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Highlights • Severe but reversible neurological toxicity due to antimonial treatment is rarely described. • Extrapyramidal symptoms and epileptogenic discharges can be observed. • EEG recordings are required to diagnose possible antimonial neurotoxicity., Introduction Although pentavalent antimonials are no longer considered the first-line therapy for visceral leishmaniasis in the developed world, they are still used in certain geographical areas and in refractory cases. These drugs have a great number of adverse effects; however, neurological toxicity has been rarely reported. Case report We present a 56-year-old woman who required long-term treatment with antimonial drugs due to refractory visceral leishmaniasis and presented clinically with tremor of extremities, myoclonus, gait disturbances and epileptic seizures. The EEG showed increased beta rhythms and generalized epileptogenic activity. She had a slow but favorable response after the withdrawal of antimonials and the initiation of anticonvulsant therapy. Conclusion Severe but reversible neurological toxicity is a rare adverse effect of prolonged antimonial treatment. More EEG record data are needed to support the suspicion of a possible increase of beta rhythms in this situation.

Objective Impulsivity and difficulties in regulating emotions are considered to be transdiagnostic characteristics of patients with eating disorders (EDs). The study aimed to investigate trait impulsivity and inhibitory components of impulsivity, related or unrelated to emotions in patients with EDs. Method A total of 17 patients with anorexia nervosa (AN), 16 patients with bulimic-spectrum EDs (BSD) and 20 healthy control (HC) participants completed an impulsivity scale (UPPS-P) before performing an emotional inhibitory control task during electroencephalography (EEG) acquisition. Results Higher trait impulsivity in EDs than HC (with higher scores among BSD patients) was observed. However, no differences in behavioural measures or neural indexes [event-related potential (ERP)] of emotional and non-emotional inhibitory control were observed between patients and HC. Conclusion The present results highlighted negative urgency, an impulsive personality trait related to emotions, as a common feature of AN and BSD. Lack of perseverance, a trait which is less related to emotions, specifically characterises patients with BSD. On the other hand, behavioural and ERP data did not show altered inhibitory control in EDs, for either general or emotional-related response inhibition.

Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN., This manuscript and research were supported by grants from the Instituto de Salud Carlos III (ISCIII) [FIS PI14/00290, PI17/01167 and cofounded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe]. CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn) is an initiative of ISCIII. M.L-M and C.V-A are supported by a predoctoral grants of the Ministerio de Educacion, Cultura y Deporte (FPU15/02911 and FPU16/01453). Study resulting from the SLT006/17/00246 grant, funded by the Department of Health of the Generalitat de Catalunya by the call "Accio instrumental de programes de recerca orientats en l'ambit de la recerca i la innovacio en salut". We thank CERCA Programme/Generalitat de Catalunya for Institutional support.

BackgroundAlthough deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes.MethodsWe investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement.ResultsCompared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWEr = −0.511, p = 0.018) and eating disorder severity (r = −0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment.ConclusionsTaken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity.

The effect of music-supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow-up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add-on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement.

Altered activity in decision-making neural circuitry may underlie the maladaptive food choices found in obesity. Here, we aimed to identify the brain regions purportedly underpinning risk-taking behavior in individuals with obesity. Twenty-three adult women with obesity and twenty-three healthy weight controls completed the Risky Gains Task during functional magnetic resonance imaging (fMRI). This task allows participants to choose between a safe option for a small, guaranteed monetary reward and risky options with larger rewards. fMRI analyses comparing losing trials to winning trials found that participants with obesity presented decreased activity in the left anterior insula in comparison to controls (p &lt, 0.05, AlphaSim corrected). Moreover, left insula activation during losses vs. wins was negatively correlated with UPPS-P questionnaire sensation seeking scores. During safe vs. risky trials following a loss, the control group exhibited increased activation in the ventromedial prefrontal cortex (vmPFC) (p &lt, 0.05, AlphaSim corrected) in comparison to the OB group. Moreover, vmPFC response in the obesity group during post-loss trials was negatively correlated with risky choices on the task overall. As a whole, our findings support that diminished tuning of the insula towards interoceptive signals may lead to a lack of input to the vmPFC when weighing the costs and benefits of risky choices.

Maladaptive emotion regulation contributes to overeating and impedes weight loss. Our study aimed to compare the voluntary downregulation of negative emotions by means of cognitive reappraisal in adult women with obesity (OB) and female healthy controls (HC) using a data-driven, multimodal magnetic resonance imaging (MRI) approach. Women with OB (n = 24) and HC (n = 25) carried out an emotion regulation task during functional MRI scanning. Seed-to-voxel resting-state connectivity patterns derived from activation peaks identified by this task were compared between groups. Diffusion tensor imaging (DTI) was used to examine white matter microstructure integrity between regions exhibiting group differences in resting-state functional connectivity. Participants in the OB group presented reduced activation in the ventromedial prefrontal (vmPFC) cortex in comparison to the HC group when downregulating negative emotions, along with heightened activation in the extrastriate visual cortex (p, Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290, PI17/ 01167; PI13/01958) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERobn and CIBERsam are both initiatives of ISCIII. M.P.-P. and G.M.-B. are supported by predoctoral AGAUR grants (2015 FI_B 00839 and 2018 FI_B2 00174), grants co-funded by the European Social Fund (ESF) “ESF”, investing in your future. I.M.-Z. receives support from a P-FIS Carlos III grant (FI17/00294). M.S. is supported by a CIBERSAM PhD grant (CNV665/914). C.S.-M. is supported by a Miguel Servet contract from the Carlos III Health Institute (CPII16/00048). Study resulting from the SLT006/17/00246 grant, funded by the Department of Health of the Generalitat de Catalunya from the call “Acció instrumental de programes de recerca orientats en l'àmbit de la recerca i la innovació en salut”. We thank CERCA Program/Generalitat de Catalunya for institutional support. Additional support received from EU Grant Eat2beNice (H2020-SFS-2016-2; Ref 728018)

Background Individuals with obesity (OB) often report suffering from addiction-like symptoms. As in addictions, deficits in executive function domains, such as decision-making and sustained attention, are found in OB. No study to date has examined the associations between food addiction, OB, and neuropsychological performance. Method Thirty-three adult women with OB and 36 healthy weight controls completed the Yale Food Addiction Scale Version 2.0, a validated instrument used to assess food-related addictive behaviours. Additionally, participants completed computerized versions of the Iowa Gambling Task (IGT) and Conners' Continuous Performance Test, second edition (CPT-II) to examine decision-making and attentional control, respectively. Results Food addiction criteria were met in 24.2% of the participants with OB and in 2.8% of the control group. In the OB group, food addiction severity levels were negatively correlated with overall scores on the IGT. Participants with OB meeting criteria for food addiction committed more omissions and perseveration errors on the CPT-II compared with those without food addiction. Conclusions Our results point to an association between food addiction severity levels and impairments in decision-making and attentional capacity in individuals with OB. Given the heterogeneity found in OB, it stands to reason that this subset of patients with food addiction could potentially benefit from interventions targeting neuropsychological deficits.

Introduction Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can change the excitability of the central nervous system and contribute to motor recovery of patients with stroke. The functional benefit may increase with the combination of tDCS with manoeuvres facilitating motor output. Most previous studies included patients in the chronic phase. We have evaluated the effects of tDCS coupled with radial nerve stimulation in the acute phase after stroke, as an add-on treatment to neurorehabilitation therapy that could potentially enhance motor recovery. Methods Twenty patients with a history of first acute cortical and/or subcortical stroke (11 ischemic and 9 hemorrhagic) were included in a prospective, double-blind, randomized study. Patients presented a moderate to severe motor deficit at onset (NIHSS: 14 ± 4.4 range 6–21 and upper limb Fugl-Meyer score: 17.4 ± 15.3, range 4–60). We studied the effects of combined peripheral radial nerve stimulation (PNS) to the paretic hand and anodal tDCS to the affected hemisphere (cathodal in the contralateral hemisphere). tDCS together with PNS were applied to 11 patients: 20 min during 5 consecutive days starting 7–15 days after the stroke. The results were compared with those of 9 patients receiving PNS with sham tDCS. All patients were under routine neurorehabilitation therapy. In sessions before, immediately after and 3, 6 months and one year after tDCS, we assessed Fugl-Meyer (FM) and modified Ashworth scales (MAS), resting motor threshold (RMT), MEPs and SEPs amplitudes, contralateral and ipsilateral silent period (cSP and iSP) duration and Hmax/Mmax ratio. Results There were significant time-related changes in clinical and neurophysiological scores, suggesting improvement in the clinically affected side in both groups (sham and real tDCS). However, there were no significant differences between real and sham tDCS in RMT, MEP amplitude, Hmax/Max ratio, cSP to TMS to the affected hemisphere, iSP to TMS to the unaffected hemisphere and FM and MAS scores (p Conclusion Five-daily sessions bihemispheric tDCS combined with radial nerve stimulation in the acute stroke patients of our study, showed a significant improvement in some clinical and neurophysiological scores, but these changes were similar to those observed in patients that received sham tDCS and PNS.

Introduction Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) is a reliable predictor of poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation. However the preservation of N20 does not prognosticate awakening, in fact is an uncertain pattern. The prognostic value of N20 amplitude has still not been sufficiently documented. In our knowledge only one study has analyzed N20 amplitude. The aim of this study was to review the relationship between N20 amplitude and neurological outcome in our postanoxic patients. Methods We retrospectively review the data of all our patients who remained comatose after cardiopulmonary resuscitation between 2013 and 2017. The following variables were collected: N20 amplitude, clinical examination, EEG data, neuron-specific enolase and outcome determined upon hospital discharge by means of Cerebral performance category (CPC). The patients with CPC 1–3 were defined as good outcome, and those with CPC 4–5 as poor outcome. Results We identified 76 postanoxic patients with N20 present. Fifty-three (69.7%) had poor outcome (CPC 4–5). The mean N20 amplitude in these patients was 1.90 μV (SD 2.01 range 0.16–7.9). Twenty-three patients (30.2%) had good outcome (CPC 1–3) and the mean N20 amplitude in these patients was 3.43 μV (SD 2.73 range 0.93–11.3). The ROC curve shows 0.86 μV as the cut-value for a better specificity with higher sensitivity. Any patient with amplitude lowest than 0.86 μV had good outcome (specificity 100%, sensitivity 50.9%, positive predictive value 100%, negative predictive value 46.9%). Conclusion In our postanoxic patients very low N20 amplitudes appear to be highly predictive of poor outcome. Our results corroborate published data.

Background Ross syndrome is a degenerative disorder characterized by the clinical triad of tonic pupil, hyporeflexia and segmental anhidrosis. Harlequin syndrome is described as segmental anhidrosis without ocular sympathetic deficit. Harlequin syndrome exhibits a selective abnormality in the peripheral skin sympathetic nerves and Ross syndrome reveals a widespread autonomic dysfunction. We present 4 patients with sudomotor dysfunction and different patterns of autonomic abnormalities. Material and methods Patients 1 and 2 complained of unilateral facial and upper limb flushing and sweating impairment. Patients 3 and 4 complained of an extensive anhidrosis and compensatory hyperhidrosis, patient 4 also presented an Adie’s pupil. Patients underwent nerve conduction studies, sympathetic skin responses (SSR), cardiovascular reflexes (deep breathing, Valsalva maneuver and standing) and laser evoked potentials. Results SSR were absent in the anhidrotic upper limb in patients 1 and 2, either to electric or laser stimuli. No evoked SSR responses were recorded in the four limbs in patients 3 and 4. Patient 4 presented slightly impaired cardiovascular reflexes and patients 2 and 4 presented mild abnormalities in sensory nerve conduction studies. Serologic screening, brain MRI and cervicothoracic CT were normal in all patients. Patients 1 and 2 were affected by a Harlequin syndrome, patient 3 presented an uncompleted Ross syndrome and patient 4 a classic Ross syndrome. Conclusions Ross and Harlequin syndrome are two clinically distinguishable expressions of partial dysautonomias belonging to a degenerative autonomic disorder that involves sympathetic, parasympathetic and myelinated nerve fibres with different distribution, extent and degree of impairment.

BackgroundSeveral recently developed therapies targeting motor disabilities in stroke sufferers have shown to be more effective than standard neurorehabilitation approaches. In this context, several basic studies demonstrated that music training produces rapid neuroplastic changes in motor-related brain areas. Music-supported therapy has been recently developed as a new motor rehabilitation intervention.Methods and resultsIn order to explore the plasticity effects of music-supported therapy, this therapeutic intervention was applied to twenty chronic stroke patients. Before and after the music-supported therapy, transcranial magnetic stimulation was applied for the assessment of excitability changes in the motor cortex and a 3D movement analyzer was used for the assessment of motor performance parameters such as velocity, acceleration and smoothness in a set of diadochokinetic movement tasks. Our results suggest that the music-supported therapy produces changes in cortical plasticity leading the improvement of the subjects' motor performance.ConclusionOur findings represent the first evidence of the neurophysiological changes induced by this therapy in chronic stroke patients, and their link with the amelioration of motor performance. Further studies are needed to confirm our observations.

Background We report the case of a chronic stroke patient (62 months after injury) showing total absence of motor activity evoked by transcranial magnetic stimulation (TMS) of spared regions of the left motor cortex, but near-to-complete recovery of motor abilities in the affected hand. Case presentation Multimodal investigations included detailed TMS based motor mapping, motor evoked potentials (MEP), and Cortical Silent period (CSP) as well as functional magnetic resonance imaging (fMRI) of motor activity, MRI based lesion analysis and Diffusion Tensor Imaging (DTI) Tractography of corticospinal tract (CST). Anatomical analysis revealed a left hemisphere subinsular lesion interrupting the descending left CST at the level of the internal capsule. The absence of MEPs after intense TMS pulses to the ipsilesional M1, and the reversible suppression of ongoing electromyographic (EMG) activity (indexed by CSP) demonstrate a weak modulation of subcortical systems by the ipsilesional left frontal cortex, but an inability to induce efficient descending volleys from those cortical locations to right hand and forearm muscles. Functional MRI recordings under grasping and finger tapping patterns involving the affected hand showed slight signs of subcortical recruitment, as compared to the unaffected hand and hemisphere, as well as the expected cortical activations. Conclusions The potential sources of motor voluntary activity for the affected hand in absence of MEPs are discussed. We conclude that multimodal analysis may contribute to a more accurate prognosis of stroke patients.