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1. Trauma and amyotrophic lateral sclerosis: a case-control study from a population-based registry

Author

Pupillo, E., Messina, P., Logroscino, G., Zoccolella, S., Chio, A., Calvo, A., Corbo, M., Lunetta, C., Micheli, A., Millul, A., Vitelli, E., Beghi, E., Bissolati, M., Formaglio, F., Gerardi, F., Giussani, G., Maestri, E., Prelle, A., Protti, A., Riva, N., Santoro, D., Al-Chalabi, A., Berro, A. C., De Mercanti, S., Giacone, S., Ilardi, A., Hardiman, O., Capozzo, R., Ludolph, A., Mitchell, D., Preux, P. -M., Swingler, R., van den Berg, L., Alvisi, E., Cereda, C., Ceroni, M., Citterio, A., di Poggio, M. B., Caponnetto, C., Buzzi, P., Colombo, I., Cotelli, M. S., Filosto, M., Padovani, A., De Lodovici, L., Ferrarese, C., Tremolizzo, L., Fetoni, V., Palazzini, E., Guaita, M. C., Perrone, P., Secchi, P., Lorusso, L., Sidoti, V., Perini, M., Tavernelli, F., Rigamonti, A., Pupillo, E, Messina, P, Logroscino, G, Zoccolella, S, Chiò, A, Calvo, A, Corbo, M, Lunetta, C, Micheli, A, Millul, A, Vitelli, E, Beghi, E, Bissolati, M, Formaglio, F, Gerardi, F, Giussani, G, Maestri, E, Prelle, A, Protti, A, Riva, N, Santoro, D, Al Chalabi, A, Berro, A, De Mercanti, S, Giacone, S, Ilardi, A, Hardiman, O, Capozzo, R, Ludolph, A, Mitchell, D, Preux, P, Swingler, R, van den Berg, L, Alvisi, E, Cereda, C, Ceroni, M, Citterio, A, di Poggio, M, Caponnetto, C, Buzzi, P, Colombo, I, Cotelli, M, Filosto, M, Padovani, A, De Lodovici, L, Ferrarese, C, Tremolizzo, L, Fetoni, V, Palazzini, E, Guaita, M, Perrone, P, Secchi, P, Lorusso, L, Sidoti, V, Perini, M, Tavernelli, F, and Rigamonti, A

Subjects
Male, ALS, trauma, risk, medicine.medical_specialty, Pediatrics, Epidemiology, Population, Poison control, Trauma, 03 medical and health sciences, 0302 clinical medicine, Injury prevention, Humans, Medicine, Registries, 030212 general & internal medicine, Amyotrophic lateral sclerosis, education, Aged, education.field_of_study, business.industry, Amyotrophic Lateral Sclerosis, Case-control study, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Risk factors, Neurology, Case-Control Studies, Multivariate Analysis, Physical therapy, Wounds and Injuries, Population study, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

BACKGROUND AND PURPOSE: Published reports on the association between amyotrophic lateral sclerosis (ALS) and trauma are controversial suggesting the need for a new case-control study done in a large population. METHODS: A case-control study was undertaken in Italy to assess this association. Cases were patients with newly diagnosed ALS from four population-based registries. For each case, two hospital controls were selected, matched for age, sex, and province of residence, one with a neurological (non-degenerative) disease and one with a non-neurological disease (other than orthopedic or surgical). Traumatic events (defined as accidental events causing injuries requiring medical care) were recorded with details on type, site, timing, severity, and complications. The risks were assessed as odds ratios (ORs) with 95% confidence intervals (CI), crude and adjusted for age, sex, education, interviewee (patient or surrogate), physical activity, smoking, alcohol, and coffee. RESULTS: The study population comprised 377 patients in each of the three groups. One or more traumatic events were reported by 225 cases (59.7%), 191 neurological controls (50.7%), and 179 non-neurological controls (47.5%) (P

Published
2012

2. Coffee and Amyotrophic Lateral Sclerosis: A Possible Preventive Role

Author

Beghi, E., Pupillo, E., Messina, P., Giussani, G., Chio, A., Zoccolella, S., Moglia, C., Corbo, M., Logroscino, G., Al-Chalabi, A., Hardiman, O., Ludolph, A., Mitchell, D., Preux, P. -M., Swingler, R., Traynor, B. J., Alvisi, E., Cereda, C., Ceroni, M., Citterio, A., di Poggio, M. B., Caponnetto, C., Bissolati, M., Buzzi, P., Colombo, I., Formaglio, F., Lunettam, C., Maestri, E., Millul, A., Prelle, A., Protti, A., Riva, N., Santoro, D., Capozzo, R., Berro, A. C., Cammarosano, S., Giacone, S., Ilardi, A., Cotelli, M. S., Filosto, M., Micheli, A., Padovani, A., De Lodovici, L., Ferrarese, C., Tremolizzo, L., Fetoni, V., Palazzini, E., Guaita, M. C., Perrone, P., Secchi, P., Lorusso, L., Sidoti, V., Perini, M., Tavernelli, F., Rigamonti, A., Vitelli, E., Beghi, E, Pupillo, E, Messina, P, Giussani, G, Chiò, A, Zoccolella, S, Moglia, C, Corbo, M, Logroscino, G, Ferrarese, C, and Tremolizzo, L

Subjects
amyotrophic lateral sclerosis, coffee, motor neuron disease, Adult, Male, medicine.medical_specialty, Epidemiology, Coffee, Young Adult, Risk Factors, Internal medicine, Coffee intake, medicine, Odds Ratio, Humans, Young adult, Amyotrophic lateral sclerosis, Inverse correlation, Aged, Aged, 80 and over, business.industry, Risk Factor, Amyotrophic Lateral Sclerosis, Case-control study, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Surgery, Italy, Case-Control Studies, Cohort, Female, business, Case-Control Studie, Human, Amyotrophic Lateral Sclerosi
Abstract

The relation between coffee intake and risk of amyotrophic lateral sclerosis (ALS) was investigated in 377 newly diagnosed ALS patients from 4 Italian population-based registries in the European ALS Consortium (EURALS Group) (2007-2010). For each patient, 2 age- and sex-matched hospital controls were selected, one from a neurology department and one from a nonneurologic department. Two additional healthy control groups were identified from local general practitioners' (GPs') lists (n = 99) and residents of the same area as a cancer cohort (n = 7,057). Coffee intake was defined in terms of status (ever consuming coffee daily for ≥6 months vs. never), duration, and history (never, former, or current). Ever coffee drinkers comprised 74.7% of ALS patients, 80.4% of neurologic controls, 85.6% of nonneurologic controls (P = 0.0004), 88.9% of GP controls (P = 0.0038), and 86.0% of cancer cohort controls (P < 0.0001). Current coffee drinkers comprised 60.2% of ALS patients, 70.2% of neurologic controls (P = 0.0294), 76.4% of nonneurologic controls (P < 0.0001), and 82.3% of GP controls (P = 0.0002); duration of intake was ≥30 years for 62.3%, 67.7%, 74.7%, and 72.6%. ALS patients had lower lifetime coffee exposure: Odds ratios were 0.7 (95% confidence interval (CI): 0.5, 1.1), 0.6 (95% CI: 0.4, 0.8), and 0.4 (95% CI: 0.2, 0.9) in comparison with neurologic, nonneurologic, and GP controls, respectively. In current (vs. never) coffee drinkers, odds ratios were 0.7 (95% CI: 0.5, 1.0), 0.5 (95% CI: 0.3, 0.7), and 0.4 (95% CI: 0.2, 0.8), respectively. These findings provide epidemiologic evidence of an inverse correlation between coffee intake and ALS risk.

Published
2011

3. Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Author

Castelnuovo, Gianluca, Giusti, Emanuele M., Manzoni, Gian Mauro, Saviola, Donatella, Gatti, Arianna, Gabrielli, Samantha, Lacerenza, Marco, Pietrabissa, Giada, Cattivelli, Roberto, Spatola, Chiara A. M., Corti, Stefania, Novelli, Margherita, Villa, Valentina, Cottini, Andrea, Lai, Carlo, Pagnini, Francesco, Castelli, Lorys, Tavola, Mario, Torta, Riccardo, Arreghini, Marco, Zanini, Loredana, Brunani, Amelia, Capodaglio, Paolo, D'aniello, Guido E., Scarpina, Federica, Brioschi, Andrea, Priano, Lorenzo, Mauro, Alessandro, Riva, Giuseppe, Repetto, Claudia, Regalia, Camillo, Molinari, Enrico, Notaro, Paolo, Paolucci, Stefano, Sandrini, Giorgio, Simpson, Susan G., Wiederhold, Brenda, Tamburin, Stefano, Agostini, Michela, Alfonsi, Enrico, Aloisi, Anna Maria, Alvisi, Elena, Aprile, Irene, Armando, Michela, Avenali, Micol, Azicnuda, Eva, Barale, Francesco, Bartolo, Michelangelo, Bergamaschi, Roberto, Berlangieri, Mariangela, Berlincioni, Vanna, Berliocchi, Laura, Berra, Eliana, Berto, Giulia, Bonadiman, Silvia, Bonazza, Sara, Bressi, Federica, Brugnera, Annalisa, Brunelli, Stefano, Buzzi, Maria Gabriella, Cacciatori, Carlo, Calvo, Andrea, Cantarella, Cristina, Caraceni, Augusto, Carone, Roberto, Carraro, Elena, Casale, Roberto, Castellazzi, Paola, Castino, Adele, Cerbo, Rosanna, Chiã², Adriano, Ciotti, Cristina, Cisari, Carlo, Coraci, Daniele, Toffola, Elena Dalla, Defazio, Giovanni, De Icco, Roberto, Del Carro, Ubaldo, Dell'isola, Andrea, De Tanti, Antonio, D'ippolito, Mariagrazia, Fazzi, Elisa, Ferrari, Adriano, Ferrari, Sergio, Ferraro, Francesco, Formaglio, Fabio, Formisano, Rita, Franzoni, Simone, Gajofatto, Francesca, Gandolfi, Marialuisa, Gardella, Barbara, Geppetti, Pierangelo, Giammã², Alessandro, Gimigliano, Raffaele, Greco, Elena, Ieraci, Valentina, Invernizzi, Marco, Jacopetti, Marco, La Cesa, Silvia, Lobba, Davide, Magrinelli, Francesca, Mandrini, Silvia, Manera, Umberto, Marchettini, Paolo, Marchioni, Enrico, Mariotto, Sara, Martinuzzi, Andrea, Masciullo, Marella, Mezzarobba, Susanna, Miotti, Danilo, Modenese, Angela, Molinari, Marco, Monaco, Salvatore, Morone, Giovanni, Nappi, Rossella, Negrini, Stefano, Pace, Andrea, Padua, Luca, Pagliano, Emanuela, Palmerini, Valerio, Pazzaglia, Costanza, Pecchioli, Cristiano, Picelli, Alessandro, Porro, Carlo Adolfo, Porru, Daniele, Romano, Marcello, Roncari, Laura, Rosa, Riccardo, Saccavini, Marsilio, Sacerdote, Paola, Schenone, Angelo, Schweiger, Vittorio, Scivoletto, Giorgio, Smania, Nicola, Solaro, Claudio, Spallone, Vincenza, Springhetti, Isabella, Tassorelli, Cristina, Tinazzi, Michele, Togni, Rossella, Torre, Monica, Traballesi, Marco, Tramontano, Marco, Truini, Andrea, Tugnoli, Valeria, Turolla, Andrea, Vallies, Gabriella, Verzini, Elisabetta, Vottero, Mario, Zerbinati, Paolo, Castelnuovo, Gianluca, Giusti, Emanuele M., Manzoni, Gian Mauro, Saviola, Donatella, Gatti, Arianna, Gabrielli, Samantha, Lacerenza, Marco, Pietrabissa, Giada, Cattivelli, Roberto, Spatola, Chiara A. M., Corti, Stefania, Novelli, Margherita, Villa, Valentina, Cottini, Andrea, Lai, Carlo, Pagnini, Francesco, Castelli, Lory, Tavola, Mario, Torta, Riccardo, Arreghini, Marco, Zanini, Loredana, Brunani, Amelia, Capodaglio, Paolo, D'Aniello, Guido E., Scarpina, Federica, Brioschi, Andrea, Priano, Lorenzo, Mauro, Alessandro, Riva, Giuseppe, Repetto, Claudia, Regalia, Camillo, Molinari, Enrico, Notaro, Paolo, Paolucci, Stefano, Sandrini, Giorgio, Simpson, Susan G., Wiederhold, Brenda, Tamburin, Stefano, Agostini, Michela, Alfonsi, Enrico, Aloisi, Anna Maria, Alvisi, Elena, Aprile, Irene, Armando, Michela, Avenali, Micol, Azicnuda, Eva, Barale, Francesco, Bartolo, Michelangelo, Bergamaschi, Roberto, Berlangieri, Mariangela, Berlincioni, Vanna, Berliocchi, Laura, Berra, Eliana, Berto, Giulia, Bonadiman, Silvia, Bonazza, Sara, Bressi, Federica, Brugnera, Annalisa, Brunelli, Stefano, Buzzi, Maria Gabriella, Cacciatori, Carlo, Calvo, Andrea, Cantarella, Cristina, Caraceni, Augusto, Carone, Roberto, Carraro, Elena, Casale, Roberto, Castellazzi, Paola, Castino, Adele, Cerbo, Rosanna, Chiã², Adriano, Ciotti, Cristina, Cisari, Carlo, Coraci, Daniele, Toffola, Elena Dalla, Defazio, Giovanni, De Icco, Roberto, Del Carro, Ubaldo, Dell'Isola, Andrea, De Tanti, Antonio, D'Ippolito, Mariagrazia, Fazzi, Elisa, Ferrari, Adriano, Ferrari, Sergio, Ferraro, Francesco, Formaglio, Fabio, Formisano, Rita, Franzoni, Simone, Gajofatto, Francesca, Gandolfi, Marialuisa, Gardella, Barbara, Geppetti, Pierangelo, Giammã², Alessandro, Gimigliano, Raffaele, Greco, Elena, Ieraci, Valentina, Invernizzi, Marco, Jacopetti, Marco, La Cesa, Silvia, Lobba, Davide, Magrinelli, Francesca, Mandrini, Silvia, Manera, Umberto, Marchettini, Paolo, Marchioni, Enrico, Mariotto, Sara, Martinuzzi, Andrea, Masciullo, Marella, Mezzarobba, Susanna, Miotti, Danilo, Modenese, Angela, Molinari, Marco, Monaco, Salvatore, Morone, Giovanni, Nappi, Rossella, Negrini, Stefano, Pace, Andrea, Padua, Luca, Pagliano, Emanuela, Palmerini, Valerio, Pazzaglia, Costanza, Pecchioli, Cristiano, Picelli, Alessandro, Porro, Carlo Adolfo, Porru, Daniele, Romano, Marcello, Roncari, Laura, Rosa, Riccardo, Saccavini, Marsilio, Sacerdote, Paola, Schenone, Angelo, Schweiger, Vittorio, Scivoletto, Giorgio, Smania, Nicola, Solaro, Claudio, Spallone, Vincenza, Springhetti, Isabella, Tassorelli, Cristina, Tinazzi, Michele, Togni, Rossella, Torre, Monica, Traballesi, Marco, Tramontano, Marco, Truini, Andrea, Tugnoli, Valeria, Turolla, Andrea, Vallies, Gabriella, Verzini, Elisabetta, Vottero, Mario, Zerbinati, Paolo, Castelnuovo G., Giusti E.M., Manzoni G.M., Saviola D., Gatti A., Gabrielli S., Lacerenza M., Pietrabissa G., Cattivelli R., Spatola C.A.M., Corti S., Novelli M., Villa V., Cottini A., Lai C., Pagnini F., Castelli L., Tavola M., Torta R., Arreghini M., Zanini L., Brunani A., Capodaglio P., D'Aniello G.E., Scarpina F., Brioschi A., Priano L., Mauro A., Riva G., Repetto C., Regalia C., Molinari E., Notaro P., Paolucci S., Sandrini G., Simpson S.G., Wiederhold B., Tamburin S., Agostini M., Alfonsi E., Aloisi A.M., Alvisi E., Aprile I., Armando M., Avenali M., Azicnuda E., Barale F., Bartolo M., Bergamaschi R., Berlangieri M., Berlincioni V., Berliocchi L., Berra E., Berto G., Bonadiman S., Bonazza S., Bressi F., Brugnera A., Brunelli S., Buzzi M.G., Cacciatori C., Calvo A., Cantarella C., Caraceni A., Carone R., Carraro E., Casale R., Castellazzi P., Castino A., Cerbo R., Chio A., Ciotti C., Cisari C., Coraci D., Toffola E.D., Defazio G., De Icco R., Del Carro U., Dell'Isola A., De Tanti A., D'Ippolito M., Fazzi E., Ferrari A., Ferrari S., Ferraro F., Formaglio F., Formisano R., Franzoni S., Gajofatto F., Gandolfi M., Gardella B., Geppetti P., Giammo A., Gimigliano R., Greco E., Ieraci V., Invernizzi M., Jacopetti M., La Cesa S., Lobba D., Magrinelli F., Mandrini S., Manera U., Marchettini P., Marchioni E., Mariotto S., Martinuzzi A., Masciullo M., Mezzarobba S., Miotti D., Modenese A., Molinari M., Monaco S., Morone G., Nappi R., Negrini S., Pace A., Padua L., Pagliano E., Palmerini V., Pazzaglia C., Pecchioli C., Picelli A., Porro C.A., Porru D., Romano M., Roncari L., Rosa R., Saccavini M., Sacerdote P., Schenone A., Schweiger V., Scivoletto G., Smania N., Solaro C., Spallone V., Springhetti I., Tassorelli C., Tinazzi M., Togni R., Torre M., Traballesi M., Tramontano M., Truini A., Tugnoli V., Turolla A., Vallies G., Verzini E., Vottero M., Zerbinati P., Giusti, Emanuele M, and Simpson, Susan G

Subjects
medicine.medical_specialty, lcsh:BF1-990, Psychological intervention, Settore M-PSI/08 - PSICOLOGIA CLINICA, Review, 03 medical and health sciences, 0302 clinical medicine, psychological distress, health psychology, Chronic pain, Clinical psychology, Health psychology, Neurorehabilitation, Pain management, Psychology (all), medicine, Psychology, psychology (all), 030212 general & internal medicine, General Psychology, neurorehabilitation, business.industry, chronic pain, clinical psychology, pain management, medicine.disease, depression, pain Treatment, Settore MED/34 - Medicina Fisica e Riabilitativa, lcsh:Psychology, Migraine, Physical therapy, Anxiety, Pain catastrophizing, medicine.symptom, business, Psychosocial, 030217 neurology & neurosurgery, clinical psychology, health psychology
Abstract

Background: In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics. Objectives: To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation. Methods: Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation. Results: The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool. Conclusions: Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions. Background: In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics. Objectives: To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation. Methods: Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation. Results: The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool. Conclusions: Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions.

Published
2016
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4. Evidence of peripheral axonal neuropathy in primary restless legs syndrome

Author

Luigi Ferini-Strambi, Salvatore Smirne, Raffaello Nemni, Angelo Quattrini, Marco Lacerenza, Sandro Iannaccone, Paolo Marchettini, S. Palazzi, Fabio Formaglio, Marco Zucconi, Iannaccone, S, Zucconi, M, Marchettini, P, FERINI STRAMBI, Luigi, Nemni, R, Quattrini, A, Palazzi, S, Lacerenza, M, Formaglio, F, and Smirne, S.

Subjects
Adult, Male, medicine.medical_specialty, Polysomnography, Sural nerve, Neurological examination, Neurological disorder, Nerve conduction velocity, Restless Legs Syndrome, mental disorders, medicine, Humans, Peripheral Nerves, Restless legs syndrome, Age of Onset, Axon, Aged, medicine.diagnostic_test, Electromyography, Peripheral Nervous System Diseases, Thermal Conductivity, Middle Aged, medicine.disease, Axons, Surgery, Electrophysiology, medicine.anatomical_structure, Peripheral neuropathy, Neurology, Sensory Thresholds, Anesthesia, Peripheral nervous system, Female, Neurology (clinical), Psychology
Abstract

Restless legs syndrome (RLS) is a well-defined clinical entity characterized by an unpleasant creeping sensation arising in the legs with an irresistible need to move them. The trouble is more pronounced when the affected people lie in a prolonged rest position and try to fall asleep. It is known that RLS may be consequent to systemic disorders and to diseases affecting the central or peripheral nervous system. The International Classification of Sleep Disorders states that peripheral neuropathy should be ruled out by medical history and clinical grounds before diagnosing primary RLS (pRLS). The present study extended peripheral nerve investigation in eight consecutive pRLS patients with normal neurological examination results and showed that all patients exhibited two or more electrical, psychophysiological, and/or morphological features of peripheral axonal neuropathy. Morphometric analysis of sural nerve showed a significant reduction in myelinated fiber density and g ratio (axon diameter/fiber diameter) in the pRLS group compared with eight control biopsy specimens. These results suggest that axonal neuropathy is often present in patients with RLS. A comprehensive peripheral nerve investigation should be considered in RLS patients.

Published
1995
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5. Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin

Author

U. Del Carro, Mauro Comola, Paolo Morana, Nilo Riva, Federica Cerri, Stefano Amadio, Giancarlo Comi, Simonetta Gerevini, Fabio Formaglio, Riva, N, Morana, P, Cerri, F, Gerevini, S, Amadio, S, Formaglio, F, Comi, Giancarlo, Comola, M, and DEL CARRO, U.

Subjects
medicine.medical_specialty, Past medical history, Nerve root, Lumbar plexus, business.industry, Stupor, Poison control, medicine.disease, Surgery, Psychiatry and Mental health, Lumbar, Anesthesia, medicine, Letters, Neurology (clinical), medicine.symptom, Paraplegia, business, Rhabdomyolysis
Abstract

We report a patient who developed acute myelopathy after intranasal insufflation of amphetamines and heroin. The functional prognosis was very poor; after 4 months, she remained paraplegic. MRI imaging showed selective T2 hyperintensity and intense enhancement confined to the spinal anterior horns and lumbar nerve roots and plexus. This unique MRI pattern, together with neurophysiological data, suggests that the pathological process at the first primary affected spinal anterior horns (SAH), conditioning motoneuron cell death, and then nerve roots and lumbar plexus as a consequence of wallerian degeneration A 17-year-old girl was admitted to the emergency department in a drowsy state and unable to walk after an overdose of intranasal insufflated heroin and amphetamines. After a few hours, drowsiness progressed to stupor, and progressive weakness in all four limbs, mainly involving the lower limbs, developed. At that time, laboratory data showed massive rhabdomyolysis (creatine phosphokinase 36 880 mg/dl) with acute renal failure (ARF), and hepatic failure; medical therapy was promptly started. The patient’s past medical history was unremarkable except for habitual use of amphetamines (ecstasy) and cannabinoids since the age of 12 years. The previous week she had insufflated heroin about once a day; the previous night she reported a double dose of heroin consumption, and a high dose (approximately 1 g) of intranasal insufflation of amphetamines. The next day the …

Published
2007
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