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Resumo O tratamento da doença de Parkinson (DP) constitui um desafio, especialmente por ser considerado muito individualizado. A Academia Brasileira de Neurologia (ABN) identificou a necessidade de disseminar o conhecimento sobre o manejo do tratamento da DP, adaptando as melhores evidências à realidade brasileira. Assim, foi realizada uma revisão sobre as principais orientações de tratamento publicadas, baseada nas recomendações elaboradas por um grupo de especialistas em transtornos do movimento do departamento científico da ABN.

ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.

https://doi.org/10.1590/0004-282x-anp-2021-0219

Acute hemicerebellitis in a young adult: a potential pitfall
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Fraiman, Pedro Henrique Almeida

; Moreira-Neto, Manuel

; Godeiro-Junior, Clecio

Arquivos de Neuro-Psiquiatria

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nov 2021, Volume 79 N. 11 Pages 1047 - 1048

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x-anp-2021-0145 1 downloads

Reply to letter regarding the article entitled: ‘Rapidly progressive sporadic Creutzfeldt-Jakob disease: isolated Heidenhain variant or a combination with PRES?’
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Fraiman, Pedro Henrique Almeida

; Teixeira, Carolina Militão

; de Oliveira, Juliano César Dantas

; de Sousa, Thadeu Alexandre Paulino

; Moreira-Neto, Manuel

; Godeiro-Junior, Clecio de Oliveira

Arquivos de Neuro-Psiquiatria

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sep 2021, Volume 79 N. 9 Pages 855 - 855

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x-anp-2021-0206r 57 downloads

Use of non-invasive stimulation in movement disorders: a critical review
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Godeiro, Clecio

; França, Carina

; Carra, Rafael Bernhart

; Saba, Felipe

; Saba, Roberta

; Maia, Débora

; Brandão, Pedro

; Allam, Nasser

; Rieder, Carlos R. M.

; Freitas, Fernando Cini

; Capato, Tamine

; Spitz, Mariana

; Faria, Danilo Donizete de

; Cordellini, Marcela

; Veiga, Beatriz A. A. G.

; Rocha, Maria Sheila G.

; Maciel, Ricardo

; Melo, Lucio B. De

; Möller, Patricia D. S.

; R. R. Júnior, Magno

; Fornari, Luís H. T.

; Mantese, Carlos E.

; Barbosa, Egberto Reis

; Munhoz, Renato P.

; Coletta, Marcus Vinicius Della

; Cury, Rubens Gisbert

Arquivos de Neuro-Psiquiatria

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jul 2021, Volume 79 N. 7 Pages 630 - 646

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A estimulação não-invasiva tem sido amplamente utilizada nos últimos 30 anos no estudo e no tratamento de um grande número de doenças neurológicas, incluindo distúrbios do movimento. Objetivos: Nesta revisão crítica, discutimos o embasamento científico do uso da estimulação não-invasiva em distúrbios do movimento e as evidências científicas dos principais ensaios clínicos realizados. Métodos: Um grupo de especialistas realizou uma revisão crítica abrangente da literatura a fim de analisar as principais aplicações da estimulação magnética transcraniana (EMT) e da estimulação transcraniana por corrente contínua (ETCC) em distúrbios do movimento. As classes de evidência e de recomendação foram descritas para cada doença. Resultados: Apesar da grande variabilidade da metodologia e baixo efeito clínico, a EMT é provavelmente eficaz para o tratamento dos sintomas motores e da depressão na doença de Parkinson. A eficácia em outros distúrbios do movimento ainda é incerta. A EMT é possivelmente eficaz para o tratamento da distonia focal da mão, do tremor essencial e da ataxia cerebelar. No entanto, é provavelmente ineficaz na redução dos tiques na síndrome de Tourette. Finalmente, a ETCC é provavelmente eficaz na melhora da marcha na doença de Parkinson. Conclusões: As evidências até o momento sugerem que a estimulação não-invasiva pode ser benéfica para o alívio de alguns sintomas em determinados distúrbios do movimento como a doença de Parkinson, o tremor essencial, a distonia e a ataxia. Os protocolos de aplicação e paradigmas de estimulação ainda precisam ser investigados em ensaios clínicos maiores, assim como os seus efeitos a longo prazo.

Abstract Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson’s disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

https://doi.org/10.1590/0004-282x-anp-2020-0381 427 downloads

Genetics of Parkinson’s disease in Brazil: a systematic review of monogenic forms
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Santos-Lobato, Bruno L.

; Schumacher-Schuh, Artur

; Mata, Ignacio F.

; Letro, Grace H.

; Braga-Neto, Pedro

; Brandão, Pedro R. P.

; Godeiro-Junior, Clécio O.

; Coletta, Marcus V. Della

; Camargos, Sarah T.

; Borges, Vanderci

; Rieder, Carlos R. M.

; Tumas, Vitor

Arquivos de Neuro-Psiquiatria

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jul 2021, Volume 79 N. 7 Pages 612 - 623

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: Um número crescente de mutações causando formas monogênicas de doença de Parkinson (DP) tem sido descrito, principalmente entre pacientes da Europa e da América do Norte. Como a arquitetura genética varia entre diferentes populações, entender os perfis genéticos específicos de pacientes brasileiros é essencial para um melhor aconselhamento genético e para a seleção de participantes para ensaios clínicos. Objetivo: Revisão sistemática para identificar estudos genéticos brasileiros na área e definir o cenário para estudos futuros das formas monogênicas de DP no Brasil. Métodos: Nós pesquisamos as bases de dados MEDLINE, EMBASE e Web of Science desde a criação até dezembro de 2019, usando termos para “Parkinson’s disease”, “genetics” e “Brazil”. A extração de dados foi feita por dois revisores independentes. Para os genes LRRK2 e PRKN, calculamos a prevalência estimada para cada estudo e realizamos uma meta-análise. Resultados: Um total de 32 estudos foram incluídos e 94 pacientes brasileiros com DP com mutações causativas foram identificados em 2872 pacientes avaliados (3.2%). As mutações no PRKN causaram DP em 48 de 576 pacientes (8.3%). As mutações no LRRK2 foram identificadas em 40 de 1566 pacientes (2.5%), sendo a mutação mais comum a p.G2019S (2.2%). Conclusões: As mutações na PRKN são a causa mais comum de DP autossômica recessiva, e as mutações no LRRK2 a causa mais comum de DP autossômica dominante. Nós observamos uma falta de estudos epidemiológicos robustos em genética de DP, especialmente por não levar em conta a diversidade de nossa população.

ABSTRACT Background: Increasing numbers of mutations causing monogenic forms of Parkinson's disease (PD) have been described, mostly among patients in Europe and North America. Since genetic architecture varies between different populations, studying the specific genetic profile of Brazilian patients is essential for improving genetic counseling and for selecting patients for clinical trials. Objective: We conducted a systematic review to identify genetic studies on Brazilian patients and to set a background for future studies on monogenic forms of PD in Brazil. Methods: We searched MEDLINE, EMBASE and Web of Science from inception to December 2019 using terms for "Parkinson's disease", "genetics" and "Brazil". Two independent reviewers extracted the data. For the genes LRRK2 and PRKN, the estimated prevalence was calculated for each study, and a meta-analysis was performed. Results: A total of 32 studies were included, comprising 94 Brazilian patients with PD with a causative mutation, identified from among 2,872 screened patients (3.2%). PRKN mutations were causative of PD in 48 patients out of 576 (8.3%). LRRK2 mutations were identified in 40 out of 1,556 patients (2.5%), and p.G2019S was the most common mutation (2.2%). Conclusions: PRKN is the most common autosomal recessive cause of PD, and LRRK2 is the most common autosomal dominant form. We observed that there was a lack of robust epidemiological studies on PD genetics in Brazil and, especially, that the diversity of Brazil’s population had not been considered.

https://doi.org/10.1590/0004-282x-anp-2020-0409 282 downloads

Rapidly progressive sporadic Creutzfeldt-Jakob disease: isolated Heidenhain variant or a combination with PRES?
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FRAIMAN, Pedro Henrique Almeida

; TEIXEIRA, Carolina Militão

; DE OLIVEIRA, Juliano César Dantas

; DE SOUSA, Thadeu Alexandre Paulino

; MOREIRA-NETO, Manuel

; GODEIRO-JUNIOR, Clecio de Oliveira

Arquivos de Neuro-Psiquiatria

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apr 2021, Volume 79 N. 4 Pages 352 - 353

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x-anp-2020-0428 163 downloads

Reply to the letter “Multifocal T2-/DWI-hyperintense cerebral lesions in COVID-19 not necessarily imply demyelination”
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PESSOA NETO, Agábio Diógenes

; ALVES, Manoella do Monte

; BRITO, Paulo Santiago de Morais

; MOREIRA NETO, Manuel

; SILVA, Rodrigo Alencar e

; TEIXEIRA DOURADO JUNIOR, Mario Emílio

; GODEIRO JUNIOR, Clécio de Oliveira

Arquivos de Neuro-Psiquiatria

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jan 2021, Volume 79 N. 1 Pages 94 - 95

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x-anp-2020-0505rep 322 downloads

10.

SPIKES-D: a proposal to adapt the SPIKES protocol to deliver the diagnosis of dementia
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Peixoto, Vanessa Giffoni de Medeiros Nunes Pinheiro

; Diniz, Rosiane Viana Zuza

; Godeiro Junior, Clécio de Oliveira

Dementia & Neuropsychologia

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dec 2020, Volume 14 N. 4 Pages 333 - 339

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO. A demência é uma condição incurável e estigmatizada, com impacto devastador na identidade pessoal do paciente e seus cuidadores. Existem muitas barreiras para uma adequada comunicação do diagnóstico às pessoas com demência, incluindo medo de causar estresse psicológico, incerteza do diagnóstico, objeção dos cuidadores e falta de treinamento em habilidades de comunicação nas escolas de medicina. Embora alguns artigos sobre como auxiliar a equipe médica a comunicar um diagnóstico de demência tenham sido publicados, nenhum protocolo específico foi publicado até o presente momento. O protocolo SPIKES é uma abordagem didática desenvolvida para auxiliar a comunicação de más notícias relacionadas ao câncer, mas tem sido utilizado em todo o mundo e nos mais diversos contextos clínicos, inclusive no ensino de habilidades de comunicação para estudantes e residentes de medicina. Entretanto, é sabido que o declínio cognitivo inerente à doença de Alzheimer e outras demências pode limitar a compreensão da complexidade do diagnóstico, tendo sido realizadas, portanto, algumas adaptações nesse protocolo após revisão da literatura acerca da comunicação do diagnóstico das demências. O protocolo SPIKES-D aqui sugerido parece englobar as diretrizes atuais sobre a comunicação do diagnóstico de demências, preservando seu caráter didático na comunicação de más notícias e auxiliando no preenchimento das lacunas neste tópico.

ABSTRACT. Dementia is a life-threatening and stigmatizing condition, with devastating impacts on the patient's personal identity and caregivers. There are many barriers to an effective diagnosis disclosure of dementia, including fear of causing distress, uncertainty of diagnosis, caregivers’ objection and lack of training in communication skills in undergraduate medical schools. Although some studies have been published on how to help physicians deliver an Alzheimer's disease diagnosis, no specific protocol has been published yet. The SPIKES protocol is a didactic approach designed to deliver bad news related to cancer, but it has been used globally and in a variety of clinical settings, including the teaching of communication skills to medical students and residents. It is known, however, that the cognitive impairment of Alzheimer's disease and other dementias may limit the understanding of the diagnosis’ complexity; hence, a few adaptations of this model were made after reviewing the current literature on dementia diagnosis disclosure. The suggested SPIKES-D protocol seems to encompass current guidelines about the communication of the diagnosis of dementia, keeping its didactic approach on breaking bad news and helping fulfill the gaps in this topic.

https://doi.org/10.1590/1980-57642020dn14-040001 913 downloads

11.

Acute parkinsonism and bilateral basal ganglia lesions
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SILVA, Rodrigo Alencar e

; DE SOUSA, Thadeu Alexandre Paulino

; GODEIRO-JUNIOR, Clécio

Arquivos de Neuro-Psiquiatria

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dec 2020, Volume 78 N. 12 Pages 816 - 816

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x20200103 454 downloads

12.

Possible acute multifocal demyelinating lesions in a COVID-19 patient
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PESSOA NETO, Agábio Diógenes

; ALVES, Manoella do Monte

; BRITO, Paulo Santiago de Morais

; MOREIRA NETO, Manuel

; SILVA, Rodrigo Alencar e

; TEIXEIRA DOURADO, Mario Emílio

; GODEIRO JUNIOR, Clécio de Oliveira

Arquivos de Neuro-Psiquiatria

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oct 2020, Volume 78 N. 10 Pages 666 - 666

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x20200126 444 downloads

13.

Magnetic resonance imaging traits may help to differentiate Pelizaeus-Merzbacher and Pelizaeus-Merzbacher-like disease
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Castro, Matheus Augusto Araújo

; Fraiman, Pedro Henrique Almeida

; Godeiro-Junior, Clecio de Oliveira

Arquivos de Neuro-Psiquiatria

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aug 2019, Volume 77 N. 8 Pages 594 - 594

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x20190081 915 downloads

14.

Minimal prevalence of Huntington’s disease in the South of Brazil and instability of the expanded CAG tract during intergenerational transmissions
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Castilhos, Raphael Machado de

; Santos, José Augusto dos

; Augustin, Marina Coutinho

; Pedroso, José Luiz

; Barsottini, Orlando

; Saba, Roberta

; Ferraz, Henrique Ballalai

; Godeiro Junior, Clécio

; Vargas, Fernando Regla

; Salarini, Diego Zanotti

; Furtado, Gabriel Vasata

; Polese-Bonatto, Marcia

; Rodrigues, Luiza Paulsen

; Sena, Lucas Schenatto

; Saraiva-Pereira, Maria Luiza

; Jardim, Laura Bannach

Genetics and Molecular Biology

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jun 2019, Volume 42 N. 2 Pages 329 - 336

Abstract: En | Text: En | PDF: En

Abstract Huntington’s disease (HD) is due to dominant expansions of the CAG repeat of the HTT gene. Meiotic instability of the (CAG)n might impact the disorder frequency. We report on HD minimal prevalence in Rio Grande do Sul (RS) state, Brazil, and on intergenerational instability of the (CAG)n in HD families. Symptomatic and at-risk subjects from 179 HD families were ascertained between 2013 and 2016. Clinical, molecular and family history data were obtained. Expanded (CAG)n length differences between parent and child (delta-expanded-(CAG)n) were calculated. Effect of parental age on the (CAG)n instability upon transmission was inferred by correlating delta-expanded-(CAG)n between siblings to their age differences. HD minimal prevalence in RS state was estimated as 1.85:100,000 inhabitants. Alleles with (CAG)27-35 were found on 21/384 non-disease associated chromosomes (5.5%); among 253 expanded alleles, four (1.6%) were within reduced penetrance range with (CAG)36-39. In 32 direct transmissions, mean instability was larger among paternal than maternal transmissions. In direct transmissions and in 51 sibling pairs, parental age at the time of child birth were not correlated with delta-expanded-(CAG)n. Briefly, HD prevalence in RS state was lower than those reported for European populations. Expanded (CAG)n transmissions were unstable and not associated to parental age.

https://doi.org/10.1590/1678-4685-gmb-2018-0032 1288 downloads

15.

Reply
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Alencar e Silva, Rodrigo

; Campelo, Camila

; Godeiro Jr., Clecio

Arquivos de Neuro-Psiquiatria

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sep 2018, Volume 76 N. 9 Pages 641 - 641

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0004-282x20180100 726 downloads

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