Case Report: Intensive multidisciplinary motor-cognitive rehabilitation treatment in Gerstmann–Sträussler–Scheinker syndrome A. De Laurenzis, C. Siri, L. Bandirali, L. Lucca, L. Covaia, et al. Frontiers in Rehabilitation Sciences, 2026 Gerstmann–Sträussler–Scheinker syndrome (GSS) is a genetic, autosomal dominant prion brain disease that causes ataxia and slow cognitive decline. Herein, we describe a 34-year-old woman (S.C.B.) diagnosed with GSS (variant Pro102Leu). In 2018, she presented with gait instability without falls, early fatigue, and dizziness; after 3 years, urinary incontinence, initial insomnia and rapid-eye movement sleep behavior disorder, writing difficulties, and occasional dysphagia had appeared. S.C.B. was admitted to the Neurorehabilitation Unit due to the progressive worsening of her balance and walking ability [Timed Up and Go (TUG): not evaluated; Berg Balance Scale (BERG): 5/56]. At admission, neurological, neuropsychological, physiotherapeutic, occupational, and speech assessments were performed. She was completely dependent in basic (ADL) and instrumental activities of daily living (iADL) (ADL: 5/6; iADL: 4/8; Barthel Index: 60); furthermore, moderate cognitive decline and depressive symptoms were observed. After 4 weeks of intensive motor-cognitive rehabilitation treatment , an improvement was observed in all the intervention areas, leading to a global gain in autonomy (TUG: 1 min 50 s; BERG: 10/56; Barthel Index: 70). This case report highlights the importance of tailored motor-cognitive rehabilitation and how these interventions can enhance patients’ quality of life and their ability to cope with their symptoms. In conclusion, this case contributes to a broader understanding of treatment options that clinicians can propose to patients.
Continuation vs Switching Direct Oral Anticoagulant Therapy after Breakthrough Stroke Lucio D’Anna, Francesca Gabriele, Raffaele Ornello, Andrea Zini, Matteo Paolucci, et al. JAMA Network Open, 2026 Importance Management after an ischemic stroke occurring despite direct oral anticoagulant (DOAC) therapy for atrial fibrillation (AF) varies widely. Switching anticoagulation is common in clinical practice, although evidence supporting this strategy is limited. Objective To evaluate whether continuation of treatment with the same DOAC was noninferior to switching oral anticoagulant therapy with respect to 90-day clinical outcomes. Design, Setting, and Participants This multicenter registry-based cohort study with an emulated target trial design included consecutive adult patients with AF who experienced a breakthrough ischemic stroke while receiving uninterrupted DOAC therapy and resumed anticoagulation therapy thereafter. Patients were enrolled between February 2020 and February 2025, across 35 stroke centers in 9 countries in Europe and North Africa, with a standardized 90-day follow-up. The dataset was locked on September 1, 2025. A noninferiority comparison of switching vs continuation strategies was performed. Baseline confounding was addressed using inverse probability of treatment weighting (IPTW). The primary noninferiority margin was an absolute risk difference of 3.0 percentage points in 90-day net clinical benefit. Exposure The intervention group switched to treatment with a different DOAC or vitamin K antagonist; the comparator group continued therapy with the prestroke DOAC. Main Outcomes and Measures The primary outcome was 90-day net clinical benefit, defined as recurrent ischemic stroke and moderate to severe bleeding. Secondary outcomes included recurrent ischemic events, symptomatic intracerebral hemorrhage, moderate to severe extracranial bleeding, all-cause mortality, and vascular death. Results Among 1006 patients included in the analysis (median age, 80.4 [IQR, 73.4-85.4] years; 503 female [50.0%] and 503 [50.0%] male), 463 (46.0%) continued the same DOAC therapy and 543 (54.0%) switched therapy. After IPTW adjustment, the 90-day net clinical benefit was 4.9% with switching and 5.1% with continuation, corresponding to a risk difference of −0.3 percentage points (90% CI, −2.7 to 2.1 percentage points), meeting the prespecified noninferiority criterion. For recurrent ischemic events and bleeding outcomes, the absolute differences were within the predefined noninferiority margins. Noninferiority was not demonstrated for all-cause or vascular mortality. Conclusions and Relevance In patients with breakthrough ischemic stroke during DOAC therapy, switching anticoagulation treatment was not associated with clinically meaningful short-term benefit compared with continuation. These findings suggest that switching does not provide additional benefit compared with continuing treatment with the same DOAC. Randomized clinical trials are needed to identify strategies to improve secondary prevention after a breakthrough ischemic stroke.
Sex Differences in Outcomes After Breakthrough Ischemic Stroke on Oral Anticoagulants for Atrial Fibrillation: An ASPERA-R Inverse Probability Weighted Analysis Matteo Foschi, Lucio D’Anna, Francesca Gabriele, Raffaele Ornello, Andrea Zini, et al. Journal of the American Heart Association, 2026 Background Sex‐specific outcomes after breakthrough ischemic stroke on oral anticoagulation (OAC) are unexplored. We compared 90‐day outcomes by sex and explored modifiers. Methods ASPERA‐R (Advancing Knowledge in Ischemic Stroke Patients on Oral Anticoagulants retrospective cohort; NCT06823466) was an international, multicenter, retrospective study enrolling adults (aged >18 years) with breakthrough ischemic stroke on OAC for atrial fibrillation. Primary outcome was 90‐day return to baseline neurologic function (modified Rankin Scale [mRS] score 0–1 maintained if prestroke 0–1; or same/lower mRS score if prestroke ≥2). Secondary outcomes were 90‐day mRS shift, recurrent ischemic stroke/transient ischemic attack, myocardial infarction, and all‐cause and vascular death. Safety outcomes included 90‐day moderate‐to‐severe bleeding, intracranial hemorrhage, 24‐hour hemorrhagic transformation, and 24‐hour symptomatic intracranial hemorrhage. We applied inverse probability weighting and regression models to compare outcomes. Prespecified subgroup analysis tested sex‐specific interactions. Results We included 1649 patients (women, 52.2%; mean±SD age, 78.0±10.7 years). Women were older (80.2±9.6 versus 76.3±10.8 years; unweighted standardized mean difference=0.376), had higher baseline National Institutes of Health Stroke Scale score (13 [interquartile range, 9–19] versus 9 [interquartile range, 4–17]; unweighted standardized mean difference=0.227), and worse prestroke mRS score (unweighted standardized mean difference=0.237). After weighting, women were less likely to return to baseline neurologic function (35.2% versus 42.7%; adjusted risk ratio, 0.82 [95% CI, 0.71–0.96]; P =0.015), had worse mRS distribution (adjusted odds ratio, 1.17 [95% CI, 1.01–1.37]; P =0.043), and had higher recurrent ischemic stroke/transient ischemic attack (4.8% versus 2.8%; adjusted hazard ratio [HR], 1.70 [95% CI, 1.01–2.86]; P =0.045). Women showed a trend toward more moderate‐to‐severe bleeding (4.6% versus 2.8%; adjusted HR, 1.63 [95% CI, 0.96–2.72]; P =0.070). Subgroup analyses revealed significant sex interactions for OAC type, competing cause, endovascular treatment, and OAC restart. Conclusions Women had worse 90‐day outcomes than men after breakthrough ischemic stroke on OAC for atrial fibrillation, highlighting the need for sex‐aware management.
Cherishing Professional Success and Personal Fulfillment: Resilience as a Pivotal Leadership Competency for Clinical Pharmacologists and Beyond Karthik Venkatakrishnan, Jing ‘Daisy’ Zhu, Federica Ferrari, Krista Levy, Beth Kennedy Journal of Clinical Pharmacology, 2025 Resilience is a critical leadership competency directly linked to engagement, sustainable innovation, and productivity. This Commentary presents resilience concepts using the Benatti Resiliency Model®, which comprises five inter‐related dimensions: Well‐being, Self‐awareness, Brand, Connection, and Innovation. Trust is discussed as a critical leadership competency, with three levels: self‐trust, trust in relationships at the team level, and community trust. The concept of Ikigai, representing the intersection of what one loves, what one is good at, what the world needs, and what one can be paid for, is discussed as a framework for self‐awareness, brand development, development planning, and mentoring. Time and energy management using the Eisenhower matrix is highlighted as a strategy to build resilience, manage stress, enhance productivity, and prevent burnout. Taken together, the strategies discussed in this commentary are intended to unlock the transformative potential of resilience for sustainable innovation and impact within and beyond the dynamic and interdisciplinary field of clinical pharmacology, ultimately enabling professional success and personal fulfillment.
Stress hyperglycemia indexes and early neurological deterioration in spontaneous intracerebral hemorrhage Carmelo Tiberio Currò, Federica Ferrari, Giovanni Merlino, Stefan Moraru, Francesco Bax, et al. Neurological Sciences, 2025 Aim To evaluate the relationship of early neurological deterioration (END) with admission glycemia (aG) and new stress hyperglycemia indexes in spontaneous intracerebral hemorrhage (ICH) patients. Methods The present retrospective study included 171 ICH patients from two stroke centers. END was defined as an increase ≥ 4 points in National Institutes of Health Stroke Scale and/or a decrease ≥ 2 points in Glasgow Coma Scale within 72 hours from admission. The included stress hyperglycemia indexes were glycemic gap (GGAP), stress hyperglycemia ratio (SHR), and glucose-glycated hemoglobin ratio. GGAP was calculated as aG – 28,7*glycated hemoglobin + 46,7; SHR as aG / (28,7*glycated hemoglobin – 46,7); Glucose-glycated hemoglobin ratio as aG / glycated hemoglobin. We performed univariate and multivariate analyses for END. The receiver operating characteristic curves were built for END-related glycemic measures; area under curves (AUC) were calculated and compared. The optimized threshold values were calculated, and significant glycemic measures were dichotomized. Univariate and multivariate analyses were performed for the dichotomized measures. Results END was present in 21 patients (12.3%) and was significantly associated with GGAP, SHR and glucose-glycated hemoglobin ratio, but not with aG. The AUC of the three stress hyperglycemia indexes did not differ significantly. The optimized cutoffs were 35.68 (sensitivity 0.47, specificity 0.81), 1.15 (sensitivity 0.62, specificity 0.68), and 26.67(sensitivity 0.43, specificity 0.80) for GGAP, SHR, and glucose-glycated hemoglobin ratio respectively. END was also associated with all stress hyperglycemia indexes expressed as categorical variables. Conclusion GGAP, SHR, and glucose-glycated hemoglobin ratio were predictors of END in ICH patients.
Impact of CYP2C19 genotype on efficacy and safety of Clopidogrel-based antiplatelet therapy in stroke or transient ischemic attack patients: an updated systematic review and … S Cargnin, F Ferrari, S Terrazzino Cardiovascular drugs and therapy 38 (6), 1397-1407 , 2024 2024 Citations: 21
Medial intracranial carotid artery calcifications and hematoma expansion in deep intracerebral hemorrhage F Mazzacane, S Moraru, B Del Bello, F Ferrari, E Ferro, A Persico, ... Annals of Clinical and Translational Neurology 11 (12), 3246-3254 , 2024 2024 Citations: 1
Apomorphine Subcutaneous Infusion Likely Induced Acute Thrombocytopenia in a Patient with Parkinson's Disease and Motor Fluctuations MM Pocora, M Avenali, MG Croce, F Ferrari, F Valentino, C Pacchetti, ... Movement Disorders Clinical Practice 12 (1), 115 , 2024 2024
The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting G Vaghi, A Morotti, EM Piella, M Avenali, D Martinelli, S Cristina, M Allena, ... Scientific Reports 14 (1), 8320 , 2024 2024 Citations: 2
Effects of Chronic Hypertension on the Energy Metabolism of Cerebral Cortex Mitochondria in Normotensive and in Spontaneously Hypertensive Rats During Aging RF Villa, F Ferrari, A Gorini Neuromolecular medicine 26 (1), 2 , 2024 2024 Citations: 5
Acute amnestic syndrome in fornix lesions: a systematic review of reported cases with a focus on differential diagnosis F Mazzacane, F Ferrari, A Malvaso, Y Mottese, M Gastaldi, A Costa, ... Frontiers in Neurology 15, 1338291 , 2024 2024 Citations: 6
Quantification and prospective evaluation of serum NfL and GFAP as blood-derived biomarkers of outcome in acute ischemic stroke patients F Ferrari, D Rossi, A Ricciardi, C Morasso, L Brambilla, S Albasini, ... Journal of Cerebral Blood Flow & Metabolism 43 (9), 1601-1611 , 2023 2023 Citations: 56
Intracranial carotid artery calcification morphology differs in patients with lacunar and nonlacunar acute ischemic strokes F Mazzacane, B Del Bello, F Ferrari, A Persico, E Rognone, A Pichiecchio, ... European journal of neurology 30 (4), 963-969 , 2023 2023 Citations: 5
Brain bioenergetics in chronic hypertension: Risk factor for acute ischemic stroke F Ferrari, RF Villa Biochemical Pharmacology 205, 115260 , 2022 2022 Citations: 20
Incretin-based drugs as potential therapy for neurodegenerative diseases: current status and perspectives F Ferrari, A Moretti, RF Villa Pharmacology & therapeutics 239, 108277 , 2022 2022 Citations: 59
Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity F Ferrari, A Moretti, RF Villa Neural regeneration research 17 (2), 292-299 , 2022 2022 Citations: 121
Synaptic ATPases and energy metabolism in the nervous system: roles and changes during aging RF Villa, F Ferrari Factors Affecting Neurological Aging, 129-139 , 2021 2021 Citations: 1
Use of cangrelor in cervical and intracranial stenting for the treatment of acute ischemic stroke: a “real life” single-center experience A Cervo, F Ferrari, G Barchetti, L Quilici, M Piano, E Boccardi, G Pero American Journal of Neuroradiology 41 (11), 2094-2099 , 2020 2020 Citations: 36
The treament of hyperglycemia in acute ischemic stroke with incretin-based drugs F Ferrari, A Moretti, RF Villa Pharmacological Research 160, 105018 , 2020 2020 Citations: 7
Synaptic ATPases system of rat frontal cerebral cortex during aging F Ferrari, P Viscardi, A Gorini, RF Villa Neuroscience letters 694, 74-79 , 2019 2019 Citations: 10
Glutamate metabolism in cerebral mitochondria after ischemia and post‐ischemic recovery during aging: relationships with brain energy metabolism F Ferrari, A Gorini, S Hoyer, RF Villa Journal of neurochemistry 146 (4), 416-428 , 2018 2018 Citations: 40
Post-stroke depression: mechanisms and pharmacological treatment RF Villa, F Ferrari, A Moretti Pharmacology & therapeutics 184, 131-144 , 2018 2018 Citations: 632
The neurobiology of depression: an integrated overview from biological theories to clinical evidence F Ferrari, RF Villa Molecular neurobiology 54 (7), 4847-4865 , 2017 2017 Citations: 281
Mitochondrial energy metabolism of rat hippocampus after treatment with the antidepressants desipramine and fluoxetine RF Villa, F Ferrari, L Bagini, A Gorini, N Brunello, F Tascedda Neuropharmacology 121, 30-38 , 2017 2017 Citations: 64
Effects of neuroprotectants before and after stroke: statins and anti-hypertensives RF Villa, F Ferrari, A Moretti Neuroprotective therapy for stroke and ischemic disease, 349-399 , 2017 2017 Citations: 5
MOST CITED SCHOLAR PUBLICATIONS
Post-stroke depression: mechanisms and pharmacological treatment RF Villa, F Ferrari, A Moretti Pharmacology & therapeutics 184, 131-144 , 2018 2018 Citations: 632
Neuroprotection for ischaemic stroke: current status and challenges A Moretti, F Ferrari, RF Villa Pharmacology & therapeutics 146, 23-34 , 2015 2015 Citations: 309
The neurobiology of depression: an integrated overview from biological theories to clinical evidence F Ferrari, RF Villa Molecular neurobiology 54 (7), 4847-4865 , 2017 2017 Citations: 281
Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity F Ferrari, A Moretti, RF Villa Neural regeneration research 17 (2), 292-299 , 2022 2022 Citations: 121
Mitochondrial energy metabolism of rat hippocampus after treatment with the antidepressants desipramine and fluoxetine RF Villa, F Ferrari, L Bagini, A Gorini, N Brunello, F Tascedda Neuropharmacology 121, 30-38 , 2017 2017 Citations: 64
Pharmacological therapy of acute ischaemic stroke: achievements and problems A Moretti, F Ferrari, RF Villa Pharmacology & therapeutics 153, 79-89 , 2015 2015 Citations: 64
Incretin-based drugs as potential therapy for neurodegenerative diseases: current status and perspectives F Ferrari, A Moretti, RF Villa Pharmacology & therapeutics 239, 108277 , 2022 2022 Citations: 59
Quantification and prospective evaluation of serum NfL and GFAP as blood-derived biomarkers of outcome in acute ischemic stroke patients F Ferrari, D Rossi, A Ricciardi, C Morasso, L Brambilla, S Albasini, ... Journal of Cerebral Blood Flow & Metabolism 43 (9), 1601-1611 , 2023 2023 Citations: 56
Energy metabolism of cerebral mitochondria during aging, ischemia and post-ischemic recovery assessed by functional proteomics of enzymes RF Villa, A Gorini, F Ferrari, S Hoyer Neurochemistry international 63 (8), 765-781 , 2013 2013 Citations: 54
Effect of desipramine and fluoxetine on energy metabolism of cerebral mitochondria RF Villa, F Ferrari, A Gorini, N Brunello, F Tascedda Neuroscience 330, 326-334 , 2016 2016 Citations: 52
Glutamate metabolism in cerebral mitochondria after ischemia and post‐ischemic recovery during aging: relationships with brain energy metabolism F Ferrari, A Gorini, S Hoyer, RF Villa Journal of neurochemistry 146 (4), 416-428 , 2018 2018 Citations: 40
Use of cangrelor in cervical and intracranial stenting for the treatment of acute ischemic stroke: a “real life” single-center experience A Cervo, F Ferrari, G Barchetti, L Quilici, M Piano, E Boccardi, G Pero American Journal of Neuroradiology 41 (11), 2094-2099 , 2020 2020 Citations: 36
Energy metabolism of rat cerebral cortex, hypothalamus and hypophysis during ageing RF Villa, F Ferrari, A Gorini Neuroscience 227, 55-66 , 2012 2012 Citations: 34
Functional proteomics of synaptic plasma membrane ATP-ases of rat hippocampus: effect of l-acetylcarnitine and relationships with Dementia and Depression pathophysiology F Ferrari, A Gorini, RF Villa European journal of pharmacology 756, 67-74 , 2015 2015 Citations: 28
Effect of CDP-choline on age-dependent modifications of energy-and glutamate-linked enzyme activities in synaptic and non-synaptic mitochondria from rat cerebral cortex RF Villa, F Ferrari, A Gorini Neurochemistry international 61 (8), 1424-1432 , 2012 2012 Citations: 28
Impact of CYP2C19 genotype on efficacy and safety of Clopidogrel-based antiplatelet therapy in stroke or transient ischemic attack patients: an updated systematic review and … S Cargnin, F Ferrari, S Terrazzino Cardiovascular drugs and therapy 38 (6), 1397-1407 , 2024 2024 Citations: 21
Brain bioenergetics in chronic hypertension: Risk factor for acute ischemic stroke F Ferrari, RF Villa Biochemical Pharmacology 205, 115260 , 2022 2022 Citations: 20
Functional proteomics related to energy metabolism of synaptosomes from different neuronal systems of rat hippocampus during aging RF Villa, F Ferrari, A Gorini Journal of Proteome Research 12 (12), 5422-5435 , 2013 2013 Citations: 20
Effect of in vivo L-acetylcarnitine administration on ATP-ases enzyme systems of synaptic plasma membranes from rat cerebral cortex RF Villa, F Ferrari, A Gorini Neurochemical research 36 (8), 1372-1382 , 2011 2011 Citations: 20
ATP-ases of synaptic plasma membranes in striatum: enzymatic systems for synapses functionality by in vivo administration of L-acetylcarnitine in relation to Parkinson’s disease RF Villa, F Ferrari, A Gorini Neuroscience 248, 414-426 , 2013 2013 Citations: 11