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Sena LS, Furtado GV, Pedroso JL, Barsottini O, Cornejo-Olivas M, Nóbrega PR, Braga Neto P, Soares DMB, Vargas FR, Godeiro C, Medeiros PFVD, Camejo C, Toralles MBP, Fagundes NJR, Jardim LB, Saraiva-Pereira ML. Spinocerebellar ataxia type 2 has multiple ancestral origins. Parkinsonism Relat Disord 2024; 120:105985. [PMID: 38181536 DOI: 10.1016/j.parkreldis.2023.105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Spinocerebellar ataxia type 2 (SCA2) is a dominant neurodegenerative disorder due to expansions of a CAG repeat tract (CAGexp) at the ATXN2 gene. Previous studies found only one ancestral haplotype worldwide, with a C allele at rs695871. This homogeneity was unexpected, given the severe anticipations related to SCA2. We aimed to describe informative ancestral haplotypes found in South American SCA2 families. METHODS Seventy-seven SCA2 index cases were recruited from Brazil, Peru, and Uruguay; 263 normal chromosomes were used as controls. The SNPs rs9300319, rs3809274, rs695871, rs1236900 and rs593226, and the STRs D12S1329, D12S1333, D12S1672 and D12S1332, were used to reconstruct haplotypes. RESULTS Eleven ancestral haplotypes were found in SCA2 families. The most frequent ones were A-G-C-C-C (46.7 % of families), G-C-C-C-C (24.6 %) and A-C-C-C-C (10.3 %) and their mean (sd) CAGexp were 41.68 (3.55), 40.42 (4.11) and 45.67 (9.70) (p = 0.055), respectively. In contrast, the mean (sd) CAG lengths at normal alleles grouped per haplotypes G-C-G-A-T, A-G-C-C-C and G-C-C-C-C were 22.97 (3.93), 23.85 (3.59), and 30.81 (4.27) (p < 0.001), respectively. The other SCA2 haplotypes were rare: among them, a G-C-G-A-T lineage was found, evidencing a G allele in rs695871. CONCLUSION We identified several distinct ancestral haplotypes in SCA2 families, including an unexpected lineage with a G allele at rs695871, a variation never found in hundreds of SCA2 patients studied worldwide. SCA2 has multiple origins in South America, and more studies should be done in other regions of the world.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil.
| | - Gabriel Vasata Furtado
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Orlando Barsottini
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Mario Cornejo-Olivas
- Neurogenetics Working Group, Universidad Cientifica del Sur, 19 Panamericana S Avenue, 15067, Lima, 15067, Peru; Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancas St, 15003, Lima, Peru
| | - Paulo Ribeiro Nóbrega
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Centro Universitário Christus, Rua Alexandre Baraúna 949, 60430-160, Fortaleza, CE, Brazil
| | - Pedro Braga Neto
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Danyela Martins Bezerra Soares
- Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Fernando Regla Vargas
- Departamento de Genética e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca 94, 20211-010, Rio de Janeiro, Brazil; Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avenida Brasil 4365, 21040-900, Rio de Janeiro, Brazil
| | - Clecio Godeiro
- Departamento de Medicina Integrada, Hospital Universitário Onofre Lopes, Avenida Nilo Peçanha, 59012-300, Natal, Brazil
| | - Paula Frassinetti Vasconcelos de Medeiros
- Unidade Acadêmica de Medicina, Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande, Rua Carlos Chagas S/n, 58107-670, Campina Grande, Brazil
| | - Claudia Camejo
- Facultad de Medicina. Universidad de La República, Avenida General Flores 3461, 11700, Montevideo, Uruguay
| | | | - Nelson Jurandi Rosa Fagundes
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Departamento de Genética, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-002, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600, 90035-003, Porto Alegre, Brazil
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Bovolenta TM, Schumacher-Schuh AF, Santos-Lobato BLD, Godeiro Júnior CDO, Silva DJD, Nicaretta D, Barbosa ER, Cardoso FEC, Della Coletta MV, Braga Neto P, Cury RG, Tumas V, Felicio AC. Average annual cost of Parkinson's disease in a Brazilian multiethnic population. Parkinsonism Relat Disord 2023; 117:105897. [PMID: 37931350 DOI: 10.1016/j.parkreldis.2023.105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION With the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far. OBJECTIVES To evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP). METHODS Categorical and numerical data were collected through a customized and standardized cost-related-questionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions. RESULTS The estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y). CONCLUSION This data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.
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Affiliation(s)
| | | | | | | | - Delson José da Silva
- Neuroscience Core, Hospital Clinics, Federal University of Goiás, Brazil Integrated Neurosciences Institute, Goiás, Brazil.
| | - Denise Nicaretta
- School of Medicine and Surgery - UNIRIO HUGG/EBSERH Rio de Janeiro, Brazil.
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, SP, Brazil.
| | - Francisco E C Cardoso
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | | | - Pedro Braga Neto
- Department of Clinical Medicine, Neurology Section, Federal University of Ceará, Ceará, Brazil.
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Vitor Tumas
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| | - Andre C Felicio
- Department of Neurology and Brain Institute, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Barsottini OGP, Moraes MPMD, Fraiman PHA, Marussi VHR, Souza AWSD, Braga Neto P, Spitz M. Sjogren's syndrome: a neurological perspective. Arq Neuropsiquiatr 2023; 81:1077-1083. [PMID: 38157875 PMCID: PMC10756846 DOI: 10.1055/s-0043-1777105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
Sjogren's syndrome (SS) is a complex autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands, resulting in sicca symptoms. Additionally, SS presents with neurological manifestations that significantly impact the nervous system. This review aims to provide a comprehensive overview of the neurological aspects of SSj, covering both the peripheral and central nervous system involvement, while emphasizing diagnosis, treatment, and prognosis.
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Affiliation(s)
- Orlando Grazianni Povoas Barsottini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Marianna Pinheiro Moraes de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Pedro Henrique Almeida Fraiman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | | | - Alexandre Wagner Silva de Souza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Divisão de Reumatologia, São Paulo SP, Brazil.
- Sociedade Brasileira de Reumatologia, Comissão de Vasculites, São Paulo SP, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brazil.
- Universidade do Estado do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil.
| | - Mariana Spitz
- Universidade do Estado do Rio de Janeiro, Serviço de Neurologia, Rio de Janeiro RJ, Brazil.
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Nóbrega PR, Vasconcelos TDMF, de Paiva ARB, Lima PLGDSB, Braga Neto P, Guimarães TG, Krueger MB. Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome. Mov Disord Clin Pract 2023; 10:1705-1706. [PMID: 37982121 PMCID: PMC10654808 DOI: 10.1002/mdc3.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
- Centro Universitário UnichristusFortalezaBrazil
| | | | | | | | - Pedro Braga Neto
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
| | | | - Mariana Braatz Krueger
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
- Hospital Infantil Albert SabinFortalezaBrazil
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Pedroso JL, Vale TC, Freitas JLD, Araújo FMM, Meira AT, Neto PB, França MC, Tumas V, Teive HAG, Barsottini OGP. Movement disorders in hereditary spastic paraplegias. Arq Neuropsiquiatr 2023; 81:1000-1007. [PMID: 38035585 PMCID: PMC10689114 DOI: 10.1055/s-0043-1777005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Hereditary or familial spastic paraplegias (SPG) comprise a group of genetically and phenotypically heterogeneous diseases characterized by progressive degeneration of the corticospinal tracts. The complicated forms evolve with other various neurological signs and symptoms, including movement disorders and ataxia. OBJECTIVE To summarize the clinical descriptions of SPG that manifest with movement disorders or ataxias to assist the clinician in the task of diagnosing these diseases. METHODS We conducted a narrative review of the literature, including case reports, case series, review articles and observational studies published in English until December 2022. RESULTS Juvenile or early-onset parkinsonism with variable levodopa-responsiveness have been reported, mainly in SPG7 and SPG11. Dystonia can be observed in patients with SPG7, SPG11, SPG22, SPG26, SPG35, SPG48, SPG49, SPG58, SPG64 and SPG76. Tremor is not a frequent finding in patients with SPG, but it is described in different types of SPG, including SPG7, SPG9, SPG11, SPG15, and SPG76. Myoclonus is rarely described in SPG, affecting patients with SPG4, SPG7, SPG35, SPG48, and SPOAN (spastic paraplegia, optic atrophy, and neuropathy). SPG4, SPG6, SPG10, SPG27, SPG30 and SPG31 may rarely present with ataxia with cerebellar atrophy. And autosomal recessive SPG such as SPG7 and SPG11 can also present with ataxia. CONCLUSION Patients with SPG may present with different forms of movement disorders such as parkinsonism, dystonia, tremor, myoclonus and ataxia. The specific movement disorder in the clinical manifestation of a patient with SPG may be a clinical clue for the diagnosis.
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Affiliation(s)
- Jose Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Hospital Universitário, Departamento de Clínica Médica, Serviço de Neurologia, Juiz de Fora MG, Brazil.
| | | | - Filipe Miranda Milagres Araújo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências Comportamental, Ribeirão Preto SP, Brazil.
| | - Alex Tiburtino Meira
- Universidade Federal da Paraíba, Departamento de Medicina Interna, Serviço de Neurologia, João Pessoa PB, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brazil.
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil.
| | - Marcondes C. França
- Universidade Estadual de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências Comportamental, Ribeirão Preto SP, Brazil.
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Ribeiro RM, Vasconcelos SC, Lima PLGDSB, Coelho EF, Oliveira AMN, Gomes EDABM, Mota LDA, Radtke LS, Carvalho MDS, Araújo DABS, Pinheiro MSN, Gama VCDV, Júnior RMM, Braga Neto P, Nóbrega PR. Pathophysiology and Treatment of Lipid Abnormalities in Cerebrotendinous Xanthomatosis: An Integrative Review. Brain Sci 2023; 13:979. [PMID: 37508912 PMCID: PMC10377253 DOI: 10.3390/brainsci13070979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive disorder caused by pathogenic variants in CYP27A1, leading to a deficiency in sterol 27-hydroxylase. This defect results in the accumulation of cholestanol and bile alcohols in various tissues, including the brain, tendons and peripheral nerves. We conducted this review to evaluate lipid profile abnormalities in patients with CTX. A search was conducted in PubMed, Embase and the Virtual Health Library in January 2023 to evaluate studies reporting the lipid profiles of CTX patients, including the levels of cholestanol, cholesterol and other lipids. Elevated levels of cholestanol were consistently observed. Most patients presented normal or low serum cholesterol levels. A decrease in chenodeoxycholic acid (CDCA) leads to increased synthesis of cholesterol metabolites, such as bile alcohols 23S-pentol and 25-tetrol 3-glucuronide, which may serve as surrogate follow-up markers in patients with CTX. Lipid abnormalities in CTX have clinical implications. Cholestanol deposition in tissues contributes to clinical manifestations, including neurological symptoms and tendon xanthomas. Dyslipidemia and abnormal cholesterol metabolism may also contribute to the increased risk of atherosclerosis and cardiovascular complications observed in some CTX patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Lucas Soares Radtke
- Faculty of Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
| | | | | | | | | | | | - Pedro Braga Neto
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
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de Lucena Alves CP, de Almeida SB, Lima DP, Neto PB, Miranda AL, Manini T, Vlietstra L, Waters DL, Bielemann RM, Correa-de-Araujo R, Trussardi Fayh AP, Costa EC. Muscle Quality in Older Adults: A Scoping Review. J Am Med Dir Assoc 2023; 24:462-467.e12. [PMID: 36963436 DOI: 10.1016/j.jamda.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults. DESIGN Scoping review. SETTING AND PARTICIPANTS All available studies. METHODS Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years. RESULTS A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%). CONCLUSIONS AND IMPLICATIONS There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults.
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Affiliation(s)
| | - Samuel Brito de Almeida
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; Division of Geriatrics, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Danielle Pessoa Lima
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; Division of Geriatrics, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Medical School, University of Fortaleza, Fortaleza, CE, Brazil
| | - Pedro Braga Neto
- Medical School, University of Fortaleza, Fortaleza, CE, Brazil; Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Center of Health Sciences, State University of Ceará, Fortaleza, Brazil
| | - Ana Lúcia Miranda
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | - Todd Manini
- Institute on Aging, Department of Health Outcomes and Biomedical Informatics, University of Florida, USA
| | - Lara Vlietstra
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Debra L Waters
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; Department of Medicine and School of Physiotherapy, University of Otago, Dunedin, New Zealand; Department of Internal Medicine/Geriatrics, University of New Mexico, Albuquerque, NM, USA
| | - Renata Moraes Bielemann
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; Graduate Program in Nutrition and Food, Faculty of Nutrition, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Ana Paula Trussardi Fayh
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Eduardo Caldas Costa
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceará, Fortaleza, CE, Brazil; ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Lima DP, Gomes VC, Viana Júnior AB, Assis FMCD, Oliveira PHA, Cunha LCV, Braga IC, Marques MLS, Assunção JDS, Damasceno ALL, Barbosa ALG, Moreira AH, Rocha MEQA, Porto MEMP, Chaves ÉCB, Oliveira LMD, Roriz Filho JDS, Sobreira Neto MA, Braga Neto P. Telehealth for Parkinson disease patients during the COVID-19 pandemic: the TeleParkinson study. Arq Neuropsiquiatr 2022; 80:1026-1035. [PMID: 36535287 PMCID: PMC9770058 DOI: 10.1055/s-0042-1758751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Telemedicine allows Parkinson disease (PD) patients to overcome physical barriers to access health care services and increases accessibility for people with mobility impairments. OBJECTIVE To investigate the feasibility indicators of a telehealth intervention for PD patients, including patient recruitment, attendance, technical issues, satisfaction, and benefits on levels of physical activity and sleep. METHODS We conducted a single-center, single-arm study of telehealth video consultations using WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA). Also, we collected the feasibility indicators as the primary endpoints. All the patients in the study were previously evaluated in person by the same team. RESULTS Patient recruitment, attendance, and technical issues rates were 61.3%, 90.5%, and 13.3%, respectively, with good scores of patient acceptance and satisfaction with the study intervention. The telehealth intervention improved physical activity, including the number of walks for at least 10 continuous minutes (p = 0.009) and the number of moderate-intensity activities lasting at least 10 continuous minutes (p = 0.001). The Pittsburgh sleep quality index (PSQI) scores also improved for one of its components: perceived sleep duration (p < 0.001) and for total Pittsburgh score (p < 0,001). The average travel time saving was 289.6 minutes, and money-saving was R$106.67 (around USD 18; almost 10% of the current minimum wage in Brazil). CONCLUSIONS Direct-to-patient telehealth video consultations proved to be feasible and effective and had a positive impact on physical activity levels and sleep in PD patients.
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Affiliation(s)
- Danielle Pessoa Lima
- Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil.,Universidade de Fortaleza, Centro de Ciências da Saúde, Fortaleza CE, Brazil.,Address for correspondence Danielle Pessoa Lima
| | | | - Antonio Brazil Viana Júnior
- Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Centro de Pesquisa Clínica, Fortaleza CE, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jarbas de Sá Roriz Filho
- Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil.
| | - Manoel Alves Sobreira Neto
- Universidade Unichristus, Faculdade de Medicina, Fortaleza CE, Brazil.,Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil.
| | - Pedro Braga Neto
- Universidade de Fortaleza, Centro de Ciências da Saúde, Fortaleza CE, Brazil.,Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil.
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Diaféria G, Bommarito S, Braga Neto P, Park SW, Padovani M, Haddad F, Haddad L, Voos MC, Chien HF, Pedroso JL, Barsottini O. Effect of speech therapy on quality of life in patients with spinocerebelar ataxia type 3. Arq Neuropsiquiatr 2022; 80:1017-1025. [PMID: 36535286 PMCID: PMC9770060 DOI: 10.1055/s-0042-1755203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with spinocerebellar ataxia type 3 (SCA3) present communication and swallowing disorders, and consequent deterioration in quality of life (QOL). OBJECTIVE To evaluate the impact of a speech therapy rehabilitation program on the QOL of patients with SCA3. METHODS All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The International Cooperative Ataxia Rating Scale scores were 32.4 ± 20.2, and the Scale for the Assessment and Rating of Ataxia scores were 11.8 ± 8.0. The intervention consisted of a 12-session speech therapy rehabilitation program with oral, pharyngeal, and laryngeal strengthening exercises-the so-called ATAXIA-Myofunctional Orofacial and Vocal Therapy (A-MOVT). They all were submitted to pre- and postintervention evaluations using the World Health Organization's Quality of Life (WHOQOL-BREF) assessment, as well as the Living with Dysarthria (LwD), Quality of Life in Swallowing Disorders (SWAL-QOL), and Food Assessment Tool (EAT-10). RESULTS The study sample consisted of 48 patients with SCA3 (STG = 25; CG = 23), mean age was 47.1 ± 11.4 years; mean age at symptom onset was 36.9 ± 11.3 years; disease duration was 11.9 ± 13.3 years. After the 3-month intervention, there were significant changes in the QOL in the STG compared with the CG, when assessed by the LwD (179.12 ± 62.55 vs. 129.88 ± 51.42, p < 0.001), SWAL-QOL (869.43 ± 153.63 vs. 911.60 ± 130.90, p = 0.010), and EAT-10 (5.16 ± 7.55 vs. 2.08 ± 3.85, p = 0.018). CONCLUSIONS Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program, because therapy helps to improve difficulty swallowing and dysarthria.
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Affiliation(s)
- Giovana Diaféria
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Silvana Bommarito
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fonoaudiologia, São Paulo SP, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Serviço de Neurologia e Neurocirurgia, Fortaleza CE, Brazil.
| | - Sung Woo Park
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Marina Padovani
- Faculdade de Ciências Médicas da Santa Casa, Departamento de Fonoaudiologia, São Paulo SP, Brazil.
| | - Fernanda Haddad
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Leonardo Haddad
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Mariana Callil Voos
- Universidade Pontífice Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil.
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil.
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Address for correspondence José Luiz Pedroso
| | - Orlando Barsottini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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Matos KC, Oliveira VFD, Oliveira PLCD, Braga Neto P. An overview of dysphagia rehabilitation for stroke patients. Arq Neuro-Psiquiatr 2022; 80:84-96. [PMID: 35239804 PMCID: PMC9651500 DOI: 10.1590/0004-282x-anp-2021-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/28/2021] [Indexed: 04/27/2023]
Abstract
ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
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Affiliation(s)
| | | | | | - Pedro Braga Neto
- Universidade Federal do Ceará, Brazil; Universidade Estadual do Ceará, Brazil; Universidade Federal do Ceará, Brazil
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Gama MTD, Rezende Filho FM, Rezende TJR, Braga Neto P, França Junior MC, Pedroso JL, Barsottini OGP. Nystagmus may be the first neurological sign in early stages of spinocerebellar ataxia type 3. Arq Neuropsiquiatr 2021; 79:891-894. [PMID: 34706018 DOI: 10.1590/0004-282x-anp-2020-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant spinocerebellar ataxia worldwide. Almost all patients with SCA3 exhibit nystagmus and/or saccades impairment. OBJECTIVE To investigate the presence of nystagmus as an early neurological manifestation, before ataxia, in some patients with SCA3 in the first six months of the disease. METHODS We evaluated a series of 155 patients with clinically and molecularly proven SCA3 between 2013 and 2020. Data regarding sex, age, age at onset, disease duration, CAG repeat expansion length, first symptom, presence of ataxia, scores on SARA and ICARS scales, and presence and characteristics of nystagmus were collected. RESULTS We identified seven patients with symptomatic SCA3 who presented with isolated nystagmus. In these seven individuals the age at onset ranged from 24 to 57 years, and disease duration from four to six months. CONCLUSIONS Our study showed that nystagmus may be the first neurological sign in SCA3. This clinical observation reinforces the idea that the neurodegenerative process in SCA3 patients may start in vestibular system connections or in flocculonodular lobe. This study adds relevant information about pre-symptomatic features in SCA3 that may work as basis for a better understanding of brain degeneration and for future therapeutic clinical trials.
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Affiliation(s)
| | | | | | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Neurologia, Fortaleza CE, Brazil
| | | | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo SP, Brazil
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12
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Tavares Júnior JWL, Braga Neto P, Bonfadini JDC, Bittencourt L, Lopes CH, Mendes L, Siqueira Neto JI, Sousa V, Amaral A, Carrilho CG, Espindola JO, Casali MEA, Veras AB, Alves GS. Clinical characteristics and diagnostic accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) in older adults with a low educational level. J bras psiquiatr 2021. [DOI: 10.1590/0047-2085000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a cognitive screening tool for older adults with low levels of schooling and healthy aging, MCI and dementia in Brazil. Methods: All participants underwent neurological and psychiatric examinations and were administered a validated version of ACE-R. Results: A total of 85 participants were evaluated; most were females (84.7%, n = 72). The post hoc analysis showed statistical differences in ACE-R total scores between older adults with mild cognitive impairment (MCI) and controls (p < 0.001) and in subitem scores including verbal fluency, language, visuospatial skills and attention (p < 0.001). The visual-spatial skills subitem was the most strongly correlated with schooling level (r = 0.509, p < 0.001), whereas late, immediate recall and recognition memory were not influenced by schooling. The ACE-R had the best diagnostic accuracy in discriminating between MCI and controls = 0.69 (<57.5; 80/66), MD and controls = 0.98 (<50; 100/96), MCI and MD = 0.86 (<49.5; 100/74). Conclusions: ACE-R and Mini-Mental State Examination (MMSE) scores for older adults with MCI and controls were significantly lower than those reported in similar studies. These preliminary findings support the need for establishing reliable cut-off scores for cognitive assessment of older Brazilian adults with low schooling at risk for dementia taking into consideration ecological and local variables.
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Affiliation(s)
| | - Pedro Braga Neto
- Federal University of Ceara, Brazil; Ceara State University, Brazil; Walter Cantídio University Hospital, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Gilberto Sousa Alves
- Federal University of Ceara, Brazil; Translational Psychiatry Research Group, Brazil; Federal University of Rio de Janeiro, Brazil
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Braga Neto P, Pedroso JL, Kuo SH, Marcondes Junior CF, Teive HAG, Barsottini OGP. Current concepts in the treatment of hereditary ataxias. Arq Neuropsiquiatr 2017; 74:244-52. [PMID: 27050855 DOI: 10.1590/0004-282x20160038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 02/19/2023]
Abstract
Hereditary ataxias (HA) represents an extensive group of clinically and genetically heterogeneous neurodegenerative diseases, characterized by progressive ataxia combined with extra-cerebellar and multi-systemic involvements, including peripheral neuropathy, pyramidal signs, movement disorders, seizures, and cognitive dysfunction. There is no effective treatment for HA, and management remains supportive and symptomatic. In this review, we will focus on the symptomatic treatment of the main autosomal recessive ataxias, autosomal dominant ataxias, X-linked cerebellar ataxias and mitochondrial ataxias. We describe management for different clinical symptoms, mechanism-based approaches, rehabilitation therapy, disease modifying therapy, future clinical trials and perspectives, genetic counseling and preimplantation genetic diagnosis.
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Affiliation(s)
- Pedro Braga Neto
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
| | - José Luiz Pedroso
- Departmento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, United States
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Alessi H, Dutra LA, Braga Neto P, Pedroso JL, Toso FF, Kayser C, Barsottini OGP. Neuropsychiatric Lupus in clinical practice. Arq Neuro-Psiquiatr 2016; 74:1021-1030. [DOI: 10.1590/0004-282x20160150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.
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Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Estadual do Ceará, Brasil; Universidade Federal do Ceará, Brasil
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15
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Albuquerque MVCD, Pedroso JL, Braga Neto P, Barsottini OGP. Phenotype variability and early onset ataxia symptoms in spinocerebellar ataxia type 7: comparison and correlation with other spinocerebellar ataxias. Arq Neuro-Psiquiatr 2015; 73:18-21. [DOI: 10.1590/0004-282x20140192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022]
Abstract
The spinocerebellar ataxias (SCA) are a group of neurodegenerative disorders characterized by heterogeneous clinical presentation. Spinocerebellar ataxia type 7 (SCA7) is caused by an abnormal CAG repeat expansion and includes cerebellar signs associated with visual loss and ophthalmoplegia. Marked anticipation and dynamic mutation is observed in SCA7. Moreover, phenotype variability and very early onset of symptoms may occur. In this article, a large series of Brazilian patients with different SCA subtypes was evaluated, and we compared the age of onset of SCA7 with other SCA. From the 26 patients with SCA7, 4 manifested their symptoms before 10-year-old. Also, occasionally the parents may have the onset of symptoms after their children. In conclusion, our study highlights the genetic anticipation phenomenon that occurs in SCA7 families. Patients with very early onset ataxia in the context of a remarkable family history, must be considered and tested for SCA7.
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Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Federal de São Paulo, Brazil; Universidade Estadual do Ceará, Brazil
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Barsottini OGP, Albuquerque MVCD, Braga Neto P, Pedroso JL. Adult onset sporadic ataxias: a diagnostic challenge. Arq Neuro-Psiquiatr 2014; 72:232-40. [DOI: 10.1590/0004-282x20130242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 11/08/2013] [Indexed: 11/22/2022]
Abstract
Patients with adult onset non-familial progressive ataxia are classified in sporadic ataxia group. There are several disease categories that may manifest with sporadic ataxia: toxic causes, immune-mediated ataxias, vitamin deficiency, infectious diseases, degenerative disorders and even genetic conditions. Considering heterogeneity in the clinical spectrum of sporadic ataxias, the correct diagnosis remains a clinical challenge. In this review, the different disease categories that lead to sporadic ataxia with adult onset are discussed with special emphasis on their clinical and neuroimaging features, and diagnostic criteria.
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Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Federal de São Paulo, Brazil; Universidade Estadual do Ceará, Brazil
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Abstract
Multiple system atrophy (MSA) is characterized by a variable combination of
cerebellar ataxia, parkinsonism and pyramidal signs associated with autonomic
failure. Classically, cognitive impairment was not considered a clinical feature
of MSA and dementia was pointed out as an exclusion diagnostic criteria. Based
on comprehensive neuropsychological assessment, cognitive impairment was found
to be a frequent feature in MSA, and clinically-defined dementia is now reported
in 14-16% of cases. This article reviews the current data on cognitive
impairment in MSA along with its neuropsychological profile and
pathophysiology.
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Affiliation(s)
- Agessandro Abrahão
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Livia Almeida Dutra
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Pedro Braga Neto
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Luiz Pedroso
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Ricardo Araújo de Oliveira
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Orlando Graziani Povoas Barsottini
- Division of General Neurology and Ataxias, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo SP, Brazil
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