1/21. Three children with a syndrome of obesity and overgrowth, atypical psychosis, and seizures: a problem in neuropsychopharmacology.Three children presented with a complex syndrome of atypical psychotic and extremely immature behavior, obesity and overgrowth, borderline retardation, and seizures (prominent in two). Weight overgrowth exceeded height overgrowth and was stratospheric (up to 8 SD above mean). obesity seemed related to lack of satiety. The cases fit no known condition: hypothalamic damage, Sotos' syndrome, and prader-willi syndrome were excluded. Empirical treatment with anticonvulsants (carbamazepine and acetazolamide) together with psychotropic agents (selective serotonin reuptake inhibitors and risperidone) controlled seizures, improved behavior, and stopped weight gain in each patient. We have not found this syndrome previously described. The etiology is unknown: perinatal encephalopathy could be a factor in the two patients with prominent seizures; in the third, familial major affective disorder is implicated. Medication responses suggest a low-serotonin state underlying the lack of satiety, an imbalance of serotonin and noradrenergic modulation in the hypothalamus, and epileptogenic disorders (or affective disorder responsive to anticonvulsants in one case) involving these same systems.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/21. Sleep-related headache syndromes.The relationship between sleep and sleep disorders and headache remains unclear. Clinical experience and numerous studies document some sort of relationship, but the exact nature remains understudied and complex. Changes in sleep duration and sleep quality appear to be capable of affecting headaches of different types. Obstructive sleep apnea can cause or exacerbate headaches in a susceptible person. Obstructive sleep apnea also may cause a specific headache when awakening, which is different from migraine or tension headache and disappears after treatment of the sleep and breathing disturbance. Hypnic headache is another type of sleep-exclusive headache that has been proposed. Hypnic headaches are brief, moderately severe, and affect the elderly primarily.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/21. kleine-levin syndrome associated with fire setting.kleine-levin syndrome is characterized by periodic hypersomnia associated with megaphagia and striking behavioral and psychiatric symptoms; it occurs primarily in adolescent boys. We treated a 17-year-old boy who had typical recurring somnolent episodes. His bizarre behavior included fire setting and stealing, both of which may have represented compulsions. His EEG during a sleepy episode was diffusely abnormal with generalized slowing of background activity; as he awoke and improved clinically, his EEG returned to normal. Between episodes, his EEG was normal. The relationship between kleine-levin syndrome and other sleep disorders is discussed. The neurochemistry and neurocircuitry that may provide the requisite substrate for this complex and fascinating neuropsychiatric disorder are briefly reviewed.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/21. Paroxysmal arousals during sleep.Six patients complained of distressing sudden awakenings with abnormal motor activity during sleep causing insomnia. polysomnography showed paroxysmal short-lasting arousals during NREM, especially slow-wave sleep, associated with complex movements and autonomic activation. Ictal and interictal EEG never showed epileptic discharges except in 1 patient who also had a tonic-clonic seizure during sleep. carbamazepine was the only effective medication in 2 patients. Paroxysmal arousals represent a sleep disturbance that may be related to deep epileptic foci.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/21. Neonatal sleep myoclonus followed by myoclonic-astatic epilepsy: a case report.Neonatal sleep myoclonus documented polygraphically during the second month of life and subsequent development of a seizure disorder are reported in a 3-year-old boy. Several generalized tonic-clonic seizures associated with febrile illnesses occurred during the first year of life; astatic and myoclonic attacks began at age 13 months. A complex partial seizure occurred for the first time at age 3 years. Differential diagnosis of age-related generalized myoclonic epileptic syndromes and various forms of neonatal myoclonus were considered in this unusual case.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/21. Benign nocturnal childhood occipital epilepsy: a new syndrome with nocturnal seizures, tonic deviation of the eyes, and vomiting.An epileptic syndrome of benign nocturnal childhood occipital epilepsy with excellent prognosis is described. The syndrome is characterized by a clinical ictal triad of nocturnal seizures, tonic deviation of the eyes, and vomiting. There may be marching to involve the head and limbs, ending with a generalized tonic-clonic seizure. consciousness is usually, but not invariably, disturbed. Infrequent daytime fits may develop one to two years after remission of the nocturnal seizures. age of onset is usually from 3 to 5 years. Both sexes are involved. There is no family history of epilepsy or migraine. No definite causative factor was detected. The frequency of the seizures is very low with two children having only solitary ones. The interictal electroencephalographic features consist of repetitive occipital spike and slow wave complexes that are induced by closed eyes and darkness and are inhibited by open eyes and fixation with visual cues. It is proposed that this is a new idiopathic age-related-onset syndrome of the localization-related epilepsies.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/21. kleine-levin syndrome ethiopathogenesis and treatment.The complex of the symptoms of psychic disorders and of the disorders of sleep, appetite, and food intake often forms the basis of the clinical picture of a mental disease. However, it is only rarely conceived in a complex manner as a set of physiologically interdependent functions. A remarkable proof of the interdependence of these functions is their complex disorder, the kleine-levin syndrome. The first descriptions of the symptoms of the kleine-levin syndrome can be found in the studies of several authors published as early as at the turn of the century. In 1942, the syndrome was designated by Critchley and Hoffmann after Willi Kleine and Max Levin, who defined it precisely in 1925 and 1929. The syndrome of periodic hypersomnia, megaphagia, and psychic disorders, originally described only in young males, was later found in females as well; the original very strict criteria were gradually broadened and complemented to some extent. At present, the most commonly accepted criterion for the diagnosis of the kleine-levin syndrome is the existence of the combined sleep disorder (hypersomnia or insomnia lasting from days to weeks), food intake disorders (megaphagia or anorexia), and various psychic abnormalities accompanying or following the attacks of the affection. We term the syndrome typical if the sleep disorder appears in the form of hypersomnia, food disorder in the form of megaphagia, and if psychic abnormalities are clearly expressed. On the other hand, we term the syndrome atypical if one of the main symptoms is opposite. The incomplete syndrome consists of only two main symptoms. The attacks of the affection set on mostly suddenly, lasting from several days to several weeks, ending suddenly again. The interparoxysmal periods last from several days to several months, sometimes even to several years. The etiopathogenesis of the affection is still unknown. A number of reports indicate a disorder of the diencephalon, perhaps only of the hypothalamus. The pathological-anatomical findings following the death of persons suffering from the disorders of sleep and food intake and from psychic abnormalities mostly reveal lesions in the region of the third brain ventricle. The development of the typical syndrome is benign, however, and morphological studies are not available. The typical kleine-levin syndrome can hardly escape the attention of clinicians owing to the richness and clarity of symptoms. The atypical or discretely expressed forms, however, often remain unrecognized even after a detailed medical examination and may lead to diagnostic uncertainty.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 3keywords = complex (Clic here for more details about this article) |
8/21. Three simultaneous major sleep disorders.A patient with complex symptomatology is described. Progress in the diagnosis of sleep disorders gradually led to successful diagnosis-based treatment.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/21. Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults.Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by intermittent loss of electromyographic atonia during REM sleep with emergence of complex and vigorous behaviors. Punching, kicking, and leaping from bed during attempted dream enactment caused repeated injury in nine of our first ten adult patients. Mean age at onset was 62 years; nine of the patients were male. All patients underwent standard polysomnographic studies with videotaping of behaviors and extensive neurologic and psychiatric evaluations. The RBD was unrelated to psychopathologic conditions but in five cases was closely linked with major neuropathologic disorders: dementia (two), olivopontocerebellar degeneration, subarachnoid hemorrhage, and the guillain-barre syndrome. Other common polysomnographic abnormalities were high REM density, increased stage 3/4 (slow-wave) sleep, and both periodic and aperiodic limb twitching in non-REM sleep. Eight patients had dream changes involving motor overactivity and violent confrontations of dream characters. clonazepam induced rapid and sustained improvement of dream and sleep behavior problems in seven patients, as did desipramine hydrochloride in one patient.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/21. Paroxysmal periodic motor attacks during sleep: clinical and polygraphic features.Three patients complained of paroxysmal motor attacks during sleep. Videopolygraphic recordings showed that motor activity could be divided into events of increasing behavioural complexity. Simpler motor events often represented the initial fragment of more complex attacks. Clinical features suggested the attacks represented frontal lobe epileptic seizures. The attacks recurred during NREM sleep with a periodic repetition every 20-60 sec. This periodicity could be related to the analogous physiological oscillation during light sleep and the periodicity of K complexes, exerting a facilitating influence upon epileptic mechanisms.- - - - - - - - - - ranking = 3keywords = complex (Clic here for more details about this article) |
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