Arquivos de neuro-psiquiatria最新文献

The present paper explores the extraordinary life of cellist Jacqueline du Pré, her remarkable contribution to music, and her battle with multiple sclerosis (MS). Beyond her artistic impact, we discuss how her story influenced the creation of the Brazilian Multiple Sclerosis Association (Associação Brasileira de Esclerose Múltipla, ABEM, in Portuguese) and its cultural significance in Brazil, particularly through the play Duet for One, by Tom Kempinski. The study reflects on the role of art as a powerful tool to raise awareness and contribute to the understanding of diseases.

Cerebellar syndrome is traditionally categorized into three primary types: cerebellar motor syndrome (CMS), vestibulocerebellar syndrome (VCS), and cerebellar cognitive affective syndrome (CCAS) or Schmahmann syndrome (SS). The first type is subdivided into five elemental features: dysmetria, kinetic tremor, asynergia, adiadochokinesis and dyschronometria. The second is characterized by dysmetria of saccades and jerky pursuit, as well as downbeat nystagmus and gaze-evoked nystagmus. And the third type is associated with a broader spectrum of cognitive and affective symptoms, including impairments in executive function, spatial cognition, language processing and emotional regulation. In its extreme form, cerebellar mutism can also develop during childhood following cerebellar vermis surgery. Recent physiological studies have shed light on the underlying neural mechanisms of these syndromes by identifying a common link of dysfunction within the cerebellum's internal forward model. This is essential to the prediction of the outcomes of motor and cognitive actions and underlines dysmetria as the core common element. Despite the diversity in clinical presentation, cerebellar syndromes can be understood as disruptions of a unified neural mechanism, providing a new framework for better understanding of cerebellar deficits.

Epilepsy is a condition that can lead to social difficulties and restrictions.To evaluate social and occupational functioning and relationships with clinical findings of Brazilian adult patients with epilepsy.The scores of the Social and Occupational Functioning Scale for Epilepsy (SOFSE) were related to the clinical data of adult patients with epilepsy.Among the 79 cases included, with a mean age of 44.3 years old, 47 were employed and 32 were unemployed. It was observed that there was a predominance of males among the employed patients (32 [68.1%] versus 15 [31.9]; p = 0.008), most patients had a companion (27 [57.4%] versus 20 [42.6%]; p = 0.005), and most patients had no anxiety symptoms on the Hospital Anxiety and Depression Scale (HADS) (30 [63.8%] versus 17 [36.2%]; p = 0.011). The total score in the SOFSE was 64.7, with a higher total score among the employed patients (56.6 ± 12.5 versus 70.3 ± 14.3; p < 0.001). There was a correlation between the total SOFSE score with formal education (r = 0.30) and with HADS-anxiety (r = - 0.56) and HADS-depression (r = - 0.36). Lower scores in the communication domain were associated with a high frequency of seizures. There were lower scores in the domain leisure activity in TLE (2.0 ± 2.0 versus. 2.2 ± 1.5; p = 0.014).The unemployment rate was high in adults with epilepsy. Employment was associated with male gender, having a companion, and absence of anxiety symptoms. Better functional adjustment was associated with schooling. Social and occupational functional impairment was associated with a high frequency of seizures, TLE, and anxious and depressive symptoms.

Myasthenia gravis (MG) is a rare neurological disease and the most common autoimmune disorder, characterized by muscle weakness. In Brazil, there is limited data on these patients within the Brazilian public healthcare system (SUS, from Sistema Único de Saúde, in Portuguese).To assess patients with MG in the Brazilian public healthcare system to understand their characteristics, patient journey, and treatment patterns.A retrospective observational study using real-world data from SUS to analyze patients with MG from January 2010 to December 2023. Data were extracted from the DATASUS, focusing on the Outpatient Procedure (SIA) and Hospital Admissions (SIH) information systems. Probabilistic record linkage compiled longitudinal patient data, assessing epidemiology, demographics, clinical characteristics, and treatment patterns, including medications, doses, and lines of treatment (LOT).A total of 13,476 patients with MG were identified. Admissions in healthcare units increased over the years, with 30.4% experiencing exacerbations and 9% crises. The mean age was 45.6 years, with a majority being female (65.4%) and white (53.4%). The case-fatality rate rose from 0.76% in 2011 to 1.90% in 2023. Treatment patterns showed frequent transitions between LOT, indicating constant instability and inadequate symptom control, with azathioprine and pyridostigmine being the most used medications. Some patients started treatment with intravenous immunoglobulin (IVIg), used in combination with other medications, and continued it continuously.The study highlights the increasing burden of MG on SUS, emphasizing the challenges of disease management and the need for continuous advancements in diagnostic and therapeutic strategies to improve patient outcomes.

Symptoms in the postictal period are often neglected by professionals and patients/family members.To relate the characteristics of the postictal period with the clinical variables of adult patients with epilepsy.Prospectively, the clinical characteristics of the postictal period were related to the clinical variables and the scores on the Hospital Anxiety and Depression Scale (HADS) and Mini-Mental State Examination (MMSE) of 70 patients with epilepsy.The mean age was 47.6 years old, and 34 (48.6%) patients were male, the mean age at onset of epilepsy was 20.3 years old, the epileptic syndrome was structural in 48 cases, the mean score in the MMSE was 23.6, the mean score in the HADS-anxiety was 7.3, and in the HADS-depression it was 5.6. Postictal manifestation occurred in 59 (84.2%) cases, with prolonged duration in 22 (37.2%) cases. There was a difference in the duration and presence of postictal manifestation according to age at the onset of epilepsy. Higher HADS-anxiety scores were associated with the presence of confusion in the postictal period (t-test; 9.3 ± 6.8 versus 5.8 ± 4.8; p = 0.015). Lower MMSE scores were related to postictal anxiety and sleepiness/headache/confusion. Left-sided epileptiform activity (EA) was associated with postictal sleepiness/headache/confusion. There was a difference in postictal manifestation according to epileptic syndrome.The characteristics of the postictal period differed according to the age of onset, the type of seizure, and the epileptic syndrome. Different symptoms in the postictal period were associated with the scores on HADS anxiety, MMSE, and left-sided EA on the electroencephalogram.

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.