Arquivos de neuro-psiquiatria最新文献

{"title":"Association between the levels of gamma-glutamyl transpeptidase and the risk of stroke: systematic review and meta-analysis.","authors":"Gustavo Adolfo Vásquez-Tirado, Stefany M Nieto-Rivera, Claudia Vanessa Quispe-Castañeda, Edinson Dante Meregildo-Rodríguez, Leslie Jacqueline Liñán-Díaz, Wilson Marcial Guzmán-Aguilar","doi":"10.1055/s-0045-1809936","DOIUrl":"10.1055/s-0045-1809936","url":null,"abstract":"<p><p>Stroke is influenced by numerous factors, both modifiable and non-modifiable. Among these, gamma-glutamyl transpeptidase (GGT) serves as a prognostic biomarker in cardiovascular diseases and, within this context, in neurological conditions like stroke.To determine whether an association exists between GGT and both ischemic and hemorrhagic strokes.A systematic and comprehensive literature search was conducted across 5 databases, encompassing studies published from their inception to January 28, 2024, following a population, exposure, comparator, outcome, and study (PECOS) framework. Ten primary studies meeting the eligibility criteria were selected.Our findings, based on a meta-analysis of the ten studies, indicate an increased risk of ischemic and hemorrhagic strokes in patients with elevated GGT levels, after excluding outliers. The analysis demonstrated a significant association, with a relative risk of 1.42 (95%CI: 1.01-1.99; I² = 19%) for hemorrhagic stroke and 1.22 (95%CI: 1.10-1.36; I² = 49%) for ischemic stroke.Our study reveals an elevated risk of stroke in patients with high GGT levels, demonstrating a 42% higher likelihood of hemorrhagic stroke and a 22% increased risk of ischemic stroke.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The best of both worlds: deep brain stimulation or high-frequency focused ultrasound for tremor refractory syndromes.","authors":"Carina França, Rubens Gisbert Cury","doi":"10.1055/s-0045-1808084","DOIUrl":"10.1055/s-0045-1808084","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-3"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical issues in the management of sleep, anxiety, and mood disorders in primary headaches.","authors":"Patrick Emanuell Mesquita Sousa-Santos, Mario Fernando Prieto Peres","doi":"10.1055/s-0045-1809881","DOIUrl":"10.1055/s-0045-1809881","url":null,"abstract":"<p><p>There are many conditions associated with primary headaches, including mood (depression), anxiety, and sleep disorders, which are highly prevalent in the general population and in tertiary headache centers. We call this set of symptoms migraine, anxiety, mood, and sleep (MAMS). The presence of one or more of these symptoms can alter the clinical course and represent a practical challenge. In the present study, we aimed to describe a practical approach to treat these symptoms frequently associated with headaches. Diagnostic aspects and secondary causes were addressed as well as the shared mechanisms and cause and effect relationship. Finally, we commented on the therapeutic approach used to treat these symptoms.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characterization, natural history, and neuroimaging of cerebellar ataxia after abdominal surgery.","authors":"Victor Rebelo Procaci, Thiago Yoshinaga Tonholo Silva, Raphael Pinheiro Camurugy da Hora, Orlando Graziani Povoas Barsottini, José Luiz Pedroso","doi":"10.1055/s-0045-1809934","DOIUrl":"10.1055/s-0045-1809934","url":null,"abstract":"<p><p>The rates of complications after major abdominal surgeries remain high, despite the advances in pre- and postoperative care and surgical techniques. In these cases, neurological disorders mainly include stroke and delirium, with a high increase of morbidity. Ataxia is rarely a consequence of abdominal procedures like, more often being related to long-term complications of bariatric surgery due to chronic vitamin deficiency.To describe seven cases of ataxia following major abdominal surgeries and propose a prophylactic approach.A retrospective case series in which medical records of patients from the Ataxia Unit of Universidade Federal de São Paulo were evaluated from January 2007 to August 2024. We identified seven patients who developed acute cerebellar ataxia after gastrointestinal surgery. Demographic, clinical, laboratory, neuroimaging, and treatment data were extracted. Descriptive statistics was used to summarize findings.There were two cases that evolved with neurological improvement, and five remained with severe cerebellar ataxia. Brain imaging showed cerebellar atrophy in three patients and signs of Wernicke encephalopathy in two.This case series describes an unusual form of acute ataxia with poor outcomes, possibly related to complications from major abdominal surgery. Early intervention and prophylactic supplementation with vitamins B1 and B12 in patients receiving TPN should be considered to avoid such severe neurological complications.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-6"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"40 years of CEPARM: transforming amyloidosis related to transthyretin from neglect to recognition.","authors":"Marcia Waddington Cruz, Marleide da Mota Gomes","doi":"10.1055/s-0045-1809401","DOIUrl":"10.1055/s-0045-1809401","url":null,"abstract":"<p><p>Variant transthyretin amyloidosis with polyneuropathy (ATTRv-PN) and cardiomyopathy (ATTRv-CM), formerly known as familial <i>amyloidotic polyneuropathy</i> (FAP), is a severe, progressive disorder caused by mutations in the <i>transthyretin</i> (<i>TTR</i>) gene. Historically, FAP was considered a neglected disease due to its rarity and the limited understanding of its pathophysiology, which led to minimal research funding and few therapeutic options. The present article explores the transformative role of Centro de Paramiloidose Antônio Rodrigues de Mello (CEPARM), established in 1984, in elevating the status of FAP through significant advancements in research and treatment. Although CEPARM was not the sole catalyst for this shift, its contributions in liver transplantation, the development of pharmacological therapies, and holistic patient care have substantially improved the recognition and management of FAP. The article also examines CEPARM's impact on patient care, the ongoing challenges, and ethical considerations within the field.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-5"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging in the diagnosis of HTLV-1-associated myelopathy.","authors":"João Marcos Carvalho, Sheila Nunes Ferraz, José Abraão Neto, Saul Schnitman, Augusto M Carvalho, Edgar M Carvalho","doi":"10.1055/s-0045-1809935","DOIUrl":"10.1055/s-0045-1809935","url":null,"abstract":"<p><p>The main neurologic manifestation of definitive human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) is spastic paraparesis, but it only occurs in 5% of the patients. In contrast, about 40% of HTLV-1-infected subjects present symptoms of urologic dysfunction, including nocturia, urgency, and incontinence, which may progress to an inability to void urine. As these patients do not present motor dysfunction, they are classified as <i>probable HAM</i>. Atrophy of the thoracic spinal cord (SC) is the main abnormality found on magnetic resonance image (MRI) scans of patients with definitive HAM, but damage to the SC has not been reported in patients with probable HAM.To determine if, through an evaluation of the metrics of conventional MRI, we can detect a decrease in the area of the SC in patients with probable HAM.Infection by HTLV-1 was herein diagnosed by a Western blot, and the MRI scan was performed using a 1.5-T scanner. Atrophy was considered when the SC area was less than 25% of the intrathecal area.We observed a progressive reduction in all segments of the SC area among HTLV-1 carriers, patients with probable and definitive HAM. Significantly, 48.3% of patients with probable HAM presented atrophy of the lumbar area.Using MRI metrics, the present study shows the atrophy of lumbar segments of the SC area in patients who present urinary symptoms associated with HTLV-1 but without motor dysfunction.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia-related primary care training needs: a qualitative study.","authors":"Tomas Leon, Deiza Troncoso, Soledad Barria, Magda Kaczmarska, Brian Lawlor, Andrea Slachevsky","doi":"10.1055/s-0045-1809544","DOIUrl":"10.1055/s-0045-1809544","url":null,"abstract":"<p><p>Most guidelines recommend that people living with dementia and their care partners should be managed in primary care. However, the knowledge and confidence of these teams in managing dementia is low, and training programs are lacking.To identify the training needs of primary care teams by integrating insights from these professionals, as well as dementia patients and their care partners.Qualitative research methods were applied, using focus group interviews with health professionals and individual interviews with people living with dementia and their care partners. A direct qualitative analysis of 15 recorded interviews (3 focus groups and 12 individuals) was performed using the transcribed data.Primary care professionals recognize the importance of continuous education on dementia and expressed the need for more knowledge about diagnosis, symptom management, and interpersonal and communication skills. Care partners and dementia patients highlighted the need for a better diagnostic disclosure process, improved continuity of care, and availability of greater postdiagnosis support.Our study, novel in Latin America, strongly supported the need for more training in dementia for primary care professionals, as well as for additional content and information not usually included in standard dementia education.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-6"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-intensity focused ultrasound (HIFU) versus deep brain stimulation (DBS) for refractory tremor: team HIFU.","authors":"Karina Silveira Massruhá, Ellison Fernando Cardoso","doi":"10.1055/s-0045-1809660","DOIUrl":"10.1055/s-0045-1809660","url":null,"abstract":"<p><p>High-intensity focused ultrasound (HIFU) has emerged as a minimally invasive and incision-free alternative for managing tremors associated with essential tremor (ET) and Parkinson's disease (PD). Approved by the United States Food and Drug Administration (FDA) for unilateral and staged bilateral thalamotomy, HIFU also addresses cardinal PD symptoms such as rigidity and bradykinesia through pallidotomy. Tremor improvement rates range from 50 to 75% for ET and 60 to 90% for tremor-dominant PD, with long-term efficacy sustained up to 5 years posttreatment, including 73% tremor improvement in a recent controlled multicenter study. Unlike deep brain stimulation (DBS), HIFU eliminates hardware-related complications, such as infections and intracerebral hemorrhage, and minimizes postprocedural maintenance. Adverse events are primarily mild and transient, including temporary paresthesia and imbalance. Real-time magnetic resonance imaging (MRI) guidance enhances targeting precision, enabling patients to resume daily activities within 24 hours. These attributes make HIFU a durable and effective treatment option.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-4"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supera cognitive stimulation study with cognitively-unimpaired older adults: methodology and initial results of a randomized controlled clinical trial.","authors":"Thais Bento Lima da Silva, Tiago Nascimento Ordonez, Gabriela Dos Santos, Laydiane Alves Costa, Ana Paula Bagli Moreira, Diana Dos Santos Bacelar, Maria Antonia Antunes de Souza, Sabrina Aparecida da Silva, Sonia Maria Dozzi Brucki, Monica Sanches Yassuda","doi":"10.1055/s-0045-1809882","DOIUrl":"10.1055/s-0045-1809882","url":null,"abstract":"<p><p>Scientific investigations have highlighted the benefits of cognitive stimulation for cognitive, psychological, and social aspects in older individuals. However, there is a dearth of long-term, methodologically-rigorous studies. The aim of the present study was to describe the methods and the initial characteristics of the participants in a randomized controlled trial on cognitive stimulation. A total of 578 older individuals accepted invitations to participate in the study. Of these respondents, 362 met the eligibility criteria, and 255 were selected and randomized into the training, active control, and passive control groups. During the baseline stage (T0), 48 participants withdrew, resulting in a final T0 sample of 207 participants. The three groups were similar in terms of cognitive performance and sociodemographic and psychosocial variables, but they differed significantly regarding depressive symptoms, with the training group scoring higher. The methods herein described can help guide future research on cognitive stimulation in older adults.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazilian Academy of Neurology recommendations for diagnosis, management, and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).","authors":"Osvaldo J M Nascimento, Wilson Marques, Marcus Vinícius Magno Gonçalves, Pedro José Tomaselli, Camila Pupe, Marcondes Cavalcante França, Francisco de Assis Aquino Gondim, Marcos Raimundo Gomes de Freitas, Rodrigo Siqueira Soares Frezatti, Acary Souza Bulle Oliveira, Francisco Tellechea Rotta, Elza Dias Tosta, Rosana Scola, Vanessa Daccach, Carlo Domenico Marrone, Jefferson Becker, Susanie Rigatto, Alberto R M Martinez, Hideraldo Cabeça, Pablo Brea Winckler, Mario Emilio Dourado, Diogo Fernandes Dos Santos","doi":"10.1055/s-0045-1809884","DOIUrl":"10.1055/s-0045-1809884","url":null,"abstract":"<p><p>Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune disorder that leads to progressive motor and sensory impairment, resulting in significant morbidity. While the incidence rates vary, CIDP remains a challenging condition requiring a standardized and optimized approach to diagnosis and management. In Brazil, a middle-income country with substantial regional disparities in healthcare access, the availability of specialized neuromuscular centers is uneven, creating obstacles to timely and effective treatment. To address these challenges, the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN, in Portuguese) has developed national recommendations for the diagnosis, management, and treatment of CIDP, tailored to the country's healthcare resources. This consensus outlines standardized diagnostic criteria that incorporate electrophysiological and imaging findings, and it emphasizes key differential diagnoses to enhance diagnostic accuracy. The recommendations were developed through expert panel discussions and a non-systematic review of the literature. The recommended treatment strategies include first-line therapies such as corticosteroids, intravenous immunoglobulin (IVIg), and plasmapheresis, with guidance on escalation and titration of immunosuppressive therapy in refractory cases. By emphasizing early intervention to prevent axonal degeneration and disability, these guidelines aim to improve clinical outcomes and support public health policies within the Brazilian National Health System (Sistema Único de Saúde, SUS, in Portuguese), ensuring equitable and effective CIDP management across the country.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-19"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}