Non-Pharmacological Treatments in Lewy Body Disease: A Systematic Review.

INTRODUCTION: Lewy body disease (LBD) is the second most common neurodegenerative disorder in patients older than 65 years. LBD is characterized by heterogeneous symptoms like fluctuation in attention, visual hallucinations, Parkinsonism, and REM sleep behaviour disorders. Considering the relevant social impact of the disease, identifying effective non-pharmacological treatments is becoming a priority. The aim of this systematic review was to provide an up-to-date literature review of the most effective non-pharmacological treatments in patients with LBD, focussing on evidence-based interventions. METHODS: Following PRISMA criteria, we carried out a systematic search through three databases (PubMed, Cochrane Libraries, and PEDro) including physical therapy (PT), cognitive rehabilitation (CR), light therapy (LT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), deep brain stimulation (DBS). All studies were qualitatively assessed using standardized tools (CARE and EPHPP). RESULTS: We obtained a total of 1,220 studies of which 23 original articles met eligibility criteria for inclusion. The total number of LBD patients included was 231; mean age was 69.98, predominantly men (68%). Some PT studies highlighted improvements in motor deficits. CR produced significant improvements in mood, cognition, and patient's quality of life and satisfaction. LT outlined a partial trend of improvements in mood and sleep quality. DBS, ECT, and TMS showed some partial improvements mainly on neuropsychiatric symptoms, whereas tDCS provided partial improvements in attention. CONCLUSION: This review highlights the efficacy of some evidence-based rehabilitation studies in LBD; however, further randomized controlled trials with larger samples are needed to provide definitive recommendations.

Intraorbital injection of Rituximab in idiopathic orbital inflammatory syndrome: case reports.

To analyze the clinical and histopathological effects of low doses of intraorbital and intralesional Rituximab (RTX) in three patients affected by idiopathic orbital inflammatory syndrome (IOIS). Three patients with IOIS were enrolled, all of whom underwent lesion biopsy to confirm the diagnosis, complete blood examinations (thyroid function tests, complete blood cell count, fasting blood glucose, liver and renal function tests, erythrocyte sedimentation rate, serum ACE, C-reactive protein, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, serum IGg4 level tests) and magnetic resonance imaging (MRI). Patients received the planned treatment schedule, consisting of a complete cycle of intraorbital injections of RTX (MabThera(®); Roche, Basel, Switzerland, 100 mg/10 ml): 10 mg, once a week for 1 month (four injections/month), in two patients repeated. The clinical and imaging follow-ups were at an average of 17.6 months (range 14-24 months) after treatment. A post-treatment bioptic procedure was performed in one patient. All patients showed a significant MRI reduction of the orbital lesion and a stable clinical improvement for the follow-up time of observation. The post-treatment histopathological specimen showed a disappearance of inflammatory cells. Low doses of intralesional RTX, which are safe, efficacious and used in other B cell-mediated disorders, are a useful treatment in IOIS, with decreased risks of generalized immunosuppression and fewer side effects than are afforded by systemic high doses of glucocorticoids and RTX. The result is very quick, effective and prolonged on the inflammatory component of the disease and seems to be related to the histologic reduction of infiltrating CD20+ lymphocytes.

Graft rejection after femtosecond laser--assisted deep anterior lamellar keratoplasty: report of 3 cases.

PURPOSE: To report 3 cases of stromal rejection after deep anterior lamellar keratoplasty (DALK) assisted by a femtosecond laser. METHODS: Three keratoconus eyes of 2 men (22 and 30 years old) and 1 woman (24 years old) who had DALK with a 60-kHz femtosecond laser developed intrastromal graft rejection with superficial and deep neovascularization after 6, 15, and 12 months, respectively. All patients underwent confocal microscopy and were treated with topical steroid therapy. RESULTS: In vivo confocal microscopy revealed cellular inflammatory infiltrates in the subepithelial and middle stroma of the donor lamella without involvement of the endothelium. Graft rejection was rapidly reversed with topical steroid therapy, and a clear cornea was restored in all cases. CONCLUSIONS: Graft rejection remains a significant complication of lamellar surgery but is associated with good tissue restoration and complete visual recovery.

Comparison between discriminant analysis models and "glaucoma probability score" for the detection of glaucomatous optic nerve head changes.

PURPOSE: The aim of this study was to evaluate and compare 4 different discriminant analysis formulas and the new Glaucoma Probability Score (GPS) for the detection of morphometric optic nerve head changes in chronic open-angle glaucoma. METHODS: This is a prospectively planned cross-sectional study. Two hundred and fourteen consecutive eyes were recruited into this study. For each patient, the eyes were evaluated by a slit lamp examination, and the visual fields were assessed by a Humphrey Field Analyzer 750 (HFA, Humphrey Inc, San Leandro, CA), using the standard full threshold 24-2 (Swedish Interactive Threshold Algorithm) program. The optic nerve heads were morphometrically evaluated using the Heidelberg Retina Tomograph 3 (HRT 3, Heidelberg Engineering, Heidelberg, Germany; software version 3.0). From the HRT data, 4 discriminant analysis formulas and the GPS were considered. All data were analyzed by Student t test and Pearson r coefficient. A linear regression model was also used to determine the independent contribution of variables included in the model. Sensitivity, specificity, diagnostic precision, and receiver operating characteristic curve areas were calculated for all the 5 methods examined. kappa statistic was used to study the agreement among, and between, the 5 different methods. RESULTS: One hundred and nineteen normal eyes and 95 eyes with primary open-angle glaucoma were included in the study. No significant difference was found between the 2 study subgroups in both age and refractive error. Significant (P<0.001) correlations were found between visual field indices and the HRT parameters. Sensitivity, specificity, and diagnostic precision of the 4 formulas ranged between 50% and 99.16%. Bathija et al's formula had the highest diagnostic precision, followed by Mikelberg's formula. Using kappa statistics, kappa ranged from 0.177 to 0.528 when comparing each single discriminant formula with the GPS. CONCLUSIONS: The GPS showed similar sensitivity and specificity to the Mikelberg and Bathija formulas; this method is a promising one for differentiating between healthy and glaucomatous eyes, requiring no subjective user input.