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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.
Roberto Eleopra; Sara Rinaldo; Grazia Devigili; Massimo Mondani; Stanislao D'Auria; Nico Golfrè Andreasi; Miran Skrap; Christian Lettieri. Globus Pallidus Internus Deep Brain Stimulation Using Frame-Based vs. Frameless Stereotaxy in Dystonia: A Single-Center Experience. Frontiers in Neurology 2021, 12, 643757 .
AMA StyleRoberto Eleopra, Sara Rinaldo, Grazia Devigili, Massimo Mondani, Stanislao D'Auria, Nico Golfrè Andreasi, Miran Skrap, Christian Lettieri. Globus Pallidus Internus Deep Brain Stimulation Using Frame-Based vs. Frameless Stereotaxy in Dystonia: A Single-Center Experience. Frontiers in Neurology. 2021; 12 ():643757.
Chicago/Turabian StyleRoberto Eleopra; Sara Rinaldo; Grazia Devigili; Massimo Mondani; Stanislao D'Auria; Nico Golfrè Andreasi; Miran Skrap; Christian Lettieri. 2021. "Globus Pallidus Internus Deep Brain Stimulation Using Frame-Based vs. Frameless Stereotaxy in Dystonia: A Single-Center Experience." Frontiers in Neurology 12, no. : 643757.
The Botulinum NeuroToxin (BoNT) comprises several serotypes with distinct properties, mechanisms of action, sensitivity and duration of effect in different species. The serotype A (BoNT/A) is the prevalent neurotoxin applied in human's disease. In this paper we present an overview of the current knowledge regarding the duration of effect and the neuromuscular sprouting of different BoNT serotypes in humans. Then, we report the original results of a study in healthy subjects treated with BoNT/A, B, C and F using different neurophysiological techniques. Twelve healthy volunteers (7 men, 5 women) are treated with BoNT/A, B, C and F or placebo in Abductor digiti minimi (ADM) muscle of the hand. Before and after injections, an extensive neurophysiological study is performed with the CMAP amplitude variation, Multi-Motor Unit Action Potentials (MUAPs) analysis, the Turns/Amplitude ratio of interference pattern (IP) and determination of jitter and Fiber Density (FD) at single-fiber electromyography (SFEMG), at week 2 (w2), 4 (w4), 6 (w6) and 8 (w8). A maximal neuromuscular block is obtained at w2 for all the serotypes. Afterwards, the CMAP trend appear similar for BoNT/A, B, and C while, BoNT/F shows a faster recover. Multi-MUAPs analysis and IP detect mild changes at w2 for all serotypes, except for BoNT/F that shows a greater change since w4. SFEMG have minimal changes in FD while, Jitter increase at w2 with a slower decrease over the time for all BoNTs. In conclusion, BoNT/F has earlier sprouting and complete recovery at w8. Other serotypes present a slower and similar profile. The EMG appear useful to study the functional recovery in humans, and these results should provide new evidence for assessing different serotypes. These findings improve our knowledge regarding the methods to evaluate duration of effects and dose equivalents in different serotypes, that in the future could change the clinicians strategy for disease-tailored BoNT therapies.
Roberto Eleopra; Sara Rinaldo; Cesare Montecucco; Ornella Rossetto; Grazia Devigili. Clinical duration of action of different botulinum toxin types in humans. Toxicon 2020, 179, 84 -91.
AMA StyleRoberto Eleopra, Sara Rinaldo, Cesare Montecucco, Ornella Rossetto, Grazia Devigili. Clinical duration of action of different botulinum toxin types in humans. Toxicon. 2020; 179 ():84-91.
Chicago/Turabian StyleRoberto Eleopra; Sara Rinaldo; Cesare Montecucco; Ornella Rossetto; Grazia Devigili. 2020. "Clinical duration of action of different botulinum toxin types in humans." Toxicon 179, no. : 84-91.
Conventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system. Impedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months). Directional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months. There was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS). Our study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.
Roberto Eleopra; Sara Rinaldo; Grazia Devigili; Christian Lettieri; Massimo Mondani; Stanislao D'auria; Massimo Piacentino; Manuela Pilleri. Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients. Clinical Neurophysiology 2019, 130, 1562 -1569.
AMA StyleRoberto Eleopra, Sara Rinaldo, Grazia Devigili, Christian Lettieri, Massimo Mondani, Stanislao D'auria, Massimo Piacentino, Manuela Pilleri. Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients. Clinical Neurophysiology. 2019; 130 (9):1562-1569.
Chicago/Turabian StyleRoberto Eleopra; Sara Rinaldo; Grazia Devigili; Christian Lettieri; Massimo Mondani; Stanislao D'auria; Massimo Piacentino; Manuela Pilleri. 2019. "Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients." Clinical Neurophysiology 130, no. 9: 1562-1569.
Roberto Eleopra; Sara Rinaldo; Grazia Devigili; Massimo Mondani; Stanislao D’Auria; Christian Lettieri; Tamara Ius; Miran Skrap. Frameless Deep Brain Stimulation Surgery: A Single-Center Experience and Retrospective Analysis of Placement Accuracy of 220 Electrodes in a Series of 110 Patients. Stereotactic and Functional Neurosurgery 2019, 97, 337 -346.
AMA StyleRoberto Eleopra, Sara Rinaldo, Grazia Devigili, Massimo Mondani, Stanislao D’Auria, Christian Lettieri, Tamara Ius, Miran Skrap. Frameless Deep Brain Stimulation Surgery: A Single-Center Experience and Retrospective Analysis of Placement Accuracy of 220 Electrodes in a Series of 110 Patients. Stereotactic and Functional Neurosurgery. 2019; 97 (5-6):337-346.
Chicago/Turabian StyleRoberto Eleopra; Sara Rinaldo; Grazia Devigili; Massimo Mondani; Stanislao D’Auria; Christian Lettieri; Tamara Ius; Miran Skrap. 2019. "Frameless Deep Brain Stimulation Surgery: A Single-Center Experience and Retrospective Analysis of Placement Accuracy of 220 Electrodes in a Series of 110 Patients." Stereotactic and Functional Neurosurgery 97, no. 5-6: 337-346.
Hip Osteoarthritis (OA) causes pain and disability. Here we evaluate abobotulinumtoxinA (Dysport®) (AboBoNT-A) injections versus placebo as a novel treatment option to improve hip range of motion, pain and quality of life. This prospective randomized double-blind multicenter study (EudraCT # 2012-004890-25) recruited 46 outpatients with hip OA who were randomized 2:1 to the Treatment Group (TG; 31 subjects), or the Placebo Group (PG; 15 subjects). The TG received 400 U of AboBoNT-A injected into the adductor muscles, and the PG received placebo solution. The primary endpoints were the difference in Harris Hip Score (HHS) and Visual Analogic Scale for pain (VAS) at Week 4 between groups (TG vs. PG). Secondary endpoints were the change from baseline in HHS, VAS pain, Medical Research Council scale for muscle strength (MRC) and Short Form scale (SF-36) scores. In TG at Week 4, the HHS and VAS score were significantly improved compared to PG, and pairwise assessments showed significant improvements in HSS and VAS pain at each time point compared to baseline for TG. No significant changes were observed in MRC and SF-36 over time, though SF-36 showed a positive trend. There were no significant differences from baseline in the PG. No adverse events were detected in either treatment group. AboBoNT-A injections in hip OA improve range of motion and pain without any significant side effects.
Roberto Eleopra; Sara Rinaldo; Christian Lettieri; Andrea Santamato; Paolo Bortolotti; Carmelo Lentino; Carmine Tamborino; Araldo Causero; Grazia Devigili. AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study. Toxins 2018, 10, 448 .
AMA StyleRoberto Eleopra, Sara Rinaldo, Christian Lettieri, Andrea Santamato, Paolo Bortolotti, Carmelo Lentino, Carmine Tamborino, Araldo Causero, Grazia Devigili. AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study. Toxins. 2018; 10 (11):448.
Chicago/Turabian StyleRoberto Eleopra; Sara Rinaldo; Christian Lettieri; Andrea Santamato; Paolo Bortolotti; Carmelo Lentino; Carmine Tamborino; Araldo Causero; Grazia Devigili. 2018. "AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study." Toxins 10, no. 11: 448.