Is there a role for melatonin in fibromyalgia?

Fibromyalgia, characterised by persistent pain, fatigue, sleep disturbance and cognitive dysfunction, is a central sensitivity syndrome that also involves abnormality in peripheral generators and in the hypothalamic pituitary adrenal axis. Heterogeneity of clinical expression of fibromyalgia with a multifactorial aetiology has made the development of effective therapeutic strategies challenging. Physiological properties of the neurohormone melatonin appear related to the symptom profile exhibited by patients with fibromyalgia and thus disturbance of it’s production would be compatible with the pathophysiology. Altered levels of melatonin have been observed in patients with fibromyalgia which are associated with lower secretion during dark hours and higher secretion during daytime. However, inconsistencies of available clinical evidence limit conclusion of a relationship between levels of melatonin and symptom profiles in patients with fibromyalgia. Administration of melatonin to patients with fibromyalgia has demonstrated suppression of many symptoms and an improved quality of life consistent with benefit as a therapy for the management of this condition. Further studies with larger samples, however, are required to explore the potential role of melatonin in the pathophysiology of fibromyalgia and determine the optimal dosing regimen of melatonin for the management of fibromyalgia

Anti-N-methyl-D-aspartate receptor encephalitis and Epstein-Barr virus: another tale on autoimmunity?

Jubilaumsfonds der Osterreichischen NationalbankUniv Fed São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilMed Univ Vienna, Inst Neurol, Vienna, AustriaUniv Fed São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilJubilaumsfonds der Osterreichischen Nationalbank: 16919Web of Scienc

Hemorragia intracraniana espontânea em paciente com afibrinogenemia congênita

Paciente com afibrinogenemia congênita, diagnosticada aos quatro meses de idade, permaneceu assintomática até os quatro anos. Nessa ocasião, foi admitida no setor de emergência e diagnosticada inicialmente com enxaqueca, sendo posteriormente diagnosticado o episódio de acidente vascular hemorrágico. A paciente recebeu tratamento com crioprecipitado, evoluindo com melhora do quadro clínico e reabsorção do hematoma subdural nas imagens de controle. Hemorragia intracerebral espontânea deve fazer parte do diagnóstico diferencial em pacientes com afibrinogenemia diagnosticada, pois a conduta terapêutica correta, e em tempo hábil, pode impedir que complicações neurológicas reversíveis se tornem permanentes

PENGANTAR ILMU HUKUM

Ilmu hukum merupakan batasan yang diberikan terhadap kajian ilmu hukum. Definisi ilmu hukum kemudian menjadi persoalan yang terlebih dahulu harus dijawab oleh para sarjana hukum sebelum mendefinisikan hukum itu sendiri. Oleh karena hukum telah berkembang menjadi ilmu pengetahuan yang sangat maju dan tak pernah putus sebagai bahan kajian. Ilmu hukum telah berkembang begitu cepat dan para sarjana hukum telah membagi ilmu hukum sebagai bagian atau salah satu ilmu sosial. Definisi ilmu hukum menjadi penting oleh karena dengan adanya definisi ilmu hukum kita dapat dengan mudah mempelajari dan pada gilirannya memahami ilmu hukum itu sendiri. Maka dari itub ilmu hukum akan mempelajari semua seluk beluk mengenai hukum, misalnya mengenai asal mula, wujud, asas-asas, sistem, macam pembagian, sumber-sumber, perkembangan, fungsi dan kedudukan hukum di dalam masyarakat. Ilmu hukum sebagai ilmu yang mempunyai objek hukum menelaah hukum sebagai suatu gejala atau fenomena kehidupan manusia dimanapun didunia ini dari masa kapanpun. Seorang yang berkeinginan mengetahui hukum secara mendalam sangat perlu mempelajari hukum itu dari lahir, tumbuh dan berkembangnya dari masa ke masa sehingga sejarah hukum besar perannya dalam hal tersebut. Tujuan Pengantar Imu Hukum adalah menjelaskan tentang keadaan, inti dan maksud tujuan dari bagian-bagian penting dari hukum, serta pertalian antara berbagai bagian tersebut dengan ilmu pengetahuan hukum. Adapun kegunaannya adalah untuk dapat memahami bagian-bagian atau jenis-jenis ilmu hukum lainnya. Kedudukan Pengantar Ilmu Hukum merupakan dasar bagi pelajaran lanjutan tentang ilmu pengetahuan dari berbagai bidang hukum. Sedangkan kedudukan dalam kurikulum fakultas hukum adalah sebagai mata kuliah keahlian dan keilmuan. Oleh karena itu pengantar ilmu hukum berfungsi memberikan pengertian-pengertian dasar baik secara garis besar maupun secara mendalam mengenai segala sesuatu yang berkaitan dengan hukum. Selain itu juga pengantar ilmu hukum juga berfungsi pedagogis yakni menumbuhkan sikap adil dan membangkitkan minat untuk denagan penuh kesungguhan mempelajari hukum

Toxocariasis of the CNS simulating acute disseminated encephalomyelitis

Universidade Federal de São Paulo, Dept Neurol & Neurol Surg, BR-04023900 São Paulo, BrazilUniv Fed Espirito Santo, Dept Pediat, Vitoria, BrazilFac Ciencias Med Santa Casa, Dept Radiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurol Surg, BR-04023900 São Paulo, BrazilWeb of Scienc

Mutation in filamin A causes periventricular heterotopia, developmental regression, and West syndrome in males

Purpose: Familial periventricular heterotopia (PH) represents a disorder of neuronal migration resulting in multiple gray-matter nodules along the lateral ventricular walls. Prior studies have shown that mutations in the filamin A (FLNA) gene can cause PH through an X-linked dominant pattern. Heterozygotic female patients usually remain asymptomatic until the second or third decade of life, when they may have predominantly focal seizures, whereas hemizygotic male fetuses typically die in utero. Recent studies have also reported mutations in FLNA in male patients with PH who are cognitively normal. We describe PH in three male siblings with PH due to FLNA, severe developmental regression, and West syndrome. Methods: The study includes the three affected brothers and their parents. Video-EEG recordings and magnetic resonance image (MRI) scanning were performed on all individuals. Mutations for FLNA were detected by using polymerase chain reaction (PCR) on genomic DNA followed by single-stranded conformational polymorphism (SSCP) analysis or sequencing. Results: Two of the siblings are monozygotic twins, and all had West syndrome with hypsarrthymia on EEG. MRI of the brain revealed periventricular nodules of cerebral gray-matter intensity, typical for PH. Mutational analyses demonstrated a cytosine-to-thymidine missense mutation (c. C1286T), resulting in a threonine-to-methionine amino acid substitution in exon 9 of the FLNA gene. Conclusions: The association between PH and West syndrome, to our knowledge, has not been previously reported. Males with PH have been known to harbor FLNA mutations, although uniformly, they either show early lethality or survive and have a normal intellect. The current studies show that FLNA mutations can cause periventricular heterotopia, developmental regression, and West syndrome in male patients, suggesting that this type of FLNA mutation may contribute to severe neurologic deficits.47121121