Linking abnormal neural activity patterns to motor deficits.

Abnormal activity in the cerebellar nuclei can be used to predict motor symptoms and induce them experimentally, pointing to potential therapeutic strategies.

Optimal Body Weights for Adults with Severe Motor and Intellectual Disabilities.

Determining the optimal body weight for individuals with severe motor and intellectual disabilities (SMID) lacks a standardized approach. In this study, we aimed to develop a formula to estimate the ideal body weight for each SMID patient, considering factors such as reduced muscle and bone mass. We analyzed data from 111 SMID patients (56 male, 55 female; age range 20 to 73 y) who underwent blood tests measuring creatinine (Cr) and cystatin C (cysC) for clinical reasons between Feb. 2018 and Feb. 2023. To create the optimal body weight formula, we utilized three variables: height, estimated glomerular filtration (eGFR)-Cr, and eGFR-cysC. The validity of the formula was assessed by comparing the measured triceps subcutaneous fat thickness (TSF) to the reference TSF (%TSF), evaluating how accurately it reflects the appropriate physique. The derived optimal body weight formula is as follows: Optimal body weight=(height)2×(18.5-25.0)×{1-0.41×(1-eGFR-cysC/eGFR-Cr)}×0.93. Our formula demonstrated validity when using %TSF as an indicator. Establishing a method to determine optimal body weight in SMID patients, considering their low muscle and bone mass, is crucial for accurate nutritional assessment and subsequent nutritional management.

The contribution of EEG to assess and treat motor disorders in multiple sclerosis.

OBJECTIVE: Electroencephalography (EEG) can highlight significant changes in spontaneous electrical activity of the brain produced by altered brain network connectivity linked to inflammatory demyelinating lesions and neuronal loss occurring in multiple sclerosis (MS). In this review, we describe the main EEG findings reported in the literature to characterize motor network alteration in term of local activity or functional connectivity changes in patients with MS (pwMS). METHODS: A comprehensive literature search was conducted to include articles with quantitative analyses of resting-state EEG recordings (spectrograms or advanced methods for assessing spatial and temporal dynamics, such as coherence, theory of graphs, recurrent quantification, microstates) or dynamic EEG recordings during a motor task, with or without connectivity analyses. RESULTS: In this systematic review, we identified 26 original articles using EEG in the evaluation of MS-related motor disorders. Various resting or dynamic EEG parameters could serve as diagnostic biomarkers of motor control impairment to differentiate pwMS from healthy subjects or be related to a specific clinical condition (fatigue) or neuroradiological aspects (lesion load). CONCLUSIONS: We highlight some key EEG patterns in pwMS at rest and during movement, both suggesting an alteration or disruption of brain connectivity, more specifically involving sensorimotor networks. SIGNIFICANCE: Some of these EEG biomarkers of motor disturbance could be used to design future therapeutic strategies in MS based on neuromodulation approaches, or to predict the effects of motor training and rehabilitation in pwMS.

Espinogénesis en motoneuronas de la médula espinal tras la lesión farmacológica de la corteza motora de ratas / Spinogenesis in spinal cord motor neurons following pharmacological lesions to the rat motor cortex

INTRODUCCIÓN: Diversas enfermedades neuropatologías asociadas a la degeneración del tracto corticoespinal muestran deterioro de las funciones motoras. Tales alteraciones neurológicas se asocian a diversos fenómenos plásticos subsecuentes, a nivel tanto presináptico como postsináptico. Sin embargo, no existe evidencia que indique la existencia de modificaciones en la transmisión de información del tracto corticoespinal a las motoneuronas espinales. MÉTODOS: Se indujo una lesión por vía estereotáxica en la corteza motora primaria de ratas hembra adultas con ácido kaínico y, 15 días después, se evaluó el desempeño motor mediante la escala BBB y en un dispositivo Rota-Rod. Paralelamente, se cuantificó la densidad numérica y proporcional de las espinas delgadas, en hongo y gordas, en motoneuronas de un segmento torácico-lumbar de la médula espinal. Así mismo, se registró la expresión de las proteínas espinofilina, sinaptofisina β III-tubulina. RESULTADOS: La lesión farmacológica provocó un desempeño motor deficiente. Así mismo, tanto la densidad de espinas como la proporción de espinas delgadas y gordas fue mayor, al igual que la expresión de las 3 proteínas estudiadas. CONCLUSIÓN: La aparición de los síntomas clínicos de daño neurológico provocado por la degeneración walleriana del tracto corticoespinal se acompaña de respuestas plásticas espontáneas de tipo compensador, a nivel sináptico. Lo anterior indica que durante la rehabilitación temprana de este tipo de pacientes, la plasticidad espontánea constituye un factor que se debe considerar para el diseño de estrategias de intervención más eficientes

INTRODUCTION: Motor function is impaired in multiple neurological diseases associated with corticospinal tract degeneration. Motor impairment has been linked to plastic changes at both the presynaptic and postsynaptic levels. However, there is no evidence of changes in information transmission from the cortex to spinal motor neurons. METHODS: We used kainic acid to induce stereotactic lesions to the primary motor cortex of female adult rats. Fifteen days later, we evaluated motor function with the BBB scale and the rotarod and determined the density of thin, stubby, and mushroom spines of motor neurons from a thoracolumbar segment of the spinal cord. Spinophilin, synaptophysin, and β III-tubulin expression was also measured. RESULTS: Pharmacological lesions resulted in poor motor performance. Spine density and the proportion of thin and stubby spines were greater. We also observed increased expression of the 3 proteins analysed. CONCLUSION: The clinical symptoms of neurological damage secondary to Wallerian degeneration of the corticospinal tract are associated with spontaneous, compensatory plastic changes at the synaptic level. Based on these findings, spontaneous plasticity is a factor to consider when designing more efficient strategies in the early phase of rehabilitation

Experiencia clínica en el tratamiento de las fluctuaciones motoras en la enfermedad de Parkinson. Consenso Delphi de un grupo / Clinical experience in the treatment of motor fluctuations in Parkinsons disease. Delphi consensus of a group of experts in movement disorders

INTRODUCCIÓN: Las fluctuaciones motoras son una de las complicaciones más frecuentes en la enfermedad de Parkinson y su tratamiento sigue siendo complejo. Por ello, desde el Grupo de Trastornos del Movimiento de la Asociación Madrileña de Neurología presentamos nuestra experiencia clínica en el tratamiento de estas complicaciones, con la intención de que sea de utilidad en la toma de decisiones en la práctica clínica diaria. DESARROLLO: Se elaboraron 19 preguntas a partir de una revisión bibliográfica y una encuesta abierta respondida por los miembros de dicho grupo. Dichas cuestiones se debatieron en dos fases, utilizando la metodología Delphi. Considerando los resultados de la encuesta, el ajuste de la dosis de levodopa y los agonistas dopaminérgicos son la opción con mejor relación eficacia/tolerabilidad en el tratamiento de las fluctuaciones motoras. La rotigotina es útil en las fluctuaciones motoras asociadas a gastroparesia, y la apomorfina subcutánea intermitente, en pacientes con off impredecible. El efecto adverso más relevante asociado a los agonistas dopaminérgicos es el trastorno del control de impulsos. Los inhibidores de la catecol-O-metiltransferasa son útiles en las fluctuaciones motoras de inicio, especialmente en el wearing off. Los inhibidores de la monoaminooxidasa son fármacos, en general, bien tolerados y útiles en las fluctuaciones motoras. En caso de que estas medidas no resulten eficaces, se deben indicar terapias de segunda línea de manera individualizada. CONCLUSIÓN: El perfil clínico del paciente con enfermedad de Parkinson es primordial para decidir la terapia más adecuada en el tratamiento de las fluctuaciones motora

INTRODUCTION. Motor fluctuations are one of the most common complications of Parkinsons disease and their treatment is still a complex matter. Therefore, from the Neurology Movement Disorders Group we present our clinical experience in the treatment of these complications, with the intention of it being useful in decision-making in daily clinical practice. DEVELOPMENT. Nineteen questions were developed based on a literature review and an open survey answered by members of this group. These issues were discussed in two phases, using the Delphi methodology. Considering the results of the survey, levodopa dose adjustment and dopamine agonists are the option with the best efficacy/tolerability ratio in the treatment of motor fluctuations. Rotigotine is useful in the motor fluctuations associated with gastroparesis, and intermittent subcutaneous apomorphine has positive effects in patients with unpredictable off periods. The most relevant adverse effect associated with dopamine agonists is impulse control disorder. Catechol-O-methyltransferase inhibitors are useful in the initial stages of motor fluctuations, especially in wearing off. Monoamine oxidase inhibitors are generally drugs that are well-tolerated and useful in motor fluctuations. If these measures are not effective, second-line treatments should be indicated on a case-by-case basis. CONCLUSION. The clinical profile of patients with Parkinson's disease is paramount in deciding the most appropriate therapy for the treatment of motor fluctuations

Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms? / Caídas en personas con enfermedad de Parkinson: ¿Los síntomas no motores importan tanto como los síntomas motores?

ABSTRACT Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.

RESUMEN Las caídas son frecuentes entre las personas con Parkinson (EP). La predicción de caídas es compleja ya que existen contribuyentes genéricos y específicos. El papel de los síntomas no motores ha sido menos estudiado. Objetivo: Identificar el papel de los factores no motores en caídas en personas con EP (PcP). Métodos: Estudio transversal en PcP reclutadas en una clínica de trastornos del movimiento. Se incluyeron datos clínicos y demográficos. Todos los PcP se evaluaron con la Escala Unificada de Enfermedad de Parkinson modificada por la Sociedad Internacional de Trastornos del Movimiento (MDS-UPDRS) y la Escala de Síntomas No Motores (NMSS). Se incluyeron variables significativas en un modelo de regresión logística. Resultados: Se incluyeron un total de 179 PcP El 16.8% había presentado una caída en los últimos doce meses y el 53.3% de forma recurrente. El número medio de caídas mensuales fue de 2.5 ± 3.3. Los factores asociados con la caída en el análisis bivariado fueron la duración de la enfermedad, Hoehn e Yahr, MDS-UPDRS parte I y II, subtipo de alteración de la marcha/inestabilidad postural (PIGD), dominio urinario del NMSS, dominio misceláneo del NMSS y carga de severidad no motora (todos los valores de p < 0.05). Después del análisis multivariado, solo la duración de la enfermedad (p = 0.03) y PIGD (p = 0.03) permanecieron como un factor de riesgo independiente. Conclusión: La duración de la enfermedad y PIGD se identificaron como factores de riesgo para caídas. Los síntomas no motores parecen tener un papel menos relevante en las caídas.

Variabilidad en la exploración motora de la enfermedad de Parkinson entre el neurólogo experto en trastornos del movimiento y la enfermera especializada / Inter-rater variability in motor function assessment in Parkinson's disease between experts in movement disorders and nurses specialising in PD management

Introducción y objetivo: En la práctica clínica la evaluación del paciente con enfermedad de Parkinson (EP) es compleja y lleva tiempo. El presente estudio pretende comparar de forma rigurosa y objetiva la evaluación motora del paciente con EP realizada por el neurólogo experto frente a la enfermera especializada de la Unidad de Parkinson. Métodos: Estudio observacional, transversal, monocéntrico en el que se incluyó a 50 pacientes con EP (52% varones, 64,7±8,7 años), que fueron evaluados entre el 05 de enero del 2016 y el 20 de julio del 2016. El neurólogo y la enfermera evaluaron a los pacientes desde el punto de vista motor mediante el uso de las escalas de Hoehn&Yahr (H&Y) modificada, Unified Parkinson's Disease Rating Scalepart-III (UPDRS-III) y part-iv (UPDRS-IV) en el mismo estado motor (48 en OFF y 2 en ON) de forma protocolizada a primera hora de la mañana. Se utilizó el coeficiente de correlación intraclase (CCI) para medir la variabilidad. Resultados: El H&Y fue el mismo según ambos evaluadores en 49 de los 50 casos. No hubo grandes diferencias entre el tiempo empleado por ambos evaluadores. El CCI para la UPDRS-IV fue de 0,955 (p < 0,0001) y para la UPDRS-III de 0,954 (p < 0,0001). La mayor variabilidad en la UPDRS-III fue para el ítem 29 (marcha) con un CCI de 0,746 (p < 0,0001) y la menor para el ítem 30 (reflejos posturales) con un CCI de 0,918 (p < 0,0001).Conclusión: La evaluación motora de los pacientes con EP realizada por una enfermera entrenada es superponible a la del neurólogo experto y empleando un tiempo similar

Introduction and objective: In clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other. Methods: We conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7 ± 8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and Hoehn &Yahr (H&Y) scale. Tests were administered in the same PD periods (in 48 patients during the ‘off’ time and in 2 patients during the 'on' time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC).Results: Forty-nine patients (98%) were classified in the same H&Y stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P < .0001) and 0.954 (P < .0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC=0.746; P<.0001) and the lowest, for item 30 (postural stability; ICC = 0.918; P < .0001). Conclusions: Motor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete

Prevalencia de alteraciones del neurodesarrollo motriz en niños prematuros sin diagnóstico de parálisis cerebral / Prevalence of neurodevelopmental motor disorders in pre-term children without a diagnosis of cerebral palsy

Antecedentes y objetivo: Las alteraciones del neurodesarrollo motriz pueden ir asociadas a la prematuridad extrema. El objetivo del estudio consiste en determinar la prevalencia de alteraciones del neurodesarrollo motriz en prematuros extremos o muy prematuros, sin diagnóstico de parálisis cerebral. Material y métodos: Participaron 23 pacientes, un 69% niños, de 68,26 ± 6 meses de edad (40-86), de los cuales 10 eran prematuros extremos (con edad gestacional < 28 semanas y peso < 1.500g al nacer) y 13 muy prematuros (≥ 28 y < 32 semanas de edad gestacional, de los cuales 8 tenían un peso < 1.500 g al nacer), todos ellos sin parálisis cerebral. Se aplicó el test de desarrollo psicomotor de Picq-Vayer y la prueba neuropsicológica Beere-Buktenica de integración visomotriz. Resultados: El 69,57% de los pacientes presentó retraso del desarrollo psicomotor leve. Los indicadores globales de la prueba de integración visomotriz mostraron que el 86,9% presentaba disminución de la edad de desarrollo. El bajo peso al nacer explicaba el 15% de la varianza en edad psicomotora (R2ajustado = 0,15; ß = 0,44; p = 0,041) y el 31% de la integración visomotriz (R2ajustado = 0,31; ß = 0,59; p = 0,004). Conclusión: El estudio contribuye a aportar pruebas relativas a la incidencia de factores asociados a la prematuridad, especialmente el bajo peso al nacer, en el neurodesarrollo motriz. Los datos apoyan la presencia significativa de alteraciones neuromotrices de carácter leve en pacientes prematuros extremos y muy prematuros, sin que exista un diagnóstico de parálisis cerebral asociado, lo que podría generar problemas a largo plazo en estos pacientes

Background and objective: Motor neurodevelopment disorders may be associated with extreme prematurity. This study aims to determine the prevalence of motor neurodevelopmental disorders of extremely pre-term or very pre-term children without a diagnosis of cerebral palsy. Material and methods: The study included 23 patients, 69% boys, age: 68.26±6 months (40-86), of which 10 were extremely preterm, with gestational age < 28 weeks and birth weight < 1500g, and 13 very preterm (≥28 and <32 weeks of gestational age), of which 8 had a birth weight < 1500g, all of them without cerebral palsy. The psychomotor development test of Picq-Vayer and the Beere-Buktenica neuropsychological test of visual-motor integration were applied. Results: A large majority (69.57%) of patients have slight psychomotor development retardation. Global indicators for the visual-motor integration test show that 86.9% had a decrease in the developmental age. Low birth weight explained 15% of the variance in psychomotor age (R2adjusted = .15, ß = .44, P = .041) and 31% of visual-motor integration (R2adjusted = .31, ß = .59, P = .004). Conclusion: The presented study contributes to provide evidence regarding the incidence of factors associated with prematurity, especially low birth weight, in motor neurodevelopment. The data support the significant presence of mild neuromotor disorders in extremely preterm and very preterm patients without an associated diagnosis of cerebral palsy, which could generate long-term problems in these patients

Fatores associados à incapacidade funcional em idosos brasileiros / Factores asociados a la discapacidad funcional en ancianos brasileños / Factors associated with functional disability in Brazilian older adults

Objetivos: Analisar a associação entre as características sociodemográficas, condições de saúde e aspectos comportamentais, e incapacidade funcional em idosos de três regiões do Brasil. Método: Estudo com delineamento transversal, com amostra composta por 909 idosos. Dados sobre características sociodemográficas, condições de saúde e aspectos comportamentais foram obtidos por meio de questionários. Modelos de regressão de Poisson com cálculo das razões de prevalências ajustadas foram utilizados para identificar os fatores associados com a incapacidade funcional. Resultados: A prevalência de incapacidade funcional foi de 51.9%. Após análise multivariada, foi observada associação da faixa etária superior a 80 anos, arranjo domiciliar multigeracional, autopercepção negativa de saúde e menor nível de atividade física com a incapacidade funcional. Conclusões: A incapacidade funcional é determinada por uma rede complexa de fatores que abrange características sociodemográficas, condições de saúde e aspectos comportamentais. Fatores relacionados a aspectos comportamentais, a exemplo do incentivo a práticas de atividades físicas, poderão contribuir na efetividade da assistência multidisciplinar ao idoso, na qual profissionais de saúde estão inseridos

Objetivo: Analizar la asociación entre las características sociodemográficas, condiciones de salud y aspectos de comportamiento, e incapacidad funcional en ancianos de tres regiones de Brasil. Método: Estudio transversal con una muestra de 909 ancianos. Los datos sobre las características sociodemográficas, condiciones de salud y aspectos de comportamiento fueron obtenidos a través de cuestionarios. Modelos de regresión de Poisson con cálculo de razones de prevalencia ajustadas fueron utilizados para identificar los factores asociados a la incapacidad funcional. Resultados: La prevalencia de la incapacidad funcional fue de 51.9%. El análisis multivariado mostró asociación del grupo de edad de más de 80 años, arreglo de la casa multigeneracional, autopercepción negativa de la salud y menor nivel de actividad física con la incapacidad funcional. Conclusiones: La incapacidad funcional está determinada por una compleja red de factores que abarcan características sociodemográficas, condiciones de salud y los aspectos de comportamiento. Factores relacionados con a aspectos de comportamiento, tales como el fomento de prácticas de actividad física, pueden contribuir a la eficacia de la atención multidisciplinar a las personas mayores, en la que están insertados los profesionales sanitarios

Objectives: To analyze the association between sociodemographic characteristics, health conditions and behavioral aspects, with functional disability in the elderly from three regions of Brazil. Method: Cross‐sectional study with a sample of 909 elderly. Data on sociodemographic characteristics, health conditions and behavioral aspects were obtained using questionnaires. Poisson regression models with calculation of adjusted prevalence ratios were used to identify factors associated with functional disability. Results: The prevalence of functional disability was 51.9%. Multivariate analysis indicated associations of the age group over 80 years, multigenerational household arrangement, negative self‐rated health and lower levels of physical activity with functional disability. Conclusions: Functional disability is determined by a complex network of factors including sociodemographic characteristics, health conditions and behavioral aspects. Factors related to behavioral aspects such as the programs that promote physical activity may contribute to the effectiveness of multidisciplinary care for the elderly, in which health professionals are inserted

Botulinum toxin for hereditary spastic paraplegia: effects on motor and non-motor manifestations / Toxina botulínica nas paraplegias espásticas hereditárias: efeitos nas manifestações motoras e não-motoras

ABSTRACT Motor and non-motor manifestations are common and disabling features of hereditary spastic paraplegia (HSP). Botulinum toxin type A (Btx-A) is considered effective for spasticity and may improve gait in these patients. Little is known about the effects of Btx-A on non-motor symptoms in HSP patients. Objective To assess the efficacy of Btx-A on motor and non-motor manifestations in HSP patients. Methods Thirty-three adult patients with a clinical and molecular diagnosis of HSP were evaluated before and after Btx-A injections. Results Mean age was 41.7 ± 13.6 years and there were 18 women. Most patients had a pure phenotype and SPG4 was the most frequent genotype. The Btx-A injections resulted in a decrease in spasticity at the adductor muscles, and no other motor measure was significantly modified. In contrast, fatigue scores were significantly reduced after Btx-A injections. Conclusion Btx-A injections resulted in no significant functional motor improvement for HSP, but fatigue improved after treatment.

RESUMO Manifestações motoras e não motoras são comuns e incapacitantes nas paraparesias espásticas hereditárias (PEH). Toxina botulínica do tipo A (TB-A) é considerada eficaz no tratamento da espasticidade e pode melhorar a marcha nesses pacientes. Pouco se sabe sobre os efeitos da TB-A sobre sintomas não-motores. Objetivo avaliar a eficácia da TB-A sobre manifestações motoras e não-motoras nas PEH. Método trinta e três pacientes adultos com PEH foram avaliados antes e depois das aplicações de TB-A. Resultados A média de idade foi 41,7 ± 13,6 anos e havia 18 mulheres. A maioria dos pacientes portava a forma pura e o genótipo mais comum foi SPG4. Houve diminuição da espasticidade dos músculos adutores da coxa sem melhora da marcha. A pontuação da fadiga reduziu após as injeções. Conclusão As aplicações de TB-A não melhoraram a marcha nos pacientes mas a redução da fadiga foi significativa após o tratamento.

Association between executive and food functions in the acute phase after stroke / Associações entre função executiva e habilidade de alimentação pós-AVC na fase aguda

ABSTRACT Purpose To investigate potential associations among executive, physical and food functions in the acute phase after stroke. Methods This is a cross-sectional study that evaluated 63 patients admitted to the stroke unit of a public hospital. The exclusion criteria were other neurological and/or psychiatric diagnoses. The tools for evaluation were: Mini-Mental State Examination and Frontal Assessment Battery for cognitive functions; Alberta Stroke Program Early CT Score for quantification of brain injury; National Institutes of Health Stroke Scale for neurological impairment; Modified Rankin Scale for functionality, and the Functional Oral Intake Scale for food function. Results The sample comprised 34 men (54%) and 29 women with a mean age of 63.6 years. The Frontal Assessment Battery was significantly associated with the other scales. In multivariate analysis, executive function was independently associated with the Functional Oral Intake Scale. Conclusion Most patients exhibited executive dysfunction that significantly compromised oral intake.

RESUMO Objetivo Investigar potenciais associações entre funções executiva, física global e de alimentação na fase aguda do acidente vascular cerebral (AVC). Métodos Trata-se de estudo transversal envolvendo 63 pacientes admitidos em unidade de AVC de um hospital público. Os critérios de exclusão foram outros diagnósticos neurológicos e/ou psiquiátricos. Os instrumentos utilizados foram: Mini-Exame do Estado Mental e Bateria de Avaliação Frontal para avaliar funções cognitivas; Alberta Stroke Program Early CT Score para quantificação da lesão cerebral; National Institutes of Health Stroke Scale para comprometimento neurológico; Escala Modificada de Rankin para funcionalidade e Functional Oral Intake Scale para função alimentar. Resultados A amostra compreendeu 34 homens e 29 mulheres, sendo a idade média de 63,6 anos. A Bateria de Avaliação Frontal correlacionou significativamente com as demais escalas. Na análise multivariada, a variável independentemente associada com a função executiva foi a Functional Oral Intake Scale. Conclusão A maioria dos pacientes com AVC apresenta alterações das funções executivas que comprometem significativamente a alimentação oral.

Candesartan, rather than losartan, improves motor dysfunction in thioacetamide-induced chronic liver failure in rats

Minimal hepatic encephalopathy is more common than the acute syndrome. Losartan, the first angiotensin-II receptor blocker (ARB), and candesartan, another widely-used ARB, have protected against developing fibrogenesis, but there is no clear data about their curative antifibrotic effects. The current study was designed to examine their effects in an already-established model of hepatic fibrosis and also their effects on the associated motor dysfunction. Low-grade chronic liver failure (CLF) was induced in 3-month old Sprague-Dawley male rats using thioacetamide (TAA, 50 mg·kg−1·day−1) intraperitoneally for 2 weeks. The TAA-CLF rats were randomly divided into five groups (n=8) treated orally for 14 days (mg·kg−1·day−1) as follows: TAA (distilled water), losartan (5 and 10 mg/kg), and candesartan (0.1 and 0.3 mg/kg). Rats were tested for rotarod and open-field tests. Serum and hepatic biochemical markers, and hepatic histopathological changes were evaluated by H&E and Masson's staining. The TAA-CLF rats showed significant increases of hepatic malondialdehyde, hepatic expression of tumor necrosis factor-α (TNF-α), and serum ammonia, alanine aminotransferase, γ-glutamyl transferase, TNF-α, and malondialdehyde levels as well as significant decreases of hepatic and serum glutathione levels. All treatments significantly reversed these changes. The histopathological changes were moderate in losartan-5 and candesartan-0.1 groups and mild in losartan-10 and candesartan-0.3 groups. Only candesartan significantly improved TAA-induced motor dysfunction. In conclusion, therapeutic antifibrotic effects of losartan and candesartan in thioacetamide-induced hepatic fibrosis in rats are possibly through angiotensin-II receptor blocking, antioxidant, and anti-inflammatory activities. Improved motor dysfunction by candesartan could be attributed to better brain penetration and slower "off-rate" from angiotensin-II receptors. Clinical trials are recommended.

Unusual motor and non-motor symptoms and signs in the early stage of Parkinson's disease / Sintomas e sinais motores e não motores pouco comuns na fase inicial da doença de Parkinson

ABSTRACT Objective Patients with Parkinson’s disease (PD) may present with unusual motor and non-motor symptoms and signs in the early stage of the disease. Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD. Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders. Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis.

RESUMO Objetivo Pacientes com doença de Parkinson (DP) podem apresentar sintomas e sinais motores e não motores pouco comuns na fase inicial da doença. Métodos Os casos foram coletados em um período de cinco anos, em dois centros terciários de distúrbios do Movimento. Todos os pacientes tinham o diagnóstico de DP com apresentações clínicas iniciais pouco comuns. Resultados Um total de 15 pacientes com DP na fase inicial, apresentando sintomas e sinais tais como, tremores atípicos, dor no ombro, sinais relacionados com a síndrome rígido-acinética, bem como casos com astenia, rinorréia, parosmia, disgeusia, sialorréia noturna e distúrbios da discriminação de cores. Conclusões Sintomas e sinais motores e não motores pouco comuns na fase inicial da DP podem ser de difícil interpretação. Neurologistas devem estar a par destas condições, como pistas para o potencial diagnóstico.

Evaluation of child development: beyond the neuromotor aspect / Avaliação do desenvolvimento infantil: além do neuromotor

Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.

Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.

Disfunción escolar en niños de 5 a 19 años con discapacidad motora exclusiva en un hospital de referencia en Argentina / School dysfunction in 5 to 19 year old children with only motor disabilities seen at a reference hospital in Argentina

A pesar de que los niños con discapacidad motora exclusiva no tienen discapacidad intelectual y deberían concurrir a escolaridad común, en la práctica pediátrica observamos un alto nivel de heterogeneidad en la escolaridad de estos niños. El objetivo de nuestro estudio fue establecer la prevalencia de disfunción escolar en niños con discapacidad motora exclusiva que concurren a un hospital de referencia y explorar si existen variables demográficas, sociales, médicas y/o escolares relacionadas con la disfunción. Se realizó un estudio trasversal, observacional, analítico y comparativo. Se incluyeron 288 pacientes con discapacidad motora exclusiva de 5 a 19 años (septiembre de 2011-febrero de 2012). El 25% (72) presentó disfunción escolar. El antecedente de cirugía (OR= 10,8 [4,23-27,57]), la baja escolaridad materna (OR= 4,20 [1,18-14,9]), el dolor crónico (OR= 3,62 [1,77-7,40]) y el uso de silla de ruedas (OR 3,01 [1,48-6,10]) resultaron factores de riesgo estadísticamente significativos para presentar disfunción escolar. El ser hijo único (OR= 0,09 [0,01-0,54]) fue, en esta muestra, un factor protector.

Although children with only motor disabilities have no intellectual disabilities and should attend a regular school, in the pediatric practice it has been observed that there is a high level of heterogeneity in their education. The objective of our study was to establish the prevalence of school dysfunction in children with only motor disabilities who are seen in a reference hospital, and explore if there are socio-demographic, medical and/or school outcome measures related to school dysfunction. The study was cross-sectional, observational, analytical, and comparative. Two hundred and eighty-eight 5 to 19 year old patients with only motor disabilities were included (September 2011-February 2012). Of them, 25% (72) had school dysfunction. A history of surgery (OR= 10.8 [4.23-27.57]), a poor maternal education (OR= 4.20 [1.18-14.9]), chronic pain (OR= 3.62 [1.77-7.40]), and the use of a wheelchair (OR= 3.01 [1.48-6.10]) were found to be statistically significant risk factors for school dysfunction. In our sample, being an only child (OR= 0.09 [0.01-0.54]) was a protective factor

Influência das distintas modalidades de reabilitação sobre as disfunções motoras decorrentes da doença de Parkinson / Influence of Different Kinds of Rehabilitation on Motor Dysfunctions Resulting from Parkinson’s Disease

Introdução: A Doença de Parkinson (DP) é a forma mais freqüente de parkinsonismo que se caracteriza por apresentar rigidez muscular, tremor de repouso, bradicinesia e instabilidade postural. A estes sinais clássicos de comprometimento da função motora, podem associar-se outras disfunções consideradas não motoras. Embora a terapêutica farmacológica seja primordial para a DP, com a progressão desta doença neurodegenerativa, não há estabilidade clínica da mesma, ocorrendo agravamento dos sintomas e/ou aparecimento de efeitos adversos a medicação. Vários estudos têm demonstrado a importância do tratamento fisioterapêutico na recuperação motora da doença e sua influência na melhora da vida diária desses indivíduos quando associado ao tratamento medicamentoso. Objetivos: Procurou-se realizar esta revisão com objetivo de verificar a repercussão dos principais programas de reabilitação e dos exercícios físicos sobre os sintomas motores da marcha ocasionados pela DP. Material e Métodos: Foram selecionados 62 artigos do banco de dados computadorizados como Pubmed, Scielo e Lilacs e disponíveis on-line no portal de Periódicos da CAPES. Resultados e Discussão: Sob distintos aspectos foram observadas as atividades sensório-motoras empregadas nos distúrbios da marcha e as estratégias motoras empregadas nos principais sintomas da doença, assim como os exercícios físicos regulares e os resistidos. Conclusão: Verificou-se que o processo reabilitatório utilizando atividades de exercícios fisioterapêuticos são fundamentais para atenuar e melhorar os distúrbios motores da marcha na DP, especialmente quando direcionados para as especificidades e necessidades funcionais de cada indivíduo, sendo, entretanto, de extrema importância sua associação ao tratamento medicamentoso.

Background: Parkinson's disease (PD) is the most frequent form of parkinsonism characterized by muscle stiffness, resting tremor, bradykinesia and postural instability. Other non motor dysfunctions can be associated to these classic symptoms of the motor function. Although the pharmacological therapeutics is essential for PD, with the progression of this neurodegenerative disease there is no clinical stability, thus the symptoms worsen and/or there are adverse effects to medication. Several studies have demonstrated the importance of physiotherapeutic treatment for the motor recovery of the disease and its influence in the improvement of the patients' daily life when it is associated to drug treatment. Objective: This review was performed with the purpose of checking the repercussion of the main rehabilitation programs and the physical exercises on the motor symptoms caused by PD. Methods: Sixty-two articles published in journals available online in CAPES Journal Gateway and on computerized databases such as Pubmed, Scielo e Lilacs were selected. Results and Discussion: Under different aspects the sensory motor area activities employed in gait disorders, motor strategies for the disease's main symptoms as well as regular physical and resistance exercises were studied. Conclusions: It was found that the rehabilitating process using physical therapeutic exercises are essential to ease and improve PD's motor dysfunctions, especially when directed to the functional specificities and needs of each person, and that its association with drug treatments is extremely important.

Current concepts of abnormal motor disorder: an experimental model of attentional deficit disorder

An attempt was made to indicate the neuropharmalogical relationship between Parkinson's disease, Huntington's chorea, tardive dyskinesia and Attentional Deficit Disorder. In the case of the latter, an experimental model has been prersented indicating cholinergic dysfunction in the nigro-striatal pathway. Postulates are proposed which will enable us to understand the many factors responsible for these clinical states. (AU)