Mirror Illusion for Sensori-Motor Training in Stroke: A Randomized Controlled Trial.

BACKGROUND: Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects. METHODS DESIGN: Randomized controlled trial. SETTING: Functional therapy laboratory of Rehabilitation Institute. PARTICIPANTS: Thirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand. OUTCOME MEASURE: Semmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery). INTERVENTION: The experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups. RESULTS: Post intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04). CONCLUSION: MT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands.

51-year old man with tingling, burning and progressive limb weakness.

Peripheral neuropathy is a common reason for referral to neurology. Chronic acquired demyelinating neuropathies are an important and varied group with overlapping presentations, and may have an immune-mediated cause. Their correct diagnosis is important as they respond to different treatments; timely intervention can prevent irreversible axonal degeneration. We present a case that highlights the approach to an adult presenting with a chronic demyelinating neuropathy.

Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy.

Sleep disturbances are common in patients of cirrhosis with minimal hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in cirrhosis with MHE and effect of lactulose on sleep disturbances and HRQOL. One hundred patients of cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included. MHE was diagnosed with psychometric hepatic encephalopathy score (PHES) ≤ -5. All patients underwent laboratory parameters including arterial ammonia and critical flicker frequency (CFF) Sleep disturbances were measured with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and polysomnography. HRQOL was measured with SF-36(v2) questionnaire. Patients with MHE were given lactulose therapy for 3 months and all the parameters were repeated. Poor quality of sleep and excessive day time sleepiness were more common in patients with MHE, compared to without MHE. With lactulose therapy there was improvement in MHE in 21 patients and arterial ammonia levels (93.74 ± 14.8 vs. 71.44 ± 18.8 µmol/L: p < 0.001), CFF (34.83 ± 3.54 vs. 39.44 ± 4.95 Hz: p < 0.001), PHES (-7.64 ± 2.1 vs. -5.58 ± 2.09: p < 0.001), PSQI (8.6 ± 3.3 vs. 5.2 ± 1.5: p < 0.001), ESS (12.52 ± 3.01 vs. 9.24 ± 2.27: p < 0.001) and HRQOL (p = 0.01). Excessive day time sleepiness and impaired sleep quality are common in patients with MHE and correlate with neuropsychiatric impairment. Improvement in MHE with lactulose also leads to improvement in sleep disturbances and HRQOL.

Spectral electroencephalogram in liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy.

BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy. Spectral electroencephalogram (sEEG) analysis improves the recognition of MHE by decreasing inter-operator variability and providing quantitative parameters of brain dysfunction. We compared sEEG in patients with cirrhosis with and without MHE and the effects of lactulose on sEEG in patients with MHE. METHODS: One hundred patients with cirrhosis (50 with and 50 without MHE) were enrolled. Diagnosis of MHE was based on psychometric hepatic encephalopathy score (PHES) of ≤ -5. Critical flicker frequency, model of end-stage liver disease score, and sEEG were performed at baseline in all patients. The spectral variables considered were the mean dominant frequency (MDF) and relative power in beta, alpha, theta, and delta bands. Patients with MHE were given 3 months of lactulose, and all parameters were repeated. RESULTS: Spectral electroencephalogram analysis showed lower MDF (7.8 ± 1.7 vs 8.7 ± 1.3 Hz, P < 0.05) and higher theta relative power (34.29 ± 4.8 vs 24 ± 6.7%, P = 001) while lower alpha relative power (28.6 ± 4.0 vs 33.5 ± 5.3%, P = .001) in patients with MHE than in patients without MHE. With theta relative power, sensitivity 96%, specificity 84%, and accuracy of 90% were obtained for diagnosis of MHE. After lactulose treatment, MHE improved in 21 patients, and significant changes were seen in MDF (7.8 ± 0.5 vs 8.5 ± 0.6), theta (34.2 ± 4.8 vs 23.3 ± 4.1%), alpha (28.6 ± 4.0 vs 35.5 ± 4.5%), and delta relative power (13.7 ± 3.5 vs 17.0 ± 3.3%) after treatment (P ≤ 0.05). CONCLUSIONS: Spectral EEG is a useful objective and quantitative tool for diagnosis and to assess the response to treatment in patients with cirrhosis with MHE.

Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial.

BACKGROUND: To establish the effect of the task-based mirror therapy (TBMT) on the upper limb recovery in stroke. METHODS: A pilot, randomized, controlled, assessor-blinded trial was conducted in a rehabilitation institute. A convenience sample of 33 poststroke (mean duration, 12.5 months) hemiparetic subjects was randomized into 2 groups (experimental, 17; control, 16). The subjects were allocated to receive either TBMT or standard motor rehabilitation-40 sessions (5/week) for a period of 8 weeks. The TBMT group received movements using various goal-directed tasks and a mirror box. The movements were performed by the less-affected side superimposed on the affected side. The main outcome measures were Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA)-FMA of upper extremity (FMA-UE), including upper arm (FMA-UA) and wrist-hand (FMA-WH). RESULTS: The TBMT group exhibited highly significant improvement on mean scores of FMA-WH (P < .001) and FMA-UE (P < .001) at postassessment in comparison to the control group. Furthermore, there was a 12% increase in the number of subjects at BRS stage 5 (out of synergy movement) in the experimental group as compared to a 0% rise at the same stage in the control group. CONCLUSIONS: This pilot trial confirmed the role of TBMT in improving the wrist-hand motor recovery in poststroke hemiparesis. MT using tasks may be used as an adjunct in stroke rehabilitation.

Solar power forecasting beneath diverse weather conditions using GD and LM-artificial neural networks.

Large-scale solar energy production is still a great deal of obstruction due to the unpredictability of solar power. The intermittent, chaotic, and random quality of solar energy supply has to be dealt with by some comprehensive solar forecasting technologies. Despite forecasting for the long-term, it becomes much more essential to predict short-term forecasts in minutes or even seconds prior. Because key factors such as sudden movement of the clouds, instantaneous deviation of temperature in ambiance, the increased proportion of relative humidity and uncertainty in the wind velocities, haziness, and rains cause the undesired up and down ramping rates, thereby affecting the solar power generation to a greater extent. This paper aims to acknowledge the extended stellar forecasting algorithm using artificial neural network common sensical aspect. Three layered systems have been suggested, consisting of an input layer, hidden layer, and output layer feed-forward in conjunction with back propagation. A prior 5-min te output forecast fed to the input layer to reduce the error has been introduced to have a more precise forecast. Weather remains the most vital input for the ANN type of modeling. The forecasting errors might enhance considerably, thereby affecting the solar power supply relatively due to the variations in the solar irradiations and temperature on any forecasting day. Prior approximation of stellar radiations exhibits a small amount of qualm depending upon climatic conditions such as temperature, shading conditions, soiling effects, relative humidity, etc. All these environmental factors incorporate uncertainty regarding the prediction of the output parameter. In such a case, the approximation of PV output could be much more suitable than direct solar radiation. This paper uses Gradient Descent (GD) and Levenberg Maquarndt Artificial Neural Network (LM-ANN) techniques to apply to data obtained and recorded milliseconds from a 100 W solar panel. The essential purpose of this paper is to establish a time perspective with the greatest deal for the output forecast of small solar power utilities. It has been observed that 5 ms to 12 h time perspective gives the best short- to medium-term prediction for April. A case study has been done in the Peer Panjal region. The data collected for four months with various parameters have been applied randomly as input data using GD and LM type of artificial neural network compared to actual solar energy data. The proposed ANN based algorithm has been used for unswerving petite term forecasting. The model output has been presented in root mean square error and mean absolute percentage error. The results exhibit a improved concurrence between the forecasted and real models. The forecasting of solar energy and load variations assists in fulfilling the cost-effective aspects.

Cognitive Dysfunction in Juvenile Myoclonic Epilepsy (JME) - A Tertiary Care Center Study.

BACKGROUND AND AIM: Epilepsy often leads to cognitive impairment. Idiopathic generalized epilepsy as a group is considered to be benign in terms of its effects on cognition. Though, neuropsychological testing reveals subtle frontal impairment in patients with juvenile myoclonic epilepsy (JME). The aim of this study is to evaluate cognitive dysfunction in patients with JME. METHOD: We compared 50 JME patients and 50 age and sex matched healthy controls above 12 years of age on various cognitive tests which included Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Executive Interview (EXIT), PGI Memory Scale (PGIMS), Clock Drawing Test (CDT), Cube copying test (CCT), and Nahor Benson Test (NBT). We correlated the cognitive dysfunction with education level, age of onset, duration of epilepsy, electroencephalogram (EEG) abnormalities, treatment, and seizure control status. RESULTS: JME patients performed significantly worse on MMSE (P = 0.001), PGI MS (P value = 0.001), FAB (P =.001), EXIT (P =.001), CDT (P =.02), and CCT (P =.001) when compared to the controls. JME patients had impaired attention, verbal fluency, design fluency, verbal memory, visual memory, conceptualization, set shifting, mental flexibility, response inhibition, and visuospatial functions. Cognitive dysfunction correlated with education level, duration of epilepsy and EEG abnormality. No correlation was seen with seizure frequency or type of antiepileptic therapy. CONCLUSIONS: JME patients demonstrate both frontal and parietooccipital lobe dysfunction. Hence detailed higher mental function tests supplemented by functional neuroimaging studies should be done in JME patients for their comprehensive management. This would also enhance our knowledge about the pathogenesis of JME.

Progressive multifocal leukoencephalopathy in a patient with idiopathic CD4+T lymphocytopenia.

Progressive multifocal leukoencephalopathy (PML) is demyelinating of central nervous system caused by JC virus infection and often occurs in immunodeficient individuals. We report progressive PML in a 30-year-old male with idiopathic severely depressed CD4+T lymphocyte count. He was sero-negative for human immunodeficiency virus (HIV) infection.

Natural history of minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction.

OBJECTIVES: Minimal hepatic encephalopathy (MHE) leads to deterioration in patient quality of life and could be a marker for future episodes of clinical hepatic encephalopathy (HE) in liver cirrhosis. Whether MHE predicts HE in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the incidence of overt HE in EHPVO patients with MHE. METHODS: Consecutive patients (from October 2006 to July 2007) with a diagnosis of EHPVO were followed up at 3-month intervals. MHE was diagnosed by abnormal psychometry (>2 s.d.) and/or P300 auditory event-related potential (P300 ERP) (>2.5 s.d.), and HE was diagnosed as per West-Heaven criteria. Critical flicker frequency (CFF) was also measured at baseline and after 1 year. RESULTS: Thirty-two EHPVO patients (age, 23.2+/-10.8 years; M/F 22:10) were followed up for 1 year. Of 32 patients, P300 ERP was prolonged in 8 (25%) (371.8+/-13.9 ms), 9 (28%) had abnormal psychometric tests, and CFF was <38 Hz in 8 (25%) patients after a follow-up of 13.5+/-2.4 months. Of 12 patients who had MHE at baseline, 9 (75%) patients continued to have MHE, and in 3 (25%) patients it disappeared. One (5%) of the remaining 20 patients developed MHE during the follow-up. Venous ammonia level was higher in patients with MHE (79.7+/-17.0 micromol/l; range 33-124) compared with patients without MHE (46.6+/-19.8 micromol/l; range 24-78, P<0.001) on follow-up. Similarly, patients who had spontaneous shunts (n=10) had significantly higher venous ammonia levels (82.4+/-20.3 vs. 47.1+/-16.7 micromol/l; P=0.001) than those who had no shunt (n=22). Neither patients who had MHE nor those who did not have MHE at baseline developed HE. CONCLUSIONS: Seventy-five percent of extrahepatic portal vein obstruction patients with MHE continued to have MHE, and new-onset MHE developed in 5% over 1 year. In this small sample, patients with EHPVO and MHE did not progress to overt encephalopathy within the relatively short time frame studied.

Implant for Augmentation of Cerebral Blood Flow Trial-1 (ImpACT-1). A single-arm feasibility study evaluating the safety and potential benefit of the Ischemic Stroke System for treatment of acute ischemic stroke.

BACKGROUND: The Ischemic Stroke System is a novel device designed to deliver stimulation to the sphenopalatine ganglion(SPG).The SPG sends parasympathetic innervations to the anterior cerebral circulation. In rat stroke models, SPG stimulation results in increased cerebral blood flow, reduced infarct volume, protects the blood brain barrier, and improved neurological outcome. We present here the results of a prospective, multinational, single-arm, feasibility study designed to assess the safety, tolerability, and potential benefit of SPG stimulation inpatients with acute ischemic stroke(AIS). METHODS: Patients with anterior AIS, baseline NIHSS 7-20 and ability to initiate treatment within 24h from stroke onset, were implanted and treated with the SPG stimulation. Patients were followed up for 90 days. Effect was assessed by comparing the patient outcome to a matched population from the NINDS rt-PA trial placebo patients. RESULTS: Ninety-eight patients were enrolled (mean age 57years, mean baseline NIHSS 12 and mean treatment time from stroke onset 19h). The observed mortality rate(12.2%), serious adverse events (SAE)incidence(23.5%) and nature of SAE were within the expected range for the population. The modified intention to treat cohort consisted of 84 patients who were compared to matched patients from the NINDS placebo arm. Patients treated with SPG stimulation had an average mRS lower by 0.76 than the historical controls(CMH test p = 0.001). CONCLUSION: The implantation procedure and the SPG stimulation, initiated within 24hr from stroke onset, are feasible, safe, and tolerable. The results call for a follow-up randomized trial (funded by BrainsGate; clinicaltrials.gov number, NCT03733236).

Minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction.

BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability in cirrhotic patients. Its prevalence in extrahepatic portal vein obstruction (EHPVO) is not known. We studied the prevalence of MHE in EHPVO patients and utility of critical flicker frequency (CFF) for diagnosing MHE. PATIENTS AND METHODS: Thirty-four EHPVO patients with a history of variceal bleed (age 23.2 +/- 11.2 yr, M:F 22:12) diagnosed by either Doppler US or MR angiography, which demonstrated portal vein obstruction and/or portal vein cavernoma, were evaluated by psychometry (number connection tests A, B or figure connection tests A, B) and P300 auditory event-related potential (P300ERP). CFF was also evaluated. MHE was diagnosed by abnormal psychometry (>2 standard deviation [SD]) and/or P300ERP (>2.5 SD). RESULTS: Prevalence of MHE (N = 12) was 35.3%. Of 34 patients, P300ERP was abnormal (380.0 +/- 28.9 msec) in 11 (32%), psychometry in 9 (26.4%), both P300ERP and psychometry in 8 (23.5%), and CFF <38 Hz in 7 (21%) patients. Six (67%) patients with abnormal psychometry and 7 (64%) with abnormal P300ERP had CFF below 38 Hz. CFF had sensitivity (75%), specificity (96%), positive predictive value (86%), negative predictive value (93%), and diagnosis accuracy of 91% when compared to patients with both abnormal psychometry and P300ERP. The venous ammonia level was higher in patients with MHE (83.1 +/- 29.7 vs 44.7 +/- 16.1 micromol/L, P < 0.001) compared to patients without MHE. Spontaneous shunts were present in 67% of patients with MHE compared to 14% of non-MHE patients. MHE was more common in patients with spontaneous shunts (72.7%vs 17.4%, P= 0.001) than without spontaneous shunts. CONCLUSIONS: Prevalence of MHE in EHPVO patients is 35.3%, and CFF alone can reliably diagnose 88% of MHE patients with both abnormal psychometry and P300ERP. However, in view of the relatively low number of patients with MHE, the usefulness of CFF in this setting awaits confirmatory studies.

An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy.

BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with lactulose and probiotics has shown some benefit. We compared lactulose with probiotics and a combination of lactulose plus probiotics in the treatment of MHE. PATIENTS AND METHODS: One hundred and ninety cirrhotic patients without overt encephalopathy [Child's A grade 71 patients (37.4%), Child's B grade 72 patients (37.9%), Child's C grade 47 patients (24.7%)] were evaluated by psychometry (number connection tests A and B or figure connection tests A and B) and P300 auditory event-related potential (P300ERP). MHE was diagnosed by abnormal psychometry and/or P300ERP. Patients were randomized to receive lactulose [group A (n=35): dose 30-60 ml/day], probiotics [group B (n=35): dose 1 capsule three times/day, each capsule contained Streptococcus faecalis 60 million, Clostridium butyricum 4 million, Bacillus mesentricus 2 million, lactic acid bacillus 100 million] and lactulose plus probiotics [group C (n=35)] for 1 month. Response was defined by normalization of the abnormal test parameters. RESULTS: MHE was diagnosed in 105 (55.2%) patients. Of the 105 patients, 75 (71%) had both abnormal psychometry and P300ERP, whereas 90 (86%) had abnormal psychometry alone, and 89 patients (85%) had abnormal P300ERP alone. Significant improvement was seen in abnormal psychometry tests (group A: n=31 vs. n=12, group B: n=29 vs. n=14, group C: n=30 vs. n=10), P300ERP (group A: 376.8+/-22.3 vs. 344.3+/-30.6 ms, group B: 385.4+/-28.5 vs. 355.5+/-27.9 ms, group C: 387.7+/-27.5 vs. 347.7+/-31.5 ms) and venous ammonia levels (group A: 102.3+/-63.1 vs. 69.3+/-33.3 micromol/l, group B: 108.2+/-37.5 vs. 75.7+/-33.0 micromol/l, group C: 96.3+/-27.7 vs. 68.7+/-28.4 micromol/l) in lactulose, probiotics and a combination of lactulose plus probiotics groups after treatment. Normalization of abnormal psychometry and P300ERP was seen in 54.8, 51.6 and 56.6% of patients treated with lactulose, probiotics and lactulose plus probiotics groups, respectively. CONCLUSION: A total of 55% of the patients with cirrhosis had MHE. Lactulose or probiotics or combinations of both are equally effective in the treatment of MHE.

Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review.

Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not provide the structural base for the neural-motor recovery. The management of subluxed shoulder has always been a challenge, complicating the motor and functional recovery. Objective To review the available studies of rehabilitation interventions for reduction of subluxed shoulder and to explore the evidence for impact of subluxation on motor recovery. Method PubMed, the Cochrane Central Register of Controlled Trials, DORIS, PEDro, and OTseeker databases were searched using the keywords: Stroke and Shoulder and Subluxation. The experimental, quasi-experimental, and single group studies investigated the rehabilitation methods to reduce the subluxation were selected. A narrative synthesis of the findings from the selected studies was carried out. Result 2717 studies were identified and 22 studies (14 RCTs or controlled trials and 8 pre-post-single group studies) were finally selected for the review. The rehabilitation intervention: Functional electrical stimulation (FES)/electrical stimulation (11), orthosis/support (07), taping (02), and robotic training and other methods (02) were reviewed. FES is effective in reducing subluxation in acute stage. Shoulder support or orthosis while in situ may reduce the subluxation temporarily. X-ray was the most commonly used assessment tool for the subluxation. Implication of the rehabilitation technique on motor recovery has not been investigated. Conclusion No technique could effectively reduce the subluxation and facilitate the upper limb recovery. Further studies integrating the usual motor training and the subluxation rehabilitation are warranted. Future trials using more precise and valid tool such as ultrasonography are also needed.

Modulation of epileptiform EEG discharges in patients with JME.

PURPOSE: To study modulation of epileptiform EEG discharges in patients with JME. METHOD: 50 subjects with JME underwent a sleep deprived EEG recording along with conventional provocative methods and testing with cognitive tasks (CTs). Both categories of tests were evaluated for their effect on occurrence of IEDs. Number of IEDs per unit time was calculated at baseline as well as with each task. Statistical and arbitrary methods were used to assess modulation. By arbitrary method if frequency of IEDs was more than twice that of baseline, it was considered as provocation and if less than half, it was considered as inhibition. To account for spontaneous fluctuation of IEDs, 95% CI was calculated for baseline IEDs in each patient and provocation/inhibition was considered if frequency of IEDs exceeded/remained below limits of CI respectively. RESULTS: There was no significant difference in rates of provocation of IEDs by conventional or CTs. However there was exclusive provocation of IEDs by CTs in 4 patients, 3 of whom were already on AEDs. There was a significant inhibitory effect of CTs as mean baseline discharge frequency was 0.4 ±â€¯1.16 IEDS/min and during CTs was 0.1 ±â€¯0.38 IEDs/min. However when spontaneous fluctuation was accounted for, inhibition was seen in only 22.23% patients by statistical method as compared to 90.91% by arbitrary method. CONCLUSIONS: Inclusion of CTs may assist in provocation of IEDs, thereby increasing yield of routine EEG. Spontaneous fluctuation of IEDs accounts for much observed inhibition by CTs in JME patients.

Association of GABAA Receptor Gene with Epilepsy Syndromes.

GABA has always been an inviting target in the etiology and treatment of epilepsy. The GABRA1, GABRG2, and GABRD genes provide instructions for making α1, ϒ2, and δ subunits of GABAA receptor protein respectively. GABAA is considered as one of the most important proteins and has found to play an important role in many neurological disorders. We explored the association of GABAA receptor gene mutation/SNPs in JME and LGS patients in Indian population. A total of 100 epilepsy syndrome patients (50 JME and 50 LGS) and 100 healthy control subjects were recruited and analyzed by AS-PCR and RFLP-PCR techniques. In our study, GABRA1 965 C > A mutation and 15 A > G polymorphism gene may play an important role in modulating the drug efficacy in LGS patients. The GABRA1 15 A > G polymorphism may also play an important role in the susceptibility of LGS and the inheritance of GG genotype of this polymorphism may provide an increased risk of development of LGS. The GABRG2 588 C > T polymorphism may decrease the duration of seizures in JME patients. The GABRD 659 G > A polymorphism may play an important role in the susceptibility of JME and LGS and this polymorphism may also increase the duration of postictal period in JME patients but may decrease the duration of seizure in LGS patients.

Sleep abnormalities in juvenile myoclonic epilepsy-A sleep questionnaire and polysomnography based study.

PURPOSE: To evaluate the quality of sleep, its architecture and occurrence of epileptiform discharges with their distribution across various stages of sleep in patients of Juvenile myoclonic epilepsy (JME), both drug naïve as well as those already on treatment. METHODS: 99 patients of JME [36 drug naïve, 63 on antiepileptic drug(s) (AED)], and 30 healthy controls were recruited. Sleep quality and daytime sleepiness were evaluated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.Polysomnography (PSG) was done to assess the sleep architecture. The EDI (Epileptiform Discharge Index) per stage of sleep was calculated. RESULTS: JME patients had significantly poor quality of sleep by PSQI (p=0.02).PSG revealed reduced sleep efficiency [p<0.001], increased sleep latency [p=0.02], increased%WASO [p<0.001], increased%N1 [p=0.01] and decreased% REM sleep [p=0.002] in the patients compared to controls. Epileptiform discharges were frequent among drug naïve JME patients [drug naïve, 868 vs. 727, treatment group]. EDI was higher in N1 (p=0.001) and N2 (p=0.007) in drug naïve compared to JME patients on treatment. EDI in valproate treatment group was relatively lower to other AEDs. CONCLUSION: JME is associated with poor sleep quality and altered architecture, irrespective of treatment status. REM sleep is significantly decreased in JME patients. Epileptiform discharges are frequent in lighter NREM sleep and EDI is higher in drug naïve patients. Although AEDs disrupt the NREM sleep, their use is associated with arousal stability in lighter stages of sleep and lower EDI, in particular with valproate.