Facial palsy after administration of immune checkpoint inhibitors: case report, literature review and clinical care management.

Neurological immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI) are rare complications of immunotherapy, particularly dreadful for patients and clinical teams. Indeed, neurological irAEs are potentially severe and their diagnosis require prompt recognition and treatment. Additionally, the spectrum of neurological irAEs is broad, affecting either neuromuscular junction, peripheral or central nervous system. Here, we described the case of a 55-year man with metastatic melanoma, facing a brutal right peripheral cerebral palsy after his third ipilimumab/nivolumab infusion. After the case presentation, we reviewed the literature about this rare complication of immunotherapy, and described its diagnosis work-up and clinical management.

Face to Face: deciphering facial involvement in inclusion body myositis.

OBJECTIVE: The objective of this study is to evaluate the frequency and characteristics of facial involvement in inclusion body myositis (IBM) patients and to compare it to the one previously described in facioscapulohumeral dystrophy (FSHD) patients. METHODS: Thirty-two IBM patients were included and compared to 29 controls and 39 FSHD patients. All participants were recorded in a video as they performed a series of seven facial tasks. Five raters independently assessed facial weakness using both a qualitative evaluation and a semi-quantitative facial weakness score (FWS). RESULTS: IBM patients had higher FWS than controls (7.89 ± 7.56 vs 1.06 ± 0.88, p < 0.001). Twenty IBM patients (63%) had a facial weakness with a FWS above the maximum value for controls. All facial tasks were significantly more impaired in IBM patients compared to controls (p < 0.001), task 2 evaluating orbiculari oculi muscle weakness being the most affected. IBM patients with facial weakness reported more swallowing troubles than IBM patients without facial weakness (p = 0.03). FSHD patients displayed higher FWS than IBM patients (12.16 ± 8.37 vs 7.89 ± 7.56, p = 0.01) with more pronounced facial asymmetry (p = 0.01). FWS inter-rater ICC was 0.775. CONCLUSION: This study enabled us to estimate the frequency of facial impairment in IBM in more than half of patients, to detail its characteristics and to compare them with those of FSHD patients. The standardized, semi-quantitative FWS is an interesting diagnostic help in IBM as it appeared more sensitive than qualitative evaluation to detect mild facial weakness.

The Dynamic Interplay of Affective, Cognitive and Contextual Resources on Children's Creative Potential: The Modulatory Role of Trait Emotional Intelligence.

In the present work we explored in two separate studies the modulatory role of trait emotional intelligence (EI) over the effect exerted on children's creative potential by two other key elements defining creativity, namely cognitive resources (here explored through basic executive functions, Study 1) and contextual-environmental factors (that is, teachers' implicit conceptions of the factors influencing children's creativity, Study 2). Confirming previous research, executive functions (particularly interference control and working memory) emerged as main predictors of children's creative performance; however, their positive effect arose especially when associated with a high trait EI level. In the same vein, teachers' implicit conception about children's creative potential and about their efficacy in teaching creativity emerged to exert a facilitatory effect on children' creative potential. This effect occurred particularly when associated with low trait EI levels, affecting differently girls and boys. Trait EI emerged from these studies as an important individual resource to consider in order to understand the potential benefit of other (cognitive and contextual-environmental) resources on children's creative potential. The implications on the role of trait EI as a constitutional element of children's creativity, capable of promoting the expression of their creative potential, are discussed.

Dopamine supports idea originality: the role of spontaneous eye blink rate on divergent thinking.

The neurotransmitter dopamine plays a crucial role in human creative behaviour. Specifically, striatal dopamine seems to be associated with specific dimensions of divergent thinking performance, especially with categorical diversity (flexibility) of ideas. In experimental contexts, spontaneous Eye Blink Rate (sEBR) has been used as a proxy for striatal dopamine, and an inverted U-shape relationship between sEBR and flexibility has been demonstrated, such that a medium sEBR level predicts highest flexibility levels. The present study aimed at carrying out further investigations about the relationship between sEBR and idea generation through divergent thinking, specifically focusing on the relationship between idea originality and dopamine level, since originality is a key element for creativity. We asked 80 participants, whose sEBR at rest was measured, to perform an Alternative Uses Task (AUT) to measure their divergent thinking performance. Results revealed that the relationship between sEBR and originality, as measured through subjective ratings of external raters, followed an inverted U-shape function with medium sEBR being associated with highest originality scores. Moreover, and most importantly, we demonstrated that sEBR predicted originality through the mediation of flexibility. Our results provide further insights on the possible role of dopamine on divergent thinking performance, demonstrating that an adequate dopamine level may facilitate the generation of original ideas through the exploration of diverse conceptual categories (higher flexibility).

Creative Potential in Science: Conceptual and Measurement Issues.

This paper examines the concept of creative potential as it applies in science. First, conceptual issues concerning the definition of creative potential are explored, highlighting that creative potential is a moving target, and measures of creative potential are estimates of future behavior. Then three main ways to detect creative potential are examined. First, a person's previous accomplishments in science can be analyzed. These accomplishments can be regarded as predictors of future creative performance. Second, science talent competitions can help to detect creative potential in children and adolescents. There are particular types of talent competitions differing from each other by the extent of focusing on individual (e.g., Science Fairs) or collaborative (e.g., Science Olympiads) work. Third, to measure an individual's creative potential, psychometric tools such as Creative Scientific Ability Test (C-SAT), Test of Scientific Creativity Animations for Children (TOSCAC), and Evaluation of Potential Creativity (EPoC) can be used. These tools are conceptualized in terms of two scientific activities: hypothesis generation and hypothesis testing. In a final section, these three types of measures are placed in a novel time-space framework as applied to creative potential. Suggestions for future work are also discussed.

Being creative during lockdown: The relationship between creative potential and COVID-19-related psychological distress in narcolepsy type 1.

The national lockdown imposed in several countries to counteract the coronavirus disease 2019 (COVID-19) pandemic led to an unprecedented situation with serious effects on mental health of the general population and of subjects affected by heterogeneous diseases. Considering the positive association between narcoleptic symptoms and creativity, we aimed at exploring the psychological distress associated with COVID-19 restrictions and its relationship with depressive symptoms and creativity in patients with narcolepsy type 1 (NT1). A total of 52 patients with NT1 and 50 healthy controls, who completed a previous study on creativity, were contacted during the first lockdown period to complete an online survey evaluating psychological distress related to the COVID-19 outbreak, sleep quality, narcolepsy and depressive symptoms, and creative abilities. The patients with NT1 showed an improvement in subjective sleepiness while controls reported worsening of sleep quality during the lockdown. Depression and NT1 symptom severity proved significant predictors of COVID-19-related distress. Creative performance, namely generative fluency, turned out to be a favourable moderator in the relationship between depression and patients' distress, reducing the detrimental effect of depression on the patients' wellbeing. On the contrary, creative originality proved to be a disadvantageous moderator in the relationship between NT1 symptom severity and the distress associated with this traumatic event indicating a higher vulnerability to developing COVID-19-related distress, particularly evident in patients displaying higher originality. Overall, these results highlight a crucial role of creativity in patients with NT1, suggesting that creative potential could be used as a protective factor against the development of distress associated with the lockdown.

Cognitive dysfunction in central disorders of hypersomnolence: A systematic review.

Central disorders of hypersomnolence (CDH) are characterized by excessive daytime sleepiness not related to comorbid sleep or medical disturbances. We systematically examined scientific literature on cognitive functions in patients suffering from CDH. Forty-eight studies proved eligible and were analyzed separately for Narcolepsy Type 1 (NT1), Narcolepsy Type 2 (NT2), Idiopathic hypersomnia (IH) and Kleine-Levin syndrome (KLS). Results were grouped into the cognitive domains of attention, memory, executive functions and higher order cognition. Consistent attention impairments emerged in NT1, NT2 and IH patients, with NT1 patients showing the most compromised profile. Memory functions are largely unimpaired in CDH patients except for KLS patients who display memory deficit. Executive functions and higher-order cognition have been assessed in NT1 while they received little-to-no attention in the other CDH. NT1 patients display high performance in executive functions but exhibit a complex pattern of impairment in higher-order cognition, showing poor decision-making and impaired emotional processing. Moreover, NT1 patients show increased creative abilities. Assessing and monitoring cognitive impairments experienced by CDH patients will allow the design of personalized interventions, parallel to pharmacological treatment, aimed at improving daytime functioning and quality of life of these patients.

Clustering and switching in divergent thinking: Neurophysiological correlates underlying flexibility during idea generation.

EEG alpha synchronization, especially in posterior parietal cortical regions of the right hemisphere, is indicative of high internal processing demands that are typically involved in divergent thinking (DT). During the course of DT, as ideation proceeds, ideas tend to become more creative, being more likely to be drawn from new conceptual categories through the use of the cognitive mechanism of flexibility. The present study investigated whether EEG alpha synchronization can be modulated by flexibility in DT by comparing cortical activation patterns during the switch of category (switching) and the stay in the same category (clustering). Twenty participants were required to generate alternative uses of everyday objects during EEG recording. Differential results were specifically found in the lower alpha band (8-10 Hz): whereas clustering showed synchronization typically lateralized in the right posterior parietal areas, switching induced posterior parietal synchronization over both right and left hemispheres. These findings indicate that the two distinct cognitive mechanisms subsuming flexibility (switching and clustering) are associated with a different hemispheric modulation of lower alpha activity, as switching, in comparison to clustering, is related to higher power in the lower alpha band over the left hemisphere. Switching in comparison to clustering may thus require a larger investment of cognitive resources due to the exploratory process of moving from one semantic conceptual category to another in the course of creative ideation.

Creativity in Narcolepsy Type 1: The Role of Dissociated REM Sleep Manifestations.

PURPOSE: A higher creative potential has been reported in narcoleptic patients and linked to lucid dreaming. The aim of the present study was to explore the role of narcolepsy symptoms (presence and severity) in predicting creativity. PATIENTS AND METHODS: Sixty-six consecutive type 1 narcolepsy patients (mean age 38.62 ± 17.05, 31 females) took part in this study. Creative achievement in different life domains and creative beliefs were assessed by a self-reported questionnaire and a scale measuring the creative self, respectively; creative performance was measured through a divergent thinking test (generation of alternative original solutions to an open problem). RESULTS: We found a key effect of hypnagogic hallucinations in modulating creative behaviour. We therefore tested at first whether hypnagogic hallucinations could interact with specific mental states associated with creativity and in particular mind wandering, a factor associated with both creative performance and achievement. Secondly, we verified if hypnagogic hallucinations could influence the definition of creative identity in type 1 narcolepsy patients, which in turn could predict their creative achievement and creative performance. Results showed that spontaneous mind wandering influenced creative achievement through a moderation effect of sleep paralysis and hypnagogic hallucinations. Moreover, sleep paralysis and hypnagogic hallucinations indirectly influenced, through creative identity, both creative achievement and performance (fluency score). CONCLUSION: Our results highlight the role of hypnagogic hallucinations in triggering the process of mind wandering which leads to greater creative success. In addition, this symptom affects creative identity in narcolepsy, leading in turn to higher creative success and creative potential of narcoleptic patients.

The Big Bang of Originality and Effectiveness: A Dynamic Creativity Framework and Its Application to Scientific Missions.

This article introduces a theoretical framework to conceptualize the dynamics of the phenomenon of creativity, which is then applied to the specific case of scientific missions for the exploration of the universe. Static definitions of creativity are insufficient for this purpose, as they fail to describe states of creative inconclusiveness as well as the time and culture-dependent estimation of the value of the outcomes of a creative process; therefore, a dynamic definition of creativity is introduced, justified, and adopted to build a dynamic creativity framework. Within this framework, creativity episodes are shown to be mutually interconnected through several mechanisms (past and future concatenation, estimation, and exaptation), to form a dynamic universal creativity process (DUCP), the beginning of which can be traced back to the Big Bang of our universe. The DUCP entails several layers of complexity (material, biological, sociocultural, and artificial), showing that creativity is not only a psychological construct for humans but rather a unifying cosmological principle. Context embeddedness is discussed in-depth, introducing a taxonomy based on the concepts of tightness and looseness as applied to conceptual space and time. This theoretical framework is, then, applied to the discussion of the design, realization, and operations of scientific missions for the exploration of the universe, taking as a reference the terminology adopted by the European Space Agency.

Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy.

BACKGROUND: Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP-TST) and MRI in the detection of abnormalities of the brachial plexus. METHODS: Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. RESULTS: MEP-TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). CONCLUSIONS: MEP-TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.

Intelligence and Creativity: Mapping Constructs on the Space-Time Continuum.

This theoretical article proposes a unified framework of analysis for the constructs of intelligence and creativity. General definitions for intelligence and creativity are provided, allowing fair comparisons between the two context-embedded constructs. A novel taxonomy is introduced to classify the contexts in which intelligent and/or creative behavior can be embedded, in terms of the tightness vs. looseness of the relevant conceptual space S and available time T. These two dimensions are used to form what is identified as the space-time continuum, containing four quadrants: tight space and tight time, loose space and tight time, tight space and loose time, loose space and loose time. The intelligence and creativity constructs can be mapped onto the four quadrants and found to overlap more or less, depending on the context characteristics. Measurement methodologies adapted to the four different quadrants are discussed. The article concludes with a discussion about future research directions based on the proposed theoretical framework, in terms of theories and hypotheses on intelligence and creativity, of eminent personalities and personality traits, as well as its consequences for developmental, educational, and professional environments.

Predicting response originality through brain activity: An analysis of changes in EEG alpha power during the generation of alternative ideas.

Growing neurophysiological evidence points to a role of alpha oscillations in divergent thinking (DT). In particular, studies have shown a consistent EEG alpha synchronization during performance on the Alternative Uses Task (AUT), a well-established DT task. However, there is a need for investigating the brain dynamics underlying the production of a sequence of multiple, alternative ideas at the AUT and their relationship with idea originality. In twenty young adults, we investigated changes in alpha power during performance on a structured version of the AUT, requiring to ideate four alternative uses for conventional objects in distinct and sequentially balanced time periods. Data analysis followed a three-step approach, including behaviour aspects, physiology aspects, and their mutual relationship. At the behavioural level, we observed a typical serial order effect during DT production, with an increase of originality associated with an increase in ideational time and a decrease in response percentage over the four responses. This pattern was paralleled by a shift from alpha desynchronization to alpha synchronization across production of the four alternative ideas. Remarkably, alpha power changes were able to explain response originality, with a differential role of alpha power over different sensor sites. In particular, alpha synchronization over frontal, central, and temporal sites was able to predict the generation of original ideas in the first phases of the DT process, whereas alpha synchronization over centro-parietal sites persistently predicted response originality during the entire DT production. Moreover, a bilateral hemispheric effect in frontal sites and a left-lateralized effect in central, temporal, and parietal sensor sites emerged as predictors of the increase in response originality. These findings highlight the temporal dynamics of DT production across the generation of alternative ideas and support a partially distinct functional role of specific cortical areas during DT.

Creativity in the Advertisement Domain: The Role of Experience on Creative Achievement.

The creativity of an advertisement campaign is one of the most relevant predictors of its success. Past research has highlighted the relevance of domain-specific experience in enhancing creativity, but the results are controversial. We explored the role of work experience, in terms of number of years spent in the advertisement domain, in various forms of creativity expressed within this specific working domain. We hypothesized a mediator role of experience in the relationship between the individual's creative potential, as measured through a series of divergent thinking tasks, and creative achievement in the advertisement domain. Moreover, considering the importance of personality in creative achievement, we also explored the influence of the openness-to-experience on advertisers' creative achievement. A range of measures assessing creative achievement, openness, and divergent thinking abilities in terms of fluency and originality were administered to a group of professionals in the advertisement domain. The results demonstrate a crucial role for experience in the connection between originality and creative achievement. Moreover, our findings extend previous studies by showing that fluency and openness are significant predictors of creative achievement in the advertisement environment. These results emphasize the importance of canalizing the advertiser's divergent thinking abilities through appropriate routes provided by working experience, raising important implications for future explorations of domain-specific creative achievement within an individual differences framework. Final indications for future developments are provided, with a special emphasis on the replication of these findings in various work domains and in various cultural contexts.

How does emotion influence the creativity evaluation of exogenous alternative ideas?

The interaction of emotions with creative cognition is one of the most intriguing topics in the creativity research. In this study, we investigated the extent to which various emotional states influence the evaluation of ideas, which is a crucial component of the creative thinking process. To this end, we used emotional (both positive and negative) and neutral pictures to induce emotional states and then asked participants to evaluate the creativity of exogenous ideas (i.e., those generated by other people) as part of an alternative use evaluation task. As the results of previous studies suggest the existence of a negative bias when judging highly creative ideas, we presented the participants with non-creative, moderately creative, and highly creative uses for everyday objects. Overall, the participants gave higher creativity ratings when under positive emotional engagement than when in negative or neutral conditions. Moreover, neutral and emotional context differently moderated the creativity evaluation of the three object use categories. Specifically, participants gave higher ratings for non-creative uses, and (to a lesser extent) for highly creative uses when in a positive emotional state, than they did when in the neutral condition. On the other hand, when in a negative emotional state, the participants gave lower ratings for moderately creative uses than they did in either the positive or neutral conditions. These data provide initial evidence that emotional states can influence the creativity evaluation of exogenous alternative ideas that are generated through divergent thinking.

Enhancing creative cognition with a rapid right-parietal neurofeedback procedure.

The present article describes an innovative neurofeedback training (NFT) procedure aimed at increasing creative cognition through the enhancement of specific brain activities previously associated with divergent thinking. We designed and tested two NFT protocols based on training alpha and beta EEG oscillations selectively measured over the right parietal region. A total of 80 participants were involved, 40 in the alpha NFT protocol and 40 in the beta NFT protocol. The NFT loop was closed on a video stream that would advance only when oscillation power exceeded a normalized threshold. The total duration of the protocol was two hours in a single day, hence its classification as rapid. Changes in ideational fluency and originality, measured with a divergent thinking task, were compared between participants receiving real video feedback and participants receiving sham feedback. We controlled for individual differences in creative achievement level. Results showed that the protocols were effective at enhancing alpha and beta activities in the targeted area. Differences between the two protocols emerged in their effectiveness at promoting divergent thinking. While no significant changes in originality resulted from the rapid alpha NFT, increases in both originality and fluency emerged as a consequence of the rapid beta NFT. These results were particularly evident in participants starting with a low creative achievement level. Possible interpretations and future directions are proposed and discussed.

Organic Creativity for Well-Being in the Post-Information Society.

The editorial dwells upon the technology-driven evolution from the Industrial to the Post-Information Society, indicating that this transition will bring about drastic transformations in our way of living, starting from the job market and then pervading all aspects at both individual and social levels. Great opportunities will come together with unprecedented challenges to living as we have always known it. In this innovation-filled scenario, it is argued that human creativity becomes the distinctive ability to provide dignity at first and survival in the long term. The term organic creativity is introduced to indicate those conditions, attitudes, and actions that bear the potential to be at the same time productive in socio-economic terms and conducive to human well-being. As a consequence, the role of psychologists in an open cooperation with sociologists, economists, computer scientists, engineers and others, will be as central as ever in establishing healthy collaboration modes between humans and machines, and large investments in related multidisciplinary scientific research are advocated to establish organic creativity as a discipline that should permeate every educational level, as well as our professional and everyday lives.