De Neurologia Research Articles

Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations.

Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. A total of 25 panelists, including adult and child neurologists, participated in the study. The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.

Guidelines for the use and interpretation of Alzheimer's disease biomarkers in clinical practice in Brazil: recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

In recent years, the diagnostic accuracy of Alzheimer's disease has been enhanced by the development of different types of biomarkers that indicate the presence of neuropathological processes. In addition to improving patient selection for clinical trials, biomarkers can assess the effects of new treatments on pathological processes. However, there is concern about the indiscriminate and poorly supported use of biomarkers, especially in asymptomatic individuals or those with subjective cognitive decline. Difficulties interpreting these tests, high costs, and unequal access make this scenario even more challenging in healthcare. This article presents the recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (Departamento Científico de Neurologia Cognitiva e Envelhecimento da Academia Brasileira de Neurologia) regarding the rational use and interpretation of Alzheimer's disease biomarkers in clinical practice. The clinical diagnosis of cognitive-behavioral syndrome is recommended as the initial step to guide the request for biomarkers.

Neuropsychological assessment and rehabilitation: an experience report at the ILCN - Instituto Luso Cubano de Neurologia in Porto, Portugal

This experience report aims to describe a period of observational/ethnographic activity in Neuropsychology, carried out at the ILCN - Instituto Luso Cubano de Neurologia, in the city of Porto, Portugal. This study presents the unit's assessment and rehabilitation models, drawing parallels with the assessment and therapeutic models in Brazil; a characterization of the Institute is carried out, with a profile of the patients and the functions performed by the multi-professional team. The theoretical concepts referenced by the neurosciences will also be described, as will the procedures and instruments used in the follow-ups, the aim of which was to qualify the treatments in order to promote the development and functionality of the users in the face of the difficulties they face on a daily basis, variables which have a direct impact on the establishment of their autonomy and quality of life. To illustrate the activities carried out, two case studies were selected which were monitored by the team from the renowned institute

Assessing the swallow tail sign in a real life scenario (P5-11.004)

<h3>Objective:</h3> To evaluate the accuracy of the swallow tail sign to differentiate between essential tremor (ET) and Parkinson’s disease (PD) in clinical practice. <h3>Background:</h3> The loss of the swallow tail sign (STS), a hyperintensity within the substantia nigra on high-resolution T2*/SWI brain MRI, is present in early stages of PD, and has been suggested as a diagnostic biomarker because of its high accuracy when evaluated by experienced neuroradiologists and with sequences with slice thickness under 1.5mm. In ET, the STS is preserved, so its evaluation could help differentiate it from PD. There are no studies that evaluate the accuracy of STS detection in clinical practice by a movement disorders neurologist using non-optimal MRI slice thickness. <h3>Design/Methods:</h3> Seventy-three 3T brain MRIs from patients who were clinically diagnosed with PD or ET were retrospectively assessed in a MacBook Pro using the software Horos by a movement disorders neurologist. In the SWAN sequence (0.68×0.68×2 mm3) five slices caudal to the upper limit of the red nucleus were selected and analyzed. The STS was assessed blindly on each side to define the PD diagnosis. Uncertainty about the presence/absence of the STS was also computed for each side. <h3>Results:</h3> The overall accuracy was 79.5%, with 86.2% sensitivity and 75.0% specificity. Interestingly, when considering only the cases where there were no uncertainties about the diagnosis based on STS presence/absence (29/73, 39.7%), the accuracy remained similar (79.3%) with a decrease in sensitivity and slight increase in specificity (76.9%, and 81.3% respectively). <h3>Conclusions:</h3> The visual assessment of the STS performed by a movement disorders neurologist in clinical practice yields good diagnostic accuracy to discriminate between ET and PD even with suboptimal image quality (slice thickness &gt;1.5mm). This supports the utility of this radiological sign in real life scenarios. <b>Disclosure:</b> Dr. Ruiz Yanzi has nothing to disclose. Dr. Matarazzo has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International Parkinson and Movement Disorders Society. Mrs. NATERA-VILLALBA has received research support from Sociedad Española de Neurologia. Jose A Pineda-Pardo has nothing to disclose.

Revista de Neurologia is celebrating its 50th anniversary

Revista de Neurologia is celebrating its 50th anniversary

Brazilian Academy of Neurology: 60 Years.

The Brazilian Academy of Neurology (ABN – Academia Brasileira de Neurologia) was founded on May 5, 1962 in the city of Rio de Janeiro, under the leadership of Professors Deolindo Augusto de Nunes Couto and Adherbal Tolosa, who were disciples of Professors Antonio Austregésilo (founder of the first school of Neurology in Brazil and first professor of Neurology at the Faculty of Medicine of Rio de Janeiro in 1912) and Enjolras Vampré (founder of the São Paulo School of Neurology in 1925 and first professor of Neurology at the University of São Paulo), respectively.[1] [2] The inaugural meeting was held at the Institute of Neurology in Rio de Janeiro, and was chaired by Professor Deolindo Couto, who was is credited as the patron of ABN.[1] [2] [3] The two masters had the support of 47 other Neurology professors, from different parts of Brazil, many of them direct disciples of these two leaders from the Rio de Janeiro and São Paulo schools of Neurology.[1] [2] [3]

How Can Biobanks Help You in Your Research Projects?

How Can Biobanks Help You in Your Research Projects?

Ten years of the prefrontal symptoms inventory (PSI). A systematic review

Ten years ago, Revista de Neurologia published the validation of a new free tool: the Prefrontal Symptoms Inventory (PSI), from which an abbreviated version (PSI-20) was subsequently extracted. Over this decade, authors have demonstrated its excellent psychometric properties and clinical usefulness. This systematic review, conducted in accordance with the PRISMA statement, aims to analyse the body of research that has used the PSI or PSI-20 in order to assess its relevance in other research teams, other clinical populations and even other cultures. A search was conducted to find articles written in Spanish, English, French and Portuguese that have used the inventory to carry out empirical research. Finally, 56 articles were selected. The results show that the PSI and the PSI-20 have been widely used in Spain as well as in other Spanish-speaking countries (Argentina, Chile, Colombia, Cuba, Ecuador or Venezuela) and employed to a moderate extent in non-Spanish-speaking countries (Belgium, Brazil, Sweden or Switzerland). The clinical populations in which they have been used range from acquired brain injury and degenerative dementias to chronic pain, fibromyalgia, addictive behaviours or personality disorders. Given their versatility, they have also been used with the general population, including prison inmates, women in rural areas, university students or to study cognitive reserve. The PSI and PSI-20 are useful instruments for research and clinical use, and the next challenge is to validate an English version, which is currently being worked on.

Headache Symptom Versus Headache Disorders: Impact on COVID-19 Survival

Background: COVID-19 has not impacted people or countries uniformly. This disparity has prompted investigations to identify clinical and genetic predictors of COVID-19 mortality. Headache, a COVID-19 symptom, has been associated with positive disease prognosis in small cohorts, but larger confirmatory data-sets are lacking. Moreover, the global predisposition to experience primary headache disorders might be correlated with variances in COVID-19 mortality rates. Methods: We conducted a meta-analysis of studies of COVID-19 inpatient survival that also reported headache as a COVID-19 symptom. Separately, using a generalized additive model regression (GAM), we analysed data across 171 nations to identify variables which impact COVID-19 mortality rates. We performed similar analyses of seasonal influenza mortality. Prevalence data were extracted from the Global Health Data Exchange. Findings: We meta-analysed 48 studies and observed a significantly higher risk ratio of survival (RR:2·178 [1·882-2·520], pInterpretation: Headache as a COVID-19 symptom enhances survival, whereas headache as a primary disorder is more prevalent in nations with higher COVID-19 mortality. Further studies should investigate (1) mechanisms whereby headache is associated with survival from certain viral infections and (2) whether selection pressures from viruses may have contributed to the evolution of primary headache disorders as adaptations.Funding: No funding was receivedDeclaration of Interests: Dr Shapiro has received in the past 12 months financial or editorial compensation as a research consultant for Eli Lilly and Lundbeck. Mr Gallardo reports no disclosures. Dr Caronna reports no disclosures. Dr Pozo-Rosich has received honoraria as a consultant and speaker for: Allergan-AbbVie, Almirall, Biohaven, Chiesi, Eli Lilly, Medscape, Neurodiem, Novartis and Teva. Her research group has received research grants from Novartis; has received funding for clinical trials from Alder, Amgen, Electrocore, Eli Lilly, Novartis, Teva. She is a trustee member of the board of the International Headache Society and the Council of the European Headache Federation. She is in the editorial board of Revista de Neurologia. She is an editor for Cephalalgia, Headache, Neurologia, Frontiers of Neurology and advisor for The Journal of Headache and Pain. She is a member of the Clinical Trials Guidelines Committee of the International Headache Society. She has edited the Guidelines for the Diagnosis and Treatment of Headache of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org. PP-R does not own stocks from any pharmaceutical company. There are no conflicts of interest in regard to this manuscript.

The case of erythrophobia

In the specialized literature for the last time, a description of a rather peculiar nervous suffering began to come across, which Pitres and Rgis called erythrophobia and the most prominent symptom of which is the periodically arising fear of reddening, on the one hand, a fearful reddening of the face, on the other hand. Apparently, the first indication of such a combination of clinical phenomena we find in Casper back in 1846. But the observation of this author, known to me only from the work of Westphalya (Ueber Zwangsvorstellungen. 1877. Berl. Klin. Woch. 1877), is too cited last day in general terms, so that one can speak about him with the desired certainty. After Casper, not one of the clinicians focused their attention on such cases, and only in 1896 appeared almost simultaneously several works devoted to the suffering of interest to us. Dugas (Revue philosophique, dec. 1896), Campbell (Brif. Med. Journal, 25 sept. 1896); Breton (Gazette des hpit. 20 oct. 1896), Pitres et Rgis (Archives de Neurologie 1896 No. 9. p. 253), Bekhterev (Review of Psychiatry 1896, No. 12; 1897 No. 1 and 8), Chigaev (Doctor 1897 30), Manheimer (La mdecine modern 1897 No. 8) published a whole series of observations in which the clinical picture of suffering is described in great detail and where its main features are already quite definite.

Commémoration des connections neurologiques franco-britanniques entre 1860 et 1920

We review interactions between British and French Neurologists from the birth of this discipline in the 1860s to the early 20th century. First connections include Robert Bentley Todd and Thomas Clifford Albutt in England and Armand Trousseau and Guillaume Benjamin Amand Duchenne in France. During the 1860–80 years, Jean-Martin Charcot in Paris created the Salpetriere school of neurology. In London, the National Hospital for the Paralysed and Epileptic was founded in Queen's Square in 1860 with Charles Brown-Sequard as a first physician. Hughlings Jackson (1862), Russell Reynolds (1863), later William Gowers (1873) and David Ferrier (1880), all influenced French Neurology. Charcot investigated paralysis agitans and named it Parkinson's disease. He emphasized the contribution of Jackson to aphasia and epilepsy. Charcot travelled frequently to Great-Britain, especially to the annual meetings of the British Medical Association. He and other French physicians interacted with British colleagues at the International Congress in London in 1881. In the late 19th century, a number of articles were published by Charcot and other French authors in Brain, and by British neurologists in Nouvelle Iconographie de la Salpetriere and Revue Neurologique. Brown-Sequard and Charcot became corresponding members of the Royal Society of Medicine in 1887, as later did Jules Dejerine, Joseph Grasset and Theodule Ribot. The creation in 1999 of the Societe de Neurologie de Paris included among the foreign corresponding members Jackson and Ferrier. Dejerine, Fulgence Raymond and Pierre Marie developed Charcot's work and received in Paris foreign neurologists, among which Samuel Alexander Kinnier Wilson who spent one year in Paris in 1903 with Pierre Marie. He returned to Queen Square and King's College Hospital and remained in contact with French neurology. Wilson presented in Paris in 1912 a new disease he called progressive lenticular degeneration with cirrhosis of the liver (Wilson's disease). During the early 20th century, Anglo-French connections were emphasized in international congresses, notably in 1900 in Paris and in 1913 in London, where Joseph Babinski made his lecture on the cerebellar syndrome. In 1914, the Societe de Neurologie de Paris elected 10 new foreign corresponding members from Great Britain. Since then, Anglo-French links have continued with other young promising neurologists travelling from France to the United Kingdom and vice-versa.

Susac Syndrome and COVID-19 Infection: A Two-Direction Therapeutic Dilemma

Susac syndrome (SuS) is an autoimmune-mediated microvessel occlusion disease of the central nervous system, retina and inner ear. Treatment consists in the use of corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, tacrolimus, rituximab and cyclophosphamide. Immunocompromised patients may be at higher risk of severe COVID-19 and, simultaneously, infections could exacerbate SuS disease activity. A 32 years-old female with extremely severe SuS, treated with a combination of mycophenolate mofetil, rituximab, cyclophosphamide and oral prednisone, developed a life-threatening COVID-19 infection. Immunosuppressants were stopped and anticoagulant therapy was instituted. Forty-one days after COVID-19 infection diagnosis, she was discharged with her neurological status unchanged. Even considering the life-threatening COVID-19 infection risk, maintaining combined immunosuppression is advised in an extremely severe SuS. Confirmation of COVID-19 infection would be the only reason to stop immunosuppressants. COVID-19 hypercoagulable state may increase thrombosis risk. Anticoagulant treatment is associated with COVID-19 lower mortality and, arguably, with a better prognosis of SuS. © 2020, Sociedade Portuguesa de Neurologia. All rights reserved.

A 3D neurons model to evaluate the neurotoxicity of harmane, a β carboline alkaloid incriminated in Essential Tremor

Event Abstract Back to Event A 3D neurons model to evaluate the neurotoxicity of harmane, a β carboline alkaloid incriminated in Essential Tremor Rania Aro1*, Alpha Diallo2, 3, Marvyn Pichueque2, 3, Mathilde Wauters4, Amandine Nachtergael1, Laurence Ris4, Pierre Duez1 and Mario Manto2, 3 1 University of Mons, Belgium 2 Free University of Brussels, Belgium 3 Service de Neurologie, Centre Hospitalier Universitaire de Charleroi, Belgium 4 Research Institute for Biosciences, University of Mons, Belgium Introduction: β-Carbolines alkaloids (βCAs) are indole alkaloids, such as harmane, that naturally occur in plants and food and are also endogenously produced in mammals and humans. Some βCAs are potent tremor inductors and exhibit neurotoxicological activities. They have been incriminated in the pathogenesis of Essential tremor (ET) as blood Harmane levels have been found to be abnormally increased in ET patients. Harmane has also been detected in post-mortem brain samples. Essential tremor (ET) is one of the most prevalent neurological diseases but, despite a high prevalence, its physiopathology remains poorly understood. There is converging evidence that both genetic and environmental factors play a role in ET pathogenesis and so the identification of involved environmental factors is a critical step towards risk reduction through the implementation of prevention strategies or interventional studies. 2D cell cultures do not represent the real cell environment where cells spatially and chemically interact; their lack in predictivity increases the cost and failure rate of clinical trials, especially in neurosciences. Recently, 3D cell cultures have received much attention, as these are closer to tissues models, although their main challenges reside in end-point measurements. Methods: We propose the use of a 3D neural spheroid cultures ("mini-brains") in vitro model to assess the neurotoxic effects of harmane. We have generated a model of 3D spheroids from embryonic mouse cortical neurons using micro-molded agarose wells. After exposure to harmane at increasing concentrations of 50, 100, 250 µM, a resazurin assay was performed to measure cell viability and a highly sensitive fluorometric method, based on the oxidation of di-chlorodihydrofluorescein DCFH, was used to measure eventually induced reactive oxygen species (ROS). Results: Hydrogel microwells facilitated the assembly of spheroids containing neurons and glia into a complex 3D structures and prevented the agglomeration of spheroids. Exposure to harmane induced a cytotoxicity in 3D neural spheroids that was correlated with harmane concentrations, with a viability down to 24 % at 250 µM. On the other hand, lower levels of oxidative stress were detected as the harmane concentration increased, although the effect was limited in time. Conclusions: We demonstrated our ability to produce a 3D culture using simple materials and routine laboratory equipment. Despite high challenges related to 3D cultures and data acquisition, this 3D neural spheroid model mimics a neuronal microenvironment, allowing a fine study of neurodegenerative disorder pathologies and the effect of chemicals on the brain. The viability and oxidative stress data support so far a dual role of harmane, as both neurotoxic and neuroprotective agent. Further studies are required to elucidate its biological activities and their eventual relationship with the ET disorder. Acknowledgements This research is in part funded through a FMRH grant and a Kangaroo grant from the UMONS Health Institute .

Reading Photography in French Nineteenth Century Journals

This article explores how photographs published in the French medical and, to some extent, the popular press helped readers to interpret expressions and gestures as signs of emotional states, morbid conditions and physiological and psychological processes. The first two sections examine the use of photography to visualise normal and pathological bodies through measurements and experiments in the medical press, particularly Nouvelle Iconographie de la Salpêtrière, Archives de Neurologie and L’Année Psychologique. The next two sections study how the development of new photographic processes such as the magnesium flash and chronophotography created new conditions in which the body could be visually scrutinised in the medical press as well as popular journals such as Le Théâtre and the general scientific journal La Nature. This analys results in two main findings: 1) medical journals used photography to assert their own disciplinary identities, and 2) photography acted as a potential bridge between audiences, as some medical and popular journals shared the same beliefs regarding photography’s ability to represent the human body, but approached photographic innovations from different, albeit complementary, ways.

Seasonal plasticity of cognition and related biological measures in adults with and without Alzheimer disease: Analysis of multiple cohorts.

BackgroundThere are few data concerning the association between season and cognition and its neurobiological correlates in older persons—effects with important translational and therapeutic implications for the diagnosis and treatment of Alzheimer disease (AD). We aimed to measure these effects.Methods and findingsWe analyzed data from 3,353 participants from 3 observational community-based cohort studies of older persons (the Rush Memory and Aging Project [MAP], the Religious Orders Study [ROS], and the Minority Aging Research Study [MARS]) and 2 observational memory-clinic-based cohort studies (Centre de Neurologie Cognitive [CNC] study at Lariboisière Hospital and the Sunnybrook Dementia Study [SDS]). We performed neuropsychological testing and, in subsets of participants, evaluated cerebrospinal fluid AD biomarkers, standardized structured autopsy measures, and/or prefrontal cortex gene expression by RNA sequencing. We examined the association between season and these variables using nested multiple linear and logistic regression models. There was a robust association between season and cognition that was replicated in multiple cohorts (amplitude = 0.14 SD [a measure of the magnitude of seasonal variation relative to overall variability; 95% CI 0.07–0.23], p = 0.007, in the combined MAP, ROS, and MARS cohorts; amplitude = 0.50 SD [95% CI 0.07–0.66], p = 0.017, in the SDS cohort). Average composite global cognitive function was higher in the summer and fall compared to winter and spring, with the difference equivalent in cognitive effect to 4.8 years’ difference in age (95% CI 2.1–8.4, p = 0.002). Further, the odds of meeting criteria for mild cognitive impairment or dementia were higher in the winter and spring (odds ratio 1.31 [95% CI 1.10–1.57], p = 0.003). These results were robust against multiple potential confounders including depressive symptoms, sleep, physical activity, and thyroid status and persisted in cases with AD pathology. Moreover, season had a marked effect on cerebrospinal fluid Aβ 42 level (amplitude 0.30 SD [95% CI 0.10–0.64], p = 0.003), which peaked in the summer, and on the brain expression of 4 cognition-associated modules of co-expressed genes (m6: amplitude = 0.44 SD [95% CI 0.21–0.65], p = 0.0021; m13: amplitude = 0.46 SD [95% CI 0.27–0.76], p = 0.0009; m109: amplitude = 0.43 SD [95% CI 0.24–0.67], p = 0.0021; and m122: amplitude 0.46 SD [95% CI 0.20–0.71], p = 0.0012), which were in phase or anti-phase to the rhythms of cognition and which were in turn associated with binding sites for several seasonally rhythmic transcription factors including BCL11A, CTCF, EGR1, MEF2C, and THAP1. Limitations include the evaluation of each participant or sample once per annual cycle, reliance on self-report for measurement of environmental and behavioral factors, and potentially limited generalizability to individuals in equatorial regions or in the southern hemisphere.ConclusionsSeason has a clinically significant association with cognition and its neurobiological correlates in older adults with and without AD pathology. There may be value in increasing dementia-related clinical resources in the winter and early spring, when symptoms are likely to be most pronounced. Moreover, the persistence of robust seasonal plasticity in cognition and its neurobiological correlates, even in the context of concomitant AD pathology, suggests that targeting environmental or behavioral drivers of seasonal cognitive plasticity, or the key transcription factors and genes identified in this study as potentially mediating these effects, may allow us to substantially improve cognition in adults with and without AD.

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico.

ABSTRACTThe objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329) and US$ 2,576 (95% CI: 2,244 – 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527), US$ 228 (95% CI: 167 – 288), US$ 157 (95% CI: 111 – 202), US$ 150 (95% CI: 106 – 204), and US$ 91 (95% CI: 27 – 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Balloon remodeling technique in endovascular treatment of intracranial aneurysms

Objectives: Endovascular treatment of intracranial aneurysms demonstrates low rates of morbidity and mortality. However, aneurysms with complex forms and wide neck remain a therapeutic challenge. The aim of this study is to evaluate the endovascular management of a series of intracranial aneurysms using the balloon remodeling technique. Method: A retrospective evaluation was performed on patients with intracranial aneurysms having undergone endovascular treatment with balloon remodeling technique at the Instituto de Neurologia de Curitiba (from October, 2006 to June, 2011). Results: Thirty-four patients were evaluated. The mean age was 55.12 years and 78.79% were female. Thirteen patients had ruptured aneurysms (38.24%) and 8 had vasospasm (23,53%). The majority of the aneurysms (61.76%) had domemeasurements between 5 to 15mm and 41.18% had a neck size of greater than or equal to 4mm. Total occlusion was obtained in 29 aneurysms (85,29%) and partial occlusion in 2 (5.88%). One patient died from a procedure-related hemorrhage. Conclusion: Endovascular treatment with balloon remodeling techniques seems to be a safe and effective treatment for intracranial aneurysms, especially those with complex formsand wide neck.

Editorial introductions

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jean-Marc LégerJean-Marc LégerDr Léger started his career in neurology at the University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), France, in 1980, where he trained in general neurology and clinical neurophysiology. He was then nominated as full-time senior neurologist in 1987 in the Department of Neurology, then Institut Hospitalo-Universitaire (IHU) de Neurosciences, University Hospital Pitié-Salpêtrière, and received his post-graduate degree (Habilitation à diriger des Recherches) from University Paris VI in 1991. He is currently coordinator, together with Dr Eymard, of the National Referral Center for rare Neuromuscular Diseases, that was built up in the IHU de Neurosciences/Institut du Cerveau et de la Moelle Epinière (IHU/ICM), at University Hospital Pitié-Salpêtrière, in 2004. Dr Léger's clinical and research interests are in the field of peripheral neuropathy and in particular chronic immune-mediated neuropathy. He has authored and co-authored more than 200 articles in peer-reviewed journals, and contributed more than 30 chapters to books on neurology, mainly in the field of diagnostic features and therapeutic trials in vasculitic neuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy and paraproteinaemic neuropathies. He served as Editor-in-Chief of the Revue Neurologique for 8 years and as member of the Editorial Board of Brain for 5 years, and is currently member of the Board of the European Journal of Neurology and Associate Editor of the Journal of the Peripheral Nervous System. Dr Léger is past President of the Société Française de Neurologie, in which he served as Secretary General for 8 years. He served as officer of the Management Committee of the European Federation of Neurological Societies (EFNS) and as chairman of the Training and Education Committee of the EFNS. He is also past member of the Board and member of the Education Committee of the Peripheral Nerve Society, and has organized its biennial meeting in Saint-Malo, France, in July 2013. He is Fellow of the American Academy of Neurology (FAAN), and Corresponding Fellow of the American Neurological Association. He was elected as Full Member of the Académie Nationale de Médecine, France, in 2016. Benedikt SchoserBenedikt SchoserBenedikt Schoser started his career with training in muscle pathology by Hans Goebel and finishing his medical thesis at the institute of neuropathology in Mainz, Germany in 1993. He started his career in neurology at the University Hospitals Mainz, Frankfurt, and Hamburg, Germany, in 1993, where he was trained in general neurology, intensive care neurology, psychiatry, and clinical neurophysiology. After spending a year in Thomas Jentsch's laboratory at the institute of neuropathophysiology in Hamburg, he was nominated as full-time senior neurologist in 2001 at the Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University Munich. He received his post-graduate degree (Habilitation) from Ludwig-Maximilians-University Munich in 2004. He is currently senior consultant neurologist and co-chair of the Friedrich-Baur-Institute, the major national referral centre for rare neuromuscular diseases in Germany. Dr Schoser's clinical and research interests are in the field of multisystemic neuromuscular diseases and in particular metabolic and myotonic myopathies. He has authored and co-authored more than 180 articles in peer-reviewed journals, and contributed more than 20 chapters to books on neurology and muscle pathology, mainly in the field of diagnostic features and therapeutic trials in myotonic dystrophies, myasthenic syndromes, metabolic myopathies, and inflammatory myopathies. He serves as member of the Editorial Board of Neuromuscular disorders, Journal of Neuromuscular diseases, and Zeitschrift für Rheumatologie. Dr Schoser is co-founder and chair of the European Pompe consortium (EPOC). He served as co-chair of the Scientific muscle and neuromuscular junction panel of the European Academy of Neurology (EAN).

Acknowledgments in Neurology research articles: A contrastive study (English – Spanish)

This article reports the findings of a content analysis of acknowledgments, authorship and collaboration practices in a medical corpus made up of 100 English- and 100 Spanish-written research papers, distributed in five blocks of 20 papers each, and randomly drawn in the period 2001-2012 from BMC Neurology and Revista Espanola de Neurologia, two of the leading Neuro- logy journals in their respective languages. In order to discover the similarities and differences between both samples, the objective of this contrastive research was three-fold: 1) to analyse the frequency, length and types of acknowledgments; 2) to examine the number of authors, sub-au- thors and unnamed individuals mentioned in the subtitles, acknowledgment sections, annexes and appendices of the research papers included in the whole sample; and 3) to explore the differ - ent types of collaboration among all the participants involved in the research. Although the types of acknowledgments are similar in both contexts, the English-medium sample presents more research papers with acknowledgments, more acknowledgments and longer acknowledgments. In both corpora public funding is the component which receives most acknowledgements, al- though again much more in English than in Spanish. Of the many people involved in the inves- tigation, Spanish-speaking authors are more numerous than English-speaking authors, whereas English sub-authors and unnamed individuals outnumber their Spanish counterparts. As for the different types of collaboration, in the two samples 'local' collaboration clearly predominates above the remaining variants. Possible explanations for the differences and similarities observed, among them a possible correlation between the higher presence of acknowledgments and the research published in English, are provided. The results presented here give some hints about the collaboration and communication practices followed by two different language scientific com -

Estresores laborales del personal de enfermería de un Hospital de Alta Especialidad en México

Introducción: el profesional de enfermería se expone diariamente con situaciones que pueden ser generadoras de estrés como lo es la confrontación con la muerte, el sufrimiento de las personas, la carga de trabajo y los posibles conflictos con el personal interdisciplinario. La presente investigación se realizó en el Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez ubicado al sur de la Ciudad de México el cual brinda atención de tercer nivel. Objetivo: identificar el nivel de estrés y los estresores laborales a los que están expuestos los enfermeros. Metodología: se realizó un estudio transversal y descriptivo, la muestra fueron 50 enfermeros adscritos a los servicios de hospitalización los cuales contestaron un instrumento autoaplicacble conformado por 32 preguntas cerradas en escala de Lickert. Resultados: el 52% de los enfermeros tiene un nivel de estrés moderado, el 46% tiene un nivel de estrés bajo frente al 2% que tiene un nivel de estrés alto. Los tres agentes estresores con medias más altas fueron en primer lugar realizar procedimientos dolorosos para el paciente (X = 1.88), en segundo lugar mirar sufrir a un paciente y terminar adolorido después de una jornada de trabajo (X = 1.82), el tercer lugar lo ocupa la falta de personal adecuado para cubrir la unidad (X = 1.7). Conclusiones: en este estudio se logró identificar los agentes estresores laborales más comunes así como el nivel de estrés al que está expuesto el personal de enfermería de las áreas de hospitalización, el cual es producto de las situaciones que viven a diario para realizar sus intervenciones a favor del paciente esto lo expone a tener un nivel de estrés moderado, lo cual podría perjudicar su salud, pudiendo provocar una disminución en el desempeño sobre la calidad de las tareas que se realizan.