Background and Purpose-Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known. Methods-We prospectively studied 152 patients (mean age 56Ϯ13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3Ϯ2 days after stroke onset and 6 months later (subacute phase). Continuous positive airway pressure (CPAP) treatment was started acutely in patients with SDB (AHI Ն15 or AHI Ն10ϩESS Ͼ10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60Ϯ16 months later (chronic phase). Results-Initial AHI was 18Ϯ16 (Ն10 in 58%, Ն30 in 17% of patients) and decreased in the subacute phase (PϽ0.001).Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r 2 ϭ0.34). In patients with AHI Ն30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI Ͻ10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease. Conclusions-SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients. (Stroke. 2006;37:967-972.)

SUMMARY The evolution of subjective sleep and sleep electroencephalogram (EEG) after hemispheric stroke have been rarely studied and the relationship of sleep variables to stroke outcome is essentially unknown. We studied 27 patients with first hemispheric ischaemic stroke and no sleep apnoea in the acute (1–8 days), subacute (9–35 days), and chronic phase (5–24 months) after stroke. Clinical assessment included estimated sleep time per 24 h (EST) and Epworth sleepiness score (ESS) before stroke, as well as EST, ESS and clinical outcome after stroke. Sleep EEG data from stroke patients were compared with data from 11 hospitalized controls and published norms. Changes in EST (>2 h, 38% of patients) and ESS (>3 points, 26%) were frequent but correlated poorly with sleep EEG changes. In the chronic phase no significant differences in sleep EEG between controls and patients were found. High sleep efficiency and low wakefulness after sleep onset in the acute phase were associated with a good long‐term outcome. These two sleep EEG variables improved significantly from the acute to the subacute and chronic phase. In conclusion, hemispheric strokes can cause insomnia, hypersomnia or changes in sleep needs but only rarely persisting sleep EEG abnormalities. High sleep EEG continuity in the acute phase of stroke heralds a good clinical outcome.

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Purpose: Epilepsy and epileptic seizures occur more frequently in patients with multiple sclerosis (MS). In this patient population most often are reported complex partial and secondarily generalized tonic-clonic seizures. The aim of this study was to analyze the clinical and some demographic characteristics of patients with epileptic seizures or epilepsy and MS who have sought specialized medical care in the area of Sofia, Bulgaria.  Methods: A prospective study with 67 consecutive cases of patients with definite MS which was realized at a Clinic of neurology of a University hospital. In all patients a disease history was reviewed with a focus on epileptic seizures and other motor phenomena, as well on epilepsy.  Results: Epileptic seizures were identified in 4 (6.0%) patients in our group. Epilepsy was identified as well in 4 (6.0%) patients. Of these, we identified simple focal motor seizures, simple focal sensory seizures, and generalized tonic-clonic seizures. Paroxysmal activity on electroencephalography (EEG) was registered in three patients. Conclusions: Our locally performed study corroborates the overall opinion that epilepsy and epileptic seizures are more frequent in patients with MS than in the general population. The seizure semiology was not different than previously reported in other MS and epilepsy studies. We did not identify any patient with an epileptic seizure as an initial or the only presentation of MS.