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Bellofatto M, Gentile L, Bertini A, Tramacere I, Manganelli F, Fabrizi GM, Schenone A, Santoro L, Cavallaro T, Grandis M, Previtali SC, Scarlato M, Allegri I, Padua L, Pazzaglia C, Villani F, Cavalca E, Saveri P, Quattrone A, Valentino P, Tozza S, Russo M, Mazzeo A, Vita G, Piacentini S, Didato G, Pisciotta C, Pareyson D. Daytime sleepiness and sleep quality in Charcot-Marie-Tooth disease. J Neurol 2023; 270:5561-5568. [PMID: 37540277 PMCID: PMC10576706 DOI: 10.1007/s00415-023-11911-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Sleep abnormalities have been reported in Charcot-Marie-Tooth disease (CMT), but data are scanty. We investigated their presence and correlation in a large CMT patients' series. METHODS Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to CMT patients of the Italian registry and controls. ESS score > 10 indicated abnormal daytime somnolence, PSQI score > 5 bad sleep quality. We analyzed correlation with disease severity and characteristics, Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS), Body Mass Index, drug use. RESULTS ESS and PSQI questionnaires were filled by 257 and 253 CMT patients, respectively, and 58 controls. Median PSQI score was higher in CMT patients than controls (6 vs 4, p = 0.006), with no difference for ESS score. Abnormal somnolence and poor sleep quality occurred in 23% and 56% of patients; such patients had more frequently anxiety/depression, abnormal fatigue, and positive sensory symptoms than those with normal ESS/PSQI. Moreover, patients with PSQI score > 5 had more severe disease (median CMT Examination Score, CMTES, 8 vs 6, p = 0.006) and more frequent use of anxiolytic/antidepressant drugs (29% vs 7%, p < 0.001). CONCLUSIONS Bad sleep quality and daytime sleepiness are frequent in CMT and correlated with anxiety, depression and fatigue, confirming that different components affect sleep. Sleep disorders, such as sleep apnea and restless leg syndrome, not specifically investigated here, are other factors known to impact on sleep quality and somnolence. CMT patients' management must include sleep behavior assessment and evaluation of its correlated factors, including general distress and fatigue.
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Affiliation(s)
- Marta Bellofatto
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Luca Gentile
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Alessandro Bertini
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Irene Tramacere
- Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Direzione Scientifica, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Fiore Manganelli
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Gian Maria Fabrizi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, 37126, Verona, Italy
| | - Angelo Schenone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Lucio Santoro
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Tiziana Cavallaro
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, 37126, Verona, Italy
| | - Marina Grandis
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Stefano C Previtali
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Marina Scarlato
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | | | - Luca Padua
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Costanza Pazzaglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Flavio Villani
- Unità di U.O. Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Eleonora Cavalca
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Paola Saveri
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Aldo Quattrone
- Dipartimento di Scienze Mediche, Università Magna Grecia, 88100, Catanzaro, Italy
| | - Paola Valentino
- Dipartimento di Scienze Mediche, Università Magna Grecia, 88100, Catanzaro, Italy
| | - Stefano Tozza
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Massimo Russo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Anna Mazzeo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Giuseppe Vita
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Sylvie Piacentini
- Unità di Neuropsicologia, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta di Milano, 20133, Milan, Italy
| | - Giuseppe Didato
- Unità di Epilettologia Clinica e Sperimentale, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Chiara Pisciotta
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Davide Pareyson
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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Bellofatto M, Gentile L, Bertini A, Tramacere I, Manganelli F, Fabrizi GM, Schenone A, Santoro L, Cavallaro T, Grandis M, Previtali SC, Scarlato M, Allegri I, Padua L, Pazzaglia C, Villani F, Cavalca E, Saveri P, Quattrone A, Valentino P, Tozza S, Russo M, Mazzeo A, Vita G, Piacentini S, Didato G, Pisciotta C, Pareyson D. Correction to: Daytime sleepiness and sleep quality in Charcot-Marie-Tooth disease. J Neurol 2023; 270:5569-5570. [PMID: 37733102 PMCID: PMC10576716 DOI: 10.1007/s00415-023-11989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Marta Bellofatto
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Luca Gentile
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Alessandro Bertini
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Irene Tramacere
- Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Direzione Scientifica, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Fiore Manganelli
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Gian Maria Fabrizi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, 37126, Verona, Italy
| | - Angelo Schenone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Lucio Santoro
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Tiziana Cavallaro
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, 37126, Verona, Italy
| | - Marina Grandis
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Stefano C Previtali
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Marina Scarlato
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | | | - Luca Padua
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Costanza Pazzaglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Flavio Villani
- Unità di U.O. Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Eleonora Cavalca
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Paola Saveri
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Aldo Quattrone
- Dipartimento di Scienze Mediche, Università Magna Grecia, 88100, Catanzaro, Italy
| | - Paola Valentino
- Dipartimento di Scienze Mediche, Università Magna Grecia, 88100, Catanzaro, Italy
| | - Stefano Tozza
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, 80131, Naples, Italy
| | - Massimo Russo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Anna Mazzeo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Giuseppe Vita
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98124, Messina, Italy
| | - Sylvie Piacentini
- Unità di Neuropsicologia, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta di Milano, 20133, Milan, Italy
| | - Giuseppe Didato
- Unità di Epilettologia Clinica e Sperimentale, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Chiara Pisciotta
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Davide Pareyson
- SC Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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Bellofatto M, Bertini A, Tramacere I, Manganelli F, Fabrizi GM, Schenone A, Santoro L, Cavallaro T, Grandis M, Previtali SC, Falzone Y, Allegri I, Padua L, Pazzaglia C, Calabrese D, Saveri P, Quattrone A, Valentino P, Tozza S, Gentile L, Russo M, Mazzeo A, Vita G, Piacentini S, Pisciotta C, Pareyson D. Frequency, entity and determinants of fatigue in Charcot-Marie-Tooth disease. Eur J Neurol 2023; 30:710-718. [PMID: 36458502 PMCID: PMC10107642 DOI: 10.1111/ene.15643] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Fatigue, a disabling symptom in many neuromuscular disorders, has been reported also in Charcot-Marie-Tooth disease (CMT). The presence of fatigue and its correlations in CMT was investigated. METHODS The Modified Fatigue Impact Scale (MFIS) was administered to CMT patients from the Italian Registry and a control group. An MFIS score >38 indicated abnormal fatigue. The correlation with disease severity and clinical characteristics, the Hospital Anxiety and Depression Scale and Epworth Sleepiness Scale scores, and drug use was analysed. RESULTS Data were collected from 251 CMT patients (136 women) and 57 controls. MFIS total (mean ± standard deviation 32 ± 18.3, median 33), physical (18.9 ± 9.7, 20) and psychosocial (2.9 ± 2.4, 3) scores in CMT patients were significantly higher than controls. Abnormal fatigue occurred in 36% of the patients who, compared to patients with normal scores, had more severe disease (median CMT Examination Score 9 vs. 7), more frequent use of foot orthotics (22% vs. 11%), need of support for walking (21% vs. 8%), hand disability (70% vs. 52%) and positive sensory symptoms (56% vs. 36%). Patients with abnormal fatigue had significantly increased frequency of anxiety/depression/general distress (Hospital Anxiety and Depression Scale), somnolence (Epworth Sleepiness Scale), obesity (body mass index ≥ 30) and use of anxiolytic/antidepressant or anti-inflammatory/analgesic drugs. CONCLUSIONS Fatigue is a relevant symptom in CMT as 36% of our series had scores indicating abnormal fatigue. It correlated with disease severity but also with anxiety, depression, sleepiness and obesity, indicating different components in the generation of fatigue. CMT patients' management must include treatment of fatigue and of its different generators, including general distress, sleepiness and obesity.
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Affiliation(s)
- Marta Bellofatto
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandro Bertini
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Direzione Scientifica, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fiore Manganelli
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Naples, Italy
| | - Gian Maria Fabrizi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Angelo Schenone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno-infantili, Università di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucio Santoro
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Naples, Italy
| | - Tiziana Cavallaro
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Marina Grandis
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno-infantili, Università di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano C Previtali
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Yuri Falzone
- INSPE and Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Luca Padua
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Daniela Calabrese
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Saveri
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Paola Valentino
- Dipartimento di Scienze Mediche, Università Magna Grecia, Catanzaro, Italy
| | - Stefano Tozza
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Naples, Italy
| | - Luca Gentile
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Massimo Russo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Anna Mazzeo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Giuseppe Vita
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Sylvie Piacentini
- Unità di Neuropsicologia, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta di Milano, Milan, Italy
| | - Chiara Pisciotta
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Davide Pareyson
- Unità di Malattie Neurodegenerative e Metaboliche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Cuccurullo C, Santulli L, Troisi S, Russo P, Catone A, Bellofatto M, Tozza S, Ugga L, Rossi S, Castellotti B, Bilo L, Coppola A. Sialidosis type 1: Long-term care of two unrelated patients and effectiveness of low doses of Perampanel. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lieto M, Roca A, Bruzzese D, Antenora A, Alfieri G, Saccà F, Bellofatto M, Bilo L, Barbato S, De Michele G, Filla A. Longitudinal study of a cohort of MSA-C patients in South Italy: survival and clinical features. Neurol Sci 2019; 40:2105-2109. [DOI: 10.1007/s10072-019-03948-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022]
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Lieto M, Roca A, Santorelli FM, Fico T, De Michele G, Bellofatto M, Saccà F, De Michele G, Filla A. Degenerative and acquired sporadic adult onset ataxia. Neurol Sci 2019; 40:1335-1342. [PMID: 30927137 DOI: 10.1007/s10072-019-03856-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/31/2023]
Abstract
The diagnosis of sporadic adult onset ataxia is a challenging task since a large collection of hereditary and non-hereditary disorders should be taken into consideration. Sporadic adult onset ataxias include degenerative non-hereditary, hereditary, and acquired ataxias. Multiple system atrophy and idiopathic late cerebellar ataxia are degenerative non-hereditary ataxias. Late-onset Friedreich's ataxia, spinocerebellar ataxia type 6 and 2, and fragile X-associated tremor/ataxia syndrome account for most sporadic hereditary ataxias. Alcoholic cerebellar degeneration, paraneoplastic and other autoimmune cerebellar degeneration, vitamin deficiencies, and toxic-induced and infectious cerebellar syndrome are the main causes of acquired cerebellar degeneration. The diagnostic approach should include a history taking, disease progression, general and neurological examination, brain MRI, and laboratory and genetic tests. Novel opportunities in massive gene sequencing will increase the likelihood to define true etiologies.
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Affiliation(s)
- Maria Lieto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Alessandro Roca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Tommasina Fico
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Marta Bellofatto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
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Bellofatto M, De Michele G, Iovino A, Filla A, Santorelli FM. Management of Hereditary Spastic Paraplegia: A Systematic Review of the Literature. Front Neurol 2019; 10:3. [PMID: 30723448 PMCID: PMC6349696 DOI: 10.3389/fneur.2019.00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/03/2019] [Indexed: 12/03/2022] Open
Abstract
The term hereditary spastic paraplegia (HSP) embraces a clinically and genetically heterogeneous group of neurodegenerative diseases characterized by progressive spasticity and weakness of the lower limbs. There currently exist no specific therapies for HSP, and treatment is exclusively symptomatic, aimed at reducing muscle spasticity, and improving strength and gait. The authors set out to perform a comprehensive systematic review of the available scientific literature on the treatment of HSP, applying Cochrane Collaboration methods. The Google Scholar, PubMed and Scopus electronic databases were searched to find relevant randomized control trials (RCTs) and open-label interventional studies, prospective, and retrospective observational studies of supplements, medications, and physical therapy, as well as case reports and case series. Two authors independently analyzed 27 articles selected on the basis of a series of inclusion criteria. Applying a best-evidence synthesis approach, they evaluated these articles for methodological quality. A standardized scoring system was used to obtain interrater assessments. Disagreements were resolved by discussion. The 27 articles focused on pharmacological treatment (n = 17 articles), physical therapy (n = 5), surgical treatment (n = 5). The drugs used in the 17 articles on pharmacological therapy were: gabapentin, progabide, dalfampridine, botulinum toxin, L-Dopa, cholesterol-lowering drugs, betaine, and folinic acid. Gabapentin, progabide, dalfampridine, and botulinum toxin were used as antispastic agents; the study evaluating gabapentin efficacy was well-designed, but failed to demonstrate any significant improvement. L-Dopa, cholesterol-lowering drugs, betaine, and folinic acid were only used in specific HSP subtypes. Two of the three studies evaluating cholesterol-lowering drugs (in SPG5 patients) were well-designed and showed a significant reduction of specific serum biomarkers (oxysterols), but clinical outcomes were not evaluated. The articles focusing on physical treatment and surgical therapy were found to be of low/medium quality and, accordingly, failed to clarify the role of these approaches in HSP. Despite recent advances in understanding of the pathogenesis of HSP and the possibility, in several centers, of obtaining more precise and rapid molecular diagnoses, there is still no adequate evidence base for recommending the various published therapies. Well-designed RCTs are needed to evaluate the efficacy of both symptomatic and pathogenetic treatments.
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Affiliation(s)
- Marta Bellofatto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Aniello Iovino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
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Lieto M, Roca A, Antenora A, Peluso S, Bellofatto M, Bruzzese D, De Michele G, Filla A. Longitudinal study of a cohort of MSA-C patients in south Italy: Survival and clinical features. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.855] [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: 10/18/2022]
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