The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended. Key words: insomnia, diagnosis of insomnia, treatment of insomnia, cognitive behavioral therapy.Novas diretrizes no diagnóstico e tratamento das insônias resumo A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina. Palavras-chave: insônia, diagnóstico da insônia, tratamento da insônia, terapia comportamental cognitiva.

Objective: To investigate the use of quantitative EEG (qEEG) in patients with acute encephalopathies (AEs) and EEG background abnormalities. Method: Patients were divided into favorable outcome (group A, 43 patients) and an unfavorable outcome (group B, 5 patients). EEGLAB software was used for the qEEG analysis. A graphic of the spectral power from all channels was generated for each participant. Statistical comparisons between the groups were performed. Results: In group A, spectral analysis revealed spectral peaks (theta and alpha frequency bands) in 84% (38/45) of the patients. In group B, a spectral peak in the delta frequency range was detected in one patient. The remainder of the patients in both groups did not present spectral peaks. Statistical analysis showed lower frequencies recorded from the posterior electrodes in group B patients. Conclusion: qEEG may be useful in the evaluations of patients with AEs by assisting with the prognostic determination.Keywords: encephalopaties, coma, EEG, neurophysiology. RESUMO Objetivos:Investigar o uso do EEG quantitativo (qEEG) em pacientes com encefalopatias agudas (EAs ) e anormalidades da atividade de base no EEG. Método: Os pacientes foram divididos em prognóstico favorável (grupo A, 43 pacientes) e desfavorável (grupo B, 5 pacientes). O programa EEGLAB foi utilizado para a análise do qEEG. Um gráfico da potência espectral de todos os canais foi gerado para cada participante. Os dois grupos foram comparados estatisticamente. Resultados: No grupo A, a análise espectral revelou picos (frequências teta e alfa) em 84% (38/45) dos pacientes. No grupo B, um pico espectral na frequência delta foi detectado em um paciente. Os pacientes remanescentes dos dois grupos não apresentaram picos espectrais. A análise estatística mostrou menores frequências registradas nos eletrodos posteriores dos pacientes do grupo B. Conclusão: O qEEG pode ser útil na avaliação de pacientes com EAs auxiliando na determinação do prognóstico.

We report on two patients with a history of chronic exposure to organochlorine insecticides who developed clinical and electromyographic signs and symptoms of chronic motor neuron disease. Measurements of aldrin, lindane and heptachlor confirmed the intoxication. We emphasize the importance of searching for toxic and environmental factors in cases of motor neuron disease especially in Third World countries, where workers usually wear no adequate protective equipment.

Study Objectives Elements impairing upper airway anatomy or muscle function (e.g. pharyngeal neuromyopathy) contribute to obstructive sleep apnea syndrome (OSAS). Structural brain imaging may differ in patients with OSAS according to dilator muscle dysfunction. Magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) and surface-based morphometry (SBM) was used to investigate this hypothesis. Methods Eighteen patients with OSAS and 32 controls underwent 3T brain MRI. T1 volumetric images were used for structural analysis. Pharyngeal electroneuromyography was performed; patients with OSAS were classified as with or without neuromyopathy. VBM and SBM analyses were conducted using SPM12 and CAT12 software. Image processing was standard. Cortical surface parameters and gray and white matter volumes from participants with OSAS with and without neuromyopathy were compared with those from controls. Results Eleven patients had OSAS with neuromyopathy and seven patients had OSAS without neuromyopathy (normal pharyngeal electroneuromyography). Comparing these groups to the controls, VBM revealed: four clusters (total volume 15,368 mm3) for patients with neuromyopathy, the largest cluster in the left cerebellum (9,263 mm3, p = 0.0001), and three clusters (total 8,971 mm3) for patients without neuromyopathy, the largest cluster in the left cerebellum (5,017 mm3, p = 0.002). Patients with OSAS with neuromyopathy showed increased proportion of atrophy (p < 0.0001). SBM showed abnormalities in patients without neuromyopathy (decreased cortical thickness, left precentral gyrus [672 vertices, p = 0.04]; increased cortical complexity, right middle temporal gyrus [578 vertices, p = 0.032]). Conclusion Damaged areas were larger in patients with OSAS with than in those without neuromyopathy, suggesting differences in brain involvement. Patients with OSAS and neuromyopathy may be more susceptible to cerebral damage.

-This re t rospective study describes 14 cases of intercostal nerve mononeuropathy (INM) found in 5,560 electromyography (EMG) exams perf o rmed between January 1991 and June 2004 in our University Hospital. Medical charts of all patients with history of thoracic pain and EMG diagnosis of intercostal monon e u ropathy were reviewed. INM was detected in 14 patients; etiology was thoracic surg e ry in 6 (43%), post-herpetic neuropathy in 4 (28%), probable intercostal neuritis in 2 (14%), lung neoplasia in 1 (7%), and radiculopathy in 1 (7%). From this study, trauma and infection were the main etiologies in intercostal neuropathic pain development. Tricyclic antidepressants and anticonvulsants were the most common therapeutic drugs used.KEY WORDS: intercostal mononeuropathy, EMG, etiology. Mononeuropatia de nervo intercostal: estudo de 14 casosRESUMO -Este trabalho apresenta estudo re t rospectivo de 14 pacientes com mononeuropatia de nerv o i n t e rcostal (MNI), obtidos dentre 5.560 exames eletromiográficos, realizados de janeiro de 1991 até junho de 2004, em nosso Hospital Universitário. MNI foi encontrada em 14 pacientes, tendo como causas prováveis intervenções cirúrgicas torácicas em 6 (43%), neuropatia por herpes-zoster em 4 (28%), pro v á v e l neurite de nervo intercostal em 2 (14%), neoplasia pulmonar em 1 (7%) e radiculopatia em 1 (7%). As principais causas de MNI de nosso Serviço são similares às da literatura. Os antidepressivos tricíclicos e anticonvulsivantes foram os fármacos mais utilizados no controle da dor. PALAVRAS-CHAVE: mononeuropatia intercostal, EMG, etiologia.The first descriptions of intercostal nerve monon e u ropathy (INM) were re p o rted by USA army surgeons treating patients with chronic pain after t h oracotomy as a result of thoracic trauma during the Second World Wa r 1 . There is an estimated 11 to 8 0 % incidence of chronic pain after thoracotomy 2 , but c h ronic pain tends to reduce over time 3 . High doses of analgesics consumed during the first week a f t e r s u rg e rymay be a risk factor for pain after thoracotomy 3 . However, low-dose treatment of post-surgical pain induces the liberation of stress re l a t e d chemical mediators, which may cause pulmonary, c a rd i o v a s c u l a r, metabolic and neuro e n d o c h r i n e d i s t u r b a n c e s 4 . Despite these clinical problems, int e rcostal nerves have been transferred to the brachial plexus to treat traumatic brachial plexopathy with minimal effects on pulmonary function 5 . The first clinical descriptions related to Va r i c e l l a zoster were in the XIX century 6 . Infection by Va r icella zoster is also a common cause of INM 7 , usually presented as unilateral vesicular eruption in a b e l tlike distribution mainly on the thoracic sensory d e rmatomes, most cases preceded by pain and pare sthesias. The prognosis is usually good, most cases p resents complete re c o v e ryor significant impro v em e n t 7 . Atypical clinical presentations are described in imunosupressed patients 7 . The objective of o...