Increase in 20–50 Hz (gamma frequencies) power spectrum and synchronization after chronic vagal nerve stimulation

Objective: Though vagus nerve stimulation (VNS) is an important option in pharmacoresistant epilepsy, its mechanism of action remains unclear. The observation that VNS desynchronised the EEG activity in animals suggested that this mechanism could be involved in VNS antiepileptic effects in humans. Indeed VNS decreases spiking bursts, whereas its effects on the EEG background remain uncertain. The objective of the present study is to investigate how VNS affects local and inter regional syncronization in different frequencies in pharmacoresistent partial epilepsy. Methods: Digital recordings acquired in 11 epileptic subjects 1 year and 1 week before VNS surgery were compared with that obtained 1 month and 1 year after VNS activation. Power spectrum and synchronization were then analyzed and compared with an epileptic group of 10 patients treated with AEDs only and with 9 non-epileptic patients. Results: VNS decreases the synchronization of theta frequencies (P!0.01), whereas it increases gamma power spectrum and synchronization (!0.001 and 0.01, respectively). Conclusions: The reduction of theta frequencies and the increase in power spectrum and synchronization of gamma bands can be related to VNS anticonvulsant mechanism. In addition, gamma modulation could also play a seizure-independent role in improving attentional performances. Significance: These results suggest that some antiepileptic mechanisms affected by VNS can be modulated by or be the reflection of EEG changes.2026-2036Pubblicat

The Effects of Tyrosine Kinase Inhibitors (TKIs) in Monotherapy and with Add-on Treatments on Health-related Quality of Life of People with Chronic Myeloid Leukemia: A Systematic Review of Randomized-Controlled Trials

Background: The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment. Methods: A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: “quality of life” OR “health-related quality of life” OR “QoL” OR “HRQoL” OR “H-QoL” AND “chronic myeloid leukemia”. Interval was set from January 2000 to December 2020. Results: 40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed. Conclusion: All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects

Posterior lumbar interbody fusion with peek cages: personal experience with 20 patients.

AIM: The use of interbody cages to obtain fusion in the lumbar spine has increased noticeably in the last few years. They are used both with and without posterior stabilization. In our institution a prospective analysis to determine whether PEEK cages can be used as a stand alone device has been performed. METHODS: The 20 patients with PEEK cages had clinical and radiological follow-up with controls at 1, 3, 6 and 9 months. RESULTS: The clinical results were considered satisfactory in 75% of the cases. There were no intra-or perioperative complications. There was no displacement of the cages. No signs of unsuccessful fusion were observed. CONCLUSIONS: Interbody PEEK cages fulfill the objective of stabilizing the treated segment immediately and subsequently. They can be used as stand alone devices with the correct surgical technique and following precise indications

Posterior approach to axis instability

Many pathologies can cause instability of the cranio-vertebral junction (CVJ). Among the most common diseases must be considered thraumatisms, neoplasms, inflammation, but also congenital malformations. Instability of the CVJ is a potentially life-threatening condition and improper treatment can lead to severe neurological deficits as well as continuous, excruciating pain in the neck. Conservative treatments are often disappointing and surgery must always be taken in consideration when approaching instability of the CVJ, being in many cases the only therapy that can provide satisfactory results. Anterior approaches to the CVJ are usually limited to few and selected cases and posterior approach must be considered the fi rst choice to restore stability of the axial cervical spine

Extradural haematoma of posterior cranial fossa.

Two cases of extradural haematoma of posterior fossa with an acute course are reported. After trauma, the two patients did not show any symptom for a time of 16 and 18 hours respectively. Both of them showed a status of coma at the moment of hospitalization. The haematoma was diagnosed by CT scan. Both of them were immediately operated in order to evacuate the haematoma. Afterwards, one of the patients presented cerebellar symptoms while the other did not show any neurologic deficiency. The authors have analysed cases of this rare form of post-traumatic pathology referred in the literature since 1941, examining them from a clinical, therapeutic and prognostic point of view. The best diagnostic and therapeutic procedures to follow on this subject are then stressed

Chronic subdural hematoma: Results of a homogeneous series of 159 patients operated on by residents

Aims: A series of cases with chronic subdural hematoma operated upon by residents in neurosurgery is analysed. Materials and Methods: 159 patients treated between 1998 and 2001 were included in the study. Mean age was 76.4 years and male/female ratio was 1.7/1. The patients were classified both on admission and at discharge according to the Markwalder scale. The standard operative procedure consisted of an enlarged single burr-hole, rinsing the subdural space with iso-osmotic saline solution and insertion of a subdural drain. Conclusion: In CSDH, operation by the residents is safe and the results are comparable to those of the major series of the literature as the surgical procedure is standardized

Occipital condyle fractures: a hidden nosologic an entity. An experience with 10 cases

Introduction. To report the incidence, treatment and outcome of occipital condyle fractures (OCFs) based on the experience of a single neurosurgical department over a period of two years. Material and methods. From April 1999 to April 2001, ten cases of OCFs were identified in 110 cervical traumas observed over a period of two years. Patients were studied by cervical x-rays, high-resolution CT scan with a 1-2 mm slice of the cranio-cervical junction (CCJ) and MRI in selected cases to evaluate the integrity of supporting ligaments. According to the Anderson and Montesano classification, 5 cases of type III, 3 cases of type II and 2 cases of type I fractures were found. Dysfunction of lower cranial nerves was observed in 8 cases. Treatment was conservative in all cases. Results. At follow-up, ranging from 18 months to 2 years, fusion was obtained in all cases; 8 patients were neurologically intact, one patient presented a mild persistent dysphonia and another mild trapezius weakness. Conclusion. OCFs are actually not rare, rather they are often overlooked. In cases of high-energy trauma of the cervical spine, the diagnostic suspicion should be kept in mind. High-resolution CT scan with slice at 1-2 mm of the CCJ is the key radiological examination in the diagnosis of this lesion. Conservative treatment using a hard collar is sufficien