SUMMARY Subjective sleep quality and its related factors were investigated in 869 (530 F, 339 M) 17-year-old adolescents, who were selected from the pupils of state-run secondary schools in the city of Pavia in the north west of Italy. The study was conducted cross sectionally, and it consisted of a questionnaire based survey. One hundred and fortytwo subjects (16.5% of the whole sample, 19% of the females and 11.7% of the males) met the criteria chosen for definition as poor sleepers (namely, a complaint of 'non restorative nocturnal sleep', 'often' or 'always' over the previous 12 mo). A significant association was found between chronic poor sleep and (1) gender (female) (2) emotional factors, such as worries, anxiety and depression (3) poor sleep hygiene (4) arousal related parasomnia. Only 4% of poor sleepers took sleep promoting drugs (including benzodiazepines, homeopathic products and other medications), generally without seeking medical advice. adolescence, poor sleep INTRODUCTION schools in the city of Pavia, which is a medium sized city of 80000 inhabitants in the north west of Italy. To date, most large community based studies have determined insomnia-like complaints and the use of hypnotic medication MATERIAL AND METHODS as primarily affecting older people (Bixler et al. 1979; Karacan et al. 1983;Lugaresi et al. 1983; Partinen et al. 1983; Hohagen The study was conducted in February and March 1992 in et al. 1993).Pavia and consisted of a cross-sectional, questionnaire based However, various epidemiological surveys indicate that survey involving subjects chosen at random from the 1226 sleeping difficulties are experienced by a remarkable number students (60% females, 40% males) attending the 4th year of of children and adolescents (Prince et al. 1978 (ISTAT 1994). Furthermore in Pavia some kinds of hygiene and parasomnia, are likely to affect sleep quality at secondary schools, traditionally, namely attended by females, pre-adult ages. A greater awareness and appreciation of sleep are overrepresented: these data account for the high proportion problems in young people, of the underlying factors and of of females in our students population. The sample consisted the type of remedy administered, could assist physicians to of subjects chosen at random from the 1226 4th year secondary plan programmes of preventive sleep medicine.school students. The randomization was carried out as follows: This study aims to assess subjective self-reported sleep quality the names of the 1226 students were listed in alphabetical and usage of sleep-promoting medications in a sample of 17-order. The randomized choice started by the 8th name of the year-old students selected from pupils of state-run secondary list. Every successive 4th name of the list was chosen for a pretest group, while the others were used for the sample group. Of the 920 subjects chosen for the sample, 32 were not presentCorrespondence: Professor A. Tartara, Neurological Institute 'C.at school during the questionnaire administration. Of th...

The majority of patients with epilepsy maintain seizure control during pregnancy. The apparently higher risk of seizures among women treated with oxcarbazepine and the more frequent increases in drug load in the oxcarbazepine and lamotrigine cohorts prompts further studies on relationships with pharmacokinetic changes. Risks associated with status epilepticus appear to be lower than previously reported.

The kinetics of oxcarbazepine (OXC) and its active metabolite 10-hydroxy-carbazepine (10-OH-CZ) after a single oral OXC dose (600 mg) were compared in healthy control subjects and in epileptic patients treated with phenobarbitone or sodium valproate (n = 8 in each group). In all groups, serum 10-OH-CZ concentrations were much higher than those of the parent drug. In patients on valproate, the kinetics of OXC and 10-OH-CZ did not differ significantly from those observed in controls. In patients on phenobarbitone, AUC values of both OXC and 10-OH-CZ were lower than in controls (2.9 ± 0.4 vs 5.1 ± 0.7 ,ug ml-' h and 89 ± 7 vs 119 ± 10 ,ug ml-' h respectively, means ± s.e. mean, P < 0.05), whereas 10-OH-CZ half-lives were only marginally shorter (17 ± 1 h vs 20 + 2 h, NS). These data indicate that the biotransformation of OXC and 10-OH-CZ may be accelerated by concomitant treatment with phenobarbitone but that the magnitude of this effect is unlikely to be of great clinical significance.

1. The single dose pharmacokinetics of orally administered nimodipine (60 mg) were investigated in normal subjects and in two groups of epileptic patients receiving chronic treatment with hepatic microsomal enzyme‐inducing anticonvulsants (carbamazepine, phenobarbitone or phenytoin) and sodium valproate, respectively. 2. Compared with the values found in the control group, mean areas under the plasma nimodipine concentration curve were lowered by about seven‐fold (P less than 0.01) in patients taking enzyme‐inducing anticonvulsants and increased by about 50% (P less than 0.05) in patients taking sodium valproate. 3. Nimodipine half‐lives were shorter in enzyme‐induced patients than in controls (3.9 +/‐ 2.0 h vs 9.1 +/‐ 3.4 h, means +/‐ s.d., P less than 0.01), but this difference could be artifactual since in the patients drug concentrations declined rapidly below the limit of assay, thus preventing identification of a possible slower terminal phase. In valproate‐treated patients, half‐lives (8.2 +/‐ 1.8 h) were similar to those found in controls.

To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. Methods: This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients' records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsingremitting course, and 4.8% of patients with sustained remission (p = .016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p = .013); for respiratory diseases were 3.6%, .3%, and .3% (p = .001), and for urogenital diseases were 3.6%, .7%, and 1.6% (p = .048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and