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Castelletti G, Misirocchi F, Zilioli A, Salvatelli ML, Rausa F, Pizzarotti S, Zinno L, Florindo I, Pedrazzi G, Parrino L, Mutti C. How can sleep disorders affect our reaction towards external stressors: a lesson from the COVID-19 outbreak. Neurol Sci 2024; 45:391-399. [PMID: 37587386 PMCID: PMC10791966 DOI: 10.1007/s10072-023-06938-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The COVID-19 outbreak produced extensive psychological consequences, especially among vulnerable populations. Sleep was identified as one of the most common "indirect targets" of the pandemia, with up to 74.8% of patients surviving from COVID-19 complaining of new-onset sleep disorders. However, so far, the clinic-psychological impact of the outbreak in patients affected by pre-existing sleep disorders has not been examined in details. MATERIALS AND METHODS In the present study, we aim to assess the effect of the COVID-19 outbreak in a cohort of 190 adult patients affected by sleep disorders, compared to 265 age and sex-matched healthy sleepers. The assessment was implemented throughout the use of ad hoc anamnestic questions, exploration of dream content, and validated questionnaires, aiming to capture the broad range of the neuropsychological nuances of the COVID-19 impact. RESULTS Subjects with pre-existent sleep disorders faced a more severe impact in terms of sleep quality and amount compared to healthy sleepers, presenting longer sleep latency, reduced sleep efficacy, and greater use of hypnotics and medications. On the other hand, healthy sleepers experienced deeper variation in sleeping habits, sleep duration, and greater impact on dream activity in terms of content, emotionality, and presence of recurrent dreams. Finally, in our sample, being female represents an important aggravating factor in the pandemic experience, both in terms of sleep deterioration and with respect to physical and mental health. For instance, females indeed presented the highest scores of Pittsburgh Sleep Quality Index (PSQI) both in cases and control groups (respectively 10 ± 3.8 vs 7.3 ± 3.9 in cases and 6.6 ± 3.6 vs 6.0 ± 3.4 in controls, p-value < 0.001). CONCLUSION Pre-existent sleep disorders and the female sex might represent risk factors increasing the clinic-psychological burden in dramatic scenarios, such as the COVID-19 pandemia, requiring dedicated attention from clinicians.
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Affiliation(s)
- Gloria Castelletti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | | | | | - Marcello Luigi Salvatelli
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Francesco Rausa
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Pizzarotti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Lucia Zinno
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Irene Florindo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Pedrazzi
- Unit of Neuroscience & Interdepartmental Center of Robust Statistics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Carlotta Mutti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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Misirocchi F, Vaudano AE, Florindo I, Zinno L, Zilioli A, Mannini E, Parrino L, Mutti C. Imaging biomarkers of sleep-related hypermotor epilepsy and sudden unexpected death in epilepsy: a review. Seizure 2024; 114:70-78. [PMID: 38088013 DOI: 10.1016/j.seizure.2023.12.001] [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: 09/06/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
In recent years, imaging has emerged as a promising source of several intriguing biomarkers in epilepsy, due to the impressive growth of imaging technology, supported by methodological advances and integrations of post-processing techniques. Bearing in mind the mutually influencing connection between sleep and epilepsy, we focused on sleep-related hypermotor epilepsy (SHE) and sudden unexpected death in epilepsy (SUDEP), aiming to make order and clarify possible clinical utility of emerging multimodal imaging biomarkers of these two epilepsy-related entities commonly occurring during sleep. Regarding SHE, advanced structural techniques might soon emerge as a promising source of diagnostic and predictive biomarkers, tailoring a targeted therapeutic (surgical) approach for MRI-negative subjects. Functional and metabolic imaging may instead unveil SHE's extensive and night-related altered brain networks, providing insights into distinctions and similarities with non-epileptic sleep phenomena, such as parasomnias. SUDEP is considered a storm that strikes without warning signals, but objective subtle structural and functional alterations in autonomic, cardiorespiratory, and arousal centers are present in patients eventually experiencing SUDEP. These alterations could be seen both as susceptibility and diagnostic biomarkers of the underlying pathological ongoing loop ultimately ending in death. Finally, given that SHE and SUDEP are rare phenomena, most evidence on the topic is derived from small single-center experiences with scarcely comparable results, hampering the possibility of performing any meta-analytic approach. Multicenter, longitudinal, well-designed studies are strongly encouraged.
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Affiliation(s)
| | - Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Florindo
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | | | - Elisa Mannini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy.
| | - Carlotta Mutti
- Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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Misirocchi F, Zilioli A, Mannini E, Lazzari S, Mutti C, Zinno L, Parrino L, De Stefano P, Florindo I. Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score. Epilepsia 2024; 65:138-147. [PMID: 37965804 DOI: 10.1111/epi.17830] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE This study was undertaken to investigate the association between the Salzburg nonconvulsive status epilepticus (NCSE) criteria and in-hospital outcome, to determine the predictive accuracy of the Status Epilepticus Severity Score (STESS), modified STESS (mSTESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE), and END-IT (encephalitis, NCSE, diazepam resistance, imaging features, and tracheal intubation) in NCSE patients, and to develop a new prognostic score specifically designed for NCSE patients. METHODS Clinical and electroencephalographic (EEG) data of adult patients treated for NCSE from 2020 to 2023 were retrospectively assessed. Age, sex, modified Rankin Scale at admission, comorbidities, history of seizures, etiology, status epilepticus type, and outcome were collected from the patients' digital charts. EEG data were assessed and categorized applying the Salzburg NCSE criteria. In-hospital death was defined as the primary outcome. RESULTS A total of 116 NCSE patients were included. Multivariable logistic regression revealed that Salzburg NCSE criterion A2 (ictal morphological, spatial, and temporal evolution) was associated with in-hospital survival. The best STESS cutoff was ≥4 (sensitivity = .62, specificity = .69, accuracy = 67%). mSTESS ≥ 5 reached a sensitivity of .68, a specificity of .57, and an overall accuracy of 60%, EMSE ≥ 64 a sensitivity of .82, a specificity of .39, and an overall accuracy of 52%, and END-IT ≥ 3 a sensitivity of .65, a specificity of .44, and an overall accuracy of 50%. Through a hypothesis-generating approach, we developed the SACE score, which integrates EEG features (criterion A2) with patient age (with a 75-year cutoff), history of seizures, and level of consciousness. With a cutoff of ≥3, it had a sensitivity of .77, a specificity of .74, and an overall accuracy of 76%, performing better than other prognostic scores. SIGNIFICANCE We developed a new user-friendly scoring system, the SACE score, which integrates EEG features with other established outcome-related variables assessable in early stages, to assist neurologists and neurointensivists in making more tailored prognostic decisions for NCSE patients.
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Affiliation(s)
- Francesco Misirocchi
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Zilioli
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Mannini
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefania Lazzari
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Unit of Neurology, University Hospital of Parma, Parma, Italy
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucia Zinno
- Unit of Neurology, University Hospital of Parma, Parma, Italy
| | - Liborio Parrino
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pia De Stefano
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Irene Florindo
- Unit of Neurology, University Hospital of Parma, Parma, Italy
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Minetti M, Balella G, Zinno L. Anti-recoverin antibodies in a cerebellar syndrome without retinal involvement. Acta Biomed 2023; 94:e2023258. [PMID: 38054667 PMCID: PMC10734245 DOI: 10.23750/abm.v94i6.15234] [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] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023]
Abstract
Anti-recoverin antibodies are typically found in cancer-associated retinopathy or autoimmune diseases. We present a case of anti-recoverin positive cerebellar syndrome without any signs of malignancy or retinopathy. The patient was treated with steroids and intravenous immunoglobulins, resulting in improvements in both cognitive and motor symptoms.
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Zucchi E, Musazzi UM, Fedele G, Martinelli I, Gianferrari G, Simonini C, Fini N, Ghezzi A, Caputo M, Sette E, Vacchiano V, Zinno L, Anceschi P, Canali E, Vinceti M, Ferro S, Mandrioli J. Effect of tauroursodeoxycholic acid on survival and safety in amyotrophic lateral sclerosis: a retrospective population-based cohort study. EClinicalMedicine 2023; 65:102256. [PMID: 37842553 PMCID: PMC10570688 DOI: 10.1016/j.eclinm.2023.102256] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Background Oral tauroursodeoxycholic acid (TUDCA) is a commercial drug currently tested in patients with amyotrophic lateral sclerosis (ALS) both singly and combined with sodium phenylbutyrate. This retrospective study aimed to investigate, in a real-world setting, whether TUDCA had an impact on the overall survival of patients with ALS who were treated with this drug compared to those patients who received standard care only. Methods This propensity score-matched study was conducted in the Emilia Romagna Region (Italy), which has had an ALS regional registry since 2009. Out of 627 patients with ALS diagnosed from January 1st, 2015 to June 30th, 2021 and recorded in the registry with available information on death/tracheostomy, 86 patients took TUDCA and were matched in a 1:2 ratio with patients who received only usual care according to age at onset, sex, phenotype, diagnostic latency, ALS Functional Rating Scale-Revised (ALSFRS-R) at first visit, disease progression rate at first visit, and BMI at diagnosis. The primary outcome was survival difference (time from onset of symptoms to tracheostomy/death) between TUDCA exposed and unexposed patients. Findings A total of 86 patients treated with TUDCA were matched to 172 patients who did not receive treatment. TUDCA-exposed patients were stratified based on dosage (less than or equal to 1000 mg/day or greater) and duration (less than or equal to 12 months or longer) of treatment. The median overall survival was 49.6 months (95% CI 41.7-93.5) among those treated with TUDCA and 36.2 months (95% CI 32.7-41.6) in the control group, with a reduced risk of death observed in patients exposed to a higher dosage (defined as ≥ 1000 mg/day) of TUDCA (HR 0.56; 95% CI 0.38-0.83; p = 0.0042) compared to both the control group and those with lower TUDCA dosages (defined as < 1000 mg/day). TUDCA was generally well-tolerated, except for a minority of patients (n = 7, 8.1%) who discontinued treatment due to side effects, primarily gastrointestinal and mild in severity; only 2 adverse events required hospital access but resolved without sequelae. Interpretation In this population-based exploratory study, patients with ALS who were treated with TUDCA may have prolonged survival compared to patients receiving standard care only. Additional prospective randomized studies are needed to confirm the efficacy and safety of this drug. Funding Emilia-Romagna Region.
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Affiliation(s)
- Elisabetta Zucchi
- Neuroscience PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Umberto Maria Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo 71, 20133, Milan, Italy
| | - Guido Fedele
- Associazione Farmaceutici dell'Industria (AFI), Viale Ranzoni 1, 20149, Milano, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Gianferrari
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Andrea Ghezzi
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Caputo
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lucia Zinno
- Neurology Unit, Department of Neuroscience, University of Parma, Parma, Italy
| | - Pietro Anceschi
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Canali
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, Bologna, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Sassi S, Bianchi E, Diamanti L, Tornabene D, Sette E, Medici D, Matà S, Leccese D, Sperti M, Martinelli I, Ghezzi A, Mandrioli J, Iuzzolino VV, Dubbioso R, Trojsi F, Passaniti C, D'Alvano G, Filosto M, Padovani A, Mazzini L, De Marchi F, Zinno L, Nuredini A, Bongioanni P, Dolciotti C, Canali E, Toschi G, Petrucci A, Perna A, Riso V, Inghilleri M, Libonati L, Cambieri C, Pupillo E. Correction to: Retrospective observational study on the use of acetyl-L-carnitine in ALS. J Neurol 2023; 270:5358-5359. [PMID: 37682317 PMCID: PMC10576664 DOI: 10.1007/s00415-023-11960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Serena Sassi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Danilo Tornabene
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisabetta Sette
- UO di Neurologia Dipartimento Neuroscienze e Riabilitazione, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Sabrina Matà
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Deborah Leccese
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Martina Sperti
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Neuroscience and Nanotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Virginia Iuzzolino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesca Trojsi
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Carla Passaniti
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Giulia D'Alvano
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Unit of Neurology ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Letizia Mazzini
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Fabiola De Marchi
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Lucia Zinno
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andi Nuredini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Bongioanni
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Dolciotti
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elena Canali
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Giulia Toschi
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Alessia Perna
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Vittorio Riso
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Inghilleri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
| | - Laura Libonati
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy.
| | - Chiara Cambieri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
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Sassi S, Bianchi E, Diamanti L, Tornabene D, Sette E, Medici D, Matà S, Leccese D, Sperti M, Martinelli I, Ghezzi A, Mandrioli J, Iuzzolino VV, Dubbioso R, Trojsi F, Passaniti C, D'Alvano G, Filosto M, Padovani A, Mazzini L, De Marchi F, Zinno L, Nuredini A, Bongioanni P, Dolciotti C, Canali E, Toschi G, Petrucci A, Perna A, Riso V, Inghilleri M, Libonati L, Cambieri C, Pupillo E. Retrospective observational study on the use of acetyl-L-carnitine in ALS. J Neurol 2023; 270:5344-5357. [PMID: 37378756 PMCID: PMC10576701 DOI: 10.1007/s00415-023-11844-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
ALCAR (Acetyl-L-carnitine) is a donor of acetyl groups and increases the intracellular levels of carnitine, the primary transporter of fatty acids across the mitochondrial membranes. In vivo studies showed that ALCAR decrease oxidative stress markers and pro-inflammatory cytokines. In a previous double-blind placebo-controlled phase II trial showed positive effects on self-sufficiency (defined as a score of 3+ on the ALSFRS-R items for swallowing, cutting food and handling utensils, and walking) ALSFRS-R total score and FVC. We conducted an observational, retrospective, multicentre, case-control study to provide additional data on the effects of ALCAR in subjects with ALS in Italy. Subjects treated with ALCAR 1.5 g/day or 3 g/day were included and matched with not treated subjects by sex, age at diagnosis, site of onset, and time from diagnosis to baseline, (45 subjects per group). ALCAR 3 g/day vs not treated: 22 not treated subjects (48.9%) were still alive at 24 months after baseline, compared to 23 (51.1%) treated subjects (adj. OR 1.18, 95% CI 0.46-3.02). No statistically significant differences were detected in ALSFRS nor FVC nor self-sufficiency. ALCAR 1.5 g/day vs not treated: 22 not treated subjects (48.9%) were still alive at 24 months after baseline, compared to 32 (71.1%) treated subjects (adj. OR 0.27, 95% CI 0.10-0.71). For ALSFRS-R, a mean slope of - 1.0 was observed in treated subjects compared to - 1.4 in those not treated (p = 0.0575). No statistically significant difference was detected in the FVC nor self-sufficiency. Additional evidence should be provided to confirm the efficacy of the drug and provide a rationale for the dosage.
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Affiliation(s)
- Serena Sassi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Danilo Tornabene
- Neuro-Oncology Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisabetta Sette
- UO di Neurologia Dipartimento Neuroscienze e Riabilitazione, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Sabrina Matà
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Deborah Leccese
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Martina Sperti
- Dipartimento Neuromuscoloscheletrico e Degli Organi di Senso, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Neuroscience and Nanotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Virginia Iuzzolino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesca Trojsi
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Carla Passaniti
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Giulia D'Alvano
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", P.Zza Miraglia 2, Naples, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Unit of Neurology ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Letizia Mazzini
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Fabiola De Marchi
- ALS Center Azienda Ospedaliero Universitaria "Maggiore della Carità" e Università del Piemonte Orientale, Novara, Italy
| | - Lucia Zinno
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andi Nuredini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Bongioanni
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Dolciotti
- Dpt. Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elena Canali
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Giulia Toschi
- U.O di Neurologia, Presidio Ospedaliero S.Maria Nuova Azienda USL, IRCCS di Reggio Emilia, Florence, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Alessia Perna
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Vittorio Riso
- Center for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Inghilleri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
| | - Laura Libonati
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy.
| | - Chiara Cambieri
- Dipartimento di Neuroscienze Umane, Università di Roma "Sapienza" UOSD Malattie Neurodegenerative-Centro Malattie Rare Neuromuscolari, Policlinico Universitario Umberto I, Rome, Italy
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Zilioli A, Misirocchi F, Mutti C, Romano S, Minetti M, Chierici E, Florindo I, Spallazzi M, Zinno L. Non-alcoholic Wernicke's Encephalopathy mimicking neuromyelitis optica spectrum disorder in a young woman: a case report and literature review. Acta Biomed 2023; 94:e2023111. [PMID: 37272602 DOI: 10.23750/abm.v94is1.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/02/2023] [Indexed: 06/06/2023]
Abstract
Wernicke's encephalopathy is an under-recognized life-threatening disease caused by thiamine (vitamin B1) deficiency. It has historically been related to chronic alcoholic intake but other causes of malnutrition, such as invasive gastric surgery and hyperemesis, have been linked to the onset of this illness over the years, often presenting with atypical clinical manifestations. Herein we report a case of a young obese woman affected by non-alcoholic Wernicke's Encephalopathy following a minimally invasive gastrointestinal surgery. She showed an unusual clinical profile characterized by prominent subacute neuro-ophthalmological involvement which combined to her juvenile age, overweight condition and brain lesions, have made diagnosis challenging due to similarities with Neuromyelitis Optica Spectrum Disorder. Our case underscores the relevance of prompt diagnosis in order to prevent the development of irreversible neuropathological changes and to avoid the use of a long-term immunosuppressive treatment.
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Gianferrari G, Martinelli I, Simonini C, Zucchi E, Fini N, Caputo M, Ghezzi A, Gessani A, Canali E, Casmiro M, De Massis P, Curro' Dossi M, De Pasqua S, Liguori R, Longoni M, Medici D, Morresi S, Patuelli A, Pugliatti M, Santangelo M, Sette E, Stragliati F, Terlizzi E, Vacchiano V, Zinno L, Ferro S, Amedei A, Filippini T, Vinceti M, Mandrioli J. Insight into Elderly ALS Patients in the Emilia Romagna Region: Epidemiological and Clinical Features of Late-Onset ALS in a Prospective, Population-Based Study. Life (Basel) 2023; 13:life13040942. [PMID: 37109471 PMCID: PMC10144747 DOI: 10.3390/life13040942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Few studies have focused on elderly (>80 years) amyotrophic lateral sclerosis (ALS) patients, who represent a fragile subgroup generally not included in clinical trials and often neglected because they are more difficult to diagnose and manage. We analyzed the clinical and genetic features of very late-onset ALS patients through a prospective, population-based study in the Emilia Romagna Region of Italy. From 2009 to 2019, 222 (13.76%) out of 1613 patients in incident cases were over 80 years old at diagnosis, with a female predominance (F:M = 1.18). Elderly ALS patients represented 12.02% of patients before 2015 and 15.91% from 2015 onwards (p = 0.024). This group presented with bulbar onset in 38.29% of cases and had worse clinical conditions at diagnosis compared to younger patients, with a lower average BMI (23.12 vs. 24.57 Kg/m2), a higher progression rate (1.43 vs. 0.95 points/month), and a shorter length of survival (a median of 20.77 vs. 36 months). For this subgroup, genetic analyses have seldom been carried out (25% vs. 39.11%) and are generally negative. Finally, elderly patients underwent less frequent nutritional- and respiratory-supporting procedures, and multidisciplinary teams were less involved at follow-up, except for specialist palliative care. The genotypic and phenotypic features of elderly ALS patients could help identify the different environmental and genetic risk factors that determine the age at which disease onset occurs. Since multidisciplinary management can improve a patient's prognosis, it should be more extensively applied to this fragile group of patients.
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Affiliation(s)
- Giulia Gianferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Elisabetta Zucchi
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
- Neuroscience Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Maria Caputo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Annalisa Gessani
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Elena Canali
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy
| | - Mario Casmiro
- Department of Neurology, Faenza and Ravenna Hospital, 48100 Ravenna, Italy
| | | | | | | | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40126 Bologna, Italy
| | - Marco Longoni
- Department of Neurology, Infermi Hospital, 48018 Rimini, Italy
- Department of Neurology, Bufalini Hospital, 47521 Cesena, Italy
| | - Doriana Medici
- Department of Neurology, Fidenza Hospital, 43036 Parma, Italy
| | | | | | - Maura Pugliatti
- Department of Neurosciences, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurology, St. Anna Hospital, 44124 Ferrara, Italy
| | | | - Elisabetta Sette
- Department of Neurology, St. Anna Hospital, 44124 Ferrara, Italy
| | - Filippo Stragliati
- Department of General and Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Emilio Terlizzi
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy
| | - Veria Vacchiano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40126 Bologna, Italy
| | - Lucia Zinno
- Department of General and Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, 40127 Bologna, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Research Centre in Environmental, Genetic and Nutritional Epidemiology-CREAGEN, University of Modena and Reggio Emilia, 41125 Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Research Centre in Environmental, Genetic and Nutritional Epidemiology-CREAGEN, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA 02118, USA
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
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Zilioli A, Misirocchi F, Pancaldi B, Mannini E, Mutti C, Zinno L, Florindo I, Spallazzi M, Parrino L. Anti-Gad 65 encephalitis with rapidly progressive temporal atrophy reveals the involvement of the temporal lobe in the neuroanatomical basis of palilalia. Cortex 2023; 160:1-8. [PMID: 36680921 DOI: 10.1016/j.cortex.2022.12.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023]
Abstract
Palilalia is an acquired speech disorder characterized by the reiteration of words or sentences, historically divided in two main subtypes: "palilalie heterolalique" and "palilalie homolalique". In the former, the reiteration is characterized by rate increase and volume decrease, while in the latter these features remain unaltered. While the "heterolalique" subtype has been mainly observed in the context of basal ganglia diseases, the neuroanatomical basis of the "homolalique" subtype has never been completely clarified. Here we report the case of an 81 years-old woman who developed an extremely repetitive and perseverative language with "homolalique" subtype features and a rapidly progressive course with severe bitemporal atrophy, as a consequence of anti-glutamic acid decarboxylase 65 (GAD 65) antibodies encephalitis. To the best of our knowledge, this is the first report of palilalia in the context of anti-GAD 65 encephalitis. Through the support of voxel-based morphometry and hippocampal subfields analysis, this case study provides a fascinating way of understanding the networks responsible for palilalia, shedding some light on the critical role of temporal areas in the onset of this rare language disorder.
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Affiliation(s)
- Alessandro Zilioli
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Francesco Misirocchi
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Beatrice Pancaldi
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Mannini
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy; Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucia Zinno
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Irene Florindo
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Spallazzi
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Unit of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy; Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Misirocchi F, Bernabè G, Zinno L, Spallazzi M, Zilioli A, Mannini E, Lazzari S, Tontini V, Mutti C, Parrino L, Picetti E, Florindo I. Epileptiform patterns predicting unfavorable outcome in postanoxic patients: A matter of time? Neurophysiol Clin 2023; 53:102860. [PMID: 37011480 DOI: 10.1016/j.neucli.2023.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Historically, epileptiform malignant EEG patterns (EMPs) have been considered to anticipate an unfavorable outcome, but an increasing amount of evidence suggests that they are not always or invariably associated with poor prognosis. We evaluated the prognostic significance of an EMP onset in two different timeframes in comatose patients after cardiac arrest (CA): early-EMPs and late-EMPs, respectively. METHODS We included all comatose post-CA survivors admitted to our intensive care unit (ICU) between 2016 and 2018 who underwent at least two 30-minute EEGs, collected at T0 (12-36 h after CA) and T1 (36-72 h after CA). All EEGs recordings were re-analyzed following the 2021 ACNS terminology by two senior EEG specialists, blinded to outcome. Malignant EEGs with abundant sporadic spikes/sharp waves, rhythmic and periodic patterns, or electrographic seizure/status epilepticus, were included in the EMP definition. The primary outcome was the cerebral performance category (CPC) score at 6 months, dichotomized as good (CPC 1-2) or poor (CPC 3-5) outcome. RESULTS A total of 58 patients and 116 EEG recording were included in the study. Poor outcome was seen in 28 (48%) patients. In contrast to late-EMPs, early-EMPs were associated with a poor outcome (p = 0.037), persisting after multiple regression analysis. Moreover, a multivariate binomial model coupling the timing of EMP onset with other EEG predictors such as T1 reactivity and T1 normal voltage background can predict outcome in the presence of an otherwise non-specific malignant EEG pattern with quite high specificity (82%) and moderate sensitivity (77%). CONCLUSIONS The prognostic significance of EMPs seems strongly time-dependent and only their early-onset may be associated with an unfavorable outcome. The time of onset of EMP combined with other EEG features could aid in defining prognosis in patients with intermediate EEG patterns.
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Zinno L, Negrotti A, Falzoi C, Messa G, Goldoni M, Calzetti S. Generalized Rhythmic Delta Activity Frontally Predominant Differentiates Dementia with Lewy Bodies From Alzheimer's Disease and Parkinson's Disease Dementia: A Conventional Electroencephalography Visual Analysis. Clin EEG Neurosci 2022; 53:426-434. [PMID: 33843293 DOI: 10.1177/1550059421997147] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. An easily accessible and inexpensive neurophysiological technique such as conventional electroencephalography may provide an accurate and generally applicable biomarker capable of differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) and Parkinson's disease-associated dementia (PDD). Method. We carried out a retrospective visual analysis of resting-state electroencephalography (EEG) recording of 22 patients with a clinical diagnosis of 19 probable and 3 possible DLB, 22 patients with probable AD and 21 with PDD, matched for age, duration, and severity of cognitive impairment. Results. By using the grand total EEG scoring method, the total score and generalized rhythmic delta activity frontally predominant (GRDAfp) alone or, even better, coupled with a slowing of frequency of background activity (FBA) and its reduced reactivity differentiated DLB from AD at an individual level with an high accuracy similar to that obtained with quantitative EEG (qEEG). GRDAfp alone could also differentiate DLB from PDD with a similar level of diagnostic accuracy. AD differed from PDD only for a slowing of FBA. The duration and severity of cognitive impairment did not differ between DLB patients with and without GRDAfp, indicating that this abnormal EEG pattern should not be regarded as a disease progression marker. Conclusions. The findings of this investigation revalorize the role of conventional EEG in the diagnostic workup of degenerative dementias suggesting the potential inclusion of GRDAfp alone or better coupled with the slowing of FBA and its reduced reactivity, in the list of supportive diagnostic biomarkers of DLB.
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Affiliation(s)
- Lucia Zinno
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
| | - Anna Negrotti
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
| | - Chiara Falzoi
- Center for Cognitive Disorders, AUSL of Parma, Parma, Emilia-Romagna, Italy
| | - Giovanni Messa
- Center for Cognitive Disorders, AUSL of Parma, Parma, Emilia-Romagna, Italy
| | | | - Stefano Calzetti
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
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13
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Mutti C, Angeli MC, Rausa F, Tontini V, Pizzarotti S, Soglia M, Pollara I, Rapina C, Azzi N, Zinno L, Parrino L. Sleep macro- and micro-structure in autoimmune encephalitis: single case report from the subacute phase of the disease to the follow-up. Neurocase 2022; 28:235-238. [PMID: 35531934 DOI: 10.1080/13554794.2022.2072228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sleep disorders are frequently described in autoimmune encephalitis (AE); however, data on sleep texture are fragmentary. We analyzed the polysomnography of a woman affected by AE, and we performed cyclic alternating pattern (CAP) scoring during the subacute phase of the disease and at follow-up. The first polysomnography showed deviations both at macro and microstructure levels, with a marked reduction of CAP rate compare to healthy sleepers (20.8% vs 33%). After 6-months sleep macrostructure improved, whilst CAP parameters remained abnormal. This is the first polysomnographic analysis, comprehensive of microstructural data, performed in AE. We briefly discuss the results.
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Affiliation(s)
- Carlotta Mutti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Marco Cesare Angeli
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Valentina Tontini
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Margherita Soglia
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Irene Pollara
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Clara Rapina
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Nicoletta Azzi
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Sleep Disorders Center, Department of General and Specialized Medicine, University Hospital of Parma, Parma, Italy
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14
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Gianferrari G, Martinelli I, Zucchi E, Simonini C, Fini N, Vinceti M, Ferro S, Gessani A, Canali E, Valzania F, Sette E, Pugliatti M, Tugnoli V, Zinno L, Stano S, Santangelo M, De Pasqua S, Terlizzi E, Guidetti D, Medici D, Salvi F, Liguori R, Vacchiano V, Casmiro M, Querzani P, Currò Dossi M, Patuelli A, Morresi S, Longoni M, De Massis P, Rinaldi R, Borghi A, Amedei A, Mandrioli J. Epidemiological, Clinical and Genetic Features of ALS in the Last Decade: A Prospective Population-Based Study in the Emilia Romagna Region of Italy. Biomedicines 2022; 10:biomedicines10040819. [PMID: 35453569 PMCID: PMC9031824 DOI: 10.3390/biomedicines10040819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Increased incidence rates of amyotrophic lateral sclerosis (ALS) have been recently reported across various Western countries, although geographic and temporal variations in terms of incidence, clinical features and genetics are not fully elucidated. This study aimed to describe demographic, clinical feature and genotype–phenotype correlations of ALS cases over the last decade in the Emilia Romagna Region (ERR). From 2009 to 2019, our prospective population-based registry of ALS in the ERR of Northern Italy recorded 1613 patients receiving a diagnosis of ALS. The age- and sex-adjusted incidence rate was 3.13/100,000 population (M/F ratio: 1.21). The mean age at onset was 67.01 years; women, bulbar and respiratory phenotypes were associated with an older age, while C9orf72-mutated patients were generally younger. After peaking at 70–75 years, incidence rates, among women only, showed a bimodal distribution with a second slight increase after reaching 90 years of age. Familial cases comprised 12%, of which one quarter could be attributed to an ALS-related mutation. More than 70% of C9orf72-expanded patients had a family history of ALS/fronto-temporal dementia (FTD); 22.58% of patients with FTD at diagnosis had C9orf72 expansion (OR 6.34, p = 0.004). In addition to a high ALS incidence suggesting exhaustiveness of case ascertainment, this study highlights interesting phenotype–genotype correlations in the ALS population of ERR.
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Affiliation(s)
- Giulia Gianferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: ; Tel.: +39-05-9396-1640; Fax: +39-05-9396-3775
| | - Elisabetta Zucchi
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
- Department of Science of Public Health, Research Centre in Environmental, Genetic and Nutritional Epidemiology, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, 40127 Bologna, Italy;
| | - Annalisa Gessani
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Elena Canali
- Neurology Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (E.C.); (F.V.)
| | - Franco Valzania
- Neurology Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (E.C.); (F.V.)
| | - Elisabetta Sette
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Valeria Tugnoli
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
| | - Lucia Zinno
- Department of Neuroscience, University of Parma, 43121 Parma, Italy; (L.Z.); (S.S.)
| | - Salvatore Stano
- Department of Neuroscience, University of Parma, 43121 Parma, Italy; (L.Z.); (S.S.)
| | - Mario Santangelo
- Department of Neurology, Carpi Hospital, 41014 Modena, Italy; (M.S.); (S.D.P.)
| | - Silvia De Pasqua
- Department of Neurology, Carpi Hospital, 41014 Modena, Italy; (M.S.); (S.D.P.)
| | - Emilio Terlizzi
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy; (E.T.); (D.G.)
| | - Donata Guidetti
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy; (E.T.); (D.G.)
| | - Doriana Medici
- Department of Neurology, Fidenza Hospital, 43036 Parma, Italy;
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Rocco Liguori
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy; (R.L.); (V.V.)
| | - Veria Vacchiano
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy; (R.L.); (V.V.)
| | - Mario Casmiro
- Department of Neurology, Faenza and Ravenna Hospital, 48121 Ravenna, Italy; (M.C.); (P.Q.)
| | - Pietro Querzani
- Department of Neurology, Faenza and Ravenna Hospital, 48121 Ravenna, Italy; (M.C.); (P.Q.)
| | - Marco Currò Dossi
- Department of Neurology, Infermi Hospital, 47923 Rimini, Italy; (M.C.D.); (M.L.)
| | - Alberto Patuelli
- Department of Neurology and Stroke Unit, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy;
| | - Simonetta Morresi
- Department of Neurology and Stroke Unit, Bufalini Hospital, 47521 Cesena, Italy;
| | - Marco Longoni
- Department of Neurology, Infermi Hospital, 47923 Rimini, Italy; (M.C.D.); (M.L.)
- Department of Neurology and Stroke Unit, Bufalini Hospital, 47521 Cesena, Italy;
| | | | - Rita Rinaldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Interaziendale Clinica Neurologica Metropolitana (NeuroMet), 40139 Bologna, Italy;
| | - Annamaria Borghi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, 40133 Bologna, Italy;
| | | | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- SOD of Interdisciplinary Internal Medicine, Azienda Ospedaliera Universitaria Careggi (AOUC), 50134 Florence, Italy
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
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Gerra ML, Mutti C, Luviè L, Daniel BD, Florindo I, Picetti E, Parrino L, Marchesi C, Zinno L. Relapsing-remitting psychosis with malignant catatonia: a multidisciplinary challenge. Neurocase 2022; 28:126-130. [PMID: 35176968 DOI: 10.1080/13554794.2022.2032185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Malignant catatonia is a life-threatening syndrome that could be observed in various psychiatric and neurological conditions. We describe the challenging case of a young woman with relapsing-remitting malignant catatonia, which finally resolve after electroconvulsive therapy (ECT). Details regarding her psychiatric symptoms, dynamics, and EEG features during each acute and post-acute phases of the disease are described and long-term follow-ups are provided. We emphasize the importance of a multidisciplinary cross talk between neurologists and psychiatrists to ensure adequate management of this dangerous condition. Knowledge and gaps in the field of autoimmune psychosis are also discussed.
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Affiliation(s)
- Maria Lidia Gerra
- Department of Mental Health, Local Health Service of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of Neurology, University Hospital of Parma, Parma, Italy
| | - Lorenzo Luviè
- Department of Anesthesia and Intensive Care, University Hospital of Parma, Parma, Italy
| | | | - Irene Florindo
- Department of Neurology, University Hospital of Parma, Parma, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, University Hospital of Parma, Parma, Italy
| | - Liborio Parrino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucia Zinno
- Department of Neurology, University Hospital of Parma, Parma, Italy
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Gianferrari G, Martinelli I, Zucchi E, Simonini C, Fini N, Canali E, Casmiro M, Curròdossi M, Depasqua S, Liguori R, Medici D, Morresi S, Patuelli A, Pugliatti M, Salvi F, Santangelo M, Sette E, Terlizzi E, Vacchiano V, Zinno L, Vinceti M, Mandrioli J. A sight into the elderly ALS patients in Emilia Romagna region: Epidemiological and clinical features of late onset ALS in a prospective population-based study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Orlandi N, Bartolini E, Audenino D, Coletti Moja M, Urso L, d'Orsi G, Pauletto G, Nilo A, Zinno L, Cappellani R, Zummo L, Giordano A, Dainese F, Nazerian P, Pescini F, Beretta S, Dono F, Gaudio LD, Ferlisi M, Marino D, Piccioli M, Renna R, Rosati E, Rum A, Strigaro G, Giovannini G, Meletti S, Cavalli SM, Contento M, Cottone S, Di Claudio MT, Florindo I, Guadagni M, Kiferle L, Lazzaretti D, Lazzari M, Coco DL, Pradella S, Rikani K, Rodorigo D, Sabetta A, Sicurella L, Tontini V, Turchi G, Vaudano AE, Zanoni T. Intravenous brivaracetam in status epilepticus: A multicentric retrospective study in Italy. Seizure 2021; 86:70-76. [PMID: 33561784 DOI: 10.1016/j.seizure.2021.01.014] [Citation(s) in RCA: 12] [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: 12/01/2020] [Revised: 12/31/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE to evaluate the use, effectiveness, and adverse events of intravenous brivaracetam (BRV) in status epilepticus (SE). METHODS a retrospective multicentric study involving 24 Italian neurology units was performed from March 2018 to June 2020. A shared case report form was used across participating centres to limit biases of retrospective data collection. Diagnosis and classification of SE followed the 2015 ILAE proposal. We considered a trial with BRV a success when it was the last administered drug prior the clinical and/or EEG resolution of seizures, and the SE did not recur during hospital observation. In addition, we considered cases with early response, defined as SE resolved within 6 h after BRV administration. RESULTS 56 patients were included (mean age 62 years; 57 % male). A previous diagnosis of epilepsy was present in 21 (38 %). Regarding SE etiology classification 46 % were acute symptomatic, 18 % remote and 16 % progressive symptomatic. SE episodes with prominent motor features were the majority (80 %). BRV was administered as first drug after benzodiazepine failure in 21 % episodes, while it was used as the second or the third (or more) drug in the 38 % and 38 % of episodes respectively. The median loading dose was 100 mg (range 50-300 mg). BRV was effective in 32 cases (57 %). An early response was documented in 22 patients (39 % of the whole sample). The use of the BRV within 6 h from SE onset was independently associated to an early SE resolution (OR 32; 95 % CI 3.39-202; p = 0.002). No severe treatment emergent adverse events were observed. CONCLUSION BRV proved to be useful and safe for the treatment of SE. Time to seizures resolution appears shorter when it is administered in the early phases of SE.
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Affiliation(s)
- Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Department, OCB Hospital, AOU Modena, Italy
| | - Emanuele Bartolini
- Neurology Unit, Nuovo Ospedale Santo Stefano, USL Centro Toscana, Prato, Italy
| | | | | | - Lidia Urso
- Neurology and Stroke Unit, PO. S. Antonio Abate, Trapani, Italy
| | - Giuseppe d'Orsi
- Epilepsy Centre - S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria Della Misericordia University Hospital, ASUFC, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria Della Misericordia University Hospital, ASUFC, Udine, Italy
| | - Lucia Zinno
- Neurology Unit, Maggiore Hospital, AOU Parma, Italy
| | | | - Leila Zummo
- Neurology and Stroke Unit, P.O. ARNAS-Civico, Palermo, Italy
| | | | - Filippo Dainese
- Epilepsy Centre, UOC Neurology, ULSS3 Serenissima, Venice, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | | | - Simone Beretta
- Department of Neurology, Ospedale San Gerardo ASST Monza, University of Milano Bicocca, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, University "G. D'Annunzio" of Chieti-Pescara, Italy
| | | | | | - Daniela Marino
- Epilepsy Center, Neurology Unit, Department of Cardio-neuro-vascular Sciences, San Donato Hospital, Arezzo, Italy
| | | | - Rosaria Renna
- Neurological Clinic and Stroke Unit - "A. Cardarelli" Hospital, Naples, Italy
| | - Eleonora Rosati
- Neurology Unit 2, Careggi University Hospital, Florence, Italy
| | - Adriana Rum
- Neurology and Neurophysiopatology Unit, Aurelia Hospital, Rome, Italy
| | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Department, OCB Hospital, AOU Modena, Italy.
| | | | | | | | | | | | | | - Martina Guadagni
- Epilepsy Center, Neurology Unit, Department of Cardio-neuro-vascular Sciences, San Donato Hospital, Arezzo, Italy
| | - Lorenzo Kiferle
- Neurology Unit, Nuovo Ospedale Santo Stefano, USL Centro Toscana, Prato, Italy
| | - Delia Lazzaretti
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | | | - Daniele Lo Coco
- Neurology and Stroke Unit, P.O. ARNAS-Civico, Palermo, Italy
| | - Silvia Pradella
- Neurology Unit, Nuovo Ospedale Santo Stefano, USL Centro Toscana, Prato, Italy
| | | | - Davide Rodorigo
- Department of Neuroscience, Imaging and Clinical Science, University "G. D'Annunzio" of Chieti-Pescara, Italy
| | - Annarita Sabetta
- Epilepsy Centre - S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Luigi Sicurella
- Neurology and Stroke Unit, PO. S. Antonio Abate, Trapani, Italy
| | | | - Giulia Turchi
- Neurology Department, OCB Hospital, AOU Modena, Italy
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Mutti C, Ciliento R, Parrino L, Florindo I, Pavesi G, Zinno L. Apathetic encephalopathy in thyreotoxicosis: an unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome. Acta Biomed 2021; 92:e2021055. [PMID: 33682841 PMCID: PMC7975956 DOI: 10.23750/abm.v92i1.9473] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
Non-alcoholic Wernicke Encephalopathy (WE) is an overlooked complication of malnourishment in all its forms including undernutrition, inadequate vitamine intake and endocrinological diseases. Both delay in treatment and overtreatment can lead to severe neurological life-long consequences. Inadequate management in patients with chronic malnutrition may cause abrupt osmolytes unbalance and subsequent osmotic demyelination syndromes. We describe a 65-year old man with apathetic encephalopathy caused by thyreotoxicosis and associated with malnutrition and severe thiamine depletion.
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Affiliation(s)
| | - Rosario Ciliento
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Liborio Parrino
- Sleep Medicine Center, Neurology Unit, Department of General and Specialistic Medicine, University Hospital of Parma, Parma, Italy.
| | - Irene Florindo
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giovanni Pavesi
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Lucia Zinno
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Mutti C, Riccò M, Bartolini Y, Bernabè G, Trippi I, Melpignano A, Ciliento R, Zinno L, Florindo I, Sasso E, Odone A, Parrino L, Vaudano AE. Incomplete hippocampal inversion and epilepsy: A systematic review and meta-analysis. Epilepsia 2020; 62:383-396. [PMID: 33325054 DOI: 10.1111/epi.16787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Incomplete hippocampal inversion (IHI) is a relatively frequent radiological finding at visual inspection in both epilepsy and healthy controls, but its clinical significance is unclear. Here, we systematically retrieve and assess the association between epilepsy and IHI using a meta-analytic approach. Additionally, we estimate the prevalence of IHI in patients with malformation of cortical development (MCD). METHODS We systematically searched two databases (Embase and PubMed) to identify potentially eligible studies from their inception to December 2019. For inclusion, studies were population-based, case-control, observational studies reporting on epilepsy and IHI. The risk of developing epilepsy in IHI (estimated with odds ratio [ORs]) and the frequency of IHI among patients with MCD are provided. RESULTS We screened 3601 records and assessed eligibility of 2812 full-text articles. The final material included 13 studies involving 1630 subjects. Seven studies (1329 subjects: 952 epileptic and 377 nonepileptic) were included for the estimation of the risk of developing epilepsy in the presence of IHI. The estimated OR of active epilepsy in IHI was 1.699 (95% confidence interval = 0.880-3.281), with moderate heterogeneity across studies (I2 = 71%). Seven studies (591 patients) provided information about the frequency of IHI in MCD. Up to one third of patients with MCD (27.9%) presented coexistent IHI. SIGNIFICANCE The present findings confirm that IHI is commonly observed in patients with MCD especially in periventricular nodular heterotopia or polymicrogyria. However, the estimated OR indicates overall weak increased odds of epilepsy in people with IHI, suggesting that the presence of isolated IHI cannot be considered a strong independent predictor for epilepsy development. Clear-cut neuroradiological criteria for IHI and advanced postprocessing analyses on structural magnetic resonance imaging scans are recommended to highlight differences between epileptogenic and nonepileptogenic IHI.
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Affiliation(s)
- Carlotta Mutti
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Matteo Riccò
- AUSL-IRCCS of Reggio Emilia, Occupational Health and Safety Service, Reggio Emilia, Italy
| | - Yerma Bartolini
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Giorgia Bernabè
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Irene Trippi
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Andrea Melpignano
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Rosario Ciliento
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Irene Florindo
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Enrico Sasso
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Liborio Parrino
- Neurology Unit, Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Anna Elisabetta Vaudano
- Neurology Unit, Baggiovara Hospital, University Hospital of Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Science, and Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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20
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Taga A, Schito P, Trapasso MC, Zinno L, Pavesi G. Pain at the onset of Amyotrophic Lateral Sclerosis: a cross-sectional study. Clin Neurol Neurosurg 2019; 186:105540. [PMID: 31634749 DOI: 10.1016/j.clineuro.2019.105540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/18/2019] [Accepted: 09/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We evaluated ALS patients reporting pain, either generalized or localized, at disease onset and determined whether this feature defined a specific ALS phenotype. PATIENTS AND METHODS We considered all consecutive ALS patients referred to our Motor Neuron Diseases Center between 2006 and 2016 and included only patients who fulfilled the El Escorial revised criteria for probable and definite ALS diagnosis. We then identified those cases who reported pain at disease onset and compared them to all remaining cases. Secondary causes of pain have been excluded. RESULTS Our initial sample consisted of 108 patients (55 men and 53 women). We identified 5 cases with generalized pain and 16 cases with localized pain at disease onset, corresponding to 4.6% and 14.8% of the initial sample, respectively. Cases with generalized pain were all female and had an earlier disease onset (49.6 ± 1.5 vs 66.6 ± 10.2 yrs, p = 0.002). Cases with localized pain showed a preponderance of upper motor neuron symptoms/signs at disease onset. Patients with pain, either localized or generalized, had a significantly higher involvement of the limbs (82.6% vs 100%, p = 0.022), while the bulbar district was spared at disease onset (17.4% vs 0%, p = 0.008). More specifically, the proximal upper and distal lower limbs were more frequently affected by ALS in patients with pain at disease onset. In two cases, the clinical presentation was notable for the resemblance with complex regional pain syndrome. CONCLUSION The presence of pain at disease onset seems to relate to peculiar clinical features of ALS and may be pathophysiologically associated with neurodegeneration.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University, 855 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Paride Schito
- Università degli Studi di Parma, Via Università 12, 43121, Parma, Italy
| | - Maria Claudia Trapasso
- Dipartimento di Emergenza-Urgenza, ed Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Lucia Zinno
- Dipartimento di Emergenza-Urgenza, ed Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giovanni Pavesi
- Dipartimento di Emergenza-Urgenza, ed Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
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Mutti C, Ciliento R, Melpignano A, Trippi I, Bernabè G, Zinno L, Parrino L. Can body position and sleep stages influence motor patterns in periodic limb movement disorder? Sleep Med 2019; 62:32-33. [PMID: 31526968 DOI: 10.1016/j.sleep.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Carlotta Mutti
- Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Rosario Ciliento
- Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | | | - Irene Trippi
- Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Giorgia Bernabè
- Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Lucia Zinno
- Department of General and Specialistic Medicine, Neurological Unit, University Hospital of Parma, Italy
| | - Liborio Parrino
- Sleep Disorders Center, University Hospital of Parma, Parma, Italy; Department of General and Specialistic Medicine, Neurological Unit, University Hospital of Parma, Italy.
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Mutti C, Curti E, Ciliento R, Melpignano A, Florindo I, Zinno L, Sasso E, Parrino L, Pavesi G, Vaudano AE. Herpes Simplex Virus 1 encephalitis with normal cerebrospinal fluid after brain radiotherapy in a patient with glioblastoma. A case report and review of literature. Acta Biomed 2019; 90:327-330. [PMID: 31125013 PMCID: PMC6776207 DOI: 10.23750/abm.v90i2.8218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
Herpes simplex virus encephalitis (HSE) is the most common cause of letal encephalitis and its prevalence appears higher among oncologic patients who undergo brain radiotherapy (RT). We describe a case of 76-year-old woman with glioblastoma multiforme (GBM) who developed HSE shortly after brain RT. Cerebrospinal fluid analysis (CSF) was normal and the diagnosis was driven by brain MRI and EEG. Prompt introduction of antiviral therapy improved the clinical picture. We highlight the importance of EEG and brain MRI for the diagnosis and suggest the possibility of antiviral profilaxys in oncologic patients who undergo brain RT. (www.actabiomedica.it)
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Mutti C, Barocco F, Zinno L, Negrotti A, Spallazzi M, Pavesi G, Gardini S, Caffarra P. A case of reversible anti-NMDA-receptor encephalitis: neuropsychological and neuroradiological features. Neurol Sci 2017; 38:2231-2236. [PMID: 28905135 DOI: 10.1007/s10072-017-3105-4] [Citation(s) in RCA: 2] [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: 05/04/2017] [Accepted: 08/30/2017] [Indexed: 01/17/2023]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalitis mainly affecting young women. We report a case of a mild paraneoplastic anti-NMDAR encephalitis in a 31-year-old female with an ovarian immature teratoma. The patient exhibited a severe short-term episodic memory impairment and psychiatric symptoms. A detailed diagnostic work-up including complete clinical and laboratory examinations, neuropsychological assessments, and neuroradiological investigations has been done at the onset and during follow-up. The amnestic syndrome and MRI medial-temporal abnormalities reversed after medical and surgical treatment. The present report indicates that the disease can be rapidly reversible if promptly diagnosed and treated. While the disease has already been described elsewhere, the course of neurospychological deficits in adults is not as much known. Usually, when the diagnosis of anti-NMDAR encephalitis is made, the severity of the disease makes the assessment of the neuropsycological profile particulary challenging. The present report is of interest because it describes the complete neuropsychological profile of a mild form of anti-NMDAR encephalitis.
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Affiliation(s)
- Carlotta Mutti
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy
| | | | - Lucia Zinno
- Department of Emergency care, General and Specialist Medical Area, AOU, Parma, Italy
| | - Anna Negrotti
- Department of Emergency care, General and Specialist Medical Area, AOU, Parma, Italy
| | | | - Giovanni Pavesi
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy
| | | | - Paolo Caffarra
- Department of Medicine and Surgery, Section of Neurology, University of Parma, Via Gramsci 14, 43126, Parma (PR), Italy.
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De Laurentiis M, Cancello G, Zinno L, Montagna E, Malorni L, Esposito A, Pennacchio R, Silvestro L, Giuliano M, Giordano A, Caputo F, Accurso A, De Placido S. Targeting HER2 as a therapeutic strategy for breast cancer: a paradigmatic shift of drug development in oncology. Ann Oncol 2005; 16 Suppl 4:iv7-13. [PMID: 15923434 DOI: 10.1093/annonc/mdi901] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [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: 11/14/2022] Open
Abstract
Targeted therapies are causing a dramatic change in cancer drug development. Trastuzumab, a humanized recombinant monoclonal antibody that recognizes the extracellular domain of HER2 trans-membrane protein, is among the first target-specific drugs that have been licensed for clinical use and its development represents a model of integration of new agents with classical treatment strategies. In preclinical models, trastuzumab has demonstrated a marked antiproliferative effect and a synergistic action with several chemotherapeutic agents. Monotherapy trials indicate that trastuzumab is active as a single agent in HER2 positive patients, is well tolerated, and is associated with preservation of quality of life (QoL). Furthermore, as first line therapy for metastatic breast cancer overexpressing HER2 receptor, the addition of trastuzumab to taxane-based chemotherapy significantly increased rate of objective response, time to disease progression and survival when compared with chemotherapy alone. Trastuzumab has shown important activity when used with many chemotherapeutic agents such as platinum salts, gemcitabine, vinorelbine and capecitabine and liposomal anthracyclines. Various trials are now ongoing to optimize the use of trastuzumab and to investigate its role in the adjuvant and in the neo-adjuvant setting.
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Affiliation(s)
- M De Laurentiis
- Department of Endocrinology and Molecular and Clinical Oncology, University Federico II, Napoli, Italy
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Gemignani F, Brindani F, Zinno L, Allegri I, Alfieri S, Marbini A. Frequency of clinically diagnosed small fiber neuropathy in a neuropathy population. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209aw.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brindani F, Gemignani F, Zinno L, Marbini A. Aquadynia. a manifestation of small fiber sensory neuropathy? J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209av.x] [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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Calzetti S, Bortone E, Negrotti A, Zinno L, Mancia D. Frontal intermittent rhythmic delta activity (FIRDA) in patients with dementia with Lewy bodies: a diagnostic tool? Neurol Sci 2002; 23 Suppl 2:S65-6. [PMID: 12548346 DOI: 10.1007/s100720200072] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 11/30/2022]
Abstract
The accuracy of the clinical diagnosis of dementia with Lewy bodies (DLB) remains poor, especially in early phases of the disease, in spite of applying current consensus diagnostic criteria. The need for supportive diagnostic tools is therefore warranted. In this study EEG recordings showed a main pattern of bilateral frontal intermittent rhythmic delta activity (FIRDA) in 7 of 10 patients, aged 58-83 years, 8 of whom were diagnosed as affected by "probable" and 2 by "possible" DLB. Conversely, the same EEG abnormality was found only in 2 of 9 age-matched patients, 8 of whom had "probable" and 1 "possible" Alzheimer's disease, according to NINCDS-ADRDA criteria, taken as controls. The degree of cognitive impairment was comparable among the two groups of patients. If these findings will be confirmed in a larger series, FIRDA, even though an aspecific EEG pattern, could be of value in improving the diagnostic accuracy of DLB.
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Affiliation(s)
- S Calzetti
- Institute of Neurology, University of Parma, Parma, Italy
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