ABSTRACT
Introduction: Holoprosencephaly (HPE) is a central nervous system malformation defined by incomplete separation of the prosencephalon in two hemispheres and determines a broad spectrum of clinical presentations based on extension of non-separation. Case Presentation: A 1 year and 8 months' old girl with semilobar HPE and 18p deletion syndrome was admitted to our hospital due to viral bronchiolitis. During hospitalization, she started generalized choreic movements, with face dyskinesia and without any identified aggravating factors. Haloperidol, clonazepam, and valproic acid did not achieve an attenuation of the movement disorder. Significant symptom relief was obtained with the use of trihexyphenidyl, with reduced amplitude and frequency of movements, but hyperthermia compromised its use. Control of chorea with no important side effects was only achieved after the introduction of carbamazepine. Discussion: Despite significant morbidity, there are few cases described in the literature of chorea and movement disorders in HPE and no effective treatment strategies described. Carbamazepine is an antiepileptic drug that stabilizes voltage-gated sodium channels and is the most effective treatment for paroxysmal kinesigenic dyskinesia. Although it has been used successfully in the treatment of different movement disorders, few therapeutic trials have been reported. The mechanism by which carbamazepine alleviates chorea is still unknown but may be justified through the blocking of post-synaptic dopamine receptors and stimulation of cholinergic pathways.
ABSTRACT
Esta revisão sistemática visa identificar os fatores de risco psicossociais para depressão pós-parto (DPP). Foram selecionados 11 artigos por meio das bases: Embase, Medline e SciELO. Os critérios de inclusão foram: data de publicação nos últimos cinco anos, língua inglesa ou portuguesa, delineamento observacional longitudinal e ser referente a fatores de risco psicossociais para DPP. Foram encontrados 25 fatores de risco psicossociais. Entre eles, os fatores mais citados foram: falta de apoio social/familiar, gravidez não planejada, história pessoal de doença psiquiátrica, relacionamento ruim com o parceiro, idade menor que 20 anos e baixa escolaridade. A prevalência de DPP alcançou valores de 4,5% até 50,3% nos estudos avaliados. Isso demonstra a importância da detecção precoce desses fatores de risco e de mais investimentos na área de prevenção dessa doença. Para uma visão integral da doença, uma análise envolvendo uma amostra maior de artigos de bases de dados alternativas se faz necessária.(AU)
This systematic review has the purpose of identifying psychosocial risk factors on post-partum depression (PPD). Eleven articles were selected utilizing three databases: Embase, Medline and SciELO. The inclusion criteria were: publication data in the last five years, English or Portuguese, longitudinal observational design and reference to psychosocial risk factors for Postpartum Depression.Twenty-five factors were identified. Some of them were identified more than others, such as social and/or family support, unplanned pregnancy, personal history of psychiatric diseases, bad relationship with the partner, age under 20 years old, and low levels of schooling. PPD's prevalence was between 4,5% and 50,3%. These numbers confirm the importance of both early detection of risk factors as well as more investments in the prevention of this disease. For an integral view of the disease, an analysis involving a larger sample of alternative database articles is required.(AU)
