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Functional movement disorders: pathophysiological mechanisms, diagnostic neurophysiological markers, and new therapeutic approaches
Slovák, Matěj ; Serranová, Tereza (advisor) ; Vevera, Jan (referee) ; Rusina, Robert (referee)
Functional movement disorders (FMD), previously referred as psychogenic, are characterized by inconsistency and incogruence with organic neurological disorders. The original psychological models of FMD were replaced by a neurobiological model of the disease. The identification of neurophysiological correlates of FMD and their comorbidities may add to the so far limited knowledge of the pathophysiology of these disorders. This Thesis focuses on three thematic areas of FMD: 1. assessment of prevalence of comorbid restless legs syndrome (RLS) and periodic limb movements (PLM) as an objective marker of RLS using actigraphy; 2. analysis of reflexive and volitional eye movements using videooculography (VOG); 3. evaluation of emotional arousal objectively by pupillometry and subjectively using affective ratings of emotional pictures. In total, 115 FMD patients and 76 age- and matched healthy controls participated in the studies. 1. FMD patients (N=96) presented with signficantly higher prevalence of RLS (43,8 % vs. 7,9 %, p<0,001) and clinically relevant PLM (20,8 % vs. 2,6 %, p=0,0002) compared to controls. The association of RLS/PLM with FMD raises the possibility of common pathophysiological mechanisms of these conditions and has clinical implications in management of FMD. 2. VOG analyses showed normal...
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Endocrine and Metabolic Aspects of Various Sleep Disorders
Vimmerová-Lattová, Zuzana ; Anders, Martin (advisor) ; Praško, Ján (referee) ; Šonka, Karel (referee)
Endocrine and Metabolic Aspects of Various Sleep Disorders MUDr. Zuzana Vimmerová Lattová Abstract: Recent epidemiological and experimental data suggest a negative influence of shortened or disturbed night sleep on glucose tolerance. However, no comparative studies of glucose metabolism have been conducted in clinical sleep disorders. Dysfunction of the HPA axis may play a causative role in some sleep disorders and in other sleep disorders it may be secondary to the sleep disorder. Moreover, dysfunction of the HPA axis is regarded as a possible causative factor for the impaired glucose sensitivity associated with disturbed sleep. However, data on HPA system activity in sleep disorders are sparse and conflicting. We studied 25 obstructive sleep apnea (OSA) patients, 18 restless legs syndrome (RLS) patients, 21 patients with primary insomnia and compared them to 33 healthy controls. We performed oral glucose tolerance test and assessed additional parameters of glucose metabolism. The dynamic response of the HPA system was assessed by the DEX-CRH-test which combines suppression (dexamethasone) and stimulation (CRH) of the stress hormone system. Compared to controls, increased rates of impaired glucose tolerance were found in OSA (OR: 4.9) and RLS (OR: 4.7), but not in primary insomnia. In addition, HbA1c...
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