Arquivos de neuro-psiquiatria最新文献

Amyotrophic lateral sclerosis (ALS) is a multifaceted neurodegenerative disorder with a poor prognosis. Weight loss and malnutrition emerge as significant clinical features during disease progression.To explore how demographic and clinical characteristics relate to survival in ALS patients, emphasizing the role of weight loss percentage at the time of diagnosis.We conducted a retrospective study that used the database of a multidisciplinary ALS care center in the city of Natal, Brazil.A total of 132 patients were included in the study. The mean age of the participants at symptom onset was of 56.9 years, and most of them were male (59.8%). Older age, bulbar onset, and faster disease progression were associated with weight loss ≥ 10% at diagnosis. Among 132 patients, 72% experienced death or tracheostomy, with a median survival of 34 months. Survival was notably reduced in patients aged ≥ 60 years, those with significant weight loss, rapid disease progression, or those submitted to gastrostomy. Weight loss and the rate of disease progression were the strongest predictors of reduced survival. Potential factors relating gastrostomy with reduced survival are discussed.The present study highlights the critical impact of weight loss and disease progression on survival in ALS patients, emphasizing the importance of early nutritional and clinical interventions. These findings underscore the need for comprehensive, multidisciplinary care strategies to address key prognostic factors and improve outcomes in ALS patients.

Obesity is a complex metabolic disorder with significant implications for both individual and public health. It has been strongly linked to chronic headache conditions, including migraines and idiopathic intracranial hypertension (IIH). Individuals with obesity who suffer from migraine are at increased risk of chronification, while weight reduction has been associated with improvement in IIH-related headaches, likely due to a decrease in cerebrospinal fluid pressure. These observations underscore the importance of weight management strategies as a therapeutic consideration in patients with obesity and headache disorders. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are pharmacological agents that mimic the hormone's endogenous activity. Analysis of selected studies highlights that these agents have emerged as a promising therapeutic option. The aim of this narrative review is to examine the role of GLP-1 RAs in the management of headaches, particularly in the context of IIH, migraine, and the gut-brain axis. Additionally, this review addresses the challenges associated with the use of this pharmaceutical class, including the potential for headaches as adverse effect, and identifies existing knowledge gaps that may guide future research.

Mitochondrial dysfunction plays a crucial role in neuropsychiatric disorders, including delirium.To explore the causal links between mitochondrial-related druggable genes, cerebrospinal fluid metabolites, and delirium.Summary-level data on mitochondrial-related druggable genes, expression quantitative trait loci (eQTLs), 338 cerebrospinal fluid (CSF) metabolites, and delirium data were obtained from publicly accessible genome-wide association studies. A two-sample Mendelian randomization (MR) was applied to assess the causal effects of blood cis-eQTL of mitochondrial-related druggable genes on delirium. Sensitivity analyses were also undertaken to ensure the MR results' reliability. We assessed whether cerebrospinal fluid metabolites mediate the causal relationship between druggable mitochondrial genes and delirium.A total of 12 mitochondrial-related druggable genes (8 protective and 4 risk) were identified to be associated with delirium risk (p < 0.05). Furthermore, 20 CSF metabolites were significantly associated with delirium, 9 positively and 11 negatively. Sensitivity analyses showed no evidence of heterogeneity or horizontal pleiotropy. Mediation analysis indicated that 3-hydroxyoctanoate partially mediated the causal association between sterol carrier protein 2 (SCP2) and delirium, accounting for approximately 19.23% of the total effect.The present work reveals that mitochondrial-related genes and CSF metabolites may play causal roles in delirium and highlights SCP2-3-hydroxyoctanoate as a novel molecular axis. These findings expand current knowledge of delirium pathogenesis and offer a potential molecular target for diagnosis and therapy. Further experimental validation and population-diverse studies are needed to confirm these findings.

Benzodiazepine (BZD) receptor agonists, commonly known as Z-drugs, are non-BZD hypnotics primarily prescribed for the treatment of insomnia. Their use is recommended for no longer than four weeks to minimize the risk of adverse effects, including dependence and withdrawal. However, these guidelines are frequently disregarded, and the abuse of and dependence on Z-drugs has emerged as a growing public health concern in Brazil. The present article reviews the current evidence on Z-drug use disorder-including dependence and withdrawal-and proposes clinical guidelines for the management of discontinuation. The recommendations were developed based on a systematic review of the literature and refined using the Delphi methodology. The consensus was developed by a multidisciplinary task force, with coordination and voting led by a steering committee. An advisory committee, consisting of neurologists from the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN, in Portuguese) and psychiatrists specializing in substance-use disorders, contributed to the selection and organization of the scientific literature and took part in the voting process. Key recommendations were established: 1) prior to discontinuation, a comprehensive assessment of mental status, psychiatric and sleep comorbidities, and the degree of pharmacological dependence is essential; 2) gradual tapering is advised; 3) non-pharmacological interventions, such as cognitive behavioral therapy for insomnia, are recommended, and acceptance and commitment therapy, which is optional, may be incorporated; 4) for zolpidem withdrawal, adjunctive pharmacotherapy, which is optional, may include trazodone, other antidepressants, quetiapine or other antipsychotics, alpha-2-delta (α2δ) ligands, or alternative hypnotics (such as ramelteon, zopiclone, and eszopiclone); 5) for Z-drug discontinuation, intermediate- or long-acting BZDs are recommended; and 6) short- or ultra-short-acting BZDs and immediate-release melatonin are not recommended.

Cervical radiculopathy (CR) is a common condition encountered in the general population, usually related to a musculoskeletal degenerative condition. Conventional electroneuromyography (ENMG) consists of nerve conduction studies (NCS) and needle electromyography (EMG), and it is regarded as the most specific diagnostic evaluation in this scenario. Although CR is commonly encountered in clinical practice, ENMG as a diagnostic tool is not often discussed in neurology residency programs. Electromyography has demonstrated modest sensitivity (50-71%) but excellent specificity (approaching 100%) for the diagnosis of CR. It can also provide valuable information about lesion chronicity. In EMG, acute lesions typically present with denervation potentials and reduced recruitment, but with preserved motor unit action potential (MUAP) morphology. In contrast, chronic lesions are characterized by remodeling, with MUAPs showing increased duration, amplitude, and number of phases, in addition to reduced recruitment. The present review aims to provide an overview of the roles of NCS and EMG, while also introducing key terminology commonly encountered in the interpretation of these diagnostic modalities.

Essential tremor (ET) is the most prevalent movement disorder globally, affecting about 1% of the general population and 5% of those aged over 65 years. Characterized by involuntary, rhythmic oscillations, it primarily manifests as postural and kinetic tremors, predominantly in the upper limbs. Genetic studies, neuropathological examinations, neurophysiological assessments, and various neuroimaging techniques have demonstrated functional, neurotransmitter-related, and structural abnormalities within the cerebello-thalamo-cortical circuit. These findings collectively portray ET as a neurodegenerative syndrome with diverse etiologies and clinical manifestations, highlighting the involvement of the cerebellum.

We review the contributions of Georges Guinon, an eminent pupil of Professor Jean-Martin Charcot, to the clinical description of Gilles de La Tourette syndrome, including phenomenological definitions and the occurrence of psychiatric findings such as obsessive-compulsive behavior.