Artigos e Materiais de Revistas Científicas - LIM/62
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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.
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- Dry needling in the treatment of myofascial trigger points and painful shoulder dysfunctions: narrative review of the literature(2023) ANTôNIO, Jhonatan Zimmermann; MATIELO, Heloísa Alonso; MINSON, Fabíola; DALE, Camila SquarzoniABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <“Dry Needling”>; <“Agulhamento a Seco”>; <“Myofascial Trigger Points”>; <“Pontos-Gatilhos Miofasciais”>; <“Shoulder Dysfunctions”>; <”Disfunções do ombro”>. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient’s pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.
- Chronic subdural hematoma drainage using anti-thrombotic catheter technique(2023) CORDEIRO, J. G.; MONACO, B. Assumpcao de; BENVENISTE, R.; ALKHACHROUM, A.; KRUEGER, E. M.; O'PHELAN, K.; JAGID, J. R.Background: Burr hole evacuation is a well-established treatment for symptomatic cases with chronic subdural hematoma (cSDH). Routinely postoperative catheter is left in the subdural space to drain the residual blood. Drainage obstruction is commonly seen, and it can be related to suboptimal treatment. Methods: Two groups of patients submitted to cSDH surgery were evaluated in a retrospective non-randomized trial, one group that had conventional subdural drainage (CD group, n = 20) and another group that used an anti-thrombotic catheter (AT group, n = 14). We compared the obstruction rate, amount of drainage and complications. Statistical analyses were done using SPSS (v.28.0). Results: For AT and CD groups respectively (median ± IQR), the age was 68.23 ± 26.0 and 70.94 ± 21.5 (p > 0.05); preoperative hematoma width was 18.3 ± 11.0 mm and 20.7 ± 11.7 mm and midline shift was 13.0 ± 9.2 and 5.2 ± 8.0 mm (p = 0.49). Postoperative hematoma width was 12.7 ± 9.2 mm and 10.8 ± 9.0 mm (p < 0.001 intra-groups compared to preoperative) and MLS was 5.2 ± 8.0 mm and 1.5 ± 4.3 mm (p < 0.05 intra-groups). There were no complications related to the procedure including infection, bleed worsening and edema. No proximal obstruction was observed on the AT, but 8/20 (40%) presented proximal obstruction on the CD group (p = 0.006). Daily drainage rates and length of drainage were higher in AT compared to CD: 4.0 ± 1.25 days vs. 3.0 ± 1.0 days (p < 0.001) and 69.86 ± 106.54 vs. 35.00 ± 59.67 mL/day (p = 0.074). Symptomatic recurrence demanding surgery occurred in two patients of CD group (10%) and none in AT group (p = 0.230), after adjusting for MMA embolization, there was still no difference between groups (p = 0.121). Conclusion: The anti-thrombotic catheter for cSDH drainage presented significant less proximal obstruction than the conventional one and higher daily drainage rates. Both methods demonstrated to safe and effective for draining cSDH.
- Handicap as a Measure of Perceived-Health Status in Parkinson's Disease(2023) SILVA, Daniela Pimenta; COELHO, Miguel; SOARES, Tiago; VALE, Thiago Cardoso; GUEDES, Leonor Correia; MACIEL, Ricardo Oliveira Horta; ANTUNES, Ana Patricia; CAMARGOS, Sarah Teixeira; VALADAS, Anabela; GODINHO, Catarina; MAIA, Debora Palma; LOBO, Patricia Pita; MAIA, Raphael Doyle; TEODORO, Tiago R.; RIEDER, Carlos; VELON, Ana Graca; TUMAS, Vitor; BARBOSA, Egberto Reis; TEIVE, Helio A. G.; FERRAZ, Henrique Ballalai; ROSAS, Maria Jose; CALADO, Ana; LAMPREIA, Tania; SIMOES, Rita; VILA-CHA, Nuno; COSTA, Maria Manuela; RODRIGUES, Ana Margarida; CANICA, Veronica; CARDOSO, Francisco J.; FERREIRA, JoaquimBackgroundHandicap is a patient-centered measure of health status that encompasses the impact of social and physical environment on daily living, having been assessed in advanced and late-stage Parkinson's Disease (PD). ObjectiveTo characterize the handicap of a broader sample of patients. MethodsA cross-sectional study of 405 PD patients during the MDS-UPDRS Portuguese validation study, using the MDS-UPDRS, Unified Dyskinesias Rating Scale, Nonmotor symptoms questionnaire, PDQ-8 and EQ-5D-3L. Handicap was measured using the London Handicap Scale (LHS). ResultsMean age was 64.42 (& PLUSMN;10.3) years, mean disease duration 11.30 (& PLUSMN;6.5) years and median HY 2 (IQR, 2-3). Mean LHS was 0.652 (& PLUSMN;0.204); ""Mobility,"" ""Occupation"" and ""Physical Independence"" were the most affected domains. LHS was significantly worse in patients with longer disease duration, older age and increased disability. In contrast, PDQ-8 did not differentiate age groups. Handicap was significantly correlated with disease duration (r = -0.35), nonmotor experiences of daily living (EDL) (MDS-UPDRS-I) (r = -0.51), motor EDL (MDS-UPDRS-II) (r = -0.69), motor disability (MDS-UPDRS-III) (r = -0.49), axial signs of MDS-UPDRS-III (r = -0.55), HY (r = -0.44), presence of nonmotor symptoms (r = -0.51) and PDQ-8 index (r = -0.64) (all P < 0.05). Motor EDL, MDS-UPDRS-III and PDQ-8 independently predicted Handicap (adjusted R-2 = 0.582; P = 0.007). ConclusionsThe LHS was easily completed by patients and caregivers. Patients were mild-moderately handicapped, which was strongly determined by motor disability and its impact on EDL, and poor QoL. Despite correlated, handicap and QoL seem to differ in what they measure, and handicap may have an added value to QoL. Handicap seems to be a good measure of perceived-health status in a broad sample of PD.
- Average annual cost of Parkinson's disease in a Brazilian multiethnic population(2023) BOVOLENTA, Tania Maria; SCHUMACHER-SCHUH, Artur F.; SANTOS-LOBATO, Bruno Lopes dos; GODEIRO JUNIOR, Clecio de Oliveira; SILVA, Delson Jose da; NICARETTA, Denise; BARBOSA, Egberto R.; CARDOSO, Francisco E. C.; COLETTA, Marcus Vinicius Della; NETO, Pedro Braga; CURY, Rubens G.; TUMAS, Vitor; FELICIO, Andre C.Introduction: With the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far.Objectives: To evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP).Methods: Categorical and numerical data were collected through a customized and standardized cost-relatedquestionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions.Results: The estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y).Conclusion: This data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.
- Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis(2023) BATISTA, Savio; BERTANI, Raphael; PALAVANI, Lucca B.; OLIVEIRA, Leonardo de Barros; BORGES, Pedro; KOESTER, Stefan W.; PAIVA, Wellingson SilvaBackground: Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection. Methods: This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023. Results: Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I-2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I-2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses. Conclusions: The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.
- Fitness-to-drive after adult civilian traumatic brain injury: protocol for a systematic review and meta-analysis(2023) FIEDLER, Augusto Mueller; ALMEIDA, Timoteo; VASCONCELLOS, Fernando De Nigris; MORELL, Alexis; MONACO, Bernardo Assumpcao de; ANGHINAH, Renato; CORDEIRO, Joacir GraciolliTraumatic brain injury (TBI) poses significant challenges for assessing fitness-to-drive (FTD) and determining the appropriate timing for return-to-driving (RTD) in civilian adults. This systematic review and meta-analysis protocol is designed to offer a comprehensive assessment of RTD timelines post-TBI, examining the effects of injury severity as well as demographic and clinical factors that influence driving capabilities. In response to gaps identified in previous literature-namely, the absence of recent systematic search strategies and thorough quality assessments-this study employs rigorous methodologies for literature search, data extraction, and evaluation of study quality. Our approach aims to provide reliable estimates and detailed analyses of subgroups within the TBI population. The findings aim to support clinical decision-making, inform RTD readiness, and potentially impact policy and driving assessment protocols. Ultimately, this review seeks to contribute to public safety measures, reduce traffic-related harm, and improve life outcomes for individuals recovering from TBI, thereby filling a vital research niche in neurotrauma rehabilitation.
- A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients(2023) PALAVANI, Lucca B.; BERTANI, Raphael; OLIVEIRA, Leonardo de Barros; BATISTA, Savio; VERLY, Gabriel; ANDREAO, Filipi Fim; FERREIRA, Marcio Yuri; PAIVA, Wellingson SilvaBackground: The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. Results: A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies. Conclusions: Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
- Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury: A Cohort Study with Paired Analysis(2023) TORRES, Gabriel Saboia de Araujo; PAIVA, Wellingson Silva; AMORIM, Robson Luis Oliveira deIntroduction Intracranial hypertension continues to be the most frequent cause of death in patients with traumatic brain injury (TBI). Thus, invasive monitoring of intracranial pressure (ICP) is a very important tool in neurointensivism. However, there is controversy regarding ICP monitoring and prognosis.Objectives To evaluate whether there is a difference in mortality between patients with severe TBI who underwent invasive ICP monitoring compared with those who did not undergo such procedure.Methodology This is a unicentric study in the prospective cohort mode. A total of 316 patients with severe TBI were evaluated and, out of these 316 individuals, 35 were submitted to ICP monitoring. All clinical data were evaluated by the Tertiary Hospital Neurosurgery team in the city of Sao Paulo.Results Of the total cohort, 35 (11%) patients underwent ICP monitoring, while 281 did not. Comparing the 2 groups, there was no difference in terms of early mortality between patients who were submitted to monitoring and those who were not (34.3 versus 14.3%; p = 0.09); there was also no difference in terms of hospital mortality (40 versus 28.5%; p = 0.31) or intensive care unit (ICU) length of stay (16.10 days, 95% confidence interval [CI]: 10.6-21.6; versus 20.60 days, 95%CI: 13.50-27.70; p = 0.31).Conclusions In this cohort, we did not identify differences in mortality or in duration of hospitalization between patients with ICP monitoring and those exclusively with clinical-radiological evaluation. However, further national co-operative studies of services using ICP monitoring are needed to achieve results with greater generalization power.
- Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review(2023) CAPATO, Tamine T. C.; RODRIGUES, Rubia; CURY, Rubens G.; TEIXEIRA, Manoel Jacobsen; BARBOSA, Egberto R.Background Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field.Objective To identify specific outcome measurements to assess upper limbs in PD and access functional capacity.Methods We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: ""upper limbs"" OR ""upper extremity"" and ""Parkinson's disease."" Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486.Results We found 797 studies, and 50 were included in this review ( n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found.Conclusion We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
- Understanding MOG antibody-associated disease in Brazil(2023) CALLEGARO, Dagoberto; SILVA, Guilherme Diogo
- Misdiagnosis in multiple sclerosis in a Brazilian reference center: Clinical, radiological, laboratory profile and failures in the diagnostic process-Cohort study(2023) TIEPPO, Eduardo Macedo de Souza; SILVA, Guilherme Diogo; SILVA, Tomas Fraga Ferreira da; ARAUJO, Roger Santana de; OLIVEIRA, Mateus Boaventura de; SPRICIGO, Mariana Gondim Peixoto; PIMENTEL, Gabriela Almeida; CAMPANA, Igor Gusmao; CASTRILLO, Bruno Batitucci; MENDES, Natalia Trombini; TEIXEIRA, Larissa Silva; NUNES, Douglas Mendes; RIMKUS, Carolina de Medeiros; ADONI, Tarso; PEREIRA, Samira Luisa Apostolos; CALLEGARO, DagobertoBackground: Multiple sclerosis misdiagnosis remains a problem despite the well-validated McDonald 2017. For proper evaluation of errors in the diagnostic process that lead to misdiagnosis, it is adequate to incorporate patients who are already under regular follow-up at reference centers of demyelinating diseases. Objectives: To evaluate multiple sclerosis misdiagnosis in patients who are on follow-up at a reference center of demyelinating diseases in Brazil. Methods: We designed an observational study including patients in regular follow-up, who were diagnosed with multiple sclerosis at our specialized outpatient clinic in the Hospital of Clinics in the University of Sao Paulo, from 1996 to 2021, and were reassessed for misdiagnosis in 2022. We evaluated demographic information, clinical profile, and complementary exams and classified participants as ""established multiple sclerosis,"" ""non-multiple sclerosis, diagnosed,"" and ""non-multiple sclerosis, undiagnosed."" Failures in the diagnostic process were assessed by the modified Diagnostic Error Evaluation and Research tool. Results: A total of 201 patients were included. After analysis, 191/201 (95.02%) participants were confirmed as ""established multiple sclerosis,"" 5/201 (2.49%) were defined as ""non-multiple sclerosis, diagnosed,"" and 5/201 (2.49%) were defined as ""non-multiple sclerosis, undiagnosed."" Conclusions: Multiple sclerosis misdiagnosis persists in reference centers, emphasizing the need for careful interpretation of clinical findings to prevent errors.
- Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review(2023) ARTUSI, Carlo Alberto; GEROIN, Christian; NONNEKES, Jorik; AQUINO, Camila; GARG, Divyani; DALE, Marian L.; SCHLOSSER, Darbe; LAI, Yijie; AL-WARDAT, Mohammad; SALARI, Mehri; WOLKE, Robin; LABOU, Valery Tsinda; IMBALZANO, Gabriele; CAMOZZI, Serena; MERELLO, Marcelo; BLOEM, Bastiaan R.; CAPATO, Tamine; DJALDETTI, Ruth; DOHERTY, Karen; FASANO, Alfonso; TIBAR, Houyam; LOPIANO, Leonardo; MARGRAF, Nils G.; MOREAU, Caroline; UGAWA, Yoshikazu; BHIDAYASIRI, Roongroj; TINAZZI, MicheleBackgroundPostural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies.ObjectivesWe conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic.MethodsWe applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps.ResultsNinety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms.ConclusionsThe recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.
- Intracranial pressure waveform in patients with essential hypertension(2023) COSTA, Matheus Martins da; SOUSA, Ana Luiza Lima; CORREIA, Mikaelle Costa; INUZUKA, Sayuri; COSTA, Thiago Oliveira; VITORINO, Priscila Valverde O.; PIZA, Polyana Vulcano de Toledo; FRIGIERI, Gustavo; COCA, Antonio; BARROSO, Weimar Kunz SebbaBackground: There is a strong association between hypertension and cerebrovascular diseases, but most of the mechanistic bases to justify this correlation remains misunderstood.Objective: To evaluate intracranial pressure waveform in long-term essential hypertensive patients with a non-invasive device, brain4care (b4c).Methods: Cross-sectional study in patients with hypertension. Office blood pressure was measured with an automatic oscillometric device. Intracranial pressure evaluation was acquired through a strain sensor that could detect and monitor nanometric skull bone displacements for each cardiac cycle. Under normal physiological conditions, P1 is greater than P2, and the normal P2/P1 ratio is <1. Time to peak (TTP) is the measurement in seconds of the beginning of waveform inscription until P1 and normal values are <0.20 s. The cut-off points >= 1.2 and >= 0.25 s were used to define intracranial hypertension (ICHT).Results: 391 consecutive patients were evaluated (75% female, mean age 64.3 +/- 12.0 years). Mean value of P2/P1 ratio was 1.18 +/- 0.25 and TTP 0.18 +/- 0.63 s The obtained P2/P1 ratios were divided in three categories according to results of previous studies of normalcy (<1.0), intracranial compliance disturbance (1.0-1.19) and ICHT (>= 1.2). Normal intracranial pressure was observed in 21.7% of patients, intracranial compliance disturbance in 32.7% and intracranial hypertension in 45.6%. Females showed a higher prevalence of ICHT (50.3%).Conclusion: The prevalence of 45.6% intra-cranial hypertension in patients with long-term hypertension, particularly in women, and in those over 65 years old, emphasizes the importance of evaluate intracranial pressure behaviour in these patients and raise a question concerning the real ability of cerebral autoregulation and vascular barriers to protect the brain.
- Efficacy and Safety of Clazosentan After Aneurysmal Subarachnoid Hemorrhage: An Updated Meta-Analysis(2023) PONTES, Julia Pereira Muniz; SANTOS, Monica D'Alma Costa; GIBRAM, Franceliny Couto; RODRIGUES, Natasha Maranhao Vieira; CAVALCANTE-NETO, Joaquim Francisco; BARROS, Alexandre Drayton Maia; SOLLA, Davi J. FontouraBACKGROUND AND OBJECTIVES: Clazosentan has been studied to treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).This meta-analysis of randomized controlled trials updates the current knowledge regarding the efficacy and safety of clazosentan compared with placebo after aSAH.METHODS: Databases were systematically searched for randomized controlled trials directly comparing the use of clazosentan and placebo for the treatment of cerebral vasospasm after aSAH. Additional eligibility criteria were the report of any of the outcomes of interest (vasospasm, morbidity, functional outcome, or mortality). The primary outcome was vasospasm-related delayed cerebral ischemia (DCI). The analyses were stratified by clazosentan dosage (low or high dose) and aneurysm treatment modality (clipping or coiling). The Cochrane RoB-2 tool was used for studies quality assessment.RESULTS: Six studies comprising 7 clinical trials were included, involving 2778 patients. Clazosentan decreased the risk of vasospasm-related DCI (risk ratio [RR] 0.56, 95% CI 0.38-0.81) and delayed ischemic neurological deficit (RR 0.63, 95% 0.50-0.80). Angiographic vasospasm (RR 0.54, 95% CI 0.47-0.61) was also decreased. Functional outcomes (favorable Glasgow Outcome Scale, RR 0.99, 95% CI 0.79-1.24) and death (RR 1.03, 95% CI 0.71-1.49) did not change. Meanwhile, adverse events were increased by clazosentan (RR 1.54, 95% CI 1.35-1.76).CONCLUSION: Clazosentan decreased vasospasm-related DCI and angiographic vasospasm but did not improve functional outcomes or mortality. Adverse events were increased by clazosentan.
- Robotic-Assisted Stereoelectroencephalography: A Systematic Review and Meta-Analysis of Safety, Outcomes, and Precision in Refractory Epilepsy Patients(2023) VASCONCELLOS, Fernando De Nigris; ALMEIDA, Timoteo; FIEDLER, Augusto Muller; FOUNTAIN, Hayes; PIEDADE, Guilherme Santos; MONACO, Bernardo A.; JAGID, Jonathan; CORDEIRO, Joacir G.Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and surgical procedures. This systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and International Prospective Register of Systematic Reviews (PROSPERO) registration, delves into the latest advancements and implications of robotic systems in SEEG, while meticulously evaluating outcomes and safety measures. Among 855 patients suffering from medicationrefractory epilepsy who underwent SEEG in 29 studies, averaging 24.6 years in age, the most prevalent robots employed were robotic surgical assistant (ROSA) (450 patients), Neuromate (207), Sinovation (140), and ISys1 (58). A total of 8,184 electrodes were successfully implanted, with an average operative time of 157.2 minutes per procedure and 15.1 minutes per electrode, resulting in an overall mean operative time of 157.7 minutes across all studies. Notably, the mean target point error (TPE) stood at 2.13 mm, the mean entry point error (EPE) at 1.48 mm, and postoperative complications occurred in 7.69% of robotically assisted (RA) SEEG cases (60), with 85% of these complications being asymptomatic. This comprehensive analysis underscores the safety and efficacy of RA-SEEG in patients with medication-refractory epilepsy, characterized by low complication rates, reduced operative time, and precise electrode placement, supporting its widespread adoption in clinical practice, with no discernible differences noted among the various robotic systems.
- Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism(2023) FLATO, Uri Adrian Prync; PEREIRA, Barbara Cristina de Abreu; COSTA, Fernando Alvares; VILELA, Marcos Cairo; FRIGIERI, Gustavo; CAVALCANTE, Nilton Jose Fernandes; ALMEIDA, Samantha Longhi Simoes deNeuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.
- Intracerebroventricular baclofen therapy improves function and quality of life in a child with severe cerebral palsy(2023) MONACO, Bernardo Assumpcao de; COSTA, Pablo Ramon Fruett da; FRANCESCHINI, Paulo RobertoLimited therapies are available for severe cerebral palsy children (CP) with complex movement disorders, especially when both dystonia and spasticity are present. In this publication, we present the improvement of a child with severe CP after intracerebroventricular baclofen therapy. The treatment can impact not just the movement disorders but also on the quality of life of the child and caregivers. Global functional improvements can be observed on the 6-month follow-up.
- Early tracheostomy versus late tracheostomy in severe traumatic brain injury or stroke: A systematic review and meta-analysis(2023) TAVARES, Wagner Malago; FRANCA, Sabrina Araujo de; PAIVA, Wellingson Silva; TEIXEIRA, Manoel JacobsenObjectives: We aim to ascertain whether the benefit of early tracheostomy can be found in patients with severe traumatic brain injury (TBI) and stroke and if the benefit will remain considering distinct pathologies.Data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, a search through Lilacs, PubMed, and Cochrane databases was conducted. Review methods: Included studies were those written in English, French, Spanish, or Portuguese, with a formulated question, which compared outcomes between early and late trach (minimum of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke had minimum hospital stay follow-up, and as for severe TBI patients, they presented Glasgow Coma Scale <8 at admission. Evaluated outcomes were the risk ratio (RR) of VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of MV, ICU LOS, and hospital LOS.Results: The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively. The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter duration of MV (MD:-4.40 days [95% CI,-8.28,-0.53] p = 0.03), and shorter ICU (MD:-6.93 days [95% CI,-8.75,-5.11] p < 0.00001) and hospital LOS (MD:-7.05 days [95% CI,-8.27,-5.84] p < 0.00001). The mortality rate did not demonstrate a statistical difference.Conclusion: Early tracheostomy could optimise patient outcomes by patients' risk for VAP and decreasing MV durationand ICU and hospital LOS.(c) 2023 Australian College of Critical Care Nurses Ltd.
- Efficacy and Safety of Intraoperative Radiotherapy for High-Grade Gliomas: A Systematic Review and Meta-Analysis(2024) PALAVANI, Lucca B.; OLIVEIRA, Leonardo de Barros; REIS, Pedro Abrahao; BATISTA, Savio; SANTANA, Lais Silva; MARTINS, Lucas Piason de Freitas; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha; PAIVA, Wellingson S.; NEVILLE, Iuri SantanaBackground and ObjectivesHigh-grade gliomas (HGGs) are aggressive tumors of the central nervous system that cause significant morbidity and mortality. Despite advances in surgery and radiation therapy (RT), HGG still has a high incidence of recurrence and treatment failure. Intraoperative radiotherapy (IORT) has emerged as a promising therapeutic approach to achieve local tumor control while sparing normal brain tissue from radiation-induced damage.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the use of IORT for HGG. Eligible studies were included based on specific criteria, and data were independently extracted. Outcomes of interest included complications, IORT failure, survival rates at 12 and 24 months, and mortality.ResultsSixteen studies comprising 436 patients were included. The overall complication rate after IORT was 17%, with significant heterogeneity observed. The IORT failure rate was 77%, while the survival rates at 12 and 24 months were 74% and 24%, respectively. The mortality rate was 62%.ConclusionThis meta-analysis suggests that IORT may be a promising adjuvant treatment for selected patients with HGG. Despite the high rate of complications and treatment failures, the survival outcomes were comparable or even superior to conventional methods. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation through prospective randomized controlled trials to better understand the specific patient populations that may benefit most from IORT. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation. Notably, the ongoing RP3 trial (NCT02685605) is currently underway, with the aim of providing a more comprehensive understanding of IORT. Moreover, future research should focus on managing complications associated with IORT to improve its safety and efficacy in treating HGG.
- Long-term tonic spinal cord stimulation in advanced Parkinson's disease: No effect from stimulation under placebo-controlled evaluation(2023) CARRA, Rafael Bernhart; CAPATO, Tamine Teixeira da Costa; MENEZES, Janaina Reis; BARBOSA, Egberto Reis; DUARTE, Kleber Paiva; TEIXEIRA, Manoel Jacobsen; CURY, Rubens Gisbert