Paolo Aloisi

Reliability of TMS-related measures of tibialis anterior muscle in patients with chronic stroke and healthy subjects.

A lack of normative data for transcranial magnetic stimulation (TMS)-related measures of the lower limb muscles in patients with stroke prevents us from understanding whether changes in TMS-related measures are induced by treatment or are due to their variability and/or the natural evolution of the disease. The purpose of this study was to determine the reliability of three TMS-related measures: motor threshold (MT), motor evoked potential latency (MEP Lat) and MEP amplitude (MEP Amp), linked to the corticospinal control of the tibialis anterior (TA) muscle in sixteen patients with chronic stroke and in sixteen aged-matched healthy subjects. Test-retest reliability was estimated using the intraclass correlation coefficient (ICC) with its 95% confidence interval (95% CI) and standard error of measurement (SEM). In healthy subjects the reliability of all the TMS-related measures yielded an ICC≥0.75. Similar reproducibility levels were found in patients with chronic stroke, with the exception of MEP Amp on the paretic side (ICC=0.38). These results suggest that the TMS-related measures investigated are reliable both in healthy subjects and, with the exception of MEP Amp on the paretic side, in patients with chronic stroke.

Levetiracetam in juvenile myoclonic epilepsy: long‐term efficacy in newly diagnosed adolescents

The aim of this study was to evaluate the efficacy and tolerability of levetiracetam (LEV) monotherapy in juvenile myoclonic epilepsy (JME). The study group consisted of 32 patients with epilepsy (20 males, 12 females) with a mean age of 13 years 3 months (SD 7y 11mo) at seizure onset. LEV was administered as the first drug; all patients were followed up at 6 and 12 months. The dose that achieved seizure control ranged from 1000 to 2500mg/daily. At 6‐month evaluation: 15 patients were seizure free; 14 patients were responders (>50% reduction in seizures); and three patients had marginal effects (<50% reduction of seizures). At 12‐month evaluation: 29 patients were seizure free; three patients were responders. No patients reported adverse events. These data provide preliminary evidence that LEV may be effective for treating patients with newly diagnosed JME.

Lacosamide in pediatric and adult patients: comparison of efficacy and safety.

PURPOSE This multicenter, prospective study investigates the efficacy and safety of lacosamide adjunctive therapy in pediatric and adult patients with uncontrolled epilepsy. METHOD This study was carried out between September 2010 and December 2011 at 16 Italian and 1 German neurologic centers. Lacosamide was added to the baseline therapy at a starting dose of 1 mg/kg/day in patients aged <16 years (group A) and 100 mg daily in subjects aged 16 and older (group B), and titrated to the target dose, ranging from 3 to 12 mg/kg/day or from 100 to 600 mg daily, respectively. After completing the titration period, patients entered a 12-month maintenance period and they were followed up at 3, 6 and 12 months. The primary assessment of efficacy was based on the change from baseline in seizure frequency per 28 days and was evaluated at 3, 6 and 12 months as follows: number and proportion of 100% responders, 50% responders, non-responders and worsening patients. Safety evaluation was also performed at 3, 6 and 12 months. RESULTS A total of 118 patients (59 group A, 59 group B) with uncontrolled generalized and focal epilepsy were enrolled. Patient mean±SD age was 15.9±6.80 years and the age range was 4-38 years. At 3-month evaluation, of 118 treated patients 56 subjects (47.4% group A; 47.4% group B; p=0.8537) experienced at least a 50% reduction in seizure frequency. At 6 and 12-month follow-up, the 50% responders were 57 (52.5% group A; 44.1% group B; p=0.4612) and 51 (47.4% group A; 39% group B; p=0.4573), respectively. Thirty-five subjects (30.5% group A; 28.8% group B; p=1) experienced side effects during the treatment period. The most common adverse events were dyspepsia for group A and dizziness for group B. CONCLUSION Lacosamide may be a useful and safe pharmacological treatment option for both pediatric and adult patients with uncontrolled seizures.

Visual evoked potentials and serum magnesium levels in juvenile migraine patients

Changes in visual evoked potentials and decreased intracellular magnesium levels have been separately described in patients affected by migraine both during the attacks and in the interictal periods. An inverse correlation between increased P100 amplitude and lowered serum magnesium levels was found in children suffering from migraine with and without aura in a headache‐free period. A 20‐day treatment with oral magnesium pidolate seemed to normalize the magnesium balance in 90% of patients. After treatment, the reduced P100 amplitude confirmed the inverse correlation with the serum magnesium level. These data seem to suggest the hypothesis that higher visual evoked potential amplitude and low brain magnesium level can both be an expression of neuronal hyperexcitability of the visual pathways related to a lowered threshold for migraine attacks.

Gabapentin in the treatment of hiccups in patients with advanced cancer: a 5-year experience.

Aim:To evaluate safety and efficacy of gabapentin in the treatment of severe chronic hiccups in patients with advanced cancer. Methods:Charts of all patients observed in the palliative care unit of a 4-bed hospital and at home by our Home Care Service were reviewed retrospectively.The presence of hiccups was routinely assessed. Patients with severe chronic hiccups were treated with gabapentin (300 mg t.i.d.). Doses of gabapentin were titrated based on the response to treatment.Gabapentin-related adverse effects were recorded. Results:Thirty-seven (3.9%) of 944 in-hospital patients and 6 (4.5%) of 134 patients observed at home presented severe chronic hiccups.We registered an improvement of hiccups, defined as complete resolution of hiccups, in 31 (83.8%) of 37 in-hospital patients and 4 (66.7%) of 6 patients observed at home.Four (10.8%) of the 37 in-hospital patients and 2 (33.3%) of the 6 patients observed at home experienced a reduction of hiccups.In 2 patients (5.4%), we registered a worsening of hiccups.Responses were observed in 32 patients (74.4%) with gabapentin at a dosage of 900 mg/d and in 9 patients (20.93%) at 1200 mg/d.In 2 patients (4.65%), grade 2 sleepiness was observed and in 10 patients (23.25%), grade 1 sleepiness was observed based on the Epworth Sleepiness Scale. Conclusion:The results of the study allow suggesting gabapentin at least as a promising drug in the treatment of severe chronic hiccups in advanced cancer patients.

The Supportive Care Task Force at the University of L’Aquila: 2-years experience

The Supportive Care Task Force (SCTF) was established within the Medical Oncology Department at the University of L’Aquila in May 2002. The missions of the SCTF were to allow systematic evaluation and treatment of symptoms, to warrant continuity of care in all phases of disease and to provide medical oncology residents with training in the treatment of symptoms. A medical oncologist, two senior residents in medical oncology and a registered nurse comprised the SCTF. A psychiatrist, two neurologists, a dietician, and two physiotherapists served as consultants or on a part-time basis. Four beds in two-bedded rooms inside the Medical Oncology Department were reserved to SCTF. A close integration with the physicians of the Medical Oncology Department was realised. The only criterion to admission was the presence of uncontrolled symptoms. Patients were evaluated and monitored with the visual analogue scale for pain and with the Edmonton Symptom Assessment Scale (ESAS). The Palliative Prognostic Score (PaP Score) was employed to assess the prognosis. Non-clinical needs were evaluated with the Need Evaluation Questionnaire (NEQ). Protocols for the treatment of common symptoms were available in written form for consultation by physicians, residents and nurses. From 1 May 2002 to 31 May 2004, we observed 208 patients: 111 women and 97 men. The median age was 64.7 (range 28–90) years. Fifty-four patients (25.9%) were admitted more than once, for a total of 285 admissions. One hundred ninety-nine admissions (69.5%) were for supportive care while 86 admissions (30.5%) were for supportive care and active treatment. The most frequent symptoms were asthenia and anorexia. We registered excellent results regarding the treatment of pain, nausea and dyspnea while psychological symptoms, anorexia and asthenia proved more difficult to treat.Two hundred twenty patients were discharged: 142 (49.8%) home; 76 (26.7%) to the Home Care Service and two (0.7%) to others units of the hospital. Sixty-five (22.8%) died in our unit.

Effects of the abrupt switch from solution to modified-release granule formulation of valproate

Verrotti A, Nanni G, Agostinelli S, Tozzi Alleva E, Aloisi P, Franzoni E, Spalice A, Chiarelli F, Coppola G. Effects of the abrupt switch from solution to modified‐release granule formulation of valproate. 
Acta Neurol Scand: 2012: 125: e14–e18. 
© 2011 John Wiley & Sons A/S.

Spectral Analysis of Visual Potentials Evoked by Pattern-Reversal Checkerboard in Juvenile Patients With Headache

Changes in visual evoked potentials, mainly affecting the amplitude of the major positive wave, are referred to by many authors and are related to the pathophysiological basis of primary headache.

Visual Evoked Potentials in Alzheimer's Disease:Electrophysiological Study of the Visual Pathways and Neuropsychological Correlates

Visual Evoked Potentials [VEP] abnormalities are reported in Alzheimer’s Disease [AD] patients. It is necessary to understand the pathophysiology, clinical relevance and the relationship with the different visual pathways. We performed a study on AD patients compared to Multi-Infarct Dementia [MID] patients by means of different visual stimuli considered selective in stimulating Magnocellular [M], Parvocellular [P] and Koniocellular [K] system. All the patients underwent a neuropsychological assessment and evaluation of disability. Our results seem to confirm major involvement of both the M system and the K system in AD patients, in accordance with the pathophysiological hypotheses regarding visual disturbances in AD. Moreover, the neurophysiological data seem to be related both to the neuropsychological features of dysexecutive syndrome and apraxia and also to disability.

Home care for cancer patients after an earthquake: the experience of the "L'Aquila per la Vita" Home Care Unit.

To the Editor: In recent years, several natural disasters have occurred around the world. Millions of people have found themselves without homes as a result, and this has posedmajor concerns for public health. In many cases, health care providers were unprepared to cope with these emergencies and to care for patients affected by chronic diseases. To our knowledge, there are no reports available on oncology home care after a catastrophe. The aim of this letter was to describe the experience of the ‘‘L’Aquila per la Vita’’ Home Care Unit (HCU) after the earthquake in L’Aquila. On April 6, 2009, an earthquake destroyed the city of L’Aquila, the capital of the Abruzzo region in central Italy. Of 70,000 inhabitants, 309 died and more than 1000 were injured. The mayor declared that many homes were completely destroyed, and the city hospital was evacuated, too. According to the environmental situation and contingent needs, the HCU tried to provide the best options available in three different phases: 1) nonabandonment, 2) continuity of care, and 3) return to normality.