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...

SUMMAR Y The increased tendency to fall asleep during the daytime together with increased wakefulness during the night has been demonstrated in patients with advanced Alzheimer's disease (AD). The aim of this study was to assess daytime sleep propensity in a cohort of patients with mild/moderate AD and to correlate it with cognitive impairment. Twenty drug-free AD patients meeting the NINCDS-ADRDA criteria for probable AD were evaluated. According to their Clinical Dementia Rating scores, subjects were classified into mild (CDR1; n ¼ 11) and moderate (CDR2; n ¼ 9) dementia patients. A group of 12 healthy subjects was taken as controls. The subjects were evaluated by the multiple sleep latency test (MSLT) after their nocturnal sleep pattern had been assessed by a polysomnographic recording throughout the night before. Both groups of AD patients showed a higher level of daytime sleepiness, which was statistically significant for mean daytime sleep latency (MDSL) (controls versus CDR1 and versus CDR2, CDR1 versus CDR2) and for 10:00 and 12:00 hour naps (controls versus CDR1, controls versus CDR2

We have investigated the cerebral activation centre in four patients with episodic cluster headache (CH) with functional magnetic resonance imaging (f-MRI). The patients underwent MRI scans for anatomical and functional data acquisition in the asymptomatic state, during a headache attack and after subcutaneous administration of sumatriptan. Anatomical images were acquired by means of 3D-MPRAGE sequences and f-MRI images were obtained by means of echo-planar imaging. Data was analysed using the BrainVoyager QX version 1.7.81 software package. In all patients, the data showed significant hypothalamic activation of the hypothalamus ipsilateral to the pain side, attributable to a headache attack. Overall, we have demonstrated the anatomical location of central nervous system activation by means the first f-MRI study in CH patients. f-MRI offers a good balance of spatial and temporal resolution, and this method of study appears appropriate for investigating the pathogenetic aspects of primary headaches. Positron emission tomography and f-MRI may be regarded as little or no importance in a clinical context, they do, however, offer great potential for the exploration of headache physiopathology and the effects of pharmacological treatment.

IntroductionThe relationship between sleep and headache has been known for over a century. Headache and sleeping problems are both some of the most commonly reported problems in clinical practice, and cause considerable social and family problems, as well as socio-economic impact and costs. Much data suggests an association between headache, especially migraine, on one side and sleep and its disorders on the other, but the cause and effect of this relationship is not clear. With regard to migraine, rest and sleep usually bring relief and have therefore been attempted in the treatment strategy; on the other hand however, migraine episodes are frequently triggered by several factors including sleep pattern changes; emotional stress, hypoglycaemia, sensorial stimulation (loud noise, bright light, heat or cold) and also lack of sleep or excess (weekend migraine) may, indeed, represent migraine triggers. Premonitory symptoms like mood states such as alert, tense, depressed or tired and changes in sleep quality have been described to occur up to 2 days before a migraine attack and were hypothesised to be related to a hypothalamic involvement in the prodromic phase of migraine [1]. Recently it has also been documented that overuse of migraine symptomatic drugs may worse sleep pattern in migraineurs and the withdrawal of the misused medication can alleviate the associated sleep disturbance [2].Several findings also suggest a role of chronobiological factors in migraine, probably related -as previously J Headache Pain (2005) 6:258-260 DOI 10.1007/s10194-005-0201-2 Sleep quality, chronotypes and preferential timing of attacks in migraine without aura Abstract Clinical observations show that migraine attacks have a seasonal, menstrual and circadian timing, suggesting a role of chronobiological mechanisms and their alterations in the disease, but little experimental data exists about this issue. The aim of this study was to estimate sleep quality chronotypes, and the possible circadian timing of attacks in migraneurs. One hundred patients suffering from migraine without aura according to the IHS criteria (2004), and 30 controls were enrolled. Morning and evening type subjects were more represented in migraine patients than in controls and showed a tendency towards worse sleep quality and higher disability. Forty-two percent of migraineurs presented more than 75% of their attacks at night. Morning and evening types rather than intermediate and differences between real and preferred times may represent stressors that can worsen the disease. A preferential timing for occurrence of migraine attacks during the night and early morning hours was documented. P S Y C H O B I O L O G I C A L A S P E C T S O F H E

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.