Publications by authors named "Orsucci D"

Background: Sex may impact clinical outcomes in patients with stroke treated with dual antiplatelet therapy (DAPT). We aimed to investigate the sex differences in the short-term outcomes of DAPT within a real-world population of patients with noncardioembolic mild-to-moderate ischemic stroke or high-risk transient ischemic attack.

Methods: We performed a propensity score-matched analysis from a prospective multicentric cohort study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]) by including patients with noncardioembolic mild-to-moderate stroke (National Institutes of Health Stroke Scale score of 0-10) or high-risk transient ischemic attack (age, blood pressure, clinical features, duration of transient ischemic attack, presence of diabetes [ABCD] ≥4) who initiated DAPT within 48 hours of symptom onset.

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  • Primary mitochondrial disorders (PMDs) are rare and complex conditions resulting from faults in the mitochondrial respiratory chain, leading to significant clinical variability among patients.
  • Studying these disorders is challenging due to low statistical power in single-center studies and the wide range of symptoms even among individuals with identical genotypes.
  • Recent years have seen significant progress through multicenter research efforts and the establishment of national and international registries for mitochondrial patients, enhancing our understanding of PMDs and paving the way for future developments.
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Background: According to the literature, about one third of patients with brain ischemic symptoms lasting <24 h, which are classified as Transient ischemic attacks (TIAs) according to the traditional "time-based" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.

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  • - Short-term dual antiplatelet treatment (DAPT) shows better effectiveness compared to single antiplatelet treatment (SAPT) for preventing secondary strokes in patients with mild to moderate strokes and high-risk TIAs, according to a study of 2016 patients.
  • - Patients treated with DAPT had a higher likelihood of regaining pre-stroke neurological function within 90 days and showed more early neurological improvement compared to those on SAPT.
  • - The study suggests that DAPT might be a safer and more effective option than SAPT in real-world settings, even for patients not fitting the criteria of major clinical trials.
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  • - The study analyzes the short-term outcomes of patients with minor ischemic stroke from small artery occlusion (SAO-MIS) treated with dual antiplatelet therapy (DAPT) and compares them to patients with other causes of minor strokes.
  • - In a sample of 678 minor ischemic stroke patients, SAO-MIS showed low rates of primary outcomes (1.2% had major cardiovascular events) and a high proportion achieving excellent functional outcomes (75.5%) within 90 days.
  • - Results indicate that SAO-MIS patients have a significantly lower risk of recurrent vascular events compared to non-SAO-MIS patients, while showing similar safety outcomes, suggesting that DAPT is beneficial for SAO-M
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Background: The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS.

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Article Synopsis
  • Short-term dual antiplatelet therapy (DAPT) has been shown to be effective in preventing recurrent strokes after minor ischemic stroke or high-risk transient ischemic attack (TIA) in controlled trials, prompting a need to evaluate its real-world efficacy and safety.
  • The READAPT study observed 1,920 patients in a real-world setting, finding that only a small percentage followed strict research protocols; however, the overall rates of stroke or death due to vascular causes were low (3.9%) and serious bleeding events were rare (0.6%).
  • Most patients did not meet the strict criteria of randomized controlled trials, yet DAPT proved to be both effective and safe, especially in patients with lower NIHSS scores and delayed treatment
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Cerebellar ataxia is a neurological syndrome characterized by the imbalance (e.g., truncal ataxia, gait ataxia) and incoordination of limbs while executing a task (dysmetria), caused by the dysfunction of the cerebellum or its connections.

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Objective: Essential Tremor (ET) is one of the most common neurological disorders. In most instances ET is inherited as an autosomal dominant trait with age-related penetrance (virtually complete in advanced age); however, ET genetics remains elusive. The current study aims to identify possibly pathogenic genetic variants in a group of well-characterized ET families.

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  • Fabry disease (FD) is a rare genetic disorder linked to strokes, and there's ongoing debate about when to test for it in stroke patients.
  • This study, part of the Fabry-Stroke Italian Registry, screened nearly 1,906 stroke patients for FD by checking alpha-galactosidase A activity and conducting genetic tests, identifying a small number of affected individuals.
  • The findings suggest that limiting FD screening only to cryptogenic strokes could miss a significant number of cases, highlighting the importance of recognizing clinical signs that may indicate the need for testing.
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Objectives: Oculodentodigital dysplasia (ODDD) is a rare autosomal dominant congenital malformation syndrome characterized by high penetrance and great phenotypic heterogeneity. Neurological manifestations are thought to occur in about one third of cases, but systematic studies are not available. We performed deep neurological phenotyping of 10 patients in one ODDD pedigree.

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  • SCN8A variants are linked to various epilepsy and neurodevelopmental disorders, with this study specifically examining ataxia symptoms resulting from these genetic changes.
  • Genetic and electro-clinical data were collected from ten individuals with novel SCN8A variants, revealing distinct effects on sodium current densities and neuronal activity.
  • Findings indicate that chronic ataxia correlates with significant loss-of-function effects, while episodic ataxia may involve both gain and loss of function; sodium channel blockers may worsen symptoms.
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Background: Telemedicine (TM) contributes to bridge the gap between healthcare facilities and patients' homes with neuromuscular disease (NMD) because of mobility issues. However, its deployment is limited due to difficulties evaluating subtle neurological signs such as mild weakness or sensory deficits. The COVID-19 pandemic has disrupted healthcare delivery worldwide, necessitating rapid measures implementation by health care providers (HCPs) to protect patients from acquiring SARS-CoV-2 while maintaining the best care and treatment.

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A mitochondrial stroke-like event is an evolving subacute neurological syndrome linked to seizure activity and focal metabolic brain derangement in a genetically determined mitochondrial disorder. The acronym "MELAS" (mitochondrial encephalopathy associated with lactic acidosis and stroke-like lesions) identifies subjects with molecular, biochemical and/or histological evidence of mitochondrial disorder who experience stroke-like lesions. MELAS is a rare inherited mitochondrial disease linked to severe multiorgan involvement and stress-induced episodes of metabolic decompensation and lactic acidosis.

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Although larger trinucleotide expansions give rise to a neurodevelopmental disorder called fragile X syndrome, fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder caused by a "premutation" (55-200 CGG repeats) in the gene. FXTAS is one of the more common single-gene forms of late-onset ataxia and tremor that may have a more complex development in women, with atypical presentations. After a brief presentation of the atypical case of an Italian woman with FXTAS, who had several paroxysmal episodes suggestive of acute cerebellar and/or brainstem dysfunction, this article will revise the phenotype of FXTAS in women.

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Until recently, most general neurologists were not interested in neurogenetics [...

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Mitochondrial disorders are a remarkably complex group of diseases caused by impairment of the mitochondrial respiratory chain (or electron transport chain) [...

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Background: TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician's attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations.

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Letter to the Editor in response to Finsterer J, Scorza FA, Scorza CA. Presentation and pathophysiology of neuro-COVID. .

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Mitochondrial diseases (MDs) are a large group of genetically determined multisystem disorders, characterized by extreme phenotypic heterogeneity, attributable in part to the dual genomic control (nuclear and mitochondrial DNA) of the mitochondrial proteome. Advances in next-generation sequencing technologies over the past two decades have presented clinicians with a challenge: to select the candidate disease-causing variants among the huge number of data provided. Unfortunately, the clinical tools available to support genetic interpretations still lack specificity and sensitivity.

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Introduction: Both prevalence and clinical features of the various movement disorders in adults with primary mitochondrial diseases are unknown.

Methods: Based on the database of the "Nation-wide Italian Collaborative Network of Mitochondrial Diseases", we reviewed the clinical, genetic, neuroimaging and neurophysiological data of adult patients with primary mitochondrial diseases (n = 764) where ataxia, myoclonus or other movement disorders were part of the clinical phenotype.

Results: Ataxia, myoclonus and movement disorders were present in 105/764 adults (13.

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Movement disorders are increasingly being recognized as a manifestation of childhood-onset mitochondrial diseases (MDs). However, the spectrum and characteristics of these conditions have not been studied in detail in the context of a well-defined cohort of patients. We retrospectively explored a cohort of individuals with childhood-onset MDs querying the Nationwide Italian Collaborative Network of Mitochondrial Diseases database.

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Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy's "first wave" was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on "severe" ( = 99) or "mild" ( = 232) outcomes.

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In the last ten years, the knowledge of the genetic basis of mitochondrial diseases has significantly advanced. However, the vast phenotypic variability linked to mitochondrial disorders and the peculiar characteristics of their genetics make mitochondrial disorders a complex group of disorders. Although specific genetic alterations have been associated with some syndromic presentations, the genotype-phenotype relationship in mitochondrial disorders is complex (a single mutation can cause several clinical syndromes, while different genetic alterations can cause similar phenotypes).

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