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Oliveira do Hospital, Portugal

Alzheimer's Disease is characterized by cognitive decline and functional impairment. The behavioural and psychological symptoms are highly prevalent and cause important distress to the patient and caregiver. To the physician that treats this pathology, these changes are a challenge, for the difficulties in their treatment and control. There is no recommended therapy for neuropsychiatric symptoms, but the approved anti-dementia drugs seem to have beneficial effects in their management.

Pereira D.,University of Porto | Garrett C.,Servico de Neurologia
Acta Medica Portuguesa | Year: 2010

The etiology of Parkinson's disease (PD) remains in a certain part unknown. Both genetic susceptibility and environmental factors are sometimes considered to be putative contributors to its origin. Recent epidemiologic studies have focused on the possible role of environmental risk factors present during adult life or aging, once pure genetic forms of PD are rare. The purpose of this study was to investigate possible environmental and familial risk factors for PD. We performed a hospital based case-control study using 88 PD patients with neurologist confirmed diagnostic, and 176 sex, age, and residence similiar controls. Several possible risk factors were evaluated related to life style, past history, family history, occupational history and other exposures to potencial neurotoxin agents. Statistical differences, using a 95% confidence interval, were observed in positive family history of PD (p = 0,002), occupation category (p = 0,001), rural living (p = 0,037), living/working near a industry (p = 0,017), exposure to pesticides, herbicides and in-secticides (p < 0,001), coffee consumption (p = 0,036) and tea consumption (p = 0,001). Sex and age adjusted logistic regression showed as potencial risk factors, a positive family history of PD (odds ratio [OR] = 9,996; 95% confidence interval [CI] = 2,19-45,597), blue collar occupations (OR = 3,967; 95% CI = 1,670-9,426), exposure to pesticides, herbicides and insecticides (OR = 2,619 ; 95% CI = 1,170-5,862). An inverse relationship was found between tea consumption and the risk of PD (OR = 0,356; 95% CI = 0,174-0,727). The results of the study show that both familial and environmental factors may contribute to the development of PD. Like other studies suggest, PD is of unknown, but presumably multifactorial etiology. © 2010 CELOM.

Schumacher-Schuh A.F.,Federal University of Rio Grande do Sul | Rieder C.R.M.,Servico de Neurologia | Rieder C.R.M.,Federal University of Health Sciences, Porto Alegre | Hutz M.H.,Federal University of Rio Grande do Sul
Pharmacogenomics | Year: 2014

Parkinson's disease (PD) is unique among neurodegenerative disorders because a highly effective pharmacological symptomatic treatment is available. The marked variability in drug response and in adverse profiles associated with this treatment led to the search of genetic markers associated with these features. We present a review of the literature on PD pharmacogenetics to provide a critical discussion of the current findings, new approaches, limitations and recommendations for future research. Pharmacogenetics studies in this field have assessed several outcomes and genes, with special focus on dopaminergic genes, mainly DRD2, which is the most important receptor in nigrostriatal pathway. The heterogeneity in methodological strategies employed by different studies is impressive. The question of whether PD pharmacogenetics studies will improve clinical management by causing a shift from a trial-and-error approach to a pharmacological regimen that takes into account the individual variability remains an open question. Collaborative longitudinal studies with larger sample sizes, better outcome definitions and replication studies are required. © 2014 Future Medicine Ltd.

Almeida V.,Servico de Neurologia | Almeida V.,Institute of Molecular Medicine | Mariotti P.,Catholic University | Veltri S.,Catholic University | Padua L.,Catholic University
Muscle and Nerve | Year: 2012

Introduction: Nerve ultrasound has been used increasingly in neurophysiology laboratories, but data on Guillain-Barré syndrome (GBS) are still limited, and no follow-up studies are available. Case report: An 8-year-old boy was admitted with severe demyelinating GBS. Serial neurophysiological evaluations were performed initially and in follow-up. Ultrasound studies showed diffuse and heterogeneous nerve swelling and focal enlargement of single fascicles inside the nerve. Together with clinical and electrophysiological improvement, progressive normalization of ultrasound changes was seen. Conclusions: Ultrasound demonstrated structural nerve abnormalities in GBS. These changes normalized as the patient improved clinically and electrophysiologically. Further studies are needed to elucidate the diagnostic and prognostic value of ultrasound in GBS. © 2012 Wiley Periodicals, Inc.

Fernandes M.L.,Servico de Anestesiologia | De Oliveira W.M.,Servico de Neurologia | Santos M.D.C.V.,Servico de Anestesiologia | Gomez R.S.,Federal University of Minas Gerais
Journal of Neurosurgical Anesthesiology | Year: 2014

Background: Sedation for electroencephalography in uncooperative patients is a controversial issue because majority of sedatives, hypnotics, and general anesthetics interfere with the brain's electrical activity. Chloral hydrate (CH) is typically used for this sedation, and dexmedetomidine (DEX) was recently tested because preliminary data suggest that this drug does not affect the electroencephalogram (EEG). The aim of the present study was to compare the EEG pattern during DEX or CH sedation to test the hypothesis that both drugs exert similar effects on the EEG.Materials and Methods: A total of 17 patients underwent 2 EEGs on 2 separate occasions, one with DEX and the other with CH. The EEG qualitative variables included the phases of sleep and the background activity. The EEG quantitative analysis was performed during the first 2 minutes of the second stage of sleep. The EEG quantitative variables included density, duration, and amplitude of the sleep spindles and absolute spectral power.Results: The results showed that the qualitative analysis, density, duration, and amplitude of sleep spindles did not differ between DEX and CH sedation. The power of the slow-frequency bands (δ and θ) was higher with DEX, but the power of the fasterfrequency bands (α and β) was higher with CH. The total power was lower with DEX than with CH.Conclusions: The differences of DEX and CH in EEG power did not change the EEG qualitative interpretation, which was similar with the 2 drugs. Other studies comparing natural sleep and sleep induced by these drugs are needed to clarify the clinical relevance of the observed EEG quantitative differences. Copyright © 2014 by Lippincott Williams & Wilkins.

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