Excessive daytime sleepiness in patients with epilepsy: a subjective evaluation.

OBJECTIVE: The main objective of the study was to evaluate excessive daytime sleepiness (EDS) in patients with epilepsy from a tertiary outpatient clinic in Rio de Janeiro, Brazil. METHODS: Ninety-nine unselected patients from the epilepsy outpatient clinic were invited and their sleep-wake habits were assessed by means of a clinical interview and four validated instruments: Epworth Sleepiness Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Basic Nordic Sleep Questionnaire. Sociodemographic information and characteristics of the epilepsy syndrome were collected. RESULTS: Complaints about EDS (Epworth Sleepiness Scale score >10) were reported by 47.5% (95% CI: 37.3-57.7) of the patients. In the sample, 52.6% (95% CI: 0.41-0.60) were overweight or obese, and 53.1% (95% CI: 0.43-0.62) had less than 8 years of formal education. Mainly anxiety, but also neck circumference, was correlated with EDS. Our patients did not exhibit quantitative sleep deprivation. No other epilepsy-related variable showed relationship with EDS. The prevalence of EDS in our population was higher than in similar studies performed in other countries. This finding does not seem to be related to epilepsy itself, but rather to other clinical factors, such as neck circumference, and mainly psychiatric factors, such as anxiety. CONCLUSIONS: Psychiatric comorbidities such as anxiety are linked to EDS and should be recognized and treated. More studies based on objective sleep quality analysis are needed to help elucidate these relationships in the Brazilian population.

Probable first report of a motor deafferentation syndrome in the Paraguayan War.

The Paraguayan War ended 150 years ago. Back then, there were outbreaks of combatants' limb weakness and tingling related to "palustrian cachexia", not clearly funded at the time on nutritional deficiency, the use of native flora to feed troops, and alcoholism. We report a case of a soldier with ascending paralysis, mental confusion and finally tetraplegia with preserved oculomotricity. This would probably be a case of locked-in syndrome (LIS) due to Gayet-Wernicke's encephalopathy consequent to thiamine deficiency. The role of thiamine in the peripheral or central nervous system expression was shown decades later to be related to poor diet, or use of foods containing thiaminase or thiamine antagonists, worsened by the fact that the bodily stores of thiamine are restricted, and deficits may grow fast.

Franz Nissl (1860-1919), noted neuropsychiatrist and neuropathologist, staining the neuron, but not limiting it.

Franz Alexander Nissl carried out studies on mental and nervous disorders, as a clinician, but mainly as a pathologist, probably the most important of his time. He recognized changes in glial cells, blood elements, blood vessels and brain tissue in general, achieving this by using a special blue stain he himself developed - Nissl staining, while still a medical student. However, he did not accept the neuron theory supported by the new staining methods developed by Camillo Golgi and Santiago Ramón y Cajal. Nissl had worked with the crème de la crème of German neuropsychiatry, including Alois Alzheimer, besides Emil Kraepelin, Korbinian Brodmann and Walther Spielmeyer. He became (1904), Kraepelin's successor as Professor of Psychiatry and Director of the Psychiatric Clinic, in Heidelberg. Moreover, in 1918, the year before Nissl´s death, Kraepelin offered him a research position as head of the Histopathology Department of the newly founded "Deutsche Forschungsanstalt fur Psychiatrie" of the Max Planck Institute for Psychiatry, in Munich.

Franz Alexander Nissl realizou estudos sobre transtornos mentais e nervosos, como clínico, mas principalmente como patologista, provavelmente o mais importante de seu tempo. Ele reconheceu mudanças nas células gliais, elementos sangüíneos, vasos sangüíneos e tecido cerebral em geral, realizando-o por meio de um corante azul especial desenvolvida por ele mesmo - coloração de Nissl, ainda como estudante de medicina. No entanto, ele não aceitou a teoria do neurônio esclarecida pelos novos métodos de coloração desenvolvidos por Camillo Golgi e Santiago Ramón y Cajal. Nissl havia trabalhado com o crème de la crème da neuropsiquiatria alemã, como Alois Alzheimer, além de Emil Kraepelin, Korbinian Brodmann e Walther Spielmeyer. Ele se tornou (1904), o sucessor de Kraepelin como professor de psiquiatria e diretor da Clínica Psiquiátrica, em Heidelberg. Além disso, em 1918, um ano antes da morte de Nissl, Kraepelin o convidou para um cargo de pesquisador, como chefe do departamento de histopatologia da recém-fundada "Deutsche Forschungsanstalt fur Psychiatrie" do Instituto Max Planck de Psiquiatria, em Munique.

Revitalizing neurology practice: integrating health humanities, neurobiology, and digital innovation / Revitalizando a prática em neurologia: integrando as humanidades em saúde, neurobiologia e inovação digital

Rapid changes in medical education are being fueled by advancements in science, technology, and societal structures. However, the traditional medical curriculum often struggles to keep pace with the evolving demands of medical practice in light of these advancements. Neurology presents distinctive challenges in modern medicine, requiring innovative solutions to improve patient care and support the well-being of healthcare providers. This essay delves into the intricate issues encountered by neurologists, such as the diminishing interpersonal connections in the medical field and the prevalent issue of burnout among professionals, exacerbated by outdated educational programs. This research advocates for a comprehensive approach to enhancing neurology practice through the perspectives of Medical Humanities (MH) and neurobiology, within the evolving realm of Neurohumanities. By integrating stateof-the-art neurobiological findings, MH/Neurohumanities, and a focus on empathy, the article proposes practical strategies to rejuvenate clinical practice and bolster the resilience of neurology practitioners. Furthermore, it underscores the untapped potential of artificial intelligence and machine learning while examining how the digital ecosystem could revolutionize neurology medical education. Grounded in evidence-based research and practical insights, this article offers valuable guidance for navigating the complexities of contemporary neurology practice and cultivating a workforce of healthcare professionals who possess both technological acumen and compassion.

Mudanças rápidas na educação médica estão sendo impulsionadas pelos avanços na ciência, tecnologia e estruturas sociais. No entanto, o currículo médico tradicional frequentemente luta para acompanhar as exigências em constante evolução da prática médica diante desses avanços. A neurologia apresenta desafios distintos na medicina moderna, exigindo soluções inovadoras para melhorar o cuidado ao paciente e apoiar o bemestar dos profissionais de saúde. Este ensaio explora as questões complexas enfrentadas pelos neurologistas, como a diminuição das conexões interpessoais no campo médico e o problema prevalente do esgotamento entre os profissionais, exacerbado por programas educacionais desatualizados. Esta pesquisa defende uma abordagem abrangente para aprimorar a prática da neurologia por meio das perspectivas das Humanidades Médicas (HM) e da neurobiologia, dentro do campo em evolução das Neuro- Humanidades. Ao integrar descobertas neurobiológicas de ponta, HM/Neuro-Humanidades e um foco na empatia, o artigo propõe estratégias práticas para rejuvenescer a prática clínica e fortalecer a resiliência dos profissionais de neurologia. Além disso, destaca o potencial inexplorado da inteligência artificial e da aprendizagem de máquina ao examinar como o ecossistema digital poderia revolucionar a educação médica em neurologia. Fundamentado em pesquisas baseadas em evidências e insights práticos, este artigo oferece orientações valiosas para navegar pelas complexidades da prática contemporânea da neurologia e cultivar uma força de trabalho de profissionais de saúde que possuam tanto acuidade tecnológica quanto compaixão.

Integrating neuroscience and humanities in healthcare evolution: a multidisciplinary perspective / Integração das neurociências e das ciências humanas na evolução dos cuidados de saúde: uma perspetiva multidisciplinar

The trajectory of healthcare has evolved from ancient holistic practices to the present biomedical model, reflecting the dynamic interplay between scientific progress, technological advancements, and the integration of humanistic values. While biomedical advancements have revolutionized medical treatments, there is an emerging recognition of the importance of integrating neuroscience and humanities to foster holistic patient care and understanding. This paper aims to explore the historical development of medicine, emphasizing the convergence of neuroscience, psychiatry, and neurology within the biomedical framework. Additionally, it investigates the resurgence of humanities in healthcare and its role in promoting patientcentered care. Through a comprehensive review of literature, this study traces the historical roots of medicine and examines the interdisciplinary intersections of neuroscience, psychiatry, neurology, and medical humanities. The exploration reveals the significant contributions of interdisciplinary approaches in enhancing patient-centered care, fostering a comprehensive understanding of health and well-being, and shaping modern healthcare practices. The integration of neuroscience and humanities offers valuable insights into the complexities of human health, bridging legacy practices with innovative approaches. Embracing this interdisciplinary perspective is crucial for promoting holistic healthcare, emphasizing patient-centered care, and enriching the understanding of health and well-being in contemporary healthcare settings.

A trajetória dos cuidados de saúde evoluiu das antigas práticas holísticas para o atual modelo biomédico, reflectindo a interação dinâmica entre o progresso científico, os avanços tecnológicos e a integração de valores humanísticos. Embora os avanços biomédicos tenham revolucionado os tratamentos médicos, há um reconhecimento emergente da importância de integrar as neurociências e as humanidades para promover a compreensão e os cuidados holísticos dos doentes. Este artigo tem como objetivo explorar o desenvolvimento histórico da medicina, salientando a convergência da neurociência, da psiquiatria e da neurologia no quadro biomédico. Além disso, investiga o ressurgimento das humanidades nos cuidados de saúde e o seu papel na promoção de cuidados centrados no doente. Através de uma revisão exaustiva da literatura, este estudo traça as raízes históricas da medicina e examina as intersecções interdisciplinares da neurociência, psiquiatria, neurologia e humanidades médicas. A exploração revela os contributos significativos das abordagens interdisciplinares para melhorar os cuidados centrados no doente, promover uma compreensão abrangente da saúde e do bem-estar e moldar as práticas modernas de cuidados de saúde. A integração das neurociências e das humanidades oferece conhecimentos valiosos sobre as complexidades da saúde humana, fazendo a ponte entre práticas antigas e abordagens inovadoras. A adoção desta perspetiva interdisciplinar é crucial para promover cuidados de saúde holísticos, enfatizando os cuidados centrados no doente e enriquecendo a compreensão da saúde e do bem-estar nos contextos de cuidados de saúde contemporâneos.

First stages towards the establishment of Brazilian neurology faculties.

OBJECTIVE: The establishment of modern medicine in Brazil was marked by the arrival of the Portuguese Court in 1808, when the Bahia and Rio de Janeiro Faculties of Medicine were founded. METHODS: The French School of Medicine exerted a strong influence on Brazilian medicine and on the main pioneers of Brazilian neurology. The elite of "Parisian neurology" trained students and doctors from around the world, and were mentors to the pioneers of Brazilian neurology in the early 20th century. CONCLUSION: In this article, the authors review the origins of neurology faculties in Brazilian medicine and the main pioneers of Brazilian neurology. RESULTS: Neurology is certainly a continuously changing field and has always adapted to new advances and discoveries, and it is an honor for the authors to pay homage to their pioneers.

Neuroculture and aesthetics: exploring the multidisciplinary ambiance of art, beauty and the human brain / Neurocultura e estética: explorando o ambiente multidisciplinar da arte, da beleza e do cérebro humano

This narrative review addresses the intersection between neuroculture and aesthetics, exploring the intricate relationship between neuroscience and the perception of beauty. The presentation begins by mentioning the philosophical foundations of aesthetics and moves on to the neural basis behind the sensory and emotional processing of beauty. Progressing further, it presents the intricate networks involved in interactions and responses to art, elucidating the brain's mechanisms for appreciating artistic stimuli. Finally, it investigates the neural networks associated with deriving personal and symbolic meaning from art forms, shedding light on how our brains deduce meaning and value from aesthetic experiences. Thus, there is an integration of studies based on the connectome with neuroaesthetics, on how the complete network of neural connections in the brain influences and shapes the way we perceive, interpret, and appreciate beauty. Furthermore, the article addresses the impact of virtual reality and artificial intelligence on traditional concepts of creativity, challenging existing paradigms. Concluding, it explores the potential educational and therapeutic applications of 'Visual Thinking Strategies' in promoting artistic engagement with potential educational and therapeutic applications.

Esta revisão narrativa aborda a intersecção entre neurocultura e estética, explorando a intrincada relação entre neurociência e a percepção da beleza. A apresentação começa mencionando os fundamentos filosóficos da estética e avança para a base neural por trás do processamento sensorial e emocional da beleza. Progredindo ainda mais, apresenta as intrincadas redes envolvidas nas interações e respostas à arte, elucidando os mecanismos do cérebro para apreciar estímulos artísticos. Por fim, investiga as redes neurais associadas à obtenção de significado pessoal e simbólico das formas de arte, esclarecendo como nossos cérebros deduzem significado e valor de experiências estéticas. Assim, há uma integração de estudos baseados no conectoma com a neuroestética, sobre como a rede completa de conexões neurais cerebrais influencia e molda a maneira como percebemos, interpretamos e apreciamos a beleza. Além disso, o artigo aborda o impacto da realidade virtual e da inteligência artificial nos conceitos tradicionais de criatividade, desafiando os paradigmas existentes. Concluindo, explora as potenciais aplicações educativas e terapêuticas das 'Estratégias de Pensamento Visual' na promoção do envolvimento artístico com potenciais aplicações educativas e terapêuticas.

The interplay between brain lesions and painter´s creative transformations / A interação entre lesões cerebrais e transformações criativas do pintor

This narrative review addresses the complex relationship between neurological diseases and artistic expression, which can have a profound impact on a painter´s works. This exploration highlights the dynamic and ever-evolving connection between neuroscience and art, offering insights into the extraordinary ways in which the human brain and artistic expression intersect and evolve. Following brain damage, there may be the emergence of sudden artistic talents, intriguing changes in the styles of established artists, the paradoxical facilitation of artistic abilities despite the cognitive decline consequent to these injuries, besides coping strategies that artists adopt in response to the challenges of health. Therefore, this article investigates different scenarios where brain injuries and disorders have had a profound impact on artists, leading to the emergence of new talents, changes in artistic styles, and unexpected improvements in their work, as well as adaptations in their artistic practices, as represented by some painters such as Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) and Charles Meryon (1821-1868). Consequently, works of art can be valuable but understudied tools for understanding brain dysfunction, although they must be interpreted with great care.

Esta revisão narrativa aborda a complexa relação entre doenças neurológicas e expressão artística, que pode ter um impacto profundo na obra de um pintor. Esta exploração destaca a conexão dinâmica e em constante evolução entre a neurociência e a arte, oferecendo insights sobre as formas extraordinárias pelas quais o cérebro humano e a expressão artística se cruzam e evoluem. Após danos cerebrais, pode haver o surgimento de talentos artísticos repentinos, mudanças intrigantes nos estilos de artistas estabelecidos, a facilitação paradoxal de habilidades artísticas, apesar do declínio cognitivo consequente a essas lesões, além de estratégias de enfrentamento que os artistas adotam em resposta aos desafios de saúde. Portanto, este artigo investiga diferentes cenários onde lesões e distúrbios cerebrais tiveram um impacto profundo nos artistas, levando ao surgimento de novos talentos, mudanças nos estilos artísticos e melhorias inesperadas em seu trabalho, bem como adaptações em suas práticas artísticas, bem como representado por alguns pintores como Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) e Charles Meryon (1821-1868). Consequentemente, as obras de arte podem ser ferramentas valiosas, mas pouco estudadas, para a compreensão da disfunção cerebral, embora devam ser interpretadas com muito cuidado.

Journey through artistic eras depicting dreams, sleep, and its disorders / Viagem por eras artísticas retratando sonhos, sono e seus transtornos

This narrative review presents a comprehensive examination of artistic periods since the Renaissance, paralleling the evolution of neurology and pictorial artistic expression about sleep, ending with the importance of the contemporary digital era. Over the centuries, artists have been drawn to the enigmatic themes of dreams, sleep, and their disorders, using them to explore the complexities of the human condition, emotions, and the interaction between reality and imagination. Thus, drawing references from diverse artistic eras, including their pictorial representations of sleep, alongside milestones in the history of neurology, this study reveals a rich interconnectivity between art, neurological advances, and social change.

Esta revisão narrativa apresenta um exame abrangente dos períodos artísticos desde o Renascimento, em paralelo com a evolução da neurologia e a expressão artística pictórica sobre o sono, terminando com a importância da era digital contemporânea. Ao longo dos séculos, os artistas foram atraídos pelos temas enigmáticos dos sonhos, do sono e dos seus distúrbios, aproveitando-os para explorar as complexidades da condição humana, das emoções e da interação entre a realidade e a imaginação. Assim, extraindo referências de diversas épocas artísticas, incluindo suas representações pictóricas do sono, paralelamente a marcos na história da neurologia, este estudo revela uma rica interconectividade entre arte, avanços neurológicos e mudanças sociais.

Epilepsy in art: a historical exploration of representations across eras / Epilepsia na arte: uma exploração histórica de representações através de épocas

This narrative review explores the diverse representations of epilepsy in art across different historical periods, examining the intersection of artistic expression with evolving cultural, medical, and societal perceptions. Beginning with ancient and medieval depictions intertwined with religious symbolism, the paper progresses through the Renaissance, and Baroque, and transitions into modern and avant-garde movements. Each period reflects changing attitudes towards epilepsy, from divine interpretations, and religious concerns to anatomical realism and, later, explorations of psychological themes. The contemporary lens focuses on inclusive and empathetic portrayals, utilizing digital media to challenge stigmas and foster understanding.

Esta revisão narrativa explora as diversas representações da epilepsia na arte em diferentes períodos históricos, examinando a intersecção da expressão artística com a evolução das percepções culturais, médicas e sociais. Começando com representações antigas e medievais entrelaçadas com simbolismo religioso, o artigo avança através da Renascença e do Barroco, e transita para movimentos modernos e de vanguarda. Cada período reflete mudanças de atitudes em relação à epilepsia, desde interpretações divinas e preocupações religiosas até o realismo anatômico e, mais tarde, explorações de temas psicológicos. A lente contemporânea centra-se em representações inclusivas e empáticas, utilizando meios digitais para desafiar estigmas e promover a compreensão.

Migraine as a source of artistic inspiration / Enxaqueca como fonte de inspiração artística

This narrative review explores the intricate relationship between migraines and art, tracing historical examples and contemporary interpretations of how migraines, especially those with a visual aura, have influenced artists. Highlights how migraines may have shaped artistic inspiration, delving into notable, questionably migraine-infected figures such as Hildegard of Bingen, Giorgio de Chirico, Pablo Picasso, and Salvador Dali, examining how their experiences may have influenced their works. Furthermore, it addresses the emergence of 'migraine art' sponsored by the pharmaceutical industry, presenting the intersection between art, neuroscience, and public engagement. The diagnostic complexity and differentiation of migraines from epilepsy are also discussed, with a special focus on the symptoms of the visual aura and how this has been portrayed through various artistic representations, thus inviting further exploration of the relationship between neurological conditions and creative expression.

Esta revisão narrativa explora a intrincada relação entre enxaquecas e arte, traçando exemplos históricos e interpretações contemporâneas de como as enxaquecas, especialmente aquelas com aura visual, influenciaram os artistas. Destaca como as enxaquecas podem ter moldado a inspiração artística, investigando figuras notáveis e questionavelmente infectadas pela enxaqueca, como Hildegard de Bingen, Giorgio de Chirico, Pablo Picasso e Salvador Dali, examinando como suas experiências podem ter influenciado suas obras. Além disso, aborda o surgimento da "arte da enxaqueca" patrocinada pela indústria farmacêutica, apresentando a intersecção entre arte, neurociência e envolvimento público. A complexidade diagnóstica e a diferenciação entre enxaquecas e epilepsia também são discutidas, com especial foco nos sintomas da aura visual e como esta tem sido retratada através de diversas representações artísticas, convidando assim a uma maior exploração da relação entre condições neurológicas e expressão criativa.

Exploring the art and experiences of painters with epilepsy / Explorando a arte e as experiências de pintores com epilepsia

This narrative review addresses the world of artists who linked their creative journeys alongside their battles with epilepsy, a neurological condition engineered by recurrent epileptic seizures, with multifaceted implications in biopsychosocial domains. By examining the lives and works of celebrated artists such as Vincent Van Gogh and contemporary painters, particularly those possibly affected by epilepsy, a narrative transcends clinical elucidations, investigating historical contexts, artistic expressions, and therapeutic interventions. The focus is on uncovering the transformative influence of engaging in artistic activities for individuals struggling with epilepsy. It investigates the profound impact of artistic pursuits on people affected by epilepsy, showing the resilience of the human spirit in harnessing adversity as a source of creativity. This exploration illuminates the potential of art, not only as a means of self-expression, but also as a therapeutic medium in the setting of epilepsy and associated neurorehabilitation.

Esta revisão narrativa aborda o mundo dos artistas que associaram as suas jornadas criativas paralelamente às suas batalhas contra a epilepsia, uma condição neurológica caracterizada por ataques epilépticos recorrentes, com implicações multifacetadas em domínios biopsicossociais. Ao examinar as vidas e obras de artistas célebres como Vincent Van Gogh e pintores contemporâneos, particularmente aqueles possivelmente afetados pela epilepsia, a narrativa transcende as elucidações clínicas, investigando contextos históricos, expressão artística e intervenções terapêuticas. O foco está em desvendar a influência transformadora do envolvimento em atividades artísticas para indivíduos que lutam contra a epilepsia. Ele investiga o profundo impacto das atividades artísticas nas pessoas afetadas pela epilepsia, mostrando a resiliência do espírito humano ao aproveitar a adversidade como uma fonte de criatividade. Esta exploração ilumina o potencial da arte, não apenas como meio de autoexpressão, mas também como meio terapêutico no cenário da epilepsia e da neurorreabilitação associada.

Sleep in the human aging process and circadian sleep rhythm disruptions / Sono no processo de envelhecimento humano e interrupções do ritmo circadiano do sono

The aging process is often related to sleeping difficulties, often due to changes in circadian rhythms. The circadian timing system is centered in the suprachiasmatic nucleus - the master biological clock - which synchronizes the rhythm of oscillators throughout the body, including the sleep-wake cycle. This affects the time, duration and quality of sleep according to the development and aging process, under external and internal influences. This review addresses the human circadian timing system, including endogenous and exogenous influences on circadian rhythms, their age-related particularities, as well as the repercussions of circadian misalignment in neurodegenerative diseases. Circadian rhythms naturally weaken with aging, but there are particularities according to age. Throughout life, sleep and circadian rhythm disorders are strongly bidirectionally related to the pathophysiology of some psychiatric and neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases. This knowledge could potentially create valuable opportunities to improve the health of the world's population that is under circadian misalignment and aging.

O processo de envelhecimento está frequentemente relacionado a dificuldades de dormir, muitas vezes decorrentes de alterações nos ritmos circadianos. O sistema de ronometragem circadiana está centrada no núcleo supraquiasmático - o relógio biológico mestre - o qual sincroniza o ritmo dos osciladores em todo o corpo, incluindo o ciclo sono-vigília. Isso afeta o tempo, a duração e a qualidade do sono de acordo com o processo de desenvolvimento e envelhecimento, sob influências externas e internas. Esta revisão aborda o sistema de temporização circadiana humana, incluindo as influências endógenas e exógenas nos ritmos circadianos, suas particularidades relacionadas à idade, bem como as repercussões do desalinhamento circadiano nas doenças neurodegenerativas. Os ritmos circadianos enfraquecem naturalmente com o envelhecimento, mas há particularidades de acordo com a idade. Ao longo da vida, os transtornos do sono e do ritmo circadiano estão fortemente relacionados bidirecionalmente à fisiopatologia de algumas doenças psiquiátricas e neurodegenerativas, como as doenças de Alzheimer e Parkinson. Esse conhecimento pode potencialmente criar oportunidades valiosas para melhorar a saúde da população mundial que está sob desalinhamento circadiano e envelhecimento.

Neurophysiology in between the interests of Dom Pedro II of Brazil, and Charles Brown-Séquard (Historical Note) / Neurofisiologia entre os interesses de Dom Pedro II do Brasil e Charles Brown-Séquard (Nota Histórica)

This article presents our historical research regarding Charles Brown-Séquard, a famous scientist with important contributions to the medical field, in particular for neurology, and endocrinology, and his relationship with Dom Pedro II, the second and last Brazilian Emperor, and an enlightened ruler. The Emperor contacted several illustrious personages in support of State policy, such as for the development of experimental physiology at the Imperial Museum of Natural History, but also for personal purposes given his health problems and those of the Empress. Charles Brown-Séquard and his pilgrimage between different worlds as a physician and physiologist are presented until his definitive establishment in Paris, where he replaces Claude Bernard in the chair of experimental medicine at the Collège de France. Jacques-Arsene d'Arsonval took over after this chair, and together with Brown-Séquard, he electrophysiologically examined the Emperor's diabetic peripheral neuropathy. In this article, the Emperor´s relationship with Brown-Séquard was studied mainly from the correspondence sent to Dom Pedro II and retrieved from the Imperial Museum in Petrópolis, Brazil, and from the accounts of his meetings that included scientific sessions and clinical consultations. This article can be used to understand the progress of knowledge in the field of neurology/clinical neurophysiology, the tracking of emerging ideas in the field of science in the past and the threat to the credibility of researchers.

Este artigo apresenta nossa pesquisa histórica a respeito de Charles Brown-Séquard, famoso cientista com importantes contribuições para a área médica, em especial para a neurologia e endocrinologia, e sua relação com Dom Pedro II, segundo e último Imperador brasileiro, e governante esclarecido. O Imperador contactou várias personalidades ilustres no apoio à política de Estado, como para o desenvolvimento da fisiologia experimental no Museu Imperial de História Natural, mas também para fins pessoais dados os seus problemas de saúde e os da Imperatriz. Charles Brown-Séquard e sua peregrinação entre diferentes mundos como médico e fisiologista são apresentados até seu estabelecimento definitivo em Paris, onde substitui Claude Bernard na cadeira de medicina experimental no Collège de France. Jacques-Arsene d'Arsonval assumiu após esta cadeira e, juntamente com Brown-Séquard, examinou eletrofisiologicamente a neuropatia periférica diabética do imperador. Neste artigo, a relação do Imperador com BrownSéquard foi estudada principalmente a partir da correspondência enviada a Dom Pedro II e recuperada no Museu Imperial de Petrópolis, Brasil, e dos relatos de seus encontros que incluíam sessões científicas e consultas clínicas . Este artigo pode ser usado para entender o progresso do conhecimento no campo da neurologia/neurofisiologia clínica, o rastreamento de ideias emergentes no campo da ciência no passado e a ameaça à credibilidade dos pesquisadores.

The decline of Dom Pedro II's empire and health: neuropathogenic implications.

The main objective of this paper is to know the medical doctors of the Emperor, the preconized treatment, and the knowledge about diabetes at that time, its repercussions on the Emperor's nervous system, and the related political implications. A narrative revision was made, based on primary and secondary sources. Dom Pedro II was examined by the aristocracy of the medicine at the time, especially Jean-Martin Charcot, amongst the doctors of international reputation, and Cláudio Velho da Motta Maia, amongst the Brazilian doctors. Charcot diagnosed in the Monarch: mental stress, diabetic neuropathy, and a cerebral vascular lesion, probably a stroke, that he differentiated from other vascular obliterations elsewhere. He demonstrated his knowledge about diabetic neuropathy, possible topographical alternatives to justify the urinary incontinence, and Dom Pedro's weakness in the legs. Throughout his illness, Dom Pedro II presented others manifestations that contributed to his physical fragility, and that, certainly too, to his political decline, deposition and the proclamation of the Brazilian Republic.

Dom Pedro I of Brazil and IV of Portugal: epilepsy and peculiar behavior.

We present medical issues related to Dom Pedro de Alcântara Bragança e Bourbon (1798-1834), first Emperor of Brazil. This is made by means of narrative revision on historical facts starting from primary and secondary sources. Dom Pedro presented familiar incidence of epilepsy. His seizures were relatively benign and scattered, supposedly started at the age of 13: idiophatic epilepsy with generalized tonic-clonic seizures only or juvenile myoclonic epilepsy. He also had behavioral disorder characterized by hypersexuality, agitation and impulsiveness. It could have facilitated his opportunistic behavior necessary for daring to transgress the conservatism of the Portuguese crown, to create the constitutional monarchism in Brazil and in Portugal.

Probable causal link between epilepsy and sleep apnea: case report.

Patients with epilepsy were reported to have concomitant sleep apnea, but it has been rarely linked to the epilepsy itself. We present a case of a 28-year-old, obese man with secondary medically resistant partial complex epilepsy due to a brain trauma, with progressive snoring, and sleep agitation, apneas, and important daytime somnolence. It was noticed in the polysomnographic study that he had several sleep respiratory events, probably due both to the epileptic seizures and the sleep apnea syndrome as a co-morbidity. Apnea and epilepsy will be discussed. A careful video-EEG-polysomnography study is important in evaluating refractory epileptic patients and/or epileptic patients with snoring.

Dom João VI's death: convulsions and coma.

Dom João VI's death occurred in adverse political conditions that led to the regicide hypothesis. The main aim of this paper is to mention life style and conditions of the death of the king by means of narrative review based on primary and secondary sources. Dom João VI died in the way of convulsions and gastrointestinal symptoms. This could be the result of the pathological chain of genetic determination, accentuated by the inappropriate life style, obesity and sedentary habits, and/or poisoning. The finding of arsenic in high doses in his viscera favors the last hypothesis as the basic cause of death, but one can not discard the atherosclerosis predisposing risk factors for a final stroke.

The Emperor Dom Pedro II: his convulsive seizures when a boy.

INTRODUCTION: Dom Pedro II, the Prince Heir and Emperor under regency, in a delicate period of the construction of the Brazilian nation, had convulsive seizures. OBJECTIVE: To investigate the convulsive seizures and related syndromes of Dom Pedro II and his family, besides the physicians in charge of the health care. METHOD: Narrative review based on primary and secondary sources. CONCLUSION: The scattered and self-limited convulsive seizures associated with physical and mental integrity favored a benign prognosis. Dom Pedro and his family presented rich history of epileptic seizures and febrile convulsion. This variety resembles the diagnosis of generalized epilepsy with febrile seizures plus that seems to be a combination of several syndromes with shared genetic susceptibility.