Different MOG(35-55) concentrations induce distinguishable inflammation through early regulatory response by IL-10 and TGF-ß in mice CNS despite unchanged clinical course.

Multiple sclerosis (MS) shows distinct clinical courses. Experimental autoimmune encephalomyelitis (EAE), a model to study multiple sclerosis, can be induced by different protocols, which show distinct cytokine and antibody production. The factors involved in this heterogeneity remain unclear. The relevance of MOG concentration in triggering a regulatory response in the chronic model of EAE is imprecise. The aim of this study was investigate if 100 or 300 µg of MOG(35-55) could induce different EAE profiles. Modifications in the concentration of MOG were able to change the patterns of chemokines, cytokines, percentage of cells, inflammatory infiltrate and the development of a regulatory response. However, these changes were unable to modify the intensity of response, which explains the chronic progression of the disease in both concentrations. The results presented in this study contribute to understanding the intricate mechanisms that trigger EAE and provide insights into the pathogenesis of various forms of MS.

Folate use in women with epilepsy: predictors of adherence in a specialized tertiary outclinic.

PURPOSE OF THE STUDY: The aims of this study were to determine the percentage of women with epilepsy (WWE) taking folic acid (FA) in an outpatient epilepsy tertiary hospital at São Paulo, Brazil, and to identify the possible predictors of adherence. METHOD: Five hundred seventy-six medical records of patients followed in our service were reviewed. Sixty-six WWE using antiepileptic drugs with age between 16 and 52, sexually active but not in menopausal period, not pregnant, and not sterilized or with vasectomized partners underwent direct interviews with a prestructured questionnaire. Logistic regression with clinical and demographic variables using a stepwise method was performed to identify predictable variables of folate use. RESULTS: We found 42.40% of FA intake. Hormonal contraceptive method use was an independent variable negatively associated with adherence to folate. Additionally, educational level was an independent variable positively associated with adherence to folate in WWE above 35years of age. CONCLUSION: We found low folate adherence. Improved planning pre-conception for WWE should improve rates of effective folate supplementation.

A pioneering FreeSurfer volumetric study of a series of patients with mesial temporal lobe epilepsy and hippocampal sclerosis with comorbid depression.

Depression is the most frequent psychiatric comorbidity in patients with mesial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). This study aimed to confirm whether patients with comorbid depression have different volumetric patterns on magnetic resonance imaging, analysing the influence of HS sides. Psychiatrists conducted semi-structured interviews with 75 patients, who were divided into non-depression group (NDG, n = 52) and depression group (DG, n = 23), and compared with 98 controls. The FreeSurfer software was used in the volumetric analysis of the estimated total intracranial volume (eTIV), bilateral cortical and subcortical regions of interest (ROIs), and for presence of left (L-, n = 41) or right (R-, n = 34) MTLE-HS. Twenty-three (30.7%) patients had depression, of whom 14 (34.1%) had l-MTLE-HS and 9 (26.5%) had R-MTLE-HS. No difference was observed between DG and NDG vs. controls in terms of eTIV and cortical ROIs, regardless of the severity of depression. In patients with l-MTLE-HS, the eTIV in the DG was reduced in comparison with that in the NDG and control group, with a small effect size. Hippocampal reduction occurred ipsilateral to HS in the l-MTLE-HS and R-MTLE-HS subgroups when DG and NDG were compared with controls, as expected according to Enhancing Neuro Imaging Genetics through Meta-Analysis (2018).

Neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy and hippocampal sclerosis.

PURPOSE: To evaluate the neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS). METHOD: Patients with drug-resistant MTLE and unilateral, left (L-) or right (R-) HS were studied. To diagnose depression, psychiatrists with expertise in epilepsy applied a semi-structured interview based on DSM. The depression group (DG) included patients with a psychiatric diagnosis in addition to a Beck Depression Inventory (BDI) score >16 points, and the non-depression group (NDG) included those without this diagnosis and with a BDI score ≤16. We analysed two clusters of neuropsychological tests, which evaluated memory (Complex Rey Figure III, Logical Memory II and RAVLT VII) and attention plus executive functions (Stroop I/II/III and Trail Making A/B). Moreover, we calculated the z-scores (Zs) using a local control group. The DG was compared to the NDG, independently and according to the HS side, using non-parametrical analyses. Due to the multivariate analysis, the p-value was corrected by applyingpost hoc Bonferroni adjustment. RESULTS: We analysed 65 patients. The NDG included 51 (78.4 %) patients, and the DG included 14 (21.5 %) patients. Pre-surgical comorbid depression occurred in eight patients with L- (n = 29) and in six patients with R-MTLE-HS (n = 36). All of these groups had similar gender, age, IQs, and years of schooling. Compared to the healthy subjects, the L-MTLE-HS patients had lower Zs in verbal episodic memory tests [Logical Memory II (p < 0.001), and RAVLT VII (p < 0.001)], and the R-MTLE-HS patients had lower scores in visual episodic memory [Complex Rey Figure III (p < 0.001)]. In the analysis of the DGvs. NDG, there were no differences in the clusters of tests of memory or in those of attention and executive functions. Moreover, when we analysed the patients according to HS side, no neuropsychological difference was observed in the DG and NDG in terms of L- and R-MTLE-HS. CONCLUSIONS: The patients with MTLE and unilateral HS in this study showed no differences in memory, attention and executive functions in relation to the presence of pre-surgical comorbid depression and independently of HS side. In this series from Latin-America, this psychiatric comorbidity did not affect cognition more than epilepsy alone.

Neurocysticercosis and pharmacoresistant epilepsy: possible role of calcified lesions in epileptogenesis.

Neurocysticercosis is a neglected and usually poverty-related disease of high public importance. The mechanisms by which the calcified lesions cause epilepsy are not known, but have been attributed to residual perilesional gliosis or an inflammatory process. This case shows that an inflammatory response to a calcified granuloma may be associated with the development of epilepsy. The increase in glutamate and kinin B1 (pro-epileptogenic) receptors added by reduced expression of kinin B2 (anti-epileptogenic) receptors may explain the chronic epileptogenesis associated with the lesion, corroborating the hypothesis of inflammatory mechanisms involved in the pathophysiology of epilepsy in these patients.

Catatonia, beyond a psychiatric syndrome.

Although catatonia is a well-known psychiatric syndrome, there are many possible systemic and neurological etiologies. The aim of this case report was to present a case of a patient with cerebral venous sinus thrombosis and infarction in which catatonia was the clinical manifestation of a possible nonconvulsive status epilepticus. To our knowledge, only one such case has been reported in the literature, which had a simplified diagnostic investigation. It is important to correctly recognize the organic cause underlying catatonia in order to treat the patient as soon as possible thereby improving outcome. Therefore, physicians need to update their knowledge on catatonia, recognizing that it can be part of a psychiatric or neurologic condition.

Embora a catatonia seja uma síndrome psiquiátrica bem conhecida, existem várias etiologias possíveis, tanto sistêmicas quanto neurológicas. O objetivo deste relato de caso é apresentar um quadro de trombose venosa central com infarto venoso em que a catatonia foi a manifestação clínica de um possível status não convulsivo. Na concepção dos autores, apenas um caso é encontrado na literatura, porém com uma propedêutica simplificada. É importante o correto reconhecimento das causas orgânicas que podem estar causando a catatonia para que sejam corrigidas assim que possível, melhorando o prognóstico do paciente. Além disso, os médicos precisam atualizar seus conhecimentos sobre a catatonia, uma vez que ela pode ser parte tanto de uma condição psiquiátrica quanto neurológica.

Autoimmune limbic encephalitis: A manifestation of systemic lupus erythematosus in the central nervous system.

Autoimmune limbic encephalitis (ALE) associated with systemic lupus erythematosus (SLE) is a rare entity with few reports in the literature to date. In general, ALE associated with SLE has a satisfactory response to immunosuppressive treatment (RIT), but the pathogenesis of this association is poorly understood and may include an autoimmunity component. We report a case study describing the diagnosis and management of limbic encephalitis in a patient with active Systemic Lupus Erythematosus disease (SLE) and past medical history of cancer (endometrial adenocarcinoma in 2004 and papillary urothelial carcinoma in 2011 with curative treatment), followed over a one-year period. We discuss the possible association between limbic encephalitis and all past neoplastic and immune-mediated conditions of this patient. In this particularly case, autoimmunity was the most relevant factor associated with limbic encephalitis given negative neoplastic screening. Moreover, a good response was observed to immunotherapy, not seen with paraneoplastic limbic encephalitis, which is associated with poor response. In this case, the association of ALE with SLE is possible, since laboratory testing disclosed lupic activity and the patient had involvement of other systems (such as hematologic) during the period. However, the presence of other surface membrane antibodies are possible in the search for alternative etiologies.

Encefalite Límbica Autoimune (EL) associada a lúpus eritematoso sistêmico (LES) é uma entidade rara, com poucos relatos na literatura até o momento. Em geral, EL associada com LES tem uma resposta satisfatória ao tratamento imunossupressor, mas a patogênese desta associação é pouco compreendida e pode incluir um componente de autoimunidade. Descrevemos em um estudo de caso o diagnóstico e o tratamento empregado na encefalite límbica ocorrida no contexto de uma paciente com LES ativo e história pregressa de doenças neoplásicas (adenocarcinoma endometrial em 2004 e carcinoma papilar urotelial em 2011 ambos com o tratamento curativo), a qual foi seguida durante um ano. Discutimos uma possível associação de encefalite límbica e todos os antecedentes neoplásicos e imunomediados desta paciente. Neste caso em particular, a autoimunidade é o fator mais relevante relacionado com a encefalite límbica devido a uma triagem neoplásica negativa. Além disso, houve uma grande resposta com a imunossupressão, o que não é visto na encefalite límbica paraneoplásica, mais relacionada com uma má resposta. Neste caso, a associação de EL com LES é possível, uma vez que testes laboratoriais confirmaram a atividade lúpica, bem como a paciente apresentava envolvimento de outros sistemas (como hematológico) neste interim. No entanto, a presença de outros anticorpos de superfície da membrana é possível em busca de diferentes etiologias.

Catatonia, beyond a psychiatric syndrome / Catatonia, além de uma síndrome psiquiátrica

ABSTRACT Although catatonia is a well-known psychiatric syndrome, there are many possible systemic and neurological etiologies. The aim of this case report was to present a case of a patient with cerebral venous sinus thrombosis and infarction in which catatonia was the clinical manifestation of a possible nonconvulsive status epilepticus. To our knowledge, only one such case has been reported in the literature, which had a simplified diagnostic investigation. It is important to correctly recognize the organic cause underlying catatonia in order to treat the patient as soon as possible thereby improving outcome. Therefore, physicians need to update their knowledge on catatonia, recognizing that it can be part of a psychiatric or neurologic condition.

RESUMO Embora a catatonia seja uma síndrome psiquiátrica bem conhecida, existem várias etiologias possíveis, tanto sistêmicas quanto neurológicas. O objetivo deste relato de caso é apresentar um quadro de trombose venosa central com infarto venoso em que a catatonia foi a manifestação clínica de um possível status não convulsivo. Na concepção dos autores, apenas um caso é encontrado na literatura, porém com uma propedêutica simplificada. É importante o correto reconhecimento das causas orgânicas que podem estar causando a catatonia para que sejam corrigidas assim que possível, melhorando o prognóstico do paciente. Além disso, os médicos precisam atualizar seus conhecimentos sobre a catatonia, uma vez que ela pode ser parte tanto de uma condição psiquiátrica quanto neurológica.

Autoimmune limbic encephalitis: A manifestation of systemic lupus erythematosus in the central nervous system / Encefalite límbica auto-imune: manifestação do lúpus eritematoso sistémico no sistema nervoso central

Autoimmune limbic encephalitis (ALE) associated with systemic lupus erythematosus (SLE) is a rare entity with few reports in the literature to date. In general, ALE associated with SLE has a satisfactory response to immunosuppressive treatment (RIT), but the pathogenesis of this association is poorly understood and may include an autoimmunity component. We report a case study describing the diagnosis and management of limbic encephalitis in a patient with active Systemic Lupus Erythematosus disease (SLE) and past medical history of cancer (endometrial adenocarcinoma in 2004 and papillary urothelial carcinoma in 2011 with curative treatment), followed over a one-year period. We discuss the possible association between limbic encephalitis and all past neoplastic and immune-mediated conditions of this patient. In this particularly case, autoimmunity was the most relevant factor associated with limbic encephalitis given negative neoplastic screening. Moreover, a good response was observed to immunotherapy, not seen with paraneoplastic limbic encephalitis, which is associated with poor response. In this case, the association of ALE with SLE is possible, since laboratory testing disclosed lupic activity and the patient had involvement of other systems (such as hematologic) during the period. However, the presence of other surface membrane antibodies are possible in the search for alternative etiologies.

Encefalite Límbica Autoimune (EL) associada a lúpus eritematoso sistêmico (LES) é uma entidade rara, com poucos relatos na literatura até o momento. Em geral, EL associada com LES tem uma resposta satisfatória ao tratamento imunossupressor, mas a patogênese desta associação é pouco compreendida e pode incluir um componente de autoimunidade. Descrevemos em um estudo de caso o diagnóstico e o tratamento empregado na encefalite límbica ocorrida no contexto de uma paciente com LES ativo e história pregressa de doenças neoplásicas (adenocarcinoma endometrial em 2004 e carcinoma papilar urotelial em 2011 ambos com o tratamento curativo), a qual foi seguida durante um ano. Discutimos uma possível associação de encefalite límbica e todos os antecedentes neoplásicos e imunomediados desta paciente. Neste caso em particular, a autoimunidade é o fator mais relevante relacionado com a encefalite límbica devido a uma triagem neoplásica negativa. Além disso, houve uma grande resposta com a imunossupressão, o que não é visto na encefalite límbica paraneoplásica, mais relacionada com uma má resposta. Neste caso, a associação de EL com LES é possível, uma vez que testes laboratoriais confirmaram a atividade lúpica, bem como a paciente apresentava envolvimento de outros sistemas (como hematológico) neste interim. No entanto, a presença de outros anticorpos de superfície da membrana é possível em busca de diferentes etiologias.

Erro médico: a perspectiva de estudantes de medicina e direito / Medical error from the perspective of medical students and law students

Nas últimas décadas, houve um crescimento das implicações em sociedade do erro médico, assunto em que se entrelaçam Medicina e Direito. Este estudo procurou conhecer a percepção de estudantes de Medicina e Direito sobre erro médico, avaliando nível de interesse e informação, e a necessidade de abordar o tema na graduação e como ela ocorre para cada área, na sua ótica. Estudo observacional descritivo transversal foi realizado na Universidade Federal de Juiz de Fora (MG) em 2008 com 185 alunos de Medicina e 119 de Direito. 88,7 por cento dos alunos de Medicina (MED) e 92,4 por cento de Direito (DIR) referiram conhecimento sobre erro médico. O interesse se dá por ser um tema muito discutido atualmente. Os alunos consideram necessária sua abordagem na graduação (97,8 por cento MED e 94,9 por cento DIR). É importante discutir um tema tão atual na graduação de Medicina e de Direito pela contribuição que pode ser oferecida para diminuir o ciclo vicioso de erros, iatrogenias e processos jurídicos, além de possibilitar uma reflexão acerca do papel da educação médica na construção ética de novos profissionais.

Recent decades have witnessed an increase in the societal implications of medical error, a subject in which Medicine and Law intertwine. This study focused on medical error from the perspective of medical students and law students, assessing their level of interest and information and the need to discuss the topic during undergraduate education and how it occurs in each field, in their view. A cross-sectional, descriptive, observational study was conducted at the Federal University in Juiz de Fora, Minas Gerais State, in 2008 with 185 medical students and 119 law students. 88.7 percent of the medical students and 92.4 percent of the law students reported knowledge of medical error. The interest was due to the fact that medical error is currently a widely discussed issue. The students thought the issue should be addressed in their undergraduate education (97.8 percent of medical students and 94.9 percent of law students). It is important to discuss such a current issue in undergraduate education in both medicine and law, because of the potential for decreasing the vicious circle of errors, iatrogenesis, and law suits, in addition to fostering reflection on the role of medical education in the ethical training of young professionals.

Fatores culturais determinantes da escolha da via de parto por gestantes / Cultural factors determining the choice of mode of delivery by pregnant women

O parto é cercado por múltiplas influências sociais, culturais, econômicas, físicas e psicológicas, sendo objeto de estudo de várias ciências, dentre elas a Antropologia. Há uma extraordinária riqueza simbólica envolvendo o parto, estando presentes crenças e mitos. O presente trabalho objetivou conhecer as crenças e outros fatores culturais que cercam o período de gestação e podem influenciar na escolha da via de parto pela mulher, bem como a relevância dessas influências. Desenvolveu-se um estudo descritivo-qualitativo entre 2009 e 2010 em Juiz de Fora - MG com 30 gestantes com 30 ou mais semanas de gestação, atendidas em uma unidade pública de atendimento a mulheres. Foi utilizada uma entrevista semi-estruturada, registrada por um gravador de voz, que passou por processos de análise do conteúdo e da temática. As gestantes sinalizaram sua preferência pelo parto normal, mais natural e humanizado, contrariando o modelo hospitalar e medicalizado predominante hoje em dia. As justificativas apontam o desejo de um parto sem intercorrências e com recuperação rápida. São significativas as influências do “medo da dor” e das experiências individuais e de outras mulheres. É necessário que o profissional de saúde respeite a bagagem cultural trazida pela gestante, procurando apoiar e esclarecer seus medos, dúvidas e anseios, sem desqualificar suas crenças a respeito das vias de parto.

Social, cultural, economic, physical and psychological influences are involved in Childbirth, being the object of study on various sciences such as Anthropology. There is an extraordinary symbolic area, which includes beliefs and myths about the mode of delivery. The present study puts lights on the beliefs and other cultural factors present in the gestation period that could influence the choice of mode of delivery by pregnant women as well as the relevance of these influences. We developed a descriptive, qualitative study between 2009 and 2010 in Juiz de Fora - MG with 30 pregnant women around thirty or more weeks of gestation, being cared in a public health service to women. We used a semi-structured interview recorded, which passed through processes of analysis of content and theme. The women indicated their preference for normal childbirth more natural and humanized, instead of the medicalized model used today. The interviewed women prefer a birth without complications and with a rapid recovery. There are significant influences of the “fear of pain” and individual experiences in addition to experiences from other women. Health professionals must respect the cultural thoughts belonging to pregnant women, as they play a role in supporting the fears, doubts and anxieties, without disqualifying the beliefs about the mode of delivery.