Calcified Neurocysticercosis that Invaded the Subarachnoid Space Presenting as Focal Status Epilepticus

Neurocysticercosis is the most common parasitic infection of the nervous system. However, the improvement in public health made the prevalence of neurocysticercosis low. Neurocysticercosis may have symptoms such as seizures, headache, and hydrocephalus, and calcified neurocysticercosis is generally known to be asymptomatic and inert. Also, status epilepticus associated with neurocysticercosis has been rarely reported. Therefore, we report a case of focal status epilepticus caused by calcified neurocysticercosis that invaded the subarachnoid space, which is uncommon pathophysiology of neurocysticercosis.

The Oxygen Desaturation Index for Severity Assessment of Obstructive Sleep Apnea Associated With Cigarette Smoking

Objectives@#Nicotine stimulates release of neurotransmitters that regulate the sleep-wake cycle and thereby leads to insomnia. Smoking is associated with upper airway distress; however, its role in severe sleep-related breathing disorders remains controversial. In this study, we investigated the effects of smoking on obstructive sleep apnea (OSA). @*Methods@#We investigated 1,163 patients diagnosed with OSA who underwent polysomnography between March 2020 and July 2022. We recorded details including smoking status (current, former, and non-smoker), demographics, questionnaire-related data, and polysomnography findings and performed univariate analysis to compare these variables between smokers and non-smokers. We also analyzed the correlation between smoking status and OSA severity. The risk of smoking on the severity of OSA was determined using logistic regression analysis. @*Results@#Current and former smokers included 461 male (49.1%) and 10 female (4.4%) (p=0.001). Smokers had a high apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (p15, odds ratio 1.33, p=0.04), and AHI was independent of smoking. @*Conclusions@#Controversy regarding the severity of OSA with smoking has currently not been definitively determined. However, our results provide new evidence to support the association between smoking and the ODI, which few studies have investigated to date.

Test-Retest Reliability of Multiple Sleep Latency Test in Diagnosis of Narcolepsy

Objectives@#The diagnosis of hypersomnia may be changed by the repeated multiple sleep latency test (MSLT). We investigated the long-term reliability of MSLT in the diagnosis of narcolepsy type 1(NT1) and 2 (NT2). @*Methods@#We reviewed the data of patients with NT1 and NT2 who underwent MSLT at least twice between 2008 and 2020. The clinical information and polysomnography/MSLT data were thoroughly assessed, and two sleep experts evaluated the consistency and reliability of diagnosis independently. @*Results@#Eighty patients (38 with NT1 and 42 with NT2 as a final diagnosis) were included in this study. Of the 80 patients, 20 (nine with NT1 and 11 with NT2) underwent the 3rd MSLT. No significant differences were found in the sleep data and Epworth Sleepiness Scale at baseline. During the 2nd MSLT, 18.4% (n=7) patients with NT1 and 47.6% (n=20) patients with NT2 did not satisfy the diagnosis of narcolepsy. At the 3rd MSLT, six out of nine patients with NT1 and seven of 11 patients with NT2 were not suitable for narcolepsy. Two of the initial NT1 (5.2%) and 10 of the initial NT2 (23.8%) patients were found to be normal. Three patients who were confirmed to have NT1 through consecutive MSLTs had significantly shorter sleep latency and more number of sleep-onset rapid eye movements than the other patients. @*Conclusions@#The reliability of MSLT were not robust in the diagnosis of NT1 and NT2 in this long-term follow-up study. The MSLT results should be interpreted with careful consideration based on elaborate preparations.

Test-Retest Reliability of Multiple Sleep Latency Test in Diagnosis of Narcolepsy

Objectives@#The diagnosis of hypersomnia may be changed by the repeated multiple sleep latency test (MSLT). We investigated the long-term reliability of MSLT in the diagnosis of narcolepsy type 1(NT1) and 2 (NT2). @*Methods@#We reviewed the data of patients with NT1 and NT2 who underwent MSLT at least twice between 2008 and 2020. The clinical information and polysomnography/MSLT data were thoroughly assessed, and two sleep experts evaluated the consistency and reliability of diagnosis independently. @*Results@#Eighty patients (38 with NT1 and 42 with NT2 as a final diagnosis) were included in this study. Of the 80 patients, 20 (nine with NT1 and 11 with NT2) underwent the 3rd MSLT. No significant differences were found in the sleep data and Epworth Sleepiness Scale at baseline. During the 2nd MSLT, 18.4% (n=7) patients with NT1 and 47.6% (n=20) patients with NT2 did not satisfy the diagnosis of narcolepsy. At the 3rd MSLT, six out of nine patients with NT1 and seven of 11 patients with NT2 were not suitable for narcolepsy. Two of the initial NT1 (5.2%) and 10 of the initial NT2 (23.8%) patients were found to be normal. Three patients who were confirmed to have NT1 through consecutive MSLTs had significantly shorter sleep latency and more number of sleep-onset rapid eye movements than the other patients. @*Conclusions@#The reliability of MSLT were not robust in the diagnosis of NT1 and NT2 in this long-term follow-up study. The MSLT results should be interpreted with careful consideration based on elaborate preparations.

Familial Creutzfeldt–Jakob Disease with a PRNP Mutation at Codon 180 Presented with Visual Hallucinations and Illusions

No abstract available.

Dream Recall Frequency and Sleep in Patients with Rapid Eye Movement Sleep Behavior Disorder

OBJECTIVES: The dream recall and sleep of patients with rapid eye movement sleep behavior disorder (RBD) were not sufficiently studied. We hypothesized that RBD patients have frequent dream recall with poor sleep quality, and investigated the relationship between the dream recall frequency and sleep quality in RBD patients compared to controls. METHODS: We analyzed 81 drug naïve patients [RBD (+), 64.6±8.3 y, 57 males] and 81 age and gender matched patients with sleep disturbances without RBD [RBD (−), 63.7±7.3 y, 57 males]. All completed Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness scale and Beck depression inventory. The 5-point rating scale was used to categorize dream recall frequency of most recent month (0=never, 4=very frequent). RESULTS: In RBD (+), dream recall frequency was much higher [frequent dreaming, 77.2% vs. 35.4%], and subjective sleep quality was much better [PSQI, 6.36±3.26 vs. 8.71±4.69]. Insomnia severity was much less in RBD (+) (ISI, 9.13±5.86) than RBD (−) (12.43±7.62). No significant differences were found in sleep parameters except lower N2 sleep % in RBD (+). The relationship between dream recall frequency and sleep was not significant in RBD (+), yet, a positive correlation was noted in RBD (−). CONCLUSIONS: RBD (+) had better sleep quality despite higher frequency of dream recall compared to RBD (−). Also dream recall was not related to their sleep quality in RBD (+), which suggests that RBD patients may have different sleep perception about their sleep and sleep quality.

Estrogen receptor independent neurotoxic mechanism of bisphenol A, an environmental estrogen

Bisphenol A (BPA), a ubiquitous environmental contaminant, has been shown to cause developmental toxicity and carcinogenic effects. BPA may have physiological activity through estrogen receptor (ER) -alpha and -beta, which are expressed in the central nervous system. We previously found that exposure of BPA to immature mice resulted in behavioral alternation, suggesting that overexposure of BPA could be neurotoxic. In this study, we further investigated the molecular neurotoxic mechanisms of BPA. BPA increased vulnerability (decrease of cell viability and differentiation, and increase of apoptotic cell death) of undifferentiated PC12 cells and cortical neuronal cells isolated from gestation 18 day rat embryos in a concentration-dependent manner (more than 50 micrometer). The ER antagonists, ICI 182,780, and tamoxifen, did not block these effects. The cell vulnerability against BPA was not significantly different in the PC12 cells overexpressing ER-alpha and ER-beta compared with PC12 cells expressing vector alone. In addition, there was no difference observed between BPA and 17-beta estradiol, a well-known agonist of ER receptor in the induction of neurotoxic responses. Further study of the mechanism showed that BPA significantly activated extracellular signal-regulated kinase (ERK) but inhibited anti-apoptotic nuclear factor kappa B (NF-kappaB) activation. In addition, ERK-specific inhibitor, PD 98,059, reversed BPA-induced cell death and restored NF-kappaB activity. This study demonstrated that exposure to BPA can cause neuronal cell death which may eventually be related with behavioral alternation in vivo. However, this neurotoxic effect may not be directly mediated through an ER receptor, as an ERK/NF-kappaB pathway may be more closely involved in BPA-induced neuronal toxicity.