Categoria: Articoli

Cosa si sa sulla Fibromialgia? Poco

La fibromialgia, come oramai è noto un po’ a tutti, è una sindrome complessa caratterizzata prevalentemente da dolore cronico diffuso, stanchezza, disturbi cognitivi (“fibro-fog”), insonnia e altre disfunzioni somatiche e autonomiche.

Altre alterazioni neurofunzionali spesso presenti nella Fibromialgia consistono in anomalie della soglia del dolore (iperalgesia, allodinia) e disfunzioni nel sistema nervoso centrale nella modulazione del dolore note, queste ultime, come central sensitization.

Cosa non si sa invece sulla Fibromialgia? Molto

Tra le varie cose che non si sanno sulla fibromialgia o, meglio, che sono troppo spesso scotomizzate, ci sono quelle che riguardano la compromissione delle funzioni e delle strutture cerebrali.

Per anni la Fibromialgia è stata ritenuta una malattia di natura reumatologica per cui poco si è fatto per investigare la sua vera natura intrinseca di carattere neurologico.

Il Cervello è l’organo che per antonomasia produce elettricità e tutto quello che fa, sia produrre pensieri astratti che spingere il corpo ad agire fisicamente o interagire con il mondo esterno, lo fa esclusivamente producendo elettricità per cui tutto ciò che non funziona nel nostro organismo o origina nel cervello o nel cervello trova la sua estrinsecazione e a questa regola assoluta certamente non sfugge la Fibromialgia.

E, dunque, l’esame principe per studiare il cervello è l’Elettroencefalografia che viene effettuato e interpretato in vari modi, alcuni di essi estremamente sofisticati e complessi tra cui, in particolare il Q-EEG, conosciuto anche con i termini di EEG Computerizzato, Quantitativo o Brain Mapping.

Il ruolo del Q-EEG è fondamentale nello studio sia del cervello (hardware) che della mente (software) in quanto la sua specifica funzione è di analizzare la potenza spettrale delle bande di frequenza (delta, theta, alfa, beta, gamma).

Con questa tecnologia all’avanguardia è possibile analizzare gli stati di attivazione corticale (iperattivazione, ipoattivazione), le anomalie nei ritmi oscillatori associati a vari tipi di percezione come a esempio quella dolorifica, attenzione, regolazione emotiva e altro ancora.

Tavola Sinottica

Delle Aree Cerebrali E Delle Bande Di Frequenza Alterate Nella Fibromialgia

Area Cerebrale	Banda EEG Alterata	Ruolo	Fibromialgia	Insonnia	ConseguenzeCliniche
Prefrontale Mediale(BA 9, BA 10)	Theta ↑, Alfa ↓	Cognizione, regolazione dolore	Deficit esecutivi, fibro-fog	Riduzione vigilanza, theta in veglia	Deficit controllocognitivo, ruminazionementale, scarsainibizione emotiva
Cingolata Anteriore(ACC) (BA 24, 32)	Gamma ↑, Coerenza ↓	Dolore emotivo	Ipersensibilitàaffettiva al dolore	Eccessiva salienzadolore nel sonno	Aumento dolore percepito, disfunzioneregolazione emotivanotturna
Insula (BA 13)	Beta/Gamma ↑	Integrazionesomatica ed emozionale	Aumentataconsapevolezzadolore, ansiasomatica	Hyperarousal, beta/gamma notturna ↑	Ipervigilanza somatica notturna, amplificazionepercezione corporea
Somatosensoriale Primaria (S1) (BA 3, 1, 2)	Beta Alta ↑	Percezionesensoriale	Ipersensibilitàcutanea, dolore cronico	Aumento attivitàsomatosensoriale	Amplificazionestimoli somatici, micro-risvegli
Precuneo (BA 7)	Alfa ↓	Consapevolezzacorporea	Disturbipercezionecorporea, alterataconsapevolezza di sé	Riduzione alfa fisiologica	Difficoltàrilassamentomentale/corporeo, senso di estraneità
Talamo	Gamma ↑	Integrazionesensoriale	Amplificazionenocicezione	Disfunzione gating sensoriale	Trasmissioneaumentata dolore anche in sonnoleggero (N1-N2)

In Sintesi

Esistono aree cerebrali chiave (quali la Prefrontale Mediale, ACC, Insula, S1, Precuneo, Talamo) che mostrano anomalie dell’elettrogenesi cerebrali che potremmo definire tipiche della fibromialgia.

In cassi del genere, dunque, è possibile utilizzare:

• il Q-EEG come strumento d’indagine in grado di localizzare e quantificare queste anomalie 
• la tES come strumento terapeutico che può essere progettata su misura, targettizzando queste aree a scopo terapeutico e, in associazione con il Neurofeedback e il Biofeedback, anche a scopo riabilitativo mentale migliorando l’efficacia terapeutica globale

Author — Pasquale Arpaia, Anna Della Calce, Lucrezia Di Marino, Luciana Lorenzon, Luigi Maffei, Nicola Moccaldi, Pedro M. Ramos, Emanuela Russo, Andrea Zingoni

IndexTerms — Electroencephalography, Autism Spectrum Disorder, Artificial Intelligence, Transcranial Electric Stimulation, Personalized Medicine

Abstract — The formalization of a personalized clinical procedure for the treatment of Autism Spectrum Disorder (ASD) based on electroencephalography-guided transcranial electrical stimulation (tES) is proposed. The clinical method, already practiced in a center of therapy for autistic individuals, has been modeled through a flow chart and a corresponding database in which the inputs and outputs of each action are recorded. The database is designed to serve as the training foundation for an artificial intelligence (AI) system that supports the progressive personalization of the method itself. While tES has shown promise in improving cognitive and behavioral symptomsin ASD, current protocols do not take individual EEG conditions into account. The EEG-guided tES framework is structured as an iterative decision making process, where stimulation parameters are dynamically adjusted based on neurophysiological and clinical responses. In addition to being modeled, the process has undergone operational qualification through a verification of its correspondence with the clinical intervention performed on two ASD patients: one 15-year- old male patient and one 25-year-old female patient. The study highlights the potential of anadaptive, EEG driven approach to tES, emphasizing the importance of integrating neurophysiological biomarkers into personalized treatment strategies for ASD, with AI as a prospective tool for further enhancing clinical decision-making.

Author — Pasquale Arpaia, Giovanni Carone, Nicol` o Castelli, Giovanni D’Errico, Ludovica Gargiulo, Luigi Maffei, Giovanna Mastrati, Nicola Moccaldi, Marco Nalin, Alessandro Perin, Mauro Picciafuoco, Cosimo Puttilli, Pedro M. Ramos and Rachele Robbio

IndexTerms — Neurofeedkack, EEG, HRV, emotion regulation, surgery

Abstract — A neurofeedback (NF) supported training is proposed to enable neurosurgeons to learn how to regulate their emotions. Electroencephalographic (EEG) signal and heart rate (HR) of 5 neurosurgeons were acquired in 4 sessions while performing NF-based emotion regulation (ER). Subjects tried to counteract anxious and stressful states through NF, that is by decreasing the power in the beta band measured in the midline areas of the scalp. The assessment of the neurofeedback effectiveness was based on the use of Heart Rate Variability (HRV) in combination with EEG. Therefore, EEG signal was exploited in real-time to guide the feedback and also in post processing, together with the HRV, to assess the effectiveness of the whole training. As the EEG signal is concerned, the results showed that the power in the beta band decreased within each session when the ER ability was strengthened, as reported in the literature. On the contrary, the HRV did not exhibit the expected increasing trend within each trial. When considering each the session on the whole, thus computing the HRV on a greater time interval, the HRV during the NF training is typically higher than the HRV computed during the rest and negative baseline phases.

Author – Pasquale Arpaia, Renato Cuocolo, Paolo De Blasiis, Anna Della Calce, Allegra Fullin, Ludovica Gargiulo, Luigi Maffei, Nicola Moccaldi

IndexTerms – executive function monitoring; wearables; brain computer interface; dual task; electroencephalographic features

Abstract – A feasibility study on electroencephalographic monitoring of executive functions during dual (motor and cognitive) task execution is presented. Electroencephalographic (EEG) signals are acquired by means of a wearable device with few channels and dry electrodes. The light weight and wireless device allow for walking in a natural way. The most significant EEG features are investigated to classify different levels of activation for two fundamental Executive Functions (EF) both in sitting and walking conditions. Power spectral density in the gamma band resulted in the most relevant feature in discriminating low and high levels of Inhibition. Power spectral density in the beta and gamma bands resulted the most discriminating the level of activation of Working Memory. The study poses the basis for (i) monitoring the activation levels of EF during Gait allowing loss prevention in the elderly and (ii) specific cognitive rehabilitation aimed at the most relevant executive functions during walking.

Author – Andrea Apicella, Simone Barbato, Luis Alberto Barradas Chacόn, Giovanni D’Errico, Lucio Tommaso De Paolis, Luigi Maffei, Patrizia Massaro, Giovanna Mastrati, Nicola Moccaldi, Andrea Pollastro, Selina Christin Wriessenegger

IndexTerms – Electroencephalography; brain computer interfaces; fear of heights; virtual reality

Abstract – An electroencephalography (EEG)-based classification system of three levels of fear of heights is proposed. A virtual reality (VR) scenario representing a canyon was exploited to gradually expose the subjects to fear inducing stimuli with increasing intensity. An elevating platform allowed the subjects to reach three different height levels. Psychometric tools were employed to initially assess the severity of fear of heights and to assess the effectiveness of fear induction. A feasibility study was conducted on eight subjects who underwent three experimental sessions. The EEG signals were acquired through a 32-channel headset during the exposure to the eliciting VR scenario. The main EEG bands and scalp regions were explored in order to identify which are the most affected by the fear of heights. As a result, the gamma band, followed by the high-beta band, and the frontal area of the scalp resulted the most significant. The average accuracies in the within-subject case for the three-classes fear classification task, were computed. The frontal region of the scalp resulted particularly relevant and an average accuracy of (68.20 ± 11.60) % was achieved using as features the absolute powers in the five EEG bands. Considering the frontal region only, the most significant EEG bands resulted to be the high-beta and gamma bands achieving accuracies of (57.90 ± 10.10) % and of (61.30 ± 8.43) %, respectively. The Sequential Feature Selection (SFS) confirmed those results by selecting for the whole set of channels, in the 48.26 % of the cases the gamma band and in the 22.92 % the high-beta band and by achieving an average accuracy of (86.10 ± 8.29) %.

Author – Leopoldo Angrisani, Andrea Apicella, Pasquale Arpaia, Andrea Cataldo, Anna Della Calce, Allegra Fullin, Ludovica Gargiulo, Luigi Maffei, Nicola Moccaldi, Andrea Pollastro

Abstract – Instrumentation for electroencephalo-graphic (EEG)-based monitoring of the executive functions in a dual-task framework is proposed. The proposed system integrates in a single solution (i) the administration of the cognitive task, (ii) the EEG signal acquisition and processing, (iii) the data storage synchronized whit an external Gait Analysis system. The system is based on a wearable passive brain computer interface solution that allows EEG monitoring during gait, by means of acoustic stimuli. The centralized platform guarantees the synchronization of all the processes, and therefore, improves the state of the art accuracy in measurements related to executive functions and gait. An experimental validation demonstrated the feasibility of the proposed solution in terms of execution of cognitive tasks during gait, real-time monitoring of EEG signals, and synchronized storage of EEG data, gait and cognitive task performances.

There are several kinds of craniopharyngioma that can be managed via two variations of the endoscopic endonasal transsphenoidal procedure: the “standard” approach to the sellar region and the “extended” approach to the suprasellar area. These two variations have different indications.

The indications for the standard approach were postulated more than 50 years ago, in the early 1960s, when Guiot and Derome [ 1 ] identifi ed the possibilities of transsphenoidal surgery for craniopharyngiomas retaining suitable for this approach infradiaphragmatic lesions, with enlarged sella that preferably already caused pan hypopituitarism. Still today these guidelines are absolutely valid for both the microsurgical and endoscopic transsphenoidal approaches. The standard transsphenoidal route for infradiaphrag matic craniopharyngiomas provides the advantage of accessing the tumor immediately after dural opening, without entering the subarachnoid space.

Later on, during the 1980s, some authors expanded the classic indications of transsphenoi dal microscopic approach, adopting this route for the management of craniopharyngiomas with extension above the diaphragma sellae, i.e., with an involvement of the subarachnoid space.

Accordingly, in order to allow the proper handling of surgical instruments and the adequate exposure of the tumor, the refi nement of bone and dural opening beyond the limits of the sella, i.e., over the tuberculum sellae and the posterior portion of the planum sphenoidale, was described. A new variation of the transsphenoidal pathway, i.e., the so-called “extended” transsphenoidal approach, was though defi ned [ 2 ].

During more recent years, there have been a worldwide diffusion and acceptance of the endoscope in transsphenoidal approaches. The panoramic and wider view offered by the endoscope increased the versatility of the transsphenoidal pathway, thus permitting the removal even of supradiaphragmatic lesions, including cranio-pharyngiomas [ 3 – 6 ]. The use of the endoscope through this route provides an access to the suprasellar supradiaphragmatic area, regardless of the sellar size (even a not enlarged sella).

It was the group of Pittsburgh, initially Jho [ 7 ] and later Kassam and Carrau [ 8 ], that defi nedand popularized the use of the endoscope in the so called “extended” endoscopic transsphenoidal approaches for the removal of suprasellar lesions.