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4. Exploring Cardiovascular Autonomic Function before and after Chronic Deep Brain Stimulation in Parkinson's Disease.

Author

Cani, Ilaria, Giannini, Giulia, Guaraldi, Pietro, Barletta, Giorgio, Sambati, Luisa, Baldelli, Luca, Cortelli, Pietro, and Calandra‐Buonaura, Giovanna

Subjects
SUBTHALAMIC nucleus, DEEP brain stimulation, PARKINSON'S disease, BRAIN stimulation, ORTHOSTATIC hypotension, BLOOD pressure, DOPA
Abstract

Background: Blood pressure control in Parkinson's disease (PD) under subthalamic deep brain stimulation (STN‐DBS) is influenced by several intertwined aspects, including autonomic failure and levodopa treatment. Objective: To evaluate the effect of chronic STN‐DBS, levodopa, and their combination on cardiovascular autonomic functions in PD. Methods: We performed cardiovascular reflex tests (CRTs) before and 6‐months after STN‐DBS surgery in 20 PD patients (pre‐DBS vs. post‐DBS). CRTs were executed without and with medication (med‐OFF vs. med‐ON). Results: CRT results and occurrence of neurogenic orthostatic hypotension (OH) did not differ between pre‐ and post‐DBS studies in med‐OFF condition. After levodopa intake, the BP decrease during HUTT was significantly greater compared to med‐OFF, both at pre‐DBS and post‐DBS evaluation. Levodopa‐induced OH was documented in 25% and 5% of patients in pre‐DBS/med‐ON and post‐DBS/med‐ON study. Conclusion: Chronic stimulation did not influence cardiovascular responses, while levodopa exerts a relevant hypotensive effect. The proportion of patients presenting levodopa‐induced OH decreases after STN‐DBS surgery. [ABSTRACT FROM AUTHOR]

Published
2024
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5. The Degree of Cardiovascular Autonomic Dysfunction is not Different in GBA-Related and Idiopathic Parkinson’s Disease Patients: A Case-Control Instrumental Evaluation

Author

Giannini, Giulia, primary, Minardi, Raffaella, additional, Barletta, Giorgio, additional, Cani, Ilaria, additional, Cecere, Annagrazia, additional, Baldelli, Luca, additional, Fiorentino, Alessia, additional, Guaraldi, Pietro, additional, Sambati, Luisa, additional, Capellari, Sabina, additional, Cortelli, Pietro, additional, Carelli, Valerio, additional, and Calandra-Buonaura, Giovanna, additional

Published
2024
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8. Levodopa‐induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure.

Author

Cani, Ilaria, Guaraldi, Pietro, Giannini, Giulia, Sambati, Luisa, Barletta, Giorgio, Cortelli, Pietro, and Calandra‐Buonaura, Giovanna

Subjects
ORTHOSTATIC hypotension, PARKINSONIAN disorders, LOGISTIC regression analysis, BLOOD pressure, VALSALVA'S maneuver
Abstract

Background and purpose: Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect. Methods: We evaluated the cardiovascular effect of LD performing head‐up tilt test (HUTT) before and 60 min after 100/25 mg LD/dopa‐decarboxylase inhibitor (pre‐LD vs. post‐LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD‐induced orthostatic hypotension (OH) were assessed by logistic regression analysis. Results: Basal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post‐LD HUTT, BP drop and HR increase were significantly greater than at pre‐LD HUTT. Thirty‐eight percent of patients had OH at post‐LD HUTT compared to 22% of patients presenting OH at pre‐LD HUTT (p < 0.001). Risk factors for LD‐induced/worsened OH were pre‐LD OH (odds ratio [OR] = 36, 95% confidence interval [CI] = 10–131), absence of overshoot at Valsalva maneuver (OR = 9, 95% CI = 4–20), and pathological Valsalva ratio (OR = 6, 95% CI = 2–15). Conclusions: LD administration caused/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD‐induced OH. In clinical practice, LD‐induced OH could represent a red flag for cardiovascular autonomic failure. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Sleep-dependent changes in the coupling between heart period and blood pressure in human subjects

Author

Silvani, Alessandro, Grimaldi, Daniela, Vandi, Stefano, Barletta, Giorgio, Vetrugno, Roberto, Provini, Federica, Pierangeli, Giulia, Berteotti, Chiara, Montagna, Pasquale, Zoccoli, Giovanna, and Cortelli, Pietro

Subjects
Blood pressure -- Measurement, Blood pressure -- Methods, Heart beat -- Measurement, Cardiovascular system -- Research, Sleep -- Physiological aspects, Biological sciences
Abstract

We investigated whether in human subjects, the pattern of coupling between the spontaneous fluctuations of heart period (HP) and those of systolic blood pressure (SBP) differs among wake-sleep states. Polysomnographic recordings and finger blood pressure measurements were performed for 48 h in 15 nonobese adults without sleep-disordered breathing. The cross-correlation function (CCF) between the fluctuations of HP and SBP at frequencies feedback and feed-forward mechanisms; baroreflex; central autonomic commands; cross-correlation analysis; sequence technique

Published
2008

28. A longitudinal study of a family with adult-onset autosomal dominant leukodystrophy: Clinical, autonomic and neuropsychological findings

Author

TERLIZZI, ROSSANA, CALANDRA BUONAURA, GIOVANNA, ZANIGNI, STEFANO, BARLETTA, GIORGIO, CAPELLARI, SABINA, CONTIN, MANUELA MARIA ANTONIA, TONON, CATERINA, LIGUORI, ROCCO, LODI, RAFFAELE, CORTELLI, PIETRO, Guaraldi, Pietro, Donadio, Vincenzo, Cason, Ernesto, Poda, Roberto, Sambati, Luisa, Gallassi, Roberto, SAMBATI, LUISA, Terlizzi, Rossana, Calandra-Buonaura, Giovanna, Zanigni, Stefano, Barletta, Giorgio, Capellari, Sabina, Guaraldi, Pietro, Donadio, Vincenzo, Cason, Ernesto, Contin, Manuela, Poda, Roberto, Tonon, Caterina, Sambati, Luisa, Gallassi, Roberto, Liguori, Rocco, Lodi, Raffaele, and Cortelli, Pietro

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Pathology, Pelizaeus-Merzbacher Disease, Neurological disorder, Autonomic disorder, Neuropsychological Tests, Adult onset, 03 medical and health sciences, Cellular and Molecular Neuroscience, Orthostatic vital signs, Executive Function, 0302 clinical medicine, Internal medicine, Gene Duplication, medicine, Humans, Longitudinal Studies, Lamin B1, Cognitive deficit, Lamin Type B, Endocrine and Autonomic Systems, business.industry, Leukodystrophy, Microneurography, Middle Aged, medicine.disease, Clonidine, Pedigree, Autonomic nervous system, 030104 developmental biology, Autonomic Nervous System Diseases, Autonomic nervous system disease, Cardiology, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background and purpose Adult-onset autosomal dominant leukodystrophy (ADLD) is a rare progressive neurological disorder caused by Lamin B1 duplication (LMNB1). Our aim was to investigate longitudinally the pattern of the autonomic dysfunction and the degree of neuropsychological involvement. Methods Three related ADLD patients and one asymptomatic carrier of LMNB1 duplication underwent a standardized evaluation of autonomic nervous system, including cardiovascular reflexes, pharmacological testing, microneurography, skin biopsy, Metaiodobenzylguanidine scintigraphy and a complete neuropsychological battery. Results An early neurogenic orthostatic hypotension was detected in all patients and confirmed by a low rise in noradrenaline levels on Tilt Test. However infusion of noradrenaline resulted in normal blood pressure rise as well as the infusion of clonidine. At the insulin tolerance test the increase in adrenaline resulted pathological in two out three patients. Microneurography failed to detect muscle sympathetic nerve activity bursts. Skin biopsy revealed a poor adrenergic innervation, while cardiac sympathetic nerves were normal. None of ADLD patients showed a global cognitive deficit but a selective impairment in the executive functions. Conclusion Autonomic disorder in ADLD involves selectively the postganglionic sympathetic system including the sympatho-adrenal response. Cognitive involvement consisting in an early impairment of executive tasks that might precede brain MR abnormalities.

Published
2016

29. Iodine-123-meta-iodobenzylguanidine Myocardial Scintigraphy in Isolated Autonomic Failure: Potential Red Flag for Future Multiple System Atrophy

Author

Baschieri, Francesca, Calandra-Buonaura, Giovanna, Cecere, Annagrazia, Barletta, Giorgio, Contin, Manuela, Parchi, Piero, and Cortelli, Pietro

Subjects
orthostatic hypotension, autonomic failure, Iodine-123-meta-iodobenzylguanidine myocardial scintigraphy, stomatognathic system, nervous system, Parkinson’s disease, multiple system atrophy, nervous system diseases, Neuroscience
Abstract

Pure autonomic failure is challenging as it can be the presenting feature of a central nervous system syncleinopathy such as Parkinson’s disease (PD) or multiple system atrophy (MSA). Because the prognosis of MSA and PD is so different, predictive features for a possible conversion can be extremely valuable. In this paper, we report three cases (two with autopsy-proven diagnosis) that had isolated AF for many years before converting to MSA or PD. Of all the tests that were performed during the premotor stage, Iodine-123-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy was predictive of the conversion to MSA. We suggest that MIBG myocardial scintigraphy, when performed in patients with isolated AF, may be a valuable predictor of conversion to MSA. On the contrary, the role of such test in parkinsonian patients irrespective of the presence of AF is still to be clarified.

Published
2017
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30. The Bologna motor and non-motor prospective study on parkinsonism at onset (BoProPark): study design and population.

Author

Calandra-Buonaura, Giovanna, Sambati, Luisa, Baschieri, Francesca, Vitiello, Maria, Contin, Manuela, Tonon, Caterina, Capellari, Sabina, Provini, Federica, Cortelli, Pietro, on behalf of the BoProPark Study Group, Barletta, Giorgio, Caltabiano, Giuseppe, Cecere, Annagrazia, Gallassi, Roberto, Giannini, Giulia, Guaraldi, Pietro, Lodi, Raffaele, Lopane, Giovanna, Manners, David Neil, and Martinelli, Paolo

Subjects
PARKINSON'S disease, LONGITUDINAL method, SYMPTOMS, DISEASE duration
Abstract

Objective: The Bologna motor and non-motor prospective study on parkinsonism at onset (BoProPark) was designed to prospectively characterize motor and non-motor features in patients with a progressive neurodegenerative disease starting with parkinsonism since early disease stage and to investigate their diagnostic and prognostic role in the differential diagnosis of Parkinson's disease from atypical parkinsonisms. The aim of this paper is to describe the method and population of the BoProPark study. Methods: Patients referred to our Department with parkinsonism within 3 years from motor onset were recruited. Secondary causes of parkinsonism were excluded. Each patient underwent a comprehensive evaluation of motor and non-motor symptoms, assessed by means of quantitative, objective instrumental tests in addition to scales and questionnaires. The evaluations were performed at enrolment (T0), after 16 months (T1) and after 5 years (T2). Diagnoses were made according to consensus criteria. Results: We recruited 150 patients, with mean age 61.5 ± 9.8 years and mean disease duration 20 ± 9 months. H&Y stage was 1 in 47.3% and 2 in 46.7% of cases. Mean UPDRS-III was 17.7 ± 9.2. Fifty-four patients were on dopaminergic treatment with median levodopa equivalent daily dose (LEDD) of 200 mg. Conclusions: We expect that the prospective nature of the BoProPark study as well as the comprehensive, instrumental evaluation of motor and non-motor symptoms in patients with parkinsonism will provide important new insights for both clinical practice and research. Our data could be used for comparison with other cohorts and shared with national and international collaborators to develop new innovative projects. [ABSTRACT FROM AUTHOR]

Published
2020
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34. A longitudinal study of a family with adult-onset autosomal dominant leukodystrophy: Clinical, autonomic and neuropsychological findings

Author

Terlizzi, Rossana, primary, Calandra-Buonaura, Giovanna, additional, Zanigni, Stefano, additional, Barletta, Giorgio, additional, Capellari, Sabina, additional, Guaraldi, Pietro, additional, Donadio, Vincenzo, additional, Cason, Ernesto, additional, Contin, Manuela, additional, Poda, Roberto, additional, Tonon, Caterina, additional, Sambati, Luisa, additional, Gallassi, Roberto, additional, Liguori, Rocco, additional, Lodi, Raffaele, additional, and Cortelli, Pietro, additional

Published
2016
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37. Monitoraggio clinico del Tilt Test: Task Force monitor e analisi HRV (Heart rate Variability)

Author

CORAZZA, IVAN, BARLETTA, GIORGIO, CORTELLI, PIETRO, ZANNOLI, ROMANO, M. C. Tozzi, L. Soliera, I. Corazza, M.C. Tozzi, G. Barletta, L. Soliera, P. Cortelli, and R. Zannoli

Abstract

Nello studio della sincope, l’analisi spettrale della variabilità della frequenza cardiaca (HRV) mediante analisi autoregressiva (AR) durante tilt test, rappresenta un ottimo strumento per ottenere informazioni sull’equilibrio simpatico-vagale. Il tilt test viene eseguito sia con sistemi di monitoraggio e acquisizione già validati che con nuove strumentazioni come il Task Force Monitor -TFM (CNSystems Medizintechnik GmbH). Le apparecchiature già validate (Poligrafo “Grass”- Light® - GRPSD, Spark S.r.l.) permettono di gestire completamente l’analisi spettrale mediante procedure lunghe e complesse. Le nuove strumentazioni elaborano il segnale ECG in tempo reale ma utilizzano un software che non dà la possibilità di gestire e controllare totalmente le procedure di analisi. L’obiettivo del presente lavoro è confrontare i risultati dell’analisi HRV durante il tilt test, ottenuti automaticamente col TFM e quelli ottenuti con il GRPSD verificando la stazionarietà del segnale ECG, scegliendo il modello AR appropriato e discriminando la componente respiratoria. 9 soggetti (5 gruppo controllo- 4 gruppo vasovagale) sono stati sottoposti a tilt test e monitorati con TFM. Il segnale ECG è stato poi esportato in formato testo per essere analizzabile anche dal GRPSD. Sono state analizzate le fasi di clinostatismo, ortostatismo e post- tilt ed è stata calcolata l’area della componente LF (0,04 Hz- 0,15 Hz) e della componente HF (0,15 Hz – 0,4 Hz) con entrambi i sistemi. E’ stata valutata la concordanza dei rapporti (LF/HF)tfm e (LF/HF)grpsd.. L’analisi statistica ha evidenziato una concordanza tra i rapporti LF/HF nell’ 82% dei casi. Nel restante 18%, risultano differenze significative dovute alla scelta sbagliata dell’ordine del modello AR da parte del TFM, che non discrimina artefatti respiratori, aritmie e non verifica la stazionarietà del segnale.

Published
2007

38. Sleep-dependent changes in the control of heart rhythm in human subjects

Author

SILVANI, ALESSANDRO, GRIMALDI, DANIELA, PIERANGELI, GIULIA, BARLETTA, GIORGIO, VANDI, STEFANO, PROVINI, FEDERICA, MONTAGNA, PASQUALE, ZOCCOLI, GIOVANNA, CORTELLI, PIETRO, Vetrugno R., Silvani A., Grimaldi D., Pierangeli G., Barletta G., Vandi S., Provini F., Vetrugno R., Montagna P., Zoccoli G., and Cortelli P.

Published
2007

39. Seeking a central autonomic hallmark in early hypertensive patients: a study of circadian rhythms and state-dependent variations of blood pressure (BP), heart rate (HR), body core temperature (BCT)

Author

PIERANGELI, GIULIA, MONTAGNA, PASQUALE, BARLETTA, GIORGIO, PROVINI, FEDERICA, PLAZZI, GIUSEPPE, VETRUGNO, ROBERTO, ZANIBONI, ANNA, VANDI, STEFANO, ZANIGNI, STEFANO, CORTELLI, PIETRO, Guaraldi P., Ribani M. A., Marchetta F., Portaluppi F., Pierangeli G., Montagna P., Barletta G., Provini F., Plazzi G., Vetrugno R., Guaraldi P., Zaniboni A., Vandi S., Zanigni S., Ribani M.A., Marchetta F., Portaluppi F., and Cortelli P.

Published
2006

40. Cardiovascular reflexes in patients with recent onset hypertension

Author

PIERANGELI, GIULIA, CORTELLI, PIETRO, BARLETTA, GIORGIO, PROVINI, FEDERICA, PLAZZI, GIUSEPPE, VETRUGNO, ROBERTO, VANDI, STEFANO, ZANIBONI, ANNA, MONTAGNA, PASQUALE, Ribani M. A., Marchetta F., Portaluppi F., Pierangeli G., Cortelli P., Barletta G., Provini F., Plazzi G., Vetrugno R., Vandi S., Zaniboni A., Ribani M.A., Marchetta F., Portaluppi F., and Montagna P.

Published
2005

43. Recurrent syncope: an unusual presentation of carotid body tumor

Author

MOSTACCI, BARBARA, SANCISI, ELISA, PIERANGELI, GIULIA, VETRUGNO, ROBERTO, BARLETTA, GIORGIO, VANDI, STEFANO, PIERANGELI, ANGELO, MONTAGNA, PASQUALE, CORTELLI, PIETRO, PISCAGLIA, FABIO, Roncaglia G., Mostacci B., Sancisi E., Pierangeli G., Vetrugno R., Piscaglia F., Barletta G., Vandi S., Roncaglia G., Pierangeli A., Montagna P., and Cortelli P.

Published
2005

45. The circadian rhythm of core body temperature in cluster headache

Author

PIERANGELI, GIULIA, BARLETTA, GIORGIO, VETRUGNO, ROBERTO, MAGNIFICO, FABIOLA, MONTAGNA, PASQUALE, CORTELLI, PIETRO, Leone M., Guaraldi P., RIZZO, GIOVANNI, Bussone G., Pierangeli G., Barletta G., Leone M., Vetrugno R., Guaraldi P., Magnifico F., Rizzo G., Montagna P., Bussone G., and Cortelli P.

Subjects
RITMO CIRCADIANO TEMPERATURA RETTALE, CEFALEA A GRAPPOLO
Published
2004

47. The implantation and stimulation of posterior hypothalamus does not affect the circadian rhythm of core body temperature in chronic intractable cluster headache patients

Author

PIERANGELI, GIULIA, BARLETTA, GIORGIO, VETRUGNO, ROBERTO, MAGNIFICO, FABIOLA, CEVOLI, SABINA, MONTAGNA, PASQUALE, CORTELLI, PIETRO, Leone M., Guaraldi P., Bussone G., Pierangeli G., Barletta G., Leone M., Vetrugno R., Guaraldi P., Magnifico F., Cevoli S., Montagna P., Bussone G., and Cortelli P.

Subjects
IPOTALAMO POSTERIORE, RITMO CIRCADIANO TEMPERATURA RETTALE, DEEP BRAIN STIMULATION
Published
2004

49. Deep brain stimulation (DBS) of posterior hypothalamus for treatment of chronic intractable cluster headache patients improves sleep structure and quality

Author

VETRUGNO, ROBERTO, PIERANGELI, GIULIA, BARLETTA, GIORGIO, MAGNIFICO, FABIOLA, PROVINI, FEDERICA, CORTELLI, PIETRO, MONTAGNA, PASQUALE, Leone M., Guaraldi P., RIZZO, GIOVANNI, Bussone G., Vetrugno R., Pierangeli G., Leone M., Barletta G., Guaraldi P., Magnifico F., Rizzo G., Provini F., Cortelli P., Bussone G., and Montagna P.

Subjects
IPOTALAMO POSTERIORE, DEEP BRAIN STIMULATION, SONNO
Published
2004

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