Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, aside from alterations in the electroencephalogram (EEG) already registered. Non-invasive brain stimulation (NIBS) techniques have been suggested as an alternative rehabilitative therapy, but the neurophysiological changes associated with these techniques are still unclear. We aimed to identify the nature and extent of research evidence on the effects of NIBS techniques in the cortical activity measured by EEG in patients with PD. A systematic scoping review was configured by gathering evidence on the following bases: PubMed (MEDLINE), PsycINFO, ScienceDirect, Web of Science, and cumulative index to nursing & allied health (CINAHL). We included clinical trials with patients with PD treated with NIBS and evaluated by EEG pre-intervention and post-intervention. We used the criteria of Downs and Black to evaluate the quality of the studies. Repetitive transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), electrical vestibular stimulation, and binaural beats (BBs) are non-invasive stimulation techniques used to treat cognitive and motor impairment in PD. This systematic scoping review found that the current evidence suggests that NIBS could change quantitative EEG in patients with PD. However, considering that the quality of the studies varied from poor to excellent, the low number of studies, variability in NIBS intervention, and quantitative EEG measures, we are not yet able to use the EEG outcomes to predict the cognitive and motor treatment response after brain stimulation. Based on our findings, we recommend additional research efforts to validate EEG as a biomarker in non-invasive brain stimulation trials in PD.
A 16-year-old previously-healthy girl started with one episode of fever and loss of consciousness a month earlier. After 15 days, she complained of a short-term memory impairment and six days later presented with status epilepticus. Cerebrospinal fluid, including PCR for herpes virus, was normal. Brain MRI revealed hyperintensities lesions in bilateral external capsules and claustrum, which disappeared four months later (Figure). The occurrence of external capsule and claustrum lesions secondary to status epilepticus has been described in few cases 1,2. Transient cognitive and behavioral disturbances have been reported, and claustrum lesions may also be a clue for autoimmune epilepsy 1 .
A 32-year-old previously healthy man presented with headache that progressively worsened during the day. He denied any previous history of headache and trauma. There was no family history of neurological diseases. Examination revealed nuchal rigidity. Cranial computed tomography disclosed a left frontal hemorrhage. Brain magnetic resonance imaging revealed multiple cerebral cavernous malformations (CCM). The patient received conservative treatment. Cerebral cavernous malformations are commonly described in the familial form and are frequently asymptomatic. When symptoms do occur, seizures are the most common followed by focal deficits and headache
for their comments and the opportunity to discuss more details about our publication "Late-onset congenital syphilis with unusual brain abnormalities". Neurosyphilis is very challenging to diagnose due to its variable and complex presentation. This was a case report of a 17-year-old woman who presented with a refractory partial epilepsy since eight years of age and progressive cognitive decline. The patient had no history of sexual intercourse, autoimmune or chronic diseases. Tests for HIV infection, and PCR for herpes simplex were negative, serum VDRL (1:16) and the FTA-ABS test was positive in the cerebrospinal fluid with an increased protein level. False positive treponemal test results, like the FTA-ABS, occur less frequently than false positive anticardiolipin tests (VDRL) and the specificity of the FTA-ABS is high (1% false positive in the general population) 2. The magnetic resonance imaging scan of her brain showed T2/FLAIR white matter hyperintensities and atrophy of the anterior temporal and frontal lobes. This image has seldom been reported in the literature in cases of neurosyphilis 3,4. Her mother reported abnormalities in serological tests for syphilis in her prenatal screening. However, she did not receive any treatment. The test was repeated and her mother had VDRL (1:4), IgM-FTA-ABS and IgG-FTA-ABS positives. The patient was treated with intravenous crystalline penicillin, and there was better control of epilepsy. Due to the evidences presented above, we believe that the diagnosis of late-onset congenital syphilis could be supported. Yours sincerely,
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