Promoting health and preventing non-communicable diseases: evaluation of the adherence of the Italian population to the Mediterranean Diet by using the PREDIMED questionnaire.

Abstract: A health promotion program was conducted in the Veneto Region in Italy. Participants were screened for non-communicable diseases and were referred to the nutrition clinic. The aim of this study was to assess the adherence to the Mediterranean diet in the Italian population by using the "PREvención con DIeta MEDiterránea" questionnaire. The data showed that 63% of the participants were overweight, 57% presented hypercholesterolemia, 36% were hypertensive and 43% had high blood glucose levels. The results highlighted a low consumption of protective foods against non-communicable diseases such as fruit, vegetables, fresh fish, legumes and oily dried fruit. Overall, only 6% of the subjects who visited the nutritional clinic had the maximum adherence to the Mediterranean diet, 73% had an average adherence, followed by 21% with low adherence. Multivariable analysis between risk factors and socio-demographic characteristics and the adherence to Mediterranean diet revealed that male gender relates directly (p =0.002, AOR = 2.95) to a low adherence. There are three criteria in the questionnaire for a point in favour of Mediterranean diet which we believe to be inadequate, as they are not in accordance with the Italian guidelines for healthy eating. The "PREvención con DIeta MEDiterránea" questionnaire, if associated with a food frequency questionnaire or a food intake record, could become a useful tool for nutritional counseling in our Country.

Non-convulsive status epilepticus in brain tumors.

Epileptic seizures are very common in brain tumors, depending on histology and tumor site. In low-grade gliomas, it can be the only symptom reaching the 100% of incidence. Pathophysiology is multifactorial and still not perfectly understood. In a high percentage of cases, epilepsy is pharmacoresistant. Surgical resection of tumors can cure it. It happens more easily in low-grade gliomas, with a preoperative epilepsy evaluation, followed by a tailored surgery, not limited to lesionectomy, and including the peritumoral epileptic focus. In high-grade gliomas, postoperative epilepsy recurrence cannot only be due to tumor recurrence, but also to bad pharmacological compliance, or to pharmacoresistance. Seizures may be clustered in a non-convulsive status epilepticus. This condition must be recognized, because it may mimic a neurological worsening due to other reasons, as it presents with confusion, aphasia, and disorientation. EEG monitoring can help recognize the status. The treatment does not differ from that of non-convulsive status, due to other etiologies, but non-inducing AEDs are preferred.

Preserved memory in temporal lobe epilepsy patients after surgery for low-grade tumour. A pilot study.

The objective was to carry out a pilot study exploring memory outcome in patients with temporal lobe epilepsy (TLE) and low-grade tumour. A prospective study using a competence-related memory assessment was carried out in the Laboratory of Neuropsychology, Epilepsy Center and Neurosurgical Department of the "C. Besta" National Neurological Institute in 24 TLE patients undergoing surgical resection for left (n=12) or right (n=12) low-grade tumours and 36 healthy subjects. Patients underwent mesial or lateral temporal lobe lesionectomy. Neuropsychological tests exploring verbal and visual short-term memory, learning, delayed recall and ability to control interference in memory were applied. Before and after surgery, significant verbal impairment was present in left TLE patients compared to controls and right TLE patients, and visual deficits were present in both groups compared to controls. After surgery, there was no significant decrease in mean verbal or visual memory scores related to the operated side. Some memory abilities subserved by the contralateral temporal lobe improved. Postoperative memory scores were related to preoperative scores, side of operation, age and education. In patients with TLE and low-grade tumour, temporal lobe surgery does not necessarily induce memory deficits. Improvement of memory abilities subserved by the unoperated temporal lobe may be expected.

Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy.

The objective was to evaluate the outcome of microsurgical "pure" lesionectomy in patients with supratentorial cavernous angiomas presenting with seizures. For this retrospective study 163 patients with cavernoma-related epileptic seizures were selected. They all underwent surgery in a single institution between 1988 and 2003. A microsurgical frame/frameless guided minimally invasive transulcal "pure" lesionectomy was performed. The haemosiderin stained gliotic brain parenchyma that was usually found surrounding the lesion was not removed. Among the 99 patients with epilepsy and longer clinical history, 68 (68.7%) were found completely to be seizure-free, 10 (10.1%) presented sporadic and less frequent seizures and 17 (17.1%) remained unchanged. Sixty-three out of 64 (98.4%) patients who experienced only single or sporadic seizures were found to be completely seizure-free after surgery. Five patients were lost at follow-up (mean 48 months, range 0.5-14 years). Long-term morbidity was 1.8%. Mortality was null. No haemorrhagic episodes were observed during follow-up. Pure lesionectomy prevents bleeding and development of epilepsy in patients that receive early surgery after the epileptic onset. In most of the epileptic patients with a good concordance between the electroclinical data and the location of the angioma, good results can be achieved by this kind of surgery so that more invasive and costly studies to find and remove the epileptogenic cerebral parenchyma seem justified only after lesionectomy fails.

Rasmussen's encephalitis: early characteristics allow diagnosis.

OBJECTIVE: To identify early manifestations of Rasmussen encephalitis (RE) that can prompt early and reasonably secure diagnosis, allowing medical or surgical therapies at an early stage when they may be more effective in slowing the disease. METHODS: The authors studied 12 patients with clinical and neuropathologic diagnosis of RE, followed from disease onset, assessing clinical history, imaging, and EEG and focusing on early characteristics. Anti-GluR3 antibody assays were also considered in 11 patients. RESULTS: By 4 months from first symptoms, all cases had 1) refractory focal seizures with a predominant motor component, 2) slow focal activity on EEG contralateral to the motor manifestations, and 3) focal contralateral white matter hyperintensity with insular cortical atrophy on neuroimaging. Less constant or later findings were epilepsia partialis continua, oligoclonal bands, and serum anti-GluR3 antibodies. CONCLUSIONS: The association of partial seizures with focal EEG and neuroimaging changes allows a tentative diagnosis of RE 4 to 6 months after first symptoms.

Clinical and molecular findings in the first identified Italian family with dentatorubral-pallidoluysian atrophy.

OBJECTIVES: Dentatorubral-pallidoluysian atrophy (DRPLA) is a rare autosomal dominant neurodegenerative disorder mostly observed in Japan, rarely reported in American and North European populations. The aim of this study is to characterize the clinical and molecular features of the first identified Italian DRPLA family. PATIENTS AND METHODS: We describe a 33-year-old female presenting with ataxia, intellectual decline, epilepsy, and choreoathetosis with an adult age onset. Genomic DNA was isolated from peripheral blood lymphocytes of the patient and of her healthy family members following standard procedures. Molecular tests were performed including genetic analysis for SCA1, 2, and 3 (spinocerebellar ataxias), Huntington's disease (HD) and DRPLA, due to a possible overlapping in clinical presentation. RESULTS: Molecular analysis revealed in our patient the presence of a pathological CAG expansion within the DRPLA gene. We have also documented the presence of a smaller CAG expansion in her apparently healthy brother, excluding the possibility of a de novo mutation. CONCLUSION: We conclude that both siblings may have inherited the molecular lesion from their deceased father, the mother being normal at molecular evaluation. Our kindred and a previously reported family from the island of Malta suggest that hereditary DRPLA may also be present in the Mediterranean area.

Lesionectomy in epileptogenic temporal lobe lesions: preoperative seizure course and postoperative outcome.

A series of 54 patients operated on for temporal epileptogenic lesions is reported: 36 had slow growing tumours, 18 supratentorial cavernous angiomas. The patients were divided into two different groups according to the presence of seizures controlled (group 1) or not controlled (group 2) by antiepileptic drugs (AEDs). All the patients underwent preoperative scalp EEG and magnetic resonance imaging (MRI). They were operated on by pure lesionectomy, associated with amygdalo-hippocampectomy in 8 cases of uncontrolled seizures. Postoperatively they underwent MRI examination which revealed an incomplete lesionectomy in 12 cases. Patients were followed up after surgery for at least 2 years, 6 of them were reoperated on for the persistence (or regrowth) of the tumour. The results of epilepsy outcome are reported. These cases underline the importance of preoperative electroclinical study, in order to determine the relationship between lesion location and epileptic focus. If good concordance is present, a complete lesionectomy is enough to cure the patient. In other cases associated amygdalo-hippocampectomy leads to better results, while more complicated cases may need preoperative stereo-EEG studies.

Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome.

OBJECTIVE: Patients operated on for supratentorial cavernous angiomas were studied to define the incidence and the course of seizures in their clinical history. Electroclinical and neuroradiological data were correlated with the location of cavernomas. The impact of lesionectomy on the outcome of seizures was evaluated. METHODS: Preoperative clinical data on the history of the seizures, semeiology, incidence, severity, and response to antiepileptic drugs were analyzed. The location of the cavernomas, revealed by magnetic resonance imaging, was correlated with electroencephalographic and clinical data. Postoperative clinical and neuroradiological data were evaluated, with particular consideration to the outcome of the seizures, antiepileptic drug withdrawal, and the completeness of the lesion excision. RESULTS: A higher incidence of severe epilepsy was observed in the patients with mesiotemporal and cortical angiomas. In most of the patients (78.7%), a good concordance between the site of the lesion and the electroclinical data was found. The complete removal of the lesion led to a favorable outcome, with discontinuation of antiepileptic drugs achieved in one-quarter of the patients. CONCLUSION: A high percentage of patients with cortical cavernomas had epileptic seizures. They often presented with chronic intractable epilepsy (44.7% in our series). In cases of good concordance between the electroclinical data and the location of the angioma, complete lesionectomy led to the disappearance of seizures. Removal of the hemosiderin ring did not correlate with better outcome. Preoperative ictal scalp recordings to assess the topographic relationship between the cavernoma and the epileptic seizures could improve outcome, which suggests different surgical strategies (lesionectomy versus enlarged resection) in patients without a clear-cut concordance between the site of the lesion and the ictal semeiology.

Visual learning on a selective reminding procedure and delayed recall in patients with temporal lobe epilepsy.

We administered a visual selective reminding procedure for the learning of designs to healthy controls and to left or right temporal lobe epilepsy (TLE) patients without demonstrable brain lesions. In comparison with the other groups, right TLE patients showed a deficit of learning characterized by an impairment in storing visual material and consistently retrieving it from long-term memory. Patients with left TLE performed similarly to controls. These data are consistent with the hypothesis of right hippocampal involvement in the learning of nonverbal material. Delayed retrieval of learned material was similar in all the subject groups tested at long time intervals, suggesting the impairment of learning in patients with right TLE does not necessarily imply a subsequent deficit in the retrieval of stored information. This finding may agree with the opinion that distinct functional systems subserve learning and memory.

Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours.

One hundred and twenty-eight adult patients presenting with and operated on for supratentorial neoplasms were studied. Sixty-five had preoperative seizures and were treated with antiepileptic drugs (AEDs). Among the 63 patients without preoperative epileptic fits, 41 were given AEDs (either phenobarbital or phenytoin) as prophylactic treatment and 22 were not treated. The preoperative epilepsy course was considered with respect to tumour site and histological type. Early and late postoperative seizure occurrence was considered in the different groups of patients. The results suggest the usefulness of a short term preventive treatment with AEDs after surgery in patients without preoperative seizures. In patients with preoperative epilepsy, AEDs should be continued after surgery. However long-term AEDs treatment should not be recommended in patients without preoperative epilepsy. In fact, no significant difference in late seizure occurrence was found between preventively treated and untreated patients.

Epilepsy course in cerebral gangliogliomas: a study of 16 cases.

From November 1979 to March 1988, 16 patients with cerebral gangliogliomas were investigated and underwent surgery at the Institute Neurologico "C. Besta" of Milan. Their age varied from 11 to 48 years. 15 of these patients presented with a seizure as the first and often the only neurological symptom. This report deals with the epileptologic and neuroradiologic features of these patients before and after surgical treatment.

Oculomotor disorders in cortical lesions in man: the role of unilateral neglect.

The saccades of 22 patients with lesions of the left (6) and right (16) hemisphere were analysed. Seven patients with a right hemispheric lesion presented a left unilateral neglect (UN) syndrome. In the first test session the saccades were performed in response to a predicted sequence of targets; in the second session the luminous stimuli were unpredicted and randomized. In patients with UN we observed the absence of saccadic response to 25% of the targets a lengthening of the reaction time and a staircase pattern in the left hemifield. In the predicted stimulus sequence the oculomotor performance was not significantly better. Hemianopia, a defect of arousal and an altered visuospatial orientation are the most important elements that account for the alterations of oculomotor strategy in the UN syndrome.

Oculomotor disturbances in Balint's syndrome: anatomoclinical findings and electrooculographic analysis in a case.

A 67-year-old man had repeated cerebral ischemic attacks, which resulted in a clinical picture combining paralysis of visual fixation, optic ataxia and impairment of visuospatial orientation, consistent with the definition of Balint's syndrome. Postmortem examination showed multiple lesions involving the occipital cortex of both sides and the white matter underlying the right insular cortex. EOG recording demonstrated a marked impairment of refixation saccades and saccades on verbal command. Smooth pursuit movements were completely abolished. Visual fixation was randomly achieved after many erratic exploratory movements and steadily maintained on the target (spasmodic fixation). During spasmodic fixation, EOG recording detected an ocular flicker resulting in a continuous instability of eye position. It is suggested that these findings may all be accounted for by the loss of panoramic vision due to a bilateral impairment of cortical areas 18 and 19.