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Di Pietro M, Dono F, Consoli S, Evangelista G, Pozzilli V, Calisi D, Barbone F, Bonanni L, Onofrj M, De Angelis MV, Sensi SL. Cerebral venous thrombosis without thrombocytopenia after a single dose of COVID-19 (Ad26.COV2.S) vaccine injection: a case report. Neurol Sci 2022; 43:2951-2956. [PMID: 35217969 PMCID: PMC8880295 DOI: 10.1007/s10072-022-05965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
Background
The coronavirus pandemic became the hard challenge for the modern global health system. To date, vaccination is the best strategy against Sars-Cov-2-related illness. About 3 billions of people received at least one of the approved vaccines. The related adverse events were reported during the various experimental phases, but newer and less common side effects are emerging post-marketing. Vaccine-induced thrombocytopenia with thrombosis (VITT) is one of these insidious adverse reactions and it is considered responsible of venous thrombosis, in both the splanchnic and the cerebral circulation. Although its mechanism has been presumably established, resembling that observed in heparin-induced thrombocytopenia, some venous thromboses seem not to recognize this etiology and their pathogenesis remains unknown. Here we described a case of cerebral venous thrombosis after administration of the Ad26.COV2.S, presenting without thrombocytopenia, paving the way for possible novel causes of this vaccine-induced pathological condition. Case presentation A 45-year-old woman came to our observation for bilateral periorbital headache associated with retro-orbital pain started 8 days after administration of COVID vaccine Jannsen. Ophthalmologic exam showing a bilateral papilledema raised the suspicion of intracranial hypertension. Cerebral magnetic resonance imaging revealed signal alteration with T1-positive contrast enhancement in the right temporal and insular lobes suggestive of cerebral venous thrombosis. The absence of thrombocytopenia and platelet factor 4 (PF-4) antibodies led the clinicians to rule out VITT. The patient was treated successfully with warfarin. Conclusion Venous thrombosis occurring after COVID-19 vaccination represents an adverse event of special interest. Patients with thrombosis and thrombocytopenia appear to be affected by a general thrombophilic state, sustained by an autoimmune mechanism, and show a higher mortality. Thrombosis without thrombocytopenia’s pathogenesis has not yet been clarified, but laboratory data and good response to vitamin K antagonists help clinicians in the differential diagnosis with VITT. Future research will allow us to discover other possible mechanisms and maybe identify a subgroup of patients with a higher risk of developing this medical complication.
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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Dono F, Evangelista G, Consoli S, Scorrano G, Di Pietro M, Vittoria De Angelis M, Faustino M, Franciotti R, Anzellotti F, Onofrj M, Frazzini V, Vollono C, Sensi SL. Heart rate variability is reduced during the menstrual phase in women with catamenial C1-type temporal lobe epilepsy. Epilepsy Behav 2022; 127:108508. [PMID: 34974372 DOI: 10.1016/j.yebeh.2021.108508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Temporal lobe epilepsy (TLE) is the most frequent focal epilepsy in adulthood. Catamenial C1-type TLE, is characterized by a cyclic seizure exacerbation during the menstrual phase. The heart rate variability (HRV) analysis assesses cardiac autonomic control and may represent a biomarker for Sudden Unexpected Death in Epilepsy (SUDEP). It is plausible that female sex hormones can influence HRV. These changes might be more pronounced in patients suffering from catamenial C1-type TLE where hormonal changes also increase seizure susceptibility. To that aim, we evaluated HRV changes during the menstrual phase of women suffering from catamenial C1-type TLE. METHODS We enrolled 12 adults with a diagnosis of catamenial C1-type TLE (Catamenial Group) and 12 age-, and seizure-frequency-matched controls with TLE (Non-Catamenial Group). Each patient underwent a 20-minute EEG + EKG recording in resting state during the menstrual phase. HRV parameters were calculated with a short-lasting analysis of EKG records. Time domain-related, frequency domain-related, as well as non-linear analysis parameters, were compared between the two groups. RESULT Compared to the Non-Catamenial Group, the Catamenial Group showed significant reductions in SDNN (p-value = 0.01), RMSSD (p-value = 0.04), pNN50 (p-value = 0.001), LnLF ms2 (p-value = 0.05), LnHF ms2 (p-value = 0.007), SD1 (p-value = 0.02), and SD2 (p-value = 0.01). These results were independent from age, disease duration, numbers of ASM, and seizure etiology. CONCLUSION Our data provide experimental evidence that vagal output is reduced during the menstrual phase in patients with catamenial C1-type TLE. These results indicate that, during the menstrual phase, patients with catamenial C1-type TLE may be at a higher risk of developing cardiac dysfunctions and SUDEP.
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Consoli S, Dono F, Evangelista G, D'Apolito M, Travaglini D, Onofrj M, Bonanni L. Status migrainosus: a potential adverse reaction to Comirnaty (BNT162b2, BioNtech/Pfizer) COVID-19 vaccine-a case report. Neurol Sci 2022; 43:767-770. [PMID: 34807361 PMCID: PMC8607053 DOI: 10.1007/s10072-021-05741-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) due to acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the largest emergency that humanity had to be dealing with in the last century. During the last months, different types of vaccines have been designed to contain the ongoing SARS-CoV-2 pandemic, with successful results in many countries. Comirnaty (Pfizer/BioNtech) COVID-19 vaccine is a lipid nanoparticle-formulated, nucleoside mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2. Although vaccines have an undeniable efficacy, they can also present several neurological side effects, including headache. According to ICHD-3 Classification, status migrainosus (SMg) is described as a debilitating migraine attack lasting for more than 72 h. Symptoms of SMg can be very severe, preventing the normal daily activities of the individual. CASE PRESENTATION In the present report, we describe a case of SMg that lasted 11 days, time correlated with the second dose of COVID-19 vaccine (Pfizer/Comirnaty) in a 37-year-old woman with a history of migraine without aura. CONCLUSIONS In patients with a history of migraine, COVID-19 vaccination could lead to a worsening of headache and, in rare cases, to the development of a SMg. This may be related to the inflammatory response that occurs after vaccination.
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Dono F, Consoli S, Evangelista G, Ricci A, Russo M, Carrarini C, Di Iorio A, Bonanni L, Anzellotti F, Onofrj M, Sensi SL. Levetiracetam Prophylaxis Therapy for Brain Tumor-Related Epilepsy (BTRE) Is Associated With a Higher Psychiatric Burden. Front Neurol 2022; 12:806839. [PMID: 35087476 PMCID: PMC8787304 DOI: 10.3389/fneur.2021.806839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Brain tumor-related epilepsy (BTRE) is a condition characterized by the development of seizures in the context of an undergoing oncological background. Levetiracetam (LEV) is a third-generation anti-seizure medication (ASM) widely used in BTRE prophylaxis. The study evaluated LEV neuropsychiatric side effects (SEs) in BTRE prophylaxis. Method: Twenty-eight patients with brain tumors were retrospectively selected and divided into two groups. In one group, we evaluated patients with a BTRE diagnosis using LEV (BTRE-group). The other group included patients with brain tumors who never had epilepsy and used a prophylactic ASM regimen with LEV (PROPHYLAXIS-group). Neuropsychiatric SEs of LEV were monitored using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at the baseline visit and the 6- and 12-month follow-up. Results: Eighteen patients of the BTRE-group and 10 patients of the PROPHYLAXIS-group were included. Compared to the BTRE-group, the PROPHYLAXIS-group showed a higher severity of neuropsychiatric symptoms. According to Linear Mixed Models (LMM), a multiplicative effect was observed for the interaction between group treatment and time. For the caregiver distress score (CDS), only a time-effect was observed. Conclusion: Prophylactic ASM with LEV is associated with an increased frequency of neuropsychiatric SE. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.
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Evangelista G, Dono F, Consoli S, Pozzilli V, Calisi D, Russo M, D'Orazio C, D'Andreagiovanni A, Montesano G, Rapini S, Caulo M, Onofrj M, Anzellotti F. Non convulsive refractory status epilepticus induced by thiocolchicoside (TCC) intrathecal injection: a case report. Br J Clin Pharmacol 2022; 88:3495-3499. [PMID: 35083767 PMCID: PMC9303690 DOI: 10.1111/bcp.15240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
TCC is a semisynthetic molecule widely used in clinical settings as a pain killer and myorelaxant. Several neurological side effects have been reported in association with TCC treatment including somnolence, confusion and seizure, the latter in a lower percentage of patients. Some previous reports described seizure onset after TCC intake in adulthood. However, major epileptological complication, namely status epilepticus, has never been previously reported in association with TCC treatment. In our report, we describe a case of acute refractory non‐convulsive status epilepticus (NCSE) in the context of a TCC‐induced acute toxic encephalopathy (ATE) in a woman without any previous neurological or physical comorbidities.
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Romozzi M, Rollo E, Quintieri P, Dono F, Evangelista G, Consoli S, Veleno L, Anzellotti F, Calvello C, Costa C, Servidei S, Calabresi P, Vollono C. Impact of COVID-19 vaccine on epilepsy in adult subjects: an Italian multicentric experience. Neurol Sci 2022; 43:4627-4634. [PMID: 35501537 PMCID: PMC9059692 DOI: 10.1007/s10072-022-06100-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the safety and tolerability of COVID-19 vaccines in people with epilepsy (PwE). METHODS In this multicentric observational cohort study, we recruited adult patients (age > 18 years old) with epilepsy who attended the Outpatient Epilepsy Clinic from 1st July to 30th October 2021. We administered to the patients a structured questionnaire and interview on demographic and epilepsy characteristics, current treatment, previous SARS-CoV-2 infection, vaccine characteristics, post-vaccine seizure relapse, other side effect, variation of sleep habits, caffeine, or alcohol intake. Seizure frequency worsening was defined as a ratio between mean monthly frequency post-vaccination and mean monthly frequency pre-vaccination superior to 1. Patients were categorized in two groups: patients with seizure frequency worsening (WORSE) and patients with seizure stability (STABLE). RESULTS A total of 358 people participated with a mean age of 47.46 ± 19.04. Focal seizure (79.1%), generalized epilepsy (20.4%), and unknown types of epilepsy (0.5%) were detected among participants. In total, 31 (8.7%) people expressed that they were not willing to receive a COVID-19 vaccine; 302 patients (92.35%) did not experience an increase in the seizure frequency (STABLE-group) whereas 25 patients (7.65%) had a seizure worsening (WORSE-group). Post-vaccine seizures occurred mainly in the 7 days following the administration of the vaccine. Patients in the WORSE-group were treated with a mean higher number of anti-seizure medication (ASMs) (p = 0.003) and had a higher pre-vaccine seizure frequency (p = 0.009) compared with patients in the STABLE-group. Drug-resistant epilepsy was also associated with seizure worsening (p = 0.01). One-year pre-vaccination seizure frequency pattern demonstrated that patients in the WORSE-group had a higher frequency pattern (p < 0.001). Multivariate analysis of the vaccinated group showed that only the seizure frequency pattern (confidence interval [CI] = 1.257-2.028; p < 0.001) was significantly associated with seizure worsening. CONCLUSION In our cohort of vaccinated PwE, only a little percentage had a transient short-term increase of seizure frequency. The present study demonstrates that COVID-19 vaccines have a good safety and tolerability profile in the short term in PwE.
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D’Onofrio A, Mastro F, Nadali M, Fiocco A, Pittarello D, Aruta P, Evangelista G, Lorenzoni G, Gregori D, Gerosa G. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6540696. [PMID: 35234902 PMCID: PMC9252130 DOI: 10.1093/icvts/ivac053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/31/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
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Dono F, Evangelista G, Consoli S, Scorrano G, Russo M, di Pietro M, Onofrj M, Sensi SL, Anzellotti F. Anti N-methyl-D-aspartate receptor (NMDAr) encephalitis during pregnancy: A case report. Epilepsy Behav Rep 2022; 19:100535. [PMID: 35520953 PMCID: PMC9062214 DOI: 10.1016/j.ebr.2022.100535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/30/2021] [Accepted: 03/13/2022] [Indexed: 11/29/2022] Open
Abstract
Focal motor status epilepticus can be a presenting sign of anti-NMDA rencephalitis during pregnancy. After the immunomodulatory treatment, the patient showed only attention deficits with normal global cognition. The newborn presented normal birth weight kg with APGAR 10 with no sign of fetal distress nor major or minor malformations.
Anti-N-methyl-D-aspartate receptor (NMDAr) antibody encephalitis is an autoimmune disorder characterized by reduced synaptic activity of the NMDAr due to circulating antibodies that target the NR1 subunit. Few cases of anti-NMDAR encephalitis during pregnancy have been described. The permeation of anti-NR1 antibodies through the placenta can be instrumental in the development of complications in newborns. We describe a case of a young woman suffering from anti-NMDAR encephalitis during the first trimester of pregnancy and focus on diagnostic and therapeutic management.
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Evangelista G, Dono F, Consoli S, Calisi D, Onofrj M, Anzellotti F, Frazzini V, Bonanni L. Autonomic Status Epilepticus in a Patient with Parasellar Meningioma: A Case Report. Case Rep Neurol 2021; 13:807-812. [PMID: 35111030 PMCID: PMC8787495 DOI: 10.1159/000519944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Autonomic status epilepticus (Aut SE) is a condition characterized by ongoing focal autonomic seizure lasting for >30 min. Aut SE can show a variety of clinical manifestations including vomiting, nausea, changes in heart rate, piloerection, pupillary abnormalities, and visual abnormalities. Although Aut SE is a common finding in childhood in the context of Panayiotopoulos syndrome, few reports have described this condition during adulthood. In the present report, we describe a case of Aut SE in an adult patient with parasellar meningioma and bilateral frontotemporal epileptiform activity on EEG record.
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Evangelista G, Dono F, Ricci A, Russo M, Carrarini C, Speranza R, Anzellotti F, Onofrj M, Sensi S, Bonanni L. Efficacy and tolerability of anti-seizure drugs in the treatment and prophylaxis of brain tumor related-epilepsy (BRTE): A real-world study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Rosa M, Calisi D, Consoli S, Evangelista G, Speranza R, Digiovanni A, Dono F, Russo M, Carrarini C, Onofrj M, Bonanni L. EEG abnormalities in patients with delirium as a predictive biomarker of dementia with Lewy bodies. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dono F, Evangelista G, Russo M, Carrarini C, Scorrano G, Lanzone J, Nucera B, Rinaldi F, Tappatà M, Calisi D, De Rosa M, Speranza R, Brigo F, Anzellotti F, Vollono C, Onofrj M, Sensi S, Bonanni L. Intermittent light stimulation in on-demand streaming television series, accuracy of information and seizure occurrence. The stream-light study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gasparini S, Ferlazzo E, Gigli G, Pauletto G, Nilo A, Lettieri C, Bilo L, Labate A, Fortunato F, Varrasi C, Cantello R, D'Aniello A, Gennaro GD, d'Orsi G, Sabetta A, Claudio MTD, Avolio C, Dono F, Evangelista G, Cavalli SM, Cianci V, Ascoli M, Mastroianni G, Lobianco C, Neri S, Mercuri S, Mammì A, Gambardella A, Beghi E, Torino C, Tripepi G, Aguglia U. Predictive factors of Status Epilepticus and its recurrence in patients with adult-onset seizures: A multicenter, long follow-up cohort study. Seizure 2021; 91:397-401. [PMID: 34298459 DOI: 10.1016/j.seizure.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. METHODS We retrospectively analyzed data of 1115 patients with seizure onset>18 years, observed from 1983 to 2020 in 7 Italian Centers (median follow-up 2.1 years). Data were collected from the databases of the Centers. Patients with SE were consecutively recruited, and patients without SE history were randomly selected in a 2:1 ratio. To assess determinants of SE, different clinical-demographic variables were evaluated and included in univariate and multivariate logistic regression model. RESULTS Three hundred forty-seven patients had a SE history, whereas the remaining 768 patients had either isolated seizures or epilepsy without SE history. The occurrence of SE was independently associated with increasing age at onset of disease (OR 1.02, 95% CI 1.01--1.03, p<0.001), female sex (OR 1.39, 95% CI 1.05--1.83, p=0.02) and known etiology (OR 3.58, 95% CI 2.61--4.93, p<0.001). SE recurred in 21% of patients with adult-onset SE and recurrence was associated with increasing number of anti-seizure medications taken at last follow-up (OR 1.88, 95% CI 1.31--2.71, p<0.001). CONCLUSIONS In patients with adult-onset seizures, SE occurrence is associated with known etiologies, advanced age and female sex. Patients with recurrent SE are likely to have a refractory epilepsy, deserving careful treatment to prevent potentially fatal events.
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Dono F, Consoli S, Evangelista G, D'Apolito M, Russo M, Carrarini C, Calisi D, De Rosa M, Di Pietro M, De Angelis MV, Travaglini D, Sensi SL, Onofrj M, Bonanni L. New daily persistent headache after SARS-CoV-2 infection: a report of two cases. Neurol Sci 2021; 42:3965-3968. [PMID: 34264414 PMCID: PMC8280630 DOI: 10.1007/s10072-021-05444-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/26/2021] [Indexed: 01/12/2023]
Abstract
Background The 2019 Coronavirus (SARS-CoV-2) is a novel respiratory virus which causes Coronavirus Disease19 (COVID-19). Although the predominant clinical picture of COVID-19 is represented by respiratory symptoms, neurological manifestations are being increasingly recognized. Headache, in particular migraine-like and tension types, has been largely reported in patients suffering from COVID-19 both in the acute and the healing phase of the infection. New daily persistent headache (NDPH) is a primary headache characterized by persistent and daily painful symptoms, with pain becoming continuous and non-remitting within 24 h, and lasting more than 3 months. Even though an increasing number of reports describe patients who develop a persistent headache, diagnosis of NPDH has been rarely explored in the context of COVID-19. Methods Two patients with persistent headache and Sars-CoV-2 infection were identified. Both underwent a full clinical and neuroradiological evaluation. Blood sample with inflammatory biomarkers search was also performed. Results According to International Classifications of Headache Disorders diagnosis of probable new daily persistent headache was made. The treatment with high doses of steroids was associated with relief of symptoms. Conclusions Our report described two cases of probable NDPH due to SARS-CoV-2 infection. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH. Given the supposed major role for neuroinflammation in the genesis of Sars-CoV-2-driven NDPH, immunomodulatory therapy should be promptly started. In line with this hypothesis, we obtained a good therapeutic response to short-term high dose of corticosteroids.
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Evangelista G, Dono F, Carrarini C, Russo M, Bonanni L. Late-onset Rasmussen encephalitis in Parry-Romberg syndrome: a case report. Neurol Sci 2021; 42:4345-4348. [PMID: 34196856 DOI: 10.1007/s10072-021-05445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
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Lattanzi S, Cagnetti C, Foschi N, Ciuffini R, Osanni E, Chiesa V, Dainese F, Dono F, Canevini MP, Evangelista G, Paladin F, Bartolini E, Ranzato F, Nilo A, Pauletto G, Marino D, Rosati E, Bonanni P, Marrelli A. Adjunctive Perampanel in Older Patients With Epilepsy: A Multicenter Study of Clinical Practice. Drugs Aging 2021; 38:603-610. [PMID: 34075567 PMCID: PMC8266697 DOI: 10.1007/s40266-021-00865-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/26/2022]
Abstract
Background Clinical data regarding use of newer antiseizure medications (ASMs) in an older population are limited. In randomized-controlled, placebo-controlled trials, older patients are under-represented, and protocols deviate markedly from routine clinical practice, limiting the external validity of results. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. Perampanel is a third-generation ASM and the first and only non-competitive alfa-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor antagonist. Objective The aim of this study was to assess the effectiveness and tolerability of adjunctive perampanel over a 1‐year period in a population of older patients with epilepsy treated in a real-world setting. Methods Older (≥ 65 years of age) patients prescribed add-on perampanel at 12 Italian epilepsy centers were retrospectively identified. Seizure occurrence, adverse events (AEs), and drug withdrawal were analyzed. Effectiveness outcomes included the rates of seizure response (≥ 50% reduction in baseline monthly seizure frequency), seizure freedom, and treatment discontinuation. Safety and tolerability outcomes were the rate of treatment discontinuation due to AEs and the incidence of AEs. Results A total of 92 patients with a median age of 69 (range 65–88) years were included. The median daily dose of perampanel at 12 months was 6 mg (interquartile range 4–6 mg). At 12 months, 53 (57.6%) patients were seizure responders, and 22 (23.9%) patients were seizure free. Twenty (21.7%) patients discontinued perampanel; the reasons for treatment withdrawal were insufficient efficacy (n = 6/20; 30.0%), AEs (n = 12/20; 60.0%), and a combination of both (n = 2/20; 10%). The most common AEs included irritability (8.7%), somnolence (4.3%), and dizziness/vertigo (4.3%). The rate of behavioral and psychiatric AEs was higher in patients with history of psychiatric comorbidities (p = 0.044). There were no differences in the occurrence of behavioral and psychiatric AEs according to the concomitant use of levetiracetam (p = 0.776) and history of cognitive decline (p = 0.332). Conclusions Adjunctive perampanel was associated with improvement in seizure control and good tolerability in a real-life setting and can represent a viable therapeutic option in older patients with epilepsy.
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Dono F, Nucera B, Lanzone J, Evangelista G, Rinaldi F, Speranza R, Troisi S, Tinti L, Russo M, Di Pietro M, Onofrj M, Bonanni L, Assenza G, Vollono C, Anzellotti F, Brigo F. Status epilepticus and COVID-19: A systematic review. Epilepsy Behav 2021; 118:107887. [PMID: 33743344 PMCID: PMC7968345 DOI: 10.1016/j.yebeh.2021.107887] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE In March 2020, the World Health Organization declared the SARS-CoV-2 infection-related coronavirus Disease (COVID-19) a pandemic. During the first and second waves of the pandemic spread, there have been several reports of COVID-19-associated neurological manifestations, including acute seizures and status epilepticus (SE). In this systematic review, we summarized the available data on clinical features, diagnosis, and therapy of COVID-19-related SE. METHODS We performed a systematic search of the literature to identify data on demographics, clinical, neurophysiological, and neuroradiological data of patients with COVID-19-related SE. We used regression models (linear or logistic) with a stepwise forward method to identify features associated with mortality or severity of SE. RESULTS Thirty-nine articles were included with a total of 47 cases of SE associated with COVID-19. Age, time between the acute respiratory phase of SARS-CoV-2 infection and SE onset, and hospitalization correlated with a higher SE severity as assessed by quantitative validated scales. CONCLUSIONS SE can be a neurological manifestation of SARS-CoV-2 infection. Although a possible association between SE and COVID-19 has been reported, the exact mechanisms are still not fully understood. Systemic inflammatory syndrome due to cytokine release could play a role in COVID-19-related SE.
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La Vecchia M, Cuccia F, Ferrera G, Mortellaro G, Cespuglio D, Ognibene L, De Gregorio G, Luca N, Trapani G, Quartuccio E, Gioia A, Palmeri A, Terranova G, Napoli G, Sanfratello A, Lotà C, Torchia M, Venuti V, Valenti V, Tripoli A, Evangelista G, Lo Casto A. PO-1127: Acute and late toxicity report of postoperative IG-IMRT for gynecological malignancies. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dono F, Evangelista G, Frazzini V, Vollono C, Carrarini C, Russo M, Ferrante C, Di Stefano V, Marchionno LP, De Angelis MV, Faustino M, Bonanni L, Onofrj M, Sensi SL, Anzellotti F. Interictal Heart Rate Variability Analysis Reveals Lateralization of Cardiac Autonomic Control in Temporal Lobe Epilepsy. Front Neurol 2020; 11:842. [PMID: 32922353 PMCID: PMC7456848 DOI: 10.3389/fneur.2020.00842] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/07/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose: The temporal lobe, a critical hub for cognition, also plays a central role in the regulation of autonomic cardiovascular functions. Lesions in this area are usually associated with abnormalities in the regulation of heart rate (HR) and blood pressure (BP). The analysis of the heart rate variability (HRV) is useful to evaluate the cardiac parasympathetic nervous system activity. This study aims at comparing HRV changes occurring in two groups of patients suffering from Temporal Lobe Epilepsy (TLE). To that aim, we evaluated patients differentiated by the right or left location of the epileptic foci. Materials and Methods: Fifty-two adult patients with a diagnosis of TLE were enrolled. Each patient underwent a 20-min EEG + EKG recording in resting state. According to the localization of epileptic focus, patients were divided into two subgroups: right TLE (R-TLE) and left TLE (L-TLE). HRV parameters were calculated with a short-lasting analysis of EKG recordings. Time-domain and frequency domain-related, as well as non-linear analysis, parameters, were compared between the two groups. Results: Compared to the R-TLE group, L-TLE subjects showed a significant decrease in low frequency (LF) (p < 0.01) and low frequency/high-frequency ratio (LF/HF) (p < 0.001) as well as increased HF values (p < 0.01), a parameter indicative of the presence of an increased cardiac vagal tone. These results were also confirmed in the subgroup analysis that took into account the seizure types, responses to antiepileptic drugs, seizure frequencies, and etiology. Conclusions: The main finding of the study is that, compared to R-TLE, L-TLE is associated with increased cardiac vagal tone. These results indicate that patients with TLE exhibit a lateralized cardiac autonomic control. L-TLE patients may have a lower risk of developing cardiac dysfunctions and less susceptible to develop Sudden Death for Epilepsy (SUDEP).
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Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol 2020; 11:461. [PMID: 32582005 PMCID: PMC7280483 DOI: 10.3389/fneur.2020.00461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4-4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to "dual diagnosis," is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.
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Pollara L, Cuccia F, Figlia V, Palmeri A, Gueci M, Luca N, Aiello D, Evangelista G, Sciumè F. EP-1976: Concomitant radio-chemotherapy and brachytherapy for advanced cervical cancer: outcomes and toxicity. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gueci M, Grillo A, Caminiti G, Evangelista G, Bono M, Sciumè F. EP-1674: Helical Tomotherapy (HT): role of Image-guided (IGRT) in treatment of nasopharynx focusing on acute toxicity. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41666-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grillo A, Gueci M, Sciumè F, Evangelista G, Lo Casto A. EP-1652: Feasibility, tolerance and toxicity of adjuvant vaginal brachytherapy in endometrial cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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