-
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 03/2012; 91(3):281-2; author reply 282-4. · 1.56 Impact Factor
-
European Journal of Neurology 01/2011; 18(6):e66-7. · 3.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients affected by carpal tunnel syndrome (CTS) often report finding themselves "dropping objects". This symptom is perceived as a severe and frustrating problem. We investigated the occurrence of "dropping objects" in a sample of 532 patients affected by CTS, studied with a multidimensional protocol (clinical, neurophysiological, and patient-oriented). To ensure that the definition of "dropping objects" was index of abnormality, we evaluated a control group interviewing 200 subjects. In order to evaluate if "dropping objects" was an index of more severe CTS impairment, we compared the severity measures between the patients with and without this condition. Severity of CTS multidimensionally assessed was significantly greater in patients with a history of dropped objects than those without. Moreover, "dropping objects" was more frequent in females, older patients, and in those patients with more functional impairment. The occurrence of "dropping objects" in CTS patients seems to be an index of CTS severity.
Neurological Sciences 03/2010; 31(4):437-9. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In carpal tunnel syndrome (CTS) distribution of paresthesias is related to the degree of the nerve impairment. To improve the clinical ability in detecting the damage severity, we have introduced the criteria "distribution of paresthesias" in a previous clinical scale: the historical-objective scale (Hi-Ob).
We evaluated 100 consecutive patients (40 bilateral CTS) to validate a five stages clinical scale: the Historical-objective-distribution based scale (Hi-Ob-Db). We compared the Hi-Ob-Db with a validated neurophysiological classification and with the Boston Carpal Tunnel Questionnaire (BCTQ). The BCTQ evaluates two domains, one assessing symptoms (SYMPT=patient-oriented symptom), and the other analysing "functional status" (FUNCT=patient-oriented function).
The positive correlation between the Hi-Ob-Db and neurophysiological findings (p<0.001, r:0.79) was stronger than correlation between the Hi-Ob and the neurophysiological classification (p<0.001, r:0.74). A linear correlation between the Hi-Ob-Db and the patient-oriented scores was observed, respectively FUNCT (p<0.003, r:0.38) and SYMPT (p<0.002, r:0.30).
The Hi-Ob-Db is a clinical scale which correlates with the neurophysiological impairment of the median nerve and with patient-oriented findings in patients with CTS.
The new scale may be useful in routine examination and for scientific purposes.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 02/2010; 121(7):1066-71. · 3.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Charcot-Marie-Tooth (CMT) disease is the most frequent inherited neuropathy, no therapies are available at the moment but clinical trials are ongoing. For that reason it is very important to know the natural history of the disease. We report the results of the natural history of clinical features and quality of life (QoL) in patients with CMT2. Twenty patients were enrolled. At recruitment and at follow-up (2 years), all patients underwent neurological evaluation, QoL and disability assessments. The study-end evaluation took place 20-28 months after the baseline evaluation. During the 2-year follow-up period, CMT2 patients showed a mild reduction of strength of distal muscles of upper limbs and proximal muscles of lower limbs, a worsening sensory function and a mild increase in walking disability. However, there was no relevant worsening of QoL, except for a mild deterioration of one mental health domain.
Neurological Sciences 12/2009; 31(2):175-8. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Multiple sclerosis (MS) is a T-cell autoimmune disease of the central nervous system (CNS). Predominance of women in autoimmune diseases suggests that sex hormones may play a role in disease susceptibility. A possible role for prolactin, a neuroendocrine peptide with powerful immunomodulatory properties, is suggested in MS. We describe the case of a 32-year-old man affected by relapsing-remitting MS who experienced the first MS clinical event during the development of a prolactin-secreting adenoma and the only two MS relapses during adenoma recurrence. Prolactin may have facilitated the inflammatory process and triggered MS clinical attacks, suggesting a role of prolactin in immunomodulation and therefore in autoimmune disease course.
Journal of Neuro-Oncology 12/2009; 98(3):407-9. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In seronegative myasthenia gravis repetitive nerve stimulation and single-fibre EMG have a crucial diagnostic value but they may be negative, particularly in repetitive nerve stimulation studies. We report the case of a 43-year-old patient with generalized seronegative myasthenia gravis with negative 3 Hz repetitive nerve stimulation at Erb's point and voluntary single-fibre EMG in the orbicularis oculi. We also performed 6 and 12 Hz repetitive nerve stimulation at Erb and stimulated single-fibre EMG in the extensor digitorum communis and our findings were pathological. Our data suggest that, for individual patients with an atypical picture characterised by dissociation between a severe clinical pattern and no definite neurophysiological findings on conventional tests, repetitive nerve stimulation with a stimulation rate higher than 3 Hz and/or stimulated single-fibre EMG with an increasing stimulation rate may be helpful.
Neuromuscular Disorders 10/2009; 19(12):825-7. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Oxidative stress seems to play a major role in the pathogenesis of neurodegeneration. In Parkinson's disease (PD) patients, the dopaminergic neurons are subjected to oxidative stress resulting from reduced levels of antioxidant defenses such as glutathione and high amount of intracellular iron. Levodopa (LD) is widely used for the symptomatic treatment of PD, but its role in oxidative damage control is still unclear. The aim of this study was to analyze the presence of DNA damage in peripheral blood lymphocytes (PBL) of PD patients, during a washout and a controlled LD dosage and to evaluate the oxidative damage fluctuation after LD intake. The standard and the Fpg-modified version of Comet assay were applied in analyzing DNA damage in PBL from blood samples of nine PD patients and nine matched controls. Due to the limited number of patients we cannot reach definite conclusions even if our data confirm the accumulation of DNA lesions in PD patients; these lesions decrease after LD intake.
Cell Biology and Toxicology 08/2009; 25(4):321-30. · 2.51 Impact Factor
-
Neurology 07/2009; 72(22):e115. · 8.31 Impact Factor
-
F Capone,
M Dileone,
P Profice,
F Pilato,
G Musumeci,
G Minicuci,
F Ranieri,
R Cadossi,
S Setti, P A Tonali,
V Di Lazzaro
[show abstract]
[hide abstract]
ABSTRACT: Behavioral and neurophysiological changes have been reported after exposure to extremely low frequency magnetic fields (ELF-MF) both in animals and in humans. The physiological bases of these effects are still poorly understood. In vitro studies analyzed the effect of ELF-MF applied in pulsed mode (PEMFs) on neuronal cultures showing an increase in excitatory neurotransmission. Using transcranial brain stimulation, we studied noninvasively the effect of PEMFs on several measures of cortical excitability in 22 healthy volunteers, in 14 of the subjects we also evaluated the effects of sham field exposure. After 45 min of PEMF exposure, intracortical facilitation produced by paired pulse brain stimulation was significantly enhanced with an increase of about 20%, while other parameters of cortical excitability remained unchanged. Sham field exposure produced no effects. The increase in paired-pulse facilitation, a physiological parameter related to cortical glutamatergic activity, suggests that PEMFs exposure may produce an enhancement in cortical excitatory neurotransmission. This study suggests that PEMFs may produce functional changes in human brain.
Acta Neurovegetativa 03/2009; 116(3):257-65. · 2.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The main objective of this study is to assess the course of peroneal mononeuropathy (PM). The study design includes Clinical and Prospective study. The setting involves neurophysiological Service. From November 2002 to January 2004, we enroled 69 consecutive patients and prospectively followed up 49 patients with multiple measurements. Comparison was made between follow-up and baseline values, and baseline factors were used to predict the PM evolution in multiple regression analysis. At follow-up, we observed a significant improvement of all clinical, neurophysiological and disability measurements, and physical aspects of quality of life (QoL). Greater muscle strength of tibialis anterior and higher conduction velocity of peroneal nerve at baseline were seen to be positive prognostic factors. A better evolution of mental aspects of QoL was observed in the subacute group and in younger patients, while a better physical evolution in QoL was observed in women. Rehabilitation is ambiguously associated with a better Deambulation Index but lower ratings in mental aspects of QoL. In conclusion, PM shows a positive spontaneous course and rehabilitation seems to help the recovery of deambulation. Further studies on the effects of conventional rehabilitation are needed.
Neurological Sciences 02/2009; 30(1):37-44. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The main objective of this study is to assess the course of peroneal mononeuropathy (PM). The study design includes Clinical
and Prospective study. The setting involves neurophysiological Service. From November 2002 to January 2004, we enroled 69
consecutive patients and prospectively followed up 49 patients with multiple measurements. Comparison was made between follow-up
and baseline values, and baseline factors were used to predict the PM evolution in multiple regression analysis. At follow-up,
we observed a significant improvement of all clinical, neurophysiological and disability measurements, and physical aspects
of quality of life (QoL). Greater muscle strength of tibialis anterior and higher conduction velocity of peroneal nerve at
baseline were seen to be positive prognostic factors. A better evolution of mental aspects of QoL was observed in the subacute
group and in younger patients, while a better physical evolution in QoL was observed in women. Rehabilitation is ambiguously
associated with a better Deambulation Index but lower ratings in mental aspects of QoL. In conclusion, PM shows a positive
spontaneous course and rehabilitation seems to help the recovery of deambulation. Further studies on the effects of conventional
rehabilitation are needed.
Neurological Sciences 01/2009; 30(1):37-44. · 1.32 Impact Factor
-
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 01/2009; 87(12):1053-4. · 1.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To characterize the progression of the cognitive involvement in patients affected by myotonic dystrophy type 1 (DM1) by a longitudinal neuropsychological follow-up study.
In a previous study we documented an ageing-related decline of frontal and temporal cognitive functions in juvenile/adult forms of DM1, irrespectively of the n(CTG) in leukocytes and the severity of muscle weakness. Here we present the results of a neuropsychological follow-up study performed in 34 out of 70 DM1 patients previously studied. Patients were divided into four groups according to their genotype (E1:50-150; E2:150-500; E3:500-1000; E4: >1000 CTG). The neuropsychological test battery included MMSE, memory, linguistic, level, praxis, attentional and frontal-executive tasks. Statistical analysis was performed by One way MANOVA with repeated measures analysis and by Wilcoxon match paired test.
The whole group of patients showed a significant deterioration in linguistic functions, together with a tendency towards decline in executive abilities, confirming a predominant involvement of cognitive functions subserved by fronto-temporal areas. We found no significant correlation between the progression of cognitive decline and the n(CTG) in leukocytes. Moreover, we observed that patients belonging to E2 group, with the highest mean age, got scores lower than E3 patients, with particular regard both to linguistic and executive tasks.
These data support our previous hypothesis that the cognitive damage is confined to frontotemporal functions in adult DM1 patients, with a tendency towards a decline with aging.
Journal of Neurology 10/2008; 255(11):1737-42. · 3.47 Impact Factor
-
Journal of Neurology 08/2008; 255(9):1429-31. · 3.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess which are the clinical examination tests that are more related to quality of life (QoL), depression, and disability in CMT patients.
Large prospective multicenter study through the use of validated clinical, disability, and QoL measurements. Correlations between clinical pattern and disability/QoL and depression were studied.
Departments of Neurology.
211 CMT patients (60% females, mean age 42.5 years).
None.
Sensory function was related to both mental and physical aspects of patient's QoL. Ability to walk on toes and heels was related to physical aspects of QoL/disability but also to bodily pain. Strength of forearm/hand intrinsic muscles was related to disability and physical aspects of QoL.
Some clinical tests may be better outcome measures than others because they are related to aspects of life highly relevant to the patients. This information may be useful in clinical practice and in clinical trials to infer the patient's QoL.
Neurological Sciences 07/2008; 29(3):157-62. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Motor conduction velocity may yield false-negative results in mild ulnar nerve entrapment at elbow (UNE). There is evidence that the clinical heterogeneity of UNE may be due to the different involvement of fascicles. We hypothesized that, if fibres to FDI are more damaged than fibres to ADM, a relative slowing of motor conduction velocity (CV) at the segment across the elbow recording from FDI (FDI-CV) versus CV at the same segment recording from ADM (ADM-CV) would occur.
We calculated the ratio between FDI-CV and ADM-CV (IN-RATIO) in 60 consecutive UNE patients, 40 norms, and 16 patients with lower cervical radiculopathy. The UNE sample consisted of (1) patients with neurophysiological evidence (UNE NF+), (2) patients without neurophysiological evidence (UNE NF-). We evaluated the possible usefulness of the IN-RATIO to increase sensitivity in diagnosing UNE.
The IN-RATIO was lower in the UNE NF- than in norms (p<0.001) and cervicobrachialgia sample (p=0.02). We found that if the IN-RATIO is <or=0.97, its sensitivity in diagnosing UNE NF- is 68%, specificity 91%.
Fibres to FDI have a higher susceptibility to damage than fibres to ADM, and the IN-RATIO is a useful neurophysiological parameter to increase diagnostic sensitivity.
Our results demonstrate the usefulness of a new neurophysiological parameter in improving diagnosis of UNE.
Clinical Neurophysiology 07/2008; 119(7):1600-6. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Amyotrophic lateral sclerosis (ALS) affects people of all ages, but whether the wide range of age at onset is due to distinct diseases or merely reflects phenotypic variability of the same disorder is still unknown. The purpose of this study is to describe clinical and prognostic features of young-adult ALS, with onset before age 40 years, and to compare them with features of the common adult-onset type.
We analyzed clinical features and long-term follow-up of 57 young-adult ALS patients, with disease onset between 20 and 40 years, and compared them with 450 patients affected by adult-onset ALS.
We found that the majority of young-adult patients showed a predominant upper motor neuron (p-UMN) ALS, characterized by marked spastic paraparesis, with lower motor neuron signs confined to the upper limbs. The proportion of patients with p-UMN ALS phenotype was 59.6% in the young-adult patients and 17.4% in the adult-onset form (p < 0.0001). Young-adult ALS with p-UMN phenotype had longer survival than did the classic phenotype: median survival was 74 months (range 10-226, 95% CI 60.61-87.38) in the former and 56 months (range 6-106, 95% CI 48.65-63.34) in the latter (p = 0.03). In the young-adult patients, a marked male excess was observed in the p-UMN ALS group (5.8:1), whereas the ratio of men to women was 1.1:1 in the classic phenotype (p = 0.01).
Our findings show that young-adult amyotrophic lateral sclerosis with the predominant upper motor neuron phenotype represents a distinctive clinical variant characterized by a unique clinical pattern, longer survival, and male prevalence.
Neurology 07/2008; 71(12):876-81. · 8.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Italian CMT study group performed a multicentre, multidimensional, longitudinal 2-year follow-up study using validated measurements of neurological impairment, disability and quality of life. The aim of the study was to evaluate the natural history of clinical features, disability and QoL in patients with CMT1A. On clinical examination, CMT1A patients showed a significant reduction in muscle strength and sensory function during the 2-year follow-up period. However, there was no worsening of QoL or disability, nor was depression observed. The discrepancy between the evolution of clinical features and the evolution of QoL and disability may be due to the development of compensatory strategies that help patients cope with the slow progression of the disease. Our observations provide information which may be useful when designing clinical trials in CMT.
Neuromuscular Disorders 04/2008; 18(3):199-203. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to verify whether degeneration of skin receptors or intradermal nerve endings by topical application of capsaicin modifies the double peak response obtained by submaximal anodal stimulation. Five healthy volunteers topically applied capsaicin to the finger-tip of digit III (on the distal phalanx) four times daily for 4-5 weeks. Before and after local capsaicin applications, we studied the following electrophysiological findings: compound sensory action potential (CSAP), double peak response, sensory threshold and double peak stimulus intensity. Local capsaicin application causes disappearance or decrease of the second component of the double peak, which gradually increases after the suspension of capsaicin. Conversely, no significant differences were observed for CSAP, sensory threshold and double peak stimulus intensity. This study suggests that the second component of the double peak may be a diagnostic tool suitable to show an impairment of the extreme segments of sensory nerve fibres in distal sensory axonopathy in the early stages of damage, when receptors or skin nerve endings are impaired but undetectable by standard nerve conduction studies.
Neurological Sciences 11/2007; 28(5):264-9. · 1.32 Impact Factor
