Cristina Boccagni

Publications of Cristina Boccagni

• Patients in a vegetative state following traumatic brain injury display a reduced intracortical modulation.

  Authors: Sergio Bagnato, Cristina Boccagni, Antonino Sant'angelo, Caterina Prestandrea, Silvia Rizzo, Giuseppe Galardi

  Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 05/2012;

  OBJECTIVE: Patients in coma who fail to wake develop a condition known as a vegetative state (VS). While we know that some cortical activities exist in patients in VS, it remains unclear whetherOBJECTIVE: Patients in coma who fail to wake develop a condition known as a vegetative state (VS). While we know that some cortical activities exist in patients in VS, it remains unclear whether interneuronal modulation can be abnormal in the cerebral cortex of these patients. The aim of the study was to evaluate the inhibitory and excitatory interneuronal circuits in patients in VS following a traumatic brain injury. METHODS: Cortical excitability was studied in 5 VS patients and in 10 healthy subjects using paired pulses transcranial magnetic stimulation (TMS). Resting motor threshold and intracortical inhibition and facilitation at short intervals (2 and 10ms, respectively) were evaluated. Two patients were studied again after their level of consciousness transitioned into a minimally conscious state (MCS). RESULTS: Both intracortical inhibition and facilitation were significantly reduced in patients compared to healthy subjects (p<0.05). In addition, these results did not significantly change in the 2 patients who evolved into a MCS. CONCLUSIONS: This is the first report showing an abnormal cortical excitability in patients in VS. SIGNIFICANCE: Our findings suggest a pathophysiological base for future work aiming to restore the lack of interneuronal transmission in patients in VS.

• Reply to "EEG in Anoxic Coma".

  Authors: Cristina Boccagni, Sergio Bagnato, Antonino Santʼangelo, Caterina Prestandrea, Giuseppe Galardi

  Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 04/2012; 29(2):199-200.

• Neuromuscular involvement in vegetative and minimally conscious states following acute brain injury.

  Authors: Sergio Bagnato, Cristina Boccagni, Antonino Sant'angelo, Caterina Prestandrea, Marcello C Romano, Giuseppe Galardi

  Journal of the peripheral nervous system : JPNS. 12/2011; 16(4):315-21.

  The aim of this study was to evaluate the presence of neuromuscular involvement in patients in vegetative and minimally conscious states (VS, MCS) following acute brain injury. Twenty-two patientsThe aim of this study was to evaluate the presence of neuromuscular involvement in patients in vegetative and minimally conscious states (VS, MCS) following acute brain injury. Twenty-two patients (11 in VS, 11 in MCS) admitted to a rehabilitation department underwent nerve conduction, electromyography (EMG) for spontaneous activity and direct muscle stimulation (DMS). Twenty (90.9%) showed abnormal nerve conduction studies, 19 (86.4%) had spontaneous EMG activity, and 7 (31.8%) had abnormal DMS. The time spent in the intensive care unit correlated significantly with the amplitude of the compound muscle action potential of the ulnar nerve and with the amplitude of the sensory nerve action potential of the sural nerve (p < 0.05). No significant differences were found between patients in VS and MCS. Neurophysiological data indicative of neuromuscular involvement are common in patients in VS and MCS. This study underlines the need to implement strategies to prevent and to treat neuromuscular complications in patients in VS and MCS.

• EEG oscillatory states as neuro-phenomenology of consciousness as revealed from patients in vegetative and minimally conscious states.

  Authors: Alexander A Fingelkurts, Andrew A Fingelkurts, Sergio Bagnato, Cristina Boccagni, Giuseppe Galardi

  Consciousness and cognition. 11/2011; 21(1):149-69.

  The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEGThe value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG microstates in resting condition quantitatively related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects. Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical-legal decisions in patients with disorders of consciousness.

• Toward operational architectonics of consciousness: basic evidence from patients with severe cerebral injuries.

  Authors: Andrew A Fingelkurts, Alexander A Fingelkurts, Sergio Bagnato, Cristina Boccagni, Giuseppe Galardi

  Cognitive processing. 10/2011;

  Although several studies propose that the integrity of neuronal assemblies may underlie a phenomenon referred to as awareness, none of the known studies have explicitly investigated dynamics andAlthough several studies propose that the integrity of neuronal assemblies may underlie a phenomenon referred to as awareness, none of the known studies have explicitly investigated dynamics and functional interactions among neuronal assemblies as a function of consciousness expression. In order to address this question, EEG operational architectonics analysis (Fingelkurts and Fingelkurts 2001, 2008) was conducted in patients in minimally conscious (MCS) and vegetative states (VS) to study the dynamics of neuronal assemblies and operational synchrony among them as a function of consciousness expression. We found that in minimally conscious patients and especially in vegetative patients neuronal assemblies got smaller, their life span shortened and they became highly unstable. Furthermore, we demonstrated that the extent/volume and strength of operational synchrony among neuronal assemblies was smallest or even absent in VS patients, intermediate in MCS patients, and highest in healthy fully conscious subjects. All findings were similarly observed in EEG alpha as well as beta1 and beta2 frequency oscillations. The presented results support the basic tenets of operational architectonics theory of brain-mind functioning and suggest that EEG operational architectonics analysis may provide an objective and accurate means of assessing signs of (un)consciousness in patients with severe brain injuries. Therefore, this methodological approach may complement the existing "gold standard" of behavioral assessment of this population of challenging patients and inform the diagnostic and treatment decision-making processes.

• Usefulness of standard EEG in predicting the outcome of patients with disorders of consciousness after anoxic coma.

  Authors: Cristina Boccagni, Sergio Bagnato, Antonino Sant Angelo, Caterina Prestandrea, Giuseppe Galardi

  Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 09/2011; 28(5):489-92.

  Although standard EEG is performed routinely in patients with disorders of consciousness after coma, its prognostic value is still debated. The aim of the present study was to evaluate the role ofAlthough standard EEG is performed routinely in patients with disorders of consciousness after coma, its prognostic value is still debated. The aim of the present study was to evaluate the role of standard EEG in predicting the recovery of cognitive functioning in patients affected by severe disturbances of consciousness after coma caused by cerebral anoxia. A standard EEG was recorded at admission to our Rehabilitation Department in 15 patients experiencing impaired consciousness because of cerebral anoxia. We quantified EEG abnormalities using the Synek scale (1988). Cognitive functioning was measured with the levels of cognitive functioning scale at the time of admission and after 3 months of recovery. EEG scores were significantly correlated with both levels of cognitive functioning scores at admission (P = 0.004) and change in levels of cognitive functioning score after 3 months (P < 0.001). The first correlation confirms the relationship between EEG and cognitive functioning, while the second correlation indicates the prognostic value of EEG in cognitive outcome. In conclusion, standard EEG is a simple and readily available tool with significant prognostic value in patients with disorders of consciousness after coma caused by cerebral anoxia.

• Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.

  Authors: Alberto Castiglione, Sergio Bagnato, Cristina Boccagni, Marcello C Romano, Giuseppe Galardi

  Archives of physical medicine and rehabilitation. 07/2011; 92(7):1034-7.

  To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP). Pilot study with assessments before and after BTX-ATo evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP). Pilot study with assessments before and after BTX-A intra-articular injection. Hospital rehabilitation department. Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm. Intra-articular BTX-A injection. Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection. Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection. We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.

• Life or death: prognostic value of a resting EEG with regards to survival in patients in vegetative and minimally conscious States.

  Authors: Alexander A Fingelkurts, Andrew A Fingelkurts, Sergio Bagnato, Cristina Boccagni, Giuseppe Galardi

  PloS one. 01/2011; 6(10):e25967.

  To investigate the potentially prognostic value of a resting state electroencephalogram (EEG) with regards to the clinical outcome from vegetative and minimally conscious states (VS and MCS) in termsTo investigate the potentially prognostic value of a resting state electroencephalogram (EEG) with regards to the clinical outcome from vegetative and minimally conscious states (VS and MCS) in terms of survival six months after a brain injury. We quantified a dynamic repertoire of EEG oscillations in resting condition with eyes closed in patients in VS and MCS. The exact composition of EEG oscillations was assessed by analysing the probability-classification of short-term EEG spectral patterns. Results demonstrated that (a) the diversity and the variability of EEG for Non-Survivors were significantly lower than for Survivors; and (b) a higher probability of mostly delta and slow-theta oscillations occurring either alone or in combination were found during the first assessment for patients with a bad outcome (i.e., those who died) within six months of an injury compared to patients who survived. At the same time, patients with a good outcome (i.e., those who survived) after six months post-injury had a higher probability of mostly fast-theta and alpha oscillations occurring either alone or in combination during the first assessment when compared to patients who died within six months of an injury. Resting state EEGs properly analysed may have a potentially prognostic value with regards to the outcome from VS or MCS in terms of survival six months after a brain injury. This work may have implications for clinical care, rehabilitative programmes and medical-legal decisions for patients with impaired consciousness states after being in a coma due to acute brain injuries.

• Motor dysfunction of the "non-affected" lower limb: a kinematic comparative study between hemiparetic stroke and total knee prosthesized patients.

  Authors: Sergio Bagnato, Cristina Boccagni, Filippo Boniforti, Antonia Trinchera, Giovanni Guercio, Giulia Letizia, Giuseppe Galardi

  Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 03/2009;

  In patients with hemispheric stroke, abnormal motor performances are described also in the ipsilateral limbs. They may be due to a cortical reorganization in the unaffected hemisphere; moreover, alsoIn patients with hemispheric stroke, abnormal motor performances are described also in the ipsilateral limbs. They may be due to a cortical reorganization in the unaffected hemisphere; moreover, also peripheral mechanisms may play a role. To explore this hypothesis, we studied motor performances in 15 patients with hemispheric stroke and in 14 patients with total knee arthroplasty, which have a reduced motility in the prosthesized leg. Using the unaffected leg, they performed five superimposed circular trajectories in a prefixed pathway on a computerized footboard, while looking at a marker on the computer screen. The average trace error was significantly different between the groups of patients and healthy subjects [F ((2,25)) = 7.9; p = 0.003]; on the contrary, the test time execution did not vary significantly. In conclusion, both groups of patients showed abnormal motor performances of the unaffected leg; this result suggests a likely contribution of peripheral mechanisms.

• Motion analysis in cervical dystonia.

  Authors: Cristina Boccagni, Jacopo Carpaneto, Silvestro Micera, Sergio Bagnato, Giuseppe Galardi

  Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 12/2008;

  OBJECTIVE: To evaluate kinematic features in cervical dystonia (CD) patients by means of a motion analysis system (Fastrack-Polhemus, Colchester VT, USA). DESIGN: Small study sample. SETTING:OBJECTIVE: To evaluate kinematic features in cervical dystonia (CD) patients by means of a motion analysis system (Fastrack-Polhemus, Colchester VT, USA). DESIGN: Small study sample. SETTING: Ambulatory care. PATIENTS AND PARTICIPANTS: 15 CD patients and 10 healthy subjects. INTERVENTIONS: Not applicable. MEASUREMENTS AND RESULTS: Posture at rest and voluntary movements in both groups. Posture at rest in CD patients was impaired in all planes; only 20% of the patients exhibited complex dystonic patterns at clinical evaluation, whereas more than 90% of them had complex ones at kinematic evaluation. The analysis of voluntary motion revealed a reduced range of voluntary excursion and increased execution time; the impairment was higher when the patients moved their heads towards the anti-dystonic side. CONCLUSIONS: Fastrack system is a sensitive tool in kinematic evaluation of CD, as it provides useful quantitative information on rest position and on motion in CD patients and may consequently improve the management of this disease.

• Characterisation of the sympathetic skin response evoked by own-face recognition in healthy subjects.

  Authors: Sergio Bagnato, Cristina Boccagni, Caterina Prestandrea, Giuseppe Galardi

  Functional neurology. 25(2):93-102.

  The ability to recognise one's own face is crucial for self-identity formation and it plays a key role in the development of social interactions. Our starting hypothesis was that own-face recognitionThe ability to recognise one's own face is crucial for self-identity formation and it plays a key role in the development of social interactions. Our starting hypothesis was that own-face recognition may be a psychophysiological phenomenon capable of activating the vegetative system in a peculiar manner, via sympathetic pathways. To test this hypothesis we studied the sympathetic skin responses (SSRs) evoked in 18 healthy subjects by the image of their own faces and by six other different visual stimuli. The SSRs were enhanced when participants were shown their own faces. Both SSR area and SSR amplitude contributed to this phenomenon. This work may offer new insights into the psycho- physiological processes involved in own-face recognition; moreover, the SSR could be a useful tool for future studies of patients affected by neuropsychiatric disorders presenting impairment of own-face recognition or representation of self-identity.