Bernardo Rodrigues

Silent saliva aspiration in Parkinson's disease

Background: Silent laryngeal penetration and silent aspiration (SLP/SA) are common manifestations in Parkinsons disease (PD) patients and are frequently associated with dysphagia. However, little is known about saliva aspiration in this population. Objective: We investigated the frequency and characteristics of saliva SLP/SA in PD patients with daily drooling (Group A) and in individuals without PD or daily drooling (Group B). Method: Both groups were evaluated by fiberoptic endoscopic evaluation of swallowing (FEES) after dyeing the oral cavity with blue dye. The oropharynx was assessed for the presence of the stasis of saliva, and sensitivity was tested by direct tactile stimuli. Results: PD patients (n = 28) and controls (n = 18) were evaluated. We observed silent aspiration of saliva in 10.7% and silent laryngeal penetration of saliva near the vocal folds in 28.6% of Group A; however, none of these events was observed in Group B. Sensitivity in the epiglottis and posterior wall of the hypopharynx was decreased in 89.2% of Group A and in 33.3% of Group B, whereas in the aryepiglottic folds and interarytenoid area, a decrease in sensitivity was observed in 92.8% and in 44.4% of Groups A and B, respectively. Conclusion: Silent aspiration and laryngeal penetration of saliva are common features in PD patients with daily drooling. The presence of hypoesthesia of the laryngeal structures and the lack of protective reflexes in such patients may play a major role in the mechanisms of SLP/SA.

Is silent aspiration a risk factor for respiratory infection in Parkinson's disease patients?

OBJECTIVE To assess if silent aspiration is a risk factor for respiratory infection in patients with Parkinsons disease (PD). METHOD From February 2006 to June 2006, 19 PD patients with diurnal sialorrhea were evaluated by swallow videofluoroscopy (VF). Two patients moved away and contact with them was lost. The other patients were divided into two groups according to the presence or absence of penetration/aspiration and were followed up for 1 year. During this period, patients were assessed for airway infections, hospital admissions, weight loss, use of nasoenteral or gastric tube and to detect cases of death. RESULTS Silent laryngeal penetration or silent aspiration (SLP/SA) was observed in four patients. During the follow up period, three of the four patients with SLP/SA developed respiratory infection, and one of the 13 patients who did not show SLP/SA had airway infection (RR=9.75, 95% CI: 1.36-69.65). Two patients with SLP/SA developed airway infection and died, and there were two deaths in the group who had not been diagnosed for SLP/SA, one due to cardiac arrest and the other related to pancreatic cancer. CONCLUSION The results suggest that patients with Parkinsons disease with diurnal sialorrhea and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in PD patients. The data support a greater emphasis on preventive interventions for silent aspirations and silent penetration to improve survival in patients with Parkinsons disease.

BOTULINUM TOXIN TYPE A FOR THE TREATMENT OF THE UPPER LIMB SPASTICITY AFTER STROKE A meta-analysis

Muscle over-activity is one of the cardinal features of spasticity and it is a common disability of stroke patients. In this group, spasticity is responsible for several limitations that interfere in their daily activities and quality of life. To treat spasticity, neurologists usually prescribe drugs as baclofen, tizanidine or benzodiazepines or even use definitive treatment as phenol or surgery. Authors suggest the use of botulinum toxin type A (BTX-A) for spasticity in the upper limbs after stroke, but there are few papers with adequate methodology supporting this idea. In this article we summarize the data of previous double-blind, randomised clinical trials to asses, with a meta-analysis, if BTX-A is an adequate treatment for spasticity due to stroke. The results show a statistical superiority of BTX-A ov%r placebo on reducing muscle tone by the Modified Ashworth Scale (WMD= 0.95 [0.74 to 1.17]) in patients with post-stroke upper limb spasticity.

Does botulinum toxin decrease frequency and severity of sialorrhea in Parkinson's disease?

This study analysed if botulinum toxin type A (BTX-A) decreases drooling in 21 Parkinsons disease patients. BTX-A injections were given in the parotid glands. The severity of drooling decreased in 18 (86%) patients, while frequency was reduced in 8 (38%). In 11(52%) patients, the frequency of drooling remained constant, which may reflect more difficulties in swallowing, compared to the group that presented such improvement. Future trials assessing the level of swallowing dysfunction may be important to establish a prognosis for patients who keep the frequency of drooling in spite of decreased severity after BTX injection.

Silent aspiration in Parkinson's disease patients with diurnal sialorrhea

OBJECTIVE We studied the frequency of silent laryngeal penetration or silent aspiration (SLP/SA) in Parkinsons disease (PD) patients with diurnal sialorrhea. PATIENTS AND METHODS In 19 consecutive PD patients with diurnal sialorrhea, swallow was evaluated using the videofluoroscopy analysis. Data were analysed to determine the frequency of aspiration and its relationship with the severity of sialorrhea. RESULTS All patients were classified in the Hoehn and Yahr stages between 2 and 5. SLP/SA was observed in 21% of patients and the score of sialorrhea in the group with SLP/SA was 8.0+/-0.81, while in the group with no SLP/SA was 6.46+/-1.06 (p=0.02). CONCLUSION SLP/SA is a frequent morbidity in PD patients, its risk is higher in later stages of disease and in those patients with severe sialorrhea. However, prospective and controlled studies of follow up will be necessary to determine the prognosis and management in this group of patients.

Antropometria craniana de recém-nascidos normais

OBJECTIVE: The study has been carried out through anthropometric measures of Bahian newborns, to define measures according with the reality of this region. METHOD: Study type transversal cut in term babies with the measures of cephalic perimeter, biauricular and anteroposterior distances, fontanel and cephalic index. RESULTS: 388 babies, 204 (52.6%) of males and 184 (47.4%) females had been evaluated. The cephalic perimeter varied between 31.0 and 38.0 cm, with 34.4 ± 1.2 average. The cephalic index varied between 0.75 and 1.06, with 0.91 ± 0.05 average. CONCLUSION: The anthropometric measures are surveyed aiming at precocious detention of anomalies. Possibly, these measures can be influenced by racial factors; however, the measures carried through in Brazil follow values of foreign authors. Thus, the study shows data of a Northeastern region and points out the importance of the accomplishment of multicentric studies.

Risk factors for dementia in a rural area of Northeastern Brazil

OBJECTIVE To identify risk factors for dementia among the elderly in a rural area of Northeastern Brazil. METHOD The subjects assessed were all 60 years old or older, and lived in a rural region of Bahia, a Northeastern State of Brazil. CAMDEX, a structured clinical evaluation protocol, was used for diagnosis, and applied at the home of the subjects. RESULTS The risk factors identified were divided in accordance with socio-demographic characteristics, the presence of co-morbid conditions, and the use of medications. The variables with strong association with dementia were age, history of stroke, arterial hypertension, and sight impairment. CONCLUSION Advanced age, arterial hypertension, and vascular brain injury were the main risk factors associated with dementia, which suggests that public health measures adopted to prevent and control modifiable risk factors can mitigate the prevalence of high rates of dementia.

Botulinum toxin type A in refractory chronic migraine: an open-label trial

Botulinum toxin type A (BT-A) has been described as an important strategy to various types of pain such as cervical dystonia, myofascial pain syndrome and headache. Although BT-A efficacy has not been proven in tension type headache, its use in migraine continues controversial. In this open trial, we evaluated the efficacy of BT-A in refractory migraine. BT-A was injected in patients diagnosed with migraine who had previously used three classes of prophylactic drugs by at least one year with no response. The most important improvement was observed within 30 days, but pain intensity and frequency of headache had been decreased until the end of three months of follow up. Side effects of BT-A were mild and self limited. We conclude that BT-A seems to be a safe and effective treatment to refractory migraine patients.

Aspectos clínicos e laboratoriais de meningite piogênica em lactentes

OBJECTIVE: to describe clinical and laboratorial characteristics of acute bacterial meningitis in infants. METHOD: data from the prospective follow-up of infants with acute bacterial meningitis, admitted at the Hospital Couto Maia between March and December 1997, were analyzed with specific statistical software. RESULTS: acute bacterial meningitis was more prevalent in infants with ages varying from 6 months to 1 year. The most frequent etiologic agent was Haemophilus influenzae. The global lethality was 25.9% and among the survivors 39.3% left the hospital with some abnormality in the neurological exam compatible with the brain involvement. CONCLUSION: acute bacterial meningitis in infants is a high lethality disease that in the majority of cases can be prevented. We consider of great relevance the adoption of health prevention strategies in order to reduce the incidence of this disease.

Características clínicas e laboratoriais da meningite asséptica associada à vacina tríplice viral

Objetivos. Descrever os achados epidemiologicos, clinicos e liquoricos dos casos de meningite asseptica associada a vacina triplice viral (sarampo, caxumba e rubeola), ocorridos no Estado da Bahia apos campanha de vacinacao em massa promovida pelo Ministerio da Saude do Brasil em agosto de 1997, e comparar esses casos aos de meningite asseptica nao associada a vacina ocorridos no mesmo ano. Metodos. Entre marco e outubro de 1997, foi realizado acompanhamento prospectivo de todos os individuos com idade de 1 a 12 anos admitidos no Hospital Couto Maia com diagnostico clinico e laboratorial de meningite asseptica. A populacao do estudo foi dividida em dois grupos, representando individuos vacinados e nao vacinados. Foram coletadas informacoes demograficas, clinicas e laboratoriais para ambos os grupos. Resultados. No mes de setembro, logo apos a campanha de vacinacao, 74 casos de meningite asseptica foram atendidos no Hospital Couto Maia, em comparacao com a media mensal de 7,5 casos. Verificamos maior frequencia de rigidez de nuca e niveis mais altos de celularidade liquorica nas criancas cuja meningite foi associada a vacina. Por outro lado, houve maior numero de casos com comprometimento encefalico no grupo de meningites nao associadas a vacinacao. Conclusoes. Embora a meningite pos-vacinal tenha curso mais benigno, seu tratamento continua gerando custos com exames complementares e internacoes. As campanhas de vacinacao em larga escala devem utilizar vacinas contendo cepas menos reatogenicas.