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Abstract Background Parkinson's disease (PD) presents motor and non-motor symptoms that impair function and quality of life. Identifying clinical factors linked to physical performance is key for patient care and management. Objective To examine associations between sarcopenia-related measures and physical performance in mild-to-moderate PD (Hoehn & Yahr [HY] I–III). Methods This was a cross-sectional study including patients with idiopathic Parkinson's disease at mild to moderate stages (Hoehn & Yahr I–III), evaluated in the ON medication state. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Sarcopenia was evaluated according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, including screening with the SARC-F questionnaire and the Ishii score, assessment of muscle strength by handgrip dynamometry, and evaluation of body composition and appendicular lean mass by whole-body dual-energy X-ray absorptiometry (DXA). Analyses included bivariate comparisons, correlation analyses, and logistic regression models (Enter and Best Subsets). Results A total of 127 patients were evaluated (mean age 66 years; 41.7% females). Low physical performance was observed in 39% (n = 50) of patients and was strongly associated with positive screening of sarcopenia (SARC-F score ≥ 4; odds ratio [OR]: 1.67; 95%CI: 1.30–2.15; p < 0.001). Ishii score (p = 0.009), reduced mean handgrip strength (26 ± 10 kgf versus 30 ± 10 kgf; p = 0.02), and postural instability and gait difficulty (PIGD) (p < 0.001) were also significantly associated with low SPPB performance in bivariate analyses. In the multivariable models, SARC-F and PIGD emerged as independent predictors of poor physical performance. The best subset model, combining SARC-F and PIGD, showed good discriminative accuracy (area under the curve [AUC] = 0.82). Conclusion Higher PIGD scores and SARC-F ≥ 4 correlated with poor physical performance in PD. Low performance was linked to both SARC-F and Ishii scores, which help identify risk of functional decline. Longitudinal studies are needed to clarify causality and treatment implications.

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Abstract Background Cognitive impairment is increasingly recognized as a long-term consequence of coronavirus disease 2019 (COVID-19), but most evidence comes from high-income settings. Little is known about its impact in socioeconomically-vulnerable populations. Objective The current study investigated long-term cognitive effects in 133 individuals older than 50 years of age with low level of schooling and low socioeconomic status who were hospitalized for COVID-19. Methods The participants were assessed 12 to 18 months after hospitalization using the Modified Telephone Interview for Cognitive Status (TICS-M). A subset of 65 participants underwent further cognitive and neuropsychiatric evaluations. Cognitive impairment was defined as scores ≤ −1.5 standard deviations from age- and education-adjusted Brazilian norms. During the acute phase of the disease, sociodemographic, clinical, and laboratory data were evaluated to identify potential risk factors. Results The mean age of the subjects (n = 65) was of 65.3 years, and the sample was composed of 69.2% of women, 57.1% of pardo individuals, 47.7% of subjects with ≤ 4 years of schooling, and 83.6% of participants with monthly family income ≤ 3 minimum wages. Hospitalization averaged 16.1 days, and 55.4% required intensive care. Cognitive impairment affected 70.8% of the participants. Higher age, female sex, and hyposmia were associated with cognitive impairment. Conclusion Cognitive impairment was frequent in this socioeconomically-vulnerable sample, a group still underrepresented in existing research.

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Abstract Background Palliative care has been shown to yield benefits in terms of quality of life and therapeutic planning in oncological and non-oncological diseases, but its integration in neurology remains limited. Objective To evaluate the predictive factors of mortality in neurological patients to improve prognosis. Methods In this 1-year cohort study, we followed patients aged > 18 years hospitalized in a neurological Semi-Intensive Care Unit in Brazil. The patients were categorized into two groups based on palliative care indication: those with and those without indication. The palliative care criteria included a "no" response to the Surprise Question, a Palliative Performance Scale (PPS) score below 70%, or significant weight loss (> 5%) with associated body changes. Results We included 166 patients, 87 with indication and 79 without it. The group with indication had a 29.8% mortality rate (26 deaths) and a 27.7-fold higher risk of death. The factors associated with increased mortality risk within 1 year included PPS score < 40%, answering "no" to the Surprise Question, and weight loss. Notably, 62% (n = 54) of the group with indication were admitted to the Intensive Care Unit (ICU), compared to 12% (n = 12) in the group without indication. Advanced directives were only documented in 31% (n = 27) of the group with indication and in 59% (n = 16) of the patients who died. Prognostic assessment in neurological diseases is challenging due to limited data. Conclusion In the present study, we found that the PPS score, the Surprise Question, and weight loss were significant predictors of mortality within 1 year. These findings highlight the need for further research to provide better end-of-life markers and ensure greater autonomy in neurological disease management.

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Abstract Background Acquired apraxia of speech is often a comorbidity that accompanies aphasia. In some cases, it may be difficult to distinguish whether speech errors are phonological (resulting from aphasia) or phonetic (resulting from apraxia of speech). Objective To verify the capacity of the Costa, Brescancini, and Ortiz (CBO) protocol to identify acquired apraxia of speech in persons with aphasia (PWA) among Brazilian Portuguese speakers. Methods This is a cross-sectional and prospective study that included the participation of 7 PWA and suspected apraxia of speech (PWAG) poststroke and 25 neurotypical individuals who formed the control group (CG). All participants were followed the tasks of the CBO protocol, such as spontaneous conversation, description of a thematic card, word repetition, and diadochokinesias (DKK). Results The protocol differentiated the groups in the spontaneous speech tasks (percentage of errors per word); word repetition list (time, punctuation, quantity, and type of manifestations); and DKK /ka/ and /pataka/. The results showed that the PWAG presented less fluent, slower speech, with more errors than the CG. Additionally, the protocol mapped the nature of the errors. Conclusion The protocol enabled the identification of acquired apraxia of speech in PWA. It was also possible to analyze the tasks and linguistic variables that most interfered with the motor production of speech in Brazilian PWA.

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Abstract Background Parkinson's disease (PD) presents with both motor and non-motor symptoms. Postural and gait aspects, as well as the risk of falls, are important causes of morbidity and mortality in PD. The neural correlates of PD are alterations in the substantia nigra of the midbrain and, among other sites mentioned, the pontine peduncle nucleus stands out. Noninvasive neuromodulation, such as galvanic vestibular stimulation (GVS), can be used in the neural centers involved in motor control alterations in PD. Projections from the vestibular system are involved in motor control and can stimulate the basal nuclei and the pontine peduncle nucleus, as well as strengthen neural networks. Objective To analyze the effects of GVS associated with physical-functional exercise on the motor control of PD patients. Methods A randomized, placebo-controlled clinical trial. Participants with PD, diagnosed through the Hoehn & Yahr scale (HY) 2 or 3, will be allocated to groups. Pre- and postintervention and follow-up assessments will follow a structured protocol of physical-functional instruments, as recommended in the European Guidelines for managing people with PD. The intervention for both groups will follow the American Neurofunctional Physical Therapy Guideline for managing people with PD. Results It is expected that, in the experimental group, the exercises will be associated with active GVS. Finally, a descriptive and statistical analysis must be conducted to verify the effects of GVS. Conclusion The study of new devices focusing on motor control in PD is a novel approach and warrants further investigation in the context of vestibular function.

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Abstract Background Neurocritical care (NCC) education involves integrating knowledge and skills into various complex areas. While the USA, Canada, and Europe regulate didactic core training for medical residencies and fellowships, the quantity and quality of these training programs in Brazil remain unclear. Objective To assess how NCC training is currently integrated into neurology and intensive care residency programs in Brazil. Methods A cross-sectional survey composed of 27 multiple-choice and short-answer questions was distributed by email to professionals registered in national congresses and medical organizations. Data regarding exposure to NCC training, duration, supervision, infrastructure, and self-perceived competencies were analyzed. Results A total of 208 responses from 82 centers across 14 Brazilian states were included. Respondents were primarily neurologists (58.2%) and intensivists (28.2%). Only 50.5% reported receiving NCC training during residency, typically lasting more than 4 weeks. Training predominantly occurred in intensive care units with 5 to 20 beds, supervised by intensivists. However, exposure to specialized skills was limited: 23% to transcranial Doppler, 21% to electroencephalogram (EEG) interpretation, and 24% to multimodal neuromonitoring. Confidence in managing complex cases was suboptimal, with 56% reporting confidence in postcardiac arrest care, 47% in refractory intracranial hypertension, and 40% in spinal cord trauma. Conclusion Neurocritical care education in Brazil is heterogeneous and remains at an early stage of development. Most residents receive limited exposure to advanced neurocritical skills, resulting in low confidence to independently manage highly complex conditions. Standardized, competency-based training programs are urgently needed to enhance professional preparedness and potentially improve patient outcomes in NCC.

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Abstract Background Trigeminal neuralgia (TN) is a severe craniofacial pain disorder that significantly impacts patient quality of life. Microvascular decompression (MVD) is the sole surgical technique directly addressing the underlying neurovascular conflict, offering durable pain relief. However, data from Latin American populations remain limited. Objective To evaluate pain improvement, recurrence, and complications in patients with classic TN undergoing MVD at a Mexican high-specialty center. Methods We retrospectively analyzed 61 consecutive classic TN patients who underwent MVD (2010–2023). Their clinical records provided demographic data, pain characteristics, Barrow Neurological Institute Pain Scale (BNI-PS) scores, intraoperative findings, and long-term outcomes. The statistical analyses were performed through the McNemar and Cochran Q tests for longitudinal changes. Results The cohort was predominantly composed of women (80.3%; median age: 59 years). Preoperatively, most reported severe pain (BNI-PS score: IV–V). After MVD, 57.4% achieved complete pain relief (BNI-PS score: I) and 13.1% had occasional pain not requiring medication (BNI-PS score: II) at the long-term follow-up. Neurovascular compression was identified in 96.7% of the cases, most frequently by the superior cerebellar artery (49.2%). The overall recurrence rate was of 14.8%, with 8.2% requiring reoperation. Early complications included transient cerebellar syndrome (8.2%) and facial hypoesthesia (11.5%); 1 case of mortality occurred due to hypertensive hemorrhage. Conclusion Microvascular decompression is a safe, effective, and durable treatment for classic TN, achieving long-term pain relief in more than 70% of the patients. The present study offers valuable clinical data from a Mexican cohort, reinforcing the efficacy and reproducibility of the procedure in diverse neurosurgical settings.

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Abstract Background Duchenne muscular dystrophy is a rare, progressive neuromuscular disorder primarily affecting boys, and it follows a predictable course. Early intervention is essential for effective management, but disparities in the care of patients with rare diseases hinder access to optimal treatment. Objective To identify unmet needs and challenges in the care of patients with Duchenne muscular dystrophy within the Brazilian public health system compared with the private system. Methods A cross-sectional observational study using the Delphi method was conducted with ten neurologists specialized in Duchenne muscular dystrophy. The specialists participated in rounds of surveys to reach consensus on key issues, including diagnosis, treatment, and care. Data was analyzed using descriptive statistics. Results According to the Delphi panel, the public health system had an average diagnostic delay of 25 months compared with 10 months in the private sector. Although genetic testing is critical, it is not funded by the public health system. Other the barriers included delayed corticosteroid treatment, limited access to multidisci-plinary care, and insufficient medical devices. Patients in the public health system lost ambulation earlier (11–12 years of age) than those in the private sector (13–14 years of age). Life expectancy was significantly shorter in the public system, averaging 19 to 20 years compared with 26 to 27 years of age in the private sector. Conclusion There are significant disparities in the care of patients with Duchenne muscular dystrophy within Brazil’s public health system, resulting in worse outcomes. Enhancing access to genetic testing and early multidisciplinary care is crucial to improve the quality of life and survival of these patients.

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Abstract Background Methylphenidate (MPH) is a psychostimulant widely used to enhance attention and executive functions through increased dopaminergic and noradrenergic transmission. Although its effects on cognitive performance are well documented, its acute influence on cortical oscillatory activity, particularly α power, during tasks requiring simultaneous motor and cognitive processing remains poorly understood in healthy adults. Objective To investigate the acute effects of 10 mg MPH on absolute α power (8–12 Hz) in frontal regions during a visuomotor task in healthy subjects. Methods A total of 13 right-handed healthy adults (7 men; age 25.6 ± 4.5 years) participated in a randomized, double-blind, placebo-controlled, crossover study. A 20-channel electroencephalography (EEG) was recorded before and after execution of the MIRA visuomotor task (joystick response when a moving target crosses a previously memorized position) under placebo and MPH (10 mg) conditions, with sessions 1 week apart. Absolute α power was compared using two-way ANOVA (condition vs. moment: pre- vs. post-joystick press), followed by paired t-tests when appropriate. Results Significant condition versus moment interactions were observed at F3 (p = 0.006), F4 (p = 0.003), and F8 (p = 0.023). The main effects of condition and/or moment occurred at Fp1, Fp2, and Fz (all p < 0.05). The use of MPH attenuated or reversed the typical task-related α desynchronization seen under placebo, especially in right frontal regions. Conclusion A single 10 mg dose of MPH homogeneously modulates frontal α power during a visuomotor task, promoting sustained cortical activation. This paradigm emerges as a sensitive tool for studying motor-cognitive coupling and may contribute to understanding MPH mechanisms in both healthy and clinical populations.

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Abstract Hereditary transthyretin amyloidosis (ATTRv) is a rare, autosomal dominant, inherited disease caused by variants in the gene encoding the transthyretin (TTR) protein. These variants lead toTTR tetramer destabilization, resulting in the formation and progressive deposition of insoluble amyloid fibrils in various tissues, including those of the central nervous system (CNS). Although previously neglected, the recognition of CNS involvement in ATTRv has become progressively relevant due to prolonged patient survival and the ineffectiveness of the current therapies in addressing CNS synthesis of TTR. The first descriptions of the pathological involvement of the CNS in ATTRv date from the 1960s; however, this topic has not been fully explored. In the present article, the main CNS clinical manifestations of ATTRv, such as transient focal neurological episodes, bleeding complications, leptomeningeal amyloidosis, and cognitive impairment, are reviewed, and the phenotypic variability of this condition is highlighted. A literature review of the PubMed/Medline database was conducted using the following keywords: hereditary amyloidosis, transthyretin amyloidosis, familial amyloidosis, central nervous system, neurological manifestations, leptomeningeal amyloidosis, cognition, and cognitive impairment. Studies published in the last 15 years, including review articles, prospective observational studies, experimental studies and clinical trials, were evaluated. Improving our understanding of CNS involvement in ATTRv will enable the early identification of neurological symptoms in this condition, which will enhance the understanding of the pathophysiological mechanisms and boost the advancement of research, expanding potential treatments and improving the quality of life of these individuals.

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Abstract We herein report the case of a 23-year-old man with a 3-year history of progressive right-hand weakness, leading to functional impairment. A neurological examination revealed signs of lower cervical motor neuron involvement, including the reverse split hand sign and the Wartenberg's sign. Electrophysiological studies showed reduced compound muscle action potentials (CMAPs) in the right ulnar and median nerves, with preserved sensory conduction and neurogenic changes in the myotomes from C7 to T1. A conventional cervical spine magnetic resonance imaging (MRI) scan was unremarkable, but a flexion MRI scan revealed anterior displacement of the posterior dura and spinal cord compression, confirming the diagnosis of Hirayama disease (HD), which is a rare, self-limiting cervical myelopathy in young male patients caused by dynamic compression during neck flexion. The diagnosis requires a high index of suspicion and flexion MRI scans. While cervical stabilization remains controversial, it may help prevent progression in selected cases. The current report highlights the clinical and radiological features of HD, discusses differential diagnoses, and underscores the importance of dynamic imaging in young patients with asymmetric upper-limb weakness.

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Abstract Jean Martin Charcot (1825–1893) was an enthusiast of hydrotherapy for the alleviation of neurological symptoms. At the Salpêtrière hospital, he frequently advised the use of a high-pressure shower, which delivered strong pulsing jets of cold water. This therapy gained particular popularity in Russia, where it remains widely used and is known as the Charcot shower treatment.

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Abstract Cerebral palsy (CP), a term coined by William John Little in 1843, represents a group of non-progressive motor disorders resulting from early brain injury. Beyond its medical characterization, there were early artistic depictions, such as Egyptian reliefs and medieval religious scenes, portraying individuals with asymmetric or contracted limbs mainly through symbolic or moral lenses. During the Renaissance and Baroque periods, artists including Dürer and Velázquez subtly represented physical diversity, though without explicit medical context. Literary portrayals evolved from mythological or moral allegory (e.g., Hephaestus, hagiographies) to empathetic narratives of individuality and inclusion, as seen in Tiny Tim, present in A Christmas Carol, written by Charles Dickens, and Draper's Out of My Mind. In modern times, artists and writers living with CP transformed disability into a means of self-expression and social critique.