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Nicola Modugno,1 Angelo Antonini,2 Alessandro Tessitore,3 Pietro Marano,4 Francesco Ernesto Pontieri,5,6 Nicola Tambasco,7 Margherita Canesi,8,9 Giovanni Fabbrini,10,11 Mariachiara Sensi,12 Rocco Quatrale,13 Paolo Solla,14 Giovanni Defazio,14 Gabriella Melzi,15 Giuliana Gualberti,15 Leonardo Lopiano16 1Neurology Unit, IRCCS Neuromed, Pozzilli, Italy; 2Parkinson and Movement Disorder Unit, Department of Neuroscience, University of Padua, Padua, Italy; 3Department of Medical and Surgery Sciences, University of Campania, “Luigi Vanvitelli”, Naples, Italy; 4Casa di Cura Madonna del Rosario, Raggruppamento di Riabilitazione, Catania, Italy; 5Department NESMOS, “Sapienza” University, Sant’Andrea Hospital, Roma, Italy; 6IRCCS Fondazione Santa Lucia, Roma, Italy; 7Department of Neurology, Perugia General Hospital and University of Perugia, Perugia, Italy; 8Dipartimento di Riabilitazione Malattia di Parkinson e Disordini del Movimento, Gravi Cerebrolesioni Acquisite, Italia Hospital - Ospedale “Moriggia-Pelascini”, Gravedona ed Uniti, Como, Italy; 9Centro Parkinson e Disordini del Movimento, CTO, G Pini, Milano, Italy; 10Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; 11IRCCS Neuromed, Pozzilli, Isernia, Italy; 12Neurology Unit, Hospital Sant’Anna, Ferrara, Italy; 13Neurology Unit, Hospital dell’Angelo, Mestre, VE, Italy; 14Neurology Unit, Policlinico Universitario Monserrato, Cagliari, Italy; 15Medical Department, AbbVie Srl, Roma, Italy; 16Department of Neuroscience “Rita Levi Montalcini” University of Torino, Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza di Torino, Torino, ItalyCorrespondence: Gabriella MelziAbbVie Srl, Viale dell’Arte 25, Roma 00144, ItalyTel +39 06928924346Email gabriella.melzi@abbvie.comPurpose: The aim of this study was to assess the burden and the quality of life (QoL) perceived by caregivers assisting advanced Parkinson’s disease (PD) patients.Patients and Methods: Consecutive advanced PD patients treated with levodopa/carbidopa intestinal gel (LCIG) or continuous subcutaneous apomorphine infusion (CSAI) or care as usual (CU) and their care partners were recruited during routine visits according to a cross-sectional design. Caregiver’s distress was assessed by Zarit Burden Interview (ZBI) and a QoL survey to evaluate and understand the burden experienced by care partners during family and working activities.Results: A total of 126 patients (53 LCIG, 19 CSAI and 54 CU) and their care partners were enrolled. The ZBI score boxplot showed that LCIG and CU populations have a similar distribution (ZBI inter-quartile range [IQR] values respectively 18– 42 for LCIG and 19– 43 for CU group), while the CSAI group has a wider score range (IQR 16– 52). Caregivers assisting patients in treatment with LCIG have more time to perform family or household duties (p=0.0022), or to engage in leisure activities (p=0.0073) compared to CU, while no difference was found when compared to CSAI group. Approximately 50% of the care partners showed mood changes in the last 6 months and LCIG and CSAI had less impact on caregiver’s mood compared to CU. Patients treated with LCIG were more independent in taking a bath or shower without assistance and were more able to move and walk without assistance.Conclusion: Care partners of advanced PD patients treated with device-aided therapies have more time for their own life and a better perception of their QoL with a tendency to an improvement of mood compared with those of patients treated with CU.Keywords: advanced Parkinson’s disease, levodopa/carbidopa, intestinal infusion, caregiver burden, quality of life; QoL

Objectives: To explore the impact of sex and age on relationship between prodromal constipation and disease phenotype in Parkinson's disease at early stages. Methods: A total of 385 Parkinson's disease patients from the PRIAMO study were classified according to the presence of prodromal constipation and followed for 24 months. Multivariable mixed-effect models were applied. All analyses were performed separately for sex (64.1% men) and median age (different by sex: 67 years-old in men and 68 years-old in women). Results: As for sex, prodromal constipation was associated with greater odds of attention/memory complaints and apathy symptoms in women only. As for age, prodromal constipation was associated with lower cognitive and higher apathy scores in older patients only. Conclusions: Prodromal constipation anticipates lower cognitive performances and more severe apathy since the earliest stages in women and older patients. Sex- and age-related heterogeneity of prodromal markers of Parkinson's disease may impact disease phenotype. [ABSTRACT FROM AUTHOR]

AIMS: Since sleep bruxism (SB) is characterized by grinding and clenching of the teeth during sleep and could be an exaggerated manifestation of normal spontaneous rhythmic masticatory muscle activity, the aim of this study was to obtain a neurophysiological assessment of the excitability of the central jaw motor pathways in patients with signs and symptoms suggestive of SB. METHODS: A total of 30 subjects diagnosed with SB on the basis of self-report of tooth grinding were studied using the 'recovery cycle' of the masseter inhibitory reflex (MIR) elicited by electric and magnetic stimulation of the mental nerves and by recording the motor potentials evoked in masseter muscles by transcranial magnetic stimulation. Tests were done during daytime, when the subjects were awake. The data obtained were compared with data from a population of normal subjects. RESULTS: In the putative SB patients and in normal subjects, the MIRs evoked by single electric and magnetic stimuli were similar. With paired stimuli, the degree of suppression of the late silent period was significantly lower (P < .01) in the patients compared to normal subjects, particularly for magnetic stimuli, at various interstimulus intervals. No significant differences were found between the 2 groups of subjects in the masseter motor potentials evoked by transcranial magnetic stimulation. CONCLUSION: Although the data were only obtained during wakefulness in patients self-reporting signs and symptoms suggestive of SB, the findings suggest that an abnormal excitability of the central jaw motor pathways may be present in SB subjects. This increased excitability could derive from an impaired modulation of brainstem inhibitory circuits and not from altered cortical mechanisms. These results support the view that bruxism is mainly centrally mediated and that it involves subcortical structures. The study also indicates that use of the MIR elicited by the double-shock technique could be valuable in the evaluation of bruxism. [ABSTRACT FROM AUTHOR]

Introduction: Globus pallidus internus (GPi) deep brain stimulation (DBS) represents a validated, effective, and safe treatment for patients affected by generalized dystonia resistant to conservative treatment. Segmental and multisegmental dystonia have more recently been proposed as further indications for GPi DBS despite the lack of long-term homogenous follow-up. Here we present an original and detailed long-term follow-up (5 years) of a homogeneous population of 11 patients affected by segmental or multisegmental dystonia. Materials and Methods: Ten patients underwent bilateral GPi DBS electrode implantations under a Leksell stereotactic guide, with intraoperative neurophysiological monitoring. The follow-ups at 1, 3 and 5 years were collected using video-BFMDRS for motor and disability scores. The statistical analysis of the results is provided. Results: We reported a statistically significant improvement in motor and disability overall scores until 5 years after treatment. At the last follow-up, even the single motor subitems were statistically improved. Discussion: We observed a continuous and statistically significant improvement in all of the motor subitems and in the overall disability score until the 3-year follow-up. These results did not improve any further but they appeared steady at the last follow-up. We also report a significant improvement in the cranial-cervical subitems. Conclusions: GPi DBS should definitely be considered a safe and effective treatment also for segmental and multisegmental dystonia even in cases of relevant or prevalent cranial-cervical involvement. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

An in vitro method is described for inducing secretion in isolated monkey eccrine sweat glands by means of electrical field stimulation (EES). Ultrastructural analyses of these glands revealed unmyelinated nerve fibres surrounding the secretory coils. Numerous small clear vesicles, characteristic of cholinergic nerve terminals, were observed, along with a few which were large and dense-cored. EFS elicited an immediate secretory response which ceased abruptly upon termination of the current. The response was inhibited in a dose-dependent manner by atropine (lC5o I.5 × 10-9 mol/l). Although most glands were completely inhibited by atropine, a minor atropine insensitive component was operative in some preparations. Physostigmine (10 6mol/l) potentiated the response to subthreshold EFS. Lidocaine (3 × 10-4 mol/l) completely and reversibly blocked EFS but had no effect on methacholine(10-6 mol/l) induced secretion. These results confirm that eccrine sweat gland activation is predominantly via cholinergic pathways and that EFS of isolated glands may be a useful model to study the control of secretory function in normal and diseased states. [ABSTRACT FROM AUTHOR]

We describe a patient with Parkinson''s Disease who underwent bilateral subthalamic nucleus deep brain stimulation and later presented with episodes of aggressive behavior disorder with disturbed impulse control and an inability to control anger likely related to the deep brain stimulation ‘switch-on stimulation’. We hypothesize that increasing voltage intensity could influence neighboring passing fibers coming from basal limbic system that are involved in the regulation of affect and emotional behavior. We suggest investigating these neuropsychological disturbances considering their influence on quality of life after surgery. [Copyright &y& Elsevier]

We report the clinical and electrophysiological features of a patient who presented unilateral facial weakness as the initial manifestation of chronic inflammatory demyelinating polyradiculopathy (CIDP). A 40-year-old man presented facial numbness and weakness. Examination demonstrated severe unilateral facial weakness with no other cranial or segmental clinical abnormalities. Blink and jaw-jerk reflex latencies were prolonged bilaterally, with a reduction of R1 amplitude recording by the symptomatic side. Somatic neurophysiological examination showed slowing of motor nerve conduction velocities, lengthening of distal motor latencies, prolonged minimal F wave latencies and partial conduction motor block, without any unusual sensory electroneurophysiological abnormalities. Cerebrospinal fluid demonstrated an elevated protein level. After 1 week of intravenous immunoglobulin treatment, the symptoms and electrophysiological findings improved. This case could represent an unusual initial presentation of isolated cranial nerve involvement in asymptomatic CIDP. Blink reflexes may be a useful electrophysiological technique to assess for peripheral nerve demyelination in patients with suspected CIDP. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the correlations among event-related evoked potentials (ERPs), neuropsychological and neuroradiological parameters in multiple sclerosis (MS) patients. We studied 10 patients with definite MS (6 males, 4 females, average age 43.6, SD = 11.3), and moderate disability (EDSS 2.85, SD = 1.45; range: 1.0–6.0). All patients underwent standardized neuropsychological tests, P300 evoked potentials study, and MRI. Registration of ERPs (P300) was performed by random double auditory discrimination task paradigm, recorded through scalp electrodes placed at Fz, Cz and Pz and linked to the referred ears. Pearson bivariate correlation test was used to evaluate correlations among latency and amplitude of P300, neuropsychological tests, clinical (age, EDSS, illness length, relapses), and MRI (cortical atrophy, Apparent Diffusion Coefficient – ADC-maps) parameters. In our small series, latency of P300 was related to ADC of corticospinal tracts ( p = 0.001) and illness length ( p = 0.001), while no clear correlation between P300 and neuropsychological or other clinical parameters was found. We suggest that P300 and MRI ADC maps could be combined to give a numerical indirect parameter of disease progression. [ABSTRACT FROM AUTHOR]

To determine the reliability of intraoperative monitoring in neurosurgical operations using phase reversal of somatosensory evoked potentials (SEPs) and to examine the effect of tumour masses in the rolandic area on the waveform characteristics and feasibility of SEP. In the last 2 years, in 26 patients with tumours of the sensory-motor region, SEP phase reversal of N20-P20 was recorded from the exposed cortex, using a strip electrode. The intraoperative phase reversal of SEP was successful in 65,3% of patients with various morphologic characteristics results. In 11,5% of the patients N20 was not recorded, plus in 3,9%the typical phase inversion was questionable or missing, 30,8% of the cases. In those patients with clear localization of the central sulcus, it was possible to obtain motor evoked potentials in 89% of the cases, with maximal signal amplitude from arm and hand; on the other side, in patients where recording of a cortical potential inversion failed, only 50% showed clearly monitorable motor responses. The SEP phase reversal of N20-P20 is a simple, feasible and reliable technique, but it is not always clearly recognizable, in these latter cases the motor monitoring is frequently not easy through the strip electrodes. [ABSTRACT FROM AUTHOR]