ABSTRACT
Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type [most commonly visual, most rarely tactile or proprioceptive stimuli]. Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures [such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle]. The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain. In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management
ABSTRACT
Obstructive sleep apnea syndrome [OSAS] is a common disorder characterized by recurrent apnea during sleep. Nocturnal laboratory-based polysomnography [PSG] is the gold standard test for diagnosis of OSA. The sufferers may complain from daytime sleepiness, snoring or occasional headaches. Serious consequences such as cardiovascular complications, stroke or symptoms of depression may complicate the syndrome. Headache prevalence due to sleep apnea is estimated 1%-2% in general population and affects 2%-8% of middle age population. Morning headache is more common in the OSAS patients. OSAS patients present with various characteristics of morning headache. Treatment with continuous positive airway pressure usually reduces headache. The pathophysiologic background for a relation between obstructive sleep apnea and morning headache is multifactorial. Some theories have been proposed for OSAS-related headaches such as changing oxygen saturation during sleep, cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation, sleep disruption and depression but the definite cause of headaches in OSAS patients is not yet clear
ABSTRACT
Overnight polysomnography is the gold standard for the detection of obstructive sleep apnea-hypopnea syndrome [OSAS]. However, it is expensive and needs attending personnel. The study of simplified sleep apnea monitoring is one of the recent trends for sleep medicine research. The proposed clinical prediction rules employ the vital and social statistics, symptoms, craniofacial traits, and obesity-related measures for initial screening of OSAS in an ambulatory setting. However, most of them are partially or completely clinical and not home-based. One disadvantage of this sort of screening methods is their inability to asses OSAS severity. Another approach of initial OSAS screening is a usage of just one or two physiological signals such as electrocardiography [ECG], pulse oximetry, snoring, nasal airflow, or even speech sound. In this study, we aimed to review the different strategies and to compare their performances, reported by means of their sensitivity-specificity and accuracy for OSAS incidence and severity. OSAS severity is determined by apnea-hypopnea index [AHI] value. Based on the data obtained from the related articles, the most accurate methods of AHI estimation exploit ECG and pulse oximetry signals
ABSTRACT
One of the factors, which is involved in obstructive sleep apnea, is anatomic or inflammatory pathologies of nasal airway obstruction. Thus, it is logical to observe improvement of polysomnographic parameters of sleep-disordered breathing after nasal surgery. The authors performed a review of the literature, up to 2013, to determine the impact of nasal surgery on obstructive sleep apnea. Most current idea in this field is based on case series studies while randomized controlled trials evaluating the effect of surgery for nasal obstruction on sleep apnea are few and far between. According to these studies, surgery for nasal obstruction does not improve objective parameters of sleep apnea. Although nasal obstruction is one of the factors involved in obstructive apnea, one has to keep in mind that surgery will not result in major reduction of obstructive sleep apnea severity to relieve nasal obstruction. Detailed upper airway analysis has to be considered when surgery is an option for obstructive sleep apnea. Thus, nasal surgeries are beneficial when they are part of a multilevel approach in obstructive sleep apnea treatment