Il sistema noradrenergico nell’epilessia

Una ricchissima letteratura stabilisce che la noradrenalina (NA) ha un potente effetto antiepilettico, indicato inizialmente dagli studi sul kindling, poi confermato in altri modelli sperimentali di epilessia fino alle recenti evidenze ottenute con l’uso di animali transgenici e knockout per specifici geni espressi nel sistema NA. Nel corso di questo dottorato una linea di ricerca è stata condotta al fine di valutare le conseguenze della deprivazione NA nel ratto in un modello di epilessia limbica basato sulla microinfusione di chemoconvulsivanti in una specifica area cerebrale ricchissima di terminazioni NA, la corteccia piriforme anteriore (area tempestas). E’ stato dimostrato che la lesione NA determina la conversione di crisi limbiche sporadiche in uno stato epilettico duraturo, come se il deficit di NA favorisse il consolidarsi di un circuito epilettico che si automantiene senza più riuscire a trovare i meccanismi attraverso cui una crisi finisce. Un’altra linea di ricerca si è proposta di valutare gli effetti dell’assunzione cronica di metilendiossimetanfetamina (MDMA, Ecstasy) sulla suscettibilità alle crisi epilettiche. Gli esperimenti condotti hanno dimostrato che l’MDMA produce alterazioni persistenti dell’EEG, del comportamento e del metabolismo cerebrale di topi trattati cronicamente con basse dosi di MDMA; tali modificazioni si associano ad un persistente incremento della suscettibilità alle crisi epilettiche, indicando una consistente tossicità limbica prodotta dalla sostanza. Una ulteriore sessione di esperimenti è stata orientata a cercare di definire i meccanismi attraverso cui si producono gli effetti dell’MDMA. In particolare, è stato studiato il ruolo del sottotipo recettoriale adrenergico α1b, la cui attività sembra coinvolta nello sviluppo della sensitizzazione agli effetti delle sostanze d’abuso. Disponendo di topi knockout per il recettore α1b abbiamo osservato l’assenza di sensitizzazione e la protezione dalle crisi indotte da MDMA, dimostrando pertanto che la stimolazione α1b è necessaria per la comparsa degli effetti a lungo termine dell’MDMA nel sistema limbico

Reversible MRI abnormalities in mesial temporal lobe epilepsy: a case report

The question regarding the existence of abnormalities in the neuroimaging exams immediately after status epilecticus or epileptic seizures, but showing complete reversibility after a proper antiepileptic therapy, has long been debated. The first reports attempting to demonstrate their existence date back to the 1980s, and relied upon computed tomography as the imaging method of choice. After the introduction of MRI, a more appropriate characterization of these abnormalities was obtained along with the description of their most frequent features: (a) T2 signal hyperintensity in the white matter and, occasionally, (b) reduced apparent diffusion coefficient (ADC) and increased signal in DWI sequences.The MRI abnormalities induced by epileptic activity pose a broad differential diagnosis including infections, inflammatory autoimmune encephalopathies, neoplasms. It remains a diagnosis of exclusion and requires proper diagnostic iter in order to reduce the risk of misdiagnosis and unnecessary intervention.In this case report, a thorough presentation will be outlined about MRI alterations in the left mesial temporal lobe, which resulted completely reversible after a proper antiepileptic therapy

Parallelism between central and enteric nervous system damage in experimental parkinsonism

Parkinson’s disease (PD) is a neurodegenerative condition which affects dopaminergic neurons of the substantia nigra (SN), leading to a movement disorder. Non motor alterations occur in several viscera, in particular the gastrointestinal tract. In 9-week old C57BL mice we examined the effects of the parkinsonism-inducing neurotoxin 1-methyl, 4-phenyl, 1,2,3,6,-tetrahydropyridine (MPTP, administered either acutely or chronically) in SN and striatum, as well as in duodenum. Motor tests (open field and PaGE) were performed. One week after treatment with MPTP (acute: 20 mg/KgX3, 2h apart or chonic: 5 mg/kg x2/die, for 3 weeks), histological investigations, immunohistochemistry and immunoblotting for tyrosine hydroxylase (TH), and α-synuclein (α-syn) were carried out. Immunocytochemical investigations were analyzed under electron microscopy. Motor tests showed a failure of the PaGE test in all MPTP-treated animals, whereas no difference was found in open field test in comparison with controls. Analysis of histological sections showed some alterations consisting of slight atrophy of duodenal mucosa and glandular disarrangement only after chronic treatment. Under electron microscopy the brush border appeared discontinuous. In all MPTP-administered mice, TH immunopositivity was reduced in SN and striatum, confirming its central dopaminergic neurotoxicity. At duodenal level, TH immunostaining was lost following all MPTP treatments with a slight variation in chronic compared with acute administrations. This was confirmed by semiquantitative immunoblotting. Moreover, α-syn immunostaining was enhanced by MPTP treatment but this was way more evident following chronic administration both at central and peripheral level. Following chronic treatment α-Syn immunopositive structures were investigated under electron microscopy. Our study shows that chronic more than acute administration of MPTP induces alterations at duodenal level reminiscent of dopaminergic damage in SN and striatum. Moreover, this experimental model of parkinsonism features gastrointestinal dysfunction observed in PD patients. These findings lend substance to the concept of the enteric nervous system as a double brain which recapitulates and is an ancestry of the central nervous system

Rischi e problematiche medico-legali in epilessia

For patients with epilepsy coping with the reaction of other people can sometimes be the most difficult part of living with the disease. In many Countries social implications of epilepsy have determined the institution of legislative interventions to patient's rights. Therefore the clinician's responsibility includes helping patients in knowing their rights and the most important laws that have special relevance for people with epilepsy. This article discusses legislative aspects, referring to the Italian law, concerning epilepsy management. Many areas of the life of a person with epilepsy are considered, such as driving, employment, and recreational pursuits

Brivaracetam as Early Add-On Treatment in Patients with Focal Seizures: A Retrospective, Multicenter, Real-World Study

Introduction In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Most real-world research on BRV has focused on refractory epilepsy. The aim of this analysis was to assess the 12-month effectiveness and tolerability of adjunctive BRV when used as early or late adjunctive treatment in patients included in the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Methods BRIVAFIRST was a 12-month retrospective, multicenter study including adult patients prescribed adjunctive BRV. Effectiveness outcomes included the rates of sustained seizure response, sustained 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. Data were compared for patients treated with add-on BRV after 1-2 (early add-on) and >= 3 (late add-on) prior antiseizure medications. Results A total of 1029 patients with focal epilepsy were included in the study, of whom 176 (17.1%) received BRV as early add-on treatment. The median daily dose of BRV at 12 months was 125 (100-200) mg in the early add-on group and 200 (100-200) in the late add-on group (p < 0.001). Sustained seizure response was reached by 97/161 (60.3%) of patients in the early add-on group and 286/833 (34.3%) of patients in the late add-on group (p < 0.001). Sustained seizure freedom was achieved by 51/161 (31.7%) of patients in the early add-on group and 91/833 (10.9%) of patients in the late add-on group (p < 0.001). During the 1-year study period, 29 (16.5%) patients in the early add-on group and 241 (28.3%) in the late add-on group discontinued BRV (p = 0.001). Adverse events were reported by 38.7% and 28.5% (p = 0.017) of patients who received BRV as early and late add-on treatment, respectively. Conclusion Brivaracetam was effective and well tolerated both as first add-on and late adjunctive treatment in patients with focal epilepsy

Response to levetiracetam or lamotrigine in subjects with Juvenile Myoclonic Epilepsy previously treated with valproic acid: A single center retrospective study

Background: Valproic acid (VPA) is the most effective medication in juvenile myoclonic epilepsy (JME) but, due to its teratogenic potential, levetiracetam (LEV) and lamotrigine (LTG) are preferred in women of childbearing age. The aim of this study was to compare the effectiveness and tolerability of LEV and LTG monotherapy in patients with a previous good seizure control in VPA monotherapy, in which VPA was withdrawn because of teratogenic potential or adverse drug effects. Methods: We retrospectively analyzed 65 patients with JME which had been followedup at the Epilepsy Center of Pisa University Hospital, identifying 28 subjects who had been successfully treated with VPA monotherapy and who were shifted to another monotherapy. The second monotherapy was LEV for 14 subjects and LTG for the remaining 14 ones. Drug efficacy was measured in terms of seizure freedom for more than twelve months after reaching the minimum effective or the highest tolerated dose. Results: In terms of seizure control, our analysis showed a significantly better outcome for LEV compared to LTG (14.3% and 71.4% of seizure relapse, respectively, p = 0.006) monotherapy. Such a higher efficacy was confirmed in those subjects with seizure relapse on LTG, who achieved good seizure control after switching to LEV monotherapy (89% of cases). Concerning tolerability, none of the patients reported sev- ere side effects. Conclusion: Although obtained in a small case series, our analysis showed a significant better efficacy of LEV compared to LTG in monotherapy, in patients with JME with a good response to VPA, concerning both myoclonic and generalized tonic-clonic seizure

PVB/ATO Nanocomposites for Glass Coating Applications: Effects of Nanoparticles on the PVB Matrix

Films made of poly(vinyl butyral) (PVB) and antimony-doped tin oxide (ATO) nanoparticles (NPs), both uncoated and surface-modified with an alkoxysilane, were prepared by solution casting at filler volume fractions ranging from 0.08% to 4.5%. The films were characterized by standard techniques including transmission electron microscopy, thermogravimetric analysis and differential scanning calorimetry (DSC). In the polymeric matrix, the primary NPs (diameter ~10 nm) aggregate exhibiting different morphologies depending on the presence of the surface coating. Coated ATO NPs form spherical particles (with a diameter of 300–500 nm), whereas more elongated fractal structures (with a thickness of ~250 nm and length of tens of micrometers) are formed by uncoated NPs. The fraction of the polymer interacting with the NPs is always negligible. In agreement with this finding, DSC data did not reveal any rigid interface and 1H time domain nuclear magnetic resonance (NMR) and fast field-cycling NMR did not show significant differences in polymer dynamics among the different samples. The ultraviolet-visible-near infrared (UV-Vis-NIR) transmittance of the films decreased compared to pure PVB, especially in the NIR range. The solar direct transmittance and the light transmittance were extracted from the spectra according to CEN EN 410/2011 in order to test the performance of our films as plastic layers in laminated glass for glazing

Nerve, muscle and heart acute toxicity following oxaliplatin and capecitabine treatment.

Capecitabine plus oxaliplatin combination (XELOX) is the first-line treatment in metastatic colorectal cancer. Here we report a case of acute, severe but substantially reversible, neuromuscular and cardiac toxicity following XELOX chemotherapy. Muscle biopsy findings were consistent with a toxic myopathy with necrotizing features and vacuolar changes; COX-negative fibers were also present. The time course could support a main role for capecitabine, which may have some neurotoxic effects (more frequently central), but a detrimental interaction between the two drugs cannot be ruled out and further studies are needed

Ictogenesis of viral pneumonia: A comparison between SARS-CoV-2 and H1N1/H3N2

Several studies reported acute symptomatic seizures as a possible neurological complication of COVID-19 pneumonia. Apart from metabolic imbalances, hypoxia, and fever, other ictogenic mechanisms are likely related to an immune-mediated damage. The same mechanisms are shared by other respiratory viruses. Since neurotropic properties of SARS-CoV-2 have been questioned, we investigated whether SARS-CoV-2 has a similar ictogenic potential to other respiratory non-neurotropic viruses. We conducted a retrospective study identifying 1141 patients with SARS-CoV-2 pneumonia and 146 patients with H1N1/H3N2 pneumonia. We found a similar prevalence of seizures in the two viral pneumonia (1.05% with SARS-CoV-2 vs 2.05% with influenza; p = 0.26). We detailed clinical, electroencephalographic, and neuroradiological features of each patient, together with the hypothesized pathogenesis of seizures. Previous epilepsy or pre-existing predisposing conditions (i.e., Alzheimer's disease, stroke, cerebral neoplasia) were found in one-third of patients that experienced seizures, while two-thirds of patients had seizures without known risk factors other than pneumonia in both groups. The prevalence of pre-existing predisposing conditions and disease severity indexes was similar in SARS-CoV-2 and H1N1/H3N2 pneumonia, thus excluding they could act as potential confounders. Considering all the patients with viral pneumonia together, previous epilepsy (p < 0.001) and the need for ventilatory support (p < 0.001), but not the presence of pre-existing predisposing conditions (p = 0.290), were associated with seizure risk. Our study showed that SARS-CoV-2 and influenza viruses share a similar ictogenic potential. In both these infections, seizures are rare but serious events, and can manifest without pre-existing predisposing conditions, in particular when pneumonia is severe, thus suggesting an interplay between disease severity and host response as a major mechanism of ictogenesis, rather than a virus-specific mechanism