Aldo Amantini

Aldo Amantini
Azienda Ospedaliero Universitaria Careggi · Department of Neuroscience

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119
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Publications

Publications (119)
Article
Aim to assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome. Setting multicentre study in 13 Italian intensive care units. Methods the N20amp in microvolts (µV) was measured at 12 h, 24 h, and 72 h from cardiac arrest, along with pu...
Article
Objectives Determining early and reliable prognosis in comatose subjects after cardiac arrest is a central component of post–cardiac arrest care both for developing realistic prognostic expectations for families, and for better determining which resources are mobilized or withheld for individual patients. The aim of the study was to evaluate the pr...
Article
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Background bilaterally absent pupillary light reflexes (PLR) or N20 waves of short-latency evoked potentials (SSEPs) are recommended by the 2015 ERC-ESICM guidelines as robust, first-line predictors of poor neurological outcome after cardiac arrest. However, recent evidence shows that the false positive rates (FPRs) of these tests may be higher tha...
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Full-text available
Recent advances in technology, information technology, Internet networks, and, more recently, fiber optics in industrialized countries allow the exchange of a huge amount of data, in real time, across the globe. The acquisition of increasingly sophisticated technologies has made it possible to develop telemedicine, by which the specialist's evaluat...
Article
Background Bilateral absence of N20 peak in median nerve Somatosensory Evoked Potentials (SSEPs) is considered the most valid predictor of poor outcome in comatose survivors after cardiopulmonary resuscitation. We investigated the consistency in interpreting SSEP recordings in a multicentre study. Methods 44 SSEP recordings randomly extracted from...
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Objective According to Electroencephalogram (EEG) descriptors included in the American‐Clinical‐Neurophysiology‐Society (ACNS) terminology we generated a score, and we compared it to the EEG scores previously proposed in order to identify the one with the best prognostic power for neurological outcome at post‐acute stages in patients with severe di...
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The data presented here are related to our research article entitled "Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: a prospective multicentre prognostication study (ProNeCA)" [1]. We report a secondary analysis on the ability of somatosensory evoked potentials (SEPs), brain compu...
Article
Aims: To assess the accuracy of electroencephalogram (EEG) and somatosensory evoked potentials (SEPs) recorded at 12 and 72 h from resuscitation for predicting six-months neurological outcome in patients who are comatose after cardiac arrest. Methods: Prospective multicentre prognostication study. EEG was classified according to the American Cli...
Article
Aims: To investigate the ability of 30-min electroencephalogram (EEG), short-latency somatosensory evoked potentials (SEPs) and brain computed tomography (CT) to predict poor neurological outcome (persistent vegetative state or death) at 6 months in comatose survivors of cardiac arrest within 24 h from the event. Methods: Prospective multicentre...
Article
Objective: To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU). Methods: We retrospectively...
Chapter
The concept of consciousness has fascinated philosophers, psychologists and neurophysiologists for a long time; however, it remains difficult to give its univocal and universally accepted definition. Consciousness is defined as “the state of full awareness of the self and one’s relationship to the environment”; consequently, a distinction must be m...
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Aim: Hypoxic-ischemic-encephalopathy is a severe and frequent neurological complication of successful cardiopulmonary-resuscitation after cardiac arrest. Prognosticating neurological outcomes in patients with hypoxic-ischemic-encephalopathy is challenging and recent guidelines suggest a multimodal approach. Only few studies have analyzed the progno...
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Full-text available
SEPs are reliable predictor of poor outcome in comatose patients after cardiac arrest (CA). Recently also the role of EEG has been reassessed. To evaluate the prognostic value of EEG and SEPs association in post-anoxic coma at different recording time. We included comatose patients after CA. EEG and SEPs were recorded within 12 hs and at 72 hs afte...
Article
Full-text available
The data presented in this article are related to our research article entitled ‘Neurophysiological and neuroradiological multimodal approach for early poor outcome prediction after cardiac arrest’ (Scarpino et al., 2018) [1]. We reported two additional analyses, including results gathered from somatosensory evoked potentials(SEPs), brain computed...
Article
Introduction: Prognosticating outcome after cardiac arrest(CA) requires a multimodal approach. However, evidence regarding combinations of methods is limited. We evaluated whether the combination of electroencephalography(EEG), somatosensory evoked potentials(SEPs) and brain computed tomography(CT) could predict poor outcome. Methods: We screene...
Article
To date no national guidelines about diagnostic and prognostic evaluation of patients with disorders of consciousness (DoC) are available. As a consequence, diagnostic and prognostic procedures for DoC are extremely heterogeneous across clinical settings both in acute and chronic phases. The aim of this study is to plan a “SINC-SIRN” protocol on di...
Article
The surgical management during ligation of a spinal dural arteriovenous fistula (SDAVF) is usually based on fluorescenceangiography, intraoperative Doppler ultrasound, and intraoperative digital subtractionangiography. We investigated the potential role of intraoperative neurophysiologic monitoring (IONM) during surgical management of SDAVF. A 45 y...
Article
To obtain normative values we performed in healthy volunteers (HV) stimulated single-fiber electromyography (SFEMG) of the Frontal muscle using concentric needle electrode (CNE). Frontal muscles SFEMG, after stimulation with needle electrodes of the temporal branch of facial nerve, was conducted in 16 HV (6 males, mean age 43.1, range 20–60 years)....
Article
We describe two patients with acute brain injury who underwent continuous EEG-SEP monitoring: an unusual phase of SEPs amplitude instability preluded to cerebral perfusion alterations in one case and to neurological deterioration up to brain death in the other. Raw and quantitative EEG were continuously recorded. Cortical SEPs after stimulation of...
Article
In comatose patients after cardiac arrest (CA) bilateral absence of cortical SEPs is a high reliable predictor of poor outcome but it is present in no more than 40%. Low amplitude pathological SEPs were found in 28.9% of subjects but only few papers analysed the prognostic significance of this pattern. To evaluated prognostic value of N20-P25 ampli...
Article
Brain Death (BD) in coma after cardiac arrest (CA) is difficult to predict. Basal ganglia Gray Matter/White Matter (GM/WM) ratio density and Somatosensory Evoked Potentials (SEPs) may differentiate patients evolving toward BD. We used SEPs and brain computed tomography (CT) within the first 24 h after the coma onset. We measured the basal ganglia l...
Article
Introduction In comatose patients after cardiac arrest (CA) bilateral absence of cortical SEPs is a high reliable predictor of poor outcome but it is present in no more than 40% (1). Low amplitude pathological SEPs were found in 28.9% (2) of subjects but only few papers analysed the prognostic significance of this pattern (3–4). Aim To evaluated p...
Article
Objective To evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) a italian multicentric study. Methods Comatose patients after CA were included.EEG and SEPs were recorded within 12 h and at 72 h after CA. EEG was classified into “non-continuous” (low voltag...
Article
Background: Brain death (BD) in coma after cardiac arrest (CA) is difficult to predict. Basal ganglia gray matter/white matter (GM/WM) ratio density and somatosensory evoked potentials (SEPs) may differentiate patients evolving toward BD. Methods: We used SEPs and brain computed tomography (CT) after coma onset, within the first 24hours. Result...
Article
Cluster headache (CH) is a primary chronic disabling form with autonomic symptoms, that often does not respond satysfactorily to prophylactic treatment. Botulinum toxin type A is an effective therapy for chronic migraine. We describe 2 clinical cases of CH examining the role of Onabotulinum-toxin-A on this form of primary headache. We treated with...
Article
We assessed whether Somatosensory Evoked Potentials (SEPs), recorded within 24 h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury (ABI) of several aetiologies. SEPs were classified as Absent (A), Pathological (P), and Normal (N). Taking into consideration responses in both hemispheres,...
Article
Objective is to identify and compare EEGs showing burst-suppression (BS) with identical bursts and BS with highly epileptiform bursts and their prognostic value in a cohort of postanoxic patients. In a retrospective cohort of postanoxic patients who underwent EEG, we selected all patients with BS (ACNS terminology, 2013) at 12 and 24 h after cardia...
Article
Somatosensory evoked potentials(SEPs) and EEG are reliable outcome predictors of coma after cardiac arrest (CA). Nevertheless, only few multicentric studies are available. Aim of the study was to evaluate the prognostic value of EEG and SEPs association in post-anoxic comatose patients at different recording time from cardiac arrest (CA) in an Ital...
Article
Objective: Investigation of the utility of association between electroencephalogram (EEG) and somatosensory-evoked potentials (SEPs) for the prediction of neurological outcome in comatose patients resuscitated after cardiac arrest (CA) treated with therapeutic hypothermia, according to different recording times after CA. Methods: Glasgow Coma Sc...
Article
Most of the patients who survive after a cardiac arrest (CA) recover responsiveness in the first 30–40 days, even if further recovers are possible also in the following months. We conducted a prospective study to correlate the recovery of consciousness with EEG and somatosensory evoked potentials (SEP) findings. The level of consciousness was evalu...
Article
Multimodal intraoperative neurophysiological monitoring (IOM) during spine surgery was introduced in clinical practice to reduce the risk of permanent neurological deficit post-surgery. The early detection of changes in neurophysiological parameters during surgical procedure, makes it possible to reverse the damage before it becomes permanent. The...
Article
Full-text available
The prediction of neurologic outcome in comatose patients after cardiac arrest (CA) has been investigated and the findings were summarized in a practice parameter of the American Academy of Neurology (1). These guidelines did not include the EEG as a reliable outcome indicator but recent studies on continuous EEG recorded during TH have re-evaluate...
Article
The prognostic role of EEG during early phase after cardiac arrest (CA) has been recently emphasized, but different classifications and definitions have been employed among studies. A standardized terminology for ICU patients has been recently proposed by American Clinical Neurophysiology Society (ACNS). We retrospectively evaluated the prognostic...
Article
Status epilepticus and myoclonus are common in comatose patients after cardiac arrest (Krumholz et al., 1988; Young et al., 1990). There is no consensus on when and for how long to treat this condition. This point became more relevant after introduction of therapeutic hypothermia (TH) because of some patients with MS treated with TH recovered consc...
Article
The purpose of this study was to evaluate the efficacy, safety and tolerability of onabotulinumtoxinA as prophylactic therapy in patients with “refractory” chronic migraine (CM). We analyzed 76 patients (12M, 64F; mean age 52 years- 23–82) with CM resistant to conventional syntomatic and/or prophylactic polytherapy, afferent to the Regional Referen...
Article
Objective: To evaluate the prognostic value of single EEG patterns recorded at various time-frames in postanoxic comatose patients. Methods: This retrospective study included 30-min EEGs, classified according to the definitions of continuity of background activity given by the American Clinical Neurophysiology Society. Isoelectric pattern was di...
Article
Backgroung: Evaluation of prognostic value of electroencephalography (EEG) and somatosensory evoked potentials (SEP) according to different recording times. Methods: A retrospective cohort study performed at the medical ICU of the AOU Careggi Teaching Hospital (Florence, Italy) of comatose adults (> 18 yrs) after cardiac arrest (CA) and treated...
Article
Objective: To assess the diagnostic accuracy of electrodiagnostic (EDX) criteria for the early detection and characterization of Guillain-Barré syndrome (GBS) in clinical practice. Methods: We conducted a prospective study in patients referred for an EDX exam with clinical suspicion of GBS. We evaluated four sets of neurophysiological criteria a...
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Phasic alertness represents the ability to increase response readiness to a target following an external warning stimulus. Specific networks in the frontal and parietal regions appear to be involved in the alert state. In this study, we examined the role of the right dorsolateral prefrontal cortex (DLPFC) during the attentional processing of a stim...
Article
The usual semiotic sign of motor neuron damage is hypotrophy of target muscle. However, in rare cases, a motor neuron damage results in hypertrophy: this is principally due to a chronic triggering of spontaneous activity in affected motor units, with continuous or subcontinuous activation of target muscular fibers. Muscular neurogenic hypertrophy w...
Article
Electrodiagnostic criteria are of support to the diagnosis of GBS. Ho/Hadden (HH) criteria are the ones most commonly used although little specific. Dutch GBS Study Group (DGBSG) criteria seem to be the most sensitive and specific. Both, however, are not sensitive for early diagnosis of GBS. The aim of our study is to determine the more useful crit...
Article
To evaluate the prognostic value of EEG and SEPs in post-anoxic comatose patients at 12 h, 24 h and 72 h from cardiac arrest (CA). Comatose patients after CA treated with TH were included. EEG and SEPs were recorded within 12 h, 24 h and 72 h after CA. EEG was classified into “non-continuous” (low voltage, isoelectric, burst-suppression) and “conti...
Article
Full-text available
We report a case of Rickettsia africae infection complicated with painful sacral syndrome in an Italian traveller returning from Zimbabwe. The patient presented with fever, a tache noire on the left leg, and a neurological syndrome characterized by severe pain of the left leg, predominantly located in the left dorsal thigh and radiating to the calf...
Article
Somatosensory evoked potentials (SEPs) are reliable predictor of poor outcome in comatose patients after cardiac arrest (CA) treated with therapeutic hypothermia (TH). Recently the role of EEG in determining the prognosis have been reassessed. A continuous EEG pattern within 12 after CA, reliably predicts awakening. Our aim was to evaluate the role...
Article
Short-term habituation (STH) represents a “bottom-up” filter for salient stimuli and a prerequisite for a subsequent “top-down” processing. Our aim was to ascertain if STH is preserved in patients with different levels of disorder of consciousness (DOC). We recorded 35 DOC patients assessed with Coma Recovery Scale-Revised. We delivered trains of s...
Article
In patients with Disorder of Consciousness (DOC) Event Related Potentials have been used for prognosis of recovery of the state of consciousness. The component that have been more studied were Mismatch Negativity and P300 but they have the limitation of low sensitivity due to pitfalls of recording and analysis during repetitive stimuli. N100 is a m...
Article
Full-text available
A 39-year-old male with epilepsia partialis continua, refractory to first- and second-line antiepileptic drugs, is described. Lacosamide produced a progressive antiepileptic effect on Jacksonian motor seizures and subsequently on positive myoclonus, which developed into negative myoclonus before complete resolution. Our report confirms the efficacy...
Article
Full-text available
Background: Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurol...
Article
Clinical neurophysiology is both an extension of clinical examination and an integration of neuroimaging. It plays a role in diagnosis, prognosis and monitoring in the Intensive Care Unit (ICU). Electroencephalography (EEG) and somatosensory evoked potentials (SEPs) are the most informative neurophysiological tests. Both have a major prognostic rol...
Article
We all share the need to optimise the evaluation of patients with disorders of consciousness (DOC), given the high rate of misdiagnosis of vegetative state based on clinical examination. We believe that one way to do this is to optimise assessment from the early stages, in order to reduce discontinuity between the hospital and rehabilitation phases...
Article
To review the predictive powers of SEPs in comatose children after acute brain injury. MEDLINE, EMBASE, OVID, ISI Web of Knowledge, BIOMED Central and the Cochrane Library (1981-2007) were searched. First, predictive values were calculated for each primary study. Second, we analysed effects of different factors on the SEP diagnostic odds ratio by m...
Article
By studying neuronal activity through neuronal electrogenesis, neurophysiological investigations provide a functional assessment of the nervous system and, therefore, has been used for quantitative assessment and follow-up of hepatic encephalopathy (HE). The different clinical neurophysiological approaches can be classified depending on the functio...
Article
Post-traumatic locked-in syndrome may be particularly difficult to recognize, especially when it follows a state of coma and presents the clinical feature of a "total" locked-in syndrome. A 56-year-old male with a closed head injury was admitted in intensive care unit (ICU) with GCS=4 (V1, M2, E1). Computed tomography (CT) scan disclosed a limited...
Article
To monitor acute brain injury in the neurological intensive care unit (NICU), we used EEG and somatosensory evoked potentials (SEP) in combination to achieve more accuracy in detecting brain function deterioration. Sixty-eight patients (head trauma and intracranial hemorrhage; GCS<9) were monitored with continuous EEG-SEP and intracranial pressure...
Article
Study aim: To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests clinically useful for the management of individual...
Article
BACKGROUND. To monitor acute brain injury in NICU we used EEG combined with Somatosensory Evoked Potentials (SEPs) to overcome the disadvantages connected to each technique and to achieve more accuracy in detecting brain function deterioration. METHODS AND RESULTS. 90 patients (traumatic and hemorrhagic; GCS < 9) were monitored with continuous EEG-...
Article
To monitor acute brain injury in Neuro Intensive Care Unit (NICU) we used in combination electroencephalogram (EEG) with Somato-sensory Evoked Potentials (SEPs) to overcome the disadvantages of each technique and achieve more accuracy in detecting brain function deterioration. 73 patients (traumatic and intracranial hemorrhage) with Glasgow Coma Sc...
Article
Fatigue is considered to be a specific manifestation of primary biliary cirrhosis (PBC). Recent reports have, however, questioned these findings. Considering the high rate of comorbidities in PBC patients and the fact that fatigue is a multifactorial symptom, we hypothesized that it might also be due to nonhepatic causes. Our aim was to evaluate fa...
Article
The most informative neurophysiological techniques available in the neurosurgical intensive care unit are electroencephalograph and somatosensory evoked potentials. Such tools, which give an evaluation of cerebral function in comatose patients, support clinical evaluation and are complementary to neuroimaging. They serve both diagnostic/prognostic...
Article
We used Motor Evoked Potentials (MEPs), elicited by transcranial magnetic stimulation, for assessing a motor pathways dysfunction in a selected group of Multiple Sclerosis (MS) patients, without limitation in walking. We selected 32 Relapsing Remitting MS patients, in remission phase, with EDSS < or = 3.5 and 20 healthy individuals with similar hei...