Gianni Pezzoli

Publications (101)435.02 Total impact

• Article: Dopamine dysregulation syndrome in Parkinson's disease: from clinical and neuropsychological characterisation to management and long-term outcome.

  Roberto Cilia, Chiara Siri, Margherita Canesi, Anna Lena Zecchinelli, Danilo De Gaspari, Francesca Natuzzi, Silvana Tesei, Nicoletta Meucci, Claudio Bruno Mariani, Giorgio Sacilotto, Michela Zini, Claudio Ruffmann, Gianni Pezzoli
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  ABSTRACT: OBJECTIVE: Dopamine dysregulation syndrome (DDS) refers to a compulsive pattern of dopaminergic drug misuse complicating Parkinson's disease (PD). To date, few data are available on DDS risk factors, cognitive profile and long-term outcome. METHODS: In this retrospective case-control study, consecutive PD outpatients fulfilling criteria for DDS were assessed over a 6-year period (2005-2011). They were compared with 70 PD cases matched for age at onset, gender and disease duration, and with 1281 subjects with motor fluctuations and dyskinesias. DDS patients and matched controls underwent extensive neuropsychological assessment. Strategies for DDS patients management and the outcome at the last follow-up visit were recorded. RESULTS: Thirty-five patients with DDS were identified, reporting history of depression, family history of PD and drug abuse, greater difference between 'Off' versus 'On' motor symptoms compared to age-matched controls. They had younger age at onset (but not any gender difference) compared to general PD population. Cognitive profile of DDS did not show major abnormalities, including executive functions. DDS patients have been followed up for 3.2±2.1 years and remission was recorded in 40% of cases. Negative DDS outcome was significantly associated with poor caregiver supervision. Sustained remission occurred more commonly on clozapine and on duodenal levodopa infusion and subthalamic nucleus deep brain stimulation (STN-DBS) than on apomorphine pump treatment. CONCLUSIONS: Clinicians should be aware of risk factors predisposing to DDS. Duodenal levodopa infusion and, less consistently, STN-DBS were more commonly associated with DDS remission. Effective caregiving plays a key role in long-term behavioural outcome.
  Journal of neurology, neurosurgery, and psychiatry 04/2013; · 4.87 Impact Factor
• Article: Nutritional status and dietary habits in Parkinson's disease patients in Ghana.

  Michela Barichella, Albert Akpalu, Momodou Cham, Giulia Privitera, Erica Cassani, Emanuele Cereda, Laura Iorio, Roberto Cilia, Alba Bonetti, Gianni Pezzoli
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  ABSTRACT: Dietary treatment is important for the management of Parkinson's disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country. Fifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia). The mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively. This study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.
  Nutrition 02/2013; 29(2):470-3. · 3.03 Impact Factor
• Source

  Available from: Roberto Cilia

  Dataset: FP-CIT in Meningioma ftp

  Roberto Cilia, Roberta Allegra, Gianni Pezzoli
• Article: Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson's disease outpatients hospitalised on a scheduled basis.

  Michela Barichella, Emanuele Cereda, Carmen Madio, Laura Iorio, Chiara Pusani, Raffaella Cancello, Riccardo Caccialanza, Gianni Pezzoli, Erica Cassani
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  ABSTRACT: Dysautonomia symptoms of nutritional interest may often occur in Parkinson's disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Malnutrition Universal Screening Tool. Presence of dysautonomia symptoms (dysphagia, sialorrhoea and constipation) was investigated using clinical rating scales. In our population, prevalence of nutritional risk was 17·2 (95 % CI 12·1, 24·0) % and relied mainly on unintentional weight loss. Sialorrhoea, dysphagia, dysphagia to liquids and constipation were observed in 10·6, 11·0, 14·4 and 59·6 % of the patients, respectively. Nutritional risk was independently associated with the number of dysautonomia symptoms (OR 1·39 (95 % CI 1·00, 1·96); P = 0·048) but not with single symptoms. An independent association was also found with the severity of motor symptoms (Hoehn-Yahr stage, OR 1·48 (95 % CI 1·00, 2·55); P = 0·049) and levodopa dose (OR 1·16 (95 % CI 1·04, 1·31) mg/kg per d; P = 0·009). Nutritional risk in PD outpatients appears to depend mainly on dysautonomic syndrome, disease severity and levodopa dosage. Implications for outcome deserve further investigation. The assessment of nutritional status and of gastrointestinal dysautonomia symptoms should be part of the routine work-up of a PD patient.
  The British journal of nutrition 12/2012; · 3.45 Impact Factor
• Source

  Available from: Roberto Cilia

  Dataset: Guella2012MovDis-VPS35-1

  Ilaria Guella, Giulia Soldà, Roberto Cilia, Gianni Pezzoli, Rosanna Asselta, Stefano Duga, Stefano Goldwurm
• Source

  Available from: Angelo Antonini

  Dataset: 10072 2012 1112 Author

  Angelo Antonini, Giovanni Abbruzzese, Luigi Ferini-Strambi, Barbara Tilley, Jing Huang, Glenn T Stebbins, Christopher G Goetz, Paolo Barone, Monica Bandettini di Poggio, Giovanni Fabbrini, [......], Leonardo Lopiano, Maurizio Zibetti, Mario Zappia, Alessandra Nicoletti, Aldo Quattrone, Maria Salsone, Gianni Cossu, Daniela Murgia, Alberto Albanese, Francesca Del Sorbo
• Article: Meningioma with intense I(123) FP-CIT uptake.

  Roberto Cilia, Roberta Allegra, Gianni Pezzoli
  Movement Disorders 12/2012; 27(14):1744-5. · 4.51 Impact Factor
• Source

  Available from: Stefano Duga

  Dataset: VPS35 Movement disorders

  Ilaria Guella, Giulia Soldà, Roberto Cilia, Gianni Pezzoli, Rosanna Asselta, Stefano Duga, Stefano Goldwurm
• Article: Diabetes and risk of Parkinson's disease.

  Emanuele Cereda, Michela Barichella, Carlo Pedrolli, Catherine Klersy, Erica Cassani, Riccardo Caccialanza, Gianni Pezzoli
  Movement Disorders 10/2012; · 4.51 Impact Factor
• Article: The sleeve gastrectomy intervention to treat morbid obesity in a Parkinson's disease patient.

  Michela Barichella, Erica Cassani, Raffaella Cancello, Anna Zecchinelli, Giuseppe Faillace, Gabriella Moise, Alessandra Zulian, Giulia Privitera, Gianni Pezzoli
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  ABSTRACT: BACKGROUND & AIMS: Some Parkinson's disease patients may develop morbid obesity, on account of the reduction in exercise and/or of the appearance of compulsive food intake in the first years after diagnosis. The prescription of central appetite suppressants is actually not recommended in Parkinson's disease patients. To the best of our knowledge, no cases of morbidly obese Parkinson's disease patients submitted to bariatric surgery procedures have been reported in literature before. METHODS: We here describe for the first time the outcome of a sleeve gastrectomy intervention in a morbidly obese Parkinson's disease patient, resistant to several non-surgical weight-loss treatments. RESULTS: The outcome of the sleeve gastrectomy intervention was satisfactory in terms of body weight-loss, long term weight stabilization and improvement of cardioprotective circulating factors, including adiponectin. Furthermore, the antiparkinson therapy (levodopa) was reduced by 25%. CONCLUSIONS: These observations suggest that morbidly obese Parkinson's disease patients, who are resistant to other dietary treatments, might be candidated for sleeve gastrectomy.
  Clinical nutrition (Edinburgh, Scotland) 07/2012; · 3.27 Impact Factor
• Article: Validation of the Italian version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale.

  Angelo Antonini, Giovanni Abbruzzese, Luigi Ferini-Strambi, Barbara Tilley, Jing Huang, Glenn T Stebbins, Christopher G Goetz, Paolo Barone, Monica Bandettini di Poggio, Giovanni Fabbrini, [......], Leonardo Lopiano, Maurizio Zibetti, Mario Zappia, Alessandra Nicoletti, Aldo Quattrone, Maria Salsone, Gianni Cossu, Daniela Murgia, Alberto Albanese, Francesca Del Sorbo
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  ABSTRACT: The Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has been available in English since 2008. As part of this process, the MDS-UPDRS organizing team developed guidelines for development of official non-English translations. We present here the formal process for completing officially approved non-English versions of the MDS-UPDRS and specifically focus on the first of these versions in Italian. The MDS-UPDRS was translated into Italian and tested in 377 native-Italian speaking PD patients. Confirmatory and exploratory factor analyses determined whether the factor structure for the English-language MDS-UPDRS could be confirmed in data collected using the Italian translation. To be designated an 'Official MDS translation,' the Comparative Fit Index (CFI) had to be ≥0.90 relative to the English-language version. For all four parts of the Italian MDS-UPDRS, the CFI, in comparison with the English-language data, was ≥0.94. Exploratory factor analyses revealed some differences between the two datasets, however these differences were considered to be within an acceptable range. The Italian version of the MDS-UPDRS reaches the criterion to be designated as an Official Translation and is now available for use. This protocol will serve as outline for further validation of this in multiple languages.
  Neurological Sciences 06/2012; · 1.32 Impact Factor
• Source

  Available from: Claudio Ruffmann

  Article: Lewy body pathology and typical Parkinson disease in a patient with a heterozygous (R275W) mutation in the Parkin gene (PARK2).

  Claudio Ruffmann, Michela Zini, Stefano Goldwurm, Manuela Bramerio, Sonia Spinello, Damiana Rusconi, Marcello Gambacorta, Fabrizio Tagliavini, Gianni Pezzoli, Giorgio Giaccone
  Acta Neuropathologica 05/2012; 123(6):901-3. · 9.32 Impact Factor
• Article: Clinical experience of tolcapone in advanced Parkinson’s disease

  Margherita Canesi, Anna Lena Zecchinelli, Gianni Pezzoli, Angelo Antonini
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  ABSTRACT: We are reporting our clinical experience in 66 patients with advanced Parkinson’s disease (PD) who were switched to tolcapone because of persisting off periods despite treatment with entacapone (according to the European Agency for the Evaluation of Medicinal products: EMEA). We used UPDRS II-III-IV in “on” state to monitor tolcapone effectiveness at 6 and 12 months. We found significant reductions in mean off-time duration (UPDRS item 39) and levodopa dose at follow up. Eleven patients dropped out (17%) during the first month of treatment, 2 (3%) because liver enzymes exceeded normal limit. Amongst patients who continued tolcapone, 30/55 (54%) reported “off-time” reduction ≥25% (UPDRS-39 decrement ≥1 point). Our findings indicate that tolcapone widens the levodopa therapeutic window, even in patients who have not benefited from entacapone. We suggest that tolcapone is indicated before patients are referred for more invasive procedures.
  Neurological Sciences 04/2012; 29:380-382. · 1.32 Impact Factor
• Article: Psychiatric symptoms in Parkinson’s disease assessed with the SCL-90R self-reported questionnaire

  Chiara Siri, Roberto Cilia, Danilo De Gaspari, Federica Villa, Stefano Goldwurm, Catalano Marco, Gianni Pezzoli, Angelo Antonini
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  ABSTRACT: The frequency of psychopathological symptoms in patients with Parkinson’s disease (PD) is often underestimated because of the lack of comprehensive evaluation tools. A total of 486 consecutive non-demented PD patients completed the Symptom Checklist 90 Revised (SCL-90R) self-reported questionnaire, a validated tool for the assessment of psychopathological symptoms on nine dimensions. Somatization, depression, anxiety and obsessive–compulsive behaviors were reported by nearly half of the PD patients. They were more likely to occur in females. Disease-related factors such as duration, severity and daily dosages, but not type of dopaminergic medications, were associated with the occurrence of these symptoms. Psychopathological features are frequent in PD and their occurrence is underlined by disease-related factors.
  Neurological Sciences 04/2012; 31(1):35-40. · 1.32 Impact Factor
• Source

  Available from: Chiara Siri

  Article: Cognitive status of patients with Parkinson’s disease and pathological gambling

  Chiara Siri, Roberto Cilia, Danilo De Gaspari, Margherita Canesi, Nicoletta Meucci, Anna Lena Zecchinelli, Gianni Pezzoli, Angelo Antonini
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  ABSTRACT: The cognitive status of patients with Parkinson’s disease (PD) who developed pathological gambling (PG) during dopamine replacement therapy has been poorly explored. We compared clinical and cognitive features of 21 consecutive PD patients with active PG (PD–PG) versus 42 PD controls of similar disease duration without any impulse control disorder. All patients underwent full neuropsychological testing to evaluate executive and other frontal lobe-related functions, attention, learning and memory, language, visuospatial abilities and neuropsychiatric status [using Geriatric Depression Scale (GDS) and Neuropsychiatric Inventory (NPI)] as well as the South Oaks Gambling Screen Scale (SOGS). PD–PG were younger (60.4 vs. 64.9, p=0.01) and more frequently of male gender (85 vs. 57%, p=0.02). The two groups did not differ in medication dosages and kind of dopamine agonist. PD–PG had higher MMSE (29.1 vs. 27.4, p=0.02) and performed better at Rey Auditory Verbal learning Test (45.9 vs. 40.4, p=0.04), verbal phonemic fluencies (38.7 vs. 31.8, p=0.02), verbal semantic fluencies (44.9 vs. 37.4, p=0.01) and attentive matrices (47.6 vs. 43.5, p=0.05) while the remaining cognitive performances were comparable to controls. Moreover, based on the NPI, PD–PG had higher aggressiveness, irritability, disinhibition and eating disorders than controls. In conclusion the occurrence of PG in our cohort of patients with PD was associated with preserved executive functions.
  Journal of Neurology 04/2012; 257(2):247-252. · 3.47 Impact Factor
• Article: Low cardiometabolic risk in Parkinson's disease is independent of nutritional status, body composition and fat distribution.

  Emanuele Cereda, Erica Cassani, Michela Barichella, Angela Spadafranca, Riccardo Caccialanza, Simona Bertoli, Alberto Battezzati, Gianni Pezzoli
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  ABSTRACT: To investigate if the reduced cardiometabolic risk in Parkinson's disease (PD) is independent of nutritional status, body composition and fat distribution. We designed a case-control study comparing 80 non underweight PD patients with 80 controls matched for sex, age and body mass index (BMI). Nutritional assessment included: anthropometry (BMI and waist circumference [WC]), body composition estimated by impedance and biochemistry (fasting glucose, serum lipids and transaminases). The presence of arterial hypertension, diabetes mellitus and metabolic syndrome (MetS) were noted. Compared to controls and independently of gender, PD patients showed lower percentage of body fat (P < 0.001) and biochemical parameters (glucose, P < 0.001; total cholesterol, P < 0.001; LDL, P < 0.001; triglycerides, P = 0.002; alanine aminotransferase, P < 0.001 and aspartate aminotransferase, P = 0.015) but similar WC (P = 0.324). The prevalence of hypertension and MetS was similar in the two groups, as well as the frequency and the number of MetS criteria. The relationship between PD and low cardiometabolic profile was independent of age, gender, current smoking and BMI. After adjusting for WC and body fat, most of the associations remained significant. PD patients seem to have a more favorable cardiometabolic risk profile, independently of nutritional status, body composition and fat distribution.
  Clinical nutrition (Edinburgh, Scotland) 03/2012; 31(5):699-704. · 3.27 Impact Factor
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  Available from: Stefano Duga

  Article: The Asp620asn mutation in VPS35 is not a common cause of familial Parkinson's disease.

  Ilaria Guella, Giulia Soldà, Roberto Cilia, Gianni Pezzoli, Rosanna Asselta, Stefano Duga, Stefano Goldwurm
  Movement Disorders 01/2012; 27(6):800-1. · 4.51 Impact Factor
• Article: Increased Levels of Endothelial Progenitor Cells in Parkinson's Disease (vol 17, pg 651, 2011)

  Ferruccio Cavanna, Michela Barichella, Erica Cassani, Gianni Pezzoli
  Parkinsonism & Related Disorders 01/2012; 18(6). · 3.80 Impact Factor
• Article: The influence of dopaminergic striatal innervation on upper limb locomotor synergies.

  Ioannis U Isaias, Jens Volkmann, Alberto Marzegan, Giorgio Marotta, Paolo Cavallari, Gianni Pezzoli
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  ABSTRACT: To determine the role of striatal dopaminergic innervation on upper limb synergies during walking, we measured arm kinematics in 13 subjects with Parkinson disease. Patients were recruited according to several inclusion criteria to represent the best possible in vivo model of dopaminergic denervation. Of relevance, we included only subjects with normal spatio-temporal parameters of the stride and gait speed to avoid an impairment of upper limbs locomotor synergies as a consequence of gait impairment per se. Dopaminergic innervation of the striatum was measured by FP-CIT and SPECT. All patients showed a reduction of gait-associated arms movement. No linear correlation was found between arm ROM reduction and contralateral dopaminergic putaminal innervation loss. Still, a partition analysis revealed a 80% chance of reduced arm ROM when putaminal dopamine content loss was >47%. A significant correlation was described between the asymmetry indices of the swinging of the two arms and dopaminergic striatal innervation. When arm ROM was reduced, we found a positive correlation between upper-lower limb phase shift modulation (at different gait velocities) and striatal dopaminergic innervation. These findings are preliminary evidence that dopaminergic striatal tone plays a modulatory role in upper-limb locomotor synergies and upper-lower limb coupling while walking at different velocities.
  PLoS ONE 01/2012; 7(12):e51464. · 4.09 Impact Factor
• Source

  Available from: Daniele Cartelli

  Article: Microtubule destabilization is shared by genetic and idiopathic Parkinson's disease patient fibroblasts.

  Daniele Cartelli, Stefano Goldwurm, Francesca Casagrande, Gianni Pezzoli, Graziella Cappelletti
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  ABSTRACT: Data from both toxin-based and gene-based models suggest that dysfunction of the microtubule system contributes to the pathogenesis of Parkinson's disease, even if, at present, no evidence of alterations of microtubules in vivo or in patients is available. Here we analyze cytoskeleton organization in primary fibroblasts deriving from patients with idiopathic or genetic Parkinson's disease, focusing on mutations in parkin and leucine-rich repeat kinase 2. Our analyses reveal that genetic and likely idiopathic pathology affects cytoskeletal organization and stability, without any activation of autophagy or apoptosis. All parkinsonian fibroblasts have a reduced microtubule mass, represented by a higher fraction of unpolymerized tubulin in respect to control cells, and display significant changes in microtubule stability-related signaling pathways. Furthermore, we show that the reduction of microtubule mass is so closely related to the alteration of cell morphology and behavior that both pharmacological treatment with microtubule-targeted drugs, and genetic approaches, by transfecting the wild type parkin or leucine-rich repeat kinase 2, restore the proper microtubule stability and are able to rescue cell architecture. Taken together, our results suggest that microtubule destabilization is a point of convergence of genetic and idiopathic forms of parkinsonism and highlight, for the first time, that microtubule dysfunction occurs in patients and not only in experimental models of Parkinson's disease. Therefore, these data contribute to the knowledge on molecular and cellular events underlying Parkinson's disease and, revealing that correction of microtubule defects restores control phenotype, may offer a new therapeutic target for the management of the disease.
  PLoS ONE 01/2012; 7(5):e37467. · 4.09 Impact Factor