Arquivos de neuro-psiquiatria最新文献

The recognition of the molecular structures, namely the node of Ranvier and the axonal regions surrounding it (the paranode and juxtaparanode), as the primary target for specific autoantibodies has introduced a new site for neurological location (microtopographic structures), in contrast to the prevailing understanding, in which lesions to neural macrostructures (roots, nerves, and/or plexus) were the focus of semiologists and electrophysiologists for topographic, syndromic, and nosological diagnoses. Therefore, there was a need to understand and characterize the components of these neural microstructures that are grouped in small regions within the nerve to optimize clinical and therapeutic reasoning.

Background:  Arquivos de Neuro-Psiquiatria (ANP), the official journal of Academia Brasileira de Neurologia (ABN, Brazilian Academy of Neurology), celebrated 80 years in 2023.

Objective:  To analyze the publication trends, authorship, and editorial patterns of the first 20 volumes of ANP.

Methods:  We analyzed the first 20 volumes of ANP, published from 1943 to 1962. The data were tabulated independently by two blinded researchers and cross-verified.

Results:  Oswaldo Lange was the chief editor, and, from 1943 to 1962, 20 volumes, 79 issues, 2 supplements, and 885 articles were published. We analyzed 509 articles (and excluded non-research papers). We found 905 authors (1.78 authors/article), and only 3.75% were women. Horacio Martins Canelas, Rolando Ângelo Tenuto, and Paulo Pinto Pupo were the most prolific authors. There were 326 papers on neurology, 83 on neurosurgery, 88 on psychiatry, and 12 on basic research. A comparison between the first 10 and second 10 volumes disclosed a significant difference in the fields of the articles: a progressive decrease in papers on psychiatry and an increase in those on neurology and basic science (p = 0.005). There was also a significant decrease in the total number of published articles in the second 10 volumes (p = 0.001), and a higher number of citations per article (p = 0.014), but no difference in the number of pages (mean number in the original articles: 11.9 ± 6.7 pages). Although most articles came from Southeastern Brazil (74%) and were written in Portuguese (84%), 91 were foreign.

Conclusion:  The first 20 volumes marked the establishment of ANP in the post-World War II era. Most papers were written in Portuguese and included international contributions from Egas Moniz, Barraquer-Bordas, Bing, Denny-Brown and Wartenberg, for example.

Background:  With the emergence of new therapies for spinal muscular atrophy linked to chromosome 5q (SMA-5q), capturing motor function changes in the upper limbs (ULs) become crucial for assessing treatment efficacy and monitoring changes in the disease. The translation and cultural adaptation of the revised upper-limb module (RULM) into Brazilian Portuguese will enable implementation in clinical settings and facilitate the conduction of national studies.

Objective:  To translate, cross-culturally adapt, and validate the RULM to Brazilian Portuguese.

Methods:  The study was conducted in two phases: translation and cross-cultural adaptation, and the reliability assessment. Both phases followed recommendations from international guidelines. The analysis of the psychometric properties was performed with 21 individuals with SMA-5q, all of whom were at least 30-months-old and capable of sitting independently. Statistical analyses were performed using Cohen's Kappa analysis (K) and the intraclass correlation coefficient (ICC).

Results:  The interrater agreement was considered excellent for items A to T (K > 0.81) and good (0.61-0.80) for items G and M. The reliability analysis showed an ICC of 0.998, indicating an extremely satisfactory level.

Conclusion:  The Brazilian Portuguese version of the RULM has been shown to be valid and reliable for the assessment of SMA-5q individuals older than 2 years of age who could sit.

The etiology of Parkinson's disease (PD) is complex and multifactorial, depending on interactions involving environmental/lifestyle and genetic factors. The genetic aspects of the disease are becoming well characterized, while the environmental factors still need further investigation. In the present narrative review, we have described the most concrete evidence of associations between environmental factors and the risk of developing PD. Physical activity, healthy dietary patterns, smoking, and caffeine intake are protective factors against PD. Head trauma, consumption of milk and dairy products, and pesticide exposure were associated with a higher risk of developing PD. The associations of alcohol consumption, living in rural areas, farming, and consumption of well water with PD are still controversial. Results of several studies strongly suggest that diabetes mellitus is a risk factor for the development of PD, as well as the pre-diabetic state. Lower serum levels of uric acid were associated with an increased risk of developing PD and with worse clinical features and faster progression of symptoms. The protective effects of nonsteroidal antiinflammatory drugs use are controversial. Several other factors were potentially associated with the risk of developing PD: environmental pollutants such as organic solvents, exposure to sunlight, vitamin D deficiency, bullous pemphigoid, bipolar disorder, inflammatory bowel disease, irritable bowel syndrome, certain infections and agents, and essential tremor. Environmental factors are important risk markers for the development of PD. Understanding these risks and protective factors could lead to the implementation of risk-modifying actions for PD.

Background:  Patients with ischemic stroke present a higher risk of stroke recurrence, neurological deterioration, and death. The benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) among patients with minor ischemic stroke is well established; however, robust evidence is lacking for those with nonminor stroke.

Objective:  To describe the benefits and risks of DAPT versus SAPT in patients with nonminor ischemic stroke.

Methods:  We searched the PubMed, Embase, and Cochrane Library databases for articles published from inception to April 2024. Data were collected from randomized clinical trials and observational studies comparing DAPT to SAPT following nonminor ischemic stroke, defined by a score ≥ 4 on the National Institutes of Health Stroke Scale (NIHSS).

Results:  In total, 6 studies were included, comprising 12,480 patients. The NIHSS score at baseline from the selected studies ranged from 4 to 15. There was no significant difference between DAPT and SAPT for recurrent stroke (risk ratio [RR] = 0.91; 95% confidence interval [95%CI] = 0.82-1.01; p = 0.09; I² = 0%), ischemic stroke (RR = 0.89; 95%CI = 0.80-1.00; p = 0.05; I² = 0%) or hemorrhagic stroke (RR = 1.23; 95%CI = 0.41-3.99; p = 0.66; I² = 27%). Major bleeding was not significantly increased in the DAPT group compared with the SAPT group (RR = 0.87; 95%CI = 0.29-2.66; p = 0.81; I² = 44%). The overall analysis did not show a significant difference in all-cause mortality (RR = 0.72; 95%CI = 0.50-1.02; p = 0.07; I² = 0%).

Conclusion:  There was no difference between DAPT and SAPT regarding recurrent stroke, ischemic stroke, hemorrhagic stroke, major bleeding, or overall mortality.

The discovery of aquaporin 4 immunoglobulin G (AQP4-IgG) autoantibody, present in ∼80% of patients with neuromyelitis optica spectrum disorder (NMOSD), dramatically improved its diagnosis, treatment, and prognosis. While Brazil has a higher prevalence of NMOSD (up to 4.5 per 100,000 people) compared with global averages, disparities in access to testing in Brazil impede early diagnosis and treatment. To tackle these issues, the Americas Health Foundation convened a three-day virtual conference with six Brazilian NMOSD experts. This paper emphasizes the importance of addressing the gaps in physicians' knowledge about NMOSD. Stakeholders, including government agencies, should develop national programs for continuing medical education. The public healthcare system should ensure the availability and accessibility of AQP4-IgG antibody testing. Clinical practice guidelines for NMOSD diagnosis and treatment must be established. Such guidelines will enable healthcare providers to manage patients promptly after the initial attack, reducing relapses and improving quality of life. Finally, addressing the fragmented healthcare system, including bridging the gap between public and private institutions and improving access to telemedicine, will aid individuals in Brazil with NMOSD in receiving early diagnosis and treatment. NMOSD presents unique challenges in Brazil because of its higher prevalence and limited access to crucial AQP4-IgG tests. Overcoming these challenges requires collaboration among experts, healthcare providers, government agencies, and the public healthcare system to improve diagnosis, treatment, and patient outcomes.

Background:  Patients with neuromuscular diseases (NMDs) often face swallowing difficulties (dysphagia) as part of their condition.

Objective:  To determine the prevalence of self-reported swallowing disorders in patients with rare NMDs and examine their correlation with related quality of life (QoL).

Methods:  The study included 103 patients with confirmed rare NMDs. Dysphagia risk was assessed using the validated Eating Assessment Tool-10 (EAT-10), and QoL related to swallowing was measured with the SWAL-QoL survey. Correlations between EAT-10 and SWAL-QoL scores were analyzed. Additionally, the mean questionnaire scores were compared among patients classified as dysphagic, dysphagic with high aspiration risk, and nondysphagic.

Results:  The estimated prevalence of dysphagia in the cohort, based on EAT-10, was 52.4%. Higher scores were significantly correlated with poorer swallowing-related QoL, except for the sleep domain. The most affected SWAL-QoL domains were burden, eating desire, eating duration, food selection, communication, fear, mental health, social functioning, and dysphagia battery score (DBS), with significant differences observed among the classifications (p < 0.001 for most domains, and p = 0.015 for eating desire). No statistically significant difference in swallowing QoL was found between sitters and walkers.

Conclusion:  Dysphagia is a prevalent symptom in patients with rare NMDs, affecting 52.4% of the cohort and significantly impacting QoL in nearly all domains except sleep.

Background:  The data on predictors of poor outcomes for stroke patients in middle-income countries are lacking.

Objective:  To identify in the acute phase after a first-ever stroke (FES) predictors of a poor outcome within 3 months and 1 year in a population-based study in the town of Matão, state of São Paulo, Brazil.

Methods:  We prospectively investigated the characteristics of patients with FES in Matão, from a prospective study, in a population-based stroke registry, from 2015 to 2020. Poor outcome was defined as a modified Rankin scale (mRS) score of 3 to 6, assessed at 3 months and 1 year of follow-up. The association between predictors and poor outcome was analyzed by logistic regression analysis.

Results:  Of the 783 patients, the final sample consisted of 378 subjects for analysis. The mean age was 69.2(± 14.3) years, and 43.1% of patients were female. At 3 months and 1 year after a FES, 50.4% and 47.1% of stroke patients were classified as poor prognosis, respectively. Older age, female gender, hemiplegia, aphasia, subarachnoid hemorrhage, and comorbidities present in the acute phase were the predictors associated with a poor outcome.

Conclusion:  Non-modified and potentially modified predictors increase the risk of a poor FES prognosis in a population-based study from a middle-income country. Interventions focusing on these target populations and improving access to prevention and stroke management in the acute phase are necessary.