OBIETTIVO Il seguente studio si è concentrato sulla valutazione della variazione di latenza dei potenziali evocati somatosensoriali (SEPs) legati a due diversi tipi di suggestioni verbali: • in situazioni di rilassamento indotto attraverso semplice induzione verbale non contestualizzata come ipnotica (compito di controllo, IMC); • in situazioni di rilassamento indotto attraverso tecniche di ipnosi contestualizzate come tali (compito sperimentale, IPN). MATERIALI E METODI I partecipanti (N=28; Maschi =15; Femmine =13) sono stati suddivisi in modo casuale nei due gruppi (IMC e IPN). A seguito del montaggio dell’elettroencefalogramma (EEG), i partecipanti hanno ricevuto 200 stimoli somatosensoriali di tipo elettrico a livello del polso sinistro e destro in due diverse fasi, una prima fase di Baseline ed una seconda fase di Test. Prima della fase di Test i partecipanti hanno ricevuto una suggestione verbale legata alla riduzione della percezione somatosensoriale del polso destro, ma non contestualizzata come suggestione ipnotica (gruppo IMC), oppure le stesse suggestioni contestualizzate come tali (gruppo IPN). In entrambe le fasi e per entrambi i lati è stata valutata la latenza dei potenziali P1 e N2 a seguito della stimolazione somatosensoriale. RISULTATI I dati raccolti hanno mostrato come, solo nel gruppo IPN, ovvero nel gruppo dove il rilassamento è stato ottenuto attraverso tecniche di ipnosi descritte e contestualizzate come tali, ci sia un significativo aumento della latenza di entrambi i potenziali misurati (P1 e N2) dopo la stimolazione ricevuta sul polso destro, ovvero il lato verso cui erano dirette le suggestioni di riduzione della percezione somatosensoriale. CONCLUSIONI I dati di questo studio sembrano dimostrare come l’efficacia dell’induzione ipnotica dipenda in modo rilevante dalla contestualizzazione della situazione come “ipnotica”. Questa contestualizzazione è rilevabile a livello di misure elettrofisiologiche come la latenza dei potenziali evocati somatosensoriali.

Background: High frequency (130 Hz) subthalamic Deep-Brain-Stimulation (STN-DBS) optimally improves cardinal motor symptoms in Parkinson disease (PD). Low stimulation frequencies (60-80 Hz) improve axial symptoms in some patients and, according to preliminary evidences, may also have a beneficial effect on the cognitive component of motor planning. Objective: To analyze the configuration of the P300 component of cortical event-related auditory potentials (ERPs), a reliable index of attentive cognitive functions, at different stimulation frequencies in STN-DBS in PD patients. Methods: 12 PD patients underwent ERPs recordings using a standard oddball auditory paradigm with STN-DBS at 60 Hz, 80 Hz, 130 Hz, and OFF-stimulation, applied in a randomized double-blind sequence. ERPs analysis considered the peak amplitude and latency of the P300 components at midline electrode positions (Fz, Cz, Pz). Results: P300 latency over Cz and Pz electrodes significantly increased with STN-DBS at 130 Hz compared to OFF-stimulation. P300 latency was also significantly increased, though to a lesser degree, over Pz electrode with stimulation at 80 Hz. No significant P300 latency modifications were detected at 60 Hz stimulation compared to OFF-stimulation condition. P300 amplitude did not change significantly for any of the stimulation conditions tested. Conclusions: Low frequency STN-DBS is associated with minor modifications of P300 latency compared to conventional stimulation at 130 Hz, possibly suggesting that 60 and 80 Hz may have less interference with attentive and cognitive processes in PD patients.

Expectations and motor reactions related to pain are mainly acquired through personal experiences. Contingent negative variation (CNV) has been shown to be an informative electrophysiological measure of this pain anticipation. Expectations can also arise while observing others in painful conditions. However, it still remains unclear what are the neural correlates of this phenomenon and how the observation of others in pain can subsequently change our personal pain perception as well as our motor reaction to pain. Using CNV as a measure of expectation, this study aims to assess whether expectations formed through observation change the observer's own experience of pain and reaction to pain. A new cooperative task was designed where one participant, the model, received an electrical stimulation while another, the observer, watched the experiment and both were asked to stop the stimulation as fast as possible. Crucially, in a successive session, participants inverted their roles so that models became observers and vice versa. CNV was recorded in both participants simultaneously by means of two synchronized electroencephalograms. Results showed that CNV area did not differ between models and observers and reaction times were significantly faster in observers compared to models. Moreover, observers' pain perception was correlated to models' pain perception as well as to observers' empathy scores. These data show how expectations, perceptions as well as reactions related to pain are crucially affected not only by observation but by personal attitudes toward others and all these changes can be clearly described through CNV.

Research applying electroencephalography (EEG) to Anorexia Nervosa (AN) is still limited, even though in other psychiatric disorders EEG has permitted to find out the hallmarks of the disorder. The aim of the study was to explore whether EEG basal activity and reactivity to musical stimulation differ in participants with AN as compared to healthy subjects (HS). Twenty female participants (respectively 10 with AN and 10 healthy controls) were administered a battery of psychometric tests and underwent EEG under three different conditions: (1) at baseline; (2) after a generic music stimulation; and (3) after a favorite musical stimulation. In participants with AN, basal EEG showed the higher absolute amplitude of cortical slow waves (theta) in the parieto-occipital and temporal derivations, with a deficit in the beta band. In AN, there was a higher N100 latency and a reduced P300 latency compared to HS. While the N100 and P300 latencies were sensitive to the musical stimulus in HS, there was no difference after music stimulation in AN. These data suggest that AN is accompanied by a state of brain hyperarousal with abnormal reactivity to environmental stimuli, similar to the state of HS after musical stimulation. If confirmed, this finding may have treatment implications. III, Evidence obtained from well-designed cohort or case–control analytic studies.

Obiettivo. Il seguente studio si è concentrato sulla valutazione della variazione dell'attività elettrica cerebrale (qEEG) in diverse condizioni di rilassamento indotte attraverso l'ipnosi, in particolare: 1) condizioni di rilassamento attraverso tecniche tradizionali (TT); 2) condizioni di rilassamento attraverso tecniche rapide (TR). Materiali e Metodi. Tutti i partecipanti hanno aderito volontariamente alla sperimentazione e sono stati reclutati secondo specifici criteri anagrafici, fisici e di stato di salute. Nessun partecipante ha presentato patologie psichiatriche o neurologiche conclamate. I partecipanti si sono recati, il giorno dello studio, presso la Fondazione Molo (Torino, Italia) in una stanza illuminata e sono stati suddivisi in modo casuale nei due gruppi sperimentali (TT e TR). Per entrambi i gruppi, prima e durante la seduta di ipnosi, è stata registrata ed analizzata l’attività cerebrale valutando le principali lunghezze d’onda cerebrali (alfa, beta, theta, delta). Risultati. I dati raccolti hanno mostrato come, nel gruppo TR, ovvero nel gruppo dove il rilassamento profondo è stato ottenuto attraverso tecniche di ipnosi rapida, un significativo aumento del ritmo delta dopo l'induzione ipnotica rispetto alle registrazioni avvenute nel gruppo TT, ovvero nel gruppo dove il rilassamento è stato ottenuto con tecniche classiche. Discussione. I dati di questo studio dimostrano come le tecniche rapide permettano una modifica dello stato di coscienza più rapido e profondo, come evidenziato dall’aumento delle onde delta, rispetto alle tecniche di induzione classica.

Introduction Changing drug dosage is common in clinical practice. Recent evidence showed that psychological factors may affect the therapeutic outcome. The aim of this study is to test whether verbal communication about drug dosage changes motor performance and fatigue in Parkinson's Disease (PD) patients. Methods: We performed clinical (Unified PD Rating Scale), motor (number of finger flexions and perceived fatigue), and electrophysiological measurements (readiness potential, RP) in PD patients during medication-off and medication-on conditions in three groups. The first group got a full dose of L-dopa and was told it was a full dose. The second group got half dose and was told it was half dose. The third group got half dose, but it was told it was a full standard dose. Results: We found that overt half dose was less effective than the full dose for clinical improvement, motor performance, and readiness potential. However, if half dose was given along with verbal instructions that it was a full dose, clinical improvement, motor performance and readiness potential were not significantly different from the full dose. Conclusions: Our findings indicate that verbal communication about dose reduction is as effective as the 50% dose reduction itself, demonstrating that deceptive information about the dose may have an important impact on the therapeutic outcome. Moreover, the supplementary motor area, source of the RP, seems to be involved in this psychological effect.

Objective. The following study investigated the effects, measured by a quantitative analysis of the cerebral frequencies (qEEG) of a clinical protocol consisting of 20 neurofeedback sessions on patients affected by aphasia divided in three groups: one experimental group who received real neurofeedback session, a placebo group and a natural history group. Materials and methods. 30 patients have been randomly divided in three groups (N = 10): one experimental group who received real neurofeedback sessions (Neurofeedback Verum, NFV), a placebo group who observed registered videos instead of real neurofeedback recordings (Neurofeedback Placebo, NFP) and a natural history group who didn’t receive any kind treatment (Natural History, NH). The neurofeedback sessions, 20 minutes long and two times per week, were based on the increase of alpha (8-12 Hz) as well as beta (12-20 Hz) frequencies. All patients were tested with qEEG before the beginning of the therapy (TEST) and after the end of the therapy (RETEST). Results. An increase of the frequencies beta 1 (12-20 Hz) in T5 and beta 2 (16-20 Hz) in T3 has been observed only in the group NFV while no change in the qEEG has been observed in the placebo (NFP) or natural history (NH) group. Discussions. The increase in beta 1 and 2 frequencies in the left temporal lobe only in the experimental group NFV indicates a possible influence of the treatment on the damaged areas after the stroke in aphasic patients. Indeed, it has been shown how the beta rhythm, in particular beta 2, is linked to the cognitive-attentive cerebral level but also to the elaboration of language. Furthermore, this frequency band is a measure of the brain damage in aphasic patients where is less represented in the central and posterior areas of the left hemisphere (thus including the temporal electrodes). Conclusions. Even though neurofeedback is used in the treatment of different neuropsychiatric disorders, there are still no systematic studies on this technique, in particular in aphasic patients. The present study represents the first step in standardizing a clinical neurofeedback protocol and collect objective data from qEEG in experimental as well as placebo groups.

Background Expectation is an important mechanism underlying placebo response. Here, we analysed expectation of placebo hypoalgesia and nocebo hyperalgesia by using, for the first time, the contingent negative variation ( CNV ), also known as expectancy wave. Methods Subjects were presented a green or red cue followed by a train of either non painful or painful electrical stimuli, and expected hypoalgesia after the green and hyperalgesia after the red cue. In experiment 1, expectation was reinforced using a conditioning procedure whereby the green and red cues were paired with non painful and painful stimuli, respectively (acquisition). In a second session (test) the intensity of the stimuli was kept constant, regardless of cue. In experiment 2 no conditioning was performed and participants expected an altered pain perception indicated by the visual cues. CNV mean amplitude, time necessary to stop the train of stimuli (reaction time) and pain ratings were measured. Results A difference in pain perception occurred when electrical stimuli followed the presentation of the green cue compared to the red in the test session, whereas reaction times showed no changes. The same difference occurred in the early CNV component, related to cognitive stimulus anticipation, whereas the late CNV component, related to motor preparation, did not change. Moreover, these differences in pain perception and CNV amplitude were less robust in the experiment 2. Conclusion Placebo hypoalgesia and nocebo hyperalgesia differently affect sensory (pain perception) and motor components (pain avoidance) of pain. Furthermore, CNV is an electrophysiological objective measure capable of dissecting these components. Significance Dissection of placebo hypoalgesia, differentiating the sensory component (pain perception) from the motor component (pain avoidance). Study of these components using the contingent negative variation ( CNV ) as an electrophysiological objective measure.

The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results.

In this paper we report the effect of a combined transcranial direct current stimulation (tDCS) and speech language therapy on linguistic deficits following left brain damage in a stroke case. We show that simultaneous electrical excitatory stimulation to the left and inhibitory stimulation to the right parietal regions (dual-tDCS) affected writing and reading rehabilitation, enhancing speech therapy outcomes. The results of a comparison with healthy controls showed that application of dual-tDCS could improve, in particular, sub-lexical transcoding and, specifically, the reading of non-words with increasing length and complexity. Positive repercussions on patient's quality of functional communication were also ascertained. Significant changes were also found in other language and cognitive tasks not directly treated (comprehension and constructive apraxia).

The aim of the present study was to further investigate the electroencephalogram (EEG) connectivity in schizophrenic patients by means of mutual information (MI), an analysis capable of detecting both the linear and nonlinear components of EEG. 19-lead EEGs were recorded in stable schizophrenic patients (N=17) and healthy controls (N=17) in two different conditions: closed eyes (CE) and open eyes (OE). In patients, higher MI values were observed in temporal-parietal-occipital regions compared with controls. In controls, an increase in brain connectivity in frontal regions was observed in the CE condition. This increase was not present in patients. Our results suggest that patients with schizophrenia present changes of brain connectivity that can be detected through MI analysis.

High-altitude, or hypobaric hypoxia, headache has recently emerged as an interesting model to study placebo and nocebo responses, and particularly their peripheral mechanisms. In this study, we analyze the response of this type of headache to either real or sham (placebo) oxygen (O(2)) administration at an altitude of 3500 m, where blood oxygen saturation (SO(2)) drops from the normal value of about 98% to about 85%. In a trial in which a double-blind administration of either 100% O(2) or sham O(2) was administered, we tested pre- and post-exercise headache, along with fatigue, heart rate (HR) responses, and prostaglandin E(2) (PGE(2)) salivary concentration. Although real O(2) breathing increased SO(2) along with a decrease in pre- and post-exercise headache, fatigue, HR, and PGE(2), placebo O(2) changed neither pre-/post-exercise headache nor SO(2)/HR/PGE(2), but it decreased fatigue. However, in another group of subjects, when sham O(2) was delivered after 2 previous exposures to O(2) (O(2) preconditioning), it decreased fatigue, post-exercise headache, HR, and PGE(2), yet without any increase in SO(2). Three main findings emerge from these data. First, placebo O(2) is effective in reducing post-exercise headache, along with HR and PGE(2) decrease, only after O(2) preconditioning. Second, pre-exercise (at rest) headache is not affected by placebo O(2), which emphasizes the limits of a placebo treatment at high altitude. Third, fatigue is affected by placebo O(2) even without prior O(2) conditioning, which suggests the higher placebo sensitivity of fatigue compared with headache pain at high altitude.

Nocebo and placebo effects have been found to modulate several neurochemical systems, such as cholecystokinin, endogenous opioids, and endocannabinoids. Here we show that also the cyclooxygenase-prostaglandins pathway can be modulated by both nocebos and placebos. In fact, we found that negative expectation, the crucial element of the nocebo effect, about headache pain led to the enhancement of the cyclooxygenase-prostaglandins pathway, which, in turn, induced pain worsening. As an experimental model, we studied hypobaric hypoxia headache at high altitude in 2 populations of subjects. Whereas the experimental nocebo group received negative information by a single individual who was informed about the risk of headache, the control group did not know about the possible occurrence of headache. We found a significant increase in headache and salivary prostaglandins and thromboxane in the nocebo group compared to the control group, suggesting that negative expectations enhance cyclooxygenase activity. In addition, placebo administration to headache sufferers at high altitude inhibited the noce-bo-related component of pain and prostaglandins synthesis, which indicates that the cyclooxygenase pathway can be modulated by both noce-bos and placebos. Our results show for the first time how nocebos and placebos affect the synthesis of prostaglandins, which represent an important target of analgesic drugs, thus emphasizing once again the notion that placebos and drugs may use common biochemical pathways. (c) 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Frontotemporal lobar degeneration (FTLD) is a form of dementia characterized by a profound alteration in personality and social behavior and is associated with atrophy in the frontal and temporal brain regions. Despite recent advances, diagnosis of FTLD remains challenging. In the last decade, different studies have combined EEG analysis with mathematical models and theories that consider EEG signals as the result of nonlinear chaotic activity. The aim of the present study was to determine whether new nonlinear dynamic analysis can provide useful information on brain activity in FTLD patients. 19-lead EEG was recorded in patients with clinical diagnosis of FTLD and in healthy controls under two different conditions: closed eyes and open eyes. A nonlinear measure of complexity, correlation dimension (D2), was calculated. Our results show an increase in D2 in healthy individuals when the eyes are open, in keeping with an increase in information processing. Conversely, in FTLD patients, no increase in D2 occurred in the open eyes condition, and D2 was significantly lower than that observed in controls. Our results suggest that the dynamic processes underlying the EEG are less chaotic and complex in FTLD patients compared with normal individuals, thus providing important information on both brain functioning and possible clinical diagnostic applications.

Pain is a negative emotional experience that is modulated by a variety of psychological factors through different inhibitory systems. For example, endogenous opioids and cannabinoids have been found to be involved in stress and placebo analgesia. Here we show that when the meaning of the pain experience is changed from negative to positive through verbal suggestions, the opioid and cannabinoid systems are co-activated and these, in turn, increase pain tolerance. We induced ischemic arm pain in healthy volunteers, who had to tolerate the pain as long as possible. One group was informed about the aversive nature of the task, as done in any pain study. Conversely, a second group was told that the ischemia would be beneficial to the muscles, thus emphasizing the usefulness of the pain endurance task. We found that in the second group pain tolerance was significantly higher compared to the first one, and that this effect was partially blocked by the opioid antagonist naltrexone alone and by the cannabinoid antagonist rimonabant alone. However, the combined administration of naltrexone and rimonabant antagonized the increased tolerance completely. Our results indicate that a positive approach to pain reduces the global pain experience through the co-activation of the opioid and cannabinoid systems. These findings may have a profound impact on clinical practice. For example, postoperative pain, which means healing, can be perceived as less unpleasant than cancer pain, which means death. Therefore, the behavioral and/or pharmacological manipulation of the meaning of pain can represent an effective approach to pain management. (C) 2012 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.

Conventional cardiovascular (CV) risk factors identify only half of subjects with incident major adverse CV events (MACE). Hence new markers are needed in high CV risk subjects, as those with erectile dysfunction (ED). A role for dynamic peak systolic velocity (D-PSV) at penile color Doppler ultrasound (PCDU) has been suggested, but it is operator dependent and time consuming. Flaccid penile acceleration (FPA) is a PCDU parameter that reflects PSV, the systolic rise time (SRT), and end diastolic velocity (EDV), arithmetically defined as (PSV−EDV)/SRT.The study aims to verify, in a large series of ED patients, whether FPA has a role in predicting MACE.A selected series of 1,903 patients (aged 54.6 ± 11.7) with a suspected organic component for ED was retrospectively studied from January 2000 until July 2012. A subset of this sample (n = 622) was enrolled in a longitudinal study that ended in December 2007.Several clinical, biochemical, and instrumental (PCDU) parameters were studied.Decreased FPA levels were associated with worse metabolic profile and sexual symptoms. In addition, FPA was positively associated with both total and calculated free testosterone. In the longitudinal study, unadjusted incidence of MACE was significantly associated with lower baseline FPA. When FPA was introduced in a multivariate model, along with D-PSV, after adjusting for age and Chronic Disease Score, lower FPA, but not D-PSV, was associated with incident MACE in lower-risk—i.e., younger (HR = 0.48 [0.23–0.99]), nonhypertensive (HR = 0.59 [0.38–0.92]), nonobese (HR = 0.68 [0.49–0.96]), or nondiabetic (HR = 0.67 [0.49–0.96] subjects; all P < 0.05—but not in higher-risk ones. FPA demonstrated a threshold effect in predicting MACE at a value <1.17 m/s2 which showed a threefold increase in incidence of MACE in apparently lower-risk individuals.FPA is an easily obtained PCDU parameter and capable of identifying adverse metabolic and CV profiles, particularly in apparently lower-risk individuals with ED. Rastrelli G, Corona G, Lotti F, Aversa A, Bartolini M, Mancini M, Mannucci E, and Maggi M. Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. J Sex Med 2014;11:173–186.

Nonostante i moderni test per diagnosticare e valutare i disturbi sessuali, non esiste un test psicofisiologico obiettivo per valutare il desiderio sessuale. Studi precedenti suggeriscono che l'ampiezza dell'onda P300 decresce durante l'esposizione a video esplicitamente sessuali.: 20 soggetti sani e 20 con disturbo del desiderio sessuale, sono stati sottoposti a blocchi di stimoli uditivi con il paradigma. La P300 uditiva č stata ottenuta mentre i soggetti guardavano videoclip di contenuto sessuale, sportivo e cartoons.: l'ampiezza e l'area della P300 uditiva decrescono significativamente durante la visione dei video. Nei soggetti sani il decremento della P300 č massimo durante la visione dei contenuti sessuali (p < .001); soggetti affetti da Disturbo del desiderio mostrano invece un decremento dell'area e dell'ampiezza della P300 minore.: il cambiamento di ampiezza e area della P300 uditiva durante la visione di videoclip a contenuto sessuale, potrebbe essere utilizzata come misurazione dell'interesse sessuale del soggetto. Questo metodo potrebbe essere applicato sia per valutare l'efficacia di eventuali interventi terapeutici, sia come strumento di diagnosi per la valutazione di disturbi di desiderio sessuale.

BACKGROUND:In spite of the large number of studies on schizophrenia, a full understanding of its core pathology still eludes us. The application of the nonlinear theory of electroencephalography (EEG) analysis provides an interesting tool to differentiate between physiologic conditions (e.g., resting state and mathematical task) and normal and pathologic brain activities. The aim of the present study was to investigate nonlinear EEG activity in patients with schizophrenia.METHODS:We recorded 19-lead EEGs in patients with stable schizophrenia and healthy controls under 4 different conditions: eyes closed, eyes open, forward counting and backward counting. A nonlinear measure of complexity was calculated by means of correlation dimension (D2).RESULTS:We included 17 patients and 17 controls in our analysis. Comparing the 2 populations, we observed greater D2 values in the patient group. In controls, increased D2 values were observed during active states (eyes open and the 2 cognitive tasks) compared with baseline conditions. This increase of brain complexity, which can be interpreted as an increase of information processing and integration, was not preserved in the patient population.LIMITATIONS:Patients with schizophrenia were taking antipsychotic medications, so the presence of medication effects cannot be excluded.CONCLUSION:Our results suggest that patients with schizophrenia present changes in brain activity compared with healthy controls, and this pathologic alteration can be successfully studied with nonlinear EEG analysis.