Andrea Vergallo

A single-center, cross-sectional prevalence study of impulse control disorders in Parkinson disease: association with dopaminergic drugs.

Abstract The current study aimed at establishing the prevalence of impulse control disorders (ICDs) in patients with Parkinson disease (PD) and their association with demographic, drug-related, and disease-related characteristics. We performed a single-center cross-sectional study of 805 PD patients. Impulse control disorders were investigated with the Questionnaire for Impulsive Compulsive Disorders in Parkinson’s Disease; also comorbid neuropsychiatric complications (dementia, delusions, visual hallucinations) were investigated with clinical interviews and ad hoc instruments (Parkinson Psychosis Questionnaire and Neuropsychiatry Inventory). Impulse control disorders were identified in 65 patients (prevalence, 8.1%), with pathological gambling and hypersexuality the most frequent. Impulse control disorders were present in 57 of 593 cognitively preserved patients (prevalence, 9.6%) and in 8 of 212 demented patients (prevalence, 3.8%). Impulse control disorders were significantly associated with dopamine agonists (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.60–12.46; P < 0.0001) and levodopa (OR, 2.43; 95% CI, 1.06–6.35; P = 0.034). Impulse control disorders frequency was similar for pramipexole and ropinirole (16.6% vs 12.5%; OR, 1.45; 95% CI, 0.79–2.74; P = 0.227). Additional variables associated with ICDs were male sex and younger age. These findings suggested that dopaminergic treatments in PD are associated with increased odds of having an ICD, but also other demographic and clinical variables are associated with ICDs, suggesting the multifactorial nature of the ICD phenomenon in PD.

Affective theory of mind in patients with Parkinson's disease

The aim of this study was to assess the hypothesis that patients with Parkinsons disease (PD) may have difficulties in tasks of affective theory of mind (ToM; the inference on others’ feelings) especially in moderate/advanced PD stages. Difficulties of cognitive ToM have already been described in several previous studies.

Triggers in allodynic and non-allodynic migraineurs. A clinic setting study.

Allodynia is considered a phenomenon of central sensitization that may lead to migraine transformation, lowering the attack threshold. Migraine triggers are factors that may induce headache attacks in susceptible individuals. We hypothesize that because allodynia decreases the migraine‐attack threshold, allodynic migraineurs are more susceptible to triggers than the non‐allodynic ones.

How Aware Are Migraineurs of Their Triggers

Broad discrepancies in the number of migraine triggers have been reported in several studies. Migraineurs do not seem to recognize easily headache triggers in clinical practice.

The cholinergic system in the pathophysiology and treatment of Alzheimer’s disease

Cholinergic synapses are ubiquitous in the human central nervous system. Their high density in the thalamus, striatum, limbic system, and neocortex suggest that cholinergic transmission is likely to be critically important for memory, learning, attention and other higher brain functions. Several lines of research suggest additional roles for cholinergic systems in overall brain homeostasis and plasticity. As such, the brains cholinergic system occupies a central role in ongoing research related to normal cognition and age-related cognitive decline, including dementias such as Alzheimers disease. The cholinergic hypothesis of Alzheimers disease centres on the progressive loss of limbic and neocortical cholinergic innervation. Neurofibrillary degeneration in the basal forebrain is believed to be the primary cause for the dysfunction and death of forebrain cholinergic neurons, giving rise to a widespread presynaptic cholinergic denervation. Cholinesterase inhibitors increase the availability of acetylcholine at synapses in the brain and are one of the few drug therapies that have been proven clinically useful in the treatment of Alzheimers disease dementia, thus validating the cholinergic system as an important therapeutic target in the disease. This review includes an overview of the role of the cholinergic system in cognition and an updated understanding of how cholinergic deficits in Alzheimers disease interact with other aspects of disease pathophysiology, including plaques composed of amyloid-β proteins. This review also documents the benefits of cholinergic therapies at various stages of Alzheimers disease and during long-term follow-up as visualized in novel imaging studies. The weight of the evidence supports the continued value of cholinergic drugs as a standard, cornerstone pharmacological approach in Alzheimers disease, particularly as we look ahead to future combination therapies that address symptoms as well as disease progression.

Peri-ictal prolonged atrial fibrillation after generalized seizures: Description of a case and etiopathological considerations

Cardiac rhythm changes are not uncommon in connection with seizures and should be considered and recognized given their potentially harmful consequences including Sudden Unexpected Death in Epilepsy (SUDEP). The most well known are ictal tachycardia and bradycardia. However, other potentially dangerous peri-ictal arrhythmias have been reported. Brief atrial fibrillation episodes, never longer than 2 min, have rarely been described in connection with seizures. We report the case of a patient who presented with two generalized tonic-clonic seizures associated with prolonged atrial fibrillation. Extensive non-invasive cardiac investigations failed to disclose cardiac abnormalities, and after proper antiepileptic drug treatment the patient had neither further seizures nor cardiac events in an 18-month follow-up. Our case, to our knowledge, is the first report of prolonged (more than 1 h) peri-ictal atrial fibrillation.

Bilateral Thalamic Infarct Caused by Spontaneous Vertebral Artery Dissection in Pre-eclampsia with HELLP Syndrome: A Previously Unreported Association

Cerebrovascular accidents are not rare during pregnancy and the postpartum period. Pre-eclampsia is a common condition that is characterized by proteinuria and de novo hypertension that may be complicated by hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Spontaneous cervical artery dissection has been rarely reported in the postpartum period but never in association with HELLP syndrome. We describe a case of pre-eclampsia and HELLP syndrome complicated in the postpartum period by bilateral thalamic infarct as result of left vertebral artery dissection. We speculated about the possible common etiopathologic mechanisms involved in this previously unreported association.

Treatment of epilepsy in patients with Alzheimer’s disease

ABSTRACT Introduction: Epilepsy is significantly more frequent in AD patients than in age-matched controls, even though the true extent of the phenomenon is not clear yet. Areas covered: In this review, we describe in detail the available data on the pharmacological treatment of epilepsy in patients with AD. We also briefly describe general principles of AEDs use in elderly, as well as the potential cognitive profile of AEDs and safety of concomitant psychotropic drugs in patients with epilepsy and AD. Expert commentary: As some preclinical data suggest a role of epileptiform discharges in cognitive decline in AD, a prompt diagnosis and treatment of seizures in these patients should be pursued. The few data on the use of AEDs in AD patients suggest that newer AEDs (in particular lamotrigine and levetiracetam) might be good choices. Experimental data even support a potential role of some AEDs in modifying the disease course of AD.

Thyroid hormone levels in the cerebrospinal fluid correlate with disease severity in euthyroid patients with Alzheimer's disease

Several reports suggest that subclinical abnormalities in thyroid function may play a role in Alzheimer’s disease (AD) [1–3]. Because of the complexity of thyroid hormone (TH) transport and metabolism in the brain, this hypothesis should be tested by assaying TH in cerebrospinal fluid (CSF). Reduced T3 and increased 3,3 0,50-triiodothyronine (rT3) [4], or decreased T4 with unchanged T3 [5], were reported in CSF of AD patients. A limitation of these studies is the use of immunological methods, which were only validated for plasmatic TH. In the present investigation, we used mass spectrometry (MS) coupled to highperformance liquid chromatography (HPLC), a highly specific and sensitive analytical technique [6], to assay CSF T4, T3 and rT3 in a retrospective series of 35 patients (9 males, 26 females, age 66 ± 2 years), observed at the Neurological Unit of Pisa University. CSF TH concentrations were related to serum TH concentration, and to other laboratory and clinical variables. Subjects and methods

Localized Calcific Hematoma of the Scalp Presenting as a Nummular-Like Headache. A Case Report

Nummular headache (NH) is a primary headache characterized by focal head pain felt in a coin-shaped area (International Classification of Headache Disorders II, A13.7.1). Pain is typically mild to moderate, with chronic exacerbations. Headache is more frequently localized in the parietal region of the skull and sometimes, sensory symptoms, tenderness, and occasionally trophic changes may coexist, sharply bordered inside the painful area. The absence of any lesion of the underlying structures is a prerequisite for the diagnosis; nonetheless, symptomatic cases have been reported in the literature. We reported a case of an NH that we suggested as secondary to a post-traumatic localized calcific hematoma of the scalp. A 46-year-old woman presented in June 2011. The patient was a strong smoker, and in her past medical history, she had experienced an episode of major depression 15 years prior to presentation in our clinic. She reported suffering from headaches 4 years prior to presentation. The pain was tightening in quality, chronic, mild in intensity, interrupted by spontaneous remission lasting from few days to 2-3 weeks. It was localized in the right parietal region on a circumscribed round-shaped area of about 3 cm in diameter. There were no signs or symptoms of sensory dysfunction without tenderness in the symptomatic area. The pain was not associated with nausea, vomiting, photophobia, phonophobia, or autonomic signs. During the last 6 months, she noted a modification of the headache pattern. The pain became continuous, moderate with some severe exacerbations lasting for 1-2 hours and was characterized as “throbbing.” The exacerbations may be triggered by emotive stress.The headache responded quite well at low doses of ibuprofen or ketoprofen. Over the year prior to the onset of headaches, she reported repeated trivial head trauma against a shelf placed behind her desk, always approximately on the scalp region of the origin of pain. This occurred because of the constricted space in which she worked. The issue of a lack of space was exacerbated by having to move away from the space in a hurry with some degree of frequency. At the patient’s physical evaluation, the scalp inspection demonstrated a bump in the painful region without trophic alteration. The neurological examination was completely negative. Scalp ultrasound, skull computed tomography, also with 3-dimensional reconstructions, and brain magnetic resonance imaging were performed and showed the presence of a lesion of about 10.5 mm, with a calcific component and a liquid layer that discloses the epicranial tissues. This lesion, compatible with a calcific hematoma, was localized exactly in the same site, the pain area fingerpointed by the patient presenting a spatial relationFrom the Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy (M. Ulivi, F. Baldacci, A. Vergallo, and U. Bonuccelli), Neurology Unit, Hospital of Viareggio, Viareggio, Italy (M. Vedovello, P. Borelli, and A. Nuti). Conflict of Interest: In the past year, Ubaldo Bonuccelli has received fees for consultation from GSK and Eisai, and for speeches from Novartis, GSK, and Lundbeck. The remaining authors report no conflict of interest. ISSN 0017-8748 doi: 10.1111/head.12131 Published by Wiley Periodicals, Inc. Headache