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Chiarello D, Cognolato E, Francione S, Nobile G, Bosisio L, Barbagallo G, Pacetti M, Tortora D, Cantalupo G, Nobili L, Consales A. Negative MRI and a seizure onset zone close to eloquent areas in FCD type II: Application of MRg-LiTT after a SEEG re-evaluation in pediatric patients with a previous failed surgery. Epilepsy Behav 2024; 153:109694. [PMID: 38401416 DOI: 10.1016/j.yebeh.2024.109694] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Negative MRI and an epileptogenic zone (EZ) adjacent to eloquent areas are two main issues that can be encountered during pre-surgical evaluation for epilepsy surgery. Focal Cortical Dysplasia type II (FCD type II) is the most common aetiology underlying a negative MRI. The objective of this study is to present three cases of pediatric patients exhibiting negative MRI and a seizure onset zone close to eloquent areas, who previously underwent traditional open surgery or SEEG-guided radiofrequency thermocoagulations (RF-TC). After seizure seizure recrudescence, pre-surgical SEEG was re-evaluated and Magnetic Resonance-guided laser interstitial thermal therapy (MRg-LiTT) was performed. We discuss the SEEG patterns, the planning of laser probes trajectories and the outcomes one year after the procedure. METHODS Pediatric patients who underwent SEEG followed by MRg-LiTT for drug-resistant epilepsy associated with FCD type II at our Centre were included. Pre-surgical videoEEG (vEEG), stereoEEG (sEEG), and MRI were reviewed. Post-procedure clinical outcome (measured by Engel score) and complications rates were evaluated. RESULTS Three patients underwent 3 MRg-LiTT procedures from January 2022 to June 2022. Epileptogenic zone was previously studied via SEEG in all the patients. All the three patients pre-surgical MRI was deemed negative. Mean age at seizure onset was 47 months (21-96 months), mean age at MRg-LiTT was 12 years (10 years 10 months - 12 years 9 months). Engel class Ia outcome was achieved in patients #2 and #3, Engel class Ib in patient #1. Mean follow-up length was of 17 months (13 months - 20 months). Complications occurred in one patient (patient #2, extradural hematoma). CONCLUSIONS The combined use of SEEG and MRg-LiTT in complex cases can lead to good outcomes both as a rescue therapy after failed surgery, but also as an alternative to open surgery after a successful SEEG-guided Radiofrequency Thermocoagulation (RF-TC). Specific SEEG patterns and a previous good outcome from RF-TC can be predictors of a favourable outcome.
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Affiliation(s)
- D Chiarello
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Neurology of Epilepsy and Movement Disorder Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Italy
| | - E Cognolato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - S Francione
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital, Milan, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Nobile
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - L Bosisio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - G Barbagallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3)
| | - M Pacetti
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - D Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - G Cantalupo
- Child Neuropsychiatry Unit, University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy; Center for Research on Epilepsy in Pediatric age (CREP), University Hospital of Verona, Verona, Italy; Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - L Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy(3).
| | - A Consales
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Williams N, Wang S, Arnulfo G, Nobili L, Palva S, Palva J. Modules in connectomes of phase-synchronization comprise anatomically contiguous, functionally related regions. Neuroimage 2023; 272:120036. [PMID: 36966852 DOI: 10.1016/j.neuroimage.2023.120036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Modules in brain functional connectomes are essential to balancing segregation and integration of neuronal activity. Connectomes are the complete set of pairwise connections between brain regions. Non-invasive Electroencephalography (EEG) and Magnetoencephalography (MEG) have been used to identify modules in connectomes of phase-synchronization. However, their resolution is suboptimal because of spurious phase-synchronization due to EEG volume conduction or MEG field spread. Here, we used invasive, intracerebral recordings from stereo-electroencephalography (SEEG, N = 67), to identify modules in connectomes of phase-synchronization. To generate SEEG-based group-level connectomes affected only minimally by volume conduction, we used submillimeter accurate localization of SEEG contacts and referenced electrode contacts in cortical gray matter to their closest contacts in white matter. Combining community detection methods with consensus clustering, we found that the connectomes of phase-synchronization were characterized by distinct and stable modules at multiple spatial scales, across frequencies from 3 to 320 Hz. These modules were highly similar within canonical frequency bands. Unlike the distributed brain systems identified with functional Magnetic Resonance Imaging (fMRI), modules up to the high-gamma frequency band comprised only anatomically contiguous regions. Notably, the identified modules comprised cortical regions involved in shared repertoires of sensorimotor and cognitive functions including memory, language and attention. These results suggest that the identified modules represent functionally specialised brain systems, which only partially overlap with the brain systems reported with fMRI. Hence, these modules might regulate the balance between functional segregation and functional integration through phase-synchronization.
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Donniaquio A, Mattioli P, Orso B, Saverino D, Strangio A, Benedetti L, Franciotta D, Cordani R, Calizzano F, Mancini R, Valcalda A, Nobili L, Nobili F, Arnaldi D. Anti-hypothalamic autoantibodies in patients with Narcolepsy. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.416] [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: 11/15/2022]
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Cordani R, Veneruso M, Napoli F, Milanaccio C, Verrico A, Consales A, Cataldi M, Fava D, Di Iorgi N, Maghnie M, Mancardi M, Nobili L. Sleep disturbances in craniopharyngioma: a challenging diagnosis. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.291] [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: 11/28/2022]
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Veneruso M, Pizza F, Filardi M, Antelmi E, Nobili L, Plazzi G. Heterogeneous Neuropsychiatric Symptoms and Outcome in Very Early-Onset Narcolepsy Type 1: a Case Series. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.432] [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: 11/16/2022]
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Miano S, Fanfulla F, Nobili L, Heinzer R, Haba-Rubio J, Berger M, Cereda C, Schmidt M, Manconi M, Bassetti C. SAS CARE 1: Sleep architecture changes in a cohort of patients with Ischemic Stroke/TIA. Sleep Med 2022; 98:106-113. [DOI: 10.1016/j.sleep.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
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Parmigiani S, Mikulan EP, Russo S, Sarasso S, Zauli FM, Rubino A, Cattani A, Fecchio M, Giampiccolo D, Lanzone J, D'Orio P, Del Vecchio M, Avanzini P, Nobili L, Sartori I, Massimini M, Pigorini A. Simultaneous stereo-EEG and high-density scalp EEG recordings to study the effects of intracerebral stimulation parameters. Brain Stimul 2022; 15:664-675. [PMID: 35421585 DOI: 10.1016/j.brs.2022.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/17/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEPs) recorded by stereo-electroencephalography (SEEG) are a valuable tool to investigate brain reactivity and effective connectivity. However, invasive recordings are spatially sparse since they depend on clinical needs. This sparsity hampers systematic comparisons across-subjects, the detection of the whole-brain effects of intracortical stimulation, as well as their relationships to the EEG responses evoked by non-invasive stimuli. OBJECTIVE To demonstrate that CCEPs recorded by high-density electroencephalography (hd-EEG) provide additional information with respect SEEG alone and to provide an open, curated dataset to allow for further exploration of their potential. METHODS The dataset encompasses SEEG and hd-EEG recordings simultaneously acquired during Single Pulse Electrical Stimulation (SPES) in drug-resistant epileptic patients (N = 36) in whom stimulations were delivered with different physical, geometrical, and topological parameters. Differences in CCEPs were assessed by amplitude, latency, and spectral measures. RESULTS While invasively and non-invasively recorded CCEPs were generally correlated, differences in pulse duration, angle and stimulated cortical area were better captured by hd-EEG. Further, intracranial stimulation evoked site-specific hd-EEG responses that reproduced the spectral features of EEG responses to transcranial magnetic stimulation (TMS). Notably, SPES, albeit unperceived by subjects, elicited scalp responses that were up to one order of magnitude larger than the responses typically evoked by sensory stimulation in awake humans. CONCLUSIONS CCEPs can be simultaneously recorded with SEEG and hd-EEG and the latter provides a reliable descriptor of the effects of SPES as well as a common reference to compare the whole-brain effects of intracortical stimulation to those of non-invasive transcranial or sensory stimulations in humans.
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Affiliation(s)
- S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - E P Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - A Cattani
- Department of Mathematics & Statistics, Boston University, Boston, MA, USA
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - D Giampiccolo
- Department of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - J Lanzone
- Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - P D'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - M Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - P Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Biomedical, V, Università degli Studi di Milano, Milan, Italy.
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Tassano E, Ronchetto P, Severino M, Divizia MT, Lerone M, Uccella S, Nobili L, Tavella E, Morerio C, Coviello D, Malacarne M. Scoliosis with cognitive impairment in a girl with 8q11.21q11.23 microdeletion and SNTG1 disruption. Bone 2021; 150:116022. [PMID: 34048959 DOI: 10.1016/j.bone.2021.116022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
Idiopathic scoliosis (IS) is an abnormality of the vertebral column with a spine curvature of at least 10 degrees. It is the most common spinal deformity in children with a prevalence of 2%-3%, and its aetiology is unknown. Genetic factors are known to play a role and a number of linkage analyses showed associations of various loci. Here we describe a new case of a de novo interstitial deletion 8q11.21q11.2 disrupting SNTG1 gene, identified by array-CGH in a girl with cognitive impairment and a scoliosis that 'appears' like to IS. SNTG1 encodes γ-1 Syntrophin protein that is part of the dystrophin associated protein complex and interacts directly with the C-terminal of dystrophin. Its expression is restricted to neurons and particularly in those areas of the brain that have been suggested to affect postural control. The involvement of SNTG1 gene in IS was already been reported in a family with a breakpoint between exons 10 and 11. Mutational analysis of SNTG1 exons in 152 sporadic IS patients had revealed changes in three patients. In conclusion, our data add a further line of evidence suggesting SNTG1 could represent an interesting candidate for its involvement in scoliosis.
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Affiliation(s)
- E Tassano
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - P Ronchetto
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M T Divizia
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Lerone
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Uccella
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Neonatolgy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Nobili
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - E Tavella
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Morerio
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Coviello
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - M Malacarne
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Coviello D, Bizzarri V, Nobili L, Amore M, Tammimies K. Essential information on genetic testing methods that each clinician needs to know/understand. Eur Psychiatry 2021. [PMCID: PMC9471902 DOI: 10.1192/j.eurpsy.2021.157] [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: 11/29/2022] Open
Abstract
Genetic testing is well established in many areas of clinical medicine, is increasingly used in clinical psychiatry and it becomes increasingly important to understand the scope and limitations of the different genetic tests applied. The recommended genetic work-up of patients with neurodevelopmental disorders (such as intellectual disability or autism spectrum disorders) includes conventional karyotyping (low resolution) able to detect chromosomal rearrangement and structural variants (>5Mb, 5 million-bp), testing for fragile X-Syndrome, screening for deletions and duplications down to 20 Kb by Comparative Genomic Hybridisation (CGH), able to detect Copy Number Variation (CNVs; gain or loss of genetic material compared to the reference genome). Sanger sequencing is used for mapping of single base pair genetic variants in single genes but unable to identify deletions or duplications. The more advanced Next Generation Sequencing (NGS) have enabled to detect variants in panels of 10-100 (or more) genes, or in all coding regions using Whole Exome Sequencing (WES; 23.000 genes). Whole Genome Sequencing (WGS) analysis enables also the detection of all size range and types of genetic variation including CNVs, trinucleotide repeats and translocations. All this led to an impressive change in interpreting genomic variants that need to be strictly linked to clinical information before it can be used by clinicians to improve diagnosis or care. Bioinformatic tools to annotate variants, predict their effects and select the genes and genomic regions of interest are needed to guide the clinical work followed with careful evaluation of the prioritized variants based on the clinical knowledge (https://www.cost.eu/actions/CA17130/#tabs|Name:overview).
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Russo S, Pigorini A, Mikulan E, Sarasso S, Rubino A, Zauli FM, Parmigiani S, d'Orio P, Cattani A, Francione S, Tassi L, Bassetti CLA, Lo Russo G, Nobili L, Sartori I, Massimini M. Focal lesions induce large-scale percolation of sleep-like intracerebral activity in awake humans. Neuroimage 2021; 234:117964. [PMID: 33771696 DOI: 10.1016/j.neuroimage.2021.117964] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Focal cortical lesions are known to result in large-scale functional alterations involving distant areas; however, little is known about the electrophysiological mechanisms underlying these network effects. Here, we addressed this issue by analysing the short and long distance intracranial effects of controlled structural lesions in humans. The changes in Stereo-Electroencephalographic (SEEG) activity after Radiofrequency-Thermocoagulation (RFTC) recorded in 21 epileptic subjects were assessed with respect to baseline resting wakefulness and sleep activity. In addition, Cortico-Cortical Evoked Potentials (CCEPs) recorded before the lesion were employed to interpret these changes with respect to individual long-range connectivity patterns. We found that small structural ablations lead to the generation and large-scale propagation of sleep-like slow waves within the awake brain. These slow waves match those recorded in the same subjects during sleep, are prevalent in perilesional areas, but can percolate up to distances of 60 mm through specific long-range connections, as predicted by CCEPs. Given the known impact of slow waves on information processing and cortical plasticity, demonstrating their intrusion and percolation within the awake brain add key elements to our understanding of network dysfunction after cortical injuries.
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Affiliation(s)
- S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - E Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - P d'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy; Institute of Neuroscience, CNR, via Volturno 39E, 43125 Parma, Italy
| | - A Cattani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - S Francione
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Tassi
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - C L A Bassetti
- Department of Neurology, Inselspital, University of Bern, Switzerland
| | - G Lo Russo
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova 16147, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Milan 20148, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada.
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Bernasconi R, Panzeri G, Firtin G, Kahyaoglu B, Nobili L, Magagnin L. Electrodeposition of ZnNi Alloys from Choline Chloride/Ethylene Glycol Deep Eutectic Solvent and Pure Ethylene Glycol for Corrosion Protection. J Phys Chem B 2020; 124:10739-10751. [PMID: 33174746 PMCID: PMC7735728 DOI: 10.1021/acs.jpcb.0c04784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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The present work follows the trend
to develop non-aqueous electrolytes
for the deposition of corrosion resistant ZnNi alloys. It investigates
the use of the choline chloride/ethylene glycol (1:2 molar ratio)
eutectic mixture and of pure ethylene glycol as solvents for ZnNi
electroplating. The electrochemical behavior of Zn and Ni is investigated
via cyclic voltammetry, and potentiostatic ZnNi deposition is performed.
Ni content is found to be precisely tunable in the 10–20% wt
range, which presents the highest industrial interest for corrosion
protection. ZnNi coatings obtained are characterized from the morphological
and phase composition point of view. Evidence of the formation of
a metastable γ ZnNi phase is observed for both choline chloride/ethylene
glycol and pure ethylene glycol. Finally, potentiodynamic corrosion
tests are performed to assess their corrosion properties.
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Affiliation(s)
- R Bernasconi
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
| | - G Panzeri
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
| | - G Firtin
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
| | - B Kahyaoglu
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
| | - L Nobili
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
| | - L Magagnin
- Dipartimento di Chimica, Materiali e Ingegneria Chimica Giulio Natta, Via Mancinelli 7, 20131, Milano, Italy
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Khalil MI, Bernasconi R, Lucotti A, Le Donne A, Mereu RA, Binetti S, Hart JL, Taheri ML, Nobili L, Magagnin L. CZTS thin film solar cells on flexible Molybdenum foil by electrodeposition-annealing route. J APPL ELECTROCHEM 2020. [DOI: 10.1007/s10800-020-01494-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Earth-abundant and non-toxic Kesterite-based Cu2ZnSnS4 (CZTS) thin film solar cells are successfully fabricated on flexible Molybdenum (Mo) foil substrates by an electrodeposition-annealing route. A well-adherent, densely packed, homogeneous, compact, and mirror-like CZT precursor is initially produced through electrodeposition by using a rotating working electrode. Subsequently, the co-electrodeposited CuZnSn (CZT) precursor is sulfurized in quartz tube furnace at 550 °C for 2 h in N2 atmosphere with the presence of elemental sulfur in order to form CZTS. Different characterization techniques like XRD, SEM, HR-TEM, Raman, and Photoluminescence demonstrate that almost phase-pure CZTS formed after sulfurization. A flexible Al/Al-ZnO/i-ZnO/CdS/CZTS/Mo foil solar cell is produced, where CdS is deposited by chemical bath deposition and transparent conducting oxide (TCO) is deposited by DC sputtering. The CZTS solar device shows a 0.55% power conversion efficiency on flexible Mo foil substrate and it constitutes the first prototype of this kind of solar cell produced by electrodeposition-annealing route without any surface modification of the Mo substrate.
Graphic abstract
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Bernasconi C, Ott SR, Fanfulla F, Miano S, Horvath T, Seiler A, Cereda CW, Brill AK, Young P, Nobili L, Manconi M, Bassetti CLA. SAS CARE 2 - a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack. Sleep Med X 2020; 2:100027. [PMID: 33870178 PMCID: PMC8041126 DOI: 10.1016/j.sleepx.2020.100027] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Objective/background The benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. Patients/methods. Non-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index. Results Among 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0–5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24. Conclusion No benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate. No benefit of CPAP started 3 months post-stroke was found. A sufficient CPAP compliance was observed over 2 years in 60% of patients. Studies of CPAP in mild stroke need to be large and include long-term outcomes.
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Affiliation(s)
- C Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S R Ott
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Pulmonary and Sleep Medicine, St. Claraspital, Basel, Switzerland
| | - F Fanfulla
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - S Miano
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - T Horvath
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - A Seiler
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - C W Cereda
- Stroke Center EOC, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - A-K Brill
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Young
- University Hospital Münster, Department of Neurology, Münster, Germany
| | - L Nobili
- Department of Neurology, Ospedale Niguarda, Milano, Italy.,DINOGMI, University of Genoa, Genoa, Italy
| | - M Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - C L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: an EAN, ESRS and ILAE-Europe consensus review. Eur J Neurol 2020; 28:15-32. [PMID: 32959446 DOI: 10.1111/ene.14468] [Citation(s) in RCA: 13] [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] [Received: 04/06/2020] [Accepted: 08/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Some epilepsy syndromes (sleep-related epilepsies, SREs) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. Our purpose was to define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology, the European Sleep Research Society and the International League Against Epilepsy Europe. The framework entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For the literature search a stepwise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: Despite a low quality of evidence, recommendations on anamnestic evaluation and tools for capturing the event at home or in the laboratory are provided for specific SREs. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizure control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. Advice is provided that could be of help for standardizing and improving the diagnostic approach of specific SREs. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- L Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy
| | - A de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, The Netherlands
| | - G Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - P Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - B Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - R Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - P Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - J Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - P Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - C Bassetti
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Koutroumanidis
- Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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Proserpio P, Marra S, Campana C, Agostoni EC, Palagini L, Nobili L, Nappi RE. Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric 2020; 23:539-549. [PMID: 32880197 DOI: 10.1080/13697137.2020.1799973] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 01/30/2023]
Abstract
The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.
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Affiliation(s)
- P Proserpio
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - S Marra
- DINOGMI, University of Genoa, Genoa, Italy
| | - C Campana
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - E C Agostoni
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - L Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, School of Medicine, University of Pisa, Pisa, Italy
| | - L Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Malattia C, Carpaneto M, Mazzoni M, Lavarello C, Fueri E, Marra S, Ravelli A, Nobili L. AB0992 CONNECTING SLEEP QUALITY, PAIN AND MOOD DISTURBANCES IN JUVENILE FIBROMYALGIA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6112] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Subjective sleep problems, including difficulties falling asleep, waking up, un-restorative sleep and daytime sleepiness are highly prevalent in patients with juvenile fibromyalgia (JFM). Sleep disturbances has been considered a consequence of severe pain and depression, but also in healthy individuals sleep deprivation is also a risk factor for the development of chronic widespread pain, tenderness and fatigue, suggesting the important role of sleep in pain control and in the pathophysiology of fibromyalgia.Objectives:To estimate the incidence of polysomnographic alterations in JFM and to explore the relationship between sleep problems and the musculoskeletal pain, fatigue and mood and anxiety disorders.Methods:21 patients (M 3; F 18; mean age 16,1) with JFM were included. The objective sleep quality was measured by overnight polysomnography (PSG) (using the EMBLETTA MPR PG device). PSG data were compared to age and sex-matched controls. The subjective sleep disturbances were assessed by the Sleep Condition Indicator (SCI). Musculoskeletal symptoms were evaluated by using the widespread pain index (WPI). Pain intensity was evaluated on a 0-10 visual analogical scale (PVAS). Fatigue was assessed by using the Symptom Severity (SS) questionnaire. Mood and anxiety disorders were evaluated by using the Children Depression Index (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Comparison of categorical data was performed by means of the Fisher’s Exact test. The relationship between sleep quality and clinical symptoms were assessed using Spearman’s rank order correlation coefficient (rs). All statistical test were 2-sided and p values less than 0.05 were considered statistically significant.Results:Nineteen out of 21 (90.5%) patients complained subjective sleep disturbances and un-restorative sleep. Seven out of 21 (33.3%) patients had mood and anxiety disorders. Eight out of 21 patients (38.1%) showed an electroencephalographic pattern of alpha wave intrusion in slow wave sleep (SWS). SCI was significantly correlated to CDI score rs -0,775 (p≤0,0001), MASC 0,61 (p=0,005), WPI -0,731 (p=0,001), SSI 0,492 (p=0,038), PVAS -0,590 (p=0,006).Conclusion:A substantial percentage of JFM patients experience sleep disturbances, which are, correlated with the severity of the muscolskeletal sympotms and mood and anxiety disorders. One third of JFM patients have alpha intrusion in the SWS. The important role of sleep in pain control suggests that the development of treatments to improve sleep quality may lead to more effective management of fibromyalgia in the future.References:[1]Ting TV et. al 2010 American College of Rheumatology Adult Fibromyalgia Criteria for Use in an Adolescent Female Population with Juvenile Fibromyalgia. J Pediatr. 2016 Feb;169:181-7.[2]Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015;11:513-20.[3]Roizenblatt S et al. Alpha sleep characteristics in fibromyalgia. Arthritis Rheum. 2001;44, 222–230.Disclosure of Interests:None declared
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Coelli S, Nobili L, Boly M, Riedner B, Bianchi AM. Optimization of the Cortical Traveling Wave Analysis framework for feasibility in Stereo-Electroencephalography. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:3854-3857. [PMID: 31946714 DOI: 10.1109/embc.2019.8857664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study of brain waves propagation is of interest to understand the neural involvement in both physiological and pathological events, such as interictal epileptic spikes (IES). The possibility to track the trajectory of IESs could be useful to better characterize the role of the involved structures in the epileptic network, adding valuable information to the epileptic focus localization. Methods for the cortical traveling wave analysis (CTWA) have been proposed to trace the preferred propagation path of sleep slow waves, using scalp high-density EEG and reconstructing the trajectories both in the sensors and in the sources space. In this work, we propose a feasibility study of the application of these concepts to Stereo-EEG (SEEG) data for the analysis of IES. Through simulations, we selected the best performing Electrical Source Imaging inverse solution for our purpose and illustrate the CTWA procedure. We further show an exemplary application on real data and discuss advantages and pitfalls of the application of CTWA in SEEG.
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Bassetti CLA, Randerath W, Vignatelli L, Ferini‐Strambi L, Brill A, Bonsignore MR, Grote L, Jennum P, Leys D, Minnerup J, Nobili L, Tonia T, Morgan R, Kerry J, Riha R, McNicholas WT, Papavasileiou V. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol 2020; 27:1117-1136. [DOI: 10.1111/ene.14201] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C. L. A. Bassetti
- Neurology Department Medical Faculty University Hospital Bern Switzerland
- Department of Neurology Sechenov First Moscow State Medical University Moscow Russia
| | - W. Randerath
- Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care Bethanien Hospital Institute of Pneumology at the University of Cologne Solingen Germany
| | - L. Vignatelli
- Servizio di Epidemiologia e Biostatistica IRCCS Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria BolognaItaly
| | - L. Ferini‐Strambi
- Department of Neurology OSR‐Turro Sleep Disorder Center Vita‐Salute San Raffaele University Milan Italy
| | - A.‐K. Brill
- Department of Pulmonary Medicine University and University Hospital Bern Bern Switzerland
| | - M. R. Bonsignore
- PROMISE Department Division of Respiratory Medicine DiBiMIS University of Palermo and IBIM‐CNR Palermo Italy
| | - L. Grote
- Sleep Disorders Center Department of Pulmonary Medicine Sahlgrenska University Hospital Göteborg Sweden
| | - P. Jennum
- Danish Center for Sleep Medicine Rigshospitalet Copenhagen Denmark
| | - D. Leys
- Department of Neurology University of Lille Lille France
| | - J. Minnerup
- Department of Neurology and Institute for Translational Neurology University of Muenster Muenster Germany
| | - L. Nobili
- Child Neuropsychiatry Unit Gaslini Institute DINOGMI University of Genova Genoa Italy
| | - T. Tonia
- Institute of Social and Preventive Medicine Universtity of Bern Bern Switzerland
| | - R. Morgan
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - J. Kerry
- Library and Information Service Leeds Teaching Hospitals NHS Trust LeedsUK
| | - R. Riha
- Sleep Research Unit Centre for Clinical Brain Sciences University of Edinburgh EdinburghUK
- Department of Sleep Medicine Royal Infirmary of Edinburgh Edinburgh UK
| | - W. T. McNicholas
- Department of Respiratory and Sleep Medicine St Vincent’s University Hospital DublinIreland
- School of Medicine University College Dublin Dublin Ireland
- First Affiliated Hospital of Guangzhou Medical University Guangzhou China
| | - V. Papavasileiou
- Leeds Teaching Hospital NHS Trust LeedsUK
- Medical School University of Leeds Leeds UK
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Panzeri G, Muller D, Accogli A, Gibertini E, Mauri E, Rossi F, Nobili L, Magagnin L. Zinc electrodeposition from a chloride-free non-aqueous solution based on ethylene glycol and acetate salts. Electrochim Acta 2019. [DOI: 10.1016/j.electacta.2018.11.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pedrazzetti L, Nobili L, Magagnin L, Bernasconi R, Lucotti A, Soltani P, Mezzi A, Kaciulis S. Growth and characterization of ultrathin carbon films on electrodeposited Cu and Ni. SURF INTERFACE ANAL 2017. [DOI: 10.1002/sia.6281] [Citation(s) in RCA: 7] [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] [Indexed: 12/28/2022]
Affiliation(s)
- L. Pedrazzetti
- Dip.to di Chimica, Materiali ed Ing. Chimica “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - L. Nobili
- Dip.to di Chimica, Materiali ed Ing. Chimica “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - L. Magagnin
- Dip.to di Chimica, Materiali ed Ing. Chimica “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - R. Bernasconi
- Dip.to di Chimica, Materiali ed Ing. Chimica “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - A. Lucotti
- Dip.to di Chimica, Materiali ed Ing. Chimica “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - P. Soltani
- Institute for the Study of Nanostructured Materials, ISMN-CNR; Rome Italy
| | - A. Mezzi
- Institute for the Study of Nanostructured Materials, ISMN-CNR; Rome Italy
| | - S. Kaciulis
- Institute for the Study of Nanostructured Materials, ISMN-CNR; Rome Italy
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21
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Coelli S, Maggioni E, Cerutti S, Nobili L, Rubino A, Campana C, Bianchi AM. Functional Clustering approach for the analysis of Stereo-EEG activity patterns in correspondence of epileptic seizures. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:2806-2809. [PMID: 29060481 DOI: 10.1109/embc.2017.8037440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, a functional clustering approach is proposed and tested for the identification of brain functional networks emerging during sleep-related seizures. Stereo-EEG signals recorded in patients with Type II Focal Cortical Dysplasia (FCD type II), were analyzed. This novel approach is able to identify the network configuration changes in pre-ictal and early ictal periods, by grouping Stereo-EEG signals on the basis of the Cluster Index, after wavelet multiscale decomposition. Results showed that the proposed method is able to detect clusters of interacting leads, mainly overlapped on the Epileptogenic Zone (EZ) identified by a clinical expert, with distinctive configurations related to analyzed frequency ranges. This suggested the presence of coupling activities between the elements of the epileptic system at different frequency scales.
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Campana C, Zubler F, Gibbs S, de Carli F, Proserpio P, Rubino A, Cossu M, Tassi L, Schindler K, Nobili L. Suppression of interictal spikes during phasic rapid eye movement sleep: a quantitative stereo-electroencephalography study. J Sleep Res 2017; 26:606-613. [DOI: 10.1111/jsr.12533] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- C. Campana
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’; University of Milan; Milan Italy
| | - F. Zubler
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - S. Gibbs
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Center for Advanced Research in Sleep Medicine; University of Montreal; Montreal Canada
| | - F. de Carli
- Institute of Bioimaging and Molecular Physiology; Genoa Section; National Research Council; Genoa Italy
| | - P. Proserpio
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - A. Rubino
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’; University of Milan; Milan Italy
| | - M. Cossu
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - L. Tassi
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - K. Schindler
- Department of Neurology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Nobili
- ’C. Munari’ Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
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Nobili L, Magagnin L, Bernasconi R, Livolsi F, Pedrazzetti L, Lucotti A, Balijepalli S, Mezzi A, Kaciulis S, Montanari R. Investigation of graphene layers on electrodeposited polycrystalline metals. SURF INTERFACE ANAL 2016. [DOI: 10.1002/sia.5996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L. Nobili
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - L. Magagnin
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - R. Bernasconi
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - F. Livolsi
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - L. Pedrazzetti
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - A. Lucotti
- Dipartimento di Chimica, Materiali e Ing. Chimica Giulio Natta; Politecnico di Milano; Milan Italy
| | - S.K. Balijepalli
- Institute for the Study of Nanostructured Materials; ISMN - CNR; Rome Italy
| | - A. Mezzi
- Institute for the Study of Nanostructured Materials; ISMN - CNR; Rome Italy
| | - S. Kaciulis
- Institute for the Study of Nanostructured Materials; ISMN - CNR; Rome Italy
| | - R. Montanari
- Department of Industrial Engineering; University of Rome-Tor Vergata; Rome Italy
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Sarasso S, Pigorini A, Proserpio P, Gibbs SA, Massimini M, Nobili L. Fluid boundaries between wake and sleep: experimental evidence from Stereo-EEG recordings. Arch Ital Biol 2015; 152:169-77. [PMID: 25828688 DOI: 10.12871/0002982920142311] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep and waking have been traditionally considered global behavioural states regulated by subcortical neuromodulatory circuits in a top-down fashion. Over the last years, we have been experiencing a paradigm shift towards a view that both wake and sleep are in essence local processes. Here we review recent clinical and basic research works supporting this view by taking advantage of stereotactic electroencephalography (Stereo-EEG, SEEG) recordings performed in epileptic patients. Specifically, we will discuss a growing body of evidence showing how electrophysiological features of sleep and wakefulness are coexisting across diffuse brain areas in pathological and physiological sleep as well as during state transitions (sleep onset and awakenings). Finally, we will discuss their implication for sleep medicine to extent that, reconsidering the classical definition of wakefulness and sleep as separate and mutually exclusive states may offer new insight for the understanding of parasomnias and other dissociated states.
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Affiliation(s)
- S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - P Proserpio
- Centre of Epilepsy Surgery "C. Munari", Niguarda Hospital, 20162 Milano, Italy.
| | - S A Gibbs
- Centre of Epilepsy Surgery "C. Munari", Niguarda Hospital, 20162 Milano, Italy.
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - L Nobili
- Centre of Epilepsy Surgery "C. Munari", Niguarda Hospital, 20162 Milano, Italy. .,Institute of Bioimaging and Molecular Physiology, Genoa Unit, National Research Council, Genoa, Italy
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Bassetti CL, Ferini-Strambi L, Brown S, Adamantidis A, Benedetti F, Bruni O, Cajochen C, Dolenc-Groselj L, Ferri R, Gais S, Huber R, Khatami R, Lammers GJ, Luppi PH, Manconi M, Nissen C, Nobili L, Peigneux P, Pollmächer T, Randerath W, Riemann D, Santamaria J, Schindler K, Tafti M, Van Someren E, Wetter TC. Neurology and psychiatry: waking up to opportunities of sleep. : State of the art and clinical/research priorities for the next decade. Eur J Neurol 2015; 22:1337-54. [DOI: 10.1111/ene.12781] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 12/22/2022]
Affiliation(s)
- C. L. Bassetti
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Ferini-Strambi
- Division of Neuroscience; Sleep Disorders Centre; Università Vita-Salute San Raffaele; Milan Italy
| | - S. Brown
- Institute of Pharmacology and Toxicology; University of Zürich; Zürich Switzerland
| | - A. Adamantidis
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - F. Benedetti
- Department of Clinical Neurosciences; Scientific Institute and University Vita-Salute San Raffaele; Milan Italy
| | - O. Bruni
- Department of Developmental and Social Psychology; Sapienza University; Rome Italy
| | - C. Cajochen
- Psychiatric University Clinic; Basel Switzerland
| | - L. Dolenc-Groselj
- Division of Neurology; Institute of Clinical Neurophysiology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | - R. Ferri
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - S. Gais
- Medical Psychology and Behavioural Neurobiology; Eberhard Karls Universität Tübingen; Tübingen Germany
| | - R. Huber
- Department of Paediatrics; Children's University Hospital; Zurich Switzerland
| | - R. Khatami
- Sleep Centre; Klinik Barmelweid AG; Barmelweid Switzerland
| | - G. J. Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden The Netherlands
- Sleep Wake Centre SEIN; Stichting Epilepsie Instellingen Nederland; Heemstede The Netherlands
| | - P. H. Luppi
- UMR 5292 CNRS/U1028 INSERM; Centre de Recherche en Neurosciences de Lyon (CRNL); Team “Physiopathologie des réseaux neuronaux responsables du cycle veille-sommeil”; Université Claude Bernard Lyon I; Lyon France
| | - M. Manconi
- Sleep and Epilepsy Centre; Neurocentre of Southern Switzerland; Civic Hospital (EOC) of Lugano; Lugano Switzerland
| | - C. Nissen
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - L. Nobili
- Centre of Epilepsy Surgery ‘C. Munari’; Niguarda Hospital; Milan Italy
| | - P. Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit; CRCN - Centre de Recherches Cognition et Neurosciences and UNI - ULB Neurosciences Institute; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - T. Pollmächer
- Center of Mental Health; Klinikum Ingolstadt; Ingolstadt Germany
| | - W. Randerath
- Institut für Pneumologie; Krankenhaus Bethanien gGmbH; Universität Witten/Herdecke; Solingen Germany
| | - D. Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - J. Santamaria
- Neurology Service; Hospital Clínic of Barcelona; Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Barcelona Spain
| | - K. Schindler
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - M. Tafti
- Centre for Integrative Genomics; University of Lausanne; Lausanne Switzerland
- Centre for Investigation and Research in Sleep; Vaud University Hospital; Lausanne Switzerland
| | - E. Van Someren
- Department of Sleep and Cognition; Netherlands Institute for Neuroscience; Amsterdam The Netherlands
- Departments of Integrative Neurophysiology and Medical Psychology; Center for Neurogenomics and Cognitive Research (CNCR); VU University and Medical Center; Amsterdam The Netherlands
| | - T. C. Wetter
- Department of Psychiatry and Psychotherapy; University of Regensburg; Regensburg Germany
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Proserpio P, Cossu M, Francione S, Gozzo F, Lo Russo G, Mai R, Moscato A, Schiariti M, Sartori I, Tassi L, Nobili L. Epileptic motor behaviors during sleep: anatomo-electro-clinical features. Sleep Med 2012; 12 Suppl 2:S33-8. [PMID: 22136897 DOI: 10.1016/j.sleep.2011.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Sleep-related complex motor seizures have long been considered pathognomonic features of Nocturnal Frontal Lobe Epilepsy (NFLE). In recent years, these manifestations have also been reported to have a temporal or insular origin. METHOD We describe 40 drug-resistant epileptic patients with complex motor seizures during sleep, submitted to presurgical stereo-EEG (SEEG) evaluation and seizure-free after surgical resection of the epileptogenic zone. RESULTS In a significant proportion (30%) of these patients, seizures arose from extra-frontal regions, including mainly the temporal lobe and the insular cortex, but also the parietal and occipital lobes. In patients with extra-frontal epilepsy, when complex motor behaviors appeared, SEEG revealed that the ictal discharge involved the cingulate and the frontal regions. Finally, at histology, Taylor's focal cortical dysplasia (TFCD) was the most common finding (90% of patients), independent of the site of seizure onset. CONCLUSION As previously reported by other studies, this histologic substrate may be a major determinant of sleep-related seizures in drug-resistant epileptic patients.
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Affiliation(s)
- P Proserpio
- C Munari Centre of Epilepsy Surgery, Niguarda Hospital, Milan, Italy
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Moroni F, De Carli F, Nobili L, Massimini M, Tempesta D, Lo Russo G, Marzano C, Cipolli C, De Gennaro L, Ferrara M. P24.2 Cortical and hippocampal low delta activity: a human Stereo-EEG study. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60609-3] [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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Proserpio P, Spreafico C, Didato G, Nobili L, Facchetti D, De Fanti CA, Protti A. Cyclic alternating pattern (CAP)-related cough and sleep-related laryngospasm. Sleep Med 2009; 11:221-3. [PMID: 19945341 DOI: 10.1016/j.sleep.2009.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/16/2009] [Revised: 07/30/2009] [Accepted: 08/07/2009] [Indexed: 12/27/2022]
Affiliation(s)
- P Proserpio
- Centre of Sleep Medicine, Centre for Epilepsy Surgery "C. Munari", Niguarda Hospital, Milan, Italy.
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Tassinari C, Cantalupo G, Högl B, Cortelli P, Tassi L, Francione S, Nobili L, Meletti S, Rubboli G, Gardella E. Neuroethological approach to frontolimbic epileptic seizures and parasomnias: The same central pattern generators for the same behaviours. Rev Neurol (Paris) 2009; 165:762-8. [DOI: 10.1016/j.neurol.2009.08.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nobili L, Francione S, Mai R, Cardinale F, Castana L, Tassi L, Sartori I, Didato G, Citterio A, Colombo N, Galli C, Lo Russo G, Cossu M. Surgical treatment of drug-resistant nocturnal frontal lobe epilepsy. Brain 2007; 130:561-73. [PMID: 17124189 DOI: 10.1093/brain/awl322] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Of the cases with nocturnal frontal lobe epilepsy (NFLE) approximately 30% are refractory to antiepileptic medication, with several patients suffering from the effects of both ongoing seizures and disrupted sleep. From a consecutive series of 522 patients operated on for drug-resistant focal epilepsy, 21 cases (4%), whose frontal lobe seizures occurred almost exclusively (>90%) during sleep, were selected. All patients underwent a comprehensive pre-surgical evaluation, which included history, interictal EEG, scalp video-EEG monitoring, high-resolution MRI and, when indicated, invasive recording by stereo-EEG (SEEG). There were 11 males and 10 females, whose mean age at seizure onset was 6.2 years, mean age at surgery was 24.7 years and seizure frequency ranged from <20/month to >300/month. Nine patients reported excessive daytime sleepiness (EDS). Prevalent ictal clinical signs were represented by asymmetric posturing (6 cases), hyperkinetic automatisms (10 cases), combined tonic posturing and hyperkinetic automatisms (4 cases) and mimetic automatisms (1 case). All patients reported some kind of subjective manifestations. Interictal and ictal EEG provided lateralizing or localizing information in most patients. MRI was unrevealing in 10 cases and it showed a focal anatomical abnormality in one frontal lobe in 11 cases. Eighteen patients underwent a SEEG evaluation to better define the epileptogenic zone (EZ). All patients received a microsurgical resection in one frontal lobe, tailored according to pre-surgical evaluations. Two patients were operated on twice owing to poor results after the first resection. Histology demonstrated a Taylor-type focal cortical dysplasia (FCD) in 16 patients and an architectural FCD in 4. In one case no histological change was found. After a post-operative follow-up of at least 12 months (mean 42.5 months) all the 16 patients with a Taylor's FCD were in Engel's Class Ia and the other 5 patients were in Engel's Classes II or III. After 6 months post-surgery EDS had disappeared in the 9 patients who presented this complaint pre-operatively. It is concluded that patients with drug-resistant, disabling sleep-related seizures of frontal lobe origin should be considered for resective surgery, which may provide excellent results both on seizures and on epilepsy-related sleep disturbances. An accurate pre-surgical evaluation, which often requires invasive EEG recording, is mandatory to define the EZ. Further investigation is needed to explain the possible causal relationships between FCD, particularly Taylor-type, and sleep-related seizures, as observed in this cohort of NFLE patients.
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Affiliation(s)
- L Nobili
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
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Abstract
BACKGROUND Stereotactic placement of intracerebral multilead electrodes for chronic EEG recording of seizures or stereoelectroencephalography (SEEG) was introduced 50 years ago at Saint Anne Hospital in Paris, France for the presurgical evaluation of patients with drug-resistant focal epilepsy. SEEG explorations are indicated whenever the noninvasive tests fail to adequately localize the epileptogenic zone (EZ). INDICATIONS Currently, approximately 35% of our operated-on children require a SEEG evaluation. Arrangement of electrodes is individualized according to the peculiar needs of each child, to verify a predetermined hypothesis of localization of the EZ based on pre-SEEG anatomo-electro-clinical findings. Multilead intracerebral electrodes are designed to sample cortical structures on the lateral, intermediate, and mesial aspect of the hemisphere, as well as deep-seated lesions. Stereotactic stereoscopic teleangiograms and coregistered 3-D MRI are employed to plan avascular trajectories and to accurately target the desired structures. Pre-SEEG stereotactic neuroradiology and electrode implantation are usually performed in separate procedures. Electrodes are removed once video-SEEG monitoring is completed. INTRACEREBRAL ELECTRICAL STIMULATIONS Intracerebral electrical stimulations are used to better define the EZ and to obtain a detailed functional mapping of critical cortical and subcortical regions. MORBIDITY Surgical morbidity of SEEG is definitely low in children. SEEG-GUIDED RESECTIVE SURGERY: In 90% of evaluated children, SEEG provides a guide for extratemporal or multilobar resections. SEEG-guided resective surgery may yield excellent results on seizures with 60% of patients in Engel's Class I.
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Affiliation(s)
- M Cossu
- Centro Claudio Munari per la Chirurgia dell'Epilessia e del Parkinson, Ospedale Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
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Nobili L, Sartori I, Terzaghi M, Tassi L, Mai R, Francione S, Cossu M, Cardinale F, Castana L, Lo Russo G. Intracerebral recordings of minor motor events, paroxysmal arousals and major seizures in nocturnal frontal lobe epilepsy. Neurol Sci 2005; 26 Suppl 3:s215-9. [PMID: 16331399 DOI: 10.1007/s10072-005-0490-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The clinical features of nocturnal frontal lobe epilepsy (NFLE) consist of a spectrum of paroxysmal motor manifestations ranging from minor motor events (MMEs) to paroxysmal arousals (PAs) and major seizures. During MMEs and PAs scalp EEG generally does not show definite ictal abnormalities. We describe the clinical and electrophysiological features of three patients affected by drug-resistant NFLE studied with intracerebral electrodes during a presurgical evaluation. The stereo-EEG (SEEG) investigation revealed that MMEs can be fragments of the major seizure and occur during a brief epileptic discharge or on the following arousal. PAs, in the same subject, do not show a definite stereotypy despite the morphological and topographic similarity of the epileptic discharges, thus indicating that other variables may influence the clinical features of PAs.
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Affiliation(s)
- L Nobili
- C. Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, I-20126 Milan, Italy.
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Mai R, Sartori I, Francione S, Tassi L, Castana L, Cardinale F, Cossu M, Citterio A, Colombo N, Lo Russo G, Nobili L. Sleep-related hyperkinetic seizures: always a frontal onset? Neurol Sci 2005; 26 Suppl 3:s220-4. [PMID: 16331400 DOI: 10.1007/s10072-005-0491-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hyperkinetic seizures are considered a typical manifestation of nocturnal frontal lobe epilepsy (NFLE). Patients with temporal lobe epilepsy with mainly sleep-related seizures have been described; however they commonly lack hyperkinetic activity and seizure frequency is low. We retrospectively analysed our population of 442 consecutive patients surgically treated between January 1996 and January 2004. Among these there were 25 patients with sleep-related hyperkinetic epileptic seizures, with a frontal lobe onset in 18 cases and a temporal lobe onset in 7. Patients with sleep-related hyperkinetic seizures with temporal lobe origin had anamnestic and clinical features strikingly similar to those with a frontal onset, with agitated movements, high seizure frequency and no history of febrile convulsions. We confirm our previous findings that this kind of epileptic manifestation is not only peculiar to frontal lobe epilepsy.
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Affiliation(s)
- R Mai
- C. Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, I-20163 Milan, Italy.
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Nobili L, Cossu M, Mai R, Tassi L, Cardinale F, Castana L, Citterio A, Sartori I, Lo Russo G, Francione S. Sleep-related hyperkinetic seizures of temporal lobe origin. Neurology 2004; 62:482-5. [PMID: 14872038 DOI: 10.1212/01.wnl.0000106945.68292.dc] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [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
Sleep-related hyperkinetic seizures are a common feature of nocturnal frontal lobe epilepsy. Although sleep-related seizures with a temporal lobe origin have been reported, they commonly lack hyperkinetic activity. The authors describe three patients with sleep-related seizures characterized by frenetic, agitated, hyperactive movements (bimanual/bipedal activity, rocking, axial, pelvic, and hemiballistic movements), in whom stereo-EEG investigation and surgical outcome demonstrated a temporal lobe origin of the attacks.
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Affiliation(s)
- L Nobili
- Epilepsy Surgery Center C. Munari, Niguarda Hospital, Milan, Italy.
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Garbarino S, Mascialino B, De Carli F, La Paglia G, Mantineo G, Nobili L, Ferrillo F. [Shift-work seniority increases the severity of sleep disorders. Comparison of different categories of shift-workers]. G Ital Med Lav Ergon 2003; 25 Suppl:227-8. [PMID: 14979161] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Shift-work disrupts the sleep-wake cycle and could bring about sleep disorders and excessive daytime sleepiness. We studied two samples of shift-workers, a group of 178 nurses and one of 174 police officers, all working in the town of Palermo (Italy); their answers to a sleep disorder questionnaire were scored and added in order to create a Sleep Disorder Score (SDS). The SDS cut-off value, discrimining pathological values from physiological ones, was settled a-priori. In both groups SDS did not depend on sex, age, weight, height nor on working seniority, but it increased non linearly (cubic form) with shift-work seniority. In nurses this mathematical description of SDS exceeded the cut-off value after 15 years of shift-work seniority; in police officers it settled asymptotically under the critical value. This could be ascribable both to the different composition in sex of the two samples (nurses: 49% F-51% M vs. police officers: 6% F-94% M) both to the self-selection process that seems to undergo police officers (nurses do not leave shift-work because of salary incentives).
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Affiliation(s)
- S Garbarino
- Centro di Medicina del Sonno, DISM, Università degli Studi di Genova
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Garbarino S, De Carli F, Mascialino B, Beelke M, Nobili L, Squarcia S, Penco MA, Ferrillo F. Sleepiness in a population of Italian shiftwork policemen. J Hum Ergol (Tokyo) 2001; 30:211-6. [PMID: 14564884] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The aim of this study was to evaluate the effects of shiftwork on sleepiness, sleep disorders and sleep related accidents in a population of policemen. Data concerning age and physical characteristics, working conditions, sleep problems and accidents were collected by a questionnaire. Sleepiness was evaluated by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SD-score) drawn from indicators of insomnia, breathing disorders, periodic limb movements-restless leg syndrome and hypersomnia. The effects of age, gender, body mass index, working condition and seniority on ESS, SD-score and accidents were analysed by linear and logistic regression. Participants were 1280 policemen: 611 shiftworkers and 669 non-shiftworkers. The ESS scores were not higher in shiftworkers than in non-shiftworkers, but the SD-score was found to be significantly influenced by shiftwork condition and seniority. The occurrence of sleep-related accidents was found to have been significantly increased for shiftworkers and related to the presence of indicators of sleep disorders. The sleepiness could be underestimated or even overcome by the influence of stressing conditions. However our data should alert occupational health physicians for the diagnosis and prevention of possible lurking intrinsic sleep disorders likely to influence health problems and risk of accidents in shiftworkers.
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Affiliation(s)
- S Garbarino
- Center of Neurology and Medical Psychology, Health Service of the State Police, Department of the Interior, Center of Sleep Medicine, University of Genoa, Italy
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Nobili L, Beelke M, Besset A, Billiard M, Ferrillo F. Nocturnal sleep features in narcolepsy: a model-based approach. Rev Neurol (Paris) 2001; 157:S82-6. [PMID: 11924047] [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: 02/24/2023]
Abstract
The internal structure of night sleep in subjects with narcolepsy significantly differs as compared to the controls. The differences consist in the presence of sleep onset REM periods (SOREMPs) and in a longer duration (120 minutes versus 90 minutes) of the NREM-REM cycles. Another difference consists in the lack of increase in REM sleep duration during the night, cycle after cycle. These characteristics, taken as a whole, suggest that the sleep structure of narcoleptic patients is due to an imbalance between the homeostatic process and the enhanced pressure of REM inducing mechanisms. With regard to the intrasleep dynamics the current extension of the Two-process model cannot give a satisfactory explanation because REM sleep is included as an external trigger with no intrinsic rhythmic property. Neurobiologic studies lead to consider the REM cyclic occurrence as the result of reciprocal interaction between two populations of REM-ON and REM-OFF cells. The introduction in the Two-process-model extended to the intra-night dynamics of an ultradian oscillator, based on a REM-ON--REM-OFF reciprocal interaction, allows the theoretical possibility to simulate a SOREMP. This revised model accounts for the progressive extension of REM sleep-periods duration in the course of the night. The sleep structure of narcoleptic patients can be simulated leaving unaltered the pressure of the homeostatic process and enhancing the REM inducing pressure. Such an enhanced REM pressure can be achieved by increasing the value of the numerical coefficient, which represents the strength of connection between the two types of REM-ON and REM-OFF cells. This modification allows not only to obtain a stronger ultradian oscillator but also a longer periodicity of REM sleep occurrence. By coupling the homeostatic process, considered as normal, to such a modified ultradian oscillator, our model can explain the intra-night sleep dynamics of narcoleptic subjects. A REM-ON REM-OFF dysregulation can be hypothesized to explain the pathophysiological basis of nocturnal sleep features in narcolepsy.
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Affiliation(s)
- L Nobili
- Center of Sleep Medicine, DISMR, University of Genova, Italy
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Garbarino S, Nobili L, Beelke M, De Carli F, Balestra V, Ferrillo F. Sleep related vehicle accidents on Italian highways. G Ital Med Lav Ergon 2001; 23:430-4. [PMID: 11758145] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Sleepiness has been identified as a significant risk factor for vehicle accidents, and specific surveys are needed for Italy. The aim of this study was to assess incidence and characteristics of sleep-related vehicle-crashes on Italian highways. The database of the Italian National Institute of Statistics (1993-1997) was the source for the survey (50859 accidents with 1632 (3.2%) ascribed to sleep by the police). The distribution of accidents was evaluated by means of the analysis of variance considering the year, the day of the week, the age and the time of day and their interactions as main factors. The relative risk of sleep-related accidents was also evaluated with reference to the relative traffic density as estimated by the Italian Highways Society. The counts of sleep-related accidents, and even more the relative risk, revealed the presence of peaks and troughs in zones at a higher level of sleepiness and alertness respectively. Death of the driver occurred in 11.4% of sleep related accidents versus 5.6% in general accidents. The great majority of sleep-related accidents occurred to drivers under 35 (61.4%) mainly during the night with an increasing trend in the yearly number of sleep-related accidents, especially on weekends. Therefore sleepiness appears a remarkable risk factor and, in our opinion, its incidence as sole or contributory cause of accidents on Italian highways is still underestimated.
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Affiliation(s)
- S Garbarino
- Centre of Neurology and Medical Psychology, Health Service of the State Police, Department of the Interior, Italy.
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Ferrillo F, Plazzi G, Nobili L, Beelke M, De Carli F, Cortelli P, Tinuper P, Avoni P, Vandi S, Gambetti P, Lugaresi E, Montagna P. Absence of sleep EEG markers in fatal familial insomnia healthy carriers: a spectral analysis study. Clin Neurophysiol 2001; 112:1888-92. [PMID: 11595148 DOI: 10.1016/s1388-2457(01)00600-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/28/2022]
Abstract
OBJECTIVES Fatal familial insomnia (FFI) is linked to a mutation at codon 178 (C178) of the prion protein gene (PRNP). FFI is pathologically characterized by selective atrophy of the anteroventral and mediodorsal thalamic nuclei and clinically by loss of sleep, dysautonomia and motor signs. A key early polysomnographic sign of the disease onset is the loss of sleep spindling (sigma activity, SA). In FFI the loss of SA leads to the spectral representation of a sudden slow wave activity (SWA) increase from an awake state, the reaching of a stable plateau without oscillations, followed by abrupt fall down to REM sleep. We evaluated the presence of differences in the spectral sleep EEG pattern in FFI relatives carriers (C178(pos)) or non-carriers (C178(neg)) of the C178 mutation. METHODS Seventeen healthy relatives of FFI patients, 8 carriers of the C178 FFI mutation in a preclinical condition and 9 non carriers, underwent two-night polysomnography. The absolute and relative EEG power of the 4 main bands (delta: SWA, 0.5-4.0 Hz; theta: TB, 4.5-8 Hz; alpha: AB, 8.5-12 Hz; sigma: SA, 12.5-16 Hz) has been studied for the total sleep time, the period of delta increase after sleep onset, and the period of delta plateau. Multiple regression has been applied to investigate relations between the power of the bands studied and 3 parameters: age, the gender of the subjects and the C178 genotype. RESULTS Our study could not show evidence of differences in the sleep EEG composition between carriers and non-carriers of the C178 FFI mutation. CONCLUSIONS The spectral analysis techniques we used were not able to disclose sleep EEG markers linked to the FFI C178(pos) in the preclinical condition. Key sleep EEG alteration become evident only at the clinical onset of the disease.
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Affiliation(s)
- F Ferrillo
- Sleep Disorder Center, DISMR, University of Genoa, Genoa, Italy.
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Nobili L, Baglietto MG, Beelke M, De Carli F, Veneselli E, Ferrillo F. Temporal relationship of generalized epileptiform discharges to spindle frequency activity in childhood absence epilepsy. Clin Neurophysiol 2001; 112:1912-6. [PMID: 11595151 DOI: 10.1016/s1388-2457(01)00624-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The hypothesis that the two main synchronizing mechanisms (spindle and delta oscillations) acting during non-rapid eye movement sleep show opposite relationship with the distribution of generalized epileptiform discharges (GEDs) during sleep was evaluated. METHODS We studied the temporal relationship between the distribution of sleep GEDs and the dynamics of Sigma Activity (SA, 12-16 Hz) and Delta Activity (DA, 0.5-4.5 Hz) in 5 children affected by childhood absence epilepsy. RESULTS Using correlation techniques, we found a high and positive correlation between GEDs and SA, while DA resulted negatively correlated with GEDs. CONCLUSION Sleep generalized spike-and-slow-waves seems to be produced when spindle synchronizing mechanisms are active while DA production seem to exert an inhibiting role. Such a feature seems to be common to other childhood partial and undetermined epileptic syndromes.
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Affiliation(s)
- L Nobili
- Centro di Medicina del Sonno, Catterdra di Neurofisiopatologia, Università di Genova, Ospedale San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
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Gaggero R, Devescovi R, Nobili L, Baglietto MG, Zucconi M, Schinardi A. Benign parasomnias and nocturnal frontal epilepsy: differential diagnosis in a case report. J Child Neurol 2001; 16:628-31. [PMID: 11510944 DOI: 10.1177/088307380101600823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a 13-year-old boy who complained of complex motor episodes during sleep characterized by sudden arousal followed by deambulation associated with automatic movements and vocalization. His family history included both epileptic and psychiatric disorders. The patient himself presented psychopathologic traits and adaptive difficulties. In support of an epileptic origin of these phenomena were the stereotyped fashion in which they appeared and their responsiveness to carbamazepine. We classified the present case as a nocturnal frontal epilepsy with variable manifestations that can be classified as paroxysmal arousals, paroxysmal dystonia, and epileptic nocturnal wanderings. It was possible to differentiate such events from the most common parasomnias on the basis of videopolysomnographic studies.
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Affiliation(s)
- R Gaggero
- Department of Child Neurology and Psychiatry, Giannina Gaslini Institute, University of Genoa, Italy.
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Baglietto MG, Battaglia FM, Nobili L, Tortorelli S, De Negri E, Calevo MG, Veneselli E, De Negri M. Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or Rolandic spikes. Dev Med Child Neurol 2001; 43:407-12. [PMID: 11409830 DOI: 10.1017/s0012162201000755] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nine children (five males, four females; age range 6 years 1 month to 11 years 1 month) affected by benign epilepsy of childhood with centrotemporal or Rolandic spikes (BECRS) with EEG evidence of marked activation of interictal epileptic discharges (IEDs) during sleep, and nine unaffected control children matched for age, sex, and socioeconomic status, were enrolled in a prospective study. At the time of detection of IED activation during sleep, patients showed a mean Full-Scale IQ score within the normal range, but significantly below that of control participants; neuropsychological assessment revealed disorders in visuospatial short-term memory (Corsi's Block Tapping Test), attention, and cognitive flexibility (Trail Making Test and Stroop Color-Word Test), picture naming, and fluency (Benton's Naming Test and Word Fluency), visuoperceptual skill (Ghent-Poppelreuter and Street Gestalt Completion Tests) and visuomotor coordination (Bender Test). After detection of IED activation during sleep, children were followed up for 2 years. At the time of IED remission (T1), neuropsychological re-evaluation showed a notable increase in IQ score and a significant improvement (t-test: p<0.007) in visuomotor coordination, non-verbal short-term memory, sustained attention and mental flexibility, picture naming, and visual-perceptual performance. At T1, patients' performance did not differ from the controls (Mann-Whitney U test).
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Affiliation(s)
- M G Baglietto
- Unità Operativa di Neuropsichiatria Infantile, Istituto G.Gaslini--Largo G Genova, Italy.
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Nobili L, Baglietto MG, Beelke M, De Carli F, De Negri E, Gaggero R, Rosadini G, Veneselli E, Ferrillo F. Distribution of epileptiform discharges during nREM sleep in the CSWSS syndrome: relationship with sigma and delta activities. Epilepsy Res 2001; 44:119-28. [PMID: 11325568 DOI: 10.1016/s0920-1211(01)00191-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The EEG pattern of epilepsy with continuous spike-waves during slow wave sleep (CSWSS) is characterized by an almost continuous activation of spike-and-slow-wave complexes during nREM sleep with a marked reduction of EEG abnormalities during REM sleep and the awake state. Experimental studies indicate that normal sleep oscillations that during nREM sleep lead to the appearance of spindles and delta waves on scalp EEG might develop into paroxysmal synchronization. Spectral analysis enables the quantitative description of the dynamics of delta (Delta Activity, DA, 0.5-4.5 Hz) and sigma activity (SA, 12-16 Hz) and can be used to assess the relationship between SA, DA and epileptiform discharges (EDs) during sleep. METHODS We analyzed the EDs distribution during sleep in five children affected by CSWSS. We used a model of the evolution of power of DA and SA to which the time series of EDs could be fitted. RESULTS We found a high and positive correlation between EDs and SA. DA resulted negatively correlated with EDs. CONCLUSION Our data suggest that neural mechanisms involved in the generation of sleep spindles facilitate EDs production in the CSWSS syndrome. Such a mechanism seems to be an age related phenomenon shared by other epileptic syndromes of childhood.
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Affiliation(s)
- L Nobili
- Center of Sleep Medicine, DISMR, University of Genoa, Genoa, Italy.
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Manni R, Politini L, Nobili L, Ferrillo F, Livieri C, Veneselli E, Biancheri R, Martinetti M, Tartara A. Hypersomnia in the Prader Willi syndrome: clinical-electrophysiological features and underlying factors. Clin Neurophysiol 2001; 112:800-5. [PMID: 11336895 DOI: 10.1016/s1388-2457(01)00483-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Excessive daytime sleepiness is a common symptom in Prader Willi syndrome (PWs). Sleep disordered breathing (SDB) and narcoleptic traits such as REM sleep onsets (SOREMPs) have been reported in these subjects. We evaluated nighttime and daytime sleep patterns in patients with PWs in order to clarify the nature of their hypersomnia. DESIGN AND METHODS We performed overnight continuous EEG-polysomnographic studies (with breathing monitoring included) in 14 subjects (6 M,8 F; mean age 17 years, range 8-37) affected by PWs unselected for sleep disturbances. Ten patients underwent a Multiple Sleep Latency Test (MSLT) the day following the nocturnal sleep studies. Patients assessment was completed by means of immunogenetic characterization. RESULTS Nocturnal polysomnographic investigation documented sleep related breathing abnormalities such as central apneas, hypopneas or hypoventilation which mainly occurred during REM sleep in 8 subjects and did not cause sleep disruption. Only 4 subjects presented an increase in the Respiratory Disorder Index (RDI) slightly above the normal limits. In 8 subjects out of 10, with and without SDB, the mean daytime sleep latency could be considered abnormal according to the Tanner staging of pubertal development. Five patients showed at least two SOREMPs at MSLT. Subjects with and without SOREMPs had, respectively, a mean age of 18.6 SD 7.9 (4 M, 1 F) and 14.5 SD 2.9 (4 F, 1 M). The paternal deletion:uniparental dysomy ratio at genotypic characterization was 4:1 and 3.5:1 in subjects with and without SOREMPs, respectively. No patient presented DR-15 nor Dq-6. CONCLUSIONS Excessive sleepiness is a frequent disturbance in PWs. Subgroups of PW patients show hypersomnolence and SOREMPs. Sleep disordered breathing appears to have a limited role in the genesis of hypersomnia which not seems on the other hand attributable to the coexistence of narcolepsy phenotype. Hypersomnia in PW syndrome is likely to mainly be attributable to a primary hypothalamic dysfunction. The potential interacting role of other factors such as subjects age, sex and genetic pattern is suggested and deserve further investigation.
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Affiliation(s)
- R Manni
- Centre of Sleep Medicine, IRCCS Institute of Neurology "C. Mondino", Via Palestro 3, 27100, Pavia, Italy
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Abstract
The combination of haloperidol and trazodone was evaluated in an open-label trial in 10 patients with chronic tic and Tourette's syndrome. We found a mean reduction of symptoms of 58.9% on the Yale Global Tic Severity Scale, with a statistically significant difference (p < 0.001) between the baseline and endpoint treatment conditions. This approach significantly reduces clinical symptoms, with the advantage of a lower dose of haloperidol than usual, with no side effects reported by the patients.
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Affiliation(s)
- L Saccomani
- Child Neuropsychiatry, DSNV, G. Gaslini Institute, University of Genova, Italy.
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Garbarino S, Nobili L, Beelke M, De Carli F, Ferrillo F. The contributing role of sleepiness in highway vehicle accidents. Sleep 2001; 24:203-6. [PMID: 11247057] [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: 02/19/2023] Open
Abstract
STUDY OBJECTIVE To evaluate the contributing role of sleepiness in Italian highway vehicle accidents during the time span 1993-1997. DESIGN We analyzed separately the hourly distribution of accidents ascribed by police officers univocally to sleepiness and the rest. PATIENTS N/A. INTERVENTIONS N/A. MEASUREMENTS Using a polynomial regression, we evaluated the relation between accidents (whether sleep-ascribed or not) and sleepiness as derived from a 24-hour sleep propensity curve. The relation between sleep-influenced and non-sleep influenced accidents was analysed using a linear regression. RESULTS The rate of non-sleep ascribed accidents is closely related with sleep propensity and bears a strong similarity with the pattern of sleep-ascribed accidents. A close relationship between the curves of non-sleep ascribed accidents and sleep-ascribed accidents is confirmed. The regression coefficient, which can be seen as the ratio between the quota of accidents that can be considered as sleep affected and those actually ascribed to sleepiness, results in a value of 5.83. Considering that the rate of sleep ascribed accidents is 3.2%, we can calculate the quota of sleep influenced accidents out of those not officially ascribed to sleepiness as 18.7% reaching an estimate of accidents related in some way to sleepiness equal to 21.9%. CONCLUSIONS Our indirect estimate of sleep influenced accidents approaches data reported by other European countries and highlights the importance of sleepiness as a direct and/or contributing factor in vehicle accident rates.
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Affiliation(s)
- S Garbarino
- Sleep Disorder Center, DISMR, University of Genoa, Italy
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Beelke M, Carozzo S, De Carli F, Massimilla S, Nobili L, Ogliastro C, Sannita WG. Factor structure and ammonia-related modulation of the human retinal oscillatory potentials. Clin Neurophysiol 2001; 112:344-50. [PMID: 11165540 DOI: 10.1016/s1388-2457(00)00524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate in man the factor structure of retinal oscillatory potentials (OPs) to full-field luminance stimulation (0.9-9.5 cd.s.m(-2)) and the correlation with the spontaneous fluctuations of plasma ammonia. METHODS Six male healthy volunteers were studied. Five OP recordings and ammonia determinations (GLDH method) were obtained for each subject at 2 h interval during an 8 h experimental session. A standard factor analysis was applied on the OP latency (time from stimulus to peak) and amplitudes values. RESULTS Two consecutive factors on latencies and two factors on amplitudes were identified, consistent with reported differences between the earlier and later OP waves. The model explained a large portion of the OP variance. Both factors on latencies and factor 1 on amplitudes were directly correlated to the stimulus intensity and the ammonia plasma concentration in the 15.8-39.5 micromol/l range. Factors 1 and 2 on latencies decreased and factor 1 on amplitude increased at increasing stimulus intensities. The latency factors decreased and the amplitude factor increased with increasing ammonia concentration. Factor 2 on amplitudes did not correlate with the stimulus intensity or ammonia concentration. CONCLUSIONS The factor structure further supports the evidence of functional differences between early and late OP waves. The observed correlation conceivably reflects a role of ammonia in the modulation of retinal electrophysiology in physiological conditions and potentially accounts for spontaneous variability in otherwise controlled electrophysiological studies.
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Affiliation(s)
- M Beelke
- Center for Neuropsychoactive Drugs, DISMR - Neurophysiopathology, University of Genoa, Ospedale S. Martino, Largo R. Benzi 10, I-16132, Genoa, Italy
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Abstract
OBJECTIVE The temporal course of sleep interictal epileptic discharges (IEDs) has been studied focusing their relationship with the temporal course of the main sleep-EEG frequency bands that is thought to reflect the action of different synchronization neural mechanisms. The existence of a mutually exclusive mechanism between spindles and delta waves should be reflected in a mutually exclusive facilitation of IEDs activation by slow wave activity (SWA) and sigma activity (SA) during synchronized NREM sleep. METHODS We reanalyzed data from 19 children and 15 adult patients affected by different partial epileptic syndromes. The temporal series of SWA, SA and theta band (TB), derived from spectral analysis, were obtained from a spike-free and pathologic alteration-free derivation, controlateral to the most active lead, where the IEDs count was performed. Relationships between SA, SWA and TB and time series of IEDs were tested by means of correlation techniques after data normalization. RESULTS A positive correlation of spike distribution with SWA time course has been found in the majority of adults. Only a few adult patients showed IEDs that were correlated with SA or TB. Conversely SA was shown to be positively correlated with spiking in many different epileptic syndromes of childhood. Moreover, in the contest of the NREM sleep cycle an inverse relationship between the SWA and SA mode of spike activation has been detected. CONCLUSIONS Overall results give evidence that 3 main rhythmic spectral components that characterize sleep EEG can exert positive influences on IEDs production. Our studies demonstrate that within NREM sleep the facilitating influences on IEDs production exerted separately by either spindle activity or delta synchronization mechanisms can be detected. Moreover, a mutually exclusive mechanism between SA and SWA oscillations is detectable in the opposite relationship of the correlation between IEDs and the two bands in the central part of the NREM cycle.
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Affiliation(s)
- F Ferrillo
- Center of Sleep Medicine, Chair of Neurophysiopathology, DISMR, University of Genoa, Genoa, Italy.
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Garbarino S, Nobili L, Beelke M, Balestra V, Carrea P, Ferrillo F. [Sleepiness and road accidents among policemen on shif-work on Italian highways: study of the national highway network in the period of 1993-1997]. Med Lav 2000; 91:486-93. [PMID: 11189786] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Sleep disorders and daytime sleepiness are the most frequent disturbances reported by shift-workers. Sleepiness and fatigue can increase the risk of human errors and accidents especially during night work. In order to evaluate the time distribution and the possible role of sleepiness on road accidents in policemen on shift-work on highway patrols over 24 hours, we analyzed 1218 car accidents that occurred on the Italian highway network in the period 1993-1997. Accidents occurring during day shifts were significantly correlated with traffic density while accidents occurring during night shifts were not. During the 19:00-01:00 h shift the number of accidents showed a progressively increasing trend with two significant peaks around 23:00 and 01:00 h. Accidents occurring during the 01:00-07:00 h shift did not show significant trends. Information about sleep habits before starting night shifts were obtained by means of telephone interviews. While 85% of the subjects usually took a nap (30-90 min) before the 01:00-07:00 h shift only 15% took a short nap (< 30 minutes) before the 19:00-01:00 h shift. The data can be interpreted as a balance between circadian factors, homeostasis and fatigue related influences and spontaneously adopted counteracting strategies to increase the level of vigilance during night work hours. While a long nap seems to reduce the risk of accidents during the 01:00-07:00 h shift, policemen seem to underestimate the risk of sleepiness during the shift 19:00-01:00 h shift.
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Affiliation(s)
- S Garbarino
- Centro di Medicina del Sonno Cattedra di Neurofisiopatologia DISMR, Università di Genova, Ospedale S. Martino, Largo R. Benzi 10-16132 Genova
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