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3. Combining transcranial direct current stimulation with hand robotic rehabilitation in chronic stroke patients: a double blind randomized clinical trial

Author

BERNAL-JIMÉNEZ, Juan J., primary, DILEONE, Michele, additional, MORDILLO-MATEOS, Laura, additional, MARTÍN-CONTY, José L., additional, DURANTEZ-FERNÁNDEZ, Carlos, additional, VIÑUELA, Antonio, additional, MARTÍN-RODRÍGUEZ, Francisco, additional, LERIN-CALVO, Alfredo, additional, ALCÁNTARA-PORCUNA, Vanesa, additional, and POLONIO-LÓPEZ, Begoña, additional

Published
2024
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8. Prehospital seizures: Short‐term outcomes and risk stratification based in point‐of‐care testing.

Author

Donoso‐Calero, María I., Martín Conty, José L., López‐Izquierdo, Raúl, Sanz‐García, Ancor, Dileone, Michele, Polonio‐López, Begoña, Mordillo‐Mateos, Laura, Delgado Benito, Juan F., del Pozo Vegas, Carlos, Mohedano‐Moriano, Alicia, and Martín‐Rodríguez, Francisco

Subjects
POINT-of-care testing, DISEASE risk factors, EMERGENCY medical services, BLOOD urea nitrogen, GLASGOW Coma Scale
Abstract

Background: Information for treatment or hospital derivation of prehospital seizures is limited, impairing patient condition and hindering patients risk assessment by the emergency medical services (EMS). This study aimed to determine the associated factors to clinical impairment, and secondarily, to determine risk factors associated to cumulative in‐hospital mortality at 2, 7 and 30 days, in patients presenting prehospital seizures. Methods: Prospective, multicentre, EMS‐delivery study involving adult subjects with prehospital seizures, including five advanced life support units, 27 basic life support units and four emergency departments in Spain. All bedside variables: including demographic, standard vital signs, prehospital laboratory tests and presence of intoxication or traumatic brain injury (TBI), were analysed to construct a risk model using binary logistic regression and internal validation methods. Results: A total of 517 patients were considered. Clinical impairment was present in 14.9%, and cumulative in‐hospital mortality at 2, 7 and 30‐days was 3.4%, 4.6% and 7.7%, respectively. The model for the clinical impairment indicated that respiratory rate, partial pressure of carbon dioxide, blood urea nitrogen, associated TBI or stroke were risk factors; higher Glasgow Coma Scale (GCS) scores mean a lower risk of impairment. Age, potassium, glucose, prehospital use of mechanical ventilation and concomitant stroke were risk factors associated to mortality; and oxygen saturation, a high score in GCS and haemoglobin were protective factors. Conclusion: Our study shows that prehospital variables could reflect the clinical impairment and mortality of patients suffering from seizures. The incorporation of such variables in the prehospital decision‐making process could improve patient outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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13. Home-based transcranial static magnetic field stimulation of the motor cortex for treating levodopa-induced dyskinesias in Parkinson's disease: A randomized controlled trial

Author

Dileone, Michele, primary, Ammann, Claudia, additional, Catanzaro, Valentina, additional, Pagge, Cristina, additional, Piredda, Rosanna, additional, Monje, Mariana H.G., additional, Navalpotro-Gomez, Irene, additional, Bergareche, Alberto, additional, Rodríguez-Oroz, María Cruz, additional, Vela-Desojo, Lydia, additional, Alonso-Frech, Fernando, additional, Catalán, María J., additional, Molina, José A., additional, López-Ariztegu, Nuria, additional, Oliviero, Antonio, additional, Obeso, José A., additional, and Foffani, Guglielmo, additional

Published
2022
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14. Comparison of Nine Early Warning Scores for Identification of Short-Term Mortality in Acute Neurological Disease in Emergency Department

Author

Durantez-Fernández, Carlos, primary, Polonio-López, Begoña, additional, Martín-Conty, José L., additional, Maestre-Miquel, Clara, additional, Viñuela, Antonio, additional, López-Izquierdo, Raúl, additional, Mordillo-Mateos, Laura, additional, Jorge-Soto, Cristina, additional, Otero-Agra, Martín, additional, Dileone, Michele, additional, Rabanales-Sotos, Joseba, additional, and Martín-Rodríguez, Francisco, additional

Published
2022
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15. BDNF polymorphism and interhemispheric balance of motor cortex excitability: a preliminary study

Author

Dubbioso, Raffaele, primary, Pellegrino, Giovanni, additional, Ranieri, Federico, additional, Di Pino, Giovanni, additional, Capone, Fioravante, additional, Dileone, Michele, additional, Iodice, Rosa, additional, Ruggiero, Lucia, additional, Tozza, Stefano, additional, Uncini, Antonino, additional, Manganelli, Fiore, additional, and Di Lazzaro, Vincenzo, additional

Published
2022
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22. Cortical disinhibition in Parkinson’s disease

Author

Ammann, Claudia, primary, Dileone, Michele, additional, Pagge, Cristina, additional, Catanzaro, Valentina, additional, Mata-Marín, David, additional, Hernández-Fernández, Frida, additional, Monje, Mariana H G, additional, Sánchez-Ferro, Álvaro, additional, Fernández-Rodríguez, Beatriz, additional, Gasca-Salas, Carmen, additional, Máñez-Miró, Jorge U, additional, Martínez-Fernández, Raul, additional, Vela-Desojo, Lydia, additional, Alonso-Frech, Fernando, additional, Oliviero, Antonio, additional, Obeso, José A, additional, and Foffani, Guglielmo, additional

Published
2020
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35. Microstructural changes of the dentato‐rubro‐thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor

Author

Pineda‐Pardo, Jose A., primary, Martínez‐Fernández, Raul, additional, Rodríguez‐Rojas, Rafael, additional, Del‐Alamo, Marta, additional, Hernández, Frida, additional, Foffani, Guglielmo, additional, Dileone, Michele, additional, Máñez‐Miró, Jorge U., additional, De Luis‐Pastor, Esther, additional, Vela, Lydia, additional, and Obeso, José A., additional

Published
2019
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36. Neuromodulation for motor recovery in stroke patients

Author

Dileone, Michele and Oliviero, Antonio

Subjects
Enfermedades neuronales, Rehabilitación, Habilidad motora
Abstract

Programa de Doctorado en Neurociencias, Stroke is a leading cause of disability worldwide. Seeking new therapeutic options is mandatory for improving existing motor rehabilitation techniques to obtain a better motor recovery. Stroke patients undergo some spontaneous degree of functional recovery; this process may occur even beyond the resolution of acute changes and could be due to the reorganization of remaining neural circuits. This reorganization falls into the concept of plasticity that could be defined as any enduring change in cortical properties. Plasticity is continuously modified by experience and learning and seems to be enhanced after brain lesions. In the last decades, plasticity of human brain after a lesion has been studied in vivo by means of non invasive brain stimulation (NIBS): neurophysiologic and biologic substrate of plasticity should provide a rational basis for tailoring specific strategies for therapeutic intervention for stroke recovery. Functional neuroimaging studies have demonstrated that recovered motor function in the paretic hand of chronic stroke patients relies predominantly on reorganized activity within motor areas of the affected hemisphere. Furthermore, changes in gamma-aminobutyric acid (GABA)-ergic activity in perilesional cortex after stroke seem to have a central role in recovery. It can be hypothesized that shaping reorganization in the adjacent intact cortex, and contralateral healthy hemisphere could facilitate functional recovery of the brain after stroke. NIBS can modulate cerebral cortex excitability not invasively and seem to be a promising tool for driving plasticity in damaged brain. The changes induced by NIBS are related to long-term changes in synaptic transmission analogue to long-term potentiation (LTP) and long-term depression (LTD) seen in the hippocampus after repeated activation. Several recent studies demonstrated that induction of LTP-like effects (by facilitatory rTMS and tDCS) in the stroke hemisphere and LTD-like effects (by inhibitory rTMS and tDCS) in healthy hemisphere can enhance the effects of motor rehabilitation after stroke, following the ¿rivalry¿ model theory. Nonetheless, the effects were limited and variable. On the other hand, it was recently demonstrated that rTMS could improve learning via a different mechanism that involves the phenomenon of ¿homeostatic¿ plasticity: a protocol capable of inducing LTD-like effects strongly facilitates motor learning while protocols inducing LTP-like effects have a less pronounced and short-lived facilitatory effect on learning. In the context of stroke this would predict that, contrary to usual practice that uses facilitatory protocols on the affected hemisphere, an inhibitory rTMS protocol (that induces LTD-like effects) over the stroke hemisphere would lead to better relearning in stroke patients through mechanisms of homeostatic metaplasticity. In sum, non-invasive brain stimulation techniques offer the opportunity to evaluate the stroke-induced change in motor cortex functionality and to modify the intra-cortical networks to promote recovery. To this aim, in a group of acute stroke patients we explored intracortical excitability of both hemisphere and looked for a possible correlation with motor recovery. Subsequently, in a different study, we tested whether the contemporary application of an excitatory neuromodulation over the affected hemisphere and an inhibitory neuromodulation over the unaffected hemisphere (following the idea of the rivalry theory) in the sub-acute phase of a stroke could enhance motor recovery. Furthermore we also tested, in a different group of patients, if the application of an inhibitory neuromodulation over the affected hemisphere, in chronic stroke patients could improve motor functionality by means of homeostatic metaplasticity. We found that the acute stroke-induced reduction of intracortical inhibition, indexed by short latency afferent inhibition (SAI), positively correlated with motor improvement at 6 months after stroke. Nevertheless, when a contemporary inhibition of the excitability of healthy hemisphere and a facilitation of the affected hemisphere were induced by means of bilateral tDCS (delivered for 40 minutes daily for 5 consecutive days) during the acute phase after a stroke, a significantly reduction of inter-hemispheric imbalance between affected and unaffected hemispheres was found without any significant change in hand motor function. At last, when an inhibitory plasticity was induced in the affected hemisphere (to achieve any metaplastic change to promote re-learning of motor function) in chronic stroke patients by means of cTBS (1 daily session for 2 weeks), a short lasting improvement in hand motor function was seen. Our studies demonstrated that NIBS, by means of repetitive TMS or tDCS, could be considered a safe procedure to apply in stroke patients both in the acute and chronic phases. On the other hand, we demonstrated that NIBS are able to change motor cortex excitability in stroke patients toward an inter-hemispheric re-balance when applied to increase stroke hemisphere excitability (or decrease unaffected hemisphere excitability) Furthermore, although larger and multi-centric studies are warranted to draw stronger conclusions, the induction of metaplasticity in the affected hemisphere by means of inhibitory protocols could be considered as a useful and promising tool to restore learning and improve motor function also years after a stroke., Universidad Pablo de Olavide de Sevilla. Departamento de Fisiología, Anatomía y Biología Celular, Postprint

Published
2017

37. Effects of patterned peripheral nerve stimulation on soleus spinal motor neuron excitability

Author

Jimenez, Samuel, primary, Mordillo-Mateos, Laura, additional, Dileone, Michele, additional, Campolo, Michela, additional, Carrasco-Lopez, Carmen, additional, Moitinho-Ferreira, Fabricia, additional, Gallego-Izquierdo, Tomas, additional, Siebner, Hartwig R., additional, Valls-Solé, Josep, additional, Aguilar, Juan, additional, and Oliviero, Antonio, additional

Published
2018
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47. Clinical Value of the Assessment of Changes in MEP Duration with Voluntary Contraction.

Author

Brum, Marisa, Cabib, Christopher, Valls-Solé, Josep, Weien Yuan, Terranova, Carmen, and Dileone, Michele

Subjects
TRANSCRANIAL magnetic stimulation, EVOKED potentials (Electrophysiology), MULTIPLE sclerosis treatment
Abstract

Transcranial magnetic stimulation (TMS) gives rise to muscle responses, known as motor evoked potentials (MEP), through activation of the motor pathways. Voluntary contraction causes facilitation of MEPs, which consists of shortening MEP latency, increasing MEP amplitude and widening MEP duration. While an increase in excitability of alpha motorneurons and the corticospinal tract can easily explain latency shortening and amplitude increase, other mechanisms have to be accounted for to explain the increase in duration.We measured the increase in duration of the MEP during contraction with respect to rest in a group of healthy volunteers and retrospectively assessed this parameter in patients who were examined in a standardized fashion during the past 5 years. We included 25 healthy subjects, 21 patients with multiple sclerosis, 33 patients with acute stroke, 5 patients with hereditary spastic paraparesis, and 5 patients with signs suggesting psychogenic paresis. We found already significant differences among groups in the MEP duration at rest, patients with MS had a significantly longer duration, and patients with stroke had significantly shorter duration, than the other two groups. The increase in MEP duration during voluntary contraction was different in patients and in healthy subjects. It was significantly shorter in MS and significantly longer in stroke patients. It was absent in the five patients with suspected psychogenic weakness. In patients with HSP, an abnormally increase in duration occurred only in leg muscles. Our results suggest that the increase in duration of the MEP during contraction may reveal the contribution of propriospinal interneurons to the activation of alpha motorneurons. This mechanism may be altered in some diseases and, therefore, the assessment proposed in this work may have clinical applicability for the differential diagnosis of weakness. [ABSTRACT FROM AUTHOR]

Published
2016
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48. Delayed hypothermia in malignant ischaemic stroke

Author

Di Lazzaro, Vincenzo, primary, Profice, Paolo, additional, Dileone, Michele, additional, Della Marca, Giacomo, additional, Colosimo, Cesare, additional, Pravatà, Emanuele, additional, Pavone, Antonino, additional, Pennisi, Mariano, additional, Maviglia, Riccardo, additional, and Pilato, Fabio, additional

Published
2011
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50. Motor cortex stimulation for ALS: A double blind placebo-controlled study

Author

Di Lazzaro, Vincenzo, primary, Pilato, Fabio, additional, Profice, Paolo, additional, Ranieri, Federico, additional, Musumeci, Gabriella, additional, Florio, Lucia, additional, Beghi, Ettore, additional, Frisullo, Giovanni, additional, Capone, Fioravante, additional, Sabatelli, Mario, additional, Tonali, Pietro A., additional, and Dileone, Michele, additional

Published
2009
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