Nocturnal Attacks Research Articles

Benign nocturnal alternating hemiplegia of childhood: six patients and long-term follow-up.

Benign familial nocturnal alternating hemiplegia of childhood refers to recurrent attacks of hemiplegia arising from sleep, described in young children without neurologic or mental impairment. It is probably migraine related. The authors report two unrelated patients with nocturnal attacks starting at 22 and 31 months, followed by daytime episodes in one. The authors confirm the benign course of this disorder. It is distinct from the classic malignant form of alternating hemiplegia of childhood.

Non-linear electroencephalogram dynamics in patients with spontaneous nocturnal migraine attacks

The present study was conducted to examine non-linear electroencephalogram (EEG) measures during the development of a spontaneous migraine attack. We investigated the sleep EEG of five patients with migraine without aura in the pain-free interval and at the onset of a nocturnal attack. Sleep EEG recordings were analysed using the method of global dimensional complexity compared to conventional sleep scoring techniques. We found no divergence between classical sleep architecture and the estimated dimensional course nor any relevant short-term changes related to the onset of headache. There was, however, a loss of dimensional complexity in the first two non-rapid eye movement sleep states in the migraine night, with statistical significance during the second sleep cycle. For the first time, these results provide evidence of a global dimension decrease that is related to cortical network changes during a migraine attack.

Theophylline chronotherapy of nocturnal asthma using bathyphase of circadian rhythm in peak expiratory flow rate

We studied the efficacy of theophylline chronotherapy for nocturnal asthma using the changes of the circadian rhythms in peak expiratory flow rate (PEF). Eight patients with nocturnal asthma were evaluated for the periods with nocturnal symptoms and with an evening dose of theophylline administered daily. Patients recorded their PEF every 4 hours on one of the days (from 7:00 to 23:00 h) in each period. Circadian rhythms in PEF were examined using the single and group-mean cosinor method. Significant circadian rhythms in PEF were observed in the period with nocturnal symptoms. When nocturnal symptoms were present, the bathyphase of PEF was present between midnight and morning. A significant circadian rhythm disappeared or PEF amplitude decreased during theophylline chronotherapy. The circadian rhythm in PEF was altered according to the severity of the asthma. In patients with symptoms present between midnight and early morning, an evening dose of theophylline chronotherapy can be prophylactically used for nocturnal asthma attacks. Consideration of the circadian rhythm and bathyphase of PEF is useful in selecting appropriate chronotherapy for nocturnal asthma.

Limits of Self-report in Assessing Sleep Terrors in a Population Survey

Sleep terrors are less frequent compared to other parasomnias, and there are no prevalence studies on adults. We performed a questionnaire study in a well-defined population-based sample, the Finnish Twin Cohort. The study population consisted of 11,220 subjects aged 33-60 years, responding to questions on the frequency of sleep terrors in childhood and as adults. In the first questionnaire about 9% reported sleep terrors often or sometimes in childhood, and 3.5% at least once monthly as adults. However, in a second more-detailed questionnaire, only 1% of those with at-least-monthly attacks in adulthood presented with features compatible with the minimal diagnostic criteria for sleep terrors of the International Classification of Sleep Disorders. There was also a strong correlation between current occurrence of nightmares and the report of sleep terrors. Although a clinically definable entity, sleep terrors seem to be unknown to lay people, at least in Finland. Therefore, the use of single items or brief question series on sleep terrors may give inaccurate results in questionnaires. An interview of a person who has witnessed the nocturnal attack suspected to be sleep terror is essential because of the patient's impaired recall of the episode. Our results also support the general view that sleep terrors are rare in adults.

Thyrotoxic periodic paralysis in a jamaican male

Thyrotoxic periodic paralysis is a rare endocrine disorder most prevalent among individuals of Asian descent that presents as proximal muscle weakness, hypokalemia, and signs of hyperthyroidism. We present the case report of a patient with previously undiagnosed hyperthyroidism, protracted muscle weakness with transient exacerbations, and nocturnal onset of periodic paralysis affecting the upper and lower limbs.

A Reality and Yet Impalpable: The Fenian Panic in Mid-Victorian Scotland

This prediction of a nation mesmerised by the threat of Fenianism was rapidly fulfilled. Like the rest of mainland Britain, Scotland was swept by Fenian Fever, a panic which reached its height at the end of 1867. In dozens of Scottish cities and towns from Stromness to Berwick, reports of nocturnal drilling and imminent attack swamped local officials and filled newspaper columns. Even the normally sedate Scotsman had its warm outflow of Christmas feeling, 'checked and chilled by the consciousness that thousands of unrecognised enemies are treading the complex paths of our commonwealth'.1 The aims of this article are two-fold. First, it seeks to understand the dynamics of the Fenian panic and the backlash it produced in the Scottish public against the local Irish population. Second, by examining the emergence and development of the Fenian movement in Scotland, it attempts to determine the proportions of fact and mythology behind the Fenian alarms.

Symptomatic nocturnal frontal lobe epilepsy

Nocturnal frontal lobe epilepsy (NFLE) is a disorder characterised by clusters of brief motor seizures during sleep, often without surface EEG epileptiform abnormalities’“. For these reasons, the prevalence of this disorder has probably been underestimated. Moreover, in the past, many patients with clusters of nocturnal motor attacks have been diagnosed as having nocturnal paroxysmal dystonia5, paroxysmal awakenings6 or episodic nocturnal wanderings’. At present, except for a case report of a patient with a ‘posttraumatic paroxysmal nocturnal hemidystonia’8, all the patients described in the literature with abnormal motor and/or behavioral nocturnal phenomena had an idiopathic form of the disorder (i.e. absence of aetiological evidence; normal neurological and neuroradiological examinations, and often an unequivocal genetic influence)‘-7. We studied, by means of nocturnal videopolysomnography, a 39-year-old man with a l4-year history of repeated brief nocturnal motor attacks who had never received a definite diagnosis. His electroclinical picture allowed the diagnosis of nocturnal frontal lobe epilepsy and was indistinguishable from those of typical idiopathic cases. Nevertheless, a magnetic resonance imaging study showed a voluminous cyst arachnoidea compressing the left frontal and temporai lobes. The compression of the frontal lobe, with the possible involvement of the orbitomesial regions, could be the aetiological factors of the nocturnal attacks of our patient.

The neurophysiological evaluation of nocturnal frontal lobe epilepsy

The most reliable technique for the diagnosis of nocturnal frontal lobe epilepsy (NFLE) is nocturnal video-polysomnography, which is an expensive procedure and unavailable in many Departments of Neurology and Epileptology around the world. The aim of the present study was to evaluate the role of routine video-EEG and video-EEG after sleep deprivation, during the daytime, in the diagnosis of NFLE. We studied 23 patients complaining of repeated nocturnal motor attacks using a 3-level neurophysiological evaluation, including video-EEG when awake (level 1), video-EEG after sleep deprivation, during the daytime (level 2) and nocturnal video-polysomnography (level 3). All the patients had a normal video-EEG when awake. The video-EEG after sleep deprivation (level 2) allowed a diagnosis of NFLE in 52.2% of the patients, while the nocturnal video-polysomnography (level 3) allowed this diagnosis in 87.0% of the same sample. In the patients complaining of repeated nocturnal motor attacks, a video-EEG after sleep deprivation performed during the daytime, could be useful for diagnosis in about one half of cases. This methodology is routinely performed in many Departments of Neurology and Epileptology, and is much less binding and expensive than nocturnal video-polysomnography and so it could be important economically for the health service.

Sleep-related laryngospasm

The term "sleep-related laryngospasm" refers to episodic, abrupt interruption of sleep accompanied by feelings of acute suffocation followed by stridor. The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there are few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patients and their families gave precise, uniform accounts of the dramatic attacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to feelings of acute suffocation, accompanied by intense fear. Apnoea lasting 5-45 s was followed by stridor. Breathing returned to normal within minutes. Patients were left exhausted by the attacks. Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patients) are caused by laryngospasm. The pathogenesis of the apparent underlying laryngeal irritability is unknown. The condition may be related to a gastro-oesophageal reflux.

Effects of light level and growth history on attack distances of visually foraging juvenile salmon in experimental tanks

The effects of light level, developmental pathway, and previous growth history on the foraging attack distances of juvenile Atlantic salmon Salmo salar were examined in circular rearing tanks. Former manipulation of growth rates had no significant influence on distances moved to intercept food items despite the fact that it caused substantial differences in post-treatment growth. Attack distances of fish that were entering a state of overwinter dormancy (lower modal group; LMG) were shorter than those of actively feeding (and growing) fish (upper modal group; UMG). These differences were explained generally by differences in body size between the two groups, suggesting that actual effort per attack was unassociated with growth requirements. Significant differences between growing and non-growing fish in attack distances could contribute to the variation in growth rates through their effect on feeding rates, but were unlikely to have affected energetic costs. This may be due to the fact that attack distances were consistently short throughout the study period as is also evident from the pattern of change between night and daytime. Whereas in the first experiment (daylight v. twilight) fish moved further to reach food during the day, in the second (daylight v. overcast night) nocturnal attack distances matched (LMG fish) or exceeded (UMG fish) diurnal attack distances. Thus diurnal attack distances were probably minimized in the second experiment. These results are interpreted within a framework of overwintering strategies.

Effects of light level and growth history on attack distances of visually foraging juvenile salmon in experimental tanks

The effects of light level, developmental pathway, and previous growth history on the foraging attack distances of juvenile Atlantic salmon Salmo salar were examined in circular rearing tanks. Former manipulation of growth rates had no significant influence on distances moved to intercept food items despite the fact that it caused substantial differences in post‐treatment growth. Attack distances of fish that were entering a state of overwinter dormancy (lower modal group; LMG) were shorter than those of actively feeding (and growing) fish (upper modal group; UMG). These differences were explained generally by differences in body size between the two groups, suggesting that actual effort per attack was unassociated with growth requirements. Significant differences between growing and non‐growing fish in attack distances could contribute to the variation in growth rates through their effect on feeding rates, but were unlikely to have affected energetic costs. This may be due to the fact that attack distances were consistently short throughout the study period as is also evident from the pattern of change between night and daytime. Whereas in the first experiment (daylight v. twilight) fish moved further to reach food during the day, in the second (daylight v. overcast night) nocturnal attack distances matched (LMG fish) or exceeded (UMG fish) diurnal attack distances. Thus diurnal attack distances were probably minimized in the second experiment. These results are interpreted within a framework of overwintering strategies.

Nocturnal melatonin onset is phase locked to the primary sleep gate.

In this study, we used the "ultrashort sleep-wake paradigm" (7/13), which measures sleep propensity three times an hour for 29 h, from 0700 to 1200 the next day, on 6 healthy male subjects concomitantly with melatonin plasma level. Melatonin was measured once an hour during the morning and early afternoon of the first day and three times an hour from 1600 to 1000 the following morning. Rectal temperature was measured continuously for four subjects. Subjects underwent the 7/13 paradigm three times, and in all three sessions consistent phase relationships were found between the nocturnal onset of melatonin secretion and opening of the nocturnal sleep gate; also, there was an inverse relationship between melatonin and core body temperature and an almost perfect out-of-phase relationship between sleep propensity and temperature, with the temperature peak falling precisely in the middle of the "forbidden zone" for sleep, i.e., the early evening nadir in sleepiness. On the basis of these phase relationships and previous findings from our laboratory on the effects of exogenous melatonin on the sleep propensity function, we conclude that melatonin participates in sleep-wake regulation in humans.

Urinary leukotriene E 4 in the assessment of nocturnal asthma

Urinary leukotriene E4 (LTE4) is a marker of the body's production of cysteinyl LTs, important mediators of airway inflammation. The role of the latter in nocturnal asthma is a topic of increasing interest. This investigation was aimed at determining whether nighttime attacks are associated with increased release of LTs, expressed by urinary LTE4, and the relationship between the two phenomena. Three groups were studied: group A, seven control subjects; group B, nine asthmatic patients without nocturnal attacks; and group C, nine asthmatic patients with a comparable daytime FEV1 but who were experiencing nocturnal exacerbations (morning dips in peak expiratory flow greater than 20%). Urine was collected over 24 hours in three samples (9:00 AM to 3:00 PM; 3:00 PM to 9:00 PM; and 9:00 PM to 9:00 AM). LTE4 was measured by high-performance liquid chromatography and radioimmunoassay and expressed as nanograms per millimole of creatinine. No significant differences between urinary LTE4 were noticed within groups A and B. Conversely, in group C urinary LTE4 at night (geometric mean with 95% confidence interval; 35.16 with 28.77-42.85) was significantly higher than that of the other samples (respectively 23.12 with 17.78-30.06, p less than 0.05; and 25.18 with 21.03-30.13, p less than 0.02); it was also significantly higher than in all the samples of other groups. A significant (p less than 0.02) linear correlation was observed between morning dip in peak expiratory flow and the log urinary LTE4 in the nocturnal sample. These results indicate the role of LTs in nocturnal asthma and suggest that urinary LTE4 may be a useful marker of this condition.

An investigation of the manifest dream content associated with migraine headaches: a study of the dreams that precede nocturnal migraines.

Clinical observations of a relationship between unpleasant dreams and migraine headaches have been reported previously. Due to the anecdotal quality of these case reports, this study empirically investigated the significance of this relationship. Dream content categories were selected corresponding to emotional factors associated with stress that trigger migraine headaches. A total of 37 migraineurs recorded 10 dreams each, 5 that preceded migraines and 5 that did not. Univariate F tests revealed that 4 of the 5 variables contributed significantly to the overall effect, specifically anger, misfortune, apprehension, and aggressive interactions. Recommendations include discussing the predictive value of dreams with regard to nocturnal migraine attacks, and therapeutic implications are suggested.

Assessment of the severity of asthma in a family practice.

The objective of this study was to evaluate clinical history and self-perception of severity as predictors of asthma severity. A short-term longitudinal study was conducted in a family practice in Melbourne, Australia, utilizing peak flow monitoring, medication diary, and self-administered asthma severity questionnaire. Seventy-two asthmatic subjects with a positive bronchodilator or exercise test, aged between 6 and 79 years, were studied. Symptom and treatment items were correlated with peak flow variability and minimal peak expiratory flow rate (PEFR). An asthma severity scale was generated using the partial credit version of Item Response Theory and the participants' severity scores were validated against lung function tests and medication usage. Quantitative modeling procedures were used to investigate the interrelationships of factors associated with peak flow variability. Severity scores demonstrated significant relationships with peak flow variability (partial r = 0.34) and treatment items. Self-perceived severity of asthma in the preceding 2 weeks showed significant association with peak flow variability (partial rho = 0.46) and minimal PEFR (rho = -0.41). The severity module of the Monash Respiratory Questionnaire is a valid and reliable instrument. The most important symptoms appear to be the frequency of use of bronchodilator and frequency of nocturnal attacks. A carefully structured clinical history in conjunction with the peak flow criteria of variability and minimal peak flow rate would be appropriate in the evaluation of asthma severity. Patients' self-perception of the severity of their asthma needs further evaluation.

Urinary 6-sulfatoxymelatonin cycle-to-cycle variability.

For either clinical or research purposes, the timing of the nocturnal onset in production of the urinary melatonin metabolite 6-sulfatoxymelatonin (UaMT6s-onset), has been proposed as a reliable and robust marker of circadian phase. However, given that most circadian rhythms show cycle-to-cycle variability, the statistical reliability of phase estimates obtained from a single study using UaMT6s-onset remains to be determined. Following 2 weeks of sleep diary and wrist actigraphy, 15 young, healthy good sleepers participated in four UaMT6s sampling sessions spaced 1 day apart. During the sampling sessions subjects remained indoors under low light conditions and hourly urine samples were collected from 19:00 to 02:00 h. Samples were subsequently assayed for UaMT6s using standard radioimmunographic techniques. UaMT6s-onset was determined by the time at which melatonin production exceeded the average of three proceeding trials by 100%. Sleep onset times were derived from sleep diary and actigraphic measures taken before the melatonin collection nights. We found that there was no significant variation between nights in group mean UaMT6s-onset times, and intraindividual variability was small. In addition, UaMT6s-onset times were highly and significantly correlated between nights (grand mean r = 0.804). Our results suggest that within 95% confidence interval limits, individual UaMT6s-onset estimates obtained from a single night UaMT6s-onset study can be used to predict subsequent UaMT6s-onset times within +/- 97 min. A close temporal relationship was also found between the timing of UaMT6s-onset and sleep onset. Overall, our results suggest that under entrained conditions single-session UaMT6s-onset studies can provide reliable individual UaMT6s-onset phase estimates and that the protocol described in this study is a practical and noninvasive methodology.

Análisis de la prevalencia de sintomatología respiratoria en la población general

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocturnal hyperventilation in pregnancy—Reversal with nasal continuous positive airway pressure

A 41-year-old mother with a twin pregnancy had disabling hyperventilation with severe nocturnal symptoms at 25 weeks' gestation. The nocturnal attacks were relieved with nasal continuous positive airway pressure, which she successfully used throughout the rest of the pregnancy. Nasal continuous positive airway pressure could be an option to control severe pregnancy-induced hyperventilation.

Análisis de la prevalencia de sintomatología respiratoria en la población general

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Tryggve Andersen: epileptic hallucinations in the 1890s, fact or fiction?

The Norwegian author Tryggve Andersen (1867-1920) had epilepsy, but was not aware of the diagnosis until late in life. In one novel, Towards Night (Mot Kvaeld), published in 1900, he described in detail nocturnal attacks with formed visual hallucinations as the initial event, seeing always the same face. He was familiar with the works of Ernst Hoffmann and probably also with those of Fiodor Dostoyevsky, but deduction of the literary influence leaves a precise description corresponding to an epileptogenic focus in the right posterotemporal region. Knowledge of his work may elucidate the subjective experience of initial epileptic manifestations, uncontaminated by previous knowledge of what can be expected in epilepsy. The descriptions provided by Andersen's writings are compared with more formal contemporary definitions of seizure events.