RESUMO JUSTIFICATIVA E OBJETIVOS: Os mecanismos subjacentes à dor nociplástica, como a fibromialgia (FM), não são totalmente compreendidos, contudo acredita-se que o processamento sensorial e a modulação da dor alterados desempenham papéis proeminentes para a manutenção da dor nociplástica. Com a hipótese de que alterações no córtex somestésico primário (S1) contribuam para o caráter de dor generalizada da FM, o objetivo deste estudo foi avaliar o envolvimento do córtex somestésico primário em humanos com FM, bem como investigar possíveis associações entre alterações de S1 com sinais e sintomas clínicos da FM. CONTEÚDO: Para esta revisão integrativa, foram utilizadas as seguintes bases de dados: Pubmed e Web of Science, incluindo estudos observacionais realizados em humanos com FM. No total, 541 estudos foram identificados e quatro foram incluídos. A maioria dos estudos são do tipo caso-controle, publicados entre 2016 e 2022. Ao todo, dados de 161 indivíduos foram incluídos. Foi identificado que há alterações morfológicas, hiperativação e aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e entre S1 e córtex cingulado anterior. CONCLUSÃO: Pacientes com FM apresentam alterações morfológicas e hiperativação em S1, bem como aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e S1 e sistema límbico. Ademais, diferentes sub-regiões somatotrópicas bilaterais (pernas, tórax, dedos, mãos, face e costas) apresentaram redução da conectividade funcional em pacientes com FM. Essas regiões são frequentemente apresentadas como “tender points” na FM. OBJETIVOS nociplástica , (FM) compreendidos acreditase acredita se S (S1 CONTEÚDO integrativa Science total 54 incluídos casocontrole, casocontrole caso controle, controle caso-controle 201 2022 todo 16 anterior CONCLUSÃO límbico Ademais subregiões sub pernas, pernas (pernas tórax dedos mãos costas tender points (FM (S 5 20 202 1 2

ABSTRACT BACKGROUND AND OBJECTIVES: The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM. CONTENTS: For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex. CONCLUSION: Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as “tender points” in FM. OBJECTIVES FM, , (FM) understood however S (S1 CONTENTS review used Science total 54 casecontrol case control 201 2022 16 CONCLUSION system Furthermore legs, legs (legs chest fingers hands back tender points (FM (S 5 20 202 1 2

Resumo Antecedentes A encefalite autoimune (EA) consiste em um grupo de doenças adquiridas que afetam o sistema nervoso central. Objetivo Descrever uma série de pacientes diagnosticados com EA em um contexto de atenção terciária à saúde com recursos limitados e analisar a terapêutica e os resultados. Métodos Revisamos retrospectivamente os prontuários eletrônicos de pacientes diagnosticados com EA no Hospital de Clínicas de Porto Alegre de 2014 a 2022. Os dados coletados incluíram apresentação clínica, neuroimagem, exames de líquido cefalorraquidiano, eletroencefalograma, autoanticorpos, tratamentos, resultados, tempo de acompanhamento, grau de comprometimento neurológico e mortalidade. Resultados Dados de 17 pacientes foram coletados. Onze casos foram classificados como EA definitivo e seis como EA possível. Autoanticorpos foram identificados em nove pacientes. O tempo para o diagnóstico foi afetado pelos altos custos associados ao teste de autoanticorpos. A maioria dos pacientes tornou-se funcionalmente dependente (82,4%), e a maioria dos sobreviventes permaneceu com epilepsia autoimune associada (75%). Cinco pacientes faleceram durante a internação, e um após 26 meses de seguimento. Conclusão No hospital em questão, os pacientes com EA tiveram um desfecho clínico pior do que o previamente descrito na literatura. O desenvolvimento de epilepsia durante o acompanhamento e a mortalidade foram maiores, enquanto o desfecho funcional foi inferior. Os testes de autoanticorpos foram inicialmente negados para a maioria dos pacientes, o que impactou o diagnóstico definitivo e o uso de terapias de segunda linha. (EA central resultados 201 2022 clínica neuroimagem cefalorraquidiano eletroencefalograma tratamentos 1 possível tornouse tornou se 82,4%, 824 82,4% , 82 4 (82,4%) 75%. 75 75% . (75%) internação 2 seguimento questão literatura maiores inferior linha 20 202 82,4 8 (82,4% 7 (75% 82, (82,4 (75 (82, (7 (82 ( (8

Abstract Background Autoimmune encephalitis (AE) consists of a group of acquired diseases that affect the central nervous system. A myriad of phenotypes may be present at the onset. Due to the heterogeneity of clinical presentations, it is difficult to achieve uniformity for the diagnostic and therapeutic processes and follow-up strategies. Objective To describe a series of patients diagnosed with AE in a resource-limited public hospital in southern Brazil and to analyze therapeutics and outcomes. Methods We retrospectively reviewed the electronic medical records of patients diagnosed with AE at the Hospital de Clínicas de Porto Alegre from 2014 to 2022. Data collected included clinical presentation, neuroimaging, cerebrospinal fluid testings, electroencephalogram, autoantibodies, treatments, outcomes, follow-up time, degree of neurological impairment, and mortality. Results Data from 17 patients were retrieved. Eleven cases were classified as definite AE and 6 as possible AE. Autoantibodies were identified in 9 patients. Timing for diagnosis was impacted by the high costs associated with autoantibody testing. Most patients became functionally dependent (82.4%) and most survivors remained with autoimmune-associated epilepsy (75%). Five patients died during hospitalization, and one after a 26-month of follow-up. Conclusion In this resource-limited hospital, patients with AE had a worse clinical outcome than that previously described in the literature. Development of epilepsy during follow-up and mortality were greater, whilst functional outcome was inferior. Autoantibody testing was initially denied in most patients, which impacted the definitive diagnosis and the use of second-line therapies. (AE system onset presentations followup follow up strategies resourcelimited resource limited outcomes 201 2022 presentation neuroimaging testings electroencephalogram autoantibodies treatments time impairment 1 retrieved 82.4% 824 82 4 (82.4% autoimmuneassociated autoimmune 75%. 75 75% . (75%) hospitalization 26month month 26 followup. up. literature greater inferior secondline second line therapies 20 202 82.4 8 (82.4 7 (75% 2 82. (82. (75 (82 (7 (8 (

Abstract Background The pathophysiology of cluster headaches (CHs) involves the trigeminovascular system, the parasympathetic nervous system, and the hypothalamus. Because of the affected hypothalamus, there may be limbic system involvement in CH. Objective To investigate the relationship between depression, anxiety, and alexithymia in CH, to demonstrate that the limbic system is affected. Methods A total of 18 patients with CHs who were outside of cluster period and 18 healthy controls were included. Participants were administered the Beck depression inventory (BDI), Beck anxiety inventory (BAI), and Toronto alexithymia scale-20 (TAS-20). Results Patients with CHs had significantly higher rates of alexithymia (p = 0.003) and depression (p = 0.014) than controls. There was no significant difference in anxiety levels (p = 0.297) between groups. Conclusion It was shown that, in addition to previously identified psychiatric disorders, alexithymia can accompany CHs in patients. (CHs hypothalamus CH 1 included BDI, BDI , (BDI) BAI, BAI (BAI) scale20 scale 20 scale-2 TAS20. TAS20 TAS . (TAS-20) p 0.003 0003 0 003 0.014 0014 014 0.297 0297 297 groups disorders (BDI (BAI scale2 2 scale- TAS2 (TAS-20 0.00 000 00 0.01 001 01 0.29 029 29 (TAS-2 0.0 0.2 02 (TAS- 0. (TAS

Resumen Antecedentes La fisiopatología de la cefalea en racimos (CER) incluye el sistema trigeminovascular, el sistema nervioso parasimpático y el hipotálamo. Debido a la afectación del hipotálamo, puede haber una afectación del sistema límbico en la CER. Objetivo Este estudio pretendía investigar la relación entre depresión, ansiedad y alexitimia en CER para demostrar que el sistema límbico está afectado. Métodos Se incluyeron en el estudio 18 pacientes con CER que se encontraban fuera del periodo de cluster y 18 sujetos control sanos. Se administró a los participantes el inventario de depresión de Beck (IDB), el inventario de ansiedad de Beck (IAB) y la escala de alexitimia de Toronto-20 (TAS-20). Resultados Los pacientes con CER presentaban tasas significativamente más altas de alexitimia (p = 0.003) y depresión (p = 0.014) que los controles. No había diferencias significativas en los niveles de ansiedad (p = 0.297) entre los grupos. Conclusión En pacientes diagnosticados de CER, se demostró que además de los trastornos psiquiátricos previamente identificados, la alexitimia también puede acompañar a la enfermedad. (CER trigeminovascular hipotálamo afectado 1 sanos IDB, IDB , (IDB) IAB (IAB Toronto20 Toronto 20 Toronto-2 TAS20. TAS20 TAS . (TAS-20) p 0.003 0003 0 003 0.014 0014 014 controles 0.297 0297 297 grupos identificados enfermedad (IDB Toronto2 2 Toronto- TAS2 (TAS-20 0.00 000 00 0.01 001 01 0.29 029 29 (TAS-2 0.0 0.2 02 (TAS- 0. (TAS

Resumen El linfoma de Hodgkin (LH) comprende un grupo heterogéneo de neoplasias linfoides cuyo origen radica en linfocitos B. Las manifestaciones neurológicas de dicha enfermedad son infrecuentes, pudiendo tener su origen por invasión directa de las células neoplásicas en el sistema nervioso, o indirectamente, a través de síndromes paraneoplásicos o como complicación del tratamiento. Dentro de los síndromes neurológicos paraneoplásicos que afectan a pacientes con LH, la degeneración cerebelosa paraneoplásica es la más frecuente. Otros reportados con menor frecuencia en series de casos o casos aislados incluyen encefalitis límbica, neuronopatía sensitiva, motora y autonómica. Estos pueden ser la manifestación inicial de la enfer medad neoplásica, y la falta de conocimiento de dicha asociación puede retrasar el diagnóstico, con inicio tardío del tratamiento y peor pronóstico. Reportamos el caso de una mujer con LH que presentó al inicio de su enfermedad neuronopatía sensitiva y autonómica como manifestaciones neurológicas paraneoplásicas. Una vez iniciado el tratamiento específico para su lin foma, la neuronopatía autonómica tuvo resolución casi completa a diferencia de la neuronopatía sensitiva, la cual demostró escasa recuperación.

Abstract Hodgkin lymphoma (HL) comprises a heterogeneous group of lymphoid neoplasms whose origin lies in B lym phocytes. The neurological manifestations of this pathol ogy are infrequent, and may arise from direct invasion of neoplastic cells to the nervous system, or indirectly, through paraneoplastic syndromes or as a complication of treatment. Among the neurological paraneoplastic syndromes that affect patients with HL, paraneoplastic cerebellar degeneration is the most common. Other few cases include limbic encephalitis, sensory, motor, and autonomic neuronopathy. These syndromes can be the initial manifestation of neoplastic disease, and the lack of information regarding this association can lead to a delay in diagnosis and consequently in the initiation of therapy worsening the prognosis. We report the case of a woman with HL who presented sensory and autonomic neuronopathy at the onset of her disease as paraneo plastic neurological manifestations. After the initiation of the specific treatment for the lymphoma, the autonomic neuronopathy had almost complete resolution, unlike the sensory neuronopathy, which showed limited recovery.

Resumen Globalmente, los fármacos son el tipo de agente más frecuentemente implicado en las intoxicaciones pediátricas y las Ben-zodiacepinas el grupo farmacológico más frecuente. La reacción paradojal, secundaria a la exposición a Benzodiacepinas se caracteriza por la presencia de signosintomatología contraria a los efectos sedativos hipnóticos esperados, pudiendo presentarse con inquietud, ansiedad, hostilidad y alteraciones de la conducta, entre otros. La mayoría de los trabajos hallados acerca de este síndrome en pediatría lo describen secundario a Midazolam endovenoso, en contexto de sedación consciente para la realización de diferentes procedimientos. Las causas por los cuales se puede generar este fenómeno de desinhibición no han sido clarificadas, postulándose tres hipótesis: la desregulación colinérgica central, el aumento del tono gabaérgico en el sistema límbico, tálamo e hipotálamo y el desbalance de serotonina. Se expone una serie de 15 pacientes de entre 1 año y 5 años, expuestos accidentalmente a Benzodiacepinas, principalmente Clonazepam y Lorazepam, a fin de describir las características de esta reacción. En esta serie se observó con latencia breve y duración variable, de hasta 11 horas, la presencia en orden de frecuencia, de: ansiedad, irritabilidad, gritos, hostilidad y conductas agresivas, llanto inconsolable, incapacidad de contención por familiares, conductas irracionales, excitación psicomotriz, desinhibición emocional, alucinaciones y aumento de locuacidad, asociado frecuentemente a ataxia.

Abstract Globally, medicines are the most frequently toxins involved in pediatric poisonings, and Benzodiazepines are the most fre-quent pharmacological group in those poisonings. The paradoxical reaction, secondary to Benzodiazepines exposure, is characterized by the presence of contrary expected sedative-hypnotic effects, and may present with restlessness, increased anxiety, hostility, and behav-ioral alterations, among others. The studies we found about this syndrome in pediatric patients describe it most frequently secondary to endovenous Midazolam, in the context of the conscious sedation to perform different procedures. The reasons why this reaction is generated have not been clarified, three hypotheses are postulated: the central cholinergic dysregulation, the increased Gabaergic tone in the limbic system, thalamus and hypothalamus and the serotonin imbalance. A series of 15 patients, between 1 year and 5 years old, accidentally exposed to Benzodiazepines, mainly Clonazepam and Lorazepam, to describe the characteristics of the paradoxical reaction secondary to Benzodiazepines exposure. In this case series, we observed with short latency and variable duration, up to 11 hours, the presence in order of frequency of: anxiety, irritability, screams, hostility and aggressive behaviors, inconsolable crying, inability to con-tain by their family members, irrational behaviors and psychomotor excitement, emotional disinhibition, hallucinations and increased talkativeness, frequently associated with ataxia.

Abstract Dopamine 1 is involved in neurodegenerative disorders affecting the central nervous system (CNS), such as Parkinson’s disease. Despite the absence of some available drugs capable of preventing, stopping or curing the progression of such diseases, there are numerous compounds designed, synthesized, and pharmacologically tested which give rise to pharmacophoric generalizations about the dopaminergic receptor required for the search of a drug able to improve or cure those pathologies. N-aralkyl-2-aminoindane derivatives have shown selective activity in the central dopaminergic system. Both the N-[(2,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 2 and N-[(3,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 3 showed an agonistic activity mediated by central dopaminergic mechanisms. To contribute to the search of new drugs able to re-establish homeostasis in the dopaminergic transmission in Parkinson’s disease, the compound N-2,6- dichloro-aralkyl-2-aminoindane 4 was designed through medicinal chemistry strategies that contain pharmacophoric approximations of prodrugs. The pharmacological evaluation of compound 4 in the stereotyped behavior of male Sprague Dawley rats showed agonistic activity through the activation of central dopaminergic mechanisms and a higher selectivity in the responses of stereo- typed behavior characteristic of the basal ganglia over the typical responses from limbic structures.

Resumen La dopamina 1, está implicada en trastornos neurodegenerativos que afectan al sistema nervioso central (SNC) tales como la enfermedad de Parkinson, entre otros. Aunque no se dispone aún de ningún fármaco capaz de prevenir, detener o curar la progresión de estas enfermedades, son numerosos los compuestos que han sido diseñados, sintetizados y evaluados farmacológicamente, que han aportado las generalizaciones farmacofóricas del receptor dopaminérgico, necesarias para la búsqueda de un fármaco capaz de mejorar o curar estas patologías. Los derivados 2-aminoindano-N-aralquílicos han mostrado tener actividad selectiva en el sistema dopaminérgico central, de modo tal que los compuestos clorhidratos de N-[(2,4-diclorofenil)-1-metil- etil]-2-aminoindano 2 y N-[(3,4-diclorofenil)-1-metil-etil]-2-aminoindano 3 demostraron tener actividad agonística mediada por mecanismos dopaminérgicos centrales. Con el propósito de contribuir en la búsqueda de nuevos fármacos que permitan restablecer la homeostasis de la transmisión dopaminérgica en la enfermedad de Parkinson, el compuesto N-2,6-dicloro-aralquil-2-aminoindano 4 fue diseñado a través de estrategias de la química medicinal, que contienen las aproximaciones farmacofóricas de los profármacos. La evaluación farmacológica del compuesto 4, en la conducta estereotipada en ratas macho de la cepa Sprague Dawley, demostró tener actividad agonística a través de la activación de los mecanismos dopaminérgicos centrales y mostró mayor selectividad en las respuestas de conductas estereotipadas propias de los ganglios basales sobre las respuestas conductuales propias de las estructuras límbicas.

Resumen Introducción: A nivel neurofisiológico el cerebelo, los ganglios basales y el sistema límbico son importantes en la coordinación y memoria del movimiento. Objetivo: Comprender los procesos que intervienen en la relación sensoperceptiva de la audición y el aprendizaje motor es una motivación permanente de diferentes disciplinas. Método: Se presenta una revisión documental que tuvo por objetivo analizar la relación de la percepción auditiva y el aprendizaje motor utilizando análisis de contenido desde las perspectivas de audiología, medicina y neurorrehabilitación. Las palabras clave y combinaciones que se tuvieron en cuenta fueron: percepción auditiva, aprendizaje, equilibrio, coordinación y las combinaciones audición-aprendizaje, audición-equilibrio, y audición-coordinación. Se utilizaron las bases de datos y metabuscadores Pubmed, Medscape, Trip, ScienceDirect, EBSCOhots, Pedro, Scielo, y Lilacs. Bibliotecas virtuales como SINAB, Cochrane, Universidad de Málaga, UsNational Library of Medicine, y National Institutes of Health. Se seleccionaron 22 artículos que cumplieron con los criterios de inclusión. Resultados: Se encontró relación entre la percepción auditiva y el aprendizaje motor en la comunicación de la información sensorial auditiva y motora a nivel del procesamiento en el cerebelo y ganglios, que es una parte fundamental en la retención y transferencia motriz. Conclusión: En el proceso del aprendizaje motor que involucra la experiencia del movimiento, proponemos la participación de la audición, mediante integrar las señales percibidas-visuales, auditivas, motrices y vestibulares- que se concretan en mejorar el aprendizaje, haciéndolo más eficaz y generando una memoria más duradera.

Resumo Introdução: A nível neurofisiológico, o cerebelo, os gânglios basais e o sistema límbico são importantes na coordenação e memória do movimento. Objetivo: Compreender os processos que implicam na relação sensorial-perceptual entre audição e aprendizagem motora como uma motivação permanente para diferentes disciplinas. Método: É apresentada uma revisão documental que visa analisar a relação entre a percepção auditiva e a aprendizagem motora utilizando a análise de conteúdo a partir das perspectivas da audiologia, medicina e neuro reabilitação. As palavras-chave e as combinações consideradas foram: percepção auditiva, aprendizagem, equilíbrio, coordenação e as combinações audição-aprendizagem, audição-equilíbrio e audição-coordenação. Foram utilizadas as bases de dados e os motores de metabusca Pubmed, Medscape, Trip, ScienceDirect, EBSCOhots, Pedro, Scielo, e Lilacs. Bibliotecas virtuais como SINAB, Cochrane, Universidade de Málaga, UsNational Library of Medicine, e National Institutes of Health. Foram selecionados 22 artigos que cumpriam os critérios de inclusão. Resultados: Foi encontrada uma relação entre percepção auditiva e aprendizagem motora na comunicação da informação sensorial auditiva e motora à nível do processamento no cerebelo e nos gânglios, que é uma parte fundamental da retenção e transferência motora. Conclusão: No processo de aprendizagem motora que envolve a experiência do movimento, propomos a participação da audição, integrando os sinais percebidos - visuais, auditivos, motores e vestibulares - que resultam na melhoria da aprendizagem, tornando-a mais eficaz e gerando uma memória mais duradoura.

Abstract Introduction: At the neurophysiological level, the cerebellum, the basal ganglia, and the limbic system are important in the coordination and memory of movement. Objective: Understanding the processes involved in the sensoperceptive relationship of hearing and motor learning is a permanent motivation of different disciplines. Method: A documentary review is presented; it aims to analyze the relationship between auditory perception and motor learning using content analysis from the perspectives of audiology, medicine, and neurorehabilitation. The keywords and combinations taken into account were the following: hearing perception, learning, balance, coordination, and combinations hearing-learning, hearing-balance, and hearing-coordination. The databases and metasearchers Pubmed, Medscape, Trip, ScienceDirect, EBSCOhost, Pedro, Scielo, and Lilacs were used. Virtual libraries such as SINAB, Cochrane, University of Malaga, UsNational Library of Medicine, and National Institutes of Health were also consulted. We selected 22 articles that met the inclusion criteria. Results: A relationship was found between auditory perception and motor learning in the communication of auditory and motor sensory information at the level of processing in the cerebellum and basal ganglia, being a fundamental part of the retention and motor transfer. Conclusion: In the motor learning process involving the experience of movement, we propose the participation of hearing by integrating the perceived signals -visual, auditory, motor, and vestibular- that are concretized to improve learning, making it more effective, generating a more lasting memory.

Abstract The critical scenario of mental health and factors that alter the typical affective neurodevelopment of the population, during 2020, the Ministry of Education has had curriculum orientations to deal with socio-emotional learning. For this reason, a systematic review of neurodevelopmental research of the limbic system and bibliographic references to the ministerial guidelines for socio-emotional learning was carried out. A total of 140 studies published between 2015 and 2020 were obtained on the neurodevelopment of the limbic system and 167 articles referenced by ministerial guidelines, which were analyzed following an adaptation of the PRISMA model. From the analysis carried out, we conclude that the curricular orientations have a theoretical-empirical sustenance supported mainly by psychology and with a low contribution from neurosciences. This suggests that Mineduc consider contributions from the neurodevelopment of the limbic system for better contextualization of socio-emotional learning.

Resumen: Ante un escenario crítico de salud mental y factores que alteran el neurodesarrollo afectivo típico en la población, durante el 2020 el Ministerio de Educación ha dispuesto de orientaciones curriculares para afrontar el aprendizaje socioemocional. Por tal motivo, se realizó una revisión sistemática de las investigaciones de neurodesarrollo del sistema límbico y de las referencias bibliográficas de las orientaciones ministeriales de aprendizaje socioemocional. Se obtuvieron 140 estudios publicados entre el 2015 y el 2020 de neurodesarrollo del sistema límbico y 167 artículos referenciados por las orientaciones ministeriales, que fueron analizadas siguiendo una adaptación del modelo PRISMA. Del análisis realizado, se concluye que las orientaciones curriculares poseen un sustento teórico-empírico apoyado principalmente por la psicología y con escaso aporte de las neurociencias. Se sugiere que el MINEDUC tome en consideración aportes del neurodesarrollo del sistema límbico para una mejor contextualización del aprendizaje socioemocional.

Resumo Objetivo Averiguar a ocorrência e o tipo de hipersensibilidade auditiva em crianças com sinais clínicos de Transtorno do Espectro do Autismo por meio do relato dos pais no contexto da pandemia da COVID-19. Método Trata-se de um estudo transversal e descritivo, composto por pais de 11 crianças com sinais clínicos de risco para Transtorno do Espectro do Autismo. As crianças eram de ambos os sexos, com média de 44,8 meses de idade. Os pais responderam, por meio de contato telefônico, a um questionário, previamente validado, sobre comportamentos de hipersensibilidade auditiva de seus filhos. Foi considerado como sinalizador de hipersensibilidade a pontuação igual ou superior a oito pontos no escore geral. Resultados 63,6% das crianças apresentaram resultado indicativo de hipersensibilidade e 54,5% obtiveram pontuação máxima nas questões relacionadas à irritabilidade a sons específicos. Os sons citados como geradores de irritabilidade foram: palmas, fogos, gritos, ferramentas de construção, canto e toque de celular. Conclusão Constatou-se ocorrência de hipersensibilidade auditiva, especialmente relacionada à irritabilidade, o que sugere relação com o sistema límbico e, portanto, pode remeter à misofonia. Assim, torna-se importante a equipe multidisciplinar atentar-se à ocorrência e a características de hipersensibilidade dessa população, a fim de maximizar condições favoráveis à reabilitação.

Abstract Objective To investigate the occurrence and type of auditory hypersensitivity in children with clinical signs of Autism Spectrum Disorder through parents' reports in the context of the COVID-19 pandemic. Method This is a cross-sectional and descriptive study, composed of parents of 11 children with clinical signs of risk for Autism Spectrum Disorder. The children were of both sexes, with a mean age of 44.8 months. Parents answered a previously validated questionnaire about their children's auditory hypersensitivity behaviors by telephone. A score equal to or greater than eight points in the general score was considered as a sign of hypersensitivity. Results 63.6% of the children presented results indicative of hypersensitivity and 54.5% obtained maximum scores on questions related to irritability to specific sounds. The sounds cited as generating irritability were: clapping, fireworks, shouting, construction tools, singing and cell phone ringtones. Conclusion Auditory hypersensitivity was observed, especially related to irritability, which suggests a relationship with the limbic system and, therefore, may refer to misophonia. Thus, it is important for the multidisciplinary team to pay attention to the occurrence and characteristics of hypersensitivity in this population, in order to maximize favorable conditions for rehabilitation.

Abstract The protocol on Psychological First Aid (PFA) establishes a number of actions to take on victims who are in the area of an event. Through these actions, the victims are assisted and helped to feel calm but not passive. Regarding the implementation of PFA in disaster situations, the type of decision-making, analytic or intuitive, could represent an important factor in the effectiveness of the actions of aid provided by volunteers in emergencies and disaster situations. Modifications of a PFA protocol are presented to apply to victims in the early stages of a disaster; these modifications are intended to clear the life-saving area for the rescuer and reduce the risk of post-traumatic stress disorder (PTSD). Starting from the premises of the original model of Farchi, known as the Model of the 6 Cs, a simplified version for its application in Argentina was denominated the Model of the 4 Cs. In the same way, it is considered that, when assisting a person in a situation of crisis or disaster, the objective is to promote the activity of the prefrontal cortex and decrease the action of the limbic system. To do this, four guidelines are proposed: 1) Cognitive Communication, 2) Control and Challenge, 3) Commitment and 4) Continuity. Likewise, a PFA protocol based on the above mentioned model is presented. An explanatory and cross-sectional study was carried out with the objective of analyzing the effectiveness and the decision times when providing a PFA in the initial phases of a disaster, depending on the style and decision process involved. An intentional non-probabilistic sample, composed of 165 rescue volunteers from 4 fire stations in the AMBA area (Metropolitan Area and Greater Buenos Aires) and a headquarters of the Red Cross of the party of Tigre (San Fernando), was randomly divided into 2 groups (trained and untrained in PFA). Each volunteer was evaluated through the Software of the First Aid Interactive Psychological System (SIPAPSI); this consisted of a simulation of different crisis situations during which the participants must decide between different options presented in audiovisual format. The user must select the video that most closely approximates to what he or she would do in the presented situation. Then, the rescuers were randomly divided with respect to the slogan about the decision-making process used in the evaluation (“decide based on what you think”, rational, or “decide based on what you feel”, affective). The software SIPAPSI recorded the participant's response and the response time for each scene. Likewise, each volunteer was evaluated using the test Bases for Urgent Decisions under Extreme Circumstances Inventory (BUDECI). The BUDECI is composed of 8 elements that evaluate the decision-making style in unexpected and very important situations according to two dimensions: affective and rational. Rescuers were divided according to their urgent decision-making style: affective or rational. Therefore, the volunteers were classified according to whether or not they presented an adjustment between the decision-making style and the decision-making process induced by the slogan. This allowed us to study the influence of this adjustment on the effectiveness and decision time in disaster situations. The results showed that the least effective and, at the same time, slowest were those trained rescuers with an urgent affective decision style but induced under an emotional process. The PFA training has enabled the acquisition of simple action strategies in emergencies and disaster situations. It is concluded that the rational decision-making style or a rational decision induction favors a greater effectiveness of the PFA actions. These results allow us to build an optimal decisional profile for the rescuer’s performance in crisis intervention tasks.

Resumen Se realizó un estudio explicativo y transversal con el objetivo de analizar la efectividad y los tiempos en la toma de decisiones al momento de brindar una primera ayuda psicológica (PAP) en las fases iniciales de un desastre en función del estilo y el proceso decisorio implicados. Se tomó una muestra no probabilística intencional de 165 voluntarios rescatistas de cuatro cuarteles de la zona de AMBA, se los dividió aleatoriamente en dos grupos (capacitados y no capacitados en PAP) y, a su vez, dichos grupos fueron divididos aleatoriamente respecto de la consigna impartida en la evaluación sobre el proceso decisorio a utilizar (decidir en función de lo que se piensa o de que lo que se siente). Asimismo, cada rescatista fue clasificado como “racional” o “afectivo” según el estilo decisorio urgente medido por el instrumento Bases for Urgent Decisions under Extreme Circumstances Inventory (BUDECI). Los resultados mostraron que los menos efectivos y más lentos fueron aquellos rescatistas capacitados con un estilo urgente decisorio afectivo, bajo una consigna que apelaba también a lo emocional. Este último grupo no presentó diferencias respecto de su efectividad cuando se lo comparó con el grupo de los no capacitados. La mayor efectividad la obtuvieron aquellos grupos que tenían un estilo o una consigna de tipo racional. La capacitación en PAP ha posibilitado la adquisición de estrategias de acción sencillas. Se concluye que el estilo decisorio y/o una inducción decisoria racionales favorecen una mayor efectividad de las acciones de PAP en las fases iniciales de un desastre.

Abstract Background: Autoimmune encephalitis occurs as a subacute condition with a strong infectious association in children. In the last 20 years, the frequency of non-infectious cases has increased significantly. Clinical case: A previously healthy eight-year-old male child with normal neurodevelopment, without a history of consanguinity, manifested progressive neurological deterioration with autoimmune encephalitis-limbic encephalitis up to hypothalamic dysfunction. Conclusion: In the mentioned case, it was documented that an inborn error of the immune system generated a severe neurological clinical picture, with permanent and irreversible damage, secondary to lack of immunological memory in the broad clinical context of a common variable immunodeficiency.

Resumen Antecedentes: La encefalitis autoinmune se presenta como un cuadro subagudo con fuerte asociación infecciosa en los niños. En los últimos 20 años, la frecuencia de casos no infecciosos ha aumentado de manera significativa Caso clínico: Niño del sexo masculino de ocho años de edad previamente sano con neurodesarrollo normal, sin antecedente de consanguinidad, en quien se manifestó deterioro neurológico progresivo con encefalitis autoinmune-encefalitis límbica hasta disfunción hipotalámica. Conclusión: En el caso referido se documentó un error innato del sistema inmunológico que generó cuadro clínico neurológico severo, con daño permanente e irreversible secundario a falta de memoria inmunológica en el contexto clínico amplio de una inmunodeficiencia común variable.

Introdução: A encefalite é uma condição inflamatória cerebral com múltiplas etiologias. Na maioria dos casos, os agentes virais são os principais responsáveis, mas raramente a etiologia pode ser autoimune/paraneoplásica. A incidência de encefalite paraneoplásica é desconhecida. As neoplasias mais frequentemente associadas a esta síndroma são o carcinoma pulmonar, tumor testicular, neoplasia da mama, timoma e linfoma de Hodgkin. Pensa-se que o mecanismo etiopatogénico se relaciona com a produção de autoanticorpos contra a superfície neuronal e/ou proteínas sinápticas. Dependendo do local do sistema nervoso afetado, a sintomatologia varia, sendo que a encefalite límbica é caracterizada pelo início agudo de alterações do comportamento, humor, memória a curto-prazo e disfunção cognitiva. A deteção e tratamento precoces melhoram o prognóstico, a rapidez da recuperação e reduzem o risco de recaída. A ausência de tratamento pode evoluir para um quadro neurológico debilitante, culminando em coma e morte em alguns doentes. Descrição do caso: Mulher de 50 anos, avaliada na Unidade de Saúde Familiar (USF) em 2017, por alterações mnésicas súbitas e alterações do comportamento. À avaliação apresentava apatia, anedonia e escassez de discurso, esboçando, por vezes, um riso inapropriado. Desorientação espacial, temporal e em relação a si própria, que evoluiu para um quadro de agressividade e não reconhecimento dos seus familiares. A investigação etiológica concluiu tratar-se de encefalite autoimune/paraneoplásica, tendo a doente sido internada em neurologia. O estudo investigacional mostrou massa no mediastino anterior, compatível com timoma. Em 2018, a doente foi submetida a exérese da neoplasia com recuperação do quadro neurológico. Comentário: A baixa prevalência desta patologia e o seu diagnóstico diferencial com doença psiquiátrica tornam difícil o diagnóstico desta síndroma. O médico de família, conhecendo os seus pacientes ao longo do tempo, está numa posição privilegiada para a deteção de sinais de alarme que carecem de investigação e tratamento diferenciados.

Introduction: Encephalitis is an inflammatory condition with multiple etiologies. In most cases, the viral agents are mainly responsible, but rarely the etiology can be autoimmune/paraneoplastic. Paraneoplastic encephalitis incidence is unknown. The neoplasms most often associated with this syndrome are pulmonary carcinoma, tumor testicular, breast neoplasm, thymoma, and Hodgkin's lymphoma. It is thought that the etiopathogenic mechanism relates to the production of autoantibodies against the neuronal surface and/or synaptic proteins. Depending on the location of the nervous system affected, the symptoms vary. Limbic encephalitis is characterized by acute onset of changes in behavior, mood, short-term memory and cognitive dysfunction. Early detection and treatment improve the prognosis, the recovery time and reduce the risk of relapse. The absence of treatment may evolve into a debilitating neurological condition, culminating in coma and death. Case description: A 50-year-old woman was evaluated at the Unidade de Saúde Familiar (USF) in 2017, due to sudden amnesic and behavioral changes. In the evaluation, she presented apathy, anhedonia and a lack of speech, occasionally sketching an inappropriate laugh. She was disoriented in space, time and in relation to herself, evolving into a picture of aggressiveness and non-recognition of her relatives. The etiological investigation concluded that the situation was compatible with autoimmune/paraneoplastic encephalitis, and the patient was admitted to neurology. The investigational study showed a mass in the anterior mediastinum compatible with thymoma. In 2018, the patient underwent excision of the neoplasia, with the recovery of the neurological condition. Comment: The low prevalence of this condition and his differential diagnosis with psychiatric illness make it difficult to diagnose this syndrome. The family doctor, who knows his patients over time, is in a privileged position for the detection of alarm signs which require differentiated investigation and treatment.

ABSTRACT Background: Persistence of cavum septum pellucidum (CSP) and cavum vergae (CV) into adulthood and their association with mood disorders is unknown. Objective: We aimed to assess persistence of these cava in Atahualpa cohort individuals, and their association with clinical depression (as a surrogate of limbic system dysfunction). Methods: Cases were defined as Atahualpa residents aged ≥20 years with CSP and/or CV and paired 1:1 to age- and sex-matched randomly-selected controls. A board-certified psychiatrist (blinded to case-control status) interviewed individuals with the aid of the Patient Health Questionnaire depression module (PHQ-9) to establish a diagnosis of clinical depression. The McNemar’s test and conditional logistic regression models were fitted to assess the independent association between persistence of CSP and/or CV and clinical depression (as the dependent variable). Results: Of 1,298 individuals undergoing a head CT, 51 (3.9%) had a CSP and/or CV. The selection process for the nested case-control study on the Atahualpa cohort (after excluding eight missing individuals with midline cava) generated 43 pairs. Nine of 43 case-patients (20.9%) and only two control subjects (4.7%) had moderate-to-severe scores on the PHQ-9 (cutoff ≥10 points). Clinical depression was significantly more frequent among case-patients than controls by the McNemar’s test (OR: 8; 95% C.I.: 1.1 - 354.9) and the conditional logistic regression model (OR: 8; 95% C.I.: 1.00 - 63.96). Conclusions: This study provides epidemiological evidence favoring the association between midline cava and clinical depression, supporting their relationship with limbic system dysfunction.

RESUMEN Antecedentes: La persistencia de cavum septum pellucidum (CSP) y cavum Vergae (CV) en adultos y su asociación con trastornos del estado de ánimo es desconocida. Objetivo: Evaluar la persistencia de estas cavidades y su asociación con depresión clínica (como marcador de disfunción del sistema límbico). Métodos: Los casos se definieron como residentes de Atahualpa con edades ≥20 años con CSP y/o CV y se emparejaron 1:1 con controles aleatoriamente seleccionados de acuerdo con edad y sexo. Un psiquiatra (ciego al estado caso/control) entrevistó a los individuos con el módulo de depresión del cuestionario de salud del paciente (PHQ-9) para establecer diagnóstico de depresión clínica. La prueba de McNemar y modelos de regresión logística condicional se utilizaron para evaluar la asociación independiente entre persistencia de CSP y/o CV y depresión clínica (como variable dependiente). Resultados: De 1.298 individuos sometidos a TC de cerebro, 51 (3.9%) tenían un CSP y/o CV. El proceso de selección para el estudio de casos y controles generó 43 pares. Nueve de 43 casos (20.9%) y solo dos controles (4.7%) tuvieron puntajes de moderados a severos en el PHQ-9 (punto de corte ≥10 puntos). La depresión clínica fue significativamente más frecuente entre los pacientes que en los controles mediante la prueba de McNemar (OR: 8; 95% C.I.: 1.1 - 354.9) y la regresión logística condicional (OR: 8; 95% C.I.: 1.00 - 63.96). Conclusiones: Este estudio proporciona evidencia epidemiológica que favorece la asociación entre persistencia de CSP y/o CV y depresión clínica, lo que favorece su relación con disfunción del sistema límbico.

Abstract Background: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. Objective: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. Method: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky’s global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. Results: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. Conclusion: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

Resumen Antecedentes: El tratamiento neuroquirúrgico, aunque polémico, se considera un recurso útil en el tratamiento de enfermedades psiquiátricas crónicas como la agresividad refractaria. Objetivo: Evaluar los resultados clínicos y los efectos colaterales de la hipotalamotomía posteromedial (HPM) asociada a amigdalotomía en pacientes con agresividad refractaria. Método: Se realizó un ensayo clínico en pacientes con agresividad crónica y refractaria a tratamiento farmacológico. Se les realizó amigdalotomía central asociada a HPM mediante termocoagulación por radiofrecuencia. El grado de agresividad se cuantificó mediante la escala global de agresividad de Yudofsky. Los cambios postoperatorios en la conducta agresiva continuaron siendo evaluados cada 6 meses durante al menos 36 meses. Resultados: Se observó un cambio estadísticamente significativo de la conducta agresiva, a lo largo de 36 meses de seguimiento. Se describen los efectos colaterales de la asociación de ambos procedimientos, siendo el de mayor frecuencia la somnolencia y algunos casos de reducción en la conducta sexual. Conclusión: Las lesiones unilaterales simétricas y simultáneas del núcleo central de la amígdala y del hipotálamo posteromedial contralaterales a la dominancia motora dan el mismo efecto clínico en la reducción de la agresividad patológica que las lesiones bilaterales.

Abstract Background Brain-imaging studies in post-traumatic stress disorder (PTSD) have consistently revealed alterations in brain structure and function and this is correlated to symptomatology. However, few studies have investigated the role of biomarkers in PTSD some specific groups, as police officers. Objective To evaluate prefrontal and limbic volumes, and cortical thickness of police officers exposed to trauma during work who developed post-traumatic stress disorder, resilient matched controls (without PTSD), and compared to healthy civilians. Methods Prefrontal and limbic volumes, and cortical thickness of 12 police officers with PTSD, 12 resilient police officers, and 12 healthy civilians who underwent brain MRI were analyzed. Results Differences in limbic structures volume were not significative after Bonferroni correction. A significant reduction in cortical thickness on right rostral cingulate, right and left middle frontal gyrus, left superior frontal, left lingual, calcarine and cuneus were observed in PTSD group in comparison to controls was observed. Discussion Although preliminary, our results suggested not only the association between cortical thickness and PTSD, but also indicated that patients and controls have anatomical differences.