Posatirelin for the treatment of degenerative and vascular dementia: results of explanatory and pragmatic efficacy analyses.

In order to confirm the efficacy and safety of posatirelin (L-pyro-2-aminoadipyl-L-leucyl-L-prolinamide), a synthetic peptide having cholinergic, catecholaminergic and neurotrophic activities, a multicentre, double-blind, controlled study versus placebo was planned in elderly patients suffering from Alzheimer's disease and vascular dementia, according to National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria, respectively. The trial consisted of a 2-week run-in phase with placebo administered once a day orally, followed by a double-blind period of 3 months, with posatirelin or placebo administered once a day intramuscularly. Efficacy was assessed using the Gottfries-Bråne-Steen (GBS) Rating Scale (primary variable) and the Rey Memory Test (secondary variable). Laboratory tests, vital signs and adverse events were monitored. A total of 360 patients were randomized, the intent-to-treat sample (ITT) being made up of 357 patients and the per protocol sample (PP) of 260 patients. Both pragmatic and explanatory analyses showed significant differences between treatment groups in the GBS Rating Scale and the Rey Memory Test, with no difference in the two types of dementia. No difference between treatments was observed in safety variables, the incidence of adverse events in the posatirelin group being 7.3%. The study confirms previous results showing that treatment with posatirelin can improve cognitive and functional abilities of patients suffering from degenerative or vascular dementia.

Correlation between neuroradiological and electrophysiological investigations in multiple sclerosis with features of a cerebral tumour.

Multiple sclerosis presenting at onset with clinical signs and CT picture suggesting a cerebral neoplasm or a slowly evolving stroke, is uncommon. We report one patient in whom cerebral tumour was suspected not only clinically but also from CT features. M.R.I., demonstrating multifocal, high intensity, unsuspected periventricular and white-matter lesions, permitted to diagnose what seemed an intracranial left parietal neoplasm as an acute plaque of demyelination. In fact, in the follow-up, this large low-intensity left parietal area acquired structural and volumetrical homogeneity compared to all other present hyperintense lesions. Instead multimodal EPs, though disclosing subclinical dysfunction in the early stage of the disease, did not correlate with changes in neurological examination to follow-up. So they, unlike the M.R.I., seem of no particular usefulness to serially monitor the clinical modification of MS.

Multimodality evoked potentials in sporadic amyotrophic lateral sclerosis: a statistical approach.

The involvement of sensory pathways in patients suffering from amyotrophic lateral sclerosis (ALS) is well reported in histopathological studies. Several laboratories have also used evoked potentials to evidentiate subtle dysfunctions of sensory systems in such patients. However, conflicting results have been presented in studies using evoked potentials. In the present experiment we have evaluated multimodality evoked potentials in subjects with sure diagnosis of sporadic ALS, by means of the Bonferroni multiple comparisons procedure. Our principal findings are: a) no statistical difference between patients and controls in BAEP and VEP recordings; b) a reduction of N13 amplitude and a prolonged P22 latency in SEP recordings. Due to the sources of N13 and P22, these latter alterations, however, do not implicate the involvement of somatosensory pathway. In conclusion, the current investigation does not provide an electrophysiological support for the involvement of sensory systems in the sporadic ALS.

Evoked potentials in brain death. A critical review.

The development of transplant surgery has determined the necessity to revise criteria and to apply new electrophysiologic techniques to add further informations when survival of brain function is in question. The EPs, which provide a sensitive tool for assessment of integrity of main sensorial systems, could have a place in the electrophysiologic evaluation of the brain death. This review deals with the role of EPs in brain death and points out the main patterns found in that clinical condition.

Evoked potentials in shoe-workers with minimal polyneuropathy.

The aim of the present research was to investigate early impairments of central nervous system in subjects exposed to a low toxic level of industrial solvents for several years. Therefore a group of fifteen shoe-workers, with symptoms of minimal polyneuropathy, and a group of twenty, sex and age matched, healthy volunteers were selected for multimodal evoked potentials studies. The statistical analysis revealed a decrease of VEP and SEP amplitudes as well as a significant higher percentage of cases with BAEP V/I ratio between 0.5 and 1 among patients. The wrist-Erb's point conduction velocity was, also, found lowered in them. In accordance with the experimental results, the systematic employment of multimodal evoked potentials is proposed for screening the subjects exposed to neurotoxic influence of industrial solvents.

Clinical applications of evoked potentials in neurological disorders.

The functional integrity of the main sensorial systems and of the central motor pathways can be evaluated through multimodal evoked potentials and non-invasive transcranial stimulation of the motor cortex. In this review the authors summarize the main clinical indications of the afore said methods specifically in the field of the neurological disorders.

Electrophysiological monitoring of neural functions during neurosurgery.

The intraoperative evoked potential monitoring has become indispensable in patients at risk for neurologic damages during surgery. This review presents the principal clinical indications for intraoperative monitoring of sensory and motor functions of spinal cord as well as of the auditory, facial and optic nerves and of brain functions during cerebrovascular surgery.

Agenesis of the cerebellar vermis: otoneurological report in one patient.

We have performed otoneurological examination in a case of vermis cerebelli agenesia, CT scan confirmed. Visuo-vestibular interaction (VST) abnormality, with normal saccades and normal smooth pursuit movements, allows to suppose normal functioning of the flocculus and a damage in the nucleus olivaris inferior and, particular, in the paraolive.

[Acute polyradiculoneuropathy of Guillain-Barré. Critical review of potential etiopathogeneses]. / La poliradicoloneuropatia acuta di Guillain-Barré. Revisione critica delle prospettive etiopatogenetiche.

The authors go over the etiopathogenetic hypothesis suggested, in the last years, a propos of the Guillain-Barrè syndrome. They point out that about two/thirds of cases are preceded by infectious symptoms of the upper respiratory and alimentary tracts, with prevailing viral etiology. The nervous lesion, which characterize the histology of the illness, seems related to immunological change. In particular one must emphasize the possibility that the Guillain-Barrè syndrome is an autoimmune disorder of delayed hypersensivity, the laboratoristics model of which is constituted from experimental allergic neuritis.