Papers by Stefania Kalampokini
Journal of Clinical Medicine
Introduction: Chronic pain is increasingly recognized as part of long COVID syndrome, mainly in t... more Introduction: Chronic pain is increasingly recognized as part of long COVID syndrome, mainly in the form of myalgias. However, chronic pain has several forms, and according to our clinical experience, COVID-19 survivors suffer from numerous painful syndromes, other than myalgias. The aim of our study was to estimate the prevalence of chronic pain, describe the commonest painful syndromes and identify pain determinants in a random population of COVID-19 survivors. Methods: This was a cross-sectional study conducted at the Medical School, University of Cyprus. A random population of 90 COVID-19 survivors was recruited. Demographic and COVID-19 related clinical characteristics were recorded. The painDETECT and DN4 questionnaires were used to evaluate the painful syndromes. Results: The prevalence of chronic pain was estimated to be 63.3%. The most common site of pain was low back (37.8%), followed by joints (28.9%) and neck (12.2%). Patients with chronic pain compared to subjects witho...
Acta Neurologica Scandinavica
Supplemental Material, Tables_carer_paper_JGPN_suppl for Caregiver Burden in Late-Stage Parkinson... more Supplemental Material, Tables_carer_paper_JGPN_suppl for Caregiver Burden in Late-Stage Parkinsonism and Its Associations by Stefania Kalampokini, Adrianus L. A. J. Hommel, Stefan Lorenzl, Joaquim J. Ferreira, Wassilios G. Meissner, Per Odin, Bastiaan R. Bloem, Richard Dodel, Anette-Eleonore Schrag and the CLaSP consortium in Journal of Geriatric Psychiatry and Neurology
Journal of Geriatric Psychiatry and Neurology, 2020
Background: Patients in the late stages of parkinsonism are highly dependent on others in their s... more Background: Patients in the late stages of parkinsonism are highly dependent on others in their self-care and activities of daily living. However, few studies have assessed the physical, psychological and social consequences of caring for a person with late-stage parkinsonism. Patients and methods: Five hundred and six patients and their caregivers from the Care of Late Stage Parkinsonism (CLaSP) study were included. Patients’ motor and non-motor symptoms were assessed using the UPDRS and Non-motor symptom scale (NMSS), Neuropsychiatric inventory (NPI-12), and caregivers’ health status using the EQ-5D-3 L. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). Results: The majority of caregivers were the spouse or life partner (71.2%), and were living with the patient at home (67%). Approximately half of caregivers reported anxiety/depression and pain/discomfort (45% and 59% respectively). The factors most strongly associated with caregiver burden were patients’ neuropsy...
Clinical Neurology and Neurosurgery, 2021
INTRODUCTION Fahr's syndrome due to hypoparathyroidism refers to bilateral basal ganglia (BG)... more INTRODUCTION Fahr's syndrome due to hypoparathyroidism refers to bilateral basal ganglia (BG) calcifications and manifests with movement disorders, seizures, cognitive and behavioral symptoms. CASE PRESENTATION We report a case of a 74-year-old woman, who presented with parkinsonism due to post-surgical hypoparathyroidism and normal DaT scan, despite extensive calcifications of the BG, periventricular white matter, and cerebellum. METHODS A comprehensive literature review of all reported cases of Fahr's syndrome due to hypoparathyroidism was conducted in the electronic databases PubMed and Web of science. Moreover, demographic and clinical characteristics of the patients overall were calculated and associated with radiological findings. RESULTS We reviewed a total of 223 cases with Fahr's syndrome due to hypoparathyroidism (124 female, 99 male). Mean age on presentation was 44.6 ± 17.7 years. Thirty nine percent of patients had idiopathic hypoparathyroidism, 35.4 % acquired and 25.6 % pseudohypoparathyroidism. Almost half of the patients had tetany, seizures or a movement disorder and approximately 40 % neuropsychiatric symptoms. The patients with a movement disorder had a 2.23 likelihood of having neuropsychiatric symptoms as well (OR 2.23, 95 % CI 1.29-3.87). Moreover, there was a statistically significant association between the phenotype severity (i.e. the presence of more than one symptom) and the extent of brain calcifications (χ2 = 32.383, p = 0.009). CONCLUSION Fahr's syndrome is a rare disorder, which nonetheless manifests with several neurological symptoms. A head CT should be considered for patients with hypoparathyroidism and neurological symptoms. More studies using DaT scan are needed to elucidate the effects of calcifications on the dopaminergic function of the BG.
Movement Disorders, 2021
tiate between PSP and PD patients in the early stages of the disease, when amarked cognitive decl... more tiate between PSP and PD patients in the early stages of the disease, when amarked cognitive decline in PD is usually absent. Finally, it is possible that some patients with normal pressure hydrocephalus (NPH) could have been misdiagnosed as PD and included in the small PD cohort by Rau et al. This hypothesis is supported by a high variability of the 3V width values measured in their PD group (mean 9.61 3.91 mm; range 3– 21 mm), suggesting a heterogenous cohort including some patients with very small 3V and others with massive ventricular dilation. In our experience with MRI measurements, such large 3V width values were never found in PD but only in patients with ventriculomegaly, mainly caused by NPH or PSP. We believe that patients who are suspected of having PD showing marked third ventricle enlargement should undergo additional diagnostic procedures to exclude NPH misdiagnosis or comorbidity before being included in research studies.
Clinical Neurology and Neurosurgery, 2021
BACKGROUND Osmotic demyelination syndrome (ODS), which embraces central pontine and extrapontine ... more BACKGROUND Osmotic demyelination syndrome (ODS), which embraces central pontine and extrapontine myelinolysis, is an uncommon neurological disorder that occurs due to plasma osmotic changes. CASE PRESENTATION We present the case of a 55-year-old man, who presented with severe hyponatremia due to repeated vomiting, antidepressant treatment and consumption of large amounts of water. Fifteen days after sodium correction, the patient showed fluctuation of vigilance, dysarthria and dysphagia, tremor, cogwheel rigidity, bilateral facial palsy, ophthalmoplegia and tetraparesis. A brain MRI scan revealed extrapontine and later on pontine myelinolysis. He received intravenous steroids and subsequently immunoglobulin. His status began to improve gradually after completion of immunoglobulin and at three month-follow-up had no neurological deficit. LITERATURE REVIEW A comprehensive literature search of all reported ODS cases that received immunoglobulin, steroids or plasmapheresis was conducted in the electronic databases PubMed and Web of science. CONCLUSIONS Improvement was seen in most cases that received immunoglobulin either during treatment or in the first days after treatment. With regard to steroids, although most cases reported improvement in the following months their effect on the outcome is unclear. Most cases treated with plasmapheresis reported favorable outcome at variable follow-up time. Immunoglobulin and steroids have immunomodulatory effects, which could contribute to promotion of myelin repair in ODS. Plasmapheresis has effects on the immune system beyond removing myelinotoxins from the circulation. More evidence is required to support their use in ODS. However, in view of the disease severity, these therapeutic choices should be considered in the clinical management of ODS.
Clinical Neurology and Neurosurgery, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Neurobiology of Aging, 2019
It is unclear whether alterations in cerebral pH underlie Alzheimer's disease (AD) and other deme... more It is unclear whether alterations in cerebral pH underlie Alzheimer's disease (AD) and other dementias. We performed proton spectroscopy after oral administration of histidine in healthy young and elderly persons and in patients with mild cognitive impairment and dementia (total N ¼ 147). We measured cerebral tissue pH and ratios of common brain metabolites in relation to phosphocreatine and creatine (Cr) in spectra acquired from the hippocampus, the white matter (WM) of the centrum semiovale, and the cerebellum. Hippocampal pH was inversely associated with age in healthy participants but did not differ between patients and controls. WM pH was low in AD and, to a lesser extent, mild cognitive impairment but not in frontotemporal dementia spectrum disorders and pure vascular dementia. Furthermore, WM pH provided incremental diagnostic value in addition to N-acetylaspartate to Cr ratio. Our study suggests that in vivo assessment of pH may be a useful marker for the differentiation between AD and other types of dementia.
Parkinson's Disease, 2019
Neuroinflammation is increasingly recognized as an important pathophysiological feature of neurod... more Neuroinflammation is increasingly recognized as an important pathophysiological feature of neurodegenerative diseases such as Parkinson’s disease (PD). Recent evidence suggests that neuroinflammation in PD might originate in the intestine and the bidirectional communication between the central and enteric nervous system, the so-called “gut-brain axis,” has received growing attention due to its contribution to the pathogenesis of neurological disorders. Diet targets mediators of inflammation with various mechanisms and combined with dopaminergic treatment can exert various beneficial effects in PD. Food-based therapies may favorably modulate gut microbiota composition and enhance the intestinal epithelial integrity or decrease the proinflammatory response by direct effects on immune cells. Diets rich in pre- and probiotics, polyunsaturated fatty acids, phenols including flavonoids, and vitamins, such as the Mediterranean diet or a plant-based diet, may attenuate chronic inflammation ...
PLOS ONE, 2015
Background Findings of behavioral studies on facial emotion recognition in Parkinson's disease (P... more Background Findings of behavioral studies on facial emotion recognition in Parkinson's disease (PD) are very heterogeneous. Therefore, the present investigation additionally used functional magnetic resonance imaging (fMRI) in order to compare brain activation during emotion perception between PD patients and healthy controls. Methods and Findings We included 17 nonmedicated, nondemented PD patients suffering from mild to moderate symptoms and 22 healthy controls. The participants were shown pictures of facial expressions depicting disgust, fear, sadness, and anger and they answered scales for the assessment of affective traits. The patients did not report lowered intensities for the displayed target emotions, and showed a comparable rating accuracy as the control participants. The questionnaire scores did not differ between patients and controls. The fMRI data showed similar activation in both groups except for a generally stronger recruitment of somatosensory regions in the patients. Conclusions Since somatosensory cortices are involved in the simulation of an observed emotion, which constitutes an important mechanism for emotion recognition, future studies should focus on activation changes within this region during the course of disease.
Neurology, 2012
A 26-year-old woman with a history of epilepsy presented with an acute onset of aphasia and verti... more A 26-year-old woman with a history of epilepsy presented with an acute onset of aphasia and vertigo followed by headache and right periumbilical paresthesia. MRI was performed to rule out stroke and revealed subependymal heterotopia 1 (figure 1), which is associated with epilepsy. In addition, diffusion-weighted imaging (DWI) showed restricted diffusion in the left occipital cortex and the heterotopic nodules (figure 2). DWI changes completely resolved in 48-hour follow-up imaging. Whereas the transient cortical and subcortical diffusion restriction is a known signal change in epilepsy, 2 this case presents novel peri-ictal restricted diffusion in heterotopic gray matter.
Aktuelle Neurologie, 2005
International Journal of Molecular Sciences, 2021
Mutations in the gene encoding amyloid precursor protein (APP) cause autosomal dominant inherited... more Mutations in the gene encoding amyloid precursor protein (APP) cause autosomal dominant inherited Alzheimer’s disease (AD). We present a case of a 68-year-old female who presented with epileptic seizures, neuropsychiatric symptoms and progressive memory decline and was found to carry a novel APP variant, c.2062T>G pLeu688Val. A comprehensive literature review of all reported cases of AD due to APP mutations was performed in PubMed and Web of Science databases. We reviewed 98 studies with a total of 385 cases. The mean age of disease onset was 51.3 ± 8.3 (31–80 years). Mutations were most often located in exons 17 (80.8%) and 16 (12.2%). The most common symptoms were dementia, visuospatial symptoms, aphasia, epilepsy and psychiatric symptoms. Mutations in the β-amyloid region, and specifically exon 17, were associated with high pathogenicity and a younger age of disease onset. We describe the second reported APP mutation in the Greek population. APP mutations may act variably on d...
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Papers by Stefania Kalampokini