BackgroundHeadache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy.MethodsAll patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ2-test, t-test and Mann–Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH.ResultsOut of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P < 0.001). Post-ictal headache (post-IH) was significantly associated with both migraineurs (OR 2.60, 95 % CI 1.85-3.64, P < 0.001) and TTH patients (OR 2.05, 95 % CI 1.41-2.98, P < 0.001). Moreover, post-IH was significantly associated with antiepileptic polytherapy (P < 0.001), high seizure frequency (P = 0.002) and tonic-clonic seizures (P = 0.043).ConclusionsMigraine was the most represented type of headache in patients with epilepsy. Migraineurs are more prone to develop pre-IH, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post-IH after seizures.
Objective Eyelid myoclonia with absences (EMA) is a syndrome characterized by eyelid myoclonia with or without absences, eye closure‐induced generalized electroencephalographic (EEG) paroxysms and photosensitivity. Few data are available about the prognostic factors of this syndrome. The main objectives of our study were to describe the clinical and EEG features of a group of patients with EMA and to evaluate the presence of prognostic factors. Methods We retrospectively selected a cohort of patients with diagnosis of EMA evaluated in the epilepsy service of the Neurological Clinic of Catania, in the Neurology and Clinical Neurophysiopathology Unit of Oasi Research Institute, Troina and in the Regional Epilepsy Centre of Bianchi‐Melacrino‐Morelli Hospital of Reggio Calabria. We considered the features of the patients during the first year of disease, and at the last follow‐up visit. We stratified the patients into two groups: “seizure‐free”, defined as the absence of seizures for at least 2 years, and “not seizure‐free” and we evaluated the evolution of their characteristics and the presence of factors associated with outcome. Results We enrolled 51 patients (40 women (78%); mean age: 30.8 years ± 15.5 [range 10‐79]). The mean follow‐up time was 8.7 ± 5.8 years. Eleven patients (21.6%) achieved the condition of seizure‐free. Family history of epilepsy was associated with the condition of seizure‐free (P = 0.05). At the last follow‐up visit, EEG photosensitivity and eye closure sensitivity were significantly associated with the condition of “not seizure‐free”. Significance The results of our study revealed that a positive family history of epilepsy might be associated with a better outcome in EMA. Furthermore, the persistence of photosensitivity and eye closure sensitivity might indicate persistence of seizures, offering an aid in therapeutic management.
Study objectives:To determine the polysomnography characteristics during sleep paralysis, false awakenings and lucid dreaming (which are states intermediate to REM sleep and wake but exceptionally observed in sleep laboratory). Methods:In 5 subjects, we captured 5 episodes of sleep paralysis (2 time-marked with the ocular left-right-left-right code normally used to signal lucid dreaming, 1 time-marked by an external noise and 2 retrospectively reported) and 2 episodes of false awakening. The sleep coding (using three seconds mini-epochs) and spectral EEG analysis were compared during these episodes and normal REM sleep as well as wakefulness in the same four among these five subjects, and vs. lucid REM sleep in four other patients with narcolepsy.Results: During episodes of sleep paralysis, 70.8 % of mini-epochs contained theta EEG rhythm, (vs. 89.7% in REM sleep and 21.2% in wakefulness), 93.8% contained chin muscle atonia (vs. 89.7% in REM sleep and 33.3% in wakefulness) and 6.9% contained rapid eye movements (vs. 11.9% in REM sleep and 8.1% in wakefulness). The EEG spectrum during sleep paralysis was intermediate between wakefulness and REM sleep in the alpha, theta and delta frequencies, whereas the beta frequencies were not different between sleep paralysis and normal REM sleep.The power spectrum during false awakening followed the same profile as in sleep paralysis. Conclusions:The predominant theta EEG rhythm during sleep paralysis and false awakenings (with rare and lower alpha rhythm) suggests that the brain during sleep paralysis is not in an awake but in a dreaming state. 4 BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep paralysis is commonly viewed as an awake brain with a complete muscle atonia, but EEG analysis during sleep paralysis is exceptional.Study Impact: Our polysomnography and spectral analysis of time-marked sleep paralyses suggest that the brain during sleep paralysis is not in an awake but in a dreaming state. This may explain why hallucinations are often associated with sleep paralysis.
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