Sleep Medicine Clinics RSS feed: Current Issue. Sleep Medicine Clinics provides a forum for invited, topical reviews in this rapidly growing field. Each issue, guest edited by a leader in the field of Sleep Medicine, provides expert, state-of-the-art reviews on a single topic, making ample use of figures, diagrams, and tables. Topics such as Obstructive Sleep Apnea, Insomnia, and Parasomnias are presented clearly and comprehensively in the Sleep Medicine Clinics¿perfect for any clinician who works with patients suffering from sleep disorders. http://www.sleep.theclinics.com/?rss=yesElsevier Inc.en © 2012 Elsevier Inc. All rights reserved. Sleep Medicine Clinics1556-407X71March 2012 © 2012 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.sleep.theclinics.com/article/PIIS1556407X12000227/abstract?rss=yesCME Accreditation Page and Author Disclosure10.1016/j.jsmc.2012.02.002Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1iiiiiihttp://www.sleep.theclinics.com/article/PIIS1556407X12000148/abstract?rss=yesForthcoming Issues10.1016/S1556-407X(12)00014-8Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1ivivhttp://www.sleep.theclinics.com/article/PIIS1556407X1200015X/abstract?rss=yesContributors10.1016/S1556-407X(12)00015-XSleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1vvihttp://www.sleep.theclinics.com/article/PIIS1556407X12000161/abstract?rss=yesContents10.1016/S1556-407X(12)00016-1Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1viixhttp://www.sleep.theclinics.com/article/PIIS1556407X12000276/abstract?rss=yesThe Brain—is wider than the sky—For—put them side by side—The one the other will containWith ease—and You—beside—The Brain is deeper than the sea—For—hold them—Blue to Blue—The one the other will absorb—As sponge—Buckets—do—The Brain is just the weight of God—For—Heft them—Pound for Pound—And they will differ—if they do—As Syllable from Sound——Emily DickinsonForewordTeofilo Lee-Chiong10.1016/j.jsmc.2012.02.003Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1xixiihttp://www.sleep.theclinics.com/article/PIIS1556407X12000082/abstract?rss=yesRelationships between sleep and epilepsy have been described since antiquity. In recent decades, polysomnography (PSG) and video electroencephalography (EEG) have extended early clinical observations. In turn, heightened awareness of these complex relationships has increased the role of the sleep clinician and sleep laboratory in the evaluation and treatment of patients with epilepsy and unexplained events in sleep.Sleep-Related Epilepsy and ElectroencephalographyMadeleine M. Grigg-Damberger, Nancy Foldvary-Schaefer10.1016/j.jsmc.2012.02.001Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1xiiixivhttp://www.sleep.theclinics.com/article/PIIS1556407X12000069/abstract?rss=yesOptimum use of electroencephalography (EEG) can be improved by an understanding of the underlying signals and the nature of the recording and display technology. Topics reviewed in this section include the source of EEG signals; electrical noise; behavior of the amplifiers, filters, sampling, and displays; construction of EEG montages; quantitative EEG; and electrical safety. The author discusses how these considerations impact data quality and interpretation.The Nuts and Bolts of ElectroencephalographyCharles M. Epstein10.1016/j.jsmc.2012.01.005Sleep Medicine Clinics 7, 1 (2012)2012-02-10Sleep Medicine Clinics2012-02-1071S1556-407X(11)X0006-1112http://www.sleep.theclinics.com/article/PIIS1556407X12000021/abstract?rss=yesThe development of organized sleep/wake states is a major feature of the neonatal period and developing infant. Although subsequent changes in the sleep/wake cycle with age are less profound, they represent predictable physiologic changes occurring as a function of age. Similarly, there are characteristic electroencephalography (EEG) patterns seen as a function of maturity in the neonate and developing child. These EEG changes continue to evolve into adulthood, offering an electrophysiologic marker of brain development.Sleep/Wake Electroencephalography Across the LifespanDinesh V. Raju, Rodney A. Radtke10.1016/j.jsmc.2012.01.001Sleep Medicine Clinics 7, 1 (2012)2012-02-10Sleep Medicine Clinics2012-02-1071S1556-407X(11)X0006-11322http://www.sleep.theclinics.com/article/PIIS1556407X11001202/abstract?rss=yesToo many sleep specialists and technologists lament they lack sufficient training in recognizing abnormalities in the limited electroencephalography (EEG) channels recorded in a polysomnograph (PSG). Moreover, increasing numbers of patients with epilepsy, dementias, and extrapyramidal diseases are being referred to sleep centers, many of whom require recording of their PSGs with expanded EEG montages. This article reviews the range of normal, abnormal, and benign EEG variants encountered in patients undergoing PSG with conventional and expanded EEG montages. Because comprehensive in-laboratory PSGs are rarely requested for patients with severe acute encephalopathies, coma, or status epilepticus, discussion of these is omitted.Recognizing Normal, Abnormal, and Benign Nonepileptiform Electroencephalographic Activity and Patterns in Polysomnographic RecordingsMartina Vendrame, Sanjeev V. Kothare10.1016/j.jsmc.2011.12.008Sleep Medicine Clinics 7, 1 (2012)2012-02-10Sleep Medicine Clinics2012-02-1071S1556-407X(11)X0006-12338http://www.sleep.theclinics.com/article/PIIS1556407X12000033/abstract?rss=yesVideopolysomnography with expanded electroencephalography (VEEG PSG) combines expanded EEG and PSG to evaluate unexplained paroxysmal nocturnal events. VEEG PSG can also provide a more comprehensive assessment of patients with neurologic disorders undergoing PSG. VEEG PSG has several advantages over routine PSG, including (1) improving the likelihood of recognizing interictal and ictal EEG activity; (2) allowing for more precise evaluation of EEG background; and (3) correlating clinical with other neurophysiologic parameters. This article reviews epileptic EEG abnormalities encountered when evaluating patients with unexplained nocturnal events in the sleep laboratory and discusses strategies to optimize the diagnostic yield of EEG and videorecordings.Identifying Interictal and Ictal Epileptic Activity in PolysomnogramsNancy Foldvary-Schaefer, Madeleine M. Grigg-Damberger10.1016/j.jsmc.2012.01.002Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-13958http://www.sleep.theclinics.com/article/PIIS1556407X12000070/abstract?rss=yesSeizures and epilepsies present with multiple causes and multiple clinical features, and change across the lifespan. Epilepsy is not a single disease but a diverse group of disorders that have in common an abnormally increased predisposition to epileptic seizures. A systematic approach to epileptic seizures and epilepsies is a first step toward the diagnosis and treatment of these disorders. Description of findings is crucial for selection of the most helpful diagnostic and therapeutic approach, defining relationships to sleep and sleep-related interactions, and comorbidities.Approach to Seizures, Epilepsies, and Epilepsy SyndromesMartina Vendrame, Tobias Loddenkemper10.1016/j.jsmc.2012.01.006Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-15973http://www.sleep.theclinics.com/article/PIIS1556407X11001147/abstract?rss=yesMany sleep disorder symptoms and some primary sleep disorders are two to three times more common in people with epilepsy than the general population. Adults with epilepsy and sleep complaints have significantly lower quality of life than those without sleep problems. Sleep problems in children with epilepsy are associated with negative effects on daytime behavior and academic performance. Late-onset or worsening seizure control in older adults may herald obstructive sleep apnea. Identifying and treating sleep disorders in people with epilepsy improves seizure control and quality of life in some cases. This article reviews the recent evidence for this claim.Primary Sleep Disorders in People with Epilepsy: What We Know, Don’t Know, and Need to KnowMadeleine M. Grigg-Damberger, Nancy Foldvary-Schaefer10.1016/j.jsmc.2011.12.002Sleep Medicine Clinics 7, 1 (2012)2012-01-09Sleep Medicine Clinics2012-01-0971S1556-407X(11)X0006-17589http://www.sleep.theclinics.com/article/PIIS1556407X11001135/abstract?rss=yesSleep deprivation can activate seizures in people with epilepsy, and a few without it. Sleep activates Interictal epileptiform discharges (IEDs). In many patients with epilepsy, IEDs are often seen only during sleep. The presence, type, and location of IEDs on an electroencephalogram (EEG) can help characterize the type of epilepsy and location of the epileptic focus, as well as predict whether seizures are likely to recur. Recording sleep in an EEG (with or without sleep deprivation or sedation) can increase the likelihood that IEDs will be found. This review provides a summary of research related to these issues.Diagnostic Yield of Sleep and Sleep Deprivation on the EEG in EpilepsyMadeleine M. Grigg-Damberger, Nancy Foldvary-Schaefer10.1016/j.jsmc.2011.12.001Sleep Medicine Clinics 7, 1 (2012)2012-01-09Sleep Medicine Clinics2012-01-0971S1556-407X(11)X0006-19198http://www.sleep.theclinics.com/article/PIIS1556407X11001172/abstract?rss=yesInteraction between circadian rhythmicity and epilepsy or seizures may have important implications in diagnostic and therapeutic options, as EEGs and treatment can be individualized. In studies in humans and animals, seizure occurrence has been shown to have a 24-hour (ie, diurnal) rhythmicity, depending on the type of seizure and lobe of origin. A pilot study in humans suggested that temporal and frontal seizures not only occur in diurnal patterns but also are time locked to the circadian phase. A study in rats showed a true endogenous-mediated circadian rhythm in seizure occurrence in a rodent model of limbic epilepsy.Seizures, Epilepsy, and Circadian RhythmsWytske A. Hofstra-van Oostveen, Al W. de Weerd10.1016/j.jsmc.2011.12.005Sleep Medicine Clinics 7, 1 (2012)2012-01-30Sleep Medicine Clinics2012-01-3071S1556-407X(11)X0006-199104http://www.sleep.theclinics.com/article/PIIS1556407X11001196/abstract?rss=yesNocturnal frontal lobe epilepsy (NFLE) is an epileptic syndrome characterized by a peculiar motor pattern with ballistic movements, bimanual-bipedal activity, rocking axial and pelvic torsion, and/or sustained dystonic posturing or tremor of the limbs often associated with emotional behaviors. Distinguishing NFLE seizures from nonepileptic sleep-related events, in particular arousal disorders, is often difficult and sometimes impossible by history taking alone. Because of its limited social impact, NFLE is usually considered a benign condition, but about a third of the cases are drug resistant. This article discusses the diagnostic and therapeutic challenges of NFLE.Nocturnal Frontal Epilepsies: Diagnostic and Therapeutic Challenges for Sleep SpecialistsFederica Provini, Francesca Bisulli, Paolo Tinuper10.1016/j.jsmc.2011.12.007Sleep Medicine Clinics 7, 1 (2012)2012-02-03Sleep Medicine Clinics2012-02-0371S1556-407X(11)X0006-1105112http://www.sleep.theclinics.com/article/PIIS1556407X11001184/abstract?rss=yesDistinguishing epileptic seizures from nonepileptic disorders of sleep can be challenging. This article covers 3 main areas: a brief review of epileptic and nonepileptic disorders associated with paroxysmal events from sleep; a discussion of important features to be uncovered in the history; and a review of the value and limitations of investigations in this setting.Differentiating Seizures from Other Paroxysmal Nocturnal Events in Young and Older AdultsChristopher P. Derry10.1016/j.jsmc.2011.12.006Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1113123http://www.sleep.theclinics.com/article/PIIS1556407X12000045/abstract?rss=yesCentral pattern generators (CPGs) are genetically determined neural circuits that produce self-sustained patterns of behavior that subserve innate motor activities essential for survival. In higher primates, CPGs are largely under neocortical control. Certain motor manifestations observed in parasomnias and epileptic seizures share similar semiological features resembling motor behaviors, which can be the expression of the same CPG. Epilepsy and sleep can lead to a temporary loss of control of neocortex on lower neural structures. We suggest that this transitory neocortical dysfunction facilitates the emergence of stereotyped inborn motor patterns that depend on the activation of the same CPGs.Relationship of Central Pattern Generators with Parasomnias and Sleep-Related Epileptic SeizuresCarlo Alberto Tassinari, Elena Gardella, Gaetano Cantalupo, Guido Rubboli10.1016/j.jsmc.2012.01.003Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1125134http://www.sleep.theclinics.com/article/PIIS1556407X11001160/abstract?rss=yesRolandic and occipital benign epilepsies of childhood are strictly linked to sleep but often no specific alterations of sleep organization were found. The spike activation is mostly evident in the first sleep cycle and related to EEG sigma band. NREM 1 and 2 sleep facilitate the spreading of epileptic discharges of benign childhood epilepsies while in NREM 3-4 sleep the spreading capacity is reduced. REM sleep inhibits both phenomena. Cyclic alternating pattern (CAP) modulates epileptiform discharges and seizures in lesional epilepsies, but shows no effect in the benign childhood epilepsies. Specific alterations of CAP structure (reduction of CAP rate and A1 phases in NREM 2) may shed light on the pathophysiology of cognitive disturbances of these children.Benign Rolandic and Occipital Epilepsies of ChildhoodOliviero Bruni, Luana Novelli, Alice Mallucci, Martina della Corte, Antonino Romeo, Raffaele Ferri10.1016/j.jsmc.2011.12.004Sleep Medicine Clinics 7, 1 (2012)2012-02-02Sleep Medicine Clinics2012-02-0271S1556-407X(11)X0006-1135145http://www.sleep.theclinics.com/article/PIIS1556407X11001159/abstract?rss=yesEncephalopathy with electrical status epilepticus in sleep (ESES) syndrome is a rare form of epilepsy in childhood. Results of treatment with antiepileptic medications or immunotherapy are variable. Epilepsy surgery should be considered in patients with a symptomatic cause. Cognitive outcome is more favorable in patients with an idiopathic form. Any newly observed seizure type or behavioral or developmental/cognitive symptom in children aged younger than 10 years with focal epilepsy should alert the clinician to the possibility of ESES syndrome. The exact pathophysiological mechanisms of ESES and associated functional impairments are still unresolved.Electrical Status Epilepticus in SleepElina Liukkonen, Madeleine M. Grigg-Damberger10.1016/j.jsmc.2011.12.003Sleep Medicine Clinics 7, 1 (2012)2012-02-06Sleep Medicine Clinics2012-02-0671S1556-407X(11)X0006-1147156http://www.sleep.theclinics.com/article/PIIS1556407X12000057/abstract?rss=yesSudden unexpected death in epilepsy (SUDEP) is the sudden unexpected death of a seemingly healthy individual with epilepsy. SUDEP is the commonest cause of death directly attributable to epilepsy, and most often occurs at or around the time of a seizure and during sleep. Sleep, respiration, arousal responses, and caudal brainstem serotoninergic neurons probably play roles in SUDEP, but more research is needed to understand these relationships. This article reviews the medical literature on the epidemiology, risk factors, and preventive measures for SUDEP in people with epilepsy, and discusses the roles of sleep, respiration, impaired autonomic functioning, and nocturnal seizures.Sudden Unexpected Death in Epilepsy: What Does Sleep Have to Do With It?Madeleine M. Grigg-Damberger10.1016/j.jsmc.2012.01.004Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1157170http://www.sleep.theclinics.com/article/PIIS1556407X12000203/abstract?rss=yesIndex10.1016/S1556-407X(12)00020-3Sleep Medicine Clinics 7, 1 (2012)2012-03-01Sleep Medicine Clinics2012-03-0171S1556-407X(11)X0006-1171177