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Gorgone G, Plastino M, Vaccaro A, Fava A, Bosco D. Colchicine may Induce Isolated and Reversible Oculomotor Neuropathy. Curr Rev Clin Exp Pharmacol 2021:CRCEP-EPUB-117596. [PMID: 34468304 DOI: 10.2174/2772432816666210901105513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Colchicine is a medication described by a complex constellation of side effects. CASE PRESENTATION We report the case of an 80s- 80-year-old subject, treated with colchicine, who developed a left monolateral ptosis with horizontal diplopia after treatment with oral colchicine. Two months later, he underwent a clinical follow-up and complete recovery of the previous third cranial nerve deficit was reported at neurological examination. A few months later, colchicine therapy was reported with a reappearance of the same ocular deficit. CONCLUSION Our report suggests that patients receiving colchicine should be followed prudently and, a possible iatrogenic origin of an isolated ocular cranial neuropathy must be taken into account, especially when other potential etiological entities are excluded by the instrumental and laboratory clinical investigations.
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Affiliation(s)
- Gaetano Gorgone
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, 88900 - Crotone, Italy
| | | | - Antonio Vaccaro
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, 88900 - Crotone, Italy
| | - Antonietta Fava
- Department of Neuroscience, "Pugliese Ciaccio" Hospital, 88100 - Catanzaro, Italy
| | - Domenico Bosco
- Department of Neuroscience, "Pugliese Ciaccio" Hospital, 88100 - Catanzaro, Italy
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Plastino M, Gorgone G, Fava A, Ettore M, Iannacchero R, Scarfone R, Vaccaro A, De Bartolo M, Bosco D. Effects of safinamide on REM sleep behavior disorder in Parkinson disease: A randomized, longitudinal, cross-over pilot study. J Clin Neurosci 2021; 91:306-312. [PMID: 34373044 DOI: 10.1016/j.jocn.2021.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Rapid Eye Movement sleep behavior disorder (RBD) is characterized by dream enactment and loss of muscle atonia during REM-sleep. RBD as a premotor feature occurred souvent in patients who develop Parkinson's disease. The glutamatergic, glycinergic, and GABA-ergic systems appear to play a crucial role in the pathogenesis of RBD. METHODS The present exploratory longitudinal cross-over study aimed to observe the effect of safinamide on RBD symptoms. Thirty patients with PD and RBD were randomized into two groups (15 subjects each), those that received for a period of 3-months safinamide (50 mg/die) in addition (Group A + ) or in absence (Group B - ) to the usual antiparkinsonian therapy. Patients exploring the clinical and video-polysomnographic changes occurred during this pharmacological therapy. RESULTS Twenty-two of 30 patients reported clear improvement in symptoms during safinamide treatment, and 16 were absolutely free from clinical RBD-symptoms at the end of the treatment. Eight patients reported slight improvement in RBD-symptoms. In 6/30 patients no substantial improvement was recorded about clinical RBD-symptoms had frightening dreams or from the bed after 1-week of treatment. In addition, after safinamide, the mean UPDRS-II and III scores decreased, while PDSS-2 score indicating an improvement in both motor symptoms and nocturnal sleep features. A significant reduction of sleep behavior disorder by questionnaire-Hong Kong-score (RBDQ-HS), mainly for two individual RBDQ-HK-items (dream related movements and failing out of bed) was registered. CONCLUSIONS This pilot study indicated that safinamide is well tolerated and improves RBD-symptom in parkinsonian.
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Affiliation(s)
- Massimiliano Plastino
- Department of Neuroscience, "Pugliese-Ciaccio" Hospital Organization, 88100 Catanzaro, Italy
| | - Gaetano Gorgone
- Department of Neuroscience, "Jazzolino" Hospital, 89900 Vibo Valentia, Italy
| | - Antonietta Fava
- Endocrinology Unit, Villa Elisa, Soverato (Catanzaro) 88068, Italy
| | - Maria Ettore
- Department of Neuroscience, "Pugliese-Ciaccio" Hospital Organization, 88100 Catanzaro, Italy
| | - Rosario Iannacchero
- Department of Neuroscience, "Pugliese - Ciaccio" Hospital Organization, 88100 Catanzaro, Italy
| | - Rita Scarfone
- Department of Neuroscience, "Pugliese-Ciaccio" Hospital Organization, 88100 Catanzaro, Italy
| | - Antonio Vaccaro
- Department of Neuroscience, "Pugliese-Ciaccio" Hospital Organization, 88100 Catanzaro, Italy
| | - Matteo De Bartolo
- Neurophysiology Unit, General Hospital, 87067 Rossano, Cosenza, Italy
| | - Domenico Bosco
- Department of Neuroscience, "Pugliese - Ciaccio" Hospital Organization, 88100 Catanzaro, Italy.
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Plastino M, Bosco D, Giofrè L, Cristiano D, Galati F, Postorino P, Consoli A, Fava A, Consoli D. Intravenous thrombolysis in stroke patients taking novel oral anticoagulants: experience with the low-dose 0.6 mg/kg of recombinant tissue-type plasminogen activator. Case reports. J Neurol Sci 2018; 393:24-26. [DOI: 10.1016/j.jns.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/12/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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Fava A, Colica C, Plastino M, Messina D, Cristiano D, Opipari C, Vaccaro A, Gorgone G, Bosco F, Fratto A, De Bartolo M, Bosco D. Cognitive impairment is correlated with insulin resistance degree: the "PA-NICO-study". Metab Brain Dis 2017; 32:799-810. [PMID: 28229380 DOI: 10.1007/s11011-017-9977-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/15/2017] [Indexed: 12/23/2022]
Abstract
Several epidemiological studies have shown that Diabetes Mellitus (DM) or Insulin Resistance (IR) increases the risk of dementia. Besides, some authors suggested that poor glucose control to be associated with worse cognitive function. We aimed to assess cognitive functions and IR-degree over time in diabetic. We also evaluated whether a greater magnitude of cognitive decline could be related with their IR degree. We enrolled 335 diabetic patients and 142 non-diabetic subjects; participants were subdivided into three groups in accordance with their IRdegree assessed by Homa-Index (HI): Normal-HI (non-diabetic NHI < 2,6), Moderate-HI (MHI > 2,6 < 10) and High-HI (HHI > 10). Metabolic status and a comprehensive neuropsycological test battery (MMSE, ADAS-Cog, ACDS-ADL) were assessed at baseline and every 12-months during the follow-up (6,8 years). At the end of the study, the average MMSE decreased significantly in patients of HHI group (P = .001) compared to baseline. MMSE scores were also reduced both in MHI group and in controls, but the difference between two groups was not significant. In HHI group, similar effects were observed for the ADAS-Cog score compared to baseline (P = 0.001); instead, when ACDS-ADL was evaluated, no differences was observed among the three groups. These results remained unchanged also after adjustment for confounding variables (i.e. APOε-status, sex, BMI, education level, heart diseases and HbA1c). We suggest that higher IR-degree is associated with greater cognitive decline in diabetic patients; so we hypothesize that IR degree, more than IR status itself, could be related to the severity of cognitive impairment.
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Affiliation(s)
- Antonietta Fava
- Department of Clinical and Experimental Medicine, University of Catanzaro, 88100, Catanzaro, Italy
| | - Carmen Colica
- Institute of Neurological Science - National Research Council, Roccelletta di Borgia, 88100, Catanzaro, Italy
| | - Massimiliano Plastino
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Demetrio Messina
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
- Institute of Neurological Science - National Research Council, UVS-IBFM, 02, Milan, Italy
| | - Dario Cristiano
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Carlo Opipari
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Antonio Vaccaro
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Gaetano Gorgone
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Francesca Bosco
- University of Pharmacology, loc. Roccelletta, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Alessandra Fratto
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | | | - Domenico Bosco
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy.
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Plastino M, Messina D, Cristiano D, Lombardo G, Bosco D. Pathological gambling associated with CADASIL: an unusual manifestation. Neurol Sci 2015; 36:1963-5. [PMID: 26142163 DOI: 10.1007/s10072-015-2301-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Massimiliano Plastino
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Demetrio Messina
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Dario Cristiano
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Giuditta Lombardo
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy
| | - Domenico Bosco
- Department of Neuroscience, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900, Crotone, Italy.
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Fava A, Plastino M, Cristiano D, Spanò A, Cristofaro S, Opipari C, Chillà A, Casalinuovo F, Colica C, De Bartolo M, Pirritano D, Bosco D. Insulin resistance possible risk factor for cognitive impairment in fibromialgic patients. Metab Brain Dis 2013; 28:619-27. [PMID: 23892884 DOI: 10.1007/s11011-013-9421-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 04/25/2013] [Accepted: 07/11/2013] [Indexed: 01/28/2023]
Abstract
To evaluate glucose metabolism and/or insulin resistance (IR) in 96 patients with Fibromyalgia (FM), associated or not to cognitive impairment. We investigated glucose metabolism in 96 FM patients. Enrolled patients were divided into two groups: 48 patients with memory deficit (group A) and 48 without memory deficit (control group). We evaluated glucose and insulin levels after a 2 h-Oral-Glucose-Tolerance-Test (2 h-OGTT) and insulin resistance (IR) by the homeostasis model assessment formula (HOMA). Body Mass Index (BMI), waist-to-hip-ratio (WHR), anxiety level, fasting plasma insulin and Non-Steroidal Anti-Inflammatory agents use were higher in patients with FM with memory impairment; while age, sex, waist circumference, education level, fasting plasma glucose, glycate hemoglobin, triglycerides, blood lipid profile, C- Reactivity-Protein (CRP), blood pressure and smoking habits were similar in both groups. Following OGTT the prevalence of glucose metabolism abnormalities was significantly higher in group A. IR was present in 79% patients, of whom 23% had also impaired glucose tolerance, 4% newly diagnosed diabetes mellitus and 52% IR only. Obesity and overweight prevailed in group A. IR, but not BMI or WHR was associated to an increased risk of memory impairment (OR = 2,6; 95% CI: 1,22-3,7). The results of this study suggest that IR may represent a risk factor for memory impairment in fibromialgic patients.
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Fava A, Pirritano D, Consoli D, Plastino M, Casalinuovo F, Cristofaro S, Colica C, Ermio C, De Bartolo M, Opipari C, Lanzo R, Consoli A, Bosco D. Chronic migraine in women is associated with insulin resistance: a cross-sectional study. Eur J Neurol 2013; 21:267-72. [PMID: 24238370 DOI: 10.1111/ene.12289] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/23/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Migraine is a common neurological disorder. It can be divided into episodic migraine (EM) and chronic migraine (CM), based on headache frequency. Some studies have shown that insulin sensitivity is impaired in migraine; moreover, hypertension, diabetes and obesity are common in patients with CM. The aim of this study was to assess serum glucose, insulin levels and insulin resistance (IR) in a sample of episodic migraineurs, chronic migraineurs and non-pain healthy controls. METHODS Eighty-three women with EM, 83 with CM and 83 healthy controls were recruited. Headache was diagnosed according to the latest International Classification of Headache Disorders 2 criteria. Waist circumference, body mass index (BMI) and blood pressure were measured. Checked metabolic parameters included fasting glucose, the 2 h 75 g oral glucose tolerance test (2 h OGTT), serum HbA1c, blood lipid profile, C-reactive protein and prolactin. The homeostasis model assessment formula was used to calculate IR. RESULTS A significant prevalence of IR in CM was observed (P = 0.002). No significant associations were found with fasting glycaemia, the 2 h OGTT, HbA1c, blood lipid profile, C-reactive protein, prolactin and waist circumference. Obesity (BMI >30 kg/m(2)) was associated with an increased risk of CM [odds ratio (OR) 2.4]. When the outcome of interest was the association between IR and obesity, the OR was significantly increased compared with IR alone (OR = 13.2). CONCLUSION This may suggest that CM is associated with IR status, particularly when it is in partnership with obesity.
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Affiliation(s)
- A Fava
- Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
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Fava A, Pirritano D, Plastino M, Cristiano D, Puccio G, Colica C, Ermio C, De Bartolo M, Mauro G, Bosco D. The Effect of Lipoic Acid Therapy on Cognitive Functioning in Patients with Alzheimer's Disease. J Neurodegener Dis 2013; 2013:454253. [PMID: 26316990 PMCID: PMC4437336 DOI: 10.1155/2013/454253] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 02/27/2013] [Accepted: 03/13/2013] [Indexed: 01/21/2023]
Abstract
Diabetes mellitus (DM) is an important risk factor for Alzheimer's disease (AD). Most diabetic patients have insulin resistance (IR) that is associated with compensatory hyperinsulinemia, one of the mechanisms suggested for increased AD risk in patients with DM. Alpha-lipoic acid (ALA) is a disulfide molecule with antioxidant properties that has positive effects on glucose metabolism and IR. This study evaluated the effect of ALA treatment (600 mg/day) on cognitive performances in AD patients with and without DM. One hundred and twenty-six patients with AD were divided into two groups, according to DM presence (group A) or absence (group B). Cognitive functions were assessed by MMSE, Alzheimer's Disease Assessment Scale-cognitive (ADAS-Cog), Clinician's Interview-Based Impression of Severity (CIBIC), Clinical Dementia Rating (CDR), and Alzheimer's Disease Functional and Change Scale (ADFACS). IR was assessed by HOMA index. At the end of the study, MMSE scores showed a significant improvement in 43% patients of group A (26 subjects) and 23% of group B (15 subjects), compared to baseline (P = .001). Also ADAS-Cog, CIBIC, and ADFACS scores showed a significant improvement in group A versus group B. IR was higher in group A. Our study suggests that ALA therapy could be effective in slowing cognitive decline in patients with AD and IR.
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Affiliation(s)
- Antonietta Fava
- Department of Clinical and Experimental Medicine, University of Catanzaro, 88100 Catanzaro, Italy
| | - Domenico Pirritano
- Department of Neuroscience, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| | | | - Dario Cristiano
- Department of Neuroscience, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| | - Giovanna Puccio
- Department of Neuroscience, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| | - Carmen Colica
- Institute of Neurological Science, National Research Council, Roccelletta di Borgia, 88021 Catanzaro, Italy
| | - Caterina Ermio
- Department of Neuroscience, “S. Giovanni Paolo II” Hospital, 88046 Lamezia Terme, Catanzaro, Italy
| | - Matteo De Bartolo
- Neurophysiology Unit, General Hospital, 87067 Rossano, Cosenza, Italy
| | - Gaetano Mauro
- General Medicine Unit, General Hospital, 87055 San Giovanni in Fiore, Cosenza, Italy
| | - Domenico Bosco
- Department of Neuroscience, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
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Consoli D, Bosco D, Postorino P, Galati F, Plastino M, Perticoni GF, Ottonello GA, Passarella B, Ricci S, Neri G, Toni D. Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project). Cerebrovasc Dis 2012; 34:282-9. [PMID: 23128439 DOI: 10.1159/000342669] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/13/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65 years. The use of antiepileptic drugs to prevent recurrent poststroke seizures is recommended. METHODS One hundred and twenty-eight patients with poststroke seizures were randomly allocated to treatment with either levetiracetam (LEV) or sustained-release carbamazepine (CBZ) in a multicenter randomized open-label study. After a titration study phase (2 weeks), the optimal individual dose of trial medication was determined and treatment was continued for another 52 weeks. The primary endpoint was defined as the proportion of seizure-free patients; the secondary endpoints were: evaluation of time recurrence to the first seizure, EEG tracings, cognitive functions and side effects. RESULTS Of 128 patients, 22 discontinued the trial prematurely; thus a total of 106 patients (52 treated with LEV and 54 treated with CBZ) were included in the analysis. The results of the study were as follows: no significant difference in number of seizure-free patients between LEV and CBZ (p = 0.08); time to the first recurrence tended to be longer among patients on LEV; there was no correlation between the therapeutic effect and the EEG findings in either treatment group; LEV caused significantly fewer (p = 0.02) side effects than CBZ; attention deficit, frontal executive functions and functional scales (Activities of Daily Living and Instrumental Activities of Daily Living indices) were significantly worse in the CBZ group. CONCLUSIONS This trial suggests that LEV may be a valid alternative to CBZ in poststroke seizures, particularly in terms of efficacy and safety. In addition, our results show that LEV has significant advantages over CBZ on cognitive functions. This trial also indicates that LEV in monotherapy is a safe and effective therapeutic option in elderly patients who have suffered epileptic seizures following a stroke.
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Affiliation(s)
- D Consoli
- Operative Unit of Neurology, Jazzolino Hospital, IT–89900 Vibo Valentia, Italy.
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Plastino M, Fava A, Carmela C, De Bartolo M, Ermio C, Cristiano D, Ettore M, Abenavoli L, Bosco D. Insulin resistance increases risk of carpal tunnel syndrome: a case-control study. J Peripher Nerv Syst 2011; 16:186-90. [DOI: 10.1111/j.1529-8027.2011.00344.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bosco D, Fava A, Plastino M, Montalcini T, Pujia A. Possible implications of insulin resistance and glucose metabolism in Alzheimer's disease pathogenesis. J Cell Mol Med 2011; 15:1807-21. [PMID: 21435176 PMCID: PMC3918038 DOI: 10.1111/j.1582-4934.2011.01318.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 03/17/2011] [Indexed: 01/21/2023] Open
Abstract
Type 2 diabetes mellitus (DM) appears to be a significant risk factor for Alzheimer disease (AD). Insulin and insulin-like growth factor-1 (IGF-1) also have intense effects in the central nervous system (CNS), regulating key processes such as neuronal survival and longevity, as well as learning and memory. Hyperglycaemia induces increased peripheral utilization of insulin, resulting in reduced insulin transport into the brain. Whereas the density of brain insulin receptor decreases during age, IGF-1 receptor increases, suggesting that specific insulin-mediated signals is involved in aging and possibly in cognitive decline. Molecular mechanisms that protect CNS neurons against β-amyloid-derived-diffusible ligands (ADDL), responsible for synaptic deterioration underlying AD memory failure, have been identified. The protection mechanism does not involve simple competition between ADDLs and insulin, but rather it is signalling dependent down-regulation of ADDL-binding sites. Defective insulin signalling make neurons energy deficient and vulnerable to oxidizing or other metabolic insults and impairs synaptic plasticity. In fact, destruction of mitochondria, by oxidation of a dynamic-like transporter protein, may cause synapse loss in AD. Moreover, interaction between Aβ and τ proteins could be cause of neuronal loss. Hyperinsulinaemia as well as complete lack of insulin result in increased τ phosphorylation, leading to an imbalance of insulin-regulated τ kinases and phosphatates. However, amyloid peptides accumulation is currently seen as a key step in the pathogenesis of AD. Inflammation interacts with processing and deposit of β-amyloid. Chronic hyperinsulinemia may exacerbate inflammatory responses and increase markers of oxidative stress. In addition, insulin appears to act as 'neuromodulator', influencing release and reuptake of neurotransmitters, and improving learning and memory. Thus, experimental and clinical evidence show that insulin action influences cerebral functions. In this paper, we reviewed several mechanisms by which insulin may affect pathophysiology in AD.
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Affiliation(s)
- Domenico Bosco
- Department of Neuroscience, 'S. Giovanni di Dio' Hospital, Via Largo Bologna, Crotone, Italy.
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Bosco D, Plastino M, Bosco F, Fava A, Rotondo A. Daily motor performance after switching levodopa to melevodopa: an open-label on advanced Parkinson's disease with "delayed-on" and/or"wearing-off". Minerva Med 2011; 102:125-132. [PMID: 21483399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Aim of the present study was to evaluate the clinical efficacy, tolerability and quality-of-life measures to melevodopa in advanced Parkinson's disease (PD) with motor fluctuations (MFs). METHODS A total of 37 patients with advanced PD and MFs participated in the study. Patients were switched from standard l-dopa/carbidopa to melevodopa and were treated for 10 weeks. RESULTS Assessment of "On-Day" time demonstrated improvement to about 0.7 hour in the melevodopa treatment. The benefit was greater in patients with "delayed-on" (P=0.002) and especially in those with both "delayed-on" and "wearing-off" (P<0.001). Most patients showed a significant improvement in PDQ-39 total score (P=0.002) and PSI distress domain (P<0.001). Instead, not significant difference was observed in patients with only wearing-off. CONCLUSION These data show that melevodopa is an effective agent for improving daily motor performance and quality-of-life in PD with "delayed-on", also in association with "wearing-off".
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Affiliation(s)
- D Bosco
- Operative Unit of Neurology, S. Giovanni di Dio, Crotone, Italy.
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Abstract
BACKGROUND Idiopathic peripheral facial nerve palsy or Bell's palsy (BP) is the most common cause of facial nerve palsy. OBJECTIVE To evaluate the role of glucose metabolism abnormalities in BP. METHODS We identified 148 patients with unilateral BP and 128 control subjects. In all we evaluated glucose level at fasting and after a 2-h oral glucose tolerance test (2h-OGTT). In addition we determined insulin resistance (IR), by HOMA-index. Patients and controls were divided in to two groups, according to their Body Mass Index (BMI). RESULTS Following a 2h-OGTT, the prevalence of glucose metabolism abnormalities was significantly higher in patients with BP than in controls (P < 0.001). Impaired glucose tolerance (IGT) was found in 57 (38%) patients and in 23 (18%) controls, while a new-diagnosed DM (NDDM) was found in 29 (19%) patients and in 8 (6%) controls. The IR was significantly increased only in BP patients with BMI ≥ 24.9 (P = 0.005). BMI, waist circumference, blood pressure, tryglicerides, serum lipid, drugs use were not significantly different between patients and controls. CONCLUSIONS In this study we found that prediabetes is frequently associated with facial palsy. We propose to perform a 2h-OGTT in patients with peripheral facial palsy and normal fasting glycaemia. HOMA-index should be evaluated in obese facial palsy patients.
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Affiliation(s)
- D Bosco
- Department of Neuroscience, S. Giovanni di Dio Hospital, Crotone, Italy.
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Rotondo A, Bosco D, Plastino M, Consoli A, Bosco F. Clozapine for medication-related pathological gambling in Parkinson disease. Mov Disord 2010; 25:1994-5. [PMID: 20669252 DOI: 10.1002/mds.23177] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bosco D, Consoli D, Lanza PL, Plastino M, Nicoletti F, Ceccotti C. Complete oculomotor palsy caused by persistent trigeminal artery. Neurol Sci 2010; 31:657-9. [DOI: 10.1007/s10072-010-0342-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 05/22/2010] [Indexed: 10/19/2022]
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Plastino M, Fava A, Pirritano D, Cotronei P, Sacco N, Sperlì T, Spanò A, Gallo D, Mungari P, Consoli D, Bosco D. Effects of insulinic therapy on cognitive impairment in patients with Alzheimer disease and diabetes mellitus type-2. J Neurol Sci 2010; 288:112-6. [PMID: 19836029 DOI: 10.1016/j.jns.2009.09.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Type-2 Diabetes Mellitus (DM-2) is an important risk factor for Alzheimer disease (AD) and vascular dementia (VD). The role of insulinic therapy on cognitive decline is controversial. OBJECTIVE To evaluate cognitive impairment in patients with AD and DM-2 treated with either oral antidiabetic drugs or combination of insulin with other diabetes medications. METHODS 104 patients with mild-to-moderate AD and DM-2 were divided into two groups, according to antidiabetic pharmacotherapy: group A, patients treated with oral antidiabetic drugs and group B, patients treated with insulin combined with other oral antidiabetic medications. Cognitive functions were assessed by the Mini Mental State Examination (MMSE) and the Clinician's Global Impression (CGI), with a follow-up of 12 months. RESULTS At the end of the study, the MMSE scores showed a significant worsening in 56.5% patients of group A and in 23.2% patients of group B, compared to baseline MMSE scores (P=.001). Also CGI-C scores showed a significant worsening for all domains after 12 months in group A vs group B (P=.001). The two groups were matched for body mass index, serum lipids, triglycerides, Apo epsilon4 allele and smoke habit. Conversely, ischemic heart disease and hypertension were significantly higher in group B (P=.002). After adjustment for this risk variables, our results remained significant (P=.001). CONCLUSIONS Our study suggests that insulinic therapy could be effective in slowing cognitive decline in patients with AD.
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Bosco D, Plastino M, Fava A, Ettore M, Bosco F, Ermio C, Tallarigo F, Pirritano D, Consoli D. Role of the Oral Glucose Tolerance Test (OGTT) in the idiopathic restless legs syndrome. J Neurol Sci 2009; 287:60-3. [DOI: 10.1016/j.jns.2009.09.008] [Citation(s) in RCA: 17] [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: 04/10/2009] [Revised: 09/04/2009] [Accepted: 09/08/2009] [Indexed: 11/28/2022]
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Bosco D, Belfiore A, Fava A, De Rose M, Plastino M, Ceccotti C, Mungari P, Iannacchero R, Lavano A. Relationship between high prolactin levels and migraine attacks in patients with microprolactinoma. J Headache Pain 2008; 9:103-7. [PMID: 18256782 PMCID: PMC3476184 DOI: 10.1007/s10194-008-0016-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/30/2007] [Accepted: 01/16/2008] [Indexed: 11/29/2022] Open
Abstract
The pathophysiology of pituitary-associated headache is unknown, although structural and functional features of the tumour are proposed mechanisms. The objective of this study was to evaluate whether headache in a population with pituitary micro-adenomas was related to hyperprolactinemia. We recruited 29 patients with microprolactinoma and headache: 16 with migraine (group A) and 13 with tension-type-headache (group B). The prolactin (PRL) levels measured during attacks of headache were significantly higher in nine patients (56%) of group A and in one patient (8%) of group B. In four of the nine patients of group A, PRL increased after thyrotropin-releasing-hormone (TRH) test and induced severe attacks. After dopamine-agonist (DA) treatment, the headache improved in seven (44%) patients of the group A and in two (15%) patients of the group B. Three of the four patients in whom the TRH-test induced headache attacks, improved after DA treatment. We suggest that hyperprolactinemia may contribute to development of pain in migraine subgroups and further TRH-test could be used to predict which patients could benefit by DA therapy.
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Affiliation(s)
- D Bosco
- Operative Unit of Neurology, S Giovanni di Dio Hospital, Via Largo Bologna, 88900 Crotone, Italy.
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Zappia M, Bosco D, Plastino M, Nicoletti G, Branca D, Oliveri RL, Aguglia U, Gambardella A, Quattrone A. Pharmacodynamics of the long-duration response to levodopa in PD. Neurology 1999; 53:557-60. [PMID: 10449120 DOI: 10.1212/wnl.53.3.557] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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
OBJECTIVE To determine the latency, magnitude, and duration of the long-duration response (LDR) to levodopa in PD in relationship to the administration of levodopa at different interdose intervals. METHODS In six patients with PD, two different 15-day treatment regimens were used in which the drug was administered with interdose intervals of 24 or 8 hours. RESULTS The LDR built up within a few days with either regimen, but a faster rate of administering levodopa shortened the latency to the appearance of a sustained LDR. Once a sustained response had been reached, the magnitude of the LDR showed a stable ceiling effect that was independent of the levodopa schedule. After discontinuation of treatment, the decay of the LDR was similar for both regimens. CONCLUSIONS The system underlying the LDR to levodopa may be completely saturated when a sustained response has been fully developed. The intervals between doses of levodopa shorter than the interval effective to reach a sustained LDR should not be used in the clinical management of patients with PD because the antiparkinsonian benefit deriving from the LDR is already maximal and briefer intervals do not provide a greater benefit.
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Affiliation(s)
- M Zappia
- Institute of Neurology, University of Catanzaro, Italy
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Zappia M, Oliveri RL, Montesanti R, Rizzo M, Bosco D, Plastino M, Crescibene L, Bastone L, Aguglia U, Gambardella A, Quattrone A. Loss of long-duration response to levodopa over time in PD: implications for wearing-off. Neurology 1999; 52:763-7. [PMID: 10078724 DOI: 10.1212/wnl.52.4.763] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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
OBJECTIVE To determine the modifications of the long-duration response to levodopa in PD over a 1-year period. BACKGROUND The development of predictable motor fluctuations in PD has been attributed mainly to modifications over time of the short-duration response to levodopa, whereas the role of the long-duration response has not been widely investigated. METHODS In 17 patients with PD the authors examined prospectively both the short-duration response and the long-duration response to levodopa under standardized conditions on two different occasions separated by a period of approximately 1 year (11.7 +/- 3.6 months). RESULTS At the end of the follow-up period, the short-duration response increased in magnitude but did not change significantly in duration. A total of 24% of patients lost the long-duration response 1 year after their first examination, but a sustained long-duration response could be reestablished by shortening the interdose interval for levodopa intake. Moreover, the duration of the long-duration response after discontinuation of treatment became significantly shorter during 1 year. CONCLUSION Modifications of the long-duration response may have a pivotal role in generating a fluctuating response, and suggest that therapeutic strategies based on maintenance of the long-duration response should be sought to avoid the appearance of motor fluctuations.
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Affiliation(s)
- M Zappia
- Institute of Neurology, University of Catanzaro, Italy
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Zappia M, Montesanti R, Colao R, Plastino M, Frangipane F, Quattrone A. 1-30-23 Loss of long duration response to levodopa in Parkinson's disease. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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