الملخص
ABSTRACT Background: Bleeding in hemophiliacs can cause complications in the central and peripheral nervous system (CNS and PNS). The incidence of intracranial hemorrhage has reduced after the introduction of prophylactic treatment with factor VIII or IX, but the benefits of this therapy have not yet been evaluated on PNS complications. Objective: The aim of this study was to determine the prevalence of neurological complications in hemophiliacs and verify the effect of prophylactic therapy in these patients, including PNS disorders. Methods: We retrospectively evaluated the prevalence of CNS and PNS disorders caused by bleeding in hemophiliacs seen at the Hemocentro Regional Norte, Ceará, Brazil, from 1992 to 2018, and we compared the incidence in different periods (before and after the introduction of prophylactic treatment in 2011). Results: Of 75 hemophilia A patients evaluated (4.61/100.000 population), 13.3% (n=10) had either CNS (n=5) or PNS (n=5) disorders secondary to bleeding. Patients submitted to factor VIII replacement prophylactic therapy were less likely to have CNS events: from 1992 to 2011, 5 of 63 patients had CNS disease, while from 2011 to 2018, there were no new cases (p=0.0181). From 2011 to 2018, 5 PNS events occurred in patients without prophylactic therapy, whereas none occurred in those covered by prophylactic therapy (5/20 versus 0/29, p=0.0081). Conclusions: The prevalence of neurological complications in hemophiliacs in our cohort is similar to other studies. Similar to CNS, prophylactic therapy also reduces the risk of PNS complications. This is the first report in the literature showing this benefit.
RESUMO Antecedentes: O sangramento em hemofílicos causa complicações no sistema nervoso central e periférico (SNC e SNP). A incidência de hemorragia intracraniana diminuiu após a introdução da profilaxia com fator VIII ou IX, entretanto esse benefício ainda não foi avaliado no SNP. Objetivo: O objetivo deste estudo foi determinar a prevalência de complicações neurológicas em hemofílicos, verificando o efeito da terapia profilática também no SNP. Métodos: Avaliamos retrospectivamente a prevalência de complicações neurológicas causadas por sangramentos em hemofílicos atendidos no Hemocentro Regional Norte, Ceará, Brasil, de 1992 a 2018, comparando a incidência em diferentes períodos (antes e depois da introdução do tratamento profilático em 2011). Resultados: Foram avaliados 75 pacientes com hemofilia A (4,61/100 mil habitantes). Deles, 13,3% (n=10) tinham distúrbios do SNC (n=5) ou do SNP (n=5) secundários a hemorragias. Os pacientes submetidos à terapia profilática com fator VIII apresentaram menor probabilidade de eventos do SNC: de 1992 a 2011, cinco de 63 pacientes apresentaram hemorragia no SNC, enquanto de 2011 a 2018 não ocorreram novos casos (p=0,0181). De 2011 a 2018, cinco eventos no SNP ocorreram entre pacientes sem terapia profilática, e nenhum ocorreu entre aqueles cobertos pela profilaxia (5/20 × 0/29, p=0,0081). Conclusões: A prevalência de complicações neurológicas em hemofílicos em nossa coorte é similar à de outros estudos. Assim como no SNC, a terapia profilática também reduz o risco de complicações no SNP. Este é o primeiro relato na literatura a mostrar esse benefício.
الموضوعات
Humans , Hemophilia A/complications , Nervous System Diseases/prevention & control , Brazil , Factor VIII , Central Nervous System , Retrospective Studies , Peripheral Nervous System/physiopathology , Hemorrhage , Nervous System Diseases/etiologyالملخص
O sistema nervoso periférico apresenta relativa capacidade de rege-neração após uma lesão. Após a axonotmese o nervo ciático produzrespostas morfo-funcionais, no músculo alvo, no epicentro da lesão ealguns distritos neuronais retrógrados. Apesar dos avanços terapêuti-cos, a restauração funcional é incompleta na maioria dos casos. Nestecontexto, nós testamos se o exercício (nado) é capaz de interferir namarcha funcional e reações de plasticidade nos motoneurônios damedula espinhal. Quarenta ratos foram divididos em quatro grupos(n=10 cada), submetidos a 30 min/dia de nado, iniciando no 1, 7, 14,21 dias após lesão do nervo ciático. Todos os grupos apresentaramrecuperação funcional, não observamos diferenças significantes nosnúmeros de motoneurônios da medula espinhal entre os diferentesgrupos estudados. De acordo com a análise funcional e histológica, oexercício terapêutico, nas condições do presente estudo, foi incapazde acelerar o processo regenerativo.
The peripheral nervous system exhibits a remarkable ability to regenerateafter injury. The sciatic nerve reactions following axonotmesis produce morpho-functional responses at the target muscle, injury epicenter and at certain retrograde neuronal districts. Despite therapeutic advancements,the functional restoration is incomplete in most cases. In this context, we tested if exercise (swimming) is able to interfere in both functional gait recovery and plastic reactions in the motoneurons of the spinal cord. FortyWistar rats were divided into four groups (n=10 each), submitted to a 30 min/day swimming routine, beginning 1, 7, 14 or 21 days after the sciatic nerve injury. All groups exhibited functional recovery, significant differences were not observed in the number of spinal motoneurons among the groups studied. According to both functional and histological analysis, therapeutic exercise, in the conditions of the present study, was unable to accelerate the regeneration process.
الموضوعات
Animals , Rats , Nerve Regeneration , Sciatic Nerve/physiology , Sciatic Nerve/injuries , Peripheral Nervous System , Peripheral Nervous System/physiopathology , Exercise Therapy , Rats, Wistar , Swimmingالملخص
Há evidências de que a terapia com o laser pode estimular a regeneração de nervos e esta hipótese foi testada em ratos. Uma lesão por esmagamento controlado foi produzida no nervo isquiático de 20 ratos Wistar, metade dos quais foram submetidos a irradiação efetiva com o laser de arseneto de gálio (AsGa) e a outra metade a irradiação simulada, durante dez dias consecutivos, começando no primeiro dia pós-operatório. Os resultados foram avaliados com três semanas pela medida do índice funcional do isquiático (IFC) em intervalos semanais e pela medida do número total de fibras nervosas e da densidade de fibras dos nervos, após o sacrifício dos animais na terceira semana, com o nível de significância de 5 por cento (p<0.05). Observou-se melhora progressiva do IFC tanto nos nervos irradiados como nos controles (69 por cento e 45 por cento, respectivamente), com diferença significante entre ambos na segunda semana (p=0,04). A densidade de fibras aumentou para os nervos irradiados e diminuiu para os nervos controle, a diferença entre ambos sendo significante (p=0,001). Os autores concluem que a terapia com o laser de baixa intensidade efetivamente acelera a regeneração do nervo isquiático do rato.
There are evidences that laser therapy may stimulate nerve regeneration and this hypothesis was tested in rats. A controlled crush injury was produced on the sciatic nerve of 20 Wistar rats, half of which submitted to effective Ga-As laser irradiation and the other half to simulated irradiation for 10 consecutive days beginning on the first postoperative day. Results were evaluated at three weeks postoperatively by measuring the sciatic functional index (SFI) at weekly intervals and the total number of nerve fibers and nerve fiber density of the sciatic nerve at three weeks (p<0.05). The SFI progressively improved for both irradiated and control nerves (69 percent and 45 percent, respectively) with a significant difference between them at two weeks (p=0.04). Nerve fiber density increased for the irradiated nerves and decreased for the control nerves, with significant differences between them (p=0.001). Low intensity therapeutic ultrasound accelerates nerve regeneration, as demonstrated with significance on the 21st postoperative day.
الموضوعات
Animals , Male , Rats , Low-Level Light Therapy , Peripheral Nerves/physiopathology , Nerve Regeneration/physiology , Crush Syndrome/physiopathology , Crush Syndrome/radiotherapy , Sciatic Nerve/physiology , Rats, Wistar , Peripheral Nervous System/physiopathology , Wounds and Injuriesالملخص
Nervous system involvement in Sjõgren's syndrome (SS) is extensive in its clinical expression and can be extremely serious, nevertheless it has been poorly studied. It can involve both the peripheral nervous system and the central nervous system, while immunological and vascular mechanism have been related to its genesis. The disease is subclinical in a good number of patients and should be looked for directly. In others however, it is the first symptom.
الموضوعات
Humans , Nervous System Diseases/etiology , Sjogren's Syndrome/complications , Sjogren's Syndrome/diagnosis , Sjogren's Syndrome/immunology , Autonomic Nervous System/physiopathology , Central Nervous System/physiopathology , Peripheral Nervous System/physiopathologyالملخص
Vários mecanismos estão envolvidos na ativação e supressão das unidades nociceptivas. Traumatismos físicos e químicos ambientais ativam e sensibilizam os nociceptivos nos tecidos. Disto resulta liberação tecidual de neurotransmissores excitatórios que sensibilizam e ativam as vias nocicepitivas no sistema nervoso periférico e central...
الموضوعات
Humans , Pain/physiopathology , Pain Measurement , Peripheral Nervous System/physiopathologyالملخص
We conducted a clinical and electromyographical study in patients with Chagas' disease indeterminiate or chronic stages of the illness. Altogether 841 patients were examined. Only 511 Were admitted within the protocol; the remainder patients were rejected because they showed other causes able to danage the nervous system. Fifty two (1O. 17 per cent) out of the 511 patients showed signs and symptoms of peripheral nervous system involvement in the form of sensory impairiment and diminished tendon jerks suggesting the presence neuropathy. Forty five of them were submitted to a conventional electromygraphical examination. Fifthem of the showed normal results, while the remainder 30 disclosed a rcduced interference pattern, being most of the remainig motor unit potentials fragmented or poliphasic, reduced sensory and motor conduction velocities and diminished amplitude of the sensory action potential. 'The findings suggest that some chagasic paties in the determinate or chronic stages of the disease may develop a clinical mild sensory-motor peripheral neuropathy.
الموضوعات
Humans , Male , Female , Adolescent , Adult , Middle Aged , Chagas Disease/physiopathology , Neural Conduction , Peripheral Nervous System/physiopathology , Chronic Disease , Electromyography , Electrophysiologyالملخص
El diagnóstico de artritis psoriásica se hace cuandopsoriasis y artritis de presentan juntas, sin nódulos subcutáneos y usualmente seronegativa para factor reumatoideo (FR) (1). Wright en 1991 (2) simplificó la clasificación en tres grupos. Revisamos la literatura y no encontramos informes de neuropatía periférica ni osteólisi de la tibia, peroné y tarso en artritis psoriática. Informamos el caso de una paciente con las anteriores manifestaciones clínicas