Jornal Internacional de Neurorreabilitação

Objective: Autonomic nervous system involvement in patients with Erectile Dysfunction (ED) has shown conflicting results. Our main purpose was to assess the effect of treatment with Viagra on autonomic function of group of ED patients in comparison with another group with control subjects with ED treated by herbal substances by measuring the frequency gain response of the two groups. Other aim of this study was to determine wither the duration of Viagra treatment correlated with measures of heart rate variability signal (HRV) using approximate entropy index (ApEn).
Methods: Twenty two patients treated for ED by Viagra (100 mg) and twenty one matched control subjects treated ED by herbal were evaluated at Erectile Dysfunction Center, Johns Hopkins Hospital, Maryland, USA during 2012/ 2013 by measuring the breathing at different rates and HRV signal derived from Electrocardiogram (ECG).The autopower and cross power spectra between HRV signal and breathing signal at different breathing rate were calculated and frequency gain response for both groups were obtained. ApEn described as measure of regularity of HRV was calculated for both patients with Viagra treatment and herbal treatment for control subjects.
Results: Both frequencies gain response and ApEn measures were increased in patients treated with Viagra in comparison with control group. The power spectra of patients with Viagra men showed both increase High Frequency (HF) value and higher low frequency bands with respect to control subjects. On other hand, ApEn measure was significantly increased in longer Viagra taking duration than in herbal group.
Conclusion: These findings suggest that the spectral analysis of HRV signal using breathing at different frequencies may detect balance of autonomic of autonomic system of ED patients treated with Viagra specially with increasing the sympathetic activity (higher low frequency) and as well as the parasympathetic tone(higher frequency gain response) which can lead to reduce sudden deaths in patients with treating with viagra. APEn may be marker related to duration of taking Viagra. Further studies are needed to include more patients to strengthen the quantitive and qualitative indices proposed in this paper.

After a peripheral nerve injury, various aspects, including mechanical nerve properties, will influence regeneration. The reduction of nerve viscoelasticity, intraneural edema, mechanosensitivity, and adhesion of neural tissue to its interfaces may be a target to approaches that impose graded mechanical loads to the nerve. However, the effects of those treatments on peripheral nerve regeneration are not clear. Particularly neurodynamic mobilizations may be very useful. They consist of therapeutic maneuvers to assess nerve mechanical properties and restore their function through graded movements of the peripheral nerve attachments to bones and muscles. Here we discuss theoretical and experimental data regarding the effects of graded mechanical loads on peripheral nerve function and regeneration, and propose how neurodynamic mobilizations would interact with the peripheral nerve in order to promote regeneration. Those effects would influence the reduction of edema, normalization of axoplasmic flow, decrease nerve mechanosensitivity, and promotion of appropriate nerve mobility, increasing glial and neuronal activity.

Background: Pure alexia is often regarded as a minor deficit when compared to other effects of brain injury. However, the loss of the ability to read is to many a true loss of quality of life.
Objective: The study is an explorative case study investigating the effects of intensive reading training in a patient with acquired pure alexia disorder. The training targeted the various stages of the basic reading process.
Methods: A patient diagnosed with pure alexia trained for 2 hours a day for 15 days. The training consisted of exposure to word, non-words, sentences and text with varying complexity in format as well content. The training material was developed to accommodate intensive and adaptive training directed at regaining fundamental reading abilities without the use of compensatory techniques.
Results: The patient improved on reading speed for short words, short sentences and text. The patients improved significantly in letter reading speed. There was no significant change in the performance on 3, 5 or 7 letter words before and after training.
Conclusion: The case is a prototype study and indicative that intensive may improve reading speed but has no effect on the fundamental problem of word length effect in alexia.

Retinoblastoma is a rare but significant cause of childhood eye cancer world-wide. The prognosis depends upon early diagnosis and treatment but also upon accurate classification of the tumours. Unilateral incidence is normally non-hereditary compared with bilateral incidence where secondary tumours are more common. Survivorship is much better for unilateral compared with bilateral and trilateral retinoblastoma. Early signs are important to detect and photography can assist in identifying no return of “red-eye” during flash photography and yellow appearance of the tumour. Treatment options are discussed together with new psycho-oncology approaches that address potential trauma in the survivor as well as in the family of the survivor.

Background: Increasing evidence suggests that gangliosides act as important mediators in both demyelination and remyelination. Objective: The purpose of the present study was to investigate the presence of IgM antibodies against GM1, GD1b and GQ1b gangliosides in the sera of in patients who suffered from Parkinson’s disease in correlation with the clinical parameters. Method: The present research is based on the investigation of 44 patients (63.7-73.3 years) for anti-ganglioside antibodies and 44 healthy age- matched individuals, as normal controls, using Enzyme-Linked Immuno-Sorbent Assays. Results: The patients revealed increased levels of the tested antibodies, compared to normal controls (p=0.0005). A correlation between IgM anti-GM1 and the level of cognitive impairment (Minimental State Examination, p=0.003; Unified Parkinson’s Disease Rating Scale I, p=0.013) was also noticed. Conclusion: A peripheral neuroimmune response may occur in patients who suffer from Parkinson’s disease especially those with cognitive impairment. Further investigation is needed to establish a direct connection between that immune response and disease pathophysiology.

Traumatic brain injury (TBI) is caused by an external mechanical force. The most common causes of TBI are car crash, falls, assaults and thefts and accidents during recreational activity. The acceleration-deceleration mechanism responsible for DAI, often damage the lateral and ventral regions of the frontal and temporal lobes. Deficits in attention and memory, difficulty in learning new information, solving problems and planning are common sequelae. Impulsivity and lack of self-control are also common after a TBI. Our goal was to correlate functional changes obtained in the electroencephalogram (EEG) with the cognitive decline in diffuse axonal injury (DAI) and understand the pathophysiology of this injury. Ten patients with diffuse axonal lesion and 5 control subjects were recruited by the Group of Cognitive Rehabilitation after TBI in the Division of Neurology, Clinics Hospital, Faculty of Medicine, University of São Paulo. A high-resolution EEG with 128 channels were performed at the Psychiatry Institute (LIM-23), University of São Paulo. The cortical sources of EEG rhythms were estimated by analysis of low resolution brain electromagnetic tomography (LORETA), which revealed that patients with DAI had reduced alpha activity and increased theta activity, indicating a slowing of brain activity. In contrast, control subjects showed a predominance of alpha activity and hippocampal activation during the exam, which was not observed in the group with DAI. The DAI patients showed reduced brain activity and little or no hippocampal activation, which is consistent with memory complaints presented by these patients.

The paper overviews physiologic efficiencies to provide justification for moving away from a medical model of rehabilitation using a binary conceptualization of impairment and moving towards a linear model of optimization and human efficiencies. While the clinical and neuropathological evaluation of neurological compromise has traditionally concentrated upon the focal distribution of brain disease, ignored have been the changes in the complex connections linking brain areas crucial for cognition and optimized human performance. The paper reviews the nature of nervous system plasticity, from a systems standpoint using language development and bilingualism as well as music and the brain as examples of optimized network functioning.

The first case of lumbar intradural disc herniation was reported as early as 1942; since then more than 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced magnetic resonance image (MRI) is considered the “gold standard” for diagnosing this entity, although it is rarely performed routinely in lumbar disc disease and diagnosis is often made intra-operatively and in retrospect in regard to the imaging. A 63-year-old Italian man presented to the emergency department complaining of lower back pain, difficulty in walking, and in urination, with bilateral leg pain. On examination, he showed uneven gait, pain in the right thigh and leg with intact sphincter function. A magnetic resonance image of the lumbar spine showed a large mediolateral herniated disc at L3-L4, also the patient had a stenosis at the thoracic level at T11-T12 and T12-L1. The plan was to do an MRI with Gado however the patient went into retention and so was operated before the MRI with Gado.
Results: Intraoperatively the pathology was first identified as a big cyst like structure, that as thought to be a synovial cyst, and then once it was opened it turned out to be an intradural extension of a herniated disc. Decompression was also done at the thoracic level and finally instrumentation was done from T10 to S1.
Conclusion: Intradural lumbar disc herniations are a rare entity, most of the time the diagnosis is not made pre operatively, however once it is diagnosed intra-operatively, careful removal of the herniated material should be done to avoid damaging the rootlets, sometimes u have double pathologies that need to be addressed like in this patient where he had both lumbar and thoracic stenoses.

Focal hand dystonia in musicians, which is characterized by involuntary flexion and/or extension of fingers while playing musical instruments, is a disabling neurological disorder that can even threaten their careers. The present study investigated whether or how a non-invasive intervention for focal hand dystonia called “slow-down exercise” affects motor performance, muscular activity, and somatosensation in a dystonic pianist. The patient was asked to performa simple five-finger exercise at three different tempi on a digital piano, just prior to, 1, 2, 3, 6, and 12 months after the onset of the slow-down exercise training. As the rehabilitation proceeded, the patient improved the regularity of piano keystrokes, as objectively quantified using musical instrument digital interface signals. Measurements of surface electromyographic activity from the forearm muscles demonstrated that the patient gradually regained the inherent bilateral difference in the co-contraction level of the extensor digitorum communis and flexor digitorum superficialis muscles. Furthermore, the practice of slow-down exercise lowered the two-point discrimination thresholds of affected fingers, indicating the restoration of tactile spatial resolution. These findings not only confirm the effectiveness of slow-down exercise for the treatment of focal hand dystonia but also provide objective evidence that a simple behavioral intervention can reverse the reorganization of sensorimotor neural networks in dystonic patients.

Background: Metronidazole has been widely used to treat various anaerobic infections for many years without producing major side effects. Some of its new therapeutic indications, however, necessitate prolonged treatment with relatively high doses. Peripheral neuropathy is clearly one of the complications that can arise with such use.
Case report: Four young male patients with history of intake of metronidazole for treatment of amoebic liver abscess and diarrhoea developed very rapid onset distal symmetrical sensory neuropathy. Patients being treated with metronidazole particularly those on high doses even for short period should be monitored for neurotoxicity
Conclusion: This drug which is widely and empirically prescribed and is an over the counter (OTC) drug for any types of diarrhoea in our country is clearly associated with neurotoxicity. Metronidazole should be used with some caution and with clear indications even when is prescribing for short course and low doses.