Identifying obstructive sleep apnea in patients with epilepsy: A cross-sectional multicenter study.

OBJECTIVE: Several screening questionnaires for obstructive sleep apnea (OSA) have been introduced. No study has compared the performance of different questionnaire in the same patients with epilepsy. Herein, we compare the performance characteristics of four common questionnaires for assessing the probability of OSA in patients with epilepsy. METHODS: This cross-sectional multicenter study was conducted among adult epilepsy patients attending neurology and general medical clinics in Thailand. Before performing full polysomnography (PSG), all participants completed the STOP-BANG, STOP-BAG, SA-SDQ, and NoSAS questionnaires. OSA was defined by apnea/ hypopnea index (AHI) criteria of AHI: ≥ 5, ≥ 15, and ≥ 30. Discriminatory ability was assessed by area under the receiver operating characteristics (ROC) curve (AUC) and likelihood ratio. To improve discriminative ability, we created 3 ranges of the score to predict lower, middle, and higher probability of OSA as defined by each diagnostic criterion. RESULTS: A total 166 patients with epilepsy were included. OSA prevalence was 38%. Overall, NoSAS had higher AUC at all AHI criteria but not significantly higher than that of other scales. Using prediction cut-points for NoSAS of ≥ 4 and ≥ 8 to predict OSA defined by AHI ≥ 5, the likelihood ratios for the 3 ranges were 0.37, 2.22 and 9.81 respectively. CONCLUSION: Among the 4 scales, the 2-cut-point NoSAS score had the highest discriminatory ability at each AHI cutoff.

Perampanel overdose in low body mass index patients with epilepsy: a case report and review of the literature.

BACKGROUND: Perampanel (PER) is a novel antiepileptic drug (AED) which employs a completely different mechanism of action compared to existing medications. Overall, PER is considered to be safe up to a dose of 12 mg per day. When used to treat refractory and super-refractory status epilepticus, PER seems to be extremely well tolerated; this is true even when used at doses of up to 32 mg. There are currently only three case reports on the effects of acute PER overdose in epilepsy patients. CASE PRESENTATION: We report a 16-year-old Thai woman with a low body weight, who took PER at a dose of 40 times that of the prescribed daily dose. She experienced only an alteration of consciousness, without any systemic medical effects, and made a full recovery within 3 days without gastric lavage or specific treatment. CONCLUSION: Our report demonstrates that an acute PER overdose may not produce serious adverse systemic effects. Individuals with adverse central nervous system (CNS) effects, such as altered consciousness, can experience a rapid recovery.

Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

PURPOSE: We aimed to determine (1) the frequency of high-risk sudden unexpected death in epilepsy (SUDEP) in patients with epilepsy who have had obstructive sleep apnea (OSA) in different stages of sleep using the revised SUDEP risk inventory (rSUDEP-7) score instrument and (2) the factors associated with high risk SUDEP in patients with epilepsy who have had OSA. METHODS: We conducted a cross-sectional study of consecutive subjects who are more than 15 years old without known sleep disorders, recruited from a single epilepsy clinic in a tertiary care facility. Participants underwent polysomnography. Scoring was performed by two blinded board-certified sleep physicians. The relationships between rSUDEP-7 scores and OSA measures were evaluated using Wilcoxon rank-sum test, chi-squared test, and quantile regression. RESULTS: Our study population consisted of 95 participants. Overall median (IQR) apnea-hypopnea index (AHI) of our populations was 2.3 (0.7,7.5) events rate per hour; 12 (75%) patients had moderate OSA and 4 (25%) patients had severe OSA. Nine patients had a rSUDEP-7 score of 5 to 7. There was no significant difference between total rSUDEP-7 score or rSUDEP-7 score of > 5 or < 5 and total AHI, supine AHI, non-supine AHI, NREM AHI, or REM AHI; similarly, (2) there was no significant difference in total rSUDEP-7 score between AHI of < 15 or > 15. CONCLUSION: Our study reveals no association between AHI score, OSA, and total rSUDEP-7 score or rSUDEP-7 score of > 5. The pathophysiology underlying SUDEP appears complex. We need further studies on SUDEP to help elucidate the cardiorespiratory mechanisms and predisposing factors.

Peripheral facial paralysis associated with HIV infection: A case series and literature review.

OBJECTIVE: The association between peripheral facial paralysis (PFP) and HIV infection has been scarcely explained. The authors aimed to describe the association between PFP and HIV infection status, along with the related co-morbidities and the outcomes of PFP, as well as the literature review on this topic. PATIENTS AND METHODS: All HIV-infected patients who experienced PFP, both before and after a positive HIV serology test, between January 2002 and June 2015 were retrospectively reviewed. The patients' demographic data, clinical characteristics, HIV co-morbidities and outcomes of PFP were summarized. A literature review of PFP in HIV infection was also performed. Descriptive statistics were used in the data analysis. The Mann-Whitney U test was performed to compare the parameters between the current case series and cases from literature review to determine statistical significant differences (p <  0.05). RESULTS: Sixteen patients (6 males and 10 females) were enrolled. Their median age was significantly higher than that of the cases in the literature review [46 (38, 49.75) vs. 33 (26, 41) years (p =  0.004)]. Nonetheless, a non-significant lower median CD4 count was observed [274 (134.5, 425.5) vs. 373 (265, 718) cells/µL (p =  0.058)]. In our series, unilateral PFP (UFP) was the most frequent, and it typically occurred long after a positive HIV serology test. However, bilateral PFP (BFP) was commonly found in the literature, and a simultaneous positive HIV serology test was reported in almost all cases. Consequently, most of our cases, except for those with HIV-related complications or co-morbidities, experienced a satisfactory recovery from PFP regardless of treatments received. CONCLUSIONS: Most of the cases in our series were UPF with a higher median age and a lower median CD4 count. Moreover, facial paralysis presented later in our series than in the previously reported cases in the literature. Most of our cases experienced satisfactory recovery of facial weakness.

Does burst-suppression achieve seizure control in refractory status epilepticus?

BACKGROUND: The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous studies have reported conflicting results, possibly owing to the inclusion of various anesthetic agents, not all patients undergoing continuous electroencephalography (cEEG), and the inclusion of anoxic encephalopathy. This study aimed to analyze the effects of midazolam-induced BS on the occurrence outcomes in refractory status epilepticus patients. METHODS: Based on a prospective database of patients who had been diagnosed with status epilepticus via cEEG, multivariate Poisson regression modules were used to estimate the effect of midazolam-induced BS on breakthrough seizure, withdrawal seizure, intra-hospital complications, functional outcome at 3 months, and mortality. Modules were based on a pre-compiled directed acyclic graph (DAG). RESULTS: We included 51 non-anoxic encephalopathy, refractory status epilepticus patients. Burst suppression was achieved in 26 patients (51%); 25 patients (49%) had non-burst suppression on their cEEG. Breakthrough seizure was less often seen in the burst suppression group than in the non-burst suppression group. The incidence risk ratio [IRR] was 0.30 (95% confidence interval = 0.13-0.74). There was weak evidence of an association between BS and increased withdrawal seizure, but no association between BS and intra-hospital complications, mortality or functional outcomes was observed. CONCLUSION: This study provides evidence that BS is safe and associated with less breakthrough seizures. Additionally, it was not associated with an increased rate of intra-hospital complications or long-term outcomes.

Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources.

INTRODUCTION: Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning. METHODS: The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis. RESULTS: A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days). CONCLUSION: Bulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.

Excessive daytime sleepiness and nighttime sleep quality in Thai patients with Parkinson's disease.

OBJECTIVE: To study the prevalence ofexcessive daytime sleepiness (EDS) and nighttime sleep quality (NSQ) in Thai patients with Parkinson's disease (PD) and compare their sleep characteristics with controls. MATERIAL AND METHOD: The Epworth Sleep Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and questions about sudden onset of sleep (SOS) were applied in a study of 73 PD patients without dementia to that of healthy controls. RESULTS: There were 36 females and 37 males with a mean (SD) age of 65.9 (9.1) years. All patients had a mean Hoehn and Yahr stage of 2.0 (range 0 to 4). EDS and poor NSQ were found in 15.1% and 37% of patients, respectively. There was a significant difference in the mean PSQI total scores (p = 0.003) between patients and controls. The subset analysis of the components of PSQI revealed that sleep disturbance and the need of medication to sleep had significantly higher scores than those of controls. Twenty point five percent of patients had experienced SOS occurring during driving, meals, and working. Four point one percent ofpatient with SOS had had an accident. CONCLUSION: This study demonstrated a prevalence of EDS and poor NSQ in Thai patients with PD. Screening for these two problems among PD patients should be considered in routine practice evaluations.

Thunderclap headache as a presentation of spontaneous spinal epidural hematoma with spontaneous recovery.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare spinal cord compression disorder. Thunderclap headache mimicking subarachnoid hemorrhage as an initial manifestation of this disorder has been scarcely reported. Moreover, the neurological outcome of conservative treatment is satisfactory only in some clinical settings. The unusual presentation and mechanisms for spontaneous recovery of SSEH are discussed. OBJECTIVE: To report a case of SSEH that presented with acute severe headache that mimicked subarachnoid hemorrhage. After a period of neurological deficit, spontaneous improvement was seen, which progressed to full recovery without neurosurgical intervention. FINDINGS: A 62-year-old man presented with acute occipital headache and neck stiffness for which subarachnoid hemorrhage was initially suspected. An emergency computed tomographic brain scan and cerebrospinal fluid analysis excluded subarachnoid hemorrhage. Later, he developed acute paraparesis, hypoesthesia up to the fourth thoracic dermatomal level (T4) as well as bowel and bladder dysfunction. The magnetic resonance imaging eventually revealed spinal epidural hematoma, located anterior to C7 through T4 spinal level. He had no previous history of spinal injury, systemic, and hematological disorders. The neurological recovery began 20 hours after the onset and continued until complete recovery, 4 months after the onset without neurosurgical intervention. CONCLUSION: SSEH could sometimes imitate subarachnoid hemorrhages when it located in the cervical region. Spontaneous recovery of SSEH without surgical intervention might be possible in cases with continuing neurological recovery, although the recovery began much later in the clinical course.

Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from southern Thailand.

Status epilepticus is a common condition in patients admitted to hospital in resource-poor countries and reports indicate that aetiology, factors of poor outcome, and treatment strategies are variable. To date, there is no report of a prospective study in Thai adults. Herein, we investigated the aetiology, clinical features, factors of predicted poor outcome, and treatment strategies in Thai adult patients who presented with convulsive status epilepticus. A total of 180 patients, whose ages ranged from 15 to 106 years, were included. Of these, 121 patients (67.2%) had acute symptomatic aetiology. The most common aetiology of status epilepticus was encephalitis (36.1%), followed by scarring of the cerebral hemisphere (15%). The median duration of status epilepticus before treatment was three hours. The rate of mortality in the study was 26.7%. Poor outcome was identified in 112 (62.2%) patients. For referral patients, all received only intravenous drugs before referral. The variables that correlated with poor outcome were aetiology and duration of status epilepticus. An approach to incorporate improved prevention of encephalitis, a more effective transportation system, and provision of the essential intravenous antiepileptic drugs would effectively increase the response to treatment.

The association between CYP 2C9 polymorphism and bone health.

PURPOSE: There is a strong scientific rationale to support the view that cytochrome P450 (CYP P450) enzyme-inducing AEDs induce bone loss in patients with epilepsy. However, no study has investigated the association between CYP 2C9 polymorphism and bone mineral density (BMD), 25-hydroxyvitamin D or parathyroid hormone levels in patients with epilepsy. This study sought to determine the association between BMD and CYP 2C9 polymorphism. METHODS: Ninety-three patients taking phenytoin as monotherapy were examined for CYP 2C9 polymorphism, vitamin D level and parathyroid hormone level and underwent basic chemistry testing. The bone mineral density of the lumbar spine and left femur were measured using dual-energy X-ray absorptiometry. RESULTS: The results indicated that about 18.3% of the patients with epilepsy were positive for CYP2C9*3. Furthermore, bone mineral density was associated with CYP 2C9 polymorphism epileptic patients. Specifically, patients with 2C9 polymorphism had higher T-scores and Z-scores of the femoral neck (p=0.02 and 0.04, respectively), but not of the lumbar spine (p=0.27 and 0.06, respectively). There was also a trend of having higher serum PTH levels and statistically significantly lower 25-hydroxyvitamin D levels in patients with wild type than in those compared with CYP 2C9 polymorphism (p=0.05 and 0.03, respectively). Additionally, the patients with CYP 2C9 polymorphism had higher plasma levels of phenytoin, particularly when compared with those with wild type (p=0.01). However, there was no association between serum levels of phenytoin and low BMD at femoral neck or lumbar spine. CONCLUSION: CYP 2C9 polymorphism is associated with higher BMD, independent of plasma levels of phenytoin.

The association between BsmI polymorphism and risk factors for atherosclerosis in patients with epilepsy taking valproate.

PURPOSE: To evaluate the association between the BsmI polymorphism and vascular risk factors or metabolic syndrome in patients with epilepsy treated with valproate. METHODS: We performed a cross-sectional study to determine glucose homeostasis, lipid profile, and evidence of metabolic syndrome, as well as the BsmI polymorphism in seizure free adults with epilepsy. RESULTS: We recruited 75 patients with epilepsy to the current study. The frequency of the BsmI polymorphism was 22.7%. We found that patients with BsmI polymorphism had significantly higher total levels of triglycerides, total cholesterol, HDL-C and LDL-C. There were no differences in terms of fasting blood glucose level and fasting insulin levels between patients with the BsmI polymorphism and those with the wild type vitamin D receptor (VDR) gene. Insulin resistance was identified in 6 of 17 patients with the BsmI polymorphism, and 18 of 58 patients with the wild type VDR gene. We calculated the homeostasis model assessment (HOMA) index and found no difference in HOMA levels between the groups. Systolic blood pressure was higher in patients with the BsmI polymorphism. There was a higher prevalence of metabolic syndrome in patients with the BsmI polymorphism than in patients with the wild type gene. The prevalence of metabolic syndrome in BsmI polymorphism carriers was 64.7% compared with 41.4% in patients with the wild type VDR gene. CONCLUSION: Young patients with epilepsy taking valproate who carry the BsmI polymorphism are at an increased risk of having vascular risk factors.

Risk factors of recurrent seizure, co-morbidities, and mortality in new onset seizure in elderly.

OBJECTIVE: To determine the risk factors of seizure recurrence and the most common comorbidities in elderly patients with epilepsy. METHOD: We did a retrospective study of 278 patients older than 65 years with first seizure. We evaluated electrolytes, blood glucose, urea and creatinine levels, and performed electrocardiography (ECG), and routine electroencephalogram (EEG) on all patients. We evaluated seizure recurrence and comorbidities at 2 years. RESULTS: Univariate analysis found that significant (P<0.05) factors affecting seizure recurrence were etiology of seizure, EEG, and status epilepticus at first presentation. In multivariate regression analysis, etiology of seizure and EEG were significant statistical factors in seizure recurrence at 2 years follow up. Age, sex, duration of time between first seizure and diagnosis of seizure, seizure type, misdiagnosis of non-epileptic seizure, and use of antiepileptic drugs were not significant factors for predicting seizure recurrence. Depression and anxiety were the most common comorbidities in our study, followed by sleep-related disorders and stroke. There were no statistically significantly differences in comorbidities between patients who remained seizure free and patients who had recurrent seizure. CONCLUSION: Most of the new onset seizures in our elderly patients were focal onset. Acute symptomatic etiology, remote symptomatic etiology, progressive symptomatic etiology and abnormal EEG features were powerful predictors of seizure recurrence, and mood disorder, sleep disorder and stroke were the common comorbidities.

Effect of switching hepatic enzyme-inducer antiepileptic drug to levetiracetam on bone mineral density, 25 hydroxyvitamin D, and parathyroid hormone in young adult patients with epilepsy.

We sought to determine the effect of changing phenytoin therapy on bone mineral density (BMD) and 25-hydroxyvitamin D in patients with epilepsy. Of the 90 patients, 54 patients had switched to levetiracetam, 19 patients had stopped, and 17 patients continued taking phenytoin. We proposed a 2-year period to examine 25-hydroxyvitamin D, parathyroid hormone, and BMD. The patients who switched or stopped phenytoin showed a significant increase in BMD of the lumbar spine and left femur, and in 25-hydroxyvitamin D. In contrast, those who continued phenytoin had a significant decrease in BMD at both sites and in 25-hydroxyvitamin D. Patients who were taken off phenytoin and those switching to levetiracetam did not show a significant difference in BMD, 25-hydroxyvitamin D, parathyroid, or calcium at follow-up. Compared with those who continued phenytoin, the BMD was significantly higher in patients switching to levetiracetam and those who stopped using phenytoin. Switching medications may be necessary in some cases to avoid low BMD.

The association between BsmI polymorphism and bone mineral density in young patients with epilepsy who are taking phenytoin.

PURPOSE: This study sought to determine the association between BsmI polymorphism and bone mineral density, 25-hydroxyvitamin D, and parathyroid hormone levels in patients with epilepsy. METHODS: We recruited ambulatory young adults with epilepsy who were taking phenytoin. Data regarding demographics, basic laboratory studies, history of clinical epilepsy, parathyroid hormone, and vitamin D levels, as well as BsmI polymorphism of the vitamin D receptor (VDR) gene, were obtained. The bone mineral density (BMD) of the lumbar spine and left femur were measured using dual-energy x-ray absorptiometry. KEY FINDINGS: Ninety-four patients were included in the study. BsmI polymorphism had a statistically significant lower T-score of the lumbar spine and left femoral neck than patients with wild-type VDR gene (p < 0.01 and p < 0.01, respectively). In addition, patients with BsmI polymorphism had a statistically significant lower z-score of the lumbar spine and left femoral neck than patients with wild-type VDR gene (p < 0.01 and p < 0.01, respectively). The 25-hydroxyvitamin D level in patients with wild-type genes was higher than in epileptic patients with BsmI polymorphism (p < 0.01 and p < 0.01, respectively). Parathyroid hormone level in patients with wild-type VDR gene or patients having BsmI polymorphism was not correlated with BMD at either site. SIGNIFICANCE: In patients with epilepsy taking phenytoin, having BsmI polymorphism was associated with lower BMD.

Role of CYP2C9 polymorphism in phenytoin-related metabolic abnormalities and subclinical atherosclerosis in young adult epileptic patients.

PURPOSE: We investigated the influence of the CYP2C9 polymorphism on the lipid profile, insulin resistance, and subclinical atherosclerosis in young epileptic patients. METHODS: We performed a cross-sectional study to evaluate the association between CYP2C9 polymorphism and lipid profile, glucose homeostasis, and subclinical atherosclerosis in young epileptic patients via the ankle brachial index. RESULTS: The frequencies of CYP2C9*1 (CYP2C9 wild type gene) and CYP2C9*3 (CYP2C9 polymorphism gene) were 75% and 25%, respectively. The mean serum total triglyceride and LDL levels were significantly higher in the wild type gene subjects than in the CYP 2C9 polymorphism gene subjects. Also, the CYP 2C9 polymorphism had marginally significant lower mean serum HDL levels than the wild type gene subjects. No patients with CYP 2C9 polymorphism gene had elevated fasting blood sugar, and insulin resistance was found in only 10 of the 75 subjects. The mean ABI was statistically significantly lower in the wild type subjects than in the CYP2C9 polymorphism gene subjects. CONCLUSION: Our study indicates that young epileptic patients with the CYP2C9 polymorphism gene have a low risk of subclinical atherosclerosis.

An uncommon cause of compressive myelopathy misdiagnosed as transverse myelitis.

Though spontaneous spinal epidural hematoma is a very uncommon cause of spinal cord compression, early correct diagnosis is crucial for final clinical outcome. A case of spontaneous spinal epidural hematoma with similar clinical presentation to transverse myelitis was reported. Careful clinical correlation and multiple sequences of spinal magnetic resonance images are critical factors for early diagnosis.

Clinical characteristics, etiology and long-term outcome of epilepsia partialis continua in adult patients in Thailand.

OBJECTIVE: Epilepsia partialis continua (EPC) is clinically defined as a syndrome of continuous focal jerking of a body part. EPC has various etiologies and outcomes depending on its cause. Most studies on EPC have been conducted in Western countries and no study on the long-term outcome in adult onset epilepsia partialis continua has been reported. The aim of this study was to analyze the clinical characteristics, etiology, and treatment outcome and measurement to identify conditions that are predictive of long-term excellent outcome following epilepsia partialis continua in Thailand. METHODS: Our study was characterized by a retrospective systematic data collection between 2003 and 2010 that lead to the inclusion of a total of 75 patients, with epilepsia partialis continua at Songklanagarind Hospital, Thailand. All of the patients received brain CT scans or MRIs after diagnosis with EPC. Basic laboratory investigations including blood sugar, blood urea nitrogen, creatinine, electrolyte, calcium, liver function, and complete blood count tests were performed. Additionally, routine electroencephalography were performed and antiepileptic drugs were given to all patients. Therapeutic outcomes and the degree of seizure control after discharge were determined by the functional status and Seizure Frequency Scoring Systems, respectively. KEY FINDING: All of our patients manifested as motor EPC. The mean duration of EPC was 6.2 days (range 1-30 days) and the most frequent distribution of EPC involved the face and arms (42.7%). Hyperglycemia was the most common cause of EPC (34 patients, 45.3%). Fifty-one patients had an excellent outcome and 24 patients had a non-excellent outcome. All of the patients with hyperglycemia had an excellent outcome and required no antiepileptics in the long term. Predictors of excellent outcome in the scoring system for seizure frequency were metabolic or hyperglycemia-induced EPC, monotherapy and duration of EPC. SIGNIFICANCE: The characteristics of epilepsia partialis continua in this study were different from those of EPC in Western countries. Its most common cause was hyperglycemia and prognostic factors depended on etiology, number of AEDs, and duration of EPC.

Short questionnaire for Parkinson's disease as a screening instrument.

OBJECTIVE: To validate and simplify a screening questionnaire for the determination of PD. METHODS: The screening questionnaire for PD was developed with the permission of the author. Reliability of the questionnaire was tested. To validate the questionnaire, 40 patients with PD and 93 controls completed the questionnaire. Multiple logistic regression analysis was used to determine the questions independently associated with PD and a risk score was calculated. The predictive performance of the risk score was evaluated via the area under the curve (AUC) of a receiver operating characteristics (ROC) curve. RESULTS: The questionnaire showed a Cronbach's alpha coefficient of 0.73 with no difference between the initial and follow up scores. The mean content validity was 0.86. Of the 11 questions, 4 were independently associated with PD and were used to calculate the risk score. The scores of these questions were 2 (clumsiness)+4 (tremor)+2 (masked face)+2 (loss of balance while turning). The AUC of a ROC curve for the sum of risk score was 0.95. With a cutoff score of 5 or higher, the sensitivity and specificity were 0.88 and 0.95, respectively. CONCLUSIONS: The screening questionnaire for PD is a reliable and valid instrument. The predictive performance of the simplified questionnaire is as good as the original.

Validation of the Thai SCOPA-sleep scale for assessment of sleep and sleepiness in patients with Parkinson's disease.

OBJECTIVE: To validate the Thai version of the Scale for Outcomes in Parkinson 's disease-Sleep Scale (SCOPA-Sleep scale)for assessment of nighttime sleep problems (NSP) and daytime sleepiness (DS). MATERIAL AND METHOD: A Thai version of SCOPA-Sleep scale has been developed with the permission of the originator. Fifty-one patients with Parkinson's disease were asked to complete the Thai SCOPA-Sleep scale (consisting of NSP and DS sections), plus the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). A second group of twenty patients completed the Thai SCOPA-Sleep scale, twice, two weeks apart. The reliability and validity were subsequently analyzed. RESULTS: The Thai SCOPA-Sleep scale showed a Cronbach 's alpha coefficient of 0.87 and 0.74 for SCOPA-NSP and SCOPA-DS, respectively with no significant difference between initial and follow-up scores. The content validity of SCOPA-NSP and SCOPA-DS were 0.9 and 0.9, respectively. There was a strong correlation between the Thai SCOPA-NSP and PSQI as well as the Thai SCOPA-DS and ESS (p < 0.01 and p < 0.01, respectively). CONCLUSION: The Thai SCOPA-Sleep scale is a reliable, valid instrument for assessing NSP and DS

Factors associated with quality of life in hemifacial spasm and blepharospasm during long-term treatment with botulinum toxin.

PURPOSE: This study was undertaken to assess the impact of hemifacial spasm (HFS) and blepharospasm (BS) on quality of life (QOL) during long-term treatment with botulinum toxin injections. METHODS: Fifty-three patients with HFS and 32 patients with BS as well as two healthy age- and sex-matched control groups were included in the study. All participants independently completed the disease-specific questionnaire for QOL, the HFS-30, and the Thai Depression Inventory, and also provided a peak improvement score assessment. RESULTS: The disease severity in both patient groups revealed mild functional impairment. The scores of HFS-30 in HFS patients (four of 8 subscales) and BS patients (3 of 8 subscales) were significantly higher than the control groups. In both HFS and BS, depression scores were positively correlated with the HFS-30 scores, while peak improvement and educational level were inversely correlated with the HFS-30 scores. Patients with BS were more affected in Mobility and Activities of Daily Living than HFS patients. CONCLUSIONS: Both HFS and BS affect QOL both physically and mentally despite clinical improvement with botulinum toxin. Depression and peak improvement after injection were associated with the level of QOL.