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Byline: Svenja Happe (1,2), Peter Anderer (3), Walter Pirker (1), Gerhard Klosch (1), Georg Gruber (3), Bernd Saletu (3), Josef Zeitlhofer (1) Keywords: K-complex; sleep spindle; Parkinson's disease; SPECT; dopamine Abstract: Abstract Objectives Along with spindles, K-complexes are well known hallmarks of stage 2 (S2) sleep. However, little is known about their quantity in S2 sleep of patients with Parkinson's disease (PD). Setting Sleep laboratory, Department of Neurology, University of Vienna, Austria. Patients and methods Whole-night polysomnography (PSG) was performed in twelve treated PD patients and ten healthy controls without history of sleep complaints. The quantity of spontaneous K-complexes, K-alpha-complexes, and sleep spindles in one hour S2 sleep, distributed in four epochs of 15 minutes all through the night, were visually selected and analysed. The quantity and the temporal course of these phasic events were compared with the quantity in age-matched healthy controls. Nine of the twelve PD patients underwent [[.sup.123]I][beta]-CIT SPECT for calculating dopamine transporter binding in the striatum and serotonin transporter density in the thalamus-hypothalamus region. Results There was no difference between the quantity of K-complexes, K-alpha-complexes, and sleep spindles in PD patients and in the healthy control group. K-complexes but not sleep spindles decreased over the night in both groups. The number of sleep spindles did not correlate with the dopamine transporter binding in the striatum or the serotonin binding in the thalamic/hypothalamic region. Conclusion K-complexes and sleep spindles are not reduced and do not seem to be related to the degree of dopaminergic degeneration in treated PD patients. Author Affiliation: (1) Department of Neurology, University of Vienna, Austria (2) Department of Clinical Neurophysiology, University of Gottingen, Robert-Koch-Str. 40, 37099, Gottingen, Germany (3) Department of Psychiatry, University of Vienna, Austria Article History: Registration Date: 01/01/2004 Received Date: 09/02/2004 Accepted Date: 27/05/2004 Article note: This research was supported in part by the European Commission, DG XII (Project Biomed-2 BMH4-CT97--2040 'SIESTA') and by the Austrian National Bank (Project 7870). Svenja Happe, MD, was recipient for a fellowship stipend of the European Neurological Society (ENS).

Byline: Svenja Happe (1), Josef Zeitlhofer (1) Author Affiliation: (1) Department of Clinical Neurology, Vienna General Hospital, University of Vienna, Vienna, Austria, AT (2) Department of Clinical Neurophysiology, University of Gottingen, Robert-Koch-Str. 40, 37075 Gottingen, Germany. shappe@gwdg.de, DE Article note: Received: 2 August 2002, Accepted: 7 October 2002 Correspondence to Svenja Happe, MD

Byline: Svenja Happe (1), Walter Pirker (2), Gerhard Klosch (2), Cornelia Sauter (2), Josef Zeitlhofer (2) Keywords: Key words [123I][beta]-CIT; Parkinson's disease (PD); periodic leg movements during sleep (PLMS); polysomnography; SPECT Abstract: We used single photon emission computed tomography (SPECT) to study striatal [[.sup.123]I][beta]-CIT binding and polysomnography to study periodic leg movements during sleep (PLMS) in eleven patients with idiopathic Parkinson's disease (PD). The reduced striatal [[.sup.123]I][beta]-CIT binding was significantly correlated with the number of PLMS. We propose that striatal dopaminergic nerve cell loss is involved in the increased number of PLMS in PD patients. Author Affiliation: (1) Department of Clinical Neurophysiology, Robert-Koch-Strasse 40, 37075 Goettingen, Germany. shappe@gwdg.de, DE (2) Department of Clinical Neurology, University of Vienna, Austria, AT Article note: Received: 26 April 2002, Received in revised form: 21 August 2002, Accepted: 29 August 2002 Correspondence to Svenja Happe, MD

Byline: Svenja Happe (1), Walter Pirker (1), Cornelia Sauter (1), Gerhard Klosch (1), Josef Zeitlhofer (1) Author Affiliation: (1) Department of Clinical Neurology, University of Vienna, Austria, AT (2) Department of Neurology, University of Muenster, Albert-Schweitzer-Strasse 33, 48129 Muenster, Germany Tel.: +49-2 51-8 34-81 93 Fax: +49-2 51-8 34-81 81 e-mail: happes@uni-muenster.de, DE Article note: Received: 27 October 2000 / Received in revised form: 29 December 2000 / Accepted: 23 February 2001

The aim of this paper was to assess the prevalence of morning headaches in the Austrian general population and to analyse their relationship to daytime functioning and quality of sleep. In a nationwide survey, we recruited 1000 adults (478 men, 522 women, age over 14 years). For this study, we selected all subjects with self-reported morning headaches as well as controls matched for age, sex, size of hometown, level of education and marital status. Forty-eight persons reported morning headaches making a prevalence of 5% in the Austrian general population. Compared to controls, subjects with morning headaches reported more often daytime sleepiness (50% vs. 18.8%, p = 0.003), difficulties in staying awake (47.9% vs. 18.8%, p = 0.005) and falling asleep involuntarily (29.2% vs. 8.3%, p = 0.019). Moreover, they reported a longer sleep onset latency (26.5 ± 27.5 vs. 13.5 ± 13.5 min, p = 0.005), and more often sleep disturbances (58.3% vs. 14.6%, p < 0.001), tossing and turning around during the night (50.0% vs. 8.0%, p < 0.001), problems with sleep maintenance (64.6% vs. 22.9%, p < 0.001) and the symptom of restless legs (20.8% vs. 2.1%, p = 0.01). In addition, subjects with morning headaches felt less often refreshed in the morning (18% vs. 51%, p < 0.001) and reported regular use of medication more often (64.6% vs. 29.2%, p = 0.001) than controls. After correction for multiple testing, the differences in sleep maintenance, sleep disturbances and regular use of medication remained statistically significant. In conclusion, this is the first Austrian population-based controlled study to show that morning headaches afflict one out of 20 persons and are related to self-reported sleep problems.

Background: Restless legs syndrome (RLS) is a movement and sleep disorder with leg dysesthesias with a high prevalence (9-18% in Austria)., Aim of the Study: Determination of frequency, diagnosis and therapy of RLS in general practitioner and specialist offices., Methods: Telephone survey of a random sample of 120 general practitioners, 100 neurologists and 80 specialists in internal medicine., Results: 69% of the whole sample of doctors reported seeing 1 to 10 RLS patients, but in proportion to the prevalence of these two conditions fewer cases of RLS than of Parkinson's disease are treated. In all three groups of doctors, 84% consider the 4 key symptoms (urge to move the legs accompanied or caused by dysesthesia; worsening of symptoms at rest or inactivity; relief by activity; worsening of symptoms in the evening/at night) the most important diagnostic criteria for RLS, followed by a complaint of disturbed sleep (75%), daytime tiredness (43%) and dopaminergic responsiveness in a therapeutic trial (29%). 83% of general practitioners and 86% of medical specialists refer their RLS patients to a neurologist, 19% to a polysomnographic examination. 75% of doctors decide for pharmacological treatment of RLS, 18% for psychotherapy, 15% for household remedies. 54% of all doctors (70% of the neurologists, 68% of the GPs, 48% of the medical specialists) prescribe dopamine agonists. L-Dopa is used by 49% (61% of the neurologists, 42% of the GPs, 44% of the medical specialists). 17% prescribe GABAergic drugs, 6% opiates. 51% would be highly interested in obtaining a drug specifically registered for the treatment of RLS., Conclusion: RLS is not as well known as Parkinson's disease. Thus providing doctors with relevant information and further education programs on this subject seems desirable. In Austrian doctors' offices the diagnosis of RLS is usually obtained clinically on the basis of the 4 key symptoms. Patients suffering from insomnia of multifactorial pathogenesis should be referred to an outpatient clinic for sleep disorders with an associated sleep laboratory. Especially neurologists and GPs consider dopamine agonists the treatment of first choice, closely followed by L-Dopa.

Study Objective: To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations., Design: Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about., Setting: The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population., Participants: The study population consisted of 7,162 Austrian people over 15 years of age., Results: About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001)., Conclusions: Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Malignant hyperthermia is an autosomal dominant disorder of the skeletal muscle that predisposes affected individuals to a life-threatening hypermetabolic reaction in response to volatile anaesthetics and depolarizing muscle relaxants. The underlying heterogeneous genetic defects are mainly point mutations within the ryanodine receptor gene of the sarcoplasmic reticulum. Following the introduction of efficient diagnostic and therapeutic tools--the in vitro contracture test and intravenous treatment with dantrolene--a dramatic decline in mortality rates has been observed. The association of malignant hyperthermia-like reactions with other neuromuscular disorders requires the collaboration of several clinical disciplines to achieve a timely recognition of this still life-threatening disorder.