Acta Medica Mediterranea, 2018, 34: 2131
FORENSIC CONSIDERATIONS ON VIOLENT PARASOMNIAS DURING LIFESPAN
FRANCESCO SESSA1*, SABRINA FRANCO2*, ELISABETTA PICCIOCCHI3,4*, DIEGO GERACI2, MARIO GIUSEPPE
CHISARI5, GABRIELLA MARSALA6, ANNA NUNZIA POLITO7, MICHELE SORRENTINO8, GABRIELE TRIPI9,10,
MARGHERITA SALERNO11, DANIELA RUSSO12, SERENA MARIANNA LAVANO14, FRANCESCO CERRONI15,
PALMIRA ROMANO16, BEATRICE GALLAI17, ROSA MAROTTA14, FRANCESCO LAVANO14, ROSARIA MARTINA
MAGLIULO18, LUCREZIA D’ORO19, ANNABELLA DI FOLCO13, LUCIA PARISI13, DAVIDE TESTA13, PAOLO
MURABITO20, MONICA SALERNO1
*
Equal contribution
1
Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 1, Foggia, 71122, Italy 2
Department of Medical, Surgical and Advanced Technology Sciences G.F. Ingrassia, University of Catania,
Catania, I-95123, Italy - 3Department of Clinical and Experimental Medicine, University of Foggia, Foggia,
Italy - 4Casa di Cura Villa dei Fiori Acerra, Napoli, Italy - 5Istituto nazionale della previdenza sociale (INPS),
Catania, Italy - 6Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di
Foggia, Foggia, Italy - 7Complex Structure of Neuropsychiatry Childhood-Adolescence of Ospedali Riuniti of
Foggia, Foggia, Italy - 8NICU -Preterm and High Risk Newborn Neurodevelopmental Follow-up Service;
Pineta Grande Hospital Castel Volturno (CE), Italy - 9Department PROSAMI, University of Palermo, Italy 10
Childhood Psychiatric Service for Neurodevelopmental Disorders, CH Chinon, France - 11Sciences for Mother
and Child Health Promotion, University of Palermo, Italy - 12Centro di Riabilitazione La Filanda LARS; Sarno,
Italy - 13Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy 14
Department of Health Sciences, University “Magna Graecia”, Catanzaro, Italy - 15Centro Manzoni s.r.l.,
Napoli, Italy- 16Centro di Riabilitazione LARS, Sarno, Italy - 17Department of Surgical and Biomedical
Sciences, University of Perugia, Perugia, Italy - 18Centro Studi Della Scoliosi S.R.L, Italy - 19Centro
Ambulatoriale Santo Stefano, Pesaro, Italy - 20Università degli Studi di Catania, Catania, Italy
ABSTRACT
Nocturnal parasomnias are a group of sleep complex manifestation that don’t alter the sleep macrostructure, but when persistent during adulthood may be assume violent aspects with relevant forensic implications about the guiltiness.
Keywords: NREM parasomnias, sleep, consciousness, guiltiness.
DOI: 10.19193/0393-6384_2018_4s_328
Received July 17, 2018; Accepted Septemper 20, 2018
Clinical background
Presently, to the attention of forensic science
and jurisprudence there arises a problem of considerable legislative difficulty, although long known, such
as violent parasomnias, which can now be subjected
to sophisticated neurophysiological studies such as to
allow its definition.
Parasomnias represent a heterogeneous group
of motor manifestations, autonomic and behavioral,
occurring in the nocturnal sleep united by not causing daytime sleepiness or insomnia. It is, therefore,
episodic nocturnal events that do not alter the normal
architecture of sleep, configuring itself as dysfunctions associated with sleep, its phases or partial
awakenings (arousal), benign evolution and tendency
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to spontaneous resolution. Some parasomnias, especially in adulthood, can easily provoke the implementation of violent or frankly criminal behavior,
with significant legal problems in determining the
mens rea or in the guilty mental state that allows the
attribution of a criminal responsibility(1-17).
In most cases these are parasomnias belonging
to the group of NREM arousal disorders (confusional
awakenings, sleepwalking, night terrors), REM
behavior disorder and nocturnal epileptic seizures.
Each of the mentioned events is well known and
defined also from the polysomnographic point of
view. The NREM arousal disorders are frequent during pediatric age and can persist also in adolescence
and adulthood(18-19), also as comorbid conditions of
sleep-related breathing disorders, primary headaches,
learning disorders, epilepsy and genetic syndromes(1829)
.
The prevalence of adult sleep-related violence
is 0.5-1.6%. Because it may have severe medicolegal consequences including sexual abuse, unintended suicides and homicides identifying and differentiating its potential causes is vitally important. The
known risk factors are the age below 35 years, male
gender, sleep apneas syndrome (OSAS), early awakening, daytime sleepiness, hypnagogic hallucinations, nightmares, depressed mood, sleep paralysis
and arousal parasomnias(1-17). On the other hand, the
parasomniac manifestations may be exacerbate
and/or evoked by substance abuse or hormonal therapy with relevant systemic effects(30-32), although also
the intensive workout, nutritional factors and surgical intervention may be considered as risk factors,
probably for the direct impact on orexin-A plasmatic
levels(33-58).
Moreover, we have also to consider the nocturnal epileptic manifestation as differential diagnosis
with the violent parasomnias and consequently if the
subject can be considered guilty or not.
Nighttime epileptic seizures are pathological
manifestations known since time immemorial in
order to provoke ictal and postictal confusional
states, in particular forms such as temporal lobe
epilepsy (the best known clinical form for the behavioral bizarreness that accompanies it) and nocturnal
epilepsy of the frontal lobe (ADFNL, the last in
order of time to be defined from the instrumental and
genetic point of view), characterized by nocturnal
wondering, walking episodes arising from sleep
associated with bizarre behavior lasting a few minutes, which can also be associated with violent
behavior.
Francesco Sessa, Sabrina Franco et Al
According to some authors, they would represent a clinical variant of sleepwalking(1-16).
Other manifestations that fall into the category
of disorders of the arousal, are the confusional awakenings (sleep drunkness or Syndrome of Elpenor) are
characterized by a confused state of variable duration
up to a few minutes, upon awakening from a slow
wave sleep phase (stage 3) -4), during which the subjects may exhibit inadequate and sometimes aggressive behavior.
Moreover an interesting clinical manifestation
is the so called Elpenor syndrome in reference to an
accident experienced by a character in Homer's epic
The Odyssey in particular when entailing defenestration. The Elpenor’s syndrome was painted by Marc
Chagall in 1975 and this syndrome has been
described in adults and adolescents; and consist in a
particular persistent crepuscular state of consciousness after the awakening(1-16).
REM behavior disorder syndrome (RBD) is
characterized by the lack of inhibition of muscle tone
in the REM phase, which leads the subject to “represent” their dreams (usually with violent content and /
or aggressive), with behaviors and gestures especially of a violent type. RBD seems to be prevalent
among males and occurs between 50 and 65 years
(range 20-80 years) and is closely related to the presence of neurodegenerative diseases such as
Parkinson’s disease, multisystem atrophy, dementia
to bodies of Lewy or the diseases known as sinucleinopathies, with an advance on the time of diagnosis
and clear clinical signs even for 15-20 years. Even
more relative recent is parasomnia called sleepsex or
sexsomnia, dominated by sexual behaviors implemented in a twilight state similar to sleepwalking(1-16).
Since these diseases have been known for centuries, the modern scientific research has tried to
identify the factors responsible for the genesis of violent behavior in sleep, but has managed only to
hypothesize triggering or facilitating as gross alterations of the macrostructure of sleep (circadian
rhythm abnormalities, sleep deprivation, instability
and sleep fragmentation), but also cognitive and hallucinatory disorders, alcohol, stressors, OSAS, brain
injuries, psychotic states, neurodevelopmental disorders(33-58) (Figure 1).
Forensic aspects
The demonstration of absence of mental activity and full consciousness during the nocturnal violent behavior related to a parasomnia is not a prob-
Forensic considerations on violent parasomnias during lifespan
lem easy to solve. However, it is now established
that the boundaries between the states of our existence, waking, NREM sleep and REM sleep can
sometimes lose the normal definition, overlap, mingle, giving rise to bizarre and complex behavior
whose extreme expression are violent acts of which
the subject is not conscious or responsible. From
what has been briefly explained, it emerges that the
human being can commit violent actions or crimes
even in sleep, as already highlighted in previous centuries by illustrious jurists of the past. In the fourteenth century Bartolo from Sassoferrato (13141357) in his book titled De tyranno did not exclude
the punishment of the crime committed in the state
of sleep as a guilt, as “aut iste talis sciebat hoc
evenire sibi, et nunc sibi debet providere ut iacet
solus vel ut nemo sit in camera sua”, if instead he
was not aware of its dangers in sleep and committed
a crime “dormiens aequiparatur furious”.
Figure 1: shows an 30 seconds of REM sleep stage
without athonia, typically characteristic of REM behavior disorder (RBD).
Again, in the sixteenth century, Ludovico
Carerio (1550) pushed even further the examination
of these positions arguing that the dormiens delinquens aware of his illness (sciens suum vitium) and
cause sleep to kill, he will have to respond with the
ordinary punishment of the malicious crime, distinguishing before time the imputability from punishment. The solution given by the jurists in order to the
murders committed in the sleep state directed on the
non-punishment of the author (“si dormiens aliquem
occidat aut aliquo modo delinquat non punitur”)
unless guilt profiles were found to his conduct, evidenced by his knowledge of this morbid state and the
absence of precautions to avoid the commission of
crimes and always that, aware of his evil, he had not
2133
preordained to commit a crime, as the person who to
find the courage to kill is intoxicated. The listing of
these guidelines highlights an alternation between
responsibility and irresponsibility for these behaviors, sometimes focusing on the pathological aspect
(vitium), sometimes on the qualification of the
patient (furiosus), not analyzing, at the time, its
imputability nor is the penalty to be imposed(59-70).
It is important to note the need for the jurist,
pushed by medical science, to examine more deeply
the link between the act and the criminal responsibility or between the author of the act and the application of a penalty and focuses on art. 34 of the Tuscan
Penal Code, therefore in pre-unification legislation,
which opened in this way a groove stating that “the
violations of the penal law are not imputable when
the perpetrators were not aware of his actions and
freedom of action”. It appears evident behind this
expression, the presence of the current of thought on
the existence of free will and on freedom of choice
and are confronted, with the first scientific approaches, the pathologies of mind that such freedom either
exclude or mitigate. Processing over time, the unitary law of the Kingdom, raises the question of the
responsibility of Man and his actions, to modulate
the ordinance answers to them.
here is a need to define the field of guilt, thus
identifying the boundaries of free will; thus appears
in negative, the infirmity of mind which, if it exists,
excludes imputability. The expression infirmity of
goals was preferred by the Reform Commission to
the one proposed by Zanardelli himself as “a state of
deficiency or morbid alteration of the mind”, since it
was believed that in the deficiency “the state of
sleep”, as lack of the will of the acts carried out by
the asleep person was to be traced back to the subjective element of the crime”. There is therefore a precise differentiation between known pathological
states, which give rise to a disability of the real mind
that excludes imputability and states of deficiency
that can not or be framed in specific mental pathologies, as happens to the delinquens dormiens that
would have acted without the will to offend. It is
only with the current Code of 1930 that the concept
of imputability finds its place as an ability to act in
criminal law and, therefore, also the capacity to be
the object of a penalty. Each individual, having
reached mental maturity, has natural qualities that
enable him to consciously and freely regulate his
actions according to the principle of free will. The
possession of this psychic quality is necessary for a
person to be held to be imputable.
2134
Imputability is the suitability to be accused of a
crime, the backbone of the penal system, represents a
way of being proper to each individual, characterized
by the psychic ability, linked to the development
appropriate to age and mental health, on which the
character depends free and conscious of human
actions in the sphere of law. The legal doctrine, however, is not unanimous of views on the legal nature
of imputability, closely linked to the capacity of
criminal law (the suitability of the individual to be
the holder of criminal law or to be judged and convicted of a crime committed), to the point consider
the capacity of criminal law to be the assumption of
imputability itself. The Compilers of the current code
have opted for the naturalistic criterion of the voluntariness of human action with respect to the crime,
on the assumption that normal man (the person who
conforms to social rules) can act freely; this criterion
is the sufficient condition for affirming the principle
of personal responsibility and for rationally justifying the punishment of the offender. The Code after
having fixed the principle that “no one can be punished for a fact foreseen by the law as a crime if, at
the time he committed it, it was not imputable”
explains that “it is imputable who has the ability to
understand and want”(Article 85).
This capacity does not exist in those who are
found by mental illness, incapable of understanding
or wanting, and which, if considered dangerous,
must be the object of a particular and different attention, indicated by the legal system as a measure of
security. The latter, unlike the penalty, which must be
imposed in a certain way, is linked to the subject and
to the verification of the existence of social danger,
and therefore to a totally uncertain and modifiable
datum. Where does the existence of a mental illness
occur, such as in the case of violent parasomnias, and
when the action carried out by those in this state constitutes a crime in itself, as the ordinamet answers?
Excluding the presence of an illness in medical
sense, since there is no psychic disorder that accompanies the neurological injury and motivates the
defect of the ability to understand or want, the action
taken by those who pay in this state constitutes a
healthy automatism(59-70).
This is the point of view of scientific knowledge, which, however, in the field of forensic medicine, must be the subject of careful and deserving
caution in order to fix as precisely as possible the
boundaries between the normal and the pathological,
between the punishable, the preventable and the
treatable; also in order not to excessively widen irre-
Francesco Sessa, Sabrina Franco et Al
sponsibility, making you fall into behavior without
organic base with the presence of the ability to
understand and to want. The hypothesis of the partial
defect of goals that, moreover, according to the opinion that seems preferable and which is reflected in
the systematic collocation of the norm, still has to
obey the above psychiatric criteria. The legal position of the behaviors assumed in case of automatism
healthy in violent parasomnia should therefore be
sought elsewhere. Although it may seem strange to
those unfamiliar with the legal system, the standard
takes into account - with its general and abstract formulation - the multiple aspects of daily life, as it
must adapt to an infinite number of cases.
Responsibility for the actions of Man must be conscious responsibility, therefore linked to the person,
therefore responsibility for the actus humanus, not
for the actus hominis. The act is human, of man, of
that man who has done a particular action, only when
he is supported by the characteristic of human action,
that is, by his thought, therefore by conscience and
will (Article 42 of the Criminal Code) Article 42 of
the Criminal Code sets an essential dogmatic rule
because it places the person and his thoughts at the
center of the positive criminal law. Consciousness
and will is a different concept from the ability of the
whole and the will and, therefore, from the
imputability(59-70).
The latter consists of a status of man, while the
single action must meet specific requirements, verifiable from time to time in the light of the traceability
of the person-behavior. Therefore there can be
imputability but not punishable if the action can be
accomplished and is evidence of the necessary psychic causality. Therefore, responsibility rests not so
much on having to act or not acting, but on being
able to act or not to act. The healthy automatisms of
violent parasomnias are not punishable, therefore,
due to the defect of the typical elements of responsible action, that is, of consciousness and will.
Moreover, if, knowing to be in a situation of
potential danger to others, the person does not take
the appropriate measures in order to avoid harmful
consequences of his, he will have to respond to the
crime that may have been committed. In this hypothesis, in fact, there is a conscious and voluntary
behavior that precedes the criminal act, with tacit
acceptance but full acceptance of the risk of the
event itself. Since the elements of responsibility and
the primary element of the typical fact are conscience and will, the relative formula of absolution
must be that the “fact does not exist” and not because
Forensic considerations on violent parasomnias during lifespan
“it does not constitute a crime”. In this way the irrevocable sentence of acquittal will be able to make
state in the civil judgment for the compensation of
the damage. In practice, the acceptance of the defensive thesis based on the presence of violent parasomnias with healthy automatisms in the agent presents,
currently, considerable difficulties due to the absence
of knowledge of the phenomenon by non-professionals and the poor dissemination of his study(59-77).
2135
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References
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
Stallman HM. Assessment and treatment of sleepwalking in clinical practice. Aust Fam Physician. 2017;
46(8): 590-593. Review. PubMed PMID: 28787563
Bugalho P, Lampreia T, Miguel R, Mendonça M,
Caetano A, Barbosa R. Characterization of motor
events in REM sleep behavior disorder. J Neural
Transm (Vienna). 2017 Oct; 124(10): 1183-1186. doi:
10.1007/s00702-017-1759-y
McKenna D, Peever J. Degeneration of rapid eye
movement sleep circuitry underlies rapid eye movement sleep behavior disorder. Mov Disord. 2017 May;
32(5): 636-644. doi: 10.1002/mds.27003
Jiang H, Huang J, Shen Y, Guo S, Wang L, Han C, Liu
L, Ma K, Xia Y, Li J, Xu X, Xiong N, Wang T. RBD
and Neurodegenerative Diseases. Mol Neurobiol. 2017
May; 54(4): 2997-3006. doi: 10.1007/s12035-0169831-4
Geddes MR, Tie Y, Gabrieli JD, McGinnis SM, Golby
AJ, Whitfield-Gabrieli S. Altered functional connectivity in lesional peduncular hallucinosis with REM sleep
behavior disorder. Cortex. 2016 Jan;74: 96-106. doi:
10.1016/j.cortex.2015.10.015
Ferini-Strambi L, Rinaldi F, Giora E, Marelli S,
Galbiati A. REM sleep Behaviour Disorder.
Parkinsonism Relat Disord. 2016 Jan;22 Suppl 1: S6972. doi: 10.1016/j.parkreldis.2015.09.002
Kotagal S. Rapid Eye Movement Sleep Behavior
Disorder During Childhood. Sleep Med Clin. 2015
Jun;10(2):163-7. doi: 10.1016/j.jsmc.2015.02.004
Szűcs A, Kamondi A, Zoller R, Barcs G, Szabó P,
Purebl G. Violent somnambulism: a parasomnia of
young men with stereotyped dream-like experiences.
Med Hypotheses. 2014 Jul; 83(1): 47-52. doi:
10.1016/j.mehy.2014.04.012
Fantini ML, Puligheddu M, Cicolin A. Sleep and violence. Curr Treat Options Neurol. 2012 Oct; 14(5):
438-50. doi: 10.1007/s11940-012-0187-4
Bisulli F, Vignatelli L, Provini F, Leta C, Lugaresi E,
Tinuper P. Parasomnias and nocturnal frontal lobe
epilepsy (NFLE): lights and shadows--controversial
points in the differential diagnosis. Sleep Med. 2011
Dec;12
Suppl
2:
S27-32.
doi:
10.1016/j.sleep.2011.10.008
Umanath S, Sarezky D, Finger S. Sleepwalking
through history: medicine, arts, and courts of law. J
Hist Neurosci. 2011 Oct; 20(4): 253-76. doi:
10.1080/0964704X.2010.513475
16)
17)
18)
19)
20)
21)
22)
23)
Mahowald MW, Schenk CH, Cramer Bornemann MA.
Violent parasomnias forensic implications. Handb Clin
Neurol. 2011; 99: 1149-59. doi: 10.1016/B978-0-44452007-4.00026-6
Ohayon MM, Schenck CH. Violent behavior during
sleep: prevalence, comorbidity and consequences.
Sleep Med. 2010 Oct; 11(9): 941-6. doi:
10.1016/j.sleep.2010.02.016
van Gastel A, De Volder I. [Parasomnia: a potentially
unrecognized cause of nocturnal violent behavior].
Tijdschr Psychiatr. 2014; 56(2): 123-4
Viana Bde M, Bawden FC, Valladares Neto Dde C,
Caramelli P. Violent sleepwalking in a general hospital
ward: a case report. Rev Bras Psiquiatr. 2009 Sep;
31(3): 281-2
Tassinari CA, 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 Oct; 165(10): 762-8. doi: 10.1016/j.neurol.2009.08.002
Turillazzi, E., Di Peri, G.P., Nieddu, A., Bello, S.,
Monaci, F., Neri, M., Pomara, C., Rabozzi, R., Riezzo,
I., Fineschi, V. Analytical and quantitative concentration of gunshot residues (Pb, Sb, Ba) to estimate
entrance hole and shooting-distance using confocal
laser microscopy and inductively coupled plasma atomic emission spectrometer analysis: An experimental
study. (2013) Forensic Science International, 231 (1-3),
pp. 142-149. DOI: 10.1016/j.forsciint.2013.04.006
Messina A, Bitetti I, Precenzano F, Iacono D, Messina
G, Roccella M, Parisi L, Salerno M, Valenzano A,
Maltese A, Salerno M, Sessa F, Albano GD, Marotta R,
Villano I, Marsala G, Zammit C, Lavano F, Monda M,
Cibelli G, Lavano SM, Gallai B, Toraldo R, Monda V,
Carotenuto M. Non-Rapid Eye Movement Sleep
Parasomnias and Migraine: A Role of Orexinergic
Projections. Front Neurol. 2018 Feb 28; 9: 95. doi:
10.3389/fneur.2018.00095
Esposito M, Parisi P, Miano S, Carotenuto M. Migraine
and periodic limb movement disorders in sleep in children: a preliminary case-control study. J Headache
Pain. 2013 Jul 1;14:57. doi: 10.1186/1129-2377-14-57
Esposito M, Carotenuto M. Intellectual disabilities and
power spectra analysis during sleep: a new perspective
on borderline intellectual functioning. J Intellect
Disabil Res. 2014 May; 58(5): 421-9. doi:
10.1111/jir.12036
Carotenuto M, Esposito M, Cortese S, Laino D,
Verrotti A. Children with developmental dyslexia
showed greater sleep disturbances than controls,
including problems initiating and maintaining sleep.
Acta Paediatr. 2016 Sep; 105(9): 1079-82. doi:
10.1111/apa.13472
Esposito M, Gallai B, Roccella M, Marotta R, Lavano
F, Lavano SM, Mazzotta G, Bove D, Sorrentino M,
Precenzano F, Carotenuto M. Anxiety and depression
levels in prepubertal obese children: a case-control
study. Neuropsychiatr Dis Treat. 2014 Oct 3;10:1897902. doi: 10.2147/NDT.S69795
Carotenuto M, Parisi P, Esposito M, Cortese S, Elia M.
Sleep alterations in children with refractory epileptic
encephalopathies: a polysomnographic study. Epilepsy
2136
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
Francesco Sessa, Sabrina Franco et Al
Behav.
2014
Jun;35:50-3.
doi:
10.1016/j.yebeh.2014.03.009;
Esposito M, Gallai B, Parisi L, Roccella M, Marotta R,
Lavano SM, Mazzotta G, Carotenuto M. Primary nocturnal enuresis as a risk factor for sleep disorders: an
observational questionnaire-based multicenter study.
Neuropsychiatr Dis Treat. 2013; 9: 437-43. doi:
10.2147/NDT.S43673
Esposito M, Roccella M, Parisi L, Gallai B, Carotenuto
M. Hypersomnia in children affected by migraine without aura: a questionnaire-based case-control study.
Neuropsychiatr Dis Treat. 2013; 9: 289-94. doi:
10.2147/NDT.S42182;
Carotenuto M, Esposito M, Parisi L, Gallai B, Marotta
R, Pascotto A, Roccella M. Depressive symptoms and
childhood sleep apnea syndrome. Neuropsychiatr Dis
Treat. 2012; 8: 369-73. doi: 10.2147/NDT.S35974;
Carotenuto M, Esposito M, D'Aniello A, Rippa CD,
Precenzano F, Pascotto A, Bravaccio C, Elia M.
Polysomnographic findings in Rett syndrome: a casecontrol study. Sleep Breath. 2013 Mar; 17(1): 93-8. doi:
10.1007/s11325-012-0654-x
Carotenuto M, Esposito M, Precenzano F, Castaldo L,
Roccella M. Cosleeping in childhood migraine.
Minerva Pediatr. 2011 Apr;63(2):105-9
Carotenuto M, Esposito M, Pascotto A. Facial patterns
and primary nocturnal enuresis in children. Sleep
Breath. 2011 May; 15(2): 221-7. doi: 10.1007/s11325010-0388-6
Pomara, C., D’Errico, S., Riezzo, I., De Cillis, G.P.,
Fineschi, V. Sudden cardiac death in a child affected by
Prader-Willi syndrome. (2005) International Journal of
Legal Medicine, 119 (3), pp. 153-157. DOI:
10.1007/s00414-004-0513-9
Fineschi, V., Neri, M., Di Donato, S., Pomara, C.,
Riezzo, I., Turillazzi, E. An immunohistochemical
study in a fatality due to ovarian hyperstimulation syndrome. (2006) International Journal of Legal Medicine,
120 (5), pp. 293-299. DOI: 10.1007/s00414-006-0104z
Turillazzi, E., Baroldi, G., Silver, M.D., Parolini, M.,
Pomara, C., Fineschi, V. A systematic study of a
myocardial lesion: Colliquative myocytolysis. (2005)
International Journal of Cardiology, 104 (2), pp. 152157. DOI: 10.1016/j.ijcard.2004.10.051
Mazzeo F, Motti ML, Messina G, Monda V, Ascione A,
Tafuri D, et al. Use of nutritional supplements among
south Italian students of physical training and sport university. Curr Top Toxicol. 2013; 9: 21-6
Messina G, Monda V, Moscatelli F, Valenzano AA,
Monda G, Esposito T, et al. Role of orexin system in
obesity. Biol Med. 2015; 7(4)
Messina G, Di Bernardo G, Viggiano A, De Luca V,
Monda V, Messina A, et al. Exercise increases the level
of plasma orexin A in humans. J Basic Clin Physiol
Pharmacol. 2016; 27(6): 611-6
Messina G, Palmieri F, Monda V, Messina A, Dalia C,
Viggiano A, et al. Exercise causes muscle GLUT4
translocation in an insulin-independent manner. Biol
Med. 2015;7(Special issue)
Messina G, Viggiano A, Tafuri D, Palmieri F, De Blasio
S, Messina A, et al. Role of orexin in obese patients in
the intensive care unit. J Anesth Clin Res. 2014; 5(3)
Monda M, Viggiano A, Viggiano A, Viggiano E,
39)
40)
41)
42)
43)
44)
45)
46)
47)
48)
49)
50)
51)
52)
Messina G, Tafuri D, et al. Quetiapine lowers sympathetic and hyperthermic reactions due to cerebral injection of orexin A. Neuropeptides. 2006; 40(5): 357-63
Chieffi S, Messina G, Villano I, Messina A, Esposito
M, Monda V, et al. Exercise influence on hippocampal
function: Possible involvement of orexin-a. Front
Physiol. 2017; 8
Valenzano A, Moscatelli F, Triggiani AI, Capranica L,
De Ioannon G, Piacentini MF, et al. Heart-rate changes
after an ultraendurance swim from Italy to Albania: A
case report. Int J Sports Physiol Perform. 2016; 11(3):
407-9
Viggiano E, Monda V, Messina A, Moscatelli F,
Valenzano A, Tafuri D, et al. Cortical spreading depression produces a neuroprotective effect activating mitochondrial uncoupling protein-5. Neuropsychiatr Dis -10
Rinaldi B, Guida F, Furiano A, Donniacuo M, Luongo
L, Gritti G, et al. Effect of Prolonged Moderate
Exercise on the Changes of Nonneuronal Cells in Early
Myocardial Infarction. Neural Plast. 2015; 2015
Monda V, Valenzano A, Moscatelli F, Salerno M, Sessa
F, Triggiani AI, et al. Primary motor cortex excitability
in karate athletes: A transcranial magnetic stimulation
study. Front Physiol. 2017; 8
Triggiani AI, Valenzano A, Ciliberti MAP, Moscatelli F,
Villani S, Monda M, et al. Heart rate variability is
reduced in underweight and overweight healthy adult
women. Clin Physiol Funct Imaging. 2017; 37(2): 1627
Messina G, Di Bernardo G, Viggiano A, De Luca V,
Monda V, Messina A, et al. Exercise increases the level
of plasma orexin A in humans. J Basic Clin Physiol
Pharmacol. 2016;27(6):611-6;
De Luca V, Viggiano E, Messina G, Viggiano A,
Borlido C, Viggiano A, et al. Peripheral amino acid levels in schizophrenia and antipsychotic treatment.
Psychiatry Investig. 2008; 5(4): 203-8;
Messina G,Dalia C,Tafuri D, Monda V, Palmieri F,
Dato A, et al. Orexin-A controls sympathetic activity
and eating behavior.Front Psychol. 2014; 8(5)997
Testa D, Marcuccio G, Panin G, Bianco A, Tafuri D,
Thyrion FZ, Nunziata M, Piombino P, Guerra G, Motta
G. Nasal mucosa healing after endoscopic sinus surgery
in chronic rhinosinusitis of elderly patients: role of
topic alpha-tocopherol acetate. Aging Clin Exp Res.
2017 Feb; 29(Suppl 1): 191-195. doi: 10.1007/s40520016-0647-x;
Testa D, Motta S, Marcuccio G, Paccone M, Rocca A,
Ilardi G, Tafuri D, Mesolella M, Motta G. Our experience in the treatment of Malignant Fibrous
Hystiocytoma of the larynx: clinical diagnosis, therapeutic approach and review of literature. Open Med
(Wars). 2016 Jun 23; 11(1): 208-214. doi:
10.1515/med-2016-0040;
Carotenuto M, Esposito M, Pascotto A. Migraine and
enuresis in children: An unusual correlation? Med
Hypotheses. 2010 Jul; 75(1): 120-2. doi:
10.1016/j.mehy.2010.02.004.
Monda M, Viggiano A, Viggiano A, Viggiano E,
Messina G, Tafuri D, et al. Sympathetic and hyperthermic reactions by orexin A: role of cerebral catecholaminergic neurons. Regul Pept. 2007; 139(1-3):
39-44;
Monda M, Messina G, Scognamiglio I, Lombardi A,
Forensic considerations on violent parasomnias during lifespan
53)
54)
55)
56)
57)
58)
59)
60)
61)
62)
63)
64)
65)
Martin GA, Sperlongano P, et al. Short term diet and
moderate exercise in young overweight men modulate
cardiocyte and hepatocarcinoma survival by oxidative
stress. Oxid Med Cell Longev. 2014; 2014 131024
Monda M, Messina G, Vicidomini C, Viggiano A,
Mangoni C, De Luca B. Activity of autonomic nervous
system is related to body weight in pre-menopausal, but
not in post-menopausal women. Nutr Neurosci. 2006;
9(3-4):141-5
Di Bernardo G, Messina G, Capasso S, Del Gaudio S,
Cipollaro M, Peluso G, et al. Sera of overweight people
promote in vitro adipocyte differentiation of bone marrow stromal cells. Stem Cell Res Ther. 2014;5(1):4
Chieffi S, Carotenuto M, Monda V, Valenzano A,
Villano I, Precenzano F, et al. Orexin System: The Key
for a Healthy Life. Front Physiol. 2017;31(8):357
Panico A, Messina G, Lupoli GA, Lupoli R,
Cacciapuoti M, Moscatelli F, et al. Quality of life in
overweight (Obese) and normal-weight women with
polycystic ovary syndrome. Patient Prefer Adherence.
2017; 11: 423-9
Viggiano A, Chieffi S, Tafuri D, Messina G, Monda M,
De Luca B. Laterality of a second player position
affects lateral deviation of basketball shooting. J Sports
Sci. 2014; 32(1): 46-52
Moscatelli F, Messina G, Valenzano A, Petito A,
Triggiani AI, Ciliberti MAP, et al. Relationship
between RPE and blood lactate after fatiguing handgrip
exercise in taekwondo and sedentary subjects. Biol
Med. 2015; 7(Special issue)
Smirni D, Smirni P, Di Martino G, Fontana ML,
Cipolotti L, Oliveri M, Turriziani P. Early detection of
memory impairments in older adults: standardization of
a short version of the verbal and nonverbal Recognition
Memory Test. Neurol Sci. 2018 Oct 1. doi:
10.1007/s10072-018-3587-8.
Chieffi S, Iachini T, Iavarone A, Messina G, Viggiano
A, Monda M. Flanker interference effects in a line
bisection task. Exp Brain Res. 2014; 232(4): 1327-34
Smirni D, Beadle JN, Paradiso S. An Initial Study of
Alexithymia and Its Relationship With Cognitive
Abilities Among Mild Cognitive Impairment, Mild
Alzheimer's Disease, and Healthy Volunteers. J Nerv
Ment
Dis,
2018,
206
(8):
628-636.
doi:10.1097/NMD.0000000000000853
Moscatelli F, Messina G, Valenzano A, Monda V,
Viggiano A, Messina A, et al.Functional Assessment of
Corticospinal System Excitability in Karate Athletes.
PLoS One. 2016; 24(5): e0155998
Turillazzi E, Greco P, Neri, M., Pomara, C., Riezzo, I.,
Fineschi, V. Anaphylactic latex reaction during anaesthesia: The silent culprit in a fatal case. (2008) Forensic
Science International, 179 (1), pp. e5-e8. DOI:
10.1016/j.forsciint.2008.03.021
Turillazzi, E., Riezzo, I., Neri, M., Pomara, C., Cecchi,
R., Fineschi, V. The diagnosis of fatal pulmonary fat
embolism using quantitative morphometry and confocal laser scanning microscopy. (2008) Pathology
Research and Practice, 204 (4), pp. 259-266. DOI:
10.1016/j.prp.2007.12.010
Turillazzi, E., Neri, M., Cerretani, D., Cantatore, S.,
Frati, P., Moltoni, L., Busardò, F.P., Pomara, C.,
Riezzo, I., Fineschi, V. Lipid peroxidation and apoptotic response in rat brain areas induced by long-term
2137
66)
67)
68)
69)
70)
71)
72)
73)
74)
75)
76)
administration of nandrolone: The mutual crosstalk
between ROS and NF-kB. (2016) Journal of Cellular
and Molecular Medicine, 20 (4), pp. 601-612. DOI:
10.1111/jcmm.12748
Albenzio M, Santillo A, Ciliberti MG, Figliola L,
Caroprese M, Polito AN, Messina G. Milk nutrition and
childhood epilepsy: an ex vivo study on cytokines and
oxidative stress in response to milk protein fractions. J
Dairy Sci. 2018 Jun; 101(6): 4842-4852. Doi:
10.3168/Jds.2017-13104
Albenzio M, Santillo A, Ciliberti MG, Figliola L,
Caroprese M, Marino R, Polito AN. Milk from different species: relationship between protein fractions and
inflammatory response in infants affected by generalized epilepsy. J Dairy Sci. 2016 Jul; 99(7): 5032-5038.
Doi: 10.3168/Jds.2015-10704
Albenzio M, Santillo A, Caroprese M, Polito AN. Role
of milk from small ruminant species on human health.
Nutrients in dairy and their implications for health and
disease. 21 June 2017, Pages 435-440
Li Volti G, Ientile R, Abraham NG, Vanella A, Cannavò
G, Mazza F, Currò M, Raciti G, Avola R, Campisi A.
Immunocytochemical localization and expression of
heme oxygenase-1 in primary astroglial cell cultures
during differentiation: effect of glutamate. Biochem
Biophys Res Commun. 2004 Mar ;315(2)517-24
Rizzo M, Abate N, Chandalia M, Rizvi AA, Giglio RV,
Nikolic D, Marino Gammazza A, Barbagallo I,
Isenovic ER, Banach M, Montalto G, Li Volti G.
Liraglutide reduces oxidative stress and restores heme
oxygenase-1 and ghrelin levels in patients with type 2
diabetes: a prospective pilot study. J Clin Endocrinol
Metab. 2015 Feb; 100(2): 603-6. doi: 10.1210/jc.20142291
Salamone F, Li Volti G, Titta L, Puzzo L, Barbagallo I,
La Delia F, Zelber-Sagi S, Malaguarnera M, Pelicci
PG, Giorgio M, Galvano F. Moro orange juice prevents
fatty liver in mice. World J Gastroenterol. 2012 Aug 7;
18(29): 3862-8. doi: 10.3748/wjg.v18.i29.3862
Viggiano E, Mollica MP, Lionetti L, Cavaliere G,
Trinchese G, De Filippo C, Chieffi S, Gaita M, Barletta
A, De Luca B, Crispino M, Monda M. Effects of an
High-Fat Diet Enriched in Lard or in Fish Oil on the
Hypothalamic Amp-Activated Protein Kinase and
Inflammatory Mediators. Front Cell Neurosci. 2016
Jun9; 10: 150. doi: 10.3389/fncel.2016.00150
Albenzio M, Santillo A, Caroprese M, Ruggieri D,
Napolitano F, Sevi A. Physicochemical properties of
Scamorza ovine cheese manufactured with different
probiotic cultures. Journal of Dairy Science. 2013, 96;
2781-2791
Carpprese M, Albenzio M, Bruno A, Annicchiarico G,
Marino R, Sevi A. Effects of shade and flaxseed supplementation on the welfare of lactating ewes under
high ambient temperatures. Small Ruminant Research,
2012, 102177-185.
Caroprese M, Albenzio M, Marzano A, Schena L,
Annicchiarico G, Sevi A. Relationship between
Cortisol Response to Stress and Behavior, Immune
Profile, and Production Performances of Dairy Ewes.
Journal of Dairy Science 2010 93: 2395-2403
Santillo A, Kelly AL, Palermo C, Sevi A, Albenzio M.
Role of indigenous enzymes in proteolysis of casein in
caprine milk. International Dairy Journal. 2009 19:
2138
77)
Francesco Sessa, Sabrina Franco et Al
655-660.
Santillo A, Albenzio M, Quinto M, Caroprese M,
Marino RM Sevi. A. Probiotic in Lamb Rennet Paste
Enhances Rennet Lipolytic Activity, and CLA and
Linoleic Acid Content in Pecorino Cheese. Journal of
Dairy Science 2009 92: 1330-1337.
_________
Corresponding author
MONICA SALERNO, MD
Department of Clinical and Experimental Medicine, University
of Foggia
Viale Pinto, 1, Foggia, 71122, Italy
(Italy)