MIGLIOR ARTICOLO DEL MESE CON PRIMO AUTORE ITALIANO

“Clinical Features and Biomarkers to Differentiate Primary and Amyotrophic Lateral Sclerosis in Patients With an Upper Motor Neuron Syndrome”

Paride Schito, Tommaso Russo, Teuta Domi, Alessandra Mandelli, Laura Pozzi, Ubaldo DelCarro, Paola Carrera, Federica Agosta, Angelo Quattrini, Roberto Furlan, Massimo Filppi, Nilo Riva

Neurology Mar 2023, DOI: https://doi.org/10.1212/WNL.0000000000207223 

Selezionato dal lettore: DENISE CERNE 

MOTIVATION: Primary lateral sclerosis (PLS) is a slowly progressive neurodegenerative disorder determing a selective upper motor neuron (UMN) dysfunction.

Differentiation of PLS from UMN-predominant forms of amyotrophic lateral sclerosis (ALS) remains a significant challenge in the early symptomatic phase of both disorders and this could be an obstacle to therapeutic development for PLS.

This is a retrospective study of 105 patients presenting with UMN-syndrome aimed to identify prognostic factors and clinical features to distinguish PLS from ALS.

An insidious onset is the rule in PLS determing a longer time to first neurological evaluation in these patients with a delayed diagnosis.  On the contrary, in this group lower levels of neurofilament light chain (NfL) are reported, leading to a better prognosis than ALS patients. NfL reflect neuronal death and axonal degeneration mainly in UMN forms involing corticospinal tract.

The authors concluded that the measurement of NfL levels, in consideration of their independent prognostic value, might help to differentiate PLS from ALS patients.

MIGLIOR ARTICOLO IN ASSOLUTO

“Cardiogenic control of affective behavioural state”

Brian Hsueh, Ritchie Chen, YoungJu Jo, Daniel Tang, Misha Raffiee, Yoon Seok Kim, Masatoshi Inoue, Sawyer Randles, Charu Ramakrishnan, Sneha Patel, Doo Kyung Kim, Tony X. Liu, Soo Hyun Kim, Longzhi Tan, Leili Mortazavi, Arjay Cordero, Jenny Shi, Mingming Zhao, Theodore T. Ho, Ailey Crow, Ai-Chi Wang Yoo, Cephra Raja, Kathryn Evans, Daniel Bernstein, Michael Zeineh, Maged Goubran and Karl Deisseroth

Nature, vol. 615 DOI: https://doi.org/10.1038/s41586-023-05748-8

Selezionato dal lettore: MATTEO CEGALIN

MOTIVATION: It is well known that emotional states influence bodily physiology, for example anxiety can increase the heart rate. However, can the opposite happen? Can tachycardia induce anxiety, apprehension or fear?

This study has tried to establish the existence of pathways from the body to the brain inducing anxiety-like behaviours in rodents. In order to demonstrate this theory, the Stanford University research group used noninvasive optogenetic pacemakers on murins to find out if tachycardia can induce anxiety-like behaviours. To identify potential mechanisms, they used whole-brain activity screening and electrophysiology to find brain regions that were activated by imposed cardiac rhythms.

What they found is that the posterior insular cortex is a pontential mediator for bottom-up cardiac interocepting processing. Furthermore, the optgenetic inhibition of this brain region seems to attenuate the anxiety-like behaviour that is induced by optical cardiac pacing. These findings suggest that the insula has a causal role in integrating sensory information from the heart with a contextual assessment of environmental risk to produce adaptive behavioural patterns.

This article should arouse the interest of neurologists because it supports the idea that the insular cortex is invollved in monitoring not only consummatory but also entirely internal interoceptive states to instruct relevant behavioural responses, as predicted from human neuroimaging studies of cardiac interoception.