Arquivos de neuro-psiquiatria最新文献

Status epilepticus (SE) is a common neurological emergency that occurs in children and adults. It can be treated with different antiseizure medications (ASMs). Benzodiazepines represent the first line of treatment. If seizure activity does not cease, it is a common clinical practice to prescribe the patient either phenytoin (PHT), levetiracetam, or valproate. For decades, PHT has remained a cornerstone in the treatment of certain types of seizures, despite the emergence of newer agents such as levetiracetam. The current article explores the ongoing relevance of phenytoin, its unique advantages over levetiracetam in specific contexts, and the importance of individualized treatment in epilepsy management.

Arquivos de Neuro-Psiquiatria (ANP) celebrated 80 years in 2023. We have previously evaluated the publication trends throughout the first 20 years.To analyze the publication trends, authorship, and editorial patterns of the volumes 21 to 40 of ANP (1983-1962).Data were tabulated independently by two blinded researchers and cross-verified by independent researchers and automated data extraction technology (Python script).From 1963 to 1982, 20 volumes, 80 issues, and 904 articles were published. In 1970, ANP became the official journal of Academia Brasileira de Neurologia (ABN, the Brazilian Academy of Neurology). We analyzed 795 articles (and excluded non-research papers). Compared to the first 20 years, there was a significant increase in the total number of authors per article (2.73; p < 0.05), a significant increase in the percentage of female authors (to 10.96%; p < 0.05), and a decrease in the number of pages per article (p < 0.05). Antonio Spina-França, Walter Carlos Pereira, and Michel Pierre Lison were the most prolific authors. Most of the articles were on the topics of Neurology/Child Neurology, with a decrease in the percentage of Psychiatry papers and an increase in Basic Research contributions. There was also a linear increase in the total number of articles from 1963 to 1982, as detected by regression analysis (R² = 0.86; p < 0.0001). Most of the articles were written in Portuguese and by authors from Southeastern Brazil (71.1%).The years 1963 to 1982 marked the resilience of ANP during the tempestuous years of the Brazilian Military dictatorship, coinciding with an increased split between the Neurology and Psychiatry fields, the appearance of clinical trials and large case series, and a greater development in the understanding of neuroinfectious diseases.

Tarsila do Amaral's painting "Abaporu" is a seminal work in Brazilian modernist art, yet its interpretation continues to intrigue scholars due to its complex symbolism.To examine "Abaporu" through the perspective of neuroesthetics, exploring potential parallels between its visual elements and sensory disturbances characteristics of migraine aura.A structured review of primary and secondary art-historical sources and a systematic literature search in PubMed and Google Scholar were conducted. The analysis focused on Amaral's recurrent use of disproportion and gigantism in the 1920s and on evaluating the plausibility of a neuroesthetic hypothesis in this art-historical context.Our analysis indicated that the gigantism and deliberate deformation in "Abaporu" belong to a consistent program already evident in Amaral's 1920s painting. From this perspective, the painting's oversized feet and hands contrasting with a diminutive head evoke perceptual alterations reminiscent of macropsia and micropsia, phenomena linked to Alice in Wonderland Syndrome and migraine aura. Its vibrant palette and melancholic undertones, likewise, resound the sensory disturbances and affective dimensions associated with migraine, suggesting that Amaral's programmatic distortions also invite a neuroesthetic reading.While no evidence supports a medical diagnosis of migraine in Amaral, the visual motifs and techniques in "Abaporu" can be read both as deliberate esthetic strategies of her Pau-Brasil and Anthropophagic phases and as intuitively resonant with neurological models of altered perception. This dual lens enriches our understanding of art's capacity to embody complex perceptual experiences and encourages further interdisciplinary dialogue between art history and neuroscience.

The neurological examination has evolved from rudimentary clinical observations in ancient civilizations to a structured and indispensable tool in modern medical diagnostics. Early contributions from Hippocratic medicine emphasized the brain as the seat of cognition and introduced systematic observation of neurological signs. In the 19^th century, figures such as Jean-Martin Charcot, Wilhelm Erb, William Gowers, and Joseph Babinski established the foundations of the modern neurological exam through anatomoclinical correlations, standardization of reflex assessment, and structured clinical reasoning. Throughout the 20^th century, seminal textbooks-such as those by Mills, McKendree, DeJong, and Wartenberg-helped consolidate and disseminate neurological semiology globally. More recently, evidence-based approaches, exemplified by Steven McGee's work, have introduced statistical rigor to bedside examinations. Despite advances in neuroimaging and electrophysiology, examinations remain a cornerstone of clinical neurology, guiding diagnosis, promoting cost-effective care, and reinforcing the doctor-patient relationship.

Dengue encephalitis is an uncommon neurological complication of dengue virus infection. In immunocompromised patients, such as solid organ transplant recipients, the clinical presentation may be atypical and nonspecific, posing significant diagnostic and therapeutic challenges. We report a clinical case and use it as a framework to discuss key considerations for suspicion of dengue encephalitis. Topics include optimal timing for clinical suspicion, essential differential diagnoses, and the most appropriate diagnostic strategies. Emphasis is placed on the correct interpretation of cerebrospinal fluid findings and recognition of subtle brain magnetic resonance imaging changes that may support the diagnosis. The discussion also reviews current evidence on dengue encephalitis in immunocompromised populations, highlighting implications for timely diagnosis and management in this vulnerable group.

SuperAgers (SA) are adults aged ≥ 80 years with memory equivalent to individuals 20 to 30 years younger. Few studies have evaluated multimodal neuroimaging approach in the same SA cohort.To investigate neurobiological mechanisms underlying exceptional cognitive aging by evaluating cortical amyloid deposition, regional cerebral glucose metabolism (rBGM), and gray matter volume (GMV), and their associations with neuropsychological performance and subjective cognitive decline (SCD).The participants were classified as SA (n = 11), age-matched healthy controls (HC80; n = 23), and healthy controls aged 60 to 69 years (HC60; n = 23). Positron-emission tomography (PET) using ¹¹C-PIB and ¹⁸F-FDG were analyzed using semiquantitative three-dimensional stereotactic surface projection (3D-SSP), with group comparisons using Statistical Parametric Mapping 8 (SPM8).The median ages were 81 years (interquartile range [IQR] = 5.0) for SA, 83 years (IQR = 5.0) for HC80, and 66 years (IQR = 3.0) for HC60. All groups had a median of 16 years of schooling (IQR for SA = 7, for HC80 and HC60 = 5). There were 4 PIB-PET positive individuals (36.4%) in the SA group, which is similar to the HC80 group (40.9%). Also, 6 SA had SCD, with 3 being PIB-positive. In SA, composite SUVr predicted RAVLT delayed recall (β = -0.666, p = 0.011, adjusted R² = 0.748), controlling for age, sex, and schooling. Compared to HC80, the SA group showed increased metabolism in the anterior cingulate gyrus and caudate, as well as increased GMV in the putamen.The SA group exhibited similar amyloid burden to HC80, yet amyloid deposition specifically impaired their memory. Increased rBGM and GMV in the salience network and striatum suggest these regions support successful cognitive aging.

Multiple sclerosis (MS) is a chronic disease with an unpredictable clinical course, presenting both recurrent relapses and progressive worsening over time. People living with MS (pwMS) are impacted physically, psychologically, and socially. Illness perception refers to a person's cognitive and emotional representations of their disease, which can impact their psychophysical well-being and treatment adherence.To assess the illness perception of pwMS and determine how it is impacted by cognitive dysfunction and fatigue.In this cross-sectional pilot survey study, the Brief Illness Perception Questionnaire (B-IPQ), Montreal Cognitive Assessment (MoCA-BR), Modified Fatigue Impact Scale (MFIS-BR), and Multiple Sclerosis Quality of Life Questionnaire (MSQOL-54) were used. Demographic and clinical data, as well as the Expanded Disability Status Scale (EDSS), were collected.A total of 30 RRMS patients (66.7% of female subjects, with a mean age of 36.8 ± 1.8 years) were enrolled. The mean score on the B-IPQ scale was of 30.2 ± 8.9 points, with 40% presenting a threat perception of the disease. No significant correlation was observed between cognitive performance and illness perception (r = -0.058; p = 0.761). However, significant correlations were found between illness perception and all fatigue domains (total: r = 0.578; p = 0.001; physical: r = 0.594; p = 0.001; psychosocial: r = 0.672; p < 0.001), except the cognitive domain (r = 0.360; p = 0.051). The EDSS and MSQOL-54 scores also demonstrate significant correlations with illness perception (EDSS = 2.30; p = 0.034; MSQOL-54 physical: r = -0.776; p < 0.001; MSQOL-54 mental: r = -0.704; p < 0.001).Illness perception in MS is influenced by patients' fatigue, quality of life, and disability levels, but it does not appear to be affected by cognition.