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Fabio Bandini

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Neurologist, Neurophysiologist and Neuro-Ophthalmologist. Head of the Department of Neurology, ASL 3 Genovese, Genova, Italy. Past President of the Italian Society for the Study of Stroke (S.I.S.S.)

less

Western Sydney University

Kansas State University

University of California, Berkeley

Sorbonne Université, Université Pierre et Marie Curie & CNRS

Vincent D . Costa

Emory University

Adolfo Vasquez Rocca

Universidad Complutense de Madrid

Yukinori Takubo

The National Institutes for the Humanities (Inter-University Research Institute Corporation)

Matthew R Longo

Birkbeck College, University of London

paolo mazzarello

University of Pavia

Jürgen Konczak

University of Minnesota

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Papers by Fabio Bandini

Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study

European Stroke Journal

Introduction: The best therapeutic strategy for patients with mechanical heart valves (MHVs) havi... more Introduction: The best therapeutic strategy for patients with mechanical heart valves (MHVs) having acute ischemic stroke during treatment with vitamin K antagonists (VKAs) remain unclear. Being so, we compared the outcomes for: (i) full dose heparin along with VKA (bridging therapy group) and (ii) restarting VKA without heparin (nonbridging group). Patients and methods: For this multicenter observational cohort study, data on consecutive acute ischemic stroke patients with MHV was retrospectively collected from prospective registries. Propensity score matching (PSM) was adopted to adjust for any treatment allocation confounders. The primary outcome was the composite of stroke, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding at 90 days. Results: Overall, 255 out of 603 patients (41.3%) received bridging therapy: 36 (14.1%) had combined outcome, compared with 28 (8.0%) in the nonbridging group (adjusted OR 1.83; 95% CI 1.05–3.18; p = 0.03). Within t...

Comparing the Impact of COVID-19 on Vaccinated and Unvaccinated Patients Affected by Myasthenia Gravis

Life, Apr 21, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

Disease-Modifying Treatments and Time to Loss of Ambulatory Function in Patients With Primary Progressive Multiple Sclerosis

JAMA Neurology

Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study

Stroke

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatme... more Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracra...

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Neurology, Apr 13, 2021

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Neurology, Apr 13, 2021

Acute Stroke Management During the COVID-19 Pandemic

Stroke, 2020

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommende... more During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per ho...

Narrow band (similar to 17-46 Hz) oscillatory response to pattern stimulation and the visual P300 of healthy subjects

Narrow-band (~17-46 Hz) oscillatory response to pattern stimulatio.n and the visual P300 of healthy subjects

The diagnostic value of vestibular evoked myogenic potentials in multiple sclerosis

Journal of Neurology, May 1, 2004

Sirs: The diagnostic value of evoked potentials (EPs) in multiple sclerosis (MS) depends mainly o... more Sirs: The diagnostic value of evoked potentials (EPs) in multiple sclerosis (MS) depends mainly on their ability to detect clinically “silent” lesions. Their use has been recently reduced by the development of MRI, which is considered to be the single most sensitive test for MS [7, 8]. MRI, however, is not specific for the disease [10], and multimodal EPs have been shown to yield clinically undetected lesions in a significant percentage of patients [1]. Furthermore, current diagnostic criteria allow MS suspects to be reclassified into definite MS categories if visually evoked potentials (VEPs) are able to identify subclinical lesions in the optic pathway [7]. Thus the development of a new, potentially diagnostic test, could enhance the utility of EPs in detecting functional CNS dysfunction. The Vestibular Evoked Myogenic Potentials (VEMPs) are a neurophysiological technique which is based upon the modulation of tonic electromyogram (EMG) activity of the sternocleidomastoid (SCM) muscle, induced by vestibular (saccular) activation. VEMPs are beginning to be applied clinically, and some encouraging reports in neurological diseases, such as spinocerebellar degeneration [15] and MS [12, 17], suggest that VEMPs may be a useful method for the diagnosis of brainstem (BS) lesions. In the present study, we were interested in evaluating VEMPs sensitivity in detecting “silent” demyelinating lesions of BS structures; we also wanted to compare it with conventional brain MRI and pattern VEPs, which are considered, together with the oligoclonal bands of the CSF, the ‘gold standard’ techniques for the diagnosis of MS [7]. Finally, we wanted to correlate VEMPs measures with the clinical staging and the duration of the disease. To accomplish this, we chose to study only patients with clinically definite MS. Thirty-six clinically definite MS patients [11], followed as outpatients at our Department of Neurosciences, University of Genoa, were enrolled in the study. There were 15 males and 21 females. The mean age was 38.8 ± 10.8 years and the mean disease duration was 84.8 ± 100.3 months. The mean EDSS clinical score [5] was 3.6 ± 2.2. Twenty-one patients had a relapsing-remitting (RR) subtype of MS, while the remaining 15 had a secondary progressive (SP) subtype. All patients with RR subtype of MS were relapse free at the time of the investigation. No patients were taking steroids. The healthy controls were 21 age-matched individuals (12 males and 9 females). Exclusion criteria for all subjects were either the history or the presence of ophthalmological or otolaryngological disorders and of any pathology affecting the SCM. All the subjects underwent pure tone audiometry, VEPs and VEMPs. MS patients underwent brain MRI. Both the neurophysiological and neuroimaging examinations were carried out within 4 weeks from the clinical evaluation. The electrophysiological data were interpreted without knowledge of the MRI findings, and vice versa. As already mentioned, our main goal was to verify the diagnostic sensitivity of VEMPs, and compare it with MRI and VEPs; we therefore chose not to consider other methods for the assessment of BS functions (e. g. caloric responses, electrooculography, brainstem trigeminal and acoustic EPs), which are no longer recommended for the diagnosis of MS [3, 7]. All subjects gave informed consent prior to their inclusion in the study. Brain MRI studies were performed with gadolinium by means of a 1.5 T scanner (Magnetom Vision, Siemens, Germany): spinecho proton density and T2weighted, spin-echo T1-weighted, flow-attenuated inversion recovery and post-contrast spin-echo T1 sequences were acquired in axial, coronal and sagittal planes. The section thickness was 5 mm, with gap interslice (50 % for flow-attenuated inversion recovery, 10 % for the other images), FOV 260, matrix 256x256, RECFOV 62–75 %. MRI scans were evaluated by an expert neuroradiologist, blinded as to the aim of the study, who counted the number of T2-weighted hyperintense BS lesions. For VEMPs recording, the MS patients were divided in two groups, depending on the presence (16 patients) or absence (20 patients) of either history or signs/symptoms of BS dysfunction. The mean EDSS score was 4 ± 2.3 in the first group and 3.4 ± 2.1 in the second group. VEMPs were evoked by square wave rarefaction clicks (duration 0.1 ms, loudness 100 dB nHl [normal hearing level]) produced by an evoked potentials stimulator (Dantec Keyboard® Portable) and delivered unilaterally to the ear by a pair of calibrated headphones, at a stimulation of 5 LETTER TO THE EDITORS

Overexpression of sphingosine-1-phosphate receptors on reactive astrocytes drives neuropathology of multiple sclerosis rebound after fingolimod discontinuation

Multiple Sclerosis Journal, Apr 30, 2018

Background: Sphingosine-1-phosphate receptor-1 (S1PR1) and signal transducer and activator of tra... more Background: Sphingosine-1-phosphate receptor-1 (S1PR1) and signal transducer and activator of transcription-3 (STAT3) play important roles in immune responses with potential oncogenic roles. Methods: We analyzed S1PR1/STAT3 pathway activation using immunohistochemistry in rituximab-treated diffuse large B-cell lymphomas (DLBCL; N = 103). Results: Nuclear expression of pSTAT3 (but not S1PR1) was associated with non-GCB phenotype (p = 0.010). In univariate survival analysis, S1PR1 expression (S1PR1+) was a poor prognostic factor in total DLBCLs (p = 0.018), as well as in nodal (p = 0.041), high-stage (III, IV) (p = 0.002), and high-international prognostic index (IPI; 3-5) (p = 0.014) subgroups, while nuclear expression of pSTAT3 (pSTAT3+) was associated with poor prognosis in the low-stage (I, II) subgroup (p = 0.022). The S1PR1/pSTAT3 risk-categories, containing high-risk (S1PR1+), intermediate-risk (S1PR1-/ pSTAT3+), and low-risk (S1PR1-/pSTAT3-), predicted overall survival (p = 0.010). This prognostication tended to be valid in each stage (p = 0.059 in low-stage; p = 0.006 in high-stage) and each IPI subgroups (p = 0.055 [low-IPI]; p = 0.034 [high-IPI]). S1PR1 alone and S1PR1/pSTAT3 risk-category were significant independent prognostic indicators in multivariate analyses incorporating IPI and B symptoms (S1PR1 [p = 0.005; HR = 3.0]; S1PR1/pSTAT3 risk-category [p = 0.019: overall; p = 0.024, HR = 2.7 for S1PR1-/pSTAT3+ vs. S1PR1+; p = 0.021, HR = 3.8 for S1PR1-/pSTAT3-vs. S1PR1+]). Conclusions: Therefore, S1PR1 and S1PR1/pSTAT3 risk-category may contribute to risk stratification in rituximab-treated DLBCLs, and S1PR1 and STAT3 might be therapeutic targets for DLBCL.

Hepatic encephalophaty: management and diagnostic therapeutic assistance path of Ligurian Local Health Company 3 (ASL3)

Minerva Medica, Mar 1, 2023

Augmentation of Zonisamide in Poor or Non-responder Patients Treated with Duloxetine for Single or Recurrent Unipolar Major Depressive Episode

European Psychiatry, 2009

The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Du... more The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Duloxetine in partial and non-responder patients in course of Unipolar Major Depressive Episode. Method: 35 outpatients will be enrolled in a 12-weeks open-label study including both genders, 18 to 65 years old subjects. Unipolar Major Depressive Episode diagnosis will be performed at screening time using "Structured Clinical Interview for DSM-IV-Axis-I Disorders-Italian 1996 version" (SCID-I, First et al., 1996) and by a ≥14 total score for the "Quick Inventory of Depressive Symptomathology-Self Rated" (QIDS-SR, Rush et al., 2003). Patients will be repeatedly evaluated during the course of the study using a wide range of mood and anxiety rating scales and monitoring biomarkers such as electroretinogram b-wave amplitude, interleukins, flogosis and BDNF factors etc. At week 6, Duloxetine partial/non responders will be augmetated to Zonisamide and further evaluations of mentioned markers will be repeated. A "Fisher-test" or χ² analysis will be performed at the end of the study. Expected p will be ≤ 0,005. Hypothesis: We expect Zonisamide augmentation to be an effective treatment for SNRI-resistant Major Depression.

Acute stroke management during the COVID19 pandemic in Liguria (Italy)

15. The effect of cannabinoids on the stretch reflex in multiple sclerosis spasticity

Clinical Neurophysiology, Dec 1, 2016

The aim of this observational study was to assess the efficacy of tetrahydrocannabinol-cannabidio... more The aim of this observational study was to assess the efficacy of tetrahydrocannabinol-cannabidiol oromucosal spray (THC:CBD) on spasticity using the stretch reflex in subjects with multiple sclerosis (MS). Numeric rating scale (NRS) for spasticity, modified Ashworth scale (MAS) and the stretch reflex were assessed before and during treatment in 57 MS patients with spasticity eligible for THC:CBD treatment. A significant reduction of stretch reflex amplitude, as well as significant reductions of NRS and MAS scores was observed. There was a low concordance between the three measures (stretch reflex, NRS and MAS), likely related to the different aspects of muscle hypertonia assessed. Stretch reflex responders were taking a significantly higher number of puffs, while no differences were found in the responders by the other scales, suggesting that higher dosage would add benefit if tolerated. The present study confirms the efficacy of cannabinoids in reducing spasticity in patients with MS, suggesting a higher sensitivity and specificity of the stretch reflex compared to other measures. As an objective and quantitative measure of spasticity, the stretch reflex is particularly useful to assess the effects of cannabinoids on spinal excitability and may have a role in future pharmacological studies.

Peripheral" locked-in syndrome and brainstem death

Boston Naming Test--15 Item; Italian Version

PsycTESTS Dataset

Eye closure affects flash VEP latency in dementia

Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section, 1995

In a group of 27 demented patients (21 with DAT and 6 with MID) with normal pattern VEP (PVEP), t... more In a group of 27 demented patients (21 with DAT and 6 with MID) with normal pattern VEP (PVEP), the latencies of the main flash VEP (FVEP) components (P1, N2, P2 and N3) were assessed both with open and closed eyes. At variance from controls, demented patients showed that both P2 and N3 components are significantly delayed with closed eyes while neither P1 nor N2 timings are affected. Control studies ruled out the possibility that such an outcome might depend on a defective pupillary responsiveness and/or an impaired sensitivity to luminance changes. On these grounds it is suggested that the effect of mode of stimulation on FVEP latency in demented patients is more likely to depend on "central" than on "peripheral" mechanisms. The dependence of latency changes on closure of the eyes seems to negate the direct effect of lesions upon visual structures and suggests an impairment of the modulatory action of non-visual afferents upon the activity of the visual cortex.

Risk Factors for Intracerebral Hemorrhage in a Pooled Prospective Study

Stroke, 2007

Background and Purpose— Few prospective studies have reported risk factors for intracerebral hemo... more Background and Purpose— Few prospective studies have reported risk factors for intracerebral hemorrhage (ICH), and results are inconsistent. We studied risk factors for ICH in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). Methods— The ARIC cohort was recruited in 1987 to 1989 and involves 15 792 men and women, aged 45 to 64 years at baseline, sampled from 4 US communities. The CHS cohort was recruited in 1989 to 1993 and involves 5888 men and women, aged 65 or over at baseline, sampled from 4 US communities. Baseline measurements included many potential vascular risk factors. The cohorts were followed for incident stroke events. Results— Over 263 489 person-years of follow-up, 135 incident ICH events occurred. In a multivariable model, age, African-American ethnicity (versus Whites), and hypertension were positively associated with incident ICH, whereas low-density lipoprotein cholesterol and triglycerides were inv...

Risk of recurrent stroke in patients with atrial fibrillation and non-valvular heart disease

Stroke, 1983

One-hundred-forty patients with atrial fibrillation (AF) due to non-rheumatic, non-valvular heart... more One-hundred-forty patients with atrial fibrillation (AF) due to non-rheumatic, non-valvular heart disease (NVHD) who suffered a cerebral infarct were identified. Fifty-three (38%) died of the initial stroke. The surviving patients were followed up to 9 years without anticoagulant therapy. In the 59 patients available for follow-up, the risk of recurrent cerebral ischemia remained at approximately 20% per year throughout the 9 year observation period. The recurrence rate was the same regardless of age, sex, previous myocardial infarction, or whether chronic AF or intermittent AF were present. Only 7 (12%) died from a second stroke, however. The high annual rate of recurrence and lack of controlled therapeutic trials in this population of patients warrant a prospective study to define the benefits and relative risks of anticoagulant therapy in AF due to NVHD.

Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study

European Stroke Journal

Introduction: The best therapeutic strategy for patients with mechanical heart valves (MHVs) havi... more Introduction: The best therapeutic strategy for patients with mechanical heart valves (MHVs) having acute ischemic stroke during treatment with vitamin K antagonists (VKAs) remain unclear. Being so, we compared the outcomes for: (i) full dose heparin along with VKA (bridging therapy group) and (ii) restarting VKA without heparin (nonbridging group). Patients and methods: For this multicenter observational cohort study, data on consecutive acute ischemic stroke patients with MHV was retrospectively collected from prospective registries. Propensity score matching (PSM) was adopted to adjust for any treatment allocation confounders. The primary outcome was the composite of stroke, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding at 90 days. Results: Overall, 255 out of 603 patients (41.3%) received bridging therapy: 36 (14.1%) had combined outcome, compared with 28 (8.0%) in the nonbridging group (adjusted OR 1.83; 95% CI 1.05–3.18; p = 0.03). Within t...

Comparing the Impact of COVID-19 on Vaccinated and Unvaccinated Patients Affected by Myasthenia Gravis

Life, Apr 21, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

Disease-Modifying Treatments and Time to Loss of Ambulatory Function in Patients With Primary Progressive Multiple Sclerosis

JAMA Neurology

Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study

Stroke

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatme... more Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracra...

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Neurology, Apr 13, 2021

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Neurology, Apr 13, 2021

Acute Stroke Management During the COVID-19 Pandemic

Stroke, 2020

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommende... more During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per ho...

Narrow band (similar to 17-46 Hz) oscillatory response to pattern stimulation and the visual P300 of healthy subjects

Narrow-band (~17-46 Hz) oscillatory response to pattern stimulatio.n and the visual P300 of healthy subjects

The diagnostic value of vestibular evoked myogenic potentials in multiple sclerosis

Journal of Neurology, May 1, 2004

Sirs: The diagnostic value of evoked potentials (EPs) in multiple sclerosis (MS) depends mainly o... more Sirs: The diagnostic value of evoked potentials (EPs) in multiple sclerosis (MS) depends mainly on their ability to detect clinically “silent” lesions. Their use has been recently reduced by the development of MRI, which is considered to be the single most sensitive test for MS [7, 8]. MRI, however, is not specific for the disease [10], and multimodal EPs have been shown to yield clinically undetected lesions in a significant percentage of patients [1]. Furthermore, current diagnostic criteria allow MS suspects to be reclassified into definite MS categories if visually evoked potentials (VEPs) are able to identify subclinical lesions in the optic pathway [7]. Thus the development of a new, potentially diagnostic test, could enhance the utility of EPs in detecting functional CNS dysfunction. The Vestibular Evoked Myogenic Potentials (VEMPs) are a neurophysiological technique which is based upon the modulation of tonic electromyogram (EMG) activity of the sternocleidomastoid (SCM) muscle, induced by vestibular (saccular) activation. VEMPs are beginning to be applied clinically, and some encouraging reports in neurological diseases, such as spinocerebellar degeneration [15] and MS [12, 17], suggest that VEMPs may be a useful method for the diagnosis of brainstem (BS) lesions. In the present study, we were interested in evaluating VEMPs sensitivity in detecting “silent” demyelinating lesions of BS structures; we also wanted to compare it with conventional brain MRI and pattern VEPs, which are considered, together with the oligoclonal bands of the CSF, the ‘gold standard’ techniques for the diagnosis of MS [7]. Finally, we wanted to correlate VEMPs measures with the clinical staging and the duration of the disease. To accomplish this, we chose to study only patients with clinically definite MS. Thirty-six clinically definite MS patients [11], followed as outpatients at our Department of Neurosciences, University of Genoa, were enrolled in the study. There were 15 males and 21 females. The mean age was 38.8 ± 10.8 years and the mean disease duration was 84.8 ± 100.3 months. The mean EDSS clinical score [5] was 3.6 ± 2.2. Twenty-one patients had a relapsing-remitting (RR) subtype of MS, while the remaining 15 had a secondary progressive (SP) subtype. All patients with RR subtype of MS were relapse free at the time of the investigation. No patients were taking steroids. The healthy controls were 21 age-matched individuals (12 males and 9 females). Exclusion criteria for all subjects were either the history or the presence of ophthalmological or otolaryngological disorders and of any pathology affecting the SCM. All the subjects underwent pure tone audiometry, VEPs and VEMPs. MS patients underwent brain MRI. Both the neurophysiological and neuroimaging examinations were carried out within 4 weeks from the clinical evaluation. The electrophysiological data were interpreted without knowledge of the MRI findings, and vice versa. As already mentioned, our main goal was to verify the diagnostic sensitivity of VEMPs, and compare it with MRI and VEPs; we therefore chose not to consider other methods for the assessment of BS functions (e. g. caloric responses, electrooculography, brainstem trigeminal and acoustic EPs), which are no longer recommended for the diagnosis of MS [3, 7]. All subjects gave informed consent prior to their inclusion in the study. Brain MRI studies were performed with gadolinium by means of a 1.5 T scanner (Magnetom Vision, Siemens, Germany): spinecho proton density and T2weighted, spin-echo T1-weighted, flow-attenuated inversion recovery and post-contrast spin-echo T1 sequences were acquired in axial, coronal and sagittal planes. The section thickness was 5 mm, with gap interslice (50 % for flow-attenuated inversion recovery, 10 % for the other images), FOV 260, matrix 256x256, RECFOV 62–75 %. MRI scans were evaluated by an expert neuroradiologist, blinded as to the aim of the study, who counted the number of T2-weighted hyperintense BS lesions. For VEMPs recording, the MS patients were divided in two groups, depending on the presence (16 patients) or absence (20 patients) of either history or signs/symptoms of BS dysfunction. The mean EDSS score was 4 ± 2.3 in the first group and 3.4 ± 2.1 in the second group. VEMPs were evoked by square wave rarefaction clicks (duration 0.1 ms, loudness 100 dB nHl [normal hearing level]) produced by an evoked potentials stimulator (Dantec Keyboard® Portable) and delivered unilaterally to the ear by a pair of calibrated headphones, at a stimulation of 5 LETTER TO THE EDITORS

Overexpression of sphingosine-1-phosphate receptors on reactive astrocytes drives neuropathology of multiple sclerosis rebound after fingolimod discontinuation

Multiple Sclerosis Journal, Apr 30, 2018

Background: Sphingosine-1-phosphate receptor-1 (S1PR1) and signal transducer and activator of tra... more Background: Sphingosine-1-phosphate receptor-1 (S1PR1) and signal transducer and activator of transcription-3 (STAT3) play important roles in immune responses with potential oncogenic roles. Methods: We analyzed S1PR1/STAT3 pathway activation using immunohistochemistry in rituximab-treated diffuse large B-cell lymphomas (DLBCL; N = 103). Results: Nuclear expression of pSTAT3 (but not S1PR1) was associated with non-GCB phenotype (p = 0.010). In univariate survival analysis, S1PR1 expression (S1PR1+) was a poor prognostic factor in total DLBCLs (p = 0.018), as well as in nodal (p = 0.041), high-stage (III, IV) (p = 0.002), and high-international prognostic index (IPI; 3-5) (p = 0.014) subgroups, while nuclear expression of pSTAT3 (pSTAT3+) was associated with poor prognosis in the low-stage (I, II) subgroup (p = 0.022). The S1PR1/pSTAT3 risk-categories, containing high-risk (S1PR1+), intermediate-risk (S1PR1-/ pSTAT3+), and low-risk (S1PR1-/pSTAT3-), predicted overall survival (p = 0.010). This prognostication tended to be valid in each stage (p = 0.059 in low-stage; p = 0.006 in high-stage) and each IPI subgroups (p = 0.055 [low-IPI]; p = 0.034 [high-IPI]). S1PR1 alone and S1PR1/pSTAT3 risk-category were significant independent prognostic indicators in multivariate analyses incorporating IPI and B symptoms (S1PR1 [p = 0.005; HR = 3.0]; S1PR1/pSTAT3 risk-category [p = 0.019: overall; p = 0.024, HR = 2.7 for S1PR1-/pSTAT3+ vs. S1PR1+; p = 0.021, HR = 3.8 for S1PR1-/pSTAT3-vs. S1PR1+]). Conclusions: Therefore, S1PR1 and S1PR1/pSTAT3 risk-category may contribute to risk stratification in rituximab-treated DLBCLs, and S1PR1 and STAT3 might be therapeutic targets for DLBCL.

Hepatic encephalophaty: management and diagnostic therapeutic assistance path of Ligurian Local Health Company 3 (ASL3)

Minerva Medica, Mar 1, 2023

Augmentation of Zonisamide in Poor or Non-responder Patients Treated with Duloxetine for Single or Recurrent Unipolar Major Depressive Episode

European Psychiatry, 2009

The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Du... more The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Duloxetine in partial and non-responder patients in course of Unipolar Major Depressive Episode. Method: 35 outpatients will be enrolled in a 12-weeks open-label study including both genders, 18 to 65 years old subjects. Unipolar Major Depressive Episode diagnosis will be performed at screening time using "Structured Clinical Interview for DSM-IV-Axis-I Disorders-Italian 1996 version" (SCID-I, First et al., 1996) and by a ≥14 total score for the "Quick Inventory of Depressive Symptomathology-Self Rated" (QIDS-SR, Rush et al., 2003). Patients will be repeatedly evaluated during the course of the study using a wide range of mood and anxiety rating scales and monitoring biomarkers such as electroretinogram b-wave amplitude, interleukins, flogosis and BDNF factors etc. At week 6, Duloxetine partial/non responders will be augmetated to Zonisamide and further evaluations of mentioned markers will be repeated. A "Fisher-test" or χ² analysis will be performed at the end of the study. Expected p will be ≤ 0,005. Hypothesis: We expect Zonisamide augmentation to be an effective treatment for SNRI-resistant Major Depression.

Acute stroke management during the COVID19 pandemic in Liguria (Italy)

15. The effect of cannabinoids on the stretch reflex in multiple sclerosis spasticity

Clinical Neurophysiology, Dec 1, 2016

The aim of this observational study was to assess the efficacy of tetrahydrocannabinol-cannabidio... more The aim of this observational study was to assess the efficacy of tetrahydrocannabinol-cannabidiol oromucosal spray (THC:CBD) on spasticity using the stretch reflex in subjects with multiple sclerosis (MS). Numeric rating scale (NRS) for spasticity, modified Ashworth scale (MAS) and the stretch reflex were assessed before and during treatment in 57 MS patients with spasticity eligible for THC:CBD treatment. A significant reduction of stretch reflex amplitude, as well as significant reductions of NRS and MAS scores was observed. There was a low concordance between the three measures (stretch reflex, NRS and MAS), likely related to the different aspects of muscle hypertonia assessed. Stretch reflex responders were taking a significantly higher number of puffs, while no differences were found in the responders by the other scales, suggesting that higher dosage would add benefit if tolerated. The present study confirms the efficacy of cannabinoids in reducing spasticity in patients with MS, suggesting a higher sensitivity and specificity of the stretch reflex compared to other measures. As an objective and quantitative measure of spasticity, the stretch reflex is particularly useful to assess the effects of cannabinoids on spinal excitability and may have a role in future pharmacological studies.

Peripheral" locked-in syndrome and brainstem death

Boston Naming Test--15 Item; Italian Version

PsycTESTS Dataset

Eye closure affects flash VEP latency in dementia

Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section, 1995

In a group of 27 demented patients (21 with DAT and 6 with MID) with normal pattern VEP (PVEP), t... more In a group of 27 demented patients (21 with DAT and 6 with MID) with normal pattern VEP (PVEP), the latencies of the main flash VEP (FVEP) components (P1, N2, P2 and N3) were assessed both with open and closed eyes. At variance from controls, demented patients showed that both P2 and N3 components are significantly delayed with closed eyes while neither P1 nor N2 timings are affected. Control studies ruled out the possibility that such an outcome might depend on a defective pupillary responsiveness and/or an impaired sensitivity to luminance changes. On these grounds it is suggested that the effect of mode of stimulation on FVEP latency in demented patients is more likely to depend on "central" than on "peripheral" mechanisms. The dependence of latency changes on closure of the eyes seems to negate the direct effect of lesions upon visual structures and suggests an impairment of the modulatory action of non-visual afferents upon the activity of the visual cortex.

Risk Factors for Intracerebral Hemorrhage in a Pooled Prospective Study

Stroke, 2007

Background and Purpose— Few prospective studies have reported risk factors for intracerebral hemo... more Background and Purpose— Few prospective studies have reported risk factors for intracerebral hemorrhage (ICH), and results are inconsistent. We studied risk factors for ICH in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). Methods— The ARIC cohort was recruited in 1987 to 1989 and involves 15 792 men and women, aged 45 to 64 years at baseline, sampled from 4 US communities. The CHS cohort was recruited in 1989 to 1993 and involves 5888 men and women, aged 65 or over at baseline, sampled from 4 US communities. Baseline measurements included many potential vascular risk factors. The cohorts were followed for incident stroke events. Results— Over 263 489 person-years of follow-up, 135 incident ICH events occurred. In a multivariable model, age, African-American ethnicity (versus Whites), and hypertension were positively associated with incident ICH, whereas low-density lipoprotein cholesterol and triglycerides were inv...

Risk of recurrent stroke in patients with atrial fibrillation and non-valvular heart disease

Stroke, 1983

One-hundred-forty patients with atrial fibrillation (AF) due to non-rheumatic, non-valvular heart... more One-hundred-forty patients with atrial fibrillation (AF) due to non-rheumatic, non-valvular heart disease (NVHD) who suffered a cerebral infarct were identified. Fifty-three (38%) died of the initial stroke. The surviving patients were followed up to 9 years without anticoagulant therapy. In the 59 patients available for follow-up, the risk of recurrent cerebral ischemia remained at approximately 20% per year throughout the 9 year observation period. The recurrence rate was the same regardless of age, sex, previous myocardial infarction, or whether chronic AF or intermittent AF were present. Only 7 (12%) died from a second stroke, however. The high annual rate of recurrence and lack of controlled therapeutic trials in this population of patients warrant a prospective study to define the benefits and relative risks of anticoagulant therapy in AF due to NVHD.