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Dive into the research topics where Francesco Cardinale is active.

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Featured researches published by Francesco Cardinale.


Neurosurgery | 2013

Stereoelectroencephalography: Surgical methodology, safety, and stereotactic application accuracy in 500 procedures

Francesco Cardinale; Massimo Cossu; Laura Castana; Giuseppe Casaceli; Marco Schiariti; Anna Miserocchi; Dalila Fuschillo; Alessio Moscato; Chiara Caborni; Gabriele Arnulfo; Giorgio Lo Russo

BACKGROUND Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. OBJECTIVE To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes. METHODS Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub--data set of 118 procedures (1567 electrodes). RESULTS The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P < 2.2 × 10). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P < 2.2 × 10), respectively. CONCLUSION SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy.


Neurosurgery | 2005

Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective analysis of 215 procedures.

Massimo Cossu; Francesco Cardinale; Laura Castana; Alberto Citterio; Stefano Francione; Laura Tassi; Alim-Louis Benabid; Giorgio Lo Russo

OBJECTIVE:To report on indications, surgical technique, results, and morbidity of stereoelectroencephalography (SEEG) in the presurgical evaluation of patients with drug-resistant focal epilepsy. METHODS:Two-hundred fifteen stereotactic implantations of multilead intracerebral electrodes were performed in 211 patients (4 patients were explored twice), who showed variable patterns of localizing incoherence among electrical (interictal/ictal scalp electroencephalography), clinical (ictal semeiology), and anatomic (magnetic resonance imaging [MRI]) investigations. MRI scanning showed a lesion in 134 patients (63%; associated with mesial temporal sclerosis in 7) and no lesion in 77 patients (37%; with mesial temporal sclerosis in 14 patients). A total of 2666 electrodes (mean, 12.4 per patient) were implanted (unilaterally in 175 procedures and bilaterally in 40). For electrode targeting, stereotactic stereoscopic cerebral angiograms were used in all patients, coupled with a coregistered three-dimensional MRI scan in 108 patients. RESULTS:One hundred eighty-three patients (87%) were scheduled for resective surgery after SEEG recording, and 174 have undergone surgery thus far. Resections sites were temporal in 47 patients (27%), frontal in 55 patients (31.6%), parietal in 14 patients (8%), occipital in one patient (0.6%), rolandic in one patient (0.6%), and multilobar in 56 patients (32.2%). Outcome on seizures (Engels classification) in 165 patients with a follow-up period of more than 12 months was: Class I, 56.4%; Class II, 15.1%; Class III, 10.9%; and Class IV, 17.6%. Outcome was significantly associated with the results of MRI scanning (P = 0.0001) and with completeness of lesion removal (P = 0.038). Morbidity related to electrode implantation occurred in 12 procedures (5.6%), with severe permanent deficits from intracerebral hemorrhage in 2 (1%) patients. CONCLUSION:SEEG is a useful and relatively safe tool in the evaluation of surgical candidates when noninvasive investigations fail to localize the epileptogenic zone. SEEG-based resective surgery may provide excellent results in particularly complex drug-resistant epilepsies.


Neurology | 2004

Sleep-related hyperkinetic seizures of temporal lobe origin

Lino Nobili; Massimo Cossu; Roberto Mai; Laura Tassi; Francesco Cardinale; Laura Castana; Alberto Citterio; Ivana Sartori; G. Lo Russo; Stefano Francione

Sleep-related hyperkinetic seizures are a common feature of nocturnal frontal lobe epilepsy. Although sleep-related seizures with a temporal lobe origin have been reported, they commonly lack hyperkinetic activity. The authors describe three patients with sleep-related seizures characterized by frenetic, agitated, hyperactive movements (bimanual/bipedal activity, rocking, axial, pelvic, and hemiballistic movements), in whom stereo-EEG investigation and surgical outcome demonstrated a temporal lobe origin of the attacks.


Epilepsia | 2008

Epilepsy Surgery in Children: Results and Predictors of Outcome on Seizures

Massimo Cossu; Giorgio Lo Russo; Stefano Francione; Roberto Mai; Lino Nobili; Ivana Sartori; Laura Tassi; Alberto Citterio; Nadia Colombo; Manuela Bramerio; Carlo Galli; Laura Castana; Francesco Cardinale

Purpose: To retrospectively analyze the results on seizures of surgery in children with drug‐resistant focal epilepsy. To identify the factors predicting seizure control among several presurgical, surgical, and postsurgical variables.


NeuroImage | 2011

Dissociated wake-like and sleep-like electro-cortical activity during sleep.

Lino Nobili; Michele Ferrara; Fabio Moroni; Luigi De Gennaro; Giorgio Lo Russo; Claudio Campus; Francesco Cardinale; Fabrizio De Carli

Sleep is traditionally considered a global process involving the whole brain. However, recent studies have shown that sleep depth is not evenly distributed within the brain. Sleep disorders, such as sleepwalking, also suggest that EEG features of sleep and wakefulness might be simultaneously present in different cerebral regions. In order to probe the coexistence of dissociated (wake-like and sleep-like) electrophysiological behaviors within the sleeping brain, we analyzed intracerebral electroencephalographic activity drawn from sleep recordings of five patients with pharmacoresistant focal epilepsy without sleep disturbances, who underwent pre-surgical intracerebral electroencephalographic investigation. We applied spectral and wavelet transform analysis techniques to electroencephalographic data recorded from scalp and intracerebral electrodes localized within the Motor cortex (Mc) and the dorso-lateral Prefrontal cortex (dlPFc). The Mc showed frequent Local Activations (lasting from 5 to more than 60s) characterized by an abrupt interruption of the sleep electroencephalographic slow waves pattern and by the appearance of a wake-like electroencephalographic high frequency pattern (alpha and/or beta rhythm). Local activations in the Mc were paralleled by a deepening of sleep in other regions, as expressed by the concomitant increase of slow waves in the dlPFc and scalp electroencephalographic recordings. These results suggest that human sleep can be characterized by the coexistence of wake-like and sleep-like electroencephalographic patterns in different cortical areas, supporting the hypothesis that unusual phenomena, such as NREM parasomnias, could result from an imbalance of these two states.


Journal of Neurology, Neurosurgery, and Psychiatry | 2003

Surgery for drug resistant partial epilepsy in children with focal cortical dysplasia: anatomical–clinical correlations and neurophysiological data in 10 patients

S. Francione; P Vigliano; Laura Tassi; Francesco Cardinale; Roberto Mai; G Lo Russo; Claudio Munari

Objective:To analyse a population of children with focal cortical dysplasia operated on for drug resistant partial epilepsy, with emphasis on clinical features, seizure semiology, interictal and ictal EEG and stereo EEG findings, histological and topographical characteristics of the lesions, extension and localisation of cerebral excision, and its postoperative effect on seizure frequency. Methods:10 patients were studied, aged between 26 months and 11 years (median 6 years). Magnetic resonance imaging (MRI) abnormalities were unilobar (temporal 3, frontal 2), bilobar (2), or multilobar (1); the two patients with negative MRI suffered from frontal seizures. Presurgical diagnostic steps varied in complexity and invasiveness depending on the anatomical/electrical/clinical features of each patient. In four patients they included only scalp video EEG monitoring, and in six, also invasive recordings using stereotactically implanted intracerebral electrodes. Surgery consisted of corticectomy plus lesionectomy in all cases. Results:70% of the patients were seizure-free after a minimum postoperative follow up of 25 months. These included three patients with temporal lesions and four of seven patients with other lobar or multilobar extratemporal localisation. One patient had improvement in seizure control. Outcome was poor in multilobar patients, but a class Ia outcome was obtained in one case after partial lesionectomy associated with bilobar corticectomy. All patients showed developmental improvement. Conclusions:Analysis of the data in these patients allowed the production of an “anatomical-clinical concordance” list, which appeared to be correlated with the diagnostic steps performed. Carrying out a stereo EEG exploration in the most complex cases proved useful in defining the epileptogenic zone in extratemporal and multilobar epilepsies. Stereo EEG recordings facilitated a tailored resection of extralesional cortex.


Epilepsia | 2011

Insular‐opercular seizures manifesting with sleep‐related paroxysmal motor behaviors: A stereo‐EEG study

Paola Proserpio; Massimo Cossu; Stefano Francione; Laura Tassi; Roberto Mai; Giuseppe Didato; Laura Castana; Francesco Cardinale; Ivana Sartori; Francesca Gozzo; Alberto Citterio; Marco Schiariti; Giorgio Lo Russo; Lino Nobili

Purpose:  Sleep‐related complex motor seizures are a common feature of nocturnal frontal lobe epilepsy. Nevertheless, recent studies also suggest that sleep‐related hypermotor seizures can originate in the insula. The present study describes the electroclinical features of eight drug‐resistant epileptic patients with insular‐opercular seizures manifesting with nocturnal complex motor seizures.


Neurological Sciences | 2005

Sleep-related hyperkinetic seizures: always a frontal onset?

Roberto Mai; Ivana Sartori; Stefano Francione; Laura Tassi; Laura Castana; Francesco Cardinale; Massimo Cossu; Alberto Citterio; Nadia Colombo; G. Lo Russo; Lino Nobili

Hyperkinetic seizures are considered a typical manifestation of nocturnal frontal lobe epilepsy (NFLE). Patients with temporal lobe epilepsy with mainly sleeprelated seizures have been described; however they commonly lack hyperkinetic activity and seizure frequency is low. We retrospectively analysed our population of 442 consecutive patients surgically treated between January 1996 and January 2004. Among these there were 25 patients with sleep-related hyperkinetic epileptic seizures, with a frontal lobe onset in 18 cases and a temporal lobe onset in 7. Patients with sleep-related hyperkinetic seizures with temporal lobe origin had anamnestic and clinical features strikingly similar to those with a frontal onset, with agitated movements, high seizure frequency and no history of febrile convulsions. We confirm our previous findings that this kind of epileptic manifestation is not only peculiar to frontal lobe epilepsy.


Epilepsia | 2009

Taylor's focal cortical dysplasia increases the risk of sleep-related epilepsy.

Lino Nobili; Francesco Cardinale; Umberto Magliola; Alessandro Cicolin; Giuseppe Didato; Manuela Bramerio; Dalila Fuschillo; Roberto Spreafico; Roberto Mai; Ivana Sartori; Stefano Francione; Giorgio Lo Russo; Laura Castana; Laura Tassi; Massimo Cossu

Purpose:  To analyze the topography of the epileptogenic zone (EZ) and the etiologic substrate as risk factors for sleep‐related focal epilepsy.


Epilepsia | 2008

Coupling of minor motor events and epileptiform discharges with arousal fluctuations in NFLE

Michele Terzaghi; Ivana Sartori; Roberto Mai; Laura Tassi; Stefano Francione; Francesco Cardinale; Laura Castana; Massimo Cossu; Giorgio LoRusso; Raffaele Manni; Lino Nobili

Purpose: We recently demonstrated that in nocturnal frontal lobe epilepsy (NFLE) highly stereotyped minor motor events (MMEs, in the form of short‐lasting stereotyped movements involving the limbs, the axial musculature, and/or the head), could occur in either the presence or absence of an epileptiform discharge (ED). In lack of a systematic analysis, both MMEs and EDs were frequently observed to occur in association with arousal fluctuations. Hereby, in the same group of refractory NFLE subjects, we report a methodical neurophysiolgical investigation set out to investigate whether, and how, the arousal mechanism, monitored through visual scoring of the cyclic alternating pattern, modulates the expression of MMEs and EDs.

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Laura Castana

Centre Hospitalier Universitaire de Grenoble

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Nadia Colombo

University of California

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Roberto Spreafico

Carlo Besta Neurological Institute

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