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Abstract Background Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with substantial disability, morbidity, and mortality. Timely diagnosis and treatment are essential to mitigate its impact. Despite its burden, real-world data on PD in Brazil remain limited. Objective To describe the demographic and clinical profile of individuals with PD treated in the Brazilian public healthcare system and to evaluate patterns of treatment and healthcare resource utilization (HCRU). Methods The present observational, retrospective, longitudinal study analyzed data from the Brazilian public healthcare system (Sistema Único de Saúde, SUS, in Portuguese) between January 2013 and December 2022. Patients aged ≥ 20 years with at least 2 core procedures coded for PD (ICD-10 G20) were included. Inpatient and outpatient datasets were analyzed separately. Results A total of 53,674 PD patients were identified. The mean age at diagnosis was 65.4 years, with a slight male predominance (53.0%). Most patients (47.0%) had more than 6 outpatient visits, and 44.4% had 1 or 2 hospitalizations. The most frequent procedures were PD treatment (inpatient) and physical therapy (outpatient). The most used medications were pramipexole (45.6%), amantadine (26.0%), and entacapone (17.1%). Conclusion The present study provides valuable insights into the demographic and clinical profile of PD patients in Brazil, highlighting frequent procedures and treatment patterns. A key limitation is the non-capture of basic PD medications, such as levodopa, which are often dispensed outside the analyzed datasets. These findings underscore the need for improved data integration and access to comprehensive PD care within the public health system.

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Abstract Background Tarsila do Amaral's painting "Abaporu" is a seminal work in Brazilian modernist art, yet its interpretation continues to intrigue scholars due to its complex symbolism. Objective To examine "Abaporu" through the perspective of neuroesthetics, exploring potential parallels between its visual elements and sensory disturbances characteristics of migraine aura. Methods A structured review of primary and secondary art-historical sources and a systematic literature search in PubMed and Google Scholar were conducted. The analysis focused on Amaral's recurrent use of disproportion and gigantism in the 1920s and on evaluating the plausibility of a neuroesthetic hypothesis in this art-historical context. Results Our analysis indicated that the gigantism and deliberate deformation in "Abaporu" belong to a consistent program already evident in Amaral's 1920s painting. From this perspective, the painting's oversized feet and hands contrasting with a diminutive head evoke perceptual alterations reminiscent of macropsia and micropsia, phenomena linked to Alice in Wonderland Syndrome and migraine aura. Its vibrant palette and melancholic undertones, likewise, resound the sensory disturbances and affective dimensions associated with migraine, suggesting that Amaral's programmatic distortions also invite a neuroesthetic reading. Conclusion While no evidence supports a medical diagnosis of migraine in Amaral, the visual motifs and techniques in "Abaporu" can be read both as deliberate esthetic strategies of her Pau-Brasil and Anthropophagic phases and as intuitively resonant with neurological models of altered perception. This dual lens enriches our understanding of art's capacity to embody complex perceptual experiences and encourages further interdisciplinary dialogue between art history and neuroscience.

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Abstract Background The Activity Limitation Measure (ACTIVLIM) is a self-reported instrument consisting of 22 daily activity items graded on 3 levels (easy, difficult, or impossible). Objective To translate, culturally adapt, and validate the Brazilian Portuguese version of the ACTIVLIM for individuals with neuromuscular disorders. Methods The present was a cross-sectional observational study. The translation process followed standardized guidelines, including steps such as forward translation, synthesis, back-translation, expert committee review, and pretesting (psychometric analysis). A total of 268 individuals with neuromuscular disorders filled out the Brazilian ACTIVLIM. Test-retest reliability was assessed in a subgroup of 60 participants, who were evaluated twice by the same physiotherapist with an interval of one month. Results The intraclass correlation coefficient (ICC) for intrarater reliability was of 0.95. Internal consistency was high (Cronbach's alpha = 0.940). External validity showed strong correlations involving ACTIVLIM scores and the scores on the Vignos scale (r = −0.907), the Brooke scale (r = −0.908), and the Functional Independence Measure (r = 0.864), all with p < 0.001. Proximal muscle strength in the upper (r = 0.748) and lower limbs (r = 0.793), measured through the Medical Research Council scale, also correlated significantly with ACTIVLIM scores. Linear regression identified that the scores on the Vignos (R2 = 0.8236), and Brooke scales (R2 = 0.8132), as well as proximal muscle strength in the lower (R2 = 0.6480) and upper limbs (R2 = 0.5805), were the main predictors of ACTIVLIM variance. Conclusion The Brazilian Portuguese version of the ACTIVLIM demonstrated strong reliability and validity. Its scores were significantly associated with disability level, functional independence, and muscle strength in individuals with neuromuscular disorders.

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Abstract Background Studies on the association between pineal gland calcification (PGC) and non-breathing sleep-related symptoms are inconclusive. Objective The present study aims to evaluate this association in middle-aged and older adults living in rural villages located in coastal Ecuador. Methods Community-dwellers aged ≥ 40 years enrolled in the Three Villages Study cohort were interviewed with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and received head computed tomography for automated measurement of PGC volumes. Generalized linear and logistic regression models were used to assess the association between PGC volumes (exposure) and the PSQI score and sleep quality (as separate dependent variables), after adjusting for age and sex. Results The study included 1,009 participants (mean age: 56.5 ± 12.6 years; 57% women). The mean volume of PGC was 51 ± 53.5 μL. The mean score of the PSQI was 5.3 ± 2.8 points, with 399 (40%) participants having poor sleep quality. Locally-Weighted Scatterplot Smoothing showed a linear relationship between continuous PGC volumes and PSQI scores. An unadjusted generalized linear regression model showed a significant association between PGC volumes stratified in tertiles and the continuous PSQI score. However, this association lost statistical significance after adjustment for age and sex. The association between tertiles of PGC and poor sleep quality was non-significant in both unadjusted and multivariate logistic regression models. Conclusion Study results did not find an association between increased PGC and sleep quality after adjusting for demographics, suggesting that PGC may not necessarily indicate pineal dysfunction but could reflect adaptive physiological mechanisms.

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Abstract Background Aging is accompanied by an increasing incidence of dementia. Alzheimer's disease (AD) is the leading cause of dementia, and it impairs autonomic function. Heart rate variability (HRV) is a marker of autonomic function, but findings in AD are conflicting, and there is scant information on the association of HRV with falls in dementia patients. Objective To assess autonomic activity in older adults with AD, comparing these patients to older adults without dementia (the control group, CG), and to investigate the relationship between HRV and falls. Methods The HRV was analyzed in older adults without dementia and in those with AD using a heart rate monitor. The measurements were made on a single day in the supine and orthostatic positions for 10 minutes each. The HRV components in the time and frequency domains were assessed, along with the history of falls in the past 3 years. Results The groups were homogenous, with a predominance of female individuals, and mean ages of 81 (AD) and 79 (CG) years. A reduction in the R-R interval upon changing from the supine to the orthostatic positions was evident in both groups, but the AD group showed reduced parasympathetic components in the orthostatic position. For the frequency domain, a reduction in high frequency (HF) and increases in low frequency (LF) and in the LF/HF ratio were observed, suggesting increased sympathetic and reduced parasympathetic activities. The AD group presented more falls, whose incidence was associated with HRV components. Conclusion Alzheimer's disease was associated with worse autonomic dysfunction, increased sympathetic activity and greater parasympathetic impairment, a high incidence of falls and interaction with HRV components.

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Abstract Background SuperAgers (SA) are adults aged ≥ 80 years with memory equivalent to individuals 20 to 30 years younger. Few studies have evaluated multimodal neuroimaging approach in the same SA cohort. Objective To investigate neurobiological mechanisms underlying exceptional cognitive aging by evaluating cortical amyloid deposition, regional cerebral glucose metabolism (rBGM), and gray matter volume (GMV), and their associations with neuropsychological performance and subjective cognitive decline (SCD). Methods The participants were classified as SA (n = 11), age-matched healthy controls (HC80; n = 23), and healthy controls aged 60 to 69 years (HC60; n = 23). Positron-emission tomography (PET) using 11C-PIB and 18F-FDG were analyzed using semiquantitative three-dimensional stereotactic surface projection (3D-SSP), with group comparisons using Statistical Parametric Mapping 8 (SPM8). Results The median ages were 81 years (interquartile range [IQR] = 5.0) for SA, 83 years (IQR = 5.0) for HC80, and 66 years (IQR = 3.0) for HC60. All groups had a median of 16 years of schooling (IQR for SA = 7, for HC80 and HC60 = 5). There were 4 PIB-PET positive individuals (36.4%) in the SA group, which is similar to the HC80 group (40.9%). Also, 6 SA had SCD, with 3 being PIB-positive. In SA, composite SUVr predicted RAVLT delayed recall (β = −0.666, p = 0.011, adjusted R2 = 0.748), controlling for age, sex, and schooling. Compared to HC80, the SA group showed increased metabolism in the anterior cingulate gyrus and caudate, as well as increased GMV in the putamen. Conclusion The SA group exhibited similar amyloid burden to HC80, yet amyloid deposition specifically impaired their memory. Increased rBGM and GMV in the salience network and striatum suggest these regions support successful cognitive aging.

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Abstract Background Fear of falling can be present in the daily lives of patients with Parkinson's disease (PD) due to their predisposition to falls. Objective The main objective of this study was to translate the Fear of Falls Scale (FFS) into Brazilian Portuguese, adapt it cross-culturally, and validate it. Methods A multicenter, cross-sectional study was conducted with PD patients fluent in Brazilian Portuguese, recruited from five research centers in Brazil. Descriptive analysis characterized the sample and compared the data. Cronbach's α and McDonald's ω coefficients were used to assess the internal consistency of the scale. Results No significant differences were observed between the translated versions T1 and T2. The B1 and B2 versions did not present significant divergences in the back-translation from the original scale. The Movement Disorder Society – Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III significantly correlated with motor skills (rho = 0.56, 0.43–0.67; p ≤ 0.001) and fear of falling (rho = 0.48, 0.34–0.60; p ≤ 0.001). Higher stages on the modified Hoehn & Yahr scale were associated with a greater decline in motor skills and a greater fear of falling (p < 0.001). The total internal consistency of balance-related motor skills and fear of falling was considered sufficiently reliable. Cronbach's α values were 0.96, 0.91, and 0.90; while McDonald's ω values were 0.96, 0.92, and 0.91, respectively. Conclusion The Brazilian version of the FFS proved to be valid and reliable for assessing fear of falling in people with PD.

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Abstract Background Multiple sclerosis (MS) is a chronic disease with an unpredictable clinical course, presenting both recurrent relapses and progressive worsening over time. People living with MS (pwMS) are impacted physically, psychologically, and socially. Illness perception refers to a person's cognitive and emotional representations of their disease, which can impact their psychophysical well-being and treatment adherence. Objective To assess the illness perception of pwMS and determine how it is impacted by cognitive dysfunction and fatigue. Methods In this cross-sectional pilot survey study, the Brief Illness Perception Questionnaire (B-IPQ), Montreal Cognitive Assessment (MoCA-BR), Modified Fatigue Impact Scale (MFIS-BR), and Multiple Sclerosis Quality of Life Questionnaire (MSQOL-54) were used. Demographic and clinical data, as well as the Expanded Disability Status Scale (EDSS), were collected. Results A total of 30 RRMS patients (66.7% of female subjects, with a mean age of 36.8 ± 1.8 years) were enrolled. The mean score on the B-IPQ scale was of 30.2 ± 8.9 points, with 40% presenting a threat perception of the disease. No significant correlation was observed between cognitive performance and illness perception (r = −0.058; p = 0.761). However, significant correlations were found between illness perception and all fatigue domains (total: r = 0.578; p = 0.001; physical: r = 0.594; p = 0.001; psychosocial: r = 0.672; p < 0.001), except the cognitive domain (r = 0.360; p = 0.051). The EDSS and MSQOL-54 scores also demonstrate significant correlations with illness perception (EDSS = 2.30; p = 0.034; MSQOL-54 physical: r = −0.776; p < 0.001; MSQOL-54 mental: r = −0.704; p < 0.001). Conclusion Illness perception in MS is influenced by patients' fatigue, quality of life, and disability levels, but it does not appear to be affected by cognition.

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Abstract Background Arquivos de Neuro-Psiquiatria (ANP) celebrated 80 years in 2023. We have previously evaluated the publication trends throughout the first 20 years. Objective To analyze the publication trends, authorship, and editorial patterns of the volumes 21 to 40 of ANP (1983–1962). Methods Data were tabulated independently by two blinded researchers and cross-verified by independent researchers and automated data extraction technology (Python script). Results From 1963 to 1982, 20 volumes, 80 issues, and 904 articles were published. In 1970, ANP became the official journal of Academia Brasileira de Neurologia (ABN, the Brazilian Academy of Neurology). We analyzed 795 articles (and excluded non-research papers). Compared to the first 20 years, there was a significant increase in the total number of authors per article (2.73; p < 0.05), a significant increase in the percentage of female authors (to 10.96%; p < 0.05), and a decrease in the number of pages per article (p < 0.05). Antonio Spina-França, Walter Carlos Pereira, and Michel Pierre Lison were the most prolific authors. Most of the articles were on the topics of Neurology/Child Neurology, with a decrease in the percentage of Psychiatry papers and an increase in Basic Research contributions. There was also a linear increase in the total number of articles from 1963 to 1982, as detected by regression analysis (R2 = 0.86; p < 0.0001). Most of the articles were written in Portuguese and by authors from Southeastern Brazil (71.1%). Conclusion The years 1963 to 1982 marked the resilience of ANP during the tempestuous years of the Brazilian Military dictatorship, coinciding with an increased split between the Neurology and Psychiatry fields, the appearance of clinical trials and large case series, and a greater development in the understanding of neuroinfectious diseases.

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Abstract Background Eye tracking technology has emerged as a pivotal tool in neurology, providing objective insights into ocular motor function and cognitive processes across various neurological conditions, including mild traumatic brain injury, autism spectrum disorder, schizophrenia, attention deficit hyperactivity disorder, and neurodegenerative diseases like Alzheimer's and Parkinson's disease. Objective The present systematic review evaluates the current applications and reliability of portable eye-tracking devices in clinical practice, highlighting their transformative potential for diagnosing and monitoring cognitive disorders. Methods A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies using portable eye-tracking devices were included. Databases searched included PubMed, Embase, and Cochrane, with studies screened and reviewed by two independent authors. Outcomes assessed were eye movements and visual responses in neurological patients. The Critical Appraisal Skills Program (CASP) checklist was used to assess study quality and bias. Results A total of 62 studies were identified, with 27 included after screening. The findings reveal significant advancements in device accessibility, sampling rates, and accuracy, which enhance the ability to detect subtle cognitive changes through eye movement patterns. Portable devices such as Neurolign DX 100 (Neurolign USA, LLC) and Tobii (Tobii), which is a portable video-oculography (VOG) devices including Neurolign DX 100 and Tobii systems, were highlighted for their precision and applicability in clinical settings. Conclusion Portable eye-tracking devices show promise for detecting cognitive impairments in neurological conditions like multiple sclerosis. Their portability and ease of use facilitate widespread clinical application, making cognitive assessments more accessible and effective in early diagnosis and monitoring of disease progression.

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Abstract Dengue encephalitis is an uncommon neurological complication of dengue virus infection. In immunocompromised patients, such as solid organ transplant recipients, the clinical presentation may be atypical and nonspecific, posing significant diagnostic and therapeutic challenges. We report a clinical case and use it as a framework to discuss key considerations for suspicion of dengue encephalitis. Topics include optimal timing for clinical suspicion, essential differential diagnoses, and the most appropriate diagnostic strategies. Emphasis is placed on the correct interpretation of cerebrospinal fluid findings and recognition of subtle brain magnetic resonance imaging changes that may support the diagnosis. The discussion also reviews current evidence on dengue encephalitis in immunocompromised populations, highlighting implications for timely diagnosis and management in this vulnerable group.

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ABSTRACT Status epilepticus (SE) is the most severe presentation of epilepsy. Most available data on the treatment of SE refers to the convulsive type. Treatment begins with an accurate diagnosis, followed by clinical stabilization and rapid administration of benzodiazepines (BZDs). Then, treatment continues with the use of an intravenous antiseizure medication (ASM). Phenytoin has been the preferred ASM as the second-line treatment of SE (after failure of BZDs to control seizures), although this choice was mostly guided by low-quality evidence. Recent evidence demonstrates that levetiracetamis at least as effective as phenytoin in the treatment of convulsive SE, both in adults and children. Moreover, growing evidence indicates that levetiracetam offers better tolerability and amore favorable safety profile. Therefore, in this Point of View, we argue that we should retire phenytoin in the treatment of convulsive SE, and levetiracetam should become the first choice of treatment.

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Abstract Status epilepticus (SE) is a common neurological emergency that occurs in children and adults. It can be treated with different antiseizure medications (ASMs). Benzodiazepines represent the first line of treatment. If seizure activity does not cease, it is a common clinical practice to prescribe the patient either phenytoin (PHT), levetiracetam, or valproate. For decades, PHT has remained a cornerstone in the treatment of certain types of seizures, despite the emergence of newer agents such as levetiracetam. The current article explores the ongoing relevance of phenytoin, its unique advantages over levetiracetam in specific contexts, and the importance of individualized treatment in epilepsy management.

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ABSTRACT The neurological examination has evolved from rudimentary clinical observations in ancient civilizations to a structured and indispensable tool in modern medical diagnostics. Early contributions from Hippocratic medicine emphasized the brain as the seat of cognition and introduced systematic observation of neurological signs. In the 19th century, figures such as Jean-Martin Charcot, Wilhelm Erb, William Gowers, and Joseph Babinski established the foundations of the modern neurological exam through anatomoclinical correlations, standardization of reflex assessment, and structured clinical reasoning. Throughout the 20th century, seminal textbooks—such as those by Mills, McKendree, DeJong, and Wartenberg—helped consolidate and disseminate neurological semiology globally. More recently, evidence-based approaches, exemplified by Steven McGee's work, have introduced statistical rigor to bedside examinations. Despite advances in neuroimaging and electrophysiology, examinations remain a cornerstone of clinical neurology, guiding diagnosis, promoting cost-effective care, and reinforcing the doctor-patient relationship.