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Background: Patients affected by Multiple Sclerosis (MS) can show a tremor of their upper limbs, mostly during the performing of finalised action (action tremor) or at the maintaining of a position against gravity (postural tremor), as key clinical feature of their disease. Objectives: In order to reduce the tremor, patients underwent to repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex of left hemisphere. Methods: Eight patients affected by a middle form of MS were enrolled into the study. A standard neurological examination was carried out and the individual degree of disability was established employing the Expanded Disability Status Score (EDSS). At EDSS patients scored from 1.5 to 6.5, mean 4.6 ±1.9 SD. Tremor was rated according to the Fahn-Tolosa Marin Rating Scale. rTMS was delivered at 1 Hz frequency, along ten subsequent, separate sessions lasting ten minutes each one (i.e. 600 pulses). All subjects were aware about the aim of the study and fulfilled a formal consent. They were free to interrupt the study at any time. Before the first session, at the fifth day and at the last day of stimulation, kinematics of upper limb movements were recorded. Patients were asked to perform a continuous pointing, moving back and forth, as fast as possible, their right index finger between two black spots depicted on a working table, placed 15 cm apart. Task lasted six minutes divided in six parts, lasting one minute each one, divided by a resting period of 30 sec. Movements were recorded by means of a optoelectronic device (ELITE system) working at the sampling rate of 100 Hz. At the end of the last session a new clinical assessment was carried out. Results: Movement time, peak of velocity and acceleration and deceleration were analysed. Number of peaks of deceleration during the targeting phase was considered as the key marker of the tremor. Results of kinematics showed an overall improvement of symptoms including a decrease of time of movement execution and time of the deceleration phase as consequence of the reduction of number of peak of deceleration (i.e. tremor). Conclusions: Reduction of tremor became apparent at the clinical evaluation. Moreover, tremor was effectively influenced by rTMS and patients reported a subjective improvement of their symptoms. We concluded that this technique could be useful in order to reduce disability in MS patients.

mild cogntiive impairment

Background:To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects.Objective:To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the caudate nuclei, and global brain atrophy.Methods:A total of 1246 NCH subjects aged 45–91 years were included in the study and underwent standard brain MRI. Atrophy of the caudate nuclei and global brain atrophy were assessed through the bicaudate ratio (BCr) and lateral ventricles to brain ratio (LVBr), respectively. WMH were assessed through visual rating scales. Lacunes were also rated. Association of nPR with vascular risk factors/diseases and imaging findings was evaluated using logistic regression analysis.Results:nPR were exhibited by 33.1% of subjects and increased with age. Subjects with nPR performed less than subjects without nPR in tests evaluating global cognition, executive functions, attention, and language. Snout reflex was the most common nPR, followed by glabellar tap and palmomental reflex. Glabellar tap was associated with parieto-temporal WMH, BCr, and LVBr; snout reflex was associated with frontal lacunes, temporal WMH, BCr, and LVBr; palmomental reflex was associated with parieto-occipital WMH, basal ganglia lacunes, BCr, and LVBr.Conclusions:This study demonstrates that in NCH aging individuals, nPR are associated with WMH, lacunes, BCr, and LVBr and are probably a warning sign of incipient cognitive decline. Therefore, NCH subjects presenting nPR should manage their vascular risk factors/vascular diseases rigorously in order to prevent or delay progression of small vessel disease, and future neurological and cognitive disabilities.

Background: Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia. Objective: The aim of this study is to investigate the role of vascular risk factors, vascular diseases, cerebrovascular disease and brain atrophy in a large hospital-based cohort of MCI types including 471 amnestic MCI (a-MCI), 693 amnestic MCI multiple domain (a-MCImd), 322 single non-memory MCI (snm-MCI), and 202 non amnestic MCI multiple domain (na-MCImd). For comparison, 1,005 neurologically and cognitively healthy subjects were also evaluated. Method: Several vascular risk factors and vascular diseases were assessed. All participants underwent neurological, neuropsychological and behavioural assessments as well as carotid ultrasonography and standard brain MRI. Multinomial logistic regression models on the MCI cohort with the NCH group and a-MCI type as reference categories were used to assess the effects of the variables evaluated on the estimated probability of one of the four MCI types. Results: This study demonstrates that cerebrovascular disease contributes substantially to the risk of non-memory MCI types and a-MCImd type, and that brain atrophy is present in all MCI types and is greater in multiple domain types particularly in the na-MCI type. Conclusion: Improving detection and control of cerebrovascular disease in aging individuals should be mandatory. Since the incidence of MCI and dementia will be expected to rise because of the progressive life expectancy, a better management of cerebrovascular disease could indeed prevent or delay the onset of MCI, or could delay progression of MCI to dementia.