Efficacy and safety of nabiximols (Sativex(®)) on multiple sclerosis spasticity in a real-life Italian monocentric study.

Multiple sclerosis (MS) patients frequently suffer from limb spasticity and pain despite antispastic treatments. To investigate nabiximols efficacy and safety in a real-world monocentric Italian cohort, the following data were collected at baseline, week 4, 14 and 48: Ambulation Index (AI), 10-min walking test (10MWT), combined Modified Ashworth scale (cMAS), scores at numerical rating scale for spasticity (sNRS) and pain (pNRS). Responder status was defined as a ≥20 % reduction in sNRS after 4 weeks of treatment. 144 MS patients (123 progressive and 21 relapsing-remitting) complaining of moderate-to-severe spasticity (mean sNRS: 7.5) were included: 138 (95.8 %) completed the first month of therapy and were classified as follows-23.2 % were non-responders, 5.1 % were responders but discontinued treatment due to side effects, 71.7 % were responders with a mean 32 % reduction in sNRS (p < 0.001). In responders sNRS further decreased between 4 and 14 weeks (p = 0.03). Similarly, pNRS improvement was seen during the first month and between 4 and 14 weeks (p < 0.001 and p = 0.004, respectively). Moreover, at 4 weeks responders showed a significant (p < 0.05) improvement in cMAS, AI and 10MWT, which was maintained at 14 weeks. At 1-year follow-up, a benefit was still evident on spasticity and painful symptoms with a low drop-out rate. Confusion/ideomotor slowing, fatigue and dizziness were the most frequent side effects; no major adverse events were reported. Shorter disease duration at treatment start was associated with better response. This real-world study confirms nabiximols efficacy and safety in the treatment of MS-related spasticity and pain, which is maintained up to 48 weeks.

Social status gates social attention in humans.

Humans tend to shift attention in response to the averted gaze of a face they are fixating, a phenomenon known as gaze cuing. In the present paper, we aimed to address whether the social status of the cuing face modulates this phenomenon. Participants were asked to look at the faces of 16 individuals and read fictive curriculum vitae associated with each of them that could describe the person as having a high or low social status. The association between each specific face and either high or low social status was counterbalanced between participants. The same faces were then used as stimuli in a gaze-cuing task. The results showed a greater gaze-cuing effect for high-status faces than for low-status faces, independently of the specific identity of the face. These findings confirm previous evidence regarding the important role of social factors in shaping social attention and show that a modulation of gaze cuing can be observed even when knowledge about social status is acquired through episodic learning.

Delayed diagnosis in pediatric headache: an outpatient Italian survey.

OBJECTIVE: The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time. METHODS: One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004). RESULTS: The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling. CONCLUSION: Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the medical community as well as social settings. There is a need for educational programs regarding headache involving not only general practitioners, pediatricians, and neurologists, but also the general population. These are desirable in order to raise awareness of such a condition and, accordingly, treat children accurately.

Eye gaze cannot be ignored (but neither can arrows).

Recent studies have tried to shed light on the automaticity of attentional shifts triggered by gaze and arrows with mixed results. In the present research, we aimed at testing a strong definition of resistance to suppression for orienting of attention elicited by these two cues. In five experiments, participants were informed with 100% certainty about the future location of a target they had to react to by presentation of either a direction word at the beginning of each trial or instructions at the beginning of each block. Gaze and arrows were presented before the target as uninformative distractors irrelevant for the task. The results showed similar patterns for gaze and arrows-namely, an interference effect when the distractors were incongruent with the upcoming target location. This suggests that the orienting of attention mediated by gaze and arrows can be considered as strongly automatic.

Racial group membership is associated to gaze-mediated orienting in Italy.

Viewing a face with averted gaze results in a spatial shift of attention in the corresponding direction, a phenomenon defined as gaze-mediated orienting. In the present paper, we investigated whether this effect is influenced by social factors. Across three experiments, White and Black participants were presented with faces of White and Black individuals. A modified spatial cueing paradigm was used in which a peripheral target stimulus requiring a discrimination response was preceded by a noninformative gaze cue. Results showed that Black participants shifted attention to the averted gaze of both ingroup and outgroup faces, whereas White participants selectively shifted attention only in response to individuals of their same group. Interestingly, the modulatory effect of social factors was context-dependent and emerged only when group membership was situationally salient to participants. It was hypothesized that differences in the relative social status of the two groups might account for the observed asymmetry between White and Black participants. A final experiment ruled out an alternative explanation based on differences in perceptual familiarity with the face stimuli. Overall, these findings strengthen the idea that gaze-mediated orienting is a socially-connoted phenomenon.