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Compliance with nasal continuous positive airway pressure (CPAP) in epilepsy and obstructive sleep apnea [Meeting Abstract]

Cheng, C K; Chiang, V; Bernbaum, M L; Koziorynska, E; Rodriguez, A J
Introduction: Obstructive sleep apnea (OSA) is prevalent in nearly a third of patients with epilepsy. Treatment with continuous positive airway pressure (CPAP) is associated with improvement in seizure control. However, CPAP is often dificult to tolerate for various reasons, and it has been suggested that noncompliant patients with epilepsy and OSA are at higher risk of recurrent seizures than are CPAP-compliant patients. Our objective is to determine short-term compliance, which predicts long-term adherence, to CPAP therapy in patients with OSA and epilepsy. Our preliminary data were presented earlier at the 2013 WASM Annual Meeting in Valencia, Spain. Methods: We retrospectively identiied patients with moderate to severe OSA (AHI > 15) started on nasal CPAP between 2012-2013 at the New York Sleep Institute. We divided them into OSA-only (control) and epilepsy- OSA groups. Patients with history of non-epileptic seizures, poor compliance with anti-epileptic drugs, greater than ten seizures a day, diagnosis of epilepsy within the past six months, a signiicant history of medical, psychiatric or substance abuse, or a two month compliance rate of less than ten percent were excluded. CPAP compliance (deined as percent of days with greater than 4 hours usage) was obtained via a monitoring card within the CPAP system. Results: Seventy-ive epilepsy patients were identiied, forty-nine (65%) of which were diagnosed with concomitant OSA. Thirty-three patients from the control group and fourteen epilepsy patients met inclusion criteria. Mean age was 50.7 and 60.5 (p = 0.016), BMI was 32.3 and 32.2 (p = 0.47), Epworth Sleepiness Scale was 8.4 and 9.6 (p = 0.27), spontaneous arousal index 10.0 and 7.5 (p = 0.16), sleep eficiency was 80.7% and 79.2% (p = 0.38), optimal CPAP pressure was 11.4 and 10.6 cm H20 (p = 0.21), and AHI 30.2 and 40.2 (p = 0.09), in the epilepsy- OSA and OSA-only groups, respectively. One month compliance rates were 65.7% in epilepsy patients and 78.9% in the control group (p = 0.029), !
EMBASE:71509814
ISSN: 0161-8105
CID: 1069412

Compliance with nasal continuous positive airway pressure (CPAP) in epilepsy and obstructive sleep apnea [Meeting Abstract]

Cheng, C; Chiang, V; Bernbaum, M; Koziorynska, E; Rodriguez, A
Introduction: Obstructive sleep apnea (OSA) is prevalent in nearly a third of patients with epilepsy. Treatment with Continuous Positive Airway pressure (CPAP) is associated with improvement in seizure control. However, CPAP is often difficult to tolerate for various reasons, and it has been suggested that noncompliant patients with epilepsy and OSA are at higher risk of recurrent seizures than are CPAP-compliant patients. Our objective is to determine short-term compliance, which predicts long-term adherence, to CPAP therapy in patients with OSA and epilepsy. Materials and methods: We retrospectively identified patients with moderate to severe OSA (AHI P15) started on nasal CPAP between 2012-2013 at the New York Sleep Institute. We divided them into OSA-only (control) and epilepsy-OSA groups. Patients with history of non-epileptic seizures, poor compliance with anti-epileptic drugs, greater than ten seizures a day, diagnosis of epilepsy within the past six months, a significant history of medical, psychiatric or substance abuse, or a two month compliance rate of less than ten percent were excluded. CPAP compliance (defined as percent of days with greater than 4 h usage) was obtained via a monitoring card within the CPAP system. Results: Sixty-five epilepsy patients were identified, forty-one (65%) of which were diagnosed with concomitant OSA. Thirty-two patients from the control group and fourteen epilepsy patients met inclusion criteria. Mean age was 50.7 and 60.4 (p = 0.018), BMI was 32.3 and 32.4 (p = 0.48), Epworth Sleepiness Scale was 8.4 and 9.8 (p = 0.23), spontaneous arousal index 10.0 and 7.7 (p = 0.19), sleep efficiency was 80.7% and 78.7% (p = 0.35), optimal CPAP pressure was 11.4 and 10.6 cm H2O (p = 0.22), and AHI 30.2 and 41.0 (p = 0.075), in the epilepsy-OSA and OSA-only groups, respectively. One month compliance rates were 65.7% in epilepsy patients and 78.3% in the control group (p = 0.038), and 2 month compliance rates were 68.3% and 71.5%, respectively (p = 0.33). Conclusion!
EMBASE:71306210
ISSN: 1389-9457
CID: 818522

Immunology and epilepsy

Najjar, Souhel; Bernbaum, Melissa; Lai, George; Devinsky, Orrin
Immune mechanisms play a critical role in systemic disorders (systemic lupus erythematosus, Sjogren's syndrome, Crohn's disease, and sarcoidosis) and in localized central nervous system (CNS) disorders (CNS vasculitis, multiple sclerosis, acute disseminated encephalomyelitis, and encephalitides). Both humoral and cell-mediated mechanisms are involved in the systemic and CNS-limited disorders. Immune mechanisms may also be a factor in a number of epilepsies such as Rasmussen's encephalitis, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and temporal lobe epilepsy. Immunologic abnormalities are found in routine epilepsy surgical specimens, suggesting a broader role of immunopathology in the etiology of epilepsy. The prevalence and impact of immunopathology in epilepsy syndromes remains to be determined by future research
PMID: 18838950
ISSN: 1545-2913
CID: 91975

Voltage-gated potassium channel antibody-mediated syndromes: a spectrum of clinical manifestations

Rueff, Laura; Graber, Jerome J; Bernbaum, Melissa; Kuzniecky, Ruben I
Immune-related neurologic disorders have long been recognized. A number of specific targets have been identified, including neurons, Purkinje cells, and pre- and postsynaptic receptors. Over the past decade, antibodies against voltage-gated potassium channels (VGKCs) have been reported in a number of neurologic syndromes, such as neuromyotonia, limbic encephalitis, and Morvan's syndrome. Recent advances have supported the pathologic mechanism of VGKC in these disorders, their response to therapy, and the possible mechanisms of peripheral, central, and autonomic dysfunctions seen in these disorders. We present a patient with 1 of these syndromes and review the literature of these disorders
PMID: 18660738
ISSN: 1545-2913
CID: 86655

Acute Parkinsonism in HIV [Meeting Abstract]

Bernbaum M; DiRocco A
ORIGINAL:0006243
ISSN: 1353-8020
CID: 75297