Arquivos de neuro-psiquiatria最新文献

Scientific investigations have highlighted the benefits of cognitive stimulation for cognitive, psychological, and social aspects in older individuals. However, there is a dearth of long-term, methodologically-rigorous studies. The aim of the present study was to describe the methods and the initial characteristics of the participants in a randomized controlled trial on cognitive stimulation. A total of 578 older individuals accepted invitations to participate in the study. Of these respondents, 362 met the eligibility criteria, and 255 were selected and randomized into the training, active control, and passive control groups. During the baseline stage (T0), 48 participants withdrew, resulting in a final T0 sample of 207 participants. The three groups were similar in terms of cognitive performance and sociodemographic and psychosocial variables, but they differed significantly regarding depressive symptoms, with the training group scoring higher. The methods herein described can help guide future research on cognitive stimulation in older adults.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune disorder that leads to progressive motor and sensory impairment, resulting in significant morbidity. While the incidence rates vary, CIDP remains a challenging condition requiring a standardized and optimized approach to diagnosis and management. In Brazil, a middle-income country with substantial regional disparities in healthcare access, the availability of specialized neuromuscular centers is uneven, creating obstacles to timely and effective treatment. To address these challenges, the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN, in Portuguese) has developed national recommendations for the diagnosis, management, and treatment of CIDP, tailored to the country's healthcare resources. This consensus outlines standardized diagnostic criteria that incorporate electrophysiological and imaging findings, and it emphasizes key differential diagnoses to enhance diagnostic accuracy. The recommendations were developed through expert panel discussions and a non-systematic review of the literature. The recommended treatment strategies include first-line therapies such as corticosteroids, intravenous immunoglobulin (IVIg), and plasmapheresis, with guidance on escalation and titration of immunosuppressive therapy in refractory cases. By emphasizing early intervention to prevent axonal degeneration and disability, these guidelines aim to improve clinical outcomes and support public health policies within the Brazilian National Health System (Sistema Único de Saúde, SUS, in Portuguese), ensuring equitable and effective CIDP management across the country.

Deep brain stimulation (DBS) has been widely accepted as a powerful tool capable of suppressing tremor by modulating the neuronal circuitry, with long-term adaptability and a profile of low adverse effects. It has been the primary treatment for refractory tremor for decades, with sustained long-term efficacy. Recently, magnetic resonance-guided high-frequency focused ultrasound (HIFU) has emerged as an alternative, prompting comparisons between these approaches. Deep brain stimulation offers long-lasting tremor control in Parkinson's disease (PD) and essential tremor (ET). In addition, it enables us to advance our understanding of brain circuits by integrating neuroimaging, electrophysiology, and connectomics data to map the best stimulation spots. Technologies such as adaptive and directional DBS enable real-time adjustments and greater precision, optimizing results and minimizing adverse effects. Although HIFU shows promising results, it remains an ablative and non-adjustable therapy, contrasting with DBS's dynamic and customizable advances.

Neurocutaneous syndromes are a group of genetically and phenotypically diverse disorders that primarily affect the skin, central and peripheral nervous systems, and eyes. Classifying neurocutaneous syndromes based on genetic mechanisms often proves impractical in routine clinical settings. This review proposes a practical classification of neurocutaneous syndromes based on their neurological manifestations, including neoplastic lesions, epilepsy, vascular abnormalities, and ataxia. In this narrative review, we examined original articles and reviews that explore neurocutaneous syndromes, published between January 2000 and July 2024. The figures are part of a personal collection of the authors. Early recognition of dermatological and neurological hallmarks can guide diagnosis and prompt timely evaluation and treatment. Therefore, a thorough understanding of neurocutaneous syndromes highlights the importance of integrated diagnostic strategies that combine neurological and dermatological assessments.

Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Levodopa has been considered the best treatment option. However, deep brain stimulation (DBS) use has increased over time, mostly when levodopa-related complications arise.To review the current evidence regarding economic evaluations assessing costs and benefits comparing pharmacological versus surgical treatment among subjects with PD.We searched three databases (PubMed, Embase, and Google Scholar) for studies comparing levodopa treatment and DBS among subjects with PD in terms of costs and benefits from therapy.Out of the 107 studies identified, 14 met the inclusion criteria. Most of the published studies were from Europe. Incremental cost-effectiveness ratios have shown variable results, from -€979 to €6,729 per change of 1 point in the score on part III of the Unified Parkinson's Disease Rating Scale (UPDRS III), while incremental cost-utility ratios depict values as low as €6,700 and as high as $704,906.03 per quality-adjusted life-years (QALY).We observed a higher cost during the 1^st year of DBS implantation due to the surgical procedure itself, subsequently, there was a trend for a lower cost over the following years, with no loss of benefit. Overall, the studies showed DBS as a cost-effective measure at 5-years after implantation.

Social determinants of health, including neighborhood and built environment factors, play a crucial but underexplored role in epilepsy incidences. Among these, air pollution emerges as a potentially-preventable driver of epilepsy and adverse health outcomes. Evidence is accumulating on the effects of air pollution on the brain, especially in stroke and neurodegenerative disorders; however, the specific impact on epilepsy remains underresearched, potentially due to the complexities of studying this condition. The present narrative review addresses a critical knowledge gap by exploring: 1) the role of air pollution in epilepsy epidemiology; 2) the biological mechanisms of air pollution in the brain in the context of epilepsy; and 3) how air pollution affects the management of people living with epilepsy. We outline vital questions and actionable interventions regarding the role of air pollution in epilepsy.

The natural history of amyotrophic lateral sclerosis (ALS), the prognoses, and the survival times are fields of considerable interest that are scarcely studied in South American countries.To describe the survival of a representative cohort of Uruguayan ALS patients, and to identify covariates associated with survival using different analyses.Survival was assessed using the Kaplan-Meier method. Different Cox proportional hazards functions were used to identify independent prognostic predictors since the diagnosis: classic, stratified, and truncated.We included 166 definite and probable ALS patients. The median follow-up was of 13.6 years. An analysis was performed according to the recruitment groups: prevalent, exhaustive incident, and non-exhaustive incident cases. The median survival since the diagnosis was longer in the prevalent group (33 months) than in the exhaustive incident (22 months) and non-exhaustive incident (14 months) groups. The median survival time of the entire cohort from onset to death was 37 months and 23 months from the diagnosis. Factors related to survival from diagnosis to death were: age at onset, bulbar region onset, clinical form, and progression rate.The present study described the role of clinical and demographic factors in ALS survival in the Uruguayan population and shed light on differences involving survival models and the temporal bias produced by the lack of precision in determining the onset of the disease.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by recurrent dream enactment behaviors like sleep-related vocalization and/or complex motor behaviors.To investigate the discriminative role of the validated Turkish version of the 9-Item Innsbruck REM Sleep Behavior Disorder Inventory (IRBD-9-Turkish) for idiopathic RBD (iRBD) in patients with obstructive sleep apnea (OSA).The current multicenter study was prospectively conducted in 13 accredited sleep centers in 10 different cities in Türkiye. Clinical data was obtained through a preformed questionnaire, and all participants were submitted to a full-night video-polysomnography (video-PSG) session in a sleep laboratory.A total of 105 patients (mean age: 58.3 ± 11.6 years; 68.6% of male subjects) were prospectively and consecutively enrolled in the study; 51 patients (48.6%) presented iRBD, and 54 (51.4%), OSA, 19 (35.2%) of whom presented abnormal nocturnal behaviors (NBs) demonstrated by clinical and video-PSG findings associated with arousal reactions secondary to apneas and hypopneas. The cut-off value of the IRBD-9 was higher in patients with OSA-NBs than in those with OSA without NBs (p < 0.001), with a sensitivity of 0.765 and a specificity of 0.667, resulting in a correct diagnosis of NBs in 75% of patients with OSA. The receiver operating characteristic (ROC) curves for Factor I (items 1, 2, 3, 6, and 8) and Factor II (items 4, 5, 7, and 9) of the IRBD-9-Turkish showed that both factors were able to distinguish patients with iRBD from those with OSA, but only Factor I distinguishes patients with iRBD from those with OSA-NBs.The present study demonstrated a very high sensitivity and specificity of the IRBD-9-Turkish not only in patients with iRBD, but also in patients with OSA.