[Narcolepsy. An illness in transition]. / Narkolepsie. Eine Erkrankung im Aufbruch.

The signs of narcolepsy have been known since the last century and the tetrad of symptoms was described 50 years ago: excessive sleepiness, cataplexy, sleep paralysis, and hallucinations. Polysomnography typically shows decreased sleep and REM sleep latency, and laboratory testing reveals a high association with the human leucocyte antigens (HLA) DQB1*0602 and DQA1*102. Actual studies suggest disturbances in the orexin (hypocretin) neurotransmitter system. However, the exact pathophysiology is still unclear. In Germany, about 1500 patients diagnosed with narcolepsy are known. The prevalence in Caucasian populations is estimated at 50/100,000. Thus, the number of undiagnosed patients is likely to be high.

Electrophysiological evidence for an inverse benzodiazepine receptor agonist in panic disorder.

Inverse agonists of the GABA(A) receptor clearly decrease the amplitudes of the spontaneous EEG in the beta-frequency range. Therefore, we tested the hypothesis that panic patients exhibit a reduction of the EEG's spectral power in the beta-frequency band. Ten unmedicated patients with panic disorder and agoraphobia according to DSM-III-R criteria and 10 matched controls were investigated under baseline conditions, after hyperventilation and 30 min after hyperventilation. EEG recordings from the position Pz and Cz were performed under eyes closed conditions. At baseline conditions the patients suffering from panic disorder depicted a reduced beta-power reaching statistically significance for lead position Pz. Immediately after hyperventilation for both channels we observed a decreased beta-power. After hyperventilation we observed the same situation as under baseline conditions. Taken together, our results point to the view that in panic disorder an endogenous inverse agonist of the GABA(A)-benzodiazepine receptor could be hypothesized.

[Adjuvant whole body acupuncture in depression. A placebo-controlled study with standardized mianserin therapy]. / Adjuvante Ganzkörperakupunktur bei depression. Eine placebokontrollierte Studie unter standardisierter Mianserintherapie.

In order to examine the efficacy of whole body acupuncture additionally applied to drug treatment in depression, a single-blind placebo-controlled study with 70 inpatients administered to three different treatment groups has been carried out. All patients were pharmacologically treated with the tetracyclic antidepressant mianserin. The verum group (n = 22) received acupuncture at specific points considered to be effective in the treatment of depression. The placebo group (n = 24) was treated with acupuncture at non-specific locations and the control group (n = 24) received only pharmacological treatment. Acupuncture was applied three times a week over a period of four weeks. Psychopathology was rated by judges blind to verum/placebo conditions twice a week over eight weeks with the CGI, GAS, BRMS and BfS rating scales. Additionally applied acupuncture improved the course of depression more than pharmacological treatment with mianserin did by itself. However, we could not detect any differences between placebo and verum acupuncture.

Effects of Lorazepam on the automatic online evaluation of sleep EEG data in healthy volunteers.

In earlier publications we described an automatic algorithm to detect rapid eye movement (REM) sleep from a single-channel EEG recording without using EMG or EOG information. This system consisted of an artificial neural network operating on the basis of preprocessed EEG data and was composed to provide a maximum of robustness for online applications. In the present study the influence of acute administration of lorazepam on the performance of the REM detection procedure was evaluated. Following an adaptation to laboratory conditions, sleep EEG data were obtained from healthy subjects in three nights each. On the evening of the second night the volunteers received a single dosage of 2.5 mg Lorazepam; the other two nights were drug-free. The sleep profile and the quantitative EEG data reflected the known changes following acute administration of benzodiazepines: during the treatment night the amount of non-REM sleep and the relative power of the EEG signal in the beta and gamma frequency bands was increased relative to the first night, while the amount of REM sleep was reduced. The night of drug discontinuation still showed some characteristics of the treatment night. The discordance rate of the REM detection algorithm relative to the manual evaluation ranged from 9% to 14.2% for the different nights. Surprisingly, the percentage of correctly classified time periods was even higher for the lorazepam night as compared to the other nights.

Analysis of sleep EEG microstructure in subchronic paroxetine treatment of healthy subjects.

Paroxetine is a selective and potent serotonin reuptake inhibitor and its efficacy for the treatment of depression has been proven. Under acute and subchronical treatment regimens, disturbances of the regular sleep pattern are a reported side effect of the drug. The present study was therefore performed to investigate the impact of subchronic treatment with the selective serotonin reuptake inhibitor paroxetine on the microstructure of the sleep EEG. The study especially addressed the question of subchronic effects of paroxetine medication (30 mg/day) in eight healthy male volunteers in a double blind, placebo-controlled crossover design. Conventional sleep EEG parameters and a spectral power analysis for different sleep stages after 4 weeks of treatment were computed. Additionally, the correlation of certain EEG rhythms across the night was calculated in order to detect subtle dynamical EEG alterations, not necessarily obvious when regarding conventional EEG analysis. Although we could not detect any alterations of the spectral power values in certain frequency bands either during NREM nor during REM sleep following subchronic paroxetine medication, the dynamical EEG attributes across the night revealed a significant enhancement of the correlation between certain EEG rhythms mainly during NREM sleep.