The role of sleep electroencephalography in patients with new onset epilepsy.

PURPOSE: An increased propensity for seizures is associated with different stages of the sleep-wake cycle. In this study, we prospectively analyzed patients with new-onset epilepsy and investigated the clinical correlates of the yield obtained from sleep electroencephalography (EEG) recordings in patients with a normal wakefulness EEG. METHODS: All patients admitted to our epilepsy unit due to unprovoked epileptic seizures and not yet treated with antiepileptic drugs were recruited consecutively for the last three years. All had a routine EEG at wakefulness (WEEG), and those with no epileptiform activity had a video-EEG recording during sleep (SEEG). RESULTS: We investigated a total of 241 patients; 129 patients (53.5%) had both wakefulness and sleep EEG recordings. The patients with abnormal WEEG were older than those with normal WEEG (p = 0.005). Abnormal WEEG was detected in only 31.2% of patients with focal seizures, but in 77.3% of patients with generalized seizures (p < 0.001). WEEG was abnormal in 44.0% of patients with diurnal seizures, but in 27.5% of nocturnal seizures (p = 0.007). Abnormal WEEG was present in 75.5% of patients with a presumed genetic origin and in 59.3% of patients with structural etiology (p < 0.001). Sleep EEG detected an abnormality in 41.8% of patients with normal WEEG; of these, 82.8% were focal abnormalities. In contrast, the majority of abnormalities detected in WEEG were generalized (55.8%, p < 0.001). CONCLUSION: Our results showed a greater likelihood of abnormal WEEG in older patients and in those with generalized epilepsy, diurnally precipitating seizures, and epilepsy of presumed genetic origin.

Interobserver variability of seizure semiology between two neurologist and caregivers.

PURPOSE: We aimed to compare the extent of inter-observer variability in the description of seizure semiology between both neurologists and caregivers. METHOD: We prospectively investigated 93 consecutive patients monitored over the past 5 years in our video-EEG unit. The videotaped seizures of the patients were reviewed independently by two neurologists who were blind to the clinical data. The questionnaires were completed by neurologists and caregivers. Interobserver rate of agreement between neurologists and caregivers was analyzed by using the kappa analysis and intraclass correlation coefficients. RESULTS: There was excellent agreement for questions regarding whether the patient's eyes remained open, laterality of head deviation, arm movements, and ictal period. On the other hand, interobserver rate of agreement was fair to moderate for the laterality of hand automatisms, the presence of nose-wiping, and oral clonic jerks. CONCLUSION: Besides variability in interobserver agreement among clinicians, the variability or concordance between physicians and caregivers are also of great importance, especially in case of epilepsy, where the accurate description of the attacks is the major determinant of an accurate diagnosis.

Long term follow-up of Parkinson's disease patients with impulse control disorders.

OBJECTIVE: Impulse control disorders (ICDs) are mainly triggered by dopaminergic therapy in Parkinson's disease (PD). Previously, we failed to identify a relationship between the types of dopaminergic therapy and occurrence of ICDs in 33 PD patients. In this study, we aim to evaluate the outcome of ICD behaviors in the same patient group. PATIENTS AND METHODS: Among 33 patients with ICDs, 22 patients were included. Demographics, dopaminergic therapy and disease severity were compared between two time points (Time 1: time of diagnosis of ICD, Time 2: last visit) and between patients who recovered from ICDs and with ongoing ICDs. Types of antipsychotic and antidepressant medication were noted. RESULTS: Mean follow-up period was 43.2 months. At Time 2 mean dopamine agonist (DA) dose was significantly lower, levodopa dose and total UPDRS score was significantly higher. ICDs were dissolved in 16 patients (73%), but persisted in six (27%). In ICD(+) subgroup, DA doses in Time 1 was found significantly higher than ICD(-). However, age, PD severity, disease duration and levodopa dosage were similar. Fourteen patients were prescribed atypical antipsychotics and 13 antidepressants. In ICD(+) group, symptoms of ICDs were mainly increased libido and compulsive eating. CONCLUSIONS: Although we studied a small number of patients the recovery from compulsive behaviors may be associated with the decrease in DA dosage and increase in levodopa. Furthermore, majority were given antipsychotic and/or antidepressant drugs. It is difficult to speculate which strategy could be more effective on the improvement of ICDs in such a small group. In patients who were on high doses of DA, ICDs could be persistent.