Rosalia Silvestri

• MD
• Managing Director at University of Messina

This study aimed to investigate sex‐related differences in the response to ropinirole and pramipexole in patients with restless legs syndrome (RLS). By analysing clinical parameters and polysomnographic (PSG) findings, we sought to elucidate the potential factors related to sex disparities modulating treatment responses and sleep quality in RLS. A...

Attention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning, and associated impairment in academic performance, although disrupted and restless sleep have been frequently reported in individuals wit...

Attention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning and the associated impairment of academic performance, although disrupted and restless sleep have been frequently reported in individuals...

Current evidence suggests that iron deficiency (ID) plays a key role in the pathogenesis of conditions presenting with restlessness such as attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS). In clinical practice, ID and iron supplementation are not routinely considered in the diagnostic work-up and/or as a treatment o...

Several pivotal differences in sleep and sleep disorders are recognized between women and men. This is not only due to changes in hormonal balance during women's reproductive life, such as in pregnancy and menopause. Women are more likely to report insomnia and non-specific symptoms of apneas, such as fatigue or mood disturbance, compared to men. T...

Introduction: Sleep disorders and epilepsy are both common diseases in the general population. Comorbidity between obstructive sleep apnea syndrome (OSAS) and epilepsy varies from 8% to 76%, with a recent meta-analysis reporting a 33.4% prevalence of mild-to-severe OSAS in epileptic patients. Case report: We describe the case of a 39 year old woman...

Introduction Patients with either Idiopathic Hypersomnia or Narcolepsy demonstrate excessive daytime somnolence (EDS) with resultant inattention mimicking Attention Deficit Hyperactivity Disorder (ADHD). Patients with ADHD also often express sleep problems including EDS. Thus, patients with ADHD and patients with idiopathic hypersomnia or narcoleps...

This review presents a detailed summary of the current literature regarding RLS and vitamin D deficiency. To our knowledge it is the first review of its kind. We review the prevalence of vitamin D deficiency in RLS as well as the evidence for the use of vitamin D supplementation in RLS management. We further examine the literature for proteomic and...

Introduction Motivated by challenges faced in outpatient sleep services for mental health and neurodevelopmental disorders (MHNDD) during the COVID-19 clinical shutdown, a pan-Canadian/international working group of clinicians and social scientists developed a concept for capturing challenging sleep and wake behaviours already at the referral stage...

In behavioral medicine, sleep disorders, insomnia in particular, may be considered comorbidities and precipitating factors to intellectual or developmental disabilities (IDD). Nevertheless, sleep alterations have often been neglected in favor of daytime features and symptoms, albeit simple behavioral nighttime observations may disclose hypermotor f...

Aims: The objective of the present study was to evaluate sleep features and sleep-modifying factors in patients with chronic migraine (CM) during the first Italian COVID-19 lockdown. Material and methods: The study was based on an e-mail survey addressed to CM patients of our headache center. The survey investigated demographic, life-style, slee...

Many physiological processes in the human body follow a 24-h circadian rhythm controlled by the circadian clock system. Light, sensed by retina, is the predominant “zeitgeber” able to synchronize the circadian rhythms to the light-dark cycles. Circadian rhythm dysfunction and sleep disorders have been associated with aging and neurodegenerative dis...

AimsThe objective of this study was to evaluate the impact of the first Italian COVID-19 lockdown on patients with chronic migraine (CM).Material and methodsThe study was based on an e-mail survey addressed to CM patients of our headache center. The survey evaluated demographic, life style, sleep, psychological, and migraine features during the COV...

Restless sleep disorder is (RSD) a condition characterized by frequent large movements during sleep associated with daytime impairment. RSD has been studied in children aged 6 to 18 years. Polysomnography is necessary for the diagnosis of RSD. The current diagnostic criteria include more than 5 large movements per hour of sleep documented by PSG. T...

Early-onset restless legs syndrome has a relatively high prevalence in pediatrics, is highly familial, and is often preceded by a diagnosis of periodic limb movement disorder or childhood insomnia. Diagnostic criteria are derived but not equal to those of the adult syndrome and are adapted according to children's age and linguistic competence. Diag...

Nocturnal leg cramps (NLCs) are a relatively common, idiopathic or symptomatic disorder, increasing in frequency with age. No apparent gender differences apply. Pain due to violent, brisk contractions of the lower limb muscles may wake the patient and interfere with nighttime and daytime activities, depending on their severity. Recognizing potentia...

Background Circadian and sleep disturbances are associated with increased risk of mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Wearable activity trackers could provide a new approach in diagnosis and prevention. Objective To evaluate sleep and circadian rhythm parameters, through wearable activity trackers, in MCI and AD patients...

Rhythmic movements during sleep may occur in the context of physiological sleep-related motor activity or be part of sleep-related movement disorders such as bruxism, periodic limb movement disorder, restless legs syndrome, and sleep-related rhythmic movement disorder. They may also characterize some frontal or temporal nocturnal seizures of sleep-...

Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded res...

Anatomical, physiological, psychological and hormonal alterations affect sleep during pregnancy. Sleep appears tobe commonly impaired only after the first trimester. Albeit objective data regarding the reduction of sleep durationand efficiency are not univocal, poor sleep is reported by over half of pregnant women. The reasons underlyingthese compl...

Sleep is commonly affected in psychiatric and behavioral pediatric disorders, contributing to children’s disability and parental burden. Difficulties initiating and maintaining sleep, often non-restorative in quality, frequent parasomnias, such as disorders of arousals, enuresis, and nightmares; sleep-related movement disorders such as bruxism, res...

Introduction Vitamin D deficiency has been recently associated with different sleep disorders, such as sleep apnea and restless leg syndrome (RLS). An increasing number of papers has been recently published concerning the contribution of D3 deficiency to OSA severity. Methods We enrolled all sleep apnea patients referred to our sleep center in the...

Individuals with mental health and/or neurodevelopmental conditions often display disruptive day- and night-time behaviours associated with abnormally increased muscular activity and/or presentations described as hyperkinesia, hypermotor-restlessness and hyper-/hypo-arousability (all summarized as H-behaviours). H-behaviours are used as a diagnosti...

Reduced sleep duration has an almost linear correlation with excessive weight and obesity in the pediatric population. This is especially true for the youngest population, less so for adolescents, whereas later on, this relationship tends to become U-shaped in middle-aged subjects. The level of physical activity is a crucial determinant of this cor...

The last few years have been characterized by a growing interest of the medical and scientific world for the field of consciousness and its related disorders. Medically speaking, consciousness can be defined as the state of awareness of self and environment and the alertness to external stimulation, besides responsiveness to inner need. Transient l...

Background: The diagnosis of Disorders of Consciousness (DOC) is still challenging. Indeed, ~ 40% of patients in vegetative state (VS) are misdiagnosed, suggesting the need of more appropriate diagnostic tools. Emerging data are showing that EEG, including sleep structure evaluation and multimodal evoked potential recording could be helpful in DOC...

Slow wave activity (SWA) generation depends on cortico-thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulati...

Menopause in the female life cycle is a special period due to important hormonal, physical and psychological changes. Sleep disruption represents a common complaint for midlife and menopausal women, related to primary sleep disorders, including insomnia, sleep disordered breathing, and restless legs syndrome (RLS), mood and anxiety disorder, other...

Sexual hormones deeply influence the physiology of human sleep and alertness across the different phases of the female reproductive cycle. Estrogen has a REM-wake promoting effect which proves important for the female cognitive and mood profile, whereas progesterone mediates sedation by increasing NREM sleep and muscle relaxation. It also impacts b...

Major sleep disorder categories according to the International Classification of Sleep Disorders are presented along with the most appropriate and practical tools to evince a correct diagnosis. The impact of insomnia and excessive daytime sleepiness on daily life activities are emphasized. Insomnias and most common types of hypersomnias are present...

The diagnosis restless legs syndrome (RLS) in children depends on the history told by the child and his parents. The description of symptoms given by the child himor herself is most important. Additional criteria are, among others, the results of polysomnography (PSG). Description of the presenting symptoms is the aim of the study. Survey in two Eu...

Sleep and Movement Disorders is divided into four major sections and subsections preceded by an introductory essay to provide perspective on the subject. All chapters have been revised with new materials and references, and several chapters have been added to address recent advances, including new sleep-related disorders that have been classified a...

Sleep-disordered breathing (SDB) during pregnancy has recently gained medical interest due to its consequences on maternal health and fetal outcome. In fact, although epidemiologic data are still scanty, several reports indicate that snoring and obstructive sleep apnea (OSA) during pregnancy are commonly associated with maternal hypertension, morbi...

OSAS and epilepsy are reciprocally associated. Literature reports a worsening of seizure control in patients suffering from OSA, with improvement of seizures with CPAP treatment. We retrospectively analysed 27 patients suffering from both OSAS and seizures referred to our sleep center. 11 out of 27 patients underwent CPAP therapy with good complian...

Medically speaking, the term consciousness is the state of the patient's awareness of self and environment and his responsiveness to external stimulation and inner need. Temporary loss of consciousness may be caused by impaired cerebral perfusion (syncope, fainting), cerebral ischemia, migraine, epileptic seizures, metabolic disturbances, sudden in...

Complex motor activity originating during nocturnal sleep may be interpreted as due to parasomnias, dissociative sleep phenomena or experiences from inappropriate CNS activation, or as partial seizures of different origin. Different instruments may help the differential diagnosis including patient's age at onset, family and personal history, episod...

Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the co...

Restless legs syndrome (RLS), a neurological sensory-motor disorder characterized by a compelling urge to move the limbs during the night, is a sleep disturbance that impairs quality of life. Prevalence of RLS and consequences on quality of life were investigated in acromegalic patients. Fifty-six patients (20 men, 55.0 ± 1.6 years), 22 with active...

Much evidence suggests that restless legs syndrome (RLS) is a disorder characterized by an unsuppressed response to sensory urges due to abnormalities in inhibitory pathways that specifically link sensory input and motor output. Therefore, in the present study, we tested sensory-motor integration in patients with RLS, measured by short latency affe...

We describe the case of a 22-year-old male affected by NFLE reporting paroxysmal RLS-like symptoms. The patient was referred to our Sleep Center due to nocturnal paresthesias and cramps involving the left leg and leading to sleep fragmentation. At age 4, the patient presented with secondary generalized seizures preceded by left leg discomfort, cont...

The comorbidity of Attention Deficit Hyperactivity Disorder (ADHD) with sleep disorders has been extensively studied. In particular, Restless Legs Syndrome (RLS) appears to be consistently more frequent in children with ADHD. Several papers also draw attention to the frequent occurrence of epileptic seizures and EEG abnormalities in ADHD children....

This chapter discusses the case of a patient who had come to the sleep clinic with complaints of restlessness and jerks all night long from the moment he fell asleep. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The patient also reported frequent palpitat...

Telephone interviews have been used extensively as a tool to explore and assess sleep disorders and psychopathological conditions. The aim of this study was to set up and validate a telephone interview aimed at assessing the correlation between mood and sleep variables in adolescents. The study included 16-18 years subjects. A total of approximatel...

To outline specific sleep disturbances in different clinical subsets of Attention Deficit/Hyperactivity Disorder (ADHD) and to confirm, by means of nocturnal video-polysomnography (video-PSG), a variety of sleep disorders in ADHD besides the classically described periodic leg movement disorder (PLMD), restless legs syndrome (RLS) and sleep related...

In the present work, we aimed at assessing whether patients with idiopathic restless legs syndrome (RLS) showed alterations of sensory-motor plasticity, an indirect probe for motor learning, within the motor cortex (M1). Previous findings suggest that learning in human M1 occurs through LTP-like mechanisms. To test our hypothesis, we employed the p...

Recent evidence has been accumulating that the sleep of individuals with attention deficit hyperactivity disorder (ADHD) is not only disrupted in a nonspecific way but that ADHD has an increased association with simple sleep related movement disorders such as restless legs syndrome/periodic limb movements in sleep (RLS/PLMS), rhythmic movement diso...

To verify the existence of a symptomatic form of restless legs syndrome (RLS) secondary to multiple sclerosis (MS) and to identify possible associated risk factors. Prospective, multicenter, case-control epidemiologic survey. Twenty sleep centers certified by the Italian Association of Sleep Medicine. Eight hundred and sixty-one patients affected b...

51 patients (35 males, 16 females, mean age 27 ± 19) with nocturnal paroxysmal events were referred over the last two years to our Sleep Centre to obtain a differential diagnosis. Clinical interview and all night video-polysomnography with extended EEG montage (10-20 system) were carried out all leading to a diagnosis of nocturnal epilepsy in 43% o...

Introduction Parasomnias, as described in the recent second edition of the International Classification of Sleep Disorders, are “undesirable physical events or experiences” occurring during sleep transition, during arousal from sleep, or within the sleep period. They correspond to CNS patterns of activation expressed through either muscle/motoric o...

In this paper we explore the prevalence of ictal and interictal epileptiform discharges (IEDs) and sleep disorders in ADHD children referred to a sleep clinic for all night video-PSG. Forty-two ADHD outpatients (35 males and 7 females) underwent video-PSG and a behavioural/neuropsychological assessment. Spearman correlation coefficients (p<0.05 cri...

3.094 SLEEP ARCHITECTURE CHANGES IN CHILDREN WITH EPILEPSY 1ShayMenascu, 1ShellyWeiss, and 1IhaonMacLusky( Neurology, Hospital for Sick Children, Toronto, ON, Canada ) Rationale: Children with epilepsy are reported to have frequent sleep disturbances including sleep fragmentation, and excessive daytime drowsiness. Epilepsy is known to affect a chil...

In order to evaluate ADHD co-morbidity with epilepsy and sleep disorders, we recorded by means of all night polysomnography, inclusive of 18 EEG leads (10-20 system), 11 male children (mean age 9.3 range 4-13) diagnosed with ADHD according to DSM IV International Criteria, none of which had a history of seizures. Interictal epileptic discharges (IE...

Sleep is known to be severely altered in temporal lobe epilepsy (TLE). Furthermore, sleep deprivation is one of the key factors contributing to cognitive deficits and drug resistance in TLE. In the past, "non-ictal" parasomnias, as well as parasomnia-like nocturnal episodes ultimately diagnosed as seizures, have been documented in epileptic patient...

Acute and chronic administration of the selective serotonin reuptake inhibitors (SSRIs) have been widely reported to disrupt sleep in laboratory studies. This study examines the naturalistic, longitudinal effects of paroxetine and fluvoxamine on sleep quality in the home setting. Fourteen healthy volunteers free of medical and neuropsychiatric symp...

Clinical lore and a small number of published studies report that the selective serotonin reuptake inhibitors (SSRIs) intensify dreaming. This study examines the dream effects of paroxetine and fluvoxamine in order to both increase clinical knowledge of these agents and to test an important potential method for probing the relationship between REM...

To examine the seizure characteristics and electroencephalogram (EEG) abnormalities in psychiatric patients taking clozapine, given the estimate of a 10% cumulative risk of generalized seizures in this population. We reviewed all consecutive EEGs of ambulatory psychiatric patients taking clozapine performed at our laboratory during 1996 and 1997. A...

The arcadian and ultradian variations of Blood Pressure (BP) and Heart Rate (HR) are the expression of an oscillating autonomie wave stricty related to different behavioural states. During sleep is possible to observe the cardiovascular autonomie drive in basal, natural and reproducible circumstances. The non-invasive continuous BP and HR recording...

Rebound insomnia is a transient intense worsening of sleep usually appearing within 3 days from the abrupt discontinuation of benzodiazepines (mainly short-acting), following long term use and abuse of these hypnotics. Zolpidem is an imidazopyridine, that binds selectively at ω1-receptor subtypes within the GABAA receptor supramolecular complex. It...