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Gentile E, Quitadamo SG, Clemente L, Bonavolontà V, Lombardi R, Lauria G, Greco G, Fischetti F, De Tommaso M. A multicomponent physical activity home-based intervention for fibromyalgia patients: effects on clinical and skin biopsy features. Clin Exp Rheumatol 2023:20077. [PMID: 38019150 DOI: 10.55563/clinexprheumatol/iukp4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Adapted physical activity (APA) has been recommended for fibromyalgia (FM) treatment as an essential component of a biopsychosocial therapeutic approach for patients. Previous studies report that aerobic and resistance training are the most effective programs in improving the quality of life and psycho-physical well-being. Patients with FM are frequently affected by an impairment of small fibers innervation, which is evident in the proximal somatic districts. Therefore, this pilot randomised controlled not pharmacological trial aimed to investigate if a 12-week home-based multicomponent (aerobic and resistance training and mobility) physical activity (PA) intervention was effective in improving pain perception, FM-related disability, and IntraEpidermal Nerve Fibers Density (IENFD) in adult FM patients. METHODS Thirty-four female subjects with a fibromyalgia diagnosis (51.5±11.88 years) were randomly assigned to an experimental group (n=17) that received a supervised home-based multicomponent PA intervention twice a week and a control group (n=17) that received a generic program of aerobic exercise. Skin biopsy was performed before the physical program and after 18 months with constant execution of the supervised PA intervention or generic aerobic exercise. Both groups assumed pharmacological treatment with duloxetine and/or pregabalin. RESULTS We found that the group performing physical activity in a supervised and regular way showed a significant improvement in the Fibromyalgia-linked invalidity questionnaire (FIQ) as well as epidermal fibers density at proximal and distal sites. CONCLUSIONS Physical activity could improve FM outcomes, with a possible beneficial impact on peripheral factors contributing to pain-related disability.
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Affiliation(s)
- Eleonora Gentile
- Neurophysiopathology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Polyclinic General Hospital, Bari, Italy
| | - Silvia Giovanna Quitadamo
- Neurophysiopathology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Polyclinic General Hospital, Bari, Italy
| | - Livio Clemente
- Neurophysiopathology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Polyclinic General Hospital, Bari, Italy
| | - Valerio Bonavolontà
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Raffaella Lombardi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Lauria
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, and Department of Medical Biotechnology and Translational Medicine, University of Milan, Italy
| | - Gianpiero Greco
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari Aldo Moro, Bari, Italy.
| | - Francesco Fischetti
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Study of Bari Aldo Moro, Bari, Italy
| | - Marina De Tommaso
- Neurophysiopathology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Polyclinic General Hospital, Bari, Italy
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de Tommaso M, La Rocca M, Quitadamo SG, Ricci K, Tancredi G, Clemente L, Gentile E, Ammendola E, Delussi M. Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients. J Headache Pain 2022; 23:52. [PMID: 35484504 PMCID: PMC9052688 DOI: 10.1186/s10194-022-01421-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discovery of the prominent action of Calcitonin Gene Related Peptide -CGRP- on trigeminal afferents and meningeal vessels, opened a new era in migraine treatment. However, how the block of nociceptive afferents could act on central mechanisms of migraine is still not clear. In this pilot study we aimed to test the effect of 3 months Galcanezumab (CGA) therapy on occipital visual reactivity in migraine patients, using the Steady State Visual Evoked Potentials-SSVEPs and Functional Near Infrared Spectroscopy -fNIRS. METHOD Thirteen migraine patients underwent clinical and neurophysiological examination in basal condition (T0), 1 h after GCA injection (T1) and after 3 months of GCA treatment (T2). Ten healthy volunteers were also evaluated. RESULTS At T2, there was a reduction of headache frequency and disability. At T2, the EEG power significantly diminished as compared to T0 and T1 at occipital sites, and the topographical analysis confirmed a restoration of SSVEPs within normal values. The Oxyhemoglobin levels in occipital cortex, which were basically increased during visual stimulation in migraine patients, reverted to normal values at T2. CONCLUSIONS The present pilot study indicates that Galcanezumab could act on cortical targets located beyond the pain network, restoring the abnormal occipital reactivity. This effect could indicate the possible disease modifying properties of CGRP related monoclonal antibodies.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Marianna La Rocca
- Dipartimento Interateneo di Fisica 'M. Merlin', Università degli Studi di Bari 'A. Moro', Bari, Italy.,Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Silvia Giovanna Quitadamo
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giusy Tancredi
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Livio Clemente
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Elena Ammendola
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro UniversityPoliclinico General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Quitadamo SG, Vecchio E, Delussi M, Libro G, Clemente L, Lombardi R, Modena D, Giannotta M, Iannone F, de Tommaso M. Outcome of small fibers pathology in fibromyalgia: a real life longitudinal observational study. Clin Exp Rheumatol 2022:18556. [DOI: 10.55563/clinexprheumatol/ld0lxn] [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: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Livio Clemente
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | | | - Debora Modena
- Neuroalgology Unit, Carlo Besta Institute, Milano, Italy
| | - Maria Giannotta
- Rheumatology Clinic, DETO Department, Aldo Moro University, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Clinic, DETO Department, Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
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Vecchio E, Giovanna Quitadamo S, Ricci K, Libro G, Delussi M, Lombardi R, Lauria G, de Tommaso M. Laser evoked potentials in fibromyalgia with peripheral small fiber involvement. Clin Neurophysiol 2022; 135:96-106. [DOI: 10.1016/j.clinph.2022.01.001] [Citation(s) in RCA: 2] [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: 08/09/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
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Quitadamo SG, Vecchio E, Libro G, Ricci K, Lombardi R, Lauria G, De Tommaso M. Topographical and dipolar analysis of laser evoked potentials in fibromyalgic patients with non lenght dependent small fiber neuropathy. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paolicelli D, Manni A, Iaffaldano A, Tancredi G, Ricci K, Gentile E, Viterbo RG, Quitadamo SG, de Tommaso M, Trojano M. Magnetoencephalography and High-Density Electroencephalography Study of Acoustic Event Related Potentials in Early Stage of Multiple Sclerosis: A Pilot Study on Cognitive Impairment and Fatigue. Brain Sci 2021; 11:481. [PMID: 33918861 PMCID: PMC8069556 DOI: 10.3390/brainsci11040481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/22/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment (CI) is a common and disabling symptom of Multiple Sclerosis (MS) with a negative impact on daily living. In this pilot study, we applied magnetoencephalography (MEG) and high density (hd) electroencephalography (EEG) study to evaluate acoustic P300 features in a cohort of early MS. Sixteen MS patients (pwMS) and 19 healthy controls (HCs) matched for age and gender underwent an MEG-/(hd)-EEG-co-recording, using 306-channel Vectorview and 64 scalp electrodes. CI was assessed using Rao's Brief Repeatable Battery (BRB). Moreover, we performed psychometric tests to assess depression and fatigue. In pwMS, we observed a slight latency prolongation of P300 peak compared to HCs, while P300 amplitude and scalp distribution were similar in the two groups. pwMS did not show an amplitude reduction and different scalp distribution of Event-Related Potentials (ERPs) and Event Related Fields (ERFs) related to an acoustic oddball paradigm. We found an inverse correlation between P300 amplitude and fatigue (r Spearman = -0.4; p = 0.019). In pwMS, phenomena of cortical adaptation to early dysfunction could preserve the cognitive performance of the P300 acoustic task, while the development of fatigue could prospectively lead to amplitude decline of P300, suggesting its possible role as a biomarker.
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Affiliation(s)
- Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Giusy Tancredi
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Katia Ricci
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Eleonora Gentile
- Basic Health District, Family Counseling Center, ASP (Local Health Company), 85038 Senise, Italy;
| | - Rosa Gemma Viterbo
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Silvia Giovanna Quitadamo
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Marina de Tommaso
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.M.); (A.I.); (G.T.); (K.R.); (R.G.V.); (S.G.Q.); (M.d.T.); (M.T.)
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de Tommaso M, Delussi M, Gentile E, Ricci K, Quitadamo SG, Libro G. Effect of single dose Erenumab on cortical responses evoked by cutaneous a-delta fibers: A pilot study in migraine patients. Cephalalgia 2021; 41:1004-1014. [PMID: 33593077 DOI: 10.1177/0333102421996345] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Erenumab is a monoclonal antibody against calcitonin gene-related peptide receptors, which showed efficacy in migraine attack prevention. The aims of the present pilot study were to i) evaluate the effect of single dose of Erenumab 70 mg on laser evoked potentials from trigeminal and brachial stimulation in a cohort of migraine patients; ii) correlate the neurophysiological changes with clinical outcome after 3 months' treatment. METHODS Laser evoked potentials were recorded by 61 electroencephalogram channels before (T0), 1 h (T1) and 7 days after (T2) Erenumab 70 mg injection, stimulating the left and right forehead and the right hand. Laser evoked potential control 1 h after the injection served as placebo session. RESULTS Seventeen migraine patients were evaluated. The N1 and N2 component obtained from the right and left trigeminal stimulation diminished in amplitude at T2, compared to T0 and T1 conditions. N2 habituation reduction slightly recovered at T2. Laser evoked potential changes did not correlate with clinical improvement after 3 months of Erenumab treatment. CONCLUSIONS A single dose of Erenumab has a mild inhibitory effect on cortical responses evoked from trigeminal cutaneous a-delta fibers. Though this phenomenon was not predictive of the clinical outcome, it confirms a wide representation of calcitonin gene-related peptide receptors on trigeminal afferents.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
| | | | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, Bari, Italy
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de Tommaso M, Vecchio E, Quitadamo SG, Coppola G, Di Renzo A, Parisi V, Silvestro M, Russo A, Tedeschi G. Pain-Related Brain Connectivity Changes in Migraine: A Narrative Review and Proof of Concept about Possible Novel Treatments Interference. Brain Sci 2021; 11:brainsci11020234. [PMID: 33668449 PMCID: PMC7917911 DOI: 10.3390/brainsci11020234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
A neuronal dysfunction based on the imbalance between excitatory and inhibitory cortical-subcortical neurotransmission seems at the basis of migraine. Intercritical neuronal abnormal excitability can culminate in the bioelectrical phenomenon of Cortical Spreading Depression (CSD) with secondary involvement of the vascular system and release of inflammatory mediators, modulating in turn neuronal activity. Neuronal dysfunction encompasses the altered connectivity between the brain areas implicated in the genesis, maintenance and chronic evolution of migraine. Advanced neuroimaging techniques allow to identify changes in functional connectivity (FC) between brain areas involved in pain processes. Through a narrative review, we re-searched case-control studies on FC in migraine, between 2015 and 2020, by inserting the words migraine, fMRI, EEG, MEG, connectivity, pain in Pubmed. Studies on FC have shown that cortical processes, in the neurolimbic pain network, are likely to be prevalent for triggering attacks, in response to predisposing factors, and that these lead to a demodulation of the subcortical areas, at the basis of migraine maintenance. The link between brain dysfunction and peripheral interactions through the inhibition of CGRP, the main mediator of sterile migraine inflammation needs to be further investigated. Preliminary evidence could suggest that peripheral nerves inference at somatic and trigeminal levels, appears to change brain FC.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
- Correspondence: ; Tel.: +39-080-5596739
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Silvia Giovanna Quitadamo
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, 00185 Rome, Italy;
| | | | - Vincenzo Parisi
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (A.D.R.); (V.P.)
| | - Marcello Silvestro
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Antonio Russo
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Gioacchino Tedeschi
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
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