Cerebral vasoreactivity and intima-media thickness in Down syndrome: A case-control study

Subjects with Down Syndrome (DS) have high prevalence of cerebral vascular amyloidosis, cognitive decline and dementia. In Alzheimer Disease, impaired vasoreactivity has been reported as the results of vascular amyloid deposition. Aim of our study was to verify presence of impaired cerebral vasoreactivity and to study carotid intima media-thickness (IMT) by carotid and transcranial ultrasound. We studied 25 DS and compared them with 25 age- and sex-matched normal controls. Vasomotor reactivity was evaluated by means of breath-holding index (BHI) test. There was no difference in IMT, both considering the two side separately (left: 0.70±0.10 vs 0.69±0.12mm, p=0.6) (right: 0.67±0.13 vs 0.68±0.10mm, p=0.5), and considering the sum of both sides (1.38±0.22 vs 1.38±0.23mm, p=1). There was a significant difference in peak systolic velocities (PSV) (139.75±27.67 vs. 123.89±25.73cm/s, p=0.04) and in pulsatility index (PI) (0.95±0.14 vs. 0.86±0.12, p=0.02). BHI was significantly lower in DS than in controls (1.15±0.38 vs 1.88±0.72, p<0.001). In conclusion, subjects with DS have increased PSV and PI, and show a reduction of BHI, expression of impaired vasomotor reserve, possibly due to micro-vascular impairment. Larger study with longitudinal design is needed to verify our data.

Periodontal treatment in private dental practice: a case-based survey

BACKGROUND

This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis.

METHODS

Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures.

RESULTS

One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation.

CONCLUSIONS

The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.

Periodontal diagnosis in private dental practice: a case-based survey

BACKGROUND

Despite the prevalence of periodontitis in Australia, there are few reports regarding periodontal diagnosis and therapies in the general dental practice setting. This study aimed to assess the degree of diagnostic accuracy in periodontal cases of Victorian general dental practitioners.

METHODS

Following ethics approval, dentists were invited to complete a scenario-based questionnaire on the Australian Dental Association Victorian Branch (ADAVB) website. Five text-based clinical scenarios (from a total of 10) were randomly presented, representing patients with a range of disease levels from periodontal health/gingivitis to severe periodontitis, and respondents were asked what examinations they would usually perform. Based upon the presented results of periodontal and radiographic examinations, a periodontal diagnosis was requested.

RESULTS

One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne; 22.5% of respondents worked in a practice employing a hygienist. The clinical parameters most commonly measured to diagnose periodontal disease were pocket depth and mobility. The majority of respondents diagnosed health, gingivitis and mild periodontitis correctly compared to American Academy of Periodontology guidelines. However, moderate periodontitis tended to be diagnosed as severe.

CONCLUSIONS

Dentists in Victoria used appropriate clinical parameters when assessing periodontal disease and were generally accurate in their diagnoses. There is a need for consensus regarding diagnostic definitions.

Cefazolin: a valid model of experimental epilepsy?

In various animal species (chicks, rats and rabbits) the intravenous injection of high doses of cefazolin, a cephalosporin not hitherto reported to produce epileptic seizures, was found to produce epileptiform electrocortrical changes similar to those evoked by intravenous benzylpenicillin. Similar phenomena as those reported after systemic injection were also observed after microinjection of cefazolin into the III cerebral ventricle. In fact, both in chicks and rats cefazolin given by the latter route produced wild running crisis, myoclonic jerks of the limbs and in some instances generalized clonic convulsions. Concomitantly, bilateral electrocortical high voltage bursts of spikes were observed, followed during the intercritic period by periodic bilateral or unilateral single spikes.

Incidence and predictors of acute symptomatic seizures after stroke

OBJECTIVE

To assess incidence and predictors of acute symptomatic seizures in a prospective cohort of patients with first stroke.

METHODS

Patients with first stroke hospitalized in 31 Italian centers were recruited. Relevant demographic data, disease characteristics, and risk factors were collected. Acute symptomatic seizures (≤7 days) were recorded and correlated to age, gender, family history of epilepsy, and vascular risk factors.

RESULTS

A total of 714 patients (315 women, 399 men; age 27-97 years) were enrolled. A total of 609 (85.3%) had cerebral infarction (32 cerebral infarction with hemorrhagic transformation [CIHT]) and 105 (14.7%) primary intracerebral hemorrhage (PIH). A total of 141 (19.7%) had a large lesion (>3 cm) and 296 (41.5%) cortical involvement. Twelve patients reported family history of seizures. Forty-five patients (6.3%) presented acute symptomatic seizures, 24 with cerebral infarction (4.2%), 4 with CIHT (12.5%), and 17 (16.2%) with PIH. In multivariate analysis, compared to cerebral infarction, PIH carried the highest risk (odds ratio [OR] 7.2; 95% confidence interval [CI] 3.5-14.9) followed by CIHT (OR 2.7; 95% CI 0.8-9.6). Cortical involvement was a risk factor for PIH (OR 6.0; 95% CI 1.8-20.8) and for CI (OR 3.1; 95% CI 1.3-7.8). Hyperlipidemia (OR 0.2; 95% CI 0.03-0.8) was a protective factor for IPH.

CONCLUSION

The incidence of acute symptomatic seizures is the highest reported in patients with first stroke with prospective follow-up. Hemorrhagic stroke and cortical lesion were independent predictors of acute symptomatic seizures. Hyperlipidemia was a protective factor for hemorrhagic stroke.

Prescribing patterns of antiepileptic drugs in Italy: a nationwide population-based study in the years 2000-2005

To evaluate prevalence of use and prescribing patterns of antiepileptic drugs (AEDs) in Italian general practice. Primary care data were obtained from the Health Search Database, a longitudinal observational database implemented by the Italian College of General Practitioners (GPs). We selected 465 061 subjects registered by the end of 2005 in the lists of 320 GPs, homogeneously distributed throughout Italy. Prevalence of AED use was assessed in the entire sample and by drug type, age group, year and main geographic area (north, centre and south/islands). Overall, 24 383 subjects (5.2%) received at least one AED prescription in the study period. Prevalence of AED use (with 95% confidence interval) increased progressively from 7.1 (6.9-7.3) in 2000 to 11.8 (11.5-12.1) in 2005 for old AEDs and from 1.1 (1.0-1.2) to 12.2 (11.9-12.5) for new AEDs. Carbamazepine, phenobarbital and valproic acid were the most common AEDs until 2003, when gabapentin became first. There were no differences in prescribing patterns in the three main geographic areas. Newer AEDs were mostly used in patients aged 65 years and older. The more widespread use of newer AEDs was for mood disorders or pain. Older AED currently remain first line drugs for epileptic disorders. An increasing use of AEDs has been recently observed over a 6-year period in Italian general practice, mostly explained by newer compounds used for conditions other than epilepsy.

Idiopathic familial trigeminal neuralgia: a case report

Trigeminal neuralgia (TN) is paroxysmal, lancinant pain often described as an "electric wave" by patients, with involvement of the divisions of the fifth cranial nerve. Demyelinating, compressive, ischaemic diseases are involved in the physiopathology of TN, but there are some cases without explanation. Familial TN (FTN) is a rare condition, about 1%-2% of all TN cases, while sporadic cases are the most common. To date, there have been about 126 reports of FTN. We describe the case of a 66-year-old man who had been complaining for 3 years of right-side paroxysmal lancinating pain in the second division of the fifth cranial nerve. A brain MRI with angiographic sequences did not show neurovascular conflicts or other pathological conditions. The patient had a family history of TN, which had been diagnosed in 3 other family members (father, sister and first cousin), who had undergone medical or surgical treatment for TN. There was no family history of hypertension, metabolic disorders, neurological or traumatic diseases. Animal studies have shown a probable involvement of genes codifying for calcium channels as the starting alterations in trigeminal excitability. Our FTN could be a good model to investigate the role of gene mutations in this condition.

PRES: posterior or potentially reversible encephalopathy syndrome?

Posterior reversible encephalopathy syndrome (PRES) is an acronym that identifies a new clinico-neuroradiologic entity occurring in association with different conditions. We report a patient with eclamptic encephalopathy whose clinico-radiological picture normalised after prompt treatment. We suggest defining this condition as potentially RES, to emphasise that reversibility is not spontaneous but is usually related to an adequate treatment, and that the posterior localisation of the lesions, even if constant, may not represent the most relevant finding in some patients.

Autonomic dysfunction in uremia

Autonomic nervous system dysfunction is a common feature in uremia and may have a number of clinical sequelae. Simple cardiovascular reflex screening can be performed in patients during conservative treatment, on periodic dialysis therapy, or after kidney transplantation to diagnose and follow up autonomic function impairment. Other approaches, such as heart-rate variability studies in the frequency domain by power spectral analysis, can provide a more accurate investigation of the disease.

Migraine stroke: a possible complication of both migraine with and without aura

We describe four migraine patients who developed an ischemic stroke during their typical migraine attacks. Cerebral infarction as a possible complication of migraine without aura is discussed. We propose a review of the migraine stroke definition of the International Headache Society.

Renal function evaluation in an adult female with cat-eye syndrome

Cat-eye syndrome is a rare congenital anomaly involving the kidney. It is rarely reported in literature, while renal function has never been studied up to now. Shown here are the morphofunctional renal alterations observed in a female patient affected by cat-eye syndrome.

[Blood aluminum in a population of hemodialyzed patients. 1981-1991: a comparison of a decade]

The authors report their data on the behaviour of serum aluminium registered at a 10 year interval among a population of haemodialyzed patients. Improved knowledge of the toxic role of aluminium and of the sources of pollution in dialyzed patients seems to relegate the neurologic toxicity of aluminium to a historical aspect.

Epilepsy associated with hypocalcemia: description of a family

The unusual occurrence of epilepsy and hypocalcemia in the same family is described. Epilepsy was present in three siblings (convulsive generalized in two females and partial in one male). All six family members had calcium ion, plasmatic phosphorus, plasmatic and erythrocytic potassium, urine calcium and phosphate concentration below the normal levels. Altered values of calcium-induced potassium membrane permeability were found in three subjects (two of them also affected by epilepsy). The assumption that alterations of membrane structure or function play an essential role in determining familial epilepsy and that the normal "set point" for calcium is genetically determined in familial hypocalcemia could explain the concomitance of both pathologies to some extent.

Complex partial status epilepticus simulating an ischemic insult: case report

A patient presenting complex partial status epilepticus (CPSE) had a clinical history and neurological picture on admission that mimicked a cerebrovascular insult. On admission she was confused and totally unresponsive to verbal stimuli. EEG showed high voltage paroxysmal activity on the left hemisphere, prominent on the temporoccipital leads and tending to spread to the opposite regions. Intravenous diazepam led to resolution of the clinical and EEG picture within 24 hours, only a medium voltage slow wave focus being present on the left temporal regions. CPSE should be considered whenever a prolonged impairment of consciousness is present. Only accurate EEG recordings permit correct diagnosis in doubtful cases.

Synergistic anticonvulsant effect of valproic acid and ethosuximide on pentylenetetrazole-induced epileptic phenomena in rats

The possible synergistic effect of valproic acid and ethosuximide in combination on pentylenetetrazole-induced epilepsy was investigated in rats. Valproic acid and ethosuximide administered intraperitoneally both showed dose-dependent anti-epileptic activity towards pentylenetetrazole-induced myoclonias and tonic-clonic seizures. The valproic acid-ethosuximide combination had a synergistic pharmacological effect. Against myoclonias combined valproic acid-ethosuximide produced a non-significant decrease in the effective dose of both drugs compared with treatment with either drug alone. In the case of tonic-clonic seizures the protective effect against the seizures was significantly increased by combined treatment compared with treatment with either drug alone. Neither plasma concentrations nor any other pharmacokinetic parameters were significantly changed when the same doses of valproic acid and ethosuximide were given, singly or in combination.

Nocturnal complex partial seizures precipitated by REM sleep. A case report

A 16-year-old patient presenting with complex partial seizures occurring in the transition from a REM period to wakefulness is described. His baseline EEG showed generalized and symmetrical slow spike and wave complexes, on a normal background activity, activated by NREM sleep. Polygraphic and videotape recordings, carried out for several nights, showed that after nearly each REM period, he would wake up briefly, presenting eye blinking followed by a burst of generalized hypersynchronous theta to start his seizures. These were characterized by moaning and autoaggressive behaviour, the ictal EEG showing generalized slow spike and wave complexes in the midst of several movement artifacts. At the end of each fit he fell back to REM sleep. Carbamazepine treatment completely resolved his symptoms, with full normalization of EEG activity.

Tuberculous meningitis: a retrospective survey of 22 cases

Clinical and biological findings likely to constitute prognostic factors were analyzed in a retrospective survey of 22 cases of tuberculous meningitis. In particular, associations between clinical and biological findings (clinical grade on admission, normal and abnormal CSF protein and glucose values) and outcome of illness were sought. On admission 16 patients had altered consciousness, 11 hemiparesis and 7 sixth cranial nerve paresis. Meningeal signs were present in all subjects. 7 had a positive culture for Mycobacterium tuberculosis. 9 patients recovered completely, 7 had serious late sequelae, 6 died. Prognosis appeared to be correlated to neurological status at admission.

Amyotrophic lateral sclerosis: an epidemiological study in the Province of Messina, Italy, 1976-1985

An epidemiological investigation of 41 subjects with amyotrophic lateral sclerosis observed in the Province of Messina during 1976-1985 was performed. The incidence was 0.61/100,000 and the prevalence 2.48/100,000 inhabitants. The illness was found to be prevalent in males. The atrophic type occurred in 17 subjects, the bulbar type in 23 cases and the pseudo-polyneuritic form in only one patient. The mean age on the onset was 57.29 +/- 10.55 years. The duration of the illness was significantly higher in patients with atrophic type (p less than 0.01). No significant difference between occupation and development of the disease was found. Among all patients 12.19% presented evidence of trauma, but traumatic events were equally present in a control group.

Occurrence of uraemic autonomic dysfunction in relation to age

A battery of cardiovascular reflex tests were performed on 20 patients with chronic renal failure on intermittent haemodialysis, to assess occurrence of parasympathetic and sympathetic abnormalities. Using age-adjusted confidence limits, elderly uraemics showed more extensive parasympathetic and sympathetic dysfunction than middle-aged patients. The results suggest that the autonomic nervous system in the elderly is more susceptible to uraemic toxins than in the middle aged. This should lead to better preventive and therapeutic strategies for older uraemics.

Age-dependent occurrence of autonomic dysfunction in chronic uraemia

A battery of cardiovascular reflex tests were performed in twenty patients with chronic renal failure on intermittent haemodialysis. Using age-adjusted confidence limits, old-aged uraemics showed more extensive parasympathetic and sympathetic dysfunction than middle-aged patients. The results suggest that autonomic nervous system in the elderly is more susceptible to uraemic toxins than in the middle age. This should lead to better preventive and therapeutic strategies in older uraemics.

Pentylenetetrazol-induced spike wave discharges in rats: a polygraphic study

14 male Wistar rats were studied, before and after pentylenetetrazol (PTZ) 20 mg/kg i.p., since a petit mal-like electroclinical pattern, either spontaneous or PTZ-induced was recently described in a breeding station where this strain is raised. In particular, surface EEG, muscular, respiratory and cardiac activities were recorded in order to detect possible clinical-electroencephalographic correlations. Spontaneous epileptic phenomena were never observed. In all the animals PTZ-induced short, usually generalized and synchronous spike wave discharges often concomitant with rhythmic twitches of the vibrissae. Epileptic bursts were related to arousal level, disappearing during motor behavior and arousing stimuli. Moreover individual discharges could be interrupted by a sudden noise. Photosensitivity was not present. Muscular tone and autonomic functions were not affected. The features of PTZ-induced generalized nonconvulsive seizures in rats are compared to those of cat penicillin epilepsy and human petit mal.

Parkinson-like side effects during prolonged treatment with flunarizine

Forty-two elderly patients affected by a generic cerebrovascular disease developed a parkinsonian syndrome after prolonged treatment with flunarizine. Following flunarizine withdrawal the extrapyramidal symptomatology remitted slowly and progressively for 12 weeks, leading to the belief that the observed parkinsonian syndrome is directly linked to the chronic use of this compound. Similar side effects are not described in young populations, however. A periodic flunarizine discontinuation in chronically treated subjects aged 65 or more is suggested.

Interictal EEG pattern in rabbit penicillin epilepsy

The effects of Na-penicillin G (1,000,000 I.U./kg i.v.) were studied in 28 rabbits implanted with surface and deep electrodes in the medial (mT) and lateral (lT) nuclei of the thalamus and in the cornu Ammonis dorsalis (CAd). Attention was focused on interictal spike activity, cortical spindle activity and spikes-spindles relationship. A multifocal interictal EEG pattern, represented by cortical and thalamic spikes, was observed in 20 animals. A clear association between cortical spikes and spindles occurred almost constantly. Moreover a statistically significant increase in the average duration of spindles without changes in the average frequency was noticed. Seizure discharges had always a focal start and secondary generalization. The EEG features of parenteral penicillin epilepsy in the rabbit appeared to be more similar to those of the rat than to those of the cat. The spindle activity changes and the paroxysmal spike activity can be interpreted as two independent penicillin induced features appearing during raised cortical excitability periods.

A case of Kufs disease with abnormal pallidonigral iron deposit

The clinical, neuropathological and ultrastructural features of a case of Kufs disease (Meyer basal ganglia form) are reported. In the present case, besides the typical lesions of Neuronal Ceroid-Lipofuscinosis, and increased iron reaction at pallidonigral level was detected histochemically. The significance of the last finding is discussed.

The effects of penicillin on the ECoG of rabbit

The effects of non-convulsive doses of i.v. penicillin (1.100.000/1.300.000 I.U./Kg) on the ECoG of rabbits was studied. A tendency to an increase in spindling activity together with the presence of characteristic penicillin spikes, polyspikes and spike and wave complexes often preceding or intermixed to the spindling activity, was the most prominent finding. These data indicate that spindles and penicillin induced spikes show a straight correlation and seem consistent with the hypothesis that spindles have a facilitant effect on epileptic discharges.

[Influence of anti-epileptic drugs on blood lipid parameters: preliminary data]

Total cholesterol, free cholesterol, HDL cholesterol, LDL cholesterol and triglycerides have been assayed in serum of 42 epileptic patients in chronic therapy (21 in monotherapy and 21 in polytherapy) in comparison with 21 normal controls. Free cholesterol showed an highly significant increase in epileptics, in whom triglycerides appeared very reduced. In contrast to previous reports of a large increase of HDL cholesterol in phenitoin treated patients, only a not significant increase was found. The other parameters appeared unchanged. No differencies could be detected among monotherapy and polytherapy or among the singles monotherapies (phenobarbital, diphenylhydantoin and carbamazepine).

Cefazolin experimental epilepsy: the effects of diazepam on the interictal ECoG

Diazepam i.v. injected at the dose of 5 mg/Kg on a group of 14 Rhode-Island-Red chicks was able to antagonize and prevent the interictal EEG pattern induced by cefazolin i.v. Since cefazolin epilepsy is most probably dependent on a receptorial antagonism with GABA, these data seem to confirm the GABA-ergic nature of cefazolin epilepsy.

[Prolactinomas and "idiopathic" hyperprolactinemia. Case series]

Endocrine features in 22 women affected by idhyopatic hyperprolactinemia and in ten women affected by prolactin secreting adenoma have been assessed basic levels of FSH, LH, E2, T3, T4, and PRL were evaluated and dynamic tests by GnRH, TRH and bromocryptine were performed prolactin basal value and TRH dynamic test show some value in differentiating hydiopatic hyperprolactinaemia from prolactynomas, but no hormon by itself nor dynamic test show a reliable effectiveness for this diagnosis.

[A case of "sensitive deficiency of polyneuropathy"]

One case of carential sensitive neuropathy in a patient 47 years old with poor and imbalanced nutrition is reported. The clinical picture is characterized by mucocutaneous lesions, paresthesias like "burning feet", serious ataxia. All these symptoms remitted after one year of appropriate therapy. The carential vitaminic aethiology and the nosographic position of the disease are discussed on the basis of the current literature.

[Phasic activity in rats]

At the central level, in the rat, phasic activity has been recorded during paradoxical sleep and in acute conditions after injection of reserpine or parachlorophenylalanine. At the external level, during paradoxical sleep, the extraocular muscles lateral rectus, superior rectus and superior oblique are activated in both plastic and tonic manners. The muscles of the whiskers are also activated; these muscular activations are more often than not synchronous with the eye movements (80%). The time distribution of these ocular movements is homogenous. Reserpine induces phasic muscular activations of the extraocular muscles.