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Voci A, Bruni O, Ferilli M, Papetti L, Tarantino S, Ursitti F, Sforza G, Vigevano F, Mazzone L, Valeriani M, Moavero R. Sleep Disorders in Pediatric Migraine: a questionnaire-based study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Moavero R, Voci A, Romigi A, Bisulli F, Luisi C, Vigevano F, Mazzone L, Valeriani M, Curatolo P, Bruni O. Sleep disorders in adults with tuberous sclerosis complex: a questionnaire-based study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Santarone M, Piscitello L, Volponi C, Vigevano F, Fusco L. Focal non-motor seizures and subsequent focal motor seizures as the main clinical expression of GLUT-1 deficiency. Epilepsy Behav Rep 2022; 20:100571. [DOI: 10.1016/j.ebr.2022.100571] [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] [Received: 12/29/2021] [Revised: 05/09/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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Falamesca C, Cappelletti S, Vicario R, Amante P, Correale C, Vigevano F, Caforio L, Grimaldi Capitello T. Prevalence of Maternal Psychological Distress in pregnant women who receipt prenatal diagnosis of fetal Central Nervous System (CNS) anomalies. Eur Psychiatry 2022. [PMCID: PMC9568258 DOI: 10.1192/j.eurpsy.2022.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Women receiving a prenatal diagnosis of fetal anomalies are a high-risk population for psychological distress leading to mood disorders. Even so, to date we have no evidence of studies who investigated the levels of maternal anxiety and depression in pregnant women receiving a prenatal diagnosis of fetal CNS anomalies. Objectives
The aim of this study was to assess the prevalence of anxiety and depression levels in a pilot sample of pregnant women at the Prenatal Diagnostic Unit of the Bambino Gesù Children Hospital. Methods We collected data among 43 women who receipt fetal brain anomaly diagnosis (mean age: 35 yrs, SD ± 6.3, range 19-48 yrs; mean week at first access 26w, SD ± 3.9, range 18-33w). Prenatal diagnosis including: ventriculomegaly (37.2%), posterior cranial fossa (23.3%), choroid plexus cysts (11.6%), anomalies of CC (7%) and other (20.9%). Pregnancies with assisted reproductive technology were 14%. We use the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorders (GAD-7) questionnaires to assess anxious-depressive symptoms. Results showed a rate of mild-to-severe anxious depressive symptoms by 60.5% and 48.8% respectively. In detail: 41.9% mild, 14% moderate and 4.7% of severe anxiety. Meanwhile, 41.9% mild and 7% moderate depression. The prevalence of comorbid depressive and anxiety symptoms was 39.5% among the entire sample. Conclusions Preliminary data showed a high prevalence of anxious depressive symptoms and comorbidity among pregnant with CNS fetal anomalies. Women receiving a fetal CNS anomaly diagnosis may need additional psychological support or counselling. Disclosure No significant relationships.
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Correale C, Tondo I, Falamesca C, Amodeo G, Boldrini F, Capitello TG, Vigevano F, Cappelletti S. Measuring anxiety and depression in parents of hospitalized children during the COVID-19 pandemic in a pediatric Italian hospital. Eur Psychiatry 2021. [PMCID: PMC9479832 DOI: 10.1192/j.eurpsy.2021.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionParents of hospitalized children with chronic illness (HCCI) during the COVID-19 epidemic may face huge pressure and worry, leading to mental health issues. Parent’s depression and anxiety disorders increase the risk of mental health problems in the child and affect his/her recovery.ObjectivesThe aim of this study was to assess the prevalence rate of depressive and anxiety symptoms among a pilot sample of parents of HCCI (in- and out-patients) with diagnosis of epilepsy (9), cystic fibrosis (8) and congenital heart anomalies (6) during COVID-19 pandemic. Pediatric patients were under a regular Children Hospital medical and psychological follow-up program.MethodsWe conducted a cross-sectional study among 23 Italian parents (15 F; 8 M) of HCCI during the COVID-19 epidemic period. We performed face-to face interviews and assessed depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorders (GAD-7) questionnaire during scheduled follow up visits.ResultsThe anxiety score of parents of HCCI was 4.43 ± 3.17, of which 39.1% of parents were anxious (≥5 points), while the depression score was 4.04 ± 2.67, of which 30.4% of parents show depressive symptoms (≥5 points). The prevalence of comorbid depressive and anxiety symptoms was 26.1% among the entire sample.ConclusionsPreliminary data of our pilot study showed a high prevalence of anxious depressive symptoms and comorbidity among parents of HCCI. Timely provision of psychologic interventions are needed during and after COVID-19 pandemic in order to empower parenting and promote children recovery and quality of life.DisclosureNo significant relationships.
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Correale C, Tondo I, Falamesca C, Capitello TG, Vigevano F, Specchio N, Cappelletti S. Depression and anxiety in hospitalized children with epilepsy during COVID-19 pandemic: Preliminary findings of a cross-sectional study. Eur Psychiatry 2021. [PMCID: PMC9480183 DOI: 10.1192/j.eurpsy.2021.1780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Anxious-depressive disorders are common among children with epilepsy. A recent Systematic Review and Meta-Analysis (Scott et al., 2020) reported that the overall pooled prevalence of anxiety disorders is 18.9% while of depressive disorders is 13.5%. COVID-19 pandemic has centralized the attention of governors and careers on the health emergency. As a result, the trajectory of the psychological care needs of this at risk population may have been neglected. Objectives The aim of the study was to assess the prevalence rate of depressive and anxiety symptoms among children with epilepsy during COVID-19 pandemic. Children were hospitalized in- and out-patients under a neurological and psychological follow up program in an Italian Children Hospital. Methods We conducted a cross-sectional study among 38 hospitalized children and adolescents with epilepsy (21F; 17M, mean age: 14,5; range: 11-18) during COVID-19 pandemic. We performed face-to face interviews and assessed depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorders (GAD-7) questionnaire during scheduled follow up checks. Results Preliminary results showed a rate of mild-to-severe anxious depressive symptoms by 49.9% and 60.5% respectively. In detail: 21.1% mild, 15.7% moderate and 13.1% of severe anxiety, meanwhile 23.7% mild, 26.3% moderate and 10.5% of severe depression. The prevalence of comorbid depressive and anxiety symptoms was 39.5% among the entire sample. Conclusions Depressive and anxiety rates among hospitalized children with epilepsy during COVID-19 outbreak are very high. Pediatric services should deserve special attention to those patients’ mental health. Regular screening protocols and empowerment interventions in Hospital should be promoted. Disclosure No significant relationships.
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Correale C, Borgi M, Collacchi B, Capitello TG, Vigevano F, Cirulli F, Cappelletti S. Improving hospitalization in children and adolescents through animal assisted interventions (AAIS): A systematic review. Eur Psychiatry 2021. [PMCID: PMC9476052 DOI: 10.1192/j.eurpsy.2021.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Animal Assisted Interventions (AAIs) are increasingly introduced in pediatric care settings as a mean to promote the physical, mental, and emotional well-being of hospitalized children and adolescents and the humanization of the hospital environment. Objectives The aim of this work was to review published studies implementing AAIs in hospital settings and to assess their effectiveness in reducing stress and pain, ameliorating social behavior, quality of life, and mood in pediatric patients. Reviewed interventions were also evaluated for their effects on caregiver’s stress and burden, as well as on perception of the work environment in hospital staff. Methods Studies were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The search was aimed at identifying studies examining the effects of AAIs on behavioral and physiological response to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations. Results Of 350 studies screened, 17 were eligible for inclusion. Most of them focused on stress, pain and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral observations/scales. The vast majority of the studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients, while acting on physiological measures associated with arousal. Conclusions Although further studies of better quality are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.
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Correale C, Di Pastena M, Tondo I, Milo F, Santato F, Amodeo G, Capitello TG, Vigevano F, Cappelletti S. Prevalence of depressive and anxiety symptoms in chronically ill children and adolescents during COVID-19 pandemic and lockdown: Preliminary findings of a pediatric hospital in Italy. Eur Psychiatry 2021. [PMCID: PMC9528511 DOI: 10.1192/j.eurpsy.2021.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Psychological problems are common among the pediatric population suffering from a chronic illness, especially compared to the normal population. Stressful life events, such as social distancing measures implemented to counter the COVID-19 pandemic emergency, can strongly influence their epidemiology. Objectives The aim of this study was to assess the prevalence rate of depressive and anxiety symptoms among an Italian pediatric population affected by chronic illness and already under a Children Hospital psychological follow-up program during COVID-19 lockdown. Methods We conducted a cross-sectional study among 54 Italian children and adolescents affected by chronic illness (mean age: 15y; range: 8.9-18y) during the COVID-19 epidemic period. We assessed depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorders (GAD-7) questionnaire during scheduled follow-up checks or teleconsulting. Results Preliminary results showed an elevated prevalence of depressive and anxiety symptoms (51% and 48% respectively) among chronically ill children during the COVID-19 outbreak. When compared with a non-ill pediatric population (Zhou et al. 2020), rates are + 7.3% higher for depression and + 10.6% for anxiety. Conclusions Chronic ill pediatric patients are a vulnerable group and require careful consideration. For this reason, the healthcare system should be able to implement and guarantee adequate mental health support programs and continuity of care. Further research is necessary since the COVID-19 outbreak could be repeated.
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Ursitti F, Roberto D, Papetti L, Moavero R, Ferilli MAN, Fusco L, Vigevano F, Curatolo P, Valeriani M. Diagnosis of pediatric anti-NMDAR encephalitis at the onset: A clinical challenge. Eur J Paediatr Neurol 2021; 30:9-16. [PMID: 33321446 DOI: 10.1016/j.ejpn.2020.12.004] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/26/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUNDS To investigate the clinical and instrumental features at the onset addressing to the diagnosis of anti-NMDAR encephalitis. METHODS Twenty children (age: 15 months-17 years; 7 males, 13 females) with initial suspected diagnosis of autoimmune encephalitis, observed between January 2008 and March 2018, were included. The final diagnosis was anti-NMDAR encephalitis in 7 children, other/probable autoimmune encephalitis in 7 children, and primary psychosis in the remaining 6 children. RESULTS At the clinical onset, anxiety disorder was the main symptom that helped in distinguishing the group of psychotic children from children with non-infectious encephalitis (P = 0.05 OR = 0.001), while epileptic seizures strongly predicted anti-NMDAR encephalitis (P = 0.04 OR = 28.6). At the onset, anti-NMDAR encephalitis could be distinguished from other/probable autoimmune encephalitis for the presence of sleep/wake rhythm alteration (P = 0.05 OR = 15). Among the symptoms occurring during the hospitalization, movement disorders (P = 0.031 OR = 12) were predictive of non-infectious encephalitis rather than primary psychosis. More specifically, the occurrence of language impairment (P = 0.03 OR = 33), epileptic seizures (P = 0.04 OR = 28.6) and catatonia (P = 0.03, OR = 33), were predictive of anti-NMDAR encephalitis. Also at this stage, anxiety disorder (P = 0.03 OR = 0.033) was predictive of primary psychosis. CONCLUSION Our findings suggest that at the clinical onset epileptic seizures and sleep/wake rhythm alteration represent the main features addressing to the diagnosis of anti-NMDAR encephalitis rather than primary psychosis and other/probable autoimmune encephalitis, while anxiety disorder could be a solid predictor of primary psychosis.
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Affiliation(s)
- F Ursitti
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy
| | - D Roberto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - L Papetti
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy
| | - R Moavero
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy; Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - M A N Ferilli
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy
| | - L Fusco
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy
| | - F Vigevano
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy
| | - P Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - M Valeriani
- Department of Neurological and Psychiatric Sciences, Bambino Gesù Children Hospital, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
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Cappelletti S, Tondo I, Pietrafusa N, Renzetti T, Pannacci I, Gentile S, Perrucci M, Calabrese C, Ferraris PC, Specchio N, Vigevano F. Improvement of quality of life in adolescents with epilepsy after an empowerment and sailing experience. Epilepsy Behav 2020; 106:106957. [PMID: 32193096 DOI: 10.1016/j.yebeh.2020.106957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/07/2020] [Accepted: 01/29/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Epilepsy in adolescents affects their psychological health, independence, and emotional adjustment. Psychological and self-management interventions might give benefits to adolescent with epilepsy in terms of quality of life, emotional well-being, and reduced fatigue. "Fondazione Tender To Nave Italia" promotes a project using sailing activities as an empowerment opportunity. The main aim of our study was to examine the empowerment effects on quality of life of adolescents with epilepsy attending sailing activities, and to compare the results perceived by adolescents and their parents. METHODS Fifty-eight patients with a diagnosis of epilepsy were included in an empowerment project titled "Waves rather than spikes" from June 2013 to July 2018. Intellectual level was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Patients were administered Pediatric Quality of Life Inventory (PedsQL), adolescent and parent version. Behavioral data were collected by parent-report Child Behavior Checklist (CBCL). RESULTS Thirty female and 28 male patients with a mean age of 15 years, referred to "Bambino Gesù Children's Hospital" in Italy, were included. Thirty-three (56.9%) patients had a history of refractory epilepsy; 34 (56.2%) received polytherapy, 19 (32.7%) monotherapy, and 5 (8.6%) were not taking antiepileptic drugs. Intellectual functioning was normal in 43 (74.1%), borderline in 9 (15.5%), and mildly impaired in 6 (10.3%). Results from PedsQL adolescent report revealed significant postintervention improvement for total score (p = 0.023) and in two domains: physical health (p = 0.0066) and emotional functioning (p = 0.015). Results from PedsQL parent report showed significant postintervention improvement for the domain of school functioning (p = 0.023). In the multivariate model, a low CBCL value was predicting a higher score in the health subscore difference between pre- and postempowerment activity (p = 000.8). CONCLUSION Empowerments activities are crucial in order to reduce the burden of epilepsy in adolescents, and to improve quality of life. These are critical factors for a well-managed transition phase to adulthood.
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Affiliation(s)
- S Cappelletti
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - I Tondo
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - N Pietrafusa
- Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - T Renzetti
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - I Pannacci
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Gentile
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Perrucci
- Administrative Staff, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Calabrese
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - N Specchio
- Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - F Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Pepi C, Cesaroni E, Striano P, Maiorani D, Pruna D, Cossu S, Di Capua M, Vigevano F, Specchio N, Cusmai R. De novo Absence Status Epilepticus in a pediatric cohort: Electroclinical pattern in a multicenter Italian patients cohort. Seizure 2019; 73:79-82. [PMID: 31776058 DOI: 10.1016/j.seizure.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/01/2019] [Revised: 10/12/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Absence Status epilepticus (AS) is a form of Non Convulsive Status Epilepticus defined as a prolonged, generalized and non-convulsive seizure, with an altered content of consciousness. We aim to describe a group of healthy children, who presented recurrent and unprovoked de novo AS as the only manifestation of their epilepsy, with an excellent response to antiepileptic drugs. METHOD We retrospectively reviewed the electroclinical and genetic features of 13 pediatric patients, referring to our epilepsy centers from 2005 to 2019, on the following criteria: (1) regular psychomotor development, (2) one or more unprovoked AS as the only epileptic manifestation, (3) normal blood testing, (4) normal neuroimaging, (5) EEG recording, (6) available follow-up (1-14 years). RESULTS Patients are 7 females and 6 males, aged 7-22, with a mean age at AS onset of 9,3 years. All of them started an antiepileptic therapy, with an excellent response to Valproic Acid (VPA) or Ethosuximide (ETS). 5 patients did not start the therapy immediately after the first AS and they presented recurrent AS (from 2 to 4 episodes). 10 of them performed aCGH, karyotype, NGS panel or Whole Exome Sequencing. CONCLUSIONS We suggest that de novo AS may be a well-defined age-related and self-limited epilepsy syndrome, with a good prognosis and excellent response to therapy, but it comes with a high risk of relapsing if not adequately treated with antiepileptic drugs.
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Affiliation(s)
- C Pepi
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital Research Institute, Rome, Italy; Child Neurology and Psychiatry Unit, System Medicine Unit, Tor Vergata University, Rome, Italy.
| | - E Cesaroni
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - P Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, "G. Gaslini" Institute, University of Genoa, Genova, Italy
| | - D Maiorani
- Division of Pediatrics, Ospedale Belcolle, Viterbo, Rome, Italy
| | - D Pruna
- Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, Italy
| | - S Cossu
- Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, Italy
| | - M Di Capua
- Unit of Neurophysiology, Department of Neurosciences, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - F Vigevano
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - N Specchio
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - R Cusmai
- Unit of Neurophysiology, Department of Neurosciences, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
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13
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Pro S, Moavero R, Marciano S, Vigevano F, Curatolo P, Valeriani M. ERP recording shows subclinical differences in ADHD patients with and without Tuberous Sclerosis. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Beghi E, Capovilla G, Franzoni E, Minicucci F, Romeo A, Verrotti A, Vigevano F, Perucca E. Midazolam vs diazepam in prolonged seizures in children: A pharmacoeconomic approach. Acta Neurol Scand 2018; 137:24-28. [PMID: 28875555 DOI: 10.1111/ane.12814] [Citation(s) in RCA: 4] [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] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A previous European cost-utility study reported that use of buccal midazolam in the community setting for the treatment of prolonged seizures (ie, seizures lasting ≥5 minutes) in children was associated with an overall €12 507 399 reduction in annual costs charged to the Italian national health service compared with rectal diazepam. We re-evaluated these findings by applying a more conservative approach. METHODS The Italian Delphi panel reconvened to apply a more conservative assessment of available reports. A decision-tree model was used, allowing for different treatment pathways depending on whether or not a caregiver administers treatment, an ambulance is required for transport of the child to hospital, and an inpatient stay is required. Direct medical costs were derived from Italian healthcare system data. Estimates of the annual number of prolonged tonic-clonic seizures expected in the country were based on studies which assessed seizure duration using video-EEG recordings and medical records. RESULTS Although drug acquisition costs were greater for buccal midazolam than for rectal diazepam, the acquisition cost difference was outweighed by larger cost savings resulting mostly from a reduction in hospital admissions. Assuming that 1.2% of tonic and/or clonic seizures occurring in children and adolescents over a 12-month period are prolonged, the annual nationwide reduction in costs from preferring buccal midazolam to rectal diazepam was estimated at €3 577 587.9. CONCLUSIONS In this more conservative revised analysis, the high cost of buccal midazolam is still counteracted by greater cost savings compared with rectal diazepam, but cost reduction was less than previously estimated.
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Affiliation(s)
- E. Beghi
- IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”; Milano Italy
| | | | - E. Franzoni
- Azienda Ospedaliera di Bologna; Bologna Italy
| | | | - A. Romeo
- Pediatric Neurology Unit and Epilepsy Center; “Fatebenefratelli e Oftalmico” Hospital; ASST Fatebenefratelli Sacco; Milan Italy
| | - A. Verrotti
- Department of Pediatrics; University of L'Aquila; L'Aquila Italy
| | - F. Vigevano
- Bambino Gesù Children's Hospital; Rome Italy
| | - E. Perucca
- Department of Internal Medicine and Therapeutics; C. Mondino National Neurological Institute; University of Pavia; Pavia Italy
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Pro S, Specchio N, De Palma L, Marras C, Fusco L, Vigevano F, Valeriani M. 40. Event related potentials recorded by intracerebral electrodes. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.047] [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]
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16
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Trivisano M, Bellusci M, Terracciano A, De Palma L, Pietrafusa N, Valeriani M, Vigevano F, Specchio. TBC1D24 gene mutations are associated with high risk of sudden unexpected death. Epilepsy Behav 2017; 72:208-209. [PMID: 28606688 DOI: 10.1016/j.yebeh.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Trivisano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - M Bellusci
- Pediatric Neurology, "12th of October" University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - A Terracciano
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Viale Di San Paolo, 15, 00146 Rome, Italy
| | - L De Palma
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - N Pietrafusa
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - M Valeriani
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - F Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRRCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Chiusolo F, Diamanti A, Bianchi R, Fusco L, Elia M, Capriati T, Vigevano F, Picardo S. From intravenous to enteral ketogenic diet in PICU: A potential treatment strategy for refractory status epilepticus. Eur J Paediatr Neurol 2016; 20:843-847. [PMID: 27594068 DOI: 10.1016/j.ejpn.2016.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/06/2016] [Accepted: 08/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ketogenic diet (KD) has been used to treat refractory status epilepticus (RSE). KD is a high-fat, restricted-carbohydrate regimen that may be administered with different fat to protein and carbohydrate ratios (3:1 and 4:1 fat to protein and carbohydrate ratios). Other ketogenic regimens have a lower fat and higher protein and carbohydrate ratio to improve taste and thus compliance to treatment. We describe a case of RSE treated with intravenous KD in the Pediatric Intensive Care Unit (PICU). CASE REPORT An 8-year-old boy was referred to the PICU because of continuous tonic-clonic and myoclonic generalized seizures despite several antiepileptic treatments. After admission he was intubated and treated with intravenous thiopental followed by ketamine. Seizures continued with frequent myoclonic jerks localized on the face and upper arms. EEG showed seizure activity with spikes on rhythmic continuous waves. Thus we decided to begin KD. The concomitant ileus contraindicated KD by the enteral route and we therefore began IV KD. The ketogenic regimen consisted of conventional intravenous fat emulsion, plus dextrose and amino-acid hyperalimentation in a 2:1 then 3:1 fat to protein and carbohydrate ratio. Exclusive IV ketogenic treatment, well tolerated, was maintained for 3 days; peristalsis then reappeared so KD was continued by the enteral route at 3:1 ratio. Finally, after 8 days and no seizure improvement, KD was deemed unsuccessful and was discontinued. CONCLUSIONS Our experience indicates that IV KD may be considered as a temporary "bridge" towards enteral KD in patients with partial or total intestinal failure who need to start KD. It allows a prompt initiation of KD, when indicated for the treatment of severe diseases such as RSE.
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Affiliation(s)
- F Chiusolo
- Department of Anesthesia and Critical Care, ARCO Rome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - A Diamanti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - R Bianchi
- Department of Anesthesia and Critical Care, ARCO Rome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Fusco
- Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Elia
- Department of Anesthesia and Critical Care, ARCO Rome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - T Capriati
- Department of Anesthesia and Critical Care, ARCO Rome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Picardo
- Department of Anesthesia and Critical Care, ARCO Rome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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De Liso P, Vigevano F, Specchio N, De Palma L, Bonanni P, Osanni E, Coppola G, Parisi P, Grosso S, Verrotti A, Spalice A, Nicita F, Zamponi N, Siliquini S, Giordano L, Martelli P, Guerrini R, Rosati A, Ilvento L, Belcastro V, Striano P, Vari M, Capovilla G, Beccaria F, Bruni O, Luchetti A, Gobbi G, Russo A, Pruna D, Tozzi A, Cusmai R. Effectiveness and tolerability of perampanel in children and adolescents with refractory epilepsies-An Italian observational multicenter study. Epilepsy Res 2016; 127:93-100. [PMID: 27568598 DOI: 10.1016/j.eplepsyres.2016.08.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the efficacy and tolerability of Perampanel (PER) in children and adolescents with refractory epilepsies in daily clinical practice conditions. PATIENTS AND METHODS This Italian multicenter retrospective observational study was performed in 16 paediatric epilepsy centres. Inclusion criteria were: (i) ≤18 years of age, (ii) history of refractory epilepsy, (iii) a follow-up ≥5 months of PER add-on therapy. Exclusion criteria were: (i) a diagnosis of primary idiopathic generalized epilepsy, (ii) variation of concomitant AEDs during the previous 4 weeks. Response was defined as a ≥50% reduction in monthly seizure frequency compared with the baseline. RESULTS 62 patients suffering from various refractory epilepsies were included in this study: 53% were males, the mean age was 14.2 years (range 6-18 years), 8 patients aged <12 years. Mean age at epilepsy onset was 3.4 years and the mean duration of epilepsy was 10.8 years (range 1-16), which ranged from 2 seizures per-month up to several seizures per-day (mean number=96.5). Symptomatic focal epilepsy was reported in 62.9% of cases. Mean number of AEDs used in the past was 7.1; mean number of concomitant AEDs was 2.48, with carbamazepine used in 43.5% of patients. Mean PER daily dose was 7.1mg (2-12mg). After an average of 6.6 months of follow-up (5-13 months), the retention rate was 77.4% (48/62). The response rate was 50%; 16% of patients achieved ≥75% seizure frequency reduction and 5% became completely seizure free. Seizure aggravation was observed in 9.7% of patients. Adverse events were reported in 19 patients (30.6%) and led to PER discontinuation in 4 patients (6.5%). The most common adverse events were behaviour disturbance (irritability and aggressiveness), dizziness, sedation and fatigue. CONCLUSION PER was found to be a safe and effective treatment when used as adjunctive therapy in paediatric patients with uncontrolled epilepsy.
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Pro S, Specchio N, De Palma L, Marras C, Fusco L, Vigevano F, Valeriani M. 97. Event related potentials recorded by intracerebral electrodes. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Pro S, Specchio N, Rebessi E, Marras C, Fusco L, Vigevano F, Valeriani M. ID 119 – Short-latency somatosensory evoked potentials to median and tibial stimulation recorded by intracerebral electrodes. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.342] [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]
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21
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Iacovelli E, Tarantino S, Pro S, Vollono C, Capuano A, Torriero R, Vigevano F, Valeriani M. 70. Correlation between abnormal brain excitability, anger management and anxiety in migraine children. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.089] [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: 11/16/2022]
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22
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Pro S, Specchio N, Rebessi E, Marras C, Fusco L, Vigevano F, Valeriani M. 48. Short-latency somatosensory evoked potentials to median and tibial stimulation recorded by intracerebral electrodes. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Vollono C, Rinalduzzi S, Miliucci R, Vigevano F, Valeriani M. Somatosensory system hyperexcitability in alternating hemiplegia of childhood. Eur J Neurol 2014; 21:1478-e97. [DOI: 10.1111/ene.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- C. Vollono
- Unit of Neurophysiopathology and Sleep Medicine; Department of Geriatrics; Neurosciences and Orthopedics; Catholic University; Rome Italy
| | - S. Rinalduzzi
- Neurology Unit; ‘Sandro Pertini’ Hospital; Rome Italy
| | - R. Miliucci
- Neurology Division; Pediatric Hospital ‘Bambino Gesù’; IRCCS; Rome Italy
| | - F. Vigevano
- Neurology Division; Pediatric Hospital ‘Bambino Gesù’; IRCCS; Rome Italy
| | - M. Valeriani
- Neurology Division; Pediatric Hospital ‘Bambino Gesù’; IRCCS; Rome Italy
- Center for Sensory-Motor Interaction; Aalborg University; Aalborg Denmark
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Pro S, Tarantino S, Capuano A, Vigevano F, Valeriani M. P898: VEP habituation distribution in the families of migraine children. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50934-0] [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: 11/16/2022]
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Pro S, Tarantino S, Capuano A, Vigevano F, Valeriani M. Primary headache pathophysiology in children: The contribution of clinical neurophysiology. Clin Neurophysiol 2014; 125:6-12. [DOI: 10.1016/j.clinph.2013.04.335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 11/28/2022]
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Pro S, Casciani C, Iacovelli E, Vigevano F, Valeriani M. 36. Spatial attention mechanisms in migraine children with imploding or exploding pain: A topographical SEP study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.063] [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: 10/26/2022]
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Casciani C, Tarantino S, Capuano A, Vigevano F, Valeriani M. 38. Familial aggregation of putative biomarkers of migraine: A family-based pilot study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.065] [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: 10/26/2022]
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28
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Valeriani M, Pazzaglia C, Ferraro D, Virdis D, Rotellini S, Le Pera D, Testani E, Minciotti I, Balestri M, Vigevano F, Vollono C. Evidence of different spinal pathways for the warmth evoked potentials. Clin Neurophysiol 2011; 122:2469-74. [DOI: 10.1016/j.clinph.2011.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 04/14/2011] [Accepted: 04/26/2011] [Indexed: 01/09/2023]
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Vollono C, Bizzarri C, Di Capua M, Cappa M, Miliucci R, Vigevano F, Valeriani M. P21.13 Conjugated linoleic acid (CLA) dietary treatment induces neurophysiological modification in heterozygous X-linked adrenoleukodystrophy. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60555-5] [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: 11/16/2022]
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30
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Iacovelli E, Tarantino S, Vollono C, Capuano A, Vigevano F, Valeriani M. P23.14 Psychophysiological mechanisms of spatial attention in migraine children with imploding and exploding pain. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60600-7] [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: 10/17/2022]
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31
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Iacovelli E, Tarantino S, De Ranieri C, Vollono C, Galli F, De Luca M, Vigevano F, Biondi G, Valeriani M. P23.4 Spatial attention in children with primary headache: a combined neurophysiological and neuropsychological approach. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60590-7] [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: 10/17/2022]
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Specchio N, Fusco L, Claps D, Trivisano M, Longo D, Cilio MR, Valeriani M, Cusmai R, Cappelletti S, Gentile S, Fariello G, Specchio LM, Vigevano F. Childhood refractory focal epilepsy following acute febrile encephalopathy. Eur J Neurol 2010; 18:952-61. [DOI: 10.1111/j.1468-1331.2010.03253.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Marini C, Mei D, Parmeggiani L, Norci V, Calado E, Ferrari A, Moreira A, Pisano T, Specchio N, Vigevano F, Battaglia D, Guerrini R. Protocadherin 19 mutations in girls with infantile-onset epilepsy. Neurology 2010; 75:646-53. [PMID: 20713952 DOI: 10.1212/wnl.0b013e3181ed9e67] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the causative role of PCDH19 gene (Xq22) in female patients with epilepsy. METHODS We studied a cohort of 117 female patients with febrile seizures (FS) and a wide spectrum of epilepsy phenotypes including focal and generalized forms with either sporadic or familial distribution. RESULTS PCDH19 screening showed point mutations in 13 probands (11%). Mean age at seizure onset was 8.5 months; 8 patients (62%) presented with FS, 4 (33%) with cluster of focal seizures, and 1 with de novo status epilepticus (SE). Subsequent seizure types included afebrile tonic-clonic, febrile, and afebrile SE, absences, myoclonic, and focal seizures. Seven patients (54%) had a clinical diagnosis consistent with Dravet syndrome (DS); 6 (46%) had focal epilepsy. In most patients, seizures were particularly frequent at onset, manifesting in clusters and becoming less frequent with age. Mental retardation was present in 11 patients, ranging from mild (7; 64%) to moderate (1; 9%) to severe (3; 27%). Five patients (38%) had autistic features in association to mental retardation. Mutations were missense (6), truncating (2), frameshift (3), and splicing (2). Eleven were new mutations. Mutations were inherited in 3 probands (25%): 2 from apparently unaffected fathers and 1 from a mother who had had generalized epilepsy. CONCLUSIONS PCDH19 is emerging as a major gene for infantile-onset familial or sporadic epilepsy in female patients with or without mental retardation. In our cohort, epileptic encephalopathy with DS-like features and focal epilepsy of variable severity were the associated phenotypes and were equally represented.
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Affiliation(s)
- C Marini
- Child Neurology Unit, Children's Hospital A. Meyer, Viale Pieraccini 24, 50139 Firenze, Italy
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Vollono C, Ferraro D, Miliucci R, Vigevano F, Valeriani M. The Abnormal Recovery Cycle of Somatosensory Evoked Potential Components in Children with Migraine can be Reversed by Topiramate. Cephalalgia 2009; 30:17-26. [DOI: 10.1111/j.1468-2982.2009.01892.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to compare the recovery cycle of somatosensory evoked potentials (SEPs) in children with migraine without aura before and after treatment with topiramate. Eleven migraine children were studied before and after a 3-month treatment with topiramate at the average dose of 1.3 mg/kg/day. We calculated the SEP latency and amplitude modifications after paired electrical stimuli at 5, 20 and 40 ms interstimulus intervals, comparing them with a single stimulus condition assumed as baseline. In nine patients, who had a significant reduction in headache frequency after treatment, the recovery cycles of the P24 ( P = 0.03) and N30 ( P < 0.005) potentials were longer after than before topiramate treatment. In two migraineurs who did not show any improvement, the recovery cycles of the cortical SEP components were even shorter after treatment. Our results suggest that topiramate efficacy in paediatric migraine prophylaxis is probably related to restored cortical excitability.
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Affiliation(s)
- C Vollono
- Headache Centre, Neurology
Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Catholic
University, Rome, Italy
| | - D Ferraro
- Institute of Neurology,
Department of Neurosciences, Catholic University, Rome, Italy
| | - R Miliucci
- Headache Centre, Neurology
Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Catholic
University, Rome, Italy
| | - F Vigevano
- Headache Centre, Neurology
Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Catholic
University, Rome, Italy
| | - M Valeriani
- Headache Centre, Neurology
Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Catholic
University, Rome, Italy
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35
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Valeriani M, Galli F, Tarantino S, Graceffa D, Pignata E, Miliucci R, Biondi G, Tozzi A, Vigevano F, Guidetti V. Correlation Between Abnormal Brain Excitability and Emotional Symptomatology in Paediatric Migraine. Cephalalgia 2009; 29:204-13. [DOI: 10.1111/j.1468-2982.2008.01708.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated a possible correlation between brain excitability in children with migraine and tension-type headache (TTH) and their behavioural symptomatology, assessed by using the Child Behaviour Checklist (CBCL). The mismatch negativity (MMN) and P300 response were recorded in three successive blocks to test the amplitude reduction of each response from the first to the third block (habituation). MMN and P300 habituation was significantly lower in migraineurs and TTH children than in control subjects (two-way ANOVA: P < 0.05). In migraineurs, but not in TTH patients, significant positive correlations between the P300 habituation deficit and the CBCL scores were found ( P < 0.05), meaning that the migraineurs with the most reduced habituation showed also the worst behavioural symptomatology. To the best of our knowledge, this is the first study showing a correlation between neurophysiological abnormality and emotional symptomatology in migraine, suggesting a role of the latter in producing the migrainous phenotype.
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Affiliation(s)
- M Valeriani
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - F Galli
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - S Tarantino
- Division of Paediatric Psychology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - D Graceffa
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - E Pignata
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - R Miliucci
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - G Biondi
- Division of Paediatric Psychology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - A Tozzi
- Epidemiology Unit, Ospedale Pediatrico Bambino Gesù IRCCS
| | - F Vigevano
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - V Guidetti
- Department of Child and Adolescent Neurology and Psychiatry, University of Rome ‘La Sapienza’, Rome, Italy
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36
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Striano P, Coppola A, Pezzella M, Ciampa C, Specchio N, Ragona F, Mancardi MM, Gennaro E, Beccaria F, Capovilla G, Rasmini P, Besana D, Coppola GG, Elia M, Granata T, Vecchi M, Vigevano F, Viri M, Gaggero R, Striano S, Zara F. An open-label trial of levetiracetam in severe myoclonic epilepsy of infancy. Neurology 2007; 69:250-4. [PMID: 17636062 DOI: 10.1212/01.wnl.0000265222.24102.db] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To conduct an open-label, add-on trial on safety and efficacy of levetiracetam in severe myoclonic epilepsy of infancy (SMEI). PATIENTS AND METHODS SMEI patients were recruited from different centers according to the following criteria: age > or =3 years; at least four tonic-clonic seizures/month during the last 8 weeks; previous use of at least two drugs. Levetiracetam was orally administrated at starting dose of approximately 10 mg/kg/day up to 50 to 60 mg/kg/day in two doses. Treatment period included a 5- to 6-week up-titration phase and a 12-week evaluation phase. Efficacy variables were responder rate by seizure type and reduction of the mean number per week of each seizure type. Analysis was performed using Fisher exact and Wilcoxon tests. RESULTS Twenty-eight patients (mean age: 9.4 +/- 5.6 years) entered the study. Sixteen (57.1%) showed SCN1A mutations. Mean number of concomitant drugs was 2.5. Mean levetiracetam dose achieved was 2,016 mg/day. Twenty-three (82.1%) completed the trial. Responders were 64.2% for tonic-clonic, 60% for myoclonic, 60% for focal, and 44.4% for absence seizures. Number per week of tonic-clonic (median: 3 vs 1; p = 0.0001), myoclonic (median: 21 vs 3; p = 0.002), and focal seizures (median: 7.5 vs 3; p = 0.031) was significantly decreased compared to baseline. Levetiracetam effect was not related to age at onset and duration of epilepsy, genetic status, and concomitant therapy. Levetiracetam was well tolerated by subjects who completed the study. To date, follow-up ranges 6 to 36 months (mean, 16.2 +/- 13.4). CONCLUSION Levetiracetam add-on is effective and well tolerated in severe myoclonic epilepsy of infancy. Placebo-controlled studies should confirm these findings.
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Affiliation(s)
- P Striano
- Epilepsy Center, Federico II University, Napoli, Italy.
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Abstract
In June 2005 a team of experts participated in a workshop with the objective of reaching agreement on the place of valproate use in the treatment of paediatric epilepsy patients. A general "consensus of the meeting" was that the initiation of antiepileptic drug (AED) treatment should be based on a seizure-syndromic approach in children. Participants of the meeting also agreed that valproate is currently the AED with the broadest spectrum across all types of seizures and syndromes. Its superiority has been shown over almost 40 years of clinical experience. The best results are seen in idiopathic generalized epilepsy with or without photosensitivity, idiopathic focal and symptomatic generalized tonic-clonic seizures (GTCS). Evidence supports the use of valproate, ethosuximide and lamotrigine in absence epilepsies and the use of carbamazepine, lamotrigine, oxcarbazepine, phenytoin, topiramate, valproate and phenobarbital for primary GTCS. For new AEDs trials have been undertaken to define their therapeutic role but studies comparing their role to 'old' broad-spectrum drugs in specific syndromes are missing. Experts concluded that intravenous (i.v.) valproate is a useful agent in the treatment of non-convulsive status epilepticus (SE). There is an easy transition to oral treatment following i.v. valproate use. The discussion also concluded that, despite the lack of studies, valproate is an interesting, underutilized alternative in convulsive SE but more controlled studies are needed. The side effects of valproate use are well documented. Its effect on cognition and behaviour is more favourable than many of the other AEDs which is an important consideration in children. Overall, the clinical consensus of the meeting was that valproate's well established therapeutic properties far outweigh the negative side effects. Contraindication or withdrawal should be assessed individually.
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Affiliation(s)
- A Aldenkamp
- Epilepsy Centre Kempenhaeghe, PO Box 21, 5590 AB Heeze, The Netherlands.
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38
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Specchio N, Fusco L, Vigevano F. P02.2 EEG and clinical characteristics of 98 children with panayiotopoulus syndrome. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Six patients with alternating hemiplegia of childhood (AHC) underwent motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs) and blink reflex recording. No SEP abnormality was found. As for MEP recording, central conduction time did not differ between patients studied during either interictal or ictal phase, and normal subjects, suggesting that the pyramidal system function is spared. In blink reflex recording, the latencies of both the ipsilateral (iR2) and contralateral (cR2) R2 components were significantly longer (P<0.01) in patients during the interictal phase than in normal subjects. Moreover, the iR2 and cR2 areas were significantly reduced (P<0.01) in patients during the interictal phase, compared with normal subjects. During the ictal phase, the ipsilateral R2 latency was significantly decreased after stimulation of the hemiplegic side, compared with the interictal phase (P<0.05). The blink reflex abnormalities suggest a brainstem dysfunction, which may be linked to the pathophysiological mechanisms of the disease.
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Affiliation(s)
- S Rinalduzzi
- Divisione di Neurologia, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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40
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Valeriani M, Tonali P, Le Pera D, Restuccia D, De Armas L, Del Vesco C, Miliucci R, Fiaschi A, Vigevano F, Arendt-Nielsen L, Tinazzi M. Modulation of laser-evoked potentials by experimental cutaneous tonic pain. Neuroscience 2006; 140:1301-10. [PMID: 16626874 DOI: 10.1016/j.neuroscience.2006.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Revised: 02/14/2006] [Accepted: 03/05/2006] [Indexed: 02/08/2023]
Abstract
The present study aimed to investigate whether tonic cutaneous pain exerts any effect on the cortical processing of nociceptive input and if this effect may involve only body parts in pain. Tonic cutaneous pain was obtained in nine healthy human subjects by infusion of a hypertonic saline (5%) in the s.c. tissue over the hypothenar muscles (10 ml/h for 20 min). Nociceptive cutaneous CO2 laser-evoked potentials were recorded after stimulation of the right hand dorsum, which was adjacent to the painful area, and the right perioral region, corresponding to the adjacent cortical sensory area. Laser-evoked potentials were obtained before saline injection, at the peak pain and 20 min after pain disappeared. During saline infusion, the laser-evoked pain to right hand stimulation was reduced and the vertex laser-evoked potentials (N2a-P2, mean latency 181 ms and 319 ms for the N2a and the P2 potentials, respectively), which are generated in the anterior cingulate cortex, were significantly decreased in amplitude compared with the baseline. Moreover, the topography of these potentials was modified by cutaneous pain, shifting from the central toward the parietal region. Dipolar modeling showed that the dipolar source in the anterior cingulate cortex moved backward during saline infusion. This result suggests that cutaneous pain may modify the relative activities of the anterior and posterior anterior cingulate cortex parts, which are thought to be devoted to encode different aspects of pain sensation. No laser-evoked potential change was observed after stimulation of the right perioral region, suggesting that functional changes in the nociceptive system are selective for the painful regions and not for areas with cortical proximity.
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Affiliation(s)
- M Valeriani
- Divisione di Neurologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza Sant'Onofrio 4, 00165 Roma, Italy.
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41
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Valeriani M, Le Pera D, Restuccia D, de Armas L, Maiese T, Tonali P, Vigevano F, Arendt-Nielsen L. Segmental inhibition of cutaneous heat sensation and of laser-evoked potentials by experimental muscle pain. Neuroscience 2005; 136:301-9. [PMID: 16182455 DOI: 10.1016/j.neuroscience.2005.07.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 07/19/2005] [Accepted: 07/20/2005] [Indexed: 12/17/2022]
Abstract
The aim of the study was to evaluate the effect of tonic muscle pain evoked by injection of 5% hypertonic saline in the right brachioradialis muscle on the somatosensory sensation of laser-evoked heat pain and laser-evoked potentials. The heat pain pathways were studied in 9 healthy human subjects by recording the scalp potentials evoked by CO(2) laser stimuli delivered on four sites: the skin above the right brachioradialis muscle (ipsilateral local pain), the wrist area where muscle pain was referred in all subjects (ipsilateral referred pain), and two areas on the left arm symmetrical to both local and referred pain (contralateral local pain and contralateral referred pain). Laser-evoked potentials were obtained from 31 scalp electrodes before saline injection, during saline infusion (bolus injection with 0.3 ml saline infused over 20 s, followed by a steady infusion rate of 30 ml/h for the next 25 min), and 20 min after muscle pain had disappeared. While the early N1/P1 component (around 130 ms and 145 ms of latency after stimulation of the skin over the brachioradialis muscle and the wrist, respectively) was not affected by muscle pain, the amplitudes of the later vertex laser-evoked potentials (N2 latency of around 175 ms and 210 ms after stimulation of the skin over the brachioradialis muscle and the wrist, respectively; P2 latency of around 305 ms and 335 ms after stimulation of the skin over the brachioradialis muscle and the wrist, respectively) evoked from ipsilateral local pain, ipsilateral referred pain, and contralateral local pain sites were significantly decreased during muscle pain compared with the baseline recording, while they recovered after pain had disappeared. At the same stimulation sites, the rating of the laser-evoked pain sensation was reduced significantly during muscle pain as compared with the baseline and it recovered after pain had disappeared. On the contrary, muscle pain did not show any effect on both laser-evoked pain and laser-evoked potential amplitude when the contralateral referred pain site was stimulated. The muscle pain inhibitory effect on both heat pain sensation and laser-evoked potential amplitude is probably mediated by an ipsilateral and contralateral segmental mechanism which acts also on the referred pain area, while more general inhibitory mechanisms, such as a distraction effect or a diffuse noxious inhibitory control, are excluded by the absence of any effect of muscle pain on laser-evoked pain and laser-evoked potentials obtained from a remote site, such as the contralateral referred pain area. Since muscle pain induced by hypertonic saline injection is very similar to clinical pain, our results can be useful in understanding the pathophysiology of the somatosensory modifications which can be observed in patients with musculoskeletal pain syndromes.
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Affiliation(s)
- M Valeriani
- Divisione di Neurologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza Sant'Onofrio 4, 00165 Roma, Italy.
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42
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Abstract
Resistant epilepsy is defined as the persistence of unacceptable seizures, despite correct drug treatment, or control of seizures at the cost of excessive side effects. About 30% of partial seizures are resistant to treatment; many of them is potentially a candidate for surgical treatment. Selection of patients is based fundamentally on precise identification of the epileptogenic area and on the evaluation that possible removal of that area will not be followed by serious neurological or neuropsychological deficits, or by onset of seizures in another part of the brain. To this end, careful clinical, neurophysiological and functional studies are conducted. Compared with adults, video-electroencephalographic (EEG) study of seizures in childhood is more difficult because of the lack of patient cooperation and, therefore, the lack of every subjective element in the seizures. Furthermore, the criteria for defining drug resistance in childhood are still under discussion, as many epilepsies are age dependent and seizures stop with growth. Despite this, the age at time of surgery has been steadily decreasing, in the conviction that the persistence of intractable partial epilepsy is detrimental to cognitive development and can damage brain areas that are apparently healthy. The clinical and EEG criteria for epilepsies that are secondary to some specific disorders have been defined, e.g. hemimegalencephalia and focal cortical dysplasias often produce epilepsy with onset in the first days of life characterized by partial seizures and subintrant spasms, EEG record of focal or hemispheric burst suppression and drug resistance that can be defined within the first months of life. Prolonged video-EEG monitoring is always necessary to establish congruence between the area in which the seizure originates and the brain lesion evidenced at neuroimaging. Correct monitoring of seizures means close cooperation between neurologist, neurophysiology technician and the patient, if the child is at least 5-6 y old. Absence of cooperation also limits the use of in-depth recording. Neuropsychological assessment of the child can be of great help in defining the area damaged by the epileptogenic site as well as the state of the other brain areas. Close cooperation between neurologist, radiologist, neuropsychologist and brain surgeon is necessary for a case-by-case assessment of indication for surgical treatment.
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Affiliation(s)
- L Fusco
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Research Institute, IRCCS, Rome, Italy.
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43
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Granata T, Fusco L, Gobbi G, Freri E, Ragona F, Broggi G, Mantegazza R, Giordano L, Villani F, Capovilla G, Vigevano F, Bernardina BD, Spreafico R, Antozzi C. Experience with immunomodulatory treatments in Rasmussen's encephalitis. Neurology 2003; 61:1807-10. [PMID: 14694056 DOI: 10.1212/01.wnl.0000099074.04539.e0] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors investigated immunomodulatory treatments in 15 patients with Rasmussen encephalitis (RE) (14 with childhood and one with adolescent onset RE). Positive time-limited responses were obtained in 11 patients using variable combinations of corticosteroids, apheresis, and high-dose IV immunoglobulins. Although surgical exclusion of the affected hemisphere is the only treatment that halts disease progression, immunomodulation can be considered when early surgery is not feasible, in late-onset patients with slower disease progression, and in the few cases of bilateral disease.
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Affiliation(s)
- T Granata
- Division of Child Neurology, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
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44
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Nabbout R, Gennaro E, Dalla Bernardina B, Dulac O, Madia F, Bertini E, Capovilla G, Chiron C, Cristofori G, Elia M, Fontana E, Gaggero R, Granata T, Guerrini R, Loi M, La Selva L, Lispi ML, Matricardi A, Romeo A, Tzolas V, Valseriati D, Veggiotti P, Vigevano F, Vallée L, Dagna Bricarelli F, Bianchi A, Zara F. Spectrum of SCN1A mutations in severe myoclonic epilepsy of infancy. Neurology 2003; 60:1961-7. [PMID: 12821740 DOI: 10.1212/01.wnl.0000069463.41870.2f] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES SCN1A mutations were recently reported in several patients with severe myoclonic epilepsy in infancy (SMEI). The authors analyzed SCN1A mutations in 93 patients with SMEI and made genotype-phenotype correlation to clarify the role of this gene in the etiology of SMEI. METHODS All patients fulfilled the criteria for SMEI. The authors analyzed all patients for SCN1A mutations using denaturing high performance liquid chromatography. If a patient's chromatogram was abnormal, the authors sequenced the gene in the patient and both parents. RESULTS SCN1A mutations were identified in 33 patients (35%). Most mutations were de novo, but were inherited in three patients. Parents carrying the inherited mutations had either no symptoms or a milder form of epilepsy. A greater frequency of unilateral motor seizures was the only clinical difference between patients with SCN1A mutations and those without. Truncating mutations were more frequently associated with such seizures than were missense mutations. The percentage of cases with family history of epilepsy was significantly higher in patients with SCN1A mutations. CONCLUSIONS Unilateral motor seizures may be a specific clinical characteristic of SMEI caused by SCN1A mutations. Ten percent of SCN1A mutations are inherited from an asymptomatic or mildly affected parent, suggesting that SMEI is genetically heterogeneous. The increased frequency of familial epilepsy indicates that other genetic factors may contribute to this disorder.
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45
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Granata T, Gobbi G, Spreafico R, Vigevano F, Capovilla G, Ragona F, Freri E, Chiapparini L, Bernasconi P, Giordano L, Bertani G, Casazza M, Dalla Bernardina B, Fusco L. Rasmussen's encephalitis: early characteristics allow diagnosis. Neurology 2003; 60:422-5. [PMID: 12578922 DOI: 10.1212/wnl.60.3.422] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify early manifestations of Rasmussen encephalitis (RE) that can prompt early and reasonably secure diagnosis, allowing medical or surgical therapies at an early stage when they may be more effective in slowing the disease. METHODS The authors studied 12 patients with clinical and neuropathologic diagnosis of RE, followed from disease onset, assessing clinical history, imaging, and EEG and focusing on early characteristics. Anti-GluR3 antibody assays were also considered in 11 patients. RESULTS By 4 months from first symptoms, all cases had 1) refractory focal seizures with a predominant motor component, 2) slow focal activity on EEG contralateral to the motor manifestations, and 3) focal contralateral white matter hyperintensity with insular cortical atrophy on neuroimaging. Less constant or later findings were epilepsia partialis continua, oligoclonal bands, and serum anti-GluR3 antibodies. CONCLUSIONS The association of partial seizures with focal EEG and neuroimaging changes allows a tentative diagnosis of RE 4 to 6 months after first symptoms.
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Affiliation(s)
- T Granata
- Division of Child Neurology, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
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46
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Lispi ML, Vigevano F. Benign paroxysmal tonic upgaze of childhood with ataxia. Epileptic Disord 2001; 3:203-6. [PMID: 11844715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Paroxysmal tonic upgaze deviation (PTU) is a rare neuro-ophthalmological disorder with onset in infancy or early childhood. It consists of episodes of sustained, conjugate, upward deviation of the eyes, down beating saccades in attempted downgaze, apparently preserved horizontal eye movements, frequent association with mild ataxia or clumsiness at time of illness, normal metabolic, electroencephalographic and neuroradiological findings. Symptoms are frequently relieved by sleep and can be exacerbated by fatigue or illness. Although PTU generally tends to disappear spontaneously within a few months or years, subsequent case reports have demonstrated the heterogeneous nature of the syndrome with respect to outcome. To date, the pathogenesis of the condition is still unknown. We present a new case of PTU with ataxia occurring in an otherwise healthy child, as documented by video recording of the phenomenon.
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Affiliation(s)
- M L Lispi
- Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
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47
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Abstract
In infancy, partial epilepsies have been considered with suspicion for their probable association with brain lesions. Japanese authors first described partial epilepsies in infancy with a favorable outcome and called them benign partial epilepsy in infancy with complex partial seizures. Similar, but familial, cases with onset during the first year of life were described some years later and called benign infantile familial convulsions. Similar familial cases with subsequent choreoathetosis were described in 1997 and called infantile convulsions and choreoathetosis. Benign infantile convulsions have also been described in association with mild gastroenteritis. Interictal electroencephalography (EEG) was always normal in all of these forms. More recently, a new epileptic syndrome characterized by partial seizures with onset between ages 13 and 30 months, a benign outcome, and characteristic EEG abnormalities in the vertex regions during sleep has been described. There is also an early-onset benign childhood occipital seizure susceptibility syndrome that can start in infancy.
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Affiliation(s)
- G Capovilla
- Department of Child Neuropsychiatry, C. Poma Hospital, Mantova, Italy.
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48
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Abstract
Spasms are a form of epileptic seizure typical of infancy. From a clinical point of view, the child presents a flexor-extensor movement involving the trunk and limbs and lasting about 1s. Although asymmetry can be present, the seizure involves both sides of the body. The ictal discharge most frequently associated with spasms in West syndrome (WS) is a diffuse triphasic slow high-amplitude wave and less frequently a low-amplitude brief rapid rhythm. The origin of the spasm in WS and classification as either partial or generalized seizure are the subject of much discussion. Factors supporting partial origin include: interictal electroencephalography (EEG) characterized by multifocal anomalies; high incidence of focal cortical lesions and remission of spasms following surgical removal of focal lesions. Factors supporting generalized origin are: clinical involvement of the entire body; mostly generalized ictal EEG pattern; existence of idiopathic cases and possibility of spasms immediately following a partial seizure like a particular form of secondary generalization. In our opinion, the categories of 'partial' and 'generalized' seizures are not applicable to spasms in WS. Sometimes the spasms in WS can be observed together with other types of partial or generalized seizures. Polygraphic recordings have demonstrated that despite being clinically similar, each spasm is different from the other because of a variable sequence in muscular contraction. These data support the peculiar nature of the spasm in WS that could be a subcortical phenomenon that requires a cortical trigger.
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Affiliation(s)
- F Vigevano
- Division of Neurology, Bambino Gesù Children Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
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49
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Abstract
The aim of the study was to assess the efficacy and safety of felbamate (FBM) as add-on therapy in pediatric patients with severe uncontrolled seizures during a 3-year follow-up. Thirty-six patients were enrolled between February 1994 and February 1997. Patients suffered from partial epilepsy (n=13), Lennox-Gastaut syndrome (LGS) (n=9), infantile spasms (IS) n=8 or other forms of generalized epilepsy (n=6). FBM was titrated weekly from 15 up to 45 mg/kg. By February 1995, all patients had hematological and biochemical monitoring prior to FBM therapy and every 15 days during the study. The results achieved at different treatment durations were analyzed. Overall efficacy measured as > or =50% reduction in seizure frequency varied during follow-up: 69% at 3 months, progressively decreasing to 66% at 6 months, to 47% at 1 year and 41% of the initial cohort at the end of the study. Most frequent side effects were anorexia, weight loss, urinary retention, somnolence, nervousness and insomnia. FBM controlled a broad spectrum of otherwise refractory seizures. Best results were obtained against simple partial seizures with or without secondary generalization, tonic and atonic seizures. A substantial improvement in seizure control was maintained in one-third of the patients for at least 3 years.
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Affiliation(s)
- M R Cilio
- Division of Neurology, Bambino Gesú Children's Hospital, Rome, Italy.
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50
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Abstract
Early-infantile epileptic encephalopathy (EIEE) with suppression-bursts is a severe neonatal epileptic encephalopathy. The etiology is multiple, with cerebral malformations as the more frequent. We review the clinical and video/EEG aspects of eight infants with EIEE. These infants, aged between 4 and 70 days at the time of video/EEG recordings, were studied in relation to their clinical and video/EEG characteristics, evolution, persistence of suppression-burst pattern and etiology. Seven of the eight infants showed an ictal clinical sign correlated to the burst of the suppression-burst pattern, four of whom died within 11 months of age. The other three are alive. One, now aged 4 years, underwent surgery for hemimegalencephaly and is seizure-free, with good neurological outcome. One, now aged 9 months, was pyridoxine-dependent and she is seizure-free, and with normal neurological evolution under pyridoxine therapy. One, now aged 3 years and 9 months, is seizure-free, but with severe neurological and cognitive impairment. The only child who did not show a clinical ictal correlation of burst is also alive, now aged 3 years and 9 months, with drug-resistant epilepsy, and severe neurological and cognitive deficits. With regard to the etiology, three showed structural abnormalities, two more showed some signs of prenatal origin of neurological disease, and three had metabolic etiology. Our study confirms that EIEE is a severe age-dependent early epileptic encephalopathy. The etiology is mostly malformative. The prognosis is poor regarding motor and cognitive development, seizures, as well as life expectancies. The presence of an ictal burst of the suppression-burst pattern usually correlates with a negative outcome.
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MESH Headings
- Brain/abnormalities
- Electroencephalography
- Epilepsy, Generalized/diagnosis
- Epilepsy, Generalized/drug therapy
- Epilepsy, Generalized/etiology
- Fatal Outcome
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/etiology
- Male
- Prognosis
- Pyridoxine/therapeutic use
- Videotape Recording
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Affiliation(s)
- L Fusco
- Division of Neurology, Bambino Gesu' Children's Hospital, Piazza S. Onofrio, 4, 00165 Rome, Italy.
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