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Merano, Italy

Study design:Repetitive transcranial magnetic stimulation study.Objectives:The analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain have been the focus of several studies. In particular, rTMS of the premotor cortex/dorsolateral prefrontal cortex (PMC/DLPFC) changes pain perception in healthy subjects and has analgesic effects in acute postoperative pain, as well as in fibromyalgia patients. However, its effect on neuropathic pain in patients with traumatic spinal cord injury (SCI) has not been assessed.Setting:Merano (Italy) and Salzburg (Austria).Methods:In this study, we performed PMC/DLPFC rTMS in subjects with SCI and neuropathic pain. Twelve subjects with chronic cervical or thoracic SCI were randomized to receive 1250 pulses at 10 Hz rTMS (n=6) or sham rTMS (n=6) treatment for 10 sessions over 2 weeks. The visual analog scale, the sensory and affective pain rating indices of the McGill Pain Questionnaire (MPQ), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were used to assed pain and mood at baseline (T0), 1 day after the first week of treatment (T1), 1 day (T2), 1 week (T3) and 1 month (T4) after the last intervention.Results:Subjects who received active rTMS had a statistically significant reduction in pain symptoms in comparison with their baseline pain, whereas sham rTMS participants had a non-significant change in daily pain from their baseline pain.Conclusion:The findings of this preliminary study in a small patient sample suggest that rTMS of the PMC/DLPFC may be effective in relieving neuropathic pain in SCI patients.Spinal Cord advance online publication, 31 May 2016; doi:10.1038/sc.2016.87. © 2016 International Spinal Cord Society Source

Nardone R.,Paracelsus Medical University | Holler Y.,Paracelsus Medical University | Brigo F.,Franz Tappeiner Hospital | Brigo F.,University of Verona | And 5 more authors.
Brain Research

Plastic changes of neural circuits occur after spinal cord injury (SCI) at various level of the central nervous system. In this review we will focus on delineating the pathophysiological mechanisms of the brain plasticity changes following SCI, based on the existing neuroimaging and neurophysiological evidence in experimental models and humans. In animal experiments, reorganization of the sensory topography as well as of the topographical map of primary motor and premotor cortices have been reported in several studies. Brain imaging revealed that cortical representation in response to spared forelimb stimulation early enlarges and invades adjacent sensory-deprived hind limb territory. Electrophysiological studies demonstrated that the deafferentation due to SCI can immediately change the state of large cortical networks within 1 h, and that these changes play a critical role in the functional reorganization after SCI. In humans neuroimaging also showed shifts of functional motor and sensory cortical representations that relate to the severity of SCI. In patients with cervical SCI, cortical forearm motor representations, as assessed by means of transcranial magnetic stimulation, may reorganize towards the intrinsic hand motor representation to maximize output to muscles of the impaired forearm. Excessive or aberrant reorganisation of cerebral cortex may also have pathological consequences, such as phantom sensations or neuropathic pain. Integrated neuroimaging and neurophysiological approaches may also lead to the development of new therapeutic strategies, which have the potential of enhancing sensorimotor recovery in patients with SCI. © 2013 Elsevier B.V. Source

Brigo F.,University of Verona | Ausserer H.,Franz Tappeiner Hospital | Tezzon F.,Franz Tappeiner Hospital | Nardone R.,Franz Tappeiner Hospital | Nardone R.,Paracelsus Medical University
Epilepsy and Behavior

The experimental and clinical evidence in support of "rational polytherapy" is sparse, and to date, no clear evidence-based indications can be made to help physicians in their choice of a specific drug combination against specific forms of epilepsy. This article briefly reviews the data available in the literature and obtained from studies conducted in humans to evaluate which main AED combinations might possess supraadditive, synergistic effects in terms of efficacy, with infraadditive toxicity. By far, the most documented association resulting in supraadditive anticonvulsant effects against focal seizures is that of VPA and LTG. There are some indications that combinations of drugs with different primary mechanisms of action may be more effective than combining drugs with the same mechanisms of action. However, further animal and human research studies that focus both on toxicity and anticonvulsant effects of various combinations of AEDs are required. © 2013 Elsevier Inc. Source

Brigo F.,University of Verona | Tezzon F.,Franz Tappeiner Hospital | Nardone R.,Franz Tappeiner Hospital | Nardone R.,Paracelsus Medical University
Epilepsy and Behavior

Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60. years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients. © 2013 Elsevier Inc. Source

Brigo F.,University of Verona | Lochner P.,Franz Tappeiner Hospital | Tezzon F.,Franz Tappeiner Hospital | Nardone R.,Franz Tappeiner Hospital | Nardone R.,Paracelsus Medical University
Multiple Sclerosis and Related Disorders

Objective Millions of people worldwide use the Internet daily as a source of health information. Google is the most popular search engine and is used by patients and physicians to search for online health-related information. This study aimed to evaluate changes in Web search behavior occurring in English-speaking countries over time for the term "multiple sclerosis" (MS). Methods Using Google Trends, data on global search queries for the term "multiple sclerosis" between January 2004 and December 2013 were analyzed. Results Over time there was a reduction in tendency to search for the term "multiple sclerosis". Most terms associated with the search queries for MS were related to causes and symptoms (including pain) of the disease, and most peaks in search volume over the period studied corresponded to news of celebrities having MS. Conclusions Most people appear to use search engines to look for MS to obtain information on symptoms, possibly to aid initial self-diagnosis. News on celebrities with MS seem to be a major factor that influences online search behavior. © 2014 Elsevier B.V. Source

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