The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and... more The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and 72 women) suffering from acute cerebral infarction not due to embolism. The results have been analysed statistically and compared to those of a control group formed by 123 neurologic patients (68 men and 55 women) chosen at random, belonging to the same age range and with no cerebrovascular disease. The hematocrit was significantly higher in the patients who had a cerebral stroke of a non-embolic origin, both males and females, than in the control group, although it was within normal limits. As far as the concentration of hemoglobin is concerned, there is a significant statistical difference between patients with and without cerebral infarction, but only for the female patients.
The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with... more The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with transient ischemic attacks (TIA) and in 349 patients with cerebral infarct have been analyzed. AF was found in 11.9% of patients with TIA and in 14.9% of patients with cerebral infarct. The difference was not significant (NS). In patients without AF, the carotid artery TIAs represent 70.6% of all TIAs, while the vertebral basilar artery TIAs account for 29.4%. When AF is present, 88.9% of all TIAs belong to the carotid artery and 11.1% to the vertebral basilar artery circulatory system (NS). TIAs lasting less than 10 minutes are 42.1% when AF is not present, while when AF is present they are only 11.1% (p less than 0.001). In patients without AF 79% of TIAs last less than one hour, while in patients with AF the percentage goes down to 38.9% (p less than 0.001). In patients with or without AF, the chronic digitalis therapy before the hospitalization does not affect in any way the occurre...
Objective To evaluate the efficacy of high-frequency rTMS in medication overuse headache (MOH). M... more Objective To evaluate the efficacy of high-frequency rTMS in medication overuse headache (MOH). Methods A eight-month prospective, single-blind, randomized, placebo-controlled trial on patients with MOH consecutively presenting in our Headache Centre was performed. Patients were randomized into rTMS or sham-TMS group. Treatment consisted of 10 consecutively TMS sessions delivered on left dorsolateral prefrontal cortex, each session being 10 trains of 2-s duration, separated by 30-s pause, 20 Hz frequency, 100% motor threshold intensity. Demographic information, MIDAS score, headache days (HD), hours of headache (HH), and symptomatic drugs (SD) in the 3 months before (T0), and in the 3 months after stimulation (T1) were analyzed using SPSS 14.0. Results We enrolled 14 patients (12 F, 2 M; mean age 45 ± 10), 7 patients underwent rTMS and 7 sham-TMS. In T1, we found a significant reduction of all analyzed variables both in rTMS and in sham-TMS group. Higher improvement was found in rTMS group in HD (46% vs 36%), HH (50% vs 32%), and in MIDAS score (60% vs 43%). SD likewise reduced in both rTMS and sham-TMS group (60% vs 61%). Conclusions Our preliminary data suggest that high-frequency rTMS is slightly superior to sham in treating medication overuse headache.
Introduction: Paired associative stimulation (PAS) protocol where transcranial magnetic stimulati... more Introduction: Paired associative stimulation (PAS) protocol where transcranial magnetic stimulation (TMS) pulse is preceded 25 ms by median nerve stimulation (MNS), PAS25, is capable of producing long-term potentiation (LPT) like changes and increase in motor cortex excitability. However, when an MNS pulse is applied 25 ms before a TMS pulse it leads to reduction of TMS elicited motor evoked potential amplitude (MEP), a phenomenon known as short-latency afferent inhibition (SAI). The dynamics of interaction between these two opposing physiological processes has not been investigated yet. Objective: To evaluate the dynamics of motor cortex excitability changes during PAS25 protocol in a group of healthy subjects (control group CG) and in a group of drug-naive PD patients (PDG); presence of deficient SAI has been already reported in PD patients. Methods: PDG had 9 patients (3 female), mean age 52.3 years, mean duration of the disease 2.5 years, and Hoehn and Yahr stage range 1 2.5 (mea 1.9); CG had 11 subjects (3 female), mean age 50.2 years. MEP amplitudes from 180 MNS-TMS successive pairs were collapsed into 18 time-bins and averaged across groups. MEP amplitudes were normalised and expressed as a percentage of pre-PAS control MEP amplitudes obtained at rest. Two-factorial repeated-measured ANOVA, with factors GROUP and TIME-BIN, was used. Results: Factor TIME-BIN, p < 0.001; factor GROUP, p < 0.001; interaction TIME-BIN × GROUP, p < 0.001. In CG MEP amplitudes were consistently diminished throughout the PAS protocol staying on average at 35.6% (range 25 45%). In PDG, in the first third of the PAS protocol MEP amplitudes remained close to 100%, while during the rest of the protocol they increased close to the 140% level and they stayed like this almost until the end. Conclusions: Results suggest that SAI mechanisms operate independently from LTP mechanisms during PAS protocol. An impairment of SAI is present even at the early stages of PD, before dopaminergic medication.
XXX Congresso Nazionale del''Associazione Italiana GMEE, 2013
L\u2019utilizzo di tracciati elettroencefalografici (EEG) come fonte di informazioni per la carat... more L\u2019utilizzo di tracciati elettroencefalografici (EEG) come fonte di informazioni per la caratterizzazione di disturbi legati al sistema nervoso \ue8 di grande interesse nel campo della diagnostica strumentale. Il presentarsi di patologie come tumori cerebrali, epilessia, ictus, ma anche di stati di anestesia, coma e fasi del sonno, si riflette sull\u2019organismo alterando in modo pi\uf9 o meno significativo l\u2019attivit\ue0 cerebrale, e di conseguenza le caratteristiche dell\u2019EEG. Il presente lavoro ha preso in analisi i tracciati EEG di soggetti con deficit neurologico di tipo aMCI (amnestic Mild Cognitive Impairment) e SMC (Subjective Memory Compliance). Individui affetti da aMCI presentano disturbi della memoria senza deficit in altre funzioni cognitive e sono potenzialmente a rischio di sviluppare demenza. A differenza dell\u2019aMCI, in cui c\u2019\ue8 un riscontro oggettivo ai test neuropsicologici effettuati, il soggetto con SMC presenta un disturbo soltanto soggettivo della memoria. Lo scopo del presente studio \ue8 stato l\u2019estrazione e la valutazione di parametri, lineari e non lineari, dall\u2019EEG che permettano di distinguere i due gruppi di soggetti in esame. In particolare gli strumenti utilizzati per la caratterizzazione dei segnali sono l\u2019analisi spettrale e l\u2019analisi frattale
The use of repetitive TMS (rTMS) for epilepsy is a potential therapy. In literature several case ... more The use of repetitive TMS (rTMS) for epilepsy is a potential therapy. In literature several case reports were published with different results. We describe two cases of refractory focal NCSE treated with rTMS with different stimulus parameters. During rTMS we monitored the brain electrical activity with standard EEG, according with our previously experiences in EEG/TMS co-registration. The stimulus was applied over the epileptic focus, according with EEG registration. We used a train stimulus of 0.5 or 1 Hz at 70 or 100 % of motor threshold, for 20 min. In the first case rTMS decreased suddenly the electrical paroxysm. In the second case rTMS reduced, but not abolished, the ictal activity. We think that the use of rTMS in selected refractory cases of both convulsive and non-convulsive status epilepticus can be useful when conventional therapies have failed. In addition, in these cases the EEG/TMS coregistration is mandatory. Future studies should investigate various rTMS parameters in different patients with refractory focal status epilepicus.
The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and... more The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and 72 women) suffering from acute cerebral infarction not due to embolism. The results have been analysed statistically and compared to those of a control group formed by 123 neurologic patients (68 men and 55 women) chosen at random, belonging to the same age range and with no cerebrovascular disease. The hematocrit was significantly higher in the patients who had a cerebral stroke of a non-embolic origin, both males and females, than in the control group, although it was within normal limits. As far as the concentration of hemoglobin is concerned, there is a significant statistical difference between patients with and without cerebral infarction, but only for the female patients.
The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with... more The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with transient ischemic attacks (TIA) and in 349 patients with cerebral infarct have been analyzed. AF was found in 11.9% of patients with TIA and in 14.9% of patients with cerebral infarct. The difference was not significant (NS). In patients without AF, the carotid artery TIAs represent 70.6% of all TIAs, while the vertebral basilar artery TIAs account for 29.4%. When AF is present, 88.9% of all TIAs belong to the carotid artery and 11.1% to the vertebral basilar artery circulatory system (NS). TIAs lasting less than 10 minutes are 42.1% when AF is not present, while when AF is present they are only 11.1% (p less than 0.001). In patients without AF 79% of TIAs last less than one hour, while in patients with AF the percentage goes down to 38.9% (p less than 0.001). In patients with or without AF, the chronic digitalis therapy before the hospitalization does not affect in any way the occurre...
Objective To evaluate the efficacy of high-frequency rTMS in medication overuse headache (MOH). M... more Objective To evaluate the efficacy of high-frequency rTMS in medication overuse headache (MOH). Methods A eight-month prospective, single-blind, randomized, placebo-controlled trial on patients with MOH consecutively presenting in our Headache Centre was performed. Patients were randomized into rTMS or sham-TMS group. Treatment consisted of 10 consecutively TMS sessions delivered on left dorsolateral prefrontal cortex, each session being 10 trains of 2-s duration, separated by 30-s pause, 20 Hz frequency, 100% motor threshold intensity. Demographic information, MIDAS score, headache days (HD), hours of headache (HH), and symptomatic drugs (SD) in the 3 months before (T0), and in the 3 months after stimulation (T1) were analyzed using SPSS 14.0. Results We enrolled 14 patients (12 F, 2 M; mean age 45 ± 10), 7 patients underwent rTMS and 7 sham-TMS. In T1, we found a significant reduction of all analyzed variables both in rTMS and in sham-TMS group. Higher improvement was found in rTMS group in HD (46% vs 36%), HH (50% vs 32%), and in MIDAS score (60% vs 43%). SD likewise reduced in both rTMS and sham-TMS group (60% vs 61%). Conclusions Our preliminary data suggest that high-frequency rTMS is slightly superior to sham in treating medication overuse headache.
Introduction: Paired associative stimulation (PAS) protocol where transcranial magnetic stimulati... more Introduction: Paired associative stimulation (PAS) protocol where transcranial magnetic stimulation (TMS) pulse is preceded 25 ms by median nerve stimulation (MNS), PAS25, is capable of producing long-term potentiation (LPT) like changes and increase in motor cortex excitability. However, when an MNS pulse is applied 25 ms before a TMS pulse it leads to reduction of TMS elicited motor evoked potential amplitude (MEP), a phenomenon known as short-latency afferent inhibition (SAI). The dynamics of interaction between these two opposing physiological processes has not been investigated yet. Objective: To evaluate the dynamics of motor cortex excitability changes during PAS25 protocol in a group of healthy subjects (control group CG) and in a group of drug-naive PD patients (PDG); presence of deficient SAI has been already reported in PD patients. Methods: PDG had 9 patients (3 female), mean age 52.3 years, mean duration of the disease 2.5 years, and Hoehn and Yahr stage range 1 2.5 (mea 1.9); CG had 11 subjects (3 female), mean age 50.2 years. MEP amplitudes from 180 MNS-TMS successive pairs were collapsed into 18 time-bins and averaged across groups. MEP amplitudes were normalised and expressed as a percentage of pre-PAS control MEP amplitudes obtained at rest. Two-factorial repeated-measured ANOVA, with factors GROUP and TIME-BIN, was used. Results: Factor TIME-BIN, p < 0.001; factor GROUP, p < 0.001; interaction TIME-BIN × GROUP, p < 0.001. In CG MEP amplitudes were consistently diminished throughout the PAS protocol staying on average at 35.6% (range 25 45%). In PDG, in the first third of the PAS protocol MEP amplitudes remained close to 100%, while during the rest of the protocol they increased close to the 140% level and they stayed like this almost until the end. Conclusions: Results suggest that SAI mechanisms operate independently from LTP mechanisms during PAS protocol. An impairment of SAI is present even at the early stages of PD, before dopaminergic medication.
XXX Congresso Nazionale del''Associazione Italiana GMEE, 2013
L\u2019utilizzo di tracciati elettroencefalografici (EEG) come fonte di informazioni per la carat... more L\u2019utilizzo di tracciati elettroencefalografici (EEG) come fonte di informazioni per la caratterizzazione di disturbi legati al sistema nervoso \ue8 di grande interesse nel campo della diagnostica strumentale. Il presentarsi di patologie come tumori cerebrali, epilessia, ictus, ma anche di stati di anestesia, coma e fasi del sonno, si riflette sull\u2019organismo alterando in modo pi\uf9 o meno significativo l\u2019attivit\ue0 cerebrale, e di conseguenza le caratteristiche dell\u2019EEG. Il presente lavoro ha preso in analisi i tracciati EEG di soggetti con deficit neurologico di tipo aMCI (amnestic Mild Cognitive Impairment) e SMC (Subjective Memory Compliance). Individui affetti da aMCI presentano disturbi della memoria senza deficit in altre funzioni cognitive e sono potenzialmente a rischio di sviluppare demenza. A differenza dell\u2019aMCI, in cui c\u2019\ue8 un riscontro oggettivo ai test neuropsicologici effettuati, il soggetto con SMC presenta un disturbo soltanto soggettivo della memoria. Lo scopo del presente studio \ue8 stato l\u2019estrazione e la valutazione di parametri, lineari e non lineari, dall\u2019EEG che permettano di distinguere i due gruppi di soggetti in esame. In particolare gli strumenti utilizzati per la caratterizzazione dei segnali sono l\u2019analisi spettrale e l\u2019analisi frattale
The use of repetitive TMS (rTMS) for epilepsy is a potential therapy. In literature several case ... more The use of repetitive TMS (rTMS) for epilepsy is a potential therapy. In literature several case reports were published with different results. We describe two cases of refractory focal NCSE treated with rTMS with different stimulus parameters. During rTMS we monitored the brain electrical activity with standard EEG, according with our previously experiences in EEG/TMS co-registration. The stimulus was applied over the epileptic focus, according with EEG registration. We used a train stimulus of 0.5 or 1 Hz at 70 or 100 % of motor threshold, for 20 min. In the first case rTMS decreased suddenly the electrical paroxysm. In the second case rTMS reduced, but not abolished, the ictal activity. We think that the use of rTMS in selected refractory cases of both convulsive and non-convulsive status epilepticus can be useful when conventional therapies have failed. In addition, in these cases the EEG/TMS coregistration is mandatory. Future studies should investigate various rTMS parameters in different patients with refractory focal status epilepicus.
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