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Raicher I, Zandonai AP, Anghinah IW, Frassetto M, Stump PRNAG, Trindade MAB, Harnik S, Oliveira RA, Macarenco RSS, Doppler K, Üçeyler N, Mello ES, Sommer C, Teixeira MJ, Galhardoni R, de Andrade DC. Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy. Pain 2023; 164:717-727. [PMID: 35972460 DOI: 10.1097/j.pain.0000000000002757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.
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Affiliation(s)
- Irina Raicher
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Hospital Israelita Albert Einstein, Pathology Laboratory, Sao Paulo, Brazil
| | | | | | - Mariana Frassetto
- University of Southern Santa Catarina (UNESC), Santa Catarina, Brazil
| | - Patrick R N A G Stump
- Department of Neurology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
- Instituto Lauro de Souza Lima, Bauru, Brazil
| | - Maria A B Trindade
- Department of Dermatology, Clinics Hospital of the University of Sao Paulo Medical School, Brazil
| | - Simone Harnik
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo A Oliveira
- Department of Statistics of the Institute of Mathematics and Statistics of the University of Sao Paulo, Sao Paulo, Brazil
| | | | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Evandro S Mello
- Cancer Institute of Sao Paulo Octavio Frias de Oliveira, University of Sao Paulo, Brazil
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Manoel J Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Daniel C de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
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Raicher I, Ravagnani LHC, Correa SG, Dobo C, Mangueira CLP, Macarenco RSES. Investigation of nerve fibers in the skin by biopsy: technical aspects, indications, and contribution to diagnosis of small-fiber neuropathy. einstein (São Paulo) 2022; 20:eMD8044. [PMID: 35830153 PMCID: PMC9262281 DOI: 10.31744/einstein_journal/2022md8044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/06/2022] [Indexed: 11/05/2022] Open
Abstract
Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a “painful burning sensation”. The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.
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Kaziyama H, Barbour J, Galhardoni R, da Silva V, Tesseroli de Siqueira S, Listik C, dos Santos GJ, Yeng LT, Marcolin MA, Raicher I, Teixeira MJ, Ciampi de Andrade D. Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype. Eur J Pain 2020; 24:1635-1647. [DOI: 10.1002/ejp.1620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Helena Kaziyama
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | - Julio Barbour
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | - Ricardo Galhardoni
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- School of MedicineUniversity of City of São Paulo (UNICID) São Paulo Brazil
| | - Valquíria da Silva
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Clarice Listik
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
| | | | - Lin T. Yeng
- Instituto de Ortopedia e TraumatologiaDivision of Physical Medicine and RehabilitationUniversity of São Paulo São Paulo Brazil
| | | | - Irina Raicher
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Manoel J. Teixeira
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
| | - Daniel Ciampi de Andrade
- Pain CenterDepartment of NeurologyUniversity of São Paulo São Paulo Brazil
- Pain CenterInstituto do Câncer do Estado de São Paulo São Paulo Brazil
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Lopes A, Duarte K, Lins C, Kubota G, Silva V, Galhardoni R, Menezes LMB, Raicher I, Teixeira MJ, Andrade DC. Spinal Cord Stimulation as a Treatment Option for Refractory Chemotherapy-Induced Peripheral Neuropathy: Case Report. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020. [DOI: 10.1055/s-0040-1709985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractColorectal cancer is one of the most common oncological diseases. Chemotherapy is usually recommended as an adjuvant treatment for stage-II, -III, and -IV tumors. Approximately 10% of the patients develop neuropathic pain after chemotherapy, and they may remain refractory despite the administration of drugs that are commonly used to treat neuropathic pain. Spinal cord stimulation is a good treatment option for neuropathic pain of the lower limbs, and it should be trialed in patients with chemotherapy-induced peripheral neuropathy. We report the case of a patient with oxaliplatin-induced neuropathy and neuropathic pain refractory to oral medication who was successfully treated by spinal cord stimulation.
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Affiliation(s)
- Arthur Lopes
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
| | - Kleber Duarte
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Catarina Lins
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Gabriel Kubota
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Valquíria Silva
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Department of Neurology, Faculdade de Medicina, Universidade Cidade de São Paulo (Unicid), São Paulo, São Paulo, Brazil
| | | | - Irina Raicher
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
| | - Manoel J. Teixeira
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Daniel C. Andrade
- Department of Neurology, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
- Neurosurgery Medical Laboratory (LIM-62), Universdade de São Paulo (USP), São Paulo, Brazil
- Pain Center, DepartmentofNeurology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
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de Andrade DC, Jacobsen Teixeira M, Galhardoni R, Ferreira KSL, Braz Mileno P, Scisci N, Zandonai A, Teixeira WGJ, Saragiotto DF, Silva V, Raicher I, Cury RG, Macarenco R, Otto Heise C, Wilson Iervolino Brotto M, Andrade de Mello A, Zini Megale M, Henrique Curti Dourado L, Mendes Bahia L, Lilian Rodrigues A, Parravano D, Tizue Fukushima J, Lefaucheur JP, Bouhassira D, Sobroza E, Riechelmann RP, Hoff PM, Valério da Silva F, Chile T, Dale CS, Nebuloni D, Senna L, Brentani H, Pagano RL, de Souza ÂM. Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial. Oncologist 2017; 22:1154-e105. [PMID: 28652279 PMCID: PMC5634769 DOI: 10.1634/theoncologist.2017-0235] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days. Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin‐related neuropathic pain, compared with placebo.
Background. Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin‐induced peripheral neuropathy (OXAIPN). Acute and chronic OXA‐related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti‐hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN. Methods. Pain‐free, chemotherapy‐naïve CRC patients receiving at least one cycle of modified‐FLOX [5‐FU(500 mg/m2)+leucovorin(20 mg/m2)/week for] 6 weeks+oxaliplatin(85 mg/m2) at weeks 1‐3‐5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow‐up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0–10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique‐4 (DN‐4), pain dimensions (short‐ form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile. Results. One hundred ninety‐nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79–1.26), and 0.85 (95% CI = 0.64–1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN‐4, NPSI, and NCS and side‐effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1–11.2]; pregabalin 6.8 [5.6–8.0]). Conclusion. The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.
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Affiliation(s)
- Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Divisão de Neurocirurgia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Galhardoni
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Medical School of University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Karine S L Ferreira
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Braz Mileno
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Nathalia Scisci
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandra Zandonai
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William G J Teixeira
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel F Saragiotto
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valquíria Silva
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Irina Raicher
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Macarenco
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | - Luciana Mendes Bahia
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - Daniella Parravano
- Centro de Dor, Departamento de Neurologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Julia Tizue Fukushima
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne, France
| | - Evandro Sobroza
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rachel P Riechelmann
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo M Hoff
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Thais Chile
- LIM 23, Instituto de Psiquiatria, Universidade de Sao Paulo, Brazil
| | - Camila S Dale
- Departamento de Anatomia, Instituto de Ciências Biomedicas, Universidade de Sao Paulo, Brazil
| | - Daniela Nebuloni
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luiz Senna
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Helena Brentani
- LIM 23, Instituto de Psiquiatria, Universidade de Sao Paulo, Brazil
| | - Rosana L Pagano
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Brazil
| | - Ângela M de Souza
- Centro de Dor, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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Santana MVB, Bina MT, Paz MG, Santos SN, Teixeira MJ, Raicher I, Martins JV, Andrade DCA, Baptista AF. High prevalence of neuropathic pain in the hand of patients with traumatic brachial plexus injury: a cross-sectional study. Arq Neuropsiquiatr 2016; 74:895-901. [PMID: 27901254 DOI: 10.1590/0004-282x20160149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/16/2016] [Indexed: 11/22/2022]
Abstract
Objective To describe the pain profile of patients with traumatic brachial plexus injury. Methods We enrolled 65 patients with traumatic brachial plexus injury. The Douleur Neuropathique 4 questionnaire was used to classify pain and the SF-36 was used to evaluate quality of life. Results The patients with traumatic brachial plexus injury were predominantly young male victims of motorcycle accidents. Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%). The use of auxiliary devices (p = 0.05) and marital status (p = 0.03) were both independent predictors of pain. Pain also impacted negatively on the quality of life (p = 0.001). Conclusions Pain is frequent in patients with traumatic brachial plexus injury. Despite the peripheral nervous system injury, nociceptive pain is not unusual. Pain evaluation, including validated instruments, is essential to guide optimal clinical management of patients with the condition.
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Affiliation(s)
- Marcus V B Santana
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Graduação em Medicina e Saúde, Salvador BA, Brasil.,Faculdade de Medicina Baiana e Saúde Pública, Salvador BA, Brasil
| | - Mauro T Bina
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil
| | - Matheus G Paz
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil
| | - Scheila N Santos
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador BA, Brasil
| | - Manoel J Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Irina Raicher
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - José V Martins
- Universidade Federal do Rio de Janeiro, Instituto Deolindo Couto de Neurologia, Rio de Janeiro RJ, Brasil
| | - Daniel C Araujo Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Abrahão F Baptista
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Graduação em Medicina e Saúde, Salvador BA, Brasil
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Attal N, de Andrade DC, Adam F, Ranoux D, Teixeira MJ, Galhardoni R, Raicher I, Üçeyler N, Sommer C, Bouhassira D. Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2016; 15:555-65. [DOI: 10.1016/s1474-4422(16)00017-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 01/22/2023]
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Cueva AS, Galhardoni R, Cury RG, Parravano DC, Correa G, Araujo H, Cecilio SB, Raicher I, Toledo D, Silva V, Marcolin MA, Teixeira MJ, Ciampi de Andrade D. Normative data of cortical excitability measurements obtained by transcranial magnetic stimulation in healthy subjects. Neurophysiol Clin 2016; 46:43-51. [DOI: 10.1016/j.neucli.2015.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/23/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022] Open
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de Andrade DC, Teixeira MJ, Galhardoni R, Ferreira KA, Malieno PB, Scisci N, Riechelmann RP, Teixeira WG, Saragiotto DF, Silva VA, Raicher I, de Castro I, Parravano D, Fukushima JT, Lefaucheur JP, Bouhassira D, Macarenco RSES, de Mello ES, Hoff PM. A phase III, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of pregabalin in the prevention and reduction of oxaliplatin-induced painful neuropathy (PreOx). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ricardo Galhardoni
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karine A.S.L. Ferreira
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Paula Braz Malieno
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nathalia Scisci
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - William G.J. Teixeira
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Valquiria Aparecida Silva
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Irina Raicher
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isac de Castro
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniella Parravano
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Julia Tizue Fukushima
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jean-Pascal Lefaucheur
- Faculté de Médecine, Université Paris Est Créteil, Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Didier Bouhassira
- INSERM E-332, AP-HP Hôpital Ambroise Pare ́, Boulogne and Universite ́ Versailles-Saint-Quentin, Paris, France
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Teixeira MJ, da Paz MGDS, Bina MT, Santos SN, Raicher I, Galhardoni R, Fernandes DT, Yeng LT, Baptista AF, de Andrade DC. Neuropathic pain after brachial plexus avulsion--central and peripheral mechanisms. BMC Neurol 2015; 15:73. [PMID: 25935556 PMCID: PMC4429458 DOI: 10.1186/s12883-015-0329-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/21/2015] [Indexed: 02/03/2023] Open
Abstract
REVIEW The pain that commonly occurs after brachial plexus avulsion poses an additional burden on the quality of life of patients already impaired by motor, sensory and autonomic deficits. Evidence-based treatments for the pain associated with brachial plexus avulsion are scarce, thus frequently leaving the condition refractory to treatment with the standard methods used to manage neuropathic pain. Unfortunately, little is known about the pathophysiology of brachial plexus avulsion. Available evidence indicates that besides primary nerve root injury, central lesions related to the abrupt disconnection of nerve roots from the spinal cord may play an important role in the genesis of neuropathic pain in these patients and may explain in part its refractoriness to treatment. CONCLUSIONS The understanding of both central and peripheral mechanisms that contribute to the development of pain is of major importance in order to propose more effective treatments for brachial plexus avulsion-related pain. This review focuses on the current understanding about the occurrence of neuropathic pain in these patients and the role played by peripheral and central mechanisms that provides insights into its treatment. Pain after brachial plexus avulsion involves both peripheral and central components; thereby it is characterized as a mixed (central and peripheral) neuropathic pain syndrome.
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Affiliation(s)
- Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
- Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil.
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
| | | | - Mauro Tupiniquim Bina
- Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil.
| | | | - Irina Raicher
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
- Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil.
| | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
| | | | - Lin T Yeng
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
- Centro de Dor, Instituto de Ortopedia e Traumatologia, University of São Paulo, São Paulo, Brazil.
| | - Abrahão F Baptista
- Functional Electrostimulation Laboratory, Federal University of Bahia, São Paulo, Brazil.
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
- Pain Center, Instituto do Câncer de São Paulo, São Paulo, Brazil.
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
- Divisão de Clínica Neurocirúrgica do Hospital das Clínicas da FMUSP, Secretaria da Neurologia, Instituto Central, Av. Dr. Enéas de Carvalho Aguiar, 255, 5° andar, sala 5084 - Cerqueira César, 05403-900, São Paulo, SP, Brazil.
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Piazza F, Greenberg S, Savoiardo M, Gardinetti M, Nitrini R, Sakaguchi H, Raicher I, Giaccone G, Chiapparini L, Brioschi M, Billo G, Colombo A, Lanzani F, Piscosquito G, Carriero M, Tagliavini F, Ferrarese C, DiFrancesco J. Autologous anti-Aß antibodies in CAA-ri: New biomarker for detection of amyloid-related imaging abnormalities (ARIA) during Aß-disease modifying therapies for AD. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Piazza F, Greenberg SM, Savoiardo M, Gardinetti M, Chiapparini L, Raicher I, Nitrini R, Sakaguchi H, Brioschi M, Billo G, Colombo A, Lanzani F, Piscosquito G, Carriero MR, Giaccone G, Tagliavini F, Ferrarese C, DiFrancesco JC. Anti-amyloid β autoantibodies in cerebral amyloid angiopathy-related inflammation: Implications for amyloid-modifying therapies. Ann Neurol 2013; 73:449-58. [DOI: 10.1002/ana.23857] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/02/2013] [Accepted: 01/04/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Fabrizio Piazza
- Department of Neuroscience and Biomedical Technologies; University of Milano-Bicocca; Monza; Italy
| | - Steven M. Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology; Massachusetts General Hospital, Harvard Medical School; Boston; MA
| | - Mario Savoiardo
- Department of Neuroradiology; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Margherita Gardinetti
- Department of Neuroscience and Biomedical Technologies; University of Milano-Bicocca; Monza; Italy
| | - Luisa Chiapparini
- Department of Neuroradiology; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Irina Raicher
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Ricardo Nitrini
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Hideya Sakaguchi
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto; Japan
| | - Monica Brioschi
- Department of Neurosciences; Niguarda Ca' Granda Hospital; Milan; Italy
| | - Giuseppe Billo
- Department of Neurology; St. Bortolo Hospital; Vicenza; Italy
| | | | | | - Giuseppe Piscosquito
- Department of Cerebrovascular Diseases; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Maria Rita Carriero
- Department of Cerebrovascular Diseases; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Giorgio Giaccone
- Department of Neurodegenerative Diseases and Division of Neuropathology-Neurology; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Fabrizio Tagliavini
- Department of Neurodegenerative Diseases and Division of Neuropathology-Neurology; IRCCS Foundation Neurological Institute Carlo Besta,; Milan; Italy
| | - Carlo Ferrarese
- Department of Neuroscience and Biomedical Technologies; University of Milano-Bicocca; Monza; Italy
| | - Jacopo C. DiFrancesco
- Department of Neuroscience and Biomedical Technologies; University of Milano-Bicocca; Monza; Italy
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Shimizu MM, Raicher I, Takahashi DY, Caramelli P, Nitrini R. Disclosure of the diagnosis of Alzheimer's disease: caregivers' opinions in a Brazilian sample. Arq Neuropsiquiatr 2009; 66:625-30. [PMID: 18949252 DOI: 10.1590/s0004-282x2008000500004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 07/16/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disclosure of the diagnosis of Alzheimer's disease (AD) remains a contentious issue, and has been little studied in developing countries. OBJECTIVE To investigate the influence of socio-demographic factors and the experience of being a caregiver on opinion about disclosing AD diagnosis to the patient in a Brazilian sample. METHOD Caregivers of 50 AD patients together with 50 control participants that did not have the experience of being a caregiver of AD patient were interviewed using a structured questionnaire. RESULTS Most of the participants (73.0%) endorsed disclosure of the diagnosis, while caregivers were less prone to disclose (58.0%) than controls (88.0%; p=0.0007). Logistic regression confirmed that only the experience of being a caregiver was associated with a lesser tendency for disclosure endorsement. CONCLUSION The majority of participants was in favor of disclosing the diagnosis, but caregivers were less willing to disclose the diagnosis to the AD patient.
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Affiliation(s)
- Marta Maria Shimizu
- Behavioral and Cognitive Neurology Unit, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Abstract
Although growing, the literature on research into attitudes of general and specialized physicians towards disclosing the diagnosis of dementia and Alzheimer's disease (AD), or the current practice on AD disclosure, remains limited. Moreover, information is also scarce on what caregivers, or indeed patients themselves, wish to know with regard to their diagnosis. The goal of the present article was to present a review of the current available literature on the topic of truth telling in dementia, especially in AD. The studies discussed in this review were mainly conducted in Europe, particularly in the United Kingdom, as well as the United States. Disclosure of AD diagnosis is not a common practice among physicians. In the clinical context, the discussion on diagnosis disclosure can be valuable for improving the care of AD patients and their families.
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Affiliation(s)
- Irina Raicher
- Division of Neurology of the Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Raicher I, Shimizu MM, Takahashi DY, Nitrini R, Caramelli P. Alzheimer's disease diagnosis disclosure in Brazil: a survey of specialized physicians' current practice and attitudes. Int Psychogeriatr 2008; 20:471-81. [PMID: 17822571 DOI: 10.1017/s1041610207005819] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is little, though growing, interest in the research area of attitudes held among physicians towards disclosing the diagnosis of dementia and Alzheimer's disease (AD), or the current practice on AD disclosure. This study aimed to investigate the practice and attitudes of specialized physicians towards AD diagnosis disclosure in Brazil. METHODS A questionnaire was devised to survey the current practice and attitudes regarding diagnosis disclosure of AD in Brazil and sent to specialized physicians (170 geriatricians, 300 neurologists and 500 psychiatrists) by electronic mail. RESULTS From 970 potential respondents, 181 physicians who usually attend AD patients returned the questionnaire. There were no significant differences between the three specialties regarding the frequency with which they informed patients of their AD diagnosis (p = 0.17). The results revealed that only 44.8% of the physicians would regularly inform the patient of the diagnosis, although 85.6% of these use clear terminology. Despite their usual practice, 76.8% would want to know their diagnosis if they themselves were affected by AD. CONCLUSIONS Disclosure of AD diagnosis is not common among specialized physicians in Brazil and different factors are involved. In the clinical context, discussion on advantages of diagnosis disclosure can be useful for improving the care of AD patients and their families.
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Affiliation(s)
- Irina Raicher
- Behavioral and Cognitive Neurology Unit, University of São Paulo School of Medicine, São Paulo, Brazil
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Raicher I, Takahashi DY, Kanda PAM, Nitrini R, Anghinah R. qEEG spectral peak in Alzheimer's disease: A possible tool for treatment follow-up. Dement Neuropsychol 2008; 2:9-12. [PMID: 29213533 PMCID: PMC5619147 DOI: 10.1590/s1980-57642009dn20100003] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 02/09/2008] [Accepted: 02/27/2008] [Indexed: 11/22/2022] Open
Abstract
qEEG spectral analysis has been considered highly sensitive to cortical functional changes and agrees strongly with the clinical diagnosis of AD. The sensitivity of spectral analysis has ranged from 71% to 81% in several studies.1-3. OBJECTIVE The aim of this study was to retrospectively evaluate whether alpha qEEG spectral peak can supplement clinical examination by constituting an independent tool to monitor treatment and follow-up of dementia progression in Alzheimer's disease (AD). In addition, we examined the demographic data and alpha power spectra distribution of patients and elderly normal controls. METHODS qEEGs were selected from 2 groups of patients: normal controls (n=30), and patients who fulfilled criteria for mild probable AD diagnosis (n=41). The alpha qEEG spectral analysis and MMSE were performed once or twice a year. RESULTS In our groups, MMSE scores and qEEG alpha spectral peak were unchanged (no statistical differences) after anticholinesterase use where qEEG spectral peak was never lower than 8 Hz in the control group. CONCLUSION This study supports two important concepts. First, 8 Hz alpha appears to be the lowest awake spectral peak compatible with normality. And finally, in a clinical context, qEEG is a valuable diagnostic tool that could prove useful for Dementia follow-up.
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Affiliation(s)
- Irina Raicher
- Behavioral and Cognitive Neurology Unit, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Daniel Yasumasa Takahashi
- Behavioral and Cognitive Neurology Unit, University of São Paulo
School of Medicine, São Paulo, Brazil
| | | | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Renato Anghinah
- Behavioral and Cognitive Neurology Unit, University of São Paulo
School of Medicine, São Paulo, Brazil
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Raicher I, Shimizu MM, Takahashi DY, Nitrini R, Caramelli P. P1–136: Alzheimer's disease diagnostic disclosure in Brazil: A pilot study of specialized physicians current practice and attitudes. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.512] [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] [Indexed: 10/24/2022]
Affiliation(s)
- Irina Raicher
- Behavioral and Cognitive Neurology Unit, Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Marta Maria Shimizu
- Behavioral and Cognitive Neurology Unit, Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Daniel Yasumasa Takahashi
- Behavioral and Cognitive Neurology Unit, Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
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Shimizu MM, Raicher I, Takahashi DY, Caramelli P, Nitrini R. P4–227: Disclosure of the diagnosis of Alzheimer's disease: Influence of education and socioeconomic factors. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1967] [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] [Indexed: 10/24/2022]
Affiliation(s)
- Marta M. Shimizu
- University of São Paulo Medical SchoolSão PauloBrazil
- CEREDIC - Reference Center for Cognitive DisordersSão PauloBrazil
| | - Irina Raicher
- University of São Paulo Medical SchoolSão PauloBrazil
| | | | | | - Ricardo Nitrini
- University of São Paulo Medical SchoolSão PauloBrazil
- CEREDIC - Reference Center for Cognitive DisordersSão PauloBrazil
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