G Comi

Università Vita-Salute San Raffaele, Milano, Lombardy, Italy

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Publications (603)2679.43 Total impact

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    ABSTRACT: Background and purposeThe Rio score (RS) and the modified Rio score (MRS) are two scoring systems that can identify the early predictive factors of disability progression in relapsing−remitting multiple sclerosis (RRMS) patients treated with interferon-β (IFN-β). The objective of the study was to validate the usefulness of the RS and MRS in a large cohort of multiple sclerosis patients treated with IFN-β in daily clinical practice.Methods The analysis included a cohort of RRMS patients treated with different formulations of IFN-β for at least 1 year. The RS and MRS were used to classify the patients after 1 year of treatment. Multivariate analysis was performed to identify predictive variables of suboptimal response at 5 years, defined as Expanded Disability Status Scale confirmed progression or switching to a second-line therapy.ResultsSixty-nine of 416 included patients were considered as suboptimal responders at 5-year evaluation. The possible score range was 0–3. A higher risk of suboptimal response was found for RS and MRS in the presence of ≥2 scores (hazard ratio 3.0, P = 0.002, and hazard ratio 5.0, P < 0.0001, respectively).Conclusions Our study confirmed, in a daily clinical setting, that MRS had a better specificity and accuracy than RS in identifying the patients who will have a poor response to long-term IFN-β treatment.
    European Journal of Neurology 04/2015; DOI:10.1111/ene.12695 · 3.85 Impact Factor
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    ABSTRACT: To better characterize brain circuits dysfunctions in normoacousic tinnitus sufferers. 17 normoacousic chronic, unilateral high-pitched tinnitus sufferers (6 females, 43.6±9.8y.o, disease duration 22±35months) underwent a 29-channel resting-state electroencephalography (EEG - 5min opened-eyes, 5min closed-eyes) and auditory oddball paradigm for event-related potentials analyses (ERPs - N1, P2 and P300). Cortical 3D distribution of current source density was computed with sLORETA. Results were compared with 17 controls (9 females, 45.7±15.1y.o). Eyes opened, tinnitus sufferers had lower alpha and beta sources in the left inferior parietal lobule. Eyes closed, tinnitus sufferers had decreased alpha sources in the left inferior temporal and post-central gyri, and low gamma sources in the left middle temporal gyrus. EEG data did not correlate with tinnitus sufferers' clinical features. Subjects with tinnitus had shorter N1 and P2 latencies. P300 did not differ between groups. sLORETA solutions showed decreased sources of these ERPs in the left inferior temporal gyrus in the tinnitus group. We showed cortico-thalamo-cortical involvements in normoacousic tinnitus with hyperexcitability of the left auditory cortex and inferior temporal gyrus. This might reflect processes of maladaptive cortical plasticity and memory consolidation. Further validation is needed to establish the value of this tool in customizing therapeutic approach. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 02/2015; DOI:10.1016/j.clinph.2015.01.027 · 2.98 Impact Factor
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    ABSTRACT: We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort. Thirty-three centres provided serum samples from 1047 CIS cases with at least two years' follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS. At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71-2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52-2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04-3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98-0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres. We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation. © The Author(s), 2015.
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    ABSTRACT: Background and purposeActive engagement in intellectually enriching activities (e.g. reading, hobbies) builds ‘reserve’ against memory decline in elders and persons with multiple sclerosis (MS), but the neural basis for this protective influence of enrichment is unknown. Herein the neuroanatomical basis of reserve against memory decline in MS patients is investigated.Methods Relapse-onset MS patients (N = 187) underwent 3.0 T magnetic resonance imaging of the brain to quantify T2 lesion volume (T2LV) and normalized volumes of total brain, total white, total grey (using SIENAX) and thalamus, caudate, putamen, pallidum, amygdala and hippocampus (using FIRST). Patients completed a survey quantifying their engagement in early life intellectual enrichment (i.e. reading, hobbies). Verbal and visuospatial episodic memory was assessed with neuropsychological tasks in a representative subsample (N = 97).ResultsControlling for demographics and T2LV, intellectual enrichment was specifically linked to larger normalized hippocampal volume (rp = 0.213, P = 0.004), with no link to other brain volumes/structures. Moreover, greater intellectual enrichment moderated/attenuated the negative relationship between normalized total brain volume (i.e. overall cerebral atrophy) and normalized hippocampal volume (i.e. hippocampal atrophy; P = 0.001) whereby patients who engaged in more early life intellectual enrichment better maintained hippocampal volume in the face of worse overall cerebral atrophy. Finally, the link between greater intellectual enrichment and better memory was partially mediated through larger hippocampal volume.Conclusions These findings support larger hippocampal volume as one key component of the neuroanatomical basis of reserve against memory decline in MS. These findings are consistent with previous literature on experience-dependent neuroplasticity within the hippocampus.
    European Journal of Neurology 02/2015; DOI:10.1111/ene.12662 · 3.85 Impact Factor
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    ABSTRACT: The role of genetic factors in influencing the clinical expression of multiple sclerosis (MS) is unclear. The objective of this paper is to identify genes, pathways and networks implicated in age at onset (AAO) and severity, measured using the Multiple Sclerosis Severity Score (MSSS), of primary-progressive MS (PPMS). We conducted a genome-wide association study (GWAS) of 470 PPMS patients of Italian origin:. Allelic association of 296,589 SNPs with AAO and MSSS was calculated. Pathway and network analyses were also conducted using different tools. No single association signal exceeded genome-wide significance in AAO and MSSS analyses. Nominally associated genes to AAO and MSSS were enriched in both traits for 10 pathways, including: "oxidative phosphorylation" (FDRAAO=9*10(-4); FDRMSSS=3.0*10(-2)), "citrate (TCA) cycle" (FDRAAO=1.6*10(-2); FDRMSSS=3.2*10(-3)), and "B cell receptor signaling" (FDRAAO=3.1*10(-2); FDRMSSS=2.2*10(-3)). In addition, an enrichment of "chemokine signaling pathway" (FDR=9*10(-4)) for AAO and of "leukocyte transendothelial migration" (FDR=2.4*10(-3)) for MSSS trait was observed, among others. Network analysis revealed that p53 and CREB1 were central hubs for AAO and MSSS traits, respectively. Despite the fact that no major effect signals emerged in the present GWAS, our data suggest that genetic variants acting in the context of oxidative stress and immune dysfunction could modulate the onset and severity of PPMS. © The Author(s), 2015.
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    ABSTRACT: IntroductionHigh levels of autoantibodies directed against glutamic acid decarboxylase (GAD) are associated with stiff-person syndrome (SPS). However, other neurological syndromes have been described in association with anti-GAD antibodies, defining a novel group of syndromes, collectively named “hyperexcitability disorders”. Here, we describe a patient complaining for acute onset of involuntary jerk movements in his legs, associated with pathologically increased level of anti-GAD antibodies.Case reportA 62-year-old man presented with a 4-day history of progressive involuntary jerk movements in his legs with unsteadiness during walking. He denied other focal neurologic or systemic symptoms.He had a medical history of arterial hypertension, diabetes mellitus under insulin treatment, and mild renal impairment. He also referred balance disorder for 2 years, without vestibular impairment, (as evaluated by the otolaryngologist), and a single episode of trunk stiffening lasted 1 month, about ...
    Neurological Sciences 01/2015; 36(4). DOI:10.1007/s10072-014-2058-0 · 1.50 Impact Factor
  • The Journal of Headache and Pain 09/2014; 15(Suppl 1):E18-E18. DOI:10.1186/1129-2377-15-S1-E18 · 3.28 Impact Factor
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    ABSTRACT: Background: RPC1063 is an oral, selective sphingosine 1-phosphate 1 receptor modulator in clinical development for the treatment of relapsing multiple sclerosis (RMS). Objectives: Demonstrate the superior efficacy of low (LD, 0.5 mg) and high (HD, 1.0 mg) dose RPC1063 vs. placebo (PBO), and characterize the safety of RPC1063 in patients with RMS. Methods: RADIANCE is an international, combined Phase 2/3 trial. In the 24-week, Phase 2 portion, 258 patients were randomized (1:1:1) to PBO (n=88), LD (n=87) or HD (n=83). The primary endpoint was the cumulative number of total gadolinium-enhancing (GdE) lesions on MRI at Wks 12, 16, 20 and 24. Key secondary endpoints included number of GdE lesions at Wk 24, cumulative number of new/enlarging T2 lesions from Wks 12-24, and annualized relapse rate (ARR). Safety was assessed using vital signs, labs, ECG, Holter monitoring, PFT, OCT and adverse events (AEs). Patients were titrated to their assigned dose over one week to mitigate first dose heart rate effects. Results: 98% of patients completed the trial. Cumulative total Wk 12-24 GdE lesions was reduced 86% in both RPC1063 arms vs. PBO (mean ± SD: PBO 11.1 ± 29.9, LD 1.5 ± 3.7, HD 1.5 ± 3.4, both p< 0.0001). Numbers of GdE lesions at Wk 24 were significantly reduced 91 and 94% (PBO 3.2 ± 9.8, LD 0.3 ± 0.9, HD 0.2 ± 0.6, both p< 0.0001) and cumulative Wks 12-24 new/enlarging T2 lesions 84 and 91% (PBO 9.0 ± 20.9, LD 1.4 ± 3.2, HD 0.8 ± 1.9, both p< 0.0001). A favorable trend in ARR reduction was observed vs. PBO (LD: 31%, p=0.27; HD: 53%, p=0.053). The AE profiles were comparable between groups. The most common AEs in combined RPC1063 vs. PBO were nasopharyngitis (9.4 vs 13.6%), headache (4.7 vs 9.1%), and urinary tract infection (4.7 vs 2.3%). During the first 6 hours post first dose of RPC1063, maximum reductions in mean hourly heart rate were < 2 bpm from baseline and no patient had a minimum hourly heart rate < 45 bpm. No notable cardiac, pulmonary, ophthalmologic or malignancy AEs were observed. Transient alanine aminotransferase ≥3x upper limit of normal occurred in 3 patients (LD 2 (2.3%), HD 1 (1.2%)) that decreased with continued treatment. Conclusions: Both doses of RPC1063 demonstrated large, significant and consistent reductions of all MRI measures of MS disease activity. The tolerability and safety results suggest a favorable risk-benefit profile of RPC1063 in the treatment of RMS. These results support the ongoing Phase 3 portion of the RADIANCE trial of RPC1063 vs. interferon beta-1a in RMS (NCT02047734).
    ACTRIMS-ECTRIMS MSBoston 2014; 09/2014
  • Clinical Neurophysiology 06/2014; 125:S145. DOI:10.1016/S1388-2457(14)50476-2 · 2.98 Impact Factor
  • Clinical Neurophysiology 06/2014; 125:S131. DOI:10.1016/S1388-2457(14)50429-4 · 2.98 Impact Factor
  • Clinical Neurophysiology 06/2014; 125:S202. DOI:10.1016/S1388-2457(14)50662-1 · 2.98 Impact Factor
  • Clinical Neurophysiology 06/2014; 125:S204. DOI:10.1016/S1388-2457(14)50667-0 · 2.98 Impact Factor
  • Clinical Neurophysiology 06/2014; 125:S131-S132. DOI:10.1016/S1388-2457(14)50430-0 · 2.98 Impact Factor
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    ABSTRACT: Introduction: To assess abnormalities of fMRI activity during a sustained attention task in pediatric patients with traumatic brain injury (TBI). Methods: FMRI scans were acquired from 22 pediatric TBI patients (mean age=14.3 years; mean time from TBI=1.96 years) and 7 healthy controls (mean age=10.8 years) during the administration of the Conners’ CPT. Patients underwent the Wechsler Intelligence Scale for Children (WISC-IV) and the Functional Independence Measure (FIM) evaluation. Results: In both groups, significant activations during the different conditions of the CPT task were found in the right somatosensory cortex, supplementary motor area, middle cingulate cortex, inferior frontal gyrus (pars opercularis) and left cerebellum. With increasing task difficulty (“load effect”) both groups had increased fMRI activity in the bilateral middle occipital gyrus. During this condition, compared to TBI patients, controls also had an increased recruitment of the middle occipital gyrus as well as temporal and parietal regions. Patients having better performances at the CPT, better scores at WISC-IV and FIM scales and a longer time from TBI showed a reduced activity of the anterior cingulate cortex, superior frontal and middle frontal gyri during the CPT task. Patients having better scores at WISC-IV and a longer time from TBI showed also higher activity of frontal and temporal regions during the “load” condition. Conclusions: Pediatric TBI patients experience an inability to optimize the recruitment of the attentional network, which might contribute to explain the attentional deficits frequently observed in this condition.
    EUROPEAN JOURNAL OF NEUROLOGY, Meeting Abstract: OS1229; 05/2014
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    ABSTRACT: The use of complementary alternative medicine (CAM) in paediatric populations is considerably increased, especially for pain and chronic conditions, as demonstrated by epidemiological surveys both in Europe and in the USA. In our study, CAM was used in 76 % patients of a cohort of 124 children affected by headache (age 4-16 years; 67 % female; 70 % migraine without aura, 12 % migraine with aura, 18 % tensive headache according to IHS criteria) consecutively recruited at a Pediatric Headache University Center. CAM was used as preventive treatment in 80 % cases. The main reasons for seeking CAM were: the wish of avoiding chronic use of drugs with their related side effects, the desire of an integrated approach, the reported inefficacy of conventional medicine, and a more suitable children disposition to CAM than to pharmacological compound. Female gender, younger age, migraine without aura, parents' higher educational status, maternal use of CAM and other associated chronic conditions, correlated with CAM use (p < 0.05). 73 % patients chose CAM also to treat other diseases (i.e. allergies, colitis, asthma, insomnia, muscle-scheletric disorders and dysmenorrhoea). The most assumed CAM were: herbal remedies (64 %) such as Valeriana, Ginkgo biloba, Boswellia serrata, Vitex agnus-castus, passion flower, Linden tree; vitamins/minerals supplements (40 %) with magnesium, 5-Hydroxytryptophan, vitamin B6 or B12, Multivitamin compounds; Homeopathy (47 %) with Silicea, Ignatia Amara, Pulsatilla, Aconitum, Nux Vomica, Calcarea phosphorica; physical treatment (45 %) such as Ayurvedic massage, shiatsu, osteopathy; yoga (33 %); acupuncture (11 %). CAM-often integrated with conventional care-was auto-prescribed in 30 % of the cases, suggested by non-physician in 22 %, by the General Practitioner in 24 % and by paediatrician in 24 %. Both general practitioners and neurologists were mostly unaware of their patients' CAM use. In conclusion, neurologists should inquire for CAM use and be prepared to learn about CAM therapies or to directly interact with CAM trained experts, in order to coordinate an integrative approach to health, as especially required in paediatric headache patients and their parents. Further studies are required to investigate safety and efficacy of CAM in pediatric headache, as a possible side-medicine to conventional pharmacological approach.
    Neurological Sciences 05/2014; 35 Suppl 1(S1):145-8. DOI:10.1007/s10072-014-1756-y · 1.50 Impact Factor
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    ABSTRACT: Introduction: We applied DT MRI to analyze damage to the supra- and infra-tentorial districts in pediatric patients with vegetative state (VS) or minimally conscious state (MCS) and their correlations with clinical scales of disease severity. Methods: Seven pediatric patients in a VS and six in a MCS, suffering from severe acquired brain injury due to non-traumatic origin and 10 pediatric healthy controls underwent a DT MRI scan and patients were assessed using the Glasgow Coma Scale and Disability Rating Scale. We obtained fractional anisotropy (FA), mean (MD), axial (AD) and radial diffusivities (RD) from the corpus callosum (CC), inferior (ICP), middle (MCP), and superior (SCP) cerebellar peduncles. Results: Compared to controls, patients had lower FA of the CC and SCP, and higher MD, AD and RD of the CC and cerebellar peduncles. Compared to acute patients, those in the chronic stage had lower FA and higher MD, AD and RD of the anterior part of the MCP. Differences of FA, MD and RD between supra- vs. infra- tentorial compartments differentiated patients from controls. Furthermore, the difference of FA between supra- vs. infra- tentorial compartments distinguished VS from MCS patients (p<0.01). Significant correlations were found between DT MRI indexes and clinical scales (r ranging from -0.77 to 0.73). Conclusions: In pediatric patients with VS/MCS due to non-traumatic origin, the severity of clinical disability correlates with structural damage to both infratentorial and the long-range cortico-cortical tracts, suggesting that global, rather than focal damage, contributes to the clinical severity of these patients.
    EUROPEAN JOURNAL OF NEUROLOGY, EP2124; 05/2014
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    ABSTRACT: Using diffusion tensor magnetic resonance imaging (DT MRI), we analyzed the architectural integrity of the brain white matter (WM) from a large cohort of MS patients to identify the structural substrates of the concomitant presence of depression and fatigue. Brain dual-echo, 3D T1-weighted and DT MRI scans were acquired from 147 MS patients and 90 gender- and age-matched healthy controls (HCs). Patients were stratified by the presence of depression (92 depressed (D), 55 not depressed (nD)) and fatigue (81 fatigued (F), 66 not fatigued (nF)). Sixty-five patients had co-occurrence of depression and fatigue (DF). Whole-brain voxel-wise comparisons of WM DT MRI abnormalities were performed using tract-based-spatial-statistics (TBSS). Tract-specific analyses were run in brain WM tracts using standard-space templates. Whole-brain voxel-wise analysis yielded no significant differences between patient subgroups. At tract-specific analysis, DF patients had reduced fractional anisotropy (FA) of the forceps minor. Reduced FA of the right anterior thalamic radiation and right uncinate fasciculus was found in F-MS vs not F-MS patients after correcting for depression. No significant differences were found between D vs not D-MS patients, after correcting for fatigue. This study provides evidence for partially overlapping damage to frontal and fronto-temporal pathways underlying depression and fatigue in MS.
    Multiple Sclerosis 04/2014; 20(12). DOI:10.1177/1352458514530022 · 4.86 Impact Factor
  • Neurological Sciences 03/2014; 35(8). DOI:10.1007/s10072-014-1721-9 · 1.50 Impact Factor
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    ABSTRACT: BACKGROUND: Teriflunomide is an oral disease-modifying therapy approved for treatment of relapsing or relapsing-remitting multiple sclerosis. We aimed to provide further evidence for the safety and efficacy of teriflunomide in patients with relapsing multiple sclerosis. METHODS: This international, randomised, double-blind, placebo-controlled, phase 3 study enrolled adults aged 18-55 years with relapsing multiple sclerosis, one or more relapse in the previous 12 months or two or more in the previous 24 months but no relapse in the previous 30 days, and an Expanded Disability Status Scale (EDSS) score of 5.5 points or less. Patients were recruited from 189 sites in 26 countries and randomly assigned (1:1:1) to once-daily placebo, teriflunomide 7 mg, or teriflunomide 14 mg via an interactive voice recognition system. Treatment duration was variable, ending 48 weeks after the last patient was included. The primary endpoint was annualised relapse rate (number of relapses per patient-year) and the key secondary endpoint was time to sustained accumulation of disability (an EDSS score increase of at least 1 EDSS point sustained for a minimum of 12 weeks), both analysed in the modified intention-to-treat population (all patients who received at least one dose of assigned study medication). This study is registered with ClinicalTrials.gov, number NCT00751881. FINDINGS: Between Sept 17, 2008, and Feb 17, 2011, 1169 patients were randomly assigned to a treatment group, of whom 388, 407, and 370 patients received at least one dose of placebo, teriflunomide 7 mg, or teriflunomide 14 mg, respectively. By the end of the study, the annualised relapse rate was higher in patients assigned to placebo (0.50 [95% CI 0.43-0.58]) than in those assigned to teriflunomide 14 mg (0.32 [0.27-0.38]; p=0.0001) or teriflunomide 7 mg (0.39 [0.33-0.46]; p=0.0183). Compared with placebo, teriflunomide 14 mg reduced the risk of sustained accumulation of disability (hazard ratio [HR] 0.68 [95% CI 0.47-1.00]; log-rank p=0.0442); however, teriflunomide 7 mg had no effect on sustained accumulation of disability (HR 0.95 [0.68-1.35]; log-rank p=0.7620). The most common adverse events were alanine aminotransferase increases (32 [8%] of 385 patients in the placebo group vs 46 [11%] of 409 patients in the teriflunomide 7 mg group vs 52 [14%] of 371 patients in the teriflunomide 14 mg group), hair thinning (17 [4%] vs 42 [10%] vs 50 [13%]), and headache (42 [11%] vs 60 [15%] vs 46 [12%]). Incidence of serious adverse events was similar in all treatment groups (47 [12%] vs 52 [13%] vs 44 [12%]). Four deaths occurred, none of which was considered to be related to study drug (respiratory infection in the placebo group, traffic accident in the teriflunomide 7 mg group, and suicide and septicaemia due to Gram-negative infection complicated by disseminated intravascular coagulopathy in the teriflunomide 14 mg group). INTERPRETATION: Teriflunomide 14 mg was associated with a lower relapse rate and less disability accumulation compared with placebo, with a similar safety and tolerability profile to that reported in previous studies. These results confirm the dose effect reported in previous trials and support the use of teriflunomide 14 mg in patients with relapsing multiple sclerosis.
    The Lancet Neurology 03/2014; 13(3):247-256. DOI:10.1016/S1474-4422(13)70308-9. · 21.82 Impact Factor

Publication Stats

14k Citations
2,679.43 Total Impact Points

Institutions

  • 2002–2015
    • Università Vita-Salute San Raffaele
      • Faculty of Psychology
      Milano, Lombardy, Italy
  • 1995–2015
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
  • 2014
    • Università Telematica San Raffaele
      Milano, Lombardy, Italy
  • 2013
    • Università degli Studi di Torino
      Torino, Piedmont, Italy
  • 1985–2012
    • University of Milan
      • Department of Neurological Sciences
      Milano, Lombardy, Italy
  • 2011
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      • Dipartimento di Neurologia
      Milano, Lombardy, Italy
    • Catholic University of the Sacred Heart
      • Institute of Human Physiology
      Milano, Lombardy, Italy
    • Medical University of Vienna
      • Department of Neurology
      Wien, Vienna, Austria
  • 2009
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      Milano, Lombardy, Italy
  • 2007
    • Università degli Studi di Genova
      Genova, Liguria, Italy
  • 2006
    • University of Ferrara
      Ferrare, Emilia-Romagna, Italy
    • Università degli Studi di Brescia
      Brescia, Lombardy, Italy
  • 2005
    • NCI-Frederick
      Фредерик, Maryland, United States
    • CRO Centro di Riferimento Oncologico di Aviano
      Aviano, Friuli Venezia Giulia, Italy
  • 2004–2005
    • University of Florence
      Florens, Tuscany, Italy
  • 2001
    • Sapienza University of Rome
      Roma, Latium, Italy
    • INO - Istituto Nazionale di Ottica
      Florens, Tuscany, Italy
    • University of Texas Health Science Center at Houston
      • Department of Neurology
      Houston, Texas, United States
  • 2000
    • The University of Western Ontario
      London, Ontario, Canada
    • Spedali Civili di Brescia
      Brescia, Lombardy, Italy
  • 1989–2000
    • Politecnico di Milano
      • • Department of Bioengineering
      • • Department of Electronics, Information, and Bioengineering
      Milano, Lombardy, Italy
  • 1999
    • IRCCS Multimedica
      Milano, Lombardy, Italy
  • 1996
    • University of Helsinki
      Helsinki, Southern Finland Province, Finland
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      • Department of Neuroscience & Imaging
      Chieta, Abruzzo, Italy
  • 1992
    • Hospital of Saint Raphael
      New Haven, Connecticut, United States