Value of tongue biting in the differential diagnosis between epileptic seizures and syncope

AbstractBackgroundTongue biting (TB) may occur both in epileptic seizures and in syncope. A comprehensive search of the literature to determine the accuracy of this physical finding and its prevalence in epileptic seizures and syncope is still lacking.AimsTo undertake a systematic review and a meta-analysis of studies evaluating the prevalence of TB in patients with epileptic seizures and syncope, and to determine sensitivity, specificity and likelihood ratios (LR) of this physical finding.MethodStudies comparing the prevalence of TB in epileptic seizures and syncope were systematically searched. Prevalence of TB was analyzed calculating odds ratio (OR) with 95% confidence intervals (CIs). Sensitivity, specificity, positive and negative likelihood ratio (pLR, nLR) of TB were determined for each study and for the pooled results.ResultsTwo studies (75 epilepsy patients and 98 subjects with syncope) were included. There was a significantly higher prevalence of TB in patients with epileptic seizures (OR 12.26; 95% CI 3.99–37.69). Pooled accuracy measures of TB for the diagnosis of epileptic seizures were: sensitivity 33%, specificity 96%, pLR 8.167 (95% CI 2.969–22.461) and nLR 0.695 (95% CI 0.589–0.82).ConclusionsA pooled analysis of data from the literature shows that TB has great value in the differential diagnosis between epileptic seizures and syncope. Given a certain pre-test probability of seizures, the presence of TB greatly increases the chance that the patient had an epileptic seizure. Systematic reviews with pooled analyses (meta-analyses) of data from the literature allow an increase in statistical power and an improvement in precision, representing a useful tool to determine the accuracy of a certain physical finding in the differential diagnosis between seizures and other paroxysmal events

Subclinical rhythmic electrographic discharges of adults and transient global amnesia: a causal or casual association?

ABSTRACTSubclinical rhythmic electrographic discharges of adults (SREDA) is an uncommon distinctive EEG rhythmic pattern with uncertain significance. We report a patient with transient global amnesia in whom an EEG recording, performed after the acute phase of the neurological event, showed SREDA. Based on this EEG finding, we discuss about a possible correlation between SREDA and transient global amnesia. The presence of SREDA in our patient with transient global amnesia seems to be incidental. When described in association with transient global amnesia, SREDA should be recognized in order to avoid misdiagnosis. Although SREDA has been fortuitously described in association with transient global amnesia, a patho‐physiological correlation with mechanisms which produce it seems unlikely

Real-Time Particle Radiography by Means of Scintillating Fibers Tracker and Residual Range Detectors

In this chapter, a detailed description of the construction and the procedure for the measurement of performances of a charged particle imaging system is given. Such a system can be realized by the combined use of a position sensitive detector and a residual range detector. The position sensitive detector is made up of two superimposed and right-angled planes, each of which subsists of two layers of pre-aligned and juxtaposed scintillating fibers. The selected 500 μm square section fibers are optically coupled to two silicon photomultiplier arrays adopting a channel reduction system patented by the Istituto Nazionale di Fisica Nucleare. The residual range detector consists of 60 parallel layers of the same fibers used in the position detector, each of which is optically coupled to a channel of silicon photomultiplier array by means of two wavelength-shifting fibers. The sensitive area of both detectors is 90 × 90 mm2. The performance of the prototypes was tested in different facilities with protons and carbon ions at energy up to about 250 MeV and rate up to about 109 particles per second. The comparison between simulations and measurements confirms the validity of this system. Based on the results, a future development is a real-time radiography system exploiting high-intensity pencil beams and real-time treatment plan verification

NURE: An ERC project to study nuclear reactions for neutrinoless double beta decay

Neutrinoless double beta decay (0νββ) is considered the best potential resource to access the absolute neutrino mass scale. Moreover, if observed, it will signal that neutrinos are their own anti-particles (Majorana particles). Presently, this physics case is one of the most important research “beyond Standard Model” and might guide the way towards a Grand Unified Theory of fundamental interactions. Since the 0νββ decay process involves nuclei, its analysis necessarily implies nuclear structure issues. In the NURE project, supported by a Starting Grant of the European Research Council (ERC), nuclear reactions of double charge-exchange (DCE) are used as a tool to extract information on the 0νββ Nuclear Matrix Elements. In DCE reactions and ββ decay indeed the initial and final nuclear states are the same and the transition operators have similar structure. Thus the measurement of the DCE absolute cross-sections can give crucial information on ββ matrix elements. In a wider view, the NUMEN international collaboration plans a major upgrade of the INFN-LNS facilities in the next years in order to increase the experimental production of nuclei of at least two orders of magnitude, thus making feasible a systematic study of all the cases of interest as candidates for 0νββ

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Lateral tongue biting versus biting at the tip of the tongue in differentiating between epileptic seizures and syncope.

no abstract availabl

Acute peroneal compartmental syndrome: report of a case

Among the compartmental syndromes the necrosis of peroneal muscles is unusual. We report a case in which the swelling of peroneal muscle causes a compression of the common peroneal nerve below the peroneal head. A disturbance of both the motility and sensibility of the deep and superficial peroneal nerve is present with different pathogenesis. In fact, EMG suggested a muscular damage of the peroneal compartment and a denervation of the pretibial muscle. Interfascicular neurolysis along the peroneal nerve was performed to decompress the common and the deep peroneal nerve. A recovery in the territory of the tibialis anterior deep peroneal nerve confirmed the different mechanisms of paralysis

Reduced servo-control of fatigued human finger extensor and flexor muscles

1. In healthy human subjects holding the index finger semi-extended at the metacarpophalangeal joint against a moderate load, electromyographic (EMG) activity was recorded from the finger extensor and flexor muscles during different stages of muscle fatigue. The aim was to study the effect of muscle fatigue on the level of background EMG activity and on the reflex responses to torque pulses causing sudden extensor unloadings. Paired comparisons were made between the averaged EMG and finger deflection responses under two conditions: (1) at a stage of fatigue (following a sustained co-contraction) when great effort was required to maintain the finger position, and (2) under non-fatigue conditions while the subject tried to produce similar background EMG levels to those in the corresponding fatigue trials. 2. Both the unloading reflex in the extensor and the concurrent stretch reflex in the flexor were significantly less pronounced and had a longer latency in the fatigue trials. Consequently, the finger deflections had a larger amplitude and were arrested later in the fatigue trials. 3. It is concluded that--with avoidance of 'automatic gain compensation', i.e. reflex modifications attributable to differences in background EMG levels--the servo-like action of the unloading and stretch reflexes is reduced in fatigued finger extensor and flexor muscles

The breach rhythm.

Electroencephalography (EEG) recordings obtained after craniotomy are difficult to interpret because of the presence of a breach rhythm (BR) consisting of unfiltered high-voltage physiological waveforms, sometimes with a spiky and irregular morphology, that can mimic interictal epileptiform abnormalities and may therefore lead to misinterpretations. In this article, we review EEG features of BR and give some technical tips to properly interpret BR and to make a correct differential diagnosis with epileptiform abnormalities. As BR itself has no relationship to epilepsy, it is very important to adopt a "conservative" reading, having a high threshold to call epileptiform abnormalities

Fear as the only clinical expression of affective focal status epilepticus.

Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is often delayed as the behavioral features, like fear, are interpreted as psychiatric disorders. We describe a patient with affective focal status epilepticus (AFSE) in which fear was the only clinical manifestation. We present electroencephalographic correlates and discuss the diagnostic difficulties that can be encountered in similar cases. AFSE with fear as the only clinical expression may represent a diagnostic challenge. When fear is the only or the prominent behavioral feature, seizures may be diagnosed as panic attacks, leading to erroneous therapy. In such situations, electroencephalography is an essential tool in differentiating between psychiatric disorders and epileptic events