Search

Background: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. Methods: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. Results: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. Conclusions: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.

Background: Theepidemiologic features of status epilepticus (SE) are still in the course of definition. Methods: We carried out an intensive survey of multiple sources of case material in the resident population of the health district of Ferrara, Italy, in 2003. Information was collected on age, gender, duration, seizure type and etiology of SE. Results: The age- adjusted annual incidence rate of SE was 27.2/100,000 (95% CI = 19.4–36.9) and it was higher in men (41.7/100,000, 95% CI = 26.9–61.7) than in women (12.3/100,000, 95% CI = 6.9–20.4). The incidence was higher in the elderly (older than 60 years, 39.2/100,000) than in younger adults in the age group 20–59 years (14.7/100,000). The age-specific incidence showed a bimodal distribution peaking in the youngest (0–4 years) and in the oldest age group (75+ years). Cerebrovascular disease was the most frequent etiologic factor (45%). Epilepsy had previously been diagnosed in 40% of the patients. The case fatality was 5%. Conclusions: The study found a higher incidence of SE than that expected on the basis of the previous European studies suggesting that the risk of SE in southern Europe is higher and more similar to that estimated in population studies in the United States. The case fatality was lower than that reported in previous South-European population studies despite the similar clinical features of the patients. Indirect evidence suggests that several factors related to the SE management could have positively influenced the outcome.

Objectives – To identify early predictors of intractability in childhood and adolescence epilepsy. Materials and methods – We carried out a community-based case–control study using the incidence cohort of epileptic patients living in the district of Copparo, in the province of Ferrara, Italy. The comparative study was performed in 31 cases and 95 controls. Cases were patients who averaged at least 1 unprovoked seizure per month during an observational period of at least 2 years. Controls were subjects having achieved remission for at least 5 years regardless of current therapy. Results – Onset at age

A double-blind, placebo-controlled, parallel-group, multicentre study was conducted to evaluate the efficacy of pentoxifylline (Trental) in patients with multi-infarct dementia (MID) according to DSM-III-R criteria. Men and women aged 45 years or older, with a Hachinski Ischemia Scale scoreor = 7 and a Mini Mental State Examination (MMSE) score of 10-25 at entry, and computed tomographic evidence of vascular disease were enrolled. A total of 289 patients were randomised to receive either oral pentoxifylline 400 mg t.i.d. or placebo for 9 months, and efficacy was assessed every 3 months. The primary outcome variable was the difference in scores between the two treatment groups, as measured on the Gottfries, Bråne, Steen (GBS) scale. Secondary outcome variables included the scores achieved on the Sandoz Clinical Assessment Geriatric (SCAG) scale and MMSE, and a battery of psychological and other tests. The intention-to-treat analysis for patients completing the study (n = 239) showed a statistically significant difference in the total GBS score in favour of pentoxifylline (improvement of 3.5 points, p = 0.028). A significant difference in the total GBS score in favour of pentoxifylline was even almost achieved in the intention-to-treat analysis for all evaluable patients (n = 269, improvement of 2.1 points, p = 0.065). It is concluded that treatment with pentoxifylline is beneficial for patients with MID, the global results of the GBS and SCAG scales being reinforced by significant improvements in those subscales specific for intellectual and cognitive function.

Few studies have been carried out in the same area at different times, allowing an assessment of the incidence of epilepsy (E.), including all ages, over time. The available data on temporal trend show a decrease in E. incidence in childhood and an increase in the elderly. We sought to update the incidence of E. in the province of Ferrara, where a previous study estimated an incidence rate of 33.1 per 100,000, 35.8, if standardized to the European population. Newly diagnosed patients aged up to 14 years were drawn from a community-based prospective multi-source registry, and adult onset E. cases were collected through multiple overlapping sources of case collection. Cases were included and classified according to ILAE recommendations. During the study period (2007-2008), 141 newly diagnosed cases (66 men and 75 women) living in the study area were identified. The crude incidence rate was 46.1 per 100,000 person-years (95 % CI 39.0-54.5), 35.5 (95 % CI 28.0-43.0) if adjusted to the European population. The incidence of childhood and adolescence epilepsy was 57.0 per 100,000 person-years (95 % CI 33.8-90.0), lower than that reported in our previous study, and it was 44.8 (95 % CI 37.4-53.6) for adult onset E., which is significantly higher as compared to our previous study. The overall incidence of E. in northern Italy is stable over time. We detected a significant decrease in incidence of childhood and adolescence E. and an increase in adult-onset E. The burden of epilepsy will increase as the population continues to age.

The frequency of multiple sclerosis (MS) in Italy and in other areas of the world seems to have increased over time, suggesting that some environmental factors operate in its etiology. We performed a retrospective, community-based case-control study on MS in order to verify the etiologic role of selected environmental factors. We found an association between MS and higher educational level, employment in public administration, past history of allergies, and infection at an early age with measles, rubella and whooping cough. Our data seem to confirm that exogenous factors play a role in the etiology of MS although some confounding variables could have accounted for the associations.

We present the case of an 87-year-old woman with history of hypertension, hypercholesterolemia, ischemic heart diseases, urinary tract infections, and cerebrovascular disease who experienced a transient clinical picture characterized by confusion, lethargy, and acute renal dysfunction in the course of urinary tract infection with Escherichia coli bacteremia. Escherichia coli bloodstream infection was associated with brain computed tomography (CT) and magnetic resonance imaging (MRI) patterns in which the lesion distribution was consistent with posterior reversible encephalopathy syndrome (PRES). Diagnosis of PRES was confirmed by demonstration of vasogenic edema on apparent diffusion coefficient (ADC) maps and near-complete resolution of clinical manifestations at discharge.

Objectives: The etiology of epilepsy remains unknown in most cases. We sought to investigate the role of some pre-, peri- and postnatal factors in the etiology of idiopathic and cryptogenetic partial epilepsy. Methods: We carried out a community-based case-control study using the incidence cohort of epileptic patients living in the district of Copparo, in the province of Ferrara, Italy. The study was performed in 55 cases and 165 controls. A standardized questionnaire was used to collect information in face-to-face interviews. Results: Multivariate logistic regression analysis found that a personal history of febrile convulsions [odds ratio (OR) = 4.01, 95% confidence interval (CI) = 1.3–19.1] and a family history of seizures in first-degree relatives (OR = 4.5, 95% CI = 1.8–18.6) were independent risk factors for the condition under study. We failed to demonstrate an association between partial epilepsy and previously suggested perinatal risk factors. Conclusion: The findings of this study further support the hypothesis of a genetic propensity for seizures, which may be expressed early by the occurrence of febrile convulsions.

A prospective study in patients with a clinical acute isolated brainstem or spinal cord disorder was undertaken. The aim was to evaluate the predictive value of IgG intrathecal synthesis (through the detection of oligoclonal bands in CSF) and MRI lesions at presentation, for the subsequent progression to multiple sclerosis. Forty four patients took part in this study: 22 had a brainstem disorder and 22 a spinal cord disorder. After a mean period of 26 (SD 22) months, 30 patients (68.2%) developed clinically definite multiple sclerosis. The remaining 14 patients were followed up for more than seven years. Twenty six (59.1%) patients had oligoclonal bands in CSF, with a sensitivity of 80.0%, specificity of 85.7%, and a predictive value of 92.2%. Magnetic resonance imaging showed disseminated white matter lesions in 22 patients (50.0%), with a sensitivity of 60.0%, a specificity of 71.4%, and a predictive value of 81.7%. The difference between patients with multiple sclerosis and patients without the disease was statistically significant for the findings of an IgG intrathecal synthesis (P < 0.001). It was only borderline for the MRI findings (P = 0.052). Thus the detection of an intrathecal synthesis at presentation seemed to be a better prognostic indicator of the progression to multiple sclerosis in patients affected by acute isolated brainstem or spinal cord syndromes.

The Guillain-Barre syndrome (GBS) incidence has been updated in the area of the Local Health District of Ferrara, Unita Sanitaria Locale n. 31 (USL 31), Northern Italy, (where a previous survey found an average annual incidence of 1.26/10000 population) in order to verify a supposed increase in GBS occurrence. The updated mean annual incidence over the years from 1981 to 1993 (average resident population: 177235 inhabitants) was 1.87/100000 population (1.66/100000 when age-adjusted). The rate increased progressively in the four subsequent time intervals into which the study period was subdivided (from 1.09/100000 in the years 1981-1984 to 2.73/100000 in the years 1991-1993) with a significant temporal variation (0.025p0.05). The incidence was higher in the urban centres than in the rural zone of USL 31 (2.22/100000 and 1.10/100000; 0.025p0.05) and an increase of GBS risk in the urban area was found. The incidence showed an increase in the oldest age groups of the study population. These findings seem to confirm a slight increase of GBS risk in the area of Ferrara with particular reference to urban centres and elderly people.

Background: Previous descriptive surveys on multiple sclerosis (MS) in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, pointed out that this area was not at lowmedium risk for MS. Objective: To verify the morbidity estimates and update the temporal trend of MS. Design and Methods: We used a complete enumeration approach by reviewing all the possible sources of case collection available in Ferrara for 1965 through 1993. We included all patients with definite and probable MS according to the criteria of Poser et al. Results: The mean annual incidence rate was 2.3 per 100 000 population (95% confidence interval, 2.0-2.6 per 100 000), 3.0 per 100 000 for women and 1.5 per 100 000 for men. On December 31,1993,249 patients (170 women and 79 men) suffering from definite or probable MS were living in the province of Ferrara, giving a crude prevalence rate per 100 000 population of 69.4 (95% confidence interval, 61.2-78.7), 90.8 for women and 46.0 for men. Conclusion: The data confirm that in Ferrara, MS occurs more frequently than previously suggested by the latitude-related epidemiological model, supporting the view that northern Italy is a high-risk area for the disease. While the prevalence rate is much higher than in our previous studies, probably owing to the increasing survival of the patients because of improving supportive care, the incidence rates, similar in magnitude to those observed in high-risk areas of northern and central Europe, have remained relatively stable over time.

We examined the etiopathogenetic role of preperinatal risk factors in the history of epileptic patients, identified in a previous descriptive study performed in Copparo, Italy. A community-based case control study of a group of epileptic patients with idiopathic generalized seizures was performed. The population consisted of 55 patients aged35 years as of December 31, 1988, residing in Copparo. Symptomatic patients were not included in the present study. The control sample consisted of 165 randomly selected healthy individuals, matched with patients for sex, age, and residence in the study area. The interview for detection of history of presumed risk factors was based on the Protocol of the Italian League Against Epilepsy. Obstetric, neurologic, and neonatal hospital charts were also reviewed. A family history of epilepsy, febrile seizures, and other perinatal factors (such as continual physical stress during pregnancy, maternal age35 years, and birth order3) were significantly more common in patients as compared with controls. Our data support the hypothesis of genetic propensity for generalized and febrile seizures, which may represent early expression of a low seizure threshold that subsequently develops into epilepsy.

It is generally agreed upon that the attacks of migraine with aura are indicative of abnormal cerebral perfusion, while the permanence of such perfusion abnormalities during the pain-free intervals of migraine remains debated. This study was aimed at assessing: 1) the presence of cerebral perfusion abnormalities also during the interictal phase and 2) the role of SPET with 99mTc HM-PAO to diagnose migraine. Twenty-eight patients (22 women and 6 men), diagnosed as having migraine with aura according to the International Headache Society (Headache Classification Committee criteria), were submitted to SPET studies, within 10 days of the last attack. 99mTc HM-PAO was used as perfusion tracer and a single head rotating gamma camera equipped with a high-resolution collimator was used for data acquisition. The qualitative analysis of SPET images showed slight hypoperfusion areas in 22 of 28 patients (79%). In 12 of 22 patients (55%) a regional correlation was observed between hypoperfusion areas and the neurologic symptoms of aura. The results of the present study are in agreement with the current physiopathologic interpretation of migraine with aura, confirming the instability of cerebral perfusion control, even with instrumental evidence of perfusion abnormalities in the interictal period. Moreover, SPET with 99mTc Hm-PAO seems to be a useful tool in the diagnostic assessment of migraine.

We have explored the variability of P300 event-related potentials in patients affected by Hakim-Adams syndrome, with raised or intermittent intracranial pressure, treated with surgical cerebrospinal fluid shunting. The clinical utility of P300 is confirmed in the light of the improvement of neurophysiological data after the surgical procedure, parallel with amelioration of neuropsychological performances.

Six patients are described who developed a wide variety of neurological manifestations heralding systemic lupus erythematosus (SLE), which included epileptic seizures, stroke, peripheral polyradiculoneuro pathy similar to Guillain-Barre syndrome, transverse my elopathy and multifocal disorders with remitting course mimicking multiple sclerosis. The peculiarity of these cases was that the neurological disorders remained the only manifestations of SLE for many years and the nervous system appeared to be the main target even after the development of systemic SLE. In five patients the prognosis was favourable and corticosteroid treatment led to prolonged remission.

β Epidemiological surveys on Parkinson's disease that have been carried out in different parts of the world have suggested that the disease is uniformly distributed in white populations. The position with regard to the Mediterranean peoples is still controversial, because of the large variation of the frequencies observed in the different areas that have been investigated. We therefore studied the frequency of Parkinson's disease in the Local Health Service of Ferrara, northeastern Italy (mean population, 187 000). Based on 394 patients, the mean incidence per year for the period from 1967 through 1987 was 10.01/100 000. The incidence rate of Parkinson's disease among cases with early onset was found to be statistically higher in rural areas as compared with urban ones (6.32/100000 vs 3.11/100000). Moreover, the study revealed a significantly higher incidence rate among agricultural workers (20.6/100 000). These results would seem to give further support to the hypothesis of a possible causal role of environmental factors that are mainly linked to agriculture, most likely due to the continual exposure to toxic agents in this area. However, further studies, which are not exclusively epidemiological, are necessary before any conclusions may be drawn, because many confounding variables may account for the results from surveys of this type.

Summary Spatial span (Corsi's block-tapping test) and verbal span (Wechsler Digits Forward test) were measured in 877 children (434 boys and 443 girls) divided into 7 age groups, aged 4 to 10 years. A significant difference (p

Summary: Worldwide investigation of the epidemiology of epilepsy has suggested wide variations in the frequency of convulsive disorders. However, descriptive studies in general populations cannot be completely comparable because of a remarkable methodological dishomogeneity in definition of epilepsy, classification of seizures, and ascertainment, collection, and selection of the cases. The position with regard to the Mediterranean people was still little known, and the few studies presently available from Italy offer underestimates of epilepsy frequency owing to incompleteness in case-collection practices and lack of information about the incidence of the disease. Therefore, to verify the true frequency of epilepsy in our country, we performed a community-based epidemiologic study of convulsive disorders in the district of Copparo (population 45,153) in northern Italy. Based on 278 accepted cases with “active” epilepsy, the prevalence per 1,000 population on December 31, 1978, was 6.2 (6.4 if standardized to the Italian population). The average annual incidence for the period 1964 through 1978 was 33.1 per 100,000 (38.3 if standardized). These results, similar to those found in other Western countries, support the view that the frequency of epilepsy in Italy as a whole is higher than that indicated by the Italian studies previously published, and suggest that epilepsy is evenly distributed in Europe and the United States. Antecedents which could be considered potential causes of epilepsy were found in 39.6%, and in 39.1% of the prevalence and incidence cases, respectively; for both prevalence and incidence groups, perinatal brain injuries were the most frequent event. This high proportion of epileptic cases with underlying causes emphasizes the urgency of planning precautionary measures in Italy to improve prenatal and perinatal medical care. RESUME Les investigations faites dans le monde sur 1‘epidemiologic de L'epilepsie ont suggere L'existence de variations importantes dans la frequence des manifestations convulsives. Cependant les etudes descriptives dans les populations generates ne peuvent pas etre reellement comparables en raison de la grande variabilitye methodologique a la fois dans la definition de L'epilepsie, la classification des crises, L'appreciation, la collection et la selection des cas. La situation a cet egard des peuples mediterraneens etait encore peu connue, et les quelques tentatives actuellement dis-ponibles en Italie sousestiment la frequence de L'epilepsie a cause des lacunes dans le systeme de collection des cas et du manque D'information sur L'incidence de la maladie. Ainsi, pour verifier la frequence reelle de L'epilepsie dans notre pays, nous avons effectue une etude epidemiologique des manifestations convulsives dans le district de Copparo (45153 habitants), dans L'ltalie du Nord. Sur la base de 278 cas ayant une epilepsie “active”, la prevalence pour 1000 habitants, le 31 decembre 1978, etait de 6,2 (6,4 en la rapportant a la population italienne). L'incidence an-nuelle moyenne pour la periode de 1964 a 1978 etait de 33,1 pour 100 000 (38,3 en la rapportant a la population italienne). Ces resultats, semblables a ceux trouves dans D'autres pays occidentaux, confirment L'hypothese que la frequence de L'epilepsie en Italie est plus elevee que celle indiquee par les etudes ital-iennes anterieurement publicees, et suggerent que L'epilepsie a une distribution reguliere en Europe et aux Etats-Unis. Des antecedents considered comme causes possibles D'epilepsie ont ete trouves dans 39,6% de la prevalence et 39,1% de L'incidence des cas; dans les deux groupes les agressions cerebrales peri-natales etaient le facteur le plus frequent. Cette grande proportion de cas avec etiologie souligne L'urgence D'etablir un plan de mesures preventives en Italie pour ameliorer la prise en charge medicate prenatale et perinatale. RESUMEN Estudios mundiales sobre la epidemiologic de la epilepsia sugieren la existencia de amplias variaciones en la frecuencia de los desordenes convulsivos. Sin embargo, los estudios descriptivos en la poblacion general no pueden ser totalmente comparables debido a la notoria falta de homogeneidad en la definicion de la epilepsyia, la clasificacion de las crisis, la indagacion, el reclutamiento y la selection de los casos. La situation, con respecto a la poblacion mediterranea, era poco conocida y los escasos intentos realizados en Italia ofrecen subestimaciones en la frecuencia de la epilepsyia debido a lo incompleto de las tecnicas en la coleccion de casos y la falta de informacion acerca de la incidencia de la enfermedad. Para verificar la ver-dadera frecuencia de la epilepsyia en nuestro pais hemos realizado un estudio epidemiologico, basado en la co-munidad, de los trastornos comiciales en el distrito de Copparo (45.153 habitantes) en el norte de Italia. Basandose en 278 casos aceptados de epilepsyia “activa”, la prevalencia por 1.000 habitantes en el 31 de Diciembre de 1.978, resulto ser de 6.2 (6.4 si se estandariza para la poblacion italiana). El promedio de incidencia anual para el periodo 1.964 a 1.978 fue 33.1 por 100.000 (38.3 si se estandariza). Estos resultados, semejantes a los que se encuentran en otros paises occidentales, apoyan la opinion de que la frecuencia de la epilepsyia en Italia, en total, es mayor que la que se indica en los estudios italianos previamente publi-cados y sugieren que la epilepsia se distribuye uni-formemente en Europa y USA. Se encontraron antecedentes, potencialmente etiologicos, en el 39.6 y 39.1 por ciento de la prevalencia e incidencia, respectiva-mente; para los grupos de prevalencia e incidencia de las lesiones perinatales fueron el acontecimiento mas frecuente. Esta alta proportion de casos de epilepsyia con causas subyacentes subrayan la urgencia de plan-ificar las medidas preventivas en Italia, para mejorar la atencion medica pre y perinatal. ZUSAMMENFASSUNG Weltweite Untersuchungen uber die Epidemiologie der Epilepsie lassen grose Unterschiede in der Haufigkeit der Krampfleiden vermuten. Allerdings konnen deskriptive Studien in der Allgemeinbevolkerung nicht vollig miteinander verglichen werden, denn es bestehen bemerkenswerte methodologische Unterschiede in der Definition der Epilepsie, in der Anfallsklassifikation, in der Sicherheit, mit der Anfalle akzeptiert werden, in der Datensammlung und Selektion der Falle. Die Situation hinsichtlich der Mittelmeerbevolkerung war wenig bekannt und die wenigen zur Zeit verfugbaren Versuche aus Italien unterschatzen die Epilepsie-Haufigkeit. Das liegt daran, das die Praktiken der Fallerfassung inkomplett sind und eine Informationslucke uber die Inzidenz der Erkrankung besteht. Um die wirkliche Haufigkeit der Epilepsie in Italien zu bestimmen, wurde eine epidemiologische Studie der Krampfleiden im Distrikt von Copparo in Norditalien durchgefuhrt. Sie beruht auf den Daten einer Gemeinde mit einer Bevolkerung von 45.153 Menschen. Bei 278 verifizierten Fallen einer “aktiven” Epilepsie betrug die Pravalenz pro 1000 der Bevolkerung am 31.12.78 6,2 (6,4 nach Standardisierung fur die italien-ische Bevolkerung). Die durchschnittliche jahrliche Inzidenz fur den Zeitraum von 1964 bis einschlieslich 1978 betrug 33,1 pro 100.000 (38,3 nach Standardisierung). Diese Ergebnisse entsprechen denen anderer westlicher Lander. Sie unterstutzen die Auffassung, das die Frequenz der Epilepsie in Italien als Ganzes hoher ist als in den italienischen Studien, die bisher publiziert wurden, angenommen; sie zeigen ferner, das die Epilepsie gleich verteilt ist in Europa und in den USA. Begebenheiten, die als mogliche Ursachen der Epilepsie angesehen werden konnen, wurden bei 39,6% der Pravalenzund bei 39,1% der Inzidenzfalle gefunden. Fur beide, Pravalenzund Inzidenz-Gruppen waren perinatale Hirnverletzungen das haufigste Ereignis. Dieser hohe Anteil an Epilepsiefallen mit bekannter Ursache betont die Dringlichkeit, in Italien Vorsorgemasnahmen zu treffen, um die pranatale und perinatale arztliche Versorgung zu verbessern.

Introduction - The period prevalence rate for anti-parkinson drugs (APD) use was reported in the Local Health Service of Ferrara (USL 31), Northern Italy, in 1988 (resident population: 177000 inhabitants). Material and methods - The study was performed through the analysis of the complete list of APD prescriptions in the USL 31 area provided by the computerized archives of USL 31 and the identification code of the patients which is unique for each resident of USL 31. The patients treated with neuroleptics known to be potential parkinsonism-inducing drugs were excluded. Results - The period prevalence rate for APD users was 456.9 per 100000 population. The prevalence rate for dopa derivatives users was 391.3 per 100000. The prevalence did not varied between rural and urban zones of USL 31 both for APD and dopa derivatives users. A higher prevalence was obtained in a small rural commune of USL 31 both for APD users (758.5 per 100 000) and dopa derivatives users (718.6 per 100000) than in the other 4 communes in which the study area is subdivided. Conclusion - The reported prevalence could provide information on the occurrence of most parkinsonisms in the study area and some suggestion on the role of possible environmental factors.

A community-based cross-sectional study was carried out in Ferrara, Northern Italy, to verify the frequency of gingival overgrowth in chronic phenytoin (PHT) users and the risk factors associated with its development. All subjects taking phenytoin were identified using the computerized list of drug prescriptions available in the study area. Most of the subjects were interviewed and underwent an oral examination to evaluate their periodontal condition. The prevalence of gingival enlargement in chronic PHT users was about 40%. In our study, sex, age age at onset of therapy, treatment duration, and oral hygiene were not significantly associated with the risk of developing gingival overgrowth. A direct relationship with daily dose was found to be an independent risk factor. Younger age and poorer oral hygiene seemed to predispose to the severest level of gingival involvement. These results support data from experimental studies by suggesting that drug-induced gingival overgrowth is a dose-dependent side effect whose severity could be affected by local factors.

We performed a community-based study among children and adolescents with idiopathic and cryptogenic epilepsy and onset of the seizures between 0 and 19 years of age on the prognosis of being seizure-free. The study population was recruited during a descriptive investigation in the Local Health Service of Copparo (USL 34), Ferrara, Northern Italy. We included 111 patients (61 males and 50 females). The average length of follow-up was 18.8 years (ranging from 7 to 24 years). The cumulative probability of being in remission was 81.2% at 15 years after onset and the estimated percentage of patients in remission without therapy was 56% for the same time period. At 15 years after the onset of epilepsy, approximately 20% of patients continued to have seizures; nearly 25% continued to take antiepileptic drugs but had been free of seizures for at least 5 years; nearly 56% had been without seizures and free of medication for at least 5 years. Seizure type, gender, age at onset of the illness, epileptic abnormalities on EEG, family history of convulsive disorders, number and frequency of seizures prior to the start of treatment were found not to be helpful as prognostic factors. This community study, carried out on patients without the well known factors that adversely affect prognosis, confirms that the prospect of seizure control and for withdrawal of therapy is (generally) good.

Introduction - We planned a descriptive study on the incidence of intracranial gliomas spanning a 16-year period (1976–1991) in the Local Health Service 31 of Ferrara, Northern Italy. Material and methods - We used a complete enumeration approach by reviewing all the possible sources of case collection available in the study area. Results - The mean annual incidence rate was 5.8 new cases per 100000 population (6.96 for men and 4.78 for women; p < 0.05), resulting in 4.7 per 100000 when directly adjusted to the Italian population. The age-specific incidences showed a small peak in childhood, an increase with age, reaching a maximum in the age group 60 to 64 and then a decline in the elderly. This pattern is similar for both sexes. The adjusted rates increased from 3.94 per 100000 population in the first five-year period to 5.6 per 100000 in the third (a nonsignificant difference). The distribution of cases within the study area was substantially uniform. Conclusion - The incidence rates of Ferrara fell into the middle-high values so far reported and confirmed the male preponderance found in previous studies. The age-related pattern is similar to that observed, with few exceptions, in other surveys. Like other authors we did not find a significant temporal trend, although the incidence rates tended to increase with time. The data encourage further, wider epidemiological studies of a prospective nature.

This study was performed in order to verify the prevalence of retinal periphlebitis and other ocular changes in a well-defined population of multiple sclerosis (MS) patients, and to correlate the presence of these features with some clinical variables which characterize the disease. 110 MS-affected subjects were submitted to a standard ophthalmologic examination including a biomicroscopical evaluation of the fundus oculi. The prevalence of retinal sheathing in MS patients was found to be nearly 36 %. It is significantly higher in patients evaluated in an active phase of the disease than in those examined in a stationary phase.

Introduction - The well-established relationship between myasthenia gravis (MG) and HLA antigens varies among different ethnic groups. In Caucasians B8 and/or DR3 alleles have been found associated with young MG women without thymoma and with high titres of acetylcholine-receptor antibody (AChR Ab). An increased frequency of haplotype HLA-A3, B7 and/or DR2 has been observed in older MG patients with low AChR Ab levels. So far, there is no convincing evidence for an association between a specific haplotype HLA and ocular MG or MG with thymoma. MG subjects often show other concurrent autoimmune disorders suggesting a more general inherited predisposition to autoimmunity. We performed a community-based study to verify the HLA-A, B, C, DR and DQ profile on ethnically homogeneous MG patients and with the aim to estimate the frequency of concurrent autoimmune diseases and to compare HLA phenotypes to autoimmune status in different MG patients groups. Methods - Forty-seven patients, living in the province of Ferrara, were followed-up in our neurologic department and typed for HLA Antigens. In addition a set of immunological laboratory tests was performed. Results - We found a trend towards an increased B8 and DR3 frequencies in total affected population; an association between B8 allele and early onset of generalized MG sustained by thymic hyperplasia. The DR3 allele is statistically associated with the presence of additional autoimmune disorders. Conclusions - Our data support the hypothesis of a genetically-based heterogeneity of the disease and show an increased prevalence of associate autoimmune conditions in MG patients.

To present new information on the semiology and short-term evolution of seizures associated with primary brain tumors (PBTs) in a prospective study.This study is a section of the PERNO study--Project of Emilia Romagna Region on Neuro-Oncology, the main aim of which is to collect prospectively all cases of PBTs occurring in the Emilia-Romagna region, northeast Italy (3,983,346 population) from January 2009 to December 2011, to allow epidemiologic, clinical, and biomolecular studies. The epilepsy section of the PERNO study included all the patients who experienced seizures, either as first symptom of the tumor or appearing during the course of the disease. Each patient was interviewed by the referring neurologist with a specific interest in epilepsy. The patients who entered the study were followed up with visits on a quarterly basis.We collected 100 cases with full clinical, neuroradiologic, and pathologic data. The majority (79\%) had high grade PBTs (glioblastoma in 50 cases), whereas the remaining patients had low-grade gliomas, mostly localized in the frontal (60\%), temporal (38\%), and parietal (28\%) lobes. Seizures were the first symptom of the tumor in 72 cases. Overall, the initial seizures were tonic-clonic (48\%) (without clear initial focal signs in more than half of the patients), focal motor (26\%), complex partial (10\%), and somatosensitive (8\%). The majority of cases (60\%) had isolated seizures or a low seizure frequency at the onset of the disease, whereas a high seizure frequency or status epilepticus was observed in 18\% and 12\% of cases, respectively. Ninety-two patients underwent surgical removal of the tumor, which was either radical (38\%) or partial (53\%). Seven patients underwent only cerebral biopsy. In the 72 patients in whom seizures were the first symptom, the mean time to the surgical treatment was 174 days, with a significant difference between high grade (95 days) and low grade (481 days) gliomas. At the time of our first observation, the majority of patients (69\%) had already undergone surgical removal, with a mean follow-up of 3 months after the procedure. Overall, 39 patients (56\%) were seizure free after tumor removal. The good outcome did not depend on presurgical seizure frequency or tumor type, although there was a trend for better results with low-grade PBTs.These data provide evidence that seizures are strictly linked to the tumoral lesion: They are the initial symptom of the tumor, reflect the tumor location and type, are usually resistant to antiepileptic treatment, and may disappear after the treatment of the lesion.