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Background: Sleep disordered breathing is common in obese people. One of the main characteristics of patients with PWS is excess body weight. In this population study we aimed to investigate the differences in sleep disordered breathing (SDB) in overweight and obese children with Prader-Willi syndrome (PWS) and obese children. Methods: 27 children previously diagnosed with PWS and 24 obese peers, matched by age and gender were recruited and underwent a 12-channel overnight polysomnography (PSG) with oxygen saturation, snoring and body position recorded. Patient (caregiver) reported data on sleep abnormalities and data on other chronic, perinatal and bihevioural conditions were also collected. Results: Mean apnea-hypopnoea index (AHI) was higher in the PWS group than in the control obese children (5.37±7.47 and 1.97±5.35, respectively, p

Parasomnija je poremećaj spavanja s visokom prevalencijom u općoj populaciji. Bez obzira na to što je parasomnija većinom benigne naravi, najčešće predstavlja vrlo neugodan i nepoželjan fenomen u spavanju u djece i odraslih, snižava kvalitetu života, a može biti krivo protumačena i liječena kao epilepsija. Diferencijalna dijagnostika je posebice izazovna u osoba s napadajima s predominantnim kompleksnim motoričkim ponašanjem koji nastaju tijekom hipermotorne epilepsije s noćnim napadajima, kada može dovesti do nepotrebnih i skupih pretraga te neuspješnog liječenja. Koegzistencija parasomnije i epilepsije u istoj obitelji i/ili u iste osobe upućuje na zajedničke neurofiziološke temelje. U ovom preglednom radu opisane su kliničke i neurofiziološke osobitosti najčešćih parasomnija, genetske osnove te pouzdani elementi u diferencijalnoj dijagnostici parasomnija i noćnih epileptičkih napadaja. Prikazana je dijagnostička vrijednost anamnestičkih podataka, video EEG polisomnografije i dijagnostičkih skala. U djece s epilepsijom i parasomnijama, pogotovo u djece koja imaju noćne napadaje, ne smije se zanemariti postojanje dnevne pospanosti i poteškoća spavanja. Svaku osobu s epilepsijom i s dnevnom pospanošću ili sumnjom i na neepileptogene noćne događaje treba poslati na cjelonoćnu polisomnografiju. Liječenje komorbiditeta koji pogoršavanju spavanje u osoba s epilepsijom i kronofarmakologija epilepsije osiguravaju bolji uspjeh liječenja epilepsije. Pravovremeno prepoznavanje postojanja parasomnije omogućava pravilnu procjenu njezinoga zdravstvenog značenja za osobu i utjecaja na kvalitetu života. Uvođenje medicine spavanja u kurikulume diplomskog i poslijediplomskog obrazovanja omogućava adekvatno obrazovanje zdravstvenih radnika i stjecanje potrebnih vještina za rad u specijaliziranim laboratorijima i odjelima za poremećaje spavanja.

Epilepsy is the only chronic neurological disease that can be fully controlled by drugs or introduced into permanent remission. Nonetheless, pharmacological treatment of epilepsy is often accompanied by a range of diagnostic and therapeutic challenges. Due to a wide variety of available antiepileptics, the selection of the first antiepileptic, as well as the combination of polytherapy, is extremely large. The choice of the ideal antiepileptic is individual and depends on a variety of factors based on the pharmacological properties of the drug and the disctinctiveness of every patient (type of seizure, age,sex, profession, comorbidity, co medication, etc.) with specific regulatory limitations (availability,price, indications of regulatory bodies). The basics of rational pharmacotherapy include slow titration of antiepileptics in monotherapy to satisfactory effect, slow drug replacement in the event of failure of the first antiepileptic, combination of two antiepileptics of different mechanism of action or selection of synergistic combinations if dual therapy is necessary, avoiding three or multiple polyterapies whenever possible, and slow reduction of antiepileptic drug after achieving a long-lasting remission.Current ILAE guidelines for epilepsy treatment imply basic and comprehensive recommendations that are acceptable worldwide, including countries with the lowest economic standard. Therefore, these guidelines do not reflect the ideal treatment options, especially in developed countries, and are actually the basis for making national guidelines. The Croatian guidelines for pharmacological treatment of epilepsy are the product of the co-operation of all relevant professional societies and reference centers in the Republic of Croatia, headed by the Croatian League Against Epilepsy and the Croatian Neurological Society. These guidelines reflect the current socioeconomic specificities in our country,the latest knowledge of pharmacological profiles, and efficacy of certain antiepileptics as well as expert opinions.

Background: Respiratory syncytial virus (RSV) stimulates the production of specific immunoglobulin (Ig) E and IgG4 antibodies as a hallmark of the Th2 immune response. In this paper, we evaluated the occurrence of atopic diseases in 10-year-old children who were positive for RSV-specific IgG antibodies during infancy. Methods: The prospective follow-up of 72 children included a physical examination, an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and the determination of RSV-specific antibodies and total and allergen-specific IgE. Results: Children with asthma had their first wheezing episode at a younger age (χ2 8.097, df = 1, p = 0.004). RSV-specific IgG4 levels at year one were positively correlated with atopic dermatitis (AD) (tau_b = 0.211, p = 0.049) and current AD (tau_b = 0.269, p = 0.012); and RSV-specific IgE levels were positively correlated with allergic rhinitis (AR) (tau_b = 0.290, p = 0.012) and current AR (tau_b = 0.260, p = 0.025). Positive RSV-specific IgE at the age of one increased the chances of asthma occurrence by 5.94 (OR = 5.94, 95% CI = 1.05–33.64; p = 0.044) and the chances of AR by more than 15 times (OR = 15.03, 95% CI = 2.08–108.72; p = 0.007). A positive family history of atopy increased the chances of asthma occurrence by 5.49 times (OR = 5.49, 95% CI = 1.01–30.07; p = 0.049), and a longer duration of exclusive breastfeeding lowered that chance (OR = 0.63, 95% CI = 0.45–0.89; p = 0.008). Prenatal smoking increased the chances of AR occurrence by 7.63 times (OR = 7.63, 95% CI = 1.59–36.53; p = 0.011). Conclusion: RSV-specific IgE and RSV-specific IgG4 antibodies could be risk markers for the development of atopic diseases in children.

Epilepsy is the most common neurological complication in pregnancy. Women with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are treated by neurologists at tertiary centers according to the place of residence. We prospectively followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors responsible for their delivery outcomes and development of their babies. Healthy pregnant women had a higher level of education and economic status, but pregnant women with epilepsy took folic acid in a higher proportion than controls, possibly due to timely preconception counseling. Complications during pregnancy depended on the number of antiepileptic drugs and epilepsy control. We noticed some behavioral and cognitive aspects in children exposed in utero to valproic acid, which required follow up. The rate of congenital malformations was not increased. In conclusion, women with epilepsy should receive preconception counseling about the risk for pregnancy, but also about the possibilities to minimize that risk. We have introduced a model of integrative management of pregnancy and epilepsy based on close collaboration among different clinical experts in Croatia, in order to provide prompt counseling and timely intervention.