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Background: Since its approval, the use of alteplase had been limited to patients aged ≤80 years., Aims: TESPI trial had been designed to evaluate whether alteplase treatment within 3 h in patients with acute ischemic stroke aged >80 years resulted in favorable benefit/risk ratio compared with standard care. The meta-analysis of randomized controlled trials was updated to put findings in the context of all available evidence., Methods: TESPI was a multicenter, open-label with blinded outcome evaluation, randomized, controlled trial. Main clinical endpoints were 90-day favorable functional outcome (mRS score 0-2) and mortality and symptomatic intracerebral hemorrhage. The trial was prematurely terminated for ethical reasons after publication of IST-3 trial which provided evidence of treatment benefit in elderly., Results: Of the planned 600 patients, 191 (88 assigned to alteplase) were enrolled. Overall, 24/83 (28.9%) alteplase patients had a favorable outcome compared to 22/95 (23.2%) controls (non-significant absolute difference of 5.7% for alteplase; OR 1.35, 95% CI 0.69-2.64, P  = 0.381). Rates of death were non-significantly lower in the alteplase patients (18.1% vs. 26.5%); rates of symptomatic intracerebral hemorrhage were similar between the two groups (5.9% vs. 5.1%). The updated meta-analysis showed consistent results with prior estimates and add weights., Conclusions: The effects of alteplase observed in this interrupted trial did not reach statistical significance, probably for the small numbers, but are consistent with and add weight to the sum total of the randomized evidence demonstrating that alteplase is beneficial in patients with acute ischemic stroke aged over 80 years, particularly if given within 3 h.

The Cerebrospinal Fluid (CSF) and the serum of 102 neurological patients was studied in subgroups according to diagnostic criteria. The Blood-Brain-Barrier (BBB) is more severely damaged in cases of cerebral tumors and haemorragic cerebral diseases; synthesis of IgG within the CNS is more pronounced in Multiple Sclerosis (MS) patients in comparison with patients of other groups. The ratio IgG/PT in CSF is very high in MS patients. Considering the degree of increase of the IgG Index and of the ratio IgG/PT in CSF the Authors found the highest values in MS and this is typical of such disease. The degree of increase of the ratio CSF albumin/serum albumin showed highest values in patients with tumors or with haemorragic cerebral diseases.

The results of 701 determinations of antiepileptic drug plasma concentrations administered to 190 patients are described. It has been possible to reduce the number of prescribed drugs to 1.55 per patient, so that only 8.1% of subjects takes three or more drugs while 53% is on monotherapy. The use of the measurement of AEDs plasma concentrations resulted very useful: a) when Phenytoin (PHT) is prescribed; b) in epileptic children; c) when the patient takes two or more drugs; d) to evaluate the compliance. A significant increase (p less than 0.01) of the level/dose ratio of Phenobarbital (PB) when PHT is in, or over, the therapeutic range was observed, while at plasma concentrations of PHT below 10 micrograms/ml it does not influence the metabolism of PB.

The nosographic relationship between Thomsen's and Steinert's disease is still uncertain. There is not agreement in the literature whether these are two different diseases or just different stages in the evolution of a single one. Four members of a family in two generations have been studied: two have a typical Steinert's, one a Thomsen's disease and one a clinical pattern that cannot be clearly considered neither of the first nor of the second type. In this patient a generalized muscular hypertrophy was followed, at the age of 54, by a generalized impairment of the muscular trophism and evolved into a severe wasting. This may be interpreted as an evolution of Thomsen's into a Steinert's disease. Furthermore, the presence in the same family of cases of both Thomsen's and Steinert's disease supports the hypothesis of a single disease. The present study suggests that Thomsen's and Steinert's diseases could be two clinical varieties of a single disease in different stages of development. This conclusion is supported by the similarity in the electromyographic patterns and in the histological picture from muscle biopsy of all patients examined.

In a group of 423 patients with cerebrovascular accident (CVA) the so-called risk factors have been studied and correlated with course and outcome of the disease. High levels of glycemia, seric lipids and uric acids, high blood pressure and cardiopathy are the most often observed abnormalities, but age is anyhow strictly correlated with the frequency of the disease and in old patients with diabetes bad outcome of the cerebrovascular accident is to be expected. The EEG, often a valid tool to evaluate the gravity of the cerebral lesion, can give clear information about the prognosis: bioelectrical signs of diffuse suffering of the brain are supporting a bad prognosis. The nature (ischaemic and haemorrhagic) of the CVA remains the most important factor influencing the course of the disease and death is very predictable in haemorrhagic accidents of diabetic patients.

The antiepileptic drug therapy of 1912 patients coming from various neurological clinics of Northern Italy has been evaluated in a collaborative survey. The following epidemiological data have been analysed: incidence of the various seizures types, according to the International Classification (Gastaut, 1969), in relation to the age; drug choice and therapeutic schedules in relation to the seizure type and to the age; number of drugs administered in various age and seizure groups; side effects in relation to type, number and plasma concentrations of the administered drugs. The analysis of the drug plasma level determinations, carried out either with gas-chromatographic methods or with the EMIT system, was effected in order to evaluate the number of patients who were under, in or over the suggested therapeutic ranges, the influence of age on drug disposition and the modifications of the drug plasma levels due to drug interactions.

The prognosis of subarachnoid haemorrhage is still a matter of debate. Reference is made to a long-term study of 34 patients not subjected to surgical management. Four recurrences (11.8%), with 3 deaths (8.8%), were noted over a 1-5 yr observation period. A crippling neurological deficiency was noted in 11 subjects (32.2%). The influence of the neurological state in the acute stage on prognosis is discussed.