Alzheimer’s disease (AD) affects millions of people, however, there is still no effective treatment. The use of focused ultrasound with microbubbles (FUS-MB) for the opening of the blood-brain barrier has been recently studied and may become a promising therapeutic target.Objective:To discuss the use of FUS-MB for the treatment of AD and to present some of the techniques used.Methods:A systematic review was performed of MEDLINE/PubMed and Biblioteca Virtual em Saúde (BVS) services, using the keywords: focused ultrasound, Alzheimer, amyloid-b. Original articles were included in the study; studies that did not focus on Alzheimer’s treatment were excluded.Results:Fifteen original studies were selected. Preclinical trials were able to reduce amyloid-b plaques and tau phosphorylation, improving cognitive performance in AD animals.Conclusion:The results are very promising, but the therapy still requires maturation. Further studies are needed to systematize all the techniques used and their effects in order to enable use in humans.

Despite advances in the treatment of Alzheimer’s disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02772185—May 5, 2016.

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A 28-year-old White Brazilian female diagnosed with attention-deficit hyperactivity disorder began to experience severe headaches with photosensitivity. After misdiagnosis and inconclusive tests, the exams indicated the presence of idiopathic epilepsy secondary to migraine with aura. Because of the photosensitivity presented during the seizures, our purpose is to report impairments in visual processing after the patient became seizure free. Evaluation of the visual function was performed, including the analysis of contrast sensitivity and color discrimination. The results showed reduction in visual processing. A significant reduction in the contrast sensitivity function and color discrimination was observed for both eyes, with the left eye being more affected than the right eye. Results confirm that there was significant visual impairment compared with the normal pattern for both eyes. Even knowing that this is a rare case, our intent is to open new avenues for research involving photosensitive epilepsy in migraine with aura.

A 19-year-old White Brazilian female with epilepsy was evaluated after failing to become seizure free even with the use of antiepileptic drugs. Due to difficulty of communication, a neurocognitive assessment indicated the presence of attenuated delayed psychomotor and cognitive development. In addition to refractory epilepsy, with 30 seizures/day, a clinical diagnosis of lissencephaly was confirmed after MRI and electroencephalography monitoring. The intervention for reducing the seizures consisted of vagus nerve stimulation (VNS). After 30 days, relatives reported significant cognitive and behavioral improvement, such as reduced aggression and impulsivity, which lasted 60 and 90 days (follow-up). Furthermore, there was an improvement in psychomotor and self-care capacity. At this time, there was a significant reduction in seizures from about 30 seizures/month to 5 seizures/month. This case highlights the significant cognitive improvement even before the reduction of seizures in a patient with intractable drug-resistant epilepsy after VNS implant. Even though this is a rare case, the use of VNS in lissencephaly may be a potential tool for cognitive and behavioral improvement.

Introducción: Los cavernomas son malformaciones vasculares de bajo flujo que ocurren principalmente en el cerebro y, menos frecuentemente, en la médula espinal. Son lesiones raras y representan alrededor del 5-13% de las malformaciones vasculares del sistema nervioso central. Objetivos: Evaluar el seguimiento de 30 casos de pacientes diagnosticados con cavernomas y describir los hallazgos clínicos, epidemiológicos, topográficos, evolutivos y la conducta terapéutica en un período de 22 años. Metodología: Se trata de un estudio observacional, transversal, de carácter cuantitativo, que incluye pacientes diagnosticados con cavernomas, a través de la recolección de datos en los Servicios de Neurocirugía de varios Hospitales de João Pessoa, Paraíba, y que requirieron abordaje clínico o quirúrgico durante el período comprendido entre 1995 y 2017. Resultados: Las manifestaciones clínicas más comunes fueron las crisis convulsivas en el 33,33% (n = 10), cefalea en un 20% (n = 6) y parálisis del nervio craneal en un 20% (n = 6). En cuanto al sexo, 63,33% (n = 19) fueron del sexo femenino y 36,66% (n = 11) del sexo masculino. En cuanto a la localización, predominó la región supratentorial (70,73%), siendo el lóbulo frontal el más acometido (41,46%). Las lesiones múltiples ocurrieron en tres casos, siendo dos de ellos confirmados de cavernoma familiar. De los 30 pacientes, 12 fueron sometidos a cirugía, por presencia de sintomatología importante o de complicaciones. Se produjo un fallecimiento debido a hematoma subdural agudo. Conclusión: Los cavernomas generalmente tienen evolución benigna, necesitando tratamiento quirúrgico sólo en los casos sintomáticos y ante la presencia de complicaciones. El seguimiento reveló una buena evolución del cuadro, siendo la mayoría de los pacientes asintomáticos o con síntomas controlados mediante medicación.

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