Purpose: We aimed to compare rapid eye movement sleep without atonia (RSWA), tonic RSWA, and phasic RSWA indices during polysomnography as a potential biomarker between narcolepsy type 1 and type 2.Methods: Medical files, polysomnography, and multiple sleep latency tests of patients with narcolepsy were evaluated retrospectively. A total of three adolescents and 31 adult patients were included. We calculated the total number of rapid eye movement (REM) epochs with tonic and phasic activity in accordance with the American Academy of Sleep Medicine manual scoring rules, version 2.4. We defined tonic RSWA index as the ratio of total number of REM sleep stage epochs with only tonic activity to total REM sleep stage epochs, phasic RSWA index as the ratio of total number of REM sleep stage epochs with only phasic activity to total REM sleep stage epochs, and RSWA index as the ratio of total number of REM stage sleep epochs with RSWA to total REM sleep stage epochs on the polysomnography.Results: Clinically and polysomnographically diagnosed 25 patients with narcolepsy type 1 and 9 patients with narcolepsy type 2 were included. The median age of the subjects was 30 (10, 61) and 36 (18, 64), respectively. Eleven narcolepsy type 1 patients (44%) and 4 narcolepsy type 2 patients (44.44%) were women. The RSWA index of $ 3% yielded a sensitivity of 76% and specificity of 88.9% (AUC ¼ 0.77 (0.09), 95% confidence interval ¼ 0.58 to 0.97, p ¼ 0.01), and the tonic RSWA index of $ 2.2% yielded a sensitivity of 72% and specificity of 77.8% (area under the curve ¼ 0.74 (0.1), 95% confidence interval ¼ 0.54-0.94, p ¼ 0.03).Conclusions: As an electrophysiological biomarker, RSWA and tonic RSWA indices can be sensitive and specific polysomnography parameters in distinguishing narcolepsy type 1 from narcolepsy type 2.

BackgroundHashimoto’s disease is an autoimmune disease characterised by autoantibody positivity in the blood and diffuse lympocyte infiltration in the thyroid. Thyroxine is an important hormone in collagen and matrix metabolism. Low levels of thyroid hormones or antibodies positivity may lead to tendon pathologies and subsequent shoulder pain in patients with Hashimoto’s disease.Objectives1)To investigate tendon thickness and pathologies in patients with Hashimoto’s disease. 2) To investigate if shoulder pain in Hashimoto’s disease is associated with ultrasonographic tendon pathologies.MethodsAssuming a 0.5 mm mean difference and 0.7 mm SD of thickness at rotator cuff tendons with 80% power and 5% significance 119 female subjects (40 patients euthyroid Hashimoto’s disease, 28 subclinical hypothyroid Hashimoto’s disease and 51 healthy subjects) were recruited.1 Participants were divided into three groups: Group 1: patients with subclinical hypothyroid Hashimoto’s disease, Group 2: patients with euthyroid Hashimoto’s disease, Group 3: healthy controls. A rheumatologist experienced in musculoskeletal ultrasonography and blind to clinical data of the patients evaluated the thickness of biceps, subscapularis, supraspinatus, infraspinatus tendons at both shoulders according to standard protocol.2 The presence of subacromial bursitis, effusion, tendon rupture or tendinosis were recorded. The participants of TSH (thyroid stimulated hormone), free T3 (triiodothyronine), free T4 (thyroxine), anti TPO (thyroid peroxidase) and anti TG (thyroglobulin) antibodies levels were measerud. In addition the presence and duration of shoulder pain of the participants were recorded.ResultsHeight, weight, BMI (body mass index), free T3 and free T4 levels were similar between three groups (p=0.830, p=0.205, p=0.374, p=0.430 and p=0.497, respectively). Tendon thicknesses in patient groups are presented in table 1. Biceps brachii, subscapularis, supraspinatus and infraspinatus tendon thicknesses were increased significantly in both euthyroid Hashimoto’s disease and subclinical hypothyroid Hashimoto’s disease groups at dominant and non- dominant arms compared to healthy controls. However there was no such difference between euthyroid Hashimoto’s disease and subclinical hypothyroid Hashimoto’s disease groups. There was no correlation between levels of TSH, anti TPO, anti TG and tendon thickness. Two participants in three groups had shoulder pain for 1–3 months. These participants had no ultrasonographic shoulder tendon pathology.Abstract FRI0564 – Table 1Differences between euthyroid Hashimoto’s disease, subclinical hypothyroid Hashimoto’s disease and health controls in dominant and non-dominant arms.ConclusionsPresence of autoimmun thyroid disease may lead to increased shoulder tendon thickness. However increase in tendon thickness is not seemed to be associated with shoulder pain.References[1] Kim K, et al. Ultrasound Dimensions of the Rotator Cuff and Other Associated Structures in Korean Healthy Adults. Journal of Korean medical science201...

No abstract

An 82-year-old, right-handed male patient was admitted to the emergency room because of continuous rhythmic clonic movements of the right forearm and hand. He was diagnosed with epilepsia partialis continua (EPC) and treated successfully with levetiracetam. In conclusion, we recommend levetiracetam as the first line treatment for EPC, which is mostly refractory to classical antiepileptic drugs.

Objectives: To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD). Material and Methods: Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured. Results: Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P = .839, P = .205, P = .374, P = .430 and P = .497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P = .003, P = .030, P < .001; P = .035, P = .042, P < .001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P = .025; P = .046, P = .017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P < .05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r = .272 P = .030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD. Conclusions: This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.