ABSTRACT
Approximately, 90% of patients with Angelman syndrome present with epileptic seizures. Obtaining an electroencephalogram (EEG) with sleep improves the chances of detecting ictal, interictal, and benign abnormal rhythms in Angelman syndrome. However, electroencephalograms, even when obtained during sleep, can be challenging in this population because of tactile sensitivities as well as anxiety related to a novel environment. We tested the hypothesis that 1 hour of sleep on an electroencephalogram would provide as much information as an entire night of electroencephalogram recording, yet more than a routine electroencephalogram conducted during the day. Overnight polysomnograms were collected in 14 children with Angelman syndrome seen at Vanderbilt University. All patients who obtained sleep within the first hour of the overnight electroencephalogram had interictal discharges recorded. Our results show that when sleep is obtained, a 1-hour electroencephalogram yields just as much information as recording an entire night.
Subject(s)
Angelman Syndrome/complications , Angelman Syndrome/diagnosis , Brain Waves/physiology , Electroencephalography , Epilepsy/complications , Sleep/physiology , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Male , Physical Stimulation , PolysomnographyABSTRACT
Insomnia is prevalent in pediatrics, particularly in those with neurodevelopmental disorders. Gabapentin has shown promise in treating insomnia in adults. The purpose of our study was to review our experience with using gabapentin to treat insomnia in children. We identified 23 children, seen by the authors in our Pediatric Sleep Clinic from January 2009 to March 2012. The mean age was 7.2 years and 70% were male. The majority (87%) had been given diagnoses of neurodevelopmental or neuropsychiatric disorders. All parents received education in sleep behavioral interventions. The majority of children (70%) had both sleep-onset and sleep maintenance insomnia. The average starting dose of gabapentin was 5 mg/kg every bedtime and the maximal dose was 15 mg/kg every bedtime. At follow-up, improved sleep was noted in 78% of children. Adverse effects were noted in 6 children.
Subject(s)
Amines/therapeutic use , Anticonvulsants/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Sleep Initiation and Maintenance Disorders/drug therapy , gamma-Aminobutyric Acid/therapeutic use , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Gabapentin , Humans , Infant , Male , Polysomnography , Retrospective StudiesABSTRACT
OBJECTIVE: Failure to record typical events during long-term video/EEG monitoring (LTM) leaves the diagnosis uncertain. The purpose of this study was to analyze predictors of an initial nondiagnostic LTM study and to evaluate the yield of a repeat study. METHODS: We reviewed all adult LTM studies performed at Vanderbilt University from January 2004 to June 2008. We identified 150 patients with no typical events on LTM and matched them with consecutive controls with typical events. We compared patient demographics, epilepsy risk factors, history of antiepileptic use/failures, and prior EEG and MRI results. RESULTS: Of 2397 LTM studies, 380 (15.8%) failed to record typical events. Absence of epilepsy risk factors and normal outpatient EEG predicted this outcome. A repeat LTM study was successful in 18 of 45 patients (42%). CONCLUSION: The prediction of a nondiagnostic LTM can help to reduce the cost of investigating spells of unknown nature.
