Peripheral neuropathy is a common neurological disorder. There may be important differences and similarities in the diagnosis of peripheral neuropathy between North America (NA) and South America (SA). Neuromuscular databases were searched for neuropathy diagnosis at two North American sites, University of Kansas Medical Center and University of Texas Southwestern Medical Center, and one South American site, Federal Fluminense University in Brazil. All patients were included into one of the six major categories: immune-mediated, diabetic, hereditary, infectious/inflammatory, systemic/metabolic/toxic (not diabetic) and cryptogenic. A comparison of the number of patients in each category was made between North America and South America databases. Total number of cases in North America was 1090 and in South America was 1034 [immune-mediated: NA 215 (19.7%), SA 191 (18%); diabetic: NA 148 (13.5%), SA 236 (23%); hereditary: NA 292 (26.7%), SA 103 (10%); infectious/inflammatory: NA 53 (4.8%), SA 141 (14%); systemic/metabolic/toxic: NA 71 (6.5%), SA 124 (12%); cryptogenic: NA 311 (28.5%), SA 239 (23%)]. Some specific neuropathy comparisons were hereditary neuropathies [Charcot-Marie-Tooth (CMT) cases] in NA 246/292 (84.2%) and SA 60/103 (58%); familial amyloid neuropathy in SA 31/103 (30%) and none in NA. Among infectious neuropathies, cases of human T-lymphotropic virus type 1 (HTLV-1) neuropathy in SA were 36/141(25%), Chagas disease in SA were 13/141(9%) and none for either in NA; cases of neuropathy due to leprosy in NA were 26/53 (49%) and in SA were 39/141(28%). South American tertiary care centers are more likely to see patients with infectious, diabetic and hereditary disorders such as familial amyloid neuropathies. North American tertiary centers are more likely to see patients with CMT. Immune neuropathies and cryptogenic neuropathies were seen equally in North America and South America.

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[Rev Bras Anestesiol 2010;60(5): 563-564] ©Elsevier Editora Ltda.

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Problem statement: Amyotrophic Lateral Sclerosis (ALS) is a progressive and degenerative disease that affects the anterior horn motor neurons of the spinal cord and pyramidal tracts. In Brazil, there are few epidemiological data on this disease. Recently, some important findings have been reported, allowing a better understanding on the underlying processes of neuronal death, as well as the characteristics of this population. To discuss the clinical and functional profile of a convenience sample of patients with ALS in Rio de Janeiro and Neurology Department-Federal Fluminense University to compare the data with studies of other regions and countries. Approach: We used the Severity and Functional Ability Scale (SFAS) as a clinical and functional indicator for ALS. The modified El Escorial criteria were used to establish the diagnosis. The participants underwent five quarterly assessments during the study period. The research took place at two University Hospitals (Hospital Universitario Antonio Pedro-Universidade Federal Fluminense and Instituto de Neurologia Deolindo Couto-Universidade Federal do Rio de Janeiro) from March 2007 to December 2009. Results: Of the 98 recruited subjects, only 24 have completed all phases of the study. The average age was 52.7±4.1 years. The time between the onset of first symptoms and seeking care services was 11.6±12.:4 months. The time between the first symptoms and the diagnosis was 20.5±8.4 months. Muscle weakness was identified as the initial symptom in most cases. Patients had impaired muscle strength, speech, swallowing, respiratory function and severity stages of SFAS. The disease had different forms of initial presentation (impaired speech, limbs strength, respiratory function or swallowing), time to progression and clinical characteristics in our population. Conclusion: The knowledge on the individual clinical evolution in ALS is of paramount importance for the healthcare team to provide a correct treatment during the decline of Am. J. Neuroscience 2 (1): [28][29][30][31][32][33][34] 2011 29 the disease and formulate theoretical and conceptual issues, aiming at solving problems in clinical practice.

Problem statement: Peripheral neuropathy due to diabetes has been studied for several decades. Until recently, we associate the involvement of peripheral nerves with an inappropriate glycemic control in the most advanced stages of the disease. Currently, it is considered that the onset of the neural injury can occur in the initial phase of this metabolic abnormality, during the period of glucose intolerance. Approach: The clinical aspects of the sensory neuropathy associated to the impaired glucose tolerance were analyzed in 35 Brazilian patients. All patients met the American Diabetes Association (ADA) and the World Health Organization (WHO) criteria for glucose intolerance. Results: We studied 20 male and 15 female, with a mean age of 62.5, ranging from 30-83 years. A distal symmetrical lower limb involvement with positive (neuropathic pain) and/or negative (reduced temperature and pinprick sensations) symptoms and clinical signs of autonomic neuropathy were seen in most patients. The glycemic levels were not related to the severity of the symptoms or to the presence of any specific symptom. Conclusion: The Impaired Glucose Tolerance (IGT) neuropathy can be included in the chronic axonal polyneuropathy and usually the patients suffer from chronic pain and disability before the diagnosis. The determination of the prevalence of symptoms is essential to recognize this disease. The early diagnosis and the aggressive treatment can be crucial for the control, development and progression of the small fiber neuropathy in glucose intolerant patients.