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Ferrara, Italy

Tamburo E.,University of Palermo | Varrica D.,University of Palermo | Dongarra G.,University of Palermo | Grimaldi L.M.E.,UO Neurologia
PLoS ONE | Year: 2015

Background: Epidemiological studies have suggested a possible role of trace elements (TE) in the etiology of several neurological diseases including Multiple Sclerosis (MS). Hair analysis provides an easy tool to quantify TE in human subjects, including patients with neurodegenerative diseases. Objective: To compare TE levels in scalp hair from patients with MS and healthy controls from the same geographic area (Sicily). Methods: ICP-MS was used to determine the concentrations of 21 elements (Ag, Al, As, Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sr, U, V and Zn) in scalp hair of 48 patients with relapsing -remitting Multiple Sclerosis compared with 51 healthy controls. Results: MS patients showed a significantly lower hair concentration of aluminum and rubidium (median values: Al = 3.76 μg/g vs. 4.49 μg/g and Rb = 0.007 μg/g vs. 0.01 μg/g;) and higher hair concentration of U (median values U: 0.014 μg/g vs. 0.007 μg/g) compared to healthy controls. The percentages of MS patients showing hair elemental concentrations greater than the 95th percentile of controls were 20% for Ni, 19% for Ba and U, and 15% for Ag, Mo and Se. Conversely, the percentages of MS patients showing hair elemental concentrations lower than the 5th percentile of healthy controls were 27% for Al, 25% for Rb, 22%for Ag, 19%for Fe, and 16% for Pb. No significant association was found between levels of each TE and age, disease duration or Expanded Disability Status Scale (EDSS) score. After stratification by gender, healthy subjects did not show any significant difference in trace element levels, while MS patients showed significant differences (p<0.01) for the concentrations of Ag, Cr, Fe, Ni and Sr. No significant differences were also found, at p<0.01, in relation to the use of cigarettes, consume of water, vegetables and place of living. Conclusion: The different distributions of TE in hair of MS patients compared to controls provides an additional indirect evidence of metabolic imbalance of chemical elements in the pathogenesis of this disease. The increase in U and decrease in Al and Rb levels in MS compared to controls require further assessments as well as the observed different distributions of other elements. © 2015 Tamburo et al.

Verrotti A.,University of Perugia | Loiacono G.,University of Chieti Pescara | Rossi A.,University of Chieti Pescara | Zaccara G.,UO Neurologia
Epilepsy Research | Year: 2014

Epilepsy is a common neurological disorder. Despite a broad range of commonly used antiepileptic drugs, approximately 30% of patients with epilepsy have drug resistance or encounter significant adverse effects. Eslicarbazepine acetate is a new central nervous system-active compound with anticonvulsant activity whose mechanism of action is by blocking the voltage-gated sodium channel. Eslicarbazepine acetate was approved by the European Medicines Agency and launched onto the European market in 2009 for adjunctive treatment in adult subjects of partial-onset seizures, with or without secondary generalization. This article provides an overview on the recent studies on eslicarbazepine acetate in the treatment of drug-resistant partial epilepsy. Efficacy and safety of this drug for partial-onset seizures were assessed in four randomized clinical trials with responder rates ranged between 17% and 43%. Adverse events were usually mild to moderate in intensity and the most common were dizziness, somnolence, nausea, diplopia, headache, vomiting, abnormal coordination, blurred vision, vertigo and fatigue. Eslicarbazepine acetate is not recommended below 18 years, but a published phase II trial had the main goal to evaluate the pharmacokinetics, efficacy and safety of this drug in pediatric population. Eslicarbazepine acetate appears to be a safe and effective drug with a linear pharmacokinetics, very low potential for drug-drug interactions and therefore it can offer a valid alternative to current antiepileptic drugs. Additionally, it is undergoing investigation for monotherapy in subjects with partial epilepsy, and other neurological and psychiatric disorders. © 2013 Elsevier B.V.

Van Zuuren E.J.,Leiden University | Fedorowicz Z.,Cochrane Collaboration | Pucci E.,UO Neurologia | Jagannath V.,American Mission Hospital
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2014

Background: It has been recently hypothesised that chronic cerebrospinal venous insuf ficiency (CCSVI) may be an important factor in the pathogenesis of multiple sclerosis (MS). The proposed treatment for CCSVI is percutaneous transluminal angioplasty, also known as the 'liberation procedure', which is claimed to improve the blood flow in the brain, thereby alleviating some of the symptoms of MS. Our objective was to determine the effects of percutaneous transluminal angioplasty used for the treatment of CCSVI in people with MS. Methods: We searched the following databases up to June 2012 for randomised controlled trials: The Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register, CENTRAL, in The Cochrane Library 2012, Issue 5, MEDLINE (from 1946), EMBASE (from 1974) and reference lists of articles. We also searched several online trials registries for ongoing trials. Results: Our searches retrieved 159 references, six of which were related to ongoing trials. No randomised controlled trials met our inclusion criteria. Conclusions: There is currently no high level evidence to support or refute the efficacy or safety of percutaneous transluminal angioplasty for treatment of CCSVI in people with MS. Clinical practice should be guided by evidence supported by well-designed randomised controlled trials: closure of some of the gaps in the evidence may be feasible at completion of the six ongoing clinical trials.

Voltage computed analysis of spikes (S) and the average amplitude of spike and wave complexes (SW) were evaluated in three adult patients with frontal pseudo-absence seizures in order to identify the origins of the abnormalities related to this type of seizures. Interhemispheric phase shift delays of S were detected in all cases. In two patients with frontal lobe damage, the average amplitude of SW was asymmetric and the phase shift analysis of S showed constant delays on one side of the brain. In one of these cases with unilateral cerebral damage, the average amplitude of SW was reduced on the damaged side, while S originated in the contralateral frontal region. In another patient with no evidence of cerebral lesions, the analysis of S indicated a bilateral independent origin of the epileptic abnormalities in homologue frontal regions, suggesting a potential pathogenic role of mirror foci in pseudo-absence seizures. Voltage computed analysis of S and SW should be considered in the diagnostic work-up of patients with generalised epileptic discharges. It should be noted that, in pseudo-absence seizures, the origin of the epileptic abnormalities may not be related to evident parenchymal damage.

Chieffi S.,The Second University of Naples | Iavarone A.,UO Neurologia | Iavarone A.,University of Naples Federico II | Carlomagno S.,University of Trieste
International Journal of Geriatric Psychiatry | Year: 2011

Objective to investigate patterns of anosognosia for memory deficit in subjects with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods the study involved twenty-five subjects with MCI, 15 with mild AD and 21 normal controls (NC). Subjective rating of memory functioning was assessed with a six-items questionnaire that was administered before and after memory testing; an informant version from caregivers gave a discrepancy score (SRD). In the Objective Judgement (OJ) task, aiming to evaluate memory-monitoring abilities, subjects were requested three times to predict their memory performance in recalling words from a list of ten. Then they had to recall the words. Prediction accuracy was computed by subtracting the predicted performance from the actual performance. Results MCI and AD showed reduced awareness of memory difficulties at the SRD and did not change their rating of these difficulties after memory testing. At the OJ task, MCI and AD consistently overestimated their memory performances as compared with NC. The SRD and OJ measures were not correlated with some patients being impaired on only one measure. Only the OJ measure was significantly related to executive functioning. Conclusions AD and MCI subjects show unawareness for memory deficit and significant memory-monitoring disorder. This confirms that anosognosia is an important symptom of MCI. Similarities of patterns of impaired awareness between AD and MCI supports the view of a continuum of the anosognosia phenomenon in MCI and AD. Copyright © 2010 John Wiley & Sons, Ltd.

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