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Sisodiya SM, Gulcebi MI, Fortunato F, Mills JD, Haynes E, Bramon E, Chadwick P, Ciccarelli O, David AS, De Meyer K, Fox NC, Davan Wetton J, Koltzenburg M, Kullmann DM, Kurian MA, Manji H, Maslin MA, Matharu M, Montgomery H, Romanello M, Werring DJ, Zhang L, Friston KJ, Hanna MG. Climate change and disorders of the nervous system. Lancet Neurol 2024; 23:636-648. [PMID: 38760101 DOI: 10.1016/s1474-4422(24)00087-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 05/19/2024]
Abstract
Anthropogenic climate change is affecting people's health, including those with neurological and psychiatric diseases. Currently, making inferences about the effect of climate change on neurological and psychiatric diseases is challenging because of an overall sparsity of data, differing study methods, paucity of detail regarding disease subtypes, little consideration of the effect of individual and population genetics, and widely differing geographical locations with the potential for regional influences. However, evidence suggests that the incidence, prevalence, and severity of many nervous system conditions (eg, stroke, neurological infections, and some mental health disorders) can be affected by climate change. The data show broad and complex adverse effects, especially of temperature extremes to which people are unaccustomed and wide diurnal temperature fluctuations. Protective measures might be possible through local forecasting. Few studies project the future effects of climate change on brain health, hindering policy developments. Robust studies on the threats from changing climate for people who have, or are at risk of developing, disorders of the nervous system are urgently needed.
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Affiliation(s)
- Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK.
| | - Medine I Gulcebi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Francesco Fortunato
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - James D Mills
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Ethan Haynes
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, UK
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Anthony S David
- Division of Psychiatry, University College London, London, UK
| | - Kris De Meyer
- UCL Climate Action Unit, University College London, London, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of the UK Dementia Research Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dimitri M Kullmann
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manju A Kurian
- Department of Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hadi Manji
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Mark A Maslin
- Department of Geography, University College London, London, UK; Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, UCL and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Marina Romanello
- Institute for Global Health, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lisa Zhang
- Centre for Behaviour Change, University College London, London, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Michael G Hanna
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; MRC International Centre for Genomic Medicine in Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
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Yahya V, Dilena R, Del Bo R, Magni M, Biella F, Salani S, Fortunato F, Scola E, Di Fonzo A, Monfrini E. Soft cerebellar signs unveil RARS2-related epilepsy. Epileptic Disord 2024. [PMID: 38733322 DOI: 10.1002/epd2.20237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Vidal Yahya
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Robertino Dilena
- Neurophysiopathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Del Bo
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manuela Magni
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Biella
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sabrina Salani
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Fortunato
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisa Scola
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Monfrini
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Rosati E, Catania C, Ferlazzo E, Casciato S, Di Gennaro G, Pizzanelli C, Giuliano L, Viola V, Mostacci B, Pignatta P, Fortunato F, Pulitano P, Panzini C, Gambardella A, Atalar AÇ, Labate A, Operto FF, Giallonardo AT, Baykan BB, Beier CP, Di Bonaventura C. Predictors of Seizure Recurrence in Women With Idiopathic Generalized Epilepsy Who Switch From Valproate to Another Medication. Neurology 2024; 102:e209222. [PMID: 38569127 DOI: 10.1212/wnl.0000000000209222] [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] [Received: 07/27/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the predictors of seizure recurrence in women of childbearing age with idiopathic generalized epilepsy (IGE) who switched from valproate (VPA) to alternative antiseizure medications (ASMs) and compare the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) as VPA alternatives after switch. METHODS This multicenter retrospective study included women of childbearing age diagnosed with IGE from 16 epilepsy centers. Study outcomes included worsening or recurrence of generalized tonic-clonic seizure (GTCS) at 12 months and 24 months after the switch from VPA to an alternative ASM. The comparative effectiveness of LEV and LTG as alternative ASM following VPA discontinuation was assessed through inverse probability treatment-weighted (IPTW) Cox regression analysis. RESULTS We included 426 women with IGE, with a median (interquartile range) age at VPA switch of 24 (19-30) years and a median VPA dosage of 750 (500-1,000) mg/d. The most common reason for VPA switch was teratogenicity concern in 249 women (58.6%), and the most common ASM used in place of VPA was LEV in 197 (46.2%) cases, followed by LTG in 140 (32.9%). GTCS worsening/recurrence occurred in 105 (24.6%) and 139 (32.6%) women at 12 and 24 months, respectively. Catamenial worsening of seizures, higher VPA dosage during switch, multiple seizure types, and shorter duration of GTCS freedom before switch were independent predictors of GTCS recurrence or worsening at 12 months according to mixed multivariable logistic regression analysis. After internal-external validation through 16 independent cohorts, the model showed an area under the curve of 0.71 (95% CI 0.64-0.77). In the subgroup of 337 women who switched to LEV or LTG, IPTW Cox regression analysis showed that LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG (adjusted hazard ratio 0.59, 95% CI 0.40-0.87, p = 0.008) during the 24-month follow-up. DISCUSSION Our findings can have practical implications for optimizing counselling and treatment choices in women of childbearing age with IGE and may help clinicians in making informed treatment decisions in this special population of patients. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for women with IGE switching from VPA, LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG.
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Affiliation(s)
- Emanuele Cerulli Irelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Enrico Cocchi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Alessandra Morano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Joanna Gesche
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Roberto H Caraballo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Simona Lattanzi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Gionata Strigaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Eleonora Rosati
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Cecilia Catania
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Edoardo Ferlazzo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Sara Casciato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Giancarlo Di Gennaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Pizzanelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Loretta Giuliano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Veronica Viola
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Barbara Mostacci
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Pietro Pignatta
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesco Fortunato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Patrizia Pulitano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Panzini
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Antonio Gambardella
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Arife Çimen Atalar
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Angelo Labate
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesca Felicia Operto
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Anna T Giallonardo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Betül B Baykan
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Christoph P Beier
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Carlo Di Bonaventura
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
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4
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Kerestes R, Perry A, Vivash L, O'Brien TJ, Alvim MKM, Arienzo D, Aventurato ÍK, Ballerini A, Baltazar GF, Bargalló N, Bender B, Brioschi R, Bürkle E, Caligiuri ME, Cendes F, de Tisi J, Duncan JS, Engel JP, Foley S, Fortunato F, Gambardella A, Giacomini T, Guerrini R, Hall G, Hamandi K, Ives-Deliperi V, João RB, Keller SS, Kleiser B, Labate A, Lenge M, Marotta C, Martin P, Mascalchi M, Meletti S, Owens-Walton C, Parodi CB, Pascual-Diaz S, Powell D, Rao J, Rebsamen M, Reiter J, Riva A, Rüber T, Rummel C, Scheffler F, Severino M, Silva LS, Staba RJ, Stein DJ, Striano P, Taylor PN, Thomopoulos SI, Thompson PM, Tortora D, Vaudano AE, Weber B, Wiest R, Winston GP, Yasuda CL, Zheng H, McDonald CR, Sisodiya SM, Harding IH. Patterns of subregional cerebellar atrophy across epilepsy syndromes: An ENIGMA-Epilepsy study. Epilepsia 2024; 65:1072-1091. [PMID: 38411286 DOI: 10.1111/epi.17881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The intricate neuroanatomical structure of the cerebellum is of longstanding interest in epilepsy, but has been poorly characterized within the current corticocentric models of this disease. We quantified cross-sectional regional cerebellar lobule volumes using structural magnetic resonance imaging in 1602 adults with epilepsy and 1022 healthy controls across 22 sites from the global ENIGMA-Epilepsy working group. METHODS A state-of-the-art deep learning-based approach was employed that parcellates the cerebellum into 28 neuroanatomical subregions. Linear mixed models compared total and regional cerebellar volume in (1) all epilepsies, (2) temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), (3) nonlesional temporal lobe epilepsy, (4) genetic generalized epilepsy, and (5) extratemporal focal epilepsy (ETLE). Relationships were examined for cerebellar volume versus age at seizure onset, duration of epilepsy, phenytoin treatment, and cerebral cortical thickness. RESULTS Across all epilepsies, reduced total cerebellar volume was observed (d = .42). Maximum volume loss was observed in the corpus medullare (dmax = .49) and posterior lobe gray matter regions, including bilateral lobules VIIB (dmax = .47), crus I/II (dmax = .39), VIIIA (dmax = .45), and VIIIB (dmax = .40). Earlier age at seizure onset (η ρ max 2 = .05) and longer epilepsy duration (η ρ max 2 = .06) correlated with reduced volume in these regions. Findings were most pronounced in TLE-HS and ETLE, with distinct neuroanatomical profiles observed in the posterior lobe. Phenytoin treatment was associated with reduced posterior lobe volume. Cerebellum volume correlated with cerebral cortical thinning more strongly in the epilepsy cohort than in controls. SIGNIFICANCE We provide robust evidence of deep cerebellar and posterior lobe subregional gray matter volume loss in patients with chronic epilepsy. Volume loss was maximal for posterior subregions implicated in nonmotor functions, relative to motor regions of both the anterior and posterior lobe. Associations between cerebral and cerebellar changes, and variability of neuroanatomical profiles across epilepsy syndromes argue for more precise incorporation of cerebellar subregional damage into neurobiological models of epilepsy.
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Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Perry
- Monash Bioinformatics Platform, Monash University, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Marina K M Alvim
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Donatello Arienzo
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
| | - Ítalo K Aventurato
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Alice Ballerini
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriel F Baltazar
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Núria Bargalló
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ricardo Brioschi
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Eva Bürkle
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jerome P Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Renzo Guerrini
- Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Gerard Hall
- School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | | | - Rafael B João
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict Kleiser
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Matteo Lenge
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - Cassandra Marotta
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mario Mascalchi
- "Mario Serio" Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and Network in Oncology of the Tuscany Region, Florence, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Conor Owens-Walton
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | | | - Saül Pascual-Diaz
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Powell
- Monash Bioinformatics Platform, Monash University, Melbourne, Victoria, Australia
| | - Jun Rao
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Lucas S Silva
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Peter N Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | | | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St. Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, Kingston, Ontario, Canada
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Hong Zheng
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
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5
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Sammarra I, Caligiuri ME, Bonacci MC, Di Gennaro G, Fortunato F, Martino I, Giugno A, Labate A, Gambardella A. May anti-seizure medications alter brain structure in temporal lobe epilepsy? A prospective study. Epilepsia Open 2024. [PMID: 38475905 DOI: 10.1002/epi4.12912] [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: 06/09/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
Mild mesial temporal lobe epilepsy (MTLE) patients may remain untreated for a considerable time after disease onset or achieve seizure control with a single anti-seizures medication (ASM). Thus, they represent an optimal population to investigate whether ASMs might have influence on brain structure. We consecutively enrolled 56 mild MTLE patients (22/56 untreated, 34/56 on-monotherapy) and 58 healthy controls, matched for age and gender. All subjects underwent 3T-brain MRI, using FreeSurfer for automated morphometry. Differences in gray matter were assessed using one-way Analysis of Covariance (ANCOVA), adjusting for age, disease duration and intracranial volume. No significant change was observed between treated and untreated patients. We observed a significant reduction in cortical thickness of left inferior parietal, inferior temporal, middle temporal gyri, and right inferior parietal gyrus, temporal pole in monotherapy patients compared to healthy controls, as well as an increase in left isthmus of cingulate gyrus in untreated MTLE subjects compared to controls. Surface and subcortical volumes analysis revealed no differences among groups. Our study demonstrated no substantial morphological abnormalities between untreated mild MTLE patients and those undergoing monotherapy. Although exploratory, these results may reassure about safety of commonly used drugs and their marginal role in influencing neuroimaging results. PLAIN LANGUAGE SUMMARY: This study investigated the following question: can medications against epileptic seizures have an effect on brain structure in mild mesial temporal lobe? Preliminary results from our analyses suggest not, as we did not find any difference in brain gray matter between untreated patients and those treated with a single anti-seizures medication. On the other hand, epilepsy patients presented cortical thinning compared to healthy controls in several regions of the temporal and parietal lobes, in line with previous studies investigating the disease.
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Affiliation(s)
- Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maria Celeste Bonacci
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Iolanda Martino
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alessia Giugno
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
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6
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Cerulli Irelli E, Cocchi E, Mostacci B, Orlando B, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Catania C, Pulitano P, Panzini C, Ferlazzo E, Pascarella A, Casciato S, Pizzanelli C, Giuliano L, Viola V, Fortunato F, Di Gennaro G, Gambardella A, Labate A, Operto FF, Giallonardo AT, Baykan B, Beier CP, Di Bonaventura C. Topiramate ban in women of childbearing potential with idiopathic generalized epilepsy: Does effectiveness offset the teratogenic risks? Epilepsia 2024; 65:e27-e34. [PMID: 38294338 DOI: 10.1111/epi.17892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
Regulatory agencies have recently discouraged the prescription of topiramate (TPM) to women of childbearing potential with epilepsy due to growing evidence of the teratogenic and neurodevelopmental risks associated with its use during pregnancy. It remains, however, unclear whether the use of TPM in this population can be supported to some extent by its high effectiveness. In this multicenter, retrospective, cohort study performed at 22 epilepsy centers, we investigated the comparative effectiveness of TPM and levetiracetam (LEV) given as first-line antiseizure medication in a cohort of women of childbearing potential with idiopathic generalized epilepsy (IGE). A total of 336 participants were included, of whom 24 (7.1%) received TPM and 312 (92.9%) LEV. Women treated with TPM had significantly higher risks of treatment failure and treatment withdrawal and were less likely to achieve seizure freedom at 12 months compared to women treated with LEV. In conclusion, this study highlighted a low tendency among clinicians to use TPM in women of childbearing potential with IGE, anticipating the recently released restrictions on its use. Furthermore, the available data on effectiveness do not appear to support the use of TPM in this population.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York, USA
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Biagio Orlando
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Cecilia Catania
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Chiara Panzini
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Center, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Center, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Chiara Pizzanelli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Loretta Giuliano
- Section of Neurosciences, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Veronica Viola
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | | | | | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Francesca F Operto
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Betul Baykan
- Department of Neurology and EMAR Medical Center, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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7
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Cerulli Irelli E, Gesche J, Schlabitz S, Fortunato F, Catania C, Morano A, Labate A, Vorderwülbecke BJ, Gambardella A, Baykan B, Holtkamp M, Di Bonaventura C, Beier CP. Epilepsy with generalized tonic-clonic seizures alone: Electroclinical features and prognostic patterns. Epilepsia 2024; 65:84-94. [PMID: 37872695 DOI: 10.1111/epi.17809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Epilepsy with generalized tonic-clonic seizures alone (GTCA) is a common but poorly characterized idiopathic generalized epilepsy (IGE) syndrome. Hence, we investigated electroclinical features, seizure outcome, and antiseizure medication (ASM) withdrawal in a large cohort of GTCA patients. METHODS In this multicenter retrospective study, GTCA patients defined according to the diagnostic criteria of the International League Against Epilepsy (2022) were included. We investigated prognostic patterns, drug resistance at the last visit, and ASM withdrawal, along with their prognostic factors. RESULTS We included 247 patients with a median (interquartile range [IQR]) age at onset of 17 years (13-22) and a median follow-up duration of 10 years (IQR = 5-20). Drug resistance at the last visit was observed in 40 (16.3%) patients, whereas the median latency to achieve 2-year remission was 24 months (IQR = 24-46.5) with a median number of 1 (IQR = 1-2) ASM. During the long-term follow-up (i.e., 202 patients followed ≥5-years after the first ASM trial), 69 (34.3%) patients displayed an early remission pattern and 36 (17.9%) patients displayed a late remission pattern, whereas 16 (8%) and 73 (36.3%) individuals had no-remission and relapsing-remitting patterns, respectively. Catamenial seizures and morning predominance of generalized tonic-clonic seizures (GTCS) independently predicted drug resistance at the last visit according to multivariable logistic regression. Treatment withdrawal was attempted in 63 (25.5%) patients, with 59 (93.7%) of them having at least a 12-month follow-up after ASM discontinuation. At the last visit, 49 (83%) of those patients had experienced GTCS recurrence. A longer duration of seizure freedom was the only factor predicting a higher chance of successful ASM withdrawal according to multivariable Cox regression. SIGNIFICANCE GTCA could be considered a relatively easily manageable IGE syndrome, with a low rate of drug resistance and a high prevalence of early response to treatment. Nevertheless, a considerable proportion of patients experience relapsing patterns of seizure control, highlighting the need for appropriate counseling and lifestyle recommendations.
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Affiliation(s)
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sophie Schlabitz
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Cecilia Catania
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Bernd J Vorderwülbecke
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Martin Holtkamp
- Epilepsy Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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8
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Ferraro F, Calafiore D, Curci C, Fortunato F, Carantini I, Genovese F, Lucchini G, Merlo A, Ammendolia A, de Sire A. Effects of intensive rehabilitation on functioning in patients with mild and moderate Charcot-Marie-Tooth disease: a real-practice retrospective study. Neurol Sci 2024; 45:289-297. [PMID: 37552411 PMCID: PMC10761523 DOI: 10.1007/s10072-023-06998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Charcot-Marie-Tooth (CMT) disease is one of the most common inherited neuropathies and can lead to progressive muscular weakness, pes cavus, loss of deep tendon reflexes, distal sensory loss, and gait impairment. There are still no effective drugs or surgical therapies for CMT, and supportive treatment is limited to rehabilitative therapy and surgical treatment of skeletal deformities. Many rehabilitative therapeutic approaches have been proposed, but timing and cadence of rehabilitative intervention are not clearly defined, and long-term follow-up is lacking in literature. The aim of this real-practice retrospective study was to assess the effectiveness of an intensive neurorehabilitation protocol on muscle strength and functioning in CMT patients. We analyzed data of patients with diagnosis of mild to moderate CMT. The rehabilitation program lasted 2-4 h a day, 5 days a week, for 3 weeks and consisted of manual treatments, strengthening exercises, stretching, core stability, balance and resistance training, aerobic exercises, and tailored self-care training. Data were collected at baseline (T0), after treatment (T1), and at the 12-month mark (T2) in terms of the following outcome measures: muscle strength, pain, fatigue, cramps, balance, walking speed, and ability. We included 37 CMT patients with a median age of 50.72 ± 13.31 years, with different forms: demyelinating (n = 28), axonal (n = 8), and mixed (n = 1). After intensive rehabilitation treatment, all outcomes significantly improved. This improvement was lost at the 1-year mark. Taken together, these findings suggest that an intensive rehabilitation program improves short-term symptoms and functional outcomes in a cohort of inpatients affected by mild to moderate CMT.
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Affiliation(s)
- Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100, Catanzaro, Italy
| | - Irene Carantini
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100, Mantova, Italy
- ACMT-Rete per la malattia di Charcot-Marie-Tooth OdV Association, Rome, Italy
| | - Filippo Genovese
- ACMT-Rete per la malattia di Charcot-Marie-Tooth OdV Association, Rome, Italy
| | | | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio, Reggio Emilia, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University Hospital "Mater Domini", University of Catanzaro Magna Graecia, Via Campanella, 115-88100, Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University Hospital "Mater Domini", University of Catanzaro Magna Graecia, Via Campanella, 115-88100, Catanzaro, Italy.
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9
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Ronchi D, Garbellini M, Magri F, Menni F, Meneri M, Bedeschi MF, Dilena R, Cecchetti V, Picciolli I, Furlan F, Polimeni V, Salani S, Pezzoli L, Fortunato F, Bellini M, Piga D, Ripolone M, Zanotti S, Napoli L, Ciscato P, Sciacco M, Mangili G, Mosca F, Corti S, Iascone M, Comi GP. A biallelic variant in COX18 cause isolated Complex IV deficiency associated with neonatal encephalo-cardio-myopathy and axonal sensory neuropathy. Eur J Hum Genet 2023; 31:1414-1420. [PMID: 37468577 PMCID: PMC10689781 DOI: 10.1038/s41431-023-01433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
Pathogenic variants impacting upon assembly of mitochondrial respiratory chain Complex IV (Cytochrome c Oxidase or COX) predominantly result in early onset mitochondrial disorders often leading to CNS, skeletal and cardiac muscle manifestations. The aim of this study is to describe a molecular defect in the COX assembly factor gene COX18 as the likely cause of a neonatal form of mitochondrial encephalo-cardio-myopathy and axonal sensory neuropathy. The proband is a 19-months old female displaying hypertrophic cardiomyopathy at birth and myopathy with axonal sensory neuropathy and failure to thrive developing in the first months of life. Serum lactate was consistently increased. Whole exome sequencing allowed the prioritization of the unreported homozygous substitution NM_001297732.2:c.667 G > C p.(Asp223His) in COX18. Patient's muscle biopsy revealed severe and diffuse COX deficiency and striking mitochondrial abnormalities. Biochemical and enzymatic studies in patient's myoblasts and in HEK293 cells after COX18 silencing showed a severe impairment of both COX activity and assembly. The biochemical defect was partially rescued by delivery of wild-type COX18 cDNA into patient's myoblasts. Our study identifies a novel defect of COX assembly and expands the number of nuclear genes involved in a mitochondrial disorder due to isolated COX deficiency.
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Affiliation(s)
- Dario Ronchi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Manuela Garbellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Francesca Magri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Francesca Menni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Regional Clinical Center for expanded newborn screening, Milan, Italy
| | - Megi Meneri
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | | | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UO Neurofisiopatologia, Milan, Italy
| | - Valeria Cecchetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Irene Picciolli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Francesca Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Regional Clinical Center for expanded newborn screening, Milan, Italy
| | - Valentina Polimeni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Sabrina Salani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Laura Pezzoli
- ASST Papa Giovanni XXIII, Laboratorio di Genetica Medica, Bergamo, Italy
| | - Francesco Fortunato
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matteo Bellini
- ASST Papa Giovanni XXIII, Laboratorio di Genetica Medica, Bergamo, Italy
| | - Daniela Piga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Michela Ripolone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Simona Zanotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Laura Napoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Patrizia Ciscato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Monica Sciacco
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | | | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefania Corti
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Maria Iascone
- ASST Papa Giovanni XXIII, Laboratorio di Genetica Medica, Bergamo, Italy
| | - Giacomo Pietro Comi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.
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10
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Rimoldi M, Magri F, Antognozzi S, Ripolone M, Salani S, Piga D, Bertolasi L, Zanotti S, Ciscato P, Fortunato F, Moggio M, Corti S, Comi GP, Ronchi D. Prominent muscle involvement in a familial form of mitochondrial disease due to a COA8 variant. Front Genet 2023; 14:1278572. [PMID: 38098475 PMCID: PMC10720436 DOI: 10.3389/fgene.2023.1278572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
Isolated mitochondrial respiratory chain Complex IV (Cytochrome c Oxidase or COX) deficiency is the second most frequent isolated respiratory chain defect. Causative mutations are mainly identified in structural COX subunits or in proteins involved in the maturation and assembly of the COX holocomplex. We describe an Italian familial case of mitochondrial myopathy due to a variant in the COX assembly factor 8 gene (COA8). Patient 1 is a 52-year-old woman who presented generalized epilepsy and retinitis pigmentosa at 10 years of age. From her early adulthood she complained about cramps and myalgia after exercise, and bilateral hearing loss emerged. Last neurological examination (52 years of age) showed bilateral ptosis, muscle weakness, peripheral neuropathy, mild dysarthria and dysphonia, cognitive impairment. Muscle biopsy had shown the presence of ragged-red fibers. Patient 2 (Patient 1's sister) is a 53-year-old woman presenting fatigability, myalgia, and hearing loss. Neurological examination showed ptosis and muscle weakness. Muscle biopsy displayed a diffuse reduction of COX activity staining and ragged-red fibers. Both sisters presented secondary amenorrhea. After ruling out mtDNA mutations, Whole Exome Sequencing analysis identified the novel homozygous COA8 defect c.170_173dupGACC, p.(Pro59fs) in the probands. Loss-of-function COA8 mutations have been associated with cavitating leukoencephalopathy with COX deficiency in 9 reported individuals. Disease course shows an early-onset rapid clinical deterioration, affecting both cognitive and motor functions over months, followed by stabilization and slow improvement over several years. Our findings expand the clinical spectrum of COA8-related disease. We confirm the benign course of this rare disorder, highlighting its (intrafamilial) clinical variability.
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Affiliation(s)
- Martina Rimoldi
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Magri
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Antognozzi
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Ripolone
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sabrina Salani
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Piga
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Bertolasi
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Zanotti
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Ciscato
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Fortunato
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Moggio
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Ronchi
- Neurology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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11
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Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Catania C, Ferlazzo E, Pascarella A, Casciato S, Quarato P, Pizzanelli C, Pulitano P, Giuliano L, Viola V, Mostacci B, Fortunato F, Marini C, Di Gennaro G, Gambardella A, Labate A, Operto FF, Giallonardo AT, Baykan B, Beier CP, Di Bonaventura C. Levetiracetam vs Lamotrigine as First-Line Antiseizure Medication in Female Patients With Idiopathic Generalized Epilepsy. JAMA Neurol 2023; 80:1174-1181. [PMID: 37782485 PMCID: PMC10546294 DOI: 10.1001/jamaneurol.2023.3400] [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] [Received: 06/02/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Importance After the recent limitations to prescribing valproate, many studies have highlighted the challenging management of female patients of reproductive age with idiopathic generalized epilepsy (IGE). However, no study, to the authors' knowledge, has addressed the comparative effectiveness of alternative antiseizure medications (ASMs) in these patients. Objective To compare the effectiveness and safety of levetiracetam and lamotrigine as initial monotherapy in female patients of childbearing age with IGE. Design, Setting, and Participants This was a multicenter, retrospective, comparative effectiveness cohort study analyzing data from patients followed up from 1994 to 2022. Patients were recruited from 22 primary, secondary, and tertiary adult and child epilepsy centers from 4 countries. Eligible patients were female individuals of childbearing age, diagnosed with IGE according to International League Against Epilepsy (2022) criteria and who initiated levetiracetam or lamotrigine as initial monotherapy. Patients were excluded due to insufficient follow-up after ASM prescription. Exposures Levetiracetam or lamotrigine as initial monotherapy. Main Outcomes and Measures Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazards regression was performed to compare treatment failure (TF) among patients who received levetiracetam or lamotrigine as initial monotherapy. Results A total of 543 patients were included in the study, with a median (IQR) age at ASM prescription of 17 (15-21) years and a median (IQR) follow-up of 60 (24-108) months. Of the study population, 312 patients (57.5%) were prescribed levetiracetam, and 231 (42.5%) were prescribed lamotrigine. An IPTW-adjusted Cox model showed that levetiracetam was associated with a reduced risk of treatment failure after adjustment for all baseline variables (IPTW-adjusted hazard ratio [HR], 0.77; 95% CI, 0.59-0.99; P = .04). However, after stratification according to different IGE syndromes, the higher effectiveness of levetiracetam was confirmed only in patients with juvenile myoclonic epilepsy (JME; IPTW-adjusted HR, 0.47; 95% CI, 0.32-0.68; P < .001), whereas no significant differences were found in other syndromes. Patients treated with levetiracetam experienced adverse effects more frequently compared with those treated with lamotrigine (88 of 312 [28.2%] vs 42 of 231 [18.1%]), whereas the 2 ASMs had similar retention rates during follow-up (IPTW-adjusted HR, 0.91; 95% CI, 0.65-1.23; P = .60). Conclusions and Relevance Results of this comparative effectiveness research study suggest the use of levetiracetam as initial alternative monotherapy in female patients with JME. Further studies are needed to identify the most effective ASM alternative in other IGE syndromes.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, New York
| | | | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Roberto H. Caraballo
- Department of Neurology, Hospital de Pediatría “Prof. Dr. Juan P Garrahan”, Buenos Aires, Argentina
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy
| | - Cecilia Catania
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, “Bianchi-Melacrino-Morelli” Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, “Bianchi-Melacrino-Morelli” Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Chiara Pizzanelli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Veronica Viola
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Carla Marini
- Child Neurology and Psychiatric Unit, Pediatric Hospital G. Salesi, United Hospitals of Ancona, Ancona, Italy
| | | | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Francesca F. Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Betul Baykan
- Istanbul University Istanbul Faculty of Medicine, Department of Neurology and EMAR Medical Center, Istanbul, Turkey
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Kerestes R, Perry A, Vivash L, O'Brien TJ, Alvim MKM, Arienzo D, Aventurato ÍK, Ballerini A, Baltazar GF, Bargalló N, Bender B, Brioschi R, Bürkle E, Caligiuri ME, Cendes F, de Tisi J, Duncan JS, Engel JP, Foley S, Fortunato F, Gambardella A, Giacomini T, Guerrini R, Hall G, Hamandi K, Ives-Deliperi V, João RB, Keller SS, Kleiser B, Labate A, Lenge M, Marotta C, Martin P, Mascalchi M, Meletti S, Owens-Walton C, Parodi CB, Pascual-Diaz S, Powell D, Rao J, Rebsamen M, Reiter J, Riva A, Rüber T, Rummel C, Scheffler F, Severino M, Silva LS, Staba RJ, Stein DJ, Striano P, Taylor PN, Thomopoulos SI, Thompson PM, Tortora D, Vaudano AE, Weber B, Wiest R, Winston GP, Yasuda CL, Zheng H, McDonald CR, Sisodiya SM, Harding IH. Patterns of subregional cerebellar atrophy across epilepsy syndromes: An ENIGMA-Epilepsy study. bioRxiv 2023:2023.10.21.562994. [PMID: 37961570 PMCID: PMC10634708 DOI: 10.1101/2023.10.21.562994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective The intricate neuroanatomical structure of the cerebellum is of longstanding interest in epilepsy, but has been poorly characterized within the current cortico-centric models of this disease. We quantified cross-sectional regional cerebellar lobule volumes using structural MRI in 1,602 adults with epilepsy and 1,022 healthy controls across twenty-two sites from the global ENIGMA-Epilepsy working group. Methods A state-of-the-art deep learning-based approach was employed that parcellates the cerebellum into 28 neuroanatomical subregions. Linear mixed models compared total and regional cerebellar volume in i) all epilepsies; ii) temporal lobe epilepsy with hippocampal sclerosis (TLE-HS); iii) non-lesional temporal lobe epilepsy (TLE-NL); iv) genetic generalised epilepsy; and (v) extra-temporal focal epilepsy (ETLE). Relationships were examined for cerebellar volume versus age at seizure onset, duration of epilepsy, phenytoin treatment, and cerebral cortical thickness. Results Across all epilepsies, reduced total cerebellar volume was observed (d=0.42). Maximum volume loss was observed in the corpus medullare (dmax=0.49) and posterior lobe grey matter regions, including bilateral lobules VIIB (dmax= 0.47), Crus I/II (dmax= 0.39), VIIIA (dmax=0.45) and VIIIB (dmax=0.40). Earlier age at seizure onset (ηρ2max=0.05) and longer epilepsy duration (ηρ2max=0.06) correlated with reduced volume in these regions. Findings were most pronounced in TLE-HS and ETLE with distinct neuroanatomical profiles observed in the posterior lobe. Phenytoin treatment was associated with reduced posterior lobe volume. Cerebellum volume correlated with cerebral cortical thinning more strongly in the epilepsy cohort than in controls. Significance We provide robust evidence of deep cerebellar and posterior lobe subregional grey matter volume loss in patients with chronic epilepsy. Volume loss was maximal for posterior subregions implicated in non-motor functions, relative to motor regions of both the anterior and posterior lobe. Associations between cerebral and cerebellar changes, and variability of neuroanatomical profiles across epilepsy syndromes argue for more precise incorporation of cerebellum subregions into neurobiological models of epilepsy.
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Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Perry
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Marina K M Alvim
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Donatello Arienzo
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Ítalo K Aventurato
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriel F Baltazar
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Núria Bargalló
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis (CDIC), Hospital Clinic de Barcelona, Barcelona, Spain
- CIBERSAM, Madrid, Spain
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ricardo Brioschi
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Eva Bürkle
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Fernando Cendes
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jerome P Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Renzo Guerrini
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Gerard Hall
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | | | - Rafael B João
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict Kleiser
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Matteo Lenge
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | | | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mario Mascalchi
- 'Mario Serio' Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and network in Oncology of the Tuscany Region, Florence, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Conor Owens-Walton
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Saül Pascual-Diaz
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Powell
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Jun Rao
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Lucas S Silva
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dan J Stein
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis (CDIC), Hospital Clinic de Barcelona, Barcelona, Spain
- CIBERSAM, Madrid, Spain
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- 'Mario Serio' Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and network in Oncology of the Tuscany Region, Florence, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
- IRCCS Istituto 'Giannina Gaslini', Genova, Italy
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
- Epilepsy Society MRI Unit, Chalfont St Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, ON, Canada
- Chalfont Centre for Epilepsy, Bucks, UK
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Istituto 'Giannina Gaslini', Genova, Italy
| | - Peter N Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, ON, Canada
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Hong Zheng
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
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13
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Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
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14
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Irelli EC, Cocchi E, Ramantani G, Morano A, Riva A, Caraballo RH, Giuliano L, Yilmaz T, Panagiotakaki E, Operto FF, Giraldez BG, Balestrini S, Silvennoinen K, Casciato S, Comajuan M, Fortunato F, Giallonardo AT, Gamirova R, Coppola A, Di Gennaro G, Labate A, Sofia V, Kluger GJ, Gambardella A, Trenite DKN, Baykan B, Sisodiya SM, Arzimanoglou A, Striano P, Di Bonaventura C. Sex-based electroclinical differences and prognostic factors in epilepsy with eyelid myoclonia. Epilepsia 2023. [PMID: 37021337 DOI: 10.1111/epi.17609] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023]
Abstract
Although a striking female preponderance has been consistently reported in epilepsy with eyelid myoclonia (EEM), no study has specifically explored the variability of clinical presentation according to sex in this syndrome. Here, we aimed to investigate sex-specific electroclinical differences and prognostic determinants in EEM. Data from 267 EEM patients were retrospectively analyzed by the EEM study group, and a dedicated multivariable logistic regression analysis was developed separately for each sex. We found that females with EEM showed a significantly higher rate of persistence of photosensitivity and eye closure sensitivity at the last visit, along with a higher prevalence of migraine with aura, whereas males with EEM presented a higher rate of borderline intellectual functioning/intellectual disability. In female patients, multivariable logistic regression analysis revealed age at epilepsy onset, eyelid myoclonia status epilepticus, psychiatric comorbidities and catamenial seizures as significant predictors of drug resistance. In male patients, a history of febrile seizures was the only predictor of drug resistance. Hence, our study reveals sex-specific differences both in terms of electroclinical features and prognostic factors. Our findings support the importance of a sex-based personalized approach in epilepsy care and research, especially in genetic generalized epilepsies.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Tülay Yilmaz
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Istanbul, Turkey
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Lyon, France
| | - Francesca F Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Beatriz Gonzalez Giraldez
- Epilepsy Unit, Neurology Service, Hospital Universitario and IIS Fundación Jiménez Díaz and CIBERER, Madrid, Spain
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK; Neuroscience Department, Meyer Children's Hospital IRCSS-University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | | | - Marion Comajuan
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Lyon, France
| | | | - Anna T Giallonardo
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | | | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Gerhard J Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany; PMU, Salzburg, Salzburg, Austria
| | | | - Dorothee Kasteleijn-Nolst Trenite
- Department of Neurosurgery and Epilepsy, University Medical Center, Member of the ERN EpiCARE, Utrecht University, Utrecht, The Netherlands; Nesmos Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Istanbul, Turkey
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Lyon, France
| | - Pasquale Striano
- IRCCS Istituto "Giannina Gaslini", Member of the ERN EpiCARE, Genoa, Italy; Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Giugno A, Martino I, Sammarra I, Fratto E, Fortunato F, Labate A, Gambardella A. Neuropsychiatric profile in average intelligent individuals with coexisting epilepsy and psychogenic non-epileptic seizures. Epilepsia Open 2023. [PMID: 36929895 DOI: 10.1002/epi4.12731] [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: 01/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Global neuropsychological impairments with intellectual disability (ID) seem to play a major role in the occurrence of psychogenic non-epileptic seizures (PNES) in epilepsy. Conversely, the pathophysiology underlying PNES combined with epilepsy without ID remains elusive. We investigated the neuropsychiatric profile in 26 average intelligent subjects (15 women, mean age: 40.04±13.53 years) with temporal lobe epilepsy (TLE) plus PNES (TLE+PNES), compared to 28 with TLE and 22 with PNES alone, matched for age and sex. All subjects underwent neuropsychiatric assessment, including Beck Depression Inventory-2 (BDI-2), State-Trait Anxiety Inventory (STAI), Dissociative Experiences Scale (DES), Toronto Alexithymia Scale (TAS-20), Traumatic Experience Checklist (TEC), and cognitive evaluation. TLE+PNES and PNES groups shared a similar psychiatric profile with higher levels of depression (BDI-2, p<0.001), anxiety (STAI-S, p<0.001; STAI-T, p<0.001), dissociation (DES, p<0.001), and alexithymia (TAS, p=0.005) scales than the TLE group. Nonetheless, like individuals with TLE, patients with TLE+PNES had a lower rate of a potentially traumatizing event than PNES. The very low rate of potentially traumatizing event in subjects with TLE+PNES leads us to hypothesize that epilepsy itself may be the psychophysiological distress that contributed to PNES. A psychopathological assessment in subjects with epilepsy is crucial to identify those more likely to develop PNES.
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Affiliation(s)
- Alessia Giugno
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
| | - Ilaria Sammarra
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
| | - Enrico Fratto
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
| | - Angelo Labate
- Neurology Unit, BIOMORF Department, University of Messina
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro
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16
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Zanotti S, Magri F, Salani S, Napoli L, Ripolone M, Ronchi D, Fortunato F, Ciscato P, Velardo D, D’Angelo MG, Gualandi F, Nigro V, Sciacco M, Corti S, Comi GP, Piga D. Extracellular Matrix Disorganization and Sarcolemmal Alterations in COL6-Related Myopathy Patients with New Variants of COL6 Genes. Int J Mol Sci 2023; 24:5551. [PMID: 36982625 PMCID: PMC10059973 DOI: 10.3390/ijms24065551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Collagen VI is a heterotrimeric protein expressed in several tissues and involved in the maintenance of cell integrity. It localizes at the cell surface, creating a microfilamentous network that links the cytoskeleton to the extracellular matrix. The heterotrimer consists of three chains encoded by COL6A1, COL6A2 and COL6A3 genes. Recessive and dominant molecular defects cause two main disorders, the severe Ullrich congenital muscular dystrophy and the relatively mild and slowly progressive Bethlem myopathy. We analyzed the clinical aspects, pathological features and mutational spectrum of 15 COL6-mutated patients belonging to our cohort of muscular dystrophy probands. Patients presented a heterogeneous phenotype ranging from severe forms to mild adult-onset presentations. Molecular analysis by NGS detected 14 different pathogenic variants, three of them so far unreported. Two changes, localized in the triple-helical domain of COL6A1, were associated with a more severe phenotype. Histological, immunological and ultrastructural techniques were employed for the validation of the genetic variants; they documented the high variability in COL6 distribution and the extracellular matrix disorganization, highlighting the clinical heterogeneity of our cohort. The combined use of these different technologies is pivotal in the diagnosis of COL6 patients.
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Affiliation(s)
- Simona Zanotti
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Magri
- Neurology Unit, Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sabrina Salani
- Neurology Unit, Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Laura Napoli
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Michela Ripolone
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Dario Ronchi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy
| | - Francesco Fortunato
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy
| | - Patrizia Ciscato
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Daniele Velardo
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Francesca Gualandi
- Medical Genetics Unit, Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy
| | - Vincenzo Nigro
- Dipartimento di Medicina di Precisione, “Luigi Vanvitelli” University of Campania and Telethon Institute of Genetics and Medicine (TIGEM), 81100 Naples, Italy
| | - Monica Sciacco
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Neurology Unit, Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefania Corti
- Neurology Unit, Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy
| | - Giacomo Pietro Comi
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy
| | - Daniela Piga
- Neurology Unit, Department of Neuroscience Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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17
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Ferrillo M, Migliario M, Marotta N, Fortunato F, Bindi M, Pezzotti F, Ammendolia A, Giudice A, Foglio Bonda PL, de Sire A. Temporomandibular disorders and neck pain in primary headache patients: a retrospective machine learning study. Acta Odontol Scand 2023; 81:151-157. [PMID: 35906722 DOI: 10.1080/00016357.2022.2105945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the linkage underpinning different clinical conditions as painful TMD and neck pain in patients affected by primary headaches. MATERIALS AND METHODS In this machine learning study, data from medical records of patients with headaches as migraine, tension-type headache (TTH) and other primary ones, referring to a University Hospital over a 10-year period were analysed. VAS was used to evaluate the intensity of the TMD and neck pain. Moreover, the magnetic resonance imaging was used to supplement the clinical data. RESULTS A total of 300 patients (72 male, 228 female), mean aged 37.78 ± 5.11 years, were included. Higher TMD and neck pain VAS in migraine patients were reported. The machine learning analysis focussed on type of primary headache demonstrated that a higher TMD VAS was correlated to migraine, whereas a higher neck pain VAS was correlated to TTH or migraine. Concerning the TMD type, arthrogenous and mixed TMD were correlated to mild-moderate TMD pain (depending on neck pain intensity), whereas myogenic TMD was correlated to moderate-severe TMD pain. CONCLUSIONS Machine-learning approach highlighted the complexity of diagnosis process and demonstrated that neck pain might be an influential variable on the belonging to different group of headaches in TMD patients.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Mario Migliario
- Dentistry Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Dentistry Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marino Bindi
- Dentistry Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Federica Pezzotti
- Dentistry Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Pier Luigi Foglio Bonda
- Dentistry Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Dentistry Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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18
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Fortunato F, Giugno A, Sammarra I, Labate A, Gambardella A. Epilepsy, Immunity and Neuropsychiatric Disorders. Curr Neuropharmacol 2023; 21:1714-1735. [PMID: 35794773 PMCID: PMC10514543 DOI: 10.2174/1570159x20666220706094651] [Citation(s) in RCA: 1] [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: 04/13/2022] [Revised: 05/03/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
Several studies have focused on the emerging role of immunity and inflammation in a wide range of neurological disorders. Autoimmune diseases involving central nervous system share well defined clinical features including epileptic seizures and additional neuropsychiatric symptoms, like cognitive and psychiatric disturbances. The growing evidence about the role of immunity in the pathophysiologic mechanisms underlying these conditions lead to the concept of autoimmune epilepsy. This relatively-new term has been introduced to highlight the etiological and prognostic implications of immunity in epileptogenesis. In this review, we aim to discuss the role of autoimmunity in epileptogenesis and its clinical, neurophysiological, neuroimaging and therapeutic implications. Moreover, we wish to address the close relationship between immunity and additional symptoms, particularly cognitive and psychiatric features, which deeply impact clinical outcomes in these patients. To assess these aspects, we first analyzed Rasmussen's encephalitis. Subsequently, we have covered autoimmune encephalitis, particularly those associated with autoantibodies against surface neuronal antigens, as these autoantibodies express a direct immune-mediated mechanism, different from those against intracellular antigens. Then, we discussed the connection between systemic immune disorders and neurological manifestations. This review aims to highlight the need to expand knowledge about the role of inflammation and autoimmunity in the pathophysiology of neurological disorders and the importance to early recognize these clinical entities. Indeed, early identification may result in faster recovery and a better prognosis.
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Affiliation(s)
- Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Alessia Giugno
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Angelo Labate
- BIOMORF Department, Neurology Unit, University of Messina, Messina, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
- Institute of Molecular Bioimaging and Physiology, National Research Council, I-88100 Catanzaro, Italy
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19
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Yahya V, Spagnolo F, Di Maggio G, Leopizzi E, De Marco P, Fortunato F, Comi GP, Rini A, Monfrini E, Di Fonzo A. Juvenile-onset dystonia with spasticity in Leigh syndrome caused by a novel NDUFA10 variant. Parkinsonism Relat Disord 2022; 104:85-87. [PMID: 36270260 DOI: 10.1016/j.parkreldis.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Vidal Yahya
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | | | | | - Paolo De Marco
- Neurological Department, A. Perrino's Hospital, Brindisi, Italy
| | - Francesco Fortunato
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo P Comi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Augusto Rini
- Neurological Department, A. Perrino's Hospital, Brindisi, Italy
| | - Edoardo Monfrini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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20
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Cerulli Irelli E, Cocchi E, Ramantani G, Riva A, Caraballo RH, Morano A, Giuliano L, Yilmaz T, Panagiotakaki E, Operto FF, Giraldez BG, Balestrini S, Silvennoinen K, Casciato S, Comajuan M, Fortunato F, Giallonardo AT, Gamirova R, Coppola A, Di Gennaro G, Labate A, Sofia V, Kluger GJ, Gambardella A, Kasteleijn-Nolst Trenite D, Baykan B, Sisodiya SM, Arzimanoglou A, Striano P, Di Bonaventura C. The spectrum of epilepsy with eyelid myoclonia: delineation of disease subtypes from a large multicenter study. Epilepsia 2022; 64:196-207. [PMID: 36307934 DOI: 10.1111/epi.17450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Epilepsy with eyelid myoclonia (EEM) has been associated with marked clinical heterogeneity. Early epilepsy onset has been recently linked to lower chances of achieving sustained remission and to a less favorable neuropsychiatric outcome. However, much work is still needed to better delineate this epilepsy syndrome. METHODS In this multicenter retrospective cohort study, we included 267 EEM patients from 9 countries. Data about electroclinical and demographic features, intellectual functioning, migraine with or without aura, family history of epilepsy and epilepsy syndromes in relatives were collected in each patient. The impact of age at epilepsy onset (AEO) on EEM clinical features was investigated, along with the distinctive clinical characteristics of patients showing sporadic myoclonia over body regions other than eyelids (body-MYO). RESULTS Kernel density estimation revealed a trimodal distribution of AEO and Fisher-Jenks optimization disclosed three EEM subgroups: early-onset (EO-EEM), intermediate-onset (IO-EEM) and late-onset subgroup (LO-EEM). EO-EEM was associated with the highest rate of intellectual disability, antiseizure medication refractoriness and psychiatric comorbidities and with the lowest rate of family history of epilepsy. LO-EEM was associated with the highest proportion of body-MYO and generalized tonic-clonic seizures (GTCS), whereas IO-EEM had the lowest observed rate of additional findings. A family history of EEM was significantly more frequent in IO-EEM and LO-EEM compared with EO-EEM. In the subset of patients with body-MYO (58/267), we observed a significantly higher rate of migraine and GTCS but no relevant differences in other electroclinical features and seizure outcome. SIGNIFICANCE Based on AEO, we identified consistent EEM subtypes characterized by distinct electroclinical and familial features. Our observations shed new light on the spectrum of clinical features of this generalized epilepsy syndrome and may help clinicians towards a more accurate classification and prognostic profiling of EEM patients.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Tülay Yilmaz
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Francesca F Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Beatriz Gonzalez Giraldez
- Epilepsy Unit, Neurology Service, Hospital Universitario and IIS Fundación Jiménez Díaz and CIBERER, Madrid, Spain
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK; Neuroscience Department, Meyer Children's Hospital-University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | | | - Marion Comajuan
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | | | - Anna T Giallonardo
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | | | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Gerhard J Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany; PMU, Salzburg, Salzburg, Austria
| | | | - Dorothee Kasteleijn-Nolst Trenite
- Department of Neurosurgery and Epilepsy, University Medical Center, Member of the ERN EpiCARE, Utrecht University, Utrecht, The Netherlands; Nesmos Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Member of the ERN EpiCARE, Genoa, Italy; Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Gaspardone C, Romagnolo D, Fasolino A, Falasconi G, Beneduce A, Fiore G, Fortunato F, Galdieri C, Savastano S, Posteraro GA, Agricola E, Oppizzi M, Gaspardone A, Pappone C, Montorfano M. A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1423] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Several electrocardiogram (ECG) criteria have been proposed to predict the location of the culprit occlusion in specific subsets of patients presenting with ST-segment elevation myocardial infarction (STEMI).
Purpose
The aim of this study was to develop, through an independent validation of currently available criteria, a comprehensive and easy-to-use ECG algorithm, and to test its diagnostic performance and reliability in real-world clinical practice.
Methods
We analyzed ECG and angiographic data from 408 consecutive STEMI patients submitted to primary percutaneous coronary intervention, dividing the overall population into derivation (306 patients) and validation (102 patients) cohorts. In the derivation cohort, we tested >60 previously published ECG criteria, using the decision-tree analysis to develop the algorithm that would best predict the infarct-related artery (IRA) and its occlusion level. We further assessed the new algorithm diagnostic performance and reliability in the validation cohort.
Results
In the derivation cohort, the algorithm correctly predicted the IRA in 91% of cases and both the IRA and its occlusion level (proximal vs. mid-distal) in 73% of cases. When applied to the validation cohort, the algorithm resulted in 90% and 69% diagnostic accuracies, respectively. In a real-world comparative test, the algorithm performed significantly better than expert physicians in identifying the site of the culprit occlusion (p=0.026 vs. best cardiologist and p<0.001 vs.best emergency medicine doctor). The algorithm showed almost perfect reliability (Cohen's kappa 0.86) between a cardiologist and an ambulance paramedic.
Conclusions
Derived from an extensive literature review, this comprehensive and easy-to-use ECG algorithm can accurately predict the IRA and its occlusion level in all-comers STEMI patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Gaspardone
- University Vita-Salute San Raffaele , Milan , Italy
| | - D Romagnolo
- University Vita-Salute San Raffaele , Milan , Italy
| | | | - G Falasconi
- University Vita-Salute San Raffaele , Milan , Italy
| | - A Beneduce
- San Raffaele Hospital, Unit of Interventional Cardiology , Milan , Italy
| | - G Fiore
- University Vita-Salute San Raffaele , Milan , Italy
| | | | - C Galdieri
- University Vita-Salute San Raffaele , Milan , Italy
| | - S Savastano
- I.R.C.C.S. San Matteo Polyclinic, Division of Cardiology , Pavia , Italy
| | - G A Posteraro
- S. Eugenio Hospital, Division of Cardiology , Rome , Italy
| | - E Agricola
- University Vita-Salute San Raffaele , Milan , Italy
| | - M Oppizzi
- San Raffaele Hospital, Emergency Department (Cardiology Division) , Milan , Italy
| | - A Gaspardone
- S. Eugenio Hospital, Division of Cardiology , Rome , Italy
| | - C Pappone
- University Vita-Salute San Raffaele , Milan , Italy
| | - M Montorfano
- San Raffaele Hospital, Unit of Interventional Cardiology , Milan , Italy
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22
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Fortunato F, Labate A, Gambardella A. Babylonian knowledge about temporal lobe epilepsy: distinguishing mesial from lateral forms. Neurol Sci 2022; 43:6149-6150. [DOI: 10.1007/s10072-022-06243-0] [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] [Received: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
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23
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Magri F, Antognozzi S, Ripolone M, Zanotti S, Napoli L, Ciscato P, Velardo D, Scuvera G, Nicotra V, Giacobbe A, Milani D, Fortunato F, Garbellini M, Sciacco M, Corti S, Comi GP, Ronchi D. Megaconial congenital muscular dystrophy due to novel CHKB variants: a case report and literature review. Skelet Muscle 2022; 12:23. [PMID: 36175989 PMCID: PMC9524117 DOI: 10.1186/s13395-022-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Choline kinase beta (CHKB) catalyzes the first step in the de novo biosynthesis of phosphatidyl choline and phosphatidylethanolamine via the Kennedy pathway. Derangement of this pathway might also influence the homeostasis of mitochondrial membranes. Autosomal recessive CHKB mutations cause a rare form of congenital muscular dystrophy known as megaconial congenital muscular dystrophy (MCMD). Case presentation We describe a novel proband presenting MCMD due to unpublished CHKB mutations. The patient is a 6-year-old boy who came to our attention for cognitive impairment and slowly progressive muscular weakness. He was the first son of non-consanguineous healthy parents from Sri Lanka. Neurological examination showed proximal weakness at four limbs, weak osteotendinous reflexes, Gowers’ maneuver, and waddling gate. Creatine kinase levels were mildly increased. EMG and brain MRI were normal. Left quadriceps skeletal muscle biopsy showed a myopathic pattern with nuclear centralizations and connective tissue increase. Histological and histochemical staining suggested subsarcolemmal localization and dimensional increase of mitochondria. Ultrastructural analysis confirmed the presence of enlarged (“megaconial”) mitochondria. Direct sequencing of CHKB identified two novel defects: the c.1060G > C (p.Gly354Arg) substitution and the c.448-56_29del intronic deletion, segregating from father and mother, respectively. Subcloning of RT-PCR amplicons from patient’s muscle RNA showed that c.448-56_29del results in the partial retention (14 nucleotides) of intron 3, altering physiological splicing and transcript stability. Biochemical studies showed reduced levels of the mitochondrial fission factor DRP1 and the severe impairment of mitochondrial respiratory chain activity in patient’s muscle compared to controls. Conclusions This report expands the molecular findings associated with MCMD and confirms the importance of considering CHKB variants in the differential diagnosis of patients presenting with muscular dystrophy and mental retardation. The clinical outcome of MCMD patients seems to be influenced by CHKB molecular defects. Histological and ultrastructural examination of muscle biopsy directed molecular studies and allowed the identification and characterization of an intronic mutation, usually escaping standard molecular testing.
Supplementary Information The online version contains supplementary material available at 10.1186/s13395-022-00306-8.
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Affiliation(s)
- Francesca Magri
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Sara Antognozzi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Michela Ripolone
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Simona Zanotti
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Laura Napoli
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Patrizia Ciscato
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Daniele Velardo
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Giulietta Scuvera
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Medical Genetics Unit, Woman-Child-Newborn Department, Milan, Italy
| | - Valeria Nicotra
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Medical Genetics Unit, Woman-Child-Newborn Department, Milan, Italy
| | - Antonella Giacobbe
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Donatella Milani
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Francesco Fortunato
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manuela Garbellini
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Monica Sciacco
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Stefania Corti
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.,Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.,IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Dario Ronchi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy. .,Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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24
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de Sire A, Moggio L, Marotta N, Fortunato F, Spalek R, Inzitari MT, Paolucci T, Ammendolia A. Ultrasound-Guided Injections and Proprioceptive Neuromuscular Facilitation as Shoulder Rehabilitation for Multiple Sclerosis and Neuropathic Pain. Healthcare (Basel) 2022; 10:healthcare10101869. [PMID: 36292316 PMCID: PMC9601756 DOI: 10.3390/healthcare10101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS) represents a major cause of chronic neurological disability in young adults and can result in upper limb sensorimotor impairment with a huge impact on manual dexterity and activities of daily living. Moreover, pain is common in MS and a large proportion of patients suffer from central neuropathic pain. To date, no rehabilitative treatment has been described as useful for these patients. A 46-year-old woman, affected by relapsing-remittent MS, described a one-year history of right shoulder pain (Visual Analogue Scale = 8) that started gradually and without trauma. The patient also presented balance and gait impairments, upper limb strength deficit, and fatigue (Expanded Disability Status Scale = 5.5). A multidisciplinary treatment was proposed, including three intra-articular corticosteroid injections and one month of manual therapy, three sessions/week, based on proprioceptive neuromuscular facilitation for the upper limb. At the end of the rehabilitative treatment, pain relief and an improvement in the range of motion of the affected shoulder, upper limb muscle strength, and hand dexterity were observed. The present paradigmatic case report with literature review demonstrated that a multidisciplinary approach seems to be effective in pain relief in a patient with central neuropathic shoulder pain and relapsing-remitting MS.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Lucrezia Moggio
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961369768
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Renata Spalek
- Rehabilitation Unit, ‘Mons. L. Novarese’ Hospital, 13040 Vercelli, Italy
- Department of Geriatrics, Neurosciences, Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Maria Teresa Inzitari
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Teresa Paolucci
- Physical Medicine and Rehabilitation, Department of Oral, Medical and Biotechnological Sciences, Physical Medicine and Rehabilitation, University G. D’Annunzio, 66100 Chieti, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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25
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Zanotti S, Magri F, Poggetti F, Ripolone M, Velardo D, Fortunato F, Ciscato P, Moggio M, Corti S, Comi GP, Sciacco M. Immunofluorescence signal intensity measurements as a semi-quantitative tool to assess sarcoglycan complex expression in muscle biopsy. Eur J Histochem 2022; 66. [PMID: 36047345 PMCID: PMC9471914 DOI: 10.4081/ejh.2022.3418] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Sarcoglycanopathies are highly heterogeneous in terms of disease progression, muscular weakness, loss of ambulation and cardiac/respiratory involvement. Their clinical severity usually correlates with the residual protein amount, which makes protein quantification extremely relevant. Sarcoglycanopathy diagnosis is genetic, but skeletal muscle analysis - by both immunohistochemistry and Western blot (WB) - is still mandatory to establish the correct diagnostic process. Unfortunately, however, WB analysis cannot be performed if the bioptic specimen is scarce. This study provides a sensitive tool for semi-quantification of residual amount of sarcoglycans in patients affected by sarcoglycanopathies, based on immunofluorescence staining on skeletal muscle sections, image acquisition and software elaboration. We applied this method to eleven sarcoglycanopathies, seven Becker muscular dystrophies, as pathological control group, and four age-matched controls. Fluorescence data showed a significantly reduced expression of the mutated sarcoglycan in all patients when compared to their respective age-matched healthy controls, and a variable reduction of the other sarcoglycans. The reduction is due to the effect of gene mutation and not to the increasing age of controls. Fluorescence normalized data analyzed in relation to the age of onset of the disease, showed a negative correlation of a-sarcoglycan fluorescence signal vs fibrosis in patients with an early age of onset and a negative correlation between d-sarcoglycan signal and fibrosis in both intermediate and late age of onset groups. The availability of a method that allows objective quantification of the sarcolemmal proteins, faster and less consuming than WB analysis and able to detect low residual sarcoglycan expression with great sensitivity, proves useful also in view of possible inferences on disease prognosis. The proposed method could be employed also to monitor the efficacy of therapeutic interventions and during clinical trials.
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Affiliation(s)
- Simona Zanotti
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Francesca Magri
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Francesca Poggetti
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Michela Ripolone
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Daniele Velardo
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Francesco Fortunato
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Patrizia Ciscato
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Maurizio Moggio
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Stefania Corti
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Giacomo Pietro Comi
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Monica Sciacco
- Neuromuscular and Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
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26
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Lopez SM, Aksman LM, Oxtoby NP, Vos SB, Rao J, Kaestner E, Alhusaini S, Alvim M, Bender B, Bernasconi A, Bernasconi N, Bernhardt B, Bonilha L, Caciagli L, Caldairou B, Caligiuri ME, Calvet A, Cendes F, Concha L, Conde‐Blanco E, Davoodi‐Bojd E, de Bézenac C, Delanty N, Desmond PM, Devinsky O, Domin M, Duncan JS, Focke NK, Foley S, Fortunato F, Galovic M, Gambardella A, Gleichgerrcht E, Guerrini R, Hamandi K, Ives‐Deliperi V, Jackson GD, Jahanshad N, Keller SS, Kochunov P, Kotikalapudi R, Kreilkamp BAK, Labate A, Larivière S, Lenge M, Lui E, Malpas C, Martin P, Mascalchi M, Medland SE, Meletti S, Morita‐Sherman ME, Owen TW, Richardson M, Riva A, Rüber T, Sinclair B, Soltanian‐Zadeh H, Stein DJ, Striano P, Taylor P, Thomopoulos SI, Thompson PM, Tondelli M, Vaudano AE, Vivash L, Wang Y, Weber B, Whelan CD, Wiest R, Winston GP, Yasuda CL, McDonald CR, Alexander D, Sisodiya SM, Altmann A. Event-based modeling in temporal lobe epilepsy demonstrates progressive atrophy from cross-sectional data. Epilepsia 2022; 63:2081-2095. [PMID: 35656586 PMCID: PMC9540015 DOI: 10.1111/epi.17316] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Recent work has shown that people with common epilepsies have characteristic patterns of cortical thinning, and that these changes may be progressive over time. Leveraging a large multicenter cross-sectional cohort, we investigated whether regional morphometric changes occur in a sequential manner, and whether these changes in people with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) correlate with clinical features. METHODS We extracted regional measures of cortical thickness, surface area, and subcortical brain volumes from T1-weighted (T1W) magnetic resonance imaging (MRI) scans collected by the ENIGMA-Epilepsy consortium, comprising 804 people with MTLE-HS and 1625 healthy controls from 25 centers. Features with a moderate case-control effect size (Cohen d ≥ .5) were used to train an event-based model (EBM), which estimates a sequence of disease-specific biomarker changes from cross-sectional data and assigns a biomarker-based fine-grained disease stage to individual patients. We tested for associations between EBM disease stage and duration of epilepsy, age at onset, and antiseizure medicine (ASM) resistance. RESULTS In MTLE-HS, decrease in ipsilateral hippocampal volume along with increased asymmetry in hippocampal volume was followed by reduced thickness in neocortical regions, reduction in ipsilateral thalamus volume, and finally, increase in ipsilateral lateral ventricle volume. EBM stage was correlated with duration of illness (Spearman ρ = .293, p = 7.03 × 10-16 ), age at onset (ρ = -.18, p = 9.82 × 10-7 ), and ASM resistance (area under the curve = .59, p = .043, Mann-Whitney U test). However, associations were driven by cases assigned to EBM Stage 0, which represents MTLE-HS with mild or nondetectable abnormality on T1W MRI. SIGNIFICANCE From cross-sectional MRI, we reconstructed a disease progression model that highlights a sequence of MRI changes that aligns with previous longitudinal studies. This model could be used to stage MTLE-HS subjects in other cohorts and help establish connections between imaging-based progression staging and clinical features.
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Affiliation(s)
- Seymour M. Lopez
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Leon M. Aksman
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Neuroradiological Academic Unit, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Jun Rao
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Erik Kaestner
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Saud Alhusaini
- Department of NeurologyAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
| | - Marina Alvim
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional NeuroradiologyUniversity Hospital TübingenTübingenGermany
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Boris Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
| | | | - Lorenzo Caciagli
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Benoit Caldairou
- Neuroimaging of Epilepsy LaboratoryMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Angels Calvet
- Magnetic Resonance Image Core FacilityAugust Pi i Sunyer Biomedical Research Institute, University of BarcelonaBarcelonaSpain
| | - Fernando Cendes
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Luis Concha
- Institute of NeurobiologyNational Autonomous University of MexicoQuerétaroMexico
| | - Estefania Conde‐Blanco
- Epilepsy Program, Neurology DepartmentHospital Clinic of BarcelonaBarcelonaSpain
- August Pi i Sunyer Biomedical Research InstituteBarcelonaSpain
| | | | - Christophe de Bézenac
- Department of Pharmacology and TherapeuticsInstitute of Systems, Molecular and Integrative Biology, University of LiverpoolLiverpoolUK
| | - Norman Delanty
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
- FutureNeuro SFI Research Centre for Rare and Chronic Neurological DiseasesDublinIreland
| | - Patricia M. Desmond
- Department of Radiology, Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Orrin Devinsky
- New York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and NeuroradiologyGreifswald University MedicineGreifswaldGermany
| | - John S. Duncan
- Department of NeurologyEmory UniversityAtlantaUSA
- Chalfont Centre for EpilepsyChalfont St PeterUK
| | - Niels K. Focke
- Department of NeurologyUniversity Medical CenterGöttingenGermany
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Marian Galovic
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Department of NeurologyUniversity Hospital ZurichZurichSwitzerland
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | | | - Renzo Guerrini
- Neuroscience DepartmentUniversity of FlorenceFlorenceItaly
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
- Wales Epilepsy Unit, Department of NeurologyUniversity Hospital of WalesCardiffUK
| | | | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental Health, Austin CampusHeidelbergVictoriaAustralia
- University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Simon S. Keller
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Peter Kochunov
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Raviteja Kotikalapudi
- Department of Radiology, Diagnostic and Interventional NeuroradiologyUniversity Hospital TübingenTübingenGermany
- Department of Clinical NeurophysiologyUniversity Hospital GöttingenGöttingenGermany
- Department of Neurology and EpileptologyHertie Institute for Clinical Brain Research, University of TübingenTübingenGermany
| | - Barbara A. K. Kreilkamp
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Clinical NeurophysiologyUniversity Medical Center GöttingenGöttingenGermany
| | - Angelo Labate
- Neuroscience Research Center, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Institute of Neurology, Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and HospitalMcGill UniversityMontrealQuebecCanada
| | - Matteo Lenge
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and LaboratoriesA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery DepartmentA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
| | - Elaine Lui
- Department of Radiology, Royal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Charles Malpas
- Department of NeurologyRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Pascal Martin
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Mario Mascalchi
- Mario Serio Department of Clinical and Experimental Medical SciencesUniversity of FlorenceFlorenceItaly
| | - Sarah E. Medland
- Psychiatric GeneticsQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology Unit, OCB HospitalModena University HospitalModenaItaly
| | - Marcia E. Morita‐Sherman
- Department of NeurologyUniversity of CampinasCampinasBrazil
- Cleveland Clinic Neurological InstituteClevelandOhioUSA
| | - Thomas W. Owen
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | | | - Antonella Riva
- Giannina Gaslini Institute, Scientific Institute for Research and Health CareGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
| | - Theodor Rüber
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | - Ben Sinclair
- Department of Neuroscience, Central Clinical School, Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and Radiology, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Hamid Soltanian‐Zadeh
- Radiology and Research AdministrationHenry Ford Health SystemDetroitMichiganUSA
- School of Electrical and Computer EngineeringCollege of Engineering, University of TehranTehranIran
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Pasquale Striano
- Giannina Gaslini Institute, Scientific Institute for Research and Health CareGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenoaItaly
| | - Peter N. Taylor
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Manuela Tondelli
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Primary Care DepartmentLocal Health Authority of ModenaModenaItaly
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Neurology Unit, OCB HospitalModena University HospitalModenaItaly
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and Radiology, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Yujiang Wang
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition ResearchUniversity of BonnBonnGermany
| | - Christopher D. Whelan
- Department of Molecular and Cellular TherapeuticsRoyal College of Surgeons in IrelandDublinIreland
| | - Roland Wiest
- Support Center for Advanced NeuroimagingUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonOntarioCanada
| | - Clarissa Lin Yasuda
- Department of Neurology and Neuroimaging LaboratoryUniversity of CampinasCampinasBrazil
| | - Carrie R. McDonald
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Ripolone M, Velardo D, Mondello S, Zanotti S, Magri F, Minuti E, Cazzaniga S, Fortunato F, Ciscato P, Tiberio F, Sciacco M, Moggio M, Bettica P, Comi GP. Muscle histological changes in a large cohort of patients affected with Becker muscular dystrophy. Acta Neuropathol Commun 2022; 10:48. [PMID: 35395784 PMCID: PMC8994373 DOI: 10.1186/s40478-022-01354-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Becker muscular dystrophy (BMD) is a severe X-linked muscle disease. Age of onset, clinical variability, speed of progression and affected tissues display wide variability, making a clinical trial design for drug development very complex. The histopathological changes in skeletal muscle tissue are central to the pathogenesis, but they have not been thoroughly elucidated yet. Here we analysed muscle biopsies from a large cohort of BMD patients, focusing our attention on the histopathological muscle parameters, as fibrosis, fatty replacement, fibre cross sectional area, necrosis, regenerating fibres, splitting fibres, internalized nuclei and dystrophy evaluation. We correlated histological parameters with both demographic features and clinical functional evaluations. The most interesting results of our study are the accurate quantification of fibroadipose tissue replacement and the identification of some histopathological aspects that well correlate with clinical performances. Through correlation analysis, we divided our patients into three clusters with well-defined histological and clinical features. In conclusion, this is the first study that analyses in detail the histological characteristics of muscle biopsies in a large cohort of BMD patients, correlating them to a functional impairment. The collection of these data help to better understand the histopathological progression of the disease and can be useful to validate any pharmacological trial in which the modification of muscle biopsy is utilized as outcome measure.
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Irelli EC, Cocchi E, Ramantani G, Caraballo RH, Giuliano L, Yilmaz T, Morano A, Panagiotakaki E, Operto FF, Giraldez BG, Silvennoinen K, Casciato S, Comajuan M, Balestrini S, Fortunato F, Coppola A, Di Gennaro G, Labate A, Sofia V, Kluger GJ, Kasteleijn-Nolst Trenité DGA, Gambardella A, Baykan B, Sisodiya SM, Arzimanoglou A, Striano P, Di Bonaventura C. Electroclinical Features and Long-term Seizure Outcome in Patients With Eyelid Myoclonia With Absences. Neurology 2022; 98:e1865-e1876. [PMID: 35292555 DOI: 10.1212/wnl.0000000000200165] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Eyelid myoclonia with absences (EMA) is a generalized epilepsy syndrome whose prognosis and clinical characteristics are still partially undefined. We investigated electroclinical endophenotypes and long-term seizure outcome in a large cohort of EMA patients. METHODS In this multicenter retrospective study, EMA patients with ≥5 years of follow-up were included. We investigated prognostic patterns and sustained terminal remission (STR), along with their prognostic factors. Moreover, a two-step cluster analysis was used to investigate the presence of distinct EMA endophenotypes. RESULTS We included 172 patients, with a median age at onset of 7 years (interquartile range (IQR) 5-10) and a median follow-up duration of 14 years (IQR 8.25-23.75). Sixty-six patients (38.4%) displayed a non-remission pattern, whereas remission and relapse patterns were encountered in 56 (32.6%) and 50 (29.1%) subjects. Early epilepsy onset, history of febrile seizures (FS) and eyelid myoclonia (EM) status epilepticus significantly predicted a non-remission pattern according to multinomial logistic regression analysis. STR was achieved by 68 (39.5%) patients with a mean latency of 14.05 years (SD ± 12.47). Early epilepsy onset, psychiatric comorbidities, and a history of FS and generalized tonic-clonic seizures (GTCS) were associated with a lower probability of achieving STR according to a Cox regression proportional hazards model. Antiseizure medication (ASM) withdrawal was attempted in 62/172 patients, and seizures relapsed in 74.2%. Cluster analysis revealed two distinct clusters with 86 patients each. Cluster 2, which we defined as "EMA-plus", was characterized by an earlier age at epilepsy onset, higher rate of intellectual disability, EM status epilepticus, generalized paroxysmal fast activity, self-induced seizures, FS, and poor ASM response, whereas Cluster 1, the "EMA-only" cluster, was characterized by a higher rate of seizure remission and more favorable neuropsychiatric outcome. DISCUSSION Early epilepsy onset was the most relevant prognostic factor for poor treatment response. A long latency between epilepsy onset and ASM response was observed, suggesting the impact of age-related brain changes in EMA remission. Finally, our cluster analysis showed a clear-cut distinction of EMA patients into an EMA-plus insidious subphenotype and an EMA-only benign cluster that strongly differed in terms of remission rates and cognitive outcomes.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Tulay Yilmaz
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alessandra Morano
- Dvepartment of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Francesca F Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Beatriz Gonzalez Giraldez
- Epilepsy Unit, Neurology Service, Hospital Universitario and IIS Fundación Jiménez Díaz and CIBERER, Madrid, Spain
| | - Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | | | - Marion Comajuan
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | | | | | - Antonietta Coppola
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy
| | | | - Angelo Labate
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Gerhard J Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | | | | | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS "Istituto Giannina Gaslini", Genova, Italy
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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Manna I, Fortunato F, De Benedittis S, Sammarra I, Bertoli G, Labate A, Gambardella A. Non-Coding RNAs: New Biomarkers and Therapeutic Targets for Temporal Lobe Epilepsy. Int J Mol Sci 2022; 23:ijms23063063. [PMID: 35328484 PMCID: PMC8954985 DOI: 10.3390/ijms23063063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy; it is considered a network disorder associated with structural changes. Incomplete knowledge of the pathological changes in TLE complicates a therapeutic approach; indeed, 30 to 50% of patients with TLE are refractory to drug treatment. Non-coding RNAs (ncRNAs), acting as epigenetic factors, participate in the regulation of the pathophysiological processes of epilepsy and are dysregulated during epileptogenesis. Abnormal expression of ncRNA is observed in patients with epilepsy and in animal models of epilepsy. Furthermore, ncRNAs could also be used as biomarkers for the diagnosis and prognosis of treatment response in epilepsy. In summary, ncRNAs can represent important mechanisms and targets for the modulation of brain excitability and can provide information on pathomechanisms, biomarkers and novel therapies for epilepsy. In this review, we summarize the latest research advances concerning mainly molecular mechanisms, regulated by ncRNA, such as synaptic plasticity, inflammation and apoptosis, already associated with the pathogenesis of TLE. Moreover, we discuss the role of ncRNAs, such as microRNAs, long non-coding RNAs and circular RNAs, in the pathophysiology of epilepsy, highlighting their use as potential biomarkers for future therapeutic approaches.
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Affiliation(s)
- Ida Manna
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), Section of Germaneto, 88100 Catanzaro, Italy
- Correspondence: (I.M.); (A.G.)
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Selene De Benedittis
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Gloria Bertoli
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), 20090 Milan, Italy;
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), Section of Germaneto, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, Institute of Neurology, University “Magna Graecia”, Germaneto, 88100 Catanzaro, Italy; (F.F.); (S.D.B.); (I.S.); (A.L.)
- Correspondence: (I.M.); (A.G.)
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31
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [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] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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Sammarra I, Martino I, Caligiuri ME, Giugno A, Fortunato F, Labate A, Gambardella A. The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study. Epilepsy Behav 2022; 128:108600. [PMID: 35151188 PMCID: PMC8801317 DOI: 10.1016/j.yebeh.2022.108600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed levels of depression, anxiety, stress, anhedonia, somatization, psychological distress, sleep, and life quality in patients with mesial temporal lobe epilepsy (MTLE) after one year of containment measures started in Italy to stem the COVID-19 pandemic. METHODS We consecutively enrolled 51 patients with MTLE, administering an online survey that compared the year before and after the COVID-19 propagation. We analyzed clinical data (e.g., seizure frequency, life quality) and neuropsychological assessment through Somatic Symptom Scale-8 (SSS-8), Beck Depression Inventory (BDI-2), State-Trait Anxiety Inventory (STAI-Y), Depression, Anxiety and Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale (SHAPS), Impact of Event Scale-Revised (IES-R). The BDI-2 and STAI-Y scores were compared to those acquired in the same patients before the COVID-19 outbreak. RESULTS Comparing our population with MTLE before and after COVID-19 outbreak, we found a significant worsening in life quality (p = 0.03), SSS-8 (p = 0.001), BDI-2 (p = 0.032), and STAI-Y scores (p < 0.001). After one year of pandemic, 88.2% of patients obtained pathological scores at PSQI, 19.6% at SHAPS, 29.4% at IES-R. Reduction of life quality correlated with anxiety, depression, stress, and somatization. Higher levels of anhedonia correlated with stress, depression, and anxiety. Somatization correlated with depression, anxiety, and sleep quality. Distress levels correlated with anxiety, somatization, and depression. CONCLUSIONS We demonstrated a significant worsening of depression, anxiety, life quality, and somatization in patients with MTLE after one year of COVID-19 beginning. Concomitantly, results suggest that the pandemic had a negative impact on sleep quality, psychological distress, and anhedonia, but not on epilepsy itself.
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Affiliation(s)
- Ilaria Sammarra
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Alessia Giugno
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Angelo Labate
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
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Fortunato F, Labate A, Trimboli M, Spaccarotella C, Indolfi C, Gambardella A. Late-Onset Ictal Asystole and Falls Related to Severe Coronary Artery Stenosis: A Case Report. Front Neurol 2022; 12:780564. [PMID: 35069412 PMCID: PMC8777096 DOI: 10.3389/fneur.2021.780564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Ictal asystole (IA) is a rare, underestimated, and life-threatening cause of transient loss of consciousness and fall. Current treatment options for seizures associated with IA usually include cardiac pacemaker implantation. We report, for the first time, a case of IA that is related to coronary stenosis, which was resolved after coronary angioplasty. Case Presentation: A 73-year-old man had a 2-year history of focal seizures with impaired awareness. Three months before our observation, he started to have sudden falls resulting in injury on several occasions. General and neurological examinations, as well as brain MRI, were unremarkable. Interictal electroencephalography (EEG) showed bitemporal spiking. Ictal video-polygraphy revealed a diffuse electrodecrement, followed by a buildup of rhythmic 4–6 Hz sharp activity, which was more evident in the left temporal region. After the seizure onset, the ECG showed sinus bradycardia, followed by sinus arrest that was associated with the patient's fall from the standing position. Afterwards, sinus rhythm returned spontaneously. A diagnosis of IA was made. A comprehensive cardiologic evaluation revealed a sub-occlusive stenosis of the left anterior descending artery. Successful coronary angioplasty resolved IA, levetiracetam was added, and no seizure or fall has occurred in the following 20 months. Moreover, he underwent a 7-day Holter ECG monitoring, and no asystole was depicted. Conclusion: The present case was unique as it shows the potential association between IA and coronary stenosis, also suggesting a possible therapeutic role for coronary angioplasty. It also highlights the importance of carefully investigating epilepsy patients with falls, especially in the elderly, since IA-related falls can be easily misdiagnosed in older age. Thus, if IA is identified, a deeper cardiac evaluation should be considered. As seen in our patient, non-invasive diagnostic examination including routine, prolonged, and exercise ECG, as well as echocardiogram, were readily available and were informative in diagnosing cardiac abnormalities that are amenable to specific treatment.
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Affiliation(s)
- Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Michele Trimboli
- Department of Medical and Surgical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Carmen Spaccarotella
- Cardiology Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Ciro Indolfi
- Cardiology Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
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Calafiore D, Invernizzi M, Ammendolia A, Marotta N, Fortunato F, Paolucci T, Ferraro F, Curci C, Cwirlej-Sozanska A, de Sire A. Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:773459. [PMID: 34956054 PMCID: PMC8702427 DOI: 10.3389/fneur.2021.773459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 09/09/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.
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Affiliation(s)
- Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Agnieszka Cwirlej-Sozanska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
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de Sire A, Moggio L, Demeco A, Fortunato F, Spanò R, Aiello V, Marotta N, Ammendolia A. Efficacy of rehabilitative techniques in reducing hemiplegic shoulder pain in stroke: Systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 65:101602. [PMID: 34757009 DOI: 10.1016/j.rehab.2021.101602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is a disabling complication affecting stroke survivors. In this context, rehabilitation might play a key role in its clinical management. Recent systematic reviews of the impact of rehabilitative approaches on pain reduction in patients with HSP are lacking. OBJECTIVE This systematic review of randomized controlled trials (RCTs) with meta-analysis aimed to investigate the efficacy of rehabilitative techniques in reducing HSP in stroke survivors. METHODS PubMed, Scopus, and Web of Science were searched from inception to March 8, 2021 to identify RCTs of stroke survivors with HSP undergoing specific rehabilitative techniques combined with conventional therapy to reduce pain intensity. A network meta-analysis and meta-analysis of the Bayesian network of random effects were performed. The risk of bias of studies was assessed with Version 2 of the Cochrane Risk of Bias tool for randomized trials. RESULTS Of 1139 articles identified, 12 were included in the final synthesis. We analyzed data for 723 stroke survivors, reporting a significant overall decrease in pain intensity after a rehabilitative approach by the Bayesian meta-analysis (standardized mean difference 2.78, 95% confidence interval 0.89;-4.59; p = 0.003). We report a significant reduction in HSP with botulinum toxin type A injection (p = 0.001), suprascapular nerve pulsed radiofrequency (p = 0.030), suprascapular nerve block (p = 0.020), and trigger-point dry needling (p = 0.005) as compared with conventional rehabilitation. Concerning the effect size, we identified a Bayesian factor10 of 97.2, with very strong evidence of superiority of rehabilitative techniques. CONCLUSIONS The present systematic review and meta-analysis showed that adding other rehabilitative techniques to conventional rehabilitation was significantly more effective than conventional rehabilitation alone in the complex management of patients affected by HSP.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Andrea Demeco
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Francesco Fortunato
- Neurology Institute, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Riccardo Spanò
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Vincenzo Aiello
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
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Fratto E, Giugno A, Sammarra I, Fortunato F, Zoleo P, Rubino V, Caligiuri ME, Trimboli M, Labate A, Gambardella A. Abnormal cortical and subcortical structure in juvenile myoclonic epilepsy demonstrated with advanced MRI analysis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118300] [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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Falzarano M, Rachele R, Mietto M, Fortunato F, Selvatici R, Spitali P, Montanaro F, Muntoni F, Ferlini A. DMD - BRAIN. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.158] [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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Fortunato F, Farnè M, Bianchi F, Neri M, Siciliano G, Sansone V, Barp A, Albamonte E, Vita G, Atalaia A, Evangelista T, Gualandi F, Ferlini A. COVID-19 AND NEUROMUSCULAR DISEASES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.048] [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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Giugno A, Trimboli M, Fortunato F, Fratto E, Procopio R, Annesi G, Labate A, Gambardella A. Mild case of Unverricht-Lundborg disease presenting as Juvenile myoclonic epilepsy. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117839] [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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Trimboli M, Fortunato F, Sturniolo M, Labate A, Gambardella A. A case of epiletic “belly dancing”. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119088] [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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Fortunato F, Trimboli M, Fortunato L, Gambardella A. Neuroma of the Inferior Alveolar Nerve: A Treatable Mimic of Refractory Trigeminal Neuralgia. Neurol Clin Pract 2021; 11:e582-e584. [PMID: 34484966 DOI: 10.1212/cpj.0000000000000938] [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: 04/27/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Francesco Fortunato
- Institute of Neurology (FF, MT, AG); and Institute of Odontostomatology (LF), University Magna Graecia of Catanzaro, Italy
| | - Michele Trimboli
- Institute of Neurology (FF, MT, AG); and Institute of Odontostomatology (LF), University Magna Graecia of Catanzaro, Italy
| | - Leonzio Fortunato
- Institute of Neurology (FF, MT, AG); and Institute of Odontostomatology (LF), University Magna Graecia of Catanzaro, Italy
| | - Antonio Gambardella
- Institute of Neurology (FF, MT, AG); and Institute of Odontostomatology (LF), University Magna Graecia of Catanzaro, Italy
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Labate A, Martino I, Caligiuri ME, Fortunato F, Bruni A, Segura-Garcia C, Arcuri P, De Fazio P, Cerasa A, Gambardella A. Orbito-frontal thinning together with a somatoform dissociation might be the fingerprint of PNES. Epilepsy Behav 2021; 121:108044. [PMID: 34051606 DOI: 10.1016/j.yebeh.2021.108044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate neuroanatomical changes in patients with psychogenic nonepileptic seizures (PNES) compared to major depressive disorder (MDD) and healthy controls. METHODS Forty-two drug-naïve PNES subjects and 25 patients with MDD, matched for demographic characteristics and level of depression (as measured by Beck Depression Inventory-II, BDI-II), were consecutively recruited. Patients performed an extensive neuropsychiatric assessment including: Hamilton Anxiety Rating Scale, Traumatic Experience Checklist, Dissociative Experiences Scale, Toronto Alexithymia Scale and Somatoform Dissociation Questionnaire (SDQ-20). All patients, together with 78 healthy matched controls, underwent 3T brain MRI followed by surface-based morphometry. RESULTS Cortical thickness analysis revealed significant cortical thinning in bilateral medial orbitofrontal cortex (OFC) and left rostral anterior cingulate cortex (ACC) in patients with MDD compared to subjects with PNES and controls. Interestingly, increased thickness of the right pars triangularis was found in PNES subjects compared to controls. PNES showed higher scores in SDQ-20 (p < 0.001) compared to MDD, which was corroborated by neuroimaging data, where somatoform dissociation scores correlated with morphological changes in the left medial OFC. CONCLUSION Our results show selective cortical thinning over the medial OFC in patients with PNES compared to wider regions of thinning in patients with MDD. Somatoform dissociation was the only psychopathological assessment significantly different in PNES and MDD.
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Affiliation(s)
- Angelo Labate
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonella Bruni
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Cristina Segura-Garcia
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Pierpaolo Arcuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Pasquale De Fazio
- Institute of Psychiatry, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonio Cerasa
- IRIB, National Research Council, Mangone, CS, Italy; S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Gasparini S, Ferlazzo E, Gigli G, Pauletto G, Nilo A, Lettieri C, Bilo L, Labate A, Fortunato F, Varrasi C, Cantello R, D'Aniello A, Gennaro GD, d'Orsi G, Sabetta A, Claudio MTD, Avolio C, Dono F, Evangelista G, Cavalli SM, Cianci V, Ascoli M, Mastroianni G, Lobianco C, Neri S, Mercuri S, Mammì A, Gambardella A, Beghi E, Torino C, Tripepi G, Aguglia U. Predictive factors of Status Epilepticus and its recurrence in patients with adult-onset seizures: A multicenter, long follow-up cohort study. Seizure 2021; 91:397-401. [PMID: 34298459 DOI: 10.1016/j.seizure.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. METHODS We retrospectively analyzed data of 1115 patients with seizure onset>18 years, observed from 1983 to 2020 in 7 Italian Centers (median follow-up 2.1 years). Data were collected from the databases of the Centers. Patients with SE were consecutively recruited, and patients without SE history were randomly selected in a 2:1 ratio. To assess determinants of SE, different clinical-demographic variables were evaluated and included in univariate and multivariate logistic regression model. RESULTS Three hundred forty-seven patients had a SE history, whereas the remaining 768 patients had either isolated seizures or epilepsy without SE history. The occurrence of SE was independently associated with increasing age at onset of disease (OR 1.02, 95% CI 1.01--1.03, p<0.001), female sex (OR 1.39, 95% CI 1.05--1.83, p=0.02) and known etiology (OR 3.58, 95% CI 2.61--4.93, p<0.001). SE recurred in 21% of patients with adult-onset SE and recurrence was associated with increasing number of anti-seizure medications taken at last follow-up (OR 1.88, 95% CI 1.31--2.71, p<0.001). CONCLUSIONS In patients with adult-onset seizures, SE occurrence is associated with known etiologies, advanced age and female sex. Patients with recurrent SE are likely to have a refractory epilepsy, deserving careful treatment to prevent potentially fatal events.
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Affiliation(s)
- Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Gianluigi Gigli
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy and Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy; Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Christian Lettieri
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Leonilda Bilo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University "Federico II", Napoli, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Claudia Varrasi
- Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Roberto Cantello
- Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Alfredo D'Aniello
- Centre for epilepsy study and treatment, IRCCS "Neuromed", Pozzilli (IS), Italy
| | | | - Giuseppe d'Orsi
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Annarita Sabetta
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Maria T Di Claudio
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Carlo Avolio
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Sciences, "D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Salvatore M Cavalli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Concetta Lobianco
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Sergio Mercuri
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Ettore Beghi
- Laboratory of Neurological Disorders IRCCS "Mario Negri", Milan, Italy
| | - Claudia Torino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy.
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Gelardi M, Giancaspro R, Fiore V, Fortunato F, Cassano M. Corrigendum to "COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children" [International Journal of Pediatric Otorhinolaryngology (2020) 138/110284]. Int J Pediatr Otorhinolaryngol 2021; 146:110702. [PMID: 33941391 PMCID: PMC8086928 DOI: 10.1016/j.ijporl.2021.110702] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - R. Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V. Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy,Corresponding author
| | - F. Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M. Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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Panella A, Solarino G, Vicenti G, Bizzoca D, Baglioni M, Fortunato F, Maruccia F, Notarnicola A, Piazzolla A, Pascarella R, Belluati A, Moretti B. Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery? Aging Clin Exp Res 2021; 33:1627-1633. [PMID: 32902823 PMCID: PMC8203512 DOI: 10.1007/s40520-020-01682-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/30/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Background Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients’ functional recovery, at 24 months follow-up. Methods Patients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited. Inclusion criteria: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ − 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT. Exclusion criteria: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0–1 mm), good (displacement 2–3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up. Results 68 patients (males 38; females 30; mean age 68.6 years old; range 60–79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up. Conclusions In this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0–1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).
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Affiliation(s)
- Antonello Panella
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Baglioni
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Francesco Fortunato
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Francesco Maruccia
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Angela Notarnicola
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Andrea Piazzolla
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Raffaele Pascarella
- Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy
| | | | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy
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Rapisarda L, Trimboli M, Fortunato F, De Martino A, Marsico O, Demonte G, Augimeri A, Labate A, Gambardella A. Facemask headache: a new nosographic entity among healthcare providers in COVID-19 era. Neurol Sci 2021; 42:1267-1276. [PMID: 33502666 PMCID: PMC7838234 DOI: 10.1007/s10072-021-05075-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 10/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND SARS-CoV-2 is a novel infectious agent causing coronavirus disease 2019, which has been declared as pandemic in March 2020. Personal protective equipment has been mandatory for healthcare workers in order to contain the outbreak of pandemic disease. Mild neurological disturbances such as headache have been related to the extensive utilization of facemask. This study aims to examine headache variations related to the intensive utilization of facemask among a cohort of healthcare professionals in a setting of low-medium risk of exposure to SARS-CoV-2. METHODS This is a cross-sectional study among healthcare providers from different hospital and clinics in Italy. Each participant completed a specifically designed self-administered questionnaire. Headache features and outcome measures' change from baseline were evaluated over a 4-month period, in which wearing facemask has become mandatory for Italian healthcare workers. RESULTS A total of 400 healthcare providers completed the questionnaire, 383 of them met the inclusion criteria. The majority were doctors, with a mean age of 33.4 ± 9.2 years old. Among 166/383 subjects, who were headache free at baseline, 44 (26.5%) developed de novo headache. Furthermore, 217/383 reported a previous diagnosis of primary headache disorder: 137 were affected by migraine and 80 had tension-type headache. A proportion (31.3%) of these primary headache sufferers experienced worsening of their pre-existing headache disorder, mainly for migraine frequency and attack mean duration. CONCLUSIONS Our data showed the appearance of de novo associated facemask headache in previous headache-free subjects and an exacerbation of pre-existing primary headache disorders, mostly experienced by people with migraine disease.
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Affiliation(s)
- Laura Rapisarda
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | - Michele Trimboli
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy.
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | - Antonio De Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | - Oreste Marsico
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | - Giulio Demonte
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | | | - Angelo Labate
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, AOU Mater Domini - Magna Græcia University, V.le Europa, 88100, Catanzaro, Italy
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Rapisarda L, Valentino P, Barone S, Torti C, La Gamba V, Fortunato F, Sammarra I, Gambardella A. Varicella zoster immunity loss in multiple sclerosis patient treated with ocrelizumab. Clin Immunol 2021; 223:108554. [DOI: 10.1016/j.clim.2020.108554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
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Martinelli D, Villone G, Fortunato F, Fiorino G, Laurieri N, Prato R, Dattoli V. [Evaluation of a pulsed xenon ultraviolet light- emitting no-touch, portable device for disinfection of surfaces in operating rooms in the Policlinico University Hospital of Foggia, Italy, 2019. Preliminary results]. Ig Sanita Pubbl 2021; 77:414-425. [PMID: 33883751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and the frequency of use of a pulsed xenon ultraviolet light-emitting no-touch portable device (PX-UV), applied after perform current cleaning, in reducing environmental bacterial burden and the presence of pathogens on surfaces in the operating rooms at the Policlinico University Hospital of Foggia. DESIGN Prospective before-and-after study with a follow up duration of four months, from May to August 2019. SETTING AND PARTICIPANTS Two operating rooms of an Orthopaedic and a Neurosurgical ward in a 780-bed university hospital in the District of Foggia, Italy (about 600,000 inhabitants). MAIN OUTCOME MEASURES According to the hygienic standards proposed by the Italian Workers Compensation Authority (ISPESL), the total and the average bacterial load and the presence of six pathogens were evaluated between pre- and post- PX-UV use combined with routine manual cleaning. RESULTS The PX-UV system was applied at five distinct time points: t1: start of the experiment, t2: after 28 days, t3: after 13 days, t4: after 7 days, and t5: after 8 days (t2-t5: 28 days in total). About 16-min of PX-UV cycle showed significant reduction in the level of environmental contamination by decreasing the mean colony count by 87.5%, compliant with the standard (5< X ≤15 CFU per plat). Staphylococcus aureus and Acinetobacter baumannii that had been isolated in some of the samplings before PX-UV were no longer detected after t1, t2 and t5 treatments. Before PX-UV, the mean colony count was similar between t1 and t2 (p>0.05); after t3 and t4 treatments, it was lower before t5 in both the Orthopaedic and Neurosurgical operating rooms (= -97% and -75%, respectively; p<0,01). CONCLUSIONS Implication for practice: PX-UV could supplement the standard cleaning process in reducing the microbial burden in the operating rooms and potentially achieving lower healthcare-associated surgical site infections rates.
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Affiliation(s)
- D Martinelli
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Villone
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy
| | - F Fortunato
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Fiorino
- Item Oxygen S.R.L., Altamura (Ba), Italy
| | - N Laurieri
- Item Oxygen S.R.L., Altamura (Ba), Italy
| | - R Prato
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - V Dattoli
- Department of Nursing, School of Health Sciences, Cyprus University of Technology
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Gelardi M, Giancaspro R, Fiore V, Fortunato F, Cassano M. COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children. Int J Pediatr Otorhinolaryngol 2020; 138:110284. [PMID: 32861977 PMCID: PMC7415340 DOI: 10.1016/j.ijporl.2020.110284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND In response to the coronavirus pandemic 2019 (COVID-19), Italy established the national school closings from March 5, 2020. It has been shown that during school closures, there are significant decreases in the diagnoses of the respiratory infections. This has brought as well to a reduction in all those symptoms related to adenotonsillar hypertrophy. METHODS The study included 162 children, aged between 3 and 13 years, waiting for adenoidectomy and/or tonsillectomy, eventually combined with tympanocentesis or tube insertion. Parents have been called to answer a telephone interview aimed at detecting how the symptoms related to adenotonsillar hypertrophy were changing during lockdown. RESULTS There was an improvement in the overall symptomatology of children during the lockdown period. The value attributed by parents to the children's general assessment during the lockdown period decreased significatively during the quarantine (p = 0,0000). CONCLUSIONS The present study demonstrates that lockdown can have a positive impact on those specific diseases derived from precocious socialization and that it results to be particularly effective for the most vulnerable children. Indeed, lockdown has resulted to be so efficient that it has caused a modification in a medical and surgical therapeutic indication.
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Affiliation(s)
- M. Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - R. Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V. Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy,Corresponding author. Unit of Otolaryngology, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - F. Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M. Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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Rossi R, Falzarano M, Pinotti M, Balestra D, Neri M, Fortunato F, Mercuri E, Pane M, Gualandi F, Selvatici R, Ferlini A. NEW GENES AND DISEASES / NGS & RELATED TECHNIQUES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.322] [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: 11/16/2022]
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