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Lanino L, Restuccia F, Perego A, Ubezio M, Fattizzo B, Riva M, Consagra A, Musto P, Cilloni D, Oliva EN, Palmieri R, Poloni A, Califano C, Capodanno I, Itri F, Elena C, Fozza C, Pane F, Pelizzari AM, Breccia M, Di Bassiano F, Crisà E, Ferrero D, Giai V, Barraco D, Vaccarino A, Griguolo D, Minetto P, Quintini M, Paolini S, Sanpaolo G, Sessa M, Bocchia M, Di Renzo N, Diral E, Leuzzi L, Genua A, Guarini A, Molteni A, Nicolino B, Occhini U, Rivoli G, Bono R, Calvisi A, Castelli A, Di Bona E, Di Veroli A, Ferrara F, Fianchi L, Galimberti S, Grimaldi D, Marchetti M, Norata M, Frigeni M, Sancetta R, Selleri C, Tanasi I, Tosi P, Turrini M, Giordano L, Finelli C, Pasini P, Naldi I, Santini V, Della Porta MG. Real-world efficacy and safety of luspatercept and predictive factors of response in patients with lower risk myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2023. [PMID: 37222267 DOI: 10.1002/ajh.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Luca Lanino
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Marta Ubezio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bruno Fattizzo
- SC Ematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico & Dipartimento di Oncologia ed Emato-oncologia, University of Milan, Milan, Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angela Consagra
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Pellegrino Musto
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Ionica, Università degli Studi "Aldo Moro", AOU Consorziale Policlinico, Bari, Italy
| | - Daniela Cilloni
- AO Ordine Mauriziano, Università degli Studi di Torino, Turin, Italy
| | - Esther Natalie Oliva
- UOC Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Antonella Poloni
- Università Politecnica Marche, UOC Ematologia, AOU Marche, Ancona, Italy
| | | | - Isabella Capodanno
- Azienda Unità Sanitaria Locale- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Itri
- AOU San Luigi Gonzaga, SCDU Medicina Interna ad Indirizzo Ematologico, Università degli Studi di Torino, Torino, Italy
| | - Chiara Elena
- UOC Ematologia1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Fozza
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | | | | | | | - Elena Crisà
- AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Dario Ferrero
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Valentina Giai
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Daniela Barraco
- SC Ematologia, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Davide Griguolo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale Maggiore, Trieste, Italy
| | - Paola Minetto
- Clinica Ematologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Martina Quintini
- Azienda Ospedaliera di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Stefania Paolini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Grazia Sanpaolo
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche - Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Mariarosaria Sessa
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliero-Universitaria, Arcispedale S.Anna, University of Ferrara, Ferrara, Italy
| | - Monica Bocchia
- UOC Ematologia, Azienda Ospedaliero Universitaria Senese, Università di Siena, Siena, Italy
| | - Nicola Di Renzo
- UOC Ematologia e Trapianto di Cellule Staminali P.O. "Vito Fazzi" -ASL Lecce, Lecce, Italy
| | - Elisa Diral
- Unità di Ematologia e Trapianto di Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Livia Leuzzi
- SC Oncologia, SS Oncoematologia, PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | | | - Barbara Nicolino
- SSD Ematologia, ASLTO4 Presidio Ospedaliero di Ivrea, Ivrea, Italy
| | | | - Giulia Rivoli
- IRCCS Ospedale Policlinico San Martino, U.O Ematologia e terapie Cellulari, Genoa, Italy
| | - Roberto Bono
- A.O.O.R Villa Sofia - Cervello, U.O.S.D. Unità Trapianti di Midollo Osseo, Palermo, Italy
| | - Anna Calvisi
- U.O.C. Ematologia - CTMO Ospedale San Francesco, Nuoro, Italy
| | | | - Eros Di Bona
- Oncoematologia, AULSS 7 Pedemontana, Bassano del Grappa, Italy
| | | | | | - Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Sara Galimberti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Monia Marchetti
- Hematology Unit, AO Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marianna Norata
- Hematology Unit, IRCCS - Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Frigeni
- Dipartimento di Oncologia ed Ematologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carmine Selleri
- UOC Ematologia, AOU San Giovanni Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Ilaria Tanasi
- U.O.C. di Ematologia Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Patrizia Tosi
- UO Ematologia Ospedale Infermi Rimini, Rimini, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Pasini
- AIPASIM (Associazione Italiana Pazienti con Sindrome Mielodisplastica), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ilaria Naldi
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Valeria Santini
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Stanzani Maserati M, D’Onofrio R, Matacena C, Sambati L, Oppi F, Poda R, De Matteis M, Naldi I, Liguori R, Capellari S. Human figure drawing distinguishes Alzheimer’s patients: a cognitive screening test study. Neurol Sci 2018; 39:851-855. [DOI: 10.1007/s10072-018-3288-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/12/2018] [Indexed: 11/29/2022]
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Evangelisti S, Testa C, Ferri L, Gramegna LL, Manners DN, Rizzo G, Remondini D, Castellani G, Naldi I, Bisulli F, Tonon C, Tinuper P, Lodi R. Brain functional connectivity in sleep-related hypermotor epilepsy. Neuroimage Clin 2017. [PMID: 29527492 PMCID: PMC5842749 DOI: 10.1016/j.nicl.2017.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To evaluate functional connectivity (FC) in patients with sleep-related hypermotor epilepsy (SHE) compared to healthy controls. Methods Resting state fMRI was performed in 13 patients with a clinical diagnosis of SHE (age = 38.3 ± 11.8 years, 6 M) and 13 matched healthy controls (age = 38.5 ± 10.8 years, 6 M). Data were first analysed using probabilistic independent component analysis (ICA), then a graph theoretical approach was applied to assess topological and organizational properties at the whole brain level. We evaluated node degree (ND), betweenness centrality (BC), clustering coefficient (CC), local efficiency (LE) and global efficiency (GE). The differences between the two groups were evaluated non-parametrically. Results At the group level, we distinguished 16 RSNs (Resting State Networks). Patients showed a significantly higher FC in sensorimotor and thalamic regions (p < 0.05 corrected). Compared to controls, SHE patients showed no significant differences in network global efficiency, while ND and BC were higher in regions of the limbic system and lower in the occipital cortex, while CC and LE were higher in regions of basal ganglia and lower in limbic areas (p < 0.05 uncorrected). Discussion and conclusions The higher FC of the sensorimotor cortex and thalamus might be in agreement with the hypothesis of a peculiar excitability of the motor cortex during thalamic K-complexes. This sensorimotor-thalamic hyperconnection might be regarded as a consequence of an alteration of the arousal regulatory system in SHE. An altered topology has been found in structures like basal ganglia and limbic system, hypothesized to be involved in the pathophysiology of the disease as suggested by the dystonic-dyskinetic features and primitive behaviours observed during the seizures. Resting state functional connectivity was studied for the first time in SHE. SHE patients showed higher connectivity in thalamic and motor regions. Motor cortex might show a higher excitability in response to thalamic projections. Brain network topology was altered mainly in basal ganglia and limbic system.
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Affiliation(s)
- Stefania Evangelisti
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy
| | - Claudia Testa
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; INFN- National Institute of Nuclear Physics, Bologna, Italy
| | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, via Altura 3, 40139, Bologna, Italy
| | - Laura Ludovica Gramegna
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy
| | - David Neil Manners
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy
| | - Giovanni Rizzo
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, via Altura 3, 40139, Bologna, Italy
| | - Daniel Remondini
- INFN- National Institute of Nuclear Physics, Bologna, Italy; Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Gastone Castellani
- INFN- National Institute of Nuclear Physics, Bologna, Italy; Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, via Altura 3, 40139, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, via Altura 3, 40139, Bologna, Italy
| | - Caterina Tonon
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, via Altura 3, 40139, Bologna, Italy
| | - Raffaele Lodi
- Functional MR Unit, Policlinico S.Orsola - Malpighi, via Massarenti 9, 40138, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, via U. Foscolo 7, 40123, Bologna, Italy.
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Naldi I, Bisulli F, Testa C, Rizzo G, Ferri L, Gramegna LL, Licchetta L, Lodi R, Tonon C, Tinuper P. Proton MR Spectroscopy in Patients With Sleep-Related Hypermotor Epilepsy (SHE): Evidence of Altered Cingulate Cortex Metabolism. Sleep 2017; 40:3930910. [PMID: 28934527 DOI: 10.1093/sleep/zsx115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives To identify structural and/or metabolic alterations in patients with sleep-related hypermotor epilepsy (SHE) using magnetic resonance imaging (MRI) and proton MR spectroscopy (1H-MRS). Methods Nineteen SHE patients (seven males; 34.7 ± 9.7 years, mean age ± standard deviation) and 17 matched healthy volunteers (seven males; 34.0 ± 8.9 years) were included in the study. In all patients, the diagnosis of SHE was confirmed by video-polysomnographic recording of seizures. Semiology, seizure frequency, and therapy were assessed for all patients. For each recruited participant, structural MRI and 1H-MRS sequences were acquired. 1H-MRS was performed on two regions of interest: the medial thalamus and the anterior cingulate gyrus. Results At examination, five patients were seizure free. In the remainder, seizure frequency ranged from yearly to multiple episodes per night. Brain MRI was normal in all patients but one. The ratio of N-acetyl-aspartate/Creatine (NAA/Cr) was significantly reduced in the anterior cingulate cortex in patients compared to controls (p < .05). Thalamic NAA/Cr showed no differences between patients and controls. Regression analysis showed that NAA/Cr in the anterior cingulate gyrus correlated with seizure frequency (p < .05), being lower in patients with higher seizure frequency. Conclusions Given the absence of structural MR changes, our 1H-MRS data point to a functional NAA reduction in the cingulate cortex of SHE patients, more severe in those patients with higher seizure frequency and thus supporting the involvement of the anterior mesial structures in the pathophysiology of SHE.
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Affiliation(s)
- Ilaria Naldi
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Claudia Testa
- Functional MR Unit, Policlinico S. Orsola-Malpighi, Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Lorenzo Ferri
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Laura L Gramegna
- Functional MR Unit, Policlinico S. Orsola-Malpighi, Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Raffaele Lodi
- Functional MR Unit, Policlinico S. Orsola-Malpighi, Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Caterina Tonon
- Functional MR Unit, Policlinico S. Orsola-Malpighi, Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche, Bologna.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
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Vignatelli L, Bisulli F, Giovannini G, Licchetta L, Naldi I, Mostacci B, Rubboli G, Provini F, Tinuper P, Meletti S. Prevalence of Sleep-Related Hypermotor Epilepsy-Formerly Named Nocturnal Frontal Lobe Epilepsy-in the Adult Population of the Emilia-Romagna Region, Italy. Sleep 2017; 40:2930670. [PMID: 28364515 DOI: 10.1093/sleep/zsw041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giada Giovannini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, Local Health Trust, Modena, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Naldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Guido Rubboli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark.,Institute of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Federica Provini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, Local Health Trust, Modena, Italy
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Licchetta L, Bisulli F, Vignatelli L, Zenesini C, Di Vito L, Mostacci B, Rinaldi C, Trippi I, Naldi I, Plazzi G, Provini F, Tinuper P. Sleep-related hypermotor epilepsy: Long-term outcome in a large cohort. Neurology 2016; 88:70-77. [PMID: 27881627 PMCID: PMC5200852 DOI: 10.1212/wnl.0000000000003459] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 05/26/2016] [Accepted: 09/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the long-term outcome of sleep-related hypermotor epilepsy (SHE). METHODS We retrospectively reconstructed a representative cohort of patients diagnosed with SHE according to international diagnostic criteria, sleep-related seizures ≥75% and follow-up ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimates to calculate the cumulative time-dependent probability of TR and to generate survival curves. Univariate and multivariate Cox regression analyses were performed. RESULTS We included 139 patients with a 16-year median follow-up (2,414 person-years). The mean age at onset was 13 ± 10 years. SHE was sporadic in 86% of cases and familial in 14%; 16% of patients had underlying brain abnormalities. Forty-five percent of patients had at least 1 seizure in wakefulness lifetime and 55% had seizures only in sleep (typical SHE). At the last assessment, 31 patients achieved TR (TR group, 22.3%), while 108 (NTR group, 77.7%) still had seizures or had been in remission for <5 years. The cumulative TR rate was 20.4%, 23.5%, and 28.4% by 10, 20, and 30 years from inclusion. At univariate analysis, any underlying brain disorder (any combination of intellectual disability, perinatal insult, pathologic neurologic examination, and brain structural abnormalities) and seizures in wakefulness were more frequent among the NTR group (p = 0.028; p = 0.043). Absence of any underlying brain disorder (hazard ratio 4.21, 95% confidence interval 1.26-14.05, p = 0.020) and typical SHE (hazard ratio 2.76, 95% confidence interval 1.31-5.85, p = 0.008) were associated with TR. CONCLUSIONS Our data show a poor prognosis of SHE after a long-term follow-up. Its outcome is primarily a function of the underlying etiology.
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Affiliation(s)
- Laura Licchetta
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Francesca Bisulli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy.
| | - Luca Vignatelli
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Corrado Zenesini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Lidia Di Vito
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Barbara Mostacci
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Claudia Rinaldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Irene Trippi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Ilaria Naldi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Giuseppe Plazzi
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Federica Provini
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
| | - Paolo Tinuper
- From IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L., F.B., L.V., C.Z., B.M., G.P., F.P., P.T.) and Department of Biomedical and Neuromotor Sciences (L.L., F.B., L.D.V., C.R., I.T., I.N., G.P., F.P., P.T.), University of Bologna, Italy
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Vignoli A, Bisulli F, Darra F, Mastrangelo M, Barba C, Giordano L, Turner K, Zambrelli E, Chiesa V, Bova S, Fiocchi I, Peron A, Naldi I, Milito G, Licchetta L, Tinuper P, Guerrini R, Dalla Bernardina B, Canevini MP. Epilepsy in ring chromosome 20 syndrome. Epilepsy Res 2016; 128:83-93. [PMID: 27816898 DOI: 10.1016/j.eplepsyres.2016.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/29/2016] [Accepted: 10/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ring chromosome 20 syndrome is characterized by severe, drug resistant childhood onset epilepsy, often accompanied by cognitive impairment. We characterized the electro-clinical phenotype and the long-term course of epilepsy in a large series. METHODS We reviewed the electro-clinical phenotype of 25 patients (aged 8-59 years), and assessed the relationship between epilepsy severity and clinical and/or genetic variables. We also searched for reports of patients diagnosed with r(20) syndrome in the literature, included those whose clinical information was sufficiently accurate, and compared their clinical features with the ones of our patients. RESULTS Epilepsy exhibited an age dependent course. When seizure onset occurred in childhood (21 patients), terrifying hallucinations associated with focal motor seizures, often sleep-related (8 patients), or dyscognitive seizures (13 patients), were prominent features, often evolving into epileptic encephalopathy associated with non-convulsive status epilepticus (11 patients). In the long-term, progressive stabilization of drug resistant epilepsy associated with non-convulsive status epilepticus, focal seizures with motor and autonomic features, and eyelid myoclonia were noticed. Epilepsy onset in adolescence (3 patients) was accompanied by a milder developmental course, dyscognitive seizures and non-convulsive status epilepticus, and no cognitive decline. Only three older patients became seizure free (>5 years) We found statistically significant correlations between age at epilepsy onset and cognitive level. Although in the study cohort the relationship between r(20) ratio, age at epilepsy onset and cognitive level was non-statistically significant, it reached significance evaluating the larger cohort of patients previously published. SIGNIFICANCE In ring(20) syndrome, epilepsy has an age dependent course and a worse outcome when age at seizure onset is earlier. The r(20) ratio and severity of cognitive impairment appear to be directly related to each other and inversely correlated with the age at epilepsy onset.
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Affiliation(s)
- Aglaia Vignoli
- Epilepsy Center, San Paolo Hospital, Milano, Italy; Department of Health Sciences, University of Milan, Milano, Italy.
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Darra
- Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | | | - Carmen Barba
- Pediatric Neurology, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | | | | | | | - Stefania Bova
- Pediatric Neurology, V. Buzzi Hospital, ICP, Milan, Italy
| | | | - Angela Peron
- Epilepsy Center, San Paolo Hospital, Milano, Italy; Department of Health Sciences, University of Milan, Milano, Italy
| | - Ilaria Naldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Milito
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Renzo Guerrini
- Pediatric Neurology, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Maria Paola Canevini
- Epilepsy Center, San Paolo Hospital, Milano, Italy; Department of Health Sciences, University of Milan, Milano, Italy
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8
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Tinuper P, Bisulli F, Cross JH, Hesdorffer D, Kahane P, Nobili L, Provini F, Scheffer IE, Tassi L, Vignatelli L, Bassetti C, Cirignotta F, Derry C, Gambardella A, Guerrini R, Halasz P, Licchetta L, Mahowald M, Manni R, Marini C, Mostacci B, Naldi I, Parrino L, Picard F, Pugliatti M, Ryvlin P, Vigevano F, Zucconi M, Berkovic S, Ottman R. Definition and diagnostic criteria of sleep-related hypermotor epilepsy. Neurology 2016; 86:1834-42. [PMID: 27164717 PMCID: PMC4862248 DOI: 10.1212/wnl.0000000000002666] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [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: 08/21/2015] [Accepted: 01/27/2016] [Indexed: 11/15/2022] Open
Abstract
The syndrome known as nocturnal frontal lobe epilepsy is recognized worldwide and has been studied in a wide range of clinical and scientific settings (epilepsy, sleep medicine, neurosurgery, pediatric neurology, epidemiology, genetics). Though uncommon, it is of considerable interest to practicing neurologists because of complexity in differential diagnosis from more common, benign sleep disorders such as parasomnias, or other disorders like psychogenic nonepileptic seizures. Moreover, misdiagnosis can have substantial adverse consequences on patients' lives. At present, there is no consensus definition of this disorder and disagreement persists about its core electroclinical features and the spectrum of etiologies involved. To improve the definition of the disorder and establish diagnostic criteria with levels of certainty, a consensus conference using formal recommended methodology was held in Bologna in September 2014. It was recommended that the name be changed to sleep-related hypermotor epilepsy (SHE), reflecting evidence that the attacks are associated with sleep rather than time of day, the seizures may arise from extrafrontal sites, and the motor aspects of the seizures are characteristic. The etiology may be genetic or due to structural pathology, but in most cases remains unknown. Diagnostic criteria were developed with 3 levels of certainty: witnessed (possible) SHE, video-documented (clinical) SHE, and video-EEG-documented (confirmed) SHE. The main research gaps involve epidemiology, pathophysiology, treatment, and prognosis.
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Affiliation(s)
- Paolo Tinuper
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Francesca Bisulli
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - J H Cross
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Dale Hesdorffer
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Philippe Kahane
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Lino Nobili
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Federica Provini
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Ingrid E Scheffer
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Laura Tassi
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Luca Vignatelli
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Claudio Bassetti
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Fabio Cirignotta
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Christopher Derry
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Antonio Gambardella
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Renzo Guerrini
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Peter Halasz
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Laura Licchetta
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Mark Mahowald
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Raffaele Manni
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Carla Marini
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Barbara Mostacci
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Ilaria Naldi
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Liborio Parrino
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Fabienne Picard
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Maura Pugliatti
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Philippe Ryvlin
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Federico Vigevano
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Marco Zucconi
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Samuel Berkovic
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
| | - Ruth Ottman
- From IRCCS Istituto delle Scienze Neurologiche (P.T., F.B., F. Provini, L.V., L.L., B.M., I.N.), Bologna; Department of Biomedical and Neuromotor Sciences (P.T., F.B., F. Provini, L.L.), University of Bologna, Italy; University College London-Institute of Child Health (J.H.C.), Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, UK; Department of Epidemiology (D.H., R.O.), Mailman School of Public Health, and G.H. Sergievsky Center, College of Physicians & Surgeons, Columbia University, New York, NY; Unité Médicale Epilepsie et Malaises (P.K.), Pôle de Neurologie et Psychiatrie, CHU de Grenoble, France; "C. Munari" Center for Epilepsy Surgery (L.N., L.T.), Niguarda Hospital, Milan, Italy; Epilepsy Research Centre (I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Australia; Department of Neurology (C.B.), University of Bern, Switzerland; Unit of Neurology (F.C.), S. Orsola-Malpighi Hospital, University of Bologna, Italy; Department of Clinical Neurosciences (C.D.), Western General Hospital, Edinburgh, UK; Department of Medical and Surgical Sciences (A.G.), Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neurology Unit and Laboratories (R.G., C.M.), A. Meyer Children's Hospital, Florence, Italy; National Institute of Clinical Neuroscience (P.H.), Budapest, Hungary; Department of Neurology (M.M.), University of Minnesota Medical School, Minneapolis; Institute of Neurology Mondino (R.M.), University of Pavia; Sleep Disorders Center (L.P.), Department of Neurology, University of Parma, Italy; Department of Neurology (F. Picard), University Hospital and Medical School of Geneva, Switzerland; Department of Biomedical and Surgical Sciences (M.P.), University of Ferrara, Italy; Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland; Functional Neurology and Epileptology (P.R.), Hospices Civils de Lyon and CRNL, Lyon; Epilepsy Institute (P.R.), IDEE, Lyon, France
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Naldi I, Piccinni C, Mostacci B, Renzini J, Accetta G, Bisulli F, Tappatà M, Piazza A, Pagano P, Bianchi S, D'Alessandro R, Tinuper P, Poluzzi E. Prescription patterns of antiepileptic drugs in young women: development of a tool to distinguish between epilepsy and psychiatric disorders. Pharmacoepidemiol Drug Saf 2016; 25:763-9. [PMID: 26887800 DOI: 10.1002/pds.3984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/27/2015] [Revised: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antiepileptic drugs (AEDs) are also prescribed for therapeutic indications other than epilepsy (EPI), namely, psychiatric disorders (PSY). Our aim was to develop an algorithm able to distinguish between EPI and PSY among childbearing age women based on differences in AED exposure in these patient groups. METHODS Two groups of women (18-45 years) with EPI or PSY treated with AEDs in the first semester of 2010 or 2011 were extracted from paper or electronic medical charts of specialized centers. Through the prescription database of Bologna Local Health Authority (Italy), AEDs, treatment schedule and co-treatments were collected for each patient. A prescription-based hierarchical classification system was developed. The algorithm obtained was subsequently validated on internal and external data. RESULTS Eighty-one EPI and 94 PSY subjects were recruited. AED monotherapy was the most common choice in both groups (69% EPI vs 79% PSY). Some AEDs were used only in EPI, others exclusively in PSY. Co-treatments with antipsychotics (6% vs 67%), lithium (0% vs 9%), and antidepressants (7% vs 70%) were fewer in EPI than in PSY. The hierarchical classification system identified antipsychotics, SSRIs (Selective Serotonin Reuptake Inhibitors), and number of AEDs as variables to discriminate EPI and PSY, with an overall error rate estimate of 9.7% (95%CI: 5.3% to 14.1%). CONCLUSION Among the differences between EPI and PSY, prescription data alone allowed an algorithm to be developed to diagnose each childbearing age woman receiving AEDs. This approach will be useful to stratify patients for risk estimates of AED-treated patients based on administrative databases. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ilaria Naldi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Jessica Renzini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gabriele Accetta
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Tappatà
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Antonella Piazza
- Mental Health Department, Bologna Local Health Authority, Bologna, Italy
| | - Paola Pagano
- Pharmaceutical Department, Bologna Local Health Authority, Bologna, Italy
| | - Stefano Bianchi
- Pharmaceutical Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Martinoni M, Marucci G, de Biase D, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Tallini G, Giulioni M. BRAF V600E mutation in neocortical posterior temporal epileptogenic gangliogliomas. J Clin Neurosci 2015; 22:1250-3. [PMID: 25937573 DOI: 10.1016/j.jocn.2015.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/24/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 02/08/2023]
Abstract
The aim of this study was to verify the presence of BRAF mutations in a series of six patients affected by drug-resistant focal epilepsy associated with neocortical posterior temporal gangliogliomas (GG) who were subjected to lesionectomy between June 2008 and November 2013. GG are an increasingly recognized cause of epilepsy and represent the most common tumor in young patients undergoing surgery for intractable focal epilepsy. BRAF mutations have been identified in up to 50% of GG. Interestingly, these six patients shared a specific anatomical posterior temporal site. In all patients, histological examination confirmed the diagnosis of GG, and two were also associated with a focal cortical dysplasia (FCD) type IIa. BRAF mutations were found in four out of six GG (66.6%). Furthermore, dysplastic tissue of Patient 2 showed a concomitant BRAF V600E mutation. All patients but one (83.3%) achieved Engel Class Ia seizure control. The patient carrying a concomitant BRAF mutation in GG and FCD fell into Engel Class II. Further analyses will be required in order to better understand the meaning of BRAF mutations in epilepsy-associated tumors and FCD and their possible role as a prognostic seizure outcome and tumor behavior marker.
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Affiliation(s)
- Matteo Martinoni
- Division of Neurosurgery, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Via Altura 1/8, Bologna 40139, Italy.
| | - Gianluca Marucci
- Section of Pathology "M.Malpighi", Department of Biomedical and NeuroMotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Dario de Biase
- Department of Experimental, Diagnostic and Specialty Medicine, Anatomic Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Epilepsy Hospitalet, Dianalund, Denmark
| | - Lilia Volpi
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- Division of Neuroradiology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- Division of Neuroradiology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, Anatomic Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Via Altura 1/8, Bologna 40139, Italy
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Martinoni M, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Focal cortical dysplasias in temporal lobe epilepsy surgery: Challenge in defining unusual variants according to the last ILAE classification. Epilepsy Behav 2015; 45:212-6. [PMID: 25812941 DOI: 10.1016/j.yebeh.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/06/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI imaging, and presumed pathogenesis; however, their clinical features and their prognostic significance are still incompletely defined. In addition, the combination of different histopathological abnormalities can represent "unusual" subtypes that can be difficult to classify. The aim of our study was to analyze the incidence and the significance of these "unusual" subtypes of FCDs in drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS We retrospectively analyzed 133 patients consecutively submitted to tailored anteromesial temporal lobe resection for pharmacoresistant MTLE. Seizure onset, seizure duration, age at surgery, and postoperative seizure outcome were evaluated in relation to the different neuropathological groups defined according to the new ILAE classification. RESULTS Focal cortical dysplasias were found in 80 out of 133 patients. Six patients were affected by isolated FCD type I, 12 patients by FCD type II, and 44 patients by FCD type III. Furthermore, we found 18 "atypical" cases (20.5% of all FCD cases and 26.6% of FCDs associated with a principal lesion): 10 cases of associated FCD type II-hippocampal sclerosis (HS) and 8 cases associated with FCD II-epilepsy-associated tumors (EATs). CONCLUSION Our results indicate that "unusual" subtypes of FCDs, in particular associated FCD type II, are not uncommon findings, suggesting that they deserve a classification recognition. Similarities in seizure outcome and immunohistochemical and molecular evidences, shared by FCD type II+EATs and EATs, suggest a common pathogenic link. The choice to create a specific unifying class or, on the contrary, to also include "associated FCD type II" in the definition of the new unifying class FCD type III should be further discussed.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology "M.Malpighi", Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Vignatelli L, Bisulli F, Giovannini G, Licchetta L, Naldi I, Mostacci B, Rubboli G, Provini F, Tinuper P, Meletti S. Prevalence of nocturnal frontal lobe epilepsy in the adult population of Bologna and Modena, Emilia-Romagna region, Italy. Sleep 2015; 38:479-85. [PMID: 25406112 DOI: 10.5665/sleep.4514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/29/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To estimate the prevalence of nocturnal frontal lobe epilepsy (NFLE) in the adults of two areas of the Emilia-Romagna region (northeast Italy) and to describe the clinical features from a population-based perspective. DESIGN Population-based retrospective cohort study including adults with NFLE. SETTING Two areas of the Emilia-Romagna region: the city of Bologna (330,901 adult residents) and five districts of the province of Modena (424,007). Prevalence day: December 31, 2010. PARTICIPANTS Patients with NFLE collected from multiple databases of neurologic hub centers of the districts involved. Diagnostic criteria: clinical history of sleep related bizarre motor attacks and videopolysomnographic recording confirming the typical features of NFLE. Inclusion criteria for prevalence calculation: residence in one of the two geographic areas on the prevalence day and an "active" or "in remission with treatment" form of NFLE. MEASUREMENTS AND RESULTS Six subjects from Bologna and eight from Modena were included. Crude prevalence (per 100,000 residents) was 1.8 (95% confidence interval 0.7-4.0) in Bologna and 1.9 (0.8-3.7) in Modena. Similarly, the main clinical features were consistent: onset during adolescence (median age 11-13 y), mainly hyperkinetic seizures, nonlesional form in more than two-thirds of cases, an active form of epilepsy in more than two-thirds of cases. A family history of epilepsy was reported only for two patients. CONCLUSIONS This epidemiologic study establishes that NFLE is a rare epileptic condition, fulfilling the definition for rare disease. Because of methodological limitations of our case ascertainment, the estimates we disclose must be considered the minimum prevalence.
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Affiliation(s)
- Luca Vignatelli
- Department of Primary Care, Local Health Trust, Bologna, Italy.,Health and Social Regional Agency, Emilia-Romagna Region, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giada Giovannini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, Local Health Trust, Modena, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Guido Rubboli
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Federica Provini
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, Local Health Trust, Modena, Italy
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Giulioni M, Marucci G, Martinoni M, Marliani AF, Toni F, Bartiromo F, Volpi L, Riguzzi P, Bisulli F, Naldi I, Michelucci R, Baruzzi A, Tinuper P, Rubboli G. Epilepsy associated tumors: Review article. World J Clin Cases 2014; 2:623-641. [PMID: 25405186 PMCID: PMC4233414 DOI: 10.12998/wjcc.v2.i11.623] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/31/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
Long-term epilepsy associated tumors (LEAT) represent a well known cause of focal epilepsies. Glioneuronal tumors are the most frequent histological type consisting of a mixture of glial and neuronal elements and most commonly arising in the temporal lobe. Cortical dysplasia or other neuronal migration abnormalities often coexist. Epilepsy associated with LEAT is generally poorly controlled by antiepileptic drugs while, on the other hand, it is high responsive to surgical treatment. However the best management strategy of tumor-related focal epilepsies remains controversial representing a contemporary issues in epilepsy surgery. Temporo-mesial LEAT have a widespread epileptic network with complex epileptogenic mechanisms. By using an epilepsy surgery oriented strategy LEAT may have an excellent seizure outcome therefore surgical treatment should be offered early, irrespective of pharmacoresistance, avoiding both the consequences of uncontrolled seizures as well as the side effects of prolonged pharmacological therapy and the rare risk of malignant transformation.
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Naldi I, Taranta M, Gherardini L, Pelosi G, Viglione F, Grimaldi S, Pani L, Cinti C. Novel epigenetic target therapy for prostate cancer: a preclinical study. PLoS One 2014; 9:e98101. [PMID: 24851905 PMCID: PMC4031137 DOI: 10.1371/journal.pone.0098101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/28/2014] [Indexed: 01/06/2023] Open
Abstract
Epigenetic events are critical contributors to the pathogenesis of cancer, and targeting epigenetic mechanisms represents a novel strategy in anticancer therapy. Classic demethylating agents, such as 5-Aza-2′-deoxycytidine (Decitabine), hold the potential for reprograming somatic cancer cells demonstrating high therapeutic efficacy in haematological malignancies. On the other hand, epigenetic treatment of solid tumours often gives rise to undesired cytotoxic side effects. Appropriate delivery systems able to enrich Decitabine at the site of action and improve its bioavailability would reduce the incidence of toxicity on healthy tissues. In this work we provide preclinical evidences of a safe, versatile and efficient targeted epigenetic therapy to treat hormone sensitive (LNCap) and hormone refractory (DU145) prostate cancers. A novel Decitabine formulation, based on the use of engineered erythrocyte (Erythro-Magneto-Hemagglutinin Virosomes, EMHVs) drug delivery system (DDS) carrying this drug, has been refined. Inside the EMHVs, the drug was shielded from the environment and phosphorylated in its active form. The novel magnetic EMHV DDS, endowed with fusogenic protein, improved the stability of the carried drug and exhibited a high efficiency in confining its delivery at the site of action in vivo by applying an external static magnetic field. Here we show that Decitabine loaded into EMHVs induces a significant tumour mass reduction in prostate cancer xenograft models at a concentration, which is seven hundred times lower than the therapeutic dose, suggesting an improved pharmacokinetics/pharmacodynamics of drug. These results are relevant for and discussed in light of developing personalised autologous therapies and innovative clinical approach for the treatment of solid tumours.
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Affiliation(s)
- Ilaria Naldi
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Experimental Oncology Unit, Siena, Italy
| | - Monia Taranta
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Experimental Oncology Unit, Siena, Italy
| | - Lisa Gherardini
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Experimental Oncology Unit, Siena, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Federica Viglione
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Settimio Grimaldi
- Institute of Translational Pharmacology, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Luca Pani
- Institute of Translational Pharmacology, Consiglio Nazionale delle Ricerche (CNR), Cagliari, Italy
| | - Caterina Cinti
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Experimental Oncology Unit, Siena, Italy
- * E-mail:
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15
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Magini P, Bisulli F, Baldassari S, Stipa C, Naldi I, Licchetta L, Menghi V, Tinuper P, Seri M, Pippucci T. LGI1 microdeletions are not a frequent cause of partial epilepsy with auditory features (PEAF). Epilepsy Res 2014; 108:972-7. [PMID: 24721199 DOI: 10.1016/j.eplepsyres.2014.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 01/27/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
Heterozygous mutations of the leucine-rich, glioma-inactivated 1 gene (LGI1) are the major known cause of partial epilepsy with auditory features (PEAF), accounting for roughly 50% of families. Recently, a partial gene microdeletion has been reported in a single family. To assess the contribution of LGI1 microrearrangements to the pathogenesis of PEAF, we screened 50 patients negative for point mutations through multiplex ligation-dependent probe amplification (MLPA) analysis. No cryptic imbalances were found in LGI1, suggesting that LGI1 microdeletions are not a frequent cause of PEAF. Despite the small number of examined patients and the need for replication studies, these findings support the hypothesis that diagnostic screening for LGI1 microrearrangements lacks clinical utility, especially for sporadic cases, and further highlight genetic heterogeneity of familial and sporadic PEAF.
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Affiliation(s)
- P Magini
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
| | - F Bisulli
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Baldassari
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - C Stipa
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - I Naldi
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - L Licchetta
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - V Menghi
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - P Tinuper
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - M Seri
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - T Pippucci
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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Bisulli F, Naldi I, Baldassari S, Magini P, Licchetta L, Castegnaro G, Fabbri M, Stipa C, Ferrari S, Seri M, Gonçalves Silva GE, Tinuper P, Pippucci T. Autosomal dominant partial epilepsy with auditory features: a new locus on chromosome 19q13.11-q13.31. Epilepsia 2014; 55:841-8. [PMID: 24579982 DOI: 10.1111/epi.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To clinically and genetically characterize a large Brazilian family with autosomal dominant partial epilepsy with auditory features (ADPEAF) not related to leucine-rich, glioma-inactivated 1 (LGI1) gene. METHODS Seventy family members (four married-ins) participating in the study were assessed by a detailed clinical interview and a complete neurologic examination. Genetic mapping was conducted through autosome-wide single nucleotide polymorphism (SNP) genotyping and subsequent linkage analysis on 16 and haplotype analysis on 25 subjects, respectively. RESULTS The pedigree comprised 15 affected members, of whom 11 were included in the study (male/female: 6/5; mean age 39.5 years). All but two (III:22 and IV:92) had focal seizures with auditory aura followed by secondary generalization in 44.4%. The mean age at onset of epilepsy seizures was 13.7 years. Initial autosome-wide SNP linkage analysis conducted on 12 subjects (8 affected) pointed to a single genomic region on chromosome 19 with a maximum multipoint logarithm of the odds (LOD) score of 2.60. Further refinement of this region through SNP and microsatellite genotyping on 16 subjects (11 affected) increased the LOD score to 3.41, thereby establishing 19q13.11-q13.31 as a novel ADPEAF locus. Haplotype analysis indicated that the underlying mutation is most likely located in a 9.74 Mb interval between markers D19S416 and D19S420. Sequence analysis of the most prominent candidate genes within this critical interval (SCN1B, LGI4, KCNK6, and LRFN1) did not reveal any mutation. SIGNIFICANCE This study disclosed a novel ADPEAF locus on chromosome 19q13.11-q13.31, contributing to future identification of a second dominant gene for this epileptic syndrome. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Grandi A, Campagnoli S, Parri M, De Camilli E, Naldi I, Gherardini L, Cinti C, Terracciano L, Jin B, Sarmientos P, Viale G, Grandi G, Pileri P, Grifantini RM. Abstract C190: A novel monoclonal antibody for colon cancer therapy. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-c190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In our recent research activities, we identified 89 novel candidate markers for prevalent cancers by a systematic Tissue microarray analysis (TMA) of a large collection of polyclonal antibodies (approximately 1600) raised against membrane-associated and secreted human proteins currently marginally characterized. Monoclonal antibodies were generated towards 20 distinct antigens that are being characterized and validated for diagnostic and therapeutic applications.
Here we describe a monoclonal antibody (mAb) targeting a protein of the protocadherin- family in colo-rectal cancer (CRC). The antibody specifically recognizes its target protein in cancer tissues, with concomitant negligible or marginal reactivity in normal colon. The protein was not previously described as CRC target. IHC data from CRC samples of approximately 200 patients, (collected at the bio-bank of the institute for Pathology of Basel, Switzerland and at the European Institute of Pathology of Milan, Italy) showed that the antibody binds up to 80% CRC cases (stages from 1 to 4) with high or moderate intensity. In most cases, the antibody gives plasma membrane by Immune Histochemistry (IHC). An expanded analysis on approximately 1000 CRC cases is ongoing to assess whether the membranous IHC staining associates with specific clinic-pathological parameters.
IHC analysis of 35 normal human tissues revealed that it gives intracellular staining in skeletal muscle, pituitary glands and prostate, whereas it gives background irrelevant staining in the other 32 tissues. The antibody is able to bind the surface of different colon cancer cells in vitro and in vivo. Upon binding it is efficiently internalized by colon cancer cells, suggesting that it can be exploited for the development of Antibody-Drug-Conjugate (ADC). Moreover, it inhibits tumor growth in athymic nude mice bearing HCT15 and HT29 colon cancer xenografts. Overall, data indicate that this monoclonal antibody could be developed for a targeted therapy of colo-rectal cancers, alone or in combinatorial strategies.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C190.
Citation Format: Alberto Grandi, Susanna Campagnoli, Matteo Parri, Elisa De Camilli, Ilaria Naldi, Lisa Gherardini, Caterina Cinti, Luigi Terracciano, Boquan Jin, Paolo Sarmientos, Giuseppe Viale, Guido Grandi, Piero Pileri, Renata Maria Grifantini. A novel monoclonal antibody for colon cancer therapy. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C190.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Boquan Jin
- 5The Fourth Military Medical University, Xi'an, China
| | | | | | - Guido Grandi
- 6Advisory Board, Externautics S.p.A. and Novartis Vaccines & Diagnostics Vaccines, Siena, Italy
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Licchetta L, Pippucci T, Bisulli F, Cantalupo G, Magini P, Alvisi L, Baldassari S, Martinelli P, Naldi I, Vanni N, Liguori R, Seri M, Tinuper P. A novel pedigree with familial cortical myoclonic tremor and epilepsy (FCMTE): clinical characterization, refinement of the FCMTE2 locus, and confirmation of a founder haplotype. Epilepsia 2013; 54:1298-306. [PMID: 23663087 DOI: 10.1111/epi.12216] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE We describe the clinical, neurophysiologic, and genetic features of a new, large family with familial cortical myoclonic tremor and epilepsy (FCMTE). METHODS Reliable clinical information was obtained on the 127 members. Thirty-one collaborative individuals were assessed by a detailed clinical interview and a complete neurologic examination. A polygraphic study was conducted in 15 patients, back-averaging analysis and somatosensory evoked potentials with C-reflex study in four. The genetic study investigated 30 subjects with microsatellite markers at three loci on chromosomes 8q (FCMTE1), 2p (FCMTE2), and 5p (FCMTE3). KEY FINDINGS The pedigree included 25 affected members (M/F: 9/16). We studied 16 of the 19 living affected members (M/F: 5/11; mean age 47.8 years). Cortical myoclonic tremor (CMT) was associated with generalized seizures in 10 patients (62.5%). The mean age at onset of CMT and seizures was 28.1 and 33.8 years, respectively. Four patients (25%) reported a slow progression of CMT, with severe gait impairment in one. Psychiatric disorders of variable severity recurred in 37.5% of cases. Rhythmic bursts at 7-15 Hz were recorded in all 11 affected members tested. Additional neurophysiologic investigations disclosed a cortical origin of myoclonus in all patients tested. Generalized epileptiform discharges were recorded in 25% of cases, and a photoparoxysmal response in 31%. Genetic analysis established linkage to the FCMTE2 locus on chromosome 2p11.1-2q12.2 (OMIM 607876) and narrowed the critical interval to a 10.4 Mb segment. Haplotype analysis in the present family identified a founder haplotype identical to that previously observed in families from the same geographic area. SIGNIFICANCE This study confirms evidence of a founder effect in Italian families and reduces the number of positional candidate genes in the FCMTE2 locus to 59, thereby contributing to future gene identification by Next Generation Sequencing approaches.
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Affiliation(s)
- Laura Licchetta
- IRCCS Institute of Neurological Sciences of Bologna, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Grandi A, Parri M, Campagnoli S, Nogarotto R, De Camilli E, Naldi I, Cinti C, Sarmientos P, Grandi G, Terracciano L, Viale G, Pileri P, Grifantini RM. Abstract 5533: Novel targets and monoclonal antibodies for cancer therapy. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer therapeutic targets is an extremely active research field in both academia and pharmaceutical companies. In our recent research activities we identified by a high-throughput immunohistochemistry screening of Tissue microarray (TMA), a panel of 89 novel candidate tumor markers for prevalent cancers representing breast, lung colon ovary and prostate carcinomas. The novel marker candidates were found over-expressed in one or more of the five tumors under analysis, with significant frequency. Three of them seems to be promising therapeutic targets for monoclonal antibody therapy, being exposed on the surface of cancer cells. They include: 1) a lectin binding protein, over-expressed in breast, lung and ovary cancer; 2) a protein involved in iron homoeostasis and over-expressed in breast, colon, lung and ovary cancers, 3) a cadherin homologous protein detected in colon, lung and ovary cancers. Gene silencing using siRNA technology and/or over-expression experiments using marker-encoding plasmids significantly alter cell proliferation, migration, invasiveness and clonal growth in vitro, indicating that expression of the three proteins confers cell phenotypes relevant for tumor progression. Highly specific murine monoclonal antibodies (mAbs) were generated against the three proteins and proved to bind the surface of cancer cells lines. Of particular interest is a murine mAb targeting the cadherin-like protein that, upon binding to the cell surface, is efficiently internalized by cancer cells, suggesting that it is amenable to the development of antibody-drug conjugates. This mAb did not show any relevant IHC cross-reactivity in the 35 human tissues requested by FDA to demonstrate antibody specificity. Furthermore this mAb significantly inhibited tumor growth in athymic nude mice bearing HCT15 and HT29 colon cancer xenograft models. Finally, IHC analysis of approximately 300 colon cancer clinical samples indicates that the antibody stains a large fraction of colon cancer samples, and gives intense membranous staining in specific patients’ group. Overall, data indicate that this antibody could be developed as a novel tool for a targeted therapy of colo-rectal cancer, alone or in combination with other treatments
Citation Format: Alberto Grandi, Matteo Parri, Susanna Campagnoli, Renzo Nogarotto, Elisa De Camilli, Ilaria Naldi, Caterina Cinti, Paolo Sarmientos, Guido Grandi, Luigi Terracciano, Giuseppe Viale, Piero Pileri, Renata Maria Grifantini. Novel targets and monoclonal antibodies for cancer therapy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5533. doi:10.1158/1538-7445.AM2013-5533
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Naldi I, Bisulli F, Vignatelli L, Licchetta L, Pittau F, Di Vito L, Mostacci B, Menghi V, Provini F, Montagna P, Tinuper P. Tobacco habits in nocturnal frontal lobe epilepsy. Epilepsy Behav 2013; 26:114-7. [PMID: 23246147 DOI: 10.1016/j.yebeh.2012.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/27/2012] [Accepted: 10/11/2012] [Indexed: 11/20/2022]
Abstract
The beneficial effect of nicotine has been reported in autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) patients, but not tested in sporadic cases. Recently, a nicotine defect in the arousal pathway has been hypothesized even in sporadic NFLE patients and their relatives. This case-control family study was designed to test whether NFLE subjects were more likely to use tobacco than controls, as an indirect marker of cholinergic arousal system dysregulation. At least four relatives were included for each NFLE proband and control. Each subject was questioned about tobacco habits; 434 individuals were recruited. Moreover, we compared NFLE patients with age- and sex-matched controls to determine whether they are more likely to use tobacco. We found a slightly higher trend of tobacco use in NFLE probands compared to that in control subjects; we did not find any significant difference in the distribution of tobacco use among NFLE group compared to that in the control group.
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Affiliation(s)
- Ilaria Naldi
- IRCCS Istituto delle Scienze Neurologiche Bologna, and Dipartimento di ScienzeBiomediche e NeuroMotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
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Grifantini R, Pileri P, Grandi A, Parri M, Campagnoli S, Naldi I, Cinti C, Grandi G, Viale G, Sarmientos P. 547 Novel Targets for Monoclonal Antibody Therapy. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Trivino Pardo JC, Grimaldi S, Taranta M, Naldi I, Cinti C. Microwave electromagnetic field regulates gene expression in T-lymphoblastoid leukemia CCRF-CEM cell line exposed to 900 MHz. Electromagn Biol Med 2012; 31:1-18. [PMID: 22332889 DOI: 10.3109/15368378.2011.596251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Electric, magnetic, and electromagnetic fields are ubiquitous in our society, and concerns have been expressed regarding possible adverse effects of these exposures. Research on Extremely Low-Frequency (ELF) magnetic fields has been performed for more than two decades, and the methodology and quality of studies have improved over time. Studies have consistently shown increased risk for childhood leukemia associated with ELF magnetic fields. There are still inadequate data for other outcomes. More recently, focus has shifted toward Radio Frequencies (RF) exposures from mobile telephony. There are no persuasive data suggesting a health risk, but this research field is still immature with regard to the quantity and quality of available data. This technology is constantly changing and there is a need for continued research on this issue. To investigate whether exposure to high-frequency electromagnetic fields (EMF) could induce adverse health effects, we cultured acute T-lymphoblastoid leukemia cells (CCRF-CEM) in the presence of 900 MHz MW-EMF generated by a transverse electromagnetic (TEM) cell at short and long exposure times. We evaluated the effect of high-frequency EMF on gene expression and we identified functional pathways influenced by 900 MHz MW-EMF exposure.
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Lande C, Cecchettini A, Tedeschi L, Taranta M, Naldi I, Citti L, Trivella MG, Grimaldi S, Cinti C. Innovative erythrocyte-based carriers for gene delivery in porcine vascular smooth muscle cells: basis for local therapy to prevent restenosis. Cardiovasc Hematol Disord Drug Targets 2012; 12:68-75. [PMID: 22746344 DOI: 10.2174/187152912801823101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 04/12/2012] [Accepted: 05/03/2012] [Indexed: 06/01/2023]
Abstract
Vascular restenosis is affecting 30-40% of patients treated by percutaneous coronary angioplasty (PTCA). The advent of stenting reduced but not abolished restenosis. The introduction of drug eluting stent (DES) further reduced restenosis, but impaired endothelization exposed to intracoronary thrombosis as late adverse event. It is widely accepted that the endothelial denudation and coronary wall damages expose Vascular Smooth Muscle Cells (VSMC) to multiple growth factors and plasma circulating agents thus activating migration and proliferative pathways leading to restenosis. Among the major players of this processes, phosphorylated Elk-1, forming the Elk-1/SRF transcription complex, controls the expression of a different set of genes responsible for cell proliferation. Therefore, it is feasible that gene-specific oligonucleotide therapy targeting VSMC migration and proliferation genes can be a promising therapeutic approach. While a plethora of vehicles is suitably working in static in vitro cultures, methods for in vivo delivery of oligonucleotides are still under investigation. Recently, we have patented a novel erythrocyte-based drug delivery system with high capability to fuse with targeted cells thus improving drug bioavailability at the site of action. Here, the potential of these engineered porcine erythrocytes to deliver a synthetic DNA Elk-1 decoy inside syngenic porcine VSMC was tested. The results of this study indicate that Elk-1 decoy is actually able to inhibit cell proliferation and migration of VSMC. Our data also suggest that erythrocyte-based carriers are more efficient in delivering these oligonucleotides in comparison to conventional vehicles. As a consequence, a lower dose of Elk-1 decoy, delivered by engineered erythrocytes, was sufficient to inhibit cell growth and migration. This approach represents the translational step to reach in vivo experiments in pigs after PTCA and/or stent implantation where oligonucleotide drugs will be site-specific administered by using erythrocyte-based carriers to prevent restenosis.
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Giulioni M, Martinoni M, Naldi I, Bisulli F, Pozzati E, Tinuper P. Successful removal and reimplant of vagal nerve stimulator device after 10 years. Ann Indian Acad Neurol 2012; 15:128-9. [PMID: 22566727 PMCID: PMC3345590 DOI: 10.4103/0972-2327.94997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/05/2010] [Indexed: 11/15/2022] Open
Abstract
The number of implanted vagal nerve stimulators is growing and the need for removal or revision of the devices will become even more frequent. A significant concern about Vagus Nerve Stimulation (VNS) therapy is the presence of the spiral stimulating electrodes, wrapped around the nerve, once treatment is considered ineffective or is no longer desired. Our purpose is to demonstrate the feasibility of complete removal and replacement of the vagal nerve stimulator electrodes using microsurgical technique even after a long period, without damaging the nerve. We attempted removal and replacement of spiral stimulating electrodes from a patient who received a 10-year long VNS therapy for drug-resistant epilepsy. Our results indicate that the spiral electrodes may be safely removed from the vagus nerve, even after several years. The reversibility of lead implantation may enhance the attractiveness of VNS therapy. Furthermore, with a correct microsurgical technique, it is possible to respect the normal anatomy and functionality of vagal nerve and to reimplant a new VNS system with all its components, maintaining the same therapeutic efficacy after many years.
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Affiliation(s)
- Marco Giulioni
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Perez-Pomares JM, Ruiz-Villalba A, Ziogas A, Segovia JC, Ehrbar M, Munoz-Chapuli R, De La Rosa A, Dominguez JN, Hove-Madsen L, Sankova B, Sedmera D, Franco D, Aranega Jimenez A, Babaeva G, Chizh N, Galchenko S, Sandomirsky B, Schwarzl M, Seiler S, Steendijk P, Huber S, Maechler H, Truschnig-Wilders M, Pieske B, Post H, Simrick S, Kreutzer R, Rao C, Terracciano CM, Kirchhof P, Fabritz L, Brand T, Theveniau-Ruissy M, Parisot P, Francou A, Saint-Michel E, Mesbah K, Kelly RG, Wu HT, Sie SS, Chen CY, Kuan TC, Lin CS, Ismailoglu Z, Guven M, Yakici A, Ata Y, Ozcan S, Yildirim E, Ongen Z, Miroshnikova V, Demina E, Rodygina T, Kurjanov P, Denisenko A, Schwarzman A, Rubanenko A, Shchukin Y, Germanov A, Goldbergova M, Parenica J, Lipkova J, Pavek N, Kala P, Poloczek M, Vasku A, Parenicova I, Spinar J, Gambacciani C, Chiavacci E, Evangelista M, Vesentini N, Kusmic C, Pitto L, Chernova A, Nikulina SUY, Arvanitis DA, Mourouzis I, Pantos C, Kranias EG, Cokkinos DV, Sanoudou D, Vladimirskaya TE, Shved IA, Kryvorot SG, Schirmer IM, Appukuttan A, Pott L, Jaquet K, Ladilov Y, Archer CR, Bootman MD, Roderick HL, Fusco A, Sorriento D, Santulli G, Trimarco B, Iaccarino G, Hagenmueller M, Riffel J, Gatzoulis MA, Stoupel EG, Garcia R, Merino D, Montalvo C, Hurle MA, Nistal JF, Villar AV, Perez-Moreno A, Gilabert R, Bernhold E, Ros E, Amat-Roldan I, Katus HA, Hardt SE, Maqsood A, Zi M, Prehar S, Neyses L, Ray S, Oceandy D, Khatami N, Wadowski P, Wagh V, Hescheler J, Sachinidis A, Mohl W, Chaudhry B, Burns D, Henderson DJ, Bax NAM, Van Marion MH, Shah B, Goumans MJ, Bouten CVC, Van Der Schaft DWJ, Bax NAM, Van Oorschot AAM, Maas S, Braun J, Van Tuyn J, De Vries AAF, Gittenberger-De Groot AC, Goumans MJ, Bageghni S, Drinkhill MJ, Batten TFC, Ainscough JFX, Onate B, Vilahur G, Ferrer-Lorente R, Ybarra J, Diez-Caballero A, Ballesta-Lopez C, Moscatiello F, Herrero J, Badimon L, Martin-Rendon E, Clifford DM, Fisher SA, Brusnkill SJ, Doree C, Mathur A, Clarke M, Watt SM, Hernandez-Vera R, Badimon L, Kavanagh D, Yemm AI, Frampton J, Kalia N, Terajima Y, Shimizu T, Tsuruyama S, Ishii H, Sekine H, Hagiwara N, Okano T, Vrijsen KR, Chamuleau SAJ, Sluijter JPG, Doevendans PFM, Madonna R, Delli Pizzi S, Di Donato L, Mariotti A, Di Carlo L, D'ugo E, Teberino MA, Merla A, T A, De Caterina R, Kolker L, Ali NN, Maclellan K, Moore M, Wheeler J, Harding SE, Fleck RA, Rowlinson JM, Kraenkel N, Ascione R, Madeddu P, O'sullivan JF, Leblond AL, Kelly G, Kumar AHS, Metharom P, Buneker CK, Alizadeh-Vikali N, Hynes BG, O'connor R, Caplice NM, Noseda M, De Smith AJ, Leja T, Rao PH, Al-Beidh F, Abreu Pavia MS, Blakemore AI, Schneider MD, Stathopoulou K, Cuello F, Ehler E, Haworth RS, Avkiran M, Morawietz H, Eickholt C, Langbein H, Brux M, Goettsch C, Goettsch W, Arsov A, Brunssen C, Mazilu L, Parepa IR, Suceveanu AI, Suceveanu AP, De Man FS, Guignabert C, Tu L, Handoko ML, Schalij I, Fadel E, Postmus PE, Vonk-Noordegraaf A, Humbert M, Eddahibi S, Sorriento D, Santulli G, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Fazal L, Azibani F, Bihry N, Merval R, Polidano E, Samuel JL, Delcayre C, Zhang Y, Mi YM, Ren LL, Cheng YP, Guo R, Liu Y, Jiang YN, Mourouzis I, Pantos C, Kokkinos AD, Cokkinos DV, Tretjakovs P, Jurka A, Bormane I, Mikelsone I, Reihmane D, Elksne K, Krievina G, Verbovenko J, Bahs G, Lopez-Andres N, Rousseau A, Calvier L, Akhtar R, Labat C, Cruickshank K, Diez J, Zannad F, Lacolley P, Rossignol P, Hamesch K, Subramanian P, Li X, Thiemann A, Heyll K, Dembowsky K, Chevalier E, Weber C, Schober A, Yang L, Kim G, Gardner B, Earley J, Hofmann-Bowman M, Cheng CF, Lian WS, Lin H, Jinjolia NJ, Abuladze GA, Tvalchrelidze SHT, Khamnagadaev I, Shkolnikova M, Kokov L, Miklashevich I, Drozdov I, Ilyich I, Bingen BO, Askar SFA, Ypey DL, Van Der Laarse A, Schalij MJ, Pijnappels DA, Roney CH, Ng FS, Chowdhury RA, Chang ETY, Patel PM, Lyon AR, Siggers JH, Peters NS, Obergrussberger A, Stoelzle S, Bruggemann A, Haarmann C, George M, Fertig N, Moreira D, Souza A, Valente P, Kornej J, Reihardt C, Kosiuk J, Arya A, Hindricks G, Adams V, Husser D, Bollmann A, Camelliti P, Dudhia J, Dias P, Cartledge J, Connolly DJ, Terracciano CM, Nobles M, Sebastian S, Tinker A, Opel A, Tinker A, Daimi H, Haj Khelil A, Be Chibani J, Barana A, Amoros I, Gonzalez De La Fuente M, Caballero R, Aranega A, Franco D, Kelly A, Bernus O, Kemi OJ, Myles RC, Ghouri IA, Burton FL, Smith GL, Del Lungo M, Sartiani L, Spinelli V, Baruscotti M, Difrancesco D, Mugelli A, Cerbai E, Thomas AM, Aziz Q, Khambra T, Tinker A, Addlestone JMA, Cartwright EJ, Wilkinson R, Song W, Marston S, Jacquet A, Mougenot NM, Lipskaia AJ, Paalberends ER, Stam K, Van Dijk SJ, Van Slegtenhorst M, Dos Remedios C, Ten Cate FJ, Michels M, Niessen HWM, Stienen GJM, Van Der Velden J, Read MI, Andreianova AA, Harrison JC, Goulton CS, Kerr DS, Sammut IA, Schwarzl M, Seiler S, Wallner M, Huber S, Steendijk P, Maechler H, Truschnig-Wilders M, Von Lewinski D, Pieske B, Post H, Kindsvater D, Saes M, Morano I, Muegge A, Jaquet K, Buyandelger B, Kostin S, Gunkel S, Vouffo J, Ng K, Chen J, Eilers M, Isaacson R, Milting H, Knoell R, Cattin ME, Crocini C, Schlossarek S, Maron S, Hansen A, Eschenhagen T, Carrier L, Bonne G, Coppini R, Ferrantini C, Olivotto I, Del Lungo M, Belardinelli L, Poggesi C, Mugelli A, Cerbai E, Leung MC, Messer AE, Copeland O, Marston SB, Mills AM, Collins T, O'gara P, Thum T, Regalla K, Lyon AR, Macleod KT, Harding SE, Rao C, Prodromakis T, Chaudhry U, Darzi A, Yacoub MH, Athanasiou T, Terracciano CM, Bogdanova A, Makhro A, Hoydal M, Stolen TO, Johnssen AB, Alves M, Catalucci D, Condorelli G, Koch LG, Britton SL, Smith GL, Wisloff U, Bito V, Claus P, Vermeulen K, Huysmans C, Ventura-Clapier R, Sipido KR, Seliuk MN, Burlaka AP, Sidorik EP, Khaitovych NV, Kozachok MM, Potaskalova VS, Driesen RB, Galan DT, Vermeulen K, Claus P, Sipido KR, De Paulis D, Arnoux T, Schaller S, Pruss RM, Poitz DM, Augstein A, Braun-Dullaeus RC, Schmeisser A, Strasser RH, Micova P, Balkova P, Hlavackova M, Zurmanova J, Kasparova D, Kolar F, Neckar J, Novak F, Novakova O, Pollard S, Babba M, Hussain A, James R, Maddock H, Alshehri AS, Baxter GF, Dietel B, Altendorf R, Daniel WG, Kollmar R, Garlichs CD, Sirohi R, Roberts N, Lawrence D, Sheikh A, Kolvekar S, Yap J, Arend M, Walkinshaw G, Hausenloy DJ, Yellon DM, Posa A, Szabo R, Szalai Z, Szablics P, Berko MA, Orban K, Murlasits ZS, Balogh L, Varga C, Ku HC, Su MJ, Chreih RM, Ginghina C, Deleanu D, Ferreira ALBJ, Belal A, Ali MA, Fan X, Holt A, Campbell R, Schulz R, Bonanad C, Bodi V, Sanchis J, Morales JM, Marrachelli V, Nunez J, Forteza MJ, Chaustre F, Gomez C, Chorro FJ, Csont T, Fekete V, Murlasits Z, Aypar E, Bencsik P, Sarkozy M, Varga ZV, Ferdinandy P, Duerr GD, Zoerlein M, Dewald D, Mesenholl B, Schneider P, Ghanem A, Rittling S, Welz A, Dewald O, Duerr GD, Dewald D, Becker E, Peigney C, Ghanem A, Welz A, Dewald O, Bouleti C, Galaup A, Monnot C, Ghaleh B, Germain S, Timmermans A, Ginion A, De Meester C, Sakamoto K, Vanoverschelde JL, Horman S, Beauloye C, Bertrand L, Maroz-Vadalazhskaya N, Drozd E, Kukharenko L, Russkich I, Krachak D, Seljun Y, Ostrovski Y, Martin AC, Le Bonniec B, Lecompte T, Dizier B, Emmerich J, Fischer AM, Samama CM, Godier A, Mogensen S, Furchtbauer EM, Aalkjaer C, Choong WL, Jovanovic A, Khan F, Daniel JM, Dutzmann JM, Widmer-Teske R, Guenduez D, Sedding D, Castro MM, Cena JJC, Cho WJC, Goobie GG, Walsh MPW, Schulz RS, Daniel JM, Dutzmann J, Widmer-Teske R, Preissner KT, Sedding D, Aziz Q, Khambra T, Sones W, Thomas AM, Kotlikoff M, Tinker A, Serizawa K, Yogo K, Aizawa K, Hirata M, Tashiro Y, Ishizuka N, Varela A, Katsiboulas M, Tousoulis D, Papaioannou TG, Vaina S, Davos CH, Piperi C, Stefanadis C, Basdra EK, Papavassiliou AG, Hermenegildo C, Lazaro-Franco M, Sobrino A, Bueno-Beti C, Martinez-Gil N, Walther T, Peiro C, Sanchez-Ferrer CF, Novella S, Ciccarelli M, Franco A, Sorriento D, Del Giudice C, Dorn GW, Trimarco B, Iaccarino G, Cseplo P, Torok O, Springo ZS, Vamos Z, Kosa D, Hamar J, Koller A, Bubb KJ, Ahluwalia A, Stepien EL, Gruca A, Grzybowska J, Goralska J, Dembinska-Kiec A, Stepien EL, Stolinski J, Grzybowska J, Goralska J, Partyka L, Gruca A, Dembinska-Kiec A, Zhang H, Sweeney D, Thomas GN, Fish PV, Taggart DP, Watt SM, Martin-Rendon E, Cioffi S, Bilio M, Martucciello S, Illingworth E, Caporali A, Shantikumar S, Marchetti M, Martelli F, Emanueli C, Marchetti M, Meloni M, Caporali A, Al Haj Zen A, Sala-Newby G, Emanueli C, Del Turco S, Saponaro C, Dario B, Sartini S, Menciassi A, Dario P, La Motta C, Basta G, Santiemma V, Bertone C, Rossi F, Michelon E, Bianco MJ, Castelli A, Shin DI, Seung KB, Seo SM, Park HJ, Kim PJ, Baek SH, Shin DI, Seung KB, Seo SM, Park HJ, Choi YS, Her SH, Kim DB, Kim PJ, Lee JM, Park CS, Rocchiccioli S, Cecchettini A, Pelosi G, Kusmic C, Citti L, Parodi O, Trivella MG, Michel-Monigadon D, Burger F, Dunoyer-Geindre S, Pelli G, Cravatt B, Steffens S, Didangelos A, Mayr U, Yin X, Stegemann C, Shalhoub J, Davies AH, Monaco C, Mayr M, Lypovetska S, Grytsenko S, Njerve IU, Pettersen AA, Opstad TB, Bratseth V, Arnesen H, Seljeflot I, Dumitriu IE, Baruah P, Antunes RF, Kaski JC, Forteza MJ, Bodi V, Trapero I, Benet I, Alguero C, Chaustre FJ, Gomez C, Sanchis J, Chorro FJ, Mangold A, Puthenkalam S, Distelmaier K, Adlbrecht C, Preissner KT, Lang IM, Koizumi T, Inoue I, Komiyama N, Nishimura S, Korneeva ON, Drapkina OM, Fornai L, Angelini A, Kiss A, Giskes F, Eijkel G, Fedrigo M, Valente ML, Thiene G, Heeren RMA, Vilahur G, Padro T, Casani L, Suades R, Badimon L, Bertoni B, Carminati R, Carlini V, Pettinari L, Martinelli C, Gagliano N, Noppe G, Buchlin P, Marquet N, Baeyens N, Morel N, Vanoverschelde JL, Bertrand L, Beauloye C, Horman S, Baysa A, Sagave J, Dahl CP, Gullestad L, Carpi A, Di Lisa F, Giorgio M, Vaage J, Valen G, Vafiadaki E, Papalouka V, Arvanitis DA, Terzis G, Spengos K, Kranias EG, Manta P, Sanoudou D, Gales C, Genet G, Dague E, Cazorla O, Payre B, Mias C, Ouille A, Lacampagne A, Pathak A, Senard JM, Abonnenc M, Da Costa Martins P, Srivastava S, Didangelos A, Yin X, Gautel M, De Windt L, Mayr M, Comelli L, Rocchiccioli S, Lande C, Ucciferri N, Trivella MG, Citti L, Cecchettini A, Ikonen L, Vuorenpaa H, Kujala K, Sarkanen JR, Heinonen T, Ylikomi T, Aalto-Setala K, Capros H, Sprincean N, Usurelu N, Egorov V, Stratu N, Matchkov V, Bouzinova E, Moeller-Nielsen N, Wiborg O, Aalkjaer C, Gutierrez PS, Aparecida-Silva R, Borges LF, Moreira LFP, Dias RR, Kalil J, Stolf NAG, Zhou W, Suntharalingam K, Brand N, Vilar Compte R, Ying L, Bicknell K, Dannoura A, Dash P, Brooks G, Tsimafeyeu I, Tishova Y, Wynn N, Oyeyipo IP, Olatunji LA, Maegdefessel L, Azuma J, Toh R, Raaz U, Merk DR, Deng A, Spin JM, Tsao PS, Lande C, Cecchettini A, Tedeschi L, Taranta M, Naldi I, Citti L, Trivella MG, Grimaldi S, Cinti C, Bousquenaud M, Maskali F, Poussier S, Marie PY, Boutley H, Karcher G, Wagner DR, Devaux Y, Torre I, Psilodimitrakopoulos S, Iruretagoiena I, Gonzalez-Tendero A, Artigas D, Loza-Alvarez P, Gratacos E, Amat-Roldan I, Murray L, Carberry DM, Dunton P, Miles MJ, Suleiman MS, Kanesalingam K, Taylor R, Mc Collum CN, Parniczky A, Solymar M, Porpaczy A, Miseta A, Lenkey ZS, Szabados S, Cziraki A, Garai J, Koller A, Myloslavska I, Menazza SM, Canton MC, Di Lisa FDL, Schulz RS, Oliveira SHV, Morais CAS, Miranda MR, Oliveira TT, Lamego MRA, Lima LM, Goncharova NS, Naymushin AV, Kazimli AV, Moiseeva OM, Lima LM, Carvalho MG, Sabino AP, Mota APL, Sousa MO, Niessner A, Richter B, Hohensinner PJ, Rychli K, Zorn G, Berger R, Moertl D, Pacher R, Wojta J, Huelsmann M, Kukharchik G, Nesterova N, Pavlova A, Gaykovaya L, Krapivka N, Konstantinova I, Sichinava L, Prapa S, Mccarthy KP, Kilner PJ, Xu XY, Johnson MR, Ho SY. Poster session 2. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bisulli F, Vignatelli L, Naldi I, Pittau F, Provini F, Plazzi G, Stipa C, Leta C, Montagna P, Tinuper P. Diagnostic accuracy of a structured interview for nocturnal frontal lobe epilepsy (SINFLE): a proposal for developing diagnostic criteria. Sleep Med 2011; 13:81-7. [PMID: 22137114 DOI: 10.1016/j.sleep.2011.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 09/23/2011] [Accepted: 09/26/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To measure the accuracy of anamnestic features collected during clinical history for the diagnosis of nocturnal frontal lobe epilepsy (NFLE). METHODS A case-control diagnostic study. Participants included a case group of people with ascertained target disease (NFLE group) and a control group of people with sleep disorders potentially confounding for NFLS (NOT-NFLE group), defined by means of a consensus procedure among experts (panel diagnosis as reference standard). Two major clinical patterns defining the semeiology of the epileptic event (i.e. dystonic, DP, and/or hyperkinetic pattern, HP), and 13 additional minor features were identified, formulated as questions, and telephonically administered to NFLE and NOT-NFLE groups by a trained doctor blinded to the final diagnosis. The diagnostic accuracy of each characteristic was tested against the reference standard. RESULTS Out of 262 selected subjects, 101 were recruited; 42 were NFLE and 59 NOT-NFLE. A positive history of DP or HP had a sensitivity of 59.5% and a specificity of 91.5%, irrespective of the other minor anamnestic features. The anamnestic model improved, with a sensitivity of 59.5% and specificity of 96.6%, if at least one of the following four minor anamnestic features was added: (a) duration less than two minutes, (b) unstructured vocalization during the episode, (c) experience of an aura preceding the motor attack, and (d) a history of tonic-clonic seizures during sleep. CONCLUSIONS The present study disclosed two major anamnestic patterns and four minor features that we called SINFLE, with unsatisfactory sensitivity but high specificity. These patterns could be the basis for developing future NFLE diagnostic criteria and to quantify the diagnostic accuracy of elements usually collected in the clinical history.
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Affiliation(s)
- Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, University of Bologna, Italy.
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Licchetta L, Bisulli F, Di Vito L, La Morgia C, Naldi I, Volta U, Tinuper P. Epilepsy in coeliac disease: not just a matter of calcifications. Neurol Sci 2011; 32:1069-74. [PMID: 21630037 DOI: 10.1007/s10072-011-0629-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
The clinical spectrum of epilepsy related to celiac disease (CD) ranges from benign syndromes to intractable epilepsy with evolution to a severe encephalopathy, including progressive myoclonic epilepsy (PME). A more specific syndrome characterised by the association of CD, epilepsy, and occipital calcifications (CEC) has also been reported. This study describes the clinical, neuroradiological and neurophysiological features of eight consecutive epileptic patients with a diagnosis of CD confirmed by laboratory tests and duodenal biopsy, referring to our Epilepsy Centre. Despite its small size, this series reflects the broad spectrum of the association between the two diseases, since it includes four cases of CEC and a more heterogeneous group of patients without cerebral calcifications comprising one case of limbic encephalitis and a case of PME. Our cohort suggests that more complex pathogenic mechanisms may be involved in the association between epilepsy and CD, and that CD should be included in the screening for PME etiology. Our data also confirm the major involvement of the occipital lobe, and minimise both the importance of calcifications in epileptogenesis and folic acid deficit in the development of calcifications.
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Affiliation(s)
- Laura Licchetta
- Department of Neurological Sciences, University of Bologna, via Ugo Foscolo 7, 40123 Bologna, Italy.
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Cinti C, Taranta M, Naldi I, Grimaldi S. Newly engineered magnetic erythrocytes for sustained and targeted delivery of anti-cancer therapeutic compounds. PLoS One 2011; 6:e17132. [PMID: 21373641 PMCID: PMC3044154 DOI: 10.1371/journal.pone.0017132] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/21/2011] [Indexed: 11/21/2022] Open
Abstract
Cytotoxic chemotherapy of cancer is limited by serious, sometimes life-threatening, side effects that arise from toxicities to sensitive normal cells because the therapies are not selective for malignant cells. So how can they be selectively improved? Alternative pharmaceutical formulations of anti-cancer agents have been investigated in order to improve conventional chemotherapy treatment. These formulations are associated with problems like severe toxic side effects on healthy organs, drug resistance and limited access of the drug to the tumor sites suggested the need to focus on site-specific controlled drug delivery systems. In response to these concerns, we have developed a new drug delivery system based on magnetic erythrocytes engineered with a viral spike fusion protein. This new erythrocyte-based drug delivery system has the potential for magnetic-controlled site-specific localization and highly efficient fusion capability with the targeted cells. Here we show that the erythro-magneto-HA virosomes drug delivery system is able to attach and fuse with the target cells and to efficiently release therapeutic compounds inside the cells. The efficacy of the anti-cancer drug employed is increased and the dose required is 10 time less than that needed with conventional therapy.
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Affiliation(s)
- Caterina Cinti
- Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Siena, Italy.
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Bisulli F, Vignatelli L, Naldi I, Licchetta L, Provini F, Plazzi G, Di Vito L, Ferioli S, Montagna P, Tinuper P. Increased frequency of arousal parasomnias in families with nocturnal frontal lobe epilepsy: a common mechanism? Epilepsia 2010; 51:1852-60. [PMID: 20477848 DOI: 10.1111/j.1528-1167.2010.02581.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Retrospective observations disclosed an overlap between parasomnias and nocturnal frontal lobe epilepsy (NFLE) not only in patients but also in their relatives, suggesting a possible common pathogenetic mechanism. This study aimed to verify whether relatives of patients with NFLE have a higher frequency of parasomnias, namely arousal disorders, and thereby shed light on the still unknown pathophysiologic mechanisms underlying NFLE. METHODS We undertook a case-control family study in which we recruited NFLE probands and healthy controls, matched for age, sex, education, and geographic origin. At least four relatives were included for each proband and control. Each subject underwent a standardized interview, with application of the International Classification of Sleep Disorders-Revised (ICSD-R 2001) minimal criteria to diagnose the lifetime prevalence of the main parasomnias. RESULTS Four hundred fifty-eight individuals were recruited: 33 NFLE probands, 200 relatives of probands, 31 controls, and 194 control relatives. All NFLE probands but one have sporadic NFLE. The lifetime prevalence of the following parasomnias differed in proband relatives versus control relatives: arousal disorders [odds ratio (OR) 4.7, 95% confidence interval (CI) 2.0-11.6; p < 0.001] and nightmares (OR 2.6, 95% CI 1.6-4.2; p < 0.001) were more frequent among NFLE proband relatives. In the secondary analysis comparing NFLE probands to controls, arousal disorders (OR 6.3, 95% CI 1.3-31.7; p = 0.023) and bruxism (OR 5.4, 95% CI 1.3-21.7; p = 0.017) were more frequent among NFLE probands. DISCUSSION The higher frequency of arousal disorders in NFLE families suggests an intrinsic link between parasomnias and NFLE and an abnormal (possibly cholinergic) arousal system as a common pathophysiologic mechanism.
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Affiliation(s)
- Francesca Bisulli
- Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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Pittau F, Bisulli F, Mai R, Fares JE, Vignatelli L, Labate A, Naldi I, Avoni P, Parmeggiani A, Santucci M, Capannelli D, Di Vito L, Gambardella A, Baruzzi A, Tinuper P. Prognostic factors in patients with mesial temporal lobe epilepsy. Epilepsia 2009; 50 Suppl 1:41-4. [PMID: 19125847 DOI: 10.1111/j.1528-1167.2008.01969.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To disclose clinical, electrophysiologic, and neuroradiologic factors correlated to prognosis in patients with mesial temporal lobe epilepsy (MTLE). METHODS One hundred thirty-six MTLE patients were studied for family history, clinical characteristics, instrumental data [electroencephalography (EEG), video-EEG, neuroimaging], and outcome. The population was divided into drug-resistant (DR: 108 patients, 79.4%) and non-drug-resistant (NDR: 28 patients, 20.6%) groups; all variables were analyzed in the two groups. RESULTS The comparison between the two groups shows a relation between resistance to therapy and febrile seizures (FS) (DR 43.5% vs. NDR 17.8%, p = 0.008), mesial temporal sclerosis (MTS) (DR 64.8% vs. NDR 32.1%, p = 0.0025), early age at seizure onset (DR 23.1% vs. NDR 3.6% p = 0.0160), and epileptiform interictal abnormalities (DR 89.7% vs. NDR 68%, p = 0.010). FS were more frequent in patients with MTS than in patients without (46.28% vs. 26.3%, p = 0.0199). Sixty-nine patients underwent surgery and 85.3% of them had a good outcome. CONCLUSION MTLE is a heterogeneous syndrome. Establishing the factors responsible for and associated with drug resistance is important for therapeutic purposes, as prompt diagnosis of drug resistance must lead to early surgical management. This study shows that FS, MTS, early age at seizure onset, and epileptiform interictal abnormalities are negative prognostic factors and that FS are related to MTS.
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Affiliation(s)
- Francesca Pittau
- Epilepsy Center for Adults and Children, Department of Neurological Sciences, University of Bologna, Bologna, Italy
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Pittau F, Tinuper P, Bisulli F, Naldi I, Cortelli P, Bisulli A, Stipa C, Cevolani D, Agati R, Leonardi M, Baruzzi A. Videopolygraphic and functional MRI study of musicogenic epilepsy. A case report and literature review. Epilepsy Behav 2008; 13:685-92. [PMID: 18753014 DOI: 10.1016/j.yebeh.2008.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [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] [Received: 04/08/2008] [Revised: 05/07/2008] [Accepted: 05/11/2008] [Indexed: 12/01/2022]
Abstract
A 36-year-old right-handed man, who had experienced partial seizures since the age of 24 every time he played or listened to music with a strong emotional charge, underwent videopolygraphic recording, including autonomic variables, and brain fMRI study during which he listened to both "neutral" and "emotionally charged" music. Three right temporal seizures recorded during videopolygraphic monitoring were elicited by listening to the triggering song. The fMRI study disclosed activation in right acoustic areas during "neutral music," whereas an "emotionally charged melody" provoked widespread activation over the right fronto-temporo-occipital area before seizure onset. The literature review disclosed 110 published cases of musicogenic epilepsy that seemed to suggest a right-sided predominance of the epileptogenic zone. Our results support the role of the right temporal lobe in musicogenic epilepsy and demonstrate that the cerebral areas activated during the period of strong emotion leading to the seizures encompass the auditory cortex activated by neutral music.
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Affiliation(s)
- Francesca Pittau
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
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Rubboli G, Bisulli F, Michelucci R, Meletti S, Ribani MA, Cortelli P, Naldi I, Riguzzi P, Tassinari CA, Tinuper P. Sudden falls due to seizure-induced cardiac asystole in drug-resistant focal epilepsy. Neurology 2008; 70:1933-5. [PMID: 18256369 DOI: 10.1212/01.wnl.0000289193.89796.83] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Rubboli
- Neurology Unit, Department of Neurosciences, Bellaria Hospital, Via Altura, 3-40139 Bologna, Italy.
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Florindo I, Bisulli F, Pittau F, Naldi I, Striano P, Striano S, Michelucci R, Testoni S, Baruzzi A, Tinuper P. Lateralizing value of the auditory aura in partial seizures. Epilepsia 2007; 47 Suppl 5:68-72. [PMID: 17239110 DOI: 10.1111/j.1528-1167.2006.00881.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the semiological features of auditory aura and to assess their possible lateralizing value in partial epilepsy. METHODS Out of a series of 8,000 patients with epilepsy, we investigated 121 cases with partial seizures in whom auditory features were the first ictal symptom. According to the dominant type of aura, patients were divided into four subgroups-1A (67 cases), 1B (22 cases), 2A (14 cases), and 2B (18 cases)-corresponding to the presence of simple or complex hallucinations and positive or negative illusions, respectively. The side of the epileptic zone (EZ) was defined based on available data: surgical/presurgical study or presence of a neuroradiological lesion, corresponding interictal epileptiform EEG and ictal semiology (level 1); a left EZ was also hypothesized in right-handed patients with ictal aphasia plus a left neuroradiological lesion or a left interictal EEG focus (level 2). RESULTS Forty-five patients (37%) described the aura as unilateral. The side of epileptogenic zone (EZ) was definable in 36 patients (level 1: 24; level 2: 12). Overall, a unilateral auditory aura was contralateral to the EZ in half of the cases (8/16), but always contralateral in patients studied for presurgical evaluation (4/4). Simple hallucinations lateralized seizure onset on the right side in nine cases, on the left in 12. Among 1B patients (either musical and verbal contents), the EZ was on the left side in all cases (5/5). Positive illusions were associated with right foci in two cases, and left foci in two. Negative illusions always lateralized seizure onset to the dominant hemisphere (6/6). CONCLUSIONS Auditory aura is a rare symptom in partial epilepsy. The perception of the auditory sensation referred to one ear is not a unique lateralizing sign for the contralateral temporal neocortex. Complex hallucinations with verbal content and negative illusion may lateralize seizure onset in the dominant hemisphere. The role of laterality for musical hallucinations remains unclear as it depends on individual musical ability and hemispheric dominance for music.
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Affiliation(s)
- Irene Florindo
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
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Vignatelli L, Bisulli F, Provini F, Naldi I, Pittau F, Zaniboni A, Montagna P, Tinuper P. Interobserver Reliability of Video Recording in the Diagnosis of Nocturnal Frontal Lobe Seizures. Epilepsia 2007; 48:1506-11. [PMID: 17484750 DOI: 10.1111/j.1528-1167.2007.01121.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nocturnal frontal lobe seizures (NFLS) show one or all of the following semeiological patterns: (1) paroxysmal arousals (PA: brief and sudden recurrent motor paroxysmal behavior); (2) hyperkinetic seizures (HS: motor attacks with complex dyskinetic features); (3) asymmetric bilateral tonic seizures (ATS: motor attacks with dystonic features); (4) epileptic nocturnal wanderings (ENW: stereotyped, prolonged ambulatory behavior). OBJECTIVE To estimate the interobserver reliability (IR) of video-recording diagnosis in patients with suspected NFLS among sleep medicine experts, epileptologists, and trainees in sleep medicine. METHODS Sixty-six patients with suspected NFLS were included. All underwent nocturnal video-polysomnographic recording. Six doctors (three experts and three trainees) independently classified each case as "NFLS ascertained" (according to the above specified subtypes: PA, HS, ATS, ENW) or "NFLS excluded". IR was calculated by means of Kappa statistics, and interpreted according to the standard classification (0.0-0.20 = slight agreement; 0.21-0.40 = fair; 0.41-0.60 = moderate; 0.61-0.80 = substantial; 0.81-1.00 = almost perfect). RESULTS The observed raw agreement ranged from 63% to 79% between each pair of raters; the IR ranged from "moderate" (kappa = 0.50) to "substantial" (kappa = 0.72). A major source of variance was the disagreement in distinguishing between PA and nonepileptic arousals, without differences in the level of agreement between experts and trainees. CONCLUSIONS Among sleep experts and trainees, IR of diagnosis of NFLS, based on videotaped observation of sleep phenomena, is not satisfactory. Explicit video-polysomnographic criteria for the classification of paroxysmal sleep motor phenomena are needed.
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Affiliation(s)
- Luca Vignatelli
- Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
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Vignatelli L, Bisulli F, Naldi I, Ferioli S, Pittau F, Provini F, Plazzi G, Vetrugno R, Montagna P, Tinuper P. Excessive Daytime Sleepiness and Subjective Sleep Quality in Patients with Nocturnal Frontal Lobe Epilepsy: A Case-Control Study. Epilepsia 2006; 47 Suppl 5:73-7. [PMID: 17239111 DOI: 10.1111/j.1528-1167.2006.00882.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Nocturnal frontal lobe epilepsy (NFLE) may be associated with sleep fragmentation and reduced sleep efficiency. Daytime sleepiness and disturbed sleep quality have been reported in some patients. We investigated the occurrence of daytime sleepiness-related symptoms and subjective sleep quality in patients with NFLE in comparison with matched controls. METHODS Patients with NFLE at a single epilepsy center and matched controls randomly selected from the general population self-administered questionnaires on daytime sleepiness-related symptoms and subjective sleep quality [Epworth sleepiness scale (ESS), Bologna questionnaire on sleepiness-related symptoms (BQS), Berlin questionnaire]. RESULTS Thirty-three patients with NFLE and 27 controls were enrolled. "Tiredness after awakening" and "spontaneous mid-sleep awakenings" were more frequent in NFLE patients than in controls (36.4% versus 11.1%, p = 0.04, and 50.0% versus 22.2%, p = 0.03). The frequency of excessive daytime sleepiness (EDS) did not differ between groups. Posthoc analysis showed that patients with a complaint of "midsleep awakenings" had higher ESS and BQS scores than those without (7.3 versus 4.3, p = 0.004, and 5.0 versus 2.2, p = 0.001, respectively) and more frequent "tiredness after awakening" (56.3% versus 18.8%, p = 0.03). CONCLUSIONS Patients with NFLE have no pathological level of EDS with respect to controls. However, daytime sleepiness-related symptoms could be more frequent in a subgroup of patients with subjective disturbed sleep quality, irrespective of the perceived frequency of seizures.
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Affiliation(s)
- Luca Vignatelli
- Dipartimento di Scienze Neurologiche, Università di Bologna, Bologna, Italy.
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Vignatelli L, Bisulli F, Zaniboni A, Naldi I, Fares JE, Provini F, Vetrugno R, Plazzi G, Tinuper P, Montagna P. Interobserver reliability of ICSD–R minimal diagnostic criteria for the parasomnias. J Neurol 2005; 252:712-7. [PMID: 15778905 DOI: 10.1007/s00415-005-0723-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 11/05/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To estimate the interobserver reliability (IR) of the minimal diagnostic criteria for the parasomnias provided in the International Classification of Sleep Disorders Revised (ICSD-R). METHODS Fifty consecutive subjects underwent a structured interview by three doctors based on the ICSD-R minimal criteria for the diagnosis of 13 parasomnias at any time in life. IR was calculated by Kappa statistics and interpreted according to conventional categories. RESULTS In the group of Arousal Disorders, IR was "substantial" (kappa 0.74) for confusional arousals, "slight" (kappa 0.36) for sleepwalking, "fair" (kappa -0.02) for sleep terrors. In the group of Wake-Sleep Transition Disorders, IR was "substantial" to "almost perfect", but "moderate" for sleep starts (kappa 0.41). In the group of Parasomnias usually associated with REM Sleep, IR was "substantial" (kappa 0.69) for sleep paralysis, "moderate" (kappa 0.46) for RBD, "fair" (kappa 0.25) for nightmares. In the group of Other Parasomnias, IR was "substantial" to "almost perfect" (kappa between 0.73 and 0.93). CONCLUSIONS When the clinical diagnosis of parasomnias is based on the ICSD-R: 1) the majority of Arousal Disorders and REM sleep parasomnias showed only a "fair" to "moderate" IR; 2) all of the other parasomnias showed a "substantial" to "almost perfect" IR. Nosological entities with unsatisfactory IR share complex motor phenomenology associated with a mental state difficult for the patient to define. The source of disagreement probably lies in the difficulty in interpreting patients' reports. For these parasomnias IR must be verified and possibly improved with training.
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Affiliation(s)
- Luca Vignatelli
- Dipartimento di Scienze Neurologiche, Università di Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
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Bisulli F, Tinuper P, Scudellaro E, Naldi I, Bagattin A, Avoni P, Michelucci R, Nobile C. A de novo LGI1 mutation in sporadic partial epilepsy with auditory features. Ann Neurol 2004; 56:455-6. [PMID: 15349881 DOI: 10.1002/ana.20218] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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