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COVID-19 pandemics required a reorganisation of social spaces to prevent the spread of the virus. Due to the common presence of fever in the symptomatic patients, temperature measurement is one of the most common screening protocols. Indeed, regulations in many countries require temperature measurements before entering shops, workplaces, and public buildings. Due to the necessity of providing rapid non-contact and non-invasive protocols to measure body temperature, infra-red thermometry is mostly used. Many countries are now facing the need to organise the return to school and universities in the COVID-19 era, which require solutions to prevent the risk of contagion between students and/or teachers and technical/administrative staff. This paper highlights and discusses some of the strengths and limitations of infra-red cameras, including the site of measurements and the influence of the environment, and recommends to be careful to consider such measurements as a single "safety rule" for a good return to normality.

Introduction Freezing of gait (FoG) is one of the most disabling gait disorders in Parkinson's disease (PD), reflecting motor and cognitive impairments, mainly related to dopamine deficiency. Recent studies investigating kinematic and kinetic factors affecting gait in these patients showed a postural instability characterized by disturbed weight-shifting, inappropriate anticipatory postural adjustment, worse reactive postural control, and a difficulty executing complex motor tasks (i.e. sit-to-walk). These symptoms are difficult to alleviate and not very responsive to Levodopa. For this reason, additional therapeutic actions based on specific therapeutic protocols may help patients with their daily lives. We conducted a randomized control trial aimed to test if two clinical protocols for PD patients with FoG were effective to improve postural control. Methods Rehabilitation protocols, conceived to improve gait, were based on learning motor exercises with the Action Observation plus Sonification (AOS) technique, or by the use of external sensory cues. We collected biomechanical data (Center of Mass COM, Center of Pressure COP, and moving timings), using the sit-to-walk task as a measure of motor and gait performance. Results Kinetic and kinematic data showed that when treatment effects consolidate, patients treated with AOS protocol are more efficient in merging subsequent motor tasks (sit-to-stand and gait initiation), and diminished the total moving time and the area of the COP positions. Conclusion We demonstrated for the first time that PD patients with FoG treated with an AOS protocol aimed at relearning appropriate gait patterns increased balance control and re-acquired more efficient postural control.

The accurate identification and prediction of cerebral infarct evolution and clinical outcome are of paramount importance in acute ischemic stroke management. Neuroimaging in acute stroke is mandatory to establish the feasibility of reperfusion therapy, but it is not practical to assess the continuous evolution of brain ischemia. EEG could be an applicable instrument to perform functional monitoring in the hyper-acute phase. EEG activity during ischemic stroke has been widely studied in sub-acute and post-acute phase of ischemic stroke. However, only few studies have focused on the early phase of brain ischemia. The aim of this study conducted at the stroke unit was to investigate stroke-related EEG changes during the earliest phase of ischemic stroke within 4.5 h from symptom onset and to correlate these data with neurological deficit in terms of NIHSS score. We studied 12 patients with ischemic stroke, who underwent EEG recordings within 4.5 h from symptom onset. The EEG signals acquisition was performed bedside without delaying reperfusion treatment, using @64 channels Wi-Fi Be Plus LTM amplifier and 19 channel 10–20 Ag/AgCl electrodes wireless prewired headset. The main finding of this study is a significant positive correlation between stroke-related EEG changes measured by DAR and DTABR parameters and the neurological deficit measured by NIHSS score, during the earliest phase of ischemic stroke. The results of this study highlight the importance of EEG as complementary tool in the assessment of stroke severity and its potential role in acute decision-making and monitoring.

Lymphopenia is a common side effect of treatment with dimethyl fumarate (DMF) in patients with multiple sclerosis (PwMS). Prevalence and predictive factors of this side effect are still uncertain, because literature has provided discrepant results and it is still a matter of debate if lymphopenia is associated with a better treatment outcome.We retrospectively recruited PwMS treated for at least one month with DMF and collected clinical, demographic data and absolute lymphocyte count (ALC) during follow-up. Lymphopenia was graded according to CTCAE. Patients according to the grade in lymphopenia (all grades) and severe lymphopenia (grade II-IV). To evaluate predictors of lymphopenia, we compared characteristics of patients with/without lymphopenia and patients with/without severe lymphopenia. A logistic binary regression was performed to elucidate any predictive factor of lymphopenia and severe lymphopenia. Area under the curve (AUC) was calculated to evaluate sensibility and specificity of predictors. We analyzed treatment outcome with NEDA-3 status at 1- and 2-years.98 of 105 patients treated with DMF were included. 46.9% developed lymphopenia, 27.6% severe lymphopenia. Lymphopenia was associated with basal ALC (p0.001, AUC=0.786), treatment duration (p = 0.01, AUC=0.685),% of reduction at third month (p = 0.001, AUC=0.616) Severe lymphopenia was associated with basal ALC (p = 0.003, AUC=0.750).NEDA-3 status at 1-year (n = 66) and at 2-year (n = 44) did not differ in patients with/without lymphopenia (p = 0.059; p = 0.583) or with/without severe lymphopenia (p = 1.02; p = 0.169).Lymphopenia is a common side effect of DMF and basal ALC predicts its development. Lymphopenia is not associated with the achievement of NEDA-3 status.

Purpose Neurogenic stuttering may be evident after a lesion/dysfunction of wider neural networks. Here we present a case of acquired stuttering as the consequence of immune-mediated encephalitis. Methods The case of a 71-year old male who complained about the progressive onset of stuttering and disequilibrium as the consequence of immune-mediated encephalitis, is here reported. Administration of corticosteroid methylprednisolone was useful to recover from impairments. An in depth analysis of the electroencephalography (relative power of brain rhythms and source localization) during different phases of the disease/treatment was also realized. Results The patient showed a stuttering-like slowed speech with blocks and repetitions, especially at the beginning of words/sentences, with associated movements of the oro-facial muscles. Speech and general motor skills resulted slowed in their preparation/execution phases. Electroencephalography showed a “slowed” pattern, with delta/theta waves mainly in the prefrontal cortex and in sensorimotor networks. Conclusion This case reports a probable immune-mediated encephalitis that resulted in acquired stuttering. The effect of “slowed” oscillatory brain activity on motor skills requesting sequencing and fine coordination (e.g. speech) could result in less “synchronized” systems, easily prone to disruptions.

INTRODUCTION: Intravenous thrombolysis within 4.5 hours from symptom onset improves functional outcome in acute ischemic stroke patients. Repeated intravenous tissue plasminogen activator (IVtPA) is contraindicated in patients presenting with early recurrent stroke (ERS) within 3 months from the initial stroke because of a greater risk of intracranial hemorrhage. CASE PRESENTATION: A 59-year-old man presented with ERS, National Institute of Health Stroke Scale of 16, 10 days after a previous stroke. Brain computed tomography (CT) showed a previous hypodensity with 4 cm volume. Angio-CT highlighted the left middle cerebral artery and left internal carotid occlusion. Perfusion CT showed small deep core and large penumbra. The patient underwent IVtPA. After 24 hours, the National Institute of Health Stroke Scale was 7, and CT scan showed an acute ischemic lesion in the left basal ganglia area and frontal lobe without hemorrhagic transformation. CONCLUSION: This case report suggests that further randomized studies may evaluate whether repeated IVtPA may be safe and effective in ERS occurring shortly after a previous stroke when patients experience a period of complete neurological regression, minor disability, and a small infarct volume. Should the hypothesis be confirmed, small volume core and wide volume penumbra at perfusion CT may support the decision of adopting IVtPA repetition.

SARS-CoV-2 pandemic heavily hit the western healthcare system saturating the hospital beds in wards and clogging the emergency departments. To avoid the collapse of Italian hospitals, office visits to outpatients were limited to emergencies and the general population went in a lockdown state. Physicians had to approach new problems in the management of chronic patients who could not leave their homes. In our experience as epilepsy clinic, the use of telemedicine was of crucial importance for monitoring our patients: phone call during lockdown let us monitor the stability of our 38 patients and psychometric parameters and habits that could influence seizures frequency. In particular, we found that in our patients, sleep quality was low resulting in high daily sleepiness and associated high stress levels. Secondly, we found an increase in daily screen hours and an association with daily sleepiness. In conclusion, we report our experience in managing people with epilepsy during the lockdown, underlining the utility of telemedicine as a valid monitoring tool and the necessity of a psychometric and behavioral screening.

Background and aims: Telemedicine in multiple sclerosis (MS) is promising, particularly for patients with high disability and difficulties to reach the treating centre. During SARS-CoV2 pandemic, teleconsults are gaining a central role. The aim of the present study was to report our single-center experience and to verify the effectiveness of teleconsults in diagnosing relapses and rating progression. Methods: During the first lockdown phase (March–May 2020) all the pre-planned consults were converted in teleconsults. The evaluation focused on new symptoms or worsening of known symptoms, disability (PDDS), patients’ satisfaction of such assessment modality (rated form 0 to 10). Patients were then re-evaluated in person within 6 months. We verified the changes in disability and the accuracy of teleconsults in diagnosing MS relapses. Results: Eighty-four patients underwent teleconsult and were re-evaluated in person within 6 months after the lockdown (69% female, mean age 50.5 ± 11.0 y, mean disease duration 13.0 ± 9.7 y 78.6% relapsing-remitting disease form, 76.2% on disease modifying treatment). Median pre-lockdown EDSS was 1.5 (range 0–8) median EDSS post lockdown was 2 (1–8) (p = 0.836);median PDDS during lockdown was 1.5 (0–8). A single disease relapse was detected with teleconsults. In the post lock-down in person evaluation no additional undiagnosed relapses were detected. Patients’ reported satisfaction was very high (median 10, range 8–10). Conclusions: Teleconsult in MS patients allowed us to guarantee a regular neurological follow-up during pandemic lockdown. No unreported relapses were missed, no significant disability changes were reported nor detected compared to pre-lockdown evaluation. Finally, patients' satisfaction of this modality was very high.

Background and aims: During SARS-CoV-2 pandemic people with multiple sclerosis (PwMS) may experience a worsening due to increased anxiety and depression, reduction in rehabilitation, and less strict connection to MS centres. The aim of our study was to describe the self-reported impact of SARS-CoV-2 pandemic and lockdown on PwMS. Methods: On June 2020, we enrolled PwMS who underwent teleconsult during the lockdown phase (March–May 2020). Self-rated worries for pandemic, perception of change in anxiety, depression, fatigue and spasticity was asked, as well as changes in weight, physical activity and food intake. We compared patients with and without reported increase in: spasticity, anxiety, depression and fatigue. Binary logistic regression analyses were applied including significant variables. Statistical significance was set at p < 0.05. Results: Ninety-three MS patients were enrolled (71% female, 77% RR, median age 50.3 y, mean disease duration ≅13 y). Many patients reported an increase of anxiety (36.6%), depression (34.4%), fatigue (26.9%) and, spasticity (18.3%), weight (47.3%) and 63.4% of patients reported e reduction of physical activity;moreover 59.1% and 43% reported particular worries for the pandemic and the perception of greater impact on PwMS of the pandemic compared to general population, respectively. In the multivariate models, anxiety was predicted by depression, particular worries for SARS-CoV2 pandemic and reduction in physical activity;depression by anxiety;fatigue by reduction in physical activity;spasticity by EDSS. Conclusions: The self-reported impact of pandemic on PwMS was deep in terms of increased depression, anxiety, fatigue and spasticity, mainly related to reduction in physical activity and pre-existing disability.

We herein report an unusual case of a 40-year-old woman presenting to the emergency department with acute-onset tetraparesis due to inhalation of chemical solvents containing n-hexane. The clinical picture, a mild albumin-cytologic dissociation and the demyelinating features on nerve conduction study initially mimicked the presentation of Guillain-Barré syndrome (GBS), but the patient failed to respond to intravenous immunoglobulin treatment and plasma exchange. Diagnosis of hexane-induced neuropathy was then confirmed by means of sural nerve biopsy, showing axonal enlargement with secondary retraction and thinning of the myelin sheath.

The aim of this study was to estimate the incidence, identify the causes, and explore treatments of the injuries to the brachial plexus and peripheral nerves of the shoulder girdle and upper limb in the 1,220,000-inhabitant Italian region Friuli Venezia Giulia.We linked at the individual patient level various administrative databases using an anonymous stochastic key: list of residents, hospital discharge, emergency department, and outpatient care prescriptions database. We abstracted hospital discharge records with at least one discharge diagnosis code ICD-9-CM 953.4 (brachial plexus) or 955.0-955.9 (upper limb). For hospitalized patients, we investigated the prescriptions of ambulatory care during the following year. Emergency department visits in the month prior to hospital admission were also assessed.From 2000 to 2015, we observed 474 hospitalizations (annual average: 61); 48% of patients received at least one prescription of outpatient physical therapy and rehabilitation in the following year, accounting for more than 25,000 visits and interventions. According to emergency department data, falls were the most common mechanism among the elderly; cuts were common among the young.This is the first population study of peripheral nerve injuries to the brachial plexus and peripheral nerves of the shoulder girdle and upper limb in Italy.

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Epilepsia partialis continua (EPC) is a rare entity, first described in 1894 by Koževnikov, as a variant of simple focal motor status epilepticus. EPC is most frequently characterized by motor symptoms, but as recently described, non-motor manifestations may occur, such as somatosensory symptoms or aura continua. EPC in adults has been attributed to various etiologies: infectious, vascular, neoplastic, and metabolic. According to the recent definition, we reported a case of EPC with behavioral symptoms, following a tick-borne encephalitis (TBE) contracted in an endemic area (North Eastern Italy). Patient's symptom was a poorly localized "whole body sensation", which is reported as a condition occurring only in frontal lobe epilepsy. Patient's EEG showed a left frontal predominance of epileptiform discharges. Literature highlighted the importance of the Far-eastern TBE variant as a cause of EPC, since no Western variant TBE cases are reported. In contrast to what was claimed so far, our case demonstrates that not only the Far-eastern TBE variant, but also Western variant TBE is a cause of EPC. Prognosis of EPC depends largely on the underlying etiology, and it is frequently drug-resistant. Our patient was treated with intravenous levetiracetam, with a subsequent clinical recovery and a disappearance of epileptiform discharges. The rapid clinic and electroencephalographic response to levetiracetam confirm that it can be a promising therapeutic option for treatment of EPC.

Background The first years of relapsing-remitting multiple sclerosis (RRMS) constitute the most vulnerable phase for the progression of cognitive impairment (CImp), due to a gradual decrease of compensatory mechanisms. In the first 10 years of RRMS, the temporal volumetric changes of deep gray matter structures must be clarified, since they could constitute reliable cognitive biomarkers for diagnostic, prognostic, and therapeutic purposes. Methods Forty-five cognitively asymptomatic patients with RRMS lasting ≤ 10 years, and with a brain MRI performed in a year from the neuropsychological evaluation (Te-MRI), were included. They performed the Brief International Cognitive Assessment battery for MS. Thirty-one brain MRIs performed in the year of diagnosis (Td-MRI) and 13 brain MRIs of age- and sex-matched healthy controls (HCs) were also included in the study. The relationships between clinical features, cognitive performances, and Te- and Td-MRI volumes were statistically analyzed. Results Cognitively preserved (CP) patients had significantly increased Td-L-putamen (P = 0.035) and Td-R-putamen volume (P = 0.027) with respect to cognitively impaired (CI) ones. CI patients had significantly reduced Te-L-hippocampus (P = 0.019) and Te-R-hippocampus volume (P = 0.042) compared, respectively, with Td-L-hippocampus and Td-R-hippocampus volume. Td-L-putamen volume (P = 0.011) and Te-L-hippocampus volume (P = 0.023) were independent predictors of the Symbol Digit Modalities Test score in all patients (r2 = 0.31, F = 6.175, P = 0.001). Conclusion In the first years of RRMS, putamen hypertrophy and hippocampus atrophy could represent promising indices of cognitive performance and reserve, and become potentially useful tools for diagnostic, prognostic, and therapeutic purposes.

To evaluate therapies employed in patients presenting to the emergency department (ED) with a chief complaint of non-traumatic headache to check if guidelines are followed. A 6-month retrospective analysis of the ED records of all the patients who referred to the ED of the University Hospital of Trieste for non-traumatic headache was performed. Out of 37.335 admissions, 336 patients were selected (0.9%). Diagnosis at discharge was primary headache (25.6%), secondary headache (40.5%), and headache “not otherwise specified” (33.9%). One-hundred-ninety-three patients were treated in mono- (51.8%) or poly-therapy (48.2%), with NSAIDs (46.5%), benzodiazepines (13.4%), antiemetics (10.7%), analgesics (8.3%), opioids (1.6%), triptans (1.5%), and other drugs (17.7%). NSAIDs, particularly ketorolac, are the class of drugs most often prescribed in ED, independently of the discharge diagnosis. Metoclopramide is rarely used in monotherapy (4%), but it is the drug most frequently used in association with NSAIDs (19.3%). Only two migraineurs received triptans. Mean time spent in ED was 231 ± 130 min, which was significantly longer in patients who received treatment (272 ± 141 vs. 177 ± 122 min; p = 0.003). No drugs had any side effects. In accordance with the current guidelines, NSAIDs monotherapy or in association with antiemetics were the drugs most often prescribed in ED. Opioids were rarely used probably because of potential sedative side effects. Only very few patients received triptans. Special attention should be drawn also in ED to apply the International Classification of Headache Disorders criteria, which can lead to clarify the diagnosis and receive the specific treatment.

Objective A very high-resolution (70 MHz) ultrasound device (VHRUS) has recently been approved for use in humans. The aim of this study was to use VHRUS to collect data on healthy subjects to propose some reference values for the digital branches of the median nerves of the hand. Methods A VHRUS with 70 MHz linear array transducer was used to measure the cross sectional area of the median nerve at the wrist (CSAw) and digital branches (CSAf), largest and smallest fascicles, the fascicles number (Nfasc), the fascicle density (FD), the flattening ratio (FR) and CSAw/CSAf. Results Data from 20 healthy subjects were obtained for both hands. The median nerve at the wrist and digital branches were properly identified without anatomical alterations. No differences were found between the right and the left hand. In the dominant hand, CSAw was 9.35 mm2 (4.57–12.35) and Nfasc was 24 (18–38). FD and FR were respectively 2.94 (2.47–4.91) and 2.74 (1.70–4.90). Conclusion VHRUS technology can visualize the median nerves at the wrist, their internal structure and their small branches at the fingers, providing both a qualitative and quantitative assessment. Results from this study provide preliminary reference values in a young healthy sample. Significance Most conventional ultrasound devices are not able to properly visualize the distal branches of the median nerve. In contrast, VHRUS allows to detect and measure smaller structures of the nerve, assisting in clinical practice.

Increasing evidence suggests that neurodegenerative disorders share a common pathogenic feature: the presence of deposits of misfolded proteins with altered physicochemical properties in the Central Nervous System. Despite a lack of infectivity, experimental data show that the replication and propagation of neurodegenerative disease-related proteins including amyloid-β (Aβ), tau, α-synuclein and the transactive response DNA-binding protein of 43 kDa (TDP-43) share a similar pathological mechanism with prions. These observations have led to the terminology of “prion-like” to distinguish between conditions with noninfectious characteristics but similarities with the prion replication and propagation process. Prions are considered to adapt their conformation to changes in the context of the environment of replication. This process is known as either prion selection or adaptation, where a distinct conformer present in the initial prion population with higher propensity to propagate in the new environment is able to prevail over the others during the replication process. In the last years, many studies have shown that prion-like proteins share not only the prion replication paradigm but also the specific ability to aggregate in different conformations, i.e., strains, with relevant clinical, diagnostic and therapeutic implications. This review focuses on the molecular basis of the strain phenomenon in prion and prion-like proteins.

Trigeminal neuralgia (TN) is a distinct, painful disorder of the face that is easily evoked by trivial stimuli and undergoes a relapsing, remitting course, with prevalence of 107.5/1,000,000 in men and 200.2/1,000,000 in women.

Abnormal cortical oscillations are markers of Parkinson's Disease (PD). Transcranial alternating current stimulation (tACS) can modulate brain oscillations and possibly impact on behaviour. Mapping of cortical activity (prevalent oscillatory frequency and topographic scalp distribution) may provide a personalized neurotherapeutic target and guide non-invasive brain stimulation. This is a cross-over, double blinded, randomized trial. Electroencephalogram (EEG) from participants with PD referred to Specialist Clinic, University Hospital, were recorded. TACS frequency and electrode position were individually defined based on statistical comparison of EEG power spectra maps with normative data from our laboratory. Stimulation frequency was set according to the EEG band displaying higher power spectra (with beta excess on EEG map, tACS was set at 4 Hz; with theta excess, tACS was set at 30 Hz). Participants were randomized to tACS or random noise stimulation (RNS), 5 days/week for 2-weeks followed by ad hoc physical therapy. EEG, motor (Unified Parkinson's Disease Rating Scale-motor: UPDRS III), neuropsychological (frontal, executive and memory tests) performance and mood were measured before (T0), after (T1) and 4-weeks after treatment (T2). A linear model with random effects and Wilcoxon test were used to detect differences. Main results include a reduction of beta rhythm in theta-tACS vs. RNS group at T1 over right sensorimotor area (p = .014) and left parietal area (p = .010) and at T2 over right sensorimotor area (p = .004) and left frontal area (p = .039). Bradykinesia items improved at T1 (p = .002) and T2 (p = .047) compared to T0 in the tACS group. In the tACS group the Montréal Cognitive Assessment (MoCA) improved at T2 compared with T1 (p = .049). Individualized tACS in PD improves motor and cognitive performance. These changes are associated with a reduction of excessive fast EEG oscillations., Highlights • Personalized tACS protocols improve motor and cognitive performance in PD. • Among motor items, bradykinesia improved most. • Fast cortical oscillations decreased after tACS.

BACKGROUND: Care partners of stroke survivors are often characterized by high burden levels and depression. Passive and active interventions have been proposed to help reduce burden and depression. The aim of this quality improvement report was to evaluate the effects of a single passive intervention on reported burden and depression in carers of stroke survivors. METHODS: A quality improvement report was conducted on carers who participated in a short passive intervention (n = 56) and a control group (n = 44). The Family Strain Questionnaire-Short Form (FSQ-SF) and the Beck Depression Inventory II were administered in both groups at patients' admission and before discharge, with the intervention taking place between the 2 data collection periods. RESULTS: No significant difference between groups was observed in FSQ-SF score and prevalence of depression at admission and in FSQ-SF at discharge. However, compared with admission, FSQ-SF at discharge was significantly reduced only in the intervention group (pre: 14, and interquartile range, 12-15; post: 9, and interquartile range, 9-13; P < .01). Moreover, a smaller proportion of carers classified as "depression" was found at discharge in the intervention group compared with controls (4% vs 28%, respectively; P < .01). CONCLUSION: Results encourage the development and use of short passive intervention to reduce burden and depression in care partners of stroke survivors.

Objectives The combined use of perfusion neuroimaging and brain oscillatory activity may provide a better clinical picture of neurovascular coupling of the injured area in ischemic stroke. The aim is to assess stroke-related topographic electroencephalography (EEG) changes during the earliest phase of ischemic stroke and to compare them with hypoperfusion identified by computer tomography perfusion (CTP). Patients and methods The study included 15 patients with ischemic stroke, who underwent both CTP and EEG recording within 4.5 h. Topographic representation of power for each band was calculated and compared with hypoperfusion areas estimated by CTP maps. Results Predominance of slow delta frequencies was found in all patients. The main finding is the agreement between slow rhythms hemispheric prevalence on EEG maps and cerebral hypoperfusion area identified using CTP. Conclusion The results of this preliminary study show that the combined use of EEG and CTP, as highly available techniques, in acute ischemic stroke may be helpful in clinical practice and provide information about functional and metabolic aspects of brain involvement. The joint use of these methodologies may give a better clinical insight of the functionality of injured area in the hyperacute phase.

Background Neurovascular Coupling is the cerebral mechanism responsible for linking neuronal activity, cerebral metabolism and regional cerebral blood flow (CBF). The direct relation between functional brain activity during active, passive and motor imagery paradigms and changes in CBF has been widely investigated using different techniques. However, CBF changes have not been investigated beat by beat during robot assisted passive movement (PM) and motor imagery (MI) of lower limb, yet. Materials and methods We investigated beat-to-beat hemodynamic changes in 8 healthy subjects using TCD during MI and robot-assisted PM of lower limb. Results The results showed that MI and PM induce a significant CBFv increase and that PM and MI lead to similar hemodynamic changes in healthy subjects. Conclusions The findings may be useful to better understand the variation of CBFv in brain pathology and to develop more specific and efficient rehabilitation therapy protocols in neurological diseases, such as stroke.

Headache is one of the most common medical complaints of civilized humans; nevertheless severe and chronic headaches are only infrequently caused by organic disease. Although the overall headache prevalence figures vary, in most studies headache prevalence lifetime is over 70%. The current International Classification of Headache Disorder provides operational definitions for all headaches types, and it divides headaches into primary and secondary headache disorders. Most headaches seen in practice belong to the category of primary headaches, where there is no underlying structural cause identifiable. Less than 10% headaches in practice belong to the category of secondary headaches where there is an underlying condition that can sometimes be ominous and life-threatening.

Introduction Thrombolysis may affect ischemic stroke-related size, pattern and nature of infarcts, and has the potential to change aphasia presentation and recovery. Data on evolution of post-stroke aphasia following thrombolysis are still scarce. The aim of this study was to determine the course of language recovery through a well-validated language assessment battery after acute ischemic stroke and investigate whether traditional categorical classifications of aphasia can describe the clinical picture in post-thrombolysis phase. Materials and methods Demographic, clinical, and language assessment data of 116 patients presenting sub-acute ischemic stroke aphasia (41 treated with r-tPA; 75 non-treated) were retrospectively analyzed. The participants were assessed by a clinical neuropsychologist with a variety of subtests taken from a well-validated Italian language battery (Neuro-Psychological Aphasia Evaluation). Results The percentage of resolved aphasia was significantly higher in treated patients compared to non-treated patients (p = 0.005) and global aphasia was more common in the non-treated group (non-treated 30.7% vs treated 17.1%). Aphasia subtypes and stroke etiologies showed no significant association, except for small vessel etiology and resolved aphasia (p = 0.041). Reperfusion treatment, baseline NIHSS, and lacunar stroke were the predictors of aphasia recovery. Conclusion The percentage of resolved aphasia was significantly higher in the treated patients compared to the non-treated, with the latter showing a higher percentage of global aphasia. Identifying classic aphasia subtypes after thrombolysis is still possible since reperfused areas do not necessary change the classification or lead to completely different aphasic syndromes. Reperfusion treatment, baseline NIHSS, and lacunar stroke were the main predictors of aphasia recovery.

Objectives Left dorsolateral prefrontal cortex anodal transcranial direct current stimulation (tDCS) was applied in a group of patients with disorders of consciousness to determine the effects of modulation of spontaneous oscillatory brain activity. Methods 12 patients in an unresponsive wakefulness syndrome (UWS) and 12 in a minimally conscious state (MCS) underwent 2-weeks active and 2-weeks sham tDCS. Neurophysiological assessment was performed with EEG power spectra and coherence analysis directly before and after each session. Results An increase of power and coherence of the frontal and parietal alpha and beta frequency bands and significant clinical improvements were seen after the active tDCS in MCS patients. In contrast, UWS patients showed some local frontal changes in the slow frequencies. No treatment effect was observed after sham. Conclusions tDCS could induce changes in cortical EEG oscillations, modulating the travel of alpha and beta waves between anterior and posterior brain areas when some cognitive functions were preserved. This plays an important role in consciousness by integrating cognitive-emotional processing with the state of arousal. In unresponsive people, brain integration seems to be lost. Significance Our results further support the critical role of long-range fronto-parietal connections in consciousness and show the potential therapeutic utility of tDCS.

Food constitutes a fuel of life for human beings. It is therefore of chief importance that their recognition system readily identifies the most relevant properties of food by drawing on semantic memory. One of the most relevant properties to be considered is the level of processing impressed by humans on food. We hypothesized that recognition of raw food capitalizes on sensory properties and that of transformed food on functional properties, consistently with the hypothesis of a sensory-functional organization of semantic knowledge. To test this hypothesis, patients with Alzheimer’s disease, frontotemporal dementia, primary progressive aphasia, and healthy controls performed lexical-semantic tasks with food (raw and transformed) and non-food (living and nonliving) stimuli. Correlations between task performance and local grey matter concentration (VBM) and white matter fractional anisotropy (TBSS) led to two main findings. First, recognition of raw food and living things implicated occipital cortices, typically involved in processing sensory information and, second, recognition of processed food and nonliving things implicated the middle temporal gyrus and surrounding white matter tracts, regions that have been associated with functional properties. In conclusion, the present study confirms and extends the hypothesis of a sensory and a functional organization of semantic knowledge.

Botulinum toxin type A (BTX-A) represent the gold standard therapy for focal dystonia and related hyperkinetic movement disorders. The main advantages of this method are low rate of complications, reversibility and efficacy in reducing spastic hypertonia or abnormal movements. The treatment is safe but it needs to be repeated periodically and some patients do not obtain effective control of the symptoms due to the onset of secondary immune resistance. For this reason we have selected 45 cases already in treatment with botulinum toxin that have been switched to incobotulinumtoxinA. At a median follow up of 8 months the greatest part of the patients, twenty-six (57.7%) remained clinically unchanged; fourteen (31.1%) had a significant clinical improvement and five (11.1%) worsened. We did not observe any general or injection site complications.