Chronic inflammatory demyelinating polyradiculoneuropathy: can a diagnosis be made in patients not fulfilling electrodiagnostic criteria?

Background and purpose The aim was to identify the clinical and diagnostic investigations that may help to support a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients not fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria. Methods The data from patients with a clinical diagnosis of CIDP included in a national database were retrospectively reviewed. Results In all, 535 patients with a diagnosis of CIDP were included. This diagnosis fulfilled the EFNS/PNS criteria in 468 patients (87.2%) (definite in 430, probable in 33, possible in three, while two had chronic immune sensory p…

Abnormal peripheral and central visual processing in migraine

Sound induced flash illusion (SIFI) is an illusory cross modal (audio-visual) phenomenon critically dependent upon excitability of visual cortex. A recent study with SIFI confirmed hyperexcitability of visual cortex in migraine; patients with migraine show abnormality of chromatic perception. Here we explored the relationship between peripheral chromatic and central visual dysfunction in patients with migraine

TRANSCRANIAL DIRECT STIMULATION (TDCS) CAN MODULATE ESOPHAGEAL MOTILITY IN GASTROESOPHAGEAL REFLUX DISEASE (GERD) PATIENTS

EFFECTS OF TMS OVER RIGHT POSTERIOR PARIETAL CORTEX AND VISUOSPATIAL NEGLECT IN NEAR AND FAR SPACE USING LINE BISECTION

Are paradoxical intensity-dependent effects of 5Hz rTMS train in motor cortex of migraine with aura patients evidence of abnormal homeostatic plasticity

Cortical excitability in episodic cluster headache

Background: Cluster headache (CH) is a severe primary headache disorder, whose pathophysiological processes remain largely unknown. Along with central disinhibition of the trigeminal nociceptive system and hypothalamic impairment, a cortical involvement has been supposed. Aim: To evaluate cortical excitability in episodic CH patients by using different paradigms of transcranial magnetic stimulation (TMS). Methods: Twenty-five patients with episodic CH and thirteen healthy subjects underwent an experimental session where we evaluated, in both hemispheres, motor-cortical response to: 1) single-pulse TMS: i.e. motor threshold (MT); input-output (IO) curves and cortical silent period (CSP) and …

Eccitabilità corticale e ciclo emicranico: studio condotto con stimolazione magnetica transcranica in pazienti affetti da emicrania con e senza aura ed emicrania cronica

Efficacy and safety of topiramate in migraine prophylaxis: an open controlled randomized study comparing Sincronil and topamax formulations.

AIM: Topiramate is a small molecule widely used for the treatment of epilepsy, migraine, bipolar disorders and alcoholism, and its availability as a generic formulation could significantly reduce the National Health Service expenditure. A generic formulation, available in Italy under the trademark Sincronil, recently showed superimposable blood levels, after oral administration to healthy volunteers, with the reference formulation. In the present study we report the results of an open label, parallel group, randomized, controlled study performed to evaluate the efficacy, tolerability and impact on disability of two different formulations of topiramate (Sincronil and Topamax) in patients wit…

Motor cortex tRNS improves pain, affective and cognitive impairment in patients with fibromyalgia: Preliminary results of a randomised sham-controlled trial

Objective. Fibromyalgia (FM) is a clinical syndrome characterised by widespread musculoskeletal pain, chronic fatigue, cognitive deficits, and sleep and mood disorders. The effectiveness of most pharmacological treatments is limited, and there is a need for new, effective and well-tolerated therapies. It has recently been shown that transcranial direct-current stimulation (tDCS) of the motor cortex reduces pain, and that tDCS of the dorso-lateral prefrontal cortex (DLPFC) improves anxiety, depression and cognitive impairment in FM patients. The new technique of transcranial random noise stimulation (tRNS) using randomly changing alternating currents has very recently been shown to improve w…

Relevance of diagnostic investigations in chronic inflammatory demyelinating poliradiculoneuropathy: Data from the Italian CIDP database

The objective of our work was to report the clinical features and the relevance of diagnostic investigations in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We retrospectively reviewed data from patients with a clinical diagnosis of CIDP included in a national database. Among the 500 included patients with a clinical diagnosis of CIDP, 437 patients (87%) fulfilled the European Federation of Neurological Societies and Peripheral Nerve Society criteria for CIDP (definite in 407, probable in 26, possible in four). In 352 patients (86%) motor nerve conduction abnormalities consistent with demyelination were sufficient for the diagnosis of definite CIDP. In 55 …

Transcranial direct current stimulation for treatment of freezing of gait: a cross-over study.

BACKGROUND AND OBJECTIVE: Progression of Parkinson's disease (PD) is frequently characterized by the occurrence of freezing of gait (FOG) representing a disabling motor complication. We aim to investigate safety and efficacy of transcranial direct current stimulation of the primary motor cortex of PD patients with FOG. METHODS: In this cross-over, double-blind, sham-controlled study, 10 PD patients with FOG persisting in "on" state underwent anodal and sham direct current stimulation for 5 consecutive days. Clinical assessment over a 1-month period was performed. RESULTS: A significant improvement of gait, as assessed by the Stand Walk Sit test, with reduction in number and duration of FOG …

SHORT-TERM SYNAPTIC PLASTICITY IN MIGRAINE MOTOR CORTEX: EVIDENCE BY PRECONDITIONING OF HIGH-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) WITH TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS).

Background: Brief 5Hz repetitive transcranial magnetic stimulation (rTMS) trains at 120% of the resting- motorthreshold (RMT) intensity determine in healthy subjects a potentiation of motor evoked potentials (MEPs), likely due to short-term presynaptic plasticity facilitation. We recently showed paradoxical intensity-dependent MEP changes to 5Hz rTMS in migraine with MEP facilitation at 110% and inhibition at 130% RMT. This provides evidence of both hyper-responsivity and self-limiting hyperexcitability capacity in migraine, likely due to earlier activation of inhibitory homeostatic plasticity mechanisms. To explore this, we applied in migraineurs cathodal transcranial Direct Current Stimul…

Allodinia, Disabilità E Parametri Clinici Dell’emicrania: Risultati Di Uno Studio Con Questionario Retrospettivo In Pazienti Affetti Da Emicrania

MAGNETIC RESONANCE IMAGING–GUIDED FOCUSED ULTRASOUND THALAMOTOMY IN PATIENT WITH TREMOR COMBINED WITH PARKINSONISM: RETREATMENT AFTER BENEFIT DECAY

Background In recent years, transcranial Magnetic Resonance-guided Focused UltraSounds (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. This technique has been proven safe and effective in selected patients. Here we present the case of a patient affected by tremor combined with parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment. Materials and Methods A 72-year-old, right-handed man, who came to our observation because of a disabling tremor affecting mainly his upper right limb and refusing any invasive surgical procedure. His …