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Mazzeo A, Cerulli Irelli E, Leodori G, Mancuso M, Morano A, Giallonardo AT, Di Bonaventura C. Resting-state electroencephalography microstates as a marker of photosensitivity in juvenile myoclonic epilepsy. Brain Commun 2024; 6:fcae054. [PMID: 38444911 PMCID: PMC10914451 DOI: 10.1093/braincomms/fcae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Juvenile myoclonic epilepsy is an idiopathic generalized epilepsy syndrome associated with photosensitivity in approximately 30-40% of cases. Microstates consist of a brief period of time during which the topography of the whole resting-state electroencephalography signal is characterized by a specific configuration. Previous neurophysiological and neuroimaging studies have suggested that Microstate B may represent activity within the visual network. In this case-control study, we aimed to investigate whether anatomical and functional alterations in the visual network observed in individuals with photosensitivity could lead to changes in Microstate B dynamics in photosensitive patients with juvenile myoclonic epilepsy. Resting-state electroencephalography microstate analysis was performed on 28 patients with juvenile myoclonic epilepsy. Of these, 15 patients exhibited photosensitivity, while the remaining 13 served as non-photosensitive controls. The two groups were carefully matched in terms of age, sex, seizure control and anti-seizure medications. Multivariate analysis of variance and repeated-measures analysis of variance were performed to assess significant differences in microstate metrics and syntax between the photosensitive and the non-photosensitive group. Post hoc false discovery rate adjusted unpaired t-tests were used to determine differences in specific microstate classes between the two groups. The four classical microstates (Classes A, B, C and D) accounted for 72.8% of the total electroencephalography signal variance in the photosensitive group and 75.64% in the non-photosensitive group. Multivariate analysis of variance revealed a statistically significant class-group interaction on microstate temporal metrics (P = 0.021). False discovery rate adjusted univariate analyses of variance indicated a significant class-group interaction for both mean occurrence (P = 0.002) and coverage (P = 0.03), but not for mean duration (P = 0.14). Post hoc false discovery rate adjusted unpaired t-tests showed significantly higher coverage (P = 0.02) and occurrence (P = 0.04) of Microstate B in photosensitive patients compared with non-photosensitive participants, along with an increased probability of transitioning from Microstates C (P = 0.04) and D (P = 0.02) to Microstate B. No significant differences were found concerning the other microstate classes between the two groups. Our study provides novel insights on resting-state electroencephalography microstate dynamics underlying photosensitivity in patients with juvenile myoclonic epilepsy. The increased representation of Microstate B in these patients might reflect the resting-state overactivation of the visual system underlying photosensitivity. Further research is warranted to investigate microstate dynamics in other photosensitive epilepsy syndromes.
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Affiliation(s)
- Adolfo Mazzeo
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | | | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
- IRCCS Neuromed, Pozzilli 86077, Italy
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
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Morano A, Orlando B, Fanella M, Cerulli Irelli E, Colonnese C, Quarato P, Giallonardo AT, Di Bonaventura C. Musicogenic epilepsy in paraneoplastic limbic encephalitis: a video-EEG case report. Epileptic Disord 2023. [PMID: 37430419 DOI: 10.1002/epd2.20111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/28/2021] [Accepted: 02/06/2021] [Indexed: 07/12/2023]
Abstract
Musicogenic epilepsy (ME), a peculiar form of reflex epilepsy, represents a neurological rarity and yet another demonstration of the extraordinary power of music on the human brain. Despite the heterogeneity of the reported musical triggers, the patients' emotional response to music is thought to play a crucial role in provoking seizures. Accordingly, the mesial temporal structures (especially of the non-dominant hemisphere) appear most involved in seizure generation, although a more complex fronto-temporal epileptogenic network was documented in some cases. Autoimmune encephalitis has been recently included among the many possible etiologies of ME thanks to few reports of music-induced seizures in patients with anti-glutamic acid decarboxylase 65 antibodies. Here we describe the case of a 25-year-old man, with long-term music education, who suffered from drug-resistant temporal lobe epilepsy following seronegative limbic encephalitis related to non-Hodgkin lymphoma. Along with spontaneous events, the patient also developed musicogenic seizures later in the disease course. After detecting five music-induced episodes via 24-h ambulatory EEG, we performed a prolonged video-EEG monitoring during which the patient presented a right temporal seizure (characterized by déjà-vu, piloerection and gustatory hallucinations) while listening to a hard-rock song (never heard before) through headphones. This observation allowed us to confirm the provoking effect of music on our patient's seizures, despite the lack of any emotional drive, which suggests that a "cognitive" trigger was more likely in this case. Our report further highlights that autoimmune encephalitis should be investigated as a novel potential cause of musicogenic epilepsy, regardless of autoantibody status.
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Affiliation(s)
- Alessandra Morano
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome
| | - Biagio Orlando
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome
| | - Martina Fanella
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome
- Neurology Unit, Ospedale "San Camillo de' Lellis" Rieti
| | | | | | | | | | - Carlo Di Bonaventura
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome
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Tullo MG, Cerulli Irelli E, Caramia F, Tessari G, Di Bonaventura C, Turchetta R, Giallonardo AT, Palumbo G, Bianchi S, Atturo F, Nebbioso M, Mancini P, Guariglia C, Giona F. The Spectrum of Neurological and Sensory Abnormalities in Gaucher Disease Patients: A Multidisciplinary Study (SENOPRO). Int J Mol Sci 2023; 24:ijms24108844. [PMID: 37240189 DOI: 10.3390/ijms24108844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Gaucher disease (GD) has been increasingly recognized as a continuum of phenotypes with variable neurological and sensory involvement. No study has yet specifically explored the spectrum of neuropsychiatric and sensory abnormalities in GD patients through a multidisciplinary approach. Abnormalities involving the nervous system, including sensory abnormalities, cognitive disturbances, and psychiatric comorbidities, have been identified in GD1 and GD3 patients. In this prospective study, named SENOPRO, we performed neurological, neuroradiological, neuropsychological, ophthalmological, and hearing assessments in 22 GD patients: 19 GD1 and 3 GD3. First, we highlighted a high rate of parkinsonian motor and non-motor symptoms (including high rates of excessive daytime sleepiness), especially in GD1 patients harboring severe glucocerebrosidase variants. Secondly, neuropsychological evaluations revealed a high prevalence of cognitive impairment and psychiatric disturbances, both in patients initially classified as GD1 and GD3. Thirdly, hippocampal brain volume reduction was associated with impaired short- and long-term performance in an episodic memory test. Fourthly, audiometric assessment showed an impaired speech perception in noise in the majority of patients, indicative of an impaired central processing of hearing, associated with high rates of slight hearing loss both in GD1 and GD3 patients. Finally, relevant structural and functional abnormalities along the visual system were found both in GD1 and GD3 patients by means of visual evoked potentials and optical coherence tomography. Overall, our findings support the concept of GD as a spectrum of disease subtypes, and support the importance of in-depth periodic monitoring of cognitive and motor performances, mood, sleep patterns, and sensory abnormalities in all patients with GD, independently from the patient's initial classification.
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Affiliation(s)
- Maria Giulia Tullo
- Department of Translational and Precision Medicine, "La Sapienza" University of Rome, 00161 Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, ITAB-Institute of Advanced Biomedical Technologies, "G. D'Annunzio" University, 66100 Chieti, Italy
| | | | - Francesca Caramia
- Department of Human Neuroscience, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Gianmarco Tessari
- Department of Psychology, "La Sapienza" University of Rome, 00185 Rome, Italy
- PhD Program in Behavioral Neuroscience, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neuroscience, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Rosaria Turchetta
- Department of Sense Organs, "La Sapienza" University of Rome, 00185 Rome, Italy
| | | | - Giovanna Palumbo
- Department of Translational and Precision Medicine, "La Sapienza" University of Rome, 00161 Rome, Italy
| | - Simona Bianchi
- Department of Translational and Precision Medicine, "La Sapienza" University of Rome, 00161 Rome, Italy
| | - Francesca Atturo
- Department of Sense Organs, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Patrizia Mancini
- Department of Sense Organs, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Cecilia Guariglia
- Department of Psychology, "La Sapienza" University of Rome, 00185 Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, "La Sapienza" University of Rome, 00161 Rome, Italy
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Giallonardo AT, Aguglia U, Goldman S, Chiacchiaretta M, Gentile A, Patten A. 068 Effect of low dose adjunctive perampanel in adults and adolescents with focal- onset seizures. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWe report a post hoc analysis of the efficacy and safety of low dose adjunctive perampanel 4 mg/day in adults and adolescents from A Mirroring Clinical Practice Study in Italy (AMPA;NCT04257604).MethodsAMPA was a prospective, observational study in patients aged ≥12 years with focal-onset seizures (FOS). Patients were prescribed adjunctive perampanel per the approved indication. Seizure diaries and treatment-emergent adverse events (TEAEs) were verified at baseline and study visits. The primary endpoint was change from baseline in seizure frequency/28 days at Month 6. Secondary endpoints included: 50% and 75% responder rates, seizure-freedom rates, retention rates and safety (≤12 months).ResultsOf the 234 patients who received adjunctive perampanel, 62 (26.5%) received a modal peram- panel dose of 4 mg/day and were included in the Safety Analysis Set. The 6-month median reduction from baseline in all-seizure frequency was 55.4% (95% confidence interval, 31.7%-90.3%). The 12-month 50% and 75% responder, seizure-freedom and retention rates were 57.1%, 46.9%, 26.0% and 46.8%, respec- tively. TEAEs occurred in 50% of patients; the most common TEAE was dizziness/vertigo (17.7% [n=11]).ConclusionsAdjunctive perampanel at 4 mg/day is efficacious and safe in adult and adolescent patients with FOS in a real-world clinical setting. Funding: Eisai s.r.l.
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De Biase A, Paparella G, Angelini L, Cannavacciuolo A, Colella D, Cerulli Irelli E, Giallonardo AT, Di Bonaventura C, Berardelli A, Bologna M. TREMOR AND MOVEMENT SLOWNESS ARE TWO UNRELATED SIDE EFFECTS INDUCED BY VALPROATE INTAKE. Mov Disord Clin Pract 2022; 9:1062-1073. [DOI: 10.1002/mdc3.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Luca Angelini
- Department of Human Neurosciences Sapienza University of Rome Italy
| | | | - Donato Colella
- Department of Human Neurosciences Sapienza University of Rome Italy
| | | | | | | | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
| | - Matteo Bologna
- Department of Human Neurosciences Sapienza University of Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
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Morano A, Cerulli Irelli E, Salamone EM, Orlando B, Fanella M, Tinelli E, Ruffolo G, Zuliani L, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Late-onset seizures and epilepsy: Electroclinical features suggestive of autoimmune etiology. Front Neurol 2022; 13:924859. [PMID: 36034285 PMCID: PMC9412019 DOI: 10.3389/fneur.2022.924859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Late-onset epilepsy (LOE) has recently become a topic of intense research. Besides stroke, tumors, and dementia, autoimmune encephalitis (AE) has emerged as another possible cause of recurrent seizures in the elderly, and may account for a proportion of cases of LOE of unknown origin (LOEUO). This 24-h ambulatory electroencephalography (AEEG)-based study compared patients with LOEUO and AE to identify features suggestive of immune-mediated seizures in the elderly. Materials and methods We retrospectively reviewed 232 AEEG examinations performed in patients over 55 years with ≥6-month follow-up, and selected 21 subjects with AE and 25 subjects with LOEUO. Clinical charts and AEEG recordings were carefully analyzed. Results Twenty-five patients with LOEUO (12 women, mean age at onset 67.9 years) and 21 AE subjects (8 women, mean age at onset 65.7 years) were enrolled. High-frequency seizures were reported in 20/21 AE and 7/25 LOEUO cases (p < 0.00001). Focal aware seizures were more common in AE (14/21 vs. 6/25, p = 0.00058), whereas “isolated” focal-to-bilateral tonic-clonic seizures occurred in 5/25 patients with LOEUO only (p = 0.053). AE subjects reported ictal autonomic manifestations more frequently (p = 0.0033). Three-hundred-seventy and 24 seizures were recorded in 13/21 patients with AE and 3/25 patients with LOEUO, respectively (p = 0.0006). Interictal epileptiform discharges were observed in 70% of both groups, but their sleep activation was more common in AE (p = 0.06). Conclusion Our study shows that high-frequency focal seizures with autonomic manifestations should raise the suspicion of AE in the elderly with new-onset seizures. It also highlights the relevant contribution of AEEG, which might reduce the diagnostic delay and provide useful clues to recognize AE.
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Affiliation(s)
- Alessandra Morano
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Enrico Michele Salamone
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Biagio Orlando
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Ospedale “Fabrizio Spaziani”, Frosinone, Italy
| | - Emanuele Tinelli
- Unit of Neuroradiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur-Fondazione Cenci Bolognetti, “Sapienza” University of Rome, Rome, Italy
- Istituto di ricerca e cura a carattere scientifico (IRCCS) San Raffaele Roma, Rome, Italy
| | | | - Jinane Fattouch
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Mario Manfredi
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Centre, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Carlo Di Bonaventura
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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: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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Cerulli Irelli E, Barone FA, Mari L, Morano A, Orlando B, Salamone EM, Marchi A, Fanella M, Fattouch J, Placidi F, Giallonardo AT, Izzi F, Di Bonaventura C. Generalized Fast Discharges Along the Genetic Generalized Epilepsy Spectrum: Clinical and Prognostic Significance. Front Neurol 2022; 13:844674. [PMID: 35356452 PMCID: PMC8960043 DOI: 10.3389/fneur.2022.844674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the electroclinical characteristics and the prognostic impact of generalized fast discharges in a large cohort of genetic generalized epilepsy (GGE) patients studied with 24-h prolonged ambulatory electroencephalography (paEEG). Methods This retrospective multicenter cohort study included 202 GGE patients. The occurrence of generalized paroxysmal fast activity (GPFA) and generalized polyspike train (GPT) was reviewed. GGE patients were classified as having idiopathic generalized epilepsy (IGE) or another GGE syndrome (namely perioral myoclonia with absences, eyelid myoclonia with absences, epilepsy with myoclonic absences, generalized epilepsy with febrile seizures plus, or GGE without a specific epilepsy syndrome) according to recent classification proposals. Results GPFA/GPT was found in overall 25 (12.4%) patients, though it was significantly less frequent in IGE compared with other GGE syndromes (9.3 vs. 25%, p = 0.007). GPFA/GPT was found independently of seizure type experienced during history, the presence of mild intellectual disability/borderline intellectual functioning, or EEG features. At multivariable analysis, GPFA/GPT was significantly associated with drug resistance (p = 0.04) and with a higher number of antiseizure medications (ASMs) at the time of paEEG (p < 0.001) and at the last medical observation (p < 0.001). Similarly, GPFA/GPT, frequent/abundant generalized spike-wave discharges during sleep, and a higher number of seizure types during history were the only factors independently associated with a lower chance of achieving 2-year seizure remission at the last medical observation. Additionally, a greater number of GPFA/GPT discharges significantly discriminated between patients who achieved 2-year seizure remission at the last medical observation and those who did not (area under the curve = 0.77, 95% confidence interval 0.57–0.97, p = 0.02) Conclusion We found that generalized fast discharges were more common than expected in GGE patients when considering the entire GGE spectrum. In addition, our study highlighted that GPFA/GPT could be found along the entire GGE continuum, though their occurrence was more common in less benign GGE syndromes. Finally, we confirmed that GPFA/GPT was associated with difficult-to-treat GGE, as evidenced by the multivariable analysis and the higher ASM load during history.
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Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | | | - Luisa Mari
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Biagio Orlando
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Enrico Michele Salamone
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Angela Marchi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Fabio Placidi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
| | - Francesca Izzi
- Epilepsy Center, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Policlinico “Umberto I”, Sapienza University, Rome, Italy
- *Correspondence: Carlo Di Bonaventura
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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] [What about the content of this article? (0)] [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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Morano A, Cerulli Irelli E, Fanella M, Orlando B, Salamone EM, Tinelli E, Ruffolo G, Zuliani L, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Olfactory impairment in autoimmune encephalitis: another piece of the puzzle. J Neurol 2022; 269:2762-2768. [PMID: 35006386 PMCID: PMC8743233 DOI: 10.1007/s00415-022-10959-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
Background Despite being long neglected, olfaction has recently become a focus of intense research in neuroscience, as smell impairment has been consistently documented in both neurodegenerative and neuroinflammatory diseases. Considering the close anatomo-functional correlations between the limbic system and the central olfactory structures, we investigated olfaction in a population of patients with autoimmune encephalitis (AE). Methods Nineteen adult subjects (14 males, median age 64 years) diagnosed with definite (14/19) or possible (5/19) AE and followed for ≥ 6 months were enrolled. The Brief Smell Identification Test (B-SIT), a 12-item, forced-choice, scratch-and-sniff measure, was used to assess the patients’ olfactory function in comparison with a group of sex- and age-matched healthy controls (HC). According to the B-SIT score, subjects were classified as anosmic (< 6), hyposmic (6–8) and normal (≥ 9). Electro-clinical, laboratory and neuroimaging findings were reviewed. Results Smell impairment was revealed in 15/19 patients (9 hyposmic, 6 anosmic), compared with 5/19 HC (p = 0.0029). Age, gender and smoking habits did not affect the participants’ performance at B-SIT. Olfactory dysfunction appeared more common among patients with definite AE (p = 0.0374), regardless of autoantibody status. Subjects with higher modified Rankin Scale (mRS) scores at AE onset more likely presented hyposmia/anosmia (p = 0.033), and so did those with bilateral ictal/interictal EEG abnormalities (p = 0.006). Conclusions We found olfaction to be impaired in a significantly large proportion of AE cases. Smell deficits appeared more common in subjects with severe AE (as indicated by both definite diagnosis and higher mRS score), and might represent an additional feature of immune-mediated encephalitis. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-10959-6.
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Affiliation(s)
- Alessandra Morano
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Ospedale "San Camillo de' Lellis", Rieti, Italy
| | - Biagio Orlando
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Enrico Michele Salamone
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur-Fondazione Cenci Bolognetti, "Sapienza" University of Rome, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Jinane Fattouch
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Mario Manfredi
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
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Canafoglia L, Franceschetti S, Gambardella A, Striano P, Giallonardo AT, Tinuper P, Di Bonaventura C, Michelucci R, Ferlazzo E, Granata T, Magaudda A, Licchetta L, Filla A, La Neve A, Riguzzi P, Cantisani TA, Fanella M, CASTELLOTTI BARBARA, Gellera C, Bahlo M, Zara F, Courage C, Lehesjoki AE, Oliver KL, Berkovic SF. Progressive Myoclonus Epilepsies. Neurol Genet 2021; 7:e641. [PMID: 34786481 PMCID: PMC8589262 DOI: 10.1212/nxg.0000000000000641] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives To assess the current diagnostic yield of genetic testing for the progressive myoclonus epilepsies (PMEs) of an Italian series described in 2014 where Unverricht-Lundborg and Lafora diseases accounted for ∼50% of the cohort. Methods Of 47/165 unrelated patients with PME of indeterminate genetic origin, 38 underwent new molecular evaluations. Various next-generation sequencing (NGS) techniques were applied including gene panel analysis (n = 7) and/or whole-exome sequencing (WES) (WES singleton n = 29, WES trio n = 7, and WES sibling n = 4). In 1 family, homozygosity mapping was followed by targeted NGS. Clinically, the patients were grouped in 4 phenotypic categories: “Unverricht-Lundborg disease-like PME,” “late-onset PME,” “PME plus developmental delay,” and “PME plus dementia.” Results Sixteen of 38 (42%) unrelated patients reached a positive diagnosis, increasing the overall proportion of solved families in the total series from 72% to 82%. Likely pathogenic variants were identified in NEU1 (2 families), CERS1 (1 family), and in 13 nonfamilial patients in KCNC1 (3), DHDDS (3), SACS, CACNA2D2, STUB1, AFG3L2, CLN6, NAXE, and CHD2. Across the different phenotypic categories, the diagnostic rate was similar, and the same gene could be found in different phenotypic categories. Discussion The application of NGS technology to unsolved patients with PME has revealed a collection of very rare genetic causes. Pathogenic variants were detected in both established PME genes and in genes not previously associated with PME, but with progressive ataxia or with developmental encephalopathies. With a diagnostic yield >80%, PME is one of the best genetically defined epilepsy syndromes.
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Morano A, Cerulli Irelli E, Fanella M, Zuliani L, Giallonardo AT, Di Bonaventura C. The grey zone between autoimmune encephalitis and autoimmune-associated epilepsy. Epilepsia Open 2021; 7:210-211. [PMID: 34779153 PMCID: PMC8886068 DOI: 10.1002/epi4.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/09/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Martina Fanella
- Neurology Unit, "San Camillo de' Lellis" Hospital, Rieti, Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
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De Biase A, Paparella G, Angelini L, Cannavacciuolo A, Colella D, Di Bonaventura C, Giallonardo AT, Berardelli A, Bologna M. Bradykinesia in patients with valproate-induced tremor. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Morano A, Irelli EC, Fanella M, Orlando B, Salamone E, Tinelli E, Ruffolo G, Giallonardo AT, Di Bonaventura C. Olfactory impairment in autoimmune encephalitis: A possible clinical clue? J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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D’Aniello A, Giallonardo AT, Mecarelli O, Aguglia U, Assenza G, Meletti S, De Giorgis V, Bonanni E, Michelucci R, Cerminara C, Romeo A, De Liso P, Copetti M, Gentile A, Chiacchiaretta M, Di Gennaro G. Ampa study (a mirroring clinical practice study of perampanel in adults and adolescents) design: Real-world prospective study of perampanel as add-on therapy for focal-onset seizures. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zummo L, Vitale AM, Caruso Bavisotto C, De Curtis M, Garbelli R, Giallonardo AT, Di Bonaventura C, Fanella M, Conway de Macario E, Cappello F, Macario AJL, Marino Gammazza A. Molecular Chaperones and miRNAs in Epilepsy: Pathogenic Implications and Therapeutic Prospects. Int J Mol Sci 2021; 22:ijms22168601. [PMID: 34445306 PMCID: PMC8395327 DOI: 10.3390/ijms22168601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a pathologic condition with high prevalence and devastating consequences for the patient and its entourage. Means for accurate diagnosis of type, patient monitoring for predicting seizures and follow up, and efficacious treatment are desperately needed. To improve this adverse outcome, miRNAs and the chaperone system (CS) are promising targets to understand pathogenic mechanisms and for developing theranostics applications. miRNAs implicated in conditions known or suspected to favor seizures such as neuroinflammation, to promote epileptic tolerance and neuronal survival, to regulate seizures, and others showing variations in expression levels related to seizures are promising candidates as useful biomarkers for diagnosis and patient monitoring, and as targets for developing novel therapies. Components of the CS are also promising as biomarkers and as therapeutic targets, since they participate in epileptogenic pathways and in cytoprotective mechanisms in various epileptogenic brain areas, even if what they do and how is not yet clear. The data in this review should help in the identification of molecular targets among the discussed miRNAs and CS components for research aiming at understanding epileptogenic mechanisms and, subsequently, develop means for predicting/preventing seizures and treating the disease.
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Affiliation(s)
- Leila Zummo
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Department of Neurology and Stroke Unit, A.R.N.A.S. Ospedale Civico—Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Alessandra Maria Vitale
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Celeste Caruso Bavisotto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Marco De Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (M.D.C.); (R.G.)
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Martina Fanella
- Department of Human Neurosciences “Sapienza”, University of Rome, 00185 Rome, Italy; (A.T.G.); (C.D.B.); (M.F.)
- Policlinico Umberto I, 00161 Rome, Italy
| | - Everly Conway de Macario
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Francesco Cappello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Alberto J. L. Macario
- Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Antonella Marino Gammazza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Section of Human Anatomy, University of Palermo, 90127 Palermo, Italy; (L.Z.); (A.M.V.); (C.C.B.); (F.C.)
- Correspondence:
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Paparella G, Angelini L, De Biase A, Cannavacciuolo A, Colella D, Di Bonaventura C, Giallonardo AT, Berardelli A, Bologna M. Clinical and Kinematic Features of Valproate-Induced Tremor and Differences with Essential Tremor. Cerebellum 2021; 20:374-383. [PMID: 33200286 PMCID: PMC8213593 DOI: 10.1007/s12311-020-01216-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Tremor is a common movement disorder that can be induced by medications, including valproate, which is used for the treatment of epilepsy. However, the clinical and neurophysiological features of valproate-induced tremor are still under-investigated. We performed a clinical and kinematic assessment of valproate-induced tremor by considering tremor body distribution and activation conditions. We investigated possible correlations between demographic and clinical data and kinematic features. Valproate-induced tremor results were also compared with those collected in a large sample of patients with essential tremor. Sixteen valproate-induced tremor patients and 93 essential tremor patients were enrolled. All participants underwent a standardised neurological examination and video recording. Patients also underwent an objective assessment of postural, kinetic and rest tremor of the upper limbs and head tremor through kinematic analysis. Nonparametric tests were used for statistical comparisons between the two groups. Clinical evaluation showed a higher occurrence of rest tremor as well as head or voice, and lower limb involvement in patients with valproate-induced tremor. Kinematic analysis showed a substantial variability in the tremor features of patients with valproate-induced tremor. Compared to essential tremor, we found a higher occurrence of rest tremor of the upper limbs and the involvement of more body segments in valproate-induced tremor patients. Valproate-induced tremor has distinctive clinical and kinematic features, which may suggest that valproate interferes with the cerebellar functions.
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Affiliation(s)
| | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandro De Biase
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Antonio Cannavacciuolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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Cerulli Irelli E, Fisco G, Morano A, Giallonardo AT, Di Bonaventura C. Letter to the editor: focal non-convulsive status epilepticus manifesting as utilization behavior. Neurol Sci 2021; 42:3885-3887. [PMID: 34043119 DOI: 10.1007/s10072-021-05334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Giacomo Fisco
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Chiesa V, Dainese F, De Maria G, Didato G, Falcicchio G, Fanella M, Ferlazzo E, Fisco G, Gangitano M, Giallonardo AT, Giorgi FS, La Neve A, Mecarelli O, Montalenti E, Piazza F, Pulitano P, Quarato PP, Ranzato F, Rosati E, Tassi L, Di Bonaventura C. Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST). CNS Drugs 2021; 35:1289-1301. [PMID: 34476770 PMCID: PMC8642333 DOI: 10.1007/s40263-021-00856-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. OBJECTIVE This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. METHODS The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure-freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. RESULTS A total of 1029 patients with a median age of 45 years (33-56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). CONCLUSION The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Laura Canafoglia
- Department of Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy ,Department of Health Sciences, Università degli Studi, Milan, Italy
| | | | - Valentina Chiesa
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center, Spedali Civili, Brescia, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari “A. Moro”, Bari, Italy
| | - Martina Fanella
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giacomo Fisco
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience, and advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Filippo Sean Giorgi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy ,Neurology Unit, Pisa University Hospital, Pisa, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari “A. Moro”, Bari, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elisa Montalenti
- Epilepsy Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Piazza
- Department of Neurosciences, Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Federica Ranzato
- Epilepsy Center, UOC Neurology, AULSS, 8 Vicenza, Vicenza, Italy
| | - Eleonora Rosati
- Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Laura Tassi
- C. Munari” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Morano A, Fanella M, Cerulli Irelli E, Barone FA, Fisco G, Orlando B, Albini M, Fattouch J, Manfredi M, Casciato S, Di Gennaro G, Giallonardo AT, Di Bonaventura C. Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis. Seizure 2020; 83:160-168. [PMID: 33161244 DOI: 10.1016/j.seizure.2020.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Seizures are common in autoimmune encephalitis (AE), and an extensive work-up is required to exclude alternative etiologies. The aim of our study was to identify possible clinical/EEG peculiarities suggesting the immune-mediated origin of late-onset seizures. METHODS Thirty patients diagnosed with AE (19 men, median age 68 years, 18 seronegative) were included. Overall 212 video-electroencephalographic (EEG) and 31 24-h ambulatory EEG (AEEG) recordings were retrospectively reviewed. Posterior dominant rhythm, interictal epileptiform discharges (IEDs), clinical (CSs) and subclinical seizures (SCSs) were analyzed. RESULTS Six-hundred-nineteen ictal events were recorded in 19/30 subjects, mostly (568/619) during AE acute stage. Among ten patients with CSs other than faciobrachial dystonic seizures, 7 showed prominent autonomic and emotional manifestations. SCSs were detected in 11 subjects, mainly via AEEG (260/287 SCSs vs 150/332 CSs, p < 0.001). Eight patients presented seizures during hyperventilation. IEDs, documented in 21 cases, were bilateral in 14 and focal temporal in 13. Multiple ictal EEG patterns were detected in 9/19 patients, 6 of whom had both CSs and SCSs, bilateral asynchronous seizures and ictal activities arising from temporal and extra-temporal regions. No correlation was found between the lateralization of MRI alterations and that of EEG findings. CONCLUSION Our study confirms that adult-onset, high frequency focal seizures with prominent autonomic and emotional manifestations should be investigated for AE. Multiple ictal EEG patterns could represent a 'red flag', reflecting a widespread neuronal excitability related to the underlying immune-mediated process. Finally, our work enhances the crucial role of long-lasting EEG monitoring in revealing subclinical and relapsing seizures.
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Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy; Neurology Unit, "San Camillo de' Lellis" General Hospital, Rieti, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesca A Barone
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Giacomo Fisco
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Biagio Orlando
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Jinane Fattouch
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Mario Manfredi
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Sara Casciato
- Epilepsy Surgery Unit, IRCCS "Neuromed", Pozzilli, IS, Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
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21
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Cerulli Irelli E, Morano A, Barone FA, Fisco G, Fanella M, Orlando B, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Persistent treatment resistance in genetic generalized epilepsy: A long‐term outcome study in a tertiary epilepsy center. Epilepsia 2020; 61:2452-2460. [DOI: 10.1111/epi.16708] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Francesca A. Barone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Giacomo Fisco
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Biagio Orlando
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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22
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Assenza G, Tombini M, Lanzone J, Ricci L, Di Lazzaro V, Casciato S, Morano A, Giallonardo AT, Di Bonaventura C, Beghi E, Ferlazzo E, Gasparini S, Giuliano L, Pisani F, Benna P, Bisulli F, De Falco FA, Franceschetti S, La Neve A, Meletti S, Mostacci B, Sartucci F, Striano P, Villani F, Aguglia U, Avanzini G, Belcastro V, Bianchi A, Cianci V, Labate A, Magaudda A, Michelucci R, Verri A, Zaccara G, Pizza V, Tinuper P, Di Gennaro G. Antidepressant effect of vagal nerve stimulation in epilepsy patients: a systematic review. Neurol Sci 2020; 41:3075-3084. [PMID: 32524324 DOI: 10.1007/s10072-020-04479-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vagal nerve stimulation (VNS) is an effective palliative therapy in drug-resistant epileptic patients and is also approved as a therapy for treatment-resistant depression. Depression is a frequent comorbidity in epilepsy and it affects the quality of life of patients more than the seizure frequency itself. The aim of this systematic review is to analyze the available literature about the VNS effect on depressive symptoms in epileptic patients. MATERIAL AND METHODS A comprehensive search of PubMed, Medline, Scopus, and Google Scholar was performed, and results were included up to January 2020. All studies concerning depressive symptom assessment in epileptic patients treated with VNS were included. RESULTS Nine studies were included because they fulfilled inclusion criteria. Six out of nine papers reported a positive effect of VNS on depressive symptoms. Eight out of nine studies did not find any correlation between seizure reduction and depressive symptom amelioration, as induced by VNS. Clinical scales for depression, drug regimens, and age of patients were broadly different among the examined studies. CONCLUSIONS Reviewed studies strongly suggest that VNS ameliorates depressive symptoms in drug-resistant epileptic patients and that the VNS effect on depression is uncorrelated to seizure response. However, more rigorous studies addressing this issue are encouraged.
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Affiliation(s)
- Giovanni Assenza
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Tombini
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Jacopo Lanzone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Ricci
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sara Casciato
- Epilepsy Surgery Center, IRCCS NEUROMED, Via Atinense 18, 86170, Pozzilli (IS), Italy
| | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Loretta Giuliano
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolo Benna
- Department of Neurosciences, University of Torino, Torino, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Silvana Franceschetti
- Department of Neurophysiopathology, Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angela La Neve
- Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Mostacci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Ferdinando Sartucci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana and Neuroscience Institute, CNR, Pisa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy.,Pediatric Neurology and Muscular Diseases Unit, IRCCS 'G. Gaslini' Institute, Genoa, Italy
| | - Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuliano Avanzini
- Department of Neurophysiopathology, Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Belcastro
- Child Neuropsychiatry Unit, Department of Mental Health, ASST-Lariana, Como, Italy
| | - Amedeo Bianchi
- Division of Neurology, Hospital San Donato Arezzo, Arezzo, Italy
| | - Vittoria Cianci
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Angelo Labate
- Institute of Neurology, University Magna Graecia, Germaneto (CZ), Italy
| | - Adriana Magaudda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Annapia Verri
- Department of Behavioural Neurology and Laboratory of Cognitive Behavioural Psychology, Fondazione Istituto Neurologico Casimiro Mondino, Pavia, Italy
| | | | - Vincenzo Pizza
- Neurophysiopatology Unit, S. Luca Hospital, Vallo della Lucania (SA), Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Center, IRCCS NEUROMED, Via Atinense 18, 86170, Pozzilli (IS), Italy.
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23
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Albini M, Morano A, Fattouch J, Fanella M, Avorio F, Basili LM, Cerulli Irelli E, Manfredi M, Giallonardo AT, Di Bonaventura C. Anxiety as the only manifestation of focal non-convulsive status epilepticus: case report and review of the literature. Neurocase 2020; 26:98-102. [PMID: 32228130 DOI: 10.1080/13554794.2020.1741647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychiatric disorders represent common comorbidities in epileptic patients. Sometimes anxiety is part of the ictal semiology, especially during seizures arising from/involving frontal or temporal lobes. We describe a patient with focal epilepsy and recurrent hyperkinetic seizures who also presented prolonged episodes characterized by massive anxiety, alarm and fear. A Video-Electroencephalographic monitoring performed during one of these attacks revealed a continuous epileptiform activity over the right frontal regions, consistent with a focal non-convulsive status epilepticus accounting for the patient's psychiatric symptoms. Our case confirms the complex relationship between epilepsy and anxiety. A review of the literature is also included.
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Affiliation(s)
- Mariarita Albini
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy.,Neurophysiopathology Department, IRCCS Neuromed Institute, Pozzilli IS, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Jinane Fattouch
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Martina Fanella
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Federica Avorio
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Luca Manfredi Basili
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Mario Manfredi
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Neurology Unit, 'Sapienza' University of Rome, Rome, Italy
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24
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Morano A, Fanella M, Albini M, Cifelli P, Palma E, Giallonardo AT, Di Bonaventura C. Cannabinoids in the Treatment of Epilepsy: Current Status and Future Prospects. Neuropsychiatr Dis Treat 2020; 16:381-396. [PMID: 32103958 PMCID: PMC7012327 DOI: 10.2147/ndt.s203782] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/18/2020] [Indexed: 01/05/2023] Open
Abstract
Cannabidiol (CBD) is one of the prominent phytocannabinoids found in Cannabis sativa, differentiating from Δ9-tetrahydrocannabinol (THC) for its non-intoxicating profile and its antianxiety/antipsychotic effects. CBD is a multi-target drug whose anti-convulsant properties are supposed to be independent of endocannabinoid receptor CB1 and might be related to several underlying mechanisms, such as antagonism on the orphan GPR55 receptor, regulation of adenosine tone, activation of 5HT1A receptors and modulation of calcium intracellular levels. CBD is a lipophilic compound with low oral bioavailability (6%) due to poor intestinal absorption and high first-pass metabolism. Its exposure parameters are greatly influenced by feeding status (ie, high fat-containing meals). It is mainly metabolized by cytochrome P 450 (CYP) 3A4 and 2C19, which it strongly inhibits. A proprietary formulation of highly purified, plant-derived CBD has been recently licensed as an adjunctive treatment for Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), while it is being currently investigated in tuberous sclerosis complex. The regulatory agencies' approval was granted based on four pivotal double-blind, placebo-controlled, randomized clinical trials (RCTs) on overall 154 DS patients and 396 LGS ones, receiving CBD 10 or 20 mg/kg/day BID as active treatment. The primary endpoint (reduction in monthly seizure frequency) was met by both CBD doses. Most patients reported adverse events (AEs), generally from mild to moderate and transient, which mainly consisted of somnolence, sedation, decreased appetite, diarrhea and elevation in aminotransferase levels, the last being documented only in subjects on concomitant valproate therapy. The interaction between CBD and clobazam, likely due to CYP2C19 inhibition, might contribute to some AEs, especially somnolence, but also to CBD clinical effectiveness. Cannabidivarin (CBDV), the propyl analogue of CBD, showed anti-convulsant properties in pre-clinical studies, but a plant-derived, purified proprietary formulation of CBDV recently failed the Phase II RCT in patients with uncontrolled focal seizures.
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Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
| | - Pierangelo Cifelli
- Department of Physiology and Pharmacology, Pasteur Institute-Cenci Bolognetti Foundation, University of Rome Sapienza, Rome, Italy
- IRCCS “Neuromed”, Pozzilli, IS, Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Pasteur Institute-Cenci Bolognetti Foundation, University of Rome Sapienza, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
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25
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Morano A, Fanella M, Giallonardo AT, Di Bonaventura C. Faciobrachial Dystonic Seizures: The Borderland Between Epilepsy and Movement Disorders. Mov Disord Clin Pract 2020; 7:228-229. [PMID: 32479568 DOI: 10.1002/mdc3.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences "Sapienza" University Rome Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences "Sapienza" University Rome Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences "Sapienza" University Rome Italy
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26
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Cerulli Irelli E, Morano A, Cocchi E, Casciato S, Fanella M, Albini M, Avorio F, Basili LM, Fisco G, Barone FA, Mascia A, D’Aniello A, Manfredi M, Fattouch J, Quarato P, Giallonardo AT, Di Gennaro G, Di Bonaventura C. Doing without valproate in women of childbearing potential with idiopathic generalized epilepsy: Implications on seizure outcome. Epilepsia 2019; 61:107-114. [DOI: 10.1111/epi.16407] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Enrico Cocchi
- Department of Public Health and Pediatrics University of Turin Turin Italy
| | | | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mariarita Albini
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Federica Avorio
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Luca M. Basili
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Giacomo Fisco
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Francesca A. Barone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | | | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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27
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Morano A, Palleria C, Citraro R, Nesci V, De Caro C, Giallonardo AT, De Sarro G, Russo E, Di Bonaventura C. Immediate and controlled-release pregabalin for the treatment of epilepsy. Expert Rev Neurother 2019; 19:1167-1177. [PMID: 31623493 DOI: 10.1080/14737175.2019.1681265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Epilepsy is a common neurological disease requiring complex therapies, which are unable to achieve seizure control in 30% of patients. Poor adherence has been recognized as a possible determinant of drug-resistance. Prolonged-release formulations of antiepileptic drugs might help increase adherence and minimize side effects.Areas covered: Pregabalin (PGB) has peculiar pharmacodynamics and almost ideal pharmacokinetics, except for a short half-life and therefore requiring multiple daily dosing. PGB immediate-release (IR) is effective in focal-onset epilepsy (FOE), neuropathic pain, generalized anxiety disorder, and fibromyalgia, despite some tolerability issues, especially at higher doses. The controlled-release formulation (CR) shares PGB IR advantages and requires slight dose adjustments to guarantee bioavailability. In 2014, PGB CR (165 and 330 mg/day) failed to prove superior to placebo in a randomized placebo-controlled trial on 323 subjects with drug-resistant FOE, although it was just as tolerable. Therefore, PGB CR is not currently licensed for epilepsy.Expert opinion: Considering the disappointing results of the only controlled trial, PGB CR is unlikely to become an established epilepsy treatment anytime soon. Nevertheless, given its peculiar properties and potential advantages, PGB (in either formulation) should be further evaluated in specific populations of patients, especially fragile subjects with several comorbidities and complex polytherapies.
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Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
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28
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Ferlazzo E, Polidoro S, Gobbi G, Gasparini S, Sueri C, Cianci V, Sofia V, Giuliano L, Giallonardo AT, Di Bonaventura C, Casciato S, Messana T, Coppola A, Striano S, Bilo L, Monoriti M, Genovese G, Sarica P, Arcudi L, Aguglia U. Epilepsy, cerebral calcifications, and gluten-related disorders: Are anti-transglutaminase 6 antibodies the missing link? Seizure 2019; 73:17-20. [PMID: 31698178 DOI: 10.1016/j.seizure.2019.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Gluten-related disorders (GRDs) are a group of immune-mediated diseases often associated to neurologic manifestations. Epilepsies with cerebral calcifications, with or without coeliac disease (CD), are rare neurological disorders characterized by childhood-onset focal seizures, often refractory to antiepileptic drugs. Transglutaminase 6 antibodies (anti-TG6) have been considered a biomarker for gluten-related ataxia and neuropathy, but their prevalence in epilepsies with cerebral calcifications is unknown. The aim of this study is to evaluate anti-TG6 prevalence in patients with epilepsies and cerebral calcifications. METHOD this was a cross-sectional study conducted at five Italian epilepsy centres. The following groups were included. Group 1: nine patients with CD, posterior cerebral calcifications and epilepsy (CEC); group 2: nine patients with epilepsy and posterior cerebral calcifications, without CD; group 3: twenty patients with focal epilepsy of unknown etiology; group 4: twenty-two healthy controls (HC). All subjects were tested for serological evidence of anti-TG6 IgA and IgG. Differences among groups were analysed using χ ² test. RESULTS anti-TG6 were present in 1/9 subjects (11%) of group 1, 2/9 subjects (22%) of group 2, 0/20 subjects in group 3, 3/22 (13.6%) of HC. No significant difference was found among the 4 groups. CONCLUSIONS Anti-TG6 do not seem to be associated to epilepsies with cerebral calcifications.
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Affiliation(s)
- Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy; Department of Medicine, Surgery and Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Serena Polidoro
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy; Department of Medicine, Surgery and Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Giuseppe Gobbi
- Child Neurology Unit, Bellaria Hospital, IRCCS - Institute of Neurological Sciences, Bologna, Italy
| | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy; Department of Medicine, Surgery and Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Chiara Sueri
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy; Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Vito Sofia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Loretta Giuliano
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Anna Teresa Giallonardo
- Department of Neurological Sciences and Mental Health, "La Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Neurological Sciences and Mental Health, "La Sapienza" University of Rome, Rome, Italy
| | | | - Tullio Messana
- Child Neurology Unit, Bellaria Hospital, IRCCS - Institute of Neurological Sciences, Bologna, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Salvatore Striano
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Leonilda Bilo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Marika Monoriti
- Autoimmunity and Allergology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giuseppe Genovese
- Autoimmunity and Allergology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Paola Sarica
- Autoimmunity and Allergology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Luciano Arcudi
- Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy; Department of Medicine, Surgery and Health Sciences, Magna Græcia University, Catanzaro, Italy.
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Fanella M, Frascarelli M, Lambiase C, Morano A, Unolt M, Liberati N, Fattouch J, Buzzanca A, Accinni T, Ceccanti M, Viganò A, Biondi M, Colonnese C, Giallonardo AT, Di Fabio F, Pizzuti A, Di Bonaventura C, Berardelli A. Myoclonic epilepsy, parkinsonism, schizophrenia and left-handedness as common neuropsychiatric features in 22q11.2 deletion syndrome. J Med Genet 2019; 57:151-159. [PMID: 31506323 DOI: 10.1136/jmedgenet-2019-106223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is considered as the genetic model of schizophrenia. However, its polymorphic nature has led researchers to further investigate its neuropsychiatric manifestations. METHODS We enrolled 56 adults (38 men, 18 women) diagnosed with 22q11.2DS. All subjects were evaluated by a multidisciplinary team. The neuropsychiatric features were investigated by means of clinical and neurophysiological evaluation (video-EEG). RESULTS Thirty per cent of our patients were left-handed. Fifty-eight per cent had a low IQ, and 22 of 56 subjects had psychotic disorders (13 of 22 with schizophrenia). Eighteen patients reported at least one seizure in their lifetime, and ten were diagnosed with epilepsy; among them, seven had genetic generalised epilepsy (GGE), and five of seven showed features suggestive of juvenile myoclonic epilepsy (JME). Video-EEG recordings revealed generalised epileptiform abnormalities in 24 of 56 cases. Besides, only one patient with epilepsy had a cardiac malformation. Lastly, 31 of 56 subjects presented with parkinsonism, 16 of whom were taking neuroleptics. None of the 15 patients with parkinsonism not related to neuroleptic therapy was diagnosed with epilepsy, compared with 6 of those taking antipsychotics. CONCLUSIONS 22q11.2DS is characterised by left-handedness and neuropsychiatric features such as cognitive impairment, schizophrenia, epilepsy and parkinsonism. GGE, mostly the JME phenotype, is the predominant epilepsy type. The significant association between 22q11.2DS and parkinsonian features confirms these patients' genetic susceptibility to parkinsonism. Despite the lack of any conclusive evidence, our study suggests a possible relationship between the analysed clinical variables: (1) an inverse correlation between low IQ/psychosis/epilepsy and major cardiac diseases; (2) a direct association between psychosis and both mental delay and epilepsy; and (3) an inverse correlation between parkinsonism and epilepsy.
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Affiliation(s)
- Martina Fanella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Alessandra Morano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marta Unolt
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Jinane Fattouch
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonino Buzzanca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Tommaso Accinni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Viganò
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Colonnese
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS "Neuromed", Pozzilli (IS), Italy
| | | | - Fabio Di Fabio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Pizzuti
- Experimental Medicine, Universita 'La Sapienza', Rome, Italy
| | | | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS "Neuromed", Pozzilli (IS), Italy
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Morano A, Basili LM, Fanella M, Giallonardo AT, Di Bonaventura C. The Evolution of Movement Disorders in N‐Methyl‐D‐Aspartate Receptor Encephalitis—A Video Log. Mov Disord Clin Pract 2019; 6:610-611. [DOI: 10.1002/mdc3.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/08/2019] [Accepted: 07/14/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences “Sapienza” University Rome Italy
| | - Luca Manfredi Basili
- Epilepsy Unit, Department of Human Neurosciences “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences “Sapienza” University Rome Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences “Sapienza” University Rome Italy
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Maschio M, Aguglia U, Avanzini G, Banfi P, Buttinelli C, Capovilla G, Casazza MML, Colicchio G, Coppola A, Costa C, Dainese F, Daniele O, De Simone R, Eoli M, Gasparini S, Giallonardo AT, La Neve A, Maialetti A, Mecarelli O, Melis M, Michelucci R, Paladin F, Pauletto G, Piccioli M, Quadri S, Ranzato F, Rossi R, Salmaggi A, Terenzi R, Tisei P, Villani F, Vitali P, Vivalda LC, Zaccara G, Zarabla A, Beghi E. Management of epilepsy in brain tumors. Neurol Sci 2019; 40:2217-2234. [PMID: 31392641 DOI: 10.1007/s10072-019-04025-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/20/2019] [Indexed: 12/15/2022]
Abstract
Epilepsy in brain tumors (BTE) may require medical attention for a variety of unique concerns: epileptic seizures, possible serious adverse effects of antineoplastic and antiepileptic drugs (AEDs), physical disability, and/or neurocognitive disturbances correlated to tumor site. Guidelines for the management of tumor-related epilepsies are lacking. Treatment is not standardized, and overall management might differ according to different specialists. The aim of this document was to provide directives on the procedures to be adopted for a correct diagnostic-therapeutic path of the patient with BTE, evaluating indications, risks, and benefits. A board comprising neurologists, epileptologists, neurophysiologists, neuroradiologists, neurosurgeons, neuro-oncologists, neuropsychologists, and patients' representatives was formed. The board converted diagnostic and therapeutic problems into seventeen questions. A literature search was performed in September-October 2017, and a total of 7827 unique records were retrieved, of which 148 constituted the core literature. There is no evidence that histological type or localization of the brain tumor affects the response to an AED. The board recommended to avoid enzyme-inducing antiepileptic drugs because of their interference with antitumoral drugs and consider as first-choice newer generation drugs (among them, levetiracetam, lamotrigine, and topiramate). Valproic acid should also be considered. Both short-term and long-term prophylaxes are not recommended in primary and metastatic brain tumors. Management of seizures in patients with BTE should be multidisciplinary. The panel evidenced conflicting or lacking data regarding the role of EEG, the choice of therapeutic strategy, and timing to withdraw AEDs and recommended high-quality long-term studies to standardize BTE care.
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Affiliation(s)
- Marta Maschio
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuliano Avanzini
- Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy
| | - Paola Banfi
- Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Giuseppe Capovilla
- Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy
| | | | - Gabriella Colicchio
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Cinzia Costa
- Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Filippo Dainese
- Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Ornella Daniele
- Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Roberto De Simone
- Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Angela La Neve
- Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy
| | - Andrea Maialetti
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Oriano Mecarelli
- Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy
| | - Marta Melis
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy
| | - Roberto Michelucci
- Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Paladin
- Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy
| | - Giada Pauletto
- Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Stefano Quadri
- USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Ranzato
- Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy
| | - Rosario Rossi
- Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy
| | | | - Riccardo Terenzi
- Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Paolo Tisei
- Neurophysiology Unit, Department of Neurology-University "La Sapienza", S. Andrea Hospital, Rome, Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy
| | - Paolo Vitali
- Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Gaetano Zaccara
- Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy
| | - Alessia Zarabla
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Ettore Beghi
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Fanella M, Morano A, Fattouch J, Albini M, Basili LM, Avorio F, Cerulli Irelli E, Manfredi M, Giallonardo AT, Di Bonaventura C. A Case of Ictal Epileptic Headache in Non Convulsive Status Epilepticus: Not Always, Not Only, a Matter of Pain. Headache 2019; 59:1090-1092. [PMID: 31260097 DOI: 10.1111/head.13581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Martina Fanella
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Luca M Basili
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Federica Avorio
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
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Zaccara G, Mula M, Ferrò B, Consoli D, Elia M, Giallonardo AT, Iudice A, La Neve A, Meletti S, Tinuper P, Zummo L, Perucca E. Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy? Epilepsia 2018; 60:175-183. [PMID: 30585315 PMCID: PMC7379205 DOI: 10.1111/epi.14622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. METHODS A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34 months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen's kappa (k) statistics and rated according to Landis and Koch's criteria. RESULTS Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k = 0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k = 0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k = 0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k = 0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have "undefined responsiveness." SIGNIFICANCE Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be "drug-resistant" were classified by the EP as having "undefined responsiveness."
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Affiliation(s)
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust and Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | | | | | | | | | - Alfonso Iudice
- Department of Clinical and Experimental Medicine, Section of Neurology, University of Pisa, Pisa, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Leila Zummo
- Department of Experimental Biomedicine and Clinical Neurosciences (BIONEC), University of Palermo, Palermo, Italy
| | - Emilio Perucca
- Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia and Clinical Trial Center, IRCCS Mondino Foundation, Pavia, Italy
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Morano A, Iannone L, Palleria C, Fanella M, Giallonardo AT, De Sarro G, Russo E, Di Bonaventura C. Pharmacology of new and developing intravenous therapies for the management of seizures and epilepsy. Expert Opin Pharmacother 2018; 20:25-39. [PMID: 30403892 DOI: 10.1080/14656566.2018.1541349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Antiepileptic drugs (AEDs) are administered orally for chronic use. Parenteral formulations might be necessary when the oral route is not feasible (e.g. an impairment of consciousness, trauma, dysphagia, gastrointestinal illness) or for treatment of seizure emergencies. At present, few intravenous (IV) formulations are available on the market. AREAS COVERED The purpose of this review is to summarize the pharmacological characteristics and clinical applications of IV medications that have been recently introduced to the armamentarium of epilepsy therapy or are currently being developed. Apart from AEDs, other compounds belonging to different pharmacological classes (e.g. diuretics, anesthetics), which have shown potential effectiveness in seizure control, are taken into consideration, and the pathophysiological premises supporting their use for epilepsy treatment are illustrated. The authors give particular focus to immunomodulatory and immunosuppressive agents, which have become the therapeutic cornerstones for immune-mediated epilepsies, despite regulatory obstacles. EXPERT OPINION In several circumstances, especially in the case of seizure-related emergencies, clinical practice seems not match literature-based evidence, and several IV AEDs are still used off-label. Strong evidence derived from randomized clinical trials (RCTs) is needed to support the effectiveness and tolerability of any therapeutic approach, however common and "accepted' it may be, in order to guarantee patient safety and well-being.
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Affiliation(s)
- Alessandra Morano
- a Neurology Unit, Department of Neurosciences, Mental Health , "Sapienza" University , Rome , Italy
| | - Luigi Iannone
- b Science of Health Department, School of Medicine , University of Catanzaro , Catanzaro , Italy
| | - Caterina Palleria
- b Science of Health Department, School of Medicine , University of Catanzaro , Catanzaro , Italy
| | - Martina Fanella
- a Neurology Unit, Department of Neurosciences, Mental Health , "Sapienza" University , Rome , Italy
| | - Anna Teresa Giallonardo
- a Neurology Unit, Department of Neurosciences, Mental Health , "Sapienza" University , Rome , Italy
| | - Giovambattista De Sarro
- b Science of Health Department, School of Medicine , University of Catanzaro , Catanzaro , Italy
| | - Emilio Russo
- b Science of Health Department, School of Medicine , University of Catanzaro , Catanzaro , Italy
| | - Carlo Di Bonaventura
- a Neurology Unit, Department of Neurosciences, Mental Health , "Sapienza" University , Rome , Italy
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Casciato S, Morano A, Fattouch J, Fanella M, Avorio F, Albini M, Basili LM, Cerulli Irelli E, Viganò A, De Risi M, Grammaldo LG, D'Aniello A, Mascia A, Manfredi M, Quarato P, Giallonardo AT, Di Gennaro G, Di Bonaventura C. Factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis. J Neurol Sci 2018; 396:102-107. [PMID: 30447604 DOI: 10.1016/j.jns.2018.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Limbic encephalitis (LE) is an autoimmune condition characterized by amnestic syndrome, psychiatric features and seizures. Early diagnosis and prompt treatment are crucial to avoid long-term sequelae, including psycho-cognitive deficits and persisting seizures. The aim of our study was to analyze the characteristics of 33 LE patients in order to identify possible prognostic factors associated with the development of chronic epilepsy. METHODS This is a retrospective cohort study including adult patients diagnosed with LE in the period 2010-2017 and followed up for ≥12 months. Demographics, seizure semiology, EEG pattern, MRI features, CSF/serum findings were reviewed. RESULTS All 33 LE patients (19 M/14F, mean age 61.2 years) presented seizures. Thirty subjects had memory deficits; 22 presented behavioural/mood disorders. Serum and/or CSF auto-antibodies were detected in 12 patients. In 31 subjects brain MRI at onset showed typical alterations involving temporal lobes. All patients received immunotherapy. At follow-up, 13/33 had developed chronic epilepsy; predisposing factors included delay in diagnosis (p = .009), low seizure frequency at onset (p = .02), absence of amnestic syndrome (p = .02) and absence/rarity of inter-ictal epileptic discharges on EEG (p = .06). CONCLUSIONS LE with paucisymptomatic electro-clinical presentation seemed to be associated to chronic epilepsy more than LE presenting with definite and severe "limbic syndrome".
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Affiliation(s)
| | - Alessandra Morano
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Federica Avorio
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Emanuele Cerulli Irelli
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandro Viganò
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | | | | | | | - Mario Manfredi
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy.
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Morano A, Fattouch J, Albini M, Casciato S, Fanella M, Basili LM, Viganò A, Manfredi M, Giallonardo AT, Di Bonaventura C. Perampanel as adjunctive therapy in highly refractory epilepsies: Real-world data from an Italian tertiary care epilepsy centre. J Neurol Sci 2018; 390:67-74. [PMID: 29801910 DOI: 10.1016/j.jns.2018.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Perampanel (PER) is a selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist, licensed as adjunctive therapy in focal epilepsy and primary generalized tonic-clonic seizures (pGTCSs). We performed a retrospective study on highly refractory adult patients taking PER, with 1-year follow-up. Retention rate represented the primary outcome of our work; seizure frequency reduction (≥50%), "switch rate" and proportion of adverse events (AEs) were evaluated as secondary endpoints. Eighty-nine subjects (47 females, age range: 19-78 years) were included. Seventy-three had focal epilepsy (FE), 9 generalized epilepsy and 7 epileptic encephalopathy. All patients were highly drug-resistant (medication failures: 5-17). Retention rate was 87.6%, 63% and 51.7% at 3, 6 and 12 months. Responders were 27/89 (30.3%), with 8/27 seizure-free. The number of previous treatment failures and the concomitant use of enzyme inducers negatively influenced clinical response, whereas no correlation was documented between PER dose and outcome. Responder proportion was more satisfying in structural FE than in FE of unknown etiology (33% versus 20%), and in secondarily GTCSs than focal seizures (54% vs 28%), whereas pGTCSs showed a lower reponse rate (25%). Mild-to-moderate AEs (mainly dizziness, gait disturbances and psychiatric effects) were reported by 40% of patients; serious psychiatric AEs usually occurred in subjects with psychiatric comorbidities. Our study confirms the tolerability and effectiveness of PER in highly drug-resistant patients with different epilepsy syndromes and aetiologies.
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Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandro Viganò
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Anna Teresa Giallonardo
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy.
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Di Bonaventura C, Albini M, D'Elia A, Fattouch J, Fanella M, Morano A, Lucignani G, Manfredi M, Colonnese C, Salvati M, Vanacore N, Berardelli A, Giallonardo AT. Epileptic seizures heralding a relapse in high grade gliomas. Seizure 2017; 51:157-162. [PMID: 28873363 DOI: 10.1016/j.seizure.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/04/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Seizures are a common clinical symptom in high-grade gliomas (HGG). The aim of the study was to investigate the relationship between seizures and HGG relapse (HGG-R). METHODS We retrospectively evaluated 145 patients who were surgically treated for HGG-R. By analyzing clinical characteristics in these patients (all operated and treated by the same protocol), we identified 37 patients with seizures during follow-up. This cohort was divided into four subgroups according to a) presence or absence of seizures at the time of diagnosis and b) temporal relationship between seizure occurrence and HGG-R during follow-up: subgroup A (25pts) had seizures at follow-up but not at onset, subgroup B (12pts) had seizures both at follow-up and onset, subgroup C (30pts) had seizures before MRI-documented HGG-R, and subgroup D (7pts) had seizures after MRI-documented HGG-R. RESULTS Although the datum was not statistically significant, survival was longer in patients with seizures during follow-up than in those without seizures (59.3% vs 51.4% alive at 2 years). In 30 patients (subgroup C) seizures heralded HGG-R. In a correlation analysis for this last subgroup, the time interval between seizure and the HGG-R was significantly associated with the number of chemotherapy cycles (r=0.470; p=0.009) and follow-up duration (r=0.566; p=0.001). A linear regression model demonstrated a reciprocal association between the above factors and that it may be possible to estimate the timing of HGG-R by combining these data. CONCLUSIONS Seizures may herald HGG-R before MRI detection of relapse, thus suggesting that seizures should always be considered a red flag during follow-up.
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Affiliation(s)
| | - Mariarita Albini
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | | | - Jinane Fattouch
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Giulia Lucignani
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Claudio Colonnese
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy; IRCCS Neuromed, "Sapienza" University of Rome, Pozzilli, IS, Italy
| | - Maurizio Salvati
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Nicola Vanacore
- National Centre of Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy; IRCCS Neuromed, "Sapienza" University of Rome, Pozzilli, IS, Italy
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Margiotti K, Pascolini G, Consoli F, Guida V, Di Bonaventura C, Giallonardo AT, Pizzuti A, De Luca A. Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients. Arch Oral Biol 2017; 80:160-163. [DOI: 10.1016/j.archoralbio.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/16/2022]
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Maschio M, Beghi E, Casazza MML, Colicchio G, Costa C, Banfi P, Quadri S, Aloisi P, Giallonardo AT, Buttinelli C, Pauletto G, Striano S, Salmaggi A, Terenzi R, Daniele O, Crichiutti G, Paladin F, Rossi R, Prato G, Vigevano F, De Simone R, Ricci F, Saladini M, Monti F, Casellato S, Zanoni T, Giannarelli D, Avanzini G, Aguglia U. Patterns of care of brain tumor-related epilepsy. A cohort study done in Italian Epilepsy Center. PLoS One 2017; 12:e0180470. [PMID: 28715490 PMCID: PMC5513411 DOI: 10.1371/journal.pone.0180470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/15/2017] [Indexed: 01/12/2023] Open
Abstract
Epilepsy is the most common comorbidity in patients with brain tumors. STUDY AIMS To define characteristics of brain tumor-related epilepsy (BTRE) patients and identify patterns of care. Nationwide, multicenter retrospective cohort study. Medical records of BTRE patients seen from 1/1/2010 to 12/31/2011, followed for at least one month were examined. Information included age, sex, tumor type/treatments, epilepsy characteristics, antiepileptic drugs (AEDs). Time to modify first AED due to inefficacy and/or toxicity was assessed with the Kaplan-Meier method and Cox proportional hazard models were used to identify predictors of treatment outcome. Enrolled were 808 patients (447 men, 361 women) from 26 epilepsy centers. Follow-up ranged 1 to 423 months (median 18 months). 732 patients underwent surgery, 483 chemotherapy (CT), 508 radiotherapy. All patients were treated with AEDs. Levetiracetam was the most common drug. 377 patients (46.7%) were still on first drug at end of follow-up, 338 (41.8%) needed treatment modifications (uncontrolled seizures, 229; side effects, 101; poor compliance, 22). Treatment discontinuation for lack of efficacy was associated with younger age, chemotherapy, and center with <20 cases. Treatment discontinuation for side effects was associated with female sex, enzyme-inducing drugs and center with > 20 cases. About one-half of patients with BTRE were on first AED at end of follow-up. Levetiracetam was the most common drug. A non enzyme-inducing AED was followed by a lower risk of drug discontinuation for SE.
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Affiliation(s)
- Marta Maschio
- UOSD di Neurologia, Centro per la Cura dell'Epilessia Tumorale, Istituto Nazionale Tumori Regina Elena, Roma, Italia
| | - Ettore Beghi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italia
| | | | | | - Cinzia Costa
- Clinica Neurologica, Università degli Studi di Perugia, Ospedale SM Misericordia, Perugia, Italia
| | - Paola Banfi
- Divisione di Neurologia, Ospedale di Circolo, Varese, Italia
| | - Stefano Quadri
- USC di Neurologia Centro Regionale Epilessia ASST Papa Giovanni XXIII, Bergamo, Italia
| | - Paolo Aloisi
- UOC di Neurofisiopatogia, Centro per l'Epilessia, L'Aquila, Italia
| | | | - Carla Buttinelli
- Dipartimento di Neurologia, Università "La Sapienza", Ospedale S. Andrea, Roma, Italia
| | - Giada Pauletto
- SOC di Neurologia, Azienda Ospedaliera Universitaria di Udine, Udine, Italia
| | - Salvatore Striano
- Centro Epilessia, Università degli studi di Napoli "Federico II", Policlinico Federico II, Napoli, Italia
| | | | | | - Ornella Daniele
- Centro per la Diagnosi e Cura dell'Epilessia, UOC Neurologia, Palermo, Italia
| | - Giovanni Crichiutti
- Clinica Pediatrica, Servizio Epilessia Infantile, Azienda Ospedaliera Università di Udine, Udine, Italia
| | - Francesco Paladin
- UOC Neurologia, Centro Epilessie, Ospedale S Giovanni e Paolo, Venezia, Italia
| | | | - Giulia Prato
- Centro Epilessie, U.O. Neuropsichiatria Infantile, Istituto Gaslini, Genova, Italia
| | - Federico Vigevano
- Dipartimento di Neuroscienze, Ospedale Pediatrico Bambin Gesù, Roma, Italia
| | | | - Federica Ricci
- S.C. Neuropsichiatria Infantile, O.I.R.M., A.O. Città della salute e della scienza, Torino, Italia
| | | | - Fabrizio Monti
- Centro per la Diagnosi e Cura delle Epilessie, UOC Neurologia, Trieste, Italia
| | - Susanna Casellato
- Centro per la Diagnosi e Cura delle Epilessie dell' Età Evolutiva, UOC di NPI, AOU, Sassari, Italia
| | - Tiziano Zanoni
- UO Neurologia, Azienda Ospedaliera Integrata-Universitaria, Verona, Italia
| | - Diana Giannarelli
- Unità di Biostatistica, Istituto Nazionale Tumori Regina Elena, Roma, Italia
| | | | - Umberto Aguglia
- Centro Regionale Epilessia, Università Magna Grecia di Catanzaro, Ospedale Riuniti, Reggio Calabria, Italia
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Casciato S, Morano A, Fattouch J, Fanella M, Albini M, Giallonardo AT, Di Bonaventura C. Ictal pain in focal non-convulsive status epilepticus. Pract Neurol 2017; 17:400-402. [DOI: 10.1136/practneurol-2017-001623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/04/2022]
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Michelucci R, Pulitano P, Di Bonaventura C, Binelli S, Luisi C, Pasini E, Striano S, Striano P, Coppola G, La Neve A, Giallonardo AT, Mecarelli O, Serioli E, Dazzo E, Fanciulli M, Nobile C. The clinical phenotype of autosomal dominant lateral temporal lobe epilepsy related to reelin mutations. Epilepsy Behav 2017; 68:103-107. [PMID: 28142128 PMCID: PMC5378904 DOI: 10.1016/j.yebeh.2016.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe the clinical phenotype of 7 families with Autosomal Dominant Lateral Temporal Lobe Epilepsy (ADLTE) related to Reelin (RELN) mutations comparing the data with those observed in 12 LGI1-mutated pedigrees belonging to our series. METHODS Out of 40 Italian families with ADLTE, collected by epileptologists participating in a collaborative study of the Commission for Genetics of the Italian League against Epilepsy encompassing a 14-year period (2000-2014), 7 (17.5%) were found to harbor heterozygous RELN mutations. The whole series also included 12 (30%) LGI1 mutated families and 21 (52.5%) non-mutated pedigrees. The clinical, neurophysiological, and neuroradiological findings of RELN and LGI1 mutated families were analyzed. RESULTS Out of 28 affected individuals belonging to 7 RELN mutated families, 24 had sufficient clinical data available for the study. In these patients, the epilepsy onset occurred at a mean age of 20years, with focal seizures characterized by auditory auras in about 71% of the cases, associated in one-third of patients with aphasia, visual disturbances or other less common symptoms (vertigo or déjà-vu). Tonic-clonic seizures were reported by almost all patients (88%), preceded by typical aura in 67% of cases. Seizures were precipitated by environmental noises in 8% of patients and were completely or almost completely controlled by antiepileptic treatment in the vast majority of cases (96%). The interictal EEG recordings showed epileptiform abnormalities or focal slow waves in 80% of patients, localized over the temporal regions, with marked left predominance and conventional 1,5T MRI scans were not contributory. By comparing these findings with those observed in families with LGI1 mutations, we did not observe significant differences except for a higher rate of left-sided EEG abnormalities in the RELN group. SIGNIFICANCE Heterozygous RELN mutations cause a typical ADLTE syndrome, indistinguishable from that associated with LGI1 mutations.
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Affiliation(s)
- Roberto Michelucci
- IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Policlinico Umberto 1° Hospital, Roma, Italy
| | | | - Simona Binelli
- C. Besta Foundation Neurological Institute, Milano, Italy
| | | | - Elena Pasini
- IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy.
| | - Salvatore Striano
- Department of Neurological Sciences, Federico II University, Napoli, Italy
| | - Pasquale Striano
- Muscular and Neurodegenerative Disease Unit, Institute “G. Gaslini,” University of Genova, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Italy
| | | | | | - Oriano Mecarelli
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Policlinico Umberto 1° Hospital, Roma, Italy
| | - Elena Serioli
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - Emanuela Dazzo
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
| | | | - Carlo Nobile
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
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Morano A, Carnì M, Casciato S, Vaudano AE, Fattouch J, Fanella M, Albini M, Basili LM, Lucignani G, Scapeccia M, Tomassi R, Di Castro E, Colonnese C, Giallonardo AT, Di Bonaventura C. Ictal EEG/fMRI study of vertiginous seizures. Epilepsy Behav 2017; 68:51-56. [PMID: 28109990 DOI: 10.1016/j.yebeh.2016.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Vertigo and dizziness are extremely common complaints, related to either peripheral or central nervous system disorders. Among the latter, epilepsy has to be taken into consideration: indeed, vertigo may be part of the initial aura of a focal epileptic seizure in association with other signs/symptoms, or represent the only ictal manifestation, a rare phenomenon known as "vertiginous" or "vestibular" seizure. These ictal symptoms are usually related to a discharge arising from/involving temporal or parietal areas, which are supposed to be a crucial component of the so-called "vestibular cortex". In this paper, we describe three patients suffering from drug-resistant focal epilepsy, symptomatic of malformations of cortical development or perinatal hypoxic/ischemic lesions located in the posterior regions, who presented clusters of vertiginous seizures. The high recurrence rate of such events, recorded during video-EEG monitoring sessions, offered the opportunity to perform an ictal EEG/fMRI study to identify seizure-related hemodynamic changes. The ictal EEG/fMRI revealed the main activation clusters in the temporo-parieto-occipital regions, which are widely recognized to be involved in the processing of vestibular information. Interestingly, ictal deactivation was also detected in the ipsilateral cerebellar hemisphere, suggesting the ictal involvement of cortical-subcortical structures known to be part of the vestibular integration network.
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Affiliation(s)
- Alessandra Morano
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Marco Carnì
- Department of Molecular medicine, University "Sapienza", Rome, Italy
| | - Sara Casciato
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, Modena, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Marco Scapeccia
- Neuroradiology Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Regina Tomassi
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | | | - Claudio Colonnese
- Neuroradiology Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy; Neuroradiology Unit, IRCCS "Neuromed", Pozzilli, IS, Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy.
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Morano A, Cifelli P, Nencini P, Antonilli L, Fattouch J, Ruffolo G, Roseti C, Aronica E, Limatola C, Di Bonaventura C, Palma E, Giallonardo AT. Cannabis in epilepsy: From clinical practice to basic research focusing on the possible role of cannabidivarin. Epilepsia Open 2016; 1:145-151. [PMID: 29588939 PMCID: PMC5719834 DOI: 10.1002/epi4.12015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 01/30/2023] Open
Abstract
Cannabidivarin (CBDV) and cannabidiol (CBD) have recently emerged among cannabinoids for their potential antiepileptic properties, as shown in several animal models. We report the case of a patient affected by symptomatic partial epilepsy who used cannabis as self‐medication after the failure of countless pharmacological/surgical treatments. Clinical and video electroencephalogram (EEG) evaluations were periodically performed, and the serum levels of CBDV, CBD, and Δ9‐tetrahydrocannabinol were repeatedly measured. After cannabis administration, a dramatic clinical improvement, in terms of both decrease in seizure frequency and recovery of cognitive functions, was observed, which might parallel high CBDV plasma concentrations. To widen the spectrum of CBDV possible mechanisms of action, electrophysiological methods were applied to investigate whether it could exert some effects on γ‐aminobutyric acid (GABA)A receptors. Our experiments showed that, in human hippocampal tissues of four patients affected by drug‐resistant temporal lobe epilepsy (TLE) transplanted in Xenopus oocytes, there is decrease of current rundown (i.e., reduction of use‐dependent GABAA current) after prolonged exposure to CBDV. This result has been confirmed using a single case of Rasmussen encephalitis (RE). Our patient's electroclinical improvement supports the hypothesis that cannabis could actually represent an effective, well‐tolerated antiepileptic drug. Moreover, the experimental data suggest that CBDV may greatly contribute to cannabis anticonvulsant effect through its possible GABAergic action.
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Affiliation(s)
- Alessandra Morano
- Department of Neurology and Psychiatry Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Pierangelo Cifelli
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy.,Ri.MED Foundation Palermo Italy
| | - Paolo Nencini
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Letizia Antonilli
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Jinane Fattouch
- Department of Neurology and Psychiatry Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | | | - Eleonora Aronica
- Department of (Neuro) Pathology Academic Medical Center University of Amsterdam Amsterdam the Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN-Heemstede) Amsterdam the Netherlands
| | - Cristina Limatola
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Carlo Di Bonaventura
- Department of Neurology and Psychiatry Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy.,IRCCS San Raffaele Pisana Rome Italy
| | - Anna Teresa Giallonardo
- Department of Neurology and Psychiatry Pasteur Institute-Cenci Bolognetti Foundation University of Rome Sapienza Rome Italy
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Albini M, Morano A, Fanella M, Lapenta L, Casciato S, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Effectiveness of Rufinamide in the Treatment of Idiopathic Generalized Epilepsy With Atypical Evolution: Case Report and Review of the Literature. Clin EEG Neurosci 2016; 47:162-6. [PMID: 25420625 DOI: 10.1177/1550059414559940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
Abstract
Rufinamide (RFD) is a novel drug that was recently approved as an adjunctive treatment for Lennox-Gastaut syndrome. Despite its reported effectiveness in generalized seizures (tonic, atonic, or tonic-clonic) in this syndrome, few data on its use in idiopathic generalized epilepsy are available. Indeed, the scientific evidence to date is limited to anecdotal cases or isolated clinical experiences. We report an uncommon, though paradigmatic, case of a woman affected by juvenile absence epilepsy (JAE) who, following a prolonged seizure-freedom period and the consequent withdrawal of valproate, presented a seizure relapse accompanied by a worsening in her electroclinical pattern. In view of this atypical evolution of JAE, characterized by drug-resistant seizures (absence and generalized tonic-clonic) and the progressive increase in electroencephalographic (EEG) abnormalities, several antiepileptic drugs were used, though to no benefit. The use of RFD instead led to a gradual control of the seizures and normalization of the EEG findings. In addition to this clinical experience, we briefly review the literature on the use of RFD in refractory generalized epilepsy.
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Affiliation(s)
- Mariarita Albini
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | - Alessandra Morano
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | - Martina Fanella
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | - Leonardo Lapenta
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | - Sara Casciato
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy Neuromed Institute of Pozzilli (IS), University of Rome "La Sapienza," Rome, Italy
| | - Jinane Fattouch
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | - Mario Manfredi
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
| | | | - Carlo Di Bonaventura
- Department of Neurological Sciences, University of Rome "La Sapienza," Rome, Italy
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Fanella M, Carnì M, Morano A, Albini M, Lapenta L, Casciato S, Fattouch J, Di Castro E, Colonnese C, Vaudano AE, Giallonardo AT, Di Bonaventura C. Behavioral and Movement Disorders due to Long-Lasting Myoclonic Status Epilepticus Misdiagnosed as ADHD in a Patient With Juvenile Myoclonic Epilepsy: Electroclinical Findings and Related Hemodynamic Changes. Clin EEG Neurosci 2016; 47:56-60. [PMID: 25733678 DOI: 10.1177/1550059415574622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) likely share common underlying neural mechanisms, as often suggested by both the evidence of electroencephalography (EEG) abnormalities in ADHD patients without epilepsy and the coexistence of these 2 conditions. The differential diagnosis between epilepsy and ADHD may consequently be challenging. In this report, we describe a patient presenting with a clinical association of "tics" and behavioral disorders that appeared 6 months before our first observation and had previously been interpreted as ADHD. A video-EEG evaluation documented an electroclinical pattern of myoclonic status epilepticus. On the basis of the revised clinical data, the EEG findings, the good response to valproate, the long-lasting myoclonic status epilepticus, and the enduring epileptic abnormalities likely causing behavioral disturbances, the patient's symptoms were interpreted as being the expression of untreated juvenile myoclonic epilepsy. The EEG-functional magnetic resonance imaging study revealed, during clinical generalized spike-and-wave and polyspike-and-wave discharges, positive blood oxygen level-dependent (BOLD) signal changes bilaterally in the thalamus, the prefrontal cortex (Brodmann area 6, supplementary motor area) and the cerebellum, and negative BOLD signal changes in the regions of the default mode network. Such findings, which are typical of BOLD changes observed in idiopathic generalized epilepsy, may also shed light on the anatomofunctional network underlying ADHD.
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Affiliation(s)
- Martina Fanella
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Carnì
- Department of Molecular Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Morano
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Mariarita Albini
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Leonardo Lapenta
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Sara Casciato
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Jinane Fattouch
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Elisabetta Di Castro
- Department of Molecular Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Claudio Colonnese
- Department of Radiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Teresa Giallonardo
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Fanella M, Morano A, Fattouch J, Albini M, Casciato S, Manfredi M, Giallonardo AT, Di Bonaventura C. Ictal epileptic headache revealing non convulsive status epilepticus in a case of eyelid myoclonia with absences. J Headache Pain 2015; 16:105. [PMID: 26644029 PMCID: PMC4671982 DOI: 10.1186/s10194-015-0587-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
Epileptic seizures and headache attacks are two common neurologic phenomena characterized by paroxysmal alteration of brain functions followed by complete restauration of the baseline condition. Headache and epilepsy are related in numerous ways, and they often co-occur. Although the link between these two diseases is not completely clear, several clinical, physiopathological and therapeutic features overlap. Headache is reported in association with epileptic seizures as a pre-ictal, ictal or post-ictal phenomenon. We present the case of a 40 year-old woman affected by eyelid myoclonia with absences (EMA) with a history of prolonged headache attacks. A video-EEG recording performed during one of these episodes showed subcontinuous epileptic activity consisting of generalized spike-and-wave discharges (GSWDs), clinically associated with tensive headache. Our work represents one of the few well EEG-documented cases of ictal epileptic headache in idiopathic generalized epilepsy (IGE).
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Affiliation(s)
- Martina Fanella
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
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Fanella M, Morano A, Fattouch J, Albini M, Manfredi M, Giallonardo AT, Di Bonaventura C. Ictal epileptic headache in adult life: Electroclinical patterns and spectrum of related syndromes. Epilepsy Behav 2015; 53:161-5. [PMID: 26580211 DOI: 10.1016/j.yebeh.2015.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Both headache and epilepsy are frequent paroxysmal disorders that often co-occur or are related in numerous ways. Although ictal epileptic headache has become the focus of several studies, this remains a very rare and not well-known phenomenon. Electroclinical features, pathophysiology, and syndromic context are heterogeneous. We investigated the electroclinical and neuroimaging findings in a population of adult patients with ictal epileptic headache. METHODS We retrospectively examined 8800 EEG recordings of almost 4800 patients admitted to our video-EEG laboratory from 2010 to 2013 with a history of well-documented epilepsy. We selected patients who reported headache closely related to a seizure documented by video-EEG or 24-hour ambulatory EEG. We analyzed ictal electroclinical features of headache, and we defined the related epileptic syndromes. RESULTS We identified five patients with ictal epileptic headache. Two patients described tension headache during an epileptic seizure. In three patients, the headache was accompanied by other "minor" neurological symptoms mimicking a migrainous aura. In all cases, the headache stopped with the end of the epileptic activity. Three patients had a history of partial symptomatic epilepsy with cerebral lesions (low grade glioma, astrocytoma, porencephalic cyst) in the left posterior regions, whereas two patients were affected by idiopathic generalized epilepsy. CONCLUSION This study confirms the rarity of ictal epileptic headache. To date, well-documented video-EEG cases remain as exceptional reports, especially in cases of idiopathic generalized epilepsies. Moreover, we confirm the main involvement of posterior regions in patients with ictal epileptic headache affected by partial symptomatic epilepsies.
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Affiliation(s)
- Martina Fanella
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy
| | | | - Carlo Di Bonaventura
- Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
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Casciato S, Di Bonaventura C, Giallonardo AT, Fattouch J, Quarato PP, Mascia A, D'Aniello A, Romigi A, Esposito V, Di Gennaro G. Epilepsy surgery in adult-onset Rasmussen's encephalitis: case series and review of the literature. Neurosurg Rev 2015; 38:463-70; discussion 470-1. [PMID: 25877887 DOI: 10.1007/s10143-015-0623-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/01/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Abstract
Rasmussen's encephalitis (RE) is a rare immune-mediated condition characterized by drug-resistant focal epilepsy, progressive neurological, and cognitive deficits associated to unilateral hemispheric atrophy. The onset is typically reported in childhood, although adult cases (A-RE) have been described. While surgical strategies in childhood RE are well defined, little is known about usefulness of epilepsy surgery in A-RE patients. We describe clinical features, surgical approach, and outcome of five A-RE patients who underwent epilepsy surgery, and we review the literature with regard to surgical A-RE cases. We retrospectively studied five A-RE patients aged 21-38 years (mean age 22.8 years) who were followed after surgery for a period ranging from to 1 to 6 years. Demographic, electroclinical, and neuroimaging data were systematically reviewed. Four out of five subjects underwent invasive EEG monitoring to define epileptogenic zone. Epilepsy outcome was defined according to Engel's classification. Surgery consisted of frontal corticectomy in three patients, temporal lobectomy in one, combined temporal lobectomy plus insular, and frontobasal corticectomy in the remaining case. No permanent neurological deficits were observed after surgery. At the last follow-up observation, one patient was seizure-free, two subjects experienced rare disabling seizures, another had moderate seizure reduction, and one had no clinical improvement. Our experience, although limited to few cases, suggests that resective surgery in A-RE may play a role in the context of multidisciplinary therapeutical approach of this severe condition. Since the lack of specific data about surgical options, this topic seems to deserve further investigations and more targeted studies.
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Affiliation(s)
- Sara Casciato
- Epilepsy Unit, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
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Casciato S, Morano A, Albini M, Fanella M, Lapenta L, Fattouch J, Carnì M, Colonnese C, Manfredi M, Giallonardo AT, Di Bonaventura C. Cryptogenic focal epilepsy and "hidden" celiac disease in adulthood: a causal or accidental link? Int J Neurosci 2014; 125:913-7. [PMID: 25387071 DOI: 10.3109/00207454.2014.983227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Celiac disease (CD) is an immuno-mediated small bowel disease characterized by chronic inflammation due to a permanent intolerance to gliadin. Several neurological complications have been described, including epilepsy, whose evolution might often improve by adopting gluten-free diet (GFD). We studied a population of adult patients affected by posterior drug-resistant epilepsy of unknown cause by performing an accurate screening for CD. In the selected patients presenting the association of epilepsy and CD, we characterized the related electro-clinical features. MATERIALS AND METHODS We consecutively identified 211 adult subjects affected by drug-resistant cryptogenic focal epilepsy with posterior seizures. All these patients underwent serological screening for CD. In 10 subjects positive serological tests allowed to perform a CD diagnosis (confirmed by duodenal biopsy). For each patient clinical and EEG data, neuroimaging studies, serological and histological findings were revised, as well as response to GFD, defined as an improvement in seizure outcome. RESULTS A significant delay between diagnosis of epilepsy and CD was documented. Visual ictal manifestations were reported in half of subjects. In all cases, interictal EEG showed slow and epileptiform abnormalities over parietal-occipital and temporal regions; in three cases, FOS phenomenon was observed. Four patients had familiar history of CD and six cases showed clinical signs/symptoms of malabsorption. GFD led to a reduction of seizure frequency in half of patients. CONCLUSIONS "Posterior" ictal semiology, peculiar EEG patterns and drug-resistance emerge as the most interesting characteristics. CD screening should be performed in epilepsy patients presenting such features.
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Affiliation(s)
- Sara Casciato
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Alessandra Morano
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Mariarita Albini
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Martina Fanella
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Leonardo Lapenta
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Jinane Fattouch
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | | | - Claudio Colonnese
- c Department of Radiology, Policlinico Umberto I, "Sapienza" University of Rome , Rome , Italy
| | - Mario Manfredi
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Anna Teresa Giallonardo
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
| | - Carlo Di Bonaventura
- a Department of Neurology and Psychiatry, Epilepsy Unit, "Sapienza" University , Rome , Italy
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Dazzo E, Santulli L, Posar A, Fattouch J, Conti S, Lodén-van Straaten M, Mijalkovic J, De Bortoli M, Rosa M, Millino C, Pacchioni B, Di Bonaventura C, Giallonardo AT, Striano S, Striano P, Parmeggiani A, Nobile C. Autosomal dominant lateral temporal epilepsy (ADLTE): novel structural and single-nucleotide LGI1 mutations in families with predominant visual auras. Epilepsy Res 2014; 110:132-8. [PMID: 25616465 DOI: 10.1016/j.eplepsyres.2014.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/11/2014] [Accepted: 12/01/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE Autosomal dominant lateral temporal epilepsy (ADLTE) is a genetic focal epilepsy syndrome characterized by prominent auditory or aphasic symptoms. Mutations in LGI1 account for less than 50% of ADLTE families. We assessed the impact of LGI1 microrearrangements in a collection of ADLTE families and sporadic lateral temporal epilepsy (LTE) patients, and investigated novel ADLTE and LTE patients. METHODS Twenty-four ADLTE families and 140 sporadic LTE patients with no evidence of point mutations in LGI1 were screened for copy number alterations using multiplex ligation-dependent probe amplification (MLPA). Newly ascertained familial and sporadic LTE patients were clinically investigated, and interictal EEG and MRI findings were obtained; probands were tested for LGI1 mutations by direct exon sequencing or denaturing high performance liquid chromatography. RESULTS We identified a novel microdeletion spanning LGI1 exon 2 in a family with two affected members, both presenting focal seizures with visual symptoms. Also, we identified a novel LGI1 missense mutation (c.1118T > C; p.L373S) in a newly ascertained family with focal seizures with prominent visual auras, and another missense mutation (c.856T > C; p.C286R) in a sporadic patient with auditory seizures. CONCLUSIONS We describe two novel ADLTE families with predominant visual auras segregating pathogenic LGI1 mutations. These findings support the notion that, in addition to auditory symptoms, other types of auras can be found in patients carrying LGI1 mutations. The identification of a novel microdeletion in LGI1, the second so far identified, suggests that LGI1 microrearrangements may not be exceptional.
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Affiliation(s)
- Emanuela Dazzo
- CNR-Neuroscience Institute, Section of Padua, Padova, Italy
| | - Lia Santulli
- Department of Neurological Sciences, Federico II University, Napoli, Italy
| | - Annio Posar
- IRCCS-Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Jinane Fattouch
- Department of Neurological Sciences, La Sapienza University, Roma, Italy
| | - Sara Conti
- IRCCS-Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | | | | | - Maurizio Rosa
- Department of Biology, University of Padova, Padova, Italy
| | | | | | | | | | - Salvatore Striano
- Department of Neurological Sciences, Federico II University, Napoli, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Institute "G. Gaslini", University of Genova, Genova, Italy
| | | | - Carlo Nobile
- CNR-Neuroscience Institute, Section of Padua, Padova, Italy.
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