Concentric Needle Jitter in 97 Myasthenia Gravis Patients.

Objectives: To estimate the jitter parameters (single-fiber electromyography) in myasthenia gravis patients mostly by electrical activation in Frontalis, Orbicularis Oculi, and Extensor Digitorum muscles using a concentric needle electrode. Methods: Between 2009 and 2019, a total of 97 myasthenia gravis patients, 52 male, and mean age 54 years were included. Results: Any abnormal jitter parameter in individual muscles was 90.5% (Frontalis), 88.5% (Orbicularis Oculi), and 86.6% (Extensor Digitorum). Any jitter parameter combining Orbicularis Oculi and Frontalis muscle was abnormal in 100% for the ocular, and in 92.9% for the generalized myasthenia gravis. The most abnormal muscle was Orbicularis Oculi for the generalized, and Frontalis for the ocular myasthenia gravis. The decrement was abnormal in 78.4%, 85.9% for the generalized, and 25% for the ocular myasthenia gravis. The mean jitter ranged from 14.2 to 86 µs (mean 33.3 µs) for the ocular myasthenia gravis and from 14.4 to 220.4 µs (mean 66.3 µs) for the generalized myasthenia gravis. The antibody titers tested positive in 86.6%, 91.8% for the generalized, and 50% for the ocular myasthenia gravis. Thymectomy was done in 48.5%, thymoma was found in 19.6%, and myasthenic crisis occurred by 21.6%. Conclusion: The jitter parameters achieved a 100% abnormality in ocular myasthenia gravis if both the Orbicularis Oculi and Frontalis muscles were tested. There was a high jitter abnormality in generalized myasthenia gravis cases with one muscle tested, with about a 2% increase in sensitivity when a second is added. Concentric needle electrode jitter had high sensitivity similar to the single fiber electrode (93.8%), followed by antibody titers (86.6%), and abnormal decrement (78.4%).

Demência frontotemporal em paciente feminina de 56 anos: relato de caso / Frontotemporal Dementia (FTD) in a fifty-six-years-old female patient: case report / Demencia Frontotemporal (DFT) en una paciente de cincuenta y seis años: informe de un caso

A demência é uma das mais importantes causas de morbimortalidade entre os idosos e se caracteriza pelo declínio progressivo em múltiplos domínios cognitivos. Paciente do sexo feminino, 56 anos, iniciou quadro há 3 anos, caracterizado por apatia, anedonia e isolamento social. Procurou atendimento com médico que atribuiu sintomas a depressão. Contudo, não houve melhora. Há dois anos evoluiu com delírios persecutórios, confabulações, alucinação visual. Acompanhante notou que a paciente tinha dificuldades em se expressar e na compreensão. Devido à refratariedade ao tratamento foi solicitada avaliação de neurologista. À consulta inicial, paciente apresentava-se orientada no tempo, espaço. Mini exame do estado mental 26/30 pontos. Fluência verbal semântica. Após 6 meses, evoluiu com empobrecimento do vocabulário. À época estava dependente de familiares para realização de atividades de vida diária. Na ressonância magnética encefálica apresentou atrofia cortical difusa, com predomínio em regiões frontais e temporais à esquerda. Atualmente está em uso de risperidona e memantina. A atrofia cerebral dos lobos frontais e temporais ou demência fronto temporal (DFT) afeta predominantemente o lobo frontal do cérebro, podendo se estender para o temporal. A patologia caracteriza-se por significativa alteração da personalidade e do comportamento, com relativa preservação das funções mnésticas e visuoespaciais. A linguagem é progressivamente afetada. A memória encontra-se preservada no início da doença e as alterações comportamentais e da personalidade são bastante significativas. A variante comportamental é a mais comum. Ela apresenta uma deterioração gradual da função executiva e da personalidade, enquanto a capacidade visuoespacial é afetada apenas em estádios avançados(AU)

Dementia is one of the most important causes of morbimortality among elderly people and is characterized by progressive decline in multiple cognitive domains. A fifty-six-years-old female patient started a medical condition three years ago, characterized by apathy, anhedonia and social isolation. She sought healthcare with a medical who assigned symptoms to depression. However, there was no improvement. Two years ago, she evolved with persecutory delirium, confabulations, visual hallucination. Due to the refractoriness of the treatment, a neurologist evaluation was requested. At the initial consultation, the patient was oriented in time and space. The Mini­Mental State Examination (MMSE) test was 26/30 points. Regarding to Semantic verbal fluency, after 6 months, she evolved with impoverishment of vocabulary. At the time she was dependent on family members for daily activities. In brain magnetic resonance, she showed having diffuse cortical atrophy, with predominance in frontal and temporal regions on the left. Currently, she's using risperidone and memantine. Cerebral atrophy of the frontal and temporal lobes or Front-Temporal Dementia (FTD) affects, predominantly the frontal lobe of the brain, and may extend to the temporal. The pathology is characterized by significant personality and behavioral changes, with relative preservation of the mnestic and visuospatial functions. The language is progressively affected. Memory is preserved at the onset of the disease and the behavioral and personality changes are quite significant. The behavioral variant is the most common. It presents a gradual deterioration of executive function and personality, while visuospatial capacity is affected only in advanced stages(AU)

La demencia es una de las causas más importantes de morbimortalidad entre personas mayores y se caracteriza por una disminución progresiva en múltiples dominios cognitivos. Una paciente de cincuenta y seis años de edad comenzó una condición médica hace tres años, caracterizada por apatía, anedonia y aislamiento social. Ella buscó atención médica y asignaron sus síntomas a depresión. Hace dos años, ella evolucionó con delirio persecutorio, confabulaciones, alucinación visual. Debido a la refractariedad del tratamiento, se solicitó una evaluación neurológica. En la consulta, el paciente estaba orientado con respecto a tiempo y espacio. En el Examen de Estado Mini-Mental (EEMM) obtuvo 26/30 puntos. Con respecto a la fluidez verbal semántica, después de 6 meses, evolucionó poco en su vocabulario. En ese momento ella dependía de los miembros de la familia para las actividades diarias. En la resonancia magnética cerebral, mostró una atrofia cortical difusa, con predominio en las regiones frontal y temporal de la izquierda. Actualmente, ella está usando risperidona y memantina. La atrofia cerebral de los lóbulos frontal y temporal afecta predominantemente el lóbulo frontal del cerebro, y puede extenderse al temporal. La patología se caracteriza por cambios significativos en la personalidad y el comportamiento, con una preservación relativa de las funciones mnisticas y visuoespaciales. El lenguaje se ve progresivamente afectado. La memoria se preserva al inicio de la enfermedad con variaciones constantes en la personalidad. La función ejecutiva se deteriora paulatinamente, mientras que la capacidad visuoespacial se ve afectada en etapas avanzadas(AU)

Problems in Comparing Jitter Values Obtained with Voluntary Activation and Electrical Stimulation.

Comparing results from jitter studies performed with voluntary and electrical activation is difficult to perform quantitatively, particularly in complex signals as seen in reinnervation. High jitter values in individual spikes in these multispike signals can be missed with both activation methods, which introduces a bias towards more normal values.With voluntary activation, triggering on a spike from an abnormal end-plate in multispike potentials will overestimate individual jitter values and the number of abnormal jitter values.With electrical stimulation, artefactually-increased jitter may be caused by subliminal stimulation, which causes uncertainty at the stimulation point. Electrical stimulation also may activate many axons, causing signal summation, with erroneous or impossible jitter estimation.Awareness of such pitfalls can improve the correct performance and interpretation of jitter recordings. Quantitative comparisons of results can be made between studies in reinnervated muscle performed with the same activation method, but not between results obtained with different activation methods.

Time perception and age.

UNLABELLED: Our internal clock system is predominantly dopaminergic, but memory is predominantly cholinergic. Here, we examined the common sensibility encapsulated in the statement: "time goes faster as we get older". OBJECTIVE: To measure a 2 min time interval, counted mentally in subjects of different age groups. METHOD: 233 healthy subjects (129 women) were divided into three age groups: G1, 15-29 years; G2, 30-49 years; and G3, 50-89 years. Subjects were asked to close their eyes and mentally count the passing of 120 s. RESULTS: The elapsed times were: G1, mean = 114.9 ± 35 s; G2, mean = 96.0 ± 34.3 s; G3, mean = 86.6 ± 34.9 s. The ANOVA-Bonferroni multiple comparison test showed that G3 and G1 results were significantly different (P < 0.001). CONCLUSION: Mental calculations of 120 s were shortened by an average of 24.6% (28.3 s) in individuals over age 50 years compared to individuals under age 30 years.

Time perception and age / Percepção do tempo e idade

ABSTRACT Our internal clock system is predominantly dopaminergic, but memory is predominantly cholinergic. Here, we examined the common sensibility encapsulated in the statement: “time goes faster as we get older”. Objective To measure a 2 min time interval, counted mentally in subjects of different age groups. Method 233 healthy subjects (129 women) were divided into three age groups: G1, 15-29 years; G2, 30-49 years; and G3, 50-89 years. Subjects were asked to close their eyes and mentally count the passing of 120 s. Results The elapsed times were: G1, mean = 114.9 ± 35 s; G2, mean = 96.0 ± 34.3 s; G3, mean = 86.6 ± 34.9 s. The ANOVA-Bonferroni multiple comparison test showed that G3 and G1 results were significantly different (P < 0.001). Conclusion Mental calculations of 120 s were shortened by an average of 24.6% (28.3 s) in individuals over age 50 years compared to individuals under age 30 years.

RESUMO Nosso sistema de relógio interno é predominantemente dopaminérgico, mas a memória é predominantemente colinérgica. Neste estudo, examinamos a assertiva comum que “o tempo passa mais rápido para pessoas mais velhas”. Objetivo Medir o intervalo de tempo 2 min contados mentalmente em pessoas de diferentes faixas etárias. Método 233 pessoas saudáveis (129 mulheres) foram divididos em três grupos: G1, 15-29 anos; G2, 30-49 anos; e G3, 50-89 anos. Foi solicitado que contassem mentalmente, com os olhos fechados, a passagem de 120 s. Resultados Os tempos aferidos foram: G1, média = 114,9 ± 35 s; G2, média = 96,0 ± 34,3 s; G3, média = 86,6 ± 34,9 s. A comparação entre os tempos de G3 e G1 (teste de comparação múltipla ANOVA-Bonferroni) foi muito significante (P < 0,001). Conclusão Cálculo mental de 120 s foi encurtado em média 24,6% (28,3 s) em pessoas maiores que 50 anos quando comparado com pessoas menores que 30 anos.