Association between spontaneous intracranial epidural hematoma and craniofacial infections: a systematic literature review

Background: Spontaneous and nontraumatic epidural hematoma (SEDH) is a rare entity. Etiology is various, including vascular malformations of the dura mater, hemorrhagic tumors, and coagulation defects. The association between SEDH and craniofacial infections is rather unusual. Methods: We performed a systematic review of the available literature using the PubMed, Cochrane Library, and Scopus research databases. Literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We exclusively included studies reporting demographic and clinical data, published until October 31, 2022. We also report one case from our experience. Results: A total of 18 scientific publications, corresponding to 19 patients, met the inclusion criteria for the qualitative and quantitative analysis. Patients were mostly adolescents, with a clear male predominance. SEDHs frequently occurred in the frontal area, usually near the site of the infection. Surgical evacuation was the treatment of choice with good postoperative outcomes. Endoscopy of the involved paranasal sinus should be achieved as soon as possible to remove the cause of the SEDH. Conclusion: SEDH may occur as a rare and life-threatening complication of craniofacial infections; therefore, prompt recognition and treatment are mandatory

EFFECTIVENESS OF SEROTONERGIC DRUGS IN THE MANAGEMENT OF PROBLEM BEHAVIORS IN PATIENTS WITH NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental disorders often result in disabilities associated with auto- and / or hetero-aggressive behaviors, that can be defined as "problem behaviors" (Lacy 2007). Therapeutic interventions are mainly directed towards the use of neuroleptic drugs or benzodiazepines, to ensure a rapid and significant sedation in most of cases. These pharmacological devices exposes the patient to clinical risks and/or long-term management difficulties. The main problem of the chronic use of benzodiazepines is the development of tolerance and dependence; furthermore benzodiazepine withdrawal or their abrupt reduction may lead to rebound effect. Regarding the long-term effects of neuroleptics, it is necessary to focus on extrapyramidal effects, motor restlessness and akathisia, anticholinergic effects, as well as endocrine and metabolic alterations. Several studies have shown that the reduction of serotonergic receptor activity is associated with the appearance of aggressive behavior (Farnam et al. 2017), especially impulsive behaviors (Manchia et al. 2017, Takahashi et al. 2012). The dynamics that subtend these data are still not fully clarified, however there are evidences that the use of selective serotonin reuptake inhibitors (SSRI) is helpful in the treatment of aggressive behavior in mental disabilities (Sterke et al. 2012, Janowsky et al. 2015). In this study we observe the behavioral response to sertraline, for minors, and to vortioxetine, for adults, considering that the literature shows significant evidence of modulation of synaptic neuroplasticity (Waller et al. 2017). To support the observation we used behavioural scales to collect the data, before the administration of the drug, during the course of treatment, at 3 months from the start of the administration. We detected the improve of behavioral disorders with the less use neuroleptic drugs and benzodiazepines

EFFECTIVENESS OF SEROTONERGIC DRUGS IN THE MANAGEMENT OF PROBLEM BEHAVIORS IN PATIENTS WITH NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental disorders often result in disabilities associated with auto- and / or hetero-aggressive behaviors, that can be defined as "problem behaviors" (Lacy 2007). Therapeutic interventions are mainly directed towards the use of neuroleptic drugs or benzodiazepines, to ensure a rapid and significant sedation in most of cases. These pharmacological devices exposes the patient to clinical risks and/or long-term management difficulties. The main problem of the chronic use of benzodiazepines is the development of tolerance and dependence; furthermore benzodiazepine withdrawal or their abrupt reduction may lead to rebound effect. Regarding the long-term effects of neuroleptics, it is necessary to focus on extrapyramidal effects, motor restlessness and akathisia, anticholinergic effects, as well as endocrine and metabolic alterations. Several studies have shown that the reduction of serotonergic receptor activity is associated with the appearance of aggressive behavior (Farnam et al. 2017), especially impulsive behaviors (Manchia et al. 2017, Takahashi et al. 2012). The dynamics that subtend these data are still not fully clarified, however there are evidences that the use of selective serotonin reuptake inhibitors (SSRI) is helpful in the treatment of aggressive behavior in mental disabilities (Sterke et al. 2012, Janowsky et al. 2015). In this study we observe the behavioral response to sertraline, for minors, and to vortioxetine, for adults, considering that the literature shows significant evidence of modulation of synaptic neuroplasticity (Waller et al. 2017). To support the observation we used behavioural scales to collect the data, before the administration of the drug, during the course of treatment, at 3 months from the start of the administration. We detected the improve of behavioral disorders with the less use neuroleptic drugs and benzodiazepines

MATHEMATICS ANXIETY AND COGNITIVE PERFORMANCE IN ADOLESCENT STUDENTS

Several studies highlight that many students feel negative feelings about mathematical learning and that the mathematics anxiety seems to play a central role in mathematical performance. More specifically students with higher level of maths anxiety are less efficient in mathematical tasks. The aim of this study was to investigate the relationship between specific mathematics anxiety as assessed by AMAS, trait and state anxiety as assessed by STAI-Y, and mathematical skills assessed through the ABCA tests in a sample of 83 adolescent students (78.3% males) without diagnosis of dyscalculia and cognitive disorder attending their first year of secondary school. Results showed that 38% of the students referred high level of maths anxiety. Independent T-test revealed that female students referred a higher level of maths anxiety as well as of trait and state anxiety than male ones, while there were no differences in the mathematics performance. The simultaneous multivariate linear regression analysis showed that maths anxiety was influenced by trait anxiety and in its turn has an impact on the high level mathematics performances (i.e. arithmetic facts). Understanding the relationships between maths anxiety and maths learning and performance may have relevant implications in clinical, educational and didactic practice

MATHEMATICS ANXIETY AND COGNITIVE PERFORMANCE IN ADOLESCENT STUDENTS

Several studies highlight that many students feel negative feelings about mathematical learning and that the mathematics anxiety seems to play a central role in mathematical performance. More specifically students with higher level of maths anxiety are less efficient in mathematical tasks. The aim of this study was to investigate the relationship between specific mathematics anxiety as assessed by AMAS, trait and state anxiety as assessed by STAI-Y, and mathematical skills assessed through the ABCA tests in a sample of 83 adolescent students (78.3% males) without diagnosis of dyscalculia and cognitive disorder attending their first year of secondary school. Results showed that 38% of the students referred high level of maths anxiety. Independent T-test revealed that female students referred a higher level of maths anxiety as well as of trait and state anxiety than male ones, while there were no differences in the mathematics performance. The simultaneous multivariate linear regression analysis showed that maths anxiety was influenced by trait anxiety and in its turn has an impact on the high level mathematics performances (i.e. arithmetic facts). Understanding the relationships between maths anxiety and maths learning and performance may have relevant implications in clinical, educational and didactic practice

EFFECTS OF MUSIC ON SEIZURE FREQUENCY IN INSTITUTIONALIZED SUBJECTS WITH SEVERE/PROFOUND INTELLECTUAL DISABILITY AND DRUG-RESISTANT EPILEPSY

Background: Approximately one-third of patients with epilepsy continue to experience seizures despite adequate therapy with antiepileptic drugs. Drug-resistant epilepsy is even more frequent in subjects with intellectual disability. As a result, several nonpharmacological interventions have been proposed to improve quality of life in patients with intellectual disability and drug-resistant epilepsy. A number of studies have demonstrated that music can be effective at reducing seizures and epileptiform discharges. In particular, Mozart’s sonata for two pianos in D major, K448, has been shown to decrease interictal EEG discharges and recurrence of clinical seizures in patients with intellectual disability and drug-resistant epilepsy as well. The aim of this study is to investigate the influence of Mozart\u27s music on seizure frequency in institutionalized epileptic subjects with profound/severe intellectual disability. Subjects and methods: Twelve patients (10 males and 2 females) with a mean age of 21.6 years were randomly assigned to two groups in a cross-over design; they listened to Mozart K448 once a day for six months. Results: A statistically significant difference was observed between the listening period and both baseline and control periods. During the music period, none of the patients worsened in seizure frequency; one patient was seizure-free, five had a greater than 50% reduction in seizure frequency and the remaining showed minimal (N=2) or no difference (N=4). The average seizure reduction compared to the baseline was 20.5%. Our results are discussed in relation to data in the literature considering differences in protocol investigation. Conclusions: Music may be considered a useful approach as add-on therapy in some subjects with profound intellectual disability and drug-resistant epilepsy and can provide a new option for clinicians to consider, but further large sample, multicenter studies are needed to better understand the characteristics of responders and non-responders to this type of non-pharmacological intervention

MOZART\u27S MUSIC AND MULTIDRUG-RESISTANT EPILEPSY: A POTENTIAL EEG INDEX OF THERAPEUTIC EFFECTIVENESS

Multidrug-resistant epilepsy is a pathological condition that affects approximately one-third of patients with epilepsy, especially those with associated intellectual disabilities. Several non-pharmacological interventions have been proposed to improve quality of life of these patients. In particular, Mozart’s sonata for two pianos in D major, K448, has been shown to decrease interictal electroencephalography (EEG) discharges and recurrence of clinical seizures in these patients. In a previous study we observed that in institutionalized subjects with severe/profound intellectual disability and drug-resistant epilepsy, a systematic music listening protocol reduced the frequency of seizures in about 50% of cases. This study aims to assess electroencephalography as a quantitative (qEEG) predictive biomarker of effectiveness of listening to music on the frequency of epileptic discharges and on background rhythm frequency (BRF)

THE EFFECT OF MOZART’S MUSIC IN SEVERE EPILEPSY: FUNCTIONAL AND MORPHOLOGICAL FEATURES

Music is a very important factor in everyday life, involving mood, emotions and memories. The effect of music on the brain is very debated. Certainly, music activates a complex network of neurones in auditory areas, mesolimbic areas, cerebellum and multisensory areas. In particular, music exerts its effects on the brain of patients with epilepsy, having a dichotomous influence: it can either be seizure-promoting in musicogenic epilepsy or antiepileptic. Several studies have shown that seizure-prone neural networks may be stimulated by certain periodicities while other frequencies may prevent seizure activity. There are a lot of data in the literature about the so-called "Mozart effect" (Rauscher et al. 1993). In previous studies we observed that in institutionalized subjects with severe/profound intellectual disability and drug-resistant epilepsy, a systematic music listening protocol reduced the frequency of seizures in about 50% of the cases. In this study we are conducting a survey on the observation of what happens to the brain of patients suffering from drug-resistant epilepsy through electroencephalographic investigations, brain MRI and behavioural analysis before and after six months of listening to Mozart music (Sonata K.448). The first step is to present the data of the first patient under investigation