Relación entre el sexo y los síntomas motores y no motores en pacientes con Parkinson / Relationship between sex and motor and non - motor symptoms in Parkinson's patients

Introducción: La enfermedad de Parkinson es una entidad neurodegenerativa caracterizada por bradicinesia, temblor en reposo y rigidez. Objetivo: Determinar la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson. Métodos: Se realizó un estudio observacional analítico transversal sobre la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson en el Hospital Clínico Quirúrgico Lucía Íñiguez Landín en el año 2018. El universo estuvo constituido por los 675 pacientes con Parkinson atendidos en consulta. La muestra fue de 110 pacientes. Resultados: Predominó el grupo etario 60-69 años (34,55 por ciento). Los síntomas no motores al inicio de la enfermedad fueron mayores para un 68,18 por ciento. Dentro de los síntomas motores, prevalecieron el temblor (80 por ciento) y la rigidez (72,72 por ciento). El síntoma más prevalente en el sexo masculino fue el temblor y en el femenino la rigidez. Dentro de los síntomas no motores destacaron los trastornos del sueño para un 92,72 por ciento y alteraciones neuropsiquiátricas para un 86,36 por ciento. Conclusiones: En el presente estudio se encontraron diferencias significativas entre hombres y mujeres en la prevalencia de algunos síntomas motores y no motores(AU)

Introduction: Parkinson's disease is a neurodegenerative entity characterized by bradykinesia, tremor at rest and rigidity. Objective: To determine the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease. Methods: A cross-sectional analytical observational study was carried out on the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease at Lucía Íñiguez Landín Clinical Surgical Hospital in 2018. The universe consisted of 675 Parkinson's patients seen in consultation. The sample consisted of 110 patients. Results: The age group 60-69 years (34.55percent) predominated. Non-motor symptoms predominated at the beginning of the disease in 68.18percent. Tremor (80percent) and rigidity (72.72percent) predominated within the motor symptoms. The most prevalent symptom in males was tremor and rigidity in females. While as the non-motor symptoms, sleep disorders predominated in 92.72percent and neuropsychiatric disorders in 86.36percent. Conclusions: In the present study, significant differences were found between men and women in the prevalence of some motor and non-motor symptoms(AU)

Engagement in different sport disciplines during university years and risk of locomotive syndrome in older age: J-Fit

BACKGROUND@#Among former Olympic-level athletes, engagement in different sport disciplines has been associated with mortality risk in subsequent years. However, limited evidence is available on whether engagement in different sport disciplines at a young age is associated with locomotive syndrome (LS) risk later in life. This study examined the relationship between engagement in different sport disciplines during university years and LS risk in older age among former university athletes.@*METHODS@#Participants were 274 middle-aged and 294 older men alumni who graduated from a school of physical education in Japan. LS risk was defined as answering "yes" to any of the Loco-check questions. Data on university sports club membership were collected using questionnaires. University clubs were classified into three groups of cardiovascular intensity (low, moderate, high), following the classification system of sport disciplines by the American College of Cardiology. This classification considers the static and dynamic components of an activity, which correspond to the estimated percent of maximal voluntary contraction reached and maximal oxygen uptake achieved, respectively. University clubs were grouped based on the risk of bodily collision (no, yes) and extent of physical contact (low, moderate, high). Relationships between engagement in different sport disciplines and LS risk were analyzed using Cox proportional hazards models, and adjusted for age, height, weight, joint disease, habitual exercise, and smoking and drinking status.@*RESULTS@#Adjusted hazard ratios and 95% confidence intervals associated with the low, moderate, and high cardiovascular intensity sports were 1.00 (reference), 0.48 (0.22-1.06, P = 0.070), and 0.44 (0.20-0.97, P = 0.042) in older men, respectively; however, there was no significant association between these parameters among middle-aged men. Engagement in sports associated with physical contact and collision did not affect LS risk in either group.@*CONCLUSIONS@#Engagement in sports associated with high cardiovascular intensity during university years may reduce the risk of LS in later life. Encouraging young people to participate in such activities might help reduce LS prevalence among older populations.

Gunshot injury to spine: An institutional experience of management and complications from a developing country / 中华创伤杂志(英文版)

PURPOSE@#Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi).@*METHODS@#This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded.@*RESULTS@#A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia.@*CONCLUSION@#The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Alterações motoras em crianças e adolescentes pós-cirurgia de tumor intramedular: estudo retrospectivo / Motor changes in children and adolescents after intramedullary tumor surgery: a retrospective study

Introdução: Os tumores intramedulares são raros e correspondem a menos de 10% das neoplasias do sistema nervoso central. O crescimento tumoral pode comprimir feixes nervosos e resultar em perda da função motora e sensorial. A abordagem cirúrgica é o principal pilar de tratamento e visa à máxima ressecção tumoral com preservação da função. A reabilitação destes pacientes é individualizada se analisarmos os déficits funcionais e prognósticos. Objetivo: Analisar a idade e sexo dos pacientes, tipo e localização do tumor, tratamento cirúrgico e tratamento oncológico dos pacientes com tumor intramedular. Descrever as alterações motoras decorrentes desse tratamento. Método: Estudo retrospectivo realizado no Instituto de Oncologia Pediátrica através de dados de prontuários de janeiro de 2013 a dezembro de 2016 de pacientes com tumor intramedular. Dados analisados: idade ao diagnóstico e no momento cirúrgico, gênero, diagnóstico e localização do tumor, tipo de tratamento oncológico, cirurgia realizada, sequela pré e pós-cirurgia, indicação de coletes ortopédicos e tempo de uso. Não houve necessidade de aplicação do Termo de Consentimento Livre e Esclarecido por ser um estudo retrospectivo. Resultados: Foram selecionados doze prontuários de pacientes. A média de idade dos pacientes ao diagnóstico foi de 10 anos e 8 meses e média de 32 dias até a abordagem cirúrgica. Sete pacientes eram do sexo feminino e cinco do sexo masculino. Todos os pacientes foram submetidos a laminectomias, sendo três submetidos também a protocolo quimioterápico e radioterápico, e dois a protocolo quimioterápico. Dois pacientes foram orientados a usar colar cervical e dois orientados a usar colete ortopédico. Todos pacientes apresentaram alteração da marcha e diminuição de força muscular nos grupos pré e pós-cirúrgico. Conclusão: A idade média dos pacientes ao diagnóstico de tumor intramedular foi inferior a 11 anos, com predomínio do sexo feminino. Os diagnósticos oncológicos e as localizações tumorais foram variados. Sete pacientes evoluíram com deambulação independente após atendimento fisioterápico. A indicação de colares e coletes cervicais precisa ser mais estudada e sistematizada.(AU)

Introduction: Intramedullary tumors are rare and account for less than 10% of neoplasms of the central nervous system. Tumor growth may compress nerve bundles and result in loss of motor and sensory function. The surgical approach is the main pillar of treatment and aims at maximum tumor resection with preservation of function. The rehabilitation of these patients is individualized if we analyze the functional and prognostic deficits. Objective: To analyze the age and sex of the patients, type and location of the tumor, surgical treatment and oncological treatment of patients with intramedullary tumor. Describe the motor changes resulting from this treatment. Method: Retrospective study conducted at the Pediatric Oncology Institute through data from medical records from January 2013 to December 2016 of patients with intramedullary tumor. Data analyzed: age at diagnosis and at the time of surgery, gender, diagnosis and location of the tumor, type of cancer treatment, surgery performed, pre and post-surgery sequelae, indication of orthopedic vests and time of use. There was no need to apply the Free and Informed Consent Term because it is a retrospective study. Results: Twelve patient charts were selected. The mean age of the patients at diagnosis was 10 years and 8 months and mean of 32 days until the surgical approach. Seven patients were female and five were male. All patients underwent laminectomies, three of which were submitted to chemotherapy and radiotherapy, and two to chemotherapy protocol. Two patients were instructed to wear cervical collar and two oriented to wear orthopedic vest. All patients presented gait alteration and decreased muscle strength in the pre and post-surgical groups. Conclusion: The mean age of the patients at the diagnosis of intramedullary tumor was less than 11 years, with a predominance of females. Oncological diagnoses and tumor sites were varied. Seven patients evolved with independent walking after physical therapy. The indication of necklaces and cervical vests needs to be further studied and systematized.(AU)

Association between executive and food functions in the acute phase after stroke / Associações entre função executiva e habilidade de alimentação pós-AVC na fase aguda

ABSTRACT Purpose To investigate potential associations among executive, physical and food functions in the acute phase after stroke. Methods This is a cross-sectional study that evaluated 63 patients admitted to the stroke unit of a public hospital. The exclusion criteria were other neurological and/or psychiatric diagnoses. The tools for evaluation were: Mini-Mental State Examination and Frontal Assessment Battery for cognitive functions; Alberta Stroke Program Early CT Score for quantification of brain injury; National Institutes of Health Stroke Scale for neurological impairment; Modified Rankin Scale for functionality, and the Functional Oral Intake Scale for food function. Results The sample comprised 34 men (54%) and 29 women with a mean age of 63.6 years. The Frontal Assessment Battery was significantly associated with the other scales. In multivariate analysis, executive function was independently associated with the Functional Oral Intake Scale. Conclusion Most patients exhibited executive dysfunction that significantly compromised oral intake.

RESUMO Objetivo Investigar potenciais associações entre funções executiva, física global e de alimentação na fase aguda do acidente vascular cerebral (AVC). Métodos Trata-se de estudo transversal envolvendo 63 pacientes admitidos em unidade de AVC de um hospital público. Os critérios de exclusão foram outros diagnósticos neurológicos e/ou psiquiátricos. Os instrumentos utilizados foram: Mini-Exame do Estado Mental e Bateria de Avaliação Frontal para avaliar funções cognitivas; Alberta Stroke Program Early CT Score para quantificação da lesão cerebral; National Institutes of Health Stroke Scale para comprometimento neurológico; Escala Modificada de Rankin para funcionalidade e Functional Oral Intake Scale para função alimentar. Resultados A amostra compreendeu 34 homens e 29 mulheres, sendo a idade média de 63,6 anos. A Bateria de Avaliação Frontal correlacionou significativamente com as demais escalas. Na análise multivariada, a variável independentemente associada com a função executiva foi a Functional Oral Intake Scale. Conclusão A maioria dos pacientes com AVC apresenta alterações das funções executivas que comprometem significativamente a alimentação oral.

Candesartan, rather than losartan, improves motor dysfunction in thioacetamide-induced chronic liver failure in rats

Minimal hepatic encephalopathy is more common than the acute syndrome. Losartan, the first angiotensin-II receptor blocker (ARB), and candesartan, another widely-used ARB, have protected against developing fibrogenesis, but there is no clear data about their curative antifibrotic effects. The current study was designed to examine their effects in an already-established model of hepatic fibrosis and also their effects on the associated motor dysfunction. Low-grade chronic liver failure (CLF) was induced in 3-month old Sprague-Dawley male rats using thioacetamide (TAA, 50 mg·kg−1·day−1) intraperitoneally for 2 weeks. The TAA-CLF rats were randomly divided into five groups (n=8) treated orally for 14 days (mg·kg−1·day−1) as follows: TAA (distilled water), losartan (5 and 10 mg/kg), and candesartan (0.1 and 0.3 mg/kg). Rats were tested for rotarod and open-field tests. Serum and hepatic biochemical markers, and hepatic histopathological changes were evaluated by H&E and Masson's staining. The TAA-CLF rats showed significant increases of hepatic malondialdehyde, hepatic expression of tumor necrosis factor-α (TNF-α), and serum ammonia, alanine aminotransferase, γ-glutamyl transferase, TNF-α, and malondialdehyde levels as well as significant decreases of hepatic and serum glutathione levels. All treatments significantly reversed these changes. The histopathological changes were moderate in losartan-5 and candesartan-0.1 groups and mild in losartan-10 and candesartan-0.3 groups. Only candesartan significantly improved TAA-induced motor dysfunction. In conclusion, therapeutic antifibrotic effects of losartan and candesartan in thioacetamide-induced hepatic fibrosis in rats are possibly through angiotensin-II receptor blocking, antioxidant, and anti-inflammatory activities. Improved motor dysfunction by candesartan could be attributed to better brain penetration and slower "off-rate" from angiotensin-II receptors. Clinical trials are recommended.

Physical exercise prevents motor disorders and striatal oxidative imbalance after cerebral ischemia-reperfusion

Stroke is the third most common cause of death worldwide, and most stroke survivors present some functional impairment. We assessed the striatal oxidative balance and motor alterations resulting from stroke in a rat model to investigate the neuroprotective role of physical exercise. Forty male Wistar rats were assigned to 4 groups: a) control, b) ischemia, c) physical exercise, and d) physical exercise and ischemia. Physical exercise was conducted using a treadmill for 8 weeks. Ischemia-reperfusion surgery involved transient bilateral occlusion of the common carotid arteries for 30 min. Neuromotor performance (open-field and rotarod performance tests) and pain sensitivity were evaluated beginning at 24 h after the surgery. Rats were euthanized and the corpora striata was removed for assay of reactive oxygen species, lipoperoxidation activity, and antioxidant markers. Ischemia-reperfusion caused changes in motor activity. The ischemia-induced alterations observed in the open-field test were fully reversed, and those observed in the rotarod test were partially reversed, by physical exercise. Pain sensitivity was similar among all groups. Levels of reactive oxygen species and lipoperoxidation increased after ischemia; physical exercise decreased reactive oxygen species levels. None of the treatments altered the levels of antioxidant markers. In summary, ischemia-reperfusion resulted in motor impairment and altered striatal oxidative balance in this animal model, but those changes were moderated by physical exercise.

Desordens do movimento: 40 aspectos e muitas dicas - Neurossemiologia / Movement disorders: 40 aspects and many tips – Neurosemiology

Os autores ressaltam aspectos neurossemiológicos que contribuem para a caracterização fenotípica de diversas desordens do movimento. Devido à alta prevalência, atenção maior é dada à doença de Parkinson e às síndromes parkinsonianas, sem contudo desprestigiar os tremores e outras hipercinesias tais como: atetose, balismo, coreia, distonias, mioclonias e as desordens do movimento de origem psicogênica...

The authors point out neurosemiologic aspects that contribute to phenotypic characterization of several movement disorders. Due to high prevalence, the authors mainly address Parkinson's disease and parkinsonian syndromes, but also consider tremors and other hyperkinesias such as: athetosis, ballism, chorea, dystonia, myoclonus and movement disorders of psychogenic origin...

Correlações anatomoclínicas na doença de Parkinson / Anatomoclinical Correlation in Parkinson´s Disease

Braak et al., em 2003, sugeriram que o processo patológico da doença de Parkinson se iniciava nos núcleos motor dorsal do vago e olfativo anterior, com progressão caudo-rostral, em seis estágios. O presente trabalho tem por finalidade correlacionar esses estágios neuropatológicos com as suas respectivas manifestações clínicas. No estágio 1, as alterações bulbares e no núcleo olfativo anterior levam a constipação intestinal, a distúrbios do sono e a hiposmia. No estágio 2, o comprometimento pontino pode induzir a depressão, a ansiedade, a distúrbios do sono e a dor de origem central. No estágio 3, a degeneração no mesencéfalo determina o aparecimento dos sintomas motores clássicos, dos distúrbios cognitivos leves e do ciclo sono-vigília. No estágio 4, as lesões saem do tronco cerebral e atingem, principalmente, o mesocórtex temporal e a amígdala, gerando as disfunções mnemônicas, executivas e a apatia. No estágio 5, as alterações acometem o neocórtex com destaque para as áreas pré-frontais e de associação sensitivas, acentuando as disfunções cognitivas. No estágio 6, a etapa mais avançada, ocorre o comprometimento difuso das áreas corticais primárias e, por conseqüência, o agravamento das dificuldades motoras e do quadro demencial. Os Autores consideram que essas observações possam contribuir, no futuro, para possíveis benefícios terapêuticos.

Braak et al., in 2003, suggested that the pathological process of Parkinson?s disease begins at the dorsal motor nucleus of the vagus and the anterior olfactory nucleus, in a six-stage caudorostral progression. The objective of our study is to correlate these neuropathological stages with their clinical manifestations. Stage 1-related pathology started at the medulla oblongata and the anterior olfactory nucleus, leading to intestinal constipation, sleep disorders and hyposmia. At stage 2 the lesions on the pons produce symptoms of depression, anxiety, sleep disorders and central pain. In the third stage the degeneration reaches the midbrain and the classical motor symptoms appear as well as mild cognitive and sleep disorders. Stage 4 - related lesions advance upwards and exit the brain stem to the temporal mesocortex and amygdala resulting in mnemonic and executive dysfunctions and apathy. At stage 5 the lesions progress to the neocortex, mainly the prefrontal and sensory association areas, worsening the cognitive dysfunctions. At stage 6, the most advanced phase, there is the spreading of the process into the primary cortical areas, further worsening the motor symptoms and dementia. The Authors speculate that these observations could contribute to the improvement of therapeutic strategies in the future.

Discinesia tardia - diagnóstico e tratamento farmacológico ao alcance do cirurgião-dentista / Tardive dyskinesia - diagnosis and pharmacological treatment within the reach of dentists

Discinesia tardia é uma síndrome irreversível caracterizada pelo aumento involuntário da atividade motora. Acomete especialmente o idoso e 20% dos indívíduos em uso de neurolépticos e andipressivos. Outros fatores de risco incluem o gênero feminino, co-morbidade psiquiátrica, transtornos extrapiramidais, fumo, diabetes e pacientes com prótese total mal adaptada. A fisiopatologia da desordem inclui alterações em neurônios dopaminérgicos, serotoninérgicos e gabaérgicos. Esta revisão tem como objetivo descrever as manifestações clínicas das discinesias orofaciais induzidas por fármacos, próteses mal adaptadas ou em decorrência de doenças hereditárias e sistêmicas, propondo tratamentos eficazes, preventivos e ao alcance do cirurgião-dentista.

Síndromes neuropsiquiátricas pós-estreptocócicas / Post-streptococcal neuropsychiatric syndromes

Nesta revisão narrativa, o nosso objetivo foi descrever as síndromes neuropsiquiátricas pós estreptocócicas e discuti-las à luz das evidências científicas atuais sobre os possíveis mecanismos patogenéticos envolvidos. Nos últimos anos, uma série de distúrbios do movimento, como tiques, distonia, parkinsonismo, e transtornos psiquiátricos, como o transtorno obsessivo-compulsivo (TOC) e o transtorno da hiperatividade com déficit de atenção (THDA), vem sendo considerada parte do espectro das manifestações pós-estreptocócicas. O termo PANDAS (acrônimo do inglês: pediatric autoimmune neuropsychiatric disorder associated with streptococcus) foi inclusive cunhado para descrever um subgrupo de pacientes com TOC e tiques que inibe flutuação clínica dos sintomas associada a infecção estreptocócica. Entretanto a análise crítica das evidências clinicolaboratoriais não apóia esse espectro ampliado das manifestações pós-estreptocócicas. Apenas na coréia de Sydenham há evidências consistentes de patogênese mediada por processo auto-imune pós-estreptocócico.

In this narrative review, our objective was to describe the post-streptococcal neuropsychiatric syndromes and to discuss the possible pathogenetic mechanisms involved in their clinical expression. Recently, several movement disorders, such as tics, dystonia, and parkinsonism, and psychiatric disorders like obsessive-compulsive disorders (OCD) and attention deficit hyperativity disorder (ADHD), are being considered part of a putative spectrum of post-streptococcal infection disorder. The term PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) has been introduced to describe a subset of patients with these diagnoses in which onset of symptoms or symptom exacerbations are related to streptococcal infection. However the critical analysis of clinical and laboratory data does not support the hypothesis of an extended spectrum of post-streptococcal neuropsychiatric disorders. Only for Sydenham chorea there is consistent evidence for a post-streptococcal autoimmune mediated pathogenesis.