Nico Golfrè Andreasi
@istituto-besta.it
Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta
RESEARCH INTERESTS
Neurology, movement disorder, deep brain stimulation, levodopa-carbidopa intestinal gel
Scopus Publications
Scopus Publications
Elisa Visani, Ferruccio Panzica, Silvana Franceschetti, Nico Golfrè Andreasi, Roberto Cilia, Sara Rinaldo, Davide Rossi Sebastiano, Paola Lanteri, and Roberto Eleopra
Frontiers Media SA
IntroductionTo investigate cortical network changes using Magnetoencephalography (MEG) signals in Parkinson’s disease (PD) patients undergoing Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy.MethodsWe evaluated the MEG signals in 16 PD patients with drug-refractory tremor before and after 12-month from MRgFUS unilateral lesion of the ventralis intermediate nucleus (Vim) of the thalamus contralateral to the most affected body side. We recorded patients 24 h before (T0) and 24 h after MRgFUS (T1). We analyzed signal epochs recorded at rest and during the isometric extension of the hand contralateral to thalamotomy. We evaluated cortico-muscular coherence (CMC), the out-strength index from non-primary motor areas to the pre-central area and connectivity indexes, using generalized partial directed coherence. Statistical analysis was performed using RMANOVA and post hoct-tests.ResultsMost changes found at T1 compared to T0 occurred in the beta band and included: (1) a re-adjustment of CMC distribution; (2) a reduced out-strength from non-primary motor areas toward the precentral area; (3) strongly reduced clustering coefficient values. These differences mainly occurred during motor activation and with few statistically significant changes at rest. Correlation analysis showed significant relationships between changes of out-strength and clustering coefficient in non-primary motor areas and the changes in clinical scores.DiscussionOne day after MRgFUS thalamotomy, PD patients showed a topographically reordered CMC and decreased cortico-cortical flow, together with a reduced local connection between different nodes. These findings suggest that the reordered cortico-muscular and cortical-networks in the beta band may represent an early physiological readjustment related to MRgFUS Vim lesion.
Elisabetta Indelicato, Luigi Michele Romito, Philip Harrer, Nico Golfrè Andreasi, Isabel Colangelo, Robert Kopajtich, Juliane Winkelmann, Holger Prokisch, Barbara Garavaglia, and Michael Zech
Wiley
Fabiana Colucci, Silvia Barca, Roberto Cilia, Valentino De Franco, Antonio E. Elia, Nico Golfrè Andreasi, Luigi Romito, Roberta Telese, Arianna Braccia, Valentina Leta,et al.
Wiley
Nico Golfrè Andreasi, Arianna Braccia, Vincenzo Levi, Sara Rinaldo, Francesco Ghielmetti, Roberto Cilia, Luigi Michele Romito, Salvatore Bonvegna, Antonio Emanuele Elia, Grazia Devigili,et al.
Wiley
AbstractBackgroundMagnetic resonance‐guided focused ultrasound (MRgFUS) thalamotomy is increasingly used to treat drug‐resistant essential tremor (ET). Data on MRgFUS thalamotomy in dystonic tremor (DT) are anecdotal.ObjectivesTo investigate efficacy, safety, and differences in target coordinates of MRgFUS thalamotomy in DT versus ET.MethodsTen patients with DT and 35 with ET who consecutively underwent MRgFUS thalamotomy were followed for 12 months. Although in both groups the initial surgical planning coordinates corresponded to the ventralis intermediate (Vim), the final target could be modified intraoperatively based on clinical response.ResultsTremor significantly improved in both groups. The thalamic lesion was significantly more anterior in DT than ET. Considering both ET and DT groups, the more anterior the lesion, the lower the odds ratio for adverse events.ConclusionsMRgFUS thalamotomy is safe and effective in DT and ET. Compared to classical Vim coordinates used for ET, more anterior targeting should be considered for DT.
Fabiana Colucci, Micol Avenali, Rosita De Micco, Marco Fusar Poli, Silvia Cerri, Mario Stanziano, Ana Bacila, Giada Cuconato, Valentina Franco, Diego Franciotta,et al.
BMJ
BackgroundHeterozygous mutations in theGBAgene, encoding the lysosomal enzyme β-glucocerebrosidase (GCase), are the most frequent genetic risk factor for Parkinson’s disease (PD).GBA-related PD (GBA-PD) patients have higher risk of dementia and reduced survival than non-carriers. Preclinical studies and one open-label trial in humans demonstrated that the chaperone ambroxol (ABX) increases GCase levels and modulates α-synuclein levels in the blood and cerebrospinal fluid (CSF).Methods and analysisIn this multicentre, double-blind, placebo-controlled, phase II clinical trial, we randomise patients with GBA-PD in a 1:1 ratio to either oral ABX 1.2 g/day or placebo. The duration of treatment is 52 weeks. Each participant is assessed at baseline and weeks 12, 26, 38, 52 and 78. Changes in the Montreal Cognitive Assessment score and the frequency of mild cognitive impairment and dementia between baseline and weeks 52 are the primary outcome measures. Secondary outcome measures include changes in validated scales/questionnaires assessing motor and non-motor symptoms. Neuroimaging features and CSF neurodegeneration markers are used as surrogate markers of disease progression. GCase activity, ABX and α-synuclein levels are also analysed in blood and CSF. A repeated-measures analysis of variance will be used for elaborating results. The primary analysis will be by intention to treat.Ethics and disseminationThe study and protocols have been approved by the ethics committee of centres. The study is conducted according to good clinical practice and the Declaration of Helsinki. The trial findings will be published in peer-reviewed journals and presented at conferences.Trial registration numbersNCT05287503, EudraCT 2021-004565-13.
Roberto Cilia, Emanuele Cereda, Marco Piatti, Andrea Pilotto, Luca Magistrelli, Nico Golfrè Andreasi, Salvatore Bonvegna, Elena Contaldi, Francesca Mancini, Gabriele Imbalzano,et al.
Wiley
Nico Golfrè Andreasi, Roberto Cilia, Luigi Michele Romito, Salvatore Bonvegna, Giulia Straccia, Antonio Emanuele Elia, Alessio Novelli, Giuseppe Messina, Giovanni Tringali, Vincenzo Levi,et al.
Wiley
BACKGROUND
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a safe and effective procedure for drug-resistant tremor in Parkinson's disease (PD).
OBJECTIVE
The aim of this study was to demonstrate that MRgFUS ventralis intermedius thalamotomy in early-stage tremor-dominant PD may prevent an increase in dopaminergic medication 6 months after treatment compared with matched PD control subjects on standard medical therapy.
METHODS
We prospectively enrolled patients with early-stage PD who underwent MRgFUS ventralis intermedius thalamotomy (PD-FUS) and patients treated with oral dopaminergic therapy (PD-ODT) with a 1:2 ratio. We collected demographic and clinical data at baseline and 6 and 12 months after thalamotomy.
RESULTS
We included 10 patients in the PD-FUS group and 20 patients in the PD-ODT group. We found a significant increase in total levodopa equivalent daily dose and levodopa plus monoamine oxidase B inhibitors dose in the PD-ODT group 6 months after thalamotomy.
CONCLUSIONS
In early-stage tremor-dominant PD, MRgFUS thalamotomy may be useful to reduce tremor and avoid the need to increase dopaminergic medications. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Annibale Antonioni, Vittorio Rispoli, Patrik Fazio, Nico Golfrè Andreasi, Vittorio Govoni, and Enrico Granieri
MDPI AG
Osmotic demyelination syndrome (ODS) is caused by damage to the pons myelin sheath and nerve cells. Although the pathophysiological mechanism responsible for the damage is not yet fully understood, it is currently believed that osmotic-type changes (especially if they are massive and too rapid) cause oedema that leads to compression and, subsequently, demyelination of white matter fibres. It generally manifests with acute paraparesis/tetraparesis, dysphagia, dysarthria, diplopia, and loss of consciousness, as well as hallucinations, spasms, and other neurological symptoms related to brainstem damage. In extreme cases, the locked-in syndrome may also appear. Of note, in some cases an association between osmotic demyelinating damage and the onset of movement disorders has been documented and, although the pathophysiology is still unknown, a correlation has been postulated between ODS and movement disorders. Here, we present a patient with ODS who developed parkinsonism, thus supporting the hypothesis of a correlation between these pathological events.
Roberta Bonomo, Antonio E. Elia, Roberto Cilia, Luigi M. Romito, Nico Golfrè Andreasi, Grazia Devigili, Salvatore Bonvegna, Giulia Straccia, Barbara Garavaglia, Celeste Panteghini,et al.
Elsevier BV
Nico Golfrè Andreasi, Luigi Michele Romito, Roberta Telese, Roberto Cilia, Antonio Emanuele Elia, Alessio Novelli, Giovanni Tringali, Giuseppe Messina, Vincenzo Levi, Grazia Devigili,et al.
Springer Science and Business Media LLC
Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for patients with Parkinson’s disease (PD) with motor complications; the contribution of sex in determining the outcome is still not understood. We included 107 patients (71 males) with PD consecutively implanted with STN-DBS at our center. We reviewed patient charts from our database and retrospectively collected demographical and clinical data at baseline and at three follow-up visits (1, 5 and 10 years). We found a long-lasting effect of DBS on motor complications, despite a progressive worsening of motor performances in the ON medication condition. Bradykinesia and non-dopaminergic features seem to be the major determinant of this progression. Conversely to males, females showed a trend towards worsening in bradykinesia already at 1-year follow-up and poorer scores in non-dopaminergic features at 10-year follow-up. Levodopa Equivalent Daily Dose (LEDD) was significantly reduced after surgery compared to baseline values; however, while in males LEDD remained significantly lower than baseline even 10 years after surgery, in females LEDD returned at baseline values. Males showed a sustained effect on dyskinesias, but this benefit was less clear in females; the total electrical energy delivered was consistently lower in females compared to males. The profile of adverse events did not appear to be influenced by sex. Our data suggest that there are no major differences on the motor effect of STN-DBS between males and females. However, there may be some slight differences that should be specifically investigated in the future and that may influence therapeutic decisions in the chronic follow-up.
Mario Stanziano, Nico Golfrè Andreasi, Giuseppe Messina, Sara Rinaldo, Sara Palermo, Mattia Verri, Greta Demichelis, Jean Paul Medina, Francesco Ghielmetti, Salvatore Bonvegna,et al.
Frontiers Media SA
Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus (Vim) for tremor has increasingly gained interest as a new non-invasive alternative to standard neurosurgery. Resting state functional connectivity (rs-FC) correlates of MRgFUS have not been extensively investigated yet. A region of interest (ROI)-to-ROI rs-FC MRI “connectomic” analysis focusing on brain regions relevant for tremor was conducted on 15 tremor-dominant patients with Parkinson's disease who underwent MRgFUS. We tested whether rs-FC between tremor-related areas was modulated by MRgFUS at 1 and 3 months post-operatively, and whether such changes correlated with individual clinical outcomes assessed by the MDS-UPDRS-III sub items for tremor. Significant increase in FC was detected within bilateral primary motor (M1) cortices, as well as between bilateral M1 and crossed primary somatosensory cortices, and also between pallidum and the dentate nucleus of the untreated hemisphere. Correlation between disease duration and FC increase at 3 months was found between the putamen of both cerebral hemispheres and the Lobe VI of both cerebellar hemispheres, as well as between the Lobe VI of untreated cerebellar hemisphere with bilateral supplementary motor area (SMA). Drop-points value of MDS-UPDRS at 3 months correlated with post-treatment decrease in FC, between the anterior cingulate cortex and bilateral SMA, as well as between the Lobe VI of treated cerebellar hemisphere and the interpositus nucleus of untreated cerebellum. Tremor improvement at 3 months, expressed as percentage of intra-subject MDS-UPDRS changes, correlated with FC decrease between bilateral occipital fusiform gyrus and crossed Lobe VI and Vermis VI. Good responders (≥50% of baseline tremor improvement) showed reduced FC between bilateral SMA, between the interpositus nucleus of untreated cerebellum and the Lobe VI of treated cerebellum, as well as between the untreated SMA and the contralateral putamen. Good responders were characterized at baseline by crossed hypoconnectivity between bilateral putamen and M1, as well as between the putamen of the treated hemisphere and the contralateral SMA. We conclude that MRgFUS can effectively modulate brain FC within the tremor network. Such changes are associated with clinical outcome. The shifting mode of integration among the constituents of this network is, therefore, susceptible to external redirection despite the chronic nature of PD.
Roberto Eleopra, Sara Rinaldo, Grazia Devigili, Massimo Mondani, Stanislao D'Auria, Nico Golfrè Andreasi, Miran Skrap, and Christian Lettieri
Frontiers Media SA
Objective: Bilateral globus pallidus internus deep brain stimulation (GPi-DBS) is an established and effective therapy for primary refractory dystonia. However, the comparison of frameless vs. frame-based DBS surgery technique is still controversial. This retrospective study aims to compare the clinical outcome of two GPi-DBS surgical techniques for patients affected by primary generalized or multi-segmental dystonia.Methods: For lead's stereotaxic placement, 10 patients underwent frame-based surgery and the other 10 subjects DBS surgery with a frameless technique. Clinical features were evaluated at baseline and 6 and 12 months after surgery by means of the Burke–Fahn–Marsden Dystonia Rating Scale.Results: Frame-based GPi-DBS and frameless stereotaxic group revealed a comparable clinical outcome with no surgical complications.Conclusions: Frameless technique is safe and well-tolerated by patients and showed similar effectiveness of the frame-based stereotaxic surgery during GPi-DBS for primary dystonia. Notably, it could be a valid alternative solution because of the great advantage in improving the patient's discomfort during awake surgery.
Salvatore Bonvegna, Giulia Straccia, Nico Golfrè Andreasi, Antonio Emanuele Elia, Gianluca Marucci, Daniela Di Bella, Roberto Cilia, and Roberto Eleopra
Wiley
ChunYu Li, MD, RuWei Ou, MD, YongPing Chen, MD, XiaoJing Gu, MD, QianQian Wei, MD, Bei Cao, MD, LingYu Zhang, MD, YanBing Hou, MD, KunCheng Liu, MD, XuePing Chen, MD, Wei Song, MD, Bi Zhao, MD, Ying Wu, MD, Tao Li, MD, and HuiFang Shang, MD* Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
Roberto Cilia, Salvatore Bonvegna, Giulia Straccia, Nico Golfrè Andreasi, Antonio E. Elia, Luigi M. Romito, Grazia Devigili, Emanuele Cereda, and Roberto Eleopra
Wiley
The impact of coronavirus disease 2019 (COVID‐19) on clinical features of Parkinson's disease (PD) has been poorly characterized so far. Of 141 PD patients resident in Lombardy, we found 12 COVID‐19 cases (8.5%), whose mean age and disease duration (65.5 and 6.3 years, respectively) were similar to controls. Changes in clinical features in the period January 2020 to April 2020 were compared with those of 36 PD controls matched for sex, age, and disease duration using the clinical impression of severity index for PD, the Movement Disorders Society Unified PD Rating Scale Parts II and IV, and the nonmotor symptoms scale. Motor and nonmotor symptoms significantly worsened in the COVID‐19 group, requiring therapy adjustment in one third of cases. Clinical deterioration was explained by both infection‐related mechanisms and impaired pharmacokinetics of dopaminergic therapy. Urinary issues and fatigue were the most prominent nonmotor issues. Cognitive functions were marginally involved, whereas none experienced autonomic failure. © 2020 International Parkinson and Movement Disorder Society
Nico Golfrè Andreasi, Vittorio Rispoli, Elena Contaldi, Fabiana Colucci, Lorenzo Mongardi, Michele Alessandro Cavallo, and Mariachiara Sensi
Elsevier BV
Axial and gait disorders in Parkinson’s Disease (PD) are considered signs of disease progression with involvement of the extra nigrostriatal system. In PD patients treated with subthalamic nucleus (STN) deep brain stimulation (DBS), these symptoms may also occur from spread of the electric field outside the STN [1]. Various approaches have been suggested to manage gait disturbances [1e3] and substantia nigra pars reticulata (SNr) DBS has recently been reported to improve resistant freezing of gait (FoG) [4,5]. We describe the case of a young-onset PD patient who developed left arm tremor at the age of 34 years. In 2005, after 10 years of disease progression, with troublesome wearing-off, resistant tremor and disabling dyskinesias, he underwent bilateral STNDBS (3389 leads, Medtronic, Minneapolis, MN, USA). Satisfactory control of motor symptoms was achieved with DBS and optimization of oral therapy with rotigotine (16 mg/day) and levodopa (500mg/day). PostoperativeMRI and initial stimulation parameters are shown in Fig. 1A. The implantable pulse generator (IPG) was replaced in 2009 with Kinetra® (Medtronic, Minneapolis, MN, USA) and in 2013 with a Libra XPTM hybrid system (Abbott-St Jude Medical, Saint Paul, USA). Stimulation parameters were not changed but switched from constant voltage (3.0 V) to constant current stimulation (3.6 mA) in both electrodes, to maintain good control of motor symptoms. Dopaminergic oral therapy was not modified. In 2015, the patient developed rare FoG episodes. After overnight withdrawal, several observations in this practical OFF medication condition suggested a major contribution of left leg in triggering FoG. These FoG episodes were unresponsive to optimization of both best medical treatment (levodopa [800 mg/day] and rotigotine [16 mg/day]) andmodification of stimulation parameters during an updated monopolar review in the right hemisphere testing the ventral and dorsal contacts (9and 12-). In addition, tric stimulation by lowering the stimulation amplitude erally to the side with longer step length did not resolve FoG. Because of battery depletion, a rechargeable IPG (VerciseTM, Boston Scientific, Marlborough, USA) was implanted in 2017, keeping the stimulation parameters constant (Fig. 1B). Over the following months, FoG became progressively disabling with occasional falls and marked turn hesitation in the left leg (Video 1, segment 1). He scored 23/64 on the Gait and Falls Questionnaire and 20/28 on the Tinetti scale (Table 1). Cognitive evaluation was normal. Therefore, we decided to use the same contacts (10and 11-) but lowered the stimulation frequency to 80 Hz and increased the amplitude to 4.5 mA to maintain the same total electrical energy delivered (TEED) bilaterally. This attempt was unsuccessful because of worsening of cardinal motor symptoms in the left hemibody without sufficient improvement of FoG. We next shaped the electric field vertically by activating the lowest contact 9 (9[50%], 10[31%], 11 e [19%]). A 4-week trial using the same setting at 80 Hz improved FoG slightly but worsened PD segmental symptoms, especially bradykinesia (Video 1, segment 2 and Table 1). Since the volume of tissue activated (VTA) with this DBS setting (GUIDETM XT software, Boston Scientific, Valencia, CA, USA), seemed to simultaneously involve the STN and SNr, we decided to stimulate both of these nuclei with high-frequency DBS, as suggested by others [4,5]. Current amplitude and frequency were respectively changed to 3.6 mA and 130 Hz (Fig. 1C), obtaining remarkable FoG relief (Video 1, segment 3). The patient reported satisfactory control of PD cardinal symptoms, with significant reduction of FoG episodes at the 6and 9month follow-up. The patient had no further falls, and gait scales improved by 39% and 40% (Gait and Falls Questionnaire and Tinetti scales, respectively), with items related to turn hesitation being most improved (Table 1). Supplementary video related to this article can be found at https://doi.org/10.1016/j.brs.2019.10.010.
Enrico Granieri, Nico Golfrè Andreasi, Paolo De Martin, Vittorio Govoni, Massimiliano Castellazzi, Edward Cesnik, Maura Pugliatti, and Ilaria Casetta
Springer Science and Business Media LLC
BackgroundGuillain-Barré syndrome (GBS) is an acute/subacute autoimmune inflammatory polyradiculoneuropathy. Previous epidemiological studies carried out in the province of Ferrara, Italy, from 1981 to 2002 indicated that GBS incidence had tendency of increase in the period considered.ObjectivesWe aimed at updating the epidemiology of GBS in the years 2003–2017 and carrying on the work started in the 1980s.MethodsWe conducted an incidence study, by adopting a complete enumeration approach. Cases were identified from administrative, medical records, and database of the Ferrara Hospital and other provincial structures of the study area. Case ascertainment and definition are analogous to those adopted in previous surveys.ResultsIn the period 1 January 2003 to 31 December 2017, 73 patients living in the province of Ferrara (mean population 353,142) were found to be new cases of GBS fulfilling the NINCDS criteria. Male/female ratio 1.15. The mean incidence rate was 1.38 per 100,000 (95% CI 1.08–1.74), 1.54 per 100,000 for men and 1.23 per 100,000 for women, a nonsignificant difference. During the period considered, the rates had slow increase or mild decrease, without nonsignificant difference. The highest rates were observed for the age groups 70–79 years for both sexes. A half of patients reported infectious events in the weeks before the onset of symptoms.ConclusionIn line with many epidemiological data, in the whole period 2003–2017, we observed a trend towards increase or decrease in incidence and periods of relative stability. Similar temporal heterogeneity with the comparison to our previous works was found.
Vittorio Rispoli, Nico Golfrè Andreasi, Giovanna Penna, Francesca Preda, Eleonora Contini, and Mariachiara Sensi
Wiley
Gait and balance disorders in advanced Parkinson's disease (aPD) heavily impact the disease burden. In this prospective observational open‐label study, our aim was to evaluate the effectiveness of levodopa/carbidopa intestinal gel (LCIG) infusion on balance and gait over a long‐term follow‐up.
V. Rispoli, V. Simioni, J. G. Capone, N. Golfrè Andreasi, F. Preda, E. Sette, V. Tugnoli, and M. Sensi
Wiley
Peripheral neuropathy (PN) is a significant concern and potential cause of withdrawal in patients with Parkinson's disease (PD) treated with Levodopa/Carbidopa Intestinal Gel (LCIG) infusion. Vitamin B deficiency and/or hyperhomocysteinemia levodopa‐related are considered possible causative factors. In this study, we evaluated PN incidence in LCIG‐PD patients treated since the beginning of infusion with vitamins B supplementation.
Mattia Fonderico, Michele Laudisi, Nico Golfrè Andreasi, Stefania Bigoni, Costanza Lamperti, Celeste Panteghini, Barbara Garavaglia, Miryam Carecchio, Elia Antonio Emanuele, Gian L. Forni,et al.
Frontiers Media SA
Here, we report the case of a 36-year-old patient with a diagnosis of de novo mutation of the WDR45 gene, responsible for beta-propeller protein-associated neurodegeneration, a phenotypically distinct, X-linked dominant form of Neurodegeneration with Brain Iron Accumulation. The clinical history is characterized by a relatively stable intellectual disability and a hypo-bradykinetic and hypertonic syndrome with juvenile onset. Genetic investigations and T1 and T2-weighted MR images align with what is described in literature. The patient was also subjected to PET with 18-FDG investigation and DaT-Scan study. In reporting relevant clinical data, we want to emphasize the fact that the patient received a chelation therapy with deferiprone (treatment already used in other forms of NBIA with encouraging results), which, however, had to be interrupted because the parkinsonian symptoms worsened. Conversely, the patient has benefited from non-drug therapies and, in particular, from an adapted motor activity with assisted pedaling (method in the process of validation in treatments of parkinsonian syndromes), which started before the treatment with deferiprone and still continues.
Mariachiara Sensi, F. Preda, L. Trevisani, E. Contini, D. Gragnaniello, J. G. Capone, E. Sette, N. Golfre-Andreasi, V. Tugnoli, M. R. Tola,et al.
Springer Science and Business Media LLC
Many studies confirmed the efficacy and safety of continuous infusion of intrajejunal levodopa/carbidopa gel (CIILG) for advanced Parkinson’s disease (PD). Although this treatment is widely used, definite inclusion/exclusion criteria do not exist. In this prospective open-label study, we evaluated the long-term outcome in 28 consecutive patients and sought to detect any predictive factor to identify the best candidates for CIILG therapy. The assessment was carried out routinely at baseline, after 6 months and every year with UPDRS III–IV, FOG Questionnaire, non-motor symptoms scale, PD questionnaire (PDQ-8), cognitive and psychiatric status evaluation (MMSE, FAB, NPI) and caregiver’s quality of life. 17/28 patients reached the 24-month follow-up. A statistically significant beneficial effect was shown on motor complications in short- and long-term follow-up, also on axial symptoms like gait disturbances. A concomitant improvement in PDQ8 score was observed, with a parallel mild amelioration, but not significant, on Caregivers QoL. When classified according to their outcome on QoL, the only predictive positive factor was less severe at Neuropsychiatric Inventory (NPI) score at baseline. Considering the improvement in motor scores (duration of “off” period), the more advanced age was associated with a poorer outcome. Our results confirmed a sustained efficacy and safety in long-term follow-up and suggest that younger age at operation and absence or mild presence of psychiatric/behavioural symptoms could be considered valid predicting factors in selecting the best candidates for this efficacious therapy.
Michele Franca, Luca Turella, Rosario Canto, Nicola Brunelli, Luisa Allione, Nico Golfré Andreasi, Marianna Desantis, Daniele Marzoli, and Luciano Fadiga
Public Library of Science (PLoS)
In 1979, Gibson first advanced the idea that the sight of graspable objects automatically activates in the observer the repertoire of actions necessary to interact with them, even in the absence of any intention to act (“affordance effect”). The neurophysiological substrate of this effect was later identified in a class of bimodal neurons, the so-called "canonical" neurons, located within monkey premotor cortex. In humans, even if different behavioral studies supported the existence of affordance effect, neurophysiological investigations exploring its neural substrates showed contradictory results. Here, by means of Transcranial Magnetic Stimulation (TMS), we explored the time-course of the “affordance effect” elicited by the observation of everyday-life graspable objects on motor cortex of resting observers. We recorded motor evoked potentials (MEP) from three intrinsic hand muscles (two "synergic" for grasping, OP and FDI and one "neutral", ADM). We found that objects’ vision determined an increased excitability at 120 milliseconds after their presentation. Moreover, this modulation was proved to be specific to the cortical representations of synergic muscles. From an evolutionary perspective, this timing perfectly fits with a fast recruitment of the motor system aimed at rapidly and accurately choosing the appropriate motor plans in a competitive environment filled with different opportunities.