Enrico Grassi

Risperidone in idiopathic and symptomatic dystonia: preliminary experience

Abstract Risperidone is a heterocyclic neuroleptic with prominent antiserotoninergic (5HT2) as well as antidopaminergic (D2) activity. We studied the efficacy of risperidone in the treatment of idiopathic and symptomatic dystonias in seven patients using the Fahn and Marsden rating scale for torsion dystonia before and after four weeks of treatment (2–6 mg/day). The twisting and involuntary movements with abnormal postures decreased in all the patients treated, with a statistically significant mean improvement (41%; p = 0.009, CI 95%). Our results suggest that risperidone is useful in idiopathic and symptomatic dystonia.

No evidence of linkage between schizophrenia and D2 dopamine receptor gene locus in Italian pedigrees

Our purpose was to test the dopamine D2 receptor gene (DRD2), the tyrosine hydroxylase (TH) gene and the monoamino oxydase A (MAO-A) gene for linkage to schizophrenia and bipolar disorders. We have analyzed seven Italian families with schizophrenia and four families with bipolar disorders for a total of 68 individuals; 32 individuals were affected. Diagnoses were made using the structured clinical interview Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L). The results of our study provide no evidence of linkage between alleles at D2 dopamine receptor loci and schizophrenia or bipolar disorders. The markers TH gene and MAO-A gene give slightly positive or negative results suggesting the utility of further analysis on more informative families.

Maurice Ravel and right hemisphere creativity – Reply

Sir, Considering the fact that ‘In the concerto for the Left Hand Ravel used a different style and structure compared with the G-major concerto’, the authors of the recently published article on Ravel’s last musical works (Amaducci et al., 2002) conclude that the Concerto for the Left Hand is ‘music originating predominantly from the right hemisphere’ because a ‘left hemisphere lesion may have modified Ravel’s music’. However, the Concerto for the Left Hand was completed in 1930 and the G-major concerto a year later in 1931. Arguing that the ‘G-major concerto was conceived much earlier’ the authors quote (Blom and Calvacoressi, 1970) that it is ‘in fact the belated materialization of a plan that ever since his youth he had kept in the back of his mind’. This means merely that Ravel wanted to write a piano concerto early in his career but does not mean that the G-major concerto ‘consist in part of an elaboration of sketches composed earlier’. All scholars agree that the materialization of plans for a (G-major)piano concerto started in 1929, shortly before Wittgenstein’s commission for a Concerto for the Left Hand. Moreover, the Concerto for the Left Hand is not Ravel’s last composition. If the Concerto for the Left Hand, completed in 1930, shows features of a latent left hemisphere disease, then Don Quichotte à Dulcinée, written during 1932–33, should show these presumed features even more. But this is not the case. Of course the Left Hand Concerto has a peculiar style, different from the G-major concerto, but this is not an argument for Ravel’s disease. All through his career, Ravel produced contrasting works. Even in the same work, e.g. the Sonata for violin and piano, there are striking stylistic differences between the Allegretto, the ‘jazzy’ Blues and the Perpetuum mobile. Actually, the stylistic peculiarities in the Concerto for the Left Hand are related to Wittgenstein’s commission. In the nature of things, the G-major concerto has a stronger presence of the piano because Ravel wrote it normally for both hands, whereas in the Concerto for the Left Hand he had to create the illusion of writing for both hands. To explain the difference in style, the authors point out that ‘the right hemisphere is activated, above all, by the processing of timbres’ and that ‘rhythm is associated mainly to the left hemisphere’. They seem to forget that this hemispheric specialization is based on experimental findings with regard to the perception of music which is not the same as the creation of music. In fact, there is neither more timbre nor less rhythm in the Concerto for the Left Hand than in the Gmajor concerto. Furthermore, they claim that ‘avoiding the difficulty of elaborating a complex structured theme, Ravel adopted the alternative use of different timbres’. Yet, the theme of the introduction of the Concerto for the Left Hand comprises not less than 32 bars and the final cadence for the piano is one of the most elaborate that exist in the whole literature. The Concerto for the Left Hand demonstrates, even more than the G-major concerto, a magistral structural cohesion. Finally, the last pages of Ravel’s manuscript of the Concerto for the Left Hand, dated 1930, which I have seen in the Pierpoint Morgan Library in New York, are as calligraphic as the G-major concerto or previous works. In my opinion, there are thus no reasons whatsoever – chronological, musicological, neurocognitive or musical – to suggest that the Concerto for the Left Hand was influenced by cerebral lesions (Baeck, 1996, 1997, 1998, 2001).

Lack of SOD1 gene mutations and activity alterations in two Italian families with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive fatal disorder, which results from the degeneration of motor neurons in the brain and spinal cord. Approximately 20% of the inherited autosomal dominant cases are due to mutations within the gene coding for Cu/Zn superoxide dismutase 1 (SOD1), a cytosolic homodimeric enzyme that catalyzes the dismutation of toxic superoxide anion. We investigated the presence of SOD1 gene mutations and activity alterations in two unrelated families of ALS patients from Elba, an island of central Italy. No mutation in SOD1 exon 1 to 5 and no activity alteration were observed in all members of the two analyzed ALS families (FALS). These data show an apparent heterogeneous distribution of ALS patients with SOD1 gene mutations among different populations and suggest that another genetic locus could be involved in the disease.

The painful muse: migrainous artistic archetypes from visual cortex

Neurological diseases which constituted traditionally obstacles to artistic creation can, in the case of migraine, be transformed by the artists into a source of inspiration and artistic production. These phenomena represent a chapter of a broader embryonic neurobiology of painting.