Tommaso Caraceni - Academia.edu (original) (raw)

Papers by Tommaso Caraceni

Advances in neurology, 1996

Journal of neural transmission. Supplementum, 1986

Some aspects of the problems of long-term L-dopa treatment syndrome are reviewed, with special at... more Some aspects of the problems of long-term L-dopa treatment syndrome are reviewed, with special attention to the changes in response to treatment with dopaminergic agents, specifically end-of-dose deterioration, the on-off phenomenon and hyperkinesia. The various hypotheses for interpreting these are presented, with particular stress on changes in the function of DA-ergic receptors. It is concluded that the on-off phenomenon is probably related to changes in plasma L-dopa levels and to decreased stores of intraneural dopamine.

Surgical Neurology, 2001

BACKGROUND Bilateral high frequency subthalamic stimulation has been reported to be effective in ... more BACKGROUND Bilateral high frequency subthalamic stimulation has been reported to be effective in the treatment of Parkinson's disease and levodopa-induced dyskinesias. To analyze the results of this surgical procedure we critically reviewed 17 parkinsonian patients with advanced disease complicated by motor fluctuations and dyskinesias. METHODS Between January 1998 and June 1999 these 17 consecutive patients (age 48-68 years; illness duration 8-27 years) underwent bilateral stereotactically guided implantation of electrodes into the subthalamic nucleus in the Department of Neurosurgery of the Istituto Nazionale Neurologico "C. Besta." Parameters used for continuous high-frequency stimulation were: frequency 160 Hz, pulse width 90 sec, mean amplitude 2.05 Ϯ 0.45 V. Parts II and III of the UPDRS were used to assess motor performance before and after operation by the neurologic team. The follow-up ranged between 6 and 18 months. RESULTS At latest examination, mean UPDRS II and III scores had improved by 30% (on stimulation, off therapy) with mean 50% reduction in daily off time. Peak dyskinesias and early morning dystonias also improved in relation to therapy reduction. Side effects were persistent postoperative supranuclear oculomotor palsy and postural instability in one case, worsened off-medication hypophonia in three, and temporary nocturnal confusion episodes in three. Postoperative MRI revealed a clinically silent intracerebral haematoma in one case. One electrode required repositioning. CONCLUSIONS Continuous high frequency STN stimulation is an effective treatment for advanced PD. A functionally useful and safe electrode placement can be performed without microrecording.

Psychopharmacology, 1979

In eight subjects with Parkinson's disease under an optimal daily dose of L-dopa, acute administr... more In eight subjects with Parkinson's disease under an optimal daily dose of L-dopa, acute administration of MIF-I (200 mg i.v.) did not ameliorate either the total disability score or the intellectual test PM 38 when evaluated in comparison with the effect induced by acute administration of a placebo. Also concomitant evaluation of the effect of MIF-I on the secretion of anterior pituitary hormones which are under dopaminergic control i.e., growth hormone and prolactin, did not reveal any potentiation of the L-dopa-induced stimulus.

Neurology, 1986

BACKGROUND AND PURPOSE: Incomplete occlusion and recanalization of large and wide-neck brain aneu... more BACKGROUND AND PURPOSE: Incomplete occlusion and recanalization of large and wide-neck brain aneurysms treated by endovascular therapy remains a challenge. We present preliminary clinical and angiographic results of an experimentally optimized Surpass flow diverter for treatment of intracranial aneurysms in a prospective, multicenter, nonrandomized, single-arm study. MATERIALS AND METHODS: At 24 centers, 165 patients with 190 intracranial aneurysms of the anterior and posterior circulations were enrolled. The primary efficacy end point was the percentage of intracranial aneurysms with 100% occlusion on 6-month DSA. The primary safety end point was neurologic death and any stroke through a minimum follow-up of 6 months. RESULTS: Successful flow-diverter delivery was achieved in 161 patients with 186 aneurysms (98%); the mean number of devices used per aneurysm was 1.05. Clinical follow-up (median, 6 months) of 150 patients (93.2%), showed that the primary safety end point occurred in 18 subjects. Permanent neurologic morbidity and mortality were 6% and 2.7%, respectively. Morbidity occurred in 4% and 7.4% of patients treated for aneurysms of the anterior and posterior circulation, respectively. Neurologic death during follow-up was observed in 1.6% and 7.4% of patients with treated intracranial aneurysms of the anterior and posterior circulation, respectively. Ischemic stroke at Յ30 days, SAH at Յ7 days, and intraparenchymal hemorrhage at Յ7 days were encountered in 3.7%, 2.5%, and 2.5% of subjects, respectively. No disabling ischemic strokes at Ͼ30 days or SAH at Ͼ7 days occurred. New or worsening cranial nerve deficit was observed in 2.7%. Follow-up angiography available in 158 (86.8%) intracranial aneurysms showed 100% occlusion in 75%. CONCLUSIONS: Clinical outcomes of the Surpass flow diverter in the treatment of intracranial aneurysms show a safety profile that is comparable with that of stent-assisted coil embolization. Angiographic results showed a high rate of intracranial aneurysm occlusion. ABBREVIATIONS: EVT ϭ endovascular treatment; FD ϭ flow diverter; PUFS ϭ Pipeline Embolization Device for Uncoilable or Failed Aneurysms P revious in vivo and in vitro hemodynamic experimental studies showed that optimization is required to balance the porosity (metal-free/metal area) and pore or mesh density (number of pores/mm 2) of flow diverters (FDs) to optimize the effect on flow reduction within the aneurysm sac while keeping the side branches (perforators) patent. 1-6 We evaluated, in a multicenter, prospective, nonrandomized study, our hypothesis that a single optimized FD would suffice to obliterate a variety of aneurysms located in the anterior and posterior circulation without occluding perforators. MATERIALS AND METHODS Patients and Study Design Patients with intracranial aneurysms undergoing attempted endovascular treatment (EVT) with the FD (Surpass FD; Stryker

Neurology, 1995

Oral levodopa substitution continues to be the most effective and best tolerated type of drug tre... more Oral levodopa substitution continues to be the most effective and best tolerated type of drug treatment for early Parkinson's disease (PD), but inevitably it leads to failure as a result of the development of drug-induced dyskinesias, motor response oscillations, psychiatric complications and the progressive emergence of poorly responsive gait and balance problems. Dopamine agonists were originally introduced to overcome some of these levodopa problems in PD by bypassing the degenerating nigrostriatal dopaminergic neurons that were believed to mediate levodopa's clinical effects through enzymatic conversion into dopamine. This approach has been partially successful: add-on therapy with dopamine agonists in …

Neurology, 1991

The aim of this study is to evaluate what factors influence the risk of occurrence of motor fluct... more The aim of this study is to evaluate what factors influence the risk of occurrence of motor fluctuations in patients with Parkinson's disease (PD) with particular reference to the role of early or delayed introduction of levodopa therapy during the course of the disease. One hundred twenty-five consecutive newly diagnosed patients with PD started levodopa treatment at the time diagnosis and were followed for 2 to 10 years. During follow-up, 60 patients had wearing-off or early morning akinesia. We estimated the cumulative time-dependent risk of motor fluctuation occurrence through a multivariable analysis. The risk was lower for patients with tremor-predominant PD, for those with shorter disease duration prior to levodopa, and for those who were relatively older at levodopa initiation. Our results suggest that, as far as motor fluctuations are concerned, disease prognosis is not influenced by early levodopa treatment. These observation support the introduction of levodopa as soon as there is a subjective need for the patients to maintain their level of social and work performance.

The Italian Journal of Neurological Sciences, 1997

Oxidative damage by free radicals may contribute to the etiology of Parkinson's disease (PD), and... more Oxidative damage by free radicals may contribute to the etiology of Parkinson's disease (PD), and increased oxidative stress in the nigral cells of PD patients may occur fotlowing L-dopa treatment, prompting suggestions that Ldopa therapy should be delayed as long as possible. Bilirubin is a potent antioxidant in vitro, even when bound to albumin, suggesting a physiological role as an antioxidant. Calculations indicate that bilirubin can pass the bloodbrain barrier in sufficient quantity to exert a significant antioxidant effect in the brain. We have found a highly significant (about 20%) increase in plasma bilirubin in 162 PD patients on chronic L-dopa treatment compared to 93 untreated parkinsonians and 224 non-parkinsonian controls. We propose that L-dopa-induced increase in nigral oxidative stress in PD may be effectively counteracted by increased bilirubin levels. The mechanism by which plasma bilirubin is increased in patients receiving L-dopa is at present unknown.

Journal of Neurology, Neurosurgery & Psychiatry, 1986

Twenty-one Parkinsonian patients were tested in on and off phases during chronic levodopa therapy... more Twenty-one Parkinsonian patients were tested in on and off phases during chronic levodopa therapy for cognitive function, affective status, and evaluation of motor performance with reaction and movement times. A worsening of mood was observed from the on to the off phase. No variation in cognitive performance was observed from the on to the off phase in spite of evident motor changes. Mood changes during on-offvariations may reflect involvement of mesocortical and mesolimbic dopaminergic systems.

Journal of Neurology, 1996

The various clinical features of multiple system atrophy (MSA) make the diagnosis of the disease ... more The various clinical features of multiple system atrophy (MSA) make the diagnosis of the disease difficult, especially in its early stages, when signs of differentiated neuroanatomical system involvement have not yet appeared. Mortality studies may be affected by the variability of the diagnostic criteria and selection bias. We used strict clinical and MRI criteria to diagnose MSA in 59 patients. Patients with parkinsonian and cerebellar onset were compared. Median survival time from the onset of the first motor symptom was 7.5 years. Our results indicated a trend (P = 0.09) for the Northwestern University Disability Scale score to correlate with mortality, but we failed to find other characteristics identifying subgroups or predictors for survival.

The Journal of Clinical Endocrinology & Metabolism, 1977

Seven patients affected by Huntington's chorea were given an acute administration of 2-Br... more Seven patients affected by Huntington's chorea were given an acute administration of 2-Br-alpha-ergocryptine (CB 154, Sandoz), a direct agonist at dopamine receptor sites. Seven nonobese hospitalized patients were used as controls. Oral administration of CB 154 (2.5 mg) induced a more prompt and consistent rise in plasma growth hormone (GH) levels in patients than in controls. GH levels rose from baseline values of 0.3+/-0.1 ng/ml to mean peak values of 20.4+/-5.1 ng/ml (120-270 min) in choreic subjects and from baseline values of 1.0+/-0.4 ng/ml to mean peak values of 5.7+/-1.6 ng/ml (180-300 min) in control subjects (P less than 0.02). Baseline plasma prolactin (PRL) values were significantly higher in choreic than in control subjects (22.1+/-6.6 ng/ml vs. 8.1+/-1.4 ng/ml, respectively, P less than 0.02); administration of CB 154 induced a more consistent PRL decrease in control than in choreic subjects. Collectively, these results suggest the existence of an abnormal regulation of GH and PRL secretion in Huntington's chorea, probably due to alterations in central dopaminergic neurotransmission.

European Neurology, 1976

The trigemino-facial reflex was studied in 7 patients affected by Huntington's chorea and... more The trigemino-facial reflex was studied in 7 patients affected by Huntington's chorea and in 10 patients affected by Parkinson's disease. The results show a different behavior of the habituation phenomenon in the two groups of patients: it is enhanced in the choreic and abolished in the parkinsonian patients. The main changes concern the time course of the second phase (the first inhibitory phase) of the reflex excitability cycle, in fact, the inhibitory phase appears very pronounced and prolonged in huntingtonian patients and reduced or abolished in parkinsonian patients. Some pathophysiological mechanisms involved in the control of the trigeminofacial reflex excitability are discussed with particular regard to the role of the hemispheric structures.

European Neurology, 1977

Dipropylacetic acid (DPA), γ-aminobutyric aicd (GABA), physostigmine, CB 154 and butyrophenones w... more Dipropylacetic acid (DPA), γ-aminobutyric aicd (GABA), physostigmine, CB 154 and butyrophenones were administered to 26 patients affected by Huntington’s chorea. The evaluation of the pharmacologic activity of the different drugs was determined by means of some clinical parameters and motor performance tests. Butyrophenones succeeded to ameliorate the hyperkinesias and the motor dexterity, CB 154 provoked a worsening of the motor

European Neurology, 1999

The incidence of sporadic chorea among general hospital admissions is unknown, and the relation o... more The incidence of sporadic chorea among general hospital admissions is unknown, and the relation of clinical manifestations and etiological factors to neuroimaging findings has been little investigated in this condition. We reviewed the 7,829 cases admitted to the neurology departments of two general hospitals over 3.25 years and identified 23 (8 male and 15 female) cases of apparently sporadic chorea. Analysis of the records of these patients permitted etiological classification as follows: drug-induced chorea (5 patients), vascular chorea (6 patients), chorea-vasculitis (1 patient), Sydenham’s chorea (1 patient), AIDS-related chorea (5 patients) and in 4 patients neither etiological factors nor neuroradiological alterations were found. Finally in 1 patient, the genetic test for Huntington’s disease was positive. Thirteen patients had pathological neuroimaging findings; however, in only 3 were basal ganglia lesions considered to be the cause of the chorea. We conclude that sporadic ...

Acta Endocrinologica, 1983

Plasma TSH and Prl responses to iv TRH (200 \ g=m\ g) were studied in 21 euthyroid patients with ... more Plasma TSH and Prl responses to iv TRH (200 \ g=m\ g) were studied in 21 euthyroid patients with streak gonad syndrome which is characterised by high levels of FSH and LH and low level of oestrogen and in 9 healthy women. The syndrome is associated with a variety of chromosome complements. Basal TSH and Prl responses to TRH were normal in patients with streak gonads irrespective of their chromosomal complements. Peak levels of both the TSH and Prl occurred at 15\p=n-\30min following TRH. The data might suggest that in hypergonadotrophic oestrogen deficiency neither the TSH nor the Prl response to TRH are attenuated. It does not seem that the associated chromosome anomalies alter the TSH and Prl responses to TRH in euthyroid affected patients.

Archives of Neurology, 1996

We read with interest the article on multiple system atrophy (MSA) by Colosimo et al 1 that appea... more We read with interest the article on multiple system atrophy (MSA) by Colosimo et al 1 that appeared in the March 1995 issue of theArchivesand completely agree with them about the clinical criteria used for the diagnosis of possible or probable MSA. However, we believe that the contribution offered by magnetic resonance imaging (MRI) cannot now be disregarded. The studies we made at the Istituto Nazionale Neurologico "C. Besta," Milan, Italy, on the neuroradiologic aspects of MSA 2-4 and on the correlations between the clinical presentation and the findings from an MRI in a large series of patients with MSA, including the varieties of striatonigral degeneration and olivopontocerebellar atrophy, 5,6 clearly demonstrate the great value of MRI in the diagnosis of MSA. In striatonigral degeneration, low-signal intensity in T 2 -weighted images at high-field intensity MRI (1.5 T) can be demonstrated in the putamen, principally in the posterolateral