Metoclopramide-induced acute oculogyric crisis treated with biperiden: A case report

Metoclopramide is an antiemetic prescribed in general medical practice. The drug can cause acute dystonic reactions. Here, we described the case of a 23-year-old young woman with a chief complaint of blurred vision and later dystonic, oculogyric-type crisis. She underwent laboratory tests and neuroimaging then was hospitalized in the Neurological Department. Treatment with intravenous biperiden interrupted the oculogyric crisis. Only a thorough drug history and correct clinical examination can discover the use of metoclopramide-induced adverse drug reaction such as oculogyric crisis

At the intersection of cultural and natural heritage: Distribution and conservation of the type localities of Italian endemic vascular plants

We conducted a GIS spatial analysis with the aim of providing the first quantitative large-scale overview of the distribution patterns of 1536 type localities (loci classici) of 1216 Italian endemic vascular plants and their relationship with a set of descriptive variables. Whereas some variables were used to model the presence-absence distribution patterns of the type localities for the whole set of endemics as well as for the subset of narrow endemics, others (e.g., presence inside or outside protected areas and Italian Important Plant Areas) were considered with the purpose of assessing potential assets or risks for conservation. The largest number of type localities was found within the Mediterranean biogeographic region (1134), followed by the Alpine region (306) and Continental region (96). A total of 670 locations are located on islands, whereas 866 are located on the Italian mainland (139 and 124 in the case of narrow endemics, respectively). A large number of type localities are located in mountainous areas and along the coastline, which can be seen as a potential risk for conservation. On the contrary, we detected a positive correlation with the distance from roads, which might be considered to be an asset. Importantly, 1030 type localities fall inside protected areas, whereas 506 localities fall outside protected areas, with 259 of these unprotected localities on islands. We propose considering the results of the analysis of the distribution of type localities of Italian endemics to be a strategic tool for conservation planning and resource management. Application of plant micro-reserves and integration of diverse legislation tools are suggested to strengthen efforts and increase conservation success

Motor cortex excitability in Alzheimer's disease and in subcortical ischemic vascular dementia.

Twenty Alzheimer's disease (AD) patients, 20 subcortical ischemic vascular dementia (SIVD) patients and 20 neurologically and cognitively normal subjects underwent transcranial magnetic stimulation to study motor cortex excitability changes. Motor threshold (MT), amplitude of motor evoked potentials, silent period and the H/M ratio (amplitude of maximal Hoffman reflex vs. that of maximal motor response) were considered. MT was lower in SIVD patients when compared with AD patients (P = 0.003) and the control group (P < 0.001) and lower in AD patients when compared with the control group (P < 0.001). The increment of motor cortex excitability in AD and SIVD did not lead us to distinguish clearly the two types of dementia. It is likely that the electrophysiological similarity between AD and SIVD could represent another common mechanism shared from these forms of dementia

Effectiveness of Perampanel as the Only Add-on: Retrospective, Multicenter, Observational Real Life Study on epilepsy patients.

Objective: Perampanel (PER) is indicated as adjunctive antiseizure medication (ASM) in adolescents and adults with epilepsy. Data from clinical trials show good efficacy and tolerability, while limited information is available on the routine clinical use of PER, especially when used as only add-on treatment. Methods: we performed an observational, retrospective, multicenter study on people with focal or generalized epilepsy aged &gt;12 years, consecutively recruited from 52 Italian epilepsy centers. All patients received PER as the only add-on treatment to a background ASM according to standard clinical practice. Retention rate, seizure frequency and adverse events were recorded at 3, 6 and 12 months after PER introduction. Sub-analyses by early or late use of PER and by concomitant ASM were also conducted. Results: 503 patients were included (age 36.5±19.9 years). Eighty-one per cent had focal epilepsy. Overall, the retention rate was very high in the whole group (89% at 12 months) according with efficacy measures. No major differences were observed in the sub-analyses, although patients who used PER as early add-on, as compared with late add-on, more often reached early seizure freedom at 3 months follow-up (66% vs. 53%, p=0.05). Treatment-emergent adverse events occurred in 25%, far less commonly than in PER randomized trials. Significance: this study confirms the good efficacy and safety of PER for focal or generalized epilepsy in real-life conditions. We provide robust data about its effectiveness as only add-on treatment even in patients with a long-standing history of epilepsy and previously treated with many ASMs

An inventory of the names of vascular plants endemic to Italy, their loci classici and types

The census of the loci classici of 1,400 Italian endemic vascular plants (i.e. not thriving elsewhere with the exception of Corsica and Malta) is here presented and described. The effective place of publication of accepted names, basionyms and homotypic synonyms were identified and critically verified. This often resulted in some change in authorship attribution and, in seven cases, in validation problems (Asperula cynanchica var. lactea var. nov., A. lactea comb. nov., Biscutella laevigata subsp. raffaelliana subsp. nov., Ferulago nodosa subsp. geniculata comb. & stat. nov., Limonium tineoi comb. nov., L. usticanum sp. nov., Noccaea torreana comb. nov.). The geographic information on the loci classici was excerpted from the protologues, as well as information on typification for the taxa described before 1 January 1958. The names without holotype are 796. For 347 names a lecto- or neo-typification is available in literature, while 449 currently accepted taxa still need of type designation

An inventory of the names of vascular plants endemic to Italy, their loci classici and types

The census of the loci classici of 1,400 Italian endemic vascular plants (i.e. not thriving elsewhere with the exception of Corsica and Malta) is here presented and described. The effective place of publication of accepted names, basionyms and homotypic synonyms were identified and critically verified. This often resulted in some change in authorship attribution and, in seven The census of the loci classici of 1,400 Italian endemic vascular plants (i.e. not thriving elsewhere with the exception of Corsica and Malta) is here presented and described. The effective place of publication of accepted names, basionyms and homotypic synonyms were identified and critically verified. This often resulted in some change in authorship attribution and, in seven cases, in validation problems (Asperula cynanchica var. lactea var. nov., A. lactea comb. nov., Biscutella laevigata subsp. raffaelliana subsp. nov., Ferulago nodosa subsp. geniculata comb. &amp; stat. nov., Limonium tineoi comb. nov., L. usticanum sp. nov., Noccaea torreana comb. nov.). The geographic information on the loci classici was excerpted from the protologues, as well as information on typification for the taxa described before 1 January 1958. The names without holotype are 796. For 347 names a lecto- or neo-typification is available in literature, while 449 currently accepted taxa still need of type designation

Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST)

Objective: Post-stroke epilepsy (PSE) is one of the most common causes of acquired epilepsy and accounts for about 10-15% of all newly diagnosed epilepsy cases. However, evidence about the clinical profile of antiseizure medications in the PSE setting is currently limited. Brivaracetam (BRV) is a rationally developed compound characterized by high-affinity binding to synaptic vesicle protein 2A. The aim of this study was to assess the 12-month effectiveness and tolerability of adjunctive BRV in patients with PSE treated in a real-world setting. Methods: This was a subgroup analysis of patients with PSE included in the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). The BRIVAFIRST was a 12-month retrospective, multicentre study including adult patients prescribed adjunctive BRV. Effectiveness outcomes included the rates of seizure response (≥50% reduction in baseline seizure frequency), seizure-freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events (AEs) and the incidence of AEs. Results: Patients with PSE included in the BRIVAFIRST were 75 and had a median age of 57 (interquartile range, 42-66) years. The median daily doses of BRV at 3, 6, and 12 months from starting treatment were 100 (100-150) mg, 125 (100-200) mg and 100 (100-200) mg, respectively. At 12 months, 32 (42.7%) patients had a reduction in their baseline seizure frequency by at least 50%, and the seizure freedom rates was 26/75 (34.7%). During the 1-year study period, 10 (13.3%) patients discontinued BRV. The reasons of treatment withdrawal were insufficient efficacy in 6 (8.0%) patients and poor tolerability in 4 (5.3%) patients. Adverse events were reported by 13 (20.3%) patients and were rated as mild in 84.6% and moderate in 15.4% of cases. Significance: Adjunctive BRV was efficacious and generally well-tolerated when used in patients with PSE in clinical practice. Adjunctive BRV can be a suitable therapeutic option for patients with PSE

IDPlanT: the Italian database of plant translocation

IDPlanT is the Italian Database of Plant Translocation, an initiative of the Nature Conservation Working Group of the Italian Botanical Society. IDPlanT currently includes 185 plant translocations.The establishment of a national database on plant translocation is a key step forward in data sharing and techniques improvement in this field of plant conservatio

Adjunctive Brivaracetam in Older Patients with Focal Seizures: Evidence from the BRIVAracetam add‑on First Italian netwoRk Study (BRIVAFIRST)

BACKGROUND: The management of epilepsy in older adults has become part of daily practice because of an aging population. Older patients with epilepsy represent a distinct and more vulnerable clinical group as compared with younger patients, and they are generally under-represented in randomized placebo-controlled trials. Real-world studies can therefore be a useful complement to characterize the drug's profile. Brivaracetam is a rationally developed compound characterized by high-affinity binding to synaptic vesicle protein 2A and approved as adjunctive therapy for focal seizures in adults with epilepsy. OBJECTIVE: The aim of this study was to assess the 12-month effectiveness and tolerability of adjunctive brivaracetam in older patients (≥65 years of age) with epilepsy treated in a real-world setting. METHODS: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a 12-month retrospective multicenter study including adult patients prescribed adjunctive brivaracetam. Effectiveness outcomes included the rates of seizure response (≥50% reduction in baseline seizure frequency), seizure freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events and the incidence of adverse events. Data were compared for patients aged ≥65 years of age ('older') vs those aged <65 years ('younger'). RESULTS: There were 1029 patients with focal epilepsy included in the study, of whom 111 (10.8%) were aged ≥65 years. The median daily dose of brivaracetam at 3 months was 100 [interquartile range, 100-175] mg in the older group and 100 [100-200] mg in the younger group (p = 0.036); it was 150 [100-200] mg in both groups either at 6 months (p = 0.095) or 12 months (p = 0.140). At 12 months, 49 (44.1%) older and 334 (36.4%) younger patients had a reduction in their baseline seizure frequency by at least 50% (p = 0.110), and the seizure freedom rates were 35/111 (31.5%) and 134/918 (14.6%) in older and younger groups, respectively (p < 0.001). During the 1-year study period, 20 (18.0%) patients in the older group and 245 (26.7%) patients in the younger group discontinued brivaracetam (p = 0.048). Treatment withdrawal because of insufficient efficacy was less common in older than younger patients [older: n = 7 (6.3%), younger: n = 152 (16.6%); p = 0.005]. Adverse events were reported by 24.2% of older patients and 30.8% of younger patients (p = 0.185); the most common adverse events were somnolence, nervousness and/or agitation, vertigo, and fatigue in both study groups. CONCLUSIONS: Adjunctive brivaracetam was efficacious, had good tolerability, and no new or unexpected safety signals emerged when used to treat older patients with uncontrolled focal seizures in clinical practice. Adjunctive brivaracetam can be a suitable therapeutic option in this special population