121 results on '"de Weerd AW"'
Search Results
2. Efficacy of rotigotine for treatment of moderate-to-severe restless legs syndrome: a randomised, double-blind, placebo-controlled trial
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Trenkwalder, Claudia, Beneš, Heike, Poewe, Werner, Oertel, Wolfgang H, Garcia-Borreguero, Diego, de Weerd, Al W, Ferini-Strambi, Luigi, Montagna, Pasquale, Odin, Per, Stiasny-Kolster, Karin, Högl, Birgit, Chaudhuri, K Ray, Partinen, Markku, Schollmayer, Erwin, Kohnen, Ralf, Högl, B, Poewe, W, Volc, D, Partinen, M, Polo, O, Backhaus, D, Behrens, S, Benes, H, Bergtholdt, B, Bodenschatz, R, Canelo, M, Eisensehr, I, Fogel, W, Franz, P, Geisler, P, Gestewitz, B, Haan, J, Happe, S, Henin, H, Karlbauer, G, Kassubek, J, Lang, M, Lünser, W, Maier, I, Odin, P, Oertel, Wh, Paulus, W, Peglau, I, Schlinsog, K, Schöll, I, Schulze, A, Schumann, G, Siever, A, Sigel, Ko, Sommer, H, Stiasny-Kolster, K, Tinschert, K, Trenkwalder, C, Ferini-Strambi, L, Ferrillo, F, Gigli, Gl, Manni, R, Montagna, P, de Weerd, Aw, Estivill, E, García-Borreguero, D, Puertas, Fj, Hallström, Y, Palm, R, Chaudhuri, Kr, Robinson, J, Taylor, S, Thompson, M, Trenkwalder C., Benes H., Poewe W., Oertel W.H., Garcia-Borreguero D., de Weerd A.W., Ferini-Strambi L., Montagna P., odin P., Stiasny-Kolster K., Hogl B., Chaudhuri K.R., Partinen M., Schollmayer E., Kohnen R., and the SP790 Study Group., Trenkwalder, C, Beneš, H, Poewe, W, Oertel, W. H, Garcia Borreguero, D, de Weerd, A. W, FERINI STRAMBI, Luigi, Montagna, P., Odin, P., Stiasny Kolster, K., Högl, B., Chaudhuri, K. R., Partinen, M., Schollmayer, E, and Kohnen, R.
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Adult ,Male ,Adolescent ,Tetrahydronaphthalenes ,Population ,Placebo-controlled study ,Thiophenes ,Placebo ,Administration, Cutaneous ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Restless Legs Syndrome ,Severity of illness ,medicine ,Humans ,030212 general & internal medicine ,Restless legs syndrome ,education ,Aged ,Retrospective Studies ,education.field_of_study ,Analysis of Variance ,Dose-Response Relationship, Drug ,business.industry ,Rotigotine ,Middle Aged ,medicine.disease ,3. Good health ,Treatment Outcome ,Anesthesia ,Dopamine Agonists ,Female ,Neurology (clinical) ,Gabapentin enacarbil ,business ,030217 neurology & neurosurgery ,medicine.drug ,Follow-Up Studies - Abstract
Summary Background Continuous administration of a dopamine agonist could be used to treat patients with restless legs syndrome. Our aim was to investigate the efficacy of transdermal rotigotine in the treatment of idiopathic restless legs syndrome. Methods In this randomised, double-blind, placebo-controlled trial, 458 patients with moderate-to-severe idiopathic restless legs syndrome (average baseline International Restless Legs Syndrome Study Group severity rating scale [IRLS] sum score of 28·1) were randomly assigned to receive transdermal rotigotine 1 mg over 24 h (n=115), 2 mg over 24 h (n=112), or 3 mg over 24 h (n=114), or to receive placebo (n=117). Study medication was delivered via patches, applied once a day for 6 months. Randomisation was done with a computer-generated randomisation list, stratified by centre. Primary efficacy outcomes were absolute change from baseline to end of maintenance in IRLS sum score and in the clinical global impressions (CGI) item 1 score, assessed by analysis of covariance in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT00136045. Findings Efficacy analyses were done on 112 patients in the 1 mg group, 109 in the 2 mg group, 112 in the 3 mg group, and 114 in the placebo group. Mean change in IRLS sum score from baseline at the end of the maintenance phase was −13·7 (SE 0·9) in the 1 mg group, −16·2 (0·9) in the 2 mg group, −16·8 (0·9) in the 3 mg group, and −8·6 (0·9) in the placebo group (p vs placebo with each dose). Mean change in CGI item 1 score from baseline at the end of the maintenance phase was −2·09 (0·14) in the 1 mg group, −2·41 (0·14) in the 2 mg group, −2·55 (0·14) in the 3 mg group, and −1·34 (0·14) in the placebo group (p vs placebo with each dose). Skin reactions, mostly mild or moderate, were seen in 145 (43%) of 341 patients who received rotigotine and in two (2%) of 117 who received placebo. Ten patients had serious adverse event that were deemed to be related to rotigotine: elevation of liver enzymes (one patient), worsening of tinnitus (one patient), non-response to anticoagulation (one patient), electrocardiogram changes (one patient), and application-site reactions (six patients). No admissions to hospital were needed for the application-site reactions, and they all resolved within a short time of patch removal without any other therapeutic intervention. The rate of typical dopaminergic side-effects in patients who received rotigotine was low; no signs of augmentation were noted. Interpretation 24 h transdermal delivery of low-dose rotigotine could be used to relieve the night-time and daytime symptoms of restless legs syndrome. Funding Schwarz Biosciences.
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- 2008
3. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome
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Walters, As, Lebrocq, C, Dhar, A, Hening, W, Rosen, R, Allen, Rp, Trenkwalder, C, Adler, C, Newman, S, Reiners, C, Aksu, M, Buchholz, D, Hening, Wa, Anderson, M, Mosko, S, Ancoli-Israel, S, Jimenez, Wb, Hallett, M, Bassetti, C, Clavadetscher, S, Bliwise, Dl, Gurecki, P, Rye, Db, Broch, Ll, Zak, R, Chokroverty, S, Coccagna, G, Lugaresi, E, Miele, F, Montagna, P, Plazzi, G, Provini, F, de Mello MT, Tufik, S, de Weerd AW, Rijsman, Rm, Ehrenberg, B, Eisensehr, I, Ekbom, K, Ljungdahl, A, Garcia-Borreguero, D, Larrosa, O, Hirsch, L, Hogl, B, Horiguchi, J, Hornyak, M, Voderholzer, U, Kryger, M, Skomrow, R, Lipinski, Jf, Masood, A, Phillips, B, Oertel, Wh, Stiasny, K, O'Keeffe, S, Oldani, A, Zucconi, M, Ondo, Wg, Picchietti, D, Poceta, Js, Rich, Gb, Scrima, L, Shafor, R, Sharon, D, Silber, M, Smith, R, Wetter, Tc, Winkelmann, J, Vanek, Z, and Wagner, M
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Adult ,medicine.medical_specialty ,Psychometrics ,International Cooperation ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Rating scale ,Restless Legs Syndrome ,mental disorders ,Criterion validity ,Medicine ,Humans ,030212 general & internal medicine ,Restless legs syndrome ,Reliability (statistics) ,Aged ,Aged, 80 and over ,business.industry ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,3. Good health ,Assessment ,Factor analysis ,Psycchometrics ,Reliability ,Validity ,BTBD9 ,Convergent validity ,Case-Control Studies ,Physical therapy ,Clinical Global Impression ,business ,Gabapentin enacarbil ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BACKGROUND There is a need for an easily administered instrument which can be applied to all patients with restless legs syndrome (RLS) to measure disease severity for clinical assessment, research, or therapeutic trials. The pathophysiology of RLS is not clear and no objective measure so far devised can apply to all patients or accurately reflect severity. Moreover, RLS is primarily a subjective disorder. Therefore, a subjective scale is at present the optimal instrument to meet this need. METHODS Twenty centers from six countries participated in an initial reliability and validation study of a rating scale for the severity of RLS designed by the International RLS study group (IRLSSG). A ten-question scale was developed on the basis of repeated expert evaluation of potential items. This scale, the IRLSSG rating scale (IRLS), was administered to 196 RLS patients, most on some medication, and 209 control subjects. RESULTS The IRLS was found to have high levels of internal consistency, inter-examiner reliability, test-retest reliability over a 2-4 week period, and convergent validity. It also demonstrated criterion validity when tested against the current criterion of a clinical global impression and readily discriminated patient from control groups. The scale was dominated by a single severity factor that explained at least 59% of the pooled item variance. CONCLUSIONS This scale meets performance criteria for a brief, patient completed instrument that can be used to assess RLS severity for purposes of clinical assessment, research, or therapeutic trials. It supports a finding that RLS is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life. In future studies, the IRLS should be tested against objective measures of RLS severity and its sensitivity should be studied as RLS severity is systematically manipulated by therapeutic interventions.
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- 2003
4. Medical technology assessment in clinical neurophysiology--Report of the second european session
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De Weerd AW
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- 1999
5. Coactivation of the ulnar nerve in motor tests for carpal tunnel syndrome
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Carpay, JA, primary, Schimsheimer, RJ, additional, and de Weerd, AW, additional
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- 1997
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6. Medical technology assessment in clinical neurophysiology: an introduction
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de Weerd, AW, primary
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- 1997
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7. Predicting success of vagus nerve stimulation (VNS) from interictal EEG.
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de Vos CC, Melching L, van Schoonhoven J, Ardesch JJ, de Weerd AW, van Lambalgen HC, and van Putten MJ
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- 2011
8. Interobserver reliability of visual interpretation of electroencephalograms in children with newly diagnosed seizures.
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Stroink H, Schimsheimer R, de Weerd AW, Geerts AT, Arts WF, Peeters EA, Brouwer OF, Boudewijn Peters A, and van Donselaar CA
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The reliability of visual interpretation of electroencephalograms (EEG) is of great importance in assessing the value of this diagnostic tool. We prospectively obtained 50 standard EEGs and 61 EEGs after partial sleep deprivation from 93 children (56 males, 37 females) with a mean age of 6 years 10 months (SE 5mo; range 4mo-15y 7mo) with one or more newly diagnosed, unprovoked seizures. Two clinical neurophysiologists independently classified the background pattern and the presence of epileptiform discharges or focal non-epileptiform abnormalities of each EEG. The agreement was substantial for the interpretation of the EEG as normal or abnormal (kappa 0.66), almost perfect for the presence of epileptiform discharges (kappa 0.83), substantial for the occurrence of an abnormal background pattern (kappa 0.73), and moderate for the presence of focal non-epileptiform discharges (kappa 0.54). In conclusion, the reliability of the visual interpretation of EEGs in children is almost perfect as regards the presence of epileptiform abnormalities, and moderate to substantial for the presence of other abnormalities. [ABSTRACT FROM AUTHOR]
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- 2006
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9. Ropinirole in the treatment of restless legs syndrome: results from the TREAT RLS 1 study, a 12 week, randomised, placebo controlled study in 10 European countries.
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Trenkwalder C, Garcia-Borreguero D, Montagna P, Lainey E, de Weerd AW, Tidswell P, Saletu-Zyhlarz G, Telstad W, Ferini-Strambi L, TREAT RLS 1 Study Group, Trenkwalder, C, Garcia-Borreguero, D, Montagna, P, Lainey, E, de Weerd, A W, Tidswell, P, Saletu-Zyhlarz, G, Telstad, W, Ferini-Strambi, L, and Therapy with Ropiunirole; Efficacy and Tolerability in RLS 1 Study Group
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Objective: To assess the efficacy, safety, and tolerability of ropinirole in the treatment of patients with restless legs syndrome.Methods: A 12 week, prospective, double blind, randomised comparison involving 284 patients from 10 European countries. All participants had a score of > or =15 on the international restless legs scale (IRLS). Patients were randomised (1:1) to receive either ropinirole 0.25-4.0 mg once daily or placebo. The primary efficacy end point was mean change from baseline to week 12 in total IRLS score. Global improvements (clinical global impression (CGI) scale) and improvements in sleep, health related quality of life (QoL; using generic and disease specific measures), work, and other activities were also assessed.Results: 112/146 patients (76.7%) taking ropinirole and 109/138 (79.0%) taking placebo completed the study. Improvement in IRLS at week 12 with ropinirole (mean (SD) dose, 1.90 (1.13) mg/day) was greater than with placebo (mean (SE): -11.04 (0.719) v -8.03 (0.738) points; adjusted difference = -3.01 (95% confidence interval (CI), -5.03 to -0.99); p = 0.0036). More patients in the ropinirole group (53.4%) showed improvement on the CGI scale at week 12 than in the placebo group (40.9%; adjusted odds ratio = 1.7 (1.02 to 2.69); p = 0.0416). Significant differences on both IRLS and CGI scales favouring ropinirole were apparent by week 1. Ropinirole was also associated with significantly greater improvements in sleep and QoL end points. The most common adverse events were nausea and headache.Conclusions: Ropinirole improves restless legs syndrome compared with placebo, with benefits apparent by week 1. It is generally well tolerated. [ABSTRACT FROM AUTHOR]- Published
- 2004
10. Letter to the editor
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Prick Fj, Rico Re, and de Weerd Aw
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medicine.medical_specialty ,business.industry ,General Medicine ,Cervical myelography ,chemistry.chemical_compound ,Text mining ,chemistry ,Metrizamide ,Medicine ,Surgery ,Neurology (clinical) ,Radiology ,business ,Adverse effect - Published
- 1982
11. Make difficult decisions easier.
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Mattern-Coren L, Gutter T, and De Weerd AW
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- 2007
12. Associating executive dysfunction with behavioral and socioemotional problems in children with epilepsy. A systematic review.
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van den Berg L, de Weerd AW, Reuvekamp MHF, and van der Meere JJ
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- Child, Executive Function, Humans, Neuropsychological Tests, Seizures, Child Behavior Disorders complications, Child Behavior Disorders epidemiology, Cognitive Dysfunction, Epilepsy complications
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As children with epilepsy may have a number of learning and behavioral problems, it is important that insight into the underlying neurocognitive differences in these children, which may underlie these areas of challenge is gained. Executive function (EF) problems particularly are associated with specific learning abilities as well as behavioral problems. We aim to review systematically the current status of empirical studies on the association between EF problems and behavior and socioemotional problems in children with epilepsy. After search, 26 empirical studies were identified, most of them of moderate quality. Overall, attention problems were the most reported cognitive deficit in test assessment and the most reported problem by parents. In 54% of the studies, children with epilepsy scored below average compared to controls/normative samples on different aspects of EF. Most studies reported behavior problems, which ranged from mild to severe. Forty-two percent of the studies specifically reported relationships between EF deficits and behavioral problems. In the remaining studies, below average neuropsychological functioning seemed to be accompanied by above average reported behavioral problems. The association was most pronounced for cognitive control and attention in relation to externalizing behavior problems. This cognitive control is also associated with social functioning. Relevant epilepsy variables in this relationship were early age at onset and high seizure frequency.Future research should distinguish specific aspects of EF and take age into account, as this provides more insight on the association between EF and behavior in pediatric epilepsy, which makes it possible to develop appropriate and early intervention.
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- 2021
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13. Sleep-Related Breathing Disorders in Young Adults With Prader-Willi Syndrome: A Placebo-Controlled, Crossover GH Trial.
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Donze SH, de Weerd AW, van den Bossche RAS, Joosten KFM, and Hokken-Koelega ACS
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Context: Sleep-related breathing disorders (SRBD) are common in people with Prader-Willi syndrome (PWS). Young adults with PWS benefit from GH continuation after attaining adult height by maintaining the improved body composition obtained during childhood. There are, no studies about the effects of GH on SRBD in young adults with PWS who were treated with GH during childhood., Objective: Investigate the effects of GH vs placebo on SRBD in young adults with PWS who were treated with GH during childhood and had attained adult height., Design: Two-year, randomized, double-blind, placebo-controlled, crossover study in 27 young adults with PWS, stratified for sex and body mass index., Setting: Dutch PWS Reference Center., Intervention: Crossover intervention with GH (0.67 mg/m2/d) and placebo, both over one year., Main Outcome Measures: Apnea hypopnea index (AHI), obstructive apnea index (OAI), central apnea index (CAI), measured by polysomnography., Results: Compared with placebo, GH did not increase AHI, CAI, or OAI (P > 0.35). The effect of GH vs placebo was neither different between men and women, nor between patients with a deletion or maternal uniparental disomy/imprinting center defect. After two years, there was no difference in AHI, CAI, or OAI compared with baseline (P > 0.18). Two patients (7%) fulfilled the criteria of obstructive sleep apnea regardless of GH or placebo., Conclusions: GH compared with placebo does not cause a substantial increase in AHI, CAI, or OAI in adults with PWS who were treated with GH during childhood and have attained adult height. Our findings are reassuring and prove that GH can be administered safely., (Copyright © 2019 Endocrine Society.)
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- 2019
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14. The burden of parenting children with frontal lobe epilepsy.
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van den Berg L, de Weerd AW, Reuvekamp HF, and van der Meere JJ
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- Adult, Checklist, Child, Child Behavior, Child, Preschool, Cost of Illness, Executive Function, Female, Humans, Male, Neuropsychological Tests, Parents psychology, Problem Behavior psychology, Reproducibility of Results, Surveys and Questionnaires, Epilepsy, Frontal Lobe psychology, Parenting
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Objective: Caring for a child with a chronic illness adds stress to the typical parenting stress in healthy developing children. This stress can place a heavy burden on parents and may increase when a child displays problem behavior. In general, parenting and child's behavior problems are associated. Furthermore, externalizing (more outgoing) behavior is reported frequently in children with frontal lobe epilepsy (FLE). Therefore, in this study, we first investigated the burden of parents of children with FLE, and second, we investigated the relation between the experienced burden and reported behavioral problems. The validity of parents' reports on proxy measures as well as duration of epilepsy is taken into account., Methods: Thirty-one parents of children with FLE completed validated questionnaires about behavioral problems and burden of parenting. To examine if parents tend to be inconsistent or unusually negative, we used the two validity scales of the Behavioral Rating Inventory of Executive Function (BRIEF) (Negativity and Inconsistency)., Results: Only parents of children with FLE who have had epilepsy for 5 years or longer report more problems on the Nijmeegse Vragenlijst voor de Opvoedingssituatie (NVOS) subscales 'Able to manage', 'Child is a burden', and 'Good Interaction' compared with the healthy controls. The subscale 'Child is a burden' significantly predicts scores in about 20% to 49% on the main scales of the Child Behavior Checklist (CBCL), the Global Executive Composite (GEC), and Behavioral Regulation Index (BRI) of the BRIEF. Only 6% of parents scored in the clinical range of the negativity scale of the BRIEF. For the inconsistency scale, this was 45%., Conclusion: Parents of children with FLE do not report excessive parental burden. Longer duration of epilepsy might be a risk factor in experiencing burden. The findings suggest a link between parental burden and behavioral problems in children with FLE. Externalizing behavioral problems are the most marked behavioral problems, which relate to the parental burden. Parents tend to be inconsistent in their ratings., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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15. Prevalence of sleep disturbances in people with epilepsy and the impact on quality of life: a survey in secondary care.
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Gutter T, Callenbach PMC, Brouwer OF, and de Weerd AW
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- Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Comorbidity, Cross-Sectional Studies, Epilepsy psychology, Epilepsy therapy, Female, Humans, Male, Middle Aged, Prevalence, Secondary Care, Sleepiness, Young Adult, Epilepsy epidemiology, Quality of Life, Sleep Wake Disorders epidemiology
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Purpose: Studies in adults with epilepsy, mainly in specialized epilepsy clinics, have shown that sleep disturbances were twice as prevalent in people with epilepsy as in healthy controls. Our aim was to determine the prevalence of sleep disturbances in people with epilepsy treated in district hospitals, as well as the impact of it on Quality of Life., Method: Adults with epilepsy, attending outpatient clinics in three district hospitals were invited to participate. Those who accepted (N = 122) provided their own controls matched for age and sex. Both groups completed four questionnaires (Groningen Sleep Quality Scale (GSQ), Medical Outcomes Study-Sleep scale (MOSS), Sleep Diagnosis List (SDL) and Epworth Sleepiness Scale) to measure their sleep over different periods and the 36-Item Short Form Health Survey (SF-36) to measure Quality of Life (QoL). The prevalence of sleep disturbances and scores on QoL were compared between both groups., Results: Sleep quality, measured by the SDL, was in the pathological range 50% more often in the epilepsy group than in controls. This was confirmed by the MOSS
INDEX and GSQ. People with epilepsy experienced excessive daytime sleepiness more often than controls. The lowest scores on nearly all domains of the SF-36 were seen in people with epilepsy and associated sleep disturbances., Conclusion: We confirmed the higher prevalence of sleep disturbances in people with epilepsy compared to controls as previously reported from specialized settings. The (co-morbid) sleep disturbances result in lower QoL scores, in both people with epilepsy and in controls, but more in people with epilepsy., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)- Published
- 2019
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16. Safety and efficiency of medication withdrawal at home prior to long-term EEG video-monitoring.
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van Griethuysen R, Hofstra WA, van der Salm SMA, Bourez-Swart MD, and de Weerd AW
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- Adult, Cohort Studies, Female, Humans, Male, Middle Aged, Sleep Deprivation etiology, Statistics, Nonparametric, Substance Withdrawal Syndrome etiology, Video Recording, Anticonvulsants adverse effects, Brain Waves drug effects, Electroencephalography, Epilepsy drug therapy, Epilepsy physiopathology, Substance Withdrawal Syndrome diagnosis
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Purpose: Long-term video-EEG monitoring (LTM) is frequently used for diagnostic purposes and in the workup of epilepsy surgery to determine the seizure onset zone. Different strategies are applied to provoke seizures during LTM, of which withdrawal of anti-epileptic drugs (AED) is most effective. Remarkably, there is no standardized manner of AED withdrawal. For instance, the majority of clinics taper medication during clinical admission, whereas we prefer to taper medication at home prior to admission. Our aim was to study the advantages (efficiency and diagnostic yield) and disadvantages (safety and complication rates) of predominantly tapering of medication at home., Method: We report a retrospective observational cohort of 273 patients who had a LTM at our tertiary epilepsy center from 2005 until 2011. Provocation methods to induce seizures were determined on individual basis. Success rate (duration of admittance, time to first seizure, efficiency and diagnostic yield) and complications and serious adverse events were assessed., Results: AED were tapered in 180 (66%) patients, in 93 (24%) of these patients with additional (partial) sleep deprivation. In all of these patients tapering started at home one to four weeks prior to admission. In the other patients, only (partial) sleep deprivation or none provocation method at all was applied. Seizure recordings were successful in 79,9% of patients. Complications occurred in 19 patients (10.9%) of which 3 had (1.7%) serious adverse events (status epilepticus (SE)) with AED withdrawal. These complications only occurred during admittance, not at home., Conclusions: AED withdrawal at home prior to LTM is an efficient and convenient method to increase the diagnostic yield of LTM and appears relatively safe., (Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
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- 2018
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17. Two Siblings With a CDKL5 Mutation: Genotype and Phenotype Evaluation.
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Hagebeuk EE, Marcelis CL, Alders M, Kaspers A, and de Weerd AW
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- Brain physiopathology, Child, Child, Preschool, Electroencephalography, Female, Genotype, Humans, Infant, Phenotype, Seizures genetics, Seizures physiopathology, Siblings, Mental Retardation, X-Linked genetics, Mental Retardation, X-Linked physiopathology, Protein Serine-Threonine Kinases genetics
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This is the second report of a family with a recurrence of a CDKL5 mutation (c. 283-3_290del) in 2 sisters. Both parents tested negative for the mutation in all tissues, but germline mosaicism is likely. Clinically CDKL5 patients resemble those with Rett syndrome, caused by a MECP2 mutation, who experience a regression, after an initial normal development. Even though both siblings showed a typical CDKL5 phenotype, their presentation is different. From birth, the oldest daughter had a severe developmental delay, feeding problems, and hypotonia and experienced daily refractory seizures. The youngest daughter appeared to be normal until age 3 months. At that age seizures started, deterioration and regression became evident, and an epileptic encephalopathy developed. This report of familial recurrence, with suspected germline mosaicism in a healthy parent, has important consequences for genetic counseling. Although it is not possible to predict an exact recurrence risk, it is likely to be increased., (© The Author(s) 2015.)
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- 2015
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18. Periictal and interictal headache including migraine in Dutch patients with epilepsy: a cross-sectional study.
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Hofstra WA, Hageman G, and de Weerd AW
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- Adolescent, Adult, Aged, Child, Child, Preschool, Cross-Sectional Studies, Epilepsy diagnosis, Epilepsy physiopathology, Ethnicity, Female, Headache classification, Humans, International Classification of Diseases, Male, Medical Records, Middle Aged, Migraine Disorders physiopathology, Prevalence, Social Behavior, Surveys and Questionnaires, Young Adult, Epilepsy epidemiology, Headache epidemiology, Headache physiopathology, Migraine Disorders epidemiology, Seizures epidemiology
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As early as in 1898, it was noted that there was a need to find "a plausible explanation of the long recognized affinities of migraine and epilepsy". However, results of recent studies are clearly conflicting on this matter. In this cross-sectional study, we aimed to define the prevalence and characteristics of both seizure-related and interictal headaches in patients with epilepsy (5-75years) seeking help in the tertiary epilepsy clinic SEIN in Zwolle. Using a questionnaire, subjects were surveyed on the existence of headaches including characteristics, duration, severity, and accompanying symptoms. Furthermore, details on epilepsy were retrieved from medical records (e.g., syndrome, seizure frequency, and use of drugs). Diagnoses of migraine, tension-type headache, or unclassifiable headache were made based on criteria of the International Classification of Headache Disorders. Between March and December 2013, 29 children and 226 adults were evaluated, 73% of whom indicated having current headaches, which is significantly more often when compared with the general population (p<0.001). Forty-nine percent indicated having solely interictal headache, while 29% had solely seizure-related headaches and 22% had both. Migraine occurs significantly more often in people with epilepsy in comparison with the general population (p<0.001), and the occurrence of tension-type headaches conforms to results in the general population. These results show that current headaches are a significantly more frequent problem amongst people with epilepsy than in people without epilepsy. When comparing migraine prevalence, this is significantly higher in the population of patients with epilepsy., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2015
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19. Headache in epilepsy patients: the (un)awareness of this phenomenon among Dutch neurologists.
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Hofstra WA, Hageman G, and de Weerd AW
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- Awareness, Humans, Netherlands, Surveys and Questionnaires, Epilepsy complications, Headache complications, Health Knowledge, Attitudes, Practice, Physicians psychology
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Purpose: Headache is a frequently heard complaint that can strongly influence quality of life. This is probably even more so in people with a chronic illness. Knowing that headache, and especially migraine, is more frequent among epilepsy patients, the knowledge concerning this problem has been studied among Dutch neurologists., Methods: Seven hundred and seventy two neurologists, working in 89 hospitals and two tertiary epilepsy clinics were asked to participate. Using a questionnaire, neurologists were surveyed on different subjects, e.g. whether they thought current headaches are more frequent in people with epilepsy than in the general population, their interest for epilepsy and how many patients with epilepsy visited their polyclinic per month., Results: In total, 334 questionnaires were returned (response rate of 43%) of which 18 were excluded. One third of neurologists responded affirmatively that current headaches are more prevalent among people with epilepsy and eight percent knows that this is, more specified, migraine. The number of years of experience does not influence knowledge on headaches in epilepsy patients. The interest in epilepsy and the number of epilepsy patients per month on the polyclinic does., Conclusions: These results show that the occurrence of headache in people with epilepsy is underestimated by Dutch neurologists. This leaves an often bothersome and potentially treatable condition underexposed., (Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
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- 2015
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20. Actigraphy, the alternative way?
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De Weerd AW
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- 2014
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21. Effectiveness of cognitive behavioral therapy for insomnia: influence of slight-to-moderate depressive symptom severity and worrying.
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Hamoen AB, Redlich EM, and de Weerd AW
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- Adult, Anxiety Disorders epidemiology, Comorbidity, Depression epidemiology, Humans, Severity of Illness Index, Sleep Initiation and Maintenance Disorders epidemiology, Anxiety Disorders therapy, Cognitive Behavioral Therapy methods, Depression therapy, Sleep Initiation and Maintenance Disorders therapy, Treatment Outcome
- Abstract
Background: Cognitive behavioral therapy for insomnia (CBT-I) is a well-known, effective treatment for primary insomnia. However, the majority of sleeping problems occur in the presence of another medical or psychiatric disorder. Depression and general anxiety disorder (with a main feature of excessive generalized worrying) are disorders that frequently co-occur with insomnia. The purpose of this study is to evaluate whether depressive symptom severity or worrying influences the subjective effectiveness of CBT-I., Methods: Patients with a complaint of insomnia received CBT-I. At the beginning of the therapy, patients completed a sleep evaluation list, the Beck Depression Inventory (BDI-II-NL, N = 92), and the Penn State Worry Questionnaire (PSWQ, N = 119). Based on the BDI and the PSWQ, the sample was divided into different groups: patients with low versus high depression scores, low worriers versus high worriers, and patients without depressive symptoms who were also classified as low worriers and patients with depressive symptoms who were also classified as high worriers. The sleep evaluation list was completed directly after the treatment and 6 months later., Results: Sleep evaluation scores, subjective total sleep time, subjective sleep onset latency, and subjective wake after sleep onset all changed in a positive way after CBT-I and remained that way over the next 6 months for all patients. These positive effects of CBT-I did not differ between the subgroups., Conclusions: Results suggest that CBT-I improves subjective sleep experiences, regardless of depressive symptom severity or worrying., (© 2014 Wiley Periodicals, Inc.)
- Published
- 2014
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22. On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of hypnotics.
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Leufkens TR, Ramaekers JG, de Weerd AW, Riedel WJ, and Vermeeren A
- Subjects
- Aged, Case-Control Studies, Female, Humans, Hypnotics and Sedatives administration & dosage, Male, Middle Aged, Polysomnography, Automobile Driving, Cognition drug effects, Hypnotics and Sedatives pharmacology, Sleep Initiation and Maintenance Disorders drug therapy
- Abstract
Rationale: Many older adults report sleep problems and use of hypnotics. Several studies have shown that hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving., Objectives: The present study aimed to compare actual driving performance and driving-related skills of chronic hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use hypnotics and good sleepers., Methods: Twenty-two frequent users of hypnotics (using hypnotics ≥ 4 nights per week for more than 3 months), 20 infrequent users (using hypnotics ≤ 3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing., Results: Polysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls., Conclusions: Driving performance in chronic users of hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.
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- 2014
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23. Residual effects of zopiclone 7.5 mg on highway driving performance in insomnia patients and healthy controls: a placebo controlled crossover study.
- Author
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Leufkens TR, Ramaekers JG, de Weerd AW, Riedel WJ, and Vermeeren A
- Subjects
- Administration, Oral, Adult, Aged, Azabicyclo Compounds administration & dosage, Case-Control Studies, Cross-Over Studies, Double-Blind Method, Female, Humans, Hypnotics and Sedatives administration & dosage, Male, Middle Aged, Piperazines administration & dosage, Automobile Driving, Azabicyclo Compounds pharmacology, Hypnotics and Sedatives pharmacology, Piperazines pharmacology, Sleep Initiation and Maintenance Disorders drug therapy
- Abstract
Rationale: Residual effects of hypnotics on driving performance have been mainly determined in studies using a standardized driving test with healthy good sleepers. Responses to effects may differ, however, between insomniacs and healthy volunteers due to the underlying sleep disorder. In addition, a majority of insomniacs uses hypnotics chronically resulting in the development of tolerance to impairing effects. Impaired driving performance in healthy volunteers may then be an overestimation of the actual effects in insomniacs., Objectives: The present study aims to compare the residual effects of zopiclone 7.5 mg on on-the-road driving performance of 16 middle-aged insomniacs chronically using hypnotics (chronic users), 16 middle-aged insomniacs not or infrequently using hypnotics (infrequent users), and 16 healthy, age matched, good sleepers (controls)., Methods: The study was conducted according to a 3 × 2 double-blind, placebo controlled crossover design, with three groups and two treatment conditions. Treatments were single oral doses of zopiclone 7.5 mg and placebo administered at bedtime (2330 hours). Between 10 and 11 h after administration subjects performed a standardized highway driving test., Results: Zopiclone 7.5 mg significantly impaired on-the-road driving performance in both insomnia groups and healthy controls. The magnitude of impairment was significantly less in the chronic users group as compared with the controls., Conclusions: The smaller magnitude of effects suggests that investigating residual effects of hypnotics in healthy volunteers may yield a minor overestimation of the actual effects in insomnia patients.
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- 2014
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24. Subjective sleep disturbances in children with partial epilepsy and their effects on quality of life.
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Gutter T, Brouwer OF, and de Weerd AW
- Subjects
- Case-Control Studies, Child, Child, Preschool, Female, Humans, Male, Prevalence, Severity of Illness Index, Surveys and Questionnaires, Epilepsies, Partial epidemiology, Epilepsies, Partial psychology, Quality of Life psychology, Sleep Wake Disorders epidemiology, Sleep Wake Disorders psychology
- Abstract
Purpose: The purposes of this study were to explore the prevalence of sleep disturbances in a large cohort of school-aged children with partial epilepsy, to compare the findings with those in children without epilepsy of the same age and gender, and to evaluate the relationship between sleep disturbances and health-related quality of life (HRQoL)., Methods: One hundred thirty children with partial epilepsy aged 4 to 10years, who were treated in the outpatient setting of a Dutch epilepsy clinic, and 161 age- and sex-matched controls participated in this study. In addition to providing information about their child's demography and health, parents of both groups of children completed three questionnaires to measure their child's sleep [Sleep Disturbance Scale for Children (SDSC), Medical Outcomes Study-Sleep Scale (MOSS-S), and Groningen Sleep Quality Scale (GSQS)] and one questionnaire to measure quality of life (Kidscreen-27). Parents of children with epilepsy also completed the Hague Scales to measure the severity of epilepsy. The prevalence of sleep disturbances and scores on HRQoL in children with and without epilepsy were compared. Additionally, the HRQoL scores were compared between children with and without sleep disturbances in children both with and without epilepsy., Results: The answers for all three questionnaires suggested worse sleep in children with epilepsy than in children of the same age and gender without epilepsy. Pathological scores (T-value>70) for total SDSC were seen twelve times more frequently in children with epilepsy (36.92% vs. 3.01%, p<0.001). Children with epilepsy also scored significantly lower for all dimensions of HRQoL. Between subgroups of children with and without disturbed sleep, insignificant differences in quality of life were found, with the lowest scores in children with sleep disturbances in both groups., Conclusion: This study confirms the high prevalence of disturbed sleep, as well as its effect on quality of life, in a large group of children with partial epilepsy. The abnormalities are both more prevalent and more severe than in children without epilepsy., (© 2013.)
- Published
- 2013
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25. Respiratory and sleep disorders in female children with atypical Rett syndrome caused by mutations in the CDKL5 gene.
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Hagebeuk EE, van den Bossche RA, and de Weerd AW
- Subjects
- Adolescent, Child, Preschool, Female, Humans, Polysomnography, Sleep Apnea Syndromes diagnosis, Mutation genetics, Protein Serine-Threonine Kinases genetics, Rett Syndrome complications, Rett Syndrome genetics, Sleep Apnea Syndromes etiology
- Abstract
Aim: In female children with drug-resistant seizures and developmental delay from birth, atypical Rett syndrome caused by mutations in the CDKL5 gene should be considered. Several clinical features resemble classic Rett syndrome. Respiratory and sleep abnormalities are frequently present in Rett syndrome, whereas little is known in patients with CDKL5 mutations., Method: In four genetically confirmed female patients with CDKL5 mutations (age range 2-15 y), the presence of breathing and sleep abnormalities was evaluated using the validated Sleep Disturbance Scale for Children and polysomnography (PSG)., Results: The Sleep Disturbance Scale for Children indicated disorders of initiating and maintaining sleep, daytime somnolence, and sleep breathing disorders. In one patient, PSG showed central apnoeas during sleep: her total apnoea-hypopnoea index (AHI) was 4.9, of which the central AHI was 3.4/h. When awake, central apnoeas were present in two of the four female children (central AHI 28/h and 41/h respectively), all preceded by hyperventilation. PSG showed low rapid eye movement (REM) sleep (9.7-18.3%), frequent awakenings, and low sleep efficiency (range 59-78%)., Interpretation: Episodic hyperventilation followed by central apnoeas was present while awake in two of four patients. This may indicate failure of brainstem respiratory centres. In addition, low REM sleep, frequent arousals (not caused by apnoeas/seizures), and low sleep efficiency were present. Similar to Rett syndrome, in patients with CDKL5 mutations PSG seems warranted to evaluate breathing and sleep disturbances., (© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.)
- Published
- 2013
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26. Sleep monitoring by actigraphy in short-stay ICU patients.
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van der Kooi AW, Tulen JH, van Eijk MM, de Weerd AW, van Uitert MJ, van Munster BC, and Slooter AJ
- Subjects
- Aged, Cardiac Surgical Procedures, Female, Humans, Length of Stay, Male, Middle Aged, Reproducibility of Results, Sensitivity and Specificity, Sleep Stages, Wakefulness, Actigraphy, Critical Care, Polysomnography, Sleep Deprivation diagnosis
- Abstract
Sleep deprivation is common in intensive care unit (ICU) patients. The criterion standard for sleep monitoring, polysomnography, is impractical in ICU. Actigraphy (a wrist watch indicating amount of sleep) proved to be a good alternative in non-ICU patients, but not in prolonged mechanically ventilated patients, probably due to ICU-acquired weakness. Short-stay ICU patients do not suffer from ICU-acquired weakness. However, the accuracy of actigraphy is unknown in these patients. Therefore, we compared actigraphy to polysomnography in short-stay ICU patients. Sleep measurements were conducted in 7 postcardiothoracic surgery patients. The sensitivity (percentage of actigraphy data that agreed with sleep determined using polysomnography) and specificity (percentage of actigraphy data that agreed with awake determined using polysomnography) were calculated. The result showed that actigraphy underestimated the amount of wake time and overestimated the amount of sleep. The median specificity for actigraphy was always less than 19% and sensitivity more than 94%. Therefore, actigraphy is not reliable for sleep monitoring in short-stay ICU patients.
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- 2013
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27. [Nocturnal choking sensation].
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Busger op Vollenbroek RJ and de Weerd AW
- Subjects
- Adult, Diagnosis, Differential, Epilepsy complications, Epilepsy diagnosis, Female, Gastroesophageal Reflux complications, Gastroesophageal Reflux diagnosis, Humans, Laryngismus complications, Laryngismus diagnosis, Male, Middle Aged, Polysomnography, Sleep Wake Disorders etiology, Airway Obstruction, Sleep Wake Disorders diagnosis
- Abstract
There are many different types of sleep disorders. The majority of sleep-related breathing disorders can be attributed to sleep apnoea syndrome. Nocturnal choking sensation is a different symptom, for which we present two cases. Nocturnal choking sensation is a terrifying symptom for the patient and the diagnostic approach can be challenging. Aside from sleep choking syndrome, this symptom may appear with nocturnal laryngospasm, insular epilepsy and nocturnal gastro-oesophageal reflux. A thorough patient history and observation of the nocturnal event, sometimes supported by EEG findings, may provide the clue to the diagnosis. These kinds of nocturnal symptoms are best analyzed in a clinic specialized in both epilepsy and sleep disorders.
- Published
- 2013
28. Effects of daytime secondarily generalized epileptic seizures on sleep during the following night.
- Author
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Gutter T and de Weerd AW
- Subjects
- Adolescent, Adult, Circadian Rhythm physiology, Electroencephalography, Female, Humans, Male, Middle Aged, Polysomnography, Retrospective Studies, Video Recording, Brain physiopathology, Epilepsy, Generalized physiopathology, Sleep physiology, Wakefulness physiology
- Abstract
Nocturnal seizures may disturb sleep, but the effect of an epileptic seizure during daytime on sleep during the next night has been under investigated. In this proof-of-principle study, the sleep of 425 patients with epilepsy, who underwent long-term video-electroencephalography recordings, was analyzed. The sleep recordings were retrospectively divided into two groups: Seizure Free, no seizure occurred at least 24 h before the start of the night sleep recording, and Daytime Seizure, at least one (secondarily) generalized seizure occurred during the day before. In Daytime Seizure, longer time in bed and latency to first REM and more NREM II were seen as well as a decrease of deep sleep and REM sleep compared to Seizure Free. As many participants underwent long-term recordings over a period longer than 48 h, we had the opportunity to compare in individual patients the sleep architecture during nights with and without seizures on the day before the recording. Time in bed and WASO were longer, and sleep efficiency was less in the nights after a seizure on the day before the recording. These differences were statistically significant, but their clinical relevance is doubtful., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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29. Morningness and eveningness: when do patients take their antiepileptic drugs?
- Author
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Hofstra WA, van der Palen J, and de Weerd AW
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Young Adult, Anticonvulsants therapeutic use, Circadian Rhythm, Epilepsy drug therapy, Sleep physiology, Wakefulness physiology
- Abstract
Almost one-third of epilepsy patients continue to have seizures despite adequate drug treatment. Chronotherapy (based on dynamic changes in drug pharmacology and disease-related processes) could be a promising treatment option. We aimed to explore whether different circadian types adjust administration times of anti-epileptic drugs (AEDs) as a step in exploring chronotherapeutic possibilities. We performed a questionnaire-based study to compare behavior of different circadian types in relation to times of taking drugs. Circadian type was determined by the Morningness-Eveningness Questionnaire. Results clearly show that morning types are taking their AEDs significantly earlier than do evening types on free days. Times of taking AEDs in the morning on work days also differ significantly between morning and evening types. Regardless of circadian type, drugs on free days are taken later than on working days. In conclusion, our study shows that patients adapt times of taking medication to their circadian type., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2012
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30. Sleep disturbances in people with epilepsy; prevalence, impact and treatment.
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van Golde EG, Gutter T, and de Weerd AW
- Subjects
- Adolescent, Adult, Central Nervous System Depressants therapeutic use, Child, Female, Humans, Male, Melatonin therapeutic use, Middle Aged, Prevalence, Sleep Apnea, Obstructive complications, Sleep Wake Disorders drug therapy, Sleep Wake Disorders epidemiology, Sleep Wake Disorders therapy, Young Adult, Epilepsy complications, Sleep Wake Disorders complications
- Abstract
The interaction between epilepsy and sleep is thoroughly studied and is very complex. This review focuses on prevalence, impact on quality of life and effects of treatment of sleep disorders on the course of epilepsy. Self-reported sleep disturbances in people with epilepsy are about twice as prevalent as in healthy controls. People with epilepsy with sleep disturbances have a significant impairment of quality of life compared to those with no sleep disturbances. In children with epilepsy, sleep problems may lead to detrimental effects on daytime behavior and cognition. Most is known about obstructive sleep apnea syndrome (OSAS). Co-morbidity of epilepsy and OSAS is shown to be far higher than expected by chance. Treatment of OSAS significantly improves seizure control in people with epilepsy. More studies on the prevalence of other sleep disorders in people with epilepsy and the effect of treatment are required. Reports on the effect of treatment for other sleep disorders are scarce and not unequivocal., (Copyright © 2011. Published by Elsevier Ltd.)
- Published
- 2011
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31. Timing of temporal and frontal seizures in relation to the circadian phase: a prospective pilot study.
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Hofstra WA, Gordijn MC, van der Palen J, van Regteren R, Grootemarsink BE, and de Weerd AW
- Subjects
- Adolescent, Adult, Electroencephalography, Female, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Time Factors, Young Adult, Circadian Rhythm physiology, Frontal Lobe physiopathology, Seizures pathology, Temporal Lobe physiopathology
- Abstract
There is strong evidence that epileptic seizures occur in diurnal or 24-h patterns. A study in rat models of partial epilepsy showed circadian seizure patterns, and in humans circadian rhythmicity in interictal discharges has been found, suggesting that circadian rhythm may play a role in epilepsy. Circadian influences on human seizure patterns have not been investigated. We performed a pilot study to ascertain influences of the circadian rhythm on seizure occurrence. We prospectively outlined circadian rhythms of patients admitted for long term EEG and video monitoring, using measurement of the dim light melatonin onset (DLMO). Seizures during admission were recorded with continuous EEG and video monitoring. The DLMO ranged from 18:46h to 23:13h (mean 21:22h). One hundred and twenty-four seizures of 21 patients were analysed. Seizures of temporal lobe origin occurred mainly between 11:00 and 17:00h and frontal seizures were seen mostly between 23:00 and 05:00h. When correlating seizure timing to the individual's circadian phase as measured by the DLMO, the following was seen: temporal seizures occurred most frequently in the 6h before DLMO and frontal seizures mainly in 6-12h after the DLMO. The results of this pilot study suggest that temporal and frontal seizures occur in a non-random fashion synchronized to a hormonal marker of the circadian timing system., (Copyright © 2011 Elsevier B.V. All rights reserved.)
- Published
- 2011
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32. [Staring episodes in children with developmental disorders: epilepsy or behaviour?].
- Author
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Bos MJ, de Weerd AW, and Hagebeuk EE
- Subjects
- Attention Deficit Disorder with Hyperactivity complications, Autistic Disorder complications, Child, Diagnosis, Differential, Epilepsy diagnosis, Humans, Male, Monitoring, Physiologic methods, Seizures diagnosis, Valproic Acid therapeutic use, Child Behavior, Electroencephalography methods, Fixation, Ocular, Valproic Acid adverse effects
- Abstract
Behavioural episodes of staring in children are difficult to distinguish from epileptic seizures, especially in children with developmental disorders such as ADHD, autism spectrum disorders and intellectual disabilities. We discuss two patients with staring episodes who were using anti-epileptic drugs. In both patients, EEG with video monitoring showed that the staring was non-epileptic. The first is an 8-year-old boy, who developed severe motor problems and ataxia during treatment with valproate. His staring episodes were behavioural, caused by his intellectual disability, and the motor problems resolved after discontinuation of valproate. The second patient is a 10-year-old boy with known autism, ADHD and infantile seizures, who developed staring for which he was using valproate. Again, video-EEG monitoring during staring showed no abnormalities and in this case the staring was caused by his intellectual disability and autism. We discuss the differential diagnosis of staring episodes in children with developmental disorders and present the pitfalls of the diagnostic process.
- Published
- 2011
33. Chronotypes and subjective sleep parameters in epilepsy patients: a large questionnaire study.
- Author
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Hofstra WA, Gordijn MC, van Hemert-van der Poel JC, van der Palen J, and De Weerd AW
- Subjects
- Adolescent, Adult, Case-Control Studies, Epilepsy, Frontal Lobe physiopathology, Epilepsy, Temporal Lobe physiopathology, Epilepsy, Temporal Lobe surgery, Female, Humans, Male, Middle Aged, Myoclonic Epilepsy, Juvenile physiopathology, Surveys and Questionnaires, Young Adult, Circadian Rhythm physiology, Epilepsy physiopathology, Sleep physiology
- Abstract
Accumulating evidence suggests epilepsy and seizures may influence circadian rhythms and that circadian rhythms may influence epilepsy. It is also conceivable that seizure timing influences the timing of daily activities, sleeping, and wakefulness (i.e., chronotype). Only one group has studied the distribution of chronotypes of epileptics, showing significant differences between the diurnal activity patterns in two groups of patients with different epilepsy syndromes. The authors performed a questionnaire-based study of 200 epilepsy patients to compare the distribution of chronotypes and subjective sleep parameters of sleep duration and time of mid-sleep on free days to the distribution in the general population (n = 4042). Within this large group of epilepsy patients, we also compared the chronotypes of subsamples with well-defined epilepsy syndromes, i.e., temporal lobe epilepsy [TLE; n = 46], frontal lobe epilepsy [FLE; n = 30], and juvenile myoclonic epilepsy [JME; n = 38]. In addition, 27 patients who had had surgery for TLE were compared with those with TLE who had not had surgery. Both the Morningness-Eveningness Questionnaire and Munich Chronotype Questionnaire were used to determine chronotypes and subjective sleep parameters. Significant differences in morningness/eveningness distribution, timing of mid-sleep (corrected for sleep duration), and total sleep time on free days were found between epileptics and healthy controls. Those with epilepsy were more morning oriented, had earlier mid-sleep on free days, and longer sleep duration on free days (p < .001). However, distributions of chronotypes and sleep parameters between the groups of people with TLE, FLE, and JME did not differ. Persons who had surgery for TLE had similar morningness-eveningness parameters and similar sleep durations compared to those without surgery, but mid-sleep on free days was earlier in operated patients (p = .039). In conclusion, this is the first large study focusing on chronotypes in people with epilepsy. We show that the distribution of chronotypes and subjective sleep parameters of epileptics, in general, is different from that of healthy controls. Nevertheless, no differences are observed between patients with specified epilepsy syndromes, although they exhibit seizures with different diurnal patterns. Our results suggest that epilepsy, itself, rather than seizure timing, has a significant influence on chronotype behavior and subjective sleep parameters.
- Published
- 2010
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34. The circadian rhythm and its interaction with human epilepsy: a review of literature.
- Author
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Hofstra WA and de Weerd AW
- Subjects
- Adult, Animals, Biological Clocks physiology, Body Temperature Regulation physiology, Brain physiopathology, CLOCK Proteins genetics, Child, Disease Models, Animal, Electroencephalography, Epilepsy diagnosis, Gene Expression genetics, Hormones blood, Humans, Melatonin blood, Rats, Sleep physiology, Wakefulness physiology, Circadian Rhythm physiology, Epilepsy physiopathology
- Abstract
Knowledge on the interaction between circadian rhythm and human epilepsy is relatively poor, although if it exists, this interaction may be of value for better knowledge of pathophysiology and for timing of diagnostic procedures and therapy. It appears that human seizure occurrence may have 24-h rhythmicity, depending on the origin. These findings are endorsed by animal studies. Rats placed in constant darkness showed spontaneous limbic seizures occurring in an endogenously mediated circadian pattern. More studies are available on the influence of epilepsy on circadian rhythms. Significant differences in chronotypes between patients with different epilepsy syndromes have been found and numerous studies have described influences of epilepsy and seizures on sleep. In contrast, knowledge on (core) body temperature and clock genes in patients is minimal. Reduced heart rate variability and changed hormone levels, which are under the influence of the biological clock, have been observed in people with epilepsy. In short, large gaps in the knowledge about the interaction of circadian rhythm and human epilepsy still remain. Proposals for studies in this borderline area between the biological clock and epilepsy will be discussed.
- Published
- 2009
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35. Temporal distribution of clinical seizures over the 24-h day: a retrospective observational study in a tertiary epilepsy clinic.
- Author
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Hofstra WA, Grootemarsink BE, Dieker R, van der Palen J, and de Weerd AW
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Electroencephalography statistics & numerical data, Epilepsies, Partial diagnosis, Epilepsies, Partial epidemiology, Epilepsy, Temporal Lobe diagnosis, Female, Humans, Incidence, Infant, Male, Middle Aged, Retrospective Studies, Seizures diagnosis, Sleep Stages physiology, Circadian Rhythm, Epilepsy, Temporal Lobe epidemiology, Seizures epidemiology
- Abstract
Purpose: Very few studies have evaluated seizure occurrence in humans over the 24-h day; data from children are particularly scarce. Circadian patterns in seizure occurrence may be of importance in epilepsy research and may have important implications in diagnosis and therapy., Methods: We have analyzed clinical seizures of 176 consecutive patients (76 children, 100 adults) who had continuous electroencephalography (EEG) and video monitoring lasting more than 22 h. Several aspects of seizures were noted, including classification, time of day, origin, and sleep stage., Results: More than 800 seizures were recorded. Significantly more seizures were observed from 11:00 to 17:00 h, and from 23:00 to 05:00 h significantly fewer seizures were seen. The daytime peak incidences were observed in seizures overall, complex partial seizures (in children and adults), seizures of extratemporal origin (in children), and seizures of temporal origin (in adults). Incidences significantly lower than expected were seen in the period 23:00 to 05:00 h in seizures overall, complex partial seizures (in children and adults), and in tonic seizures (in children). In addition, significantly fewer seizures of temporal (in children and adults) and extratemporal origin (in children) were observed in this period., Discussion: The results suggest that certain types of seizures have a strong tendency to occur in true diurnal patterns. These patterns are characterized by a peak during midday and a low in the early night.
- Published
- 2009
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36. The relationship between central adrenal insufficiency and sleep-related breathing disorders in children with Prader-Willi syndrome.
- Author
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de Lind van Wijngaarden RF, Joosten KF, van den Berg S, Otten BJ, de Jong FH, Sweep CG, de Weerd AW, and Hokken-Koelega AC
- Subjects
- Adrenal Insufficiency epidemiology, Child, Child, Preschool, Diagnostic Techniques, Endocrine, Female, Humans, Male, Metyrapone pharmacology, Metyrapone therapeutic use, Polysomnography, Prader-Willi Syndrome epidemiology, Sleep drug effects, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes epidemiology, Adrenal Insufficiency complications, Adrenal Insufficiency diagnosis, Prader-Willi Syndrome complications, Sleep Apnea Syndromes complications
- Abstract
Background: The annual death rate of patients with Prader-Willi syndrome (PWS) is high (3%). Many deaths of children are sudden and unexplained. Sleep apneas have been suggested to play a role in sudden deaths. Recently, we discovered that 60% of patients with PWS suffer from central adrenal insufficiency (CAI) during stress., Objective: The aim was to study the relationship between CAI and sleep-related breathing disorders., Design: In 20 children with PWS who underwent a metyrapone test (30 mg/kg at 2330 h), sleep-related breathing was evaluated by polysomnography before the metyrapone test. In addition, we recorded sleep-related breathing in 10 children with PWS during their metyrapone test. CAI was diagnosed when ACTH levels during the metyrapone test were below 33 pmol/liter at 0730 h. All tests were performed during healthy condition., Setting: The study was conducted in a pediatric intensive care unit and specialized sleep center., Results: Median (interquartile range) age was 8.4 yr (6.5-10.2). After metyrapone administration, median (interquartile range) central apnea index (number/hour) increased significantly from 2.2 (0.4-4.7) to 5.2 (1.5-7.9) (P = 0.007). The increase tended to be higher in children with CAI [2.8 (2.0-3.9) vs. 1.0 (-0.2 to 2.6); P = 0.09]. During polysomnography before the metyrapone test, sleep-related breathing was worse in children with CAI, who had a significantly higher central apnea index and tended to have a lower minimum oxygen saturation compared to those without CAI (P = 0.03 and P = 0.07)., Conclusions: In children with PWS, the central apnea index increased significantly after metyrapone administration, particularly in those with CAI during stress. In addition, children with CAI had a higher central apnea index compared to those without several months before the metyrapone test.
- Published
- 2009
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37. Diurnal rhythms in seizures detected by intracranial electrocorticographic monitoring: an observational study.
- Author
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Hofstra WA, Spetgens WP, Leijten FS, van Rijen PC, Gosselaar P, van der Palen J, and de Weerd AW
- Subjects
- Adolescent, Adult, Age Factors, Female, Humans, Male, Middle Aged, Monitoring, Physiologic methods, Obsessive Behavior, Video Recording methods, Young Adult, Circadian Rhythm physiology, Electroencephalography methods, Seizures physiopathology
- Abstract
Few studies have evaluated human seizure occurrence over the 24-hour day, and only one group has employed intracranial electrocorticography monitoring to record seizures. Circadian patterns in seizures may have important implications in diagnosis and therapy and provide opportunities in research. We have analyzed spontaneous seizures in 33 consecutive patients with long-term intracranial EEG and video monitoring. Several aspects of seizures were noted, including time of day, origin, type, and behavioral state (sleeping/awake). We recorded 450 seizures that showed an uneven distribution over the day, depending on lobe of origin: temporal lobe seizures occurred preferentially between 1100 and 1700 hours, frontal seizures between 2300 and 0500 hours, and parietal seizures between 1700 and 2300 hours. In the awake state, larger proportions of clinical seizures were seen from 0500 to 1100 hours and from 1700 to 2300 hours. During sleep, larger proportions occurred from 1100 to 1700 hours and from 2300 to 0500 hours. Our results suggest that seizures from different brain regions have a strong tendency to occur in different diurnal patterns.
- Published
- 2009
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38. [Recognition of temporal lobe epilepsy in adults].
- Author
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Deckers CL, Stapert JR, and de Weerd AW
- Subjects
- Aged, Diagnosis, Differential, Epilepsy, Temporal Lobe complications, Female, Humans, Limbic System physiopathology, Male, Middle Aged, Neocortex physiopathology, Panic Disorder diagnosis, Seizures etiology, Automatism diagnosis, Epilepsy, Temporal Lobe diagnosis, Seizures diagnosis
- Abstract
Temporal lobe epilepsy has a subtle and diverse symptomatology, and therefore temporal lobe seizures can initially be misdiagnosed. Here we discuss 3 patients with this type of epilepsy, but with completely different presentations. The first, a 67-year-old woman suffered from episodes of confusion, and later she developed tonic-clonic seizures. The second patient, a 58-year-old man, had auras followed by impaired consciousness and oral automatisms and also developed a type of seizure resembling panic attacks. The third patient, a 65-year-old man, presented with isolated auras. A few years later he developed tonic-clonic seizures, and the diagnosis 'temporal lobe epilepsy' was made. This article discusses differences in presentation between limbic and neocortical temporal lobe epilepsy, as well as the results of EEG and MRI investigations.
- Published
- 2009
39. Cognition and behavior in pre-pubertal children with Prader-Willi syndrome and associations with sleep-related breathing disorders.
- Author
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Festen DA, Wevers M, de Weerd AW, van den Bossche RA, Duivenvoorden HJ, and Hokken-Koelega AC
- Subjects
- Behavior, Child, Child Behavior Disorders etiology, Cognition, Cognition Disorders etiology, Female, Genomic Imprinting, Humans, Male, Mutation, Prader-Willi Syndrome genetics, Prader-Willi Syndrome psychology, Sleep Apnea, Central etiology, Child Behavior Disorders diagnosis, Cognition Disorders diagnosis, Prader-Willi Syndrome complications, Sleep Apnea, Central diagnosis
- Abstract
Prader-Willi syndrome (PWS) is characterized by hypotonia, hypogonadism, obesity, and short stature. Neurobehavioral abnormalities, cognitive impairment, and sleep-related breathing disorders (SRBD) are common. In the general population associations between neurobehavioral and cognitive abnormalities and SRBD have been found. We investigated cognition, behavior, and SRBD in children with PWS. Thirty-one pre-pubertal PWS children were evaluated (5 with paternal deletion, 14 with maternal disomy, 4 with imprinting-center mutation, and in 8 the defect was not specified). Cognition was assessed by Wechsler scale subtests, and behavior by parent-questionnaires. Polysomnography was performed. Cognition, behavior, and associations with SRBD were evaluated. All cognitive subtests were significantly below O SDS, with the lowest median (interquartile range) scores for the Block design subtest (-2.7 SDS (-3.0 to -0.3)). In 60%, verbal subtests were less affected than performance subtests. Parents reported problem behavior related to "emotions/behavior not adapted to the social situation" and "insensitivity to social information." All children had SRBD, with an Apnea Hypopnea Index of 4.1/hr (2.6-7.9). One performance subtest score was significantly higher in children with better sleep efficiency, and daytime sleepiness was associated with more autistic-like social impairment. In contrast to our expectations, behavior was worse in children with better sleep-related breathing. In pre-pubertal PWS children, cognition is impaired. Neurobehavioral abnormalities are common, particularly autistic-like social impairment. Sleep efficiency was associated with better performance on one of the performance subtests, and neurobehavioral abnormalities were associated with daytime sleepiness. In contrast, we could not confirm a positive association of neurobehavioral abnormalities with SRBD in PWS., (Copyright (c) 2008 Wiley-Liss, Inc.)
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- 2008
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40. How to assess circadian rhythm in humans: a review of literature.
- Author
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Hofstra WA and de Weerd AW
- Subjects
- Humans, Individuality, Melatonin metabolism, Circadian Rhythm physiology
- Abstract
It is well known that seizures of some types of epilepsy tend to occur in patterns. The circadian rhythm may play a significant role in this phenomenon. In animal studies it has been found that seizures in experimental partial epilepsy are probably under the influence of the biological clock. In this review an introduction to the influence of the human circadian rhythm in epilepsy is given. Furthermore, the methodology of measuring the circadian rhythm in humans is explored. An overview of widely used methods includes protocols used to desynchronize circadian rhythm, and sleep-wake and biological markers such as the dim light melatonin onset, core body temperature, and cortisol that are employed to determine the phase of the circadian rhythm. Finally, the use of sleep parameters, actigraphy, and questionnaires is discussed. These are also important in assessment of the circadian rhythm.
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- 2008
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41. Psychomotor development in infants with Prader-Willi syndrome and associations with sleep-related breathing disorders.
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Festen DA, Wevers M, de Weerd AW, van den Bossche RA, Duivenvoorden HJ, Otten BJ, Wit JM, and Hokken-Koelega AC
- Subjects
- Body Mass Index, Child, Preschool, Female, Humans, Infant, Intellectual Disability physiopathology, Male, Polysomnography, Prader-Willi Syndrome physiopathology, Prader-Willi Syndrome psychology, Sleep Apnea, Central physiopathology, Sleep Apnea, Central psychology, Sleep Apnea, Obstructive physiopathology, Sleep Apnea, Obstructive psychology, Child Development, Intellectual Disability etiology, Prader-Willi Syndrome complications, Psychomotor Performance, Sleep Apnea, Central etiology, Sleep Apnea, Obstructive etiology
- Abstract
Prader-Willi syndrome (PWS) is a neurogenetic disorder with hypotonia, psychomotor delay, obesity, short stature, and sleep-related breathing disorders. The aim of this study was to evaluate the association between psychomotor development and sleep-related breathing disorders in PWS infants. Bayley Scales of Infant Development were performed in 22 PWS infants, with a median (interquartile range, IQR) age of 1.8 (1.1-3.4) y, and a body mass index SD score (BMISDS) of -0.5 (-1.3 to 1.6). We evaluated psychomotor development in relation to results of polysomnography. Median (IQR) mental and motor development was 73.1% (64.3-79.6%) and 55.2% (46.5-63.1%) of normal children, respectively. All infants had sleep-related breathing disorders, mostly of central origin. The apnea hypopnea index was not associated with psychomotor development. Only four infants had obstructive sleep apnea syndrome (OSAS). They had a significantly delayed mental development of 65.5% (60.0-70.3%) of normal. They had a median BMISDS of 1.4 (0.1-1.6), which tended to be higher than in those without OSAS. Our data indicate that psychomotor development in PWS infants is not related to central sleep-related breathing disorders, but infants with OSAS have more severely delayed mental development, suggesting that PWS infants should be screened for OSAS.
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- 2007
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42. Validation of the Augmentation Severity Rating Scale (ASRS): a multicentric, prospective study with levodopa on restless legs syndrome.
- Author
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García-Borreguero D, Kohnen R, Högl B, Ferini-Strambi L, Hadjigeorgiou GM, Hornyak M, de Weerd AW, Happe S, Stiasny-Kolster K, Gschliesser V, Egatz R, Cabrero B, Frauscher B, Trenkwalder C, Hening WA, and Allen RP
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Psychometrics, Quality of Life, Restless Legs Syndrome physiopathology, Surveys and Questionnaires, Antiparkinson Agents administration & dosage, Levodopa administration & dosage, Restless Legs Syndrome drug therapy, Severity of Illness Index, Sickness Impact Profile
- Abstract
Background: Augmentation is the main complication during long-term dopaminergic treatment of restless legs syndrome (RLS) and reflects an overall increase in RLS severity. Its severity varies considerably from a minor problem to a devastating exacerbation of disease. Despite its clinical relevance, systematic evaluations have rarely been undertaken and there has been no development of methods to assess the severity of augmentation. To fill this gap, the European RLS Study Group (EURLSSG) has developed the Augmentation Severity Rating Scale (ASRS), using three items that assess the degree of change in three specific dimensions of augmentation. The changes in each dimension are summed to give an ASRS total score., Methods: The ASRS was developed to cover the basic dimensions defining RLS augmentation. The items were developed by an interactive process involving professional and patient input. The ASRS that was evaluated included four major items and two alternative forms of one item. The validation was conducted using 63 (85%) mostly untreated RLS patients from six centers, who were treated for six months with levodopa (L-Dopa) (up to 500 mg/day, as clinically needed). Two consecutive assessments before and at baseline measured test-retest reliability. Consecutive ASRS ratings by two independent raters on a subsample of patients evaluated inter-rater reliability. Comparison with clinical severity ratings of two independent experts provided external validation of the ASRS. Comparison of patients with and without augmentation with regard to the items and the total score of the ASRS added discriminant validity., Results: Sixty patients (63% females, mean age: 53 years, baseline International RLS Severity Rating (IRLS) score 24.7+/-5.2) were treated with a median daily dose of 300 mg L-Dopa (range: 50-500 mg). Thirty-six patients (60%) experienced augmentation. Item analyses indicated that one item could be removed as it did not contribute significantly to the test score and only one form of the duplicated item needed to be used. The final ASRS then included three items. Test-retest reliability for the total score was rho=0.72, and inter-rater reliability was rcc=0.94. Cronbach's alpha was 0.62. Validity as assessed by the correlation between the worst ASRS total score during the trial and the expert rating was rho=0.72. ASRS total score differed between patients without versus with augmentation (mean: 7.4 (standard deviation (SD)=4.0) vs. 2.0 (2.7) (P<0.0001)., Conclusions: The ASRS is a reliable and valid scale to measure the severity of augmentation. Due to the need to systematically quantify augmentation for both long-term efficacy and tolerability, the ASRS may become a useful tool to monitor augmentation in future clinical trials.
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- 2007
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43. [Interactions of epilepsy and psychiatric problems: life-threatening situations].
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Jonker AK, Verkade JJ, and De Weerd AW
- Subjects
- Adult, Dose-Response Relationship, Drug, Epilepsy drug therapy, Female, Humans, Mental Disorders drug therapy, Vomiting complications, Anticonvulsants therapeutic use, Epilepsy complications, Mental Disorders complications
- Abstract
Epilepsy and psychiatric problems can occur simultaneously and can, quite unexpectedly, trigger interactions that may lead to life-threatening situations. This became obvious in the case of a female patient who suddenly developed a status epilepticus while admitted to hospital. The seizure was probably connected with secret self-induced vomiting which led to a low intake of antiepileptic medication. She used the vomiting to control emotionally charged post-traumatic intrusions. Both the vomiting and the number of seizures were triggered by a life event (in this case emigration). In case of epilepsy, early screening for psychopathology seems advisable because there may be interactions with epileptic variables.
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- 2007
44. [Melatonin: physiological and pathophysiological aspects and possible applications].
- Author
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de Weerd AW
- Subjects
- Circadian Rhythm drug effects, Dose-Response Relationship, Drug, Humans, Time Factors, Circadian Rhythm physiology, Melatonin adverse effects, Melatonin therapeutic use
- Published
- 2006
45. Sleep-related breathing disorders in prepubertal children with Prader-Willi syndrome and effects of growth hormone treatment.
- Author
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Festen DA, de Weerd AW, van den Bossche RA, Joosten K, Hoeve H, and Hokken-Koelega AC
- Subjects
- Child, Child, Preschool, Female, Humans, Male, Polysomnography methods, Human Growth Hormone therapeutic use, Prader-Willi Syndrome complications, Prader-Willi Syndrome drug therapy, Respiration drug effects, Sleep Apnea Syndromes complications, Sleep Apnea Syndromes drug therapy
- Abstract
Context: Recently, several cases of sudden death in GH-treated and non-GH-treated, mainly young Prader-Willi syndrome (PWS), patients were reported. GH treatment in PWS results in a remarkable growth response and an improvement of body composition and muscle strength. Data concerning effects on respiratory parameters, are however, limited., Objective: The objective of the study was to evaluate effects of GH on respiratory parameters in prepubertal PWS children., Design: Polysomnography was performed before GH in 53 children and repeated after 6 months of GH treatment in 35 of them., Patients: Fifty-three prepubertal PWS children (30 boys), with median (interquartile range) age of 5.4 (2.1-7.2) yr and body mass index of +1.0 sd score (-0.1-1.7)., Intervention: Intervention included treatment with GH 1 mg/m2.d., Results: Apnea hypopnea index (AHI) was 5.1 per hour (2.8-8.7) (normal 0-1 per hour). Of these, 2.8 per hour (1.5-5.4) were central apneas and the rest mainly hypopneas. Duration of apneas was 15.0 sec (13.0-28.0). AHI did not correlate with age and body mass index, but central apneas decreased with age (r = -0.34, P = 0.01). During 6 months of GH treatment, AHI did not significantly change from 4.8 (2.6-7.9) at baseline to 4.0 (2.7-6.2; P = 0.36). One patient died unexpectedly during a mild upper respiratory tract infection, although he had a nearly normal polysomnography., Conclusions: PWS children have a high AHI, mainly due to central apneas. Six months of GH treatment does not aggravate the sleep-related breathing disorders in young PWS children. Our study also shows that monitoring during upper respiratory tract infection in PWS children should be considered.
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- 2006
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46. [The restless legs syndrome can be treated with dopamine agonists].
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Aramideh M and de Weerd AW
- Subjects
- Adult, Aged, Anemia, Iron-Deficiency complications, Anemia, Iron-Deficiency drug therapy, Female, Humans, Iron blood, Iron therapeutic use, Male, Middle Aged, Restless Legs Syndrome epidemiology, Restless Legs Syndrome etiology, Selective Serotonin Reuptake Inhibitors adverse effects, Selective Serotonin Reuptake Inhibitors therapeutic use, Treatment Outcome, Dopamine Agonists therapeutic use, Restless Legs Syndrome drug therapy
- Abstract
In three patients, a man aged 46 years and two women aged 74 and 38 years, respectively, restless legs syndrome (RLS) was diagnosed. The second patient had a low serum ferritin concentration. The patients were successfully treated with ropirinol, iron suppletion and gabapentine, and pramipexol, respectively. With a prevalence of 7% in the general population, RLS is a frequent disease. Patients complain about unpleasant feelings in the legs and have an urge to move the legs, causing discomfort during rest. Sleep is disturbed significantly, which interferes with normal functioning of the patients during the day. RLS may be caused by anaemia, uraemia or as a side effect of drugs such as selective serotonin uptake inhibitors (SSRIs), lithium and tricyclic antidepressants. RLS can be treated successfully by dopaminergic agents, especially dopamine agonists.
- Published
- 2006
47. ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage.
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Schuiling WJ, Algra A, de Weerd AW, Leemans P, and Rinkel GJ
- Subjects
- Adult, Aged, Arrhythmias, Cardiac physiopathology, Brain Ischemia physiopathology, Cerebrovascular Circulation, Electrocardiography methods, Female, Heart innervation, Heart physiopathology, Humans, Male, Middle Aged, Myocardial Ischemia complications, Myocardial Ischemia diagnosis, Myocardial Ischemia physiopathology, Predictive Value of Tests, Prognosis, Retrospective Studies, Subarachnoid Hemorrhage physiopathology, Arrhythmias, Cardiac complications, Arrhythmias, Cardiac diagnosis, Brain Ischemia diagnosis, Brain Ischemia etiology, Electrocardiography standards, Subarachnoid Hemorrhage complications
- Abstract
Background: Electrocardiographic (ECG) abnormalities frequently occur after subarachnoid haemorrhage (SAH), and have been linked with poor outcome. The pathogenesis behind this relation is unclear. We hypothesized that cardiac dysfunction may contribute to the development of delayed cerebral ischemia (DCI) and investigated if electrocardiographic repolarization abnormalities on admission, representing this cardiac dysfunction, are related to DCI. We also assessed the additional value of ECG characteristics to establish prognosticators for clinical outcome (WFNS, age and Hijdra score)., Method: In a series of 121 consecutive patients with aneurysmal SAH we related individual repolarization-like ECG changes (ST and T-wave changes, QTc prolongation, a U-wave) to the occurrence of DCI by means of Cox proportional hazard modelling and to poor outcome (death or dependence) with logistic regression analysis. We used ROC curves to assess the additional prognostic value of the most important ECG characteristics to established prognosticators., Findings: Only ST segment depression had a statistically significant relationship with the occurrence of DCI (HR 2.4 [95%CI 1.2-4.9]) in univariate analysis. In a similar analysis ST-elevation (OR 4.9; [95%CI 0.99-24.0]), ST-depression (OR 10.6; [95%CI 2.3-48.8]), T-wave inversion (OR 2.5; [95%CI 1.1-5.5]) and ischemic like ECG abnormalities (OR 8.3; [95%CI 3.0-22.2]) were significantly related to poor outcome. In multivariate models with extension of these ECG characteristics for establishing prognosticators the AUC of the ROC improved from 0.81 to 0.84., Conclusions: ECG abnormalities did not contribute to the prediction of DCI and have limited value in prognosticating poor outcome. The occurrence of DCI is not the explanation of this relationship between ECG characteristics and outcome.
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- 2006
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48. The simplified acute physiology score to predict outcome in patients with subarachnoid hemorrhage.
- Author
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Schuiling WJ, de Weerd AW, Dennesen PJ, Algra A, and Rinkel GJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Area Under Curve, Blood Pressure physiology, Body Temperature physiology, Cohort Studies, Female, Glasgow Outcome Scale, Heart Rate physiology, Humans, Intensive Care Units statistics & numerical data, Leukocyte Count methods, Male, Middle Aged, Multivariate Analysis, Outcome Assessment, Health Care, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Retrospective Studies, Statistics as Topic, Subarachnoid Hemorrhage mortality, Time Factors, Tomography, X-Ray Computed methods, Severity of Illness Index, Subarachnoid Hemorrhage diagnosis, Subarachnoid Hemorrhage physiopathology
- Abstract
Objective: Current prognosticators for patients with subarachnoid hemorrhage (SAH) do not take into account signs of extracerebral organ dysfunction. This may explain the only moderate predictive value of these prognosticators. We assessed the prognostic value of the simplified acute physiology score (SAPS) II in SAH patients., Methods: In a retrospective cohort study of 148 consecutive SAH patients, we related the SAPS II calculated within 24 hours after admission to clinical and initial computed tomographic imaging characteristics using the Mann-Whitney U test. We compared the prognostic value of the SAPS II with that of the World Federation of Neurosurgical Surgeons score, the patient's age, and the amount of blood showing in computed tomographic imaging for the occurrence of delayed cerebral ischemia using Cox proportional hazards modeling or, for poor outcome (death or dependence), logistic regression modeling., Results: In the univariate analysis, the SAPS II was the strongest prognosticator; in the multivariate model, the SAPS II was the only independent predictor for outcome (odds ratio, 1.08; 95% confidence interval, 1.06-1.11]). Patients in the highest tertile of SAPS II had a significantly higher risk of poor outcome than those in the lowest tertile (odds ratio, 30.9; 95% confidence interval, 9.9-96.7]). The SAPS II was also the only independent predictor for the occurrence of delayed cerebral ischemia (hazard ratio, 1.020; 95% confidence interval, 1.002-1.039])., Conclusion: The SAPS II is a useful and reliable prognosticator in SAH patients. This score may provide more information than specific SAH scales in predicting poor outcome or the occurrence of delayed cerebral ischemia in some circumstances.
- Published
- 2005
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49. Disorders of sleep and wake in patients after subarachnoid hemorrhage.
- Author
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Schuiling WJ, Rinkel GJ, Walchenbach R, and de Weerd AW
- Subjects
- Electromyography methods, Female, Humans, Male, Middle Aged, Polysomnography methods, Prospective Studies, Quality of Life, Surveys and Questionnaires, Sleep Wake Disorders etiology, Subarachnoid Hemorrhage complications, Wakefulness physiology
- Abstract
Background and Purpose: To determine the frequency and severity of disorders of sleep and wake and their relation to the quality of life (QoL) in patients who have survived an episode of subarachnoid hemorrhage (SAH)., Methods: In a prospectively collected, consecutive series of 89 patients, 83 patients completed validated and frequently used questionnaires for the assessment of disorders of sleep and wake (SDL and Epworth Sleepiness Score) at least 1 year (range, 1 to 3.4 years) after the SAH. We used the modified Rankin scale for functional outcome and Short Form 36 (SF-36) to assess QoL. We related the occurrence of severe problems with sleep (insomnia or excessive daytime sleepiness score or both > or =3 on SDL) to functional outcome and to the QoL scores and compared the latter scores with data from a Dutch reference population. In a subset of 20 patients with severe problems with sleep, we performed polysomnographic and actigraphic studies at home during 48 hours., Results: Twenty eight (34%) patients had severe problems with sleep. Frequently reported problems are initiating (25%) or maintaining (31%) sleep, difficulty returning (28%) asleep, tiredness (31%), and excessive sleepiness during the day (6%). QoL was considerably reduced in patients with severe problems with sleep. During the sleep monitoring studies, severe sleep fragmentation, sleep apnea, restless legs syndrome/periodic limb movement disorder, or a combination of these disorders of sleep and wake occurred in 19 of 20 patients., Conclusions: Many patients who have survived an episode of SAH have disorders of sleep and wake, which are related to the QoL.
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- 2005
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50. Abnormal H-reflexes in periodic limb movement disorder; impact on understanding the pathophysiology of the disorder.
- Author
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Rijsman RM, Stam CJ, and de Weerd AW
- Subjects
- Adult, Aged, Electric Stimulation methods, Electromyography methods, Evoked Potentials, Motor radiation effects, Female, Humans, Male, Middle Aged, Reaction Time physiology, Reaction Time radiation effects, Time Factors, Evoked Potentials, Motor physiology, H-Reflex physiology, Muscle, Skeletal physiopathology, Nocturnal Myoclonus Syndrome physiopathology, Reflex, Abnormal physiology
- Abstract
Objective: To get more insight in the pathophysiological basis of periodic limb movement disorder (PLMD) with or without restless legs syndrome (RLS), we investigated whether these patients have spontaneous changes in H-reflexes or show altered reflex patterns after (external) inhibition or excitation of the relevant spinal segment., Methods: The ratio of the peak-to-peak values of the maximal soleus H-reflex and the maximal direct muscle potential (H/M ratio), H-reflex recruitment curves, vibratory inhibition and recovery curves of the soleus H-reflex in double stimulus experiments were measured in 9 PLMD patients and 11 controls., Results: In comparison to controls the vibratory inhibition, predominantly reflecting pre-synaptic inhibitory action, was depressed in PLMD patients. The soleus H-reflex recovery curves showed increased late facilitation and depressed late inhibition, both reflecting diminished inhibition due to post-synaptic central activity., Conclusions: Our data indicate diminished inhibition at spinal level in PLMD patients. This is probably due to altered function of the descending spinal tracts, peripheral influence or changes at the inter-neural circuitry at spinal level itself, or combinations of these 3 possibilities., Significance: The results of this study give further insight in the pathophysiology of PLMD and RLS by stressing the importance of diminished central inhibition.
- Published
- 2005
- Full Text
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