Neurodevelopmental disorders (NDDs) are substantial burdens for individuals and health systems; yet, their long-term epidemiology in South America is poorly characterized. To describe the trends from 1990 to 2023 in the age-standardized prevalence rates (ASPRs) of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and idiopathic developmental intellectual disability (IDID) across 12 South American countries using Global Burden of Disease (GBD) 2023 estimates. Country-specific annual ASPRs and 95% uncertainty intervals (95%UIs) were obtained from the GBD 2023. Sex-stratified ASPRs were used to calculate male-to-female ratios (MFRs) and summarize long-term sex disparities. Temporal trends were assessed using the average annual percent change (AAPC) from log-linear regression for each country. In 2023, the ASPRs ranged from 0.57 to 1.06% for ASD, from 1.00 to 2.55% for ADHD, and from 0.42 to 0.54% for IDID across countries. Between 1990 and 2023, the ASD ASPRs increased in all countries, with AAPCs from +0.35%/year (Paraguay) to +0.79%/year (Chile). The ADHD ASPRs showed little net change, with AAPCs from -0.10%/year (Argentina) to +0.39%/year (Brazil). And the IDID ASPRs declined consistently, with AAPCs from -0.79%/year (Bolivia) to -0.30%/year (Suriname). Sex differences in ASPRs were large and persistent for ASD and ADHD, but small for IDID. The MFR trajectories suggested a slight widening of the ASD male-female gap, largely stable ADHD disparities, and minimal variability for IDID. Over 3 decades, the ASD ASPRs rose modestly, the ADHD ASPRs were broadly stable, and the IDID ASPRs declined across South America. The GBD 2023 estimates point to enduring diagnostic and structural inequities and to the need for strengthened surveillance and more equitable access to developmental assessment.
Eye tracking technology has emerged as a pivotal tool in neurology, providing objective insights into ocular motor function and cognitive processes across various neurological conditions, including mild traumatic brain injury, autism spectrum disorder, schizophrenia, attention deficit hyperactivity disorder, and neurodegenerative diseases like Alzheimer's and Parkinson's disease.The present systematic review evaluates the current applications and reliability of portable eye-tracking devices in clinical practice, highlighting their transformative potential for diagnosing and monitoring cognitive disorders.A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies using portable eye-tracking devices were included. Databases searched included PubMed, Embase, and Cochrane, with studies screened and reviewed by two independent authors. Outcomes assessed were eye movements and visual responses in neurological patients. The Critical Appraisal Skills Program (CASP) checklist was used to assess study quality and bias.A total of 62 studies were identified, with 27 included after screening. The findings reveal significant advancements in device accessibility, sampling rates, and accuracy, which enhance the ability to detect subtle cognitive changes through eye movement patterns. Portable devices such as Neurolign DX 100 (Neurolign USA, LLC) and Tobii (Tobii), which is a portable video-oculography (VOG) devices including Neurolign DX 100 and Tobii systems, were highlighted for their precision and applicability in clinical settings.Portable eye-tracking devices show promise for detecting cognitive impairments in neurological conditions like multiple sclerosis. Their portability and ease of use facilitate widespread clinical application, making cognitive assessments more accessible and effective in early diagnosis and monitoring of disease progression.
Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS), leading to higher mortality and poor functional outcomes. Early identification of at-risk individuals is critical for timely interventions. To identify the independent risk factors for SAP in AIS patients and to develop a predictive nomogram for early risk stratification. We conducted a retrospective analysis of 280 AIS patients admitted between January 2021 and August 2025. Multivariable logistic regression identified independent SAP risk factors, and a nomogram was developed. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Internal validation was performed using bootstrap resampling (1 thousand iterations). The incidence of SAP was of 30.0% (84/280). The independent risk factors included advanced age, atrial fibrillation, higher score on the National Institutes of Health Stroke Scale (NIHSS), nasogastric tube insertion, mechanical ventilation, and elevated monocyte-to-lymphocyte ratio (MLR). Higher albumin levels were protective. The nomogram showed good discrimination (area under the curve [AUC]= 0.816; 95%CI: 0.765-0.871), satisfactory calibration, and favorable clinical usefulness, as demonstrated by the DCA. We developed a nomogram to predict SAP risk in AIS patients. The key risk factors included advanced age, atrial fibrillation, NIHSS score, nasogastric tube insertion, mechanical ventilation, and elevated MLR, while higher albumin levels were protective. The nomogram demonstrated strong discriminatory power and clinical usefulness, supporting early risk stratification and targeted interventions.
Ataxia comprises a heterogeneous group of disorders with multiple clinical and etiological presentations. The frontal subtype, in particular, is poorly defined and often misdiagnosed, reflecting both its complex historical evolution and lack of formal diagnostic criteria. To evaluate clinical and epidemiological characteristics of a sample of patients with ataxia under follow-up in a private neurology clinic. We evaluated 48 patients diagnosed with ataxia over a 4-month period and followed them for 1-year in a private neurology clinic in southern Brazil. Clinical, neuroimaging, and laboratory data were analyzed. Patients were classified according to clinical and etiological subtypes based on criteria defined by the authors. Frontal ataxia was the most frequent presentation (n = 15; 31.3%), predominantly affecting elderly patients with systemic arterial hypertension, diabetes mellitus, and MRI evidence of small vessel disease. These patients had a later disease onset (mean: 75.9 ± 8.8 years), lower SARA scores, and a nonprogressive course compared with degenerative cerebellar ataxias (p < 0.0001). No correlation was observed between the severity of small vessel disease (Fazekas scale) and gait ataxia (rs = -0.28, p = 0.31). Hereditary ataxias, particularly spinocerebellar ataxias (SCAs), were the second most frequent group, followed by atypical Parkinsonian syndromes. Frontal ataxia emerged as a frequent and underrecognized subtype in routine neurological practice. These findings underscore the need for increased awareness and the development of evidence-based diagnostic criteria to better define and distinguish it within the spectrum of ataxic disorders.
Impulse control disorders (ICDs) are potentially serious complications of Parkinson's disease (PD). Treatment, particularly the use of dopamine agonists (DAs), is associated with the development of ICDs and related behaviors. However, susceptibility to these disorders appears to be linked to specific risk factors. To assess the frequency, clinical presentation, and factors associated with the development of ICDs in a population of patients with PD. Patients with PD were screened for ICD-related symptoms using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson''s Disease -Current Short (QUIP-CS) questionnaire. Additionally, they underwent cognitive evaluation and were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Sociodemographic data and disease progression information were collected. Levodopa equivalent daily dose (LEDD) was calculated for each patient. Of the 90 patients evaluated, 42 (46.6%) exhibited symptoms of ICDs. The most frequent subtype was binge eating (50%), followed by compulsive buying (33.3%) and hypersexuality (21.4%). A significant association was found between DA use and the development of ICDs (p = 0.041). Patients with ICDs using DAs had a higher mean LEDD (p < 0.001) and a higher frequency of motor complications (MDS-UPDRS Part IV, p = 0.028) compared to those not using DAs. In the current study, the use of DAs was the main risk factor associated with the development of impulse control disorders. No other significant associated factors could be identified.
Stroke remains the second leading cause of death worldwide and the leading cause in Brazil. The implementation of a stroke center (SC) has played a crucial role in improving outcomes, increasing both survival rates and functional recovery.To examine the experience of Hospital Universitário de Brasília of Universidade de Brasília's (HUB-UnB) SC, focusing on its performance indicators.The present observational, retrospective, and analytical study evaluated 19 patients diagnosed with acute ischemic stroke (AIS) who received intravenous thrombolysis with alteplase at the HUB-UnB SC between July 2021 and December 2024. Performance indicators were compared with national and international data.The door-to-CT time was less than 25 minutes in 16 patients (84%), and the door-to-needle time was less than 60 minutes in 12 patients (63%). The mean National Institutes of Health Stroke Scale score significantly decreased from 12.4 at admission to 1.6 at discharge. Consequently, 76% of patients achieved a modified Rankin Scale score of 0 to 2. Complication rates were low, including 5.3% hemorrhagic transformation and 10.5% in-hospital mortality. No statistically significant differences were observed when comparing performance indicators with national and international benchmarks.The implementation of the HUB-UnB's SC proved feasible and effective in providing specialized care for AIS within a university hospital of the Unified Health System (Sistema Único de Saúde, SUS, in Portuguese). Despite operating only during weekday business hours, outcomes were comparable to those of high-income countries. Expansion to 24-hour operation, infrastructure improvements, recruitment of additional healthcare professionals, and greater integration with the SUS remain key challenges.
Purpose in life (PiL) is an important aspect of psychological wellbeing, which can be influenced by sociodemographic factors.To analyze the relationship between sociodemographic variables and PiL in older individuals.A quantitative study that evaluated 189 participants using the PiL Scale (PLS) was conducted. Participants were divided into two groups according to median PLS score. The Mann-Whitney U-test was used to assess group differences, given the non-normal distribution of variables. Spearman's bivariate correlations and a stepwise logistic regression model were applied to identify predictors of PiL.Of the total participants, 77.25% were female. The mean age was significantly lower in the high PiL group (p = 0.017). Spearman's correlations revealed a weak negative relationship between age and PiL (rho = -0.151; p = .038) and a weak positive relationship between schooling and PiL (rho = 0.156; p = 0.032). Logistic regression indicated that higher education (OR = 1.087; p = 0.017) and being female (OR = 2.546; p = 0.018) were associated with higher PiL.High PiL was associated with higher education and being female. Although age showed a negative correlation, the variable did not remain an independent predictor in the final multivariate model.
Amyotrophic lateral sclerosis (ALS) is a rare degenerative disease of motor neurons, predominantly sporadic, with approximately 10% of the cases showing familial inheritance.To characterize the clinical and sociodemographic profile of patients with familial ALS type 8 (fALS8) and compare it with sporadic ALS (sALS).We reviewed the medical records (1997-2022) from a specialized Brazilian center. Patients with a confirmed diagnosis of ALSs were included, and sociodemographic and clinical data were collected.The sample was composed of 89 ALS patients, with a slight female predominance (53%) and a high frequency of fALS8 cases (45%). The fALS8 patients were diagnosed at a younger age, at approximately 50 years, compared to 53 years among the sALS patients (p = 0.043). Lower limb onset predominated in the fALS8 group (87%), while the sALS group showed more heterogeneous presentations, including bulbar onset (14%). The time until the diagnosis was significantly longer in the fALS8 group compared to the sALS group, both from symptom onset (approximately 51 versus 30 months respectively; p < 0.001) and after admission to a specialized center (7 versus 4 months respectively; p = 0.002). Dysphagia and gastrostomy were more frequent in the sALS group compared to the fALS8 group (p = 0.02 and p < 0.01 respectively), and older age at diagnosis was associated with worse functional scores.The fALS8 group presented with distinct clinical and demographic features compared to the sALS group, including younger age at diagnosis, more homogeneous symptom onset, and lower frequency of dysphagia and need for gastrostomy. The diagnosis was more delayed in the fALS8 group, and older age at diagnosis was associated with worse functional status. The current study contributes to the scarce data on fALS8 in South America.
Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are neurobehavioral disorders in which behavioral abnormalities are common but often not recognized. To bring to life the actual descriptions rendered by our patients of their unusual experiences. Members of the Parkinson Study Group were asked to provide illustrative examples of particularly memorable abnormal behaviors that their own PD patients or family members reported. These recollections were deidentified and sorted into categories. These disorders include the classically described syndromes of Capgras, Cotard, Diogenes, Ekbom, Othello as well as overlap parasomnias, and impulse control disorders. Patients with PD often have had unusual experiences that they may not share without inquiries by their healthcare providers, fearful of how they will be perceived. Sensitive inquiries are required to reveal these problems. We believe that reading about real experiences will help sensitize the reader.
Self-compassion (SC), defined as a positive and accepting attitude towards oneself during times of suffering or failure, is receiving more attention in the context of chronic pain disorders. However, very little is known regarding the link between SC, psychological symptoms, and migraine features. To compare the SC levels of migraine patients to those of healthy controls and investigate the relationships among SC, anxiety, depression, and migraine features. This cross-sectional study comprised 90 healthy controls (age: 35 ± 9.8 years, 75 female patients) and 98 migraine sufferers (age: 36.7 ± 11.3 years, 84 female patients). The Beck depression inventory, Beck anxiety inventory, and self-compassion scale were completed by the participants. The SC levels were considerably lower in migraine patients. Patients with chronic migraine performed worse than those with episodic migraines on the self-kindness, common humanity, and mindfulness subscales. Patients with medication overuse also had reduced SC. Higher isolation scores were linked to aura presence. We found impaired SC in individuals with migraine, and a connection with greater emotional distress and migraine characteristics. These results demonstrate the possible value of emphasizing SC in migraine therapies, especially for those who suffer from chronic migraine, aura, or medication overuse.
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.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.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.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 barriers included delayed corticosteroid treatment, limited access to multidisciplinary 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.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.
Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurological emergency associated with high rates of mortality and disability. While multiple prognostic scores have been developed in high-income countries, evidence from low- and middle-income settings remains limited. To evaluate the predictive performance of clinical and radiological scores for mortality and functional outcomes in aSAH patients treated in a public tertiary center in a resource-limited country. We conducted a retrospective cohort study of adult patients with confirmed aSAH admitted between June 2018 and March 2022. Eight prognostic scores were applied: World Federation of Neurosurgical Societies (WFNS), Barrow Neurological Institute (BNI), VASOGRADE, Hunt and Hess score, Age, Intraventricular hemorrhage, and Rebleeding (HAIR), WFNS grade, Age, and Pupillary reactivity (WAP), Hemorrhage, Age, Treatment, Clinical Status, and Hydrocephalus (HATCH), Brain Aneurysm Institute (BAI), and modified BNI score. Primary outcomes were in-hospital mortality and poor functional outcome (modified Rankin Scale 4-6) at 90 days. Discriminative ability was assessed using the area under the receiver operating characteristic curve (AUROC) and bootstrap comparisons. Among 74 patients, in-hospital mortality was 42%, and 68.9% had poor functional outcomes. All scores demonstrated good predictive performance (AUROC ≥ 0.78). The mBNI and WFNS had the highest AUROCs for functional outcome (0.88 and 0.86, respectively), with mBNI significantly outperforming BNI (difference = 0.16; 95% CI: 0.085-0.25). The HATCH score showed moderate accuracy (AUROC 0.79), although significantly inferior to mBNI in pairwise comparison. There were no missing data, and scores were not used to guide clinical care. Despite being developed in high-income countries, the selected prognostic scores showed strong performance in a resource-limited setting. These results support their use as early risk stratification tools and emphasize the need for further validation in middle-income healthcare systems.
Rituximab, an anti-cluster of differentiation 20 (anti-CD20) monoclonal antibody, has been widely used off-label for multiple sclerosis (MS) treatment, demonstrating high effectiveness and a favorable safety profile. However, real-world data from Brazil, particularly within the public healthcare system, remain scarce. To assess the real-world effectiveness and safety of rituximab for MS treatment in a Brazilian tertiary center. We conducted a single-center, observational study at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), including MS patients treated with rituximab between January 2016 and October 2024. The primary outcome was the change in annualized relapse rate (ARR) following rituximab initiation. The secondary outcomes included disability progression, radiological activity, and safety. The statistical analyses employed non-parametric tests and time-to-event analysis. Among the 45 patients (25 with relapsing-remitting MS [RRMS], 18 with secondary progressive MS, and 2 with primary progressive MS), rituximab reduced the ARR by 89.8% (from 0.49-0.05; p < 0.001), with 90.9% remaining relapse-free. In RRMS patients, the ARR significantly decreased, from 0.56 to 0.17, after rituximab initiation (p = 0.019), with 88% remaining relapse-free (95%CI: 68.8-97.5). Radiological activity was observed in 6.8% of the sample. Patients with breakthrough disease activity (n = 4; 8.9%) presented more frequent prior natalizumab use than those without it (75.0% versus 43.9%; p = 0.039), as well as higher pretreatment relapse rates (1.8 versus 0.7; p = 0.033). Infusion-related reactions affected 12 (26.7%) patients, and they were mostly mild, while infections were the most common non-infusion adverse event (20; 57.8%). In total, 4 patients discontinued rituximab, mainly due to access limitations. Rituximab demonstrated high effectiveness and acceptable safety for MS treatment in a Brazilian public healthcare setting. Its favorable risk-benefit profile supports broader adoption in resource-limited contexts.
Cerebral arteriovenous malformation (cAVM) is a rare and complex cerebrovascular disease that may cause neurological symptoms, cognitive complaints, and psychological distress even without hemorrhage, potentially impairing long-term quality of life. To assess the impact of cAVM on mental health and quality of life, considering patients' clinical presentation and the type of treatment received. In the present cross-sectional study, adults aged 18 to 65 with ruptured or unruptured cAVM treated with conservative, or multimodal approaches were recruited. Data were collected through an online survey distributed by participating institutions. Mental health, psychological distress, and quality of life were evaluated using the 5-item Mental Health Index (MHI-5), the Self-Reporting Questionnaire (SRQ-20), and the World Health Organization Quality of Life-brief version questionnaire (WHOQOL-BREF). Results were categorized and compared with normative data. Statistical analyses included descriptive statistics, analysis of variance (ANOVA), t-tests, χ2, and Fisher's exact tests. Eighty-six participants with cAVM completed the questionnaire. Unruptured lesions accounted for 62.8% and ruptured cAVM 37.2%. Neurological deficits were reported by 94.2% of participants. Among conservatively-managed unruptured cases, 47.1% reported neurological deficits, without significant differences when compared with other treatments. Despite similar neurological status, conservatively managed unruptured patients showed poorer mental health (p = 0.048) and lower quality of life in the physical (p < 0.001) and social domains (p = 0.016). Patients with unruptured cAVM managed conservatively exhibit significantly worse mental health and reduced physical and social quality of life, despite a similar prevalence of neurological deficits relative to other groups. These findings highlight the importance of incorporating psychosocial outcomes into treatment decision-making for cAVM.
In-hospital stroke is associated with delayed recognition, reduced access to acute treatment, and worse outcomes, particularly in low- and middle-income countries. To characterize the clinical profile, care processes, and outcomes of patients with ischemic stroke occurring during hospitalization. The present retrospective cohort study included adult patients with ischemic stroke diagnosed during hospitalization at a comprehensive stroke center. Stroke recognition time was used as the reference point. Clinical characteristics, stroke severity, acute treatment, and in-hospital outcomes were analyzed. Primary outcomes were in-hospital mortality, discharge destination, and functional independence. Fifty-two patients were included. Most strokes occurred in patients admitted for non-neurological conditions, mainly in surgical specialties. Stroke recognition was delayed in a relevant proportion of cases, and reperfusion therapy was infrequently performed, with no procedure-related complications. Moderate-to-severe strokes were common. In-hospital mortality was 9.6%, and functional status significantly declined from admission to discharge. Most patients received therapeutic care planning and were referred for rehabilitation. In-hospital ischemic stroke predominantly affects patients hospitalized for non-neurological conditions and is frequently recognized late, limiting access to reperfusion therapies. These findings highlight important gaps in in-hospital stroke detection and support the implementation of structured rapid-response protocols.
Down syndrome regression disorder (DSRD) is a rare cause of neuropsychiatric regression observed in previously-healthy individuals with Down syndrome (DS). There have been reports of brain iron accumulation in the basal ganglia of patients with DS and DSRD, although the underlying etiology remains unclear. The current study aims to report, through detailed neuroimaging, laboratory tests, and clinical data findings, the case of a patient with DS who experienced a significant loss of abilities, accompanied by neuroimaging findings indicative of abnormal brain iron accumulation. While an extensive investigation with blood, cerebrospinal fluid (CSF), and genetic markers was unremarkable, magnetic resonance imaging (MRI) scans revealed abnormal iron deposition and calcifications in the globus pallidus. The abnormal iron accumulation in the basal ganglia of patients with DSRD could be a potential neuroimaging marker for this condition.
Epilepsy, described for millennia, has historically been interpreted through supernatural perspectives, leading to the search for religious intercession. Among the saints associated with the disease, Saint Valentine stood out in medieval Europe, especially in German-speaking regions, where his image was depicted curing people with seizures. Pilgrimages to sites with relics and popular names such as "Saint Valentine's Disease" highlight this devotion. In the 21st century, this symbolic heritage was reinterpreted in the context of advocacy, influencing the creation of International Epilepsy Day, celebrated on the second Monday of February, close to the saint's liturgical date on February 14th. This article revisits the historical trajectory of this association and discusses how cultural elements can be used to reduce stigma and promote scientific awareness about epilepsy.
Pathogenic variants of the COQ7 gene result in a spectrum of neurological diseases, mainly distal hereditary motor neuropathy (dHMN). We herein report cases of dHMN related to biallelic p.Met1? (c.3G > T [NM_016138]). We compare phenotypes among different COQ7variants reported in the literature. To describe and analyze our case series, review COQ7-related diseases, and compare our case series with the literature reports. We described 5 dHMN-p.Met1? patients and searched dHMN AND Brazil and COQ7 in the PubMed/MEDLINE, SciELO and Scopus databases. The categorical variables were expressed as absolute frequencies, and they were compared using the Fisher's exact test and odds ratios with 95%CIs; moreover, exploratory multivariate logistic models with penalization were applied to adjust the associations for genotype/geographic origin. We analyzed four patients with dHMN plus (two with pyramidal syndrome [PS], one with cerebellar ataxia [CA] and PS, and one with cognitive impairment [CI]) and one with pure dHMN. Our search identified 47 cases of COQ7-related disorders, and The p.Met1? variant was more frequent in dHMN (p < 0.001). In exploratory multivariate models adjusting for genotype/geographic origin, the associations observed in the univariate analyses were partially sustained. The p.Met1? variant remained related to earlier age at onset, CI, and proximal lower limb weakness, whereas Brazilian origin continued to show association with cerebellar manifestations. The 95%CIs were wide due to the small sample, and the results should be interpreted as exploratory. In conclusion, our findings suggest that the p.Met1? variant is associated with selected phenotype, even after adjustment for genotype/geographic origin. Brazilian origin remained independently related to cerebellar involvement, indicating potential modifying factors beyond genotype.
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.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.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.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.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.
Myasthenia gravis (MG) is an immune-mediated disease with a bimodal incidence: early-onset (< 50 years, predominantly female) and late-onset (> 50 years, predominantly male). Recently, a subgroup with very late-onset (≥ 65 years) has been described; however, its clinical relevance concerning disease course and prognosis remains uncertain. To evaluate the potential clinical implications of very late presentations of MG. The present is a retrospective cohort study comprising all patients diagnosed with MG currently followed up in the Neuromuscular Disorders Unit of a tertiary center. Clinical and paraclinical parameters including number of hospitalization and current regime were evaluated. A total of 92 patients were included, 51 (55.4%) of whom were female. Concerning the age of onset, 23 (25.6%) patients were classified as very late-onset. In order to better understand the clinical implications of a later onset, we compare the very late-onset subgroup to the late-onset subgroup. Gender distribution and number of patients with minimal manifestation status or better did not statistically differ between these subgroups. Myasthenic crisis and refractoriness were more frequent in the late-onset subgroup compared with very late-onset, but no statistical difference was found (p = 0.221 and p = 0.650 respectively). We did not find statistically significant differences in acetylcholine receptor antibody titers between the groups. Concomitant autoimmune diseases were found in 14 (15.2%) patients, comprising three patients with late-onset and three patients with very late-onset MG. Our study suggests that the recently established subgroup of very late-onset may not be clinically distinct from late-onset MG, as these patients seem to exhibit a similar clinical trajectory.