Summary: Purpose: Because several reports have described the relation between epilepsy and cardiac arrhythmias and suggest that changes in autonomic neural control of the heart could be involved in the pathogenesis of sudden unexplained death in patients with epilepsy, the aim of this study was to evaluate cardiac function in patients with temporal lobe epilepsy.Methods: Sixty-five patients with epilepsy were evaluated by simultaneous ambulatory 24-h EEG-ECG monitoring, and in 30 of these, power spectral analysis of relative-risk (RR) variability also was carried out, both in the supine position and in a passive tilt position at 60". The power spectrum of RR variability, the two major spectral components detectable at low frequency (LF) and at high frequency (HF), respectively, and the LF/HF ratio were calculated.Results: By EEG-ECG monitoring, we recorded six partial seizures, and in four cases, discharges were associated with sinus tachycardia. However, interictally the occurrence of ventricular and supraventricular arrhythmias was not different from that in normal subjects. The spectral analysis of RR variability, on the other hand, demonstrated in patients with epilepsy a significant decrease in the total RR variability and in both of its components (LF and HF) in the supine position, and of the LF/HF ratio in orthostatic position.Conclusions: These findings suggest that the spectral analysis of RR variability may detect disorders of autonomic cardiac control in patients with epilepsy, even in the absence of abnormal findings during ECG monitoring. This alteration, which is more severe in cases with right EEG focus, could play a role in the pathogenesis of cardiac arrhythmias. Key Words: Temporal lobe epilepsy-Sudden unexplained death in patients with epilepsy-ECG monitoring-Heart rate variabilityAutonomic disorders.Sudden unexplained death in patients with epilepsy (SUDEP) is a well-recognized phenomenon (l), although its pathogenesis is not yet completely understood. In a recent cohort study (2), the maximal overall incidence of SUDEP observed was 1.35 cases/l,OOO person-years, which was similar to values described in previous studies (3,4). In particular, the incidence of SUDEP is increased in males and is correlated with the number of antiepileptic drugs (AEDs) prescribed and with treatment. with psychotropic drugs. It is also associated with alcohol abuse and slightly with mental retardation.With regard to the pathogenesis of SUDEP, the hypothesis of an acute disturbance of the cardiac rhythm as a possible mechanism is supported by various clinical case reports of patients with temporal lobe epilepsy (5,6) Accepted September 13, 1996. Address correspondence and reprint requests to Dr. L. Mum at Department of Neurosciences, Institute of Neurology, Via Roma, 67, 56126 Pisa, Italy and by the finding that both simple and complex partial seizures (CPSs) are consistently associated with tachycardia (7,s) and rarely with bradycardia (9,lO). On the other hand, certain data obtained interictally provide only par...

SUMMARYMorning recall of words presented before sleep was studied in relation to intervening night sleep measures in elderly subjects. Night sleep of 30 elderly subjects aged 61-75 years was recorded. Before sleep, subjects were presented with a list of paired non-related words and cued recall was asked immediately after the morning awakening. Recall positively correlated with average duration of NREM/REM cycles, and with the proportion of time spent in cycles (TCT) over total sleep time (TST). No significant correlations were found with other sleep or wake measures. These results suggest the importance of sleep structure for sleep-related memory processes in elderly adults.

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Nineteen patients with unilateral hemispheric lesions of a vascular or neoplastic nature were studied. Before the onset of disease, these patients had experienced dream recall at least once a week. During hospitalization their dream recall was investigated using a morning diary for 10 consecutive days. During this period, seven patients reported having dreamed, whereas 12 had no dream recall. Subsequently, the patients' sleep was interrupted during both stage 2 NREM and REM sleep. With this method, 11 patients reported having dreamed at least once, whereas eight had no dream recall. Patients with lesions in the temporo-parieto-occipital region had a more frequent loss of dream recall than those with lesions outside this area. The agreement between the results obtained using the diary and those from provoked awakening was significant. The results obtained from compilation of a diary on morning awakening appear sufficiently reliable to reveal the presence or absence of dream recall in patients with focal cerebral lesions in the acute phase of the disease.