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1.
Int J Mol Sci ; 22(9)2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33947043

RESUMO

Neonatal arterial ischemic stroke is one of the more severe birth complications. The injury can result in extensive neurological damage and is robustly associated with later diagnoses of cerebral palsy (CP). An important part of efforts to develop new therapies include the on-going refinement and understanding of animal models that capture relevant clinical features of neonatal brain injury leading to CP. The potent vasoconstrictor peptide, Endothelin-1 (ET-1), has previously been utilised in animal models to reduce local blood flow to levels that mimic ischemic stroke. Our previous work in this area has shown that it is an effective and technically simple approach for modelling ischemic injury at very early neonatal ages, resulting in stable deficits in motor function. Here, we aimed to extend this model to also examine the impact on cognitive function. We show that focal delivery of ET-1 to the cortex of Sprague Dawley rats on postnatal day 0 (P0) resulted in impaired learning in a touchscreen-based test of visual discrimination and correlated with important clinical features of CP including damage to large white matter structures.


Assuntos
Isquemia Encefálica/complicações , Paralisia Cerebral/etiologia , Modelos Animais de Doenças , Endotelina-1/toxicidade , Vasoconstritores/toxicidade , Animais , Animais Recém-Nascidos , Aprendizagem por Associação , Atrofia , Isquemia Encefálica/induzido quimicamente , Isquemia Encefálica/patologia , Contagem de Células , Córtex Cerebral/patologia , Paralisia Cerebral/patologia , Transtornos Cognitivos/etiologia , Corpo Estriado/patologia , Endotelina-1/administração & dosagem , Inflamação , Injeções , Microglia/patologia , Transtornos dos Movimentos/etiologia , Neurônios/patologia , Transtornos da Percepção/etiologia , Ratos , Ratos Sprague-Dawley , Teste de Desempenho do Rota-Rod , Vasoconstritores/administração & dosagem , Substância Branca/patologia
4.
J Neuroeng Rehabil ; 18(1): 16, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494755

RESUMO

Chemotherapy agents used in the standard treatments for many types of cancer are neurotoxic and can lead to lasting sensory and motor symptoms that compromise day-to-day movement functions in cancer survivors. To date, the details of movement disorders associated with chemotherapy are known largely through self-reported symptoms and functional limitations. There are few quantitative studies of specific movement deficits, limiting our understanding of dysfunction, as well as effective assessments and interventions. The aim of this narrative review is to consolidate the current understanding of sensorimotor disabilities based on quantitative measures in cancer survivors who received chemotherapy. We performed literature searches on PubMed and found 32 relevant movement studies. We categorized these studies into three themes based on the movement deficits investigated: (1) balance and postural control; (2) gait function; (3) upper limb function. This literature suggests that cancer survivors have increased postural sway, more conservative gait patterns, and suboptimal hand function compared to healthy individuals. More studies are needed that use objective measures of sensorimotor function to better characterize movement disabilities and investigate the underlying causes, as required for developing targeted assessments and interventions. By updating our understanding of movement impairments in this population, we identify significant gaps in knowledge that will help guide the direction of future research.


Assuntos
Antineoplásicos/efeitos adversos , Transtornos dos Movimentos/etiologia , Neoplasias/tratamento farmacológico , Síndromes Neurotóxicas , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Humanos
7.
Neurol Sci ; 42(3): 905-910, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33443666

RESUMO

BACKGROUND: Recognition of secondary movement disorders (SMDs) is fundamental either to alleviate disabling disturbances or to treat potentially life-threatening conditions, such as brain tumors. Primary CNS lymphoma (PCNSL) is a rare form of CNS cancer that is often located in subcortical areas, accounting for both neuropsychiatric and motoric disorders. Nevertheless, an overview on PCNSL-related movement disorders (MDs) phenomenology has not been provided yet. OBJECTIVE: To outline the main features of PCNSL-related MDs. METHODS: A retrospective analysis was conducted on a cohort of patients with PCNSL presenting with MDs, including all existing cases identified by a systematic literature review (source: Medline; period: 1946-2020) and two unreported cases. Data on phenomenology, neuroimaging, histology, and clinical course were collected. RESULTS: A total cohort of fifteen subjects was defined, enrolling thirteen previously described patients extracted from eleven published studies, and our two unreported cases. A parkinsonian syndrome appearing at about 60 years of age, unresponsive to levodopa, associated to other neurological signs, resulted as the most common presentation of PCNSL-related MD. Chorea, dystonia, and dyskinesia occurred less frequently, with some degree of responsiveness to symptomatic treatments. Basal ganglia were involved in most cases and motoric disturbances often ameliorated after tumor mass reduction. CONCLUSIONS: This study identified those features of PCNSL-related MDs that could support an appropriate approach to such a rare condition. In fact, while the outcome remains still poor, the therapeutic scenario of PCNSL is changing; an early diagnosis together with an adequate management will be thus crucial for timely and successful interventions.


Assuntos
Neoplasias Encefálicas , Neoplasias do Sistema Nervoso Central , Linfoma não Hodgkin , Transtornos dos Movimentos , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/terapia , Humanos , Transtornos dos Movimentos/etiologia , Estudos Retrospectivos
8.
Eur J Paediatr Neurol ; 30: 9-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33321446

RESUMO

BACKGROUNDS: To investigate the clinical and instrumental features at the onset addressing to the diagnosis of anti-NMDAR encephalitis. METHODS: Twenty children (age: 15 months-17 years; 7 males, 13 females) with initial suspected diagnosis of autoimmune encephalitis, observed between January 2008 and March 2018, were included. The final diagnosis was anti-NMDAR encephalitis in 7 children, other/probable autoimmune encephalitis in 7 children, and primary psychosis in the remaining 6 children. RESULTS: At the clinical onset, anxiety disorder was the main symptom that helped in distinguishing the group of psychotic children from children with non-infectious encephalitis (P = 0.05 OR = 0.001), while epileptic seizures strongly predicted anti-NMDAR encephalitis (P = 0.04 OR = 28.6). At the onset, anti-NMDAR encephalitis could be distinguished from other/probable autoimmune encephalitis for the presence of sleep/wake rhythm alteration (P = 0.05 OR = 15). Among the symptoms occurring during the hospitalization, movement disorders (P = 0.031 OR = 12) were predictive of non-infectious encephalitis rather than primary psychosis. More specifically, the occurrence of language impairment (P = 0.03 OR = 33), epileptic seizures (P = 0.04 OR = 28.6) and catatonia (P = 0.03, OR = 33), were predictive of anti-NMDAR encephalitis. Also at this stage, anxiety disorder (P = 0.03 OR = 0.033) was predictive of primary psychosis. CONCLUSION: Our findings suggest that at the clinical onset epileptic seizures and sleep/wake rhythm alteration represent the main features addressing to the diagnosis of anti-NMDAR encephalitis rather than primary psychosis and other/probable autoimmune encephalitis, while anxiety disorder could be a solid predictor of primary psychosis.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Adolescente , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Catatonia/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos dos Movimentos/etiologia , Transtornos Psicóticos/etiologia , Convulsões/etiologia
9.
Lancet Neurol ; 20(2): 117-126, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33357514

RESUMO

BACKGROUND: Although there is a strong biological rationale for early decompression of the injured spinal cord, the influence of the timing of surgical decompression for acute spinal cord injury (SCI) remains debated, with substantial variability in clinical practice. We aimed to objectively evaluate the effect of timing of decompressive surgery for acute SCI on long-term neurological outcomes. METHODS: We did a pooled analysis of individual patient data derived from four independent, prospective, multicentre data sources, including data from December, 1991, to March, 2017. Three of these studies had been published; of these, only one study previously specifically analysed the effect of the timing of surgical decompression. These four datasets were selected because they were among the highest quality acute SCI datasets available and contained highly granular data. Individual patient data were obtained by request from study authors. All patients who underwent decompressive surgery for acute SCI within these datasets were included. Patients were stratified into early (<24 h after spinal injury) and late (≥24 h after spinal injury) decompression groups. Neurological outcomes were assessed by American Spinal Injury Association (ASIA), or International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), examination. The primary endpoint was change in total motor score from baseline to 1 year after spinal injury. Secondary endpoints were ASIA Impairment Scale (AIS) grade and change in upper-extremity motor, lower-extremity motor, light touch, and pin prick scores after 1 year. One-stage meta-analyses were done by hierarchical mixed-effects regression adjusting for baseline score, age, mechanism of injury, AIS grade, level of injury, and administration of methylprednisolone. Effect sizes were summarised by mean difference (MD) for sensorimotor scores and common odds ratio (cOR) for AIS grade, with corresponding 95% CIs. As a secondary analysis, change in total motor score was regressed against time to surgical decompression (h) as a continuous variable, using a restricted cubic spline with adjustment for the same covariates as in the primary analysis. FINDINGS: We identified 1548 eligible patients from the four datasets. Outcome data at 1 year after spinal injury were available for 1031 patients (66·6%). Patients who underwent early surgical decompression (n=528) experienced greater recovery than patients who had late decompression surgery (n=1020) at 1 year after spinal injury; total motor scores improved by 23·7 points (95% CI 19·2-28·2) in the early surgery group versus 19·7 points (15·3-24·0) in the late surgery group (MD 4·0 points [1·7-6·3]; p=0·0006), light touch scores improved by 19·0 points (15·1-23·0) vs 14·8 points (11·2-18·4; MD 4·3 [1·6-7·0]; p=0·0021), and pin prick scores improved by 18·3 points (13·7-22·9) versus 14·2 points (9·8-18·6; MD 4·0 [1·5-6·6]; p=0·0020). Patients who had early decompression also had better AIS grades at 1 year after surgery, indicating less severe impairment, compared with patients who had late surgery (cOR 1·48 [95% CI 1·16-1·89]; p=0·0019). When time to surgical decompression was modelled as a continuous variable, there was a steep decline in change in total motor score with increasing time during the first 24-36 h after injury (p<0·0001); and after 36 h, change in total motor score plateaued. INTERPRETATION: Surgical decompression within 24 h of acute SCI is associated with improved sensorimotor recovery. The first 24-36 h after injury appears to represent a crucial time window to achieve optimal neurological recovery with decompressive surgery following acute SCI. FUNDING: None.


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Traumatismos da Medula Espinal/cirurgia , Adolescente , Adulto , Anti-Inflamatórios/uso terapêutico , Vértebras Cervicais/cirurgia , Avaliação da Deficiência , Determinação de Ponto Final , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Sensação , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
10.
Mov Disord ; 36(3): 581-593, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33332680

RESUMO

Patients with movement disorders experience fluctuations unrelated to disease progression or treatment. Extrinsic factors that contribute to the variable expression of movement disorders are environment related. They influence the expression of movement disorders through sensory-motor interactions and include somatosensory, visual, and auditory stimuli. Examples of somatosensory effects are stimulus sensitivity of myoclonus on touch and sensory amelioration in dystonia but also some less-appreciated effects on parkinsonian tremor and gait. Changes in visual input may affect practically all types of movement disorders, either by loss of its compensatory role or by disease-related alterations in the pathways subserving visuomotor integration. The interaction between auditory input and motor function is reflected in simple protective reflexes and in complex behaviors such as singing or dancing. Various expressions range from the effect of music on parkinsonian bradykinesia to tics. Changes in body position affect muscle tone and may result in marked fluctuations of rigidity or may affect dystonic manifestations. Factors intrinsic to the patient are related to their voluntary activity and cognitive, motivational, and emotional states. Depending on the situation or disease, they may improve or worsen movement disorders. We discuss various factors that can influence the phenotypic variability of movement disorders, highlighting the potential mechanisms underlying these manifestations. We also describe how motor fluctuations can be provoked during the clinical assessment to help reach the diagnosis and appreciated to understand complaints that seem discrepant with objective findings. We summarize advice and interventions based on the variability of movement disorders that may improve patients' functioning in everyday life. © 2020 International Parkinson and Movement Disorder Society.


Assuntos
Distúrbios Distônicos , Transtornos dos Movimentos , Cognição , Distúrbios Distônicos/terapia , Emoções , Humanos , Transtornos dos Movimentos/etiologia , Tremor
11.
Stroke ; 52(1): 241-249, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317414

RESUMO

BACKGROUND AND PURPOSE: Despite continuing efforts in the multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the ipsilesional corticospinal tract integrity and the role of the contralesional hemisphere are still lacking. This research aimed to find the best combination of motor system metrics, allowing the classification of patients into 3 predefined groups of upper limb motor recovery. METHODS: We enrolled 35 chronic ischemic stroke patients (mean 47 [26-66] years old, 29 [6-58] months poststroke) with a single supratentorial lesion and unilateral upper extremity weakness. Patients were divided into 3 groups, depending on upper limb motor recovery: good, moderate, and bad. Nonparametric statistical tests and regression analysis were used to investigate the relationships among microstructural (fractional anisotropy (FA) ratio of the corticospinal tracts at the internal capsule (IC) level (classic method) and along the length of the tracts (Fréchet distance), and of the corpus callosum) and functional (motor evoked potentials [MEPs] for 2 hand muscles) motor system metrics. Stratification rules were also tested using a decision tree classifier. RESULTS: IC FA ratio in the IC and MEP absence were both equally discriminative of the bad motor outcome (96% accuracy). For the 3 recovery groups' classification, the best parameter combination was IC FA ratio and the Fréchet distance between the contralesional and ipsilesional corticospinal tract FA profiles (91% accuracy). No other metrics had any additional value for patients' classification. MEP presence differed for 2 investigated muscles. CONCLUSIONS: This study demonstrates that better separation between 3 motor recovery groups may be achieved when considering the similarity between corticospinal tract FA profiles along its length in addition to region of interest-based assessment and lesion load calculation. Additionally, IC FA ratio and MEP absence are equally important markers for poor recovery, while for MEP probing it may be important to investigate more than one hand muscle.


Assuntos
AVC Isquêmico/fisiopatologia , Transtornos dos Movimentos/fisiopatologia , Adulto , Idoso , Anisotropia , Doença Crônica , Imagem de Tensor de Difusão , Potencial Evocado Motor , Feminino , Lateralidade Funcional , Humanos , AVC Isquêmico/complicações , AVC Isquêmico/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico por imagem , Transtornos dos Movimentos/etiologia , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Desempenho Psicomotor , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica , Extremidade Superior/fisiopatologia
12.
Rev Neurol ; 71(12): 431-437, 2020 12 16.
Artigo em Espanhol | MEDLINE | ID: mdl-33319345

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a collapse situation in many hospitals around the world. The aim of this study is to analyse the utility of the electroencephalogram (EEG) in the management of the neurological patient during the COVID-19 pandemic. PATIENTS AND METHODS: The Clinical Neurophysiology Department of the Hospital Central de la Defensa Gomez Ulla was dissolved due to the hospital collapse situation. Therefore, the EEG was performed exceptionally in those cases with the greatest probability of providing a benefit in its management. We describe seven patients (four in ICU and three hospitalized) diagnosed with COVID-19, who underwent through an EEG. RESULTS: The EEG showed abnormalities in all cases, including one case of brain death. The EEG resulted in a change in clinical management in four of the patients (57%) and helped the clinician provide information to the family. In the other three cases, a toxic-metabolic origin was suspected before the EEG was performed, so it did not imply a change in the clinical management already proposed, although it facilitated a prognostic orientation. Slow polymorphic waves were evident in five cases. Five patients were unresponsive. Currently, one patient remain hospitalized and four have died. CONCLUSIONS: The EEG was useful and facilitated decision making in COVID-19 patients in whom it was requested. It guided the diagnosis in cases where CT was non-contributory and led to a change in therapeutic management in most patients. The most frequent findings were signs of encephalopathy and epileptiform discharges.


Assuntos
COVID-19/fisiopatologia , Eletroencefalografia , Encefalite Viral/diagnóstico , SARS-CoV-2/isolamento & purificação , Idoso , COVID-19/complicações , COVID-19/diagnóstico , Teste de Ácido Nucleico para COVID-19 , Comorbidade , Transtornos da Consciência/etiologia , Transtornos da Consciência/fisiopatologia , Encefalite Viral/etiologia , Feminino , Parada Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Nasofaringe/virologia , Pandemias , Prognóstico , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-33321850

RESUMO

This study examined the association between functional movement (FM) and adiposity in adolescent population (16-17 years). This study was conducted in a representative sample of urban adolescents as the part of the CRO-PALS longitudinal study (n = 652). Body mass index (BMI), a sum of four skinfolds (S4S), waist and hip circumference were measured, and FM was assessed via Functional Movement ScreenTM (FMSTM). Furthermore, total FMSTM screen was indicator of FM with the composite score ranged from 7 to 21, with higher score indicating better FM. Multilevel analysis was employed to determine the relationship between different predictors and total FMS score. In boys, after controlling for age, moderate-to-vigorous physical activity, socioeconomic status, and total FMS score was inversely associated with BMI (ß = -0.18, p < 0.0001), S4S (ß = -0.04, p < 0.0001), waist circumference (ß = -0.08, p < 0.0001), and hip circumference (ß = -0.09, p < 0.0001). However, among girls, in adjusted models, total FMS score was inversely associated with S4S (ß = -0.03, p < 0.0001), while BMI (ß = -0.05, p = 0.23), waist circumference (ß = -0.04, p = 0.06), and hip circumference: ß = -0.01, p = 0.70) failed to reach statistical significance. Results showed that the association between adiposity and FM in adolescence is sex-specific, suggesting that boys with overweight and obesity could be more prone to develop dysfunctional movement patterns. Therefore, exercise interventions directed toward correcting dysfunctional patterns should be sex-specific, targeting more boys with excess weight rather than adolescent girls with excess weight.


Assuntos
Adiposidade , Transtornos dos Movimentos , Adolescente , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos dos Movimentos/etiologia , Obesidade/patologia , Fatores Sexuais
16.
Rev. neurol. (Ed. impr.) ; 71(2): 69-73, 16 jul., 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195448

RESUMO

INTRODUCCIÓN: La discinesia de la mutación ADCY5 es un raro trastorno del movimiento de inicio en la infancia. Se caracteriza por movimientos coreicos aislados o asociados a mioclonías y distonías que afectan a las extremidades, el cuello y la cara. El escaso número de pacientes y familias no permite aún una adecuada relación genotipo-fenotipo. OBJETIVOS: Presentar el caso de un niño con trastornos del movimiento de inicio precoz en el seno de una familia con tres generaciones de afectados, y realizar una revisión actualizada de la casuística y el tratamiento de esta rara enfermedad. CASO CLÍNICO: Varón de 6 años, remitido por retraso del lenguaje e hiperactividad. Tras seis meses de seguimiento, comenzó a presentar movimientos coreicos de predominio facial y de la raíz de los miembros, especialmente al despertar. Al año de seguimiento, se evidenció corea generalizado en reposo con afectación orofacial y torpeza en la marcha. Como antecedentes familiares destacaban su madre, abuelo, tío y prima maternos, que fueron diagnosticados de síndrome de Meige (distonía oromandibular y músculos periorbitarios) con trastornos del movimiento de tipo coreiforme sin filiar desde la infancia. El estudio cerebral por resonancia magnética no presentó alteraciones. Se realizó un exoma clínico dirigido a trastornos del movimiento que descubrió la mutación patógena en el gen ADCY5 causante de la discinesia familiar autosómica. CONCLUSIÓN: La mutación c.1126G > A p.A376T muestra una historia natural con un fenotipo clínico no progresivo en tres generaciones de afectados, con inicio en la infancia y respuesta al tratamiento con guanfacina


INTRODUCTION. Dyskinesia of the ADCY5 mutation is a rare movement-onset disorder in childhood. It is characterized by isolated chorea movements or associated with myoclonus and dystonia affecting the limbs, neck and face. The low number of patients and families still does not allow an adequate genotype-phenotype relationship. AIMS. The case of a child with movement disorders of early onset is presented in a family with three generations of affected members. An updated review of the casuistry and management of this rare disease is made. CASE REPORT: A 6-year-old boy referred for language delay and hyperactivity. After six months of follow-up he begins to show chorea movements of predominantly facial and limb roots, especially when waking up. At one year of follow-up, generalized chorea at rest with orofacial involvement and awkward gait begins to show. His family history includes his mother, grandfather, maternal uncle and cousin, who were diagnosed with Meige's syndrome (oromandibular dystonia and periorbital muscles) with choreiform-like movement disorders without affiliation since childhood. The brain study by MRI showed no alterations. A clinical exome targeting movement disorders was performed that discovered the pathogenic mutation in the ADCY5 gene causing autosomal familial dyskinesia. CONCLUSION: The c.1126G>A p.A376T mutation shows a natural history with a non-progressive clinical phenotype in three generations of affected members, with childhood debut and response to guanfacine treatment


Assuntos
Humanos , Masculino , Criança , Discinesias/genética , Transtornos dos Movimentos/complicações , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Levetiracetam/administração & dosagem , Metilfenidato/administração & dosagem , Guanfacina/administração & dosagem , Transtornos dos Movimentos/etiologia , Mioclonia/complicações , Discinesia Tardia/complicações , Transtornos do Desenvolvimento da Linguagem/complicações , Síndrome de Meige/diagnóstico , Fenótipo , Genótipo
17.
World Neurosurg ; 139: e345-e354, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298824

RESUMO

BACKGROUND: Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE: We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS: We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months. RESULTS: The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points). CONCLUSIONS: We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.


Assuntos
Neoplasias Encefálicas/terapia , Terapia a Laser/métodos , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Glioma/cirurgia , Glioma/terapia , Humanos , Avaliação de Estado de Karnofsky , Terapia a Laser/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Transtornos dos Movimentos/etiologia , Metástase Neoplásica , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
19.
Prague Med Rep ; 121(1): 5-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191616

RESUMO

Buspirone (BUS) belongs to the azapirone chemical class. The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of BUS-associated movement disorders (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 25 reports containing 65 cases were assessed. The MD associated with BUS were: dyskinesia in 14 cases, 10 of akathisia, 8 of myoclonus, 6 of Parkinsonism, and 6 of dystonia. The cases not clearly defined were 7 tension, 14 incoordination, and the undefined number of dyskinesia, tics, and Parkinsonism. The mean age was 45.23 years (range: 15-74). The male was the predominant sex in 60.86% and the most common BUS-indication was anxiety disorder. The mean BUS-dose was 42.16 mg (range: 5-100). The time from the beginning of BUS administration to the MD onset was one month or less in 76%. The time from BUS withdrawal to complete recovery was within one month in 87.5%. The most common management was BUS withdrawal. In 16 patients the follow-up was reported: 14 had a full recovery, but in two (1 dyskinesia + 1 dystonia) the symptoms continued after the BUS withdrawal. MD associated with BUS were scarcely reported in the literature. Moreover, in the majority of cases, no clear description of the clinical profile, neurological examination, or the time data of the movement disorder onset and recovery were given.


Assuntos
Ansiolíticos , Buspirona , Transtornos dos Movimentos , Adolescente , Adulto , Idoso , Ansiolíticos/efeitos adversos , Buspirona/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Adulto Jovem
20.
Acta Neurol Scand ; 142(3): 216-220, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32198926

RESUMO

BACKGROUND: During the latest decades, the hypothesis that the subjective experience of free will is determined by preconscious activity in the dominant dorsal medial frontal cortex (dMFC) has repeatedly challenged our commonly held concepts of moral responsibility. AIMS OF THE STUDY: To investigate whether dMFC activity determines the sense of free will and to investigate the effects of resections in this area on quality of life (QoL). METHODS: A cohort of nine patients affected by transient declines in speech and movement skills after surgery involving the left dMFC answered questions about their post-operative, subjective experiences of volition in relation to symptoms. In eight cases, resections were performed as part of glioma surgery, and in the ninth case, a meningioma adjacent to the dMFC was resected. In addition, a QoL questionnaire was administrated before and after surgery. RESULTS: None of the patients perceived the transient disabilities related to surgery as associated with a loss or absence of volition. No declines in QoL were detected after surgery. Two QoL domains showed improved function (motor dysfunction and future uncertainty). CONCLUSIONS: The subjective sense of volition is not contingent on dMFC activity. Surgical resections of this area are not typically associated with declines in QoL.


Assuntos
Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Glioma/psicologia , Glioma/cirurgia , Adulto , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/etiologia , Complicações Pós-Operatórias/psicologia , Desempenho Psicomotor , Qualidade de Vida , Distúrbios da Fala/epidemiologia , Distúrbios da Fala/etiologia , Inquéritos e Questionários , Volição
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