1
|
Derchi CC, Arcuri P, Comanducci A, Caronni A, Pagliari C, Viganò A, Volpato E, Navarro J, Trimarchi PD. Italian translation and cultural adaptation of the Agitated Behavior Scale (ABS-I) in patients with acquired brain injuries. J Rehabil Med 2024; 56:jrm11663. [PMID: 38576089 PMCID: PMC11005175 DOI: 10.2340/jrm.v56.11663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE The objective of this study was to produce a cross-cultural adaptation in Italian of the Agitated Behavior Scale (ABS), originally developed in English, as the first of two stages that also include cross-cultural validation and allow a clinical scale to be used in the proper setting such as rehabilitation units. METHODS In order to adapt the ABS scale to a different cultural environment, five consecutive steps were performed: (1) forward translations (n = 8), (2) synthesis of the 8 forward translations to obtain a first shared italian version (ABS_I_trial), (3) back translations (n = 3), (4) creation of an expert committee to evaluate forward and back translations and finally (5) the cognitive debriefing. RESULTS After the five steps, including forward translations and back translations, the process of committee verification and judgement and the evaluative step of cognitive debriefing, high comprehensibility of all items was found, resulting in an Italian translation version of ABS suitable for application in a clinical setting. CONCLUSION ABS translation was produced by means of a standardized procedure aimed at minimizing cross-cultural gaps. The expert committee evaluated the version produced as highly understandable in Italian. Further steps, such as the subsequent validation of its psychometric properties, are needed to employ this translation in a clinical setting.
Collapse
Affiliation(s)
| | | | - Angela Comanducci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Caronni
- IRCCS, Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | | | | | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | |
Collapse
|
2
|
Maestrini I, Viganò A, Di Stefano G, Toscano M, Di Piero V. Neurophysiological investigations in a case of primary paroxysmal hemicrania-tic syndrome. Neurol Sci 2024:10.1007/s10072-024-07470-3. [PMID: 38523207 DOI: 10.1007/s10072-024-07470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The association between paroxysmal hemicrania (PH) and trigeminal neuralgia-the so-called PH-tic syndrome-has rarely been described. However, a correct diagnosis is crucial since both disorders require specific treatments. Little is known about pathophysiological mechanisms, and, to date, there are no electrophysiological studies in patients with PH-tic syndrome. CASE We describe the case of a 52-year-old man with a PH-tic syndrome successfully treated with an association of carbamazepine (1200 mg/day) and indomethacin (150 mg/die). Patient underwent trigeminal reflex testing, including blink and masseter inhibitory reflex, and laser-evoked potential (LEP) recording after supraorbital region stimulation in the affected and unaffected side. Both neurophysiological investigations resulted normal; LEPs failed to detect any latency asymmetry between both sides. CONCLUSIONS Neurophysiological findings demonstrate for the first time the integrity of somatosensory system in a primary PH-tic syndrome case. Central pathophysiological mechanisms and hypothalamic dysregulation may contribute to the development of this rare syndrome.
Collapse
Affiliation(s)
- Ilaria Maestrini
- Department of Systems Medicine, University Hospital of Rome "Tor Vergata", Rome, Italy.
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
| | - Alessandro Viganò
- Rehabilitation Neurology Unit, I.R.C.C.S. Fondazione Don Carlo Gnocchi, Via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Giulia Di Stefano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
- Department of Neurology, Fatebenefratelli Hospital-Gemelli Isola, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
- University Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, Italy
| |
Collapse
|
3
|
Lanzone J, Zulueta A, Boscarino M, Gallotta M, Argentieri MR, Viganò A, Sarasso S, Colombo MA, D’Ambrosio S, Lunetta C, Parati E. Spectral exponent assessment and neurofilament light chain: a comprehensive approach to describe recovery patterns in stroke. Front Neurol 2024; 15:1329044. [PMID: 38562428 PMCID: PMC10982436 DOI: 10.3389/fneur.2024.1329044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Understanding the residual recovery potential in stroke patients is crucial for tailoring effective neurorehabilitation programs. We propose using EEG and plasmatic Neurofilament light chain (NfL) levels as a model to depict longitudinal patterns of stroke recovery. Methods We enrolled 13 patients (4 female, mean age 74.7 ± 8.8) who underwent stroke in the previous month and were hospitalized for 2-months rehabilitation. Patients underwent blood withdrawal, clinical evaluation and high-definition EEG at T1 (first week of rehabilitation) and at T2 (53 ± 10 days after). We assessed the levels of NfL and we analyzed the EEG signal extracting Spectral Exponent (SE) values. We compared our variables between the two timepoint and between cortical and non-cortical strokes. Results We found a significant difference in the symmetry of SE values between cortical and non-cortical stroke at both T1 (p = 0.005) and T2 (p = 0.01). SE in the affected hemisphere showed significantly steeper values at T1 when compared with T2 (p = 0.001). EEG measures were consistently related to clinical scores, while NfL at T1 was related to the volume of ischemic lesions (r = 0.75; p = 0.003). Additionally, the combined use of NfL and SE indicated varying trends in longitudinal clinical recovery. Conclusion We present proof of concept of a promising approach for the characterization of different recovery patterns in stroke patients.
Collapse
Affiliation(s)
- Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Marilisa Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Matteo Gallotta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Maria Rosaria Argentieri
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Michele A. Colombo
- Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Sasha D’Ambrosio
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Eugenio Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| |
Collapse
|
4
|
Casarotto S, Hassan G, Rosanova M, Sarasso S, Derchi CC, Trimarchi PD, Viganò A, Russo S, Fecchio M, Devalle G, Navarro J, Massimini M, Comanducci A. Dissociations between spontaneous electroencephalographic features and the perturbational complexity index in the minimally conscious state. Eur J Neurosci 2024; 59:934-947. [PMID: 38440949 DOI: 10.1111/ejn.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
The analysis of spontaneous electroencephalogram (EEG) is a cornerstone in the assessment of patients with disorders of consciousness (DoC). Although preserved EEG patterns are highly suggestive of consciousness even in unresponsive patients, moderately or severely abnormal patterns are difficult to interpret. Indeed, growing evidence shows that consciousness can be present despite either large delta or reduced alpha activity in spontaneous EEG. Quantifying the complexity of EEG responses to direct cortical perturbations (perturbational complexity index [PCI]) may complement the observational approach and provide a reliable assessment of consciousness even when spontaneous EEG features are inconclusive. To seek empirical evidence of this hypothesis, we compared PCI with EEG spectral measures in the same population of minimally conscious state (MCS) patients (n = 40) hospitalized in rehabilitation facilities. We found a remarkable variability in spontaneous EEG features across MCS patients as compared with healthy controls: in particular, a pattern of predominant delta and highly reduced alpha power-more often observed in vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients-was found in a non-negligible number of MCS patients. Conversely, PCI values invariably fell above an externally validated empirical cutoff for consciousness in all MCS patients, consistent with the presence of clearly discernible, albeit fleeting, behavioural signs of awareness. These results confirm that, in some MCS patients, spontaneous EEG rhythms may be inconclusive about the actual capacity for consciousness and suggest that a perturbational approach can effectively compensate for this pitfall with practical implications for the individual patient's stratification and tailored rehabilitation.
Collapse
Affiliation(s)
- Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | | | | | - Simone Russo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Matteo Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Guya Devalle
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jorge Navarro
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Angela Comanducci
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Università Campus Bio-Medico di Roma, Rome, Italy
| |
Collapse
|
5
|
Comanducci A, Casarotto S, Rosanova M, Derchi CC, Viganò A, Pirastru A, Blasi V, Cazzoli M, Navarro J, Edlow BL, Baglio F, Massimini M. Unconsciousness or unresponsiveness in akinetic mutism? Insights from a multimodal longitudinal exploration. Eur J Neurosci 2024; 59:860-873. [PMID: 37077023 DOI: 10.1111/ejn.15994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/02/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023]
Abstract
The clinical assessment of patients with disorders of consciousness (DoC) relies on the observation of behavioural responses to standardised sensory stimulation. However, several medical comorbidities may directly impair the production of reproducible and appropriate responses, thus reducing the sensitivity of behaviour-based diagnoses. One such comorbidity is akinetic mutism (AM), a rare neurological syndrome characterised by the inability to initiate volitional motor responses, sometimes associated with clinical presentations that overlap with those of DoC. In this paper, we describe the case of a patient with large bilateral mesial frontal lesions, showing prolonged behavioural unresponsiveness and severe disorganisation of electroencephalographic (EEG) background, compatible with a vegetative state/unresponsive wakefulness syndrome (VS/UWS). By applying an unprecedented multimodal battery of advanced imaging and electrophysiology-based techniques (AIE) encompassing spontaneous EEG, evoked potentials, event-related potentials, transcranial magnetic stimulation combined with EEG and structural and functional MRI, we provide the following: (i) a demonstration of the preservation of consciousness despite unresponsiveness in the context of AM, (ii) a plausible neurophysiological explanation for behavioural unresponsiveness and its subsequent recovery during rehabilitation stay and (iii) novel insights into the relationships between DoC, AM and parkinsonism. The present case offers proof-of-principle evidence supporting the clinical utility of a multimodal hierarchical workflow that combines AIEs to detect covert signs of consciousness in unresponsive patients.
Collapse
Affiliation(s)
| | - Silvia Casarotto
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Rosanova
- Department Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | | | | | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jorge Navarro
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Marcello Massimini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
6
|
Viganò A, Sasso D’Elia T, Sava SL, Colosimo A, Di Piero V, Magis D, Schoenen J. Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache. Biomedicines 2024; 12:288. [PMID: 38397890 PMCID: PMC10886990 DOI: 10.3390/biomedicines12020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude (p < 0.05) and its habituation (p < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days (p < 0.01). In patients reversing from CM-MOH to episodic migraine (n = 6), VEP habituation significantly improved after treatment (p = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.
Collapse
Affiliation(s)
- Alessandro Viganò
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
| | - Tullia Sasso D’Elia
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- IRCCS San Raffaele Alla Pisana, 00163 Rome, Italy
| | - Simona Liliana Sava
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Headache Clinic of Valdor—ISOSL, 4020 Liège, Belgium
| | - Alfredo Colosimo
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics Sapienza, Sapienza—University of Rome, 00185 Rome, Italy
| | - Vittorio Di Piero
- Subintensive Neurology & Headache Centre, Department of Human Neurosciences, Sapienza—University of Rome, 00185 Rome, Italy
| | - Delphine Magis
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Neurology Department and Pain Clinic (CMTD), CHR East Belgium, 4800 Verviers, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
| |
Collapse
|
7
|
Mastria G, Mancini V, Viganò A, Piervincenzi C, Petsas N, Puma M, Giannì C, Pantano P, Di Piero V. Neuroimaging markers of Alice in Wonderland syndrome in patients with migraine with aura. Front Neurol 2023; 14:1210811. [PMID: 37767534 PMCID: PMC10520557 DOI: 10.3389/fneur.2023.1210811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Background The Alice in Wonderland syndrome (AIWS) is a transient neurological disturbance characterized by sensory distortions most frequently associated with migraine in adults. Some lines of evidence suggest that AIWS and migraine might share common pathophysiological mechanisms, therefore we set out to investigate the common and distinct neurophysiological alterations associated with these conditions in migraineurs. Methods We conducted a case-control study acquiring resting-state fMRI data from 12 migraine patients with AIWS, 12 patients with migraine with typical aura (MA) and 24 age-matched healthy controls (HC). We then compared the interictal thalamic seed-to-voxel and ROI-to-ROI cortico-cortical resting-state functional connectivity between the 3 groups. Results We found a common pattern of altered thalamic connectivity in MA and AIWS, compared to HC, with more profound and diffuse alterations observed in AIWS. The ROI-to-ROI functional connectivity analysis highlighted an increased connectivity between a lateral occipital region corresponding to area V3 and the posterior part of the superior temporal sulcus (STS) in AIWS, compared to both MA and HC. Conclusion The posterior STS is a multisensory integration area, while area V3 is considered the starting point of the cortical spreading depression (CSD), the neural correlate of migraine aura. This interictal hyperconnectivity might increase the probability of the CSD to directly diffuse to the posterior STS or deactivating it, causing the AIWS symptoms during the ictal phase. Taken together, these results suggest that AIWS in migraineurs might be a form of complex migraine aura, characterized by the involvement of associative and multisensory integration areas.
Collapse
Affiliation(s)
- Giulio Mastria
- My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | | | | | | | - Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
8
|
Antunovic L, Artesani A, Viganò A, Chiti A, Santoro A, Sollini M, Morbelli SD, De Sanctis R. Imaging Correlates between Headache and Breast Cancer: An [ 18F]FDG PET Study. Cancers (Basel) 2023; 15:4147. [PMID: 37627174 PMCID: PMC10453040 DOI: 10.3390/cancers15164147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to examine brain metabolic patterns on [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) in breast cancer (BC), comparing patients with tension-type headache (TTH), migraine (MiG), and those without headache. Further association with BC response to neoadjuvant chemotherapy (NAC) was explored. In this prospective study, BC patients eligible for NAC performed total-body [18F]FDG PET/CT with a dedicated brain scan. A voxel-wise analysis (two-sample t-test) and a multiple regression model were used to compare brain metabolic patterns among TTH, MiG, and no-headache patients and to correlate them with clinical covariates. A single-subject analysis compared each patient's brain uptake before and after NAC with a healthy control group. Primary headache was diagnosed in 39/46 of BC patients (39% TTH and 46% MiG). TTH patients exhibited hypometabolism in specific brain regions before NAC. TTH patients with a pathological complete response (pCR) to NAC showed hypermetabolic brain regions in the anterior medial frontal cortex. The correlation between tumor uptake and brain metabolism varied before and after NAC, suggesting an inverse relationship. Additionally, the single-subject analysis revealed that hypometabolic brain regions were not present after NAC. Primary headache, especially MiG, was associated with a better response to NAC. These findings suggest complex interactions between BC, headache, and hormonal status, warranting further investigation in larger prospective cohorts.
Collapse
Affiliation(s)
- Lidija Antunovic
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
| | - Alessia Artesani
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | | | - Arturo Chiti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Martina Sollini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Silvia D. Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Rita De Sanctis
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| |
Collapse
|
9
|
Puledda F, Viganò A, Sebastianelli G, Parisi V, Hsiao FJ, Wang SJ, Chen WT, Massimini M, Coppola G. Electrophysiological findings in migraine may reflect abnormal synaptic plasticity mechanisms: A narrative review. Cephalalgia 2023; 43:3331024231195780. [PMID: 37622421 DOI: 10.1177/03331024231195780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The cyclical brain disorder of sensory processing accompanying migraine phases lacks an explanatory unified theory. METHODS We searched Pubmed for non-invasive neurophysiological studies on migraine and related conditions using transcranial magnetic stimulation, electroencephalography, visual and somatosensory evoked potentials. We summarized the literature, reviewed methods, and proposed a unified theory for the pathophysiology of electrophysiological abnormalities underlying migraine recurrence. RESULTS All electrophysiological modalities have determined specific changes in brain dynamics across the different phases of the migraine cycle. Transcranial magnetic stimulation studies show unbalanced recruitment of inhibitory and excitatory circuits, more consistently in aura, which ultimately results in a substantially distorted response to neuromodulation protocols. Electroencephalography investigations highlight a steady pattern of reduced alpha and increased slow rhythms, largely located in posterior brain regions, which tends to normalize closer to the attacks. Finally, non-painful evoked potentials suggest dysfunctions in habituation mechanisms of sensory cortices that revert during ictal phases. CONCLUSION Electrophysiology shows dynamic and recurrent functional alterations within the brainstem-thalamus-cortex loop varies continuously and recurrently in migraineurs. Given the central role of these structures in the selection, elaboration, and learning of sensory information, these functional alterations suggest chronic, probably genetically determined dysfunctions of the synaptic short- and long-term learning mechanisms.
Collapse
Affiliation(s)
- Francesca Puledda
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | | | - Fu-Jung Hsiao
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| |
Collapse
|
10
|
Viganò A, Ghareghani M, Mallick B, Russo S. Where do we look for the next breakthrough in sleep research? BMC Neurol 2023; 23:283. [PMID: 37507691 PMCID: PMC10375768 DOI: 10.1186/s12883-023-03330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The wakefulness-sleep cycle sets the pace of our life. Sleep research examines the transition between wakefulness and sleep, its hormonal regulation, and its pathological disruption. Understanding sleep mechanisms would improve quality-of-life well beyond sleep itself. To this aim, we invite contributions for the Collection "sleep physiology and circadian rhythms".
Collapse
Affiliation(s)
| | - Majid Ghareghani
- Neuroscience Laboratory, CHU de Québec Research Centre, Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec City, Québec, G1V 4G2, Canada
| | - Birendra Mallick
- Amity Institute of Neuropsychology & Neurosciences, Amity University Campus, Noida, India
| | - Simone Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
- Department of Philosophy 'Piero Martinetti', University of Milan, Milan, Italy.
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, US.
| |
Collapse
|
11
|
Tiberio P, Viganò A, Ilieva MB, Pindilli S, Bianchi A, Zambelli A, Santoro A, De Sanctis R. The Role of Female Reproductive Hormones in the Association between Migraine and Breast Cancer: An Unanswered Question. Biomedicines 2023; 11:1613. [PMID: 37371707 DOI: 10.3390/biomedicines11061613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulating epidemiological studies have investigated a possible interconnection between migraine (Mi) and breast cancer (BC) because of the strong link between these diseases and female reproductive hormones. This review aims to consolidate findings from epidemiological studies and explore biologically plausible hypothetical mechanisms related to hormonal pathways. Current evidence suggests a protective role of Mi in BC development, particularly in case-control studies but not in cohort ones. The inconsistency among studies may be due to several reasons, including diagnostic criteria for Mi and the age gap between the development of these two diseases. Furthermore, recent research has challenged the concept of a net beneficial effect of Mi on BC, suggesting a more complex relationship between the two conditions. Many polymorphisms/mutations in hormone-related pathways are involved in at least one of the two conditions. The most promising evidence has emerged for a specific alteration in the estrogen receptor 1 gene (rs2228480). However, the possible specific mutation or polymorphism involved in this association has not yet been identified. Further studies with robust methodologies are needed to validate the protective role of Mi in BC and fully elucidate the precise nature of this causal relationship.
Collapse
Affiliation(s)
- Paola Tiberio
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Alessandro Viganò
- Neurology Unit, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Mariya Boyanova Ilieva
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| | | | - Anna Bianchi
- Neurology Unit, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Alberto Zambelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| | - Rita De Sanctis
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| |
Collapse
|
12
|
Ilieva MB, Tiberio P, Torrisi R, Lanzone J, Di Piero V, Santoro A, Viganò A, De Sanctis R. Profiling the Spectrum of Headache Disorders on 440 Breast Cancer Patients: Highlights on Clinical and Pathological Mechanisms. Biomedicines 2023; 11:biomedicines11041059. [PMID: 37189678 DOI: 10.3390/biomedicines11041059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Although widely studied, the association between migraines (M) and breast cancer (BC) risk remains evasive. In this prospective single-center study, 440 early or locally advanced BC patients were enrolled at IRCCS Humanitas Research Hospital. Clinical and demographical data were collected. Those who suffered from headaches were evaluated with the International Classification of Headache Disorders. M was found to be significantly more prevalent in BC patients: 56.1% versus an expected prevalence of 17% in the global population. M patients showed a higher risk of having stage II or III BC than stage I, which was more frequently found in the non-headache population. Interestingly, the frequency of headache attacks was positively correlated with estrogen (r = 0.11, p = 0.05) and progesterone (r = 0.15, p = 0.007) expression, especially in patients with migraine without aura. The higher the expression of hormone receptors in BC, the higher the headache frequency. Moreover, patients suffering from headaches showed an overall earlier onset of BC. Our findings challenge the idea of a net preventive role of M on BC, suggesting a rather complex interaction in which M mostly influences some BC subtypes and vice versa. Further multi-center studies with extended follow-up are needed.
Collapse
|
13
|
Colombo MA, Comanducci A, Casarotto S, Derchi CC, Annen J, Viganò A, Mazza A, Trimarchi PD, Boly M, Fecchio M, Bodart O, Navarro J, Laureys S, Gosseries O, Massimini M, Sarasso S, Rosanova M. Beyond alpha power: EEG spatial and spectral gradients robustly stratify disorders of consciousness. Cereb Cortex 2023:7091601. [PMID: 36977648 DOI: 10.1093/cercor/bhad031] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/30/2023] Open
Abstract
Neurophysiological markers can overcome the limitations of behavioural assessments of Disorders of Consciousness (DoC). EEG alpha power emerged as a promising marker for DoC, although long-standing literature reported alpha power being sustained during anesthetic-induced unconsciousness, and reduced during dreaming and hallucinations. We hypothesized that EEG power suppression caused by severe anoxia could explain this conflict. Accordingly, we split DoC patients (n = 87) in postanoxic and non-postanoxic cohorts. Alpha power was suppressed only in severe postanoxia but failed to discriminate un/consciousness in other aetiologies. Furthermore, it did not generalize to an independent reference dataset (n = 65) of neurotypical, neurological, and anesthesia conditions. We then investigated EEG spatio-spectral gradients, reflecting anteriorization and slowing, as alternative markers. In non-postanoxic DoC, these features, combined in a bivariate model, reliably stratified patients and indexed consciousness, even in unresponsive patients identified as conscious by an independent neural marker (the Perturbational Complexity Index). Crucially, this model optimally generalized to the reference dataset. Overall, alpha power does not index consciousness; rather, its suppression entails diffuse cortical damage, in postanoxic patients. As an alternative, EEG spatio-spectral gradients, reflecting distinct pathophysiological mechanisms, jointly provide a robust, parsimonious, and generalizable marker of consciousness, whose clinical application may guide rehabilitation efforts.
Collapse
Affiliation(s)
| | - Angela Comanducci
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | | | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | | | - Alice Mazza
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | | | - Melanie Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, WI 53705-2281, USA
| | - Matteo Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Jorge Navarro
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège and Centre du Cerveau2, University Hospital of Liège, Liège 4000, Belgium
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
- IRCCS, Fondazione Don Carlo Gnocchi Onlus, Milan 20148, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
| |
Collapse
|
14
|
Maestrini I, Rocchi L, Puledda F, Viganò A, Giuliani G, Jannini TB, Celletti C, Altieri M, Camerota F, Toscano M, Di Piero V. Habituation deficit of visual evoked potentials in migraine patients with hypermobile Ehlers-Danlos syndrome. Front Neurol 2023; 14:1072785. [PMID: 36970542 PMCID: PMC10034036 DOI: 10.3389/fneur.2023.1072785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesMigraine is one of the most frequent clinical manifestations of hypermobile Ehlers-Danlos syndrome (hEDS). The comorbidity between these two diseases has been only partially investigated. We aimed to observe whether neurophysiological alterations described in migraineurs in visual evoked potentials (VEPs) were present in hEDS patients with migraine.MethodsWe enrolled 22 hEDS patients with migraine (hEDS) and 22 non-hEDS patients with migraine (MIG), with and without aura (according to ICHD-3), as well as 22 healthy controls (HC). Repetitive pattern reversal (PR)-VEPs were recorded in basal conditions in all participants. During uninterrupted stimulation, 250 cortical responses were recorded (4,000 Hz sample rate) and divided into epochs of 300 ms after the stimulus. Cerebral responses were divided into five blocks. The habituation was calculated as the slope interpolating the amplitudes in each block, for both the N75-P100 and P100-N145 components of PR-VEP.ResultsWe observed a significant habituation deficit of the P100-N145 component of PR-VEP in hEDS compared to HC (p = 0.002), unexpectedly more pronounced than in MIG. We observed only a slight habituation deficit of N75-P100 in hEDS, with a slope degree that was intermediate between MIG and HC.DiscussionhEDS patients with migraine presented an interictal habituation deficit of both VEPs components like MIG. Pathophysiological aspects underlying the pathology could account for the peculiar pattern of habituation in hEDS patients with migraine characterized by a pronounced habituation deficit in the P100-N145 component and a less clear-cut habituation deficit in the N75-P100 component with respect to MIG.
Collapse
Affiliation(s)
- Ilaria Maestrini
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: Ilaria Maestrini
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Puledda
- Headache Group, Wolfson Centre for Age-Related Diseases (CARD), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Alessandro Viganò
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giada Giuliani
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
| | | | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
- Department of Neurology, Fatebenefratelli Hospital - Gemelli Isola, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Headache Centre, “Sapienza” University of Rome, Rome, Italy
- University Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, Italy
| |
Collapse
|
15
|
Comanducci A, Viganò A, Meloni M. Can Patients with Encephalitis Lethargica Wake Up from Local Sleep? A Reply to Brigo et al. "You Are Older, although You Do Not Know That": Time, Consciousness, and Memory in "A Kind of Alaska" by Harold Pinter (1930-2008). Eur Neurol 2023; 86:78-80. [PMID: 36516808 DOI: 10.1159/000527768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| |
Collapse
|
16
|
Rosanova M, Casarotto S, Derchi C, Hassan G, Russo S, Sarasso S, Viganò A, Massimini M, Comanducci A. The perturbational complexity index detects capacity for consciousness earlier than the recovery of behavioral responsiveness in subacute brain-injured patients. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.731] [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: 02/17/2023] Open
|
17
|
Piervincenzi C, Petsas N, Viganò A, Mancini V, Mastria G, Puma M, Giannì C, Di Piero V, Pantano P. Functional connectivity alterations in migraineurs with Alice in Wonderland syndrome. Neurol Sci 2023; 44:305-317. [PMID: 36114397 DOI: 10.1007/s10072-022-06404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Alice in Wonderland syndrome (AIWS) is a neurological disorder characterized by erroneous perception of the body schema or surrounding space. Migraine is the primary cause of AIWS in adults. The pathophysiology of AIWS is largely unknown, especially regarding functional abnormalities. In this study, we compared resting-state functional connectivity (FC) of migraine patients experiencing AIWS, migraine patients with typical aura (MA) and healthy controls (HCs). METHODS Twelve AIWS, 12 MA, and 24 HCs were enrolled and underwent 3 T MRI scanning. Independent component analysis was used to identify RSNs thought to be relevant for AIWS: visual, salience, basal ganglia, default mode, and executive control networks. Dual regression technique was used to detect between-group differences in RSNs. Finally, AIWS-specific FC alterations were correlated with clinical measures. RESULTS With respect to HCs, AIWS and MA patients both showed significantly lower (p < 0.05, FDR corrected) FC in lateral and medial visual networks and higher FC in salience and default mode networks. AIWS patients alone showed higher FC in basal ganglia and executive control networks than HCs. When directly compared, AIWS patients showed lower FC in visual networks and higher FC in all other investigated RSNs than MA patients. Lastly, AIWS-specific FC alterations in the executive control network positively correlated with migraine frequency. CONCLUSIONS AIWS and MA patients showed similar FC alterations in several RSNs, although to a different extent, suggesting common pathophysiological underpinnings. However, AIWS patients showed additional FC alterations, likely due to the complexity of AIWS symptoms involving high-order associative cortical areas.
Collapse
Affiliation(s)
| | | | | | - Valentina Mancini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Giulio Mastria
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, IS, Italy
| |
Collapse
|
18
|
Viganò A, Toscano M, Petolicchio B, Bianchi A, Cabrini DM, Di Piero V. Letter to the editor regarding "Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial". Cephalalgia 2022; 42:1443-1444. [PMID: 35786012 DOI: 10.1177/03331024221111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,UO Neurologia e Neurofisiopatologia, PO Sandro Pertini, Rome, Italy
| | - Anna Bianchi
- IRCCS - Fondazione Don Carlo Gnocchi, Milano, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain, UCADH, Pavia, Italy
| |
Collapse
|
19
|
Tiberio P, Antunovic L, Gaudio M, Viganò A, Pastore M, Miggiano C, Jacobs F, Benvenuti C, Farina E, Chiti A, Santoro A, De Sanctis R. The relationship among bowel FDG-PET uptake, pathological complete response, and eating habits in breast cancer patients undergoing neoadjuvant chemotherapy. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01520-9] [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: 11/19/2022]
|
20
|
Tiberio P, Antunovic L, Gaudio M, Viganò A, Pastore M, Miggiano C, Jacobs F, Benvenuti C, Farina E, Chiti A, Santoro A, De Sanctis R. 48P The relationship among bowel FDG-PET uptake, pathological complete response, and the influence of eating and exercise habits in breast cancer patients undergoing neoadjuvant chemotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
21
|
Alessiani M, Petolicchio B, De Sanctis R, Squitieri M, Di Giambattista R, Puma M, Franzese C, Toscano M, Derchi CC, Gilliéron E, Viganò A, Di Piero V. A Propensity Score Matching Study on the Effect of OnabotulinumtoxinA Alone versus Short-Term Psychodynamic Psychotherapy Plus Drug-of-Choice as Preventive Therapy in Chronic Migraine: Effects and Predictive Factors. Eur Neurol 2022; 85:453-459. [PMID: 35772386 DOI: 10.1159/000525152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to test the superiority of multidisciplinary approach, that is, Short-Term Psychodynamic Psychotherapy (STPP) plus drug of choice, versus monotherapy, that is, OnabotulinumtoxinA (OnaBoNT-A). METHOD We consecutively recorded data from chronic migraine (CM) patients, with or without medication overuse headache (MOH), who underwent STPP or OnaBoNT-A, with a 3-month follow-up schedule. Headache days and analgesics intake were monitored as primary outcome measures. Propensity score matching (PSM) was used to eliminate discrepancies between groups. Discriminant function analysis (DFA) was used to pinpoint predictive factors associated with the clinical response. RESULTS 96 patients with CM (64% with MOH) were treated with STPP and 54 (59% with MOH) with OnaBoNT-A. At baseline, OnaBoNT-A patients had more failed preventive therapies, more years of illness and chronicity, and were older; STPP patients were more depressed and had a higher HIT-6. Both STPP and OnaBoNT-A patients showed a significant reduction of headache days (STPP: -14 vs. OnaBoNT-A:-14.3) and analgesics intake (STPP: -12,3 vs. OnaBoNT-A -13.5 pills/month), respectively. MOH diminished more in STPP, adherence was higher in OnaBoNT-A. Results were confirmed after PSM balancing of the groups for those variables that resulted as different (but age). CONCLUSION OnaBoNT-A monotherapy produced similar results to psychotherapy plus medication, after correcting for baseline differences.
Collapse
Affiliation(s)
- Michele Alessiani
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,"Enzo Borzomati" Pain Medicine Unit, University Hospital Policlinico Umberto I, Rome, Italy
| | - Rita De Sanctis
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | | | - Marta Puma
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital (IRCCS), Rozzano, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | | | | | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,"Enzo Borzomati" Pain Medicine Unit, University Hospital Policlinico Umberto I, Rome, Italy.,Istituto Europeo di Psicoterapia Psicoanalitica, IREP, Rome, Italy
| |
Collapse
|
22
|
De Sanctis R, Antunovic L, Benvenuti C, Jacobs F, Gaudio M, Ilieva M, Viganò A, Chiti A, Santoro A. Brain 18-FDG-PET patterns in early breast cancer subtypes: Relationship with headache. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12560 Background: Brain metabolic response on 18F-fuorodeoxiglucose(FDG)-PET in breast cancer (BC) patients is not routinely investigated, although several bidirectional relationships have been described between BC (and BC therapies) and brain functions. For example, common forms of headaches, as migraine (Mi) and tension-type headache (TTH), seem to be oddly distributed among BC subtypes and possibly influence the outcome. Methods: We recruited patients with early BC referring to IRCCS Humanitas Research Hospital who received neoadjuvant chemotherapy. Demographic data, BC characteristics and headache diagnosis were recorded, through detailed interview and instrumental investigation. Ki67 was considered high if above 20%. All patients underwent dedicated 18F-FDG PET scan for the evaluation of brain metabolism. Semiquantitative image analysis was performed using Cortex ID software (GE), comparing patient’s scan with a control group by the means of Z-score. The difference between patients’ subgroups were assessed using One-way ANOVA model. Results: Twenty-three patients were recruited. The median age was 52.5±10.8 years; 65.2% were postmenopausal, 30% premenopausal, and one patient perimenopausal. Ten patients were diagnosed as triple-negative BC, 6 as HER2-positive and 7 as Luminal B/HER2+. Nearly 70% (16/23) of patients had high Ki67 values. All patients had ECOG PS 0. Ten patients were diagnosed with TTH, 9 with migraine of whom two with aura, and four patients had no headache. Eleven patients had active headache at the moment of the study. At the whole brain level, we found a significant increase of brain metabolism in the left hemisphere of BC patients with high Ki-67 (p=0.007). Moreover, the same result was found in parietal cortex and in general associative areas bilaterally. Instead, HER-2 positive BC patient showed a reduced metabolism in right temporal cortex compared to HER-2 negative (p=0.04). Grading and other tumor characteristics did not influence FDG-PET uptake. BC patients with TTH had a reduced activity in right medial frontal lobe compared with migraine patients (p=0.01). Those with an active headache had increased activity in posterior cingulate and reduced activity in visual networks (p=0.03). Conclusions: Although exploratory, this study suggests that BC subtypes could present different metabolic pattern of cerebral activity, particularly in dominant hemisphere and associative areas. The high prevalence of headache in our sample does not affect the above pattern, but it is associated with an altered activation in other networks, mainly cingulate and visual cortex, which are well-known areas involved in primary headache.
Collapse
Affiliation(s)
- Rita De Sanctis
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - Lidija Antunovic
- IRCCS Humanitas Research Hospital, Department of Nuclear Medicine, Rozzano (Milan), Italy
| | - Chiara Benvenuti
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - Flavia Jacobs
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - Mariangela Gaudio
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano (Milan), Italy
| | - Mariya Ilieva
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (Milan), Italy
| | | | - Arturo Chiti
- Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Department of Nuclear Medicine, Pieve Emanuele (Milan), Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| |
Collapse
|
23
|
De Sanctis R, Antunovic L, Benvenuti C, Jacobs F, Gaudio M, Ilieva M, Viganò A, Chiti A, Santoro A. 50P Brain 18-FDG-PET patterns in early breast cancer subtypes: Relationship with headache. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.065] [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: 11/01/2022] Open
|
24
|
Comanducci A, Viganò A, Caronni A. Letter to the editor: COVID in patients with brain injury with a disorder of consciousness: a pathogenetic theory. Brain Inj 2021; 35:1647-1648. [PMID: 34487470 DOI: 10.1080/02699052.2021.1972456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We recently published in this journal (Caronni and colleagues, Brain Injury, 2021-04-16) the first description of the spread of the SARS-CoV-2 infection in a cohort of brain injured patients with a disorder of consciousness (DOC). Surprisingly enough we showed that, in these patients, the COVID was moderate and did not result in fatalities. The pathogenesis of the COVID is characterized by the profound dysregulation of the immune system. To explain our findings, we speculated that the immunosuppression due to the brain injury could be protective against the development of the COVID in patients with DOC. More recently, a second group of authors (Marino and colleagues, PLoSOne, 2021-06-30) described the course of the COVID in an independent cohort of patients with DOC. Since our results were quite unexpected, we have been very comforted by the data reported by Marino and colleagues. Moreover, these data also offer a unique opportunity to further evaluate our theory regarding the COVID pathogenesis in patients with DOC. In the current Letter to the Editor it is shown that the independent data presented by Marino and colleagues do support our theory. Waiting for larger cohorts to further test it (and in case falsify it), our interpretation seems to remain valid.
Collapse
|
25
|
Fecchio M, Russo S, Parmigiani S, Mazza A, Viganò A, Casali AG, Comolatti R, Mikulan E, Massimini M, Rosanova M. Spatiotemporal specificity of TMS-evoked potentials versus sensory evoked potentials. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.320] [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: 10/19/2022] Open
|
26
|
Toscano M, Viganò A, Jannini TB, Ruggiero M, Comanducci A, Di Piero V. Intensity-Dependence of Auditory Evoked Potentials (IDAP) as a Neurophysiological Parameter to Predict Anti-Aggressive Responsiveness to SSRI Treatment. Front Pharmacol 2021; 12:716338. [PMID: 34456730 PMCID: PMC8397375 DOI: 10.3389/fphar.2021.716338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | | | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Ruggiero
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
27
|
De Sanctis R, Viganò A, Torrisi R, Santoro A. Re: Carvedilol blocks neural regulation of breast cancer progression in vivo and is associated with reduced breast cancer mortality in patients: Sympathetic nervous system activity on breast cancer: the story of migraine. Eur J Cancer 2021; 152:250-251. [PMID: 34053844 DOI: 10.1016/j.ejca.2021.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rita De Sanctis
- Medical Oncology and Hematology Unit, IRCCS Humanitas Clinical and Research Center, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | | | - Rosalba Torrisi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Clinical and Research Center, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Clinical and Research Center, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| |
Collapse
|
28
|
Mastria G, Viganò A, Corrado A, Mancini V, Pirillo C, Badini S, Petolicchio B, Toscano M, Altieri M, Delle Chiaie R, Di Piero V. Chronic Migraine Preventive Treatment by Prefrontal-Occipital Transcranial Direct Current Stimulation (tDCS): A Proof-of-Concept Study on the Effect of Psychiatric Comorbidities. Front Neurol 2021; 12:654900. [PMID: 34079513 PMCID: PMC8166222 DOI: 10.3389/fneur.2021.654900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/17/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
Chronic migraine (CM) is often complicated by medication overuse headache (MOH) and psychiatric comorbidities that may influence the clinical outcome. This study aimed to investigate the relationship between psychiatric comorbidities and the effect of transcranial direct current stimulation (tDCS) in patients with CM with or without MOH. We recruited 16 consecutive CM patients who had an unsatisfactory response to at least three pharmacological preventive therapies. They were treated with anodal right-prefrontal and cathodal occipital tDCS (intensity: 2 mA, time: 20 min) three times per week for 4 weeks. All patients underwent a psychopathological assessment before and after treatment, and five of them were diagnosed with bipolar disorder (BD). After treatment, all the patients showed a significant decrease of severe and overall headache days per month. Despite having a higher migraine burden at baseline, patients with CM and BD showed a significantly greater reduction of severe headaches and psychiatric symptoms. Overall, tDCS seems to be effective in the treatment of CM patients with a poor response to different classes of pharmacological therapies, whereas BD status positively influences the response of migraineurs to tDCS.
Collapse
Affiliation(s)
- Giulio Mastria
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Alessandra Corrado
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Cristina Pirillo
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | - Simone Badini
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | | | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,Department of Neurology-Fatebenefratelli Hospital, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza-University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain-UCADH, Pavia, Italy
| |
Collapse
|
29
|
Mastria G, Mancini V, Cesare MD, Puma M, Alessiani M, Petolicchio B, Viganò A, Di Piero V. Prevalence and characteristics of Alice in Wonderland Syndrome in adult migraineurs: Perspectives from a tertiary referral headache unit. Cephalalgia 2021; 41:515-524. [PMID: 33167711 DOI: 10.1177/0333102420968245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Migraine affects how the brain processes sensory information at multiple levels. The aberrant integration of visual and somatosensory stimuli is thought to underlie Alice in Wonderland Syndrome, a disorder often reported as being associated with migraine. However, there is still a lack of knowledge about the epidemiology of this syndrome in migraineurs and the association between Alice in Wonderland Syndrome episodes and migraine attacks. Therefore, we conducted a prospective cohort study to systematically evaluate the prevalence and the clinical features of Alice in Wonderland Syndrome in a large sample of patients with migraine. METHODS All the patients attending for the first time a tertiary-level headache clinic were consecutively screened for Alice in Wonderland Syndrome symptoms by means of an ad hoc questionnaire and detailed clinical interview, over a period of 1.5 years. Patients experiencing Alice in Wonderland Syndrome symptoms were contacted for a follow-up after 8-12 months. RESULTS Two hundred and ten patients were recruited: 40 patients (19%) reported lifetime occurrence of Alice in Wonderland Syndrome, 90% of whom (38/40) had migraine with aura. Thirty-one patients experienced episodes of Alice in Wonderland Syndrome within 1 h from the start of migraine headache. Patients reported either visual or visual and somatosensory symptoms (i.e. somatosensory symptoms never presented alone). We collected the follow-up details of 30 patients with Alice in Wonderland Syndrome, 18 of whom had been prescribed a preventive treatment for migraine. After 8-12 months, 5 of the treated patients reported a decrease, while 13 reported no episodes of Alice in Wonderland Syndrome. CONCLUSION Alice in Wonderland Syndrome prevalence in migraineurs was found to be higher than expected. Alice in Wonderland Syndrome was mostly associated with migraine with aura and tended to occur close to the migraine attack, suggesting the existence of a common pathophysiological mechanism. Patients treated with migraine preventive treatments had a higher chance of decreasing or even resolving Alice in Wonderland Syndrome episodes.
Collapse
Affiliation(s)
- Giulio Mastria
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marco Di Cesare
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Marta Puma
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Michele Alessiani
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
| |
Collapse
|
30
|
Sarasso S, D'Ambrosio S, Fecchio M, Casarotto S, Viganò A, Landi C, Mattavelli G, Gosseries O, Quarenghi M, Laureys S, Devalle G, Rosanova M, Massimini M. Local sleep-like cortical reactivity in the awake brain after focal injury. Brain 2021; 143:3672-3684. [PMID: 33188680 PMCID: PMC7805800 DOI: 10.1093/brain/awaa338] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022] Open
Abstract
The functional consequences of focal brain injury are thought to be contingent on neuronal alterations extending beyond the area of structural damage. This phenomenon, also known as diaschisis, has clinical and metabolic correlates but lacks a clear electrophysiological counterpart, except for the long-standing evidence of a relative EEG slowing over the injured hemisphere. Here, we aim at testing whether this EEG slowing is linked to the pathological intrusion of sleep-like cortical dynamics within an awake brain. We used a combination of transcranial magnetic stimulation and electroencephalography (TMS/EEG) to study cortical reactivity in a cohort of 30 conscious awake patients with chronic focal and multifocal brain injuries of ischaemic, haemorrhagic and traumatic aetiology. We found that different patterns of cortical reactivity typically associated with different brain states (coma, sleep, wakefulness) can coexist within the same brain. Specifically, we detected the occurrence of prominent sleep-like TMS-evoked slow waves and off-periods—reflecting transient suppressions of neuronal activity—in the area surrounding focal cortical injuries. These perilesional sleep-like responses were associated with a local disruption of signal complexity whereas complex responses typical of the awake brain were present when stimulating the contralesional hemisphere. These results shed light on the electrophysiological properties of the tissue surrounding focal brain injuries in humans. Perilesional sleep-like off-periods can disrupt network activity but are potentially reversible, thus representing a principled read-out for the neurophysiological assessment of stroke patients, as well as an interesting target for rehabilitation.
Collapse
Affiliation(s)
- Simone Sarasso
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Sasha D'Ambrosio
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Matteo Fecchio
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Silvia Casarotto
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Alessandro Viganò
- Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Cristina Landi
- Fondazione Europea per la Ricerca Biomedica Onlus, Milan, Italy
| | | | - Olivia Gosseries
- Coma Science Group, University and University Hospital of Liege, GIGA-Consciousness, 4000 Liege, Belgium
| | - Matteo Quarenghi
- Unità Operativa Radiologia, Azienda Ospedaliera Vizzolo P -Risonanza Magnetica- ASST Melegnano e Martesana, Vizzolo Predabissi, Italy
| | - Steven Laureys
- Coma Science Group, University and University Hospital of Liege, GIGA-Consciousness, 4000 Liege, Belgium
| | - Guya Devalle
- Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy.,Fondazione Europea per la Ricerca Biomedica Onlus, Milan, Italy
| | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy.,Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| |
Collapse
|
31
|
Caronni A, Liaci E, Bianchi A, Viganò A, Marenco F, Comanducci A, Cabrini DM, Meloni M, Alberoni M, Farina E, Bianco M, Galeri S, Devalle G, Navarro J. Clinical course of SARS-CoV-2 infection in patients with severe acquired brain injury and a disorder of consciousness: an observational study. Brain Inj 2021; 35:520-529. [PMID: 33587672 DOI: 10.1080/02699052.2021.1887937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: SARS-CoV-2 infection can cause the coronavirus disease (COVID), ranging from flu-like symptoms to interstitial pneumonia. Mortality is high in COVID pneumonia and it is the highest among the frailest. COVID could be particularly serious in patients with severe acquired brain injury (SABI), such as those with a disorder of consciousness. We here describe a cohort of patients with a disorder of consciousness exposed to SARS-CoV-2 early after their SABI.Materials and methods: The full cohort of 11 patients with SABI hospitalized in March 2020 in the IRCCS Fondazione Don Gnocchi rehabilitation (Milan, Italy) was recruited. Participants received SARS-CoV-2 testing and different clinical and laboratory data were collected.Results: Six patients contracted SARS-CoV-2 and four of them developed the COVID. Of these, one patient had ground-glass opacities on the chest CT scan, while the remaining three developed consolidations. No patient died and the overall respiratory involvement was mild, requiring in the worst cases low-flow oxygen.Conclusions: Here we report the clinical course of a cohort of patients with SABI exposed to SARS-CoV-2. The infection spread among patients and caused COVID in some of them. Unexpectedly, COVID was moderate, caused at most mild respiratory distress and did not result in fatalities.
Collapse
Affiliation(s)
| | - Emanuele Liaci
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Anna Bianchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milano, Italy
| | | | | | | | | | - Mario Meloni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milano, Italy
| | | | | | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milano, Italy
| | - Guya Devalle
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milano, Italy
| | - Jorge Navarro
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milano, Italy
| |
Collapse
|
32
|
Puma M, Petolicchio B, Viganò A, Maestrini I, Di Piero V. Corrigendum: A Case of Post-traumatic Persistent Nasal Pain. Front Neurol 2021; 11:636634. [PMID: 33469443 PMCID: PMC7813995 DOI: 10.3389/fneur.2020.636634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,"Enzo Borzomati" Pain Medicine Unit-University Hospital Policlinico Umberto I, Rome, Italy
| | | | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,"Enzo Borzomati" Pain Medicine Unit-University Hospital Policlinico Umberto I, Rome, Italy
| |
Collapse
|
33
|
Degabriel D, Cerutti A, Caramanica L, Viganò A, Fusi-Schmidhauser T. Association of Hashimoto's Thyroiditis and Burkitt Lymphoma: A Rare Condition to Be Considered. Praxis (Bern 1994) 2021; 110:812-815. [PMID: 34702058 DOI: 10.1024/1661-8157/a003736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We present the case of a 72-year-old woman who was diagnosed with Hashimoto's thyroiditis and who developed a low-grade fever, fatigue, and weight loss that prompted to perform a thyroid biopsy to rule out an underlying primary thyroid lymphoma. This case report offers the opportunity to review the association between Hashimoto's thyroiditis and primary thyroid lymphoma. Furthermore, it underlines the importance of considering the diagnosis of lymphoma when a thyroid mass is found in patients with an underlying Hashimoto's disease, as the timely management is essential for survival with this rare thyroid condition.
Collapse
Affiliation(s)
- Dea Degabriel
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano
| | - Alberto Cerutti
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano
| | - Laura Caramanica
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano
| | - Alessandro Viganò
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano
| | - Tanja Fusi-Schmidhauser
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano
| |
Collapse
|
34
|
Toscano M, Ricci M, Celletti C, Paoloni M, Ruggiero M, Viganò A, Jannini TB, Altarocca A, Liberatore M, Camerota F, Di Piero V. Motor Recovery After Stroke: From a Vespa Scooter Ride Over the Roman Sampietrini to Focal Muscle Vibration (fMV) Treatment. A 99mTc-HMPAO SPECT and Neurophysiological Case Study. Front Neurol 2020; 11:567833. [PMID: 33281704 PMCID: PMC7705992 DOI: 10.3389/fneur.2020.567833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023] Open
Abstract
Focal repetitive muscle vibration (fMV) is a safe and well-tolerated non-invasive brain and peripheral stimulation (NIBS) technique, easy to perform at the bedside, and able to promote the post-stroke motor recovery through conditioning the stroke-related dysfunctional structures and pathways. Here we describe the concurrent cortical and spinal plasticity induced by fMV in a chronic stroke survivor, as assessed with 99mTc-HMPAO SPECT, peripheral nerve stimulation, and gait analysis. A 72-years-old patient was referred to our stroke clinic for a right leg hemiparesis and spasticity resulting from a previous (4 years before) hemorrhagic stroke. He reported a subjective improvement of his right leg's spasticity and dysesthesia that occurred after a30-min ride on a Vespa scooter as a passenger over the Roman Sampietrini (i.e., cubic-shaped cobblestones). Taking into account both the patient's anecdote and the current guidelines that recommend fMV for the treatment of post-stroke spasticity, we then decided to start fMV treatment. 12 fMV sessions (frequency 100 Hz; amplitude range 0.2–0.5 mm, three 10-min daily sessions per week for 4 consecutive weeks) were applied over the quadriceps femoris, triceps surae, and hamstring muscles through a specific commercial device (Cro®System, NEMOCOsrl). A standardized clinical and instrumental evaluation was performed before (T0) the first fMV session and after (T1) the last one. After fMV treatment, we observed a clinically relevant motor and functional improvement, as assessed by comparing the post-treatment changes in the score of the Fugl-Meyer assessment, the Motricity Index score, the gait analysis, and the Ashworth modified scale, with the respective minimal detectable change at the 95% confidence level (MDC95). Data from SPECT and peripheral nerve stimulation supported the evidence of a concurrent brain and spinal plasticity promoted by fMV treatment trough activity-dependent changes in cortical perfusion and motoneuron excitability, respectively. In conclusion, the substrate of post-stroke motor recovery induced by fMV involves a concurrently acting multisite plasticity (i.e., cortical and spinal plasticity). In our patient, operant conditioning of both cortical perfusion and motoneuron excitability throughout a month of fMV treatment was related to a clinically relevant improvement in his strength, step symmetry (with reduced limping), and spasticity.
Collapse
Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Maria Ricci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, "Sapienza" University of Rome, Rome, Italy
| | - Marco Ruggiero
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | | | - Tommaso B Jannini
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Altarocca
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Mauro Liberatore
- Department of Radiological, oncological and pathological Sciences - Radiometabolic Division, Umberto I Hospital, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
35
|
|
36
|
Edvinsson JCA, Viganò A, Alekseeva A, Alieva E, Arruda R, De Luca C, D'Ettore N, Frattale I, Kurnukhina M, Macerola N, Malenkova E, Maiorova M, Novikova A, Řehulka P, Rapaccini V, Roshchina O, Vanderschueren G, Zvaune L, Andreou AP, Haanes KA. The fifth cranial nerve in headaches. J Headache Pain 2020; 21:65. [PMID: 32503421 PMCID: PMC7275328 DOI: 10.1186/s10194-020-01134-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.
Collapse
Affiliation(s)
- J C A Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark. .,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A Viganò
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Alekseeva
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - E Alieva
- GBUZ Regional Clinical Hospital № 2, Krasnodar, Russia
| | - R Arruda
- Department of Neuroscience, University of Sao Paulo, Ribeirao Preto, Brazil
| | - C De Luca
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, 56126, Pisa, Italy.,Department of Public Medicine, Laboratory of Morphology of Neuronal Network, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - N D'Ettore
- Department of Neurology, University of Rome, Tor Vergata, Rome, Italy
| | - I Frattale
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - M Kurnukhina
- Department of Neurosurgery, First Pavlov State Medical University of St.Petersburg, Lev Tolstoy Street 6-8, St.Petersburg, Russia.,The Leningrad Regional State Budgetary Institution of health care "Children's clinical hospital", St.Petersburg, Russia
| | - N Macerola
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Malenkova
- Pain Department, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M Maiorova
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A Novikova
- F.F. Erisman Federal Research Center for Hygiene, Mytishchy, Russia
| | - P Řehulka
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - V Rapaccini
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Unità Sanitaria Locale (USL) Umbria 2, Viale VIII Marzo, 05100, Terni, Italy.,Department of Neurology, Headache Center, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - O Roshchina
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - G Vanderschueren
- Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - L Zvaune
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Riga Stradins University, Riga, Latvia.,Department of Pain Medicine, Hospital Jurmala, Jurmala, Latvia.,Headache Centre Vivendi, Riga, Latvia
| | - A P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - K A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | | |
Collapse
|
37
|
Viganò A, Mancini V, Mastria G, Di Piero V. Is it Useful to Do a Taxonomy of Complex Visual Symptoms in Migraine? A Comment on Coining the Pablo Picasso Syndrome. Headache 2020; 60:1200-1201. [DOI: 10.1111/head.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Valentina Mancini
- Centre Hospitalier Universitaire Vaudois (CHUV) My Space Lab Department of Clinical Neuroscience University of Lausanne Lausanne Switzerland
| | - Giulio Mastria
- Developmental Imaging and Psychopathology Laboratory University of Geneva School of Medicine Geneva Switzerland
| | - Vittorio Di Piero
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| |
Collapse
|
38
|
Viganò A, Maestria G, Mancini V, Piero VDI. Adding pieces to the Alice in wonderland syndrome puzzle: a comment to the paper by Brooks and colleagues. Arq Neuropsiquiatr 2020; 78:242-243. [PMID: 32294752 DOI: 10.1590/0004-282x20190194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 06/11/2023]
Affiliation(s)
| | - Giulio Maestria
- University of Lausanne, Centre Hospitalier Universitaire Vaudois (CHUV), My Space Lab, Department of Clinical Neuroscience, Lausanne, Switzerland
| | - Valentina Mancini
- University of Geneva School of Medicine, Developmental Imaging and Psychopathology Laboratory, Geneva, Switzerland
| | - Vittorio DI Piero
- Sapienza Università di Roma, Dipartimento di Neuroscienze Umane, Roma, Italia
- Consorzio Universitario per i Disordini Adattativi e la Cefalea, Pavia, Italia
| |
Collapse
|
39
|
Viganò A, Savastano E, Petolicchio B, Toscano M, De Sanctis R, Maestrini I, Di Piero V. A Study of Clinical Features and Risk Factors of Self-Referring Emergency Department Headache Patients: A Comparison with Headache Center Outpatients. Eur Neurol 2020; 83:34-40. [PMID: 32155625 DOI: 10.1159/000505915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nonlife-threatening headaches account for 3% of emergency department (ED) admissions, with social and economic negative consequences. We aim to investigate clinical features and risk factors of nonlife-threatening headache patients referring to ED versus those referring to headache outpatient clinics. METHODS During 6 months, we promptly reevaluated in our headache unit (HU) patients discharged from ED. We compared the clinical characteristics of patients who referred to ED with those of HU outpatients visited in the same time interval. Discriminant Function Analysis and Correspondence Analysis were used to determine risk factors for ED referral. RESULTS We recruited 49 post-ED patients and 126 outpatients. The main reasons for ED admission were poor response to acute treatment and aura-related symptoms. Headache diagnoses made in ED were generally not confirmed later (overall concordance of 47%), except for cluster headache (CH) and migraine with aura (MA). ED patients complained higher headache intensity, longer duration, and prolonged aura compared to outpatients. Aura was the main risk factor associated with ED admission on statistical models, while less prominent risk factors were sex, age, and years from migraine onset. CONCLUSIONS ED patients presented a more severe headache clinical phenotype compared with outpatients. Headache diagnosis remains difficult in the emergency setting and is more easily achieved for the headache forms with standout features, such as MA or CH. According to statistical models, the aura is the most important risk factor for ED admissions.
Collapse
Affiliation(s)
| | - Ersilia Savastano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,"Enzo Borzomati" Pain Medicine Unit, University Hospital Policlinico Umberto I, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Calabita, Isola, Tiberina Hospital, Rome, Italy
| | - Rita De Sanctis
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy.,Humanitas University - Department of Biomedical Sciences, Pieve Emanuele, Italy
| | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain, UCADH, Pavia, Italy
| |
Collapse
|
40
|
Puma M, Petolicchio B, Viganò A, Maestrini I, Di Piero V. A Case of Post-traumatic Persistent Nasal Pain. Front Neurol 2020; 10:1409. [PMID: 32116984 PMCID: PMC7009175 DOI: 10.3389/fneur.2019.01409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Abstract
Nasal pain is a complex and misdiagnosed entity with various peripheral and central etiologies. It is often a bothersome, treatment-resistant condition and could be spontaneous or post-traumatic. Although pain usually occurs immediately after injury, rarely it may occur long after the nasal trauma. Due to its rarity, successful treatment is difficult because of the lack of standardized options. According to our experience, an effective therapeutic approach should take into account both local inflammatory factors and aberrant nerve modulations. We describe the case of a young woman complaining of a delayed onset persistent nasal pain occurring 1 month after facial trauma and who has improved with the addition of intranasal steroids to first-line neuropathic pain treatment.
Collapse
Affiliation(s)
- Marta Puma
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Marta Puma
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- “Enzo Borzomati” Pain Medicine Unit–University Hospital Policlinico Umberto I, Rome, Italy
| | | | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- “Enzo Borzomati” Pain Medicine Unit–University Hospital Policlinico Umberto I, Rome, Italy
| |
Collapse
|
41
|
Fanella M, Frascarelli M, Lambiase C, Morano A, Unolt M, Liberati N, Fattouch J, Buzzanca A, Accinni T, Ceccanti M, Viganò A, Biondi M, Colonnese C, Giallonardo AT, Di Fabio F, Pizzuti A, Di Bonaventura C, Berardelli A. Myoclonic epilepsy, parkinsonism, schizophrenia and left-handedness as common neuropsychiatric features in 22q11.2 deletion syndrome. J Med Genet 2019; 57:151-159. [PMID: 31506323 DOI: 10.1136/jmedgenet-2019-106223] [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: 04/16/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is considered as the genetic model of schizophrenia. However, its polymorphic nature has led researchers to further investigate its neuropsychiatric manifestations. METHODS We enrolled 56 adults (38 men, 18 women) diagnosed with 22q11.2DS. All subjects were evaluated by a multidisciplinary team. The neuropsychiatric features were investigated by means of clinical and neurophysiological evaluation (video-EEG). RESULTS Thirty per cent of our patients were left-handed. Fifty-eight per cent had a low IQ, and 22 of 56 subjects had psychotic disorders (13 of 22 with schizophrenia). Eighteen patients reported at least one seizure in their lifetime, and ten were diagnosed with epilepsy; among them, seven had genetic generalised epilepsy (GGE), and five of seven showed features suggestive of juvenile myoclonic epilepsy (JME). Video-EEG recordings revealed generalised epileptiform abnormalities in 24 of 56 cases. Besides, only one patient with epilepsy had a cardiac malformation. Lastly, 31 of 56 subjects presented with parkinsonism, 16 of whom were taking neuroleptics. None of the 15 patients with parkinsonism not related to neuroleptic therapy was diagnosed with epilepsy, compared with 6 of those taking antipsychotics. CONCLUSIONS 22q11.2DS is characterised by left-handedness and neuropsychiatric features such as cognitive impairment, schizophrenia, epilepsy and parkinsonism. GGE, mostly the JME phenotype, is the predominant epilepsy type. The significant association between 22q11.2DS and parkinsonian features confirms these patients' genetic susceptibility to parkinsonism. Despite the lack of any conclusive evidence, our study suggests a possible relationship between the analysed clinical variables: (1) an inverse correlation between low IQ/psychosis/epilepsy and major cardiac diseases; (2) a direct association between psychosis and both mental delay and epilepsy; and (3) an inverse correlation between parkinsonism and epilepsy.
Collapse
Affiliation(s)
- Martina Fanella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Alessandra Morano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marta Unolt
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Jinane Fattouch
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonino Buzzanca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Tommaso Accinni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Viganò
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Colonnese
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS "Neuromed", Pozzilli (IS), Italy
| | | | - Fabio Di Fabio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Pizzuti
- Experimental Medicine, Universita 'La Sapienza', Rome, Italy
| | | | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS "Neuromed", Pozzilli (IS), Italy
| |
Collapse
|
42
|
Sarasso S, Casarotto S, Fecchio M, Derchi C, Mazza A, D’Ambrosio S, Viganò A, Casali AG, Comolatti R, Comanducci A, Rosanova M, Massimini M, Parmigiani S. P52-S State-dependent changes in cortical reactivity: comparison between direct cortical and peripheral stimulation. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
Viganò A, Manica A, Di Piero V, Leonardi M. Did Going North Give Us Migraine? An Evolutionary Approach on Understanding Latitudinal Differences in Migraine Epidemiology. Headache 2019; 59:632-634. [PMID: 30957222 PMCID: PMC6519367 DOI: 10.1111/head.13520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Accepted: 01/23/2019] [Indexed: 12/02/2022]
Abstract
This commentary discusses a recent publication by evolutionary biologists with strong implications for migraine experts. The Authors showed that a gene polymorphism associated with migraine gave our ancestors an evolutionary advantage when colonizing northern, and thus colder, territories. They then highlight that the prevalence of migraine may differ among countries because of climatic adaptation. These results may prove useful in planning both epidemiological and physiological studies in the field of migraine.
Collapse
Affiliation(s)
- Alessandro Viganò
- NeuroCritical Care Unit & Headache Centre, Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,Brain Morphometry and Dynamics, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza - University of Rome, Rome, Italy
| | - Andrea Manica
- Department of Zoology, University of Cambridge, Cambridge, United Kingdom
| | - Vittorio Di Piero
- NeuroCritical Care Unit & Headache Centre, Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
| | - Michela Leonardi
- Department of Zoology, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
44
|
Bogdanov VB, Bogdanova OV, Viganò A, Noirhomme Q, Laureys S, Dallel R, Phillips C, Schoenen J. Increased cerebral responses to salient transitions between alternating stimuli in chronic migraine with medication overuse headache and during migraine attacks. Cephalalgia 2019; 39:988-999. [DOI: 10.1177/0333102418825359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction In a previous study exploring central pain modulation with heterotopic stimuli in healthy volunteers, we found that transitions between sustained noxious and innocuous thermal stimulations on the foot activated the “salience matrix”. Knowing that central sensory processing is abnormal in migraine, we searched in the present study for possible abnormalities of these salient transitional responses in different forms of migraine and at different time points of the migraine cycle. Methods Participants of both sexes, mostly females, took part in a conditioned pain modulation experiment: Migraineurs between (n = 14) and during attacks (n = 5), chronic migraine patients with medication overuse headache (n = 7) and healthy volunteers (n = 24). To evoke the salience response, continuous noxious cold or innocuous warm stimulations were alternatively applied on the right foot. Cerebral blood oxygenation level dependent responses were recorded with fMRI. Results Switching between the two stimulations caused a significant transition response in the “salience matrix” in all subject groups (effect of the condition). Moreover, some group effects appeared on subsequent post-hoc analyses. Augmented transitional blood oxygenation level dependent responses in the motor cortex and superior temporal sulcus were found in two patient groups compared to healthy controls: chronic migraine with medication overuse headache patients and migraineurs recorded during an attack. In chronic migraine with medication overuse headache patients, salience-related responses were moreover greater in the premotor cortex, supplementary motor area, lingual gyrus and dorso-medial prefrontal cortex and other “salience matrix” areas, such as the anterior cingulate and primary somatosensory cortices. Conclusion This study shows salience-related hyperactivation of affective and motor control areas in chronic migraine with medication overuse headache patients and, to a lesser extent, in episodic migraine patients during an attack. The greater extension of exaggerated blood oxygenation level dependent responses to unspecific salient stimuli in chronic migraine with medication overuse headache than during a migraine attack could be relevant for headache chronification.
Collapse
Affiliation(s)
- Volodymyr B Bogdanov
- Centre de Recherche en Neurosciences de Lyon Inserm, U1028 - CNRS UMR5292 Bâtiment Inserm, Bron, France
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
| | - Olena V Bogdanova
- Centre de Recherche en Neurosciences de Lyon Inserm, U1028 - CNRS UMR5292 Bâtiment Inserm, Bron, France
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
| | - Alessandro Viganò
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Department of Neurology and Psychiatry, La Sapienza, University of Rome, Rome, Italy
| | - Quentin Noirhomme
- GIGA institute, University of Liège, Liège, Belgium
- Coma Science Group, Department of Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA institute, University of Liège, Liège, Belgium
- Coma Science Group, Department of Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Radhouane Dallel
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Christophe Phillips
- GIGA institute, University of Liège, Liège, Belgium
- Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
| |
Collapse
|
45
|
Toscano M, Celletti C, Viganò A, Altarocca A, Giuliani G, Jannini TB, Mastria G, Ruggiero M, Maestrini I, Vicenzini E, Altieri M, Camerota F, Di Piero V. Short-Term Effects of Focal Muscle Vibration on Motor Recovery After Acute Stroke: A Pilot Randomized Sham-Controlled Study. Front Neurol 2019; 10:115. [PMID: 30873102 PMCID: PMC6401608 DOI: 10.3389/fneur.2019.00115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/29/2019] [Indexed: 12/01/2022] Open
Abstract
Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group-VG), while 12 underwent the sham treatment (control group-CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2-0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS (p < 0.001), Fugl-Meyer (p = 0.001), and Motricity Index (p < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients.
Collapse
Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Alessandro Viganò
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Alberto Altarocca
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Giada Giuliani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Tommaso B. Jannini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulio Mastria
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Edoardo Vicenzini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marta Altieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I University Hospital, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
46
|
|
47
|
Tomba P, Viganò A, Nucci Pagliaro P, Roio N, Negro E, Griffoni C, Gasbarrini A. Medicine in the time of Carracci: the cases of Domenico Lanzoni and Giuseppe Rosaccio. Eur Rev Med Pharmacol Sci 2019; 23:464-470. [PMID: 30720152 DOI: 10.26355/eurrev_201901_16857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During the 16th century and at the beginning of the 17th century the age-old competition between scholarly doctors and folk healers became more and more serious, creating a division between the two categories entrusted with treating population diseases. On one side there were the representatives who practiced medicine in an official capacity, and on the other, the "others", that is, the charlatans, the acrobats and female healers. Two representatives of these contrasting approaches of practicing medicine within the health profession during that historical period were two Italian doctors, Domenico Lanzoni and Giuseppe Rosaccio. Together, with their ties to the city of Bologna and the bolognese Carracci family of painters, they were able to describe in complete detail these two types of practices as medical sciences of the sixteenth and early seventeenth century.
Collapse
Affiliation(s)
- P Tomba
- Scientific Libraries, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
48
|
Viganò A, Toscano M, Puledda F, Di Piero V. Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity. Front Pharmacol 2019; 10:32. [PMID: 30804782 PMCID: PMC6370938 DOI: 10.3389/fphar.2019.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic migraine (CM) is the most disabling form of migraine, because pharmacological treatments have low efficacy and cumbersome side effects. New evidence has shown that migraine is primarily a disorder of brain plasticity and migraine chronification depends on a maladaptive process favoring the development of a brain state of hyperexcitability. Due to the ability to induce plastic changes in the brain, researchers started to look at Non-Invasive Brain Stimulation (NIBS) as a possible therapeutic option in migraine field. On one side, NIBS techniques induce changes of neural plasticity that outlast the period of the stimulation (a fundamental prerequisite of a prophylactic migraine treatment, concurrently they allow targeting neurophysiological abnormalities that contribute to the transition from episodic to CM. The action may thus influence not only the cortex but also brainstem and diencephalic structures. Plus, NIBS is not burdened by serious medication side effects and drug–drug interactions. Although the majority of the studies reported somewhat beneficial effects in migraine patients, no standard intervention has been defined. This may be due to methodological differences regarding the used techniques (e.g., transcranial magnetic stimulation, transcranial direct current stimulation), the brain regions chosen as targets, and the stimulation types (e.g., the use of inhibitory and excitatory stimulations on the basis of opposite rationales), and an intrinsic variability of stimulation effect. Hence, it is difficult to draw a conclusion on the real effect of neuromodulation in migraine. In this article, we first will review the definition and mechanisms of brain plasticity, some neurophysiological hallmarks of migraine, and migraine chronification-related (dys)plasticity. Secondly, we will review available results from therapeutic and physiological studies using neuromodulation in CM. Lastly we will discuss the results obtained in these preventive trials in the light of a possible effect on brain plasticity.
Collapse
Affiliation(s)
- Alessandro Viganò
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College Hospital, King's College London, London, United Kingdom
| | - Vittorio Di Piero
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
| |
Collapse
|
49
|
Mancini V, Mastria G, Frantellizzi V, Troiani P, Zampatti S, Carboni S, Giardina E, Campopiano R, Gambardella S, Turchi F, Petolicchio B, Toscano M, Liberatore M, Viganò A, Di Piero V. Migrainous Infarction in a Patient With Sporadic Hemiplegic Migraine and Cystic Fibrosis: A 99mTc-HMPAO Brain SPECT Study. Headache 2019; 59:253-258. [DOI: 10.1111/head.13472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Valentina Mancini
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Giulio Mastria
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Viviana Frantellizzi
- Department of Radiological, Oncological and Anatomopathological Sciences; Sapienza University of Rome; Rome Italy
| | - Patrizia Troiani
- Department of Pediatrics; Sapienza University of Rome; Rome Italy
| | - Stefania Zampatti
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
- Molecular Genetics Center; IRCCS Neuromed; Pozzilli Italy
| | - Stefania Carboni
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
| | - Emiliano Giardina
- Genomic Medicine Laboratory UILDM; IRCCS Santa Lucia Foundation; Rome Italy
- Department of Biomedicine and Prevention; University of Rome “Tor Vergata”; Rome Italy
| | | | | | - Federica Turchi
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | | | | | - Mauro Liberatore
- Department of Radiological, Oncological and Anatomopathological Sciences; Sapienza University of Rome; Rome Italy
| | - Alessandro Viganò
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences; Sapienza University of Rome; Rome Italy
| |
Collapse
|
50
|
Toscano M, Viganò A, Rea A, Verzina A, Sasso D'Elia T, Puledda F, Longo L, Mancini V, Ruggiero M, Jannini TB, Giuliani G, Albino F, Altieri M, Vicenzini E, Fattapposta F, Pauri F, Giacomini P, Ruoppolo G, Di Piero V. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. Eur J Neurol 2018; 26:596-602. [PMID: 30414300 DOI: 10.1111/ene.13862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia occurs in up to 50% of all patients with acute stroke. There is debate regarding which is the most effective screening tool in identifying aspiration in patients with acute stroke. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke (GLOBE-3S), which combines the Toronto Bedside Swallowing Screening Test (TOR-BSST©) with oxygen desaturation and laryngeal elevation measurement during swallowing. METHODS We prospectively enrolled consecutive patients with stroke within 72 h of symptom onset. All patients with stroke firstly underwent a standard neurological examination, then the GLOBE-3S evaluation and finally the fiberoptic endoscopic evaluation of swallowing (FEES). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and each other's evaluation, administered the GLOBE-3S and FEES examination. We assessed the accuracy of the GLOBE-3S in detecting post-stroke swallow impairment with aspiration using the FEES as the standard. RESULTS We enrolled 50 patients with acute stroke, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. A total of 33 patients (66%) failed the GLOBE-3S evaluation. The GLOBE-3S reached a sensitivity of 100% and a specificity of 77.3% (negative predictive value, 100%; positive likelihood ratio, 4.34). The median time required for the GLOBE-3S to be performed was 297 s. CONCLUSIONS GLOBE-3S is quick to perform at the bedside and can accurately identify aspiration in patients with acute stroke. By including the measurement of laryngeal elevation and monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.
Collapse
Affiliation(s)
- M Toscano
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - A Viganò
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, 'Sapienza' University of Rome, Rome, Italy
| | - A Rea
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - A Verzina
- Neurology Clinic, University of Perugia - Perugia General Hospital, Perugia, Italy
| | - T Sasso D'Elia
- Physical Medicine and Rehabilitation Division, 'Sapienza' University of Rome, Rome, Italy
| | - F Puledda
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - L Longo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Mancini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - M Ruggiero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - T B Jannini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - G Giuliani
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Albino
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - M Altieri
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - E Vicenzini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Fattapposta
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - F Pauri
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - P Giacomini
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - G Ruoppolo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Di Piero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| |
Collapse
|