1,721,124 research outputs found
Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization
No full textCognitive Deterioration: Looking for a Better Clinical Characterization and a Definition of the Determining Factors
No full textCognitive impairment is among the major emerging medical problems. The number of subjects with a progressive loss of cognitive abilities is growing, also in relation to the increase in life expectancy. Medical and social consequences are enormous. Research has made significant progresses in the field of dementia, especially as regards pathophysiological knowledge and diagnostic approaches. From a therapeutic point of view, the situation is less satisfying. The Neurological Clinic of the Marche Polytechnic University has traditionally devoted resources and energies to the study of conditions favoring the development of cognitive deterioration in an attempt to underline the importance of early diagnosis, correct clinical classification and definition of mechanisms able to favor the development and progression of deficits. In this chapter, the scientific evidences obtained about the possibility to characterize the clinical pictures of the different forms of cognitive deterioration are discussed. Furthermore, ample space is devoted to illustrate the results of the studies carried out in order to identify reliable markers of cognitive deterioration onset and progression
Lacosamide monotherapy for partial onset seizures
No full textPURPOSE: To evaluate the 1-year efficacy and safety of oral lacosamide as conversion monotherapy in adult patients with partial onset seizures with or without generalization.
METHOD: We prospectively followed-up consecutive patients converted to lacosamide monotherapy after 1-year seizure freedom on lacosamide add-on therapy and withdrawal of the concurrent antiepileptic drug (AED). Seizure occurrence, treatment compliance and drug toxicity were assessed every 3 months up to 1 year. The study outcomes were the retention rate of lacosamide as single AED and the seizure freedom under lacosamide monotherapy at 1 year from withdrawal of background AED. The safety variable was the prevalence of lacosamide related adverse events (AEs).
RESULTS: Among the 58 included patients, at 1 year from withdrawal of background medication, 37 (63.8%) retained lacosamide as single AED and 32 (55.2%) were free from seizure occurrence under lacosamide monotherapy throughout the entire follow-up. The history of less than three lifetime AEDs turned out to be significant predictor of seizure freedom (adjusted OR=6.38, 95% CI 1.85-21.98, p=0.003). Twelve (20.8%) subjects reported mild to moderate AEs, with the commonest being drowsiness, dizziness, and headache.
CONCLUSION: Conversion to lacosamide monotherapy could be effective and well tolerated in selected adults patients with partial onset seizures who had achieved seizure freedom during lacosamide add-on therapy
La TMS inibitoria potenzia la plasticità motoria in pazienti con stroke: un trial clinico randomizzato
No full textIntroduzione: Recentemente la TMS ripetitiva (rTMS) è stata usata per inibire la corteccia motoria sana (M1S) in pazienti con stroke unilaterale, in modo da ridurre transitoriamente l’eccessiva inibizione trascallosale sulla corteccia motoria dell’emisfero leso (M1L) e aumentare conseguentemente l’eccitabilità di M1L. In questo studio indaghiamo l’effetto a lungo termine di un trattamento che combina l’inibizione di M1S e un trattamento riabilitativo (TR) task-oriented in pazienti con esiti di ictus che comportino paresi di entità moderata.
Materiali e Metodi: Trenta pazienti a più di sei mesi dallo stroke sono stati arruolati in un trial clinico doppio-cieco randomizzato condotto presso gli Ospedali Riuniti di Ancona. I pazienti ricevevano 10 sessioni giornaliere di rTMS a bassa frequenza (1Hz) su M1S. In gruppi diversi, la stimolazione poteva essere attiva (rTMS-A) o sham (rTMS-S) e poteva essere somministrata immediatamente prima o dopo la seduta di TR condotta con il fisioterapista. Il TR era teso a migliorare la destrezza e la forza della key-grip (presa a chiave). Le misure di outcome includevano la destrezza (Jebsen-Taylor, Box&Block, e Nine hole test), la forza (key-grip), l’inibizione trascallosale e l’eccitabilità delle cortecce motorie ed erano monitorate per tre mesi successivi alla fine del trattamento.
Risultati: Dopo rTMS-A si assisteva ad una riduzione di inibizione trascallosale da M1S a M1L e a un aumento di eccitabilità di M1L. Tutti i gruppi presentavano dei miglioramenti nelle abilità esercitate (destrezza e forza manuale). Nei pazienti sottoposti a rTMS-S (linee grigie nel grafico), i miglioramenti erano modesti e transitori. Nei pazienti sottoposti a rTMS-A, i miglioramenti erano significativamente maggiori e perduravano per almeno tre mesi. I pazienti sottoposti a rTMS-A immediatamente prima del TR (linee nere), mostravano miglioramenti robusti e stabili per tutti i follow-up. I pazienti sottoposti a rTMS-A dopo il TR (linee rosse), mostravano un miglioramento tendente al declino negli ultimi follow-up.
Conclusioni: I nostri risultati suggeriscono che la rTMS-A prima del TR favorisce la plasticità uso-dipendente e ri-bilancia l’eccitabilità nelle due cortecce motorie. Il trattamento combinato appare un approccio valido e promettente per pazienti con stroke e disturbi motori. Lo studio fornisce evidenza di Classe I che la rTMS prima o dopo il TR migliora misure di destrezza e forza nell’arto malato in pazienti con disturbi motori a più di sei mesi dall’ictus (Avenanti et al., 2012).
Bibliografia: Avenanti, Coccia, Ladavas, Provinciali, Ceravolo (2012) Low-frequency rTMS promotes use-dependent motor plasticity in chronic stroke. A randomized trial. Neurology. 2012;78:256-6
The role of Framingham risk score in the progression from mild cognitive impairment to dementia
No full textBackground: Mild cognitive impairment (MCI) often represents the clinical
manifestation of cognitive deterioration preceding Alzheimer’s disease
(AD). Currently, there are no reliable approaches for an objective evaluation
of the risk of developing AD in patients affected by amnestic MCI (aMCI).
Objective: The aim of this study was to verify whether the Framingham
cardiovascular risk profile (FCRP) could be useful to identify patients at the
highest risk of conversion from MCI to AD.
Methods: Patients with aMCI were carefully investigated to assess their
vascular risk profile. They were also submitted to a comprehensive neuropsychological
evaluation. FCRP was calculated for each patient and apolipoprotein
E (ApoE) genotype was determined from peripheral blood cells.
The main outcome was defined as a conversion to AD within 24 months after inclusion.
Results: 385 consecutive aMCI subjects were included. Age, FCRP, and
vascular age showed a fairly predictive value on conversion to AD. Selecting
the subpopulation of ApoE ε4 carriers, we observed that FCRP had an
increased performance in predicting the conversion. The rate of conversion
increased from 12.5% in the FCRP low-risk group to 43.2% in the high-risk
group (p < 0.0001). ApoE ε4 carriers had a 3.7-times increased probability
of conversion with respect to the other subjects (p < 0.0001).
Conclusions: FCRP assessment could be considered a reliable approach
to predict conversion to AD in aMCI subjects. The presence of ApoE ε4
increases significantly the risk of conversion. These data confirm the narrow
relationship between genetic and vascular risk factors in influencing the
evolution of cognitive impairment
Low-frequency rTMS promotes use-dependent motor plasticity in chronic stroke: a randomized trial
No full textObjective: To investigate the long-term behavioral and neurophysiological effects of combined time-locked repetitive Transcranial Magnetic Stimulation (rTMS) and physical therapy (PT) intervention in chronic stroke patients with mild motor disabilities.
Methods: 30 patients were enrolled in a double-blind, randomized, single-center clinical trial. Patients received 10 daily sessions of 1Hz rTMS over the intact motor cortex. In different groups, stimulation was either real (rTMSR) or sham (rTMSS) and was administered either immediately before or after PT. Outcome measures included dexterity, force, interhemispheric inhibition and corticospinal excitability and were assessed for three months after the end of treatment.
Results: Treatment induced cumulative rebalance of excitability in the two hemispheres and a reduction of interhemispheric inhibition in the rTMSR-groups. Use-dependent improvements were detected in all groups. Improvements in trained abilities were small and transitory in rTMSS patients. Greater behavioral and neurophysiological outcomes were found after rTMSR, with the group receiving rTMSR before PT (rTMSR-PT) showing robust and stable improvements and the other group (PT-rTMSR) showing a slight improvements decline over time.
Conclusion: Our findings indicate that priming PT with inhibitory rTMS is optimal to boost use-dependent plasticity and rebalance motor excitability and suggest that time-locked rTMS is a valid and promising approach for chronic stroke patients with mild motor impairment.
Classification of evidence: This interventional study provides Class I evidence that time-locked repetitive Transcranial Magnetic Stimulation (rTMS) before or after physical therapy improves measures of dexterity and force in the affected limb in patients with chronic deficits more than 6 months post stroke
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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