Andrea Santamato | Università degli Studi di Foggia (original) (raw)

Papers by Andrea Santamato

Neurobiology of Aging, 2009

At present, there is clearly no full consensus in epidemiological studies regarding the role and ... more At present, there is clearly no full consensus in epidemiological studies regarding the role and timing of plasma/serum total cholesterol (TC) levels in cognitive decline, i.e. agerelated cognitive decline (ARCD), mild cognitive impairment (MCI), or dementia of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia, VaD). Recent data from observational studies suggesting that therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may delay the onset of AD by a variety of proposed mechanisms, such as suppression of ␤-amyloid (A␤) metabolism, vascular effects, and anti-inflammatory effects. Statins are the first-line treatment option for hypercholesterolemia, and observational studies have suggested that the risk of AD is reduced in patients who receive statin therapy in midlife . van der Kommer et al. (2007) in the Longitudinal Aging Study Amsterdam (LASA), a population-based study on 1181 individuals ≥65 years, showed that a higher TC level at the age of 65 years and older was an independent predictor of a relatively better level of general cognitive and general cognitive performance, and a relatively higher level of information processing speed over a 6-year period. Only in the apolipoprotein E (APOE) 4 carrier group, a higher level of TC was an inde- * Corresponding author. (F. Panza). pendent predictor of a slower rate of decline on information processing speed (van der Kommer et al., 2007).

Neuroscience Letters, 2008

Catalase (CAT) −262 C/T promoter (rs1001179), cathepsin D (CTSD) exon 2 (rs17571), and apolipopro... more Catalase (CAT) −262 C/T promoter (rs1001179), cathepsin D (CTSD) exon 2 (rs17571), and apolipoprotein E (APOE) gene polymorphisms were studied in 242 patients with sporadic Alzheimer's disease (AD) and 421 unrelated age-, sex-, and ethnically matched control subjects from Apulia (Southern Italy). No statistically significant differences in CAT rs1001179 and CTSD rs17571 genotype and allele distribution between AD cases and

Orthopedics, 2009

Painful adductor muscle contracture is an important cause of failure during rehabilitation follow... more Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.

Physical Therapy, 2009

resulting from the entrapment of anatomical structures between the anteroinferior corner of the a... more resulting from the entrapment of anatomical structures between the anteroinferior corner of the acromion and the greater tuberosity of the humerus.

European journal of physical and rehabilitation medicine, 2014

Spasticity is a common disabling symptom of several neurological conditions including stroke. Bot... more Spasticity is a common disabling symptom of several neurological conditions including stroke. Botulinum toxin type A (BTX-A) injection represents the gold standard therapy for focal spasticity. Post-stroke management of patients receiving BTX-A therapy has been variously investigated, but general agreement on how and when to implement rehabilitation is lacking. To perform a national survey of experts on the most appropriate rehabilitation procedures after BTX-A therapy for the focal treatment of spasticity. The study employed the Delphi technique through the COSMO project (Consensus on Post-Injection Management in Post-stroke Spasticity). Italian neurologists and physiatrists with experience in BTX-A therapy were selected to participate in the survey. Their anonymous opinions on key issues in treatment strategies in post-stroke spasticity were collected in three sequential rounds facilitated by a web platform. Consensus on a given issue was defined as agreed opinion by at least 66% ...

NeuroRehabilitation, 2014

Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin t... more Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed. High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection. Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects - 16 subjects with BI and 6 with CP - were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not ...

European journal of physical and rehabilitation medicine, 2013

In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has be... more In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity. To assess the safety and evaluate the effects of BTX-A NT 201 free from complexing proteins for the treatment of post-stroke lower limb spasticity evaluating spasticity grade, passive ankle dorsi-flexion motion, and muscle's spasms, as well as its efficacy and rate of satisfaction for patients and for the physicians. Prospective open-label study. Patients (71) with post-stroke lower limb spasticity at least 5 months by the event. Intramuscular injections of BTX-A NT 201 in soleus, medial, and lateral gastrocnemius with a maximum total dose of 180 U. Each patients was assessed at baseline, 30, and 90 days after treatment using Modified Ashworth Scale, Spasm Frequency Scale, evaluating passive ankle dorsi-flexion motion, and the rate of satisfaction for patients and investigators. Pat...

Journal of Alzheimer's disease : JAD, 2012

In the last decade, cumulative epidemiological evidence suggested that vascular- and metabolic-ba... more In the last decade, cumulative epidemiological evidence suggested that vascular- and metabolic-based risk factors may be important in the development of mild cognitive impairment and dementia. Epidemiological and basic research have also proposed a model of cognitive impairment linked to metabolic syndrome (MetS) and metabolic disorders, suggesting for research purposes a "metabolic-cognitive syndrome" (MCS) in patients with MetS plus cognitive impairment of degenerative or vascular origin. In particular, MetS has been associated with the risk of age-related cognitive decline and vascular dementia, but contrasting findings also existed on the possible role of MetS in overall dementia and Alzheimer's disease. Among metabolic determinants of cognitive impairment, a better approach to the understanding of mechanisms could be to hypothesize a continuum leading to various degrees of late-life cognitive disorders in older subjects with metabolic-based risk factors. The MCS m...

European journal of physical and rehabilitation medicine, 2012

The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and internatio... more The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and international guidelines and highlighted by the National Institute of Clinical Excellence as one of the six key priorities for improving the care of chronic obstructive pulmonary disease (COPD) patients. PR is likely to be effective in bronchiectasis as it is in COPD. We evaluated the efficacy of PR in the management of bronchiectasis. Three outpatients affected by bronchiectasis, with cough, sputum production, dyspnea, and decreased exercise tolerance, were submitted to five months of PR program consisting in treadmill walking, cycle ergometry, breathing exercises, and postural drainage with clapping percussion-vibratory-shaking. In all patients, after PR, chest X-ray showed that the obstructive disease decreased with bronchial wall thickness reduction. This improvement facilitated the performance of breath actions increasing the exercise tolerance and quality of life, evaluated respectively with...

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2010

Clinical and epidemiologic research has focused on the identification of risk factors that may be... more Clinical and epidemiologic research has focused on the identification of risk factors that may be modified in predementia syndromes, at a preclinical and early clinical stage of dementing disorders, with specific attention to the role of depression. Our goal was to provide an overview of these studies and more specifically to describe the prevalence and incidence of depression in individuals with mild cognitive impairment (MCI), the possible impact of depressive symptoms on incident MCI, or its progression to dementia and the possible mechanisms behind the observed associations. Prevalence and incidence of depressive symptoms or syndromes in MCI vary as a result of different diagnostic criteria and different sampling and assessment procedures. The prevalence of depression in individuals with MCI was higher in hospital-based studies (median: 44.3%, range: 9%-83%) than in population-based studies (median: 15.7%, range: 3%-63%), reflecting different referral patterns and selection crit...

Expert Review of Neurotherapeutics, 2014

Journal of the Neurological Sciences, 2015

Journal of Neurology & Neurophysiology, 2013

Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Centra... more Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012). Search terms varied slightly across databases but included: "cerebrovascular accident" or "stroke" and the terms "botulinum toxin", "spasticity" as either MeSH terms, key words, or subject headings. Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Studies of treatment for both lower and/or UL spasticity were included if the results for patients with UL spasticity were reported separately. Prospective open label, case series, cohort studies and case reports were excluded. Furthermore, because confounding results, RTs were also excluded whether: i) post-stroke spasticity was treated by different serotype neurotoxin; ii) botulinum toxin was given early after the stroke, before clinical evidence of severe spasticity was established; iii) mixed sample of subjects with spasticity secondary to stroke or other neurological disorders was enrolled; iv) spasticity followed a non-Abstract Objective: Botulinum toxin type A (BTX-A) use reduces upper limb (UL) spasticity in stroke patients, but the effects on functional recovery remain uncertain. The aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain of UL or in activity of daily living in post-stroke patients.

Clinical Rehabilitation, 2014

Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A e... more Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A effect for wrist and finger flexor spasticity after stroke. Design: A single-blind randomized trial. Subjects: Seventy patients with upper limb post-stroke spasticity. Methods: Adults with wrist and finger flexor muscles spasticity after stroke were submitted to botulinum toxin type A therapy. After the treatment, the subjects injected were randomly divided into two groups and submitted to adhesive taping (Group A) or daily muscle manual stretching, passive articular mobilization of wrist and fingers, and palmar splint (Group B) for 10 days. We measured spasticity with Modified Ashworth Scale, related disability with Disability Assessment Scale, and fingers position at rest. The measurements were done at baseline, after two weeks, and after one month from the treatment session. Results: After two weeks, subjects in Group A reported a significantly greater decrease in spasticity scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.3±0.6 vs. 2.1±0.6; Modified Ashworth Scale Downloaded from 2 Clinical Rehabilitation wrist: 1.7 ±0.6 vs. 2.3 ±0.8), and after one month in spasticity and disability scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.9 ±0.7 vs. 2.5 ±0.6; Modified Ashworth Scale wrist: 2.0 ±0.7 vs. 2.6 ±0.6; Disability Assessment Scale: 1.6 ±0.7 vs. 2.1 ±0.7) compared with Group B subjects. Subjects in Group A reported also a significantly improved fingers position at rest compared with Group B subjects after two weeks (2.8 ±0.9 vs. 2.1 ±0.7) and one month (2.3 ±0.7 vs. 1.5 ±0.6). Conclusions: Adhesive taping of wrist and finger flexor muscles appeared to enhance the effect of botulinum toxin type A therapy more than daily manual muscle stretching combined with passive articular mobilization and palmar splint.

Orthopedics, 2009

Dystonia is a set of disorders characterized by abnormal postures and unwanted muscle spasms that... more Dystonia is a set of disorders characterized by abnormal postures and unwanted muscle spasms that interfere with motor performance. Focal dystonias, the most common, affect just 1 body part. A 25-year-old woman had a focal hand dystonia with pain and muscle spasms in the right hand after surgical treatment for thumb duplication. According to Wassel's classification, she was type II, with duplication of the distal phalanx. She had undergone Bilhaut-Cloquet surgery to remove a radial supernumerary thumb. During repetitive movements, she reported pain and muscle cramping in the right thumb and wrist. Force was rated, according to the Medical Research Council scale, from grades 0 to 5, and the patient had a score of 4. No sign of joint instability was found in her hand, and normal active and passive range of motion were found for interphalangeal or metacarpophalangeal joints of right thumb. However, right thenar muscle hypoplasia was found. Repetitive activity acted as an environmen...

Journal of the Neurological Sciences, 2014

Background: Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, an... more Background: Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, and the accuracy in delivering the toxin to the target muscles may influence the treatment outcome. Our aim was to compare the reduction of spasticity and the related finger position at rest improvement in post-stroke patients treated with botulinum toxin type A in upper limb muscles using ultrasound guidance and manual needle placement. Methods: In a randomized clinical trial, two groups of 15 stroke patients were treated with botulinum toxin type A injections in the wrist and finger flexor muscles of the affected upper limb using ultrasound guidance or manual needle placement. The Modified Ashworth Scale and the finger position at rest were measured at baseline and one month after toxin injections. Results: After one month of follow-up from toxin injections, the Modified Ashworth Scale and finger position at rest significantly improved in both treatment groups, although these clinical outcomes were significantly better in patients treated under ultrasound guidance than in patients injected using manual needle placement. Conclusion: Ultrasound guidance for botulinum toxin type A injections could improve clinical outcome measures better than manual needle placement in post-stroke patients with spasticity.

Ultrasound in Medicine & Biology, 2013

Research is on-going to identify new methods of biostimulation to increase the effect of botulinu... more Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediately after BTX-A injections compared with electrical stimulation (ES) given immediately after BTX-A therapy for the management of focal upper limb spasticity in stroke patients. ES was given for 30 min twice a day for 5 days starting at 5 Hz; ESWT was given once a day for 5 days. At study follow-up, patients treated with BTX-A injections and ESWT showed a statistically greater significance and continuous decrease of spasticity measure (modified Ashworth scale [MAS]: 1.37, 1.75 and 1.58 at 15, 30 and 90 days post-treatment, respectively), of spasms (spasm frequency scale [SFS]: 0.8 and 0.25 at 30 and 90 days post-treatment, respectively) and of pain (visual analogue scale [VAS]: 1.94 and 1.87 at 30 and 90 days, respectively) compared with patients treated with BTX-A injections and ES (MAS: 2.37, 2.18 and 2.18, respectively) (p < 0.05) (SFS: 1.5 and 1.06, respectively) (p < 0.05) (VAS: 2.44 and 2.69 respectively) (p < 0.05). ESWT enhances the effect of BTX-A to a greater extent than ES, probably by modulating rheology of the muscle and neurotransmission at the neuromuscular junction.

Orthopedics, 2009

Painful adductor muscle contracture is an important cause of failure during rehabilitation follow... more Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.

Brain Injury, 2010

In rehabilitation settings, motor imagery, motor observation and mirror therapy serve as techniqu... more In rehabilitation settings, motor imagery, motor observation and mirror therapy serve as techniques for the recovery of paretic upper limb in patients with movement disorders after stroke, whereas botulinum toxin type A (BTX-A) offers the best treatment for focal spasticity. After haemorrhagic stroke, three patients (two men and one woman, mean age: 61.2 +/- 7.03) presented with hemiparesis of the left or right hand and arm with flexion of fingers, wrist and elbow, with no disturbance to sensitivity but with loss of use handoff the limb to write, eat or dress. After BTX-A injections, the patients underwent a daily rehabilitation programme based on motor imagery and motor observation for 1 month. Before and after the combined treatment, the motor function, spasticity and functional deficits of the patient were extensively measured. After a 3-month follow-up, upper limb spasticity measured with the Modified Ashworth Scale had worsened, yet the associated score remained lower than that at baseline. However, in these three patients a large improvement of motor function of the hemiparetic upper limb was observed. Combined treatment may be a viable rehabilitation option in post-stroke patients with disability to upper-extremity motor function, however further investigations are needed to determine its reproducibility in larger case series or clinical trials.

Neurobiology of Aging, 2009

At present, there is clearly no full consensus in epidemiological studies regarding the role and ... more At present, there is clearly no full consensus in epidemiological studies regarding the role and timing of plasma/serum total cholesterol (TC) levels in cognitive decline, i.e. agerelated cognitive decline (ARCD), mild cognitive impairment (MCI), or dementia of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia, VaD). Recent data from observational studies suggesting that therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may delay the onset of AD by a variety of proposed mechanisms, such as suppression of ␤-amyloid (A␤) metabolism, vascular effects, and anti-inflammatory effects. Statins are the first-line treatment option for hypercholesterolemia, and observational studies have suggested that the risk of AD is reduced in patients who receive statin therapy in midlife . van der Kommer et al. (2007) in the Longitudinal Aging Study Amsterdam (LASA), a population-based study on 1181 individuals ≥65 years, showed that a higher TC level at the age of 65 years and older was an independent predictor of a relatively better level of general cognitive and general cognitive performance, and a relatively higher level of information processing speed over a 6-year period. Only in the apolipoprotein E (APOE) 4 carrier group, a higher level of TC was an inde- * Corresponding author. (F. Panza). pendent predictor of a slower rate of decline on information processing speed (van der Kommer et al., 2007).

Neuroscience Letters, 2008

Catalase (CAT) −262 C/T promoter (rs1001179), cathepsin D (CTSD) exon 2 (rs17571), and apolipopro... more Catalase (CAT) −262 C/T promoter (rs1001179), cathepsin D (CTSD) exon 2 (rs17571), and apolipoprotein E (APOE) gene polymorphisms were studied in 242 patients with sporadic Alzheimer's disease (AD) and 421 unrelated age-, sex-, and ethnically matched control subjects from Apulia (Southern Italy). No statistically significant differences in CAT rs1001179 and CTSD rs17571 genotype and allele distribution between AD cases and

Orthopedics, 2009

Painful adductor muscle contracture is an important cause of failure during rehabilitation follow... more Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.

Physical Therapy, 2009

resulting from the entrapment of anatomical structures between the anteroinferior corner of the a... more resulting from the entrapment of anatomical structures between the anteroinferior corner of the acromion and the greater tuberosity of the humerus.

European journal of physical and rehabilitation medicine, 2014

Spasticity is a common disabling symptom of several neurological conditions including stroke. Bot... more Spasticity is a common disabling symptom of several neurological conditions including stroke. Botulinum toxin type A (BTX-A) injection represents the gold standard therapy for focal spasticity. Post-stroke management of patients receiving BTX-A therapy has been variously investigated, but general agreement on how and when to implement rehabilitation is lacking. To perform a national survey of experts on the most appropriate rehabilitation procedures after BTX-A therapy for the focal treatment of spasticity. The study employed the Delphi technique through the COSMO project (Consensus on Post-Injection Management in Post-stroke Spasticity). Italian neurologists and physiatrists with experience in BTX-A therapy were selected to participate in the survey. Their anonymous opinions on key issues in treatment strategies in post-stroke spasticity were collected in three sequential rounds facilitated by a web platform. Consensus on a given issue was defined as agreed opinion by at least 66% ...

NeuroRehabilitation, 2014

Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin t... more Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed. High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection. Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects - 16 subjects with BI and 6 with CP - were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not ...

European journal of physical and rehabilitation medicine, 2013

In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has be... more In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity. To assess the safety and evaluate the effects of BTX-A NT 201 free from complexing proteins for the treatment of post-stroke lower limb spasticity evaluating spasticity grade, passive ankle dorsi-flexion motion, and muscle's spasms, as well as its efficacy and rate of satisfaction for patients and for the physicians. Prospective open-label study. Patients (71) with post-stroke lower limb spasticity at least 5 months by the event. Intramuscular injections of BTX-A NT 201 in soleus, medial, and lateral gastrocnemius with a maximum total dose of 180 U. Each patients was assessed at baseline, 30, and 90 days after treatment using Modified Ashworth Scale, Spasm Frequency Scale, evaluating passive ankle dorsi-flexion motion, and the rate of satisfaction for patients and investigators. Pat...

Journal of Alzheimer's disease : JAD, 2012

In the last decade, cumulative epidemiological evidence suggested that vascular- and metabolic-ba... more In the last decade, cumulative epidemiological evidence suggested that vascular- and metabolic-based risk factors may be important in the development of mild cognitive impairment and dementia. Epidemiological and basic research have also proposed a model of cognitive impairment linked to metabolic syndrome (MetS) and metabolic disorders, suggesting for research purposes a "metabolic-cognitive syndrome" (MCS) in patients with MetS plus cognitive impairment of degenerative or vascular origin. In particular, MetS has been associated with the risk of age-related cognitive decline and vascular dementia, but contrasting findings also existed on the possible role of MetS in overall dementia and Alzheimer's disease. Among metabolic determinants of cognitive impairment, a better approach to the understanding of mechanisms could be to hypothesize a continuum leading to various degrees of late-life cognitive disorders in older subjects with metabolic-based risk factors. The MCS m...

European journal of physical and rehabilitation medicine, 2012

The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and internatio... more The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and international guidelines and highlighted by the National Institute of Clinical Excellence as one of the six key priorities for improving the care of chronic obstructive pulmonary disease (COPD) patients. PR is likely to be effective in bronchiectasis as it is in COPD. We evaluated the efficacy of PR in the management of bronchiectasis. Three outpatients affected by bronchiectasis, with cough, sputum production, dyspnea, and decreased exercise tolerance, were submitted to five months of PR program consisting in treadmill walking, cycle ergometry, breathing exercises, and postural drainage with clapping percussion-vibratory-shaking. In all patients, after PR, chest X-ray showed that the obstructive disease decreased with bronchial wall thickness reduction. This improvement facilitated the performance of breath actions increasing the exercise tolerance and quality of life, evaluated respectively with...

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2010

Clinical and epidemiologic research has focused on the identification of risk factors that may be... more Clinical and epidemiologic research has focused on the identification of risk factors that may be modified in predementia syndromes, at a preclinical and early clinical stage of dementing disorders, with specific attention to the role of depression. Our goal was to provide an overview of these studies and more specifically to describe the prevalence and incidence of depression in individuals with mild cognitive impairment (MCI), the possible impact of depressive symptoms on incident MCI, or its progression to dementia and the possible mechanisms behind the observed associations. Prevalence and incidence of depressive symptoms or syndromes in MCI vary as a result of different diagnostic criteria and different sampling and assessment procedures. The prevalence of depression in individuals with MCI was higher in hospital-based studies (median: 44.3%, range: 9%-83%) than in population-based studies (median: 15.7%, range: 3%-63%), reflecting different referral patterns and selection crit...

Expert Review of Neurotherapeutics, 2014

Journal of the Neurological Sciences, 2015

Journal of Neurology & Neurophysiology, 2013

Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Centra... more Search of relevant studies was conducted on MEDLINE (from 1995 to July 2012), the Cochrane Central Register of Controlled Trials and EMBASE (1995 to July 2012). Search terms varied slightly across databases but included: "cerebrovascular accident" or "stroke" and the terms "botulinum toxin", "spasticity" as either MeSH terms, key words, or subject headings. Only randomized studies (RT) treating patients with UL post-stroke spasticity by BTX-A injection were included. Studies of treatment for both lower and/or UL spasticity were included if the results for patients with UL spasticity were reported separately. Prospective open label, case series, cohort studies and case reports were excluded. Furthermore, because confounding results, RTs were also excluded whether: i) post-stroke spasticity was treated by different serotype neurotoxin; ii) botulinum toxin was given early after the stroke, before clinical evidence of severe spasticity was established; iii) mixed sample of subjects with spasticity secondary to stroke or other neurological disorders was enrolled; iv) spasticity followed a non-Abstract Objective: Botulinum toxin type A (BTX-A) use reduces upper limb (UL) spasticity in stroke patients, but the effects on functional recovery remain uncertain. The aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain of UL or in activity of daily living in post-stroke patients.

Clinical Rehabilitation, 2014

Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A e... more Objective: To compare the effectiveness of two procedures increasing the botulinum toxin type A effect for wrist and finger flexor spasticity after stroke. Design: A single-blind randomized trial. Subjects: Seventy patients with upper limb post-stroke spasticity. Methods: Adults with wrist and finger flexor muscles spasticity after stroke were submitted to botulinum toxin type A therapy. After the treatment, the subjects injected were randomly divided into two groups and submitted to adhesive taping (Group A) or daily muscle manual stretching, passive articular mobilization of wrist and fingers, and palmar splint (Group B) for 10 days. We measured spasticity with Modified Ashworth Scale, related disability with Disability Assessment Scale, and fingers position at rest. The measurements were done at baseline, after two weeks, and after one month from the treatment session. Results: After two weeks, subjects in Group A reported a significantly greater decrease in spasticity scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.3±0.6 vs. 2.1±0.6; Modified Ashworth Scale Downloaded from 2 Clinical Rehabilitation wrist: 1.7 ±0.6 vs. 2.3 ±0.8), and after one month in spasticity and disability scores (Modified Ashworth Scale fingers: mean (standard deviation) 1.9 ±0.7 vs. 2.5 ±0.6; Modified Ashworth Scale wrist: 2.0 ±0.7 vs. 2.6 ±0.6; Disability Assessment Scale: 1.6 ±0.7 vs. 2.1 ±0.7) compared with Group B subjects. Subjects in Group A reported also a significantly improved fingers position at rest compared with Group B subjects after two weeks (2.8 ±0.9 vs. 2.1 ±0.7) and one month (2.3 ±0.7 vs. 1.5 ±0.6). Conclusions: Adhesive taping of wrist and finger flexor muscles appeared to enhance the effect of botulinum toxin type A therapy more than daily manual muscle stretching combined with passive articular mobilization and palmar splint.

Orthopedics, 2009

Dystonia is a set of disorders characterized by abnormal postures and unwanted muscle spasms that... more Dystonia is a set of disorders characterized by abnormal postures and unwanted muscle spasms that interfere with motor performance. Focal dystonias, the most common, affect just 1 body part. A 25-year-old woman had a focal hand dystonia with pain and muscle spasms in the right hand after surgical treatment for thumb duplication. According to Wassel's classification, she was type II, with duplication of the distal phalanx. She had undergone Bilhaut-Cloquet surgery to remove a radial supernumerary thumb. During repetitive movements, she reported pain and muscle cramping in the right thumb and wrist. Force was rated, according to the Medical Research Council scale, from grades 0 to 5, and the patient had a score of 4. No sign of joint instability was found in her hand, and normal active and passive range of motion were found for interphalangeal or metacarpophalangeal joints of right thumb. However, right thenar muscle hypoplasia was found. Repetitive activity acted as an environmen...

Journal of the Neurological Sciences, 2014

Background: Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, an... more Background: Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, and the accuracy in delivering the toxin to the target muscles may influence the treatment outcome. Our aim was to compare the reduction of spasticity and the related finger position at rest improvement in post-stroke patients treated with botulinum toxin type A in upper limb muscles using ultrasound guidance and manual needle placement. Methods: In a randomized clinical trial, two groups of 15 stroke patients were treated with botulinum toxin type A injections in the wrist and finger flexor muscles of the affected upper limb using ultrasound guidance or manual needle placement. The Modified Ashworth Scale and the finger position at rest were measured at baseline and one month after toxin injections. Results: After one month of follow-up from toxin injections, the Modified Ashworth Scale and finger position at rest significantly improved in both treatment groups, although these clinical outcomes were significantly better in patients treated under ultrasound guidance than in patients injected using manual needle placement. Conclusion: Ultrasound guidance for botulinum toxin type A injections could improve clinical outcome measures better than manual needle placement in post-stroke patients with spasticity.

Ultrasound in Medicine & Biology, 2013

Research is on-going to identify new methods of biostimulation to increase the effect of botulinu... more Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediately after BTX-A injections compared with electrical stimulation (ES) given immediately after BTX-A therapy for the management of focal upper limb spasticity in stroke patients. ES was given for 30 min twice a day for 5 days starting at 5 Hz; ESWT was given once a day for 5 days. At study follow-up, patients treated with BTX-A injections and ESWT showed a statistically greater significance and continuous decrease of spasticity measure (modified Ashworth scale [MAS]: 1.37, 1.75 and 1.58 at 15, 30 and 90 days post-treatment, respectively), of spasms (spasm frequency scale [SFS]: 0.8 and 0.25 at 30 and 90 days post-treatment, respectively) and of pain (visual analogue scale [VAS]: 1.94 and 1.87 at 30 and 90 days, respectively) compared with patients treated with BTX-A injections and ES (MAS: 2.37, 2.18 and 2.18, respectively) (p < 0.05) (SFS: 1.5 and 1.06, respectively) (p < 0.05) (VAS: 2.44 and 2.69 respectively) (p < 0.05). ESWT enhances the effect of BTX-A to a greater extent than ES, probably by modulating rheology of the muscle and neurotransmission at the neuromuscular junction.

Orthopedics, 2009

Painful adductor muscle contracture is an important cause of failure during rehabilitation follow... more Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.

Brain Injury, 2010

In rehabilitation settings, motor imagery, motor observation and mirror therapy serve as techniqu... more In rehabilitation settings, motor imagery, motor observation and mirror therapy serve as techniques for the recovery of paretic upper limb in patients with movement disorders after stroke, whereas botulinum toxin type A (BTX-A) offers the best treatment for focal spasticity. After haemorrhagic stroke, three patients (two men and one woman, mean age: 61.2 +/- 7.03) presented with hemiparesis of the left or right hand and arm with flexion of fingers, wrist and elbow, with no disturbance to sensitivity but with loss of use handoff the limb to write, eat or dress. After BTX-A injections, the patients underwent a daily rehabilitation programme based on motor imagery and motor observation for 1 month. Before and after the combined treatment, the motor function, spasticity and functional deficits of the patient were extensively measured. After a 3-month follow-up, upper limb spasticity measured with the Modified Ashworth Scale had worsened, yet the associated score remained lower than that at baseline. However, in these three patients a large improvement of motor function of the hemiparetic upper limb was observed. Combined treatment may be a viable rehabilitation option in post-stroke patients with disability to upper-extremity motor function, however further investigations are needed to determine its reproducibility in larger case series or clinical trials.