Normal pressure hydrocephalus: Neurophysiological and neuropsychological aspects: a narrative review.

ABSTRACT: Idiopathic normal pressure hydrocephalus (NPH) is a syndrome that affects elderly people and is characterized by excessive accumulation of cerebrospinal fluid in the brain ventricles. Diagnosis is based on the evaluation of clinical symptoms, which consists of a classic triad (Hakim triad), gait disturbances, cognitive impairment, and urinary incontinence. However, this complete triad is not always seen; therefore, it is difficult to make the diagnosis. NPH can be divided into primary or idiopathic NPH and secondary NPH. Diagnostic criteria for NPH remain a topic of discussion; however, the development of diagnostic techniques has brought new opportunities for diagnosis. The aim of this review is to present an overview of neurophysiological and neuropsychological approaches to support the clinical evaluation of patients with NPH and contribute to the differential diagnosis of NPH and dementia, as the clinical symptoms of NPH may resemble other neurodegenerative disorders.

Psychological well-being in people with multiple sclerosis: a descriptive review of the effects obtained with mindfulness interventions.

Multiple sclerosis is a neuroinflammatory and neurodegenerative disease causing several psychosocial problems that significantly impairs quality of life. The most common physical and mental symptoms are anxiety, depression, stress, fatigue, and pain. Several studies investigated the effectiveness of non-pharmacological approaches in improving psychological well-being. This review focused on the impact of mindfulness interventions in patients with multiple sclerosis to reduce psychopathological symptoms and improve well-being. We searched on PubMed database and screening references of included studies and review articles for additional citations. From initial 107 studies, only 8 met search criteria. Our studies showed the efficacy of mindfulness treatment with a reduction in depressive symptoms, a better quality of life (both mental and physical), and a decreased level of fatigue. Findings demonstrated that mindfulness is useful for the improvement of psychological symptoms and pain management and this improvement has also been shown to have a positive impact on the quality of life and coping and adaptation strategies. However, according to the poor available clinics evidence, on cannot conclude that mindfulness interventions are superior to other active interventions in the treatment of psychological symptoms of SM.

Case report of anosognosia for hemiplegia: A fMRI study.

OBJECTIVE: The aim of this study is to verify the functional activation in a patient with anosognosia for hemiplegia following left brain lesions. METHODS: We report a case of a 53-year-old right-handed female patient. She came to our rehabilitative unit with a diagnosis of an ischemic major stroke in the left internal carotid artery and important hemiplegia to the right side. She underwent functional magnetic resonance imaging (fMRI), during which she performed a motor imagery task. RESULTS: The fMRI assessment showed an ischemic lesion in the frontotemporal and insular left areas. In the fMRI experiment, we revealed activation of the residual neural patterns of both hemispheres. CONCLUSION: We underlined an interest in the compensation mechanism that involved neural networks near brain lesions and some areas of the contro-lesional hemisphere, suggesting that the synaptic plasticity permitted an intra and inter-hemispheric reorganization of the cerebral system.

Analgesic hypnotic treatment in a post-stroke patient.

In recent years, hypnotic suggestions have been used in several clinical conditions. This treatment is often used for anxiety treatment, somatization, and post-traumatic stress disorder. Hypnotic analgesia is one of the most clinically useful phenomena of hypnosis. The article describes the case of a patient who underwent hypnotic treatments for hypersensitivity and chronic pain. Results showed an improvement of pain control and a decrease of pain hypersensibility. In addition, during rehabilitative treatments, the patient reported a high level of compliance with the multidisciplinary team. These findings suggest that hypnosis could be a useful treatment for post-stroke pain management.

Neurophysiological assessment in a patient affected by Marfan syndrome.

BACKGROUND: Marfan syndrome (MS) is a hereditary connective tissue disorder characterized by different multiorgan patterns. The guidelines for MS diagnosis do not highlight the usefulness-or even the use-of any neurophysiological techniques for diagnosing this disease. Moreover, few neurophysiological studies assessing the central and peripheral nervous systems in MS subjects have been reported to date.Case presentation: We describe a male patient affected by MS. To assess sensory and nociceptive pathways in this patient, a neurophysiological assessment was performed using electroencephalogram, nerve conduction studies, and somatosensory and laser-evoked potentials. To the best of our knowledge, this is the first published case report to evaluate the role of evoked potential assessments for the study of sensory and nociceptive pathways in MS. CONCLUSION: Future studies should investigate the use of a complete neurophysiological approach for the clinical and therapeutic management of MS patients in a large sample.

Factors related to cognitive reserve among caregivers of severe acquired brain injury.

Stroke is one of the severe cause of motor and cognitive disabilities. These type of disabilities occurred a strong impact on whole family system. Caregiver burden may determine in relatives of patients with brain injury a decreasement of mental and physical health. The present study aims to better clarify the mechanism through which chronic stress influence caregivers' cognitive functioning and how the psychological and cognitive resources may represent as a predictive factor. Caregivers were submitted to neuropsychological tests that evaluated level of mental health ad level of burden. Our results showed a significant correlation between cognitive reserve and self-efficacy skills in health care of patients. Findings suggested that the caregiver burden and the level of general distress influenced the cognitive performance. An improvement of cognitive functions is associated with a reduction of self-efficacy skills, causing a caregiver burden improvement.

Neuropsychological assessment and clinical evaluation in temporal lobe epilepsy with associated cortical dysplasia.

Temporal Lobe Epilepsy (TLE) is a chronic neurological disorder, often associated to cognitive deficits. Focal cortical dysplasia (FCD), frequently associated to high risk of epilepsy, can lead to abnormalities in cognition. The aim of this study was to explore neuropsychological performance and to identify potential risk factors for cognitive impairment in TLE subjects with associated FCD. Our sample was composed by 46 TLE patients with FCD (37.76 ± 12.60 years; 29 females and 16 males) and 44 healthy controls (41.05 ± 9.74 years; 25 females and 19 males). All subjects performed a neuropsychological battery associated to a measurement of depression and anxiety. Results showed a poor performance of all domains of cognitive functioning and identified age of epilepsy onset as potential risk factor of cognitive impairment. These findings support the importance to focus on cognitive impairment in TLE patients with FCD to better clarify the impact of epilepsy features and FCD in therapeutic and everyday management.

Role of visual P300 in cognitive assessment of subacute stroke patients: a longitudinal study.

Aim: The aim of this study was to assess if pre- and post- event related potentials (ERPs) components after visual stimulation training admitted differences exist in subacute stroke patients and to observe the outcome markers of cognitive functions recovery by using Neurowave system.Materials and Methods: Eighteen ischemic subacute stroke patients were enrolled and underwent to neuropsychological evaluation and ERPs recording at two time points, at baseline (T0) and after 3 months from (T1). All patients were stimulated with customized images for three days a week.Findings: Intra group analysis showed a significance difference in ERPs parameters and neuropsychological tests. Correlation analysis showed a significant relation between neuropsychological and ERP values.Conclusion: Our findings confirm that P300 ERPs' component could be a predictive marker for cognitive recovery of ischemic subacute stroke patients. Intensive programs of neurosensory stimulation could facilitate recovery of cognitive and attentive functions in subacute cerebrovascular disease.

Quantitative assessment of Parkinsonian tremor by using biosensor device.

Parkinson disease (PD) is the second most common neurodegenerative disease which affects population older than 65 years. Tremor represents one of the main symptomatic triads in PD, particularly in rest state.We enrolled 41 idiopathic PD patients, to validate the assessment of tremor symptoms.To be enrolled in the study, patients had to fulfill the movement disorder society clinical diagnostic criteria for PD.We used an innovative home-made, low-cost device, able to quantify the frequency and amplitude of rest tremor and stress conditionOur results confirmed the presence of tremor during muscular effort in a significant number of patients and the influence of emotional stress.We suppose that this new device should be validated in clinical practice as a support of differential diagnosis and therapeutic management of PD patients.

fMRI and electroencephalographic evaluation of sleep deprivation in epilepsy patients: An observational study.

BACKGROUND: Sleep deprivation (SD) is considered an important activation test to facilitate the visualization of electroencephalogram (EEG) epileptic abnormalities, in order to perform a correct diagnosis. OBJECTIVE: The aim of this study was to evaluate the local functional activity in healthy controls (HC) subjects and left mesial temporal lobe epilepsy-hippocampal sclerosis patients, after a SD, by using functional Magnetic Resonance Imaging (fMRI) and EEG. MATERIALS AND METHODS: We enrolled 22 healthy controls and 34 patients with a diagnosis of left mesial temporal lobe epilepsy-hippocampal sclerosis. Each participant underwent two examinations separately: an fMRI study using 3 T MRI to detect spontaneous activity during the RS-fMRI and an EEG. RESULTS: The SD-EEG results showed the presence of epileptiform discharges predominantly in left fronto-centro-temporal areas. fMRI findings if compared to HC showed an increase of functional activity in some areas. DISCUSSION: We showed that SD-EEG study confirmed a high specificity to assess a specific diagnosis. Therefore, the decrease of activity observed in DMN could be explain by a different amount of sleep/awake time during fMRI recording in the two groups or the interictal activity during fMRI acquisition. Our study highlighted alterated functional activity in SD cortical areas of epileptic patients if compared to HC.

A multidisciplinary approach to assess recovery of consciousness in a patient with moyamoya disease.

INTRODUCTION: Moyamoya disease (MMD) meaning "hazy puff of smoke" in Japanese is a rare chronic cerebrovascular syndrome characterized by progressive stenosis and occlusion of the internal carotid arteries (ICAs) anterior cerebral arteries (ACAs), and middle cerebral arteries (MCAs). METHODS: Our moyamoya patient with severely impaired cognitive and motor functions underwent a specific motor and neuropsychological rehabilitative treatments to assess the recovery of consciousness. RESULTS: Results obtained showed an improvement of clinical and neuropsychological examination. These findings highlighted the importance of an intensive rehabilitation techniques used in the care of disorders of consciousness patients. CONCLUSIONS: The use of sensory methods provides advantages for the rehabilitation. In fact, in this study, we showed a correlation between sensory stimulation and changes in patient's clinical status.

Motor imagery in stroke patients: a descriptive review on a multidimensional ability.

Purpose/aim: Motor imagery (MI) is the mental representation of a movement without engaging its actual execution. MI shares neuroanatomical correlates with brain motor networks. Neurologic disorders affecting motor skills, such as stroke, have been related to impairments in MI. A descriptive review was conducted to explore the effects of stroke on MI ability and its background mechanisms. Materials and Methods: We searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. Results: On a total of 885 studies, only 15 articles met inclusion criteria. Results suggested that MI is impaired after stroke, in implicit and explicit abilities. Impairments in mental chronometry as well as in accuracy and reaction times were observed. Conclusions: Neuroimaging findings confirmed a brain reorganization after a stroke and a compensatory over-usage of contralesional hemisphere was highlighted.

The value of midbrain morphology in predicting prognosis in chronic disorders of consciousness: A preliminary ultrasound study.

Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation. All the patients showed an increase of pulsatility index and numerous morphological alterations on all the scan planes. In particular, we found a loss of the characteristic butterfly-shape of the midbrain, which appeared hypoechoic in the UWS but not in the MCS patients. After six months, the patients were clinically assessed by using Glasgow Outcome Scale Extended (GOSE). We found that a higher increase in GOSE scoring at follow-up was correlated with larger area and higher echogenicity of the midbrain at baseline. The present study suggests that TCS data of the midbrain may support clinical assessment of patients with chronic DOC to estimate their outcome.