Faculty Bibliography

BACKGROUND: Despite the high prevalence of insomnia in veterans with epilepsy, it remains understudied. Our aim was to identify the associations of insomnia with epilepsy, comorbidities, and treatment-related variables in South Florida veterans. METHODS: We performed a cross-sectional analysis of veterans attending an epilepsy clinic over 18 months. Participants completed standardized assessments of seizure and sleep. Insomnia was defined as 1) difficulty with sleep onset, maintenance, or premature awakenings with daytime consequences or 2) sedative-hypnotic use on most nights of the previous month. RESULTS: One hundred sixty-five veterans (87% male, age 56 +/- 15 years) were included: 66 reporting insomnia (40%). In logistic regression analysis, insomnia was significantly associated with post-traumatic seizure etiology, lamotrigine prescription, and mood and psychotic disorders. Female gender and levetiracetam treatment were associated with lower odds for insomnia. CONCLUSION: Insomnia was associated with post-traumatic epilepsy, mood/psychotic comorbidities, and antiepileptic regimen. Insomnia represents an under-recognized opportunity to improve comprehensive epilepsy care.

Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE.

Guillain-Barre syndrome (GBS) is the eponym used to describe acute inflammatory polyradiculoneuropathies, which manifest with weakness and diminished reflexes. Although the classic form of GBS is considered to be an ascending demyelinating polyneuropathy, several variants have been described in the literature, including the Miller-Fisher syndrome, acute panautonomic neuropathy, acute motor axonal neuropathy, and acute motor-sensory axonal neuropathy (AMSAN). Few cases of postoperative GBS have been documented, particularly for the AMSAN variant. The authors describe the case of a patient who developed AMSAN after thoracic spine surgery and highlight the importance of investigating new-onset weakness in the postoperative period.

OBJECTIVE: : We report a case of ecstatic seizures with religious overtones in a patient whose semiology resembles that of Saint Theresa of Avila (1515 to 1582), and review the anatomical basis of this phenomenon. BACKGROUND: : Seizures with an emotional component are typically associated with negative sensations. Ecstatic seizures, particularly those with a religious character, are rarely reported, although they hold an important place in history, as a number of religious figures have been posited to be epileptic. Here, we present a patient with ecstatic seizures whose semiology and religious overtones resemble those of Saint Theresa of Avila (1515 to 1582), and discuss the anatomical basis of this phenomenon. METHOD: : Case report. RESULTS: : Evaluation of the patient demonstrated right temporal encephalomalacia on magnetic resonance imaging of the brain. Electroencephalogram showed focal slowing and poorly defined sharp waves in the right frontotemporal region. This area of pathology concurs with prior studies that localize ecstatic seizures to the anterior insula or temporal lobes. CONCLUSIONS: : Ecstatic seizures may involve the right temporal region. Although interpretation of ecstatic seizures is subject to individual variation, a similar localization and our patient's religious background may explain the resemblance between the semiology of his seizures, and that of Saint Theresa's visions as described almost 5 centuries ago.