Eva Svanborg

Nonconvulsive Status Epilepticus: High Incidence of Complex Partial Status

Summary: Nonconvulsive status epilepticus may be subdivided into generalized (absence) status and complex partial status. The latter is regarded as a rarity, whereas the former constitutes the dominant part of the hitherto reported cases. We report 10 consecutive cases of adult patients with nonconvulsive status epilepticus, all documented by ictal electroencephalographic (EEG) recordings. Five had a complex partial status; the origin of the complex partial status appeared to be frontal in four of these patients. Three had recurrent complex partial seizures with incomplete recovery between seizures, and two had more continuous symptoms. One of the latter exhibited neither motor phenomena nor automatisms. The effect of diazepam or clonazepam was immediate in all 10 cases though transient in eight. A lasting control of the status was not achieved in six patients until i.v. phenytoin was added. The difficulties in the differentiation between complex partial status and absence status despite ictal EEG recordings are discussed, illustrated by a case with seizure discharges of a focal onset which rapidly generalized. The study indicates that complex partial status may be more common and the clinical expressions of absence status more variable than hitherto recognized.

Obstructive Sleep Apnea Syndrome in Male Hypertensives, Refractory to Drug Therapy. Nocturnal Automatic Blood Pressure Measurements — an Aid to Diagnosis?

Sixteen therapy resistant hypertensive males and 16 responders to antihypertensive drug treatment, matched for age, gender and body mass index, were examined by means of Static Charge Sensitive Bed (SCSB) and oximetry for the presence of obstructive sleep apnea syndrome (OSAS). In borderline cases, polysomnography was performed. The prevalence of OSAS among therapy resistant patients was 56%, as compared to 19% in the control group (p less than 0.05). This higher prevalence of OSAS in a weight-matched group of subjects with severe hypertension supports the notion of a causal connexion between hypertension and OSAS. In 10 OSAS patients and 10 hypertensives with normal respiration during sleep, ambulatory noninvasive monitoring (ABPM) of arterial pressure (AP) and heart rate (HR) was also performed. The OSAS patients had a higher nocturnal variability of HR, systolic blood pressure (both p less than 0.05), and diastolic blood pressure (p less than 0.01) in 8 half-hourly single ABPM measurements. Contrary to the non-OSAS subjects they also had a higher HR variability during sleep than they had in the waking state (p less than 0.05). For subjects less than 60 yrs a range/median value of greater than 0.32 for nocturnal diastolic pressure was found to predict OSAS with a sensitivity of 87.5% and a specificity of 100%. It is concluded that therapy-resistant male hypertensives have a high prevalence of OSAS. As this may be a deleterious combination, screening for OSAS is highly indicated in such patients. A high variability of HR and AP in nocturnal ABPM suggests OSAS.

UPPP for habitual snoring: A 5‐year follow‐up with respiratory sleep recordings

Fifty‐six men who underwent uvulopalatopha‐ryngoplasty (UPPP) because of habitual snoring without preoperative obstructive sleep apnea (OSA), according to respiratory sleep recordings, were interviewed concerning persistent snoring and excessive daytime sleepiness (EDS). Renewed recordings were made in 53 of them at a median time of 63 months postoperatively. Median preoperative oxygen desaturation index (ODI) was 0; the median postoperative index was 1. Median duration of the preoperative obstructive respiratory pattern was 8% of total sleeping time, and the median duration postoperatively was 17%. (Significant individual increases were P=.0005 and P=.004, respectively.) Six patients answered to OSA criteria postoperatively. Weight increases were significantly correlated to increases in both ODI and obstructive respiratory pattern and to persistent snoring. Preoperatively 51 of 56 patients reported EDS, and 73% of the patients were improved or cured. From snoring, 87% reported improvement or cure. No patient had any serious sequelae of UPPP. Uvulopalatopharyngoplasty is a safe and effective treatment for habitual snoring, but it does not give absolute protection from development of OSA.

Anti-idiotypic antibodies, acetylcholine receptor antibodies and disturbed neuromuscular function in healthy relatives to patients with myasthenia gravis

Fifty-eight first-degree relatives to 40 patients with myasthenia gravis were investigated regarding presence of acetylcholine receptor antibodies, anti-idiotypic antibodies against the receptor antibodies and clinical and electrophysiological signs of disturbed neuromuscular function. No relative had clinical signs of muscle weakness. The prevalence of low concentrations of receptor antibodies was 54%, of anti-idiotypic antibodies 37% and of pathological and borderline single fibre EMG 45%. No sibling, only 2/11 children and 3/14 parents were normal in all three tests. A combination of receptor antibodies and anti-idiotypic antibodies was the most common finding and was especially frequent in children. In female siblings and children there was a positive correlation between the presence of HLA-antigen A1 and/or B8 and that of receptor antibodies and anti-idiotypic antibodies. Male siblings and children showed no such correlation but had a higher frequency of pathological single fibre EMG than females.

Voice Quality After Radiofrequency Volumetric Tissue Reduction of the Soft Palate in Habitual Snorers

Objective To evaluate whether radiofrequency volumetric tissue reduction of the soft palate is causing voice changes as a result of velopharyngeal insufficiency in patients with heavy snoring.

B cell and autoantibody repertoire in a pair of monozygotic twins discordant for myasthenia gravis

A pair of identical twins, 47 years of age, who have been discordant for myasthenia gravis for 15 years were studied with regard to clinical status, neuromuscular function, and presence and properties of myasthenia specific autoantibodies. The autoantibody repertoire was tested in serum, as produced by peripheral lymphocytes in culture and as revealed by B cell lines. The healthy twin had no clinical signs of myasthenia and no signs of impaired neuromuscular function on electrophysiological tests. The autoantibody repertoire and the avidity of the anti-receptor antibodies were similar in both individuals. Epstein-Barr virus transformation of peripheral lymphocytes revealed a higher incidence of B cells committed to make autoantibodies in the healthy twin than in her myasthenic sister.

76. Obstructive sleep apnea syndrome in male hypertensives, refractory to drug therapy: nocturnal automatic blood pressure measurements, an aid to diagnosis?

Sixteen therapy resistant hypertensive males and 16 responders to antihypertensive drug treatment, matched for age, gender and body mass index, were examined by means of Static Charge Sensitive Bed (SCSB) and oximetry for the presence of obstructive sleep apnea syndrome (OSAS). In borderline cases, polysomnography was performed. The prevalence of OSAS among therapy resistant patients was 56%, as compared to 19% in the control group (p less than 0.05). This higher prevalence of OSAS in a weight-matched group of subjects with severe hypertension supports the notion of a causal connexion between hypertension and OSAS. In 10 OSAS patients and 10 hypertensives with normal respiration during sleep, ambulatory noninvasive monitoring (ABPM) of arterial pressure (AP) and heart rate (HR) was also performed. The OSAS patients had a higher nocturnal variability of HR, systolic blood pressure (both p less than 0.05), and diastolic blood pressure (p less than 0.01) in 8 half-hourly single ABPM measurements. Contrary to the non-OSAS subjects they also had a higher HR variability during sleep than they had in the waking state (p less than 0.05). For subjects less than 60 yrs a range/median value of greater than 0.32 for nocturnal diastolic pressure was found to predict OSAS with a sensitivity of 87.5% and a specificity of 100%. It is concluded that therapy-resistant male hypertensives have a high prevalence of OSAS. As this may be a deleterious combination, screening for OSAS is highly indicated in such patients. A high variability of HR and AP in nocturnal ABPM suggests OSAS.