The intricate connection between eating behaviors and sleep habits is often overlooked in clinical practice, despite their profound interdependence. Sleep plays a key role in modulating psychological, hormonal and metabolic balance and exerting an influence on food choices. Conversely, various eating disorders may affect sleep continuity, sometimes promoting the development of sleep pathologies. Neurologists, nutritionists and psychiatrists tend to focus on these issues separately, resulting in a failure to recognize the full extent of the clinical conditions. This detrimental separation can lead to underestimation, misdiagnosis and inappropriate therapeutic interventions. In this review, we aim to provide a comprehensive understanding of the tangled relationship between sleep, sleep pathologies and eating disorders, by incorporating the perspective of sleep experts, psychologists and psychiatrists. Our goal is to identify a practical crossroad integrating the expertise of all the involved specialists.

Objective: This study was undertaken to investigate the association between the Salzburg nonconvulsive status epilepticus (NCSE) criteria and in‐hospital outcome, to determine the predictive accuracy of the Status Epilepticus Severity Score (STESS), modified STESS (mSTESS), Epidemiology‐Based Mortality Score in Status Epilepticus (EMSE), and END‐IT (encephalitis, NCSE, diazepam resistance, imaging features, and tracheal intubation) in NCSE patients, and to develop a new prognostic score specifically designed for NCSE patients.Methods: Clinical and electroencephalographic (EEG) data of adult patients treated for NCSE from 2020 to 2023 were retrospectively assessed. Age, sex, modified Rankin Scale at admission, comorbidities, history of seizures, etiology, status epilepticus type, and outcome were collected from the patients' digital charts. EEG data were assessed and categorized applying the Salzburg NCSE criteria. In‐hospital death was defined as the primary outcome.Results: A total of 116 NCSE patients were included. Multivariable logistic regression revealed that Salzburg NCSE criterion A2 (ictal morphological, spatial, and temporal evolution) was associated with in‐hospital survival. The best STESS cutoff was ≥4 (sensitivity = .62, specificity = .69, accuracy = 67%). mSTESS ≥ 5 reached a sensitivity of .68, a specificity of .57, and an overall accuracy of 60%, EMSE ≥ 64 a sensitivity of .82, a specificity of .39, and an overall accuracy of 52%, and END‐IT ≥ 3 a sensitivity of .65, a specificity of .44, and an overall accuracy of 50%. Through a hypothesis‐generating approach, we developed the SACE score, which integrates EEG features (criterion A2) with patient age (with a 75‐year cutoff), history of seizures, and level of consciousness. With a cutoff of ≥3, it had a sensitivity of .77, a specificity of .74, and an overall accuracy of 76%, performing better than other prognostic scores.Significance: We developed a new user‐friendly scoring system, the SACE score, which integrates EEG features with other established outcome‐related variables assessable in early stages, to assist neurologists and neurointensivists in making more tailored prognostic decisions for NCSE patients.

OBJECTIVES: Although myoclonus less than or equal to 72 hours after cardiac arrest (CA) is often viewed as a single entity, there is considerable heterogeneity in its clinical and electrophysiology characteristics, and its strength of association with outcome. We reviewed definitions, electroencephalogram, and outcome of myoclonus post-CA to assess the need for consensus and the potential role of electroencephalogram for further research. DATA SOURCES: PubMed, Embase, and Cochrane databases. STUDY SELECTION: English-language adult (≥ 18 yr) studies from 1966 to May 31, 2024, reporting myoclonus, myoclonic status/status myoclonus (MyS/SM), myoclonic status epilepticus (MSE), and/or early Lance-Adams Syndrome (eLAS) less than or equal to 72 hours post-CA. All study designs were independently screened by two authors. DATA EXTRACTION: Data on patients presenting myoclonus, MyS/SM, MSE, and eLAS less than or equal to 72 hours post-CA, along with their definitions, electroencephalogram, and outcomes were extracted. The Newcastle-Ottawa Scale and Cochrane-Risk-of-Bias Assessment tool were used to evaluate study quality (PROSPERO n.CRD42023438107). DATA SYNTHESIS: Of 585 identified articles, 119 met the inclusion criteria, revealing substantial heterogeneity in definitions, electroencephalogram, and outcomes. Among 3881 patients, myoclonus was reported in 2659, MyS/SM in 883, MSE in 569, and eLAS in 40. Among patients with a defined outcome, a Cerebral Performance Category (CPC) scale of 1–2 was reported in 9.8% of patients with myoclonus, 5.8% with MyS/SM, 5.7% with MSE, and 82.0% with eLAS. Electroencephalogram was recorded in 2714 patients (69.9%). CPC of 1–2 was observed in 1.6% of patients with suppression/suppression burst (SB)/unreactive (U) electroencephalogram, 11.3% with non-SB/U electroencephalogram and status epilepticus (SE), and 22.3% with non-SB/U electroencephalogram without SE. CONCLUSIONS: Heterogeneity in definitions resulted in weak associations with outcomes. We propose to investigate myoclonus by including related electroencephalogram patterns: myoclonus associated with suppression/SB background electroencephalogram, myoclonus with nonsuppression/SB background but SE-electroencephalogram, and myoclonus with nonsuppression/SB background without SE-electroencephalogram. This pragmatic research approach should be validated in future studies.

The prognostic significance and the benefits of antiseizure treatment for definite and possible status epilepticus (SE) after cardiac arrest (CA) remain debated. The study aims to identify clinical and EEG predictors of outcome in definite and possible SE after CA and to determine patient categories in which antiseizure medication is useful. We conducted a multicenter pooled analysis of individual patient data from the Treatment of ELectroencephalographic STatus epilepticus After cardiopulmonary Resuscitation trial and 2 local registries (Brussels and Geneva). Patients with EEG patterns fulfilling the American Clinical Neurophysiology Society criteria for definite or possible SE within 72 hours after CA were included. Primary outcome was the cerebral performance category (CPC) at 3 months, dichotomized as good (CPC 1-2) or poor (CPC 3-5). Patients, clinical, EEG, and treatment characteristics were related to outcome using univariate and multivariate analyses in the whole cohort and separate for patients without ≥2 poor outcome European Resuscitation Council (ERC)/European Society of Intensive Care Medicine (ESICM) criteria. This latter group of patients was further divided into 2 subgroups: those with definite SE and those with possible SE. Of 274 patients (median age 66 [interquartile range (IQR) 55-75], 31% female) with definite or possible SE, 24 (8.8%) had good recovery. In multivariate analysis, nonmotor semiology and SE cessation were associated with good recovery. After exclusion of patients with ≥2 poor outcome ERC/ESICM criteria (180 patients), we included 94 patients (52 definite SE and 42 possible SE), 25% having good outcome. In definite SE, SE cessation (12 [100%] vs 20 [50%], p = 0.002), higher discharge frequency (3 Hz [IQR 2-3] vs 2 Hz [IQR 2-3], p = 0.024), guideline-recommended SE treatment (12 [100%] vs 28 [70%], p = 0.047), and higher doses of levetiracetam (4,250 [IQR 3,750-4,500] mg vs 2,000 [IQR 2,000-3,000] mg, p = 0.001) and valproic acid (4,800 [IQR 3,600-5,400] mg vs 2,000 [IQR 1,850-2,250] mg, p = 0.032) were associated with favorable outcome. None of the definite or possible SE patients with good outcome had a suppressed/suppression-burst background before SE onset. Patients with postanoxic definite or possible SE have a 25% chance of good outcome in the absence of ≥2 poor outcome ERC/ESICM factors. EEG background continuity before SE onset and higher discharge frequency contribute to the identification of patients who may benefit from protracted treatment.

Background: Outcome prediction in Status epilepticus (SE) aids in clinical decision‐making, yet existing scores have limitations due to SE heterogeneity. Serum albumin is emerging as a readily available prognostic biomarker in various clinical conditions. This study evaluates hypoalbuminemia in predicting short‐ and long‐term mortality.Methods: Observational cohort study including non‐hypoxic SE adult patients admitted to the University Hospital of Geneva (Switzerland) between 2015 and 2023. Primary outcomes were in‐hospital and 6‐month mortality.Results: Four hundred and ninety‐six patients were included, 46 (9.3%) died in hospital; 6‐month outcome was available for 364 patients, 86 (23.6%) were not alive at follow‐up.Hypoalbuminemia was associated with older age and patients' comorbidities. Binomial regression showed an independent correlation between hypoalbuminemia and short‐ (p = 0.005, OR = 3.35, 95% CI = 1.43–7.86) and long‐term mortality (p = 0.001, OR = 3.59,95% CI = 1.75–7.35).The Status Epilepticus Severity Score (STESS) had an overall AUC of 0.754 (95% CI = 0.656–0.836) for predicting in‐hospital mortality and of 0.684 (95% CI = 0.613–0.755) for 6‐month mortality. Through an exploratory analysis, we replaced age with hypoalbuminemia in the STESS, creating the Albumin‐STESS (A‐STESS) score (0–6). The global A‐STESS AUC significantly improved for both in‐hospital (0.837, 95% CI = 0.760–0.916, p = 0.002) and 6‐month (0.739, 95% CI = 0.688–0.826; p = 0.033) mortality prediction. A‐STESS‐3 cutoff demonstrated a strong sensitivity‐specificity balance for both in‐hospital (sensitivity = 0.88, specificity = 0.68, accuracy = 0.70) and 6‐month (sensitivity = 0.67, specificity = 0.73, accuracy = 0.72) mortality.Conclusions: Hypoalbuminemia is an easily measurable biomarker reflecting the overall patient's condition and is independently related to short‐ and long‐term SE mortality. Integrating hypoalbuminemia into the STESS (A‐STESS) significantly enhances mortality prediction. Future studies are needed to externally validate the A‐STESS and evaluate the benefits of albumin supplementation in SE patient prognosis.