José Luiz de Sá Cavalcanti

Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson's disease: pilot study.

Introduction Physical rehabilitation is commonly used in patients with Parkinson’s disease (PD) to improve their health and alleviate the symptoms. Objective We compared the effects of three programs, strength training (ST), aerobic training (AT), and physiotherapy, on motor symptoms, functional capacity, and electroencephalographic (EEG) activity in PD patients. Methods Twenty-two patients were recruited and randomized into three groups: AT (70% of maximum heart rate), ST (80% of one repetition maximum), and physiotherapy (in groups). Subjects participated in their respective interventions twice a week for 12 weeks. The assessments included measures of disease symptoms (Unified Parkinson’s Disease Rating Scale [UPDRS]), functional capacity (Senior Fitness Test), and EEG before and after 12 weeks of intervention. Results The PD motor symptoms (UPDRS-III) in the group of patients who performed ST and AT improved by 27.5% (effect size [ES]=1.25, confidence interval [CI]=−0.11, 2.25) and 35% (ES=1.34, CI=−0.16, 2.58), respectively, in contrast to the physiotherapy group, which showed a 2.9% improvement (ES=0.07, CI=−0.85, 0.99). Furthermore, the functional capacity of all three groups improved after the intervention. The mean frequency of the EEG analysis mainly showed the effect of the interventions on the groups (F=11.50, P=0.0001). Conclusion ST and AT in patients with PD are associated with improved outcomes in disease symptoms and functional capacity.

Cognitive disconnective syndrome by single strategic strokes in vascular dementia

Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.

Alzheimer's disease and proton magnetic resonance spectroscopy of limbic regions: a suggestion of a clinical-spectroscopic staging

OBJECTIVE To compare magnetic resonance proton spectroscopic with clinical data and to propose a spectroscopic staging of Alzheimers disease (AD). METHOD Subjects (n = 46), normals (12) and with AD (34), paired to age (CDR0-CDR3); AD diagnosis according to DSM-IV/NINCDS-ADRDA criteria; 1H-MRS with Signa Horizon LX-GE, 1.5T; single voxel at hippocampal region/HCR and posterior cingulate area/PCA. RESULTS Statistically significant decrease (p < 0.01) only of Naa/Cr--at HCR among the CDR0, CDR1+CDR2, and CDR3, and at PCA between CDR0 and CDR1+CDR2 in relation to CDR3. CONCLUSION The HCR is the first to show Naa reduction (CDR1). The PCA suffers later (CDR3). These values decline progressively according to the severity stages. Considering the disparities between the HCR and PCA it is possible to suggest a spectroscopic (metabolite) staging (MS) of AD, as follows: MS0 (-CDR0) = both normal HCR and PCA, MS1-2 (approximately CDR1-2) = abnormal HCR and normal PCA, and MS3 (approximately CDR3) = both abnormal HCR and PCA. These results make possible the early diagnosis, to follow the degenerative process throughout the course, and to suggest a spectroscopic staging related to the clinical stages of AD.

Vascular dementia: Cognitive, functional and behavioral assessment. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part II

Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition.

Vascular dementia: Diagnostic criteria and supplementary exams: Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I.

Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based, systematized approach. The knowledge used to define these guidelines was retrieved from searches of several databases (Medline, Scielo, Lilacs) containing scientific articles, systematic reviews, meta-analyses, largely published within the last 15 years or earlier when pertinent. Information retrieved and selected for relevance was used to analyze diagnostic criteria and to propose a diagnostic system encompassing diagnostic criteria, anamnesis, as well as supplementary and clinical exams (neuroimaging and laboratory). Wherever possible, instruments were selected that had versions previously adapted and validated for use in Brazil that take into account both schooling and age. This task led to proposed protocols for supplementary exams based on degree of priority, for application in clinical practice and research settings.

The Brazilian Neurology centenary (1912-2012) and the common origin of the fields of Neurology and Psychiatry

It is reported the Brazilian Neurology birth (1912), that has as the hallmark its first Neurology Cathedra of Rio de Janeiro, and the links between Neurology and Psychiatry, besides the main medical protagonists at that time in Rio de Janeiro: João Carlos Teixeira Brandão (1854-1921), first professor of the cathedra of Clinical Psychiatry and Nervous Diseases (1883-1921); Juliano Moreira (1873-1933), the founder of the Brazilian scientific Psychiatry and director of the Hospício Nacional de Alienados (National Hospice for the Insane) (1903-1930); Antônio Austregésilo Rodrigues de Lima (1876-1960), first professor of the cathedra of Neurology, considered the father of the Brazilian Neurology. Aloysio de Castro (1881-1959) was a great Brazilian neurosemiologist at that time. Austregésilo practiced both disciplines, Neurology and Psychiatry, and like Jean-Martin-Charcot, he was very interested in a typically psychiatric disorder, the hysteria. It is also considered in this paper the first Brazilian authors of Neurology and/or Psychiatric texts and the places where Neurology was initially developed by the main founders: Hospício Nacional de Alienados, Santa Casa de Misericórdia do Rio de Janeiro and Policlínica Geral do Rio de Janeiro.

French school of neurology in the 19 th and first half of the 20th century, and its influence in Brazil

French medicine was of the utmost importance for the birth of modern medicine and neurology in the 19th century. Innovative approaches, such as examination at the bedside, the use of the stethoscope, techniques of auscultation, palpation, and close patient examination, besides emphasis on anatomical-clinical correlation and observation of the outcome of the disease, were put into practice. French medicine offered professional training and incentives for the beginnings of Brazilian neurology and psychiatry. Returning from France, many Brazilian physicians implemented what they had learned, mainly in Paris. The most important pupils of the French neurology schools in Brazil during the 19th century and first half of the 20th century include names like Antonio Austregesilo, Aloysio de Castro, Enjolras Vampré, and Deolindo Couto, founders of the leading Brazilian neurological schools, directly influenced by Dejerine, Pierre Marie, Guillain and Babinski.

Fifty years of the Brazilian Academy of Neurology

The 50th anniversary of the Brazilian Academy Neurology (BAN) is being celebrated. BAN was founded on May 5th, in 1962. The BAN initial leaders and members are treated with reverence, as well as the honorable place where its foundation took place: the Institute of Neurology, first in Brazil, at the backyards of the ancient National Hospice for the Insane, which is an important and fruitful birthplace of the Brazilian Neurology.

Guillain-Barré-Strohl syndrome: prognostic factors

The authors analysed retrospectively 29 in-patients with Guillain-Barré-Strohl syndrome intending to recognize severity indexes as far as the development of complications and death are concerned. Sensory signs, autonomic dysfunction, respiratory insufficiency, sphincteric disturbances and a longer time in hospital turned out to be severity indexes, when present in these patients.

Hemorragia cerebral como primeira manifestação do lupus eritematoso sistêmico: estudo clínico e histopatológico de dois casos

Two patients with cerebral hemorrhage as the first manifestation of systemic lupus erythematosus (SLE) are reported. The first one showed in the CT scan blood within the brain. Laboratory findings gave the diagnosis of lupus. She was treated with corticosteroids and plasmapheresis with good results. The second patient died within few days and the anatomopathologic study showed a large area of hemorrhage within the brain. The microscopic study of the kidney and other organs made the diagnosis of lupus erythematosus. The authors regard the intracranial bleeding as a rare complication of lupus. They consider that the CT scan must be done in all patients with central nervous system complications of SLE. They consider that the cerebral hemorrhage must be related to the autoimmune disorders that occur in SLE.Two patients with cerebral hemorrhage as the first manifestation of systemic lupus erythematosus (SLE) are reported. The first one showed in the CT scan blood within the brain. Laboratory findings gave the diagnosis of, lupus. She was treated with corticosteroids and plasmaferesis with good results. The second patient died within few days and the anatomopathologic study showed a large area of hemorrhage within the brain. The microscopic study of the kidney and other organs made the diagnosis of lupus erythematosus. The authors regard the intracranial bleeding as a rare complication of lupus. They consider that the CT scan must be done in all patients with central nervous system complications of SLE. They consider that the cerebral hemorrhage must be related to the autoimmune disorders that ocurr in SLE.