Publications (194) View all
-
Article: Parry Romberg Syndrome associated with chronic facial pain.
[show abstract] [hide abstract]
ABSTRACT: Parry Romberg Syndrome (PRS) is a rare condition of unknown cause and pathophysiology. It is characterized by progressive facial hemiatrophy, and neurological abnormalities are found in 20% of cases. We describe a 50-year-old woman with PRS and severe neurological involvement (lateralised epileptic seizure activity and facial pain refractory to medication). Pain intensity and frequency was reduced and control of epileptic crises was improved using levetiracetam as an additional therapy. In previous published cases associated with facial pain, the most frequent diagnoses were migraine and trigeminal neuralgia. Our findings suggest that in this patient PRS-related persistent pain has peculiar features possibly attributed to the underlying musculoskeletal abnormalities.Journal of Clinical Neuroscience 03/2013; · 1.25 Impact Factor -
Article: The Cognitive Reserve Theory in the Setting of Pediatric-Onset Multiple Sclerosis
[show abstract] [hide abstract]
ABSTRACT: http://www.neurology.org/cgi/content/meeting_abstract/80/1_MeetingAbstracts/P02.115Neurology 02/2013; · 8.31 Impact Factor -
Article: Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS)The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS. METHODS: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis. RESULTS: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5+/-3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95%CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95%CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95%CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95%CI 1.2-3.3; p=0.005). CONCLUSIONS: Our findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.BMC Neurology 12/2012; 12(1):165. · 2.17 Impact Factor -
Article: Effects of early treatment with glatiramer acetate in patients with clinically isolated syndrome.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: The placebo-controlled phase of the PreCISe study showed that glatiramer acetate delayed onset of clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome and brain lesions on MRI. OBJECTIVE: To compare the effects of early versus delayed glatiramer acetate treatment in the open-label phase of PreCISe. METHODS: Patients with a clinically isolated syndrome suggestive of MS with unifocal manifestation and ≥2 T2-weighted brain lesions were randomized to receive glatiramer acetate 20 mg/d (early-treatment, n=198) or placebo (delayed-treatment, n=211) for 36 months or until conversion to CDMS, followed by open-label glatiramer acetate treatment for two years. RESULTS: Early glatiramer acetate treatment reduced CDMS conversion risk by 41% (hazard ratio 0.59, 95% confidence interval 0.44-0.80; p=0.0005) versus delayed-treatment, and was associated with a 972-day delay (185%) in conversion to CDMS, less brain atrophy (-28%, p=0.0209), fewer new T2 lesions/year (-42%, <0.0001) and lower T2 lesion volume (-22%, p=0.0005) versus delayed treatment. Adverse events were consistent with the established safety profile of glatiramer acetate. CONCLUSIONS: Effects of early glatiramer acetate treatment on the rate of conversion to CDMS and on MRI measures of disease activity and lesion burden support initiating glatiramer acetate treatment soon after the first clinical symptoms suggestive of MS and continuing treatment to sustain benefits.Multiple Sclerosis 12/2012; · 4.26 Impact Factor -
Article: Teaching Video NeuroImages: Speech-induced oromandibular dystonia relieved by singing.
[show abstract] [hide abstract]
ABSTRACT: We report a rare task-specific dystonia(1,2) in a 26-year-old man with a 4-year progressive speech disorder characterized by oromandibular spasms. Family and medical history were unremarkable; he was never exposed to neuroleptic drugs or toxic agents. Neurologic examination revealed only speech-induced oromandibular dystonic movements, characterized by forced jaw opening, interfering with speech (video on the Neurology(®) Web site at www.neurology.org). However, he was able to sing and to perform other voluntary activities (swallowing, drinking, chewing). Laboratory tests and brain magnetic resonance scans were normal. He received a placebo injection with no benefit. Trihexyphenidyl was started with moderate benefit. This rare form of dystonia is sometimes triggered by praying,(1,2) resembling task-specific occupational dystonias.Neurology 11/2012; 79(21):e184. · 8.31 Impact Factor
