[Show abstract][Hide abstract] ABSTRACT: An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2(®)), and the Hospital Anxiety and Depression Scale.
During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12-14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259).
Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo.
International Journal of General Medicine 01/2014; 7:531-8.
[Show abstract][Hide abstract] ABSTRACT: To monitor the long-term cognitive function evolution of patients undergoing carotid artery stenting (CAS), using detection of embolic signals (ES) as a potential marker of cognitive decline.
This is an ongoing prospective nonrandomized single-center study of patients undergoing carotid artery angioplasty and stenting using standard techniques. Neurologic status is evaluated by history, physical examination and the National Institutes of Health Stroke Scale. A complete Doppler-ultrasound investigation of the brain-supplying arteries has been performed in every patient. A 45minute cognitive battery designed to assess motor speed/coordination and executive function, psychomotor speed, language (naming), working memory/concentration, verbal fluency, and learning/memory is performed by a certified neuropsychologist in the first week after CAS and repeated a year after the procedure. Each patient undergoes bilateral ultrasonographic-Doppler monitoring of the middle cerebral artery (MCA) for microemboli detection. The patients are monitored during the first week after CAS and again a year after stenting.
32 patients were included. The mean baseline Mini-Mental State Examination (MMSE) score was 28.7 points. During the first ultrasonographic monitoring 28 patients (87.5%) had at least three times more ES detected on the stented side (a mean of 24ES/30minutes was detected in the stented side compared to a mean of 4ES/30min in the non-stented side). At the one-year follow-up 68% of the patients who have undergone CAS maintain a high number of ES detected in the territory of the stented carotid artery, finding that is well correlated with the cognitive decline in those patients, as assessed by the MMSE score.
ES detection is a useful tool for predicting cognitive decline that can be used to monitor CAS patients and adjust preventive measures in order to avoid progression of vascular cognitive impairment. It is important that further studies comparing carotid endarterectomy and CAS monitor long-term cognitive function outcome.
Journal of the neurological sciences 03/2013; 326(1-2):96-9. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Some patients with ischemic stroke are subject to hemorrhagic transformation, a complication leading to increased patient morbidity and mortality. The discovery of biomarkers that can be used to identify ischemic strokes prone to this complication are very important for the clinical practice because therapy could be altered to mitigate the risk. We discuss here the results of a trial that evaluated for the first time tight junction proteins as biomarkers of blood-brain barrier disruption and hemorrhagic transformation in ischemic stroke.
[Show abstract][Hide abstract] ABSTRACT: The actual criteria for diagnosis of dementia have many shortages, due to the fact that both DSM 4 and ICD 10 criteria are essentially based on the typical evolution of Alzheimer's disease, which is the most frequent, but not the only one cause of dementia in the general population. In the new project of DSM-5, proposed for public debate by the American Psychiatric Association (APA), new criteria for neurocognitive disorders are defined which seem more suitable to cover in a much more appropriate way all the entities potentially leading to dementia. In our view, these new criteria are also in line with the updated knowledge about these diseases as they are reflected in the recent publications and recommendations of international experts and medical associations.
Journal of the neurological sciences 08/2012; 322(1-2):17-9. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Magnetic resonance imaging (MRI) has been explored as a noninvasive tool to assess pathology in multiple sclerosis (MS) patients. However, the correlation between classical MRI measures and physical disability is modest in MS. The diffusion tensor imaging (DTI) MRI technique holds particular promise in this regard. The present study shows brain regions where FA and individual diffusivities abnormalities are present and check their correlations with physical disability clinical scores.
Eight patients and 12 matched healthy controls were recruited. The Multiple Sclerosis Functional Composite was administered. For MR-DTI acquisitions, a Genesis Signa 1.5 T MR system, an EP/SE scanning sequence, 25 gradient directions were used.
Tract Based Spatial Statistics (TBSS) group comparisons showed reduced FA and increased individual diffusivities in several brain regions in patients. Significant correlations were found between FA and: EDSS, 9-HPT(NON)DOM and 25 FW score; between λ2 and: P100 (r&l), 9-HPT(NON)DOM and 25 FW; between λ3 and: 9-HPT(NON)DOM and 25 FW score.
Fractional anisotropy and individual radial diffusivities proved to be important markers of motor disabilities in MS patients when the disease duration mean and the disability scores values range are relatively high.
European journal of radiology 03/2012; 81(3):e386-91. · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Optic neuropathy (ON) is defined as the reduction of vision due to inflammatory lesion of the optic nerve. The patient with ON has to be evaluated clinically but also with complex techniques (magnetic resonance imaging, visual evoked potentials, cerebrospinal fluid examination) because ON could be the presenting symptom in multiple sclerosis patients. Corticosteroids should be administrated intravenous and the patient should be followed by the neurologist in order to signal the appearance of new neurological signs.
[Show abstract][Hide abstract] ABSTRACT: The amplitude and habituation of the click-evoked vestibulo-collic reflex (VCR) was found reduced between attacks in migraineurs without complaints of ictal or interictal vertigo or dizziness, compared with healthy subjects. As a next step we recorded VCR in 17 migraine patients (eight with migraine without aura and nine with migraine with aura) who presented ictal migrainous vertigo according to the criteria defined by Neuhauser et al., using a method described previously. Migraineurs with migrainous vertigo have similar VCR abnormalities as patients without vertigo, i.e. a decreased global amplitude and absence of habituation. Potentiation seemed more pronounced in migraineurs with vertigo (7.46 +/- 18.6), but the difference was not significant.
[Show abstract][Hide abstract] ABSTRACT: Vertigo and dizziness are frequently reported by patients with migraine. There is a high co-morbidity between migraine and balance disturbance, but clinical observations suggest that vertigo can be an independent migrainous symptom. Vertigo and dizziness can be related to migraine in various ways: causally (migrainous vertigo), statistically (vertigo syndrome are not caused by migraine, but show a statistical association, possibly as a result of on association of both condition with a third factor) or just by chance (co-existence by coincidence). The recent term of migrainous vertigo (MV) is more precise in defining migraine and balance symptoms occur as a part of a single phenomenon, differentiating from simply co-morbid symptoms. Because MV is not presently included in the IHS classification of migraine, Neuhauser et al. proposed operational clinical criteria modelled on IHS headaches classification.
[Show abstract][Hide abstract] ABSTRACT: Reproductive endocrine dysfunction has been reported during adolescence and adulthood in female subjects with epilepsy. Epilepsy itself and antiepileptic drugs (AEDs) may have complex interactions with reproductive system. Reproductive endocrine disorders may have an impact on fertility in women with epilepsy, and therefore it is important to identify the possibly treatable disorders. We report a young epileptic woman, with idiopathic primary generalized seizures, treated with lamotrigine in the last 12 months, without seizures, who presented endocrine-reproductive dysfunction (irregular menstrual cycles, elevated estradiol levels and LH/ FSH ratio, and polycystic ovaries).