Francisco Eduardo Costa Cardoso

Ziprasidone-related oculogyric crisis in an adult

INTRODUCTION Drug-induced dyskinesias are common side-effects of first-generation antipsychotics (FGAs) but are not usually related to second-generation antipsychotics (SGAs). Oculogyric crisis (OGC) is a disabling acute dystonia that affects extra-ocular muscles usually resulting in an upward deviation of the eyes, which lasts from minutes to hours. CASE REPORT We describe an adult patient, previously exposed to an FGA, who developed OGC on 80mg/day of ziprasidone. The movement disorder significantly improved after use of 1mg/day of clonazepam without the need to switch to another SGA. DISCUSSION The clinical features of the movement disorder of our patient meet the criteria for OGC. It is, sometimes, difficult to directly correlate a drug-induced dyskinesia to a SGA due to previous exposures to FGAs. The onset of OGC after exposure to ziprasidone without simultaneous use of other antipsychotic suggests a casual relationship between the former and the movement disorder. It is possible that previous use of an FGA was a risk factor for the development of OGC. CONCLUSION To the best of our knowledge, this is the first report of ziprasidone-related OGC in an adult patient. Physicians must be aware of its occurrence in order to improve care of patients treated with these agents.

Care of patients with Huntington's disease in South America: a survey

Huntingtons disease (HD) is a rare neurodegenerative disease with a multitude of symptoms, which requires access to specialized multidisciplinary care for adequate management. The aim of this study was to survey the characteristics of care in various HD centers in South America (SA). Methods A questionnaire was sent to 24 centers involved in the care for HD patients in SA. Results Of the total 24 centers, 19 (79.2%) are academic units. The majority of centers (62.5%) are general movement disorders clinics. Multidisciplinary care is available in 19 (79.2%) centers and in 20 (83.3%) care is provided free of charge. Genetic testing and counseling are available in 25 and 66.6% of centers, respectively. The majority of centers (83.3%) have no institutional support for end-stage care. Conclusions Although HD centers in SA are committed to providing multidisciplinary care, access to genetic counseling and end-stage care are lacking in most centers.

Idiopathic Parkinson's disease: vocal and quality of life analysis

OBJECTIVE To compare voice and life quality of male patients with idiopathic Parkinsons disease, with individuals without disease (Control Group). METHODS A cross-sectional study that evaluated the voice of individuals with Parkinsons disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96). The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR). For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS Fundamental frequency and jitter presented higher values in the Parkinsons group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS Individuals with Parkinsons disease have an altered voice quality and a negative impact on quality of life.

Parkinsonian signs and symptoms in adults with a history of Sydenham's chorea.

BACKGROUND Sydenhams chorea is associated with dysfunction of fronto-striatal circuits induced by cross-reactive antibodies to group A β-hemolytic streptococcus. High susceptibility of extrapyramidal effects of neuroleptics in patients with Sydenhams chorea suggests underlying nigro-striatal dysfunction. OBJECTIVE To study the presence of parkinsonism in patients with a history of Sydenhams Chorea. METHODS We used the UFMG Sydenhams Chorea Rating Scale (USCRS) and the Unified Parkinsons Disease Rating Scale (UPDRS) part III, respectively, to determine the presence of chorea and parkinsonian symptoms and signs in 25 adults with a history of previous Sydenhams Chorea currently without chorea or use of anti-choreic drugs. RESULTS Bradykinesia was found in 64% of subjects. There was a statistically significant correlation between bradykinesia and hemichorea (-0.412; p = 0.036) and bradykinesia and generalized chorea (0.412; p = 0.036). There was no correlation between bradykinesia and use of anti-choreic drugs. CONCLUSIONS Bradykinesia is common in patients with Sydenhams Chorea in remission. This finding suggests an immune-mediated dysfunction of the nigro-striatal system.

QUALIDADE DE VIDA EM VOZ: ESTUDO NA DOENÇA DE PARKINSON IDIOPÁTICA E NA DISFONIA ESPASMÓDICA ADUTORA

PURPOSE: to evaluate the impact of voice disorders on quality of life of patients with idiopathic Parkinsons disease and with adductor spasmodic dysphonia. METHOD: the study consisted of 56 females, 28 in the control group; 14, the adductor spasmodic dysphonia group in the period prior to treatment with botulinum toxin; and 14, the group of idiopathic Parkinsons disease. The participants filled in the Voice-Related Quality of life (V-RQOL) questionnaire validated for Brazilian Portuguese. To check the difference between averages of the groups it was used the method of analysis of variance by Kruskal-Wallis and Tamhane test for multiple comparisons, with significance <0.05. RESULTS: the average age of the groups were 66.18 for the control group, 67.21 for the Parkinsons disease group and 59.7 for the adductor spasmodic dysphonia group, with no statistical difference between the groups. In the V-RQOL protocol the mean domain social-emotional, physical functioning and total score were higher in the control group, followed by group of Parkinsons disease and, finally, the group of adductor spasmodic dysphonia with statistically significant difference between them. In addition, there was statistical difference for each pair of groups, concerning the areas V-RQOL protocol, except as regards the pair control and Parkinsons disease group in the social-emotional domain (p= 0,076) CONCLUSION: the negative impact of voice on quality of life is greatest in the adductor spasmodic dysphonia group, followed by Parkinsons disease group and at last, the control group.

Objective and subjective analysis of women's voice with idiopathic Parkinson's disease

OBJECTIVE To compare the voice quality of women with idiopathic Parkinsons disease and those without it. METHODS An evaluation was performed including 19 female patients diagnosed with idiopathic Parkinsons disease, with an average age of 66 years, and 27 women with an average of 67 years-old in the Control Group. The assessment was performed by computed acoustic analysis and perceptual evaluation. RESULTS Parkinsons disease patients presented moderate rough and unstable voice quality. The parameters of grade, roughness, and instability had higher scores in Parkinsons disease patients with statistically significant differences. Acoustic measures of Jitter and period perturbation quotient (PPQ) significantly differ between groups. CONCLUSIONS Parkinsons disease female individuals showed more vocal alterations compared to the Control Group, when both perceptual and acoustic evaluations were analyzed.

Neurology in Federico Fellini?s work and life

The authors present a historical review of the neurological diseases related to the famous moviemaker Federico Fellini. There is an account of diseases depicted on his movies as well as his ischemic stroke and consequent neurological deficit - left spatial neglect.