Arquivos de neuro-psiquiatria最新文献

Small fiber neuropathy (SFN) affects thinly myelinated and unmyelinated fibers, often presenting with subtle clinical signs that are undetectable in routine nerve conduction studies. Vitamin B12 deficiency is a known risk factor for SFN, yet early-stage cases frequently remain undiagnosed. Sympathetic skin response (SSR) and cutaneous silent period (CSP) are noninvasive electrophysiological techniques used to assess autonomic and somatic small fiber function.The present study aimed to evaluate the diagnostic utility of SSR and CSP in detecting possible subclinical small-fiber neuropathy (pSFN) in individuals with early-stage vitamin B12 deficiency.The present observational study included 28 patients with vitamin B12 deficiency who had nonspecific complaints, Douleur Neuropathique en 4 Questions (DN4) scores < 4, and normal nerve conduction studies, along with 25 healthy controls. Electrophysiological testing involved SSR recordings from all extremities and CSP measurements from the right median and sural nerves.In the patient group, Median Nerve Cutaneous Silent Period (MN-CSP) and Tibialis Anterior -Sural Cutaneous Silent Period (TA-sural CSP) durations were significantly shorter, while termination and onset latencies were prolonged compared with controls. MN-CSP and TA-sural CSP durations demonstrated high diagnostic accuracy. Sympathetic skin response latencies were significantly prolonged in both hands and feet, indicating autonomic dysfunction. No significant differences were observed in SSR amplitudes.Sympathetic skin response and CSP are valuable tools for detecting possible subclinical SFN in vitamin B12 deficiency. Sympathetic skin response effectively identified autonomic dysfunction, while CSP provided additional diagnostic value for somatic small fiber impairment. Combining SSR and CSP may enhance early detection of pSFN in vitamin B12 deficiency and allow timely intervention.

Medication-overuse headache affects 1 to 2% of the global population and is often associated with chronic migraine. This condition significantly impacts the lives of patients, as well as their families, and it poses a major economic burden due to lost productivity and medical costs. The present narrative review is part of a controversy session. We argue that reversing the behavior of overusing symptomatic pain medications is important for the treatment of this type of headache. To support this argument, the article reviews and critically analyzes the relevant literature on the subject.

Mercury intoxication poses a significant challenge and growing threat to public health, particularly in the Amazon region. Despite a known history of neurological damage, as evidenced by Japan's Minamata disease, mercury intoxication remains underdiagnosed in Brazil. This review underscores the need for increased clinical awareness among neurologists, as mercury exposure has been linked to over 250 neurological symptoms, including cognitive impairment, cerebellar ataxia, peripheral neuropathy, and psychiatric disturbances. The Indigenous and riverside populations in the Amazon present a high prevalence of cognitive and motor deficits, tremors, and sensory disturbances, which are associated with mercury body burdens. Diagnosis relies on a combination of clinical suspicion, environmental exposure history, and biomonitoring through hair and urine analyses. Given the widespread environmental contamination and potential long-term health consequences, neurologists must be vigilant in recognizing and managing mercury-related neurotoxicity, particularly in vulnerable Brazilian populations.

The present review article explores the neuroscience of musical perception, examining the roles of specific brain regions in decoding and interpreting music. Musical perception engages multiple cortical and subcortical areas that work in an integrated manner to process musical elements such as melody, harmony, and rhythm. The paper reviews the current knowledge about the brain circuits involved, as well as pathological conditions that result in abnormalities of musical perception. In addition, the relationship between musical perception and neurological conditions such as epilepsy and Alzheimer's disease is explored. The present review is based on findings from structural and functional neuroimaging studies, neuropsychology, neurophysiology, and clinical research, aiming to show how the brain transforms music sounds into meaningful experiences and addressing pathological conditions in which this complex process may be affected, either in isolation or in association with other forms of neurological impairment.

Several studies describe a strong association between structural and functional abnormalities of the cerebellum and psychiatric disorders. It is possible to find investigations especially in cases of schizophrenia, bipolar disorder, depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The involvement of the cerebellum in these conditions is also supported by clinical, functional, and structural imaging studies. The present narrative review aims to discuss and highlight the role of the cerebellum in these disorders, gathering evidence on the possible locations and connections of the affected cerebellar areas and their implications in the cognitive, emotional, and behavioral domains.

For the purposes of the present study, we define vertigo as the sensation of rotation of the environment or of the person moving. The demand for care for this complaint has been increasing; therefore, it is important to know the profile of patients treated with this complaint, the causes, the comorbidities, the associated factors, and the response of these individuals to rehabilitation.To analyze the epidemiological profile of patients reporting vertigo and their outcome after physiotherapeutic rehabilitation.We conducted a descriptive cross-sectional study of secondary data analysis. The sample was collected through a census in a specialized clinic in the south of the state of Santa Catarina, Brazil. Individuals were evaluated through a questionnaire developed by the authors, which covered the patient's demographic and clinical data. The statistical analysis was performed using the IBM SPSS Statistics for Windows (IBM Corp.) software, version 23.0.A total of 200 medical records were evaluated, 5 of which were excluded due to non-adherence to treatment, totaling a sample of 195 patients. Their mean age was of 51.18 ± 16.84 years, 62.6% were female subjects, and benign paroxysmal positional vertigo (BPPV) was the most prevalent cause (55.9%), with associated symptoms such as tinnitus (30.8%) and depression and/or anxiety (29.2%). Of the 195 patients, 193 responded positively to the vestibular rehabilitation treatment, and the vertigo of 58% improved after 1 session.The population older than 50 years of age is the most affected by vertigo, especially women, with BPPV as the main cause and associated symptoms such as tinnitus, depression, and anxiety. Most patients improved after the first vestibular rehabilitation session.

West syndrome is an epileptic encephalopathy for which combination therapies with adrenocorticotropic hormone and vigabatrin have emerged as new treatment options.To evaluate the clinical and electroencephalographic remission rates, tolerability, and relapse rates in patients with West syndrome who failed primary treatment and underwent sequential therapy with vigabatrin and adrenocorticotropic hormone.We included 39 patients with West syndrome from 2 specialized centers, aged 2 to 120 months. The patients were treated with intramuscular tetracosactide depot added to vigabatrin and were prospectively followed up for ≥ 1 year. The outcomes were clinical, and electroencephalographic remission rates at 7 and 30 days and 1 year following combined therapy initiation, progression to other epilepsy types, therapy tolerability, and relapse rates were recorded.Of the original sample, 71% of the subjects were boys, and 87% had a known etiology. The clinical and electroencephalographic remission rates were 46.1%, 94.8% (p = 0.001), and 74.1% (p = 0.01) at 7 and 30 days, and 1 year after the initiation of combined therapy, respectively. At the 1-year follow-up, adverse effects were observed in 86.0% and the relapse rate was 21.6%. After a median follow-up of 21 months, 73.6% of the patients developed epilepsy.Combined therapy demonstrated a favorable efficacy profile in achieving clinical and electroencephalographic remission but was associated with significant seizure relapse rates in the medium term. Thus, it represents a feasible option for patients in whom initial treatment has failed.

Although it is known that the most commonly used therapies for West syndrome (WS) are intramuscular adrenocorticotropic hormone (ACTH) and oral prednisolone, there is still controversy in the literature regarding the equivalence of their effects.We aimed to present an updated review comparing the therapeutic and adverse effects of ACTH therapy versus corticosteroids in children with West syndrome (WS).The PubMed, EMBASE, and Cochrane Central databases were searched. The outcomes of interest selected were spasm cessation on day 14 of therapy, cessation of hypsarrhythmia and adverse effects such as weight gain, infection, irritability, and hypertension. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a meta-analysis was performed. We compared the results using the risk ratio (RR) and odds ratio (OR). for the binary outcomes, with 95% confidence intervals (CI) and a random-effects model. Statistical analysis was performed using RevMan 5.1.7.Compared with corticoids, ACTH was associated with a significant increase in weight (RR: 1.41; 95% CI: 1.01-1.97; p = 0.04). There was no significant difference in cessation of spasms on day 14 (OR: 0.91; 95% CI: 0.47-1.47; p = 0.79), hypsarrhythmia (OR: 0.97; 95% CI: 0.22-4.34), irritability (RR: 0.78; 95% CI: 0.30-1.99), hypertension (RR: 0.64; 95% CI: 0.35-1.15; p = 0.14), and infection (RR: 0.69; 95% CI: 0.19-2.50; p = 0.57).This study provides robust evidence regarding the safety and efficacy of ACTH or corticoids in children with WS. However, the significant heterogeneity between studies restricts the analysis, emphasizing the need for additional research to assess the best WS treatment option.

Clobazam (CLB) has been an established treatment for epilepsy since the 1970s, with a broad spectrum. It is frequently used as add on therapy for refractory patients. Furthermore, it is different from classic benzodiazepines (BZD) for containing nitrogen atoms in 1 and 5 positions of B ring (other are 1.4-BZD). This explains why CLB has a better tolerability and a lower chance of causing sedation, being an excellent option for epilepsy treatment compared with other BZDs. Evidence argues against the development of CLB tolerance in most patients. Antiseizure medication shortages have been reported by many countries, including the one studied here. Shortages make treatment harder, increase the need for extra clinical appointments, for orientation and medication changes, increase medication errors, decrease adherence, and cause insecurity. A literature review showed scarce evidence of alternatives, with a wide variation in dosage equivalence. A survey of specialists revealed that switch appropriateness was deemed inadequate by the majority, due to risk of seizure worsening and side effects. Clonazepam and nitrazepam were the most used BZDs, but there was great variation for clonazepam dosages (0.25-2 mg, commonly 1 per 10 mg of CLB). Better consensus was obtained for nitrazepam (5 per 10 mg of CLB). Gradual tapering of CLB, with concomitant increase of clonazepam or nitrazepam under close supervision, is advised. It is important to assess tolerability and the need for increased dosage. As CLB is an essential tool in the epilepsy armamentarium, shortages pose great risk to the patients. Governments and society must create mechanisms to prevent shortages of critical and unique medications.