Neurophysiology of the pelvic floor in clinical practice: a systematic literature review.

Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.

Autonomic nerve dysfunction in pathologically obese patients.

BACKGROUND: Obese patients frequently present clinical symptoms related to gastrointestinal motility alterations and autonomic nervous system dysfunction. AIM: To evaluate the possible correlation between cardiovascular autonomic nervous dysfunction and oesophageal motility in pathologically obese patients. PATIENTS AND METHODS: Enrolled in the study were 22 patients with a body mass index of 45.72 +/- 7.48 and 10 control subjects, all within 20% of their ideal weight. Oesophageal motility was measured by stationary manometry and scintigraphic transit. Tests for the evaluation of autonomic nervous system were: Valsalva ratio, deep breathing, sustained handgrip, sudormotor axon reflex test and spectral analysis of the variability of R-R interval. RESULTS: The mean pressure of oesophageal peristaltic waves in patients and controls was 39.36 +/- 14 mmHg and 73 +/- 12 mmHg, respectively The scintigraphic mean transit time was 22.96 +/- 16.26 seconds in patients and 10.23 +/- 16.26 seconds in controls (p < 0.001). Spectral analysis of the variability of the R-R interval showed an increase in the parasympathetic component both in the lying and standing position compared to controls. The other autonomic nervous system function tests showed no significant difference between obese patients and controls. CONCLUSIONS: These results suggest that obese patients present a reduction of oesophageal transit and autonomic nervous system dysfunction albeit no direct correlation was found between these phenomena.

Ability and fitness to drive of Parkinson's disease patients.

The authors review reports in the literature on the fitness and ability to drive of neurosurgical patients and subjects afflicted by neurological disorders, before focusing on their own series of 204 idiopathic Parkinson's disease (PD) patients. The study sample comprised 173 men and 31 women (average age 70.6 and 74.2 years, respectively) of whom 51, for various reasons, still drove (albeit only short distances). Different variables were examined (Hoehn & Yahr scale values (of the total group and of the subgroup of active drivers), scores for various clinical diseases, and so on) looking for an association between these variables and the number of accidents incurred by PD patients as compared with the healthy population and with a control group of healthy age-matched subjects (ISTAT data). The need for adequate legislation on driving in PD emerges clearly and recommendations are given on which such legislation might be based.

[Nonpsychotic involutional inhibited depressions and psycho-organic deteriorations: treatment with Viloxazine and piracetam]. / Depressioni involutive, inibite, non psicotiche e decadimenti psico-organici: trattamento con viloxazina e piracetam.

Involutional depression is often the first symptom of a psycho-organic syndrome or dementia and may not present overt symptoms itself; these depressive states have been variously classified by different schools in various countries. The hypothesis of catecholamine and indolamine in the aetiopathogenic agent is oversimplistic and the theory that abnormal receptor hypersensitivity is the cause of the condition is more convincing. On the basis of this hypothesis numerous studies have been conducted into the efficacy of various antidepressants in the treatment of this hypersensitivity. Involutional depressions are more common among women and are found in about 10% of 60-65 year olds. This report claims that combined viloxazine-piracetam is the most appropriate treatment for involutional depression. This approach (200 mg oral viloxazine and 9 g oral piracetam a day) was adopted for 3 months in 33 out patients about 64 years old who were subsequently put on maintenance doses (100 mg viloxazine, 3 g piracetam a day). The various Hamilton scale parameters were assessed as were reaction times to auditory and visual simple stimuli. Result sat the start and end of treatment were then compared. About three quarters of the patients showed improvement in both depression and psycho-organic syndrome symptoms, while total remission or lasting improvement in both pathologies was obtained in about 50%.

Operatory indications and licence of craniostenosis.

On average 0.04% of the population is affected by craniostenosis. It is believed there are anatomo-clinical forms at moderate risk and others at high risk. The neurosurgical indications are very different according to various Authors. The forms at high risk which are caused by an isolated synostosis of the coronal system with brachicephalia are either associated to other synostosis (oxicephalia) or to facial synostosis should always be operated, with various techniques, within the first 6 months of life. Basing on the experience of 3 cases of craniostenosis, deliberately not operated on, followed and controlled for over 20 years from the decision of not to operate, all in excellent general condition both neurological and psychiatric, the Authors consider and discuss the criteria of surgical indications with particular regard to clinical objectivity (implicity disregarding a precise value of the craniometric data).

[Neurotraumatology and post-traumatic epilepsy. Prevention, treatment and long-term follow-up. Barbexaclone + phenobarbital (maliasin) versus diphenylhydantoin, phenobarbital, primidone, carbamazepine]. / Neurotraumatologia ed epilessia post-traumatica. Profilassi, trattamento e follow-up a lunga distanza. Barbesaclone + PB ("maliasin") vs difenilidantoina, phenobarbital, primidone, carbamazepina.

A report is presented on 58 patients (46 males, 12 females) all suffering from post-traumatic epilepsy (PTE) and followed up for a minimum of 1 year to maximum of 23 years after the injury (mean 6.3 years). The type and site of the head injury, the nature of the brain lesions, the time elapsing before the first critical manifestation, the clinical character of the epileptic attacks, EEG, cerebral CAT and RMN data were performed are given for all patients. The therapeutic and prophylactic strategies adopted are then described in detail with particular emphasis on the use of diphenylhydantoin (DPH) and barbexaclone. The latter drug, used for the last 3 years was found to be particularly useful in the treatment of patients suffering from a post-traumatic psycho-organic syndrome in addition to the PTE.