Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital / Consultas neurológicas e diagnósticos em um grande hospital universitário dedicado a COVID-19

ABSTRACT Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

RESUMO Introdução: Mais de um terço dos pacientes com COVID-19 apresentam sintomas neurológicos que variam de anosmia a AVC e encefalopatia. Além disso, doenças neurológicas prévias podem exigir tratamento especial e estar associadas a piores desfechos. Não obstante, o papel dos neurologistas na COVID-19 é provavelmente pouco reconhecido. Objetivo: O objetivo deste estudo foi relatar os motivos para solicitar consultas neurológicas por clínicos e intensivistas em um hospital dedicado à COVID-19. Métodos: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil, um centro dedicado à COVID-19 com 900 leitos (incluindo 300 leitos para unidades de terapia intensiva). O diagnóstico de COVID-19 foi confirmado por SARS-CoV-2-RT-PCR em swabs nasais. Todas as interconsultas de neurologia hospitalar entre 23 de março e 23 de maio de 2020 foram analisadas. Os neurologistas realizaram o exame neurológico, avaliaram todos os dados disponíveis para diagnosticar a patologia neurológica e solicitaram exames adicionais conforme necessidade. Diagnósticos difíceis foram estabelecidos em reuniões de consenso. Após o diagnóstico, os neurologistas participaram da condução dos casos. Resultados: Foram solicitadas consultas neurológicas para 89 de 1.208 (7,4%) em pacientes internados por COVID-19 durante o período. Os principais diagnósticos neurológicos incluíram: encefalopatia (44,4%), acidente vascular cerebral (16,7%), doenças neurológicas prévias (9,0%), crises epilépticas (9,0%), transtornos neuromusculares (5,6%), outras lesões encefálicas agudas (3,4%) e outros sintomas leves inespecíficos (11,2%). Conclusões: A maioria das consultas neurológicas em um hospital dedicado à COVID-19 foi solicitada para condições graves que poderiam afetar o desfecho clínico. Os médicos na linha de frente devem ser capazes de reconhecer sintomas neurológicos. Os neurologistas são membros importantes da equipe médica no atendimento hospitalar à COVID-19.

Non-invasive brain stimulation therapies / Terapias de neuroestimulação não invasivas

Noninvasive brain stimulation therapies are a promising field for the development of new protocols for the treatment of neuropsychiatric disorders. They are based on the stimulation of neural networks with the intent of modeling their synaptic activity to adequate levels. For this, it is necessary to precisely determine which networks are related to which brain functions, and the normal activation level of each of these networks, so that it is possible to direct the stimulation to the affected networks in order to induce the desired effects. These relationships are under intense investigation by the scientific community, and will contribute to the advancement of treatments by neurostimulation, with the emergence of increasingly accurate and effective protocols for different disorders. Currently, the most used techniques are Transcranial Direct Current Stimulation and Transcranial Magnetic Stimulation, with the most common applications being for treating Major Depressive Disorder. The advancement of research in this field may determine new target networks for stimulation in the treatment of other disorders, extending the application of these techniques and also our knowledge about brain functioning.

As terapias biológicas não invasivas se apresentam como um campo promissor para o desenvolvimento de novos protocolos de tratamento de transtornos neuropsiquiátricos. Elas se baseiam na estimulação de redes neurais com intuito de modular sua atividade sináptica para níveis adequados. Para isso, é necessário a determinação precisa de quais redes estão relacionadas a quais funções cerebrais, e do nível de ativação normal de cada uma dessas redes, para que então seja possível direcionar a estimulação às redes afetadas a fim de induzir os efeitos desejados. Essas relações estão sob intensa investigação pela comunidade científica, e vão contribuir para o avanço dos tratamentos por neuroestimulação, com o surgimento de protocolos cada vez mais precisos e efetivos para diferentes transtornos. Atualmente, as técnicas mais utilizadas são a Estimulação Transcraniana por Corrente Contínua e a Estimulação Magnética Transcraniana, sendo a aplicação mais comum no tratamento do Transtorno Depressivo Maior. O avanço das pesquisas possivelmente determinará novas redes alvo para estimulação no tratamento de outros transtornos, estendendo a aplicação dessas técnicas e também do nosso conhecimento sobre o funcionamento cerebral.

Biologically active dietary supplement for correction of exchange disorders in nervous system diseases

The prescription composition of the biologically active dietary supplement (BADS) Oleopren Neuro has been scientifically substantiated through the pharmacological evaluation of the effective agents, polyprenols being the main of them. The technology of an innovative product has been developed, with the establishment of adjustable production parameters securing high organoleptic advantages and stability of the BADS. Regulated indicators of quality and nutritional value have been determined. Sanitary toxicological and hygienic safety indicators of the product under development had been studied, which allowed to establish a shelf life of two years taking the safety margin of three months into account. The possible mechanisms of the dolichols effect on the metabolic status of the organism were considered. Clinical trials of the efficiency and functional focus of a specialized product on a representative group of patients with the dyscirculatory encephalopathy (DE) of vascular genesis stages I ­ II were conducted. The BADS were included in the diet of patients, along with the basic therapy, one capsule twice a day for 10 days. The materials obtained in this article allow to recommend the developed product as an efficient means of increasing the body's resistance to adverse effects of the environment, stressful situations, as well as psychoemotional and physical stress.

Nanotechnology and multipotent adult progenitor cells in Reparative Medicine: therapeutic perspectives / Nanotecnologia e as células progenitoras adultas multipotentes na Medicina Reparativa: perspectivas terapêuticas

ABSTRACT The biology of stem cells is one of the most dynamic and promising fields of the biological sciences, since it is the basis for the development of organisms. Its biological complexity demands efforts from several lines of research aimed mainly at its therapeutic use. Nanotechnology has been emerging as a new field of study, which shows great potential in the treatment of various diseases. This new area of health has been called "Nanomedicine" or "Bionanotechnology", which can be applied in Medicine by transport and drug delivery systems, robotic tools to be used in diagnostic and surgical processes, nanobiomaterials, gene therapies, nanobiomedical devices, among others. Because stem cells and Nanotechnology are two areas of extremely promising science, a new field of study, called "stem cell Nanotechnology", has gradually emerged. In this, Nanotechnology is used to help the stem cells apply their therapeutic potential in the treatment, cure, and repair of the damaged tissues, in an effective and safe way. In this way, stem cell Nanotechnology has generated great interest, since it may result in significant contributions to Regenerative Medicine and tissue engineering. The present work aims to present the state-of-the-art regarding its therapeutic use in Human Medicine.

RESUMO A biologia das células-tronco é um dos campos mais dinâmicos e promissores das ciências biológicas, pois é a base do desenvolvimento dos organismos. Sua complexidade biológica demanda esforços de diversas linhas de pesquisa, visando principalmente à sua utilização terapêutica. A Nanotecnologia surge como um novo campo de estudo, o qual demonstra grande potencial no que tange ao tratamento de diversas doenças. Esta nova área da saúde vem sendo denominada "Nanomedicina" ou "Bionanotecnologia", a qual pode ser aplicada na Medicina por meio da utilização de sistemas de transporte e liberação de fármacos, ferramentas robóticas a serem utilizadas em processos de diagnóstico e cirurgia, nanobiomateriais, terapias gênicas, dispositivos nanobiomédicos, entre outros. Em razão das células-tronco e a Nanotecnologia serem duas áreas da ciência extremante promissoras, um novo campo de estudo, denominado "Nanotecnologia das células-tronco", surge gradativamente. Neste, a Nanotecnologia é utilizada de forma a auxiliar as células-tronco a exercerem seu potencial terapêutico no tratamento, na cura e na reparação dos tecidos lesionados, de forma eficaz e segura. A Nanotecnologia das células-tronco tem gerado grande interesse, podendo resultar em contribuições significativas na Medicina Regenerativa e na engenharia de tecidos. O presente trabalho teve por objetivo apresentar o estado da arte visando à sua utilização terapêutica na Medicina Humana.

Relationship of family management with sociodemographic aspects and children's physical dependence in neurological disorders / Relação do manejo familiar com aspectos sociodemográficos e de dependência física infantojuvenil em agravos neurológicos / Relación del manejo familiar con aspectos sociodemográficos y de dependencia física infantojuvenil en agravio neurológicos

ABSTRACT Objective: To investigate the relationship of family management with sociodemographic and physical dependence aspects of children and adolescents with neurological impairment. Method: Descriptive, cross-sectional study conducted at a child neurology center. A non-probabilistic sample was obtained from 141 family members who answered two instruments: a) Sociodemographic condition of families; b) Family Management Measure. In the statistical analysis, we used the Spearman Coefficient and the Mann Whitney Test. Results: the longer the specialized care time, the lower the identity score (rs = - 0.209, p = 0.01); the higher the effort score (rs = 0.181, p = 0.03), the family difficulty score (rs = 0.239, p = 0.001) and the impact of the disease on family life (rs = 0.213, p = 0.01). The families of children and adolescents with physical dependence for activities of daily living presented a higher score in the following dimensions: management effort (<0.001), family difficulty (p = 0.004) and perception of disease impact (p = 0.001). Conclusion: There was evidence of a correlation between management with sociodemographic and child dependence aspects, with an association between management difficulty and longer time of child and adolescent care.

RESUMO Objetivo: investigar a relação do manejo familiar com aspectos sociodemográficos e de dependência física de crianças e adolescentes com agravo neurológico. Método: estudo descritivo, transversal, realizado em um centro de neurologia infantil. Obteve-se amostra não probabilística de 141 familiares que responderam a dois instrumentos: a) Condição sociodemográfica das famílias; b) Medida de Manejo Familiar. Na análise estatística, utilizou-se o Coeficiente de Spearman e o Teste de Mann Whitney. Resultados: quanto maior o tempo de atendimento especializado, menor o escore de identidade (rs= - 0,209, p=0,01); maior o escore de esforço (rs=0,181, p = 0,03), de dificuldade familiar (rs=0,239, p = <0,001) e do impacto da doença na vida familiar (rs=0,213, p=0,01). As famílias de crianças e adolescentes com dependência física para as atividades de vida diária apresentaram maior escore nas seguintes dimensões: esforço de manejo (<0,001), dificuldade familiar (p=0,004) e visão do impacto da doença (p=<0,001). Conclusão: evidenciou-se correlação entre o manejo com os aspectos sociodemográficos e de dependência física infantojuvenil, com associação entre a dificuldade de manejo e maior tempo de atendimento infantojuvenil.

RESUMEN Objetivo: investigar la relación del manejo familiar con aspectos sociodemográficos y de dependencia física de niños y adolescentes con agravio neurológico. Método: estudio descriptivo, transversal, realizado en un centro de neurología infantil. Se Obtuvo la muestra no probabilística de 141 familiares que respondieron a dos instrumentos: a) Condición sociodemográfica de las familias; b) Medida de Manejo Familiar. En el análisis estadístico, se utilizó el Coeficiente de Spearman y el Test de Mann Whitney. Resultados: cuanto mayor el tiempo de atendimiento especializado, menor el puntaje de identidad (rs= - 0,209, p=0,01); mayor el puntaje de esfuerzo (rs=0,181, p = 0,03), de dificultad familiar (rs=0,239, p = <0,001) y del impacto de la enfermedad en la vida familiar (rs=0,213, p=0,01). Las familias de niños y adolescentes con dependencia física para las actividades de vida diaria presentaron mayor puntaje en las siguientes dimensiones: esfuerzo de manejo (<0,001), dificultad familiar (p=0,004) y visión del impacto de la enfermedad (p=<0,001). Conclusión: se evidenció una correlación entre el manejo con los aspectos sociodemográficos y de dependencia física infantojuvenil, con asociación entre la dificultad de manejo y mayor tiempo de atendimiento infantojuvenil.

Acute Onset Neurological Disorders during Pregnancy: A Literature Review / Doenças neurológicas de início durante a gravidez: análise crítica da literatura

Abstract Objectives To characterize the most common peripheral and central neurological disorders during pregnancy. Methods Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases. Results Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications. Conclusions It is possible to achieve a precise diagnosis,management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.

Resumo Objetivos Caracterizar as alterações neurológicas centrais e periféricas mais comuns durante a gravidez. Métodos Foi efetuada uma revisão da literatura acerca de complicações neurológicas durante a gravidez. Foram utilizadas diversas bases de dados usando palavras-chave relacionadas com o tema. Resultados A gravidez envolve alterações fisiológicas que podem desencadear alterações neurológicas periféricas e/ou do sistema nervoso central, por vezes associadas a distúrbios hipertensivos. Um diagnóstico definitivo pode ser feito tendo em conta o trimestre de gravidez e os achados clínicos encontrados. A síndrome do túnel carpal e a paralisia facial periférica são alterações neurológicas periféricas comuns que ocorrem mais frequentemente na segunda metade da gravidez. As alterações em termos do sistema nervoso central são mais complexas. Um diagnóstico preciso é fulcral, não só para melhorar os desfechos perinatais, mas também para efetuar uma vigilância e tratamento adequados e para prevenir complicações agudas e a longo prazo. Conclusões Um diagnóstico preciso e um acompanhamento e tratamento apropriados dos distúrbios neurológicos durante a gravidez são ações exequíveis. Contudo, requerem uma abordagem multidisciplinar, crucial para melhorar os desfechos perinatais.

Simple motor tasks independently predict extubation failure in critically ill neurological patients / Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

ABSTRACT Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

RESUMO Objetivo: Avaliar a utilidade de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. Métodos: Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. Resultados: Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo menos 24 h e que passaram no teste de respiração espontânea. A regressão logística mostrou que a incapacidade dos pacientes de apertar a mão do examinador (risco relativo = 1,57; IC95%: 1,01-2,44; p < 0,045) e de pôr a língua para fora (risco relativo = 6,84; IC95%: 2,49-18,8; p < 0,001) foram fatores independentes de risco de extubação malsucedida. Houve diferenças significativas entre os pacientes nos quais a extubação foi malsucedida e aqueles nos quais a extubação foi bem-sucedida quanto à pontuação obtida no Acute Physiology and Chronic Health Evaluation II (p = 0,02), pontuação obtida na Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). Conclusões: A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders / Uso clínico da estimulação magnética transcraniana e da estimulação transcraniana por corrente direta em transtornos de ansiedade e de transtornos neuropsiquiátricos

ABSTRACT Transcranial magnetic stimulation (TMS) has recently been investigated as a possible adjuvant treatment for many neuropsychiatric disorders, and has already been approved for the treatment of drug-resistant depression in the United States and in Brazil, among other countries. Although its use in other neuropsychiatric disorders is still largely experimental, many physicians have been using it as an off-label add-on therapy for various disorders. More recently, another technique, transcranial direct current stimulation (tDCS), has also become available as a much cheaper and portable alternative to TMS, although its mechanisms of action are different from those of TMS. The use of off-label therapeutic TMS or tDCS tends to occur in the setting of diseases that are notoriously resistant to other treatment modalities. Here we discuss the case of anxiety disorders, namely panic and post-traumatic stress disorders, highlighting the uncertainties and potential problems and benefits of the clinical use of these neuromodulatory techniques at the current stage of knowledge.

RESUMO A estimulação magnética transcraniana (TMS) foi recentemente proposta como um possível tratamento adjuvante para muitos distúrbios neuropsiquiátricos, e já foi aprovada para o tratamento de depressão fármaco-resistente nos Estados Unidos e no Brasil, entre outros países. Apesar do fato de que seu uso em outros transtornos neuropsiquiátricos ainda é em grande parte experimental, muitos médicos têm utilizado essas técnicas como uma terapia off-label em várias doenças. Mais recentemente, uma outra técnica, a estimulação transcraniana por corrente contínua (ETCC), tornou-se também disponível como uma alternativa muito mais barata e portátil do que a TMS, embora os seus mecanismos de ação sejam diferentes daqueles da TMS. O uso off-label de TMS ou ETCC tende a ocorrer no caso de doenças que são notoriamente resistentes a outras modalidades terapêuticas. Aqui nós discutimos o caso dos transtornos de ansiedade, ou seja, transtorno do pânico e estresse pós-traumático, destacando as incertezas, benefícios e problemas potenciais inerentes ao uso clínico dessas técnicas neuromoduladoras no atual estágio do conhecimento.

Reflex cough PEF as a predictor of successful extubation in neurological patients / Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

AbstractObjective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

ResumoObjetivo:Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.Métodos:Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.Resultados:A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR < 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.Conclusões:O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

Umbilical cord mesenchymal stem cells in neurological disorders: A clinical study.

We investigated the intrathecally administrated unbilical cord mesenchymal stem cells (UC-MSCs) by lumbar puncture and assessed the technical difficulties and effects in various neurological conditions. One hundred patients underwent subarachnoid placement of UC-MSCs between December 2006 and May 2010 in the Affiliated Hospital of Medicine. Technical difficulties in patients in the form of localization of subarachnoid space, number of attempts, and post-procedural complications were evaluated. Functional evaluation was done using Hauser Ambulation Index (HAI) by the stem cell transplant team on a regular basis. All patients were followed-up for more than 1 yr after the treatment. Clinical symptoms, related biochemical index and photographic examinations were observed regularly. We encountered technical difficulties in 31 patients (31%) in the form of general anesthesia supplementation and difficulty localizing the lumbar space. Side effects (headache, low-grade fever, low back pain and lower limb pain) were observed in 22 (22%) patients, which were treated with symptomatic therapy within 48 h. One year after the treatment, functional indices improved in 47 patients (47%): 12 patients with spinal cord injury, 11 patients with cerebral palsy, 9 patients with post-traumatic brain syndrome, 9 patients with post-brain infarction syndrome, 3 patients with spinocerebellar ataxias, and 3 patients with motor neuron disease. In conclusion,intrathecal administration of UC-MSCs is a safe and effective way to treat neurological disorders. Our encouraging results of intrathecal administration of UC-MSCs indicate the potential of restoration of lost tissue and improvement of function in patients with profound neurological defects and inefficient conventional cure. These data support expanded double-blind, placebo-controlled studies for this treatment modality.

Neuroactive compounds obtained from arthropod venoms as new therapeutic platforms for the treatment of neurological disorders

The impact of neurological disorders in society is growing with alarming estimations for an incidence increase in the next decades. These disorders are generally chronic and can affect individuals early during productive life, imposing real limitations on the performance of their social roles. Patients can have their independence, autonomy, freedom, self-image, and self-confidence affected. In spite of their availability, drugs for the treatment of these disorders are commonly associated with side effects, which can vary in frequency and severity. Currently, no effective cure is known. Nowadays, the biopharmaceutical research community widely recognizes arthropod venoms as a rich source of bioactive compounds, providing a plethora of possibilities for the discovery of new neuroactive compounds, opening up novel and attractive opportunities in this field. Several identified molecules with a neuropharmacological profile can act in the central nervous system on different neuronal targets, rendering them useful tools for the study of neurological disorders. In this context, this review aims to describe the current main compounds extracted from arthropod venoms for the treatment of five major existing neurological disorders: stroke, Alzheimers disease, epilepsy, Parkinsons disease, and pathological anxiety.

Prise en charge des douleurs neuropathiques au Sénegal : expérience du centre national d'appareillage orthopédique de Dakar

Introduction : Les douleurs neuropathiques sont graves et de prise en charge difficile. L'efficacité du traitement est jugée sur l'amélioration de la qualité de vie.Objectifs : Déterminer la fréquence des douleurs neuropathiques et apprécier l'efficacité de thérapeutiques utilisées et les difficultés à l'instauration des recommandation dans un centre à Dakar.Méthodologie : Une étude prospective de 4 mois a été menée au Centre National d'Appareillage Orthopédique dont l'objectif a été d'apprécier les obstacles à l'instauration des recommandations internationales sur la prise en charge des douleurs neuropathiques. Les patients reçus pour des douleurs chroniques ont répondu aux questionnaires DN4 et ceux qui ont eu des douleurs neuropathiques inclus. L'intensité de la douleur, le retentissement fonctionnel, et la qualité du sommeil, ont été évalués avant et après traitement. Les effets secondaires des médicaments, les raisons d'une non adhérence au traitement ont été notés et la conformité des examens complémentaires vérifiée.Résultats : 53 patients avec un âge moyen de 50,22 ans ont été inclus. L'EVA moyen a été de 5,75. La marche a été anormale dans 33,96% des cas, impossible (4 cas), la montée et descente des escaliers impossible (18,83%), le périmètre de marche inferieur à 1000m (18,86%) et 13,20% des patients incapables de ramasser un objet à terre. Les activités professionnelles suspendues dans 2 cas et le sommeil perturbé dans 33,96% des cas. Le traitement de première intention a été l'Amitriptyline (54,71%) et a été responsable d'effets secondaires dans 3 cas. Après un recul de 2 mois, la reprise effective des différentes activités a été obtenue dans 94,53%.Discussion et Conclusion : Même si la diminution de l'EVA au cours des douleurs neuropathiques sous traitement est parfois minime, le retentissement sur la qualité de vie doit être apprécié avant de conclure à une inefficacité thérapeutique. Le choix des molécules doit tenir compte de l'accessibilité du médicament. La rééducation doit être effectuée surtout en cas de retentissement fonctionnel et/ ou d'association à d'autres déficiences neurologiques

Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review / Estimulação transcutânea do nervo vago e do nervo trigêmeo para o tratamento de distúrbios neuropsiquiátricos: revisão sistemática

We reviewed trigeminal nerve stimulation (TNS) and transcutaneous vagus nerve stimulation (tVNS). All techniques have shown preliminary promising results, although the results are mixed. Method: We performed a systematic review of the Medline and Embase databases, with no constraint to dates, through June 2013. The keywords were [(1) trigeminal nerve stimulation OR (2) cranial nerve OR (3) trigemin* OR (4) transcutaneous VNS OR (5) transcutaneous cranial nerve stimulation] and (6) mental disorders. Results: We included four preclinical and clinical five studies on TNS. All clinical data were based on open-label studies with small samples, which diminished the external validity of the results, thus reflecting the modest impact of TNS in current clinical practice. Of the tVNS clinical trials, three assessed physiological features in healthy volunteers, and one examined patients with epilepsy. Conclusion: TNS and tVNS improve treatment of particular neuropsychiatric disorders such as depression. .

O uso de estimulação de nervos cranianos de maneira transcutânea tem sido uma estratégia em desenvolvimento recente. Diferentes estudos apontam para resultados clínicos favoráveis no tratamento de diferentes quadros neuropsiquiátricos. Método: Revisão sistemática da literatura com base nas bibliotecas eletrônicas Medline e Embase, sem restrição de data inicial, até agosto de 2013. Os termos de busca utilizados foram [(1) trigeminal nerve stimulation OR (2) cranial nerve OR (3) trigemin* OR (4) transcutaneous VNS OR (5) transcutaneous cranial nerve stimulation] and (6) mental disorders. Resultados: Incluímos quatro estudos pré-clinicos e cinco estudos clínicos abordando estimulação do nervo trigêmeo. Todos os estudos foram abertos, com pequenas amostras, o que reduz a validade externa dos dados, refletindo a ainda incipiente atuação da técnica, apesar de promissora. Considerando-se a estimulação do nervo vago, três artigos avaliaram aspectos fisiológicos em voluntários saudáveis e um artigo estudou pacientes com epilepsia. Conclusão: As estratégias de estimulação transcutânea de nervos cranianos, apesar de incipiente, tem demonstrado resultados clínicos favoráveis no tratamento de distúrbios neuropsiquiátricos. .

Presente y futuro de la estimulación magnética transcraneal / Present and future of the transcranial magnetic stimulation

La estimulación magnética transcraneal ha llamado la atención de neurocientíficos y público en general por la posibilidad de estimular y “controlar” el sistema nervioso de forma no invasiva, realizar diagnósticos más exactos, y aplicar tratamientos y programas de rehabilitación más efectivos en múltiples enfermedades que afectan el sistema nervioso. Así mismo, esta novedosa herramienta ha ayudado a develar la complejidad del comportamiento neural, sus conexiones y su modulación plástica. La estimulación magnética aplicada de manera simple o pareada, se ha convertido en una alternativa útil en el diagnóstico de enfermedades como esclerosis múltiple, enfermedad de Parkinson, epilepsia, distonía, esclerosis lateral amiotrófica, enfermedad cerebro vascular, así como el sueño y sus trastornos, entre otras alteraciones. A nivel terapéutico, se ha sugerido el uso de la estimulación magnética repetitiva con diferentes niveles de evidencia en depresión refractaria a tratamiento farmacológico convencional, tinitus, afonía psicógena, enfermedad de Alzheimer, autismo, enfermedad de Parkinson, distonías, accidente cerebro vascular, epilepsia, trastornos de ansiedad generalizada, estrés post-traumático, alucinaciones auditivas, dolor crónico, afasias, trastorno obsesivo compulsivo, disquinesias inducidas por L-Dopa, manía y síndrome de Rasmussen, entre otros trastornos. Su beneficio en neurorehabilitación es una realidad inocultable, en cuyo caso se ha podido usar con efectividad y, prácticamente, sin efectos secundarios.

Magnetic stimulation has called the attention of neuroscientists and the public due to the possibility to stimulate and “control” the nervous system in a non-invasive way. It has helped to make more accurate diagnosis, and apply more effective treatments and rehabilitation protocols in several diseases that affect the nervous system. Likewise, this novel tool has increased our knowledge about complex neural behavior, its connections as well as its plastic modulation. Magnetic stimulation applied in simple or paired-pulse protocols is a useful alternative in the diagnosis of diseases such as multiple sclerosis, Parkinson disease, epilepsy, dystonia, amyotrophic lateral sclerosis, cerebrovascular disease, and sleep disorders. From the therapeutic perspective, magnetic stimulation applied repetitively has been found useful, with different degrees of efficacy, in treating resistant depression, tinnitus, psychogenic dysphonia, Alzheimer disease, autism, Parkinson disease, dystonia, stroke, epilepsy, generalized anxiety as well as post traumatic stress disorder, auditory hallucinations, chronic pain, aphasias, obsessive-compulsive disorders, L-dopa induced dyskynesia, mania and Rasmussen syndrome, among others. The potential of magnetic stimulation in neurorehabilitation is outstanding, with excellent range of safety and, in practical terms, without side effects.