Functional neurology最新文献

The present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life Post-Stroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA - according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures - should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.

It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital platform was developed as a training tool. The platform has been active since 1 October 2014. It is readily accessible to doctors by free registration. Users have access to all the material available on the platform, which includes scientific articles, e-books, presentations and images. Users can share their own material and clinical cases directly. At the time of this study, the platform had 37 users. In the second year following its launch 316 files were downloaded and five discussions were started. These saw 22 contributions. Fifteen of the 37 members did not perform any action on the platform. In total, 74 files were uploaded in the second year of activity, but 90% of the contributions came from a very small group of users. There were no significant differences in use of the platform between members of the Italian Society for the Study of Headache and other specialists. Even though the platform appears to be an easily accessible, interactive and inexpensive instrument, the higher number of downloads than uploads suggests that it is used passively.

This study aimed to investigate the incidence of aggressiveness in patients with severe drug-refractory focal epilepsy (DRE) who started perampanel (PER) as add-on treatment, and to identify possible predisposing factors. Data on 49 consecutive patients with severe DRE who initiated PER were retrospectively collected. Twelve of the 49 patients experienced aggressiveness as adverse event related to PER treatment, one third of them on low (2-4 mg/day) PER dosages. PER was discontinued in 10/12 patients because of aggressive behaviors. Aggressiveness could appear after several months or even more than one year of PER treatment. One third of patients with PER-related aggressiveness had intellectual disabilities and 5/12 patients took levetiracetam as a concomitant antiepileptic drug. Our study suggests that the occurrence of aggressive behaviors in patients with severe DRE is not uncommon during PER treatment and that it may occur after months or even years of treatment with a stable dosage, requiring PER discontinuation in the great majority of patients.

The Authors of this letter look at consumption of opioids and a2- ligands, also known as "gabapentinoids", in Italy, and specifically in the Provincial Health District of Cosenza, as compared with USA trends of recent decades. Access to analgesic drugs since the introduction of Italian law 38/2010 is also evaluated and possible future measures for better management of chronic pain are proposed.

Cytosine arabinoside (Ara-C) is one of the key drugs for treating acute myeloid leukemia (AML). High intravenous doses may produce a number of central nervous system (CNS) toxicities and contribute to modifications in brain functional connectivity. sLORETA is a software used for localizing brain electrical activity and functional connectivity. The aim of this study was to apply sLORETA in the evaluation of possible effects of Ara-C on brain connectivity in patients with AML without CNS involvement. We studied eight patients with AML; four were administered standard doses of Ara-C while the other four received high doses. sLORETA was computed from computerized EEG data before treatment and after six months of treatment. Three regions of interest, corresponding to specific combinations of Brodmann areas, were defined. In the patients receiving high-dose Ara-C, a statistically significant reduction in functional connectivity was observed in the fronto-parietal network, which literature data suggest is involved in attentional processes. Our data highlight the possibility of using novel techniques to study potential CNS toxicity of cancer therapy.

Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.

Corticobasal degeneration is a rare disorder, which usually consists of a combination of complex movement disorders, apraxia and cortical changes. Its definition is still evolving and in 2013 an international consortium tried to develop new criteria, based on a systematic literature review. Over a long period of time, we carefully selected 23 patients who fulfilled the criteria for a diagnosis of corticobasal degeneration; all had the so-called corticobasal syndrome phenotype, in accordance with Armstrong et al. (2013). Through a dedicated study, we set out to study behavioral alterations, specifically apathy, and to compare the results obtained with those deriving from a well-defined Parkinson's disease population. On the basis of our limited but specific results, we argue for a possible role of the parietal neural networks as a determinant of apathy, and provide an overview of emerging data in the imaging and pathology literature.

The first part of this paper reports an interview with the philosopher Peter Singer. In the second, we examine Singer's background: naturalism and neurophilosophy, discussing three of its theses, as presented by Patricia Smith Churchland. Finally, we go back to Singer himself, to draw some conclusions.