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Proost R, Lagae L, Van Paesschen W, Jansen K. Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature. Eur J Paediatr Neurol 2022; 38:53-61. [PMID: 35395626 DOI: 10.1016/j.ejpn.2022.03.010] [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: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
Children with epilepsy have more sleep disorders compared to healthy children. The bidirectional interaction between epilepsy and sleep is not completely understood. However, disruption of sleep architecture during childhood may have consequences for cognitive development. As children with drug-refractory epilepsy often have intellectual disability, sleep disruption could be an important contributing factor in severity of their cognitive impairment. To better understand these interactions, sleep architecture in children with drug-refractory epilepsy and epileptic encephalopathies should be investigated. In this review, we conducted a systematic literature search on this topic. Articles that investigated sleep macro- and/or microstructure by means of electroencephalogram/polysomnography were included, as well as articles that used validated questionnaires. Sixteen articles were reviewed, eight of which used polysomnography. Only 2 articles examined sleep in children with epileptic encephalopathies. Consistent findings on measures of sleep architecture were a reduction in REM percentage and an increase in sleep fragmentation when comparing drug-refractory patients with non-refractory and healthy subjects. The findings on slow wave sleep were less clear. Studies with questionnaires unambiguously confirmed subjectively more sleep problems in children with drug-refractory epilepsy. This is the first review of literature in this patient population. More good quality sleep studies in children with drug-refractory epilepsy are warranted. The use of wearables in the home setting together with automatic sleep staging could provide more insights.
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Affiliation(s)
- R Proost
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
| | - L Lagae
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium
| | - W Van Paesschen
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - K Jansen
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
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2
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Garg D, Charlesworth L, Shukla G. Sleep and Temporal Lobe Epilepsy – Associations, Mechanisms and Treatment Implications. Front Hum Neurosci 2022; 16:849899. [PMID: 35558736 PMCID: PMC9086778 DOI: 10.3389/fnhum.2022.849899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
In this systematic review, we aim to describe the association between temporal lobe epilepsy (TLE) and sleep, with bidirectional links in mechanisms and therapeutic aspects. Sleep stages may variably impact seizure occurrence, secondary generalization and the development, frequency and distribution of interictal epileptiform discharges. Conversely, epilepsy affects sleep micro- and macroarchitecture. TLE, the most frequent form of drug resistant epilepsy (DRE), shares an enduring relationship with sleep, with some intriguing potential mechanisms specific to anatomic localization, linking the two. Sleep characteristics of TLE may also inform localizing properties in persons with DRE, since seizures arising from the temporal lobe seem to be more common during wakefulness, compared to seizures of extratemporal origin. Polysomnographic studies indicate that persons with TLE may experience excessive daytime somnolence, disrupted sleep architecture, increased wake after sleep onset, frequent shifts in sleep stages, lower sleep efficiency, decreased rapid eye movement (REM) sleep, and possibly, increased incidence of sleep apnea. Limited literature suggests that effective epilepsy surgery may remedy many of these objective and subjective sleep-related concerns, via multipronged effects, apart from reduced seizure frequency. Additionally, sleep abnormalities also seem to influence memory, language and cognitive-executive function in both medically controlled and refractory TLE. Another aspect of the relationship pertains to anti-seizure medications (ASMs), which may contribute significantly to sleep characteristics and abnormalities in persons with TLE. Literature focused on specific aspects of TLE and sleep is limited, and heterogeneous. Future investigations are essential to understand the pathogenetic mechanisms linking sleep abnormalities on epilepsy outcomes in the important sub-population of TLE.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Garima Shukla
- Division of Epilepsy and Sleep Medicine, Queen’s University, Kingston, ON, Canada
- *Correspondence: Garima Shukla,
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Clinical features of paediatric and adult autoimmune encephalitis: A multicenter sample. Eur J Paediatr Neurol 2021; 30:82-87. [PMID: 33461084 DOI: 10.1016/j.ejpn.2021.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/29/2020] [Accepted: 01/02/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Autoimmune encephalitis (AE) is a heterogeneous class of inflammatory diseases of the brain that can present with a wide spectrum of neuropsychiatric symptoms. Patients may be negative for CSF anti-neuronal antibodies, which can make the diagnosis of AE challenging. Distinguishing features between paediatric and adult patients with AE are not well characterized. OBJECTIVE Describe the clinical presentation, seizure type, EEG and sleep patterns in paediatric and adult patients with AE. METHODS/DESIGN Retrospective review of clinical data from paediatric and adult patients diagnosed with AE from three medical centers between 1/2008-12/2019. RESULTS We included 100 patients with AE, including 65 children. Median age at presentation was 14 years (1-88years). Fifty-five patients had positive CSF autoantibody results (NMDAR 36%, VGKC Ab 10%, anti-GAD65 4%, miscellaneous 3%), and 47 patients were autoantibody-negative. Paediatric patients were more likely to present with psychiatric symptoms, focal seizures and/or status epilepticus, and sleep disturbances compared to adult patients (p < 0.05). There was a higher incidence of NMDA-R encephalitis in children compared to adults. CONCLUSION Paediatric patients with AE were more likely to present with psychiatric symptoms, sleep disturbances, focal seizures, and/or status epilepticus compared to adults (p < 0.05). Insomnia and hypersomnia are common sleep problems associated with AE that should be screened early in the diagnostic evaluation. Further studies can be performed to explore the relationship between sleep disturbances and long-term cognitive effects and the incidence of chronic epilepsy in this subset of patients.
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SLEEP ABNORMALITIES AND POLYSOMNOGRAPHIC PROFILE IN CHILDREN WITH DRUG-RESISTANT EPILEPSY. Seizure 2020; 82:59-64. [DOI: 10.1016/j.seizure.2020.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
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Precenzano F, Parisi L, Lanzara V, Vetri L, Operto FF, Pastorino GMG, Ruberto M, Messina G, Risoleo MC, Santoro C, Bitetti I, Marotta R. Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications. ACTA ACUST UNITED AC 2020; 56:medicina56090419. [PMID: 32825169 PMCID: PMC7559692 DOI: 10.3390/medicina56090419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/03/2022]
Abstract
A large body of literature reports the higher prevalence of epilepsy in subjects with Autism Spectrum Disorder (ASD) compared to the general population. Similarly, several studies report an increased rate of Subclinical Electroencephalographic Abnormalities (SEAs) in seizure-free patients with ASD rather than healthy controls, although with varying percentages. SEAs include both several epileptiform discharges and different non-epileptiform electroencephalographic abnormalities. They are more frequently associated with lower intellectual functioning, more serious dysfunctional behaviors, and they are often sign of severer forms of autism. However, SEAs clinical implications remain controversial, and they could represent an epiphenomenon of the neurochemical alterations of autism etiology. This paper provides an overview of the major research findings with two main purposes: to better delineate the state-of-the-art about EEG abnormalities in ASD and to find evidence for or against appropriateness of SEAs pharmacological treatment in ASD.
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Affiliation(s)
- Francesco Precenzano
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Lucia Parisi
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Valentina Lanzara
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Luigi Vetri
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-328-643-4126
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Grazia Maria Giovanna Pastorino
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Maria Ruberto
- Centro Pro Juventute Minerva SRL, 80131 Napoli, Italy;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Risoleo
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Claudia Santoro
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Ilaria Bitetti
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Rosa Marotta
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
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Raucci U, Pro S, Di Capua M, Di Nardo G, Villa MP, Striano P, Parisi P. A reappraisal of the value of video-EEG recording in the emergency department. Expert Rev Neurother 2020; 20:459-475. [PMID: 32249626 DOI: 10.1080/14737175.2020.1747435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Capua
- Neurophysiological Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, ‘G. Gaslini’ Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Rome, Italy
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Chan SYS. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol 2020; 62:426-433. [PMID: 31879946 DOI: 10.1111/dmcn.14437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.
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Affiliation(s)
- Samantha Yuen-Sum Chan
- Clinical Neurosciences Section, Developmental Neurosciences Programme, UCL GOS Institute of Child Health, London, UK
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8
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Li X, Xie LL, Han W, Hong SQ, Ma JN, Wang J, Jiang L. Clinical Forms and GRIN2A Genotype of Severe End of Epileptic-Aphasia Spectrum Disorder. Front Pediatr 2020; 8:574803. [PMID: 33240831 PMCID: PMC7677254 DOI: 10.3389/fped.2020.574803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aims to analyze the electroclinical characteristics and gene test results of children on the severe end of the epilepsy aphasia spectrum (EAS) and also the correlation of EAS-related GRIN2A genes to explore the genotype-phenotype relationships, as well as potential pathogenic mechanism of EAS. Methods: A retrospective study was conducted on the participants diagnosed with Landau-Kleffner syndrome (LKS), epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS), and atypical benign partial epilepsy (ABPE) at the Children's Hospital of Chongqing Medical University from January 2013 to June 2019. Whole-exome sequencing was performed in six patients, and epileptic panel was carried out in two. In addition, we reviewed all the published literatures reporting EAS patients with pathogenic variants until June 2019 and conducted Gene Ontology (GO) analysis, as well as protein-protein interaction (PPI) network. Results: The mean age at seizure onset was 55.4 ± 27.0 months. The baseline severity of the spike-wave index (SWI) was not significantly correlated with intellectual disability (ID) level. Two pathogenic de novo GRIN2A null variants were identified in patients with ABPE who had less severe ID, despite the electrical status epilepticus during slow-wave sleep (ESES). By literature reviewing, 18 GRIN2A missense mutations and 11 GRIN2A truncating mutations which lead to N-methyl-d-aspartate receptors' loss of function has been reported. Of these mutations, 9 (31.0%) are situated in amino (N)-terminal domain, 6 (20.7%) in linger-binding domain S1, and 10 (34.5%) in linger-binding domain S2. EAS-related genes were enriched in the biological process of chemical synaptic transmission and vocalization (FDR, <0.01). The hub protein in PPI network is GluN2A, which might affect language function via foxp2-srpx2/uPAR signal network. Conclusion: Our data suggested that when children suspected with benign epilepsy of children with centrotemporal spikes (BECTs) have early-onset age, changed seizure semiology, and deterioration of behavior/cognition/motor function, neurologists should be alert of the appearance of ESES. The neuropsychological deterioration in children with EAS might not only be completely affected by electric discharge severity but also genetic etiology. Our finding also enforced the current genotype-phenotype relationship theory about EAS. For EAS children, GRIN2A-FOXP2-SRPX2/uPAR signal network might contribute to the mechanism of their language deficit.
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Affiliation(s)
- Xiao Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling-Ling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wei Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Si-Qi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian-Nan Ma
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Juan Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Marcuccio G, DI Bari MM, Precenzano F, Operto FF, Bitetti I, Motta G, Testa D. Relationship between sleep quality and rhinitis in children: role of medical treatment with isotonic and hypertonic saline. Minerva Pediatr (Torino) 2019; 73:301-306. [PMID: 31352769 DOI: 10.23736/s2724-5276.19.05563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The nose represents the port of entry, the first part of the upper airway and accounts for 50% of its total resistance. Many authors identified rhinitis as relevant factor affecting quality of life, and sleep habits of sufferers and their caregiver's, particularly between 4-17 years old children. Both allergic rhinitis and non-allergic rhinitis may represent an important risk for obstructive sleep apnea syndrome in children. We evaluated the quality of sleep and the role of nasal irrigations with saline solutions in children with sign and symptoms of rhinitis. METHODS An observational retrospective study was conducted on 58 children aged 3-6 years old receiving diagnosis of rhinitis according to clinical and amnestic evaluation. All recruited children were screened before medical topic treatment with the Pediatric Sleep Questionnaire test in order to evaluate the sleep habits and after isotonic and hypertonic saline nasal irrigation for six months. One-Way ANOVA was used for statistical analysis of the results. RESULTS Forty-nine of 58 recruited children reached the follow-up control after six months of medical treatment. Mean score at Pediatric Sleep Questionnaire before and after medical treatments was respectively 0.39 and 0.28. One-Way ANOVA test showed a significant statistical difference (P<0.05). CONCLUSIONS Nasal topic decongestant may be used only for short-term treatments, and they do not seem to have long-term results. Topic corticosteroids may be used for long term treatment and their correlations with OSA seem to have different results. This study aims to attracting the attention of pediatricians on the importance of nasal topic saline solutions irrigations in children with rhinitis in improving HRQoL decreasing snoring and apneas and so daytime symptoms.
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Affiliation(s)
- Giuseppina Marcuccio
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Matteo Matteo DI Bari
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesco Precenzano
- Unit of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesca F Operto
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy
| | - Ilaria Bitetti
- Unit of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Gaetano Motta
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Domenico Testa
- Unit of Head and Neck Surgery, Division of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Bektaş G, Tekin U, Yıldız EP, Aydınlı N, Çalışkan M, Özmen M. Autism spectrum disorder and attention-deficit/hyperactivity disorder-related symptoms in benign childhood epilepsy with centrotemporal spikes: A prospective case-control study. Epilepsy Behav 2019; 95:61-64. [PMID: 31026784 DOI: 10.1016/j.yebeh.2019.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Benign childhood epilepsy with centrotemporal spikes (BECTS), one of the most common idiopathic epilepsy syndromes in children, has been associated with neuropsychological problems. PURPOSE The objective of this study was to investigate the frequency of symptoms related to comorbid neurodevelopmental disorders, the autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children with typical BECTS, and to identify corresponding risk factors. METHODS Children and adolescents with typical BECTS aged 6-16 years were included in the study period from January 1, 2017, to December 31, 2017. Children with atypical presentations of BECTS, other neurological disorders, and preexisting neuropsychiatric disorders were excluded. The ASD and ADHD were assessed by the Social Communication Questionnaire (SCQ) and the Turgay Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), respectively. Patients' scores were compared with those of healthy subjects. Correlation analyses were performed to evaluate the association between the age at seizure onset, the total number of seizures and the SCQ and T-DSM-IV-S scores. RESULTS Fifty-eight children with BECTS and 60 healthy children participated in the study. The total SCQ score, the SCQ reciprocal social interaction score, and the SCQ communication score significantly differed between children with BECTS and the control group (p = 0.001, p < 0.001, p = 0.001, respectively). The total ADHD score was significantly different between patients and controls (p < 0.001). A significant difference was observed between patients and controls in terms of the T-DSM-IV-S hyperactivity-impulsivity score and the T-DSM-IV-S inattention score (p = 0.012, p < 0.001, respectively). The age at seizure onset was significantly correlated with the total SCQ score (p = 0.03). The Spearman's correlation coefficient was 0.352 for the total SCQ score, indicating a positive association between the age at seizure onset and the total SCQ score. CONCLUSION Children with typical BECTS may have an increased risk of suffering from symptoms of ASD and ADHD. Children with late onset of seizures may be more likely to develop neuropsychological disturbances regarding ASD and ADHD.
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Affiliation(s)
- Gonca Bektaş
- Division of Pediatric Neurology, Department of Pediatrics, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey.
| | - Uğur Tekin
- Department of Child and Adolescent Psychiatry, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Edibe Pembegül Yıldız
- Division of Pediatric Neurology, Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Nur Aydınlı
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mine Çalışkan
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral Özmen
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Chakravarty K, Shukla G, Poornima S, Agarwal P, Gupta A, Mohammed A, Ray S, Pandey RM, Goyal V, Srivastava A, Behari M. Effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy versus healthy controls - A prospective study. Epilepsy Behav 2019; 92:176-183. [PMID: 30665125 DOI: 10.1016/j.yebeh.2018.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 01/16/2023]
Abstract
We aimed to evaluate the effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy and compare these with healthy individuals. We prospectively enrolled 37 adolescent and adult patients with refractory focal epilepsy (Group 1) and controlled epilepsy (Group 2) in each group. History pertaining to epilepsy and sleep were recorded, and all patients underwent overnight polysomnography. Language, memory, and executive function assessments were done using Western Aphasia Battery, Post Graduate Institute (PGI) memory scale, and battery of four executive function tests (Trail Making Test A & B, Digit symbol test, Stroop Task, and Verbal Fluency Test), respectively. Forty age- and sex-matched controls were also included in the study. Significant differences were noted in both objective and subjective sleep parameters among all the groups. On polysomnography, parameters like total sleep time, sleep efficiency, sleep latency, and rapid eye movement (REM) latency were found to be significantly worse in Group 1 as compared with Group 2. Cognitive and executive parameters were significantly impaired in Group 1. Shorter total sleep time, poorer sleep efficiency, and prolonged sleep latencies were observed to be associated with poor memory and executive function in patients with refractory epilepsy. Our study strongly suggests that sleep disturbances, mainly shorter total sleep time, poor sleep efficiency, and prolonged sleep latencies, are associated with impaired memory and executive function in patients with refractory focal epilepsy and to a lesser extent, among those with medically controlled epilepsy.
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Affiliation(s)
- Kamalesh Chakravarty
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivani Poornima
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupama Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Afsar Mohammed
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sucharita Ray
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhuri Behari
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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12
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Nenadic-Baranasic N, Gjergja-Juraski R, Lehman I, Turkalj M, Nogalo B, Barisic N. Overnight Video-Polysomnographic Studies in Children with Intractable Epileptic Encephalopathies. Med Sci Monit 2018; 24:5405-5411. [PMID: 30076286 PMCID: PMC6089594 DOI: 10.12659/msm.908911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to assess sleep architecture and respiration during sleep in children with intractable epileptic encephalopathies using overnight video-polysomnography (V-PSG). Material/Methods Between 2015 to 2017 overnight V-PSG recordings were made for 31 children (22 boys and 9 girls) with intractable epileptic encephalopathy with a mean age of 6.78±3.61 years and a mean body mass index (BMI) of 15.83±3.16 kg/m3. Thirty-one healthy children were matched for sex, age, and BMI as the control group. The phases of sleep studied included rapid eye movement (REM) sleep, and non-REM (NREM) phases NREM 1, NREM 2, and NREM 3. Respiratory function during sleep was evaluated. Results Children with epileptic encephalopathies receiving antiepileptic treatment had significantly decreased total sleep time (TST) (p=0.038), significantly increased percentage of NREM1 (p=0.033), and a significantly lower percentage of total REM (p<0.0001), compared with the control group. All children 31/31 (100%) with epileptic encephalopathies had interictal epileptiform discharges, and 4/31 (12.9%) had ictal events. The number of respiratory events did not differ significantly between the two groups (p=0.118), but children in the epileptic encephalopathy group had a significantly shorter average duration (p=0.008) and longest duration (p=0.048) of respiratory events. Average (p=0.006) and least (p=0.0004) oxygen saturation (SatO2) were significantly lower in children with epileptic encephalopathies compared with the control group. Conclusions Children with epileptic encephalopathies had altered sleep architecture and marked oxygen desaturation, which supports the need for referral of children with epileptic encephalopathy for overnight sleep evaluation.
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Affiliation(s)
| | - Romana Gjergja-Juraski
- Unit for Sleep Disorders in Children, Srebrnjak Children's Hospital, Zagreb, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ivan Lehman
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Turkalj
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Reference Center for Clinical Pediatric Allergology of the Ministry of Health, Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Boro Nogalo
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Nina Barisic
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Shehata HS, AbdelGhaffar HM, Nasreldin M, Elmazny A, Abdelalim A, Sabbah A, Shalaby NM. Clinical patterns and outcomes of status epilepticus in patients with tuberous sclerosis complex. Ther Clin Risk Manag 2017; 13:779-785. [PMID: 28721058 PMCID: PMC5501639 DOI: 10.2147/tcrm.s138576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Refractory epilepsy is a common clinical manifestation in patients with tuberous sclerosis complex (TSC), which can be complicated by many life-threatening conditions, such as status epilepticus (SE). However, very few reports mention the patterns and semiology of SE in those patients. OBJECTIVE To study the clinical characteristics and outcomes of SE in TSC patients. MATERIALS AND METHODS This observational, prospective study was carried out on 36 Egyptian children with definite TSC. Clinical history, general and neurological examination and psychometric evaluation by standard questionnaires were used to explore characteristics of epileptic manifestations and clinical patterns of SE. All included patients were required to have long-term video electroencephalograms (EEGs) and brain MRI performed. RESULTS A total of 32 attacks of SE were recorded in 21 patients (58.3%) in our cohort during a follow-up period of 2.8±1.1 years; of those patients, 15 had convulsive status, 7 had non-convulsive SE, 6 had refractory/super-refractory SE and 14 patients had a history of infantile spasms (epileptic spasms). The duration of status ranged from 40 to 150 min (mean ± standard deviation: 90±15). Fourteen patients with SE had severe mental retardation, 9 had autistic spectrum disorder and 22 had severe epileptogenic EEG findings. Patients with SE had higher tuber numbers (mean: 9.6), 5 patients had subependymal giant cell astrocytomas and 2 patients had their SE after receiving everolimus. CONCLUSIONS The incidence of SE in our patient sample is high (>50%); severe mental retardation, autistic features, history of infantile spasm (epileptic spasms) and high tuber burden are risk factors for developing SE.
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14
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An Z, Wang D, Yang G, Zhang WQ, Ren J, Fu JL. Role of microRNA-130a in the pathogeneses of obstructive sleep apnea hypopnea syndrome-associated pulmonary hypertension by targeting the GAX gene. Medicine (Baltimore) 2017; 96:e6746. [PMID: 28514291 PMCID: PMC5440128 DOI: 10.1097/md.0000000000006746] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to elucidate the role of microRNA-130a (miR-130a) in obstructive sleep apnea hypopnea syndrome (OSAHS)-associated pulmonary hypertension (PHT) by targeting the growth arrest-specific homeobox (GAX) gene. METHODS A total of 108 patients with OSAHS-associated PHT were recruited as the OSAHS-associated PHT group and 110 healthy individuals were randomly selected as the normal control group. Human umbilical vein endothelial cells (HUVECs) were selected and divided into the control, miR-130a mimic, mimic negative control (NC), miR-130a inhibitor, and inhibitor-NC groups. The dual luciferase reporter gene assay was used to identify the relationship between miR-130a and the GAX gene. The quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were applied for the relative expressions of miR-130a and the mRNA and protein expressions of GAX. Serum levels of endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), nitric oxide (NO), and super oxide dismutase (SOD) were detected. Cell apoptosis and angiogenic activity were analyzed by flow cytometry and cell tube formation assay. RESULTS GAX was a target gene of miR-130a. Compared with the normal control group, the relative expression of miR-130a and the serum levels of ET-1 and VEGF were increased, whereas the mRNA expression of GAX and the serum levels of NO and SOD were decreased in the OSAHS-associated PHT group. Compared with the control, mimic-NC, and inhibitor-NC groups, the relative expressions of miR-130a in the miR-130a mimic group were enhanced, whereas the expression of miR-130a in the miR-130a inhibitor group was reduced. However, the mRNA and protein expressions of GAX showed an opposite trend in the miR-130a mimic and miR-130a inhibitor groups. In comparison to the control, mimic-NC, and inhibitor-NC groups, the miR-130a mimic group had an increase of ET-1 and VEGF expressions, whereas the expressions of NO and SOD were reduced. However, the miR-130a inhibitor group exhibited an opposite trend. The apoptosis rate and tube formation number in the miR-130a mimic group were obviously increased, whereas the miR-130a inhibitor group showed an obvious decrease. CONCLUSION These data provided strong evidence that miR-130a may be involved in the progression of OSAHS-associated PHT by down-regulating GAX gene.
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Affiliation(s)
- Zhe An
- Department of Cardiology, China-Japan Union Hospital of Jilin University
| | - Dan Wang
- Department of Breast Surgery, The Second Hospital of Jilin University
| | - Guang Yang
- Department of Molecular Biology, College of Basic Medical Sciences, Jilin University
| | - Wen-Qi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University
| | - Jin Ren
- Department of Respiratory Medicine, the Second Hospital of Jilin University
| | - Jin-Ling Fu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, P.R. China
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15
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Precenzano F, Ruberto M, Parisi L, Salerno M, Maltese A, Gallai B, Marotta R, Lavano SM, Lavano F, Roccella M. Visual-spatial training efficacy in children affected by migraine without aura: a multicenter study. Neuropsychiatr Dis Treat 2017; 13:253-258. [PMID: 28184165 PMCID: PMC5291325 DOI: 10.2147/ndt.s119648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Routinely in the clinical practice, children affected by migraine without aura (MwA) tend to exhibit severe and persistent difficulties within cognitive processes such as attention, memory, and visual-motor integration (VMI) skills. The aim of this study was to assess the visual-spatial and visual-motor abilities among a sample of children with MwA and the effects of a specific computerized training. The study population was composed of 84 patients affected by MwA (39 girls and 45 boys; mean age: 8.91±2.46 years), and they were randomly divided into two groups (group A and group B) comparable for age (P=0.581), gender (P=0.826), socioeconomic status (SES), migraine frequency (P=0.415), and intensity (P=0.323). At baseline (T0), the two groups were comparable for movement assessment battery for children (M-ABC) and VMI performances. After 6 months of treatment (T1), group A showed lower scores in the dexterity item of M-ABC test (P<0.001) and higher scores in M-ABC global performance centile (P<0.001) and total (P<0.001), visual (P=0.017), and motor (P<0.001) tasks of VMI test than group B. Moreover, at T1, group A showed higher scores in total (P<0.001) and motor (P<0.001) tasks of VMI test and in M-ABC global performance centile (P<0.001) and lower scores in the dexterity item of M-ABC test (P<0.001) than at T0. Group B showed, at T1, performances comparable to T0 for all evaluations. As reported by recent studies about alteration MwA among children in motor abilities, our study confirmed these difficulties and the efficacy of a specific software training, suggesting a new rehabilitative proposal in childhood.
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Affiliation(s)
- Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Headache Center for Children and Adolescent. Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania Luigi Vanvitelli, Naples
| | - Lucia Parisi
- Department of Psychological, Pedagogical and Educational Sciences
| | - Margherita Salerno
- Sciences for Mother and Child Health Promotion, University of Palermo, Palermo
| | - Agata Maltese
- Department of Psychological, Pedagogical and Educational Sciences
| | - Beatrice Gallai
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia
| | | | | | | | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences
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16
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Wang B, Isensee C, Becker A, Wong J, Eastwood PR, Huang RC, Runions KC, Stewart RM, Meyer T, Brüni LG, Zepf FD, Rothenberger A. Developmental Trajectories of Sleep Problems from Childhood to Adolescence Both Predict and Are Predicted by Emotional and Behavioral Problems. Front Psychol 2016; 7:1874. [PMID: 27990129 PMCID: PMC5131000 DOI: 10.3389/fpsyg.2016.01874] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
Although the prevalence rates of sleep disorders at different stages of childhood and adolescence have been well established, little is known about the developmental course of general sleep problems. This also holds true for the bidirectional relationship between sleep problems and emotional as well as behavioral difficulties. This longitudinal study investigated the general pattern and the latent trajectory classes of general sleep problems from a large community sample aged 5–14 years. In addition, this study examined the predictive value of emotional/behavioral difficulties (i.e., anxiety/depression, attention problems, and aggressive behavior) on sleep problems latent trajectory classes, and vice-versa. Participants (N = 1993) were drawn from a birth cohort of Western Australian children born between 1989 and 1991 who were followed until 14 years of age. Sleep problems were assessed at ages 5, 8, 10, and 14, respectively, whereas anxiety/depression, attention problems, and aggressive behavior were assessed at ages 5 and 17 years. Latent growth curve modeling revealed a decline in an overall pattern of sleep problems during the observed 10-year period. Anxiety/depression was the only baseline factor that predicted the longitudinal course of sleep problems from ages 5 to 14 years, with anxious and depressed participants showing faster decreasing patterns of sleep problems over time than those without anxiety or depression. Growth mixture modeling identified two classes of sleep problem trajectories: Normal Sleepers (89.4%) and Troubled Sleepers (10.6%). Gender was randomly distributed between these groups. Childhood attention problems, aggressive behavior, and the interaction between gender and anxiety/depression were significantly predictive of membership in the group of Troubled Sleepers. Group membership in Troubled Sleepers was associated with higher probability of having attention problems and aggressive behavior in mid-adolescence. Boys and girls with behavioral difficulties, and girls with emotional difficulties were at increased risk of having sleep problems during later childhood and adolescence. Developmental trajectories of sleep problems were also predictive of behavioral difficulties in later life. Findings from this study provide empirical evidence for the heterogeneity of sleep problems and their development, and emphasize the importance of understanding sleep problems and their relationship to children and adolescents’ mental health.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Janice Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth WA, Australia
| | | | - Kevin C Runions
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Goettingen Goettingen, Germany
| | - L G Brüni
- Child and Adolescent Psychiatry, Psychiatry Services Thurgau Frauenfeld, Switzerland
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, PerthWA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health, PerthWA, Australia
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
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Mengatto CM, Coelho-de-Souza FH, de Souza Junior OB. Sleep bruxism: challenges and restorative solutions. Clin Cosmet Investig Dent 2016; 8:71-7. [PMID: 27217798 PMCID: PMC4853149 DOI: 10.2147/ccide.s70715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Bruxism is a parafunctional activity related to clenching or grinding the teeth and tooth wear can be a consequence of sleep bruxism (SB). Management of severe tooth wear due to SB is a challenging situation because of the common reduced amount of remaining dental structure and loss of vertical dimension of occlusion. Rationale for the planning of oral rehabilitation of patients with SB presenting severe tooth wear should rely on evidence-based approaches; however, few studies have discussed properties of dental materials for SB rehabilitation and how to cosmetically manage severe tooth wear. This review aimed to provide an overview into bruxism cosmetic rehabilitation and how this can be implemented with good outcomes for the patient.
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Affiliation(s)
- Cristiane Machado Mengatto
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fábio Herrmann Coelho-de-Souza
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Oswaldo Baptista de Souza Junior
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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18
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Establishing a Role for Polysomnography in Hospitalized Children. Pediatr Neurol 2016; 57:39-45.e1. [PMID: 26774552 DOI: 10.1016/j.pediatrneurol.2015.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/03/2015] [Accepted: 12/21/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with medical complexity have a high prevalence of sleep disorders. However, outpatient polysomnography to evaluate for these conditions may be difficult to perform because of lack of skilled nursing care. The aim of this study was to explore polysomnography indications in hospitalized children and assess its impact on patient care. METHODS Data from 85 inpatient polysomnographies of 70 children hospitalized between March and December 2014 were retrospectively collected. RESULTS Sixty percent of patients were boys with ages 6.5 ± 6 years. Chronic respiratory failure was present in 33.8%, airway obstruction due to defects of the tracheobronchial tree or craniofacial abnormalities in 54.3%, neurological complications of the perinatal period in 22.9%, genetic syndromes and neurodegenerative disorders in 31.4%, congenital myopathies in 5.7%, metabolic diseases in 4.3% and congenital cyanotic heart defects in 4.3%. Indications for polysomnography included assessment of chronic pulmonary disease (60%), ventilator requirements (41.2%), apnea/desaturation (23.5%), and acute life-threatening events (1.2%). Abnormal results were found in 89.4%. The observed diagnosis was obstructive sleep apnea in 64.7%, signs of chronic lung disease in 34.1%, hypoventilation in 9.4%, periodic breathing in 3.5%, and periodic limb movement of sleep in 4.7%. The following interventions were performed: adjustment of ventilator parameters (45.8%), positive airway pressure initiation (24.7%), otorhinolaryngology referral (30.6%), supraglottoplasty (2.4%), tracheostomy decannulation (2.4%), and tracheostomy placement (3.5%). Nine patients had available follow-up polysomnograms, all showing improvement in sleep variables after adherence to recommended interventions. CONCLUSIONS In individuals with complex medical disorders, inpatient polysomnographies give invaluable information to guide immediate medical decision making and should be strongly considered if resources allow this.
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Gregory AM, Sadeh A. Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science. J Child Psychol Psychiatry 2016; 57:296-317. [PMID: 26412255 DOI: 10.1111/jcpp.12469] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. FINDINGS To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. CONCLUSIONS While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Chen TY, Chou YC, Tzeng NS, Chang HA, Kuo SC, Pan PY, Yeh YW, Yeh CB, Mao WC. Effects of a selective educational system on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. Neuropsychiatr Dis Treat 2015; 11:741-50. [PMID: 25834449 PMCID: PMC4372029 DOI: 10.2147/ndt.s77179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan. METHODS This cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261), Grade 2 (n=228), Grade 3T (n=199; Grade 3 students who had another college entrance test to take), and Grade 3S (n=69; Grade 3 students who had succeeded in their college application). Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory - Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory(®)-II (BDI-II), respectively. RESULTS Physical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test) students had the worst fatigue severity, and the Grade 3S (success) students had the least fatigue severity. More than half of the students (60.9%) went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3%) and Grades 3T/S (30.2%/30.4%) possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24), and the Grade 3S students had a much lower BDI-II score (7.91±6.13). CONCLUSION Relatively high proportions of fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents were found in our study. The severities of fatigue, sleep problems, and depression were significantly diminished in the group under less academic stress (Grade 3S). Our findings may increase the understanding of the mental health of senior high school students under academic pressure in Taiwan. Further large sample size and population-based study should be done for better understanding about this topic.
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Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shin-Chang Kuo
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Wei Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chung Mao
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Wang S, Fallah A. Optimal management of seizures associated with tuberous sclerosis complex: current and emerging options. Neuropsychiatr Dis Treat 2014; 10:2021-30. [PMID: 25364257 PMCID: PMC4211915 DOI: 10.2147/ndt.s51789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Seizures are clinically significant manifestations associated with 79%-90% of patients with tuberous sclerosis complex. Often occurring within the first year of life in the form of infantile spasms, seizures interfere with neuropsychiatric, social, and cognitive development and carry significant individual and societal consequences. Prompt identification and treatment of seizures is an important focus in the overall management of tuberous sclerosis complex patients. Medical management, either after seizure onset or prophylactically in infants with electroencephalographic abnormalities, is considered first-line therapy. Vigabatrin and adrenocorticotropic hormone have emerged over the past few decades as mainstay pharmacologic modalities. Furthermore, emerging research on mammalian target of rapamycin inhibitors demonstrated promise for the management of seizures and subependymal giant cell astrocytoma. For appropriate surgical candidates with an epileptogenic zone associated with one or more glioneuronal hamartomas, ideally in noneloquent cortex, resective surgery can be considered, which provides a cure in 56% of patients. For medically refractory patients who do not meet criteria for curative surgery, palliative surgical approaches focused on reducing seizure burden, in the form of corpus callosotomy and vagus nerve stimulation, are alternative management options. Lastly, the ketogenic diet, a reemerging therapy based on the anticonvulsant effects of ketone bodies, can be utilized independently or in conjunction with other treatment modalities for the management of difficult-to-treat seizures.
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Affiliation(s)
- Shelly Wang
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Aria Fallah
- Department of Neurosurgery, Miami Children's Hospital, Miami, FL, USA ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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