Objective: We investigated the prevalence of nocturnal smoking (NS) in patients with RLS.Methods: One hundred RLS patients living in Emilia-Romagna (Northern Italy) and 100 matched controls, randomly selected from the general population, underwent interviews for the presence of nocturnal smoking and for obsessive-compulsive traits, depression, excessive daytime sleepiness (EDS) and subjective sleep quality.Results: NS was more prevalent in RLS patients than controls (lifetime prevalence: 12% vs. 2%, P = 0.012). Patients with INS had more frequently Sleep-Related Eating Disorders (SRED) than patients without NS (83.3% vs. 26.1%, P=0.0002). Pathological and borderline Maudsley Obsessive-Compulsive Inventory (MOCI) values as well as pathological values at the Beck Depression Inventory (BDI) increased from controls to RLS patients without NS to RLS patients with NS (P = 0.005 and P = 0.01, respectively).Conclusions: We demonstrate an increased prevalence of INS in patients with RLS, in many cases associated with increased SIRED. NS may be associated with psychopathological traits in RLS and may be relevant in the management of RLS patients. (C) 2009 Elsevier B.V. All rights reserved.

Objective: The present work aimed to evaluate the performance of an automatic slow eye movement (SEM) detector in overnight and 24-h electro-oculograms (EOG) including all sleep stages (1, 2, 3, 4, REM) and wakefulness.Methods: Ten overnight and five 24-h EOG recordings acquired in healthy subjects were inspected by three experts to score SEMs. Computerized EOG analysis to detect SEMs was performed on 30-s epochs using an algorithm based on EOG wavelet transform, recently developed by our group and initially validated by considering only pre-sleep wakefulness, stages 1 and 2.Results: The validation procedure showed the algorithm could identify epochs containing SEM activity (concordance index k = 0.62, 80.7% sensitivity, 63% selectivity). In particular, the experts and the algorithm identified SEM epochs mainly in pre-sleep wakefulness, stage 1, stage 2 and REM sleep. In addition, the algorithm yielded consistent indications as to the duration and position of SEM events within the epoch.Conclusions: The study confirmed SEM activity at physiological sleep onset (pre-sleep wakefulness, stage 1 and stage 2), and also identified SEMs in REM sleep. The algorithm proved reliable even in the stages not used for its training.Significance: The study may enhance our understanding of SEM meaning and function. The algorithm is a reliable tool for automatic SEM detection, overcoming the inconsistency of manual scoring and reducing the time taken by experts. (c) 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Objective To estimate the interobserver reliability (IR) of the minimal diagnostic criteria for the parasomnias provided in the International Classification of Sleep Disorders Revised (ICSD-R). Methods Fifty consecutive subjects underwent a structured interview by three doctors based on the ICSD-R minimal criteria for the diagnosis of 13 parasomnias at any time in life. IR was calculated by Kappa statistics and interpreted according to conventional categories. Results In the group of Arousal Disorders, IR was "substantial" (kappa 0.74) for confusional arousals, "slight" (kappa 0.36) for sleepwalking, "fair" (kappa -0.02) for sleep terrors. In the group of Wake-Sleep Transition Disorders, IR was "substantial" to "almost perfect", but "moderate" for sleep starts (kappa 0.41). In the group of Parasomnias usually associated with REM Sleep, IR was "substantial" (kappa 0.69) for sleep paralysis, "moderate" (kappa 0.46) for RBD, "fair" (kappa 0.25) for nightmares. In the group of Other Parasomnias, IR was "substantial" to "almost perfect" (kappa between 0.73 and 0.93). Conclusions When the clinical diagnosis of parasomnias is based on the ICSD-R: 1) the majority of Arousal Disorders and REM sleep parasomnias showed only a "fair" to "moderate" IR; 2) all of the other parasomnias showed a "substantial" to "almost perfect" IR. Nosological entities with unsatisfactory IR share complex motor phenomenology associated with a mental state difficult for the patient to define. The source of disagreement probably lies in the difficulty in interpreting patients' reports. For these parasomnias IR must be verified and possibly improved with training.

OBJECTIVES:Little is known about the long term outcome of patients with periventricular nodular heterotopia (PNH) and epilepsy, particularly the course of seizures. This study investigated the electroclinical and prognostic features of 16 patients with PNH.METHODS:Of 120 patients with epilepsy and malformations of cortical development, 16 had PNH. Of these, eight patients had periventricular nodules only (simple PNH) and eight also presented with other cortical or cerebral malformations (subcortical heterotopia; polymicrogyria; focal dysplasia; schizencephaly; cortical infolding; agenesis of the corpus callosum; mega cisterna magna and cerebellar atrophy) (PNH plus). All patients underwent clinical, neurophysiological, and MRI investigation. The mean follow up was 17.3 years (2-40 years).RESULTS:Two electroclinical patterns emerged: (1) The first pattern, associated with simple PNH, was characterised by normal intelligence and seizures, usually partial, which began during the second decade of life. The seizures never became frequent and tended to disappear or become very rare. The EEG showed focal abnormalities. (2) The second pattern, associated with PNH plus, was characterised by mental retardation and seizures that began during the first decade of life. The seizures were very frequent in most cases and sudden drops were observed in six patients. Seizures were medically refractory in four patients. The EEG showed focal and bisynchronous abnormalities.CONCLUSIONS:Two groups of PNH patients with different electroclinical and neuroradiological features can be identified after a long term follow up. The presence of other types of cortical or cerebral malformations, in addition to periventricular nodules, determines a poor prognosis.

Few studies have focused on the clinical, neurophysiological and prognostic features of adult epileptic patients with malformation of cortical development. We reviewed the clinical data of a series of sixty adult epileptic patients with different types of malformation of cortical development, who had been followed at the Epilepsy Centre of the Department of Neurological Sciences of the University of Bologna, with particular attention to age at seizure onset, mental retardation, response to therapy, and EEG features. The heterogeneity of our population, especially when divided into the different groups of malformation of cortical development, precluded any general conclusions, but we stress the following aspects: 1) epilepsy due to malformation of cortical development may begin in adolescents and young adults; 2) epileptic seizures with clinical and polygraphic features of infantile spasms may persist into adulthood; 3) complex cortical malformation is not necessarily associated with severe epileptic encephalopathy. In periventricular nodular heterotopias, the largest in our series (nine patients), age at onset of seizures, response to therapy and mental deterioration differed according to the presence of nodules confined to the ventricular wall (‘pure’ form) or periventricular nodules associated with other cerebral cortical malformations ('plus' form).