Francisco de Assis Aquino Gondim

Clinical and Electrodiagnostic Findings in Patients with Peripheral Neuropathy and Inflammatory Bowel Disease.

Background:Several neurological diseases, especially different types of peripheral neuropathy (PN) are common in inflammatory bowel disease (IBD). Methods:We prospectively evaluated the presence of PN in 121 patients with IBD (51 with Crohns disease [CD] and 70 with ulcerative colitis [UC]) and 50 controls (gastritis and dyspepsia) over 3.5 years. Results:A total of 15 patients (12.4%) with small-fiber neuropathy and IBD (7 CD and 8 UC) and 24 patients (19.8%) with large-fiber PN (12 CD and 12 UC) were diagnosed. Small-fiber neuropathy affected 6% and large-fiber PN affected 4% of the control patients. Patients with CD with PN were older, had more metabolic complications and more severe motor involvement than patients with UC with PN. Carpal tunnel syndrome was more common in patients with UC. Sural and median sensory nerves were the most commonly and severely affected sensory responses. Tibial, peroneal, median, and ulnar compound muscle action potential amplitudes were also significantly decreased in patients with CD and UC. In general, sensory and motor amplitudes were a more sensitive marker for PN in patients with IBD than conduction velocities. Conclusions:In summary, PN is common in patients with IBD. It may be primarily related to IBD, phenotypically modified by metabolic complications. Its phenotype is diverse (most commonly small to predominantly axonal sensory large-fiber), but usually more severe in CD. It also includes ataxic and demyelinating forms. Results from our 10-year follow-up will elucidate the PN clinical course and the real impact of the comorbidities and new therapies.

Movement-induced heart rate changes in epileptic and non-epileptic seizures

Heart rate changes are common in epileptic and non-epileptic seizures. Previous studies have not adequately assessed the contribution of motor activity on these changes nor have evaluated them during prolonged monitoring. We retrospectively evaluated 143 seizures and auras from 76 patients admitted for video EEG monitoring. The events were classified according to the degree of ictal motor activity (severe, moderate and mild/absent) in: severe epileptic (SE, N=17), severe non-epileptic (SNE, N=6), moderate epileptic (ME, N=28), moderate non-epileptic (MNE, N=11), mild epileptic (mE, N=35), mild non-epileptic (mNE, N=33) and mild aura (aura, N=13). Heart rate increased in the ictal period in severe epileptic, severe non-epileptic, moderate epileptic and mild epileptic events (p<0.05). Heart rate returned to baseline levels during the post ictal phase in severe non-epileptic seizures but not in severe epileptic patients. Aura events had a higher baseline heart rate. A cut-off of 20% heart rate increase may distinguish moderate epileptic and mild epileptic events lasting more than 30 seconds. In epileptic seizures with mild/absent motor activity, the magnitude of heart rate increase is proportional to the event duration. Heart rate analysis in seizures with different degrees of movement during the ictal phase can help to distinguish epileptic from non-epileptic events.

Neuropsychiatric phenomena in the medieval text Cantigas de Santa Maria

Objective: To discuss the neuropsychiatric phenomena described in Cantigas de Santa Maria (Canticles of St. Mary [CSM]). Background: CSM is a collection of 427 canticles composed in Galician-Portuguese between 1252 and 1284 at the Court of King Alfonso X the Wise of Spain (1221–1284). The canticles (of which 9 are repeated) include devotional and liturgical poems and 353 narrative stories consisting mainly of depictions of Marian miracles. Most are set to music and many are illustrated. Methods: We reviewed the canticles for description of miracles and other neuropsychiatric phenomena. Two neurologists reached a consensus about the descriptions. Results: Of the 353 miracles, 279 medically relevant facts (from 187 canticles) and 25 instances of resurrection were reported. Possible neuropsychiatric conditions were described in 98 canticles. Physicians were mentioned in 16 narratives. The most common neurologic conditions detailed were blindness (n = 17), dystonia, weakness, and deformities (n = 20). Other common conditions included psychosis (n = 15), speech disorder/deaf-mutism (n = 12), infections (n = 15), sexual dysfunction/infertility/obstetrical-gynecologic issues (n = 18), head trauma (n = 5), ergotism/St. Anthonys fire (n = 7), and others. There were 9 instances of prodromic mystical experiences/hallucinations heralding death. Conclusions: While limited by retrospection and interpretation of neuropsychiatric phenomena in the medieval context, these short accounts are among the first descriptions of neuropsychiatric conditions in early Portuguese/Galician. They reflect how medieval societies used rational and irrational approaches to understand occurrences in their lives.

Polymyositis in childhood as clinical manifestation associated with HTLV-1

Laboratory of Experimental Neurology and Neurophysiology/DFF/UFC and Institute of Biomedicine of the Brazilian Semiarid/ INCT/CNPq: MD, MSc; MD, PhD, Full Professor of Neurology and Neurophysiology/DFF/UFC; MD, Medical Doctor of the Brasilia Base Hospital; MSc, PhD, Associate Professor of the Medicine Course of the Christus Faculty; DVM; DVM, PhD, Professor of the Superior School of Agriculture of Mossoro; DVM, PhD, Associate Professor of Histology/DM/UFC; MD, PhD, Associate Professor of Neuropsychology/DFF/UFC. The HTLV-1 (human T-cell lymphotropic virus type 1) is a retrovirus etiologically associated with tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/ HAM) and adult T-cell lymphoma/leukemia (ATLL). These two forms of clinical presentation are the best known and studied, although the virus may be also related with other clinical conditions, among them, the polymyositis. In Jamaica and Japan, the association between HTLV-1 seropositivity and polymyositis has been described in 85% and 16%, respectively. In the present study, we report a case of polymyositis associated with HTLV-1 as an uncommon form of clinical manifestation in a 10 years-old child mimicking muscular dystrophy. The possibility of vertical transmission (breast feeding) is outlined in this case. The parents of the patient signed a consent form.

Delusional parasitosis heralding the diagnosis of peripheral neuropathy

1Universidade Federal do Ceara, Fortaleza CE, Brazil; 2Department of Neurology and Psychiatry, Saint Louis University; 3Medical School Christus, Fortaleza CE, Brazil. Correspondence: Francisco Gondim; Faculdade de Medicina Christus; Rua Joao Adolfo Gurgel 133; 60190-060 Fortaleza CE Brasil; E-mail: gondimfranc@yahoo.com Conflict of interest: There is no conflict of interest to declare. Received 03 March 2012; Received in final form 19 July 2012; Accepted 26 July 2012

Repeated cisplatin treatments inhibit gastrointestinal motility and induces baroreflex changes and mechanical hyperalgesia in rats.

Cisplatin is a chemotherapy agent known for its neurotoxicity. We evaluated the effect of cisplatin on the gastric emptying (GE), gastrointestinal (GI) transit of liquid, baroreflex function, thermal, and mechanical withdrawal latencies in rats. Cisplatin increased the GE of liquid with doses ≥2 mg.kg−1 by 59.7–77.4%. This GE delay was not present two weeks after the treatment with five doses of cisplatin at 1 mg.kg−1. Cisplatin also enhanced baroreflex gain possibly by increasing sympathetic activity. Our results demonstrated that cisplatin (2–10 mg.kg−1) causes autonomic neuropathy with GI and baroreflex changes and mechanical but not thermal hyperalgesia in rats.