RESUMO
OBJECTIVE: Hyperventilation (HV) is one of the main and basic activation methods during ambulatory electroencephalogram (EEG), unless medical reasons contraindicate it. During the COVID-19 pandemic, with the high risk of human-to-human infection, local guidelines and recommendations have been developed that suggest not to perform the HV maneuver routinely. Our objective was to characterize patients who present positive HV in an epilepsy center. METHODS: We analyzed retrospectively all the ambulatory EEGs performed during one year in our specialized ambulatory child and adolescent epilepsy center, and describe patients with positive maneuver. RESULTS: A total of 305 EEGs were performed. Patients under 3 years and 11 months were excluded as well as all patients that did not fill up the criteria for epilepsy diagnosis. From the 252 EEGs that were included in the study, 194 EEGs (77%) were classified as abnormal and 58 (23%) as normal. From these same 252 EEGs, 150 EEG finished correctly the HV maneuver. Physiological slowing response was found in 54 EEGs (36%), no changes (negative) in 83 (55%), and abnormal response (positive) in 13 EEGs (9%). The 13 HV-positive EEGs showed 4 patients with an increase of epileptiform activity, 3 patients experienced an increase of basal preregistered abnormal slowing, and 6 EEGs showed trigger of bilaterally synchronous and symmetric 2-4 Hz spike-and-slow wave discharges and absences. None of these last 6 patients needed more than 3 minutes to elicit the paroxysmal discharge. SIGNIFICANCE: Based on these findings and according with other studies, the low positivity and high specificity of the HV maneuver support the idea that HV could be excluded during the COVID-19 pandemic situation, and also reevaluate whether it could be changed to a complementary maneuver, restricted only for cases where absence epilepsy is suspected. Larger studies will be needed to reaffirm this proposal.
Assuntos
Assistência Ambulatorial , COVID-19 , Eletroencefalografia/métodos , Epilepsia Tipo Ausência , Adolescente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Chile/epidemiologia , Técnicas de Diagnóstico Neurológico/normas , Técnicas de Diagnóstico Neurológico/tendências , Epilepsia Tipo Ausência/diagnóstico , Epilepsia Tipo Ausência/epidemiologia , Epilepsia Tipo Ausência/fisiopatologia , Feminino , Humanos , Hiperventilação , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Convulsões/diagnóstico , Convulsões/fisiopatologia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Motor coordination, the ability to produce context-dependent organized movements in spatial and temporal domains, is impaired after neurological injuries. Outcome measures assessing coordination mostly quantify endpoint performance variables (ie, temporal qualities of whole arm movement) but not movement quality (ie, trunk and arm joint displacements). OBJECTIVE: To develop an outcome measure to assess coordination of multiple body segments at both endpoint trajectory and movement quality levels, based on observational kinematics, in adults with neurological injuries. METHODS: A 3-phase study was used to develop the Comprehensive Coordination Scale (CCS): instrument development, Delphi process, and focus group meeting. The CCS was constructed from common tests used in clinical practice and research. Rating scales for different behavioral elements were developed to guide analysis. For content validation, 8 experts (ie, neurological clinicians/researchers) answered questionnaires about relevance, comprehension, and feasibility of each test and rating scale. A focus group conducted with 6 of 8 experts obtained consensus on rating scale and instruction wording, and identified gaps. Three additional experts reviewed the revised CCS content to obtain a final version. RESULTS: Experts identified a gap regarding assessment of hand/finger coordination. The CCS final version is composed of 6 complementary tests of coordination: finger-to-nose, arm-trunk, finger, lower extremity, and 2- and 4-limb interlimb coordination. Constructs include spatial and temporal variables totaling 69 points. Higher scores indicate better performance. CONCLUSIONS: The CCS may be an important, understandable and feasible outcome measure to assess spatial and temporal coordination. CCS measurement properties are presented in the companion article.
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Técnicas de Diagnóstico Neurológico , Atividade Motora , Avaliação de Resultados em Cuidados de Saúde , Desempenho Psicomotor , Índice de Gravidade de Doença , Reabilitação do Acidente Vascular Cerebral , Técnica Delphi , Técnicas de Diagnóstico Neurológico/normas , Grupos Focais , Humanos , Atividade Motora/fisiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Desempenho Psicomotor/fisiologia , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND PURPOSE: Telephone-based assessment may be a valuable and cost-effective approach to improve monitoring and follow-up assessments in patients and research participants. Telephone-based assessment may be of particular value during times when it is important to reduce in-person contract, such as during the Covid-19 pandemic. The purpose of this study was to investigate concurrent validity of the telephone-based administration of the ABILHAND for the assessment of manual ability in individuals with stroke. METHODS: Using a cross-sectional study design, participants with stroke were invited to answer the ABILHAND questionnaire on 2 randomized occasions, face to face and by telephone, 5 to 7 days apart. The mean difference (MD) between the interviews was calculated (95% confidence interval [95% CI]) to investigate the concurrent validity. Intraclass correlation (ICC) and weighted κ coefficients were used to investigate the agreement between face-to-face and telephone-based administration. RESULTS: One hundred two participants (50 men; mean age = 65 years, SD = 13 years) were included. No significant differences were observed between the mean scores obtained with face-to-face and telephone-based administration of the ABILHAND (MD = -0.06; 95% CI, -0.72 to 0.60). Very high agreement was found between face-to-face and telephone-based administration (ICC = 0.90; 95% CI, 0.85 to 0.93) on the ABILHAND total scores. Most of the individual items had moderate or substantial κ agreement. DISCUSSION AND CONCLUSIONS: Telephone-based administration of the ABILHAND is valid for the assessment of manual ability after stroke. Clinicians and researchers may use the ABILHAND for monitoring manual ability in persons with stroke and/or screening potential research participants.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A318).
Assuntos
Técnicas de Diagnóstico Neurológico/normas , Mãos/fisiopatologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Telemedicina , Telefone , Idoso , COVID-19 , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Neuroleptic malignant syndrome requires prompt recognition for effective management, but there are no established diagnostic criteria. This is the first validation study of recently published international expert consensus (IEC) diagnostic criteria, which include priority points assigned on the basis of the importance of each criterion for making a diagnosis of neuroleptic malignant syndrome. METHODS: Data were extracted from 221 archived telephone contact reports of clinician-initiated calls to a national telephone consultation service from 1997 to 2009; each case was given a total priority point score on the basis of the IEC criteria. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR) research criteria, in original form and modified to accept less than "severe" rigidity, served as the primary diagnostic reference standard. Consultants' diagnostic impressions were used as a secondary reference standard. Receiver operating characteristic curve analysis was used to optimize the priority point cutoff score with respect to the reference standards. RESULTS: Area under the receiver operating characteristic curve ranged from 0.715 (95% confidence interval, 0.645-0.785; P = 1.62 × 10) for consultant diagnoses to 0.857 (95% confidence interval, 0.808-0.907; P < 5 × 10) for modified DSM-IV-TR criteria. The latter was associated with 69.6% sensitivity and 90.7% specificity. CONCLUSIONS: Agreement was best between IEC criteria with a cutoff score of 74 and modified DSM-IV-TR criteria (sensitivity, 69.6%; specificity, 90.7%); this cutoff score demonstrated the highest agreement in all comparisons. Consultant diagnoses showed much better agreement with modified, compared with original, DSM-IV-TR criteria, suggesting that the DSM-IV-TR criterion of "severe" rigidity may be more restrictive than what most knowledgeable clinicians use in practice.
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Consenso , Técnicas de Diagnóstico Neurológico/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Síndrome Maligna Neuroléptica/diagnóstico , Humanos , Síndrome Maligna Neuroléptica/classificação , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Quantitative Sensory Testing (QST) is more often used because of the increasing recognition of small fiber neuropathy. METHODS: We studied QST in a systematic way in an age-stratified cohort of 83 neurological-free Hispanic Latinamerican patients. Predefined standardized stimuli were applied using the method of limits. RESULTS: WDT range from 2.2 to 3.3°C in hands, and from 4.0°C up to 6.6°C in feet. Cold detection threshold range from 2.2 to 3.6°C in hands, and from 2.6°C to 4.5°C in feet. Heat-induced pain (HP) was induced at lower temperatures than previously reported, with a range from 41.8°C to 44.5°C in hands and from 43.2 to 45.7°C in feet. Similar to HP, cold pain was also induced at much higher temperatures, between 21.4-17.3°C in hands and 21.5-16.5°C in feet. Vibratory stimuli ranged from 0.8 to 1.7 µ/sec in hands and from 1.4 to 3.5 µ/sec in feet. CONCLUSION: Temperature and vibration thresholds were similar to those previously reported in other populations except for pain thresholds that were lower in this population than in the Caucasian population.
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Técnicas de Diagnóstico Neurológico/normas , Hispânico ou Latino , Medição da Dor/métodos , Medição da Dor/normas , Adulto , Fatores Etários , Idoso , Algoritmos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Valores de Referência , Limiar Sensorial/fisiologia , Adulto JovemRESUMO
Médicos no Brasil e também nos Estados Unidos adquirem, durante seus anos de treinamento, conhecimentos adequados sobre eletrocardiogramas, exames de raio X, tomografia computadorizada, ultra-sonografia e outros exames. Em geral, eles não obtêm informações semelhantes da natureza, uso e limitações de eletroencefalogramas (EEGs). Este artigo trata de algumas das falhas mais comuns de médicos não-especialistas em Neurologia e Psiquiatria: 1. EEGs não dão informações sobre as personalidades e os estados emocionais e intelectuais dos pacientes; 2. EEGs podem ser úteis na avaliação e tratamento de pacientes com dores de cabeça somente se o médico enfatiza que a maioria das cefaléias não está relacionada ao cérebro, mas tem as suas causas nas tensões das camadas musculares da cabeça e em outras estruturas não-cerebrais da cabeça; 3. EEGs são de muito valor no diagnóstico de ausências (epilepsia pequeno mal) mas para obter este valor o médico tem de entender bem a natureza deste tipo de convulsão; 4. EEGs têm utilidade no diagnóstico de epilepsia grande mal, mas eles possuem limitações neste campo; 5. EEGs são úteis no tratamento de pacientes com traumatismo craniano leve, mas neste caso eles também têm de ser utilizados nos contextos da situação total da vida do doente, e o significado do seu traumatismo craniano deverá ser explicado. O artigo trata ligeiramente de outros assuntos semelhantes