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Ginanneschi F, Vinciguerra C, Volpi N, Piscosquito G, Barone P, Rossi A. Chronic inflammatory demyelinating polyneuropathy after SARS-CoV2 vaccination: update of the literature and patient characterization. Immunol Res 2023; 71:833-838. [PMID: 37395901 DOI: 10.1007/s12026-023-09406-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023]
Abstract
Since the beginning of worldwide vaccination against COVID-19 disease, some reports have revealed a possible relationship between SARS CoV2 vaccination and chronic inflammatory demyelinating polyneuropathy (CIDP). We reviewed the available evidences regarding this topic, adding three new cases to those reported so far, with the purpose to outline the characteristics of these post-vaccinal CIDP. Seventeen subjects were studied. A total of 70.6% of CIDP cases were related to viral vector vaccines, most occurring after the administration of the first dose. CIDPs that occurred after the second dose (17%) were temporally associated with mRNA vaccines. The clinical course and electrophysiology of all patients met the criteria for acute-subacute CIDP (A-CIDP). Administration of the viral vector vaccine was significantly correlated with a higher probability of having cranial nerve impairment (p = 0.004). The electrophysiological phenotype, laboratory and imaging data, and first-line therapies were substantially similar to those of the classical CIDP. The take-home message of the present paper is that the SARS CoV2 vaccine, especially the AstraZeneca vaccine, may be associated with inflammatory neuropathies with acute onset, often indistinguishable from Guillain-Barré syndrome (GBS). Hence, the importance of tracked prospectively patients with GBS occurred post-SARS-CoV2 vaccine. Distinguishing GBS from A-CIDP is crucial because treatment strategies and long-term prognosis are different.
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Affiliation(s)
- Federica Ginanneschi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
| | - Claudia Vinciguerra
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Paolo Barone
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Alessandro Rossi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
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Di Maggio A, Volpi N, Marigliani D, Garosi G, Rollo F, Ginanneschi F, Tosi GM, Fabiani C. Purtscher-like retinopathy in a patient with systemic tacrolimus vasculopathy. Eur J Ophthalmol 2023; 33:NP103-NP108. [PMID: 36451542 DOI: 10.1177/11206721221143157] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Purtscher-like retinopathy is a rare occlusive retinal microangiopathy, whose pathogenesis has not been totally defined yet. Most frequent cause of Purtscher-like retinopathy is acute pancreatitis, but it may be triggered by other systemic or toxic conditions. We report herein a case of Purtscher-like retinopathy in the context of systemic tacrolimus vasculopathy. CASE REPORT A 56-years old male with history of kidney transplant was referred to local emergency room because of a global worsening of health conditions, with fatigue, muscular pain and diuresis contraction. During hospitalization the patient came to our attention for sudden and severe visual acuity impairment in both eyes. Extensive ophthalmological assessment, optical coherence tomography (OCT) and fluorescein angiography (FA) were performed disclosing a marked drop in best corrected visual acuity (BCVA) (20/200 in the right eye and 10/400 in the left eye) caused by a bilateral severe occlusive retinal microangiopathy complicated by diffuse retinal ischaemia and neovascular glaucoma. Muscular biopsy showed a necrotizing myopathy with autoimmune features, as indicated by conspicuous upregulation of MHC-I complex and microangiopathic changes, consistent with tacrolimus toxicity. Tacrolimus administration was interrupted, and intravenous glucocorticoids were administered. The large areas of retinal ischemia and neovascular glaucoma were treated with pan-retinal photocoagulation and intravitreal injections of bevacizumab with complete regression of iris neovascolarization. BCVA measured 20/200 in both eyes at last follow-up visit, 20 months after symptoms onset. CONCLUSIONS Purtscher-like retinopathy should be suspected in patients under treatment with calcineurin inhibitors especially in case of sudden and severe bilateral visual impairment.
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Affiliation(s)
- Alessandro Di Maggio
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Davide Marigliani
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Guido Garosi
- Nephrology, Dialysis and Renal Transplant Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Fabio Rollo
- Nephrology, Dialysis and Renal Transplant Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Federica Ginanneschi
- Neurology and Clinical Neurophysiology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Vinciguerra C, Bevilacqua L, Lupica A, Ginanneschi F, Piscosquito G, Rini N, Rossi A, Barone P, Brighina F, Di Stefano V. Diagnosis and Management of Seronegative Myasthenia Gravis: Lights and Shadows. Brain Sci 2023; 13:1286. [PMID: 37759888 PMCID: PMC10526522 DOI: 10.3390/brainsci13091286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Myasthenia gravis (MG) is an antibody-mediated neuromuscular disease affecting the neuromuscular junction. In most cases, autoantibodies can be detected in the sera of MG patients, thus aiding in diagnosis and allowing for early screening. However, there is a small proportion of patients who have no detectable auto-antibodies, a condition termed "seronegative MG" (SnMG). Several factors contribute to this, including laboratory test inaccuracies, decreased antibody production, immunosuppressive therapy, immunodeficiencies, antigen depletion, and immune-senescence. The diagnosis of SnMG is more challenging and is based on clinical features and neurophysiological tests. The early identification of these patients is needed in order to ensure early treatment and prevent complications. This narrative review aims to examine the latest updates on SnMG, defining the clinical characteristics of affected patients, diagnostic methods, management, and therapeutic scenarios.
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Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Antonino Lupica
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (F.G.)
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Nicasio Rini
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (F.G.)
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
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Porcelli B, d'Alessandro M, Gupta L, Grazzini S, Volpi N, Bacarelli MR, Ginanneschi F, Biasi G, Bellisai F, Fabbroni M, Bennett D, Fabiani C, Cantarini L, Bargagli E, Frediani B, Conticini E. Anti-Cytosolic 5'-Nucleotidase 1A in the Diagnosis of Patients with Suspected Idiopathic Inflammatory Myopathies: An Italian Real-Life, Single-Centre Retrospective Study. Biomedicines 2023; 11:1963. [PMID: 37509600 PMCID: PMC10377506 DOI: 10.3390/biomedicines11071963] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Anti-cytosolic 5'-nucleotidase 1A (anti-cN1A) antibodies were proposed as a biomarker for the diagnosis of inclusion body myositis (IBM), but conflicting specificity and sensitivity evidence limits its use. Our study aimed to assess the diagnostic accuracy of anti-cN1A in a cohort of patients who underwent a myositis line immunoassay for suspected idiopathic inflammatory myopathies (IIM). We also assessed the agreement between two testing procedures: line immunoassay (LIA) and enzyme-linked immunoassay (ELISA). MATERIALS AND METHODS We collected retrospective clinical and serological data for 340 patients who underwent a myositis antibody assay using LIA (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag et cN-1A (IgG) line immunoassay) and verification with an anti-cN1A antibody assay using ELISA (IgG) (Euroimmun Lubeck, Germany). RESULTS The serum samples of 20 (5.88%) patients (15 females, 5 males, mean age 58.76 ± 18.31) tested positive for anti-cN1A using LIA, but only two out of twenty were diagnosed with IBM. Seventeen out of twenty tested positive for anti-cN1A using ELISA (median IQR, 2.9 (1.9-4.18)). CONCLUSIONS Our study suggests excellent concordance between LIA and ELISA for detecting anti-cN1A antibodies. LIA may be a rapid and useful adjunct, and it could even replace ELISA for cN1A assay. However, the high prevalence of diseases other than IBM in our cohort of anti-cN1A-positive patients did not allow us to consider anti-cN1A antibodies as a specific biomarker for IBM.
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Affiliation(s)
- Brunetta Porcelli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria alle Scotte, AOU Senese, 53100 Siena, Italy
- Dipartimento Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, 53100 Siena, Italy
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Silvia Grazzini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Maria Romana Bacarelli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria alle Scotte, AOU Senese, 53100 Siena, Italy
| | - Federica Ginanneschi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Francesca Bellisai
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Marta Fabbroni
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - David Bennett
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, 53100 Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, 53100 Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
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Ginanneschi F, Cioncoloni D, Capoccitti G, Volpi N, Ferretti F, Giannini F, Rossi A. Study of total duration of distal compound muscle action potential in demyelinating and axonal Guillain-Barre' syndrome. Neurol Res 2023; 45:381-389. [PMID: 36403142 DOI: 10.1080/01616412.2022.2148517] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Electrophysiology plays a crucial role in Guillain-Barré syndrome (GBS) diagnosis and subtype classification. The aim of our study was to assess the potential role of distal compound muscle action potential (dCMAP) for early differentiation between acute inflammatory demyelinating polyneuropathy (AIDP) and axonal GBS. METHODS We retrospectively reviewed the medical records of 24 subjects with AIDP and 18 subjects with axonal GBS. We built up receiver operating characteristic curves for total dCMAP duration and negative phase of dCMAP duration, in order to derive cut-off values able to differentiate between AIDP and axonal GBS. RESULTS The total duration of dCMAP was significantly prolonged in AIDP compared to axonal GBS. AUCs, odds ratio and positive predictive values were higher for total duration than for negative peak duration. Nerve conduction parameters in the lower limbs were more sensitive than those in the upper limbs in distinguishing AIDP from axonal GBS. DISCUSSION Total duration of dCMAP dispersion may capture an adjunctive component of distal demyelination, not measured by the more traditional parameters and may thus represent a useful tool for early differentiation between AIDP and axonal GBS.
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Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giorgio Capoccitti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Giannini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Vinciguerra C, Iacono S, Bevilacqua L, Landolfi A, Piscosquito G, Ginanneschi F, Schirò G, Di Stefano V, Brighina F, Barone P, Balistreri CR. Sex differences in neuromuscular disorders. Mech Ageing Dev 2023; 211:111793. [PMID: 36806604 DOI: 10.1016/j.mad.2023.111793] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
The prevalence, onset, pathophysiology, and clinical course of many neuromuscular disorders (NMDs) may significantly differ between males and females. Some NMDs are more frequently observed in females, and characterized to show a higher grade of severity during or after the pregnancy. Meanwhile, others tend to have an earlier onset in males and exhibit a more variable progression. Prevalently, sex differences in NMDs have a familiar character given from genetic inheritance. However, they may also influence clinical presentation and disease severity of acquired NMD forms, and are represented by both hormonal and genetic factors. Consequently, to shed light on the distinctive role of biological factors in the different clinical phenotypes, we summarize in this review the sex related differences and their distinctive biological roles emerging from the current literature in both acquired and inherited NMDs.
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Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy.
| | - Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Annamaria Landolfi
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Giuseppe Schirò
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo
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Alberti M, Ginanneschi F, Rossi A, Monti L. Case report: A quantitative and qualitative diffusion tensor imaging (DTI) study in varicella zoster-related brachial plexopathy. Front Neuroimaging 2023; 1:1034241. [PMID: 37555181 PMCID: PMC10406270 DOI: 10.3389/fnimg.2022.1034241] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 08/10/2023]
Abstract
Diffusion tensor imaging (DTI) is considered feasible for the nerve plexuses' imaging and quantitative evaluation but its value in the clinical practice is still virtually unexplored. We present the DTI profile of a case of acute varicella-zoster virus (VZV)-related brachial plexopathy. A 72-year-old woman presented with left upper-limb segmental paresis involving the spinal metamers C6-C7, preceded by a painful dermatomal vesicular eruption in C5-T1 dermatomes. Clinical and electrophysiological findings and magnetic resonance imaging indicated a plexus involvement. DTI analysis showed decreased fractional anisotropy (FA) and an increase of all the other diffusivity indexes, i.e., mean, axial, and radial diffusivity. The mechanisms underlying DTI parameter differences between healthy and pathologic brachial plexus sides could be related to microstructural fiber damage. Water diffusion is affected within the nerve roots by increasing the diffusion distance, leading to increased diffusion perpendicular to the largest eigenvalue and therefore to decreased FA values The role of DTI in clinical practice has not been defined yet. Additional quantitative and qualitative DTI information could improve the assessment and follow-up of brachial plexopathy.
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Affiliation(s)
- Manfredi Alberti
- Neurology Unit, Department of Neurology and Human Movement Sciences, University Hospital of Siena, Siena, Italy
- Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Federica Ginanneschi
- Neurology Unit, Department of Neurology and Human Movement Sciences, University Hospital of Siena, Siena, Italy
- Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Neurology Unit, Department of Neurology and Human Movement Sciences, University Hospital of Siena, Siena, Italy
- Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Lucia Monti
- Diagnostic and Functional Neuroimaging Unit, Department of Neurology and Human Movement Sciences, University Hospital of Siena, Siena, Italy
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Falsetti P, Conticini E, Baldi C, D’Ignazio E, Al Khayyat SG, Bardelli M, Gentileschi S, D’Alessandro R, D’Alessandro M, Acciai C, Ginanneschi F, Cantarini L, Frediani B. A Novel Ultrasonographic Anthropometric-Independent Measurement of Median Nerve Swelling in Carpal Tunnel Syndrome: The "Nerve/Tendon Ratio" (NTR). Diagnostics (Basel) 2022; 12:diagnostics12112621. [PMID: 36359465 PMCID: PMC9689936 DOI: 10.3390/diagnostics12112621] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background: There is little consensus on ultrasound (US) normative values of cross-sectional area of median nerve (MN-CSA) in carpal tunnel syndrome (CTS) because of its dependency on anthropometric parameters. We aim to propose a novel anthropometric-independent US parameter: MN-CSA/flexor radialis carpi CSA (FCR-CSA) ratio (“Nerve Tendon Ratio”, NTR), in the diagnosis of clinically and electrodiagnostic (EDS)-defined CTS. Methods: 74 wrists of 49 patients with clinically defined CTS underwent EDS (scored by the 1−5 Padua Scale of electrophysiological severity, PS) and US of carpal tunnel with measurement of MN-CSA (at the carpal tunnel inlet), FCR-CSA (over scaphoid tubercle) and its ratio (NTR, expressed as a percentage). US normality values and intra-operator agreement were assessed in 33 healthy volunteers. Results: In controls, the mean MN-CSA was 5.81 mm2, NTR 64.2%. In 74 clinical CTS, the mean MN-CSA was 12.1 mm2, NTR 117%. In severe CTS (PS > 3), the mean MN-CSA was 15.9 mm2, NTR 148%. In CTS, both MN-CSA and NTR correlated with sensitive conduction velocity (SCV) (p < 0.001), distal motor latency (DML) (p < 0.001) and PS (p < 0.001), with a slight superiority of NTR vs. MN-CSA when controlled for height, wrist circumference and weight. In CTS filtered for anthropometric extremes, only NTR maintained a correlation with SCV (p = 0.023), DML (p = 0.016) and PS (p = 0.009). Diagnostic cut-offs were obtained with a binomial regression analysis. In those patients with a clinical diagnosis of CTS, the cut-off of MN-CSA (AUROC: 0.983) was 8 mm2 (9 mm2 with highest positive predictive value, PPV), while for NTR (AUROC: 0.987), the cut-off was 83% (100% with highest PPV). In patients with EDS findings of severe CTS (PS > 3), the MN-CSA (AUROC: 0.876) cut-off was 12.3 mm2 (15.3 mm2 with highest PPV), while for NTR (AUROC: 0.858) it was 116.2% (146.0% with highest PPV). Conclusions: NTR can be simply and quickly calculated, and it can be used in anthropometric extremes.
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Affiliation(s)
- Paolo Falsetti
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
- Correspondence:
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Emilio D’Ignazio
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Suhel Gabriele Al Khayyat
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Roberto D’Alessandro
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Miriana D’Alessandro
- Unit of Respiratory Diseases and Lung Transplantation, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Caterina Acciai
- Neurorehabilitation Unit, San Donato Hospital, 52100 Arezzo, Italy
| | - Federica Ginanneschi
- Neurology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical, Surgical Sciences and Neurosciences, University Hospital of Siena, 53100 Siena, Italy
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Ginanneschi F, Giannini F, Sicurelli F, Battisti C, Capoccitti G, Bartalini S, Mignarri A, Volpi N, Cioncoloni D, Franci L, De Stefano N, Rossi A. Clinical Features and Outcome of the Guillain–Barre Syndrome: A Single-Center 11-Year Experience. Front Neurol 2022; 13:856091. [PMID: 35860488 PMCID: PMC9289976 DOI: 10.3389/fneur.2022.856091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/16/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Clinical presentation, electrophysiological subtype, and outcome of the Guillain–Barre' Syndrome (GBS) may differ between patients from different geographical regions. This study aims to assess clinical–neurophysiological features of an adult, Italian GBS cohort over 11 years. Methods Retrospective (from 1 January 2011 to 31 December 2021) analysis was carried out on patients admitted to the Siena University Hospital who fulfilled the GBS diagnostic criteria. Demographic data, clinical characteristics, treatment, need of mechanical ventilation (MV), laboratory and electrophysiological tests, preceding infections/vaccination/other conditions, and comorbidities were collected for each patient. Results A total of 84 patients (51 men, median age of 61 years), were identified. GBS subtype was classified as acute inflammatory demyelinating polyneuropathy (AIDP) in the 66.6% of patients, acute motor/sensory axonal neuropathy (AMAN/AMSAN) in 20.2%, and the Miller Fisher syndrome in 5 (5.9%). Flu syndrome and gastrointestinal infection were the most common preceding conditions. In total, five (5.9%) subjects had concomitant cytomegalovirus (CMV) infection. Cranial nerve involvement occurred in 34.5% of subjects. Differences between the axonal and AIDP forms of GBS concerned the presence of anti-ganglioside antibodies. In total, seven (8.33%) patients required MV. Discussion The epidemiological and clinical characteristics of GBS in different countries are constantly evolving, especially in relation to environmental changes. This study provides updated clinical-epidemiological information in an Italian cohort.
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Affiliation(s)
- Federica Ginanneschi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- *Correspondence: Federica Ginanneschi
| | - Fabio Giannini
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Sicurelli
- Clinical Neurology and Neurometabolic Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Carla Battisti
- Clinical Neurology and Neurometabolic Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giorgio Capoccitti
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Sabina Bartalini
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Andrea Mignarri
- Clinical Neurology and Neurometabolic Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Laura Franci
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Clinical Neurology and Neurometabolic Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Mondelli M, Aretini A, Ginanneschi F. Electrophysiological Study of the Tibial Nerve Across the Tarsal Tunnel in Distal Symmetric Diabetic Polyneuropathy. Am J Phys Med Rehabil 2022; 101:152-159. [PMID: 33901043 DOI: 10.1097/phm.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes. DESIGN One hundred twenty-four consecutive patients (mean age = 66.6 yrs, 62.1% male) with distal symmetric diabetic polyneuropathy clinically diagnosed were prospectively enrolled. Nerve conduction studies of deep peroneal, tibial, superficial peroneal, medial plantar, and sural nerves and standard needle electromyography in the lower limbs were performed. Demographic, anthropometric, and clinical findings were collected. RESULTS Motor conduction velocity of the tibial nerve across tarsal tunnel was slowed in 60.5% of patients; another 4% showed conduction block across tarsal tunnel without reduction of motor conduction velocity. Overall percentage of abnormalities across tarsal tunnel (64.5%) exceeds that of the sensory conduction velocities of proximal sural and superficial peroneal nerves. Abnormal tibial motor conduction velocity across tarsal tunnel represents the most common abnormality among all motor nerve conduction study parameters and significantly correlates with hemoglobin level, diabetic neuropathic index score, and diabetic complications frequency. CONCLUSIONS Tibial conduction abnormalities across tarsal tunnel are the most sensitive motor parameter in distal symmetric diabetic polyneuropathy, second only to conduction abnormalities of sensory/mixed distal nerves of the feet. The use of nerve conduction studies across tarsal tunnel of the tibial nerve may be useful in the electrophysiological protocol to confirm the diagnosis of distal symmetric diabetic polyneuropathy.
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Affiliation(s)
- Mauro Mondelli
- From the EMG Service, Local Health Unit Toscana Sud Est, Siena, Italy (MM, AA); and Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy (FG)
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11
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Ginanneschi F, Vittori C, Tassi R, Severi I, Giuggioli F, Auletta C, Diana F, Rossi A. Somatosensory evoked potentials and transcranial color Doppler monitoring in subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106214. [PMID: 34923433 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106214] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The outcome of patients with subarachnoid hemorrhage (SAH) is broadly influenced by the complications that may result from the hemorrhage. We describe a series of subjects, in which neurophysiological monitoring executed by simultaneous recording of somatosensory evoked potentials (SEPs) and transcranial color Doppler (TCD) was performed to reveal possible, early complications following acute SAH. MATERIALS AND METHODS We described the absolute and interhemispheric values of SEPs from the upper limb and TCD examinations of the cerebral arteries in 13 subjects with acute SAH. RESULTS In cases with middle cerebral artery (MCA) vasospasm, N20 SEP amplitude absolute values for the hemisphere involved in the vasospasm were much lower than the contralateral ones. The N20 amplitude ratio reduction correlated with reciprocal of MCA mean flow velocity values detected within each patient. In the subjects with early ischemic damage following SAH, the affected hemisphere showed N20 amplitude drop; in addition, the relationship between SEPs and TCD findings was missing. CONCLUSION Our findings emphasize the utility of simultaneous evaluation of SEPs and TCD in SAH follow-up, since the two methods reflect different pathomechanisms of possible secondary brain damage in aneurysmal SAH.
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Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
| | - Cesare Vittori
- Anesthesia and Neurosurgical Intensive Care Unit, Department of Neurological and Human Movement Sciences, AOUS, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency-Urgency and Transplants, AOUS, Siena, Italy
| | - Ilaria Severi
- Stroke Unit, Department of Emergency-Urgency and Transplants, AOUS, Siena, Italy
| | - Federico Giuggioli
- Stroke Unit, Department of Emergency-Urgency and Transplants, AOUS, Siena, Italy
| | - Caterina Auletta
- Anesthesia and Neurosurgical Intensive Care Unit, Department of Neurological and Human Movement Sciences, AOUS, Siena, Italy
| | - Francesca Diana
- Anesthesia and Neurosurgical Intensive Care Unit, Department of Neurological and Human Movement Sciences, AOUS, Siena, Italy
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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12
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Bocci S, Giannini F, Volpi N, Rossi A, Ginanneschi F. Multifocal motor neuropathy occurring after acute motor axonal neuropathy: two stages of the same disease? Neurol Sci 2021; 43:1463-1465. [PMID: 34800200 DOI: 10.1007/s10072-021-05725-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Silvia Bocci
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Fabio Giannini
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Alessandro Rossi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
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Lopergolo D, Bocci S, Pinto AM, Valentino F, Doddato G, Ginanneschi F, Volpi N, Renieri A, Giannini F. A new mutation in DNM2 gene in a large Italian family. Neurol Sci 2021; 42:2509-2513. [PMID: 33459893 DOI: 10.1007/s10072-020-04972-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
The Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy with great clinical and genetic heterogeneity. Mutations in DNM2 have been associated with CMT dominant intermediate B (CMTDIB). However, mutations in the same gene are known to induce also axonal CMT (CMT2M) or centronuclear myopathy. Moreover, the ability of effectively and simultaneously sequencing different CMT-related genes by next-generation sequencing approach makes it possible to detect even the presence of modifier genes that sometimes give reason of clinical variability in the context of complex phenotypes. Here, we describe an Italian family with very variable severity of phenotype among members harboring a novel DNM2 gene mutation which caused a prevalent CMT2M phenotype. The contemporary presence of a de novo variant in PRX gene in the most severely affected family member suggests a possible modulator effect of the PRX variant thus highlighting the possible impact of modifier genes in CMT.
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Affiliation(s)
- Diego Lopergolo
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Silvia Bocci
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,UOC Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Maria Pinto
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,UOC Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,UOC Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy. .,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Fabio Giannini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,UOC Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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14
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Rossi A, Feurra M, Rossi S, Santarnecchi E, Ginanneschi F. Impact of β-range-induced oscillatory activity on human input-output relationship of the corticospinal pathway. Neurol Res 2021; 43:496-502. [PMID: 33441044 DOI: 10.1080/01616412.2020.1870358] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of the study was to show that short-lasting (90 s) transcranial alternating current stimulation (tACS) at 20 Hz delivered over the left primary motor cortex (M1) is able to change the shape of recruitment curve of the corticospinal pathway.Methods: The corticospinal pathway was studied during tACS by means of the relationship between the intensity of transcranial magnetic stimulation (TMS) delivered over the left M1 and corresponding motor evoked potentials (MEPs) recorded from the right first dorsal interosseus muscle (FDI), in nine healthy subjects. In order to extract characteristics of the input-output relationship that have particular physiological relevance, data were fitted to the Boltzmann sigmoidal function by the Levenberg-Marquardt nonlinear, least mean squares algorithm.Results: The β-rhythm tACS influenced the shape and parameters of the input-output relation, so that the initial segment of the conditioned curve (from threshold to 30% of maximum muscle size) diverged, while the subsequent segment converged to overlap the unconditioned control curve.Discussion: β-rhythm tACS conditions only a definite subset of corticospinal elements influencing less than 30% of the entire motoneuronal pool. The fact that β-rhythm tACS mainly affects the most excitable motoneurons could explain the observed antikinetic effect of the tACS at β-rhythm applied in the motor regions.
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Affiliation(s)
- Alessandro Rossi
- Department of Medical, Surgery and Neurological Sciences, Brain Investigation and Neuromodulation Lab (Si-bin Lab), University of Siena, Siena, Italy
| | - Matteo Feurra
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University, Higher School of Economics, Moscow, Russia
| | - Simone Rossi
- Department of Medical, Surgery and Neurological Sciences, Brain Investigation and Neuromodulation Lab (Si-bin Lab), University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Department of Medical, Surgery and Neurological Sciences, Brain Investigation and Neuromodulation Lab (Si-bin Lab), University of Siena, Siena, Italy.,Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Federica Ginanneschi
- Department of Medical, Surgery and Neurological Sciences, Brain Investigation and Neuromodulation Lab (Si-bin Lab), University of Siena, Siena, Italy
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Mondelli M, Vinciguerra C, Aretini A, Ginanneschi F. The effects of anthropometric and demographic factors on conduction parameters of the ulnar nerve: Multivariate analysis. Neurosci Lett 2020; 734:135107. [PMID: 32485286 DOI: 10.1016/j.neulet.2020.135107] [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] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Abstract
The objective of the study is to investigate the effects of age, height, gender, body mass index (BMI), waist-to-hip ratio (WHR), arm and elbow measures on ulnar nerve conduction. We enrolled 261 "disease-free" subjects. We analyzed motor conduction velocity (MCV) in across elbow (AE) and forearm tracts, and sensory conduction velocity in 4th, 5th digit-wrist tracts (U4, U5) and in dorsal ulnar cutaneous nerve (DUC). We calculated the amplitudes of sensory and motor potentials (CMAPa and SNAPa), % of CMAPa drop AE, MCV drop and distal motor latency (DML). Univariate and multivariate analyses were performed. We estimated the predictive equations. The median nerve was examined for comparison. Age was negatively correlated with all conduction parameters. Forearm and AE MCV, % of CMAPa drop, DML, U4 and U5 SCV also depended upon height. Females had higher U4 and U5 SNAPa than males. BMI showed inverse relationship with U4 and U5 SNAPa. DUC parameters depended upon BMI and arm length. Similar trends were observed for the median nerve. "Normative" ulnar conduction parameters should be adjusted for demographic and anthropometric measures to improve diagnostic sensitivity.
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Affiliation(s)
- Mauro Mondelli
- EMG Service, Local Health Unit "Toscana Sud Est", Siena, Italy
| | | | | | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy.
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Ginanneschi F, Curti S, Marinelli F, Nft AA, Cioncoloni D, Mattioli S, Mondelli M. Reference values for distal motor conduction of the tibial nerve: Effects of demographic and anthropometric measures. Muscle Nerve 2020; 62:219-225. [PMID: 32362001 DOI: 10.1002/mus.26908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/11/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In this study we collected reference values for the across-tarsal-tunnel conduction of the motor tibial nerve (mTN). METHODS The mTN compound muscle action potentials (CMAPs) from the abductor hallucis muscle were obtained by stimulating below/above the malleolus and the popliteal fossa. The effect of weight, height, body mass index (BMI), foot and leg length, sex, and age were evaluated using univariate and multivariate correlation analyses, and predictive equations for each mTN conduction parameter were developed. RESULTS On the basis of data from 185 subjects, there were differences between women and men in all anthropometric parameters and for some nerve conduction values. Through multivariate analysis, age, but not sex, was found to have a significant impact. Height affected both distal and proximal conduction velocity. BMI affected CMAP amplitude. DISCUSSION mTN conduction is influenced by various demographic and anthropometric factors. For all intrinsic factors, height demonstrated the greatest effect on mTN conduction across the tarsal tunnel.
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Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Marinelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - David Cioncoloni
- Unità Operativa Professionale, Professioni della Riabilitazione, Siena, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
BACKGROUND Prospective study to investigate the effects of elastic stockings (GCS) 23-32 mmHg at ankle on Hoffmann reflex (H-reflex) from soleus muscle under rest and after a walking program. METHODS Fourteen subjects wore two types of GCS, at different times. Electrophysiological examinations were carried out at rest without and with GCS, immediately after walking with GCS and 20 minutes later after removing GCS. RESULTS Peripheral nerve conduction remained unchanged after using the GCS. Conversely, walking with GCS led to changes in a spinal cord pathway expressed as a decrease of H-threshold and an increase of H-size as a function of stimulus intensity, which lasted for at least 20 minutes. CONCLUSIONS GCS has no effect on the peripheral nervous system. The GCS intolerance and the discomfort sometimes reported by patients do not derive from a dysfunction of the lower limb peripheral nervous system. A positive action on spinal reflex excitability is detected after walking while wearing GCS. We suggest that nervous descending activity due to voluntary contractions, and afferent cutaneous discharge, enhanced by movement under compression, converge on inhibitory interneurons, thus impinging on presynaptic pathways. All this can lead to an enhancement of the monosynaptic responses. Higher limb oxygenation detected during walking with GCS, found by other Authors, could increase the sensitivity of the muscle spindle afferents and/or motor neuron excitability resulting in an increase in H-reflex excitability, with potential positive effects on neuromuscular activities improving proprioception and postural control of the lower limbs.
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Affiliation(s)
- Stefano Mancini
- Unit of Phlebolymphology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabrizio Mariani
- European Training Center in Phlebology - European Union of Medical Specialists, Angiomedica Vein Clinic, Colle Val d'Elsa, Siena, Italy
| | - Alessandro Rossi
- Section of Neurology and Clinical Neurophysiology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- Unit of Rehabilitation, University Hospital of Siena, Siena, Italy
| | - Federica Ginanneschi
- Section of Neurology and Clinical Neurophysiology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy -
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Ginanneschi F, D’Amore A, Barghigiani M, Tessa A, Rossi A, Santorelli FM. SPG8 mutations in Italian families: clinical data and literature review. Neurol Sci 2019; 41:699-703. [DOI: 10.1007/s10072-019-04180-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/25/2019] [Indexed: 01/03/2023]
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Messa LV, Ginanneschi F, Momi D, Monti L, Battisti C, Cioncoloni D, Pucci B, Santarnecchi E, Rossi A. Functional and Brain Activation Changes Following Specialized Upper-Limb Exercise in Parkinson's Disease. Front Hum Neurosci 2019; 13:350. [PMID: 31749690 PMCID: PMC6843060 DOI: 10.3389/fnhum.2019.00350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 05/24/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
For the management of Parkinson's disease (PD), the concept of forced exercise (FE) has drawn interest. In PD subjects, the FE executed with lower limbs has been shown to lessen symptoms and to promote brain adaptive changes. Our study is aimed to investigate the effect of an upper-limb exercise, conceptually comparable with the FE, in PD. Upper-limb exercise was achieved in a sitting position by using a specially designed device (Angel's Wings®). Clinical data, computerized dynamic posturography, magnetic resonance imaging (MRI) (resting-state MRI and arterial spin labeling), and neuropsychological tests were used before and after 2 months' exercise training. We found a significant long-lasting improvement in Unified Parkinson Disease Rating Scale (UPDRS)-III and cognitive scales, along with improvement in balance and postural control (better alignment of the gravity center and improvement in weight symmetry and in anticipatory motor strategies). Computerized dynamic posturography pointed out an enhanced central ability to integrate the vestibular signals with afferents from other sensory systems. Neuroimaging analyses after 2 months' exercise training showed, with respect to pretraining condition, many changes. An increase of the cerebral blood flow was evident in the left primary motor cortex (M1), left supplementary motor cortical area, and left cerebellar cortex. The bilateral globus pallidus showed an increased functional connectivity to the right central operculum, right posterior cingulate gyrus, and left sensorimotor cortex. Seed-to-voxel analysis demonstrated a functional connectivity between M1 and the left superior frontal gyrus. Left crus II showed strengthened connections with the left pre-rolandic area, left post-rolandic area, and left supramarginal area. These findings likely reflect compensatory mechanisms to the neuropathological hallmark of PD. Overall, our results show that this upper-limb exercise model, conceptually comparable with the FE already tested in the lower limbs, leads to a global improvement (involving non-exercised limbs) likely consistent with the functional changes observed in the central nervous system.
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Affiliation(s)
- Luca Valerio Messa
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Davide Momi
- Siena Brain Investigation and Neuromodulation Lab, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Carla Battisti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Barbara Pucci
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,The Center for Complex Network Research, Department of Physics, Northeastern University, Boston, MA, United States
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Ginanneschi F, Rubegni A, Moro F, Volpi N, Santorelli FM, Rossi A. SCN11A variant as possible pain generator in sensory axonal neuropathy. Neurol Sci 2019; 40:1295-1297. [PMID: 30623267 DOI: 10.1007/s10072-019-3703-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte. Viale Bracci 1, 53100, Siena, Italy.
| | - Anna Rubegni
- Molecular Medicine & Neurogenetics, IRCCS Stella Maris, Pisa, Italy
| | - Francesca Moro
- Molecular Medicine & Neurogenetics, IRCCS Stella Maris, Pisa, Italy
| | - Nila Volpi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte. Viale Bracci 1, 53100, Siena, Italy
| | | | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte. Viale Bracci 1, 53100, Siena, Italy
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Ginanneschi F, Filippou G, Adinolfi A, Di Sabatino V, Frediani B, Rossi A. Spasmophilia and entrapment nerve syndrome comorbidities in fibromyalgic patients: a possible neuromuscular pain generator. Reumatismo 2018; 70:251-256. [PMID: 30570243 DOI: 10.4081/reumatismo.2018.1079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 06/09/2018] [Indexed: 11/23/2022] Open
Abstract
This paper is aimed at investigating whether peripheral dysfunction at the neuromuscular level may represent a pain generator in fibromyalgia. We studied the prevalence of spasmophilia (SP), carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE) in a group of 40 subjects suffering from fibromyalgia. Clinical and electrophysiological data were obtained to ascertain whether comorbid conditions were present. For subjective evaluation of symptoms severity, validated questionnaires for CTS and UNE were completed by patients. Twenty subjects were positive for SP (50%); CTS was diagnosed in 12 subjects (30%); no patient suffered from UNE; 6 subjects were affected at the same time by SP and CTS (15%); 14 subjects (35%) were affected by SP alone. The prevalence of CTS and SP was higher in fibromyalgia subjects than in the general population. The scores of the questionnaires related to CTS were significantly higher in fibromyalgia subjects positive for CTS, with respect to the other subjects. In fibromyalgia, CTS and SP may be considered clinical entities in themselves, the importance of which lies in their acting as peripheral pain generators that enhance or initiate central sensitization, thereby contributing to chronic widespread pain. The amplification of pain is indeed a correctable/misguided message that occurs inside the brain of fibromyalgia subjects and identification and local treatment of pain generators would lessen the total pain burden. The magnitude of the overlap in symptoms between fibromyalgia and CTS/SP necessitates careful investigation of these conditions.
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Affiliation(s)
- F Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, Rheumatology Section, University of Siena.
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Mondelli M, Ginanneschi F, Aretini A. Diagnostic Accuracy of Sensory Clinical Findings of the Hand Dorsum and of Neurography of the Dorsal Ulnar Cutaneous Nerve in Ulnar Neuropathy at the Elbow. Arch Phys Med Rehabil 2018; 100:908-913. [PMID: 30352224 DOI: 10.1016/j.apmr.2018.09.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/22/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The main objective is to investigate the diagnostic accuracy and the relation of touch sensation and subjective sensory symptoms in the medial aspect of the hand dorsum, and neurography of the dorsal ulnar cutaneous nerve (DUCN) in ulnar neuropathy at the elbow (UNE). Secondary objective is to report the electrophysiological occurrence of anatomical variant of sensory innervation of the medial aspect of the hand dorsum from superficial radial nerve (SRN). DESIGN Prospective, cohort study. SETTING Electromyography laboratory. PARTICIPANTS Consecutive participants (N=282), those with UNE (n=81) and those without UNE (n=201), were enrolled. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Accuracy and agreement between sensory clinical findings of the medial hand dorsum and neurography of DUCN in UNE diagnosis. RESULTS DUCN neurographic and sensory findings had high specificity and relatively low sensitivity. Normal or abnormal sensory nerve action potential (SNAP) of DUCN matched with normal or abnormal touch sensation of the medial aspect of hand dorsum. Abnormal DUCN SNAP was related to the clinical severity of UNE and to the axonal damage of the ulnar nerve. Anatomical variant of the innervation of hand dorsum from SRN was demonstrated in 31 of 564 hands (6.2%) belonging to 26 of 282 participants (9.2%). If the variant was present, DUCN SNAP of the same side was more frequently absent or of low amplitude. CONCLUSIONS The utility of DUCN neurography and sensory findings of the medial aspect of the dorsum of the hand is limited in the diagnosis of UNE. However, if DUCN SNAP is absent or low in amplitude, it is advisable to check the presence of the anatomical variant of the innervation of the medial aspect of the hand dorsum from SRN.
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Affiliation(s)
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Ginanneschi F, Mondelli M, Cioncoloni D, Rossi A. Impact of carpal tunnel syndrome on ulnar nerve at wrist: Systematic review. J Electromyogr Kinesiol 2018; 40:32-38. [DOI: 10.1016/j.jelekin.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/10/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022] Open
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Abstract
The F-wave/M-wave amplitude (F/M-amp) ratio has been shown to be increased in peripheral neuropathies, provided the maximum M-wave is relatively preserved. Reduced M-wave amplitudes and central facilitation of antidromically-induced reactivation of the anterior horn cells' axon hillocks (F-wave) are believed to contribute to higher F/M-amp ratios. The present study was undertaken to re-evaluate mechanisms responsible for higher F/M-amp ratios in carpal tunnel syndrome (CTS). We enrolled 232 cases affected by CTS and 108 controls. Fand M-wave amplitudes and F-wave chronodispersion were analyzed for the median and ulnar nerves. The F/M-amp ratio of the median nerve in CTS subjects with moderate-severe nerve damage was significantly higher than that of mild CTS subjects and controls. Chronodispersion of the median nerve F-wave increased with increasing CTS severity. We conclude that the relative preservation of the median nerve F-wave is due to damage to the large diameter muscle afferent fibers responsible for the monosynaptic response. Absence of the monosynaptic response makes the small motoneurons, usually inaccessible to the antidromic volley because of its collision with the orthodromic reflex volley, able to fire in the F-wave.
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Ginanneschi F, Mignarri A, Lucchiari S, Ulzi G, Comi GP, Rossi A, Dotti MT. Neuromuscular excitability changes produced by sustained voluntary contraction and response to mexiletine in myotonia congenita. Neurophysiol Clin 2017; 47:247-252. [PMID: 28153715 DOI: 10.1016/j.neucli.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate the cause of transient weakness in myotonia congenita (MC) and the mechanism of action of mexiletine in reducing weakness. METHODS The changes in neuromuscular excitability produced by 1min of maximal voluntary contractions (MVC) were measured on the amplitude of compound muscle action potentials (CMAP) in two patients with either recessive or dominant MC, compared to control values obtained in 20 healthy subjects. Measurements were performed again in MC patients after mexiletine therapy. RESULTS Transient reduction in maximal CMAP amplitude lasting several minutes after MVC was evident in MC patients, whereas no change was observed in controls. Mexiletine efficiently reduced this transient CMAP depression in both patients. DISCUSSION Transient CMAP depression following sustained MVC may represent the electrophysiological correlate of the weakness clinically experienced by the patients. In MC, the low chloride conductance could induce self-sustaining action potentials after MVC, determining progressive membrane depolarization and a loss of excitability of muscle fibers, thus resulting in transient paresis. Mexiletine may prevent conduction block due to excessive membrane depolarization, thus reducing the transient CMAP depression following sustained MVC.
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Affiliation(s)
- Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy.
| | - Andrea Mignarri
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy
| | - Sabrina Lucchiari
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianna Ulzi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo P Comi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy
| | - Maria Teresa Dotti
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy
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Mondelli M, Farioli A, Mattioli S, Aretini A, Ginanneschi F, Greco G, Curti S. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures. PLoS One 2016; 11:e0164715. [PMID: 27768728 PMCID: PMC5074522 DOI: 10.1371/journal.pone.0164715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/29/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales. Methods We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender. Results We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar. Conclusions Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.
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Affiliation(s)
- Mauro Mondelli
- EMG Service, Local Health Unit no.7, Siena, Italy
- * E-mail:
| | - Andrea Farioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Federica Ginanneschi
- Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Giuseppe Greco
- EMG Service, Local Health Unit no.7, “Nottola” Hospital, Montepulciano, Siena, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Vergori A, Masi G, Donati D, Ginanneschi F, Annunziata P, Cerase A, Mencarelli M, Rossetti B, De Luca A, Zanelli G. Listeria meningoencephalitis and anti-GQ1b antibody syndrome. Infection 2016; 44:543-6. [PMID: 26825308 DOI: 10.1007/s15010-015-0862-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 01/20/2023]
Abstract
We report the first case of Listeria monocytogenes meningoencephalitis associated with anti-GQ1b antibody syndrome in an immunocompetent adult. A prompt diagnosis, made thanks to the multidisciplinary contribution, allowed a combined therapeutic approach leading to final favourable outcome, despite several intercurrent complications.
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Affiliation(s)
- A Vergori
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - G Masi
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - D Donati
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - F Ginanneschi
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - P Annunziata
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - A Cerase
- Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy
| | - M Mencarelli
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - B Rossetti
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - A De Luca
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - G Zanelli
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy.
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Abstract
Although the knee jerk reflex is mediated by the L3 and L4 nerve roots, evidence exists that altered knee jerk expression may occur with exclusively L5 radiculopathy. The present study set out to identify the factors responsible for knee jerk reflex abnormalities in L5 monoradiculopathy. We analyzed clinical and electrophysiological data in 56 subjects affected by L5 monoradiculopathy. Seventeen patients (30.3%) showed an abnormal knee reflex. L5 patients with an abnormal knee reflex differed significantly, in severity of pretibial muscle damage, from those with a normal knee reflex. On the basis of evidence, in humans, of a specific spinal pathway linking the pretibial and quadriceps muscles, we infer that an impairment of the proprioceptive drive from the pretibial muscles to spinal premotor excitatory interneurons contacting quadriceps motor neurons is the main causative factor responsible for reducing knee jerk expression. This mechanism should be considered to avoid misinterpretation of knee jerk reflex changes in lumbar radiculopathies.
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Mignarri A, Malandrini A, Del Puppo M, Magni A, Monti L, Ginanneschi F, Tessa A, Santorelli FM, Federico A, Dotti MT. Treatment of SPG5 with cholesterol-lowering drugs. J Neurol 2015; 262:2783-5. [DOI: 10.1007/s00415-015-7971-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
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Mondelli M, Curti S, Farioli A, Aretini A, Ginanneschi F, Greco G, Mattioli S. Anthropometric measurements as a screening test for carpal tunnel syndrome: receiver operating characteristic curves and accuracy. Arthritis Care Res (Hoboken) 2015; 67:691-700. [PMID: 25187375 DOI: 10.1002/acr.22465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/21/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify optimal cutoff values for body, hand, and wrist measurements in order to correctly identify individuals with carpal tunnel syndrome (CTS), using receiver operating characteristic (ROC) curves. METHODS We enrolled patients with CTS and control subjects at a 1:2 ratio, regardless of age and sex. The diagnosis of CTS was based on clinical findings and delayed distal conduction velocity of the median nerve. The anthropometric measurements included weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, and palm length/width. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), sensitivity, specificity, and likelihood ratios were calculated separately according to sex. To assess the role of multiple anthropometric measurements, we fit multivariable logistic regression models including age, wrist ratio, shape index, body mass index, and waist-to-hip ratio. RESULTS The study group comprised 1,117 subjects (250 female patients and 474 female controls; 120 male patients and 273 male controls). In women, the accuracy of all anthropometric measures was low (AUC ≤0.64). In men, the accuracy of the hand ratio, shape index, and wrist-to-palm ratio was moderate (AUC = 0.75). The estimates from the multivariable models confirmed the well-known associations between the selected variables and the risk of CTS, but the use of multiple predictors did not dramatically improve the diagnostic performance observed for single anthropometric indexes. CONCLUSION In clinical practice, the cutoff values for many anthropometric measurements have limited value as tools for the diagnosis of CTS.
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Ginanneschi F, Cioncoloni D, Bigliazzi J, Bonifazi M, Lorè C, Rossi A. Sensory axons excitability changes in carpal tunnel syndrome after neural mobilization. Neurol Sci 2015; 36:1611-5. [PMID: 25896622 DOI: 10.1007/s10072-015-2218-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
Abstract
Increased mechanosensitivity of the median nerve in carpal tunnel syndrome (CTS) has been demonstrated during upper limb tension test 1 (ULTT1) when the nerve is passively elongated. However, the neurophysiological changes of the sensory axons during stressing activities are unknown. The aim of present study was to verify possible changes in the excitability of median nerve afferent axons following nerve stress in elongation, in subjects with and without CTS. Eight CTS hands and eight controls were selected. Recruitment properties of the median nerve were studied by analyzing the relationship between the intensity of electrical stimulation and the size of motor response, before and after intermittent-repetitive neural mobilization. Only in CTS hands, after the intervention, the stimulus-response curve was strikingly abnormal: both plateau and slope values were significantly lower. During anatomical stress across the median nerve in elongation, compressive forces may exert mechanical traction on the median nerve, since it is 'tethered' at the carpal tunnel, resulting inactivation of Na(+) channels at the wrist, or impairment of energy-dependent processes which affect axonal conduction block. We conclude that in entrapment neuropathies, neural mobilization during nerve elongation may generate conduction failure in peripheral nerve. Our study supports specific considerations for patient education and therapeutic approaches.
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Affiliation(s)
- Federica Ginanneschi
- Neurology-Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy,
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Ginanneschi F, Filippou G, Ulivelli M, Mignarri A, Rossi A. A mimic of first dorsal interosseus atrophy revealed by ultrasound study. Clin Neurophysiol 2015; 126:423-4. [DOI: 10.1016/j.clinph.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/19/2014] [Accepted: 05/03/2014] [Indexed: 12/22/2022]
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Del Sordo E, Casali S, Ginanneschi F, Insana L, Capoccitti G, Cardinali C, Battista D, Borgheresi A, Cincotta M, Borsini W, Giannini F. 93. CANOMAD: Clinical and neurophysiological findings in two cases. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Mignarri A, Battistini S, Tomai Pitinca ML, Monti L, Burroni L, Ginanneschi F, Ricci C, Bavazzano A, Federico A, Restagno G, Dotti MT. Double trouble? Progranulin mutation and C9ORF72 repeat expansion in a case of primary non-fluent aphasia. J Neurol Sci 2014; 341:176-8. [PMID: 24703252 DOI: 10.1016/j.jns.2014.03.030] [Citation(s) in RCA: 13] [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: 03/09/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Andrea Mignarri
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Stefania Battistini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Lucia Monti
- Unit of Diagnostic and Therapeutic Neuroradiology, Azienda Ospedaliera di Siena, Italy
| | - Luca Burroni
- Unit of Nuclear Medicine, Azienda Ospedaliera di Siena, Italy
| | | | - Claudia Ricci
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Gabriella Restagno
- Department of Laboratory Medicine, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.
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Mondelli M, Aretini A, Ginanneschi F, Greco G, Mattioli S. Waist circumference and waist-to-hip ratio in carpal tunnel syndrome: a case-control study. J Neurol Sci 2014; 338:207-13. [PMID: 24468538 DOI: 10.1016/j.jns.2014.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/10/2013] [Revised: 01/05/2014] [Accepted: 01/08/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between carpal tunnel syndrome (CTS) and high body mass index (BMI) and some hand measures is well known. No study has been specifically focused on waist circumference (WC) and waist-to-hip-ratio (WHR). The aim of this prospective case-control study is to evaluate the association between CTS and WC, WHR and other body and hand anthropometric measures. METHODS We consecutively enrolled one "idiopathic" CTS case for two controls in 3 outpatient electromyography labs. The main anthropometric measures were BMI, WC, WHR, wrist ratio (WR) and hand ratio (HR). We performed univariate and multivariate analyses. RESULTS Female cases and controls were 250 and 474 and male cases and controls were 120 and 273, respectively. At univariate analysis there were differences in many anthropometric measures between cases and controls. At multivariate logistic regression analyses high BMI, WC and WHR and abnormal HR and WR were independent risk factors for CTS. Crossing two categories between BMI, WC and WHR, the overweight subjects, especially females, were at risk only if they had very high WC or high WHR. The risk increased if they were obese. CONCLUSIONS High WC/WHR doubles the risk of CTS, the risk further increased if overweight/obese subjects have also very high WC or high WHR. The obese subjects were always at risk regardless of WC and WHR values. Metabolic causes of this association with CTS were hypothesised. BMI is not the only and most powerful body predictor of "idiopathic" CTS, but also WHR and WC should be considered. These measures may not be interchangeable and it may be desirable to consider the utility of their joint use.
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Affiliation(s)
| | | | - Federica Ginanneschi
- Dpt. Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Italy
| | - Giuseppe Greco
- EMG Service, Local Health Unit 7, "Nottola" Hospital, Montepulciano, Siena, Italy
| | - Stefano Mattioli
- Dpt. Medical and Surgical Sciences, University of Bologna, Italy
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Ginanneschi F, Volpi N, Giannini F, Rocchi R, Donati D, Aglianò M, Lorenzoni P, Rossi A. Rhabdomyolysis in an elderly multitreated patient: multiple drug interactions after statin withdrawal. J Neurol Sci 2013; 336:284-7. [PMID: 24252882 DOI: 10.1016/j.jns.2013.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 07/22/2013] [Revised: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 01/16/2023]
Abstract
Rhabdomyolysis precipitated by multitherapy is most frequently described during statin treatment, due to impairment of statin clearance by drugs sharing cytochrome P450 biotransformation pathway. Modulation of membrane transporters for drug efflux, operated by substrates, can also affect drugs' tissue levels. We report rhabdomyolysis in an elderly patient, in multitreatment with different potentially myotoxic medications, taking place seven months after atorvastatin discontinuation. Affected by ischaemic heart disease, arterial hypertension and dementia-related behaviour disturbances, the patient was receiving angiotensin 2-receptor inhibitors, beta-blockers, vasodilators, diuretics, salycilates, allopurinol, proton pump inhibitors, antipsychotics and antidepressants. He had taken atorvastatin for 14 years, with constantly normal creatine-kinase plasma levels. Two months after addition of the antianginal drug ranolazine, creatine-kinase mildly increased and atorvastatin was withdrawn. Nonetheless, creatine-kinase progressively rose, with severe weakness and rhabdomyolysis developing seven months later. Muscle biopsy showed a necrotizing myopathy with no inflammation or autoimmune changes. After ranolazine withdrawal, creatine-kinase and myoglobin returned to normal levels and strength was restored. Several psychotropic and cardiovascular medications prescribed to the patient share either cytochrome P450 biotransformation and permeability-glycoprotein efflux transport. In the event of cardiovascular/neuropsychiatric polypharmacy in geriatric patients, the risk of muscle severe adverse effects from pharmacokinetic drug-drug interaction should be considered beyond the direct myotoxicity of statins.
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Affiliation(s)
- Federica Ginanneschi
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Nila Volpi
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy.
| | - Fabio Giannini
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Raffaele Rocchi
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Donatella Donati
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Margherita Aglianò
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Paola Lorenzoni
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
| | - Alessandro Rossi
- Department of Medical Sciences, Surgical Sciences and Neurosciences, Siena University, 53100 Siena, Italy
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Giannini F, Casali S, Torzini A, Franci L, Ginanneschi F, Celli L, Matà S. 77. Electrophysiological follow up in anti-MAG polineuropathy after Rituximab therapy. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.104] [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: 10/26/2022]
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Torzini A, Greco G, Piu P, Ginanneschi F, Casali S, Franci L, Curcio M, Insana L, Giannini G. 69. A new selective slowing index of median nerve at wrist. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.096] [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: 10/26/2022]
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Ginanneschi F, Filippou G, Frediani B, Rossi A. Injury of cutaneous branches of the femoral nerve following varicose vein surgery. Acta Neurol Belg 2013; 113:355-6. [PMID: 23297165 DOI: 10.1007/s13760-012-0173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 12/20/2012] [Indexed: 11/30/2022]
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Ginanneschi F, Filippou G, Giannini F, Carluccio MA, Adinolfi A, Frediani B, Dotti MT, Rossi A. Sonographic and electrodiagnostic features of hereditary neuropathy with liability to pressure palsies. J Peripher Nerv Syst 2013; 17:391-8. [PMID: 23279340 DOI: 10.1111/j.1529-8027.2012.00437.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In hereditary neuropathy with liability to pressure palsies (HNPP), the increase in distal motor latencies (DMLs) is often out of proportion to the slowing of conduction velocities, but the pathophysiological mechanism is still unclear. We used a combined electrophysiological and ultrasonographic (US) approach to provide insight into this issue. Twelve HNPP subjects underwent extensive electrophysiological studies and US measurements of the cross-sectional area (CSA) of several peripheral nerves. US nerve enlargement was only observed in the carpal tunnel, Guyon's canal, the elbow and the fibular head. We did not observe US abnormalities at sites where nerve entrapment is uncommon. An increase in DMLs was observed regardless of US nerve enlargement. The increased nerve CSA only in common sites of entrapment likely reflected the well-documented nerve vulnerability to mechanical stress in HNPP. No morphometric changes were seen in the distal nerve segments where compression/entrapment is unlikely, despite the fact that the DMLs were increased. These data suggest that factors other than mechanical stress are responsible for the distal slowing of action potential propagation. We speculate that a mixture of mechanical insults and an axon-initiated process in the distal nerves underlies the distal slowing and/or conduction failure in HNPP.
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Affiliation(s)
- Federica Ginanneschi
- Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Siena, Italy.
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Abstract
The aim of the study was to identify specific factors that affect the outcome in patients with long thoracic mononeuropathy. The authors reviewed all medical records of patients with long thoracic mononeuropathy from the archive of the electromyography service over the past 16 years. Age, sex, occupation, pain at onset, symptom duration, neuropathy causes and side, and electromyography findings were collected. The outcome was evaluated by performing standard telephone interviews consisting of 9 queries about use limitations in the affected upper limb. If no limitation existed, the recovery was considered complete. If partial limitations only affected the upper limb in performing 5 or fewer of 9 specific activities, the outcome was considered good; if limitations affected more than 5 activities, the outcome was considered poor. The authors performed a multivariate logistic regression to calculate the association between good outcome or full recovery and poor outcome with demographic, clinical, and electromyography findings. Forty-one patients were included (mean±SD age, 39±14 years; 68.3% men). Causes were shoulder-arm overuse or trauma in 19 patients, iatrogenic in 5, idiopathic in 9, and inflammatory in 8. Twenty-seven patients had a good outcome and full recovery and 14 had a poor outcome. No patient underwent surgery. Age, sex, occupation, pain at onset, symptom duration, neuropathy side, and electromyography findings were not predictive of the outcome. The probability of full recovery and good outcome was 7.5 times greater in long thoracic mononeuropathy secondary to idiopathic or inflammatory causes compared with other etiologies.
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Affiliation(s)
- Mauro Mondelli
- Electromyography Service, Local Health Unit 7, University of Siena, Siena, Italy.
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Mondelli M, Aretini A, Arrigucci U, Ginanneschi F, Greco G, Sicurelli F. Sensory nerve action potential amplitude is rarely reduced in lumbosacral radiculopathy due to herniated disc. Clin Neurophysiol 2013; 124:405-9. [DOI: 10.1016/j.clinph.2012.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/11/2012] [Accepted: 07/19/2012] [Indexed: 12/17/2022]
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Rossi A, Rossi S, Ginanneschi F. Activity-dependent changes in intrinsic excitability of human spinal motoneurones produced by natural activity. J Neurophysiol 2012; 108:2473-80. [PMID: 22933724 DOI: 10.1152/jn.00477.2012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The current study was designed to evaluate activity-dependent changes intrinsic to the spinal motoneurones (MNs) associated with sustained contractions. The excitability of spinal MNs (reflected by the antidromically evoked F-wave) innervating the abductor digiti minimi muscle (ADM) was measured in 12 healthy subjects following maximum voluntary contractions (MVCs) of ADM lasting 5 s, 15 s, 30 s, and 60 s. Upon cessation of the contractions, F-waves showed a depression, which increased in depth and duration with increasing duration of contraction. Following a 5-s contraction, there was a 20% decrease, which waned in 2 min, whereas a 60-s contraction produced a 40% decrease and waned in over 15 min. The changes in excitability of peripheral motor axons produced by the MVCs were measured by recording an ADM compound muscle action potential (CMAP) of ~50% of maximum to a constant ulnar nerve electrical stimulation. On cessation of the contractions, there was a prominent decrease in size of the CMAP: following a 5-s MVC, it produced a 10% decrease in the size of the test CMAP, which recovered in 2 min, whereas following a 60-s MVC, it produced a 30% decrease, which recovered in over 15 min. Statistical analysis (correntropy) showed a high-order mutual dependence between F-wave and CMAP, and both were significantly dependent on MVC duration. Because of the parallel excitability changes in peripheral axons and spinal MNs, our interpretation is that intrinsic excitability of the axon initial segment (i.e., where the action potential is generated) and peripheral axon segments changed in a similar, activity-dependent manner.
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Affiliation(s)
- Alessandro Rossi
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy.
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Ginanneschi F, Mignarri A, Mondelli M, Gallus GN, Del Puppo M, Giorgi S, Federico A, Rossi A, Dotti MT. Polyneuropathy in cerebrotendinous xanthomatosis and response to treatment with chenodeoxycholic acid. J Neurol 2012; 260:268-74. [PMID: 22878431 DOI: 10.1007/s00415-012-6630-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/02/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
Polyneuropathy has been reported in cerebrotendinous xanthomatosis (CTX), although its nature and possible association with certain genotypes and phenotypes are unclear. The effect of chronic administration of chenodeoxycholic acid (CDCA) on peripheral nerve conduction parameters is still debated. We report clinical, laboratory, and electrophysiological findings in 35 CTX patients. Twenty-six subjects (74.2 %) showed peripheral nerve abnormalities. Polyneuropathy was predominantly axonal (76.9 % of patients) and generally mild. No correlation was found between its presence and clinical or biochemical data. In polyneuropathic patients, CDCA treatment improved electrophysiological conduction parameters, irrespective of the duration of therapy. Improvement mainly concerned nerve conduction velocities, whereas most nerve amplitudes remained unchanged. This means that CDCA treatment did not influence the number of axons activated by maximum electrical stimulation but increased the conduction of the still-excitable fibers. Our findings may suggest that CDCA treatment promotes myelin synthesis in nerve fibers with residual unaffected axons. The effect of therapy may therefore depend largely on the extent of irreversible structural damage to axons.
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Affiliation(s)
- F Ginanneschi
- Section of Neurology and Clinical Neurophysiology, Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100, Siena, Italy
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Ginanneschi F, Malandrini A, Monti L, Rossi A. Acute shoulder-girdle neuralgic amyotrophy (Parsonage-Turner syndrome with saphenous nerve involvement. Acta Neurol Belg 2011; 111:333-336. [PMID: 22368976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Parsonage-Turner syndrome (PTS) is a relatively rare cause of upper extremity weakness and pain. There is currently no effective treatment for PTS although corticosteroids are recommended. Here we report the case of a man with acute PTS and exceptional involvement of both saphenous nerves, advantageously treated with intravenous immunoglobulin.
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Affiliation(s)
- F Ginanneschi
- Department of Neurological, Neurometabolic Unit, University of Siena, Italy.
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Annunziata P, Carnicelli N, Galluzzi P, Pippi F, Almi P, Ginanneschi F, Gennari P. Erratum to: Miller–Fisher syndrome following vaccination against influenza virus A/H1N1 in an AIDS patient. Infection 2011. [DOI: 10.1007/s15010-011-0210-9] [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: 10/17/2022]
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Annunziata P, Carnicelli N, Galluzzi P, Pippi F, Almi P, Ginanneschi F, Gennari P. Miller-Fisher syndrome following vaccination against influenza virus A/H1N1 in an AIDS patient. Infection 2011; 40:97-9. [PMID: 21877180 DOI: 10.1007/s15010-011-0184-7] [Citation(s) in RCA: 6] [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: 05/26/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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Milani P, Mondelli M, Ginanneschi F, Mazzocchio R, Rossi A. Progesterone - new therapy in mild carpal tunnel syndrome? Study design of a randomized clinical trial for local therapy. J Brachial Plex Peripher Nerve Inj 2010; 5:11. [PMID: 20420674 PMCID: PMC2873263 DOI: 10.1186/1749-7221-5-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/26/2010] [Indexed: 01/21/2023] Open
Abstract
Background Local corticosteroid injection for carpal tunnel syndrome (CTS) provides greater clinical improvement in symptoms one month after injection compared to placebo but significant symptom relief beyond one month has not been demonstrated and the relapse of symptoms is possible. Neuroprotection and myelin repair actions of the progesterone was demonstrated in vivo and in vitro study. We report the design of a randomized controlled trial for the local injection of cortisone versus progesterone in "mild" idiopathic CTS. Methods Sixty women with age between 18 and 60 years affected by "mild" idiopathic CTS, diagnosed on the basis of clinical and electrodiagnostic tests, will be enrolled in one centre. The clinical, electrophysiological and ultasonographic findings of the patients will be evaluate at baseline, 1, 6 and 12 months after injection. The major outcome of this study is to determine whether locally-injected progesterone may be more beneficial than cortisone in CTS at clinical levels, tested with symptoms severity self-administered Boston Questionnaire and with visual analogue pain scale. Secondary outcome measures are: duration of experimental therapy; improvement of electrodiagnostic and ultrasonographic anomalies at various follow-up; comparison of the beneficial and harmful effects of the cortisone versus progesterone. Conclusion We have designed a randomized controlled study to show the clinical effectiveness of local progesterone in the most frequent human focal peripheral mononeuropathy and to demonstrate the neuroprotective effects of the progesterone at the level of the peripheral nervous system in humans.
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Affiliation(s)
- Paolo Milani
- Dept, Neurological, Neurosurgical and Behavioural Sciences, Neurophysiology Clinic Section, University of Siena, Siena, Italy.
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Mondelli M, Baldasseroni A, Aretini A, Ginanneschi F, Padua L. Prevalent involvement of thenar motor fibres in vineyard workers with carpal tunnel syndrome. Clin Neurophysiol 2010; 121:1251-5. [PMID: 20231111 DOI: 10.1016/j.clinph.2010.02.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/24/2010] [Accepted: 02/16/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Carpal tunnel syndrome (CTS) has a high prevalence in agricultural workers, especially those engaged in vineyards. We postulated that vineyard CTS was electrophysiologically different from CTS of other subjects. We performed a retrospective cross-sectional electrophysiological study of two cohorts of consecutive patients with CTS, the first consisting of vineyard workers and the second, of other unselected types of workers, housewives and pensioners. METHODS Thirty-three vineyard workers (mean age 46.8years, 42% women) and 205 patients with other occupations (mean age 53.7years; 66% women) were enrolled. All patients underwent sensory and motor neurography of the median and ulnar nerves. Differences in demographic and electrophysiological findings between groups were calculated and multiple linear regression analysis was performed to eliminate the influence of potential confounding factors (age, sex, BMI, clinical severity of CTS) on the results of univariate difference analysis. RESULTS Univariate analysis showed that DML was longer and compound muscle action potential amplitude of the median nerve, recorded from the abductor pollicis brevis muscle, was smaller in vineyard workers than in the other CTS patients. These differences remained significant after adjusting the results for confounding factors. CONCLUSIONS The vineyard workers showed a different pattern of CTS than the other patients: thenar motor fibres were more affected, presumably due to chronic compression on the thenar branch. This suggests an association between "common" CTS and thenar mononeuropathy. SIGNIFICANCE Occupational physiologists should clarify the mechanisms of neuromuscular engagement in particular jobs and ergonomists design suitable working tools, because many "individual" risk factors are difficult to change, but workplace-related risk factors can be modified.
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Affiliation(s)
- M Mondelli
- EMG Service, Local Health Unit 7, Siena, Italy.
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Ginanneschi F, Filippou G, Reale F, Scarselli C, Galeazzi M, Rossi A. Ultrasonographic and functional changes of the ulnar nerve at Guyon’s canal after carpal tunnel release. Clin Neurophysiol 2010; 121:208-13. [DOI: 10.1016/j.clinph.2009.09.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 08/21/2009] [Accepted: 09/02/2009] [Indexed: 11/29/2022]
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