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Ciaramitaro P, Cruccu G, de Tommaso M, Devigili G, Fornasari D, Geppetti P, Lacerenza M, Lauria G, Mameli S, Marchettini P, Nolano M, Polati E, Provitera V, Romano M, Solaro C, Tamburin S, Tugnoli V, Valeriani M, Truini A. A Delphi consensus statement of the Neuropathic Pain Special Interest Group of the Italian Neurological Society on pharmacoresistant neuropathic pain. Neurol Sci 2019; 40:1425-1431. [PMID: 30941628 DOI: 10.1007/s10072-019-03870-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/23/2019] [Indexed: 12/25/2022]
Abstract
To improve patient care and help clinical research, the Neuropathic Pain Special Interest Group of the Italian Neurological Society appointed a task force to elaborate a consensus statement on pharmacoresistant neuropathic pain. The task force included 19 experts in neuropathic pain. These experts participated in a Delphi survey consisting of three consecutive rounds of questions and a face-to-face meeting, designed to achieve a consensus definition of pharmacoresistant neuropathic pain. In the three rounds of questions, the participants identified and described the main distinguishing features of pharmacoresistance. In the face-to-face meeting the participants discussed the clinical features determining pharmacoresistance. They finally agreed that neuropathic pain is pharmacoresistant when "the patient does not reach the 50% reduction of pain or an improvement of at least 2 points in the Patient Global Impression of Change, having used all drug classes indicated as first, second, or third line in the most recent and widely agreed international guidelines, for at least 1 month after titration to the highest tolerable dose." Our consensus statement might be useful for identifying eligible patients for invasive treatments, and selecting patients in pharmacological trials, thus improving patient care and helping clinical research.
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Affiliation(s)
- P Ciaramitaro
- Clinical Neurophysiology, Neuroscience Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - G Cruccu
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy
| | - M de Tommaso
- Applied Neurophysiology and Pain Unit, Basic Medical Science, Neuroscience and Sensory System-SMBNOS-Department, Aldo Moro University, Bari, Italy
| | - G Devigili
- Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - D Fornasari
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - P Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology and Headache Center, University of Florence, Florence, Italy
| | - M Lacerenza
- Neurology and Pain Medicine Center, Humanitas, San Pio X Clinic, Milan, Italy
| | - G Lauria
- Neuroalgology Unit, IRCCS Foundation, "Carlo Besta" Neurological Institute, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - S Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, 09134, Cagliari, Italy
| | - P Marchettini
- Department of Health Sciences, Section of Clinical Pharmacology and Headache Center, University of Florence, Florence, Italy
- Pain Medicine Centre, Ospedale San Raffaele, Milan, Italy
- University of Applied Science of Southern Switzerland, Pain Pathophysiology and Therapy Programme, Manno, Switzerland
| | - M Nolano
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri, 4, 27100, Pavia, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - E Polati
- Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Centre, Verona University Hospital, Verona, Italy
| | - V Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Telese Terme (BN), Telese Terme, Italy
| | - M Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - C Solaro
- CRRF Mons L Novarese Moncrivello (VC), Moncrivello, Italy
| | - S Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - V Tugnoli
- Neurology Unit, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - M Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy.
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Ferrari A, Manca M, Tugnoli V, Alberto L. Pharmacological differences and clinical implications of various botulinum toxin preparations: a critical appraisal. Funct Neurol 2019; 33:7-18. [PMID: 29633692 DOI: 10.11138/fneur/2018.33.1.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Three different type A botulinum neurotoxins (BoNTAs) - onabotulinumtoxinA, abobotulinumtoxinA and incobotulinumtoxinA) - are currently marketed in Europe to treat several conditions. Differences between BoNTA preparations, which depend on their specific biotypes and manufacturing processes, lead to clinically relevant pharmacotherapeutic dissimilarities. All three available products are separately recognized and reviewed in American Academy of Neurology guidelines. The neurotoxin load/100U is likewise different among the different BoNTAs, with the result that the specific potency of the 150kD BoNTA neurotoxin is calculated as 137 units/ng for onabotulinumtoxinA, 154 units/ng for abobotulinumtoxinA, and 227 units/ng for incobotulinumtoxinA. It is important for clinicians to have all three BoNTAs available in order to choose the most suitable preparation for the specific indication in the single patient. Commercially available BoNTAs must be recognized as different from one another, and therefore as non-interchangeable. The essential experience of the clinician is of the utmost importance in choosing the most appropriate treatment.
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Simioni V, Locatelli E, Capone J, Sette E, Cavallo M, Tugnoli V. Preoperative neurophysiological evaluation of motor function using transcranial magnetic stimulation. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.054] [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: 10/27/2022]
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Simioni V, Capone JG, Sette E, Granieri E, Farneti M, Cavallo MA, Tugnoli V. Intraoperative monitoring of sensory part of the trigeminal nerve using blink reflex during microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 2018; 160:165-169. [PMID: 29177630 DOI: 10.1007/s00701-017-3405-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
Intraoperative monitoring during cerebellopontine angle surgery is widely accepted. While techniques which monitor cranial motor nerves are commonly used, monitoring the sensory afferents has been challenging. Considering the reflex arc, blink reflex (BR) might be useful in monitoring the sensory part of the trigeminal nerve, the brainstem connections and the facial nerve. We describe the case of a patient who developed hemifacial hypoesthesia after microvascular decompression surgery for trigeminal neuralgia. Intraoperative BR showed a severe loss of R1 amplitude. BR might be a useful intraoperative technique to monitor the sensory part of the trigeminal nerve.
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Affiliation(s)
- Valentina Simioni
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy.
| | - J G Capone
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - E Sette
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - E Granieri
- Department of Biomedical and Surgical Science, Section of Neurological, Psychiatric and Psychological Sciences, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - M Farneti
- Department of Neuroscience and Rehabilitation, Division of Neurosurgery, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - M A Cavallo
- Department of Neuroscience and Rehabilitation, Division of Neurosurgery, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - V Tugnoli
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
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Cesnik E, Fallica E, Mazzoli S, Rispoli V, Govoni V, Calanca C, Tugnoli V. 32. Facio-brachial dystonic seizures in LGI1 Limbic Encephalitis: Analysis of video EEG monitoring in a small group of patients. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.039] [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: 12/01/2022]
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Mazzoli S, Fallica E, Cesnik E, Govoni V, Rispoli V, Contaldi E, Tugnoli V. 34. A case of takotsubo syndrome induced by seizures. Review of letterature. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.041] [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: 10/18/2022]
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Diozzi E, Villani G, Bentivogli S, Di Bono M, Mussoni P, Simioni V, Sette E, Capone J, Tugnoli V. 82. Inter- and intraexaminer reliability of nerve conduction measurements in the upper limb of healthy subjects. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rispoli V, Simioni V, Capone JG, Golfrè Andreasi N, Preda F, Sette E, Tugnoli V, Sensi M. Peripheral neuropathy in 30 duodopa patients with vitamins B supplementation. Acta Neurol Scand 2017; 136:660-667. [PMID: 28608472 DOI: 10.1111/ane.12783] [Citation(s) in RCA: 21] [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] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Peripheral neuropathy (PN) is a significant concern and potential cause of withdrawal in patients with Parkinson's disease (PD) treated with Levodopa/Carbidopa Intestinal Gel (LCIG) infusion. Vitamin B deficiency and/or hyperhomocysteinemia levodopa-related are considered possible causative factors. In this study, we evaluated PN incidence in LCIG-PD patients treated since the beginning of infusion with vitamins B supplementation. MATERIALS & METHODS In this prospective open-label pilot study, 30 consecutive patients with PD on LCIG infusion were evaluated with clinical, neurophysiological, and biochemical assessments for a mean follow-up of 42.4 months (range 24-72). All evaluations were repeated every 6 months. RESULTS At baseline, 21 of 30 presented no signs or symptoms of PN, and 9 of 30 had pre-existing chronic PN. In whole population, a progressive worsening in nerve conduction studies of sural sensory and peroneal motor nerves was observed during the long-term follow-up. 4 of 21 patients, with normal clinical, electrophysiological assessment at baseline, developed distal symmetrical axonal polyneuropathy that remained asymptomatic during the long-term follow-up. Patients with pre-existing PN (9 of 30) showed a mild worsening of electrophysiological features during the period of observation. In none PN was cause of discontinuation of LCIG therapy. No incident cases of acute-subacute PN were documented. No correlation was found with age, sex, Levodopa dosage, duration of levodopa exposure, and homocysteine plasma levels. CONCLUSION In this consecutive series of 30 patients with PD on LCIG infusion, with early and continuous vitamins B integration, we observed a low rate (19%) of new onset peripheral polyneuropathy that remained stable after long-term follow-up. Larger studies, controlled, with blinded evaluation, are needed to confirm these findings.
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Affiliation(s)
- V. Rispoli
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - V. Simioni
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - J. G. Capone
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - N. Golfrè Andreasi
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - F. Preda
- Neurology Department; Ospedale Bufalini; Cesena Italy
| | - E. Sette
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - V. Tugnoli
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
| | - M. Sensi
- Neurology Department; Az. Ospedaliero-Universitaria Arcispedale Sant'Anna; Cona Ferrara Italy
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Vigneri S, Sindaco G, Zanella M, La Grua M, Pari G, Tugnoli V. 77. Altered H-reflex following pulsed radiofrequency in patients with lumbosacral radicular pain. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rispoli V, Diozzi E, Villani G, Capone J, Sette E, Simioni V, Tugnoli V. 50. Inter hemispheric comparison of PAS-induced cortical plasticity: A pilot study in healthy subjects. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Simioni V, Capone J, Sette E, Farneti M, Cavallo M, Tugnoli V. 71. Intraoperative blink reflex monitoring during microvascular decompression for trigeminal neuralgia. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donato F, Turri M, Zanette G, Tugnoli V, Deotto L, Teatini F, Romito S, Moretto G, Squintani G. 63. A study of cortical and spinal excitability in patients affected by multiple sclerosis and spasticity after oromucosal cannabinoid spray (THC/CBD). Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.071] [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: 10/22/2022]
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Turri M, Donato F, Teatini F, Zanette G, Tugnoli V, Deotto L, Moretto G, Squintani G. 17. Pain modulation in patients with Multiple Sclerosis, pain and spasticity after oromucosal cannabinoid spray (THC/CBD): A study with quantitative sensory testing and laser evoked potentials. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.025] [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: 10/22/2022]
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Scotton C, Italyankina E, Storbeck M, Vezyroglou K, Heller R, Neri M, Di Raimo F, Mauro A, Tugnoli V, Timmerman V, Wirth B, De Grandis D, Gualandi F, Ferlini A. Next generation sequencing identifies a novel ATP7A mutation in two brothers with distal hereditary motor neuropathy and autonomic dysfunction. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Govoni V, Della Coletta E, Cesnik E, Casetta I, Tugnoli V, Granieri E. Space-time distribution of the ALS incident cases by onset type in the Health District of Ferrara, Italy. Acta Neurol Scand 2015; 131:246-52. [PMID: 25312935 DOI: 10.1111/ane.12316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES An ecological study in the resident population of the Health District (HD) of Ferrara, Italy, has been carried out to establish the distribution in space and time of the amyotrophic lateral sclerosis (ALS) incident cases according to the disease onset type and gender in the period 1964-2009. MATERIAL AND METHODS The hypothesis of a uniform distribution was assumed. RESULTS The incident cases of spinal onset ALS and bulbar onset ALS were evenly distributed in space and time in both men and women. The spinal onset ALS incident cases distribution according to gender was significantly different from the expected in the extra-urban population (20 observed cases in men 95% Poisson confidence interval 12.22-30.89, expected cases in men 12.19; six observed cases in women 95% Poisson confidence interval 2.20-13.06, expected cases in women 13.81), whereas no difference was found in the urban population. The spinal onset ALS incidence was higher in men than in women in the extra-urban population (difference between the rates = 1.53, 95% CI associated with the difference 0.52-2.54), whereas no difference between sexes was found in the urban population. CONCLUSIONS The uneven distribution according to gender of the spinal onset ALS incident cases only in the extra-urban population suggests the involvement of a gender related environmental risk factor associated with the extra-urban environment. Despite some limits of the spatial analysis in the study of rare diseases, the results appear consistent with the literature data.
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Affiliation(s)
- V. Govoni
- Department of the University of Ferrara; Neurological Clinic, Biomedical and Specialized Surgery Sciences; Ferrara Italy
| | - E. Della Coletta
- Department of the University of Ferrara; Neurological Clinic, Biomedical and Specialized Surgery Sciences; Ferrara Italy
| | - E. Cesnik
- Department of the University of Ferrara; Neurological Clinic, Biomedical and Specialized Surgery Sciences; Ferrara Italy
| | - I. Casetta
- Department of the University of Ferrara; Neurological Clinic, Biomedical and Specialized Surgery Sciences; Ferrara Italy
| | - V. Tugnoli
- Neurology Unit; University Hospital of Ferrara; Ferrara Italy
| | - E. Granieri
- Department of the University of Ferrara; Neurological Clinic, Biomedical and Specialized Surgery Sciences; Ferrara Italy
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Simioni V, Sette E, Capone J, Cavallo M, Farneti M, Granieri E, Tugnoli V. 96. Blink reflex intraoperative monitoring during microvascular decompression for hemifacial spasm: Our experience. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vigneri S, Rispoli V, Azzini C, Caniatti M, Tola M, Simioni V, Capone J, Sette E, Tugnoli V. 66. Autonomic-sensory neuropathy onset in a patient with acute brainstem impairment – A case report. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sensi M, Preda F, Trevisani L, Contini E, Gragnaniello D, Capone JG, Sette E, Golfre-Andreasi N, Tugnoli V, Tola MR, Quatrale R. Emerging issues on selection criteria of levodopa carbidopa infusion therapy: considerations on outcome of 28 consecutive patients. J Neural Transm (Vienna) 2014; 121:633-42. [DOI: 10.1007/s00702-013-1153-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/25/2013] [Indexed: 11/28/2022]
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Sette E, Capone J, Sensi M, Simioni V, Roversi G, Tugnoli V. 55. Neurophysiological monitoring during Duodopa therapy for Parkinson’s disease (PD). Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Diozzi E, Sette E, J.G.Capone, Villani G, Simioni V, Cavallo M, Farneti M, Pellegrini M, Cabboi M, Tugnoli V. 92. The role of blink reflex in intraoperative neurophysiological facial nerve monitoring during cerebellopontine angle (CPA) surgery. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simioni V, Capone J, Sette E, Cavallo M, Farneti M, Granieri E, Tola M, Tugnoli V. 89. Facial nerve monitoring during cerebellopontine angle surgery: Our experience. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sarubbo S, Latini F, Tugnoli V, Quatrale R, Granieri E, Cavallo MA. Spinal anesthesia and minimal invasive laminotomy for paddle electrode placement in spinal cord stimulation: technical report and clinical results at long-term followup. ScientificWorldJournal 2012; 2012:201053. [PMID: 22566761 PMCID: PMC3330743 DOI: 10.1100/2012/201053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/27/2011] [Accepted: 01/05/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECT We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. METHODS 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. RESULTS No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. CONCLUSIONS Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.
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Affiliation(s)
- S Sarubbo
- Division of Neurosurgery, Department of Neuroscience and Rehabilitation, University Hospital S. Anna, 203, C.so Giovecca, Ferrara, 44100 Ferrara, Italy.
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Angelini C, Semplicini C, Ravaglia S, Bembi B, Servidei S, Moggio M, Filosto M, Sette E, Pegoraro E, Crescimanno G, Tonin P, Parini R, Morandi L, Marrosu G, Greco G, Musumeci O, Di Iorio G, Siciliano G, Donati M, Mongini T, Toscano A, Vercelli L, Di Giacopo R, Lucchini V, Tugnoli V, Rigoldi M, Piras R, Giannini F, Gasperini S, Volpi L, Diodato D, Ariatti A. I-4
Long-term follow-up effects on enzyme
replacement treatment of adult form of acid
maltase deficiency myopathy. ACTA MYOLOGICA 2011. [PMCID: PMC3235867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- C. Angelini
- Coordinators of the Italian Group on GSDII, University of Padova, Torino and Messina, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - T. Mongini
- Coordinators of the Italian Group on GSDII, University of Padova, Torino and Messina, Italy
| | - A. Toscano
- Coordinators of the Italian Group on GSDII, University of Padova, Torino and Messina, Italy
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Tugnoli V, Sette E, Capone J, Cavallo M, Farneti M, Pellegrini M, Diozzi E, Villani G, Quatrale R. P12.14 Intraoperative neurophysiological facial nerve monitoring during cerebellopontine angle (CPA) surgeries: the role of blink reflex. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60417-3] [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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Sarubbo S, Latini F, Panajia A, Candela C, Quatrale R, Milani P, Fainardi E, Granieri E, Trapella G, Tugnoli V, Cavallo MA. Awake surgery in low-grade gliomas harboring eloquent areas: 3-year mean follow-up. Neurol Sci 2011; 32:801-10. [DOI: 10.1007/s10072-011-0587-3] [Citation(s) in RCA: 24] [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] [Received: 11/15/2010] [Accepted: 04/04/2011] [Indexed: 11/30/2022]
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26
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Bonora S, Di Foggia M, Markarian S, Tugnoli V. Vibrational and calorimetric study on the effect of di-n-propylsulfoxide (DPSO) on DMPC, DPPC and DMPE liposomes. J Mol Struct 2009. [DOI: 10.1016/j.molstruc.2009.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ricci R, Bacci A, Tugnoli V, Battaglia S, Maffei M, Agati R, Leonardi M. Metabolic findings on 3T 1H-MR spectroscopy in peritumoral brain edema. AJNR Am J Neuroradiol 2007; 28:1287-91. [PMID: 17698529 PMCID: PMC7977674 DOI: 10.3174/ajnr.a0564] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the metabolic properties of brain edema associated with tumors. This work was conducted on the basis of the assumption that, in the presence of intra-axial and extra-axial brain tumors, the white matter involved by the edema is a site of metabolic change that involves the structure of the myelin sheath. MATERIALS AND METHODS Thirteen patients comprised our cohort affected by intra-axial and extra-axial cerebral tumors with a peritumoral T2-weighted MR signal hyperintensity as a result of edema, where MR spectroscopy showed no increase in choline-containing compounds. Measurements on proton MR spectroscopy (1H-MR spectroscopy) were performed with a 3T whole-body scanner with use of a point-resolved spectroscopy sequence for localization (TR, 2000 ms; TE, 35 ms), and the metabolites were quantified with the SAGE method. Peak intensities of the main metabolites were expressed as ratios of one another and were compared with values obtained in the white matter of the left frontal region in a control group of 16 healthy volunteers. RESULTS Choline-to-creatine (Cho/Cr) and myo-inositol-to-creatine (mIns/Cr) signal intensity ratios were normal in all patients. N-acetylaspartate-to-creatine (NAA/Cr) and N-acetylaspartate-to-choline (NAA/Cho) ratios decreased in 4 patients. Glutamate plus glutamine-to-creatine (Glx/Cr) was increased in 10 patients. A resonance peak at 3.44 ppm, strongly suggesting the presence of glucose, was detected in all but 1 patient. Lactate was detected in 12 patients and lipids in 5. Moreover, the resonances that pertained to the aliphatic amino acids valine, leucine, and isoleucine were present in 12 patients. CONCLUSIONS Our findings on MR spectroscopy confirmed the hypothesis that in the edema surrounding brain tumors, an energy-linked metabolic alteration was associated with injury to the myelin sheath.
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Affiliation(s)
- R Ricci
- Department of Neuroradiology, Bellaria Hospital, and the Department of Biochemistry G. Moruzzi, University of Bologna, Italy.
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Devigili G, Tugnoli V, Quatrale R, Casetta I, Gastaldo E, Tola M, Lauria G, Granieri E. 264 NEUROPATHIC ITCHING SYNDROME: A PRELIMINARY STUDY. Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Muscolo A, Sidari M, Francioso O, Tugnoli V, Nardi S. The auxin-like activity of humic substances is related to membrane interactions in carrot cell cultures. J Chem Ecol 2007; 33:115-29. [PMID: 17111220 DOI: 10.1007/s10886-006-9206-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A detailed characterization of two humic fractions was performed: One with low relative molecular mass (LMr<3,500 Da) and one with high relative molecular mass (HMr>3,500 Da). Distinct (1)H NMR spectroscopic patterns were observed for the two fractions. HMr showed an aromatic proton region, an intense and broad region (3.0-5.0 ppm) attributed to sugar-like and polyether components, and an intense doublet at 1.33 ppm (identified as protons of the beta-CH(3) in lactate). In contrast, LMr did not show resonances due to aromatic protons and was characterized by a broad unresolved region, assigned to sugar-like components. The (13)C NMR spectra showed that the LMr humic fraction was richer in carboxylic and aliphatic C groups compared to HMr fraction. These substances were fluorescein-labeled [fluorescein isothiocyanate (FITC)], and their interaction with carrot cells in culture was monitored for 10 d, and compared to FITC-indole-3-acetic acid (IAA) to clarify their mechanisms of biological activity. After different incubation times, fluorescein staining of carrot cells and decrease of fluorescein concentration in the culture medium were evaluated. Fluorescent membrane staining was only present in IAA and the LMr humic fraction treated cell cultures. A consequential decrease of fluorescein concentration in the culture media was also observed. Pretreatment of carrot cells with unconjugated IAA or LMr humic fraction markedly reduced fluorescein staining of both FITC-IAA and FITC-LMr humic fraction. Blocking tests gave indirect evidence of possible binding of the LMr humic fraction to IAA cell membrane receptors. These results indicate that the two humic fractions behave differently. Only LMr humic fraction, like IAA, interacts with cellular membranes in carrot cell cultures.
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Affiliation(s)
- A Muscolo
- Department of Agricultural and Forest Systems Management, University Mediterranea of Reggio Calabria, Feo di Vito-89100, Reggio Calabria, Italy.
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Monari M, Trinchero A, Calabrese C, Cattani O, Serrazanetti GP, Foschi J, Fabbri A, Zahlane D, Di Febo G, Tonini V, Cervellera M, Tosi MR, Tugnoli V. Superoxide dismutase in gastric adenocarcinoma: is it a clinical biomarker in the development of cancer? Biomarkers 2006; 11:574-84. [PMID: 17056476 DOI: 10.1080/13547500600899134] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gastric cancer is the second most common cancer worldwide. The involvement of reactive oxygen species (ROS) in the pathogenesis of gastric malignancies is well known. Many human tumours have shown significant changes in the activity and expression of superoxide dismutase (SOD), which might be correlated with clinical-pathological parameters for the prognosis of human carcinoma. The aim of this study is the detection of MnSOD and CuZnSOD activity and their expression in gastric adenocarcinoma and healthy tissues. Gastric samples (adenocarcinoma and healthy tissues) harvested during endoscopy or resected during surgery were used to determine MnSOD and CuZnSOD activity and expression by spectrophotometric and Western blotting assays. The total SOD activity was significantly higher (p<0.05) in healthy mucosa with respect to gastric adenocarcinomas. No differences were found in MnSOD activity and, on the contrary, CuZnSOD activity was significantly lower (p<0.001) in cancer samples with respect to normal mucosa. The rate of MnSOD/CuZnSOD activity in adenocarcinoma was over ninefold higher than that registered in healthy tissues (p<0.05). Moreover, in adenocarcinoma MnSOD activity represented the 83% of total SOD with respect to healthy tissues where the ratio was 52% (p<0.001). On the contrary, in cancer tissues, CuZnSOD activity accounted for only 17% of the total SOD (p<0.001 if compared with the values recorded in normal mucosa). After immunoblotting, MnSOD was more expressed in adenocarcinoma with respect to normal mucosa (p<0.001), while CuZnSOD was similarly expressed in adenocarcinoma and healthy tissues. The SOD activity assay might provide a specific and sensitive method of analysis that allows the differentiation of healthy tissue from tumour tissue. The MnSOD to CuZnSOD activity ratio, and the ratio between these two isoforms and total SOD, presented in this preliminary study might be considered in the identification of cancerous from healthy control tissue.
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Affiliation(s)
- M Monari
- Dipartimento di Biochimica G. Moruzzi, Università di Bologna, Bologna, Italy.
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Tugnoli V, Mucci A, Schenetti L, Righi V, Calabrese C, Fabbri A, Di Febo G, Tosi MR. Ex vivo HR-MAS Magnetic Resonance Spectroscopy of human gastric adenocarcinomas: a comparison with healthy gastric mucosa. Oncol Rep 2006; 16:543-53. [PMID: 16865254 DOI: 10.3892/or.16.3.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/06/2022] Open
Abstract
The present study reports the characteristics of the biochemical profile of human gastric adenocarcinoma in comparison with that of healthy gastric mucosa, using ex vivo HR-MAS Magnetic Resonance Spectroscopy. Healthy human mucosa is mainly characterized by the presence of small metabolites (more than 50 identified) and macromolecules, whereas the adenocarcinoma spectra are dominated by the presence of signals due to triglycerides, whose content on the contrary is very low in healthy gastric mucosa. The use of spin-echo experiments enable us to detect some metabolites in the unhealthy tissues and to determine their variation with respect to the healthy ones. We have observed that the Cho:ChoCC ratio changes from 20:80 in the healthy tissues to 80:20 in the neoplastic gastric mucosa.
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Affiliation(s)
- V Tugnoli
- Dipartimento di Biochimica G. Moruzzi, Università di Bologna, 40126 Bologna, Italy
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Eleopra R, Tugnoli V, Quatrale R, Rossetto O, Montecucco C, Dressler D. Clinical use of non-A botulinum toxins: botulinum toxin type C and botulinum toxin type F. Neurotox Res 2006; 9:127-31. [PMID: 16785109 DOI: 10.1007/bf03033930] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Botulinum neurotoxin (BoNT) serotype A is commonly used in the treatment of focal dystonia, but some patients are primarily or become secondarily resistant to it. Consequently, other serotypes have to be used when immuno-resistance is proven. In the literature, patients with focal dystonia have been treated with BoNT serotype F with clinical benefit but with short lasting effects. Recently, BoNT serotype C has been used with positive clinical outcome. An update on the clinical use of BoNT serotype F and BoNT serotype C is provided.
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Affiliation(s)
- R Eleopra
- Clinical Neuroscience Department, Neurology Section, Umberto I Hospital, Venice, Italy.
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33
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Tugnoli V, Schenetti L, Mucci A, Nocetti L, Toraci C, Mavilla L, Basso G, Rovati R, Tavani F, Zunarelli E, Righi V, Tosi MR. A comparison between in vivo and ex vivo HR-MAS 1H MR spectra of a pediatric posterior fossa lesion. Int J Mol Med 2005; 16:301-7. [PMID: 16012766 DOI: 10.3892/ijmm.16.2.301] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present case report was aimed at identifying the molecular profile characteristic of a primitive neuro-ectodermal tumor (PNET) in a 3-year-old child affected by a lesion localized in the cerebellar region. The histological diagnosis was medulloblastoma. In vivo single voxel 1H magnetic resonance spectroscopy (MRS) shows high specificity in detecting the main metabolic alterations in the primitive cerebellar lesion; a very high amount of the choline-containing compounds and very low level of creatine derivatives and N-acetylaspartate. Ex vivo high resolution magic angle spinning (HR-MAS) 1H magnetic resonance spectroscopy, performed at 9.4 Tesla on the neoplastic specimen collected during surgery, allows for the unambiguous identification of several metabolites giving a more in-depth evaluation of the metabolic pattern of the lesion. The ex vivo HR-MAS MR spectra show that the spectral detail is much higher than that obtained in vivo and that, for example, myo-inositol, taurine and phosphorylethanolamine contribute to the in vivo signal at 3.2 ppm, usually attributed to choline-containing compounds. In addition, the spectroscopic data appear to correlate with some morphological features of the medulloblastoma. Consequently, the present study shows that ex vivo HR-MAS 1H MRS is able to strongly improve the clinical possibility of in vivo MRS and can be used in conjunction with in vivo spectroscopy for clinical purposes.
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Affiliation(s)
- V Tugnoli
- Dipartimento di Biochimica, Università di Bologna, via Belmeloro 8/2, 40126 Bologna, Italy.
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Abstract
Since Alan Scott's research, botulinum toxin (BoNT) has been used in several diseases or conditions characterised by muscular overactivity. BoNT acts on either neuromuscular or autonomic cholinergic junctions. Seven different serotypes are known, with antigenic specificity and different therapeutic profiles. BoNT is made up of a heavy chain, involved in binding and membrane translocation, and a light chain, involved in blocking neuroexcytosis. Each serotype shares a specific acceptor on the presynaptic membrane of a cholinergic junction. The available BoNT preparations differ in toxicity, purity and stability. Injection of the neurotoxin produces several modifications at a neuromuscular junction. Axonal sprouting, muscular fibre atrophy, and new end-plates are the most evident histological events after BoNT treatment. They appear to be reversible in untreated muscles. Diffusion can occur at first by haematogeneous or local BoNT spread. Several factors, such as dose, volume, site of injection, muscle size, and muscular fascia, can influence the amount of diffusion and possible side-effects. After prolonged BoNT treatment patients can become unresponsive. Antibodies directed against BoNT have been observed with ELISA or mouse bioassay. Different serotypes have been used to treat non-responder patients. Novel toxins with lower immunogenicity and prolonged clinical efficacy are required for more effective treatment.
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Affiliation(s)
- V Tugnoli
- Neurological Department, St Anna Hospital, Corso Giovecca 203, 44100 Ferrara, Italy
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Tugnoli V, Mucci A, Schenetti L, Calabrese C, Di Febo G, Rossi MC, Tosi MR. Molecular characterization of human gastric mucosa by HR-MAS magnetic resonance spectroscopy. Int J Mol Med 2005; 14:1065-71. [PMID: 15547675 DOI: 10.3892/ijmm.14.6.1065] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present study was aimed at identifying the molecular profile characteristic of the healthy human gastric mucosa. Ex vivo HR-MAS magnetic resonance spectroscopy performed at 9.4 Tesla (400.13 MHz for (1)H) on gastric specimens collected during endoscopy, permits the identification of more than forty species giving a detailed picture of the biochemical pattern of the gastric tissues. These preliminary data will be used for a comparison with gastric preneoplastic and neoplastic situations. Moreover, the full knowledge of the biochemical pattern of the healthy gastric tissues is the necessary presupposition for the application of magnetic resonance spectroscopy directly in vivo.
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Affiliation(s)
- V Tugnoli
- Dipartimento di Biochimica 'G. Moruzzi', I-40126 Bologna, Italy.
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36
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Tosi MR, Rodriguez-Estrada MT, Lercker G, Poerio A, Trinchero A, Reggiani A, Tugnoli V. Magnetic resonance spectroscopy and chromatographic methods identify altered lipid composition in human renal neoplasms. Int J Mol Med 2005; 14:93-100. [PMID: 15202022 DOI: 10.3892/ijmm.14.1.93] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report on the characterization of the lipid obtained from cortical and medullary normal human kidney tissue, benign renal neoplasms (oncocytoma) and 2 different types of malignant renal neoplasms (chromophobic cell carcinoma and clear cell carcinoma). The total lipid fractions were analyzed by 13C magnetic resonance spectroscopy and thin-layer chromatography, whereas the composition of the total fatty acids and the content of total cholesterol were determined by gas chromatography. alpha-Tocopherol was detected and quantified by high-performance liquid chromatography. The spectroscopic and chromatographic analysis revealed significant differences in the renal tissues examined. It was confirmed that cholesteryl esters (mainly oleate) are typical of clear cell renal carcinomas. Their potential role as prognostic and diagnostic factors is discussed, with particular emphasis on its capability to indicate the tumor diffusion in healthy renal parenchyma. alpha-Tocopherol is prevalent in clear cell carcinoma and it is present in nearly the same low amounts in cortex, medulla and chromophobic cell renal carcinoma. Q10 coenzyme and dolichols were detected by thin-layer chromatography and they are present in significant amounts in the cortex and the benign oncocytoma. Great variations were found in the distribution of saturated and unsaturated fatty acids, especially in the docosapentaenoic, docosahexaenoic and arachidonic acids and the corresponding omega-6/omega-3 fatty acids ratio.
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Affiliation(s)
- M R Tosi
- Dipartimento di Biochimica, Sezione di Chimica e Propedeutica Biochimica, I-40126 Bologna, Italy.
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Tugnoli V, Poerio A, Tosi MR. Phosphatidylcholine and cholesteryl esters identify the infiltrating behaviour of a clear cell renal carcinoma: 1H, 13C and 31P MRS evidence. Oncol Rep 2005; 12:353-6. [PMID: 15254701 DOI: 10.3892/or.12.2.353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/06/2022] Open
Abstract
This study presents a multinuclear (1H, 13C and 31P) magnetic resonance spectroscopy characterization of the total lipid fraction extracted from different regions of a human kidney affected by a clear cell renal carcinoma. It was thus possible to demonstrate that cholesteryl esters and phosphatidylcholine are markers of the tumor infiltration, histologically confirmed, in the kidney medulla. The tumor tissue contains twice the amount of phosphatidylcholine compared to normal cortex. The results appear relevant in light of new clinical applications based on the biochemical composition of human tissues.
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Affiliation(s)
- V Tugnoli
- Dipartimento di Biochimica G. Moruzzi, Sez. di Chimica e Propedeutica Biochimica, 40126 Bologna, Italy.
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38
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Sensi M, Eleopra R, Cavallo MA, Sette E, Milani P, Quatrale R, Capone JG, Tugnoli V, Tola MR, Granieri E, Data PG. Explosive-aggressive behavior related to bilateral subthalamic stimulation. Parkinsonism Relat Disord 2004; 10:247-51. [PMID: 15120100 DOI: 10.1016/j.parkreldis.2004.01.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [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: 07/24/2003] [Revised: 01/08/2004] [Accepted: 01/12/2004] [Indexed: 10/26/2022]
Abstract
We describe a patient with Parkinson's Disease who underwent bilateral subthalamic nucleus deep brain stimulation and later presented with episodes of aggressive behavior disorder with disturbed impulse control and an inability to control anger likely related to the deep brain stimulation "switch-on stimulation". We hypothesize that increasing voltage intensity could influence neighboring passing fibers coming from basal limbic system that are involved in the regulation of affect and emotional behavior. We suggest investigating these neuropsychological disturbances considering their influence on quality of life after surgery.
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Affiliation(s)
- M Sensi
- Dipartimento di Neuroscienze applicate alla clinica, U.O. Neurologia, Azienda Ospedaliera Universitaria S. Anna, Hospital of Ferrara, Corso Giovecca 203, Ferrara 44100, Italy.
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Nolano M, Provitera V, Perretti A, Saltalamacchia AM, Tugnoli V, Donadio V, Manganelli F, Santoro L. Cutaneous innervation in ross syndrome: a functional and morphological study in 8 patients. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209ah.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Quatrale R, Manconi M, Gastaldo E, Eleopra R, Tugnoli V, Tola MR, Granieri E. Neurophysiological study of corticomotor pathways in restless legs syndrome. Clin Neurophysiol 2003; 114:1638-45. [PMID: 12948792 DOI: 10.1016/s1388-2457(03)00137-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To test the variations in cerebral motor excitability in patients with primary restless legs syndrome (RLS) by using electrophysiological techniques. In RLS patients periodic legs movements (PLMs) in sleep and wake have been described and it is hypothesised that PLMs result from a sleep-related disinhibition of descending central motor inhibitory pathways. Moreover, in primary RLS, these modifications are still debated. METHODS In 15 patients with primary RLS, transcranial magnetic stimulation (TMS) was carried out using several paradigms, particularly paired pulse TMS with short interstimulus intervals (ISI) in abductor digiti minimi (ADM) and tibialis anterior (TA) muscles. RESULTS Short ISI paired TMS showed a significant decrease in inhibition and increase in facilitation in ADM muscles. This result was even more evident in TA muscles of patients as compared to the controls and these modifications were more evident in the limbs which were more affected by PLM. Moreover, intracortical (corticocortical) inhibition (ICI) and intracortical facilitation (ICF) unchanged their biphasic time course. CONCLUSIONS In our study the changes in short paired-pulse ICI and ICF revealed the presence of an altered excitability of central motor pathways, with good correlation with asymmetric distribution of symptoms.
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Affiliation(s)
- R Quatrale
- Department of Neurology, S. Anna Hospital, University of Ferrara, C.so Giovecca, 203 I-44100 Ferrara, Italy.
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Francioso O, Ciavatta C, Montecchio D, Tugnoli V, Sánchez-Cortés S, Gessa C. Quantitative estimation of peat, brown coal and lignite humic acids using chemical parameters, 1H-NMR and DTA analyses. Bioresour Technol 2003; 88:189-195. [PMID: 12618040 DOI: 10.1016/s0960-8524(03)00004-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Humic acids extracted from peats (P), brown coals (BC) and lignites (L), were characterized using different (chemical, 1H-nuclear magnetic resonance spectroscopy and differential thermal analysis) techniques. Fourteen variables were obtained from these analyses and only five were selected because uncorrelated in multiple partial correlation. The chosen variables were C concentration, aliphatic and aromatic components and the heat of reaction of the second exothermic peak. The multivariate discriminant analysis was performed on these variables and a discriminant function was obtained which was able to efficiently separate the P, BC and L. This function enables simple predictions on samples of unknown origin. The straightforward method proposed and the results obtained are discussed.
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Affiliation(s)
- O Francioso
- Dipartimento di Scienze e Tecnologie Agroambientali, Università degli Studi di Bologna, V.le Fanin 40, Bologna 40126, Italy.
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Tosi MR, Reggiani A, Tugnoli V. Are molecular features of a chromophobic cell renal cell carcinoma correlated with clinical findings? Int J Mol Med 2003; 12:99-102. [PMID: 12792817 DOI: 10.3892/ijmm.12.1.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lipids extracted from three human renal neoplasms have been characterized by means of 13C magnetic resonance spectroscopy. The presence of free cholesterol, high levels of unsatured fatty acids, and phosphatidylcholine, and a very high fatty acids/cholesterol ratio makes the lipid profile of a rare chromophobe cell carcinoma very similar to that of an oncocytoma. On the contrary, clear cell carcinomas are mainly characterized by the presence of almost fully esterified cholesterol and by a markedly lower level of unsatured fatty acids. Since chromophobic cell carcinomas have a more favourable prognosis than clear cell carcinomas, their analogy in the lipid composition with a benign renal neoplasm could have a clinical significance. In particular, our report suggests that cholesteryl esters and high levels of unsatured fatty acids could be a marker of a poor (clear cell carcinomas) or a good (chromophobic cell carcinomas) prognosis, respectively. More in depth studies are required of the molecular composition of the neoplastic pathologies that add new knowledge, with potential clinical implications.
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Affiliation(s)
- M R Tosi
- ITOI-CNR, Sezione di Bologna, presso IOR, v. di Barbiano 1/10, I-40136 Bologna, Italy.
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Gastaldo E, Graziani A, Paiardi M, Quatrale R, Eleopra R, Tugnoli V, Granieri E. Recovery cycle of the masseter inhibitory reflex after magnetic stimulation in normal subjects. Clin Neurophysiol 2003; 114:1253-8. [PMID: 12842722 DOI: 10.1016/s1388-2457(03)00079-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
OBJECTIVE To evaluate the differences in the recovery cycle of the masseter inhibitory reflex (MIR) obtained with electrical and magnetic stimulation. METHODS In 31 healthy subjects we studied the MIR evoked by electrical or magnetic stimulation of the mental territory and the recovery cycle of this reflex with the paired stimuli technique at different interstimulus intervals (ISI), between 100 and 600 ms. RESULTS Latency and area of the early and late silent periods (SPs) of the MIR were similar after electrical and magnetic stimulation. The recovery cycle of the test late SP was similar with the two kinds of stimulation, except for short ISIs. The main difference between the two kinds of stimulation was in the painful quality of the stimulus: the magnetic stimuli were always below pain threshold. CONCLUSIONS As with electrical stimulation, it is possible to obtain a MIR with magnetic peripheral stimulation. The magnetic paired stimuli are equally effective in the evaluation of the recovery cycle of the MIR. The results demonstrate that magnetic stimulation is a useful tool in the evaluation of excitability of the trigeminal motoneuronal system, with little discomfort for the patient. They also confirm the unlikelihood of nociceptive afferences involvement.
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Affiliation(s)
- E Gastaldo
- Neuroscience Department, Neurophysiology Unit, University of Ferrara, Ferrara, Italy.
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Abstract
Lipids from human renal tissues are studied by means of (1)H- and (13)C-NMR spectroscopy. The total lipid fractions obtained from healthy kidneys, malignant renal cell carcinomas, and benign oncocytomas are characterized and analyzed to elucidate the main differences between the functional and neoplastic tissues. In all cases the lipid components are well identified. The healthy kidney is characterized by high amounts of triglycerides and the presence of cholesterol in its free form. On the contrary, renal cell carcinomas contain high amounts of cholesterol that are almost completely esterified as oleate, suggesting an intracellular localization of the cholesteryl esters synthesis. Cholesteryl esters are considered markers of renal cell carcinomas, thus supporting recent theories that these compounds play a leading role in cell proliferation. Oncocytomas are particularly rich in phosphatidylcholine and, analogous to the healthy kidney, are completely lacking in cholesteryl esters. Healthy kidneys and oncocytomas appear to have other similarities if compared with renal cell carcinomas: a very high fatty acyl/cholesterol ratio, the presence of dolichols, and a higher grade of unsaturation. The (13)C data suggest a new method for the direct evaluation of the saturated/unsaturated fatty acyl ratio.
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Affiliation(s)
- V Tugnoli
- Dipartimento di Biochimica G. Moruzzi, Sezione di Chimica e Propedeutica Biochimica, Università di Bologna, Via Belmeloro 8/2, 40126 Bologna, Italy.
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45
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Eleopra R, Quatrale R, Tugnoli V. [Treatment of spasticity with botulinum toxin]. J Neurosurg Sci 2003; 47:68-73. [PMID: 14631679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- R Eleopra
- Dipartimento di Neuroscienze Azienda Ospedaliera Universitaria Arcispedale S. Anna di Ferrara, Ferrara, Italy
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46
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Perretti A, Nolano M, De Joanna G, Tugnoli V, Iannetti G, Provitera V, Cruccu G, Santoro L. Is Ross syndrome a dysautonomic disorder only? An electrophysiologic and histologic study. Clin Neurophysiol 2003; 114:7-16. [PMID: 12495758 DOI: 10.1016/s1388-2457(02)00323-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To define the involvement of peripheral nerve fibers in Ross syndrome. METHODS Mechanical pain perception, tactile and thermal thresholds on hand, foot dorsum, thigh, median nerve orthodromic sensory conduction velocity (SCV) and motor conduction velocity (MCV), sural nerve antidromic SCV, peroneal nerve MCV, H-reflex, F-wave, median, tibial nerve somatosensory evoked potentials (SSEPs), perioral, hand CO(2) laser late (LEPs) and ultralate evoked potentials, sympathetic skin response (SSRs), cardiovascular, Minor sweat, silastic imprint, histamine, photopletysmographic and pupil pilocarpine tests, cutaneous innervation immunohistochemical techniques were studied in 3 patients with Ross syndrome. RESULTS Quantitative sensory testing showed altered results in patients 1 and 2, and patient 3 had a slight impairment of mechanical pain perception. Nerve conduction, except for a median nerve distal reduction of sensory conduction in patient 1, F-wave and SSEP findings were normal; H-reflex was absent at rest in all patients. Hand LEPs were absent in patient 2, ultralate potentials were absent in patients 1 and 2. Skin biopsy showed a disease duration related reduction of unmyelinated and myelinated sensory fibers and a lack of unmyelinated autonomic fibers in all patients. CONCLUSIONS Our data suggest that Ross syndrome is a degenerative disorder involving progressive sudomotor fibers, and then epidermal sensory unmyelinated and myelinated fibers.
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Affiliation(s)
- A Perretti
- Department of Neurological Sciences, University of Naples 'Federico II', Via Sergio Pansini 5, Naples, Italy
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47
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Abstract
Cholesteryl esters (CholE) were detected in human malignant neoplasms by means of in vitro nuclear magnetic resonance spectroscopy. Spectroscopic analysis of the total lipid extracts obtained from cerebral tumors revealed appreciable amount of esterified cholesterol in high grade gliomas such as glioblastomas and anaplastic oligodendrogliomas, characterized by prominent neovascularity. The finding that no CholE were detected in the healthy brain and in low grade and benign tumors supports a possible correlation between this class of lipids and histological vascular proliferation. Compared with high grade gliomas, renal cell carcinomas show higher levels of CholE, absent in the healthy renal parenchyma and in benign oncocytomas. In nefro-carcinomas, cytoplasmic lipid inclusions and prominent vascularization contribute to the increased levels of CholE present mainly as oleate. CholE are discussed as potential biochemical markers of cancer and as a target for new therapeutic strategies.
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Affiliation(s)
- M R Tosi
- Istituto di Citomorfologia Normale e Patologica del CNR, Bologna, Italy.
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48
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Taddei P, Tugnoli V, Bottura G, Dallavalle E, Zechini D'Aulerio A. Vibrational, 1H-NMR spectroscopic, and thermal characterization of gladiolus root exudates in relation to Fusarium oxysporum f. sp. gladioli resistance. Biopolymers 2002; 67:428-39. [PMID: 12209451 DOI: 10.1002/bip.10170] [Citation(s) in RCA: 15] [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: 12/14/2022]
Abstract
Fourier transform Raman (FT Raman) and IR (FTIR) and (1)H-NMR spectroscopies coupled with differential scanning calorimetry (DSC) were applied to the characterization of root exudates from two cultivars of gladiolus (Spic Span and White Prosperity) with different degrees of resistance and susceptibility to Fusarium oxysporum gladioli, the main pathogen of gladiolus. This work was aimed at correlating the composition of root exudates with the varietal resistance to the pathogen. Spectroscopic analysis showed that White Prosperity root exudate differs from Spic Span root exudate by a higher relative amount of the aromatic-phenolic and sugarlike components and a lower relative amount of carbonylic and aliphatic compounds. DSC analysis confirmed the spectroscopic results and showed that White Prosperity root exudate is characterized by an aromatic component that is present in a higher amount than in the Spic Span root exudate. The results are discussed in relation to the spore germination tests showing that White Prosperity, which is characterized by a remarkable resistance toward F. oxysporum gladioli, exudes substances having a negative influence on microconidial germination of the pathogen; root exudates from Spic Span, one of the most susceptible cultivars to F. oxysporum gladioli, proved to have no effect. White Prosperity's ability to inhibit conidial germination of F. oxysporum gladioli can be mainly related to the presence of a higher relative amount of aromatic-phenolic compounds.
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Affiliation(s)
- P Taddei
- Dipartimento di Biochimica G. Moruzzi, Sezione di Chimica e Propedeutica Biochimica, Centro di Studio sulla Spettroscopia Raman, Università degli Studi di Bologna, Via Belmeloro 8/2, 40126 Bologna, Italy
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49
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Tugnoli V, Eleopra R, Quatrale R, Capone JG, Sensi M, Gastaldo E. Botulism-like syndrome after botulinum toxin type A injections for focal hyperhidrosis. Br J Dermatol 2002; 147:808-9. [PMID: 12366438 DOI: 10.1046/j.1365-2133.2002.49101.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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Tugnoli V, Marchese Ragona R, Eleopra R, Quatrale R, Capone JG, Pastore A, Montecucco C, De Grandis D. The role of gustatory flushing in Frey's syndrome and its treatment with botulinum toxin type A. Clin Auton Res 2002; 12:174-8. [PMID: 12269549 DOI: 10.1007/s10286-002-0026-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [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: 10/27/2022]
Abstract
After parotid surgery, gustatory sweating and flushing occur more frequently, the former reportedly in 15-100% of cases, while no reliable data are available for the latter. Although botulinum toxin (BoNT) is effective in controlling sweating, little is known about its effect on flushing. In 17 patients suffering from Frey's syndrome after parotid surgery, we studied the gustatory flushing phenomenon as compared to gustatory sweating, analyzing their frequency, area, type of stimulus and response to BoNT administration. Cutaneous blood flow (CBF) was monitored by laser Doppler flowmetry (LDF) on affected and unaffected areas of the cheek in basal conditions and after meals, before and then 1 month after starting the BoNT injections. The Minor test was used to identify the sweating area. Flushing was observed in 7 of 17 patients after masticatory activity, spicy meals or citrus fruits. No clinical data correlated with any presence of flushing. Flushing regressed completely after BoNT administration and CBF reached similar values in the affected and unaffected sites. No adverse effects were observed. BoNT administration proved an effective and safe treatment for gustatory sweating and flushing in patients with Frey's syndrome.
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Affiliation(s)
- V Tugnoli
- Neurology Department, S.Anna Hospital, Ferrara, Italy.
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