A novel DMD intronic alteration: a potentially disease-causing variant of an intermediate muscular dystrophy phenotype.

Pathogenic germline variants in DMD gene, which encodes the well-known cytoskeletal protein named dystrophin, are associated with a wide range of dystrophinopathies disorders, such as Duchenne muscular dystrophy (DMD, severe form), Becker muscular dystrophy (BMD, mild form) and intermediate muscular dystrophy (IMD). Muscle biopsy, immunohistochemistry, molecular (multiplex ligation-dependent probe amplification (MLPA)/next-generation sequencing (NGS) and Sanger methods) and in silico analyses were performed in order to identify alterations in DMD gene and protein in a patient with a clinical manifestation and with high creatine kinase levels. Herein, we described a previously unreported intronic variant in DMD and reduced dystrophin staining in the muscle biopsy. This novel DMD variant allele, c.9649+4A>T that was located in a splice donor site within intron 66. Sanger sequencing analysis from maternal DNA showed the presence of both variant c.9649+4A>T and wild-type (WT) DMD alleles. Different computational tools suggested that this nucleotide change might affect splicing through a WT donor site disruption, occurring in an evolutionarily conserved region. Indeed, we observed that this novel variant, could explain the reduced dystrophin protein levels and discontinuous sarcolemmal staining in muscle biopsy, which suggests that c.9649+4A>T allele may be re-classified as pathogenic in the future. Our data show that the c.9649+4A>T intronic sequence variant in the DMD gene may be associated with an IMD phenotype and our findings reinforce the importance of a more precise diagnosis combining muscle biopsy, molecular techniques and comprehensive in silico approaches in the clinical cases with negative results for conventional genetic analysis.

Intracranial Subdural Hematoma after Spinal Anesthesia: Report of Two Cases with different Outcomes

Spinal anesthesia is a technique commonly used for local anesthesia and in obstetric surgeries. Rarely, the formation of an intracranial subdural hematoma (SDH) may result from spinal anesthesia, constituting a serious condition that often leads to severe neurological deficits. The presentation and course of this pathology may occur in a completely different way, which makes its diagnosis and management difficult. In the present article, the authors report two cases of patients with intracranial SDH after spinal anesthesia with completely different presentations and outcomes, demonstrating the variability of the manifestations of this condition. A quick review of key points of its pathophysiology, symptomatology, diagnosis, and treatment was also performed.

Distinct Phospho-TDP-43 brain distribution in two cases of FTD, one associated with ALS.

INTRODUCTION: TDP-43 is an intranuclear protein involved in many cellular processes. When altered, it shows a change in pattern of distribution, as well as in functioning, throughout the Central Nervous System structures. Frontotemporal Lobar Degeneration (FTLD) and Amyotrophic Lateral Sclerosis (ALS) are examples of TDP-43 proteinopathy. These disorders form a clinical spectrum, with some patients having a pure cognitive disorder while others also exhibit motor features. METHODS: We studied two donated brains from patients with a diagnosis of Frontotemporal Dementia (FTD), one of which was associated with ALS (ALS-FTD). After fixation and macroscopic examinations, sample analyses were performed. Specific regions were chosen for the application of immunohistochemistry (IHC) with anti-Aß, AT8, anti-α-synuclein and anti-phospho-TDP-43. RESULTS: Both brains presented anti-phospho-TDP-43 positivity, but this was not equally distributed throughout the encephalic zones. In the FTD case, the studied brain presented phosphorylated TDP-43- in the frontal cortex, hippocampus, entorhinal cortex and mesencephalon; in the ALS-FTD case, the abnormal protein was also seen in the pons and medulla oblongata. The brain in the ALS-FTD case presented Aß and AT8 positivity in the hippocampus and entorhinal cortex (Braak I and II). DISCUSSION: The hypothesis supported by scientific literature that these neurodegenerative diseases can have the same etiology with distinct encephalic region involvement is corroborated by the present study.

INTRODUÇÃO: TDP-43 é uma proteína intranuclear envolvida em vários processos celulares. Essa molécula, quando alterada, mostra padrões de distribuição modificados, assim como de funcionamento, ao longo das estruturas do Sistema Nervoso Central. A Degeneração Lobar Frontotemporal (DLFT) e a Esclerose Lateral Amiotrófica (ELA) são dois exemplos de proteinopatia de TDP-43. Esses transtornos formam um espectro clínico, com alguns pacientes apresentando um transtorno cognitivo puro enquanto outros também apresentam disfunções motoras. MÉTODOS: Nós estudamos dois cérebros doados de pacientes com diagnóstico de Demência Frontotemporal (DFT), um dos quais se associava com ELA (ELA-DFT). Após fixação e exame macroscópico, foram realizadas análises de amostras. Regiões específicas foram escolhidas para aplicação de imunohistoquímica (IHQ) com anti-Aß, AT8, anti-α-sinucleina e anti-fosfo-TDP-43. RESULTADOS: Ambos os cérebros foram positivos para anti-fosfo-TDP-43, mas de forma não igualmente distribuida pelas regiões encefálicas. No caso DFT, o cérebro estudado apresentou TDP-43-fosforilada no córtex frontal, hipocampo, córtex entorrinal e mesencéfalo; no caso ELA-DFT, a proteína anormal também foi vista na ponte e no bulbo. O cérebro do caso ELA-DFT foi positivo para Aß e AT8 no hipocampo e no córtex entorrinal (Braak I e II). DISCUSSÃO: O presente estudo corrobora a hipótese atualmente sustentada pela literatura científica de que essas duas doenças neurodegenerativas possuem a mesma etiologia, mas acometem regiões encefálicas distintas.

Distinct Phospho-TDP-43 brain distribution in two cases of FTD, one associated with ALS / Distribuição cerebral distinta de fosfo-tdp-43 em dois casos de dft, um associado com ela

ABSTRACT. INTRODUCTION: TDP-43 is an intranuclear protein involved in many cellular processes. When altered, it shows a change in pattern of distribution, as well as in functioning, throughout the Central Nervous System structures. Frontotemporal Lobar Degeneration (FTLD) and Amyotrophic Lateral Sclerosis (ALS) are examples of TDP-43 proteinopathy. These disorders form a clinical spectrum, with some patients having a pure cognitive disorder while others also exhibit motor features. METHODS: We studied two donated brains from patients with a diagnosis of Frontotemporal Dementia (FTD), one of which was associated with ALS (ALS-FTD). After fixation and macroscopic examinations, sample analyses were performed. Specific regions were chosen for the application of immunohistochemistry (IHC) with anti-Aß, AT8, anti-α-synuclein and anti-phospho-TDP-43. RESULTS: Both brains presented anti-phospho-TDP-43 positivity, but this was not equally distributed throughout the encephalic zones. In the FTD case, the studied brain presented phosphorylated TDP-43- in the frontal cortex, hippocampus, entorhinal cortex and mesencephalon; in the ALS-FTD case, the abnormal protein was also seen in the pons and medulla oblongata. The brain in the ALS-FTD case presented Aß and AT8 positivity in the hippocampus and entorhinal cortex (Braak I and II). DISCUSSION: The hypothesis supported by scientific literature that these neurodegenerative diseases can have the same etiology with distinct encephalic region involvement is corroborated by the present study.

RESUMO. INTRODUÇÃO: TDP-43 é uma proteína intranuclear envolvida em vários processos celulares. Essa molécula, quando alterada, mostra padrões de distribuição modificados, assim como de funcionamento, ao longo das estruturas do Sistema Nervoso Central. A Degeneração Lobar Frontotemporal (DLFT) e a Esclerose Lateral Amiotrófica (ELA) são dois exemplos de proteinopatia de TDP-43. Esses transtornos formam um espectro clínico, com alguns pacientes apresentando um transtorno cognitivo puro enquanto outros também apresentam disfunções motoras. MÉTODOS: Nós estudamos dois cérebros doados de pacientes com diagnóstico de Demência Frontotemporal (DFT), um dos quais se associava com ELA (ELA-DFT). Após fixação e exame macroscópico, foram realizadas análises de amostras. Regiões específicas foram escolhidas para aplicação de imunohistoquímica (IHQ) com anti-Aß, AT8, anti-α-sinucleina e anti-fosfo-TDP-43. RESULTADOS: Ambos os cérebros foram positivos para anti-fosfo-TDP-43, mas de forma não igualmente distribuida pelas regiões encefálicas. No caso DFT, o cérebro estudado apresentou TDP-43-fosforilada no córtex frontal, hipocampo, córtex entorrinal e mesencéfalo; no caso ELA-DFT, a proteína anormal também foi vista na ponte e no bulbo. O cérebro do caso ELA-DFT foi positivo para Aß e AT8 no hipocampo e no córtex entorrinal (Braak I e II). DISCUSSÃO: O presente estudo corrobora a hipótese atualmente sustentada pela literatura científica de que essas duas doenças neurodegenerativas possuem a mesma etiologia, mas acometem regiões encefálicas distintas.

Early-life environmental intervention may increase the number of neurons, astrocytes, and cellular proliferation in the hippocampus of rats.

Neonatal handling reduces the stress response in adulthood due to a feedback mechanism. The present study analyzed the effects of repeated neonatal environmental intervention (daily handling during the first 10 days after birth) on neuron-, astroglial cell density, and cellular proliferation of the hippocampal (CA1, CA2, and CA3) pyramidal cell layers in female rats. Pups were divided into two groups, nonhandled and handled, which were submitted to repeated handling sessions between postnatal days 1 and 10. Histological and immunohistochemical procedures were used to determine changes in neuron density, astroglial cell density, and cellular proliferation. We found an increase in neuron density in each pyramidal cell layer of the hippocampus (CA1, CA2, and CA3) in female rats (11 and 90 day old) that were handled during the neonatal period. Furthermore, we found an increase in astroglial cell density in both hemispheres of the brain in the handled group. Finally, we observed an increase in cellular proliferation in both hippocampi (CA1, CA2, and CA3) of the brain in female pups (11 days old) handled during the neonatal period. This study demonstrates that an early-life environmental intervention may induce morphological changes in a structure involved with several functions, including the stress response. The results of the current study suggest that neonatal handling may influence the animals' responses to environmental adversities later in life.

Analysis of leukocytes in medication-overuse headache, chronic migraine, and episodic migraine.

OBJECTIVE: To evaluate the number of immune cells in the peripheral blood of medication-overuse headache (MOH), chronic migraine (CM), and migraine without aura (MWA) patients, as well as from controls. BACKGROUND: Migraine has been linked to immunologic disturbances, but the role of the immune system in chronic forms of headache that evolve from migraine has not been studied. Psychiatric co-morbidity has been related to both headache chronification and immunologic alterations. METHODS: This cross-sectional study comprised 68 subjects divided in 4 groups: MOH, CM, MWA, control. Subjects were gender-matched, had no physical co-morbidity, and were taking only acetaminophen. Clinical and psychological data were recorded in a standardized protocol. Samples of peripheral blood for hematological analysis were obtained in the morning during the ictal (MOH, CM, and MWA groups) and interictal periods (MWA group), as well from control group. RESULTS: A higher lymphocyte count was measured in MOH patients relative to the MWA patients (mean ± standard deviation: 2448.7/mm3 ± 775.8 vs. 1859.7/mm3 ± 564.7; P = .027). The numbers of blood lymphocytes for CM and control subjects were 2086.1/mm3 ± 540.5 and 1961.7/mm3 ± 385.6, respectively. Multiple linear regression analysis demonstrated that only MOH and MWA groups remained associated with lymphocyte count (B = 540.7; CI 95%: 55.2-1026.1; P = .03; R2 = 19.2%). Analysis for linearity of variables in the spectrum control/MWA/CM/MOH resulted positive for body mass index (from 23.5 ± 3.25 in controls to 26.5 ± 4.49 in MOH patients; P = .034), scores on Beck Depression Inventory (from 3.29 ± 3.05 to 14.65 ± 11.21; P < 0.001) and Hamilton Anxiety Scale (from 4.29 ± 3.93 to 23.24 ± 11.01; P < 0.001), hemoglobin (from 13.7 ± 0.79 to 14.6 ± 1.31; P = .022), and lymphocyte count (from 1961.7 ± 385.6 to 2448.7 ± 775.8; P = .01), but negative for CD8+ T lymphocytes (from 34.0 ± 8.82 to 30.0 ± 6.64; P = .046). CONCLUSIONS: A higher lymphocyte count in the MOH group relative to the MWA group may indicate a chronic inflammatory state. Several clinical and laboratorial characteristics have a range along a spectrum extending from healthy subjects to patients suffering from chronic forms of migraine.

Olfactory function and Parkinson's disease in Southern Brazil.

UNLABELLED: The idiopathic Parkinson disease (IPD) is traditionally diagnosed by motor signs, but non-motor symptoms and signs are frequent and may help in the clinical diagnosis. PURPOSE: To evaluate the olfactory function in Brazilian healthy subjects, patients with early-onset PD (EOPD) and late-onset PD (LOPD) using the Sniffin' Sticks odor-identification test (SST). METHOD: We studied 70 patients with IPD (19 EOPD and 51 LOPD) and 70 controls matched for gender, age and years of schooling. Subjects with dementia and loss of smell for other reasons were excluded. RESULTS: The SST showed a significant difference (p<0.001) between groups: control groups (12.0 + or - 0.3), EOPD (8.3 + or - 0.7), and LOPD (6.7 + or - 0.4) when the groups were adjusted for gender, age, disease duration, and years of schooling. CONCLUSION: Both groups of IPD patients presented olfactory impairments, but those whose symptoms started before 45 years-old (EOPD) had better sense of smell than the LOPD patients.

Olfactory function and Parkinson's disease in Southern Brazil / Função olfatória e doença de Parkinson no sul do Brasil

The idiopathic Parkinson disease (IPD) is traditionally diagnosed by motor signs, but non-motor symptoms and signs are frequent and may help in the clinical diagnosis. PURPOSE: To evaluate the olfactory function in Brazilian healthy subjects, patients with early-onset PD (EOPD) and late-onset PD (LOPD) using the Sniffin' Sticks odor-identification test (SST). METHOD: We studied 70 patients with IPD (19 EOPD and 51 LOPD) and 70 controls matched for gender, age and years of schooling. Subjects with dementia and loss of smell for other reasons were excluded. RESULTS: The SST showed a significant difference (p<0.001) between groups: control groups (12.0±0.3), EOPD (8.3±0.7), and LOPD (6.7±0.4) when the groups were adjusted for gender, age, disease duration, and years of schooling. CONCLUSION: Both groups of IPD patients presented olfactory impairments, but those whose symptoms started before 45 years-old (EOPD) had better sense of smell than the LOPD patients.

A doença de Parkinson idiopática (DPI) tradicionalmente é diagnosticada pelos sinais motores, porém os sinais e sintomas não-motores são freqüentes. OBJETIVO: Avaliar a função olfatória em sujeitos brasileiros saudáveis e em pacientes com doença de Parkinson precoce (DPP) e doença de Parkinson tardia (DPT) utilizando o teste Sniffin' Sticks (TSS) de identificação de odores. MÉTODO: Setenta pacientes com DPI (19 DPP e 51 DPT) e 70 controles pareados para as variáveis gênero, idade e anos de escolaridade foram estudados. Foram excluídos sujeitos com demência e/ou perda de olfato por outros motivos. RESULTADOS: O TSS mostrou uma diferença significativa (p<0,001) entre os grupos controle (12,0±0,3), DPP (8,3±0,7) e DPT (6,7±0,4) quando os grupos foram ajustados para sexo, idade, duração da doença e anos de escolaridade. CONCLUSÃO: Pacientes com DPI apresentam redução do olfato, sendo mais importante entre aqueles com DPT. A disfunção olfatória pode ser uma ferramenta muito útil no diagnóstico de DPI.