G.C. Muscas

Azienda Ospedaliero Universitaria Careggi, Firenzuola, Tuscany, Italy

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Publications (11)11.76 Total impact

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    ABSTRACT: We described 6 patients (age range 39-78), presenting with recurrent extended episodes of alteration of cognitive functions, with predominant encoding memory deficit. All patients were previously misdiagnosed with conditions other than epilepsy. Thus, the suspect of "Transient Epileptic Amnesia (TEA)" lead to a more accurate evaluation through the analysis of video and/or EEG recording that confirmed the epileptic origin of all the events. Direct observations and recorded data showed more complex clinical and EEG ictal and post-ictal traits than TEA features only. We concluded that this proposed syndrome is still not well defined even if we agree that every effort should be made for a correct diagnosis of epileptic cognitive disorders, since in all reported cases drug treatment readily controlled symptoms.
    No preview · Article · Apr 2011 · Bollettino - Lega Italiana contro l'Epilessia
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    ABSTRACT: We report on a 19-year-old woman presenting with a 10-month history of misdiagnosed recurrent secondarily generalized seizures and a 4-month history of continuous myoclonus of the right hand. No structural abnormalities were detected by conventional Magnetic Resonance Imaging (MRI) and minimal atrophy was found on a 3T MRI. Clinical and neurophysiological examination lead to the diagnosis of Epilepsia Partialis Continua (EPC). Perfusion weighted imaging (PWI) showed moderate increase of the cerebral blood volume (CBV) in the left rolandic area and posterior frontal cortex. In the same regions the Positron Emission Tomography with F-18-Fluoro-Deoxy-Glucose ([F-18]FDG-PET) revealed hypermetabolism. Functional MRI (fMRI) demonstrated decreased blood oxygenation level-dependent signal of primary and supplementary right hand motor cortex compared to the controlateral suggesting a left motor area dysfunction. We demonstrate that fMRI can show, noninvasively, alterations that standard MRI may not reveal, but that are detectable through neurophysiological and PET studies.
    No preview · Article · Apr 2011 · Bollettino - Lega Italiana contro l'Epilessia
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    ABSTRACT: We investigated the prevalence and the clinical association of high titer of antibodies against glutamic acid decarboxylase (hGADAb) among unselected patients with inflammatory/autoimmune disorders of the nervous system. By indirect immunofluorescence examination of samples from 1435 patients, we identified 7 cases (0.48%) with hGADAb. Although stiff-person plus syndrome was the commonest clinical accompaniment, most of the patients presented with a combination of different symptoms, including psychiatric disturbances and intestinal motility disorders. Diagnosis delay and chronic evolution were common findings. In two cases persistently high values of hGADAb over the years were observed. The rarity and the phenotype heterogeneity of hGADAb clinical association should not discourage clinicians from antibody screening, at least in selected cases, as an early immunotherapy can change the otherwise chronic progression of this complex disorder spectrum.
    No preview · Article · Oct 2010 · Journal of neuroimmunology
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    ABSTRACT: The clinical and EEG data of a 49-year-old man with myoclonic and generalized tonic-clonic seizures resulting from early childhood encephalitis are described. He experienced no tonic-clonic seizure for 10 years before brief exposure first to 60 mg/day duloxetine and then to 20mg/day paroxetine for depressive symptoms. These drugs were separately prescribed at a 9-month interval, and after beginning each drug, the patient experienced tonic-clonic seizures of worsening intensity and myoclonus of increasing frequency. Clinical features correlated with subcontinuous, generalized spike-wave discharges on the EEG. Discontinuation of antidepressant treatment resulted in rapid disappearance of clinical and electrophysiological manifestations of myoclonic status. We suggest care must be taken when using serotonin-noradrenaline reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs), as these drugs pose the risk of complications in the specific population of people with myoclonic seizures.
    No preview · Article · May 2009 · Epilepsy & Behavior
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    ABSTRACT: Limbic encephalitis (LE) is a neurological syndrome that may present in association with cancer, infection, or as an isolate clinical condition often accompanying autoimmune disorders. Here we have characterized the clinical and laboratory features of two patients presenting with subacute onset, and chronic evolution, of anterograde amnesia and drug-resistant epilepsy associated with thyroid autoimmunity and in absence of tumoral pathology despite long follow-up. Antibodies against onconeural antigens, voltage gated potassium channel and glutamate receptors, which may accompany paraneoplastic as well as non-paraneoplastic LE, were negative. However, biochemical studies showed high titers, and sustained intrathecal synthesis, of antibodies directed against neuronal glutamic acid decarboxylase (GAD). In one patient, plasma exchange determined a dramatic improvement of the neurological deficits along with the decrease of autoantibodies.
    No preview · Article · Jul 2008 · Journal of Neuroimmunology
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    ABSTRACT: Refractory status epilepticus (RSE) is associated with frequent medical problems. Levetiracetam (LEV) is a broad-spectrum, safe and effective antiepileptic drug (AED) which has no known pharmacologic interaction. We screened from 1 year status epilepticus (SE) database of two tertiary referral hospitals 10 patients (5 male, mean age 64.6 years) with both convulsive and not convulsive SE. Acute aetiology was present in 5 cases. AEDs withdrawal was the aetiology in the other cases with remote symptomatic epilepsy. Patients were initially treated with i.v. lorazepam, diazepam, or midazolam as first-line treatment and PHT, VPA as second-line treatment. LEV was administered as oral bolus of 3000 mg followed by 1000 mg t.i.d. Symptoms and EEG improvement were observed in the first 12 hours after LEV administration in 6 cases and later (up to 96 hours) in the remaining. Adjunctive LEV should be considered as a choice for patients with RSE.
    No preview · Article · May 2008 · Bollettino - Lega Italiana contro l'Epilessia
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    ABSTRACT: Limbic encephalitis (LE) is frequently associated with malignancy.Non- paraneoplastic variants of LE have been described in association with antibodies directed against cell-membrane antigens such as voltage gated potassium channel (VGKC), novel cell-membrane antigens (nCMAg), N-methyl-D-aspartate receptor (NMDAR) and the glutamic acid decarboxylase (GAD-Ab). Actually there aren't sufficient data to aid the diagnosis of this disorder and guide its management.We sought to address some of these issues by retrospectively analyzing data on a serie of patients with diagnosis of LE during a 6-year period.
    No preview · Article · Jan 2008 · Bollettino - Lega Italiana contro l'Epilessia
  • E. Bertini · E. Rosati · B. Chiocchetti · V. Bessi · G.C. Muscas
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    ABSTRACT: Over 1-year period data from a consecutive sample of 75 elderly outpatients were collected. Patients filled in the Health-related QOL 36-item Short Form (SF-36), the Adverse Events Profile (AEP) questionnaire and were evaluated by many cognitive, functional and psychological/behavioural measures. The majority of patients (58.7%) experienced seizures after the age of 60; 31 (44%) were 1-year seizure-free, 47 (63%) were on monotherapy and 28 (37%) on polytherapy. Twenty-eight patients (37%) had a clinical and neuropsychological diagnosis of dementia and 22 (29%) had minor cognitive and memory deficits. Depression, anxiety, sleep disturbances and other psychiatric symptoms were detected in 59 (79%) patients and in patients completing the QOL and AEP questionnaire scores were worst than those of the reference group. Our data shows that in an Epilepsy Center of a tertiary referral hospital elderly patients with epilepsy frequently have drug-resistant seizures, cognitive impairment, psychiatric symptoms and worse QOL.
    No preview · Article · Jul 2006 · Epilepsia
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    ABSTRACT: In a 2-year open-label study we attempt to evaluate efficacy and tolerability of Levetiracetam in elderly patients with seizures and cognitive impairment. Twenty-five epileptic patients with a clinical and supported neuropsychological diagnosis of mild cognitive impairment or dementia were treated as add-on therapy or alternative monotherapy with LEV. Assessments and outcomes measures included standardized dementia scales for cognitive, behavioural, psychiatric and daily living assessment. Mean follow-up was 11.4 months (SD 8.8) with 18 patients completed 6th months, 12 completed 1 year and 5 completed 2 years of observation. At the last follow-up visit 21 subjects (84%) were on LEV therapy. LEV and change in antiepileptic regimen improved in Alzheimer's Disease Cooperative Study-Clinician's Global Impression of Change score in more than half patients. The others outcome's scores were stable or slightly modified. Conclusion: LEV is an effective and well-tolerated drug for elderly subjects with epilepsy and cognitive impairment.
    No preview · Article · Jan 2005
  • A. Gaudenzi · E. Rosati · B. Chiocchetti · G.C. Muscas
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    ABSTRACT: We have studied the efficacy and tollerability of levetiracetam (LEV) as add-on therapy in 17 patients with epilepsy and mental disability. Two patients early discontinued the treatment, 1 for aggressiveness, while the others 15 had a mean follow-up period of 15.9 weeks (range 8-29 weeks). In these patients we have observed a good efficacy in 5 patients who had a seizures' reduction > 50%. Overall treatment was well tollerated and only 3 patients showed emergent behavior disturbance wich didn't require discontinuation of LEV.
    No preview · Article · Jul 2003
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    ABSTRACT: The diagnosis of epilepsy can be difficult and incomplete diagnosis, leading to inappropriate treatment, is well-documented in the literature. We studied the incidence of non-epileptic parossistic disturbances versus epilepsy in a population of patients referred to our centre from January the 1st 2000, to January the 1st 2003 and we assessed the use of health services and diagnostic facilities in the two different groups.
    No preview · Article · Jul 2003 · Bollettino - Lega Italiana contro l'Epilessia