The activities of the laboratory refer to the epidemiology of neurological disorders (observational studies on the frequency, risk factors and prognosis; randomized trials on drugs, therapeutic strategies and devices for the treatment of neurological disorders).
The main research field are:
- amyotrophic lateral sclerosis (ALS) and other motor neuron diseases
- Parkinson disease
- peripheral neuropathies
- physical medicine and rehabilitation.
Epilepsy: Long-term prognosis and drug resistance
Studies on the long-term prognosis of epilepsy have shown that the outcome of the disease is characterized by differing patterns within which drug resistance is inscribed. From these observations it appears that drug resistance is a dynamic process and that poor response to drugs depends only in part on the classification of patients in predefined syndromic categories. The Laboratory of Neurological Diseases is completing a study on the indicators of prognosis and drug resistance in a large cohort of patients recruited in epilepsy centers disseminated in the entire national territory.
Epilepsy: Comparison of differing therapeutic strategies
The treatment of epilepsy is based on the use of numerous marketed active principles. However, the correct maintenance daily dose in newly diagnosed epilepsies and the time required to complete treatment discontinuation in patients in remission in clinical practice are still poorly defined. The Laboratory of Neurological Diseases conceived a multicenter randomized pragmatic trial comparing standard doses of antiepileptic drugs to half of those doses (low doses) in newly diagnosed epilepsies. The study will verify the impact of the two therapeutic strategies on seizure relapse and prolonged seizure remission. The Laboratory is also collaborating with the Epilepsy Center of the University of Catanzaro in the conduction of a multicenter randomized comparative trial confronting a rapid discontinuation (2 months) and a slow discontinuation (6 months) on the occurrence of seizure relapse.
Epidemiology of epilepsy and other neurological diseases
The growth and aging of the world population and the effects of the campaigns for the prevention and control of communicable diseases in developing countries had significant reflections on the global burden of diseases. The Laboratory is collaborating with the Institute of Health Metrics and Evaluation in Seattle, USA in the analysis of data collected in the field of epilepsy and other neurological diseases at a global level and, more specifically, in the European Union. From this collaboration it followed that the burden of idiopathic epilepsy (premature mortality and persisting disability) has substantially decreased since 1990 while an inverse trend has been observed for Alzheimer and Parkinson disease.
ALS: Effects of pharmacological treatment on biomarkers and overall efficacy
In the absence of treatments preventing or at least slowing the progression of ALS, experimental trials have moved their focus to the study of biomarkers of disease in the intent to couple the action of new drugs on molecules involved in the mechanisms of the disease to symptoms and signs of progression. One of the investigational drugs is RNS60, a product active on the mechanisms of inflammation whose efficacy in ALS has been documented by in vitro studies and in experimental animals. The study, coordinated by the Laboratory of Neurological Diseases, aims at verifying the effects of the drug on 6 biomarkers and a series of clinical parameters in patients in the early phase of the disease.
Environmental risk factors in ALS
The observation of a high number of patients with ALS among former soccer players led researchers to verify if and by which mechanisms professional soccer is a risk factor for ALS. The Laboratory of Neurological Diseases showed in the past an association between ALS and repeated traumatic events and an earlier onset of symptoms in ALS patients who had been physically active. On this background, a retrospective cohort study is ongoing to verify whether former soccer players are at higher risk of hospital admission or death for ALS or other neurodegenerative diseases (Alzheimer and Parkinson disease) than the Italian population.
Regional ALS Registry
Since 1998 in Lombardy, Northern Italy, a regional ALS registry has been active for the calculation of the incidence of the disease, the assessment of long-term prognosis and the study of a number of putative risk factors (trauma, physical exercise, diet). A new study in the same area has shown no substantial trends in the incidence of ALS in a 10-year period. This observation is in contrast with reports showing a recent increase of the incidence of the disease. The registry is included in a consortium of active Italian and European registries for the study of genetic and environmental risk factors. The patients included in the Lombardy registry are also investigated for the study of therapeutic prescriptions in search of inappropriate and/or potentially noxious treatments.
International Consensus on Cardiopulmonary Resuscitation.