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Zanus C, Miladinović A, De Dea F, Skabar A, Stecca M, Ajčević M, Accardo A, Carrozzi M. Sleep Spindle-Related EEG Connectivity in Children with Attention-Deficit/Hyperactivity Disorder: An Exploratory Study. Entropy (Basel) 2023; 25:1244. [PMID: 37761543 PMCID: PMC10530036 DOI: 10.3390/e25091244] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder with known brain abnormalities but no biomarkers to support clinical diagnosis. Recently, EEG analysis methods such as functional connectivity have rekindled interest in using EEG for ADHD diagnosis. Most studies have focused on resting-state EEG, while connectivity during sleep and spindle activity has been underexplored. Here we present the results of a preliminary study exploring spindle-related connectivity as a possible biomarker for ADHD. We compared sensor-space connectivity parameters in eight children with ADHD and nine age/sex-matched healthy controls during sleep, before, during, and after spindle activity in various frequency bands. All connectivity parameters were significantly different between the two groups in the delta and gamma bands, and Principal Component Analysis (PCA) in the gamma band distinguished ADHD from healthy subjects. Cluster coefficient and path length values in the sigma band were also significantly different between epochs, indicating different spindle-related brain activity in ADHD.
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Affiliation(s)
- Caterina Zanus
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (C.Z.); (M.C.)
| | - Aleksandar Miladinović
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (C.Z.); (M.C.)
| | - Federica De Dea
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy (M.A.); (A.A.)
- Department of Life Science, University of Trieste, 34127 Trieste, Italy
| | - Aldo Skabar
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (C.Z.); (M.C.)
| | - Matteo Stecca
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (C.Z.); (M.C.)
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy (M.A.); (A.A.)
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy (M.A.); (A.A.)
| | - Marco Carrozzi
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (C.Z.); (M.C.)
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Devescovi R, Bresciani G, Colonna V, Carrozzi M, Dissegna A, Celea MA, Cescon D, Frisari S, Guerrieri M, Placer F, Stocchi M, Terpini C, Colombi C. Short-Term Outcomes of an ESDM Intervention in Italian Children with Autism Spectrum Disorder following the COVID-19 Lockdown. Children (Basel) 2023; 10:children10040691. [PMID: 37189940 DOI: 10.3390/children10040691] [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] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic caused a temporary lockdown period in Italy, during which the delivery of in-person treatment for children with autism spectrum disorder (ASD) in public health services was discontinued. This occurrence represented a crucial challenge for both families and professionals. We assessed the short-term outcomes of a sample of 18 children who received an early intervention with the Early Start Denver Model (ESDM), delivered at low intensity over one year in the pre-pandemic period, after six months of interruption of in-presence treatment due to lockdown restrictions. Children who received the ESDM treatment maintained their gains in sociocommunicative skills and did not exhibit any developmental regression. Additionally, there was evidence of a decrease in the restrictive and repetitive behavior (RRB) domain. The parents, who were already familiar with the principles of the ESDM, only received telehealth support from therapists that aimed to sustain the gains already achieved. We believe that it is always helpful to support parents in their daily lives by implementing interactional and play skills with their children to integrate and consolidate the results obtained in the individual interventions conducted by experienced therapists.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
- CIMeC Centre for Mind/Brain Sciences, University of Trento, 38068 Rovereto, Italy
| | - Maria Antonella Celea
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Devid Cescon
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Sara Frisari
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Marcella Guerrieri
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Francesca Placer
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Monica Stocchi
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Chiara Terpini
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
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Bresciani G, Da Lozzo P, Lega S, Bramuzzo M, Di Leo G, Dissegna A, Colonna V, Barbi E, Carrozzi M, Devescovi R. Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder. Children (Basel) 2023; 10:children10020253. [PMID: 36832380 PMCID: PMC9955415 DOI: 10.3390/children10020253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023]
Abstract
The aim of this study was to evaluate the interaction between gastrointestinal (GI) disorders, sleep problems, and challenging behaviors in children with a diagnosis of Autism Spectrum Disorder (ASD) and their effect on parental stress. The secondary objective was to assess the frequency and type of GI and feeding disorders in a sample of children with ASD through a multidisciplinary assessment and, finally, to investigate families' perceptions and satisfaction with the proposed multidisciplinary approach. All children underwent a comprehensive gastroenterological and neuropsychiatric evaluation supported by standardized questionnaires. Pediatric gastroenterologists, specifically trained in Applied Behavior Analysis (ABA), provided advice for parent-delivered behavioral intervention for food selectivity. Thirty-six children with an autism diagnosis (29 males, age 4.5 +/-2.2 years, mean +/- SD) were enrolled. A positive correlation between sleep problems and aggressive behavior was found, and this association was stronger in children experiencing more problematic mealtime behaviors (b = 0.788, p = 0.014). Sleep difficulties were associated with stereotyped behaviors and parent-perceived stress. Parents interviewed about the gastroenterology visit perceived this multidisciplinary approach as helpful in addressing food selectivity. This study shows that sleep and mealtime issues can have a synergistic negative impact on ASD symptoms. A multidisciplinary approach and an integrated assessment of GI, feeding problems, and sleep disorders could be helpful in diagnosing comorbidities and to provide targeted advice to parents.
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Affiliation(s)
- Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Prisca Da Lozzo
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
| | - Sara Lega
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Grazia Di Leo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 38122 Trieste, Italy
- CIMeC Centre for Mind/Brain Sciences, University of Trento, 38122 Rovereto, Italy
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- Correspondence:
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
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Di Stazio M, Zanus C, Faletra F, Pesaresi A, Ziccardi I, Morgan A, Girotto G, Costa P, Carrozzi M, d’Adamo AP, Musante L. Haploinsufficiency as a Foreground Pathomechanism of Poirer-Bienvenu Syndrome and Novel Insights Underlying the Phenotypic Continuum of CSNK2B-Associated Disorders. Genes (Basel) 2023; 14:genes14020250. [PMID: 36833176 PMCID: PMC9957394 DOI: 10.3390/genes14020250] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
CSNK2B encodes for the regulatory subunit of the casein kinase II, a serine/threonine kinase that is highly expressed in the brain and implicated in development, neuritogenesis, synaptic transmission and plasticity. De novo variants in this gene have been identified as the cause of the Poirier-Bienvenu Neurodevelopmental Syndrome (POBINDS) characterized by seizures and variably impaired intellectual development. More than sixty mutations have been described so far. However, data clarifying their functional impact and the possible pathomechanism are still scarce. Recently, a subset of CSNK2B missense variants affecting the Asp32 in the KEN box-like domain were proposed as the cause of a new intellectual disability-craniodigital syndrome (IDCS). In this study, we combined predictive functional and structural analysis and in vitro experiments to investigate the effect of two CSNK2B mutations, p.Leu39Arg and p.Met132LeufsTer110, identified by WES in two children with POBINDS. Our data prove that loss of the CK2beta protein, due to the instability of mutant CSNK2B mRNA and protein, resulting in a reduced amount of CK2 complex and affecting its kinase activity, may underlie the POBINDS phenotype. In addition, the deep reverse phenotyping of the patient carrying p.Leu39Arg, with an analysis of the available literature for individuals with either POBINDS or IDCS and a mutation in the KEN box-like motif, might suggest the existence of a continuous spectrum of CSNK2B-associated phenotypes rather than a sharp distinction between them.
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Affiliation(s)
- Mariateresa Di Stazio
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Caterina Zanus
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Flavio Faletra
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Alessia Pesaresi
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Ilaria Ziccardi
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Anna Morgan
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Giorgia Girotto
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Paola Costa
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
| | - Adamo P. d’Adamo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
- Correspondence:
| | - Luciana Musante
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, 34137 Trieste, Italy
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Musante L, Faletra F, Meier K, Tomoum H, Najarzadeh Torbati P, Blair E, North S, Gärtner J, Diegmann S, Beiraghi Toosi M, Ashrafzadeh F, Ghayoor Karimiani E, Murphy D, Murru FM, Zanus C, Magnolato A, La Bianca M, Feresin A, Girotto G, Gasparini P, Costa P, Carrozzi M. TTC5 syndrome: Clinical and molecular spectrum of a severe and recognizable condition. Am J Med Genet A 2022; 188:2652-2665. [PMID: 35670379 PMCID: PMC9541101 DOI: 10.1002/ajmg.a.62852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 01/24/2023]
Abstract
Biallelic mutations in the TTC5 gene have been associated with autosomal recessive intellectual disability (ARID) and subsequently with an ID syndrome including severe speech impairment, cerebral atrophy, and hypotonia as clinical cornerstones. A TTC5 role in IDs has been proposed based on the physical interaction of TTC5 with p300, and possibly reducing p300 co-activator complex activity, similarly to what was observed in Menke-Hennekam 1 and 2 patients (MKHK1 and 2) carrying, respectively, mutations in exon 30 and 31 of CREBBP and EP300, which code for the TTC5-binding region. Recently, TTC5-related brain malformation has been linked to tubulinopathies due to the function of TTC5 in tubulins' dynamics. We reported seven new patients with novel or recurrent TTC5 variants. The deep characterization of the molecular and phenotypic spectrum confirmed TTC5-related disorder as a recognizable, very severe neurodevelopmental syndrome. In addition, other relevant clinical aspects, including a severe pre- and postnatal growth retardation, cryptorchidism, and epilepsy, have emerged from the reversal phenotype approach and the review of already published TTC5 cases. Microcephaly and facial dysmorphism resulted in being less variable than that documented before. The TTC5 clinical features have been compared with MKHK1 published cases in the hypothesis that clinical overlap in some characteristics of the two conditions was related to the common p300 molecular pathway.
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Affiliation(s)
- Luciana Musante
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Flavio Faletra
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Kolja Meier
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Hoda Tomoum
- Department of PediatricsAin Shams UniversityCairoEgypt
| | | | - Edward Blair
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Sally North
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Susann Diegmann
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Mehran Beiraghi Toosi
- Pediatric Neurology Department, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Farah Ashrafzadeh
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ehsan Ghayoor Karimiani
- Department of Molecular GeneticsNext Generation Genetic PolyclinicMashhadIran
- Molecular and Clinical Sciences InstituteSt. George's, University of LondonLondonUK
- Innovative Medical Research Center, Mashhad BranchIslamic Azad UniversityMashhadIran
| | - David Murphy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Flora Maria Murru
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Caterina Zanus
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Andrea Magnolato
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Martina La Bianca
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Agnese Feresin
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Giorgia Girotto
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Paolo Gasparini
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Paola Costa
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
| | - Marco Carrozzi
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo”TriesteItaly
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Zoia S, Biancotto M, Caravale B, Valletti A, Montelisciani L, Croci I, Voller F, Rusconi F, Carrozzi M, Chiandotto V, Di Lallo D, Vicari S, Cuttini M. Early factors associated with risk of developmental coordination disorder in very preterm children: A prospective area-based cohort study in Italy. Paediatr Perinat Epidemiol 2022; 36:683-695. [PMID: 35437802 PMCID: PMC9546412 DOI: 10.1111/ppe.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Developmental coordination disorder (DCD) is a motor disorder of unknown aetiology that may have long-term consequences on daily activities, and psychological and physical health. Studies investigating risk factors for DCD have so far provided inconsistent results. OBJECTIVES To assess, using a parent-report screening tool, risk of DCD in school-age very preterm children born in Italy, and investigate the associated early biomedical and sociodemographic factors. METHODS A prospective area-based cohort (804 children, response rate 73.4%) was assessed at 8-11 years of age in three Italian regions. Perinatal data were abstracted from medical records. DCD risk was measured using the Italian-validated version of the Developmental Coordination Disorder Questionnaire (DCDQ-IT). For this study, children with cognitive deficit (i.e. intelligence quotient <70), cerebral palsy, severe vision and hearing disabilities, and other impairments affecting movement were excluded. A total of 629 children were analysed. We used inverse probability weighting to account for loss to follow-up, and multilevel, multivariable modified Poisson models to obtain adjusted risk ratio (aRR) and 95% confidence interval (CI). Missing values in the covariates were imputed. RESULTS 195 children (weighted proportion 31.8%, 95% CI 28.2, 35.6) scored positive on the DCDQ-IT, corresponding to the 15th centile of the reference Movement-ABC test. Factors associated with overall DCD risk were male sex (aRR 1.35, 95% CI 1.05, 1.73), intrauterine growth restriction (aRR 1.45, 95% CI 1.14, 1.85), retinopathy of prematurity (aRR 1.62, 95% CI 1.07, 2.45), and older maternal age at delivery (aRR 1.39, 95% CI 1.09, 1.77). Complete maternal milk feeding at discharge from the neonatal unit and higher parental socio-economic status were associated with decreased risk. CONCLUSIONS Both biomedical and sociodemographic factors increase DCD risk. These findings can contribute to elucidating the origins of this disorder, and assist in the identification of children at risk for early referral and intervention.
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Affiliation(s)
- Stefania Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne FamigliaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | - Marina Biancotto
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne FamigliaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | - Barbara Caravale
- Department of Developmental and Social PsychologyLa Sapienza UniversityRomeItaly
| | - Alessandra Valletti
- Clinical Care and Management Innovation Research AreaBambino Gesù Children’s HospitalIRCCSRomeItaly
| | - Laura Montelisciani
- Clinical Care and Management Innovation Research AreaBambino Gesù Children’s HospitalIRCCSRomeItaly
| | - Ileana Croci
- Clinical Care and Management Innovation Research AreaBambino Gesù Children’s HospitalIRCCSRomeItaly
| | - Fabio Voller
- Unit of EpidemiologyRegional Health Agency of TuscanyFlorenceItaly
| | - Franca Rusconi
- Unit of EpidemiologyMeyer Children's University HospitalFlorenceItaly,Present address:
Department of Mother and Child HealthAzienda USL Toscana Nord OvestPisaItaly
| | - Marco Carrozzi
- Department of NeuroscienceBurlo Garofolo Maternal and Child Health HospitalIRCCSTriesteItaly
| | - Valeria Chiandotto
- Neonatal Intensive Care Unit, S. Maria della Misericordia University HospitalUdineItaly
| | - Domenico Di Lallo
- Hospital Network Planning and Research AreaLazio Regional Health AuthorityRomeItaly
| | - Stefano Vicari
- Department of Life Sciences and Public HealthCatholic University, and Department of NeuroscienceChild & Adolescent Psychiatry UnitBambino Gesù Children’s HospitalIRCCSRomeItaly
| | - Marina Cuttini
- Clinical Care and Management Innovation Research AreaBambino Gesù Children’s HospitalIRCCSRomeItaly
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Giurin MS, Trojniak MP, Arbo A, Carrozzi M, Abbracciavento G, Monasta L, Zanus C. Safety of Off-Label Pharmacological Treatment in Pediatric Neuropsychiatric Disorders: A Global Perspective From an Observational Study at an Italian Third Level Children’s Hospital. Front Pharmacol 2022; 13:837692. [PMID: 35496268 PMCID: PMC9039008 DOI: 10.3389/fphar.2022.837692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The acquisition of proper and relevant pediatric clinical data is essential to ensure tolerable and effective pediatric drug therapies. In the field of pharmacological treatment of neuropsychiatric disorders, the lack of sufficient high quality scientific evidence for pediatric age results in the frequent need to prescribe off-label drugs. With the aim of improving knowledge about safety profile of off-label drug prescription in children and adolescent with neurological and/or psychiatric disorders, we realized a multidisciplinary pharmacovigilance study. Materials and methods: An observational retrospective study was conducted to assess the safety of off-label pharmacological therapies in patients aged 0–18 years, admitted to the Neuropsychiatry Unit of the Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” between January 2016 and December 2018. Prescription patterns and adverse drug reactions were evaluated by a multidisciplinary team. Results: Overall, 230 patients were enrolled, 48% boys (N = 111), 52% girls (N = 119), average age of 10 years, and a total of 534 prescriptions was analyzed. 54.5% (N = 125) of patients had epilepsy, 37.5% (N = 86) suffered from psychiatric disorders, 8% (N = 19) had other neurological disorders. The prevalence of off-label prescriptions was 32% and 50% of the study population received at least one off-label drug. A total of 106 ADRs was detected: 57% of ADRs were due to drug-drug interactions, 30% were due to off-label prescriptions, 10% were due to overdose and 3% were due to improper use. No significant association between emerged ADRs and off label prescriptions was found (Fisher’s exact two-tailed test, p = 1.000). There was significant association between increasing number of administrated drugs and risk of ADRs (OR 1.99; IC95% 1.58–2.5; p = 0.000). Psychiatric disorders were associated with at least three times higher risk to be treated with an off-label drug (OR 3.30; IC95% 2.26–4.83; p = 0.000). Conclusions: This study shows that off-label prescribing in neuropsychiatric disorders does not pose a greater risk of ADRs than on-label prescribing and highlights unmet clinical needs in pediatric neuropsychopharmacology. The multidisciplinary approach can provide important contributions to improve therapeutic path of these already complex pathologies by careful monitoring of therapeutic appropriateness and drug interactions.
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Burlo F, Barbi E, Carrozzi M, Zanus C. Case report: A relevant misdiagnosis: Photosensitive epilepsy mimicking a blinking tic. Front Pediatr 2022; 10:918420. [PMID: 36467468 PMCID: PMC9709211 DOI: 10.3389/fped.2022.918420] [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] [Received: 04/12/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Blinking in children is most frequently a functional and transient symptom. Nonetheless, sometimes it is the first clinical manifestation of a neurological disorder. The differential diagnosis between voluntary actions, tics and other neurological disorders among which seizures may be challenging and misdiagnosis is common. A 6-year-old girl in good health was admitted for a recent history of bilateral eye blinking. Blinking did not interfere with the girl's activities. The patients reported that blinking seemed to be triggered by sunlight exposure and that girl sometimes seemed to be attracted by the sunlight. Ophthalmological diseases had been already excluded. The girl was addressed to our hospital for neurological consultation, as tic disease was considered the most probable hypothesis. Neurological examination was negative. In the field of differential diagnosis of photosensitive abnormal eyelid movements, the hypothesis of seizures was explored and further investigated with a video-EEG recording with light stimulation. This exam demonstrated a photoparoxysmal response (PPR) to intermittent photic stimulation with appearance on EEG of bilateral spike and polyspike waves associated with eyelid jerks. This girl suffers from generalized epilepsy with photosensitivity. Photosensitivity is a common feature of many epilepsy syndromes, mainly occurring in children and adolescents. To control the seizures, it is essential to avoid the triggering stimulus, by wearing specific glasses. Additional antiseizures treatment is often necessary, at first with valproate and levetiracetam, and ethosuximide, lamotrigine, and benzodiazepines as the second choice. Overlapping phenomenology of seizures and movement disorders is well known in paediatric clinical practice. Moreover, epilepsy and movement disorder may coexist, mainly in children. Seizures with semeiology limited to eye motor manifestations may mimic functional blinking, tics, and other motor events frequently observed in childhood. Differentiating seizures from other non-epileptic paroxysmal movements may be challenging and specialist evaluation is needed for proper treatment and prognostic counselling.
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Affiliation(s)
- Francesca Burlo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Caterina Zanus
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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9
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Cervesi C, Di Marzio GM, Kiren V, Cattaruzzi E, Costa P, Carrozzi M. Sclerosi tuberosa ed everolimus: una nuova storia. Medico e Bambino 2021; 40:443-449. [DOI: 10.53126/meb40443] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder, due to inactivating muta-tions of TSC1 or TSC2 mTOR pathway genes and is characterized by variable multisystem manifestations ranging from hamartomas to malignant neoplasms. It frequently associated to seizures, intellectual disability and behavioural disorders. Surgical treatment has traditionally been used to manage subependymal giant cells astrocytomas (SEGA). The introduction of mTOR inhibitor rapamycin, with its definite role both as primary and as adjuvant treatment, has significantly modified the management opportunities in the clinical practice. It is important to consider both treatment options in a balanced way and not only the SEGA, but also the individual patient and their associated comorbidities. The pros and the cons of both options should be discussed by a multidisciplinary team before establishing an individualized treatment recommendation. The paper reports the case of a patient with an asymptomatic SEGA who was treated with everolimus. The treatment was effective in reducing the size of the tumour, it was safe and well tolerated.
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Affiliation(s)
- Chiara Cervesi
- SC di Neuropsichiatria Infantile, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
| | | | - Valentina Kiren
- SC di Neuropsichiatria Infantile, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
| | | | - Paola Costa
- SC di Neuropsichiatria Infantile, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
| | - Marco Carrozzi
- SC di Neuropsichiatria Infantile, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
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10
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Devescovi R, Colonna V, Dissegna A, Bresciani G, Carrozzi M, Colombi C. Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region. Brain Sci 2021; 11:brainsci11091191. [PMID: 34573216 PMCID: PMC8464931 DOI: 10.3390/brainsci11091191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The Early Start Denver Model (ESDM) is an evidence-based early intervention model for young children with autism spectrum disorder (ASD). It is crucial to investigate the feasibility of the ESDM in community settings in contexts that are culturally different from American universities in which the model was originally developed. The aim was to further evaluate the effectiveness of the ESDM delivered within the Italian community setting at low intensity. We compared a group aged 19 to 43 months receiving the ESDM for 2 h per week over the course of 1 year with a concurrent, comparable, non-randomized control group receiving treatment as usual (TAU). Children were evaluated at baseline (T0) and after 6 months (T1) and 12 months (T2) of intervention. Feasibility was evaluated by parent and therapist questionnaires, retention rate, and therapist treatment fidelity. Both groups made similar gains in cognition and language abilities. The ESDM group made larger improvement in domains measured by the ESDM Curriculum Checklist, including communication, social skills, and maladaptive behaviors. Feasibility seemed well supported by retentions, therapists and parent satisfaction, and treatment fidelity. Our study further supports the feasibility of the ESDM implemented within the Italian public health system and suggests a better response in the ESDM-treated group than in the control group.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- Correspondence:
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Costanza Colombi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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11
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Benvenuto S, Gortani G, Bussani R, Poropat F, Murru FM, Carrozzi M, Tommasini A, Taddio A. Severe onset of inflammatory myositis in a child: think to paraneoplastic myositis. Ital J Pediatr 2021; 47:146. [PMID: 34210321 PMCID: PMC8252287 DOI: 10.1186/s13052-021-01098-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Juvenile idiopathic inflammatory myopathies (JIIMs) are a group of heterogenous, acquired, autoimmune disorders that affect the muscle. While the association between IIMs and malignancy has been widely reported in adults, cancer-associated myositis (CAM) is rare in children, so that routine malignancy screening is not generally performed. This report shows a case of severe CAM in a child. Case presentation An 11-years-old girl presented with worsening dyspnea after a 3-weeks history of progressive proximal weakness, myalgia, dysphagia, and weight loss. Her past history was remarkable for a type I Arnold-Chiari malformation associated with an anterior sacral meningocele. Physical examination showed severe hypotony and hypotrophy. Pulse oximetry and blood test showed a type II respiratory failure (SpO2 88%, pCO2 68 mmHg) and increased muscle enzyme levels (CPK 8479 U/L, AST 715 U/L, ALT 383 U/L, LDH 1795 U/L). The patient needed invasive mechanical ventilation. Inflammatory myositis was considered and treatment with intravenous methylprednisolone (30 mg/Kg/day for 3 days followed by 2 mg/Kg/day) and IVIG (1 g/kg/day for 2 days) was started. Muscle biopsy showed endomysial and perimysial necrosis and inflammation. The presence of serum anti-TIF1-γ antibody positivity led to a malignancy screening. Whole-body MRI showed a mature teratoma underneath sacral meningocele and both lesions were surgically removed. Given the histological and clinical severity of the myopathy, mycophenolate (500 mg twice a day) and rituximab (360 mg/m2, 4 weekly infusions) were added. Due to extreme muscular wasting, severe malnutrition and intolerance to enteral feeding the patient needed a transient tracheostomy and parenteral nutrition, followed by physiotherapy, speech therapy and nocturnal non-invasive ventilation. A complete remission was achieved 3 months after. Conclusions Among cancer-associated autoantibodies (CAAs) in adult patients, anti-TIF1-γ carries the highest risk of CAM, which recognizes with a high likelihood a paraneoplastic pathogenesis. In children, anti-TIF1-γ antibody has been associated with severe cutaneous disease, lipodystrophy, and chronic disease course, but not with CAM, which is overall rare in younger patients. Severe onset of a JIIM, especially if anti-TIF1-γ antibody positive, should prompt suspect of a CAM and lead to a screening for malignancy.
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Affiliation(s)
| | - Giulia Gortani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Federico Poropat
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Flora Maria Murru
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alberto Tommasini
- University of Trieste, Via dell'Istria 65/1, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- University of Trieste, Via dell'Istria 65/1, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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12
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Zanus C, Battistutta S, Aliverti R, Monasta L, Montico M, Ronfani L, Carrozzi M. High-school students and self-injurious thoughts and behaviours: clues of emotion dysregulation. Ital J Pediatr 2021; 47:14. [PMID: 33482895 PMCID: PMC7821399 DOI: 10.1186/s13052-021-00958-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Suicide attempts and self-harm in adolescence are a major public health concern: they are among the main causes of disability-adjusted life-years worldwide, with severe long-term health consequences in terms of mental illness and psychiatric hospitalisation and a significantly increased risk of suicide. Several studies recently focused on the hypothesis that adolescents may be particularly vulnerable to emotional dysregulation and on the relation between problems with emotion regulation and suicidal and self-harming behaviours. Italian epidemiological data about prevalence of these behaviours at the community level are lacking. Our study aimed to estimate the prevalence of self-injurious thoughts and behaviours (SITBs) in a representative sample of community adolescents, and to examine the association between SITBs and the emotional and behavioural profiles. Methods Anonymous self-report questionnaires were completed by 1507 students aged 11–18 years from 24 high schools in the North-eastern Italian region of Friuli Venezia Giulia. Information was collected on SITBs, on the socio-environmental context, and on the psychological profile (‘Achenbach’s YSR questionnaire 11–18, Multidimensional Test of Self-harm and Multi-Attitude Suicide Tendency Scale). Results Overall, 11.1% of adolescents reported self-harming behaviours without suicide ideation or attempts, 6.4% declared having thought to suicide without acting a suicide attempt or self-harm, 1.4% declared having attempted suicide and really thought to take away their life. Access to health services following a suicide thought, a self-harming behaviour or suicide attempt was infrequent, particularly for suicide ideation. At the YSR, all the SITBs groups reported high scores in almost all scales, with the most evident differences in the self-harming groups in which adolescents reported significantly higher scores in all scales, both internalising and externalising. An emotion dysregulation profile was found in almost all the groups. Conclusions This study provides us with an estimate of the prevalence of SITBs in the adolescent population and confirms the importance of further investigating the association between SITBs and emotion dysregulation. The naturalistic setting of community studies appears to be useful for studies in this field, and it allows to approach the onerous and often neglected issue of adolescent suicidality. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-00958-0.
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Affiliation(s)
- Caterina Zanus
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sara Battistutta
- Child and Adolescent Neuropsychiatry Service, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Renata Aliverti
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Marcella Montico
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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13
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Grigoletto V, Cognigni M, Occhipinti AA, Abbracciavento G, Carrozzi M, Barbi E, Cozzi G. Rebound of Severe Alcoholic Intoxications in Adolescents and Young Adults After COVID-19 Lockdown. J Adolesc Health 2020; 67:727-729. [PMID: 32943287 PMCID: PMC7490634 DOI: 10.1016/j.jadohealth.2020.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The coronavirus lockdown in Italy ended, but the postlockdown phase may be even more challenging than the outbreak itself if the impact on mental health is considered. To date, little evidence is available about the effect of lockdown release in terms of adolescent health from the perspective of an emergency department (ED). METHODS We reviewed data on ED arrivals of adolescents and young adults (aged 13-24 years) in the weeks immediately before and after the Italian lockdown release in 2020, and in the same periods in 2019, with a focus on cases of severe alcohol abuse, psychomotor agitation, and other mental issues. RESULTS The relative frequency of severe alcohol intoxications increased from .88% during the last part of the lockdown to 11.3% after lockdown release. When comparing these data with the same period in 2019, a highly significant difference emerged, with severe alcohol intoxications accounting for 11.31% of ED visits versus 2.96%, respectively. The relative frequency of ED arrivals related to psychomotor agitation or other mental health issues was not significantly increased after lockdown release. CONCLUSIONS This report suggests that emergency services should be prepared for a possible peak of alcohol intoxication-related emergencies in adolescents and young adults. The connection between alcohol abuse and mental health should not be overlooked.
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Affiliation(s)
- Veronica Grigoletto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - Marta Cognigni
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Agostino Occhipinti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,Emergency Department, Cattinara Hospital, Trieste, Italy
| | | | - Marco Carrozzi
- Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy
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14
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Devescovi R, Monasta L, Bin M, Bresciani G, Mancini A, Carrozzi M, Colombi C. A Two-Stage Screening Approach with I-TC and Q-CHAT to Identify Toddlers at Risk for Autism Spectrum Disorder within the Italian Public Health System. Brain Sci 2020; 10:brainsci10030184. [PMID: 32210022 PMCID: PMC7139459 DOI: 10.3390/brainsci10030184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/17/2023] Open
Abstract
Standardized screening programs ensure that children are monitored for early signs of autism spectrum disorder (ASD) in order to promote earlier diagnosis and intervention. The aim of this study is to identify early signs of atypical development consistent with ASD or other developmental disorders in a population of 224 low-risk toddlers through a two-stage screening approach applied at 12 and 18 months of age. We adopted two screening tools combined: 1. the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist (I-TC) and 2. The Quantitative Checklist for Autism in Toddlers (Q-CHAT). We assessed their sensitivity and specificity related to the diagnostic outcome at 36 months. The results showed that autistic signs can be detected as early as the first year even through a few questions extrapolated from both screeners and that our model could be used as a screening procedure in the Italian public health system.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
- Correspondence:
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Maura Bin
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Alice Mancini
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA;
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15
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Costa P, Zanus C, Faletra F, Ventura G, di Marzio GM, Cervesi C, Carrozzi M. Epileptic encephalopathy with microcephaly in a patient with asparagine synthetase deficiency: a video-EEG report. Epileptic Disord 2019; 21:466-470. [PMID: 31617495 DOI: 10.1684/epd.2019.1100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Asparagine synthetase deficiency is a rare autosomal recessive neurometabolic disorder caused by mutations in the asparagine synthetase gene. It is characterized by congenital microcephaly, intellectual disability, progressive cerebral atrophy, and intractable seizures. A decrease in asparagine in CSF or plasma guides subsequent investigations in some cases, but normal values are described in other cases. Therefore, reaching a diagnosis is challenging and relies on exome sequencing. We report the case of a child with progressive microcephaly, irritability, startle reflexes, and jitteriness since birth. Focal clonic and myoclonic seizures, status epilepticus, and infantile spasms appeared in the first months of life. At first, the EEG showed multifocal epileptic activity which later turned into modified hypsarrhythmia and discontinuous activity. Brain MRI showed brain atrophy, a simplified gyral pattern, and poor myelination. Plasma asparagine levels were normal. Due to remote parental consanguinity, a study of contiguous regions of runs of homozygosity was performed, showing a 5-Mb region (chr7:95629078-100679007) including the asparagine synthetase gene. The molecular analysis of this gene led to identification of a novel homozygous missense mutation, c.761G>T(p.Gly254Val), in our patient. The peculiar electroclinical phenotype may lead to diagnostic suspicion and molecular analysis which may benefit genetic counselling. [Published with video sequence].
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Affiliation(s)
- Paola Costa
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste
| | - Caterina Zanus
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste
| | - Flavio Faletra
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste
| | | | | | - Chiara Cervesi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste
| | - Marco Carrozzi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste
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16
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Caravale B, Herich L, Zoia S, Capone L, Voller F, Carrozzi M, Chiandotto V, Balottin U, Lacchei M, Croci I, Cuttini M. Risk of Developmental Coordination Disorder in Italian very preterm children at school age compared to general population controls. Eur J Paediatr Neurol 2019; 23:296-303. [PMID: 30711366 DOI: 10.1016/j.ejpn.2019.01.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/21/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder that involves difficulties in goal-directed motor coordination, with ineffective control of fine and gross motor movements in the absence of sensory impairment or neurological condition. DCD is frequently reported in children born very preterm (VP) who survive without CP. AIMS To measure the risk of DCD at school age in a large area-based cohort of VP children and general population controls, adjusting for gender, birth weight by gestational age and age at assessment. METHODS VP children (N = 608) were part of a prospective cohort study in Italy. Controls (N = 370) were participants in the DCDQ-Italian validation study in the same age range. The Italian version of Developmental Coordination Disorder Questionnaire (DCDQ-Italian) was used to measure the performances in motor coordination during ordinary activities from the parental point of view. Multivariable regression analysis was used to obtain adjusted risk ratios of screening positive for DCD. RESULTS VP children had scores significantly lower than peers, and about 30% of them appeared at risk of DCD using the 15th percentile cut-off of the Italian validation study. Birth-weight <10th percentile for gestational age and male gender were significant predictors. A slight trend effect was present, with extremely preterm children (<28 weeks gestation) showing the highest risk. CONCLUSIONS Our study confirmed the higher DCD risk in VP children, particularly when males and SGA.
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Affiliation(s)
- Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Lena Herich
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Stefania Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste, Via Giovanni Sai 7, 34128, Trieste, Italy.
| | - Luca Capone
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Fabio Voller
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Marco Carrozzi
- Department of Neuroscience, Burlo Garofolo Hospital, IRCCS, Via dell'Istria 65/1, 34127, Trieste, Italy.
| | - Valeria Chiandotto
- Neonatal Intensive Care Unit, S. Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy; Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Maria Lacchei
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
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17
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Barbiero C, Montico M, Lonciari I, Monasta L, Penge R, Vio C, Tressoldi PE, Carrozzi M, De Petris A, De Cagno AG, Crescenzi F, Tinarelli G, Leccese A, Pinton A, Belacchi C, Tucci R, Musinu M, Tossali ML, Antonucci AM, Perrone A, Lentini Graziano M, Ronfani L. The lost children: The underdiagnosis of dyslexia in Italy. A cross-sectional national study. PLoS One 2019; 14:e0210448. [PMID: 30673720 PMCID: PMC6343900 DOI: 10.1371/journal.pone.0210448] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background Developmental dyslexia is one of the most common neurobehavioral disorders affecting children, but prevalence data on this condition are poor. The objective of the present study is to determine the prevalence of dyslexia in Italy in an unselected school population, using clearly defined diagnostic criteria and methods. Methods Cross-sectional study carried out in nine Italian Regions: two located in Northern Italy (Friuli Venezia Giulia and Veneto), three in Central Italy (Marche, Lazio and Umbria) and four in Southern Italy (Abruzzo, Molise, Puglia and Sardegna). Three consecutive levels of screening were carried out: the first two at school, to screen the population and identify children with suspect dyslexia; the last in centers with multi-professional staff specialized in learning disabilities to confirm the diagnosis. The key outcome measure is the prevalence of dyslexia, defined as the ratio between the number of children confirmed positive at the third level of screening and the total number of children enrolled in the study. Results We finally recruited 11094 children aged 8–10 years, of which 9964 constituted the final working sample after applying exclusion criteria and including only children who received parents’ consent to participate. The prevalence of dyslexia in the whole sample was 3.5% (95% CI 3.2–3.9%), with little differences between Northern, Central and Southern Italy (respectively 3.6%, 3.2% and 3.7%). In almost two out of three children with dyslexia the disorder had not been previously diagnosed. Conclusions This study confirms that in primary school children at the age of 8–10 years in Italy dyslexia is widely underestimated. Reliable data on dyslexia prevalence are needed to allocate necessary human and financial resources both to Health Services and Schools, ensuring timely support to children and families.
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Affiliation(s)
- Chiara Barbiero
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marcella Montico
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Isabella Lonciari
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Roberta Penge
- Child Neuropsychiatry Department, UOC NPI B La Sapienza University, Rome, Italy
| | - Claudio Vio
- Child Neuropsychiatry Unit, Hospital of San Donà di Piave, San Donà di Piave, Italy
| | | | - Marco Carrozzi
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Anna De Petris
- Department of otolaryngology and Head and Neck Surgery, “Santo Spirito” Hospital, Pescara, Italy
| | | | | | - Giovanna Tinarelli
- Centro di neuropsicologia clinica dell'età evolutiva Giorgio Sabbadini, Perugia, Italy
| | | | | | - Carmen Belacchi
- Department of Communication Sciences, Humanities and International Studies, University of Urbino “Carlo Bo”, Urbino, Italy
| | - Renzo Tucci
- Studio di Psicologia e Logopedia, Verona, Italy
| | - Maria Musinu
- Associazione Italiana per la Ricerca e l'Intervento nella Psicopatologia dell'Apprendimento (AIRIPA), Padua, Italy
| | | | | | | | | | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
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Zoia S, Biancotto M, Guicciardi M, Lecis R, Lucidi F, Pelamatti GM, Carrozzi M, Skabar A, Sugden DA, Barnett AL, Henderson SE. An evaluation of the Movement ABC-2 Test for use in Italy: A comparison of data from Italy and the UK. Res Dev Disabil 2019; 84:43-56. [PMID: 29716782 DOI: 10.1016/j.ridd.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The standardized test within the Movement Assessment Battery for Children-2nd edition (MABC-2) is used worldwide to assess motor problems in children. Ideally, any country using a test developed in another country should produce national norms to ensure that it functions effectively in the new context. AIM The first objective of this study was to explore the differences in motor performance between Italian and British children. The second was to examine the structural validity of the test for the Italian sample. METHOD A total of 718 Italian (IT) and 765 British (UK) children, aged 3-10 years, were individually tested on the age-appropriate items of the MABC-2 Test. RESULTS Developmental trends emerged on every task and differences between IT and UK children were obtained on 11 of 27 task comparisons. Interactions between age and country indicated that differences were not consistently in favor of one culture. Confirmatory factor analysis generally supported the proposed structure of the MABC-2 Test. CONCLUSION Although the differences between the IT and the UK children were relatively few, those that did emerge emphasize the need for population specific norms and suggest that cultural diversity in motor experiences should be considered when evaluating motor abilities in children.
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Affiliation(s)
- Stefania Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
| | | | | | | | | | | | - Marco Carrozzi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Aldo Skabar
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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De Dea F, Zanus C, Carrozzi M, Stecca M, Accardo A. Characteristics of EEG power spectrum during sleep spindle events in ADHD children. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1456-1459. [PMID: 30440667 DOI: 10.1109/embc.2018.8512486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder that interferes with the typical development and both learning and motor functioning in a child's life. Most of the children with ADHD present also sleep problems like difficulties in falling asleep and maintaining sleep. Sleep spindles are characteristic waves of sleep stage 2 in humans and are characterized by a fusiform morphology. In the last years, the empirical evidence indicates that spindles are associated with cognitive faculties and intelligence as well as with several disease states. On the other hand, power spectral analysis of EEG represents a powerful noninvasive tool for examining cerebral behavior. The aim of this study is to evaluate the differences between ADHD and healthy children of the power spectral values in delta, theta, alpha, beta and gamma bands, before, during and after sleep spindles. Our results show significant differences concentrated in the period immediately after spindle epochs, in the left hemisphere of the brain, in almost all bands, with greater values in control than in ADHD children.
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20
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Maggio MC, Mastrangelo G, Skabar A, Ventura A, Carrozzi M, Santangelo G, Vanadia F, Corsello G, Cimaz R. Atypical presentation of anti-N-methyl-D-aspartate receptor encephalitis: two case reports. J Med Case Rep 2017; 11:225. [PMID: 28810906 PMCID: PMC5558759 DOI: 10.1186/s13256-017-1388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/13/2017] [Indexed: 02/06/2023] Open
Abstract
Background Anti-N-methyl-D-aspartate receptor encephalitis is a rare autoimmune disease characterized by severe neurological and psychiatric symptoms and a difficult diagnosis. The disease is often secondary to a neoplastic lesion, seldom diagnosed years later. Psychiatric symptoms are prevalent in adults; neurologic symptoms are more evident in children, who typically present primarily with neurological symptoms. To the best of our knowledge, the association with juvenile idiopathic arthritis has not been described. Case presentation We report the cases of two caucasian girls with an atypical presentation. The first patient was an 8-year-old girl with normal psychomotor development. Over a 4-month period she developed behavioral problems, speech impairment, and deterioration in academic skills. Within 8 months from the onset of symptoms, choreic movements gradually appeared. Hematological, neuroradiological, and neurophysiological examinations were negative; however, her symptoms worsened and treatment with prednisone was started. Although her choreic movements improved within 1 month, her neuropsychological and behavioral symptoms continued. Anti-N-methyl-D-aspartate receptor antibodies in cerebrospinal fluid and in blood were detected. Therapy with intravenously administered immunoglobulins was administered, without improvement of symptoms. After 2 months of steroid treatment, she suddenly started to pronounce some words with a progressive improvement in language and behavior. The second patient was a 14-year-old girl with classic anti-N-methyl-D-aspartate receptor encephalitis, treated successfully with intravenously administered immunoglobulins and methylprednisolone, followed by orally administered prednisone, who developed chronic arthritis of the hip. The arthritis was confirmed by magnetic resonance imaging and associated to antinuclear antigen antibody positivity. One year after the encephalitis presentation, an ovarian cystic mass was identified as a teratoma. The surgical resection of the mass was followed by the resolution of the psychotic spectrum and arthritis. Conclusions Anti-N-methyl-D-aspartate receptor encephalitis in pediatric patients can present initially with neuropsychological and behavioral symptoms. In the literature, the association of anti-N-methyl-D-aspartate receptor encephalitis with juvenile idiopathic arthritis is not yet described: to the best of our knowledge, this is the first case reported. The link to a neoplastic lesion can explain the favorable course of encephalitis and arthritis, after the surgical resection of the mass. Early diagnosis and treatment can improve the patient’s outcome.
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Affiliation(s)
- Maria Cristina Maggio
- Department Pro.Sa:M.I. "G. D'Alessandro" ARNAS, University of Palermo, Palermo, Italy.
| | - Greta Mastrangelo
- Department of Rheumatology, Meyer Children's Hospital, Florence, Italy
| | - Aldo Skabar
- Department of Advanced Diagnostic and Clinical Trials, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Ventura
- Department of Advanced Diagnostic and Clinical Trials, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Department of Advanced Diagnostic and Clinical Trials, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppe Santangelo
- Unit of Paediatric Neuropsychiatry, Children Hospital "G. Di Cristina", ARNAS, Palermo, Italy
| | - Francesca Vanadia
- Unit of Paediatric Neuropsychiatry, Children Hospital "G. Di Cristina", ARNAS, Palermo, Italy
| | - Giovanni Corsello
- Department Pro.Sa:M.I. "G. D'Alessandro" ARNAS, University of Palermo, Palermo, Italy
| | - Rolando Cimaz
- Department of Rheumatology, Meyer Children's Hospital, Florence, Italy
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Zanus C, Battistutta S, Aliverti R, Montico M, Cremaschi S, Ronfani L, Monasta L, Carrozzi M. Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors. PLoS One 2017; 12:e0170979. [PMID: 28125701 PMCID: PMC5268645 DOI: 10.1371/journal.pone.0170979] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/04/2016] [Accepted: 01/13/2017] [Indexed: 12/23/2022] Open
Abstract
The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.
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Affiliation(s)
- Caterina Zanus
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Sara Battistutta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Renata Aliverti
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Silvana Cremaschi
- Child and Adolescent Neuropsychiatry Service, ASS4 Medio Friuli, Udine, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
| | - Marco Carrozzi
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
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22
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Abate MV, Stocco G, Devescovi R, Carrozzi M, Pierobon C, Valencic E, Lucafò M, Di Silvestre A, D'Adamo P, Tommasini A, Decorti G, Ventura A. Carbamazepine-induced thrombocytopenic purpura in a child: Insights from a genomic analysis. Blood Cells Mol Dis 2016; 59:97-9. [PMID: 27282575 DOI: 10.1016/j.bcmd.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Maria Valentina Abate
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Raffaella Devescovi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Chiara Pierobon
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Erica Valencic
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marianna Lucafò
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessia Di Silvestre
- Graduate School in Reproduction and Developmental Sciences, University of Trieste, Trieste, Italy
| | - Pio D'Adamo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Tommasini
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Giuliana Decorti
- Department of Life Sciences, University of Trieste, Trieste, Italy.
| | - Alessandro Ventura
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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23
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Devescovi R, Monasta L, Mancini A, Bin M, Vellante V, Carrozzi M, Colombi C. Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service. Neuropsychiatr Dis Treat 2016; 12:1379-84. [PMID: 27366069 PMCID: PMC4913966 DOI: 10.2147/ndt.s106850] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System. METHODS Twenty-one toddlers at risk for autism spectrum disorders, aged 20-36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents' and teachers' active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months). RESULTS Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment. CONCLUSION Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alice Mancini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maura Bin
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valerio Vellante
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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24
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Parisi P, Verrotti A, Costa P, Striano P, Zanus C, Carrozzi M, Raucci U, Villa MP, Belcastro V. Diagnostic criteria currently proposed for "ictal epileptic headache": Perspectives on strengths, weaknesses and pitfalls. Seizure 2015; 31:56-63. [PMID: 26362378 DOI: 10.1016/j.seizure.2015.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 05/16/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE When we published the diagnostic criteria for "ictal epileptic headache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity. METHODS Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria. CONCLUSIONS EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epileptic patient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.
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Affiliation(s)
- Pasquale Parisi
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | | | - Paola Costa
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy
| | - Caterina Zanus
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Umberto Raucci
- Emergency Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Maria Pia Villa
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Vincenzo Belcastro
- Neurology Clinic, Department of Neuroscience, Sant'Anna Hospital, Como, Italy
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Alberini E, Vellante V, Zennaro F, Calligaris L, Barbi E, Carrozzi M, Devescovi R. Acute pseudotumoral hemicerebellitis in a child: a rare and distinct entity? J Child Neurol 2015; 30:496-9. [PMID: 25143480 DOI: 10.1177/0883073814545114] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
Abstract
A pseudotumoral presentation of acute hemicerebellitis is rare in pediatric age. The authors report a new single case study of a 7-year-old child with pseudotumoral unilateral cerebellitis mimicking an intracranial tumor, which clinically presented itself with signs of intracranial hypertension and mild contralateral hemiparesis, completely recovered after anti-inflammatory therapy. Brain magnetic resonance imaging (MRI) was essential for the differential diagnosis between inflammatory and neoplastic processes. The literature highlighting specific clues about pseudotumoral hemicerebellitis as a distinct clinical and radiological entity is reviewed.
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Affiliation(s)
- Elena Alberini
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Valerio Vellante
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Floriana Zennaro
- Division of Radiology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Lorenzo Calligaris
- Pediatric Emergency Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
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26
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Barone R, Carrozzi M, Parini R, Battini R, Martinelli D, Elia M, Spada M, Lilliu F, Ciana G, Burlina A, Leuzzi V, Leoni M, Sturiale L, Matthijs G, Jaeken J, Di Rocco M, Garozzo D, Fiumara A. A nationwide survey of PMM2-CDG in Italy: high frequency of a mild neurological variant associated with the L32R mutation. J Neurol 2014; 262:154-64. [DOI: 10.1007/s00415-014-7549-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 12/25/2022]
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Valent F, Mariuz M, Bin M, Little D, Mazej D, Tognin V, Tratnik J, McAfee AJ, Mulhern MS, Parpinel M, Carrozzi M, Horvat M, Tamburlini G, Barbone F. Associations of prenatal mercury exposure from maternal fish consumption and polyunsaturated fatty acids with child neurodevelopment: a prospective cohort study in Italy. J Epidemiol 2013; 23:360-70. [PMID: 23933621 PMCID: PMC3775530 DOI: 10.2188/jea.je20120168] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 05/05/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mercury is a neurotoxin, and limited prenatal exposure to it can affect long-term child neurodevelopment. However, results of epidemiologic studies of such exposure have been inconsistent. We examined the association of prenatal mercury exposure from maternal fish consumption with child neurodevelopment in northern Italy. METHODS A population-based cohort of 606 children and their mothers was studied from pregnancy to age 18 months. Mercury levels were measured in maternal hair and blood during pregnancy and in umbilical cord blood and breast milk. Levels of polyunsaturated fatty acids (PUFAs) were measured in maternal serum. Maternal and child intakes of fish were assessed by using a food frequency questionnaire. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was used to evaluate child neurodevelopment. Multivariate linear regression was used to examine the association of mercury exposure with BSID-III scores, after controlling for maternal fish intake, PUFAs during pregnancy, and several other confounders. RESULTS Mean weekly fish intake during pregnancy was less than 2 servings. Mercury concentrations in biological samples were low (mean, 1061 ng/g in hair) and moderately correlated with fish intake, particularly of carnivorous species. Maternal ω-3 PUFA concentrations were poorly correlated with fish intake. Maternal intelligence quotient (IQ) and child intake of fish were significantly associated with neurodevelopment scores. In multivariate models, the level of Hg exposure was not associated with neurodevelopmental performance at 18 months. CONCLUSIONS In this Italian population, neurodevelopment at 18 months was associated with child intake of fresh fish and maternal IQ rather than with mercury exposure. The expected beneficial effect of maternal fish intake (from maternal ω-3 PUFAs) was not found.
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Affiliation(s)
- Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.
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Bortot B, Cosentini D, Faletra F, Biffi S, De Martino E, Carrozzi M, Severini GM. PMM2-CDG: phenotype and genotype in four affected family members. Gene 2013; 531:506-9. [PMID: 23988505 DOI: 10.1016/j.gene.2013.07.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/12/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
Congenital disorders of glycosylation (CDG) are genetic defects in protein and lipid glycosylation. PMM2-CDG is the most prevalent protein N-glycosylation disorder with more than 700 reported patients. Here we report on a large Italian family with four affected members and three mutations. Two young sisters are compound heterozygous for mutations p.Leu32Arg and p.Arg141His, while two paternal great-aunts are compound heterozygosity for p.Leu32Arg and p.Thr237Met. The latter association has not been reported before. The most severely affected member had in addition an ALG6 mutation known to exacerbate the phenotype of patients with PMM2-CDG.
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Affiliation(s)
- Barbara Bortot
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137 Trieste, Italy
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Deroma L, Bin M, Tognin V, Rosolen V, Valent F, Barbone F, Carrozzi M. [Interrater reliability of the Bayley III test in the Italian Northern-Adriatic Cohort II]. Epidemiol Prev 2013; 37:297-302. [PMID: 24293495] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE to assess the agreement between two trained psychologists who administered the Bayley Scale of Infant Development III (BSID III) to detect neurodevelopment deficits in a cohort of children within the Northern Adriatic Cohort II (NAC II) longitudinal study, which aims to assess the impact of mercury exposure through food consumption of mothers in pregnancy on their children's neurodevelopment. DESIGN a reliability study was carried out. Two trained psychologists administered the test, each one scoring the test independently, and serving as the primary examiner for half of the sample and as the observer for the other half. SETTING AND PARTICIPANTS a sample of 53 children of 18 months of age was enrolled consecutively within the Italian NAC II, and tested using the Bayley Scale of Infant Development III (BSID III) to detect neurodevelopment deficits. MAIN OUTCOME MEASURES the cognitive, language, and motor scales of the BSID III were evaluated and the respective Intraclass Correlation Coefficients (ICC) were calculated. RESULTS overall, the ICCs for the cognitive and language scales were very high (≥0.98), while the ICCs for the motor scales were slightly lower, ranging from 0.86 (gross motor, scaled) to 0.97 (fine motor, scaled), but still higher than 0.80, reported as the general acceptable benchmark for psychological testing. CONCLUSION the interrater reliability of all BSID III scales for this sample of 18-month-old children is very high and assures comparable results between the two psychologists involved in the Italian NAC II study. The reasons are a common training, the joint evaluation of many children during the preliminary phase of the study, the discussion of inconsistent results, but also the "go no-go" nature of the items in BSID III.
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Affiliation(s)
- Laura Deroma
- Istituto di igiene ed epidemiologia clinica, Azienda ospedaliero universitaria di Udine
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Barbiero C, Lonciari I, Montico M, Monasta L, Penge R, Vio C, Tressoldi PE, Ferluga V, Bigoni A, Tullio A, Carrozzi M, Ronfani L. The submerged dyslexia iceberg: how many school children are not diagnosed? Results from an Italian study. PLoS One 2012; 7:e48082. [PMID: 23118930 PMCID: PMC3485303 DOI: 10.1371/journal.pone.0048082] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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: 06/15/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although dyslexia is one of the most common neurobehavioral disorders affecting children, prevalence is uncertain and available data are scanty and dated. The objective of this study is to evaluate the prevalence of dyslexia in an unselected school population using clearly defined and rigorous diagnostic criteria and methods. METHODS Cross sectional study. We selected a random cluster sample of 94 fourth grade elementary school classes of Friuli Venezia Giulia, a Region of North Eastern Italy. We carried out three consecutive levels of screening: the first two at school and the last at the Neuropsychiatry Unit of a third level Mother and Child Hospital. The main outcome measure was the prevalence of dyslexia, defined as the number of children positive to the third level of screening divided by the total number of children enrolled. RESULTS We recruited 1774 children aged 8-10 years, of which 1528 received parents' consent to participate. After applying exclusion criteria, 1357 pupils constituted the final working sample. The prevalence of dyslexia in the enrolled population ranged from 3.1% (95% CI 2.2-4.1%) to 3.2% (95% CI 2.4-4.3%) depending on different criteria adopted. In two out of three children with dyslexia the disorder had not been previously diagnosed. CONCLUSIONS This study shows that dyslexia is largely underestimated in Italy and underlines the need for reliable information on prevalence, in order to better allocate resources both to Health Services and Schools.
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Affiliation(s)
- Chiara Barbiero
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Isabella Lonciari
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marcella Montico
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Roberta Penge
- Child Neuropsychiatry Department, UOC NPI B La Sapienza University, Rome, Italy
| | - Claudio Vio
- Child Neuropsychiatry Unit, Hospital of San Donà di Piave, San Donà di Piave, Italy
| | | | - Valentina Ferluga
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Anna Bigoni
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Alessia Tullio
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marco Carrozzi
- Child Neurology and Psychiatry Ward, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Luca Ronfani
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
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Zorzi M, Barbiero C, Facoetti A, Lonciari I, Carrozzi M, Montico M, Bravar L, George F, Pech-Georgel C, Ziegler JC. Extra-large letter spacing improves reading in dyslexia. Proc Natl Acad Sci U S A 2012; 109:11455-9. [PMID: 22665803 PMCID: PMC3396504 DOI: 10.1073/pnas.1205566109] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [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] [Indexed: 11/18/2022] Open
Abstract
Although the causes of dyslexia are still debated, all researchers agree that the main challenge is to find ways that allow a child with dyslexia to read more words in less time, because reading more is undisputedly the most efficient intervention for dyslexia. Sophisticated training programs exist, but they typically target the component skills of reading, such as phonological awareness. After the component skills have improved, the main challenge remains (that is, reading deficits must be treated by reading more--a vicious circle for a dyslexic child). Here, we show that a simple manipulation of letter spacing substantially improved text reading performance on the fly (without any training) in a large, unselected sample of Italian and French dyslexic children. Extra-large letter spacing helps reading, because dyslexics are abnormally affected by crowding, a perceptual phenomenon with detrimental effects on letter recognition that is modulated by the spacing between letters. Extra-large letter spacing may help to break the vicious circle by rendering the reading material more easily accessible.
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Affiliation(s)
- Marco Zorzi
- Department of General Psychology and Center for Cognitive Science, University of Padova, 35131 Padua, Italy.
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Faletra F, D'Adamo AP, Santa Rocca M, Carrozzi M, Perrone MD, Pecile V, Gasparini P. Does the 1.5 Mb microduplication in chromosome band Xp22.31 have a pathogenetic role? New contribution and a review of the literature. Am J Med Genet A 2011; 158A:461-4. [PMID: 22140086 DOI: 10.1002/ajmg.a.34398] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 10/31/2011] [Indexed: 02/05/2023]
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Biancotto M, Skabar A, Bulgheroni M, Carrozzi M, Zoia S. Neuromotor deficits in developmental coordination disorder: evidence from a reach-to-grasp task. Res Dev Disabil 2011; 32:1293-1300. [PMID: 21377830 DOI: 10.1016/j.ridd.2011.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 01/27/2011] [Accepted: 02/05/2011] [Indexed: 05/30/2023]
Abstract
Developmental coordination disorder (DCD) has been classified as a specific learning disability, nonetheless the underlying cognitive mechanisms are still a matter of discussion. After a summary of the main hypotheses on the principal neuromotor causes of DCD, this study applies a causal model framework to describe the possible coexistence of more than one deficit in this disorder. For this purpose, kinematic analysis was applied to an ecological task, the reach-to-grasp action, introducing the manipulation of three variables: vision, distance and object size. After a thorough neurological and neuropsychological evaluation, 9 children with DCD (7-9 years old) were selected and compared to 27 age-matched control children. The results suggest that children with DCD have a normal neurological characterization of the reaching and grasping movements, in terms of proximal to distal action, but their grasping aperture (MGA) was always wider with respect to controls, particularly when vision was not allowed. In addition, the performance of children with DCD was always slower, more dependent on vision and more variable than that of controls. The MGA of children with DCD could be explained by a deficit in the internal construction of movement for a forward model, while slowness could be related to a control problem in the neuronal firing of the muscles. The idea of a possible coexistence of these two deficits is discussed in accordance to a causal model framework and also addressed considering recent neurophysiologic evidences.
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Affiliation(s)
- Marina Biancotto
- Child Neurology and Psychiatry Unit, Institute for Maternal and Child Health, I.R.C.C.S. Burlo Garofolo, via Dell'Istria 65/1, Trieste 34127, Italy
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Abstract
Tolosa-Hunt syndrome (THS) is characterized by unilateral painful ophthalmoplegia with oculomotor paresis, associated with an idiopathic granulomatous inflammation involving the cavernous sinus, with a typical relapsing-remitting course. We report a case of an 8-year-old girl who was admitted because of an ophthalmoplegia with exotropia and ptosis of the left eyelid, accompanied by diplopia and left sovraorbital pain. The clinical data, neuroradiological findings and response to steroid treatment suggested THS, as defined by the 2004 International Classification of Headache Disorders (ICHD)-II criteria. THS must be considered a possible cause of painful ophthalmoplegia in childhood, as well as in adults, and confirmed with a focused neuroradiological investigation. The few paediatric cases described in the literature that meet the 2004 ICHD-II criteria are not sufficient to identify possible differences between the paediatric and the adult forms. Every new paediatric case should therefore be reported in order to gather and compare further information.
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Affiliation(s)
- C Zanus
- Child Neurology and Psychiatry Ward, Department of Paediatrics, Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’ Trieste
| | - C Furlan
- Radiologia, Ospedale Maggiore, Azienda Ospedaliera e Ospedali Riuniti Trieste, Trieste, Italy
| | - P Costa
- Child Neurology and Psychiatry Ward, Department of Paediatrics, Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’ Trieste
| | - D Cosentini
- Child Neurology and Psychiatry Ward, Department of Paediatrics, Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’ Trieste
| | - M Carrozzi
- Child Neurology and Psychiatry Ward, Department of Paediatrics, Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’ Trieste
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Benussi DG, Costa P, Zollino M, Murdolo M, Petix V, Carrozzi M, Pecile V. Trisomy 12p and monosomy 4p: phenotype-genotype correlation. Genet Test Mol Biomarkers 2009; 13:199-204. [PMID: 19378504 DOI: 10.1089/gtmb.2008.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
4p Monosomy and 12p trisomy have been discussed and redefined along with recently reviewed chromosomal syndromes. 12p Trisomy syndrome is characterized by normal or increased birth weight, developmental delay with early hypotonia, psychomotor delay, and typical facial appearance. Most likely, the observed phenotypic variability depends on the type and extent of the associated partial monosomy. Partial deletions of the short arm of one chromosome 4 cause the Wolf-Hirschhorn syndrome (WHS). Affected patients present Greek helmet face, growth and mental retardation, hypotonia, and seizures. The combination of these characteristics constitutes the phenotypic core of WHS. We present a clinical and molecular cytogenetic characterization of a 4-year old mentally retarded girl with macrosomy, facial dysmorphisms, and epilepsy, in whom an unbalanced t(4;12)(p16.3;p13.3) translocation was detected, giving rise to partial 4p monosomy and partial 12p trisomy. Because the patient shows most of the phenotypic characteristics of 12p trisomy, this case could contribute to a better definition of the duplicate critical region that determines the phenotype of the 12p trisomy syndrome.
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Bortot B, Barbi E, Biffi S, Lunazzi G, Bussani R, Burlina A, Norbedo S, Ventura A, Carrozzi M, Severini GM. Two novel POLG mutations causing hepatic mitochondrial DNA depletion with recurrent hypoketotic hypoglycaemia and fatal liver dysfunction. Dig Liver Dis 2009; 41:494-9. [PMID: 19195941 DOI: 10.1016/j.dld.2008.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/29/2008] [Accepted: 11/13/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inherited mtDNA depletion syndromes (MDS) are a group of severe mitochondrial disorders resulting from defects in nucleus-encoded factors and often associated with severe or fatal liver failure. PATIENT In this article, we describe the case of an 18-month-old patient with recurrent hypoketotic hypoglycaemia and fatal hepatic dysfunction with liver mtDNA depletion. METHODS The assessment of mtDNA copy number was performed on leucocytes, liver and muscle biopsy by Quantitative Real Time PCR and total RNA from liver biopsy was used as a template to amplify the cDNA of the POLG1 gene. RESULTS Sequence analysis identified two previously undescribed mutations (1868T>G and 2263A>G) located in the gene coding the catalytic subunit of mitochondrial DNA polymerase gamma (POLG), predicting an L623W and K755E amino acid change, respectively. Both mutations were located in the highly conserved linker region of the protein and were absent in more than 200 healthy unrelated control subjects. The identification of these two mutations allowed us to perform genetic counselling and prenatal diagnosis. CONCLUSION Our data further expand the spectrum of POLG1 gene mutations and the unique phenotype reported (late onset isolated liver disease without lactic acidosis) increase the variability of clinical presentations associated with mutations in this gene.
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Affiliation(s)
- B Bortot
- Children's Neurology and Psychiatry Unit, Institute of Child Health IRCCS, Burlo Garofolo, Via dell'Istria, Trieste, Italy
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Bortot B, Barbi E, Biffi S, Angelini C, Faleschini E, Severini G, Carrozzi M. Two novel cosegregating mutations in tRNAMet and COX III, in a patient with exercise intolerance and autoimmune polyendocrinopathy. Mitochondrion 2009; 9:123-9. [DOI: 10.1016/j.mito.2009.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 11/27/2008] [Accepted: 01/12/2009] [Indexed: 01/25/2023]
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Lenzini E, Ballarati L, Drigo P, Carrozzi M, Gambel-Benussi D, Giardino D, Petix V, Rizzotto MR, Pecile V. 1q44-qter trisomy: clinical report and review of the literature. Genet Test Mol Biomarkers 2009; 13:79-86. [PMID: 19309278 DOI: 10.1089/gtmb.2008.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Subtelomeric rearrangements are one of the main causes of multiple congenital anomalies and mental retardation, and they are detected in 5% of patients. We report on a 6.5-year-old boy with mental retardation, dysmorphic features, and behavioral problems, who revealed 1q44-qter trisomy and 22q13.3-qter monosomy due to a maternal cryptic translocation t(1;22). We compared the clinical and cytogenetic data of our patient with those of another case presenting a pure 22qter monosomy and with those of all 1qter trisomy cases reported in the international literature. To the best of our knowledge, the subterminal 1q trisomy found in the present case has been reported in only 12 patients to date (including five familial cases). This report aims to contribute to our understanding of 1q44-qter trisomy.
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Affiliation(s)
- Elisabetta Lenzini
- Molecular Cytogenetic Laboratory, Pediatrics Department, University of Padua, Padova, Italy.
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Calligaris L, Stocco G, De Iudicibus S, Marino S, Decorti G, Barbi E, Carrozzi M, Marchetti F, Bartoli F, Ventura A. Carbamazepine hypersensitivity syndrome triggered by a human herpes virus reactivation in a genetically predisposed patient. Int Arch Allergy Immunol 2009; 149:173-7. [PMID: 19127076 DOI: 10.1159/000189202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 09/30/2008] [Indexed: 11/19/2022] Open
Abstract
A case of severe hypersensitivity syndrome, triggered by carbamazepine in the presence of a concomitant active human herpes virus (HHV) 6 and 7 infection is described. To further understand the molecular mechanism of this adverse reaction, analyses of the genetic variants of human leukocyte antigen (HLA) and of the epoxide hydrolase gene (EPHX1), previously associated with carbamazepine hypersensitivity, were performed. A lymphocyte transformation test (LTT) was conducted in order to detect drug-specific lymphocytes. In the hypersensitive patient, 2 genetic factors previously associated with intolerance to carbamazepine were detected: the allele HLA-A*3101 and homozygosity for the variant allele of SNP rs1051740 in EPHX1. Drug-specific lymphocytes could be detected by LTT when the HHV was active (positive PCR for viral DNA and increased anti-HHV 6 IgG titer), but not when it was no longer active. In conclusion, we document a case of severe carbamazepine hypersensitivity triggered by viral reactivation in a patient presenting the interaction of 2 unfavorable genetic factors.
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Affiliation(s)
- Lorenzo Calligaris
- IRCCS Burlo Garofolo, Pediatric Clinic, University of Trieste, Trieste IT-34127, Italy
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Battistutta S, Aliverti R, Montico M, Zin R, Carrozzi M. Chronic tension-type headache in adolescents. Clinical and psychological characteristics analyzed through self- and parent-report questionnaires. J Pediatr Psychol 2008; 34:697-706. [PMID: 18927182 DOI: 10.1093/jpepsy/jsn102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyze the relation between the symptoms reported by adolescents with chronic tension-type headache (CTTH) and their perception of their emotional and behavioral functioning. METHODS Two groups of adolescents (clinical group, n = 48; control group, n = 135) and their parents (clinical group, n = 42; control group, n = 128) were studied, respectively, with the Youth Self-Report Questionnaire and the Child Behavior Checklist. Moreover, a secondary analysis was performed, identifying another subgroup of adolescents who reported having headaches. RESULTS The clinical group of adolescents obtained higher scores than the control group in Internalizing Syndrome; Aggressive Behavior for Externalizing Syndrome; Social, Thought, and Attention Problems; and in all Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)-oriented scales (except conduct problems). Differences between the two groups of parents were found in all the scales. The controls reporting headaches obtained interesting intermediate scores. CONCLUSIONS Adolescents with CTTH show greater emotional and behavioral problems than their healthy peers. Consequently, clinical approaches for proper diagnosis and treatment need to adopt a multidisciplinary prospective.
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Affiliation(s)
- Sara Battistutta
- Child Neurology and Psychiatry Ward, Department of Pediatric, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Biffi S, Tamaro G, Bortot B, Zamberlan S, Severini GM, Carrozzi M. Carbohydrate-deficient transferrin (CDT) as a biochemical tool for the screening of congenital disorders of glycosylation (CDGs). Clin Biochem 2007; 40:1431-4. [DOI: 10.1016/j.clinbiochem.2007.08.015] [Citation(s) in RCA: 17] [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: 04/04/2007] [Revised: 07/27/2007] [Accepted: 08/28/2007] [Indexed: 11/30/2022]
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Abstract
BACKGROUND In children affected by specific language impairment (SLI), many authors have investigated a link between language and epileptiform discharges during sleep resembling the focal sharp waves typical of benign epilepsy with centro-temporal spikes (BECTS), the so-called rolandic spikes. On the other hand, the same electroencephalographic trait occurs in more than 50% of children affected by learning or behavioural disabilities without seizures, supporting the hypothesis of a common genetic disposition. The biological background of Developmental Coordination Disorder (DCD) is currently unknown, but a genetic liability may be assumed. The aims of our study were first to estimate the prevalence of sleep-related epileptiform discharges in children affected by DCD and second to investigate the occurrence of DCD in a population of children affected by BECTS. METHODS We selected a group of eight children with severe DCD. In this group, the presence of epileptiform activity was investigated. We also searched for DCD among a group of 13 children affected by BECTS. RESULTS We found rolandic spikes in more than 70% of the children with severe DCD and severe DCD in more than 30% of the children with BECTS. CONCLUSIONS In children with severe DCD other disabilities are frequently associated. In these children, epileptiform activity during sleep is very frequently found and in our opinion, this represents a hallmark of 'Hereditary Impairment of Brain Maturation', a term only partially resembling 'Atypical Brain Development'.
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Affiliation(s)
- A Scabar
- Mother-and-Child Referral Hospital and Research Institute, Department of Infantile Neuropsychiatry, Trieste, Italy.
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Zoia S, Pezzetta E, Blason L, Scabar A, Carrozzi M, Bulgheroni M, Castiello U. A Comparison of the Reach-To-Grasp Movement Between Children and Adults: A Kinematic Study. Dev Neuropsychol 2006; 30:719-38. [PMID: 16995833 DOI: 10.1207/s15326942dn3002_4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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: 10/31/2022]
Abstract
In this study, the reach-to-grasp movement of 5-year-old children was compared to that of adults. Participants were required to reach out and grasp objects, with and without on-line visual feedback. Object size and distance were covaried in a within-subjects design and it was found that for both groups, grip formation and reach kinematics were affected by the manipulation of either variable. Although there are a large number of similarities, a few differences between the two groups emerge. For the reaching component, the children revealed a longer movement duration and deceleration time and a lower maximum height of wrist trajectory than in adults. For the grasp component, the children, in both the vision and no-vision condition, show a maximal finger aperture larger than the adults. Further, the children of this study were able to scale their grip aperture according to object size when visual feedback during the movement was lacking. These findings suggest that children adopt different strategies than adults when planning a reach-to-grasp movement on the basis of object size, distance, and the predictability of visual feedback. The results are discussed in terms of the neural mechanisms underlying hand action and how these mechanisms may not be fully developed by the age of 5.
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Affiliation(s)
- Stefania Zoia
- Child Neurology and Psychiatry Department, Institute of Child Health IRCCS Burlo Garofolo, via Dell'Istria 65/1, 34137 Trieste, Italy.
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Abstract
STUDY OBJECTIVES In this work, we studied the behavior of the fractal dimension during each of the neonatal electroencephalogram (EEG) sleep phases and during the awake state, comparing the results with those of the classical spectral parameters and with zero crossing values. DESIGN Fractal dimension, zero crossing, and spectral parameters of the EEG bands were determined for each 2-second frame of the EEG sleep-time series. Eight channels of each EEG recording were examined. PARTICIPANTS Twenty healthy full-term newborns (10 boys and 10 girls) with normal psychomotor development evaluated at 24 and 36 months of age, were chosen to participate in this study. MEASUREMENTS AND RESULTS Fractal analysis showed that where rhythmic and regular activity are present, as during quiet sleep, the fractal dimension is low and rises when bioelectric activity is more variable and complex, reaching its maximum value during wakefulness. The discriminative value of this parameter was similar to that of some spectral bands. CONCLUSIONS This work was an initial attempt to apply techniques derived from the nonlinear deterministic studies used to evaluate system complexity, to the neonatal EEG, in order to acquire a normative database that can be used as a reference in neurological pathologies. Fractal dimension alone or together with zero crossing and theta and delta bands could be used for computerized discrimination of neonatal EEG sleep phases.
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Affiliation(s)
- Marco Carrozzi
- UO di Neuropsichiatria Infantile, IRCSS Burlo Garofolo, Via dell'Istria 65/1, I34100 Trieste, Italy.
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Demori E, Devescovi R, Benussi DG, Dolce S, Carrozzi M, Villa N, Miertus J, Amoroso A, Pecile V. Supernumerary ring chromosome 8: Clinical and molecular cytogenetic characterization in a case report. ACTA ACUST UNITED AC 2004; 130A:288-94. [PMID: 15378554 DOI: 10.1002/ajmg.a.20677] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/07/2022]
Abstract
We report on a 3-year-old male with developmental delay, autistic behavior, and minor abnormalities consistent with trisomy 8 syndrome whose cytogenetic analysis revealed mosaicism for a supernumerary ring chromosome (SRC). Fluorescence in situ hybridization (FISH) studies, using centromeric and yeast artificial chromosome (YAC) probes, were performed to characterize further the supernumerary chromosome. The ring origin has been detected from the short arm of chromosome 8, resulting in r(8)(p10p23.1). Moreover, uniparental disomy (UPD) using microsatellite analysis was excluded. To our knowledge a total of 25 cases, confirmed by FISH, have been reported with either supernumerary marker or ring chromosome 8. We present a detailed clinical and molecular cytogenetic characterization of this additional case in order to better define the genotype-phenotype correlation.
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Affiliation(s)
- Eliana Demori
- Medical Genetics Service, Children Hospital I.R.C.C.S. "Burlo Garofolo," Trieste, Italy
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Bembi B, Zambito Marsala S, Sidransky E, Ciana G, Carrozzi M, Zorzon M, Martini C, Gioulis M, Pittis MG, Capus L. Gaucher's disease with Parkinson's disease: clinical and pathological aspects. Neurology 2003; 61:99-101. [PMID: 12847165 DOI: 10.1212/01.wnl.0000072482.70963.d7] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [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: 11/15/2022] Open
Abstract
The association between type 1 Gaucher disease and PD has been reported in the literature. The clinical picture is characterized by the predominance of bilateral akinetic-rigid signs and poor response to levodopa therapy. The authors describe four patients (two siblings) with type 1 Gaucher disease presenting with the following signs of typical PD: asymmetric onset of rigidity, resting tremor, bradykinesia, and a favorable response to Parkinson therapies.
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Affiliation(s)
- B Bembi
- Unità Operativa Dipartimentale di Malattie Metaboliche, I.R.C.C.S. Burlo Garofolo, Trieste, Italy.
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Di Rocco M, Barone R, Adami A, Burlina A, Carrozzi M, Dionisi-Vici C, Gatti R, Iannetti P, Parini R, Raucci U, Roccella M, Spada M, Fiumara A. Carbohydrate-deficient glycoprotein syndromes: the Italian experience. J Inherit Metab Dis 2000; 23:391-5. [PMID: 10896302 DOI: 10.1023/a:1005608019977] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M Di Rocco
- Institute of Pediatrics, Giannina Gaslini Institute, Genoa, Genova, Italy
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Accardo A, Affinito M, Carrozzi M, Bouquet F. Use of the fractal dimension for the analysis of electroencephalographic time series. Biol Cybern 1997; 77:339-350. [PMID: 9418215 DOI: 10.1007/s004220050394] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Electroencephalogram (EEG) traces corresponding to different physiopathological conditions can be characterized by their fractal dimension, which is a measure of the signal complexity. Generally this dimension is evaluated in the phase space by means of the attractor dimension or other correlated parameters. Nevertheless, to obtain reliable values, long duration intervals are needed and consequently only long-term events can be analysed; also much calculation time is required. To analyse events of brief duration in real-time mode and to apply the results obtained directly in the time domain, thus providing an easier interpretation of fractal dimension behaviour, in this work we optimize and propose a new method for evaluating the fractal dimension. Moreover, we study the robustness of this evaluation in the presence of white or line noises and compare the results with those obtained with conventional spectral methods. The non-linear analysis carried out allows us to investigate relevant EEG events shorter than those detectable by means of other linear and non-linear techniques, thus achieving a better temporal resolution. An interesting link between the spectral distribution and the fractal dimension value is also pointed out.
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Affiliation(s)
- A Accardo
- Dip. di Elettrotecnica, Elettronica e Informatica (DEEI), Università di Trieste, Italy.
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Abstract
Recurring episodes of stupor in adults have been shown to be related to increased levels of endozepines, which are endogenous ligands for the GABAA receptors. We report here two children presenting with recurrent episodes of stupor associated with fast EEG activity who had increased levels of endozepine-4 in plasma. Mass spectroscopy did not reveal commercially available benzodiazepines. Interictal endozepine-4 levels were normal. In one of the patients, administration of flumazenil (0.25 mg i.v.), a benzodiazepine inverse agonist, induced improvement of consciousness and attenuation of EEG fast activity. In conclusion, children presenting with recurrent episodes of stupor and EEG fast activity should be evaluated for endozepine levels and can be effectively treated with i.v. flumazenil.
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Affiliation(s)
- S Soriani
- Institute of Pediatrics, University of Ferrara, Italy
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Giacomello A, Peters GJ, Eriksson S, Abreu R, Kristensen T, Munch-Petersen B, Vincenzetti S, Cambi A, Neuhard J, Garattini E, Vita A, Oka J, Matsumoto A, Hosokawa Y, Inoue S, Allegrini S, Johnson RB, Fiol CJ, Eriksson S, Fabianowska-Majewska K, Wasiak T, Duley J, Simmonds A, Bretner M, Felczak K, Poznański J, Dzik JM, Golos B, Jarmuła A, Rode W, Kulikowski T, Codacci-Pisanelli G, Pinedo HM, Noordhuis P, Groeningen CJ, Wilt CL, Franchi F, Hatse S, Balzarini J, Clercq E, Marinello E, Rosi F, Dispensa E, Mangiavacchi P, Riario-Sforza G, Agostinho AB, Smolenski RT, Müller MM, Roch-Ramel F, Guisan B, Diezi J, Tavenier M, Skladanowski AC, Abreu RA, Jong JW, Åmellem Ø, Löffler M, Pettersen EO, Boulieu R, Lenoir A, Bertocchi M, Mornex JF, Makarewicz W, Spychala J, Mitchell BS, Barankiewcz J, Góra-Tybor J, Robak T, Spasokukotskaja T, Sasvári-Székely M, Piróth Z, Kazimierczuk Z, Staub M, Keuzenkamp-Jansen CW, Abreu RA, Bökkerink JPM, Trijbels JMF, Eriksson S, Warzocha K, Krykowski E, Góra-Tybor J, Fronczak A, Robak T, Minelli A, Moroni M, Monacelli N, Mezzasoma I, Amici A, Emanuelli M, Raffaelli N, Ruggieri S, Magni G, Carta MC, Mattana A, Poddie F, Sgarrella F, Tozzi MG, Veerman G, Ruiz van Haperen VWT, Moorsel CJA, Pesi R, Baiocchi C, Camici M, Ipata PL, Kozłowska M, Świerczyński J, Smoleński RT, Jastorff B, Messina E, Savini F, Procopio A, Giacomello A, Wielgus-Kutrowska B, Kulikowska E, Wierzchowski J, Bzowska A, Shugar D, Fairbanks LD, Ruckemann K, Simmonds HA, Kaletha K, Szymańska G, Thebault M, Raffin JP, Gal Y, Griesmacher A, Abreu RA, Zych M, Ruckemann K, Jagodzinski P, Kochan Z, Stolk J, Boerbooms A, Abreu R, Koning D, Putte L, Fiorini M, Bazzichi L, Bertolini G, Martini C, Ciompi ML, Lucacchini A, Pizzichini M, Terzuoli L, Arezzini L, Fe L, Pagani R, Miscetti P, Allegrucci C, Sebesta I, Duley JA, Simmonds HA, Gross M, Salerno C, Stone TW, Berghe G, Valik D, Jones JD, Guerranti R, Fè L, Sforza GR, Knecht W, Grein K, Lodi R, Iotti S, Barbiroli B, Bonin B, Chantin C, Bory C, Micheli V, Jacomelli G, Morozzi G, Fioravanti A, Marcolongo R, Pompucci G, Peters GJ, Noordhuis P, Komissarov A, Holwerda U, Kok RM, Laar JAM, Wilt CL, Groeningen CJ, Pinedo HM, Perrett D, Jacobsson B, Sisto A, Iezzi A, Carlo M, Pizzigallo E, Akhondzadeh S, MacGregor DG, Ogilvy HV, Zoref-Shani E, Brosh S, Sidi Y, Bromberg Y, Sperling O, Gennip AH, Abeling NGGM, Stroomer AEM, Lenthe H, Bakker HD, Kuilenburg ABP, Connolly GP, Abbott NJ, Lilling G, Gozes I, Vreken P, Meinsma R, Ahreu RA, Diasio RB, Albin N, Johnson MR, Shahinian H, Wang K, Gathof BS, Rocchigiani M, Puig JG, Mateos F, Sestini S, Krijt J, Shin Y, Gresser U, Costa A, Maximova N, Andolina M, Paci M, Carrozzi M, Osbich A, Durighello M, Cavalli F, Geatti O, Zammarchi E, Morgan G, Webster ADB, Slavin S, Naparstek E, Nagler A, Acker M, Cividalli G, Kapellushnik Y, Varadi G, Ben-Yoseph R, Or R, Parfenov VV, Ignatenko MA, Amchenkova AM, Narovlyansky AN, Spoto G, Mastropasqua L, Gizzi F, Arduini A, Gallo P, Ciancaglini M, Gallenga PE, Šebesta I, Zeman J, Crifò C, Vito M, Lomonte A, Gerber G, Carlucci F, Tabucchi A, Vannoni P, Pietro MC, Vincent MF, Bontemps F, Boer P, Rötzer E, Ehrmann D, Empl W, Bride MBM, Ogg CS, Cameron JS, Moro F, Rigden S, Rees L, Hoff WV, Raman V, Palmieri P, Mastropierro G, Albertazzi A, Rucci C, Darlington LG, Cotton SR, Gorter JJ, Lawrence ES, Petrie A, Sarsam RP, Semple MJ, Warburton EA, Quaratino CP, Talone L, Sciascio N, Hrebíček MH, Poupětová H, Ledvinová J, Elleder M, Vondrák K, Rees PC, Wonke B, Thein SL, Clegg JB, Marlewski M, Pennelli A, Marzio M, Angelini G, Sabatino G, Koning P, Kerstens P, Graaf R, Hayek G, Cardona F. Preface. Pharm World Sci 1995; 17:K4-K4. [DOI: 10.1007/bf01875184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
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