Clinical Neuroscience

[Diagnosis of primary insomnia by actigraphy - Improved results by data selection]

RAJNA Péter, TAKÁCS Johanna

JANUARY 30, 2014

Clinical Neuroscience - 2014;67(01-02)

[Study objectives - In spite of the useful information provided by actigraphy in sleep medicine it is still not an independent tool either in the clinical diagnosis or in the follow-up. In the frame of a retrospective study, a simple new method of data reduction was applied with the aim of improving the clinical impact of actigraphy for the diagnosis of primary insomnia. Methods - Actigraphic records with a duration of 1 week produced on 47 subjects who met the inclusion-exclusion criteria. The daily activities during the investigational period were registered by means a self-completed questionnaire. Three parameters (sleep latency, sleep fragmentation and sleep efficiency) and only their three ’worse - as regards insomnia’ daily values were analyzed statistically. The study participants comprised 13 healthy controls, 17 healthy ‘bad sleepers’ and 17 subjects with primary insomnia. Results - The post-hoc tests did not reveal statistically significant difference in the three parameters between the healthy and ‘bad sleeper’ groups, but these two groups differed statistically from the primary insomnia group. Conclusion - The actigraphic analysis of sleep latency, sleep fragmentation and sleep efficacy allows a significant differentiation between subjects with primary insomnia and healthy controls, but not between healthy controls and healthy ‘bad sleepers’. Statistical algorithms indicated ‘models’ for clinically good and bad sleepers. Further studies on large populations are necessary before this method can be introduced in the routine medical care of individuals with primary insomnia.]

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[Relationship between default mode network and consciousness]

GYULAHÁZI Judit, VARGA Katalin

[Neural correlation with consciousness represents a main topic of neuroscience studies. New results of consciousness researches proved that based on a coherent function in between its components the default mode network activity is the condition for awake consciousness. The subject of consciousness is self. Tasks related with the self were proving a high default mode network activity. Using connections inside the network, results which were related with self, could be considered to represent a polymodal integration system are they are participating in fine processing of the highly integrated associative information. It could be a result of the convergence of cognitive binding. There is a strong connection between the level of consciousness and praecuneal activation. It was proved that the network activity is changing during sleeping (normal condition), trauma or under drug induced altered consciousness. The default network activity can be considered as the neural correlate of consciousness. Further researches are warranted to answer the question: is the activity of the network the cause or is just accompanying the development of human consciousness?]

Clinical Neuroscience

[Dostoyevsky’s epilepsy in the light of recent neurobiological data]

TÉNYI Dalma, RAJNA Péter, JANSZKY József, HORVÁTH Zsuzsanna, TÉNYI Tamás, GYIMESI Csilla

[Background and purpose -Since the 1960s several theories have developed on the epilepsy of Fyodor Mikhailovich Dostoyevsky. Probably the most exciting and still actual question might be the subject of the „ecstatic aura”, he described in his novels based on his own experiences. During this extremely rare seizure onset the patients experience a strong sense of happiness, harmony and wholeness. The symptomatogenic zone of ecstatic seizures were considered to be of temporal lobe origin for a long time. Lately though this theory seems to be questioned based on the results of SPECT and deep brain EEG monitoring techniques in addition to the enrichment of our knowledge concerning the function of the insular cortex. Methods - Literary and scientific overview on the subject of Dostoyevsky’s epilepsy, with special concern to his ecstatic seizures. Results and conclusion - According to new electrophysiology and imaging techniques ecstatic seizures - including the seizure onset of Dostoyevsky - could rather be connected to the insular cortex.]

Clinical Neuroscience

[Sleep-EEG in dizygotic twins discordant for Williams syndrome]

BÓDIZS Róbert, GOMBOS Ferenc, SZŐCS Katalin, RÉTHELYI M. János, GERVÁN Patrícia, KOVÁCS Ilona

[Background and purpose - Reports on twin pairs concordant and discordant for Williams syndrome were published before, but no study unravelled sleep physiology in these cases yet. We aim to fill this gap by analyzing sleep records of a twin pair discordant for Williams syndrome extending our focus on presleep wakefulness and sleep spindling. Methods - We performed multiplex ligation-dependent probe amplification of the 7q11.23 region of a 17 years old dizygotic opposite-sex twin pair discordant for Williams syndrome. Polysomnography of laboratory sleep at this age was analyzed and followed-up after 1.5 years by ambulatory polysomnography. Sleep stages scoring, EEG power spectra and sleep spindle analyses were carried out. Results - The twin brother showed reduced levels of amplification for all of the probes in the 7q11.23 region indicating a typical deletion spanning at least 1.038 Mb between FKBP6 and CLIP2. The results of the twin sister showed normal copy numbers in the investigated region. Lower sleep times and efficiencies, as well as higher slow wave sleep percents of the twin brother were evident during both recordings. Roughly equal NREM, Stage 2 and REM sleep percents were found. EEG analyses revealed state and derivation- independent decreases in α power, lack of an α spectral peak in presleep wakefulness, as well as higher NREM sleep σ peak frequency in the twin brother. Faster sleep spindles with lower amplitude and shorter duration characterized the records of the twin brother. Spectra show a striking reliability and correspondence between the two situations (laboratory vs. home records). Conclusion - Alterations in sleep and specific neural oscillations including the α/σ waves are inherent aspects of Williams syndrome.]

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[The role of sleep in different memory processes is debated. Probably it plays an active role in the memory consolidation or possibly it prevents forgetting by protecting against interference or it makes the memory performance more efficient by facilitating the forgetting. The beneficial effect of sleep in explicit memory is well demonstrated, while the role of sleep in implicit mechanisms has not been comprehensively characterized so far. There are several factors which affect the appearance of sleep effect, such as the structure, the length and the complexity of sequence being used, the awareness of the sequence, the length of the learning blocks and the offline period. Besides the classical sleep deprivation methods with healthy participants, examining patients with sleep disorders could be a new method of the investigation of the sleep effect which enables us to enrich our knowledge not only about the sleep-dependent memory consolidation but also the cognitive dysfunction related to sleep pathologies. This new line of research can help the development of more effective rehabilitation programs.]

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Clinical Neuroscience

[Actigraphy: A valuable diagnostic tool or a luxury investigation? (Neuropsychiatric aspects)]

RAJNA Péter, SZOMSZÉD Anita

[Aim - Despite of the continuing interest in actigraphy it has a relatively low impact on the everyday medical routine. Accordingly, we set out to review the current state and to recommend relevant further indications for its application, especially in neuropsychiatry. Method - We surveyed the areas of its use and then reviewed the literature, with special regard to its advantages and methodological limitations. Adding to the results we enlarged the results with our own personal experience. Results - The limitations of the method may be decreased by methodological manipulations (a simple rational data reduction is recommended). Actigraphy appears to be a useful tool in the diagnosis of illnesses, syndromes or disorders influencing the vigilance level, the motor performance or the energetic balance of the organism. We constructed a list of the most relevant fields of indication of actigraphy in diagnostics, illustrated by anecdotal actigraphic case records. Conclusion - Further methodological considerations are needed for the successful evaluation of accelerometry. Targeted basic epidemiological studies in the healthy population and in patient groups should solve various open questions in order to make full use of the advantages of actigraphy in the everyday clinical routine.]

Clinical Neuroscience

[PRAMIPEXOLE THERAPY OF RESTLESS LEGS SYNDROME]

VIDA Zsuzsanna, SZAKÁCS ZOLTÁN

[The restless legs syndrome is a disorder belonging to the family of movement disorders during sleep, often remains unrecognized, although it is the second most common cause of chronic sleep deficiency and daytime sleepiness. In accordance with international guidelines, pharmacotherapy of this disorder should begin with a dopamine agonist. Owing to their efficacy and favorable safety profile, newly introduced, selective dopamine agonists have become extensively used for this purpose. This study evaluated the efficacy of one of the products in this group, pramipexole. Fifty-one patients suffering from idiopathic restless legs syndrome underwent monotherapy with pramipexole in daily doses of 0.25 to 1.0 mg. Therapeutic efficacy was evaluated using three tools, i.e. follow-up questionnaires, actigraphy, and Forced Immobilisation Test. An excellent therapeutic effect was seen in more than 80 per cent of the study population. As shown by findings of the follow-up questionnaires, pramipexole resulted in substantial improvements of both daytime and nighttime symptoms of RLS. Actigraphy monitoring demonstrated a statistically significant increase in the ratio of time spent without limb movement to the time spent in bed; furthermore, the result of the Forced Immobilisation Test also improved. It seems fair to conclude from the findings of this study that pramipexole monotherapy is an effective treatment in restless legs syndrome.]

Clinical Neuroscience

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