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1. Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome

Author

Giussani, G, Bianchi, E, Beretta, S, Carone, D, Difrancesco, J, Stabile, A, Zanchi, C, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Tinti, L, Scanziani, S, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Cantisani, A, De Maria, G, Albanese, Y, Giussani G., Bianchi E., Beretta S., Carone D., DiFrancesco J. C., Stabile A., Zanchi C., Pirovano M., Trentini C., Padovano G., Colombo M., Cereda D., Tinti L., Scanziani S., Gasparini S., Bogliun G., Ferrarese C., Beghi E., Romeo A., Viri M., Specchio L., Trivisano M., Mecarelli O., Zarabla A., Capovilla G., Beccaria F., Sasanelli F., Galimberti C. A., Tartara E., Zamponi N., Cappanera S., Aguglia U., Ferlazzo E., La Neve A., Luisi C., Pontrelli G., Cantisani A. T., De Maria G., Albanese Y., Giussani, G, Bianchi, E, Beretta, S, Carone, D, Difrancesco, J, Stabile, A, Zanchi, C, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Tinti, L, Scanziani, S, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Cantisani, A, De Maria, G, Albanese, Y, Giussani G., Bianchi E., Beretta S., Carone D., DiFrancesco J. C., Stabile A., Zanchi C., Pirovano M., Trentini C., Padovano G., Colombo M., Cereda D., Tinti L., Scanziani S., Gasparini S., Bogliun G., Ferrarese C., Beghi E., Romeo A., Viri M., Specchio L., Trivisano M., Mecarelli O., Zarabla A., Capovilla G., Beccaria F., Sasanelli F., Galimberti C. A., Tartara E., Zamponi N., Cappanera S., Aguglia U., Ferlazzo E., La Neve A., Luisi C., Pontrelli G., Cantisani A. T., De Maria G., and Albanese Y.

Abstract

Objective: To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. Methods: This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients’ records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing-remitting course, and 4.8% of patients with sustained remission (p =.016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p =.013); for respiratory diseases were 3.6%,.3%, and.3% (p =.001), and for urogenital diseases were 3.6%,.7%, and 1.6% (p =.048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission. Signifi

Published
2021

2. Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome

Author

Giussani G., Bianchi E., Beretta S., Carone D., DiFrancesco J. C., Stabile A., Zanchi C., Pirovano M., Trentini C., Padovano G., Colombo M., Cereda D., Tinti L., Scanziani S., Gasparini S., Bogliun G., Ferrarese C., Beghi E., Romeo A., Viri M., Specchio L., Trivisano M., Mecarelli O., Zarabla A., Capovilla G., Beccaria F., Sasanelli F., Galimberti C. A., Tartara E., Zamponi N., Cappanera S., Aguglia U., Ferlazzo E., La Neve A., Luisi C., Pontrelli G., Cantisani A. T., De Maria G., Albanese Y., Giussani, G, Bianchi, E, Beretta, S, Carone, D, Difrancesco, J, Stabile, A, Zanchi, C, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Tinti, L, Scanziani, S, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Cantisani, A, De Maria, G, and Albanese, Y

Subjects
Adult, medicine.medical_specialty, comorbiditie, mechanism, Comorbidity, Disease, Urogenital diseases, Cohort Studies, Epilepsy, Risk Factors, Internal medicine, cohort study, Humans, Endocrine system, Medicine, In patient, Child, business.industry, Mental Disorders, medicine.disease, Neurology, epilepsy, Neurology (clinical), Sustained remission, business, prognosi, Cohort study
Abstract

Objective: To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. Methods: This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10years. Two pairs of raters independently reviewed patients’ records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing-remitting course, and 4.8% of patients with sustained remission (p=.016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p=.013); for respiratory diseases were 3.6%,.3%, and.3% (p=.001), and for urogenital diseases were 3.6%,.7%, and 1.6% (p=.048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission. Significance: Comorbidities in epilepsy are not uncommon and reflect differing underlying mechanisms. Psychiatric, endocrine/metabolic, and respiratory disorders are associated with a worse long-term epileptological outcome.

Published
2021

3. Long-term applicability of the new ILAE definition of epilepsy. Results from the PRO-LONG study

Author

Beretta, S, Carone, D, Zanchi, C, Bianchi, E, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Scanziani, S, Giussani, G, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Lodi, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Andrea Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Pustorino, G, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Basso, P, Pozzi, A, Cantisani, A, Papetti, R, De Maria, G, Difrancesco, J, Albanese, Y, Beretta, Simone, Carone, Davide, Zanchi, Clara, Bianchi, Elisa, Pirovano, Marta, Trentini, Claudia, Padovano, Giada, Colombo, Matteo, Cereda, Diletta, Scanziani, Sofia, Giussani, Giorgia, Gasparini, Sara, Bogliun, Graziella, Ferrarese, Carlo, Beghi, Ettore, Romeo, Antonino, Viri, Maurizio, Lodi, Monica, Specchio, Luigi, Trivisano, Marina, Mecarelli, Oriano, Zarabla, Alessia, Capovilla, Giuseppe, Beccaria, Francesca, Sasanelli, Francesco, Andrea Galimberti, Carlo, Tartara, Elena, Zamponi, Nelia, Cappanera, Silvia, Aguglia, Umberto, Pustorino, Giuseppe, Ferlazzo, Edoardo, La Neve, Angela, Luisi, Concetta, Pontrelli, Giuseppe, Basso, Pierfranco, Pozzi, Annalisa, Cantisani, Anna Teresa, Papetti, Rossella, De Maria, Giovanni, DiFrancesco, Jacopo C., Albanese, Yasmin, Beretta, S, Carone, D, Zanchi, C, Bianchi, E, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Scanziani, S, Giussani, G, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Lodi, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Andrea Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Pustorino, G, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Basso, P, Pozzi, A, Cantisani, A, Papetti, R, De Maria, G, Difrancesco, J, Albanese, Y, Beretta, Simone, Carone, Davide, Zanchi, Clara, Bianchi, Elisa, Pirovano, Marta, Trentini, Claudia, Padovano, Giada, Colombo, Matteo, Cereda, Diletta, Scanziani, Sofia, Giussani, Giorgia, Gasparini, Sara, Bogliun, Graziella, Ferrarese, Carlo, Beghi, Ettore, Romeo, Antonino, Viri, Maurizio, Lodi, Monica, Specchio, Luigi, Trivisano, Marina, Mecarelli, Oriano, Zarabla, Alessia, Capovilla, Giuseppe, Beccaria, Francesca, Sasanelli, Francesco, Andrea Galimberti, Carlo, Tartara, Elena, Zamponi, Nelia, Cappanera, Silvia, Aguglia, Umberto, Pustorino, Giuseppe, Ferlazzo, Edoardo, La Neve, Angela, Luisi, Concetta, Pontrelli, Giuseppe, Basso, Pierfranco, Pozzi, Annalisa, Cantisani, Anna Teresa, Papetti, Rossella, De Maria, Giovanni, DiFrancesco, Jacopo C., and Albanese, Yasmin

Abstract

Objective: The new epilepsy definition adopted by the International League Against Epilepsy (ILAE) includes patients with one unprovoked seizure with a probability of further seizures, similar to the general recurrence risk after two unprovoked seizures, occurring in a 10-year period. Long-term follow-up of patients diagnosed after a single seizure is needed to assess the applicability of the new epilepsy definition in clinical practice. Methods: Patients with newly diagnosed epilepsy were recruited retrospectively with a minimum follow-up of 10 years. Patients were stratified in two groups depending on the occurrence of one (new definition, ND) or two or more unprovoked seizures (traditional definition, TD) at the time of epilepsy diagnosis and compared for disease characteristics and factors predicting seizure recurrence. The primary outcome was the occurrence of a new unprovoked seizure during follow-up in the ND group. The secondary outcome was the achievement of an early remission in both groups. Results: Among 1,006 patients with newly diagnosed epilepsy, 152 (15.1%) were diagnosed after a single seizure. Compared to patients diagnosed using the TD, patients diagnosed according to the ND showed a higher proportion of subjects with an abnormal neurologic examination (19.9% vs. 13.7%, p = 0.0504) and with focal seizures (69.3% vs. 60.4%, p = 0.0021). The two samples differed in the presence of at least one of the factors predicting seizure recurrence (focal seizures or abnormal findings in at least one among the following: neurologic examination, electroencephalography [EEG], and neuroimaging) (94.6% vs. 89.1%, p = 0.0376). Long-term recurrence in patients diagnosed with the new definition was 83.6% at 10 years and 89.1% at 15 years. The probability of early remission did not differ between the two groups. Significance: Our results support the applicability of the new epilepsy definition in clinical practice. Individual patient characteristics and a personalized

Published
2017

4. Multidimensional geriatric evaluation at initial treatment in urological neoplasia: A cooperative prospective study

Author

Monfardini, S., primary, Morlino, S., additional, Catanzaro, M., additional, Tafa, A., additional, Bortolato, B., additional, Petralia, G., additional, Bonetto, E., additional, Villa, E., additional, Picozzi, S., additional, Locatelli, M.C., additional, Galetti, G., additional, Millul, A., additional, Albanese, Y., additional, Panzarino, C., additional, Gerardi, F., additional, and Beghi, E., additional

Published
2013
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5. Long-term applicability of the new ILAE definition of epilepsy. Results from the PRO-LONG study

Author

Beretta, Simone, Carone, Davide, Zanchi, Clara, Bianchi, Elisa, Pirovano, Marta, Trentini, Claudia, Padovano, Giada, Colombo, Matteo, Cereda, Diletta, Scanziani, Sofia, Giussani, Giorgia, Gasparini, Sara, Bogliun, Graziella, Ferrarese, Carlo, Beghi, Ettore, Romeo, Antonino, Viri, Maurizio, Lodi, Monica, Specchio, Luigi, Trivisano, Marina, Mecarelli, Oriano, Zarabla, Alessia, Capovilla, Giuseppe, Beccaria, Francesca, Sasanelli, Francesco, Andrea Galimberti, Carlo, Tartara, Elena, Zamponi, Nelia, Cappanera, Silvia, Aguglia, Umberto, Pustorino, Giuseppe, Ferlazzo, Edoardo, La Neve, Angela, Luisi, Concetta, Pontrelli, Giuseppe, Basso, Pierfranco, Pozzi, Annalisa, Cantisani, Anna Teresa, Papetti, Rossella, De Maria, Giovanni, DiFrancesco, Jacopo C., Albanese, Yasmin, Beretta, S, Carone, D, Zanchi, C, Bianchi, E, Pirovano, M, Trentini, C, Padovano, G, Colombo, M, Cereda, D, Scanziani, S, Giussani, G, Gasparini, S, Bogliun, G, Ferrarese, C, Beghi, E, Romeo, A, Viri, M, Lodi, M, Specchio, L, Trivisano, M, Mecarelli, O, Zarabla, A, Capovilla, G, Beccaria, F, Sasanelli, F, Andrea Galimberti, C, Tartara, E, Zamponi, N, Cappanera, S, Aguglia, U, Pustorino, G, Ferlazzo, E, La Neve, A, Luisi, C, Pontrelli, G, Basso, P, Pozzi, A, Cantisani, A, Papetti, R, De Maria, G, Difrancesco, J, and Albanese, Y

Subjects
Male, Pediatrics, medicine.medical_specialty, Neurology, Adolescent, diagnosis, Early remission, Definition, epilepsy, first seizure, long term, adolescent, child, child, preschool, female, humans, infant, infant, newborn, male, recurrence, retrospective studies, seizures, terminology as topic, Electroencephalography, preschool, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Neuroimaging, Retrospective Studie, newborn, Recurrence, Seizures, Terminology as Topic, medicine, Single unprovoked seizure, Humans, In patient, 030212 general & internal medicine, Child, Retrospective Studies, medicine.diagnostic_test, business.industry, Infant, Newborn, Infant, Retrospective cohort study, medicine.disease, Seizure, Child, Preschool, Physical therapy, Female, Neurology (clinical), business, Diagnosis, First seizure, Long term, 030217 neurology & neurosurgery, Diagnosi, Human
Abstract

SummaryObjective The new epilepsy definition adopted by the International League Against Epilepsy (ILAE) includes patients with one unprovoked seizure with a probability of further seizures, similar to the general recurrence risk after two unprovoked seizures, occurring in a 10-year period. Long-term follow-up of patients diagnosed after a single seizure is needed to assess the applicability of the new epilepsy definition in clinical practice. Methods Patients with newly diagnosed epilepsy were recruited retrospectively with a minimum follow-up of 10 years. Patients were stratified in two groups depending on the occurrence of one (new definition, ND) or two or more unprovoked seizures (traditional definition, TD) at the time of epilepsy diagnosis and compared for disease characteristics and factors predicting seizure recurrence. The primary outcome was the occurrence of a new unprovoked seizure during follow-up in the ND group. The secondary outcome was the achievement of an early remission in both groups. Results Among 1,006 patients with newly diagnosed epilepsy, 152 (15.1%) were diagnosed after a single seizure. Compared to patients diagnosed using the TD, patients diagnosed according to the ND showed a higher proportion of subjects with an abnormal neurologic examination (19.9% vs. 13.7%, p = 0.0504) and with focal seizures (69.3% vs. 60.4%, p = 0.0021). The two samples differed in the presence of at least one of the factors predicting seizure recurrence (focal seizures or abnormal findings in at least one among the following: neurologic examination, electroencephalography [EEG], and neuroimaging) (94.6% vs. 89.1%, p = 0.0376). Long-term recurrence in patients diagnosed with the new definition was 83.6% at 10 years and 89.1% at 15 years. The probability of early remission did not differ between the two groups. Significance Our results support the applicability of the new epilepsy definition in clinical practice. Individual patient characteristics and a personalized diagnostic approach can justify treatment after a single unprovoked seizure.

Published
2017

6. Follow-up of elderly patients with urogenital cancers: Evaluation of geriatric care needs and related actions.

Author

Monfardini S, Morlino S, Valdagni R, Catanzaro M, Tafa A, Bortolato B, Petralia G, Bonetto E, Villa E, Picozzi S, Locatelli MC, Galetti G, Millul A, Albanese Y, Bianchi E, Panzarino C, Gerardi F, and Beghi E

Subjects
Activities of Daily Living, Aged, Aged, 80 and over, Comorbidity, Follow-Up Studies, Frailty diagnosis, Hospitalization statistics & numerical data, Humans, Italy epidemiology, Male, Prospective Studies, Severity of Illness Index, Geriatric Assessment, Kidney Neoplasms epidemiology, Kidney Neoplasms pathology, Kidney Neoplasms therapy, Prostatic Neoplasms epidemiology, Prostatic Neoplasms pathology, Prostatic Neoplasms therapy, Survivorship, Urinary Bladder Neoplasms epidemiology, Urinary Bladder Neoplasms pathology, Urinary Bladder Neoplasms therapy
Abstract

Objectives: To investigate a comprehensive geriatric assessment (CGA) with subsequent investigation of healthcare patterns in older patients with urological cancers undergoing initial surgery or radiotherapy, to verify the usefulness of the incorporation of geriatric principles in future care plans., Material and Methods: This is a prospective cohort study. From November 2011 to March 2015, CGA was offered to all patients aged 70+ years treated with radiotherapy or surgery at seven tertiary centers. Patients were classified as fit, vulnerable, or frail according to Balducci's definition. CGA and follow-up data were collected by two trained evaluators at 6 and 12months. The information collected was not available to the caring physicians during follow-up., Results: CGA was performed in 453 patients with prostate cancer (295), bladder cancer (126), or kidney cancer (32). 40% of patients with prostate cancer were fit, 47% vulnerable, and 13% frail. The corresponding values for renal cancer were 25%, 40%, and 34%, and for bladder cancer, 21%, 42%, and 37%. During follow-up, 60% of patients with cardiac diseases, 42% of those with diabetes/other metabolic disorders, 35% of those with hypertension, and 35% of those with respiratory diseases were followed by a specialist (for these severe/extremely severe comorbidities). Of 16 patients with ADL impairment and 63 with IADL impairment, only 4 (25%) and 6 (10%), respectively, were referred to a rehabilitation service. Only one case was referred to a geriatrician., Conclusions: Appropriate clinical care patterns are advisable to improve quality of survivorship in older patients with urological cancers., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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7. Preventive study in subjects at risk of fatal familial insomnia: Innovative approach to rare diseases.

Author

Forloni G, Tettamanti M, Lucca U, Albanese Y, Quaglio E, Chiesa R, Erbetta A, Villani F, Redaelli V, Tagliavini F, Artuso V, and Roiter I

Subjects
Adult, Clinical Trials as Topic, Doxycycline therapeutic use, Humans, Middle Aged, Insomnia, Fatal Familial drug therapy, Insomnia, Fatal Familial genetics, Insomnia, Fatal Familial prevention & control
Abstract

The text describes a preventive clinical trial with drug treatment in a very rare neurodegenerative disease (Fatal familial Insomnia, FFI) designed with the help of individuals at genetic risk of developing the disease, asymptomatic carriers, who have agreed to be exposed over a 10-year period to doxycycline, an antibiotic with anti-prion activity. At least 10 carriers of the FFI mutation over 42 y old will be treated with doxycycline (100 mg/die) and the incidence of the disease will be compared to that of an historical dataset. For ethical reasons a randomized, double-blind, placebo-controlled trial was not feasible, however the study design and the statistical analysis ensure the scientific value of the results. This approach might represent an important breakthrough in terms of potential therapy and knowledge of rare diseases that could give some hopes to these neglected patients.

Published
2015
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