Béla Faludi

Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson's Disease

BACKGROUND Sleep problems are among the most common non-motor symptoms of Parkinsons disease (PD). The PD Sleep Scale 2nd version (PDSS-2) improved the original PDSS by adding more items on different aspects of sleep problems, making it a more robust tool to evaluate the severity of sleep disturbances. However, previous studies on deep brain stimulation (DBS) have not used the PDSS-2. OBJECTIVE To determine if the PDSS-2 could detect improvement reliably in sleep problems after bilateral subthalamic nucleus DBS for PD. METHODS In this prospective study, 25 consecutive patients undergoing DBS implantation were enrolled. Patients were examined twice: 1 week prior to the DBS implantation (baseline) and 12 months postoperatively. Severity of PD symptoms were assessed by the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Presence and severity of sleep disturbances were specifically measured by PDSS-2. RESULTS Total score of MDS-UPDRS improved from 81 (median, interquartile-range: 63-103) to 55 points (median, IQR: 46-75, p <  0.001). Health-related quality of life, measured by PDQ-39, also improved from 29 (IQR: 18-40) to 15 (IQR: 9-28) points (p = 0.002). Most domains of NMSS also improved. At baseline 13 patients reported sleep problems, but 1 year after DBS implantation only 3 did (p = 0.012). Although only 6 out of 15 items showed a significant decrease after DBS implantation, the total score of PDSS-2 decreased from 24 (IQR: 17-32) to 10 (IQR: 7-18) points (P <  0.001). CONCLUSIONS Based on our results, PDSS-2 can detect improvements in sleep quality reliably after DBS implantation.

Disturbances of neophobia and taste-aversion learning after bilateral kainate microlesions in the rat pallidum

These experiments aimed to elucidate feeding-associated behavioral roles of globus pallidus (GP) neurons in gustatory functions: The effects of bilateral microiontophoretic kainate (KA) lesions of the ventromedial pallidal (vmGP) region on neophobia and conditioned taste aversion (CTA) were studied. Lesioned rats displayed strong and persistent neophobia to a mild citric acid solution. Neuron-specific damage to the vmGP also prevented rats from proper acquisition of CTA. Rats that previously showed normal neophobia and successfully learned CTA demonstrated difficulties in CTA retention after GP lesions. KA-lesioned rats, in addition, exhibited deficits in orientation reactions but did not have aphagia, adipsia, or motor disturbances seen after larger pallidal lesions. These findings suggest that neurons of the GP are significant in acquisition, memory storage, and retrieval mechanisms of feeding-associated taste information.

Is the MDS-UPDRS a Good Screening Tool for Detecting Sleep Problems and Daytime Sleepiness in Parkinson’s Disease?

Movement Disorder Society-sponsored Unified Parkinsons Disease Rating Scale (MDS-UPDRS) has separate items for measuring sleep problems (item 1.7) and daytime sleepiness (1.8). The aim of our study was to evaluate the screening sensitivity and specificity of these items to the PD Sleep Scale 2nd version (PDSS-2) and Epworth Sleepiness Scale (ESS). In this nationwide, cross-sectional study 460 PD patients were enrolled. Spearmans rank correlation coefficients were calculated between the individual items, domains, and the total score of PDSS-2 and item 1.7 of MDS-UPDRS. Similarly, the items and the total score of ESS were contrasted to item 1.8 of MDS-UPDRS. After developing generalized ordinal logistic regression models, the transformed and observed scores were compared by Lins Concordance Correlation Coefficient. Only item 3 difficulties staying asleep and the “disturbed sleep” domain of PDSS-2 showed high correlation with “sleep problems” item 1.7 of the MDS-UPDRS. Total score of PDSS-2 had moderate correlation with this MDS-UPRDS item. The total score of ESS showed the strongest, but still moderate, correlation with “daytime sleepiness” item 1.8 of MDS-UPDRS. As intended, the MDS-UPDRS serves as an effective screening tool for both sleep problems and daytime sleepiness and identifies subjects whose disabilities need further investigation.

Test-retest validity of Parkinson's disease sleep scale 2nd version (PDSS-2).

BACKGROUND AND AIMS The aim of the present study was to measure the test-retest validity of Parkinsons Disease Sleep Scale 2nd version (PDSS-2) on PD patients with stable medication and motor symptoms over the period of 4 weeks. METHODS The subject population consisted of 92 PD patients. Besides PDSS-2, Unified PD rating scale, Montgomery-Asberg Depression Rating Scale and EQ-5D were assessed at baseline and 4 weeks later. RESULTS The total score of PDSS-2 decreased from 19.06 ± 10.78 points to 18.00 ± 9.34 points (p > 0.05). For the total score of PDSS-2 the Intra-class and Lins Concordance Correlation Coefficients were 0.782 and 0.799. The average difference between the baseline and follow-up total PDSS-2 scores was -1.06 points with the 95% confidence interval of -7.96 and +5.84 points. CONCLUSIONS Our data supports that the items and the total score of PDSS-2 have acceptable test-retest reliability over a four week period on patients with stable PD symptoms and pharmacological therapy.

Alvászavarok Parkinson-kórban: megjelenés, kivizsgálás, terápiás lehetőségek

INTRODUCTION: Parkinsons disease is a well known representent of the movement disorder group of neurological disorders. The diagnosis of Parkinsons disease is based on specific symptoms and signs of movement abnormalities. In addition to classic motor symptoms, Parkinsons disease has characteristic non-motor features, and some of these emerges the classic signs. AIM: The authors discuss characteristics and therapeutic interventions in Parkinsons disease related sleep disturbances. METHOD: The authors reviewed and summarised literature data on sleep disorders in Parkinsons disease published in the PubMed database up to January 2015. RESULTS: Sleep problems are important non-motor complains (insomnia, hypersomnia, REM behaviour disorder, sleep apnea and restless legs syndrome). The neurodegenerative process of the brain-stem, the effect of symptoms of Parkinsons disease on sleep and concomitant sleep disorders constitute the background of the patients complains. CONCLUSIONS: Appropriate diagnosis and therapy of the consequential or concomitant sleep disorders in Parkinsons disease will help to improve the patients quality of life.INTRODUCTION Parkinsons disease is a well known representent of the movement disorder group of neurological disorders. The diagnosis of Parkinsons disease is based on specific symptoms and signs of movement abnormalities. In addition to classic motor symptoms, Parkinsons disease has characteristic non-motor features, and some of these emerges the classic signs. AIM The authors discuss characteristics and therapeutic interventions in Parkinsons disease related sleep disturbances. METHOD The authors reviewed and summarised literature data on sleep disorders in Parkinsons disease published in the PubMed database up to January 2015. RESULTS Sleep problems are important non-motor complains (insomnia, hypersomnia, REM behaviour disorder, sleep apnea and restless legs syndrome). The neurodegenerative process of the brain-stem, the effect of symptoms of Parkinsons disease on sleep and concomitant sleep disorders constitute the background of the patients complains. CONCLUSIONS Appropriate diagnosis and therapy of the consequential or concomitant sleep disorders in Parkinsons disease will help to improve the patients quality of life.

Dynamic changes in sleep-related breathing abnormalities in bilateral paramedian mesencephalon and thalamus stroke: a follow-up case study

BackgroundBilateral paramedian thalamic stroke is characterized by hypersomnia, vertical gaze palsy, amnestic alteration, and apathic state. Combined lesion of the paramedian thalamus and mesencephalon bilaterally is extremely rare. Little is known about the breathing disturbances of the particular region due to the lesion. The following describes the specific case of a woman, age 62, with bilateral paramedian thalamic and mesencephalic stroke. Initially, the patient’s complaints exhibited altered vigilance and vertical gaze palsy. Notably, following the acute phase, fluctuating hypersomnia was detected. The MRI (brain) revealed an ischemic lesion in the medial part of the mesencephalon and paramedian thalamus, bilaterally.AimsThe aim of the present study is to elucidate the involvement and characteristics of sleep-related breathing abnormalities in the clinical manifestation of the combined paramedian thalamic and mesencephalic stroke.MethodsPolysomnographic recordings were accomplished seven times with 1-week interval between the consecutive recordings, toward investigating the early changes of sleep and sleep-related breathing abnormalities.ResultsSleep structure examination featured a decrease in N3 and REM ratio and an increase in N1 and N2 ratio with minimal improvement during the recovery period. In contrast, significant changes were found in the breathing pattern: the initial central apnea dominance was followed by obstructive apneas with a gradual decrease of the total pathological respiratory events.ConclusionIn addition to the structural abnormality of the sleep regulating network, sleep-disordered breathing is another possible cause of hypersomnia in patients afflicted with the present localization of the lesion.

Az insomniák kezelésének helye az alvásmedicinában: gyógyszeres és nem gyógyszeres eljárások

Insomnia - one of the most prevalent sleep complain - has a great impact on the everyday life. Basically two different form of insomnia can be defined: the insomnia disorder and the co-morbid insomnias. To treat adequately determination of background pathology is essential, which is based on the help of Sleep Medicine Centers. According to the newest guidelines, the treatment of insomnia disorder is based on cognitive behavioural therapies followed by pharmaceutical intervention. In this review we provide the short description of cognitive behavioural therapies and basic principles of hypnotic drugs. Despite the availability of insomnia guidelines the huge variation of the insomnia medication can be seen in the daily practice. Due to the above mentioned reasons we summarize the good clinical practice of hypnotic drug administration for insomnia patients.

Combination of severe facial and cervical vascular malformation with obstructive sleep apnea syndrome: Diagnostic and therapeutic approaches

The combination of obstructive sleep apnea syndrome and vascular malformation within the head and neck region is a rare condition, and interestingly, only a few cases have recently been published. Propagation of the vascular mass to the larynx and pharynx can cause breathing and swallowing difficulties. Due to these sypmtoms, examination and initiation of appropriate therapy for such patients are indeed challenging. We reviewed the literature available and present our case of a 64 year old woman emphasizing the complaints of sleep apnea syndrome and vascular malformation of the face and neck region. Polygraphic examination detected severe obstructive sleep apnea syndrome. The MR examination of the neck revealed extensive vascular mass narrowing the pharyngo-laryngeal region, thereby causing temporal bone destruction on the right side with intracranial propagation. ENT examination demonstrated significant narrowing of the pharyngeal lumen and the laryngeal aditus caused by multiple hemangiomas. CPAP titration showed the minimalization of the apnea-hypopnea index on the effective pressure level. Regular CPAP usage resulted in diminishing a majority of the patients complaints. Our examination clearly demonstrates, obstructive sleep apnea syndrome coupled with significantly obstructing vascular malformation in the head and neck region can be effectively treated safely with a CPAP device, if surgical therapy is not possible. We summarized our findings and the data available in the literature to set up recommendations for the appropriate examination and therapy (including mask fit, etc.) of vascular malformations and hemangiomas causing pharyngo-laryngeal obstruction.

S104 Polysomnography: From the basis to the information content

Objectives and methods Polysomnography (PSG) is the widely used diagnostic method of sleep medicine. The recorded parameters are the EEG, eye movements, muscle tone, different cardiorespiratory parameters (nasal air flow, breathing effort, ECG, oxygen saturation, etc.), body position, snoring and limb movements. On the base of the recorded parameters the alteration of the sleep architecture and background pathology can be determined. The polysomnographic abnormalities are described in the guidelines. The main challenge of PSG is the interpretation of these result. Here we present the basic principles and interpretation aspects of polysomnography. Results The two most important background pathologies - affecting the sleep architecture - are the breathing abnormalities and movement events. The patterns of respiratorical abnormalities can define different clinical pictures. The same movement event can be the consequence of many different background pathologies (from breathing related events to periodic limb movement disorder or narcolepsy). Discussion Interpretation of different polysomnographic abnormalities and patterns are more than a simple count of the pathological events. Different pathological backgrounds can lead to the same basic abnormalities. The clinical information about the sleep disorders will help to improve the interpretation of the polysomnographic abnormalities. Beside the clinical information, the interpretation of the polysomnographic recording depends on the reliability of the scoring and staging of the pathological events. Conclusions Clinical information is essential for the appropriate interpretation of the polysomnographic results. Significance Clinical information based interpretation of the PSG.

Insomnia és elalvást segítő szokások felmérése felnőttek körében

Absztrakt Bevezetes: Az alvasminőseget szamos tenyező befolyasolhatja, az insomnia pedig hatassal van az egeszsegi allapotra. Celkitűzes: Kutatasunk celja felmerni az insomnia gyakorisagat es hatasait, az alvast befolyasolo tenyezőket es az elalvast segitő szokasokat felnőttek koreben. Modszer: Az adatfelvetel orszagosan online es a del-dunantuli regioban papiron tortent, 455 felnőtt toltotte ki a kerdőivet, amelynek resze az Athen Insomnia Skala. Eredmenyek: A vizsgalatban reszt vevők 13,4%-a insomnias. Az insomniat (atlagpont: 5,08) befolyasolja a taplalkozas minősege (p<0,001), a kavefogyasztas (p = 0,045) es a sport (p = 0,011), tovabba osszefuggesben van a kronikus betegsegek (p = 0,001) es a pszichoszomatikus panaszok gyakorisagaval (p<0,001). Az alvaszavar leggyakoribb okai: munkahelyi stressz (35,6%), maganeleti stressz (35,4%) es fajdalom (24,2%). Akik a maganeleti stresszt (p = 0,001) es fajdalmat (p = 0,033) jeloltek oknak, rosszabbul alszanak. Elalvasi problemak eseten alkalmazott leggyakoribb...