Temporal lobe neoplasm and seizures: how deep does the story go?

[March 2008-Cleveland Case Report]. There is a well-described association between the occurrence of developmental tumors and the presence of cortical dysplasia in the neighboring brain tissue. The main surgical approaches in the treatment of medically refractory epilepsy related to such developmental tumors include a lesionectomy versus a tailored cortical resection, often guided by an invasive evaluation.

Prevalence and characteristics of restless legs syndrome in patients with pulmonary hypertension.

Background: Patients with pulmonary hypertension (PH) have an increased prevalence of risk factors for restless legs syndrome (RLS). We performed a cross-sectional study to determine the prevalence and characteristics of RLS in this population.

Methods: Patients filled out two questionnaires during a visit: (1) a diagnostic tool for RLS, based on the core clinical features; and (2) a 10-question rating scale used to assess severity.

Diagnosis of sleep-related breathing disorders by visual analysis of transthoracic impedance signals in pacemakers.

Background: Minute ventilation sensors of cardiac pacemakers measure ventilation by means of transthoracic impedance changes between the pacemaker case and the electrode tip. We investigated whether this technique might detect sleep-related breathing disorders.

Methods And Results: In 22 patients, analog waveforms of the transthoracic impedance signal measured by the pacemaker minute ventilation sensor over the course of a night were visualized, scored for apnea/hypopnea events, and compared with simultaneous polysomnography.

Comparison of Epworth Sleepiness Scale scores by patients with obstructive sleep apnea and their bed partners.

Objectives: In some patients with obstructive sleep apnea (OSA), Epworth Sleepiness Scale scores (ESS) do not reflect the severity of disease. In many cases, bed partners (BPs) report more severe hypersomnia on the part of the patient than the patient him/herself. The purpose of this study was to assess the agreement between patients and BPs on ESS scores and to compare patients and BPs on the correlation between ESS and the severity of OSA.

Prediction of the final MSLT result from the results of the first three naps.

Objectives: To determine if the mean sleep latency (mSL) and the presence of significant sleep onset rapid eye movement periods (SOREMPs) can be predicted from the results of the first three naps in selected patients undergoing multiple sleep latency test (MSLT).

Methods: Retrospective analysis of a number of MSLTs to identify the tests in which the mSL category and the presence of > or =2 naps with SOREMPS can be accurately predicted from the sleep latencies (SLs) of and SOREMPs in the first three naps.

Results: The study included 588 consecutive MSLTs performed on 552 patients during a 3-year period.

Sleep-related eating disorder in fraternal twins.

Sleep-related eating disorder (SRED) is characterized by nocturnal partial arousals associated with compulsive consumption of food and altered levels of consciousness. Reports of an increased incidence of SRED in relatives of affected individuals suggest a genetic predisposition. We report a woman with SRED whose fraternal twin sister and father are also affected.

Ictal urinary urge: further evidence for lateralization to the nondominant hemisphere.

Purpose: To determine the lateralizing value of ictal urinary urgency.

Methods: A retrospective database search was performed for patients with ictal urinary urgency admitted to the Epilepsy Monitoring Unit at the Cleveland Clinic between 1994 and 2001.

Results: Six patients were identified; intracarotid amytal test demonstrated left hemispheric speech dominance in five cases.

Sleep and Epilepsy.

Seizures and antiepileptic drugs (AEDs) affect sleep macroarchitecture and may produce excessive daytime sleepiness (EDS) in patients with epilepsy. Sleep is a potent activator of seizures and epileptiform discharges. In some patients, seizures occur exclusively or predominately in sleep.