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Actigraphy has been used for more than 60 years to objectively measure sleep–wake rhythms. Improved modern devices are increasingly employed to diagnose sleep medicine disorders in the clinical setting. Although less accurate than polysomnography, the chief advantage of actigraphs lies in the cost-effective collection of objective data over prolonged periods of time under everyday conditions. Since the cost of wrist actigraphy is not currently reimbursed, this method has not enjoyed wide acceptance to date. The present article provides an overview of the main clinical applications of actigraphy, including the recommendations of specialist societies.

Seit mehr als 60 Jahren wird die Aktigraphie eingesetzt, um den Schlaf-Wach-Rhythmus objektiv zu erfassen. Zunehmend werden verbesserte moderne Geräte angewendet, um schlafmedizinische Erkrankungen im klinischen Rahmen zu diagnostizieren. Aktigraphen sind zwar weniger genau als die Polysomnographie, aber ihr größter Vorteil liegt in der kostengünstigen Sammlung objektiver Daten über längere Zeiträume unter Alltagsbedingungen. Da die Kosten der Handgelenksaktigraphie derzeit nicht erstattet werden, hat dieses Verfahren bisher keine breite Akzeptanz erlangt. In der vorliegenden Arbeit wird ein Überblick über die wesentlichen klinischen Anwendungen der Aktigraphie sowie über die Empfehlungen der Fachgesellschaften gegeben.

To investigate differences between visual sleep scoring according to the classification developed by Rechtschaffen and Kales (R&K, 1968) and scoring based on the new guidelines of the American Academy of Sleep Medicine (AASM, 2007).

Purpose: To investigate whether filter-protected carotid artery stenting (CAS) using a covered self-expanding stent reduces the risk of cerebral embolization.Methods: Fourteen asymptomatic patients (13 men; median age 77 years, IQR 73–83) were enrolled in a randomized pilot trial comparing the rates of cerebral microembolism during and after filter-protected CAS using either a self-expanding covered (n=8) or a bare (n=6) carotid stent. Transcranial Doppler (TCD) monitoring was done during and for 90 minutes after the procedure. Diffusion-weighted magnetic resonance imaging (DW-MRI) was performed before and 24 hours after CAS. Patients were followed for 6 months for neurological events and occurrence of restenosis.Results: A significant reduction in ipsilateral microembolic signals by TCD was observed with the covered (median 1, IQR 0–4) versus the bare stent (median 6, IQR 3–8; p=0.043). Comparison of the preprocedural and 24-hour postprocedural DW-MRI images showed no new ipsilateral lesions but 1 new lesion in the contralateral hemisphere in the covered stent group, resulting in an overall 7% (95% CI 0%–20%) rate of new ischemic lesions. No neurological complications occurred up to 6 months. Restenosis (>70%) occurred in 3 (38%) of 8 patients with the covered versus none of the bare stents (p=0.21). The trial was stopped when the third restenosis of a covered stent was detected.Conclusion: Self-expanding covered stents potentially reduce the risk of cerebral microembolism during and after carotid stenting. However, the problem of in-stent restenosis has to be resolved before these devices can be considered for further investigation.

Functional significance of stage 2 sleep spindle activity for declarative memory consolidation.

Objective: Together with spindles, K-complexes are well known hallmarks of stage 2 sleep (S2). However, little is known about their topographical distribution in comparison to delta-waves and to K-complexes superimposed by spindles. Patients and methods: In this study, the topographical distribution of spontaneous K-complexes and delta-waves in S2 and delta-waves in stage 4 sleep (S4) in 10 healthy young adults (aged 20 to 35 years, 7 female) was investigated. K-complexes with and without spindles in S2, delta-waves with and without spindles in S2, and delta-waves in S4 distributed all over the night were visually selected. EEG power maps and statistical parametric maps were calculated. Results: Absolute delta power of S2 K-complexes appeared to be significantly higher than of S2 delta-waves and delta power of S4 delta-waves was higher than of S2 delta-waves. In K-complexes and delta-waves, power was found to be highest over medio-frontal regions in the delta frequency band (0.5 - 4.0 Hz) with a second maximum occipitally in delta-waves, no matter whether superimposed by a spindle or not. Conclusion: K-complexes and delta-waves in S2 differ in topographical distribution. Even though in S2 delta-waves have less power, they have a similar topographical distribution in S2 and S4, supporting the hypothesis that delta-waves in S2 further develop towards delta-waves in slow wave sleep. The delta frequency components of K-complexes and delta-waves are unaffected by spindles.

Acute treatment of myasthenic crisis with immunoadsorption (IA) or plasma exchange is well established. The efficiency of chronic apheresis therapy in myasthenia gravis (MG), however, and its efficacy in reducing concomitant potentially harmful immunosuppressive therapy, is unknown. We treated 13 patients with therapy-resistant MG or severe steroid or azathioprine therapy-related side effects, or both, with long-term IA [median, 38 (range: 16–59) months]. IA was performed every second day until partial remission was achieved (modified Osserman score <2). Subsequently, oral immunosuppressive therapy was reduced and the frequency of IA adapted to the clinical symptoms. After initiation of IA the mean (SEM) Osserman score decreased from 3.23 ± 0.12 to 1.23 ± 0.08 within 1 month (P < 0.01). Mean azathioprine dose was reduced concomitantly from 89 ± 9.4 mg/day to 56 ± 11 mg/day (P < 0.05), and mean prednisolone dose from 41 ± 7.6 mg/day to 22 ± 8.5 mg/day (P < 0.05). After 36 months the number of IA-sessions/month had been reduced from 4.81 ± 0.24 to 2.64 ± 0.4 (P < 0.05), the mean azathioprine dose to 25 ± 17 mg/day and the mean prednisolone dose to 9 ± 3.6 mg/day. Six out of thirteen patients were weaned from IA after a median of 33 (range, 16–50) months and a decrease of the Osserman score to 0.33 ± 0.33. In these patients MG remained stable during a follow-up period of 28 (range, 16–38) months. We conclude that long-term IA enables the reduction of oral immunosuppressants in patients with contraindications or resistance to steroid and azathioprine therapy. Furthermore, almost 50% of the patients can be weaned from IA with then substantial lower need of further immunosuppressive therapy. J. Clin. Apheresis 17:84–87, 2002. © 2002 Wiley-Liss, Inc.

Acute treatment of myasthenic crisis with immunoadsorption (IA) or plasma exchange is well established. The efficiency of chronic apheresis therapy in myasthenia gravis (MG), however, and its efficacy in reducing concomitant potentially harmful immunosuppressive therapy, is unknown. We treated 13 patients with therapy-resistant MG or severe steroid or azathioprine therapy-related side effects, or both, with long-term IA [median, 38 (range: 16–59) months]. IA was performed every second day until partial remission was achieved (modified Osserman score <2). Subsequently, oral immunosuppressive therapy was reduced and the frequency of IA adapted to the clinical symptoms. After initiation of IA the mean (SEM) Osserman score decreased from 3.23 ± 0.12 to 1.23 ± 0.08 within 1 month (P < 0.01). Mean azathioprine dose was reduced concomitantly from 89 ± 9.4 mg/day to 56 ± 11 mg/day (P < 0.05), and mean prednisolone dose from 41 ± 7.6 mg/day to 22 ± 8.5 mg/day (P < 0.05). After 36 months the number of IA-sessions/month had been reduced from 4.81 ± 0.24 to 2.64 ± 0.4 (P < 0.05), the mean azathioprine dose to 25 ± 17 mg/day and the mean prednisolone dose to 9 ± 3.6 mg/day. Six out of thirteen patients were weaned from IA after a median of 33 (range, 16–50) months and a decrease of the Osserman score to 0.33 ± 0.33. In these patients MG remained stable during a follow-up period of 28 (range, 16–38) months. We conclude that long-term IA enables the reduction of oral immunosuppressants in patients with contraindications or resistance to steroid and azathioprine therapy. Furthermore, almost 50% of the patients can be weaned from IA with then substantial lower need of further immunosuppressive therapy. J. Clin. Apheresis 17:84–87, 2002. © 2002 Wiley-Liss, Inc.

Acute treatment of myasthenic crisis with immunoadsorption (IA) or plasma exchange is well established. The efficiency of chronic apheresis therapy in myasthenia gravis (MG), however, and its efficacy in reducing concomitant potentially harmful immunosuppressive therapy, is unknown. We treated 13 patients with therapy‐resistant MG or severe steroid or azathioprine therapy‐related side effects, or both, with long‐term IA [median, 38 (range: 16–59) months]. IA was performed every second day until partial remission was achieved (modified Osserman score <2). Subsequently, oral immunosuppressive therapy was reduced and the frequency of IA adapted to the clinical symptoms. After initiation of IA the mean (SEM) Osserman score decreased from 3.23 ± 0.12 to 1.23 ± 0.08 within 1 month (P< 0.01). Mean azathioprine dose was reduced concomitantly from 89 ± 9.4 mg/day to 56 ± 11 mg/day (P< 0.05), and mean prednisolone dose from 41 ± 7.6 mg/day to 22 ± 8.5 mg/day (P< 0.05). After 36 months the number of IA‐sessions/month had been reduced from 4.81 ± 0.24 to 2.64 ± 0.4 (P< 0.05), the mean azathioprine dose to 25 ± 17 mg/day and the mean prednisolone dose to 9 ± 3.6 mg/day. Six out of thirteen patients were weaned from IA after a median of 33 (range, 16–50) months and a decrease of the Osserman score to 0.33 ± 0.33. In these patients MG remained stable during a follow‐up period of 28 (range, 16–38) months. We conclude that long‐term IA enables the reduction of oral immunosuppressants in patients with contraindications or resistance to steroid and azathioprine therapy. Furthermore, almost 50% of the patients can be weaned from IA with then substantial lower need of further immunosuppressive therapy. J. Clin. Apheresis 17:84–87, 2002. © 2002 Wiley‐Liss, Inc.

In this study we describe an autosomal dominant distal muscular dystrophy in a small Austrian family. The myopathy started in early adulthood with a slowly progressive weakness of the muscles of the anterior tibial compartment, followed by the long finger extensors and sternocleidomastoids in some family members. Other muscles were spared. Histopathology showed fiber size variation and autophagic vacuoles. This disease pattern is similar to Laing distal myopathy, which has been described previously in only one other family. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1876–1879, 2000

In this study we describe an autosomal dominant distal muscular dystrophy in a small Austrian family. The myopathy started in early adulthood with a slowly progressive weakness of the muscles of the anterior tibial compartment, followed by the long finger extensors and sternocleidomastoids in some family members. Other muscles were spared. Histopathology showed fiber size variation and autophagic vacuoles. This disease pattern is similar to Laing distal myopathy, which has been described previously in only one other family. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1876–1879, 2000

We determined central motor conduction time (CMCT) (motor cortex to root C-8 and motor cortex to root S-1) as well as the amplitude of the compound muscle action potentials in the hypothenar and the abductor hallucis muscles on both sides in 44 patients with definite MS. We compared the values with standards obtained from 86 healthy controls and correlated them with the degree of clinical deficit of the limbs examined. Thirty-nine patients (88.6) showed a prolonged CMCT. By comparison, only 74.4 of patients had abnormal visual evoked potentials.

Nine patients with idiopathic restless legs syndrome (RLS) were treated with 300 mg of gabapentin as an initial dose and an up-titration until relief of symptoms for 4 weeks. Subjective symptoms improved significantly. Polysomnographic data showed a reduction of periodic leg movements during sleep (PLMS) (p0.003) and PLMS index (p0.001). The authors conclude that gabapentin provides a well-tolerated and effective treatment of idiopathic RLS.