Identification of factors related to cases of benign paroxysmal positional vertigo refractory to canalicular repositioning maneuvers and evaluation of the need for magnetic resonance imaging in their management: retrospective analysis of a series of 176 cases

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo, and, in most cases, it presents a favorable prognosis. The treatment is based on a series of specific canalicular repositioningmaneuvers that offer an efficacy close to 100%. Despite this, there are cases that are refractory to treatment, with the persistence of the vertigo symptoms. Objectives: The objective of the present paper is to analyze the factors associated with an increased risk of refractory BPPV and the importance of nuclear magnetic resonance in the study of these patients. Methods: We retrospectively reviewed the cases of 176 patients diagnosed with BPPV in our center.We divided them into two groups: responders and non-responders to the treatment, and analyzed the possible risk factors associated with a higher risk of refractory vertigo. Fischer exact test was used. Results: We found 11 cases refractory to treatment; all of them underwent magnetic resonance imaging (MRI) with gadoliniumaccording to our protocol. Of these, four had an otoneurologic background or pathology, and two other patients presented a multicanal involvement. The difference between the two groups was statistically significant (p < 0.05). Conclusion: Otoneurologic background and multicanal involvement were associated with a higher risk of refractory BPPV. When dealing with a BPPV with persistent symptomatology/nystagmus or with early relapse after an initial improvement, other entities that enter into the differential diagnosis must always be considered. We consider it essential to perform an MRI with gadolinium to rule out cases of BPPV that have a central cause (AU)

Everything you always wanted to know about sex and Neurology: neurological disability and sexuality / Todo lo que siempre quiso saber sobre sexo y Neurologia pero nunca se atrevió a preguntar: estudio sobre discapacidad neurologica y sexualidad

ABSTRACT Chronic neurological disorders generate disabilities affecting multiple aspects of life, including sexuality. Objective To describe the presence of sexual dysfunction and comorbidities in a population with chronic neurological disorders. To analyze the relationship between disability and sexual dysfunction. Methods A cross-sectional case-control study was carried out. Patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson's disease (PD), and stroke of at least one year since the onset of symptoms were included, and compared with controls with no neurological disease, matched by age and sex. Results We included 71 participants: 29 controls, with a mean age of 49.4 years, and 42 patients with a mean age of 53.8 years. Sexual dysfunction was present in 22.5% of the controls and 77.5% of the patients. A statistically significant relationship between sexual dysfunction and disability was found in the logistic regression analysis (OR = 20.38, 95%CI: 2.5 -165.86). Conclusions Disability proved to be the main variable related to the presence of sexual dysfunction. Patients with ALS had the worst rates of sexual dysfunction. Patients with MS were similar to the control group. As for the PD group, no patient had normal sexuality. Finally, in stroke patients, the presence of comorbidities and their treatment may have negatively influenced sexuality. These findings showed that patients with chronic neurological diseases have sexual dysfunction and underscore the need for neurologists to know and address this problem.

RESUMO Las enfermedades neurológicas crónicas generan discapacidad afectando múltiples aspectos de la vida, incluida la sexual. Objetivo Describir en una población con enfermedades neurológicas crónicas la presencia de disfunción sexual y posibles comorbilidades acompañantes. Analizar la relación entre discapacidad y disfunción sexual. Métodos Se realizó un estudio transversal de tipo casos y controles. Se incluyeron pacientes con Esclerosis Lateral Amiotrófica (ELA), Esclerosis Múltiple (EM), enfermedad de Parkinson (EP) y secuelados por enfermedad cerebrovascular (sACV) de al menos un año de evolución, controlando con sujetos sin enfermedad neurológica pareados por edad y sexo. Resultados Se incluyeron 71 sujetos: 29 controles, con una edad media 49,4 años y 42 casos con una edad media de 53,8 años. Presentaron disfunción sexual el 22,5% de los controles y el 77,5% de los casos. En el análisis por regresión logística se encontró una relación estadísticamente significativamente entre disfunción sexual y discapacidad. (OR = 20.38, IC95%: 2.5-165.86). Conclusiones La discapacidad demostró ser la principal variable relacionada con la presencia de disfunción sexual. Los enfermos con ELA fueron los que peores índices de disfunción sexual presentaron. Los pacientes con EM se comportaron de forma similar al grupo control. En cuanto al grupo de EP todos los pacientes tuvieron algún trastorno en su sexualidad. Por último, en sACV la presencia de comorbilidades y su tratamiento podrían influir negativamente en la sexualidad. Estos hallazgos evidencian que la disfunción sexual está presente en los pacientes con enfermedades neurológicas crónicas y confirma la necesidad de conocer este problema por parte de los neurólogos.

A percepção dos cuidadores domiciliares no cuidado a clientes com sequelas neurológicas / La percepción de los cuidadores domiciliarios en el cuidado a clientes con secuelas neurológicas / Perception of care by home-based family caretakers of clients with neurological sequels

O cuidador domiciliar de clientes com sequelas neurológicas assume maior responsabilidade ao direcionar atenção e cuidados contínuos à pessoa cuidada. Essa condição leva intensa sobrecarga física e psicológica ao cuidador. Objetivou-se apreender as percepções do cuidador familiar no cuidado a clientes com sequelas neurológicas, propondo estratégias para o cuidar do cuidador. Estudo qualitativo fenomenológico, desenvolvido de março/2007 a junho/2008. Valeu-se de entrevistas domiciliares gravadas com cinco cuidadores regularmente cadastrados no projeto extensionista Renascer desenvolvido pela Universidade Federal de Alfenas, Minas Gerais, aos quais foi indagado: Como você se sente cuidando de seu familiar sequelado? Após descrição, redução e compreensão das experiências que os sujeitos vivenciaram foram destacadas quatro categorias: sobrecarga (física, mental e financeira); religiosidade/fé; dedicação/satisfação e solidariedade/empatia com seus respectivos núcleos de sentido. A sobrecarga experimentada pelos cuidadores ao exercerem o cuidado foi confirmada, e sugeriu-se a organização de grupos de orientação e apoio às famílias desses clientes crônicos.

The home-based caregiver of a family member with neurological sequels has higher responsibility in the provision of attention and continuous care. Intense physical and psychological overload to the caregiver occurs. The objective of this piece of research was to identify the caretaker's perceptions on the issue, suggesting strategies for the caretaker's care. Qualitative phenomenological study developed from March, 2007 to June, 2008. Home interviews recorded with five caretakers registered with the extension project Renascer, developed by the Federal University of Alfenas, Minas Gerais, Brazil, were recorded on the basis of a leading question: How do you feel about taking care of a relative with neurological sequels? After description, reduction, and understanding of the experience the interviewees had, four categories were outstanding: overload (physical, mental, and financial); religiosity/faith; dedication/satisfaction; and solidarity/empathy with their respective sense nuclei. The overload family caretakers experience was confirmed. Suggestions were made towards the organization of teams for counseling and support to the family of these chronic clients.

El cuidador domiciliario de clientes con secuelas neurológicas asume responsabilidad más grande cuando atención y cuidados a la persona cuidada. Se objetivó aprehender las percepciones del cuidador familiar en el cuidado a clientes con secuelas neurológicas, proponiendo estrategias para el asistir del cuidador. Estudio cualitativo fenomenológico, desarrollado de marzo/2007 a junio/2008. Fueron realizadas entrevistas domiciliarias grabadas con cinco cuidadores regularmente registrados en el proyecto de extensión Renascer desarrollado por la Universidad Federal de Alfenas, Minas Gerais, Brazil, a los cuales fue indagado: Cómo se siente usted cuidando de su familiar con secuela? Después de la descripción, reducción y comprensión de las experiencias vividas por los sujetos fueron destacadas cuatro categorias: sobrecarga (física, mental y financiera); religiosiad/fe; dedicación/satisfacción y solidaridad/empatía con sus respectivos núcleos de sentido. La sobrecarga experimentada por los cuidadores en el ejercicio del cuidado fue confirmada, y se propuso la organización de grupos de orientación y apoyo a las familias de esos clientes crónicos.

Repercussão das medidas de correção das comorbidades no resultado da reabilitação vestibular de idosos / The treatment of diseases related to balance disorders in the elderly and the effectiveness of vestibular rehabilitation

OBJETIVO: Considerando o aumento da população idosa e conseqüentemente as alterações de equilíbrio a ela relacionadas, realizamos um estudo para avaliar o impacto do tratamento adequado das doenças coexistentes ao desequilíbrio corporal no resultado da Reabilitação Vestibular (RV). MATERIAL E MÉTODOS: 52 idosos com queixa de tontura e/ou desequilíbrio com indicação RV participaram deste ensaio clínico aberto e prospectivo realizado no Ambulatório de Otoneurologia Geriátrica da Instituição, entre 2003 e 2005. Os pacientes do grupo de estudo foram previamente tratados das doenças clínicas diagnosticadas e posteriormente submetidos à RV. Foram então comparados com o grupo total de idosos tratados pela RV no mesmo período. RESULTADOS: Os pacientes do grupo de estudo apresentaram 65 comorbidades diagnosticadas, com média de 1,25 por paciente. A efetividade total foi de 84,5 por cento neste grupo contra 81,8 por cento no grupo controle, sem diferença significante. No entanto, a completa remissão dos sintomas ocorreu em 69,2 por cento dos casos contra 43,18 por cento dos controles, significante para p<0,02. CONCLUSÃO: A diferença na efetividade da RV entre os grupos demonstra a importância do tratamento etiológico das afecções clínicas coexistentes aos problemas de equilíbrio corporal.

The aim of this study was to assess the impact of adequate treatment of concomitant diseases in the elderly undergoing Vestibular Rehabilitation (VR). METHOD: 52 elderly patients with complaints of vertigo and/or imbalance requiring VR participated in this prospective study. The trial was designed as an open clinical assay at the Ear Nose and Throat Department Geriatric Otoneurology Clinic, and was done between 2003 and 2005. Patients were compared with the total group of elderly individuals treated with VR during the same period. RESULTS: 65 diseases were diagnosed in the study group, an average 1.25 diseases per patient. After the treatment of these diseases, patients underwent VR. The effectiveness of VR (remission and partial improvement rates) was 84.5 percent in the study group against 81.8 percent in the control group, which was not significant. Remission of symptoms, however, was present in 69.2 percent of the study group against 43.18 percent of the control group, which was statistically significant. CONCLUSION:The difference in the effectiveness of VR in both groups highlights the importance of the etiological treatment of concomitant diseases in patients with vestibular disorders.