CARLOS OTTO HEISE
Índice h a partir de 2011
14
Projetos de Pesquisa
Unidades Organizacionais
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Nerve transfers for acute flaccid myelitis: a case series(2021) HEISE, C. O.; OLIVEIRA, A. J. de; BHERING, T.; MARTINS, R. S.; STERMAN-NETO, H.; FORONI, L.; SIQUEIRA, M. G.Background Acute flaccid myelitis (AFM) syndrome consists of loss of lower motor neurons following a viral infection, with preserved sensory function. It usually affects the upper limbs asymmetrically, with proximal more than distal muscle involvement. Methods Five cases were surgically treated with nerve transfers: spinal accessory to suprascapular nerve transfer (4 patients), branch of radial nerve to axillary nerve transfer (Somsak's procedure) (2 patients), and transfer of a fascicle of the ulnar nerve to the motor branch to the biceps (Oberlin's procedure) (1 patient). Results Motor improvement was seen in three cases. Widespread motor involvement was associated with poor outcome. Conclusion This small series of cases reinforces that nerve transfers are a reliable option for treatment of selected children with AFM.
bookPart Neuropatias hereditárias(2021) GRATIVVOL, Ronnyson Susano; GRATIVVOL, Letícia Prandi Barbarioli; HEISE, Carlos Otto- Fascicular Anatomy of the Musculocutaneous Nerve in Its Origin in Lateral Cord. Could It Be Used for Better Surgical Results?(2021) FORONI, Luciano; OLIVEIRA, Adilson Jose Manuel de; SIQUEIRA, Mario Gilberto; MARTINS, Roberto Sergio; HEISE, Carlos OttoBACKGROUND: Though anatomy of the brachial plexus is well known, its fascicular anatomy is still a challenge. In case of themusculocutaneous nerve (MCN), the position of the motor branches at its terminations is well known; however, their position in the lateral cord has been rarely investigated. OBJECTIVE: To describe the position of motor branches of the MCN at its origin in the lateral cord. METHODS: The MCN of 26 adult nonfixed cadavers was dissected from its terminal branches in the medial aspect of the arm to its origin from the lateral cord of the brachial plexus (from distal to proximal) on the right side, removed, and fixed. Intraneural longitudinal fascicular dissectionwas performed using microsurgical techniques, withmeticulous removal of connective tissue and subsequent identification and tracking of fibers of each MCN branch. RESULTS: At the origin of the nerve, biceps and brachialis muscle fiberswere concentrated in the lateral portion of the nerve (100%), and the sensory fiberswere preferentially located in the medial portion (78%). CONCLUSION: At its origin, the lateral portion of the MCN is the best location to coapt. donor nerves in order to improve motor results.
- One-year prospective nerve conduction study of thalidomide neuropathy in lupus erythematosus: Incidence, coasting effect and drug plasma levels(2021) YUKI, Emily Figueiredo Neves; SOARES, Renata; KUPA, Leonard de Vinci Kanda; HEISE, Carlos Otto; AIKAWA, Nadia Emi; ARNONE, Marcelo; ROMITI, Ricardo; PEDROSA, Tatiana do Nascimento; SILVA, Clovis Artur Almeida da; BONFA, Eloisa; PASOTO, Sandra GofinetBackground Few prospective studies in cutaneous and systemic lupus erythematosus (CLE/SLE) assessed thalidomide-induced peripheral neuropathy (TiPN) incidence/reversibility, and most have not excluded confounding causes neither monitored thalidomide plasma levels. Objectives To evaluate TiPN incidence/reversibility, coasting effect and its association with thalidomide plasma levels in CLE/SLE. Methods One-year prospective study of thalidomide in 20 CLE/SLE patients without pregnancy potential, with normal nerve conduction study (NCS), and excluded other PN causes. Thalidomide levels were determined by high-performance liquid chromatography/tandem mass spectrometry. Results Twelve patients (60%) developed TiPN: 33.3% were symptomatic and 66.6% asymptomatic. Half of this latter group developed coasting effect (TiPN symptoms 1-3 months after drug withdrawal). The main predictive factors for TiPN were treatment duration >= 6 months (p = 0.025) and cumulative dose (p = 0.023). No difference in plasma thalidomide levels between patients with/without TiPN was observed (p = 0.464). After drug withdrawal, 75% symptomatic TiPN patients improved their symptoms. Seven TiPN patients underwent an additional NCS after drug withdrawal: 42.8% worsened NCS, 14.2% was stable, and 42.8% had improved NCS. Conclusion Our data provides novel evidence of coasting effect in half of asymptomatic patients with TiPN. The irreversible nature of this lesion in 25% of TiPN patients reinforces the relevance of early NCS monitoring, and suggests thalidomide use solely as a bridge for other effective therapy for refractory cutaneous lupus patients.
- Motor unit number index (MUNIX) in children and adults with 5q-spinal muscular atrophy: Variability and clinical correlations(2021) MENDONCA, Rodrigo Holanda; MACHADO, Ligia Maria Sotero; HEISE, Carlos Otto; POLIDO, Graziela Jorge; MATSUI, Ciro; SILVA, Andre Macedo Serafim; REED, Umbertina Conti; ZANOTELI, EdmarSpinal muscular atrophy (SMA) is a motor neuron disease associated with progressive muscle weakness and motor disability. The motor unit number index (MUNIX) is a biomarker used to assess loss of motor units in later-onset SMA patients. Twenty SMA patients (SMA types 3 and 4), aged between 7 and 41 years, were clinically evaluated through the Hammersmith Motor Functional Scale Expanded and the Spinal Muscular Atrophy-Functional Rating Scale. The patients underwent compound motor action potential (CMAP) and MUNIX studies of the right abductor pollicis brevis, abductor digiti minimi and tibialis anterior (TA) muscles. Age-matched healthy controls (n = 20) were enrolled to obtain normative CMAP and MUNIX values from the same muscles. Compared to healthy controls, SMA patients showed significant reductions in MUNIX values among all muscles studied, whereas CMAP showed reductions only in the weaker muscles (abductor digiti minimi and TA). MUNIX variability was significantly higher in the SMA group than in the control group. MUNIX variability in TA correlated with CMAP variability. Motor functional scores correlated with TA MUNIX. The MUNIX study is feasible in later-onset SMA patients, and TA MUNIX values correlate with disease severity in patients with mild motor impairment.
bookPart Eletroneuromiografia(2021) HEISE, Carlos Otto- The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series(2021) MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; FORONI, Luciano; NETO, Hugo Sterman; TEIXEIRA, Manoel JacobsenOBJECTIVE Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series. METHODS Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength. RESULTS The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade >= 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer. CONCLUSIONS The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.
- Teaching Video NeuroImage: Reflex Facilitation in Lambert-Eaton Myasthenic Syndrome(2021) CAMELO-FILHO, Antonio Edvan; ESTEPHAN, Eduardo de Paula; HEISE, Carlos Otto; ZANOTELI, Edmar
bookPart Afecções das raízes, plexos e nervos(2021) GUSHI, Renam Seikitsi; HEISE, Carlos Otto- Thalidomide and Lenalidomide for Refractory Systemic/Cutaneous Lupus Erythematosus Treatment A Narrative Review of Literature for Clinical Practice(2021) YUKI, Emily Figueiredo Neves; SILVA, Clovis A.; AIKAWA, Nadia E.; ROMITI, Ricardo; HEISE, Carlos Otto; BONFA, Eloisa; PASOTO, Sandra GofinetBackground: Thalidomide has shown exceptional results in systemic/cutaneous lupus erythematosus(SLE/CLE). Recently, lenalidomide has been also prescribed for SLE/CLE treatment. Literature regarding efficacy/adverse events for these drugs is scarce with a single systematic review and meta-analysis focused solely on thalidomide for refractory cutaneous lupus subtypes. Objective: We, therefore, addressed in this narrative review the efficacy/adverse effects of thalidomide and lenalidomide for SLE and CLE. In addition, we provide a specialist approach for clinical practice based on the available evidence. Results: Efficacy of thalidomide for refractory cutaneous lupus treatment was demonstrated by several studies, mostly retrospective with small sample size(<= 20). The frequency of peripheral polyneuropathy is controversial varying from 15-80% with no consistent data regarding cumulative dose and length of use. Drug withdrawn results in clinical partial/complete reversibility for most cases (70%). For lenalidomide, seven studies (small sample sizes) reported its efficacy for SLE/CLE with complete/partial response in all patients with a mean time to response of 3 months. Flare rate varied from 25-75% occurring 0.5-10 months after drug withdrawn. There were no reports of polyneuropathy/worsening of previous thalidomide-induced neuropathy, but most of them did not perform nerve conduction studies. Teratogenicity risk exist for both drugs and strict precautions are required. Conclusions: Thalidomide is very efficacious as an induction therapy for patients with severe/refractory cutaneous lupus with high risk of scarring, but its longstanding use should be avoided due to neurotoxicity. Lenalidomide is a promising drug for skin lupus treatment, particularly regarding the apparent lower frequency of nerve side effects.