Results: The literature search yielded 2352 results and the final database included 400 articles.... more Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
further interest in investigation of any links between these conditions. Therefore, prevalence of... more further interest in investigation of any links between these conditions. Therefore, prevalence of FM in patients with painful knee OA is of considerable interest. Objectives: The purpose of this study was to evaluate the prevalence of fibromyalgia (FM) in patients with painful knee OA. Methods: The study involved 92 patients (63 females and 29 males) with painful knee OA ACR 1986 Osteoarthritis Knee Criteria) with non-surgical management aged 59.4±14.3 (M±SD) yrs. 4 Radiographic findings for OA were classified according to Kellgren-Lawrence scale grading. 5 FM was diagnosed in these subjects if both ACR 1990 and 2010 criteria were met. 5-6 Results: FM was diagnosed in 21painful knee OA patients (22.83%). Among female patients FM was confirmed in 19 from 63 subjects (30.16%) compared to 2 from 29 male patients (6.90%). No relationship was found between the radiologic stage of the knee OA and FM prevalence in the investigated subjects. Conclusions: FM prevalence is relatively high in painful knee OA patients, mostly female. Further studies investigating possible FM impact on pain modulation, functional disability and quality of life in painful knee OA are needed.
Aim: The aim of the study was to compare LASER versus transcutaneous electrical nerve stimulation... more Aim: The aim of the study was to compare LASER versus transcutaneous electrical nerve stimulation (TENS) in reducing pain and paraesthesia; and in improving motor and sensory median nerve conduction parameters in mild to moderate carpal tunnel syndrome (CTS). Design: Randomised blinded pilot study. Patients and staff administered treatments and outcome measures were blinded. Setting: Outpatient; Research and Care Rehabilitation Institute. Participants: Twenty CTS symptomatic patients. Interventions: Fifteen sessions of: 1) 100 Hz TENS (30 minutes; rectangular waves; 80 ms width, intensity below muscle contraction); 2) combined 830-1064 nm LASER (radiating dose: 250 J cm-2 delivered to the skin overlying the course of the median nerve at the wrist for 100 s at 25 W (18 W [1064 nm] + 7 W [830 nm]) via a fiber-optic probe with a spot size of ~1 cm2). Outcome measures. Visual analogue scale (VAS) for pain and paresthesia; median nerve distal motor latency and sensory nerve conduction velocity. Results: LASER improved both positive and negative sensory symptoms. TENS induced clinical improvement but this was not statistically significant and was limited to pain reduction. LASER but not TENS favourably modified the neurophysiological parameters. Conclusion: High-intensity combined LASER wavelengths of 830 nm and 1064 nm, which produce a better transparency with less scattering and a high energy transfer, are better than TENS in improving both pain and paraesthesia as well as neurophysiological parameters in CTS.
Egyptian Rheumatology and Rehabilitation, Jul 1, 2015
The aim of this study was to ascertain the existence of contralateral painful muscle areas mirror... more The aim of this study was to ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetics versus saline, injected contralaterally to control phantom and phantom limb pain. Design This was a double-blinded cross-over study. Participants This study included eight lower-limb amputees with phantom limb pain in the past 6 months. Interventions Either 1 ml of 0.25% bupivacaine or 0.9% saline was injected alternately in each point with a 28-G needle, with 72 h between injections. The main outcomes measured were phantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. Results Painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. At 60 min after the injection, a statistically significantly greater relief of phantom limb pain was observed after using a local anaesthetic compared with that when using saline injection (P = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in six out of eight patients. These effects on phantom sensation were not observed after saline injections. Conclusion Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.
... The superficial muscle layer of the pelvic floor is made up of three bilateral muscles (the i... more ... The superficial muscle layer of the pelvic floor is made up of three bilateral muscles (the ischiocavernosus muscle, the bulbocavernosus muscle, and the transverse superficial muscle of the perineum), one unpaired muscle (the external anal sphincter muscle), and the ...
Electroencephalography and Clinical Neurophysiology, Aug 1, 1993
Poster sessions battery by the results of the simple test was excellent. Only in four cases the n... more Poster sessions battery by the results of the simple test was excellent. Only in four cases the new test showed a normal result whereas the conventional testing battery proved damage of parasympathetic innevation of the heart. So the new method is suggested to be an easy to perform, quick and reliable screening procedure in autonomic neuropathy.
Objectives: To investigate the frequency and the main electrophysiological characteristics of the... more Objectives: To investigate the frequency and the main electrophysiological characteristics of the canalicolar passage nerve involvement in patients with systemic sclerosis (SSc). Methods: Thirty-two SSc patients were enrolled in the study, classified according to the type (diffuse or limited) and the duration (> / < 5 years) of the disease. Sensory-motor nerve conduction studies (NCS) of the upper and lower limbs, in particular at the critical canalicolar points, were conducted by recording the Compound Muscular Action Potential (CMAP) and the Sensory Action Potential (sNAP). The following parameters were evaluated: Motor Nerve Conduction Velocity (MNCV) and Sensory Nerve Conduction Velocity; distal and proximal latency of the CMAP and the onset and peak latency of the sNAP; peak-peak amplitude and negative-peak area of the CMAP and sNAP; and the Terminal Latency Index (TLI) (Terminal Distance/MCNV x Distal latency). Results: Four (12.5%) patients had a distal neuropathy of the upper limbs (one with monolateral and two with bilateral involvement of the median nerve and one bilateral involvement of the ulnar nerve). Fourteen (43.7%) patients showed a decrement of the median nerve TLI and seven (21.8%) of either the median or the ulnar nerve (Table I). Motor and sensitive conduction velocity and latency studies did not show a statistical difference between SSc patients and controls. The amplitude and area of the CMAP (distal and proximal), sNAP and of the median nerve TLI were significantly decreased in patients with respect to controls. Conclusion: Distal mononeuropathy of the median nerve was the most frequent result in our patients. The involvement of the peripheral nervous system seems to be strictly topographical, following the modifications of the tissues and vascular tone (Raynaud's phenomenon) at the upper acral level. The neurophysiological alterations detected in our study at the wrist level may not be linked merely to a compressive event but also to microvascular involvement. Nerve involvement closely connected with the pathogenesis and distribution of SSc should be considered when peripheral nervous system involvement is the initial symptom of the disease.
Erectile dysfunction (ED) is common in men with obstructive sleep apnea (OSAS) but no completely ... more Erectile dysfunction (ED) is common in men with obstructive sleep apnea (OSAS) but no completely convincing hypotheses about the underlying pathogenic mechanisms have been published in the literature. The aims of the present study were to assess the presence of ED in a group of OSAS patients without daytime respiratory failure and to determine whether this dysfunction was related to peripheral nerve involvement. Evaluation of the bulbocavernosus reflex (BCR) and the somato-sensory evoked potentials of pudendal nerve (PSEPs), the most widely established method of documenting pudendal neuropathies as being the cause of impotence, was performed in 25 patients. Data on BCR were compared with those of 25 healthy males volunteers matched for age. BCR was altered in 17 patients: in 6 it was elicited while in 11 it had a prolonged latency and reduced amplitude. Patients with altered BCR presented an higher AHI, an higher percentage of sleep time spent with SaO2 <90% (TST90) and a lower daytime PaO 2. Six patient had clinically silent neurophysiological signs of mild polyneuropathy. The degree of OSAS and gas exchange alteration was more severe in patients with polyneuropathy than in those with isolated BCR alteration. ED is a common finding in OSAS patients and this alteration seems to be related to a nerve dysfunction. The development of nerve dysfunction is associated with a more severe degree of OSAS and nocturnal hypoxia.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Best Practice & Research: Clinical Rheumatology, Aug 1, 2018
Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, wh... more Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood-brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients' peripheral blood S100β, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1β levels were measured at the beginning of the study and after 6 months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100β and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100β and GFAP levels were significantly decreased 6 months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100β levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood-brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.
Neurophysiological evaluation of respiratory muscles is applied to traditional diagnosis, kinesio... more Neurophysiological evaluation of respiratory muscles is applied to traditional diagnosis, kinesiology and the study of localized respiratory muscle fatigue.
Objective: The neuromuscular quickness capacity can be assessed calculating the rate of torque de... more Objective: The neuromuscular quickness capacity can be assessed calculating the rate of torque development (RTD) during ballistic contractions of maximal (RTDmaximal) or submaximal (RTDsubmaximal) amplitudes. In a series of ballistic contractions of submaximal amplitudes, RTD scaling factor (RTD-SF) represents the slope of the linear regression between achieved peak torques and the corresponding RTD. We firstly investigated if the RTD-SF contributes to predict, together with maximal voluntary torques (MVT), the RTDmaximal. Then, we evaluated the agreement between the z-scores of RTDmaximal and RTDsubmaximal. Approach: MVT of quadriceps and hamstrings muscles were obtained in 22 elite young soccer players. RTD-SF was quantified in a series of ballistic contractions of submaximal and maximal amplitudes. RTDsubmaximal was estimated from the regression relationship between the peak torques and the corresponding RTD. Main results: MVT, RTD-SF and y-intercept accounted all together for 76.9 and 61.2% of the variance in RTDmaximal in quadriceps and hamstrings, respectively. Specifically, RTD-SF accounted for 13.7% and 18.7% of the variance in RTDmaximal respectively. Generally, the agreement between the z-scores of RTDmaximal and RTDsubmaximal was poor both in quadriceps and hamstrings. Significance: These results suggest that RTD-SF may have a functional relevance in the relationship between MVT and RTDmaximal and influence the amount of torque that can be achieved in a quick muscle contraction. Moreover, evaluating the RTDsubmaximal does not provide interchangeable results with RTDmaximal. Thus, evaluating the RTD across the whole range of torque could provide additional meaningful information about neuromuscular quickness.
Background: Complex regional pain syndrome is a painful and disabling post-traumatic primary pain... more Background: Complex regional pain syndrome is a painful and disabling post-traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS. Methods: The European Pain Federation established a pan-European task force of experts in CRPS who followed a four-stage consensus challenge process to produce This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background and objective: Low back pain (LBP) is one of the most common chronic pain conditions. ... more Background and objective: Low back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments. Databases and data treatment: Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature. Results: Chronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears underrecognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP. Conclusions: Chronic LBP often has an under-recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. What does this review add?: Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism-based therapies. Open and retrospective studies suggest that agents like tapentadol and topical analgesicssuch as the capsaicin 8% patch and the lidocaine 5% medicated plastermay be effective options for the treatment of neuropathic low back pain in defined patient groups.
Topographical disorientation is a clinical syndrome characterized by the inability to find ones w... more Topographical disorientation is a clinical syndrome characterized by the inability to find ones way in familiar surroundings and to learn new routes. In neuropsychology it is possible to rehabilitate this disorder with cognitive exercises that provide for the recovery of memory, attention and impaired abilities of executive functions. In general, even if physically navigating in space and reasoning on it can be considered as conceptually linked, cognitive and motor rehabilitation treatments are often provided separately. Contrariwise, introducing an embodied cognition approach, this study aims to investigate the role of motor rehabilitation in the recovery of cognitive spatial ability. We present a single case study of a single male patient admitted with a diagnosis of chronic stroke. In the study he was rehabilitated with Lokomat technology for walking while his cognitive ability in topographical orientation was evaluated before and after the physical training with a standard neuropsychology battery. Moreover, ongoing evaluations in virtual reality spatial tasks were conducted during the rehabilitation period. Data shows an improvement in cognitive performances both in standard tests and virtual ones. The patient, more than a physiotherapy improvement, shows a gradual recovery of its spatial skills. Those data gives insight about the efficacy of embodied approach to rehabilitation by showing how exclusively by rehabilitating the body, with the help of robotic technology, we can expect an improvement in terms of cognitive functioning.
Topical analgesics may play an important role in the management of chronic pain and have good tol... more Topical analgesics may play an important role in the management of chronic pain and have good tolerability. Systemic ketamine has limited usage as an anesthetic and along with its potential for addiction and dependence has not gained popularity as an analgesic compound. Topical ketamine however, is devoid of serious side effects, and thus can be used in the management of various pain states such as neuropathic pain and complex regional pain syndrome. Despite using high concentrations of topical ketamine, clinically significant side effects are rare. The measured plasma levels of ketamine and norketamine in various studies were mostly below the threshold of detection. Topical ketamine has been used as compounded formulations alone in concentrations from 0.5% to 20% or in combination with other (co-)analgesics. Its efficacy may depend on the choice of vehicle, the concentration and the pain state. Suboptimal concentration of ketamine and suboptimal pharmaceutical properties of the cream base might have contributed to the negative results of some studies. In this article we will review clinical studies involving the use of topical ketamine for pain.
Results: The literature search yielded 2352 results and the final database included 400 articles.... more Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
further interest in investigation of any links between these conditions. Therefore, prevalence of... more further interest in investigation of any links between these conditions. Therefore, prevalence of FM in patients with painful knee OA is of considerable interest. Objectives: The purpose of this study was to evaluate the prevalence of fibromyalgia (FM) in patients with painful knee OA. Methods: The study involved 92 patients (63 females and 29 males) with painful knee OA ACR 1986 Osteoarthritis Knee Criteria) with non-surgical management aged 59.4±14.3 (M±SD) yrs. 4 Radiographic findings for OA were classified according to Kellgren-Lawrence scale grading. 5 FM was diagnosed in these subjects if both ACR 1990 and 2010 criteria were met. 5-6 Results: FM was diagnosed in 21painful knee OA patients (22.83%). Among female patients FM was confirmed in 19 from 63 subjects (30.16%) compared to 2 from 29 male patients (6.90%). No relationship was found between the radiologic stage of the knee OA and FM prevalence in the investigated subjects. Conclusions: FM prevalence is relatively high in painful knee OA patients, mostly female. Further studies investigating possible FM impact on pain modulation, functional disability and quality of life in painful knee OA are needed.
Aim: The aim of the study was to compare LASER versus transcutaneous electrical nerve stimulation... more Aim: The aim of the study was to compare LASER versus transcutaneous electrical nerve stimulation (TENS) in reducing pain and paraesthesia; and in improving motor and sensory median nerve conduction parameters in mild to moderate carpal tunnel syndrome (CTS). Design: Randomised blinded pilot study. Patients and staff administered treatments and outcome measures were blinded. Setting: Outpatient; Research and Care Rehabilitation Institute. Participants: Twenty CTS symptomatic patients. Interventions: Fifteen sessions of: 1) 100 Hz TENS (30 minutes; rectangular waves; 80 ms width, intensity below muscle contraction); 2) combined 830-1064 nm LASER (radiating dose: 250 J cm-2 delivered to the skin overlying the course of the median nerve at the wrist for 100 s at 25 W (18 W [1064 nm] + 7 W [830 nm]) via a fiber-optic probe with a spot size of ~1 cm2). Outcome measures. Visual analogue scale (VAS) for pain and paresthesia; median nerve distal motor latency and sensory nerve conduction velocity. Results: LASER improved both positive and negative sensory symptoms. TENS induced clinical improvement but this was not statistically significant and was limited to pain reduction. LASER but not TENS favourably modified the neurophysiological parameters. Conclusion: High-intensity combined LASER wavelengths of 830 nm and 1064 nm, which produce a better transparency with less scattering and a high energy transfer, are better than TENS in improving both pain and paraesthesia as well as neurophysiological parameters in CTS.
Egyptian Rheumatology and Rehabilitation, Jul 1, 2015
The aim of this study was to ascertain the existence of contralateral painful muscle areas mirror... more The aim of this study was to ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetics versus saline, injected contralaterally to control phantom and phantom limb pain. Design This was a double-blinded cross-over study. Participants This study included eight lower-limb amputees with phantom limb pain in the past 6 months. Interventions Either 1 ml of 0.25% bupivacaine or 0.9% saline was injected alternately in each point with a 28-G needle, with 72 h between injections. The main outcomes measured were phantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. Results Painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. At 60 min after the injection, a statistically significantly greater relief of phantom limb pain was observed after using a local anaesthetic compared with that when using saline injection (P = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in six out of eight patients. These effects on phantom sensation were not observed after saline injections. Conclusion Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.
... The superficial muscle layer of the pelvic floor is made up of three bilateral muscles (the i... more ... The superficial muscle layer of the pelvic floor is made up of three bilateral muscles (the ischiocavernosus muscle, the bulbocavernosus muscle, and the transverse superficial muscle of the perineum), one unpaired muscle (the external anal sphincter muscle), and the ...
Electroencephalography and Clinical Neurophysiology, Aug 1, 1993
Poster sessions battery by the results of the simple test was excellent. Only in four cases the n... more Poster sessions battery by the results of the simple test was excellent. Only in four cases the new test showed a normal result whereas the conventional testing battery proved damage of parasympathetic innevation of the heart. So the new method is suggested to be an easy to perform, quick and reliable screening procedure in autonomic neuropathy.
Objectives: To investigate the frequency and the main electrophysiological characteristics of the... more Objectives: To investigate the frequency and the main electrophysiological characteristics of the canalicolar passage nerve involvement in patients with systemic sclerosis (SSc). Methods: Thirty-two SSc patients were enrolled in the study, classified according to the type (diffuse or limited) and the duration (> / < 5 years) of the disease. Sensory-motor nerve conduction studies (NCS) of the upper and lower limbs, in particular at the critical canalicolar points, were conducted by recording the Compound Muscular Action Potential (CMAP) and the Sensory Action Potential (sNAP). The following parameters were evaluated: Motor Nerve Conduction Velocity (MNCV) and Sensory Nerve Conduction Velocity; distal and proximal latency of the CMAP and the onset and peak latency of the sNAP; peak-peak amplitude and negative-peak area of the CMAP and sNAP; and the Terminal Latency Index (TLI) (Terminal Distance/MCNV x Distal latency). Results: Four (12.5%) patients had a distal neuropathy of the upper limbs (one with monolateral and two with bilateral involvement of the median nerve and one bilateral involvement of the ulnar nerve). Fourteen (43.7%) patients showed a decrement of the median nerve TLI and seven (21.8%) of either the median or the ulnar nerve (Table I). Motor and sensitive conduction velocity and latency studies did not show a statistical difference between SSc patients and controls. The amplitude and area of the CMAP (distal and proximal), sNAP and of the median nerve TLI were significantly decreased in patients with respect to controls. Conclusion: Distal mononeuropathy of the median nerve was the most frequent result in our patients. The involvement of the peripheral nervous system seems to be strictly topographical, following the modifications of the tissues and vascular tone (Raynaud's phenomenon) at the upper acral level. The neurophysiological alterations detected in our study at the wrist level may not be linked merely to a compressive event but also to microvascular involvement. Nerve involvement closely connected with the pathogenesis and distribution of SSc should be considered when peripheral nervous system involvement is the initial symptom of the disease.
Erectile dysfunction (ED) is common in men with obstructive sleep apnea (OSAS) but no completely ... more Erectile dysfunction (ED) is common in men with obstructive sleep apnea (OSAS) but no completely convincing hypotheses about the underlying pathogenic mechanisms have been published in the literature. The aims of the present study were to assess the presence of ED in a group of OSAS patients without daytime respiratory failure and to determine whether this dysfunction was related to peripheral nerve involvement. Evaluation of the bulbocavernosus reflex (BCR) and the somato-sensory evoked potentials of pudendal nerve (PSEPs), the most widely established method of documenting pudendal neuropathies as being the cause of impotence, was performed in 25 patients. Data on BCR were compared with those of 25 healthy males volunteers matched for age. BCR was altered in 17 patients: in 6 it was elicited while in 11 it had a prolonged latency and reduced amplitude. Patients with altered BCR presented an higher AHI, an higher percentage of sleep time spent with SaO2 <90% (TST90) and a lower daytime PaO 2. Six patient had clinically silent neurophysiological signs of mild polyneuropathy. The degree of OSAS and gas exchange alteration was more severe in patients with polyneuropathy than in those with isolated BCR alteration. ED is a common finding in OSAS patients and this alteration seems to be related to a nerve dysfunction. The development of nerve dysfunction is associated with a more severe degree of OSAS and nocturnal hypoxia.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Best Practice & Research: Clinical Rheumatology, Aug 1, 2018
Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, wh... more Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood-brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients' peripheral blood S100β, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1β levels were measured at the beginning of the study and after 6 months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100β and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100β and GFAP levels were significantly decreased 6 months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100β levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood-brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.
Neurophysiological evaluation of respiratory muscles is applied to traditional diagnosis, kinesio... more Neurophysiological evaluation of respiratory muscles is applied to traditional diagnosis, kinesiology and the study of localized respiratory muscle fatigue.
Objective: The neuromuscular quickness capacity can be assessed calculating the rate of torque de... more Objective: The neuromuscular quickness capacity can be assessed calculating the rate of torque development (RTD) during ballistic contractions of maximal (RTDmaximal) or submaximal (RTDsubmaximal) amplitudes. In a series of ballistic contractions of submaximal amplitudes, RTD scaling factor (RTD-SF) represents the slope of the linear regression between achieved peak torques and the corresponding RTD. We firstly investigated if the RTD-SF contributes to predict, together with maximal voluntary torques (MVT), the RTDmaximal. Then, we evaluated the agreement between the z-scores of RTDmaximal and RTDsubmaximal. Approach: MVT of quadriceps and hamstrings muscles were obtained in 22 elite young soccer players. RTD-SF was quantified in a series of ballistic contractions of submaximal and maximal amplitudes. RTDsubmaximal was estimated from the regression relationship between the peak torques and the corresponding RTD. Main results: MVT, RTD-SF and y-intercept accounted all together for 76.9 and 61.2% of the variance in RTDmaximal in quadriceps and hamstrings, respectively. Specifically, RTD-SF accounted for 13.7% and 18.7% of the variance in RTDmaximal respectively. Generally, the agreement between the z-scores of RTDmaximal and RTDsubmaximal was poor both in quadriceps and hamstrings. Significance: These results suggest that RTD-SF may have a functional relevance in the relationship between MVT and RTDmaximal and influence the amount of torque that can be achieved in a quick muscle contraction. Moreover, evaluating the RTDsubmaximal does not provide interchangeable results with RTDmaximal. Thus, evaluating the RTD across the whole range of torque could provide additional meaningful information about neuromuscular quickness.
Background: Complex regional pain syndrome is a painful and disabling post-traumatic primary pain... more Background: Complex regional pain syndrome is a painful and disabling post-traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS. Methods: The European Pain Federation established a pan-European task force of experts in CRPS who followed a four-stage consensus challenge process to produce This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background and objective: Low back pain (LBP) is one of the most common chronic pain conditions. ... more Background and objective: Low back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments. Databases and data treatment: Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature. Results: Chronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears underrecognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP. Conclusions: Chronic LBP often has an under-recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. What does this review add?: Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism-based therapies. Open and retrospective studies suggest that agents like tapentadol and topical analgesicssuch as the capsaicin 8% patch and the lidocaine 5% medicated plastermay be effective options for the treatment of neuropathic low back pain in defined patient groups.
Topographical disorientation is a clinical syndrome characterized by the inability to find ones w... more Topographical disorientation is a clinical syndrome characterized by the inability to find ones way in familiar surroundings and to learn new routes. In neuropsychology it is possible to rehabilitate this disorder with cognitive exercises that provide for the recovery of memory, attention and impaired abilities of executive functions. In general, even if physically navigating in space and reasoning on it can be considered as conceptually linked, cognitive and motor rehabilitation treatments are often provided separately. Contrariwise, introducing an embodied cognition approach, this study aims to investigate the role of motor rehabilitation in the recovery of cognitive spatial ability. We present a single case study of a single male patient admitted with a diagnosis of chronic stroke. In the study he was rehabilitated with Lokomat technology for walking while his cognitive ability in topographical orientation was evaluated before and after the physical training with a standard neuropsychology battery. Moreover, ongoing evaluations in virtual reality spatial tasks were conducted during the rehabilitation period. Data shows an improvement in cognitive performances both in standard tests and virtual ones. The patient, more than a physiotherapy improvement, shows a gradual recovery of its spatial skills. Those data gives insight about the efficacy of embodied approach to rehabilitation by showing how exclusively by rehabilitating the body, with the help of robotic technology, we can expect an improvement in terms of cognitive functioning.
Topical analgesics may play an important role in the management of chronic pain and have good tol... more Topical analgesics may play an important role in the management of chronic pain and have good tolerability. Systemic ketamine has limited usage as an anesthetic and along with its potential for addiction and dependence has not gained popularity as an analgesic compound. Topical ketamine however, is devoid of serious side effects, and thus can be used in the management of various pain states such as neuropathic pain and complex regional pain syndrome. Despite using high concentrations of topical ketamine, clinically significant side effects are rare. The measured plasma levels of ketamine and norketamine in various studies were mostly below the threshold of detection. Topical ketamine has been used as compounded formulations alone in concentrations from 0.5% to 20% or in combination with other (co-)analgesics. Its efficacy may depend on the choice of vehicle, the concentration and the pain state. Suboptimal concentration of ketamine and suboptimal pharmaceutical properties of the cream base might have contributed to the negative results of some studies. In this article we will review clinical studies involving the use of topical ketamine for pain.
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Papers by Roberto Casale