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Stroke represents a major cause of functional disability with increasing prevalence. Thus, it is imperative that stroke prognosis be both timely and valid. Up to today, several biomarkers have been investigated in an attempt to forecast stroke survivors’ potential for motor recovery, transcranial magnetic stimulation (TMS) being among them. A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1990 and 2021 that focused on the potential utility of TMS implementation on stroke prognosis. Only full-text articles published in the English language were included. Thirty-nine articles have been traced and included in this review. Motor evoked potentials (MEPs) recording is indicative of a favorable prognosis concerning the motor recovery of upper and lower extremities’ weakness, swallowing and speech difficulties, and the patient’s general functional outcome. On the contrary, MEP absence is usually associated with poor prognosis. Relative correlations have also been made among other TMS variants (motor threshold, MEP amplitude, central motor conduction time) and the expected recovery rate. Overall, TMS represents a non-invasive, fast, safe, and reproducible prognostic tool poststroke that could resolve prognostic uncertainties in cases of stroke.

Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10-25) and 16.6 (95%CI: 10-24) per 100,000 person-years. Patients with ESUS were younger (p .001) and had lower median admission NIHSS-scores (p .001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p = .033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, -3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

Funding Acknowledgements Type of funding sources: None. Introduction Sleep disorders are an increasing and modifiable risk factor for cardiovascular disease (CVD). Purpose The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD. Methods In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire. Results The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea. Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health. Abstract Figure. Results

Funding Acknowledgements Type of funding sources: None. Introduction Sleep disorders are an emerging and modifiable risk factor for cardiovascular disease (CVD). Purpose The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD. Methods In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire. Results The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea. Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health. Abstract Figure. Results

The current study aims to investigate the influence of socio-demographic factors on the Montreal Cognitive Assessment (MoCA) test results in a Greek-speaking population consisting of a sample of healthy older adults, individuals with mild cognitive impairment (MCI), and dementia patients in rural areas. In addition, the current research focuses on determining optimal cut-off scores for the clinical diagnoses of MCI and dementia. The data originated from 283 participants in an ongoing registry of the Neurology Department of Alexandroupolis University Hospital, recruited in different rural districts of north-eastern Greece, across a broad range of educational and occupational categories. Total and sub-domain scores for the MoCA varied significantly, according to sex, age, and education, among the three study groups. The optimal cut-off points of 25/26 for the MoCA total score was determined to classify healthy subjects from individuals with MCI, 24 to discriminate healthy participants from demented, and 21/22 to discriminate subjects with MCI from dementia. Overall, the clinical use of the MoCA test can be supported by demographically adjusted standard scores in a Greek-speaking rural population. These findings serve to improve the diagnostic accuracy and utility of the MoCA test.

Lay abstract Hypertension, or high blood pressure, is considered the leading cause of cardiovascular death and disability and is usually treated with medication to lower blood pressure and by making changes to the dietary habits of the patient. Lack of sleep is also a potential risk factor for high blood pressure. However, results on this matter have been contradictory so far. We investigated the relationship between sleep characteristics with high blood pressure in a representative Greek population using self-reported questionnaires. Our study revealed that short sleep duration, excessive daytime sleepiness, insomnia, poor sleep quality and high risk of obstructive sleep apnea are associated with increased prevalence of hypertension among younger and middle-aged adults, affecting everyone equally, regardless of sex. Thus, early medical or cognitive behavioral interventions that improve sleep might be necessary in order to reduce high blood pressure and consequently risk of other diseases of the heart and blood vessels.

A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.

A cross-sectional population-based study was conducted in order to evaluate the association of sleep characteristics with anxiety disorders using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants between 19 and 86 years old were enrolled in our study. Anxiety symptoms were assessed using the Zung Self-rating Anxiety Scale. Participants self-reported their daily sleep habits and filled in the following scales: Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of anxiety was 33.6%. Anxiety symptoms were more prominent among minority groups. Subjects with anxiety reported shorter sleep duration and reduced sleep efficiency. After adjusting for all possible confounders, they were five times more likely to exhibit short sleep duration (≤6h) and 0.60 times less likely long sleep duration (>8h). These relations remained significant in both genders, but were more pronounced among men. Moreover, anxiety was associated with excessive daytime sleepiness, insomnia, poor sleep quality and higher risk of obstructive sleep apnea (OSA). Results highlight the association of sleep disturbances with anxiety disorders and call for conduction of larger scale prospective studies in order to assess causality on the clinically important relationship between sleep characteristics and anxiety disorders.

BACKGROUND The search for reliable techniques to assess gait in stroke patients is crucial for the design and follow-up of rehabilitation programs. OBJECTIVE To assess the reproducibility of kinematic and kinetic gait parameters in chronic stroke patients using a three-dimensional gait analysis system. METHODS Ten chronic stroke patients were assessed while walking along a 20 m walkway at their natural speed, using a gait analysis system of six infrared cameras and two force plates. Each patient performed 10 gait trials on 2 separate days. Inter-measurement agreement was assessed with the Coefficient of Multiple Correlation, while Root Mean Square Differences were used to quantify the variability of the trials. RESULTS The majority of kinetics and kinematics showed excellent reproducibility in all patients. Joints' power seemed to be more reliable compared with joints' angle and moment. Most parameters presented greater variability in non-paretic than the paretic leg, while they were less variable in the sagittal compared with the non-sagittal planes. Less than 10 trials were sufficient to obtain excellent reproducibility for most kinematic and kinetic parameters. CONCLUSIONS The reproducibility of movement assessment through three-dimensional gait analysis appears excellent in chronic stroke patients.

Introduction: Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Methods: Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. Results: We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10-25) and 16.6 (95%CI: 10-24) per 100,000 person-years. Patients with ESUS were younger [median age 68 years (IQR:61-75) vs. 79 years (IQR:73-83); p Conclusions: ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

Up to date there is no population-based study from Greece providing long-term data on incidence of both all-cause mortality and stroke recurrence for patients with first ever stroke (FES). Adult patients with FES were registered during a 24-month period (2010–2012) and followed-up for 12 months. We calculated cumulative incidences of stroke mortality and recurrence. Univariable and multivariable Cox proportional hazards regression analyses were used to identify independent determinants of 1-year mortality and 1-year stroke recurrence. We prospectively documented 703 first ever stroke cases (mean age 75 ± 12 years; 52.8% males; ischemic stroke 80.8%, intracerebral hemorrhage 11.8%, subarachnoid hemorrhage 4.4%, undefined 3.0%) with a total follow-up time of 119,805 person-years. The cumulative incidence rates of mortality of all FES patients at 28 days, 3 months and 1 year were 21.3% (95% CI 18.5–24.5%), 26% (95% CI 22.9–29.4%) and 34.7% (95% CI 31.3–38.3%), respectively. The risk of 1-year mortality was independently (p

Introduction: Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros perfecture, a region of a total 147,947 residents located in North Eastern Greece. Methods: Adult patients with first ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population (ESP) of 2013 and applied criteria of data quality, as proposed by the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project. Stroke diagnosis and classification was performed using WHO criteria on the basis of neuroimaging and/or autopsy data. Results: We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% males; ischemic stroke (IS): 80.8%, intracerebral hemorrhage (ICH): 11.8%, subarachnoid hemorrhage (SAH): 4.4%, undefined: 3.0%) with a total follow-up time of 119,805 person-years. The unadjusted and ESP adjusted incidences of all strokes were 586.8 (95%CI: 543.4-630.2) and 534.3 (95%CI: 532.3-536.3) per 100,000 person-years, respectively. The unadjusted incidence rates for IS, ICH and SAH were 474.1 (95%CI: 435-513), 69.3 (95%CI: 54-84) and 25.8 (95%CI: 25.7-25.9) per 100,000 person-years, respectively. The corresponding ESP-adjusted incidence rates per 100,000 person-years were 425.9 (95%CI: 424-427), 63.3 (95%CI: 63-63.5) and 25.8 (95%CI: 25.7-25.9) for IS, ICH and SAH, respectively. The overall 30-day case fatality rate was 21.3% (95%: 18.3-24.4%) for all strokes, and was higher in hemorrhagic strokes than IS (40.4%, 95%CI: 31.3-49.4% vs 16.2%, 95%CI: 13.2%-19.2%). Conclusion: This is the largest to date population-based study in Greece documenting one of the highest stroke incidences in South-Eastern Europe.

Background and Purpose— Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece. Methods— Adult patients with first-ever stroke were registered during a 24-month period (2010–2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data. Results— We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population–adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4–630.2) and 534.1 (95% CI, 494.6–573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435–513), 69.3 (95% CI, 54–84), and 25.9 (95% CI, 17–35) per 100 000 person-years, respectively. The corresponding European Standard Population–adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9–460.9), 63.3 (95% CI, 49.7–76.9), and 25.8 (95% CI, 16.7–34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%–24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40.4%, 95% CI, 31.3%–49.4% versus 16.2%, 95% CI, 13.2%–19.2%). Conclusions— This is the largest to date population-based study in Greece documenting one of the highest stroke incidences ever reported in South Europe, highlighting the need for efficient stroke prevention and treatment strategies in Northeastern Greece.

Key clinical Message A 22‐year‐old male presented with progressive muscular weakness of the upper extremities. MRI of the cervical spine established the final diagnosis of Hirayama disease (HD). HD is a rare disease with benign progress. Neurologists and radiologists should be aware of the specific neuroimaging signs of this rare clinical entity.

AIM: Peripheral neuropathy is often described in inflammatory bowel disease (IBD). The aim of this study was to assess the need for neurophysiological testing in IBD patients without neurological symptoms or signs to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. MATERIALS AND METHODS: Ninety-seven consecutive IBD patients were screened for neurological symptoms and clinical signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 45 asymptomatic patients were tested electrophysiologically for peripheral nerve involvement. RESULTS: None of the examined patients showed evidence for subclinical neuropathy. CONCLUSION: IBD patients with a normal neurological clinical examination and no symptoms have no evidence for neuropathy. Therefore, proper electrophysiological testing is not considered necessary.

The aim of this study was to investigate sleep architecture in stroke patients, and correlate possible disturbances with the topography, severity and outcome of stroke and the presence of sleep-disordered breathing (SDB). In total, 62 acute stroke patients and 16 age- and gender-matched hospitalised controls underwent polysomnographic studies. Sleep architecture was analysed according to the topography of lesion, severity (National Institutes of Health Stroke Scale) and outcome (Barthel Index) of stroke. We found that sleep architecture is disturbed in stroke patients, regardless of SDB. Stroke patients (without SDB) have reductions in total sleep time and sleep efficiency, reduced stage II and slow wave sleep, increased wakefulness during sleep and increased sleep latency. Rapid eye movement (REM) sleep is reduced when SDB is also present. REM sleep is relatively preserved in cerebellar strokes, as opposed to other topographies. Sleep stages I and REM are negatively associated with stroke severity, and the latency to REM sleep is positively correlated with a good outcome. Sleep architecture is impaired in stroke patients (with fragmentation, increased wakefulness and reduced slow wave sleep), and this correlates with severity and outcome. Sleep disturbances should be investigated and addressed in these patients. Further studies are needed to confirm these findings and assess the clinical and therapeutic implications.

Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the 'majority Greek group' with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses.A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions.In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection-disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification.Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology.

The aim was to study the influence of patients’ age, frequency and type of seizures, disease duration, number of AEDs and use of benzodiazepines on the quality of life of patients with epilepsy. We consecutively identified 223 patients with epilepsy who attended the epilepsy outpatient clinics at three university hospitals in Greece. Quality of life was evaluated by QOLIE-31. One-way analysis was used to assess the association of the studied factors and QOLIE-31 subscales. After checking for co-linearity, we performed multivariate stepwise linear regression analysis with all the variables that on univariate analysis showed a statistically significant effect on each subscale of QOLIE-31 to explore which of the studied factors affect independently on QOLIE-31 scores. Of a total of 223 patients, 118 (52.95%) were men; mean age was 35.18 ± 13.22; mean duration of the disease was 13 years; 58 (26%) patients had generalized seizures, 93 (41.7%) had PS, and 72 (32.3%) of the patients had PsG; 85 (38.1%) were on polytherapy and 38 (17%) were taking benzodiazepines. Independent factors affecting QoL were: seizure frequency (Overall QoL P = 0.0001, Seizure worry and Emotional well-being P

In Greece, as in other countries, major depressive disorder is underdiagnosed. Its severity, implications and outcomes are often not adequately evaluated. The Depression Outcomes Module (DOM) was developed in order to meet the need for a global assessment of this disorder. The objective of the current study was to estimate the psychometric properties of DOM in a Greek population presenting depressive symptoms. The DOM was translated into Greek. Patients were examined twice (baseline and follow-up assessment). The psychometric properties of DOM were calculated. Subjects were 83 psychiatric inpatients and outpatients presenting depressive symptoms. The measures used were DOM, Structured Clinical Interview for DSM III-R (SCID) and Hamilton Rating Scale for Depression (Ham-D). The results were: (a) baseline assessment: test-retest reliability k = 0.90, internal consistency 0.93, sensitivity 97%, specificity 90%; (b) follow up assessment: test-retest reliability k = 0.89, sensitivity 81% and specificity 67%. Recovery from depression detected by DOM at the follow-up was significantly correlated both with pharmacotherapy and with a combination of pharmacotherapy and supportive psychotherapy. It was concluded that the Greek version of DOM is a comprehensive, useful instrument for diagnosing, assessing depression and evaluating its outcomes. Copyright © 2005 John Wiley & Sons, Ltd.

This study is presenting the translation and cultural adaptation into Greek of the Quality of Life in Epilepsy Inventory (QOLIE-31). We adapted the QOLIE-31 to Greek through a procedure of translation-back-translation. Sixty-three patients were interviewed and completed the QOLIE-31 and the GHQ questionnaires. We re-examined a subset of them after a period of 2-5 weeks to evaluate the test-retest reliability of the questionnaire. We assessed the convergent validity by comparison of the QOLIE-31 and the GHQ and QOLIE-31 subscales and external measures. Discriminative validity was evaluated using the method of known-groups comparisons. The internal consistency was high for the QOLIE-31 and its' subscales (Cronbach's alpha 0.92 and 0.59-0.83 respectively). Test-retest reliability was acceptable (intra-class correlation coefficient 0.49-0.89 and Pearson's coefficient 0.53-0.92) for the group of patients who were re-examined. Comparison of the QOLIE-31 and GHQ scores showed agreement between the two questionnaires (Pearson's coefficient -0.61). We demonstrated the discriminative validity by the difference in the QOLIE-31 scores between patients with different seizure frequencies and different employment status. We concluded that the Greek version of the QOLIE-31 has psychometric properties equivalent to those of the original American-English version and is a valid and reliable instrument.

SummaryThe frequency of sleep disturbances in patients with epilepsy and their impact on quality of life (QoL) have been documented in a few reports, and the results are conflicting. We identified 124 consecutive epilepsy out-patients who visited the epilepsy out-patient clinics at the University Hospital of Alexandroupolis, the AHEPA Hospital in Thessaloniki and the Aeginitio Hospital in Athens. We measured excessive daytime sleepiness (EDS) with the Epworth Sleepiness Scale (ESS), obstructive sleep apnea (OSA) with the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ), and insomnia with the Athens Insomnia Scale (AIS). We evaluated quality of life by the Quality of Life in Epilepsy Inventory (QOLIE-31). EDS was found in 16.9% (21/124) of epileptic patients, OSA in 28.2% (35/124), and insomnia in 24.6% (30/122). In multivariate analysis, we found that insomnia was an independent negative factor for Total score (p