Neurite orientation dispersion and density imaging (NODDI), a MRI multi-shell diffusion technique, has offered new insights for the study of microstructural changes in neurodegenerative diseases. Mainly, the present stud...Neurite orientation dispersion and density imaging (NODDI), a MRI multi-shell diffusion technique, has offered new insights for the study of microstructural changes in neurodegenerative diseases. Mainly, the present study aimed to determine the connection between NODDI-derived parameters and changes in white matter (WM) abnormalities at early stages of amyotrophic lateral sclerosis (ALS). Spinal cords from ALS mice (G93A-SOD1 mice) were scanned in a Bruker Avance III HD 17.6T magnet. Fluorescent axonal-tagged mice (YFP, G93A-SOD1 mice) were used for quantitative histological analysis. NODDI showed a decrease in intra-cellular volume fraction (-24%) and increases in orientation dispersion index (+35%) and isotropic volume fraction (+33%). In addition, histoathological results demonstrated a reductions in axonal area (-11%) and myelin content (-29%). A histological decrease in WM intra-axonal space (-71%) and an increase in the extra-axonal compartment (+22%) were also detected. Our studies demonstrate that NODDI may be a suitable technique for detecting presymptomatic spinal cord WM microstructural degeneration in ALS.
The ventral tegmental area (VTA) is a brain region recently shown to interfere with pain perception. According to previous studies, improvement of antioxidant defense mechanisms reduces pain. The aim of this study was to...The ventral tegmental area (VTA) is a brain region recently shown to interfere with pain perception. According to previous studies, improvement of antioxidant defense mechanisms reduces pain. The aim of this study was to show that lack of social interaction influences oxidative stress in the VTA and that this results in increased pain tolerance. In this study, 21 male Sprague-Dawley rats were randomly divided into 2 groups: paired and socially isolated (SI). After one week of acclimatization, the SI rats were isolated for 14 days and the other rats were paired for the same period. On day 15, pain tolerance was assessed through the tail flick test, and two days later the rats were investigated for anxiety in an elevated plus maze (EPM). Indices of oxidative stress (levels of malondialdehyde, glutathione, nitrite/nitrate and catalase activity in the VTA) were then studied in the animals. Malondialdehyde in the VTA was found to be reduced in the SI rats compared with the paired rats. Furthermore, catalase activity, glutathione and nitrite/nitrate levels in the VTA were increased in SI compared with paired rats. Pain tolerance on the tail flick test was increased in SI rats compared with paired rats, while anxiety, as assessed by EPM, was reduced in the SI rats compared with the paired rats. Improvement of antioxidant defense and reduction of oxidative stress in the VTA increases pain tolerance and reduces anxiety. In this sense, environmental conditions play an important role in pain control.
Dimitriou TD, Verykouki E, Papatriantafyllou J
… +3 more, Konsta A, Kazis D, Tsolaki M
Funct Neurol
· 2018 · PMID 30457967
Agitation/aggressive behaviour is a common behavioural and psychological symptom in people with dementia (PwD), occurring with a frequency of between 13-50.4% according to recent studies, and the rate increases as the se...Agitation/aggressive behaviour is a common behavioural and psychological symptom in people with dementia (PwD), occurring with a frequency of between 13-50.4% according to recent studies, and the rate increases as the severity of cognitive decline increases. The burden on caregivers is considerable. This trial is a randomized controlled crossover trial conducted in Greece. The following measures were used: the Mini-Mental State Examination, Addenbrooke's Cognitive Examination Revised, Geriatric Depression Scale, Functional Rating Scale for Symptoms in Dementia and Neuropsychiatric Inventory. According to the results the most effective nonpharmacological intervention for reducing agitation/aggressive behaviour in PwD was music therapy, followed by aromatherapy and massage, and finally physical exercise.
Rozin Kleiner AF, Cubillos DM, Pinto C
… +5 more, Salazar AP, Marchese RR, Barros RML, Galli M, Pagnussat AS
Funct Neurol
· 2018 · PMID 30457966
The required coefficient of friction (RCOF) is frequently reported in the literature as an indicator of slip propensity, a consequence of the collisional aspect of legged locomotion. Little is known about the RCOF in pat...The required coefficient of friction (RCOF) is frequently reported in the literature as an indicator of slip propensity, a consequence of the collisional aspect of legged locomotion. Little is known about the RCOF in pathological gait. Therefore, this study aimed to quantify the RCOF in subjects with Parkinson's disease (PD) and freezing of gait (FOG) during the OFF-pharma phase, and to investigate the interplay between RCOF parameters and ankle kinematic and kinetic gait variables. Fourteen subjects with PD and 14 healthy age-matched subjects were instructed to walk barefoot at self-selected speed over a force platform. The RCOF curve was obtained as the ratio between the tangential and vertical ground reaction forces. Then, the following discrete variables were identified: P1COF (the peak at the loading response phase), V1COF (the valley at midstance phase) and P2COF (the peak at push-off phase). Stepwise multiple regressions were applied to observe the influence of the gait speed and ankle kinematic and kinetic gait variables on RCOF variables. In subjects with PD and FOG the gait speed is a predictor of the RCOF in the loading response phase; plantarflexion and the plantarflexion moment are strong predictors of the RCOF in midstance; finally, push-off power is a predictor of RCOF increasing in the push-off phase. These results characterized the biomechanical strategies adopted by subjects with PD and FOG during gait in order to avoid falls.
Lupo A, Cinnera AM, Pucello A
… +7 more, Iosa M, Coiro P, Personeni S, Gimigliano F, Iolascon G, Paolucci S, Morone G
Funct Neurol
· 2018 · PMID 30457965
Stroke patients have reduced balance and postural control that limits their activities of daily living and participation in social life. Recently, many exergaming systems based on video-biofeedback have been developed fo...Stroke patients have reduced balance and postural control that limits their activities of daily living and participation in social life. Recently, many exergaming systems based on video-biofeedback have been developed for balance training in neurological conditions, however their efficacy remains to be proven. The aim of this study was to investigate the effects on balance skills and patient compliance of biofeedback training based on inertial measurement units and exergaming in subacute stroke. The enrolled subjects were randomized into two groups: subjects allocated to the experimental group performed 10 sessions of biofeedback balance training using inertial sensors, whereas subjects allocated to the control group performed 10 sessions of conventional balance training. All subjects were assessed at T0 (pre-treatment), T1 (posttreatment) and T2 (1-month follow-up). The Berg Balance Scale, Rivermead Mobility Index and modified Barthel Index were used to assess balance, mobility and global disability, respectively. To assess the severity of the stroke and its effects on the patient we used the National Institutes of Health Stroke Scale and the Canadian Neurological Scale. Finally, a static force platform evaluating stabilometric parameters was used to assess balance skills. Fifteen subjects with subacute stroke (4F; age 57.80 ± 13.7) completed the experimental protocol. The analysis showed a significant improvement in balance skills and in the overall clinical outcomes in the experimental group compared with the control group; the experimental group also showed better compliance with the training. The biofeedback system of the device used in this study probably enhances neuroplasticity mechanisms of postural and balance skills in subacute stroke patients.
Geroin C, Tamburin S, Pagano G
… +2 more, Gandolfi M, Tinazzi M
Funct Neurol
· 2018 · PMID 30457964
Drugs used for the treatment of chronic lumbosacral radicular pain (LRP) may have frequent adverse effects leading to medication withdrawal. The use of add-on nutraceuticals, which have no side effects, may therefore pla...Drugs used for the treatment of chronic lumbosacral radicular pain (LRP) may have frequent adverse effects leading to medication withdrawal. The use of add-on nutraceuticals, which have no side effects, may therefore play a role in LRP treatment. We performed a six-week, single-center, open label prospective uncontrolled clinical study to evaluate the effect of a nutraceutical combination (Noxiall®) used as an add-on therapy in patients with chronic LRP. Fifteen patients were treated with Noxiall® twice a day for 10 consecutive days, followed by once-daily administration up to the end of the six-week treatment. The participants were evaluated at two visits (before-after), when primary and secondary outcomes were assessed. We found a significant reduction in pain severity post-treatment, as assessed using a numerical rating scale (p= 0.03), and a significant reduction in painkiller intake (p=0.03). Nutraceuticals could be a complementary therapy for chronic LRP.
Baricich A, Cosenza L, Sandrini G
… +8 more, Paolucci S, Morone G, Santamato A, Cinone N, Peri E, Picelli A, Invernizzi M, Ferriero G
Funct Neurol
· 2018 · PMID 29984689
In the emerging scenario of patient-centered medicine, it is becoming increasingly important to involve patients in the management of chronic diseases. The rehabilitation field currently has no assessment tool for evalua...In the emerging scenario of patient-centered medicine, it is becoming increasingly important to involve patients in the management of chronic diseases. The rehabilitation field currently has no assessment tool for evaluating the functional impact of post-stroke spasticity on activities of daily living. The aim of this study was to identify a tool to fill this gap. The "Spasticity Questionnaire in Real Life" (SPQR) was administered, twice, to 39 patients with poststroke spasticity. Statistical analysis showed internal consistency and reliability of the questionnaire, with values greater than 0.96 and 0.76, respectively. These results show that the SPQR is a promising tool for evaluating the functional impact of post-stroke spasticity.
Lo Monaco MR, Laudisio A, Fusco D
… +6 more, Vetrano DL, Ricciardi D, Delle Donne V, Proietti F, Zuccalà G, Silveri MC
Funct Neurol
· 2018 · PMID 29984688
Experimental evidence suggests that motor imagery (MI) engages the same neural substrates supporting actual motor activities and is likely impaired when such substrates are damaged, as in Parkinson's disease (PD). MI int...Experimental evidence suggests that motor imagery (MI) engages the same neural substrates supporting actual motor activities and is likely impaired when such substrates are damaged, as in Parkinson's disease (PD). MI intuitively relies on visual imagery (VI), because mental simulations of physical movements depend on the visual retrieval of these movements. Although VI is generally considered a right hemispheric function, the hemispheric dominance of MI is still in dispute. Disparities in sidedness of motor disturbances are a distinctive feature of PD, and recent findings indicate that such disparities may similarly characterize cognition. Specifically, the deficits observed may depend upon which hemisphere is principally involved. Essentially, MI and VI are cognitive tasks subject to differential impairment and reflecting the prevalence of hemispheric impairment in PD. Motor imagery (assessed by the Vividness of Motor Imagery Questionnaire [VMIQ]) and VI (assessed by the Vividness of Visual Imagery Questionnaire [VVIQ] and Test of Visual Imagery Control [TVIC]) were examined in patients with asymmetric PD and in healthy elderly control subjects (HC group). VMIQ scores were similar in PD laterality subsets and the HC group, but VVIQ scores were significantly lower in both PD groups compared with the HC group. TVIC scores were significantly lower in the presence of left motor (right hemispheric) impairment and were predictive of left motor (right hemispheric) impairment. We suspect that MI is strongly reliant on VI and that language may mediate these two functions, to the extent that both are evoked through verbal stimuli. Working memory, both visual and verbal, is also involved in MI and VI tasks. Without due attention to laterality of symptoms, any training incorporating MI and VI may not deliver expected outcomes in the setting of asymmetric PD symptomatology.
Avesani R, Dambruoso F, Scandola M
… +6 more, Formisano R, De Tanti A, Ferro S, Smania N, Roncari L, Rossato E
Funct Neurol
· 2018 · PMID 29984687
Recent studies on recovery of consciousness of subjects in a vegetative state (VS) admitted to rehabilitation units have focused mainly on the identification of prognostic factors, whereas few studies have focused on out...Recent studies on recovery of consciousness of subjects in a vegetative state (VS) admitted to rehabilitation units have focused mainly on the identification of prognostic factors, whereas few studies have focused on outcome. The aim of this study was to compare demographic and clinical data and report functional outcome of patients in a VS due to severe acquired brain injury (ABI) of different aetiologies. The study was a retrospective multicentre cohort study and involved 492 patients in a VS due to traumatic (TBI) or non-traumatic (NTBI) severe ABI admitted to 29 Italian rehabilitation units. Demographic and clinical data recorded included age, gender, aetiology, Glasgow Coma Scale score; onset-to-admission interval; length of stay in the rehabilitation unit; the department from which they were referred; and the presence of percutaneous endoscopic gastrostomy or tracheostomy. Recovery of consciousness and disability were evaluated using a discharge Disability Rating Scale. At discharge, 53.11% patients had emerged from VS, with TBI subjects significantly more likely to recover consciousness than NTBI ones. Subjects with NTBI had a significantly worse prognosis than those with TBI, and within the NTBI group, subjects with a cerebrovascular aetiology had a better outcome than those with an anoxic aetiology. Among the patients who emerged from VS, 71.30% of TBI and 83.06% of NTBI subjects presented extremely severe disability. Only 37.93% of subjects affected by TBI and 17.44% of those affected by NTBI who presented extremely severe disability returned home after their rehabilitation stay. Even though almost a half of the patients emerged from VS, a large number of these subjects showed severe disability, often making it impossible for them to return home. This situation has a major impact on the healthcare system.
Saviola D, De Tanti A, Delsoldato S
… +3 more, Chiari M, Inzaghi MG, Baldari F
Funct Neurol
· 2018 · PMID 29984686
Safe resumption of driving after a severe acquired brain injury (sABI) is a strongly felt need because driving is related to recovery of independence and social-occupational re-integration. The aim of this prospective ob...Safe resumption of driving after a severe acquired brain injury (sABI) is a strongly felt need because driving is related to recovery of independence and social-occupational re-integration. The aim of this prospective observational cohort study was to determine whether epilepsy secondary to sABI is a significant factor for being declared fit to drive by the relevant government authorities in Italy. In the period 2006-2015 we recruited 187 patients with sABI, 30 of whom (16.4%) developed secondary epilepsy. The interval between the acute event and the first seizure varied widely (6-96 months), confirming the need for prolonged follow-up. With regard to the aetiology, traumatic brain injury (TBI) was associated with the highest risk of epilepsy: 66.7% of the 30 patients with epilepsy had TBI, as opposed to cerebrovascular disease or anoxic brain damage (33.3%). The percentage of patients who resumed driving was about the same in the epilepsy (80%) and non-epilepsy (81%) groups.
Hiraoka K, Kento Y, Kiya H
… +2 more, Nozaki Y, Hayashi T
Funct Neurol
· 2018 · PMID 29984685
This study looked for a direction-specific cortical response immediately after application of moving tactile stimuli in healthy female humans. Four pairs of stimulus electrodes were placed over the left index finger pulp...This study looked for a direction-specific cortical response immediately after application of moving tactile stimuli in healthy female humans. Four pairs of stimulus electrodes were placed over the left index finger pulp on the distal-proximal axis. Four times, once in every 40 ms interval, an electrical stimulus to the finger pulp was delivered through one of the four pairs of electrodes; each time the stimulus site changed in order to induce a sensation of tactile motion. The slope of the electroencephalographic trace, as recorded from electrodes placed over the CP, P4 and right hMT+/V5 in the period 150-200 ms after the onset of stimuli delivered in sequence from the distal to proximal site, was significantly different from that after stimuli delivered in sequence from the proximal to distal site. The cortical response immediately after the proximally-directed moving tactile stimuli was different from that after the distally-directed moving tactile stimuli in the hemisphere contralateral to the stimulus side.
Published studies have shown differences in types and underlying mechanisms of stroke between different regions of the world. There is a lack of published literature describing the characteristics of acute stroke in Saud...Published studies have shown differences in types and underlying mechanisms of stroke between different regions of the world. There is a lack of published literature describing the characteristics of acute stroke in Saudi Arabia. The aim of this study was to identify different types and associated risk factors among acute stroke patients in Saudi Arabia. In this descriptive study, records of 500 patients with acute stroke were included. Acute stroke was classified as ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis or subarachnoid hemorrhage. The TOAST classification was used to categorize ischemic stroke. Ischemic stroke was found to be the most common type (86.6%). The patients included comprised 326 (65.2%) males and 174 (34.8%) females. Small vessel occlusive disease was the most common etiology of ischemic stroke. The males had a lower mean age than the females (p=0.00). The results of our study are largely in agreement with published literature, although a few differences emerged which need to be verified through further prospective multicenter studies.
Hyperglycemia-associated chorea-ballism (HCB) is an infrequent neurological syndrome whose pathophysiology remains poorly understood. Positron emission tomography (PET) studies have offered valuable information regarding...Hyperglycemia-associated chorea-ballism (HCB) is an infrequent neurological syndrome whose pathophysiology remains poorly understood. Positron emission tomography (PET) studies have offered valuable information regarding regional glucose metabolism. The studies included were published between 1980-2017 and reported demographic, clinical, laboratory and imaging data from patients with HCB in whom a PET scan had been performed. Eleven patients were evaluated (women 82%, Asian origin 91%, mean age 71 years). The main findings were an increase in glucose metabolism at the contralateral motor cortex related to recent episodes of hemiballism-hemichorea in 2 patients, and an altered metabolism in the affected basal ganglia in all of them: decreased in 10 patients (91%) and increased in 1 (9%). However during the acute period the patients showed only an increased metabolism, or even no changes. Contrary to what has previously been suggested in a metabolic failure hypothesis, changes in glucose metabolism in the basal ganglia may not be a key factor in the pathogenesis of HCB, and may potentially be a direct result of histological changes such as cellular ischemia and gliosis related to HCB development.
Cluster headache (CH) is arguably the most severe pain condition that afflicts humans. The severity of the pain has earned it the nickname "suicide headache". Understanding how CH impacts on those who suffer from it is e...Cluster headache (CH) is arguably the most severe pain condition that afflicts humans. The severity of the pain has earned it the nickname "suicide headache". Understanding how CH impacts on those who suffer from it is essential, because this understanding creates empathy, which is so valuable to these patients. On the occasion of Cluster Headache Day 2017, we asked CH patients from different European countries to share their experiences, in order to help people to imagine what it means to live with the condition. Here, we look at some extracts from their stories. These CH patients' direct accounts provide an important illustration of the clinical features and consequences of the disease, helping to contextualise it and its psychological and social consequences. Reports of CH patients' first-person accounts might help to underline the physicians' role and responsibility with regard to the psychological and social consequences of this disease.
It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital...It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital platform was developed as a training tool. The platform has been active since 1 October 2014. It is readily accessible to doctors by free registration. Users have access to all the material available on the platform, which includes scientific articles, e-books, presentations and images. Users can share their own material and clinical cases directly. At the time of this study, the platform had 37 users. In the second year following its launch 316 files were downloaded and five discussions were started. These saw 22 contributions. Fifteen of the 37 members did not perform any action on the platform. In total, 74 files were uploaded in the second year of activity, but 90% of the contributions came from a very small group of users. There were no significant differences in use of the platform between members of the Italian Society for the Study of Headache and other specialists. Even though the platform appears to be an easily accessible, interactive and inexpensive instrument, the higher number of downloads than uploads suggests that it is used passively.