Billy McBenedict

Multiple sclerosis (MS) is a heterogeneous autoimmune disease driven by peripheral immune dysregulation and compartmentalized central nervous system (CNS) inflammation. Despite more than 20 approved disease-modifying therapies, disability accrual remains common, particularly in patients with highly active relapsing disease and progressive phenotypes characterized by silent progression and smoldering neuroinflammation. Two emerging therapeutic strategies address these unmet needs: Bruton’s tyrosine kinase (BTK) inhibitors and autologous haematopoietic stem cell transplantation (HSCT). Although mechanistically distinct, both aim to overcome limitations of conventional immunosuppression by intervening more deeply in the autoimmune cascade. This narrative review synthesized mechanistic, clinical, and translational evidence identified through a comprehensive search of PubMed, Scopus, Web of Science, and ClinicalTrials.gov from January 2010 to August 2025. BTK inhibitors are oral, CNS-penetrant therapies that selectively modulate B-cell signaling and CNS-resident myeloid cells without broad lymphocyte depletion, enabling continuous immunomodulation. Phase II–III trials of evobrutinib, tolebrutinib, and fenebrutinib show consistent MRI activity suppression but variable effects on relapses and disability, suggesting relevance in microglial-driven, relapse-independent disease. HSCT is a one-time immune reconstitution therapy that eradicates autoreactive immune clones and restores immune tolerance. Randomized and real-world studies demonstrate profound suppression of inflammatory activity, stabilization or improvement of disability, and durable treatment-free remission in selected patients with highly active relapsing–remitting MS, although procedure-related risks require strict eligibility criteria and experienced centers. Together with BTK inhibitors, HSCT represents a complementary strategy within an increasingly personalized MS treatment paradigm, emphasizing biomarker-guided patient selection and optimized therapeutic sequencing.

A musicoterapia é uma prática integrativa que busca, através do uso da música e dos seus componentes, promover o desenvolvimento pessoal dos indivíduos, seja no âmbito motor, cognitivo, social ou outros. Diante da sua relevância, este trabalho objetiva realizar uma revisão narrativa da neuromusicoterapia e de alguns dos seus usos na neuropsiquiatria (Parkinson, demência, AVE e autismo). Para isso, foram selecionados 20 artigos da base de dados do PubMed, além de artigos da internet. Foi possível observar que a neuromusicoterapia apresenta resultados promissores na formação de estratégias adaptativas, como no Parkinson e na demência, na melhora de algumas dificuldades, como as habilidades sociais no autismo, e na recuperação de funções motoras e cognitivas, como ocorre no AVE. Ainda, além de apresentar bons resultados, a prática conta com um baixo custo e baixo risco de eventos adversos, sendo uma ferramenta notável no cuidado aos pacientes.

Background/Objectives: Multiple sclerosis (MS) is a chronic autoimmune disease marked by inflammatory demyelination in the central nervous system, leading to debilitating spasticity. Managing spasticity in MS remains a challenge, and intrathecal baclofen (ITB) therapy has emerged as a potential targeted treatment. This systematic review investigated the efficacy of ITB pumps in managing MS-related spasticity and explored their immunomodulatory effects. Methods: This review adhered to PRISMA guidelines and was submitted for registration retrospectively with the Open Science Foundation. A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science from January 2013 to August 2024. Studies were included if they examined adult MS patients receiving ITB for spasticity, reporting outcomes related to spasticity and quality of life. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools, and findings were synthesized narratively. Results: Eight studies (n = 723 participants) met inclusion criteria. ITB was associated with significant reductions in spasticity severity and improvements in quality of life, with reduced reliance on oral antispasticity medications. Immunologically, ITB has demonstrated potential in modulating inflammatory pathways, downregulating pro-inflammatory cytokines, and shifting immune responses toward an anti-inflammatory profile. Common complications included catheter-related issues and infections, with low overall complication rates. Sensitivity analyses indicated robustness in outcomes across higher-quality studies. Conclusions: ITB pumps are effective in controlling spasticity and offer additional immunological benefits for MS patients. Further research should explore ITB’s long-term immunomodulatory effects and its potential in combined therapeutic strategies. The review was not financially supported, and no conflicts of interest were declared by the authors.

O presente relato de caso descreve uma paciente de 34 anos com diagnóstico de Transtorno de Personalidade Borderline (TPB), caracterizado por autolesões graves, ideação suicida e comportamento sexual de risco associado a parafilias, incluindo asfixiofilia. A paciente apresenta um histórico de instabilidade emocional, impulsividade e dificuldades interpessoais, associado a episódios de autolesões e práticas sexuais potencialmente letais. Durante o acompanhamento, foi identificada uma relação entre impulsividade, busca por validação emocional e práticas de risco, que podem ser mediadas por alterações neurobiológicas, como disfunções no córtex pré-frontal e hiperatividade da amígdala. As intervenções terapêuticas envolveram o uso de fluoxetina e quetiapina, além da Terapia Comportamental Dialética (TCD), resultando em melhora significativa na frequência de autolesões e maior compreensão dos gatilhos emocionais. Apesar da redução parcial dos comportamentos sexuais de risco, a persistência desses comportamentos ressalta a necessidade de intervenções direcionadas, como a Terapia Cognitivo-Comportamental Sexual. Este caso reforça a importância de abordagens terapêuticas multidimensionais e individualizadas para condições complexas, destacando a interseção entre impulsividade, regulação emocional disfuncional e busca por experiências extremas no TPB.

Psoas muscle abscess is an insidious disease, with varied clinical manifestations and a challenging diagnosis. This pathology has been more frequently identified due to the increased availability of high-quality radiological imaging, such as computed tomography. In Brazil, Mycobacterium tuberculosis is the most common secondary etiologic agent of psoas abscess. We report the case of a 28-year-old immunocompetent man diagnosed with disseminated tuberculosis, affecting the lungs, lumbar spine, and psoas muscle, leading to permanent locomotion sequelae. This case is very relevant for osteoarticular complaints, as low back pain and limping were the initial symptoms. Diagnosis was confirmed by ultrasound-guided percutaneous drainage of the psoas muscle abscess and detection of the M. tuberculosis complex via Xpert MTB/RIF. A 12-month treatment with antitubercular drugs was effective.

Urogenital tuberculosis (UGT) constitutes a significant extrapulmonary form of tuberculosis, often presenting non-specific symptoms and a prolonged indolent course that leads to delayed diagnosis and treatment, which can result in severe and irreversible complications such as urinary strictures, renal failure, and infertility. This report describes a case of a 38-year-old man with a five-month history of low back pain, hematuria, dysuria, and altered urinary frequency. Initial treatment for a presumed urinary tract infection failed, and subsequent diagnostic investigations showed stones, nodules, and cysts in his left kidney. A positive tuberculin skin test confirmed the diagnosis of UGT and identification of Mycobacterium tuberculosis in urine samples. The patient underwent standard six-month antituberculosis therapy and subsequent retreatment due to persistent symptoms. Despite significant symptom amelioration, irreversible urological sequelae, including infundibular stenosis, polyuria, and nocturia, remained. This case underscores the importance of early suspicion, accurate diagnosis, and timely treatment of UGT to minimize long-term complications. It also highlights the potential need for extended treatment length in complex cases to improve outcomes and reduce sequelae, warranting further research in this area.

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by significant sensory, motor, and autonomic dysfunction, often following trauma or nerve injury. Historically known as causalgia and reflex sympathetic dystrophy, CRPS manifests as severe, disproportionate pain, often accompanied by hyperalgesia, allodynia, trophic changes, and motor impairments. Classified into type I (without nerve injury) and type II (associated with nerve damage), CRPS exhibits a complex pathophysiology involving peripheral and central sensitization, neurogenic inflammation, maladaptive brain plasticity, and potential autoimmune and psychological influences. The diagnosis relies primarily on clinical evaluation using criteria such as the Budapest Criteria, supported by supplementary tests to exclude differential diagnoses. However, its overlapping features with other conditions complicate diagnostic accuracy.