Arquivos de neuro-psiquiatria最新文献

{"title":"Jitter and muscle fiber conduction velocity in long COVID fatigue.","authors":"João Aris Kouyoumdjian, Leticia Akemi Rama Yamamoto, Carla Renata Graca","doi":"10.1055/s-0045-1802961","DOIUrl":"https://doi.org/10.1055/s-0045-1802961","url":null,"abstract":"<p><strong>Background: </strong> Long coronavirus disease (long COVID, LC) is defined as the continuation or development of new symptoms 3 months after the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In LC, the rate of fatigue/postexertional malaise (F-PEM) has been described to be as high as 70%, regardless of age or severity of the acute symptoms.</p><p><strong>Objective: </strong> To evaluate the neuromuscular junction (NMJ) function and the isolated muscle fiber conduction velocity (MFCV) in situ in LC cases and controls.</p><p><strong>Methods: </strong> We studied 37 subjects without SARS-CoV-2 (controls) and 32 cases of SARS-CoV-2 infection, half with LC symptoms (LC-yes) and half without them (LC-no). Single-fiber electromyography (jitter measured with a concentric electrode), MFCV, the fast-to-slow MFCV ratio (F/S ratio), and the motor unit potentials (MUPs) were taken in the tibialis anterior muscle.</p><p><strong>Results: </strong> At least 1 jitter parameter was abnormal in 1/37 controls, in 1/16 LC-no patients, and in 2/16 LC-yes patients, without significant differences among them. None of the subjects with abnormal jitter presented fluctuation symptoms or positive acetylcholine-receptor antibody. The MFCV and F/S ratios did not show abnormalities in any of the participants. The MUPs did not show myopathic or neurogenic abnormality in needle electromyography. The most frequent symptom in LC was F-PEM, which occurred in all LC-yes patients and was significantly different from the other groups.</p><p><strong>Conclusion: </strong> Fatigue/postexertional malaise was found in all cases of LC, and the electrophysiological findings did not indicate the muscle fiber or the NMJ as a relevant factor in this condition.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490485","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":"Diagnosing preclinical and clinical Alzheimer's disease with visual atrophy scales in the clinical practice.","authors":"Karen Luiza Ramos Socher, Douglas Mendes Nunes, Deborah Cristina P Lopes, Artur Martins Novaes Coutinho, Daniele de Paula Faria, Paula Squarzoni, Geraldo Busatto Filho, Carlos Alberto Buchpiguel, Ricardo Nitrini, Sonia Maria Dozzi Brucki","doi":"10.1055/s-0045-1802960","DOIUrl":"https://doi.org/10.1055/s-0045-1802960","url":null,"abstract":"<p><strong>Background: </strong> Visual atrophy scales from the medial temporal region are auxiliary biomarkers of neurodegeneration in Alzheimer's disease (AD). Therefore, they may correlate with progression from cognitively unimpaired (CU) status to mild cognitive impairment (MCI) and AD, and they become a valuable tool for diagnostic accuracy.</p><p><strong>Objective: </strong> To compare the medial temporal lobe atrophy (MTA) and entorhinal cortex atrophy (ERICA) scores measured through magnetic resonance image (MRI) scans as a useful method for probable AD diagnosis regarding clinical diagnosis and amyloid positron-emission tomography (PET).</p><p><strong>Methods: </strong> Two neurologists blinded to the diagnoses classified 113 older adults (age > 65 years) through the MTA and ERICA scores. We investigated the correlations involving these scores and sociodemographic data, amyloid brain cortical burden measured through PET imaging with (11)C-labeled Pittsburgh Compound-B (11C-PIB PET), and clinical cognitive status, in individuals diagnosed as CU (CU; <i>N</i> = 30), presenting mild cognitive impairment (MCI, <i>N</i> = 52), and AD patients (<i>N</i> = 31).</p><p><strong>Results: </strong> The inter-rater reliability of the atrophy scales was excellent (0.8-1) according to the Cohen analysis. The CU group presented lower MTA scores (median value: 0) than ERICA (median value: 1) scores in both hemispheres. The 11C-PIB-PET was positive in 45% of the sample. In the MCI and AD groups, the ERICA score presented greater sensitivity, and the MTA score presented greater specificity. The accuracy of the clinical diagnosis was sufficient and no more than 70% for both scores in AD.</p><p><strong>Conclusion: </strong> In the present study, we found moderate sensitivity for the ERICA score, which could be a better screening tool than the MTA score for the diagnosis of AD or MCI. However, none of the scores were useful imaging biomarkers in preclinical AD.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530998","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":"Erratum.","authors":"","doi":"10.1055/s-0045-1802550","DOIUrl":"https://doi.org/10.1055/s-0045-1802550","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389899","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":"Guidelines for Parkinson's disease management part II: consensus from the movement disorders scientific department of the Brazilian Academy of Neurology - non-motor symptoms.","authors":"Débora Palma Maia, Rubens Gisbert Cury, Pedro Renato P Brandão, Francisco E C Cardoso, Ana Paula Bertholo, André Carvalho Felicio, Arlete Hilbig, Bruno Lopes Santos Lobato, Eline Rozária F Barbosa, Elizabeth Maria A B Quagliato, Gustavo H C Sousa, Jacy Bezerra Parmera, Márcia Rúbia, Marcus Vinícius Della Coletta, Maria Sheila Guimarães Rocha, Mariana Spitz, Mônica Haddad, Nina Rosa A F Murta, Paulo Caramelli, Raimundo N D Rodrigues, Ricardo Nitrini, Roberto Prado, Vitor Tumas, Ylmar Corrêa Neto, Roberta Arb Saba","doi":"10.1055/s-0045-1802962","DOIUrl":"https://doi.org/10.1055/s-0045-1802962","url":null,"abstract":"<p><p>The treatment of Parkinson's disease (PD) is a challenge, especially because it is considered highly individualized. The Brazilian Academy of Neurology (ABN) has identified the need to disseminate knowledge about its management, adapting the best evidence to the Brazilian population. The present article aims to report the recommendations for the treatment of non-motor symptoms of PD, developed by a group of specialists in movement disorders from the ABN's scientific department. In 2021, the first part, referring to the motor symptoms of PD, was published. The main non-motor symptoms were addressed-among them neuropsychiatric symptoms, such as depression, anxiety, cognitive alteration, and psychosis-as well as the possible recommended therapies and medications used to control pain, sleep disorders, and dysautonomia.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490482","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":"Real-world tafamidis experience in hereditary transthyretin amyloidosis with peripheral neuropathy in Brazil.","authors":"Luiz Felipe Pinto, Marcus V Pinto, Paula Accioli, Gabriela Amorim, Renata Gervais de Santa Rosa, Moises Dias, Mariana Guedes, Carlos P Gomez, Roberto C Pedrosa, Marcia Waddington-Cruz","doi":"10.1055/s-0044-1793936","DOIUrl":"10.1055/s-0044-1793936","url":null,"abstract":"<p><strong>Background: </strong> Tafamidis is a kinetic stabilizer that binds to the transthyretin (TTR) gene, inhibiting its dissociation. It is the only disease-modifying treatment for hereditary TTR amyloidosis with peripheral neuropathy (ATTRv-PN) available in the National Therapeutic Form (Formulário Terapêutico Nacional, FTN, in Portuguese) of the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese).</p><p><strong>Objective: </strong> To assess if the efficacy and safety of tafamidis in the Brazilian real-world experience are comparable to the results of clinical trials.</p><p><strong>Methods: </strong> We retrospectively studied all patients with ATTRv-PN evaluated at our center from September 2011 to March 2022 (data cut-off) who were initiated on tafamidis and had at least 1 follow up visit 6 months after the initiation of the drug treatment. Neurologic and functional outcomes were compared from day 1 (D1) of the tafamidis treatment (baseline) to the last follow-up.</p><p><strong>Results: </strong> In total, 33 patients were included, 18 (55%) of whom were female. All patients were carriers of the V30M mutation of ATTRv-PN, and 20 (61%) presented early onset (EO) ATTRv-PN. At baseline, the median age of the sample was of 40 (interquartile range [IQR]: 36-68) years, the median Neuropathy Impairment Score (NIS) was of 10 (6-24) points, and the median body mass index (BMI) was of 26 (23-28) kg/m². The mean follow-up time was of 3.4 years. At the last follow-up, the BMI, the neurological impairment, and the level of disability slightly worsened compared with baseline, while the findings of the nerve conduction studies remained stable. These same results were observed across EO and late-onset (LO) ATTRv-PN patients. A total of 25 (75.8%) patients were considered responders, and 8 (24.2%), non-responders.</p><p><strong>Conclusion: </strong> The efficacy and safety of tafamidis reported in clinical trials is expandable to the Brazilian real-world scenario in EO and late-onset (LO) ATTRv-PN.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arquivos de Neuro-Psiquiatria: 82 years old, a new phase begins now.","authors":"Hélio Afonso Ghizoni Teive, Ayrton Roberto Massaro, Carlos Henrique Ferreira Camargo, Clécio de Oliveira Godeiro","doi":"10.1055/s-0045-1804506","DOIUrl":"https://doi.org/10.1055/s-0045-1804506","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490544","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":"Treatment of convulsive status epilepticus in Brazil: a review.","authors":"Luis Otavio Caboclo","doi":"10.1055/s-0045-1801872","DOIUrl":"https://doi.org/10.1055/s-0045-1801872","url":null,"abstract":"<p><p>Status epilepticus (SE) is the most severe presentation of epilepsy. Currently, SE is defined according to 2 sequential time frames: time 1, after which it is unlikely that the seizure will resolve spontaneously, therefore requiring the initiation of therapy; and time 2, when long-term consequences become more likely. For convulsive SE, these time frames are well defined: 5 minutes for time 1 and 30 minutes for time 2. \"Time is brain\" in the treatment of SE, as delays in diagnosis and treatment are associated with worse outcomes. After clinical stabilization, the first step is the administration of intravenous (IV) benzodiazepines. Rapid initiation of treatment and use of appropriate dosing are more important than the selection of a specific benzodiazepine. Following this, treatment continues with the use of an IV antiseizure medication (ASM). In Brazil, the recommended options available are phenytoin and levetiracetam. Status epilepticus is considered refractory to treatment if seizures persist after the administration of benzodiazepines and IV ASM. The cornerstone of this stage is the induction of therapeutic coma using IV anesthetic drugs (IVADs), although evidence is limited regarding the choice among midazolam, propofol, or barbiturates. Super-refractory SE is defined when seizures persist despite continuous infusion of IVADs or recur after these drugs are tapered. There is very limited data regarding the treatment of super-refractory SE. In the absence of randomized controlled trials, treatment should be guided by the physician's experience, clinical judgment, and established therapeutic options from previous reports.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397934","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":"When flames hit the brain, and the spark is far away: the role of PET-CT in diagnosing neurological Erdheim-Chester disease.","authors":"Caio César Diniz Disserol, Guilherme Fleury Perini, Flávia Fernandes Silva Zacchi, Lívia Almeida Dutra","doi":"10.1055/s-0045-1802959","DOIUrl":"https://doi.org/10.1055/s-0045-1802959","url":null,"abstract":"<p><p>Erdheim-Chester disease (ECD) is a rare histiocytic disorder that poses diagnostic and therapeutic challenges. Neurological manifestations are characterized by involvement of the meninges, brainstem, and/or cerebellum, and the differential diagnoses include sarcoidosis, IgG4 related disorders, autoimmune encephalitis, and high-risk syndromes. While present in a significant proportion of cases, neurological involvement is a predictor of mortality and may be the sole manifestation of the disease. In this paper, we discuss recent updates in histiocytic disorders and complementary diagnostic approaches, including positron-emission tomography-computed tomography (PET-CT), as guidance for biopsy in patients with neurological symptoms. Additionally, we explore how clinicians can interpret biopsy findings in conjunction with immunohistochemistry to guide targeted therapies, such as vemurafenib, for <i>BRAF</i> V600E mutation.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531005","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":"Dosage of botulinum toxin in patients undergoing treatment for hemifacial spasm: is there modification during follow-up?","authors":"Fátima de Menezes Dantas, Felipe Olobardi Freire, Agábio Diógenes Pessoa Neto, Clécio de Oliveira Godeiro Júnior, Rodrigo Alencar E Silva","doi":"10.1055/s-0044-1793935","DOIUrl":"10.1055/s-0044-1793935","url":null,"abstract":"<p><strong>Background: </strong> The movement disorder known as hemifacial spasm is characterized by involuntary contractions of the muscles that are innervated by the facial nerve. The treatment of choice for this condition is botulinum toxin injections.</p><p><strong>Objective: </strong> To analyze the botulinum toxin dosage in patients undergoing treatment for hemifacial spasm during a 14-year period.</p><p><strong>Methods: </strong> A retrospective study of medical records from patients treated at the Neurology Service of Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, from 2010 to 2024, was performed.</p><p><strong>Results: </strong> A total of 151 patients met the inclusion criteria. The dose of botulinum toxin revealed a statistically significant increase during the first 3.46 years of follow-up. In the long-term, a trend toward dose stabilization was identified. The median latency for the onset of effect was 4 days, while the median duration of effect was 3 months. All side effects were temporary, with the most common being hemifacial weakness (17.9%) and palpebral ptosis (3.3%). Most patients presented primary hemifacial spasm (88.1%), with a neurovascular conflict identified in 24.1% of cases.</p><p><strong>Conclusion: </strong> The increase in botulinum toxin dosage during the first years may be explained by dosage adjustment to control hemifacial spasm with the lowest possible doses. A prolonged interval between applications may also be associated with this increase. Dose stabilization tends to be achieved over time, indicating disease control.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated intravenous thrombolysis in early recurrent stroke due to free-floating thrombus.","authors":"Luis Eduardo Borges de Macedo Zubko, Felipe Trevisan Matos Novak, Marcos C Lange","doi":"10.1055/s-0044-1792090","DOIUrl":"10.1055/s-0044-1792090","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 1","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}