hydrate group, in 83.3 % (N = 25) of CH + H group and in 96.7 % (N = 29) of CH + P group (p = 0.02). Mild clinical adverse events including vomiting [16.7 % (N = 5) in CH, 6.7 % (N = 2) in CH + P, 6.7 % (N = 2) in CH + H], agitation in 3.3 % of CH + P (N = 1) group and mild transient hypotension in 3.3 % of CH + H (N = 1) group occurred. Safety of these three sedation regimens was not statistically significant different (p = 0.14). CONCLUSIONS Combination of chloral hydrate-antihistamines can be used as the most effective and safe sedation regimen in drug induced sleep electroencephalography of kids.
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