ContributorsGIW wrote and revised the manuscript in response to co-author comments. He finalized all the figures and tables, performed the literature search, and assisted with data interpretation. HJK critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. IBA performed the data analysis, constructed the figures and tables, and made important suggestions to improve the manuscript. H-CK assisted with the data analysis and also reviewed the manuscript. GRC critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. All other authors were given the opportunity to review the manuscript and make suggestions which GIW received, either revising the paper or providing explanations. All who are not deceased were involved with approval of the manuscript.

This consensus prepared by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology is aimed at recommending new criteria for the diagnosis of dementia and Alzheimer’s disease (AD) in Brazil. A revision was performed of the proposals of clinical and of research criteria suggested by other institutions and international consensuses. The new proposal for the diagnosis of dementia does not necessarily require memory impairment if the cognitive or behavioral compromise affects at least two of the following domains: memory, executive function, speech, visual-spatial ability and change in personality. For the purpose of diagnosis, AD is divided into three phases: dementia, mild cognitive impairment and pre-clinical phase, where the latter only applies to clinical research. In the dementia picture, other initial forms were accepted which do not involve amnesia and require a neuroimaging examination. Cerebrospinal fluid biomarkers are recommended for study, but can be utilized as optional instruments, when deemed appropriate by the clinician.

-To know the impact of the Guillain Barré syndrome (GBS) in the population less than 15 years old, after the eradication of poliomyelitis. Data bank from the program of epidemiological surveillance of acute flaccid palsies (AFP) from the Fundação Nacional de Saúde were analyzed between 1990 -1996. From 3619 notifications of AFP there were 1678 GBS. GBS yearly incidence rates is 0.39-0.63 cases/100,000. No consistent seasonal variation existed or relationship to vaccines. Weakness at inclusion were, moderate 52.1%, severe in 47.9%, sixty days after 57.1% normal, 7.4% mild, 15.7% moderate, 10.4% with severe deficits, death in 5.4%. 67 (4.0%) cases unknown. Death rates varies from 2.8% in southeast to 7.9% in the northeast. GBS was the most frequent cause of AFP. In spite of the severity of this disease being similar in the different regions, the outcome varies according to origin of the cases, possibly reflecting the economical conditions in those places.KEY WORDS: Guillain Barré syndrome, epidemiology, vaccines, follow up.Síndrome de Guillain-Barré na população menor de quinze anos no Brasil Síndrome de Guillain-Barré na população menor de quinze anos no Brasil Síndrome de Guillain-Barré na população menor de quinze anos no Brasil Síndrome de Guillain-Barré na população menor de quinze anos no Brasil Síndrome de Guillain-Barré na população menor de quinze anos no Brasil RESUMO -Com o objetivo de conhecer a importância da síndrome de Guillain Barré (SGB) na população menor de quinze anos, após a erradicação da poliomielite, foi analizado o banco de dados do programa da vigilância epidemiológica das paralisias agudas e flácidas (PAF) da Fundação Nacional de Saúde, entre 1990 e 1996. De 3619 notificações de PAF encontraram-se 1678 com SGB, com incidência anual de 0,39-0,63 casos/ 100.000. Não se comprovou variação sazonal nem relação com a vacina. Os casos eram de acometimento: moderado em 52,1%, grave em 47,9%, 60 dias após 57,1% eram normais, 7,4% leves, 15,7% moderados, 10,4% graves, morte em 5,4%, 67 (4,0%) casos perdidos para o acompanhamento. Mortes ocorreram em 2,8% no sudeste, e 7,9% no nordeste. SGB é a causa mais frequente de PAF. Embora a gravidade da doença seja semelhante nas diferentes regiões, a evolução varia conforme o local de origem, possivelmente refletindo diferentes condições econômicas. PALAVRAS-CHAVE: síndrome de Guillain Barré, epidemiologia, vacina, evolução.The acute flaccid palsies (AFP) are a group of diseases, with many etiologies, variable incidences and variable prognoses, that affect population around the year in the world. Until mid 80's the acute poliomyelitis was the main cause of acute flaccid palsies but with the program of eradication of poliomyelitis had emerged the Guillain-Barré syndrome (GBS) as the major etiology, such statement is already proved in the developed countries, but still unknown in many communities. The epidemiological data has been shown valuable in evaluating the frequency of GBS in various populations, studying changes in incidence over time, detec...

Congenital myasthenic syndrome (CMS) is a heterogeneous disorder that causes fatigable muscle weakness. CMS has been associated with variants in the MuSK gene and, to date, 16 patients have been reported. MuSK-CMS patients present a different phenotypic pattern of limb girdle weakness. Here, we describe four additional patients and discuss the phenotypic and clinical relationship with those previously reported. Two novel damaging missense variants are described: c.1742T > A; p.I581N found in homozygosis, and c.1634T > C; p.L545P found in compound heterozygosis with p.R166*. The reported patients had predominant limb girdle weakness with symptom onset at 12, 17, 18, and 30 years of age, and the majority exhibited a good clinical response to Salbutamol therapy, but not to esterase inhibitors. Meta-analysis including previously reported variants revealed an increased likelihood of a severe, respiratory phenotype with null alleles. Missense variants exclusively affecting the kinase domain, but not the catalytic site, are associated with late onset. These data refine the phenotype associated with MuSK-related CMS.

-Objectives: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in Brazil in 1998. Method: Structured Clinical Report Forms (CRFs) sent to 2,505 Brazilian neurologists from January to September 1998 to be filled with demographic and clinical data regarding any ALS patient seen at any time during that year. Results: Five hundred and forty CRFs were returned by 168 neurologists. Data on 443 patients meeting the criteria of probable or definite ALS according to El Escorial definition were analysed: 63 probable (14.2%) and 380 definite (85.8%). Two hundred and fifty-nine (58.5%) of the patients were male, mean age of onset was 52. Spinal onset occurred in 306 patients (69%); bulbar onset in 82 (18.5%), and both in 52 (11.7%). Twenty-six (5.9%) had a family history of ALS. Two hundred and fifty-nine (58.6%) were seen by private practitioners, and 178 (40.2%) at a hospital clinic. Age-ajusted incidence shows a peak incidence at the 65-74 years old range. Conclusions: The disease's characteristics are similar to those described in international studies, except for age of onset (Brazilian patients are younger). This difference is not confirmed when figures are age-adjusted.KEY WORDS: amyotrophic lateral sclerosis, ALS, epidemiology, prevalence, incidence. Esclerose lateral amiotrófica no Brasil: registro nacional, 1998RESUMO -Objetivos: Avaliar as características epidemiológicas da esclerose lateral amiotrófica (ELA) no Brasil durante o ano de 1998. Método: Formulários estruturados enviados a 2.505 neurologistas brasileiros de janeiro a setembro de 1998 para serem preenchidos com dados demográficos e clínicos de todos os pacientes com ELA atendidos no ano de 1998. Resultados: Quinhentos e quarenta formulários retornaram, enviados por 168 neurologistas. Dados sobre 443 pacientes que se enquadravam nos critérios de ELA provável ou definida de acordo com El Escorial foram analisados: 63 provável (14,2%) e 380 definida (85,8%). Duzentos e cinquenta (58,5%) eram do sexo masculino. A idade média de aparecimento dos primeiros sintomas foi de 52 anos. O início em membros ocorreu em 306 pacientes (69%), bulbar em 82 (18,5%) e generallizada em 52 (11,7%). Vinte e seis (5,9%) tinham história familiar. Duzentos e cinquenta e nove (58,6%) foram atendidos em clínicas ou consultórios, e 178 (40,2%) em ambulatório de hospital. Ajustando para a distribuição da população brasileira segundo faixa etária, a maior incidência ocorre entre 65 e 74 anos de idade. Conclusões: As características epidemiológicas da doença são semelhantes àquelas descritas em estudos internacionais, exceto para idade dos primeiros sintomas (pacientes brasileiros são mais jovens). Esta diferença desaparece quando os valores são ajustados para idade. PALAVRAS-CHAVE: esclerose lateral amiotrófica, ELA, epidemiologia, prevalência, incidência.Amyotrophic lateral sclerosis (ALS) is an invariably fatal neurodegenerative disease encompassed in the spectrum of neuromuscular disorders (NMD) and characterized by progressive

Pompe disease (PD) is a potentially lethal illness involving irreversible muscle damage resulting from glycogen storage in muscle fiber and activation of autophagic pathways. A promising therapeutic perspective for PD is enzyme replacement therapy (ERT) with the human recombinant enzyme acid alpha-glucosidase (Myozyme®). The need to organize a diagnostic flowchart, systematize clinical follow-up, and establish new therapeutic recommendations has become vital, as ERT ensures greater patient longevity. A task force of experienced clinicians outlined a protocol for diagnosis, monitoring, treatment, genetic counseling, and rehabilitation for PD patients. The study was conducted under the coordination of REBREPOM, the Brazilian Network for Studies of PD. The meeting of these experts took place in October 2013, at L’Hotel Port Bay in São Paulo, Brazil. In August 2014, the text was reassessed and updated. Given the rarity of PD and limited high-impact publications, experts submitted their views.

Multiple sclerosis (MS) is an inflammatory, autoimmune, demyelinating, and degenerative central nervous system disease. Even though the etiology of MS has not yet been fully elucidated, there is evidence that genetic and environmental factors interact to cause the disease. Among the main environmental factors studied, those more likely associated with MS include certain viruses, smoking, and hypovitaminosis D. This review aimed to determine whether there is evidence to recommend the use of vitamin D as monotherapy or as adjunct therapy in patients with MS. We searched PUBMED, EMBASE, COCHRANNE, and LILACS databases for studies published until September 9 th , 2013, using the keywords "multiple sclerosis", "vitamin D", and "clinical trial". There is no scientific evidence up to the production of this consensus for the use of vitamin D as monotherapy for MS in clinical practice.

Objective:To examine whether sustained minimal manifestation status (MMS) with complete withdrawal of prednisone is better achieved in thymectomized myasthenia gravis (MG) patients.Methods:This study is a post hoc analysis of data from the randomized trial of thymectomy in myasthenia gravis (MGTX). MGTX was a multicenter, randomized, rater-blinded 3-year trial that was followed by a voluntary 2-year extension for patients with acetylcholine receptor (AChR) antibody positive MG without thymoma. Patients were randomized 1:1 to thymectomy plus prednisone versus prednisone alone. Participants were age 18-65 years at enrollment with disease duration less than 5 years. All patients received oral prednisone titrated up to 100mg on alternate-days until they achieved MMS, which prompted a standardized prednisone taper as long as MMS was maintained. The achievement rate of sustained MMS (no symptoms of MG for 6 months) with complete withdrawal of prednisone, was compared between the thymectomy plus prednisone and prednisone alone groups.Results:MG patients in the thymectomy plus prednisone group achieved sustained MMS with complete withdrawal of prednisone more frequently (64% vs 38%) and quickly compared to the prednisone alone group (median time 30 months vs no median time achieved, P<0.001) over the 5-year study period. Prednisone associated adverse symptoms were more frequent in the prednisone alone group and distress level increased with higher doses of prednisone.Conclusions:Thymectomy benefits MG patients by increasing the likelihood of achieving sustained MMS with complete withdrawal of prednisone.Trial Registration:The trial was registered on clinicaltrials.gov, number NCT00294658Classification of Evidence: This study provides Class II evidence that for generalized MG patients with AChR antibody, those receiving thymectomy plus prednisone are more likely to attain sustained MMS and complete prednisone withdrawal than those on prednisone alone.