Transient episodes of brain oscillations are a common feature of both the waking and the sleeping brain. Sleep spindles represent a prominent example of a poorly understood transient brain ...oscillation that is impaired in disorders such as Alzheimer’s disease and schizophrenia. However, the causal role of these bouts of thalamo-cortical oscillations remains unknown. Demonstrating a functional role of sleep spindles in cognitive processes has, so far, been hindered by the lack of a tool to target transient brain oscillations in real time. Here, we show, for the first time, selective enhancement of sleep spindles with non-invasive brain stimulation in humans. We developed a system that detects sleep spindles in real time and applies oscillatory stimulation. Our stimulation selectively enhanced spindle activity as determined by increased sigma activity after transcranial alternating current stimulation (tACS) application. This targeted modulation caused significant enhancement of motor memory consolidation that correlated with the stimulation-induced change in fast spindle activity. Strikingly, we found a similar correlation between motor memory and spindle characteristics during the sham night for the same spindle frequencies and electrode locations. Therefore, our results directly demonstrate a functional relationship between oscillatory spindle activity and cognition.
•Feedback-controlled tACS (FB-tACS, 12 Hz) boosted subsequent sleep spindle activity•FB-tACS enhanced sleep-dependent motor, but not declarative memory, consolidation•Stimulation-induced fast spindle activity changes predicted motor memory benefits•The correlation of spindles and motor memory in sham session agrees with FB-tACS results
Lustenberger et al. engineered a novel feedback-controlled spindle stimulation approach that selectively targeted and modulated sleep spindles in real time. This approach revealed, for the first time, that fast sleep spindles play a functional role in motor memory consolidation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Sleep and Epilepsy Kataria, Lynn; Vaughn, Bradley V
Sleep medicine clinics,
03/2016, Volume:
11, Issue:
1
Journal Article
Sleep plays an intricate role in the disease process of epilepsy. Despite the complexity of this relationship, the prognosis is a favorable one for patients presenting with sleep disorders and ...epilepsy. Clinicians need to be vigilant about asking about and addressing sleep complaints in patients with epilepsy. Ultimately, improving sleep and optimizing seizure control can have significant positive effects on the quality of life of these patients.
Rett syndrome (RTT) is a severe X-linked dominant neurodevelopmental disorder predominantly affecting females and over 90% of these patients mutations linked to the methyl-CpG-binding protein 2 ...(MeCP2) gene. Although the syndrome is well noted for the classic repetitive hand motion with decline in speech, patients may have a wide range of cognitive and motor impairments. Typical comorbidities in RTT are characterized by poor growth, seizures, disrupted sleep, hyperventilation, breath holding spells, feeding difficulties, scoliosis, and behavioral issues. This paper aims to provide a brief overview of RTT, focusing on the clinical features of sleep and epilepsy, effects on childhood development, and available emerging treatment options. Sleep disturbances, epilepsy, and developmental regression can have profound effects on the quality of life in affected individuals. Current management strategies focus on a multidisciplinary approach to address symptoms and enhance overall wellbeing of individuals with RTT.
Polysomnography has developed from our understanding of sleep and its associated physiologic processes. This important tool extends the clinical examination into dynamic states that typically do not ...permit intrusive inspection. The two critical components of polysomnography are the determination of sleep-wake stage and identification of related bodily processes. In this article, the authors review the current standards for clinical polysomnography and discuss technical considerations that influence the accuracy of recorded data.
Our understanding of non-REM parasomnias is just beginning to unfold the potential biomarkers and underlying pathophysiologic processes that lead to these events. Biomarkers need further ...investigation and will help us to understand better ways to develop risk models and possible mechanisms. Similarly, as we develop more accurate pathophysiologic-based diagnostic testing for non-REM parasomnias, we will begin the evolution toward a physiologic-based classification scheme that aids the application of precision medicine. This article explores currently known characteristics and exploratory features that may aid in this transition to better understanding our individual patients with non-REM parasomnias and tailoring their treatments.
Background:
Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients’ lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability ...and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices.
Aim:
To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES.
Methods:
An integrative review guided by the Whittemore and Knafl approach.
Results:
The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies).
Conclusions:
Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Patients with Down syndrome (DS) are at risk for both obstructive sleep apnea (OSA) and central sleep apnea (CSA); however, it is unclear how these components evolve as patients age and whether ...patients are also at risk for hypoventilation. A retrospective review of 144 diagnostic polysomnograms (PSG) in a tertiary care facility over 10 years was conducted. Descriptive data and exploratory correlation analyses were performed. Sleep disordered breathing was common (seen in 78% of patients) with an average apnea-hypopnea index (AHI) = 10. The relative amount of obstructive apnea was positively correlated with age and body mass index (BMI). The relative amount of central sleep apnea was associated with younger age in the very youngest group (0-3 years). Hypoventilation was common occurring in more than 22% of patients and there was a positive correlation between the maximum CO₂ and BMI. Sleep disordered breathing, including hypoventilation, was common in patients with DS. The obstructive component increased significantly with age and BMI, while the central component occurred most in the very young age group. Due to the high risk of hypoventilation, which has not been previously highlighted, it may be helpful to consider therapies to target both apnea and hypoventilation in this population.
OBJECTIVETo present (1) justification for earmarking sleep medicine education as an essential component of all medical school curricula and (2) various avenues to incorporate sleep medicine exposure ...into medical school curricula through (primarily) neuroscience and neurology courses.
METHODSPer consensus of a team of leading neurology and sleep medicine educators, an evidence-based rationale for including sleep medicine across a 4-year medical school curriculum is presented along with suggested content, available/vetted resources, and formats for delivering sleep medicine education at various points and through various formats.
RESULTSGrowing evidence has linked sleep disorders (e.g., sleep-disordered breathing, chronic insufficient sleep) as risk factors for several neurologic disorders. Medical educators in neurology/neuroscience are now strongly advocating for sleep medicine education in the context of neurology/neuroscience pre and post graduate medical education. Sleep medicine education is also a critical component of a proactive strategy to address physician wellness and burnout. The suggested curriculum proposes a sleep educational exposure time of 2–4 hours per year in the form of lectures, flipped-classroom sessions, clinical opportunities, and online educational tools that would result in a 200%–400% increase in the amount of sleep medicine exposure that US medical schools currently provide. The guidelines are accompanied by the recommendation for use of technological education, to facilitate more seamless curricular incorporation.
CONCLUSIONEven in this era with limited flexibility to add content to an already packed medical school curriculum, incorporating sleep medicine exposure into the current medical school curriculum is both justified and feasible.
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