Alterations in functional brain connectivity following treatment for restless legs syndrome: The role of symptom improvement in restoring functional connectivity.

The pathophysiology of restless legs syndrome (RLS) remains incompletely understood. Although several studies have investigated the alterations of brain connectivity as one of the pathophysiological mechanisms of RLS, there are only few reports on functional connectivity changes after RLS treatment. Forty-nine patients with newly diagnosed RLS and 50 healthy controls were prospectively enrolled. The patients underwent resting-state functional magnetic resonance imaging (rs-fMRI) at baseline, and 39 patients underwent follow-up rs-fMRI, 3 months after treatment with pramipexole or pregabalin. Patients were divided into good or poor medication response groups. Functional brain connectivity was analysed using rs-fMRI and graph theoretical analysis. Significant differences in functional connectivity were observed between the RLS patients and healthy controls. The average path length, clustering coefficient, transitivity, and local efficiency were lower (2.02 vs. 2.30, p < 0.001; 0.45 vs. 0.56, p < 0.001; 3.08 vs. 4.21, p < 0.001; and 0.71 vs. 0.76, p < 0.001, respectively) and the global efficiency was higher (0.53 vs. 0.50, p < 0.001) in patients with RLS than in healthy controls. Differences in functional connectivity at the global level were also observed between post- and pre-treatment RLS patients who showed a good medication response. Transitivity in the post-treatment group was higher than that in the pre-treatment group (3.22 vs. 3.04, p = 0.007). Global efficiency was positively correlated with RLS severity (r = 0.377, p = 0.007). This study demonstrates that RLS is associated with distinct alterations in brain connectivity, which can be partially normalised following symptom management. These findings suggest that therapeutic interventions for RLS modulate brain function, emphasising the importance of symptom-focussed treatment in managing RLS.

Erectile dysfunction in patient with obstructive sleep apnea: effects of continuous positive airway pressure.

BACKGROUND: Obstructive sleep apnea (OSA) is linked to various health complications, including erectile dysfunction (ED), which is more prevalent in individuals with OSA. This study explored ED in Korean OSA patients and assessed the impact of continuous positive airway pressure (CPAP) therapy on ED. METHODS: A total of 87 male patients with OSA from four different sleep centers underwent physical measurements and completed sleep and mental health (MH) questionnaires, including the Korean version of the International index of erectile function (IIEF), before and three months after initiating CPAP therapy. RESULTS: After three months of CPAP therapy, the patients demonstrated a significant improvement in ED as measured on the IIEF. However, the study found no significant correlation between the duration of CPAP use and the improvement in IIEF score. It did identify the SF36 quality of life assessment as a significant factor influencing ED improvement after CPAP. CONCLUSIONS: ED is a prevalent issue that escalates with age and is associated with OSA. CPAP therapy has shown potential in alleviating ED symptoms, particularly in those with underlying psychological conditions, although further research is required to confirm these findings and understand the underlying mechanisms.

Structural and functional multilayer network analysis in restless legs syndrome patients.

The combination of brain structural and functional connectivity offers complementary insights into its organisation. Multilayer network analysis explores various relationships across different layers within a single system. We aimed to investigate changes in the structural and functional multilayer network in 69 patients with primary restless legs syndrome (RLS) compared with 50 healthy controls. Participants underwent diffusion tensor imaging (DTI) and resting state-functional magnetic resonance imaging (rs-fMRI) using a three-tesla MRI scanner. We constructed a structural connectivity matrix derived from DTI using a DSI program and made a functional connectivity matrix based on rs-fMRI using an SPM program and CONN toolbox. A multilayer network analysis, using BRAPH program, was then conducted to assess the connectivity patterns in both groups. At the global level, significant differences there were between the patients with RLS and healthy controls. The average multiplex participation was lower in patients with RLS than in healthy controls (0.804 vs. 0.821, p = 0.042). Additionally, several regions showed significant differences in the nodal level in multiplex participation between patients with RLS and healthy controls, particularly the frontal and temporal lobes. The regions affected included the inferior frontal gyrus, medial orbital gyrus, precentral gyrus, rectus gyrus, insula, superior and inferior temporal gyrus, medial and lateral occipitotemporal gyrus, and temporal pole. These results represent evidence of diversity in interactions between structural and functional connectivity in patients with RLS, providing a more comprehensive understanding of the brain network in RLS. This may contribute to a precise diagnosis of RLS, and aid the development of a biomarker to track treatment effectiveness.

Association Between Electronic Device Use at Bedtime and COVID-19 Vaccine-Related Adverse Events During the COVID-19 Pandemic in Korean Adults: A Nationwide Cross-Sectional Population-Based Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to heightened mood disturbances linked to increased electronic device use at bedtime (EUB). General anxiety may contribute to an increased likelihood of experiencing nocebo responses, which have been reported to be associated with COVID-19 vaccine-related adverse events (CAEs). However, no related studies have been conducted to examine this association to date. METHODS: We executed a nationwide cross-sectional study to explore these correlations during the pandemic. Using data from the 2022 National Sleep Survey of South Korea, we analyzed the sleep health of 4,000 adults aged 20-69 years between January and February 2022. Shift workers and those with severe sleep disorders were excluded. Participants with EUB more than four days a week were labeled as high frequency EUB, and those reporting CAEs after both vaccine doses were marked as having a presence of CAEs. The survey also included details about anthropometric data, socioeconomic status, and sleep status. RESULTS: Of the 3,702 participants, 92.6% had received two or more vaccine doses, with 41.2% experiencing CAEs. Furthermore, 73.7% had a high EUB frequency. Factors associated with CAE reporting included younger age, female sex, and high EUB frequency, while heavy alcohol use was found to be less likely to be associated with CAE reporting. Notably, a high EUB frequency was significantly associated with reported CAEs (odds ratio, 1.223; 95% confidence interval, 1.028-1.455; P = 0.023). CONCLUSION: A nationwide online survey conducted in South Korea during the pandemic found that individuals who engaged in the relatively frequent use of electronic devices during bedtime had worse sleep quality and increased COVID-19-related adverse events compared with those using these devices less frequently. These findings have the potential to enhance our understanding of the impact of the use of electronic devices at bedtime on health.

Usefulness of electronic stimulation in restless legs syndrome: a pilot study.

PURPOSE: This study aims to investigate the effect of electronic stimulation (ES) as a non-pharmacological treatment in restless legs syndrome (RLS). METHODS: This is a randomized, single-blind study. A total of 46 patients were included, consisting of an active group and a sham group with 22 and 24 members, respectively. The stimulation was administered to bilateral lower legs using the tapping mode (3 Hz) on a handheld ES device, and symptom changes were measured in both groups. The effects of the stimuli were analyzed with repeated measures ANOVA. RESULTS: The symptom severity was significantly reduced in the active group, and showed significant interaction effects in the time * group (F = 4.441, p = 0.031). Although both the active and sham groups reported improved symptoms upon receiving longer periods of treatment, the effect of the ES was greater in the active group. CONCLUSIONS: ES treatment resulted in symptom improvement when using ideal levels of stimulation intensity. ES can be considered as a non-pharmacological treatment option for RLS.

Tolerability of lacosamide rapid dose titration: A randomized, multicenter, prospective, open-label study.

OBJECTIVE: Currently recommended dosing of lacosamide often necessitates long titration periods. However, the use of a regimen consisting of initial loading dose of 200 mg followed by a maintenance dose of 200 mg/day in practice suggests tolerability of more rapid titration schedules. We aimed to clarify whether the shortened titration schedule affects tolerability of lacosamide. METHODS: We evaluated the safety of two rapid titration protocols designed to reach the target dose of 400 mg/day within 1 week, and the conventional weekly titration protocol (reaching the target dose of 400 mg/day in three weeks). The ≥50% responder rate and steady-state plasma concentration of lacosamide were also analyzed. Adverse events were assessed at 1 week and 5 weeks after reaching the target dose. RESULTS: Seventy-five patients with epilepsy were enrolled and evenly distributed to three titration protocols, from which 5 patients were lost to follow-up and excluded from the safety analysis. Discontinuation of lacosamide or dose reductions due to adverse events occurred in 32 patients (46%), of whom a large majority (74%) had experienced adverse events after reaching 400 mg/day, demonstrating apparent dose-dependency. There was no difference in safety outcomes among the three titration groups. Concomitant use of sodium channel blockers significantly increased the risk of adverse events. CONCLUSION: Rapid titration protocols for lacosamide were not associated with an increased risk of adverse events compared to the conventional weekly titration protocol. Uptitration of lacosamide at shorter intervals to an effective target dosage may be feasible in appropriate clinical situations.

Development of the clinical assessment scale in autoimmune encephalitis.

OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). INTERPRETATION: CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.

Symptom-related changes in current perception threshold of restless legs syndrome.

Few studies have investigated the mechanisms responsible for the symptoms of restless legs syndrome (RLS). However, these studies were mainly performed during the asymptomatic period and therefore their findings might not apply to changes in sensory processing that occur during the symptomatic period. The objective of this study was to investigate the function of sensory nerve fibres in RLS patients using the current perception threshold (CPT) test during the daytime and in the presence of symptoms. Ninety-three patients with RLS and 34 healthy controls were included in the study. RLS patients were further divided into two subgroups, those who were experiencing RLS symptoms during the CPT test (symptom+) and those without symptoms (symptom-). Demographic data, RLS rating scale score and visual analogue scale were collected. Of the 127 enrolled subjects, CPT values were significantly lower in RLS patients than in controls for all three frequencies. Among the control and RLS subgroups (53 symptom+, 40 symptom-), symptom+ patients showed lower CPT values than controls. This finding indicates a relative hyperaesthetic state in the sensory afferents of peripheral nerves in symptom+ patients. There were no significant differences between the symptom- group and controls. The significantly lower CPT values for all three frequencies in symptom+ patients suggest that central sensory processing disturbance of sensory nerve fibres' input may be involved in the development of symptoms in RLS patients.

Treatment of epilepsy in adults: Expert opinion in South Korea.

OBJECTIVE: The aim of this study was to gather the expert opinions of Korean epileptologists regarding the treatment of adult patients with epilepsy. METHODS: A total of 42 neurologists who specialized in epilepsy were surveyed. They completed an online questionnaire describing multiple patient scenarios. Using these scenarios, they evaluated treatment strategies and gave their preference for specific antiepileptic drugs (AEDs) used to treat genetically mediated generalized epilepsy and focal epilepsy. RESULTS: Initial AED monotherapy, followed by a second form of alternative monotherapy or an add-on combination therapy, was the preferred treatment strategy. The experts reached consensus for 87.2% of the items. The most commonly selected AEDs for the initial monotherapy for patients with generalized epilepsy were levetiracetam or valproate. For those with focal epilepsy, levetiracetam, oxcarbazepine, or lamotrigine were the most popular selections. Ethosuximide was the treatment of choice only for patients with generalized epilepsy with prominent absence seizures. Levetiracetam was preferred as an add-on therapy for both generalized and focal epilepsy. For special populations of patients, such as elderly adults or those with comorbid diseases, levetiracetam or lamotrigine was selected as the treatment of choice. CONCLUSION: Most of the survey results were in accordance with the US expert opinion survey published in 2016. This survey can assist clinicians in making clinical decisions when treating individual adult patients with epilepsy.

Quality of sleep and quality of life measured monthly in pregnant women in South Korea.

PURPOSE: The change in sleep patterns across the duration of pregnancy is an item of interest. The aim of this study is to provide data on pregnant women's quality of sleep (QoS) and quality of life (QoL) to determine appropriate times to screen for potential problems. METHODS: This is a multicenter, prospective, longitudinal observational study. Primigravidae, with no previous illness, completed questionnaires once a month. Strict exclusion criteria were applied in order to evaluate QoS and QoL in "normal" pregnant women. RESULTS: A total of 83 normal primigravidae completed this study. The mean age was 33.1 ± 4.0. During pregnancy, body mass index gradually increased, and QoS worsened to a significant degree between the fifth and ninth months (Pittsburgh Sleep Quality Index 6.8 ± 2.8 vs. 8.9 ± 3.6, p < 0.001). There was a statistically significant difference in QoL between the fifth and seventh months (Short Form-36 70.8 ± 18.3 vs. 67.3 ± 15.1, p = 0.009). There was no evidence of significant depression or suspicion of sleep-disordered breathing. CONCLUSIONS: Pregnant women in South Korea have gradual worsening of QoS which becomes clinically significant by full term. QoL changes significantly between the fifth and seventh months. The results of this observational study suggest that it would be fruitful to evaluate QoS and QoL in pregnant women between the second and third trimesters.

Pregnancy and Epilepsy: a Korean Tertiary Epilepsy Center Review.

BACKGROUND: Pregnancy in women with epilepsy (WWE) is known to have a higher risk for fetal development complications, which may include congenital malformations. Unfortunately, information pertaining to pregnancy in WWE is difficult to obtain because there are considerable ethical issues preventing these studies from being conducted on pregnant women. Therefore, this study investigated the pregnancies of Korean WWE in a tertiary epilepsy center to observe data resulting from the outcome of the pregnancies. METHODS: This was a retrospective study of 48 pregnant WWE who were treated at the regional tertiary epilepsy center. All records of hospital visits before and after the period of pregnancy were analyzed to obtain information about the seizures as well as pregnancy-related outcomes, including the status of the newborns' conditions. RESULTS: The subject group consisted of 31 (63.3%) with partial epilepsy, 6 (12.5%) with generalized epilepsy, and 11 (22.9%) with unclassified epilepsy. There were 27 subjects who took one antiepileptic drug (AED), and 12 who took two AEDs. The most commonly used drug was lamotrigine (29.8%). Of the 48 WWE involved in the study, 31 underwent caesarian sections and 17 opted for natural birth. Thirty-nine (81.3%) delivered at full-term, but 9 (18.7%) delivered at preterm. Compared to full-term infants, pre-mature infants showed lower birth weight, smaller head circumference, shorter height, and lower 1-minute Apgar scores, but seizure frequencies of the mothers did not differ. CONCLUSION: In WWE, epilepsy classification, number of AEDs taken, and frequency of seizures are not significantly correlated with delivery and fetal condition. This data could be used as a clinical reference for physicians to provide useful information to WWE if they are concerned about their pregnancies.

The clinical utility of non-invasive video-electroencephalographic monitoring has been diversifying.

BACKGROUND: Inpatient long-term video-electroencephalographic (VEEG) monitoring has been used extensively for differential diagnosis of paroxysmal events. We evaluated the diagnostic yield and clinical utility of VEEG performed in a comprehensive epilepsy center. METHOD: We retrospectively reviewed all cases of VEEG performed from May 2003 to April 2018. We analyzed the data to determine its clinical utility and diagnostic yield. RESULTS: A total of 1335 cases were reviewed. After excluding 147 cases of intracranial recording and 163 cases with incomplete medical records, 1025 cases of VEEG were included. The mean duration of VEEG was 2.3 ± 1.6 days (range = 1-14). A total of 763 VEEGs documented epileptic seizures or interictal epileptiform discharges (IEDs) to confirm the diagnosis of epilepsy. There were 99 psychogenic non-epileptic seizure, 36 status epilepticus, and 34 VEEGs which revealed generalized or focal slow activities without any clinical seizures or IEDs. VEEG was normal in 170 cases. The diagnostic yield of VEEG varied from 83.4 to 88.4% depending on its definition. The proportion of epilepsy in total cases of VEEG continued to decrease from 77.2 to 61.4%. In contrast, the proportion of normal VEEG steadily increased from 4.1 to 24.1% during the same time period. CONCLUSIONS: This study ascertained how useful VEEG is and the utility of VEEG has been diversifying in clinical circumstances beyond epilepsy. VEEG can play a pivotal role in the diagnostic approach to epilepsy and its differential diagnoses.

Real-world STOPBANG: how useful is STOPBANG for sleep clinics?

PURPOSE: The STOPBANG questionnaire has been widely used for screening obstructive sleep apnea (OSA) due to its time friendly, economic advantages over overnight polysomnography (PSG). The aim of this study was to analyze the usefulness of the items constituting the utility of STOPBANG in a sleep clinic and to establish the best assembly for OSA-screening methods in the Korean population. METHODS: We retrospectively analyzed all patients who completed PSG as well as STOPBANG at a sleep center in a tertiary hospital from January 2016 to December 2017. The sensitivity and specificity of STOPBANG and its smaller counterparts (i.e., SOPBAG) were compared. RESULTS: A total of 541 subjects completed PSG and STOPBANG. Two hundred thirty-five patients were diagnosed with OSA (OSA+) and were compared to those who were not (OSA-). The respective scores of STOPBANG in OSA+ versus OSA- were 4.29 ± 1.46 and 2.53 ± 1.48 (p < 0.001). There were significant differences in all factors except tiredness and age (SOPBNG). STOPBANG showed sensitivity of 89.1% and specificity of 57.4%. The AUC was 0.809. Excluding tiredness as well as neck circumference (SOPBAG), the AUC was 0.811. The sensitivity and specificity were 71.8% and 77.9%, respectively. The AUC of SOPBAG was neither superior nor inferior to that of STOPBANG. CONCLUSION: The screening value of STOPBANG for OSA did not perform as expected when compared to PSG for accuracy in Koreans. STOPBANG can be simplified to SOPBAG while maintaining comparable screening performance. It may be practical to consider performing PSGs without the use of the STOPBANG in Korea.

Sleep Quality Independently Affects Health-related Quality of Life and Cognitive Function in Korean Female Patients with Rheumatoid Arthritis: a Case-control Study.

BACKGROUND: This study aimed to address sleep quality in patients with rheumatoid arthritis (RA) and to determine how it affects health-related quality of life (HRQoL) and cognitive function. METHODS: One hundred and twenty-three patients with RA and 76 healthy controls were enrolled in this study. Sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (PSQI). Cognitive function and HRQoL was evaluated by a Korean-Montreal Cognitive Assessment (MoCA-K) and 36-item Short-Form Health Survey (SF-36), respectively. Other clinical, demographic, and laboratory data were obtained from retrospective medical chart review. RESULTS: More patients in the RA group reported poor sleep quality (PSQI > 5) than in the control group (61% [75/123] vs. 39.5% [30/76]; P = 0.003). Total PSQI was also significantly higher in the RA group (median [interquartile range], 7 [5-11] vs. 5 [3-6.75]; P = 0.001). Total PSQI score negatively correlated with MoCA-K score (Spearman's rho (r) = -0.223; P = 0.003) with a physical component summary (PCS) of SF-36 (r = -0.221; P = 0.003) and a mental component summary (MCS) of SF-36 (r = -0.341; P < 0.001), which means that poor sleep quality was associated with poor cognitive function and low HRQoL. CONCLUSION: The findings of this study suggest that poor sleep quality is an independent risk factor for low HRQoL and cognitive dysfunction. Efforts to improve the sleep quality of RA patients seem to be an important aspect of integrative treatment for RA.

Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea.

There have been few quality of life studies in patients with idiopathic rapid eye movement sleep behaviour disorder. We compared the quality of life in idiopathic rapid eye movement sleep behaviour disorder patients to healthy controls, patients with hypertension, type 2 diabetes mellitus without complication and idiopathic restless legs syndrome. Sixty patients with idiopathic rapid eye movement sleep behaviour disorder (24 female; mean age: 61.43 ± 8.99) were enrolled retrospectively. The diagnosis was established based on sleep history, overnight polysomnography, neurological examination and Mini-Mental State Examination to exclude secondary rapid eye movement sleep behavior disorder. All subjects completed questionnaires, including the Short Form 36-item Health Survey for quality of life. The total quality of life score in idiopathic rapid eye movement sleep behaviour disorder (70.63 ± 20.83) was lower than in the healthy control group (83.38 ± 7.96) but higher than in the hypertension (60.55 ± 24.82), diabetes mellitus (62.42 ± 19.37) and restless legs syndrome (61.77 ± 19.25) groups. The total score of idiopathic rapid eye movement sleep behaviour disorder patients had a negative correlation with the Pittsburg Sleep Quality Index (r = -0.498, P < 0.001), Insomnia Severity Index (r = -0.645, P < 0.001) and the Beck Depression Inventory-2 (r = -0.694, P < 0.001). Multiple regression showed a negative correlation between the Short Form 36-item Health Survey score and the Insomnia Severity Index (ß = -1.100, P = 0.001) and Beck Depression Inventory-2 (ß = -1.038, P < 0.001). idiopathic rapid eye movement sleep behaviour disorder had a significant negative impact on quality of life, although this effect was less than that of other chronic disorders. This negative effect might be related to a depressive mood associated with the disease.

Mood Symptoms and Restless Legs Syndrome Without Periodic Limb Movements During Sleep: Is it a Clinical Subtype?

Frequently co-occurring restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS) are postulated to share common pathophysiology. The authors compared clinical characteristics and polysomnography (PSG) parameters among 155 idiopathic, untreated RLS patients who were stratified into three groups based on periodic limb movement index (PLMI). The authors found that RLS patients without PLMS (PLMI <5) had higher depression and anxiety scores, a lower total arousal index, longer latency to REM, and a higher spontaneous arousal frequency on PSG than RLS patients with PLMS. RLS severity was associated with PLMI in RLS patients with PLMS but not without PLMS. RLS without PLMS seems to be a phenotypically distinct clinical subtype of RLS. Future study should examine whether RLS without PLMS has a different clinical course, treatment response, and pathophysiology than RLS with PLMS.

The prevalence and clinical significance of sleep disorders in acute ischemic stroke patients-a questionnaire study.

PURPOSE: Sleep disturbances are frequently reported in stroke patients and associated with the outcome of strokes. Using sleep questionnaires, we investigated the prevalence of classified sleep disturbance and the influence of sleep disorders upon a stroke prognosis. METHODS: Patients with acute ischemic strokes or transient ischemic attacks (TIA) were included. We investigated the prevalence of sleep disturbance and the association of outcomes resulting from strokes. The National Institutes of Health Stroke Scale score at day 7 (NIHSS-7) and modified Rankin Scale score at month 3 (mRS-3) stood for short- and long-term outcomes. A series of questionnaires including all Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), Epworth Sleepiness Scale (ESS-K), Berlin Questionnaire, Sleep Obstructive apnea score optimized for Stroke (SOS), Beck Depression Inventory-2, and Hospital Anxiety and Depression Scale were used. RESULTS: A total of 241 (mean age was 64.2 ± 11.9, 146 males; 60.6%) consecutive acute ischemic stroke patients, including 36 TIAs, were enrolled. The NIHSS score at admission, NIHSS-7, and mRS-3 were 3.26 ± 3.64, 1.72 ± 2.29, and 0.21 ± 0.82, respectively. PSQI-K ≥8.5 was reported in 79 subjects (32.8%), ISI-K ≥15.5 in 29 (12.0%), ESS-K ≥11 in 21 (8.7%), and SOS ≥11 in 48 (20.3%). The NIHSS-7 was associated with the SOS (standardized ß = 0.281, p < 0.001) and the mRS-3 with the ISI-K (standardized ß = 0.219, p = 0.001) and the SOS (standardized ß = 0.171, p = 0.011). CONCLUSIONS: Screening for and intervening in the sleep problems of stroke patients could improve their outcome. As sleep disturbances are associated with short-term and/or long-term outcomes of strokes, active screening and intervention for sleep disturbances after strokes are needed.

Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

BACKGROUND: Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in predicting the functional outcome in patients with SE. METHODS: The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to December 2014 were derived from a prospective SE database. The primary outcome variable was defined as in-hospital death. The secondary outcome variable was defined as a poor functional outcome, i.e., a score of 1-3 on the Glasgow Outcome Scale, at discharge. RESULTS: Among the 120 non-hypoxic patients with SE recruited into the study, 16 (13.3%) died in the hospital and 64 (53.3%) were discharged with a poor functional outcome. The receiver-operating characteristic (ROC) curve for prediction of in-hospital death based on the STESS had an area under the curve of 0.673 with an optimal cutoff value for discrimination (best match for both sensitivity (0.56) and specificity (0.70)) that was ≥ 4 points. The two combinations of elements of the EMSE system (EMSE-ALDEg and EMSE-ECLEg) predicted not only in-hospital mortality with the best match for sensitivity (more than 0.6) and specificity (more than 0.6), but also a poor functional outcome with the best match for both sensitivity (>0.7) and specificity (>0.6). STESS did not predict a poor functional outcome (area under the ROC, 0.581; P = 0.23). CONCLUSION: Although the EMSE is a clinical scoring system that focuses on individual mortality, we did not find differences between the EMSE and STESS in the prediction of in-hospital death. The EMSE was useful in predicting poor functional outcome, as it was significantly better than STESS.

The Severity and Pattern of Autonomic Dysfunction in Idiopathic Rapid Eye Movement Sleep Behavior Disorder.

BACKGROUND: Autonomic dysfunction in idiopathic rapid eye movement sleep behavior disorder patients has not yet been quantified. The aim of this study was to characterize dysautonomia in patients with idiopathic rapid eye movement sleep behavior disorder using the Composite Autonomic Severity Score, which is a validated instrument for the quantitation of autonomic failure. METHODS: We prospectively enrolled patients with idiopathic rapid eye movement sleep behavior disorder. A battery of standardized autonomic function tests was performed. Autonomic data obtained from the patients were compared to age- and sex-matched healthy controls. RESULTS: Seventeen patients were enrolled. All but 1 patient showed at least one autonomic deficit. These deficits were predominantly adrenergic and cardiovagal and involved relatively few sudomotor problems. The degree of autonomic dysfunction according to the Composite Autonomic Severity Score was mild to moderate in most patients. CONCLUSIONS: Idiopathic rapid eye movement sleep behavior disorder is linked to mild-to-moderate autonomic dysfunction, which is predominantly adrenergic and cardiovagal.

Durability of Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir.

INTRODUCTION: Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied. METHODS: We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment. RESULTS: Only 4 (7%) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24%) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69%) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62%) remained HBeAg negative/anti-HBe positive, 12 (32%) became HBeAg positive, and 2 (5%) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse. CONCLUSIONS: Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.