Publications by authors named "Viola Baione"

13 Publications

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The efficacy of rehabilitation in people with Guillain-Barrè syndrome: a systematic review of randomized controlled trials.

Expert Rev Neurother 2021 Feb 23:1-7. Epub 2021 Feb 23.

Department of Human Neurosciences, Sapienza University of Rome, Viale Dell' Università, Rome, Italy.

Introduction: Individuals with Guillain-Barrè syndrome (GBS) showed significant longer-term psychological sequelae, due to persistent disability. In recent years, great advances have been made in medical care for patients with GBS. However, the focus has been mainly on patient care in the acute phase and improving survival instead of long-term disability. The purpose of this study was to evaluate the efficacy of rehabilitation in people with GBS through a systematic review of randomized controlled trials.

Area Covered: PRISMA guidelines were used to perform this systematic review. Six bibliographic databases were searched: PUBMED, WEB OF SCIENCE, PEDro, CINHAL, PSYCHINFO, and SCOPUS. Papers included in the systematic review should have a search design of a randomized controlled trial. The quality of the clinical trials included was evaluated according to Jadad score.

Expert Opinion: After eliminating duplicates, 472 records got screened, three RCTs were included in the systematic review. Overall, the analysis of the three randomized controlled trials showed that various types of rehabilitation interventions are correlated to an improvement in the patient's well-being. Finally, it is not possible to extrapolate definite conclusions on the effectiveness of rehabilitation treatment in patients with GBS. Therefore, high-quality future studies are needed to confirm these hypotheses.
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http://dx.doi.org/10.1080/14737175.2021.1890034DOI Listing
February 2021

Operationalization of a frailty index in patients with multiple sclerosis: A cross-sectional investigation.

Mult Scler 2021 Feb 10:1352458520987541. Epub 2021 Feb 10.

Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy.

Background: Frailty is an age-related status of increased vulnerability to stressors caused by the accumulation of multiple health deficits. This construct may allow to capture the clinical complexity of patients with multiple sclerosis (MS).

Objective: To investigate the relationship between frailty and the clinical manifestations of MS.

Methods: Patients with MS were consecutively enrolled at five tertiary dedicated services. Disability and fatigue were assessed. The phenotypes of MS were also identified. Frailty was measured using a frailty index (FI), computed by cumulatively considering 42 age-related multidimensional health deficits.

Results: Overall, 745 MS patients (mean age = 48.2 years, standard deviation = 11.7 years; women 68%) were considered. The median FI value was 0.12 (interquartile range = 0.05-0.19) and the 99th percentile was 0.40. FI scores were associated with MS disease duration, disability, fatigue, as well as with the number of previous disease-modifying treatments and current symptomatic therapies. A logistic regression analysis model showed that FI score was independently associated with the secondary progressive phenotype.

Conclusion: Frailty is significantly associated with major characteristics of MS. The findings of the present cross-sectional investigation should be explored in future longitudinal studies.
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http://dx.doi.org/10.1177/1352458520987541DOI Listing
February 2021

Outcome measures for physical fatigue in individuals with multiple sclerosis: a systematic review.

Expert Rev Pharmacoecon Outcomes Res 2021 Jan 28. Epub 2021 Jan 28.

Department of Human Neurosciences, Sapienza University of Rome , Piazzale Aldo Moro 5, 00185, Rome, Italy.

Introduction: : Physical fatigue can be a common reason for early retirement or sick leave since it appears in the earliest stages of multiple sclerosis (MS). Therefore, a prompt and accurate diagnosis is essential. This systematic review aims to identify and describe the instruments used to assess physical fatigue in MS patients with consideration for the languages used to validate the instruments and their methodological qualities.

Area Covered: : This study has been carried out through "Medline," "Scopus," "Cinhal," and "Web of Science" databases for all the papers published before January 24, 2020. Three independent authors have chosen the eligible studies based upon pre-set criteria of inclusion. Data collection, data items, and assessment of the risk of bias: the data extraction approach was chosen based on the Cochrane Methods. For data collection, the authors followed the recommendations from the COSMIN initiative. Study quality and risk of bias were assessed using the COSMIN Check List.

Expert Opinion: : 119 publications have been reviewed. The 45 assessment scales can be divided into specific scales for physical fatigue and specific scales for MS. The most popular tools are the Fatigue Severity Scale and the Modified Fatigue Impact Scale.
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http://dx.doi.org/10.1080/14737167.2021.1883430DOI Listing
January 2021

Is somatosensory temporal discrimination threshold a biomarker of disease progression in multiple sclerosis?

Clin Neurophysiol 2020 Dec 13;131(12):2935-2936. Epub 2020 Oct 13.

Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.

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http://dx.doi.org/10.1016/j.clinph.2020.09.012DOI Listing
December 2020

Is somatosensory temporal discrimination threshold a biomarker of disease progression in multiple sclerosis?

Clin Neurophysiol 2020 Dec 13;131(12):2935-2936. Epub 2020 Oct 13.

Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.

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http://dx.doi.org/10.1016/j.clinph.2020.09.012DOI Listing
December 2020

Early diagnosis of secondary progressive multiple sclerosis: focus on fluid and neurophysiological biomarkers.

J Neurol 2020 Jun 5. Epub 2020 Jun 5.

Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.

Background And Aims: Most patients with multiple sclerosis presenting with a relapsing-remitting disease course at diagnosis transition to secondary progressive multiple sclerosis (SPMS) 1-2 decades after onset. SPMS is characterized by predominant neurodegeneration and atrophy. These pathogenic hallmarks result in unsatisfactory treatment response in SPMS patients. Therefore, early diagnosis of SPMS is necessary for prompt treatment decisions. The aim of this review was to assess neurophysiological and fluid biomarkers that have the potential to monitor disease progression and support early SPMS diagnosis.

Methods: We performed a systematic review of studies that analyzed the role of neurophysiological techniques and fluid biomarkers in supporting SPMS diagnosis using the preferred reporting items for systematic reviews and meta-analyses statement.

Results: From our initial search, we selected 24 relevant articles on neurophysiological biomarkers and 55 articles on fluid biomarkers.

Conclusion: To date, no neurophysiological or fluid biomarker is sufficiently validated to support the early diagnosis of SPMS. Neurophysiological measurements, including short interval intracortical inhibition and somatosensory temporal discrimination threshold, and the neurofilament light chain fluid biomarker seem to be the most promising. Cross-sectional studies on an adequate number of patients followed by longitudinal studies are needed to confirm the diagnostic and prognostic value of these biomarkers. A combination of neurophysiological and fluid biomarkers may be more sensitive in detecting SPMS conversion.
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http://dx.doi.org/10.1007/s00415-020-09964-4DOI Listing
June 2020

Botulinum Toxin Effects on Sensorimotor Integration in Focal Dystonias.

Toxins (Basel) 2020 04 25;12(5). Epub 2020 Apr 25.

IRCCS NEUROMED, Via Atinense, 18, 86077 Pozzilli (IS), Italy.

(1) Background: In dystonia, the somatosensory temporal discrimination threshold (STDT) is abnormally increased at rest and higher and longer-lasting during movement execution in comparison with healthy subjects (HS), suggesting an abnormal sensorimotor integration. These abnormalities are thought to depend on abnormal proprioceptive input coming from dystonic muscles. Since Botulinum toxin-A (BT-A) reduces proprioceptive input in the injected muscles, our study investigated the effects of BT-A on STDT tested at rest and during voluntary movement execution in patients with focal dystonia. (2) Methods: We enrolled 35 patients with focal dystonia: 14 patients with cervical dystonia (CD), 11 patients with blepharospasm (BSP), and 10 patients with focal hand dystonia (FHD); and 12 age-matched HS. STDT tested by delivering paired stimuli was measured in all subjects at rest and during index finger abductions. (3) Results: Patients with dystonia had higher STDT values at rest and during movement execution than HS. While BT-A did not modify STDT at rest, it reduced the abnormal values of STDT during movement in CD and FHD patients, but not in BSP patients. (4) Conclusions: BT-A improved abnormal sensorimotor integration in CD and FHD, most likely by decreasing the overflow of proprioceptive signaling from muscle dystonic activity to the thalamus.
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http://dx.doi.org/10.3390/toxins12050277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290883PMC
April 2020

Cortical M1 plasticity and metaplasticity in patients with multiple sclerosis.

Mult Scler Relat Disord 2020 Feb 5;38:101494. Epub 2019 Nov 5.

Department of Human Neurosciences, Sapienza, University of Rome, Viale dell' Università 30, 00185 Rome, Italy; IRCCS Neuromed, via Atinense 18, 86077 Pozzilli (IS), Italy. Electronic address:

Background: Previous studies on patients with Multiple Sclerosis (MS) have reported contrasting findings on cortical plasticity of the primary motor cortex and no study has yet evaluated the regulatory mechanisms of cortical plasticity (i.e., metaplasticity) in MS patients. The aim of the present study was to investigate primary motor cortex (M1) plasticity and metaplasticity in patients with MS.

Methods: Nineteen patients affected by Relapsing--Remitting MS (RR-MS) and 16 age- and sex-matched healthy controls underwent intermittent Theta Burst Stimulation (iTBS) to evaluate cortical plasticity and iTBS preceded by repetitive index finger movements to evaluate M1 metaplasticity.

Results: In healthy subjects MEP size significantly increased after iTBS whereas it significantly decreased when repetitive index finger movements preceded iTBS (metaplasticity) (factor PROTOCOL: p < 0.0001; PROTOCOL x TIME interaction: p = 0.001). Conversely, in MS patients MEP size mildly increased, albeit not significantly in both conditions (p > 0.05). In MS patients, percentage changes in MEP size induced by plasticity and metaplasticity protocol were significantly associated to EDSS (p = 0.001) and kinematics of index finger movements (p = 0.01).

Conclusion: M1 plasticity and metaplasticity are both altered in MS patients. When TBS is used for therapeutic purposes, TBS protocols should be tailored according to the M1 plasticity functional reserve of each MS patient.
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http://dx.doi.org/10.1016/j.msard.2019.101494DOI Listing
February 2020

Motor and non-motor symptoms in blepharospasm: clinical and pathophysiological implications.

J Neurol 2019 Nov 29;266(11):2780-2785. Epub 2019 Jul 29.

IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.

Introduction: Patients with blepharospasm in addition to involuntary contraction of the orbicularis oculi muscle also have non-motor symptoms (psychiatric, sleep, cognitive, and ocular). In this paper, we investigated the relationship of non-motor with motor symptoms and the total burden of non-motor symptoms in patients with blepharospasm. Results were compared with those of age- and sex-matched healthy controls.

Methods: We enrolled 60 patients with blepharospasm and 40 age-matched healthy controls. In all patients, the severity of blepharospasm was assessed clinically with the Blepharospasm Severity Rating Scale. All the participants underwent a psychiatric, sleep, cognitive, and ocular symptom evaluation. We investigated the correlations between motor, non-motor symptoms, and patients' clinical and demographic features.

Results: The frequency of psychiatric, sleep, and cognitive disorders and ocular symptoms was higher in blepharospasm patients than in healthy controls. Non-motor symptoms coexisted in the majority of patients and there was no correlation between non-motor and motor symptoms. The total burden of non-motor symptoms did not associate with motor symptoms and demographic features in blepharospasm.

Conclusions: Non-motor symptoms are independent of motor features and likely belong to the clinical spectrum of blepharospasm. The presence of non-motor symptoms possibly reflects a complex network disorder of blepharospasm.
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http://dx.doi.org/10.1007/s00415-019-09484-wDOI Listing
November 2019

Unravelling mechanisms of altered modulation of trigemino-facial circuits in blepharospasm.

Clin Neurophysiol 2019 09 9;130(9):1642-1643. Epub 2019 Jul 9.

Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.

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http://dx.doi.org/10.1016/j.clinph.2019.07.001DOI Listing
September 2019

Writing, reading, and speaking in blepharospasm.

J Neurol 2019 May 19;266(5):1136-1140. Epub 2019 Feb 19.

IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.

The aim of the study was to evaluate the effects of writing, reading, and speaking on orbiculari oculi (OO) muscle spasms and on the blink rate in patients with blepharospasm (BSP). Patients with hemifacial spasm (HFS) and healthy subjects (HS) acted as control subjects. Thirty patients with BSP, 20 patients with primary HFS and 20 age-matched healthy subjects were videotaped according to a standardized procedure: at rest with eyes open; while writing a standard sentence on paper; while writing a standard sentence on a blackboard keeping the head straight; during a conversation based on a simple topic (speaking task); and while reading a standard text aloud. Two independent movement disorders specialists reviewed the videotapes and measured the number of OO spasms and blinks in each segment. Writing and reading reduced the number of OO spasms in BSP patients, whereas speaking did not. On the other hand, writing, reading, and speaking did not modify spasms in HFS patients. These tasks modulated the blink rate in all the three groups of subjects (BSP, HFS, and HS). Our hypothesis is that the modulation of OO spasm in BSP during writing and reading depends on influences coming from occipital areas onto the brainstem circuits. Whether cognitive training with reading and writing may be used to improve OO muscle spasms is an issue that warrants further investigation.
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http://dx.doi.org/10.1007/s00415-019-09243-xDOI Listing
May 2019

Abnormal Temporal Coupling of Tactile Perception and Motor Action in Parkinson's Disease.

Front Neurol 2017 6;8:249. Epub 2017 Jun 6.

Department of Neurology and Psychiatry, Sapienza University Rome, Rome, Italy.

Evidence shows altered somatosensory temporal discrimination threshold (STDT) in Parkinson's disease in comparison to normal subjects. In healthy subjects, movement execution modulates STDT values through mechanisms of sensory gating. We investigated whether STDT modulation during movement execution in patients with Parkinson's disease differs from that in healthy subjects. In 24 patients with Parkinson's disease and 20 healthy subjects, we tested STDT at baseline and during index finger abductions (at movement onset "0", 100, and 200 ms thereafter). We also recorded kinematic features of index finger abductions. Fifteen out of the 24 patients were also tested ON medication. In healthy subjects, STDT increased significantly at 0, 100, and 200 ms after movement onset, whereas in patients with Parkinson's disease in OFF therapy, it increased significantly at 0 and 100 ms but returned to baseline values at 200 ms. When patients were tested ON therapy, STDT during index finger abductions increased significantly, with a time course similar to that of healthy subjects. Differently from healthy subjects, in patients with Parkinson's disease, the mean velocity of the finger abductions decreased according to the time lapse between movement onset and the delivery of the paired electrical stimuli for testing somatosensory temporal discrimination. In conclusion, patients with Parkinson's disease show abnormalities in the temporal coupling between tactile information and motor outflow. Our study provides first evidence that altered temporal processing of sensory information play a role in the pathophysiology of motor symptoms in Parkinson's disease.
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http://dx.doi.org/10.3389/fneur.2017.00249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459880PMC
June 2017

Attention-related changes in short-term cortical plasticity help to explain fatigue in multiple sclerosis.

Mult Scler 2016 09 16;22(10):1359-66. Epub 2015 Dec 16.

IRCCS Neuromed Institute, Pozzilli, ItalyDepartment of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy

Background: In multiple sclerosis (MS), pathophysiology of fatigue is only partially known.

Objective: The aim of this study was to investigate whether the attention-induced modulation on short- and long-term cortical plasticity mechanisms in primary motor area (M1) is abnormal in patients with MS-related fatigue.

Methods: All participants underwent 5-Hz repetitive transcranial magnetic stimulation (rTMS), reflecting short-term plasticity, and paired associative stimulation (PAS), reflecting long-term plasticity, and were asked to focus their attention on the hand contralateral to the M1 stimulated. A group of age-matched healthy subjects acted as control.

Results: In patients with MS, 5-Hz rTMS and PAS failed to induce the normal increase in motor-evoked potential (MEP). During the attention-demanding condition, 5-Hz rTMS- and PAS-induced responses differed in patients with MS with and without fatigue. Whereas in patients with fatigue neither technique induced the attention-induced MEP increase, in patients without fatigue they both increased the MEP response, although they did so less efficiently than in healthy subjects. Attention-induced changes in short-term cortical plasticity inversely correlated with fatigue severity.

Conclusion: Short-term and long-term plasticity mechanisms are abnormal in MS possibly owing to widespread changes in ion-channel expression. Fatigue in MS reflects disrupted cortical attentional networks related to movement control.
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http://dx.doi.org/10.1177/1352458515619780DOI Listing
September 2016