Girolamo Garreffa

Cognitive profile and brain morphological changes in obstructive sleep apnea

Obstructive sleep apnea (OSA) is accompanied by neurocognitive impairment, likely mediated by injury to various brain regions. We evaluated brain morphological changes in patients with OSA and their relationship to neuropsychological and oximetric data. Sixteen patients affected by moderate-severe OSA (age: 55.8±6.7 years, 13 males) and fourteen control subjects (age: 57.6±5.1 years, 9 males) underwent 3.0 Tesla brain magnetic resonance imaging (MRI) and neuropsychological testing evaluating short- and long-term memory, executive functions, language, attention, praxia and non-verbal learning. Volumetric segmentation of cortical and subcortical structures and voxel-based morphometry (VBM) were performed. Patients and controls differed significantly in Rey Auditory-Verbal Learning test (immediate and delayed recall), Stroop test and Digit span backward scores. Volumes of cortical gray matter (GM), right hippocampus, right and left caudate were smaller in patients compared to controls, with also brain parenchymal fraction (a normalized measure of cerebral atrophy) approaching statistical significance. Differences remained significant after controlling for comorbidities (hypertension, diabetes, smoking, hypercholesterolemia). VBM analysis showed regions of decreased GM volume in right and left hippocampus and within more lateral temporal areas in patients with OSA. Our findings indicate that the significant cognitive impairment seen in patients with moderate-severe OSA is associated with brain tissue damage in regions involved in several cognitive tasks. We conclude that OSA can increase brain susceptibility to the effects of aging and other clinical and pathological occurrences.

The aerobic brain: Lactate decrease at the onset of neural activity

The metabolic events of neuronal energetics during functional activity are still partially unexplained. In particular, lactate (and not glucose) was recently proposed as the main substrate for neurons during activity. By means of proton magnetic resonance spectroscopy, lactate was reported to increase during the first minutes of prolonged stimulation, but the studies reported thus far suffered from low temporal resolution. In the present study we used a time-resolved proton magnetic resonance spectroscopy strategy in order to analyse the evolution of lactate during the early seconds following a brief visual stimulation (event-related design). A significant decrease in lactate concentration was observed 5 s after the stimulation, while a recovering of the baseline was observed at 12 s.

Performances Evaluation and Optimization of Brain Computer Interface Systems in a Copy Spelling Task

The evaluation of the performances of brain-computer interface (BCI) systems could be difficult as a standard procedure does not exist. In fact, every research team creates its own experimental protocol (different input signals, different trial structure, different output devices, etc.) and this makes systems comparison difficult. Moreover, the great question is whether these experiments can be extrapolated to real world applications or not. To overcome some intrinsic limitations of the most used criteria a new efficiency indicator will be described and used. Its main advantages are that it can predict with a high accuracy the performances of a whole system, a fact that can be used to successfully improve its behavior. Finally, simulations were performed to illustrate that the best system is built by tuning the transducer (TR) and the control interface (CI), which are the two main components of a BCI system, so that the best TR and the best CI do not exist but just the best combination of them.

EEG/fMRI Study of Ictal and Interictal Epileptic Activity: Methodological Issues and Future Perspectives in Clinical Practice

Summary:  Purpose: Electroencephalography/functional magnetic resonance imaging (EEG/fMRI) has been proposed recently as a tool to study electrophysiological activity and, consequently, detect brain regions activated during epileptiform EEG abnormalities. The purpose of the study was to review our two‐year experience with studying ictal and interictal activities in patients with epilepsy.

Gilles de la Tourette syndrome and voluntary movement: A functional MRI study

Tourette syndrome (TS) is hypothesised to be caused by an abnormal organization of movement control. The aim of this study was to use functional magnetic resonance imaging to study motor cortex activation in a TS patient. Usual and unusual self-paced voluntary movements were performed. The TS patient displayed supplementary motor area (SMA) activation during both tasks. This activation reflects a continuous use of the SMA to perform the voluntary motor movements required in both tasks. Moreover, the absence of tics during the execution of these voluntary motor tasks suggests that tic activity may be suppressed by additional mental effort.

Issues concerning the construction of a metabolic model for neuronal activation

The metabolic events underlying neuronal activity still remain the object of intense debate, in spite of the considerable amount of information provided from different experimental techniques. Indeed, several attempts at linking the cellular metabolic phenomena with the macroscopic physiological changes have not yet attained foolproof conclusions. The difficulties in drawing definitive conclusions are due primarily to the heterogeneity of the experimental procedures used in different laboratories, and also given the impossibility of extrapolating the findings obtained under stationary conditions (prolonged stimulation) to dynamic and transient phenomena. Recently, lactate has received much attention, following its proposal by Pellerin and Magistretti (1994; Proc. Natl. Acad. Sci. USA 91:10625–10629), instead of glucose, as the main substrate for neurons during activity. Several challenging aspects suggest the return to a more conventional view of neuronal metabolism, in which neurons are able to metabolize ambient glucose directly as their major substrate, also during activation.

Ictal hemodynamic changes in late‐onset rasmussen encephalitis

We thank Dr Jellinger for his comments on our work as well as his extensive contributions to the study of cerebral amyloid angiopathy (CAA). Differences between samples drawn from autopsy series of demented individuals and from magnetic resonance imaging (MRI) examination of clinical subjects are perhaps not surprising. A radiological–pathological correlation study has suggested that gradient-echo MRI and histopathological examination may each detect microbleeds missed by the other. Although histopathology remains the “gold standard,” we note several advantages to MRI-based analysis, including the ability to study subjects during life and the ready capacity for correlating anatomic location of hemorrhages across multiple subjects. We also note that in analyzing the spatial clustering of hemorrhages, it is important to account for relative differences in the volume of cerebral cortex in each of the cerebral lobes. Further advances in the in vivo imaging of -amyloid promise still greater insight into the distribution of cerebrovascular amyloid and its consequences.

Characterization of the functional response in the human spinal cord: Impulse-response function and linearity

Functional magnetic resonance imaging (fMRI) has emerged during the last decade as the main non-invasive technique for the investigation of human brain function. More recently, fMRI was also proposed for functional studies of the human spinal cord, but with controversial results. In fact, the functional contrast is not well-characterized, and even its origin has been challenged. In the present work, we characterized the temporal features of the functional signal evoked in the human spinal cord by a motor task, studied with an approach based on time-locked averaging of functional time series of different durations. Based on the results here reported, we defined an impulse-response function (irf) able to explain the functional response for motor tasks in the interval of 15-42 s of duration, thus suggesting the linearity of the phenomenon in this interval. Conversely, with stimulation durations ranging between 3 and 9 s, the functional signal was not detectable, and was under the level predicted by a linear behavior, suggesting deviation from linearity during short stimulations. The impulse-response function appeared slower than in the brain, peaking at about 9 s after its beginning. The observed contrast was generally larger than in the brain, on the order of about 5.4% of baseline signal at 1.5 T. The findings further suggested that the physiological origin of T(2) weighted functional imaging is similar in the spinal cord and in the brain.

Metabolic correlatives of brain activity in a FOS epilepsy patient

The correlation and the interactions between neuronal activity and underlying metabolic dynamics are still a matter of debate, especially in pathological conditions. This study reports findings obtained on a subject suffering from fixation‐off sensitivity (FOS) epilepsy, exploited as a model system of triggerable anomalous electrical activity. Functional Magnetic Resonance Spectroscopy was used to investigate the metabolic response to visual spike‐inducing stimuli in a single voxel placed in the temporo‐occipital lobe of a FOS epilepsy patient. MRS measurements were additionally performed on a control group of five healthy volunteers. The FOS patient also underwent an EEG session with the same stimulus paradigm. Uniquely in the FOS patient, glutamate and glutamine concentration increased during the first 10 min of stimulation and then returned to baseline. On the other hand, FOS‐induced epileptic activity (spiking) endured throughout all the stimulation epoch. The observed metabolic dynamics may be likely linked to a complex interplay between alterations of the metabolic pathways of glutamate and modulation of the neuronal activity. Copyright

Long‐term Reproducibility of fMRI Activation in Epilepsy Patients with Fixation Off Sensitivity

Recently EEG/functional magnetic resonance imaging (f MRI) has been proposed in epilepsy research to study and map electrophysiological activity. It can detect regions in the brain activated during interictal or ictal EEG abnormalities and thus contribute to a clearer understanding of neurophysiologic mechanisms underlying epileptic phenomena (1‐3). However, f MRI studies are limited by a number of factors: some are related to the technique itself (nonstandardized technical approach, heterogeneous procedures used in the experimental paradigms, image processing and statistical analysis, and varying sensitivity of the instrument), whereas others are related to the seizures (unpredictable occurrence, technical problems, and artifact on images in case of motor activity). It may, consequently, be difficult to verify the reproducibility of results over time, as is suggested by the lack of studies focusing on this aspect.