Francesca Izzi

Accurate differentiation between low-grade gliomas and encephalitis remains challenging due to overlapping MRI features. This study investigated whether MRI-based radiomics derived from routine non-contrast MRI could improve the differentiation of these entities in diagnostically challenging cases presenting in emergency settings. This retrospective single-center study included 41 patients with ambiguous MRI findings who underwent 3T MRI within 48 h of symptom onset. Radiomic features extracted from T2-FLAIR, DWI, and T1-TSE images, together with laboratory data available at presentation, were analyzed. Random Forest classifiers were developed using selected radiomic features, and model performance was evaluated using nested cross-validation, independent validation, receiver operating characteristic (ROC) analysis, and DeLong’s test. The cohort included 23 patients with histologically proven low-grade gliomas and 18 with confirmed encephalitis and was divided into training ( n = 31) and validation ( n = 10) sets. FLAIR-based models showed the best discriminatory performance, achieving an AUC of 0.82 (95% CI: 0.54–1.00) for both the radiomics-only and radiomics-clinical models outperforming T1-weighted (AUC 0.52 for radiomics-only and 0.60 for radiomics-clinical model) and DWI models (AUC 0.72 for both radiomics-only and radiomics-clinical approaches). The combined-sequence radiomics-clinical model achieved an AUC of 0.80 (95% CI: 0.41–1.00), with 100% sensitivity, 80% specificity, and 90% accuracy. Comparison of the ROC curves using DeLong’s test did not demonstrate statistically significant differences between the radiomics-only and radiomics-clinical models for any MRI sequence. This proof-of-concept study suggests that radiomic features extracted from routine non-contrast MRI may help differentiate low-grade gliomas from encephalitis in diagnostically challenging cases; however, these preliminary findings warrant validation in larger multicenter cohorts before clinical implementation.

Objective: Levetiracetam (LEV) is an antiseizure medication approved for focal and generalized epilepsy. Despite its efficacy, neuropsychiatric adverse effects (NP‐AEs) may lead to treatment discontinuation. Quantitative electroencephalographic (qEEG) graph‐theoretical analysis has emerged as a valuable tool for identifying neurophysiological markers of treatment response. We investigated whether baseline network metrics could identify drug‐naive people with focal epilepsy (PwE) at risk of developing clinically significant LEV‐related NP‐AEs. Methods: We conducted a multicenter retrospective longitudinal study across three Italian centers. From an original LEV monotherapy cohort of 134 PwE, we identified all 31 eligible patients who developed clinically significant LEV‐related NP‐AEs within the first month after LEV initiation (AE+) and matched them by age and sex with 31 patients without NP‐AEs (AE−). All participants underwent resting‐state EEG within 30 days before LEV. We compared relative power spectral density (PSD) and weighted phase lag index (wPLI) connectivity‐derived graph‐theoretical metrics (clustering coefficient, global efficiency, path length, modularity, node strength) using linear mixed‐effects models. Baseline variables showing significant between‐group differences were included in an elastic‐net penalized logistic regression model. Model performance was evaluated using nested cross‐validation and permutation testing (1000 permutations). Results: Relative PSD showed no differences between groups. The AE+ group showed higher baseline theta‐band wPLI‐derived clustering coefficient ( p = .032), characteristic path length ( p = .033), and node strength ( p = .03) than AE−. In the elastic net model, theta‐band graph‐theoretical metrics predicted NP‐AE occurrence with an accuracy of .71 (95% confidence interval [CI] = .60–.82) and an area under the curve of .71 (95% CI = .57–.83). Permutation testing confirmed that model discrimination exceeded chance level ( p = .003). Significance: Baseline theta‐band qEEG functional network organization emerged as a significant neurophysiological predictor of LEV‐related NP‐AEs. These findings suggest that pretreatment EEG may capture a neurophysiological vulnerability phenotype associated with LEV tolerability, supporting the potential role of network‐level biomarkers in guiding individualized treatment decisions.

Background: Emotional impulsivity has been found to be relevant in explaining the association between sleep problems and depressive symptoms, suggesting the potential role of impulsivity as a key underlying mechanism of this link. The objective of this study was to take a preliminary step in understanding the mediating role of impulsivity in the relation between excessive daytime sleepiness (EDS) and depression in patients with obstructive sleep apnea syndrome (OSAS) and to compare psychological and demographic characteristics between different levels of daytime sleepiness. Methods: A total of 138 patients with OSAS underwent polygraphic cardiorespiratory monitoring and completed a series of questionnaires investigating perceived sleepiness, depression, impulsivity, and other psychological characteristics. A mediational model was tested in order to assess whether impulsivity mediated the relation between sleepiness and depressive symptoms while controlling for the effects of age, sex, BMI, and oxygen saturation parameters. Results: the mediation model showed that there was a significant indirect effect of impulsivity in the sleepiness–depression link (αβ = 0.084 [0.0243–0.1617]). Conclusions: The here-presented results showed that the sleepiness–depression link is not direct as previous studies asserted, but instead it may be better explained by impulsivity. Research and practical implications are discussed.

Objective: Epilepsy treatment during pregnancy is still challenging. The study is aimed at comparing the efficacy and safety of carbamazepine (CBZ), lamotrigine (LTG) and levetiracetam (LEV) monotherapies during pregnancy in women with focal (FE) or generalized (GE) epilepsy. Methods: A multicentre retrospective study was conducted to evaluate seizures frequency and seizure freedom (SF) rate during 3 months before pregnancy, each trimester of gestation and post-partum period in women on monotherapy with CBZ, LTG and LEV. Results: Fifty-seven pregnancies (45 FE, 12 GE) on monotherapy (29 CBZ, 11 LTG, 17 LEV) were included. A significant reduction of seizure frequency was found in the first trimester of pregnancy as compared with that one before pregnancy (p = 0.004), more evident in GE (p = 0.003) and in LEV group (p = 0.004). The SF rate significantly increased in the first trimester in comparison to that one before pregnancy and persisted in the post-partum period in the whole sample (p < 0.001) and in women on LEV (p = 0.004). Besides, 88.57% of SF women before pregnancy remained unchanged during gestation and the post-partum period. One major heart malformation in CBZ and no major malformations in LTG and LEV groups were found. Conclusions: A better clinical outcome during pregnancy emerged since the first trimester in comparison to the before-pregnancy period, mostly evident in women with GE and LEV therapy, reinforcing the hypothesis of a protective role of pregnancy versus seizures. SF before pregnancy represents a significant predictive factor of good clinical outcome during gestation and the post-partum period. Compared to CBZ, LTG and LEV showed a better safety profile.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for developing Parkinson’s disease (PD) and may represent its prodromal state. We compared neuropsychological and neuropsychiatric phenotypes of idiopathic (i) RBD, PD and healthy comparators (HC) in order to identify iRBD specific characteristics. Thirty-eight patients with iRBD, 38 PD patients with RBD (PD + RBD), 38 PD patients without RBD (PD-RBD) and 38 HC underwent a comprehensive neurological, neuropsychological and neuropsychiatric evaluation. iRBD, PD + RBD and PD-RBD performed worse than HC in short-term verbal memory, praxia, language and executive functions. iRBD had higher levels of anxiety, depression, apathy and alexithymia than HC. iRBD had higher levels of apathy than PD + RBD. Both PD groups had higher levels of anxiety and depression than HC. Surprisingly, iRBD performed better than all groups in long-term verbal memory. Patients diagnosed with iRBD are characterized by poor global cognitive performance, but better long-term memory and higher levels of depression, anxiety, alexithymia and apathy. Alexithymia and apathy in patients diagnosed with iRBD may be the expression of precocious derangement of emotional regulation, subsequently observed also in PD. Cognitive and neuropsychiatric symptoms of iRBD are early clinical manifestations of widespread neurodegeneration.

Purpose To evaluate cardiovascular and sudomotor function during wakefulness and to assess autonomic symptoms in de novo patients with type 1 narcolepsy compared to healthy controls. Methods De novo patients with type 1 narcolepsy (NT1) and healthy controls underwent cardiovascular function tests including head-up tilt test, Valsalva maneuver, deep breathing, hand grip, and cold face, and sudomotor function was assessed through Sudoscan. Autonomic symptoms were investigated using the Scales for Outcomes in Parkinson’s Disease–Autonomic Dysfunction (SCOPA-AUT) questionnaire. Results Twelve de novo patients with NT1 and 14 healthy controls were included. In supine rest condition and at 3 min and 10 min head-up tilt test, the systolic blood pressure values were significantly higher in the NT1 group than in controls (p < 0.05). A lower Valsalva ratio (p < 0.01), significantly smaller inspiratory–expiratory difference in deep breathing (p < 0.05), and lower delta heart rate in the cold face test (p < 0.01) were also observed in the NT1 group. The mean hand electrochemical skin conductance values were significantly lower (p < 0.05) and the mean SCOPA-AUT total scores were significantly higher in patients with NT1 than in healthy subjects (p < 0.001), with greater involvement of cardiovascular and thermoregulatory items. Conclusion De novo patients with NT1 exhibit blunted parasympathetic activity during wakefulness, mild sudomotor dysfunction, and a large variety of autonomic symptoms.