1/30. 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 = state (Clic here for more details about this article) |
2/30. Prognostic value of evoked potentials and sleep recordings in the prolonged comatose state of children. Preliminary data.OBJECTIVES: Sleep recordings and evoked potentials (EPs) were used in five comatose children to evaluate their predictive value for outcome following a severe comatose state. methods AND SUBJECTS: The protocol included EEG, Brainstem Evoked Responses (BERs), Somatosensory evoked potentials (SEPs) and polysomnography. From 10 to 15 days post-coma (D10 to D15), EEG and clinical examinations were carried out every second day, then one day in four from 15 to 30 days post-coma (D15 to D30), and one day in seven from D30 to six months (M6). evoked potentials and polysomnography were recorded on D10-D15 or D30 in the second month (M2) and in M6. Of the five children, three were in anoxic coma and two in traumatic coma. All had extensive lesions and a glasgow coma scale (GCS) score of less than five. The results of the EEG, polysomnographic and EP recordings were compared to the clinical outcome. RESULTS AND CONCLUSION: In the three anoxic comas we observed BER abnormalities and the absence of SEP N20 associated with wide cortical lesions with brainstem extension. Sleep recordings showed major alterations of the wake-sleep cycle without any improvement in M6. Abnormalities included loss of the normal REM-sleep pattern associated with alteration of NREM sleep and periods of increase in motor activity without EEG arousal. This sleep pattern appeared to be associated with involvement of the brainstem. In the two traumatic comas, alterations of the early cortical SEP responses were less severe and the BERs were normal. Some sleep spindles were observed as well as the persistence of sleep cycles in the first weeks post-coma. The combined use of EEG, EPs and polysomnography improved the outcome prediction in comparison with the use of just one modality. EPs and sleep recordings were far superior to clinical evaluation and to GCS in the appreciation of the functional status of comatose children. The reappearance of sleep patterns is considered to be of favorable prognosis for outcome of the coma state, as is the presence of sleep spindles in post-trauma coma. This study showed that EPs and sleep recordings help to further distinguish between patients with good or bad outcomes.- - - - - - - - - - ranking = 6keywords = state (Clic here for more details about this article) |
3/30. Dreaming sleep attacks and desynchronized sleep enhancement. Report of a case of brain stem signs.When central neurologic signs were localized to the vestibular region of the brain stem and cerebellum, a 54-year-old man experienced frequent awakenings from nocturnal sleep and daytime sleep attacks with hallucinosis. Sleep attacks were characterized by lid fluttering and closure, upward turning of the eyes, rapid eye movements, myoclonic twitching of all extremities, and loss of consciousness, lasting one or two minutes and aborted by strong sensory stimulation. At their termination, reports of hallucinoid imagery were given. In a sleep record of 6.5 hours, there were 2.2 hours awake (34%), 4.3 hours desynchronized sleep (66%), and a complete absence of synchronized sleep. Reports of hallucinoid imagery were given after awakenings from desynchronized sleep. The findings support the hypotheses that desynchronized sleep is normally under brain stem control and that some types of narcolepsy may be pathophysiologically related to desynchronized sleep.- - - - - - - - - - ranking = 15.030477138048keywords = consciousness (Clic here for more details about this article) |
4/30. Sleep and dream suppression following a lateral medullary infarct: a first-person account.consciousness can be studied only if subjective experience is documented and quantified, yet first-person accounts of the effects of brain injury on conscious experience are as rare as they are potentially useful. This report documents the alterations in waking, sleeping, and dreaming caused by a lateral medullary infarct. Total insomnia and the initial suppression of dreaming was followed by the gradual recovery of both functions. A visual hallucinosis during waking that was associated with the initial period of sleep and dream suppression is described in detail. Since the changes in sleep and their recovery are comparable to results of animal experiments, it can be concluded that damage to the medullary brain stem causes extreme but short-lived alterations in conscious state and that substantial recovery occurs even though the damage to the brain stem endures.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
5/30. Vasovagal syncope interrupting sleep?Clinical data are reported for 13 patients who were referred with recurrent loss of consciousness at night interrupting their sleep. Most of the patients were women (10 of 13) with a mean age of 45 years (range 21-72 years). The histories were more consistent with vasovagal syncope than with epilepsy. This was supported by electroencephalographic and tilt test results. More polysomnographic monitoring data are required to confirm the diagnosis of vasovagal syncope interrupting sleep. This will be difficult because, although the condition may not be rare, the episodes are usually sporadic.- - - - - - - - - - ranking = 15.030477138048keywords = consciousness (Clic here for more details about this article) |
6/30. Persistent neuropsychological problems after 7 years of abstinence from recreational Ecstasy (MDMA): a case study.This case study concerns a 26-yr.-old male who had consumed large amounts of Ecstasy seven years previously. He stated that his increasingly intensive use of ecstasy over a 4-yr. period had led to the emergence of multiple psychiatric and psychological problems. Given these problems, he stopped using Ecstasy, but the problems had not resolved despite seven years of abstinence. The neurocognitive profile was very similar to that shown by current heavy Ecstasy users, with deficits in immediate and delayed verbal recall, moderately impaired memory function, but normal expressive language ability and perceptual functioning. Extremely high pathology was evident, including depression and phobic anxiety. Severe problems with sleep and sex were also reported. Further studies involving larger groups of abstinent former users are needed; adverse sequelae associated with intensive Ecstasy use may sometimes be enduring.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
7/30. Status dissociatus--a perspective on states of being.During the course of routine clinical study, it has become apparent that the all-or-none concept of state determination (wakefulness, nonrapid eye movement sleep, rapid eye movement sleep) does not always exist, and that ambiguous, multiple, or rapid oscillation of state-determining variables appear in a wide variety of experimental and clinical situations. Six cases of extreme state dissociation are presented, with a review of the human and animal clinical and experimental literature. This multiple component concept of state determination must be kept in mind when pharmacologic or lesion studies are employed to suppress one or another state. Such manipulation may suppress some of the commonly used markers for that state (i.e., polygraphic) without affecting other variables of that state. The existence of mixed states will be a challenge to the development of automated computerized polysomnogram scoring.- - - - - - - - - - ranking = 12keywords = state (Clic here for more details about this article) |
8/30. The exploding head syndrome: polysomnographic recordings and therapeutic suggestions.attention has recently been drawn to a condition termed the exploding head syndrome, which is characterized by unpleasant, even terrifying sensations of flashing lights and/or sounds during reported sleep. Nine patients complaining of sensations of explosions in the head during sleep or drowsiness were investigated with polysomnographic recordings. None of them had any neurological disorder. Five patients reported explosions during the recording sessions. According to the recordings, the attacks always took place when the patients were awake and relaxed. In two cases abrupt electroencephalographic (EEG) and electromyographic changes indicating increasing alertness were recorded at the time of the reported attacks. In the remaining three cases no EEG changes were seen. Thus, there were no indications of an epileptic etiology to the condition. In all patients the symptoms ameliorated spontaneously with time. The severity of the symptoms was reduced by reassurance of the harmlessness of the condition. clomipramine was prescribed to three patients who all reported immediate relief of symptoms. It is concluded that symptoms of this type are probably not true hypnagogic phenomena but may be an expression of emotional stress in the awake state.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
9/30. Sleep violence--forensic science implications: polygraphic and video documentation.During the past century, infrequent, anecdotal reports of sleep-related violence with forensic science implications have appeared. Recent rapid developments in the field of sleep-disorders medicine have resulted in greater understanding of a variety of sleep-related behaviors, and formal sleep-behavior monitoring techniques have permitted their documentation and classification. Sleep-related violence can be associated with a number of diagnosable and treatable sleep disorders, including (1) night terrors/sleepwalking, (2) nocturnal seizures, (3) rapid eye movement (REM) sleep-behavior disorder, (4) sleep drunkenness, and (5) psychogenic dissociative states occurring during the sleep period. Potentially violent automatized behavior, without consciousness, can and does occur during sleep. The violence resulting from these disorders may be misinterpreted as purposeful suicide, assault, or even homicide. Sleep-related violence must be added to the list of automatisms. A classification system of both waking and sleep-related automatic behavior is proposed, with recommendations for assessment of such behavior.- - - - - - - - - - ranking = 16.030477138048keywords = consciousness, state (Clic here for more details about this article) |
10/30. 24 hour polysomnographic evaluation in a patient with sleeping sickness.A 24 h polysomnographic recording was performed in a patient with sleeping sickness presenting an atypical neurological syndrome. trypanosoma gambiense was found in a lymph gland puncture and the CSF, and a serologic immunofluorescence test was positive. The scoring technique of the polygraphic traces had to be adapted because of the presence of a permanent EEG delta wave activity during the NREM sleep stages, and the method used by Schwartz and Escande (1970) was applied. REM sleep and wakefulness presented normal polygraphic characteristics. The patient had 8 sleep episodes throughout the recording period, occurring during the daytime and at night, forming the classical diurnal sleepiness and nocturnal restlessness of sleeping sickness. All but one episode represented 1-3 complete REM-NREM sleep cycles. On all occasions, REM latency was short and 2 SOREM episodes were observed. The nychthemeral organization of the stages of vigilance differed from one state to another. wakefulness and REM sleep had a circadian rhythmicity, while NREM sleep, total sleep time and deep sleep (corresponding to stages 3 and 4) had an ultradian periodicity. The concordance between the higher pressure for wakefulness and lower pressure for sleep around 20.00 h defined the time of occurrence of a 'forbidden zone' for sleep.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
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