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4. No evidence of disease activity (NEDA-3) and disability improvement after alemtuzumab treatment for multiple sclerosis: a 36-month real-world study

Author

Prosperini, L, Annovazzi, P, Boffa, L, Buscarinu, Mc, Gallo, A, Matta, M, Moiola, L, Musu, L, Perini, P, Avolio, C, Barcella, V, Bianco, A, Farina, D, Ferraro, E, Pontecorvo, S, Granella, F, Grimaldi, Lme, Laroni, A, Lus, G, Patti, F, Pucci, E, Pasca, M, Sarchielli, P, Ghezzi, A, Zaffaroni, M, Baroncini, D, Buttari, F, Centonze, D, Fornasiero, A, Salvetti, M, Docimo, R, Signoriello, E, Tedeschi, G, Bertolotto, A, Capobianco, M, Comi, G, Cocco, E, Gallo, P, Puthenparampil, M, Grasso, R, Di Francescantonio, V, Rottoli, Mr, Mirabella, M, Lugaresi, A, De Luca, G, Di Ioia, M, Di Tommaso, V, Mancinelli, L, Di Battista, G, Francia, A, Ruggieri, S, Pozzilli, C, Curti, E, Tsantes, E, Palmeri, B, Lapucci, C, Mancardi, Gl, Uccelli, A, Chisari, C, D'Amico, E, Cartechini, E, Repice, Am, Magnani, E, Massaccesi, L, Calabresi, P, Di Filippo, M, Di Gregorio, M, Italian Alemtuzumab Study, Group., Prosperini, Luca, Annovazzi, Pietro, Boffa, Laura, Buscarinu, Maria Chiara, Gallo, Antonio, Matta, Manuela, Moiola, Lucia, Musu, Luigina, Perini, Paola, Avolio, Carlo, Barcella, Valeria, Bianco, Assunta, Farina, Deborah, Ferraro, Elisabetta, Pontecorvo, Simona, Granella, Franco, Grimaldi, Luigi M E, Laroni, Alice, Lus, Giacomo, Patti, Francesco, Pucci, Eugenio, Pasca, Matteo, and Sarchielli, Paola

Subjects
Adult, Male, medicine.medical_specialty, Neurology, Outcome measurement, Relapsing-Remitting, Follow-Up Studie, Multiple sclerosis, 03 medical and health sciences, Immunologic Factor, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, Alemtuzumab, Multiple sclerosis, Outcome measurement, Retrospective Studie, Alemtuzumab, Internal medicine, Medicine, Humans, Immunologic Factors, Multiple sclerosi, 030212 general & internal medicine, Female, Follow-Up Studies, Magnetic Resonance Imaging, Retrospective Studies, Treatment Outcome, Neurology (clinical), Expanded Disability Status Scale, medicine.diagnostic_test, business.industry, Retrospective cohort study, Magnetic resonance imaging, Odds ratio, medicine.disease, alemtuzumab, multiple sclerosis, outcome measurement, neurology, Clinical trial, Settore MED/26 - NEUROLOGIA, business, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

In this retrospective, multicenter, real-world study we collected clinical and magnetic resonance imaging (MRI) data of all patients (n = 40) with relapsing-remitting multiple sclerosis (RRMS) treated with alemtuzumab according to a "free-of-charge" protocol available before the drug marketing approval in Italy. Almost all (39/40) started alemtuzumab after discontinuing multiple disease-modifying treatments (DMTs) because of either lack of response or safety concerns. We considered the proportion of alemtuzumab-treated patients who had no evidence of disease activity (NEDA-3) and disability improvement over a 36-month follow-up period. NEDA-3 was defined as absence of relapses, disability worsening, and MRI activity. Disability improvement was defined as a sustained reduction of ≥ 1-point in Expanded Disability Status Scale (EDSS) score. At follow-up, 18 (45%) patients achieved NEDA-3, 30 (75%) were relapse-free, 33 (82.5%) were EDSS worsening-free, and 25 (62.5%) were MRI activity-free. Eleven (27.5%) patients had a sustained disability improvement. We found no predictor for the NEDA-3 status, while the interaction of higher EDSS score by higher number of pre-alemtuzumab relapses was associated with a greater chance of disability improvement (odds ratio 1.10, p = 0.049). Our study provides real-world evidence that alemtuzumab can promote clinical and MRI disease remission, as well as disability improvement, in a significant proportion of patients with RRMS despite prior multiple DMT failures. The drug safety profile was consistent with data available from clinical trials.

Published
2018

5. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, and Rottoli, Maira Rosa

Abstract

Objective early diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-pML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-pML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal pML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter. Methods all Italian patients who developed NTZ-pML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant. results (1) pML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) pML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort. Conclusions considering the latency of pML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3-4 months. early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and Jc virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

6. No evidence of disease activity (NEDA-3) and disability improvement after alemtuzumab treatment for multiple sclerosis: a 36-month real-world study

Author

Prosperini, L., Annovazzi, P., Boffa, L., Buscarinu, M. C., Gallo, A., Matta, M., Moiola, L., Musu, L., Perini, P., Avolio, C., Barcella, V., Bianco, Assunta, Farina, D., Ferraro, E., Pontecorvo, S., Granella, F., Grimaldi, L. M. E., Laroni, A., Lus, G., Patti, F., Pucci, E., Pasca, M., Sarchielli, P., Ghezzi, A., Zaffaroni, M., Baroncini, D., Buttari, F., Centonze, D., Fornasiero, A., Salvetti, M., Docimo, R., Signoriello, E., Tedeschi, G., Bertolotto, A., Capobianco, M., Comi, G., Cocco, E., Gallo, P., Puthenparampil, M., Grasso, R., Di Francescantonio, V., Rottoli, M. R., Mirabella, Massimiliano, Lugaresi, A., De Luca, G., Di Ioia, M., Di Tommaso, V., Mancinelli, L., Di Battista, G., Francia, A., Ruggieri, S., Pozzilli, C., Curti, E., Tsantes, E., Palmeri, B., Lapicci, C., Mancardi, G. L., Uccelli, A., Chisari, C., D'Amico, E., Cartechini, E., Repice, A. M., Magnani, E., Massaccesi, L., Calabresi, Paolo, Di Filippo, Mario, Di Gregorio, M., Bianco A., Mirabella M. (ORCID:0000-0002-7783-114X), Calabresi P. (ORCID:0000-0003-0326-5509), Di Filippo M., Prosperini, L., Annovazzi, P., Boffa, L., Buscarinu, M. C., Gallo, A., Matta, M., Moiola, L., Musu, L., Perini, P., Avolio, C., Barcella, V., Bianco, Assunta, Farina, D., Ferraro, E., Pontecorvo, S., Granella, F., Grimaldi, L. M. E., Laroni, A., Lus, G., Patti, F., Pucci, E., Pasca, M., Sarchielli, P., Ghezzi, A., Zaffaroni, M., Baroncini, D., Buttari, F., Centonze, D., Fornasiero, A., Salvetti, M., Docimo, R., Signoriello, E., Tedeschi, G., Bertolotto, A., Capobianco, M., Comi, G., Cocco, E., Gallo, P., Puthenparampil, M., Grasso, R., Di Francescantonio, V., Rottoli, M. R., Mirabella, Massimiliano, Lugaresi, A., De Luca, G., Di Ioia, M., Di Tommaso, V., Mancinelli, L., Di Battista, G., Francia, A., Ruggieri, S., Pozzilli, C., Curti, E., Tsantes, E., Palmeri, B., Lapicci, C., Mancardi, G. L., Uccelli, A., Chisari, C., D'Amico, E., Cartechini, E., Repice, A. M., Magnani, E., Massaccesi, L., Calabresi, Paolo, Di Filippo, Mario, Di Gregorio, M., Bianco A., Mirabella M. (ORCID:0000-0002-7783-114X), Calabresi P. (ORCID:0000-0003-0326-5509), and Di Filippo M.

Abstract

In this retrospective, multicenter, real-world study we collected clinical and magnetic resonance imaging (MRI) data of all patients (n = 40) with relapsing-remitting multiple sclerosis (RRMS) treated with alemtuzumab according to a “free-of-charge” protocol available before the drug marketing approval in Italy. Almost all (39/40) started alemtuzumab after discontinuing multiple disease-modifying treatments (DMTs) because of either lack of response or safety concerns. We considered the proportion of alemtuzumab-treated patients who had no evidence of disease activity (NEDA-3) and disability improvement over a 36-month follow-up period. NEDA-3 was defined as absence of relapses, disability worsening, and MRI activity. Disability improvement was defined as a sustained reduction of ≥ 1-point in Expanded Disability Status Scale (EDSS) score. At follow-up, 18 (45%) patients achieved NEDA-3, 30 (75%) were relapse-free, 33 (82.5%) were EDSS worsening-free, and 25 (62.5%) were MRI activity-free. Eleven (27.5%) patients had a sustained disability improvement. We found no predictor for the NEDA-3 status, while the interaction of higher EDSS score by higher number of pre-alemtuzumab relapses was associated with a greater chance of disability improvement (odds ratio 1.10, p = 0.049). Our study provides real-world evidence that alemtuzumab can promote clinical and MRI disease remission, as well as disability improvement, in a significant proportion of patients with RRMS despite prior multiple DMT failures. The drug safety profile was consistent with data available from clinical trials.

Published
2018

7. Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone

Author

Martinelli, V., Cocco, E., Capra, R., Salemi, G., Gallo, P., Capobianco, M., Pesci, I., Ghezzi, A., Pozzilli, Carlo, Lugaresi, A., Bellantonio, P., Amato, M. P., Grimaldi, L. M., Trojano, M., Mancardi, G. L., Bergamaschi, R., Gasperini, Claudio, Rodegher, M., Straffi, L., Ponzio, M., Comi, G., For The Italian Mitoxantrone Group, Radaelli, M, Esposito, F, Moiola, L, Colombo, B, Rossi, P, Marrosu, Mg, Frau, J, Lorefice, L, Coghe, G, Savettieri, Giovanni, Ragonese, P, Cusimano, V, Perini, P, Rinaldi, F, Vidali, A, Bertolotto, A, Malucchi, S, Di Sapio, A, Montanari, E, Guareschi, A, Rizzo, A, Zaffaroni, M, Baldini, S, De Rossi, N, Cordioli, C, Rasia, S, Salvetti, M, Buttinelli, C, AUSILI CEFARO, Luca, De Luca, G, Tommaso, D, Farina, D, Fantozzi, R, Ruggieri, S, Amato, Mp, Hakiki, B, Zipoli, V, Portaccio, E, Bartolozzi, Ml, Scandellari, C, Stecchi, S, Marchello, Lp, Palmeri, B, Vitello, G, Iaffaldano, P, Lucchese, G, Dattola, V, Buccafusca, M, Sola, P, Simone, Am, Barreca, F, Patti, F, Laisa, P, Cavalla, P, Masera, S, Tavazzi, E, Galgani, S, Tedeschi, G, Sacco, R, Provinciali, L, Maura, D, Lus, G, Alfieri, G, Ticca, A, Piras, Ml, Maimone, D, Bianca, M, Iudice, A, Giro, Me, Galeotti, M, Florio, C, Spitalieri, P, La Mantia, L, Motti, L, Rottoli, Mr, Granella, F, Solaro, C, Scarpini, E, Servillo, G, Cavaletti, G., Martinelli, V., Cocco, E., Capra, R., Salemi, G., Gallo, P., Capobianco, M., Pesci, I., Ghezzi, A., Pozzilli, C., Lugaresi, A., Bellantonio, P., Amato, M. P., Grimaldi, L. M., Trojano, M., Mancardi, G. L., Bergamaschi, R., Gasperini, C., Rodegher, M., Straffi, L., Ponzio, M., Comi, G., Radaelli, M., Esposito, F., Moiola, L., Colombo, B., Rossi, P., Marrosu, M. G., Frau, J., Lorefice, L., Coghe, G., Savettieri, G., Ragonese, P., Cusimano, V., Perini, P., Rinaldi, F., Vidali, A., Bertolotto, A., Malucchi, S., Di Sapio, A., Montanari, E., Guareschi, A., Rizzo, A., Zaffaroni, M., Baldini, S., De Rossi, N., Cordioli, C., Rasia, S., Salvetti, M., Buttinelli, C., Ausili Cefaro, L., De Luca, Giovanna, Tommaso, D., Farina, D., Fantozzi, R., Ruggieri, S., Hakiki, B., Zipoli, V., Portaccio, E., Bartolozzi, M. L., Scandellari, C., Stecchi, S., Marchello, L. P., Palmeri, B., Vitello, G., Iaffaldano, P., Lucchese, G., Dattola, V., Buccafusca, M., Sola, P., Simone, A. M., Barreca, F., Patti, F., Laisa, P., Cavalla, P., Masera, S., Tavazzi, E., Galgani, S., Tedeschi, G., Sacco, R., Provinciali, L., Maura, D., Lus, G., Alfieri, G., Ticca, A., Piras, M. L., Maimone, D., Bianca, M., Iudice, A., Giro, M. E., Galeotti, M., Florio, C., Spitalieri, P., La Mantia, L., Motti, L., Rottoli, M. R., Granella, F., Solaro, C., Scarpini, E., Servillo, G., Cavaletti, G., Radaelli, M, Esposito, F, Moiola, L, Colombo, B, Rossi, P, Marrosu, MG, Frau, J, Lorefice, L, Coghe, G, Savettieri, G, Ragonese, P, Cusimano, V, Perini, P, Rinaldi, F, Vidali, A, Bertolotto, A, Malucchi, S, Di Sapio, A, Montanari, E, Guareschi, A, Rizzo, A, Zaffaroni, M, Baldini, S, De Rossi, N, Cordioli, C, Rasia, S, Salvetti, M, Buttinelli, C, Ausili Cefaro, L, De Luca, G, Tommaso, D, Farina, D, Fantozzi, R, Ruggieri, S, Amato, MP, Hakiki, B, Zipoli, V, Portaccio, E, Bartolozzi, ML, Scandellari, C, Stecchi, S, Marchello, LP, Palmeri, B, Vitello, G, Iaffaldano, P, Lucchese G, Dattola V, Buccafusca M, Sola, P, Simone, AM, Barreca, F, Patti, F, Laisa, P, Cavalla, P, Masera, S, Tavazzi, E, Galgani, S, Tedeschi, G, Sacco, R, Provinciali, L, Maura, D, Lus, G, Alfieri, G, Ticca, A, Piras, ML, Maimone, D, Bianca, M, Iudice, A, Giro, ME, Galeotti, M, Florio, C, Spitalieri, P, La Mantia, L, Motti, L, Rottoli, MR, Granella, F, Solaro, C, Scarpini, E, Servillo, G, Cavalletti, G, Salemi, G, Martinelli, V, Cocco, E, Capra, R, Gallo, P, Capobianco, M, Pesci, I, Ghezzi, A, Pozzilli, C, Lugaresi, A, Bellantonio, P, Amato, M, Grimaldi, L, Trojano, M, Mancardi, G, Bergamaschi, R, Gasperini, C, Rodegher, M, Straffi, L, Ponzio, M, Comi, G, Cavaletti, G, and DIPARTIMENTO DI SCIENZE BIOMEDICHE E NEUROMOTORIE

Subjects
Male, medicine.medical_specialty, Myeloid, mitoxantrone, acute myelocytic leukemia, multiple sclerosis, Population, Statistics, Nonparametric, Follow-Up Studie, Arts and Humanities (miscellaneous), Retrospective Studie, Internal medicine, Multiple Sclerosi, medicine, Humans, multiple sclerosis, leukemia, mitoxantrone, Prospective cohort study, education, Retrospective Studies, Aged, Analgesics, education.field_of_study, Mitoxantrone, Cumulative dose, business.industry, Multiple sclerosis, Incidence (epidemiology), leukemia, Myeloid leukemia, Retrospective cohort study, medicine.disease, Confidence interval, Surgery, Leukemia, Leukemia, Myeloid, Acute, medicine.anatomical_structure, Italy, Cohort, Settore MED/26 - Neurologia, Analgesic, Female, Neurology (clinical), business, Follow-Up Studies, medicine.drug, Human
Abstract

none 25 no Abstract OBJECTIVES: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. METHODS: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. RESULTS: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean ± SD) was 49 ± 29 months (range 12-140 months). We observed 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m(2), p = 0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%. CONCLUSIONS: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML. none Martinelli V; Cocco E; Capra R; Salemi G; Gallo P; Capobianco M; Pesci I; Ghezzi A; Pozzilli C; Lugaresi A; Bellantonio P; Amato MP; Grimaldi LM; Trojano M; Mancardi GL; Bergamaschi R; Gasperini C; Rodegher M; Straffi L; Ponzio M; Comi G; For The Italian Mitoxantrone Group; De Luca G; Di Tommaso V; Farina D Martinelli V; Cocco E; Capra R; Salemi G; Gallo P; Capobianco M; Pesci I; Ghezzi A; Pozzilli C; Lugaresi A; Bellantonio P; Amato MP; Grimaldi LM; Trojano M; Mancardi GL; Bergamaschi R; Gasperini C; Rodegher M; Straffi L; Ponzio M; Comi G; For The Italian Mitoxantrone Group; De Luca G; Di Tommaso V; Farina D

Published
2011

8. Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone

Author

Martinelli V, Cocco E, Capra R, Salemi G, Gallo P, Capobianco M, Pesci I, Ghezzi A, Pozzilli C, Lugaresi A, Bellantonio P, Amato MP, Grimaldi LM, Trojano M, Mancardi GL, Bergamaschi R, Gasperini C, Rodegher M, Straffi L, Ponzio M, Comi G, Italian Mitoxantrone G.r.o.u.p. COLLABORATORS: Radaelli M, Esposito F, Moiola L, Colombo B, Rossi P, Marrosu MG, Frau J, Lorefice L, Coghe G, Savettieri G, Ragonese P, Cusimano V, Perini P, Rinaldi F, Vidali A, Bertolotto A, Malucchi S, Di Sapio A, Montanari E, Guareschi A, Rizzo A, Zaffaroni M, Baldini S, De Rossi N, Cordioli C, Rasia S, Salvetti M, Buttinelli C, Ausili Cefaro L, De Luca G, Tommaso D, Farina D, Fantozzi R, Ruggieri S, Hakiki B, Zipoli V, Portaccio E, Bartolozzi ML, Scandellari C, Stecchi S, Marchello LP, Palmeri B, Vitello G, Iaffaldano P, Lucchese G, Dattola V, Buccafusca M, Sola P, Simone AM, Barreca F, Patti F, Laisa P, Cavalla P, Masera S, Tavazzi E, Galgani S, Sacco R, Provinciali L, Maura D, LUS, Giacomo, Alfieri G, Ticca A, Piras ML, Maimone D, Bianca M, Iudice A, Giro ME, Galeotti M, Florio C, Spitalieri P, La Mantia L, Motti L, Rottoli MR, Granella F, Solaro C, Scarpini E, Servillo G, Cavalletti G., TEDESCHI, Gioacchino, Martinelli, V, Cocco, E, Capra, R, Salemi, G, Gallo, P, Capobianco, M, Pesci, I, Ghezzi, A, Pozzilli, C, Lugaresi, A, Bellantonio, P, Amato, Mp, Grimaldi, Lm, Trojano, M, Mancardi, Gl, Bergamaschi, R, Gasperini, C, Rodegher, M, Straffi, L, Ponzio, M, Comi, G, COLLABORATORS: Radaelli M, Italian Mitoxantrone G. r. o. u. p., Esposito, F, Moiola, L, Colombo, B, Rossi, P, Marrosu, Mg, Frau, J, Lorefice, L, Coghe, G, Savettieri, G, Ragonese, P, Cusimano, V, Perini, P, Rinaldi, F, Vidali, A, Bertolotto, A, Malucchi, S, Di Sapio, A, Montanari, E, Guareschi, A, Rizzo, A, Zaffaroni, M, Baldini, S, De Rossi, N, Cordioli, C, Rasia, S, Salvetti, M, Buttinelli, C, Ausili Cefaro, L, De Luca, G, Tommaso, D, Farina, D, Fantozzi, R, Ruggieri, S, Hakiki, B, Zipoli, V, Portaccio, E, Bartolozzi, Ml, Scandellari, C, Stecchi, S, Marchello, Lp, Palmeri, B, Vitello, G, Iaffaldano, P, Lucchese, G, Dattola, V, Buccafusca, M, Sola, P, Simone, Am, Barreca, F, Patti, F, Laisa, P, Cavalla, P, Masera, S, Tavazzi, E, Galgani, S, Tedeschi, Gioacchino, Sacco, R, Provinciali, L, Maura, D, Lus, Giacomo, Alfieri, G, Ticca, A, Piras, Ml, Maimone, D, Bianca, M, Iudice, A, Giro, Me, Galeotti, M, Florio, C, Spitalieri, P, La Mantia, L, Motti, L, Rottoli, Mr, Granella, F, Solaro, C, Scarpini, E, Servillo, G, and Cavalletti, G.

Published
2011

9. Predictors of caregiver burden in partners of patients with Parkinson's disease

Author

D'AMELIO, Marco, TERRUSO, Valeria, ARIDON, Paolo, RAGONESE, Paolo, SAVETTIERI, Giovanni, Palmeri, B, Di Benedetto, N, Famoso, G, Cottone, P, D'Amelio, M, Terruso, V, Palmeri, B, Di Benedetto, N, Famoso, G, Cottone, P, Aridon, P, Ragonese, P, and Savettieri, G

Subjects
Parkinson's Disease, Settore MED/26 - Neurologia, caregiver
Published
2009

11. Predictors of caregiver burden in partners of patients with Parkinson's disease.

Author

D'Amelio M, Terruso V, Palmeri B, Di Benedetto N, Famoso G, Cottone P, Aridon P, Ragonese P, Savettieri G, D'Amelio, Marco, Terruso, Valeria, Palmeri, Barbara, Di Benedetto, Norma, Famoso, Giorgia, Cottone, Paolo, Aridon, Paolo, Ragonese, Paolo, and Savettieri, Giovanni

Abstract

Aim of this study was to determine the predictors of caregiver burden among spouse caregivers of patients with Parkinson's disease (PD). Forty consecutive PD patients and their spouse caregivers were included. Patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn and Yahr scale (HY), the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Geriatric Depression Scale (GDS). Stress and depressive symptoms among caregivers were evaluated using the Caregiver Burden Inventory (CBI) scale and the GDS. Only PD severity (HY) and mental symptoms (NPI) were significantly associated to caregiver distress. A major attention must be given to the early identification of factors generating stress in caregivers in order to improve caregiver quality of life and patient's care. [ABSTRACT FROM AUTHOR]

Published
2009
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13. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, and Valentino, P

Subjects
natalizumab treatment, Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Surgery, Neurology (clinical), Psychiatry and Mental Health, natalizumab, progressive multifocal leucoencephalopathy, Progressive Multifocal, Lesion, Leukoencephalopathy, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Psychiatry and Mental Health, progressive multifocal leucoencephalopathy, medicine, Humans, Immunologic Factors, Young adult, Progressive multifocal leucoencephalopathy, Retrospective Studies, medicine.diagnostic_test, business.industry, Multiple sclerosis, Natalizumab, Leukoencephalopathy, Progressive Multifocal, Magnetic resonance imaging, Retrospective cohort study, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Early Diagnosis, Female, Italy, Cohort, Settore MED/26 - Neurologia, Radiology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

ObjectiveEarly diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-PML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-PML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal PML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter.MethodsAll Italian patients who developed NTZ-PML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant.Results(1) PML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) PML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort.ConclusionsConsidering the latency of PML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3–4 months. Early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and JC virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

14. High Prevalence and Fast Rising Incidence of Multiple Sclerosis in Caltanissetta, Sicily, Southern Italy

Author

Luigi M.E. Grimaldi, Roberto Grimaldi, Marco D'Amelio, Gaetano Vitello, Paolo Ragonese, Giovanni Savettieri, Giuseppe Salemi, Barbara Palmeri, Giuseppe Giglia, GRIMALDI, LM, PALMERI, B, SALEMI, G, GIGLIA, G, D'AMELIO, M, GRIMALDI, R, VITELLO, G, RAGONESE, P, and SAVETTIERI, G

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Adolescent, Multiple sclerosis incidence, Prevalence, Sicily, Epidemiology, Age Distribution, Prevalence, medicine, Humans, Sex Distribution, Sicily, Aged, High prevalence, business.industry, Incidence, Multiple sclerosis, Incidence (epidemiology), Urban Health, Middle Aged, medicine.disease, Health Surveys, humanities, Female, Settore MED/26 - Neurologia, Neurology (clinical), business, Mediterranean Islands, Follow-Up Studies, Demography
Abstract

Background: Epidemiological studies conducted in Sicily and Sardinia, the two major Mediterranean islands, showed elevated incidence and prevalence of multiple sclerosis (MS)and a recent increase in disease frequency. Objective: To confirm the central highlands of Sicily as areas of increasing MS prevalence and elevated incidence, we performed a follow-up study based on the town of Caltanissetta (Sicily), southern Italy. Methods: We made a formal diagnostic reappraisal of all living patients found in the previous study performed in 1981. All possible information sources were used to search for patients affected by MS diagnosed according to the Poser criteria. We calculated prevalence ratios, for patients affected by MS who were living and resident in the study area on December 31, 2002. Crude and age- and sex-specific incidence ratios were computed for the period from January 1, 1993, to December 31, 2002. Results: The prevalence of definite MS rose in 20 years from 69.2 (retrospective prevalence rate) to 165.8/100,000 population. We calculated the incidence of definite MS for the period 1970–2000. These rates calculated for 5-year periods increased from 2.3 to 9.2/100,000/year. Conclusion: This survey shows the highest prevalence and incidence figures of MS in the Mediterranean area and confirms central Sicily as a very-high-risk area for MS.

Published
2006
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15. MRI abnormalities following repeated and incoming seizures

Author

Paolo Ragonese, Ornella Daniele, Barbara Palmeri, Marco D'Amelio, Simona Talamanca, Valeria Terruso, Paolo Aridon, Palmeri, B, Talamanca, S, Ragonese, P, Aridon, P, Daniele, O, Terruso, V, and D'Amelio, M

Subjects
Long lasting, Adult, medicine.medical_specialty, Clinical Neurology, Status epilepticus, MRI abnormality, Epilepsy, Neuroimaging, Recurrence, Seizures, Medicine, Humans, Brain magnetic resonance imaging, business.industry, Electroencephalography, General Medicine, medicine.disease, Seizure, Magnetic Resonance Imaging, Neurology, Etiology, Settore MED/26 - Neurologia, Female, Neurology (clinical), Tomography, Radiology, medicine.symptom, business, Brain neoplasm, Epilepsy, MRI
Abstract

Neuroimaging, an important diagnostic tool frequently used in the evaluation of patients with epilepsy, has mainly the aim to identify structural abnormalities needing a treatment and to contribute to the definition of the aetiology. Brain magnetic resonance imaging (MRI) in epilepsy is more sensitive than computerized tomography (CT) scan for detecting abnormalities. Status epilepticus (SE) and repeated incoming seizures may determine extensive and transient or long lasting pronounced MRI changes. We describe a case of a 41-year-old woman with a history of brain neoplasm, whose contrast-enhanced MRI images following repeated and incoming seizures were characterized either by reversible and irreversible abnormalities.

Published
2010

16. Multiple sclerosis survival: a population-based study in Sicily

Author

RAGONESE, Paolo, ARIDON, Paolo, MAZZOLA, Maria Antonietta, CALLARI, Graziella, PALMERI, Barbara, FAMOSO, Giorgia, TERRUSO, Valeria, SALEMI, Giuseppe, D'AMELIO, Marco, SAVETTIERI, Giovanni, Ragonese, P., Aridon, P., Mazzola, M., Callari, G., Palmeri, B., Famoso, G., Terruso, V., Salemi, G., D'Amelio, M., and Savettieri, G.

Subjects
Multiple sclerosis, Multiple sclerosis, survival, population-based study, prognosis, Settore MED/26 - Neurologia
Abstract

Background and purpose: There are few population-based surveys on multiple sclerosis (MS) survival. To investigate MS survival in MS patients recruited during surveys conducted in Sicily. Methods: Multiple sclerosis patients identified during previous surveys were randomly matched to two referent subjects by residence, year of birth, and gender. Living status was obtained by municipality records (end of follow-up June, 30th 2007) and, for the deceased, date and causes of death were searched. Kaplan-Meier plots were used to calculate differences in mortality between MS patients and referent subjects. MS risks for mortality with 95% confidence intervals (CI) were also calculated. Results: We included 194 MS patients and 388 matched persons. Thirty MS patients (15.5%) and 28 referents (7.2%) had died until the end of follow-up. Mean survival from onset of the disease to death was 20.6 years. Mean age at death was 55.5 for MS patients and 64.8 for the referents. Adjusted Hazard Ratios for mortality in MS was 1.81 (95% CI 1.36-2.40). Kaplan-Meier estimates showed a higher mortality amongst patients compared to referent subjects (P < 0.001). Conclusions: The present study confirms the higher mortality risk in MS patients with no significant gender difference. Causes of death are related to complications of high disability and to increasing age

Published
2010

17. BODY MASS INDEX DOES NOT CHANGE BEFORE PARKINSON'S DISEASE ONSET

Author

Graziella Callari, Marco D'Amelio, Barbara Palmeri, Valeria Terruso, Paolo Ragonese, Maria Antonietta Mazzola, Paolo Aridon, Giuseppe Salemi, N Di Benedetto, Giovanni Savettieri, RAGONESE P, D'AMELIO M, CALLARI G, DI BENEDETTO N, PALMERI B, MAZZOLA MA, TERRUSO V, SALEMI G, SAVETTIERI G, and ARIDON P

Subjects
Adult, Male, medicine.medical_specialty, Parkinson's disease, Hypercholesterolemia, Population, Comorbidity, Weight Gain, Coffee, Body Mass Index, Risk Factors, Internal medicine, Diabetes mellitus, Weight Loss, Epidemiology, Diabetes Mellitus, medicine, Humans, Obesity, Age of Onset, education, Aged, Aged, 80 and over, Hypertriglyceridemia, education.field_of_study, business.industry, Smoking, Case-control study, nutritional and metabolic diseases, Parkinson Disease, Middle Aged, Overweight, medicine.disease, Neurology, Case-Control Studies, Healthy individuals, anthropometrical measures, body mass index, case–control study, epidemiology, Parkinson's disease, risk factors, Physical therapy, Female, Settore MED/26 - Neurologia, Neurology (clinical), business, Body mass index
Abstract

Background and purpose: Previous studies on the association between Parkinson’s disease (PD) and body mass index (BMI) have reported conflicting results. We investigated the relationship between PD and BMI by a case–control study. Methods: PD patients were randomly matched to healthy individuals by sex and age. BMI distribution in cases has been compared with BMI of controls and odd ratios (ORs) with 95% CI were calculated. Results: We included 318 PD patients and 318 controls. We observed no association between PD and BMI. BMI distribution in cases and controls was similar also when we adjusted for diabetes, hypercholesterolemia and the time elapsed between PD onset and the interview (OR = 0.99; CI = 0.94–1.03; P = 0.51). Conclusions: These results did not confirm the previously reported association between PD and BMI. Population characteristics and methodological issues may partially account for the differences observed between the present study and the others.

Published
2008

20. Dropped head as an unusual presenting sign of myasthenia gravis

Author

DI BENEDETTO, Norma, D'AMELIO, Marco, RAGONESE, Paolo, PALMERI, Barbara, DANIELE, Ornella, BRIGHINA, Filippo, FIERRO, Brigida, SAVETTIERI, Giovanni, DI BENEDETTO N, D'AMELIO M, RAGONESE P, PALMERI B, DANIELE O, BRIGHINA F, FIERRO B, and SAVETTIERI G

Published
2006

22. Dropped head as an unusual presenting sign of myastenia gravis

Author

DI BENDETTO N, D'AMELIO, Marco, RAGONESE, Paolo, PALMERI, Barbara, DANIELE, Ornella, BRIGHINA, Filippo, FIERRO, Brigida, SAVETTIERI, Giovanni, DI BENDETTO N, D'AMELIO M, RAGONESE P, PALMERI B, DANIELE O, BRIGHINA F, FIERRO B, and SAVETTIERI G

Published
2006

23. MRI abnormalities following repeated and incoming seizures

Author

PALMERI, Barbara, D'AMELIO, Marco, RAGONESE, Paolo, SARNO, Celeste, DI BENEDETTO, Norma, DANIELE, Ornella, FIERRO, Brigida, SAVETTIERI, Giovanni, BENCIVINNI, F, PALMERI, B, D'AMELIO, M, RAGONESE, P, SARNO, C, BENCIVINNI, F, DI BENDETTO, N, DANIELE, O, FIERRO, B, and SAVETTIERI, G

Abstract

Neuroimaging, an important diagnostic tool frequently used in the evaluation of patients with epilepsy, has mainly the aim to identify structural abnormalities needing a treatment and to contribute to the definition of the aetiology. Brain magnetic resonance imaging (MRI) in epilepsy is more sensitive than computerized tomography (CT) scan for detecting abnormalities. Status epilepticus (SE) and repeated incoming seizures may determine extensive and transient or long lasting pronounced MRI changes. We describe a case of a 41-year-old woman with a history of brain neoplasm, whose contrast-enhanced MRI images following repeated and incoming seizures were characterized either by reversible and irreversible abnormalities.

Published
2006

24. Practice Change After Training Psychiatry Residents in Tobacco Use Disorder.

Author

Williams JM, Steinberg ML, Wang H, Chaguturu V, Poulsen R, Tobia A, and Palmeri B

Subjects
Attitude of Health Personnel, Female, Humans, Male, Teaching, United States, Clinical Competence, Internship and Residency, Psychiatry education, Smoking Cessation methods, Tobacco Use Disorder therapy
Abstract

The goal of this study was to evaluate treatment practices among psychiatry residents before and 3 months after a course on tobacco use disorder. After completing the course, residents (N=89) reported a significant increase in the frequency in nine of the 12 tobacco use disorder treatment practices studied. Participants reported being more likely to assess patient willingness to quit smoking, advise patients to stop smoking, prescribe treatment medications, and provide cessation treatment. Being a junior vs. senior resident was a significant predictor of increased practices. Completing online training was associated with significant increases in the use of specific tobacco treatments.

Published
2020
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25. Evaluation of an Online Residency Training in Tobacco Use Disorder.

Author

Williams JM, Poulsen R, Chaguturu V, Tobia A, and Palmeri B

Subjects
Attitude of Health Personnel, Clinical Competence statistics & numerical data, Curriculum, Female, Follow-Up Studies, Humans, Male, Program Evaluation, Surveys and Questionnaires, Tobacco Use Disorder diagnosis, United States, Computer-Assisted Instruction methods, Internship and Residency methods, Psychiatry education, Tobacco Use Disorder therapy
Abstract

Background and Objectives: Despite the overwhelming need for tobacco use disorder (TUD) treatment in behavioral health settings, few models have emerged for training psychiatry residents. One barrier may be a lack of curricula or faculty expertize in this area. The goal of this project was to develop and evaluate a 3 hour online webinar-based course for teaching psychiatry residents about TUD., Methods: Residents from 42 participating general psychiatry residency programs were emailed a unique link to course materials. Participation was voluntary., Results: Two-hundred and seven residents completed the pretest measuring baseline knowledge and 199 completed the survey measuring attitudes toward treatment of tobacco use. Mean pretest scores were 53.0% correct (SD 19.6), showing low levels of baseline knowledge. Pretest knowledge scores differed by residency year, suggesting no gain in knowledge during residency training. About 80% of participants completed the entire course and posttest evaluations. Paired t tests for 150 individuals who completed both a pretest and posttest indicated a significant increase in knowledge, with a mean gain in score of 35 points., Discussion and Conclusions: Many residents reported feeling not well prepared to treat TUD from prior education. The vast majority (98%) felt the program enhanced their professional experience somewhat or substantially or would recommend the program to others (82%)., Scientific Significance: Online training for residents is a viable option to address knowledge deficits in TUD. (Am J Addict 2019;28:277-284)., (© 2019 American Academy of Addiction Psychiatry.)

Published
2019
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26. MRI abnormalities following repeated and incoming seizures.

Author

Palmeri B, Talamanca S, Ragonese P, Aridon P, Daniele O, Terruso V, and D'Amelio M

Subjects
Adult, Electroencephalography, Female, Humans, Recurrence, Magnetic Resonance Imaging, Seizures diagnosis, Seizures physiopathology
Abstract

Neuroimaging, an important diagnostic tool frequently used in the evaluation of patients with epilepsy, has mainly the aim to identify structural abnormalities needing a treatment and to contribute to the definition of the aetiology. Brain magnetic resonance imaging (MRI) in epilepsy is more sensitive than computerized tomography (CT) scan for detecting abnormalities. Status epilepticus (SE) and repeated incoming seizures may determine extensive and transient or long lasting pronounced MRI changes. We describe a case of a 41-year-old woman with a history of brain neoplasm, whose contrast-enhanced MRI images following repeated and incoming seizures were characterized either by reversible and irreversible abnormalities., (Copyright © 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Published
2011
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27. Patient recall of therapeutic paralysis in a surgical critical care unit.

Author

Wagner BK, Zavotsky KE, Sweeney JB, Palmeri BA, and Hammond JS

Subjects
Adolescent, Adult, Aged, Attitude of Health Personnel, Cognition physiology, Critical Care, Persons with Disabilities psychology, Follow-Up Studies, Glasgow Coma Scale, Hemodynamics, Humans, Hypnotics and Sedatives administration & dosage, Hypnotics and Sedatives therapeutic use, Infusions, Intravenous, Interviews as Topic, Lorazepam administration & dosage, Lorazepam therapeutic use, Midazolam administration & dosage, Midazolam therapeutic use, Middle Aged, Monitoring, Intraoperative, Neuromuscular Blockade, Neuropsychological Tests, Pain etiology, Pain psychology, Paralysis complications, Paralysis psychology, Postoperative Complications drug therapy, Postoperative Complications psychology, Propofol administration & dosage, Propofol therapeutic use, Prospective Studies, Respiratory Insufficiency etiology, Respiratory Insufficiency psychology, Time Factors, Hospital Units, Mental Recall physiology, Paralysis surgery
Abstract

Study Objective: To investigate patient recall of therapeutic paralysis (TP) in a surgical critical care unit., Design: Prospectively applied structured interview of patients undergoing TP over 18 months., Setting: Surgical critical care unit with 27 beds at a tertiary care university teaching hospital., Patients: Forty patients admitted for postoperative care after coronary artery bypass graft surgery, trauma, or gastrointestinal surgery., Interventions: Patients received TP and concurrent sedation with benzodiazepines, propofol, and narcotics., Measurements and Main Results: After the end of TP patients were asked to recall the experience, and their responses were ranked on a four-point ordinal scale. Four of 11 patients recalled mostly negative events and experiences with TP, such as sleeplessness, discomfort, pain, anxiety, and inconsistent caregiver communication. All patients with recall experienced fear, anxiety, and sleeplessness. Single-drug therapy with propofol and inadequate benzodiazepine dosing were linked to patient recall., Conclusions: Patient recollection from TP may be more common than appreciated and is generally unpleasant. Adequate dosing with benzodiazepines and narcotics is warranted to prevent recall and discomfort.

Published
1998

28. Somatoform disorders: diagnosis and treatment.

Author

Forman N, Palmeri BA, and Menza MA

Subjects
Diagnosis, Differential, Female, Humans, Hypochondriasis therapy, Male, Referral and Consultation, Hypochondriasis diagnosis, Somatoform Disorders diagnosis, Somatoform Disorders therapy
Abstract

Somatoform disorders are a group of syndromes in which patients focus on and complain of physical symptoms when there is no demonstrable underlying organic pathology or when complaints are in excess of what is expected. Medical and psychiatric physicians must seek better treatment and diagnosis.

Published
1993

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