Publications by authors named "Piantino J"
Article Synopsis
- * A study of veterans revealed significant reductions in heart rate variability (HRV) during NREM sleep for RBD+NT participants, indicating greater autonomic dysfunction.
- * These findings suggest that HRV during sleep could serve as an early biomarker for diagnosing and understanding neurodegenerative conditions in individuals with RBD+NT.
The glymphatic pathway was defined in rodents as a network of perivascular spaces (PVSs) that facilitates organized distribution of cerebrospinal fluid (CSF) into the brain parenchyma. To date, perivascular CSF and cerebral interstitial fluid exchange has not been shown in humans. Using intrathecal gadolinium contrast-enhanced MRI, we show that contrast-enhanced CSF moves through the PVS into the parenchyma, supporting the existence of a glymphatic pathway in humans.
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- A recent study investigated how MRI-visible perivascular spaces (MV-PVS) develop in adolescents and young adults, focusing on their volume and how factors like age, sex, and BMI affect these changes.
- The study analyzed data from 783 healthy participants aged 12-21 over five years, revealing that males consistently had larger MV-PVS volumes than females.
- It was found that for females, increases in body mass index (BMI) were linked to increases in MV-PVS volume, suggesting a relationship between sex, BMI, and MV-PVS that could inform future research.
Article Synopsis
- The study investigates the relationship between perivascular space (PVS) volume in the brain and lifetime exposure to repetitive head impacts (RHI) in individuals at risk for neurodegenerative diseases, particularly focusing on former American football players.
- Conducted across four US study sites from 2016 to 2020, the research involved 224 participants, including 170 former football players and 54 control participants, with analyses exploring how PVS volume correlates with cognitive impairment.
- Results showed that former football players exhibited larger PVS volumes compared to the control group, suggesting that RHI exposure could contribute to changes in brain structure associated with neurodegeneration.
Article Synopsis
- Mild traumatic brain injury (mTBI), especially from blast exposure, is linked to a higher risk of developing neurodegenerative diseases like Alzheimer's and chronic traumatic encephalopathy, particularly in military personnel.
- Research showed distinct changes in the expression of AQP4, a protein important for brain fluid dynamics, in the frontal cortex after blast exposure in both humans and a mouse model.
- Veterans with blast mTBI exhibited MRI-visible changes that suggest disruption of brain fluid clearance, which may contribute to lasting symptoms and long-term brain health issues.
Article Synopsis
- During long spaceflights, astronauts experience fluid shifts and changes in brain spaces, creating challenges for understanding their effects due to the difficulty of studying them directly.
- This study analyzed the effects of head-down tilt bed rest (HDBR) and elevated carbon dioxide on the brain's perivascular spaces, which simulate conditions in space.
- Results showed that while overall changes in these spaces were minimal, individuals with symptoms of Spaceflight Associated Neuro-ocular Syndrome (SANS) had different responses, suggesting the need for countermeasures to protect astronauts' health during space missions.
Blast-related mild traumatic brain injury (mTBI) is recognized as the "signature injury" of the Iraq and Afghanistan wars. Sleep disruption, mTBI, and neuroinflammation have been individually linked to cerebral perivascular space (PVS) dilatation. Dilated PVSs are putative markers of impaired cerebrospinal fluid (CSF) and interstitial fluid exchange, which plays an important role in removing cerebral waste.
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- Sleep disturbances are linked to dementia and cognitive decline, but the relationship between changing sleep patterns and cognitive impairment over time is not fully understood.
- This study aimed to analyze how variations in sleep duration affect cognitive function in healthy older adults over several years.
- By examining data from the Seattle Longitudinal Study, researchers assessed sleep duration and cognitive performance to evaluate potential connections between sleep patterns and cognitive health in older individuals.*
Background: Compared to standard neuro-diagnostic techniques, retinal biomarkers provide a probable low-cost and non-invasive alternative for early Alzheimer's disease (AD) risk screening. We have previously quantified the periarteriole and perivenule capillary free zones (mid-peripheral CFZs) in cognitively unimpaired (CU) young and older adults as novel metrics of retinal tissue oxygenation. There is a breakdown of the inner retinal blood barrier, pericyte loss, and capillary non-perfusion or dropout in AD leading to potential enlargement of the mid-peripheral CFZs.
View Article and Find Full Text PDFPurpose: Delayed treatment in status epilepticus (SE) is independently associated with increased treatment resistance, morbidity, and mortality. We describe the prehospital management pathway and Emergency Medical Services (EMS) timeliness in children who developed refractory convulsive status epilepticus (RCSE).
Methods: Retrospective multicenter study in the United States using prospectively collected observational data from June 2011 to March 2020.
Importance: Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions. It remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment.
Objective: To evaluate how longitudinal sleep patterns contribute to age-related changes in cognitive function in healthy adults.
Importance: Morbidity and mortality after pediatric cardiac arrest are chiefly due to hypoxic-ischemic brain injury. Brain features seen on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) after arrest may identify injury and aid in outcome assessments.
Objective: To analyze the association of brain lesions seen on T2-weighted MRI and diffusion-weighted imaging and N-acetylaspartate (NAA) and lactate concentrations seen on MRS with 1-year outcomes after pediatric cardiac arrest.
Background And Objectives: The objective of this study was to determine patient-specific factors known proximate to the presentation to emergency care associated with the development of refractory convulsive status epilepticus (RSE) in children.
Methods: An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to stop their seizures (RSE). These subpopulations were obtained from the pediatric Status Epilepticus Research Group study cohort.
Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%.
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- Inpatient child neurology programs are vital for pediatric care, and researchers aimed to assess the structure and challenges of these programs in North America.
- A survey was conducted among child neurologists from various academic programs, with a response rate of 71%, primarily from program directors and senior staff.
- The findings revealed issues such as high workload, out-of-hours documentation, and frequent phone calls related to patient care, which contribute to faculty burnout and indicate a need for better support and resources in these programs.
Importance: Families and clinicians have limited validated tools available to assist in estimating long-term outcomes early after pediatric cardiac arrest. Blood-based brain-specific biomarkers may be helpful tools to aid in outcome assessment.
Objective: To analyze the association of blood-based brain injury biomarker concentrations with outcomes 1 year after pediatric cardiac arrest.
Background: Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.
Methods: A survey was distributed to pediatric institutions participating in three international studies.
Humans are exposed to extreme environmental stressors during spaceflight and return with alterations in brain structure and shifts in intracranial fluids. To date, no studies have evaluated the effects of spaceflight on perivascular spaces (PVSs) within the brain, which are believed to facilitate fluid drainage and brain homeostasis. Here, we examined how the number and morphology of magnetic resonance imaging (MRI)-visible PVSs are affected by spaceflight, including prior spaceflight experience.
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- During the first 6 weeks of COVID-19 Shelter-in-Place orders, there was a 54% reduction in hospital encounters for children with neurologic conditions compared to the same period in the previous 3 years.
- The patients seen during this period were younger, with significant drops in cases of migraines (72%) and acute neurologic issues such as status epilepticus and traumatic brain injury (56% reductions across the board).
- Those who were hospitalized required more intensive care and diagnostic testing, indicating a need for continued neurologic hospital services amid concerns about delayed care for serious conditions.
Mild traumatic brain injury (mTBI), often referred to as concussion, is a major cause of morbidity and mortality worldwide. Sleep disturbances are common after mTBI. Moreover, subjects who develop subjective sleep complaints after mTBI also report more severe somatic, mental health, and cognitive impairment and take longer to recover from mTBI sequelae.
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- * Out of 293 children studied, many received multiple doses of BZDs, especially if seizures started outside of the hospital and if they delayed treatment — with 57.3% receiving BZDs beyond 30 minutes after the onset.
- * The findings suggest that more timely escalation from BZDs to non-BZD ASMs is needed, particularly for patients whose seizures began before they arrived at the hospital.
Purpose: Wrist-worn actigraphy via research-grade devices, a well-established approach to the assessment of rest-activity, is limited by poor compliance, battery life, and lack of direct evidence for time spent physically in the bed. A non-invasive bed sensor (Emfit) may provide advantages over actigraphy for long-term sleep assessment in the home. This study compared sleep-wake measurements between this sensor and a validated actigraph.
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- The study aimed to examine long-term outcomes in pediatric patients experiencing refractory status epilepticus (RSE) and to identify factors linked to new neurological deficits following RSE.
- Data from 276 patients showed a 4% in-hospital mortality rate, with 62.9% of patients later developing unprovoked seizures and 39.3% of those with normal development before RSE acquiring new neurological deficits.
- Longer durations of electroclinical RSE were associated with higher risks of new deficits, and the study highlights that about one-third of previously seizure-free patients experienced recurrent seizures post-RSE.
Objectives: To characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients and comparing relevant clinical characteristics, including outcomes, between super-refractory status epilepticus, and nonsuper-refractory status epilepticus patients.
Design: Retrospective cohort study with prospectively collected data between June 2011 and January 2019.
Setting: Seventeen academic hospitals in the United States.