Arquivos de neuro-psiquiatria最新文献_第4页

High-intensity focused ultrasound (HIFU) versus deep brain stimulation (DBS) for refractory tremor: team HIFU. 高强度聚焦超声（HIFU）与深部脑刺激（DBS）治疗难治性震颤：HIFU团队。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-07-01 Epub Date: 2025-07-17 DOI: 10.1055/s-0045-1809660

Karina Silveira Massruhá, Ellison Fernando Cardoso

{"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":"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.","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270635/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The costs and benefits of deep brain stimulation in Parkinson's disease: a review and social network analysis. 帕金森病深部脑刺激的成本和收益：综述和社会网络分析。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-07-01 Epub Date: 2025-07-17 DOI: 10.1055/s-0045-1809996

Carlos Zúñiga-Ramírez, Katia Carmina Farías-Moreno, Gabriel Moreno, Enrique Gómez-Figueroa, Hernando Efraín Caicedo-Ortíz, José Damián Carrillo-Ruíz

{"title":"The costs and benefits of deep brain stimulation in Parkinson's disease: a review and social network analysis.","authors":"Carlos Zúñiga-Ramírez, Katia Carmina Farías-Moreno, Gabriel Moreno, Enrique Gómez-Figueroa, Hernando Efraín Caicedo-Ortíz, José Damián Carrillo-Ruíz","doi":"10.1055/s-0045-1809996","DOIUrl":"10.1055/s-0045-1809996","url":null,"abstract":"Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Levodopa has been considered the best treatment option. However, deep brain stimulation (DBS) use has increased over time, mostly when levodopa-related complications arise.To review the current evidence regarding economic evaluations assessing costs and benefits comparing pharmacological versus surgical treatment among subjects with PD.We searched three databases (PubMed, Embase, and Google Scholar) for studies comparing levodopa treatment and DBS among subjects with PD in terms of costs and benefits from therapy.Out of the 107 studies identified, 14 met the inclusion criteria. Most of the published studies were from Europe. Incremental cost-effectiveness ratios have shown variable results, from -€979 to €6,729 per change of 1 point in the score on part III of the Unified Parkinson's Disease Rating Scale (UPDRS III), while incremental cost-utility ratios depict values as low as €6,700 and as high as $704,906.03 per quality-adjusted life-years (QALY).We observed a higher cost during the 1st year of DBS implantation due to the surgical procedure itself, subsequently, there was a trend for a lower cost over the following years, with no loss of benefit. Overall, the studies showed DBS as a cost-effective measure at 5-years after implantation.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 7","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658247","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}

引用次数: 0

The role of air pollution in epilepsy: a better understanding is needed. 空气污染在癫痫中的作用：需要更好地了解。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-07-02 DOI: 10.1055/s-0045-1809663

Prem Jareonsettasin, John S Ji, Xiaowen Zhou, Ding Ding, Josemir W Sander

引用次数: 0

Prognostic factors in ALS: different approaches to the same problem. 肌萎缩侧索硬化症的预后因素：同一问题的不同方法。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-20 DOI: 10.1055/s-0045-1809407

Maria Cristina Vázquez, Abayubá Perna, Mariana Legnani, Gustavo Saona

{"title":"Prognostic factors in ALS: different approaches to the same problem.","authors":"Maria Cristina Vázquez, Abayubá Perna, Mariana Legnani, Gustavo Saona","doi":"10.1055/s-0045-1809407","DOIUrl":"10.1055/s-0045-1809407","url":null,"abstract":"The natural history of amyotrophic lateral sclerosis (ALS), the prognoses, and the survival times are fields of considerable interest that are scarcely studied in South American countries.To describe the survival of a representative cohort of Uruguayan ALS patients, and to identify covariates associated with survival using different analyses.Survival was assessed using the Kaplan-Meier method. Different Cox proportional hazards functions were used to identify independent prognostic predictors since the diagnosis: classic, stratified, and truncated.We included 166 definite and probable ALS patients. The median follow-up was of 13.6 years. An analysis was performed according to the recruitment groups: prevalent, exhaustive incident, and non-exhaustive incident cases. The median survival since the diagnosis was longer in the prevalent group (33 months) than in the exhaustive incident (22 months) and non-exhaustive incident (14 months) groups. The median survival time of the entire cohort from onset to death was 37 months and 23 months from the diagnosis. Factors related to survival from diagnosis to death were: age at onset, bulbar region onset, clinical form, and progression rate.The present study described the role of clinical and demographic factors in ALS survival in the Uruguayan population and shed light on differences involving survival models and the temporal bias produced by the lack of precision in determining the onset of the disease.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 6","pages":"1-7"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336289","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}

引用次数: 0

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a narrative review. 动脉瘤性蛛网膜下腔出血后迟发性脑缺血：叙述性回顾。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-25 DOI: 10.1055/s-0045-1809885

Ingrid Pereira Marques, Carolina Rouanet Cavalcanti de Albuquerque, Natalia Vasconcellos de Oliveira Souza, João Brainer Clares de Andrade, Gisele Sampaio Silva, Pedro Kurtz

{"title":"Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a narrative review.","authors":"Ingrid Pereira Marques, Carolina Rouanet Cavalcanti de Albuquerque, Natalia Vasconcellos de Oliveira Souza, João Brainer Clares de Andrade, Gisele Sampaio Silva, Pedro Kurtz","doi":"10.1055/s-0045-1809885","DOIUrl":"10.1055/s-0045-1809885","url":null,"abstract":"Aneurismal subarachnoid hemorrhage (aSAH) is a condition with elevated mortality and morbidity, which usually affects a working-age population, leading to a high socioeconomic burden. Among those who survive the initial bleeding, approximately 30% will experience delayed cerebral ischemia (DCI), which is a significant factor in poor outcomes. However, it is potentially reversible if appropriate treatment is promptly initiated. The amount of blood present on the initial computed tomography (CT) scan, assessed through the modified Fisher scale (mFisher), and the patient's neurological status upon admission, are the strongest predictors of DCI. Early prevention is essential and typically involves administration of enteral nimodipine and the maintenance of euvolemia, while other treatment options have limited supporting evidence. Diagnosing remains a challenge, primarily due to its reliance on clinical examinations. This is more pronounced in high-grade aSAH patients who are unconscious or sedated. In such cases, additional methods may be necessary, such as transcranial Doppler (TCD), continuous electroencephalography (cEEG), or CT with perfusion (CTP). Treatment aims to prevent cerebral infarction and poor clinical outcomes, and it is based on hemodynamic optimization, hypertension induction, cardiac output augmentation, and endovascular therapy. Nevertheless, randomized data on DCI management remains scarce, highlighting the urgent need for more studies and a better understanding of this SAH complication. Addressing this gap may lead to more effective preventive strategies and treatments, which is crucial for improving the prognosis of these patients.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 6","pages":"1-14"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12196565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493834","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}

引用次数: 0

The influence of hospital type (public versus private) on mortality and survival after stroke. 医院类型（公立与私立）对中风后死亡率和生存率的影响。

IF 1 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-20 DOI: 10.1055/s-0045-1809418

Carla Heloisa Cabral Moro, Maria Izabel Rodrigues Mendes, Milena Veiga Wiggers, Thaís de Faria Cardoso, Henrique Diegoli, Luciano Henrique Pinto, Helbert do Nascimento Lima

{"title":"The influence of hospital type (public versus private) on mortality and survival after stroke.","authors":"Carla Heloisa Cabral Moro, Maria Izabel Rodrigues Mendes, Milena Veiga Wiggers, Thaís de Faria Cardoso, Henrique Diegoli, Luciano Henrique Pinto, Helbert do Nascimento Lima","doi":"10.1055/s-0045-1809418","DOIUrl":"10.1055/s-0045-1809418","url":null,"abstract":"Stroke has been a leading cause of death in Brazil throughout the past three decades. Although several cities in the country have implemented urgent/emergency stroke care units, the impact of the hospital type (public versus private) has not been evaluated.To compare the mortality and survival of patients admitted with stroke to two private hospitals without stroke units with a public hospital with a stroke unit.We conducted a historical cohort in the city of Joinville, Southern Brazil. Stroke patients admitted to a public hospital with a stroke unit were compared with those admitted to private hospitals without stroke units in terms of fatality rate and 30-day survival between January 2018 and December 2020. The Cox regression was used.Of the 4,508 patients, 85.6% were from public hospital, and 14.4%, from the 2 private hospitals. The crude mortality rate was of 11.4% among the public hospital patients, and of 9.1% among the patients from the private hospitals (p = 0.085). In the multivariate analysis, there was no difference in mortality between patients treated in the public hospital with a stroke unit (hazard ratio = 1.21; 95%CI: 0.87-1.68; p = 0.262) and those admitted to the 2 private hospitals without a stroke unit.Stroke units are an important public policy that minimizes the impact of stroke.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 6","pages":"1-9"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336290","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}

引用次数: 0

Charcot revived. 夏科恢复。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-11 DOI: 10.1055/s-0045-1804489

Hélio A G Teive

引用次数: 0

The impact of changing diagnostic criteria on disability in a Brazilian multiple sclerosis cohort. 巴西多发性硬化症队列中改变诊断标准对残疾的影响。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-25 DOI: 10.1055/s-0045-1809662

Felipe Toscano Lins de Menezes, Jéssica Monique Dias Alencar, Alexandre Bussinger Lopes, Leizian de Souza Amorim, Raquel Paiva Portugal, Flávia Timbó Albuquerque, Natasha Pryanca de Araújo Bessa, Larissa Sabino Ferreira Vicente, Nilton Amorim de Souza, Denis Bernardi Bichuetti, Enedina Maria Lobato de Oliveira

{"title":"The impact of changing diagnostic criteria on disability in a Brazilian multiple sclerosis cohort.","authors":"Felipe Toscano Lins de Menezes, Jéssica Monique Dias Alencar, Alexandre Bussinger Lopes, Leizian de Souza Amorim, Raquel Paiva Portugal, Flávia Timbó Albuquerque, Natasha Pryanca de Araújo Bessa, Larissa Sabino Ferreira Vicente, Nilton Amorim de Souza, Denis Bernardi Bichuetti, Enedina Maria Lobato de Oliveira","doi":"10.1055/s-0045-1809662","DOIUrl":"10.1055/s-0045-1809662","url":null,"abstract":"Updating multiple sclerosis (MS) diagnostic criteria over recent decades may have impacted disability progression.To assess the effects of the passage of time and changes in diagnostic criteria on disability.A retrospective study of Brazilian people with relapsing-remitting MS from 1994 to 2019. Descriptive analysis compared three periods based on admission: Epoch 1 (1994-2001), 2 (2002-2010), and 3 (2011-2019). Cox regressions were performed for the outcomes of the expanded disability status scale (EDSS) 6.0 and conversion to secondary progressive MS (SPMS). We compared the three Epochs in sequence, the Poser with all McDonald criteria combined, and Poser versus each McDonald criteria (2001, 2005, 2010, and 2017). A multivariate logistic regression assessed the impact of diagnostic criteria on patients reaching EDSS 6.0.Time to diagnosis and treatment decreased across Epochs. For reaching EDSS 6.0, the Cox regression indicated a hazard ratio (HR) 63% lower for Epoch 3 compared with 1, an HR 50% lower for the McDonald criteria combined, and an HR 65% lower for McDonald 2010 compared with Poser. Regarding the conversion to SPMS, the HR was 53% lower for Epoch 3, 48% lower for the McDonald criteria combined, and 64% lower for McDonald 2010. The multivariate logistic regression demonstrated that incomplete recovery of initial symptoms was the main prognostic factor for reaching EDSS 6.0. However, transitioning diagnostic criteria from Poser to McDonald 2001 and 2005 decreased these odds by 54%.Newer diagnostic criteria have reduced the likelihood of reaching EDSS 6.0 and converting to SPMS over the past 25 years.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 6","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12196560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493835","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}

引用次数: 0

Application value of the FOCUS-PDCA cycle in nursing care for dysphagia in patients with cerebral infarction: a meta-analysis. FOCUS-PDCA循环在脑梗死患者吞咽困难护理中的应用价值：meta分析。

IF 1 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-17 DOI: 10.1055/s-0045-1809417

Xiaojing Lu, Jiandong Zhang, Ranran Wang, Xiujuan Liu

{"title":"Application value of the FOCUS-PDCA cycle in nursing care for dysphagia in patients with cerebral infarction: a meta-analysis.","authors":"Xiaojing Lu, Jiandong Zhang, Ranran Wang, Xiujuan Liu","doi":"10.1055/s-0045-1809417","DOIUrl":"https://doi.org/10.1055/s-0045-1809417","url":null,"abstract":"In recent years, there has been growing interest in applying quality improvement methodologies to healthcare processes. One such approach is the Find, Organize, Clarify, Understand, Select-Plan, Do, Check, and Act (FOCUS-PDCA) cycle.To evaluate the effectiveness of the FOCUS-PDCA cycle in the management of dysphagia in patients with cerebral infarction.We conducted a comprehensive literature search on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang databases for articles published up to October 31st, 2024, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized controlled trials and high-quality retrospective studies comparing the FOCUS-PDCA cycle with conventional care were included. The primary outcomes were swallowing function, quality of life, neurological and limb functions, and complication rates. Data were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic.We included 6 studies involving 638 patients. The FOCUS-PDCA group showed significant improvements in swallowing function (standardized mean difference [SMD] = 1.65; 95%CI: 0.08-3.21), quality of life (SMD = 2.16; 95%CI: 0.54-3.79), and neurological and limb functions (SMD = 1.03; 95%CI: 0.07-2.00) compared with the conventional care group. The FOCUS-PDCA approach significantly reduced complication rates (risk ratio = 0.48; 95%CI: 0.32-0.68).The FOCUS-PDCA cycle appears to be an effective strategy to improve outcomes in patients with cerebral infarction and dysphagia. However, more high-quality studies are needed to confirm these findings and guide clinical practice.","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"83 6","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315845","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}

引用次数: 0

A moral history of seizures: reported causes of seizures in the nineteenth century. 癫痫发作的道德史：19世纪癫痫发作的报告原因。

IF 1.6 4区医学

Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 DOI: 10.1055/s-0045-1806829

Márcio Pinheiro Lima, Elza Márcia Targas Yacubian

引用次数: 0