Abstract in English:

Abstract Background A prior study showed that people with temporal lobe epilepsy (TLE) with an active lifestyle present a better quality of life (QoL), but the influence of aerobic physical exercise (APE) in the QoL of these patients is still unclear. As pharmacoresistance is commonly associated with TLE, the possibility of seizures during the activities might prevent patients from benefiting from APE. Objective To analyze the influence of APE in the QoL of TLE patients and also focus on the seizure worry subitem of the QoL in epilepsy 31 (QoLIE-31) questionnaire. Methods We analyzed data from 25 individuals with TLE who participated in a 6-month APE program under the supervision of a board-certified physical trainer. TLE patients were divided into training (TLE-training) and control (TLE-control) groups. The TLE-training group underwent an APE program of 6 months, while the control group was oriented to keep their routine. We assessed all patients with the QoLIE-31 at baseline and after 6 months. We used a mixed-between-subjects ANOVA to assess the APE intervention compared with TLE-control pre- and postintervention on the QoL. Results We found a significant interaction between intervention groups and APE-time (p = 0.0005), showing that only patients in the TLE-training group presented higher QoL after the intervention (p = 0.001). We found no significant differences between groups for seizure worry (p = 0.50). Conclusion There was improvement in QoL due to APE, with no increase in seizure worry, which might be a feature of concern for both patients and healthcare practitioners. Further studies should focus on long-term interventions to evaluate the impact of APE in QoL.

Abstract in English:

Abstract Background Patients with neuromuscular diseases (NMDs) often face swallowing difficulties (dysphagia) as part of their condition. Objective To determine the prevalence of self-reported swallowing disorders in patients with rare NMDs and examine their correlation with related quality of life (QoL). Methods The study included 103 patients with confirmed rare NMDs. Dysphagia risk was assessed using the validated Eating Assessment Tool-10 (EAT-10), and QoL related to swallowing was measured with the SWAL-QoL survey. Correlations between EAT-10 and SWAL-QoL scores were analyzed. Additionally, the mean questionnaire scores were compared among patients classified as dysphagic, dysphagic with high aspiration risk, and nondysphagic. Results The estimated prevalence of dysphagia in the cohort, based on EAT-10, was 52.4%. Higher scores were significantly correlated with poorer swallowing-related QoL, except for the sleep domain. The most affected SWAL-QoL domains were burden, eating desire, eating duration, food selection, communication, fear, mental health, social functioning, and dysphagia battery score (DBS), with significant differences observed among the classifications (p < 0.001 for most domains, and p = 0.015 for eating desire). No statistically significant difference in swallowing QoL was found between sitters and walkers. Conclusion Dysphagia is a prevalent symptom in patients with rare NMDs, affecting 52.4% of the cohort and significantly impacting QoL in nearly all domains except sleep.

Abstract in English:

Abstract Background Excessive daytime sleepiness (EDS) refers to the propensity to become drowsy or fall asleep when the intention and expectation would be to stay awake, and the Epworth Sleepiness Scale (ESS) is an easy-to-apply instrument that can be used to assess the presence of EDS. Objective To evaluate the psychometric properties of the ESS, including its construct validity and internal consistency, in a population of university students. Methods Two samples of 400 students from the medicine program of a university located in the Midwest of Brazil were randomly selected from a cross-sectional academic study conducted in 2018. Construct validity was examined through exploratory and confirmatory factor analysis of the eight items of the ESS, and the internal consistency was evaluated using the Cronbach's α coefficient (α). Results It was found that factor analyses revealed better adjustment measures when considering the ESS to be two-dimensional, grouped into two main factors: the first factor referring to the evaluation of sleepiness at rest, and the second referring to drowsiness in activity (standardized root mean square residual [SRMR] = 0.053; root mean square error of approximation [RMSEA] = 0.095; Comparative Fit Index [CFI] = 0.937; and Tucker-Lewis Index [TLI] = 0.908; p < 0.05). Moreover, the ESS presented an adequate internal consistency (α = 0.75). Conclusion The present study showed general psychometric properties adequate for the ESS in medical students, including an acceptable construct validity and internal consistency. Thus, the ESS may be suitable to assess EDS in university students, especially medical students.

Abstract in English:

Abstract Background The data on predictors of poor outcomes for stroke patients in middle-income countries are lacking. Objective To identify in the acute phase after a first-ever stroke (FES) predictors of a poor outcome within 3 months and 1 year in a population-based study in the town of Matão, state of São Paulo, Brazil. Methods We prospectively investigated the characteristics of patients with FES in Matão, from a prospective study, in a population-based stroke registry, from 2015 to 2020. Poor outcome was defined as a modified Rankin scale (mRS) score of 3 to 6, assessed at 3 months and 1 year of follow-up. The association between predictors and poor outcome was analyzed by logistic regression analysis. Results Of the 783 patients, the final sample consisted of 378 subjects for analysis. The mean age was 69.2(± 14.3) years, and 43.1% of patients were female. At 3 months and 1 year after a FES, 50.4% and 47.1% of stroke patients were classified as poor prognosis, respectively. Older age, female gender, hemiplegia, aphasia, subarachnoid hemorrhage, and comorbidities present in the acute phase were the predictors associated with a poor outcome. Conclusion Non-modified and potentially modified predictors increase the risk of a poor FES prognosis in a population-based study from a middle-income country. Interventions focusing on these target populations and improving access to prevention and stroke management in the acute phase are necessary.

Abstract in English:

Abstract Background Soccer is the most popular sport worldwide, and the only one in which players purposely and repetitively use their head to hit the ball. In recent years, more attention has been given to subconcussive impacts, which are characterized by a cranial impact that does not result in known or diagnosed concussion on clinical grounds. Objective To investigate the effects of soccer heading on cognitive functioning among professional soccer players. Methods In a longitudinal case-control study, 22 professional soccer players were compared with 37 non-athletes on 2 occasions (T0 and T1) separated by a 1-year interval. The cognitive assessment consisted of computerized neuropsychological tests and the Brief Neuropsychological Assessment Battery (NEUPSILIN). Results There was no evidence of cognitive impairment among athletes, who actually outperformed the controls in terms of score, accuracy, and reaction time in certain tests. Moreover, the estimates of heading exposure did not correlate with the cognitive performance of players. The intragroup analyses revealed that while the controls improved their performance on three cognitive variables from T0 to T1, no improvement occurred among players. However, within-group variation in performance from T0 to T1 was similar. Conclusion Although the present study has not shown an association between soccer heading and cognitive impairment, subconcussive impacts may have a negative effect on brain function, as improvement in cognitive performance was not observed among athletes. Future and longer longitudinal investigations are needed to clarify the relationship between soccer heading and cognition.

Abstract in English:

Abstract Background The neuropsychological breakdowns of autobiographical memory (AM) in adults suffering from genetic generalized epilepsy (GGE) are far from being understood and largely neglected. Objective We aimed at identifying AM impairments in GGE by analyzing neurocognitive deficits in illness-related variables possibly affecting AM. Methods Patients with GGE were compared to healthy controls (HCs), through semistructured interviews on AM, as well as neuropsychological measures to identify potential determinants of AM impairment. Results A single GGE group was formed by including patients with juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and epilepsy with generalized tonic-clonic seizures alone (EGTCA). Both GGE patients and HCs were tested for differential impairments in autobiographical episodic memory (AEM) and/or autobiographical semantic memory (ASEM), as well as other episodic- and/or semantic-memory and executive-function domains. Conclusion The GGE patients exhibited overall impairment in autobiographical episodic and semantic information retrieval compared to HCs, both regarding childhood and the recent past. Furthermore, GGE patients demonstrated significantly poorer performance in immediate and delayed episodic recall, visuospatial working memory, visuoperceptual organization, face recognition memory, and verbal-executive functions compared to HCs. A distinct visuoperceptual involvement in retrieving childhood autobiographical episodic and semantic information has emerged, suggesting a potential connection between the latter AM systems and visual cognition.

Abstract in English:

Abstract Background Telemedicine, a patient-centered approach that leverages technology, has emerged as a cost-effective solution to provide comprehensive medical services for acute and chronic conditions. Objective We aim to document the experiences of pediatric neurologists using teleconsultations within the TeleNortheast program, a specialized medical assistance initiative in the Northeast of Brazil. Methods A retrospective analysis of teleconsultations was conducted from January to October 2023. Data from 546 teleconsultations, involving 506 pediatric patients, were extracted from medical records. Consultations were conducted between pediatric neurologists in São Paulo and primary care professionals in Sergipe. The analysis included patients’ demographics, diagnoses, and outcomes. Results Of the 506 teleconsultation patients seen, 89% continued treatment within their primary care settings without needing in-person referrals. Discharge was observed in 9.5% of cases, and only 1.4% required specialized in-person care. The most frequent diagnosis was autism spectrum disorder (19.1%), followed by epilepsy (7.1%), attention-deficit/hyperactivity disorder (6.7%), and intellectual disability (5.9%). A cost-saving analysis indicated that teleconsultations avoided significant transportation costs, which could reach up to R$ 21 thousand for travel and feeding expenses. Conclusion The results highlight the effectiveness of teleconsultations in improving access to pediatric neurological care in underserved regions, reducing the need for in-person counseling, with the potential to provide significant cost savings for the public health system. The TeleNortheast program demonstrates the potential of this approach to bridge healthcare gaps, particularly in regions with limited access to specialized care.

Abstract in English:

Abstract Background Finger extension weakness could be a presentation of either posterior interosseous nerve (PIN) syndrome or multifocal motor neuropathy (MMN). However, there is a delay in the diagnosis of MMN in cases with a selective radial weakness, as they are frequently misdiagnosed as PIN. Objective To analyze which variables in nerve conduction studies could aid in the early diagnosis of MMN. Methods We reviewed charts of patients with diagnoses of MMN or PIN syndrome, from 2014 to 2022, in a single Brazilian reference center. Electrophysiological parameters included in the analysis were motor conduction velocity (CV), the presence and magnitude of conduction block (CB), distal motor latencies (DML), and the compound muscle action potential amplitude (CMAP) of the affected radial nerve. Results A total of 44 radial nerves were included in the study. Axonal loss was associated with a diagnosis of PIN syndrome, while conduction block was associated with MMN (p < 0.05). No patient with PIN had a CB over 60%, while 7 out of 12 radial CB blocks in patients with MMN were above that. Axonal degeneration was present in 4 MMN patients and in all patients with PIN syndrome. There was no difference in CV and DML between groups. Conclusion The presence of CB or the absence of distal CMAP amplitude reduction should lead physicians to consider MMN, and a comprehensive nerve conduction study should be performed.

Abstract in English:

Abstract Background Patients with ischemic stroke present a higher risk of stroke recurrence, neurological deterioration, and death. The benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) among patients with minor ischemic stroke is well established; however, robust evidence is lacking for those with nonminor stroke. Objective To describe the benefits and risks of DAPT versus SAPT in patients with nonminor ischemic stroke. Methods We searched the PubMed, Embase, and Cochrane Library databases for articles published from inception to April 2024. Data were collected from randomized clinical trials and observational studies comparing DAPT to SAPT following nonminor ischemic stroke, defined by a score ≥ 4 on the National Institutes of Health Stroke Scale (NIHSS). Results In total, 6 studies were included, comprising 12,480 patients. The NIHSS score at baseline from the selected studies ranged from 4 to 15. There was no significant difference between DAPT and SAPT for recurrent stroke (risk ratio [RR] = 0.91; 95% confidence interval [95%CI] = 0.82–1.01; p = 0.09; I2 = 0%), ischemic stroke (RR = 0.89; 95%CI = 0.80–1.00; p = 0.05; I2 = 0%) or hemorrhagic stroke (RR = 1.23; 95%CI = 0.41-3.99; p = 0.66; I2 = 27%). Major bleeding was not significantly increased in the DAPT group compared with the SAPT group (RR = 0.87; 95%CI = 0.29–2.66; p = 0.81; I2 = 44%). The overall analysis did not show a significant difference in all-cause mortality (RR = 0.72; 95%CI = 0.50–1.02; p = 0.07; I2 = 0%). Conclusion There was no difference between DAPT and SAPT regarding recurrent stroke, ischemic stroke, hemorrhagic stroke, major bleeding, or overall mortality.

Abstract in English:

Abstract The discovery of aquaporin 4 immunoglobulin G (AQP4-IgG) autoantibody, present in ~80% of patients with neuromyelitis optica spectrum disorder (NMOSD), dramatically improved its diagnosis, treatment, and prognosis. While Brazil has a higher prevalence of NMOSD (up to 4.5 per 100,000 people) compared with global averages, disparities in access to testing in Brazil impede early diagnosis and treatment. To tackle these issues, the Americas Health Foundation convened a three-day virtual conference with six Brazilian NMOSD experts. This paper emphasizes the importance of addressing the gaps in physicians' knowledge about NMOSD. Stakeholders, including government agencies, should develop national programs for continuing medical education. The public healthcare system should ensure the availability and accessibility of AQP4-IgG antibody testing. Clinical practice guidelines for NMOSD diagnosis and treatment must be established. Such guidelines will enable healthcare providers to manage patients promptly after the initial attack, reducing relapses and improving quality of life. Finally, addressing the fragmented healthcare system, including bridging the gap between public and private institutions and improving access to telemedicine, will aid individuals in Brazil with NMOSD in receiving early diagnosis and treatment. NMOSD presents unique challenges in Brazil because of its higher prevalence and limited access to crucial AQP4-IgG tests. Overcoming these challenges requires collaboration among experts, healthcare providers, government agencies, and the public healthcare system to improve diagnosis, treatment, and patient outcomes.

Abstract in English:

Abstract Research into Wilson's disease (WD) in Brazil had the effective participation of Professor Horácio Martins Canelas, from the Neurologic Clinic of the Teaching Hospital of the School of Medicine of Universidade de São Paulo (USP). His exponential contributions to the study of WD placed Brazil on the international stage, making USP's Neurologic Clinic one of the world's leading research centers in the area of neurodegenerative diseases with metal accumulation.