Alessandro Di Rocco, M.D.

Basal ganglia and kinematics modulation: insights from Parkinson's and Huntington's diseases
Moisello, Clara; Perfetti, Bernardo; Marinelli, Lucio; Sanguineti, Vittorio; Bove, Marco; Feigin, Andrew; Di Rocco, Alessandro; Eidelberg, David; Ghilardi, M F
2011 Sep;17(8):642-644, Parkinsonism & related disorders
Movement kinematic variables related to force production can be modulated to respond appropriately to different contexts. We previously showed that in a choice-reaction time and a predictable timed-response task, normal subjects perform reaching movements to the same targets with two different kinematic patterns, a marker of flexibility. Here, we used the two tasks to determine whether basal ganglia are involved in the selection and modulation of movement kinematics and therefore in flexible force production. We tested seventeen patients in the early stages of Parkinson's disease, eleven pre-symptomatic Huntington's disease carriers and sixteen age-matched normal controls with the above-mentioned motor tasks. In both patient groups, the difference in kinematics (movement duration, peak velocity and acceleration) between the two tasks was significantly reduced compared to controls, indicating a limited range of choices or flexibility. However, this reduction was skewed in opposite directions in the two disorders, with force production being generally higher in Huntington's carriers and lower in Parkinson's patients compared to controls. We conclude that basal ganglia are involved in adapting movement to different contexts and selecting the appropriate movement force. The opposite trends in Parkinson's and Huntington's disease suggest that such regulation might depend on the balance between the outputs of direct and indirect pathways
— id: 142645, year: 2011, vol: 17, page: 642, stat: Journal Article,

Modulation of gamma and theta spectral amplitude and phase synchronization is associated with the development of visuo-motor learning
Perfetti, Bernardo; Moisello, Clara; Landsness, Eric Carl; Kvint, Svetlana; Lanzafame, Simona; Onofrj, Marco; Di Rocco, Alessandro; Tononi, Giulio; Ghilardi, M Felice
2011 Oct 12;31(41):14810-14819, Journal of neuroscience
The formation of new motor memories, which is fundamental for efficient performance during adaptation to a visuo-motor rotation, occurs when accurate planning is achieved mostly with feedforward mechanisms. The dynamics of brain activity underlying the switch from feedback to feedforward control is still matter of debate. Based on the results of studies in declarative learning, it is likely that phase synchronization of low and high frequencies as well as their temporal modulation in power amplitude underlie the formation of new motor memories during visuo-motor adaptation. High-density EEG (256 electrodes) was recorded in 17 normal human subjects during adaptation to a visuo-motor rotation of 60 degrees in four incremental steps of 15 degrees . We found that initial learning is associated with enhancement of gamma power in a right parietal region during movement execution as well as gamma/theta phase coherence during movement planning. Late stages of learning are instead accompanied by an increase of theta power over that same right parietal region during movement planning, which is correlated with the degree of learning and retention. Altogether, these results suggest that the formation of new motor memories and, thus, the switch from feedback to feedforward control is associated with the modulation of gamma and theta spectral activities, with respect to their amplitude and phase, during movement planning and execution. Specifically, we propose that gamma/theta phase coupling plays a pivotal role in the integration of a new representation into motor memories
— id: 142642, year: 2011, vol: 31, page: 14810, stat: Journal Article,

Treatment of advanced Parkinson's disease
Varanese, Sara; Birnbaum, Zoe; Rossi, Roger; Di Rocco, Alessandro
2011 ;2010:480260-480260, Parkinson's disease
Patients at late stage Parkinson's disease (PD) develop several motor and nonmotor complications, which dramatically impair their quality of life. These complications include motor fluctuations, dyskinesia, unpredictable or absent response to medications, falls, dysautonomia, dementia, hallucinations, sleep disorders, depression, and psychosis. The therapeutic management should be driven by the attempt to create a balance between benefit and side effects of the pharmacological treatments available. Supportive care, including physical and rehabilitative interventions, speech therapy, occupational therapy, and nursing care, has a key role in the late stage of disease. In this review we discuss the several complications experienced by advance PD patients and their management. The importance of an integrative approach, including both pharmacological and supportive interventions, is emphasized
— id: 124101, year: 2011, vol: 2010, page: 480260, stat: Journal Article,

Apathy, but not depression, reflects inefficient cognitive strategies in Parkinson's disease
Varanese, Sara; Perfetti, Bernardo; Ghilardi, Maria Felice; Di Rocco, Alessandro
2011 ;6(3):e17846-e17846, PLoS ONE
BACKGROUND: The relationship between apathy, depression and cognitive impairment in Parkinson's disease (PD) is still controversial. The objective of this study is to investigate whether apathy and depression are associated with inefficient cognitive strategies in PD. METHODS: In this prospective clinical cohort study conducted in a university-based clinical and research movement disorders center we studied 48 PD patients. Based on clinical evaluation, they were classified in two groups: PD with apathy (PD-A group, n = 23) and PD without apathy (PD-NA group, n = 25). Patients received clinical and neuropsychological evaluations. The clinical evaluation included: Apathy Evaluation Scale-patient version, Hamilton Depression Rating Scale-17 items, the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr staging system; the neuropsychological evaluation explored speed information processing, attention, working memory, executive function, learning abilities and memory, which included several measures of recall (immediate free, short delay free, long delay free and cued, and total recall). FINDINGS: PD-A and PD-NA groups did not differ in age, disease duration, treatment, and motor condition, but differed in recall (p<0.001) and executive tasks (p<0.001). Immediate free recall had the highest predictive value for apathy (F = 10.94; p = 0.002). Depression and apathy had a weak correlation (Pearson index = 0.3; p<0.07), with three items of the depression scale correlating with apathy (Pearson index between .3 and.4; p<0.04). The depressed and non-depressed PD patients within the non-apathetic group did not differ. CONCLUSION: Apathy, but not depression, is associated with deficit in implementing efficient cognitive strategies. As the implementation of efficient strategies relies on the fronto-striatal circuit, we conclude that apathy, unlike depression, is an early expression of executive impairment in PD
— id: 129326, year: 2011, vol: 6, page: e17846, stat: Journal Article,

Repetitive transcranial magnetic stimulation enhances BDNF-TrkB signaling in both brain and lymphocyte
Wang, Hoau-Yan; Crupi, Domenica; Liu, Jingjing; Stucky, Andres; Cruciata, Giuseppe; Di Rocco, Alessandro; Friedman, Eitan; Quartarone, Angelo; Ghilardi, M Felice
2011 Jul 27;31(30):11044-11054, Journal of neuroscience
Repetitive transcranial magnetic stimulation (rTMS) induces neuronal long-term potentiation or depression. Although brain-derived neurotrophic factor (BDNF) and its cognate tyrosine receptor kinase B (TrkB) contribute to the effects of rTMS, their precise role and underlying mechanism remain poorly understood. Here we show that daily 5 Hz rTMS for 5 d improves BDNF-TrkB signaling in rats by increasing the affinity of BDNF for TrkB, which results in higher tyrosine-phosphorylated TrkB, increased recruitment of PLC-gamma1 and shc/N-shc to TrkB, and heightened downstream ERK2 and PI-3K activities in prefrontal cortex and in lymphocytes. The elevated BDNF-TrkB signaling is accompanied by an increased association between the activated TrkB and NMDA receptor (NMDAR). In normal human subjects, 5 d rTMS to motor cortex decreased resting motor threshold, which correlates with heightened BDNF-TrkB signaling and intensified TrkB-NMDAR association in lymphocytes. These findings suggest that rTMS to cortex facilitates BDNF-TrkB-NMDAR functioning in both cortex and lymphocytes
— id: 138582, year: 2011, vol: 31, page: 11044, stat: Journal Article,

Increased reaction time predicts visual learning deficits in Parkinson's disease
Marinelli, Lucio; Perfetti, Bernardo; Moisello, Clara; Di Rocco, Alessandro; Eidelberg, David; Abbruzzese, Giovanni; Ghilardi, Maria Felice
2010 Jul 30;25(10):1498-1501, Movement disorders
To determine whether the process involved in movement preparation of patients in the early stages of Parkinson's disease (PD) shares attentional resources with visual learning, we tested 23 patients with PD and 13 healthy controls with two different tasks. The first was a motor task where subjects were required to move as soon as possible to randomly presented targets by minimizing reaction time. The second was a visual learning task where targets were presented in a preset order and subjects were asked to learn the sequence order by attending to the display without moving. Patients with PD showed higher reaction and movement times, while visual learning was reduced compared with controls. For patients with PD, reaction times, but not movement times, displayed an inverse significant correlation with the scores of visual learning. We conclude that visual declarative learning and movement preparation might share similar attentional and working memory resources. (c) 2010 Movement Disorder Society
— id: 142654, year: 2010, vol: 25, page: 1498, stat: Journal Article,

Attention modulation regulates both motor and non-motor performance: a high-density EEG study in Parkinson's disease
Perfetti, B; Moisello, C; Lanzafame, S; Varanese, S; Landsness, E C; Onofrj, M; Di Rocco, A; Tononi, G; Ghilardi, M F
2010 Sep;148(3):279-288, Archives italiennes de biologie
We have previously shown that, in early stages of Parkinson's disease (PD), patients with higher reaction times are also more impaired in visual sequence learning, suggesting that movement preparation shares resources with the learning of visuospatial sequences. Here, we ascertained whether, in patients with PD, the pattern of the neural correlates of attentional processes of movement planning predict sequence learning and working memory abilities. High density Electroencephalography (EEG, 256 electrodes) was recorded in 19 patients with PD performing reaching movements in a choice reaction time paradigm. Patients were also tested with Digit Span and performed a visuomotor sequence learning task that has an important declarative learning component. We found that attenuation of alpha/beta oscillatory activity before the stimulus presentation in frontoparietal regions significantly correlated with reaction time in the choice reaction time task, similarly to what we had previously found in normal subjects. In addition, such activity significantly predicted the declarative indices of sequence learning and the scores in the Digit Span task. These findings suggest that some motor and non motor PD signs might have common neural bases, and thus, might have a similar response to the same behavioral therapy. In addition, these results might help in designing and testing the efficacy of novel rehabilitative approaches to improve specific aspects of motor performance in PD and other neurological disorders
— id: 142653, year: 2010, vol: 148, page: 279, stat: Journal Article,

Impaired Development of Strategies is Associated with Apathy in Parkinson's Disease
Varanese, S.; Perfetti, B.; Morrison, C.; Ghilardi, M. F.; Di Rocco, A.
2010 SEP 15 ;25(15):S691-S692, Movement disorders
— id: 113908, year: 2010, vol: 25, page: S691, stat: Journal Article,

NMDA antagonist memantine improves levodopa-induced dyskinesias and "on-off" phenomena in Parkinson's disease
Varanese, Sara; Howard, Jonathan; Di Rocco, Alessandro
2010 Mar 15;25(4):508-510, Movement disorders
— id: 108786, year: 2010, vol: 25, page: 508, stat: Journal Article,

Thalidomide induced acute worsening of Parkinson's disease
Crystal, Sara C; Leonidas, John; Jakubowski, Ann; Di Rocco, Alessandro
2009 Sep 15;24(12):1863-1864, Movement disorders
— id: 102400, year: 2009, vol: 24, page: 1863, stat: Journal Article,

Learning and consolidation of visuo-motor adaptation in Parkinson's disease
Marinelli, Lucio; Crupi, Domenica; Di Rocco, Alessandro; Bove, Marco; Eidelberg, David; Abbruzzese, Giovanni; Ghilardi, M Felice
2009 Jan;15(1):6-11, Parkinsonism & related disorders
We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naive patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep
— id: 90490, year: 2009, vol: 15, page: 6, stat: Journal Article,

Fava beans and Parkinson's disease: useful 'natural supplement' or useless risk?
Raguthu, L; Varanese, S; Flancbaum, L; Tayler, E; Di Rocco, A
2009 OCT ;16(10):e171-e171, European journal of neurology
— id: 102472, year: 2009, vol: 16, page: e171, stat: Journal Article,

Early impairment of synaptic plasticity in patients with Down's syndrome
Battaglia, Fortunato; Quartarone, Angelo; Rizzo, Vincenzo; Ghilardi, Maria Felice; Di Rocco, Alessandro; Tortorella, Gaetano; Girlanda, Paolo
2008 Aug;29(8):1272-1275, Neurobiology of aging
We investigated synaptic plasticity in persons with Down' syndrome (DS) and control subjects used paired associative stimulation (PAS) protocol, a paradigm capable of producing long-term potentiation (LTP)-like changes in the sensorimotor system. After PAS, patients showed less LTP-like plasticity compared to control subjects. Abnormal motor cortex synaptic plasticity may play a role in the development of motor signs in DS
— id: 75223, year: 2008, vol: 29, page: 1272, stat: Journal Article,

Cortical and brainstem LTP-like plasticity in Huntington's disease
Crupi, Domenica; Ghilardi, Maria Felice; Mosiello, Clara; Di Rocco, Alessandro; Quartarone, Angelo; Battaglia, Fortunato
2008 Jan 31;75(1):107-114, Brain research bulletin
Recent studies have reported abnormalities in short-term plasticity in patients with Huntington's disease (HD). However, is not known whether long-term potentiation (LTP)-like plasticity is also affected in these patients. We tested cortical and brainstem LTP-like plasticity in eight symptomatic HD patients and in 10 healthy age-matched controls. To probe motor cortex LTP-like plasticity we used paired associative stimulation (PAS), a technique that combines repetitive electric stimulation of the median nerve with subsequent transcranial magnetic stimulation (TMS) of the contralateral motor cortex at 25ms. To investigate brainstem plasticity, we induced LTP-like phenomena in the trigeminal wide dynamic range neurons (WDR) of the blink reflex circuit by pairing an high-frequency train of electrical stimuli (HFS) over the right supraorbital nerve (SO) coincident with the R2 response elicited by a preceding SO stimulus. Our results demonstrate impairment of both cortical and brainstem LTP-like plasticity in symptomatic HD patients which is similar to LTP deficits previously reported in HD animal models. These findings might well represent the neurophysiological correlates of memory deficits often present in HD
— id: 75221, year: 2008, vol: 75, page: 107, stat: Journal Article,

Implicit and explicit aspects of sequence learning in pre-symptomatic Huntington's disease
Ghilardi, M F; Silvestri, G; Feigin, A; Mattis, P; Zgaljardic, D; Moisello, C; Crupi, D; Marinelli, L; Dirocco, A; Eidelberg, D
2008 Aug;14(6):457-464, Parkinsonism & related disorders
Learning deficits may be part of the early symptoms of Huntington's disease (HD). Here we characterized implicit and explicit aspects of sequence learning in 11 pre-symptomatic HD gene carriers (pHD) and 11 normal controls. Subjects moved a cursor on a digitizing tablet and performed the following tasks: SEQ: learning to anticipate the appearance of a target sequence in two blocks; VSEQ: learning a sequence by attending to the display without moving for one block, and by moving to the sequence in a successive block (VSEQ test). Explicit learning was measured with declarative scores and number of anticipatory movements. Implicit learning was measured as a strategy change reflected in movement time. By the end of SEQ, pHD had a significantly lower number of correct anticipatory movements and lower declarative scores than controls, while in VSEQ and VSEQ test these indices improved. During all three tasks, movement time changed in controls, but not in pHD. These results suggest that both explicit and implicit aspects of sequence learning may be impaired before the onset of motor symptoms. However, when attentional demands decrease, explicit, but not implicit, learning may improve
— id: 90488, year: 2008, vol: 14, page: 457, stat: Journal Article,

A novel paradigm to assess mental fatigue in Parkinson's disease
Battaglia, F; Crupi, D; Di Rocco, A; Quartarone, A; Ghilardi, F
2007 APR 24 ;22(17):S160-S160, Movement disorders
— id: 75273, year: 2007, vol: 22, page: S160, stat: Journal Article,

Objective assessment of mental fatigue in untreated early Parkinson's disease
Battaglia, F; DiRocco, A; Quartarone, A; Ghilardi, MF
2007 MAR 20 ;68(12):A38-A38, Neurology
— id: 75255, year: 2007, vol: 68, page: A38, stat: Journal Article,

Brainstem and motor cortex plasticity in Huntington's disease
Battaglia, F; Ghilardi, MF; Quartarone, A; Dirocco, A
2007 MAR 20 ;68(12):A229-A229, Neurology
— id: 75257, year: 2007, vol: 68, page: A229, stat: Journal Article,

Acute Parkinsonism in HIV
Bernbaum M; DiRocco A
2007 ;13(Suppl 2):S81-S81 A1.316, Parkinsonism & related disorders
— id: 75297, year: 2007, vol: 13, page: S81, stat: Journal Article,

VHDL program enables PCI-bus-arbiter core
Di Rocco, A
2007 SEP 13 ;52(19):70-70, EDN
— id: 75271, year: 2007, vol: 52, page: 70, stat: Journal Article,

HIV myelopathy
Di Rocco, Alessandro
2007 ;85:123-128, Handbook of clinical neurology
— id: 90489, year: 2007, vol: 85, page: 123, stat: Journal Article,

Vitamins and entacapone in levodopa-induced hyperhomocysteinemia: a randomized controlled study
Di Rocco, Alessandro; Werner, Peter
2007 Apr 24;68(17):1440-1440, Neurology
— id: 75222, year: 2007, vol: 68, page: 1440, stat: Journal Article,

Sequence learning and the basal ganglia
Ghilardi MF; Bassiri-Tehrani M; Maldonando N; Moisello C; DiRocco A; Eidelberg D
2007 ;13(Suppl 2):S59-S59 A1.197, Parkinsonism & related disorders
— id: 75295, year: 2007, vol: 13, page: S59, stat: Journal Article,

Increased reaction time predicts deficit of explicit visual learning in the early stages of Parkinson's Disease
Ghilardi MF; Marinelli L; Moisello C; Abbruzzese G; DiRocco A
2007 ;13(Suppl 2):S59-S60 A1.199, Parkinsonism & related disorders
— id: 75293, year: 2007, vol: 13, page: S59, stat: Journal Article,

Trajectory control and motor learning in pre-symptomatic Huntington's disease (pHD)
Ghilardi, F; Feigin, A; Moisello, C; Battaglia, F; Di Rocco, A; Eidelberg, D
2007 APR 24 ;22(17):S159-S160, Movement disorders
— id: 75272, year: 2007, vol: 22, page: S159, stat: Journal Article,

L-Dopa infusion does not improve explicit sequence learning in Parkinson's disease
Ghilardi, M Felice; Feigin, Andrew S; Battaglia, Fortunato; Silvestri, Giulia; Mattis, Paul; Eidelberg, David; Di Rocco, Alessandro
2007 Apr;13(3):146-151, Parkinsonism & related disorders
We have recently introduced a set of sequence learning tasks that emphasize explicit learning and target anticipation and involve the activation of frontal lobes. This type of learning is impaired even in the early stages of Parkinson's disease (PD). Studies on the effects of L-Dopa on cognitive symptoms of PD have yielded controversial results. To verify whether L-Dopa acutely improves explicit sequence learning, we tested six normal subjects and seven PD patients both off-drug and during L-Dopa infusion with two tasks: SEQ, a motor task with multiple demands, where a sequence had to be learned while reaching for a targets; VSEQ, a visual task where a sequence had to be learned by attending to a visual display without moving. Motor performance was assessed with simple motor tasks. L-Dopa improved motor scores and movement speed, but had no beneficial effect on either type of sequence learning
— id: 75225, year: 2007, vol: 13, page: 146, stat: Journal Article,

A three-year follow-up study in pre-symptomatic Huntington's disease (pHD): Trajectory control and motor learning
Ghilardi, MF; Feigin, A; Battaglia, F; DiRocco, A; Eidelberg, D
2007 MAR 20 ;68(12):A229-A229, Neurology
— id: 75256, year: 2007, vol: 68, page: A229, stat: Journal Article,

Cervical dystonia affects trajectory formation and botulinium toxin restores it
Pelosin E; Bove M; Marinelli L; Moisello C; DiRocco A; Ghilardi MF; Abbruzzese G
2007 ;13(Suppl 2):S67-S67 A1.257, Parkinsonism & related disorders
— id: 75294, year: 2007, vol: 13, page: S67, stat: Journal Article,

Phenotypic characterization of parkinsonism in patients with Gaucher Disease
Sathe S; Pastores GM; Kolodny E; DiRocco A
2007 ;13(Suppl 2):S64-S64 A1.216, Parkinsonism & related disorders
— id: 75296, year: 2007, vol: 13, page: S64, stat: Journal Article,

Acute worsening of Parkinson's disease induced by thalidomide
Tarshish, SC; Leonidas, JC; Jakubowski, AA; Di Rocco, A
2007 MAR 20 ;68(12):A231-A231, Neurology
— id: 75274, year: 2007, vol: 68, page: A231, stat: Journal Article,

Interjoint coordination in cervical dystonia: The effect of botulinum toxin
Abbruzzese, G; Pelosin, E; Bove, M; Marinelli, L; Di Rocco, A; Battaglia, F; Ghilardi, A
2006 OCT 25 ;21(1-2):S381-S381, Movement disorders
— id: 75276, year: 2006, vol: 21, page: S381, stat: Journal Article,

Abnormal LTP-like plasticity in Huntington's disease
Battaglia, F; Ghilardi, M; Dirocco, A; Quartarone, A
2006 MAR 20 ;21(12):S359-S359, Movement disorders
— id: 75258, year: 2006, vol: 21, page: S359, stat: Journal Article,

A randomized controlled trial of etilevodopa in patients with Parkinson disease who have motor fluctuations
Blindauer, Karen; Shoulson, Ira; Oakes, David; Kieburtz, Karl; Schwid, Steven; Fahn, Stanley; Stern, Matthew; Goetz, Christopher; Nutt, John; Goren, Sari; Sayag, Naim; Scolnik, Marisa; Levy, Ruth; Eyal, Eli; Salzman, Phyllis; Pagano, Mary
2006 Feb;63(2):210-216, Archives of neurology
BACKGROUND: Motor fluctuations are a common complication in patients with Parkinson disease (PD) receiving long-term levodopa therapy. Slowed gastric emptying and poor solubility of levodopa in the gastrointestinal tract may delay the onset of drug benefit after dosing. Etilevodopa is an ethyl-ester prodrug of levodopa that has greater gastric solubility, passes quickly into the small intestine, is rapidly hydrolyzed to levodopa, and has a shortened time to maximum levodopa concentration. OBJECTIVE: To determine the efficacy, safety, and tolerability of etilevodopa in patients with PD who have motor fluctuations. DESIGN: A double-blind, randomized, comparative clinical trial. SETTING: Forty-four sites in the United States and Canada. PATIENTS: Three hundred twenty-seven patients with PD who had a latency of at least 90 minutes total daily time to 'on' (TTON) after levodopa dosing. INTERVENTION: Treatment with either etilevodopa-carbidopa or levodopa-carbidopa for 18 weeks. MAIN OUTCOME MEASURE: Change from baseline in total daily TTON as measured using home diaries. RESULTS: The reduction in mean total daily TTON from baseline to treatment was 0.58 hour in the etilevodopa-carbidopa group and 0.79 hour in the levodopa-carbidopa group (P = .24). There was no significant difference between the etilevodopa-carbidopa and levodopa-carbidopa groups in the reduction of response failures (-6.82% vs -4.69%; P = .20). Total daily 'off' time improved in the etilevodopa-carbidopa (-0.85 hour) and levodopa-carbidopa (-0.87 hour) groups without an increase in on time with troublesome dyskinesias. CONCLUSION: Despite the theoretical pharmacokinetic advantage of etilevodopa, there was no improvement in TTON, response failures, or off time compared with levodopa
— id: 75253, year: 2006, vol: 63, page: 210, stat: Journal Article,

Inhaled cocaine used to relieve "off" periods in patients with Parkinson disease and unpredictable motor fluctuations: a report of 2 cases
Di Rocco, Alessandro; Nasser, Sabina; Werner, Peter
2006 Dec;26(6):689-690, Journal of clinical psychopharmacology
— id: 75224, year: 2006, vol: 26, page: 689, stat: Journal Article,

Characterization of depression subtypes in Parkinson's disease
Ferrando, SJ; Barnhill, J; Findler, M; Godbold, J; Petrescu, O; Veytsman, M; Di Rocco, A
2006 OCT 25 ;248(1-2):289-289, Journal of the neurological sciences
— id: 75275, year: 2006, vol: 248, page: 289, stat: Journal Article,

Normal learning and lack of consolidation in early Parkinson's disease
Ghilardi, M; Battaglia, F; Marinelli, L; Bove, M; Abbruzzese, G; Dirocco, A
2006 MAR 20 ;21(12):S542-S543, Movement disorders
— id: 75259, year: 2006, vol: 21, page: S542, stat: Journal Article,

Effect of L-dopa on explicit sequence learning in Parkinson's disease
Ghilardi, M; Fegin, A; Battaglia, F; Mattis, P; Eidelberg, D; Di Rocco, A
2006 OCT 25 ;21(1-2):S653-S654, Movement disorders
— id: 75277, year: 2006, vol: 21, page: S653, stat: Journal Article,

Motor skill consolidation in Parkinson's disease (PD)
Ghilardi, MF; Silvestri, G; Ghez, C; Battaglia, F; DiRocco, A; Eidelberg, D
2006 MAR 20 ;21(12):S99-S99, Movement disorders
— id: 75260, year: 2006, vol: 21, page: S99, stat: Journal Article,

Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles
Rossi, Roger P; Strax, Thomas E; Di Rocco, Alessandro
2006 Dec;85(12):1011-1013, American journal of physical medicine & rehabilitation
We report a case of severe dysphagia in a 29-yr-old woman with cerebral palsy after she was injected with botulinum toxin B to her lower limbs and lumbar paraspinal muscles. Four days after the treatment, she developed difficulty swallowing, more severe for solid foods than for liquids, accompanied by dry mouth, blurred vision, and voice hoarseness. Fifteen days after the injection, with worsening of her dysphagia, she was hospitalized. A laryngoscopic evaluation revealed bilateral vocal cord paresis, and a modified barium swallow test demonstrated delayed oral initiation, upper airway penetration, and no reflexive cough. In the following days, she improved spontaneously and was discharged 12 days later when she re-acquired the ability to swallow solid foods. Her symptoms resolved completely only 75 days after the injection. Although dysphagia is a common side effect of botulinum injection in the neck, to our knowledge, this is the first reported case of severe dysphagia after injection in a distant anatomic site
— id: 75226, year: 2006, vol: 85, page: 1011, stat: Journal Article,

Melvin D. Yahr (1917-2004): A life dedicated to Parkinson's disease and neurology
Di Rocco, A
2005 NOV ;72(6):COVER3-COVER3, Mount Sinai journal of medicine
— id: 75278, year: 2005, vol: 72, page: COVER3, stat: Journal Article,

Depression subtypes are associated with motor subtypes of Parkinson's disease
Kavanagh, P; Ferrando, SJ; Godbold, J; Veytsman, M; Di Rocco, A
2005 SEP ;20(5):S138-S139, Movement disorders
— id: 75279, year: 2005, vol: 20, page: S138, stat: Journal Article,

Dyskinesias predict the onset of motor response fluctuations in patients with Parkinson's disease on L-dopa monotherapy
Mazzella, L; Yahr, M D; Marinelli, L; Huang, N; Moshier, E; Di Rocco, A
2005 May;11(3):151-155, Parkinsonism & related disorders
The aim of the study was to investigate the relationship between dyskinesias and motor fluctuations in patients with Parkinson's disease on l-dopa monotherapy. We identified 116 patients on l-dopa monotherapy treated between 1965 and 1992 and followed until death. Dyskinesias occurred in 102 patients. Of these, 48 only developed dyskinesias while 54 had both dyskinesias and motor fluctuations. Among patients with both complications, 49 developed dyskinesias before fluctuations, and only five had dyskinesias after the onset of fluctuations. Our findings suggest that dyskinesias predict the onset of motor fluctuations, and may share a common pathophysiological mechanism
— id: 66166, year: 2005, vol: 11, page: 151, stat: Journal Article,

Effects of hepatic function and hepatitis C virus on the nervous system assessment of advanced-stage HIV-infected individuals
Morgello, Susan; Estanislao, Lydia; Ryan, Elizabeth; Gerits, Pieter; Simpson, David; Verma, Susama; DiRocco, Alessandro; Sharp, Victoria
2005 Oct;19 Suppl 3:S116-S122, AIDS
OBJECTIVES: To examine the effects of liver function and hepatitis C virus (HCV) serostatus on neurological, neuropsychological, and psychiatric abnormalities in an advanced-stage HIV-infected cohort. DESIGN: A correlational analysis of baseline data accumulated on 137 participants in the Manhattan HIV Brain Bank, a longitudinal study of HIV-infected individuals. METHODS: Patients underwent a battery of neuropsychological tests, a semi-structured psychiatric interview, and a neurological examination. The resulting diagnostic data were correlated with biochemical indices of hepatic function and HCV serostatus. RESULTS: Biochemical indices of liver function correlated with motor dysfunction determined by neurological evaluation, but not with neuropsychological or psychiatric disorders. Discrete neurological diagnostic entities showed no relationship with biochemical indices, with one exception: patients with cryptococcal leptomeningitis had worse liver function than those without. HCV had no relationship with any neurological disorder or symptom complex. In contrast, HCV serostatus was related to neuropsychological and psychiatric abnormalities, and indices of liver function were not. HCV-seropositive patients were more likely to have histories of opiate, cocaine or stimulant dependency, to have greater impairment in executive functioning, and to meet diagnostic criteria for AIDS dementia, compared with HCV-negative individuals of similar immunological and virological status. CONCLUSIONS: HCV and biochemical indices of liver function associate differentially with nervous system abnormalities in this HIV-infected population. Neurological abnormalities correlate with biochemical indices of liver function, whereas neuropsychological and psychiatric dysfunction are linked to HCV infection. We postulate that multifactorial impacts of HCV and liver disease on HIV-related nervous system disorders may originate in different anatomical and cellular compartments
— id: 64370, year: 2005, vol: 19 Suppl 3, page: S116, stat: Journal Article,

Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study
Vanitallie, T B; Nonas, C; Di Rocco, A; Boyar, K; Hyams, K; Heymsfield, S B
2005 Feb 22;64(4):728-730, Neurology
Ketones may bypass the defect in complex I activity implicated in Parkinson disease (PD). Five of seven volunteers with PD were able to prepare a 'hyperketogenic' diet at home and adhere to it for 28 days. Substituting unsaturated for saturated fats appeared to prevent cholesterol increases in four volunteers. Unified Parkinson's Disease Rating Scale scores improved in all five during hyperketonemia, but a placebo effect was not ruled out
— id: 66167, year: 2005, vol: 64, page: 728, stat: Journal Article,

Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study
Di Rocco, A; Werner, P; Bottiglieri, T; Godbold, J; Liu, M; Tagliati, M; Scarano, A; Simpson, D
2004 Oct 12;63(7):1270-1275, Neurology
BACKGROUND: The histopathology of AIDS-associated myelopathy (AM) closely resembles that of myelopathies due to cobalamin or folate deficiency, with white matter vacuolization in the spinal cord. The pathogenesis of AM appears unrelated to direct HIV infection of the spinal cord. There is abnormal trans-methylation metabolism in AM, with decreased availability of the methyl group donor S-adenosyl-methionine (SAM). The authors hypothesized that treatment with l-methionine, the direct metabolic precursor of SAM, might improve AM. OBJECTIVE: To determine the safety and efficacy of l-methionine treatment in AM. METHODS: Fifty-six patients with clinical diagnosis of AM were randomized to a Phase II, double-blind, placebo-controlled study comparing the effect of l-methionine 6 g/day in two divided doses with that of placebo. Study duration was 12 weeks. All patients had somatosensory evoked potentials with prolonged central conduction time (CCT) at entry. Change in CCT was the primary endpoint of the study. Frequency of adverse events (AEs) was used to assess safety. Secondary endpoints were strength, spasticity, and urinary function. Biochemical measurements included serum methionine and homocysteine and CSF SAM. RESULTS: There were no significant differences in AEs between the two groups. Serum homocysteine increased in l-methionine-treated patients from 7.2 (+/-5.2 SD) to 12.6 (+/-6.15 SD) micromol/L. The mean CCT at baseline was 25.9 milliseconds (+/-7.3 SD) for the treatment group and 24.1 milliseconds (+/-7.0 SD) for the placebo group. At completion, it was 3.0 milliseconds (+/-6.1 SD) for the treatment group and 23.6 milliseconds (+/-5.5 SD) for the placebo group (p = 0.17). In a subset of 15 patients with CSF studies, SAM levels increased in the l-methionine but not in the placebo group (p = 0.07). There was no significant effect of treatment on strength, spasticity, or urinary function. CONCLUSIONS: l-methionine was safe and well tolerated although in some patients induced an increase of serum homocysteine. There was a nonsignificant improvement in CCT in treated patients but no benefit in any of the clinical measures
— id: 66168, year: 2004, vol: 63, page: 1270, stat: Journal Article,

Effect of L-dopa on plasma homocysteine in PD patients: relationship to B-vitamin status
Di Rocco, Alessandro; Werner, Peter
2004 Feb 24;62(4):676-676, Neurology
— id: 66170, year: 2004, vol: 62, page: 676, stat: Journal Article,

Professor Melvin David Yahr 1917-2004
Di Rocco, Alessandro; Werner, Peter
2004 Mar;10(3):123-124, Parkinsonism & related disorders
— id: 66169, year: 2004, vol: 10, page: 123, stat: Journal Article,

Dyskinesias predict the onset of motor response fluctuations in patients with Parkinson's disease on L-dopa monotherapy
Mazzella, L; Huang, N; Di Rocco, A; Yahr, MD
2004 OCT 12 ;19(7):S127-S128, Movement disorders
— id: 75280, year: 2004, vol: 19, page: S127, stat: Journal Article,

HIV-associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: the Manhattan HIV Brain Bank
Morgello, Susan; Estanislao, Lydia; Simpson, David; Geraci, Anthony; DiRocco, Alessandro; Gerits, Pieter; Ryan, Elizabeth; Yakoushina, Tatiana; Khan, Shafat; Mahboob, Rashid; Naseer, Mubasher; Dorfman, David; Sharp, Victoria
2004 Apr;61(4):546-551, Archives of neurology
OBJECTIVES: To examine distal sensory polyneuropathy (DSP) in a highly active antiretroviral therapy era, human immunodeficiency virus (HIV)-infected cohort, to determine whether clinical manifestations are affected by demographic or other clinical variables. PATIENTS: One hundred eighty-seven patients with HIV infection enrolled in the Manhattan HIV Brain Bank underwent baseline neurologic evaluations between January 29, 1999, and June 17, 2002. Distal sensory polyneuropathy was diagnosed if patients displayed abnormalities in 2 or more of the following: ankle reflexes or vibratory or pinprick perception. Patients were classified as symptomatic if they described pain, paresthesia, or numbness. Nonneurologic information was obtained by interview, laboratory testing, and medical chart review. Psychiatric and substance use disorders were elucidated by semistructured interview. In 36 patients, morphometric analysis was performed on autopsy-derived sural nerves. RESULTS: Of 187 patients, 99 (53%) had DSP. Patients with neuropathy were older than those without (mean +/- SD age, 45.3 +/- 0.7 vs 41.2 +/- 0.8 years, P <.001), and DSP was significantly more common in men (58% [83/99]) than in women (37% [16/99]) (P =.02). The presence of neuropathy was not correlated with plasma viral load, decreased CD4 cell counts, or neurotoxic antiretroviral therapy. Twenty-six of 99 patients with DSP were asymptomatic. Asymptomatic neuropathy was correlated with histories of opiate and sedative abuse and dependence. Symptomatic DSP correlated with ethanol and hallucinogen syndromes, but not neurotoxic therapy. Sural nerve morphometric findings did not distinguish between patients with substance use syndromes and those without. CONCLUSIONS: In contrast to populations before the era of highly active antiretroviral therapy, DSP in the Manhattan HIV Brain Bank cohort is not associated with increased viral load or decreased CD4 cell counts in this cross-sectional analysis. Symptoms in DSP are associated with substance use disorders, but no difference in morphologic structure is seen in nerves of patients with HIV infection with and without substance use histories. Previously reported virologic and immunologic underpinnings of DSP may be affected by highly active antiretroviral therapy. Furthermore, symptoms of DSP in substance users may be altered by central mechanisms of increased or decreased tolerance to sensory disturbance
— id: 64371, year: 2004, vol: 61, page: 546, stat: Journal Article,

Parkinson's disease: A clinical study of factors with impact on quality of life. Predictors for nursing home placement
Toma, ME; Di Rocco, A; Yahr, MD
2004 OCT 12 ;19(7):S206-S206, Movement disorders
— id: 75281, year: 2004, vol: 19, page: S206, stat: Journal Article,

Natural history of HIV myelopathy in the HAART era
Banks, LT; Geraci, A; Liu, M; Gobold, J; DiRocco, A
2002 APR 9 ;58(7):A441-A441, Neurology
— id: 75261, year: 2002, vol: 58, page: A441, stat: Journal Article,

MTHFR (C677T) and MetSyn (A2756G) functional polymorphisms in patients with AIDS myelopathy
Bottiglieri, T; Ozelius, L; Godbold, J; Werner, P; Di Rocco, A
2002 APR 9 ;58(7):A407-A407, Neurology
— id: 75283, year: 2002, vol: 58, page: A407, stat: Journal Article,

Abnormal cobalamin-dependent transmethylation in AIDS-associated myelopathy
Di Rocco, A; Bottiglieri, T; Werner, P; Geraci, A; Simpson, D; Godbold, J; Morgello, S
2002 Mar 12;58(5):730-735, Neurology
BACKGROUND: White matter vacuolization of the spinal cord is common in patients with AIDS and may lead to clinical manifestations of myelopathy. The pathogenesis of AIDS-associated myelopathy (AM) is unknown and may be related to metabolic abnormalities rather than to direct HIV infection. The striking pathologic similarity between AM and the vacuolar myelopathy associated with vitamin B(12) deficiency suggests that abnormal metabolism of the B(12)-dependent transmethylation pathway may be important in the pathogenesis of AM. METHODS: The authors compared S-adenosyl-methionine (SAM), methionine, homocysteine, and glutathione in serum and CSF of 15 patients with AM vs. 13 HIV-infected controls without myelopathy (HWM). They also compared the results with a non-HIV--infected reference population (NC). All patients had normal B(12), folate, and methylmalonic acid levels. RESULTS: There was a decrease in CSF SAM in the AM group compared with the HWM group (p < 0.0001) and the NC group (p < 0.0001). CSF SAM in the HWM group was also lower than that in the NC group (p = 0.015). Serum methionine was also reduced in serum of the myelopathic group compared with the NC group (p = 0.006). CONCLUSIONS: AM is associated with an abnormality of the vitamin B(12)-dependent transmethylation pathway
— id: 66172, year: 2002, vol: 58, page: 730, stat: Journal Article,

Axonal damage is a late component of vacuolar myelopathy
Rottnek, Matthew; Di Rocco, Alessandro; Laudier, Damien; Morgello, Susan
2002 Feb 12;58(3):479-481, Neurology
The role of axonopathy in myelin disorders recently has been examined. To investigate axonal pathologic changes in vacuolar myelopathy (VM), semiquantitative immunohistochemical stains for inflammation, axonal damage, and gliosis were performed on spinal cord sections from patients with AIDS with and without VM and from HIV-negative controls. Significant axonal damage was present in only moderate to severe VM, despite inflammation at all stages. The authors conclude that axonal damage is not present in early disease; it is present in moderate to severe vacuolar myelopathy and may contribute to clinical deficits in late stages of this disorder
— id: 66173, year: 2002, vol: 58, page: 479, stat: Journal Article,

Alopecia induced by dopamine agonists
Tabamo, Rowena E; Di Rocco, Alessandro
2002 Mar 12;58(5):829-830, Neurology
— id: 66171, year: 2002, vol: 58, page: 829, stat: Journal Article,

MPP+ and 6-OHDA neurotoxicity to dopaminergic neurons is ameliorated by NSAIDs
Werner, P; Carrasco, E; Di Rocco, A; Yahr, MD
2002 FEB 24 ;17(4):S24-S24, Movement disorders
— id: 75282, year: 2002, vol: 17, page: S24, stat: Journal Article,

Neurologic complications of aids
Geraci, AP; Di Rocco, A; Simpson, DM
2001 MAR ;7(2):82-97, Neurologist
BACKGROUND- Neurologic complications of acquired immunodeficiency syndrome (AIDS) are diverse and include opportunistic infections of the central and peripheral nervous systems, lymphoma, and primary neurologic disorders directly related to human immunodeficiency virus-1 (HIV-1) infection. REVIEW SUMMARY- This article will review the etiology, pathogenesis, clinical features, and treatment of the most common opportunistic infections of the central and peripheral nervous systems in patients with AIDS. These include toxoplasmic encephalitis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, syphilis, and cytomegalovirus infection. Primary central nervous system lymphoma occurs in patients with AIDS more frequently than in the general population but may be decreasing in incidence with the advent of highly active antiretroviral therapy. Primary neurologic disorders, which result from direct or indirect effects of HIV infection on the nervous system, will be reviewed. These include HIV-related dementia, myelopathy, and neuropathy. Understanding the pathophysiology of these entities is important to develop effective treatments. CONCLUSIONS- AIDS-related neurologic disease is a significant cause of morbidity and mortality. However, a growing number of neurologic disorders can now be treated with highly active antiretroviral therapy, and increasing use of these agents has led to a significant decline in the incidence of opportunistic infections of the nervous system and primary neurologic disorders, such as HIV-related dementia
— id: 75285, year: 2001, vol: 7, page: 82, stat: Journal Article,

A multicenter assessment of dopamine transporter imaging with DOPASCAN/SPELT in parkinsonism
Marek, K; Seibyl, J; Holloway, R; Kieburtz, K; Oakes, D; Lang, A; Yim, J; Dey, H; Cellar, J; Fussell, B; Broshjeit, S; Early, M; Smith, EO; Sudarsky, L; Johnson, KA; Corwin, C; Johnson, D; Lajoie, S; Reich, SG; Frost, JJ; Goldberg, P; Flesher, JE; Feigin, A; Mazurkiewicz, J; Castronuovo, J; Joseph, F; Cove, G; DiRocco, A; Olanow, CW; Machac, J; Cotei, D; Webner, P; Rudolph, A; Day, D; Casaceli, C; Freimuth, A; Orme, C; Hodgeman, K; Eberly, S; Henry, E; Morgan, G; Westwater, D; Haley, JB; Henry, E
2001 NOV ;57(10):S52-S59, Neurology
Background: In vivo imaging of the dopamine transporter (DAT) with SPELT is a quantitative biomarker for PD onset and severity. Objective: To use a multicenter study to evaluate the diagnostic accuracy of DOPASCAN and SPELT in patients with PD, progressive supranuclear palsy (PSP), and essential tremor (ET), and in healthy controls (HC). Methods: Ninety-six individuals with known clinical diagnosis were imaged with DOPASCAN at five sites with different multidetector SPELT systems. Both masked visual interpretation and region of interest (ROI) analysis were performed at each site and at a core analysis center. Results: Visual interpretation of the images by an expert panel demonstrated a sensitivity of 0.98 and specificity of 0.83 comparing parkinsonian (PD + PSP) versus nonparkinsonian (ET + HC) controls. Quantitative analysis of putamen and caudate DOPASCAN uptake for each region in the PD or PSP groups was significantly reduced compared to the ET or HC groups. Comparison of parkinsonian (PD + PSP) versus nonparkinsonian (ET + HC) individuals demonstrated a reduction of 76% in mean putamen and 48% in mean caudate DOPASCAN uptake. Conclusions: DOPASCAN and SPELT imaging reliably and effectively distinguish between subjects with Parkinson's syndrome (PD + PSP) and without Parkinson's syndrome (HC + ET). This is the first multicenter assessment of dopamine transporter imaging demonstrating that this tool may be used widely to assess dopaminergic degeneration in patients with parkinsonism
— id: 75262, year: 2001, vol: 57, page: S52, stat: Journal Article,

Axonal damage in AIDS-related vacuolar myelopathy: An autopsy study
Rottnek, M; diRocco, A; Laudier, D; Morgello, S
2001 MAY ;60(5):510-510, Journal of neuropathology & experimental neurology
— id: 75263, year: 2001, vol: 60, page: 510, stat: Journal Article,

Cognitive impairment in patients with HIV-associated myelopathy
Scarano, A; Dorfman, D; Gongvatana, A; Di Rocco, A
2001 APR 24 ;56(8):A475-A475, Neurology
— id: 75284, year: 2001, vol: 56, page: A475, stat: Journal Article,

COMT-dependent protection of dopaminergic neurons by methionine, dimethionine and S-adenosylmethionine (SAM) against L-dopa toxicity in vitro
Werner P; Di Rocco A; Prikhojan A; Rempel N; Bottiglieri T; Bressman S; Yahr MD
2001 Mar 2;893(1-2):278-281, Brain research
L-dopa may be toxic to dopamine neurons, possibly due to catechol-autoxidation. Catechols are O-methylated by catechol-O-methyltransferase (COMT) in a SAM consuming reaction, preventing the initiation of catechol autoxidation. We hypothesized that SAM or SAM-precursors ameliorate L-dopa neurotoxicity, in a COMT-dependent fashion. We tested this hypothesis in primary mesencephalic cultures by adding 200 microM L-dopa with 2 mM methionine or 1 mM dimethionine or 0.5 mM SAM with or without 0.2 microM of the COMT-inhibitor 2', 5'-dinitrocatechol (OR 486). L-dopa was found to be neurotoxic as the surviving neurons had fewer and shorter processes. Methionine, dimethionine and SAM all protected DA neurons against damaged induced by L-dopa. The COMT inhibitor dinitrocatechol (DNC) completely abolished the protective effect against L-dopa toxicity. We conclude that supplementation with methionine, dimethionine or SAM ameliorates L-dopa neurotoxicity to dopamine neurons, while inhibition of COMT may aggravate or unmask L-dopa neurotoxicity
— id: 66175, year: 2001, vol: 893, page: 278, stat: Journal Article,

Decreased homovanilic acid in cerebrospinal fluid correlates with impaired neuropsychologic function in HIV-1-infected patients
di Rocco A; Bottiglieri T; Dorfman D; Werner P; Morrison C; Simpson D
2000 Jul-Aug;23(4):190-194, Clinical neuropharmacology
To determine whether dopamine metabolism is abnormal in HIV infected patients and whether dopamine metabolism abnormalities are related to specific neuropsychologic characteristics in HIV-infected patients, we measured cerebrospinal fluid (CSF) levels of homovanilic acid (HVA), the primary dopamine metabolite, in 10 HIV-infected patients and compared it to HVA levels in CSF in a group of 13 healthy control subjects. HIV-infected patients were also assessed with a battery of neuropsychologic tests and HVA levels were then correlated with performance on specific neuropsychologic tests. The mean (+/-SD) HVA level in CSF was 100.9 +/- 29.3 nmol/L in the HIV-infected study group and 230.5 +/- 50.0 nmol/L in the non-HIV-infected control group (p < 0.0001). The decrease in concentrations of HVA in CSF correlated with impairment on performance on neuropsychologic testing (Spearman r = 0.67; p = 0.03). When the relationship between HVA levels and specific cognitive domains was evaluated, we observed trends for positive correlation between HVA levels and tests that measure motor speed (r = 0.59; p = 0.074) and those testing attention, concentration, and executive control (r = 0.54; p = 0.108). There was no relationship between performance on memory tests and CSF HVA levels (r = -0.0061; p = 0.987). These results further support the hypothesis that dopaminergic dysfunction plays an important role in the pathogenesis of AIDS dementia complex (ADC) and suggest that specific motor and cognitive abnormalities may be related to depressed dopaminergic activity. This may have important implications for the development of treatments or preventive strategies for ADC
— id: 66177, year: 2000, vol: 23, page: 190, stat: Journal Article,

S-Adenosyl-Methionine improves depression in patients with Parkinson's disease in an open-label clinical trial
Di Rocco A; Rogers JD; Brown R; Werner P; Bottiglieri T
2000 Nov;15(6):1225-1229, Movement disorders
We report a pilot study of S-adenosyl-methionine (SAM) in 13 depressed patients with Parkinson's disease. All patients had been previously treated with other antidepressant agents and had no significant benefit or had intolerable side effects. SAM was administered in doses of 800 to 3600 mg per day for a period of 10 weeks. Eleven patients completed the study, and 10 had at least a 50% improvement on the 17-point Hamilton Depression Scale (HDS). One patient did not improve. Two patients prematurely terminated participation in the study because of increased anxiety. One patient experienced mild nausea, and another two patients developed mild diarrhea, which resolved spontaneously. The mean HDS score before treatment was 27.09 +/- 6.04 (mean +/- standard deviation) and was 9.55 +/- 7.29 after SAM treatment (p < 0.0001). Although uncontrolled and preliminary, this study suggests that SAM is well tolerated and may be a safe and effective alternative to the antidepressant agents currently used in patients with Parkinson's disease
— id: 66176, year: 2000, vol: 15, page: 1225, stat: Journal Article,

Remission of HIV myelopathy after highly active antiretroviral therapy
Di Rocco A; Tagliati M
2000 Aug 8;55(3):456-456, Neurology
— id: 66180, year: 2000, vol: 55, page: 456, stat: Journal Article,

Levodopa induces a cytoplasmic localization of D1 dopamine receptors in striatal neurons in Parkinson's disease
Di Rocco A; Werner P
2000 Jan;47(1):136-137, Annals of neurology
— id: 66183, year: 2000, vol: 47, page: 136, stat: Journal Article,

Manchester co-decoder fits into 32-macrocell PLD
Di Rocco, A
2000 JAN 6 ;45(1):122-122, EDN
— id: 75290, year: 2000, vol: 45, page: 122, stat: Journal Article,

VHDL customizes serializer/deserializer
Di Rocco, A
2000 JUN 5 ;45(12):166-+, EDN
— id: 75289, year: 2000, vol: 45, page: 166, stat: Journal Article,

VHDL produces CRC checker
Di Rocco, A
2000 AUG 3 ;45(16):120-+, EDN
— id: 75286, year: 2000, vol: 45, page: 120, stat: Journal Article,

Trans-methylation abnormality in CSF of patient with AIDS-associated vacuolar myelopathy
Di Rocco, A; Bottiglieri, T; Werner, P; Geraci, A; Godbold, J; Simpson, D; Morgello, S
2000 APR 11 ;54(7):A253-A253, Neurology
— id: 75288, year: 2000, vol: 54, page: A253, stat: Journal Article,

AIDS myelopathy is not associated with elevated HIV viral load in cerebrospinal fluid
Geraci A; Di Rocco A; Liu M; Werner P; Tagliati M; Godbold J; Simpson D; Morgello S
2000 Aug 8;55(3):440-442, Neurology
ARTICLE ABSTRACT: The pathogenesis of AIDS-associated myelopathy is unknown. Elevated HIV-1 viral load in CSF has been associated with cognitive impairment. The authors investigated if a similar association exists in patients with myelopathy. The authors evaluated levels of HIV-1 RNA in the CSF of 16 individuals with AIDS myelopathy and in 16 nonmyelopathic HIV-infected control subjects. There was no correlation between levels of HIV-1 RNA and the presence or severity of myelopathy
— id: 66179, year: 2000, vol: 55, page: 440, stat: Journal Article,

Anti-HIV therapy
Geraci AP; Di Rocco A
2000 Sep 8;14(13):2059-2061, AIDS
— id: 66178, year: 2000, vol: 14, page: 2059, stat: Journal Article,

AIDS-myelopathy is not associated with elevated HIV viral load in cerebrospinal fluid
Geraci, AP; Di Rocco, A; Liu, MS; Werner, P; Tagliati, M; Godbold, J; Simpson, DM
2000 APR 11 ;54(7):A172-A172, Neurology
— id: 75287, year: 2000, vol: 54, page: A172, stat: Journal Article,

A multicenter assessment of dopamine transporter imaging with DOPASCAN/SPECT in parkinsonism
Marek, K; Seibyl, J; Holloway, R; Kieburtz, K; Oakes, D; Lang, A; Yim, J; Dey, H; Cellar, J; Fussell, B; Broshjeit, S; Early, M; Smith, EO; Sudarsky, L; Johnson, KA; Corwin, C; Johnson, D; Lajoie, S; Reich, SG; Frost, JJ; Goldberg, P; Flesher, JE; Feigin, A; Mazurkiewicz, J; Castronuovo, J; Joseph, F; DiRocco, A; Olanow, CW; Machac, J; Cotei, D; Webner, P; Rudolph, A; Day, D; Casaceli, C; Freimuth, A; Orme, C; Hodgeman, K; Eberly, S; Henry, E; Morgan, G; Haley, JB; Henry, E
2000 NOV 28 ;55(10):1540-1547, Neurology
Background: In vivo imaging of the dopamine transporter (DAT) with SPECT is a quantitative biomarker for PD onset and severity. Objective: To use a multicenter study to evaluate the diagnostic accuracy of DOPASCAN and SPECT in patients with PD, progressive supranuclear palsy (PSP), and essential tremor (ET), and in healthy controls (HC. Methods: Ninety-six individuals with known clinical diagnosis were imaged with DOPASCAN at five sites with different multidetector SPECT systems. Both masked visual interpretation and region of interest (ROI) analysis were performed at each site and at a core analysis center. Results: Visual interpretation of the images by an expert panel demonstrated a sensitivity of 0.98 and specificity of 0.83 comparing parkinsonian (PD + PSP) versus nonparkinsonian (ET + HC) controls. Quantitative analysis of putamen and caudate DOPASCAN uptake for each region in the PD or PSP groups was significantly reduced compared to the ET or HC groups. Comparison of parkinsonian (PD + PSP) versus nonparkinsonian (ET + HC) individuals demonstrated a reduction of 76% in mean putamen and 48% in mean caudate DOPASCAN uptake. Conclusions: DOPASCAN and SPECT imaging reliably and effectively distinguish between subjects with Parkinson's syndrome (PD + PSP) and without Parkinson's syndrome (RC + ET). This is the first multicenter assessment of dopamine transporter imaging demonstrating that this tool may be used widely to assess dopaminergic degeneration in patients with parkinsonism
— id: 75264, year: 2000, vol: 55, page: 1540, stat: Journal Article,

The role of somatosensory evoked potentials in the diagnosis of AIDS-associated myelopathy
Tagliati M; Di Rocco A; Danisi F; Simpson DM
2000 Apr 11;54(7):1477-1482, Neurology
BACKGROUND: Although AIDS-associated vacuolar myelopathy is detected in >50% of autopsy cases, it is often unrecognized during life. The clinical assessment is often difficult because of concurrent peripheral neuropathy and lack of specific diagnostic markers. Somatosensory evoked potentials (SEPs) have been successfully used to evaluate central conduction in a number of diseases involving the spinal cord. OBJECTIVES: To assess the diagnostic yield of SEPs in AIDS-associated myelopathy. METHODS: We recorded tibial and median nerve SEPs in 69 HIV-infected subjects referred for evaluation of lower extremity neurologic abnormalities. Stimulation of the peroneal nerve at the popliteal fossa was performed in patients with absent response to ankle stimulation. RESULTS: HIV-infected subjects had significantly delayed latencies of both peripheral and central potentials, suggesting a combination of peripheral and CNS abnormalities. Analysis of peripheral and central latencies allowed us to discriminate between neuropathy and myelopathy in individual patients. Abnormalities of tibial central conduction time (CCT) correlated with clinical diagnosis of myelopathy. There was no significant difference in median CCTs between patients and controls, suggesting that conduction abnormalities were restricted to the thoracolumbar spinal cord. A derived spinal conduction time was a sensitive indicator of central conduction abnormalities in AIDS patients with myelopathy. CONCLUSIONS: The combination of median, posterior tibial, and peroneal SEPs is a valuable tool in the diagnosis of AIDS-associated myelopathy, particularly when myelopathy and peripheral neuropathy coexist. The use of a derived spinal conduction time improves the diagnostic yield of SEPs in AIDS-associated myelopathy
— id: 66181, year: 2000, vol: 54, page: 1477, stat: Journal Article,

MR findings in AIDS-associated myelopathy
Chong J; Di Rocco A; Tagliati M; Danisi F; Simpson DM; Atlas SW
1999 Sep;20(8):1412-1416, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: The most common cause of spinal cord disease among patients with AIDS or those infected with HIV-1 is AIDS-associated myelopathy. The purpose of this study was to determine the MR characteristics of the spinal cord in this patient population and to correlate these findings with the clinical severity of myelopathy. METHODS: MR images of the spinal cord in 21 patients with documented HIV-1 infection or AIDS and a clinical diagnosis of AIDS-associated myelopathy were assessed retrospectively for atrophy, intrinsic signal abnormality, and abnormal enhancement. The clinical severity of myelopathy was graded by a neurologist on the basis of physical examination, and a qualitative correlation was made with the MR findings. RESULTS: MR findings were abnormal in 18 of the 21 patients. The most common feature was spinal cord atrophy (n = 15), typically involving the thoracic cord with or without cervical cord involvement, followed by intrinsic cord signal abnormality (n = 6), and normal-appearing cord (n = 3). Three patients had both cord atrophy and intrinsic cord signal abnormality. The cord signal abnormality was diffuse, without predilection for any specific distribution pattern. Enhancement was not seen in any of the 10 patients who received intravenous contrast material. Only one of 16 patients with moderate to severe myelopathy had normal MR findings, as compared with two of five patients with mild myelopathy. CONCLUSION: MR findings in the spinal cord are abnormal in the majority of patients with AIDS-associated myelopathy, typically showing spinal cord atrophy, with or without intrinsic cord signal abnormality. Patients with moderate to severe myelopathy have an increased frequency of spinal cord abnormalities, but a definite correlation between clinical severity of myelopathy and extent of MR abnormalities remains to be established
— id: 66184, year: 1999, vol: 20, page: 1412, stat: Journal Article,

A randomized, double-blind, placebo-controlled trial of deprenyl and thiotic acid in HIV-associated cognitive impairment
Di Rocco A
1999 Jun 10;52(9):1920-1920, Neurology
— id: 66185, year: 1999, vol: 52, page: 1920, stat: Journal Article,

Diseases of the spinal cord in human immunodeficiency virus infection
Di Rocco A
1999 ;19(2):151-155, Seminars in neurology
The most common disease of the spinal cord in human immunodeficiency virus (HIV) infection is vacuolar myelopathy. Pathology studies have demonstrated that vacuolization in the thoracic spinal cord is present in more than a third of patients with AIDS. The disease, however, manifests clinically only when the vacuolization in the spinal cord has become severe, with prominent myelin loss in the lateral and posterior columns. Vacuolar myelopathy presents usually with slowly progressing spastic paraparesis, accompanied by loss of vibratory and position sense and urinary frequency and urgency. In males, erectile dysfunction can be an early manifestation of the disease. The pathogenesis of vacuolar myelopathy is unknown but may be related to abnormal trans-methylation mechanisms induced by the HIV virus and cytokines. There is no known treatment for the disease, although therapy with methylating agents is being investigated. There are other rarer causes of spinal cord disease in AIDS, including a number of infectious myelitis and neoplastic and vascular myelopathies
— id: 66182, year: 1999, vol: 19, page: 151, stat: Journal Article,

Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS
Di Rocco A; Werner P
1999 Apr;66(4):554-554, Journal of neurology neurosurgery & psychiatry
— id: 66186, year: 1999, vol: 66, page: 554, stat: Journal Article,

Dopaminergic function in AIDS
Di Rocco, A; Bottiglieri, T; Werner, P
1999 APR ;52(6):A192-A192, Neurology
— id: 75292, year: 1999, vol: 52, page: A192, stat: Journal Article,

COMT-dependent protection of dopamine neurons against L-dopa toxicity by methionine, dimethionine and S-adenosylmethionine
Werner, P; Di Rocco, A; Rempel, N; Bottiglieri, T; Rogers, J; Bressman, SB
1999 SEP ;73(8):S186-S186, Journal of neurochemistry
— id: 75291, year: 1999, vol: 73, page: S186, stat: Journal Article,

The protective effect of NBQX in experimental autoimmune encephalomyelitis (EAE) is not due to modulation of the immune response
Werner, P; Pitt, D; DiRocco, A; Raine, CS
1999 NOV 28 ;73(10):S156-S156, Journal of neurochemistry
— id: 75265, year: 1999, vol: 73, page: S156, stat: Journal Article,

Sertraline induced parkinsonism. A case report and an in-vivo study of the effect of sertraline on dopamine metabolism
Di Rocco A; Brannan T; Prikhojan A; Yahr MD
1998 ;105(2-3):247-251, Journal of neural transmission
We report a patient with a parkinsonian syndrome induced by sertraline (Zoloft), an SSRI antidepressant, whose symptoms resolved after the drug was discontinued. This case prompted us to investigate the effect of sertraline on dopamine metabolism in animals. Sertraline (30 mg/kg, i.p.) or placebo (vehicle) was administered to two groups of six normal, anesthetized rats and using cerebral microdyalisis extracellular striatal levels of dopamine, the dopamine metabolites (HVA and DOPAC), as well as the serotonin metabolite 5-HIIA were monitored. In animals pre-treated with sertraline, DOPAC, HVA, and 5-HIAA levels were significantly decreased compared to control animals (p < 0.01). These data indicate that sertraline has an effect on dopamine metabolism, which may alter function in the striatum and induce a parkinsonian syndrome
— id: 66188, year: 1998, vol: 105, page: 247, stat: Journal Article,

AIDS-associated vacuolar myelopathy
Di Rocco A; Simpson DM
1998 Jun;12(6):457-461, AIDS patient care & STDs
AIDS-associated vacuolar myelopathy (VM) is a common neurologic complication of AIDS. Pathologically, VM is characterized by vacuolization in the lateral and posterior columns of the thoracic spinal cord and has a striking similarity with the myelopathy of vitamin B12 deficiency. In autopsy series, 20% to 55% of patients with AIDS have evidence of spinal cord disease consistent with VM. The myelopathy usually manifests late in the course of HIV infection, with slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency. Its course is invariably progressive and leads to severe paralysis of the lower limbs, with loss of the ability to walk and of sphincter control. The differential diagnosis is extensive and includes metabolic, infective, and neoplastic spinal cord diseases. The diagnosis is based on the clinical observation and the exclusion of other causes of myelopathy via serologic, radiographic, and cerebrospinal fluid studies. The pathogenesis of VM is unknown. Attempts to detect HIV in the spinal cord have not yielded significant results, and there is no evidence of a relationship between the presence of HIV and the development of myelopathy. A metabolic disorder of the vitamin B12-dependent transmethylation pathway, induced by HIV or cytokine activation, is considered the possible cause of VM associated with AIDS. There is no known treatment for AIDS myelopathy and there is no evidence that antiretroviral drugs can improve the symptoms or slow the progression of VM. The symptomatic treatment includes antispasticity agents, management of sphincter dysfunction, and physical therapy. Experimental treatments are being tested in clinical trials
— id: 66174, year: 1998, vol: 12, page: 457, stat: Journal Article,

A pilot study of L-methionine for the treatment of AIDS-associated myelopathy
Di Rocco A; Tagliati M; Danisi F; Dorfman D; Moise J; Simpson DM
1998 Jul;51(1):266-268, Neurology
The pathogenesis of AIDS-associated vacuolar myelopathy (VM) may be related to abnormality of transmethylation mechanisms in the nervous system. To evaluate the safety and potential efficacy of the methyl-group donor L-methionine in AIDS-associated VM, we conducted a pilot clinical trial in 12 patients with VM. Seven of the nine patients who completed the study had clinical and electrophysiologic improvement. Controlled studies may be indicated to assess the efficacy and safety of L-methionine in AIDS-associated VM
— id: 66187, year: 1998, vol: 51, page: 266, stat: Journal Article,

Somatosensory evoked potentials in patients with HIV-associated myelopathy
Danisi, F; Tagliati, M; DiRocco, A; Mylin, L; Simpson, DM
1997 MAR ;48(3):2003-2003, Neurology
— id: 75266, year: 1997, vol: 48, page: 2003, stat: Journal Article,

Oral methionine may improve neuropsychological function in patients with AIDS myelopathy: results of an open-label trial
Dorfman D; DiRocco A; Simpson D; Tagliati M; Tanners L; Moise J
1997 Jul;11(8):1066-1067, AIDS
— id: 66163, year: 1997, vol: 11, page: 1066, stat: Journal Article,

Neurology and murderers
Di Rocco A
1996 Dec;47(6):1610-1610, Neurology
— id: 66189, year: 1996, vol: 47, page: 1610, stat: Journal Article,

Parkinson's disease: progression and mortality in the L-DOPA era
Di Rocco A; Molinari SP; Kollmeier B; Yahr MD
1996 ;69:3-11, Advances in neurology
— id: 66191, year: 1996, vol: 69, page: 3, stat: Journal Article,

Methionine treatment for AIDS-associated vacuolar myelopathy
DiRocco, A; Tagliati, M; Dorfman, D; Moise, J; Simpson, D
1996 FEB ;46(2):6124-6124, Neurology
— id: 75267, year: 1996, vol: 46, page: 6124, stat: Journal Article,

An unusual sphenoid ridge tumor: cementifying fibroma
Molinari SP; Di Rocco A; Merchant C; Sen CN; Wolfe D; Yahr MD
1996 Jan;243(1):103-104, Journal of neurology
— id: 66190, year: 1996, vol: 243, page: 103, stat: Journal Article,

Human transplacental transfer of carbidopa/levodopa
Merchant CA; Cohen G; Mytilineou C; DiRocco A; Moros D; Molinari S; Yahr MD
1995 ;9(2-3):239-242, Journal of neural transmission. Parkinson's disease & dementia section
A paucity of information is available concerning the use of levodopa and carbidopa during pregnancy. Particularly lacking is whether these agents cross the placenta and whether levodopa undergoes metabolism in the fetus. The present study carried out in aborted fetal tissues demonstrates that levodopa crosses the placental barrier and suggests that it may be metabolized in fetal tissues, including the brain and spinal cord. The possibility exists that early exposure to levodopa or dopamine may alter the normal neuronal development in the fetus, and caution in the use of levodopa during pregnancy should be observed
— id: 66164, year: 1995, vol: 9, page: 239, stat: Journal Article,

The use of famotidine in the treatment of Parkinson's disease: a pilot study
Molinari SP; Kaminski R; Di Rocco A; Yahr MD
1995 ;9(2-3):243-247, Journal of neural transmission. Parkinson's disease & dementia section
Seven patients with idiopathic Parkinson's disease were enrolled in a ten week study to evaluate the efficacy of famotidine, an histamine H2-antagonist, in the treatment of bradyphrenia. Patients received famotidine 80 mg/day for a period of six weeks and were evaluated with neuropsychological tests. Overall, patients demonstrated improvement in variables measured. Some patients also reported an improvement in their motor symptoms
— id: 66192, year: 1995, vol: 9, page: 243, stat: Journal Article,

HUMAN TRANSPLACENTAL TRANSMISSION OF CARBIDOPA/LEVODOPA
MERCHANT, CA; COHEN, G; MYTILINEOUS, C; DIROCCO, A; MOLINARI, S; MOROS, D; YAHR, MD
1994 APR ;44(4):A247-A248, Neurology
— id: 75268, year: 1994, vol: 44, page: A247, stat: Journal Article,

Impaired oxidative decarboxylation of pyruvate in fibroblasts from patients with Parkinson's disease
Mytilineou C; Werner P; Molinari S; Di Rocco A; Cohen G; Yahr MD
1994 ;8(3):223-228, Journal of neural transmission. Parkinson's disease & dementia section
Whether or not a reported deficiency in brain mitochondrial complex I activity in Parkinson's disease represents a defect encompassing other organs or tissues has been a source of some controversy. We have examined mitochondrial respiration in fibroblasts from patients with Parkinson's disease by measuring the oxidative decarboxylation of [2-14C]pyruvate and [1,4-14C]succinate. We report that oxidation of pyruvate but not succinate was significantly reduced in fibroblasts from Parkinson patients when compared to healthy controls. These observations support the view that a widespread deficit in mitochondrial respiration exists in Parkinson's disease. Fibroblast cultures, moreover, are a source of affected proliferating cells, which can be used for in vitro studies of the nature of the respiratory defect and for testing of pharmacological interventions to correct the deficiency
— id: 66193, year: 1994, vol: 8, page: 223, stat: Journal Article,

Low and high dose bromocriptine have different effects on striatal dopamine release: an in vivo study
Brannan T; Martinez-Tica J; Di Rocco A; Yahr MD
1993 ;6(2):81-87, Journal of neural transmission. Parkinson's disease & dementia section
We wished to determine if low and high doses of bromocriptine produce distinct patterns of dopamine release and metabolism. Accordingly, we administered bromocriptine (0, 2.5, 5, and 10 mg/kg, IP) to rats and monitored extracellular concentrations of dopamine and dopamine metabolites in the corpus striatum with the technique of cerebral microdialysis. Extracellular dopamine levels increased following administration of 2.5 and 5 mg/kg bromocriptine. In contrast, dopamine levels decreased following 10 mg/kg bromocriptine. Dopamine metabolite levels decreased 45 minutes following all doses of bromocriptine. Bromocriptine administration had no effect on the levels of 5HIAA, the major serotonin metabolite. These findings with high dose bromocriptine fit the predicted profile of a dopamine D2 receptor agonist. The delayed decrease in dopamine metabolites at all bromocriptine doses is consistent with the known dopamine synthesis inhibiting action of bromocriptine. In contrast, the increased dopamine release observed following low and medium doses of bromocriptine is not readily explainable by current theories of bromocriptine action which predict decreased dopamine release and therefore decreased striatal extracellular dopamine levels with both high and low-doses of bromocriptine. Our findings indicate that bromocriptine has a complex pharmacological action that extends beyond simple agonism at dopamine D2 receptors
— id: 66195, year: 1993, vol: 6, page: 81, stat: Journal Article,

MRI abnormalities in Creutzfeldt-Jakob disease
Di Rocco A; Molinari S; Stollman AL; Decker A; Yahr MD
1993 ;35(8):584-585, Neuroradiology
Two patients with biopsy-proven Creutzfeldt-Jakob disease had MRI studies that revealed increased signal in the basal ganglia on T-2 weighted images, suggesting that MRI can be a useful diagnostic instrument in Creutzfeldt-Jakob disease
— id: 66194, year: 1993, vol: 35, page: 584, stat: Journal Article,

ALS and eye movements
Norris FH; Okuda B; Gizzi M; Cohen B; DiRocco A; Sivak M
1993 Feb;43(2):450-451, Neurology
— id: 66347, year: 1993, vol: 43, page: 450, stat: Journal Article,

Ocular motor function in motor neuron disease
Gizzi M; DiRocco A; Sivak M; Cohen B
1992 May;42(5):1037-1046, Neurology
We studied ocular motor function in 34 patients with motor neuron disease (MND) and in 18 age-matched controls. This included the latency, accuracy, and amplitude-velocity relationships of saccades. We also examined ocular pursuit, the slow phases of optokinetic nystagmus, and the ability to suppress the vestibulo-ocular reflex (VOR) with visual fixation of a head-mounted target. Five of the subjects with MND had pronounced parkinsonian features on neurologic examination. The nonparkinsonian MND subjects had normal ocular motor function for all measures. Most subjects suppressed the VOR completely. The parkinsonian-MND patients had impairment of both saccadic and pursuit eye movements, and one parkinsonian-MND patient with poor pursuit was unable to suppress the VOR. We conclude that ocular motor function is generally spared in MND. The occasional appearance of ocular motor dysfunction probably reflects the incidence of secondary abnormalities such as parkinsonism
— id: 66165, year: 1992, vol: 42, page: 1037, stat: Journal Article,

Methionine in the treatment of nitrous-oxide-induced neuropathy and myeloneuropathy
Stacy CB; Di Rocco A; Gould RJ
1992 Aug;239(7):401-403, Journal of neurology
Two cases of severe myeloneuropathy and macrocytic anemia associated with a low serum level of vitamin B12 after prolonged exposure to nitrous oxide are reported. In both cases, the neurological manifestations worsened initially despite B12 supplementation, although in one case the use of methionine seemed to arrest the progression of the disease and accelerate recovery. This offers further support for the biochemical hypothesis of methionine synthetase inhibition by nitrous oxide and reproduces in man previously reported animal studies with methionine. Methionine may be an important first-line therapy in the initial treatment of neuropathy and myeloneuropathy induced by nitrous oxide, and has a hypothetical role in the treatment of subacute combined degeneration of the cord
— id: 66196, year: 1992, vol: 239, page: 401, stat: Journal Article,

Delayed epidural hematoma
Di Rocco A; Ellis SJ; Landes C
1991 ;33(3):253-254, Neuroradiology
A case of delayed epidural hematoma is described who had an initial computerized tomography (CT) scan reported as normal. Repeat CT scan at 48 h demonstrated a right temporal epidural hematoma. A skull fracture was not observed radiographically or at surgery. The world literature is reviewed and the criteria for repeat CT scanning is discussed
— id: 66197, year: 1991, vol: 33, page: 253, stat: Journal Article,

DIFFERENTIAL EXPRESSION OF NEURONAL CLASS-III BETA-TUBULIN ISOTYPE AND CALBINDIN D28K IN THE DEVELOPING HUMAN CEREBELLAR CORTEX AND CEREBELLAR NEUROBLASTOMAS (MEDULLOBLASTOMAS)
KATSETOS, CD; FRANKFURTER, A; CHRISTAKOS, S; TSOKOS, M; VALSAMIS, MP; MAKER, HS; WOLFE, D; DIROCCO, A; BERGLAND, RM; URICH, H
1991 MAY ;50(3):293-293, Journal of neuropathology & experimental neurology
— id: 75269, year: 1991, vol: 50, page: 293, stat: Journal Article,

Excess mortality in Harlem
Carr J; Di Rocco A
1990 May 31;322(22):1606-1607, New England journal of medicine
— id: 66346, year: 1990, vol: 322, page: 1606, stat: Journal Article,

1ST VERSUS 2ND PORTION OF EXPIRED AIR AND DURATION OF BREATH HOLDING IN THE SAMPLING OF EXPIRED AIR CARBON-MONOXIDE
BIGLAN, A; MAGIS, K; DIROCCO, A; SILVERBLATT, A
1986 APR ;81(2):283-286, British journal of addiction
— id: 75270, year: 1986, vol: 81, page: 283, stat: Journal Article,