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Introduction: Obstructive sleep apnea (OSA) is a chronic condition characterized by intermittent hypoxia (IH) and sleep fragmentation (SF). OSA can induce excessive daytime sleepiness (EDS) and is associated with impaired cognition and anxiety. Solriamfetol (SOL) and modafinil (MOD) are widely used wake-promoting agents in OSA patients with EDS., Methods: Male C57Bl/6J mice were exposed to SF along with sleep controls (SC) or to IH and room air (RA) controls during the light (inactive) phase for 4 and 16 weeks, respectively. Both IH and SF exposures were then discontinued to mimic "ideal" continuous positive airway pressure (CPAP) adherence. All groups were then randomly assigned to receive once daily intraperitoneal injections of SOL, MOD, or vehicle (VEH) for 6 days. Sleep/wake activity was assessed along with tests of explicit memory, anxiety and depression were performed before and after treatments., Results: IH and SF exposures increased sleep percentage in the dark phase and reduced wake bouts lengths (i.e., EDS), and induced cognitive deficits and impulsivity in mice. Both SOL and MOD treatments effectively mitigated EDS when combined with recovery, while recovery alone did not improve EDS over the 6-day period. Furthermore, improvements explicit memory emerged only after SOL., Conclusion: Chronic IH and SF induce EDS in young adult mice that is not ameliorated by recovery except when combined with either SOL or MOD. SOL, but not MOD, significantly improves IH-induced cognitive deficits. Thus, SOL emerges as a viable adjuvant medication for residual EDS in OSA along with its positive impact on cognition., (Copyright © 2023 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

The Locked-In Syndrome is an infrequent disease in our community. It is a destructiveprocess usually due to obstruction of the basilar artery. There is interruption of thedescending corticobulbar and corticospinal tracts, leaving uninvolved the fibers thatcontrol the blinking and the vertical ocular movements (allowing patient to communicate)and the ascending reticular matter. Case report: a 63 years old woman, with ahistory of hypertension and stroke, who suddenly develop dysartria, hemiparesis thatprogress into quadriplegia, and keeps the wakefulness and vertical eye movements.Traqueostomy was required, as well as placement of a percutaneous gastric tube. She was managed with oral antihypertensive drugs, intravenous anticoagulation and broadspectrumantibiotic treatment for nosocomial pneumonia. Physiotherapy was given, aswell as general nursing care. This case is presented due to the special characteristics ofthe syndrome, its low prevalence and the palliative conduct offered by the health caresystem. RESUMEN:El síndrome de enclaustramiento es una patología infrecuente en nuestro medio. Esun proceso destructivo, generalmente es una obstrucción de la arteria basilar coninfarto de tronco encefálico, que interrumpe los tractos descendentes corticobulbaresy corticoespinales, quedando intactas las fibras que controlan el parpadeo, losmovimientos oculares verticales y la sustancia reticular ascendente. Estos pacientesse comunican únicamente mediante parpadeos o movimientos oculares verticales.Caso clínico de una mujer de 63 años, con antecedentes de hipertensión y accidentecerebro vascular, quien súbitamente presentó disartria, hemiparesia que progresa acuadriplejia, disnea, apertura ocular espontánea, conservando los movimientos ocularesconjugados verticales y la vigilia. Se realizó traqueostomía, gastrostomía, manejo de lascifras tensionales con antihipertensivos orales, anticoagulación parenteral, tratamientoantibiótico de amplio espectro por neumonía nosocomial, fisioterapia y los cuidadosgenerales de enfermería. Este caso comenta las características especiales del síndrome,enfatizando su baja prevalencia y la conducta paliativa ofrecida por el área de salud.

Introduction: Glial brain tumours usually require neurosurgical treatment and they are associated with cognitive, emotional and behavioural impairments. Awake intraoperative brain mapping is the gold standard technique used to optimize the onco-functional balance. Neuropsychological assessment and intervention have relevance in this type of procedures. Currently, there is a lack of protocolled structure for the neuropsychological intervention being able to satisfy patient needs., Method: A retrospective descriptive study of 52 patients was performed, all of them with a diagnosis of glial tumour. The structure of the protocol developed in our centre is reported, also data of neuropsychological evaluation, comparing baseline performance with both immediate posterior performance, and long term performance., Results: We describe our experience in each step of the intervention, highlighting the development of eight neurocognitive protocols for intraoperative brain mapping. The results of the neuropsychological examination objectify deficits in the immediate after surgery assessment which are reduced in the long-term assessment., Conclusions: We emphasize the need of providing and structuring the cognitive and emotional aspects of patients suffering from any pathology that entails acquired brain damage in hospital environment. This type of approach is aimed at increasing the quality of life of cancer patients by structuring and optimizing tasks during their surgical intervention and attending to the neuropsychological difficulties they suffer., (Copyright © 2020 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Klippel-Feil Syndrome is a disease characterised by congenital fusion of cervical vertebra, which leads to cervical limitation and instability. In these cases, the best option is the orotracheal intubation with the fibre-optic bronchoscope with the patient awake. The advantage is that cervical movements that could lead to neurological damage are minimised. In these patients, adequate sedation, together with instillation of local anaesthetic in the pharynx and hypopharynx, is the key to reducing patient discomfort and achieving successful orotracheal intubation. Dexmedetomidine is a selective α2- adrenergic receptor agonist that produces sedation and analgesia at the locus coeruleus without producing respiratory depression, as well as maintaining patient collaboration. The case is presented of a patient with Klippel-Feil Syndrome and difficult airway management, who was given a dexmedetomidine infusion at 0.6μg/kg/h as sedation for an awake fibre-optic endotracheal intubation., (Publicado por Elsevier España, S.L.U.)

Brain tumours located in or in proximity to eloquent areas are a significant neurosurgical challenge. Performing this kind of surgery with neurophysiological monitoring to improve resections with reduced permanent focal neurological deficit has become widely accepted in the literature. However, how to conduct this monitoring, the exact definition of an eloquent area and whether to perform this surgery with the patient awake or asleep are still subject to rigorous scientific debate. Members of the Neuro-oncology Working Group (GTNO) of the Spanish Society of Neurosurgery (SENEC) and members of the Spanish Society of Clinical Neurophysiology (SENFC) have published a consensus statement to explain the different neurophysiological monitoring options currently available in awake and asleep patients to obtain better surgical resection without neurological deficits. An exhaustive review of the literature has also been conducted., (Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery., (Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

The incidence and causes that may lead to an early end (unfinished cortical/subcortical mapping) of awake surgery for language mapping are little known. A study was conducted on 41 patients with brain glioma located in the language area that had awake surgery under conscious sedation. Surgery was ended early in 6 patients. The causes were: tonic-clonic seizure (1), lack of cooperation due to fatigue/sleep (4), whether or not word articulation was involved, a decreased level of consciousness for ammonia encephalopathy that required endotracheal intubation (1). There are causes that could be expected and in some cases avoided. Tumour size, preoperative aphasia, valproate treatment, and type of anaesthesia used are variables to consider to avoid failure in awake surgery for language mapping. With these results, the following measures are proposed: l) If the tumour is large, perform surgery in two times to avoid fatigue, 2) if patient has a preoperative aphasia, do not use sedation during surgery to ensure that sleepiness does not cause worse word articulation, 3) if the patient is on valproate treatment, it is necessary to rule out the pre-operative symptoms that are not due to ammonia encephalopathy., (Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Introduction: It is a well-known fact that epileptic seizures disrupt sleep, yet little information is available about sleep disorders according to the type of epileptic seizures., Materials and Methods: The sleep architecture of rats was evaluated in polysomnography recordings 36 hours after inducing partial and generalised epileptic seizures in them. The epileptic seizures were induced by applying 50-100 IU of sodium G penicillin in the amygdala of the temporal lobe., Results: Partial and generalised seizures triggered an increase in the latency of slow wave sleep (SWS) and rapid eye movement (REM) sleep. The number of episodes of the phases of wakefulness, SWS and REM sleep was reduced and the mean duration of the episodes of wakefulness and SWS increased, while that of REM sleep diminished. The total percentage of REM sleep diminished significantly. During the first period of light the partial and generalised seizures triggered an increase in wakefulness and a reduction in the phases of SWS and REM sleep. In the period of darkness, the SWS increased and wakefulness decreased, while there were no changes in REM sleep. In the second period of light, the percentages of the phases of wakefulness and SWS returned to control values and the percentage of REM sleep continued to be reduced., Conclusions: Changes in the structuring of sleep depend on the type of epileptic seizure that presents. Generalised epileptic seizures caused greater deterioration in REM sleep.

Background and Objective: In this study, 123 recordings of blood pressure (BP) obtained by ambulatory BP monitoring were analyzed. These recordings were measured in 2011 in patients from a Spanish tertiary university hospital. All participating patients were treated with 2, 3 or 4 anti-hypertensive drugs. The main aim of this study was to determine differences in BP control, if any, depending on the medication schedule. Thus, BP levels were studied at 3 periods of the day: activity hours, rest hours and 24h., Patients and Method: We compared subjects taking all anti-hypertensive agents during the day (n=70, group 1) with those taking at least one at night (n=53, group 2)., Results: Significant differences were found on diastolic BP, where group 2 patients had lower levels at activity, 24h periods and sleep-time. Even if it was not statistically significant, lower levels of systolic BP from group 2 were also observed at activity and 24h periods as well as lower levels of systolic, diastolic and mean BP at rest hours periods. There were also significant group differences in relation to the number of prescribed agents (with the mean being higher for group 2) and the type of agent (beta-blockers and calcium antagonists were more prevalent in group 2). Nevertheless, the multivariate regression analysis done taking into account these variables did not change the observed statistical significance., Conclusion: The administration of anti-hypertensive drugs at night could be associated with lower BP levels., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

Background: Berger related the EEG with cognition; we are attempting to identify which rhythms and circuits participate in habituation, a learning that decreases responses to meaningless stimuli which, changed the absolute power (AP) of EEG oscillations., Objective: To characterize habituation, analyzing the AP of four rhythms in lateral regions of both hemispheres (BH), proposing that their diminution, desynchronization (D), means activation whereas their increase, synchronization (S), means inhibition., Material and Methods: qEEG analysis in 83 college students, in waking state with closed eyes, and photostimulated (RPh). The used UAMI/Yáñez software identifies RPh signals and takes 2-s samples before (Pre) and during RPh; the Welch periodogram integrates the AP of the four rhythms. We calculated the average AP (AAP) in Pre and RPh per frequency in bipolar lateral leads per hemisphere. AAP differences were evaluated with the Wilcoxon tests correcting with Bonferroni for repeated samples. Applying the linear regression model, we plotted the AAP distribution slopes during Pre and RPh., Results: We established the differences of the AP of the four rhythms within each hemisphere and between both hemispheres (BH). During PRE, AAP of δ and θ increased whereas α and β decreased. RPh increased the AAP (p = 0.01) of the four rhythms in fronto-frontal (FF) leads; the increase in δ persisted in fronto-temporal (FT) and temporo-occipital (TO), whereas β's increase persisted in all leads. The AAP of α decreased with the first RPh (D) increasing with the following ones; its slope starts with desynchronization and ends with synchronization. Theta followed a D/S pattern in temporal leads. Beta followed and ascending (S) slope in all leads., Conclusions: Habituation results from the D/S of a in all cortical regions, of θ in temporal, of δ in frontal regions and β in all regions. Synchronization reflects hyperpolarization of neuronal membranes, decreasing their activity.

Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population., (Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Introduction: Over the last few decades, the terminology, diagnostic techniques and treatment of patients with altered levels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase., Aims: The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population., Development: The concept of 'vegetative state', a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as 'unresponsive wakefulness syndrome'. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledged that there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures., Conclusions: The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects the clinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population.

Objective: To assess successful intubation, hemodynamic and respiratory stability, and patient wellbeing during awake orotracheal intubation using the AirTraq device in patients anticipated to have difficult airways., Patients and Methods: Prospective observational study in patients who were candidates for awake intubation with the AirTraq device based on a score of 11 or more on the Arné test to predict a difficult airway. The 3 sets of variables assessed were intubation success, hemodynamic and respiratory stability, and subjective and objective measures of patient well-being., Results: Eleven patients were enrolled. Intubation was successful in 10 patients. Hemodynamic and respiratory stability was maintained in all cases. When well-being during intubation was subjectively assessed on a 10-point scale, the average score was 7.27 points on discharge from the recovery room and 7.45 points a month after the procedure. As objective reflections of well-being, nausea was reported by 5 patients, cough was recorded in 4 cases and agitation in 2., Conclusions: The AirTraq can be used for awake intubation in cases of anticipated difficult airway when other approaches to intubation have failed or are not viable. Intubation is achieved successfully and hemodynamic and respiratory stability maintained. The device is well tolerated. An advantage of the AirTraq is that it allows the glottis to be visualized as the endotracheal tube is being inserted between the vocal cords so damage can be minimized.

The method of choice for managing the expected difficult airway is tracheal intubation with an awake patient breathing spontaneously. The CTrach Laryngeal Mask Airway (LMA) is a modified version of the Fastrach LMA that incorporates a fiberoptic system that provides a view of the glottis during ventilation and intubation. We describe 2 cases of intubation in which the CTrach device was used in patients breathing spontaneously. In both cases difficult intubation was foreseen. The CTrach LMA facilitates management of the airway in these circumstances. It is well tolerated and enables a clear view of the airway and permits assisted ventilation when necessary.

Objectives: To study muscle weakness caused by low doses of rocuronium and rocuronium intolerance in healthy volunteers, with the general aim of producing brief skeletal-muscle relaxation that would have potential applications in clinical situations., Patients and Methods: After receiving authorization from the clinical research ethics committee of our hospital, we set out to study the effects on subjective and objective muscle strength of injecting 3 doses of rocuronium (0.1 mg x kg(-1), 0.05 mg x kg(-2), and 0.075 mg x kg(-1)) in healthy volunteers, each dose on a different day. Objective muscle strength was measured using a hand dynamometer. We also recorded the development of expected adverse effects (diplopia, dysarthria, and dysphagia)., Results: Five volunteers (all authors) were studied. In the first subject, the dose of 0.1 mg x kg(-1) of rocuronium was unsatisfactory because it was too strong, causing extreme skeletal-muscle weakness and discomfort due to diplopia, dysarthria, and dysphagia. The dose of 0.05 mg x kg(-1) was well tolerated but caused no subjective feeling of weakness or any effect measurable on dynamometry. These doses were not administered to the other subjects. In the 4 remaining volunteers, the dose of 0.075 mg x kg(-1) caused a brief feeling of muscle weakness that was considered to be acceptable, though the findings were compromised by 2 technically defective baseline dynamometry readings. The volunteers also reported brief, mild discomfort, principally due to dysphagia., Conclusions: Doses of 0.075 mg x kg(-1) of rocuronium in healthy awake subjects breathing spontaneously are acceptably tolerated and cause brief muscle weakness that may be of use in situations that require skeletal muscle relaxation at specific moments.

Introduction: The relationship between headache and sleep is complex and runs in two directions. Headache may be the consequence of a (primary or secondary) sleep disorder or its cause (in chronic tension-type headache and/or chronic migraine with or without painkiller abuse). It can also be related to sleep in an intrinsic way, as in the case of hypnic headache (which only appears during sleep) or other primary headaches, such as migraine and certain trigeminal-autonomic cephalgias (which can appear during the waking state or during sleep); this type of headache occurs mostly during REM sleep., Development: The neural pathways that control sleep and pain are anatomically, physiologically and neurochemically cross-linked. These neural systems are located in the brain stem, the hypothalamus and the basal brain. Such cross-links are produced on two different levels. On the one hand, they occur in the serotoninergic nuclei of the brain stem, whose activity in physiologically diminished during REM sleep and which are involved in antinociceptive control. On the other hand, they are also to be found in the hypothalamus, where serotoninergic terminals have been detected in the suprachiasmatic nucleus (SCN). As cells in the SCN are lost with age, their circadian and homeostatic functioning fails, the activity of the hypothalamus-pineal axis is reduced and the endogenous melatonin rhythm is altered. This results in a disorder affecting the control of the sleep-waking cycle and antinociceptive control., Conclusions: Dysfunctions in these neuronal networks in the brain stem (especially in the serotoninergic nuclei) or the hypothalamus (SCN) can account for headaches that begin in the REM phase of sleep and affect biologically predisposed subjects.

Background: The aim of this study was to describe our experience in managing the new adult color model of the Lo-Pro GlideScope in a diverse group of patients., Material and Methods: Prospective, descriptive study of 350 ASA 1-5 patients who underwent oral or nasal tracheal intubation with the Lo-Pro Adult Color GlideScope. Patients whose maximum mouth opening was inadequate were excluded. We recorded the following data: demographic variables, predictors of difficult direct laryngoscopy, Cormack-Lehane grade, presence of morbid obesity, adjusting maneuvers required, intubations in awake patients, intubations with a selective double lumen tube, rescues of failed intubations, oropharyngeal lesions, postoperative sore throat, and failed intubation., Results: Cormack-Lehane grade was 1 in 80.6% of the cases, 2 in 16.9%, and 3 in 2.6%. There were no Cormack-Lehane 4 patients. Rotation of the tube was necessary when entering the glottis in 38%. There were no significant differences in the incidence of oropharyngeal lesions between oral and nasal intubations. There were no abandoned attempts., Conclusions: The rate of successful tracheal intubation is high with the new Lo-Pro Adult Color GlideScope when it is used by trained staff, even in patients with difficult airways. It is also a useful device for intubating awake patients.

Objectives: Spectral entropy quantifies variations in cortical electrical activity measured by electroencephalography and frontal activity measured by electromyography. The aim of this study, in the context of general anesthesia, was to compare bispectral index values with the two components of spectral entropy: state entropy and response entropy., Material and Methods: Sixteen women (ASA I-II) undergoing gynecological surgery were enrolled. The bispectral index was maintained between 40 and 50 for all patients. Both sensors, for monitoring the bispectral index and spectral entropy, were placed on each patient. Simultaneous readings were recorded at the following moments: operating room arrival, induction, relaxation, intubation, switching on the vaporizer, start of surgery, traction of the intestinal mesenteries and maneuvering of the electric scalpel, switching off the vaporizer, end of surgery, during cough, extubation, and eye opening. The data sets were subjected to analysis of variance, and the intraclass correlation coefficient (ICC) was used to analyze agreement., Results: Differences between mean values of the bispectral index, state entropy and response entropy were observed at operating room arrival, intubation, and induction. Differences when the patient awakened from anesthesia were observed only between the bispectral index and response entropy, on the one hand, and state entropy on the other. There was no agreement (ICC<0.7) upon operating room arrival, maneuvering the electric scalpel, or awakening from anesthesia., Conclusion: The bispectral index, state entropy, and response entropy show good agreement during recordings that reflect the effects of anesthesia. The differences observed at baseline and upon awakening can be attributed to frontal electromyographic activity. Distinguishing cortical electrical activity from frontal electromyographic activity may provide additional information in these situations.

Introduction: The sensory information that the central nervous system receives represents an enormous amount of data coming from the outer world and from the body itself. This constitutes a set of influences that affects the general brain developing as well as on the sleep-waking organization., Development: We have proposed changes in the auditory information processing throughout the sleep-wakefulness cycle may be at least partially evidenced by single neurons extracellular recordings. We introduce the concept that the neural network organization during sleep vs that of wakefulness is different and can be modulated by sensory signals, and vice versa, the sensory input may be influenced by the central nervous system asleep or awake. During sleep the evoked firing of auditory units increases, decreases or remains similar to that observed during quiet wakefulness. There has been no auditory unit yet that stopped firing as the guinea pig enters sleep. Approximately half of the cortical neurons studied did not change firing rate when passing into sleep while others increased or decreased. Thus, the system is continuously aware of the environment., Conclusions: We postulate that those neurons that changed their evoked firing during sleep, increasing or decreasing, are part of active sleep processes. Thus, the continuous sensory information input to the brain during sleep may serve to 'sculpt', modulate, the brain by activity-dependent mechanisms of neural development as has been postulated for wakefulness.

Introduction: Neuronal activity of sensory systems depends on input from the environment, the body and the brain itself. Various rhythms have been shown to affect sensory processing, such as the waking-sleep cycle and hippocampal theta waves, our aim in this revision. The hippocampus, known as a structure involved in learning and memory processing, has the theta rhythm (4-10 Hz), present in all behavioural states. This rhythm has been temporally related to automatic, reflex and voluntary movements, both during wakefulness and sleep, and in the autonomic control of the heart rate. On the other hand theta rhythm has been considered as a novelty detector expressing different level of attention, selecting the information and protecting from interference., Development and Conclusions: Our research is based on the hypothesis that sensory processing needs a timer to be processed and stored, and hippocampal theta rhythm could contribute to the temporal organization of these events. We have demonstrated that auditory and visual unitary discharges in guinea pigs show phase-locking to the hippocampal theta rhythm. This temporal correlation appears during both spontaneous and specific sensory stimulation evoked discharges. Neuronal discharges fluctuate between phase-locked and uncorrelated firing modes relative to the theta rhythm. This changing state depends on known and unknown situations. We have provoked, changing the visual stimuli, a power theta rhythm increment and the phase-locking between this rhythm and the lateral geniculate neurone discharge during wakefulness. In slow wave sleep results were different demonstrating that the ways of the inputs processing have changed.

Objectives: To study the prevalence of external sleep disturbances and their influence in sleep quality., Design: Transversal descriptive study based on personal self-applied interview and the application of the Pittsburg Sleep Quality Index (PSQI) in 1053 persons selected among the over 18 year old population of the city of Valladolid between September 1997 and August 1998 in relation to different sociodemographics variables, life habits and psychiatric pathologies (anxiety and depression evaluated by Golberg Scale)., Results: Worsening of life quality and sleep efficiency was significantly associated to external disturbances such as coughing, going to the bathroom and nocturnal awakening and, less significantly, to pain sensation, having nightmares, dysthermic sensations and difficulty to breathing. Sleep external disturbances did not affect daytime activity but was associated to an increased hypnotic drug taking., Interpretation: Sleep external disturbances are one of the most relevant and unknown variables associated to a decrease in sleep quality and, consequently, in life quality.

In attempt to identify the possible role of mayor genes, multifactorial inheritance, and cohort effects in the susceptibility to idiopathic epilepsy with generalized tonic clonic seizures of the awakening type (GTCS), complex segregation analysis was performed in 196 nuclear families ascertained through affected with probands with idiopathic epilepsy with GTCS belonging to the Paisa community of Antioquia (Colombia). Models postulating no transmission, single mayor locus (dominant and recessive) only, and multifactorial component only, were rejected. The models postulating no polygenic component to transmission, and no transmission of the major effect were also rejected. Thus far, complex segregation analysis suggested that a major autosomal codominant allele together with a multifactorial component (mixed model) best explains clustering of idiopathic epilepsy with GTCS in families of the Paisa community. The deficit of transmission of heterozygotes (0.17) is compatible with the existence of epistasis acting on a major gene whose frequency was estimated to be 0.0211. Its transmission variance accounts for 81% of the susceptibility to idiopathic epilepsy with GTCS. The complementary variance (19%) is due to polygenic component.

Introduction: Seventeen girls diagnosed as Rett syndrome (RS) patients suffer or have suffered epileptic fits; we have analyzed the evolution of these seizures. The RS diagnosis is based on criteria established by the Rett Syndrome Diagnostic Criteria Working Group in 1988., Patients and Methods: All girls have had clinical, biochemical, electroneurophysiological neuroimaging and cytogenetic studies done on them. Periodic EEG were carried out while the girls were awake; all had night-time EEGs done. The females are aged between 7 y 5 m, and 22 y 7 m (medium 14 years, 8 months). The age at first seizure was between 18 m and 7 y 8 m (median 4 years 5 months)., Results: The clinic semiology is in decreasing order: tonic, generalized clonic, partial, absence and myoclonic seizures; eight patients have had more than one type of seizures. The frequency is variable: one or more continuous seizures in 6 cases, sporadic seizures in 3 cases, series of seizures in 4 cases, and subnitrant seizures in 4 cases. The evolution is variable: 6 cases have presented only the first fit, and 11 cases recurrent seizures which in 5 have ceased between 8 and 9 years, and 1 case at 13 years., Conclusions: The study shows that the epileptic seizures in RS present three evolution profiles: 1. One or more non recurrent seizures (35.3%); 2. Recurrent seizures until 8-9 years (35.3%); 3. Recurrent seizures in subnitrant form which continued after puberty (29.4%).

Introduction: The paroxystical disorders and episodic symptoms not epileptics related to the sleep, constitute a great preoccupation motive for the parents as well as for all the professionals related to the Pediatrics, and defer in a way substantial of those which are gone to find in subsequent ages of the life. Development. A great number of they are bound to the development and have their maximum or exclusive incidence in the infantile age; and those which also occur in the adult age, have some special connotations in the infancy, with a thoroughly different therapeutic boarding to that of other ages therefore it is necessary an exhaustive knowledge of the same for their correct identification, by having a high incidence, and especially by the frequent mistakes that generate, since frequently they can carry to diagnostic of epilepsy those processes that it be not, with the social connotations that this implies, the countless complementary exams accomplishment and the possibility of certain drugs administration potentially toxic., Conclusions: It is discussed the need of a classification of the disorders of the sleep in the child and is accomplished a detailed description of the same emphasizing the important differential characteristics with other processes, taking into account to of the problems of the sleep that interests to consider in the pediatric age, the most important are found between those incidents associated with the stages of the sleep or the awake partial, recognized as parasomnias. Specific disorders are discussed.

Objective: The initial phases and transitional periods of sleep facilitate electroclinical manifestations of juvenile myoclonic epilepsy (JME). The period at the time of waking is identified in the different phases of sleep by cyclic electrophysiological oscillations, which in turn are synchronous with the spike-and-wave or multiple spike-and-wave activity of the electric crises seen in JME and other epileptic syndromes. This observation supports the theory of an alternating cyclical pattern (ACP) as the trigger of these discharges., Patients and Methods: Following classical macrostructural and microstructural patterns of EEG sleep analysis, we investigated electrophysiological behavior in 13 patients diagnosed as having JME, and 5 persons of homogeneous epidemiological characteristics as controls., Results: In our study we observed that both groups had similar macrostructural sleep parameters. However, in patients prone to crises, these were concentrated in the first two hours recorded and showed no differences in sleep-waking transition or ACP of phase I sleep. These were significant when both periods were compared with the remaining NREM sleep., Conclusion: We conclude from this study that ACP is the microstructural element of sleep which modulates and permits classification of epileptiform anomalies, mainly in studies at the time of wakening.

A study was made of the degree of orientation, cooperation, and anxiety of patients admitted to the Intensive Care Unit of the Hospital de la Santa Creu i Sant Pau (level III), at the conclusion of prolonged continuous sedation. Recovery time was evaluated, understood as the time required to achieve orientation in time, place, and person. The study was descriptive. An analysis was made of 37 patients who met inclusion criteria between July 1995 and March 1996. After discontinuing sedation, the Glasgow assessment was carried out (modified by Cook and Palma) every four hours until a score of > or = 14 was obtained. From then on, the degree of anxiety, using the Hamilton scale, and cooperation and orientation, using our own scales, were evaluated four times a day. The assessment concluded when the patient was oriented in time, space, and person. We recorded age, sex, disease, disease severity, previous admissions, type of sedation, need for additional bolus injections, and the state of anxiety as perceived by family members. Mean age of patients was 65.1 +/- 13.3 years; 81.1% were men. Respiratory disease was the most common pathology, mean SAPS was 10.7 +/- 2.6, and the most frequently administered drug was midazolam (81%). Patients required an average of 15 hours (164-0) to awaken and tended to taken longer to awake with midazolam. Once the were awake, the required 10 hours (48-0) hours before the were completely oriented. The degree of anxiety was mild and cooperation was regular during all measurements. No relation was found between variables. Our results suggest that a care plan designed to shorten temporal disorientation and promote cooperation would improve the quality of awakening.