Navegando por Autor "Godeiro Junior, Clécio de Oliveira"

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Accessory nerve injury after deep brain stimulation surgery in a Parkinson’s disease patient
(Elsevier, 2021-10-13) Godeiro Junior, Clécio de Oliveira; Aquino, Barbara Cristina Vieira de; Pessoa Neto, Agabio Diogenes; Dourado Junior, M ário Emílio Teixeira; Dantas, Sérgio Adrian Fernandes; Silva, Rodrigo Alencar e; 0000-0002-4312-1633
DBS is an established form of surgical therapy for Parkinson’s disease and is also used for other pathologies, such as dystonia and essential tremor. There are few articles in the literature discussing exclusively about surgical complications. In fact, most papers describe surgical-related complications such seizures, device infection, hemorrhage and permanent deficit. However, less usual complications can also occur, as in the case described below, of an injury to the accessory nerve after the DBS procedure. We describe a case of a 56-year-old woman with PD who underwent to STN DBS, presented hypotrophy and weakness of the right trapezius after the surgery. Electroneuromyography (ENMG) suggested partial right spinal accessory injury. Patient recovery spontaneously 5 months after surgery. While DBS promises dramatic improvement in select PD symptoms, it can have disappointing or even serious adverse results. This paper ratifies the need of screening of accessory nerve injury for early rehabilitation.
Accessory nerve injury after deep brain stimulation surgery in a Parkinson’s disease patient
(2022-03) Aquino, Bárbara Cristina Vieira de; Pessoa Neto, Agábio Diógenes; Dourado Junior, Mário Emílio Teixeira; Dantas, Sérgio Adrian Fernandes; Silva, Rodrigo Alencar e; Godeiro Junior, Clécio de Oliveira
DBS is an established form of surgical therapy for Parkinson's disease and is also used for other pathologies, such as dystonia and essential tremor. There are few articles in the literature discussing exclusively about surgical complications. In fact, most papers describe surgical-related complications such seizures, device infection, hemorrhage and permanent deficit. However, less usual complications can also occur, as in the case described below, of an injury to the accessory nerve after the DBS procedure. We describe a case of a 56-year-old woman with PD who underwent to STN DBS, presented hypotrophy and weakness of the right trapezius after the surgery. Electroneuromyography (ENMG) suggested partial right spinal accessory injury. Patient recovery spontaneously 5 months after surgery. While DBS promises dramatic improvement in select PD symptoms, it can have disappointing or even serious adverse results. This paper ratifies the need of screening of accessory nerve injury for early rehabilitation.
Acute parkinsonism and bilateral basal ganglia lesions
(SciELO, 2020-12) Godeiro Junior, Clécio de Oliveira; Silva, Rodrigo Alencar e; Sousa, Thadeu Alexandre Paulino de; 0000-0002-4312-1633
A 58-year-old man with arterial hypertension and poorly controlled type 2 diabetes using glyburide/metformin presented a history of sudden slurred speech and gait disturbance eight days before clinical evaluation.
Amyotrophic Lateral Sclerosis and Palatal Myoclonus: An Uncommon Association
(Movement Disorders Clinical Practice, 2020-10-18) Godeiro Junior, Clécio de Oliveira; Fraiman, Pedro Henrique Almeida; Dourado, Mario Emilio; 0000-0002-4312-1633
We read the article by Rebello et al.1 with great interest. It is an interesting case because it aligns with the modern perspective that amyotrophic lateral sclerosis (ALS) neurodegeneration not only affects the motor neurons. However, we have few considerations related to major points for the uncommon association presented in the case.
Análise clínica das crises epilépticas em crianças com microcefalia decorrente da síndrome de infecção congênita pelo vírus Zika
(Universidade Federal do Rio Grande do Norte, 2019-06-17) Bandeira, Hugo Matos; Melo, Aurea Nogueira de; Melo, Aurea Nogueira de; Godeiro Junior, Clécio de Oliveira; Souza, Leonardo Moura Ferreira de
Objetivo: realizar análise clínica das crises epilépticas, apresentadas pelos pacientes com microcefalia decorrente da infecção congênita pelo vírus Zika. Métodos: realizamos um estudo descritivo/prospectivo com base em um protocolo padrão, com as principais variáveis analisadas. O diagnóstico das crises epilépticas foi obtido através da descrição dos pais e/ou observação dos pesquisadores e classificadas de acordo com a International League Against Epilepsy. Analisamos a resposta terapêutica aos fármacos utilizados em regime de monoterapia, biterapia e politerapia, considerando resposta terapêutica total, parcial ou refratária de acordo com as manifestações de crises ao final do período de seguimento. Resultados: a população de estudo foi constituída de 27 (49%) crianças que apresentaram crises epilépticas, sendo 24 (89%) com crises epilépticas focais e 13 (48%) com crises generalizadas. Em relação às crises focais, 22 (92%) tiveram crises motoras e as crises focais não motoras foram observadas em 2 (8%) pacientes. Quanto às crises generalizadas: 4 (31%) crianças apresentaram crises tônicas, 11 (85%) espasmos epilépticos, e em 2 (15%) crianças observaram-se ambos os tipos de crise. O tratamento das crises epilépticas com resposta eficaz foi em biterapia com ácido valproico e vigabatrina (11%). Significância: a partir da observação de poucos estudos na literatura acerca da caracterização pormenorizada das crises epilépticas nessa população, sua evolução e resposta aos fármacos antiepilépticos, esse estudo ganha importância para entendimento da história natural dessa patologia e a realização de outros trabalhos que venham a contribuir com o entendimento das manifestações epilépticas nessas crianças.
ANTI-MA2 encephalitis mimicking diencephalic demyelinating syndrome
(Elsevier, 2020-11-03) Godeiro Junior, Clécio de Oliveira; Pessoa Neto, Agábio Diógenes; Aquino, Bárbara Cristina Vieira de; Brito, Paulo Santiago de Morais; Silva, Rodrigo de Alencar e; Moreira Neto, Manuel; Barsottini, Orlando Graziani Povoas; Dutra, Lívia Almeida; 0000-0002-4312-1633
Anti Ma 2 encephalitis is an autoimmune encephalitis, usually paraneoplastic, characterized by isolated or combined limbic, diencephalic, or brainstem dysfunction. Limbic encephalitis (LE) is the most common manifestation. Anti-Ma2 LE can also be manifested as a pure psychiatric disturbance associated or not with hypokinesia. Other patients exhibit excessive daytime sleepiness, vertical ophthalmoparesis, or both associated with LE, due to diencephalic and/or upper brainstem involvement. These cases are challenging and demand extensive work-up for differential diagnosis.
Association of BDNF Val66MET polymorphism with parkinson’s disease and depression and anxiety symptoms
(Psychiatry Online, 2016-11-17) Godeiro Junior, Clécio de Oliveira; Cagni, Fernanda Carvalho; Campêlo, Clarissa Loureiro das Chagas; Coimbra, Daniel Gomes; Barbosa, Mayara Rodrigues; Oliveira Júnior, Luiz Gonzaga; Silva Neto, Antônio Braz; Ribeiro, Alessandra Mussi; Andrade, Tiago Gomes de; Silva, Regina Helena; 0000-0002-4312-1633
Parkinson’s disease (PD) is a progressive neurodegenerative disease that affects mainly dopaminergic neurons of the substantia nigra pars compacta (SNpc), leading to motor symptoms (tremor, bradykinesia, rigidity, and postural instability). PD also presents nonmotor symptoms, such as cognitive impairments and emotional disturbances (depression and anxiety). Although the direct cause is unknown, PD is a multifactorial disease influenced by environmental and genetic factors, with aging being the core predisposing factor.
ATXN3, ATXN7, CACNA1A, and RAI1 genes and mitochondrial polymorphism a10398g did not modify age at onset in spinocerebellar ataxia type 2 patients from South America
(Springer, 2015-04-14) Godeiro Junior, Clécio de Oliveira; Pereira, Fernanda S.; Monte, Thais L.; Locks-Coelho, Lucas D.; Silva, Amanda S. P.; Barsottini, Orlando; Pedroso, José L.; Cornejo-Olivas, Mario; Mazzetti, Pilar; Vargas, Fernando R.; Lima, Maria Angélica F. D.; Linden Junior, Hélio van der; Toralles, Maria Betânia Pereira; Medeiros, Paula F. V.; Ribeiro, Erlane; Braga-Neto, Pedro; Salarini, Diego; Castilhos, Raphael M.; Pereira, Maria Luiza Saraiva; Jardim, Laura Bannach; 0000-0002-4312-1633
The spinocerebellar ataxia type 2 (SCA2) is a rare autosomal dominant neurodegenerative disease caused by expansions of a CAG repeat tract at ATXN2 gene. These repeats range from 22 to 31 CAG in normal alleles and from 32–34 to 64 and more, in expanded alleles. ATXN2 expansion accounts for around 50 % of the variability in age at onset (AO) of symptoms . Former studies reported that other genes may be responsible for small effects in SCA2 AO. The CAG repeats’ length (CAGn) at RAI1 gene would explain 4 % of the remaining variance in AO in 46 SCA2 patients with no clear-cut geographical origin. Two publications studied candidate genes among patients with highly discordant AO, from an original sample of 394 patients from Holguin, Cuba Their data pointed to the CAGn at CACNA1A gene [3] and to a polymorphism of the mitochondrial complex I A10398G (rs2853826) as modifiers of SCA2 AO. We have previously found that longer CAGn at ATXN3 gene were associated with earlier ages at onset in a former sample of 49 SCA2 patients from Brazil. SCA2 AO was associated with the CAGn at ATXN7 gene in a European cohort of 289 SCA2 patients but this association was not confirmed in a second cohort [6]. Since replications in additional, independent samples of patients are required to validate a genetic association, we aimed to investigate these same loci in a South American cohort of SCA2 in order to add evidences on their role as modifiers of AO in this disease.
Autosomal Recessive Cerebellar Ataxias in South America: A Multicenter Study of 1338 Patients
(Elsevier, 2020-11-03) Godeiro Junior, Clécio de Oliveira; Gama, Maria Thereza D.; Braga-Neto, Pedro; Rangel, Deborah M.; Silva, Rodrigo de Alencar e; Embiruçu, Emília K.; Cornejo-Olivas, Mario; Sarapura-Castro, Elison; Awad, Paula Saffie; Chesta, Daniela Muñoz; Kauffman, Marcelo; Quiroga, Sergio Rodriguez; Jardim, Laura B.; Graça, Felipe F. da; França Junior, Marcondes C.; Tomaselli, Pedro J.; Marques Junior, Wilson; Teive, Helio A.G.; Barsottini, Orlando G.P.; Pedroso, José Luiz; Synofzik, Matthis; 0000-0002-4312-1633
Autosomal recessive cerebellar ataxias (ARCAs) comprise complex genetic ataxia disorders with variable central and peripheral nervous system involvement and systemic changes. They can overlap with other conditions such as hereditary spastic paraplegia, inborn errors of metabolism, and genetic encephalopathies.1 While usually starting in childhood or young adulthood, late adult-onset may occur. The advanced application of next-generation sequencing has allowed the molecular definition of many previously undetermined ARCAs in the last decade, including many new ARCA genes
Cervical dystonia in a case of longstanding secondary progressive multiple sclerosis
(Elsevier, 2019-04) Godeiro Junior, Clécio de Oliveira; Cavallieri, F.; Lino Junior, J. Correa; Moro, E.; 0000-0002-4312-1633
A 50-year-old woman with longstanding secondary progressive multiple sclerosis (MS) presented with a 3-year history of cervical dystonia. She was diagnosed with MS after the onset of diplopia and cerebellar syndrome in 1991. She started to present with neck dystonic posture in 2014, with slow progressive worsening and functional impairment.
COVID-19 and cerebrovascular diseases: a systematic review and perspectives for stroke management
(Frontiers in Neurology, 2020-11) Godeiro Junior, Clécio de Oliveira; Fraiman, Pedro Henrique Almeida; Cavallieri, Francesco; Moro, Elena; Zedde, Marialuisa; 0000-0002-4312-1633
Importance: Reported cerebrovascular events in patients with COVID-19 are mainly ischemic, but hemorrhagic strokes and cerebral venous sinus thrombosis (CSVT), especially in critically ill patients, have also been described. To date, it is still not clear whether cerebrovascular manifestations are caused by direct viral action or indirect action mediated by inflammatory hyperactivation, and in some cases, the association may be casual rather than causal. Objective: To conduct a systematic review on the cerebrovascular events in COVID-19 infection. Evidence review: A comprehensive literature search on PubMed was performed including articles published from January 1, 2020, to July 23, 2020, using a suitable keyword strategy. Additional sources were added by the authors by reviewing related references. The systematic review was conducted in accordance with the PRISMA guidelines. Only articles reporting individual data on stroke mechanism and etiology, sex, age, past cardiovascular risk factors, COVID symptoms, admission NIHSS, D-dimer levels, and acute stroke treatment were selected for the review. Articles that did not report the clinical description of the cases were excluded. A descriptive statistical analysis of the data collected was performed. Finding: From a total of 1,210 articles published from January 1, 2020, to July 23, 2020, 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. A total of 226 cases of ischemic stroke (IS), 35 cases of intracranial bleeding, and 14 cases of CVST were found. Among patients with IS, the mean age was 64.16 ±14.73 years (range 27–92 years) and 53.5% were male. The mean NIHSS score reported at the onset of stroke was 15.23 ±9.72 (range 0–40). Primary endovascular thrombectomy (EVT) was performed in 24/168 patients (14.29%), intravenous thrombolysis (IVT) was performed in 17/168 patients (10.12%), and combined IVT+EVT was performed in 11/168 patients (6.55%). According to the reported presence of large vessel occlusion (LVO) (105 patients), 31 patients (29.52%) underwent primary EVT or bridging. Acute intracranial bleeding was reported in 35 patients: 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. Fourteen cases of CVST were reported in the literature (50% males), mean age 42.8 years ±15.47 (range 23–72). Treatment was reported only in nine patients; seven were treated with anticoagulant therapy; one with acetazolamide, and one underwent venous mechanical thrombectomy. Conclusion: Cerebrovascular events are relatively common findings in COVID-19 infection, and they could have a multifactorial etiology. More accurate and prospective data are needed to better understand the impact of cerebrovascular events in COVID-19 infection.
Development of a digital Tool to assist the training of health professionals in the determination of brain death
(Studies in Health Technology and Informatics, 2019) Correia, Carlos Eduardo Rocha; Godeiro Junior, Clécio de Oliveira
Due to technological advancement of medicine, patients have been maintained through mechanical ventilation and vasoactive drugs despite complete and irreversible brain injuries. Accurate diagnosis of brain death (BD) reduces costs, shortens family's suffering, and increases availability of intensive care beds and organs for transplantation. Guidelines were created to standardize BD diagnostic parameters, but knowledge of medical students and medical professionals has been demonstrated to be insufficient. To assist health professionals’ in BD determination, a digital training tool that contained images, videos and interactive content was developed for desktops and mobile devices. Software to create and animate 3D models (MakeHuman™ and Blender™) and a game development platform (Unity) were used. Versions for all the major operating systems (iOS™, Android™, macOS™, Windows™ and Linux™) are being made available through online repositories and mobile application stores.
A diagnostic approach for neurodegeneration with brain iron accumulation: clinical features, genetics and brain imaging
(SciELO, 2016-04-26) Godeiro Junior, Clécio de Oliveira; Salomão, Rubens Paulo Araújo; Pedroso, José Luiz; Gama, Maria Thereza Drumond; Maciel, Ricardo Horta; Chien, Hsin Fen; Teive, Hélio A. G.; Cardoso, Francisco; Barsottini, Orlando G. P.; 0000-0002-4312-1633
A neurodegeneração com acúmulo cerebral de ferro (sigla em inglês NBIA) representa um grupo heterogêneo e complexo de doenças neurodegenerativas hereditárias, caracterizada pelo acúmulo cerebral de ferro, especialmente nos núcleos da base. O quadro clínico das NBIAs em geral inclui distúrbios do movimento, particularmente parkinsonismo e distonia, disfunção cognitiva, sinais piramidais e anormalidades da retina. As formas de NBIA descritas até o momento incluem neurodegeneração associada a pantothenase kinase (PKAN), neurodegeneração associada a phospholipase A2 (PLAN), neuroferritinopatia, aceruloplasminemia, neurodegeneração associada a beta-propeller protein (BPAN), síndrome de Kufor-Rakeb, neurodegeneração associada a mitochondrial membrane protein (MPAN), neurodegeneração associada a “fatty acid hydroxylase” (FAHN), neurodegeneração associada a coenzyme A synthase protein (CoPAN) e síndrome de Woodhouse-Sakati. Esta revisão é uma orientação para o diagnóstico das NBIAs, partindo das características clínicas e achados de neuroimagem, até a etiologia genética.
Genetics of Parkinson’s disease in Brazil: a systematic review of monogenic forms
(SciELO, 2021-07) Godeiro Junior, Clécio de Oliveira; Lobato, Bruno L. Santos; Schuh, Artur Schumacher; Mata, Ignacio F.; Letro, Grace H.; Braga Neto, Pedro; Brandão, Pedro R. P.; Coletta, Marcus V. Della; Rieder, Carlos R. M.; Tumas, Vitor; 0000-0002-4312-1633
Background: Increasing numbers of mutations causing monogenic forms of Parkinson's disease (PD) have been described, mostly among patients in Europe and North America. Since genetic architecture varies between different populations, studying the specific genetic profile of Brazilian patients is essential for improving genetic counseling and for selecting patients for clinical trials. Objective: We conducted a systematic review to identify genetic studies on Brazilian patients and to set a background for future studies on monogenic forms of PD in Brazil. Methods: We searched MEDLINE, EMBASE and Web of Science from inception to December 2019 using terms for "Parkinson's disease", "genetics" and "Brazil". Two independent reviewers extracted the data. For the genes LRRK2 and PRKN, the estimated prevalence was calculated for each study, and a meta-analysis was performed. Results: A total of 32 studies were included, comprising 94 Brazilian patients with PD with a causative mutation, identified from among 2,872 screened patients (3.2%). PRKN mutations were causative of PD in 48 patients out of 576 (8.3%). LRRK2 mutations were identified in 40 out of 1,556 patients (2.5%), and p.G2019S was the most common mutation (2.2%). Conclusions: PRKN is the most common autosomal recessive cause of PD, and LRRK2 is the most common autosomal dominant form. We observed that there was a lack of robust epidemiological studies on PD genetics in Brazil and, especially, that the diversity of Brazil’s population had not been considered.
Hemorrhagic stroke and COVID-19 infection: coincidence or causality?
(Elsevier, 2020-12) Godeiro Junior, Clécio de Oliveira; Freire, Mariana; Moreira Neto, Manuel; Fraiman, Pedro Henrique Almeida; 0000-0002-4312-1633
Amyloid Protein Precursor gene duplication is a rare cause of early-onset Alzheimer's disease that can be associated with Cerebral Amyloid Angiopathy. This condition predisposes cerebrovascular events, specifically, intracerebral hemorrhagic stroke. This report describes a case of first-time intracerebral hemorrhage in a patient with APP gene duplication during SARS-CoV-2 infection, a typically pro-thrombotic and pro-inflammatory condition, as a possible trigger for this condition.
How to keep medical preceptors effectively motivated in a web-learning environment? An overview
(Elsevier, 2017) Godeiro Junior, Clécio de Oliveira; Pinheiro, Valéria Góes Ferreira; Dias, Cristina Maria Ganns Chaves; Machado, Tao; Grosseman, Suely; Dantas, Fernanda Lage Lima; Torreão, Lara de Araújo; Guará, José Pereira; 0000-0002-4312-1633
Abstract Distance learning has strengthened medical education, especially in geographically extensive regions. Despite the many characteristics of these web-based resources, the motivation of students to perform effectively in virtual educational programs remains a challenge.
Influence of treadmill gait training with additional load on motor function, postural instability and history of falls for individuals with Parkinson's disease: a randomized clinical trial
(Elsevier, 2017-01) Godeiro Junior, Clécio de Oliveira; Trigueiro, Larissa Coutinho de Lucena; Gama, Gabriela Lopes; Ribeiro, Tatiana Souza; Ferreira, Louise Gabriella Lopes de Macedo; Galvão, Élida Rayanne Viana Pinheiro; Silva, Emília Márcia Gomes de Souza e; Lindquist, Ana Raquel Rodrigues; 0000-0002-4312-1633
Background: Evaluate the effects of additional load (5% and 10% of body weight) with treadmill gait training on the motor aspects in Parkinson's disease (PD). Methods: Randomized controlled single-blind trial with 30 individuals with PD. The volunteers were divided into three groups (treadmill with 0%, 5% or 10% load), where Unified Parkinson's Disease Rating Scale was applied. Treadmill gait training was conducted over 4 consecutive weeks, with three weekly sessions of 30 min each. Results: There was a significant reduction in all groups in the time factor for motor function (F = 12.92; P = 0.001) and postural instability (F = 11.23; P = 0.002). No significant difference was observed in group × time interaction (F < 1.76; P > 0.19). Conclusion: The treadmill comprises an effective therapy for people with PD, for important motor aspects such as motor function and postural instability. Additional load had no influence on results.
Magnetic resonance imaging traits may help to differentiate Pelizaeus-Merzbacher and Pelizaeus-Merzbacher-like disease
(SciELO, 2019-08) Godeiro Junior, Clécio de Oliveira; Castro, Matheus Augusto Araújo; Fraiman, Pedro Henrique Almeida; 0000-0002-4312-1633
A six-year-old boy with nystagmus and developmental delay from six months of age, was born from healthy first-degree cousins. On neurological examination, he presented with spontaneous and multidirectional nystagmus, gait and upper limb ataxia, and lower limb hyperreflexia/spasticity.
Managing gait, balance, and posture in Parkinson’s disease
(Springer, 2018-04-06) Godeiro Junior, Clécio de Oliveira; Debû, Bettina; Moro, Elena; Lino, Jarbas Correa; 0000-0002-4312-1633
Purpose of Review: Postural instability and gait difficulties inexorably worsen with Parkinson’s disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. Recent Findings: It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients’ condition. Summary: Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients’ management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
Medical and surgical management of advanced Parkinson's disease
(Movement Disorders, 2018-03-23) Godeiro Junior, Clécio de Oliveira; Antonini, Angelo; Moro, Elena; Reichmann, Heinz; 0000-0002-4312-1633
Advanced Parkinson's disease is characterized by the presence of motor fluctuations, various degree of dyskinesia, and disability with functional impact on activities of daily living and independence. Therapeutic management aims to extend levodopa benefit while minimizing motor complications and includes, in selected cases, the implementation of drug infusion and surgical techniques. In milder forms of motor complications, these can often be controlled with manipulation of levodopa dose and the introduction of supplemental therapies such as catechol-O-methyl transferase inhibitors, monoamine oxidase B inhibitors, and dopamine agonists including apomorphine. Clinical experience and evidence from published studies indicate that when these agents cannot satisfactorily control motor complications, patients should be assessed and considered for device-aided therapies. This review article summarizes some of the newer available therapeutic opportunities such as use of enzyme inhibitors like opicapone and safinamide, adenosine A2A receptor antagonists, apomorphine and levodopa/carbidopa intestinal gel infusion, deep brain stimulation including the role of closed-loop and adaptive stimulation, and MRI-guided focused ultrasound. © 2018 International Parkinson and Movement Disorder Society

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Navegando por Autor "Godeiro Junior, Clécio de Oliveira"