LEVITIRACETAM IN THE TREATMENT OF CREUTZFIELDT-JACOB DISEASE

Disfunzioni sessuali, farmaci antiepilettici e profilo ormonale sierico negli uomini affetti da epilessia

Razionale ed obiettivi: Le disfunzioni sessuali sono un problema relativamente comune nei pazienti di sesso maschile affetti da epilessia, la cui.prevalenza varia dal 38-71%. La loro eziologia non è conosciuta e potrebbe essere multifattoriale; possono essere implicati nella loro genesi sia l’epilessia che l’utilizzo di farmaci antiepilettici (FAE). L’assunzione di farmaci per la terapia dell’epilessia può essere all’origine della presenza di DS e di alterazioni ormonali e riproduttive in questa popolazione di pazienti. Lo scopo dello studio è valutare l’incidenza delle DS negli uomini con epilessia, valutando il tipo di epilessia, la frequenza delle crisi, il tipo di FAE utilizzato, il pro…

Stroke and cardiac arrhythmias.

Stroke is frequently followed by electrocardiographic (ECG) changes. The aim of the present study was to evaluate the global incidence of these changes after ischemic or hemorrhagic strokes, but it focused on cardiac arrhythmias. In ischemic strokes, these were correlated with the side of the lesion(s). The study was retrospective, and 450 patients (out of 971 examined) were entered in the study based on the following inclusion criteria: (1) "completed" stroke (352 ischemic and 98 hemorrhagic), (2) ECG on admission, and (3) at least 1 previous ECG. We also examined 71 patients with carotid or vertebro-basilar transient ischemic attacks (TIA). As controls, 71 patients suffering from nonvascu…

Evoked potential study in facio-scapulo-humeral muscular dystrophy.

Nerve conduction velocities (NCVs), somatosensory (SEPs) and auditory evoked potentials (BAEPs) were recorded in 9 patients with facio-scapulo-humeral dystrophy (FSHD) and in 20 age-matched controls. In FSHD patients a significant increase of the nerve distal sensory latencies and of the absolute SEP latencies revealed a subclinical involvement of the afferent sensory pathways, as well as the abnormal slowing of the later components of the BAEPs, pointed to a central auditory dysfunction. Moreover all patients underwent brain MRI that showed the presence of white matter hyperintense lesions in 4 of them (44%). No correlations were found between individual or total number of SEP and BAEP abn…

Polycistic ovary syndrome and antiepileptic drugs: a cross-sectional study

Perceptual and response bias in visuospatial neglect due to frontal and parietal repetitive transcranial magnetic stimulation in normal subjects.

Recently some authors have challenged the conventional association of directional motor neglect with damage of frontal structures, showing that pure sensory perceptual neglect (classically associated with parietal lesion) can follow damage of right frontal cortex. The aim of the present study was to assess the type of defect in visuo-spatial attention consequent upon a virtual frontal or parietal lesion induced by transcranial magnetic stimulation in normal subjects. To this purpose eleven subjects performed a visuo-spatial task requiring judgement about the length of the two segments of asymmetrically bisected horizontal lines, presented for 50 ms on a computer monitor. After each visual s…

Use of antiepileptic drugs in women with polycystic ovary syndrome

Levetiracetam, a new option Treatment for Creutzfeldt-Jacob Disease.

Validation Study of Italian Version of Inventory for DéJà vu Experiences Assessment (I-IDEA): A Screening Tool to Detect DéJà vu Phenomenon in Italian Healthy Individuals

The Inventory Déjà Vu Experiences Assessment (IDEA) is the only screening instrument proposed to evaluate Déjà vu (DV) experience. Here we intended to validate the Italian version of IDEA (I-IDEA) and at the same time to investigate the incidence and subjective qualities of DV phenomenon in Italian healthy adult individuals on basis of an Italian multicentre observational study. In this study we report normative data on the I-IDEA, collected on a sample of 542 Italian healthy subjects aging between 18 to 70 years (average age 40, range 18-70) with a formal educational from 1-19 years. From September 2013 to March 2016 were recruited 542 healthy vo…

Modulatory effects of low-and high-frequence repetitive trancranial magnetic stimulation on visual cortex of healthy subjects undergoing light deprivation.

MRI abnormalities following repeated and incoming seizures

Neuroimaging, an important diagnostic tool frequently used in the evaluation of patients with epilepsy, has mainly the aim to identify structural abnormalities needing a treatment and to contribute to the definition of the aetiology. Brain magnetic resonance imaging (MRI) in epilepsy is more sensitive than computerized tomography (CT) scan for detecting abnormalities. Status epilepticus (SE) and repeated incoming seizures may determine extensive and transient or long lasting pronounced MRI changes. We describe a case of a 41-year-old woman with a history of brain neoplasm, whose contrast-enhanced MRI images following repeated and incoming seizures were characterized either by reversible and…

Dropped head as an unusual presenting sign of myasthenia gravis.

Prominent or isolated weakness of cervical extensor muscles is a relatively rare clinical sign. Commonly, this is known as "dropped-head syndrome". This abnormal flexion of the head may occur in a variety of neuromuscular diseases and in a few non-neurological disorders as well. The case we describe concerns a 61-year-old woman with dropped-head syndrome as the unique complaint of myasthenia gravis.

Antiepileptic Drugs, Sexual Functions and Serum Hormonal Profile in Males with Epilepsy

Sexual dysfunctions are a common problem in epileptic men. Etiology is multifactorial involving both epilepsy and antiepileptic drugs. Purpose of this study was to evaluate incidence of sexual dysfunctions in epileptic men, assessing epilepsy, antiepileptic drugs, serum hormonal profile, psychiatric disorders.

A six month open label study to test efficacy and tolerability of Levetiracetam as prophylactic treatment of migraine with aura.

Bimodal sensory stimulation-induced seizures.

Abstract A curious case is reported in which the patient, a young woman, exibited convulsive seizures when approaching closely to a television. The visual and acoustic stimulation did not change her EEG, whereas simultaneous stimulation with both the modalities induced bilateral and symmetrical high-voltage spikes (with their diffusion) that led to a convulsive seizure. Results are discussed with relation to the literature.

Levetiracetam in the treatment of primary generalized seizures.

Gabapentin in the treatment of hemifacial spasm

Objectives To evaluate the efficacy of gabapentin in the treatment of hemifacial spasm. Material and methods Twenty-three patients with hemifacial spasm not suitable for surgery or therapy with botulinum toxin were treated with gabapentin. The main efficacy parameter was the percentage of spasm reduction. Results A clinically significant reduction of spasms was obtained by 16 patients. Conclusion Gabapentin was effective and safe in reducing hemifacial spasm in 16 out 23 (69.6%) patients.

Hemispheric cerebellar rTMS to treat drug-resistant epilepsy: case reports.

Electrical stimulation of the cerebellar cortex by implanted electrodes has been shown to ameliorate refractory epilepsy. We investigated the potential therapeutic role of high-frequency cerebellar rTMS in patients affected by refractory epilepsy due to single or multiple foci. Six patients, three with single and three with multiple epileptic foci, underwent 20 rTMS sessions. Each session was given daily, excluding weekends, and consisted of two trains of 50 stimuli (5 Hz frequency and 90% motor threshold intensity), separated by 50s interval. rTMS was delivered through a focal coil (2 cm below and lateral to the inion) bilaterally in patients with multiple foci (two trains for hemisphere: …

Modulation of motor cortex excitability by 1 Hz rTMS of cerebellar cortex.

1 Hz repetitive transcranial magnetic stimulation of the unaffected hemisphere ameliorates contralesional visuospatial neglect in humans

The aim of the study was to investigate whether low-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected hemisphere can ameliorate visuospatial neglect. We treated three right brain damaged patients with left neglect. 900 pulses (1 Hz frequency) were given over left posterior parietal cortex every other day for 2 weeks. Patients performed a computerized task requiring length judgement of prebisected lines, tachistoscopically presented for 150 ms. With respect to rTMS the task was given 15 days before, at the beginning, at the end and 15 days after. At these times patients performed also line bisection and clock drawing tasks. rTMS induced a significant improveme…

Ruolo del cervelletto nella percezione temporale: risultati di uno studio con rTMS a bassa frequenza in soggetti sani

Effects of Levetiracetam on stroke-related seizures. An open-label trial. Preliminary report

MRI abnormalities following repeated and incoming seizures.

Abstract Neuroimaging, an important diagnostic tool frequently used in the evaluation of patients with epilepsy, has mainly the aim to identify structural abnormalities needing a treatment and to contribute to the definition of the aetiology. Brain magnetic resonance imaging (MRI) in epilepsy is more sensitive than computerized tomography (CT) scan for detecting abnormalities. Status epilepticus (SE) and repeated incoming seizures may determine extensive and transient or long lasting pronounced MRI changes. We describe a case of a 41-year-old woman with a history of brain neoplasm, whose contrast-enhanced MRI images following repeated and incoming seizures were characterized either by rever…

Reduced cerebellar inhibition in migraine with aura: a TMS study.

Subtle clinical cerebellar alterations have been found in migraine. Moreover, abnormalities in visual and motor cortex excitability consistent with a lack of inhibitory efficiency have been described in migraine, and it is known that cerebellum exerts an inhibitory control on cerebral cortex. Here, we investigated if impairment of cerebellar activity on motor cortex, i.e. reduced inhibitory control, can be found in migraine. Ten migraineurs with aura and seven healthy controls underwent a transcranial magnetic stimulation (TMS) protocol to investigate the cerebellar inhibitory drive on motor cortex: a conditioning pulse on right cerebellar cortex was delivered 5, 7, 10, 15 ms before a test …

Can cerebellum play a role in pathophysiology of migraine?: evidence of reduced cerebellar inhibition in migraine with aura.

Neurophysiological and radiological findings in myotonic dystrophy patients

Somatosensory evoked potentials (SEPs) and brainstem auditory evoked potentials (BAEPs) were recorded in 10 patients with myotonic dystrophy and in 20 sex and age-matched healthy controls. In all patients a brain MRI examination was also performed. In our results, the significantly longer absolute peak latencies of the SEPs and the abnormal increasing of the later components of the BAEPs suggest an involvement of the afferent sensory and central auditory pathways. Brain MRI showed white matter hyperintense lesions (WMHL) in eight patients (80%). No correlations were found between individual abnormal electrophysiological parameters or severity of WMHL and age, age at onset, disease duration …

Dropped head as an unusual presenting sign of myastenia gravis

Social cognition dysfunctions in patients with epilepsy: Evidence from patients with temporal lobe and idiopathic generalized epilepsies

Abstract Background and aim Despite an extensive literature on cognitive impairments in focal and generalized epilepsy, only a few number of studies specifically explored social cognition disorders in epilepsy syndromes. The aim of our study was to investigate social cognition abilities in patients with temporal lobe epilepsy (TLE) and in patients with idiopathic generalized epilepsy (IGE). Materials and methods Thirty-nine patients (21 patients with TLE and 18 patients with IGE) and 21 matched healthy controls (HCs) were recruited. All subjects underwent a basic neuropsychological battery plus two experimental tasks evaluating emotion recognition from facial expression (Ekman-60-Faces test…

LACOSAMIDE: TERAPIA IN ADD ON NEL TRATTAMENTO DELL’EPILESSIA PARZIALE

Razionale ed obiettivi: La lacosamide è una nuova molecola con spiccata attività anticonvulsivante utilizzata nelle forme di epilessia ad esordio focale. Obiettivo del nostro studio è quello di valutare la tollerabilità, le interazioni farmacologiche e l’efficacia di questo nuovo farmaco usato in associazione ai vecchi ed ai nuovi farmaci antiepilettici. Pazienti e metodi: Abbiamo arruolato 30 pazienti afferenti al nostro Centro per la Diagnosi e la Cura dell’Epilessia dell’Università degli studi di Palermo affetti da epilessia parziale in bi-politerapia. L’età media dei pazienti era di 36,6 anni, l’età media di esordio della prima crisi di 15,9; 25 erano farmacoresistenti e 22 hanno presen…

CEREBELLUM AND TIME PERCEPTION: A LOW-FREQUENCY STIMULATION STUDY IN HEALTHY SUBJECTS

Bilateral ptosis and internuclear ophthalmoplegia in a case of bilateral thalamic and midbrain Infarct.

CAN HIGH-FREQUENCY RTMS RESTORE NORMAL INTRACORTICAL EXCITABILITY IN MIGRAINE WITH AURA? EFFECTS OF PRIMING STIMULATION ON 1 HZ RTMS OF MOTOR CORTEX

Lacosamide in patients with temporal lobe epilepsy: An observational multicentric open-label study.

Abstract Purpose The aim of this study was to evaluate the efficacy and tolerability of lacosamide (LCM) both as add-on therapy and monotherapy in patients with temporal lobe epilepsy (TLE) based on an observational, prospective, multicenter study. Methods We enrolled 100 patients (mean age: 43.4 ± 12.53 years, 57 females) with nonlesional TLE and TLE with hippocampal sclerosis (HS) that did not respond to the first drug and who were referred to epilepsy centers of the University of Catanzaro, University of Palermo, IRCSS Neuromed of Pozzilli, and Otto-von-Guericke University of Magdeburg. In this open-label, multicenter trial, patients were initiated on oral LCM as add-on therapy to first …

Insight into epileptic and physiological déjà vu: from a multicentric cohort study

Background and purpose The presence of a continuum between physiological deja vu (DV) and epileptic DV is still not known as well as epidemiological data in the Italian population. The aim was to identify the epidemiological distribution of DV in Italy, and secondly to look for specific features of DV able to discriminate between epileptic and non-epileptic DV. Methods In all, 1000 individuals, 543 healthy controls (C) (313 women; age 40 ± 15 years) and 457 patients with epilepsy (E) (260 women; age 39 ± 14 years), were prospectively recruited from 10 outpatient neurological clinics throughout Italy. All populations were screened using the Italian Inventory for Deja Vu Experiences Assessmen…

rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study

A recent fMRI study showed that dorsolateral prefrontal cortex (DLPFC) exerts an inhibitory control on pain pathways in humans. We investigated whether high-frequency rTMS over left DLPFC could ameliorate chronic migraine. Treatment consisted of 12 rTMS sessions, delivered in alternate days over left DLPFC. Sham rTMS was used as placebo. Eleven patients were randomly assigned to the rTMS (n=6) or to the placebo (n=5) treatment. Measures of attack frequency, headache index, number of abortive medications (outcome measures) were recorded in the month before, during and in the month after treatment. Subjects treated by rTMS showed a significant reduction of the outcome measures during and in t…

Modulatory effects of low- and high-frequency repetitive transcranial magnetic stimulation on visual cortex of healthy subjects undergoing light deprivation.

The aim of the present study was to explore further the effects of light deprivation (LD) on visual cortex excitability. Healthy subjects reporting reliable induction of phosphenes by occipital transcranial magnetic stimulation (TMS) underwent 60 min of complete LD. Phosphene threshold (PT) was measured before (T0), after 45 min (T1) and 60 min (T2) of LD, and then every 10 min after light re-exposure until recovery to T0 values. Repetitive TMS (rTMS) (at 1 or 10 Hz) was applied in separate sessions during the last 15 min of LD. PTs significantly decreased after 45 min of LD. rTMS differentially modified the effects of 60 min LD on PTs depending on stimulation frequency. One hertz rTMS did …

Low-frequency transcranial magnetic stimulation in patients with cortical dysplasia

The sporadic and familial Creuzfeldt-Jacob disease in Palermo from 1996 to 2006: epidemiological, clinical and neurophysiologic characteristics.

Levetiracetam in the Treatment of Creutzfeldt-Jacob Disease.

Whole-brain histogram and voxel-based analyses of apparent diffusion coefficient and magnetization transfer ratio in celiac disease, epilepsy, and cerebral calcifications syndrome

BACKGROUND AND PURPOSE: Diffusion and magnetization transfer (MT) techniques have been applied to the investigation with MR of epilepsy and have revealed changes in patients with or without abnormalities on MR imaging. We hypothesized that also in the coeliac disease (CD), epilepsy and cerebral calcifications (CEC) syndrome diffusion and MT techniques could reveal brain abnormalities undetected by MR imaging and tentatively correlated to epilepsy. MATERIALS AND METHODS: Diffusion and MT weighted images were obtained in 10 patients with CEC, 8 patients with CD without epilepsy and 17 healthy volunteers. The whole brain apparent diffusion coefficient (ADC) and MT ratio (MTR) maps were analyze…

Modulatory effects of low- and high-frequence repetitive trancranial magnetic stimulation on visual cortex of healthy subjects undergoing light deprivation

rTMS modulation of visual cortex in healthy subjects undergoing light deprivation: implication for the pathophysiology of migraine.

Auditory event-related potentials (P300) in epileptic patients.

Auditory event-related potentials (AERPs) were recorded during an auditory oddball paradigm in 108 epileptics and in 32 healthy controls. P300 latency varied in relationship with age only in controls. Symptomatic epileptics had significantly prolonged P300 mean latency compared to those without detectable brain lesion(s) on MR scan. Moreover, these latter patients were compared on the basis of epilepsy duration, type of seizure, seizure frequency and antiepileptic treatment; the application of a multiple regression model showed a significant relationship between P300 latency prolongation and epilepsy duration, seizure frequency and polytherapy.

Levetiracetam in the Treatment of Primary Generalised Seizures

Motor intracortical inhibition in PD: L-DOPA modulation of high-frequency rTMS effects

Dopaminergic drugs and deep brain stimulation restore cortical inhibition in Parkinson disease (PD) patients. High-frequency rTMS was also found to increase cortical inhibition in PD but its therapeutic effect is still controversial. Here we hypothesize that, if dopaminergic drugs reverse to normal cortical excitability in M1, the effect of high-frequency (hf)-rTMS in PD patients could depend on whether they are in a medicated or unmedicated state. The present study aims to explore the lasting effects of sub-threshold hf rTMS trains over M1 on cortical inhibition in patients with "on" and without "off" L-DOPA treatment. Fourteen PD patients were examined twice while "on" and "off" medicatio…

Disfunzioni sessuali, farmaci antiepilettici e profilo ormonale sierico negli uomini affetti da epilessia. Sexual disfunctions, antiepileptic drugs, blood hormonal profile in epileptic men

Sexual dysfunctions (SD) are a relatively common problem in men with epilepsy; the prevalence ranges from 38-71%. Etiology may be multifactorial and may involve both the epilepsy and the use of antiepileptic drugs. The purpose of this study was to evaluate the incidence of SD in epileptic men, assessing the type of epilepsy, seizures frequency, antiepileptic drugs used, the serum hormonal profile and the presence of psychiatric disorders.

Emotion recognition in temporal lobe epilepsy and idiopathic generalized epilepsy

Role of the cerebellum in time perception: A TMS study in normal subjects

The aim of this study was to investigate the role of the cerebellum in a temporal-discrimination task without movement production in healthy subjects. Ten healthy subjects underwent a time-perception task with somatosensory stimuli. Two pairs of electrical stimuli: the first considered the reference pair (rp) with a standard interval of 400 ms and the second, the test pair (tp), with variable intervals ranging from 300 to 500 ms, were applied by surface electrodes on the right forearm. Subjects were instructed to compare time intervals of rp and tp and to estimate whether the tp interval was shorter than, equal to, or longer than that of rp. The task was performed in baseline and after 1 Hz…

High-Frequency Transcranial Magnetic Stimulation on Motor Cortex of Patients Affected by Migraine With Aura: A Way to Restore Normal Cortical Excitability?

We showed reduced motor intracortical inhibition (ICI) and paradoxical increase of intracortical facilitation (ICF) to 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients affected by migraine with aura (MA). In conditions of enhanced excitability due to a reduced inhibition, high-frequency rTMS was found to potentiate intracortical inhibition. Here we explored the conditioning effects of high-frequency priming stimulation of motor cortex with the aim of normalizing excitability reverting paradoxical facilitation by 1 Hz rTMS in MA. Nine patients with MA and nine healthy controls underwent a paired-pulse TMS paradigm to evaluate motor intracortical excitability (ICI and ICF…

A novel mutation of the extracellular matrix protein 1 gene (ECM1) in a patient with lipoid proteinosis (Urbach-Wiethe disease) from Sicily

Summary Background  Lipoid proteinosis (LP), also known as Urbach–Wiethe disease, is a rare autosomal recessive disorder characterized by a hoarse voice, warty skin infiltration and scarring. Mutations within the extracellular matrix protein 1 (ECM1) gene cause LP. Objectives  We report the molecular analysis of the ECM1 gene in a Sicilian patient with LP in order to extend the mutation spectrum of this genodermatosis. Methods  We studied a 32-year-old female born from consanguineous parents who was diagnosed at the age of 11 years as having LP. She has a clinical phenotype corresponding to Urbach–Wiethe disease characterized by papules/nodules, indurated plaques and sometimes ulcerated les…

Efficacy and tolerability of Levetiracetam as prophylactic treatment of migraine with aura: a preliminary open-label study

non presente

Auditory event-related potentials in subcortical vascular cognitive impairment and in Alzheimer's disease.

Few studies exist on ERPs and patients with subcortical vascular cognitive impairment (SVCI). This latter is a quite homogeneous subtype of vascular dementia whose cognitive profile is quite different from that of Alzheimer disease (AD).The present study aims at comparing the ERPs profile both in patients with SVCI and in patients with AD.ERPs and psychometric tests were collected from 39 healthy elderly controls, 51 patients with SVCI and 43 patients with AD. Subjects mentally count high pitched target tones that were randomly intermixed with low pitched frequent tones. We measured ERPs latencies (N1, P2, N2 and P3), and interpeak latencies (N1-P3, N1-P2, N1-N2).Grand averaged potentials i…

Effects of Levetiracetam on stroke related seizures: an open trial, preliminary report.

Epileptic seizures and cerebrovascular disease

- A series of 88 patients with completed stroke was selected in which heralding, early and late seizures were distinguished according to their onset. Relationships between CT scan and clinical EEG data are discussed with particular emphasis on possible mechanisms of seizures. Thus, small emboli or haemodynamic factors are stressed in the cases of heralding seizures, metabolic disturbances with cytotoxic effects in early seizures and chronic epileptic focus in late seizures.

Excessive Daytime Sleepiness and Sleep Disorders in a Population of Patients with Epilepsy: a Case-Control Study

Background and purpose There are several primary causes for excessive daytime sleepiness (EDS) and sleep disorders in patients with epilepsy. Up to now, studies in the literature report conflicting data in terms of both prevalence and aetiology. The aim of our study was therefore to evaluate the prevalence of EDS and some sleep disorders in a population of patients with epilepsy treated with no more than two antiepileptic drugs (AEDs). We also investigated the role of the depression of mood as a variable that can negatively affect EDS. Methods We prospectively and consecutively recruited 99 patients with a diagnosis of epilepsy, sleep disorders and EDS, belonging to the Centre for Epilepsy …

levetiracetam in treatment of idiopatic generalized serizures

Levetiracetam nel trattamento delle epilessie vascolari: studio aperto. Dati preliminari.

Efficacy and tolerability of levetiracetam as prohylactic treatment of migraine with aura: A preliminary open label study

Dropped head as an unusual presenting sign of myasthenia gravis

Modulatory effects of low- and high-frequency repetitive transcranial magnetic stimulation on visual cortex of healthy subjects undergoing light deprivation

The aim of the present study was to explore further the effects of light deprivation (LD) on visual cortex excitability. Healthy subjects reporting reliable induction of phosphenes by occipital transcranial magnetic stimulation (TMS) underwent 60 min of complete LD. Phosphene threshold (PT) was measured before (T0), after 45 min (T1) and 60 min (T2) of LD, and then every 10 min after light re-exposure until recovery to T0 values. Repetitive TMS (rTMS) (at 1 or 10 Hz) was applied in separate sessions during the last 15 min of LD. PTs significantly decreased after 45 min of LD. rTMS differentially modified the effects of 60 min LD on PTs depending on stimulation frequency. One hertz rTMS did …

EMpathy ability and emotion recognition in temporal lobe epilepsy and idhiopathic generalizede epileps