Rocco Salvatore Calabrò

Cardiovascular reflex tests ☆: Assessment of age-adjusted normal range

To assess the relationship between aging and autonomic control of heart rate and blood pressure, cardiovascular reflex tests were performed in 70 healthy volunteers in the age range 25-71 years. R-R interval variation, heart rate change with deep breathing, 30/15 ratio and blood pressure response to standing appeared significantly declining with age. For each test we calculated the P0.99 and P0.01 confidence limits for individual observations. On the other hand, Valsalva ratio and the blood pressure response to sustained handgrip appeared to be unrelated to age. These results suggest that there is an age-dependent degradation of the mechanisms involved in the cardiovascular reflexes. The assessment of age-adjusted normal values improves the criteria for delineating abnormal from normal results in individual testing of autonomic function.

Sexual and reproductive dysfunction associated with antiepileptic drug use in men with epilepsy

The association between epilepsy and sexual disorders has long been known. However, the etiology remains uncertain, although it is likely to be multifactorial in origin involving neurological, endocrine, iatrogenic, psychiatric and psychosocial factors. Sexual disorders associated with epilepsy can be directly related to seizures (ictal), or unrelated in time to seizure occurrence (interictal). The most common sexual dysfunction is hyposexuality, even if hypersexuality and different paraphilias have been reported in males with epilepsy. Epilepsy and antiepileptic drugs can also alter sex hormone levels to promote the development of reproductive endocrine disorders. This article aims to explore the prevalence and etiology of sexual and reproductive dysfunctions in men with epilepsy, highlighting the pivotal role of antiepileptic drugs in their pathogenesis.

Misdiagnosed Chronic Pelvic Pain: Pudendal Neuralgia Responding to a Novel Use of Palmitoylethanolamide

BACKGROUND Pudendal neuralgia is a cause of chronic, disabling, and often intractable perineal pain presenting as burning, tearing, sharp shooting, foreign body sensation, and it is often associated with multiple, perplexing functional symptoms. CASE REPORT We report a case of a 40-year-old man presenting with chronic pelvic pain due to pudendal nerve entrapment and successfully treated with palmitoylethanolamide (PEA). CONCLUSION PEA may induce relief of neuropathic pain through an action upon receptors located on the nociceptive pathway as well as a more direct action on mast cells via an ALIA (autocoid local injury antagonism) mechanism. As recently demonstrated in animal models, the present case suggests that PEA could be a valuable pharmacological alternative to the most common drugs (anti-epileptics and antidepressants) used in the treatment of neuropathic pain.

Topiramate-induced erectile dysfunction

Described here is a case of topiramate-induced reversible erectile dysfunction in which possible pathogenetic mechanisms were excluded by use of appropriate psychological, neurophysiological, ultrasound, and laboratory tests.

Heavy Metals and Neurodegenerative Diseases: An Observational Study

In this study, we evaluated the levels of some of the most investigated metals (Cu, Se, Zn, Pb, and Hg) in the blood of patients affected by the most common chronic neurodegenerative diseases like Alzheimer’s disease (AD) and multiple sclerosis (MS), in order to better clarify their involvement. For the first time, we investigated a Sicilian population living in an area exposed to a potentially contaminated environment from dust and fumes of volcano Etna and consumer of a considerable quantity of fish in their diet, so that this represents a good cohort to demonstrate a possible link between metals levels and development of neurodegenerative disorders. More specifically, 15 patients affected by AD, 41 patients affected by MS, 23 healthy controls, and 10 healthy elderly controls were recruited and subjected to a venous blood sampling. Quantification of heavy metals was performed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). This technique has allowed us to establish that there is a concomitance of heavy metal unbalance associated with AD more than in other neurodegenerative pathologies, such as MS. Also, we can assess that the concentration of these elements is independent from the diet, especially from occasional or habitual consumption of fruits and vegetables, prevalence in the diet of meat or fish, possible exposure to contaminated environment due both to the occupation and place of residence.

Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now?

Gait abnormalities following neurological disorders are often disabling, negatively affecting patients’ quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one’s ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson’s disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.

Can transcranial direct current stimulation be useful in differentiating unresponsive wakefulness syndrome from minimally conscious state patients

PURPOSE Disorders of consciousness (DOC) diagnosis relies on the presence or absence of purposeful motor responsiveness, which characterizes the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS), respectively. Functional neuroimaging studies have raised the question of possible residual conscious awareness also in clinically-defined UWS patients. The aim of our study was to identify electrophysiological parameters, by means of a transcranial magnetic stimulation approach, which might potentially express the presence of residual networks sustaining fragmentary behavioral patterns, even when no conscious behavior can be observed. METHODS We enrolled 25 severe DOC patients, following post-anoxic or traumatic brain injury and 20 healthy individuals (HC) as control group. Baseline electrophysiological evaluation evidenced, in comparison to HC, a partial preservation of cortical effective connectivity and excitability in clinically defined MCS, whereas these components were absent in clinically defined UWS. Then, we applied an anodal transcranial direct current stimulation (a-tDCS) protocol over the orbitofrontal cortex. RESULT a-tDCS was able to boost cortical connectivity and excitability in all HC, MCS, and to unmask such excitability/connectivity in some UWS patients. CONCLUSION a-tDCS could be useful in identifying residual connectivity markers in clinically-defined UWS, who may lack of purposeful behavior as a result of a motor-output failure.

Single tonic–clonic seizure after energy drink abuse

Energy drinks are soft beverages especially marketed for adolescents in order to obtain a heightened sense of awareness. Concerns about the safety of these drinks are raised based on our observation of potentially serious adverse effects. Caffeine and taurine are psychoactive agents highly present in energy drinks, which may lead to modification of neurotransmission. We herein report the case of a 20-year-old man presenting with a generalized epileptic seizure after energy drink consumption.

Male Sexual Disorders Following Stroke: An Overview

ABSTRACT Stroke is one of the leading causes of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little information is known about one of the crucial aspect of the quality of life of stroke patients, namely, sexual functioning and satisfaction. Poststroke sexual dysfunctions seem to be very common since in men affected by stroke, a decline in libido and poor or tailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (i.e., lesion localization, premorbid medical conditions, and medications) and psychosocial (i.e., fear of recurrences, loss of self-esteem, role changes, anxiety, and depression). Thus, exploration in sexual dysfunctions and sexual counseling by trained professionals should be a part of stroke rehabilitation. The aim of this review is to evaluate the burden of stroke on sexual function taking into account the complex interaction between neurological, psychological, and relational factors.

Does lacosamide aggravate Lennox–Gastaut syndrome? Report on three consecutive cases

Lennox-Gastaut syndrome is an intractable epileptic encephalopathy, with most patients experiencing daily seizures despite therapy with multiple antiepileptic drugs. New treatments need to be tested to define their efficacy in this syndrome. Lacosamide is a new antiepileptic drug recently approved for the treatment of partial-onset seizures. We describe three patients with Lennox-Gastaut syndrome resistant to conventional antiepileptic drugs whose seizures were aggravated by lacosamide.