Unita Operativa di Neurologia

Santa Maria della Versa, Italy

Unita Operativa di Neurologia

Santa Maria della Versa, Italy
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Giovannelli F.,Unita Operativa di Neurologia | Giovannelli F.,University of Florence | Innocenti I.,University of Siena | Rossi S.,University of Siena | And 5 more authors.
Cerebral Cortex | Year: 2014

Synchronization of body movements to an external beat is a universal human ability, which has also been recently documented in nonhuman species. The neural substrates of this rhythmic motor entrainment are still under investigation. Correlational neuroimaging data suggest an involvement of the dorsal premotor cortex (dPMC) and the supplementary motor area (SMA). In 14 healthy volunteers, we more specifically investigated the neural network underlying this phenomenon using a causal approach by an established 1-Hz repetitive transcranial magnetic stimulation (rTMS) protocol, which produces a focal suppression of cortical excitability outlasting the stimulation period. Synchronization accuracy between rhythmic cues and right index finger tapping, as measured by the mean time lag (asynchrony) between motor and auditory events, was significantly affected when the right dPMC function was transiently perturbed by "off-line" focal rTMS, whereas the reproduction of the rhythmic sequence per se (inter-tap-interval) was spared. This approach affected metrical rhythms of different complexity, but not non-metrical or isochronous sequences. Conversely, no change in auditory-motor synchronization was observed with rTMS of the SMA, of the left dPMC or over a control site (midline occipital area). Our data strongly support the view that the right dPMC is crucial for rhythmic auditory-motor synchronization in humans. © 2012 The Author. Published by Oxford University Press. All rights reserved.


Innocenti I.,University of Siena | Giovannelli F.,Unita Operativa di Neurologia | Giovannelli F.,University of Florence | Cincotta M.,Unita Operativa di Neurologia | And 5 more authors.
NeuroImage | Year: 2010

The "level of processing" effect is a classical finding of the experimental psychology of memory. Actually, the depth of information processing at encoding predicts the accuracy of the subsequent episodic memory performance. When the incoming stimuli are analyzed in terms of their meaning (semantic, or deep, encoding), the memory performance is superior with respect to the case in which the same stimuli are analyzed in terms of their perceptual features (shallow encoding).As suggested by previous neuroimaging studies and by some preliminary findings with transcranial magnetic stimulation (TMS), the left prefrontal cortex may play a role in semantic processing requiring the allocation of working memory resources. However, it still remains unclear whether deep and shallow encoding share or not the same cortical networks, as well as how these networks contribute to the "level of processing" effect. To investigate the brain areas casually involved in this phenomenon, we applied event-related repetitive TMS (rTMS) during deep (semantic) and shallow (perceptual) encoding of words. Retrieval was subsequently tested without rTMS interference. RTMS applied to the left dorsolateral prefrontal cortex (DLPFC) abolished the beneficial effect of deep encoding on memory performance, both in terms of accuracy (decrease) and reaction times (increase). Neither accuracy nor reaction times were instead affected by rTMS to the right DLPFC or to an additional control site excluded by the memory process (vertex). The fact that online measures of semantic processing at encoding were unaffected suggests that the detrimental effect on memory performance for semantically encoded items took place in the subsequent consolidation phase. These results highlight the specific causal role of the left DLPFC among the wide left-lateralized cortical network engaged by long-term memory, suggesting that it probably represents a crucial node responsible for the improved memory performance induced by semantic processing. © 2010 Elsevier Inc.


Sacco S.,University of L'Aquila | Stracci F.,University of Perugia | Cerone D.,University of L'Aquila | Ricci S.,Unita Operativa di Neurologia | Carolei A.,University of L'Aquila
International Journal of Stroke | Year: 2011

This study reviews available data on stroke epidemiology in Italy. Data were identified through Medline/PubMed, Embase, and from reference lists, related articles, and citation lists of each of the retrieved papers. Nineteen papers were considered, referring to selected stroke-registers performed in seven different geographical areas: Acquaviva-Casamassima county, Aeolian Islands, Aosta district, Belluno district, L'Aquila district, Trasimeno area, and Vibo Valentia district. Registers covered a total population of 2262940 people, with a hospitalization rate from 82% to 98%. The mean age at stroke onset was 74·6 ± 1·1 years, 72·3 years in men and 76·6 years in women. Among all strokes: 67·3-82·6% were classified ischemic 9·9-19·6% as primary intracerebral hemorrhage 1·6-4·0% as sub-arachnoid hemorrhage, and 1·2-17·7% as undetermined. Annual incidence rates standardized to the Italian population ranged from 175/100000 to 360/100000 in men and from 130/100000 to 273/100000 in women. Thirty-day case-fatality rates for all strokes ranged from 18·1% to 33·0% while one-year case-fatality rates ranged from 37·9% to 40·2%. Data from selected Italian registers on stroke incidence and case-fatality indicate the great burden of the disease on our national healthcare system. The continuous implementation of preventive strategies, either population-based or addressed to the single patient at a high risk of stroke, is important to reduce the burden of the disease. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.


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.


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.

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