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Silva GD, Mahler JV, da Silva Junior SRP, Mendonça LO, de Sá Barreto Lima PLG, Nóbrega PR, Kok F, Freua F. Identifying high-risk neurological phenotypes in adult-onset classic monogenic autoinflammatory diseases: when should neurologists consider testing? BMC Neurol 2024; 24:130. [PMID: 38632524 PMCID: PMC11022464 DOI: 10.1186/s12883-024-03621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Monogenic autoinflammatory disorders result in a diverse range of neurological symptoms in adults, often leading to diagnostic delays. Despite the significance of early detection for effective treatment, the neurological manifestations of these disorders remain inadequately recognized. METHODS We conducted a systematic review searching Pubmed, Embase and Scopus for case reports and case series related to neurological manifestations in adult-onset monogenic autoinflammatory diseases. Selection criteria focused on the four most relevant adult-onset autoinflammatory diseases-deficiency of deaminase 2 (DADA2), tumor necrosis factor receptor associated periodic fever syndrome (TRAPS), cryopyrin associated periodic fever syndrome (CAPS), and familial mediterranean fever (FMF). We extracted clinical, laboratory and radiological features to propose the most common neurological phenotypes. RESULTS From 276 records, 28 articles were included. The median patient age was 38, with neurological symptoms appearing after a median disease duration of 5 years. Headaches, cranial nerve dysfunction, seizures, and focal neurological deficits were prevalent. Predominant phenotypes included stroke for DADA2 patients, demyelinating lesions and meningitis for FMF, and meningitis for CAPS. TRAPS had insufficient data for adequate phenotype characterization. CONCLUSION Neurologists should be proactive in diagnosing monogenic autoinflammatory diseases in young adults showcasing clinical and laboratory indications of inflammation, especially when symptoms align with recurrent or chronic meningitis, small vessel disease strokes, and demyelinating lesions.
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Affiliation(s)
- Guilherme Diogo Silva
- Neuroimmunology Group, Division of Neurology, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | - Leonardo Oliveira Mendonça
- Division of Clinical Immunology and Allergy, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Paulo Ribeiro Nóbrega
- Division of Neurology, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil.
- Centro Universitário Christus, Fortaleza, Brazil.
| | - Fernando Kok
- Neurogenetics Group, Division of Neurology, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fernando Freua
- Neurogenetics Group, Division of Neurology, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Sena LS, Furtado GV, Pedroso JL, Barsottini O, Cornejo-Olivas M, Nóbrega PR, Braga Neto P, Soares DMB, Vargas FR, Godeiro C, Medeiros PFVD, Camejo C, Toralles MBP, Fagundes NJR, Jardim LB, Saraiva-Pereira ML. Spinocerebellar ataxia type 2 has multiple ancestral origins. Parkinsonism Relat Disord 2024; 120:105985. [PMID: 38181536 DOI: 10.1016/j.parkreldis.2023.105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Spinocerebellar ataxia type 2 (SCA2) is a dominant neurodegenerative disorder due to expansions of a CAG repeat tract (CAGexp) at the ATXN2 gene. Previous studies found only one ancestral haplotype worldwide, with a C allele at rs695871. This homogeneity was unexpected, given the severe anticipations related to SCA2. We aimed to describe informative ancestral haplotypes found in South American SCA2 families. METHODS Seventy-seven SCA2 index cases were recruited from Brazil, Peru, and Uruguay; 263 normal chromosomes were used as controls. The SNPs rs9300319, rs3809274, rs695871, rs1236900 and rs593226, and the STRs D12S1329, D12S1333, D12S1672 and D12S1332, were used to reconstruct haplotypes. RESULTS Eleven ancestral haplotypes were found in SCA2 families. The most frequent ones were A-G-C-C-C (46.7 % of families), G-C-C-C-C (24.6 %) and A-C-C-C-C (10.3 %) and their mean (sd) CAGexp were 41.68 (3.55), 40.42 (4.11) and 45.67 (9.70) (p = 0.055), respectively. In contrast, the mean (sd) CAG lengths at normal alleles grouped per haplotypes G-C-G-A-T, A-G-C-C-C and G-C-C-C-C were 22.97 (3.93), 23.85 (3.59), and 30.81 (4.27) (p < 0.001), respectively. The other SCA2 haplotypes were rare: among them, a G-C-G-A-T lineage was found, evidencing a G allele in rs695871. CONCLUSION We identified several distinct ancestral haplotypes in SCA2 families, including an unexpected lineage with a G allele at rs695871, a variation never found in hundreds of SCA2 patients studied worldwide. SCA2 has multiple origins in South America, and more studies should be done in other regions of the world.
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Affiliation(s)
- Lucas Schenatto Sena
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil.
| | - Gabriel Vasata Furtado
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil
| | - José Luiz Pedroso
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Orlando Barsottini
- Universidade Federal do Estado de São Paulo, Rua Pedro de Toledo 650, 04039-031, São Paulo, Brazil
| | - Mario Cornejo-Olivas
- Neurogenetics Working Group, Universidad Cientifica del Sur, 19 Panamericana S Avenue, 15067, Lima, 15067, Peru; Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancas St, 15003, Lima, Peru
| | - Paulo Ribeiro Nóbrega
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Centro Universitário Christus, Rua Alexandre Baraúna 949, 60430-160, Fortaleza, CE, Brazil
| | - Pedro Braga Neto
- Setor de Neurologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Rua Professor Costa Mendes, 1608, 60430-140, Fortaleza, CE, Brazil; Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Danyela Martins Bezerra Soares
- Curso de Medicina, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Avenida Dr. Silas Munguba, 1700, 60714-903, Fortaleza, CE, Brazil
| | - Fernando Regla Vargas
- Departamento de Genética e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca 94, 20211-010, Rio de Janeiro, Brazil; Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avenida Brasil 4365, 21040-900, Rio de Janeiro, Brazil
| | - Clecio Godeiro
- Departamento de Medicina Integrada, Hospital Universitário Onofre Lopes, Avenida Nilo Peçanha, 59012-300, Natal, Brazil
| | - Paula Frassinetti Vasconcelos de Medeiros
- Unidade Acadêmica de Medicina, Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande, Rua Carlos Chagas S/n, 58107-670, Campina Grande, Brazil
| | - Claudia Camejo
- Facultad de Medicina. Universidad de La República, Avenida General Flores 3461, 11700, Montevideo, Uruguay
| | | | - Nelson Jurandi Rosa Fagundes
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Departamento de Genética, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-002, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, Brazil; Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90035-903, Porto Alegre, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2340, 90.035-903, Brazil; Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600, 90035-003, Porto Alegre, Brazil
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Nóbrega PR, de Brito de Souza JL, Maurício RB, de Paiva ARB, Dias DA, Camelo CG, Zanotelli E, Schlesinger D, Braga-Neto P, Moreno CAM. Marked neuropsychiatric involvement and dysmorphic features in nemaline myopathy. Neurol Sci 2024; 45:1225-1231. [PMID: 37851294 DOI: 10.1007/s10072-023-07128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Inherited nemaline myopathy is one of the most common congenital myopathies. This genetically heterogeneous disease is defined by the presence of nemaline bodies in muscle biopsy. The phenotypic spectrum is wide and cognitive involvement has been reported, although not extensively evaluated. METHODS We report two nemaline myopathy patients presenting pronounced central nervous system involvement leading to functional compromise and novel facial and skeletal dysmorphic findings, possibly expanding the disease phenotype. RESULTS One patient had two likely pathogenic NEB variants, c.2943G > A and c.8889 + 1G > A, and presented cognitive impairment and dysmorphic features, and the other had one pathogenic variant in ACTA1, c.169G > C (p.Gly57Arg), presenting autism spectrum disorder and corpus callosum atrophy. Both patients had severe cognitive involvement despite milder motor dysfunction. CONCLUSION We raise the need for further studies regarding the role of thin filament proteins in the central nervous system and for a systematic cognitive assessment of congenital myopathy patients.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Department of Neurology, Faculdade de Medicina, Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil.
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil.
- Faculty of Medicine, Unichristus University, Rua Vereador Paulo Mamede, 131, Fortaleza, CE, 60160-196, Brazil.
| | - Jorge Luiz de Brito de Souza
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Rebeca Bessa Maurício
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Anderson Rodrigues Brandão de Paiva
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
| | - Daniel Aguiar Dias
- Department of Radiology, Faculdade de Medicina da Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
| | - Clara Gontijo Camelo
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
| | - Edmar Zanotelli
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
| | - David Schlesinger
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
| | - Pedro Braga-Neto
- Department of Neurology, Faculdade de Medicina, Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Cristiane Araujo Martins Moreno
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
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Nóbrega PR, Braga-Neto P. Editorial for Brain Sciences Special Issue: "Neurogenetic Disorders across Human Life: From Infancy to Adulthood". Brain Sci 2024; 14:111. [PMID: 38391686 PMCID: PMC10887029 DOI: 10.3390/brainsci14020111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024] Open
Abstract
This Special Issue assembles papers that highlight different types of neurogenetic disorders that occur throughout human life, from childhood to adulthood, focusing on their natural history, epidemiology, diagnosis, and treatment approaches [...].
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil
- Campus Parque Ecológico, Centro Universitário Christus, Fortaleza 60160-230, CE, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil
- Center of Health Sciences, State University of Ceará, Fortaleza 60714-903, CE, Brazil
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Camelo-Filho AE, Martins MRA, Souza JLDBD, Maurício RB, Nóbrega PR. Pompe disease misdiagnosed as polymyositis. Pract Neurol 2024; 24:66-69. [PMID: 37852755 DOI: 10.1136/pn-2023-003935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
Late-onset Pompe disease manifests predominantly in the proximal lower limbs and may be mistaken for an inflammatory myopathy. A 46-year-old man with acromegaly had an 8-year history of progressive weakness. His myopathy was initially attributed to the acromegaly, but severe progression prompted a muscle biopsy, which suggested an inflammatory myopathy. However, his weakness progressed despite treatment for polymyositis. His muscle ultrasound scan pattern was more suggestive of Pompe disease than polymyositis, and Pompe disease was confirmed by genetic and enzymatic testing. Patients with apparent polymyositis, which persists despite treatment, require reconsideration of the diagnosis, with particular attention to treatable genetic causes.
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Affiliation(s)
- Antonio Edvan Camelo-Filho
- Department of Neurology, Universidade Federal do Ceará Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil
| | - Manoel Ricardo Alves Martins
- Department of Endocrinology, Universidade Federal do Ceará Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil
| | | | | | - Paulo Ribeiro Nóbrega
- Department of Neurology, Universidade Federal do Ceará Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil
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Barros LL, Lima PLGDSB, de Oliveira Júnior PH, Dias DA, Santos CDF, Braga-Neto P, Nóbrega PR. Peculiar aetiology for orbital apex syndrome: Wyburn-Mason syndrome as orbital apex lesion. BMJ Neurol Open 2024; 6:e000559. [PMID: 38268749 PMCID: PMC10806852 DOI: 10.1136/bmjno-2023-000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 01/26/2024] Open
Abstract
Background Wyburn-Mason syndrome is a rare, non-hereditary congenital disease, belonging to the group of neurocutaneous syndromes with fewer than 100 cases reported since its first description in 1937. Case report A young adult man was initially evaluated at the age of 2 years for proptosis and progressive visual impairment of the right eye, followed by impairment in ocular abduction, adduction and elevation as well as amaurosis. MRI revealed an expansive formation centred in the right orbit compromising conal spaces with distortion of eye muscles and optic nerve. The lesion extended through the superior orbital fissure into the right cavernous sinus and to the contralateral orbit. Despite embolisation, proptosis and oedema of the periorbital tissue continued to worsen. The combination of facial, ocular and intracranial vascular malformations and the exclusion of alternative aetiologies led to a diagnosis of cerebrofacial arteriovenous metameric syndrome (CAMS) 1 (Wyburn-Mason syndrome). Discussion Important differential diagnoses are other CAMS, such as Sturge-Weber syndrome, as well as other conditions such as retinal cavernous haemangioma and vasoproliferative tumours. The optimal treatment regimen for severe cases of this syndrome is still unclear. Wyburn-Mason syndrome should be considered in patients presenting multiple arteriovenous malformations with orbital apex lesions.
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Affiliation(s)
| | | | | | | | | | - Pedro Braga-Neto
- State University of Ceara, Fortaleza, Brazil
- Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Federal University of Ceara, Fortaleza, Brazil
- Centro Universitário Christus, Fortaleza, Brazil
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Bandeira GG, Barreto Lima PLGDS, Araújo DABS, Pinheiro MSN, Albuquerque Mota LD, Simão RM, de Carvalho FMO, Vazquez FD, de Vasconcelos Gama VC, de Queiroz DC, da Fonseca Lira MZR, de Oliveira Júnior PH, Guimarães Junior FA, Caminha GC, de Figueiredo Santos C, Sobreira-Neto MA, Braga-Neto P, Silva GD, Nóbrega PR. Controversies in immunotherapy for anti-NMDA receptor encephalitis: a scoping review with a proposal of operational definitions. Neurol Sci 2023; 44:4307-4312. [PMID: 37597088 DOI: 10.1007/s10072-023-07018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Anti-NMDA receptor encephalitis (NMDARE), an autoimmune encephalitis associated with autoantibodies against the N-methyl-D-aspartate (NMDA) receptor, affects predominantly young women and is associated with psychiatric symptoms, seizures, movement disorders, and autonomic instability. Traditional treatments of anti-NMDA receptor encephalitis involve corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, and rituximab. However, many controversies remain in the treatment for NMDA receptor encephalitis, such as optimal timing and combination of different immunotherapies, the role of newer strategies (e.g., bortezomib or tocilizumab) for severe and refractory patients, and the need or not for long-term immunosuppression. Our goal was to perform a scoping review to discuss the controversial topics of immunotherapy for NMDA receptor encephalitis and propose operational definitions to guide clinical practice and future research in the field.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carolina de Figueiredo Santos
- Universidade de Fortaleza, Ceara, Fortaleza, Brazil
- Hospital Infantil Albert Sabin, Ceara, Fortaleza, Brazil
- Núcleo de Tratamento e Estimulação Precoce, Federal University of Ceara, Fortaleza, Brazil
| | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Guilherme Diogo Silva
- Division of Neurology, Hospital of Clinics, University of São Paulo, São Paulo, Brazil
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Nóbrega PR, Vasconcelos TDMF, de Paiva ARB, Lima PLGDSB, Braga Neto P, Guimarães TG, Krueger MB. Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome. Mov Disord Clin Pract 2023; 10:1705-1706. [PMID: 37982121 PMCID: PMC10654808 DOI: 10.1002/mdc3.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
- Centro Universitário UnichristusFortalezaBrazil
| | | | | | | | - Pedro Braga Neto
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
| | | | - Mariana Braatz Krueger
- Division of Neurology, Department of Clinical MedicineFederal University of CearáFortalezaBrazil
- Hospital Infantil Albert SabinFortalezaBrazil
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Braga VLL, Lima DP, Mariano TC, Lima PLGDSB, Maia ABDA, da Silva Meireles WW, de Oliveira Pessoa KT, de Oliveira CM, Ribeiro EM, Nóbrega PR, Pessoa ALS. Higher Prevalence of Nonsense Pathogenic DMD Variants in a Single-Center Cohort from Brazil: A Genetic Profile Study That May Guide the Choice of Disease-Modifying Treatments. Brain Sci 2023; 13:1521. [PMID: 38002481 PMCID: PMC10669865 DOI: 10.3390/brainsci13111521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Dystrophinopathies are muscle diseases caused by pathogenic variants in DMD, the largest gene described in humans, representing a spectrum of diseases ranging from asymptomatic creatine phosphokinase elevation to severe Duchenne muscular dystrophy (DMD). Several therapeutic strategies are currently in use or under development, each targeting different pathogenic variants. However, little is known about the genetic profiles of northeast Brazilian patients with dystrophinopathies. We describe the spectrum of pathogenic DMD variants in a single center in northeast Brazil. This is an observational, cross-sectional study carried out through molecular-genetic analysis of male patients diagnosed with dystrophinopathies using Multiplex Ligation-dependent Probe Amplification (MLPA) followed by Next-Generation Sequencing (NGS)-based strategies. A total of 94 male patients were evaluated. Deletions (43.6%) and duplications (10.6%) were the most recurring patterns of pathogenic variants. However, small variants were present in 47.1% of patients, most of them nonsense variants (27.6%). This is the largest South American single-center case series of dystrophinopathies to date. We found a higher frequency of treatment-amenable nonsense single-nucleotide variants than most previous studies. These findings may have implications for diagnostic strategies in less-known populations, as a higher frequency of nonsense variants may mean a higher possibility of treating patients with disease-modifying drugs.
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Affiliation(s)
- Vitor Lucas Lopes Braga
- Division of Pediatry, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil; (V.L.L.B.); (A.B.d.A.M.)
| | - Danielle Pessoa Lima
- Division of Geriatry, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil;
| | - Tamiris Carneiro Mariano
- Division of Neurogenetics and Neuromuscular Disorders, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil;
| | | | - Ana Beatriz de Almeida Maia
- Division of Pediatry, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil; (V.L.L.B.); (A.B.d.A.M.)
| | | | | | | | | | - Paulo Ribeiro Nóbrega
- Division of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil
- Campus Parque Ecológico, Centro Universitário Christus, Fortaleza 60160-230, CE, Brazil
| | - André Luiz Santos Pessoa
- Albert Sabin Children’s Hospital, Fortaleza 60410-794, CE, Brazil;
- Faculty of Medicine, State University of Ceará (UECE), Fortaleza 60714-903, CE, Brazil
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de Freitas Dias B, Fieni Toso F, Slhessarenko Fraife Barreto ME, de Araújo Gleizer R, Dellavance A, Kowacs PA, Teive H, Spitz M, Freire Borges Juliano A, Januzi de Almeida Rocha L, Braga-Neto P, Ribeiro Nóbrega P, Oliveira-Filho J, Maciel Dias R, de Oliveira Godeiro Júnior C, Martins Maia F, Barbosa Thomaz R, Santos ML, Sousa de Melo E, da Nóbrega Júnior AW, Lin K, Graziani Povoas Barsottini O, Endmayr V, Coelho Andrade LE, Höftberger R, Almeida Dutra L. Brazilian autoimmune encephalitis network (BrAIN): antibody profile and clinical characteristics from a multicenter study. Front Immunol 2023; 14:1256480. [PMID: 37954587 PMCID: PMC10634608 DOI: 10.3389/fimmu.2023.1256480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background The frequency of antibodies in autoimmune encephalitis (AIE) may vary in different populations, however, data from developing countries are lacking. To describe the clinical profile of AIE in Brazil, and to evaluate seasonality and predictors of AIE in adult and pediatric patients. Methods We evaluated patients with possible AIE from 17 centers of the Brazilian Autoimmune Encephalitis Network (BrAIN) between 2018 and 2022. CSF and serum were tested with TBAs and CBAs. Data on clinical presentation, complementary investigation, and treatment were compiled. Seasonality and predictors of AIE in adult and pediatric populations were analyzed. Results Of the 564 patients, 145 (25.7%) were confirmed as seropositive, 69 (12.23%) were seronegative according to Graus, and 58% received immunotherapy. The median delay to diagnosis confirmation was 5.97 ± 10.3 months. No seasonality variation was observed after 55 months of enrolment. The following antibodies were found: anti-NMDAR (n=79, 54%), anti-MOG (n=14, 9%), anti-LGI1(n=12, 8%), anti-GAD (n=11, 7%), anti-GlyR (n=7, 4%), anti-Caspr2 (n=6, 4%), anti-AMPAR (n=4, 2%), anti-GABA-BR (n=4, 2%), anti-GABA-AR (n=2, 1%), anti-IgLON5 (n=1, 1%), and others (n=5, 3%). Predictors of seropositive AIE in the pediatric population (n=42) were decreased level of consciousness (p=0.04), and chorea (p=0.002). Among adults (n=103), predictors of seropositive AIE were movement disorders (p=0.0001), seizures (p=0.0001), autonomic instability (p=0.026), and memory impairment (p=0.001). Conclusion Most common antibodies in Brazilian patients are anti-NMDAR, followed by anti-MOG and anti-LGI1. Only 26% of the possible AIE patients harbor antibodies, and 12% were seronegative AIE. Patients had a 6-month delay in diagnosis and no seasonality was found. Findings highlight the barriers to treating AIE in developing countries and indicate an opportunity for cost-effect analysis. In this scenario, some clinical manifestations help predict seropositive AIE such as decreased level of consciousness, chorea, and dystonia among children, and movement disorders and memory impairment among adults.
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Affiliation(s)
| | | | | | | | | | | | - Helio Teive
- Hospital Universitário da Universidade Federal do Paraná, Curitiba, Brazil
| | - Mariana Spitz
- Hospital Universitário Pedro Ernesto da Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | | | | | | | | | | | | | - Katia Lin
- Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Verena Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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11
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Brito LA, Nóbrega PR, Dias DA, Barreto ARF, Freitas HC, Kok F, Rodrigues CL. New observations on minifascicular neuropathy with sex-dependent gonadal dysgenesis: a case series with nerve ultrasound assessment. Neurol Sci 2023; 44:3691-3696. [PMID: 37140833 DOI: 10.1007/s10072-023-06792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Gonadal dysgenesis with minifascicular neuropathy (GDMN) is a rare autosomal recessive condition associated with biallelic DHH pathogenic variants. In 46, XY individuals, this disorder is characterized by an association of minifascicular neuropathy (MFN) and gonadal dysgenesis, while in 46, XX subjects only the neuropathic phenotype is present. Very few patients with GDMN have been reported so far. We describe four patients with MFN due to a novel DHH likely pathogenic homozygous variant and the results of nerve ultrasound assessment. METHODS This retrospective observational study included 4 individuals from 2 unrelated Brazilian families evaluated for severe peripheral neuropathy. Genetic diagnosis was performed with a peripheral neuropathy next-generation sequencing (NGS) panel based on whole exome sequencing focused analysis that included a control SRY probe to confirm genetic sex. Clinical characterization, nerve conduction velocity studies, and high-resolution ultrasound nerve evaluation were performed in all subjects. RESULTS Molecular analysis disclosed in all subjects the homozygous DHH variant p.(Leu335Pro). Patients had a striking phenotype, with marked trophic changes of extremities, sensory ataxia, and distal anesthesia due to a sensory-motor demyelinating polyneuropathy. One 46, XY phenotypically female individual had gonadal dysgenesis. High-resolution nerve ultrasound showed typical minifascicular formation and increased nerve area in at least one of the nerves assessed in all patients. CONCLUSION Gonadal dysgenesis with minifascicular neuropathy is a severe autosomal recessive neuropathy characterized by trophic alterations in limbs, sensory ataxia, and distal anesthesia. Nerve ultrasound studies are very suggestive of this condition and may help to avoid invasive nerve biopsies.
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Affiliation(s)
- Lara Albuquerque Brito
- Neuromuscular Unit of Neurology Department From Hospital Geral de Fortaleza, Ceará, Brazil
| | - Paulo Ribeiro Nóbrega
- Department of Neurology, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, Brazil.
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Daniel Aguiar Dias
- Department of Radiology, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, Brazil
| | | | - Hermany Capistrano Freitas
- Neuromuscular Unit of Neurology Department From Hospital Geral de Fortaleza, Ceará, Brazil
- Clinical Neurophysiology of Neurology Department From Hospital Geral de Fortaleza, Ceará, Brazil
| | - Fernando Kok
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Mendelics Genomic Analysis, Sao Paulo, Brazil
| | - Cleonisio Leite Rodrigues
- Neuromuscular Unit of Neurology Department From Hospital Geral de Fortaleza, Ceará, Brazil
- Clinical Neurophysiology of Neurology Department From Hospital Geral de Fortaleza, Ceará, Brazil
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12
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Soares DMB, Araújo DABS, de Souza JLDB, Maurício RB, Soares EMB, Neto FDCA, Pinheiro MSN, Gama VCDV, Braga-Neto P, Nóbrega PR, Aragão GF. Correlation between ABO blood type, susceptibility to SARS-CoV-2 infection and COVID-19 disease severity: A systematic review. Hematol Transfus Cell Ther 2023; 45:483-494. [PMID: 36467112 PMCID: PMC9708632 DOI: 10.1016/j.htct.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To verify the association between the ABO blood type and the risk of SARS-CoV-2 infection and COVID-19 disease severity. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the 2020 PRISMA Checklist and flow diagram, and articles selected for review were analyzed using the Newcastle-Ottawa Quality Rating Scale. The research question was: "Would the ABO blood group influence the risk of infection and clinical course of patients infected with SARS-CoV-2?", The following databases were used: Embase, PubMed, Virtual Health Library (VHL), Web of Science, ScienceDirect and Scopus. The protocol for this review was registered in the Prospective Register of Systematic Reviews (PROSPERO), number CRD42021245945. RESULTS We found 798 articles across PubMed, Embase, Scopus, Web of Science, Science Direct and Virtual Health Library and 54 articles were included in the final analysis. Among 30 studies evaluating the risk of COVID-19 infection, 21 found significant correlations with ABO blood groups, 14 of them revealing an increased risk in blood group A and 15 studies showing a decreased risk in blood group O. Most studies found no significant correlation with disease severity or mortality. CONCLUSION The qualitative assessment of available information suggests that blood group A may be a risk factor for COVID-19 infection and that blood group O may have a protective effect. We were unable to determine a clear association between the ABO blood group and mortality. These conclusions are based on highly heterogenous evidence.
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13
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Gomes GRF, Mariano TC, Braga VLL, Ribeiro EM, Guimarães IP, Pereira KSAF, Nóbrega PR, Pessoa ALS. Bailey-Bloch Congenital Myopathy in Brazilian Patients: A Very Rare Myopathy with Malignant Hyperthermia Susceptibility. Brain Sci 2023; 13:1184. [PMID: 37626540 PMCID: PMC10452826 DOI: 10.3390/brainsci13081184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Congenital myopathy-13 (CMYP13), also known as Bailey-Bloch congenital myopathy and Native American myopathy (NAM), is a condition caused by biallelic missense pathogenic variants in STAC3, which encodes an important protein necessary for the excitation-relaxation coupling machinery in the muscle. Patients with biallelic pathogenic variants in STAC3 often present with congenital weakness and arthrogryposis, cleft palate, ptosis, myopathic facies, short stature, kyphoscoliosis, and susceptibility to malignant hyperthermia provoked by anesthesia. We present two unrelated cases of Bailey-Bloch congenital myopathy descendants of non-consanguineous parents, which were investigated for delayed psychomotor development and generalized weakness. To the best of our knowledge, these are the first descriptions of CMYP13 in Brazil. In both patients, we found the previously described pathogenic missense variant p.Trp284Ser in homozygosity. CONCLUSION We seek to highlight the need for screening for CMYP13 in patients expressing the typical phenotype of the disease even in the absence of Lumbee Native American ancestry, and to raise awareness to possible complications like malignant hyperthermia in Bailey-Bloch congenital myopathy.
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Affiliation(s)
| | - Tamiris Carneiro Mariano
- Albert Sabin Pediatric Hospital (HIAS), Fortaleza 60410-794, Brazil; (T.C.M.); (V.L.L.B.); (E.M.R.)
| | - Vitor Lucas Lopes Braga
- Albert Sabin Pediatric Hospital (HIAS), Fortaleza 60410-794, Brazil; (T.C.M.); (V.L.L.B.); (E.M.R.)
| | - Erlane Marques Ribeiro
- Albert Sabin Pediatric Hospital (HIAS), Fortaleza 60410-794, Brazil; (T.C.M.); (V.L.L.B.); (E.M.R.)
- Faculty of Medicine, Unichristus University, Fortaleza 60160-196, Brazil;
| | - Ingred Pimentel Guimarães
- Faculty of Medicine, Ceará State University, Fortaleza 60714-903, Brazil; (G.R.F.G.); (I.P.G.); (K.S.A.F.P.)
| | | | - Paulo Ribeiro Nóbrega
- Faculty of Medicine, Unichristus University, Fortaleza 60160-196, Brazil;
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza 60430-372, Brazil
| | - André Luiz Santos Pessoa
- Faculty of Medicine, Ceará State University, Fortaleza 60714-903, Brazil; (G.R.F.G.); (I.P.G.); (K.S.A.F.P.)
- Albert Sabin Pediatric Hospital (HIAS), Fortaleza 60410-794, Brazil; (T.C.M.); (V.L.L.B.); (E.M.R.)
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14
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da Silva Rocha EB, de Lima Rodrigues K, Montouro LAM, Coelho ÉN, Kouyoumdjian JA, Kok F, Nóbrega PR, Graca CR, Morita MDPA, Estephan EDP. A case of mitochondrial DNA depletion syndrome type 11 - expanding the genotype and phenotype. Neuromuscul Disord 2023; 33:692-696. [PMID: 37429773 DOI: 10.1016/j.nmd.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/12/2023]
Abstract
Mitochondrial DNA depletion syndrome type 11 (MTDPS11) is caused by pathogenic variants in MGME1 gene. We report a woman, 40-year-old, who presented slow progressive drop eyelid at 11-year-old with, learning difficulty and frequent falls. Phisical examination revealed: mild scoliosis, elbow hyperextensibility, flat feet, chronic progressive external ophthalmoplegia with upper eyelid ptosis, diffuse hypotonia, and weakness of arm abduction and neck flexion. Investigation evidenced mild serum creatine kinase increase and glucose intolerance; second-degree atrioventricular block; mild mixed-type respiratory disorder and atrophy and granular appearance of the retinal pigment epithelium. Brain magnetic resonance showed cerebellar atrophy. Muscle biopsy was compatible with mitochondrial myopathy. Genetic panel revealed a homozygous pathogenic variant in the MGME1 gene, consistent with MTDPS11 (c.862C>T; p.Gln288*). This case of MTDPS11 can contribute to the phenotypic characterization of this ultra-rare mitochondrial disorder, presenting milder respiratory and nutritional involvement than the previously reported cases, with possible additional features.
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Affiliation(s)
- Emanuelle Bianchi da Silva Rocha
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Ketteny de Lima Rodrigues
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Laura Alonso Matheus Montouro
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Érica Nogueira Coelho
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Fundação Faculdade Regional de Medicina São José do Rio Preto (FUNFARME), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - João Aris Kouyoumdjian
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Fernando Kok
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ovídio Pires de Campos Street, 225, 05403-010 São Paulo, Brazil
| | - Paulo Ribeiro Nóbrega
- Department of Neurology, Faculdade de Medicina da Universidade Federal do Ceará (UFC), Alexandre Baraúna, 949, 60430-160 Fortaleza, Ceará, Brazil
| | - Carla Renata Graca
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Maria da Penha Ananias Morita
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade Estadual de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil
| | - Eduardo de Paula Estephan
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Fundação Faculdade Regional de Medicina São José do Rio Preto (FUNFARME), Brigadeiro Faria Lima Avenue, 5416, 15090-000 São José do Rio Preto, São Paulo, Brazil; Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ovídio Pires de Campos Street, 225, 05403-010 São Paulo, Brazil; Hospital Santa Marcelina, Department of Neurology, São Paulo, Brazil; Faculdade de Medicina Santa Marcelina (FASM), Department of Medical Clinic, São Paulo, Brazil.
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15
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Pessoa ALS, Quesada AA, Nóbrega PR, Viana APO, de Oliveira KT, Figueiredo T, Santos S, Kok F. Neuropsychological Characterization of Autosomal Recessive Intellectual Developmental Disorder 59 Associated with IMPA1 (MRT59). Brain Sci 2023; 13:1048. [PMID: 37508980 PMCID: PMC10377093 DOI: 10.3390/brainsci13071048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Biallelic loss of function of IMPA1 causes autosomal recessive intellectual developmental disorder 59 (MRT59, OMIM #617323). MRT59 has been reported to present with significant intellectual disability and disruptive behavior, but little is known about the neurocognitive pattern of those patients. Thus, the aims of this study were: (1) to assess the cognitive profile of these patients, and (2) to evaluate their functional dependence levels. Eighteen adults, aged 37 to 89 years, participated in this study: nine MRT59 patients, five heterozygous carriers and four non-carrier family members. All of them were from a consanguineous family living in Northeast Brazil. All IMPA1 patients had the (c.489_493dupGGGCT) pathogenic variant in homozygosis. For cognitive assessment, the WASI battery was applied in nine MRT59 patients and compared to heterozygous carriers and non-carrier family members. Functional dependence was evaluated using the functional independence measure (FIM). Patients showed moderate to severe intellectual disability and severe functional disabilities. Heterozygous carriers did not differ from non-carriers. MRT59 patients should be followed up by health professionals in an interdisciplinary way to understand their cognitive disabilities and functional needs properly.
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Affiliation(s)
- Andre Luiz Santos Pessoa
- Albert Sabin Children's Hospital, Fortaleza 60410-794, Brazil
- Faculty of Medicine, State University of Ceará (UECE), Fortaleza 60714-903, Brazil
| | - Andrea Amaro Quesada
- The Edson Queiroz Foundation, University of Fortaleza (UNIFOR), Fortaleza 60811-905, Brazil
| | - Paulo Ribeiro Nóbrega
- Hospital Universitário Walter Cantídio-UFC, Fortaleza 60430-372, Brazil
- Faculty of Medicine, Centro Universitário Christus, Fortaleza 60160-230, Brazil
| | | | | | - Thalita Figueiredo
- Faculty of Medicine, Federal University of Alagoas (UFAL), Maceio 57200-000, Brazil
| | - Silvana Santos
- State University of Paraíba (UEPB), Campina Grande 58429-500, Brazil
| | - Fernando Kok
- Department of Neurology, University of São Paulo (USP), São Paulo 05508-220, Brazil
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16
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Ribeiro RM, Vasconcelos SC, Lima PLGDSB, Coelho EF, Oliveira AMN, Gomes EDABM, Mota LDA, Radtke LS, Carvalho MDS, Araújo DABS, Pinheiro MSN, Gama VCDV, Júnior RMM, Braga Neto P, Nóbrega PR. Pathophysiology and Treatment of Lipid Abnormalities in Cerebrotendinous Xanthomatosis: An Integrative Review. Brain Sci 2023; 13:979. [PMID: 37508912 PMCID: PMC10377253 DOI: 10.3390/brainsci13070979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive disorder caused by pathogenic variants in CYP27A1, leading to a deficiency in sterol 27-hydroxylase. This defect results in the accumulation of cholestanol and bile alcohols in various tissues, including the brain, tendons and peripheral nerves. We conducted this review to evaluate lipid profile abnormalities in patients with CTX. A search was conducted in PubMed, Embase and the Virtual Health Library in January 2023 to evaluate studies reporting the lipid profiles of CTX patients, including the levels of cholestanol, cholesterol and other lipids. Elevated levels of cholestanol were consistently observed. Most patients presented normal or low serum cholesterol levels. A decrease in chenodeoxycholic acid (CDCA) leads to increased synthesis of cholesterol metabolites, such as bile alcohols 23S-pentol and 25-tetrol 3-glucuronide, which may serve as surrogate follow-up markers in patients with CTX. Lipid abnormalities in CTX have clinical implications. Cholestanol deposition in tissues contributes to clinical manifestations, including neurological symptoms and tendon xanthomas. Dyslipidemia and abnormal cholesterol metabolism may also contribute to the increased risk of atherosclerosis and cardiovascular complications observed in some CTX patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Lucas Soares Radtke
- Faculty of Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
| | | | | | | | | | | | - Pedro Braga Neto
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceara, Fortaleza 60430-372, Brazil
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17
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Nóbrega PR, Lima PRO, de Oliveira Junior PH, Sanders LP, Sobreira-Neto MA, Magalhães SC, Sanders LLO, Braga-Neto P. Persistent psychosis associated with extreme delta brush in anti-NMDA receptor encephalitis: a case report. BMC Psychiatry 2023; 23:256. [PMID: 37069530 PMCID: PMC10111700 DOI: 10.1186/s12888-023-04750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Anti-NMDAR encephalitis is an emerging differential diagnosis of first episode and persistent psychosis in the psychiatric community, as clinical manifestations include psychiatric symptoms, cognitive dysfunction, seizures, decreased consciousness, and dyskinesias. This disease is associated with extreme delta brush (EDB), but the significance and temporal course of this EEG pattern still needs to be determined. Herein, we report a case of anti-NMDAR encephalitis with persistent psychosis associated with EDB occurrence on multiple occasions during a 5-year disease course. CASE PRESENTATION A 15-year-old girl was diagnosed with anti-NMDAR encephalitis and treated with progressive improvement. Four years after initial manifestations, an EDB pattern was seen on electroencephalogram (EEG) without new neurological symptoms. She had residual symptoms of episodic auditory hallucinations and impulsivity. One year later, the patient had a recurrence of neurological symptoms (seizures, dyskinesias and impaired attention), persisting with EDB on EEG. Clinical symptoms and EDB resolved after second-line treatment with rituximab. CONCLUSION We describe the first case of persistent psychosis in anti-NMDAR encephalitis associated with extreme delta brush on multiple EEGs on prolonged follow-up. Electroencephalographic patterns such as EDB may serve as markers of residual disease activity, including psychiatric symptoms. Further studies with prolonged EEG monitoring are needed to better understand these findings.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil
| | - Paulo Reges Oliveira Lima
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil
| | | | - Lorena Pitombeira Sanders
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil
| | | | - Samir Câmara Magalhães
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil
- Universidade de Fortaleza, Fortaleza, Brazil
| | - Lia Lira Olivier Sanders
- Division of Psychiatry, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Ceará, Brazil.
- Center of Health Sciences, Universidade Estadual do Ceará, Ceará, Brazil.
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18
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de Oliveira Scott SS, Pedroso JL, Elias VV, Nóbrega PR, Sobreira EST, de Almeida MP, Gama MTD, Massuyama BK, Barsottini OGP, Frota NAF, Braga-Neto P. Correction to: Translation, Cross-Cultural Adaptation, and Validation to Brazilian Portuguese of the Cerebellar Cognitive Affective/Schmahmann Syndrome Scale. Cerebellum 2023; 22:295. [PMID: 35644794 DOI: 10.1007/s12311-022-01423-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - José Luiz Pedroso
- Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Paulo Ribeiro Nóbrega
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal Do Ceara, Fortaleza, Brazil
| | - Emmanuelle Silva Tavares Sobreira
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal Do Ceara, Fortaleza, Brazil.,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Maria Thereza Drumond Gama
- Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Breno Kazuo Massuyama
- Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Pedro Braga-Neto
- Neurology Section, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal Do Ceara, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual Do Ceara, Fortaleza, Brazil.
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19
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Paiva ARBD, Pessoa ALS, Nóbrega PR, Moreno CAM, Lynch DS, Taniguti LM, Kitajima JP, Freua F, Della-Ripa B, Cunha P, Peixoto de Barcelos I, Macedo-Souza LI, Takeuchi CA, Garcia AMS, Nardes F, Fontão R, Antoniuk SA, Troncoso M, Spécola N, Durand C, Madeiro BDACS, Doriqui MJR, Vergara D, Houlden H, Kok F. Ceroid lipofuscinosis type 5: novel pathogenic variants and unexpected phenotypic findings. J Neurol Neurosurg Psychiatry 2023; 94:405-408. [PMID: 36737246 DOI: 10.1136/jnnp-2022-330135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Anderson Rodrigues Brandão de Paiva
- Mendelics Genomic Analysis, São Paulo, SP, Brazil
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Neurology Department, Hospital São Rafael - Rede D'or São Luiz, Salvador, BA, Brazil
| | - André Luiz Santos Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, CE, Brazil
- Universidade Estadual do Ceara, Fortaleza, CE, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Neurology Department, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Cristiane Araujo Martins Moreno
- Mendelics Genomic Analysis, São Paulo, SP, Brazil
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - David S Lynch
- Department of Neurogenetics, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | | | - Fernando Freua
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Neurology Department, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Bruno Della-Ripa
- Mendelics Genomic Analysis, São Paulo, SP, Brazil
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulina Cunha
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Institut du Cerveau (ICM), APHP, Pitié Salpêtrière Hospital, Paris, France
| | - Isabella Peixoto de Barcelos
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Flávia Nardes
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ramiro Fontão
- Neuropediatrics, Penna Hospital, Bahía Blanca, Buenos Aires, Argentina
| | | | - Monica Troncoso
- Pediatric Neurology Department, Hospital Clínico San Borja Arriarán, University of Chile, Santiago, Chile
| | - Norma Spécola
- Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - Consuelo Durand
- Laboratorio de Neuroquímica Dr. N.A. Chamoles, Buenos Aires, Argentina
| | | | | | - Diane Vergara
- Pediatric Neurology Department, Hospital Clínico San Borja Arriarán, University of Chile, Santiago, Chile
| | - Henry Houlden
- Department of Neurogenetics, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Fernando Kok
- Mendelics Genomic Analysis, São Paulo, SP, Brazil
- Neurology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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20
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Nóbrega PR, Morais JLA, Ferreira AM, de Medeiros AD, Duarte BA, Rangel DM, Lima FO, de Paiva ARB, Paim-Marques L, Kok F, Pessoa ALS, Braga-Neto P, Carvalho FMM. Aseptic meningitis in Fabry disease due to a novel GLA variant: an expanded phenotype? Neurol Sci 2023; 44:319-327. [PMID: 36094773 DOI: 10.1007/s10072-022-06388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/31/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND F abry disease (FD) is an X-linked lysosomal storage disorder with accumulation of globotriosylceramide, causing neurologic involvement mainly as acroparesthesias and cerebrovascular disease. Aseptic meningitis has been reported in 11 patients with FD, but no prior study has correlated alpha-galactosidase (GLA) specific variants with meningitis. We present in this manuscript a family in which a novel GLA pathogenic variant was associated with aseptic meningitis in 2 of 5 family members. METHODS This study began with identifying the proband, then screening family members for FD symptoms and evaluating symptomatic individuals for genetic and biochemical status. All patients underwent magnetic resonance imaging, and those with headache underwent cerebrospinal fluid (CSF) analysis. RESULTS Five patients (3 females) from a single family were included in this study. Mean age at diagnosis was 20.6 years. Two patients (40%) had aseptic meningitis; one of them also had cerebrovascular events. C-reactive protein and erythrocyte sedimentation rate were elevated during aseptic meningitis episodes. Both patients responded to intravenous methylprednisolone with resolution of fever, headache, and vomiting. One of them recurred and needed chronic immunosuppression with azathioprine. CONCLUSION We described aseptic meningitis in a family with a novel GLA variant. Meningitis might be a common phenomenon in FD and not a particularity of this variant. Understanding the mechanisms underlying meningitis and its association with cerebrovascular events may lead to a new paradigm of treatment for stroke in these patients. Further prospective studies with CSF collection in patients with FD and recurrent headache could help to elucidate this question.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurogenetics Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Alliane Milliane Ferreira
- Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil.,Department of Clinical Medicine, Universidade de Fortaleza, Ceará, Brazil
| | - Alisson Dantas de Medeiros
- UNICHRISTUS University Center, Ceará, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil
| | | | - Deborah Moreira Rangel
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil
| | | | | | | | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.,Mendelics Genomic Analysis, São Paulo, Brazil
| | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
| | - Fernanda Martins Maia Carvalho
- Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil.,Department of Clinical Medicine, Universidade de Fortaleza, Ceará, Brazil
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21
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Nóbrega PR, Bernardes AM, Ribeiro RM, Vasconcelos SC, Araújo DABS, Gama VCDV, Fussiger H, Santos CDF, Dias DA, Pessoa ALS, Pinto WBVDR, Saute JAM, de Souza PVS, Braga-Neto P. Cerebrotendinous Xanthomatosis: A practice review of pathophysiology, diagnosis, and treatment. Front Neurol 2022; 13:1049850. [PMID: 36619921 PMCID: PMC9816572 DOI: 10.3389/fneur.2022.1049850] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Cerebrotendinous Xanthomatosis represents a rare and underdiagnosed inherited neurometabolic disorder due to homozygous or compound heterozygous variants involving the CYP27A1 gene. This bile acid metabolism disorder represents a key potentially treatable neurogenetic condition due to the wide spectrum of neurological presentations in which it most commonly occurs. Cerebellar ataxia, peripheral neuropathy, spastic paraparesis, epilepsy, parkinsonism, cognitive decline, intellectual disability, and neuropsychiatric disturbances represent some of the most common neurological signs observed in this condition. Despite representing key features to increase diagnostic index suspicion, multisystemic involvement does not represent an obligatory feature and can also be under evaluated during diagnostic work-up. Chenodeoxycholic acid represents a well-known successful therapy for this inherited metabolic disease, however its unavailability in several contexts, high costs and common use in patients at late stages of disease course limit more favorable neurological outcomes for most individuals. This review article aims to discuss and highlight the most recent and updated knowledge regarding clinical, pathophysiological, neuroimaging, genetic and therapeutic aspects related to Cerebrotendinous Xanthomatosis.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil,Neurogenetics Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Anderson Moura Bernardes
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Rodrigo Mariano Ribeiro
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Sophia Costa Vasconcelos
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Helena Fussiger
- School of Medicine, Universidade Federação de Estabelecimentos de Ensino Superior em Novo Hamburgo, Novo Hamburgo, Brazil,Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - André Luíz Santos Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil,Center of Health Science, Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | - Jonas Alex Morales Saute
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,Medical Genetics Service and Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Victor Sgobbi de Souza
- Neurometabolic Unit, Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil,*Correspondence: Paulo Victor Sgobbi de Souza ✉
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil,Center of Health Science, Universidade Estadual do Ceará, Fortaleza, Brazil
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22
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Nóbrega PR, Castro MAA, de Paiva ARB, Kok F. Mystery solved after 23 years: M syndrome is PIGT-associated multiple congenital anomalies-hypotonia-seizures syndrome 3. Am J Med Genet A 2022; 188:3567-3568. [PMID: 36177944 DOI: 10.1002/ajmg.a.62977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurogenetics Unit, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Matheus Augusto Araújo Castro
- Neurogenetics Unit, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil.,Mendelics Genomic Analysis, São Paulo, Brazil
| | | | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil.,Mendelics Genomic Analysis, São Paulo, Brazil
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23
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Moura AEF, Oliveira DN, Torres DM, Tavares-Júnior JWL, Nóbrega PR, Braga-Neto P, Sobreira-Neto MA. Central hypersomnia and chronic insomnia: expanding the spectrum of sleep disorders in long COVID syndrome - a prospective cohort study. BMC Neurol 2022; 22:417. [DOI: 10.1186/s12883-022-02940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Long-onset COVID syndrome has been described in patients with COVID-19 infection with persistence of symptoms or development of sequelae beyond 4 weeks after the onset of acute symptoms, a medium- and long-term consequence of COVID-19. This syndrome can affect up to 32% of affected individuals, with symptoms of fatigue, dyspnea, chest pain, cognitive disorders, insomnia, and psychiatric disorders. The present study aimed to characterize and evaluate the prevalence of sleep symptoms in patients with long COVID syndrome.
Methodology
A total of 207 patients with post-COVID symptoms were evaluated through clinical evaluation with a neurologist and specific exams in the subgroup complaining of excessive sleepiness.
Results
Among 189 patients included in the long COVID sample, 48 (25.3%) had sleep-related symptoms. Insomnia was reported by 42 patients (22.2%), and excessive sleepiness (ES) was reported by 6 patients (3.17%). Four patients with ES were evaluated with polysomnography and test, multiple sleep latencies test, and actigraphic data. Two patients had a diagnosis of central hypersomnia, and one had narcolepsy. A history of steroid use was related to sleep complaints (insomnia and excessive sleepiness), whereas depression was related to excessive sleepiness. We observed a high prevalence of cognitive complaints in these patients.
Conclusion
Complaints related to sleep, such as insomnia and excessive sleepiness, seem to be part of the clinical post-acute syndrome (long COVID syndrome), composing part of its clinical spectrum, relating to some clinical data.
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24
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Nóbrega PR, Junior PHDO, de Freitas HC, D'almeida JAC, Rodrigues CL. Letter response to “The Janus faces of SARS-COV-2 infection in myasthenia gravis and myasthenic crisis”. Neurol Sci 2022; 43:5805-5806. [PMID: 35941335 PMCID: PMC9360651 DOI: 10.1007/s10072-022-06318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Rua Capitão Francisco Pedro, 1290, Rodolfo Teófilo, Fortaleza, Ceara, 60430, Brazil.
| | - Pedro Helder de Oliveira Junior
- Division of Neurology, Department of Clinical Medicine, Federal University of Ceará, Rua Capitão Francisco Pedro, 1290, Rodolfo Teófilo, Fortaleza, Ceara, 60430, Brazil
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25
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Freua F, Almeida MEDC, Nóbrega PR, Paiva ARBD, Della-Ripa B, Cunha P, Macedo-Souza LI, Bueno C, Lynch DS, Houlden H, Lucato LT, Kok F. Arginase 1 deficiency presenting as complicated hereditary spastic paraplegia. Cold Spring Harb Mol Case Stud 2022; 8:mcs.a006232. [PMID: 36180229 PMCID: PMC9632362 DOI: 10.1101/mcs.a006232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Argininemia or arginase deficiency is a metabolic disorder caused by pathogenic variants in ARG1 and consists of a variable association of progressive spastic paraplegia, intellectual disability, and seizures. Hereditary spastic paraplegia (HSP) is a group of inherited diseases whose main feature is a progressive gait disorder characterized by lower limb spasticity. This study presents 7 patients with arginase 1 deficiency from 6 different families, all with an initial diagnosis of complicated HSP. METHODS We evaluated the clinical data of 7 patients belonging to six independent families who were diagnosed with hyperargininemia in a neurogenetics outpatient clinic. RESULTS All patients had lower limb spasticity and six had global developmental delay. Five individuals had intellectual disability and two had epilepsy. Psychiatric abnormalities were seen in two patients. In two participants of this study, MRI disclosed thinning of the corpus callosum. Molecular diagnosis was made by whole exome sequencing. All variants were present in homozygosis; we identified two novel missense variants, one novel frameshift variant, and one previously published missense variant. DISCUSSION Clinical diagnosis of early onset complicated hereditary spastic paraplegia was made in all patients. Two patients were initially suspected of having SPG11 due to thinning of the corpus callosum. As argininemia may present with a highly penetrant phenotype of spastic paraplegia associated with additional symptoms, this disease may represent a specific entity amongst the complicated HSPs.
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Affiliation(s)
- Fernando Freua
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil;;
| | - Mariana Espíndola de Castro Almeida
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anderson Rodrigues Brandáo de Paiva
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Della-Ripa
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulina Cunha
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lúcia Inês Macedo-Souza
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clarissa Bueno
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David S Lynch
- Department of Neuromuscular Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Leandro Tavares Lucato
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
| | - Fernando Kok
- Neurogenetics Outpatient, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo, Sáo Paulo, Brazil
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26
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Carvalho CGM, Nóbrega PR, Scott SSDO, Rangel DM, Soares DMB, Maia CSC, Braga-Neto P. Nutritional status and eating habits of patients with hereditary ataxias: a case-control study. Nutr Neurosci 2022:1-6. [PMID: 35857702 DOI: 10.1080/1028415x.2022.2088942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Hereditary Ataxias (HAs) comprise a wide spectrum of genetically determined neurodegenerative diseases with progressive ataxia as the main symptom. Few studies have evaluated nutritional profile in HA patients and most of these focused on specific ataxia subtypes. The objectives of this study were: (1) to investigate whether hereditary ataxias were associated with changes in energy expenditure, body composition and dietary intake; (2) to verify differences in these variables according to ataxia subtype, sex, age, and disease severity. METHODS Thirty-eight hereditary ataxia patients from two neurology centers in Northeastern Brazil and 38 controls were evaluated. Body composition was assessed with bio-impedance analysis and dietary intake was estimated with a validated questionnaire (24-hour dietary recall). RESULTS Mean body mass index (BMI) was lower in HA compared to controls (p = 0.032). Hereditary ataxia patients showed lower protein intake, higher frequency of dysphagia and higher incidence of nausea and diarrhea. The difference in average estimated caloric intake did not reach statistical significance (2359kcal ± 622 in patients × 2713kcal ± 804 in controls, p = 0.08). Disease severity measured by the SARA scale was not associated with BMI, nor was ataxia subtype (autosomal dominant × non-autosomal dominant ataxias). CONCLUSION Hereditary ataxia patients have lower BMI compared to healthy controls. There was no difference in this cohort between dominant or non-dominant ataxia regarding BMI. Weight loss may be a common finding among hereditary ataxias and may affect the quality of life in these patients.
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Affiliation(s)
| | - Paulo Ribeiro Nóbrega
- Neurology Division, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Deborah Moreira Rangel
- Neurology Division, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Micronutrient and Chronic disease Group, Nutrition and Health Post Graduation Department, UniversidadeEstadual do Ceará, Fortaleza, Brazil
| | | | - Carla Soraya Costa Maia
- Center of Health Science, Universidade Estadual do Ceará, Fortaleza, Brazil.,Micronutrient and Chronic disease Group, Nutrition and Health Post Graduation Department, UniversidadeEstadual do Ceará, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Center of Health Science, Universidade Estadual do Ceará, Fortaleza, Brazil.,Neurology Division, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Brazil
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27
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Vasconcelos TDMF, Nóbrega PR, Ferreira GDM, de Souza MLP, Vanderlei AS, de Castro JDV, Braga-Neto P, Sobreira-Neto MA. Normal pressure hydrocephalus associated with COVID-19 infection: a case report. BMC Infect Dis 2022; 22:216. [PMID: 35241017 PMCID: PMC8892823 DOI: 10.1186/s12879-022-07184-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 is a pandemic disease responsible for many deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) 2 months after acute COVID19 infection, in a patient without other risk factors. CASE PRESENTATION A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. CONCLUSION Other infections such as syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.
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Affiliation(s)
| | - Paulo Ribeiro Nóbrega
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Moysés Loiola Ponte de Souza
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | - Pedro Braga-Neto
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil. .,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil. .,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
| | - Manoel Alves Sobreira-Neto
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.,Department of Clinical Medicine, Neurology Section, Universidade Federal do Ceará, Fortaleza, Brazil.,Unichristus University, Fortaleza, Brazil
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28
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de Paiva ARB, Fonseca Neto RE, Afonso C, Freua F, Nóbrega PR, Kok F. Incidental MRI findings leading to an unusual diagnosis: adult-onset Krabbe disease. Eur J Neurol 2022; 29:1859-1862. [PMID: 35212100 DOI: 10.1111/ene.15298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Krabbe disease (KD), or globoid cell leukodystrophy (OMIM #245200), is an autosomal recessive lysosomal storage disease caused by mutations in GALC leading to galactocerebrosidase deficiency. Age of onset can vary from early infantile (3 to 6 months of age) to adulthood, which has been rarely reported. Little is known about the natural history and early manifestations of adult-onset Krabbe disease (AOKD). METHODS Here we report a patient with an incidental diagnosis of AOKD and discuss management options in this scenario. RESULTS A 32 year-old woman came to medical attention because of headache and had brain MRI findings compatible with AOKD, two pathogenic variants in GALC and reduced activity of galactocerebrosidase. The jury is still out about the best management of such cases, and clinicians should be aware of this diagnosis, as AOKD is a potentially treatable condition. CONCLUSIONS Adult-onset Krabbe disease is a rare and potentially treatable condition. More studies on natural history of AOKD are urgently needed to guide the best management of this disease.
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Affiliation(s)
| | | | - Clara Afonso
- Ophthalmology Service, Hospital de Olhos - HCOE, Feira de Santana, Brazil.,Associate Professor, Hospital Santa Luzia, Salvador, Brazil
| | - Fernando Freua
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.,Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará
| | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.,Mendelics Genomic Analysis, Sao Paulo, Brazil
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29
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Rocha VCDRR, Vasconcelos TDMF, Albuquerque CPD, Ribeiro Nóbrega P, Castro JDVD. Diagnóstico por imagem de arteriopatia cerebral associada a mutação ACTA2: relato de caso. Rev Med UFC 2022. [DOI: 10.20513/2447-6595.2022v62n1e62540p1-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivos: descrever as características radiológicas que permitem o reconhecimento da arteriopatia cerebral associada à mutação ACTA2 nas imagens de ressonância magnética. Metodologia: foram analisadas imagens de ressonância magnética (RM) e angiorresonância (ARM) de crânio. Resultados: paciente do sexo feminino, 19 anos, com déficit cognitivo e cefaleia occipital, evoluindo com paraparesia à direita e amaurose bilateral. Realizou RM e ARM de crânio, que demonstrou achados característicos: retificação das estruturas arteriais, hipoplasia e arqueamento do corpo caloso anteriormente, aspecto em “V” do joelho do corpo caloso e proeminente impressão da artéria basilar sobre a ponte. Foram também vistos focos de alteração de sinal em zona de fronteira vascular frontal direita. Conclusão: Mutações ACTA2 são raras e caracterizam-se por uma disfunção sistêmica do músculo liso, causando alterações cerebrovasculares, dissecções e aneurismas de aorta, hipertensão pulmonar, dentre outros. A arteriopatia cerebral é responsável por episódios de acidente vascular cerebral na infância, sendo caracterizada por retificação das estruturas arteriais e oclusão progressiva das artérias carótidas internas terminais e seus ramos. Tem características de imagem únicas, que permitem diferenciá-la da doença Moya-Moya, conforme acima descritas. Os radiologistas devem, portanto, reconhecer tais achados uma vez que o correto diagnóstico tem importantes implicações no manejo e no prognóstico.
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Rodrigues CL, de Freitas HC, Lima PRO, de Oliveira Junior PH, Fernandes JMA, D’Almeida JAC, Nóbrega PR. Myasthenia gravis exacerbation and myasthenic crisis associated with COVID-19: case series and literature review. Neurol Sci 2022; 43:2271-2276. [PMID: 35039987 PMCID: PMC8763445 DOI: 10.1007/s10072-021-05823-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that can be exacerbated by many viral infections, including COVID-19. The management of MG exacerbations is challenging in this scenario. We report 8 cases of MG exacerbation or myasthenic crisis associated with COVID-19 and discuss prognosis and treatment based on a literature review. RESULTS Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up. DISCUSSION This is the largest case series of MG exacerbation or myasthenic crisis due to COVID-19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab, and tocilizumab.
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Affiliation(s)
- Cleonisio Leite Rodrigues
- grid.414722.60000 0001 0756 5686Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Paulo Reges Oliveira Lima
- grid.8395.70000 0001 2160 0329Division of Neurology, Department of Clinical Medicine, Universidade Federal Do Ceará, Fortaleza, Brazil
| | - Pedro Helder de Oliveira Junior
- grid.8395.70000 0001 2160 0329Division of Neurology, Department of Clinical Medicine, Universidade Federal Do Ceará, Fortaleza, Brazil
| | - José Marcelino Aragão Fernandes
- grid.8395.70000 0001 2160 0329Division of Neurology, Department of Clinical Medicine, Universidade Federal Do Ceará, Fortaleza, Brazil
| | | | - Paulo Ribeiro Nóbrega
- grid.8395.70000 0001 2160 0329Division of Neurology, Department of Clinical Medicine, Universidade Federal Do Ceará, Fortaleza, Brazil
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Abstract
A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of systemic chemotherapy. MR scan of the spinal cord showed bilateral symmetric and extensive T2/fluid attenuated inversion recovery (FLAIR) increased signal involving the dorsal columns in the thoracic cord. His serum folate concentration was at the lower end of the normal range. We stopped the intrathecal chemotherapy and gave folate; after a few days, he progressively improved. Myelopathy is an important adverse effect of intrathecal methotrexate, which may cause clinical and imaging features resembling subacute combined degeneration of the spinal cord. CNS infiltration must be excluded, intrathecal chemotherapy stopped and deficiency of folate or vitamin B12 treated as appropriate.
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Affiliation(s)
| | - Talles Tavares de Lima
- Department of Clinical Medicine, Hospital Universitário Lauro Wanderley, João Pessoa, Paraíba, Brazil
| | - Fernando Barroso Duarte
- Department of Surgery, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.,Division of Cell Processing, Centro de Hematologia e Hemoterapia do Ceara, Fortaleza, Ceará, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Nóbrega PR, Rodrigues PGB, de Sousa Pereira I, de Figueiredo Santos C, Gerson G, de Arruda JAM, Júnior JWLT, de Araújo Coimbra PP, Braga-Neto P. Steroid responsive cavernous sinus syndrome due to Rosai-Dorfman disease: beyond Tolosa-Hunt syndrome - a case report. BMC Neurol 2021; 21:264. [PMID: 34225703 PMCID: PMC8256567 DOI: 10.1186/s12883-021-02255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term "Tolosa-Hunt syndrome" (THS) has been used to refer to painful ophthalmoplegia associated with nonspecific inflammation of the cavernous sinus and many processes can result in a similar clinical picture, including infectious, inflammatory and neoplastic diseases. Rosai-Dorfman disease (RDD) is a lymphoproliferative disorder that rarely affects the central nervous system. We report a case of isolated CNS Rosai-Dorfman disease involving the cavernous sinus and presenting as "Tolosa-Hunt syndrome". CASE PRESENTATION Our patient presented with horizontal diplopia due to impairment of cranial nerves III, IV and VI and a stabbing/throbbing headache predominantly in the left temporal and periorbitary regions. There was a nonspecific enlargement of the left cavernous sinus on MRI and the patient had a dramatic response to steroids. Biopsy of a frontal meningeal lesion was compatible with RDD. CONCLUSIONS We highlight the importance of including Rosai-Dorfman disease as a differential diagnosis in cavernous sinus syndrome and demonstrate a satisfactory long-term response to steroid treatment in this disease.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1290, 60430-370, Fortaleza, Brazil.
| | - Pedro Gustavo Barros Rodrigues
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1290, 60430-370, Fortaleza, Brazil
| | - Isabelle de Sousa Pereira
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1290, 60430-370, Fortaleza, Brazil
| | | | - Gunter Gerson
- Department of Pathology, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - José Wagner Leonel Tavares Júnior
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1290, 60430-370, Fortaleza, Brazil
| | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Rua Capitão Francisco Pedro, 1290, 60430-370, Fortaleza, Brazil.,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
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Lessa AGU, Albuquerque LAFD, Morais NMDM, Dias DA, Nóbrega PR. Multinodular and vacuolating neuronal tumor of the cerebrum: three case reports. Rev Med UFC 2021. [DOI: 10.20513/2447-6595.2021v61n1e43432p1-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a seizure-associated rare lesion that currently appears to be a malformative lesion or hamartoma rather than a low-grade neoplastic lesion. MVNT pathognomonic magnetic resonance imaging (MRI) features allow for diagnostic accuracy in the differential diagnosis. Lesions are usually asymptomatic, nonprogressive and incidentally found requiring only imaging monitoring over time. Although uncommon, it is important to be familiar with MVNT clinical presentation and key imaging features. We here present a series of three cases with imaging findings similar to those described in the literature. These patients were followed with serial neuroimaging.
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Rodrigues PGB, Pereira IDS, Lima Filho VB, Dias DA, Nóbrega PR, Braga-Neto P. Intracranial mass lesions and skin discoloration in the armpits as unusual clues to Erdheim-Chester disease: a case report. BMC Neurol 2021; 21:81. [PMID: 33602153 PMCID: PMC7891159 DOI: 10.1186/s12883-021-02107-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background Erdheim–Chester disease (ECD) is a non-Langerhans histiocytosis that results in multi-organ disease involving the skin, bones, lungs and kidneys. Central nervous system (CNS) involvement occurs in about 50 % of patients, and diabetes insipidus, visual disturbances, and cerebellar ataxia are the most frequent neurological signs. We report a case of Erdheim-Chester disease with central nervous system involvement in the form of enhancing intracranial mass lesions with massive edema. Case presentation The patient presented with vertigo, ataxia, encephalopathy and pyramidal signs. Diagnosis was suggested by xanthomatous skin lesions and a biopsy was compatible with Erdheim-Chester disease demonstrating xanthogranulomas CD68 positive (clone KP1) and CD1a and S100 negative. Testing for BRAF mutation was negative, which precluded treatment with Vemurafenib. Treatment with steroids and interferon resulted in improvement of neurological signs and regression of edema on MRI. Conclusions The diagnosis of Erdheim-Chester disease should be considered in intracranial mass lesions. Xanthomatous skin lesions are a clue to the diagnosis.
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Affiliation(s)
| | - Isabelle de Sousa Pereira
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Valter Barbalho Lima Filho
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
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Vasconcelos GDA, Barreira RM, Antoniollo KENT, Pinheiro AMN, Maia CFR, Alves DMBS, Nóbrega PR, Braga-Neto P. Autoimmune Encephalitis in Latin America: A Critical Review. Front Neurol 2021; 11:606350. [PMID: 33551968 PMCID: PMC7859257 DOI: 10.3389/fneur.2020.606350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Autoimmune encephalitis is an increasingly recognized cause of encephalitis. The majority of case series report patients residing in developed countries in the northern hemisphere. The epidemiologic features of autoimmune encephalitis in Latin America are still unclear. The aim of the study was to perform a review of the clinical presentation of autoimmune encephalitis in Latin America and compare to world literature. References were identified by an in-depth literature search and selected on the basis of relevance to the topic and authors' judgment. We selected clinical studies and case reports published from 2007 to July, 2020 including patients from Latin American countries. Of the 379 patients included, the majority were cases of anti-NMDA receptor encephalitis (93.14%), followed by anti-VGKC-complex encephalitis (N = 17; 4.48%), anti-GAD encephalitis (N = 9; 2.37%), anti-AMPA receptor encephalitis (N = 1; 0.26%), anti-GABA receptor encephalitis (N = 1; 0. 26%), anti-mGluR5 encephalitis (N = 1; 0. 26%), and anti-mGluR1 encephalitis (N = 1; 0. 26%). Reported cases of Anti-NMDA encephalitis in Latin-America had a very slight female predominance, lower prevalence of associated tumors and a lower incidence of extreme delta brush on electroencephalogram. Autoimmune encephalitis is possibly underdiagnosed in underdeveloped countries. Its outcome after treatment, however, appears to be similarly favorable in Latin American patients as has been reported in developed countries based on available case reports and case series. Regional specificities in the manifestation of autoimmune encephalitis could be related to epidemiologic factors, such as the presence of different triggers and different genetic and immunologic background, that need to be studied by future research.
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Affiliation(s)
| | | | | | | | | | | | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Fortaleza, Brazil.,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.,Division of Neurology, Department of Clinical Medicine, Fortaleza, Brazil
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Nóbrega PR, Morais NMDM, Braga-Neto P, Barros LSDS, Honório FPP, Dellavance A, Hoftberger R, Dutra LA. NMDAR Encephalitis Associated With Acute Chikungunya Virus Infection: A New Trigger? Front Pediatr 2020; 8:176. [PMID: 32426307 PMCID: PMC7204150 DOI: 10.3389/fped.2020.00176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Anti-NMDAR encephalitis is the most frequent cause of autoimmune encephalitis. Chikungunya (CHIK) is an arbovirus responsible for outbreaks of fever, cutaneous rash and arthritis in underdeveloped countries, and a trigger for autoimmunity. Case Presentation: We report a five-year-old male patient with fever, myalgia, headache and conjunctivitis for 5 days. After 1 week he developed tonic-clonic seizures and evolved with dystonia and oromandibular dyskinesia followed by onset of focal motor seizures, decreased level of consciousness, dysautonomia and central apnea. Brain MRI was normal, CSF analysis revealed 15 cells, protein 16.6 mg/dL and glucose 68 mg/dL. Anti-NMDAR antibodies were detected in serum and CSF after 3 weeks of symptom onset. CHIK serology was positive for both IgM and IgG, suggesting a recent infection. Dengue and Zika serologies were negative. CSF PCR for herpes viruses and arboviruses (CHIK, Dengue and Zika) were negative. Conclusion: We report the occurrence of anti-NMDAR encephalitis after acute CHIK infection. The biphasic course, positivity for both CHIK IgM and IgG and negative CHIK CSF PCR results, as well as a dramatic response to immunotherapy suggest an immune-mediated pathogenesis. Because of the global epidemic of CHIK infection and unknown mechanisms involving CHIK and autoimmunity, patients with acute CHIK infections and neurological manifestations should be considered for antineuronal antibody testing.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Norma Martins de Menezes Morais
- Department of Pediatrics, Unichristus Medical School, Fortaleza, Brazil.,Pediatric Service, Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | | | | | - Romana Hoftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
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Nóbrega PR, Pitombeira MS, Mendes LS, Krueger MB, Santos CF, Morais NMDM, Simabukuro MM, Maia FM, Braga-Neto P. Clinical Features and Inflammatory Markers in Autoimmune Encephalitis Associated With Antibodies Against Neuronal Surface in Brazilian Patients. Front Neurol 2019; 10:472. [PMID: 31139134 PMCID: PMC6527871 DOI: 10.3389/fneur.2019.00472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute encephalitis is a debilitating neurological disorder associated with brain inflammation and rapidly progressive encephalopathy. Autoimmune encephalitis (AE) is increasingly recognized as one of the most frequent causes of encephalitis, however signs of inflammation are not always present at the onset which may delay the diagnosis. We retrospectively assessed patients with AE associated with antibodies against neuronal surface diagnosed in reference centers in Northeast of Brazil between 2014 to 2017. CNS inflammatory markers were defined as altered CSF (pleocytosis >5 cells/mm3) and/or any brain parenchymal MRI signal abnormality. Thirteen patients were evaluated, anti-NMDAR was the most common antibody found (10/13, 77%), followed by anti-LGI1 (2/13, 15%), and anti-AMPAR (1/13, 7%). Median time to diagnosis was 4 months (range 2–9 months). Among these 13 patients, 6 (46.1%) had inflammatory markers and when compared to those who did not present signs of inflammation, there were no significant differences regarding the age of onset, time to diagnosis and modified Rankin scale score at the last visit. Most of the patients presented partial or complete response to immunotherapy during follow-up. Our findings suggest that the presence of inflammatory markers may not correlate with clinical presentation or prognosis in patients with AE associated with antibodies against neuronal surface. Neurologists should be aware to recognize clinical features of AE and promptly request antibody testing even without evidence of inflammation in CSF or MRI studies.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceara, Fortaleza, Brazil.,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Milena Sales Pitombeira
- Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Department of Neurology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Silvestre Mendes
- Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Unichristus Medical School, Unichristus, Fortaleza, Brazil
| | - Mariana Braatz Krueger
- Child Neurology Service, Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Medical Sciences Post-Graduation Program, Universidade de Fortaleza, Fortaleza, Brazil
| | | | - Norma Martins de Menezes Morais
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceara, Fortaleza, Brazil.,Unichristus Medical School, Unichristus, Fortaleza, Brazil
| | - Mateus Mistieri Simabukuro
- Department of Neurology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Martins Maia
- Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Medical Sciences Post-Graduation Program, Universidade de Fortaleza, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceara, Fortaleza, Brazil.,Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Center of Health Sciences, Universidade Estadual do Ceara, Fortaleza, Brazil
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Rangel DM, Nóbrega PR, Saraiva-Pereira ML, Jardim LB, Braga-Neto P. A case series of hereditary cerebellar ataxias in a highly consanguineous population from Northeast Brazil. Parkinsonism Relat Disord 2018; 61:193-197. [PMID: 30389370 DOI: 10.1016/j.parkreldis.2018.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are few studies reporting characteristics of patients with cerebellar ataxias in the Brazilian population. The aim of this study was to provide a detailed neurological description of patients with hereditary ataxia followed by a neurology outpatient service in Brazil. METHODS Neurological and clinical evaluation of patients with hereditary ataxia was performed at a neurology service outpatient clinic of a hospital in Northeast Brazil between October 2013 and January 2015. RESULTS A total of 47 patients had ataxia as the main symptom. A high prevalence of consanguinity was found in the population studied (40.4%). Mean age was 38.4 ± 15.3 years, mean age at disease onset was 25.6 ± 17.3 years, mean disease duration was 12.8 ± 9.7 years, and mean score on the Scale for the Assessment and Rating of Ataxia (SARA) was 18.4 ± 7.7. Patients with recessive pattern of inheritance were younger, had earlier age at disease onset and greater severity of ataxia, measured by the SARA. Diagnosis was confirmed by molecular analysis, laboratory exams or biopsy in 42.56% (n = 20) of these patients. The most prevalent diseases were: Friedreich's ataxia in 35% (n = 7), Niemann-Pick type C (NPC) in 15% (n = 3), and ataxia with oculomotor apraxia type 2 in 15% (n = 3). CONCLUSIONS In contrast with other studies, our prevalence of recessive ataxias was much higher than that of dominant ataxias. These findings might be explained by the high number of patients living in rural areas with a higher rate of consanguineous marriages, absence of a dominant ataxia founder effect or difficult access to healthcare system.
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Affiliation(s)
- Deborah Moreira Rangel
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil; Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Center of Health Sciences, Universidade Estadual do Ceará, Brazil.
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Bezerra Lima L, Alves Sobreira-Neto M, Braga-Neto P, Ribeiro Nóbrega P. Isolated central nervous system Rosai-Dorfman disease and breast cancer: an unusual presentation. Int J Neurosci 2018; 129:393-396. [PMID: 30296195 DOI: 10.1080/00207454.2018.1533823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The association between Rosai-Dorfman Disease (RDD) and cancer was reported for the first time in 1984. However, there are still a small number of reports of this association. We describe a 60-year-old woman who presented with a focal onset motor seizure followed by tonic-clonic generalization and persistent headache. Magnetic Resonance Imaging disclosed an irregular hyperintense lesion in T2 and vasogenic edema in the left parietal region. Immunohistochemical analysis of a biopsy fragment was positive for protein S-100 and CD68 and negative for CD1a, compatible with the diagnosis of RDD. She previously had breast cancer six years earlier and had used tamoxifen for two years and anostrozol for three years after diagnosis of cancer. RDD has been already associated with different cancers, such as Hodgkin's lymphoma, non-Hodgkin's lymphoma, follicular lymphoma, melanoma, adenocarcinoma and small cell lung cancer. As far as we know, this is the first report of an association between breast cancer and RDD.
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Affiliation(s)
- Lailson Bezerra Lima
- a Neurology Service Hospital Universitário Walter Cantídio Universidade Federal do Ceará , Fortaleza, Ceará , Brazil
| | - Manoel Alves Sobreira-Neto
- a Neurology Service Hospital Universitário Walter Cantídio Universidade Federal do Ceará , Fortaleza, Ceará , Brazil.,b Division of Neurology, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza, Ceará , Brazil
| | - Pedro Braga-Neto
- a Neurology Service Hospital Universitário Walter Cantídio Universidade Federal do Ceará , Fortaleza, Ceará , Brazil.,b Division of Neurology, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza, Ceará , Brazil.,c Center of Health Sciences, Universidade Estadual do Ceará , Fortaleza, Ceará , Brazil
| | - Paulo Ribeiro Nóbrega
- a Neurology Service Hospital Universitário Walter Cantídio Universidade Federal do Ceará , Fortaleza, Ceará , Brazil.,b Division of Neurology, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza, Ceará , Brazil
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Smid J, Studart A, Landemberger MC, Machado CF, Nóbrega PR, Canedo NHS, Schultz RR, Naslavsky MS, Rosemberg S, Kok F, Chimelli L, Martins VR, Nitrini R. High phenotypic variability in Gerstmann-Sträussler-Scheinker disease. Arq Neuropsiquiatr 2017; 75:331-338. [PMID: 28658400 DOI: 10.1590/0004-282x20170049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 12/20/2022]
Abstract
Gerstmann-Sträussler-Scheinker is a genetic prion disease and the most common mutation is p.Pro102Leu. We report clinical, molecular and neuropathological data of seven individuals, belonging to two unrelated Brazilian kindreds, carrying the p.Pro102Leu. Marked differences among patients were observed regarding age at onset, disease duration and clinical presentation. In the first kindred, two patients had rapidly progressive dementia and three exhibited predominantly ataxic phenotypes with variable ages of onset and disease duration. In this family, age at disease onset in the mother and daughter differed by 39 years. In the second kindred, different phenotypes were also reported and earlier ages of onset were associated with 129 heterozygosis. No differences were associated with apoE genotype. In these kindreds, the codon 129 polymorphism could not explain the clinical variability and 129 heterozygosis was associated with earlier disease onset. Neuropathological examination in two patients confirmed the presence of typical plaques and PrPsc immunopositivity.
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Affiliation(s)
- Jerusa Smid
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Adalberto Studart
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | | | | | - Paulo Ribeiro Nóbrega
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Neurologia, Fortaleza CE Brasil
| | | | - Rodrigo Rizek Schultz
- Universidade Federal de São Paulo, Seção de Neurologia Comportamental, São Paulo SP, Brasil
| | - Michel Satya Naslavsky
- Universidade de São Paulo, Instituto de Biociências, Centro de Estudos do Genoma Humano, São Paulo SP, Brasil
| | - Sérgio Rosemberg
- Universidade de São Paulo, Departamento de Patologia, Divisão de Neuropatologia, São Paulo SP, Brasil
| | - Fernando Kok
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Leila Chimelli
- Universidade Federal do Rio de Janeiro, Departamento de Patologia, Rio de Janeiro RJ, Brasil
| | | | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
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41
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Scott SSDO, Braga-Neto P, Pereira LP, Nóbrega PR, de Assis Aquino Gondim F, Sobreira-Neto MA, Schiavon CCM. Immunoglobulin-responsive chikungunya encephalitis: two case reports. J Neurovirol 2017; 23:625-631. [PMID: 28577289 DOI: 10.1007/s13365-017-0535-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/23/2017] [Accepted: 05/16/2017] [Indexed: 11/24/2022]
Abstract
Chikungunya virus is an alphavirus transmitted by the mosquito Aedes, mainly Aedes aegypti and Aedes albopictus, that can cause acute illness, mostly self-limited, characterized by fever, maculopapular rash, and disabling polyarthritis/arthralgia, with an incubation period of 1 to 12 days. Chikungunya was largely regarded as a non-fatal and self-limited disease, but recently, serious cases have been reported including some with severe involvement of the nervous system, such as meningoencephalitis, myelitis, polyradiculitis, and polyradiculoneuropathy. In this report, we describe the clinical and laboratory findings of two patients with encephalitis associated with chikungunya in a northeastern city in Brazil, who exhibited a good outcome, with improvement after treatment with i.v. immunoglobulin (IVIg).
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Affiliation(s)
- Stephanie Suzanne de O Scott
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Av Rogaciano Leite 900 apto 503, Torre Friburgo, Guararapes, Fortaleza, Ceará, Brazil.
| | - Pedro Braga-Neto
- Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - Lícia Pacheco Pereira
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Av Rogaciano Leite 900 apto 503, Torre Friburgo, Guararapes, Fortaleza, Ceará, Brazil
| | - Paulo Ribeiro Nóbrega
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Av Rogaciano Leite 900 apto 503, Torre Friburgo, Guararapes, Fortaleza, Ceará, Brazil
| | | | - Manoel Alves Sobreira-Neto
- Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Claudia Carvalho Mendes Schiavon
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Av Rogaciano Leite 900 apto 503, Torre Friburgo, Guararapes, Fortaleza, Ceará, Brazil
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42
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Pereira LP, Villas-Bôas R, Scott SSDO, Nóbrega PR, Sobreira-Neto MA, Castro JDVD, Cavalcante B, Braga-Neto P. Encephalitis associated with the chikungunya epidemic outbreak in Brazil: report of 2 cases with neuroimaging findings. Rev Soc Bras Med Trop 2017; 50:413-416. [DOI: 10.1590/0037-8682-0449-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022] Open
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43
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Simabukuro MM, Nóbrega PR, Pitombeira M, Cavalcante WCP, Grativvol RS, Pinto LF, Castro LHM, Nitrini R. The importance of recognizing faciobrachial dystonic seizures in rapidly progressive dementias. Dement Neuropsychol 2016; 10:351-357. [PMID: 29213481 PMCID: PMC5619277 DOI: 10.1590/s1980-5764-2016dn1004016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Creutzfeldt-Jakob Disease (CJD) is the prototypical cause of rapidly
progressive dementia (RPD). Nonetheless, efforts to exclude reversible
causes of RPD that mimic prion disease are imperative. The recent expanding
characterization of neurological syndromes associated with antibodies
directed against neuronal cell surface or sympathic antigens, namely
autoimmune encephalitis is shifting paradigms in neurology. Such antigens
are well known proteins and receptors involved in synaptic transmission.
Their dysfunction results in neuropsychiatric symptoms, psychosis, seizures,
movement disorders and RPD. Faciobrachial dystonic seizure (FBDS) is a novel
characterized type of seizure, specific for anti-LGI1 encephalitis. Objective In order to improve clinical recognition we report the cases of two Brazilian
patients who presented with characteristic FDBS (illustrated by videos) and anti-LGI1 encephalitis. Methods We have included all patients with FBDS and confirmed anti-LGI1 encephalitis
and video records of FDBS in two tertiary Brazilian centers: Department of
Neurology of Hospital das Clínicas, Sao Paulo University, Sao Paulo,
Brazil and Hospital Geral de Fortaleza, Fortaleza, Brazil between January 1,
2011 and December 31, 2015. Results Both patients presented with clinical features of limbic encephalitis
associated with FBDS, hyponatremia and normal CSF. None of them presented
with tumor and both showed a good response after immunotherapy. Conclusion FBDSs may be confounded with myoclonus and occurs simultaneously with rapid
cognitive decline. Unawareness of FDBS may induce to misdiagnosing a
treatable cause of RPD as CJD.
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Affiliation(s)
- Mateus Mistieri Simabukuro
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Milena Pitombeira
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Ronnyson Susano Grativvol
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Lécio Figueira Pinto
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Neurology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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de Paiva ARB, Freua F, Lucato LT, Parmera J, Dória D, Nóbrega PR, Olávio TR, Macedo-Souza LI, Kok F. A novel GFAP mutation in a type II (late-onset) Alexander disease patient. J Neurol 2016; 263:821-2. [PMID: 26914930 DOI: 10.1007/s00415-016-8065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Anderson Rodrigues Brandão de Paiva
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil.
| | - Fernando Freua
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Leandro Tavares Lucato
- Radiology Institute, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Jacy Parmera
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Denise Dória
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Thiago Rosa Olávio
- Centro de Estudos do Genoma Humano, Universidade de São Paulo, São Paulo, Brazil
| | | | - Fernando Kok
- Neurogenetics, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-000, Brazil
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45
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Studart Neto A, Nóbrega PR, Duarte MIS, Lucato LT, Castro LHM, Nitrini R. Adult-onset subacute sclerosing panencephalitis manifesting as slowly progressive dementia. J Neurovirol 2015; 21:468-71. [PMID: 25851779 DOI: 10.1007/s13365-015-0336-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Adalberto Studart Neto
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil,
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46
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Hirata FC, Lima MCO, de Bruin VMS, Nóbrega PR, Wenceslau GP, de Bruin PFC. Depression in medical school: the influence of morningness-eveningness. Chronobiol Int 2007; 24:939-46. [PMID: 17994347 DOI: 10.1080/07420520701657730] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Medical students are at higher risk for depression, affecting not only their lives but also patient care. This article studied a population of medical students engaged in lecture-based learning regarding the presence of depressive symptoms and its relation to morningness-eveningness. Depressive symptoms were assessed by the Beck Depressive Inventory scale (BDI>10), and diurnal preference was assessed by the Horne & Ostberg Morningness/Eveningness Questionnaire (MEQ). Family history of depression and involvement in regular physical activity were also investigated. A total of 161 students, 77 (47.8%) males, aged 19 to 30 yrs (22.1+/-2.1) living in a city close to the equator were evaluated. Fifty-three individuals (32.9%) had depressive symptoms. Depressive individuals showed a trend to be female (p=0.07). Also, female gender showed a non-significant shift toward morningness. Fifty-eight (36.0%) subjects participated in regular physical activity. In 57 cases (35.4%), there was a history of depression in the family. Fifteen individuals (9.3%) were definitely evening type, 42 (26.1%) were moderately evening type, 44 (27.3%) were indifferent, 42 (26.1%) were moderately morning type, and 18 (11.2%) were definitely morning type. Family history of depression (OR=0.29, 95% CI=1.37-6.12) and sedentary life (OR=0.28, 95% CI=0.12-0.65) were associated with depressive symptoms. Eveningness was associated with depressive symptoms (OR=0.66, 95% CI=0.50-0.88), and this association remained significant after adjusting for the presence of familial depression and physical activity (OR=0.71, 95% CI=0.52-0.95). In conclusion, depressive symptoms are independently associated with "eveningness" in medical students. These results should be confirmed by future studies involving a larger number of subjects.
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