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74. Adaptive Deep Brain Stimulation (ADBS) tested clinically in a patient with advanced Parkinson Disease
Society Proceedings / Clinical Neurophysiology 126 (2015) e1–e28
compared to healthy children. In both the second and third blocks, a significant correlation between P300 deficit habituation and SAFA-A (social anxiety subscale) was found. Moreover, the P300 habituation was also correlated with PFS-I (intraggressive anger) in the second block and with the total SAFA-A score in the third block. To our knowledge, this is the first study showing a correlation between abnormal brain excitability, intraggressive anger and anxiety, suggesting a possible role of the latters in producing the migraine phenotype. doi:10.1016/j.clinph.2014.10.089
71. Functional reorganization of brain networks in patients with painful chronic pancreatitis—M. Valeriani, D. Lelic, S.S. Olesen, T.M. Hansen, A.M. Drewes (Aalborg, Denmark, Roma, Italy) To investigate the organization of brain networks involved in nociceptive processing in patients with painful CP. Contact heatevoked potentials (CHEPs) were recorded in 15 CP patients and in 15 healthy volunteers. The upper abdominal area (sharing spinal innervation with the pancreatic gland) was used as a proxy of ‘pancreatic stimulation’, while stimulation of the right forearm was used as a control. The brain source organization of CHEPs components were analysed. After abdominal stimulation, brain source analysis revealed abnormalities in the cingulate/operculo-insular network. A posterior shift of the operculo-insular source (p = 0.004) and an anterior shift of the cingulate source (p < 0.001) were seen in CP patients, along with a decreased strength of the cingulate source (p = 0.01). The operculo-insular shift was positively correlated with the severity of pain (r = 0.61; p = 0.03). CP patients showed abnormal cerebral processing after stimulation of the upper abdominal area. These changes correlated with the severity of pain, probably reflecting maladaptive neuroplastic changes. doi:10.1016/j.clinph.2014.10.090
72. Impaired pain processing in patients with silent myocardial ischemia—C. Vollono, A. Di Franco, G. Lanza, E. Mazzucchi, G. Russo, A. Villano, D. Virdis, C. Pazzaglia, A. Sestito, F. Crea, P.M. Rossini, M. Valeriani (Roma, Italy, Aalborg, Denmark) The aim of the study was to investigate the nociceptive system in patients with silent Myocardial Ischemia (MI) by CO2 laser evoked potential (LEP) recording. We studied 3 groups: (1) 11 asymptomatic, non-diabetic patients with documented obstructive Coronary Artery Disease (CAD) (silent-MI group); (2) 10 patients with obstructive CAD showing the clinical pattern of chronic stable angina (symptomatic-MI group); (3) 14 healthy subjects matched for age and gender to patients (control group). LEPs were recorded from 3 electrodes, placed at Cz, Fz, and T3 according to 10–20 International System, in response to chest as well as right hand skin stimulation. Three sequences of stimuli were applied, separated by 5-min intervals. N2-P2 amplitude during the first sequence of chest stimulation was reduced in silent-MI group compared to other groups (p = 0.03). N2-P2 amplitude decreased across the three sequences of stimuli in symptomatic-MI group and control group, but not in silent-MI group (comparison among groups, p = 0.015). CAD patients with silent-MI show a reduced amplitude of N2–P2 component and inadequate habituation to painful stimuli. These findings are consistent with an abnormal central pain processing in patients with silent-MI that might, at least in part, explain their typical misperception. doi:10.1016/j.clinph.2014.10.091
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73. N-acetyl-cysteine inhibits nociceptive pathway function. A combined animal and human study—S. Piroso, G. Di Stefano, S. La Cesa, A. Biasiotta, E. Pasquale, C. Leone, A. Pepe, G. Cruccu, F. Nicoletti, A. Truini (Roma, Italy) Despite concerted efforts from pharmacologic research into pain, many patients fail to achieve sufficient pain relief with the currently available drug. N-acetyl-cysteine (NAC), an old and safe drug used as a mucolytic agent, enhances the endogenous activation of presynaptic metabotropic glutamate receptors type 2 and inhibits neurotransmitter release, thus possibly negatively modulating nociceptive pathway function. In this study we verified whether 1200 mg of oral NAC inhibits nociceptive pathway function by investigating how this drug modulates pain related responses in animals and humans. We have investigated the NAC-induced changes in tail flick evoked by heat stimulation in 6 mice; then in 10 healthy subjects we measured changes induced by NAC on thermal-pain perceptive thresholds as assessed by quantitative sensory testing and laser evoked potentials, according to a cross over, double-blind placebo-controlled design. In mice, NAC caused a tail flick delay, reverted by a single injection of the mGlu2/3 receptor antagonist (LY341495). In humans, NAC did not change the thermal-pain perceptive thresholds as assessed by quantitative sensory testing (P > 0.08), but reduced the laser pain ratings and the amplitude of laser evoked potentials (P < 0.05). Our data, showing that NAC delays the tail flick response and reduces the laser pain ratings and the amplitude of laser-evoked potentials, indicate that NAC inhibits nociceptive pathway function. These findings suggest that this drug is worthy of being tested in a clinical trial in patients with pain. doi:10.1016/j.clinph.2014.10.092
74. Adaptive Deep Brain Stimulation (ADBS) tested clinically in a patient with advanced Parkinson Disease—M. Arlotti, M. Rosa, L. Rossi, S. Marceglia, F. Cogiamanian, G. Ardolino, M.G. Carrabba, P.M. Rampini, A. Priori (Milano, Italy) Conventional deep brain stimulation DBS (cDBS) could be optimized by adapting the stimulation to the patient’s clinical state marked by a control variable (i.e. adaptive DBS). Local field potentials (LFPs) recorded from DBS electrodes correlate with the patient‘s clinical state and can be a reliable control variable for aDBS. We developed an external portable aDBS device controlled by LFPs and we present its clinical assessment in a freely moving PD patient. The 5th and the 6th day after the DBS electrodes implant in the subthalamic nucleus, the patient, after the standard antiparkinsonian medication, underwent 2 h of cDBS and 2 h of aDBS, respectively. The patient was not aware of the DBS type. The motor state was evaluated by a blinded neurologist through the UPDRS motor scale (part III), and dyskinesia scale (Rush filming protocol). Whereas the UPDRS III score was the same during aDBS and cDBS, the dyskinesias were less severe by 57.59% during aDBS compared to cDBS. The aDBS device controlled better the motor fluctuations than cDBS, reducing dyskinesias. This study represents a proof of aDBS application for PD. doi:10.1016/j.clinph.2014.10.093
75. Automatic detection of dysprosody patterns in patients with idiopathic Parkinson’s disease—A. Bandini, F. Giovannelli, M. Cincotta, P. Vanni, R. Chiaramonti, A. Borgheresi, G. Zaccara, S. Orlandi, C. Manfredi (Firenze, Italy, Bologna, Italy) Dysprosody is characterized by alterations of rhythm and speed of speech and represents one of the most frequent alteration of
compared to healthy children. In both the second and third blocks, a significant correlation between P300 deficit habituation and SAFA-A (social anxiety subscale) was found. Moreover, the P300 habituation was also correlated with PFS-I (intraggressive anger) in the second block and with the total SAFA-A score in the third block. To our knowledge, this is the first study showing a correlation between abnormal brain excitability, intraggressive anger and anxiety, suggesting a possible role of the latters in producing the migraine phenotype. doi:10.1016/j.clinph.2014.10.089
71. Functional reorganization of brain networks in patients with painful chronic pancreatitis—M. Valeriani, D. Lelic, S.S. Olesen, T.M. Hansen, A.M. Drewes (Aalborg, Denmark, Roma, Italy) To investigate the organization of brain networks involved in nociceptive processing in patients with painful CP. Contact heatevoked potentials (CHEPs) were recorded in 15 CP patients and in 15 healthy volunteers. The upper abdominal area (sharing spinal innervation with the pancreatic gland) was used as a proxy of ‘pancreatic stimulation’, while stimulation of the right forearm was used as a control. The brain source organization of CHEPs components were analysed. After abdominal stimulation, brain source analysis revealed abnormalities in the cingulate/operculo-insular network. A posterior shift of the operculo-insular source (p = 0.004) and an anterior shift of the cingulate source (p < 0.001) were seen in CP patients, along with a decreased strength of the cingulate source (p = 0.01). The operculo-insular shift was positively correlated with the severity of pain (r = 0.61; p = 0.03). CP patients showed abnormal cerebral processing after stimulation of the upper abdominal area. These changes correlated with the severity of pain, probably reflecting maladaptive neuroplastic changes. doi:10.1016/j.clinph.2014.10.090
72. Impaired pain processing in patients with silent myocardial ischemia—C. Vollono, A. Di Franco, G. Lanza, E. Mazzucchi, G. Russo, A. Villano, D. Virdis, C. Pazzaglia, A. Sestito, F. Crea, P.M. Rossini, M. Valeriani (Roma, Italy, Aalborg, Denmark) The aim of the study was to investigate the nociceptive system in patients with silent Myocardial Ischemia (MI) by CO2 laser evoked potential (LEP) recording. We studied 3 groups: (1) 11 asymptomatic, non-diabetic patients with documented obstructive Coronary Artery Disease (CAD) (silent-MI group); (2) 10 patients with obstructive CAD showing the clinical pattern of chronic stable angina (symptomatic-MI group); (3) 14 healthy subjects matched for age and gender to patients (control group). LEPs were recorded from 3 electrodes, placed at Cz, Fz, and T3 according to 10–20 International System, in response to chest as well as right hand skin stimulation. Three sequences of stimuli were applied, separated by 5-min intervals. N2-P2 amplitude during the first sequence of chest stimulation was reduced in silent-MI group compared to other groups (p = 0.03). N2-P2 amplitude decreased across the three sequences of stimuli in symptomatic-MI group and control group, but not in silent-MI group (comparison among groups, p = 0.015). CAD patients with silent-MI show a reduced amplitude of N2–P2 component and inadequate habituation to painful stimuli. These findings are consistent with an abnormal central pain processing in patients with silent-MI that might, at least in part, explain their typical misperception. doi:10.1016/j.clinph.2014.10.091
e17
73. N-acetyl-cysteine inhibits nociceptive pathway function. A combined animal and human study—S. Piroso, G. Di Stefano, S. La Cesa, A. Biasiotta, E. Pasquale, C. Leone, A. Pepe, G. Cruccu, F. Nicoletti, A. Truini (Roma, Italy) Despite concerted efforts from pharmacologic research into pain, many patients fail to achieve sufficient pain relief with the currently available drug. N-acetyl-cysteine (NAC), an old and safe drug used as a mucolytic agent, enhances the endogenous activation of presynaptic metabotropic glutamate receptors type 2 and inhibits neurotransmitter release, thus possibly negatively modulating nociceptive pathway function. In this study we verified whether 1200 mg of oral NAC inhibits nociceptive pathway function by investigating how this drug modulates pain related responses in animals and humans. We have investigated the NAC-induced changes in tail flick evoked by heat stimulation in 6 mice; then in 10 healthy subjects we measured changes induced by NAC on thermal-pain perceptive thresholds as assessed by quantitative sensory testing and laser evoked potentials, according to a cross over, double-blind placebo-controlled design. In mice, NAC caused a tail flick delay, reverted by a single injection of the mGlu2/3 receptor antagonist (LY341495). In humans, NAC did not change the thermal-pain perceptive thresholds as assessed by quantitative sensory testing (P > 0.08), but reduced the laser pain ratings and the amplitude of laser evoked potentials (P < 0.05). Our data, showing that NAC delays the tail flick response and reduces the laser pain ratings and the amplitude of laser-evoked potentials, indicate that NAC inhibits nociceptive pathway function. These findings suggest that this drug is worthy of being tested in a clinical trial in patients with pain. doi:10.1016/j.clinph.2014.10.092
74. Adaptive Deep Brain Stimulation (ADBS) tested clinically in a patient with advanced Parkinson Disease—M. Arlotti, M. Rosa, L. Rossi, S. Marceglia, F. Cogiamanian, G. Ardolino, M.G. Carrabba, P.M. Rampini, A. Priori (Milano, Italy) Conventional deep brain stimulation DBS (cDBS) could be optimized by adapting the stimulation to the patient’s clinical state marked by a control variable (i.e. adaptive DBS). Local field potentials (LFPs) recorded from DBS electrodes correlate with the patient‘s clinical state and can be a reliable control variable for aDBS. We developed an external portable aDBS device controlled by LFPs and we present its clinical assessment in a freely moving PD patient. The 5th and the 6th day after the DBS electrodes implant in the subthalamic nucleus, the patient, after the standard antiparkinsonian medication, underwent 2 h of cDBS and 2 h of aDBS, respectively. The patient was not aware of the DBS type. The motor state was evaluated by a blinded neurologist through the UPDRS motor scale (part III), and dyskinesia scale (Rush filming protocol). Whereas the UPDRS III score was the same during aDBS and cDBS, the dyskinesias were less severe by 57.59% during aDBS compared to cDBS. The aDBS device controlled better the motor fluctuations than cDBS, reducing dyskinesias. This study represents a proof of aDBS application for PD. doi:10.1016/j.clinph.2014.10.093
75. Automatic detection of dysprosody patterns in patients with idiopathic Parkinson’s disease—A. Bandini, F. Giovannelli, M. Cincotta, P. Vanni, R. Chiaramonti, A. Borgheresi, G. Zaccara, S. Orlandi, C. Manfredi (Firenze, Italy, Bologna, Italy) Dysprosody is characterized by alterations of rhythm and speed of speech and represents one of the most frequent alteration of