Martina Gandola

Objective: Surgical intervention is frequently considered for drug‐resistant focal structural epilepsy. However, the impact of early surgery on seizure control, cognitive performance, and quality of life (QoL) across drug‐sensitive and drug‐resistant patients remains incompletely characterized. Methods: We conducted a prospective–retrospective study on 214 patients with age > 6 years with focal structural epilepsy (focal cortical dysplasia type II, hippocampal sclerosis, low‐grade epilepsy‐associated tumors) stratified as: drug‐sensitive (DS, n = 72) and drug‐resistant (DR, n = 112) patients undergoing surgery, and drug‐resistant patients on pharmacological treatment (DRT, n = 30). Cognitive function (including language, verbal and visuospatial memory, attention/executive functions) and QoL (using the Quality of Life in Epilepsy Inventory [QOLIE] and 36‐Item Short Form Survey [SF‐36] questionnaires) were assessed at baseline and 1‐year follow‐up in patient subgroups. Statistical analyses included chi‐square tests, t tests, analysis of variance (ANOVA), and multivariable regression models; p < .05 was considered statistically significant. Results: The DS patients demonstrated superior rates of complete seizure freedom (86%) compared with DR patients (69%, p = .009). At baseline, DS patients exhibited significantly fewer cognitive deficits compared with DR and DRT patients ( p < .05). At the 1‐year follow‐up, no significant changes in neuropsychological performance were observed in any group, although a mild decline in verbal and/or visuospatial memory performance was observed in DRT patients. In a subset of patients ( n = 59 adults) at baseline, DR and DRT patients reported significantly worse overall subjective QoL compared with DS patients ( p = .047 and p = .036, respectively). Longitudinal analysis revealed significant improvements in QoL among surgically treated patients. Significance: Early epilepsy surgery in symptomatic focal epilepsy yields excellent seizure outcomes, particularly in DS patients. Baseline preservation of cognitive function and QoL, together with the stability of these measures after surgery, suggests that timely surgery may help prevent deterioration in cognitive and psychosocial functioning. These findings support early referral for surgical evaluation in selected patients and highlight the need for larger studies with extended follow‐up, to confirm surgical outcome, long‐term neuropsychological, and patient‐reported benefits.

Background: Patients with brain damage may deny the presence of their contralesional motor deficits. Some individuals may even claim they performed specific actions with the paralyzed limb, such as clapping hands. This well-known condition, called anosognosia for motor deficits, has been more frequently associated with right-brain lesions, primarily involving the posterior parietal cortex, the frontal cortex, and the insula. Instances of anosognosia for motor deficits in patients with left hemispheric lesions have also been described. However, less is known about the underlying mechanisms or differences in clinical manifestation. Methods: Following PRISMA guidelines, the present systematic review investigated the prevalence of anosognosia for motor deficits in patients with left-hemispheric brain lesions, focusing on its severity, clinical manifestation, and anatomical correlates. Moreover, we review adopted assessment methods and discuss the potential role of handedness and atypical hemispheric specialization in determining anosognosia for motor deficits. A comprehensive search across multiple databases up to the 28th of February 2025 identified 893 studies, with 25 included in the present study. Results: Reported prevalence of anosognosia for motor deficits in left brain-damaged patients ranged from 3.6 to 50% of assessed patients. These wide-ranging estimates may reflect the high heterogeneity in the tools adopted to assess both motor deficits and anosognosia, as well as in the diagnostic criteria employed to define anosognosia itself. Lesional data, when provided, showed a substantial overlap with the distributed network identified as the lesion substrate of anosognosia following right-hemisphere damage. Conclusion: Anosognosia for motor deficits following left-hemisphere lesions is less rare than previously assumed, thus challenging the hypothesis that the right hemisphere has an exclusive role in motor awareness. However, considering the sparsity and heterogeneity of current evidence, multicentric studies are required to better characterize the specific features of anosognosia associated with left-sided lesions and tackle unresolved issues such as the role of atypical hemispheric specialization.

Tactile agnosia is the inability to recognize objects via haptic exploration, in the absence of an elementary sensory deficit. Traditionally, it has been described as a disturbance in extracting information about the physical properties of objects (“apperceptive agnosia”) or in associating object representation with its semantic meaning (“associative agnosia”). However, tactile agnosia is a rare and difficult-to-diagnose condition, due to the frequent co-occurrence of sensorimotor symptoms and the lack of consensus on the terminology and assessment methods. Among tactile agnosia classifications, hyloagnosia (i.e., difficulty in quality discrimination of objects) and morphoagnosia (i.e., difficulty in shape and size recognition) have been proposed to account for the apperceptive level. However, a dissociation between the two has been reported in two cases only. Indeed, very few cases of pure tactile agnosia have been described, mostly associated with vascular damages in somatosensory areas, in pre- and postcentral gyrus, intraparietal sulcus, supramarginal gyrus, and insular cortex. An open question is whether degenerative conditions affecting the same areas could lead to similar impairments. Here, we present a single case of unilateral right-hand tactile agnosia, in the context of corticobasal syndrome (CBS), a rare neurodegenerative disease. The patient, a 55-year-old woman, initially presented with difficulties in tactile object recognition, apraxia for the right hand, and an otherwise intact cognitive profile. At the neuroimaging level, she showed a lesion outcome of a right parietal oligodendroglioma removal and a left frontoparietal atrophy. We performed an experimental evaluation of tactile agnosia, targeting every level of tactile processing, from elementary to higher order tactile recognition processes. We also tested 18 healthy participants as a matched control sample. The patient showed intact tactile sensitivity and mostly intact hylognosis functions. Conversely, she was impaired with the right hand in exploring geometrical and meaningless shapes. The patient’s clinical evolution in the following 3 years became consistent with the diagnosis of CBS and unilateral tactile apperceptive agnosia as the primary symptom onset in the absence of a cognitive decline. This is the third case described in the literature manifesting morphoagnosia with almost completely preserved hylognosis abilities and the first description of such dissociation in a case with CBS.

Background: The COVID-19 pandemic and associated lockdown measures posed an unprecedented challenge to the crucial role of grandparenting in family-oriented cultures, such as Italy. Reduced contact with grandchildren during this period potentially threatened grandparents’ mental health and well-being. Methods: We analysed data from the LOckdown and lifeSTyles in Lombardia cross-sectional study conducted in November 2020. The study included a representative sample of 4400 older adults from Lombardy, Italy, of which 1289 provided childcare to their grandchildren. Results: A decrease in self-reported grandparenting was associated with an increased likelihood of experiencing depressive symptoms among grandparents (OR 1.50, 95% CI 1.01–2.24). Conversely, an increase in grandparenting was linked to poorer sleep quality (OR 11.67, 95% CI 5.88–23.17) and reduced sleep quantity (OR 2.53, 95% CI 1.45–4.41). Conclusions: Despite the barriers posed by the pandemic, grandparenting played a beneficial role in maintaining the mental health and well-being of older adults. However, it is crucial to recognise specific vulnerabilities, such as gender, feelings of hopelessness and overcrowding, which can have detrimental effects during and beyond emergency situations. Careful attention to these factors is essential for developing targeted support systems and interventions aimed at safeguarding the mental health of older adults and enhancing their resilience in crises.

COVID-19 may induce short- and long-term cognitive failures after recovery, but the underlying risk factors are still controversial. Here, we investigated whether (i) the odds of experiencing persistent cognitive failures differ based on the patients’ disease course severity and sex at birth; and (ii) the patients’ electrolytic profile in the acute stage represents a risk factor for persistent cognitive failures. We analysed data from 204 patients suffering from COVID-19 and hospitalised during the first pandemic wave. According to the 7-point WHO-OS scale, their disease course was classified as severe or mild. We investigated the presence of persistent cognitive failures collected after hospital discharge, while electrolyte profiles were collected during hospitalisation. The results showed that females who suffered from a mild course compared to a severe course of COVID-19 had a higher risk of presenting with persistent mental fatigue after recovery. Furthermore, in females who suffered from a mild course of COVID-19, persistent mental fatigue was related to electrolyte imbalance, in terms of both hypo- and hypernatremia, during hospitalisation in the acute phase. These findings have important implications for the clinical management of hospitalised COVID-19 patients. Attention should be paid to potential electrolyte imbalances, mainly in females suffering from mild COVID-19.

Body integrity dysphoria (BID), a long-lasting desire for the amputation of physically healthy limbs, is associated with reduced fMRI resting-state functional connectivity of somatosensory cortices. Here, we used fMRI to evaluate whether these findings could be replicated and expanded using a task-based paradigm. We measured brain activations during somatosensory stimulation and motor tasks for each of the four limbs in ten individuals with a life-long desire for the amputation of the left leg and fourteen controls. For the left leg, BID individuals had reduced brain activation in the right superior parietal lobule for somatosensory stimulation and in the right paracentral lobule for the motor task, areas where we previously found reduced resting-state functional connectivity. In addition, for somatosensory stimulation only, we found a robust reduction in activation of somatosensory areas SII bilaterally, mostly regardless of the stimulated body part. Areas SII were regions of convergent activations for signals from all four limbs in controls to a significantly greater extent than in subjects with BID. We conclude that BID is associated with altered integration of somatosensory and, to a lesser extent, motor signals, involving limb-specific cortical maps and brain regions where the first integration of body-related signals is achieved through convergence.

“Body integrity dysphoria” (BID) is a severe condition affecting non-psychotic individuals where a limb may be experienced as not being part of the body, despite normal anatomical development and intact sensorimotor functions. Limb amputation is desired for restoring their own identity. We previously demonstrated altered brain structural (gray matter) and functional connectivity in 16 men with a long-lasting and exclusive desire for left leg amputation. Here we aimed to identify in the same sample altered patterns of white matter structural connectivity. Fractional anisotropy (FA), derived from Diffusion Tensor Imaging data, was considered as a measure of structural connectivity. Results showed reduced structural connectivity of: i) the right superior parietal lobule (rSPL) with the right cuneus, superior occipital and posterior cingulate gyri ii) the pars orbitalis of the right middle frontal gyrus (rMFGOrb) with the putamen iii) the left middle temporal gyrus (lMTG) with the pars triangularis of the left inferior frontal gyrus. Increased connectivity was observed between the right paracentral lobule (rPLC) and the right caudate nucleus. By using a complementary method of investigation, we confirmed and extended previous results showing alterations in areas tuned to the processing of the sensorimotor representations of the affected leg (rPCL), and to higher-order components of bodily representation such as the body image (rSPL). Alongside this network for bodily awareness, other networks such as the limbic (rMFGOrb) and the mirror (lMTG) systems showed structural alterations as well. These findings consolidate current understanding of the neural correlates of BID, which might in turn guide diagnostics and rehabilitative treatments.

The human trapeziometacarpal (TMC) joint has a crucial evolutionary importance as it permits rotation and opposition of the thumb to the other fingers. In chronic TMC joint osteoarthritis (i.e., rhizarthrosis), this motor ability, essential for pinching, grasping, and manipulating objects, may become difficult or impossible due to intolerable pain. Here, we assess whether patients with rhizarthrosis show signs of abnormal brain representation of hand movements. To this end, we studied 35 patients with rhizarthrosis, affecting predominantly one of the two hands, and 35 healthy subjects who underwent both behavioural and fMRI measures of brain activity during overtly executed or imagined thumb-to-finger-opposition movements. The patients with rhizarthrosis were slower than controls both in motor execution and imagination. In the patients, correlation between the motor execution and imagination times was preserved, even though such correlation was less strong than in normal controls. The fMRI measures showed reduced activation in the hand primary motor and dorsal premotor cortex for the patients only during explicit movements. This was true for both hands, yet more so for the most affected hand. No significant differences were seen for the motor imagery task. These results show that an orthopaedic disorder that reduces patients’ motoric repertoire in the absence of any neurological impairment is sufficient to induce neurofunctional changes in the cortical representation of hand movements. The substantial preservation of motor imagery with its neural counterparts distinguishes the neurological patterns of rhizarthrosis from those of complete immobilization or amputation suggesting that motor imagery may be used to boost motor recovery in rhizarthrosis after surgical treatment.