Abstract Objectives To report the results of a national survey aimed at quantifying the current level of diffusion of Levodopa/carbidopa intestinal gel (LCIG) in Italy. Methods Sixty Parkinson's ...Disease (PD) specialists in Italy were invited to complete a survey covering issues on clinical and practical aspects of LCIG therapy. Results Clinical features of 905 patients were collected retrospectively. The majority of centres reported the use of a multidisciplinary team, biochemistry testing, neurophysiological and neuropsychological tests before and after treatment, in addition to caregivers' training and patient's follow as outpatients. Most centres (60%) used internal guidelines for patient selection. The overall rate of adverse events was 55.1%. Weight loss, chronic polyneuropathy and stoma infection were the most frequently reported. 40% of centres used replacement therapy with Vitamin B12 and Folic acid from the start of LCIG and continued this for the duration of treatment. The rate of discontinuation was of 25.7% overall, with 9.5% of cases occurring in the first year. The main causes of withdrawal were device-related complications, disease progression (comorbidity, severe dementia) and caregiver and/or patient dissatisfaction. Conclusions In Italy LCIG infusion is managed in a uniform manner at a clinical, practical and organizational level even though the selection criteria are not standardized through the country. The high percentage of patients remaining on treatment in the short- and long-term follow-up confirms effectiveness of treatment, careful follow-up, and appropriate patient and caregivers training.
Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. ...There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors.
PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used.
A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of -0.62 (95%CI - 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = -1.019, 95% CI - 1.827; -0.210,
-value = 0.0135).
RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy.
The aim of this study was to compare the efficacy of sodium valproate and topiramate in treating chronic migraine.
Forty-nine patients with chronic migraine were randomly assigned to 1 of 2 groups of ...treatment: 750 mg/day valproate or 75 mg/day topiramate. Efficacy variables were number of days with headache over a 30-day period and changes in Migraine Disability Assessment (MIDAS) scores at 3 months.
At baseline the 2 groups had similar numbers of days with headache and mean MIDAS scores. At the end of the treatment period, a significant reduction in 30-day headache frequency with respect to baseline (P < 0.00001) and a significant reduction in MIDAS scores (P < 0.00001) were recorded in both groups. There were no significant differences in beneficial effects between the 2 drugs.
Valproate and topiramate seem to be able to manage successfully chronic migraine without substantial differences in efficacy and tolerability. This affords clear practical advantages-in the event of failure of or intolerance for one treatment, the patient may be switched to the other.
CATHODAL tDCS OF THE PARIETAL CORTEX COMBINED WITH MIRROR THERAPY IS EFFECTIVE AT IMPROVING HAND DEXTERITY IN FOCAL DYSTONIA: A CLINICAL CASE.Martina Pigliapoco1, Elisa Andrenelli1, Mara Fabri2, ...Gabriele Polonara3, Marianna Capecci1, Maria Gabriella Ceravolo1.1Neurorehabilitation Clinic, Department of Experimental and Clinical Medicine - u201cPolitecnica delle Marcheu201d University, Ancona Italy.2Neuroscience and Cell Biology Section, Department of Experimental and Clinical Medicine - u201cPolitecnica delle Marcheu201d University, Ancona Italy.3Neuroradiology Unit, Department of Clinical Sciences - u201cPolitecnica delle Marcheu201d University, Ancona Italy.Introduction. The role of not-invasive brain stimulation (NIBS) as an add-on treatment to motor training in children suffering from focal dystonia has already been described in the literature with contrasting results.Purpose. To describe the clinical and functional outcome observed in a 13-years-old girl suffering from hand dystonia and undergone NIBS combined with mirror therapy.Methods. We report the case of a 13-years-old girl suffering from hand dystonia following right hemisphere lesion in the basal ganglia area, due to cerebrovascular accident occurred in the infancy. At the basal assessment she showed a complete muscle strength recovery, a quite normal gait pattern, but a complete impairment in left hand dexterity due to hand muscle dystonia. She had already undergone several training protocols, including splint wearing and repeated botulinum toxin injections. These last induced a partial resolution of muscle contraction at rest, without any improvement in hand dexterity.We proposed the following treatment protocol: daily sessions (20 minute each) of cathodal tDCS on the right sensorimotor cortex (P4), 1 mA, followed, in the same morning, by 20 minutes mirror therapy, for five consecutive days. Functional status was assessed using the Fugl-Meyer upper limb score at baseline (T0), after treatment end (T1) and one month later (T2). Moreover, a fMRI was performed at T0 and T1, in order to look what brain networks were activated during the left and right limb movements.Results.The NIBS was well tolerated. No adverse events were complained for. The Fugl-Meyer score increased from 21/66 (T0) to 29/66 (T1) and up to 30/66 (T2). The fMRI showed a significant reduction of brain activation under active left limb movement after treatment.Conclusions.Parietal cortex inhibition via cathodal tDCS at the lesioned hemisphere was effective at reducing dystonia, improving voluntary movement and inducing the reorganization of brain networks.
COVID-19 caused important consequences on public health, economy, physical, and mental health of people. The aim of this study was to evaluate the impact of COVID-19 on frontline workers, comparing ...them with their colleagues who had no contact with the patients and with the general population, by administering an online questionnaire based on the Distress Questionnaire—5 (DQ5). The study was carried out during the first Italian wave of COVID-19 pandemic from 1st to 30th of April. Participants were divided in 3 groups: group 1 is general population group that includes the general population which are quarantined but not isolated, group health care staff not working in COVID-19 hospitals, and group 3 healthcare staff group working in COVID-19 hospitals. The survey was carried with the Distress Questionnaire—5 (DQ5) as a tool to detect the psychological distress and mental health problems. A total of 2983 people participated in this survey. Seven hundred and twenty four out of 1123 (64%) were employers of the 4 hospitals included in this study. Particularly among the respondents, 2259 (75.7%) were general population, 502 (16.8%) were health care staff not working in COVID-19 hospitals, while 222 (7.4%) were health care staff working in covid-19 hospitals. Health care personnel working in COVID-19 hospitals (DQ-5 = 13, 10-16) had less psychological distress compared with health care staff not working in COVID-19 hospitals (DQ-5 = 14, 11-16) and general population (DQ-5 = 14, 11-17; P = .04). The regression model showed that people aged 26 to 35 (OR: 2.06, 95% CI: 1.21-3.48) and female (OR: 2.35, 95% CI: 1.95-2.83) were significantly at risk to develop a DQ-5 ≥ 11. During the first Italian wave of COVID-19 pandemic, healthcare personnel working in COVID-19 hospitals had less psychological distress compared with health care staff not working in COVID-19 hospitals and general population, probably because they were prepared to face situations like outbreak or emergencies.
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