Extradural Motor Cortex Stimulation might improve episodic and working memory in patients with Parkinson\u2019s disease

Electric Extradural Motor Cortex Stimulation (EMCS) is a neurosurgical procedure suggested for treatment of patients with advanced Parkinson\u2019s disease (PD). We report two PD patients treated by EMCS, who experienced worsening of motor symptoms and cognition 5 years after surgery, when EMCS batteries became discharged. One month after EMCS restoration, they experienced a subjective improvement of motor symptoms and cognition. Neuropsychological assessments were carried out before replacement of batteries (off-EMCS condition) and 6 months afterward (on-EMCS condition). As compared to off-EMCS condition, in on-EMCS condition both patients showed an improvement on tasks of verbal episodic memory and backward spatial short-term/working memory task, and a decline on tasks of selective visual attention and forward spatial short-term memory. These findings suggest that in PD patients EMCS may induce slight beneficial effects on motor symptoms and cognitive processes involved in verbal episodic memory and in active manipulation of information stored in working memory

Dynamic11 c-methionine pet-ct: Prognostic factors for disease progression and survival in patients with suspected glioma recurrence

Purpose: The prognostic evaluation of glioma recurrence patients is important in the therapeutic management. We investigated the prognostic value of11 C-methionine PET-CT (MET-PET) dynamic and semiquantitative parameters in patients with suspected glioma recurrence. Methods: Sixty-seven consecutive patients who underwent MET-PET for suspected glioma recurrence at MR were retrospectively included. Twenty-one patients underwent static MET-PET; 46/67 underwent dynamic MET-PET. In all patients, SUVmax, SUVmean and tumour-to-background ratio (T/B) were calculated. From dynamic acquisition, the shape and slope of time-activity curves, time-to-peak and its SUVmax (SUVmaxTTP ) were extrapolated. The prognostic value of PET parameters on progression-free (PFS) and overall survival (OS) was evaluated using Kaplan–Meier survival estimates and Cox regression. Results: The overall median follow-up was 19 months from MET-PET. Recurrence patients (38/67) had higher SUVmax (p = 0.001), SUVmean (p = 0.002) and T/B (p < 0.001); deceased patients (16/67) showed higher SUVmax (p = 0.03), SUVmean (p = 0.03) and T/B (p = 0.006). All static parameters were associated with PFS (all p < 0.001); T/B was associated with OS (p = 0.031). Regarding kinetic analyses, recurrence (27/46) and deceased (14/46) patients had higher SUVmaxTTP (p = 0.02, p = 0.01, respectively). SUVmaxTTP was the only dynamic parameter associated with PFS (p = 0.02) and OS (p = 0.006). At univariate analysis, SUVmax, SUVmean, T/B and SUVmaxTTP were predictive for PFS (all p < 0.05); SUVmaxTTP was predictive for OS (p = 0.02). At multivariate analysis, SUVmaxTTP remained significant for PFS (p = 0.03). Conclusion: Semiquantitative parameters and SUVmaxTTP were associated with clinical outcomes in patients with suspected glioma recurrence. Dynamic PET-CT acquisition, with static and kinetic parameters, can be a valuable non-invasive prognostic marker, identifying patients with worse prognosis who require personalised therapy

Role of duration of post-stress left ventricular dysfunction in the identification of multivassel coronary artery disease: a Tc-99m sestamibi gated-SPECT study

Objectives: Transient left ventricular (LV) dilation is a well-known marker for coronary artery disease (CAD). However only limited data correlating severity and behavior over time of post-ischemic stunning with CAD extension are available. So the purpose of this study was to assess if there is a relationship among the duration of left ventricular contractile dysfunction induced by physical effort, the extent of reversible defects and the number of coronary vessels involved in the atherosclerotic process. Methods: The study population consisted of 298 patients (124 women and 174 men, mean age 64±9 years) showing at least one reversible defect (Summed Difference Score SDS>3) during a separate day rest/stress Tc-99m sestamibi gated-SPECT myocardial scintigraphy, clinically indicated for suspected CAD. All subjects underwent physical exercise and stress images were acquired 15 minutes after tracer injection. In patients with a reduction of left ventricular ejection fraction (LVEF) more than 5% in comparison with rest data a second gated-SPECT acquisition was performed at 60 minutes. All patients underwent coronary angiography within 3 months of gated SPECT studies. Results: On the basis of scintigraphic results, subjects were divided as follows: group A (137) “no evidence of LVEF decrease after stress or less than 5%”; group B (103) “decrease of LVEF >5% only in early stress acquisition”; group C (58) “evidence of decrease of LVEF >5% both in early and late post-stress studies”. The comparison between coronary anatomy findings and gated-SPECT data showed that 74% of subjects with not significant or single vessel CAD were in group A, 71% with two vessels disease belonged to group B and 72% with left-main or three vessels involvement were included in group C. In particular only 6% of group A patients had multivessel disease. Moreover SDS were significantly higher (P<.0001) in both group B (7.3±6.2) and C (9.8±7.3) patients in comparison to group A (3.5±3.9). Finally the multivariate analysis revealed that the combination of SDS, long-lasting post-stress left ventricular dysfunction, and diabetes mellitus best identified multivessel CAD, with a sensitivity of 82% and a specificity of 86% (χ2, 83.5). Conclusions: The results of this preliminary study support the hypothesis that sustained LV functional abnormalities after exercise stress as assessed by gated- SPECT may significantly contribute to the detection of multivessel disease, a high-risk subset of CAD. Larger prospective trials are needed to confirm these findings and to assess their potential impact on clinical practice

Imaging studies on dopamine transporter and depression: A review of literature and suggestions for future research

We review the conflicting results from imaging studies of dopamine transporter availability in depressed patients and also discuss the heterogeneity of the variables involved. Major depression includes diverse clinical manifestations and in recent years there has been an increasing interest in the identification of homogeneous phenotypes and different clinical subtypes of depression, e.g. anhedonic depression, retarded depression, etc. In addition, the use of different radioligands and imaging techniques, diverse rating scales, together with the lack of control of clinical variables (clinical course, recent or past use of substances of abuse, etc.) make it difficult to clearly identify neuronal regions or networks with consistently abnormal structures or functions in major depressive disorder. It is probably necessary to build a shared approach between clinicians and researchers in order to identify standardized procedures to better understand the role of the dopamine transporter in depression. We outline a list of major issues and also suggest some standardized procedures in collecting clinical and imaging data on major depressed patients. Our aim is to delineate a possible "modus operandi" that would be a proposal for neuroreceptor studies on major depression. (C) 2013 Elsevier Ltd. All rights reserved

A role for accelerometry in the differential diagnosis of tremor syndromes

Accelerometry is a reliable tool for gauging the occurrence, amplitude and frequency of tremor. However, there is no consensus on criteria for accelerometric diagnosis of tremor syndromes. We enrolled 20 patients with essential tremor (ET), 20 with dystonic tremor (DT), and 20 with classic parkinsonian tremor (PD-T), all meeting accepted clinical criteria. All the patients underwent dopamine transporter imaging (by means of single-photon emission computed tomography) and triaxial accelerometric tremor analysis. The latter revealed groupwise differences in tremor frequency, peak dispersion, spectral coherence, unilaterality and resting vs action tremor amplitude. From the above, five diagnostic criteria were extrapolated for each condition. Receiver operating characteristic curves, depicting criteriabased scoring of each tremor type, showed negligible declines in specificity for scores 654 in patients with ET or DT and scores 653 in patients with PD-T, thus providing a simple scoring method (accelerometrically derived) for differential diagnosis of the principal tremor syndromes

Diagnostic role of 11C-methionine PET/CT in patients with multiple myeloma and other plasma cell malignancy: a literature review

In patients with plasma cell malignancy (multiple myeloma and plasmacytoma), whole-body low-dose computed tomography, magnetic resonance imaging, and 18F-FDG PET/CT are widely applied and suggested by international guidelines to assess the disease extension. Recently, 11C-methionine PET/CT has proven to be promising in those patients compared to other diagnostic techniques. We aimed to review current literature on the state of the art of 11C-methionine PET/CT in patients with plasma cell malignancy. PubMed/MEDLINE database was screened to find articles regarding the role of 11C-methionine PET/CT in plasma cell malignancy. Terms (PET OR positron emission tomography) AND methionine AND myeloma were used. Among 23 studies initially retrieved, 7 (overall 258 patients) were included. In all except two studies, 11C-methionine PET/CT was related to 18F-FDG PET/CT (of whom one also with 11C-4′-thiothymidine PET/CT), one study to 11C-choline PET/CT and one compared multiple myeloma and control patients, both having 11C-methionine scan. Overall, 11C-methionine PET/CT resulted able to detect a higher number of positive patients as well as more bone lesions than 18F-FDG and 11C-choline (detection rate: 75.6–90.7%, 55.0–76.7%, and 73.7%, respectively). A stronger correlation with bone marrow histological results was found for 11C-methionine than for 18F-FDG and 11C-choline PET/CT scans. Although additional studies are needed to validate the role of 11C-methionine PET/CT, it seems to be a safety and effective tool in identification of medullary and extramedullary disease in patients with plasma cell malignancy