Šmigelskytė, Agnė

Background and Objectives: People with epilepsy frequently complain of poor sleep quality, excessive daytime sleepiness (EDS), and insomnia. Therefore, this study aimed to evaluate differences in anxiety and depression symptoms, as well as clinical characteristics, across groups defined by sleep quality in patients with epilepsy. Materials and Methods: Seventy-eight adults with epilepsy were assessed using standardized questionnaires for sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), insomnia severity (Insomnia Severity Index, ISI), and psychiatric symptoms (PHQ-9, GAD-7, and HADS). Demographic data (age and sex), seizure frequency and characteristics, use of antiepileptic drugs (AEDs), and EEG findings were collected. Patients were divided into groups based on sleep quality scores, and comparisons were made regarding anxiety, depression, and selected clinical variables. Associations were analyzed using t-tests, chi-squared tests, and Spearman correlation coefficients. Results: Poor sleep quality (PSQI > 5) was present in 70.9% of patients and was significantly associated with insomnia, daytime sleepiness, depression, and anxiety symptoms (p < 0.001 for all comparisons). Patients who had experienced generalized tonic–clonic seizures (GTCS) in the past year had significantly worse sleep quality compared to those without GTCS (p = 0.025). Clinical insomnia (ISI ≥ 15) was observed in 23.1% of cases and was significantly associated with the presence of seizures (p = 0.015). EDS was present in 19% of cases and was associated with depressive symptoms (p = 0.019). A higher concentration of levetiracetam was associated with better sleep quality, whereas a higher concentration of lamotrigine was associated with worse sleep quality (p = 0.024 for both). EEG abnormalities, seizure frequency, and duration of epilepsy were not associated with sleep quality. Conclusions: Poor sleep quality was reported in 70% of the study patients and was associated with increased insomnia severity, EDS, and psychiatric comorbidities. People with EDS were more likely to have higher levels of depression and anxiety. Patients who experienced GTCS within the past year were significantly more likely to report poor sleep quality. Insomnia was associated with older age and female sex. Seizure-free patients had less insomnia. Nevertheless, no associations were found between sleep evaluation scores and other demographic or clinical epilepsy characteristics.

Objectives Despite advances in diagnostic testing, significant challenges remain in the diagnosis of inflammatory polyneuropathies. Recently, considerable attention has been given to neuromuscular ultrasound, with numerous studies proposing various measurement protocols; however, it is still unclear which protocol offers the greatest clinical value. So, the aim of this study was to evaluate and compare several established ultrasound protocols used to assess inflammatory polyneuropathies within a unified patient group. Materials and Methods High-resolution nerve ultrasound examinations were carried out following three protocols: the Bochum Ultrasound Score (BUS)/Neuropathy Ultrasound Protocol (NUP), the Ultrasound Pattern Sum Score (UPSS), and the protocol recommended by the European Academy of Neurology and the Peripheral Nerve Society (EAN/PNS). These protocols were applied to patients diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), acute inflammatory demyelinating polyneuropathy (AIDP), and multifocal motor neuropathy (MMN), as well as to a group of healthy controls. The reference upper limits for nerve size were adapted to fit our laboratory’s normative values for all protocols. Additionally, nerve measurements were reanalyzed using the standard EAN/PNS reference values. Results A total of 189 individuals participated in the study (105 men and 84 women): 40 with CIDP, 13 with MMN, 11 with AIDP, and 125 healthy controls. Using the original EAN/PNS protocol bilaterally, 72.9% of CIDP cases were correctly identified. When adjusted according to our normative data, the protocol achieved a 100% detection rate and 100% sensitivity. The adjusted BUS/NUP and UPSS protocols each demonstrated a 90% specificity in diagnosing CIDP. For MMN, the EAN/PNS protocol (applied unilaterally) detected 69.23% of cases and had a 100% sensitivity, whereas the UPSS protocol showed the highest specificity at 96%. In AIDP cases, the adjusted EAN/PNS protocol identified 90.9% of patients using either unilateral or bilateral assessments, with a sensitivity of 91% and specificity of 88%. Conclusions The EAN/PNS protocol, especially when adjusted to local normative values, proved most effective for identifying treatable inflammatory neuropathies. Meanwhile, the BUS/NUP and UPSS protocols were particularly useful for distinguishing between different subtypes of inflammatory polyneuropathy. Additional detailed investigations are necessary to establish optimal approaches for disease monitoring.

Objectives: We aimed to compare well-known ultrasound protocols for inflammatory polyneuropathies in a single cohort. Methods: High-resolution ultrasound was performed according to the Bochum ultrasound score (BUS)/neuropathy ultrasound protocol (NUP), ultrasound pattern sum score (UPSS), and EAN/PNS suggested protocol for patients with chronic (CIDP) and acute inflammatory polyneuropathies (AIDP), multifocal motor neuropathies (MMN) and healthy controls. The upper boundaries were adjusted according to our laboratory normative values to all above-mentioned protocols; additionally, another calculation was performed using the peripheral nerve size values officially proposed by EAN/PNS. Results: We enrolled a total of 189 subjects (105 males and 84 females), comprising 40 patients with CIDP, 13 with MMN, 11 with AIDP, and 125 healthy controls. The mean ages were 62.49 years (range 37–84 years) for the CIDP patients; 55.92 years (range 32–71 years) for the MMN patients; 68.09 years (range 51–88 years) for the AIDP patients; and 49.02 years (range 25–80 years) for the healthy controls. Using the EAN/PNS protocol bilaterally, 72.9% of CIDP cases were identified. When the adjusted EAN/PNS protocol was applied, the detection rate rose to 100%, with a sensitivity of 100%. Both the adjusted BUS/NUP and UPSS protocols demonstrated a specificity of 90% in diagnosing CIDP. EAN/PNS protocol detected 69.23% of MMN cases measured unilaterally and had a 100% sensitivity to distinguish MMN, while the UPSS protocol had the highest specificity (96%). In AIDP cases, the adjusted EAN/PNS protocol identified 90.90% of cases through unilateral or bilateral measurements, with sensitivity 91% and specificity 88%. Conclusions: The EAN/PNS protocol was the most valuable in the detection of treatable states, and the BUS/NUP, UPSS protocols were the most valuable in the differentiation of specific inflammatory polyneuropathies.

Background: Transthyretin (ATTR) amyloidosis is a multisystemic disorder caused by the extracellular deposition of misfolded ATTR protein in multiple organs. ATTR amyloid deposition may either be inherited or acquired. Hereditary amyloidosis typically presents with axonal polyneuropathy and/or cardiomyopathy. [...].

Background: Seipinopathy is a rare motor neuron disease caused by a mutation in the BSCL2 gene encoding the seipin protein. It is necessary for the endoplasmic reticulum's normal function and can result in various disease phenotypes when damaged. Only a handful of cases have been described in the literature. Therefore, we would like to add to the existing knowledge by presenting our case. [...].

We aimed to provide data of nerve sizes and echogenicity reference values of the Lithuanian population.

Background and objectives: while acute ischemic stroke is the leading cause of epilepsy in the elderly population, data about its risk factors have been conflicting. Therefore, the aim of our study is to determine the association of early and late epileptic seizures after acute ischemic stroke with cerebral cortical involvement and electroencephalographic changes. Materials and methods: a prospective cohort study in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics Department of Neurology was conducted and enrolled 376 acute ischemic stroke patients. Data about the demographical, clinical, radiological, and encephalographic changes was gathered. Patients were followed for 1 year after stroke and assessed for late ES. Results: the incidence of ES was 4.5%, the incidence of early ES was 2.7% and the incidence of late ES was 2.4%. The occurrence of early ES increased the probability of developing late ES. There was no association between acute cerebral cortical damage and the occurrence of ES, including both early and late ES. However, interictal epileptiform discharges were associated with the occurrence of ES, including both early and late ES.

Background. Peripheral nerve ultrasound is a useful tool in the diagnosis of inflammatory polyneuropathies. To differentiate pathology from normal variations it is necessary to have normative values. Therefore, our objective is to present ultrasound reference values of peripheral nerve cross-sectional area (CSA) in health Lithuanian adults. [...].

Purpose: Analyse and compare knowledge about epilepsy between medical and non-medical students of Lithuanian University of Health Sciences. Method: Students participated in an online survey in which they had to choose correct answers about epilepsy. The survey was sent through the official email system of LUHS in 2022. It was sent to 600 and answered by 228 (38.0%) students - 130 (57.0%) medical and 98 (43.0%) non-medical students (of odontology, nursing, pharmacy, veterinary, etc.). Medical and non-medical student groups did not differ by gender and age (p>0.05). Results: The correct answer that epilepsy is a neurological disease did not differ (p>0.05) between medical (116 (89.2%) and non-medical students (81 (82.7%). Students who correctly chose all 5 epilepsy causes (head trauma, genetics, brain tumor, birth trauma, stroke) given in the survey did not differ (p>0.05) between the two groups; however, more medical 102 (78.5%) compared to 63 (64.3%) non-medical students chose head injury (respectively 102 (78,5%) and 63 (64.3%), (p<0.05) and brain tumor (respectively 85 (65.4%) and 49 (50.0%) as the correct answers (p<0.05). All 4 epileptic seizure symptoms given in the survey were chosen correctly by 69 (53.1%) medical and only by 35 (35.7%) non-medical students (p<0.05). Moreover, 118 (90.8%) medical students chose postictal confusion as the correct answer compared to 77 (78.6%) non-medical students and an episode of memory loss (respectively 89 (68.5%) and 54 (55.1%) (p<0.05). Other answers like jerking of limbs, changes in behavior did not differ between the groups (p>0.05). Conclusion: Both, medical and non-medical LUHS students had background knowledge about epilepsy. Medical students knew more, especially about specific information. Although, further education about epilepsy is necessary.

Purpose: Analyse and compare viewpoint on epilepsy between medical and non-medical students of Lithuanian University of Health Sciences. Method: Students participated in an online survey in which they had to choose correct answers about epilepsy. The survey was sent through the official email system of LUHS in 2022. It was sent to 600 and answered by 228 (38.0%) students - 130 (57.0%) medical and 98 (43.0%) non-medical students (of odontology, nursing, pharmacy, veterinary, etc.). Medical and non-medical student groups did not differ by gender and age (p>0.05). Results: 53 (40.8%) medical and 33 (33.7%) non-medical students have witnessed an epileptic seizure (p>0.05). The two groups felt different during the epileptic seizure (p<0.05): 13 (10.0%) medical students said that they were feeling as usual compared to 3 (3.1%) non-medical students; medical students felt compassion more often than non-medical students (respectively 21 (16.2%) and 6 (6.1%), (p<0.05) . Other feelings like fear or discomfort during the seizure did not differ between the two groups (p>0.05). LUHS medical and non-medical students have similar opinions about the lives of epilepsy patients (p>0.05) - they think that people with epilepsy can live a fulfilling life (respectively 83.1% and 77.6%), find a partner (respectively 49,2% and 44,9%), study (respectively 86.2% and 80.1%), choose any profession (respectively 14,6% and 21,2%), be employed (respectively 16,2% and 14,3%), be valued by colleagues (respectively 79,2% and 80,1%), their families’ have more issues (respectively 20% and 22,4%) drive a car if epileptic seizures are under control (respectively 68.5% and 71.4%), travel (respectively 83,8% and 74,5%). Conclusion: The viewpoint on epilepsy did not differ between LUHS medical and non-medical students, although, medical students who saw epileptic seizures more often felt as usual or compassion for the person.