Botulin toxin (BTX) has been proposed as a potential obesity treatment.
In a pilot study, the short-term efficacy and safety of BTX was assessed in eight subjects (four men, four women; median age, ...46 years; range, 35-57 years) with severe obesity (median body mass index BMI, 47.1 kg/m(2); range 38.2-56.7 kg/m(2)) and multiple dietary treatment failures. In a single endoscopic session, 500 UI of BTX-A was injected in the gastric antral region.
No clinically significant side effects were observed. In all patients, despite their not being on a specific diet, a reduction of body weight was observed at 1 month (median baseline weight, 124.4 kg vs 121.8 kg at 1 month; P < 0.05). Two treatment-unrelated dropouts were observed. At 4 months, three of the six patients had a further weight loss. The treatment effect was apparently independent of changes in hunger or satiety, or of changes in fasting and postprandial plasma ghrelin and serum leptin, thus suggesting a different pharmacological mechanism.
BTX-A treatment appears to be safe and well tolerated by obese patients, while its short-term efficacy varied widely.
Objective: It was suggested that the bimanual coupling effect might be linked to motor intentionality and planning, which are the top-down components of motor execution. However, previous results in ...pathological and healthy individuals have also underlined the pivotal role of bottom-up sensorimotor information. Method: In this single-case study, the Circles−Lines Coupling Task was administered to a left-parietal-brain-damaged individual. The cerebral lesion caused a central proprioceptive loss, relative to the impaired right hand, when out of the visual control. For the 1st time in literature, we sought to investigate whether the movement of the unaffected hand induced an efficient coupling effect on the movement of the affected one. The bimanual task was performed in the presence and absence of visual input. The patient's performance was compared with that of healthy controls. Results: We observed the traditional bimanual coupling effect in healthy controls. Moreover, we also replicated the effect when they performed the task blindfolded. In the case of the patient, both hands showed the typical ovalization of the line trajectory when the task was performed in visual modality. It is interesting that when the patient performed the task blindfolded, the trajectories of the impaired right hand seemed to be not influenced by the concomitant circular movement of the spared left hand. Conclusions: The movement of the unaffected hand induced a bimanual coupling effect on the movement of the affected one only when the visual input was available. In absence of a visual feedback, the aberrant proprioceptive information might preclude the emerging of bimanual coupling, even in the case of a preserved motor intentionality and planning.
General Scientific Summary
When individuals simultaneously trace out lines with one hand and circles with the other, the two hands influence each other. This phenomenon, noted as the bimanual coupling effect, is linked to the motor intentionality and planning. Here we studied this behavior in a brain-damaged individual who experienced a central proprioceptive loss, relative to the impaired right hand, when out of the visual control. In the absence of a visual feedback, the aberrant proprioceptive information might preclude the emerging of bimanual coupling, even in the case of a preserved motor intentionality and planning.
Cri du chat syndrome (CDCS) is a rare genetic disease that is caused by a deletion in the short arm of chromosome 5 (5p) and has a variable clinical spectrum. To our knowledge, no study in the ...literature has ever applied 18F-FDG PET/CT to investigate alterations in brain glucose metabolism in these subjects. The aims of this study were to detect differences in brain 18F-FDG metabolism in CDCS patients with different clinical presentations and identify possible brain metabolic phenotypes of this syndrome. Methods: Six patients (5 male and 1 female; age range, 10–27 y) with CDCS were assessed for the presence of cognitive and behavioral symptoms using a battery of neuropsychologic tests and then classified as having either a severe or a mild phenotype. The patients then underwent brain 18F-FDG PET/CT. The PET/CT findings were compared with an age- and sex-matched control group using statistical parametric mapping (SPM). Whether there was an association between different clinical phenotypes and 18F-FDG PET/CT findings was investigated. Results: Four patients had the severe phenotype, and 2 patients demonstrated the mild phenotype. SPM single-subject analysis, and a group analysis in comparison with the control cohort, revealed significant hypometabolism in the left temporal lobe (Brodmann areas BAs 20, 36, and 38), in the right frontal subcallosal gyrus (BA 34) and caudate body, and in the cerebellar tonsils (P < 0.001). Hypermetabolism (P = 0.001) was revealed in the right superior and precentral frontal gyrus (BA 6) in the patient group, compared with the control cohort. In SPM single-subject analysis, the hypermetabolic areas were detected only in patients with the severe phenotype. Conclusion: This study revealed different patterns of brain glucose metabolism in patients with the severe and mild phenotypes, compared with control subjects. In particular, abnormal hypermetabolism in the brain, as evaluated by18F-FDG PET/CT, seems to correlate with the severe CDCS phenotype.
Several studies have demonstrated the capability of PD subjects to improve gait if appropriate visual cues are provided. Possible explanations referred to attentional factors and to the presence of ...optic flow on peripheral vision. The aim of the present study was to evaluate separately these two mechanisms in a group of fifteen subjects with Parkinson's Disease at different stages and in a group of ten age-matched controls.
A microprocessor-controlled portable device implementing two different optical stimulation modalities has been used: bilateral continuous optic flow and unilateral reciprocal optical stimulus that is synchronized to the swing phase of gait. The latter allowed for the implementation of an attentional strategy.
Results showed that mild PD subjects (H&Y<= 2) are responsive to forward oriented optic flow which produces an increment of gait cadence (+ 7.8%) and velocity (+ 8.1%) (p < 0.05), while PD subjects at more advanced stages (H&Y>2) tend to be more responsive to the attentional strategy, through an increase of stride length (+ 19.8%) and a compensatory decrease of cadence (- 16.2%).
Although stated with caution due to the limited number of considered subjects, a possible descriptive model explaining the above findings is proposed, which correlates the different responsiveness to visual stimulation strategies with the progression of pathology and the consequent changes on the activation levels of the involved motor and associative areas.
Traditional stress management techniques require significant professional training and expertise to administer as well as people, time, and resources, which can be difficult to achieve. Thanks to the ...recent progress and diffusion of mobile electronic devices, it is possible today to set up and test an effective self-help stress management program outside a clinical setting. Although the efficacy of mobile self-help approaches have been tested through several studies, and promising applications can be developed, as yet no study has tested the feasibility of mobile platforms to actually elicit core affective states. In this study we used an advanced approach to assess the efficacy of these mobile platforms by recording and processing many psychophysiological measures, which extend the capabilities of the standard self-report questionnaires, objectifying the subjective. Our results seem to show the efficacy of inducing positive and negative affective states, using smart phones.
Sleep disorders are frequent in Parkinson's disease (PD). Apart from the occurrence of REM behavior disorders, in the early phase of the disease standard sleep macrostructure evaluation was ...inconclusive.
We analyzed non-rapid eye movement (NREM) sleep microstructure (CAP) in a group of PD patients to provide an objective measure of sleep disruption.
We recruited 31 PD patients mean age 59.5 ± 12.4 years; mean Hoehn-Yahr (H-Y) stage: 3.4 ± 1.8 and 34 age-matched non-parkinsonian subjects (mean age 61.5 ± 15.2 years) as a control group. All patients underwent full-night laboratory polysomnography (PSG). Conventional sleep macro/microstructure analysis was performed. Patients were then divided into two groups: group 1 (H-Y stage ≤ 2) and group 2 (H-Y stage ≥ 3).
In group 2 PD patients compared to controls, alterations of both sleep macrostructure and microstructure were found. The PD subgroup with milder disease (group 1) presented sleep macrostructure, movements and respiratory parameters not significantly different from controls, although their CAP rate was significantly higher and the proportion of the A1 phase of CAP was reduced (p = 0.03). Multivariate logistic regression showed that disease duration, disease severity, and arousal index emerged as independent predictive factors for CAP rate ≥55% and the A1 phase of CAP ≤40% (p < 0.05).
The main result of our study consists in the disclosure of altered NREM sleep microstructure in PD even at an early stage of the disease, suggesting an early alteration of the central pathways involved in the NREM sleep building-up and stability.
•Sleep disorders are frequent in Parkinson's disease (PD).•Cyclic alternating pattern (CAP) constitutes an NREM sleep instability marker.•NREM sleep instability is present even in earlier stages of Parkinson's disease.•NREM sleep microstructure alterations represent an early sign of NREM impairment.•Longitudinal data will clarify the biological meaning of NREM instability in PD.
Cri du chat syndrome (CDCS) is a rare genetic disease that is caused by a deletion in the short arm of chromosome 5 (5p) and has a variable clinical spectrum. To our knowledge, no study in the ...literature has ever applied
F-FDG PET/CT to investigate alterations in brain glucose metabolism in these subjects. The aims of this study were to detect differences in brain
F-FDG metabolism in CDCS patients with different clinical presentations and identify possible brain metabolic phenotypes of this syndrome.
Six patients (5 male and 1 female; age range, 10-27 y) with CDCS were assessed for the presence of cognitive and behavioral symptoms using a battery of neuropsychologic tests and then classified as having either a severe or a mild phenotype. The patients then underwent brain
F-FDG PET/CT. The PET/CT findings were compared with an age- and sex-matched control group using statistical parametric mapping (SPM). Whether there was an association between different clinical phenotypes and
F-FDG PET/CT findings was investigated.
Four patients had the severe phenotype, and 2 patients demonstrated the mild phenotype. SPM single-subject analysis, and a group analysis in comparison with the control cohort, revealed significant hypometabolism in the left temporal lobe (Brodmann areas BAs 20, 36, and 38), in the right frontal subcallosal gyrus (BA 34) and caudate body, and in the cerebellar tonsils (
< 0.001). Hypermetabolism (
= 0.001) was revealed in the right superior and precentral frontal gyrus (BA 6) in the patient group, compared with the control cohort. In SPM single-subject analysis, the hypermetabolic areas were detected only in patients with the severe phenotype.
This study revealed different patterns of brain glucose metabolism in patients with the severe and mild phenotypes, compared with control subjects. In particular, abnormal hypermetabolism in the brain, as evaluated by
F-FDG PET/CT, seems to correlate with the severe CDCS phenotype.
In this study, we first characterize the sit-to-stand (S2S) task, which contributes to the evaluation of the degree of severity of the Parkinson's disease (PD), through kinematic features, which are ...then linked to the Unified Parkinson's disease rating scale (UPDRS) scores. We propose to use a single body-worn wireless inertial node placed on the chest of a patient. The experimental investigation is carried out considering 24 PD patients, comparing the obtained results directly with the kinematic characterization of the leg agility (LA) task performed by the same set of patients. We show that i) the S2S and LA tasks are rather unrelated and ii) the UPDRS distributions (for both S2S and LA tasks) across the patients have a direct impact on the observed system performance.
•Dance can provide relevant benefit in rehabilitation of Parkinsonian patients.•Health improvement has been reported for PD people dancing tango.•Extensive professional tango training may be ...difficult for Parkinsonian patients.•A home based Tango training protocol was tested.•After five weeks, ten patients ameliorated their UPDRS and kinematic performances.
A style of dance called tango translates clinical practice into a new philosophy and rehabilitative approach for individuals with Parkinson’s disease (PD). The style of dance mixes music, self-generated and external cued strategies and social and emotional recovery. In recent years, there has been an increase in the number of studies reporting health benefits for people diagnosed with PD who dance tango. However, there are some organisational limitations to people participating in dance classes, including having trained Tango teachers, an appropriate space for dancing, and schedule that allows for participants with motor inabilities.
This pilot study involved the observation of PD patients who completed four days of home exercise plus a tango dance lesson each week for five weeks.
Ten PD patients improved their quality of life, their motor score on the Unified Parkinson’s Disease Rating Scale and their kinematic performances.
We propose a protocol of exercises that has been derived from the tango dance and that can be performed in a patient’s home.
Several recent studies have pointed out that early impairment of executive functions (EFs) in Parkinson's Disease (PD) may be a crucial marker to detect patients at risk for developing dementia. The ...main objective of this study was to compare the performances of PD patients with mild cognitive impairment (PD-MCI) with PD patients with normal cognition (PD-NC) and a control group (CG) using a traditional assessment of EFs and the Virtual Multiple Errands Test (VMET), a virtual reality (VR)-based tool. In order to understand which subcomponents of EFs are early impaired, this experimental study aimed to investigate specifically which instrument best discriminates among these three groups.
The study included three groups of 15 individuals each (for a total of 45 participants): 15 PD-NC; 15 PD-MCI, and 15 cognitively healthy individuals (CG). To assess the global neuropsychological functioning and the EFs, several tests (including the Mini Mental State Examination (MMSE), Clock Drawing Test, and Tower of London test) were administered to the participants. The VMET was used for a more ecologically valid neuropsychological evaluation of EFs.
Findings revealed significant differences in the VMET scores between the PD-NC patients vs. the controls. In particular, patients made more errors in the tasks of the VMET, and showed a poorer ability to use effective strategies to complete the tasks. This VMET result seems to be more sensitive in the early detection of executive deficits because these two groups did not differ in the traditional assessment of EFs (neuropsychological battery).
This study offers initial evidence that a more ecologically valid evaluation of EFs is more likely to lead to detection of subtle executive deficits.
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