Keywords:
Neurology - History - Stroke - Multiple Sclerosis - Parkinsonian Disorders
Palavras-chave:
Neurologia - História - Acidente Vascular Cerebral - Esclerose Múltipla - Transtornos
Parkinsonianos
INTRODUCTION
Brazilian neurology, particularly in São Paulo, was strongly influenced by French
neurology[1],[2]. The first chair of neurology at the School of Medicine of Universidade de São Paulo (USP) was filled by professor Enjolras Vamprè in 1935; after his premature death
in 1938, his assistant professor Aderbal Tolosa was chosen to replace him through
an open selection process[2],[3],[4],[5]. In 1945, the neurology clinic at the School of Medicine of USP was transferred
to Hospital das Clínicas under the leadership of Tolosa and his assistants Oswaldo Lange and Oswaldo Freitas
Julião, along with several volunteer assistants, including Roberto Melaragno Filho[3],[4],[5],[6],[7],[8]. Melaragno had exceptional didactic capacity and relevant scientific production,
and came to represent Brazilian neurology to the rest of the world[7]. This historical review presents Roberto Melaragno's main contributions to Brazilian
neurology.
ROBERTO MELARAGNO FILHO — BIOGRAPHY
ROBERTO MELARAGNO FILHO — BIOGRAPHY
Roberto Melaragno Filho ([Figure 1]) was born in São Paulo in 1919 and obtained his degree in medicine from the School
of Medicine of USP in 1942[7],[8]. In 1943, he began working as a volunteer assistant at the neurology clinic of USP,
Hospital das Clínicas, under the supervision of Aderbal Tolosa[3],[4],[7],[8]. In 1947 and 1948, he completed his studies as an Assistant Foreigner at the School
of Medicine of Paris under professor Raymond Garcin[7],[8]. Melaragno was appointed Free Lecturer at USP in 1954 and remained very active in
the neurology service through didactic and scientific work until leaving in 1965 to
take over as the head of the neurology service at Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO)[3],[4],[6],[7],[8]. There, he was responsible for training many neurologists until his retirement in
1989[7],[8]. Melaragno was a founding member of the Brazilian Academy of Neurology; he was a
frequent participant in congresses and sponsored the creation of the Henrique Sam
Midlin award. In 1998, on the eve of his seventy-ninth birthday, he died in the city
of São Paulo[7],[8].
Figure 1 Roberto Melaragno Filho (1919–1998).Source: Paiva Melo[7].
Professor Melaragno together with Professor Luiz Augusto Franco de Andrande, from
Escola Paulista de Medicina (Universidade Federal de São Paulo) were the creators and first coordinators of the Brazilian Academy of Neurology working
group on extrapyramidal diseases, today, movement disorders scientific department.
On March 11th, 1985, in the city of São Paulo/SP, the group was created with the presence of several
neurologists and with the participation of an international guest, Professor Urpo
Rinne from Filand. In the following year, Professor Melaragno and Professor Franco
de Andrade organized an international symposium on movement disorders, that took place
in the cities of Rio de Janeiro and São Paulo, with the participation of Professor
C.D. Marsden (from the United Kingdom) and Professor Yves Agid (from France). Today
the Associação Paulista de Medicina awards Professor Roberto Melaragno Filho.
RELEVANT SCIENTIFIC CONTRIBUTIONS TO NEUROLOGY
RELEVANT SCIENTIFIC CONTRIBUTIONS TO NEUROLOGY
Melaragno published several scientific articles in Brazil, mainly in Arquivos de Neuro-Psiquiatria (the official journal of the Brazilian Academy of Neurology), and abroad, particularly
in France[9],[10],[11],[12],[13],[14],[15]. Initially, he published on general neurology, then made more frequent contributions
in the areas of cerebrovascular diseases and, later, neuroimmunology and multiple
sclerosis, including books on these topics[7],[8],[15]. Notable articles addressed cerebrovascular diseases, studies on the pharmacology
of cerebral circulation, thrombosis of the internal carotid artery, intracranial aneurysms,
and clinical hemorheology in the study of cerebral blood flow[12],[14]. In neuroimmunology he published articles on cerebrospinal fluid immunoglobulins
G in nervous system diseases[15], and on the topic of neuromuscular diseases, he addressed ocular myopathy, periodic
paralysis, and Charcot-Marie disease[10]. In the area of movement disorders, he published articles on cerebellar ataxias,
with one of the first descriptions of Pierre-Marie heredo-ataxia or spinocerebellar
degeneration (today known as spinocerebellar ataxia or SCAS) in Brazil[9] ([Figure 2]). He also published case reports about myoclonic cerebellar dyssynergy, Hallervorden-Spatz
syndrome, Parkinsonian disorders and dementia, and Parkinson disease, and was a pioneer
in the use of levodopa in Brazil[11],[13],[16]. He was also the author of several case reports in general neurology, particularly
in the Brazilian journal Arquivos de Neuro-Psiquiatria
[7],[8]. One of his most significant studies discussed gait disorders in patients with parkinsonian
disorders, presenting different subtypes of freezing[17].
Figure 2 Sam Mindlin & Melaragno's paper about spinocerebellar ataxias published in 1943.Source:
reproduced from reference [9].
INTERNSHIP IN PARIS WITH RAYMOND GARCIN
INTERNSHIP IN PARIS WITH RAYMOND GARCIN
During the two years he interned at the School of Medicine of Paris under Raymond
Garcin, Melaragno published important studies that allowed him to obtain the title
of Foreign Assistant[7],[8]. He studied motor phenomena that can occur in movement disorders syndromes, particularly
parkinsonian disorders, assessing the “kinetic restraint” (“enrayage cinétique”) of the gait, characterized by the presence of a gait disorder, or the occurrence
of quick steps in the same place during movement (“signe de piétinement,” “trampling sign”). Another gait disorder he studied was defined as “bégaiement de la mise en route,” currently considered a gait block or freezing, which tends to occur in parkinsonian
patients. Another topic discussed in the same article was perseverance or tonic innervation,
in which patients exhibit a sudden inhibition during voluntary movements, with their
limbs frozen for seconds in bizarre positions. In Melaragno's time, this phenomenon
was considered an extreme manifestation of bradykinesia and was related to motor blocks
or freezing, as it is currently defined[17].
Professor Roberto Melaragno Filho is recognized as one of Brazil's most important
professors of neurology and made major contributions to solidify neurology as a specialty
in the state of São Paulo and across the country[7],[8]. His scientific publications in Brazil and abroad were relevant in several different
areas of neurology, combined with his presence in domestic and international professional
congresses, led the late Dr. Antonio Spina-França to describe him as an world ambassador
for Brazilian neurology[7].
