The still under-investigated role of cognitive deficits in PML diagnosis

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should strongly suggest PML. Clinicians should be sensitive to the importance of formal neuropsychological evaluation, with particular focus on executive function, which are not easily detected without a formal assessment

Impact of 2021 European Academy of Neurology/Peripheral Nerve Society diagnostic criteria on diagnosis and therapy of chronic inflammatory demyelinating polyradiculoneuropathy variants

Background and purpose: there are different criteria for the diagnosis of different variants of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The 2021 European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) guidelines provide specific clinical criteria for each CIDP variant even if their therapeutical impact has not been investigated. Methods: we applied the clinical criteria for CIDP variants of the 2021 EAN/PNS guidelines to 369 patients included in the Italian CIDP database who fulfilled the 2021 EAN/PNS electrodiagnostic criteria for CIDP. Results: according to the 2021 EAN/PNS clinical criteria, 245 patients achieved a clinical diagnosis of typical CIDP or CIDP variant (66%). We identified 106 patients with typical CIDP (29%), 62 distal CIDP (17%), 28 multifocal or focal CIDP (7%), four sensory CIDP (1%), 27 sensory-predominant CIDP (7%), 10 motor CIDP (3%), and eight motor-predominant CIDP (2%). Patients with multifocal, distal, and sensory CIDP had milder impairment and symptoms. Patients with multifocal CIDP had less frequently reduced conduction velocity and prolonged F-wave latency and had lower levels of cerebrospinal fluid protein. Patients with distal CIDP more frequently had reduced distal compound muscle action potentials. Patients with motor CIDP did not improve after steroid therapy, whereas those with motor-predominant CIDP did. None of the patients with sensory CIDP responded to steroids, whereas most of those with sensory-predominant CIDP did. Conclusions: the 2021 EAN/PNS criteria for CIDP allow a better characterization of CIDP variants, permitting their distinction from typical CIDP and more appropriate treatment for patients

Correspondence between neurophysiological and clinical measurements of chemotherapy-induced peripheral neuropathy: secondary analysis of data from the CI-PeriNoms study

Chemotherapy-induced peripheral neuropathy (CIPN) lacks standardized clinical measurement. The objective of the current secondary analysis was to examine data from the CIPN Outcomes Standardization (CI-PeriNomS) study for associations between clinical examinations and neurophysiological abnormalities. Logistic regression estimated the strength of associations of vibration, pin, and monofilament examinations with lower limb sensory and motor amplitudes. Examinations were classified as normal (0), moderately abnormal (1), or severely abnormal (2). Among 218 participants, those with class 1 upper extremity (UE) and classes 1 or 2 lower extremity (LE) monofilament abnormality were 2.79 (95% confidence interval [CI]: 1.28-6.07), 3.49 (95%CI: 1.61-7.55), and 4.42 (95%CI: 1.35-14.46) times more likely to have abnormal sural nerve amplitudes, respectively, compared to individuals with normal examinations. Likewise, those with class 2 UE and classes 1 or 2 LE vibration abnormality were 8.65 (95%CI: 1.81-41.42), 2.54 (95%CI: 1.19-5.41), and 7.47 (95%CI: 2.49-22.40) times more likely to have abnormal sural nerve amplitudes, respectively, compared to participants with normal examinations. Abnormalities in vibration and monofilament examinations are associated with abnormal sural nerve amplitudes and are useful in identifying CIPN

Effect of recombinant human nerve growth factor on cisplatin neurotoxicity in rats

In this study we evaluated the effect of recombinant human nerve growth factor (rhNGF) on cisplatin (CDDP)-induced sensory neuronopathy in an experimental paradigm in the rat. Young adult female Wistar rats were treated with CDDP (2 mg/kg ip twice weekly for nine times) alone or in combination with rhNGF (1 mg/kg sc on alternate days). The effect of CDDP \uc2\ub1 NGF treatment was evaluated with behavioral (tail-flick test) and neurophysiological (nerve conduction velocity in the tail) methods immediately after treatment and after a follow-up period of 6 weeks. Pathological and morphometrical examinations of the dorsal root ganglia (DRG) and sciatic and saphenous nerves were also performed, rhNGF treatment induced a significant reduction in the CDDP-induced decrease in nerve conduction velocity (P < 0.05), and this was associated with a significant protection against the decrease in somatic (P < 0.05), nuclear (P < 0.05), and nucleolar size (P < 0.01) caused by CDDP treatment. However, for each of the parameters examined the neuroprotection obtained with rhNGF treatment was not complete. At the follow-up examination no differences between the three groups were observed in tail-flick test and nerve conduction velocity. We conclude that rhNGF, administered according to the schedule used in this experiment, exerts a biologically significant neuroprotective effect against CDDP peripheral neurotoxicity

Prometheus - Testo Atlante di Anatomia \u2013 Testa, Collo e Neuroanatomia

Il Testo Atlante di Anatomia \u2013 Prometheus rappresenta un atlante anatomico di moderna impostazione e di raffinata realizzazione; non solo strumento utile per gli studenti, in grado di fornire nozioni anatomiche precise, dettagliate e selezionate nell\u2019ottica della professione medica e quindi estremamente valido durante l\u2019apprendimento dell\u2019anatomia, ma anche preziosa opera di aggiornamento, verifica e consultazione nella professione quotidiana per i Medici, per gli Specialisti e, in generale, per tutti i Professionisti Sanitari. I contenuti trattati sono stati scelti in base a criteri di "completezza", ma anche in base alla valutazione dell'importanza di un determinato argomento per la comprensione di base dell'Anatomia o per creare collegamenti logici con l'attivit\ue0 clinica del medico. Le migliaia di illustrazioni, create appositamente per quest'opera, forniscono una visione incredibilmente chiara delle strutture del corpo umano e sono corredate da un ampio testo che serve a renderle pi\uf9 comprensibili mediante spiegazioni, indicazioni didattiche, riferimenti anatomo- funzionali ed anatomo-clinici. Questa nuova edizione include anche ossa, legamenti, articolazioni e organi del collo con i relativi vasi e nervi; alcuni argomenti di Neuroanatomia sono stati completamente rielaborati per correlarli meglio alla conoscenza delle funzioni connesse alla Neurofisiologia, agli approfondimenti clinici e ad esami diagnostici. Gli argomenti che sono stati profondamente rivisti includono, per esempio, la formazione reticolare, la terminologia di lemnischi e nuclei olivari e la classificazione dei gangli autonomi e sensitivi dei nervi cranici. Il Capitolo \u201cTesta e Collo\u201d \ue8 stato ampliato introducendo lo sviluppo dei denti, la radiologia diagnostica e l\u2019anestesia; inoltre nuove immagini ricostruiscono rigorosamente la struttura di denti e gengive rendendo l\u2019intero capitolo adatto anche agli studenti di Odontoiatri

Optimal outcome measures for assessing exercise and rehabilitation approaches in chemotherapy-induced peripheral-neurotoxicity: Systematic review and consensus expert opinion

Introduction: Chemotherapy-induced peripheral neurotoxicity (CIPN) remains a significant toxicity in cancer survivors without preventative strategies or rehabilitation. Exercise and physical activity-based interventions have demonstrated promise in reducing existing CIPN symptoms and potentially preventing toxicity, however there is a significant gap in evidence due to the lack of quality clinical trials and appropriate outcome measures. Areas covered: The authors systematically reviewed outcome measures in CIPN exercise and physical rehabilitation studies with expert panel consensus via the Peripheral Nerve Society Toxic Neuropathy Consortium to provide recommendations for future trials. Across 26 studies, 75 outcome measures were identified and grouped into 16 domains within three core areas - measures of manifestations of CIPN (e.g. symptoms/signs), measures of the impact of CIPN and other outcome measures. Expert opinion: This article provides a conceptual framework for CIPN outcome measures and highlights the need for definition of a core outcome measures set. The authors provide recommendations for CIPN exercise and physical rehabilitation trial design and outcome measure selection. The development of a core outcome measure set will be critical in the search for neuroprotective and treatment approaches to support cancer survivors and to address the significant gap in the identification of effective rehabilitation and treatment options for CIPN

Prometheus. Atlante di anatomia. Testa, collo e neuroanatomia

Il Testo Atlante di Anatomia \u2013 Prometheus rappresenta un atlante anatomico di moderna impostazione e di raffinata realizzazione; non solo strumento utile per gli studenti, in grado di fornire nozioni anatomiche precise, dettagliate e selezionate nell\u2019ottica della professione medica e quindi estremamente valido durante l\u2019apprendimento dell\u2019anatomia, ma anche preziosa opera di aggiornamento, verifica e consultazione nella professione quotidiana per i Medici, per gli Specialisti e, in generale, per tutti i Professionisti Sanitari. I contenuti trattati sono stati scelti in base a criteri di "completezza", ma anche in base alla valutazione dell'importanza di un determinato argomento per la comprensione di base dell'Anatomia o per creare collegamenti logici con l'attivit\ue0 clinica del medico. Le migliaia di illustrazioni, create appositamente per quest'opera, forniscono una visione incredibilmente chiara delle strutture del corpo umano e sono corredate da un ampio testo che serve a renderle pi\uf9 comprensibili mediante spiegazioni, indicazioni didattiche, riferimenti anatomo-funzionali ed anatomo-clinici