Arquivos de neuro-psiquiatria最新文献

Neuromyelitis optica spectrum disorder (NMOSD) is a debilitating recurrent inflammatory disease of the central nervous system. Establishing management guidelines is essential to optimize patient care in Brazil.To combine the Delphi and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approaches to validate evidence-based guideline statements for NMOSD treatment.These guidelines focused on providing recommendations for different scenarios: general management and diagnosis of NMOSD; acute and preventive treatments (including systemic immunosuppressants and anti-B cell, anti-interleukin-6, and anti-complement monoclonal antibodies); and therapeutic approaches in special groups (such as the pediatric population and pregnant women). A literature review based on the Population, Intervention, Comparator, and Outcome (PICO) framework was performed, and studies were evaluated using the GRADE system. An initial questionnaire containing 19 statements was sent to 44 specialists from all regions of Brazil.Three voting rounds were necessary to reach consensus in all statements. After the first voting round, 17 statements reached consensus (level of agreement > 70%). Two statements failed to reach consensus and were, thus, revised. One of them was segmented into three different statements. After the second voting round, three out of the four revised statements reached consensus. Upon further revision, the last statement was again submitted to voting, reaching consensus in this third round. Overall, agreement was achieved on the 21 proposed statements.The primary objective in the management of NMOSD is to mitigate the severity of the attacks and prevent relapses, thereby minimizing the risk of irreversible neurological deficits. The statements in the current guideline offer evidence-based recommendations for such management within the Brazilian context.

Pituitary macroadenomas (PMAs) are frequently encountered tumors, predominantly characterized as soft and easily resectable during neurosurgery. In contrast, fibrous PMAs present difficulties during surgical removal. Therefore, the ability to predict the consistency of PMAs preoperatively could enhance surgical planning.To evaluate the ability of conventional T2-weighted imaging (T2WI) to predict PMA consistency by comparing isolated tumor signal intensity with the adenoma-to-middle cerebellar peduncle (ACP) ratio.Magnetic resonance imaging (MRI) scans from 45 patients with PMAs were independently reviewed by 3 blinded radiologists. For each case, the signal intensity (SI) of the adenoma and of the middle cerebellar peduncle was measured, and the ACP ratio (SI_adenoma/SI_peduncle) was calculated. Tumor consistency (soft or fibrous) was determined intraoperatively by a single neurosurgeon.Intraoperative assessment classified 29 PMAs (64.4%) as soft and 16 (35.6%) as fibrous. Isolated adenoma SI on T2WI differed significantly between soft and fibrous tumors (p = 0.013), while the ACP ratio demonstrated stronger discriminatory power (p < 0.0001). The receiver operating characteristic (ROC) curve yielded an area under the curve of 0.939 for the ACP ratio. Threshold values > 1.59 were highly predictive of soft tumors (sensitivity 72.4%; specificity 100.0%), whereas values < 1.27 were associated with fibrous tumors (sensitivity 100.0%; specificity 37.5%).Although isolated adenoma SI on T2WI showed statistical significance, it was not sufficient for consistent preoperative prediction of tumor consistency. The ACP ratio provided superior accuracy and clinical utility, supporting its role as a noninvasive imaging biomarker to enhance preoperative assessment and surgical planning in patients with pituitary macroadenomas.

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune demyelinating disease characterized by a high risk of relapse and disability. In cases positive for aquaporin 4-immunoglobulin G (AQP4-IgG), long-term immunosuppression is the established standard. However, the management of double-seronegative NMOSD remains controversial due to limited data. Although some authors propose treatment discontinuation in patients with prolonged remission, there are no reliable predictors of sustained disease inactivity. Given the unpredictability and severity of the relapses, even after a decade of stability, and the lack of robust evidence supporting safe cessation, we argue that maintenance immunotherapy should remain the standard of care in most cases. The risks of disease reactivation outweigh the potential benefits of treatment withdrawal. Until validated biomarkers or clinical tools for individualized risk stratification emerge, the default approach should prioritize sustained disease suppression.

Stroke is a major cause of mortality and disability globally. Dysphagia is a frequent complication that increases the risk of aspiration pneumonia, a key contributor to stroke-related deaths. Early screening is essential for improving outcomes.To identify clinical indicators that can help prioritize swallowing assessments in the emergency room, enabling faster and safer resumption of oral feeding.A prospective cohort of 134 postacute ischemic stroke patients admitted to the emergency room was assessed. Patients were divided into 2 groups: G1 (at risk of dysphagia) and G2 (no risk). Swallowing function was evaluated using the Dysphagia Risk Evaluation Protocol (DREP) and the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale. A subset (n = 15) underwent videofluoroscopic swallowing study (VFSS). Stroke severity was measured using the National Institutes of Health (NIH) stroke scale (NIHSS). Statistical analyses included t-tests, Chi-squared test, Pearson's correlation, and Cochran's Q test (p < 0.05).Patients from G1 were older (mean: 69.1 vs. 63.0 years, p = 0.023), had more severe strokes (NIHSS ≥ 9.8, p = 0.002), and were more likely to require alternative feeding methods. Older age and longer hospital stays correlated with increased dysphagia risk. Coughing during the 50-ml water swallow test was a strong predictor of aspiration.Key indicators of aspiration risk in postacute ischemic stroke patients include age ≥ 69, NIHSS score ≥ 9, and the need for alternative feeding. Coughing during the water swallow test is a valuable clinical predictor. Early identification can support targeted interventions and reduce complications.

White matter hyperintensities (WMH) are commonly detected on brain magnetic resonance imaging (MRI) scans of migraine patients, but their clinical relevance and underlying mechanisms remain uncertain.To systematically review the relationship between WMH and migraine, focusing on prevalence, progression, and associations with clinical and demographic characteristics.We conducted a systematic review of observational studies published between 1990 and May 2025, including adult patients with migraine (with or without aura) who underwent brain MRIs with at least 1.5T scanners. Data extraction was performed by two independent reviewers, with disagreements resolved by a third. Study quality was assessed using the Newcastle-Ottawa scale for observational studies.A total of 25 studies were included, comprising approximately 3,600 participants, of whom 1,725 had migraine. Most participants were women and reported age means or medians typically between 30 and 60 years. Frequently, WMHs were observed in migraine patients, particularly in those with aura, longer disease duration, and higher headache frequency. No consistent association was found between WMH and comorbidities. Significant heterogeneity in imaging protocols, lesion quantification methods, and study design limited data comparability and precluded meta-analysis.Migraine patients often present with WMHs, but their clinical significance remains unclear. Future studies should employ standardized MRI protocols, volumetric lesion quantification, and consistent migraine phenotyping to clarify its pathophysiological role in migraine and potential implications for diagnosis and management.

Cisplatin, a potent platinum-based chemotherapeutic, effectively treats various cancers. However, it is limited by cisplatin-induced peripheral neuropathy (CIPN), driven by oxidative stress and neuroinflammation.The present study investigates the neuroprotective potential of Taraxacum officinale L. leaf extract (TOE), rich in polyphenols such as luteolin and quercetin, known for their antioxidant and antiinflammatory properties.Molecular docking of 10 polyphenols against NF-κB1 revealed that luteolin and quercetin outperform synthetic inhibitors, forming strong interactions with key residues. These compounds exhibited favorable pharmacokinetics, including high gastrointestinal absorption and nontoxicity. The CIPN was induced in male Wistar albino mice (3 mg/kg cisplatin, i.p., weekly for 5 weeks), with TOE (500 mg/kg, intragastric, daily) or saline administered concurrently. A TOE-only group served as a control. Behavioral assessments (rotarod, hot plate, cold plate, tail flick) evaluated sensory and motor function, while biochemical assays measured antioxidant enzymes (CAT, GPx1, SOD2), oxidative stress markers (MDA, TOS, IMA), and proinflammatory cytokines (NF-κB, TNF-α, IL-6) in serum and sciatic nerve tissues.Cisplatin induced significant behavioral deficits, reduced antioxidant capacity, and elevated oxidative and inflammatory markers. The TOE significantly ameliorated these effects, restoring behavior, enhancing antioxidant status, and reducing inflammation, consistent with the in silico predictions of NF-κB1 inhibition.These findings highlight T. officinale as a promising, safe, complementary therapy for CIPN, warranting further clinical exploration.

Migraine is a common neurological disorder associated with an increased risk of cardiovascular conditions, including arrhythmias. Although autonomic dysfunction is considered a key mechanism linking migraine and cardiac abnormalities, its impact during pain-free intervals remains unclear.To investigate the association between migraine and cardiac arrhythmias, focusing on the prevalence of premature ventricular contractions (PVCs) and autonomic dysfunction during pain-free periods.A total of 50 migraine patients and 51 age- and sex-matched healthy controls were enrolled in the present observational, cross-sectional study. All participants underwent 24-hour Holter monitoring, standard electrocardiographic and echocardiographic evaluation. The frequencies of PVCs, PR interval, QT interval (QTc), heart rate variability, and sinus tachycardia prevalence were compared between groups. Migraine-related disability was assessed using the Migraine Disability Assessment Scale (MIDAS) and the Headache Impact Test-6 (HIT-6).At least 1 PVC was detected in 40% of migraine patients, although no significant difference was observed compared with controls (p > 0.05). However, migraine patients showed a significantly higher prevalence of sinus tachycardia (p < 0.05). Additionally, a positive correlation was found between PVC burden and MIDAS scores, suggesting a potential link between migraine severity and arrhythmia risk. No significant differences were observed in QTc intervals or other major arrhythmic parameters.Migraine patients may exhibit increased sinus tachycardia and subtle electrocardiographic changes even during pain-free intervals, possibly reflecting underlying autonomic dysfunction.