Publications by authors named "Massimiliano Prencipe"

30 Publications

  • Page 1 of 1

An observational study on electrolyte disorders in the acute phase of ischemic stroke and their prognostic value.

J Clin Neurosci 2012 Apr 8;19(4):513-6. Epub 2012 Feb 8.

Clinical Trial Center, IRCCS San Raffaele Pisana, Via della Pisana 235, Rome, Italy.

Data on electrolyte disorders in neurological conditions and in acute stroke are somewhat scanty and not easily compared. In our Stroke Unit we studied patients hospitalized within six hours of the onset of an acute ischemic stroke and recorded their demographic and clinical data. Blood test results were recorded before any pharmacological therapy. A total of 475 individuals (256 M, 219 F; range: 14-96 years) treated over a period of 18 consecutive months, were selected. According to multiple logistic regression analysis, the baseline National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR]=1.33; 95% confidence interval [CI]: 1.22-1.44) and natremia alterations (OR=6.89; 95% CI=1.94-24.40) were associated with higher odds of death. Based on the ordinal logistic regression analysis, the baseline NIHSS score (OR=1.07; 95% CI=1.03-1.10) and baseline hypernatremia (OR=9.69; 95% CI=1.55-60.69) were related to early neurological worsening. Our work suggests an association between serum sodium alterations and mortality, and between high sodium levels and neurological clinical impairment, in the acute phase of an ischemic stroke.
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http://dx.doi.org/10.1016/j.jocn.2011.07.041DOI Listing
April 2012

Ictal epileptic headache as "subtle" symptom in generalized idiopathic epilepsy.

Epilepsia 2012 Apr 7;53(4):e67-70. Epub 2012 Feb 7.

Department of Neuroscience, Neurology Unit, Sapienza University, Rome, Italy.

Epilepsy and migraine are common neurologic chronic disorders with episodic manifestations characterized by recurrent attacks and a return to baseline conditions between attacks. Epilepsy and migraine are frequently observed in comorbidity, with the occurrence of one disorder increasing the probability of the other: Migraine occurs in about one-fourth of patients with epilepsy, whereas epilepsy is present in 8-15% of patients with migraine. The link between headache and seizures is controversial and multifactorial. In epilepsy, headache can be seen as a preictal, ictal, or postictal phenomenon. In this report, we describe a case of a 37-year-old patient, affected by both drug-resistant generalized idiopathic epilepsy and headache, who displayed the sudden onset of a headache attack referred during a 24-h electroencephalography (EEG). The EEG tracing during this event revealed the activation of subcontinuous epileptic activity consisting of generalized spike-wave discharges (GSWDs) and generalized polyspike and wave discharges (GPSWDs) that persisted for 60 min, that is, until the disappearance of the headache. The case we describe appears to be original in that it represents one of the few EEG-documented ictal epileptic headaches in generalized idiopathic epilepsy.
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http://dx.doi.org/10.1111/j.1528-1167.2011.03387.xDOI Listing
April 2012

Ictal haemodynamic changes in a patient affected by "subtle" Epilepsia Partialis Continua.

Seizure 2012 Jan 29;21(1):65-9. Epub 2011 Sep 29.

Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Universita' 30, 00185, Rome, Italy.

We report on a 64 year-old woman presenting with Epilepsia Partialis Continua (EPC) affecting the left hand since the age of 24 without neurological deficit. Structural MRI showed a region of focal cortical dysplasia (FCD) over the right central gyrus and lesions in the mesial frontal and occipital cortex secondary to perinatal hypoxic injury. Ictal spike haemodynamic mapping using simultaneous EEG-fMRI revealed significant BOLD signal changes prominent in the region of FCD (larger cluster), occipital cortex (global statistical maximum), prefrontal cortex and cerebellum. The cluster over FCD was in good agreement with the result of EEG source analysis. Our findings provide an interesting illustration of the ability of EEG-fMRI to reveal epileptogenic networks confirming the intrinsic epileptogenic properties of dysplastic neurons.
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http://dx.doi.org/10.1016/j.seizure.2011.09.003DOI Listing
January 2012

Feasibility and clinical utility of transesophageal echocardiography in the acute phase of cerebral ischemia.

Am J Cardiol 2010 Nov;106(9):1339-44

Heart and Great Vessels "A. Reale" Department, "Sapienza" University of Rome, Italy.

We evaluated the feasibility and clinical utility of transesophageal echocardiography (TEE) in the early management of ischemic stroke. TEE was performed in consecutive patients with acute cerebral ischemia within 48 hours of symptoms onset. The data were analyzed by age (<55 vs ≥55 years), and the baseline stroke etiology was classified (determined vs undetermined). TEE was feasible in 660 (61%) of 1,080 patients. Left atrial abnormalities and complicated aortic plaques prevailed in older patients (p <0.05), irrespective of the stroke etiology. A patent foramen ovale prevailed in younger patients (p <0.05) but even in older patients was present in 13% of the determined and 31% of the undetermined stroke subgroups. Overall, high-risk and potentially high-risk cardioembolic sources were detected in 47% of the patients, and stroke etiology was consequently reviewed: 40% of the baseline undetermined strokes were reclassified as cardioembolic, and 29% of lacunar, 42% of large artery, and 30% of other determined-cause strokes were reclassified as concurrent etiology. Subsequently, according to the current guidelines, 12% of patients were reassigned from antiplatelet to anticoagulant therapy and 17% of patients were treated with high-dose statins; overall, secondary prevention treatment was modified in 26% of patients. In conclusion, TEE was feasible in about 2/3 of the patients investigated within 48 hours of the index event, contributed to stroke classification in 1/3 of cases, and guided secondary prevention therapy in 1/4 of patients. Therefore, TEE is useful for defining patients' risk profile for stroke recurrence.
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http://dx.doi.org/10.1016/j.amjcard.2010.06.066DOI Listing
November 2010

Seizures in Alzheimer's disease: a retrospective study of a cohort of outpatients.

Epileptic Disord 2010 Mar 22;12(1):16-21. Epub 2010 Feb 22.

Department of Neuroscience, Sapienza University of Rome, Italy.

Purpose: The aim of our study was to define the frequency of seizures in a population of outpatients attending a cognitive function clinic in Italy and to identify risk factors for seizures in patients with Alzheimer's disease.

Methods: In this retrospective study, we analyzed our clinical records to gather information on patients' demographic, metabolic, cardiovascular and cognitive features. We sought to determine the significance of abnormal neuroimaging findings and the use of potentially epileptogenic drugs on the onset of seizures. From the records of 583 patients referred to the clinic for cognitive disturbances, we identified 145 patients with Alzheimer's disease.

Results: Of these 145 patients, 14 (9.7%) had a history of complex partial or generalised seizures, or both. Of the risk factors identified, onset of seizures was associated with male gender and none of the patients with seizures had diabetes. The risk of seizure onset was higher in Alzheimer's disease patients with hyperlipaemia and severe dementia. No other risk factors were identified, although hypertensive patients seemed to be protected.

Conclusions: Seizures in Alzheimer's disease are frequent and often under-recognized. In elderly patients, especially those with Alzheimer's disease, correct diagnosis and treatment are important to prevent disease from worsening and disability from increasing. Patients with dementia should routinely undergo history-taking designed to elicit a history of seizures and define patients at high risk.
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http://dx.doi.org/10.1684/epd.2010.0290DOI Listing
March 2010

Focal epileptic seizure induced by transient hypoglycaemia in insulin-treated diabetes.

Epileptic Disord 2010 Mar 16;12(1):84-7. Epub 2010 Feb 16.

Department of Neurological Sciences, Policlinico Umberto I, University of Rome, Italy.

Hypoglycaemia, common in diabetic patients treated with insulin, can induce various neurological disturbances. Of these, seizures are the most common acute symptom, mainly of the generalised tonic-clonic type, with focal events only exceptionally being reported and documented. Hypoglycaemia can modify cortical excitability by determining an imbalance between excitation and inhibition; some brain structures, such as the temporal lobe and hippocampus, appear to be particularly susceptible to this insult. We describe a case of a 61-year-old diabetic patient in whom insulin-induced transient hypoglycaemia triggered a focal seizure of temporal origin that was well documented by EEG during 24-hour ambulatory monitoring. This is, to our knowledge, one of the few, well-documented cases of this type of seizure.
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http://dx.doi.org/10.1684/epd.2010.0293DOI Listing
March 2010

Drug resistant ADLTE and recurrent partial status epilepticus with dysphasic features in a family with a novel LGI1mutation: electroclinical, genetic, and EEG/fMRI findings.

Epilepsia 2009 Nov 22;50(11):2481-6. Epub 2009 Jun 22.

Department of Neurological Sciences, University of Rome, Rome, Italy.

Purpose: We characterized a family with autosomal dominant lateral temporal epilepsy (ADLTE) whose proband presented uncommon electroclinical findings such as drug-resistant seizures and recurrent episodes of status epilepticus with dysphasic features.

Methods: The electroclinical characteristics and LGI1 genotype were defined in the family. In the proband, the ictal pattern was documented during video-EEG monitoring and epileptic activity was mapped by EEG/fMRI.

Results: The affected members who were studied had drug-resistant seizures. In the proband, seizures with predominant dysphasic features often occurred as partial status epilepticus. The video-EEG-documented ictal activity and fMRI activation clearly indicated the elective involvement of the left posterior lateral temporal cortex. Sequencing of LGI1 exons revealed a heterozygous c.367G>A mutation in exon 4, resulting in a Glu123Lys substitution in the protein sequence.

Conclusions: The uncommon clinical pattern (high seizure frequency, drug-resistance) highlights the variability of the ADLTE phenotype and extends our knowledge of the clinical spectrum associated with LGI1 mutations.
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http://dx.doi.org/10.1111/j.1528-1167.2009.02181.xDOI Listing
November 2009

An emergency clinical pathway for stroke patients--results of a cluster randomised trial (isrctn41456865).

BMC Health Serv Res 2009 Jan 21;9:14. Epub 2009 Jan 21.

Public Health Agency of the Latium Region, Rome, Italy.

Background: Emergency Clinical Pathways (ECP) for stroke have never been tested in randomized controlled trials (RCTs).

Objective: To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy) emergency system.

Methods: cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS) and Emergency Room (ER) health professionals trained in the ECP, with those of non-trained EMS and ER controls. Primary outcome measure was the proportion of eligible (aged
Results: 2656 patients in the intervention arm and 2239 in the control arm required assistance; 78.3% of the former and 80.6% of the latter were admitted to hospitals, and respectively 74.8% and 78.3% were confirmed strokes. Of the eligible confirmed strokes, 106/434 (24.4%) in the intervention arm and 43/328 (13.1%) in the control arm were referred to the SU in the ITT analysis (RR = 2.01; 95% CI: 0.79-4.00), and respectively 105/243 (43.2%) and 43/311 (13.8%) in the PP analysis (RR = 3.21; 95%CI: 1.62-4.98). Of patients suitable for i.v. thrombolysis, 15/175 (8.6%) in the intervention arm and 2/115 (1.7%) in the control arm received thrombolysis (p = 0.02) in the ITT analysis, and respectively 15/99 (15.1%) and 2/107 (1.9%)(p = 0.001) in the PP analysis.

Conclusion: Our data suggest potenti efficiency and feasibility of an ECP. The integration of EMS and ERs with SU networks for organised acute stroke care is feasible and may ameliorate the quality of care for stroke patients.

Trial Registration: Current Controlled Trials (ISRCTN41456865).
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http://dx.doi.org/10.1186/1472-6963-9-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640375PMC
January 2009

Diffusion-weighted magnetic resonance imaging in patients with partial status epilepticus.

Epilepsia 2009 Jan;50 Suppl 1:45-52

Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.

Purpose: Diffusion-weighted magnetic resonance imaging (DWI) is used to detect changes in the distribution of water molecules in regions affected by various pathologies. Like other conditions, ictal epileptic activity, such as status epilepticus (SE), can cause regional vasogenic/cytotoxic edema that reflects hemodynamic and metabolic changes. This study describes the electroclinical and neuroimaging findings in 10 patients with partial SE whose DWI evaluation disclosed periictal changes related to sustained epileptic activity.

Patients And Methods: In this retrospective study we selected 10 patients with partial SE of different etiologies (six acute symptomatic SE; four with previous epilepsy and concomitant precipitating factors) who underwent video-EEG (electroencephalography) monitoring and a DWI study during the periictal phase. We analyzed ictal electroclinical features and DWI changes in the acute phase and during the follow-up period.

Results: DWI images revealed significant signal alterations in different brain regions depending on the location of ictal activity. DWI changes were highly concordant with the electroclinical findings in all 10 patients. As the SE resolved and the clinical conditions improved, DWI follow-up showed that the signal alterations gradually disappeared, thereby documenting their close relationship with ictal activity.

Conclusions: This study confirms the usefulness of DWI imaging in clinical practice for a more accurate definition of the hemodynamic/metabolic changes occurring during sustained epileptic activity.
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http://dx.doi.org/10.1111/j.1528-1167.2008.01970.xDOI Listing
January 2009

Early clinical diagnosis of lacunar strokes.

Stroke 2008 Oct 7;39(10):e152; author reply e153. Epub 2008 Aug 7.

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http://dx.doi.org/10.1161/STROKEAHA.108.507897DOI Listing
October 2008

Asymmetric responses to repetitive transcranial magnetic stimulation (rTMS) over the left and right primary motor cortex in a patient with lateralized progressive limb-kinetic apraxia.

Neurosci Lett 2008 May 28;437(2):125-9. Epub 2008 Mar 28.

Neurology Neurophysiopathology Unit S. Pertini Hospital, Rome, Italy.

Repetitive transcranial magnetic stimulation (5 Hz-rTMS, 10 stimuli, 120% resting motor threshold intensity, RMT) produces in healthy subjects a progressive facilitation of motor-evoked potential (MEP) amplitude probably through a short-term enhancement of cortical excitatory interneurones. We had the opportunity to investigate the effect of 5 Hz-rTMS delivered over the right and left primary motor cortex (M1) in a patient with limb-kinetic apraxia of the left hand and fingers and reduced cerebral perfusion in the fronto-parietal cortex of the right hemisphere documented by single-photon emission computed tomography scans. Changes in the MEP size during the trains and the RMT were measured and compared between the hemispheres. 5 Hz-rTMS was also delivered in a group of healthy subjects over both hemispheres in order to compare changes in the MEP size from the right and left M1. In the patient, 5 Hz-rTMS delivered over the left hemisphere elicited normal MEPs that progressively increased in size during the trains whereas 5 Hz-rTMS delivered over the right affected hemisphere failed to facilitate the MEP size. RMT was similar in both hemispheres. In healthy subjects, 5 Hz-rTMS delivered over either hemisphere elicited a similar, significant MEP size facilitation. Despite the limitations of a single case, our findings suggest an altered response to 5 Hz-rTMS over the M1 of the affected hemisphere. This asymmetric response correlated with the altered perfusion in the right hemisphere and the patient's lateralized clinical manifestations of apraxia.
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http://dx.doi.org/10.1016/j.neulet.2008.03.072DOI Listing
May 2008

Influence of the corticospinal tract on the cutaneous silent period: a study in patients with pyramidal syndrome.

Neurosci Lett 2008 Mar 10;433(2):109-13. Epub 2008 Jan 10.

Department of Neurological Sciences, University of Rome Sapienza, Viale dell'Università 30, 00185 Rome, Italy.

The cutaneous silent period (CSP) is a brief transient suppression of the voluntary muscle contraction that follows a noxious cutaneous nerve stimulation. In this study we investigated the influence of the corticospinal tract on this spinal inhibitory reflex. In patients with pyramidal syndrome and in a group of healthy subjects we delivered painful electrical finger stimulation during sustained contraction of the ipsilateral abductor digiti minimi muscle. The CSP latency and duration and the background electromyographic (EMG) activity were measured and compared between-groups. The compound motor action potential amplitude and F-wave latency were also measured after electrical stimulation of the ulnar nerve at the wrist. The CSP latency was significantly longer in patients than in healthy subjects. None of the other variables differed in patients and healthy subjects. Our findings suggest that corticospinal projections influence the CSP latency probably by modulating the balance of excitability in the underlying circuits.
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http://dx.doi.org/10.1016/j.neulet.2007.12.055DOI Listing
March 2008

Transforming guidelines in routine practice.

Stroke 2008 Feb 27;39(2):e22; author reply e23. Epub 2007 Dec 27.

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http://dx.doi.org/10.1161/STROKEAHA.107.500314DOI Listing
February 2008

Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.

Cerebrovasc Dis 2008 11;25(1-2):129-35. Epub 2007 Dec 11.

Unità di Trattamento Neurovascolare, Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.

Background: Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke. However, little information exists on its use in elderly patients, in particular those aged >80 years, who at present are excluded from treatment.

Methods: In a multicenter Italian study on i.v. thrombolysis, patients aged >80 years (n = 41) were compared with those aged
Results: The percentage of SICH (nonfatal and fatal) was comparable between older (2.4%, 2.4%) and younger (2.4%, 2.4%) patient groups (p = 1.0). At 3 months, favorable outcome occurred in 44% and dependence in 22% of the older, and respectively in 58.5 and in 30.9% of the younger patients (p = 0.897). Patients aged >80 years had a higher mortality (34.1%) as compared to those aged 80-year-old group.

Conclusions: Acute ischemic stroke patients aged >80 years treated with i.v. rt-PA have a higher mortality than younger patients, but there are no differences for SICH nor for favorable outcome. Our data suggest that thrombolytic therapy should not be a priori denied for appropriately selected >80-year-old patients but randomized controlled clinical trials are necessary before definite recommendations can be given.
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http://dx.doi.org/10.1159/000112323DOI Listing
April 2008

Screening of a microvascular endothelial cDNA library identifies rabaptin 5 as a novel autoantigen in Alzheimer's disease.

J Neuroimmunol 2007 Dec 24;192(1-2):105-12. Epub 2007 Oct 24.

Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome, Italy.

The pathogenesis of Alzheimer's disease (AD) includes the participation of the immune system. To identify antigenic targets in AD, we screened a human microvascular endothelial cell cDNA library with sera from patients with AD, and we identified rabaptin 5 (RABPT5). We detected serum IgG specific to RABPT5 in 65% of patients with AD and in 35% of patients with systemic lupus erythematosus, but in no healthy controls. Our results demonstrated a massive redistribution of this protein in the cytoplasm of endothelial and neuronal cells in apoptosis. In conclusion, we identified RABPT5 as a novel autoantigen in AD.
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http://dx.doi.org/10.1016/j.jneuroim.2007.09.027DOI Listing
December 2007

Over-interpretation of electroclinical and neuroimaging findings in syncopes misdiagnosed as epileptic seizures.

Epileptic Disord 2007 Jun;9(2):170-3

Epilepsy Unit, Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.

Syncope and epileptic seizures share some common clinical characteristics that may complicate the diagnostic process. In clinical practice, syncope is frequently misdiagnosed as an epileptic seizure and consequently treated with antiepileptic drugs. In this study, we identified 57 patients with syncope (diagnosis based on accepted criteria) who had come to our unit with a previous diagnosis of definite epilepsy in 30 cases (syncope misdiagnosed as epileptic seizures, SMS), or suspected epilepsy in the remaining 27 cases (unrecognized syncope, US). We attempted to identify factors underlying misdiagnosis by reviewing clinical findings, particularly potentially confounding features, and EEG/neuroimaging data. Finally, we compared these two groups of patients to search for crucial elements that had led to misdiagnosis. Although some clinical elements were found to be confounding in both groups, it was the interpretation of the EEG and MRI findings, particularly when combined with the confounding clinical features that constituted the main reasons for misdiagnosis.
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http://dx.doi.org/10.1684/epd.2007.0099DOI Listing
June 2007

Determinants of plasma levels of brain natriuretic peptide after acute ischemic stroke or TIA.

J Neurol Sci 2007 Sep 21;260(1-2):139-42. Epub 2007 May 21.

Department of Neurological Sciences, University of Rome La Sapienza, Italy.

Plasma levels of brain natriuretic peptide (BNP) are frequently elevated after an acute stroke and have been shown to be an independent predictor of mortality. However, the relationships between stroke and BNP concentrations have not yet been systematically investigated. Plasma BNP assay and echocardiography were performed in 48 patients with ischemic stroke or TIA with a mean delay of 12.7 h after onset. Median BNP concentration was 88.6 pg/mL (range 5-1270). Older age, chronic heart failure, atrial fibrillation, stroke severity, lower hemoglobin levels, lower left ventricular ejection fraction, and abnormalities of left atrium or appendage (LA/LAA) were univariately associated with increased BNP levels. At multivariable analysis, the presence of at least one LA/LAA abnormality (atrial dilatation, low flow velocity, spontaneous echocontrast or thrombus) had the strongest association with BNP, explaining 38.9% of the variance in the whole sample and 28.5% in patients without atrial fibrillation. In acute ischemic stroke patients, elevated plasma BNP levels have multiple determinants, among which left atrial disease appears to be the stronger, even in patients without atrial fibrillation. These results encourage further investigation of plasma BNP concentration as a potential marker of the presence of left atrial sources of emboli.
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http://dx.doi.org/10.1016/j.jns.2007.04.018DOI Listing
September 2007

Video-EEG study of psychogenic nonepileptic seizures: differential characteristics in patients with and without epilepsy.

Epilepsia 2006 ;47 Suppl 5:64-7

Department of Neurological Sciences, Policlinico Umberto I, University of Rome, La Sapienza, Rome.

Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video-EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.

Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video-EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow-up).

Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow-up.

Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients.
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http://dx.doi.org/10.1111/j.1528-1167.2006.00880.xDOI Listing
June 2007

EEG/fMRI study of ictal and interictal epileptic activity: methodological issues and future perspectives in clinical practice.

Epilepsia 2006 ;47 Suppl 5:52-8

Department of Neurological Sciences, University of Rome, La Sapienza, Rome, Italy.

Purpose: Electroencephalography/functional magnetic resonance imaging (EEG/fMRI) has been proposed recently as a tool to study electrophysiological activity and, consequently, detect brain regions activated during epileptiform EEG abnormalities. The purpose of the study was to review our two-year experience with studying ictal and interictal activities in patients with epilepsy.

Methods: Using EEG/fMRI, we studied hemodynamic changes associated with ictal and interictal EEG abnormalities in 43 patients with partial (31 cases) or generalized (12 cases) epilepsy. Using two different paradigms (block design and event-related design), we studied several forms of EEG activity consisting of (i) interictal abnormalities constantly elicitable by specific stimulation (8 cases); (ii) focal and generalized interictal activity, such as focal spikes or typical and atypical generalized spike-and-wave discharges (18 cases); and (iii) focal and generalized ictal electro-clinical activity, such as tonic seizures or pseudo-absences in frontal lobe epilepsy, typical absences in idiopathic generalized epilepsy, complex partial seizures in temporal lobe epilepsy, and perisylvian seizures in special syndromes (17 patients).

Results: EEG/fMRI revealed clear hemodynamic changes related to EEG abnormalities in 21 patients. In 18 of these patients, the changes were highly concordant with electro-clinical findings. In the remaining 22 patients, fMRI analysis data failed to show activation or deactivation clusters, probably owing either to lack or inadequate amount of temporal distribution of abnormal EEG activity, or to intrinsic methodological problems.

Conclusions: By defining the electro-clinical and hemodynamic correlates of EEG activity, fMRI may shed light on the neurophysiological mechanisms underlying epileptic phenomena. However, as several methodological issues have yet to be addressed, further studies are warranted to assess the reliability and usefulness of EEG/fMRI in clinical practice.
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http://dx.doi.org/10.1111/j.1528-1167.2006.00878.xDOI Listing
June 2007

Effects of repetitive transcranial magnetic stimulation on spike-and-wave discharges.

Neurosci Res 2007 Jan 7;57(1):140-2. Epub 2006 Nov 7.

Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.

Aim of this study was to evaluate the effect of 5Hz-suprathreshold repetitive transcranial magnetic stimulation (rTMS) on the duration of the spike-and-wave discharges (SWDs) in a patient presenting idiopathic absence seizures. At the moment of the study the patient presented a mild blunting of consciousness due to the high frequency of absences and EEG recordings showed sub-continuous, generalized, symmetrical and synchronous 3c/s SWDs, petit mal status. Trains of 10 stimuli (120% resting motor threshold) were delivered at 5Hz frequency at the beginning of the SWDs. 5Hz-rTMS trains significantly changed the EEG activity by reducing the duration of SWDs without changing the intervals between two consecutive discharges. rTMS had not significant after-effects on the epileptic activity and patient's clinical status. Despite the limitations of a single case report, our neurophysiological findings suggest that 5Hz-suprathreshold rTMS delivered in short trains induces a transitory interference of the ongoing epileptic activity.
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http://dx.doi.org/10.1016/j.neures.2006.09.015DOI Listing
January 2007

Status epilepticus in a patient with fragile X syndrome: electro-clinical features and peri-ictal neuroimaging.

Epileptic Disord 2006 Sep;8(3):195-9

Department of Neurological Sciences, Rome, Italy.

Fragile X syndrome (Fra-X) is a common cause of mental retardation that can be associated with partial epilepsy characterized by a variety of electro-clinical features. A wide spectrum of interictal activities are reported, although no data regarding ictal EEG activity have as yet been published. Drug-resistant seizures are uncommon, and the occurrence of clustering seizures or status epilepticus has only been reported anecdotally. We describe a Fra-X patient with refractory partial epilepsy related to a malformation of cortical development who experienced a partial status epilepticus that was well documented by video-EEG and MRI. We report the electro-clinical features and peri-ictal neuroimaging data.
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September 2006

Metabolic alteration transients during paroxysmal activity in an epileptic patient with fixation-off sensitivity: a case study.

Magn Reson Imaging 2006 May 20;24(4):373-9. Epub 2006 Mar 20.

Museo storico della fisica e Centro di studi e ricerche Enrico Fermi, 00184 Rome, Italy.

The purpose of this study was to investigate short-time metabolic variations related to continuous epileptic activity elicited by fixation-off sensitivity (FOS). Time-resolved magnetic resonance spectroscopy was performed on a patient on whom previous clinical findings clearly indicated presence of FOS. The epileptic focus was localized with a simultaneous electroencephalographic and functional magnetic resonance imaging study. The results showed a linear increase of the sum of glutamate and glutamine with time of paroxysmal activity in epileptic focus and much greater concentration of choline-containing compounds in focus than in the contralateral side.
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http://dx.doi.org/10.1016/j.mri.2005.11.003DOI Listing
May 2006

The COX-2 G/C -765 polymorphism may modulate the occurrence of cerebrovascular ischemia.

Blood Coagul Fibrinolysis 2006 Mar;17(2):93-6

Unita' di Aterosclerosi e Trombosi, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy.

In the atherosclerotic plaque, cyclooxygenase-2 (COX-2) catalyzes prostaglandin E formation, which acts as a pro-atherogenic factor. A polymorphism, G/C -765, within the COX-2 promoter region modulates gene expression and the risk of cerebrovascular disease. We have evaluated the relation between COX-2 G/C -765 genotypes and the occurrence of cerebrovascular ischemia. We evaluated the COX-2 G/C -765 polymorphism in 110 consecutive patients with a documented history of acute ischemic cerebrovascular disease, in 110 age-matched and sex-matched subjects without such history, and in a general population (n = 324) from the same ethnical background. The frequency of the COX-2 -765C allele in patients [0.21; 95% confidence interval (CI), 0.16-0.26] was similar to those found in controls (0.28; 95% CI, 0.22-0.34) and in the general population (0.26; 95% CI, 0.23-0.29). Carriers of the CC genotype differed between patients (0.02; 95% CI, 0.00-0.05) and controls [0.10 (95% CI, 0.04-0.16), P = 0.019; odds ratio, 0.17 (95% CI, 0.04-0.79)] or the general population [0.08 (95% CI, 0.05-0.11), P = 0.023; odds ratio, 0.22 (95% CI, 0.05-0.95)]. In a multiple logistic regression analysis adjusted for confounding variables, smoking status (P < 0.001), atrial fibrillation (P = 0.004) and COX-2 G/C-765 polymorphism (P = 0.016) independently contributed to cerebrovascular ischemia, with CC carriers exhibiting a lower risk (odds ratio, 0.07; 95% CI, 0.01-0.61). Our data show an association between the COX-2 G/C-765 gene polymorphism and cerebrovascular ischemia, suggesting that the COX-2 gene is a susceptibility locus for the risk of cerebrovascular ischemic disease.
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http://dx.doi.org/10.1097/01.mbc.0000214706.88621.daDOI Listing
March 2006

Clinical experience with levetiracetam in idiopathic generalized epilepsy according to different syndrome subtypes.

Epileptic Disord 2005 Sep;7(3):231-5

Department of Neurological Sciences, Italy.

Clinical experience in open-label studies and anectodal reports suggest that levetiracetam is effective in generalized epilepsy. In this open-label prospective study, 19 patients (3 men, 16 women) affected by idiopathic generalized epilepsy were followed for at least 6 months following the introduction of levetiracetam. Patients were categorized according to syndrome subtype: juvenile myoclonic epilepsy (8), juvenile absence epilepsy (5), childhood absence epilepsy (4), and eyelid myoclonia with absences (2). Eleven patients received levetiracetam as monotherapy, eight as add-on therapy. Effectiveness was demonstrated in 18 patients: 13 became seizure-free (five juvenile myoclonic epilepsy, five juvenile absence epilepsy, three childhood absence epilepsy), and five achieved significant reductions in seizure frequency (three juvenile myoclonic epilepsy, one childhood absence epilepsy, one eyelid myoclonia with absences). Only one patient experienced no change in seizure frequency (eyelid myoclonia with absences). Clinical improvement was accompanied by EEG abnormality suppression or reduction. Levetiracetam was well tolerated; no patient reported side-effects.
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September 2005

Prevalence of non-dementing cognitive disturbances and their association with vascular risk factors in an elderly population.

J Neurol 2003 Aug;250(8):907-12

To assess the prevalence of "Cognitive Impairment No Dementia" (CIND) and circumscribed memory impairment (CMI) and to evaluate their association with vascular risk factors and stroke, we examined all people aged 65 years or over living in three rural Italian villages. The survey was conducted by means of a doorto-door 2-phase procedure. As phase 1 screening tests, we used the Mini-Mental State Examination (MMSE), or the Mental Status Questionnaire (MSQ) for people with < 3 years of schooling. In phase 2, four neurologists examined people with MMSE scores < 28 or MSQ scores < 10. The diagnostic study consisted of a clinical and neuropsychological examination which included a structured interview with a close respondent. Dementia was diagnosed by means of DSM III-R criteria. The study protocol was completed by 968 (84.4%) of the 1147 eligible people. Of the 968 participants, 690 (71.3 %) had no cognitive abnormalities, 78 (8.1%) were demented and 200 (20.6 %) suffered from CIND. The CIND group included 59 people (6.1% of the study population) with CMI. At the multiple logistic regression analysis, CIND was associated with age >or= 75 years (OR 1.6, 95 % CI 1.1.-2.2), < 5 years of schooling (OR 3.7, 95% CI 2.5.-5.5), stroke (OR 3.3, 95% CI 1.8.-6.1) and hypertension (OR 2.3, 95% CI 1.5.-3.5),while CMI was associated with < 5 years of schooling (OR 3.8, 95 % CI 1.9.-7.7), stroke (OR 3.1, 95% CI 1.2.-7.9) and hypertension (OR 3.7, 95% CI 1.7.-8.0). Using normotensive people as a reference group and adjusting for age, sex, education and stroke, the ORs for CIND were 1.9 (95 % CI 1.2.-3.0) for treated and 2.9 (95 % CI 1.8.-4.6) for untreated hypertensive patients. In conclusion, hypertension is significantly and independently associated with both CIND and CMI, and the risk of CIND is higher in untreated than treated hypertensive patients.
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http://dx.doi.org/10.1007/s00415-003-1094-0DOI Listing
August 2003

T cell response to amyloid-beta and to mitochondrial antigens in Alzheimer's disease.

Dement Geriatr Cogn Disord 2003 ;16(1):35-8

Department of Neurological Sciences, University of Rome La Sapienza, Viale Dell'Università 30, I-00185 Rome, Italy.

Despite the vast amount of literature on non-specific immune mechanisms in Alzheimer's disease (AD), little is known about the role of antigen-specific immune responses. We investigated T cell reactivity to fragment 1-42 of amyloid-beta (Abeta) and to N-terminal peptides of human mitochondrial and control microbial proteins. Thirty subjects with a diagnosis of probable AD according to NINCDS-ADRDA criteria and 30 sex- and age-matched healthy controls were enrolled. T cell responses to Abeta fragment showed no significant differences between AD patients and controls. By contrast, the mean number of positive T cell responses to both human mitochondrial and microbial peptides was significantly decreased in AD patients compared to control subjects. No significant correlation was found between T cell responses and both the severity of cognitive impairment and duration of the disease. Our results suggest that antigen-specific immune responses are impaired in AD. Protective immune responses to harmful amyloidogenic substances may also be impaired, thus favoring their accumulation in the brain.
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http://dx.doi.org/10.1159/000069991DOI Listing
November 2003
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