Studi neuroepidemiologici in Epilessia e Disturbi del Sonno

Neuroepidemiological studies on epilepsy and Restless Leg Syndrome conducted by the research group of Clinical Neurology of Ferrara are presented in the thesis. The first part of the work is dedicated to epidemiology of epilepsy. We made a study in order to calculate incidence rates in children and adult population in the District of Ferrara. We first investigate children population under fifteen years in order to estimate the incidence of epilepsy from 1996 to 2005; we estimated an overall annual rate of 46,4 cases x 100.000 inhabitants/year (95% C.I. 36.7-57-9). The second study calculated incidence of epilepsy in adult population over fifteen from 2007 to 2008. We found 125 incident cases with an overall annual rate of 45.7 cases x 100.000 inhabitants/year (95% C.I. 38.2-54.7). The second part of the thesis focus on epidemiology of Restless leg Syndrome (RLS). Pregnancy is a significant risk factor for transient form of RLS, we present a long-term follow-up study which investigate whether transient RLS during pregnancy represents a risk factor for later development of the syndrome. Women who experienced the transient pregnancy-RLS form showed a significant increased risk of developing a chronic form of the disease (O.R. 3.9, 95% CI: 1,7-9,4) and for a new transient symptomatology in a future pregnancy (O.R. 44,8; 95% CI: 6,2-98.1)

Studi neuroepidemiologici in Epilessia e Disturbi del Sonno

Neuroepidemiological studies on epilepsy and Restless Leg Syndrome conducted by the research group of Clinical Neurology of Ferrara are presented in the thesis. The first part of the work is dedicated to epidemiology of epilepsy. We made a study in order to calculate incidence rates in children and adult population in the District of Ferrara. We first investigate children population under fifteen years in order to estimate the incidence of epilepsy from 1996 to 2005; we estimated an overall annual rate of 46,4 cases x 100.000 inhabitants/year (95% C.I. 36.7-57-9). The second study calculated incidence of epilepsy in adult population over fifteen from 2007 to 2008. We found 125 incident cases with an overall annual rate of 45.7 cases x 100.000 inhabitants/year (95% C.I. 38.2-54.7). The second part of the thesis focus on epidemiology of Restless leg Syndrome (RLS). Pregnancy is a significant risk factor for transient form of RLS, we present a long-term follow-up study which investigate whether transient RLS during pregnancy represents a risk factor for later development of the syndrome. Women who experienced the transient pregnancy-RLS form showed a significant increased risk of developing a chronic form of the disease (O.R. 3.9, 95% CI: 1,7-9,4) and for a new transient symptomatology in a future pregnancy (O.R. 44,8; 95% CI: 6,2-98.1)

Post-Traumatic Epilepsy: Review

Post traumatic epilepsy is defined by recurrent seizures secondary to brain injury following head trauma and represent the most frequent cause of epilepsy in young adults. Most post traumatic epilepsies start within two years from trauma, but in some cases may present several years after the brain injury. Severe traumatic brain injuries tend to correlate with an increased risk of developing early and late post-traumatic seizures. A cranial trauma creates a potentially epileptogenic brain damage through a number of different mechanisms. Several structural, physiological and biochemical modifications occur in a brain after a head injury that promote oxidative stress mechanisms and excitotoxic mechanisms. Current evidence shows that prophylactic use of antiepileptic drugs prevent the occurrence of early post-traumatic seizure but does not influence the incidence of post-traumatic epilepsy. Some authors propose treatment with antioxidant drugs in acute phase of severe traumatic brain injuries in order to prevent early tissue changes established in the traumatized tissue

Posterior reversible encephalopathy associated with nocturnal blood pressure non-dipping pattern

We report the case of a 70-year-old man who presented with a recent history of headache, altered mental status and sleepiness. He was known to have type II diabetes mellitus, and a mild, treated and apparently well controlled hypertension. Brain magnetic resonance imaging demonstrated extensive abnormalities in the parieto-occipital white matter, suggestive of posterior reversible encephalopathy syndrome (PRES). An extensive diagnostic evaluation did not allow the detection of any known cause of the syndrome. Twenty-four-hour non-invasive ambulatory blood pressure monitoring showed a mild to moderate hypertension, with non-dipping pattern. This case suggests that, in the context of an overnight blunted blood pressure profile, even a mild or moderate hypertension can result in cerebral vasogenic oedema, underlining the diagnostic importance of 24-h blood pressure monitoring in patients with PRES without severe hypertension or other commonly recognized causes of posterior reversible encephalopathy. © 2014 Scandinavian Foundation for Cardiovascular Research

The distribution of the transient global amnesia in the province of Ferrara, Italy, a clue to the pathogenesis?

The pathophysiology of transient global amnesia (TGA) is uncertain. In the province of Ferrara (Fe-province) the cases of TGA correspond to the resident outpatients diagnosed as TGA in the ER of the University Hospital of Ferrara. Thanks to this, a retrospective survey identified 35 (14 men, 21 women) first-ever TGA cases in the resident population of the Fe-province in 2018 giving a crude incidence rate of 10.10/100,000 (95% CI 7.00 - 14.00), 8,40 (95% CI 4.60 - 14.10) for men and 11.60 (95% CI 7.20-17.80) for women, a non significant gender difference. The monthly cases of TGA followed the Poisson distribution (goodness-of-fit test: chi-square = 2.557, 5 degrees of freedom , p>0.70). The incidence of TGA in the Fe-province was higher in the highest level of urbanization (21.40/100,000 95% CI 13.10 - 33.00) than in the lowest one (4.20/100,000 95% CI 1.92-8.00). The incident cases of TGA incresed with the level of urbanization (chi-square trend test = 19.940, p < 0.001) and the population density level (chi-square trend test = 46.684, p< 0.001). Since urbanization is likely involved in stress-related disorders, these findings support the hypothesis of the involvement of stress in TGA

The urgent neurological consultation in the population of the province of Ferrara, Italy

In the province of Ferrara, Italy, the urgent neurological consultation (UNC) cases in the population correspond to the resident outpatients who undergo a UNC in the ER of the university hospital of Ferrara (UHFe). Thanks to this health organization a retrospective survey identified 612 UNC cases (range of age 7–102 years, median 67,5 years) in the study period giving a period prevalence rate of 173 per 100,000 (95% CI 159.3–187.3) which increased with age (χ2for trend = 178.4 p 0.70). The prevalence rate decreased with the distance between the patients’ residence and the UHFe (χ2for trend = 82.9, p < 0.001). The commonest clinical conditions requiring UNCs were acute cerebrovascular disorders (28%), headache (14%), and vertigo (9%). The hospital admission rate was 32.5% which increased with age (χ2for trend = 35.8, p < 0.001). The commonest discharge diagnoses of the admitted cases were ischemic stroke (57.3%), epilepsy (7%), TIA (6%), and intraparenchymal hemorrhage (5.5%). Acute cerebrovascular disease accounted for 69% of the discharge diagnoses. The survey showed that the UNCs’ demand was higher than previous Italian data confirming that acute cerebrovascular disease is the most frequent acute neurological condition requiring attention in the ER. It also suggested that the UNCs could be poorly appropriate. These findings would require the healthcare administrators attention

A case of multiple sclerosis associated with early onset parkinsonism

Background: The association of MS and parkinsonism is still a controversial topic because it has not been yet established whether these two conditions occur coincidentally or causally. Case report: We report a 53 year-old woman with an insidious onset of extrapyramidal syndrome. Brain magnetic resonance imaging (MRI) scan revealed multiple hyperintense T2-weighted lesions in the white matter and no lesions in the basal ganglia or midbrain. DaT-SCAN showed reduced level of dopamine carrying protein on right side. Treatment with levodopa induced a marked improvement. Seven years later she developed a myelitis. Spinal cord MRI detected two hyperintense lesions at cervical and dorsal levels. Complete blood count, biochemical profile and coagulation were normal as well as autoimmunity screening. Cerebrospinal fluid (CSF) analysis showed intrathecal synthesis with oligoclonal bands. The patient received intravenous methylprednisolone with marked improvement. A new MRI scan shows a new paraventricular hyperintense T2 weighted lesion. Conclusion: There are some case reports describing patients with parkinsonism and MS demyelinating lesions. Two hypotheses might account for this association. The first one is the coincidental occurrence of Parkinson's disease in MS patients. The second hypothesis postulates that parkinsonism is due to MS itself as a secondary manifestation of immune and neurodegenerative damages affecting dopaminergic pathways. © 2013 Elsevier GmbH

Can the age at onset give a clue to the pathogenesis of ALS?

Pathogenesis could play an important role in the mid- to late - life onset of symptoms in ALS

CEREBRAL BLEPHAROPTOSIS: TWO NEW CASES LITERATURE REVIEW AND PROPOSAL FOR DIAGNOSTIC CRITERIA.

Cerebral ptosis (CP) consists of acute and bilateral drooping eyelids due to a right or left middle cerebral artery territory stroke, without involvement of brain stem, third cranial nerve or oculosympathetic fibres. The pathogenesis of CP is still unknown, but most authors have hypothesised that eyelid control is hemispherically lateralised. Two new cases of CP and a complete literature review are reported in this paper. Because no unanimous criteria for CP diagnosis are currently available, a proposal for new criteria is also included

INSIDIOSA RECIDIVA DI ENCEFALITE ERPETICA: IL RUOLO DELL'EEG

La patogenesi della recidiva di encefalite erpetica non è chiara. Alcuni autori suggeriscono una riattivazione del virus mentre altri sottolineano la possibilità di una risposta immuno-mediata. Talora anche l'esame liquorale può essere negativo. Nel caso clinico descritto l'EEG è stato determinante per il corretto inquadramento clinico confermandosi ancora oggi un fondamentale strumento diagnostico