Olimpia Difruscolo

Effects of rivastigmine on motor and cognitive impairment in Huntington's disease

To evaluate the efficacy of rivastigmine on motor and cognitive impairment in Huntingtons disease (HD), we carried out a prospective, open‐label, randomized, controlled study. Twenty‐one HD patients were enrolled: 14 were randomly sorted into medication and 7 to no‐treatment groups. Clinical and demographic features were similar between groups. After 8 months, an efficacy evaluation was carried out to compare the two groups. The improvement of cholinergic transmission in HD patients seemed to have a slight effect in ameliorating cognitive performance and slowing motor deterioration.

Changes in Cortical Processing of Pain in Chronic Migraine

Objective.—The aim of this study was to perform a topographic and dipolar analysis of nociceptive‐evoked responses obtained by laser stimulus under basal conditions in a cohort of chronic migraine (CM) patients, compared with migraine without aura (MWA) patients and noncraniofacial pain controls.

Topographic and dipolar analysis of laser-evoked potentials during migraine attack.

Objective.—The aim of this study was to perform further evaluation of laser‐evoked potentials (LEPs) during migraine attacks using multichannel recording and topographic analysis. Specifically, this study aimed to confirm the pattern previously observed in acute migraine, while also defining the components of LEPs that are mainly modified during headache, as well as the correlation between features of LEPs and clinical variables. In addition, we aimed to conduct a dipolar source analysis of the main LEP waves in migraine patients to check the variability in the source location of LEPs during acute migraine.

Effects of remote cutaneous pain on trigeminal laser-evoked potentials in migraine patients

The present study aimed to evaluate heat pain thresholds and evoked potentials following CO2 laser thermal stimulation (laser-evoked potentials, LEPs), during remote application of capsaicin, in migraine patients vs. non-migraine healthy controls. Twelve outpatients suffering from migraine without aura were compared with 10 healthy controls. The LEPs were recorded by 6 scalp electrodes, stimulating the dorsum of the right hand and the right supraorbital zone in basal condition, during the application of 3% capsaicin on the dorsum of the left hand and after capsaicin removal. In normal subjects, the laser pain and the N2-P2 vertex complex obtained by the hand and face stimulation were significantly reduced during remote capsaicin application, with respect to pre-and post-capsaicin conditions, while in migraine LEPs and laser pain were not significantly modified during remote painful stimulation. In migraine a defective brainstem inhibiting control may coexist with cognitive factors of focalised attention to facial pain, less sensitive to distraction by a second pain.

Nitroglycerin induces migraine headache and central sensitization phenomena in patients with migraine without aura: a study of laser evoked potentials

In migraineurs nitroglycerin (NTG) induces severe delayed headache, resembling spontaneous migraine attacks. The aim of the present study was to evaluate NTG laser evoked potentials (LEP) features amplitude and pain sensation to laser stimuli during NTG-induced headache. Nine patients were selected. Headache was induced by oral administration of 0.6 mg of NTG; signals were recorded through disk electrodes placed at the vertex and referred to linked earlobes. CO(2)-LEPs delivered by stimulation of the dorsum of both hands and the right and left supraorbital zones were evaluated after the onset of moderate or severe headache resembling spontaneous migraine and at least 72 h after the end of the headache phase. Patients exhibited a significant heat pain threshold reduction and an LEPs amplitude increment during headache when both the supraorbital zones were stimulated. NTG appeared to support a reliable experimental model of migraine, based on the neuronal effects on the integrative-nociceptive structures. The LEPs facilitation during NTG-induced headache may be subtended by a hyperactivity of nociceptive cortex as well as by a failure of pain-inhibitory control.

Detection of subclinical brain electrical activity changes in Huntington's disease using artificial neural networks

OBJECTIVE The aim of this study was to analyze EEG background activity in Huntingtons disease (HD) patients and relatives at risk, in relation to CAG repeat size and clinical state, in order to detect an electrophysiological marker of early disease. METHODS We selected 13 patients and 7 subjects at risk. Thirteen normal subjects, sex- and age-matched, were also evaluated. Artifact-free epochs were selected and analyzed through Fast-Fourier Transform. EEG background activity was tested using both linear analysis and artificial neural network (ANN) classifier in order to evaluate whether EEG abnormalities were linked to functional changes preceding the onset of the disease. RESULTS The most important EEG classification pattern was the absolute alpha power not correlated with cognitive decline. The ANN correctly classified 11/13 patients and 12/13 normals. Moreover, the neural scores for subjects at risk seemed to be correlated to the expected time before the onset of the disease. CONCLUSIONS ANN is a very powerful method to discriminate between normals and patients. It could be used as an automatic diagnostic tool. EEG changes in positive gene-carriers for HD confirm an early functional impairment which should be taken into account in the genetic counseling and in the management of the early stages of the disease.

Effects of Distraction Versus Spatial Discrimination on Laser‐Evoked Potentials in Migraine

Objectives.— To evaluate whether migraine patients exhibit less inhibition to painful stimuli when distracted from pain as compared to healthy subjects, testing the spatial discrimination of painful stimuli, the performance during the mental arithmetic task used to contrast the discrimination performance and the behavior of N1 and N2‐P2 laser‐evoked potentials (LEPs) amplitudes during spatial discrimination and during distraction.

Interictal lack of habituation of mismatch negativity in migraine

The aim was to study mismatch negativity features and habituation during the interictal phase of migraine. In migraine patients, a strong negative correlation has been found between the initial amplitude of long latency auditory-evoked potentials and their amplitude increase during subsequent averaging. We studied 12 outpatients with a diagnosis of migraine without aura recorded in a headache-free interval and 10 gender- and age-matched healthy volunteers not suffering from any recurrent headache. The experiment consisted of two sequential blocks of 2000 stimulations, during which 1800 (90%) recordings for standard tones and 200 (10%) for target tones were selected for averaging. The latency of the N1 component was significantly increased in migraine patients in respect of controls in both the first and second repetitions; the MMN latency was increased in the second repetition. In the control group the MMN amplitude decreased on average by 3.2 ± 1.4 μV in the second trial, whereas in migraine patients it showed a slight increase of 0.21 ± 0.11 μV in the second repetition. The MMN latency relieved in the second trial was significantly correlated with the duration of illness in the migraine patients (Spearman correlation coefficient: 0.69; P < 0.05). The increases in N1 latency and MMN latency and amplitude, the latter correlated with duration of illness, seemed to be due to a reduced anticipatory effect of stimulus repetition in migraine patients. This suggests that such hypo-activity of automatic cortical processes, subtending the discrimination of acoustic stimuli, may be a basic abnormality in migraine, developing in the course of the disease.

Laser evoked potentials in amyotrophic lateral sclerosis

The pathophysiological mechanism of the pain in ALS is still unclear. The aim of the study was to evaluate the laser evoked potentials (LEPs) in ALS patients in relation to their clinical features. Twenty-four ALS patients were selected. Pain features were assessed and their intensity was measured by a 0-10 VAS. LEPs were recorded in all patients and in 23 healthy subjects. The dorsum of both hands was stimulated, at laser stimuli intensity of 7.5 W, with 10s inter-stimulus interval and 25 ms duration. Four electrodes were placed at Cz, T3, T4 and Fz positions, with the reference electrode at the nasion; T3 and T4 electrodes were referred off-line to Fz, in order to detect the N1 component. Latencies of N2, P2 and N1 waves were significantly higher in ALS than in controls. N1 amplitude was significantly increased in ALS patients compared to controls, with a similar trend for the N2-P2 complex. No correlation was found between LEP abnormalities, pain intensity and clinical features. A degeneration of subcortical structures may subtend a delay in the afferent input to the nociceptive cortex in ALS. On the other hand, an increase of pain processing at the cortical level may derive from a potential sensory compensation to motor cortex dysfunction.

Influence of MTHFR Genotype on Contingent Negative Variation And MRI Abnormalities in Migraine

Background.—The MTHFR C677T genotype has been associated with increased risk of migraine, particularly of migraine with aura (MA) in selected clinical samples and with elevated homocysteine. The hyper‐homocysteinemia may favor the vascular and neuronal mechanism underlying migraine, and the risk of stroke.