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Clinical Neuroscience

SEPTEMBER 30, 2020

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

JANUARY 30, 2016

Long term follow-up of lesional and non-lesional patients with electrical status epilepticus in slow wave sleep

HEGYI Márta, SIEGLER Zsuzsa, FOGARASI András, BARSI Péter, HALÁSZ Péter

Objectives – A retrospective study has been done at the Bethesda Children’s Hospital Epilepsy Center with those patients whose EEG records fulfilled in one or more records the criteria of electrical status epilepticus in slow wave sleep (ESES) pattern, occupying at least 75% of NREM sleep with bilateral discharges, and had detailed disease history and long term follow-up data, between 2000 and 2012. Patients and methods – Thirty-three patients (mean 11.1±4.2 years of age) were studied by 171 sleep EEG records. Sleep was recorded after sleep deprivation or during spontaneous sleep at least for one hour length of NREM. From the 492 EEGs, 171 sleep records were performed (average five/patient). Average follow-up time was 7.5 years. Eighty-two ESES records have been analyzed in 15 non-lesional and 18 lesional (11 with dysgenetic and seven with perinatal - asphyxic or vascular origin) patients. Variability of seizure types, seizure frequency and frequency of status epilepticus was higher in the lesional group. Impairment of the cognitive functions was moderate and partial in the non-lesional, while severely damaged in the lesional group. Results – EEG records of 29 patients showed unihemispherial spike fields with a perpendicular axis (in anterior, medial and posterior variants) to the Sylvian fissure, regardless their lesional or non-lesional origin. Only three (1one non-lesional and two lesional) patients had bilateral synchronous spike-wave discharges with bilateral symmetric frontocentral spike fields. The individual discharges of the sleep EEG pattern were very similar to the awake interictal records except their extension in time and field, their increased number, amplitude, and continuity of them and furthermore in the increased trans-hemispheral propagation and their synchronity. Conclusions – Assumed circuits involved in the pathomechanism of discharges during NREM sleep in ESES are discussed based on our findings.

Clinical Neuroscience

SEPTEMBER 30, 2019

[Newer studies on the strong link between sleep and epilepsy: Epilepsy as an epileptic transformation of sleep plastic functions]

HALÁSZ Péter

[Aims - Overview of the new data about the strong link of sleep and epilepsy and conjoining cognitive impairment. Methods - Search for relevant references and summary of our own research activity on the topic. Results - Strong interrealtionship exists between epilepsy and plastic brain functions (memory processing and synaptic homeostasis) and the working modes of NREM sleep. In the most frequent childhood and adult epilepsy networks responsible for plastic functions can be derailed to an epileptic level of excitability, and suffer a transitory or permanent epileptic transformation. Exampling on the three big epilepsies: absence epilepsy; medial temporal lobe epilepsy; and childhood idiopathic focal age dependent epilepsy spectrum we demonstrate the most important features of this epileptic transformation. The association of cognitive impairment to certain sleep dependent epilepsies gains explanation by the epilepsy caused interference with slow wave decline (ICFE) and memory consolidation (MTLE) during NREM sleep. This paper serves also to introduce the concept of sleep dependent system epilepsies. Conclusions - We provide evidences about shared mechanisms among sleep related epilepsies being the derailment of sleep plastic funcions toward exaggerated excitability determined by the inherent possibilities of the signal transduction properties. ]

Clinical Neuroscience

JULY 30, 2019

[Sleep habits among preschool- and schoolchildren]

FUSZ Katalin, RITECZ Bernadett, BALOGH Brigitta, TAKÁCS Krisztina, SOMLAI Eszter, RAPOSA L. Bence, OLÁH András

[Objective - Our aim is to evaluate sleep habits, sleep quality and influencing factors among preschool- and schoolchildren. Method - Two questionnaires were recorded. Questionnaire 1 dealt with sleeping habits, breastfeeding and health behavior of preschool children and infant, and it contained the abbreviated version of the Children’s Sleep Habits Questionnaire. Questionnaire 2 dealt with health behavior and the application of sleep hygiene rules, as well as it contained the Athens Insomnia Scale. Subjects - We assessed a total of 1063 questionnaires: 516 kindergarten children participated in our online survey across the country; 547 primary and secondary school students participated in the 2nd questionnaire survey in Szolnok. Results - Parents’ observation shows that the average nighttime sleeping time of kindergarten children is 10 hours 20 minutes on weekdays and 10 hours 36 minutes on weekends. The most popular sleeping habits in kindergarten age: teal reading (65.1%) and co-sleeping (42.8%). Parents of infants used breastfeeding (50.4%) and rocking (43.2%) most frequently before sleep. Co-sleeping has a positive influence on the length of lactation. Among the preschool sleeping habits we have proved a number of positive effects of teal reading, while watching television have negative effects. The sleep quality of school-age children according to the Athens Insomnia Scale is 6.11 points (SD: 4.11), 19% of the children are insomniac. Their sleep time is 7 hours 31 minutes on weekdays and 9 hours 30 minutes on weekends. The usage of good health behavior and sleep hygiene rules positively influence sleep quality and sleep duration. Conclusions - With our results, we would like to draw the attention of children and parents to the importance of sleeping and using sleep hygiene rules.]

Clinical Neuroscience

NOVEMBER 20, 2015

[Sleep disordered breathing and epilepsy: relationships and therapeutic considerations]

FALUDI Béla, BÓNÉ Beáta, KOMOLY Sámuel, JANSZKY József

[The importance of the sleep related breathing disorders (obstructive sleep apnea syndrome, central sleep apnea, and Cheyne-Stokes breathing) in the pathophysiology crebro- and cardiovascular disorders is well known. The relationship of sleep related breathing abnormalities and epilepsy is also important but underestimated in the daily practice. The relation is bidirectional. The breathing abnormalities in sleep may play important role in generating epileptic seizure, but the adverse effect of seizure and antiepileptic therapy (generation of apneas and hypopneas) may worsen the seizure control. The effect of new therapies (vagal nerve and deep brain stimulation) on the sleep architecture and sleep disordered breathing must be examined and discussed. Here we present a brief case of epileptic patient with deep brain stimulation therapy on sleep as well. The examination of the sleep related breathing abnormalities in epilepsy patient may help improve the effectiveness of antiepileptic therapy.]

Clinical Neuroscience

JULY 30, 2019

Relationship between Status Epilepticus Severity Score and etiology in adult NCSE patients

GENC Fatma, ERDAL Abidin, AKCA Gizem, KARACAY Ertan, GÖKSU Özaydın Eylem, KUTLU Gülnihal, GÖMCELI Bicer Yasemin

Purpose - Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. Method - In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. Results - There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). Conclusions - This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.

Journal of Nursing Theory and Practice

APRIL 30, 2019

Socioeconomic status and health status: mortality and morbidity

DABES Meshik Alphonsus, PAPP Katalin

There is no situation that the individual’s socioeconomic status (SES) play a huge role in the individual’s health outcomes and the health care they receive. Socioeconomic status is mostly measured by education, income and occupation. People of higher SES tend to have more knowledge on health and health behaviours, and that determined their accessibility, acceptability and affordability of health care services. Arpey et al 2017, opined that people of lower SES are more likely to have worse self-reported health, lower life expectancy, and suffer from more chronic conditions when compared with those of higher SES. In this study, I want to analyse the relationship between socioeconomic status and health status considering mortality and morbidity among people of lower SES and higher SES using current literatures review. Base on this study it is clearly understood that there is a clear disparity in health status between lower socioeconomic status and higher socioeconomic status population. This health inequality is as a result of differences in economic, social and cultural factors. Health inequalities is avoidable and unfair because it is as a result of an unjust distribution of the underlying social determinants of health such as, unequal opportunities in education and/or employment which are the core determinants of persons socioeconomic status. Therefore, in order to reduce the inequality in health among higher and lower SES group, there should be equal distribution and opportunity for both groups to access education and employment.

Clinical Neuroscience

JULY 30, 2019

Restless leg syndrome frequency in health workers

ÖCAL Ruhsen, ATGÜDEN Gizem, AYCAN Cagri, BALABAN Zeynep, SENAR Seran, YAVUZ Sena

Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2018

[Sleep Disorders among ICU Patients]

PUSZTAI Dorina Erzsébet, FULLÉR Noémi

[Aim: To examine the changes of sleep quality and quantity among patinets in the intensive care unit, to determine the factors which have influence on sleeping and to bare the methods that can help to optimize sleeping. Theme and method: During a quantitative, longitudinal research 82 patients datas and questionnaire answers were analysed. In Microsoft Excel and SPSS 22.0 program we used c2-probe, T-probe, linear regression, Mann-Whitney U probe, descriptive statistics (p<0.05) Results: In comparison of the sleep quality and quantity, both variables changed in negative direction in ICU. The most common factors that influence sleep are: thirst/feeling of mouth dought, uncomfortable posture, therapeutic tools. Correlation is detected between the quality of sleep in ICU and the severity of the existing disease (p=0.004) and therapeutic tools (p=0.002) and noises (p=0.003). Conclusion: In changed environment, mainly in the ICU, the sleep quality and quantity are poor compared to home’s and standard department’s. ]

Lege Artis Medicinae

MARCH 20, 2019

[Long-term CPAP compliance among Sleep Apnea Patients at the Sleep Laboratory of the Hungarian Defense Forces Medical Center ]

DOMBOVÁRI Magdolna, BERNÁT István, TERRAY-HORVÁTH Attila, CSATLÓS Dalma, HARGITTAY Csenge, TORZSA Péter

[Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder, with a prevalence of 2-4% in the overall popula­tion. It is a risk factor for cardiovascular diseases and its daytime symptoms significantly impair the patients’ quality of life and increase the risk of work and road accidents. Its first-line treatment is the CPAP device (Continuous Positive Airway Pres­sure) the effectiveness of which is significantly determined by the compliance of the patient. Although the issue of compliance in such treatment is a very important factor, long-term studies including a large number of patients have not been published yet, and there are no known data about it in Hungary. OBJECTIVE - Examining the long-term compliance of CPAP among OSAS patients in a sleep laboratory in Hungary. METHOD - 3403 OSAS patients were selected for our study between January 1, 2007, and September 30, 2017. The diagnosis and titration of effective CPAP pressure were determined by polysomnography. Patients were controlled after 2 months of therapy and then every 6 and 12 months. During the care, their compliance value was determined by data downloaded from their device's memory card. RESULTS - The mean age (± SD) of patients was 59.0 (± 10.5) years, most of them were male, 2676 (78.6%), their average body mass index (BMI) was 32.6 (± 5.25) kg/m2, their average Epworth Sleepiness Scale score was 11.4 (± 5.0), their average Apnea-Hypopnoe index was 51.0 (± 19.5) events/hour. The average usage time of the CPAP device was 5.0 (± 1.9) hours. 72.3% of the patients used the device for over 4 hours and 27.7% used it for less than 4 hours. 34.7% of the patients used the device for more than 6 hours. The Epworth Sleepiness Score showed a significant and dose-dependent improvement over CPAP treatment, with a greater improvement among patients who used the machine for longer hours. The highest score improvement was achieved by users who used CPAP between 6-7 hours, averaging 7.3 (± 3.2) points (p <0.001). CONCLUSIONS - Our present study shows that high average compliance can be achie­ved among well-adjusted and well-maintained patients. ]