Biomedical subjects
Publications and source records attributed to E Lugaresi.
Auditory stimuli induce facilitation of the H reflex during wakefulness (so-called audio-spinal influence). In 5 subjects we found that, during SWS, the same stimuli may provoke phasic losses of muscle tone and H reflex inhibition. Similar losses of tone and H reflex inhibition were related to epileptic spikes in 3 patients.
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Three patients showing clinical and electrophysiological evidence of peripheral neuropathy also suffered from the syndrome of "painful legs and moving toes". Polygraphic recordings during wakefulness and sleep were consistent with the hypothesis that pathological afferent discharges arising peripherally may induce, via the spinal cord, motor excitation and pain. A severe disruption of the pattern of sleep was found in all cases.
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In order to evaluate autonomic nervous system changes occurring before nocturnal headache attacks, we studied three subjects (one male, two females) suffering from chronic migraine. All three patients underwent a nocturnal polygraphic recording including continuous monitoring of systemic arterial pressure and heart rate. Two subjects showed increases and irregularities of arterial pressure before awakening with headache. These changes began during N-REM sleep and lasted during REM sleep preceding the awakening with headache. Heart rate did not change before the attacks. These findings do not support the hypothesis that autonomic instability during REM sleep represents the precipitating factor of the attacks.
In a double-blind study with Latin square design, phenobarbital (about 1.3 mg per kilogram), propranolol (about 1.7 mg per kilogram), and placebo were given orally for 1 month to 12 patients with essential tremor. By clinical evaluation, only propranolol appeared to be significantly more effective than placebo. As judged by tests of manual skill, none of the treatments significantly improved tremor. Patients' subjective evaluation and tremor amplitude measurement (by accelerometer) showed a significantly better effect of both propranolol and phenobarbital than placebo. These data suggest that phenobarbital may be a valuable alternative to propranolol in essential tremor.
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In a case of common migraine and in two cases of cluster headache we monitored the arterial pressure and the heart rate by means of polygraphic recordings before, during and after headache attacks. During migraine attacks the arterial pressure did not show significant changes; the heart rate increased. During cluster attacks the arterial pressure increased with frequent hypertensive peaks; the heart rate on average slowed down and showed marked irregularities.
Among 1,000 outpatient epileptics who visited the Epilepsy Center of Bologna consecutively from 1974 to 1978, 596 cases of partial epilepsy (PE) were chosen, representing 62.9% of all cases classified according to the International Classification of epilepsies. Fifty-four of these cases (5.7%) of those classifiable) that were affected by benign infantile epilepsy with rolandic spikes were not analyzed further. The remaining cases were divided up into three groups based on the symptomatology of the seizures: (1) partial elementary epilepsy (PEE), 102 cases (10.8%); (2) partial complex epilepsy (PCE), 332 cases (35%); and (3) partial secondarily generalized epilepsy (PSGE), 108 cases (11.4%). The three groups were compared according to the parameters that distinguish recognized epileptic syndromes, in order to see whether they constitute autonomous nosographic entities. Among the three groups, significant differences did not arise with regard to the incidence of single lesional etiological factors, the age of onset of the epilepsy, the neurological context, and the general features of interictal EEG. PSGE instead differs significantly from the other two forms for the minor severity of the epilepsy at first examination and for its more favorable course: after at least 2 years of follow-up under treatment, the epilepsy appeared to be controlled in 60.6% of the cases with PSGE, in 31.6% of those with PEE, and in 37.5% of those with PCE (p less than 0.05). For those with PE, globally considered, only three parameters have a favorable prognostic value: the brief duration of the epilepsy at the first observation, the rarity of the seizures, and the presence of only one type of seizure.
The clinical course of 100 consecutive patients with angiographically proven carotid occlusion was reviewed. Ninety-three patients had been hospitalised for early stroke appropriate to the occlusion, and seven for transient ischaemic attacks. 68 patients were followed up from 1.5 to 5.9 years. The observed five year survival rate on an actuarial basis was 62.3%, compared to the expected rate of 90% in a matched normal population. The observed rate of recurrent stroke was 4.8% at 1 year. 12.2% at 3 years, 17.1% at 5 years. Among survivors, six patients (11.3%) developed seizures.
Out of 233 patients admitted for head trauma during 1977-1978, 93 had a CT scan examination within the first 48 hours. Forty-nine of these had at least one clinical risk factor for post-traumatic epilepsy. Ten of this group developed post-traumatic epilepsy. In all cases early CT scan showed focal brain damage, which was related more significantly to post-traumatic epilepsy than to risk factors.
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Five patients between the ages of 7 and 74 years presented with nocturnal episodes characterized by coarse, often violent movements of the limbs and by a tonic phase of variable duration. Seizures recurred every night or almost every night during slow wave (NREM) sleep and were not associated with electroencephalographic (EEG) abnormalities. Interictal EEGs were normal during both sleep and wakefulness. Carbamazepine treatment was effective in all patients. Uniform clinical behavior and EEG patterns indicate a distinct nosological entity whose pathophysiology is not yet understood.
Polygraphic findings during spontaneous nocturnal sleep of 2 patients suffering from Shy-Drager syndrome are reported. In both patients, total sleep time was reduced--sleep latency and awakening periods during the night being increased. Considerable reductions of rapid eye movement (REM) stage and, in 1 patient, also of deep non-REM (NREM; stages 3-4) were found. No apneas were recorded. In normal subjects, systemic systolic and diastolic pressure decreases during all the sleep stages; in our patients, arterial pressure values rose progressively during NREM sleep stages and showed a further increase in REM sleep. In all the sleep stages, sudden phasic swings of systemic arterial pressure were observed.