N Gadoth

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (78)160.79 Total impact

  • Natan Gadoth, Arie Oksenberg
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    ABSTRACT: Although sleep abnormalities in general and sleep-related breathing disorders (SBD) in particular are quite common in healthy children; their presence is notably under-recognized. Impaired sleep is a frequent problem in subjects with inborn errors of metabolism as well as in a variety of genetic disorders; however, they are commonly either missed or underestimated. Moreover, the complex clinical presentation and the frequently life-threatening symptoms are so overwhelming that sleep and its quality may be easily dismissed. Even centers, which specialize in rare genetic-metabolic disorders, are expected to see only few patients with a particular syndrome, a fact that significantly contributes to the under-diagnosis and treatment of impaired sleep in this particular population. Many of those patients suffer from reduced life quality associated with a variable degree of cognitive impairment, which may be worsened by poor sleep and abnormal ventilation during sleep, abnormalities which can be alleviated by proper treatment. Even when such problems are detected, there is a paucity of publications on sleep and breathing characteristics of such patients that the treating physician can refer to. In the present paper, we provide an overview of sleep and breathing characteristics in a number of rare genetic-metabolic disorders with the hope that it will serve as a reminder for the medical professional to look for possible impaired sleep and SBD in their patients and when present to apply the appropriate evaluation and treatment options.
    Frontiers in Neurology 07/2014; 5:133. DOI:10.3389/fneur.2014.00133
    This article is viewable in ResearchGate's enriched format
  • Arie Oksenberg, Natan Gadoth
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    ABSTRACT: Obstructive sleep apnea (OSA) is a sleep disorder which has been gradually accepted as an important cause of increased morbidity and mortality. The treatment of moderate-severe OSA has improved dramatically since the introduction of continuous positive airway pressure (CPAP) devices; however, the adherence of patients to CPAP treatment is relatively low. Adherence appears to be even worse in patients with mild or asymptomatic OSA. The failure to identify and treat mildly symptomatic or asymptomatic OSA patients may be costly, as such patients comprise about 20% of the general adult population. OSA patients could be divided into positional and non-positional patients. Positional patients show most of their breathing abnormalities while sleeping in the supine position. Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas. On the contrary, non-positional patients suffer from breathing abnormalities in the supine and lateral postures, and as a consequence those are the most severe OSA patients for whom CPAP is the treatment of choice. In this paper we intend to argue that positional therapy, i.e. avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA. Considering the fact that the vast majority of mild-moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them. High-quality research regarding this issue is needed to evaluate the real effectiveness of this mode of therapy.
    Journal of Sleep Research 10/2013; 23(2). DOI:10.1111/jsr.12097 · 2.95 Impact Factor
  • Natan Gadoth
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    ABSTRACT: Subacute sclerosing panencephalitis (SSPE), is a devastating "slow virus" brain disease which affects young children who had measles some 6-7 years earlier. Although, the pandemic of SSPE during 1960-1980's was almost eradicated due to mass immunization, the disease is still taking the life of young children in countries where measles immunization is incomplete and in world regions where genetic polymorphism to this particular infection is present. The present review was written for the fortunate young generation of pediatricians and pediatric neurologists who probably have not seen a case of SSPE during their career, and for those who work in counties where the disease has not been eradicated. It is also a reminder that with full coverage of measles immunization this devastating disease can be fully eradicated.
    Brain & development 01/2012; 34(9):705-11. DOI:10.1016/j.braindev.2011.12.008 · 1.74 Impact Factor
  • N Gadoth
    Brain & development 01/2012; 34(5). DOI:10.1016/j.braindev.2011.12.002 · 1.74 Impact Factor
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    Arie Oksenberg, Natan Gadoth
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    ABSTRACT: Periodic limb movements (PLM) during sleep are believed to be under the control of the sympathetic nervous system and may cause interrupted sleep and daytime sleepiness. The present case highlights the close relationship between PLM and significant heart rate changes independent of the presence of arousals. Thus, in addition to the already known deleterious effect on sleep continuity, moderate-severe PLM may also affect cardiovascular health.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(4):447-9. DOI:10.5664/jcsm.2046 · 2.93 Impact Factor
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    ABSTRACT: The aim of this work was to study the relationship between changes of body posture dominance and changes of body weight overtime in adults with obstructive sleep apnoea. The participants were 112 non-treated adults with obstructive sleep apnoea who underwent two polysomnographic evaluations at our Sleep Disorders Unit during an average of 6.2years interval. Positional patients - having most of their breathing abnormalities in the supine posture and who became non-positional patients - had a significant gain in weight and a significant increase in apnoea-hypopnoea index, mainly in lateral apnoea-hypopnoea index. On the contrary, non-positional patients who became positional patients had a significant decrease in weight (but less than the increase in weight of positional patients who became non-positional patients) and showed a significant improvement in apnoea-hypopnoea index, again mainly in lateral apnoea-hypopnoea index. These non-positional patients who became positional patients initially had a less severe disease, as judged by apnoea-hypopnoea index, lateral apnoea-hypopnoea index and minimum SaO(2) during non-rapid eye movement sleep, and were less obese than non-positional patients who remained non-positional patients. The later were the patients who showed initially the worst disease and were more obese than the rest of the patients, and their condition did not change significantly over time. Non-positional patients who converted to positional patients showed a decrease in body weight and improvement of obstructive sleep apnoea, while positional patients who converted to non-positional patients showed an increase in body weight and worsening of obstructive sleep apnoea. It appears that weight changes have a modulatory effect on positional dominance, and lateral apnoea-hypopnoea index appears to be a sensitive parameter of these changes.
    Journal of Sleep Research 12/2011; 21(4):402-9. DOI:10.1111/j.1365-2869.2011.00988.x · 2.95 Impact Factor
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    Natan Gadoth
    Pathogenesis of Encephalitis, 12/2011; , ISBN: 978-953-307-741-3
  • Natan Gadoth
    Brain & development 11/2010; 33(8):700; author reply 700-1. DOI:10.1016/j.braindev.2010.10.018 · 1.74 Impact Factor
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    ABSTRACT: A 48-year-old female presented with bilateral paralysis of supranuclear hori zontal conjugated gaze and impairment of various pontine, cerebellar and cervical spinal cord functions. The clinical signs and laboratory work-up indicated myeloencephalitis, probably of viral etiology. Paralysis of supranuclear horizontal conjugated gaze was produced experimentally by damaging the paramedial pontine reticularformation(PPRF). In the human, this a bnor-mality is extremely rare and, to the best of our knowledge, has not been reported previously in reversible encephalitis.
    Neuro-Ophthalmology 07/2009; 5(3):211-213. DOI:10.3109/01658108509079666 · 0.18 Impact Factor
  • Neurology 04/2007; 68(14):1161; author reply 1161. DOI:10.1212/01.wnl.0000261162.61360.a2 · 8.30 Impact Factor
  • E Mass, M Lapidot, N Gadoth
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    ABSTRACT: BACKGROUND: Familial dysautonomia (FD) is a rare autosomal recessive disorder of the peripheral nervous system, affecting exclusively Jewish children of Ashkenazi extraction. The typical clinical features consist of somatic abnormalities: failure to thrive, characteristic facies, excessive sweating, labile blood pressure, recurrent aspiration pneumonias, lack of tears, and diminished and later absent deep tendon reflexes with generalized reduction of pain sensation. Oro-dental features include a lack of tongue fungiform papillae, impairment of taste, oro-dental self-mutilation, dental crowding, excessive plaque and calculus accumulation, salivary over production and low caries experience. CASE REPORT: A child with multiple endocrine neoplasia type 2B (MEN 2B) received, at the age of 11 months, an incorrect diagnosis of familial dysautonomia (FD). At the age of 6 years, a paediatric dentist experienced with FD noticed a normal number and shape of tongue fungiform papillae, while expecting to find a smooth tongue lacking those structures. The presence of numerous submucosal neuromata initiated a meticulous neurological and endocrine work-up, which established the diagnosis of MEN 2B. This led to an early detection and appropriate treatment of asymptomatic medullary thyroid carcinoma (MTC).
    European Journal of Paediatric Dentistry 04/2005; 6(1):48-50. · 0.48 Impact Factor
  • C R Gordon, N Gadoth
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    ABSTRACT: To evaluate the effectiveness and possible side effects of a single session of repeated particle repositioning maneuver (PRM) to treat posterior canal benign paroxysmal positional vertigo (BPPV) and the usefulness of post-treatment restrictions. A total of 125 consecutive patients with idiopathic BPPV participated in the study. Fifty patients received a single session of repeated PRM only (group I). Results were compared with those of 50 patients with BPPV who received a single PRM (group IIb), and 25 patients who received a single PRM followed by the use of a neck collar and keeping the head upright for 48 h (group IIa). Forty-six patients (92%) of group I, 40 patients (80%) of group IIb, and 21 patients (84%) of group IIa were completely free of signs and symptoms when re-examined 1 week after treatment. Transient nausea and disequilibrium following treatment were reported equally in all subgroups and well tolerated. Nearly all patients of group IIa considered the post-treatment restrictions very inconvenient. A single session of repeated physical procedure seems to be clinically superior to one single maneuver and well tolerated. Additional post-treatment measurements are inconvenient and should be abandoned.
    Acta Neurologica Scandinavica 10/2004; 110(3):166-9. DOI:10.1111/j.1600-0404.2004.00296.x · 2.44 Impact Factor
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    ABSTRACT: To identify the presence of vestibulo-ocular arreflexia in patients with Machado-Joseph disease (MJD), which can easily be diagnosed at the bedside. Seven patients with MJD from five unrelated families and 11 patients with sporadic or hereditary cerebellar ataxia other than MJD underwent a detailed neuro-otological and oculomotor examination. Six MJD and five non-MJD patients also underwent electro-oculographic recordings and caloric tests. Gaze evoked nystagmus, smooth pursuit, and saccade abnormalities were found in both MJD and non-MJD patients. However, in all seven MJD patients but in none of the non-MJD patients, sudden passively induced head thrust to both sides elicited pathological corrective catch-up saccades, indicating bilateral loss of the horizontal vestibulo-ocular reflex. This was further confirmed in six MJD patients who had absent vestibular response to both a standard caloric test and ice water ear irrigation. Nystagmus was induced by standard caloric irrigation in all non-MJD patients examined. There was no correlation between the loss of vestibular function and the severity of cerebellar impairment. The presence of vestibulo-ocular arreflexia, as measured by the head thrust test in a patient with dominant cerebellar ataxia, strongly suggests the diagnosis of MJD.
    Journal of Neurology Neurosurgery & Psychiatry 10/2003; 74(10):1403-6. DOI:10.1136/jnnp.74.10.1403 · 5.58 Impact Factor
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    R Hering-Hanit, N Gadoth
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    ABSTRACT: Caffeine is the most widely used behaviourally active substance. Excessive caffeine consumption, mostly in the form of coffee and tea, is a well-recognized cause of headache or migraine, and withdrawal can cause headache. Nevertheless, caffeine abuse headache is not listed as a separate category in the International Headache Society classification, 1988. We report our experience with children and adolescents with daily or near-daily headache and excessive consumption of caffeine in the form of cola drinks. Over a period of 5 years we have encountered, in a tertiary headache clinic in a general hospital, 36 children and adolescents (17 girls and 19 boys) with daily or near-daily headache related to excessive caffeine intake in the form of cola drinks. The mean age of the subjects was 9.2 years (range 6-18) and mean headache duration was 1.8 years (range 0.6-5). All were heavy cola drinks consumers; at least 1.5 L of cola drinks per day (192.88 mg of caffeine daily), and an average of 11 (range 10.5-21) L of cola drinks a week, which amounts to 1414.5 mg of caffeine (range 1350.1-2700.3). Patients were encouraged to achieve gradual withdrawal from cola drinks, which led to complete cessation of all headaches in 33 subjects, whereas one boy and two adolescent girls continued to suffer from migraine without aura not frequent enough to justify prophylactic medication. Children and adolescents with high daily caffeine consumption in the form of cola drinks may suffer from caffeine-induced daily headache. Gradual withdrawal can be achieved without withdrawal headache and with complete disappearance of the induced chronic daily headache.
    Cephalalgia 07/2003; 23(5):332-5. DOI:10.1046/j.1468-2982.2003.00576.x · 4.12 Impact Factor
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    ABSTRACT: There is only scant information on sleep characteristics and long-term follow-up in patients with Kleine-Levin syndrome (KLS). This study describes the clinical course, results of polysomnography and long-term follow-up in a relatively large group of patients with KLS. During the years 1982-97, we encountered 34 patients (26 males and eight females) with KLS. We were able to obtain the original polysomnographs from 28 males and four females. In 25 patients, data regarding their present state of health were obtained. Fourteen agreed to be present at a detailed interview and examination while 11 gave the information by phone. The mean age at onset was 15.8 +/- 2.8 years and the mean diagnostic delay, 3.8 +/- 4.2 years. The mean duration of a single hypersomnolent attack was 11.5 +/- 6.6 days. The main abnormal findings extracted out of 35 polysomnographs obtained from 32 patients during and/or in-between attacks included: decreased sleep efficiency, and frequent awakenings from sleep stage 2. All 25 patients reported present perfect health, with no evidence of behavioral or endocrine dysfunction. In adolescents with periodic hypersomnia, the diagnosis of KLS should be explored. Sleep recordings during a hypersomnolent period will often show frequent awakenings from sleep stage 2. The long-term prognosis is excellent.
    Journal of Sleep Research 01/2002; 10(4):337-41. DOI:10.0000/096132198370010 · 2.95 Impact Factor
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    ABSTRACT: To determine total serum homocysteine levels in a large group of patients with migraine with and without aura. Hypercoagulable state is a known risk factor for stroke in the young. The existence of a hypercoagulable state has been postulated in migraine and homocysteinemia with young-onset stroke. To the best of our knowledge, blood homocysteine has not been studied in a significant number of patients with various forms of migraine. Total serum homocysteine was measured with high-performance liquid chromatography in 78 patients with migraine and in 126 age- and sex-matched healthy volunteers. Seventy-eight patients aged 18 to 65 years were studied: 22 with migraine with aura and 56 with migraine without aura. Only 1 man had significantly elevated blood homocysteine (38.6 micromol/L), while another had a borderline elevation (15.8 micromol/L) (reference value for both sexes in our laboratory is 4 to 14 micromol/L). Both patients suffered from migraine without aura. Blood homocysteine is not elevated in migraine.
    Headache The Journal of Head and Face Pain 10/2001; 41(8):779-81. DOI:10.1046/j.1526-4610.2001.01143.x · 3.19 Impact Factor
  • G Vainstein, D Yafe, N Gadoth
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    ABSTRACT: During July-August 1998, we encountered 4 patients who suffered from syringomyelia. The diagnosis in each case could not be reached on clinical grounds only, since the characteristic thermoanalgesia dissociation was absent in all patients. In each case the spinal MRI showed the typical intraspinal cystic lesion, which finally established the diagnosis and led to appropriate treatment.
    Harefuah 08/2001; 140(7):610-3, 678.
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    ABSTRACT: Abuse of ergotamine and analgesics is common in adults. It coexists with headache and can also induce headaches. Ten to 15% of patients attending headache clinics and 1% of the general population suffer from chronic daily headache due to medication misuse. Indeed, this phenomenon was recently regarded as an epidemic. Nonetheless, analgesic-induced headache in children and adolescents was first reported in 1998. We report on our experience with children and adolescents with daily or almost-daily headache concomitant with daily or almost-daily analgesic intake. Over a period of 3 years, we evaluated 26 children (19 girls and 7 boys) with chronic daily or near-daily headache related to daily analgesic intake. The mean age of the group was 14.2 years (range, 12-18), and the mean headache history duration was 1.6 years (range, 3 months to 4 1/2 years). The mean number of headache days per month was 28.1 (range, 19-31). All patients had no history of migraine prior to the chronic headache phase according to the International Headache Society criteria. They were using at least one dose of analgesic drug for each headache, whereas 16 were using analgesic drugs daily. The weekly analgesic intake averaged 28.1 tablets (range, 19-41). The majority abused simple analgesics. Twenty-one took acetaminophen alone. Five took a combination; four took a compound containing acetaminophen, caffeine, and codeine; and the fifth patient took a compound containing aspirin, caffeine, and codeine. All patients were informed about the phenomenon of medication-induced headache and were encouraged to achieve drug withdrawal. Withdrawal led to complete cessation of all headaches in 20 patients. In 5 patients, the daily headache resolved; however, they suffered from intermittent episodic migraine attacks, which were frequent enough in 3 to initiate prophylactic medication. One adolescent continued to have daily headache. Analgesic-induced headache does occur in adolescents. Successful withdrawal from the offending analgesics was achieved without hospitalization or significant interference with daily life and with complete disappearance of the induced chronic daily headache in 25 of 26 patients.
    Journal of Child Neurology 07/2001; 16(6):448-9. DOI:10.2310/7010.2001.7178 · 1.67 Impact Factor
  • A Kesler, N Gadoth
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    ABSTRACT: To determine the incidence, demographic, and clinical features of Pseudo Tumor Cerebri (PTC)/Idiopathic Intracranial Hypertension (IIH) in Israel. The chairpersons of all neurology and ophthalmology departments in Israel were asked to complete questionnaires regarding patients diagnosed with PTC/IIH from 1998 through 1999. Each questionnaire contained details regarding patient's age, sex, country of birth, age at diagnosis, weight, height, presence of obesity, and the results of lumbar puncture, brain computed tomography, magnetic resonance imaging, and/or magnetic resonance venography. Ninety-one patients with PTC/IIH were diagnosed during the years 1998 to 1999. Eighty-five (93.4%) patients were females and six (6.6%) patients were males. The calculated incidence of PTC/IIH in the Israeli general population was 0.57 to 0.94 per 100,000 persons, with incidences of 1.82 per 100,000 for women and 0.034 per 100,000 for men. The incidence for women during the childbirth years was 4.02 per 100,000. The female to male ratio was higher than previously reported for Western countries. Although the population of Israel is a mixture of people originating from Eastern and Western countries, the incidence of PTC/IIH was found to be similar to that of Western countries. This finding is an additional support to the notion that PTC/IIH is more common in obese populations.
    Journal of Neuro-Ophthalmology 03/2001; 21(1):12-4. DOI:10.1097/00041327-200103000-00003 · 1.81 Impact Factor
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    ABSTRACT: The purpose of the present study was to investigate possible inner ear changes related to professional diving, by the documentation of auditory and vestibular function in 13 asymptomatic professional divers and 12 nondiver controls. A higher average pure tone hearing threshold, although of no clinical significance, was found in the study group (8.53 +/- 4.85 versus 6.67 +/- 3.54 dB hearing level, p = .04). In the vestibular evaluation, the smooth harmonic acceleration test phase leads for 0.01, 0.02, and 0.04 Hz were significantly lower in the divers (0.01 Hz, 38.46 degrees +/- 7.15 degrees versus 45.83 degrees +/- 9.02 degrees, p = .02; 0.02 Hz, 21.08 degrees +/- 5.19 +/- versus 25.17 degrees +/- 5.78 degrees, p = .05: 0.04 Hz, 12.38 degrees +/- 3.69 degrees versus 14.25 degrees +/- 3.14 degrees, p = .05). We suggest that the lower smooth harmonic acceleration phase values found in the professional divers, reflecting longer vestibulo-ocular reflex primary time constants and enhancement of the velocity storage mechanism, are the result of a habituation process that augments the low-frequency response of the canal-ocular system.
    The Annals of otology, rhinology, and laryngology 03/2001; 110(2):127-31. DOI:10.1177/000348940111000207 · 1.05 Impact Factor

Publication Stats

958 Citations
160.79 Total Impact Points

Institutions

  • 1979–2014
    • Tel Aviv University
      • • Department of Neurology
      • • Department of Pediatric Dentistry
      Tell Afif, Tel Aviv, Israel
  • 2012
    • CLALIT
      • Sleep Disorders Unit
      Tell Afif, Tel Aviv, Israel
  • 1998–2004
    • Meir Medical Center
      Kafr Saba, Central District, Israel
  • 2001
    • Carmel Medical Center
      H̱efa, Haifa District, Israel
  • 1983
    • Technion - Israel Institute of Technology
      H̱efa, Haifa District, Israel
  • 1978
    • Ben-Gurion University of the Negev
      • Faculty of Health Sciences
      Be'er Sheva`, Southern District, Israel