Revista de neurologia最新文献

Introduction Monoclonal antibodies against calcitonin gene-related peptide (CGRP) have revolutionized migraine treatment, though one-third of patients do not respond to these medications. One of the emergent reasons for this apparent lack of response could be a wearing-off effect, as the case of our patient illustrates. Clinical Case A woman aged 36 years with the diagnosis of migraine with aura since childhood, which transforms to chronic migraine and daily headache, with analgesic overuse for the past 5 years. She failed to respond to multiple oral preventatives, botulinum toxin, and two CGRP antibodies (erenumab and galcanezumab). After initiating quarterly eptinezumab, she noticed a relevant improvement in the number of headache days per month for the first 8 weeks but experienced a clear wearing-off effect during the third month of treatment, for two consecutive treatments. We altered administration to every 8 weeks, which better controlled her migraine frequency. Conclusions CGRP antibodies can show a wearing-off effect, which should be identified in order to plan individualized treatment and avoid an incorrect interpretation as therapeutic failure. Our case also shows that patients with chronic migraine refractory to two antibodies can respond to a third CGRP antibody, in this case, intravenous eptinezumab.

In epidemiology, the relative frequency of a disease is expressed as the proportion of individuals affected, typically expressed as a percentage, or per thousand individuals. Another important measure is the odds, which represents the ratio of affected individuals to unaffected individuals, calculated by dividing by the proportion of affected individuals by the proportion of unaffected individuals. To assess whether a specific factor increases or decreases the risk of disease, researchers compare the proportion of affected individuals in an exposed group (where the factor is present) with an unexposed group (where the factor is absent). This comparison can be quantified using three key measures: Risk Difference (RD): The absolute difference in disease risk between the exposed and unexposed groups. Relative Risk (RR): The ratio of disease risk in the exposed group to that in the unexposed group. Odds Ratio (OR): The ratio of the odds of disease in the exposed group to the odds in the unexposed group. While risk reflects the proportion of individuals affected within a population, odds represent the ratio of affected to unaffected individuals. The OR is particularly useful in case-control studies because it can approximate the RR when diseases are rare, providing valuable insights even when direct risk calculations are not feasible.

Abusive head trauma (AHT), commonly known as "shaken infant syndrome" is a severe form of child abuse characterized by the triad of acute encephalopathy, retinal hemorrhages, and cerebral hemorrhage, leading to high mortality and neurological complications. Many caregivers are unaware of the risks associated with shaking an infant, making prevention efforts essential. Our center observed an increase in AHT cases from late 2021 to early 2022, prompting the creation of a regional prevention campaign. This initiative introduced a scannable quick response (QR) code linking easily accessible educational materials on AHT prevention and parenting resources that promote safer caregiving practices.

Introduction: Autoimmune encephalitis (AE) represents a severe neuropsychiatric disorder that requires early diagnosis. This study describes the frequency, clinical characteristics, and paraclinical findings in patients with possible autoimmune encephalitis treated in a neurological emergency department, as well as factors associated with poor functional prognosis at discharge.

Material and methods: This was an observational ambispective cohort study including patients diagnosed with AE who were treated in a neurological emergency department in 2022. Demographic, clinical, and paraclinical characteristics were evaluated, along with functional outcomes using the modified Rankin scale (mRS); ≤2 points, was considered as good prognosis. In the statistical analysis we used the chi-squared test, Fisher's exact test, Student's T-test, and Mann-Whitney U test.

Results: Out of 9046 patients, 31 (0.3%) met the criteria for probable autoimmune encephalitis (PAE). The average age was 28.4 ± 12.1 years and 51.6% were female. Cognitive alterations (90.3%), psychosis (74.2%), abnormal movements (71%), catatonia (67.7%), seizures/status epilepticus (64.5%, 19.4%), and dysautonomia (58.1%) were observed; 58.1% had a good functional prognosis. Factors associated with poor prognosis included older age (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), status epilepticus (0% vs. 46.2%, p = 0.002), and lower frequency of headache (61.1% vs. 15.4%, p = 0.025).

Conclusions: AE represents a rare diagnosis even in a neurological emergency center; older age, status epilepticus and absence of headache were associated with poor functional prognosis at discharge.

Introduction: We present a rare case of acute immune-mediated polyradiculoneuritis, a Guillain-Barré Syndrome (GBS) variant, manifesting as ophthalmoparesis-ataxia, facial diplegia, and acute bulbar palsy, accompanied by a unique autoimmune profile.

Clinical case: A 75-year-old female developed rapidly progressive symptoms, including bilateral non-reactive mydriasis, ptosis, complete ophthalmoplegia, bilateral facial weakness, tongue immobility, palatal paralysis, limb dysmetria, ataxia, and brisk generalized tendon reflexes, all while maintaining a preserved mental state. Symptoms emerged 10 days after a probable gastrointestinal infection. Severe bulbar dysfunction necessitated orotracheal intubation and a tracheotomy. Extensive cranial nerve involvement initially suggested a brainstem lesion, with oculomotor and acute bulbar palsy as prominent signs. However, brainstem and spinal magnetic resonance imaging along with cerebrospinal fluid analysis yielded negative results. Electromyography reveled a sensorimotor demyelinating polyradiculoneuropathy, and serum testing identified IgG antibodies targeting multiple gangliosides, including the disialosyl group and terminal NeuNAc(α2-3)Gal. Treatment with intravenous immunoglobulin (IVIG) led to gradual clinical improvement.

Conclusions: This case highlights a rare and severe GBS phenotype characterized by reactivity to multiple gangliosides. It highlights the role of shared ganglioside epitopes in antibody-mediated neurological damage and expands the clinical spectrum of GBS variants.

Introduction: Long COVID is defined by National Institute for Health and Care Excellence (NICE) as the set of signs and symptoms that develop during or after a SARS-CoV-2 infection and continue for more than twelve weeks without any alternative diagnosis. One of the most frequent persistent symptoms reported by patients and verified in neuroimaging studies is cognitive dysfunction, due to a generalized hypoconnectivity and a diffuse axonal lesion in white matter. Therefore, the objectives of the present review are to determine how long cognitive functions remain affected during Long COVID and to explore which cognitive functions are most affected beyond three months of follow-up in patients up to 65 years of age without previous neuropsychological or psychiatric complications.

Methods: A systematic review was performed using PRISMA criteria and 11 articles were included through a comprehensive search of five different databases: PubMed, Medline, Scopus, WOS and ProQuest. The risk of bias of the articles was assessed using the Newcastle-Ottawa scale.

Results: Cognitive problems in Long COVID persist over time and improve slowly, although studies seem to agree that most areas improved significantly after one year. The cognitive functions that remained impaired the longest were processing speed and attention.

Conclusions: These cognitive alterations cause a reduction in the quality of life of the patients and a reduction in work capacity and manifest the need for a cognitive intervention.

Introduction: Valle-Inclán's Bohemian Lights is the inaugural work of the esperpento, a literary genre that was born with the intention of offering distorted images of reality as a way of accessing it in a reflexive way.

Material and methods: Critical reading of the editio princeps of the work to analyze its neurological content.

Results: The character of Max Estrella, inspired by the figure of Alejandro Sawa, would not meet the criteria for encephalitis. The diagnoses of Charles Bonnet syndrome and death due to stroke are more likely. The characters at the wake discuss the differential diagnosis between death and catalepsy, and one of them suffers a non-epileptic event.

Conclusions: Bohemian Lights reflects different social, political and cultural aspects contemporary to the author. Health and disease are also addressed, with a preponderant role for neurology.

Objective: This study aimed to systematically review the available evidence on the effects of boxing interventions on people with Parkinson disease.

Methods: Four electronic databases were searched systematically from their inception until December 2023. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales.

Results: A total of 13 studies were included. Data synthesis indicated that participants who performed boxing programs did not have a significant effect in the polled data on functional mobility, balance, motor symptoms, gait and cardiorespiratory fitness Accordingly, for the effects of boxing on self-reported quality of life, the polled data showed a non-significant trend towards improving Hedges' g. Also, when the analysis was performed by comparing the experimental and control groups, the results remained non-significant.

Conclusions: The evidence regarding the use of boxing as a program exercise for patients with Parkinson disease remains uncertain. Preliminary findings indicate that participation in boxing does not demonstrate a substantial impact on either physical or mental health outcomes.

Introduction: Neuropsychology is an area of psychology that studies, through different methodologies, the relationship between the nervous system and behavior. This study aims to describe the profile of the patient who most frequently received a neuropsychological assessment at HULP between 2018 and 2023.

Patients and methods: This is a retrospective observational study of 394 clinical records of subjects aged 18 years or older who were attended in the neuropsychology consultation of HULP between 2018 and 2023. The data was recorded and anonymized in a database properly guarded. Frequency tables were extracted and χ² tests were made. SPSS 26 was the programme used to make data analysis.

Results: A total of 232 women (mean age of 46,47 years) and 162 men (mean age 43,31 years) were evaluated. The most frequent reason for consultation in both groups was suspicion of dementia (112 consultations for this reason in the female group; 76 in the male group). Regardless of the reason for consultation, there were more cases of patients who had studied up to the age of 18 years. Binomial analysis reveals a statistically significant relationship between being assessed in the neuropsychology consultation at HULP and having completed studies before the age of 18.

Conclusions: The profile of the patient who is most frequently attended at the neuropsychology consultation of HULP is a middle-aged woman with education up to 18 years of age, referred by the Mental Health Service for suspected dementia. The information obtained from this analysis will help to guide future planning of assessment strategies for patients with neuropsychological problems.