Publications by authors named "Mariano Serrao"

141 Publications

An artificial neural network approach to detect presence and severity of Parkinson's disease via gait parameters.

PLoS One 2021 19;16(2):e0244396. Epub 2021 Feb 19.

Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.

Introduction: Gait deficits are debilitating in people with Parkinson's disease (PwPD), which inevitably deteriorate over time. Gait analysis is a valuable method to assess disease-specific gait patterns and their relationship with the clinical features and progression of the disease.

Objectives: Our study aimed to i) develop an automated diagnostic algorithm based on machine-learning techniques (artificial neural networks [ANNs]) to classify the gait deficits of PwPD according to disease progression in the Hoehn and Yahr (H-Y) staging system, and ii) identify a minimum set of gait classifiers.

Methods: We evaluated 76 PwPD (H-Y stage 1-4) and 67 healthy controls (HCs) by computerized gait analysis. We computed the time-distance parameters and the ranges of angular motion (RoMs) of the hip, knee, ankle, trunk, and pelvis. Principal component analysis was used to define a subset of features including all gait variables. An ANN approach was used to identify gait deficits according to the H-Y stage.

Results: We identified a combination of a small number of features that distinguished PwPDs from HCs (one combination of two features: knee and trunk rotation RoMs) and identified the gait patterns between different H-Y stages (two combinations of four features: walking speed and hip, knee, and ankle RoMs; walking speed and hip, knee, and trunk rotation RoMs).

Conclusion: The ANN approach enabled automated diagnosis of gait deficits in several symptomatic stages of Parkinson's disease. These results will inspire future studies to test the utility of gait classifiers for the evaluation of treatments that could modify disease progression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244396PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894951PMC
February 2021

Critical Issues and Imminent Challenges in the Use of sEMG in Return-To-Work Rehabilitation of Patients Affected by Neurological Disorders in the Epoch of Human-Robot Collaborative Technologies.

Front Neurol 2020 22;11:572069. Epub 2020 Dec 22.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy.

Patients affected by neurological pathologies with motor disorders when they are of working age have to cope with problems related to employability, difficulties in working, and premature work interruption. It has been demonstrated that suitable job accommodation plans play a beneficial role in the overall quality of life of pathological subjects. A well-designed return-to-work program should consider several recent innovations in the clinical and ergonomic fields. One of the instrument-based methods used to monitor the effectiveness of ergonomic interventions is surface electromyography (sEMG), a multi-channel, non-invasive, wireless, wearable tool, which allows in-depth analysis of motor coordination mechanisms. Although the scientific literature in this field is extensive, its use remains significantly underexploited and the state-of-the-art technology lags expectations. This is mainly attributable to technical and methodological (electrode-skin impedance, noise, electrode location, size, configuration and distance, presence of crosstalk signals, comfort issues, selection of appropriate sensor setup, sEMG amplitude normalization, definition of correct sEMG-related outcomes and normative data) and cultural limitations. The technical problems are being resolved minimized also thanks to the possibility of using reference books and tutorials. Cultural limitations are identified in the traditional use of qualitative approaches at the expense of quantitative measurement-based monitoring methods to design and assess ergonomic interventions and train operators. To bridge the gap between the return-to-work rehabilitation and other disciplines, several teaching courses, accompanied by further electrodes and instrumentations development, should be designed at all Bachelor, Master and PhD of Science levels to enhance the best skills available among physiotherapists, and ergonomists.
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http://dx.doi.org/10.3389/fneur.2020.572069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783040PMC
December 2020

Impaired short-term visual paired associative plasticity in patients with migraine between attacks.

Pain 2021 Mar;162(3):803-810

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.

Abstract: A common experimental neurophysiological method to study synaptic plasticity is pairing activity of somatosensory afferents and motor cortical circuits, so-called paired associative stimulation (PAS). Dysfunctional inhibitory and excitatory PAS mechanisms within the sensorimotor system were described in patients with migraine without aura (MO) between attacks. We have recently observed that the same bidirectional PAS rules also apply to the visual system. Here, we have tested whether dysfunctioning associative plasticity might characterize the visual system of patients with MO. In 14 patients with MO between attacks and in 15 healthy volunteers, we performed a previously validated visual PAS (vPAS) protocol by coupling 90 black-and-white checkerboard reversals with low-frequency transcranial magnetic stimulation pulses over the occipital cortex at 2 interstimulus intervals of -25/+25 ms around the visual-evoked potential (VEP) P1 latency. We recorded VEPs (600 sweeps) before, immediately after, and 10 min after each vPAS session. We analysed VEP N1-P1 amplitude and delayed habituation. Although vPAS-25 significantly enhanced and vPAS + 25 reduced VEP amplitude habituation in healthy volunteers, the same protocols did not significantly change VEP amplitude habituation in MO between attacks. We provide evidence for lack of habituation enhancing and habituation suppressing visual PAS mechanisms within the visual system in interictal migraine. This finding, in combination with those previously obtained studying the sensorimotor system, leads us to argue that migraine disease-related dysrhythmic thalamocortical activity prevents the occurrence of physiological bidirectional synaptic plasticity induced by vPAS.
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http://dx.doi.org/10.1097/j.pain.0000000000002085DOI Listing
March 2021

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile.

J Headache Pain 2020 Jul 18;21(1):92. Epub 2020 Jul 18.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.

Background: We investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM).

Methods: We performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD).

Results: TBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC).

Conclusion: Our results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain.
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http://dx.doi.org/10.1186/s10194-020-01159-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368770PMC
July 2020

Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation.

Gait Posture 2020 07 12;80:280-284. Epub 2020 Jun 12.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy.

Background: Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking.

Research Question: This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis.

Methods: The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis.

Results: Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls.

Significance: Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
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http://dx.doi.org/10.1016/j.gaitpost.2020.06.013DOI Listing
July 2020

Impairment of Global Lower Limb Muscle Coactivation During Walking in Cerebellar Ataxias.

Cerebellum 2020 Aug;19(4):583-596

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.

The aim of this study was to investigate the time-varying multi-muscle coactivation function (TMCf) in the lower limbs during gait and its relationship with the biomechanical and clinical features of patients with cerebellar ataxia. A total of 23 patients with degenerative cerebellar ataxia (16 with spinocerebellar ataxia, 7 with adult-onset ataxia of unknown etiology) and 23 age-, sex-, and speed-matched controls were investigated. The disease severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA) in all patients. During walking, simultaneous acquisition of kinematic, kinetic, and electromyography data was performed using a motion analysis system. The coactivation was processed throughout the gait cycle using the TMCf, and the following parameters were measured: synthetic coactivation index, full width at half maximum, and center of activity. Spatiotemporal (walking speed, stance duration, swing duration, first and second double-support durations, step length, step width, stride length, Center of Mass displacement), kinetic (vertical component of GRFs), and energy consumption (total energy consumption and mechanical energy recovered) parameters were also measured. The coactivation variables were compared between patients and controls and were correlated with both clinical and gait variables. A significantly increased global TMCf was found in patients compared with controls. In addition, the patients showed a significant shift of the center of activity toward the initial contact and a significant reduction in energy recovery. All coactivation parameters were negatively correlated with gait speed, whereas the coactivation index and center of activity were positively correlated with both center-of-mass mediolateral displacement values and SARA scores. Our findings suggest that patients use global coactivation as a compensatory mechanism during the earliest and most challenging subphase (loading response) of the gait cycle to reduce the lateral body sway, thus improving gait stability at the expense of effective energy recovery. This information could be helpful in optimizing rehabilitative treatment aimed at improving lower limb muscle control during gait in patients with cerebella ataxia.
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http://dx.doi.org/10.1007/s12311-020-01142-6DOI Listing
August 2020

Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation.

Sensors (Basel) 2020 Apr 29;20(9). Epub 2020 Apr 29.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy.

The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.
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http://dx.doi.org/10.3390/s20092543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249183PMC
April 2020

Short-latency afferent inhibition and somato-sensory evoked potentials during the migraine cycle: surrogate markers of a cycling cholinergic thalamo-cortical drive?

J Headache Pain 2020 Apr 16;21(1):34. Epub 2020 Apr 16.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.

Background: Short-latency afferent inhibition (SAI) consists of motor cortex inhibition induced by sensory afferents and depends on the excitatory effect of cholinergic thalamocortical projections on inhibitory GABAergic cortical networks. Given the electrophysiological evidence for thalamo-cortical dysrhythmia in migraine, we studied SAI in migraineurs during and between attacks and searched for correlations with somatosensory habituation, thalamocortical activation, and clinical features.

Methods: SAI was obtained by conditioning the transcranial magnetic stimulation-induced motor evoked potential (MEP) with an electric stimulus on the median nerve at the wrist with random stimulus intervals corresponding to the latency of individual somatosensory evoked potentials (SSEP) N20 plus 2, 4, 6, or 8 ms. We recruited 30 migraine without aura patients, 16 between (MO), 14 during an attack (MI), and 16 healthy volunteers (HV). We calculated the slope of the linear regression between the unconditioned MEP amplitude and the 4-conditioned MEPs as a measure of SAI. We also measured SSEP amplitude habituation, and high-frequency oscillations (HFO) as an index of thalamo-cortical activation.

Results: Compared to HV, SAI, SSEP habituation and early SSEP HFOs were significantly reduced in MO patients between attacks, but enhanced during an attack. There was a positive correlation between degree of SAI and amplitude of early HFOs in HV, but not in MO or MI.

Conclusions: The migraine cycle-dependent variations of SAI and SSEP HFOs are further evidence that facilitatory thalamocortical activation (of GABAergic networks in the motor cortex for SAI), likely to be cholinergic, is reduced in migraine between attacks, but increased ictally.
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http://dx.doi.org/10.1186/s10194-020-01104-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164277PMC
April 2020

The function of the lateral inhibitory mechanisms in the somatosensory cortex is normal in patients with chronic migraine.

Clin Neurophysiol 2020 04 3;131(4):880-886. Epub 2020 Feb 3.

Sapienza University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.

Objective: To study lateral inhibition and habituation/sensitization in the somatosensory cortex of patients with chronic migraine (CM) and to identify correlations with clinical migraine features.

Methods: Sixteen patients with CM without medication overuse, and 17 healthy volunteers (HVs) received somatosensory evoked potentials (SSEPs) elicited by separate electrical stimulation of the right median (M) and ulnar (U) nerves at the wrist and by simultaneous nerve stimulation (MU). We measured the N20-P25 amplitudes and calculated the lateral inhibition (LI) percentage using the formula {100-[MU/(M + U) * 100]}. We also calculated sensitization (SSEP amplitude during block 1) and delayed habituation to M-nerve stimulation.

Results: The percentage of LI did not differ between the groups (40.2% in HV, 47.4% in CM, p = 0.276) and was negatively correlated with the monthly headache-day number (r = -0.532, p = 0.034). Patients showed a generalized increase in SSEP amplitudes compared to HVs and habituated normally.

Conclusions: We showed a pattern of somatosensory response in CM similar to that observed during attacks of episodic migraine.

Significance: In the transition process between episodic migraine and CM, LI attempts to physiologically counteract the mounting increase in attack frequency, but this is insufficient to allow patients to exit the chronic phase.
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http://dx.doi.org/10.1016/j.clinph.2020.01.009DOI Listing
April 2020

Exploring Risk of Falls and Dynamic Unbalance in Cerebellar Ataxia by Inertial Sensor Assessment.

Sensors (Basel) 2019 Dec 17;19(24). Epub 2019 Dec 17.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy.

Background: Patients suffering from cerebellar ataxia have extremely variable gait kinematic features. We investigated whether and how wearable inertial sensors can describe the gait kinematic features among ataxic patients.

Methods: We enrolled 17 patients and 16 matched control subjects. We acquired data by means of an inertial sensor attached to an ergonomic belt around pelvis, which was connected to a portable computer via Bluetooth. Recordings of all the patients were obtained during overground walking. From the accelerometric data, we obtained the harmonic ratio (HR), i.e., a measure of the acceleration patterns, smoothness and rhythm, and the step length coefficient of variation (CV), which evaluates the variability of the gait cycle.

Results: Compared to controls, patients had a lower HR, meaning a less harmonic and rhythmic acceleration pattern of the trunk, and a higher step length CV, indicating a more variable step length. Both HR and step length CV showed a high effect size in distinguishing patients and controls (p < 0.001 and p = 0.011, respectively). A positive correlation was found between the step length CV and both the number of falls (R = 0.672; p = 0.003) and the clinical severity (ICARS: R = 0.494; p = 0.044; SARA: R = 0.680; p = 0.003).

Conclusion: These findings demonstrate that the use of inertial sensors is effective in evaluating gait and balance impairment among ataxic patients.
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http://dx.doi.org/10.3390/s19245571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960492PMC
December 2019

Modular motor control of the sound limb in gait of people with trans-femoral amputation.

J Neuroeng Rehabil 2019 11 6;16(1):132. Epub 2019 Nov 6.

Department of Engineering, University Roma TRE, Roma, Italy.

Background: The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects.

Methods: In this study, we used muscle synergy analysis techniques to characterize the differences in the modular motor control schemes between a population of 14 people with trans-femoral amputation and 12 healthy subjects walking at two different (slow and normal self-selected) speeds. Muscle synergies were extracted from a 12 lower-limb muscles sEMG recording via non-negative matrix factorization. Equivalence of the synergy vectors was quantified by a cross-validation procedure, while differences in terms of time activation coefficients were evaluated through the analysis of the activity in the different gait sub-phases.

Results: Four synergies were able to reconstruct the muscle activity in all subjects. The spatial component of the synergy vectors did not change in all the analysed populations, while differences were present in the activity during the sound limb's stance phase. Main features of people with trans-femoral amputation's muscle synergy recruitment are a prolonged activation of the module composed of calf muscles and an additional activity of the hamstrings' module before and after the prosthetic heel strike.

Conclusions: Synergy-based results highlight how, although the complexity and the spatial organization of motor control schemes are the same found in healthy subjects, substantial differences are present in the synergies' recruitment of people with trans femoral amputation. In particular, the most critical task during the gait cycle is the weight transfer from the sound limb to the prosthetic one. Future studies will integrate these results with the dynamics of movement, aiming to a complete neuro-mechanical characterization of people with trans-femoral amputation's walking strategies that can be used to improve the rehabilitation therapies.
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http://dx.doi.org/10.1186/s12984-019-0616-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836453PMC
November 2019

Increased neural connectivity between the hypothalamus and cortical resting-state functional networks in chronic migraine.

J Neurol 2020 Jan 12;267(1):185-191. Epub 2019 Oct 12.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.

Objective: The findings of resting-state functional MRI studies have suggested that abnormal functional integration between interconnected cortical networks characterises the brain of patients with migraine. The aim of this study was to investigate the functional connectivity between the hypothalamus, brainstem, considered as the migraine generator, and the following areas/networks that are reportedly involved in the pathophysiology of migraine: default mode network (DMN), executive control network, dorsal attention system, and primary and dorsoventral visual networks.

Methods: Twenty patients with chronic migraine (CM) without medication overuse and 20 healthy controls (HCs) were prospectively recruited. All study participants underwent 3-T MRI scans using a 7.5-min resting-state protocol. Using a seed-based approach, we performed a ROI-to-ROI analysis selecting the hypothalamus as the seed.

Results: Compared to HCs, patients with CM showed significantly increased neural connectivity between the hypothalamus and brain areas belonging to the DMN and dorsal visual network. We did not detect any connectivity abnormalities between the hypothalamus and the brainstem. The correlation analysis showed that the severity of the migraine headache was positively correlated with the connectivity strength of the hypothalamus and negatively with the connectivity strength of the medial prefrontal cortex, which belongs to the DMN.

Conclusion: These data provide evidence for hypothalamic involvement in large-scale reorganisation at the functional-network level in CM and in proportion with the perceived severity of the migraine pain.
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http://dx.doi.org/10.1007/s00415-019-09571-yDOI Listing
January 2020

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover.

Front Neurol 2019 29;10:902. Epub 2019 Aug 29.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity. Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period. Forty individuals with idiopathic PD in Hoehn and Yahr stages 1-4. Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B). Spatiotemporal gait parameters, joint kinematics, and trunk kinematics. UPDRS-III scale scores. The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously. The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD. : www.ClinicalTrials.gov, identifier NCT03346265.
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http://dx.doi.org/10.3389/fneur.2019.00902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730596PMC
August 2019

Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease.

Front Neurol 2019 2;10:826. Epub 2019 Aug 2.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1-3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.
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http://dx.doi.org/10.3389/fneur.2019.00826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688512PMC
August 2019

A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones?

Nutrients 2019 Jul 28;11(8). Epub 2019 Jul 28.

Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy.

Here we aimed at determining the therapeutic effect of a very low-calorie diet in overweight episodic migraine patients during a weight-loss intervention in which subjects alternated randomly between a very low-calorie ketogenic diet (VLCKD) and a very low-calorie non-ketogenic diet (VLCnKD) each for one month. In a nutritional program, 35 overweight obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order (VLCKD-VLCnKD or VLCnKD-VLCD). The primary outcome measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Secondary outcome measures were 50% responder rate for migraine days, reduction of monthly migraine attacks, abortive drug intake and body mass index (BMI) change. Only data from the intention-to-treat cohort ( = 35) will be presented. Patients who dropped out ( = 6) were considered as treatment failures. Regarding the primary outcome, during the VLCKD patients experienced -3.73 (95% CI: -5.31, -2.15) migraine days respect to VLCnKD ( < 0.0001). The 50% responder rate for migraine days was 74.28% (26/35 patients) during the VLCKD period, but only 8.57% (3/35 patients) during VLCnKD. Migraine attacks decreased by -3.02 (95% CI: -4.15, -1.88) during VLCKD respect to VLCnKD ( < 0.00001). There were no differences in the change of acute anti-migraine drug consumption ( = 0.112) and BMI ( = 0.354) between the 2 diets. A VLCKD has a preventive effect in overweight episodic migraine patients that appears within 1 month, suggesting that ketogenesis may be a useful therapeutic strategy for migraines.
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http://dx.doi.org/10.3390/nu11081742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722531PMC
July 2019

A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs.

BMC Neurol 2019 Jun 22;19(1):136. Epub 2019 Jun 22.

Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy.

Background: A short ketogenic diet (KD) treatment can prevent migraine attacks and correct excessive cortical response. Here, we aim to prove if the KD-related changes of cortical excitability are primarily due to cerebral cortex activity or are modulated by the brainstem.

Methods: Through the stimulation of the right supraorbital division of the trigeminal nerve, we concurrently interictally recorded the nociceptive blink reflex (nBR) and the pain-related evoked potentials (PREP) in 18 migraineurs patients without aura before and after 1-month on KD, while in metabolic ketosis. nBR and PREP reflect distinct brain structures activation: the brainstem and the cerebral cortex respectively. We estimated nBR R2 component area-under-the-curve as well as PREP amplitude habituation as the slope pof the linear regression between the 1st and the 2nd block of 5 averaged responses.

Results: Following 1-month on KD, the mean number of attacks and headache duration reduced significantly. Moreover, KD significantly normalized the interictal PREP habituation (pre: + 1.8, post: - 9.1, p = 0.012), while nBR deficit of habituation did not change.

Conclusions: The positive clinical effects we observed in a population of migraineurs by a 1-month KD treatment coexists with a normalization at the cortical level, not in the brainstem, of the typical interictal deficit of habituation. These findings suggest that the cerebral cortex may be the primary site of KD-related modulation.

Trial Registration: ClinicalTrials.gov NCT03775252 (retrospectively registered, December 09, 2018).
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http://dx.doi.org/10.1186/s12883-019-1351-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588932PMC
June 2019

OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity.

Toxins (Basel) 2019 06 20;11(6). Epub 2019 Jun 20.

Neurorehabilitation Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy.

Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity.
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http://dx.doi.org/10.3390/toxins11060359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628414PMC
June 2019

Spatial and temporal characteristics of the spine muscles activation during walking in patients with lumbar instability due to degenerative lumbar disk disease: Evaluation in pre-surgical setting.

Hum Mov Sci 2019 May 29;66:371-382. Epub 2019 May 29.

Department of NESMOS, Sapienza University, Rome, Italy.

Our purpose was to investigate the spatial and temporal profile of the paraspinal muscle activation during gait in a group of 13 patients with lumbar instability (LI) in a pre-surgical setting compared to the results with those from both 13 healthy controls (HC) and a sample of 7 patients with failed back surgery syndrome (FBSS), which represents a chronic untreatable condition, in which the spine muscles function is expected to be widely impaired. Spatiotemporal gait parameters, trunk kinematics, and muscle activation were measured through a motion analysis system integrated with a surface EMG device. The bilateral paraspinal muscles (longissimus) at L3-L4, L4-L5, and L5-S1 levels and lumbar iliocostalis muscles were evaluated. Statistical analysis revealed significant differences between groups in the step length, step width, and trunk bending and rotation. As regard the EMG analysis, significant differences were found in the cross-correlation, full-width percentage and center of activation values between groups, for all muscles investigated. Patients with LI, showed preserved trunk movements compared to HC but a series of EMG abnormalities of the spinal muscles, in terms of left-right symmetry, top-down synchronization, and spatiotemporal activation and modulation compared to the HC group. In patients with LI some of such EMG abnormalities regarded mainly the segment involved by the instability and were strictly correlated to the pain perception. Conversely, in patients with FBSS the EMG abnormalities regarded all the spinal muscles, irrespective to the segment involved, and were correlated to the disease's severity. Furthermore, patients with FBSS showed reduced lateral bending and rotation of the trunk and a reduced gait performance and balance. Our methodological approach to analyze the functional status of patients with LI due to spine disease with surgical indications, even in more complex conditions such as deformities, could allow to evaluate the biomechanics of the spine in the preoperative conditions and, in the future, to verify whether and which surgical procedure may either preserve or improve the spine muscle function during gait.
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http://dx.doi.org/10.1016/j.humov.2019.05.013DOI Listing
May 2019

Aberrant interactions of cortical networks in chronic migraine: A resting-state fMRI study.

Neurology 2019 05 3;92(22):e2550-e2558. Epub 2019 May 3.

From the Department of Medico-Surgical Sciences and Biotechnologies (G. Coppola, M.S., F.P.), Sapienza University of Rome Polo Pontino, Latina; Research Unit of Neurophysiology of Vision and Neuroophthalmology (A.D.R., V.P.), IRCCS-Fondazione Bietti; Department of Human Neurosciences (B.P., E.T., V.C., S.T., G. Cartocci, F.C., V.D.P.), Sapienza University of Rome; Don Carlo Gnocchi Onlus Foundation (C.D.L.), Milan, Italy; Headache Research Unit, University Department of Neurology CHR (J.S.), Citadelle Hospital, University of Liège, Belgium; and IRCCS-Neuromed (F.P.), Pozzilli, Italy.

Objective: We investigated resting-state (RS)-fMRI using independent component analysis (ICA) to determine the functional connectivity (FC) between networks in chronic migraine (CM) patients and their correlation with clinical features.

Methods: Twenty CM patients without preventive therapy or acute medication overuse underwent 3T MRI scans and were compared to a group of 20 healthy controls (HC). We used MRI to collect RS data in 3 selected networks, identified using group ICA: the default mode network (DMN), the executive control network (ECN), and the dorsal attention system (DAS).

Results: Compared to HC, CM patients had significantly reduced functional connectivity between the DMN and the ECN. Moreover, in patients, the DAS showed significantly stronger FC with the DMN and weaker FC with the ECN. The higher the severity of headache, the increased the strength of DAS connectivity, and the lower the strength of ECN connectivity.

Conclusion: These results provide evidence for large-scale reorganization of functional cortical networks in chronic migraine. They suggest that the severity of headache is associated with opposite connectivity patterns in frontal executive and dorsal attentional networks.
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http://dx.doi.org/10.1212/WNL.0000000000007577DOI Listing
May 2019

Clinical neurophysiology of migraine with aura.

J Headache Pain 2019 Apr 29;20(1):42. Epub 2019 Apr 29.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Corso della Repubblica, 79-04100, Latina, Italy.

Background: The purpose of this review is to provide a comprehensive overview of the findings of clinical electrophysiology studies aimed to investigate changes in information processing of migraine with aura patients.

Main Body: Abnormalities in alpha rhythm power and symmetry, the presence of slowing, and increased information flow in a wide range of frequency bands often characterize the spontaneous EEG activity of MA. Higher grand-average cortical response amplitudes, an increased interhemispheric response asymmetry, and lack of amplitude habituation were less consistently demonstrated in response to any kind of sensory stimulation in MA patients. Studies with single-pulse and repetitive transcranial magnetic stimulation (TMS) have reported abnormal cortical responsivity manifesting as greater motor evoked potential (MEP) amplitude, lower threshold for phosphenes production, and paradoxical effects in response to both depressing or enhancing repetitive TMS methodologies. Studies of the trigeminal system in MA are sparse and the few available showed lack of blink reflex habituation and abnormal findings on SFEMG reflecting subclinical, probably inherited, dysfunctions of neuromuscular transmission. The limited studies that were able to investigate patients during the aura revealed suppression of evoked potentials, desynchronization in extrastriate areas and in the temporal lobe, and large variations in direct current potentials with magnetoelectroencephalography. Contrary to what has been observed in the most common forms of migraine, patients with familial hemiplegic migraine show greater habituation in response to visual and trigeminal stimuli, as well as a higher motor threshold and a lower MEP amplitude than healthy subjects.

Conclusion: Since most of the electrophysiological abnormalities mentioned above were more frequently present and had a greater amplitude in migraine with aura than in migraine without aura, neurophysiological techniques have been shown to be of great help in the search for the pathophysiological basis of migraine aura.
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http://dx.doi.org/10.1186/s10194-019-0997-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734510PMC
April 2019

Effect of phobic visual stimulation on spinal nociception.

Physiol Behav 2019 07 19;206:22-27. Epub 2019 Mar 19.

"Sapienza" University of Rome Polo Pontino, Department of Medico-Surgical Sciences and Biotechonologies, Latina, Italy.

To explore the role of strong negative emotions in spinal nociception, we evaluated the effect of fear-relevant videos of small animals on the nociceptive withdrawal reflex (NWR) and reflex-related pain perception in healthy subjects with a specific phobia of small animals. Twenty healthy subjects with a specific phobia of small animals diagnosed according to DSM-V criteria were included in this study. The NWR was evoked in the lower limb by stimulating the sural nerve and recording EMG activity in the biceps femoris. NWR pain-related perception was quantified on an 11-point numerical rating scale (NRS). Subjects were examined during 4 recording sessions. In the baseline session, no images were projected. In the other sessions, the subjects were invited to watch a video containing either neutral or phobic content. To evaluate neurovegetative responses, we measured heart rate using a pulse oximeter during each recording session. A series of clinical rating scales were administered to subjects to evaluate disgust, fear, and anxiety. The NWR amplitude was significantly increased during the phobic video session and was associated with the fear inventory scale scores. Women showed higher NWR amplitude values during the phobic video session and a lower recovery rate during the after-effect video session than did men. The NWR amplitude and related pain perception were dissociated from each other during the phobic video session, as the NRS score remained unchanged while the NWR increased in amplitude. Emotions induced by the viewing of phobic videos seem to enhance the activation of the spinal circuitries involved in nociception and the withdrawal reaction without interfering with pain processing pathways or dissociating the reflex response from related pain perception. This effect appears to differ by sex, as it was more intense and longer lasting in women than in men. Emotions induced by phobic video viewing increase the alertness devoted to the defensive reaction by emphasizing nociceptive responses independently from pain perception. The NWR may represent an interesting tool for exploring the interaction between strong negative emotions and spinal nociception. A better understanding of this mechanism may be a theoretical prerequisite for the optimization of pain management in several chronic pain syndromes.
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http://dx.doi.org/10.1016/j.physbeh.2019.03.021DOI Listing
July 2019

Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components.

Hum Mov Sci 2019 Mar 16;66:9-21. Epub 2019 Mar 16.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy.

The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.
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http://dx.doi.org/10.1016/j.humov.2019.03.008DOI Listing
March 2019

The cutaneous silent period: An underutilized tool in clinical neurophysiology.

Authors:
Mariano Serrao

Clin Neurophysiol 2019 04 7;130(4):556-557. Epub 2019 Feb 7.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.clinph.2019.01.014DOI Listing
April 2019

Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache.

Neurol Sci 2019 May 1;40(5):963-969. Epub 2019 Feb 1.

Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.

Objectives: To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH).

Methods: Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant.

Results: All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH.

Conclusions: The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.
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http://dx.doi.org/10.1007/s10072-019-03735-4DOI Listing
May 2019

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients.

Brain Behav 2018 09 23;8(9):e01069. Epub 2018 Aug 23.

Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.

Objectives: The aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT-A) in poststroke subacute hemiparetic patients.

Methods: Fourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT-A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT-A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores.

Results: Comparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT-A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0.

Conclusion: Injection of BoNT-A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR-related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex-mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT-A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons.
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http://dx.doi.org/10.1002/brb3.1069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160647PMC
September 2018

Short-term cortical synaptic depression/potentiation mechanisms in chronic migraine patients with or without medication overuse.

Cephalalgia 2019 02 19;39(2):237-244. Epub 2018 Jun 19.

5 G. B. Bietti Foundation IRCCS, Research Unit of Neurophysiology of Vision and Neurophthalmology, Rome, Italy.

Objective: To study the effects of trains of repetitive transcranial magnetic stimulation (rTMS) over the motor cortex in patients with chronic migraine (CM) with or without medication overuse (MOH).

Subjects And Methods: Thirty-two patients (CM [n = 16]; MOH [n = 16]) and 16 healthy volunteers (HVs) underwent rTMS recording. Ten trains of 10 stimuli each (120% resting motor threshold) were applied over the left motor cortex at 1 Hz or 5 Hz in random order. The amplitude of motor evoked potential (MEP) was evaluated from electromyographic recording in the first dorsal interosseous muscle. The slope of the linear regression line for the 10 stimuli for each participant was calculated using normalized data.

Results: rTMS-1 Hz had a normal depressive effect on MEP amplitude in all groups. rTMS-5 Hz depressed instead of potentiating MEP amplitudes in MOH patients, with a significantly different response from that in HVs and CM patients. The slope of the linear regression of MEP amplitudes was negatively correlated with pain intensity in CM patients, and with the duration of overuse headache in MOH patients.

Conclusions: This different plastic behaviour suggests that MOH and CM, despite exhibiting a similar clinical phenotype, have different neurophysiological learning processes, probably related to different pathophysiological mechanisms of migraine chronification.
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http://dx.doi.org/10.1177/0333102418784747DOI Listing
February 2019

Neurophysiology of gait.

Handb Clin Neurol 2018 ;154:299-303

Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.

Beyond the classic clinical description, recent studies have quantitatively evaluated gait and balance dysfunction in cerebellar ataxias by means of modern motion analysis systems. These systems have the aim of clearly and quantitatively describing the differences, with respect to healthy subjects, in kinematic, kinetic, and surface electromyography variables, establishing the basis for a rehabilitation strategy and assessing its efficacy. The main findings which characterize the gait pattern of cerebellar patients are: increased step width, reduced ankle joint range of motion with increased coactivation of the antagonist muscles, and increased stride-to-stride variability. Whereas the former is a compensatory strategy adopted by patients to keep the center of mass within the base of support, the latter indicates the inability of patients to maintain dynamic balance through a regular walking pattern and may reflect the primary deficit directly related to cerebellar dysfunction and the consequent lack of muscle coordination during walking. Moreover, during the course of the disease, with the progressive loss of walking autonomy, step length, and lower-limb joint range of motion are drastically reduced. As to the joint coordination defect, abnormal intralimb joint coordination during walking, in terms of both joint kinematics and interaction torques, has been reported in several studies. Furthermore, patients with cerebellar ataxia show a poor intersegmental coordination, with a chaotic coordinative behavior between trunk and hip, leading to increased upper-body oscillations that affect gait performance and stability, sustaining a vicious circle that transforms the upper body into a generator of perturbations. The use of motion analysis laboratories allows a deeper segmental and global characterization of walking impairment in these patients and can shed light on the nature of both the primary specific gait disorder and compensatory mechanisms. Such deeper understanding might reasonably represent a valid prerequisite for establishing better-targeted rehabilitation strategies.
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http://dx.doi.org/10.1016/B978-0-444-63956-1.00018-7DOI Listing
September 2018

Trait- and Frequency-Dependent Dysfunctional Habituation to Trigeminal Nociceptive Stimulation in Trigeminal Autonomic Cephalalgias.

J Pain 2018 09 12;19(9):1040-1048. Epub 2018 Apr 12.

IRCCS Neuromed, Pozzilli, IS, Italy; Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy.

We investigated whether the stimulation frequency (SF), the pain phases, and different diagnoses of trigeminal autonomic cephalalgias (TACs) may influence the habituation to pain. We studied the habituation of the nociceptive blink reflex R2 responses at different SFs (.05, .1, .2, .3, .5, and 1 Hz), in 28 episodic cluster headache (ECH) patients, 16 during and 12 outside the bout; they were compared with 16 episodic paroxysmal hemicrania (EPH) during the bout and 21 healthy subjects. We delivered 26 electrical stimuli and subdivided stimuli 2 to 26 in 5 blocks of 5 responses for each SF. Habituation values for each SF were expressed as the percentages of the mean area value of second through fifth blocks with respect to the first one. A significant lower mean percentage decrease of the R2 area across all blocks was found at .2 to 1 Hz SF during ECH, outside of the ECH, and EPH compared with healthy subjects. We showed a common frequency-dependent deficit of habituation of trigeminal nociceptive responses at higher SFs in ECH and EPH patients, independently from the disease phase. This abnormal temporal pattern of pain processing may suggest a trait-dependent dysfunction of some underlying pain-related subcortical structures, rather than a state-dependent functional abnormality due to the recurrence of the headache attacks during the active period.

Perspective: TACs showed a frequency-related defective habituation of nociceptive trigeminal responses at the higher SFs, irrespectively of the diagnosis and/or the disease phase. We showed that the clinical similarities in the different subtypes of TACs are in parallel with a trait-dependent dysfunction in pain processing.
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http://dx.doi.org/10.1016/j.jpain.2018.03.015DOI Listing
September 2018

Biomechanical characterization of the Junzuki karate punch: indexes of performance.

Eur J Sport Sci 2018 Jul 3;18(6):796-805. Epub 2018 Apr 3.

b Rehabilitation Centre , Policlinico Italia , Rome , Italy.

The aims of this study were: (i) to determine kinematic, kinetic, and electromyographic characteristics of Junzuki karate punch in professional karate athletes; (ii) to identify biomechanical parameters that correlate with punch force and lead to a higher punching performance; (iii) to verify the presence of muscle co-activation in the upper limb, trunk, and lower limb muscles. Data were collected from nine experienced karatekas from the Accademia Italiana Karate e Arti Marziali during the execution of the specific punch. Mean punch forces (181.2 N) delivered to the target, the range of motion of both right and left knees (1.13 and 0.82 rad) and right elbow (1.49 rad) joints, and the angles at impact (knee: 0.81 and 0.91 rad; elbow: 1.19 rad) in the sagittal plane were computed. Furthermore, the trunk rotational angular acceleration (63.1 rads), force related to the lower limbs (550.2 and 425.1 N), and co-activation index for the upper limb (36.1% and 34.7%), trunk (24.5% and 16%), and lower limbs (16.0% and 16.1%) muscles were evaluated bilaterally. Significant positive correlations were found between the punch force and both right and left knee flexion at the instant of impact and right and left leg force. Significant negative correlation was found between the punch force and maximum trunk angular acceleration. Significant differences (p = .03) in the co-activation index among the upper limb, trunk, and lower limbs muscles highlighted a rostro-caudal gradient on both body sides. This research could be of use to performers and coaches when considering training preparations.
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http://dx.doi.org/10.1080/17461391.2018.1455899DOI Listing
July 2018