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Bacellar A, Assis TRD, Pedreira BB, CÔrtes L, Santana S, Nascimento OJMD. Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:687-694. [PMID: 33263637 DOI: 10.1590/0004-282x20200062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Population ageing is a global phenomenon, and life expectancy in Brazil is growing fast. Epilepsy is the third most important chronic neurological disorder, and its incidence is higher among elderly patients than in any other segment of the population. The prevalence of epilepsy is greater among inpatients than in the general population and it is related to long length of hospital stay (LOS), which is associated with hospital mortality and higher healthcare costs. Despite these facts, reports of elderly inpatients admitted with seizures and associated outcomes are scarce. To identify predictors of long LOS among elderly inpatients admitted with seizures. METHODS We prospectively enrolled elders admitted with epileptic seizures or who experienced seizures throughout hospitalization between November 2015 and August 2019. We analysed demographic data, neurological disorders, clinical comorbidities, and seizure features to identify risk factors. RESULTS The median LOS was 11 days, with an interquartile range (IQR) of 5-21 days. The frequency of long LOS (defined as a period of hospitalization ≥12 days) was 47%. Multivariate analysis showed there was an exponential increase in long LOS if a patient showed any of the following conditions: intensive care unit (ICU) admission (OR=4.562), urinary tract infection (OR=3.402), movement disorder (OR=5.656), early seizure recurrence (OR=2.090), and sepsis (OR=4.014). CONCLUSION Long LOS was common among elderly patients admitted with seizures, and most predictors of long LOS found in this cohort might be avoidable; these findings should be confirmed with further research.
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Affiliation(s)
- Aroldo Bacellar
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Telma Rocha de Assis
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Bruno Bacellar Pedreira
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Luan CÔrtes
- Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil
| | - Silas Santana
- Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil
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Barcelon EA, Mukaino T, Yokoyama J, Uehara T, Ogata K, Kira JI, Tobimatsu S. Grand Total EEG Score Can Differentiate Parkinson's Disease From Parkinson-Related Disorders. Front Neurol 2019; 10:398. [PMID: 31057481 PMCID: PMC6482237 DOI: 10.3389/fneur.2019.00398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Semi-quantitative electroencephalogram (EEG) analysis is easy to perform and has been used to differentiate dementias, as well as idiopathic and vascular Parkinson's disease. Purpose: To study whether a semi-quantitative EEG analysis can aid in distinguishing idiopathic Parkinson's disease (IPD) from atypical parkinsonian disorders (APDs), and furthermore, whether it can help to distinguish between APDs. Materials and Methods: A comprehensive retrospective review of charts was performed to include patients with parkinsonian disorders who had at least one EEG recording available. A modified grand total EEG (GTE) score evaluating the posterior background activity, and diffuse and focal slow wave activities was used in further analyses. Results: We analyzed data from 76 patients with a final diagnosis of either IPD, probable corticobasal degeneration (CBD), multiple system atrophy (MSA), or progressive supra-nuclear palsy (PSP). IPD patients had the lowest mean GTE score, followed those with CBD or MSA, while PSP patients scored the highest. However, none of these differences were statistically significant. A GTE score of ≤9 distinguished IPD patients from those with APD (p < 0.01) with a sensitivity of 100% and a specificity of 33.3%. Conclusion: The modified GTE score can distinguish patients with IPD from those with CBD, PSP or MSA at a cut-off score of 9 with excellent sensitivity but poor specificity. However, this score is not able to distinguish a particular form of APD from other forms of the disorder.
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Affiliation(s)
- Ela Austria Barcelon
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiko Mukaino
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Yokoyama
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taira Uehara
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Ogata
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sánchez MP, García-Cabrero AM, Sánchez-Elexpuru G, Burgos DF, Serratosa JM. Tau-Induced Pathology in Epilepsy and Dementia: Notions from Patients and Animal Models. Int J Mol Sci 2018; 19:ijms19041092. [PMID: 29621183 PMCID: PMC5979593 DOI: 10.3390/ijms19041092] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 12/24/2022] Open
Abstract
Patients with dementia present epilepsy more frequently than the general population. Seizures are more common in patients with Alzheimer’s disease (AD), dementia with Lewy bodies (LBD), frontotemporal dementia (FTD) and progressive supranuclear palsy (PSP) than in other dementias. Missense mutations in the microtubule associated protein tau (MAPT) gene have been found to cause familial FTD and PSP, while the P301S mutation in MAPT has been associated with early-onset fast progressive dementia and the presence of seizures. Brains of patients with AD, LBD, FTD and PSP show hyperphosphorylated tau aggregates, amyloid-β plaques and neuropil threads. Increasing evidence suggests the existence of overlapping mechanisms related to the generation of network hyperexcitability and cognitive decline. Neuronal overexpression of tau with various mutations found in FTD with parkinsonism-linked to chromosome 17 (FTDP-17) in mice produces epileptic activity. On the other hand, the use of certain antiepileptic drugs in animal models with AD prevents cognitive impairment. Further efforts should be made to search for plausible common targets for both conditions. Moreover, attempts should also be made to evaluate the use of drugs targeting tau and amyloid-β as suitable pharmacological interventions in epileptic disorders. The diagnosis of dementia and epilepsy in early stages of those diseases may be helpful for the initiation of treatments that could prevent the generation of epileptic activity and cognitive deterioration.
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Affiliation(s)
- Marina P Sánchez
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - Ana M García-Cabrero
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
- Department of Immunology and Oncology and Protein Tools Unit, Biotechnology National Center (CNB/CSIC), 28049 Madrid, Spain.
| | - Gentzane Sánchez-Elexpuru
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - Daniel F Burgos
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
| | - José M Serratosa
- Laboratory of Neurology, IIS (Instituto Investigación Sanitaria/Health Research Institute)-Jiménez Díaz Foundation, UAM (Universidad Autonoma de Madrid/Autonomous University of Madrid) and Biomedical Research Network Center on Rare Diseases (CIBERER), 28045 Madrid, Spain.
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Decker JM, Krüger L, Sydow A, Dennissen FJ, Siskova Z, Mandelkow E, Mandelkow EM. The Tau/A152T mutation, a risk factor for frontotemporal-spectrum disorders, leads to NR2B receptor-mediated excitotoxicity. EMBO Rep 2016; 17:552-69. [PMID: 26931569 DOI: 10.15252/embr.201541439] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/28/2016] [Indexed: 12/14/2022] Open
Abstract
We report on a novel transgenic mouse model expressing human full-length Tau with the Tau mutation A152T (hTau(AT)), a risk factor for FTD-spectrum disorders including PSP and CBD Brain neurons reveal pathological Tau conformation, hyperphosphorylation, mis-sorting, aggregation, neuronal degeneration, and progressive loss, most prominently in area CA3 of the hippocampus. The mossy fiber pathway shows enhanced basal synaptic transmission without changes in short- or long-term plasticity. In organotypic hippocampal slices, extracellular glutamate increases early above control levels, followed by a rise in neurotoxicity. These changes are normalized by inhibiting neurotransmitter release or by blocking voltage-gated sodium channels. CA3 neurons show elevated intracellular calcium during rest and after activity induction which is sensitive to NR2B antagonizing drugs, demonstrating a pivotal role of extrasynaptic NMDA receptors. Slices show pronounced epileptiform activity and axonal sprouting of mossy fibers. Excitotoxic neuronal death is ameliorated by ceftriaxone, which stimulates astrocytic glutamate uptake via the transporter EAAT2/GLT1. In summary, hTau(AT) causes excitotoxicity mediated by NR2B-containing NMDA receptors due to enhanced extracellular glutamate.
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Affiliation(s)
| | - Lars Krüger
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Astrid Sydow
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany Max-Planck-Institute for Metabolism Research (Cologne), Hamburg Outstation, Hamburg, Germany
| | | | - Zuzana Siskova
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Eckhard Mandelkow
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany Max-Planck-Institute for Metabolism Research (Cologne), Hamburg Outstation, Hamburg, Germany Caesar Research Center, Bonn, Germany
| | - Eva-Maria Mandelkow
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany Max-Planck-Institute for Metabolism Research (Cologne), Hamburg Outstation, Hamburg, Germany Caesar Research Center, Bonn, Germany
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Lanza G, Papotto M, Pennisi G, Bella R, Ferri R. Epileptic seizure as a precipitating factor of vascular progressive supranuclear palsy: a case report. J Stroke Cerebrovasc Dis 2014; 23:e379-81. [PMID: 24656241 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/22/2013] [Accepted: 12/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular progressive supranuclear palsy (vPSP) is an uncommon akinetic-rigid syndrome characterized by asymmetric lower body involvement, predominant corticospinal and pseudobulbar signs, urinary incontinence, cognitive impairment, and increased frequency of stroke risk factors, together with neuroimaging evidence of vascular disease. CASE REPORT We report a case of a patient with a PSP-like phenotype and marked cognitive impairment who significantly worsened after a generalized epileptic seizure that occurred a few months after its clinical onset. RESULTS Signs of widespread ischemic subcortical vascular disease, together with atrophy of the midbrain tectum, corpus callosum, and cerebral cortex, were evident on brain magnetic resonance imaging. CONCLUSIONS vPSP is a condition that should be considered when a patient presents with a gradually progressive clinical picture suggestive of idiopathic PSP associated with neuroimaging evidence of cerebrovascular disease. The occurrence of epileptic seizures has not been reported before in vPSP but they might trigger the onset or precipitate the course of the PSP-like disorders.
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Affiliation(s)
- Giuseppe Lanza
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy.
| | - Maurizio Papotto
- Department of Neurorehabilitation, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy
| | - Giovanni Pennisi
- Department of Neurosciences, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Neurosciences, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy
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De Toffol B, Hommet C. Epilessia nel soggetto anziano. Epilessia e demenze. Neurologia 2012. [DOI: 10.1016/s1634-7072(12)62057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kamogawa K, Okuda S, Tomita H, Okamoto K, Okuda B. [A case of progressive supranuclear palsy with late-onset supplementary motor area seizure]. Rinsho Shinkeigaku 2010; 50:485-488. [PMID: 20681267 DOI: 10.5692/clinicalneurol.50.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report a 75-year-old, right-handed man, presenting with supplementary motor area (SMA) seizure. The patient had suffered from frequent attacks of transient inability to speak and move without loss of awareness. On admission, he presented with vertical gaze paresis, axial rigidity, paratonia of extremities and gait disturbance. The attacks were preceded by discomfort on the head, followed by inability to move the whole body and arrest of vocalization with tonic posture and exaggerated breathing. Consciousness and cognitive function were preserved throughout the attacks. Electroencephalography recorded intermittently slow theta waves in the bifrontal regions. Brain MRI showed atrophy of the midbrain tegmentum with lacunar state suggesting progressive supranuclear palsy. SPECT with 123I-iomazenil revealed decreased uptake in the medial frontal areas including SMA, bilaterally. The seizures resolved completely following treatment with carbamazepine. Based on clinical features and neuroimagings, we speculated that the negative motor area within SMA was responsible for his seizure. Physicians should keep in mind that SMA seizure comprising negative motor phenomenon can occur in the elderly.
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Affiliation(s)
- Kenji Kamogawa
- Department of Neurology, Ehime Prefectural Central Hospital
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Douglas VC, DeArmond SJ, Aminoff MJ, Miller BL, Rabinovici GD. Seizures in corticobasal degeneration: a case report. Neurocase 2009; 15:352-6. [PMID: 19544144 PMCID: PMC2829102 DOI: 10.1080/13554790902971158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Seizures are relatively common in Alzheimer disease (AD) and other neurodegenerative disorders. To our knowledge, however, there have been no reports of seizures associated with corticobasal degeneration (CBD). We describe a patient with brain biopsy features suggestive of CBD whose course was complicated by complex partial seizures with secondary generalization. Thus, the occurrence of seizures in a patient with dementia should not exclude the diagnosis of CBD.
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Affiliation(s)
- Vanja C Douglas
- University of California Department of Neurology Box 0114 400 Parnassus Ave, 8th Floor Neurology Clinic San Franciso, CA 94143-0114, USA.
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Tashiro K, Ogata K, Goto Y, Taniwaki T, Okayama A, Kira JI, Tobimatsu S. EEG findings in early-stage corticobasal degeneration and progressive supranuclear palsy: A retrospective study and literature review. Clin Neurophysiol 2006; 117:2236-42. [PMID: 16920021 DOI: 10.1016/j.clinph.2006.06.710] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/05/2006] [Accepted: 06/11/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although neuroimaging and electrophysiological tests are potentially useful to distinguish corticobasal degeneration (CBD) from progressive supranuclear palsy (PSP), little is known about the diagnostic value of electroencephalography (EEG) for their distinction. We assessed the value of EEG for differentiating CBD from PSP. METHODS We reviewed conventional EEGs recorded at an early stage of disease in 10 CBD patients and 14 PSP patients. We focused on slowing of background activity (SBA), frontal intermittent rhythmic delta activity (FIRDA) and focal slow waves (FSWs). Statistical analysis was performed by Fisher's exact test. RESULTS SBA was observed in 1 CBD patient and 2 PSP patients. FSWs were found in 8 CBD patients (80.0%), but only 2 PSP patients (14.3%) (p=0.002); they appeared contralateral to the dominantly-affected side in 6 of 8 CBD patients, and ipsilateral to the side with most atrophy on MRI in 7 of 8 CBD patients. FIRDA was observed in 2 CBD patients (20.0%) and 5 PSP patients (35.7%) (p=0.357). CONCLUSIONS FSWs are characteristic of CBD, but FIRDA was not disease-specific. SIGNIFICANCE FSWs on EEG, in addition to clinical criteria, yield useful supplementary information to distinguish between these diseases at early stages.
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Affiliation(s)
- Kenshi Tashiro
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 26-1997. A 64-year-old man with progressive dementia, seizures, and unstable gait. N Engl J Med 1997; 337:549-56. [PMID: 9262500 DOI: 10.1056/nejm199708213370808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
The clinical diagnosis of PSP depends primarily on the history and the physical findings. Clinicians should be alerted to the possibility of this condition in assessing patients presenting with atypical parkinsonism and other complex extrapyramidal syndromes in late middle age or later. The differential diagnosis includes MSA (both OPCA and SND), PD, CBD and cerebrovascular disease. PD is probably the most common erroneous diagnosis. Unfortunately, pathognomonic signs do not usually appear until several years, after symptom onset. No specific laboratory test is yet available. Neuroimaging studies show characteristic anatomic alterations only late in the course of the illness and must be correlated with the clinical findings.
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Affiliation(s)
- R C Duvoisin
- Department of Neurology, University of Medicine and Dentistry of New Jersey, New Brunswick
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Trevisol-Bittencourt PC. [Progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of a case and review of the literature]. ARQUIVOS DE NEURO-PSIQUIATRIA 1992; 50:369-74. [PMID: 1308417 DOI: 10.1590/s0004-282x1992000300018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Progressive supranuclear palsy (PSP) was first recognized as a distinct syndrome by Richardson, Steele and Olszewski roughly a quarter century ago. Subsequent clinical experience has corroborated and enlarged their original observations. PSP has become familiar as a chronic progressive disorder with extrapyramidal rigity, bradykinesia, gait impairment, bulbar palsy, dementia and a characteristic supranuclear ophthalmoplegia. It is a significant cause of parkinsonism and its etiology remains obscure. The case of a patient from Santa Catarina who presented definite clinical evidences of this syndrome is reported. This is the first description in this southern Brazilian State, where at least 50 more patients should exist, if we may extrapolate the prevalence rate of this condition in developed countries to this well developed area of Brazil. A review of the literature was undertaken with emphasis on recent clinical and therapeutic aspects of PSP.
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Stacy M, Jankovic J. Differential Diagnosis of Parkinson’s Disease and the Parkinsonism Plus Syndromes. Neurol Clin 1992. [DOI: 10.1016/s0733-8619(18)30214-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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