Quantitative EEG for early differential diagnosis of dementia with Lewy bodies.

Introduction: Differentiating between the two most common forms of dementia, Alzheimer's dementia and dementia with Lewy bodies (DLB) remains difficult and requires the use of invasive, expensive, and resource-intensive techniques. We aimed to investigate the sensitivity and specificity of electroencephalography quantified using the statistical pattern recognition method (qEEG-SPR) for identifying dementia and DLB. Methods: Thirty-two outpatients and 16 controls underwent clinical assessment (by two blinded neurologists), EEG recording, and a 6-month follow-up clinical assessment. EEG data were processed using a qEEG-SPR protocol to derive a Dementia Index (positive or negative) and DLB index (positive or negative) for each participant which was compared against the diagnosis given at clinical assessment. Confusion matrices were used to calculate sensitivity, specificity, and predictive values for identifying dementia and DLB specifically. Results: Clinical assessment identified 30 cases of dementia, 2 of which were diagnosed clinically with possible DLB, 14 with probable DLB and DLB was excluded in 14 patients. qEEG-SPR confirmed the dementia diagnosis in 26 out of the 32 patients and led to 6.3% of false positives (FP) and 9.4% of false negatives (FN). qEEG-SPR was used to provide a DLB diagnosis among patients who received a positive or inconclusive result of Dementia index and led to 13.6% of FP and 13.6% of FN. Confusion matrices indicated a sensitivity of 80%, a specificity of 89%, a positive predictive value of 92%, a negative predictive value of 72%, and an accuracy of 83% to diagnose dementia. The DLB index showed a sensitivity of 60%, a specificity of 90%, a positive predictive value of 75%, a negative predictive value of 81%, and an accuracy of 75%. Neuropsychological scores did not differ significantly between DLB and non- DLB patients. Head trauma or story of stroke were identified as possible causes of FP results for DLB diagnosis. Conclusion: qEEG-SPR is a sensitive and specific tool for diagnosing dementia and differentiating DLB from other forms of dementia in the initial state. This non-invasive, low-cost, and environmentally friendly method is a promising diagnostic tool for dementia diagnosis which could be implemented in local care settings.

SARCOPENIA IS A FREQUENT DISEASE IN SARS-COV-2 INFECTION.

Objective: We aimed to investigate the clinical symptoms and specific care requirements of SARS-CoV-2 patients who were admitted to a COVID-19 Rehabilitation Unit while still infectious for SARS-CoV-2 and in the subacute phase of the disease. Methods: Patients admitted to our COVID-19 Rehabilitation Unit from March 2020 to December 2020 were evaluated for sarcopenia, and they also completed the following assessments: functional independence measure, short physical performance battery and Hamilton Rating Scale for Depression. Age and body mass index and symptoms of dysosmia or dysgeusia were also recorded. Results: A total of 126 patients were enrolled (50 women, median age 72 years, 18.7 years), of whom 82% of patients presented with low grip strength. Sarcopenia was diagnosed in 52 patients. Sarcopenic patients were older than non-sarcopenic ones (median age 73.4 years, IQR 13.2 vs 63.9 years, IQR 14.5, respectively, p = 0.014). Sarcopenia was associated with the presence of depression (p = 0.008), was more common in women (p = 0.023) and was associated with greater functional deficits (functional independence measure and short physical performance battery analyses, p < 0.05). Sarcopenic patients also had a lower body mass index than other patients (p < 0.01). Conclusion: More than 40% of our patients suffered from sarcopenia, which was associated with ageing, depression, low body mass index, reduction in functional autonomy and being a woman. Such data provide evidence for the need to assist hospitalized COVID-19 patients by means of a multidisciplinary specialist team.

Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis.

Trigeminal neuralgia (TN) is the most frequent craniofacial pain condition, which commonly affects patients suffering from multiple sclerosis (MS). Stereotactic radiosurgery, especially Gamma Knife radiosurgery (GKRS), represents a safe and effective treatment for TN, and it has been adopted also for MS-TN, with a lower success rate. Therefore, we aimed to analyze the outcome of GKRS for MS-TN. PubMed, Web of Science, and Google Scholar and the reference list of relevant articles were searched for GKRS in MS-TN. Two investigators independently identified the articles, assessed the study quality, and extracted the data. Endpoints of interest were initial pain responders, successful treatments at the end of follow-up, and factors influencing the outcome. Data analyses were performed using R software. Twelve articles involving 646 patients met our inclusion criteria. Pooled proportion of patients who experienced an initial response to GKRS treatment was 83% (CI 74-90%). The cumulative proportion of successful treatments at the end of follow-up was 47% (CI 33-60%). No variables were found to have a significant contribution to heterogeneity regarding the initial response outcome. The only variable significantly explaining the heterogeneity found in the proportion of successful treatments was the length of the follow-up, with a negative b coefficient (- 0.0051, p value = 0.0047). Regarding the efficacy of GKRS in MS-TN, the initial pain response rate was 83%, which dramatically decreases to 47% during follow-up. GKRS still represents a valuable option for MS-TN; however, its long-term efficacy should be always considered.

The optimal numerosity of the referral population of pituitary tumors centers of excellence (PTCOE): A surgical perspective.

Surgical experience is of paramount importance to reach therapeutic success and minimize operative complications. In the field of pituitary surgery, this led to the concept of Pituitary Center of Excellence (PTCOE) defined as a center where an interdisciplinary team works in collaboration and where surgeons can be trained appropriately to reach and keep excellence in daily practice. To review the literature to define the optimal referral population size to establish a PTCOE to optimize both training and specific field research. A review of the literature was performed about epidemiology. The time needed to observe 200 cases of PAs in a single PTCOE and to reach the minimal surgical experience threshold (MSET) was calculated for different referral population groups. The time needed to reach MSET decreased as population size increased. We defined a population as the optimal one to be served by a single PTCOE with a single dedicated neurosurgeon. PTCOEs should be established after an analysis of the referral population, number of cases suitable for surgical treatment and number of dedicated neurosurgeons.

Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region.

BACKGROUND: Skull-base reconstruction represents a concern after resection of middle fossa (MF) tumors by the extradural subtemporal transzygomatic approach (ESTZ). Regional pedicled flaps appear to be the best option. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for MF reconstruction, which might preserve temporal muscle (TM) function and its blood supply. METHODS: The technique to harvest a combined segmented temporal myofascial flap (CSTMF) is described. The flap consists in a temporal fascial (TFF) and a muscle flap (TMF), composed by TM anterior-medial bundle (AMB). RESULTS: CSTMF provides wide coverage of dural lining, through the TFF, and of dead-space, through the TMF. The possibility to tailor TMF according to the need, anatomically preserving the blood supply, enables to significantly increase its volume. CONCLUSION: CSTMF represents an effective option as regional multilayered pedicled flap for MF reconstruction, potentially preserving TM function and minimizing the cosmetic impact.