The Role of Treatment-Related Parameters and Brain Morphology in the Lesion Volume of Magnetic-Resonance-Guided Focused Ultrasound Thalamotomy in Patients with Tremor-Dominant Neurological Conditions.

PURPOSE: To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson's disease (PD) and essential tremor (ET) patients. METHODS: Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. RESULTS: The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. CONCLUSIONS: Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes.

Changes in cerebral cortex activity during a simple motor task after MRgFUS treatment in patients affected by essential tremor and Parkinson's disease: a pilot study using functional NIRS.

Objective.Magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) is a non-invasive thermal ablation method that involves high-intensity focused ultrasound surgery (FUS) and Magnetic Resonance Imaging for anatomical imaging and real-time thermal mapping. This technique is widely employed for the treatment of patients affected by essential tremor (ET) and Parkinson's disease (PD). In the current study, functional near-infrared spectroscopy (fNIRS) was used to highlight hemodynamics changes in cerebral cortex activity, during a simple hand motor task, i.e. unimanual left and right finger-tapping, in ET and PD patients.Approach.All patients were evaluated before, one week and one month after MRgFUS treatment.Main results.fNIRS revealed cerebral hemodynamic changes one week and one month after MRgFUS treatment, especially in the ET group, that showed a significant clinical improvement in tremor clinical scores.Significance.To our knowledge, our study is the first that showed the use of fNIRS system to measure the cortical activity changes following unilateral ventral intermediate nucleus thalamotomy after MRgFUS treatment. Our findings showed that therapeutic MRgFUS promoted the remodeling of neuronal networks and changes in cortical activity in association with symptomatic improvements.

Brain Active Areas Associated with a Mental Arithmetic Task: An eLORETA Study.

The neural underpinnings of mental calculation, the fundamentals of arithmetic representations and processes, and the development of arithmetic abilities have been explored by researchers over the years. In the present work, we report a study that analyzes the brain-activated areas of a group of 35 healthy subjects (9 males, 26 females, mean age ± SD = 18.23 ± 2.20 years) who performed a serial subtraction arithmetic task. In contrast to most of the studies in the literature based on fMRI, we performed the brain active source reconstruction starting from EEG signals by means of the eLORETA method. In particular, the subjects were classified as bad counters or good counters, according to the results of the task, and the brain activity of the two groups was compared. The results were statistically significant only in the beta band, revealing that the left limbic lobe was found to be more active in people showing better performance. The limbic lobe is involved in visuospatial processing, memory, arithmetic fact retrieval, and emotions. However, the role of the limbic lobe in mental arithmetic has been barely explored, so these interesting findings could represent a starting point for future in-depth analyses. Since there is evidence in the literature that the motor system is affected by the execution of arithmetic tasks, a more extensive knowledge of the brain activation associated with arithmetic tasks could be exploited not only for the assessment of mathematical skills but also in the evaluation of motor impairments and, consequently, in rehabilitation for motor disorders.

Psychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study.

BACKGROUND: Married people have, on average, better mental health than no married people. Psychological symptoms as anxiety and depression occur frequently in patients with multiple sclerosis (MS), increasing the severity of neurologic disability. The aim of this retrospective study was to investigate the relationship between functional disability and psychological symptoms differentiating by marital status. METHODS: In this study 150 MS outpatients without a history of psychological disorders were selected from the hospital database. The outpatient procedure for all patients includes the administration of the Expanded Disability Status Scale and the questionnaire Symptoms Checklist-90-Revised (SCL-90-R) a multidimensional self-report inventory, consisting of 90 items covering nine clinical dimensions: somatization (SOM), obsessive-compulsive (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), psychoticism (PSY), and three global indices of distress: global severity index (GSI), positive symptoms total (PST) and positive symptom distress index (PSDI). According to marital status, subjects were subdivided in single, married (including cohabitants), and divorced (including separated). A nonparametric group comparisons analysis was performed, as well as multivariate analysis which included generalized linear regression models. RESULTS: Regression results showed that functional disability was a significant predictor for all SCL- 90-R subscales. Moreover, it would seem that the single condition might be a protective factor for the development of psychological symptoms in SM patients. Notably, findings showed that younger subjects were predominantly single and had less psychological symptoms, whereas patients with greater psychological alterations were older in a stable affective couple relationship, presenting an elevation in depression, anxiety, somatization and compulsive, and obsessive scales. CONCLUSION: Numerous factors contribute to the onset of psychological disorders in multiple sclerosis. Marriage does not represent a protective factor for the development of psychological symptoms in SM patients. Future investigation is needed to ascertain the prevalence and underlying causes of psychological symptoms.

Paving the Way for Predicting the Progression of Cognitive Decline: The Potential Role of Machine Learning Algorithms in the Clinical Management of Neurodegenerative Disorders.

Alzheimer's disease (AD) is the most common form of neurodegenerative disorder. The prodromal phase of AD is mild cognitive impairment (MCI). The capacity to predict the transitional phase from MCI to AD represents a challenge for the scientific community. The adoption of artificial intelligence (AI) is useful for diagnostic, predictive analysis starting from the clinical epidemiology of neurodegenerative disorders. We propose a Machine Learning Model (MLM) where the algorithms were trained on a set of neuropsychological, neurophysiological, and clinical data to predict the diagnosis of cognitive decline in both MCI and AD patients. METHODS: We built a dataset with clinical and neuropsychological data of 4848 patients, of which 2156 had a diagnosis of AD, and 2684 of MCI, for the Machine Learning Model, and 60 patients were enrolled for the test dataset. We trained an ML algorithm using RoboMate software based on the training dataset, and then calculated its accuracy using the test dataset. RESULTS: The Receiver Operating Characteristic (ROC) analysis revealed that diagnostic accuracy was 86%, with an appropriate cutoff value of 1.5; sensitivity was 72%; and specificity reached a value of 91% for clinical data prediction with MMSE. CONCLUSION: This method may support clinicians to provide a second opinion concerning high prognostic power in the progression of cognitive impairment. The MLM used in this study is based on big data that were confirmed in enrolled patients and given a credibility about the presence of determinant risk factors also supported by a cognitive test score.

Neural Plasticity Changes Induced by Motor Robotic Rehabilitation in Stroke Patients: The Contribution of Functional Neuroimaging.

Robotic rehabilitation is one of the most advanced treatments helping people with stroke to faster recovery from motor deficits. The clinical impact of this type of treatment has been widely defined and established using clinical scales. The neurofunctional indicators of motor recovery following conventional rehabilitation treatments have already been identified by previous meta-analytic investigations. However, a clear definition of the neural correlates associated with robotic neurorehabilitation treatment has never been performed. This systematic review assesses the neurofunctional correlates (fMRI, fNIRS) of cutting-edge robotic therapies in enhancing motor recovery of stroke populations in accordance with PRISMA standards. A total of 7, of the initial yield of 150 articles, have been included in this review. Lessons from these studies suggest that neural plasticity within the ipsilateral primary motor cortex, the contralateral sensorimotor cortex, and the premotor cortices are more sensitive to compensation strategies reflecting upper and lower limbs' motor recovery despite the high heterogeneity in robotic devices, clinical status, and neuroimaging procedures. Unfortunately, the paucity of RCT studies prevents us from understanding the neurobiological differences induced by robotic devices with respect to traditional rehabilitation approaches. Despite this technology dating to the early 1990s, there is a need to translate more functional neuroimaging markers in clinical settings since they provide a unique opportunity to examine, in-depth, the brain plasticity changes induced by robotic rehabilitation.

Body Image and Emotional Status in Patients with Acquired Brain Injury.

Emotional experiences can lead to a real or distorted self-representation. After brain damage, altered self-perception of one's own body image is frequent. This study evaluates the relationship of mood disorders and lesion sites on body image in a cohort of ABI patients. A total of 46 patients (26 men, 20 women) without severe physical impairments were found eligible for this study. Patients underwent Beck's Depression Inventory and the Hamilton Rating Scale for Anxiety to assess mood disorders, whereas the Body Image Scale and Human Figure Drawing were used to evaluate body dissatisfaction and implicit body image. The Montreal Cognitive Assessment was used to assess patients' cognitive condition. We found a moderate correlation between depression and body image (r = 0.48), as well as between anxiety and body image (r = 0.52), and the regression model also reported the right lesion site as a predictive variable for body image score. In addition, the regression model built by Human Figure Drawing scores showed anxiety, cognitive functioning, and a marital status of single to be significant predictors. The study confirmed that participants with acquired brain injury have deficits in body representation associated with mood disorders, regardless of the side of the lesions. A neuropsychological intervention could be useful for these patients to improve their cognitive performance and learn to manage emotional dysfunction in order to increase their self-perception of body image and improve their quality of life.

The Relationship between Body Image, Disability and Mental Health in Patients with Multiple Sclerosis.

BACKGROUND: Multiple sclerosis is a progressive degenerative disorder that frequently involves the development of physical and emotional changes, including loss of limb function or sensitivity, sexual dysfunction, and cognitive and mood alterations. It is likely that these alterations lead to changes in body aspects. However, knowledge about body image perception in multiple sclerosis is lacking. PURPOSE: The present study investigated the relationship between body image perception and its correlation with a disability, neuropsychiatric symptoms, and self-esteem. METHODS: A total of 100 outpatients with relapsing-remitting multiple sclerosis underwent neurological assessment using the Expanded Disability Status Scale. Participants also completed the Body Image Scale (BIS), Rosenberg Self-Esteem Scale (RSES), and Symptom Checklist-90-Revised (SCL-90-R). RESULTS: We found a significant positive correlation between body image and disability (r = 0.21; p = 0.03), body image and self-esteem (r = -0.52; p < 0.001), body image and somatization (r = 0.44; p < 0.001), body image and depression (r = 0.57; p < 0.001), and body image and anxiety (r = 0.5; p < 0.001). CONCLUSIONS: The body is considered one of the main parts of a person's identity. Dissatisfaction with one's own body changes the general evaluation of the "self". The body image construct has important health outcomes and should be studied more in patients with multiple sclerosis.

Role of Nutrition in the Etiopathogenesis and Prevention of Nonalcoholic Fatty Liver Disease (NAFLD) in a Group of Obese Adults.

Nonalcoholic fatty liver disease (NAFLD) is liver damage characterized by an accumulation of triglycerides in hepatocytes of >5% (due to an alteration of the balance of the lipid metabolism in favour of lipogenesis compared to lipolysis) that is not induced by the consumption of alcohol. The pathology includes simple steatosis and nonalcoholic steatohepatitis, or NASH (steatosis associated with microinflammatory activities), which can evolve in 15% of subjects with hepatic fibrosis to cirrhosis and the development of hepatocellular carcinoma. The aim of this study is to report the role of macro- and micronutrients in the pathogenesis and prevention of NAFLD in obese subjects. A total of 22 obese or overweight patients with hepatic steatosis were monitored periodically, evaluating their eating habits, fasting glycaemia, lipid picture, liver enzymes, anthropometric parameters, nutrition status, liver ultrasound, oxidative stress, and adherence to the Mediterranean diet. A statistical analysis shows a significant positive relationship between total cholesterol and the Mediterranean adequacy index (MAI) (r = -0.57; p = 0.005) and a significant negative relationship between ALT transaminases and the MAI (r = -0.56; p = 0.007). Nutrition and diet are important factors in the pathogenesis and prevention of NAFLD. The dietary model, based on the canons of the Mediterranean diet, prevents and reduces the accumulation of fat in hepatocytes. Therefore, in agreement with other studies in the literature, we can state that a dietary model characterized by foods rich in fibre, carotenoids, polyphenols, ω3 fatty acids, folic acid, and numerous other molecules is inversely correlated with the serum levels of ALT transaminases, an enzyme whose level increases when the liver is damaged and before the most obvious symptoms of organ damage appear.

Improvement of Self-Esteem in Children with Specific Learning Disorders after Donkey-Assisted Therapy.

Dyslexia is a learning disorder related to receptive language characterized by difficulties with decoding, fluent word recognition, automatic naming skills and/or reading comprehension skills. It usually leads to severe functional impairment and the permanent need for support and interventions. Since animal-assisted interventions (AAIs) have been found to improve physical, emotional, cognitive and/or social functioning in humans, the aim of this study is to demonstrate the effectiveness of onotherapy on children with SLD by improving self-esteem and school performance. Sixteen patients with a diagnosis of dyslexia were randomly assigned to two treatment groups: the first was a conventional neuropsychological group therapy without onotherapy, and the second was a neuropsychological group therapy incorporating AAIs with therapy donkeys. The neuropsychological assessment included the WISC-IV, DDE and the TMA test, which were administered before and after the treatment in both groups. The results of the experimental group show significant improvement in word reading test correctness (p = 0.03) and speed (p = 0.03), non-word reading test speed (p = 0.01), reading text test correctness (p = 0.05) and speed (p = 0.03), word writing test correctness (p = 0.01), non-word writing test correctness (p = 0.02), writing sentences with homophonic words correctness (p = 0.01), interpersonal TMA (p = 0.04) and the total TMA (p = 0.04), which were significative. On the other hand, in the control group, significant differences were found in word reading test speed (p = 0.01), non-word reading test speed (p = 0.04), reading text test speed (p = 0.02), writing word test correctness (p = 0.01), writing non-word test correctness (p = 0.01) and writing sentences with homophonic words (p = 0.01). However, in this group, we observed no significant difference in the esteem of children. Training associated with the donkeys determined improved scholastic performances as far as reading is concerned and a change in self-esteem. Therefore, we can state that AAIs for dyslexia could be a viable and effective option to enhance the rehabilitation process, increase self-esteem and improve cognitive functions and language skills recovery.

The effect of Computer Assisted Rehabilitation Environment (CAREN) in cognitive impairment and coping strategies in Parkinson's disease: a preliminary study.

Parkinson's disease is a neurodegenerative disorder characterized by different motor, vegetative, behavioral, and cognitive impairments, with worsening quality of life. Virtual reality devices have given promising results in neurorehabilitation as they can provide multisensory stimulation in a realistic environment. This study aims to test the efficacy of virtual reality training by using Computer Assisted Rehabilitation Environment in cognitive impairment in a sample of PD. 31 patients affected by PD were enrolled. All PD patients underwent 24 sessions of Computer Assisted Rehabilitation Environment training. The participants were assessed at baseline (T0) and after two months (T1). Our results suggested that Computer Assisted Rehabilitation Environment training may be effective in the cognitive and emotional domains, particularly by improving executive function, anxiety, and depressive symptoms. These changes have helped to improve self-efficacy and coping strategies. These results indicate greater cognitive and physical effort to overcome stressors. Our results show that Computer Assisted Rehabilitation Environment training was beneficial in improving cognitive functions. Longer duration training may be especially beneficial for patients with mild cognitive impairment. Our findings open the door to tailored personalized treatments based on the patient's motor and cognitive profiles.

Importance of telemedicine in mild cognitive impairment and Alzheimer disease patients population during admission to emergency departments with COVID-19.

In March 2020, the World Health Organization declared a global pandemic due to the new coronavirus SARS-CoV-2, and several governments have planned a national quarantine to control the spread of the virus. Acute psychological effects during hospitalization in frail elderly individuals with special needs, such as patients with dementia, have been little studied. The greatest distress manifested by these kinds of patients was isolation from their families during hospitalization. Thus, structured video call interventions were carried out to family caregivers of patients diagnosed with dementia during their hospitalization in the COVID-19 ward. The purpose of this quasi-experimental study was to assess changes in cognitive and behavioral symptoms in both patients and caregivers. All study participants underwent psychological assessments. Specifically, the psychological well-being states of patients and their caregivers were measured at admission (T0) and discharge (T1) using psychometric tests and clinical scales. Each participant received an electronic device to access video calls in addition meetings were scheduled with the psychologist and medical team to keep caregivers updated on the health status of their relatives. A psychological support and cognitive rehabilitation service was also provided. Significant differences were found in all clinical variables of the caregiver group. Results showed a significant relationship in the quality of life score between the patient and caregiver groups. The results of this study has highlighted the importance of maintaining significantly effective relationships during the hospitalization period of patients admitted to COVID wards.

Effects of Alcohol Consumption on Oxidative Stress in a Sample of Patients Recruited in a Dietary Center in a Southern University Hospital: A Retrospective Study.

Background and objectives: The aim of this retrospective study was to evaluate the effects of alcohol consumption on oxidative stress. Materials and Methods: The study was conducted by analyzing the increase in lipid peroxidation, the reduction of antioxidant defenses and the alteration of the oxidation/antioxidant balance after the administration of ethanol in 25% aqueous solution (v/v) at a concentration of 0.76 g/kg of body weight daily in two doses for 3 days. The changes in oxidative stress indices were investigated by standard methods previously described. Results: Ethanol administration has determined a significant increase in plasma levels of lipid hydroperoxide (LOOH), malonilaldehyde (MDA) and oxidized glutathione (GSSH), and a decrease in total antioxidant capacity (TAC), reduced glutathione (GSH) and GSH/GSSH ratio. Conclusions: In the proposed experimental condition, the excessive and repeated consumption of ethanol causes oxidative damage, as shown by the increase in lipid peroxidation, the reduction of antioxidant defenses and the alteration of the oxidation/antioxidant balance, which, at least in part, are responsible for the harmful effects of excess ethanol.

Effects of COVID-19 in Endocrine Patients: A Cross-Sectional Study.

Introduction: Home confinement due to COVID-19 lockdown led to changes in daily routines, including social interactions, as well as restrictions on the possibility of playing sports and eating habits. These changes could have a greater impact on patients suffering from chronic diseases, such as endocrine patients, especially in emotional and behavioral dimensions. Materials and Methods: This study aimed to assess the effects of COVID-19-induced quarantine on daily habits in a group of patients with endocrine disorders, focusing on food consumption, eating habits and sleep during the confinement. Eighty-five endocrine patients were enrolled. A structured interview was administered to investigate socio-demographic information, general medical conditions, and habits adopted during quarantine. All patients underwent the Spielberger State Anxiety Inventory (STAI-Y1) to assess state anxiety. Result: Results showed that subjects mainly had a sedentary lifestyle. We found a significant increase in the number of cigarettes in smokers and in meals consumed during confinement, as well as a high rate of sleep disturbance, especially insomnia. Notably, physical well-being resulted to be a predictive factor (OR = 0.38; 95%CI = [0.95,0.66]), whereas anxiety was a risk factor for sleep disorder (OR = 1.22; 95%CI = [1.10,1.40]), as was working in public and private offices and being a student. Conclusions: Changes in daily habits were likely due to the alterations in routine, resulting in greater boredom and inactivity during the day. In addition, future research should focus on the importance of patient adherence to therapy.

Feasibility, Usability, and Customer Satisfaction of the Tele-COVID19 Project, Sicilian Model.

Background and Objectives: In March 2020, COVID-19 pandemic affected the world. All countries, to limit viral transmission, imposed quarantine. This emergency exerted personal, social, economic, and psychological impact on people. For health systems, was needed to create alternative care pathways. Telemedicine can be helpful to reduce isolation, provide health care services, and monitor virus infections. Italian regions, including Sicily, have activated telemedicine services for management of patients with COVID-19. Objective: The purpose of study is to describe a Sicilian telemedicine model for management of COVID-19 patients, showing results on feasibility, usability and quality of service and patient satisfaction. Materials and Methods: This is a descriptive exploratory study on a telemedicine service for residents in Messina infected by COVID-19. It included monitoring of vital signs and specialist consultations (i.e., doctor, psychologists, social workers, and nutritionist biologists). Results: More than twenty percent (23.8%) of participants used tele-monitoring and tele-counselling services; 14.3% were only telemonitored. Participants judged positively telemedicine service (30% were quiet and 50% were very satisfied), as well as tool (70% were quiet and 10% were very satisfied). Telemonitoring had a low agreement (10% were slightly satisfied and 50% were neutral); tele-counselling had a high rate of satisfaction (40% quiet and 60% were very satisfied). Conclusions: This study showed that telemedicine model for Sicilian population affected by COVID-19 was feasible, easy to use and appreciated by patients. Our promising results allow us to assume that if in Sicily there was a return of the emergency, we would be ready to manage it This system can be the solution to remote management of these patients, to reduce isolation, provide health services, and monitor virus infections. The use of this technology should encourage future research to change the health care system and provides opportunities to ensure health and care for oneself and others.

Apathy and impulsiveness in Parkinson disease: Two faces of the same coin?

Apathy and impulsiveness are 2 common non-motor symptoms in Parkinson disease that could occur in different periods or simultaneously. Apathy and impulsiveness could be interpreted as opposite extremes of a spectrum of motivated behavior dependent on dopaminergic dysfunction, in which, impulsivity, is a result of a hyperdopaminergic state, whereas apathy is viewed as a hypodopaminergic. The study aimed to investigate the presence of impulsiveness and other neuropsychiatric symptoms in Parkinson disease patients with apathy symptoms. Eighty-one patients with Parkinson disease were enrolled in this retrospective study. All subjects were evaluated by the Italian version of the Dimensional Apathy Scale and the Barratt Impulsiveness Scale-version 11, to assess, respectively, apathy and impulsiveness; they were divided into 2 groups (apathy and no apathy). All patients were administered also with questionnaires assessing depressive and anxious symptoms. Statistical analyses showed relevant results. In no-apathy group, education was a significant predictor on impulsiveness (attentional and motor) and apathy (executive and emotional); depression was a significant predictor on planning impulsivity and apathy. This study aimed to consider the importance of apathy and impulsivity in Parkinson disease. Although these are considered as opposite extremes of a spectrum of motivated behavior dependent on dopaminergic dysfunction, these can also occur separately. Moreover, several variables could represent important predictors of apathy and impulsiveness, such as depression. Future investigations should deepen the role of other demographics and psychological variables.

Cognitive and Speech Rehabilitation in a Patient Affected by Takotsubo Cardiomyophathy: A Case Report.

Background and Objectives: Takotsubo Syndrome (TS) constitutes one of the most recent clinical realities in modern cardiology. It is clinically similar to the acute coronary syndrome, in the absence of obstructive coronary artery disease. Case Presentation: We described a case of a female patient affected by TS and left ventricular apical thrombus. Several studies described the cardiological syndrome, overlooking the neuropsychological and psychological outcomes. We aimed to assess the advantages of an integrated, multidisciplinary and multifunctional rehabilitation. Conclusions: This specific training contributed to reducing the tolerance to frustration given by her communication's difficulty. It has favored a good therapeutic alliance and a good success of the psychotherapeutic path, guaranteeing the reduction of her anxious symptoms and an improvement in the emotive and relational status.

Humanoid Robot Use in Cognitive Rehabilitation of Patients with Severe Brain Injury: A Pilot Study.

Severe acquired brain injury (SABI) is a major global public health problem and a source of disability. A major contributor to disability after SABI is limited access to multidisciplinary rehabilitation, despite evidence of sustained functional gains, improved quality of life, increased return to work, and reduced need for long-term care. Twelve patients with a diagnosis of SABI were enrolled and equally divided into two groups: experimental and control. Patients in both groups underwent intensive neurorehabilitation according to the severity of their disabilities (motor, psycho-cognitive, and sensory deficits). However, in the experimental group, the treatment was performed by using a humanoid robot. At baseline, the two groups differed significantly only in Severe Impairment Battery (SIB) scores. Results showed that the experimental treatment had a higher effect than the traditional one on quality of life and mood. In conclusion, this pilot study provides evidence of the possible effects of relational and cognitive stimulation in more severely brain-injured patients.

Early and Innovative Rehabilitation in Warkany Syndrome 2 Associated with Agenesis of the Corpus Callosum: A Case Report.

Trisomy 8 mosaicism syndrome (T8MS) or "Warkany's syndrome 2" is a rare chromosomal disorder characterized by three copies of chromosome 8 in some cells of the body. T8MS incidence in the world population is about 1/25,000-50,000 live births with a 5:1 ratio between males and females. Since chromosomal mosaicism is often present in this syndrome, affected subjects present a phenotype varying from mild dysmorphism to severe structural anomalies. Malformations, including corpus callosum agenesis and renal abnormalities, have been described by many studies. We present a case in a girl 36 months in age, born to assisted fertilization (FIVET) and prenatal diagnosis by amniocentesis. In a fetus in the 22 week of gestation, she presented trisomy 8 mosaicism with ventriculomegaly, agenesis of the corpus callosum and a sequence of polymalformations. Through the early identification of symptoms that gradually occurred during development, the girl was submitted, early, to innovative complex instrumental using virtual reality (VR) rehabilitation. This study involves continuous monitoring and early management of symptoms, with the aim of improving the neurobehavioral outcomes of children with this rare disease by inducing structural neuroplastic responses and significantly reducing the impact that this disorder has on the development of children born without corpus callosum.

Investigations of Personality Trait in Subacute Post-Stroke Patients: Some Preliminary Observations.

BACKGROUND AND OBJECTIVES: Personality change is an important psychiatric complication following stroke linked to severe affective dysregulation and behavioral alterations. METHODS: We investigated personality traits in 20 patients (age 45.37 ± 13.41 years) with subacute stroke submitted to rehabilitation training within 1-3 months after a first-onset stroke. All patients underwent psychological evaluation by using the Personality Inventory for DSM-5 for adults (PID-5), a specific instrument that enables traits (dimensions and facets) to be assessed by providing a personality profile, and the Inventory of Interpersonal Problems 47 (IIP-47), a brief and valid self-report measure for screening personality disorders. RESULTS: Personality change was identified by a positive correlation IIP-47 and PID-5 (r = 0.76; p = 0.03). Our patients, after a stroke, presented maladaptive personality traits associated with negative affect such as anxiety, emotional lability, and rigid perfectionism, and they reported interpersonal problems. These negative affective disorders correlated positively with cluster C personality disorders, including the avoidant, dependent, and obsessive compulsive personality disorders. CONCLUSION: Preliminary results show personality changes in stroke survivors. The evaluation of personality changes could be useful to improve the management of the patient's behavioral alterations in a familiar environment and permit the possibility of prevention of psychological distress of the patients and their respective caregivers.