Showing papers in "Arquivos De Neuro-psiquiatria in 1999"
TL;DR: A concordância entre os escores de itens individuais da escala foi avaliada pelo coeficiente estatistico Kappa, sugere that essas versoes tem utilidade clinica limitada.
Abstract: Depressao e problema de saude frequente entre idosos, embora a identificacao desses pacientes seja muitas vezes dificil na pratica clinica. Nesse sentido, a avaliacao sistematica dos individuos nessa faixa etaria pode contribuir para melhorar a deteccao dos casos de depressao. Este estudo foi desenhado com o objetivo de avaliar a confiabilidade de teste-reteste das versoes com 15, 10, 4, e 1 itens da Escala de Depressao em Geriatria (GDS). Foram selecionados 64 individuos com 60 ou mais anos de idade atendidos de forma consecutiva nos ambulatorios da Unidade de Idosos do Departamento de Saude Mental da Santa Casa de Sao Paulo entre fevereiro e maio de 1998. Todos preenchiam criterios para o diagnostico de transtorno depressivo (em remissao ou atual) de acordo com a CID-10 e apresentavam escores maiores do que 10 no Mini-Exame do Estado Mental. Eles foram avaliados duas vezes com a GDS-15, sendo as entrevistas conduzidas com intervalo de 48 a 72 horas. Cinquenta e um pacientes aceitaram participar do estudo. A concordância entre os escores de itens individuais da escala foi avaliada pelo coeficiente estatistico Kappa. Estes oscilaram entre 0,04 e 0,49, indicando baixa estabilidade na resposta dos pacientes. Os escores totais da GDS-15 mantiveram-se relativamente estaveis durante o reteste, conforme indicado pelo teste pareado de Wilcoxon (z=1,60; p=0,109), correlacao de Spearman (rho=0,86; p<0,001), e Kappa ponderado (Kappa=0,64). O mesmo padrao foi observado para a GDS-10 no teste de Wilcoxon (z=0,85; p=0,402), Spearman (rho=0,81; p<0,001), e Kappa ponderado (Kappa=0,60). O escore total da GDS-4 mostrou variacoes significativas do teste para o reteste (z=3,75; p<0,001; rho=0,56; p<0,001; Kappa=0,37). Esses resultados indicam que as versoes com 1 e 4 itens apresentam baixos coeficientes de confiabilidade. Isso sugere que essas versoes tem utilidade clinica limitada. Por outro lado, a GDS com 15 e 10 iitens pode ser utilizada com relativa confiabilidade na pratica clinica, particularmente quando se consideram os escores totais das escalas.
729 citations
TL;DR: The results indicate that the short GDS versions with 1 and 4 items are unreliable for use in clinical practice, and in contrast, the GDS with 10 and 15 items produced consistent results in the assessment of elderly patients when total scores were used as clinical guidelines.
Abstract: Depression is a frequent health problem in old age, although the detection of such cases in clinical practice is often difficult. The systematic use of depression rating scales may increase diagnostic rates of depression amongst the elderly. This study aimed to assess the test-retest reliability of short versions of the Geriatric Depression Scale (GDS) with 1, 4, 10, and 15 items. Sixty-four consecutive patients aged 60 or over attending the outpatient clinic for the elderly (UNID) at the Department of Mental Health of Santa Casa of Sao Paulo were recruited for the study between February and May 1998. All subjects fulfilled criteria for the diagnosis of a depressive disorder (current or in remission) according to ICD-10, and had Mini Mental State scores greater than 10. They were evaluated twice in 48 to 72 hours with the GDS-15. Fifty-one patients completed both assessments. Agreement between scores for individual items was evaluated with Kappa statistic. Kappa coefficients ranged from 0.04 to 0.49, indicating that there was much variation within individual items. Total GDS-15 scores were reasonably stable, as assessed by paired Wilcoxon (z = 1.60, p = 0.109), Spearman correlation coefficient (rho = 0.86, p < 0.001), and weighted Kappa (Kappa = 0.64). The same pattern was also observed for the total scores of the GDS-10 on the paired Wilcoxon (z = 0.85, p = 0.402), Spearman correlation coefficient (rho = 0.81, p < 0.001), and weighted Kappa (Kappa = 0.60). Total score for the GDS-4 showed significant changes from test to retest (z = 3.75, p < 0.001; rho = 0.56, p < 0.001; Kappa = 0.37). These results indicate that the short GDS versions with 1 and 4 items are unreliable for use in clinical practice. In contrast, the GDS with 10 and 15 items produced consistent results in the assessment of elderly patients when total scores were used as clinical guidelines.
515 citations
Journal Article•
TL;DR: A new frequency-domain approach to describe the relationships (direction of information flow) between multivariate time series based on the decomposition of multivariate partial coherences computed from multivariate autoregressive models is introduced.
Abstract: Abstract. This paper introduces a new frequency-domain approach to describe the relationships (direction of information flow) between multivariate time series based on the decomposition of multivariate partial coherences computed from multivariate autoregressive models. We discuss its application and compare its performance to other approaches to the problem of determining neural structure relations from the simultaneous measurement of neural electrophysiological signals. The new concept is shown to reflect a frequency-domain representation of the concept of Granger causality.
176 citations
Journal Article•
124 citations
TL;DR: The clinical, psychiatric, and neuropsychological impairments of untreated GH-deficient adults can be decreased by rh-GH therapy.
Abstract: BACKGROUND: Untreated GH-deficient adults have a diversity of dysfunctions (e.g. reduced muscle strength, emotional instability during stress, depressive symptoms) that may cause deleterious effects on quality of life, and may be positively influenced by recombinant human growth hormone (rh-GH) therapy. AIM: To evaluate the impact of a clinical intervention with rh-GH therapy on GH - deficient adults. METHOD: The physical, psychiatric and neuropsychological status of 9 GH-deficient adults was determined before and after the administration of rh-GH (0.250 IU/Kg/week) in a double blind placebo-controlled trial for six months. Patients then received rh-GH for a further period of 6 months and their status was re-evaluated. RESULTS: Rh-GH was significant better than placebo at 6th month (p<0.05), producing increased serum Insulin like growth factor-I (IGF-1) levels, reduced body mass index (BMI) and body fat, increased lean body mass and water, reduced waist/hip ratio and increased energy expenditure. The rh-GH therapy was also significantly better than placebo on depressive features as measured by the Hamilton Depression Scale (17-items) (p= 0.0431) and the Beck Depression Inventory (p= 0.0431). Neuropsychological evaluations showed significant improvements in measures of Attention: Digit Backward (p= 0.035),Verbal Fluency (FAS) (p= 0.02) and Cognitive Efficiency (WAIS-R tests): Vocabulary (p= 0.027) , Picture Arrangements (p= 0.017), and Comprehension (p= 0.01) following rh-GH therapy. CONCLUSION: The clinical, psychiatric, and neuropsychological impairments of untreated GH-deficient adults can be decreased by rh-GH therapy.
63 citations
TL;DR: Este estudo tem como objetivo realizar revisao sistematica da literatura sobre esse assunto de todos os trabalhos listados no banco de dados MedLine, que incluissem os seguintes unitermos: 'burden or impact or cost' e 'dementia or Alzheimer's disease' and 'carer or caregiver or caregiving or family'.
Abstract: Diversos estudos indicam que o cuidado de pacientes com demencia esta associado a sobrecarga importante sobre a vida do cuidador. Ha evidencias crescentes de que esse desgaste esta mais intimamente ligado a presenca de sintomas nao cognitivos (ou psiquiatricos). Este estudo tem como objetivo realizar revisao sistematica da literatura sobre esse assunto de todos os trabalhos listados no banco de dados MedLine, que incluissem os seguintes unitermos: 'burden or impact or cost' e 'dementia or Alzheimer's disease' e 'carer or caregiver or caregiving or family'. Foram incluidos artigos impressos entre janeiro de 1990 e janeiro de 1998. Quatorze estudos preencheram os criterios de inclusao da revisao, dentre aqueles disponiveis nas bibliotecas das universidades de Sao Paulo. Estes revelaram que transtornos de comportamento em pacientes dementados sao importantes causas de sobrecarga na vida do cuidador, porem um consenso sobre o conceito desses transtornos ainda nao esta totalmente estabelecido. Alem disto, nao esta claro quais sintomas nao cognitivos sao os principais responsaveis por aumento do impacto. Futuras pesquisas devem abordar esses aspectos no sentido de elucidar quais os melhores metodos de intervencao para esses casos.
60 citations
TL;DR: This study might be a warning as to the cares that need to be taken regarding drug use and occupational exposure to chemical agents, as both types of substances present secondary PD action.
Abstract: A case-control study of Parkinson's disease (PD) was conducted in the city of Rio de Janeiro based on the assumption that neurotoxins with secondary parkinsonian action may be related to the development of Parkinson's disease. Ninety-two subjects with PD and 110 controls were queried through a questionnaire in order to investigate possible risk factors for the disease. The following factors were studied: herbicides/pesticides, exposure to chemicals, ingestion of drugs with secondary PD effects, rural life, water well source, family history, cranial trauma and cigarette smoking. Study of mentioned factors was achieved through univariate, stratified and multivariate analyses. Univariate and multivariate analyses demonstrated that PD was positively associated with family history (OR = 14.5; CI = 2.98 - 91.38), with the use of drugs with secondary PD action (OR = 11.01; CI = 3.41 - 39.41) and with exposure to chemical agents (OR = 5.87; CI = 1.48 - 27.23). PD was found to be inversely associated with cigarette smoking (OR = 0.39; IC = 0.16 - 0.95). Stratified analysis only confirmed family history and drug use, besides demonstrating that cigarette consumption could be a protection factor, when aforementioned factors were involved. This study might be a warning as to the cares that need to be taken regarding drug use and occupational exposure to chemical agents, as both types of substances present secondary PD action.
51 citations
TL;DR: In this paper, the authors report three cases of pseudodementia and discuss the difficulties in establishing limits between normality and illness in the elderly, and suggest the diagnostic process should be based on a comprehensive neuropsychological and behavioral evaluation (including a survey of the subject's premorbid level of cognitive and socio-occupational functioning), supplemented by neuroimaging and laboratory tests.
Abstract: The author reports three cases of pseudodementia and discuss the difficulties in establishing limits between normality and illness in the elderly. The mental and neuropathological changes that accompany the normal ageing of the brain are similar to those of early Alzheimer's dementia (AD). These similarities often lead to difficulties in the differential diagnosis, hence the search for consensus criteria. The decline of working and secondary memory is greater than that of primary and tertiary memory, as is found in AD. On the other hand, tests of delayed recall of 10 to 15 unrelated words, logical memory, categorical thinking, visuo-motor-spatial skills, and Boston Naming Test have been pointed out as the most discriminative. Neuroimaging findings of atrophy or hipoperfusion in the entorhinal-hippocampal or temporo-parietal regions are suggestive of DA, but they can be lacking in the early stages of this disease. In the conclusion, the author suggests the diagnostic process should be based on a comprehensive neuropsychological and behavioral evaluation (including a survey of the subject's premorbid level of cognitive and socio-occupational functioning), supplemented by neuroimaging and laboratory tests. If inconclusive, the whole evaluation can be repeated after 4 to 6 months, to check the consistency of the findings.
46 citations
TL;DR: In this article, a popular escala de tracos autisticos, construída by Ballabriga et al. in Barcelona, was evaluated, a partir da analise of uma populacao of 31 pacientes portadores de deficiencia mental and 30 paciente diagnosticados como portadore de autismo, conforme os criterios diagnosticos do DSM-IV, traduzir, adaptar, and validar a escala of traco autisticos.
Abstract: O objetivo deste estudo foi, a partir da analise de uma populacao de 31 pacientes portadores de deficiencia mental e de 30 pacientes diagnosticados como portadores de autismo, conforme os criterios diagnosticos do DSM-IV, traduzir, adaptar e validar a escala de tracos autisticos, construida em Barcelona por Ballabriga e colaboradores. O ponto de corte encontrado foi 15 (p= 0,05); o coeficiente de variacao (confiabilidade), 0,27; a validade externa mostrou baixa concordância (kappa= 0,04) e a validade interna foi 100%, mostrando que, em todos os pacientes avaliados, os diagnosticos clinicos concordaram com os realizados atraves da escala. O indice de correlacao foi 0,42, mostrando-se especifico para os quadros autisticos. Apresentou ainda, capacidade de discriminacao e consistencia interna, com alfa de Cronbach 0,71 . Consideramos, assim, que a escala mostra-se confiavel para a sua utilizacao em nosso meio.
36 citations
TL;DR: The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirao Preto and concludes that the drugs used have similar efficacy profiles and costs and can be used at basic health unities.
Abstract: Headache is one of the most common symptoms observed in clinical practice. It has a considerable economic impact and overburdens emergency rooms. In Brazil, most emergency rooms have no tryptans. The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirao Preto. In 1996, 1254 patients were treated for headache and 64 of them required hospitalization. Of the non-hospitalized (NH) patients, 77% had primary headache, as opposed to 29.7% of hospitalized patients. Of the patients with migraine, 83.6% improved with intravenous dipyrone, 66.7% improved with intramuscular diclofenac and 81.8% improved with intravenous chlorpromazine. The percentages of patients with tension-type headache who improved with the same drugs were 77.8%, 80% and 100%, respectively. Among NH patients, 16.3% improved without any medication. We conclude that the drugs used have similar efficacy profiles and costs and can be used at basic health unities. The major drawback is parenteral administration.
34 citations
TL;DR: The data supports claims that oestrogen replacement therapy reduces the risk of Alzheimer's disease in later life and improves response of patients to anticholinesterase treatment, and preliminary findings suggest that testosterone therapy may improve mood when used in isolation or in association with oestrogens.
Abstract: Women now spend more than 1/3 of their lives in a state of oestrogen deprivation as a result of increased life expectancy. A similar, but milder, hypogonadal state has been described for elderly men. This paper aims to review the available literature on the effects of both oestrogen and testosterone on mood and cognition. Oestrogen replacement therapy of postmenopausal women is associated with improvements in measures of well being and decline in depression scores. In addition, oestrogen seems to augment the response of postmenopausal women with major depression to antidepressant treatment. Most studies designed to investigate the impact of oestrogen on cognition indicate that replacement therapy is associated with better performance on neuropsychological tests, particularly in measures of verbal memory and fluency. The data also supports claims that oestrogen replacement therapy reduces the risk of Alzheimer's disease in later life and improves response of patients to anticholinesterase treatment. Data on the effects of testosterone is sparser. Preliminary findings suggest that testosterone therapy may improve mood when used in isolation or in association with oestrogen. The effects of testosterone on cognitive functioning are less clear - some studies indicate that the administration of testosterone to non-demented subjects is associated with better visuospatial functioning and deterioration of verbal skills. In summary, gonadal hormones seem to modulate various aspects of mental functioning. If future studies prove this to be true, hormone replacement therapy should have a major impact on the physical and mental health of older people in the years to come.
TL;DR: Clinically, ALS presented as initials symptoms, principally, asymmetrical and symmetrical weakness of extremities, besides bulbar signs, fasciculations, and atrophy, and the predominant initial anatomic site was the spinal cord.
Abstract: We report on the clinical characteristics of amyotrophic lateral sclerosis (ALS) in Fortaleza (Northeastern Brazil). For this, we analyzed retrospectively (from 1980 to 1999) 78 cases of ALS from the Service of Neurology of the University Hospital of Fortaleza diagnosed clinically and laboratorially (EMG, muscle biopsy, myelography, blood biochemistry, muscle enzymes and cranio-cervical X-ray). The results showed that they were mostly sporadic ALS (76/78), and they were divided into definite (n= 36), probable (n= 20), possible (n= 15) and suspected (n= 7), according to the level of diagnostic certainty. They were also subdivided into juvenile (n= 17), early-onset adult (n= 18), age-specific (n= 39) and late-onset (n= 4) groups. Clinically, they presented as initials symptoms, principally, asymmetrical (30/78) and symmetrical (24/78) weakness of extremities, besides bulbar signs, fasciculations, and atrophy. Curiously, pain as first symptom occurred in an expressive fashion (17/78). The predominant initial anatomic site, in this series, was the spinal cord, and mainly affecting the arms. As to the symptom accrual from region to region, this occurs more quickly in contiguous areas, and fasciculations are predominant when bulbar region was associated.
TL;DR: The EDSS score seems to be worse in patients with specific cerebellar and pyramidal signs, higher number of relapses and longer time of disease but it is not related to the number of white matter lesions found at MRI.
Abstract: Multiple sclerosis, seems to be a rare disease however in the population herein studied it is similar to the one described by others, in Brazil and abroad. We studied 50 patients classified according Poser's criteria that were followed at the Department of Neurology UNIFESP-EPM from 1983 to 1995. The clinical findings of these 50 patients were similar to those described in other series. We found a high prevalence among female young patients who presented relapsing-remitting evolution. The most common symptoms were those related to pyramidal and cerebellar dysfunctions. The EDSS score seems to be worse in patients with specific cerebellar and pyramidal signs, higher number of relapses and longer time of disease but it is not related to the number of white matter lesions found at MRI.
TL;DR: The effects of increasing median blockage in CTS are more severe as long as patients become older regardless duration of symptomatology, and aging correlates more positively than duration of complaints with severity of SDL/MDL in C TS.
Abstract: Median sensory and motor distal latencies (SDL/MDL) were correlated with age and duration of symptomatology in 1498 carpal tunnel syndrome (CTS) patients (17-90 years old, 87.6% female). Patients were distributed in four groups according to distal latencies severity. There was an increase in age as long as SDL/MDL became more severe, ranging from 47.5 to 67 years old (mild to severe-absence potentials in both hands groups, respectively). There was a less dramatic increase in duration of complaints as long as SDL/MDL became more severe, ranging from 12 to 30.7 months (mild to severe-absence potentials in both hands groups, respectively). Aging correlates more positively than duration of complaints with severity of SDL/MDL in CTS. The effects of increasing median blockage in CTS are more severe as long as patients become older regardless duration of symptomatology.
TL;DR: Patients with relapsing remitting MS living in the city of São Paulo had a deficit in learning and verbal long-term memory tasks and in visual long- term memory of complex figure and in timed tasks.
Abstract: Multiple sclerosis (MS) is a common disease in Western countries of temperate/cold climate, but in tropical countries an increasing number of cases have been diagnosticated. Moved by the lack of information about cognitive dysfunction of Brazilian MS patients, the present study attempted to describe features of neuropsychological alterations in patients with relapsing remitting MS living in the city of Sao Paulo. They were compared to healthy volunteers, matched for age and education. In the absence of global intellectual deterioration, the patients had a deficit: a) in learning and verbal long-term memory tasks and in visual long-term memory of complex figure; b) in timed tasks, accounted for by a slowness of mental processes; c) in tasks with a motor component. Tendency to depression was observed; anxiety levels were normal.
TL;DR: A case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation is reported.
Abstract: We report a case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation. Pathophysiological aspects of these three diseases are discussed and also the unfavorable prognosis of this association.
TL;DR: This study presents a simplified inventory of quality of life, with cultural, personal, social and relationship aspects for children with epilepsy, with a high prevalence of behavior problems and learning problems.
Abstract: Epilepsy is a chronic disorder in which onset occurs primarily during childhood and adolescence. Traditionally, treatment of childhood epilepsy emphasizes neurologic aspects over psychological factors. The attention to the seizure control in the clinical setting will not address the full range of quality of life problems of childhood epilepsy. Many of the psychosocial difficulties that plague adults with epilepsy develop from the complications associated with this early onset. Children with epilepsy have a high prevalence of behavior problems and learning problems. Assessing quality of life in pediatric epilepsy is especially important because children are in critical periods of development during which many cognitive and social skills are being learned. This study presents a simplified inventory of quality of life, with cultural, personal, social and relationship aspects. This investigation makes possible to the professional knowledge about children and a best direction of their conducts.
TL;DR: Five patients with a tumefactive lesion were clinically followed from 1992 to 1993 and exclusion of other pathologies and clinical and radiological improvement after corticotherapy, pointed to an inflammatory disease.
Abstract: Five patients with a tumefactive lesion were clinically followed from 1992 to 1993. Four patients were female; age ranged from 32 to 57 years, the duration of symptoms varied from 3 days to 3 years. Neurological examination disclosed dementia in two patients, aphasia in three, hemiparesis in four, hemihypoaesthesia in three, optical neuritis in two, tetraparesis with sensitive level and neurogenic bladder in one. MRI disclosed lesions with a hypersignal on images assessed at T2 and hyposignal at T1, and gadolinium heterogeneous enhancement; these lesions were located in the: a) temporooccipital region bilaterally and brain stem, b) frontoparietal white matter , c) basal ganglia, bilateral white matter and brain stem, d) left parietal region, e) cervical spinal cord, with enlargement of this region. Cerebral biopsy was performed in three patients; acute and subacute demyelinating disease was diagnosed by histological examination. Two patients had an evolutive diagnosis; exclusion of other pathologies and clinical and radiological improvement after corticotherapy, pointed to an inflammatory disease.
TL;DR: The panic disorder group was more sensitive to hyperventilation than normal volunteers and may be a useful and simple test for validating the diagnosis in some specific panic disorder patients.
Abstract: Disturbios respiratorios estao associados a ansiedade, especialmente aos ataques de pânico. Sufocamento, sensacao de "cabeca leve", tonteira, parestesias e taquipneia aparecem na descricao psiquiatrica e respiratoria do transtorno do pânico. Pacientes com transtorno do pânico apresentam respostas comportamentais e fisiologicas anormais a testes respiratorios. Objetivo: Observamos a inducao de ataques de pânico atraves de hiperventilacao em um grupo de pacientes com transtorno do pânico (DSM-IV). Metodo: Selecionamos de forma randomizada 13 pacientes com transtorno do pânico e 11 voluntarios normais. Todos estavam sem medicacao ha uma semana. Foram induzidos a hiperventilar (30 inspiracoes/minuto) durante 3 minutos. Escalas de ansiedade foram utilizadas antes e apos o teste. Resultados: No grupo com transtorno de pânico, 9 (69,2%) pacientes apresentaram ataque de pânico apos a hiperventilacao e apenas 1 (9,1%) no grupo controle (p<0,05). Conclusao: Os pacientes com transtorno do pânico foram mais sensiveis a hiperventilacao que o grupo controle. A inducao de ataques de pânico atraves da hiperventilacao pode ser metodo util e simples para validar o diagnostico em um grupo especifico de pacientes com transtorno do pânico.
TL;DR: A possible dose-dependent analgesic effect of vigabatrin (gamma-vinyl-GABA) on experimental neuropathic pain, which seems not to be opioid mediated and corroborated by similar findings with analgesic anticonvulsants.
Abstract: Since anticonvulsants have been used for treating neuralgias, an interest has arisen to experimentally test vigabatrin for its gabaergic mechanism of action. For this, 41 Wistar rats were used, and in 25 of them a constrictive sciatic neuropathy was induced (Bennet & Xie model). For testing pain symptoms, spontaneous (scratching) and evoked behaviors to noxious (46o C) and non-noxious (40o C) thermal stimuli were quantified. Moreover, a comparative pharmacological study of vigabatrin with other analgesic anticonvulsant drugs was also performed. The results showed a possible dose-dependent analgesic effect of vigabatrin (gamma-vinyl-GABA) on experimental neuropathic pain, as shown by the significant (p<0.05) decreasing effect of vigabatrin on scratching and by its significant (p<0.05) increasing effect on the latency of the right hindpaw withdrawal of the animals to noxious thermal stimulus. This was corroborated by similar findings with analgesic anticonvulsants (carbamazepine, phenytoin and valproic acid). This possible and not yet described analgesic effect of vigabatrin seems not to be opioid mediated.
TL;DR: This article identified as the etiologias mais provaveis of epilepsia iniciada apos os 18 anos de idade, and a prevalencia encontrada for epilepsias tardia foi 29,48%.
Abstract: OBJETIVO: Identificar em nossa sociedade as etiologias mais provaveis de epilepsia iniciada apos os 18 anos de idade. METODO: Estudo retrospectivo e descritivo na CME/SUS de Florianopolis de 1990 a 1998, analisando 120 prontuarios de pacientes com epilepsia tardia, isto e, aqueles que iniciaram suas crises epilepticas dos 18 anos em diante. As variaveis coletadas foram: idade da primeira crise, etiologias provaveis, historia morbida familiar. RESULTADOS: A prevalencia encontrada para epilepsia tardia foi 29,48%.Epilepsias parciais sintomaticas foram majoritarias e as etiologias mais frequentes e relevantes encontradas foram: cisticercose com cerca de 20%, trauma crânio encefalico com 15%, convulsao febril na infância com 5% e 35% da amostra foi classificada como idiopatica. CONCLUSAO: prevalencia de epilepsia de inicio tardio em nossa sociedade e 29,48%, cifra ligeiramente superior a relatada em paises desenvolvidos (25%). Muito provavelmente, esta diferenca e consequencia do carater epidemico de cisticercose entre nos. Alem disso, trauma crânio encefalico e crises febris sao etiologias comuns. Profilaxia de epilepsia e viavel e urgentemente necessaria em nosso Estado.
TL;DR: Electro EEG brain mapping and other QEEG techniques should be clinically used only by physicians highly skilled in clinical EEG interpretation and as an adjunct to traditional EEG work.
Abstract: Digital EEG (DEEG) and quantitative EEG (QEEG) are recently developed tools present in many clinical situations. Besides showing didactic and research utility, they may also have a clinical role. Although a considerable amount of scientific literature has been published related to QEEG, many controversies still subsist regarding its clinical utilization. Clinical applications are: 1. DEEG is already an established substitute for conventional EEG, representing a clear technical advance. 2. Certain QEEG techniques are an established addition to DEEG for: 2a) screening for epileptic spikes or seizures in long-term recordings; 2b) Operation room and intensive care unit EEG monitoring. 3. Certain QEEG techniques are considered possible useful additions to DEEG: 3a) topographic voltage and dipole analysis in epilepsy evaluations; 3b) frequency analysis in cerebrovascular disease and dementia, mostly when other tests have been inconclusive. 4. QEEG remains investigational for clinical use in postconcussion syndrome, learning disability, attention disorders, schizophrenia, depression, alcoholism and drug abuse. EEG brain mapping and other QEEG techniques should be clinically used only by physicians highly skilled in clinical EEG interpretation and as an adjunct to traditional EEG work.
TL;DR: The authors discuss that this increased reactivity probably results from a greater NADH/NAD+ ratio, described in many tissues of diabetic animals, which has consequences on the modulation of the enzymes that use these cofactors and whose activity is detected by the NADH-diaphorase technique.
Abstract: This study had as its purpose to assess the effects of acute diabetes induced by streptozotocin (35 mg/kg body weight) on the number and size of the myenteric neurons of the duodenum of adult rats considering equally the antimesenteric and intermediate regions of the intestinal circumference. Experimental period extended for a week. Neuronal counts were carried out on the same number of fields of both regions of the duodenal circumference and measurements of neuronal and nuclear areas on equal numbers of cells. Number and size of the myenteric neurons stained with Giemsa were not significantly different between groups. On the other hand, the proportion of NADH-positive neurons increased from 18.54% on the controls to 39.33% on the diabetics. The authors discuss that this increased reactivity probably results from a greater NADH/NAD+ ratio, described in many tissues of diabetic animals, which has consequences on the modulation of the enzymes that use these cofactors and whose activity is detected by the NADH-diaphorase technique.
TL;DR: A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review, revealing a prolonged distal segmental sensory latency and also on distal motor latency.
Abstract: A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal) or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low significance. Magnetic resonance could be a useful tool for selected atypical cases. Conservative treatment and controversies on surgery timing are discussed. Classical conduction studies on median nerve reveal a prolonged distal segmental sensory latency and also on distal motor latency. Increasing sensitivity may be reach using additional methods such as, median mixed mid-palm latency, comparative mid-palm latency median/ulnar, comparative sensory latency median/radial and median/ulnar, inching method from wrist to palm recording on index/middle finger and comparative motor median/ulnar recording on lumbrical/interosseous muscle.
TL;DR: The results showed the sensitivity of this test in detecting visuo-spatial impairment in myotonic dystrophy and the patients denoted considerable difficulty to perform the test.
Abstract: Foram avaliados 39 casos de distrofia miotonica a partir do desempenho no teste dos cubos de Kohs. Havia 21 casos femininos e 18 masculinos, idade variando de 9 a 70 anos e diferentes niveis educacionais (do primario ao superior). Alguns encontravam-se ativos profissionalmente, enquanto outros nunca exerceram uma ocupacao profissional. Os pacientes denotaram consideravel dificuldade na execucao deste teste que e instrumento que se apresenta fundamentalmente por reproducao de figuras. Houve casos que construiram figuras com formas bem diferentes dos desenhos apresentados. O desempenho foi insuficiente em 71,4 % dos casos, os quais nao conseguiram resolver 50% do teste. Muitas das reproducoes fugiram ao padrao correto, traduzindo comprometimento visuo-espacial pela grave distorcao em comparacao com a figura modelo. Os niveis de analise e sintese estavam comprometidos de forma importante. Dentre os pacientes, 18 casos nao alcancaram os 10 pontos, dos 133 possiveis, nao realizando sequer 20% do teste. Os resultados comprovaram a sensibilidade deste teste em detectar comprometimento visuo-espacial na distrofia miotonica.
TL;DR: Professor Antonio Austregésilo was the pioneer of neurology in Brazil, creating the first neurologícal school in Rio de Janeiro, and publishing several works, including a rival sign of Babinski and the first description of a posttraumatic dystonia.
Abstract: Professor Antonio Austregesilo was the pioneer of neurology in Brazil, creating the first neurological school, in Rio de Janeiro, of which he was the first professor. He was also the first to study the movement disorders in Brazil, publishing several works on this subject, primarily in "Revue Neurologique", and "L'Encephale", including a rival sign of Babinski and the first description of a posttraumatic dystonia.
TL;DR: In this paper, 1 059 carpal tunnel syndrome hands (CTS) from 668 patients were studied, none of which had previously operated and all had bilateral conduction studies; peripheral neuropathy was excluded; the patients were selected with sensory median/radial difference (MRD) ³ 10 ms that strongly supports electrodiagnosis of CTS (standard deviation >6) after stimulation on wrist and recording on thumb Normal MRD were obtained in 125 hands with upper limit of normality = 0,43 ms (mean + 2 SD)
Abstract: Between January/1989 and June/1996, 1 059 carpal tunnel syndrome hands (CTS) from 668 patients were studied None had been previously operated and all had bilateral conduction studies; peripheral neuropathy was excluded The patients were selected with sensory median/radial difference (MRD) ³ 10 ms that strongly supports electrodiagnosis of CTS (standard deviation >6) after stimulation on wrist and recording on thumb Normal MRD were obtained in 125 hands with upper limit of normality = 0,43 ms (mean + 2 SD) The age ranged from 17 to 83 years (mean 475) and 913% were female; the complaints were bilateral in 72% and nocturnal/awakening in 853% Pain, numbness and paraesthesia occurred in 644%; pain as the only symptom was rare but proximal extension was frequent (394%) All fingers were symptomatic in 425%, followed by middle, middle-ring, thumb-index-middle and then index-middle-ring ones There was no correlation with traumatic past history on wrist The duration CTS symptoms ranged from 1 to > 120 months Diabetes mellitus was present in 44% even after peripheral neuropathy exclusion
TL;DR: Penytoin induced dyskinesia may occur during either chronic or initial treatment and with normal serum phenytoin levels, however, it occurs most often in patients on polytherapy, usually after increasing dosage and with toxic serum levels.
Abstract: Phenytoin is an effective antiepileptic drug, although, it can be associated with many side effects, including dyskinesia. OBJECTIVE: To describe the clinical characteristics of phenytoin induced dyskinesia. METHODS: We investigated the occurrence of involuntary movements in patients followed at our adult and pediatric epilepsy clinics during the period of one year. RESULTS: Three patients presented with phenytoin-induced dyskinesia: one adult with axial and orofacial dyskinesia, and two children with choreoathetosis. They did not have other signs of phenytoin intoxication and had complete recovery after phenytoin withdrawal. CONCLUSION: Phenytoin induced dyskinesia may occur during either chronic or initial treatment and with normal serum phenytoin levels. However, it occurs most often in patients on polytherapy, usually after increasing dosage and with toxic serum levels. Other signs of phenytoin intoxication may be present in these patients, but often the dyskinesia is the only side effect, which may delay the diagnosis and treatment. The clinical characteristics of the involuntary movements vary and may be focal or generalized, most often characterized by choreoathetosis and dyskinesias. These may last for hours, days or even years, but frequently disappear completely after phenytoin withdrawal.
TL;DR: Cosleeping--sleeping together with family members--was a remarkable finding, in every child 0-2 year old and in 81.5% in the 2-10 years group, the second characteristic was sleeping with many people in the same room.
Abstract: Sleep behavior patterns in childhood are influenced by familial, cultural and environmental factors. In understanding sleep in Native Brazilian Bororo children, one should consider the influence of their culture on the child's sleep. This research analyzes sleep habits of Native Bororo children from the Meruri village, located in an Indian Reservation in the state of Mato Grosso. Fourty four children ( 24 M; 20 F) were evaluated; ages ranged from one month to 10 years, with a mean age of 4.9 years. Sleep characteristics were assessed by means of a standard questionnaire applied to the mothers. Cosleeping - sleeping together with family members - was a remarkable finding, in every child 0-2 year old and in 81.5% in the 2-10 years group. The second characteristic was sleeping with many people in the same room. There was an average of 5.1 people per room in the younger group and 3.9 people in the older group
TL;DR: A case of malaria with an atypical evolution, with a stroke lesion in the territory of the middle cerebral artery, with no association with encephalitis is reported, and it is concluded that the mechanical theory is the one applicable to this patient.
Abstract: Malaria is a parasitic disease with high prevalence in several regions of the world. Infestation by Plasmodium faciparum can, in some cases, affect the central nervous system producing encephalitis resulting in death or neurological sequelae. The mechanisms involved in the pathophysiology of the cerebral lesion are not totally clear and there are currently two theories (mechanical and humoral) concerning this. We report a case of malaria with an atypical evolution, with a stroke lesion in the territory of the middle cerebral artery, with no association with encephalitis. We conclude that the mechanical theory is the one applicable to this patient.