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Ceccanti M, Libonati L, Ruffolo G, Cifelli P, Moret F, Frasca V, Palma E, Inghilleri M, Cambieri C. Effects of 3,4-diaminopyridine on myasthenia gravis: Preliminary results of an open-label study. Front Pharmacol 2022; 13:982434. [PMID: 36052140 PMCID: PMC9424766 DOI: 10.3389/fphar.2022.982434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background: 3,4-diaminopyridine (3,4-DAP) can lead to clinical and electrophysiological improvement in myasthenic syndrome; it may thus represent a valuable therapeutic option for patients intolerant to pyridostigmine. Objective: to assess 3,4-diaminopyridine (3,4-DAP) effects and tolerability in patients with anti-AChR myasthenia gravis. Method: Effects were monitored electrophysiologically by repetitive nerve stimulation (RNS) and by standardized clinical testing (QMG score) before and after a single dose administration of 3,4-DAP 10 mg per os in 15 patients. Patients were divided according to their Myasthenia Gravis Foundation of America (MGFA) class into mild and severe. Results: No significant side effects were found, apart from transient paresthesia. 3,4-DAP had a significant effect on the QMG score (p = 0.0251), on repetitive nerve stimulation (p = 0.0251), and on the forced vital capacity (p = 0.03), thus indicating that it may reduce the level of disability and the decremental muscle response. When the patients were divided according to the MGFA classification, 3,4-DAP showed a positive effect in the severe group, either for the QMG score (p = 0.031) or for the RNS decrement (p = 0.031). No significant difference was observed in any of the outcome measures within the mild group (p > 0.05). A direct effect of 3,4-DAP on nicotinic ACh receptors (nAChRs) was excluded since human nAChRs reconstituted in an expression system, which were not affected by 3,4-DAP application. Conclusion: Our results suggest that 3,4-DAP may be a useful add-on therapy, especially in most severe patients or when immunosuppressive treatment has not yet reached its full effect or when significant side-effects are associated with anticholinesterase.
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Affiliation(s)
- Marco Ceccanti
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Laura Libonati
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Institute Pasteur- Fondazione Cenci Bolognetti, University of Rome Sapienza, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Pierangelo Cifelli
- Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Moret
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Vittorio Frasca
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Institute Pasteur- Fondazione Cenci Bolognetti, University of Rome Sapienza, Rome, Italy
| | - Maurizio Inghilleri
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Chiara Cambieri
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
- *Correspondence: Chiara Cambieri,
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Ceccanti M, Pozzilli V, Cambieri C, Libonati L, Onesti E, Frasca V, Fiorini I, Petrucci A, Garibaldi M, Palma E, Bendotti C, Fabbrizio P, Trolese MC, Nardo G, Inghilleri M. Creatine Kinase and Progression Rate in Amyotrophic Lateral Sclerosis. Cells 2020; 9:cells9051174. [PMID: 32397320 PMCID: PMC7291088 DOI: 10.3390/cells9051174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no recognized clinical prognostic factor. Creatinine kinase (CK) increase in these patients is already described with conflicting results on prognosis and survival. In 126 ALS patients who were fast or slow disease progressors, CK levels were assayed for 16 months every 4 months in an observational case-control cohort study with prospective data collection conducted in Italy. CK was also measured at baseline in 88 CIDP patients with secondary axonal damage and in two mouse strains (129SvHSD and C57-BL) carrying the same SOD1G93A transgene expression but showing a fast (129Sv-SOD1G93A) and slow (C57-SOD1G93A) ALS progression rate. Higher CK was found in ALS slow progressors compared to fast progressors in T1, T2, T3, and T4, with a correlation with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores. Higher CK was found in spinal compared to bulbar-onset patients. Transgenic and non-transgenic C57BL mice showed higher CK levels compared to 129SvHSD strain. At baseline mean CK was higher in ALS compared to CIDP. CK can predict the disease progression, with slow progressors associated with higher levels and fast progressors to lower levels, in both ALS patients and mice. CK is higher in ALS patients compared to patients with CIDP with secondary axonal damage; the higher levels of CK in slow progressors patients, but also in C57BL transgenic and non-transgenic mice designs CK as a predisposing factor for disease rate progression.
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Affiliation(s)
- Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Valeria Pozzilli
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Chiara Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Laura Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Emanuela Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Vittorio Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Ilenia Fiorini
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
| | - Antonio Petrucci
- Centre for Neuromuscular and Neurological Rare Diseases, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Matteo Garibaldi
- Neuromuscular Disease Centre, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Laboratory Affiliated to Istituto Pasteur Italia, Sapienza University of Rome, 00185 Rome, Italy;
| | - Caterina Bendotti
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Paola Fabbrizio
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maria Chiara Trolese
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Giovanni Nardo
- Laboratory Molecular Neurobiology, Department of Neuroscience, Istituto di Ricerche Famacologiche Mario Negri-IRCCS, 20156 Milan, Italy; (C.B.); (P.F.); (M.C.T.); (G.N.)
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (V.P.); (C.C.); (L.L.); (E.O.); (V.F.); (I.F.)
- Correspondence: ; Tel.: +39-0-6499-14122
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Pozzilli V, Giona F, Ceccanti M, Cambieri C, Frasca V, Onesti E, Libonati L, Di Bari S, Fiorini I, Cardarelli L, Santopietro M, Inghilleri M. A case of motor neuron involvement in Gaucher disease. Mol Genet Metab Rep 2019; 21:100540. [PMID: 31844629 PMCID: PMC6895677 DOI: 10.1016/j.ymgmr.2019.100540] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
Gaucher disease (GD) is a genetic disorder characterized by an accumulation of glucosylceramide in cells in the monocyte-macrophage system. We describe a case of a 33-year-old man with a previous diagnosis of type 3 GD who displayed a progressive weakening of the limbs followed by upper motor neuron involvement. A diagnosis of definite Amyotrophic Lateral Sclerosis was made. This is the first reported case of concurrent Gaucher disease and the ALS phenotype in the same patient.
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Affiliation(s)
- V Pozzilli
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - F Giona
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - C Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - V Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - E Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - L Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - S Di Bari
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - I Fiorini
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - L Cardarelli
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Santopietro
- Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - M Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University, Rome, Italy
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Libonati L, Barone TF, Ceccanti M, Cambieri C, Tartaglia G, Onesti E, Petrucci A, Frasca V, Inghilleri M. Heteronymous H reflex in temporal muscle as sign of hyperexcitability in ALS patients. Clin Neurophysiol 2019; 130:1455-1459. [PMID: 31164256 DOI: 10.1016/j.clinph.2019.05.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/23/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The stimulation of the masseteric nerve elicits a homonymous and a heteronymous H reflex in the masseter muscle and in the temporalis one. The presence of the H reflex may be considered a sign of upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS) patients. The aim of this study was to evaluate the presence of the heteronymous H reflex in patients with ALS and compare it with normal subjects. METHODS We enrolled 36 ALS patients and 52 healthy subjects. We stimulated the masseteric nerve in the infratemporal fossa and recorded the muscle responses ipsilaterally to the stimulation. RESULTS The heteronymous temporalis H reflex was elicitable in 88.9% of ALS patients and in none of the controls. CONCLUSION The heteronymous H reflex does not disappear when the stimulation intensity is increased. It can be used as sign of UMN involvement and may prove useful in patients with suspected MND/ALS with purely lower motor neurons (LMN) signs and no signs of UMN involvement. SIGNIFICANCE The heteronymous H reflex is present far more often in ALS patients than in healthy people. It is a simple test that may be used to detect UMN involvement in patients in whom the only evident signs are LMN impairment, improving diagnosis of ALS.
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Affiliation(s)
- Laura Libonati
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Cambieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Emanuela Onesti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Petrucci
- Neuromuscular and Neurological Rare Diseases Center ASO San Camillo-Forlanini, Rome, Italy
| | - Vittorio Frasca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
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Onesti E, Frasca V, Ceccanti M, Tartaglia G, Gori MC, Cambieri C, Libonati L, Palma E, Inghilleri M. Short-Term Ultramicronized Palmitoylethanolamide Therapy in Patients with Myasthenia Gravis: a Pilot Study to Possible Future Implications of Treatment. CNSNDDT 2019; 18:232-238. [DOI: 10.2174/1871527318666190131121827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022]
Abstract
Background: The cannabinoid system may be involved in the humoral mechanisms at the
neuromuscular junction. Ultramicronized-palmitoylethanolamide (μm-PEA) has recently been
shown to reduce the desensitization of Acetylcholine (ACh)-evoked currents in denervated patients
modifying the stability of ACh receptor (AChR) function.
<p>
Objective: To analyze the possible beneficial effects of μm-PEA in patients with myasthenia gravis
(MG) on muscular fatigue and neurophysiological changes.
<p>
Method: The duration of this open pilot study, which included an intra-individual control, was three
weeks. Each patient was assigned to a 1-week treatment period with μm-PEA 600 mg twice a day. A
neurophysiological examination based on repetitive nerve stimulation (RNS) of the masseteric and the
axillary nerves was performed, and the quantitative MG (QMG) score was calculated in 22 MG patients
every week in a three-week follow-up period. AChR antibody titer was investigated to analyze a
possible immunomodulatory effect of PEA in MG patients.
<p>
Results: PEA had a significant effect on the QMG score (p=0.03418) and on RNS of the masseteric
nerve (p=0.01763), thus indicating that PEA reduces the level of disability and decremental muscle response.
Antibody titers did not change significantly after treatment.
<p>
Conclusion: According to our observations, μm-PEA as an add-on therapy could improve muscular
response to fatigue in MG. The possible modulation of AChR currents as a means of eliciting a direct
effect from PEA on the conformation of ACh receptors should be investigated. The co-role of cytokines
also warrants an analysis. Given the rapidity and reversibility of the response, we suppose that
PEA acts directly on AChR, though further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Emanuela Onesti
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Vittorio Frasca
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Tartaglia
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Maria Cristina Gori
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Chiara Cambieri
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Laura Libonati
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Institute Pasteur- Fondazione Cenci Bolognetti, University of Rome Sapienza, Rome, Italy
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neuroscience, Sapienza University, Rome, Italy
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Barone T, Libonati L, Fanella G, Pozzilli V, Fiorini I, Di Bari S, Goglia M, Romano M, Masini E, Tartaglia G, Cambieri C, Ceccanti M, Onesti E, Frasca V, Inghilleri M. Heteronymous h temporal reflex as sign of hyperexcitability in ALS. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fanella G, De Salvo G, Frasca V, Calamani M, Onesti E, Ceccanti M, Cucchiella C, Barone T, Pozzilli V, Fiorini I, Goglia M, Di Bari S, Inghilleri M. Amyotrophic Lateral Sclerosis (ALS): Telemedicine system for home care and patient monitoring. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bianchi F, Squintani GM, Osio M, Morini A, Bana C, Ardolino G, Barbieri S, Bertolasi L, Caramelli R, Cogiamanian F, Currà A, de Scisciolo G, Foresti C, Frasca V, Frasson E, Inghilleri M, Maderna L, Motti L, Onesti E, Romano MC, Del Carro U. Neurophysiology of the pelvic floor in clinical practice: a systematic literature review. Funct Neurol 2018; 22:173-193. [PMID: 29306355 DOI: 10.11138/fneur/2017.32.4.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.
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Ceccanti M, Onesti E, Rubino A, Cambieri C, Tartaglia G, Miscioscia A, Frasca V, Inghilleri M. Modulation of human corticospinal excitability by paired associative stimulation in patients with amyotrophic lateral sclerosis and effects of Riluzole. Brain Stimul 2018; 11:775-781. [DOI: 10.1016/j.brs.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
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Onesti E, Ceccanti M, Rubino A, Frasca V, Inghilleri M. Atypical case of diaphragmatic pseudo myoclonus. Parkinsonism Relat Disord 2017; 43:118-119. [DOI: 10.1016/j.parkreldis.2017.06.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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Libonati L, Onesti E, Gori MC, Ceccanti M, Cambieri C, Fabbri A, Frasca V, Inghilleri M. Vitamin D in amyotrophic lateral sclerosis. Funct Neurol 2017; 32:35-40. [PMID: 28380322 DOI: 10.11138/fneur/2017.32.1.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vitamin D supplementation has been proposed as a potential treatment to delay amyotrophic lateral sclerosis (ALS) progression. The aims of this study were to compare retrospectively vitamin D blood levels in ALS patients with those in healthy subjects; to correlate vitamin D blood levels with clinical functions in patients; and to evaluate whether administration of vitamin D could modify the clinical progression of the disease. Vitamin D blood levels were evaluated in 57ALS patients and in 57 healthy subjects. In the ALS patients the following clinical variables were evaluated every 3 months: Medical Research Council scale (MRC) score; revised ALS functional rating scale (ALSFRS-R) score; forced vital capacity (FVC). Twentyfour patients were treated with high doses of cholecalciferol. No significant differences were found between the vitamin D blood levels in the ALS patients (18.8 ± 12.2) and the healthy subjects (20.7 ± 10.1). The vitamin D levels in the ALS patientsdid not correlate with recorded clinical parameters. No clinical differences in terms of ALSFRS-R, MRC or FVC were found between the treated and the untreated patients over time. In ALS, as in other chronic neurological diseases, levels of vitamin D in blood appeared reduced, but no difference was found between the levels in ALS patients and in healthy subjects. Oral vitamin D supplementation in ALS patients was not associated with better prognosis in comparison with untreated ALS patients. Further prospective controlled studies are needed to clarify the effect of vitamin D on the progression of ALS disease.
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Cambieri C, Iacovelli E, Gori MC, Onesti E, Ceccanti M, Frasca V, Inghilleri M. Effects of visual deprivation on primary motor cortex excitability: a study on healthy subjects based on repetitive transcranial magnetic stimulation. Exp Brain Res 2017; 235:2059-2067. [DOI: 10.1007/s00221-017-4945-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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Onesti E, Schettino I, Gori MC, Frasca V, Ceccanti M, Cambieri C, Ruoppolo G, Inghilleri M. Dysphagia in Amyotrophic Lateral Sclerosis: Impact on Patient Behavior, Diet Adaptation, and Riluzole Management. Front Neurol 2017; 8:94. [PMID: 28377742 PMCID: PMC5359548 DOI: 10.3389/fneur.2017.00094] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/27/2017] [Indexed: 01/01/2023] Open
Abstract
This retrospective study aimed to investigate the clinical features associated with deteriorated swallow in amyotrophic lateral sclerosis (ALS) patients with spinal and bulbar onset, describe the modification of diet and liquid intake, and assess the impact of dysphagia on the use of riluzole. One hundred forty-five patients were observed periodically every 3–6 months. They underwent routinely fiberoptic endoscopic evaluation of swallowing (FEES) and spirometry; dysphagia severity was classified according to the Penetration Aspiration Scale and the Pooling score (P-score) integrated with other parameters such as sensation, collaboration, and age (P-SCA score). During a mean follow-up period of about 2 years, the percentage of ALS patients suffering from dysphagia increased to 85 (rising from 35 to 73% in patients with spinal onset and from 95 to 98% in those with bulbar onset). Also, 8% of patients with dysphagia by FEES did not perceive the disorder. The frequency of normal and semi-solid diets decreased over time, while that of pureed diets and percutaneous endoscopic gastrostomy (PEG) prescription increased. Forty-four percent of dysphagic patients refused thickeners or PEG. A significant difference was observed in the mortality rate between patients untreated with riluzole and patients treated with riluzole oral suspension (p < 0.05). Disease duration mainly impacted on the frequency of dysphagia in spinal onset patients, appearing very early in those with bulbar onset. Riluzole oral suspension would allow the safe administration in dysphagic ALS patients to avoid tablet crushing and consequent dispersion in food, common practices that are inconsistent with the safe and effective use of the drug.
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Affiliation(s)
- Emanuela Onesti
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Ilenia Schettino
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University , Rome , Italy
| | - Maria Cristina Gori
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Vittorio Frasca
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Chiara Cambieri
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University , Rome , Italy
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
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Ceccanti M, Cambieri C, Onesti E, Tartaglia G, Frasca V, Rubino A, Inghilleri M. 67. Impact of Riluzole on the effects of paired associative stimulation (PAS) on cortical excitability in ALS patients. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ruoppolo G, Onesti E, Gori MC, Schettino I, Frasca V, Biasiotta A, Giordano C, Ceccanti M, Cambieri C, Greco A, Buonopane CE, Cruccu G, De Vincentiis M, Inghilleri M. Laryngeal Sensitivity in Patients with Amyotrophic Lateral Sclerosis. Front Neurol 2016; 7:212. [PMID: 27965622 PMCID: PMC5124602 DOI: 10.3389/fneur.2016.00212] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022] Open
Abstract
Recent studies have shown the involvement of the sensory nervous system in patients with amyotrophic lateral sclerosis (ALS). The aim of our study was to investigate the correlation between the laryngeal sensitivity deficit and the type of ALS onset (bulbar or spinal) in a large series of 114 consecutive ALS patients. Participants were subdivided into two groups, bulbar and spinal ALS, according to the clinical onset of disease and submitted to a clinical and instrumental evaluation of swallowing, including a fiber-optic endoscopic evaluation of swallowing with sensory testing. Dysphagia severity was scored using the Penetration–Aspiration Scale (PAS) and the Pooling score (P-score). In addition, three patients with laryngeal sensitivity deficit were submitted to a laryngeal biopsy to assess the status of the sensory innervation. All patients showed a normal glottal closure during phonation and volitional cough. Fifty-six subjects (49%), 14 spinal- and 42 bulbar-onset ALS, showed dysphagia at the first clinical observation (PAS score >1; P-score >5). Dysphagia resulted more frequently in bulbar-onset ALS (P < 0.01). Thirty-eight (33%) patients had a sensory deficit of the larynx. The sensory deficit of the larynx was significantly more frequent in bulbar-onset ALS (P < 0.01). The sensory deficit of the larynx among dysphagic patients was also significantly more frequent in bulbar-onset ALS (P = 0.02). Several abnormalities were found in all three subjects who underwent a laryngeal biopsy: in one patient, no intraepidermal fiber was found; in the other two, the fibers showed morphological changes. Our observations are important to consider for assessment and management of dysphagia in patients with ALS.
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Affiliation(s)
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | | | - Ilenia Schettino
- Department of Sensorial Organs, Sapienza University , Rome , Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | | | - Carla Giordano
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University , Rome , Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Chiara Cambieri
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Antonio Greco
- Department of Sensorial Organs, Sapienza University , Rome , Italy
| | | | - Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
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Ceccanti M, Cambieri C, Frasca V, Onesti E, Biasiotta A, Giordano C, Bruno SM, Testino G, Lucarelli M, Arca M, Inghilleri M. A Novel Mutation in ABCA1 Gene Causing Tangier Disease in an Italian Family with Uncommon Neurological Presentation. Front Neurol 2016; 7:185. [PMID: 27853448 PMCID: PMC5089975 DOI: 10.3389/fneur.2016.00185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/11/2016] [Indexed: 02/02/2023] Open
Abstract
Tangier disease is an autosomal recessive disorder characterized by severe reduction in high-density lipoprotein cholesterol and peripheral lipid storage. We describe a family with c.5094C > A p.Tyr1698* mutation in the ABCA1 gene, clinically characterized by syringomyelic-like anesthesia, demyelinating multineuropathy, and reduction in intraepidermal small fibers innervation. In the proband patient, cardiac involvement determined a myocardial infarction; lipid storage was demonstrated in gut, cornea, and aortic wall. The reported ABCA1 mutation has never been described before in a Tangier family.
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Affiliation(s)
- Marco Ceccanti
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Chiara Cambieri
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University , Rome , Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, Sapienza University , Rome , Italy
| | - Antonella Biasiotta
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University , Rome , Italy
| | - Carla Giordano
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University , Rome , Italy
| | - Sabina M Bruno
- Department of Cellular Biotechnologies and Hematology, Sapienza University , Rome , Italy
| | - Giancarlo Testino
- Department of Cellular Biotechnologies and Hematology, Sapienza University , Rome , Italy
| | - Marco Lucarelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy; Pasteur Institute, Cenci Bolognetti Foundation, Sapienza University, Rome, Italy
| | - Marcello Arca
- Department of Internal Medicine and Medical Specialties, Sapienza University , Rome , Italy
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Onesti E, Gori MC, Frasca V, Inghilleri M. Transcranial magnetic stimulation as a new tool to control pain perception. World J Anesthesiol 2016; 5:15-27. [DOI: 10.5313/wja.v5.i1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/07/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Treatment for chronic pain is frequently unsuccessful or characterized by side-effects. The high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been suggested in the management of refractory chronic pain. Various studies have shown that HF-rTMS sessions of long-duration applied at primary motor cortex induce pain relief through mechanisms of plastic changes. Efficacy of rTMS mostly depends on stimulation parameters, but this aspect requires better characterization. A rationale to target other cortical areas exists. Current data are promising, but a careful analysis of stimulation settings and maintenance treatment design are need.
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Schettini F, Riccio A, Simione L, Liberati G, Caruso M, Frasca V, Calabrese B, Mecella M, Pizzimenti A, Inghilleri M, Mattia D, Cincotti F. Assistive device with conventional, alternative, and brain-computer interface inputs to enhance interaction with the environment for people with amyotrophic lateral sclerosis: a feasibility and usability study. Arch Phys Med Rehabil 2015; 96:S46-53. [PMID: 25721547 DOI: 10.1016/j.apmr.2014.05.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and usability of an assistive technology (AT) prototype designed to be operated with conventional/alternative input channels and a P300-based brain-computer interface (BCI) in order to provide users who have different degrees of muscular impairment resulting from amyotrophic lateral sclerosis (ALS) with communication and environmental control applications. DESIGN Proof-of-principle study with a convenience sample. SETTING An apartment-like space designed to be fully accessible by people with motor disabilities for occupational therapy, placed in a neurologic rehabilitation hospital. PARTICIPANTS End-users with ALS (N=8; 5 men, 3 women; mean age ± SD, 60 ± 12 y) recruited by a clinical team from an ALS center. INTERVENTIONS Three experimental conditions based on (1) a widely validated P300-based BCI alone; (2) the AT prototype operated by a conventional/alternative input device tailored to the specific end-user's residual motor abilities; and (3) the AT prototype accessed by a P300-based BCI. These 3 conditions were presented to all participants in 3 different sessions. MAIN OUTCOME MEASURES System usability was evaluated in terms of effectiveness (accuracy), efficiency (written symbol rate, time for correct selection, workload), and end-user satisfaction (overall satisfaction) domains. A comparison of the data collected in the 3 conditions was performed. RESULTS Effectiveness and end-user satisfaction did not significantly differ among the 3 experimental conditions. Condition III was less efficient than condition II as expressed by the longer time for correct selection. CONCLUSIONS A BCI can be used as an input channel to access an AT by persons with ALS, with no significant reduction of usability.
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Affiliation(s)
- Francesca Schettini
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Computer, Control, and Management Engineering Antonio Ruberti, "Sapienza" University of Rome, Rome, Italy.
| | - Angela Riccio
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Luca Simione
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
| | - Giulia Liberati
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; Institute of Neuroscience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Mario Caruso
- Department of Computer, Control, and Management Engineering Antonio Ruberti, "Sapienza" University of Rome, Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Barbara Calabrese
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Massimo Mecella
- Department of Computer, Control, and Management Engineering Antonio Ruberti, "Sapienza" University of Rome, Rome, Italy
| | | | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Donatella Mattia
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Febo Cincotti
- Neuroelectrical Imaging and BCI Lab, IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Computer, Control, and Management Engineering Antonio Ruberti, "Sapienza" University of Rome, Rome, Italy
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Ceccanti M, Cambieri C, Capua G, Lopergolo D, Frasca V, Gabriele M, Inghilleri M. 90. Strength and respiratory evaluation in ALS: A follow up study. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lopergolo D, Isak B, Gabriele M, Onesti E, Ceccanti M, Capua G, Fionda L, Biasiotta A, Di Stefano G, La Cesa S, Frasca V, Inghilleri M. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2014; 126:1780-9. [PMID: 25497713 DOI: 10.1016/j.clinph.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP), a spinal inhibitory reflex mainly mediated by A-delta fibres, in demyelinating and axonal polyneuropathy (PNP) and evaluate whether CSP parameters differ between patients with and without neuropathic pain. METHODS Eighty-four patients with demyelinating PNP, 178 patients with axonal PNP and 265 controls underwent clinical examination, DN4 questionnaire, standard nerve conduction study, motor-root stimulation and CSP recordings from abductor digiti minimi. We calculated the afferent conduction time of CSP (a-CSP time) with the formula: CSP latency-root motor evoked potential latency. RESULTS In the demyelinating PNP group the a-CSP time was significantly longer; in the axonal PNP group, CSP duration was shorter than the demyelinating group (p=0.010) and controls (p=0.001). CSP parameters were not different between patients with and without neuropathic pain. CONCLUSIONS The abnormality of a-CSP time in the demyelinating PNP group suggests the crucial role of A-delta fibres in the mechanism of CSP; the shorter CSP duration in the axonal PNP group supports the strong influence of the number of axons on this parameter. Our study suggests that neuropathic pain could be related to pathophysiological mechanisms differing from mere A-delta fibre loss. SIGNIFICANCE CSP evaluation is effective in detecting A-delta fibre dysfunction in axonal as well as demyelinating PNP.
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Affiliation(s)
- Diego Lopergolo
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Baris Isak
- Marmara University Hospital School of Medicine, Department of Neurology, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41, 34899 Ust Kaynarca/Pendik, Istanbul, Turkey; Department of Clinical Neurophysiology, Aarhus Universitets hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Maria Gabriele
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Gelsomina Capua
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Laura Fionda
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.
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Tomassini V, Onesti E, Tinelli E, Frasca V, Antonilli L, Aragona M, Lopergolo D, Capua G, Pozzilli C, Pantano P, Inghilleri M. Assessing the Neurophysiological Effects of Cannabinoids on Spasticity in Multiple Sclerosis. ACTA ACUST UNITED AC 2014. [DOI: 10.17653/2374-9091.ss0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 2013; 128:397-401. [PMID: 23668293 DOI: 10.1111/ane.12136] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. MATERIALS AND METHODS A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. RESULTS Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. CONCLUSIONS Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS.
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Affiliation(s)
- G. Ruoppolo
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - I. Schettino
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Frasca
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - E. Giacomelli
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - C. Cambieri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - R. Roma
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - A. Greco
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - P. Mancini
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - M. De Vincentiis
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Silani
- Department of Neurological Sciences; University of Milan; Milan Italy
| | - M. Inghilleri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
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Lopergolo D, Tartaglia G, Isak B, Cambieri C, Gabriele M, Capua G, Ceccanti M, Frasca V, Truini A, Cruccu G, Inghilleri M. 78. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Capua G, Cambieri C, Lopergolo D, Tartaglia G, Ceccanti M, Gabriele M, Frasca V, Inghilleri M. 29. Effects of visual deprivation on primary motor cortex excitability of healthy subjects: A study with repetitive transcranial magnetic stimulation. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.056] [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: 11/26/2022]
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Mannarelli D, Pauletti C, Locuratolo N, Vanacore N, Frasca V, Trebbastoni A, Inghilleri M, Fattapposta F. Attentional processing in bulbar- and spinal-onset amyotrophic lateral sclerosis: Insights from event-related potentials. Amyotroph Lateral Scler Frontotemporal Degener 2013; 15:30-8. [DOI: 10.3109/21678421.2013.787628] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pichiorri F, Vicenzini E, Gilio F, Giacomelli E, Frasca V, Cambieri C, Ceccanti M, Di Piero V, Inghilleri M. Effects of intermittent theta burst stimulation on cerebral blood flow and cerebral vasomotor reactivity. J Ultrasound Med 2012; 31:1159-1167. [PMID: 22837279 DOI: 10.7863/jum.2012.31.8.1159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether intermittent theta burst stimulation influences cerebral hemodynamics, we investigated changes induced by intermittent theta burst stimulation on the middle cerebral artery cerebral blood flow velocity and vasomotor reactivity to carbon dioxide (CO(2)) in healthy participants. The middle cerebral artery flow velocity and vasomotor reactivity were monitored by continuous transcranial Doppler sonography. Changes in cortical excitability were tested by transcranial magnetic stimulation. METHODS In 11 healthy participants, before and immediately after delivering intermittent theta burst stimulation, we tested cortical excitability measured by the resting motor threshold and motor evoked potential amplitude over the stimulated hemisphere and vasomotor reactivity to CO(2) bilaterally. The blood flow velocity was monitored in both middle cerebral arteries throughout the experimental session. In a separate session, we tested the effects of sham stimulation under the same experimental conditions. RESULTS Whereas the resting motor threshold remained unchanged before and after stimulation, motor evoked potential amplitudes increased significantly (P = .04). During and after stimulation, middle cerebral artery blood flow velocities also remained bilaterally unchanged, whereas vasomotor reactivity to CO(2) increased bilaterally (P = .04). The sham stimulation left all variables unchanged. CONCLUSIONS The expected intermittent theta burst stimulation-induced changes in cortical excitability were not accompanied by changes in cerebral blood flow velocities; however, the bilateral increased vasomotor reactivity suggests that intermittent theta burst stimulation influences the cerebral microcirculation, possibly involving subcortical structures. These findings provide useful information on hemodynamic phenomena accompanying intermittent theta burst stimulation, which should be considered in research aimed at developing this noninvasive, low-intensity stimulation technique for safe therapeutic applications.
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Affiliation(s)
- Floriana Pichiorri
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185 Rome, Italy
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Conte A, Bettolo CM, Onesti E, Frasca V, Iacovelli E, Gilio F, Giacomelli E, Gabriele M, Aragona M, Tomassini V, Pantano P, Pozzilli C, Inghilleri M. Cannabinoid-induced effects on the nociceptive system: A neurophysiological study in patients with secondary progressive multiple sclerosis. Eur J Pain 2012; 13:472-7. [DOI: 10.1016/j.ejpain.2008.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/22/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
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Conte A, Barbanti P, Frasca V, Iacovelli E, Gabriele M, Giacomelli E, Aurilia C, Pichiorri F, Gilio F, Inghilleri M. Differences in short-term primary motor cortex synaptic potentiation as assessed by repetitive transcranial magnetic stimulation in migraine patients with and without aura. Pain 2010; 148:43-48. [DOI: 10.1016/j.pain.2009.09.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 07/18/2009] [Accepted: 09/29/2009] [Indexed: 11/28/2022]
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Gilio F, Iacovelli E, Frasca V, Gabriele M, Giacomelli E, Picchiori F, Soldo P, Cipriani AM, Ruoppolo G, Inghilleri M. Botulinum toxin type A for the treatment of sialorrhoea in amyotrophic lateral sclerosis: A clinical and neurophysiological study. ACTA ACUST UNITED AC 2009; 11:359-63. [DOI: 10.3109/17482960903264998] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gilio F, Iacovelli E, Frasca V, Gabriele M, Giacomelli E, De Lena C, Cipriani AM, Inghilleri M. Electrical and magnetic repetitive transcranial stimulation of the primary motor cortex in healthy subjects. Neurosci Lett 2009; 455:1-3. [DOI: 10.1016/j.neulet.2009.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/18/2009] [Accepted: 03/09/2009] [Indexed: 11/17/2022]
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Conte A, Lenzi D, Frasca V, Gilio F, Giacomelli E, Gabriele M, Marini Bettolo C, Iacovelli E, Pantano P, Pozzilli C, Inghilleri M. Intracortical excitability in patients with relapsing–remitting and secondary progressive multiple sclerosis. J Neurol 2009; 256:933-8. [DOI: 10.1007/s00415-009-5047-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 01/15/2009] [Accepted: 01/20/2009] [Indexed: 11/30/2022]
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Gilio F, Iacovelli E, Conte A, Frasca V, Gabriele M, Giacomelli E, Bettolo CM, Scaldaferri N, Trebbastoni A, Prencipe M, Inghilleri M. Asymmetric responses to repetitive transcranial magnetic stimulation (rTMS) over the left and right primary motor cortex in a patient with lateralized progressive limb-kinetic apraxia. Neurosci Lett 2008; 437:125-9. [DOI: 10.1016/j.neulet.2008.03.072] [Citation(s) in RCA: 4] [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] [Received: 01/16/2008] [Revised: 03/01/2008] [Accepted: 03/19/2008] [Indexed: 01/23/2023]
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Gilio F, Bettolo CM, Conte A, Iacovelli E, Frasca V, Serrao M, Giacomelli E, Gabriele M, Prencipe M, Inghilleri M. Influence of the corticospinal tract on the cutaneous silent period: a study in patients with pyramidal syndrome. Neurosci Lett 2008; 433:109-13. [PMID: 18242857 DOI: 10.1016/j.neulet.2007.12.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 12/17/2007] [Accepted: 12/26/2007] [Indexed: 02/08/2023]
Abstract
The cutaneous silent period (CSP) is a brief transient suppression of the voluntary muscle contraction that follows a noxious cutaneous nerve stimulation. In this study we investigated the influence of the corticospinal tract on this spinal inhibitory reflex. In patients with pyramidal syndrome and in a group of healthy subjects we delivered painful electrical finger stimulation during sustained contraction of the ipsilateral abductor digiti minimi muscle. The CSP latency and duration and the background electromyographic (EMG) activity were measured and compared between-groups. The compound motor action potential amplitude and F-wave latency were also measured after electrical stimulation of the ulnar nerve at the wrist. The CSP latency was significantly longer in patients than in healthy subjects. None of the other variables differed in patients and healthy subjects. Our findings suggest that corticospinal projections influence the CSP latency probably by modulating the balance of excitability in the underlying circuits.
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Affiliation(s)
- Francesca Gilio
- Department of Neurological Sciences, University of Rome Sapienza, Viale dell'Università 30, 00185 Rome, Italy
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Lenzi D, Conte A, Mainero C, Frasca V, Fubelli F, Totaro P, Caramia F, Inghilleri M, Pozzilli C, Pantano P. Effect of corpus callosum damage on ipsilateral motor activation in patients with multiple sclerosis: a functional and anatomical study. Hum Brain Mapp 2007; 28:636-44. [PMID: 17080438 PMCID: PMC6871400 DOI: 10.1002/hbm.20305] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Functional MRI (fMRI) studies have shown increased activation of ipsilateral motor areas during hand movement in patients with multiple sclerosis (MS). We hypothesized that these changes could be due to disruption of transcallosal inhibitory pathways. We studied 18 patients with relapsing-remitting MS. Conventional T1- and T2-weighted images were acquired and lesion load (LL) measured. Diffusion tensor imaging (DTI) was performed to estimate fractional anisotropy (FA) and mean diffusivity (MD) in the body of the corpus callosum (CC). fMRI was obtained during a right-hand motor task. Patients were studied to evaluate transcallosal inhibition (TCI, latency and duration) and central conduction time (CCT). Eighteen normal subjects were studied with the same techniques. Patients showed increased MD (P < 0.0005) and reduced FA (P < 0.0005) in the body of the CC. Mean latency and duration of TCI were altered in 12 patients and absent in the others. Between-group analysis showed greater activation in patients in bilateral premotor, primary motor (M1), and middle cingulate cortices and in the ipsilateral supplementary motor area, insula, and thalamus. A multivariate analysis between activation patterns, structural MRI, and neurophysiological findings demonstrated positive correlations between T1-LL, MD in the body of CC, and activation of the ipsilateral motor cortex (iM1) in patients. Duration of TCI was negatively correlated with activation in the iM1. Our data suggest that functional changes in iM1 in patients with MS during a motor task partially represents a consequence of loss of transcallosal inhibitory fibers.
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Affiliation(s)
- Delia Lenzi
- Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.
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Conte A, Gilio F, Iezzi E, Frasca V, Inghilleri M, Berardelli A. Attention influences the excitability of cortical motor areas in healthy humans. Exp Brain Res 2007; 182:109-17. [PMID: 17516055 DOI: 10.1007/s00221-007-0975-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 04/23/2007] [Indexed: 01/23/2023]
Abstract
We investigated whether human attentional processes influence the size of the motor evoked potentials (MEP) facilitation and the duration of the cortical silent period (CSP) elicited by high-frequency repetitive transcranial magnetic stimulation (rTMS). In healthy subjects we assessed the effects of 5 Hz-rTMS, delivered in trains of 10 stimuli at suprathreshold intensity over the hand motor area, on the MEP size and CSP duration in different attention-demanding conditions: "relaxed," "target hand," and "non-target hand" condition. We also investigated the inhibitory effects of 1 Hz-rTMS conditioning to the premotor cortex on the 5 Hz-rTMS induced MEP facilitation. F-waves evoked by ulnar nerve stimulation were also recorded. rTMS trains elicited a larger MEP size facilitation when the subjects looked at the target hand whereas the increase in CSP duration during rTMS remained unchanged during the three attention-demanding conditions. The conditioning inhibitory stimulation delivered to the premotor cortex decreased the MEP facilitation during the "target hand" condition, leaving the MEP facilitation during the other conditions unchanged. None of the attentional conditions elicited changes in the F wave. In healthy subjects attentional processes influence the size of the MEP facilitation elicited by high-frequency rTMS and do so through premotor-to-motor connections.
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Affiliation(s)
- Antonella Conte
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università, 30, 00185 Rome, Italy
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Conte A, Gilio F, Iacovelli E, Bettolo CM, Di Bonaventura C, Frasca V, Carbone A, Prencipe M, Berardelli A, Inghilleri M. Effects of repetitive transcranial magnetic stimulation on spike-and-wave discharges. Neurosci Res 2007; 57:140-2. [PMID: 17088005 DOI: 10.1016/j.neures.2006.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 09/25/2006] [Accepted: 09/26/2006] [Indexed: 11/16/2022]
Abstract
Aim of this study was to evaluate the effect of 5Hz-suprathreshold repetitive transcranial magnetic stimulation (rTMS) on the duration of the spike-and-wave discharges (SWDs) in a patient presenting idiopathic absence seizures. At the moment of the study the patient presented a mild blunting of consciousness due to the high frequency of absences and EEG recordings showed sub-continuous, generalized, symmetrical and synchronous 3c/s SWDs, petit mal status. Trains of 10 stimuli (120% resting motor threshold) were delivered at 5Hz frequency at the beginning of the SWDs. 5Hz-rTMS trains significantly changed the EEG activity by reducing the duration of SWDs without changing the intervals between two consecutive discharges. rTMS had not significant after-effects on the epileptic activity and patient's clinical status. Despite the limitations of a single case report, our neurophysiological findings suggest that 5Hz-suprathreshold rTMS delivered in short trains induces a transitory interference of the ongoing epileptic activity.
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Affiliation(s)
- Antonella Conte
- Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy
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Gilio F, Conte A, Vanacore N, Frasca V, Inghilleri M, Berardelli A. Excitatory and inhibitory after-effects after repetitive magnetic transcranial stimulation (rTMS) in normal subjects. Exp Brain Res 2006; 176:588-93. [PMID: 16900360 DOI: 10.1007/s00221-006-0638-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 07/14/2006] [Indexed: 12/31/2022]
Abstract
We investigated the post-train effects of repetitive transcranial magnetic stimulation (rTMS) on motor evoked potential (MEP) size and cortical silent period (SP) duration. rTMS was delivered over the primary motor cortex in trains of 5, 10, 20, 40 and 60 stimuli in normal subjects at rest and in trains of 5, 10 and 20 stimuli during voluntary muscle contraction. The intensity of stimulation was 120% of resting motor threshold. Test MEPs were delivered at different interstimulus intervals after rTMS ended. At rest, 5 Hz trains produced an increase in the MEP size that persisted after the end of the trains. Trains of 5 stimuli produced after-effects that persisted for 0.5 s, whereas trains of 40 and 60 stimuli produced a facilitation that lasted for several seconds. 5 Hz-rTMS delivered during muscle contraction increased the SP duration during stimulation but the increase persisted for only 1 s after the train ended. The present experiments show that the after-effects of rTMS on MEP amplitude and SP duration have different time-courses. rTMS probably elicits its after-effects on excitatory and inhibitory cortical elements through different physiological mechanisms.
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Affiliation(s)
- F Gilio
- Dipartimento Scienze Neurologiche, Università di Roma La Sapienza, Viale dell'Università, 30, 00185, Rome, Italy
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Inghilleri M, Gilio F, Conte A, Frasca V, Marini Bettolo C, Iacovelli E, Gregori B, Prencipe M, Berardelli A. Topiramate and cortical excitability in humans: a study with repetitive transcranial magnetic stimulation. Exp Brain Res 2006; 174:667-72. [PMID: 16896986 DOI: 10.1007/s00221-006-0506-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/11/2006] [Indexed: 10/24/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) delivered at 5 Hz frequency and suprathreshold intensity progressively increases the size of muscle evoked potentials (MEPs) and the duration of the cortical silent period (CSP) in normal subjects. The aim of this study was to evaluate the effects of topiramate (TPM) at different doses on cortical excitability variables tested with rTMS. We tested the facilitation of the MEP size and CSP duration evoked by focal rTMS in eight patients before and after treatment with TPM at different doses for chronic neuropathic pain. In each patient, rTMS (5 Hz frequency-120% resting motor threshold) was applied at baseline and during the TPM induction phase (drug intake schedule: week I 25 mg/day, week II 50 mg/day, week III 75 mg/day, week IV 100 mg/day) and total TPM plasma concentrations were measured. The effects on the MEP size of 5 Hz-rTMS delivered over repeated sessions were tested in eight control subjects. TPM had no effect on the resting motor threshold. Antiepileptic treatment at increasing doses abolished the normal rTMS-induced MEP facilitation. ANOVA showed that this was a dose-related effect. Accordingly, in patients receiving TPM at higher doses (75 and 100 mg) rTMS failed to elicit the MEP facilitation. TPM left the progressive lengthening of the CSP during the rTMS train unchanged. In control subjects, rTMS applied over repeated sessions elicited a constant increase in MEP size. Our results suggest that TPM modulates the excitatory intracortical interneurons probably by altering rTMS-induced synaptic potentiation. These drug-induced effects are related to TPM doses and plasma concentrations. In conclusion, rTMS may be useful for quantifying the effectiveness of antiepileptic drugs and for assessing individual responses to different drugs but acting through similar mechanisms, thus combining functional neurophysiological information and laboratory data.
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Affiliation(s)
- M Inghilleri
- Dipartimento Scienze Neurologiche, Università di Roma La Sapienza, Rome, Italy.
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Mecarelli O, Gregori B, Gilio F, Conte A, Frasca V, Accornero N, Inghilleri M. Effects of repetitive transcranial magnetic stimulation in a patient with fixation-off sensitivity. Exp Brain Res 2006; 173:180-4. [PMID: 16783556 DOI: 10.1007/s00221-006-0577-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 05/26/2006] [Indexed: 11/24/2022]
Abstract
Aim of the present study was to evaluate the acute and long-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on focal epileptiform interictal EEG activity in a patient with fixation-off sensitivity and partial epilepsy. Real and sham rTMS were delivered over the vertex. Two trains of 500 stimuli per day were delivered at 0.33 Hz frequency and threshold intensity for five consecutive days. The number of posterior EEG spikes and spike-and-wave complexes/min before and after the application of rTMS were compared in a blinded manner. In our patient, real-rTMS induced a long-lasting decrease in the number of posterior EEG spikes and spike-and-wave complexes/min. Despite the limitations of a single case report, our study confirms that low-frequency rTMS significantly reduces interictal focal epileptic activity over time.
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Affiliation(s)
- O Mecarelli
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, 00185 Rome, Italy
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Inghilleri M, Conte A, Frasca V, Scaldaferri N, Gilio F, Santini M, Fabbrini G, Prencipe M, Berardelli A. Altered response to rTMS in patients with Alzheimer's disease. Clin Neurophysiol 2005; 117:103-9. [PMID: 16364684 DOI: 10.1016/j.clinph.2005.09.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 09/12/2005] [Accepted: 09/23/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we tested the excitability of cortical motor areas in patients with Alzheimer's disease. Because repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability, possibly by inducing a short-term increase in synaptic efficacy, we used rTMS to investigate motor cortex excitability in patients with Alzheimer's disease. METHODS We tested the changes in the size and threshold of motor evoked potential (MEP) and cortical silent period (CSP) duration evoked by focal rTMS delivered in 10 trains of 10 stimuli at 5Hz frequency and 120% rMth intensity in a group of patients with Alzheimer's disease, and age-matched controls. In a further session, rTMS was also delivered at 1Hz frequency (trains of 10 stimuli, 120% rMth). RESULTS Whereas in control subjects, 5Hz-rTMS elicited normal MEPs that progressively increased in size during the train, in patients, it elicited MEPs that decreased in size. The increase in the duration of the CSP was similar in patients and healthy controls. One hertz rTMS left the MEP amplitude unchanged in patients and healthy controls. CONCLUSIONS The lack of MEP facilitation reflects an altered response to 5Hz-rTMS in patients with Alzheimer's disease. SIGNIFICANCE Our rTMS findings strongly suggest an altered cortical plasticity in excitatory circuits within motor cortex in patients with Alzheimer's disease.
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Affiliation(s)
- M Inghilleri
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università, 30, 00185 Rome, Italy.
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Abstract
BACKGROUND Occasional case reports describe urinary incontinence in patients taking the selective serotonin and norepinephrine reuptake inhibitor antidepressant venlafaxine. OBJECTIVE In this study the authors investigated the possible effect of venlafaxine on urinary function in a series of 9 patients with urinary retention resulting from spinal cord lesions. They primarily sought to understand whether the reported venlafaxine-induced urinary incontinence was a specific drug-induced effect and, if so, whether venlafaxine might be an effective treatment of urinary retention. METHODS During a 1-week baseline period, patients measured postvoiding residual volume through a catheter and recorded the number of micturitions within 24 hours. At the end of the baseline period, venlafaxine 75 mg extended-release on a once-daily evening administration schedule was added to their therapy for 1 week. RESULTS None of the patients reported severe/uncontrollable side effects while taking venlafaxine. Extended-release venlafaxine (75 mg/day) significantly reduced the postvoiding residual volume and increased the micturition rate; the volume diminished on the first day of treatment and remained stable over the ensuing days. CONCLUSION These findings suggest that venlafaxine could be useful to improve voiding in patients with spinal cord disease.
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Affiliation(s)
- Maurizio Inghilleri
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, 00185 Rome, Italy.
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Abstract
We report on a case of spinal myoclonus resembling a belly dance syndrome.
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Affiliation(s)
- Maurizio Inghilleri
- Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.
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Inghilleri M, Conte A, Frasca V, Gilio F, Lorenzano C, Berardelli A. Synaptic potentiation induced by rTMS: effect of lidocaine infusion. Exp Brain Res 2005; 163:114-7. [PMID: 15940502 DOI: 10.1007/s00221-005-2225-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 12/09/2004] [Indexed: 01/04/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) delivered at various intensities and frequencies excites cortical motor areas. Trains of stimuli (at 5-Hz frequency, and suprathreshold intensity) progressively increase the size of motor evoked potentials (MEPs) and the duration of the cortical silent period (CSP) in normal subjects. Because antiepileptic drugs, acting mainly on sodium channels, depress MEP facilitation during rTMS, we suggested that rTMS trains facilitate the MEP size by inducing synaptic potentiation primarily involving voltage-gated sodium channels. The aim of this study was to evaluate the effect of lidocaine-a drug that acts selectively on sodium channels-on the rTMS-induced changes in cortical excitability. We tested the changes in motor threshold, MEP size, CSP duration evoked by focal rTMS and the M-wave amplitude in healthy subjects before and after lidocaine infusion. Lidocaine abolished the normal rTMS-induced facilitation of MEPs but left the other rTMS variables and the M-wave unchanged. Our results suggest that the MEP facilitation related to rTMS-induced synaptic potentiation results from an increase in cortical excitatory interneuron excitability that involves voltage-gated sodium channels.
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Affiliation(s)
- M Inghilleri
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università, 30., 00185 Rome, Italy.
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Mainero C, Inghilleri M, Pantano P, Conte A, Lenzi D, Frasca V, Bozzao L, Pozzilli C. Enhanced brain motor activity in patients with MS after a single dose of 3,4-diaminopyridine. Neurology 2004; 62:2044-50. [PMID: 15184612 DOI: 10.1212/01.wnl.0000129263.14219.a8] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND 3,4-diaminopyridine (3,4-DAP), a potassium (K+) channel blocker, improves fatigue and motor function in multiple sclerosis (MS). Although it was thought to do so by restoring conduction to demyelinated axons, recent experimental data show that aminopyridines administered at clinical doses potentiate synaptic transmission. OBJECTIVE To investigate motor cerebral activity with fMRI and transcranial magnetic stimulation (TMS) after a single oral dose of 3,4-DAP in patients with MS. METHODS Twelve right-handed women (mean +/- SD age 40.9 +/- 9.3 years) underwent fMRI on two separate occasions (under 3,4-DAP and under placebo) during a simple motor task with the right hand. FMRI data were analyzed with SPM99. After fMRI, patients underwent single-pulse TMS to test motor threshold, amplitude, and latency of motor evoked potentials, central conduction time, and the cortical silent period; paired-pulse TMS to investigate intracortical inhibition (ICI) and intracortical facilitation (ICF); and quantitative electromyography during maximal voluntary contraction. RESULTS FMRI motor-evoked brain activation was greater under 3,4-DAP than under placebo in the ipsilateral sensorimotor cortex and supplementary motor area (p < 0.05). 3,4-DAP decreased ICI and increased ICF; central motor conduction time and muscular fatigability did not change. CONCLUSION 3,4-DAP may modulate brain motor activity in patients with MS, probably by enhancing excitatory synaptic transmission.
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Affiliation(s)
- C Mainero
- Section of Clinical Neurology, Department of Neurological Sciences, University of Rome La Sapienza, Italy.
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Inghilleri M, Conte A, Currà A, Frasca V, Lorenzano C, Berardelli A. Ovarian hormones and cortical excitability. An rTMS study in humans. Clin Neurophysiol 2004; 115:1063-8. [PMID: 15066531 DOI: 10.1016/j.clinph.2003.12.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ovarian steroids influence neural excitability. Using repetitive transcranial magnetic stimulation (rTMS) we investigated changes in cortical excitability during the menstrual cycle. METHODS Eight women underwent rTMS on Days 1 and 14 of the menstrual cycle. As a control group, 8 age-matched men were also tested twice, with a 14-day interval between the two experimental sessions. Repetitive magnetic pulses were delivered in trains of 10 stimuli (5 Hz frequency and 120% of the motor threshold calculated at rest) to the left motor area of the first dorsal interosseous muscle. RESULTS In women, the motor evoked potential (MEP) size did not increase on Day 1, but it increased progressively during the train on Day 14. The duration of the silent period progressively lengthened during the train on both days. In men the MEP increased in size, and the silent period lengthened to a similar extent on both days. CONCLUSIONS In women, hormone changes related to the menstrual cycle alter cortical excitability. SIGNIFICANCE Low estrogen levels probably reduce cortical excitability because their diminished action on sodium channels reduces recruitment of excitatory interneurons during rTMS thus abolishing the MEP facilitation.
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Affiliation(s)
- M Inghilleri
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, 00185 Rome, Italy.
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Inghilleri M, Conte A, Frasca V, Curra' A, Gilio F, Manfredi M, Berardelli A. Antiepileptic drugs and cortical excitability: a study with repetitive transcranial stimulation. Exp Brain Res 2003; 154:488-93. [PMID: 14579005 DOI: 10.1007/s00221-003-1685-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 07/21/2003] [Indexed: 02/06/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) delivered at various intensities and frequencies excites cortical motor areas. Trains of stimuli (at 5 Hz frequency, and suprathreshold intensity) progressively increase the size of muscle evoked potentials (MEPs) and the duration of the cortical silent period (CSP) in normal subjects. The aim of this study was to evaluate the effect of the antiepileptic drugs carbamazepine, gabapentin, and topiramate on cortical excitability variables tested with rTMS. We tested the changes in motor threshold, MEP size and CSP duration evoked by focal rTMS in 23 patients with neuropathic pain before and after a 1-week course of treatment with carbamazepine, gabapentin, topiramate and placebo. None of the three antiepileptic drugs changed the resting or active magnetic and electrical motor threshold. Antiepileptic treatment, but not placebo, abolished the normal rTMS-induced facilitation of MEPs, but left the progressive lengthening of the CSP during the rTMS train unchanged. Our results suggest that carbamazepine, gabapentin and topiramate modulate intracortical excitability by acting selectively on excitatory interneurons.
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Affiliation(s)
- M Inghilleri
- Department of Neurological Sciences, Viale dell'Università 30, 00185, Rome, Italy.
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Inghilleri M, Lorenzano C, Conte A, Frasca V, Manfredi M, Berardelli A. Effects of transcranial magnetic stimulation on the H reflex and F wave in the hand muscles. Clin Neurophysiol 2003; 114:1096-101. [PMID: 12804678 DOI: 10.1016/s1388-2457(03)00056-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In 14 healthy subjects, we studied the effects of transcranial magnetic stimulation (TMS) on the excitability of spinal motoneurons in the abductor pollicis brevis muscle (ABP), by testing the F wave and H reflex. METHODS TMS pulses were delivered with the subjects at rest and at various motor threshold (Mth) intensities. Electrical stimuli were delivered to the median nerve at the wrist at two different intensities. High-intensity pulse was used to evoke an F wave and low-intensity paired pulse to evoke an H reflex in the ABP muscle. The effects of TMS were studied using a conditioning-test paradigm. The tests F wave and H reflex were conditioned by TMS (120% Mth) at various interstimulus intervals (ISIs) (30-100ms) and intensities (90-200% Mth). RESULTS At 30ms but not at ISIs from 40 to 100ms, conditioning TMS (120% Mth) significantly increased the F-wave area. At the 30ms ISI, conditioning TMS at 120% Mth intensity significantly increased the F-wave area whereas higher intensities (140-180% Mth) did not. At 200% Mth intensity, the F-wave area decreased significantly. At 30 and 40ms ISIs, conditioning TMS at 120% Mth significantly reduced the H-reflex area. At 50-100ms ISIs, the H-reflex area almost matched the control value. At the 30ms ISI, conditioning TMS at >or=100% Mth intensity significantly decreased the H-reflex area. CONCLUSIONS In conclusion, our findings suggest that the distinct changes in the TMS-conditioned F wave and H reflex reflect changing excitability in the motoneuronal populations activated by the cortical input.
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Affiliation(s)
- M Inghilleri
- Dipartimento Scienze Neurologiche, Università di Roma La Sapienza, Viale Università, 30, 00185, Rome, Italy.
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Abstract
We studied a patient with a history of absence attacks in childhood in whom an absence status with bilateral spike-and-wave discharges developed after a top-of-the-basilar syndrome. Surprisingly, even though the ischemic lesion involved the left thalamus alone, spike-and-wave discharges were recorded from the two hemispheres. Three days after antiepileptic treatment (sodium valproate 500mg 3 times a day) began, electroenceplalographic recordings and consciousness became normal.
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Affiliation(s)
- M Inghilleri
- Department of Neurological Sciences, University of Rome, Rome, Italy.
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Abstract
In humans, high-intensity electrical stimuli delivered to the fingers induce an inhibitory effect on C7-T1 motoneurons. This inhibitory reflex, called the cutaneous silent period (CSP) is considered a defense response specific for the human upper limbs. It is not clear whether the CSP-like other defense responses such as the corneal reflex and the R III reflex-is an opiate-sensitive nociceptive reflex. Because opiates suppress some, but not all, nociceptive reflexes, we studied the effect of the narcotic-analgesic drug fentanyl on the CSP and the R III reflex. The CSP was recorded from the first dorsal interosseous (FDI) muscle in seven normal subjects during voluntary contraction, before and 10 and 20 min after fentanyl injection. To assess possible fentanyl-induced changes, we also tested the effect of finger stimulation on motor evoked potentials (MEPs) elicited in the FDI muscle by transcranial magnetic stimulation before and after fentanyl injection. Fentanyl-induced changes were also studied on the R III reflex recorded from the biceps femoris muscle. Fentanyl, as expected, suppressed the R III reflex but failed to change the inhibitory effect of finger stimulation on FDI motoneurons. Finger stimulation reduced the size of MEPs in the FDI, and fentanyl injection left this inhibitory effect unchanged. The differential fentanyl-induced modulation of the CSP and R III reflex provides evidence that the CSP circuit is devoid of mu-opiate receptors and is therefore an opiate-insensitive nociceptive reflex, which may be useful in the assessment of central-acting, non-opioid drugs.
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Affiliation(s)
- Maurizio Inghilleri
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Antonella Conte
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
| | - Alfredo Berardelli
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Mario Manfredi
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Giorgio Cruccu
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
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Zydowsky TM, Courtney LF, Frasca V, Kobayashi K, Shimizu H, Yuen LD, Matthews RG, Benkovic SJ, Floss HG. Stereochemical analysis of the methyl transfer catalyzed by cobalamin-dependent methionine synthase from Escherichia coli B. J Am Chem Soc 2002. [DOI: 10.1021/ja00271a081] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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