Marina Saladini - Academia.edu (original) (raw)

Papers by Marina Saladini

Journal of Neurosurgery, 2014

Epilepsy Behav, 2011

Disulfiram and γ-hydroxybutyric acid (GHB) are used to treat alcohol dependence and may both incr... more Disulfiram and γ-hydroxybutyric acid (GHB) are used to treat alcohol dependence and may both increase dopamine brain levels and modulate GABAergic transmission. We describe a patient affected by bipolar disorder (on valproate as mood-stabilizing treatment) and alcohol dependence who developed a disulfiram-induced hypomanic episode and in whom the switch from disulfiram to GHB induced recurrent convulsive seizures, not responsive to treatment with diazepam, and psychosis. Seizures and psychiatric symptoms ceased after GHB discontinuation. We outline the deregulation of the neurotransmitter systems (GABAergic and dopaminergic networks) that are involved in these drug–drug interactions and that might be responsible for both psychosis and generalized tonic–clonic seizures resistant to standard treatments.

Epilepsy & Behavior Case Reports, 2013

In ictal psychosis with complex visual hallucinations (VHs), widespread functional changes of cor... more In ictal psychosis with complex visual hallucinations (VHs), widespread functional changes of cortical networks have been suggested. We describe the clinical and EEG findings of a patient with bipolar disorder who manifested complex VHs associated with intense emotional symptoms caused by frontal epileptic seizures. This description highlights the challenges of diagnosing the epileptic nature of new psychotic phenomena in patients with previous psychiatric disorders and shines light into the role of the frontal cortex in the genesis of complex VHs.

European Neuropsychopharmacology, 2015

Recent animal studies demonstrate that compulsive cocaine seeking strongly reduces prelimbic fron... more Recent animal studies demonstrate that compulsive cocaine seeking strongly reduces prelimbic frontal cortex activity, while optogenetic stimulation of this brain area significantly inhibits compulsive cocaine seeking, providing a strong rationale for applying brain stimulation to reduce cocaine consumption. Thus, we employed repetitive transcranial magnetic stimulation (rTMS), to test if dorsolateral prefrontal cortex (DLPFC) stimulation might prevent cocaine use in humans. Thirty-two cocaine-addicted patients were randomly assigned to either the experimental group (rTMS) on the left DLPFC, or to a control group (pharmacological agents) during a 29-day study (Stage 1). This was followed by a 63-day follow-up (Stage 2), during which all participants were offered rTMS treatment. Amongst the patients who completed Stage 1, 16 were in the rTMS group (100%) and 13 in the control group (81%). No significant adverse events were noted. During Stage 1, there were a significantly higher number of cocaine-free urine drug tests in the rTMS group compared to control (p=0.004). Craving for cocaine was also significantly lower in the rTMS group compared to the controls (p=0.038). Out of 13 patients who completed Stage 1 in the control group, 10 patients received rTMS treatment during Stage 2 and showed significant improvement with favorable outcomes becoming comparable to those of the rTMS group. The present preliminary findings support the safety of rTMS in cocaine-addicted patients, and suggest its potential therapeutic role for rTMS-driven PFC stimulation in reducing cocaine use, providing a strong rationale for developing larger placebo-controlled studies. Trial name: Repetitive transcranial magnetic stimulation (rTMS) in cocaine abusers, URL:〈http://www.isrctn.com/ISRCTN15823943?q=&amp;amp;filters=&amp;amp;sort=&amp;amp;offset=8&amp;amp;totalResults=13530&amp;amp;page=1&amp;amp;pageSize=10&amp;amp;searchType=basic-search〉, ISRCTN15823943.

Annals of Vascular Surgery, 1997

The purposes of this study are to (1) demonstrate the association of elongations of the internal ... more The purposes of this study are to (1) demonstrate the association of elongations of the internal carotid artery (ICA), that is, kinking, coiling, tortuousity, and angulation, and the neurologic symptoms with high stroke risk; (2) compare the results of the surgical treatment versus the medical treatment alone; (3) contribute to the knowledge of the natural history of these anatomical particularities. From January 1992 to December 1994, 113 patients with ICA kinking, coiling, tortuousity, and angulation were randomized either to surgery (group I, n = 55) or not (group II, n = 58). Patients, who presented a carotid hemodynamically significant lesion (>60%) at the origin and associated distal elongation were excluded. The groups were comparable with regard to sex, age, risk factors for atherosclerosis, associated diseases, symptoms and anatomic feature of the contralateral ICA. Follow-up was obtained in all patients: it consisted of clinical evaluation and Duplex scan control at 3-month intervals during the follow-up period (6-36 months; average, 23). Histologic specimens were obtained in all surgically treated arteries. Early results were excellent: in group I, no patient died, no patient presented major or minor stroke. Only one patient had an immediate transient ischemic attack (TIA) which spontaneously recovered within 24 hours. All symptomatic patients examined the complete disappearance of clinical signs. There were no late deaths due to stroke and no late major or minor neurologic deficit occurred. All reconstructed ICAs were patent. In group II, three patients experienced a major stroke with hemiplegia due to ICA occlusion. Most of the symptomatic patients (37) of group II remained stable, while seven of them had worsening of symptoms and were referred for surgery. To conclude, all surgically treated patients had the complete relief of preoperative neurologic symptoms; none of the medically treated patients had an improvement. Although there was no statistically significant difference between the two groups with regard to stroke risk, three medically treated patients progressed to total occlusion. This suggests that kinking, coiling, tortuousity, and angulations of the ICA are not merely an anatomic curiosity but a potentially disabling, even fatal condition.

Acta Neurochirurgica, 2015

Parietal areas play a crucial role in calculation processing. The purpose of this study is to rep... more Parietal areas play a crucial role in calculation processing. The purpose of this study is to report our experience in the assessment of calculation processing during awake surgery in parietal areas, focusing on clinical implications and new insights provided by this approach. We retrospectively reviewed clinical and surgical data of 13 patients who underwent parietal surgery with calculation mapping. Cortical and sub-cortical areas (in 13 and five patients, respectively) involved in single-digit multiplications and additions were identified using bipolar electro-stimulation. Cortical stimulation data showed that the inferior parietal lobule and the intraparietal sulcus were specifically related to calculation in all cases, regardless of the side (100 % of cases, in both sides). Conversely, the superior parietal lobule was inconstantly involved in calculation processing (40 % of cases in the left and 75 % in the right side), whereas the somatosensory area was never involved. Sub-cortical stimulation was able to detect functional areas for calculation in all patients: in 90 % of cases the sub-cortical sites positive for calculation were in close anatomical connection with the cortical sites mapping for the same function. The intraoperative preservation (-or damaging-) of functional sites correlated with the absence (- or occurrence-) of post-operative calculation processing impairment. Our findings support the specificity of the reported technique in the intraoperative identification of sites functional for calculation. Our data show the bilateral involvement of parietal cortex, especially of the inferior lobule, in calculation processing. Furthermore, our study suggests the existence of a sub-cortical pathway specific for calculation, whose better understanding might be crucial for the clinical outcome of patients.

Annales de Chirurgie Vasculaire, 2010

ABSTRACT Introduction L’endartériectomie carotidienne (CEA) est associé à un risque d’ischémie cé... more ABSTRACT Introduction L’endartériectomie carotidienne (CEA) est associé à un risque d’ischémie cérébrale pendant le clampage carotidien, dont découlent diverses stratégies de protection cérébrale, comprenant une prise en charge pharmacologique et la pose d’un shunt systématique ou sélective. Cette étude avait pour but d’analyser les résultats de la CEA avec une surveillance électroencephalographique (EEG) peropératoire afin d’identifier les facteurs liés aux modifications de l’EEG compatibles avec une ischémie cérébrale nécessitant la pose d’un shunt. Méthodes Une base de données remplie de façon prospective automatisée de toutes les CEAs réalisées dans notre établissement avec une surveillance EEG pour des lésions carotidiennes sévères symptomatiques ou asymptomatiques entre janvier 1990 et juin 2009 a été analysée. Résultats Au total, 1914 procédures de CEA ont été réalisées chez 1696 patients, dont 218 ont eu une CEA bilatérale. Les modifications EEG ont été enregistrées chez 392 patients (20,5%), mais un shunt a été posé au cours de 312 procédures de CEA (16,3%). L’analyse multivariée a montré que le caractère symptomatique (Odds ratio [OR], 1,37 ; intervalles de confiance à 95% [IC], 1,07-1,76 ; p = 0,012), un antécédent d’accident vasculaire cérébral (OR, 2,28 ; IC de 95%, 1,66-3,13 ; p < 0,001), une occlusion carotidienne controlatérale (OR, 2,14 ; IC de 95%, 1,18-3,91 ; p = 0,019), et une sténose carotidienne homolatérale modérée (<80%) (OR, 1,95 ; IC de 95%, 1,08-3,52 ; p = 0,033) étaient des facteurs prédictifs de pose de shunt. Conclusions L’EEG a été un excellent détecteur d’ischémie cérébrale et un outil valable pour indiquer la pose de shunts. Les patients qui étaient symptomatiques ou qui avaient un antécédent d’accident vasculaire cérébral, une occlusion carotidienne controlatérale, ou une sténose carotidienne modérée homolatérale étaient plus enclins à des modifications EEG compatibles avec une ischémie cérébrale. Les chirurgiens devraient considérer les modifications EEG au cours du clampage comme un critère efficace pour la pose sélective de shunt.

Annals of Vascular Surgery, 1999

The aim of this retrospective study was to determine whether age per se constitutes a contraindic... more The aim of this retrospective study was to determine whether age per se constitutes a contraindication to surgery in the elderly patient undergoing carotid endarterectomy (CEA) with regard to operative mortality and stroke risk morbidity. During an 8-year period, 96 patients aged 75 years or more underwent 103 CEAs. The age range was 75 to 89 years, with a median age of 79 and a mean age of 79.4 years. Fifty-nine CEAs with patch closure and 44 carotid eversion endarterectomies and reimplantation were performed for symptomatic (70.9%) and asymptomatic (29.1%) carotid lesions under general anesthesia and with continuous perioperative electroencephalographic (EEG) monitoring. In light of the efficacy and success achieved in this experience, advanced age does not seem in itself to contraindicate the performance of CEA; the surgical risk for elderly patients appears sufficiently low to justify the operation. A more aggressive approach may be warranted in elderly patients because of the morbidity and cost of the disease that it effectively prevents.

Annals of Vascular Surgery, 2010

Surgery, 1999

The aim of this study was to determine whether clinical evaluation and duplex ultrasonography (DU... more The aim of this study was to determine whether clinical evaluation and duplex ultrasonography (DUS) alone can replace contrast cerebral arteriography (CA) for the detection of patients suitable for surgery at our institution. During an 18-month period, 100 patients underwent DUS and CA during evaluation for carotid endarterectomy (CEA). All patients were studied prospectively; in each case an initial decision for or against CEA on the basis of DUS evaluation of the internal carotid arteries (ICAs) was subsequently compared with the surgeon's final management plan after CA. Of the 200 ICAs evaluated, 113 were considered for CEA but 14 were excluded from the study because the patient could not be evaluated before and after CA. This left 99 ICAs (86 patients) available for comparative analysis. The outcome of the 2 diagnostic modalities was perfectly consistent in 95.3% of the ICAs (kappa = 0.969). The clinical management decision was altered by the CA findings in only 2 cases (2%). Of the 99 ICAs considered suitable, 97 underwent CEA. No arteriographic complications occurred among the 100 patients undergoing CA. The perioperative stroke risk and mortality rates were 0%. Ninety-eight percent of the ICAs considered for surgery would have received appropriate clinical treatment on the strength of the patients' neurologic history and the outcome of DUS alone. Our results indicate that DUS is sufficient to establish the need for surgery in symptomatic and asymptomatic patients being considered for CEA and can replace CA in most clinical circumstances.

Surgery, 2002

Although many retrospective and a few prospective studies have analyzed the outcome of early and ... more Although many retrospective and a few prospective studies have analyzed the outcome of early and delayed carotid endarterectomy (CEA) after a recent minor or nondisabling stroke (ie, a minimal and stabilized focal neurologic deficit of acute onset persisting for more than 24 hours and not leading to a handicap or to a significant impairment of daily living activities), the optimal timing of surgery remains uncertain. The purpose of this study was to prospectively compare the perioperative death and stroke rates of CEA performed within 30 days (early group) or more than 30 days (delayed group) after a nondisabling ischemic stroke in patients with carotid bifurcation disease. During a 4-year period, of 86 patients experiencing a minor stroke, 45 were randomized to undergo early CEA and 41 to undergo delayed CEA. All patients underwent preoperative cerebral computed tomography, duplex ultrasonographic scanning and angiography of the supra-aortic trunks. All CEAs were carotid eversion endarterectomies and were performed by the same surgeon, using deep general anesthesia, with continuous electroencephalographic monitoring for the selective shunting. The perioperative death and stroke rates were compared between the 2 groups. No perioperative deaths occurred in either group. No recurrent strokes occurred during the waiting period in the delayed group. The incidence of perioperative stroke was comparable in the 2 groups (1 of 45, 2% vs 1 of 41, 2%). The mean follow-up was 23 months (range, 6 to 50 months). Survival rates after 1, 2, and 3 years were similar in the 2 groups. Early CEA after a nondisabling ischemic stroke can be performed safely with perioperative mortality and stroke rates comparable with those of delayed CEA. The timing of surgery does not seem to influence the benefit of the CEA.

Journal of Vascular Surgery, 2012

Although the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in selected s... more Although the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in selected symptomatic and asymptomatic patients has been well documented, the higher incidence of adverse events after CEA for women than for men remains controversial. The purpose of this study was to analyze the effect of female gender on perioperative (30-day) and long-term outcomes after eversion CEA (eCEA). Patients entered into a prospectively compiled computerized database of all primary consecutive eCEAs performed at our institution from September 1998 to December 2009 were analyzed. Endpoints were perioperative death and stroke, late carotid restenosis or occlusion, and long-term freedom from stroke and survival rates. Long-term follow-up was obtained in 96.8% of patients (97.5% of the women). Among 1294 patients who underwent 1458 eCEAs under general anesthesia with continuous electroencephalographic monitoring and selective shunting, 409 (31.6%) were women (466 eCEAs). More women than men were over 80 years old (P = .001), and female patients were more likely to have arterial hypertension (P = .02) or hyperlipidemia (P = .006) than male patients. Preoperative statin medication (P = .01), contralateral carotid occlusion (P = .02), and shunting use (P = .03) were more frequent among female patients. No perioperative deaths occurred in the series as a whole, while the perioperative stroke risk (0.6% vs 0.5%), and the combined late carotid restenosis and occlusion rate (1.1% vs 0.4%) were comparable between female and male patients. The 7-year stroke-free survival and overall survival rates did not differ significantly between female and male patients (98.3% vs 98.8% and 87.2% vs 93.8%, respectively). This single-center university hospital study shows that although women have a different cardiovascular risk profile from men when they undergo eCEA, there is no evidence of a different gender effect on perioperative and long-term outcomes.

Journal of Vascular Surgery, 2008

Journal of Vascular Surgery, 2009