Estimulação Transcraniana para Transtornos do Sono: uma revisão sistemática / Transcranial Stimulation in Sleep Disorders: a systematic review / Estimulación Transcraneal para los Trastornos del Sueño: una revisión sistemática

Os transtornos do sono podem ter várias consequências para a cognição, comportamento e vida social das pessoas. No entanto, a terapia utilizada para avaliar e intervir nesses transtornos ainda não está consolidada. Nesse contexto, o objetivo deste estudo foi verificar a aplicabilidade e eficácia da estimulação transcraniana (ETCA / ETCC / EMTr) nos transtornos do sono. Foi realizada uma busca sistemática de acordo com as diretrizes do PRISMA nas bases de dados Web of Science, PubMed, LILACS e SciELO. Inicialmente, foram encontrados 448 artigos, de acordo com os critérios de elegibilidade. O banco de dados de evidências de fisioterapia (PEDro) foi utilizado para avaliar a qualidade metodológica dos 11 artigos finais. Em geral, os resultados indicam que há tanto relatos favoráveis quanto desfavoráveis à eficácia do uso terapêutico das técnicas de estimulação transcraniana nos transtornos do sono e, portanto, ainda se configura como uma questão em aberto, dependendo de múltiplos fatores metodológicos e conceituais.

Sleep disorders can have several consequences on people's cognition, behavior and social life. However, the therapy used to assess and intervene in these disorders is not yet consolidated. In this context, the aim of this study was to verify the applicability and effectiveness of transcranial stimulation (tACS / tDCS / rTMS) in sleep disorders. A systematic search was performed according to PRISMA guidelines in the Web of Science, PubMed, LILACS, and SciELO databases. Initially, 448 articles were found, according to the eligibility criteria. The physiotherapy evidence database (PEDro) was used to assess the methodological quality of the 11 final articles. In general, the results indicate that there are both favorable and unfavorable reports on the effectiveness of the therapeutic use of transcranial stimulation techniques in sleep disorders and, therefore, it is still an open question, depending on multiple methodological and conceptual factors.

Trastornos del sueño pueden tener varias consecuencias para la cognición, el comportamiento y la vida social de las personas. La terapia utilizada para evaluar e intervenir en estos trastornos aún no está consolidada. En este contexto, el objetivo de este estudio fue verificar la aplicabilidad y efectividad de la estimulación transcraneal (ETCA / ETCC / EMTr) en los trastornos del sueño. Se realizó una búsqueda sistemática según las guías PRISMA en las bases de datos Web of Science, PubMed, LILACS y SciELO. Inicialmente se encontraron 448 artículos, según los criterios de elegibilidad. Se utilizó la base de datos PEDro para evaluar la calidad metodológica de los 11 artículos finales. En general, los resultados indican que existen informes tanto favorables como desfavorables sobre la efectividad del uso terapéutico de las técnicas de estimulación transcraneal en los trastornos del sueño y, por tanto, sigue siendo una cuestión abierta, dependiendo de múltiples factores metodológicos y conceptuales.

Association of low-dose naltrexone and transcranial direct current stimulation in fibromyalgia: a randomized, double-blinded, parallel clinical trial

Abstract Introduction Fibromyalgia is a complex, generalized, and diffuse chronic musculoskeletal pain. Pharmacological approaches are widely used to relieve pain and increase quality of life. Low-Dose Naltrexone (LDN) was shown to increase the nociceptive threshold in patients with fibromyalgia. Transcranial Direct Current Stimulation (tDCS) is effective for pain management. Objective The purpose of this study was to evaluate the analgesic and neuromodulatory effects of a combination of LDN and tDCS in patients with fibromyalgia. Methods This was a randomized, double-blinded, parallel, placebo/sham-controlled trial (NCT04502251; RBR-7HK8N) in which 86 women with fibromyalgia were included, and written informed consent was obtained from them. The patients were allocated into four groups: LDN + tDCS (n = 21), LDN + tDCS Sham (n = 22), placebo + tDCS (n = 22), and placebo+tDCS Sham (n = 21). The LDN or placebo (p.o.) intervention lasted 26 days; in the last five sessions, tDCS was applied (sham or active, 20 min, 2 mA). The following categories were assessed: sociodemographic, Visual Analog Pain Scale (VAS), Pain Catastrophizing Scale (PCS), State-Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI-II), Profile of Chronic Pain Scale (PCP:S), Pain Pressure Threshold (PPT), and Conditioned Pain Modulation (CPM). Blood samples were collected to analyze BDNF serum levels. Results At baseline, no significant difference was found regarding all measurements. VAS pain was significantly reduced in the LDN + tDCS (p = 0.010), LDN + tDCS Sham (p= 0.001), and placebo+tDCS Sham (p= 0.009) groups. In the PCP:S, the LDN+tDCS group showed reduced pain frequency and intensity (p= 0.001), effect of pain on activities (p= 0.014) and emotions (p= 0.008). Depressive symptoms reduced after all active interventions (p > 0.001). Conclusion Combined LDN+tDCS has possible benefits in reducing pain frequency and intensity; however, a placebo effect was observed in pain using VAS, and further studies should be performed to analyze the possible association.

Neural Mechanism Underlying Task-Specific Enhancement of Motor Learning by Concurrent Transcranial Direct Current Stimulation / 神经科学通报·英文版

The optimal protocol for neuromodulation by transcranial direct current stimulation (tDCS) remains unclear. Using the rotarod paradigm, we found that mouse motor learning was enhanced by anodal tDCS (3.2 mA/cm2) during but not before or after the performance of a task. Dual-task experiments showed that motor learning enhancement was specific to the task accompanied by anodal tDCS. Studies using a mouse model of stroke induced by middle cerebral artery occlusion showed that concurrent anodal tDCS restored motor learning capability in a task-specific manner. Transcranial in vivo Ca2+ imaging further showed that anodal tDCS elevated and cathodal tDCS suppressed neuronal activity in the primary motor cortex (M1). Anodal tDCS specifically promoted the activity of task-related M1 neurons during task performance, suggesting that elevated Hebbian synaptic potentiation in task-activated circuits accounts for the motor learning enhancement. Thus, application of tDCS concurrent with the targeted behavioral dysfunction could be an effective approach to treating brain disorders.

Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward / 神经科学通报·英文版

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.

Efeitos da estimulação transcraniana por corrente contínua (ETCC) na voz e fala na doença de Parkinson: relato de caso / Effects of transcranial direct current stimulation (tDCS) on voice and speech in Parkinson's disease: a case report

RESUMO Este estudo descreve os resultados de duas intervenções diferentes para a disartria na doença de Parkinson (DP). Trata-se de dois pacientes do sexo masculino com DP e disartria hipocinética que foram submetidos à avaliação fonoaudiológica. O primeiro (S1) recebeu dez sessões de 20 minutos de estimulação transcraniana por corrente contínua (ETCC), enquanto o segundo (S2) recebeu dez sessões de 20 minutos de ETCC e terapia fonoaudiológica. Os pacientes foram reavaliados imediatamente após a intervenção e novamente após 30 dias. A melhora no tempo de fonação, movimento velar e outras medidas de disartria foram mais significativas no S1. De acordo com os parâmetros da análise acústica de fonte glótica, a melhora nas medidas de frequência e Jitter, Shimmer e ruído foi maior no S2 tanto na avaliação pós-intervenção imediata quanto na avaliação 30 dias pós-intervenção, seguida por S1 na avaliação pós-intervenção imediata. S1 apresentou melhores resultados na avaliação perceptivo-auditiva de fala e voz, enquanto S2 obteve melhores escores na análise acústica. Esses achados sugerem que a terapia fonoaudiológica convencional associada à ETCC tem um impacto mais significativo na fala e voz do que a ETCC isolada, demonstrando o potencial da ETCC como tratamento complementar para pacientes com DP.

ABSTRACT This study describes the results of two different interventions for dysarthria in Parkinson's disease (PD). It concerns two male patients with PD and hypokinetic dysarthria who underwent speech and voice assessment. The first (S1) received ten 20-minute sessions of transcranial direct current stimulation (tDCS), while the second (S2) received ten 20-minute sessions of tDCS as well as speech therapy. The patients were re-evaluated immediately after the intervention and again after 30 days. Improvements in phonation time, velar movement, and other measures of dysarthria were more significant in S1. According to the acoustic analysis source parameters, improvements in the frequency measurements and Jitter, Shimmer, and noise measurements were greater in S2 in both the immediate post-intervention and 30-day postintervention assessments, followed by S1 in the immediate post-intervention assessment. S1 showed better results in the auditory-perceptual evaluation of speech and voice, whereas S2 obtained better scores in acoustic analysis. These findings suggest that conventional speech therapy combined with tDCS has a more significant impact on speech and voice than tDCS alone, demonstrating the potential of tDCS as an adjuvant treatment for patients with PD.

Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . Methods: In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. Results: The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (P=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant (P(3 d)=0.045, 0.032, P(7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (P=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (P=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (P=0.013) . Conclusion: The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.

Effects of transcranial direct current stimulation on event-related potentials of mental rotation / 生物医学工程学杂志

There are few researches on the modulation effect of transcranial direct current stimulation(tDCS) on complex spatial cognition. Especially, the influence of tDCS on the neural electrophysiological response in spatial cognition is not yet clear. This study selected the classic spatial cognition task paradigm (three-dimensional mental rotation task) as the research object. By comparing the changes in behavior and event-related potentials in different modes of tDCS before, during and after the application of tDCS, this study analyzed the behavioral and neurophysiological effects of tDCS on mental rotation. The comparison between active-tDCS and sham-tDCS showed no statistically significant difference in behavior between different stimulation modes. Still, the changes in the amplitudes of P2 and P3 during the stimulation were statistically significant. Compared with sham-tDCS, the amplitudes of P2 and P3 in active-tDCS mode showed a greater decrease during the stimulation. This study clarifies the influence of tDCS on the event-related potentials of the mental rotation task. It shows that tDCS may improve the brain information processing efficiency during the mental rotation task. Also, this study provides a reference for an in-depth understanding and exploration of the modulation effect of tDCS on complex spatial cognition.

O uso da estimulação transcraniana como tratamento na reabilitação motora de criança com paralisia cerebral - projeto de estudo de caso / El uso de la estimulación transcraneal como tratamiento en la rehabilitación motora de un niño con parálisis cerebral -un proyecto de estudio de caso / The use of transcranial stimulation as a treatment in the motor rehabilitation of a child with cerebral palsy -a case study projec

RESUMO A Paralisia Cerebral (PC) também denominada como encefalopatia crônica não-progressiva da infância é consequência de lesões não progressivas que aconteceram no cérebro imaturo no período pré, peri ou pós-natal, afetando o sistema nervoso central em fase de maturação estrutural e funcional. O presente trabalho trata-se de um estudo de caso com características de Pesquisa Experimental, Intervencional, onde foi realizado um protocolo de duas sessões semanais, com tempo de atendimento de 40 minutos, num total de 20 (vinte) sessões. O protocolo terapêutico consistiu de estimulação transcraniana e teve como objetivo geral investigar os efeitos da ETCC, associada à cinesioterapia e ativação dos neurônios espelhos, na reabilitação de uma criança com paralisia cerebral, sexo masculino, 54 meses de idade cronológica, grau moderado de hipotonia muscular em membros inferiores, movimentos voluntários com debilidade de força muscular; escoliose dorso-lombar e pontuação zero na Escala de Mobilidade Funcional e Asworth Modificada. O Sistema de Classificação da Função Motora Grossa (GMFCS) apresentou-se com classificação nível V, limitação na habilidade de manter as posturas anti-gravitacionais da cabeça e tronco e de controlar os movimentos de braços e pernas. Índice de Barthel Modificado com pontuação 11- classificação de dependência severa. A escala Denver II com prejuízos significativos nos domínios: pessoal-social, motor fino adaptativo, linguagem e motor grosso.

RESUMEN La parálisis cerebral (PC) también denominada como encefalopatía crónica no progresiva de la infancia es consecuencia de lesiones no progresivas que ocurrieron en el cerebro inmaduro en el periodo pre, peri o post-natal, afectando el sistema nervioso central en la fase de maduración estructural y funcional. El presente trabajo trata de un estudio de caso con características de investigación experimental, intervencional, donde fue realizado un protocolo de dos sesiones semanales de cuarenta minutos, con un total de veinte (20) sesiones. El protocolo terapéutico consistió en una estimulación transcraniana y tuvo como objetivo general, investigar los efectos de la ETCC, asociada a la cinesioterapia y activación de las neuronas espejo, en la rehabilitación de un niño con parálisis cerebral de 54 meses de edad cronológica, grado moderado de hipertonía muscular en miembros inferiores, movimientos voluntarios con debilidad de fuerza muscular; escoliosis dorsolumbar y puntuación cero en la escala de Movilidad Fun.

ABSTRACT Cerebral Palsy (CP) also known as chronic non-progressive encephalopathy of childhood is a consequence of non-progressive lesions that occurred in the immature brain in the pre, peri or postnatal period, affecting the central nervous system in a phase of structural maturation and functional. The present work is a case study with characteristics of Experimental, Interventional Research, where a protocol of two weekly sessions was carried out, with a service time of 40 minutes, in a total of 20 (twenty) sessions. The therapeutic protocol consisted of transcranial stimulation and aimed to investigate the effects of tDCS, associated with kinesiotherapy and activation of mirror neurons, in the rehabilitation of a 54-month-old male child with cerebral palsy, moderate degree of muscular hypotonia in the lower limbs, voluntary movements with weak muscular strength; dorsolumbar scoliosis and zero score on the Functional Mobility and Modified Asworth Scale. The Gross Motor Function Classification System (GMFCS) has a level V classification, limiting the ability to maintain antigravity postures of the head and trunk and to control arm and leg movements. Modified Barthel Index with score 11- severe dependency rating. The Denver II scale with significant impairments in the following domains: personal-social, adaptive fine motor, language and gross motor.

Combining electroacupuncture and transcranial direct current stimulation as an adjuvant therapy enhances spontaneous conversation and naming in subacute vascular aphasia: A retrospective analysis / 中西医结合学报

OBJECTIVE@#Emerging evidence shows the effectiveness of speech and language therapy (SLT); however, precise therapeutic parameters remain unclear. Evidence for the use of adjunctive transcranial direct current stimulation (tDCS) to treat post-stroke aphasia (PSA) is promising; however, the utility of combining tDCS and electroacupuncture (EA) has not yet been analyzed. This study assessed the therapeutic consequences of EA and tDCS coupled with SLT in subacute PSA patients who were also undergoing hyperbaric oxygen therapy (HBOT).@*METHODS@#A retrospective analysis was conducted on subacute (< 6 months) PSA patients who were divided into three groups: patients who received EA plus tDCS (acupuncture group), patients who underwent tDCS (tDCS group), and patients who experienced conventional therapy (HBOT + SLT). All subjects underwent 21 days of treatment and also received conventional treatment. The aphasia battery of Chinese (ABC) was used to score pre- and post-intervention status.@*RESULTS@#The analysis comprised 238 patients. Cerebral infarction was the most frequent stroke type (137 [57.6%]), while motor (66 [27.7%]) and global aphasia (60 [25.2%]) were the most common types of aphasia. After 21 days of intervention, the ABC scores of all patients were improved. The acupuncture group had the highest ABC scores, but only repetition, naming, and spontaneous speech were statistically improved (P < 0.01). Post-hoc tests revealed significant improvement in word retrieval in the acupuncture and tDCS groups (P < 0.01, P = 0.037), while the acupuncture group had additional significant improvement in spontaneous conversation (P < 0.01).@*CONCLUSION@#Combining acupuncture and tDCS as an adjuvant therapy for subacute PSA led to significant spontaneous speech and word retrieval improvements. Future prospective, multi-ethnic, multi-center trials are warranted.

Phase amplitude coupling analysis of local field potentials in working memory of rats affected by transcranial magneto-acoustic-electrical stimulation / 生物医学工程学杂志

Transcranial magneto-acoustic-electrical stimulation is a new non-invasive neuromodulation technology, in which the induced electric field generated by the coupling effect of ultrasound and static magnetic field are used to regulate the neural rhythm oscillation activity in the corresponding brain region. The purpose of this paper is to investigate the effects of transcranial magneto-acoustic-electrical stimulation on the information transfer and communication in neuronal clusters during memory. In the experiment, twenty healthy adult Wistar rats were randomly divided into a control group (five rats) and stimulation groups (fifteen rats). Transcranial magneto-acoustic-electrical stimulation of 0.05~0.15 T and 2.66~13.33 W/cm 2 was applied to the rats in stimulation groups, and no stimulation was applied to the rats in the control group. The local field potentials signals in the prefrontal cortex of rats during the T-maze working memory tasks were acquired. Then the coupling differences between delta rhythm phase, theta rhythm phase and gamma rhythm amplitude of rats in different parameter stimulation groups and control group were compared. The experimental results showed that the coupling intensity of delta and gamma rhythm in stimulation groups was significantly lower than that in the control group ( P<0.05), while the coupling intensity of theta and gamma rhythm was significantly higher than that in the control group ( P<0.05). With the increase of stimulation parameters, the degree of coupling between delta and gamma rhythm showed a decreasing trend, while the degree of coupling between theta and gamma rhythm tended to increase. The preliminary results of this paper indicated that transcranial magneto-acoustic-electrical stimulation inhibited delta rhythmic neuronal activity and enhanced the oscillation of theta and gamma rhythm in the prefrontal cortex, thus promoted the exchange and transmission of information between neuronal clusters in different spatial scales. This lays the foundation for further exploring the mechanism of transcranial magneto-acoustic-electrical stimulation in regulating brain memory function.

The measurements of the similarity of dynamic brain functional network / 生物医学工程学杂志

Brain functional network changes over time along with the process of brain development, disease, and aging. However, most of the available measurements for evaluation of the difference (or similarity) between the individual brain functional networks are for charactering static networks, which do not work with the dynamic characteristics of the brain networks that typically involve a long-span and large-scale evolution over the time. The current study proposes an index for measuring the similarity of dynamic brain networks, named as dynamic network similarity (DNS). It measures the similarity by combining the "evolutional" and "structural" properties of the dynamic network. Four sets of simulated dynamic networks with different evolutional and structural properties (varying amplitude of changes, trend of changes, distribution of connectivity strength, range of connectivity strength) were generated to validate the performance of DNS. In addition, real world imaging datasets, acquired from 13 stroke patients who were treated by transcranial direct current stimulation (tDCS), were used to further validate the proposed method and compared with the traditional similarity measurements that were developed for static network similarity. The results showed that DNS was significantly correlated with the varying amplitude of changes, trend of changes, distribution of connectivity strength and range of connectivity strength of the dynamic networks. DNS was able to appropriately measure the significant similarity of the dynamics of network changes over the time for the patients before and after the tDCS treatments. However, the traditional methods failed, which showed significantly differences between the data before and after the tDCS treatments. The experiment results demonstrate that DNS may robustly measure the similarity of evolutional and structural properties of dynamic networks. The new method appears to be superior to the traditional methods in that the new one is capable of assessing the temporal similarity of dynamic functional imaging data.

Effects of transcranial magneto-acoustic electrical stimulation on calcium signals in prefrontal nerve clusters / 生物医学工程学杂志

Transcranial magneto-acoustic electrical stimulation (TMAES) is a novel method of brain nerve regulation and research, which uses induction current generated by the coupling of ultrasound and magnetic field to regulate neural electrical activity in different brain regions. As the second special envoy of nerve signal, calcium plays a key role in nerve signal transmission. In order to investigate the effect of TMAES on prefrontal cortex electrical activity, 15 mice were divided into control group, ultrasound stimulation (TUS) group and TMAES group. The TMAES group received 2.6 W/cm 2 and 0.3 T of magnetic induction intensity, the TUS group received only ultrasound stimulation, and the control group received no ultrasound and magnetic field for one week. The calcium ion concentration in the prefrontal cortex of mice was recorded in real time by optical fiber photometric detection technology. The new object recognition experiment was conducted to compare the behavioral differences and the time-frequency distribution of calcium signal in each group. The results showed that the mean value of calcium transient signal in the TMAES group was (4.84 ± 0.11)% within 10 s after the stimulation, which was higher than that in the TUS group (4.40 ± 0.10)% and the control group (4.22 ± 0.08)%, and the waveform of calcium transient signal was slower, suggesting that calcium metabolism was faster. The main energy band of the TMAES group was 0-20 Hz, that of the TUS group was 0-12 Hz and that of the control group was 0-8 Hz. The cognitive index was 0.71 in the TMAES group, 0.63 in the TUS group, and 0.58 in the control group, indicating that both ultrasonic and magneto-acoustic stimulation could improve the cognitive ability of mice, but the effect of the TMAES group was better than that of the TUS group. These results suggest that TMAES can change the calcium homeostasis of prefrontal cortex nerve clusters, regulate the discharge activity of prefrontal nerve clusters, and promote cognitive function. The results of this study provide data support and reference for further exploration of the deep neural mechanism of TMAES.

Research on electroencephalogram power spectral density of stroke patients under transcranial direct current stimulation / 生物医学工程学杂志

Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.

Estimulação elétrica transcraniana nos transtornos depressivos: determinação de parâmetros para a prática clínica / Effectiveness of transcranial electric stimulation in depressive disorders: parameters determination for clinical practice

A estimulação elétrica transcraniana (EET) é uma técnica de neuromodulação não invasiva, que tem sido utilizada como coadjuvante no tratamento de transtornos depressivos devido à sua capacidade de modificar a excitabilidade cortical. Objetivo: Analisar os efeitos da EET nos transtornos depressivos e propor parâmetros para a prática clínica. Métodos: Estudo de revisão sistemática no qual foram incluídos ensaios clínicos randomizados que utilizaram a EET no tratamento dos transtornos depressivos, publicados entre 2010 e junho de 2018, nas línguas inglesa e portuguesa. Resultados: Foram encontrados 14.775 estudos, sendo selecionados para a amostra apenas 15 trabalhos. Todos os estudos selecionados utilizaram a EET por corrente contínua e apresentaram semelhanças em relação aos demais parâmetros elétricos de tratamento e locais de aplicação dos eletrodos. Em 12 dos 15 estudos avaliados foi observada melhora significativa (p < 0,05) dos sintomas depressivos e, em relação aos efeitos adversos, constatou-se que são inferiores aos tratamentos convencionais. Conclusão: A EET apresenta eficácia no tratamento dos transtornos depressivos e que isto está diretamente relacionado ao uso adequado dos parâmetros e técnicas de aplicação da corrente elétrica. (AU)

O uso da estimulação transcraniana por corrente contínua em crianças com paralisia cerebral: uma revisão sistemática / The use of transcranial direct current stimulation in children with cerebral palsy: a systematic review

Estimulação Transcraniana por Corrente Contínua (ETCC) é um recurso terapêutico não invasivo ao paciente, de baixo custo, baseado na alteração da excitabilidade do córtex motor. Técnica capaz de influenciar no mecanismo autônomo do SNC, aumentando a eficiência sináptica e favorecendo o aprendizado motor. Objetivo: Sistematizar evidências científicas sobre a ETCC como recurso terapêutico no processo de reabilitação de crianças com paralisia cerebral. Métodos: Revisão sistematizada seguindo recomendações do PRISMA e a busca estratégica PICO diante da indicação da ETCC, como recurso terapêutico no processo de reabilitação de crianças com paralisia cerebral. Incluídos ensaios clínicos controlados e randomizados, publicados nos últimos 10 anos, disponíveis em cinco relevantes bases de dados em saúde nos idiomas inglês, espanhol e português. Resultados: Foram encontrados 604 estudos, dos quais, após aplicação dos critérios de elegibilidade, quatro deles foram selecionados. Os resultados de tais estudos se mostraram benéficos no tratamento de crianças com paralisia cerebral, incluindo aquelas com mais de 70% de presença de espasticidade. Conclusão: ETCC constitui recurso promissor no tratamento da criança com paralisia cerebral, aceito pelas crianças visto ser indolor e apresentar reações leves como vermelhidão e formigamento no local da aplicação. Os efeitos favoráveis destacados foram: melhora no desempenho funcional e da marcha. (AU)

Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

Estimulação transcraniana por corrente contínua para melhorar o desempenho matemático em crianças discalculia de desenvolvimento em idade escolar: um único grupo pré-teste-pós-teste, estudo quase experimental / Transcranial direct current stimulation to enhance mathematical performance in school going developmental dyscalculic children: A single group pretest-posttest, quasi experimental study

INTRODUÇÃO: A discalculia do desenvolvimento (DD) lida com o desempenho matemático prejudicado e afeta as atividades educacionais e do dia a dia das crianças. Há evidências de que a estimulação transcraniana por corrente contínua (ETCC) aplicada ao córtex parietal posterior facilita a estrutura neuronal hipoativa e melhora o desempenho matemático em indivíduos com DD. OBJETIVO: O objetivo deste estudo é investigar se tDCS adjuvante com treinamento convencional de numeramento (CNT) aumentaria as habilidades matemáticas de crianças em idade escolar afetadas com DD. MATERIAIS E MÉTODOS: Treze crianças em idade escolar afetadas com DD receberam tDCS e CNT três sessões por semana por até 2 semanas. Foi dada estimulação anódica esquerda e catódica direita na região P3 / P4, com intensidade de 2mA, combinada com CNT por 30 minutos em um dia. O inventário de diagnóstico de deficiência de aprendizagem (LDDI) foi usado como uma medida de resultado e coletado no início e no final da intervenção de 2 semanas. RESULTADOS: Houve melhora significativa no desempenho matemático de crianças em idade escolar. Os resultados mostram uma melhora estatística e clinicamente significativa após 2 semanas de intervenção. CONCLUSÕES: tDCS combinado com CNT é eficaz para melhorar as habilidades matemáticas de crianças em idade escolar afetadas com DD. Os resultados deste estudo fornecem uma nova perspectiva para a reabilitação de crianças com DD em idade escolar.

INTRODUCTION: Developmental dyscalculia (DD) deals with impaired mathematical performance and affects children's educational and day-to-day activities. There is evidence that transcranial direct current stimulation (tDCS) applied to the posterior parietal cortex facilitates the hypoactive neuronal structure and improves mathematical performance in individuals with DD. OBJECTIVE: The objective of this study is to investigate whether tDCS adjuvant with conventional numeracy training (CNT) would enhance the mathematical abilities of school-going children affected with DD. MATERIALS AND METHODS: Thirteen school-going children affected with DD received tDCS and CNT three sessions per week for up to 2 consecutive weeks. Left anodal and right cathodal stimulation at P3/P4 region with 2mA intensity combined with CNT for 30 minutes in a day was given. Learning disability diagnostic inventory (LDDI) was used as an outcome measure and collected at baseline and the end of the 2-week intervention. RESULTS: There was a significant improvement in the mathematical performance of school-going children. The results show statistically as well as a clinically significant improvement after the two weeks of intervention. CONCLUSIONS: tDCS combined with CNT effectively improves the mathematical abilities of school-going children affected with DD. The findings of this study provide a new perspective for the rehabilitation of school-going DD children.

Prison research: a bioethics or an ethics issue? / Investigación en prisión: ¿una cuestión de bioética o de ética? / Investigação em contexto prisional: Um questão de bioética ou de ética?

Abstract: The hypothesis of reducing aggressiveness through transcranial direct current stimulation was recently tested on a cohort of inmates in Spain. The experiment, including 1.5 mA electric shocks, was an external research initiative that received the initial acquiescence of the carceral system. An alarm was raised at the time the research was published, encouraging the directorate of prisons to stop the ongoing replication of the experiment. Nevertheless, no (bio)ethics committee, in the universities or among bioethics experts, has questioned the research. In this think piece, we aim to again discuss some ethical approaches to these clinical interventions on crime. After its positivistic period, the field of criminology has been questioning the simple psychobiological approach to crime because of the reductionistic view of this phenomenon and its harmful consequences. Thus, we address academic experimentation under prison governance and the "re" roles of prisons. We argue that the minor disadvantages of such research, if performed with consent, could be positive if the research can minimize the harmfulness of prison itself; thus, penitentiary treatment and science should go together. Prison administrations, in addition to their duty to protect the individuals under their control from ethically biased research, must promote reintegration. We conclude that human rights are over criminal policy and science and that ethics are over narrower bioethics.

Resumen: La hipótesis de la reducción de la agresividad por medio de estimulaciones transcraneales ha sido recientemente testada sobre encarcelados en España. El experimento, que incluyó descargas eléctricas de 1.5mA, fue una iniciativa de investigadores externos que encontró la aquiescencia inicial del sistema carcelario. La alarma surgió en el momento en que se publicó la investigación, alentando a la dirección de las prisiones a detener la replicación del experimento. Sin embargo, hasta entonces, ningún comité encontró ningún inconveniente, ni en las universidades ni entre expertos en bioética. En este artículo de reflexión pretendemos argumentar algunos enfoques éticos de estas intervenciones clínicas sobre la delincuencia. De nuevo, ya que la criminología, después de su periodo positivista, ha venido cuestionado el mero enfoque psicobiológico de la delincuencia. Así, abordamos el experimento académico dentro de la gobernanza penitenciaria y los roles "re" de las prisiones. Argumentamos que no es tanto que no se pueda investigar con internos, sino que posibles inconvenientes de tales investigaciones puedan servir, bajo consentimiento, para minimizar los inconvenientes de la misma pena de prisión. La administración, además del deber de proteger a sus individuos de investigaciones éticamente sesgadas ha de fomentar la reintegración. Concluimos que los derechos humanos han de estar por encima de la política criminal y de la ciencia, y la ética por encima de una más limitada bioética.

Resumo: A hipótese de diminuir a agressividade através da estimulação elétrica transcraniana foi recentemente testada num grupo de reclusos em Espanha. A experiência, que incluiu choques elétricos de 1,5mA, partiu de uma iniciativa de investigadores externos que encontraram a aquiescência no sistema prisional. O alarme surgiu no momento em que a investigação foi publicada, o que levou a direção administrativa das prisões a interromper a replicação do estudo. No entanto, até ao momento, nenhuma comissão de (bio)ética encontrou qualquer inconveniente, nem nas universidades, nem entre os especialistas em bioética. Com este artigo, pretendemos discutir algumas abordagens éticas dessas intervenções clínicas no crime. A criminologia tem vindo a questionar, após o seu período de investigação positivista, a abordagem psicobiológica do crime, devido à visão redutora desse fenómeno e das suas consequências nefastas. Assim, neste artigo, abordamos a experiência académica dentro da governança prisional e os fins da prisão. Concluímos que as pequenas desvantagens da investigação seriam positivas se pudessem, sob consentimento, minimizar os malefícios da própria prisão, o que significa que o tratamento penitenciário e a ciência deveriam andar 'de mãos dadas'. A administração das prisões, para além do dever de proteger os indivíduos de estudos que acarretem problemas éticos, deve promover a reintegração. Concluímos, assim, que os direitos humanos estão acima da política e da ciência criminais, e a ética acima da bioética mais restrita.