Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee

The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504–32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer’s disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentatothalamo- motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity

Abnormal cortical responses to somatosensory stimulation in medication-overuse headache

BACKGROUND: Medication-overuse headache (MOH) is a frequent, disabling disorder. Despite a controversial pathophysiology convincing evidence attributes a pivotal role to central sensitization. Most patients with MOH initially have episodic migraine without aura (MOA) characterized interictally by an absent amplitude decrease in cortical evoked potentials to repetitive stimuli (habituation deficit), despite a normal initial amplitude (lack of sensitization). Whether central sensitization alters this electrophysiological profile is unknown. We therefore sought differences in somatosensory evoked potential (SEP) sensitization and habituation in patients with MOH and episodic MOA. METHODS: We recorded median-nerve SEPs (3 blocks of 100 sweeps) in 29 patients with MOH, 64 with MOA and 42 controls. Episodic migraineurs were studied during and between attacks. We measured N20-P25 amplitudes from 3 blocks of 100 sweeps, and assessed sensitization from block 1 amplitude, and habituation from amplitude changes between the 3 sequential blocks. RESULTS: In episodic migraineurs, interictal SEP amplitudes were normal in block 1, but thereafter failed to habituate. Ictal SEP amplitudes increased in block 1, then habituated normally. Patients with MOH had larger-amplitude block 1 SEPs than controls, and also lacked SEP habituation. SEP amplitudes were smaller in triptan overusers than in patients overusing nonsteroidal anti-inflammatory drugs (NSAIDs) or both medications combined, lowest in patients with the longest migraine history, and highest in those with the longest-lasting headache chronification. CONCLUSIONS: In patients with MOH, especially those overusing NSAIDs, the somatosensory cortex becomes increasingly sensitized. Sensory sensitization might add to the behavioral sensitization that favors compulsive drug intake, and may reflect drug-induced changes in central serotoninergic transmission

Altered processing of sensory stimuli in patients with migraine

Migraine is a cyclic disorder, in which functional and morphological brain changes fluctuate over time, culminating periodically in an attack. In the migrainous brain, temporal processing of external stimuli and sequential recruitment of neuronal networks are often dysfunctional. These changes reflect complex CNS dysfunction patterns. Assessment of multimodal evoked potentials and nociceptive reflex responses can reveal altered patterns of the brain's electrophysiological activity, thereby aiding our understanding of the pathophysiology of migraine. In this Review, we summarize the most important findings on temporal processing of evoked and reflex responses in migraine. Considering these data, we propose that thalamocortical dysrhythmia may be responsible for the altered synchronicity in migraine. To test this hypothesis in future research, electrophysiological recordings should be combined with neuroimaging studies so that the temporal patterns of sensory processing in patients with migraine can be correlated with the accompanying anatomical and functional changes

Pathophysiology and treatment of cranial distonia

Patients with cranial dystonia have blepharospasm, oromandibular dystonia, or a combination of both. Blepharospasm is characterised by involuntary spasms of the orbicularis oculi (OO) muscles, which result in forceful eyelid closure. Oromandibular dystonia consists of contractions of the perioral or masticatory muscles, or both, resulting in jaw-closing movements, lip or tongue protrusion, and lower facial twitching. Electromyographic (EMG) studies indicate that involuntary spasmodic contractions in blepharospasm can arise from various parts of the OO. The OO muscle consists of three functional components: the pretarsal region is mainly responsible for spontaneous, voluntary, or reflex blinking; the preseptal part for blinking and sustained activities (unilateral or bilateral narrowing or closure of the eyelids); and the orbital part is involved in sustained contraction of the eyelids. In patients with blepharospasm, combining EMG recordings from the OO and levator palpebrae (LP) muscles, Aramideh and colleagues1,2 identified three distinct patterns of involuntary muscle activity, all showing the typical features of EMG activity observed in other forms of focal dystonia, namely, excessive muscle activity in the target muscle, co-contraction of antagonists, and failed voluntary activation of a target muscle. The first EMG pattern is characterised by involuntary discharges confined to the OO with preservation of reciprocal inhibition in LP and OO muscles. The second shows involuntary activity in the OO accompanied either by LP involuntary inhibition or disturbed OO-LP reciprocal innervation. The third EMG pattern consists of LP involuntary inhibition alone, and when patients try to open the eyes, the EMG shows involuntary LP inhibition but no OO activity

Studi per il recupero: storia, costruzione e progetto nelle aree ex industriali a Rieti

Il volume nasce nell’ambito dell’Osservatorio di Archeologia Industriale per Rieti e Sabina. Gli autori trattano in particolare gli aspetti storico, architettonico-costruttivo e urbanistico degli impianti ex industriali studiati in tre anni di attività dell’Osservatorio, nato da un accordo di collaborazione scientifica tra l’Università di Roma “Sapienza” e l’Archivio di Stato di Rieti. Gli esiti parziali hanno già costituito la piattaforma tecnica per mettere a confronto l’amministrazione comunale, l’iniziativa privata e la collettività sui valori propri di una porzione rilevante del territorio comunale reatino e sulle potenzialità insite in una trasformazione culturalmente consapevole e costruttivamente sostenibile. Tale attività di ricerca si è inoltre svolta in coordinamento sinergico con diverse attività di ricerca parallele, finanziate dall'Ateneo Federato della Scienza e della Tecnica – Sapienza e dal CRITEVAT-Sapienza e raccoglie gli esiti di un assegno di ricerca (titolare Edoardo Currà, finanziato nel 2010 dal centro di ricerca CRITEVAT-Sapienza). Tra il 1883 ed il 1937 si sono insediate a Rieti diverse industrie che hanno dato vita ad un distretto produttivo impostato sull’asse di Viale Maraini e servito dalle infrastrutture ferroviarie che da subito lo innervano. In particolare, nell’ambito delle attività dell’Osservatorio di Archeologia Industriale per Rieti e Sabina, ci si è concentrati su tre impianti (lo zuccherificio Maraini, 1873; la S.a. Supertessile, 1926; la Montecatini, 1937) che, per la loro posizione rispetto alla città, baricentrici tra città storica e nuove espansioni, collocate, come sono, in un ambito con diffusi connotati agrari, si pensa debbano costituire oggetto prioritario di attenzione per delineare le strategie di sviluppo della città. Ne è conferma anche la consistenza dimensionale del sito che, con centinaia di migliaia di metri quadrati di superficie coperta, si propone come emergenza a livello urbano e territoriale. La vicenda storica, che getta luce su nuovi aspetti della evoluzione del sito ed evidenzia i caratteri strutturanti di questa porzione di territorio urbano, si intreccia con la conoscenza del dato materiale, inteso non come semplice complemento ma come elemento fondamentale per procedere all’attuazione delle emergenti istanze di recupero. Nei casi in esame la ricerca ha permesso di evidenziare particolari specificità costruttive che costituiscono elementi delle valutazioni di valore e di invarianza che si propongono alla elaborazione progettuale. Per tutte e tre le fabbriche emerge il filo diretto che l’imprenditoria stabilì con la categoria professionale di ingegneri e architetti, sviluppando complesse interconnessioni tra linguaggi “tradizionalisti” e “modernisti”. Basti citare il binomio Giovanni Agnelli-Giacomo Mattè Trucco nella fabbrica del Lingotto, dove alla modernità dell’edificio produttivo risponde il dialogo con la storia del palazzo Uffici. Caso eclatante fu poi la figura di Carlo Gualino, che instaurò complessi e contraddittori rapporti con un ampio stuolo di progettisti, dall’eclettico Vittorio Tornielli ai “razionalisti” Alberto Sartoris, Gigi Chessa, Giuseppe Pagano e Gino Levi Montalcini. Un altro industriale piemontese, il barone Alberto Fassini Camossi, ebbe diversi progettisti di fiducia: prima Ernesto Basile, poi Carlo Maria Busiri Vici, da ultimo Arturo Hoerner, con il quale stabilì, a differenza dei primi due, un duraturo rapporto di committenza per circa due decenni. Questi in particolare sono i due principali protagonisti della realizzazione dello stabilimento reatino della Supertessile, e nella monografia si inquadra la vicenda progettuale e costruttiva nell’ambito delle numerose altre occasioni di collaborazione tra committente e progettista. Emerge inoltre, per l’intero distretto industriale, e non solo per lo zuccherificio, una “coerenza tecnologica” con le coeve realizzazioni italiane per l’industria. D’altronde l’iniziativa e l’imprenditoria delle tre grandi fabbriche è quasi completamente estranea alla città e collocabile in un più ampio contesto imprenditoriale nazionale. La costruzione per l’industria di Viale Maraini non risente perciò delle arretratezze tecniche e culturali della città e della regione, confermate ancora nel 1958 (Lorenzetti R., Ravaioli N. 1995), anche per la vicinanza con Roma e con il polo delle acciaierie di Terni (a cui si devono riferire molti dei componenti in acciaio per le costruzioni) ma offre invece una versione in cui “il localismo si esplica soprattutto negli elementi tecnici che non necessitano di aggiornate soluzioni tecnologiche” (principalmente le murature portanti, le tamponature e gli elementi in laterizio). A fianco ai localismi vi sono quindi importanti testimonianze della costruzione in intelaiatura di acciaio e, ancor più rilevanti, dell’affermazione e della sperimentazione dei brevetti italiani per la costruzione del cemento armato, in particolare del brevetto Baroni-Lüling. Il testo descrive ed illustra tramite un ricco apparato grafico originale, il dettagliato lavoro di rilievo sul campo e l’analisi dei caratteri specifici della costruzione che ha permesso di scoprire le peculiarità di una apparecchiatura costruttiva che le precedenti ricerche non avevano ancora messo in luce e le colloca nel contesto dell’evoluzione della costruzione in Italia. L’intento multidisciplinare dell’attività dell’Osservatorio ha aperto un laboratorio permanente di individuazione di strumenti e scenari di attuazione urbana. L’ultimo capitolo è dedicato perciò ad inquadrarli in un contesto che, dagli studi storici e della costruzione, permuta il senso di continuità che si può ricercare nella trasformazione del territorio come elemento per la prefigurazione equilibrata di direttrici di sviluppo e come tramite di valorizzazione dell’identità e del territorio

3D-DIC analysis for BIM-oriented SHM of a lab-scale aluminium frame structure

In recent years, three-dimensional Digital Image Correlation (3D-DIC) has proven to be a reliable technique for Structural Health Monitoring (SHM) by allowing full line-of-sight, high-resolution, and contactless measurements of structures. The large amount of raw output resulting from 3D-DIC requires appropriate methods to visualise and analyse the data systematically. In this context, Building Information Modeling (BIM) emerges as a robust repository and data management tool to store, query, and assess long sequences of SHM data. Different sensors have been used to collect SHM data and digital sensors have been created in the BIM environment to mimic the behaviour of the physical ones on site. This research focuses on the BIM implementation of virtual sensors from information retrieved using 3D-DIC to store frequency and time domain data and monitor structural changes in a targeted system over time. The application of the Phase-based Motion Magnification (PMM) technique is proposed as a preprocessing tool for 3D-DIC analysis videos to obtain displacement information in specific frequency bands and make those values structurally effective. As a case study, a three-story aluminium frame structure with a damaged and undamaged configuration is used to validate the developed methodology

Near infrared spectroscopy as a tool for in vivo analysis of human muscles

Human skeletal muscles may undergo qualitative and quantitative, physiological and pathological changes during life. Some of these changes may be detected with imaging techniques, others with immunohystochemical and molecular analysis. Both these types of investigation are expensive, time consuming, and not readily available. Therefore, at present, a cheap, reliable, and widely applicable technique for non-invasive in vivo analysis of human muscles is lacking. Here we propose optical spectroscopy as a tool that can be added to clinical investigation without significant cost and time penalties. Recent advances in materials and fabrication techniques provided portable, performant, sensing optical spectrometers readily operated by user-friendly cabled or wireless systems. Such systems allow rapid, non-invasive and not destructive quantitative analysis of human tissues. In this investigation, we tested whether infrared spectroscopy techniques, currently utilized in many areas as primary/secondary raw materials sector, cultural heritage, agricultural/food industry, environmental remote and proximal sensing, pharmaceutical industry, etc., could be applied in living humans to categorize muscles. We acquired muscles reflectance spectra in the Vis-SWIR regions (350-2500 nm), utilizing an ASD FieldSpec 4™ Standard-Res Spectroradiometer with a spectral sampling capability of 1.4 nm at 350- 1000 nm and 1.1 nm at 1001-2500 nm. Spectra were collected from the upper limb muscles (i.e. biceps, a forearm flexor, and triceps, a forearm extensor) placed in fixed limb postures (elbow angle approximately 90°) of 22 healthy subjects (age 25-89 years, 11 females). Spectra off-line analysis included preliminary pre-processing for signal scattering reduction, Principal Component Analysis (PCA) aimed to spectral grouping and Partial Least-Squares Discriminant Analysis (PLS-DA) for implementing discrimination/prediction models. Spectral data were correlated with anthropometric variables. Optical spectroscopy proved effective for studying human muscles in vivo. Vis-SWIR spectra acquired from the arm detect muscles from other tissues, and distinguished flexors from extensors

Near infrared spectroscopy of human muscles

Optical spectroscopy is a powerful tool in research and industrial applications. Its properties of being rapid, non-invasive and not destructive make it a promising technique for qualitative as well as quantitative analysis in medicine. Recent advances in materials and fabrication techniques provided portable, performant, sensing spectrometers readily operated by user-friendly cabled or wireless systems. We used such a system to test whether infrared spectroscopy techniques, currently utilized in many areas as primary/secondary raw materials sector, cultural heritage, agricultural/food industry, environmental remote and proximal sensing, pharmaceutical industry, etc., could be applied in living humans to categorize muscles. We acquired muscles infrared spectra in the Vis-SWIR regions (350-2500 nm), utilizing an ASD FieldSpec 4™ Standard-Res Spectroradiometer with a spectral sampling capability of 1.4 nm at 350-1000 nm and 1.1 nm at 1001-2500 nm. After a preliminary spectra pre-processing (i.e. signal scattering reduction), Principal Component Analysis (PCA) was applied to identify similar spectral features presence and to realize their further grouping. Partial Least-Squares Discriminant Analysis (PLS-DA) was utilized to implement discrimination/prediction models. We studied 22 healthy subjects (age 25-89 years, 11 females), by acquiring Vis-SWIR spectra from the upper limb muscles (i.e. biceps, a forearm flexor, and triceps, a forearm extensor). Spectroscopy was performed in fixed limb postures (elbow angle approximately 90°). We found that optical spectroscopy can be applied to study human tissues in vivo. Vis-SWIR spectra acquired from the arm detect muscles, distinguish flexors from extensors

Intracerebral hemorrhage after cranioplasty: an unpredictable treacherous complication due to reperfusion or possible systemic inflammatory response syndrome

Introduction: In case of malignant cerebral infarction and progressive neurological worsening, decompressive craniectomy is the surgical option that is recommended when medical therapies fail. The occurrence of an intracerebral hemorrhage after reconstruction of the bone defect is extremely rare. This is an extremely rare complication, with only four cases reported thus far in the literature. Case Report: A 54-year-old male suffered a malignant cerebral infarction and progressive neurological worsening requiring decompressive hemicraniectomy. Three months later, an autologous cranioplasty was performed. Postoperatively, the patient experienced a generalized epileptic seizure and a hemorrhage in the left cerebellar hemisphere on control CT scan. After surgical removal the patient did not improve, and CT revealed the occurrence of further cerebellar, mesencephalic, and intraventricular hemorrhages. Systemic inflammatory response syndrome was suspected, but death occurred 72 hours after cranioplasty. Conclusions: The reperfusion-hyperperfusion mechanism after cranioplasty might favor intracerebral hemorrhages limited to the ischemic tissue, which is unable to support the cerebral blood perfusion pressure. When diffuse atypical hemorrhages far from the surgical site occur after cranioplasty, a systemic inflammatory response syndrome is supposed