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1.
Neurol Sci ; 45(1): 203-211, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37507617

RESUMO

AIM: To describe different referral strategies for acute ischemic stroke (AIS) patients in a Hub-Spoke emergency stroke network with their incidence, time metrics and related outcomes. METHODS: Referral paradigms were defined as follows: primary transfer to the comprehensive stroke center (CSC) from a remote region, called mothership (MS); secondary transfer to the CSC from a primary stroke center where intravenous thrombolysis was available, called drip and ship (DS); secondary transfer to the CSC from a community hospital where no reperfusion therapy was available, called ship and drip (SD); primary transfer to the CSC from its catchment area, called direct CSC (dCSC). RESULTS: Among 517 anterior circulation AIS patients treated with mechanical thrombectomy between 2015 and 2020, 16.6% of them were SD, in addition to the well-known referral paradigms of MS (21.8%) and DS (18.1%). This rate grew to 30% when only patients whose place of onset was outside the CSC catchment area were considered. In the SD group, onset to CSC and onset to groin were significantly longer (178±80 min vs. 102±60 min, p<0.001, and 277±77 min vs. 211±61 min, p<0.001, respectively), and the risk of any intracranial hemorrhage (ICH) was significantly higher (OR: 2.514; 95%CI: 1.18-5.35, p=0.017) compared to MS. CONCLUSION: In this hub-spoke stroke network, a high proportion of SD paradigm was found, which was associated with longer times to treatment and higher rates of any ICH. A closer cooperation between hospital stroke physicians, national health system staff, and paramedics is warranted to identify the most appropriate referral strategy for each patient.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , AVC Isquêmico/etiologia , Isquemia Encefálica/terapia , Isquemia Encefálica/tratamento farmacológico , Terapia Trombolítica , Transferência de Pacientes , Resultado do Tratamento , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Hemorragias Intracranianas/etiologia , Encaminhamento e Consulta , Trombectomia/efeitos adversos , Estudos Retrospectivos
2.
AJNR Am J Neuroradiol ; 41(11): 2088-2093, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32972953

RESUMO

BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions. MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization. RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16-2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55-0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03-0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage. CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragias Intracranianas/epidemiologia , AVC Isquêmico/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Idoso , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Feminino , Humanos , Hemorragias Intracranianas/etiologia , AVC Isquêmico/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Trombectomia/métodos , Resultado do Tratamento
3.
Eur J Neurol ; 27(9): 1776-1780, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32426890

RESUMO

BACKGROUND AND PURPOSE: Patients with acute ischemic stroke are at high-risk for contracting COVID-19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS-CoV-2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID-19 pandemic with the aim of protecting both patients and ultrasound providers. METHODS: The "ultrasound in acute stroke working group" of the ESNCH examined literature articles and reviews using the following key words: "corona virus" or "COVID-19" or "SARS-CoV-2 virus", and "acute stroke" or "cerebrovascular disease", and "ultrasound". Thereafter, a thorough discussion was conducted with the "education and guidelines working group" of the ESNCH. RESULTS: We propose rapid up-to-date recommendations for healthcare personnel involved in the pre-hospital and intra-hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance. CONCLUSION: The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID-19.


Assuntos
Encéfalo/diagnóstico por imagem , COVID-19 , AVC Isquêmico/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Consenso , Hemodinâmica , Humanos , Pandemias
4.
AJNR Am J Neuroradiol ; 38(8): 1569-1573, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28619833

RESUMO

BACKGROUND AND PURPOSE: Noncontrast CT ASPECTS has been investigated as a predictor of outcome in patients with acute ischemic stroke. Our purpose was to investigate whether CTA source images are a better predictor of clinical and radiologic outcomes than NCCT ASPECTS in candidates for endovascular stroke therapy. MATERIALS AND METHODS: CT scans of patients (n = 124) were independently evaluated by 2 readers for baseline NCCT and CTA source image ASPECTS and for follow-up ASPECTS. An mRS of ≤2 at 3 months was considered a favorable outcome. Receiver operating characteristic curve analysis was used to assess the ability of NCCT and CTA source image ASPECTS to identify patients with favorable outcomes. A stepwise multiple regression analysis was performed to find independent predictors of outcome. RESULTS: Baseline CTA source image ASPECTS correlated better than NCCT ASPECTS with follow-up ASPECTS (r = 0.76 versus r = 0.51; P for comparison of the 2 coefficients < .001). Receiver operating characteristic curve analysis showed that baseline CTA source image ASPECTS compared with NCCT ASPECTS can better identify patients with favorable outcome (CTA source image area under the curve = 0.83; 95% CI, 0.76-0.91; NCCT area under the curve = 0.67; 95% CI, 0.58-0.77; P < .001). Finally, the stepwise regression analysis showed that lower age, good recanalization, lower time to recanalization, and good baseline CTA source image ASPECTS, not NCCT ASPECTS, were independent predictors of favorable outcome. CONCLUSIONS: CTA source image ASPECTS predicts outcome better than NCCT ASPECTS; this finding suggests CTA rather than NCCT as a main step in the decision-making process for patients with acute ischemic stroke.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Angiografia Cerebral , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
5.
J Neurol Neurosurg Psychiatry ; 76(12): 1717-9, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16291901

RESUMO

BACKGROUND: Episodic non-ketotic hyperglycaemia in patients with diabetes may be responsible for a syndrome characterised by hemichorea-hemiballism associated with unique radiological features. OBJECTIVE: To investigate whether factors other than hyperglycaemia may be responsible for the neurological involvement. METHODS: Three patients who developed a persistent chorea-ballism syndrome triggered by a hyperglycaemic crisis were investigated. In these patients, the persistence of the involuntary movements required neuroleptic medication. RESULTS: T1 weighted magnetic resonance imaging revealed bilateral hyperintense lesions involving the striatum. Surprisingly, in these patients, the laboratory investigations revealed peripheral red blood cell acanthocytosis in a significant proportion of cells. CONCLUSION: Compared with the large population of patients with diabetes who do not show abnormal involuntary movements, unrecognised acanthocytosis in diabetes might render patients prone to develop hemichorea-hemiballism.


Assuntos
Coreia/etiologia , Discinesias/etiologia , Eritrócitos/patologia , Hiperglicemia/complicações , Hiperglicemia/etiologia , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome
6.
Neurology ; 65(6): 919-21, 2005 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-16051646
7.
Neurology ; 63(5): 800-4, 2004 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-15365126

RESUMO

OBJECTIVE: To test the hypothesis that infection with virulent cytotoxin-associated gene-A (CagA)-bearing Helicobacter pylori strains influences the atherosclerotic process and the clinical course in atherosclerotic stroke patients. METHODS: ELISA was used to assess the seroprevalence of infection by H. pylori and CagA-positive strains in 185 patients. Intima-media thickness (IMT) was determined by Doppler ultrasound. Baseline, 1-week, and 1-month NIH Stroke Scale (NIHSS) scores were used to evaluate the short-term clinical course. RESULTS: H. pylori infection was found in 79% of patients; 58% of these tested positive for CagA. IMT was higher among CagA-positive patients than among CagA-negative ones (1.13 +/- 0.26 mm vs 0.97 +/- 0.15 mm; univariate analysis, p = 0.0001; multivariate analysis, odds ratio [OR], 2.36; 95% CI, 1.57 to 3.54; p = 0.0001) or H. pylori-negative ones (1.01 +/- 0.17 mm; univariate analysis, p = 0.007; multivariate analysis, OR, 1.90; 95% CI, 1.22 to 2.97; p = 0.005). CagA-positive patients had poorer initial outcomes based on serial measurements of the NIHSS score (repeated measures analysis of variance, p < 0.0001). No significant difference in IMT and NIHSS score was found between H. pylori-positive and H. pylori-negative patients. CONCLUSIONS: Infection with cytotoxin-associated gene-A-positive Helicobacter pylori strains in atherosclerotic stroke patients is associated with greater intima-media thickness and poorer short-term outcome compared with cytotoxin-associated gene-A-negative patients.


Assuntos
Antígenos de Bactérias/análise , Proteínas de Bactérias/análise , Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori/patogenicidade , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Proteína C-Reativa/análise , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Comorbidade , Feminino , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/genética , Helicobacter pylori/imunologia , Humanos , Hiperglicemia/epidemiologia , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Soroepidemiológicos , Índice de Gravidade de Doença , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , Ultrassonografia , Virulência
8.
Stroke ; 33(3): 689-94, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11872889

RESUMO

BACKGROUND AND PURPOSE: Increases in the thickness of the intima and media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtype of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examines the relationship between vascular risk factors, including carotid artery intima-media thickness (IMT), and lacunar versus nonlacunar infarcts. METHODS: We collected data from patients with acute ischemic stroke admitted to hospital. Patients and 129 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and nonlacunar infarcts with age, sex, and potential vascular risk factors. RESULTS: Of 292 adult patients with an acute first-ever ischemic stroke, 96 were considered lacunar and 196 were considered nonlacunar strokes. We did not find a significantly different percentage of diabetes, smoking, hypertension, dyslipidemia, myocardial infarction, and previous transient ischemic attack between the 2 groups of patients. The multinomial logistic regression procedure selected carotid artery IMT and atrial fibrillation as the only independent factors able to discriminate between lacunar and nonlacunar patients. IMT values were significantly higher in patients with nonlacunar stroke versus both those with lacunar stroke and control subjects. CONCLUSIONS: The present results indicate the usefulness of noninvasive measurement of IMT with ultrasonic techniques as a diagnostic tool that may help to identify different subtypes of ischemic stroke patients. The noninvasive measurements may have predictive power with respect to lacunar versus nonlacunar infarcts.


Assuntos
Infarto Encefálico/classificação , Infarto Encefálico/diagnóstico , Artéria Carótida Primitiva/diagnóstico por imagem , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , Doença Aguda , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Distribuição por Sexo , Ultrassonografia Doppler em Cores
9.
Arch Neurol ; 58(4): 577-81, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11295988

RESUMO

OBJECTIVES: To investigate the association between different kinds of ischemic lesions and cerebrovascular reactivity (CR) and to evaluate their relationships with the major risk factors for stroke. SUBJECTS AND METHODS: We evaluated CR using the breath-holding index technique during bilateral transcranial Doppler monitoring of flow velocity in the middle cerebral arteries of 41 consecutive patients attending our clinic for a recent, first-ever, ischemic stroke and in 15 control subjects. Based on the location of the lesion determined by computed tomography, the following 3 types of infarctions were identified: cortical (or territorial), single subcortical, and subcortical with multiple silent subcortical infarctions. Patients with a condition of severe carotid artery stenosis or occlusion, which in itself could account for altered CR, were excluded from this study. All physiological and pathologic conditions that could possibly cause an impairment in CR were recorded. RESULTS: The breath-holding index was significantly lower in the multiple subcortical infarctions group than in the control subjects (P < .001), single subcortical infarctions group (P < .01), and cortical infarctions group (P < .01). In all of the groups male sex (P < .05) and a history of hypertension (P < .05), regardless of whether hypertension was treated, correlated with low CR. The multiple regression analysis indicated that the only significant factor able to influence the breath-holding index was the type of lesion. CONCLUSIONS: Nonstenotic patients with first-ever stroke who had a recent symptomatic subcortical infarction associated with multiple silent infarctions seem to have an impaired cerebrovascular reserve capacity. The strong association of subcortical infarctions with multiple silent infarctions with low CR indicates the role of small vessel vasculopathy and hypoperfusion as possible pathogenetic mechanisms of subcortical infarctions with multiple silent infarctions.


Assuntos
Infarto Cerebral/fisiopatologia , Circulação Cerebrovascular , Sistema Vasomotor/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/complicações , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Valores de Referência , Respiração , Caracteres Sexuais
10.
J Neurosurg ; 94(4): 559-64, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11302653

RESUMO

OBJECT: The purpose of this study was to evaluate cerebral hemodynamics in patients suffering from occlusion of the carotid artery (CA) and contralateral CA stenosis. METHODS: Using transcranial Doppler ultrasonography, the cerebrovascular reactivity to hypercapnia in the middle cerebral arteries was evaluated by calculating the breath-holding index (BHI) of 69 symptomatic patients suffering from internal CA (ICA) occlusion and moderate or severe contralateral ICA stenosis. To evaluate which variables influenced BHIs ipsilateral to the site of ICA occlusion, a multiple stepwise linear regression analysis was performed that included the following factors: patient age, percentage of contralateral ICA stenosis, contralateral BHI, number of collateral pathways, and presence of hypertension, diabetes, smoking, and hyperlipidemia. An analysis of variance was conducted to evaluate the impact of the type of collateral vessels on the BHI. A regression analysis showed that the BHI ipsilateral to the site of ICA occlusion could be accounted for by the contralateral BHI (which was entered at the first step of the analysis, p < 0.001) and by the number of collateral pathways (which was entered at the second step, p = 0.033). Neither the degree of contralateral ICA stenosis nor the other variables could be added to improve the model. The analysis demonstrated that the absence of collateral pathways and the presence of the anterior communicating artery (ACoA) alone were associated with lower BHI values than those found in the presence of two or three collateral vessels, regardless of the presence of an anterior collateral pathway. CONCLUSIONS: On the basis of these data one can infer that the cerebral hemodynamic status of patients with occlusive disease of the CA is influenced by individual anatomical and functional characteristics. Because improvement in contralateral hemodynamics after surgical correction of an ICA stenosis can only be expected in the presence of an ACoA, the planning of strategies for influencing cerebral blood flow distal to an ICA occlusion and, in particular, the consideration of a contralateral carotid endarterectomy, should be preceded by a careful evaluation of the intracranial hemodynamic adaptive status of the patient. Particular attention should be paid to cerebrovascular reactivity and the number and type of collateral vessels that are present.


Assuntos
Arteriopatias Oclusivas/fisiopatologia , Artérias Carótidas , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Valores de Referência , Respiração , Índice de Gravidade de Doença , Ultrassonografia Doppler Transcraniana
11.
J Neurol Sci ; 185(1): 49-53, 2001 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-11266691

RESUMO

The interactions between estrogens and the cerebrovascular system are complex and not fully understood. There are evidences suggesting that the hormones confer protection against cerebral ischemia. Our aim in this study was to investigate the effects of physiological variations of estradiol plasmatic concentration on cerebral hemodynamics. We investigated cerebrovascular reactivity to hypercapnia with transcranial Doppler ultrasonography and the breath-holding index method in the right middle cerebral artery of 20 young women during the menstrual and the ovulatory phase. Data were compared with those of 20 men matched for age. The mean value of the breath-holding index was significantly higher (p<0.001) in females during the ovulatory phase than in the menstrual phase. In men, values were similar to those of women during the menstrual phase. These results suggest that estrogens influence the adaptation capacity of the cerebrovascular system. The possible pathophysiological implications of the relationships between sex hormones and cerebral hemodynamics deserve further investigation.


Assuntos
Circulação Cerebrovascular/fisiologia , Estrogênios/metabolismo , Ciclo Menstrual/fisiologia , Adulto , Feminino , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiologia , Ultrassonografia Doppler Transcraniana
12.
Clin Neurophysiol ; 111 Suppl 2: S115-9, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10996564

RESUMO

The interactions between sleep and epilepsy are well known. A nodal point of the relationship between sleep and epilepsy is represented by pharmacological treatment. Sleep disturbances such as drowsiness are among the most frequent side effects of treatment with antiepileptic drugs, since they can deeply modify both sleep architecture and the sleep-wake cycle. Severe daytime somnolence affects patients' activities and it may facilitate the occurrence of seizures. These considerations underline the importance of antiepileptic drugs having anticonvulsant properties that do not negatively influence sleep and daytime somnolence. In this paper we review some relevant aspects of the effects of antiepileptic drugs on sleep.


Assuntos
Anticonvulsivantes/farmacologia , Epilepsia/tratamento farmacológico , Sono/efeitos dos fármacos , Anticonvulsivantes/uso terapêutico , Epilepsia/fisiopatologia , Humanos , Sono/fisiologia
13.
Acta Neurol Scand ; 102(2): 81-6, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10949523

RESUMO

OBJECTIVES: The aim of our study was to evaluate possible changes in nocturnal sleep, daytime somnolence and cognitive functions induced by add-on therapy with lamotrigine (LTG). MATERIAL AND METHODS: Thirteen patients affected by seizures resistant to common antiepileptic drugs (AEDs) underwent nocturnal polysomnographic monitorings, daytime somnolence evaluations and a neuropsychological battery before and after 3 months of treatment with LTG. RESULTS: With LTG therapy we observed a significant increase in REM sleep and a significant reduction in the number of entries into REM and stage shifts. No significant correlation was observed between the decrease in nocturnal epileptiform activity and the increase in REM sleep. Other sleep parameters were unmodified. No significant changes were observed in daytime somnolence and in cognitive performances. CONCLUSION: LTG may produce positive effects on epileptic seizures and interictal abnormalities without interfering negatively on REM sleep, with improvement of sleep stability and without changes in daytime somnolence and neuropsychological performances. For these reasons it could be an important drug for improving epileptic patients' quality of life.


Assuntos
Anticonvulsivantes/farmacologia , Cognição/efeitos dos fármacos , Epilepsias Parciais/tratamento farmacológico , Fases do Sono/efeitos dos fármacos , Triazinas/farmacologia , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Encéfalo/fisiopatologia , Resistência a Múltiplos Medicamentos , Quimioterapia Combinada , Epilepsias Parciais/fisiopatologia , Feminino , Humanos , Lamotrigina , Masculino , Pessoa de Meia-Idade , Polissonografia , Sono REM/efeitos dos fármacos , Resultado do Tratamento , Triazinas/uso terapêutico
14.
Neurology ; 54(5 Suppl 1): S25-32, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10718681

RESUMO

Our objective was to determine, in three separate studies, the effects of controlled-release carbamazepine (CBZ-CR), lamotrigine (LTG), and gabapentin (GBP) on nocturnal sleep in epilepsy. Antiepileptic drugs (AEDs) control seizures and also modify hypnic structure. Despite widespread clinical use, their effects on sleep are not well known. PSG was performed in all three studies as follows: CBZ-CR: at baseline, after initial administration of CBZ-CR 400 mg, and after 1 month of CBZ-CR treatment (400 mg BID) in a sample of seven temporal lobe epileptic (TLE) patients. Results were compared with those of nine healthy volunteers; LTG: at baseline, after 3 months of stable treatment with LTG (300 mg/day); GBP: at baseline, after 3 months of stable treatment with GBP (1800 mg/day). Significant findings are as follows for each study. The acute administration of CBZ-CR increased number of stage shifts, reduced REM sleep, and increased REM sleep fragmentation. In the TLE group, these effects were almost completely reversed after chronic treatment. LTG increased REM sleep, reduced number of entries into REM sleep, decreased number of phase shifts, and decreased percentage of slow-wave sleep. GBP increased REM sleep percentage, increased mean duration of REM periods, reduced number of awakenings, and reduced stage 1 sleep percentage. We conclude that CBZ-CR disrupts REM sleep, but only during acute administration. LTG and GBP improve sleep stability while reducing seizures.


Assuntos
Aminas , Anticonvulsivantes/uso terapêutico , Ritmo Circadiano/fisiologia , Ácidos Cicloexanocarboxílicos , Epilepsia/tratamento farmacológico , Epilepsia/fisiopatologia , Sono/efeitos dos fármacos , Sono/fisiologia , Ácido gama-Aminobutírico , Acetatos/uso terapêutico , Adulto , Carbamazepina/uso terapêutico , Feminino , Gabapentina , Humanos , Lamotrigina , Masculino , Pessoa de Meia-Idade , Triazinas/uso terapêutico
15.
Brain Dev ; 21(8): 548-53, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10598057

RESUMO

We compared sleep parameters in mentally retarded infantile autism (MRIA) and mentally retarded Down's syndrome (MRDS) by means of polysomnography, evaluating traditional analysis with particular attention to the phasic components in each disorder. Data were compared with those obtained in normal subjects matched for age and sex. Mental age, Intellectual Quotient and the Childhood Autism Rating Scale were performed to obtain an estimation of the neuropsychological deficit. Abnormalities of phasic components of sleep and the presence of REM sleep components into non-REM sleep were observed in both MRIA and MRDS even if in different ways. In fact, MRDS subjects presented a reduction of REM sleep percentage and R index (number of high frequency REMs against number of low frequency REMs) and this was positively correlated to a low IQ. Unlike MRDS subjects, MRIA subjects did not show any parallelism between intellectual abilities and REM sleep deficit. In addition, the presence of undifferentiated sleep in autistic subjects implies a maturational deficit that is still present in adulthood. Finally, a high R index in MRIA was observed. This finding, which is not present in MRDS, could represent an estimation of the disorganized arrival of information caused by a dyscontrol or a reduction of inhibitor pathway. With reference to sleep mechanisms, our results suggest that the cognitive deficit in MRIA may differ from that of MRDS subjects. A maturational deficit of CNS with a dysfunction of brainstem monoaminergic neurons could represent the underlying mechanism.


Assuntos
Transtorno Autístico/complicações , Síndrome de Down/complicações , Deficiência Intelectual/complicações , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/fisiopatologia , Adolescente , Adulto , Criança , Eletroencefalografia , Feminino , Humanos , Masculino , Sono/fisiologia
16.
Neurology ; 53(2): 430-2, 1999 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-10430446

RESUMO

Patients with the trisomy 9p syndrome and CNS abnormalities have been poorly assessed. We report a patient with trisomy 9p who showed band heterotopia on MRI. Abnormal neuronal migration is sufficiently frequent in patients with the trisomy 9p syndrome that brain MRI should be routinely considered in all patients with this syndrome.


Assuntos
Encéfalo/anormalidades , Cromossomos Humanos Par 9/genética , Trissomia/genética , Adulto , Humanos , Cariotipagem , Masculino , Síndrome
17.
Cephalalgia ; 19(1): 27-31, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10099857

RESUMO

We have investigated the prolactin response to bromocriptine (BRC), a D2 dopamine receptor agonist in migrainous women before and after treatment with flunarizine. We evaluated whether this test was predictive of therapeutic efficacy of flunarizine treatment and whether the therapeutic response to flunarizine treatment was related to its effect on dopaminergic system at tuberoinfundibular level. Ten migrainous women underwent a BRC test in the late follicular phase before and after 1 and 3 months of treatment with flunarizine 10 mg at bedtime. Blood samples of prolactin (PRL), growth hormone, follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were taken at basal condition. PRL was also evaluated 1 and 2 h after BRC (2.5 mg) administration. Each patient kept a daily headache diary for 1 month prior to the test and throughout the study. The level of PRL inhibition after BRC administration, observed before flunarizine treatment, was not predictive of the therapeutic response observed after 1 and 3 months of treatment. The effect of flunarizine on PRL level was not related to the therapeutic efficacy of the drug. These data suggest that flunarizine does not attenuate the activity of dopaminergic neurons in migrainous patients, and that the antimigraine effect of flunarizine does not seem related to its action on dopaminergic system at least at tuberoinfundibular level.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Flunarizina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Sistemas Neurossecretores/efeitos dos fármacos , Receptores Dopaminérgicos/fisiologia , Adulto , Análise de Variância , Bromocriptina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Feminino , Humanos , Transtornos de Enxaqueca/sangue , Prolactina/sangue , Receptores Dopaminérgicos/efeitos dos fármacos , Resultado do Tratamento
18.
J Sleep Res ; 7(4): 288-92, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9844856

RESUMO

Several studies have demonstrated a clear association between snoring, sleep apnoea and increased risk of stroke. However, the possible role of sleep apnoea in the pathophysiogenetic mechanisms of cerebrovascular disease is still unknown. Our aim in this study was to investigate cerebral haemodynamic changes during the waking state in eight patients with sleep apnoea syndrome (OSAS) by means of transcranial Doppler (TCD). In particular, we studied cerebral vascular reactivity (CVR) to hypercapnia calculated by means of the breath holding index (BHI). The investigation was performed in the early morning, soon after awakening, and in the late afternoon. Data were compared with those of eight healthy subjects matched for age and vascular risk factors. OSAS patients showed significantly lower BHI values with respect to controls both in the morning (0.56 vs. 1.36; P < 0.0001) and in the afternoon (1.12 vs. 1.53; P < 0.0001). In patients, BHI values in the afternoon were significantly higher than in the morning (P < 0.0001). These data demonstrate a diminished vasodilator reserve in OSAS patients, particularly evident in the morning. This reduction of the possibility of cerebral vessels to adapt functionally in response to stimulation could be linked to hyposensitivity of cerebrovascular chemoreceptors after the continuous stress caused by nocturnal hypercapnia.


Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Síndromes da Apneia do Sono/diagnóstico , Adulto , Ritmo Circadiano , Humanos , Hipercapnia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndromes da Apneia do Sono/fisiopatologia , Ultrassonografia Doppler Transcraniana
19.
Neurology ; 51(4): 1051-6, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9781528

RESUMO

BACKGROUND AND OBJECTIVE: A clear association among snoring, sleep apnea, and increased risk of stroke has been shown by previous studies. However, the possible role played by sleep apnea in the pathogenesis of cerebrovascular disease is subject to debate. To evaluate the influence of hemodynamic changes caused by obstructive sleep apnea syndrome (OSAS), we investigated cerebrovascular reactivity to hypercapnia in patients with OSAS. METHODS: The study was performed at baseline and after 1 night and 1 month of nasal continuous positive airway pressure (n-CPAP) therapy, with patients in the waking state (8:00 to 8:30 AM and 5:30 to 6:00 PM) with transcranial Doppler ultrasonography. Cerebrovascular reactivity was calculated with the breath-holding index (BHI). RESULTS: In the baseline condition, compared with normal subjects, patients with OSAS showed significantly lower BHI values in both the morning (0.57 versus 1.40, p < 0.0001) and the afternoon (1.0 versus 1.51, p < 0.0001). Cerebrovascular reactivity was significantly higher in the afternoon than it was in the morning in both patients (p < 0.0001) and controls (p < 0.05). In patients, the BHI returned to normal values, comparable with those of control subjects, after both 1 night and 1 month of n-CPAP therapy. CONCLUSIONS: These findings suggest an association between OSAS and diminished cerebral vasodilator reserve. This condition may be related to the increased susceptibility to cerebral ischemia in patients with OSAS, particularly evident in the early morning.


Assuntos
Circulação Cerebrovascular , Respiração com Pressão Positiva , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/terapia , Adulto , Pressão Sanguínea , Dióxido de Carbono/análise , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Respiração , Fases do Sono
20.
Stroke ; 29(7): 1305-10, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9660377

RESUMO

BACKGROUND AND PURPOSE: Functional recovery after cerebral infarction is a complex phenomenon that depends on various factors. The aim of this study was to investigate changes in cerebral perfusion during motor activity in stroke patients with very early recovery of motor function. METHODS: We included 9 consecutive patients hospitalized for acute-onset hemiparesis who showed complete functional recovery within 24 hours. CT of the brain showed an ischemic or hemorrhagic cerebral lesion in areas compatible with the symptomatology. Within 36 hours (range, 28 to 36) all patients were examined for the effects of a thumb-to-finger opposition task on cerebral blood flow in the middle cerebral arteries, evaluated by means of bilateral transcranial Doppler ultrasonography. Data were compared with those of 9 healthy subjects matched for age and sex. In patients, the evaluation was repeated 2 to 4 months later. RESULTS: A comparable increase in flow velocity (% mean+/-SD) was observed with respect to baseline in the contralateral middle cerebral artery during motor activity with patients' normal (8.8+/-2.0%) and recovered hand (9.7+/-4.1%) and with both hands of control subjects (10.6+/-1.4%). In the middle cerebral artery ipsilateral to the hand performing the motor task, the increase in flow velocity was significantly higher (P<0.0001) during movement of the recovered hand in patients (8.6+/-2.7%) than during movement of the normal hand in both patients (2.6+/-1.6%) and control subjects (1.4+/-0.7%). In patients, pattern of changes in flow velocity during motor performance remained the same in the second evaluation. CONCLUSIONS: These observations suggest that areas of the healthy hemisphere can be activated soon after a focal injury and contribute to the positive evolution of a functional deficit in some patients. This phenomenon of ipsilateral activation cannot be considered transient because it is evident months after stroke onset.


Assuntos
Circulação Cerebrovascular/fisiologia , Transtornos Cerebrovasculares/fisiopatologia , Dominância Cerebral/fisiologia , Atividade Motora/fisiologia , Ultrassonografia Doppler Transcraniana , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência
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