Katarína Klobučníková

Sleep disorders in patients with multiple sclerosis.

OBJECTIVE Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). The objective of the study was to assess the relationship between nocturnal polysomnographic (PSG) findings and quality of sleep, fatigue, and increased daytime sleepiness among patients with MS. METHODS Clinical characteristics were collected. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and International Restless Legs Syndrome Rating Scale were used to assess quality of sleep, fatigue, excessive daytime sleepiness, and the presence of restless legs syndrome (RLS). All patients underwent nocturnal diagnostic PSG examination. RESULTS Fifty patients with MS were enrolled into the study. Age was the only independent variable significantly determining apnea-hypopnea index and desaturation index (DI) (beta = 0.369, p = 0.010, beta 0.301, p = 0.040). PSQI and ESS score were significantly higher in a population with RLS (p = 0.004, p = 0.011). FSS significantly correlated with DI (r = 0.400, p = 0.048). Presence of RLS was the only independent variable significantly determining PSQI and ESS (p = 0.005, p = 0.025). DI and presence of RLS were independent variables determining FSS (p = 0.015, p = 0.024). CONCLUSION Presence of RLS seems to be the main factor determining poor sleep, fatigue, and daytime somnolence. Sleep disordered breathing and its severity influences only fatigue in patients with MS.

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study.

STUDY OBJECTIVES Sleep disordered breathing (SDB) is a frequent comorbidity in stroke patients. SDB is one of the independent risk factors for ischemic stroke. Conversely, stroke may contribute to SDB onset or aggravate premorbid SDB. Multiple mechanisms underlying SDB might be responsible for the development of stroke. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of wake-up (WUS) and non-wake-up acute ischemic strokes (NWUS). METHODS We prospectively enrolled 88 patients with acute ischemic stroke. Clinical characteristics of the population were recorded on admission, and blood samples were obtained in the fasting condition following morning. SDB was assessed using standard overnight polysomnography in the acute phase of the stroke. RESULTS WUS were present in 16 patients (18.2%), and NWUS in 72 patients (81.8%). In WUS compared to NWUS, we observed significantly higher values of apnea-hypopnea index (24.8 vs. 7.6, p = 0.007), desaturation index ([DI] 26.9 vs. 8.8, p = 0.005), arousal index (22.6 vs. 13.1, p = 0.035), diastolic blood pressure (91.6 mm Hg vs. 85.2 mm Hg, p = 0.039), triglyceride levels ([TG] 1.9 mmol/L vs. 1.2 mmol/L, p = 0.049), and significantly lower levels of D-dimer (0.4 μg/L vs. 0.7 μg/L, p = 0.035). DI (CI: 1.003-1.054, p = 0.031) and TG (CI: 1.002-1.877, p = 0.049) were the only independent variables significantly associated with WUS in binary logistic regression model. CONCLUSIONS Although the design of our study does not prove the causal relationship between SDB and WUS, higher severity of SDB parameters in WUS supports this hypothesis. COMMENTARY A commentary on this article appears in this issue on page 467.

Characteristics of Sleep-Disordered Breathing in Etiologic Subtypes of Minor-to-Moderate Acute Ischemic Stroke

BACKGROUND Sleep-disordered breathing (SDB) is frequent in stroke patients. A strong association has been suggested between SDB and atrial fibrillation (AF). In this study, we evaluated the characteristics of SDB in etiologic subtypes of acute ischemic stroke. We also investigated the relationship between SDB and AF in acute ischemic stroke. METHODS We prospectively enrolled 72 patients with minor-to-moderate acute ischemic stroke. Clinical and laboratory characteristics of population were recorded on admission. SDB was assessed using standard polysomnography within 7 days after stroke onset. RESULTS Apnea-hypopnea index (AHI) in small-vessel strokes was significantly lower than that in large-artery atherosclerosis strokes (P = .031), cardioembolic strokes (P = .011), and strokes of other or unknown etiology (.008). Desaturation index (DI) in small-vessel strokes was significantly lower than that in cardioembolic strokes and in large-artery strokes (P = .008, P = .035). Arousal index (AI) in large-artery strokes was significantly higher than that in small-vessel strokes (P = .013), cardioembolic strokes (P = .007), and strokes of other or unknown etiology (.027). In a multivariate regression model were age (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.022-1.148; P = .007) and DI (OR, 1.037; 95% CI, 1.004-1.071; P = .026) the only significant variables independently associated with AF. CONCLUSIONS We observed higher AHI, DI, and AI in large-artery strokes that may relate to more severe neurologic deficit in this subgroup. Age and DI were the only independent variables significantly associated with AF in acute ischemic stroke. Higher AHI and DI in cardioembolic strokes may thus mirror more frequent premorbid presence of SDB in patients with AF.

Causes of Excessive Daytime Sleepiness in Patients with Acute Stroke—A Polysomnographic Study

BACKGROUND Sleep disorders are common in stroke patients. Sleep-disordered breathing (SDB), which is present in up to 72% of stroke patients, is the most frequent cause of excessive daytime sleepiness (EDS) in common population. The aim of this study was to assess the frequency of EDS in stroke patients and to analyze the impact of SDB, stroke severity, and location of stroke on EDS in the acute phase of stroke. METHODS We enrolled 102 patients with the clinical diagnosis of acute stroke. Baseline clinical characteristics were recorded on admission. An Epworth sleepiness scale score higher than 9 was considered as EDS. To detect SDB, we performed standard overnight polysomnography within 4 ± 2 days after the stroke onset. RESULTS EDS was present in 21 patients (20.6%). In a population with EDS, we found a significantly higher number of obstructive apneic pauses, central apneic pauses, as well as significantly higher values of respiratory disturbance index (RDI), RDI during nonrapid eye movement sleep, desaturation index, and significant decrease of REM sleep duration. RDI (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.007-1.056; P = .01) and duration of REM sleep (OR, .922; 95% CI, .853-.997; P = .042) were the only independent variables significantly associated with EDS in a binary multivariate regression model. CONCLUSION SDB is a common, significant, and treatable cause of EDS in acute stroke patients. We suppose that examination in sleep laboratories is reasonable in all stroke patients with EDS, although the impact of SDB therapy on EDS and overall outcome in acute stroke remains unknown.

Carotid intima-media thickness is not associated with homocysteine and vitamin D levels in obstructive sleep apnea

Abstract Obstructive sleep apnea syndrome (OSA) is associated with increased vascular morbidity. Accelerated atherosclerosis might be one of the most important mechanisms linking OSA with the development of vascular disorders. Homocysteine (HCY) and vitamin D has been associated with atherogenesis. The aim of this study was to assess a possible association between the levels of HCY and vitamin D and the carotid intima-media thickness (cIMT), which is a known marker for subclinical atherosclerosis in patients with OSA. We prospectively enrolled 110 patients with the history of snoring, who underwent standard overnight polysomnography. Clinical characteristics of the population were recorded on admission and blood samples were obtained in the fasting condition following morning. Extracranial cIMT measurements were performed according to the standardized scanning protocol. A significant correlation was found between cIMT and apnea-hypopnea index (r = .276, p = .006), age (r = .486, p < .001), diabetes mellitus (r = .377, p < .001), coronary artery disease (r = .274, p = .006) and history of stroke (r = .251, p = .012). We failed to find any significant correlation between cIMT and the levels of HCY (r = .036, p = .724) or vitamin D (r = .027, p = .800). In conclusion, our data suggest that the association of cIMT with the severity of OSA can be influenced by multiple metabolic consequences of OSA including traditional and non-traditional risk factors. HCY and vitamin D do not seem to play a superior role in this process.

Solitary Epileptic Seizures in the Clinical Practice

An epileptic seizure may be conceptualized as a paroxysmal pathological process in the brain of a heterogeneous etiology with heteromorphic clinical and electrophysiological manifestation.The cases of epileptic seizures are classified according to The International Classification of Epileptic Seizures (ICES) published for the first time by The International League Against Epilepsy (ILAE) in 1970 and revised in 1981 (Commission on Classification and Terminology of the International League Against Epilepsy, 1981). This classification is a clinical one related to semiology of the seizures not to their etiology. Therefore it is necessary to exclude an acutely occurring cause responsible for occurrence of the seizure. In such cases we talk about the so-called acute symptomatic seizures. The underlying cause may be structural (e.g. head trauma), metabolic, toxic (e.g. alcohol), or an acute CNS infection, etc.. The most frequent acute symptomatic seizures are the febrile seizures. In fact, the acute symptomatic seizures occur more frequently than epilepsy (“unprovoked” seizures). The risk of occurrence during one’s life is very high approximately 5% in males and 2.5% in females. If the acutely occurring cause has been withdrawn or cured without a residuum in the form of a brain lesion, the seizures do not recur (Dasheiff, 1987; Fromm, 1987). The antiepileptic medication is necessary for suppressing the seizures in the acute stage but usually there is no need for treatment continuation after the complete cure of the underlying disease. If the acutely occurring cause was not responsible for epileptic seizure we talk about a so-called unprovoked seizure. If the unprovoked epileptic seizure occurs in relation to a preceding neurological insult, the disorders is regarded as secondary to this insult; we call it the late symptomatic epileptic seizure or late symptomatic epilepsy in case of seizure recurrence. A general principle of treatment for the symptomatic (secondary) epileptic seizures has been a primary effort for resolution of the underlying disease that is the etiological factor responsible for the seizures. Given that it is impossible, the antiepileptic treatment in accordance with the treatment guidelines for individual seizure types (together with adherence to right living, behavioural precautions and concomitant solutions of the social and psychological issues) is indicated (Hovorka et al. 2004a; Hovorka et al. 2004b; Oslejskova, 2007). Approximately 5% of the population experiences one unprovoked epileptic seizure in the lifetime (Forsgren et al., 1996; Hauser et al. 1993). The febrile seizure before the age of 5 occurs in approximately 5% of population (Hauser et al. 1996). Only about 25% of people experiencing the first unprovoked seizure see the doctor and nearly always the seizure is a generalized tonic-clonic one. Most of the people have no

Excessive Daytime Sleepiness in Acute Ischemic Stroke: Association With Restless Legs Syndrome, Diabetes Mellitus, Obesity, and Sleep-Disordered Breathing

STUDY OBJECTIVES Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke. METHODS We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission. RESULTS EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis. CONCLUSIONS Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke.

Association of lipoprotein subfractions with endothelial function and arterial stiffness in acute ischemic stroke.

Abstract Hypercholesterolemia represents a risk factor for the development of atherosclerosis. Lipoprotein research has recently been focused on the phenomenon of atherogenic and non-atherogenic lipoproteins. The aim of this study was to explore the association of lipoprotein subfractions with a measure for endothelial function (represented by reactive hyperemia index [RHI]) and arterial stiffness (represented by augmentation index [AI]) in patients with acute ischemic stroke. We enrolled 51 patients with acute ischemic stroke. Blood samples were obtained within 24 h after the stroke onset in a fasting condition. Electrophoresis method on polyacrylamide gel was used for the analysis of plasma lipoproteins. RHI and AI was measured by peripheral arterial tonometry (EndoPAT2000 device). We failed to find any significant correlation between RHI and baseline characteristics of the population. Significant correlation was found between AI and age, hypertension, low density lipoprotein cholesterol (LDL) 1, LDL 3–7, score for anti-atherogenic risk and atherogenic profile. Age (beta = .362, p = .006) and LDL1 (beta = −0.283, p = .031) were the only independent variables significantly associated with AI in regression analysis. Significantly higher AI was found in an atherogenic lipoprotein profile compared to a non-atherogenic profile population (median 25% vs. median 11.5%, p = .043). In conclusion, our results suggest significant inverse correlation between levels of LDL 1 subfraction and measures of AI in patients with acute ischemic stroke. Significantly higher values of AI were observed in the population with an atherogenic lipoprotein profile.

Predictors of endothelial dysfunction in obstructive sleep apnea syndrome

WCN 2013 No: 1214 Topic: 36 — Other Topic Predictors of endothelial dysfunction in obstructive sleep apnea syndrome P. Siarnik, Z. Carnicka, L. Križova, K. Klobucnikova, B. Kollar, P. Turcani, M. Sýkora. 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Department of Neurology, Heidelberg, Germany Introduction: Obstructive sleep apnea syndrome (OSA) is a highly prevalent disorder, which is associated with increased cardiovascular morbidity. One of the most important mechanisms responsible for development of vascular diseases in patients with OSA could be atherosclerosis. Endothelial dysfunction is an initial process and a key component of atherogenesis. Using peripheral arterial tonometry (PAT) we investigated the relationship between reperfusion hyperaemia index (RHI), which is regarded as being representative of endothelial function, and potential vascular risk factors in population with suspected OSA. Methods: We enrolled 31 patients (42.1 ± 11.7 years) with suspected OSA, without history of regular medication or history of cardiovascular disease. Besides gaining general clinical characteristics, we performed polysomnography, assessment of PAT, assessment of baroreflex sensitivity and blood tests. Results: Significant inverse correlation was found between RHI and apnea–hypopnea index (AHI) (r =−0.550, p = 0.001), and between RHI and desaturation index (r =−0.533, p = 0.002). Positive correlation was found between RHI andminimal nocturnal saturation of blood with oxygen (r = 0.394, p = 0.028). In stepwise multiple linear regression analysis AHI was the only significant variable to determine RHI (β=−0.522, p = 0.003). We found no significant correlation betweenRHI and other sleep, clinical or biochemical characteristics. RHI in population with severe OSA (AHI above 30) was significantly lower than RHI in the rest of the population (p= 0.012). Conclusion: AHI was the only significant independent predictor of impaired endothelial function expressed by RHI determined using PAT. RHI was decreased significantly in population with severe OSA. doi:10.1016/j.jns.2013.07.2233 Abstract — WCN 2013 No: 1751 Topic: 36 — Other Topic Effect of albendazole therapy in patients with seizure and radiological lesion consistent with neurocysticercosis: An open labeled randomized placebo controlled trial WCN 2013 No: 1751 Topic: 36 — Other Topic Effect of albendazole therapy in patients with seizure and radiological lesion consistent with neurocysticercosis: An open labeled randomized placebo controlled trial R. Paudel, L. Thapa, B.R. Pokhrel, P.V.S. Rana. Neurology, College of Medical Sciences, Chitwan, Nepal Background: There are controversies in using albendazole in treatment of solitary cerebral cysticercosis. Objective: To evaluate the effectiveness in resolution of solitary cerebral neurocysticercosis and seizure free status after one week of albendazole therapy. Methodology: Randomized placebo controlled trial was done in sixty consecutive patients of solitary cerebral cysticercal lesions attending the Neurology Department at a tertiary hospital in Nepal during the time period November 2009 to December 2010. Treatment group was given oral albendazole and similar looking tabletswere given to placebo group along with a short course of steroid and antiepileptics. Follow-up head CT scans were done at end of one, three and six months to look for resolution of lesion. They were followed up for any seizure recurrence during treatment. Results: Out of a total of 60 patients (treatment n = 28 and control group n= 32), at onemonth follow-up complete resolution of cyst was observed in 25% (n= 7) of patients in treatment as compared to 15.6% (n= 5) in the placebowhichwas statistically not significant (p N 0.05). Resolution rate at 3 and 6 months follow-up was also not significant. There was also insignificant difference in seizure recurrence rate on follow-ups. Conclusion: The present study showed that patients treated with albendazole therapy did not differ statistically in both the outcome measures in terms of complete resolution of the lesion and seizure free status. doi:10.1016/j.jns.2013.07.2234 Abstract — WCN 2013 No: 1754 Topic: 36 — Other Topic Blood flow velocity changes in anterior cerebral arteries during cognitive tasks performance WCN 2013 No: 1754 Topic: 36 — Other Topic Blood flow velocity changes in anterior cerebral arteries during cognitive tasks performance M. Boban, P. Crnac, B. Malojcic, A. Junakovic. Department of Neurology, University Hospital Centre Zagreb, Croatia; School ofMedicine, University of Zagreb, Zagreb, Croatia Abstracts / Journal of the Neurological Sciences e629 (2013) e629–e678 e643

Proton magnetic resonance spectroscopy in patients with solitary and sporadic temporal lobe epileptic seizures

Proton magnetic resonance spectroscopy (1H MRS) is an optional diagnostic method for potential epilepsy surgery candidates. The aim of this study was to determine the credibility of 1H MRS examination in a group of patients suffering from solitary and sporadic epileptic seizures generated in temporal lobe. We recorded a 100% sensitivity of 1H MRS in a group of ten patients in terms of detection of a pathological process in the temporal lobe. 1H MRS also enabled determination of lateralization of the pathological process in three patients with bilateral epileptiform abnormalities on electroencephalography. Based on these results we suggest new perspectives on 1H MRS as a part of standard diagnostic algorithm for solitary and sporadic temporal lobe epileptic seizures, particularly in cases with normal electroencephalography and magnetic resonance imaging findings.