A “Painful Tic Convulsif” (Trigeminal Neuralgia And Ipsilateral Facial Spasm) Due To Double Neuro-Vascular Impingement: A Case Report.

LEVITIRACETAM IN THE TREATMENT OF CREUTZFIELDT-JACOB DISEASE

Modulation of visual cortex excitability in patients affected by Friedreich ataxia

TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY ITALIAN (AND WORLD-FIRST) EXPERIENCE AT 1,5 TESLA (first 3 cases treated)

PURPOSE: We present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. TcMRgFUS is a promising new technology for the non-invasive treatment of neurologic disorders such as Essential Tremor (ET), tremor dominant idiopathic Parkinson's Disease (PD) and Neuropathic Pain (NP). This is a new method for focal targeting and lesioning of specific regions in the brain through intact skull by using high intensity focused ultrasound beam to achieve thermal ablation and …

A VALIDATION STUDY OF AN ITALIAN VERSION OF THE “ID MIGRAINE”

Cortical hypoactivity or reduced efficiency of cortical inhibition in migraine?. vol. 27, pp. 187-188.

Transcranial direct current stimulation preconditioning modulates the effect of high-frequency repetitive transcranial magnetic stimulation in the human motor cortex

Experimental studies emphasize the importance of homeostatic plasticity as a mean of stabilizing the properties of neural circuits. In the present work we combined two techniques able to produce short-term (5-Hz repetitive transcranial magnetic stimulation, rTMS) and long-term (transcranial direct current stimulation, tDCS) effects on corticospinal excitability to evaluate whether and how the effects of 5-Hz rTMS can be tuned by tDCS preconditioning. Twelve healthy subjects participated in the study. Brief trains of 5-Hz rTMS were applied to the primary motor cortex at an intensity of 120% of the resting motor threshold, with recording of the electromyograph traces evoked by each stimulus o…

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…

O047. The sound-induced flash illusions reveal visual cortex hyperexcitability in cluster headache

Objectives Pathophysiology of cluster headache (CH) is not wellknown. Although posterior hypothalamus has been suggested to play a pivotal role, evidence exists of a more diffuse involvement of the central nervous system including brainstem and cerebral cortex. In this regard, we recently observed increased motor cortical excitability in episodic CH patients both outside and inside bout [1]. The sound-induced flash illusions (SIFI) represent an example of multisensory integration, and provide a tool to indirectly explore the excitability state of the visual cortex [2]. SIFI are classified as “fission” and “fusion” illusions. When one visual stimulus (flash) is accompanied by two or more aud…

TRANSCRANIAL DIRECT CURRENT STIMULATION FOR TREATMENT OF FREEZING OF GAIT IN PARKINSON’S DISEASE. A CROSS-OVER STUDY

Reduced cerebellar inhibition in migraine with aura: a transcarnial magnetic stimulation (TMS) study.

Timing of right parietal and frontal cortex activity in visuo-spatial perception: A TMS study in normal individuals

In a recent study we showed that repetitive transcranial magnetic stimulation (rTMS) with train duration of 400 ms over right frontal and right posterior parietal cortices gives rise to transitory contralateral visuo-spatial neglect in normal subjects. In the present experiment we investigated whether using single-pulse TMS it is possible to obtain information about the timing of cortical activity related to spatial cognition. Nine healthy subjects performed in baseline condition and during TMS a tachistoscopic task, requiring a forced-choice estimation of the length of the two segments of prebisected horizontal lines. Single-pulse TMS was triggered at various time intervals (150 ms, 225 ms…

Analysis of F-wave in metabolic neuropathies: a comparative study in uremic and diabetic patients.

Motor nerve conduction study along the entire length of the ulnar and tibialis posterior nerves was carried out in 30 diabetics compared with 30 uremic patients and 30 control subjects. The conduction in the proximal and the distal nerve segments was evaluated by the determination of the M and F latencies, MNCV (between the stimulus sites), FWCV (between the spinal cord and the stimulus sites), and F-ratio (conduction time ratio of proximal to distal segment). In both groups of patients the lower limbs appear much more involved than the upper, where the ulnar nerve is more commonly affected in uremic than in diabetic patients. In diabetic neuropathy the motor conduction abnormalities are di…

Transcranial magnetic stimulation reveals cortical hyperexcitability in episodic cluster headache

Abstract Evidence shows involvement of the cerebral cortex in the pathophysiology of cluster headache (CH). Here we investigated cortical excitability in episodic CH patients by using transcranial magnetic stimulation. In 25 patients with episodic CH and 13 healthy subjects we evaluated the motor cortical response to single-pulse (ie, motor threshold, input-output curves, cortical silent period) and paired-pulse (ie, intracortical facilitation, short intracortical inhibition) transcranial magnetic stimulation in both hemispheres. Thirteen patients were evaluated outside bout and the remaining 12 patients inside bout. Our results showed increased slope of the input-output curves after stimul…

Intracortical facilitation within the migraine motor cortex depends on the stimulation intensity. A paired-pulse TMS study

Abstract Introduction Connectivity within the primary motor cortex can be measured using the paired-pulse transcranial magnetic stimulation (TMS) paradigm. This evaluates the effect of a first conditioning stimulus on the motor evoked potential (MEP) elicited by a second test stimulus when different interstimulus intervals are used. Aim of the present study was to provide, in patients suffering from migraine without aura (MwoA), additional information on intracortical facilitation (ICF), short intracortical inhibition (SICI), and long intracortical inhibition (LICI), using different intensities of the test stimulus (TS). Methods We enrolled 24 patients with episodic MwoA and 24 age- and sex…

INFLUENCE OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) ON ACTION TREMOR IN MULTIPLE SCLEROSIS PATIENTS

Cortical excitability in episodic cluster headache. Neurol Sci

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…

Increasing patient information to reduce the burden of migraine: a new project: “The headache days”

Repetitive transcranial magnetic stimulation in migraine: recent evidence

A validation study of an Italian version of the ID Migraine: preliminary results

Migraine is a highly prevalent and disabling disease that is substantially undiagnosed in primary care. Recently, the ID Migraine, a self–administered questionnaire, was shown to be a valid and reliable screener for migraine in primary care in the USA. To validate an Italian version of the ID Migraine, we planned a multicentric study, evaluating at least 220 patients affected by various form of headache. The responses to the questionnaire were compared with the diagnosis of headache made by a headache specialist blind to the result of the questionnaire. Sensitivity, specificity, and positive and negative predictive values for migraine were calculated. The statistical analysis on 140 patient…

Effects of high-frequency repetitive transcranial magnetic stimulation of primary motor cortex on laser-evoked potentials in migraine.

The aim of this study was to examine the effects of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) on subjective pain and evoked responses induced by laser stimulation (LEPs) of the contralateral hand and supraorbital zone in a cohort of migraine patients without aura during the inter-critical phase, and to compare the effects with those of non-migraine healthy controls. Thirteen migraine patients and 12 sex- and age-matched controls were evaluated. Each rTMS session consisted of 1,800 stimuli at a frequency of 5 Hz and 90% motor threshold intensity. Sham (control) rTMS was performed at the same stimulation position. The vertex …

Neglect-like effects induced by tDCS modulation of posterior parietal cortices in healthy subjects

Background Repetitive transcranial magnetic stimulation (rTMS) over right posterior parietal cortex was shown to induce interference on visuospatial perception in healthy subjects. Transcranial direct current stimulation (tDCS) is another noninvasive brain stimulation technique that works modulating cortical activity. It is applied through easy to use, noncostly, and portable devices. Objective/Hypothesis The aim of the current study was to investigate if the novel approach of “dual” stimulation over parietal cortices compared with the unilateral (right) cathodal one is able to induce greater and/or longer-lasting neglect-like effects in normal subjects performing a computerized visuospatia…

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…

Magnetic stimulation study during observation of motor tasks.

The aim of the study was to assess if the observation of single or more complex muscle movements activates the premotor cortex in man. We stimulated by transcranial magnetic stimulation the right and left motor cortex recording from the abductor pollicis brevis of eight normal subjects, during observation of different movements performed by the examiner: (1) single movements: thumb abduction, arm elevation; (2) motor sequences: finger opposing movements performed in an ordinate sequence: 1-2, 1-3, 1-4, 1-5, 1-2ellipsis, and in a non-consecutive non-repetitive order: 1-3, 1-5, 1-4, 1-2, 1-5, 1-2ellipsis We found an increased excitability of the right cortex during observation of isolated mus…

A case-control study of amyotrophic lateral sclerosis

A retrospective case-control study was conducted using 46 patients affected by amyotrophic lateral sclerosis and 92 closely matched healthy controls. Cases were ascertained through typical clinical and instrumental findings. Putative risk factors (bone fractures or major trauma, exposure to domestic animals, surgical operations, disease among first degree relatives and others) were investigated anamnestically using a standard questionnaire. Using Mantel-Haenzsel estimates of the odds ratio, no association was found between amyotrophic lateral sclerosis and the investigated variables.

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

Anodal transcranial direct current stimulation of the right dorsolateral prefrontal cortex enhances memory-guided responses in a visuospatial working memory task.

Several studies have shown that transcranial direct current stimulation (tDCS) is able to enhance performances on verbal and visual working memory (WM) tasks. Available evidence points to the right dorsolateral prefrontal cortex (DLPFC) as a critical area in visual WM, but to date direct comparisons of the effects obtained by stimulating the left versus the right DLPFC in the same subject are lacking. Our aim was to determine whether tDCS over the right DLPFC can differently affect performance as compared with left DLPFC stimulation. Ten healthy subjects performed a memory-guided visuospatial task in three conditions: baseline, during anodal stimulation applied over the right and during ano…

Brain excitability in migraine: Hyperexcitability or inhibited inhibition?

While migraine has been considered for a long time a disease of the head vascular structures, it has been more and more evident that the involvement of the cerebral cortex has a primary role in the cascade of events which trigger the migraine attacks. Neurophysiological studies gave an important contribution to our knowledge of the mechanisms underlying the migraine disease

Effects of cerebellar TMS on motor cortex of patients with focal dystonia

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…

Study of molecular mechanism involved in neuronal plasticity induced by magnetic stimulation in cultured hippocampal neurons

Although a large number of investigations have shown that transcranial magnetic stimulation, a non-invasive method of brain stimulation with minimal side effects, is able to induce neuronal synaptic plastic change, very few studies have examined the molecular mechanisms of magnetic stimulation involved in synaptic plasticity. Since it is well known that neurotrophins and their receptors regulate synaptic strength and thereby mediate plasticity, in this study we have investigated the effects of low-frequency (1 Hz) magnetic stimulation, at different intensities, on the activation of neurotrophic factors receptors and relative intracellular pathways in primary cultures of hippocampal neurons.…

Anodal transcranial direct current stimulation over the right hemisphere improves auditory comprehension in a case of dementia.

Background Noninvasive transcranial stimulation methods have been increasingly employed in order to improve cognitive performance in neurological patients. In previous studies with both stroke patients and healthy subjects, noninvasive stimulation of temporal-parietal regions and their homologue produced an improvement in linguistic tasks. Objective The aim of the current study was to evaluate if anodal transcranial direct current stimulation (tDCS) over Brodmann areas 39/40 (angular and supramarginal gyri) could promote the recovery of linguistic functions, in particular comprehension and naming, in a single patient affected by dementia. Methods Three preliminary explorative single session…

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.

Application of tRNS to improve multiple sclerosis fatigue: a pilot, single-blind, sham-controlled study

We evaluated the effects of transcranial random noise stimulation (tRNS) on fatigue in 17 subjects with relapsing–remitting multiple sclerosis with low physical disability. Two different patient groups underwent real or sham stimulation for 10 days, targeting the primary motor cortex of the dominant side or contralateral to the most compromised limb. In the ‘real group’, beneficial effects were observed using the Modified Fatigue Impact Scale (p = 0.04; physical subscale: p = 0.03), the subscales ‘change in health’ (p = 0.006) and ‘role limitations due to physical problems’ (p = 0.001) of the Multiple Sclerosis Quality of Life-54, and by assessing the patient impression of perceived fatigue…

Modulation of dorsolateral prefrontal cortex (DLPFC) through repetitive transcranial magnetic stimulation (rTMS) during capsaicin induced pain: effects on nociceptive control and motor cortical circuits

Insidious onset of Pisa syndrome after rasagiline therapy in a patient with Parkinson’s disease

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Abnormal facilitatory mechanisms in motor cortex of migraine with aura

Experimental evidence suggests impairment of inhibitory intracortical circuits in migraine, while not much is known about activity of facilitatory intracortical circuits. In the present work we evaluated the effects of high frequency-repetitive transcranial magnetic stimulation (hf-rTMS) on the activity of facilitatory circuits of motor cortex in 18 patients affected by migraine with aura and 18 healthy subjects. Trains of 10 stimuli were applied to the motor cortex at 5-Hz frequency with recording of the EMG traces from the contralateral abductor pollicis brevis muscle (APB). Two intensities of stimulation (110% and 130% of resting motor threshold) were used in order to explore whether mot…

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.

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 epi…

From different neurophysiological methods to conflicting pathophysiological views in migraine: a critical review of literature.

Abnormal increased cortical responsivity to various types of stimuli plays a major role in migraine pathogenesis. Neurophysiological studies, however, have provided ambiguous findings of either hypo or hyper cortical excitability. This is why the term "dysexcitability" has been recently proposed to indicate a more general dysregulation of cortical excitability. The aims of this review are: (1) to provide existing knowledge and research advances in migraine pathophysiology; (2) to propose a unitary interpretation of apparently conflicting neurophysiological findings. Data of studies conducted in migraine through various evoked potentials techniques and non-invasive brain stimulation methods …

L'ELETTROMIOGRAFIA PREOPERATORIA DEI MUSCOLI NASALI

APPLICAZIONI TERAPEUTICHE DELLA RTMS IN PSICHIATRIA

Inferior altitudinal hemianopia associated with a tumor in the posterior fossa: report of a case

Altitudinal hemianopias may be related to chiasmatic involvement. A case in which horizontal inferior hemianopia is associated with a tumor in the posterior fossa producing a triventricular hydrocephalus is described. The visual field defect is interpreted as a consequence of the pressure by a dilated third ventricle upon the chiasmatic area.

Illusory contours and specific regions of human extrastriate cortex: evidence from rTMS

Functional magnetic resonance imaging studies showed that perception of illusory contours is associated with extrastriate cortex activation prevailing on the right side. 1 Hz repetitive transcranial magnetic stimulation (rTMS) is able to induce lasting inhibition of cortical activity. The objective of the study was to investigate the role of extrastriate cortex in illusory contour perception inducing 1 Hz rTMS interference in healthy subjects. Eight healthy subjects underwent 1 Hz rTMS (600 pulses) through a figure-of-eight coil over right and left occipital cortex (O1 and O2 of 10/20 EEG system); sham magnetic stimulation on the same sites and right motor cortex rTMS (in three subjects) we…

Basal ganglia calcifications and ALS syndrome.

We report the case of a patient with idiopathic hypoparathyroidism and unusually large symmetrical calcifications in the basal ganglia, thalami, cerebellar hemispheres and brainstem, who clinically presented an ALS-like syndrome. We discuss the possible role of abnormal calcium metabolism in the pathogenesis of motoneuron disease.

TRANSCRANIAL DIRECT STIMULATION (tcds) CAN MODULATE ESOPHAGEAL MOTILITY IN GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD) PATIENTS

Levetiracetam in the treatment of primary generalized seizures.

A case of atypical sporadic hemiplegic migraine associated with PFO and hypoplasia of vertebro-basilar system.

We describe the case of a patient with atypical hemiplegic migraine and associated basilar symptoms, where a large patent foramen ovale (PFO) and hypoplasia of basilar artery were found. The longer period of 4-year remission of the headache attacks was coincident with the percutaneous PFO closure. When 5 years after, hemiplegic migraine attacks relapsed, with more relevant basilar symptoms, a mild re-opening of PFO was found. The atypical presentation of attacks with basilar symptoms and prolonged hemiplegia does not strictly fit the diagnostic criteria of ICHD-II.

LOW-DOSAGE TOPIRAMATE IN PROPHYLAXIS OF MIGRAINE: RESULTS OF A RETROSPECTIVE STUDY IN 490 PATIENTS.

P072. The visual cortical excitability in pediatric migraine as tested by sound-induced flash illusions

Objectives Sound-induced flash illusions (SIFI) depend on visual cortex (V1) excitability [1]. In adults with migraine, in response to visual-acoustic illusions, V1 is hyperexcitable [2]. Susceptibility to SIFI is increased in children than adults. During childhood there is a change in sensory dominance: acoustic dominant switching to a visual [3]. Here we used SIFI to evaluate V1 excitability in children with migraine assessing also age-related differences in cross-modal audio-visual perception.

A case study of Primary Progressive Aphasia: improvement on verbs after rTMS treatment.

This case-report shows that high frequency repetitive Transcranial Magnetic Stimulation (hf-rTMS), applied to the left prefrontal cortex, may improve the linguistic skills in Primary Progressive Aphasia (PPA). The patient's performance was evaluated on a battery of language production and memory span tasks, before and after two hf-rTMS treatments and one SHAM treatment. We observed a significant and lasting improvement of the patient's performance on verb production following the application of hf-rTMS versus Baseline and SHAM conditions. This finding suggests that hf-rTMS may directly strengthen the neural connections within an area of metabolic dysfunction and encourages the use of rTMS a…

Transcranial Direct Current Stimulation over the Right Inferior Parietal Cortex Reduces Transposition Errors in a Syllabic Reordering Task

Evidence derived from functional imaging and brain-lesion studies has shown a strong left lateralization for language, and a complementary right hemisphere dominance for visuospatial abilities. Nevertheless, the symmetrical functional division of the two hemispheres gives no reason for the complexity of the cognitive operations involved in carrying out a linguistic task. In fact, a growing number of neuroimaging and neurostimulation studies suggest a possible right hemisphere involvement in language processing. The objective of this work was to verify the contribution of the left and right parietal areas in a phonological task. We applied anodal transcranial direct current stimulation (tDCS…

Prophylaxis of hemicrania continua: two new cases effectively treated with topiramate.

Hemicrania continua (HC) is an uncommon and under-recognized primary headache disorder characterized by a strictly unilateral continuous headache of moderate intensity with possible exacerbations and associated with ipsilateral autonomic features. HC has generally a prompt and enduring response to indomethacin although 25% to 50% of treated patients develop gastrointestinal side effects. These cases pose a difficult management challenge as no other drug is consistently effective in HC. Recently 2 HC patients responsive to topiramate treatment have been reported. Here we describe 2 more patients effectively treated with topiramate. Neither reported any side effects and one had persisting res…

Conduction velocity study in type 1 diabetic patients.

The role of metabolic abnormalities in the development of diabetic neuropathy is controversial. To investigate the peripheral nerve function and the influence of hyperglycemia on nerve conduction in insulin-dependent diabetes, a one-year neurophysiological study was carried out in 30 type 1 diabetic patients ranging in age from 2-16 years. During the 12-month follow-up period the glycosylated hemoglobin determination, motor conduction velocity of the peroneal nerve and the motor and sensory conduction of the tibial nerve were assessed 3 times, at the beginning of the study and every 6 months thereafter. The sensory latency was found significantly delayed in these patients as compared with t…

Brain Modulation by Electric Currents in Fibromyalgia: A Structured Review on Non-invasive Approach With Transcranial Electrical Stimulation

Fibromyalgia syndrome (FMS) is a complex disorder where widespread musculoskeletal pain is associated with many heterogenous symptoms ranging from affective disturbances to cognitive dysfunction and central fatigue. FMS is currently underdiagnosed and often very poorly responsive to pharmacological treatment. Pathophysiology of the disease remains still obscure even if in the last years fine structural and functional cerebral abnormalities have been identified, principally by neurophysiological and imaging studies delineating disfunctions in pain perception, processing and control systems. On such basis, recently, neurostimulation of brain areas involved in mechanism of pain processing and …

Visuospatial learning is fostered in migraine: evidence by a neuropsychological study

Cognitive profile in migraine patients still remains undefined. Contradictory evidence has been provided, with impairments in different cognitive domains, normal cognition, or even better performance compared to healthy controls (HC). The latter is of particular interest considering the evidence of glutamatergic upregulation in migraine, particularly in the visual cortex, and the role of the glutamatergic system in synaptic plasticity and learning. The aim of our study is to compare cognitive performance for visuospatial memory and learning (supraspan modality) between migraineurs without aura (MwoA) and HC. Twenty-one subjects suffering from MwoA and 21 HC were enrolled. Migraineurs during…

Cyclical changes of cortical excitability and metaplasticity in migraine: evidence from a repetitive transcranial magnetic stimulation study.

The primary brain dysfunctions leading to the onset of a migraine attack remain largely unknown. Other important open questions concern the mechanisms of initiation, continuation, and termination of migraine pain, and the changes in brain function underlying migraine transformation. Brief trains of high-frequency repetitive transcranial magnetic stimulation (rTMS), when applied to the primary motor cortex at suprathreshold intensity (⩾120% of resting motor threshold [RMT]), elicit in healthy subjects a progressive, glutamate-dependent facilitation of the motor evoked potentials (MEP). Conversely, in conditions of increased cortical excitability, the rTMS trains induce inhibitory MEP respons…

Recovery of aphasia: a case study with “dual” tdcs.

Objectives. In the present study we used a “dual” tDCS (Vines et al., 2008; Giglia et al., 2011) training on inferior frontal gyrus’s (IFG) areas in order to improve the linguistic performance of EBE, an Italian female, left-handed, presenting a global aphasia following a stroke of right middle cerebral artery. Materials. For the picture naming task, 20 object and 20 action images, selected from a set of picture standardized for frequency, were presented on a paper sheet one at time. Method. Stimulation was used at 1mA for 15 minutes. Dual tDCS was given over both IFGs, cathode in the right (damaged areas) and anode in the left (preserved areas) daily for two weeks (weekend-free). The posit…

Visual cortex hyperexcitability in migraine in response to sound-induced flash illusions

Objective: Sound-induced flash illusions depend on visual cortical excitability. In this study, we explored whether sound-induced flash illusions are perceived differently in migraine, a condition associated with pathologic cortical hyperexcitability. Methods: Sound-induced flash illusions were examined in 59 migraine patients (mean age = 32 ± 16 years; 36 females), 32 without aura and 27 with aura, and in 24 healthy controls (mean age = 42 ± 17 years; 16 females). Patients were studied during attacks and interictally. Visual stimuli (flashes) accompanied by sounds (beeps) were presented in different combinations: a single flash with multiple beeps was given to induce the perception of mult…

DOES MOTOR CORTEX HIGH FREQUENCY RTMS MODULATE INTRACORTICALINHIBITION IN PATIENTS WITH PARKINSON'S DISEASE ?

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: …

ANODAL TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) APPLIED TO THE MOTOR CORTEX AMELIORATES FREEZING OF GAIT IN PATIENTS AFFECTED BY PARKINSON’S DISEASE

Background: Progression of Parkinson’s disease (PD) is frequently characterized by the occurrence of freezing of gait (FOG), which generally does not improve with dopaminergic therapy and with current available surgical therapies. Recent evidences show that motor symptoms may be ameliorated by means of non-invasive brain stimulation techiniques in PD (transcranial current direct stimulation, TDCS; repetitive transcranial magnetic stimulation, RTMS). Objective: To investigate the efficacy of anodal TDCS in the treatment of FOG in PD. Excitatory anodal tDCS was applied unilaterally to the motor and premotor cortices controlateral to the most affected leg. Methods: randomized, double-blind, sh…

Atherothrombotic Stroke: Plasmatic Modification Of Homocysteine and Other Thiols

Ocular pseudomyasthenia: report of a case with a pineal region tumor.

A case presenting with clinical features of ocular myasthenia and a false-positive edrophonium test is reported. Brain CT and MRI scan revealed a pineal region tumor histologically verified as germinoma. We recommend evaluating patients with clinical features of myasthenia gravis (MG) confined to the ocular muscles for intracranial mass lesions.

Cortical and subcortical visual event-related potentials to oddball stimuli in rabbits

We applied repetitive transcranial magnetic stimulation (rTMS) in order to induce interference on visuo-spatial perception in 11 healthy subjects. Subjects performed a visuo-spatial task requiring judgements about the symmetry of prebisected lines. Visual stimuli consisted of symmetrically or asymmetrically transected lines, tachystoscopically presented for 50 ms on a computer-monitor. Performance was examined in basal condition and during rTMS trains of 10 stimuli at 25 Hz, delivered through a focal coil over right or left posterior parietal cortex (P5 and P6 sites) and triggered synchronously with visual stimulus. Randomly intermixed sham rTMS trains were employed to control for non-speci…

Expression pattern of matrix metalloproteinases-2 and -9 and their tissue inhibitors in patients with chronic inflammatory demyelinating polyneuropathy

Background: Matrix metalloproteinases (MMPs) are a heterogeneous family of endopeptidases that play a role in many physiological functions, including the immune response. An imbalance between the activity of MMPs and their physiological tissue inhibitors (TIMPs) has been proposed in the pathophysiology of different autoimmune disorders. We aimed to assess the plasmatic levels of MMP-2, MMP-9, and their inhibitors TIMP-1 and -2 in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Subjects and methods: Twenty patients with CIDP and 20 age- and sex-matched healthy controls were enrolled. Plasma concentrations of MMP-2, MMP-9, TIMP-1, and TIMP-2 were determined by the enzy…

Frovatriptan versus almotriptan for acute treatment of menstrual migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study

The objective of the study was to compare the efficacy and safety of frovatriptan and almotriptan in women with menstrually related migraine (IHS Classification of Headache disorders) enrolled in a multicenter, randomized, double-blind, cross-over study. Patients received frovatriptan 2.5 mg or almotriptan 12.5 mg in a randomized sequence: after treating 3 episodes of migraine in no more than 3 months with the first treatment, the patient was switched to the other treatment. 67 of the 96 female patients of the intention-to-treat population of the main study had regular menstrual cycles and were thus included in this subgroup analysis. 77 migraine attacks classified as related to menses were…

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

Reversible Pisa Syndrome in a patient with Parkinson's disease on rasagiline therapy

Sensory System Abnormalities In Amyotrophic Lateral Sclerosis: An Electrophysiological Approach.

Reorganization of cortical motor area in prior polio patients

Focal transcranial magnetic stimulation (TMS) was used to study the motor maps of upper limb muscles in 7 adult patients with a history of paralytic poliomyelitis. The aim of the study was to verify the potential for long-term cortical reorganization of a selective peripheral motor neuron lesion suffered early in life.Patient selection was based on the prevalent involvement of proximal muscles in only one of the upper limbs. Motor evoked potentials (MEPs) were recorded from deltoid and abductor pollicis brevis (APB) muscles. Each muscle map was characterized by area (no. of excitable positions), volume (the sum of MEP amplitudes at all scalp positions), maximal amplitude (the highest MEP re…

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…

Modulation of action tremor by repetitive transcranial magnetic stimulation in multiple sclerosis patients

Background: Patients affected by Multiple Sclerosis (MS) can show a tremor of their upper limbs, mostly during the performing of finalised action (action tremor) or at the maintaining of a position against gravity (postural tremor), as key clinical feature of their disease. Objectives: In order to reduce the tremor, patients underwent to repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex of left hemisphere. Methods: Eight patients affected by a middle form of MS were enrolled into the study. A standard neurological examination was carried out and the individual degree of disability was established employing the Expanded Disability Status Score (EDSS). At EDSS pa…

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

Prophylaxis of hemicrania continua with topiramate: report of 2 cases.

Reduced Threshold for Inhibitory Homeostatic Responses in Migraine Motor Cortex? A tDCS/TMS Study

Background and Objective Neurophysiological studies in migraine have reported conflicting findings of either cortical hyper- or hypoexcitability. In migraine with aura (MwA) patients, we recently documented an inhibitory response to suprathreshold, high-frequency repetitive transcranial magnetic stimulation (hf-rTMS) trains applied to the primary motor cortex, which is in contrast with the facilitatory response observed in the healthy subjects. The aim of the present study was to support the hypothesis that in migraine, because of a condition of basal increased cortical responsivity, inhibitory homeostatic-like mechanisms of cortical excitability could be induced by high magnitude stimulati…

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

TRANSCRANIAL DIRECT CURRENT STIMULATION ENHANCES SUCKING OF A LIQUID BOLUS IN HEALTHY HUMANS

Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive technique used for modulating cortical excitability in vivo in humans. Here we evaluated the effect of tDCS on behavioral and electrophysiological aspects of physiological sucking and swallowing. Methods Twelve healthy subjects underwent three tDCS sessions (anodal, cathodal and sham stimulation) on separate days in a double-blind randomized order. The active electrode was placed over the right swallowing motor cortex. Repeated sucking and swallowing acts were performed at baseline and at 15 and 60 min after each tDCS session and the mean liquid bolus volume ingested at each time point was measured. We also…

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 …

Ruolo dell'area prefrontale dorsolaterale sinistra nel controllo della nocicezione e dei meccanismi di sensibilizzazione: effetti della

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

CLINICAL EFFECTS OF DIFFERENT MONTAGES OF TRANSCRANIAL DIRECT CURRENT STIMULATION IN PATIENTS WITH PARKINSON’DISEASE

O069. Menstrual cycle affects cortical excitability differently in females with migraine and in healthy controls: a new perspective by cross modal sound induced flash illusions

The sound-induced flash illusions (SIFI) represent a valid tool to explore multimodal perception and are critically dependent on visual and acoustic cortical excitability [1, 2]. In a previous study [3], we observed a significant reduction of illusions in migraine patients with respect to healthy controls, probably due to a condition of visual cortex hyperexcitability. Aim of the present study was to evaluate SIFI perceptions in healthy women and patients with menstrual migraine and to describe the effects of cyclical change of steroid hormones and cortical responsiveness.

A painful tic convulsif due to double neurovascular impingement

Here we present the case of a 50-year-old man suffering from "painful tic convulsif", on the left side of the face, i.e., left trigeminal neuralgia associated with ipsilateral hemifacial spasm. An angio-MRI scan showed a neurovascular confliction of left superior cerebellar artery with the ipsilateral V cranial nerve and of the left inferior cerebellar artery with the ipsilateral VII cranial nerve. Neurophysiological evaluation through esteroceptive blink reflex showed the involvement of left facial nerve. An initial carbamazepine treatment (800 mg/daily) was completely ineffective, so the patient was shifted to lamotrigine 50 b.i.d. that was able to reduce attacks from 4 to 6 times per day…

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…

Effects of transcranial direct current stimulation on esophageal motility in patients with gastroesophageal reflux disease

To evaluate the effects of transcranial direct current stimulation (tDCS) on esophageal peristalsis in patients with gastroesophageal reflux disease (GERD).Patients with GERD preliminary diagnosis were included in a randomized double-blind sham-controlled study. Esophageal manometry was performed before and during transcranial direct current stimulation (tDCS) of the right precentral cortex. Half of patients were randomly assigned to anodal, half to sham stimulation. Distal waves amplitude and pathological waves percentage were measured, after swallowing water boli, for ten subsequent times. Last, a 24h pH-bilimetry was done to diagnose non-erosive reflux disease (NERD) or functional heartb…

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

Paired pulse TMS over the right posterior parietal cortex modulates visuospatial perception

Abstract Objective We previously observed a relative contralateral neglect by right parietal single-pulse TMS given 150 ms after visual stimulus presentation. Here we investigated the effects of parietal paired TMS in normal subjects performing a visuospatial task. Methods Thirteen right-handed healthy subjects underwent a line-length judgement task during single-pulse and paired (1, 3, 5, 10 ms ISIs) TMS, delivered on the right parietal cortex 150 ms after visual stimulus. Results Single pulse TMS over the right parietal cortex induced a significant rightward bias compared to the baseline condition. At 1 and 3 ms ISIs, paired-pulse TMS did not show any effect in comparison with single puls…

Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.

Abstract Objective To investigate frequency and associated factors of post polio syndrome (PPS) in an Italian cohort of people with prior poliomyelitis. Methods We screened subjects admitted for poliomyelitis at the paediatric hospital of the University of Palermo during the time frame 1945–1960. Patients who developed PPS were identified through a structured questionnaire and a neurologic examination. PPS diagnosis was made according to specified diagnostic criteria. Frequency of PPS was calculated in the selected cohort of polio survivors. The association with the investigated risk factors (sex, age at onset of polio, extension and severity of polio, education, associated diseases, cigare…

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

Distribution of Visuospatial Attention in "Open-Skill Sport" Athletes

Pisa syndrome after rasagiline therapy in a patient with Parkinson’s disease

Dear Editor, We have read with interest comments by Solla et al. [1] regarding our Letter to the Editor published in NeurologicalSciences titled ‘‘Insidious onset of Pisa Syndrome afterrasagiline therapy in a patient with Parkinson’s Disease’’[2]. We thank the authors for their interest in our paper, but we think it is necessary to make some clarifications regarding the temporal relationship between the onset of Pisa Syndrome (PS) and rasagiline therapy. PS occurred in fact after and not before rasagiline treatment as stated by Solla et al. In particular, PS occurred after a time interval of 6–12 months and anyway after rasagiline was added to patient’s therapy. This long time interval is o…

Multiple sclerosis: Haemorheological pattern

Electrophysiological Investigations of Shape and Reproducibility of Oropharyngeal Swallowing: Interaction with Bolus Volume and Age

Electrophysiological assessment provides valuable information on physiological and pathophysiological characteristics of human swallowing. Here, new electrophysiological measures for the evaluation of oropharyngeal swallowing were assessed: (1) the activation pattern of the submental/suprahyoid EMG activity (SHEMG); (2) the reproducibility of the oral and pharyngeal phases of swallowing, by calculating the similarity index (SI) of the SHEMG (SI-SHEMG) and of the laryngeal-pharyngeal mechanogram (SI-LPM) during repeated swallows; and (3) kinesiological measures related to the LPM. An electrophysiological-mechanical method for measuring the activation pattern of the SHEMG, the SI-SHEMG, and t…

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort.

Background and aims. Patients with Myasthenia gravis (MG) are considered vulnerable as they may present with respiratory muscle weakness and because they are on immunosuppressive treatment; thereby, COVID-19 may have a detrimental effect on these patients. Vaccines against COVID-19 are currently available and it has been shown as they can prevent severe COVID-19 in vulnerable patients. Notwithstanding their efficacy, vaccine hesitancy has not been completely dispelled in the general population. Unfortunately, there is limited data about the safety of these vaccines in MG patients. The aims of this study are to evaluate the impact of COVID-19 in a MG cohort, the adherence to COVID-19 vaccina…

Levetiracetam in the prophylaxis of migraine with aura: a 6-month open-label study.

OBJECTIVE: To evaluate the efficacy of levetiracetam as prophylactic treatment for migraine with aura with high frequency of attacks. BACKGROUND: Migraine with aura with high frequency of attacks could represent a very demanding therapeutic problem. Efficacy of the antiepileptic drug, lamotrigine, has been reported in this form of migraine. Levetiracetam is a new antiepileptic drug with an excellent tolerability profile. Mechanisms of action of this drug remain largely unknown, but recently, it has been shown to exert inhibitory effects on neuronal-type calcium channels. METHODS: We performed a small open-label trial treating 16 patients affected by migraine with aura with high frequency of…

When nominal feaures are marked on verbs: a transcranial magnetic stimulation study:

Suggested randomized, controlled trial for frovatriptan: a reply

Dear Sir, We read with interest the comments of Dr. Tfelt-Hansen [1] regarding our three recently published randomized controlled trials comparing patients’ preference (primary endpoint) and efficacy (secondary endpoints) of frovatriptan 2.5 mg versus zolmitriptan 2.5 mg [2], rizatriptan 10 mg [3] and almotriptan 12.5 mg [4], and the meta-analysis of pooled individual data from the three studies [5]. In all studies frovatriptan showed similar preference and short-term efficacy outcomes (pain relief and pain-free episodes at 2 h) with respect to the other three triptans. The questions put by Dr. Tfelt-Hansen sound appropriate. Doubts are raised on the usefulness of head-to-head preference tr…

Mild cognitive impairment in Parkinson’s disease: the Parkinson’s disease cognitive study (PACOS)

Approximately 30% of Parkinson's disease (PD) patients show impaired cognitive performance, which is suggestive of Mild Cognitive Impairment (MCI), representing a predictor of dementia, especially when present at diagnosis. The objective of the study was to evaluate the frequency and clinical predictors of MCI in a large hospital-based cohort of PD patients. We collected cross-sectional data from the Parkinson's disease cognitive impairment study (PACOS), a multicenter study involving two Movement Disorder centers, which are located in south Italy. The PD subjects were diagnosed according to the UK Brain Bank criteria and they underwent an extensive neuropsychological assessment. PD-MCI was…

Modulatory effects of 1 Hz rTMS over the cerebellum on motor cortex excitability

Clinical observations and data from animal experiments point to a physiological facilitatory influence of the deep cerebellar structures on the motor system through the cerebello-thalamo-cortical pathways. The aim of the present study was to explore the long-term effects of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) over the cerebellum on short intracortical inhibition (SICI) and facilitation (ICF) of the motor cortex in normal subjects. Eight healthy subjects (mean age 26.9 +/- 3.1) underwent 1 Hz frequency rTMS delivered on the right cerebellar hemisphere. Before and after cerebellar rTMS, SICI and ICF were assessed in the motor cortex contralateral to the st…

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…

Illusory contours and specific regions of human extrastriate cortex: evidence from rTMS.

Functional magnetic resonance imaging studies showed that perception of illusory contours is associated with extrastriate cortex activation prevailing on the right side. 1 Hz repetitive transcranial magnetic stimulation (rTMS) is able to induce lasting inhibition of cortical activity. The objective of the study was to investigate the role of extrastriate cortex in illusory contour perception inducing 1 Hz rTMS interference in healthy subjects. Eight healthy subjects underwent 1 Hz rTMS (600 pulses) through a figure-of-eight coil over right and left occipital cortex (O1 and O2 of 10/20 EEG system); sham magnetic stimulation on the same sites and right motor cortex rTMS (in three subjects) we…

A validation study of an Italian version of the "ID Migraine".

Background.—Migraine is a highly prevalent and disabling disease which is substantially underdiagnosed in primary care. Recently, the ID Migraine, a self-administered questionnaire, consisting of only 3 items, was shown to be a valid and reliable screening instrument for migraine in primary care in the United States. Objective.—The aim of the present study was to validate an Italian version of the “ID Migraine” questionnaire. Methods.—Two hundred and twenty-two consecutive headache patients referring to 8 headache centers in Sicily (Italy) completed an Italian version of the ID Migraine. The responses to the questionnaire were compared with the diagnosis of headache made by a headache speci…

Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) during capsaicin-induced pain: modulatory effects on motor cortex excitability

Evidence by functional imaging studies suggests the role of left DLPFC in the inhibitory control of nociceptive transmission system. Pain exerts an inhibitory modulation on motor cortex, reducing MEP amplitude, while the effect of pain on motor intracortical excitability has not been studied so far. In the present study, we explored in healthy subjects the effect of capsaicin-induced pain and the modulatory influences of left DLPFC stimulation on motor corticospinal and intracortical excitability. Capsaicin was applied on the dorsal surface of the right hand, and measures of motor corticospinal excitability (test-MEP) and short intracortical inhibition (SICI) and facilitation (ICF) were obt…

Anodal tDCS of the swallowing motor cortex for treatment of dysphagia in multiple sclerosis: a pilot open-label study

Swallowing difficulties are a common symptom of multiple sclerosis (MS). The early detection and treatment of dysphagia is critical to prevent complications, including poor nutrition, dehydration, and lung infections. Recently, transcranial direct current stimulation (tDCS) has been proven to be effective in ameliorating swallowing problems in stroke patients. In this pilot study, we aimed to assess safety and efficacy of transcranial direct current stimulation (tDCS) in the treatment of dysphagia in MS patients. We screened 30 patients by using the 10-item DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire, and patients at risk for dysphagia underwent a clinical and fiberoptic endoscopi…

Ruolo dell'area prefrontale dorsolaterale sinistra nel controllo della nocicezione e dei meccanismi di sensibilizzazione: effetti della stimolazione magnetica transcranica ripetitiva su un modello di dolore neuropatico indotto da capsaicina in soggetti normali

Amyotrophic lateral sclerosis in Palermo, Italy: an epidemiological study

The incidence, prevalence and natural course of ALS were determined in the population of the province of Palermo, Italy. The average annual incidence calculated for the years 1973 through 1984, was 044./100.000 inhabitants. The prevalence rate on prevalence day December 31, 1984, was 1.67/100.000 population. The male/female ratio was 1.38. The mean age at onset was 54.3±11.02. The most common clinical form was the conventional one (61.4%); the bulbar form was more frequent among females than males. The mean duration of the disease was 33.7±35.8 months. The longest duration belongs to the pseudopolyneuritic form. The median survival was 36 months: 16 months for the bulbar, 36 months for the …

O046. Color vision and visual cortex excitability are impaired in episodic migraine. Simply coexisting or pathophysiologically related dysfunctions?

Background and objectives Evidence of abnormal color vision processing in migraine comes from observation of positive symptoms during visual aura, effects of strong color contrast triggering attacks and of colored-spectacles reducing migraine frequency. Although the central or peripheral basis of such color misperception remains unclear, several authors reported a selective deficit of shortwavelength cones (S-cones) [1]. Sound-induced flash illusions (SIFI) are a simple way to describe visual distorsion induced by acoustic perception. SIFI critically depend on excitability of primary visual cortex (V1) as they are reduced by facilitatory anodal transcranial direct current stimulation (tDCS)…

Seizure following the Use of the COX-2 Inhibitor Etoricoxib

We describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presenta…

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 …

Are Multiple Domicile Changes a Risk Factor for Multiple Sclerosis?

A retrospective case-control study was conducted to estimate the possible association between risk of multiple sclerosis (MS) and the number of changes in residence before the age 20 years. Forty-one patients and 82 controls were interviewed. Using the Mantel-Haenszel estimate of the odds ratio, no association was found between the number of moves and MS.

Low-frequency transcranial magnetic stimulation in patients with cortical dysplasia

New frontiers in anticoagulation: non vitamin-K oral anticoagulants in stroke prevention

ABSTRACTIntroduction: Non vitamin-K oral anticoagulants (NOACs) are direct and specific inhibitors of the coagulation factors IIa (dabigatran) and Xa (apixaban, rivaroxaban, edoxaban) which share many pharmacokinetic properties. However, indications are lacking regarding the use of NOACs during thrombolysis, surgery and bleeding events.Areas covered: In this paper, the authors retrospectively analyzed the relevant literature on the NOACs using the PubMed and Google Scholar databases.Expert commentary: Although warfarin is effective in cardioembolic stroke prevention, easier handling and more favorable risk-benefit profile often render NOACs a more preferable therapy choice for neurologists.…

Modulation of visual cortex excitability in migraine with aura: effects of valproate therapy.

We explored the effects of valproate treatment on visual cortex excitability changes in migraine with aura patients. Abnormal cortical excitability has been suggested to play an important role in the etiopathogenesis of migraine; in particular, it has been suggested a failure of inhibitory circuits in migraine with aura. Valproate acts as a central GABA agonist and it is reasonable suppose that VPA could modify cortical excitability state. Phosphene threshold (PT) was assessed at baseline and after 1 Hz rTMS before and after one month therapy. We found that low-frequency rTMS in drug-free migraineurs decreased PT, while the treatment with the GABA agonist valproate is able to revert the eff…

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

Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Objective This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy w…

Levetiracetam in the Treatment of Creutzfeldt-Jacob Disease.

A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine

The objective of this study was to evaluate patients’ satisfaction with acute treatment of migraine with frovatriptan or almotriptan by preference questionnaire. One hundred and thirty three subjects with a history of migraine with or without aura (IHS 2004 criteria), with at least one migraine attack in the preceding 6 months, were enrolled and randomized to frovatriptan 2.5 mg or almotriptan 12.5 mg, treating 1–3 attacks. The study had a multicenter, randomized, double blind, cross-over design, with treatment periods lasting <3 months. At study end patients assigned preference to one of the treatments using a questionnaire with a score from 0 to 5 (primary endpoint). Secondary endpoints w…

"Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods This is a point prevalence study (called “Delirium Day”) including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium wa…

Mechanisms of cortical plasticity in migraine patients.

Relation between Sexual Dysfunctions and Epilepsy, Type of Epilepsy, Type of Antiepileptic Drugs: A Prospective Study

Introduction The aim of this study was to evaluate the incidence of sexual dysfunctions in males with epilepsy, the type of epilepsy, the frequency of seizures, the type of antiepileptic drugs (AEDs), the serum hormonal profile and the presence of psychiatric comorbidity. Methods Sixty-one patients focused on type of epilepsy, frequency of seizures, AEDs, hormonal profile and presence of mood disorders. We excluded all patients with severe neurologic and psychiatric impairment and patient who were not able to fill questionnaires. Mean age was 31.2 years (range 18-50 years); 31 patients (50.8%) had an idiopathic generalised epilepsy and 30 (49.2%) a focal epilepsy; among them, latter 18 (60%…

The importance of the reproducibility of oropharyngeal swallowing in amyotrophic lateral sclerosis. An electrophysiological study

Abstract Objective To investigate electrophysiologically the reproducibility of oropharyngeal swallowing in patients with ALS. Methods We enrolled 26 ALS patients, both with and without clinical signs of dysphagia, and 30 age-matched controls. The reproducibility of the electrophysiological signals related to the oral phase (electromyographic activity of the submental/suprahyoid muscles) and the pharyngeal phase (laryngeal-pharyngeal mechanogram) of swallowing across repeated swallows was assessed. To do this we computed two similarity indexes (SI) by using previously described mathematical algorithms. Results The reproducibility of oropharyngeal swallowing was significantly reduced both in…

A single case study of primary progressive aphasia: progressive improvement in verb production after rTMS treatment. Abstracts del XXXVII Congresso della Società Italiana di Neurologia Neurol Sci 2006, Suppl. 27, S236

Multisensorial Perception in Chronic Migraine and the Role of Medication Overuse.

Multisensory processing can be assessed by measuring susceptibility to crossmodal illusions such as the Sound-Induced Flash Illusion (SIFI). When a single flash is accompanied by 2 or more beeps, it is perceived as multiple flashes (fission illusion); conversely, a fusion illusion is experienced when more flashes are matched with a single beep, leading to the perception of a single flash. Such illusory perceptions are associated to crossmodal changes in visual cortical excitability. Indeed, increasing occipital cortical excitability, by means of transcranial electrical currents, disrupts the SIFI (ie, fission illusion). Similarly, a reduced fission illusion was shown in patients with episod…

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

Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease.

OBJECTIVETranscranial magnetic resonance–guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson’s disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world’s first tcMRgFUS system integrated with a 1.5-T MRI unit.METHODSThe authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was pe…

Brain stimulation in migraine

Migraine is a very prevalent disease with great individual disability and socioeconomic burden. Despite intensive research effort in recent years, the etiopathogenesis of the disease remains to be elucidated. Recently, much importance has been given to mechanisms underlying the cortical excitability that has been suggested to be dysfunctional in migraine. In recent years, noninvasive brain stimulation techniques based on magnetic fields (transcranial magnetic stimulation, TMS) and on direct electrical currents (transcranial direct current stimulation, tDCS) have been shown to be safe and effective tools to explore the issue of cortical excitability, activation, and plasticity in migraine. M…

Cortical excitability changes in chronic migraine vs episodic migraine: evidence by sound-induced flash illusions

Introduction: Sound-induced flash illusions(SIFI) permit to evaluate crossmodal audio-visual perception. When one flash is accompanied by two beeps, it is perceived as two flashes(’fission’illusion); a ‘fusion’ illusion occurs when a single beep causes the fusion of a double flash stimulus. SIFI strictly depends on cortical excitability: healthy controls perceive less illusions by increasing visual cortex excitability through anodal tDCS [1]. Aim: to evaluate if, due to cortical hyperexcitability, differences in SIFI occur in migraine and further changes can be found across migraine cycle, migraine chronification an drug overuse. Methods: we enrolled 64 patients with episodic migraine, 32 w…

Changes in glutamatergic neurotransmission within the migraine cycle

Background Although some neurophysiological studies have showed cortical excitability changes during different phases of the migraine cycle, the pathophysiological mechanisms underlying attacks recurrence remain unknown. Here we evaluated the response of the migraine motor-cortex to brief trains of 5-Hz repetitive transcranial magnetic stimulation (rTMS) in order to study, indirectly, presynaptic mechanisms of glutamatergic neurotransmission across the different phases of the migraine cycle.

Two cases of cluster headache effectively treated with levetiracetam.

Cluster headache (CH), which is characterized by recurrent attacks of short-lasting excruciating pain accompanied by signs of autonomic dysfunction (ICHD-II) (Headache Classification Subcommittee of the IHS, 2004), is the most severe of the primary headache syndromes. CH is the most common of the trigeminal autonomic cephalalgias (TACs), whose pathophysiology has not been completely elucidated ( Leone and Bussone, 2009). The treatment of CH is still debated. Verapamil (a calcium antagonist) and lithium are the first-option drugs. Several drugs have been proposed as alternative treatments, but only some of these showed limited efficacy. Recently, a new-generation antiepileptic drug, topirama…

NOCICEPTIVE EVOKED POTENTIAL MODULATION BY CORTICAL rTMS: COMPARI-SON BETWEEN MOTOR AND DORSOLATERAL PREFRONTAL (DLPFC) CORTEX STIM-ULATION. JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM

Transcranial direct current stimulation (TDCS) can modulate esophageal motility in gatroesophageal reflux disease (GERD)patients.

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.

Magnetic stimulation study in patients with myotonic dystrophy

To further define motor nervous system alterations in myotonic dystrophy (MD), motor potentials to transcranial and cervical magnetic stimulation (MEPs) were recorded from the right abductor pollicis brevis muscle in 10 patients with MD and in 10 healthy controls. Cortical and cervical latencies, central motor conduction time (CMCT), stimulus threshold intensity and cortical MEP amplitudes expressed both as absolute values and as %M were analysed. MEP cervical latency, absolute or relative amplitude and excitability threshold did not significantly differ in patients and controls. The mean cortical motor latency and CMCT were significantly prolonged in MD patients with respect to normal subj…

Cortical Hypoactivity or Reduced Efficiency of Cortical Inhibition in Migraine?

Lack of effects of low frequency repetitive transcranial magnetic stimulation on alpha rhythm phase synchronization in migraine patients

The study aimed to test the modulation induced by 1 Hz repetitive Transcranial Magnetic Stimulation (rTMS) of the occipital cortex on the alpha phase synchronization under repetitive flash stimuli in 15 migraine without aura patients compared to 10 controls. The EEG was recorded by 7 channels, while flash stimuli were delivered at 9, 18, 21 and 24 Hz in basal, rTMS (15 min of 1 Hz stimulation of the occipital cortex) and sham conditions. Migraine patients displayed increased alpha-band phase synchronization under visual stimulation, while an overall desynchronizing effect was evident in controls. The rTMS resulted in a slight increase of synchronization index in migraine patients, which did…

Modulation of intracortical inhibition induced by low- and high-frequency repetitive transcranial magnetic stimulation.

We studied the changes of duration of subsequent silent periods (SPs) during repetitive magnetic stimulation (rTMS) trains of ten stimuli delivered at low (1 Hz) and high (7 Hz) frequencies. The effects at different intensities of stimulation (motor threshold, MT, 115% and 130% above the MT) were also evaluated. rTMS was performed in eight healthy subjects with a figure-of-eight coil placed over the hand motor area. The SP was recorded from abductor pollicis brevis (APB) muscle during a voluntary contraction of 30% of maximum effort. rTMS at 1-Hz frequency progressively decreased the duration of SP, whereas an alternating pattern of smaller and larger values was observed during trains at 7-…

Hypo-excitability of cortical areas in patients affected by Friedreich ataxia: A TMS study

The aim of the study was to explore excitability of a motor and a non-motor (visual) area in patients affected by Friedreich ataxia and to correlate neurophysiological data with clinical parameters. Seven patients (3M/4F) and ten healthy controls (5M/5F) participated in the study. The hot-spot for activation of right abductor pollicis brevis was checked by means of a figure-of-eight coil and the motor threshold (MT) on this point was recorded. The phosphene threshold (PT) was measured by means of a focal coil over the occipital cortex as the lower intensity of magnetic stimulation able to induce the perception of phosphenes. The patients showed a significantly higher mean PT (p<.03) and MT …

Facilitatory effects of 1 Hz rTMS in motor cortex of patients affected by migraine with aura

We previously showed paradoxical facilitatory effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on striate and extrastriate cortex of patients suffering migraine with aura. In this study we evaluated the effects of 1 Hz rTMS on the excitability of inhibitory and facilitatory circuits of motor cortex to explore whether the abnormal pattern of excitability extends beyond the sensory cortex also involving motor areas in migraine with aura. Nine patients affected by migraine with aura and eight healthy controls entered into the study. The hot spot for activation of the right abductor pollicis brevis (APB) was checked by means of a figure-of-eight coil and motor thresh…

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…

Transcranial direct current stimulation preconditioning modulates the effect of high-frequency repetitive transcranial magnetic stimulation in the human motor cortex

Is lack of habituation a biomarker of migraine? A critical perspective

Processing of sensory stimuli has been supposed to be dysfunctioning in migraine. A basis for such abnormality has been identified in a defective ability to habituate to repetitive sensorial stimulation. Habituation, i.e. the way the nervous system attenuates response to repeated non noxious stimuli is a fundamental function of sensory systems, that allows appropriate adaptation of neural responses to the relevance of incoming stimuli. In humans, habituation can be studied by evoked potentials where it is indexed by a reduction of amplitude of the evoked response to repeated stimulation. After the first evidence by Schoenen et al in 1995[1] of reduced habituation to visual evoked potentials…

EFFECTS OF TRANSCRANIAL DIRECT STIMULATION (tdcs) ON ESOPHAGEAL MOTILITY AND PATHOLOGICAL WAVES IN GASTROESOPHAGEAL REFLUX DISEASE (GERD) PATIENTS

Effects of More-Affected vs. Less-Affected Motor Cortex tDCS in Parkinson’s Disease

Objective. To evaluate therapeutic potential of different montages of transcranial direct current stimulation (tDCS) in Parkinson’s Disease (PD) patients with asymmetric motor symptoms. Materials and Methods. Fourteen patients with asymmetric PD underwent, while on treatment, seven separate sessions including electrophysiological and clinical evaluation at baseline and after anodal, cathodal and sham tDCS of the primary motor cortex (M1) of the two hemispheres. Changes in motor cortical excitability were evaluated by transcranial magnetic stimulation. Effects on motor symptoms were assessed by testing finger tapping and upper limb bradykinesia, and by using the Italian validated Movement Di…

Valutazione neurofisiologica del dolore neuropatico.

FUNCTIONAL CONNECTIVITY MODULATION INDUCED BY TRANSCRANIAL DIRECT CURRENT STIMULATION OF THE MOTOR NETWORK

Background: Brain functions arise from the orchestrated activation and cooperation of networks of regions whose specific relationship varies dynamically across functional states. Resting state functional Magnetic Resonance Imaging (RS-fMRI) analyses focuses on spontaneous low frequency fluctuations (< 0.1 Hz) in the BOLD signal and investigates synchronous activations between regions that are spatially distinct (functional connectivity, FC), occurring in the absence of a task or stimulus. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is known to modulate cortical activity and FC among brain regions, as measured by functional Magnetic Reson…

Far Space Remapping by Tool Use: A rTMS Study Over the Right Posterior Parietal Cortex

Abstract Background In previous studies, rTMS has been successfully employed to interfere with the right posterior parietal cortex (rPPC) inducing neglect-like behavior in healthy subjects. Several studies have shown that the use of tools can modulate the boundaries between near and far space: indeed when far space is reached by the stick, far space can be remapped as near. Objective The aim of the present study was to investigate whether once that rTMS on the rPPC has selectively induced neglect-like bias in the near space (but not in the far space), neglect can appears also in the far space when the subjects used a tool to perform the task. Methods Fifteen right-handed healthy subjects ex…

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…

A single case study of primary progressive aphasia: progressive improvement in verb production after rTMS treatment.

HOMOZIGOUS DJ-1 MUTATION IN A FAMILY FROM SOUTHERN ITALY WITH AMYOTROPHIC LATERAL SCLEROSIS-PARKINSONISM-DEMENTIA COMPLEX

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…

Myasthenia-like syndrome induced by cardiovascular agents. Report of a case

The case of a myasthenia-like syndrome induced by cardiovascular drugs is reported. The clinical and electrophysiological features of the case are discussed. © 1987 Masson Italia Periodici S.r.l.

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

non presente

1 Hz rTMS enhances extrastriate cortex activity in migraine

We recently reported a paradoxical facilitatory effect of 1 Hz repetitive TMS (rTMS) on the primary visual cortex in migraine possibly due to the failure of inhibitory circuits, unable to be upregulated by low frequency rTMS. To investigate if inhibitory circuit dysfunction extends beyond striate cortex in migraine with aura, we studied the effects of 1 Hz rTMS over the right extrastriate cortex on perception of illusory contours in these patients. Low-frequency rTMS enhanced activity of extrastriate cortex in migraineurs, speeding up reaction times on illusory contour perception. This finding supports the view of a failure of inhibitory circuits also involving the extrastriate cortex in mi…

Repetitive Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) represents a valuable neurophysiological technique useful for both research and clinical practice purposes [1]. TMS acts by inducing electrical fields which cause electric currents to flow in targeted cortical areas. These currents interact with the electrical activity of the brain and can depolarize cortical interneurons and/or projection neurons depending on the characteristics of the stimulation. The induced excitation can spread throughout the nervous system by the brain’s normal mechanisms of propagation of neuronal signals. In this way, TMS can also induce functional changes in areas remote to the stimulated cortical area, including both functio…

When to use frovatriptan in migraine? A reply

Dear Sir, We read with interest the comments of Dr. Tfelt-Hansen [1] on the two recently published randomized controlled trials comparing patients’ preference (primary end-point) and efficacy (secondary end-points) of frovatriptan with respect to rizatriptan [2] and almotriptan [3]. In both studies, frovatriptan showed similar preference and short-term efficacy outcomes (pain relief and pain free episodes at 2 h) with respect to the other two triptans. The principal concern of Dr. Tfelt-Hansen was the very early use of frovatriptan in these studies, making their results hardly comparable with those of previous randomized controlled trials [4–6], where patients waited until the headache was …

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

Analysis of F response in upper motoneurone lesions

The F response can provide a measure of motoneurone excitability (MNE) and so it may be used to investigate upper motoneurone disorders. This report studies the F-wave configuration in patients with stroke to evaluate the changes of the central excitability of the motoneurones at different times after an acute cerebral insult. Various parameters of the F response, including amplitude (absolute and F%/M), duration, and persistence have been determined in 26 patients with unilateral hemiplegia and in 32 healthy subjects of both sexes in the same age range. The investigation was carried out applying a series of 20 supramaximal stimuli at 0.5 Hz on tibial and ulnar nerves bilaterally. In all pa…

Habituation or lack of habituation: What is really lacking in migraine?

Migraine is very prevalent disease with consistent disability and socioeconomic burden (Lipton et al., 2007). Despite intensive research effort, particularly in last decades, allowing significant insight in many aspects of the disease, its precise pathophysiological bases remain still to be defined. One influential view suggests that dysfunctions in sensory information processing could play a critical role (de Tommaso et al., 2014). In this frame a relevant phenomenological marker is considered the inability of migraine patients to habituate to repeated sensory stimulation.

Repetitive Transcranial Magnetic Stimulation rTMS modulation of visual cortex in healthy subjects undergoing light deprivation: A human model to study the pathophysiology of migraine.

Wernicke-Korsakoff syndrome complicated by subacute beriberi neuropathy in an alcoholic patient.

Thiamine (vitamin B1) deficiency is a common condition in alcohol abusers, which can lead to damage of both the peripheral and the central nervous systems. Here we describe the case of an alcoholic patient who presented with acute onset of ataxia, severe weakness of the four limbs, and hypoesthesia and dysesthesia of the distal portion of the upper and lower extremities. The clinical picture also included mental confusion and amnesia. A diagnosis of Wernicke-Korsakoff syndrome was made based on clinical symptoms and brain RMI findings. Electromyography and electroneurography revealed signs of subacute axonal sensory-motor polyneuropathy that were compatible with a rare acute presentation of…

Activity of intracortical inhibitory and facilitatory circuits in the visuo-spatial attention in humans: a paired TMS study

Can Wii modulate visuospatial attention lateralization?

EFFECTS OF LEFT DLPFC RTMS ON PAIN INDUCED BY CAPSAICIN IN HEALTHY SUBJECT.

Frovatriptan vs almotriptan for treatment of menstrual migraine: a double-blind, randomized, cross-over, multicenter Italian study

Results 67 of the 96 female patients of the intention-to-treat population of the main study had regular menstrual cycles and were thus included in this subgroup analysis. 77 migraine attacks classified as related to menses were treated with frovatriptan and 78 with almotriptan. Rate of pain relief at 2and 4-hrs was 36% and 53% for frovatriptan and 41% and 50% for almotriptan (p=NS between treatments). Rate of pain free at 2and 4-hrs was 19% and 47% with frovatriptan and 29% and 54% for almotriptan (p=NS). At 24-hrs, 62% of frovatriptanand 67% of almotriptan-treated patients had pain relief, while 60% vs. 67% were pain free (p=NS). Recurrence at 24-hrs was significantly (p<0.05) lower with f…

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 …

When nominal features are marked on verbs: A transcranial magnetic stimulation study

It has been claimed that verb processing (as opposed to noun processing) is subserved by specific neural circuits in the left prefrontal cortex. In this study, we took advantage of the unusual grammatical characteristics of clitic pronouns in Italian (e.g., lo and la in portalo and portala 'bring it [masculine]/[feminine]', respectively)-the fact that clitics have both nominal and verbal characteristics, to explore the neural correlates of verb and clitic processing. We used repetitive transcranial magnetic stimulation (rTMS) to suppress the excitability of the left prefrontal cortex and to assess its role in producing verb+det+noun and verb+clitic phrases. Results showed an interference ef…

Myasthenia gravis associated with Charcot-Marie-Tooth neuropathy: report of a case

We report the case of a 24 year old woman who developed myasthenia gravis in the course of a mild form of Charcot-Marie-Tooth neuropathy. We describe the clinical manifestations together with the neurophysiological, pathological, serological findings and response to therapy and discuss the unusual association in the light of the relevant literature. © 1992 Masson Italia Periodici S.r.l.

Effetti della modulazione cerebellare sulla corteccia motoria di pazienti con distonie focali

levetiracetam in treatment of idiopatic generalized serizures

Impaired Glutamatergic Neurotransmission in Migraine With Aura? Evidence by an Input-Output Curves Transcranial Magnetic Stimulation Study

(Headache 2011;51:726-733) Objective.— An imbalance between activity of inhibitory and facilitatory intracortical circuits could play a central role in migraine etiology. We used input–output curves to achieve further information about intracortical excitability of motor cortex in migraine with aura. Methods.— Input–output curves were measured in the right abductor pollicis brevis muscle at rest in 12 patients suffering from migraine with aura and 8 healthy subjects. Stimuli were delivered at intensity ranging from 100% to 160% of resting motor threshold with 10-second inter-stimulus intervals. Seven patients were studied before and during treatment with levetiracetam. Results.— Results sho…

A case of post-traumatic complex auditory hallucinosis treated with rTMS.

Previous studies of auditory hallucinations in schizophrenia found that the hallucinations were reduced by the application of transcranial magnetic stimulation (rTMS). Here we describe a case of traumatic brain injury associated with continuous music hallucinations. An MRI scan showed a structural lesion of the right temporal pole and a PET scan indicated a hyperactive area of the posterior right temporal lobe. We hypothesized that rTMS applied to the right temporal area would reduce this activity and the corresponding hallucinations. The patient's music hallucinations were significantly reduced by rTMS treatment. A PET scan following treatment also indicated that rTMS treatment reduced bra…

Improving neglect by TMS.

Hemispatial neglect refers to the defective ability of patients to explore or act upon the side of space contralateral to the lesion and to attend to stimuli presented in that portion of space. Evidence from animal models suggests that many of the behavioural sequelae associated with visual neglect may result not solely from the size of the lesion, but also from a pathological state of increased inhibition exerted on the damaged hemisphere by the contralesional hemisphere. On the basis of these potential mechanisms underlying neglect, in this review we discuss therapeutic approaches, focusing particularly on recent research using transcranial magnetic stimulation (TMS). This technique, besi…

POST-THALAMOTOMY NEUROFUNCTIONAL FINDINGS ON PATIENTS TREATED WITH TRANS-CRANIAL MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY RESULTS

BACKGROUND AND PURPOSE: We present functional connectivity (FC) changes found in the very first patients treated with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. TcMRgFUS is a promising new technique for non-invasive treatment of neurologic disorders such as Essential Tremor, tremor associated to Parkinson's Disease and Neuropathic Pain. TcMRgFUS is able to focally target and destroy specific regions in the brain through intact skull, by using a high intensity focused ultrasound beam. Resting state functional Magnetic Resonance Imaging (RS-fMRI) analyses focuses on spontaneous low frequency …

Cortical inhibition and habituation to evoked potentials: relevance for pathophysiology of migraine

Dysfunction of neuronal cortical excitability has been supposed to play an important role in etiopathogenesis of migraine. Neurophysiological techniques like evoked potentials (EP) and in the last years non-invasive brain stimulation techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation gave important contribution to understanding of such issue highlighting possible mechanisms of cortical dysfunctions in migraine. EP studies showed impaired habituation to repeated sensorial stimulation and this abnormality was confirmed across all sensorial modalities, making defective habituation a neurophysiological hallmark of the disease. TMS was employed to…

EHMTI-0220. Cortical excitability in episodic cluster headache.

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 2) paired-pulse TMS: i.e. intracortical facilitation (ICF) and short intracortical inhibition (SICI). Thirteen patients were evaluated outside bout, while the remaining twelve patients were inside bout at the time of recording.

A transcranial magnetic stimulation study evaluating methylprednisolone treatment in multiple sclerosis

Objective - To investigate the efficacy of two different high doses of intravenous methylprednisolone (IVMP) during Multiple Sclerosis (MS) relapses. Background - Transcranial Magnetic Stimulation (TMS) is the most sensitive neurophysiological ascertainment to quantify motor disability, to follow the recovery from an MS relapse, and to detect the response to treatment. Design and method - Twenty-four clinically definite relapsing - remitting MS patients presenting a relapse were randomly assigned to a treatment for 5 days with IVMP 1 or 2 g/day. The response to treatment of each patient was evaluated through Expanded Disability Status Scale (EDSS), Medical Research Council (MRC) score, and …

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

Metalloproteinases and Tissue Inhibitors in Generalized Myasthenia Gravis. A Preliminary Study

Introduction: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have recently been proposed as promising biomarkers in different immune-mediated disorders. We evaluated the plasma levels of MMP-9 and MMP-2 and their tissue inhibitors TIMP-1 and TIMP-2 in a patients’ cohort with generalized myasthenia gravis (MG). Methods: Plasma concentrations of MMP-9, MMP-2, TIMP-1 and TIMP-2 were evaluated in 14 patients with generalized MG and 13 age- and sex-matched healthy controls. The severity of disease was assessed by the modified Osserman classification. Results: Compared to the healthy subjects, MG patients had increased plasma concentrations of MMP-9, but redu…

A transcranial magnetic stimulation study evaluating methylprednisolone treatment in multiple sclerosis

Objective To investigate the efficacy of two different high doses of intravenous methylprednisolone (IVMP) during Multiple Sclerosis (MS) relapses. Background Transcranial Magnetic Stimulation (TMS) is the most sensitive neurophysiological ascertainment to quantify motor disability, to follow the recovery from an MS relapse, and to detect the response to treatment. Design and method Twenty-four clinically definite relapsing - remitting MS patients presenting a relapse were randomly assigned to a treatment for 5 days with IVMP 1 or 2 g/day. The response to treatment of each patient was evaluated through Expanded Disability Status Scale (EDSS), Medical Research Council (MRC) score, and TMS by…

Nerve conduction velocity and circulating immunocomplexes in type 1 diabetic children.

There is evidence from several laboratories of an increased prevalence of circulating immuno-complexes (CIC) in diabetic patients. It has also been suggested that CIC are pathogenetically related to chronic diabetic complications. The aim of this study was to assess peripheral nerve function in children with Type 1 diabetes and to evaluate the relationship between the neurophysiological abnormalities and the possible presence of CIC. The investigation was carried out in 25 Type 1 diabetic patients ranging in age from 7-19 years and in 20 normal controls. Neurophysiological assessment was performed to evaluate motor and sensory conduction velocity on median and tibial nerves. IgG-CIC were de…

Impaired glutamatergic neurotransmission in migraine with aura? Evidence by an input-output curves transcranial magnetic stimulation study.

Objective: An imbalance between activity of inhibitory and facilitatory intracortical circuits could play a central role in migraine etiology. We used input-output curves to achieve further information about intracortical excitability of motor cortex in migraine with aura. METHODS: Input-output curves were measured in the right abductor pollicis brevis muscle at rest in 12 patients suffering from migraine with aura and 8 healthy subjects. Stimuli were delivered at intensity ranging from 100% to 160% of resting motor threshold with 10-second inter-stimulus intervals. Seven patients were studied before and during treatment with levetiracetam. RESULTS: Results showed a greater motor-evoked pot…

Dropped head as an unusual presenting sign of myasthenia gravis

Different forms of trigeminal autonomic cephalalgias in the same patient: description of a case.

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania and SUNCT, are characterized by the cardinal combination of short-lasting unilateral pain and autonomic phenomena affecting the head. Hemicrania continua (HC) shares many clinical characteristics with TACs, including unilateral pain and ipsilateral autonomic features. Nevertheless, HC is separately classified in the revised International Classification of Headache Disorders (ICHD-II). Here, we describe the case of a 45-year-old man presenting an unusual concurrence of different forms of primary headaches associated with autonomic signs, including subsequently ipsilateral cluster headache, SUNCT a…

Modulation of pain perception by transcranial magnetic stimulation of left prefrontal cortex.

Evidence by functional imaging studies suggests the role of left dorsolateral prefrontal cortex (DLPFC) in the inhibitory control of nociceptive transmission system. Repetitive transcranial magnetic stimulation (rTMS) is able to modulate pain response to capsaicin. In the present study, we evaluated the effect of DLPFC activation (through rTMS) on nociceptive control in a model of capsaicin-induced pain. The study was performed on healthy subjects that underwent capsaicin application on right or left hand. Subjects judged the pain induced by capsaicin through a 0–100 VAS scale before and after 5 Hz rTMS over left and right DLPFC at 10 or 20 min after capsaicin application in two separate gr…

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 …

Evidence Of Visual Cortical Hyperexcitability By Sound- Induced Flash Illusions In Migraine: Preliminary Results In 47 Patients

The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis

Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have de…

F-Wave study in patients with chronic renal failure on regular haemodialysis

Motor nerve conduction along the entire length of ulnar and tibialis posterior nerves was studied in 30 uraemic patients and in 20 control subjects. The M and F latencies, MNCV (between the stimulus sites), FWCV (between the spinal cord and the stimulus sites) and F-ratio (conduction time ratio of proximal to distal segment) were assessed to evaluate the conduction in the proximal versus the distal nerve segment. In the uraemic patients, the slowing of nerve conduction involved both segments of the tested nerves to the same extent. In fact, the F-ratio did not show any significant difference between the two groups; in only one patient was its value lower than the normal limit in the tibiali…

Does habituation depend on cortical inhibition? Results of a rTMS study in healthy subjects

Habituation, i.e. the decremental response to repeated sensorial stimulation, is studied in humans through evoked potential stimulation. Mechanisms underlying habituation are not yet cleared, even if inhibitory circuits are supposed to play an important role. Light deprivation (LD) increases visual cortical excitability likely through down-regulation of GABA circuits. We previously found that high-frequency repetitive transcranial magnetic stimulation (hf-rTMS) can revert these facilitatory effects likely restoring the activity of inhibitory circuits. Here, we studied the effects of LD and rTMS on habituation of visual evoked potentials (VEPs). The hypothesis was that if the inhibitory circ…

Effects of cerebellar TMS on motor cortex of patient with focal dystonia: a preliminary report

Recent evidence suggests a role for cerebellum in pathophysiology of dystonia. Here we explored, the cerebellar modulation of motor cortex in patients with focal upper limb dystonia. Eight patients and eight controls underwent a transcranial magnetic stimulation protocol to study the cerebellar-brain-inhibition (CBI): a conditioning cerebellar stimulus (CCS) was followed 5 ms after by the contralateral motor cortex stimulation (test stimulus: TS). We explored the effects of CBI on MEP amplitude, short intracortical inhibition (SICI) and intracortical facilitation (ICF) measures. At baseline no differences in TS-MEP amplitude, SICI or ICF were found between patients and controls. Cerebellar-…

Peripheral nerve involvement in chronic liver disease. Clinical and electrophysiological study.

A clinical and electrophysiological study was carried out on 19 selected patients with chronic liver disease. Clinical signs of peripheral nerve involvement were found in 4 patients (21%); while electrophysiological impairment was present in 11 patients (57.8%). These abnormalities were mostly limited to the sensory and motor fibers of the tibialis posterior nerve. Our data confirm the presence of peripheral nerve involvement in chronic liver disease, and that it may be evidenced by careful electrophysiological examination.

Ipsilesional and contralesional regions participate in the improvement of poststroke aphasia: a transcranial direct current stimulation study

In the past few years, noninvasive cerebral stimulations have been used to modulate language task performance in healthy and aphasic patients. In this study, a dual transcranial direct current stimulation (tDCS) on anterior and posterior language areas was applied for 2 weeks to a patient with a possible crossed aphasia following a right hemisphere stroke. Inhibitory cathodal stimulation of the right Brodmann areas (BA) 44/45 and simultaneous anodal stimulation of the left BA 44/45 improved the patient’s performance in picture naming. Conversely, the same bilateral montage on BA 39/40 did not produce any significant improvement; finally, electrode polarity inversion over BA 39/40 yielded a fu…

Main Topics

DJ-1 mutations and parkinsonism-dementia-amyotrophic lateral sclerosis complex.

Mutations in DJ-1 gene have been recently shown to cause autosomal recessive early-onset Parkinson’s disease (EOPD) in a large Dutch family and in a small consanguineous Italian family.1 Subsequent to this initial finding, several additional DJ-1 mutations were identified in subjects with EOPD.2–6 We describe a family from southern Italy with three brothers affected by a complex disorder characterized by early-onset parkinsonism-dementia-amyotrophic lateral sclerosis (EOPD-D-ALS). The analysis of the DJ-1 gene showed a novel homozygous mutation (E163K) in exon 7 and a novel homozygous mutation (g.168_185dup) in the promoter region of this gene in living affected subjects

Prophylaxis of hemicrania continua with topiramate: report of two cases.

Efficacy and tolerability of pregabalin in prophylaxis of chronic and refractory migraine.