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Orlandi N, d'Orsi G, Pauletto G, Nilo A, Sicurella L, Pescini F, Giglia F, Labate A, Laganà A, Renna R, Cavalli SM, Zummo L, Coletti Moja M, Vollono C, Sabetta A, Ranzato F, Zappulla S, Audenino D, Miniello S, Nazerian P, Marino D, Lattanzi S, Piccioli M, Estraneo A, Zini A, Servo S, Giovannini G, Meletti S, Bianchini D, Contardi S, Fasolino A, Fiore GM, Foschi N, Giordano A, Laisa P, Lo Coco D, Maccora S, Magaudda A, Panebianco M, Merli E, Piccirillo G, Pugnaghi M, Ramacciotti L, Vaudano AE, Vitale G, Zaniboni A. A retrospective multicentric study on the effectiveness of intravenous brivaracetam in seizure clusters: Data from the Italian experience. Seizure 2023; 108:72-80. [PMID: 37104972 DOI: 10.1016/j.seizure.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Nearly half of people with epilepsy (PWE) are expected to develop seizure clusters (SC), with the subsequent risk of hospitalization. The aim of the present study was to evaluate the use, effectiveness and safety of intravenous (IV) brivaracetam (BRV) in the treatment of SC. METHODS Retrospective multicentric study of patients with SC (≥ 2 seizures/24 h) who received IV BRV. Data collection occurred from January 2019 to April 2022 in 25 Italian neurology units. Primary efficacy outcome was seizure freedom up to 24 h from BRV administration. We also evaluated the risk of evolution into Status Epilepticus (SE) at 6, 12 and 24 h after treatment initiation. A Cox regression model was used to identify outcome predictors. RESULTS 97 patients were included (mean age 62 years), 74 (76%) of whom had a history of epilepsy (with drug resistant seizures in 49% of cases). BRV was administered as first line treatment in 16% of the episodes, while it was used as first or second drug after benzodiazepines failure in 49% and 35% of episodes, respectively. On the one hand, 58% patients were seizure free at 24 h after BRV administration and no other rescue medications were used in 75 out of 97 cases (77%) On the other hand, SC evolved into SE in 17% of cases. A higher probability of seizure relapse and/or evolution into SE was observed in patients without a prior history of epilepsy (HR 2.0; 95% CI 1.03 - 4.1) and in case of BRV administration as second/third line drug (HR 3.2; 95% CI 1.1 - 9.7). No severe treatment emergent adverse events were observed. SIGNIFICANCE In our cohort, IV BRV resulted to be well tolerated for the treatment of SC and it could be considered as a treatment option, particularly in case of in-hospital onset. However, the underlying etiology seems to be the main outcome predictor.
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Affiliation(s)
- Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology department, OCB Hospital, AOU Modena, Italy
| | - Giuseppe d'Orsi
- Neurology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
| | | | | | - Francesca Giglia
- Neurology Division with Stroke Unit, "San Giovanni di Dio" Hospital, Agrigento
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, Regional Epilepsy Centre, University of Messina, Italy
| | - Angelina Laganà
- Neurophysiopatology and Movement Disorders Clinic, Regional Epilepsy Centre, University of Messina, Italy
| | - Rosaria Renna
- Neurological Clinic and Stroke Unit - "A. Cardarelli" Hospital, Naples, Italy
| | | | - Leila Zummo
- Neurology and Stroke Unit, P.O. ARNAS-Civico, Palermo, Italy
| | | | - Catello Vollono
- Department of Geriatrics, Neurosciences and Orthopedics, Unit of Neurophysiopatology, IRCSS Policlinico Universitario Agostino Gemelli Catholic University, Rome, Italy
| | - Annarita Sabetta
- Epilepsy Centre - S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | | | | | | | - Stefania Miniello
- Neurology and Stroke Unit, AORN "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Daniela Marino
- Epilepsy Center, Neurology Unit, Department of Cardio-neuro-vascular Sciences, San Donato Hospital, Arezzo, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | - Anna Estraneo
- Neurology Unit and Stroke Unit, Santa Maria della Pietà Hospital, Nola, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Serena Servo
- Neurology Unit, Santa Croce Hospital, Cuneo, Italy
| | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology department, OCB Hospital, AOU Modena, Italy.
| | | | - Sara Contardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Alessandra Fasolino
- Neurological Clinic and Stroke Unit - "A. Cardarelli" Hospital, Naples, Italy
| | | | - Nicoletta Foschi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | | | - Daniele Lo Coco
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Simona Maccora
- Neurology and Stroke Unit, P.O. ARNAS-Civico, Palermo, Italy
| | - Adriana Magaudda
- Epilepsy Center, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Elena Merli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Giovanni Piccirillo
- Neurology and Stroke Unit, AORN "Sant'Anna E San Sebastiano", Caserta, Italy
| | | | | | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology department, OCB Hospital, AOU Modena, Italy
| | | | - Anna Zaniboni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
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Mazzini L, Gelati M, Profico DC, Sgaravizzi G, Projetti Pensi M, Muzi G, Ricciolini C, Rota Nodari L, Carletti S, Giorgi C, Spera C, Domenico F, Bersano E, Petruzzelli F, Cisari C, Maglione A, Sarnelli MF, Stecco A, Querin G, Masiero S, Cantello R, Ferrari D, Zalfa C, Binda E, Visioli A, Trombetta D, Novelli A, Torres B, Bernardini L, Carriero A, Prandi P, Servo S, Cerino A, Cima V, Gaiani A, Nasuelli N, Massara M, Glass J, Sorarù G, Boulis NM, Vescovi AL. Human neural stem cell transplantation in ALS: initial results from a phase I trial. J Transl Med 2015; 13:17. [PMID: 25889343 PMCID: PMC4359401 DOI: 10.1186/s12967-014-0371-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanità and the competent Ethics Committees and was monitored by an external Safety Board. Methods Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials. Results No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease. Conclusions We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material. Trial registration EudraCT:2009-014484-39.
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Affiliation(s)
- Letizia Mazzini
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurizio Gelati
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Daniela Celeste Profico
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Giada Sgaravizzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Massimo Projetti Pensi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Gianmarco Muzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Claudia Ricciolini
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Rota Nodari
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Sandro Carletti
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cesare Giorgi
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cristina Spera
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Frondizi Domenico
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Enrica Bersano
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Francesco Petruzzelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Carlo Cisari
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annamaria Maglione
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Maria Francesca Sarnelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Alessandro Stecco
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Giorgia Querin
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Stefano Masiero
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Roberto Cantello
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Daniela Ferrari
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Cristina Zalfa
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Elena Binda
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Alberto Visioli
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Domenico Trombetta
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Antonio Novelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Barbara Torres
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Bernardini
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Alessandro Carriero
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Paolo Prandi
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Serena Servo
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annalisa Cerino
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Valentina Cima
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Alessandra Gaiani
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicola Nasuelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurilio Massara
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Jonathan Glass
- Department of Neurology Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Gianni Sorarù
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicholas M Boulis
- Department of Neurosurgery Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Angelo L Vescovi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy. .,Fondazione Cellule Staminali di Terni, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
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Pagliardini V, Pagliardini S, Corrado L, Lucenti A, Panigati L, Bersano E, Servo S, Cantello R, D'Alfonso S, Mazzini L. Chitotriosidase and lysosomal enzymes as potential biomarkers of disease progression in amyotrophic lateral sclerosis: a survey clinic-based study. J Neurol Sci 2014; 348:245-50. [PMID: 25563799 DOI: 10.1016/j.jns.2014.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 12/13/2022]
Abstract
The aim of this study was to determine if blood chitotriosidase (Chit) activity and lysosomal enzyme levels might represent markers of disease activity and progression in amyotrophic lateral sclerosis (ALS). It is a survey clinic-based study performed in a tertiary ALS centre. Blood samples were obtained from 76 patients with ALS in different stages of the disease and from 106 healthy individuals serving as controls. Chit activity and the levels of acid alpha-glucosidase, acid alpha-galattosidase A, beta-glucocerebrosidase, and alpha-l-iduronidase were detected using the dried blood spots (DBS) technique. The CHIT1 genotype for exon 10 duplication and for the p.G102S variant was also determined. Chit activity was significantly higher in ALS patients than in healthy individuals. This difference was independent of the genotypes at CHIT1 functional variants. Chit were significantly higher in 34 rapidly progressing patients as compared to 42 with slowly progressive disease. Acid alpha-glucosidase was higher than normal and significantly correlated with the severity of the disease. Glucocerebrosidase and alpha-l-iduronidase activity were significantly lower in patients than in the controls. Alpha-galactosidase A was higher than normal only in rapidly progressing patients. We have employed a very simple and affordable laboratory test to measure blood Chit and lysosomal enzymes activity which could be easily included in the screening of ALS patients recruited in clinical trials. Remarkably, high levels of chitinase and alpha-galactosidase A could help to distinguish patients with fast progression from those with slow progression of the disease and possibly to follow the effects of treatments on neuroinflammation and autophagy.
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Affiliation(s)
| | - Severo Pagliardini
- Department of Pediatric and Newborn Screening, University of Torino, Italy
| | - Lucia Corrado
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases, A. Avogadro' University, Italy
| | - Ausiliatrice Lucenti
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Laura Panigati
- Department of Pediatric, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Enrica Bersano
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Serena Servo
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Roberto Cantello
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases, A. Avogadro' University, Italy
| | - Letizia Mazzini
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy.
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Mazzini L, Mareschi K, Ferrero I, Miglioretti M, Stecco A, Servo S, Carriero A, Monaco F, Fagioli F. Mesenchymal stromal cell transplantation in amyotrophic lateral sclerosis: a long-term safety study. Cytotherapy 2011; 14:56-60. [PMID: 21954839 DOI: 10.3109/14653249.2011.613929] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AIMS Mesenchymal stem cells/marrow stromal cells (MSC) represent a promising tool for stem cell-based clinical trials in amyotrophic lateral sclerosis (ALS). We present the results of long-term monitoring of 19 ALS patients enrolled in two phase I clinical trials of autologous MSC transplantation. METHODS Nineteen patients (11 male and eightfemale) with ALS were enrolled in two consecutive phase I clinical trials. The patients were followed-up for 6-9 months and then treated with autologous MSC isolated from bone marrow and implanted into the dorsal spinal cord with a surgical procedure. The patients were monitored regularly before and after transplantation with clinical, psychological and neuroradiologic assessments every 3 months, at the tertiary referral ALS center in Novara (Italy), until death. RESULTS Follow-up brain magnetic resonance imaging (MRI) revealed no structural changes (including tumor formation) relative to the baseline throughout the follow-up. There was no deterioration in the psychosocial status and all patients coped well. No clear clinical benefits were detected in these patients but the recruitment and selection of appropriate patients into larger trials will be needed to test the efficacy of the treatment. CONCLUSIONS This study is the first to show the safety of MSC transplantation in the central nervous system during a follow-up of nearly 9 years, and is in support of applying MSC-based cellular clinical trials to neurodegenerative disorders.
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Affiliation(s)
- Letizia Mazzini
- ALS Centre Department of Neurology 'Eastern Piedmont' University, Maggiore della Carità Hospital, Novara, Italy.
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Mazzini L, Oggioni GD, Nasuelli N, Servo S, Testa L, Monaco F. Disabling Parkinsonism following brief exposure to lithium carbonate in amyotrophic lateral sclerosis. J Neurol 2010; 258:333-4. [DOI: 10.1007/s00415-010-5753-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/07/2010] [Accepted: 09/07/2010] [Indexed: 12/12/2022]
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Cavanna AE, Stecco A, Rickards H, Servo S, Terazzi E, Peterson B, Robertson MM, Carriero A, Monaco F. Corpus callosum abnormalities in Tourette syndrome: an MRI-DTI study of monozygotic twins. J Neurol Neurosurg Psychiatry 2010; 81:533-5. [PMID: 20176604 DOI: 10.1136/jnnp.2009.173666] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a chronic neurodevelopmental disorder characterised by the presence of multiple motor and phonic tics. Recent brain imaging investigations with diffusion tensor imaging (DTI) techniques found reduced measures of connectivity in the corpus callosum of children with TS compared with healthy controls, thus raising the hypothesis that the reduced interhemispherical connectivity in TS reflects neural plasticity processes. METHODS We assessed corpus callosum white-matter connectivity with fractional anisotropy (FA) index from magnetic resonance-DTI in two monozygotic twins (male sex; age 20) discordant for the diagnosis of TS. RESULTS Both conventional morphological magnetic resonance images and fibre-tracking reconstruction failed to show any difference between the two twins. On the other hand, mean corpus callosum FA values were significantly lower in the affected twin than in the unaffected twin (p<0.01). The differences in FA values were highest in the posterior portions of the corpus callosum, and lowest in the central area. CONCLUSIONS Our findings of reduced interhemispherical white-matter connectivity in the affected twin support the hypothesis that plastic remodelling in the corpus callosum possibly represents an adaptation mechanism in TS.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neurology, Amedeo Avogadro University, Novara, Italy.
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Cavanna AE, Cavanna SL, Servo S, Monaco F. The neural correlates of impaired consciousness in coma and unresponsive states. Discov Med 2010; 9:431-438. [PMID: 20515611] [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: 05/29/2023]
Abstract
Over the last few years, functional neuroimaging studies have provided new insights into cerebral activity in subjects with severe brain damage leading to coma and other clinical states characterized by unresponsiveness. The present paper introduces the clinical picture of patients with impaired consciousness, and reviews the nosological criteria and functional neuroanatomical basis for brain death, coma, vegetative state, minimally conscious state, and the locked-in syndrome. Converging evidence suggests that disrupted activity in higher-order association areas, especially prefrontal and posteromedial parietal regions, plays a pivotal role within the neural correlates of impaired consciousness in the unresponsive patient.
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Affiliation(s)
- Andrea Eugenio Cavanna
- Department of Neuropsychiatry, University of Birmingham and Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom.
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Cavanna AE, Bertero L, Cavanna S, Servo S, Strigaro G, Monaco F. Persistent akinetic mutism after bilateral paramedian thalamic infarction. J Neuropsychiatry Clin Neurosci 2009; 21:351. [PMID: 19776325 DOI: 10.1176/jnp.2009.21.3.351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Virtually no neurologist nor psychiatrist today can be unaware of the diagnosis of Gilles de la Tourette syndrome (GTS). Although the eponymous description by Dr. Georges Gilles de la Tourette was published in 1885, familiarity with this syndrome has been achieved only recently. In this article, the two most renown accounts of exceptional individuals retrospectively diagnosed with GTS are critically analyzed: British lexicographer Samuel Johnson and Austrian musician Wolfgang Amadeus Mozart. In both cases, clinical descriptions have been retrieved from written documents predating Gilles de la Tourette's original publication. The case for Samuel Johnson having GTS is strong, mainly based on Boswell's extensive biographical account. Johnson was reported to have a great range of tics and compulsions, including involuntary utterances, repetitive ejaculations, and echo-phenomena. On the other hand, there is circumstantial evidence that Mozart may have had hyperactivity, restlessness, sudden impulses, odd motor behaviors, echo/palilalia, love of nonsense words, and scatology, the latter being documented in autograph letters ("coprographia"). However, the evidence supporting the core features of GTS, i.e., motor and vocal tics, is rather inconsistent. Thus, GTS seems to be an implausible diagnosis in Mozart's medical history and completely unrelated to his undisputed musical genius.
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Affiliation(s)
- Francesco Monaco
- Department of Neurology, Amedeo Avogadro University, Novara, Italy
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Abstract
Gilles de la Tourette syndrome is a neurodevelopmental disorder consisting of multiple motor and one or more vocal/phonic tics. Tourette's syndrome is increasingly recognized as a common neuropsychiatric disorder usually diagnosed in early childhood, and comorbid neuropsychiatric disorders occur in approximately 90% of patients; the most common of these are attention deficit hyperactivity disorder and obsessive-compulsive disorder. Depression is also common, with a lifetime risk of 10% of patients. Moreover, a high prevalence of personality disorders has been reported in preliminary investigations on Tourette's syndrome populations. This paper provides an updated review of the literature on the multifaceted phenotype of Tourette's syndrome, with special attention to the behavioral problems and the relationship between Tourette's syndrome and comorbid neuropsychiatric conditions. The issue of whether Tourette's syndrome should still be considered as a unitary nosological entity is also addressed.
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Mazzini L, Vercelli A, Ferrero I, Mareschi K, Boido M, Servo S, Oggioni GD, Testa L, Monaco F, Fagioli F. Stem cells in amyotrophic lateral sclerosis: state of the art. Expert Opin Biol Ther 2009; 9:1245-58. [DOI: 10.1517/14712590903186956] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cavanna AE, Mula M, Strigaro G, Servo S, Tota G, Barbagli D, Collimedaglia L, Viana M, Cantello R, Monaco F. Clinical correlates of pathological gambling symptoms in patients with epilepsy. Epilepsia 2008; 49:1460-4. [DOI: 10.1111/j.1528-1167.2008.01586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cavanna AE, Mula M, Servo S, Strigaro G, Tota G, Barbagli D, Collimedaglia L, Viana M, Cantello R, Monaco F. Measuring the level and content of consciousness during epileptic seizures: the Ictal Consciousness Inventory. Epilepsy Behav 2008; 13:184-8. [PMID: 18353730 DOI: 10.1016/j.yebeh.2008.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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: 12/03/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 01/21/2023]
Abstract
Ictal alterations of the level of general awareness and subjective content of consciousness play a pivotal role in the clinical phenomenology of epilepsy, and reflect the pathological involvement of different neurobiological substrates. However, no self-reported measures have been proposed for patients experiencing altered conscious states during seizures. This study describes the development and validation of a new scale for the quantitative assessment of the level and content of ictal consciousness, the Ictal Consciousness Inventory (ICI). The ICI is a 20-item questionnaire generated on the basis of interviews with patients, literature review, and consultation with experts. It was tested on a sample of 110 patients attending three different epilepsy clinics in Northern Italy, who also completed standardized clinical scales. Standard psychometric methods were used to demonstrate that this scale satisfies criteria for acceptability, reliability, and validity. The ICI is proposed as a user-friendly and clinically sound instrument for the measurement of ictal alterations of consciousness in patients with epilepsy.
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Affiliation(s)
- A E Cavanna
- Department of Neurology, Amedeo Avogadro University, Novara, Italy.
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