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Verona, Italy

Farina E.,Neurorehabilitation Unit | Raglio A.,University of Ferrara | Giovagnoli A.R.,Fondazione Istituto Neurologico C. Besta
Epilepsy Research

To review the modalities of cognitive rehabilitation (CR), outcome endpoints, and the levels of evidence of efficacy of different interventions. Methods: A systematic research in Pubmed, Psychinfo, and SCOPUS was performed assessing the articles written in the entire period covered by these databases till December 2013. Articles in English, Spanish or French were evaluated. A manual research evaluated the references of all of the articles. The experimental studies were classified according to the level of evidence of efficacy, using a standardized Italian method (SPREAD, 2007), adopting the criteria reported by Cicerone et al. (2000, 2011). Results: Eighteen papers were classified into two reviews, four papers dealing with the principles and efficacy of CR in epilepsy, a methodological paper, a single-case report, a multiple-case report, and nine experimental papers. Most studies involved patients with temporal lobe epilepsy. Different types of CR were used to treat patients with epilepsy. A holistic rehabilitation approach was more useful than selective interventions to treat memory and attention disturbances. Conclusions: CR may be a useful tool to treat cognitive impairment in patients with epilepsy. However, the modalities of treatment and outcome endpoints are important concerns of clinical care and research. Controlled studies are needed to determine the efficacy of rehabilitation in well-defined groups of patients with epilepsy. © 2014 Elsevier B.V. Source

Mamo J.P.,Neurorehabilitation Unit
Scottish Medical Journal

Myocardial damage indicated by a rise in cardiac Troponin may not necessarily be due to a cardiac event. Many diseases such as sepsis, pulmonary embolism, heart and renal failure can also be associated with an elevated cardiac Troponin level. This brief report discusses the rare event of a patient with motor neurone disease, where the possible diagnosis of acute myocardial infarction arose due to an elevated cardiac Troponin. A 69-year-old gentleman presented with a history of a central chest ache of mild intensity, lasting a total of 2 h prior to complete resolution. Multiple cardiac Troponin assays were elevated, and echocardiography did not show any acute changes of myocardial damage. His electrocardiogram was also normal. This patient’s raised cardiac Troponin was therefore explained on the basis of his active motor neurone disease. This rare case outlines the importance of considering motor neurone disease as a cause of elevated cardiac Troponin in the absence of clinical evidence of an acute coronary event. © 2015, The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav. Source

Micheli S.,Neurorehabilitation Unit | Corea F.,Brain Injury Unit
Frontiers of Neurology and Neuroscience

Small-vessel disease is the accepted most frequent cause of lacunar stroke. The main clinical features seen with lacunar infarcts are motor and/or sensitive deficit, ataxic sign, without cortical involvement. A lacunar syndrome is generally the result of a small deep infarct within the territory of a single perforating artery with the maximum diameter on imaging of 15 mm. Recent studies have demonstrated alternative causes of lacunar stroke other than small-vessel disease (e.g. cardio embolism, atherosclerosis or other causes), especially in large lacunae, with a potential relevance on functional outcome. These findings suggest that lacunar stroke is not always a benign disease. Moreover, clinical features may be significant in terms of disability in lacunae in close proximity to crucial anatomical site. The following chapter reports the classical lacunar syndrome and discusses the debated etiology of lacunar stroke. Copyright © 2012 S. Karger AG, Basel. Source

Colagiorgio P.,University of Pavia | Colnaghi S.,Neurorehabilitation Unit | Versino M.,University of Pavia | Ramat S.,University of Pavia
Frontiers in Neurology

Peripheral vestibular function may be tested quantitatively, by measuring the gain of the angular vestibulo-ocular reflex (aVOR), or functionally, by assessing how well the aVOR performs with respect to its goal of stabilizing gaze in space and thus allow to acquire visual information during the head movement. In recent years, several groups have developedclinical and quantitative approaches to functional testing of the vestibular system based on the abilityto identify an optotype briefly displayed on screen during head rotations. Although the proposed techniques differ in terms of the parameters controlling the testing paradigm, no study has thus far dealt with understanding the role of such choices in determining the effectiveness and reliability of the testing approach. Moreover, recent work has shown that peripheral vestibular patients may produce corrective saccades during the head movement (covert saccades), yet the role of these eye movements toward reading ability during head rotations is not yet understood. Finally, no study has thus far dealt with measuring the true performance of their experimental setups, which is nonetheless likely to be crucial information for understanding the effectiveness of functional testing approaches. Thus we propose a new software and hardware research tool allowing the combined measurement of eye and head movements, together with the timing of the optotype on screen, during functional testing of the vestibulo-ocular reflex (VOR) based on the Head ImpulseTest. The goal of such tool is therefore that of allowing functional testing of the VOR while collecting the experimental data necessary to understand, for instance, (a) the effectiveness of the covert saccades strategy toward image stabilization, (b) which experimental parameters are crucial for optimizing the diagnostic power of the functional testing approach, and (c) which conditions lead to a successful reading or an error trial. Source

Engelter S.T.,Neurorehabilitation Unit | Engelter S.T.,University of Basel
European Journal of Physical and Rehabilitation Medicine

Pharmacological enhancement of neurorehabilitation is based on the concept of neuroplasticity. Agents with probably unfavourable effects on recovery (e.g. classical antiepileptic drugs, butyrophenones) should be avoided. The findings of experimental studies in animal models, investigations in healthy subjects and the findings of neurophysiological studies indicate that there is scope for benefit from pharmacological enhancement in stroke rehabilitation in the clinical setting - in addition to rehabilitative therapies. Randomized controlled clinical trials have shown benefit of pharmacological enhancement in stroke rehabilitation for some agents. Nevertheless, the clinical evidence regarding benefits of this treatment approach is still considered weak for the following reason: First, the beneficial findings of some studies were not confirmed by others. Second, several studies were limited by small patient populations and narrow inclusion criteria. Third, there were concerns regarding safety of some agents (i.e., piracetam, and amphetamines). Dopaminergic agents, Selective Serotonin-Reuptake-Inhibitors (SSRI) and acetylcholinesterase- inhibitors are promising candidates. Their safety and efficacy should be further investigated; ideally in - sufficiently powered - large randomized controlled trials. Source

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