Arquivos de neuro-psiquiatria最新文献

{"title":"From science to sleep: the promise of dual orexin receptor antagonists.","authors":"Dalva Poyares, Ronaldo D Piovezan, Sergio Tufik","doi":"10.1055/s-0046-1827822","DOIUrl":"10.1055/s-0046-1827822","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103467","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":"Labyrinthine hemorrhage: practical lessons from a rare cause of acute vestibular syndrome.","authors":"César Minoru Toita Koga, Marcos Christiano Lange, Valéria Cristina Scavasine, Hélio Afonso Ghizoni Teive, Henry Koiti Sato, Caio César Diniz Disserol","doi":"10.1055/s-0046-1818604","DOIUrl":"10.1055/s-0046-1818604","url":null,"abstract":"<p><strong>Abstract: </strong>Labyrinthine hemorrhage (LH) is a rare cause of sudden sensorineural hearing loss (SNHL) and acute vestibular syndrome (AVS), which may mimic both peripheral and central etiologies. We report a case of a 76-year-old male on edoxaban therapy presenting with sudden right-sided SNHL and vertigo. Brain magnetic resonance imaging (MRI) performed 2 weeks later showed T1 and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the right inner ear, consistent with LH. Evaluation of AVS in the emergency setting remains challenging, as LH may present as a rare stroke mimic, often indistinguishable from isolated labyrinthine stroke or labyrinthitis. Proper application and interpretation of vestibular assessment protocols, such as HINTS-plus, are critical in such cases. When bedside vestibular testing suggests central-type findings, but initial neuroimaging is normal, high-resolution brain MRI focused on the inner ear might be essential to rule out LH. Awareness of this rare entity may help prevent misdiagnosis, inappropriate thrombolysis, and delayed recognition, although stroke management should still be prioritized when HINTS-plus suggests a central pattern. This case highlights the diagnostic complexity of AVS and its potential pitfalls in bedside and imaging assessment, raising awareness of LH as a rare but clinically relevant stroke mimic.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-5"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925999","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":"Autoimmune-associated epilepsy: definitions and diagnosis - a narrative review.","authors":"Tomásia Oliveira de Holanda Monteiro Frezatti, Vanessa Daccach Marques, Américo Ceiki Sakamoto","doi":"10.1055/s-0046-1827055","DOIUrl":"10.1055/s-0046-1827055","url":null,"abstract":"<p><strong>Abstract: </strong>Autoimmune-associated epilepsy (AAE) is an increasingly-recognized condition in which seizures result from immune-mediated mechanisms, such as Rasmussen's encephalitis and antibody-associated epilepsies. Its timely identification may enable more efficacious therapy and improve outcomes. The current paper aims to provide a clinically-oriented review of AAE, focusing on clinical identification, use of diagnostic scoring systems, and immunological testing strategies. Antibody-associated epilepsy encompasses a broad spectrum of presentations, from postencephalitic epilepsy to isolated drug-resistant temporal-lobe epilepsy. Neuronal-surface autoantibodies (such as anti-N-methyl-D-aspartate receptor (anti-NMDAR), anti- leucine-rich glioma-inactivated protein 1 (anti-LGI1), anti-CASPR2) and intracellular antibodies (such as anti-GAD65) are variably associated with pathogenesis and chronicity. Clinical scoring systems (such as Antibody Prevalence in Epilepsy and Encephalopathy - APE2, Antibody Contributing to Focal Epilepsy Signs and Symptoms - ACES, ntibody Prevalence in Epilepsy before Surgery - APES, Antibody in Drug-Resistant Temporal Lobe Epilepsy - ARTE and 'Obvious' Indications for Neural Antibody Testing in Epilepsy or Seizures - ONES) are helpful in selecting patients for autoantibody testing. A comprehensive workup includes magnetic resonance imaging (MRI) scans, prolonged electroencephalographic (EEG) monitoring, cerebrospinal fluid (CSF) analysis, and combined serum/CSF antibody panels. Testing methodology and antibody type must be carefully interpreted in the light of clinical context. In low-resource settings, cost-effective testing strategies and clinical-screening tools are crucial to optimize the diagnostic yield. Early clinical suspicion, guided use of diagnostic scores, and appropriate immunological investigation are central to manage AAE. Recognizing AAE as a distinct diagnostic category is essential to improve care and guide immunotherapeutic decisions.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863538","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":"Clinical profile and quality of life in late-onset and very-late-onset myasthenia gravis: a cross-sectional study.","authors":"Alessandra Filpo Ferreira da Silva, Cláudia Suemi Kamoi Kay, Renata Dal-Prá Ducci, Paula Raquel do Vale Pascoal Rodrigues, Otto Jesus Hernandez Fustes, Paulo José Lorenzoni, Rosana Herminia Scola","doi":"10.1055/s-0046-1827053","DOIUrl":"10.1055/s-0046-1827053","url":null,"abstract":"<p><strong>Background: </strong>The incidence of late-onset and very-late-onset myasthenia gravis (MG) has increased worldwide, but national data in Brazil remain scarce. Characterizing the clinical profile and quality of life (QoL) of these patients is essential to improve care strategies.</p><p><strong>Objective: </strong>To describe the clinical profile and assess QoL of patients with late- and very-late-onset MG followed at a Brazilian tertiary hospital, comparing them with early-onset MG patients.</p><p><strong>Methods: </strong>Cross-sectional observational study including adult MG patients followed at a tertiary university hospital. Demographic, clinical, serological, neurophysiological, and radiological data were collected. Disease severity was assessed using the Myasthenia Gravis Composite (MGC) and Quantitative Myasthenia Gravis (QMG) scales. Furthermore, QoL was assessed using the 15-item Myasthenia Gravis QoL questionnaire (MG-QOL15). Correlation analyses were performed between MG-QOL15, MGC, and QMG scores.</p><p><strong>Results: </strong>In total, 28 MG patients were included: 13 early-onset, 7 late-onset, and 8 very-late-onset. Male predominance, shorter disease duration, and absence of thymectomy were more frequent in the late and very-late-onset groups. These subgroups also showed better symptom control and perceived QoL, particularly the very-late-onset group. The MG-QOL15 scores showed a moderate correlation with MGC and a weaker correlation with QMG.</p><p><strong>Conclusion: </strong>Late-onset and very-late-onset MG patients showed satisfactory QoL and clinical profiles, consistent with international data. These correlations reinforce the complementary role of patient-reported outcomes alongside objective clinical scales. Further studies with larger cohorts and longitudinal follow-up are needed.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-6"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757749","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":"Long-term use of dual orexin receptor antagonists for the treatment of insomnia: a systematic review and meta-analysis.","authors":"Luis Miguel Moraes Araujo, Arthur Duarte de Sousa, Camila de Carvalho Vieira, João Pedro Pimentel Abreu, Cristiane Fiquene Conti, Melaine Mont'Alverne Lawall Silva, Marcio Moyses de Oliveira","doi":"10.1055/s-0046-1827049","DOIUrl":"10.1055/s-0046-1827049","url":null,"abstract":"<p><strong>Background: </strong>Insomnia is a prevalent disorder associated with impaired daytime functioning and reduced quality of life. Dual orexin receptor antagonists (DORAs) have shown favorable short-term efficacy and safety profiles. However, evidence regarding their long-term (≥ 6 months) effects remains limited.</p><p><strong>Objective: </strong>To synthesize the available evidence on prolonged DORA use in adults with chronic insomnia.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trial. Adults with primary insomnia treated with DORAs (suvorexant, lemborexant, or daridorexant) approved by the United States Food and Drug Administration (FDA) for ≥ 6 months were included. The outcomes included patient-reported sleep parameters, adverse events, and treatment discontinuation.</p><p><strong>Results: </strong>We included 6 randomized controlled trials comprising 3,546 participants. After 6 and 12 months, DORAs improved subjective sleep parameters of efficacy. Overall, DORAs showed adverse events similar to those of placebo at 6 months, but higher rates at 12 months. The overall rate of discontinuation due to adverse events did not differ significantly, although higher doses of certain DORAs increased the discontinuation rate at 6 months.</p><p><strong>Conclusion: </strong>In chronic insomnia, DORAs provide sustained improvements in key subjective sleep outcomes, with overall acceptable safety and tolerability profiles. Higher doses may be less well tolerated. Additional long-term randomized trials are needed to better define the efficacy and safety of DORAs in clinical practice.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758472","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":"Risk factors for drug-resistant epilepsy according to sex: a cohort study conducted in a middle-income country.","authors":"Ignacio Lagger, Sol Pacha, Eliana Garino, Oscar Martinez, Eduardo Knorre, Glenda Ernst","doi":"10.1055/s-0046-1827051","DOIUrl":"10.1055/s-0046-1827051","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant epilepsy (DRE) affects 30% of patients with epilepsy. Although multiple risk factors (RFs) are recognized, there are few studies that explore the differences in clinical presentation, etiology and RFs considering the sex, especially in Latin America.</p><p><strong>Objective: </strong>To analyze sex differences in clinical features, outcomes and RFs for DRE in patients enrolled in 2 hospitals of Buenos Aires between 2020 and 2022.</p><p><strong>Methods: </strong>Multicenter retrospective cohort study. Clinical variables, epilepsy characteristics, and complementary studies of patients over 18 years with epilepsy were collected. Descriptive analyses, bivariate comparisons (Chi-squared, <i>t</i>-test/Mann-Whitney U test) and logistic regressions were applied to adjust for confounding factors.</p><p><strong>Results: </strong>A total of 122 patients were included, of whom 44 had DRE. The prevalence of DRE was slightly higher in men than in women (39.6 vs. 33.3%). Male sex showed 4 RFs for DRE: personal history (odds ratio [OR]: 7.82; 95%CI: 1.54-39.51), magnetic resonance imaging (MRI) with abnormal findings (OR: 4.40; 95%CI: 1.26-15.41), symptomatic etiology (OR: 4.77; 95%CI: 1.44-15.77), and time of evolution (OR: 1.05; 95%CI: 1.00-1.06). In women, time of evolution was the only RF for DRE (OR: 1.04; 95%CI: 1.00-1.08).</p><p><strong>Conclusion: </strong>There are sex differences in clinical, etiological, and imaging features of DRE. It is important to incorporate a sex perspective into the initial assessment, as this could contribute to the early identification of patients with higher risk of DRE. Particularly in men with clinical factors associated with higher risk, it would be advisable to implement earlier and more intensive follow-up strategies.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757195","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":"Cross-cultural adaptation and initial evaluation of measurement properties of the Brazilian Portuguese version of the Lower Extremity Motor Function Test (LE-MFT).","authors":"Laura Hellen S Cerqueira Gomes, Darlene Barbosa Marques, Lisandra Cristine de Faria, Gitendra Uswatte, Edward Taub, Sarah Dos Anjos, Natalia Duarte Pereira","doi":"10.1055/s-0046-1827052","DOIUrl":"10.1055/s-0046-1827052","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity motor function assessments are essential to evaluate mobility and independence in stroke survivors. However, widely-used instruments do not account for the use of assistive devices, which may limit their sensitivity in detecting functional changes over time.</p><p><strong>Objective: </strong>To translate and cross-culturally adapt the Lower Extremity Motor Function Test (LE-MFT) into Brazilian Portuguese and to evaluate its initial measurement properties.</p><p><strong>Methods: </strong>The present study reports the translation, cross-cultural adaptation, evaluation of internal consistency, interrater reliability, construct validity, and floor/ceiling effects of the LE-MFT Brazil. The LE-MFT was translated and culturally adapted following international guidelines. Fifty stroke survivors were evaluated by two independent raters to examine the interrater reliability. Construct validity was assessed through correlations with the Timed Up and Go (TUG) test and the 10-Meter Walk Test (10MWT). Floor and ceiling effects were also analyzed.</p><p><strong>Results: </strong>All LE-MFT scales showed excellent interrater reliability (intraclass correlation coefficient [ICC] = 0.86-0.96) and internal consistency (Cronbach's Alpha [α] = 0.92-0.96). Strong correlations were found between the LE-MFT and TUG (r ≥ 0.78; <i>p</i> < 0.001), and between the LE-MFT and 10MWT (r ≥ 0.71; <i>p</i> < 0.001), supporting construct validity. No floor nor ceiling effects were observed, except on the Equipment scale, which showed a ceiling effect in 38% of the participants.</p><p><strong>Conclusion: </strong>The Brazilian version of the LE-MFT is a valid and reliable instrument to assess lower-limb motor function in individuals with chronic stroke. Its consideration of assistive-device use provides added clinical value for tracking functional independence.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757625","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":"Acoustic voice analysis of women with migraine.","authors":"Helena Cysneiros, Taciana Maciel, Pedro Souza, Pedro Sampaio Rocha-Filho, Marcelo Moraes Valença, Daniella Araújo de Oliveira","doi":"10.1055/s-0046-1827041","DOIUrl":"10.1055/s-0046-1827041","url":null,"abstract":"<p><strong>Background: </strong>Migraine and voice are related because of the shared pathophysiological mechanisms involving the vagus nerve, which also innervates the larynx.</p><p><strong>Objective: </strong>To conduct acoustic voice analysis and evaluate voice-related quality of life in women with migraine, in comparison with a control group.</p><p><strong>Methods: </strong>In the current cross-sectional study, we performed voice recordings and used the Voice-Related Quality of Life and migraine characteristics questionnaires. The variables included loudness, fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, and phonatory deviation diagram.</p><p><strong>Results: </strong>The sample comprised 193 women (55 in the control group and 138 in the migraine group). No statistically significant differences were observed between the groups regarding the acoustic variables studied. The migraine group reported poorer scores in the physical domain of the Voice-Related Quality of Life questionnaire (<i>p</i> = 0.003) compared to the control group. The Random Forest statistical model predicted group allocation with 76% of precision.</p><p><strong>Conclusion: </strong>In the studied sample, no differences were observed between women with migraine and the control group regarding the parameters of acoustic voice analysis. Women with migraine presented poorer voice-related quality of life compared to the control group.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863528","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":"In memoriam: Mark Hallett, MD (1943-2025).","authors":"Francisco Cardoso, Joseph Jankovic","doi":"10.1055/s-0046-1827044","DOIUrl":"10.1055/s-0046-1827044","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849710","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":"Dark-white matter sign in uncontrolled diabetes: a radiologic marker of critical metabolic injury.","authors":"Rodolfo E Arce, Kevin J Abrams, Leonardo Furtado Freitas","doi":"10.1055/s-0046-1825763","DOIUrl":"10.1055/s-0046-1825763","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 7","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598157","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}