Highlights • Theta-burst stimulation (TBS) changed the altered somatosensory temporal discrimination in patients. • TBS elicited normal homotopic cortical plasticity in S1 in patients with dystonia. ...• TBS over S1 failed to improve writing performances in patients with dystonia.
OBJECTIVE:To design and validate a clinical diagnostic guideline for aiding physicians in confirming or refuting suspected blepharospasm.
METHODS:The guideline was developed and validated in a 3-step ...procedure1) identification of clinical items related to the phenomenology of blepharospasm, 2) assessment of the relevance of each item to the diagnosis of blepharospasm, and 3) evaluation of the reliability and diagnostic sensitivity/specificity of the selected clinical items.
RESULTS:Of 19 clinical items initially identified, 7 were admitted by content validity analysis to further assessment. Both neurologists and ophthalmologists achieved satisfactory interobserver agreement for all 7 items, including “involuntary eyelid narrowing/closure due to orbicularis oculi spasms,” “bilateral spasms,” “synchronous spasms,” “stereotyped spasm pattern,” “sensory trick,” “inability to voluntarily suppress the spasms,” and “blink count at rest.” Each selected item yielded unsatisfactory accuracy in discriminating patients with blepharospasm from healthy subjects and patients with other eyelid disturbances. Combining the selected items, however, improved diagnostic sensitivity/specificity. The best combination, yielding 93% sensitivity and 90% specificity, was an algorithm starting with the item “stereotyped, bilateral, and synchronous orbicularis oculi spasms inducing eyelid narrowing/closure” and followed by recognition of “sensory trick” or, alternatively, “increased blinking.”
CONCLUSION:This study provides an accurate and valid clinical guideline for diagnosing blepharospasm. Use of this guideline would make it easier for providers to recognize dystonia in clinical and research settings.
Emergency departments (EDs) play an increasingly crucial role in the management of patients with suicidal behavior (SB). Demoralization has been associated with SB in various populations and ...conditions, but little is known about the effect of this construct in SB patients who attend an ED. Therefore, a more inclusive SB assessment which considers the demoralization construct could be useful in clinical practice. The main aim of this study was to assess the presence and severity of demoralization in patients visiting EDs for SB. Secondly, the maintenance of the relationship between demoralization and SB after controlling for depression and the proportion of variance which accounted for hopelessness was investigated. A cross-sectional study of patients (
= 199) visiting an ED for SB was performed, which examined the role of demoralization, hopelessness, and depression on suicidal ideation (SI) and suicide attempts (SAs). Demoralization was strongly and positively correlated with SI. Demoralization was related to major depressive episodes, but it was confirmed to be a different and, probably, more sensitive construct for SB, validating its specificity in relation to depression. Hopelessness accounted for a small portion of the variance in SI, compared to demoralization. Formal support for the association of demoralization with SI was provided. Demoralization can improve SB assessment in EDs, particularly among patients whose suicide risk can be unnoticed. Furthermore, demoralization represents a clinically useful concept to increase comprehension of the suffering of the suicidal patient and a possible target for psychotherapeutic interventions.
Botulinum neurotoxins have been shown to be a safe and effective therapeutic option for most forms of focal dystonia, and are now considered to provide the best symptomatic treatment in these ...disorders. However, only a few papers addressed the long-term efficacy and safety of repeated treatments with this drug. This article reviews the data from clinical trials that have assessed the long-term results of botulinum neurotoxin type A (BoNT-A) and type B in the treatment of the different forms of focal craniocervical dystonia, cervical dystonia (CD), blepharospasm, oromandibular, and laryngeal dystonia. Studies on the long-term effects of BoNT-A therapy have demonstrated that the majority of patients comply with this repeated treatment because they experience a positive and stable effect over time. It is still unclear whether in patients with focal dystonia the mean dose of BoNT-A changes over time. In spite of the wide spectrum of side effects reported to be associated with BoNT-A treatment, there is no evidence of specific side effects due exclusively to the long-term use of such drugs. The only exception to these positive long-term findings is the occurrence of a subgroup of patients with CD who fail to maintain a sustained response after the first or second effective treatment, partly owing to the development of neutralizing antibodies against the toxin. Longitudinal studies aimed at defining the risk factors for this abnormal pattern of response to botulinum toxin treatment are currently being conducted.
Alpha-synuclein (α-syn) aggregation is the pathological hallmark of Parkinson's Disease (PD). In this study, we measured α-syn total (α-syntotal), oligomeric α-syn (α-synolig) and ...α-synolig/α-syntotal ratio in the saliva of patients affected by PD and in age and sex-matched healthy subjects. We also compared salivary α-syntotal measured in PD with those detected in Progressive Supranuclear Palsy (PSP), in order to assess whether salivary α-syn can be used as a biomarker for PD and for the differential diagnosis between PD and PSP.
We studied 100 PD patients, 20 patients affected by PSP and 80 age- and sex-matched healthy subjects. ELISA analysis was performed using two commercial ELISA platforms and a specific ELISA assay for α-syn aggregates.
We detected lower α-syntotal and higher α-synolig in PD than in healthy subjects. Conversely in PSP salivary α-syntotal concentration was comparable to that measured in healthy subjects. Receiver Operating Characteristic analyses revealed specific cut-off values able to differentiate PD patients from healthy subjects and PSP patients with high sensitivity and specificity. However, there was no significant correlation between clinical and molecular data.
Salivary α-syn detection could be a promising and easily accessible biomarker for PD and for the differential diagnosis between PD and PSP.
•Salivary α-syntotal (unaggregated) is reduced in PD patients but not in PSP patients.•Salivary α -synolig is higher in PD patients than in healthy subjects.•Salivary α-syntotal, α-synolig and α -synolig/α -syntotal ratio can distinguish PD patients from healthy subjects.•Salivary α-syntotal can distinguish PD patients from PSP patients.•Heterogeneity of α-syn aggregates ay determine the low sensitivity when differentiating PD patients from healthy subjects.
The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and ...depression in the elderly). However, the role of trazodone in several aspects of depression is not well known.INTRODUCTIONThe efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known.Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone.AREA COVEREDEight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone.Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.EXPERT OPINIONEvidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.
Abstract
Linguistic tasks facilitate corticospinal excitability as revealed by increased motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS) in the dominant hand. This ...modulation of the primary motor cortex (M1) excitability may reflect the relationship between speech and gestures. It is conceivable that in healthy individuals who use a sign language this cortical excitability modulation could be rearranged. The aim of this study was to evaluate the effect of spoken language tasks on M1 excitability in a group of hearing signers. Ten hearing Italian Sign Language (LIS) signers and 16 non-signer healthy controls participated. Single-pulse TMS was applied to either M1 hand area at the baseline and during different tasks: (i) reading aloud, (ii) silent reading, (iii) oral movements, (iv) syllabic phonation and (v) looking at meaningless non-letter strings. Overall, M1 excitability during the linguistic and non-linguistic tasks was higher in LIS group compared to the control group. In LIS group, MEPs were significantly larger during reading aloud, silent reading and non-verbal oral movements, regardless the hemisphere. These results suggest that in hearing signers there is a different modulation of the functional connectivity between the speech-related brain network and the motor system.
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