Need for a standardized technique of nap EEG recordings: results of a national online survey in Italy

The aim of this study is to report current clinical practice for sleep induction in Italian epilepsy centers. We administered an online-structured survey between March and November 2017 and collected data from pediatric and adult neurophysiologists belonging to 73 epilepsy centers. The preferred time for EEG recording is variable, depending on daily schedule of each laboratory. To facilitate spontaneous sleep during nap EEGs, almost all centers require sleep deprivation before the examination, with partial loss preferred to total deprivation in most centers (58/73 vs 12/73, p?<?0.001). Other non-pharmacological procedures include breast/bottle feeding or listening to music (encouraged in most centers). Pharmacological sleep induction is performed in 40% of laboratories, more commonly in children than in adults (27/60 vs 7/42, p?=?0.003). Melatonin is the most frequently prescribed drug to facilitate spontaneous sleep (one third of participating centers). Our study highlights the great heterogeneity among Italian epilepsy centers in current clinical practice for sleep EEG recordings. Expert consensus for sleep induction procedure is warranted.     

癫痫病人外周血T淋巴细胞及其亚群的改变

采用单克隆抗体间接免疫荧光技术对60例癫痫病人外周血T淋巴细胞亚群的分布进行了研究。发现T总淋巴细胞(T_3细胞),T辅助淋巴细胞(T_4细胞)及T辅助淋巴细胞/T抑制淋巴细胞(T_4/T_8)比值减低,与对照组比较有显著或极显著性差异(P<0.05或P<0.01);T_8细胞呈增高趋势,与对照组比较无显著差异(P>0.05)。E玫瑰花环形成率及淋巴细胞转化率明显降低,与对照组比较有显著或极显著差异(P<0.05或P<0.01)。以上变化与癫痫病人的类型、病程,测定距末次发作时间长短以及是否服用抗癫痫药物均无明显关系(P>0.05)。     

强化花粉对苯妥英钠致畸的预防作用

作者用大鼠实验观察强化花粉(花粉+叶酸)对苯妥英钠致畸的预防。结果显示强化花粉或叶酸可部分防止苯妥英钠引起的胚胎毒性和胎鼠毒性,但对于胎鼠体重减轻、掌骨、近端掌骨、跖骨、上枕骨骨化不全、胸骨缺失、皮下出血、单眼缺失、肾盂积水、蛛网膜下腔扩大等的预防作用,强化花粉优于叶酸。并对其预防作用的可能机理进行了讨论。     

Impact of the COVID-19 pandemic on clinical autonomic practice in Europe: a survey of the European Academy of Neurology and the European Federation of Autonomic Societies

Background and purpose

The objective was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on European clinical autonomic practice.

Methods

Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021.

Results

Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every third center reported major adverse events due to postponed examinations or visits. The most frequent newly diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome, orthostatic hypotension and recurrent vasovagal syncope, deemed to be likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new onset of orthostatic intolerance but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently postural orthostatic tachycardia syndrome and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50%–100% recovery rates at follow-up.

Conclusions

Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, whilst the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.