Santa Maria della Versa, Italy
Santa Maria della Versa, Italy

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Beghi E.,CNR Institute of Neuroscience | Beretta S.,NeuroLogica | Consoli D.,U.O. di Neurologia | Crespi V.,U.O. di Neurologia | And 10 more authors.
Neurology | Year: 2011

Objective: To assess incidence and predictors of acute symptomatic seizures in a prospective cohort of patients with first stroke. Methods: Patients with first stroke hospitalized in 31 Italian centers were recruited. Relevant demographic data, disease characteristics, and risk factors were collected. Acute symptomatic seizures (≤7 days) were recorded and correlated to age, gender, family history of epilepsy, and vascular risk factors. Results: A total of 714 patients (315 women, 399 men; age 27-97 years) were enrolled. A total of 609 (85.3%) had cerebral infarction (32 cerebral infarction with hemorrhagic transformation [CIHT]) and 105 (14.7%) primary intracerebral hemorrhage (PIH). A total of 141 (19.7%) had a large lesion (>3 cm) and 296 (41.5%) cortical involvement. Twelve patients reported family history of seizures. Forty-five patients (6.3%) presented acute symptomatic seizures, 24 with cerebral infarction (4.2%), 4 with CIHT (12.5%), and 17 (16.2%) with PIH. In multivariate analysis, compared to cerebral infarction, PIH carried the highest risk (odds ratio [OR] 7.2; 95% confidence interval [CI] 3.5-14.9) followed by CIHT (OR 2.7; 95% CI 0.8-9.6). Cortical involvement was a risk factor for PIH (OR 6.0; 95% CI 1.8-20.8) and for CI (OR 3.1; 95% CI 1.3-7.8). Hyperlipidemia (OR 0.2; 95% CI 0.03-0.8) was a protective factor for IPH. Conclusion: The incidence of acute symptomatic seizures is the highest reported in patients with first stroke with prospective follow-up. Hemorrhagic stroke and cortical lesion were independent predictors of acute symptomatic seizures. Hyperlipidemia was a protective factor for hemorrhagic stroke. Copyright © 2011 by AAN Enterprises, Inc.


Giovannelli F.,Unita Operativa di Neurologia | Giovannelli F.,University of Florence | Banfi C.,University of Florence | Borgheresi A.,Unita Operativa di Neurologia | And 5 more authors.
Cortex | Year: 2013

Transcranial magnetic stimulation (TMS) and neuroimaging studies suggest a functional link between the emotion-related brain areas and the motor system. It is not well understood, however, whether the motor cortex activity is modulated by specific emotions experienced during music listening. In 23 healthy volunteers, we recorded the motor evoked potentials (MEP) following TMS to investigate the corticospinal excitability while subjects listened to music pieces evoking different emotions (happiness, sadness, fear, and displeasure), an emotionally neutral piece, and a control stimulus (musical scale). Quality and intensity of emotions were previously rated in an additional group of 30 healthy subjects. Fear-related music significantly increased the MEP size compared to the neutral piece and the control stimulus. This effect was not seen with music inducing other emotional experiences and was not related to changes in autonomic variables (respiration rate, heart rate). Current data indicate that also in a musical context, the excitability of the corticomotoneuronal system is related to the emotion expressed by the listened piece. © 2012 Elsevier Ltd.


Stracciari A.,Unita Operativa di Neurologia | Baldin E.,Unita Operativa di Neurologia | Cretella L.,Unita Operativa di Neurologia | Delaj L.,Unita Operativa di Neurologia | And 2 more authors.
Neurological Sciences | Year: 2011

Three cirrhotic patients with chronic acquired hepatocerebral degeneration (CAHD) received neurologic, neuropsychologic and neuroimaging assessment before and after liver transplantation (LT). Before transplantation, neurologic dysfunction consisted in severe bradykinesia, dystonia, dyskinesia, ataxia and dysarthria. Cognitive impairment affected mainly attentional and executive domains. Brain MRI showed bilateral hyperintensities of the basal ganglia on T1-weighted images. After transplantation, motor manifestations promptly resolved. Cognitive testing showed a major improvement in two patients, whereas cognitive performances were slightly worsened in the third, reasonably due to the effects of a head injury before LT and a tacrolimus-related encephalopathy arising early after LT. MRI images 12 months later showed a slight reduction of the previously disclosed abnormalities in all three patients. None of them experienced recurrence of CAHD. Our observation reinforces the assumption that surgery is the best treatment option for CAHD and that severe neurological impairment in CAHD should not be considered a contraindication for LT. © Springer-Verlag 2010.


Galli G.,University of Florence | Ragazzoni A.,Unita Operativa di Neurologia | Viggiano M.P.,University of Florence
Alzheimer's and Dementia | Year: 2010

Background: Our goal was to verify whether behavioral and electrophysiological measures of visual object priming can differentiate between patients with mild cognitive impairment (MCI) and elderly control subjects. Methods: An identification-priming paradigm with spatially filtered stimuli was used. Subjects were presented with complete forms of the stimuli in the study phase. In the subsequent test phase, studied items were repeated in an ascending sequence of spatially filtered stimuli, following a coarse-to-fine order. Event-related potentials and behavioral measures were recorded. Results: Behavioral priming effects were observed in the elderly and in MCI participants. None of the well-known event-related potential indices of stimulus repetition emerged in the MCI group. In elderly controls, stimulus repetition was associated with a frontal modulation, likely indexing familiarity. Priming effects in the MCI group were probably based on memory mechanisms altered by degenerative pathology. Conclusions: Event-related potentials hold great potential for the early detection of subjects at risk for dementia, because they may reveal possible functional brain abnormalities that are not detectable at clinical or behavioral levels. © 2010 The Alzheimer's Association. All rights reserved.


Picetti E.,Servizio Anestesia Rianimazione | Antonini M.V.,Servizio Anestesia Rianimazione | Bartolini Y.,University of Parma | DeAngelis A.,University of Parma | And 4 more authors.
Neurocritical Care | Year: 2016

Background: The aim of this study was to evaluate the association between fever after the first days of ICU stay and neurological outcome after cardiac arrest (CA). Methods: We retrospectively analyzed CA patients admitted to intensive care unit (ICU). Inclusion criteria: age ≥18 years, Glasgow Coma Scale score ≤8 at ICU admission and assessment of body core temperature (BCT) using bladder or intravascular probes. Exclusion criteria: ICU length of stay (LOS) <3 days and pregnancy. The primary endpoint was neurological outcome assessed with Cerebral Performance Category (CPC) scale 6 months after CA. Results: One hundred thirty-two patients were analyzed. Fever was present in 105 (79.6 %) patients. Variables associated with unfavorable outcome were (1) older age (p < 0.0025); (2) non-shockable cardiac rhythms (p < 0.0001); (3) higher Simplified Acute Physiology Score (SAPS) II (p < 0.0001); (4) pupillary abnormalities at ICU admission (p < 0.018); and (5) elevated degree of maximal BCT (Tmax) during ICU stay (p < 0.046). After multivariate analysis, Tmax maintained a significant relationship with neurological outcome. An increase of 1 °C in Tmax during ICU stay decreased the odds ratio for a favorable outcome by a factor of 31 % (p < 0.001). Moreover, we discovered a significant interaction between the day of Tmax (t-Tmax) and Tmax (p = 0.004); the later Tmax occurs, the more deleterious effects are observed on outcome. Conclusions: Fever is frequent after CA, and Tmax in ICU is associated with worsened neurological outcome. This association becomes stronger as the timing of Tmax extends further from the CA. © 2016, Springer Science+Business Media New York.


Caravaglios G.,Unita Operativa di Neurologia | Muscoso E.G.,Unita Operativa di Neurologia | Di Maria G.,Unita Operativa di Neurologia | Costanzo E.,Unita Operativa di Neurologia
Journal of Neural Transmission | Year: 2013

We examined the hypothesis that the attention/executive deficits in mild cognitive impairment (MCI) due to Alzheimer's disease is associated to an abnormal cortical activation, revealed by the method of event-related synchronization/desynchronization (ERS/ERD) in the theta band during a paradigm of temporal orienting of attention. MCI patients (n = 25) and healthy elderly (HE) matched controls (n = 15) performed a task in which periodically omitted tones had to be predicted and their virtual onset time had to be marked by pressing a button. Single-trial theta responses were measured, respectively, before and after the motor response. Then, theta responses were compared to theta power during eyes closed resting state (ERD/ERS method).The temporal course of the task was characterized by two different behavioural conditions: (1) a pre-event epoch, in which the subject awaited the virtual onset of the omitted tone, (2) a post-event (after button pressing) epoch, in which the subject was in a post-motor response condition. The most important findings are summarized as follows: (1) in both groups, the pre-event epoch was characterized by theta ERS on temporal electrodes, but HE had a greater theta ERS compared to that of MCI group; (2) in both groups, during the post-motor condition, there was a theta ERS on prefrontal regions, and, also in this case, HE showed a greater theta enhancement compared to that of MCI patients; (3) HE showed evidence of lateralization: during the waiting epoch, theta ERS was dominant on the right posterior temporal lead (T6), whilst, during the post-motor epoch, theta ERS was greater on the left, as well as the midline prefrontal leads. Compared to the traditional neuropsychological measures for the episodic memory, these theta ERS indicators were less accurate in differentiating MCI patients from healthy elderly. The clinical relevance of these findings is that the weaker theta reactivity in MCI would indicate an early impairment in the temporal orienting of attention in the early stage of the clinical course of this neurodegenerative disease. © 2012 Springer-Verlag Wien.


Tomasino B.,IRCCS E. Medea | Marin D.,IRCCS E. Medea | Maieron M.,Fisica Medica A.O.S. Maria della Misericordia | Ius T.,Unita Operativa di Neurochirurgia | And 4 more authors.
Cortex | Year: 2013

The present study explored the functional neuroanatomy of Foreign Accent Syndrome (FAS) in an Italian native speaker who developed an altered speech rhythm and melody following a circumscribed tumour to the left precentral gyrus. Structural, functional, fibre tracking and intraoperative findings were combined. No signs of dysarthria, apraxia of speech, or aphasia nor other cognitive deficits were detected, except for the fact that the patient was perceived as a non-native speaker. The patient fMRI maps were compared with a control group of 12 healthy controls. During counting, sentences and pseudoword pronunciation the patient showed an additional increased sparse activation in areas around the pre/postcentral gyrus corresponding to those involved in phonation (i.e., larynx motor area). The intraoperative cortical stimulation mapping evidenced a mouth motor representation close to the tumour, a motor type of speech arrest site just below it, and anteriorly a proper speech arrest site. Our results are discussed within the current neurolinguistic models of speech production, and emphasize the importance of the primary motor cortex. We argue that this FAS case should be thought of as a disorder of the feedforward control commands, in particular of the articulator velocity and position maps which are hypothesized to lie along the caudoventral portion of the precentral gyrus. © 2011 Elsevier Ltd.


Parma V.,University of Padua | Zanatto D.,University of Padua | Straulino E.,University of Padua | Scaravilli T.,Unita Operativa di Neurologia | Castiello U.,University of Padua
Frontiers in Neurology | Year: 2014

The performance of patients with vascular parkinsonism (VPD) on a reach-to-grasp task was compared with that of patients affected by idiopathic Parkinson's disease (IPD) and age-matched control subjects. The aim of the study was to determine how patients with VPD and IPD compare at the level of the kinematic organization of prehensile actions. We examined how subjects concurrently executed the transport and grasp components of reach-to-grasp movements when grasping differently sized objects. When comparing both VPD and IPD groups to control subjects, all patients showed longer movement duration and smaller hand opening, reflecting bradykinesia and hypometria, respectively. Furthermore, for all patients, the onset of the manipulation component was delayed with respect to the onset of the transport component. However, for patients with VPD this delay was significantly smaller than that found for the IPD group. It is proposed that this reflects a deficit - which is moderate for VPD as compared to IPD patients - in the simultaneous (or sequential) implementation of different segments of a complex movement. Altogether these findings suggest that kinematic analysis of reach-to-grasp movement has the ability to provide potential instruments to characterize different forms of parkinsonism. © 2014 Parma, Zanatto, Straulino, Scaravilli and Castiello.


PubMed | Servizio Anestesia Rianimazione, University of Parma and Unita Operativa di Neurologia
Type: Journal Article | Journal: Neurocritical care | Year: 2016

The aim of this study was to evaluate the association between fever after the first days of ICU stay and neurological outcome after cardiac arrest (CA).We retrospectively analyzed CA patients admitted to intensive care unit (ICU).age 18 years, Glasgow Coma Scale score 8 at ICU admission and assessment of body core temperature (BCT) using bladder or intravascular probes.ICU length of stay (LOS) <3 days and pregnancy. The primary endpoint was neurological outcome assessed with Cerebral Performance Category (CPC) scale 6 months after CA.One hundred thirty-two patients were analyzed. Fever was present in 105 (79.6%) patients. Variables associated with unfavorable outcome were (1) older age (p < 0.0025); (2) non-shockable cardiac rhythms (p < 0.0001); (3) higher Simplified Acute Physiology Score (SAPS) II (p < 0.0001); (4) pupillary abnormalities at ICU admission (p < 0.018); and (5) elevated degree of maximal BCT (Tmax) during ICU stay (p < 0.046). After multivariate analysis, Tmax maintained a significant relationship with neurological outcome. An increase of 1 C in Tmax during ICU stay decreased the odds ratio for a favorable outcome by a factor of 31% (p < 0.001). Moreover, we discovered a significant interaction between the day of Tmax (t-Tmax) and Tmax (p = 0.004); the later Tmax occurs, the more deleterious effects are observed on outcome.Fever is frequent after CA, and Tmax in ICU is associated with worsened neurological outcome. This association becomes stronger as the timing of Tmax extends further from the CA.


PubMed | Fondazione IRCCS Instituto Neurologico Carlo Besta, University of Padua, University of Florence and Unita Operativa di Neurologia
Type: | Journal: Neuroscience | Year: 2014

In time processing, the role of different cortical areas is still under investigation. Event-related potentials (ERPs) represent valuable indices of neural timing mechanisms in the millisecond-to-second domain. We used an interference approach by repetitive TMS (rTMS) on ERPs and behavioral performance to investigate the role of different cortical areas in processing basic temporal information. Ten healthy volunteers were requested to decide whether time intervals between two tones (S1-S2, probe interval) were shorter (800ms), equal to, or longer (1200ms) than a previously listened 1000-ms interval (target interval) and press different buttons accordingly. This task was performed at the baseline and immediately after a 15-min-long train of 1-Hz rTMS delivered over the supplementary motor area, right posterior parietal cortex, right superior temporal gyrus, or an occipital control area. Task accuracy, reaction time, and ERPs during (contingent negative variation, CNV) and after the presentation of probe intervals were analyzed. At the baseline, CNV amplitude was modulated by the duration of the probe interval. RTMS had no significant effect on behavioral or ERP measures. These preliminary data suggest that stimulated cortical areas are less crucially involved than other brain regions (e.g. subcortical structures) in the explicit discrimination of auditory time intervals in the range of hundreds of milliseconds.

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