L'Obiettivo 3 dell'Agenda 2030: salute e benessere. Statistiche, politiche e diritto

Il volume raccoglie gli atti di un seminario dedicato alla sostenibilità, con particolare riferimento all'Obiettivo 3 (Salute e benessere) dell'Agenda 2030. I diversi contributi si soffermano sull'impatto dell'emergenza sanitaria da Covid-19 sull'organizzazione e sull'erogazione dei servizi sanitari e sulle prospettive aperte dal Piano Nazionale di Ripresa e Resilienza. La prospettiva di analisi è di tipo multi e interdisciplinare, i contributi sono stati elaborati da esperti di varie discipline (statistiche, mediche, giuridiche) e sono stati accolti nella Collana che raccoglie i report del Centro Interdisciplinare di Studi sul Diritto Sanitario diretto dalla prof.ssa M.A. Sandulli

Prolonged epileptic discharges predict seizure recurrence in JME: Insights from prolonged ambulatory EEG

Objective: Markers of seizure recurrence are needed to personalize antiseizure medication (ASM) therapy. In the clinical practice, EEG features are considered to be related to the risk of seizure recurrence for genetic generalized epilepsies (GGE). However, to our knowledge, there are no studies analyzing systematically specific EEG features as indices of ASM efficacy in GGE. In this study, we aimed at identifying EEG indicators of ASM responsiveness in Juvenile Myoclonic Epilepsy (JME), which, among GGE, is characterized by specific electroclinical features. Methods: We compared the features of prolonged ambulatory EEG (paEEG, 22 h of recording) of JME patients experiencing seizure recurrence within a year (“cases”) after EEG recording, with those of patients with sustained seizure freedom for at least 1 year after EEG (“controls”). We included only EEG recordings of patients who had maintained the same ASM regimen (dosage and type) throughout the whole time period from the EEG recording up to the outcome events (which was seizure recurrence for the “cases”, or 1-year seizure freedom for “controls”). As predictors, we evaluated the total number, frequency, mean and maximum duration of epileptiform discharges (EDs) and spike density (i.e. total EDs duration/artifact-free EEG duration) recorded during the paEEG. The same indexes were assessed also in standard EEG (stEEG), including activation methods. Results: Both the maximum length and the mean duration of EDs recorded during paEEG significantly differed between cases and controls; when combined in a binary logistic regression model, the maximum length of EDs emerged as the only valid predictor. A cut-off of EDs duration of 2.68 seconds discriminated between cases and controls with a 100% specificity and a 93% sensitivity. The same indexes collected during stEEG lacked both specificity and sensitivity. Significance: The occurrence of prolonged EDs in EEG recording might represent an indicator of antiepileptic drug failure in JME patients

Increased production of inflammatory cytokines by circulating monocytes in mesial temporal lobe epilepsy: A possible role in drug resistance

: We analyzed peripheral blood mononuclear cells (PBMCs) and serum inflammatory biomarkers in patients with mesial temporal lobe epilepsy (drug-resistant - DR, vs. drug-sensitive - DS). Patients with epilepsy showed higher levels of serum CCL2, CCL3, IL-8 and AOPP, and lower levels of FRAP and thiols compared to healthy controls (HC). Although none of the serum biomarkers distinguished DR from DS patients, when analysing intracellular cytokines after in vitro stimulation, DR patients presented higher percentages of IL-1β and IL-6 positive monocytes compared to DS patients and HC. Circulating innate immune cells might be implicated in DR epilepsy and constitute potential new targets for treatments

Adjunctive brivaracetam and sustained seizure frequency reduction in very active focal epilepsy

Objective: This study aimed to explore the effectiveness of brivaracetam (BRV) according to baseline seizure frequency and past treatment history in subjects with focal epilepsy who were included in the Brivaracetam Add-On First Italian Network Study (BRIVAFIRST). Methods: BRIVAFIRST was a 12-month retrospective, multicenter study including adults prescribed adjunctive BRV. Study outcomes included sustained seizure response (SSR), sustained seizure freedom (SSF), and the rates of treatment discontinuation and adverse events (AEs). Baseline seizure frequency was stratified as <5, 5–20, and >20 seizures per month, and the number of prior antiseizure medications (ASMs) as <5 and ≥6. Results: A total of 994 participants were included. During the 1-year study period, SSR was reached by 45.8%, 39.3%, and 22.6% of subjects with a baseline frequency of <5, 5–20, and >20 seizures per month (p <.001); the corresponding figures for the SSF were 23.4%, 9.8%, and 2.8% (p <.001). SSR was reached by 51.2% and 26.5% participants with a history of 1–5 and ≥6 ASMs (p <.001); the corresponding rates of SSF were 24.7% and 4.5% (p <.001). Treatment discontinuation due to lack of efficacy was more common in participants with >20 seizures compared to those with <5 seizures per month (25.8% vs. 9.3%, p <.001), and in participants with history of ≥6 prior ASMs compared to those with history of 1–5 ASMs (19.6% vs. 12.2%, p =.002). There were no differences in the rates of BRV withdrawal due to AEs and the rates of AEs across the groups of participants defined according to the number of seizures at baseline and the number of prior ASMs. Significance: The baseline seizure frequency and the number of previous ASMs were predictors of sustained seizure frequency reduction with adjunctive BRV in subjects with focal epilepsy

Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy

Passato e presente del diritto amministrativo. Liber amicorum in onore di Alberto Massera

Il volume raccoglie le relazioni e le comunicazioni presentate in occasione della Giornata di studi in onore di Alberto Massera, organizzata presso il Dipartimento di Scienze Politiche l'8 marzo 2017, ed ulteriori contributi, alcuni dei quali afferenti il diritto amministrativo ed altri il dialogo tra il diritto amministrativo e altre scienze. Il volume tratta le tematiche del procedimento amministrativo, dell'organizzazione, dell'attività amministrativa e della giustizia amministrativa in prospettiva nazionale ed europea

Experiencias de comunidad para la transición energética justa e inclusiva: el modelo italiano

Il contributo analizza il contributo delle comunità energetiche al raggiungimento degli obiettivi di sostenibilità economica, ambientale e sociale, nel quadro delle politiche energetiche dell'UE, soffermandosi sul modello italiano delle comunità energetiche rinnovabili quale esperienza applicativa del principio di sussidiarietà e nuova forma di partenariato pubblico-privat

La “speciale” consultazione pubblica per la realizzazione del Deposito nazionale dei rifiuti radioattivi

Il contributo analizza il peculiare processo di consultazione pubblica previsto al fine della localizzazione del deposito nazionale dei rifiuti radioattivi dall’art. 27 del d.lgs. n. 31/2010 e si sofferma sulla vicenda relativa alla questione dell'accettabilità sociale della suddetta infrastruttura critica e sulle misure compensative previste dalla normativa

Le zone dedicate alle energie rinnovabili

Il contributo analizza il quadro regolatorio, sottoposto a numerosi interventi di modifica e integrazione e richiamato dal PNRR, relativo al potere dello Stato e delle Regioni di identificare “aree idonee” alla costruzione e messa in esercizio degli impianti energetici alimentati da fonti rinnovabili. La questione si colloca nel contesto relativo al rapporto conflittuale tra il principio della massima diffusione delle energie rinnovabili e altri interessi costituzionalmente protetti (in particolare l’interesse alla tutela del paesaggio) e agli obiettivi di semplificazione del sistema di permitting promossi dalle recenti misure emergenziali (e non ) varate dall’UE