RESUMO
OBJECTIVE: Compare the effectiveness of active and sham transcranial direct current stimulation (tDCS) during the training of a dual task in children with spastic cerebral palsy (CP). METHODS: Thirty children with CP were submitted to ten sessions of either active (n = 15) or sham (n = 15) tDCS over the motor cortex for 20 minutes during the training of a dual task. Pre-intervention, post-intervention and follow-up evaluations involved measures of functional performance, intellectual performance, functional mobility and cortical excitability. RESULTS: The combination of active tDCS and dual task training led to improvements in functional mobility as well as functional and intellectual performances one month after the end of the intervention. CONCLUSION: The combination of active tDCS and dual task training demonstrated promising effects for children with spastic CP.
Assuntos
Paralisia Cerebral , Córtex Motor , Estimulação Transcraniana por Corrente Contínua , Humanos , Criança , Projetos Piloto , Método Duplo-Cego , Córtex Motor/fisiologiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Ânus/cirurgia , Neoplasias do Ânus/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Neoplasias do Colo/cirurgia , Neoplasias do Colo/patologia , Melanoma/cirurgia , Melanoma/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Primárias Múltiplas/patologiaRESUMO
The current priority of investigations involving transcranial direct current stimulation (tDCS) and neurorehabilitation is to identify biomarkers associated with the positive results of the interventions such that respondent and non-respondent patients can be identified in the early phases of treatment. The aims were to determine whether: (1) present motor evoked potential (MEP); and (2) injuries involving the primary motor cortex, are associated with tDCS-enhancement in functional outcome following gait training in children with cerebral palsy (CP). We reviewed the data from our parallel, randomized, sham-controlled, double-blind studies. Fifty-six children with spastic CP received gait training (either treadmill training or virtual reality training) and tDCS (active or sham). Univariate and multivariate logistic regression analyses were employed to identify clinical, neurophysiologic and neuroanatomic predictors associated with the responsiveness to treatment with tDCS. MEP presence during the initial evaluation and the subcortical injury were associated with positive effects in the functional results. The logistic regression revealed that present MEP was a significant predictor for the six-minute walk test (6MWT; p = 0.003) and gait speed (p = 0.028), whereas the subcortical injury was a significant predictor of gait kinematics (p = 0.013) and gross motor function (p = 0.021). In this preliminary study involving children with CP, two important prediction factors of good responses to anodal tDCS combined with gait training were identified. Apparently, MEP (integrity of the corticospinal tract) and subcortical location of the brain injury exerted different influences on aspects related to gait, such as velocity and kinematics.
Assuntos
Adenocarcinoma , Neoplasias do Ânus , Neoplasias do Colo , Melanoma , Neoplasias Primárias Múltiplas , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/cirurgia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Humanos , Masculino , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgiaRESUMO
Vitamin B12 or cyanocobalamin is an important substance that is included in several metabolic pathways. Its deficiency is a common event after bariatric surgery, decreasing the vitamin B12 absorption after almost all of the stomach and duodenum are eliminated from the digestion process. Neurological manifestations of cyanocobalamin deficiency are not uncommon. We report a case of a young woman who developed ataxia, weakness and peripheral neuropathy after bariatric surgery, but with normal value of vitamin B12 dosage. For the diagnosis, it was necessary to dose methylmalonic acid. We discuss the importance of methylmalonic acid dosage after bariatric surgery in patients who present suspect of cyanocobalamin deficiency with normal values of this vitamin and the role of proton pump inhibitor use and vitamin supplementation in patients with early neurological presentation.