Jessie Navarro

Avaliação e acompanhamento audiológico após meningite bacteriana

Hearing loss is the more frequent sequel of bacterial meningitis in children. This study describes the audiological profile (peripheric and central) of 89 children admitted to the hospital wards with the diagnosis of bacterial meningitis. Those children attended audiological follow up, after their hospital descharge, and were submitted to audiological tests. The results showed that 85.4% among them presented normal hearing in both ears 10.1% presented bilateral neurosensorial hearing loss and 4.5% presented unilateral neurosensorial hearing loss. The results from the auditory processing skills assessment showed that 10% of those children presented auditory localization and recognition of sentences with competitive messages (Paediatric Sentences Identification - ipsilateral) disorders.

Intraoperative dopamine release during globus pallidus internus stimulation in Parkinson's disease

It is still unclear whether dopamine (DA) levels correlate with Parkinsons disease (PD) severity or play a role in the mechanisms of high‐frequency stimulation (HFS).

Lesões hipoatenuantes dos gânglios da base associadas a quadro pirâmido-extrapiramidal: relato dos casos de dois irmãos

Sao relatados os casos de dois irmaos com tomografia computadorizada de crânio evidenciando lesoes hipoatenuantes dos gânglios da base. No caso 1 a anormalidade e de maior dimensao, bilateral e associa-se a quadro neurologico em que as alteracoes mais importantes sao: presenca de posturas distonicas, principalmente nos membros inferiores e reflexos patelares exaltados, com clono de rotula bilateral. No caso 2 a alteracao tomografica estava presente com localizacao semelhante, porem menor e somente a esquerda e o exame neurologico e normal apesar do relato de quedas frequentes. Os autores discutem o diagnostico diferencial do ponto de vista clinico e tomografico.Two cases (siblings) with computed tomography showing slow attenuation of basal ganglia are reported. In case 1 the abnormality is larger, bilateral and the most important neurological features are: dystonic postures mainly in lower extremities and very active patellar reflexes with sustained knee clonus on both sides. In case 2 the tomographic examination disclosed a similar, but more discrete lesion only on the left side; the neurological examination is normal despite a history of frequent falls. The authors discuss the differential diagnosis from a clinical and tomographic approach.

Lateral hypothalamic activity indicates hunger and satiety states in humans

Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader–Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food‐related cues induced an increase in beta/low‐gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha‐frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.

Caudal Zona Incerta/VOP Radiofrequency Lesioning Guided by Combined Stereotactic MRI and Microelectrode Recording for Posttraumatic Midbrain Resting-Kinetic Tremor.

OBJECTIVE Reporting the outcome of two patients who underwent unilateral ablative stereotactic surgery to treat pharmacologic resistant posttraumatic tremor (PTT). METHODS We present two patients (31 and 47 years old) with refractory PTT severely affecting their quality of life. Under stereotactic guidance, refined by T2-weighted magnetic resonance imaging and double-channel multiunit microelectrode recording (MER), three sequential radiofrequency lesions were performed in the caudal zona incerta (cZi) up to the base of thalamus (VOP). Effects of cZi/VOP lesion were prospectively rated with a tremor rating scale. RESULTS Both patients demonstrated intraoperative tremor suppression with sustained results up to 18 months follow-up, with improvement of 92% and 84%, respectively, on the tremor rating scale. Tremor improvement was associated with enhancement functionality and quality of life for the patients. The patients returned to their work after the procedure. No adverse effects were observed up to the last follow-up. CONCLUSION Radiofrequency lesion of the cZi/VOP target was effective for posttraumatic tremor in both cases. The use of T2-weighted images and MER was found helpful in increasing the precision and safety of the procedure, because it leads the RF probe by relying on neighbor structures based on thalamus and subthalamic nucleus.

Surgical variation of microvascular decompression for trigeminal neuralgia: A technical note and anatomical study.

Background: In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia. Methods: The microvascular decompression technique used in the authors’ institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques. Results: Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques. Conclusion: Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.

Coréia familiar benigna: relato de dois casos

Two cases (siblings) of benign familial chorea are reported. The familys pedrigree shows an autosomic dominant form of inheritance with incomplete penetrance. The differential diagnosis is discussed as well a brief literature revision is made.

Reconstruction of reaching movement trajectories using electrocorticographic signals in humans

In this study, we used electrocorticographic (ECoG) signals to extract the onset of arm movement as well as the velocity of the hand as a function of time. ECoG recordings were obtained from three individuals while they performed reaching tasks in the left, right and forward directions. The ECoG electrodes were placed over the motor cortex contralateral to the moving arm. Movement onset was detected from gamma activity with near perfect accuracy (> 98%), and a multiple linear regression model was used to predict the trajectory of the reaching task in three-dimensional space with an accuracy exceeding 85%. An adaptive selection of frequency bands was used for movement classification and prediction. This demonstrates the efficacy of developing a real-time brain-machine interface for arm movements with as few as eight ECoG electrodes.

Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time

OBJECT Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinsons disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinsons Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.