1
|
Sangalli D, Versino M, Colombo I, Ciccone A, Beretta S, Marcheselli S, Roncoroni M, Beretta S, Lorusso L, Cavallini A, Prelle A, Guidetti D, La Gioia S, Canella S, Zanferrari C, Grampa G, d'Adda E, Peverelli L, Colombo A, Martinelli-Boneschi F, Salmaggi A. Sex differences in ischemic stroke during COVID-19 first outbreak in northern Italy. J Neurol Sci 2023; 454:120848. [PMID: 37939626 DOI: 10.1016/j.jns.2023.120848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION COVID-19 pandemic had a great impact on outcome in SARS-CoV-2 positive patients with ischemic stroke during the first wave in Italy. Few data are available on outcome stratified by sex. METHODS The Italian Society of Hospital Neuroscience conducted a multi-center, retrospective, observational study on neurological complications in COVID-19 patients with ischemic stroke. All the patients admitted from March 1st to April 30th, 2020 in 20 Neurology Units in Northern Italy were recruited. Demographical and clinical features, treatment and outcome data were compared focusing on sex differences. RESULTS 812 patients with ischemic stroke were enrolled, of whom 129 with COVID-19; males were 53.8%. In-hospital mortality in COVID-19 patients was 35.3% in males and 27.9% in females while 8.5% in male and 5.8% in female patients without COVID-19. SARS-CoV-2 positive patients had a higher frequency of stroke of undetermined etiology, than negative ones (32.8% vs 22.5%; p = 0.02), especially in females compared to males (36.1% vs 27.9%), albeit without statistical significance. Male patients with SARS-CoV-2 were more likely to require cPAP (30.9% vs 14.8%; p = 0.03), endotracheal tube (14.9% vs 3.3%; p = 0.02) and reperfusion strategies (29.4% vs 11.5%; p = 0.01) than females, as well as to have a higher CRP and D-dimer. These elements together with older age, a total anterior circulation stroke and lymphopenia were predictors of a worse outcome. DISCUSSION Our study detected some differences due to sex in ischemic stroke with and without COVID-19, supporting the possibility to perform sex analyses for SARS-CoV-2 positive patients for a better clinical management.
Collapse
Affiliation(s)
- Davide Sangalli
- Neurological Department, "Alessandro Manzoni" Hospital, ASST, Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy.
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST SetteLaghi, Ospedale di Circolo, Varese, Italy; DMC, University of Insubria, Varese, Italy
| | - Irene Colombo
- Neurology and Stroke Unit, Ospedale di Desio, ASST, Monza, MB, Italy
| | - Alfonso Ciccone
- Department of Neurosciences, Carlo Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Simone Beretta
- Department of Neurology, San Gerardo Hospital, ASST Monza, University of Milano Bicocca, Monza, Italy; NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Mauro Roncoroni
- Neurology and Stroke Unit, P.O. Saronno, ASST Valle Olona, Varese, Italy
| | - Sandro Beretta
- Neurology Unit, Vimercate Hospital, ASST-Brianza, Vimercate, MB, Italy
| | - Lorenzo Lorusso
- Neurological Department, San Leopoldo Mandic Hospital, ASST, Lecco, Merate, Italy
| | - Anna Cavallini
- Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | | | - Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Sara La Gioia
- Department of neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefania Canella
- Neurology and Stroke Unit, San Giuseppe-Multimedica Hospital, Milan, Italy
| | - Carla Zanferrari
- Neurology and Stroke Unit, PO Vizzolo Predabissi, ASST Melegnano Martesana, Milan, Italy
| | | | - Elisabetta d'Adda
- Neurology Unit, Ospedale Maggiore di Crema, ASST Crema, Crema, Italy
| | | | | | - Filippo Martinelli-Boneschi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy; Neurology Unit and MS Centre, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Andrea Salmaggi
- Neurological Department, "Alessandro Manzoni" Hospital, ASST, Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy
| |
Collapse
|
2
|
Gentile L, Pracucci G, Saia V, Falcou A, Biraschi F, Zini A, Simonetti L, Riva L, Bigliardi G, Vallone S, Nencini P, Limbucci N, Diomedi M, Da Ros V, Longoni M, Ruggiero M, Tassinari T, Allegretti L, Cerrato P, Rubino E, Bergui M, Cavallo R, Naldi A, Comelli C, Cappellari M, Zivelonghi C, Plebani M, De Vito A, Merli N, Saletti A, Musolino RF, Ferraù L, Vinci SL, Sacco S, Orlandi B, De Santis F, Filauri P, Ruiz L, Sepe FN, Gallesio I, Petruzzellis M, Chiumarulo L, Sangalli D, Salmaggi A, Filizzolo M, Moller J, Melis M, Comelli S, Magoni M, Gilberti N, Gasparotti R, Invernizzi P, Pavia M, Pinto V, Laspada S, Marcheselli S, Ajello D, Viaro F, Baracchini C, Causin F, Giannini N, Caselli MC, Mancuso M, Cosottini M, Scoditti U, Menozzi R, Russo M, Amistá P, Napoletano R, Romano DG, Tassi R, Bracco S, Carimati F, Versino M, Giorgianni A, De Boni A, Fasano A, Barbarini L, Paladini A, Franchini E, Dall'Ora E, Comai A, Giovanni F, Pedicelli A, Sallustio F, Casetta I, Fainardi E, Mangiafico S, Toni D. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke. Neurol Sci 2023; 44:3577-3585. [PMID: 37199875 DOI: 10.1007/s10072-023-06830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF. METHODS The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed. RESULTS Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0-2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results. CONCLUSION MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments.
Collapse
Affiliation(s)
- Luana Gentile
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Anne Falcou
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Zini
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- Neuroradiology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Letizia Riva
- Cardiology Unit, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Di Modena, Ospedale Civile Baggiovara, Modena, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile Di Baggiovara, Azienda Ospedaliera Universitaria Di Modena, Modena, Italy
| | - Patrizia Nencini
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Limbucci
- Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Luca Allegretti
- Department of Interventional Neuroradiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Paolo Cerrato
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Elisa Rubino
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Mauro Bergui
- Neuroscience Department, University of Torino, Turin, Italy
| | | | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Comelli
- Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Manuel Cappellari
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cecilia Zivelonghi
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mauro Plebani
- Interventional Neurovascular Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Nicola Merli
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Andrea Saletti
- Department of Radiology, Neuroradiology Unit, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Neuroradiology Unit, University of Messina, Messina, Italy
| | - Simona Sacco
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Berardino Orlandi
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Federica De Santis
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Pietro Filauri
- Neuroradiology Unit, SS. Filippo and Nicola Hospital, Avezzano, Italy
| | - Luigi Ruiz
- Stroke Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Marco Petruzzellis
- Neurology Unit and Stroke Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | | | | | | | - Marco Filizzolo
- Interventional Neuroradiology Unit, AOOR Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Mauro Magoni
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | - Nicola Gilberti
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | | | - Paolo Invernizzi
- Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Pavia
- Neuroradiology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Perrino Hospital, Brindisi, Italy
| | | | | | - Daniele Ajello
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Viaro
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Francesco Causin
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Nicola Giannini
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Maria Chiara Caselli
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technology in Medicine and Surgery, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Umberto Scoditti
- Stroke Unit, Neurology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Neuroradiology Unit, University Hospital of Parma, Parma, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Pietro Amistá
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Rosa Napoletano
- Stroke Unit, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Daniele Giuseppe Romano
- Unita Operativa Radiologia Vascolare, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Sandra Bracco
- UO Neurointerventistica, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Federico Carimati
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Maurizio Versino
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | | | - Antonio Fasano
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | | | | | - Enrica Franchini
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Elisa Dall'Ora
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Alessio Comai
- Neuroradiology Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Frisullo Giovanni
- Department of Neurology and Stroke Unit, Catholic University, Rome, Italy
| | - Alessandro Pedicelli
- Dipartimento Di Diagnostica Per Immagini, UOSA Neuroradiologia Interventistica, RadioterapiaOncologica Ed Ematologia, Fondazione PoliclinicoUniversitarioA.Gemelli Di Roma, Rome, Italy
| | - Fabrizio Sallustio
- Unitá Di Trattamento Neurovascolare, Ospedale Dei Castelli-ASL6, Rome, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento Di Scienze Biomediche, Sperimentali E Cliniche, Università Degli Studi Di Firenze, Ospedale Universitario Careggi, NeuroradiologiaFlorence, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS NeuromedPozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy.
| |
Collapse
|
3
|
Gastaldi M, Foiadelli T, Greco G, Scaranzin S, Rigoni E, Masciocchi S, Ferrari S, Mancinelli C, Brambilla L, Mancardi M, Giacomini T, Ferraro D, Della Corte M, Gallo A, Di Filippo M, Benedetti L, Novi G, Versino M, Banfi P, Iorio R, Moiola L, Turco E, Sartori S, Nosadini M, Ruggieri M, Savasta S, Colombo E, Ballante E, Jarius S, Mariotto S, Franciotta D. Prognostic relevance of quantitative and longitudinal MOG antibody testing in patients with MOGAD: a multicentre retrospective study. J Neurol Neurosurg Psychiatry 2023; 94:201-210. [PMID: 36460438 DOI: 10.1136/jnnp-2022-330237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND IgG antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) define a subset of associated disorders (myelin oligodendrocyte glycoprotein associated disorders (MOGAD)) that can have a relapsing course. However, information on relapse predictors is scarce. The utility of retesting MOG-IgG over time and measuring their titres is uncertain. We aimed to evaluate the clinical relevance of longitudinal MOG-IgG titre measurement to predict relapses in patients with MOGAD. METHODS In this retrospective multicentre Italian cohort study, we recruited patients with MOGAD and available longitudinal samples (at least one >3 months after disease onset) and tested them with a live cell-based assay with endpoint titration (1:160 cut-off). Samples were classified as 'attack' (within 30 days since a disease attack (n=59, 17%)) and 'remission' (≥31 days after attack (n=295, 83%)). RESULTS We included 102 patients with MOGAD (57% adult and 43% paediatric) with a total of 354 samples (83% from remission and 17% from attack). Median titres were higher during attacks (1:1280 vs 1:640, p=0.001). Median onset titres did not correlate with attack-related disability, age or relapses. Remission titres were higher in relapsing patients (p=0.02). When considering the first remission sample available for each patient, titres >1:2560 were predictors of relapsing course in survival (log rank, p<0.001) and multivariate analysis (p<0.001, HR: 10.9, 95% CI 3.4 to 35.2). MOG-IgG seroconversion to negative was associated with a 95% relapse incidence rate reduction (incidence rate ratio: 0.05, p<0.001). CONCLUSIONS Persistent MOG-IgG positivity and high remission titres are associated with an increased relapse risk. Longitudinal MOG-IgG titres could be useful to stratify patients to be treated with long term immunosuppression.
Collapse
Affiliation(s)
- Matteo Gastaldi
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Thomas Foiadelli
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giacomo Greco
- Department of Neurosciences, Università degli Studi di Pavia, Pavia, Italy.,Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Rigoni
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Masciocchi
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Neurosciences, Università degli Studi di Pavia, Pavia, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Laura Brambilla
- Neuroimmunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milano, Italy
| | - Margherita Mancardi
- Child Neuropsychiatry Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, Giannina Gaslini Institute, Genova, Italy
| | - Thea Giacomini
- Child Neuropsychiatry Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, Giannina Gaslini Institute, Genova, Italy
| | - Diana Ferraro
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marida Della Corte
- Department of Neurosciences, Division of Neurology, Santobono-Pausilipon Children's Hospital, Napoli, Italy
| | - Antonio Gallo
- Division of Neurology, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Luana Benedetti
- Neurology Department, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giovanni Novi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Maurizio Versino
- Department of Biotechnology and Life Sciences, University of insubria, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, ASST SetteLaghi, Ospedale di Circolo/Fondazione Macchi, Varese, Italy
| | - Raffaele Iorio
- Department of Neuroscience, Institute of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Turco
- Child Neuropsychiatry Unit, Mother and Child Department, University Hospital of Parma, Parma, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Salvatore Savasta
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Mathematics, University of Pavia, Pavia, Italy
| | - Sven Jarius
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Diego Franciotta
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | |
Collapse
|
4
|
Martinelli-Boneschi F, Colombo A, Bresolin N, Sessa M, Bassi P, Grampa G, Magni E, Versino M, Ferrarese C, Zarcone D, Albanese A, Micieli G, Zanferrari C, Cagnana A, Ferrante C, Zilioli A, Locatelli D, Calloni MV, Delodovici ML, Pozzato M, Patisso V, Bortolan F, Foresti C, Frigeni B, Canella S, Xhani R, Crabbio M, Clemenzi A, Mauri M, Beretta S, La Spina I, Bernasconi S, De Santis T, Cavallini A, Ranieri M, D'Adda E, Fruguglietti ME, Peverelli L, Agosti E, Leoni O, Rigamonti A, Salmaggi A. COVID-19-associated Guillain-Barré syndrome in the early pandemic experience in Lombardia (Italy). Neurol Sci 2023; 44:437-446. [PMID: 36289117 PMCID: PMC9607708 DOI: 10.1007/s10072-022-06429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. METHODS Adult patients admitted to 20 Neurological Units between 1/3-30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). RESULTS Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. CONCLUSIONS We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.
Collapse
Affiliation(s)
- Filippo Martinelli-Boneschi
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. .,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy.
| | - Antonio Colombo
- Membro Direttivo Nazionale SNO, Polo Neurologico Brianteo, Seregno, MB, Italy
| | - Nereo Bresolin
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Maria Sessa
- U.O. Neurologia Ospedale Giovanni XXIII, Bergamo, Italy
| | - Pietro Bassi
- U.O. Neurologia, Ospedale San Giuseppe, Milan, Italy
| | | | | | - Maurizio Versino
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy
| | - Carlo Ferrarese
- Università Degli Studi Milano Bicocca, U.O. Neurologia, Ospedale San Gerardo, Monza, Italy
| | - Davide Zarcone
- U.O. Neurologia, Ospedale Sant'Antonio Abate, Gallarate, VA, Italy
| | | | | | - Carla Zanferrari
- U.O. Neurologia, Ospedale Vizzolo Predabissi, Vizzolo Predabissi, MI, Italy
| | | | - Claudio Ferrante
- U.O. Ospedale Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
| | | | - Davide Locatelli
- Università Insubria, U.O. NeurochirurgiaOspedale Di Varese, Varese, Italy
| | | | - Maria Luisa Delodovici
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy.,Membro Direttivo Regionale Lombardo SNO, Milan, Italy
| | - Mattia Pozzato
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Valerio Patisso
- Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Francesco Bortolan
- U.O. Osservatorio Epidemiologico Regionale, Struttura Epidemiologia E Valutazione Delle Performance, Milan, Regione Lombardia, Italy
| | | | | | | | | | | | | | - Marco Mauri
- Università Dell' InsubriaU.O. Neurologia Ospedale Di Varese, Varese, Italy
| | - Simone Beretta
- Università Degli Studi Milano Bicocca, U.O. Neurologia, Ospedale San Gerardo, Monza, Italy
| | - Isidoro La Spina
- U.O. Neurologia, Ospedale Sant'Antonio Abate, Gallarate, VA, Italy
| | | | | | | | - Michela Ranieri
- U.O. Neurologia, Ospedale Vizzolo Predabissi, Vizzolo Predabissi, MI, Italy
| | | | | | | | - Edoardo Agosti
- Università Insubria, U.O. NeurochirurgiaOspedale Di Varese, Varese, Italy
| | - Olivia Leoni
- U.O. Osservatorio Epidemiologico Regionale, Struttura Epidemiologia E Valutazione Delle Performance, Milan, Regione Lombardia, Italy
| | | | - Andrea Salmaggi
- Coordinatore SNO Lombardia, U.O. Neurologia, Ospedale Manzoni, Lecco, Italy
| |
Collapse
|
5
|
Princiotta Cariddi L, Mauri M, Cosentino M, Versino M, Marino F. Alzheimer’s Disease: From Immune Homeostasis to Neuroinflammatory Condition. Int J Mol Sci 2022; 23:13008. [PMID: 36361799 PMCID: PMC9658357 DOI: 10.3390/ijms232113008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/14/2022] [Indexed: 08/13/2023] Open
Abstract
Alzheimer’s Disease is the most common cause in the world of progressive cognitive decline. Although many modifiable and non-modifiable risk factors have been proposed, in recent years, neuroinflammation has been hypothesized to be an important contributing factor of Alzheimer’s Disease pathogenesis. Neuroinflammation can occur through the combined action of the Central Nervous System resident immune cells and adaptive peripheral immune system. In the past years, immunotherapies for neurodegenerative diseases have focused wrongly on targeting protein aggregates Aβ plaques and NFT treatment. The role of both innate and adaptive immune cells has not been fully clarified, but several data suggest that immune system dysregulation plays a key role in neuroinflammation. Recent studies have focused especially on the role of the adaptive immune system and have shown that inflammatory markers are characterized by increased CD4+ Teff cells’ activities and reduced circulating CD4+ Treg cells. In this review, we discuss the key role of both innate and adaptive immune systems in the degeneration and regeneration mechanisms in the pathogenesis of Alzheimer’s Disease, with a focus on how the crosstalk between these two systems is able to sustain brain homeostasis or shift it to a neurodegenerative condition.
Collapse
Affiliation(s)
- Lucia Princiotta Cariddi
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, 21100 Varese, Italy
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi Hospital, 21100 Varese, Italy
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
| |
Collapse
|
6
|
Fanella G, Baiata C, Candeloro E, Toscano G, Colnaghi S, Mauri M, Cariddi LP, Rebecchi V, Solazzo F, Banfi P, Piatti M, Ferrarese C, Versino M. New-onset myasthenia gravis after mRNA SARS-CoV-2 vaccination: a case series. Neurol Sci 2022; 43:5799-5802. [PMID: 35870026 PMCID: PMC9308404 DOI: 10.1007/s10072-022-06284-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Background Myasthenia gravis (MG) is an autoimmune disease that targets acetylcholine receptor (AChR) of the neuromuscular junction. New-onset MG after SARS-CoV-2 vaccination has rarely been reported. Case presentation We report about three patients who presented new-onset myasthenia gravis after receiving mRNA SARS-CoV-2 vaccination. The patients were all males and older than 55 years. All the patients presented with ocular and bulbar symptoms. The interval between vaccine administration and MG onset ranged from 3 days after the first dose to 10 days after the second dose. All the patients had elevated serum AChR antibodies and responded to pyridostigmine. Two out of three patients were successfully treated with IVIG or plasma exchange and with long-term immunosuppression. Conclusions MG is a rare disease; clinicians should be aware of possible new-onset MG after SARS-CoV-2 vaccination, especially with the current recommendation of booster doses. The hyperstimulation of the innate immune system or the exacerbation of a subclinical pre-existing MG could be possible explanations.
Collapse
Affiliation(s)
- Gaia Fanella
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Claudio Baiata
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Elisa Candeloro
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Gianpaolo Toscano
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Silvia Colnaghi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Valentina Rebecchi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Francesca Solazzo
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
| | - Marialuisa Piatti
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, Circolo Hospital ASST Sette Laghi, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| |
Collapse
|
7
|
Casetta I, Fainardi E, Pracucci G, Saia V, Sallustio F, da Ros V, Nappini S, Nencini P, Bigliardi G, Vinci S, Grillo F, Bracco S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Simonetti L, Zini A, Ruggiero M, Longoni M, Castellan L, Malfatto L, Castellini P, Cosottini M, Comai A, Franchini E, Lozupone E, Della Marca G, Puglielli E, Casalena A, Baracchini C, Savio D, Duc E, Ricciardi G, Cappellari M, Chiumarulo L, Petruzzellis M, Cavallini A, Cavasin N, Critelli A, Burdi N, Boero G, Giorgianni A, Versino M, Biraschi F, Nicolini E, Comelli S, Melis M, Padolecchia R, Tassinari T, Paolo Nuzzi N, Marcheselli S, Sacco S, Invernizzi P, Gallesio I, Ferrandi D, Fancello M, Valeria Saddi M, Russo M, Pischedda A, Baule A, Mannino M, Florio F, Inchingolo V, Elena Flacco M, Romano D, Silvagni U, Inzitari D, Mangiafico S, Toni D. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study. Eur Stroke J 2022; 7:151-157. [PMID: 35647312 PMCID: PMC9134778 DOI: 10.1177/23969873221091648] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND AND PURPOSE We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients. METHODS From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set. RESULTS Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53). CONCLUSIONS Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.
Collapse
Affiliation(s)
- Ilaria Casetta
- Clinical Neurology, University of
Ferrara, Ferrara, Italy
| | | | | | - Valentina Saia
- Hospital Santa Corona Pietra Ligure,
Pietra Ligure, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Andrea Saletti
- Azienda Ospedaliero Universitaria di
Ferrara, Ferrara, Italy
| | | | | | - Mauro Magoni
- Azienda Socio Sanitaria Territoriale
degli Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Zini
- IRCCS Istituto Delle Scienze
Neurologiche di Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrica Duc
- Ospedale San Giovanni Bosco, Torino,
Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesco Florio
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Inchingolo
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | - Danilo Toni
- University of Rome La Sapienza, RM,
Roma, Italy
| | | |
Collapse
|
8
|
Mallampalli MP, Rizk HG, Kheradmand A, Beh SC, Abouzari M, Bassett AM, Buskirk J, Ceriani CEJ, Crowson MG, Djalilian H, Goebel JA, Kuhn JJ, Luebke AE, Mandalà M, Nowaczewska M, Spare N, Teggi R, Versino M, Yuan H, Zaleski-King A, Teixido M, Godley F. Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit. Front Neurol 2022; 12:812678. [PMID: 35046886 PMCID: PMC8762211 DOI: 10.3389/fneur.2021.812678] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.
Collapse
Affiliation(s)
- Monica P Mallampalli
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Amir Kheradmand
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shin C Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Alaina M Bassett
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - James Buskirk
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Claire E J Ceriani
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye & Ear and Harvard Medical School, Boston, MA, United States
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Joel A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jeffery J Kuhn
- Department of Research, Bayview Physicians Group, Chesapeake, VA, United States
| | - Anne E Luebke
- Biomedical Engineering and Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
| | - Marco Mandalà
- Otolaryngology Unit, University of Siena, Siena, Italy
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, Laryngological Oncology, Nicolaus Copernicus University, Torun, Poland
| | - Nicole Spare
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberto Teggi
- Department of Otolaryngology, San Raffaele Scientific Hospital, Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashley Zaleski-King
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, MD, United States
| | - Michael Teixido
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Frederick Godley
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| |
Collapse
|
9
|
Pezzini A, Grassi M, Silvestrelli G, Locatelli M, Rifino N, Beretta S, Gamba M, Raimondi E, Giussani G, Carimati F, Sangalli D, Corato M, Gerevini S, Masciocchi S, Cortinovis M, La Gioia S, Barbieri F, Mazzoleni V, Pezzini D, Bonacina S, Pilotto A, Benussi A, Magoni M, Premi E, Prelle AC, Agostoni EC, Palluzzi F, De Giuli V, Magherini A, Roccatagliata DV, Vinciguerra L, Puglisi V, Fusi L, Diamanti S, Santangelo F, Xhani R, Pozzi F, Grampa G, Versino M, Salmaggi A, Marcheselli S, Cavallini A, Giossi A, Censori B, Ferrarese C, Ciccone A, Sessa M, Padovani A. SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy. J Neurol 2022; 269:1-11. [PMID: 34031747 PMCID: PMC8142879 DOI: 10.1007/s00415-021-10620-8] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients. METHODS In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19. RESULTS Among 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06-2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05-2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17-5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death. CONCLUSIONS Ischemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase.
Collapse
Affiliation(s)
- Alessandro Pezzini
- Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Mario Grassi
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy
| | - Giorgio Silvestrelli
- grid.413174.40000 0004 0493 6690Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Martina Locatelli
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy ,grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Nicola Rifino
- grid.415025.70000 0004 1756 8604Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Simone Beretta
- grid.415025.70000 0004 1756 8604Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Massimo Gamba
- grid.412725.7Vascular Neurology-Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | - Elisa Raimondi
- Neurology Unit, Ospedale Nuovo, ASST Ovest Milanese, Legnano, Italy
| | - Giuditta Giussani
- Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Carimati
- grid.412972.bNeurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Davide Sangalli
- grid.413175.50000 0004 0493 6789Neurology Unit, Ospedale “A. Manzoni”, ASST Lecco, Lecco, Italy
| | - Manuel Corato
- grid.417728.f0000 0004 1756 8807Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Simonetta Gerevini
- grid.460094.f0000 0004 1757 8431Department of Neuroradiology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Masciocchi
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Matteo Cortinovis
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Sara La Gioia
- grid.460094.f0000 0004 1757 8431Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Barbieri
- grid.413174.40000 0004 0493 6690Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Valentina Mazzoleni
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Debora Pezzini
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Sonia Bonacina
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Andrea Pilotto
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Alberto Benussi
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | - Mauro Magoni
- grid.412725.7Vascular Neurology-Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | - Enrico Premi
- grid.412725.7Vascular Neurology-Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Elio Clemente Agostoni
- Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fernando Palluzzi
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy
| | - Valeria De Giuli
- grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Anna Magherini
- grid.413174.40000 0004 0493 6690Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Daria Valeria Roccatagliata
- grid.413174.40000 0004 0493 6690Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Luisa Vinciguerra
- grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Valentina Puglisi
- grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Laura Fusi
- grid.512106.1Neurology Unit, Ospedale “Sant’Anna”, ASST Lariana, Como, Italy
| | - Susanna Diamanti
- grid.415025.70000 0004 1756 8604Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Francesco Santangelo
- grid.415025.70000 0004 1756 8604Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Rubjona Xhani
- grid.512106.1Neurology Unit, Ospedale “Sant’Anna”, ASST Lariana, Como, Italy
| | - Federico Pozzi
- grid.512106.1Neurology Unit, Ospedale “Sant’Anna”, ASST Lariana, Como, Italy
| | - Giampiero Grampa
- grid.512106.1Neurology Unit, Ospedale “Sant’Anna”, ASST Lariana, Como, Italy
| | - Maurizio Versino
- grid.412972.bNeurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Andrea Salmaggi
- grid.413175.50000 0004 0493 6789Neurology Unit, Ospedale “A. Manzoni”, ASST Lecco, Lecco, Italy
| | - Simona Marcheselli
- grid.417728.f0000 0004 1756 8807Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Anna Cavallini
- Stroke Unit, IRCCS Fondazione “C. Mondino”, Pavia, Italy
| | - Alessia Giossi
- grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Bruno Censori
- grid.419450.dNeurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Carlo Ferrarese
- grid.415025.70000 0004 1756 8604Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy ,grid.7563.70000 0001 2174 1754Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Alfonso Ciccone
- grid.413174.40000 0004 0493 6690Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Maria Sessa
- grid.460094.f0000 0004 1757 8431Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Padovani
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
| | | |
Collapse
|
10
|
Mauri M, Gobbo CL, Princiotta Cariddi L, Schiorlin I, Versino M. Depressive symptoms in amnesic mild cognitive impairment: an FDG-PET/CT study. Arch Med Sci 2022; 18:1108-1111. [PMID: 35832723 PMCID: PMC9266860 DOI: 10.5114/aoms/149717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The detection in mild cognitive impairment (MCI) of metabolic alterations suggestive of depression and/or of evolution to dementia. METHODS Sixty-nine MCI patients underwent clinical and imaging evaluation including position emission tomography/computed tomography with fluorodeoxy-glucose (FDG-PET/CT). RESULTS The metabolism mean values in parietal, temporal and pre-cuneus areas were lower in subjects who evolved to dementia, and in frontal and in anterior cingulate areas in depressed subjects. Abnormal metabolism values were higher in the frontal and parietal lobes, and in the precuneus in subjects who evolved to dementia independently from depression. CONCLUSIONS In MCI FDG-PET/CT abnormality patterns suggest the presence of depression or the evolution to dementia.
Collapse
Affiliation(s)
- Marco Mauri
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Clara Luigia Gobbo
- Nuclear Medicine Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - Lucia Princiotta Cariddi
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- PhD program in Clinical and Experimental Medicine and Clinical Humanities, University of Insubria, Varese, Italy
| | - Ilaria Schiorlin
- Nuclear Medicine Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - Maurizio Versino
- U.O.C. Neurologia e Stroke Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
11
|
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Kheradmand A, Newman-Toker D. Vestibular migraine: Diagnostic criteria1. J Vestib Res 2022; 32:1-6. [PMID: 34719447 PMCID: PMC9249276 DOI: 10.3233/ves-201644] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). It contains a literature update while the original criteria from 2012 were left unchanged. The classification defines vestibular migraine and probable vestibular migraine. Vestibular migraine was included in the appendix of the third edition of the International Classification of Headache Disorders (ICHD-3, 2013 and 2018) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.
Collapse
Affiliation(s)
- Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | - Jes Olesen
- Danish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Furman
- Departments of Otolaryngology and Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Waterston
- Monash University Department of Neuroscience, Alfred Hospital, Melbourne, Australia
| | - Barry Seemungal
- Department of Clinical Neuroscience, Charing Cross Hospital, London, UK
| | - John Carey
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- University of Insubria, Varese, Italy
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Amir Kheradmand
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Newman-Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
12
|
Pilati L, Terzaghi M, Ghiotto N, Arnaldi D, Versino M, Rustioni V, Sartori I, Manni R. Twenty-four hours blood pressure profile in idiopathic REM sleep behavior disorder. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Terzaghi M, Pilati L, Ghiotto N, Arnaldi D, Versino M, Rustioni V, Rustioni G, Sartori I, Manni R. Twenty-four hour blood pressure profile in idiopathic REM sleep behaviour disorder. Sleep 2021; 45:6374537. [PMID: 34555174 DOI: 10.1093/sleep/zsab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To determine whether autonomic dysfunction in idiopathic REM sleep behaviour disorder (iRBD) affects circadian blood pressure (BP) profile. METHODS 21 iRBD (mean age 68.8±6.4, mean age at onset 62.2±9.3), 21 drug-free de novo Parkinson's disease (PD) subjects and 21 control subjects (HCs), comparable for age and sex, underwent 24-hour ambulatory BP monitoring. A prospective follow-up study was performed to evaluate the occurrence of neurodegenerative disorders in the iRBD cohort. RESULTS In the iRBD group, night-time systolic BP (SBP) was higher (124.0±20.0, p=.026), nocturnal BP decrease lower (4.0±8.7% for SBP and 8.7±8.0% for DBP, p=.001), and non-dipping status more frequent (71.4% for systolic and 52.4% for diastolic BP; p=.001 and p=.01 respectively) than in the HCs. Reverse dipping of SBP was found in 23.8% (p=.048) of the iRBD subjects. Non-dipping status was not associated with differences in gender, age, disease duration, age at disease onset, UPDRS score, presence of antihypertensive therapy or polysomnographic measures. Patients with PD showed daytime and night-time BP profiles comparable to those observed in iRBD. A sub-group analysis considering only the subjects without antihypertensive therapy (12 iRBD, 12 PD) showed results superimposable on those of the whole iRBD and PD groups.Longitudinal follow up (mean 5.1±1.9 years) showed no differences in BP profile at baseline between converters (n=6) and non-converters. CONCLUSIONS 24-hour BP control was impaired in iRBD. This impairment, similar to patterns observed in de novo PD, consisted of reduced amplitude of nocturnal dipping and increased frequency of non-dipping status. These findings could have implications for cardiovascular morbidity and mortality in iRBD.
Collapse
Affiliation(s)
- Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Laura Pilati
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Natascia Ghiotto
- Interinstitutional Center of Neurological Medicine, IRCCS Mondino Foundation, Pavia, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette laghi Ospedale di Circolo, Varese; DMC University of Insubria, Varese, Italy
| | - Valter Rustioni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gianluca Rustioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivana Sartori
- C. Munari Center of Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
14
|
Terzaghi M, Romani A, Ranzani M, Callieco R, Avantaggiato F, Cremascoli R, Picascia M, Pilati L, Arnaldi D, Rustioni V, Sartori I, Zangaglia R, Pacchetti C, Colnaghi S, Versino M. Neurophysiological evaluation of visual function in iRBD: potential role in stratifying RBD conversion risk. Sleep Med 2021; 84:26-31. [PMID: 34090010 DOI: 10.1016/j.sleep.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/01/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES To evaluate neurophysiological alterations of visual function in idiopathic REM sleep Behavior Disorder (iRBD) both as markers and predictors of neurodegenerative disorders. METHODS In a longitudinal follow-up study of 46 consecutive iRBD patients (follow-up duration 8.4 ± 3.4 years), the baseline parameters in luminance-contrast pattern (VEPp), red-green color (VEPc) and motion-onset (VEPm) Visual Evoked Potentials in iRBD were compared to early (ePD) and advanced (aPD) Parkinson's Disease subjects. Parameters of latency and amplitude of iRBD converters to neurodegenerative disease were compared with those of the non-converters. RESULTS The VEP P100 mean latency values for both eyes and for both stimulation checks (30' and 15') were significantly longer in all the three groups of patients as compared to controls; moreover latencies were longer in aPD than in the iRBD group who did not differ from the ePD group. The same held true when we analyzed the number of abnormal subjects belonging to each diagnostic group with a higher number of abnormal subjects in the aPD group compared to both the ePD and in iRBD groups. Chromatic and motion potentials were not different from controls and did not differ in the 3 diagnostic groups. The iRBD subjects who converted to a neurodegenerative disorder showed longer P100 latencies and a higher occurrence of VEPp abnormalities than those who did not convert. Again chromatic and motion VEPs were not different depending on conversion. CONCLUSIONS In iRBD patients the detection of an abnormal VEPp should be considered as a red flag for possible synnucleinopathy, eventually contributing in stratifying the risk of phenoconversion.
Collapse
Affiliation(s)
- Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Alfredo Romani
- Laboratory of Evoked Potentials, IRCCS Mondino Foundation, Pavia, Italy
| | - Marina Ranzani
- Laboratory of Evoked Potentials, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Callieco
- Laboratory of Evoked Potentials, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Riccardo Cremascoli
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Picascia
- Laboratory of Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Laura Pilati
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy; Department of Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valter Rustioni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivana Sartori
- C. Munari Center of Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Colnaghi
- Laboratory of Evoked Potentials, IRCCS Mondino Foundation, Pavia, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi Ospedale di Circolo, Varese; DMC University of Insubria, Varese, Italy
| |
Collapse
|
15
|
Rebecchi V, Gallo D, Princiotta Cariddi L, Piantanida E, Tabaee Damavandi P, Carimati F, Gallazzi M, Clemenzi A, Banfi P, Candeloro E, Tanda ML, Mauri M, Versino M. Vitamin D, Chronic Migraine, and Extracranial Pain: Is There a Link? Data From an Observational Study. Front Neurol 2021; 12:651750. [PMID: 34054696 PMCID: PMC8155378 DOI: 10.3389/fneur.2021.651750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023] Open
Abstract
Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level <20 ng/ml, was detectable in 46.1% of the patients, and it occurred more frequently (p = 0.009) in patients suffering from chronic migraine (CM)–medication overuse migraine (MOH) (62.9%) than in episodic migraine (EM, 25.7%) or tension-type headache (TTH, 11.4%). The occurrence of extracranial pain and allodynia was higher in the CM-MOH than in the EM and in the TTH groups but was not related to the co-occurrence of vitD deficiency (Fisher's exact test p = 0.11 and p = 0.32, respectively). Our findings show that 25(OH)D deficit is also related to chronic headache, probably because of vitD anti-inflammatory and tolerogenic properties, reinforcing the idea of a neuroinflammatory mechanism underpinning migraine chronification.
Collapse
Affiliation(s)
| | - Daniela Gallo
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Eliana Piantanida
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Carimati
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Marco Gallazzi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | | | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Elisa Candeloro
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy
| | - Maria Laura Tanda
- Endocrine Unit, University of Insubria, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi di Varese, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
16
|
Sangalli D, Martinelli-Boneschi F, Versino M, Colombo I, Ciccone A, Beretta S, Marcheselli S, Altavilla R, Roncoroni M, Beretta S, Lorusso L, Cavallini A, Prelle A, Guidetti D, La Gioia S, Santalucia P, Zanferrari C, Grampa G, D'Adda E, Peverelli L, Colombo A, Salmaggi A. Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy. J Neurol Sci 2021; 426:117479. [PMID: 34004463 PMCID: PMC8096523 DOI: 10.1016/j.jns.2021.117479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022]
Abstract
Introduction Growing evidence has been published as to the impact of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) on cerebrovascular events over the last few months, with considerable attention paid to ischemic strokes. Conversely, little is known about the clinical course of intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection. Method The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurological Departments in Northern Italy. Clinical data on patients with acute cerebrovascular diseases, admitted from March 1st to April 30th, 2020, were collected. A comparison was made of the demographical and clinical features of both SARS-CoV-2 positive and negative patients with ICH. Results 949 patients were enrolled (average age 73.4 years; 52.7% males); 135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, both symptomatic and asymptomatic. SARS-CoV-2 related pneumonia or respiratory distress (OR 5.4), lobar location (OR 5.0) and previous antiplatelet or anticoagulant treatment (OR 2.9) were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a non-significantly increased risk of in-hospital death (37.5% vs 23.4%, p = 0.2). Discussion ICH patients with COVID-19 did not experience an increase in mortality as striking as ischemic stroke. The inflammatory response and respiratory complications could justify the slight increase of death in ICH. Bleeding sites and previous antiplatelet or anticoagulant treatment were the only other predictors of a worse outcome.
Collapse
Affiliation(s)
- Davide Sangalli
- Neurological Department, "Alessandro Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy.
| | - Filippo Martinelli-Boneschi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Via Francesco Sforza 35, 20122 Milan, Italy; Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST SetteLaghi, Ospedale di Circolo, DMC, University of Insubria, Varese, Italy
| | - Irene Colombo
- Neurology and Stroke Unit, Ospedale di Desio, ASST, Monza, MB, Italy
| | - Alfonso Ciccone
- Department of Neurosciences, Carlo Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Simone Beretta
- Department of Neurology, San Gerardo Hospital, ASST Monza, University of Milano Bicocca, Monza, NeuroMi (Milan Center for Neuroscience), Milan, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Riccardo Altavilla
- Neurology and Stroke Unit, P.O. San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro Roncoroni
- Neurology and Stroke Unit, P.O. Saronno, ASST Valle Olona, Varese, Italy
| | - Sandro Beretta
- Neurology, Vimercate Hospital, ASST Vimercate, Vimercate, MB, Italy
| | - Lorenzo Lorusso
- Neurological Department, San Leopoldo Mandic Hospital, ASST Lecco, Merate, Italy
| | - Anna Cavallini
- Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | | | - Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Sara La Gioia
- Department of neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Santalucia
- Neurology and Stroke Unit, San Giuseppe-Multimedica Hospital, Milan, Italy
| | - Carla Zanferrari
- Neurology and Stroke Unit, PO Vizzolo Predabissi, ASST Melegnano Martesana, Milan, Italy
| | | | - Elisabetta D'Adda
- Neurology Unit, Ospedale Maggiore di Crema, ASST Crema, Crema, Italy
| | | | | | - Andrea Salmaggi
- Neurological Department, "Alessandro Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy
| | | |
Collapse
|
17
|
Gallazzi M, Mauri M, Bianchi ML, Riboldazzi G, Princiotta Cariddi L, Carimati F, Rebecchi V, Versino M. Selegiline reduces daytime sleepiness in patients with Parkinson's disease. Brain Behav 2021; 11:e01880. [PMID: 33759401 PMCID: PMC8119812 DOI: 10.1002/brb3.1880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Excessive daytime sleepiness (EDS) affects a large percentage of Parkinson's disease (PD) patients, and it is enhanced by dopamine agonist drugs. Currently, there is no treatment of choice for EDS in PD. Our aim was to check the clinical impression that some patients who were given selegiline, a selective inhibitor of monoamine oxidase B, experienced an improvement in their daytime somnolence. METHODS In the present study, we retrospectively identified 45 Parkinson's disease patients (21 females and 24 males) among those referred to the PD Center in Varese that (a) showed excessive daytime sleepiness, usually developed after the introduction of a dopamine agonist, (b) were given selegiline 10 mg to improve their treatment schedule independently of excessive sleepiness, and (c) in whom the Epworth Sleepiness Scale (ESS) and the Parkinson's Disease Sleep Scale (PDSS) scores were available both before and 3 months after the introduction of selegiline. RESULTS We compared the corresponding scores (ESS, PDSS, and UPDRS III) evaluated before and 3 months after the introduction of selegiline by the nonparametric Mann-Whitney U test: The differences showed a statistically significant improvement of somnolence but no change in the UPDRS III scores. CONCLUSION Despite some limitations, our data suggest that selegiline may be a valuable add-on therapy in PD patients to reduce their daytime somnolence.
Collapse
Affiliation(s)
- Marco Gallazzi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Marco Mauri
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | | | - Giulio Riboldazzi
- Neurologia e Stroke Unit, ASST Valle Olona, Ospedale S. Antonio Abate, Gallarate, Italy
| | - Lucia Princiotta Cariddi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | - Federico Carimati
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Valentina Rebecchi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Maurizio Versino
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| |
Collapse
|
18
|
Pezzini A, Grassi M, Silvestrelli G, Locatelli M, Rifino N, Beretta S, Gamba M, Raimondi E, Giussani G, Carimati F, Sangalli D, Corato M, Gerevini S, Masciocchi S, Cortinovis M, La Gioia S, Barbieri F, Mazzoleni V, Pezzini D, Bonacina S, Pilotto A, Benussi A, Magoni M, Premi E, Prelle AC, Agostoni EC, Palluzzi F, De Giuli V, Magherini A, Roccatagliata DV, Vinciguerra L, Puglisi V, Fusi L, Xhani R, Pozzi F, Diamanti S, Santangelo F, Grampa G, Versino M, Salmaggi A, Marcheselli S, Cavallini A, Giossi A, Censori B, Ferrarese C, Ciccone A, Sessa M, Padovani A. Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network. J Neurol 2021; 268:3561-3568. [PMID: 33683456 PMCID: PMC7937781 DOI: 10.1007/s00415-021-10497-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022]
Abstract
Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62–80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5–270) minutes vs. 190 (IQR 150–245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82–13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10–0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04–4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85–14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions.
Collapse
Affiliation(s)
- Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Mario Grassi
- Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy
| | - Giorgio Silvestrelli
- Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - Martina Locatelli
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
- Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Nicola Rifino
- Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Simone Beretta
- Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Massimo Gamba
- Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | - Elisa Raimondi
- Neurology Unit, Ospedale Nuovo, ASST Ovest Milanese, Legnano, Italy
| | - Giuditta Giussani
- Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Carimati
- Neurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Davide Sangalli
- Neurology Unit, Ospedale "A. Manzoni", ASST Lecco, Lecco, Italy
| | - Manuel Corato
- Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Simonetta Gerevini
- Department of Neuroradiology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Masciocchi
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Matteo Cortinovis
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Sara La Gioia
- Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Barbieri
- Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - Valentina Mazzoleni
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Debora Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Sonia Bonacina
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Alberto Benussi
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Mauro Magoni
- Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | - Enrico Premi
- Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Elio Clemente Agostoni
- Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fernando Palluzzi
- Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy
| | - Valeria De Giuli
- Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Anna Magherini
- Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | | | | | | | - Laura Fusi
- Neurology Unit, Ospedale "Sant'Anna", ASST Lariana, Como, Italy
| | - Rubjona Xhani
- Neurology Unit, Ospedale "Sant'Anna", ASST Lariana, Como, Italy
| | - Federico Pozzi
- Neurology Unit, Ospedale "Sant'Anna", ASST Lariana, Como, Italy
| | - Susanna Diamanti
- Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Francesco Santangelo
- Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | | | - Maurizio Versino
- Neurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Andrea Salmaggi
- Neurology Unit, Ospedale "A. Manzoni", ASST Lecco, Lecco, Italy
| | - Simona Marcheselli
- Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Anna Cavallini
- Stroke Unit, IRCCS Fondazione "C. Mondino", Pavia, Italy
| | - Alessia Giossi
- Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Bruno Censori
- Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy
| | - Carlo Ferrarese
- Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy
- Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Alfonso Ciccone
- Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - Maria Sessa
- Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| |
Collapse
|
19
|
Piubelli L, Pollegioni L, Rabattoni V, Mauri M, Princiotta Cariddi L, Versino M, Sacchi S. Serum D-serine levels are altered in early phases of Alzheimer's disease: towards a precocious biomarker. Transl Psychiatry 2021; 11:77. [PMID: 33500383 PMCID: PMC7838302 DOI: 10.1038/s41398-021-01202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
D-Serine acts as a co-agonist of N-methyl-D-aspartate receptors (NMDAR) which appear overactivated in AD, while D-aspartate is a modulatory molecule acting on NMDAR as a second agonist. The aim of this work is to clarify whether the levels of these D-amino acids in serum are deregulated in AD, with the final goal to identify novel and precocious biomarkers in AD. Serum levels of L- and D-enantiomers of serine and aspartate were determined by HPLC using a pre-column derivatization procedure and a selective enzymatic degradation. Experimental data obtained from age-matched healthy subjects (HS) and AD patients were statistically evaluated by considering age, gender, and disease progression, and compared. Minor changes were apparent in the serum L- and D-aspartate levels in AD patients compared to HS. A positive correlation for the D-serine level and age was apparent in the AD cohort. Notably, the serum D-serine level and the D-/total serine ratio significantly increased with the progression of the disease. Gender seems to have a minor effect on the levels of all analytes tested. This work proposes that the serum D-serine level and D-/total serine ratio values as novel and valuable biomarkers for the progression of AD: the latter parameter allows to discriminate CDR 2 and CDR 1 patients from healthy (CDR 0) individuals.
Collapse
Affiliation(s)
- Luciano Piubelli
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Loredano Pollegioni
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Valentina Rabattoni
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Mauri
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Neurology Unit, Ospedale di Circolo and Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Lucia Princiotta Cariddi
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology Unit, Ospedale di Circolo and Fondazione Macchi, ASST Settelaghi, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia Sacchi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
20
|
Sturchio A, Gastaldi M, Cariddi LP, Biacchi D, Espay AJ, Franciotta D, Versino M, Mauri M. Levodopa-responsive progressive encephalomyelitis with rigidity and myoclonus associated with glycine receptor antibodies. Parkinsonism Relat Disord 2021; 82:7-9. [DOI: 10.1016/j.parkreldis.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
|
21
|
Colombo A, Martinelli Boneschi F, Beretta S, Bresolin N, Versino M, Lorusso L, Spagnoli D, Nastasi G, Vallauri D, Rota S, Repaci M, Ferrarini M, Pozzato M, Princiotta Cariddi L, Tabaee Damavandi P, Carimati F, Banfi P, Clemenzi A, Marelli M, Giorgianni A, Vinacci G, Mauri M, Melzi P, Di Stefano M, Tetto A, Canesi M, Salmaggi A. Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy. eNeurologicalSci 2020; 22:100306. [PMID: 33490654 PMCID: PMC7806512 DOI: 10.1016/j.ensci.2020.100306] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/03/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.
Collapse
Affiliation(s)
- Antonio Colombo
- SNO (Society of Hospital Neurosciences, Italy) and Polo Neurologico Brianteo, Seregno, MB, Italy
| | - Filippo Martinelli Boneschi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Sandro Beretta
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Nereo Bresolin
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Maurizio Versino
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Lorenzo Lorusso
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | - Diego Spagnoli
- Neurosurgery and Neurorehabilitation Gravedona Hospital, Como, Italy
| | - Giulia Nastasi
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Davide Vallauri
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Stefania Rota
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Maria Repaci
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Massimo Ferrarini
- Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy
| | - Mattia Pozzato
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy
| | - Lucia Princiotta Cariddi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Payam Tabaee Damavandi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Federico Carimati
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Paola Banfi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Alessandro Clemenzi
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Margherita Marelli
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Andrea Giorgianni
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Gabriele Vinacci
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy
| | - Paola Melzi
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | | | - Antonio Tetto
- Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy
| | - Margherita Canesi
- Neurosurgery and Neurorehabilitation Gravedona Hospital, Como, Italy
| | | |
Collapse
|
22
|
De Icco R, Putortì A, De Paoli I, Ferrara E, Cremascoli R, Terzaghi M, Toscano G, Allena M, Martinelli D, Cosentino G, Grillo V, Colagiorgio P, Versino M, Manni R, Sances G, Sandrini G, Tassorelli C. Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: A pilot double-blind randomized sham-controlled trial. Clin Neurophysiol 2020; 132:126-136. [PMID: 33271482 DOI: 10.1016/j.clinph.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/18/2020] [Revised: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little evidence is available on the role of transcranial direct current stimulation (tDCS) in patients affected by chronic migraine (CM) and medication overuse headache (MOH). We aim to investigate the effects of tDCS in patients with CM and MOH as well as its role on brain activity. METHODS Twenty patients with CM and MOH were hospitalized for a 7-day detoxification treatment. Upon admission, patients were randomly assigned to anodal tDCS or sham stimulation delivered over the primary motor cortex contralateral to the prevalent migraine pain side every day for 5 days. Clinical data were recorded at baseline (T0), after 1 month (T2) and 6 months (T3). EEG recording was performed at T0, at the end of the tDCS/Sham treatment, and at T2. RESULTS At T2 and T3, we found a significant reduction in monthly migraine days (p = 0.001), which were more pronounced in the tDCS group when compared to the sham group (p = 0.016). At T2, we found a significant increase of alpha rhythm in occipital leads, which was significantly higher in tDCS group when compared to sham group. CONCLUSIONS tDCS showed adjuvant effects to detoxification in the management of patients with CM and MOH. The EEG recording showed a significant potentiation of alpha rhythm, which may represent a correlate of the underlying changes in cortico-thalamic connections. SIGNIFICANCE This study suggests a possible role for tDCS in the treatment of CM and MOH. The observed clinical improvement is coupled with a potentiation of EEG alpha rhythm.
Collapse
Affiliation(s)
- R De Icco
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - A Putortì
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - I De Paoli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - E Ferrara
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - R Cremascoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Toscano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - M Allena
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - D Martinelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - G Cosentino
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - V Grillo
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - P Colagiorgio
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Versino
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy; DMC Department, Insubria University, Varese, Italy
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sances
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
23
|
Cabrini L, Ageno W, Balbi S, Baruzzi F, Candeloro E, Capra C, Carimati F, Castiglioni B, Conti V, DE Ponti R, Franchi D, Gini G, Giorgianni A, Sartorelli M, Landoni G, Locatelli D, Maffioli L, Pradella R, Severgnini P, Tozzi M, Versino M, Zocchi G, Zoli A. Caring for acute coronary syndrome and other time-sensitive medical emergencies during the coronavirus disease 2019 pandemic in Northern Italy: report from a hub center. Minerva Cardiol Angiol 2020; 70:303-309. [PMID: 33258565 DOI: 10.23736/s2724-5683.20.05384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from time-sensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies. METHODS We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year. RESULTS Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24 h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed. CONCLUSIONS Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.
Collapse
Affiliation(s)
- Luca Cabrini
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Walter Ageno
- University of Insubria, Varese, Italy.,Emergency Department, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Sergio Balbi
- University of Insubria, Varese, Italy.,Department of Neurological Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Fabio Baruzzi
- Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Elisa Candeloro
- Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Carlo Capra
- Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Federico Carimati
- Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Battistina Castiglioni
- Department of Cardiology, Luigi Galmarini Hospital, ASST Settelaghi, Tradate, Varese, Italy
| | - Vinicio Conti
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Roberto DE Ponti
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | | | - Giancarlo Gini
- Emergency Department, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Marianna Sartorelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy - .,Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Davide Locatelli
- University of Insubria, Varese, Italy.,Department of Neurological Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | | | - Rita Pradella
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Paolo Severgnini
- University of Insubria, Varese, Italy.,Department of Biotechnology and Sciences of Life, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Matteo Tozzi
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Maurizio Versino
- University of Insubria, Varese, Italy.,Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Giuliano Zocchi
- University of Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Alberto Zoli
- Lombardy EMS Regional Agency (AREU), Milan, Italy
| |
Collapse
|
24
|
Cabrini L, Ageno W, Balbi S, Baruzzi F, Candeloro E, Capra C, Carimati F, Castiglioni B, Conti V, De Ponti R, Franchi D, Gini G, Giorgianni A, Sartorelli M, Landoni G, Locatelli D, Maffioli L, Pradella R, Severgnini P, Tozzi M, Versino M, Zocchi G, Zoli A. Caring for acute coronary syndrome and other time-sensitive medical emergencies during the coronavirus disease 2019 pandemic in Northern Italy: report from a hub centre. Minerva Cardioangiol 2020. [PMID: 33258565 DOI: 10.23736/s0026-4725.20.05384-0] [Citation(s) in RCA: 3] [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: 11/08/2022]
Abstract
BACKGROUND The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from timesensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies. METHODS We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year. RESULTS Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed. CONCLUSIONS Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.
Collapse
Affiliation(s)
- Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Walter Ageno
- Università degli Studi dell'Insubria, Varese, Italy.,Emergency Department, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Sergio Balbi
- Department of of Biotechnology and Sciences of Life, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy.,Department of Neurological Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Fabio Baruzzi
- Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Elisa Candeloro
- Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Carlo Capra
- Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Federico Carimati
- Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Battistina Castiglioni
- Department of Cardiology, Ospedale Luigi Galmarini, Tradate, ASST-Settelaghi, Varese, Italy
| | - Vinicio Conti
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Roberto De Ponti
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | | | - Giancarlo Gini
- Emergency Department, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Marianna Sartorelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy - .,Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Davide Locatelli
- Università degli Studi dell'Insubria, Varese, Italy.,Department of Neurological Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | | | - Rita Pradella
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Paolo Severgnini
- Università degli Studi dell'Insubria, Varese, Italy.,Department of of Biotechnology and Sciences of Life, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Matteo Tozzi
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Maurizio Versino
- Università degli Studi dell'Insubria, Varese, Italy.,Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | - Giuliano Zocchi
- Università degli Studi dell'Insubria, Varese, Italy.,Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
| | | |
Collapse
|
25
|
Candeloro E, Carimati F, Tabaee Damavandi P, Princiotta Cariddi L, Banfi P, Clemenzi A, Gallazzi M, Mauri M, Rebecchi V, Baruzzi F, Giorgianni A, Tozzi M, Bianchi M, Ageno W, Versino M. An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era. Front Neurol 2020; 11:1029. [PMID: 33178094 PMCID: PMC7593656 DOI: 10.3389/fneur.2020.01029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.
Collapse
Affiliation(s)
- Elisa Candeloro
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Bicocca University, Milan, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Alessandro Clemenzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Gallazzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Valentina Rebecchi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Fabio Baruzzi
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Vascular Surgery Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Massimo Bianchi
- Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| |
Collapse
|
26
|
Paciaroni M, Agnelli G, Alberti A, Becattini C, Guercini F, Martini G, Tassi R, Marotta G, Venti M, Acciarresi M, Mosconi MG, Marcheselli S, Fratticci L, D'Amore C, Ageno W, Versino M, De Lodovici ML, Carimati F, Pezzini A, Padovani A, Corea F, Scoditti U, Denti L, Tassinari T, Silvestrelli G, Ciccone A, Caso V. PREvention of VENous Thromboembolism in Hemorrhagic Stroke Patients - PREVENTIHS Study: A Randomized Controlled Trial and a Systematic Review and Meta-Analysis. Eur Neurol 2020; 83:566-575. [PMID: 33190135 DOI: 10.1159/000511574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/14/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this randomized trial, currently utilized standard treatments were compared with enoxaparin for the prevention of venous thromboembolism (VTE) in patients with intracerebral hemorrhage (ICH). METHODS Enoxaparin (0.4 mg daily for 10 days) was started after 72 h from the onset of ICH. The primary outcome was symptomatic or asymptomatic deep venous thrombosis as assessed by ultrasound at the end of study treatment. The safety of enoxaparin was also assessed. We included the results of this study in a meta-analysis of all relevant studies comparing anticoagulants with standard treatments or placebo. RESULTS PREVENTIHS was prematurely stopped after the randomization of 73 patients, due to the low recruitment rate. The prevalence of any VTE at 10 days was 15.8% in the enoxaparin group and 20.0% in the control group (RR 0.79 [95% CI 0.29-2.12]); 2.6% of enoxaparin and 8.6% of standard therapy patients had severe bleedings (RR 0.31 [95% CI 0.03-2.82]). When these results were meta-analyzed with the results of the selected studies (4,609 patients; 194 from randomized trials), anticoagulants were associated with a nonsignificant reduction in any VTE (OR 0.81; 95% CI 0.43-1.51), in pulmonary embolism (OR 0.53; 95% CI, 0.17-1.60), and in mortality (OR 0.85; 95% CI 0.64-1.12) without increase in hematoma enlargement (OR 0.97; 95% CI, 0.31-3.04). CONCLUSIONS In patients with acute ICH, the use of anticoagulants to prevent VTE was safe but the overall level of evidence was low due to the low number of patients included in randomized clinical trials.
Collapse
Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy,
| | - Giancarlo Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Francesco Guercini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | | | | | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Monica Acciarresi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Maria Giulia Mosconi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Lara Fratticci
- Humanitas Clinical and Research Center - IRCSS, Milano, Italy
| | - Cataldo D'Amore
- Stroke Unit, Ospedale di Portogruaro, Portogruaro (Venice), Italy
| | - Walter Ageno
- Department of Medicine, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Settelaghi, DMC University of Insubria, Varese, Italy
| | | | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Francesco Corea
- UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy
| | - Umberto Scoditti
- Stroke Unit, Neuroscience Department, University of Parma, Parma, Italy
| | - Licia Denti
- Stroke Unit - Dipartimento Geriatrico Riabilitativo - University of Parma, Parma, Italy
| | - Tiziana Tassinari
- Stroke Unit & Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Alfonso Ciccone
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| |
Collapse
|
27
|
Sturchio A, Dwivedi AK, Vizcarra JA, Chirra M, Keeling EG, Mata IF, Kauffman MA, Pandey MK, Roviello G, Comi C, Versino M, Marsili L, Espay AJ. Genetic parkinsonisms and cancer: a systematic review and meta-analysis. Rev Neurosci 2020; 32:159-167. [PMID: 33151182 DOI: 10.1515/revneuro-2020-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
Genes associated with parkinsonism may also be implicated in carcinogenesis, but their interplay remains unclear. We systematically reviewed studies (PubMed 1967-2019) reporting gene variants associated with both parkinsonism and cancer. Somatic variants were examined in cancer samples, whereas germline variants were examined in cancer patients with both symptomatic and asymptomatic (carriers) genetic parkinsonisms. Pooled proportions were calculated with random-effects meta-analyses. Out of 9,967 eligible articles, 60 were included. Of the 28 genetic variants associated with parkinsonism, six were also associated with cancer. In cancer samples, SNCA was predominantly associated with gastrointestinal cancers, UCHL1 with breast cancer, and PRKN with head-and-neck cancers. In asymptomatic carriers, LRRK2 was predominantly associated with gastrointestinal and prostate cancers, PRKN with prostate and genitourinary tract cancers, GBA with sarcoma, and 22q11.2 deletion with leukemia. In symptomatic genetic parkinsonism, LRRK2 was associated with nonmelanoma skin cancers and breast cancers, and PRKN with head-and-neck cancers. Cancer was more often manifested in genetic parkinsonisms compared to asymptomatic carriers. These results suggest that intraindividual genetic contributions may modify the co-occurrence of cancer and neurodegeneration.
Collapse
Affiliation(s)
- Andrea Sturchio
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Joaquin A Vizcarra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Martina Chirra
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Elizabeth G Keeling
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Ignacio F Mata
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marcelo A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología José María Ramos Mejía, Buenos Aires, Argentina
| | - Manoj K Pandey
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Interdisciplinary Research Centre of Autoimmune Diseases, Movement Disorders Centre, University of Piemonte Orientale, Novara, Italy
| | | | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St., Cincinnati, OH45219, USA
| |
Collapse
|
28
|
Cortese A, Callegari I, Currò R, Vegezzi E, Colnaghi S, Versino M, Alfonsi E, Cosentino G, Valente E, Gana S, Tassorelli C, Pichiecchio A, Rossor AM, Bugiardini E, Biroli A, Di Capua D, Houlden H, Reilly MM. Mutation in RNF170 causes sensory ataxic neuropathy with vestibular areflexia: a CANVAS mimic. J Neurol Neurosurg Psychiatry 2020; 91:1237-1238. [PMID: 32943585 PMCID: PMC8311668 DOI: 10.1136/jnnp-2020-323719] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy .,Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Ilaria Callegari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | | | - Maurizio Versino
- Neurology Unit, ASST Settelaghi-Insubria University-DMC, Varese, Italy
| | | | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Enzamaria Valente
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Alexander M Rossor
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Enrico Bugiardini
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Antonio Biroli
- Neurosurgery Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Di Capua
- Neurologia, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Henry Houlden
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Mary M Reilly
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| |
Collapse
|
29
|
Sturchio A, Dwivedi AK, Marsili L, Hadley A, Sobrero G, Heldman D, Maule S, Lopiano L, Comi C, Versino M, Espay AJ, Merola A. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 2020; 268:1006-1015. [PMID: 32979099 DOI: 10.1007/s00415-020-10240-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that technology could predict the risk of falls in Parkinson's disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment. METHODS Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg. CONCLUSIONS Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.
Collapse
Affiliation(s)
- Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- University of Pavia, Pavia, Italy
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aaron Hadley
- Great Lakes NeuroTechnologies, Cleveland, OH, USA
| | - Gabriele Sobrero
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Simona Maule
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurizio Versino
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
| |
Collapse
|
30
|
De Francesco E, Terzaghi M, Storelli E, Magistrelli L, Comi C, Legnaro M, Mauri M, Marino F, Versino M, Cosentino M. CD4+ T-cell Transcription Factors in Idiopathic REM Sleep Behavior Disorder and Parkinson's Disease. Mov Disord 2020; 36:225-229. [PMID: 32649001 DOI: 10.1002/mds.28137] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND CD4+ T-cell dysregulation occurs in Parkinson's disease (PD); however, it is unknown whether it contributes to PD development. The objective of this study was to investigate transcription factor gene expression in CD4+ T cells in idiopathic rapid eye movement sleep behavior disorder, the strongest risk factor for prodromal PD. METHODS Expression of transcription factors (TBX21, STAT1, STAT3, STAT4, STAT6, RORC, GATA3, FOXP3, and NR4A2) was measured in CD4+ T cells from 33 polysomnographically confirmed idiopathic rapid eye movement sleep behavior disorder subjects and compared with expression in cells from matched healthy subjects and antiparkinson drugs-naive PD patients. RESULTS Compared with healthy subjects, idiopathic rapid eye movement sleep behavior disorder subjects and PD patients had lower TBX21, STAT3, and STAT4, and higher FOXP3 expression. TBX21 expression discriminated healthy subjects from idiopathic rapid eye movement sleep behavior disorder subjects and PD patients, but not idiopathic rapid eye movement sleep behavior disorder subjects with PD. CONCLUSIONS In idiopathic rapid eye movement sleep behavior disorder subjects CD4+ T cells exhibit a peculiar molecular signature strongly resembling cells from PD patients, suggesting early involvement of peripheral immunity in PD. © 2020 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Erika De Francesco
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Storelli
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | - Cristoforo Comi
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy.,Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Massimiliano Legnaro
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Marco Mauri
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy.,Center of Research in Neuroscience, University of Insubria, Varese, Italy
| | - Maurizio Versino
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy.,Center of Research in Neuroscience, University of Insubria, Varese, Italy
| |
Collapse
|
31
|
Cappellari M, Pracucci G, Forlivesi S, Saia V, Nappini S, Nencini P, Inzitari D, Greco L, Sallustio F, Vallone S, Bigliardi G, Zini A, Pitrone A, Grillo F, Musolino R, Bracco S, Tinturini R, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Casetta I, Gasparotti R, Magoni M, Castellan L, Malfatto L, Menozzi R, Scoditti U, Causin F, Baracchini C, Puglielli E, Casalena A, Ruggiero M, Malatesta E, Comelli C, Chianale G, Lauretti DL, Mancuso M, Lafe E, Cavallini A, Cavasin N, Critelli A, Ciceri EFM, Bonetti B, Chiumarulo L, Petruzzelli M, Giorgianni A, Versino M, Ganimede MP, Tinelli A, Auteri W, Petrone A, Guidetti G, Nicolini E, Allegretti L, Tassinari T, Filauri P, Sacco S, Pavia M, Invernizzi P, Nuzzi NP, Carmela Spinelli M, Amistà P, Russo M, Ferrandi D, Corraine S, Craparo G, Mannino M, Simonetti L, Toni D, Mangiafico S. General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke. Stroke 2020; 51:2036-2044. [DOI: 10.1161/strokeaha.120.028963] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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
Background and Purpose:
As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA).
Methods:
We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.
Results:
GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0–2 (aOR, 0.659 [95% CI, 0.538–0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095–1.823]).
Conclusions:
GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.
Collapse
Affiliation(s)
- Manuel Cappellari
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Giovanni Pracucci
- NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.)
| | - Stefano Forlivesi
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Sergio Nappini
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
| | - Patrizia Nencini
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
| | - Domenico Inzitari
- NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.)
| | - Laura Greco
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.)
| | - Fabrizio Sallustio
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.)
| | - Stefano Vallone
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.)
| | - Guido Bigliardi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.)
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.)
| | - Antonio Pitrone
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Francesco Grillo
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Rosa Musolino
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Sandra Bracco
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Rebecca Tinturini
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Rossana Tassi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Mauro Bergui
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.)
| | - Paolo Cerrato
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.)
| | - Andrea Saletti
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Alessandro De Vito
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Ilaria Casetta
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Roberto Gasparotti
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni)
| | - Mauro Magoni
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni)
| | - Lucio Castellan
- Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.)
| | - Laura Malfatto
- Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.)
| | - Roberto Menozzi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.)
| | - Umberto Scoditti
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.)
| | - Francesco Causin
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.)
| | - Claudio Baracchini
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.)
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena)
| | - Alfonsina Casalena
- Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena)
| | - Maria Ruggiero
- Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.)
| | - Emanuele Malatesta
- Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.)
| | - Chiara Comelli
- Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale)
| | - Gigliola Chianale
- Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale)
| | - Dario Luca Lauretti
- Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso)
| | - Michelangelo Mancuso
- Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso)
| | - Elvis Lafe
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.)
| | - Anna Cavallini
- Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini)
| | - Nicola Cavasin
- Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli)
| | - Adriana Critelli
- Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli)
| | - Elisa Francesca Maria Ciceri
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Bruno Bonetti
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli)
| | - Marco Petruzzelli
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli)
| | - Andrea Giorgianni
- Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.)
| | - Maurizio Versino
- Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.)
| | - Maria Porzia Ganimede
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.)
| | - Angelica Tinelli
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.)
| | - Wiliam Auteri
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.)
| | - Alfredo Petrone
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.)
| | - Giulio Guidetti
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Ettore Nicolini
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Luca Allegretti
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Pietro Filauri
- Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.)
| | - Simona Sacco
- Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.)
| | - Marco Pavia
- Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.)
| | - Paolo Invernizzi
- Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.)
| | - Nunzio Paolo Nuzzi
- Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.)
| | - Maria Carmela Spinelli
- Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.)
| | - Pietro Amistà
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo)
| | - Monia Russo
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo)
| | - Delfina Ferrandi
- Neuroradiology Unit and Neurology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy (D.F.)
| | - Simona Corraine
- Interventional Vascular Unit and Stroke Unit, Ospedale S. Michele-AO Brotzu, Cagliari, Italy (S.C.)
| | - Giuseppe Craparo
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.)
| | - Marina Mannino
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.)
| | - Luigi Simonetti
- Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.)
| | - Danilo Toni
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Salvatore Mangiafico
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
| |
Collapse
|
32
|
Princiotta Cariddi L, Tabaee Damavandi P, Carimati F, Banfi P, Clemenzi A, Marelli M, Giorgianni A, Vinacci G, Mauri M, Versino M. Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient. J Neurol 2020; 267:3157-3160. [PMID: 32583053 PMCID: PMC7312113 DOI: 10.1007/s00415-020-10001-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.
Collapse
Affiliation(s)
- Lucia Princiotta Cariddi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,University of Milano Bicocca, Monza, Italy
| | - Federico Carimati
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | - Alessandro Clemenzi
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy
| | | | - Andrea Giorgianni
- Neuroradiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Gabriele Vinacci
- Radiology Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy.,Clinical and Experimental Medicine and Medical Humanities, Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy.,University of Insubria, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Viale Borri, 57, 20100, Varese, Italy. .,University of Insubria, Varese, Italy.
| |
Collapse
|
33
|
Banfi P, Coll M, Oliva A, Alcalde M, Striano P, Mauri M, Princiotta L, Campuzano O, Versino M, Brugada R. Lamotrigine induced Brugada-pattern in a patient with genetic epilepsy associated with a novel variant in SCN9A. Gene 2020; 754:144847. [PMID: 32531456 DOI: 10.1016/j.gene.2020.144847] [Citation(s) in RCA: 6] [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] [Received: 04/07/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND A 30-year-old man presented with intellectual disability associated with epilepsy. The epilepsy was initially treated with sodium valproate and since he was 28 years-old with lamotrigine. With the addition of lamotrigine, a pattern of Brugada syndrome appeared on the electrocardiogram. The family history was positive for epilepsy from the motheŕs side, who had never been treated with lamotrigine. OBJECTIVE Determine the genetic cause of the intellectual disability, epilepsy and Brugada syndrome of the patient and try to establish a possible correlation between the genetic background and the Brugada syndrome pattern under lamotrigine treatment. METHODS A standard karyotype, array comparative genomic hybridization and two different NGS panels have done to the index case to identify the genetic causes of the intellectual disability, epilepsy and Brugada syndrome pattern. RESULTS Genetic analyses in the family identified a de novo duplication of 1.3 Mb in 8p21.3 as well as two novel heterozygous rare variants in SCN9A and AKAP9 genes, both inherited from the mother. CONCLUSION We hypothesize that in this family the SCN9A variant was responsible for the epileptic syndrome. In addition, given that SCN9A is lightly expressed in the heart tissue, we postulate that this SCN9A variant, alone or in combination with AKAP9 variant, might be responsible for the Brugada pattern when challenged by lamotrigine.
Collapse
Affiliation(s)
- P Banfi
- Neurology and Stroke Unit Divison, Circolo Hospital ASST Settelaghi University of Insubria Varese, Italy
| | - M Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - A Oliva
- Institute of Public Health, Section of Legal Medicine, Catholic University, Rome, Italy
| | - M Alcalde
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - P Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - M Mauri
- Neurology and Stroke Unit Divison, Circolo Hospital ASST Settelaghi University of Insubria Varese, Italy
| | - L Princiotta
- Neurology and Stroke Unit Divison, Circolo Hospital ASST Settelaghi University of Insubria Varese, Italy
| | - O Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - M Versino
- Neurology and Stroke Unit Divison, Circolo Hospital ASST Settelaghi University of Insubria Varese, Italy
| | - R Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Cardiology Service, Hospital JosepTrueta, University of Girona, Girona, Spain.
| |
Collapse
|
34
|
Versino M, Mandalà M, Colnaghi S, Ricci G, Faralli M, Ramat S. The integration of multisensory motion stimuli is impaired in vestibular migraine patients. J Neurol 2020; 267:2842-2850. [PMID: 32448951 DOI: 10.1007/s00415-020-09905-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is a relatively recently acknowledged vestibular syndrome with a very relevant prevalence of about 10% among patients complaining of vertigo. The diagnostic criteria for VM have been recently published by the Bárány Society, and they are now included in the latest version of the International Classification of Headache Disorders, yet there is no instrumental test that supports the diagnosis of VM. OBJECTIVE In the hypothesis that the integration of different vestibular stimuli is functionally impaired in VM, we tested whether the combination of abrupt vestibular stimuli and full-field, moving visual stimuli would challenge vestibular migraine patients more than controls and other non-vestibular migraineurs. METHODS In three clinical centers, we compared the performance in the functional head impulse test (fHIT) without and with an optokinetic stimulus rotating in the frontal plane in a group of 44 controls (Ctrl), a group of 42 patients with migraine (not vestibular migraine, MnoV), a group of 39 patients with vestibular migraine (VM) and a group of 15 patients with vestibular neuritis (VN). RESULTS The optokinetic stimulation reduced the percentage of correct answers (%CA) in all groups, and in about 33% of the patients with migraine, in as many as 87% of VM patients and 60% of VN patients, this reduction was larger than expected from controls' data. CONCLUSIONS The comparison of the fHIT results without and with optokinetic stimulation unveils a functional vestibular impairment in VM that is not as large as the one detectable in VN, and that, in contrast with all the other patient groups, mainly impairs the capability to integrate different vestibular stimuli.
Collapse
Affiliation(s)
- Maurizio Versino
- Neurology Unit, ASST Settelaghi, Insubria University, DMC, Varese, Italy.,Neuro-Otology and Neuro-Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Silvia Colnaghi
- Neuro-Otology and Neuro-Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giampietro Ricci
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Mario Faralli
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Stefano Ramat
- Department of Computer, Electric and Biomedical Engineering, University of Pavia, Via Ferrata, 5, 27100, Pavia, Italy.
| |
Collapse
|
35
|
Belcastro V, Brigo F, Ferlazzo E, Gasparini S, Mastroianni G, Cianci V, Lattanzi S, Silvestrini M, Versino M, Banfi P, Carimati F, Grampa G, Lochner P, Gigli GL, Bax F, Merlino G, Valente M, Vidale S, Aguglia U. Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study: (TESI study: "Trombolisi/Trombectomia e crisi Epilettiche precoci nello Stroke Ischemico"). Epilepsy Behav 2020; 104:106476. [PMID: 31431399 DOI: 10.1016/j.yebeh.2019.106476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of this study was to prospectively investigate the occurrence of early poststroke seizures (within 7 days of stroke) in patients undergoing reperfusion therapies (intravenous rtPA [recombinant tissue plasminogen activator] and/or endovascular thrombectomy) in comparison to those not undergoing these procedures. METHODS Patients aged ≥18 years with acute ischemic stroke admitted in five Italian centers were prospectively recruited. Clinical data, details on stroke type and etiology, stroke treatment, and radiological data were collected. The frequency of early poststroke seizures was assessed, and predictive factors for their occurrence were evaluated. RESULTS Five hundred and sixteen patients (262 in the reperfusion therapies group) were included. Stroke severity on admission and at discharge was higher among patients undergoing reperfusion therapies. Ten patients (3.8%) undergoing reperfusion therapies and 6 (2.3%) of those not receiving these treatments experienced early poststroke seizures (p = 0.45). There were no differences in any of the baseline characteristics between patients experiencing and those not experiencing early seizures. CONCLUSION The incidence of early poststroke seizures was overall rare, and no significant differences emerged between patients receiving and those not receiving reperfusion therapies. This article is part of the Special Issue "Seizures and Stroke".
Collapse
Affiliation(s)
| | - Francesco Brigo
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
| | - Giovanni Mastroianni
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
| | - Vittoria Cianci
- Neurology and Stroke Unit, Great Metropolitan Hospital, Reggio Cal., Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Maurizio Versino
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy; DMC Department, University of Insubria, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy
| | | | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | | | - Francesco Bax
- Clinical Neurology Unit, University of Udine, Udine, Italy
| | | | | | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
| |
Collapse
|
36
|
Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
Collapse
Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
37
|
Versino M, Colnaghi S, Corallo G, Mandalà M, Ramat S. The functional head impulse test: Comparing gain and percentage of correct answers. Prog Brain Res 2019; 248:241-248. [PMID: 31239135 DOI: 10.1016/bs.pbr.2019.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The video head impulse test (vHIT) provides as output a gain value that summarizes the behavior of the vestibulo-ocular reflex as the ratio of a measure of eye movement to the corresponding measure of head movement and is not directly informative of the functional effectiveness of the motor response. The functional HIT (fHIT) is based on the ability to recognize the orientation of a Landolt C optotype that briefly appears on a computer screen during passive head impulses imposed by the examiner over a range of head accelerations; accordingly fHIT is a functional measurement of the vestibular-ocular reflex since it measures the capability to keep clear vision and to read during head movement. METHODS We compared the results of the fHIT with those of the vHIT and the results of the Dizziness Handicap Inventory (DHI) questionnaire in a group of 27 vestibular neuritis patients recorded acutely and at 3-months follow-up. RESULTS Both the vHIT and fHIT exams correctly classified all patients as abnormal on the affected side when tested in the acute phase. After a 3-month follow-up, both were able to show that compensation phenomena had occurred. Otherwise the data from the two techniques were not correlated. More specifically, the fHIT detected more abnormalities than the vHIT, for head rotation toward the healthy side, both in the acute phase and after 3 months, and for head rotation toward the affected side after 3 months. The asymmetry indices, that compare the performance of the healthy to the affected side, also were larger for the fHIT than for the vHIT both at onset and after 3 months. There was no significant correlation between the different vHIT and fHIT parameters and indices, or with the DHI values after 3 months. CONCLUSIONS The fHIT data are able to detect a difference between the healthy and the affected side in the acute phase, and they show an improvement after 3 months. fHIT detects more abnormalities than vHIT, but both these techniques lack a correlation with the DHI score.
Collapse
Affiliation(s)
- Maurizio Versino
- Neurology Unit, ASST Settelaghi-Insubria University-DMC, Varese, Italy; Neuro-Otology and Neuro-Ophthalmology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Colnaghi
- Neuro-Otology and Neuro-Ophthalmology Laboratory, IRCCS Mondino Foundation, Pavia, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
| | - Giulia Corallo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Siena, Siena, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| |
Collapse
|
38
|
Terzaghi M, Toscano G, Casoni F, Picascia M, Arnaldi D, Rustioni V, Versino M, Sinforiani E, Manni R. Assessment of cognitive profile as a prodromal marker of the evolution of rapid eye movement sleep behavior disorder. Sleep 2019; 42:5477298. [DOI: 10.1093/sleep/zsz103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
To search for a specific neuropsychological profile in idiopathic REM sleep behavior disorder (iRBD), able to predict the onset of neurodegenerative disorders.
Methods
In a longitudinal follow-up study of 63 consecutive iRBD patients (follow-up duration 6.7 ± 3.8 years), the baseline cognitive profile of converters to neurodegenerative disease was compared with that of the nonconverters. Five cognitive domains were assessed: memory, attention-working memory, executive functions, visuospatial abilities, language. Mild cognitive impairment (MCI) was diagnosed according to the Movement Disorder Society’s diagnostic criteria for Parkinson’s disease.
Results
30 subjects (47.6%) developed a neurodegenerative disease (latency to conversion 60.33 ± 44.81 months). MCI was found in 50% of the converters and 12% of the nonconverters (p = .001), and its presence conferred a neurodegenerative disease risk of 10% at 3 years, 36% at 5 years, and 73% at 10 years (p = .002). Pathological equivalent scores on at least one neuropsychological test were detected in 46.7% of the converters versus 21.2% of the nonconverters in the memory domain (p = .032), in 40.0% versus 6.1% in that of executive functions (p = .002), and in 20.0% versus 3% in the visuospatial abilities domain (p = .047). On multivariate analysis, impaired executive functions significantly correlated with phenoconversion (p = .018). Lower Mini Mental State Examination (MMSE) scores (p = .004) and memory deficits (p = .031) were found in patients who developed dementia first.
Conclusions
Cognitive profile is useful for stratifying risk of phenoconversion in patients with iRBD. The presence of MCI and impaired executive functions, memory, and visuospatial abilities discriminated the converters. Lower MMSE scores and memory deficits may characterize those subjects who first develop dementia.
Collapse
Affiliation(s)
- Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gianpaolo Toscano
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Picascia
- Laboratory of Neuropsychology/Alzheimer’s Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valter Rustioni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- DMC University of Insubria, ASST Sette laghi Ospedale di Circolo, Varese, Italy
| | - Elena Sinforiani
- Laboratory of Neuropsychology/Alzheimer’s Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
39
|
Colnaghi S, Beltrami G, Poloni G, Pichiecchio A, Bastianello S, Galimberti CA, Versino M. Parahippocampal Involvement in Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis: A Proof of Concept from Memory-Guided Saccades. Front Neurol 2017; 8:595. [PMID: 29163352 PMCID: PMC5681931 DOI: 10.3389/fneur.2017.00595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/23/2017] [Indexed: 02/04/2023] Open
Abstract
Objective Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) may involve extrahippocampal areas of structural damage and dysfunction. The accuracy of medium-term spatial memory can be tested by memory-guided saccades (MGS) to evaluate a functional impairment of the parahippocampal cortex (PHC), while voxel-based morphometry (VBM) analysis can be used to detect a structural damage of the latter region. Methods MGS with 3- and 30-s memorization delays were compared between 7 patients affected by right MTLE-HS (r-MTLE-HS), 6 patients affected by left MTLE-HS, and 13 healthy controls. The same subjects underwent brain MRI for a VBM analysis. Correlation analysis was performed between the results of VBM and MGS and with patients’ clinical data. Results Right MTLE-HS patients showed impaired accuracy of leftward MGS with a 30-s memorization delay; their gray-matter volume was reduced in the right hippocampus and inferior temporal gyrus, and bilaterally in the cerebellum. Left MTLE-HS patients had normal MGS accuracy; their gray-matter volume was reduced in the left hippocampus, in the right-inferior temporal gyrus and corpus callosus, and bilaterally in the insular cortex and in the cerebellum. The difference between right and left parahippocampal volumes correlated with MGS accuracy, while right and left hippocampal volumes did not. Hippocampal and parahippocampal volume did not correlate with clinical variables such as febrile seizures, age at disease onset, disease duration, and seizure frequency. Conclusion MGS abnormalities suggested the functional involvement of the right PHC in patients with r-MTLE-HS, supporting a right lateralization of spatial memory control and showing a relation between functional impairment and degree of atrophy.
Collapse
Affiliation(s)
- Silvia Colnaghi
- Laboratory of Neuro-otology and Neuro-ophtalmology, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giorgio Beltrami
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Guy Poloni
- Neuroradiology Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlo Andrea Galimberti
- Epilepsy Centre, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy
| | - Maurizio Versino
- Laboratory of Neuro-otology and Neuro-ophtalmology, Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IRCCS), Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
40
|
Colnaghi S, Rezzani C, Gnesi M, Manfrin M, Quaglieri S, Nuti D, Mandalà M, Monti MC, Versino M. Validation of the Italian Version of the Dizziness Handicap Inventory, the Situational Vertigo Questionnaire, and the Activity-Specific Balance Confidence Scale for Peripheral and Central Vestibular Symptoms. Front Neurol 2017; 8:528. [PMID: 29066999 PMCID: PMC5641311 DOI: 10.3389/fneur.2017.00528] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
Neurophysiological measurements of the vestibular function for diagnosis and follow-up evaluations provide an objective assessment, which, unfortunately, does not necessarily correlate with the patients’ self-feeling. The literature provides many questionnaires to assess the outcome of rehabilitation programs for disequilibrium, but only for the Dizziness Handicap Inventory (DHI) is an Italian translation available, validated on a small group of patients suffering from a peripheral acute vertigo. We translated and validated the reliability and validity of the DHI, the Situational Vertigo Questionnaire (SVQ), and the Activities-Specific Balance Confidence Scale (ABC) in 316 Italian patients complaining of dizziness due either to a peripheral or to a central vestibular deficit, or in whom vestibular signs were undetectable by means of instrumental testing or clinical evaluation. Cronbach’s coefficient alpha, the homogeneity index, and test–retest reproducibility, confirmed reliability of the Italian version of the three questionnaires. Validity was confirmed by correlation test between questionnaire scores. Correlations with clinical variables suggested that they can be used as a complementary tool for the assessment of vestibular symptoms. In conclusion, the Italian versions of DHI, SVQ, and ABC are reliable and valid questionnaires for assessing the impact of dizziness on the quality of life of Italian patients with peripheral or central vestibular deficit.
Collapse
Affiliation(s)
- Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristiana Rezzani
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Gnesi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Manfrin
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | - Daniele Nuti
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
41
|
Colnaghi S, Colagiorgio P, Versino M, Koch G, D'Angelo E, Ramat S. A role for NMDAR-dependent cerebellar plasticity in adaptive control of saccades in humans. Brain Stimul 2017; 10:817-827. [PMID: 28501325 DOI: 10.1016/j.brs.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Saccade pulse amplitude adaptation is mediated by the dorsal cerebellar vermis and fastigial nucleus. Long-term depression at the parallel fibre-Purkinjie cell synapses has been suggested to provide a cellular mechanism for the corresponding learning process. The mechanisms and sites of this plasticity, however, are still debated. OBJECTIVE To test the role of cerebellar plasticity phenomena on adaptive saccade control. METHODS We evaluated the effect of continuous theta burst stimulation (cTBS) over the posterior vermis on saccade amplitude adaptation and spontaneous recovery of the initial response. To further identify the substrate of synaptic plasticity responsible for the observed adaptation impairment, subjects were pre-treated with memantine, an N-methyl-d-aspartate receptor (NMDAR) antagonist. RESULTS Amplitude adaptation was altered by cTBS, suggesting that cTBS interferes with cerebellar plasticity involved in saccade adaptation. Amplitude adaptation and spontaneous recovery were not affected by cTBS when recordings were preceded by memantine administration. CONCLUSION The effects of cTBS are NMDAR-dependent and are likely to involve long-term potentiation or long-term depression at specific synaptic connections of the granular and molecular layer, which could effectively take part in cerebellar motor learning.
Collapse
Affiliation(s)
- S Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy; Laboratory of Neuro-otology and Neuro-ophtalmology, C. Mondino National Neurological Institute, via Mondino 2, 27100 Pavia, Italy.
| | - P Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, via Ferrata 5, 27100 Pavia, Italy
| | - M Versino
- Laboratory of Neuro-otology and Neuro-ophtalmology, C. Mondino National Neurological Institute, via Mondino 2, 27100 Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy
| | - G Koch
- Laboratorio di Neurologia Clinica e Comportamentale, Fondazione S. Lucia IRCCS, via Ardeatina 306, 00179 Rome, Italy; Dipartimento di Neurologia, Policlinico Tor Vergata, viale Oxford 81, 00133 Rome, Italy
| | - E D'Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, via Forlanini 6, 27100 Pavia, Italy; Brain Connectivity Center, C. Mondino National Neurological Institute, via Mondino 2, 27100 Pavia, Italy
| | - S Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, via Ferrata 5, 27100 Pavia, Italy
| |
Collapse
|
42
|
Colagiorgio P, Versino M, Colnaghi S, Quaglieri S, Manfrin M, Zamaro E, Mantokoudis G, Zee DS, Ramat S. New insights into vestibular-saccade interaction based on covert corrective saccades in patients with unilateral vestibular deficits. J Neurophysiol 2017; 117:2324-2338. [PMID: 28404827 DOI: 10.1152/jn.00864.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/07/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 11/22/2022] Open
Abstract
In response to passive high-acceleration head impulses, patients with low vestibulo-ocular reflex (VOR) gains often produce covert (executed while the head is still moving) corrective saccades in the direction of deficient slow phases. Here we examined 23 patients using passive, and 9 also active, head impulses with acute (< 10 days from onset) unilateral vestibular neuritis and low VOR gains. We found that when corrective saccades are larger than 10°, the slow-phase component of the VOR is inhibited, even though inhibition increases further the time to reacquire the fixation target. We also found that 1) saccades are faster and more accurate if the residual VOR gain is higher, 2) saccades also compensate for the head displacement that occurs during the saccade, and 3) the amplitude-peak velocity relationship of the larger corrective saccades deviates from that of head-fixed saccades of the same size. We propose a mathematical model to account for these findings hypothesizing that covert saccades are driven by a desired gaze position signal based on a prediction of head displacement using vestibular and extravestibular signals, covert saccades are controlled by a gaze feedback loop, and the VOR command is modulated according to predicted saccade amplitude. A central and novel feature of the model is that the brain develops two separate estimates of head rotation, one for generating saccades while the head is moving and the other for generating slow phases. Furthermore, while the model was developed for gaze-stabilizing behavior during passively induced head impulses, it also simulates both active gaze-stabilizing and active gaze-shifting eye movements.NEW & NOTEWORTHY During active or passive head impulses while fixating stationary targets, low vestibulo-ocular gain subjects produce corrective saccades when the head is still moving. The mechanisms driving these covert saccades are poorly understood. We propose a mathematical model showing that the brain develops two separate estimates of head rotation: a lower level one, presumably in the vestibular nuclei, used to generate the slow-phase component of the response, and a higher level one, within a gaze feedback loop, used to drive corrective saccades.
Collapse
Affiliation(s)
- Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Inter-Department Multiple Sclerosis Research Centre, C. Mondino National Neurological Institute, Pavia, Italy
| | - Silvia Quaglieri
- UOC Otorinolaringoiatria, Fondazione IRCCS San Matteo and University of Pavia, Pavia, Italy
| | - Marco Manfrin
- UOC Otorinolaringoiatria, Fondazione IRCCS San Matteo and University of Pavia, Pavia, Italy
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and
| | - David S Zee
- Department of Neurology, Otolaryngology-Head and Neck Surgery, Neuroscience, Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy;
| |
Collapse
|
43
|
Versino M, Colagiorgio P, Sacco S, Colnaghi S, Quaglieri S, Manfrin M, Benazzo M, Moglia A, Ramat S. Reading while moving: the functional assessment of VOR. J Vestib Res 2015; 24:459-64. [PMID: 25564089 DOI: 10.3233/ves-140531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
The head impulse test (HIT) is nowadays recognized as the gold standard for clinical testing of the angular vestibulo-ocular reflex (VOR). By imposing unpredictable, abrupt head rotations in canal pairs' planes it aims at unveiling the dysfunction of the semicircular canal towards which the head is rotated based on Ewald's II law. Functional testing of the VOR aims at assessing the ability of the reflex to stabilize gaze in space and thus allow clear vision during head movements. The HIT device (HITD) approach exploits impulsive head rotations spawning a range of angular accelerations while requiring subjects to identify optotypes briefly displayed on a screen. Here we also recorded eye movements, so that the evaluation of the individual subject is based both on the VOR gain and on the percentage of correct answers with respect to a population of controls. Here we used the HITD to study 14 patients suffering from vestibular neuritis and 7 of those were re-tested after three months. We found that the HITD was able to unveil the ipsilesional deficit and the contralesional impairment, together with the improvement in the follow-up test.
Collapse
Affiliation(s)
- Maurizio Versino
- C. Mondino National Neurological Institute, Pavia, Italy Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Paolo Colagiorgio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Simone Sacco
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Silvia Quaglieri
- S.C, di Otorinolaringoiatria Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Marco Manfrin
- S.C, di Otorinolaringoiatria Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- S.C, di Otorinolaringoiatria Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arrigo Moglia
- C. Mondino National Neurological Institute, Pavia, Italy Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| |
Collapse
|
44
|
Versino M, Colnaghi S, Ranzani M, Alloni R, Bolis C, Sacco S, Moglia A, Callieco R. Ocular vestibular evoked myogenic potentials in response to air-conducted 500 Hz short tones: Effect of stimulation procedure (monaural or binaural), age and gender. J Vestib Res 2015; 25:143-9. [DOI: 10.3233/ves-150554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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]
Affiliation(s)
- Maurizio Versino
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Silvia Colnaghi
- Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Marina Ranzani
- Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Roberto Alloni
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Carlotta Bolis
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Simone Sacco
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Arrigo Moglia
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| | - Roberto Callieco
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Università di Pavia, Fondazione Istituto Neurologico Nazionale C. Mondino, IRCCS, Pavia, Italy
| |
Collapse
|
45
|
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Migraine vestibulaire : critères diagnostiques. Document consensuel de la Société Bárány et de la Société internationale des céphalées. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2013.05.010] [Citation(s) in RCA: 7] [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] [Indexed: 11/28/2022]
|
46
|
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Migraña vestibular: criterios diagnósticos. Documento de consenso de la Bárány Society y la International Headache Society. Acta Otorrinolaringológica Española 2013. [DOI: 10.1016/j.otorri.2013.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
47
|
Abstract
Peripheral vestibular function may be tested quantitatively, by measuring the gain of the angular vestibulo-ocular reflex (aVOR), or functionally, by assessing how well the aVOR performs with respect to its goal of stabilizing gaze in space and thus allow to acquire visual information during the head movement. In recent years, several groups have developed clinical and quantitative approaches to functional testing of the vestibular system based on the ability to identify an optotype briefly displayed on screen during head rotations. Although the proposed techniques differ in terms of the parameters controlling the testing paradigm, no study has thus far dealt with understanding the role of such choices in determining the effectiveness and reliability of the testing approach. Moreover, recent work has shown that peripheral vestibular patients may produce corrective saccades during the head movement (covert saccades), yet the role of these eye movements toward reading ability during head rotations is not yet understood. Finally, no study has thus far dealt with measuring the true performance of their experimental setups, which is nonetheless likely to be crucial information for understanding the effectiveness of functional testing approaches. Thus we propose a new software and hardware research tool allowing the combined measurement of eye and head movements, together with the timing of the optotype on screen, during functional testing of the vestibulo-ocular reflex (VOR) based on the Head Impulse Test. The goal of such tool is therefore that of allowing functional testing of the VOR while collecting the experimental data necessary to understand, for instance, (a) the effectiveness of the covert saccades strategy toward image stabilization, (b) which experimental parameters are crucial for optimizing the diagnostic power of the functional testing approach, and (c) which conditions lead to a successful reading or an error trial.
Collapse
Affiliation(s)
- Paolo Colagiorgio
- Bioengineering Laboratory, Department of Computer, Electrical and Biomedical Engineering, Università degli Studi di Pavia , Pavia , Italy
| | | | | | | |
Collapse
|
48
|
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Vestibular migraine: diagnostic criteria. J Vestib Res 2013; 22:167-72. [PMID: 23142830 DOI: 10.3233/ves-2012-0453] [Citation(s) in RCA: 604] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.
Collapse
Affiliation(s)
- Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Colnaghi S, Ramat S, D'Angelo E, Cortese A, Beltrami G, Moglia A, Versino M. θ-burst stimulation of the cerebellum interferes with internal representations of sensory-motor information related to eye movements in humans. Cerebellum 2012; 10:711-9. [PMID: 21544589 DOI: 10.1007/s12311-011-0282-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Continuous theta-burst stimulation (cTBS) applied over the cerebellum exerts long-lasting effects by modulating long-term synaptic plasticity, which is thought to be the basis of learning and behavioral adaptation. To investigate the impact of cTBS over the cerebellum on short-term sensory-motor memory, we recorded in two groups of eight healthy subject each the visually guided saccades (VGSs), the memory-guided saccades (MGSs), and the multiple memory-guided saccades (MMGSs), before and after cTBS (cTBS group) or simulated cTBS (control group). In the cTBS group, cTBS determined hypometria of contralateral centrifugal VGSs and worsened the accuracy of MMGS bilaterally. In the control group, no significant differences were found between the two recording sessions. These results indicate that cTBS over the cerebellum causes eye movement effects that last longer than the stimulus duration. The VGS contralateral hypometria suggested that we eventually inhibited the fastigial nucleus on the stimulated side. MMGSs in normal subjects have a better final accuracy with respect to MGSs. Such improvement is due to the availability in MMGSs of the efference copy of the initial reflexive saccade directed toward the same peripheral target, which provides a sensory-motor information that is memorized and then used to improve the accuracy of the subsequent volitional memory-guided saccade. Thus, we hypothesize that cTBS disrupted the capability of the cerebellum to make an internal representation of the memorized sensory-motor information to be used after a short interval for forward control of saccades.
Collapse
Affiliation(s)
- Silvia Colnaghi
- Department of Public Health and Neuroscience, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | |
Collapse
|
50
|
Ramat S, Colnaghi S, Boehler A, Astore S, Falco P, Mandalà M, Nuti D, Colagiorgio P, Versino M. A Device for the Functional Evaluation of the VOR in Clinical Settings. Front Neurol 2012; 3:39. [PMID: 22470364 PMCID: PMC3311056 DOI: 10.3389/fneur.2012.00039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 01/09/2012] [Accepted: 03/02/2012] [Indexed: 11/15/2022] Open
Abstract
We developed the head impulse testing device (HITD) based on an inertial sensing system allowing to investigate the functional performance of the rotational vestibulo-ocular reflex (VOR) by testing its gaze stabilization ability, independently from the subject’s visual acuity, in response to head impulses at different head angular accelerations ranging from 2000 to 7000 deg/s2. HITD was initially tested on 22 normal subjects, and a method to compare the results from a single subject (patient) with those from controls was set up. As a pilot study, we tested the HITD in 39 dizzy patients suffering, non-acutely, from different kinds of vestibular disorders. The results obtained with the HITD were comparable with those from the clinical head impulse test (HIT), but an higher number of abnormalities was detectable by HITD in the central vestibular disorders group. The HITD appears to be a promising tool for detecting abnormal VOR performance while providing information on the functional performance of the rotational VOR, and can provide a valuable assistance to the clinical evaluation of patients with vestibular disorders.
Collapse
Affiliation(s)
- Stefano Ramat
- Department of Computer and Systems Science, University of Pavia Pavia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|