Massimo Del Sette

Sant'Andrea Medical Hospital, Spezia, Liguria, Italy

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Publications (133)489.13 Total impact

  • C Finocchi · M Del Sette
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    ABSTRACT: Several observational studies report that subjects with migraine with aura have a higher prevalence of right-to left shunt, commonly due to patent foramen ovale, and that patent foramen ovale is more prevalent in subjects with migraine with aura. Although migraine without aura has been less extensively studied, it does not seem to be associated with an increased prevalence of right-to left shunt. The mechanism that underlies the possible relationship between patent foramen ovale and migraine with aura remains speculative. The proposed mechanisms are migraine-triggering vasoactive chemicals bypassing the pulmonary filter and reaching the cerebral circulation and paradoxical microembolization. However, it is unclear, at this time, if there is a causal or comorbid association between the two conditions. In some families atrial shunts show a dominant inheritance that seems to be linked to inheritance of migraine with aura. Migraine with aura is an independent risk factor for ischemic stroke, and patent foramen ovale is present more frequently in patients with cryptogenic stroke than in controls. At this moment, there is no convincing evidence that excess stroke risk of migraine is simply mediated by patent foramen ovale through paradoxical embolism. Several non-controlled studies suggest that closure of the foramen ovale significantly reduces attack frequency in migraine patient, but the only prospective placebo-controlled trial does not support these results. Patent foramen ovale closure, at present, is not indicated as a treatment for migraine in clinical practice.
    Neurological Sciences 05/2015; 36 Suppl 1(S1):61-6. DOI:10.1007/s10072-015-2163-8 · 1.50 Impact Factor
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    ABSTRACT: The practice of inhaling liquefied petroleum gas (LPG) to commit suicide is uncommon and almost exclusively a prerogative of the prison population. Numerous cases of sudden deaths caused by intentional propane and/or butane inhalation have been described, but these cases survived and a description of the consequences is very rare. We describe a prisoner who survived after voluntary inhalation of LPG, and who developed ataxia, Parkinsonism, and dystonia. Brain MRI showed bilateral hyperintensity in the basal ganglia and in the cerebellar hemispheres. The clinical evolution and the MRI abnormalities are similar to those described in cases of poisoning by CO where the mechanism of brain injury is related to histotoxic hypoxia. We believe that LPG, considered until now a mixture of gas with low neurotoxic power, may have caused direct toxic damage to the brain, mediated by a mechanism of hypoxia, such as in CO intoxication.
    Neuropsychiatric Disease and Treatment 05/2015; 11:1157-9. DOI:10.2147/NDT.S80460 · 2.15 Impact Factor
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    ABSTRACT: Cognitive training has reported to improve cognitive performance in Mild Cognitive Impairment (MCI) as well as in older healthy subjects. 18F-FDG-PET is widely used in the diagnoses of dementia for its ability to identify early metabolic changes. This study was aimed to assess the effect of cognitive stimulation on brain metabolic network and clinical cognitive performance. Thirty aMCI subjects were enrolled in the study and allocated in two groups matched for cognitive profile, sex and schooling and then randomly assigned to the training arm or to the placebo arm. All subjects underwent neuropsychological assessment and PET imaging before and after intervention. We found significant association between brain metabolism and cognitive stimulation in treated aMCI subjects. Brain metabolic changes included Brodmann areas reported to be involved in working memory and attentive processes as well as executive functions. Our study shows that metabolic changes occur earlier than possible clinical changes related to the intervention. 18F-FDG-PET could provide a useful biomarker of response to identify a population of aMCI suitable to respond to treatment, according to most recent data on default network mode and its adaptivity to external stimuli.
    04/2015; 8(1). DOI:10.2174/1874471008666150428122924
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    ABSTRACT: Erratum to: Neurol Sci (2014) 35:867-873 DOI 10.1007/s10072-013-1615-2The affiliation details of the co-authors were incorrect in the original publication of the article. The correct information is given below:P. CerratoAOU “Molinette”, Turin, ItalyC. SerratiAO “S. Martino”, Genoa, ItalyM. Del SetteNeurology Unit, S. Andrea Hospital, Via Vittorio Veneto 197, 19124 La Spezia, ItalyA. CavalliniUC Malattie Cerebrovascolari/Stroke Unit, IRCCS “C. Mondino”, Pavia, ItalyM. DiomediUOC Stroke Unit, Dipartimento di Neuroscienze, Università degli Studi di Roma Tor Vergata, Rome, ItalyS. RicciUO Neurologia, ASL 1 dell’Umbria Ospedale, Via Engels, 06012 Città di Castello (PG), Italy
    Neurological Sciences 04/2015; DOI:10.1007/s10072-015-2209-y · 1.50 Impact Factor
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    Journal of the neurological sciences 04/2015; 353(1-2). DOI:10.1016/j.jns.2015.03.035 · 2.26 Impact Factor
  • Alberto Chiti · Lavinia Dinia · Massimo Del Sette
    New England Journal of Medicine 03/2015; 372(12):1176-7. DOI:10.1056/NEJMc1501204#SA2 · 54.42 Impact Factor
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    ABSTRACT: The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00-3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed.
    Journal of Neurology 12/2014; 262(2). DOI:10.1007/s00415-014-7550-1 · 3.84 Impact Factor
  • Journal of the American Geriatrics Society 12/2014; 62(12):2437-8. DOI:10.1111/jgs.13169 · 4.22 Impact Factor
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    ABSTRACT: Factors predicting family history (FH) of premature arterial thrombosis in young patients with ischaemic stroke (IS) have not been extensively investigated, and whether they might influence the risk of post-stroke recurrence is still unknown. In the present study we analysed 1,881 consecutive first-ever IS patients aged 18-45 years recruited from January 2000 to January 2012 as part of the Italian Project on Stroke in Young Adults (IPSYS). FH of premature arterial thrombosis was any thrombotic event [IS, myocardial infarction or other arterial events event] < 45 years in proband's first-degree relatives. Compared with patients without FH of premature arterial thrombosis, those with FH (n = 85) were more often smokers (odds ratio [OR], 1.94; 95 % confidence interval [CI], 1.21-3.09) and carriers of procoagulant abnormalities (OR, 3.66; 95 % CI, 2.21-6.06). Smoking (OR, 2.48; 95 % CI, 1.20-5.15), the A1691 mutation in factor V gene (OR, 3.64; 95 % CI, 1.31-10.10), and the A20210 mutation in the prothrombin gene (OR, 8.40; 95 % CI 3.35-21.05) were associated with FH of premature stroke (n = 33), while circulating anti-phospholipids to FH of premature myocardial infarction (n = 45; OR, 3.48; 95 % CI, 1.61-7.51). Mean follow-up time was 46.6 ± 38.6 months. Recurrent events occurred more frequently in the subgroup of patients with FH of premature stroke [19.4 %); p = 0.051] compared to patients without such a FH. In conclusion, young IS patients with FH of premature arterial thrombosis exhibit a distinct risk-factor profile, an underlying procoagulant state and have worse vascular prognosis than those with no FH of juvenile thrombotic events.
  • 11/2014; 1(1):110-128. DOI:10.17229/jdit.2014-1113-008
  • Annual Congress Of European Association of Nuclear Medicine, Gothenburg - Sweeden; 10/2014
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    ABSTRACT: BACKGROUND AND PURPOSECerebral vasomotor reserve (VMR) is the capability of cerebral arterioles to change their diameter in response to various stimuli, such hypercapnia. Changes of VMR due to transcranial direct current stimulation (tDCS) have been poorly studied.METHODS Twenty-five healthy subjects underwent anodal/cathodal and sham tDCS on right primary motor area. Before and after tDCS, we assessed VMR by Transcranial Color-Coded Sonography (TCCS) calculating trought Breath Holding Index (BHI) and Heart Rate Variability (HRV), in particular after Valsalva manouver.RESULTSA-tDCS decreased VMR and BHI (p < 0.05), whereas C-tDCS increased VMR, and BHI (p < 0.05); Sham doesn't provide statistically significant of both VMR, BHI and HRV (p > 0.05).CONCLUSIONS Our study confirms that tDCS induces a modification of bilateral VMR with a polarity-specific effect; based on this bilateral MFV and BHI modifications, we can speculate an involvement of the SNS in the VMR regulation.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 09/2014; 25(4). DOI:10.1111/jon.12162 · 1.82 Impact Factor
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    ABSTRACT: Patent foramen ovale (PFO) is a common congenital anatomical defect in the general population with a mean prevalence of 20 %. Transcranial Doppler sonography and echocardiography, both with infusion of agitated saline as an echo contrast, have been introduced for the diagnosis of PFO. Transesophageal echocardiography is considered the gold standard. Several studies have suggested an association between cryptogenetic stroke and PFO, but the role of this condition as a risk factor for stroke is still debated. The aims of this prospective multicentre study are the evaluation of PFO prevalence in the whole ischemic stroke population and the identification of a stroke recurrence profile risk in patients with PFO. All consecutive patients admitted for acute ischemic stroke and with a confirmed diagnosis at discharge are eligible cases for the study. Demographic and vascular risk factors are registered. Clinical severity is summarized by the National Institute of Health stroke scale. Echocardiographic and transcranial studies are performed in each patient to detect the presence of PFO. Prevalence of PFO will be calculated with 95 % CIs. Univariate analysis will be performed to detect the correlation of PFO with different registered factors and multivariable analysis with PFO as independent variable. The present study should contribute to better identify the role of PFO in ischemic stroke risk and recurrence-related events. Qualifying findings of the study are represented by the high number of enrolled patients, the prospective methodology of the study and the presence of secondary instrumental endpoints.
    Neurological Sciences 06/2014; 39(3-4). DOI:10.1007/s10072-013-1615-2 · 1.50 Impact Factor
  • Atti del IV Meeting dell'associazione Italiana per lo studio del sistema periferico, S2-S2; 04/2014
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    ABSTRACT: Fifteen days after a respiratory infection, a 45-year-old woman presented with paresthesias in the hands and feet, bilateral loss of vision, fever, headache, and impairment of consciousness. Magnetic resonance imaging (MRI) showed predominant lesions in the optic tracts, optic chiasm, and hypothalamus. Cerebrospinal fluid analysis revealed elevated protein level, and lymphocytic pleocytosis. Neurophysiological studies disclosed a demyelinating sensorimotor polyneuropathy. Serum anti-Mycoplasma pneumoniae immunoglobulin (Ig)M, anti-GM1 IgG, and anti-AQP4 IgG were positive. This case, which is remarkable for post-infectious meningoencephalitis-like onset, MRI picture, and dysimmunity to central and peripheral nervous system autoantigens, underpins the pivotal diagnostic role of anti-AQP4-IgG, and expands the list of clinico-pathological findings that can associate with neuromyelitis optica spectrum disorders.
    Multiple Sclerosis 02/2014; 21(2). DOI:10.1177/1352458514524294 · 4.86 Impact Factor
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    ABSTRACT: Introduction: The most common cause of sudden isolated and prolonged global aphasia is acute stroke, affecting the cortical or subcortical language network. However, an aphasic status epilepticus (ASE) has to be considered as a possible differential diagnosis in awake patients presenting with acute and prolonged language impairment. ASE is suggestive of a localized dysfunction of language processing in the dominant hemisphere. ASE is a rare phenomenon and few cases are reported in the current literature. In the differential diagnosis between ASE and stroke with aphasia, FDG-PET imaging could be used when EEG shows no clear evidence of epileptic activity. Case Presentation: We described a case of a 74 year-old woman who presented sudden onset of isolated and prolonged global aphasia; she suffered 5 months before of a left temporo-occipital hemorrhage and 20 days before a left hemispheric ischemic stroke. A new ischemic or hemorrhagic event was excluded by neuroimaging (CT and MRI, including DWI). Since several EEGs did not show ictal epileptic pattern, but only inter-ictal slow waves in the left temporal region, an FDG-PET was performed, resulting in two hypermetabolic areas in the left temporal and occipital lobes. The aphasia improved after anti-epileptic therapy. Discussion and Conclusion: In conclusion, this is a case of post-stroke ASE, in which the evidence of hypermetabolism on FDG-PET allowed a definite diagnosis of epilepsy, despite the non-ictal EEG pattern.
  • Andrea Ciarmiello · Chiara Gaeta · Claudio Guidotti · Massimo del Sette
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    ABSTRACT: Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are in vivo imaging techniques that, using a wide range of tracers, allow the non-invasive tracking of pathophysiological processes in healthy and diseased brain. One of most promising of the various PET and SPECT applications is the investigation of pathophysiological aspects of neurodegenerative disorders. This is an extremely important area of investigation given the aging of the global population and the high prevalence of brain disorders such as Alzheimer’s disease and Parkinson’s disease in elderly persons. Clinical translation of advances in molecular imaging research into clinical practice may, by overcoming the limitations of a diagnostic approach that relies exclusively on clinical judgment and structural imaging, lead to better clinical management of affected patients.
    12/2013; 1(6). DOI:10.1007/s40336-013-0042-y
  • Clinical Neurophysiology 11/2013; 124(11):e221. DOI:10.1016/j.clinph.2013.06.172 · 2.98 Impact Factor
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    ABSTRACT: PURPOSE: To test whether the use of a striatum weighted image may improve registration accuracy and diagnostic outcome in patients with parkinsonian syndromes (PS). METHODS: Weighted images were generated by increasing signal intensity of striatal voxels and used as intermediate dataset for co-registering the brain image onto template. Experimental validation was performed using an anthropomorphic striatal phantom. (123) I-FP-CIT SPECT binding ratios were manually determined in 67 PS subjects an and compared to those obtained using unsupervised standard (UWR) and weighted registered (WR) approach. Normalized cost function was used to evaluate the accuracy of phantom and subjects registered images to the template. Reproducibility between unsupervised and manual ratios was assessed by using intra-class correlation coefficient (ICC) and Bland and Altman analysis. Correlation coefficient was used to assess the dependence of semi-quantitative ratios on clinical findings. RESULTS: Weighted method improves accuracy of brain registration onto template as determined by cost function in phantom (0.86 ± 0.06vs.0.98 ± 0.02; Student's t test, P = 0.04) and in subject scans (0.69 ± 0.06vs.0.53 ± 0.06; Student's t test, P < 0.0001). Agreement between manual and unsupervised derived binding ratios as measured by ICC was significantly higher on WR as compared to UWR images (0.91vs.0.76). Motor UPDRS score was significantly correlated with manual and unsupervised derived binding potential. In phantom as well as in subjects studies, correlations were more significant using the WR method (BPm:R(2) = 0.36,p = 0.0001; BPwr:R(2) = 0.368,P = 0.0001; BPuwr:R(2) = 0.300,P = 0.0008). CONCLUSION: Weighted registration improves accuracy of binding potential estimates and may be a promising approach to enhance the diagnostic outcome of SPECT imaging, correlation with disease severity, and for monitoring disease progression in parkinsonian syndromes. © 2013 Wiley Periodicals, Inc.
    Journal of Cellular Physiology 10/2013; 228(10). DOI:10.1002/jcp.24378 · 3.87 Impact Factor

Publication Stats

2k Citations
489.13 Total Impact Points


  • 2012–2015
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2010–2015
    • Sant´Andrea Hospital
      Roma, Latium, Italy
    • Foundation of the Carlo Besta Neurological Institute
      Milano, Lombardy, Italy
  • 2014
    • University of Florence
      Florens, Tuscany, Italy
  • 1988–2013
    • Università degli Studi di Genova
      • Dipartimento di Medicina sperimentale (DIMES)
      Genova, Liguria, Italy
  • 1992
    • The University of Western Ontario
      • Department of Clinical Neurological Sciences
      London, Ontario, Canada