Edward Cesnik

University of Ferrara, Ferrare, Emilia-Romagna, Italy

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Publications (32)61.28 Total impact

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    ABSTRACT: Objectives An ecological study in the resident population of the Health District (HD) of Ferrara, Italy, has been carried out to establish the distribution in space and time of the amyotrophic lateral sclerosis (ALS) incident cases according to the disease onset type and gender in the period 1964–2009.Material and methodsThe hypothesis of a uniform distribution was assumed.ResultsThe incident cases of spinal onset ALS and bulbar onset ALS were evenly distributed in space and time in both men and women. The spinal onset ALS incident cases distribution according to gender was significantly different from the expected in the extra-urban population (20 observed cases in men 95% Poisson confidence interval 12.22–30.89, expected cases in men 12.19; six observed cases in women 95% Poisson confidence interval 2.20–13.06, expected cases in women 13.81), whereas no difference was found in the urban population. The spinal onset ALS incidence was higher in men than in women in the extra-urban population (difference between the rates = 1.53, 95% CI associated with the difference 0.52–2.54), whereas no difference between sexes was found in the urban population.Conclusions The uneven distribution according to gender of the spinal onset ALS incident cases only in the extra-urban population suggests the involvement of a gender related environmental risk factor associated with the extra-urban environment. Despite some limits of the spatial analysis in the study of rare diseases, the results appear consistent with the literature data.
    No preview · Article · Oct 2014 · Acta Neurologica Scandinavica
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    ABSTRACT: Introduction. The subcortical region underneath Wernicke's area (WA) is a critical crossing of the eloquent language pathways involved in all semantic, phonological, syntactic, and working memory elaboration. We report the resection of a CA located underneath the dominant WA discussing the functional and anatomical evidence provided by fMRI, dissections with Klingler's technique, and intraoperative mapping during awake surgery. Case Report. A 64-year-old right-handed female affected by daily complex focal seizures underwent f-MRI, showing language activations in the middle and inferior temporal gyri and an unusual free entry zone in the "classical" WA. The cortical intraoperative mapping partially confirmed the f-MRI results, and we approached the lesion directly through WA. Subcortical DES allowed the identification of the eloquent language pathways and the radical resection of the perilesional gliotic rim. The patient did not report deficits and she is seizures and drug free after 1-year surgery. Discussion. Cortical DES demonstrated the variability of the eloquent areas within the cortex of the dominant temporal lobe. The subcortical DES confirmed the crucial role in language elaboration and the anatomical course of the bundles underneath WA. Conclusions. Awake surgery with DES represents a reliable and dynamic technique also for safer and functional-customized resection of CAs.
    Full-text · Article · Jun 2013
  • Ilaria Casetta · Edward Cesnik · Francesco Pedelini
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    ABSTRACT: We report the case of a 70-year-old man who presented with a recent history of headache, altered mental status and sleepiness. He was known to have type II diabetes mellitus, and a mild, treated and apparently well controlled hypertension. Brain magnetic resonance imaging demonstrated extensive abnormalities in the parieto-occipital white matter, suggestive of posterior reversible encephalopathy syndrome (PRES). An extensive diagnostic evaluation did not allow the detection of any known cause of the syndrome. Twenty-four-hour non-invasive ambulatory blood pressure monitoring showed a mild to moderate hypertension, with non-dipping pattern. This case suggests that, in the context of an overnight blunted blood pressure profile, even a mild or moderate hypertension can result in cerebral vasogenic oedema, underlining the diagnostic importance of 24-h blood pressure monitoring in patients with PRES without severe hypertension or other commonly recognized causes of posterior reversible encephalopathy.
    No preview · Article · Jun 2013 · Blood pressure
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    ABSTRACT: Few studies have been carried out in the same area at different times, allowing an assessment of the incidence of epilepsy (E.), including all ages, over time. The available data on temporal trend show a decrease in E. incidence in childhood and an increase in the elderly. We sought to update the incidence of E. in the province of Ferrara, where a previous study estimated an incidence rate of 33.1 per 100,000, 35.8, if standardized to the European population. Newly diagnosed patients aged up to 14 years were drawn from a community-based prospective multi-source registry, and adult onset E. cases were collected through multiple overlapping sources of case collection. Cases were included and classified according to ILAE recommendations. During the study period (2007-2008), 141 newly diagnosed cases (66 men and 75 women) living in the study area were identified. The crude incidence rate was 46.1 per 100,000 person-years (95 % CI 39.0-54.5), 35.5 (95 % CI 28.0-43.0) if adjusted to the European population. The incidence of childhood and adolescence epilepsy was 57.0 per 100,000 person-years (95 % CI 33.8-90.0), lower than that reported in our previous study, and it was 44.8 (95 % CI 37.4-53.6) for adult onset E., which is significantly higher as compared to our previous study. The overall incidence of E. in northern Italy is stable over time. We detected a significant decrease in incidence of childhood and adolescence E. and an increase in adult-onset E. The burden of epilepsy will increase as the population continues to age.
    No preview · Article · Apr 2013 · Neurological Sciences
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    ABSTRACT: Epilepsy is most frequent in Learning Disability (LD) patients. The frequency ranges from 6% (moderate LD) to 50% (severe/profound LD). The aim of our study is to analyse a LD outpatients series followed up in the Ferrara Hospital Adult Epilepsy Center to evaluate their epilepsy long-term prognosis and possible conditioning clinic and psychosocial factors involved. In the Ferrara Hospital Adult Epilepsy Center database the LD patients, in follow up by more than 5 years with a last examination in the years 2010-2011, were identified and their data were crossed with the data of the same patients who were previously followed up in the Paediatric Epilepsy Outpatient Clinic to obtain a long-term observation. 86 patients were identified (35 F, 51 M, mean age 41 years). 73% of them had a symptomatic epilepsy (mainly pre- and post-natal injury and cerebral malformations) whereas 7% had a chromosomal-genetic disorder. In the 43% of the cases the seizure's frequency was high (>2/months from the onset) with no significant improvement over time. 45% of the patients had a drug-resistant epilepsy. Psychiatric disorders were present in 48% of patients, most were behavioural disorders (37%) such hyperactivity, inappropriate speech, lethargy and aggressiveness. Our findings support limited evidence from the literature that the LD severity does not affect the prognosis of epilepsy as the high frequency of seizures at onset. It is prognostically unfavourable for an institutionalization of psychiatric comorbidity.
    No preview · Article · Apr 2013 · Bollettino - Lega Italiana contro l'Epilessia
  • Edward Cesnik · Ilaria Casetta · Enrico Granieri
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    ABSTRACT: Post traumatic epilepsy is defined by recurrent seizures secondary to brain injury following head trauma and represent the most frequent cause of epilepsy in young adults. Most post traumatic epilepsies start within two years from trauma, but in some cases may present several years after the brain injury. Severe traumatic brain injuries tend to correlate with an increased risk of developing early and late post-traumatic seizures. A cranial trauma creates a potentially epileptogenic brain damage through a number of different mechanisms. Several structural, physiological and biochemical modifications occur in a brain after a head injury that promote oxidative stress mechanisms and excitotoxic mechanisms. Current evidence shows that prophylactic use of antiepileptic drugs prevent the occurrence of early post-traumatic seizure but does not influence the incidence of post-traumatic epilepsy. Some authors propose treatment with antioxidant drugs in acute phase of severe traumatic brain injuries in order to prevent early tissue changes established in the traumatized tissue.
    No preview · Article · Jan 2013
  • M. Gentile · E. Groppo · E. Cesnik · E. Granieri
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    ABSTRACT: Background The association of MS and parkinsonism is still a controversial topic because it has not been yet established whether these two conditions occur coincidentally or causally. Case report We report a 53 year-old woman with an insidious onset of extrapyramidal syndrome. Brain magnetic resonance imaging (MRI) scan revealed multiple hyperintense T2-weighted lesions in the white matter and no lesions in the basal ganglia or midbrain. DaT-SCAN showed reduced level of dopamine carrying protein on right side. Treatment with levodopa induced a marked improvement. Seven years later she developed a myelitis. Spinal cord MRI detected two hyperintense lesions at cervical and dorsal levels. Complete blood count, biochemical profile and coagulation were normal as well as autoimmunity screening. Cerebrospinal fluid (CSF) analysis showed intrathecal synthesis with oligoclonal bands. The patient received intravenous methylprednisolone with marked improvement. A new MRI scan shows a new paraventricular hyperintense T2 weighted lesion. Conclusion There are some case reports describing patients with parkinsonism and MS demyelinating lesions. Two hypotheses might account for this association. The first one is the coincidental occurrence of Parkinson's disease in MS patients. The second hypothesis postulates that parkinsonism is due to MS itself as a secondary manifestation of immune and neurodegenerative damages affecting dopaminergic pathways.
    No preview · Article · Jan 2013 · Basal Ganglia
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    ABSTRACT: The purpose of the present study is to evaluate accelerometric parameters of gait in different neurological conditions with pathological gait impairment compared to healthy subjects. We studied 17 patients affected by Parkinson's disease, 24 with ataxic gait due to different diseases and 24 healthy subjects supplied with a triaxial accelerometer with a portable datalogger which measures acceleration and deceleration on an anterior-posterior, mediolateral and vertical plane at an approximate level of the center of mass (back sacral localization) and in other two positions (sternal and frontal sacral region) during a steady-state walking. Analyses of the basic accelerometric parameters associated with a jerk analysis allowed us to differentiate between the population groups. We observed a significant reduction of acceleration parameters in neurological patients when compared with healthy subjects, with a reduction of the mean acceleration of 0.30 m/s(2) for ataxic and 0.64 m/s(2) for parkinsonian patients (t test, p < 0.01). The root-mean square of the accelerations was used to quantify the attenuations of accelerations. This study suggests that a triaxial accelerometer is a good practical and an economic tool for assessing the alteration of perambulation. Moreover, it is plausible to use these data to obtain objective parameters in the evaluation of the progression of the disease and the efficacy of therapeutic tools.
    No preview · Article · Mar 2012 · Neurological Sciences
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    ABSTRACT: Data about the temporal trend of amyotrophic lateral sclerosis (ALS) incidence in southern Europe are scarce. Incidence studies on ALS have been carried out in the health district of Ferrara, Italy, since 1960s. We expanded the previous studies from 1964 to 2009. The study was prospective with a subsequent retrospective intensive survey of multiple sources of case ascertainment. All patients with a definite and probable ALS according to the original El Escorial criteria were selected. There were 130 incident cases in the years 1964-2009 giving an average annual crude incidence of 1.82 per 100,000 population (95% CI 1.53-2.17). An incidence increase during the study period was estimated in women (χ(2) test for trend = 7.19, p < 0.01) and in the elderly (χ(2) test for trend = 7.803, p < 0.01). The age-adjusted incidence was stable over time in both women (1.19 per 100,000, 95% CI 0.90-1.52) and men (1.45 per 100,000, 95% CI 0.12-1.84). The annual number of new ALS cases in the study population followed the Poisson distribution in both sexes as well as in the elderly group of the population. The present findings suggest that ALS incidence is nearly stable over time. The crude incidence increase we estimated over time among women is mainly explained by population ageing. The increasing incidence in the elderly population was likely the consequence of an increasing precision in ALS diagnosis in the elderly since the increasing attention and care over time of neurologic elderly patients that likely concern elderly women more than previous time periods rather than better case ascertainment of diagnosed patients. The present findings do not support the role of specific environmental factors in ALS pathogenesis.
    No preview · Article · Jan 2012 · Journal of Neurology
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    ABSTRACT: The annual incidence of childhood and adolescence epilepsy ranges from 41 to 97 diagnoses per 100,000 people in western Countries, with a reported decline over time. We aimed at studying the incidence of epilepsy in children and adolescents (1 month to 14 years) and its temporal trend in the province of Ferrara, northern Italy. We implemented a community-based prospective multi-source registry. All children with newly diagnosed epilepsy in the period 1996-2005 were recorded. The incidence rate of newly diagnosed epilepsy in the considered age range was 57 per 100,000 person-years, (95% CI: 49.3-65.9), with a peak in the first year of life (109.4; 95% CI: 69.4-164.1), without differences between the two gender. The estimates were significantly lower than those observed previously (97.3; 95% CI: 81.9-115.7). Incidence rates for epilepsy in the Italian population aged 1 month to 14 years are in line with those of other European and Northern American Countries. The incidence of childhood epilepsy has declined over time in our area. A reduced impact of serious perinatal adverse events could partly explain the decline.
    No preview · Article · Sep 2011 · European Journal of Neurology
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    ABSTRACT: The reported annual incidence of juvenile stroke ranges from 9 to 47 cases per 100,000 inhabitants. We sought to estimate the incidence of first-ever stroke in young adults through a population-based stroke registry in a well-defined and stable population. We planned to collect all cases of new stroke in people aged 15-44 years in Ferrara, Italy, over the period 2002-2007. During the surveillance period, a first-ever stroke was diagnosed in 39 patients, giving a mean annual crude incidence rate of 12.1 cases per 100,000 person-years (95% CI 8.6-16.5), 9.1 when adjusted to the European population. The overall 30-day case fatality rate was 7.7, 21.4% for hemorrhagic stroke. The incidence rate was in the range of estimates detected in western countries. The case-fatality rate was lower than that reported in less recent studies. The stroke subtype predicted the probability of death and the outcome.
    No preview · Article · Jun 2011 · Neurological Sciences
  • N Mobilio · I Casetta · E Cesnik · S Catapano
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    ABSTRACT: The aim of this study was to estimate the prevalence of temporomandibular disorders (TMD) symptoms in an Italian population sample, focusing on gender and age differences. We selected 2005 individuals by telephone survey and asked them about TMD symptoms like difficulty in jaw movement, jaw pain and joint sounds. Also, tooth-clenching and/or tooth-grinding habits were investigated. Of the study population, 8·1% reported limitations in jaw movements, 5·1% reported jaw pain and 33·3% reported joint sounds. Furthermore, 37·3% reported tooth-clenching/tooth-grinding. Confidence intervals of proportions were calculated. Significant gender differences were found for jaw limitation and pain (chi-square test; P < 0·05). Symptoms reduced with increasing age. The prevalence of TMD symptoms in the Italian population was consistent with data reported from similar studies. Gender and age differences were found for jaw pain and limitation in jaw movements.
    No preview · Article · May 2011 · Journal of Oral Rehabilitation
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    ABSTRACT: West Nile virus is a mosquito-borne flavivirus isolated in human blood in 1937. In less than 1% is possible a severe neuroinvasive disease: meningitis, encephalitis, and acute flaccid paralysis. Between April 2008 and October 2009 has been observed a cluster of 16 cases in the north-east of Italy (in Ferrara, Rovigo and Mantova area). In this report we try to characterize clinical and EEG spectrum of 6 patients with proven West Nile Virus admitted in Ferrara hospital.
    No preview · Article · Apr 2011
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    ABSTRACT: We report a case of an Italian 40 years-old interpreter of English language, male, who present an aphasic status epilepticus characterized by a loss of understanding and partial loss of expression of the Italian language with preservation of the expression and comprehension of English words. Neurochemical and neuroradiological findings showed a bitemporal herpetic encephalitis with significant involvement of left temporal lobe. The case presented documents as the bilateral cortical representation of a second acquired language could be a protection factor of language in case of left temporal lobe lesions.
    No preview · Article · Apr 2011 · Bollettino - Lega Italiana contro l'Epilessia

  • No preview · Article · Mar 2011 · Journal of Neurology
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    ABSTRACT: The annual incidence of myasthenia gravis (MG) ranges from 3 to 30 per 1,000,000 people. Since the mid-1980s, an increasing incidence has been reported, mainly due to late-onset MG. Whether the increase was due to population aging, improved diagnosis and case collection, or a true excess of incidence cases is still under debate. We used a complete enumeration approach by reviewing all possible sources of case collection in the province of Ferrara, Italy, to estimate the MG incidence and its temporal trend over the study period (1985-2007). The mean annual age-adjusted incidence of MG was 18 per 1,000,000, without any significant temporal trend. The incidence rates in the period 1985-1990 were 14 both for early and late-onset MG. Thereafter, a significant increase in incidence of late-onset MG (p < 0.05), and a decrease in early onset MG were detected (p < 0.01). These findings were related to nonthymoma MG. The median age at onset of the disease steadily increased over time. A changing pattern of MG incidence with an increase in frequency of late-onset and a decrease of early onset MG was found in the last years, giving a significant shift to older age at onset of the disease. Unknown environmental factors may have driven this change in MG epidemiology.
    No preview · Article · Dec 2010 · Journal of Neurology
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    ABSTRACT: Pregnancy is a risk factor for transient restless legs syndrome, which usually recovers during the postdelivery period. The goal of the present survey is to investigate whether restless legs syndrome during pregnancy represents a risk factor for later development of restless legs syndrome. A long-term follow-up study, planned as an extension of a previous survey on restless legs syndrome during pregnancy, was carried out. After a mean interval of 6.5 years, 207 parous women were contacted again to compare the incidence of restless legs syndrome among subjects who never experienced the symptoms with those who reported restless legs syndrome during the previously investigated pregnancy. Seventy-four women who experienced restless legs syndrome during previous pregnancy, and 133 who did not, were included in the study. The incidence of restless legs syndrome was 56% person/year in women who experienced the transient pregnancy restless legs syndrome form, and 12.6% person/year in subjects who did not, with a significant 4-fold increased risk of developing chronic restless legs syndrome in women who presented restless legs in the previous pregnancy. Considering further new pregnancies during the follow-up period, the restless legs symptoms reappeared in 58% of the cases, while they emerged for the first time in only 3% of women who had never experienced restless legs syndrome. The transient pregnancy restless legs syndrome form is a significant risk factor for the development of a future chronic idiopathic restless legs syndrome form, and for a new transient symptomatology in a future pregnancy.
    No preview · Article · Dec 2010 · Neurology
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    ABSTRACT: The aim of the study was to evaluate the efficacy and tolerability of zonisamide (ZNS) as add-on treatment in a series of 20 patients with refractory focal epilepsy. The results of our analysis show ZNS being efficacious in both symptomatic and cryptogenetic focal epilepsy. The study also confirmed an excellent tolerability profile of the drug.
    No preview · Article · Apr 2010 · Bollettino - Lega Italiana contro l'Epilessia
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    ABSTRACT: The majority of children of mothers with epilepsy are normal, but they are at increased risk for cognitive defects. Various AEDs have been claimed to impair or delay intellectual development in the offspring. Several reports have focused on prenatal exposure to valproic acid being especially associated with an increased risk of requiring additional educational support and developmental delay, particularly in verbal performance. The aim of this study was to assess psychomotor development with Bayley scale, WPPSI and WISC-R in a small group (18) of children exposed to AEDs in utero. Results revealed normal scores in most cases; we found only two children with selective cognitive disfunction in verbal intelligence (significant difference between verbal and performance IQ), but not related to specific antiepileptic drug. Our findings indicate that careful and regular follow-ups are needed to monitor the developmental stages of children of mothers with epilepsy.
    No preview · Article · Apr 2010 · Bollettino - Lega Italiana contro l'Epilessia
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    ABSTRACT: Women have about twice the risk of developing multiple sclerosis (MS) compared with men, a ratio that seems to be increasing. Most studies show that female patients seem to have a more favourable outcome of the disease. We studied the gender-specific impact of MS on health-related quality of life. We surveyed the population prevalence of MS patients in Ferrara, Italy. Data were extracted from the MS registry of the study area. Health-related quality of life was assessed using the MSQOL54 questionnaire. We analysed 370 patients (105 men and 265 women). They had worse scores than the general population in all health-related quality of life dimensions, ranging from 2.5 standard deviations (SD) lower for physical functioning to less than 0.5 standard deviations for mental health. Health-related quality of life scores were inversely correlated with disability scores. The impact of disability on health-related quality of life was higher for men than women regarding physical functioning (p < 0.01), vitality (p < 0.001), social functioning (p < 0.001), emotional wellbeing (p < 0.05) and mental health (p < 0.01). For scales reflecting mental health, a marked reduction with increasing disability was seen for men, while a linear reduction in the range of Expanded Disability Status Scale score 0-5 was reported for women, followed by no clear decrease for higher scores. We conclude that MS affects health-related quality of life in all of its dimensions. The impact of disability seems to be stronger among men, in particular for scales related to mental well-being. This could indicate that interventions should to be gender specific in order to better meet patients' needs.
    No preview · Article · Oct 2009 · Multiple Sclerosis

Publication Stats

495 Citations
61.28 Total Impact Points


  • 2004-2014
    • University of Ferrara
      • • Department of Biomedical Sciences and Surgical Specialties
      • • Sezione di Neurologia
      • • Neuroscience Center
      Ferrare, Emilia-Romagna, Italy
  • 2013
    • Università degli Studi di Trento
      Trient, Trentino-Alto Adige, Italy