Detection of encephalitis-causing viruses reveals predominance of chikungunya virus in the state of Bahia, Brazil.

OBJECTIVES: Encephalitis is a severe neurological syndrome for which herpesvirus and enteroviruses are the most common etiological agents. Arboviruses, a wildly diverse group of pathogens, are also critical epidemiological agents associated with encephalitis. In Brazil, little is known about the causative agents of encephalitis. METHODS: We conducted a hospital surveillance for encephalitis between 2020 and 2022. Molecular (RT-PCR and qPCR) and serological (virus-specific IgM and viral antigens) techniques were performed in cerebrospinal fluid and serum samples obtained from study participants. RESULTS: In the 43 participants evaluated, the etiologic agent or the presence of IgM was detected in 16 (37.2%). Nine (20.9%) cases were positive for chikungunya virus (CHIKV), three (7.0%) for dengue virus, two (4.7%) for human adenovirus, one (2.3%) for varicella-zoster virus, and one (2.3%) for enterovirus. Whole-genome sequencing revealed that the CHIKV identified belongs to the East/Central/South African lineage. CONCLUSION: Herein, CHIKV is a common pathogen identified in encephalitis cases. Our results reinforce previous evidence that chikungunya represents a significant cause of encephalitis during CHIKV outbreaks and epidemics and add to existing information on the epidemiology of encephalitis in Brazil.

Frequency and Characterization of Movement Disorders in Anti-IgLON5 Disease.

OBJECTIVE: Anti-IgLON5 disease is a recently described neurological disease that shares features of autoimmunity and neurodegeneration. Abnormal movements appear to be frequent and important but have not been characterized and are under-reported. Here we describe the frequency and types of movement disorders in a series of consecutive patients with this disease. METHODS: In this retrospective, observational study, the presence and phenomenology of movement disorders were assessed with a standardized clinical questionnaire. Available videos were centrally reviewed by three experts in movement disorders. RESULTS: Seventy two patients were included. In 41 (57%) the main reason for initial consultation was difficulty walking along with one or several concurrent movement disorders. At the time of anti-IgLON5 diagnosis, 63 (87%) patients had at least one movement disorder with a median of three per patient. The most frequent abnormal movements were gait and balance disturbances (52 patients, 72%), chorea (24, 33%), bradykinesia (20, 28%), dystonia (19, 26%), abnormal body postures or rigidity (18, 25%), and tremor (15, 21%). Other hyperkinetic movements (myoclonus, akathisia, myorhythmia, myokymia, or abdominal dyskinesias) occurred in 26 (36%) patients. The craniofacial region was one of the most frequently affected by multiple concurrent movement disorders (23 patients, 32%) including dystonia (13), myorhythmia (6), chorea (4) or myokymia (4). Considering any body region, the most frequent combination of multiple movement disorders consisted of gait instability or ataxia associated with craniofacial dyskinesias or generalized chorea observed in 31(43%) of patients. In addition to abnormal movements, 87% of patients had sleep alterations, 74% bulbar dysfunction, and 53% cognitive impairment. Fifty-five (76%) patients were treated with immunotherapy, resulting in important and sustained improvement of the movement disorders in only seven (13%) cases. CONCLUSIONS: Movement disorders are a frequent and leading cause of initial neurological consultation in patients with anti-IgLON5 disease. Although multiple types of abnormal movements can occur, the most prevalent are disorders of gait, generalized chorea, and dystonia and other dyskinesias that frequently affect craniofacial muscles. Overall, anti-IgLON5 disease should be considered in patients with multiple movement disorders, particularly if they occur in association with sleep alterations, bulbar dysfunction, or cognitive impairment.

The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory.

OBJECTIVE: Evaluate the accuracy of diagnosis of major depression in patients with Parkinson's disease (PD) using the UPDRS, the 15-item Geriatric Depression Scale (GDS15) and the Beck Depression Inventory (BDI). METHOD: 50 consecutive patients with PD were evaluated. The diagnosis of major depression was made according to the DSM-IV criteria. RESULTS: We found a 24% prevalence of major depression. All depression scales were highly correlated but UPDRS depression item had the lowest diagnostic value. The GDS15 had the more appropriate "receiver operating characteristics" curve. The best cut-off scores for screening depression were 17/18 for BDI and 8/9 for GDS15. We did not find any correlation between the level of depression and intensity of motor symptoms, functional capacity and duration of the disease. CONCLUSION: GDS15 is better than the BDI and the UPDRS for screening depression in PD and depression is not related to the degree of parkinsonian symptoms.

The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory / A precisão do diagnóstico de depressão na doença de Parkinson: um estudo comparativo entre a UPDRS, a escala geriátrica de depressão e o inventário de depressão de Beck

OBJECTIVE: Evaluate the accuracy of diagnosis of major depression in patients with Parkinson's disease (PD) using the UPDRS, the 15-item Geriatric Depression Scale (GDS15) and the Beck Depression Inventory (BDI). METHOD: 50 consecutive patients with PD were evaluated. The diagnosis of major depression was made according to the DSM-IV criteria. RESULTS: We found a 24 percent prevalence of major depression. All depression scales were highly correlated but UPDRS depression item had the lowest diagnostic value. The GDS15 had the more appropriate "receiver operating characteristics" curve. The best cut-off scores for screening depression were 17/18 for BDI and 8/9 for GDS15. We did not find any correlation between the level of depression and intensity of motor symptoms, functional capacity and duration of the disease. CONCLUSION: GDS15 is better than the BDI and the UPDRS for screening depression in PD and depression is not related to the degree of parkinsonian symptoms.

OBJETIVO: Avaliar a precisão do diagnóstico de depressão em pacientes com doença de Parkinson avaliados pela UPDRS, pela Escala Geriátrica de Depressão com 15 itens (EGD15) e pelo Inventário de Depressão de Beck (IDB). MÉTODO: 50 pacientes com DP foram avaliados. O diagnóstico de depressão maior foi feito segundo os critérios do DSM-IV. RESULTADOS: A prevalência de depressão foi 24 por cento. As escalas de depressão tiveram elevada correlação entre si. A UPDRS apresentou a menor sensibilidade para o diagnóstico. A EGD15 mostrou uma curva ROC mais apropriada que o IDB. Os melhores escores-de-corte para diagnóstico de depressão foram 17/18 para o IDB e 8/9 para a EGD15. Não houve correlação entre os níveis de depressão e a intensidade do parkinsonismo, a capacidade funcional ou a duração da doença. CONCLUSÃO: A EGD15 é melhor que o IDB para diagnosticar depressão na DP. A depressão não está relacionada à gravidade dos sintomas parkinsonianos.