Arquivos de neuro-psiquiatria最新文献

{"title":"Magnetic resonance imaging in leukodystrophies: characteristic patterns and diagnostic relevance.","authors":"Matheus de Lima Ruffini, Danilo de Assis Pereira, Rafael Saliba Helmer, Adolfo Moraes de Souza, Bernardo Savaya Lima, Gabrielle Baccarin, Gustavo Kazuo Yamada, Luiz Fernando Monte Borella, Renan Denadai Turci, Juliana Ávila Duarte, Fabiano Reis","doi":"10.1055/s-0046-1824758","DOIUrl":"10.1055/s-0046-1824758","url":null,"abstract":"<p><strong>Background: </strong>Leukodystrophies are inherited disorders that primarily affect the central nervous system white matter and often present with nonspecific symptoms, making early diagnosis difficult. Magnetic resonance imaging (MRI) is the key initial imaging test because it reveals characteristic myelin patterns that can guide biochemical and genetic workups.</p><p><strong>Objective: </strong>To review clinically useful MRI and MR spectroscopy (MRS) patterns in major leukodystrophies and emphasize their diagnostic relevance using a practical, pattern-recognition approach.</p><p><strong>Methods: </strong>Narrative review of the literature integrating conventional MRI, including T1/T2 fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI), as well as advanced techniques (MRS), with a pictorial, case-based approach.</p><p><strong>Results: </strong>The pivotal imaging distinction is between hypomyelination-diffuse, persistent T2/FLAIR hyperintensity with relative temporal stability and absent enhancement-and demyelination, characterized by confluent, progressive lesions with disorder-specific topographic predilection. Recognizable signatures include U-fiber sparing and a tigroid pattern in metachromatic leukodystrophy (MLD); parieto-occipital predominance with trizonal enhancement and restricted diffusion in X-linked adrenoleukodystrophy (X-ALD); frontal predominance and the \"tadpole sign\" in Alexander's disease; optic pathway and thalamic involvement in Krabbe's disease; markedly elevated N-acetylaspartate (NAA) on MRS in Canavan's disease; and tract-selective leukoencephalopathy brainstem/spinal cord involvement with a lactate peak (LBSL). These imaging clues refine differential diagnosis, guide targeted genetic testing, and support longitudinal monitoring.</p><p><strong>Conclusion: </strong>The use of MRI-especially when complemented by DWI and MRS-remains central for early recognition and classification of leukodystrophies. A structured, pattern-based approach integrating clinical context with imaging topography can reduce diagnostic delay and support timely management.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-14"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468599","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":"Sleep quality is influenced by multiple factors and cannot be reduced to the volume of pineal gland calcification.","authors":"Carla A Scorza, Fulvio A Scorza, Josef Finsterer","doi":"10.1055/s-0046-1820103","DOIUrl":"10.1055/s-0046-1820103","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13301290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326058","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":"Prevalence and predictors of low bone mineral density in Myasthenia gravis.","authors":"Renata Dal-Prá Ducci, Lucas Ferreira Santana, Claudia Kamoi Kay, Raphael Henrique Déa Cirino, Paulo José Lorenzoni, Otto Jesus Hernandez Fustes, Paula Raquel Do Vale Pascoal Rodrigues, Carolina Aguiar Moreira, Rosana Hermínia Scola","doi":"10.1055/s-0046-1824431","DOIUrl":"10.1055/s-0046-1824431","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Treatment often includes corticosteroids, which may reduce bone mass.</p><p><strong>Objective: </strong>To evaluate the prevalence and predictors of low bone mineral density (BMD) in MG patients.</p><p><strong>Methods: </strong>A cross-sectional study included patients over 18 years with MG followed at the Neuromuscular Diseases Service, Hospital de Clínicas, Universidade Federal do Paraná (2018-2022). Data were obtained through clinical evaluation, medical records, MG Composite Scale, and Quantitative MG Test. Lumbar spine and proximal femur BMD were assessed using a GE Lunar densitometer, with T or Z-scores according to age/menopausal status. Logistic regression identified factors independently associated with BMD alterations.</p><p><strong>Results: </strong>In total, 92 patients (64.1% female, mean age: 51.3 years) were included, of whom 79.3% had early-onset MG. Past or present corticosteroid use were reported in 94.5 and 45.6%, respectively. Only 27.6% practiced regular physical activity, though most had adequate calcium intake. There were six (7.8%) patients with fragility fractures, and ⅕ were at high fracture risk according to the FRAX results. We found that BMD alterations occurred in 43.5% of patients. No significant association was found with corticosteroid use or MG severity. Age was independently associated with BMD (OR = 1.06, 95% CI: 1.03-1.09, <i>p</i> = 0.0005). A cutoff age ≥ 49 years yielded 82.5% sensitivity, 63.5% specificity, and an area under the ROC curve of 0.72 (95% CI: 0.61-0.83).</p><p><strong>Conclusion: </strong>Reduced BMD is frequent in MG, highlighting the importance of screening and prevention of low bone mass, osteoporosis, and fragility fractures, particularly in patients over 49 years, regardless of corticosteroid use or MG severity.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381436","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":"Reply to the Letter to the Editor on: impact of screen use on behavior and sleep in patients with autism spectrum disorder.","authors":"Matheus Eugênio de Sousa Lima, Lívia Maria Eugênio Lopes, Fernanda Eugênio de Sousa Lima","doi":"10.1055/s-0046-1823654","DOIUrl":"10.1055/s-0046-1823654","url":null,"abstract":"","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306751","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":"Self-compassion in migraine: associations with depression, anxiety, and clinical characteristics.","authors":"Ruken Simsekoglu, Zarife Tugce Yıldız, Nilay Garipbas","doi":"10.1055/s-0046-1820105","DOIUrl":"10.1055/s-0046-1820105","url":null,"abstract":"<p><strong>Background: </strong>Self-compassion (SC), defined as a positive and accepting attitude towards oneself during times of suffering or failure, is receiving more attention in the context of chronic pain disorders. However, very little is known regarding the link between SC, psychological symptoms, and migraine features.</p><p><strong>Objective: </strong>To compare the SC levels of migraine patients to those of healthy controls and investigate the relationships among SC, anxiety, depression, and migraine features.</p><p><strong>Methods: </strong>This cross-sectional study comprised 90 healthy controls (age: 35 ± 9.8 years, 75 female patients) and 98 migraine sufferers (age: 36.7 ± 11.3 years, 84 female patients). The Beck depression inventory, Beck anxiety inventory, and self-compassion scale were completed by the participants.</p><p><strong>Results: </strong>The SC levels were considerably lower in migraine patients. Patients with chronic migraine performed worse than those with episodic migraines on the self-kindness, common humanity, and mindfulness subscales. Patients with medication overuse also had reduced SC. Higher isolation scores were linked to aura presence.</p><p><strong>Conclusion: </strong>We found impaired SC in individuals with migraine, and a connection with greater emotional distress and migraine characteristics. These results demonstrate the possible value of emphasizing SC in migraine therapies, especially for those who suffer from chronic migraine, aura, or medication overuse.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760796","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":"Trends in the age-standardized prevalence of neurodevelopmental disorders in South America, 1990-2023.","authors":"Mauricio Lopez-Espejo","doi":"10.1055/s-0046-1820532","DOIUrl":"10.1055/s-0046-1820532","url":null,"abstract":"<p><strong>Background: </strong>Neurodevelopmental disorders (NDDs) are substantial burdens for individuals and health systems; yet, their long-term epidemiology in South America is poorly characterized.</p><p><strong>Objective: </strong>To describe the trends from 1990 to 2023 in the age-standardized prevalence rates (ASPRs) of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and idiopathic developmental intellectual disability (IDID) across 12 South American countries using Global Burden of Disease (GBD) 2023 estimates.</p><p><strong>Methods: </strong>Country-specific annual ASPRs and 95% uncertainty intervals (95%UIs) were obtained from the GBD 2023. Sex-stratified ASPRs were used to calculate male-to-female ratios (MFRs) and summarize long-term sex disparities. Temporal trends were assessed using the average annual percent change (AAPC) from log-linear regression for each country.</p><p><strong>Results: </strong>In 2023, the ASPRs ranged from 0.57 to 1.06% for ASD, from 1.00 to 2.55% for ADHD, and from 0.42 to 0.54% for IDID across countries. Between 1990 and 2023, the ASD ASPRs increased in all countries, with AAPCs from +0.35%/year (Paraguay) to +0.79%/year (Chile). The ADHD ASPRs showed little net change, with AAPCs from -0.10%/year (Argentina) to +0.39%/year (Brazil). And the IDID ASPRs declined consistently, with AAPCs from -0.79%/year (Bolivia) to -0.30%/year (Suriname). Sex differences in ASPRs were large and persistent for ASD and ADHD, but small for IDID. The MFR trajectories suggested a slight widening of the ASD male-female gap, largely stable ADHD disparities, and minimal variability for IDID.</p><p><strong>Conclusion: </strong>Over 3 decades, the ASD ASPRs rose modestly, the ADHD ASPRs were broadly stable, and the IDID ASPRs declined across South America. The GBD 2023 estimates point to enduring diagnostic and structural inequities and to the need for strengthened surveillance and more equitable access to developmental assessment.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926064","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":"Rhabdomyolysis: a narrative review.","authors":"Celia Harumi Tengan, Acary Souza Bulle Oliveira, Alzira Alves de Siqueira Carvalho, Cezar Daniel Snak de Souza, Claudia Ferreira da Rosa Sobreira, Edmar Zanoteli, Helga Cristina Almeida da Silva","doi":"10.1055/s-0046-1824437","DOIUrl":"10.1055/s-0046-1824437","url":null,"abstract":"<p><strong>Abstract: </strong>Rhabdomyolysis is the acute necrosis of striated skeletal muscle, with release of its constituents into the extracellular space and circulation. Acute muscle pain (myalgia), weakness, and edema are associated with serum levels of the muscle enzyme creatine kinase (CK) above 1,000 IU/L or 5 times the upper limit of the normal value. This narrative review provides an overview of the clinical and laboratory findings, etiology, treatment, and prevention of rhabdomyolysis in humans. Additionally, we highlighted the main syndromes and muscular disorders associated with rhabdomyolysis: 1. Clinical syndromes: neuroleptic malignant syndrome, serotoninergic syndrome, sympathomimetic syndrome, malignant hyperthermia, and anesthesia-induced rhabdomyolysis; and 2. Myopathies: toxic myopathies, idiopathic inflammatory myopathies, muscular dystrophies, ion channel diseases, glycogen storage diseases, fatty acid beta oxidation defects, and mitochondrial myopathies.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306783","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 implications of a very late presentation in myasthenia gravis: real world experience in a tertiary center.","authors":"André Aires Fernandes, Luís Braz, Goreti Nadais, Fernando Silveira, Maria João Pinto","doi":"10.1055/s-0046-1824432","DOIUrl":"10.1055/s-0046-1824432","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an immune-mediated disease with a bimodal incidence: early-onset (< 50 years, predominantly female) and late-onset (> 50 years, predominantly male). Recently, a subgroup with very late-onset (≥ 65 years) has been described; however, its clinical relevance concerning disease course and prognosis remains uncertain.</p><p><strong>Objective: </strong>To evaluate the potential clinical implications of very late presentations of MG.</p><p><strong>Methods: </strong>The present is a retrospective cohort study comprising all patients diagnosed with MG currently followed up in the Neuromuscular Disorders Unit of a tertiary center. Clinical and paraclinical parameters including number of hospitalization and current regime were evaluated.</p><p><strong>Results: </strong>A total of 92 patients were included, 51 (55.4%) of whom were female. Concerning the age of onset, 23 (25.6%) patients were classified as very late-onset. In order to better understand the clinical implications of a later onset, we compare the very late-onset subgroup to the late-onset subgroup. Gender distribution and number of patients with minimal manifestation status or better did not statistically differ between these subgroups. Myasthenic crisis and refractoriness were more frequent in the late-onset subgroup compared with very late-onset, but no statistical difference was found (<i>p</i> = 0.221 and <i>p</i> = 0.650 respectively). We did not find statistically significant differences in acetylcholine receptor antibody titers between the groups. Concomitant autoimmune diseases were found in 14 (15.2%) patients, comprising three patients with late-onset and three patients with very late-onset MG.</p><p><strong>Conclusion: </strong>Our study suggests that the recently established subgroup of very late-onset may not be clinically distinct from late-onset MG, as these patients seem to exhibit a similar clinical trajectory.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306786","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":"Hypochondriasis, somatic amplification, and pain beliefs in patients with medication overuse headache.","authors":"Zeynep Ziroglu, Burçin Çolak, Hafize Nalan Güneş, Şeval Ozaydınlı, Levent Ertuğrul İnan","doi":"10.1055/s-0046-1824430","DOIUrl":"10.1055/s-0046-1824430","url":null,"abstract":"<p><strong>Background: </strong>Medication overuse headache (MOH) is a chronic headache (CH) that develops or worsens due to medication overuse. Somatization and hypochondriasis, as well as beliefs about the experienced pain, may accompany many chronic pain situations from a holistic perspective.</p><p><strong>Objective: </strong>This study aimed to compare MOH patients with CH and episodic headache (EH) in terms of somatization, hypochondriasis, and beliefs and attitudes on pain.</p><p><strong>Methods: </strong>The Hospital Depression and Anxiety Scale (HADS), the Somatosensory Amplification Scale (SSAS), the Pain Beliefs Questionnaire (PBQ), the Pain Catastrophizing Scale (PCS), Eysenck Personality Questionnaire Revised-Short Form (EPQR-S), and Whiteley index-7 (WI-7) were administered to the participants with MOH (n = 80), CH (n = 81), and EH (n = 79).</p><p><strong>Results: </strong>There were no group differences in terms of somatic amplification between MOH and CH group. A high WI_Total score (lower hypochondriacal tendency) was predictive in separating the MOH group from the CH one. The score obtained from the PBQ_Organic subscale in the MOH group was significantly lower than the EH group, while the PCS_Total, PCS_Helplessness, PCS_Rumination, and HADS scores were significantly higher (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Our results indicate that the patients in the MOH group had more organic pain beliefs, felt more helpless in case of pain, and experienced exaggeration and rumination more than the EH group, while hypochondriasis was lower than in the CH group. This could indicate that patients with MOH do not seek further treatment that can lead to more headache medication use without medical examination.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381453","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":"Isolated dysphagia masking myasthenia gravis diagnosis.","authors":"Isabella Lopes Lusvarghi, Eduarda Heringer Bernis, Rafaela Gatti Lopes, Rafaela Costa Vieira, Breno Franco Silveira Fernandes, Davi Teixeira Urzêdo Queiroz","doi":"10.1055/s-0046-1817045","DOIUrl":"10.1055/s-0046-1817045","url":null,"abstract":"<p><p>Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterized by fluctuating skeletal muscle weakness. We report a 61-year-old woman presenting with progressive dysphagia as the sole initial symptom for 15 months, leading to diagnostic delay. Esophageal manometry suggested ineffective motility, and electroneuromyography was normal, reinforcing a non-neurological hypothesis. During hospitalization for worsening dysphagia, cervical magnetic resonance imaging (MRI) incidentally revealed an anterior mediastinal nodule consistent with thymoma. Pulse corticosteroid therapy caused abrupt clinical deterioration, prompting neurological evaluation. Pyridostigmine produced marked improvement within 48 hours, and acetylcholine receptor antibody testing confirmed MG (18.7 nmol/L, radioimmunoassay). Robotic thymectomy revealed a type AB thymoma. The patient remains stable on azathioprine 2.5 mg/kg/day, with oncologic follow-up. This case highlights that MG should be considered in persistent unexplained dysphagia, particularly when symptoms worsen after corticosteroid exposure. Early recognition avoids morbidity and unnecessary invasive procedures.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"84 5","pages":"1-4"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430696","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}