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Solaro C.,Neurology Unit | Trabucco E.,Neurology Unit
Current Neurology and Neuroscience Reports | Year: 2013

Pain is a common symptom in multiple sclerosis (MS) and has recently been estimated to be experienced by up to 75 % of patients. Pain can be present at any point in the course of the disease and patients may experience pain from various causes simultaneously. Pain in MS can also be secondary to other symptoms, such as spasticity, fatigue, and mood disorder. Of all drug use to treat MS symptoms, treatment for pain accounts for nearly 30 % of total use. At the same time, patients report low satisfaction with pain management. Pain affects quality of life and can influence a person's participation in family life and work and affect mood. Most of the pain literature in the field of MS is based on open-label studies involving small numbers of subjects. Placebo-controlled trials in severe pain syndromes such as trigeminal neuralgia are unethical but for other types of MS-related pain conditions, placebo-controlled trials are ethical and necessary to establish efficacy, particularly given the well-documented placebo effect for various painful conditions This review discusses available data and emphasizes areas of pain research that require further attention © 2012 Springer Science+Business Media New York.


Mendez-Ayala A.,Neurology Unit | Narino D.,Neurology Unit | Rosselli D.,Pontifical Xavierian University
Neuroepidemiology | Year: 2015

Background: Epilepsy lays an important burden on healthcare systems and society in general. Disability adjusted life years (DALYs) have been developed to compare the burden of this disease both between conditions and between geographical boundaries. With improving data on disease incidence and prevalence in Colombia, we can refine our DALYs-based estimates. Methods: Using different strategies, including the official healthcare provision database and death certificates, as well as extrapolation from published neuroepidemiologic studies, we estimated the incidence and prevalence by age groups, disease duration and attributable mortality. With this information we calculated DALYs for the year 2012. Results: Overall, it was found that epilepsy was responsible for 0.88% of all deaths in Colombia. A total of 5.25 DALYs per 1,000 person-years are lost due to epilepsy in Colombia, 75% of which (3.91 DALYs) are due to premature mortality, with a higher burden in men (6.12 DALYs) than in women (4.41 DALYs). Conclusions: We reported new estimations on epilepsy incidence and prevalence by age groups in Colombia and conclude that DALYs lost due to epilepsy in Colombia are almost double the previous figure, mostly because of the underestimation of attributable mortality. With this figure, epilepsy ranks 12th instead of 19th in the list of the most important causes of DALYs lost. © 2015 S. Karger AG, Basel.


Agosta F.,Vita-Salute San Raffaele University | Canu E.,Vita-Salute San Raffaele University | Valsasina P.,Vita-Salute San Raffaele University | Riva N.,San Raffaele Scientific Institute | And 4 more authors.
Neurobiology of Aging | Year: 2013

Using resting state (RS) functional magnetic resonance imaging and independent component analysis, the integrity of brain networks related to cognition and behavior was investigated in 20 nondemented patients with amyotrophic lateral sclerosis (ALS). The association between RS functional connectivity and executive functions was assessed in 16 patients with neuropsychological assessment. ALS patients compared with control subjects showed a decreased connectivity of the right orbitofrontal cortex, and an enhanced connectivity of the left precuneus in the default mode network; a decreased connectivity of the left inferior frontal cortex, and an increased connectivity of the right angular gyrus in the right frontoparietal network; and an increased connectivity of the parietal cortex in the left frontoparietal network. The enhanced parietal connectivity was associated with the clinical and cognitive deficits of the patients. In ALS, an alteration of large-scale functional brain networks associated with cognition does occur, even in the absence of overt dementia. The increased parietal connectivity may have a role in an attempt to maintain cognitive efficiency in the presence of structural frontotemporal injury. © 2013 Elsevier Inc.


Le Rhun E.,University Hospital | Le Rhun E.,Neurology Unit | Taillibert S.,University Pierre and Marie Curie | Chamberlain M.C.,University of Washington
Expert Review of Neurotherapeutics | Year: 2015

Anaplastic glioma (AG) is divided into three morphology-based groups (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma) as well as three molecular groups (glioma-CpG island methylation phenotype [G-CIMP] negative, G-CIMP positive non-1p19q codeleted tumors and G-CIMP positive codeleted tumors). The RTOG 9402 and EORTC 26951 trials established radiotherapy plus (procarbazine, lomustine, vincristine) chemotherapy as the standard of care in 1p/19q codeleted AG. Uni-or non-codeleted AG are currently best treated with radiotherapy only or alkylator-based chemotherapy only as determined by the NOA-04 trial. Maturation of NOA-04 and results of the currently accruing studies, CODEL (for codeleted AG) and CATNON (for uni or non-codeleted AG), will likely refine current up-front treatment recommendations for AG. © 2015 Infoema Uk, Ltd.


Poletti M.,Neurology Unit | Poletti M.,University of Pisa | Emre M.,Istanbul University | Bonuccelli U.,Neurology Unit | Bonuccelli U.,University of Pisa
Parkinsonism and Related Disorders | Year: 2011

Patients with Parkinson's disease (PD) typically present with motor symptoms, but non-motor symptoms, including cognitive impairment, autonomic dysfunction and neuropsychiatric symptoms, are usually also present, when looked for carefully. The objective of this paper is to provide an up-to-date, comprehensive review of two undecided issues about cognitive impairment in PD patients without dementia: the concept of Mild Cognitive Impairment (MCI) and the concept of Cognitive Reserve (CR). Empirical findings support the value of the concept of MCI in this population, from the early untreated stages onwards. Further studies are needed to establish 1) the clinical-neuroimaging characteristics of MCI subtypes in PD, in comparison to those MCI subtypes in patients without PD; 2) whether different types of MCI in PD are associated with different rates of cognitive decline during the progression of the disease. Preliminary empirical evidence also shows that education might exert a protective effect on cognitive decline in PD and that less educated subjects are at increased risk for developing dementia, lending support to the CR hypothesis, in this population as well. Further studies are necessary to investigate how CR modulates cognitive decline in PD and other frontal-subcortical disorders, e.g. by identifying possible differential effects of CR on different cognitive domains. © 2011 Elsevier Ltd.


Yuvaraj R.,University Malaysia Perlis | Murugappan M.,University Malaysia Perlis | Norlinah M.I.,Neurology Unit | Sundaraj K.,University Malaysia Perlis | Khairiyah M.,Neurology Unit
Dementia and Geriatric Cognitive Disorders | Year: 2013

Objective: Patients suffering from stroke have a diminished ability to recognize emotions. This paper presents a review of neuropsychological studies that investigated the basic emotion processing deficits involved in individuals with interhemispheric brain (right, left) damage and normal controls, including processing mode (perception) and communication channels (facial, prosodic-intonational, lexical-verbal). Methods: An electronic search was conducted using specific keywords for studies investigating emotion recognition in brain damage patients. The PubMed database was searched until March 2012 as well as citations and reference lists. 92 potential articles were identified. Results: The findings showed that deficits in emotion perception were more frequently observed in individuals with right brain damage than those with left brain damage when processing facial, prosodic and lexical emotional stimuli. Conclusion: These findings suggest that the right hemisphere has a unique contribution in emotional processing and provide support for the right hemisphere emotion hypothesis. Significance: This robust deficit in emotion recognition has clinical significance. The extent of emotion recognition deficit in brain damage patients appears to be correlated with a variety of interpersonal difficulties such as complaints of frustration in social relations, feelings of social discomfort, desire to connect with others, feelings of social disconnection and use of controlling behaviors. © 2013 S. Karger AG, Basel.


Salawu F.K.,Neurology Unit
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria | Year: 2010

BACKGROUND: Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health, quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. METHODS: Literature search was performed using the reference databases Medline, Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms', Parkinson's disease, olfaction and constipation. Papers discovered by this search were reviewed, as were references cited therein. RESULTS: Contrary to common perception, many NMS of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction. CONCLUSION: There is compelling evidence that non-motor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoL of their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated.


Salawu F.K.,Neurology Unit
The Nigerian postgraduate medical journal | Year: 2011

Although epilepsy affects men and women equally, there are special implications for women, especially during their childbearing years, and particularly when pregnancy is contemplated. This review summarisesthe complexity and multifaceted nature of health issues affecting women with epilepsy (WWE) in general and epilepsy in women beyond childbearing age. The female sex hormones and their cyclic as well as age-related variations certainly influence seizure activity and epilepsy in women. Catamenial epilepsy is a multifaceted neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around perimenstrual or periovulatory period. There are special concerns for women of child bearing years with regard to contraception, pregnancy and teratogenicity that should be considered during counseling and selection of appropriate treatment.Although the majority of pregnant WWE experience normal pregnancies and deliveries, their children have a higher risk of birth defects. Individualised treatment coupling antiepileptic drug use (AED) and the specific phase of impact of the reproductive cycle must be considered in treatment selection. As the number of available treatment options for epilepsy increases, the optimal goal for the general practitioner is to work as a team with obstetricians and gynaecologists, and neurologists in an effort to ensure the best treatment of WWE


Solaro C.,Neurology Unit
Current neurology and neuroscience reports | Year: 2013

Pain is a common symptom in multiple sclerosis (MS) and has recently been estimated to be experienced by up to 75 % of patients. Pain can be present at any point in the course of the disease and patients may experience pain from various causes simultaneously. Pain in MS can also be secondary to other symptoms, such as spasticity, fatigue, and mood disorder. Of all drug use to treat MS symptoms, treatment for pain accounts for nearly 30 % of total use. At the same time, patients report low satisfaction with pain management. Pain affects quality of life and can influence a person's participation in family life and work and affect mood. Most of the pain literature in the field of MS is based on open-label studies involving small numbers of subjects. Placebo-controlled trials in severe pain syndromes such as trigeminal neuralgia are unethical but for other types of MS-related pain conditions, placebo-controlled trials are ethical and necessary to establish efficacy, particularly given the well-documented placebo effect for various painful conditions This review discusses available data and emphasizes areas of pain research that require further attention.


Naco D.,Neurology unit
Medicinski arhiv | Year: 2013

To evaluate the usefulness of MMSE score in vascular dementia and the influence of different factors on the MMSE score. We studied 78 stroke patients followed up at the neurology unit, Specialistic Polyclinic 2, Tirana. A neurological visit is done and the MMSE score is calculated for each of them. We noted the stroke form (ischemic, hemorrhagic), patient's age, education, time from stroke onset, accompanying neurological disorders (parkinsonism, epilepsy), risk factors (arterial hypertension, cardiac diseases, diabetes mellitus, smoking, carotid stenosis). The imaging (CT and/or MRI) of the brain is requested. Independent Samples Test, t-test for Equality of Means, 2 - tailed, is applied for the statistical evaluation. The mean age of the patients in the study is 70.31 years old. There are 37 females (47.43%) and 41 males (52.56%). 12 (15.38%) patients had hemorrhagic and 66 (84.61%) ischemic stroke. The mean time from stroke onset is 4.55 years. 15 (19.2%) patients have parkinsonism, 1 other extra pyramidal disorder, 3 (3.8%) secondary generalized epilepsy. The mean MMSE score for all patients is 23.48. The multi ischemic cerebral lesions were present in the imaging of 12 (15.38%) patients. The generalized cortical atrophy is found in 25 (32%) patients and the temporal atrophy in 14 (17.94%) patients. We analyzed the data of 37 patients [16 (43.24%) females and 21 (56.75%) males], with MMSE score < or = 23. The mean age is 75.39 years old. 6 (16.21%) patients are diagnosed with hemorrhagic stroke. 3 (8.1%) patients have secondary generalized epilepsy, 9 (24.32%) are suffering of parkinsonism and the mean time from stroke onset is 4.31 years. The imaging study revealed multi ischemic cerebral lesions in 9 (24.3%) patients. We found accompanying temporal atrophy in 10 (27%) patients, frontal atrophy in 2 (5.4%) patients, and generalized cortical atrophy in 17 (45.9%) patients. Dementia after stroke is frequent. The MMSE is still a useful scale to evaluate the VaD and is related to age, gender, education, stroke age, cardiovascular risk factors, stroke type and localization, other neurological disorders as epilepsy and parkinsonism.

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