F. Giovannelli
Santa Maria Nuova Hospital
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Featured researches published by F. Giovannelli.
Movement Disorders | 2006
Massimo Cincotta; A. Borgheresi; F. Balestrieri; F. Giovannelli; A. Ragazzoni; P. Vanni; Francesco Benvenuti; Gaetano Zaccara; Ulf Ziemann
The neural mechanisms underlying unintended mirror movements (MMs) of one hand during unimanual movements of the other hand in patients with Parkinsons disease (PD) are largely unexplored. Here we used surface electromyographic (EMG) analysis and focal transcranial magnetic stimulation (TMS) to investigate the pathophysiological substrate of MMs in four PD patients. Surface EMG was recorded from both abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Cross‐correlation EMG analysis revealed no common motor drive to the two APBs during intended unimanual tasks. Focal TMS of either primary motor cortex (M1) elicited normal motor‐evoked potentials (MEPs) in the contralateral APB, whereas MEPs were not seen in the ipsilateral hand. During either mirror or voluntary APB contraction, focal TMS of the contralateral M1 produced a long‐lasting silent period (SP), whereas stimulation of the ipsilateral M1 produced a short‐lasting SP. During either mirror or voluntary finger tapping, 5 Hz repetitive TMS (rTMS) of the contralateral M1 disrupted EMG activity in the target FDI, whereas the effects of rTMS of the ipsilateral M1 were by far slighter. During either mirror or voluntary APB contraction, paired‐pulse TMS showed a reduction of short‐interval intracortical inhibition in the contralateral M1. These findings provide converging evidence that, in PD, MMs do not depend on unmasking of ipsilateral projections but are explained by motor output along the crossed corticospinal projection from the mirror M1.
Experimental Brain Research | 2006
F. Giovannelli; A. Borgheresi; F. Balestrieri; A. Ragazzoni; Gaetano Zaccara; Massimo Cincotta; Ulf Ziemann
A distributed cortical network enables the lateralization of intended unimanual movements, i.e., the transformation from a default mirror movement to a unimanual movement. Little is known about the exact functional organization of this “non-mirror transformation” network. Involvement of the right dorsal premotor cortex (dPMC) was suggested because its virtual lesion by high-frequency repetitive transcranial magnetic stimulation (rTMS) increased the excitability of the left primary motor cortex (M1) during unilateral isometric contraction of a left hand muscle (Cincotta et al., Neurosci Lett 367: 189–93, 2004). However, no behavioural effects were observed in that experimental protocol. Here we tested behaviourally twelve healthy volunteers to find out whether focal disruption of the right dPMC by “off-line” One Hz rTMS (900 pulses, 115% of resting motor threshold) enhances “physiological” mirroring.This was measured by an established protocol (Mayston et al., Ann Neurol 45: 583–94, 1999) that quantifies the mirror increase in the electromyographic (EMG) level in the isometrically contracting abductor pollicis brevis (APB) muscle of one hand during brief phasic contractions performed with the APB of the other hand. Mirroring in the right APB significantly increased after real rTMS of the right dPMC. In contrast, no change in mirroring was seen with sham rTMS of the right dPMC, real rTMS of the right M1, or real rTMS of the left dPMC. These findings strongly support the hypothesis that the right dPMC is part of the non-mirror transformation cortical network.
Movement Disorders | 2006
Massimo Cincotta; F. Giovannelli; A. Borgheresi; F. Balestrieri; P. Vanni; A. Ragazzoni; Gaetano Zaccara; Ulf Ziemann
Patients with Parkinsons disease (PD) may present mirror movements (MM). Transcranial magnetic stimulation data indicate that these movements reflect an abnormal enhancement of the “physiological mirroring” that can be observed in healthy adults during complex and effortful tasks. It was hypothesized that, in PD, enhanced mirroring is caused by a failure of basal ganglia output to support the cortical network that is responsible for the execution of strictly unimanual movements. If so, it is likely that subtle alterations of voluntary unimanual motor control are also present in PD patients without overt MM. We tested this hypothesis by using surface electromyographic (EMG) techniques in 12 mildly to moderately affected PD patients without overt MM, and in 2 control groups (12 age‐matched and 10 young healthy volunteers). Subjects performed unilateral phasic thumb abduction during a sustained tonic contraction of the opposite abductor pollicis brevis. All patients were tested on dopaminergic therapy. On a separate day, 7 of 12 patients were re‐tested after withdrawal of medication. During this task, involuntary mirror‐like increase in surface EMG of the tonically abducting thumb was significantly larger in PD patients than in age‐matched or young healthy volunteers. Off therapy, mirroring was slightly greater than on medication, although this difference was not significant. Our findings suggest that dysfunction of unimanual motor control is a general feature of PD. It is likely that this deficient movement lateralization contributes to an impairment of nonsymmetrical bimanual movements in PD.
Experimental Brain Research | 2006
Massimo Cincotta; F. Giovannelli; A. Borgheresi; F. Balestrieri; Gaetano Zaccara; M. Inghilleri; Alfredo Berardelli
In healthy subjects, suprathreshold repetitive transcranial magnetic stimulation (rTMS) at frequencies >2xa0Hz prolongs the cortical silent period (CSP) over the course of the train. This progressive lengthening probably reflects temporal summation of the inhibitory interneurons in the stimulated primary motor cortex (M1). In this study, we tested whether high-frequency rTMS also modulates the ipsilateral silent period (ISP). In nine normal subjects, suprathreshold 10-pulse rTMS trains were delivered to the right M1 at frequencies of 3, 5, and 10xa0Hz during maximal isometric contraction of both first dorsal interosseous muscles. At 10xa0Hz, the second pulse of the train increased the area of the ISP; the other stimuli did not increase it further. During rTMS at 3 and 5xa0Hz, the ISP remained significantly unchanged. Control experiments showed that 10-Hz rTMS delivered at subthreshold intensity also increased the ISP. rTMS over the hand motor area did not facilitate ISPs in the biceps muscles. Finally, rTMS-induced ISP facilitation did not outlast the 10-Hz rTMS train. These findings suggest that rTMS at a frequency of 10xa0Hz potentiates the interhemispheric inhibitory mechanisms responsible for the ISP, partly through temporal summation. The distinct changes in the ISP and CSP suggest that rTMS facilitates intrahemispheric and interhemispheric inhibitory phenomena through separate neural mechanisms. The ISP facilitation induced by high-frequency rTMS is a novel, promising tool to investigate pathophysiological abnormal interhemispheric inhibitory transfer in various neurological diseases.
Clinical Neurophysiology | 2005
Massimo Cincotta; A. Borgheresi; Patrick Jung; F. Balestrieri; F. Giovannelli; Gaetano Zaccara; Ulf Ziemann
OBJECTIVEnTo analyse the interactions between simultaneous or nearly simultaneous focal transcranial magnetic stimulation (TMS) of the motor cortex hand area (M1hand) of both hemispheres.nnnMETHODSnIn 7 healthy subjects, motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration were elicited in the right hand by bihemispheric focal TMS of M1hand (8-shaped coils, monophasic current waveform, stimulus intensity 120% above motor threshold, TMS of right M1hand preceding TMS of left M1hand by 0-1000 micros), or by unilateral TMS of left M1hand alone. A dipole probe was used to measure the physical interactions between the two stimulating coils.nnnRESULTSnBihemispheric TMS markedly decreased MEP and CSP at intervals of 0 and 50 micros compared to unilateral TMS, whereas both measures increased at the interval of 150 micros. The dipole probe experiments showed that the physical interactions between the electrical fields of the two coils entirely explained the MEP and CSP findings, but only under the assumption that excitation of M1hand is not point-focal but extends over several centimetres.nnnCONCLUSIONSnFirst, simultaneous focal TMS of distant brain sites may result in marked distortion of brain excitation through physical interaction between the induced electrical fields. Second, these findings support the notion that excitation of human M1hand is relatively non-focal, even if a focal stimulating coil and low stimulus intensity are used.nnnSIGNIFICANCEnPotentially marked physical interaction between induced electrical fields must be taken into account when testing or disrupting distant brain sites with simultaneous focal TMS.
Clinical Neurophysiology | 2006
Massimo Cincotta; F. Giovannelli; A. Borgheresi; F. Balestrieri; Gaetano Zaccara; Maria Pia Viggiano; Ulf Ziemann
Background: Repetitive transcranial magnetic stimulation (rTMS) represents an important therapeutic tool and it has been suggested that some of these therapeutic effects are mediated through enhanced cortical inhibition (CI). Therefore, this study endeavored to explore the effects of several different rTMS stimulus conditions on inhibition and excitability in the human motor cortex. Methods: Twelve healthy control subjects participated in this study. Subjects were randomly assigned to receive either 1, 10 or 20 Hz rTMS for a total of 900 stimulations or priming rTMS (10 subjects) (i.e., 600 6 Hz stimuli followed by 600 1 Hz stimuli) all separated by 1 week. CI was indexed using single pulse and paired TMS paradigms including short interval cortical inhibition (SICI) and cortical silent period (CSP), respectively. Cortical excitability was indexed using the rest EMG during the rTMS stimulus train and motor threshold and motor evoked potential (MEP) size after the stimulus train. Results: Across all stimulus conditions there was a significant increase in the CSP. There was also a significant increase in SICI, particularly in those subjects with reduced baseline SICI. There was no significant difference in the extent of inhibition (i.e., CSP, SICI) induced by different stimulus conditions. There was also a strong correlation between rest EMG activity and stimulation frequency during the stimulus train but no significant change in measures of excitability (e.g., MT and MEP size) after the stimulus train. Conclusions: These findings suggest that rTMS increases inhibition following an rTMS course and that higher rTMS frequency stimulation results in greater cortical excitability during the stimulus train but not afterward. Future studies designed to replicate these initial findings as well as assessing the effects of repeated administration of rTMS courses on CI are warranted to elucidate potential novel therapeutic mechanisms involved in this exciting new treatment.
Clinical Neurophysiology | 2016
F. Giovannelli; Simone Rossi; A. Borgheresi; M. Calistri; Gaetano Zaccara; G. Avanzini; Maria Pia Viggiano; Massimo Cincotta
Neurophysiological studies suggest that reading sheet music facilitates sensorimotor cortex in musicians. The aim of the present study was twofold: to evaluate (1) whether in piano players, reading notes in the bass clef (usually played with the left hand) and in the treble clef (usually played with the right hand) selectively enhances right and left M1 excitability, respectively (inter-hemispheric effect); and (2) whether reading notes played with the thumb or with the little finger selectively modulate the excitability of the abductor pollicis brevis (APB) and abductor digitorum minimi (ADM) muscles, respectively (intra-hemispheric effect). Seven pianists participated to the study. Single pulse TMS was applied to either M1 while subjects alternatively read the bass or the treble clef of five sheets music without any movements. As a baseline condition TMS was delivered during the observation of a blank pentagram. When subjects read the treble clef, the excitability of the left M1 was significantly higher compared to that recorded in the right M1. No significant differences emerged during reading of the bass clef. Moreover, motor-evoked potentials were higher in the ADM muscle regardless the note. These preliminary data support the view that music reading may induce specific inter-hemispheric modulation of the motor cortex excitability.
Clinical Neurophysiology | 2016
F. Giovannelli; B. Mastrolorenzo; A. Rossi; Gioele Gavazzi; A. Borgheresi; M. Calistri; Gaetano Zaccara; Maria Pia Viggiano; Massimo Cincotta
Deficient voluntary control of behaviour and impulsivity are key aspects of impulse control disorders. The objective of the present study was to evaluate the relationship between behavioural measures of impulsivity and awareness of voluntary action. Seventy-four healthy volunteers completed the Barratt Impulsiveness Scale (BIS), a questionnaire used to measure impulsive personality traits, and a go/no-go task. Moreover, all participants performed a task in which, using the Libet’s clock, they were requested to report the time of a self-initiated movement (M-judgment) or the time they first felt intention to move (W-judgment). A positive relationship between W-judgment and impulsivity measures emerged. Namely, high scores in the attentional and motor impulsivity subscales of BIS and in the number of inhibitory failure responses in the go/no-go task, were related to a low difference between the W-judgment and the actual movement (i.e. the awareness of intention to move was closer to the voluntary movement execution). In contrast no relationship emerged with M-judgment. Findings suggest that impulsivity may be related to a delayed awareness of voluntary action. We hypothesize that in impulse control disorders the interval between conscious intention and actual movement could be insufficient to allow a conscious ‘veto’ of the impending action.
Clinical Neurophysiology | 2015
A. Bandini; F. Giovannelli; Massimo Cincotta; P. Vanni; R. Chiaramonti; A. Borgheresi; Gaetano Zaccara; S. Orlandi; C. Manfredi
Dysprosody is characterized by alterations of rhythm and speed of speech and represents one of the most frequent alteration of speech in patients with Parkinson’s disease (PD). Our aim was to identify the presence of rhythmic alterations in the parameters related to speech rate in PD patients with no or mild hypophonia during a sentence repetition task. Twenty PD patients (6 women) and 19 healthy controls (10 women) were tested. The task consisted in the repetition of a standardized Italian vocalic sentence (“Il bambino ama le aiuole della mamma”) at least 10 times at comfortable loudness. Audio analysis is based on a newly developed automatic voiced-unvoiced segmentation to calculate net speech rate and the percentage of voiced segments with respect to the sentence duration. The analysis showed that in PD patients the speech is characterized by short rushes followed by inappropriate pauses, as revealed by the reduction of the sentence duration and the increase in net speech rate. PD patients tend to repeat the same sentence in a shorter time period than controls, but with a longer recovery time. Current data suggest that rhythmic alterations of speech may be detectable in patients using a sentence repetition task.
Clinical Neurophysiology | 2013
F. Giovannelli; A. Borgheresi; I. Innocenti; Simone Rossi; Gaetano Zaccara; Maria Pia Viggiano; Massimo Cincotta
Transcranial magnetic stimulation (TMS) and neuroimaging studies suggest a functional link between the emotion-related brain areas and the motor system. It is not well understood, however, whether the motor cortex activity is modulated by specific emotions experienced during music listening. In 23 healthy volunteers, we recorded the motor evoked potentials (MEP) following TMS to investigate the corticospinal excitability while subjects listened to music pieces evoking different emotions (happiness, sadness, fear, and displeasure), an emotionally neutral piece, and a control stimulus (musical scale). Quality and intensity of emotions were previously rated in an additional group of 30 healthy subjects. Fear-related music significantly increased the MEP size compared to the neutral piece and the control stimulus. This effect was not seen with music inducing other emotional experiences and was not related to changes in autonomic variables (respiration rate, heart rate). Current data indicate that also in a musical context, the excitability of the corticomotoneuronal system is related to the emotion expressed by the listened piece.