Leona Bassein

REM sleep behaviour disorder in Parkinson's disease: a questionnaire-based study

The aim of the study was to determine the clinical frequency and features of REM sleep behaviour disorder (RBD) in a large population of Parkinson’s disease (PD) patients using defined diagnostic criteria both for RBD and PD. Six trained neurologists used a semistructured questionnaire based on ICSD-R diagnostic criteria for RBD to evaluate 200 PD patients and their caregivers. Interobserver reliability for the diagnosis of RBD was “substantial” (Kappa 0.65). Five patients were excluded from the study because of an MMSE lower than 25. The demographic and PD clinical features were compared in the clinically defined RBD group and in those without RBD (NRBD). Then the RBD features during the last year were analysed in the affected group. Out of 195 patients, 66 fulfilled the ICSD-R criteria for RBD; 62 patients reported RBD during the last year (frequency 31.8%). RBD features: two or more episodes per week in 35.5%; upper limb movements in 87%; lower limb movements in 79%; vocalisations during events in 85%. RBD onset was before PD in 27% of patients; 69% of the RBD group had injured themselves or their caregivers during sleep. According to multivariate analysis, RBD was associated with male gender, age and PD duration. Brief training and the use of a semistructured questionnaire may help the neurologist in dealing with sleep disturbances in PD patients. The search for RBD symptoms in PD is highly recommended, especially in patients with a long disease duration, the risk of sleep-related injuries being high.

Fibrin sealant in laparoscopic adhesion prevention in the rabbit uterine horn model

OBJECTIVE To assess the effects of fibrin sealant on adhesions after laparoscopic surgery. DESIGN Standardized surgical trauma was induced in 60 female rabbits. The animals were randomized in three groups for different adhesion prevention treatment. SETTING University research laboratory. INTERVENTIONS After standardized trauma was induced, group 1 (n = 20) received no treatment, group 2 animals (n = 20) were injected in the abdominal cavity with 60 mL of Ringers lactate, and human fibrin sealant was applied on the surgical lesions under laparoscopic vision in group 3 (n = 20). MAIN OUTCOME MEASURES Five weeks after laparoscopy, a laparotomy was performed, and the adhesions were scored. RESULTS Fourteen of 20 rabbits in the control group (70%) presented postoperative adhesions, 11 of 20 (55%) in the Ringers group, and 5 of 20 (25%) in the fibrin sealant group. High-score adhesions were seen in 15% of cases in control and Ringers group and in 5% of cases in the fibrin sealant group. CONCLUSIONS When used during laparoscopic surgery, fibrin sealant has a preventive effect on de novo postsurgical adhesions. To assess the efficacy in reproductive surgery, a trial on recurrent postsurgical adhesions is required.

Validation of Symptoms Related to Excessive Daytime Sleepiness

The aim of this study was to validate some recurring definitions of excessive daytime sleepiness (EDS) obtained from descriptive epidemiological studies. We devised questions concerning concepts such as ‘tiredness’, ‘resistible sleepiness’, ‘irresistible sleepiness’ and ‘sudden sleep attacks’. The validation was done by comparing the answers with the results of the Multiple Sleep Latency Test (MSLT), considered the gold standard, or criterion measure, for the diagnosis of EDS. The sample study comprised 73 subjects, 57 outpatients referred to our Sleep Center complaining of daytime sleepiness, snoring or sleep apnea and 16 inpatients admitted to our Neurological Institute for causes other than sleep disorders. A moderate correlation (p = –0.38, 95% confidence interval –0.57 to –0.19) was found between ‘irresistible sleepiness’ and mean sleep latency (MSL). The best combinations of sensitivity and specificity in identifying EDS, for 5- and 8-min MSL cutoffs, were observed for the questions concerning ‘sudden sleep attacks’ and ‘irresistible sleepiness’ (areas under the receiver-operating characteristic curves = 66 and 67%, respectively). The subitems exploring the frequency and situations of occurrence of these symptoms improved the validity in identifying EDS. The items regarding ‘tiredness’ and ‘resistible sleepiness’ were not related to the results of the MSLT. In subgroup analysis, irresistible sleepiness failed to identify pathologic MSLT in sleep-disordered breathing subjects. According to previous observations, we suggest that the concept of sleepiness includes various domains heterogeneously related with MSL and that questionnaires must be tailored to the different populations studied.

Cough during Treatment with Angiotensin Converting Enzyme Inhibitors

SummaryThe role of age, gender, smoking habits and concomitant drug treatment, and type and dose of angiotensin converting enzyme (ACE) inhibitor as prognostic factors for the development of cough during ACE inhibition was investigated in a group of 1591 patients. In 117 of these patients cough was identified as drug related. Logistic regression confirmed that females, nonsmokers and patients treated with enalapril are at greater risk of developing cough. On the other hand, our data provided no evidence for a prognostic role of higher doses of the ACE inhibitor or of concomitant drug treatment; in particular, the use of β-adrenoceptor antagonists was not associated with a higher incidence of cough.

Effect of single dose of oral erythromycin on gastric and gallbladder emptying : simultaneous assessment by ultrasound

To evaluate the effects of a single oral dose of erythromycin on gastric and gallbladder emptying, 10 volunteers, without a known history of gastrointestinal disease, were investigated. Erythromycin stearate (500 mg) or placebo was given on separate mornings 30 min before a standard solid meal in a randomized, double-blind, crossover study. Gastric and gallbladder emptying rates were simultaneously evaluated by means of real-time ultrasonography. Gastric antral area and gallbladder volume were determined before the meal and 30, 60, 120, 180, 240, and 300 min after commencing eating. Erythromycin, compared to placebo, significantly accelerates and increases the degree of both gastric and gallbladder emptying. As previously reported for intravenous and chronic oral assumption, also a single dose of oral erythromycin is able to accelerate gastric and gallbladder emptying in normal human subjects.

Risk of seizures while awake in pure sleep epilepsies A prospective study

Objective: To estimate the risk of seizures while awake in pure sleep epilepsies in a prospective study. Methods: From October 1, 1992, to October 31, 1996, all patients with pure sleep epilepsy presenting at a participating center were enrolled. Children with benign rolandic epilepsy and patients with frontal lobe epilepsy were excluded. Patients were followed for at least 2 up to 6 years. The primary endpoint was the occurrence of a seizure while awake. Results: The authors enrolled 161 patients (64% male). Age at the time of inclusion ranged from 11 to 83 years (mean 43.2, median 39). Eighty-five percent presented generalized tonic clonic seizures. Both sleep seizures and seizures while awake were absent for 2 years after inclusion in the study in 78% of patients. Eighteen patients presented a seizure while awake. The estimated risk of a seizure while awake during 6 years of follow-up was 13% (95% CI 7 to 18%). Multivariate analysis showed that episodes of sudden withdrawal of therapy and a higher frequency of seizures at inclusion were associated with an increased risk of seizures while awake. The estimated risk of a seizure while awake in patients with none of the above risk factors was 6.5% (95% CI 1.5 to 11.3%) during 6 years of follow-up. Conclusion: The clinical picture of pure sleep epilepsies is characterized by a preponderance of generalized tonic clonic seizures, low seizure frequency, and a good prognosis. The risk of occurrence of a seizure while awake is low, particularly among patients with rare seizures and good compliance with the therapy.

Contents Vol. 20, 2001

M.Z. Al Kawi, Riyadh A. Alpérovitch, Paris D.W. Anderson, Bethesda, Md. E. Beghi, Milano M.M. Ben Hamida, Tunis F. Bermejo, Madrid N.E. Bharucha, Bombay G. Boysen, Copenhagen M.M.B. Breteler, Rotterdam R. D’Alessandro, Bologna J.F. Dartigues, Bordeaux G.M. Franklin, Seattle, Wash. G. Friday, Wynnewood, Pa. R. Hart, San Antonio, Tex. W.A. Hauser, New York, N.Y. C. Ketzoian, Montevideo S.J. Kittner, Baltimore, Md. W.C. Koller, Miami, Fla. A. Korczyn, Tel Aviv J.F. Kurtzke, Washington, D.C. S.-M. Lai, Kansas City, Kans. J. Matias-Guiu, Alicante R.P. Mayeux, New York, N.Y. K. Nakashima, Yonago K. Nelson, Bethesda, Md. L. Nelson, Stanford, Calif. A.H. Rajput, Saskatoon D. Rosselli, Bogotá D. Royall, San Antonio, Tex. R.L. Sacco, New York, N.Y. I. Skoog, Göteborg C. Tanner, Sunnyvale, Calif. X. Zhang, Beijing Editor-in-Chief