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Bellini BB, Scholz JR, Abe TO, Arnaut D, Tonstad S, Alberto RL, Gaya PV, de Moraes IRA, Teixeira MJ, Marcolin MA. Does deep TMS really works for smoking cessation? A prospective, double blind, randomized, sham controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110997. [PMID: 38531486 DOI: 10.1016/j.pnpbp.2024.110997] [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: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION A substantial proportion of smokers wishing to quit do not stop smoking when using current therapies to aid cessation. Magnetic pulses to specific brain areas designated as transcranial magnetic stimulation may modulate brain activity and thereby change chemical dependencies. Deep transcranial magnetic stimulation (dTMS) with the H4 coil stimulates neuronal pathways in the lateral prefrontal cortex and insula bilaterally, areas involved in tobacco addiction. OBJECTIVE To evaluate the efficacy and safety of dTMS with T4 coil in smoking cessation. METHODS In a double blind, controlled clinical trial, adult smokers of at least 10 cigarettes/day were randomized to active (n = 50) versus sham dTMS (n = 50). The protocol involved up to 21 sessions administered over up to 12 weeks. Tobacco use was monitored by self-report and confirmed by expired air monoximetry (at each dTMS visit) and blood cotinine (at the screening visit and at the end of sessions). Participants completed abstinence, mood and cognition scales at determined timepoints during follow-up. RESULTS In the intention to-treat-analysis, the cessation rate of the intervention and control groups was 14.0%. The reported side effects were as expected for this procedure. Although there were no serious adverse events, three participants were withdrawn according to safety criteria. CONCLUSION Active treatment with dTMS H4 coil was safe but not effective for smoking cessation.
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Affiliation(s)
- Bianca B Bellini
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil; Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil.
| | - Jaqueline R Scholz
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Debora Arnaut
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Rodrigo L Alberto
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco A Marcolin
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
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Coelho F, Noleto GS, Solla DJF, Martins PN, Andrade AF, Teixeira MJ, Paiva WS, Anghinah R. Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study. BRAIN IMPAIR 2023; 24:721-731. [PMID: 38167367 DOI: 10.1017/brimp.2023.2] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke. METHODS In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2. RESULTS A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes. CONCLUSION Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.
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Affiliation(s)
- F Coelho
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - G S Noleto
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - D J F Solla
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - P N Martins
- Faculty of Medicine, Juiz de Fora Medical School, Juiz DE Fora, Brazil
| | - A F Andrade
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - M J Teixeira
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - W S Paiva
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - R Anghinah
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
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da Silva ML, Fernandes AM, Silva VA, Galhardoni R, Felau V, de Araujo JO, Rosi J, Brock RS, Kubota GT, Teixeira MJ, Yeng LT, de Andrade DC. Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes. Neurophysiol Clin 2023; 53:102853. [PMID: 37018953 DOI: 10.1016/j.neucli.2023.102853] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). METHODS Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. RESULTS 60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. CONCLUSIONS Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.
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Affiliation(s)
- Marcelo Luiz da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquíria A Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Valter Felau
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Joaci O de Araujo
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Roger S Brock
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Raicher I, Zandonai AP, Anghinah IW, Frassetto M, Stump PRNAG, Trindade MAB, Harnik S, Oliveira RA, Macarenco RSS, Doppler K, Üçeyler N, Mello ES, Sommer C, Teixeira MJ, Galhardoni R, de Andrade DC. Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy. Pain 2023; 164:717-727. [PMID: 35972460 DOI: 10.1097/j.pain.0000000000002757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.
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Affiliation(s)
- Irina Raicher
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Hospital Israelita Albert Einstein, Pathology Laboratory, Sao Paulo, Brazil
| | | | | | - Mariana Frassetto
- University of Southern Santa Catarina (UNESC), Santa Catarina, Brazil
| | - Patrick R N A G Stump
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Instituto Lauro de Souza Lima, Bauru, Brazil
| | - Maria A B Trindade
- Department of Dermatology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
| | - Simone Harnik
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo A Oliveira
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | | | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Evandro S Mello
- Cancer Institute of Sao Paulo Octavio Frias de Oliveira, University of Sao Paulo, Brazil
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Manoel J Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Daniel C de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
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5
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Kubota GT, Soares FHC, da Fonseca AS, Rosa TDS, da Silva VA, Gouveia GR, Faria VG, da Cunha PHM, Brunoni AR, Teixeira MJ, de Andrade DC. Pain paths among post-COVID-19 condition subjects: A prospective cross-sectional study with in-person evaluation. Eur J Pain 2023; 27:636-650. [PMID: 36799447 DOI: 10.1002/ejp.2094] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND New-onset chronic pain has been acknowledged as part of the post-COVID-19 condition. However, available fine-grained data about its clinical phenotype, trajectories and main associated characteristics remain scarce. We described the distinct temporal evolutions of post-COVID-19 pain and their epidemiological and phenotypical features. METHODS A prospective cross-sectional study enrolled post-COVID-19 condition patients (i.e. who had persisting COVID-19-related symptoms over 30 days since their first positive laboratory test), whose COVID-19 diagnosis had been supported by RT-PCR of oral/nasopharyngeal swab or serology. They underwent in-person evaluations with a structured interview, pain and quality-of-life-related questionnaires and thorough physical examination. Chronic pain (CP) and probable neuropathic pain (NP) were defined according to IASP criteria. RESULTS The present study included 226 individuals, 177 (78.3%) of whom presented over 3 months since their first COVID-19 symptom. New-onset pain occurred in 170 (75.2%) participants and was chronic in 116 (68.2%). A chronic course was associated with COVID-19-related hospitalization, new-onset fatigue, lower cognitive performance, motor and thermal sensory deficits, mood and sleep impairments and overall lower quality-of-life levels. Probable NP occurred in only 7.6% new-onset pain patients, and was associated with pain chronification, new-onset fatigue, motor and thermal sensory deficits, mechanical allodynia and lower rates of SARS-CoV-2 vaccination. Previous CP was reported by 86 (38.1%) individuals and had aggravated after the infection in 66 (76.7%) of them, which was associated with orthostatic hypotension. CONCLUSIONS Post-COVID pain phenomena follow different paths, which are associated with specific clinical and epidemiological features, and possibly distinct underlying mechanisms, prognostic and therapeutic implications. SIGNIFICANCE COVID-19-related pain usually follows a chronic course and is non-neuropathic. Its possible courses and phenotypes are associated with distinct clinical and epidemiological features. This suggests differing underlying mechanisms, which may have significant prognostic and therapeutic implications.
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Affiliation(s)
- Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.,Pain Treatment Center, Sao Paulo State Cancer Institute, São Paulo, Brazil
| | - Felipe H C Soares
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Talita Dos Santos Rosa
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquiria A da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation, Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Gisele R Gouveia
- Clinical Pathology Laboratory, Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Viviane G Faria
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Pedro H M da Cunha
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Laboratory of Neuroscience, Department of Psychiatry, Institute of Psychiatry, National Institute of Biomarkers in Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Daniel C de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.,Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Brasil S, Nogueira RC, Salinet ASM, Yoshikawa MH, Teixeira MJ, Paiva W, Malbouisson LMS, Bor-Seng-Shu E, Panerai RB. Contribution of intracranial pressure to human dynamic cerebral autoregulation after acute brain injury. Am J Physiol Regul Integr Comp Physiol 2023; 324:R216-R226. [PMID: 36572556 DOI: 10.1152/ajpregu.00252.2022] [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] [Indexed: 12/28/2022]
Abstract
Cerebral perfusion pressure (CPP) is normally expressed by the difference between mean arterial blood pressure (MAP) and intracranial pressure (ICP) but comparison of the separate contributions of MAP and ICP to human cerebral blood flow autoregulation has not been reported. In patients with acute brain injury (ABI), internal jugular vein compression (IJVC) was performed for 60 s. Dynamic cerebral autoregulation (dCA) was assessed in recordings of middle cerebral artery blood velocity (MCAv, transcranial Doppler), and invasive measurements of MAP and ICP. Patients were separated according to injury severity as having whole/undamaged skull, large fractures, or craniotomies, or following decompressive craniectomy. Glasgow coma score was not different for the three groups. IJVC induced changes in MCAv, MAP, ICP, and CPP in all three groups. The MCAv response to step changes in MAP and ICP expressed the dCA response to these two inputs and was quantified with the autoregulation index (ARI). In 85 patients, ARI was lower for the ICP input as compared with the MAP input (2.25 ± 2.46 vs. 3.39 ± 2.28; P < 0.0001), and particularly depressed in the decompressive craniectomy (DC) group (n = 24, 0.35 ± 0.62 vs. 2.21 ± 1.96; P < 0.0005). In patients with ABI, the dCA response to changes in ICP is less efficient than corresponding responses to MAP changes. These results should be taken into consideration in studies aimed to optimize dCA by manipulation of CPP in neurocritical patients.
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Affiliation(s)
- Sérgio Brasil
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Ricardo C Nogueira
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Angela S M Salinet
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Márcia H Yoshikawa
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Manoel J Teixeira
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Wellingson Paiva
- Department of Neurology, School of Medicine University of São Paulo, Brazil
| | - Luiz M S Malbouisson
- Department of Intensive Care, School of Medicine University of São Paulo, Brazil
| | | | - Ronney B Panerai
- Cardiovascular Sciences Department, University of Leicester, United Kingdom.,National Institute for Health and Care Research, Cardiovascular Research Centre, Glenfield Hospital, University of Leicester, United Kingdom
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Miotto EC, Bazán PR, Batista AX, Conforto AB, Figueiredo EG, Martin MDGM, Avolio IB, Amaro E, Teixeira MJ. Corrigendum: Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients. Front Neurol 2021; 12:785008. [PMID: 34803900 PMCID: PMC8595913 DOI: 10.3389/fneur.2021.785008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2020.01048.].
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Affiliation(s)
- Eliane C Miotto
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Paulo R Bazán
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
| | - Alana X Batista
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Edson Amaro
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
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Hamani C, Fonoff ET, Parravano DC, Silva VA, Galhardoni R, Monaco B, Navarro J, Yeng LT, Teixeira MJ, Ciampi de Andrade D. Motor cortex stimulation for chronic neuropathic pain: results of a double-blind randomized study. Brain 2021; 144:2994-3004. [PMID: 34373901 DOI: 10.1093/brain/awab189] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 02/25/2021] [Revised: 04/04/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Motor cortex stimulation (MCS) via surgically implanted electrodes has been used as an off-label treatment for chronic neuropathic pain (cNeP) but its efficacy has not been fully established. We aimed to objectively study the efficacy of MCS and characterize potential predictors of response. In this randomised, double-blind, sham-controlled, single centre trial, we recruited 18 cNeP patients who did not adequately respond to conventional treatment and had a numerical rating pain scale (NRS) score ≥ 6. Patients were initially assigned to receive three months of active ("on") or sham ("off") stimulation in a double-blind cross-over phase. This was followed by a 3-month single-blind phase, and 6 months of open-label follow-up. A meaningful response in our trial was defined as a ≥ 30% or 2-point reduction in NRS scores during active stimulation. Using Bayesian statistics, we found a 41.4% probability of response towards "on" vs. "off" MCS. The probability of improvement during active stimulation (double-blind, single-blind and open label phases) compared to baseline was of 47.2-68.5%. 39% of patients were long-term responders, 71.4% of whom had facial pain, phantom limb pain, or complex regional pain syndrome. In contrast, 72.7% of non-responders had either post-stroke pain or pain associated with brachial plexus avulsion. 39% of patients had a substantial post-operative analgesic effect after electrode insertion in the absence of stimulation. Individuals with diagnoses associated with a good postoperative outcome or those who developed an insertional effect had a near 100% probability of response to MCS. In summary, we found that approximately 40% of patients responded to MCS, particularly those who developed an insertional effect or had specific clinical conditions that seemed to predict an appropriate postoperative response.
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Affiliation(s)
- Clement Hamani
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Harquail Centre for Neuromodulation, Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Erich T Fonoff
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniella C Parravano
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Valquiria A Silva
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bernardo Monaco
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jessie Navarro
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Functional Neurosurgery, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Pain Center, LIM-62, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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9
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Abbas-Kayano RT, Solla DJF, Rabelo NN, Teles Gomes MDQ, Cabrera HTN, Teixeira MJ, Figueiredo EG. Long-term Dysphagia following Acoustic Neuroma Surgery: Prevalence, Severity, and Predictive Factors. Indian Journal of Neurosurgery 2021. [DOI: 10.1055/s-0040-1719202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves.
Objective To describe swallowing function outcomes in the late postoperative period after AN surgery.
Methods This cohort study included patients operated on between 1999–2014, with a mean follow up of 6.4 ± 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression.
Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 ± 16.0 years (range 19–80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 ± 1.1 vs. 3.1 ± 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (≥2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House–Brackmann [HB] grade ≥3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade ≥3 (OR 12.99, p = 0.002).
Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period.
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Affiliation(s)
| | | | - Nicollas Nunes Rabelo
- Department of Neurosurgery, University of São Paulo, Brazil
- Department of Neurosurgery, University of São Paulo, Brazil
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Mylius V, Perez Lloret S, Cury RG, Teixeira MJ, Barbosa VR, Barbosa ER, Moreira LI, Listik C, Fernandes AM, de Lacerda Veiga D, Barbour J, Hollenstein N, Oechsner M, Walch J, Brugger F, Hägele-Link S, Beer S, Rizos A, Chaudhuri KR, Bouhassira D, Lefaucheur JP, Timmermann L, Gonzenbach R, Kägi G, Möller JC, Ciampi de Andrade D. The Parkinson disease pain classification system: results from an international mechanism-based classification approach. Pain 2021; 162:1201-1210. [PMID: 33044395 PMCID: PMC7977616 DOI: 10.1097/j.pain.0000000000002107] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Santiago Perez Lloret
- Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), and Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Rubens G. Cury
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Manoel J. Teixeira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Victor R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Egberto R. Barbosa
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Larissa I. Moreira
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Clarice Listik
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Ana M. Fernandes
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Diogo de Lacerda Veiga
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | - Julio Barbour
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
| | | | - Matthias Oechsner
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Julia Walch
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | | | - Serafin Beer
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Alexandra Rizos
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
| | - Kallol Ray Chaudhuri
- King's College Hospital, Parkinson Foundation Centre of Excellence, London, United Kingdom
- King's College London, Department Basic and Clinical Neuroscience, London, United Kingdom
- The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Assistance Publique—Hôpitaux de Paris, Boulogne-Billancourt and Université Versailles-Saint-Quentin, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine de Créteil, Université Paris-Est-Créteil, France
| | - Lars Timmermann
- Department of Neurology, Philipps University, Marburg, Germany
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St, Gallen, Switzerland
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Daniel Ciampi de Andrade
- Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, Brazil
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Tavares WM, de Franca SA, Vasconcelos AS, Parra DSL, Araújo SRR, Teixeira MJ. Robotic and standard surgical intervention as adjunct therapies for retroperitoneal ganglioneuroma resection: a case report. BMC Surg 2021; 21:143. [PMID: 33740932 PMCID: PMC7980646 DOI: 10.1186/s12893-021-01146-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ganglioneuroma (GN) is ranked by the International Neuroblastoma Pathology Classification as a benign tumor. It can occur anywhere along the sympathetic nerve chain and surgical excision is the treatment of choice. Case presentation An 18-year-old female patient sought medical assistance after 6 months of constant dorsal and back pain radiating from the thoracic region to the right abdominal flank. Magnetic resonance imaging revealed a solid nodular lesion with heterogeneous post-contrast enhancement and lobulated contours, centered on the right foramina of D12–L1, with a projection to the intracanal space, which compressed and laterally displaced the dural sac and had a right paravertebral extension between the vertebral bodies of D11 and superior aspect of L2. Ganglioneuroma was diagnosed using immunohistochemical analysis. It was decided to use a surgical approach in two stages: robot assisted for the anterior/retroperitoneal mass and a posterior hemilaminectomy/microsurgical approach to attempt total resection, avoiding the traditional anterior thoracoabdominal surgical incision and optimizing the patient’s postoperative outcomes. No postoperative adverse events were noted, and the patient was discharged on postoperative day 5. Conclusion This retroperitoneal GN presentation was peculiar because it originated at the D12 nerve root, which extended to the retroperitoneal space and inside the spinal canal. We hope that our case report can assist future decisions in similar circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01146-x.
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Affiliation(s)
- Wagner M Tavares
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil.,Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
| | - Sabrina Araujo de Franca
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil.
| | - Amsterdam S Vasconcelos
- Surgical Oncology Department, Hospital Santa Catarina, 200 Paulista Avenue, Bela Vista, São Paulo, SP, 01310-000, Brazil
| | - David S L Parra
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil
| | - Sergio R R Araújo
- LabPac, Laboratório Anatomia Patológica Imuno-Histoquímica Citopatologica, 75 Calixto da Mota Street, Vila Mariana, São Paulo, SP, 04117-100, Brazil
| | - Manoel J Teixeira
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
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Alonso-Matielo H, Gonçalves ES, Campos M, Oliveira VRS, Toniolo EF, Alves AS, Lebrun I, de Andrade DC, Teixeira MJ, Britto LRG, Hamani C, Dale CS. Electrical stimulation of the posterior insula induces mechanical analgesia in a rodent model of neuropathic pain by modulating GABAergic signaling and activity in the pain circuitry. Brain Res 2021; 1754:147237. [PMID: 33400930 DOI: 10.1016/j.brainres.2020.147237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
The insula has emerged as a critical target for electrical stimulation since it influences pathological pain states. We investigated the effects of repetitive electrical stimulation of the insular cortex (ESI) on mechanical nociception, and general locomotor activity in rats subjected to chronic constriction injury (CCI) of the sciatic nerve. We also studied neuroplastic changes in central pain areas and the involvement of GABAergic signaling on ESI effects. CCI rats had electrodes implanted in the left agranular posterior insular cortex (pIC), and mechanical sensitivity was evaluated before and after one or five daily consecutive ESIs (15 min each, 60 Hz, 210 μs, 1 V). Five ESIs (repetitive ESI) induced sustained mechanical antinociception from the first to the last behavioral assessment without interfering with locomotor activity. A marked increase in Fos immunoreactivity in pIC and a decrease in the anterior and mid-cingulate cortex, periaqueductal gray and hippocampus were noticed after five ESIs. The intrathecal administration of the GABAA receptor antagonist bicuculline methiodide reversed the stimulation-induced antinociception after five ESIs. ESI increased GAD65 levels in pIC but did not interfere with GABA, glutamate or glycine levels. No changes in GFAP immunoreactivity were found in this work. Altogether, the results indicate the efficacy of repetitive ESI for the treatment of experimental neuropathic pain and suggest a potential influence of pIC in regulating pain pathways partially through modulating GABAergic signaling.
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Affiliation(s)
- Heloísa Alonso-Matielo
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 2415, ICB-III, Cidade Universitária, 05508-900 São Paulo, SP, Brazil
| | - Elizamara S Gonçalves
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 2415, ICB-III, Cidade Universitária, 05508-900 São Paulo, SP, Brazil
| | - Mariana Campos
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 2415, ICB-III, Cidade Universitária, 05508-900 São Paulo, SP, Brazil
| | - Victória R S Oliveira
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 2415, ICB-III, Cidade Universitária, 05508-900 São Paulo, SP, Brazil
| | - Elaine F Toniolo
- Center of Research in Neuroscience, Universidade Cidade de São Paulo, R. Cesário Galero, 448/475 - Tatuapé, São Paulo, SP 03071-000, Brazil
| | - Adilson S Alves
- Department of Physiology and Biophysics, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 1524, ICB-I, Cidade Universitária, 05508-000 São Paulo, SP, Brazil
| | - Ivo Lebrun
- Laboratoryof Biochemistry and Biophysics, Institute Butantan, São Paulo, Brazil
| | - Daniel C de Andrade
- Department of Neurology, Central Institute, Av. Dr Enéas de Carvalho Aguiar, 255, 5(th) Floor, Room 5084, Cerqueira César, 05403-900 São Paulo, SP, Brazil; Instituto do Câncer Octavio Frias de Oliveira, University of São Paulo, Brazil
| | - Manoel J Teixeira
- Department of Neurology, Central Institute, Av. Dr Enéas de Carvalho Aguiar, 255, 5(th) Floor, Room 5084, Cerqueira César, 05403-900 São Paulo, SP, Brazil
| | - Luiz R G Britto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 1524, ICB-I, Cidade Universitária, 05508-000 São Paulo, SP, Brazil
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N3M5, Canada
| | - Camila S Dale
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo - Av. Prof. Lineu Prestes, 2415, ICB-III, Cidade Universitária, 05508-900 São Paulo, SP, Brazil; Department of Surgical Technique, Medical School, University of São Paulo, Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brazil.
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Araujo de Franca S, Tavares WM, Salinet ASM, Paiva WS, Teixeira MJ. Early tracheostomy in stroke patients: A meta-analysis and comparison with late tracheostomy. Clin Neurol Neurosurg 2021; 203:106554. [PMID: 33607581 DOI: 10.1016/j.clineuro.2021.106554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Abstract
Tracheostomy (TQT) timing and its benefits is a current discussion in medical society. We aimed to compare the outcomes of early (ET) versus late tracheostomy (LT) in stroke patients with systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five hundred and nineteen studies were retrieved, whereas three were selected for the systematic review and meta-analysis. There were 5636 patients in the ET group (3151 male, 2470 female, 15 not reported - NR) and 7637 patients in the LT group (4098 male, 3542 female, and 33 NR). ET was significantly associated with fewer days in the hospital (weighted mean difference: -7.73 [95 % CI -8.59-6.86], p < 0.001) and reduced cases of ventilator-associated pneumonia (VAP) (risk difference: 0.71 [95 % CI 0.62-0.81], p < 0.001). There were no between-group statistical differences in intensive care unit stay duration, mechanical ventilation duration, or mortality. The findings from this meta-analysis cannot state that ET in severe stroke patients contributes to better outcomes when compared with LT. Scandalized assessments and randomized trials are encourage for better assessment.
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Affiliation(s)
- Sabrina Araujo de Franca
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil.
| | - Wagner M Tavares
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil; Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Angela S M Salinet
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil; Division of Functional Neurosurgery, Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Wellingson S Paiva
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Manoel J Teixeira
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
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de Oliveira AJM, Pinto FCG, Teixeira MJ. Comparative Study of the Effectiveness of Lumboperitoneal and Ventriculoperitoneal Shunting with Neuronavigation in the Treatment of Idiopathic Intracranial Hypertension. Neurol India 2020; 68:1061-1064. [PMID: 33109853 DOI: 10.4103/0028-3886.294549] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Idiopathic intracranial hypertension is an uncommon intracranial disorder in which intracranial pressure is increased without radiological evidence of lesions. Surgery is indicated when severe optic neuropathy is present or medical treatment fails. Objective To assess the comparative effectiveness of lumboperitoneal (LPS) and ventriculoperitoneal shunt (VPS) with neuronavigation. Subjects and Methods A retrospective study was performed based on our database. We analyzed demographics, pre and postoperative parameters, and follow-up data on patients who had undergone either LPS or VPS between January 2007 and December 2017. Results Group I consisted of 17 VPS patients, of which 16 were female, and group II consisted of 29 LPS patients, of which 26 were female. The number of surgeries performed in the LPS group was higher (due to recurrence) than that in the VPS group. Moreover, the rate of complications was higher in the LPS group. Conclusions VPS is safer and has a lower rate of complications and reinterventions compared to LPS.
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Affiliation(s)
- Adilson J M de Oliveira
- Neurosurgery Division, Hospital Das Clinicas da Faculdade de Medicina da USP, São Paulo, Brazil; Neurosurgery Division, Clinica Girassol, Luanda, Angola
| | - Fernando C G Pinto
- Neurosurgery Division, Hospital Das Clinicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Manoel J Teixeira
- Neurosurgery Division, Hospital Das Clinicas da Faculdade de Medicina da USP, São Paulo, Brazil
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Cury RG, Carra RB, Capato TTC, Teixeira MJ, Barbosa ER. Spinal Cord Stimulation for Parkinson's Disease: Dynamic Habituation as a Mechanism of Failure? Mov Disord 2020; 35:1882-1883. [PMID: 33068473 DOI: 10.1002/mds.28271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rubens G Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael B Carra
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tamine T C Capato
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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16
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Miotto EC, Bazán PR, Batista AX, Conforto AB, Figueiredo EG, Martin MDGM, Avolio IB, Amaro E, Teixeira MJ. Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients. Front Neurol 2020; 11:1048. [PMID: 33041987 PMCID: PMC7522394 DOI: 10.3389/fneur.2020.01048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Stroke lesions are frequently followed by cognitive impairments. Cognitive training is a non-pharmacological intervention that can promote neural compensation mechanisms and strategies to remediate cognitive impairments. The aims of this study were: (1) To investigate the cognitive performance, generalization effects, and neural correlates of semantic organization strategy training (SOST) in patients with chronic left frontoparietal stroke and healthy controls (HC); and (2) to compare the behavioral effects and neural correlates of SOST with an active control psychoeducation intervention (PI). In this randomized controlled study, all participants were randomly allocated into two groups, one group received SOST, and the other received PI intervention. Participants underwent two fMRI sessions, one prior and the other, after intervention. In each fMRI session, images were obtained during memory encoding task using a list of semantically related words. We found improved post-intervention memory performance in participants that received SOST (both patients and controls), indicated by number of words recalled, word clustering scores, and performance in a generalization task. The fMRI analysis revealed negative correlation between task performance and regions of the default-mode network. These results suggest that cognitive training using semantic organization strategy can improve episodic memory performance and promote potential functional neuroplasticity in patients with ischemic stroke lesions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03644290.
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Affiliation(s)
- Eliane C Miotto
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Paulo R Bazán
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
| | - Alana X Batista
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Edson Amaro
- Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil
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França C, de Andrade DC, Silva V, Galhardoni R, Barbosa ER, Teixeira MJ, Cury RG. Effects of cerebellar transcranial magnetic stimulation on ataxias: A randomized trial. Parkinsonism Relat Disord 2020; 80:1-6. [PMID: 32920321 DOI: 10.1016/j.parkreldis.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cerebellar ataxia remains a neurological symptom orphan of treatment interventions, despite being prevalent and incapacitating. We aimed to study, in a double-blind design, whether cerebellar modulation could improve ataxia. METHODS We included patients with diagnosis of spinocerebellar ataxia type 3, multiple systems atrophy cerebellar type, or post-lesion ataxia. Patients received five sessions each of sham and active cerebellar 1 Hz deep repetitive transcranial magnetic stimulation in randomized order. Our primary outcome was the decrease in the Scale for the Assessment and Rating of Ataxia when comparing phases (active x sham). Secondary outcomes measures included the International Cooperative Ataxia Rating Scale, and other motor, cognitive, and quality of life scales. This study was registered at clinicaltrials.gov (protocol NCT03213106). RESULTS Twenty-four patients aged 29-74 years were included in our trial. After active stimulation, the Scale for the Assessment and Rating of Ataxia score was significantly lower than the score after sham stimulation [median (interquartile range) of 10.2 (6.2, 16.2) versus 12.8 (9.6, 17.8); p = 0.002]. The International Cooperative Ataxia Rating Scale score also improved after active stimulation versus sham [median (interquartile range) of 29.0 (21.0, 43.5) versus 32.8 (22.0, 47.0); p = 0.005]. Other secondary outcomes were not significantly modified by stimulation. No patient presented severe side effects, and nine presented mild and self-limited symptoms. CONCLUSIONS Our protocol was safe and well-tolerated. These findings suggest that cerebellar modulation may improve ataxic symptom and provide reassurance about safety for clinical practice.
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Affiliation(s)
- Carina França
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel C de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Valquíria Silva
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens G Cury
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Ciampi de Andrade D, Galhardoni R, da Silva VA, García-Larrea L, Dale C, Baptista AF, Barbosa LM, Bahia Menezes LM, de Siqueira SRDT, Valério F, Rosi J, Lilian de Lima Rodrigues A, Toledo Reis Mendes Fernandes D, Selingardi PML, Marcolin MA, Luís de Souza Duran F, Ono CR, Lucato LT, Fernandes AMBL, da Silva FEF, Yeng LT, Brunoni AR, Buchpiguel CA, Teixeira MJ. Author response: Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain. Neurology 2020; 94:721-722. [PMID: 32312880 DOI: 10.1212/wnl.0000000000009304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Kaziyama H, Barbour J, Galhardoni R, da Silva V, Tesseroli de Siqueira S, Listik C, dos Santos GJ, Yeng LT, Marcolin MA, Raicher I, Teixeira MJ, Ciampi de Andrade D. Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype. Eur J Pain 2020; 24:1635-1647. [DOI: 10.1002/ejp.1620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Helena Kaziyama
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | - Julio Barbour
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | - Ricardo Galhardoni
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- School of MedicineUniversity of City of São Paulo (UNICID) São Paulo Brazil
| | - Valquíria da Silva
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Clarice Listik
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Lin T. Yeng
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | | | - Irina Raicher
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Manoel J. Teixeira
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Daniel Ciampi de Andrade
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
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Lopes A, Duarte K, Lins C, Kubota G, Silva V, Galhardoni R, Menezes LMB, Raicher I, Teixeira MJ, Andrade DC. Spinal Cord Stimulation as a Treatment Option for Refractory Chemotherapy-Induced Peripheral Neuropathy: Case Report. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020. [DOI: 10.1055/s-0040-1709985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractColorectal cancer is one of the most common oncological diseases. Chemotherapy is usually recommended as an adjuvant treatment for stage-II, -III, and -IV tumors. Approximately 10% of the patients develop neuropathic pain after chemotherapy, and they may remain refractory despite the administration of drugs that are commonly used to treat neuropathic pain. Spinal cord stimulation is a good treatment option for neuropathic pain of the lower limbs, and it should be trialed in patients with chemotherapy-induced peripheral neuropathy. We report the case of a patient with oxaliplatin-induced neuropathy and neuropathic pain refractory to oral medication who was successfully treated by spinal cord stimulation.
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Affiliation(s)
- Arthur Lopes
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
| | - Kleber Duarte
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Catarina Lins
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Gabriel Kubota
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Valquíria Silva
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Department of Neurology, Faculdade de Medicina, Universidade Cidade de São Paulo (Unicid), São Paulo, São Paulo, Brazil
| | | | - Irina Raicher
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Manoel J. Teixeira
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Daniel C. Andrade
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
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22
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Brasil S, Renck AC, de Meneck F, Brioschi ML, Costa EF, Teixeira MJ. A systematic review on the role of infrared thermography in the Brown adipose tissue assessment. Rev Endocr Metab Disord 2020; 21:37-44. [PMID: 31965434 DOI: 10.1007/s11154-020-09539-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/13/2022]
Abstract
Brown adipose tissue (BAT) is an endocrine adipose tissue with attributes to dissipate energy as heat in response to changes in temperature and diet. Infrared thermography (IRT) has been studied in recent years in the assessment of BAT thermogenesis, as an option to positron emission tomography - computed tomography (PET-CT), because of several advantages. We performed a systematic review on the use of IRT in BAT assessment. Comprehensive online search was performed in different databases. The QUADAS 2 tool was used to evaluate studies' quality. 12 studies fit the inclusion criteria, whereas only one of these was considered of low risk of bias. 10 studies were favorable to IRT appliance in BAT evaluation, observing elevation of supraclavicular skin temperature correlated with BAT activity. Studies were heterogeneous in design, and a meta-analysis was precluded. Further studies with similar methodologies are needed. Conclusion: Despite the large number of published methodologies, IRT is a promising method for detecting BAT activation. Current knowledge already allows a better understanding of thermography to improve and standardize the technique.
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Affiliation(s)
- Sérgio Brasil
- Division of Neurological Surgery. Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Alessandra C Renck
- Department of Endocrinology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Franciele de Meneck
- Department of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Marcos L Brioschi
- Division of Neurological Surgery. Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elaine F Costa
- Department of Endocrinology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurological Surgery. Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Mandel M, Tutihashi R, Figueiredo EG, Rossi J, Teixeira MJ. Abstract WMP35: Prospective Randomized Study Comparing Clinical, Functional, Aesthetic and Quality of Life Results of Trans-Eyelid and Minipterional Approaches for Treatment of Unruptered Brain Aneurysms. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp35] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Minimally invasive neurosurgery is already a reality in many centers across the world. However, the real role of these techniques and their effect on the outcome of patients is still obscure.
Objectives:
To evaluate the safety and results of minimally invasive techniques in brain aneurysm clipping and determine the possibility of early hospital discharge.
Methods:
111 adult patients with unruptured anterior circulation aneurysms were randomized and underwent a minimally invasive surgical approach, (36 by trans-eyelid approach (Figure1) and 34 through a reduced minipterional craniotomy) or classical pterional approach (41 patients). Patients in the study group were subjected to a specific protocol for assessment of early hospital discharge.
Results:
In both groups, the demographics and characteristics of aneurysms were similar. The average time of surgery was lower in the study group (214 min. vs. 292 min, p = 0.0008). The need for blood transfusion was lower in the study group (1 patient vs 7 patients, p = 0.018). The number of ischemic events was lower in the study group (patients 4 patients vs. 8, p = 0.07), but events with clinical significance were similar (3 patients vs. 2 patients, p = 0.53). The presence of residual neck on control angiography was lower in the study group (6 patients vs 11, p = 0.021). The paralysis of the frontal branch of the facial nerve was lower in the study group, both temporary (3 vs 14, p = 0.008) and definitive (0 vs. 4, p = 0.032). The atrophy of the temporal muscle was less frequent and less severe in the study group (9 vs 14, p = 0.012). Most patients in the study group (91.4%), were discharged on the next day of the surgery.
Conclusions:
The results showed that the proposed minimally invasive alternatives are safe. Clinical and surgical results are equal or superior to conventional treatment in several topics. Early discharge in these patients is possible and safe. The described approaches (nanopterional or transpalpebral) are better alternatives to the classical pterional craniotomy to treat unruptured aneurysms of the anterior circulation.
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Bor-Seng-Shu E, Paschoal FM, Almeida KJ, De Lima Oliveira M, Nogueira RC, Teixeira MJ, Walter U. Transcranial brain sonography for Parkinsonian syndromes. J Neurosurg Sci 2020; 63:441-449. [PMID: 31210040 DOI: 10.23736/s0390-5616.19.04696-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantia nigra (SN) hyperechogenicity has been proved to be a characteristic finding for idiopathic Parkinson's disease (PD), occurring in more than 90% of the patients. This echofeature is owed to increased amounts of iron in the SN region and reflects a functional impairment of the nigrostriatal dopaminergic system. In a prospective blinded study in which a group of patients with early mild signs and symptoms of unclear Parkinsonism were followed until a definite clinical diagnosis of PD, the hyperechogenicity of the SN was demonstrated to be highly predictive of a final diagnosis of PD. For the diagnosis of PD in individuals with early motor symptoms, both the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90% and both the specificity and negative predictive value were higher than 80%. For early differential diagnosis between PD and atypical Parkinsonian syndromes, the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90%, and both the specificity and negative predictive value were higher than 80%. The diagnostic specificity is increased if combining the TCS findings of SN, lenticular nucleus and third ventricle. In asymptomatic adult subjects, SN hyperechogenicity, at least unilaterally, indicates a subclinical functional insufficiency of the nigrostriatal dopaminergic system. Recent papers revealed that SN hyperechogenicity might suggest preclinical PD. Reduced echogenicity of midbrain raphe indicates increased risk of depression in PD patients. Caudate nucleus hyperechogenicity has been associated with drug-induced psychosis, and frontal horn dilatation >20 mm with dementia. Transcranial brain sonography can be a valuable tool for managing patients with Parkinsonian signs and symptoms.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil -
| | - Fernando M Paschoal
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Kelson J Almeida
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo De Lima Oliveira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo C Nogueira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
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Abstract
ABSTRACTObjectives: To investigate the clinical characteristics of patients with trigeminal neuralgia referred to surgery in a center of reference.Methods: We evaluated the general characteristics of 395 patients with trigeminal neuralgia referred to neurosurgery as treatment. They corresponded to 2 samples of 1984 and 2004. The EDOFHC protocol (Orofacial Pain Questionnaire) and the medical profile were used.Results: In the first study (1984), with 290 patients, the higher prevalence was: women (57.3%), white (95.5%), with mean age of 62.5. The most affected trigeminal branches were the maxillary and / or mandibular branches (65.5%), and the right side was the most affected (57.6%). From the second study (2004), with 105 patients, 57.1% were women, 75.2% white, with a mean age of 60.8. The maxillary and / or mandibular branches (79.0%) and the right side (69.5%) were the most affected. Both samples had neurological abnormalities and systemic diseases (mainly cardiovascular).Conclusions: General characteristics of these patients were similar to other samples of trigeminal neuralgia. Neurological findings were also present in patients with no previous surgical treatment for TN. Hypertension and cardiac diseases were also frequent and make the monitoring of the patients during crises necessary. (Eur J Dent 2009;3:207-212)
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Affiliation(s)
- Silvia RDT Siqueira
- DDS, PhD, Assistant Professor at Escola de Artes, Ciencias e Humanidades and member of the Orofacial Pain Team, Dentistry Division, Hospital das Clinicas, Medical School, University of São Paulo, SP, Brazil
| | - Manoel J Teixeira
- MD, PhD, Head of the Pain Center of Hospital das Clinicas, Chairman of Neurosurgery, Neurology Department, Medical School, University of São Paulo, SP, Brazil
| | - José TT Siqueira
- DDS, PhD, Head of the Orofacial Pain Team, Dentistry Division, Hospital das Clínicas, Medical School, University of São Paulo, SP, Brazil
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Abstract
Background: Cerebral aneurysm prevalence may vary from 0.4% to 10%. The decision to treat or not incidental aneurysms remains controversial, especially when the lesions are small (<5 mm). Many recent publications are demonstrating that these lesions often bleed. Methods: We reviewed admitted patients with angiographic studies submitted to intracranial aneurysm surgical treatment from April 2012 to July 2013 in the Neurosurgery Department of São Paulo Medical School University (15 months), to define the rate and risk of bleeding. In addition, we proceeded literature review with collected 357 papers (past 5 years) which were selected 50 that were focused on our research. Clinical patients’ status at the time of discharge was evaluated with the modified Rankin scale. Results: A series of 118 cases of surgically clipped aneurysms was analyzed: 73.7% woman; Ruptured (61 cases, 51%); middle cerebral artery (51 cases, 43%) was the more common aneurysm. Small size (<5 mm) was 25 cases (21%); that 2 died (16%), 3 (25%) with severe disability,restricted to bed and dependent on nursing care; blood pressure was the main risk factors (56%); and an aneurysm <2 mm (100%) was ruptured. Conclusion: The number of small aneurysms in our series was significant (25 cases, 21%), and its rate of bleeding was high (25 cases, 48%), resulting in death and disability in a significant number of cases. Our tendency is for surgical treatment when it is associated with risk factors.
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Affiliation(s)
- Gustavo Noleto
- Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nícollas Nunes Rabelo
- Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo Abaurre
- Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Hugo Sterman Neto
- Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Mario Siqueira
- Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
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Galhardoni R, Aparecida da Silva V, García-Larrea L, Dale C, Baptista AF, Barbosa LM, Menezes LMB, de Siqueira SRDT, Valério F, Rosi J, de Lima Rodrigues AL, Reis Mendes Fernandes DT, Lorencini Selingardi PM, Marcolin MA, Duran FLDS, Ono CR, Lucato LT, Fernandes AMBL, da Silva FEF, Yeng LT, Brunoni AR, Buchpiguel CA, Teixeira MJ, Ciampi de Andrade D. Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain. Neurology 2019; 92:e2165-e2175. [PMID: 30952795 DOI: 10.1212/wnl.0000000000007396] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. METHODS Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session. RESULTS Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018). CONCLUSIONS ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se. CLINICALTRIALSGOV IDENTIFIER NCT01932905.
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Affiliation(s)
- Ricardo Galhardoni
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Valquíria Aparecida da Silva
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Luís García-Larrea
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Camila Dale
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Abrahão F Baptista
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Luciana Mendonça Barbosa
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Luciana Mendes Bahia Menezes
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Silvia R D T de Siqueira
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Fernanda Valério
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Jefferson Rosi
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Antonia Lilian de Lima Rodrigues
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Diego Toledo Reis Mendes Fernandes
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Priscila Mara Lorencini Selingardi
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Marco Antônio Marcolin
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Fábio Luís de Souza Duran
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Carla Rachel Ono
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Leandro Tavares Lucato
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Ana Mércia B L Fernandes
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Fábio E F da Silva
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Lin T Yeng
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - André R Brunoni
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Carlos A Buchpiguel
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Manoel J Teixeira
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France
| | - Daniel Ciampi de Andrade
- From the Pain Center (L.M.B., L.M.B.M., R.D.T.d.S., F.V., J.R., M.J.T., D.C.d.A.), Instituto do Câncer do Estado de São Paulo; Pain Center (R.G.G., V.S., A.L.d.L.R., D.T.R.M.F., P.M.L.S., M.A.M., S.R.D.T.d.S., A.M.B.L.F., M.J.T., D.C.d.A.), LIM62 Neurosurgery LIM, Department of Neurology, Instituto de Ortopedia e Traumatologia (L.T.Y.), Division of Physical Medicine and Rehabilitation, and Laboratory of Psychiatric Neuroimaging (LIM-21) (F.L.d.S.D.), Department and Institute of Psychiatry, School of Medicine, University of São Paulo; Service of Interdisciplinary Neuromodulation (R.G.G., V.S., A.R.B., M.J.T., D.C.d.A.), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry, Department and Institute of Psychiatry, Neuroradiology Section (L.T.L., F.E.F.d.S.), Instituto de Radiologia, and Department of Radiology (C.R.O., C.A.B.), University of São Paulo School of Medicine; Center for Mathematics, Computation and Cognition (A.F.B.), Federal University of ABC, São Bernardo do Campo; School of Medicine (R.G.G.), University of City of São Paulo; Department of Anatomy (C.D.), Institute of Biomedical Sciences of University of São Paulo, Brazil; and Central Integration of Pain (NeuroPain) (L.G.-L.), Lyon Centre for Neurosciences, Inserm U1028, University Claude Bernard Lyon 1, and Hospices Civils de Lyon, France.
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Hayashi C, Neville IS, Rodrigues P, Galhardoni RRG, de Andrade DC, Zaninotto AL, Teixeira MJ, Paiva WS. Abstract #77: Repetitive Transcranial Magnetic Stimulation (rTMS) in chronic diffuse axonal injury: a randomized controlled trial. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hayashi C, Nevile IS, Almeida CC, Rodrigues P, Galhardoni RRG, de Andrade DC, Teixeira MJ, Paiva WS. Abstract #80: Assessment of cortical excitability with Transcranial Magnetic Stimulation in patients with brain tumor. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Batista CM, Mariano ED, Dale CS, Cristante AF, Britto LR, Otoch JP, Teixeira MJ, Morgalla M, Lepski G. Pain inhibition through transplantation of fetal neuronal progenitors into the injured spinal cord in rats. Neural Regen Res 2019; 14:2011-2019. [PMID: 31290460 PMCID: PMC6676883 DOI: 10.4103/1673-5374.259624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Neuropathic pain after spinal cord injury (SCI) is a complex condition that responds poorly to usual treatments. Cell transplantation represents a promising therapy; nevertheless, the ideal cell type in terms of neurogenic potential and effectiveness against pain remains largely controversial. Here, we evaluated the ability of fetal neural stem cells (fNSC) to relieve chronic pain and, secondarily, their effects on motor recovery. Adult Wistar rats with traumatic SCI were treated, 10 days after injury, with intra-spinal injections of culture medium (sham) or fNSCs extracted from telencephalic vesicles (TV group) or the ventral medulla (VM group) of E/14 embryos. Sensory (von Frey filaments and hot plate) and motor (the Basso, Beattie, Bresnahan locomotor rating scale and inclined plane test) assessments were performed during 8 weeks. Thereafter, spinal cords were processed for immunofluorescence and transplanted cells were quantified by stereology. The results showed improvement of thermal hyperalgesia in the TV and VM groups at 4 and 5 weeks after transplantation, respectively. Moreover, mechanical allodynia improved in both the TV and VM groups at 8 weeks. No significant motor recovery was observed in the TV or VM groups compared with sham. Stereological analyses showed that ~70% of TV and VM cells differentiated into NeuN+ neurons, with a high proportion of enkephalinergic and GABAergic cells in the TV group and enkephalinergic and serotoninergic cells in the VM group. Our study suggests that neuronal precursors from TV and VM, once implanted into the injured spinal cord, maturate into different neuronal subtypes, mainly GABAergic, serotoninergic, and enkephalinergic, and all subtypes alleviate pain, despite no significant motor recovery. The study was approved by the Animal Ethics Committee of the Medical School of the University of São Paulo (protocol number 033/14) on March 4, 2016.
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Affiliation(s)
- Chary M Batista
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eric D Mariano
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Camila S Dale
- Department of Anatomy, Institute of Biomedical Science, University of São Paulo, São Paulo, Brazil
| | - Alexandre F Cristante
- Department of Orthopedic and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz R Britto
- Department of Physiology and Biophysics, Institute of Biomedical Science, University of São Paulo, São Paulo, Brazil
| | - Jose P Otoch
- Department of Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matthias Morgalla
- Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany
| | - Guilherme Lepski
- Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany; Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
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Franco RR, Fonoff ET, Alvarenga PG, Alho EJL, Lopes AC, Hoexter MQ, Batistuzzo MC, Paiva RR, Taub A, Shavitt RG, Miguel EC, Teixeira MJ, Damiani D, Hamani C. Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome. JAMA Netw Open 2018; 1:e185275. [PMID: 30646396 PMCID: PMC6324383 DOI: 10.1001/jamanetworkopen.2018.5275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Deep brain stimulation (DBS) has been investigated for treatment of morbid obesity with variable results. Patients with Prader-Willi syndrome (PWS) present with obesity that is often difficult to treat. OBJECTIVE To test the safety and study the outcome of DBS in patients with PWS. DESIGN, SETTING, AND PARTICIPANTS This case series was conducted in the Hospital das Clínicas, University of São Paulo, Brazil. Four patients with genetically confirmed PWS presenting with severe obesity were included. EXPOSURE Deep brain stimulation electrodes were bilaterally implanted in the lateral hypothalamic area. After DBS implantation, the treatment included the following phases: titration (1-2 months), stimulation off (2 months), low-frequency DBS (40 Hz; 1 month), washout (15 days), high-frequency DBS (130 Hz; 1 month), and long-term follow-up (6 months). MAIN OUTCOMES AND MEASURES Primary outcome measures were adverse events recorded during stimulation and long-term DBS treatment. Secondary outcomes consisted of changes in anthropometric measures (weight, body mass index [calculated as weight in kilograms divided by height in meters squared], and abdominal and neck circumference), bioimpedanciometry, and calorimetry after 6 months of treatment compared with baseline. The following evaluations and measurements were conducted before and after DBS: clinical, neurological, psychiatric, neuropsychological, anthropometry, calorimetry, blood workup, hormonal levels, and sleep studies. Adverse effects were monitored during all follow-up visits. RESULTS Four patients with PWS were included (2 male and 2 female; ages 18-28 years). Baseline mean (SD) body mass index was 39.6 (11.1). Two patients had previous bariatric surgery, and all presented with psychiatric comorbidity, which was well controlled with the use of medications. At 6 months after long-term DBS, patients had a mean 9.6% increase in weight, 5.8% increase in body mass index, 8.4% increase in abdominal circumference, 4.2% increase in neck circumference, 5.3% increase in the percentage of body fat, and 0% change in calorimetry compared with baseline. Also unchanged were hormonal levels and results of blood workup, sleep studies, and neuropsychological evaluations. Two patients developed stimulation-induced manic symptoms. Discontinuation of DBS controlled this symptom in 1 patient. The other required adjustments in medication dosage. Two infections were documented, 1 associated with skin picking. CONCLUSIONS AND RELEVANCE Safety of lateral hypothalamic area stimulation was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS. In the small cohort of patients with PWS treated in our study, DBS was largely ineffective.
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Affiliation(s)
- Ruth R. Franco
- Children’s Institute, Division of Pediatric Endocrinology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T. Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro G. Alvarenga
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo J. L. Alho
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Antonio Carlos Lopes
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Raquel R. Paiva
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Anita Taub
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Roseli G. Shavitt
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Euripides C. Miguel
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel J. Teixeira
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Durval Damiani
- Children’s Institute, Division of Pediatric Endocrinology, University of São Paulo Medical School, São Paulo, Brazil
| | - Clement Hamani
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- Harquail Centre for Neuromodulation, Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Rosi J, Morais BA, Pecorino LS, Oliveira AR, Solla DJ, Teixeira MJ, Figueiredo EG. Hyperhomocysteinemia as a Risk Factor for Intracranial Aneurysms: A Case–Control Study. World Neurosurg 2018; 119:e272-e275. [DOI: 10.1016/j.wneu.2018.07.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
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Beer-Furlan A, Neto SG, Teixeira MJ, Figueiredo EG. Fulfilling Need for Neurosurgical Services in Sub-Saharan Africa: Initial Angola-Brazil Training Experience. World Neurosurg 2018; 122:29-32. [PMID: 30366143 DOI: 10.1016/j.wneu.2018.10.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/19/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although Africa accounts for 15% of the global volume of neurosurgical disease, African hospitals and health care networks have access to <1% of the neurosurgeon community. Health care and neurosurgical care are particularly scarce in sub-Saharan Africa due to long periods of imperialism, civil war, poverty, and famines that have plagued the area. METHODS We provide a historical perspective and initial experience of the development of neurosurgery in Angola. RESULTS The Republic of Angola has the seventh largest territory in Africa and a population of approximately 29 million people; however, it has a severe deficit of neurosurgery specialists. Between 1975 and 2012, only 5 neurosurgeons practiced in the country. We report the initial experience of the first Angolan physician who completed a full neurosurgical residency in Brazil through the Hospital das Clínicas-University of São Paulo Medical School international medical training program. The challenges of fulfilling the need for neurosurgical services and the future perspectives of building a sustainable program in Angola are discussed. CONCLUSIONS Partnerships between developing countries and sub-Saharan African countries may be the starting point in supplying neurosurgical specialists to the countries in need.
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Affiliation(s)
- André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
| | - Sérgio G Neto
- Department of Surgery, Neurosurgery Service, Clínica Girassol, Luanda, Angola; Department of Surgery, Neurosurgery Service, Clínica Sagrada Esperança, Luanda, Angola
| | - Manoel J Teixeira
- Department of Neurology, Discipline of Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eberval G Figueiredo
- Department of Neurology, Discipline of Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Cury RG, França C, Barbosa ER, Galhardoni R, Lepski G, Teixeira MJ, Ciampi de Andrade D. Dentate nucleus stimulation in a patient with cerebellar ataxia and tremor after cerebellar stroke: A long-term follow-up. Parkinsonism Relat Disord 2018; 60:173-175. [PMID: 30297213 DOI: 10.1016/j.parkreldis.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Carina França
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Guilherme Lepski
- Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of Tübingen, Germany
| | - Manoel J Teixeira
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil
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Gorgulho AA, Fernandes F, Damiani LP, Barbosa DAN, Cury A, Lasagno CM, Bueno PRT, Santos BFO, Santos RHN, Berwanger O, Cavalcanti AB, Teixeira MJ, Moreno RA, De Salles AAF. Double Blinded Randomized Trial of Subcutaneous Trigeminal Nerve Stimulation as Adjuvant Treatment for Major Unipolar Depressive Disorder. Neurosurgery 2018; 85:717-728. [DOI: 10.1093/neuros/nyy420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders.
OBJECTIVE
To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD).
METHODS
The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales.
EXPECTED OUTCOMES
The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability.
DISCUSSION
This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.
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Affiliation(s)
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Lucas P Damiani
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Daniel A N Barbosa
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Abrão Cury
- Internal Medicine Department, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Camila M Lasagno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Priscila R T Bueno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Bruno F O Santos
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Renato H N Santos
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Otávio Berwanger
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | | | - Manoel J Teixeira
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
- Neurosurgery Discipline, Neurology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
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Parravano D, de Andrade DCA, Fonoff ET, Monaco BA, Navarro J, Yeng LT, Teixeira MJ, Hamani C. In Reply: Quality of Life After Motor Cortex Stimulation: Clinical Results and Systematic Review of the Literature. Neurosurgery 2018; 83:E132. [PMID: 29850854 DOI: 10.1093/neuros/nyy250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniella Parravano
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Daniel Ciampi A de Andrade
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Erich T Fonoff
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Bernardo A Monaco
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Jessie Navarro
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Lin T Yeng
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil
| | - Clement Hamani
- Division of Neurosurgery Department of Neurology University of São Paulo Medical School São Paulo, Brazil.,Division of Neurosurgery Sunnybrook Health Sciences Centre Toronto, Canada
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Mandel M, Tutihashi R, Figueiredo EG, Junior JR, Jeng B, Teixeira MJ. 107 Prospective Randomized Study Comparing Clinical, Functional, Aesthetic and Quality of Life Results of Transpalpebral, Nanopterional, and Classic Pterional Approaches. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Solla DJF, Amorim RL, Teixeira MJ, Paiva WS. 190 Incremental Prognostic Value of the Activated Partial Thromboplastin Time and Creatinine in Addition to the Crash Score in Traumatic Brain Injury Patients. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morais BA, Cardeal DD, Andrade FG, Paiva WS, Matushita H, Teixeira MJ. Reversible ventriculoperitoneal shunt dysfunction and chronic constipation: case report. J Neurosurg Pediatr 2018; 22:147-150. [PMID: 29749881 DOI: 10.3171/2018.2.peds17574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Constipation can cause transient malfunction of the ventriculoperitoneal shunt (VPS). Patients with myelomeningocele or cerebral palsy are often diagnosed with hydrocephalus and constipation due to neurogenic bowel. These patients are more prone to VPS dysfunction, often requiring surgical revision. The authors report the case of a 6-year-old girl with a VPS that had been implanted due to hydrocephalus secondary to myelomeningocele. The patient was brought to the emergency department with intermittent headache, vomiting, constipation, and abdominal distension and pain. A CT scan revealed ventricular dilatation and radiography of the abdomen showed bowel loop distension. After a Fleet enema and digital maneuvers, her abdominal distension and symptoms improved. A CT scan obtained 24 hours later showed a reduction in ventricular size. The mechanism by which constipation can lead to VPS malfunction can be traced to indirect increases of intraabdominal pressure and direct obstruction of the catheter by distended intestinal loops. Treating constipation can restore the free circulation of the CSF and avoid surgical intervention. Careful neurological monitoring of these patients is essential, because some measures used to treat constipation can increase intracranial pressure. The objective of this report was to highlight constipation as a possible cause of transient VPS malfunction, thereby avoiding unnecessary surgical revisions, to which children with hydrocephalus are frequently submitted.
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Galhardoni R, Ciampi de Andrade D, Puerta MYT, Brunoni AR, Varotto BLR, de Siqueira JTT, Teixeira MJ, Siqueira SRDT. Altered cortical excitability in persistent idiopathic facial pain. Cephalalgia 2018; 39:219-228. [DOI: 10.1177/0333102418780426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Persistent idiopathic facial pain is a refractory and disabling condition of unknown mechanism and etiology. It has been suggested that persistent idiopathic facial pain patients have not only peripheral generators of pain, but also central nervous system changes that would contribute to the persistence of symptoms. We hypothesized that persistent idiopathic facial pain would have changes in brain cortical excitability as measured by transcranial magnetic stimulation compared to healthy controls. Methods Twenty-nine persistent idiopathic facial pain patients were compared to age- and sex-matched healthy controls and underwent cortical excitability measurements by transcranial magnetic stimulation applied to the cortical representation of the masseter muscle of both hemispheres. Single-pulse stimulation was used to measure the resting motor threshold and suprathreshold motor-evoked potentials. Paired-pulse stimulation was used to assess short intracortical inhibition and intracortical facilitation. Clinical pain and associated symptoms were assessed with validated tools. Results Spontaneous pain was found in 27 (93.1%) and provoked pain was found in two (6.9%) persistent idiopathic facial pain patients. The motor-evoked potentials at 120% and 140% were significantly lower for both hemispheres compared to controls. Persistent idiopathic facial pain patients had lower short-interval intracortical inhibition compared with controls. These changes were correlated with some aspects of quality of life, and higher mood symptoms. These neurophysiological alterations were not influenced by analgesic medication, as similar changes were observed in patients with or without central-acting drugs. Conclusions Persistent idiopathic facial pain is associated with changes in intracortical modulation involving GABAergic mechanisms, which may be related to certain aspects of the pathophysiology of this chronic pain condition. Trial registration: NTC01746355.
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Affiliation(s)
- Ricardo Galhardoni
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Pain Center, Cancer Institute of State of São Paulo “Octavio Frias de Oliveira”, São Paulo, Brazil
| | - Mariana YT Puerta
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Bruna LR Varotto
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - José TT de Siqueira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Manoel J Teixeira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Pain Center, Cancer Institute of State of São Paulo “Octavio Frias de Oliveira”, São Paulo, Brazil
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Silvia RDT Siqueira
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo SP, Brazil
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- School of Arts, Science and Humanities, University of São Paulo, São Paulo, Brazil
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Peres CMA, Caldas JGMP, Puglia P, de Andrade AF, da Silva IAF, Teixeira MJ, Figueiredo EG. Endovascular management of acute epidural hematomas: clinical experience with 80 cases. J Neurosurg 2018; 128:1044-1050. [DOI: 10.3171/2016.11.jns161398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESmall acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions.METHODSThe study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group.RESULTSThe causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation.CONCLUSIONSThis study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.
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Affiliation(s)
| | | | | | - Almir F. de Andrade
- 3Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Igor A. F. da Silva
- 3Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Manoel J. Teixeira
- 3Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil
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de França SA, Nepomuceno TB, Paiva WS, Andrade AF, Teixeira MJ, Tavares WM. Cranial autologous bone flap resorption after a cranioplasty: A case report. Surg Neurol Int 2018; 9:61. [PMID: 29629228 PMCID: PMC5875111 DOI: 10.4103/sni.sni_388_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/06/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Craniectomies and cranioplasty are common neurosurgical procedures performed after brain trauma, ischemia, tumor resection, or infection. Post-cranioplasty autologous bone flap resorption may occur in patients after delayed cranial reconstruction. The occurrence is usually low when bone flaps are stored in subcutaneous abdominal tissue. We report a unique case of post-cranioplasty cranial bone flap. CASE DESCRIPTION We report a total autologous bone flap resorption in a 28-year-old man with a history of alcohol abuse. He was found unconscious in his bedroom with a head trauma of unknown mechanism. After an emergency room assessment, he was diagnosed with an acute subdural hematoma and underwent to emergency surgical drainage and a craniectomy. Three months later, a cranioplasty was performed and he exhibited exceptional outcomes. During a follow-up assessment, 7 months post-cranioplasty, total bone flap resorption was observed on computerized tomography image. CONCLUSION This case described an abnormal accelerated resorption of an autologous bone flap cranioplasty inserted after 3 months. Thus, to avoid bone flap resorption, an as early as possibly strategy may prevent this. Still, the exact mechanisms underlying bone resorption are poorly understood.
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Affiliation(s)
- Sabrina A. de França
- IPSPAC – Instituto Paulista de Saúde para a Alta Complexidade. 6, Santo André, São Paulo, Brazil
| | - Thales B. Nepomuceno
- Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellingson S. Paiva
- Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Almir F. Andrade
- Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel J. Teixeira
- Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wagner M. Tavares
- Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Cury RG, Carvalho MDJ, Lasteros FJL, Dias AE, Dos Santos Ghilardi MG, Paiva ARB, Coutinho AM, Buchpiguel CA, Teixeira MJ, Barbosa ER, Fonoff ET. Effects of Subthalamic Stimulation on Olfactory Function in Parkinson Disease. World Neurosurg 2018; 114:e559-e564. [PMID: 29548954 DOI: 10.1016/j.wneu.2018.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Olfactory dysfunction is a nonmotor symptom of Parkinson disease (PD) associated with reduction in quality of life. There is no evidence on whether improvements in olfaction after subthalamic deep brain stimulation (STN-DBS) may be directly attributable to motor improvement or whether this reflects a direct effect of DBS on olfactory brain areas. The aim of the present study was to evaluate the effect of DBS on olfactory function in PD, as well as to explore the correlation between these changes and changes in motor symptoms and brain metabolism. METHODS Thirty-two patients with PD were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. Primary outcome was the change in olfactory function (Sniffin' Sticks odor-identification test [SST]) after surgery among the patients with hyposmia at baseline. Secondary outcomes included the relationship between motor outcomes and olfactory changes and [18F]fluorodeoxyglucose-positron emission tomography analysis between subgroups with improvement versus no improvement of smell. RESULTS STN-DBS improved SST after surgery (preoperative SST, median 7.3 ± 2.4 vs. postoperative SST, median 8.2 ± 2.1; P = 0.045) in a subset of patients among 29 of 32 patients who presented with hyposmia at baseline. The improvement in SST was correlated with DBS response (r = 0.424; P = 0.035). There was also an increase in glucose metabolism in the midbrain, cerebellum, and right frontal lobe in patients with SST improvement (P < 0.001). CONCLUSIONS STN-DBS improves odor identification in a subset of patients with PD. Motor improvement together with changes in the brain metabolism may be linked to this improvement.
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Affiliation(s)
- Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Margarete de Jesus Carvalho
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernando Jeyson Lopez Lasteros
- Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alice Estevo Dias
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Artur Martins Coutinho
- Nuclear Medicine Center-LIM43, Department of Radiology, Medical School, University of São Paulo, São Paulo, Brazil; Nuclear Medicine and PET/CT Service, Sirio Libanes Hospital, São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Center-LIM43, Department of Radiology, Medical School, University of São Paulo, São Paulo, Brazil; Nuclear Medicine and PET/CT Service, Sirio Libanes Hospital, São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Erich Talamoni Fonoff
- Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Parravano DC, Ciampi DA, Fonoff ET, Monaco B, Navarro J, Yeng LT, Teixeira MJ, Hamani C. Quality of Life After Motor Cortex Stimulation: Clinical Results and Systematic Review of the Literature. Neurosurgery 2018; 84:451-456. [DOI: 10.1093/neuros/nyy060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniella C Parravano
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel A Ciampi
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T Fonoff
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Bernardo Monaco
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Jessie Navarro
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Lin T Yeng
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Clement Hamani
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- Division of Neurosurgery Toronto Western Hospital, University of Toronto, Toronto, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Canada
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de-Lima-Oliveira M, Salinet ASM, Nogueira RC, de Azevedo DS, Paiva WS, Teixeira MJ, Bor-Seng-Shu E. Intracranial Hypertension and Cerebral Autoregulation: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 113:110-124. [PMID: 29421451 DOI: 10.1016/j.wneu.2018.01.194] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 11/15/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To present a systematic review and meta-analysis to establish the relation between cerebral autoregulation (CA) and intracranial hypertension. METHODS An electronic search using the term "Cerebral autoregulation and intracranial hypertension" was designed to identify studies that analyzed cerebral blood flow autoregulation in patients undergoing intracranial pressure (ICP) monitoring. The data were used in meta-analyses and sensitivity analyses. RESULTS A static CA technique was applied in 10 studies (26.3%), a dynamic technique was applied in 25 studies (65.8%), and both techniques were used in 3 studies (7.9%). Static CA studies using the cerebral blood flow technique revealed impaired CA in patients with an ICP ≥20 (standardized mean difference [SMD] 5.44%, 95% confidence interval [CI] 0.25-10.65, P = 0.04); static CA studies with transcranial Doppler revealed a tendency toward impaired CA in patients with ICP ≥20 (SMD -7.83%, 95% CI -17.52 to 1.85, P = 0.11). Moving correlation studies reported impaired CA in patients with ICP ≥20 (SMD 0.06, 95% CI 0.07-0.14, P < 0.00001). A comparison of CA values and mean ICP revealed a correlation between greater ICP and impaired CA (SMD 5.47, 95% CI 1.39-10.1, P = 0.01). Patients with ICP ≥20 had an elevated risk of impaired CA (OR 2.27, 95% CI 1.20-4.31, P = 0.01). CONCLUSIONS A clear tendency toward CA impairment was observed in patients with increased ICP.
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Affiliation(s)
- Marcelo de-Lima-Oliveira
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Angela S M Salinet
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo C Nogueira
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel S de Azevedo
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wellingson S Paiva
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
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Figueiredo EG, Teixeira MJ, Welling LC. Letter to the Editor. Rendering unto Caesar: mini-pterional and mini-orbitozygomatic approaches. J Neurosurg 2018; 128:957-959. [PMID: 29350597 DOI: 10.3171/2017.6.jns171319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Talakoub O, Paiva RR, Milosevic M, Hoexter MQ, Franco R, Alho E, Navarro J, Pereira JF, Popovic MR, Savage C, Lopes AC, Alvarenga P, Damiani D, Teixeira MJ, Miguel EC, Fonoff ET, Batistuzzo MC, Hamani C. Lateral hypothalamic activity indicates hunger and satiety states in humans. Ann Clin Transl Neurol 2017; 4:897-901. [PMID: 29296618 PMCID: PMC5740250 DOI: 10.1002/acn3.466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 12/02/2022] Open
Abstract
Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader–Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food‐related cues induced an increase in beta/low‐gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha‐frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.
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Affiliation(s)
- Omid Talakoub
- Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto Canada
| | - Raquel R Paiva
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Matija Milosevic
- Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto Canada.,Rehabilitation Engineering Laboratory Toronto Rehabilitation Institute - University Health Network Toronto Canada
| | - Marcelo Q Hoexter
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Ruth Franco
- Division of Pediatric Endocrinology Children's Institute of Neurology University of São Paulo Medical School São Paulo Brazil
| | - Eduardo Alho
- Division of Functional Neurosurgery of Institute of Psychiatry Department of Neurology University of São Paulo Medical School São Paulo Brazil
| | - Jessie Navarro
- Division of Functional Neurosurgery of Institute of Psychiatry Department of Neurology University of São Paulo Medical School São Paulo Brazil
| | - José F Pereira
- Division of Functional Neurosurgery of Institute of Psychiatry Department of Neurology University of São Paulo Medical School São Paulo Brazil
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto Canada.,Rehabilitation Engineering Laboratory Toronto Rehabilitation Institute - University Health Network Toronto Canada
| | - Cary Savage
- Banner Alzheimer's Institute Phoenix United States
| | - Antonio C Lopes
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Pedro Alvarenga
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Durval Damiani
- Division of Pediatric Endocrinology Children's Institute of Neurology University of São Paulo Medical School São Paulo Brazil
| | - Manoel J Teixeira
- Division of Functional Neurosurgery of Institute of Psychiatry Department of Neurology University of São Paulo Medical School São Paulo Brazil
| | - Euripides C Miguel
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry Department of Neurology University of São Paulo Medical School São Paulo Brazil.,Instituto de Ensino e Pesquisa Hospital Sírio-Libanês Sǎo Paulo Brazil
| | - Marcelo C Batistuzzo
- Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
| | - Clement Hamani
- Behavioural Neurobiology Laboratory Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Canada.,Division of Neurosurgery Toronto Western Hospital University of Toronto Canada.,Department of Psychiatry Institute of Psychiatry University of São Paulo Medical School São Paulo Brazil
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Hamani C, Florence G, Heinsen H, Plantinga BR, Temel Y, Uludag K, Alho E, Teixeira MJ, Amaro E, Fonoff ET. Subthalamic Nucleus Deep Brain Stimulation: Basic Concepts and Novel Perspectives. eNeuro 2017; 4:ENEURO.0140-17.2017. [PMID: 28966978 PMCID: PMC5617209 DOI: 10.1523/eneuro.0140-17.2017] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 08/06/2017] [Indexed: 12/21/2022] Open
Abstract
Over the last decades, extensive basic and clinical knowledge has been acquired on the use of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD). It is now clear that mechanisms involved in the effects of this therapy are far more complex than previously anticipated. At frequencies commonly used in clinical practice, neural elements may be excited or inhibited and novel dynamic states of equilibrium are reached. Electrode contacts used for chronic DBS in PD are placed near the dorsal border of the nucleus, a highly cellular region. DBS may thus exert its effects by modulating these cells, hyperdirect projections from motor cortical areas, afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques may allow us to identify these structures optimizing surgical targeting. In this review, we provide an update on mechanisms and the neural elements modulated by STN DBS.
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Affiliation(s)
- Clement Hamani
- Division of Neurosurgery Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neuroimaging, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Gerson Florence
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Helmut Heinsen
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany
| | - Birgit R. Plantinga
- Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kamil Uludag
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Eduardo Alho
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel J. Teixeira
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Amaro
- Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T. Fonoff
- Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo, Brazil
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Lopes LCG, Galhardoni R, Silva V, Jorge FMH, Yeng LT, Callegaro D, Chadi G, Teixeira MJ, Ciampi de Andrade D. Beyond weakness: Characterization of pain, sensory profile and conditioned pain modulation in patients with motor neuron disease: A controlled study. Eur J Pain 2017; 22:72-83. [PMID: 28833988 DOI: 10.1002/ejp.1091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Motor neuron diseases (MND) represent a group of disorders that evolve with inexorable muscle weakness and medical management is based on symptom control. However, deeper characterization of non-motor symptoms in these patients have been rarely reported. METHODS This cross-sectional study aimed to describe non-motor symptoms in MND and their impact on quality of life and functional status, with a focus on pain and sensory changes. Eighty patients (31 females, 55.7 ± 12.9 years old) with MND underwent a neurological examination, pain, mood, catastrophizing and psychophysics assessments [quantitative sensory testing (QST) and conditioned pain modulation (CPM)], and were compared to sex- and age-matched healthy controls (HC). RESULTS Chronic pain was present in 46% of patients (VAS =5.18 ± 2.0). Pain of musculoskeletal origin occurred in 40.5% and was mainly located in the head/neck (51%) and lower back (35%). Neuropathic pain was not present in this sample. Compared to HC, MND patients had a lower cold detection threshold (p < 0.002), and significantly lower CPM scores (4.9 ± 0.2% vs. 22.1 ± 0.2%, p = 0.012). QST/CPM results did not differ between MND patients with and without pain. Pain intensity was statistically correlated with anxiety, depression and catastrophism, and spasticity scores were inversely correlated with CPM (ρ = -0.30, p = 0.026). CONCLUSIONS Pain is frequently reported by patients with MNDs. Somatosensory and CPM changes exist in MNDs and may be related to the neurodegenerative nature of the disease. Further studies should investigate the most appropriate treatment strategies for these patients. SIGNIFICANCE We report a comprehensive evaluation of pain and sensory abnormalities in motor neuron disease (MND) patients. We assessed the different pain syndromes present in MND with validated tools, and described the QST and conditioned pain modulation profiles in a controlled design.
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Affiliation(s)
- L C G Lopes
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Neurology Division, Department of Neurology, São Paulo State University (Unesp) Medical School, Botucatu, Brazil
| | - R Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - V Silva
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - F M H Jorge
- Neuroregeneration Center and ALS Brazil Project, Department of Neurology, University of São Paulo School of Medicine, Brazil
| | - L T Yeng
- Instituto de Ortopedia e Traumatologia, Division of Physical Medicine and Rehabilitation, University of São Paulo, Brazil
| | - D Callegaro
- Neuroimmunology Group, Department of Neurology, University of São Paulo, Brazil
| | - G Chadi
- Neuroregeneration Center and ALS Brazil Project, Department of Neurology, University of São Paulo School of Medicine, Brazil
| | - M J Teixeira
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
| | - D Ciampi de Andrade
- Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo, Brazil.,Pain Center, Department of Neurology, University of São Paulo, Brazil.,Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, Brazil
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Vitorino Araujo JL, Veiga JCE, Wen HT, de Andrade AF, Teixeira MJ, Otoch JP, Rhoton AL, Preul MC, Spetzler RF, Figueiredo EG. Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle. J Neurosurg 2017; 127:209-218. [DOI: 10.3171/2016.8.jns16403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAccess to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed.METHODSThe anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test.RESULTSIn the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 ± 11 mm2; transchoroidal 121 ± 8 mm2; p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 ± 9 mm2; transchoroidal 80 ± 5 mm2; p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71° ± 7°; transchoroidal 64° ± 6°; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62° ± 6°; transchoroidal 55° ± 5°; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 ± 3 mm, the mean thickness of the corpus callosum trunk was 10 ± 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 ± 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region.CONCLUSIONSThe transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.
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Affiliation(s)
- João Luiz Vitorino Araujo
- 1Division of Neurosurgery, University of São Paulo Medical School
- 2Discipline of Neurosurgery, Santa Casa de São Paulo Medical School, São Paulo, Brazil
| | - José C. E. Veiga
- 2Discipline of Neurosurgery, Santa Casa de São Paulo Medical School, São Paulo, Brazil
| | - Hung Tzu Wen
- 1Division of Neurosurgery, University of São Paulo Medical School
| | | | | | - José P. Otoch
- 1Division of Neurosurgery, University of São Paulo Medical School
| | - Albert L. Rhoton
- 3Department of Neurological Surgery, University of Florida, Gainesville, Florida; and
| | - Mark C. Preul
- 4Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- 4Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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