Spinocerebellar ataxia type 10 (SCA10) is an autosomal dominant ataxia caused by an ATTCT repeat expansion in an intron of the SCA10 gene. SCA10 has been reported only in Mexican families, in which the disease showed a combination of cerebellar ataxia and epilepsy. The authors report 28 SCA10 patients from five new Brazilian families. All 28 patients showed cerebellar ataxia without epilepsy, suggesting that the phenotypic expression of the SCA10 mutation differs between Brazilian and Mexican families.

RESUMO -Apresentamos revisão sobre o tratamento atual da espasticidade, enfocando a terapêutica farmacológica, fisioterápica e através da utilização de toxina botulínica. PALAVRAS-CHAVE: espasticidade, fisioterapia, toxina botulínica. Treatment of spasticity: an updateABSTRACT -We present an update about the treatment of spasticity, stressing the pharmacological treatment, physical therapy and botulinum toxin therapy.KEY WORDS: spasticity, physical therapy, botulinum toxin.A espasticidade pode ser definida como o aumento, velocidade dependente, do tônus muscular, com exacerbação dos reflexos profundos, decorrente de hiperexcitabilidade do reflexo do estiramento. A espasticidade associa-se, dentro da síndrome do neurônio motor superior, com a presença de fraqueza muscular, hiperreflexia profunda e presença de reflexos cutâneo-musculares patológicos, como o sinal de Babinski 1-4 .Dentre os vários mecanismos fisiopatológicos, originados em vários pontos da via do reflexo do estiramento, envolvendo os motoneurônios alfa, gama, interneurônios da medula espinhal e vias aferentes e eferentes, sobressai a teoria clássica do aumento do tônus, secundário à perda das influências inibitórias descendentes (via retículo-espinhal), como resultado de lesões comprometendo o trato córtico-espinhal (piramidal, agora melhor definido como vias mediadoras de influências supra-espinhais sobre a medula espinhal). A perda da influência inibitória descendente resultará em aumento da excitabilidade dos neurônios fusimotores gama e dos moto-neurônios alfa [1][2][3][4][5] . Os principais neurotransmissores envolvidos no mecanismo do tônus muscular são: ácido gamaminobutírico (GABA) e glicina (inibitórios) e glutamato (excitatório), além da noradrenalina, serotonina e de neuromoduladores como a adenosina e vários neuropeptídeos.

Perry syndrome (PS) is a rare hereditary neurodegenerative disease characterized by autosomal dominant parkinsonism, psychiatric symptoms, weight loss, central hypoventilation, and distinct TDP-43 pathology. The mutated causative gene for PS is DCTN1, which encodes the dynactin subunit p150Glued. Dynactin is a motor protein involved in axonal transport; the p150Glued subunit has a critical role in the overall function. Since the discovery of DCTN1 in PS, it has been increasingly recognized that DCTN1 mutations can exhibit more diverse phenotypes than previously thought. Progressive supranuclear palsy- and/or frontotemporal dementia-like phenotypes have been associated with the PS phenotypes. In addition, DCTN1 mutations were identified in a family with motor-neuron disease before the discovery in PS. In this review, we analyze the clinical and genetic aspects of DCTN1-related neurodegeneration and discuss its pathogenesis. We also describe three families with PS, Canadian, Polish, and Brazilian. DCTN1 mutation was newly identified in two of them, the Canadian and Polish families. The Canadian family was first described in late 1970’s but was never genetically tested. We recently had the opportunity to evaluate this family and to test the gene status of an affected family member. The Polish family is newly identified and is the first PS family in Poland. Although still rare, DCTN1-related neurodegeneration needs to be considered in a differential diagnosis of parkinsonian disorders, frontotemporal dementia, and motor-neuron diseases, especially if there is family history.

The authors review ataxia telangiectasia, emphasizing historical aspects, genetic discoveries and the clinical presentations of the classical and atypical forms. Our conclusion is that the term ataxia telangiectasia is a misnomer because it represents a multisystem entity with pleomorphic neurological and systemic manifestations. ATM syndrome is proposed as a more adequate designation for this entity.

The traditional pathological description of PD as a pre-synaptic degenerative process affecting dopaminergic neurons in the substantia nigra pars compacta (SNc) of the midbrain with formation of Lewy bodies (LB) has changed dramatically in the last decade since functional and neuropathological studies showed the occurrence of extensive extranigral involvement 1 . Among these investigations, the seminal study of Braak et al. 2 suggested that the degenerative process in the PD starts in the caudal regions of the brainstem and the olfactory bulb, progressing in the caudal-rostral direction. The involvement of the SNc occurs, according to this hypothesis, on the third of a six-stage process that begins in the dorsal motor nuclei of the glossopharyngeal and vagus nerves and the olfactory bulb. Although it demonstrates the occurrence of this peculiar pathological distribution, the study fails to make the clinical correlation between any of these changes and motor or non-motor manifestations. On the other hand, even considering this caveat, it was one of the studies that formed the basis and motivated the dissemination of the concept of the existence of non-motor signs (NMS), especially dysautonomia, olfaction and sleep disorders, as part of the disease, sometimes even preceding the classic motor symptoms of PD.The motor aspects of PD typically have a slow progression and direct correlation with the presence of neuronal degeneration in the SNc, but they do not represent the actual beginning of the degenerative process. This process is, in fact, in full progression, despite been apparently silent when one seeks only for motor signs 3 . EXTRANIGRAL DEGENERATIONThe notion of PD as a multisystemic disease, not restricted to the nigrostriatal tract is not new, however the cited ABSTRACTDuring the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem process with diverse non-motor signs (NMS). In addition to been extremely common, these NMS play a major role in undermining functionality and quality of life. On the other hand, NMS are under recognized by physicians and neglected by patients. Here, we review the most common NMS in PD, including cognitive, psychiatric, sleep, metabolic, and sensory disturbances, discuss the current knowledge from biological, epidemiological, clinical, and prognostic standpoints, highlighting the need for early recognition and management.Keywords: Parkinson's disease, non-motor signs, dementia, hyposmia, psychosis. RESUMONo decorrer da última década, a visão da doença de Parkinson (DP) como um distúrbio de movimento puro mudou significativamente, sendo atualmente reconhecida como um processo multisistêmico com diversos sinais não motores (SNM). Além de serem extremamente comuns, estes SNM têm um impacto muito significativo na limitacão funcional e da qualidade de vida na DP. Por outro lado, os SNM são mal reconhecidos pelos clínicos e negligenciados pelos pacientes. Nessa revisão os SNM mais comuns na DP fo...

-Huntington disease (HD) is associated with expansions of a CAG trinucleotide repeat in the HD gene. Accurate measurement of a specific CAG repeat sequence in the HD gene in 92 Brazilian controls without HD, 44 Brazilian subjects with clinical findings suggestive of HD and 40 individuals from 6 putative HD families, showed a range from 7 to 33 repeats in normal subjects and 39 to 88 repeats in affected subjects. A trend between early age at onset of first symptoms and increasing number of repeats was seen. Major increase of repeat size through paternal inheritance than through maternal inheritance was observed. Data generated from this study may have significant implications for the etiology, knowledge of the incidence, diagnosis, prognosis, genetic counseling and treatment of HD Brazilian patients.KEY WORDS: Huntington disease, CAG repeats, Brazil, DNA, PCR. Doença de Huntington: análise de DNA na população brasileiraRESUMO -A doença de Huntington (DH) está associada a expansões da seqüência repetitiva de trinucleotídeos CAG no gene HD. Através de análise do número de repetições CAG em indivíduos brasileiros, amostras de 92 indivíduos-controle não afetados pela DH, 44 pacientes com DH e 40 indivíduos de 6 famílias com a DH, demonstrou-se a presença de repetições de 7 até 33 trinucleotídeos CAG nos indivíduos-controle e de 39 até 88 nos alelos mutados dos indivíduos afetados. Foi constatada relação inversa entre a idade de manifestação dos primeiros sintomas da doença e o tamanho do fragmento encontrado. Também foi observado que o número de casos em que ocorrem expansões do trinucleotídeo foi maior quando o pai transmite o alelo mutado do que quando a mãe o transmite. Os dados gerados com este estudo têm importância significativa para a compreensão da etiologia, incidência, diagnóstico, prognóstico e tratamento dos pacientes com DH na população brasileira. O conhecimento da base genética desta doença na população brasileira permitirá um aconselhamento genético mais eficiente às famílias em risco.

Neurodegeneration with brain iron accumulation (NBIA) represents a heterogeneous and complex group of inherited neurodegenerative diseases, characterized by excessive iron accumulation, particularly in the basal ganglia. Common clinical features of NBIA include movement disorders, particularly parkinsonism and dystonia, cognitive dysfunction, pyramidal signs, and retinal abnormalities. The forms of NBIA described to date include pantothenase kinase-associated neurodegeneration (PKAN), phospholipase A2 associated neurodegeneration (PLAN), neuroferritinopathy, aceruloplasminemia, beta-propeller protein-associated neurodegeneration (BPAN), Kufor-Rakeb syndrome, mitochondrial membrane protein-associated neurodegeneration (MPAN), fatty acid hydroxylase-associated neurodegeneration (FAHN), coenzyme A synthase protein-associated neurodegeneration (CoPAN) and Woodhouse-Sakati syndrome. This review is a diagnostic approach for NBIA cases, from clinical features and brain imaging findings to the genetic etiology.

Spinocerebellar ataxia type 10 (SCA10) is an autosomal dominant disorder caused by an ATTCT repeat intronic expansion in the SCA10 gene. SCA 10 has been reported in Mexican, Brazilian, Argentinean and Venezuelan families. Its phenotype is overall characterized by cerebellar ataxia and epilepsy. Interestingly, Brazilian patients reported so far showed pure cerebellar ataxia, without epilepsy. Here, authors provide a systematic analysis of the presence, frequency and electroencephalographic presentation of epilepsy among 80 SCA10 patients from 10 Brazilian families. Overall, the frequency of epilepsy was considered rare, been found in 3.75 % of the cases while this finding in populations from other geographic areas reaches 60% of SCA10 cases.