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4. Visual fixation in disorders of consciousness: Development of predictive models to support differential diagnosis

Author

Sattin, D, Rossi Sebastiano, D, Magnani, F, D'Incerti, L, Marotta, G, Benti, R, Tirelli, S, Bersano, A, Duran, D, Visani, E, Ferraro, S, Minati, L, Nigri, A, Rosazza, C, Bianchi Marzoli, S, Ciasca, P, Carcagni, A, Bruzzone, M, Franceschetti, S, Leonardi, M, Guido, D, Sattin D., Rossi Sebastiano D., Magnani F. G., D'Incerti L., Marotta G., Benti R., Tirelli S., Bersano A., Duran D., Visani E., Ferraro S., Minati L., Nigri A., Rosazza C., Bianchi Marzoli S., Ciasca P., Carcagni A., Bruzzone M. G., Franceschetti S., Leonardi M., Guido D., Sattin, D, Rossi Sebastiano, D, Magnani, F, D'Incerti, L, Marotta, G, Benti, R, Tirelli, S, Bersano, A, Duran, D, Visani, E, Ferraro, S, Minati, L, Nigri, A, Rosazza, C, Bianchi Marzoli, S, Ciasca, P, Carcagni, A, Bruzzone, M, Franceschetti, S, Leonardi, M, Guido, D, Sattin D., Rossi Sebastiano D., Magnani F. G., D'Incerti L., Marotta G., Benti R., Tirelli S., Bersano A., Duran D., Visani E., Ferraro S., Minati L., Nigri A., Rosazza C., Bianchi Marzoli S., Ciasca P., Carcagni A., Bruzzone M. G., Franceschetti S., Leonardi M., and Guido D.

Abstract

The visual fixation represents a doubtful behavioral sign to discriminate Vegetative from Minimally Conscious State (MCS). To disentangle its meaning, we fitted univariate and multivariable logistic regression models matching different neurophysiological and neuroimaging data of 54 patients with Disorders of Consciousness to select the best model predicting which visual performance (visual blink or pursuit) was shown by patients and the best predictors set. The best models found highlighted the importance of the structural MRI and the visual evoked potentials data in predicting visual pursuit. Then, a qualitative pilot test was made on four patients showing visual fixation revealing that the obtained models correctly predict whether the patients’ visual performance could support/correlate to a cognitively mediated behavior. The present pilot models could help clinicians to evaluate if the visual fixation response can support the MCS diagnosis.

Published
2021

16. Progressive myoclonic epilepsies Definitive and still undetermined causes

Author

Franceschetti S., Michelucci R., Canafoglia L., Striano P., Gambardella A., Magaudda A., La Neve A., Ferlazzo E., Gobbi G., Giallonardo A. T., Capovilla G., Visani E., Panzica F., Avanzini G., Tassinari C. A., Bianchi A., Zara F., TINUPER, PAOLO, BISULLI, FRANCESCA, POSAR, ANNIO, SANTUCCI, MARGHERITA, LICCHETTA, LAURA, Franceschetti S., Michelucci R., Canafoglia L., Striano P., Gambardella A., Magaudda A., Tinuper P., La Neve A., Ferlazzo E., Gobbi G., Giallonardo A.T., Capovilla G., Visani E., Panzica F., Avanzini G., Tassinari C.A., Bianchi A., Zara F., Bisulli F., Posar A., Santucci M., Licchetta L., and (Collaborative LICE study group on PMEs)

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Pathology, Adolescent, Disease, Lafora body disease, Article, Lafora disease, Young Adult, Epilepsy, Progressive, Arts and Humanities (miscellaneous), Unverricht-Lundborg Syndrome, Myoclonic Epilepsies, Cluster Analysis, Humans, Medicine, Young adult, progressive myoclonic epilepsies, diagnosis/physiopathology/therapy, business.industry, Middle Aged, Myoclonic Epilepsies, Progressive, medicine.disease, Female, Follow-Up Studies, Italy, Lafora Disease, Neurology (clinical), diagnosis/physiopathology/therapy, Epilepsy, Etiology, medicine.symptom, business, Myoclonus, Psychomotor delay
Abstract

Objective: To define the clinical spectrum and etiology of progressive myoclonic epilepsies (PMEs) in Italy using a database developed by the Genetics Commission of the Italian League against Epilepsy. Methods: We collected clinical and laboratory data from patients referred to 25 Italian epilepsy centers regardless of whether a positive causative factor was identified. PMEs of undetermined origins were grouped using 2-step cluster analysis. Results: We collected clinical data from 204 patients, including 77 with a diagnosis of Unverricht-Lundborg disease and 37 with a diagnosis of Lafora body disease; 31 patients had PMEs due to rarer genetic causes, mainly neuronal ceroid lipofuscinoses. Two more patients had celiac disease. Despite extensive investigation, we found no definitive etiology for 57 patients. Cluster analysis indicated that these patients could be grouped into 2 clusters defined by age at disease onset, age at myoclonus onset, previous psychomotor delay, seizure characteristics, photosensitivity, associated signs other than those included in the cardinal definition of PME, and pathologic MRI findings. Conclusions: Information concerning the distribution of different genetic causes of PMEs may provide a framework for an updated diagnostic workup. Phenotypes of the patients with PME of undetermined cause varied widely. The presence of separate clusters suggests that novel forms of PME are yet to be clinically and genetically characterized.

Published
2014

17. Metabolic syndrome and drug discontinuation in schizophrenia: a randomized trial comparing aripiprazole olanzapine and haloperidol

Author

Parabiaghi, A, Tettamanti, M, D'Avanzo, B, Barbato, A, Aguglia, Eugenio, Bufalino, C, Cannavo', D, Gandolfo, L, Bassi, M, Erlicher, A, Agnetti, G, Breviario, G, Casacchia, M, Pollce, R, Pomero, P, Colotto, A, Manfrinati, S, Cattaneo, Ci, Corrivetti, G, Pinto, G, Ferranini, L, Marcenaro, M, Vaggi, M, Ghio, L, Natta, W, Ferrato, F, Francomano, A, La Placha, M, Mastroeni, A, Rigamonti, D, Groppi, C, Mauri, Mc, De Gaspari IF, Percudanim, Picci, R, Comino, L, Paschetta, E, Pioli, R, Bignotti, S, Smerieri, G, Ghinaglia, Visani, E, Lucattini, A, Caverzasi, E, Colombo, R, Cervetti, A, D'Aloise, A, Parise, Vf, Florio, V, Hadjichristos, A, D'Avamzo, B, Buratti, G, Buratti, L, De Micheli, A, Furlato, K, D'Onofrio, S, Mariannantoni, I, Rapisarda, F, Riccardi, F, Ruberto, A, Ruggirello, I, Santini, I, Trivelli, F, and Ullo, A.

Subjects
Olanzapine, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Aripiprazole, law.invention, 03 medical and health sciences, Benzodiazepines, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Haloperidol, Medicine, Humans, Antipsychotic, Psychiatry, Adverse effect, Metabolic Syndrome, business.industry, Middle Aged, medicine.disease, 030227 psychiatry, Discontinuation, Psychiatry and Mental health, Treatment Outcome, Schizophrenia, Female, business, 030217 neurology & neurosurgery, medicine.drug, Antipsychotic Agents, Follow-Up Studies
Abstract

Objective To determine whether the prescription of aripiprazole, compared with olanzapine and haloperidol, was associated with a lower frequency of metabolic syndrome (MS) and treatment discontinuation at 1 year. Method Patients were randomly assigned to be treated open-label and according to usual clinical practice with either aripiprazole, olanzapine, or haloperidol and followed up for 1 year. Results Three hundred out-patients with persistent schizophrenia were recruited in 35 mental health services. The intention-to-treat (ITT) analysis found no significant differences in the rate of MS between aripiprazole (37%), olanzapine (47%), and haloperidol (42%). Treatment discontinuation for any cause was higher for aripiprazole (52%) than for olanzapine (33%; OR, 0.41; P = 0.004), or haloperidol (37%; OR, 0.51; P = 0.030). No significant difference was found between olanzapine and haloperidol. Time to discontinuation for any cause was longer for olanzapine than for aripiprazole (HR, 0.55; P

Published
2015

18. The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence [L'accettabilità delle raccomandazioni NICE per la schizofrenia nei Dipartimenti di Salute Mentale Italiani. Il Progetto SIEP-DIRECT'S sulle discrepanze fra pratiche di routine ed evidenze]

Author

Semisa, D, Lasalvia, A, Miceli, M, Dall'Agnola, R, Pucci, C, Bissoli, S, Visani, E, Pismataro, C, Vanetti, M, Pioli, R, Ruggeri, M, Lora, A, Asioli, F, Balbi, A, Buscaglia, G, Carra, G, Casacchia, M, Corlito, G, Di Munzio, W, Erlicher, A, Marinoni, A, Morosini, P, Semisa D., Lasalvia A., Miceli M., Dall'Agnola R. B., Pucci C., Bissoli S., Visani E., Pismataro C. P., Vanetti M., Pioli R., Ruggeri M., Lora A., Asioli F., Balbi A., Buscaglia G., Carra G., Casacchia M., Corlito G., Di Munzio W., Erlicher A., Marinoni A., Morosini P., Semisa, D, Lasalvia, A, Miceli, M, Dall'Agnola, R, Pucci, C, Bissoli, S, Visani, E, Pismataro, C, Vanetti, M, Pioli, R, Ruggeri, M, Lora, A, Asioli, F, Balbi, A, Buscaglia, G, Carra, G, Casacchia, M, Corlito, G, Di Munzio, W, Erlicher, A, Marinoni, A, Morosini, P, Semisa D., Lasalvia A., Miceli M., Dall'Agnola R. B., Pucci C., Bissoli S., Visani E., Pismataro C. P., Vanetti M., Pioli R., Ruggeri M., Lora A., Asioli F., Balbi A., Buscaglia G., Carra G., Casacchia M., Corlito G., Di Munzio W., Erlicher A., Marinoni A., and Morosini P.

Abstract

Aims - This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. Methods - In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. Results - Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic

Published
2008

25. The gambling disorder: family styles and cognitive dimensions.

Author

PAOLINI, D., LEONARDI, C., VISANI, E., and RODOFILI, G.

Abstract

OBJECTIVE: In this study we present data from a research carried out on a population of people with gambling disorder (GD). SUBJECTS AND METHODS: This research investigated the representation of family styles for subjects with gambling disorder, using the Family Adaptability and Cohesion Evaluation Scale (FACES-IV), their cognitive distortions through Gambling Related Cognitions Scale (GRCS-I), and the relation between these two dimensions. RESULTS: People with GD represent families with emotional detachment, while in the area of management of relational rules and roles, they reveal a perception of disorganization. Concerning their cognitive bias, GD people show the illusion of being able to control and predict the winnings and the perception of being unable to quit playing. CONCLUSIONS: Overall, these data provide specific directions for both the prevention and the therapeutic treatment of GD, highlighting the importance of a family therapeutic approach for the prevention of cognitive distortions. [ABSTRACT FROM AUTHOR]

Published
2018

28. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

Author

Ruggeri, M., Lora, A., (SIEP-DIRECT'S Group authors: Asioli F, Semisa D., Balbi, A, Buscaglia, G, Carrà, G, Casacchia, M, Corlito, G, Di Munzio, W, Erlicher, A, Lasalvia, A, Marinoni, A, Miceli, M, Morganti, C, Morosini, P, Iacchetti, D, Pegoraro, M, Scavo, V, Alderighi, M, Lorenzo, P, Lecci, F, Tanini, A, Cefalì, T, Pucci, C, Caneschi, A, Ottanelli, R, Magnani, N, Bardicchia, F, Pescosolido, R, Allevi, L, Confalonieri, S, Ferrigno, J, Giusto, F, Rolando, P, Burti, L, Dall'Agnola, R, Bissoli, S, Cassano, Am, Ciampolillo, G, Fracchiolla, P, Lupoi, S, Visani, E, Cerbo, Gm, Pismataro, Cp, Mari, L, Gazale, Mf, Bianchi, I, Milano, Mc, Amideo, F, Basile, F, Santelia, S, Bacigalupi, M, Parravani, R, Vanetti, M, Carnevale, L, Debernardi, C, Fiorica, L, Roncone, R, Pollice, R, Cavicchio, A, Pioli, R, Cicolella, G, Riva, E, Cristofalo, D, Leng, G, Levav, I, Losavio, T, Maj, M, Pilling, S, Saxena, S, Tansella, M., Ruggeri, M, Lora, A, Semisa, D, Asioli, F, Balbi, A, Buscaglia, G, Carra', G, Casacchia, M, Corlito, G, Di Munzio, W, Erlicher, A, Lasalvia, A, Marinoni, A, Miceli, M, Morganti, C, and Morosini, P

Subjects
medicine.medical_specialty, Epidemiology, Family support, Nice, Context (language use), Psychosi, Nursing, Guidelines implementation, Medicine, Humans, psychosis, Clinical guideline, Societies, Medical, clinical guidelines, schizophrenia, clinical routine, community mental health services, guidelines implementation, computer.programming_language, First episode, business.industry, Community mental health service, Public Health, Environmental and Occupational Health, Guideline, Monitoring and evaluation, Mental illness, medicine.disease, Mental health, Italy, Psychiatry and Mental Health, Family medicine, Practice Guidelines as Topic, Clinical routine, Schizophrenia, business, computer, Forecasting
Abstract

SUMMARYAims– To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs.Methods– The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management.Results– The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process.Conclusions– The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.Declaration of Interest: None.

Published
2008

29. Somatosensory conduction pathway in spastic paraplegia type 5

Author

Vanotti, A, Nanetti, L, Rossi, S, Visani, E, Duran, D, Di Bella, D, Sarto, E, Caccia, C, Leoni, V, Taroni, F, Mariotti, C, Rossi, SD, Vanotti, A, Nanetti, L, Rossi, S, Visani, E, Duran, D, Di Bella, D, Sarto, E, Caccia, C, Leoni, V, Taroni, F, Mariotti, C, and Rossi, SD

Published
2014

30. Hemodynamic and EEG Time-Courses During Unilateral Hand Movement in Patients with Cortical Myoclonus. An EEG-fMRI and EEG-TD-fNIRS Study

Author

Visani, E., primary, Canafoglia, L., additional, Gilioli, I., additional, Sebastiano, D. Rossi, additional, Contarino, V. E., additional, Duran, D., additional, Panzica, F., additional, Cubeddu, R., additional, Contini, D., additional, Zucchelli, L., additional, Spinelli, L., additional, Caffini, M., additional, Molteni, E., additional, Bianchi, A. M., additional, Cerutti, S., additional, Franceschetti, S., additional, and Torricelli, A., additional

Published
2014
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34. A neurophysiological study of myoclonus in patients with DYT11 myoclonus-dystonia syndrome

Author

Marelli, C, Canafoglia, L, Zibordi, F, Ciano, C, Visani, E, Zorzi, G, Garavaglia, B, Barzaghi, C, Albanese, Alberto, Soliveri, P, Leone, M, Panzica, F, Scaioli, V, Pincherle, A, Nardocci, N, Franceschetti, Silvana, Albanese, Alberto (ORCID:0000-0002-5864-0006), Marelli, C, Canafoglia, L, Zibordi, F, Ciano, C, Visani, E, Zorzi, G, Garavaglia, B, Barzaghi, C, Albanese, Alberto, Soliveri, P, Leone, M, Panzica, F, Scaioli, V, Pincherle, A, Nardocci, N, Franceschetti, Silvana, and Albanese, Alberto (ORCID:0000-0002-5864-0006)

Abstract

Mutations in the epsilon-sarcoglycan (SGCE) gene have been associated with DYT11 myoclonus-dystonia syndrome (MDS). The aim of this study was to characterize myoclonus in 9 patients with DYT11-MDS presenting with predominant myoclonus and mild dystonia by means of neurophysiological techniques. Variously severe multifocal myoclonus occurred in all of the patients, and included short (mean 89.1 +/- 13.3 milliseconds) electromyographic bursts without any electroencephalographic correlate, sometimes presenting a pseudo-rhythmic course. Massive jerks could be evoked by sudden stimuli in 5 patients, showing a "startle-like" muscle spreading and latencies consistent with a brainstem origin. Somatosensory evoked potentials and long-loop reflexes were normal, as was silent period and long-term intracortical inhibition evaluated by means of transcranial magnetic stimulation; however, short-term intracortical inhibition revealed subtle impairment, and event-related synchronization (ERS) in the beta band was delayed. Blink reflex recovery was strongly enhanced. Myoclonus in DYT11-MDS seems to be generated at subcortical level, and possibly involves basal ganglia and brainstem circuitries. Cortical impairment may depend from subcortical dysfunction, but it can also have a role in influencing the myoclonic presentation. The wide distribution of the defective SCGE in DYT11-MDS may justify the involvement of different brain areas.

Published
2008

36. P17.7 EEG, fMRI, TMS and fNIRS: a comparison of different methods for brain mapping of cortical motor hand areas

Author

Visani, E., primary, Rossi Sebastiano, D., additional, Gilioli, I., additional, Granvillano, A., additional, Canafoglia, L., additional, Panzica, F., additional, Cubeddu, R., additional, Torricelli, A., additional, Spinelli, L., additional, Contini, D., additional, Caffini, M., additional, Zucchelli, L., additional, Molteni, E., additional, Bianchi, A.M., additional, Cerutti, S., additional, and Franceschetti, S., additional

Published
2011
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46. A neurophysiological study of myoclonus in patients with DYT11 myoclonus-dystonia syndrome.

Author

Marelli C, Canafoglia L, Zibordi F, Ciano C, Visani E, Zorzi G, Garavaglia B, Barzaghi C, Albanese A, Soliveri P, Leone M, Panzica F, Scaioli V, Pincherle A, Nardocci N, and Franceschetti S

Abstract

Mutations in the epsilon-sarcoglycan (SGCE) gene have been associated with DYT11 myoclonus-dystonia syndrome (MDS). The aim of this study was to characterize myoclonus in 9 patients with DYT11-MDS presenting with predominant myoclonus and mild dystonia by means of neurophysiological techniques. Variously severe multifocal myoclonus occurred in all of the patients, and included short (mean 89.1 +/- 13.3 milliseconds) electromyographic bursts without any electroencephalographic correlate, sometimes presenting a pseudo-rhythmic course. Massive jerks could be evoked by sudden stimuli in 5 patients, showing a 'startle-like' muscle spreading and latencies consistent with a brainstem origin. Somatosensory evoked potentials and long-loop reflexes were normal, as was silent period and long-term intracortical inhibition evaluated by means of transcranial magnetic stimulation; however, short-term intracortical inhibition revealed subtle impairment, and event-related synchronization (ERS) in the beta band was delayed. Blink reflex recovery was strongly enhanced. Myoclonus in DYT11-MDS seems to be generated at subcortical level, and possibly involves basal ganglia and brainstem circuitries. Cortical impairment may depend from subcortical dysfunction, but it can also have a role in influencing the myoclonic presentation. The wide distribution of the defective SCGE in DYT11-MDS may justify the involvement of different brain areas. [ABSTRACT FROM AUTHOR]

Published
2008
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47. The gambling disorder: Family styles and cognitive dimensions

Author

Daniele Paolini, Leonardi, C., Visani, E., Rodofili, G., Paolini, D, Leonardi, C, Visani, E, and Rodofili, G

Subjects
FACES-IV, GRCS-I, Family tnerapy, Gambling disorder, Family valuation, Cognitive bia
Abstract

OBJECTIVE: In this study we present data from a research carried out on a population of people with gambling disorder (GD).SUBJECTS AND METHODS: This research investigated the representation of family styles for subjects with gambling disorder, using the Family Adaptability and Cohesion Evaluation Scale (FACES-IV), their cognitive distortions through Gambling Related Cognitions Scale (GRCS-I), and the relation between these two dimensions.RESULTS: People with GD represent families with emotional detachment, while in the area of management of relational rules and roles, they reveal a perception of disorganization. Concerning their cognitive bias. GD people show the illusion of being able to control and predict the winnings and the perception of being unable to quit playing.CONCLUSIONS: Overall, these data provide specific directions for both the prevention and the therapeutic treatment of GD, highlighting the importance of a family therapeutic approach for the prevention of cognitive distortions.

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