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Biomedical subjects

G L Gigli

Publications and source records attributed to G L Gigli.

At least 37 records · Page 2Linked to original sources
PubMed1997

Poststroke late seizures and their role in rehabilitation of inpatients.

PURPOSE: This study was designed to (a) identify the prevalence of poststroke late seizures in a population of patients admitted to rehabilitation of neurologic sequelae of their first stroke, (b) recognize reliable prognostic factors associated with the occurrence of poststroke late seizures, and (c) evaluate the impact of seizures on the results of rehabilitation treatment. METHODS: In a prospective study of 306 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, we assessed the relation among 15 independent variables and the development of seizures by using multiple regression analysis (forward stepwise). In addition, we evaluated the impact of occurrence of poststroke seizures on both efficiency and effectiveness of rehabilitation and length of stay. RESULTS: Poststroke late seizures occurred in 46 (15.03%) patients, with a mean interval from stroke of 101.98 +/- 37.96 days. In multiple regression analysis, putaminal and lobar hemorrhages showed a significant positive association with the development of seizures (p < 0.005), whereas high scores on the Canadian Neurological Scale (CNS) (indicating less severe strokes) and increasing age were negatively associated (p < 0.01 and p < 0.05, respectively). Patients with putaminal and lobar hemorrhages and patients with severe stroke (CNS score at admission, <7) were at significantly greater relative risk of seizures [relative risk (RR) = 1.99, 95% confidence interval (CI), 1.11-1.39; RR = 3.00, CI, 1.06-1.13; and RR = 2.41, CI, 1.01-1.27, respectively). No significant association was found between poststroke seizures and results of rehabilitation. CONCLUSIONS: Poststroke late seizures occurred mainly in patients with putaminal and lobar hemorrhagic strokes but, if treated, did not affect rehabilitation therapy.

Aged↗
PubMed1997

Nocturnal sleep and daytime somnolence in untreated patients with temporal lobe epilepsy: changes after treatment with controlled-release carbamazepine.

PURPOSE: To define sleep disturbances in patients with temporal lobe epilepsy (TLE) and explore the association between carbamazepine (CBZ) therapy, sleep, and daytime somnolence. METHODS: We recorded nocturnal polysomnography and measured subjective and objective daytime somnolence in a group of newly diagnosed TLE patients, who had no evidence of anatomic brain lesion on neuroimaging and had never been treated before. Recordings were performed at baseline, after the initial administration of 400 mg CBZ-controlled release (CR) and after 1 month of treatment (400 mg twice daily b.i.d.). The findings were compared with those of a group of young healthy volunteers, both at baseline and after the first administration of CBZ. The chronic effect of CBZ-CR treatment was evaluated only in TLE patients. RESULTS: At baseline, nocturnal sleep patterns of TLE patients did not show marked alterations when the influence of seizures, cerebral lesions, and drugs had been ruled out. In both the TLE and the control groups, initiation of CBZ therapy provoked a reduction and a fragmentation of rapid eye movement (REM) sleep and an increase in the number of sleep stage shifts. In the TLE group, these effects were almost completely reversed after 1 month of treatment, and no significant difference was noted between baseline condition and long-term follow-up. With regard to daytime sleepiness, initial administration of the drug caused an increase in objective sleepiness only in the control group. Subjective sleepiness was higher in the control group than in the TLE group but was not modified by the drug. CONCLUSIONS: We conclude that CBZ-CR has negative effects on REM sleep during initial administration but chronic treatment does not significantly modify nocturnal sleep or daytime somnolence.

Adult↗
PubMed1997

Case report: subependymal diffuse heterotopia. Clinical, EEG, and neuroimaging findings.

We report the case of a 41 year-old woman with a slight mental retardation and epilepsy. MRI showed a diffuse subependymal heterotopia. The cognitive level supports the view that the ectopic cells are probably not important for the normal cortical functions but that they are likely able to maintain some of the electric properties of normal neurons, even if with altered discharge modalities. The genetic etiology of subependymal neuronal migration disorders is discussed. This is the second reported case of diffuse subependymal heterotopia in a female patient.

Adult↗
PubMed1996

Effect of lamotrigine on EEG paroxysmal abnormalities and background activity: a computerized analysis.

1. Little information is available about the action of lamotrigine (LTG) on EEG paroxysmal abnormalities and background activity. On the contrary, several clinical trials have shown the therapeutic efficacy of the drug in preventing partial and generalized seizures. 2. We performed computerized EEG monitoring in 21 patients suffering from focal and generalized epilepsy before and 4 months after addition of LTG. The anticonvulsant modified the EEG ictal events by reducing their frequency and duration. A statistically significant decrease of the interictal spikes was observed. The decrease involved mainly the spreading component of the interictal events leading to a better spatial definition of the epileptic focus. 3. In the presence of LTG, generalized tonic-clonic attacks were completely controlled, whereas partial seizures were decreased. 4. The EEG background activity was not modified by the addition of the drug. 5. Our findings suggest a specific role for LTG in the generation and propagation processes of epileptiform activity without interfering with the EEG background activity.

Adolescent↗
PubMed1996

Valproate-induced systemic lupus erythematosus in a patient with partial trisomy of chromosome 9 and epilepsy.

We report a mentally retarded 30-year-old woman with partial trisomy of chromosome 9 (46, XX-6, +der(6)t(6,9)pat) who has had epilepsy since age 11 months. She had been treated with various combinations of drugs. After 1 year of treatment with valproate (VPA) and ethosuximide (ESM), the patient developed arthralgias, muscle weakness, fatigue, and fever. Laboratory examination showed increased sedimentation rate, hypergammaglobulinemia, and high titers of antinuclear antibodies (ANA). The possibility of VPA-induced systemic lupus erythematosus (SLE) was considered. This diagnosis was supported by detection of antihistone antibodies and the HLA-DR4 antigen. VPA dosage was tapered and discontinued, with accompanying resolution of clinical, immunological and hematological signs of SLE 6 weeks after VPA discontinuation. This is the fourth reported case of VPA-induced SLE.

Adult↗
PubMed1996

Sleep in healthy elderly subjects: a 24-hour ambulatory polysomnographic study.

It is still debated whether the deterioration of the sleep pattern, frequently reported by elderly subjects, is due only to aging per se. Other factors associated with aging or modifications of biological rhythms could also be involved. Elderly subjects frequently complain of daytime sleepiness, but it is not clear whether this actually represents a return to a polyphasic structure of sleep, or only a consequence of a disturbed night sleep. Ten healthy, independent and active elderly subjects (age > 72 years) were elevated by means of 24-hour ambulatory polysomnography. Findings of nocturnal sleep were compared with sleep of the same group in the 24-hour period and with sleep of young healthy controls. We observed a fragmentation of nocturnal sleep, but a fairly good representation of stages and a preservation of cyclicity. Except for three cases, with early or late times of sleep onset and wake-up, sleep disruption did not seem to be related to modification of circadian rhythms. Only three subjects presented undesired daytime naps, whereas the others either did not show daytime sleep at all, or were used to having their siesta after lunch since their young adulthood. In normal aging, daytime sleep does not constitute a social problem. Ambulatory polysomnography is a valid alternative to laboratory recordings in the identification of daytime sleep.

Aged↗
PubMed1996

Rapidly progressive form of Creutzfeldt-Jakob disease without dementia: a case report.

We describe a case of a patient with Creutzfeldt-Jakob disease (CJD) characterized by a rapid clinical course lasting one and a half months, by: presence of focal dystonic movements at onset, absence of mental deterioration in the period preceding the impairment of consciousness, ataxia, myoclonus and periodic EEG abnormalities. The autopsy confirmed subacute spongiform encephalopathy, but no evident neuronal loss was observed. An acute clinical course of CJD may explain this latter histological finding which, in turn, probably provides an explanation for the absence of intellectual impairment.

Aged↗
PubMed1996

Cognitive performances in newly referred patients with temporal lobe epilepsy: comparison with normal subjects in basal condition and after treatment with controlled-release carbamazepine.

In order to verify whether the performance of patients with temporal lobe epilepsy (TLE) were different from those of the normal controls in various cognitive tasks, we conducted a neuropsychological study in the two groups, excluding the presence of other confounding factors in the group of TLE patients (newly referred, previously untreated, without cerebral lesions at neuroimaging, with low recurrence of seizures). In basal condition, no significant difference was found between the nine healthy controls and the eight TLE patients. The second aim of the study was to investigate the effect of the first administration of 400 mg controlled-release carbamazepine (CBZ-CR). The drug caused a significant decrease in verbal memory (short and long-term) in TLE patients, whereas, in the control group, the first administration of CBZ-CR caused only a less significant impairment of long-term verbal-memory. Finally, the cognitive effects of CBZ-CR were assessed after one month of therapy, only in the group of patients. Our data suggest that: 1) differences between patients and controls in basal conditions are not relevant, once the influence of seizures, of treatment and of anatomical lesions has been ruled out. In other words, our patients did not perform differently from controls simply because they had become epileptic 2) also in the controlled-release preparation, adverse effects of CBZ on cognitive function are minimal and limited to the beginning of treatment.

Adult↗
PubMed1996

Clinical case report: multiple idiosyncratic adverse effects of antiepileptic drugs in trisomy 9p.

We report the case of a mentally retarded 30 y.o. patient with partial trisomy of chromosome 9, affected by epilepsy. Following treatment with antiepileptic drugs (AEDs), the patient developed several rare complications: after beginning therapy with phenytoin, the patient developed pseudolymphoma; after monotherapy with carbamazepine (CBZ), the patient thereafter developed myoclonic jerks of upper and lower limbs upon awakening; after one year of treatment with valproate (VPA) the patient developed clinical and immuno-haematological signs of SLE. Gradual withdrawal of AED, obtained clinical remission. The possibility that the chromosomal abnormality of the patient was responsible for the three rare complications observed during AED therapy is considered.

Adult↗
PubMed1995

Long-term administration of butoctamide hydrogen succinate on nocturnal sleep of mentally retarded subjects: a polygraphic study versus placebo.

Butoctamide hydrogen succinate (BAHS) has been proved to increase REM sleep in patients with reduced REM sleep. Following previous experiments on the effects of BAHS on nocturnal sleep of mentally retarded (MR) subjects, a polygraphic study was conducted on 20 MR subjects (age 8-14 years) to verify the effects of BAHS, 1) after long-term administration and 2) in different etiologies of MR. Subjects were divided into two balanced groups receiving placebo or 400 mg BAHS before sleep for a 6-month period. Basal sleep did not differ substantially in the two groups, both presenting reduced REM sleep. Low amounts of REM sleep were partially reversed by BAHS administration, which caused a significant increase in the REM sleep stage. Post-treatment sleep modifications found in the experimental group were not observed in the control group. BAHS produced its effects on REM sleep immediately after the first administration of the drug, but they became more apparent after long-term treatment. Our findings indicate that long-term administration of BAHS at low dosage maintains its effects on REM sleep of mentally retarded children, causing modifications similar to those previously obtained with single administration at higher dosages in cats, in healthy young and elderly volunteers and in Down's syndrome children. In addition, our observations demonstrate the effectiveness of BAHS on REM sleep, when utilized in mental retardation of etiologies other than Down's syndrome.

Adolescent↗
PubMed1995

Development of myoclonus in patients with partial epilepsy during treatment with vigabatrin: an electroencephalographic study.

In the context of a study of the effects of gamma-vinyl-GABA (GVG) on seizure occurrence and on EEG abnormalities we present three cases with focal epilepsy in which new clinical and EEG paroxysmal manifestations were observed during GVG therapy. At that time, whereas an amelioration or no change in patients' habitual seizures were observed, myoclonic jerks appeared with related changes in the EEG paroxysmal abnormalities, represented by generalized polyspike and wave complexes. An electroclinical correlation was recorded in one case. These data indicate that, although occurring rarely, it is possible to have epileptic myoclonus during GVG treatment. Mechanisms underlying these manifestations are difficult to explain. Probably a shift in the anti/proconvulsant GABAergic balance towards the latter may compromise the therapeutic effect of GVG.

Adolescent↗
PubMed1995

Sodium valproate and mental processes in newly referred epileptic patients. A computerized EEG study.

Seventeen epileptic patients suffering from generalized idiopathic epilepsy who underwent antiepileptic treatment with sodium valproate (NaVPA) for the first time were studied. The EEG was recorded at rest with eyes closed (EC), during blocking reaction, fixation and mental arithmetic tasks. The computerized EEG study, performed before and after therapy, utilized spectral analysis; data underwent statistical evaluation including ANOVA and correlation analysis. Before NaVPA therapy, a significant decrease of beta 1 and beta 2 relative power, compared with control subjects, was observed in epileptic patients at rest with EC, whereas fast activity increased during mental tasks. After treatment, no significant variations in fast activity were observed during tasks, with a pattern similar to that observed in the control population. Therefore, considering the effect of NaVPA primarily on fast activity, which reflects rather well preserved mental functioning processes, it is possible to hypothesize that the drug interferes positively with mental activities.

Adolescent↗
PubMed1994

Lack of potentiation of anticonvulsant effect by fluoxetine in drug-resistant epilepsy.

To test the hypothesis that fluoxetine may be a useful adjunct to antiepileptic therapy, we treated with fluoxetine (20-40 mg/day) nine patients suffering from medically intractable epilepsy with daily seizures. Five patients remained unchanged and four worsened. Worsening was more evident at 40 mg/day. One patient improved when receiving the lower dose (20 mg/day) and worsened with the higher dose (40 mg/day). These data suggest: (1) that fluoxetine is not effective as add-on antiepileptic treatment; (2) that caution should be exerted when using fluoxetine as an antidepressive treatment in epileptic patients.

Adolescent↗
PubMed1994

Quantitative EEG evaluation in normal elderly subjects during mental processes: age-related changes.

Computerized EEG study was performed on 39 healthy elderly subjects (50-90 years), divided into two cohorts of increasing age (old, older) and on a group of 21 young controls. The EEG was recorded at rest, with eyes closed (EC) and during blocking reaction (BR), fixation (FIX) and mental arithmetic (MA) tasks. At rest with EC, the only significant variation was an increase of beta 1 relative power in old subjects which was positively correlated with age. During the performance of the mental tasks, in the elderly population when compared to young controls, the slow activity decreased slightly or was not significantly modified, while the alpha reactivity progressively decreased, showing a negative correlation with age in the older group. Beta 2 increased significantly in elderly subjects during BR and FIX but such change was less consistent with increasing age. Data show that at rest, the EEG in the elderly population differs only from that of young controls by showing a more pronounced fast activity, while only during mental processes is it possible to evidence changes that can be utilized as physiological "markers" of normal aging.

Adult↗
PubMed1993

Spastic paraplegia, epilepsy, and mental retardation in several members of a family: a novel genetic disorder.

We report on a family in which an association between spastic paraplegia and epilepsy has been observed. This disorder is an autosomal dominant trait with incomplete penetrance and variable expressivity. The onset was limited to the first four decades of life; the symptoms were typically those of progressive weakness and spasticity of lower limbs. Epilepsy was present in members of three of the four generations on whom we have information. The concomitance of spastic paraplegia and epilepsy in several members of the same family is unlikely to be fortuitous and probably represents the pleiotropic effect of a single mutant gene.

Adolescent↗
PubMed1993

Effect of carbamazepine on EEG background activity and on interictal epileptiform abnormalities in focal epilepsy.

The effect of carbamazepine (CBZ) on EEG background activity and on interictal epileptiform abnormalities (IEA) was studied in 15 patients with focal epilepsy who started antiepileptic drug treatment (AED) for the first time. A computerized EEG study, performed before and two months after starting therapy, utilized spectral analysis and automatic recognition of IEA. The occurrence of seizures was considered in order to clarify the relationship between IEA and the seizures themselves. Statistical evaluation of EEG spectral values was calculated through analysis of variance (ANOVA), while for IEA the non parametric Wilcoxon test was utilized. In 13 patients who remained seizure-free during the two month-period of observation, IEA was unchanged or decreased. In one of the two patients who continued to have seizures, IEA significantly increased. During therapy, the background activity presented significant increase of slow activity in approximately half the patients. This increase was more evident in those patients showing active epileptic foci before treatment, rather than in those with rare or no spikes. The changes in IEA seem to be related to the occurrence of seizures rather than to a direct action of CBZ on spikes.

Adolescent↗