Motor Stimulation Research Articles

Selecting stimulation intensity in repetitive transcranial magnetic stimulation studies: A systematic review between 1991 and 2020.

Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used, non-invasive brain stimulation technique in neuroscience research and clinical practice with a broad spectrum of suggested applications. Among other parameters, the choice of stimulus intensity and intracranial electric field strength substantially impacts rTMS outcome. This review provides a systematic overview of the intensity selection approaches and stimulation intensities used in human rTMS studies. We also examined whether studies report sufficient information to reproduce stimulus intensities for basic science research models. We performed a systematic review by focusing on original studies published between 1991 and 2020. We included conventional (e.g., 1 or 10Hz) and patterned protocols (e.g., continuous or intermittent theta burst stimulation). We identified 3,784 articles in total, and we manually processed a representative portion (20%) of randomly selected articles. The majority of the analyzed studies (90% of entries) used the motor threshold (MT) approach and stimulation intensities from 80% to 120% of the MT. For continuous and intermittent theta burst stimulation, the most frequent stimulation intensity was 80% of the active MT. Most studies (92% of entries) did not report sufficient information to reproduce the stimulation intensity. Only a minority of studies (1.03% of entries) estimated the rTMS-induced electric field strengths. We formulate easy-to-follow recommendations to help scientists and clinicians report relevant information on stimulation intensity. Future standardized reporting guidelines may facilitate the use of basic science approaches aiming at better understanding the molecular, cellular, and neuronal mechanisms of rTMS.

Modulated in vitro lymphocytes in the treatment of alcoholism: Experimental study

IntroductionImmune cells are dysfunctional during long-term ethanol consumption and may contribute to the progression from healthy to problem drinking. Lymphocytes from mice with chronic ethanol exposure characterized by impaired functional activity, manifested in the combination of increased spontaneous proliferation against the background of low sensitivity to T- cell mitogens.ObjectivesWe first demonstrated that original compound meta-chloro-benzhydryl-urea (m-ch-BHU) in vitro restored long-term alcoholized mice lymphocytes activity through GABA(A) receptors. We also revealed the possibility of animal’s behavioral regulation by the transplantation of immune cells with definite functional characteristics, also modulated by psychoactive drugs. Based on the previous results we investigated effects of m-ch-BHU modulated lymphocytes transplantation in recipients with experimental alcoholism.MethodsMale (CBAxC57Bl/6)F1 mice with 6-month 10% ethanol exposure were undergoing the transplantation of syngeneic long-term alcoholized mice lymphocytes, pretreated in vitro with m-ch-BHU. Recipient’s ethanol consumption, nervous and immune systems functional activities were estimated.ResultsIt was shown that transplantation of lymphocytes with in vitro m-ch-BHU modulated functional activity caused in syngeneic recipients with chronic alcohol exposure essential ethanol consumption decrease and stimulation of motor and exploratory activities in the “open field” against the background of cytokines modulation in brain. The significant stimulation of humoral immune response, estimated by the relative number of antibody-forming spleen cells, and stimulation of DTH reaction were also detected in recipients after lymphocytes transplantation.ConclusionsResults demonstrated that transplantation of m-ch-BHU modulated lymphocytes caused positive psychoneuroimmunomodulating effect in animals with chronic alcohol exposure, so, it may be considered as a promising method in the treatment of alcoholismDisclosureNo significant relationships.

Physical Therapist Interventions for Infants With Nonsynostotic Positional Head Deformities: A Systematic Review.

This study sought to examine the methodological quality and summarize the evidence from clinical trials that examined the effectiveness of physical therapist interventions in the management of nonsynostotic positional head deformities in infants. The following electronic databases were searched: PubMed/MEDLINE, ScienceDirect, CINAHL, Scopus, PEDro, and Web of Science. Two different authors conducted the searches and completed the data extraction. Randomized and non-randomized clinical trials were included. The risk of bias was assessed using the Downs and Black Scale and the Cochrane Collaboration's tool. Six articles were finally included. The main features of interventions included education to parents about positioning, manual therapy, and motor stimulation. The small sample sizes were not adequately powered and methodological quality showed a high risk of bias, mainly from a lack of blinding and limited external validity. There are indicators that suggest that physical therapist interventions may be useful for infants with nonsynostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such conclusion is limited because most trials included had a high risk of bias. More rigorous research on physical therapy, including randomized controlled trials with larger sample sizes, is required in this area. The high prevalence and incidence of nonsynostotic positional head deformities in infants calls for the development of effective interventions. Physical therapists have a promising role in the improvement of cranial asymmetry and motor development. The most reported interventions involved educating parents about positioning and manual therapy. Some studies show that changes obtained after physical therapist intervention were comparable with those obtained after helmet therapy. Early referral to physical therapy may help to prevent or reduce the severity of nonsynostotic positional head deformities. Education about positioning is important to prevent and improve the asymmetry of the baby's head when there is nonsynostotic positional head deformity. Physical therapist interventions can improve motor development in infants with nonsynostotic positional head deformity who have motor delays.

Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial

BackgroundAlthough evidence has indicated a positive effect of transcranial direct current stimulation (tDCS) on reducing pain, few studies have focused on the elderly population with knee osteoarthritis (KOA). ObjectiveTo evaluate whether tDCS reduces KOA pain in elderly individuals with a dysfunctional descending pain inhibitory system (DPIS). MethodsIn a double-blind trial, individuals ≥ 60 years with KOA pain and a dysfunctional DPIS, we randomly assigned patients to receive 15 daily sessions of 2 mA tDCS over the primary motor cortex (anode) and contralateral supraorbital area (cathode) (M1-SO) for 20 min or sham tDCS. Change in pain perception indexed by the Brief Pain Inventory (BPI) at the end of intervention was the primary outcome. Secondary outcomes included: disability, quantitative sensory testing, pain pressure threshold and conditioned pain modulation (CPM). Subjects were followed-up for 2 months. ResultsOf the 104 enrolled subjects, with mean (SD) age of 73.9 (8.01) years and 88 (84.6%) female, 102 finished the trial. In the intention-to-treat analysis, the active tDCS group had a significantly greater reduction in BPI compared to the sham group (difference, 1.59; 95% CI, 0.95 to 2.23; P < 0.001; Cohen’s d, 0.58); and, also a significantly greater improvement in CPM-pressure in the knee (P = 0.01) and CPM-pain in the hand (P = 0.01). These effects were not sustained at follow-up. The intervention was well tolerated, with no severe adverse effects. ConclusionM1-SO tDCS is associated with a moderate effect size in reducing pain in elderly patients with KOA after 15 daily sessions of stimulation. This intervention has also shown to modulate the DPIS.

Behavioral Battery for Testing Candidate Analgesics in Mice. I. Validation with Positive and Negative Controls

This study evaluated a battery of pain-stimulated, pain-depressed, and pain-independent behaviors for preclinical pharmacological assessment of candidate analgesics in mice. Intraperitoneal injection of dilute lactic acid (IP acid) served as an acute visceral noxious stimulus to produce four pain-related behaviors in male and female ICR mice: stimulation of 1) stretching, 2) facial grimace, 3) depression of rearing, and 4) depression of nesting. Additionally, nesting and locomotion in the absence of the noxious stimulus were used to assess pain-independent drug effects. These six behaviors were used to compare effects of two mechanistically distinct but clinically effective positive controls (ketoprofen and oxycodone) and two negative controls that are not clinically approved as analgesics but produce either general motor depression (diazepam) or motor stimulation (amphetamine). We predicted that analgesics would alleviate all IP acid effects at doses that did not alter pain-independent behaviors, whereas negative controls would not. Consistent with this prediction, ketoprofen (0.1-32 mg/kg) produced the expected analgesic profile, whereas oxycodone (0.32-3.2 mg/kg) alleviated all IP acid effects except depression of rearing at doses lower than those that altered pain-independent behaviors. For the negative controls, diazepam (1-10 mg/kg) failed to block IP acid-induced depression of either rearing or nesting and only decreased IP acid-stimulated behaviors at doses that also decreased pain-independent behaviors. Amphetamine (0.32-3.2 mg/kg) alleviated all IP acid effects but only at doses that also stimulated locomotion. These results support utility of this model as a framework to evaluate candidate-analgesic effects in a battery of complementary pain-stimulated, pain-depressed, and pain-independent behavioral endpoints. SIGNIFICANCE STATEMENT: Preclinical assays of pain and analgesia often yield false-positive effects with candidate analgesics. This study used two positive-control analgesics (ketoprofen, oxycodone) and two active negative controls (diazepam, amphetamine) to validate a strategy for distinguishing analgesics from nonanalgesics by profiling drug effects in a battery of complementary pain-stimulated, pain-depressed, and pain-independent behaviors in male and female mice.

Clinical and Neurophysiological Effects of the Therapeutic Combination of High-Frequency Rhythmic Transcranial Magnetic Stimulation of the Motor and Frontal Cortex in Parkinson’s Disease

Objective. To run a parallel placebo-controlled trial to assess the effects of navigated combined high-frequency rhythmic transcranial magnetic stimulation (rTMS) of the primary motor (bilateral) and left dorsolateral prefrontal cortex on the clinical dynamics of the symptoms of Parkinson’s disease (PD). Materials and methods. A total of 46 patients took part in the trial and were randomized to active (n = 23) and placebo (n = 23) rTMS. Navigated therapeutic and placebo rTMS were performed for areas of the primary motor and left dorsolateral prefrontal cortex at a frequency of 10 Hz (20 daily sessions for three weeks). Changes in clinical symptoms were assessed on the MDS-UPDRS (parts I–IV) before sessions, immediately after 20 sessions, and 4–6 weeks after courses of rTMS. Nonmotor and mental symptoms were evaluated on the Hamilton depression scale (HDRS-17), the Beck scale (BDI-II), the depression, anxiety, and stress scale (DASS-21), and the mini mental state examination (MMSE). Results. Statistically signifi cant therapeutic effects were obtained with rTMS as compared with placebo, with greater reductions in total scores on the MDS-UPDRS (parts I–IV), the severity of nonmotor (part I)and motor (Part III, with greater therapeutic effects for rigidity, bradykinesia, and postural instability) signs, as well as the severity of motor complications of dopamine replacement therapy (part IV). The effects of rTMS on motor symptoms persisted at four weeks after completion of stimulation courses. It is also important to note that the signifi cant improvements in the rTMS and placebo groups were similar in terms of the magnitudes of reductions in the severity of daily motor symptoms (part II of the MDS-UPDRS) and increases in the total scores on the MMSE, HDRS, BDI-II, and DASS-21. Conclusions. Combined high-frequency rTMS of two areas of the cerebral cortex – the motor (bilaterally) and the left dorsolateral prefrontal – had positive therapeutic effects on the motor and affective symptoms of PD which were signifi cantly greater than obtained using placebo stimulation.

An international survey of different transcranial magnetic stimulation (TMS) protocols for patients with obsessive-compulsive disorder (OCD)

This study aims to evaluate current preferences and trends in the delivery of Transcranial Magnetic Stimulation (TMS) for Obsessive-Compulsive Disorder (OCD). A 10-item online questionnaire was developed and conducted online between April to June 2020, surveying providers of TMS for patients with OCD internationally. A total of 27 valid responses were analysed from 10 countries. The most common target for TMS was the supplementary motor area and stimulation was commonly given bilaterally, but techniques differed between centres. Exposure tasks were not commonly used during TMS. The study calls for more research clarifying the best mode of TMS delivery for OCD.

Validating the use of functional Near-Infrared Spectroscopy in monkeys: The case of brain activation lateralization in Papio anubis

Hemispheric asymmetries have long been seen as characterizing the human brain; yet, an increasing number of reports suggest the presence of such brain asymmetries in our closest primate relatives. However, most available data in non-human primates have so far been acquired as part of neurostructural approaches such as MRI, while comparative data in humans are often dynamically acquired as part of neurofunctional studies. In the present exploratory study in baboons (Papio anubis), we tested whether brain lateralization could be recorded non-invasively using a functional Near-Infrared Spectroscopy (fNIRS) device in two contexts: motor and auditory passive stimulations. Under light propofol anaesthesia monitoring, three adult female baboons were exposed to a series of (1) left- versus right-arm passive movement stimulations; and (2) left- versus right-ear versus stereo auditory stimulations while recording fNIRS signals in the related brain areas (i.e., motor central sulcus and superior temporal cortices respectively). For the sensorimotor condition our results show that left-arm versus right-arm stimulations induced typical contralateral difference in hemispheric activation asymmetries in the three subjects. For the auditory condition, we also revealed typical human-like patterns of hemispheric asymmetries in one subject, namely a leftward lateralization for right ear stimulations for all three channels. Overall, our findings support the use of fNIRS to investigate brain processing in non-human primates from a functional perspective, opening the way for the development of non-invasive procedures in non-human primate brain research.

Effects of burst-timing-dependent plasticity on synchronous behaviour in neuronal network

Brain plasticity or neuroplasticity refers to the ability of the nervous system to reorganise itself in response to stimuli. For instance, sensory and motor stimulation, memory formation, and learning depend on brain plasticity. Neuronal synchronisation can be enhanced or suppressed by the plasticity. Synchronisation is related to many functions in the brain, as well as to some brain disorders. One possible plasticity rule is the burst-timing-dependent plasticity (BTDP), that induces synaptic alteration according to the timing of neuronal bursts. In this work, we build a network of coupled Rulkov maps where the excitatory connections are randomly distributed. We consider the BTDP to study its effects on the synchronous neuronal activities. In our simulations, we observe that depending on the initial synaptic weights, the whole network or part of it can have its neuronal synchronisation improved. This increase can be reached by two different mechanisms, the initial burst synchronisation and random statistical coincidence. A mix of these two mechanism is also found in the network. BTDP can induce the formation of desynchronised and synchronised clusters that operate in different frequencies, but only if the noise level is low. Our results show possible mechanisms of cluster formation in burst neuronal networks. We also consider the BTDP rule on a small-world network and show that, depending on the initial connection strength, the network can exhibit local or non-local properties.

A Hybrid-FES Based Control System for Knee Joint Movement Control.

Introduction:Utilizing Functional Electrical Stimulation (FES) and rehabilitation robots for motion control is an open research problem. In this paper, a new control algorithm has been proposed which was de-signed based on a combination of FES and an active mechanical actuator to control the knee joint movement.Methods:An adaptive controller and a Proportional-Derivative (PD) controller have adjusted the motor torque and stimulation intensity, respectively. The FES controller was activated whenever a disturbance observer detected the presence of the external disturbance. In this manner, the occurrence of the muscle fatigue arises from the FES can be postponed.Results:The simulation studies were carried out on a model of muscle-joint system along with a model of a servo-motor. The computed RMS of the tracking errors compared to the range of knee motion show that the tracking performance is acceptable. In this research, the trajectories envisioned as the knee joint reference trajectory were designed using the recorded human data.Conclusion:The achieved results prove the ability of the proposed control strategy to not only reject the external disturbance but also compensate the muscle fatigue.

First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit.

ObjectiveTo present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit.MethodsWe employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines.ResultsWe included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking.ConclusionAlthough all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant’s specific needs and that interventions and be carried out by expert professionals.

Bangunan Heritage Sebagai Materi Pembelajaran Daring Tematik

The Covid – 19 pandemic has been generated the biggest disruption of education teaching and learning methods at all levels of education, from kindergarten to tertiary institution. Distance learning solutions were developed as a quick response to support education continuity. At the early childhood educations, the teachers are expected to adjust quickly to create attractive and innovative learning materials to replace face-to face learning in school and to make it easier for parents who accompany her children at home. Based on those issues, and the contect of distance learning currently held by schools, this Community Services Program are carried out by designing learning material packages that can be used by the kindergarten teachers to teach thematic learning online. The theme developed in this program is expected to replace the study tour around Bandung activity which is regularly held by school every year, in the form of project based learning for kindergarten with tutorial video available. Partner involved in this community services program is Taman Firdaus Percikan Iman (TPFPI), in Ciwaruga, Parongpong, Bandung Barat. Those learning materials packages regarding the introduction of heritage building in Bandung City by through fine motor and cognitivie stimulation activities. Thus, hopefully the results of this community services program can be an alterative solution for distance learning models, not only in TPFPI but also in other kindergartens in Bandung City.

Systematic Review of Sensory Stimulation Programs in the Rehabilitation of Acquired Brain Injury

Abstract. Acquired Brain Injury (ABI) can lead to sensory deficits and compromise functionality. However, most studies have been focused on motor stimulation in stroke and traumatic brain injury (TBI). Sensory stimulation in stroke and mild/moderate TBI has received reduced interest. The main objective of this review is to know the methodological characteristics and effects of sensory programs in ABI. Studies with the purpose of testing the efficacy of those programs were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty-three studies were included in this review. The results show that in most studies sensory stimulation started within 12 months after injury and there is no consensus regarding frequency, duration and number of sessions, duration of intervention, and instruments used to assess outcomes. Most programs involved unisensory stimulation, and vision was the predominant target. The most used methods were compensation and somatosensory discrimination training. Most studies used a pre- and post-intervention assessment, with few studies comprising follow-up assessment. Regarding the studies revised, the interventions with positive outcomes in ABI are: compensation, cognitive training, vestibular intervention, somatosensory discrimination training, proprioceptive stimulation with muscle vibration, and sustained attention training with olfactory stimulation. Available findings suggest that sensory stimulation has positive results with immediate and long-term improvements in sensory functioning. This review provides useful information to improve rehabilitation and to design future investigation.

Neurorozwojowy wymiar gestu wskazywania palcem – rozwój i stymulacja

Artykuł stanowi kontynuację rozważań autorek nad gestem wskazywania palcem (GWP) u niemowląt. Podstawy teoretyczne zawarte w tekście Gest wskazywania palcem w świetle doniesień neurobiologicznych zostały dopełnione o rozważania nad konsekwencjami braku GWP u dzieci oraz o ćwiczenia stymulujące, które zaprogramowano z uwzględnieniem trzech aspektów istotnych dla jego pojawienia się: stymulacji motorycznej, poznawczej oraz językowej. Przedstawiony autorski model oddziaływań terapeutycznych stanowi podstawę do budowania u dziecka zdolności komunikowania się – początkowo z wykorzystaniem gestu wskazywania, a następnie gestu werbalnego.

Mitogen and Stress-activated Protein Kinase 1 Negatively Regulates Hippocampal Neurogenesis

Neurogenesis in the subgranular zone (SGZ) of the adult hippocampus can be stimulated by a variety of means, including via exposure of experimental animals to an enriched environment that provides additional sensory, social, and motor stimulation. Tangible health and cognitive benefits accrue in enriched animals, including the amelioration of signs modelling psychiatric, neurological and neurodegenerative conditions that affect humans, which may in part be due to enhanced production of neurons. A key factor in the neuronal response to enrichment is the release of brain-derived neurotrophic factor (BDNF) and the activation of the Mitogen-Activated Protein Kinase (MAPK) cascade, which can lead to the stimulation of neurogenesis. Mitogen- and Stress-Activated protein Kinase 1 (MSK1) is a nuclear enzyme downstream of BDNF and MAPK that regulates transcription. MSK1 has previously been implicated in both basal and stimulated neurogenesis on the basis of studies with mice lacking MSK1 protein. In the present study, using mice in which only the kinase activity of MSK1 is lacking, we show that the rate of cellular proliferation in the SGZ (Ki-67 staining) is unaffected by the MSK1 kinase-dead (KD) mutation, and no different from controls levels after five weeks of enrichment. However, compared to wild-type mice, the number of doublecortin (DCX)-positive cells was greater in both standard-housed and enriched MSK1 KD mice. These observations suggest that, while MSK1 does not influence the basal rate of proliferation of neuronal precursors, MSK1 negatively regulates the number of cells destined to become neurons, potentially as a homeostatic control on the number of new neurons integrating into the dentate gyrus.

Temporal Dynamics of Visually Induced Motion Perception and Neural Evidence of Alterations in the Motion Perception Process in an Immersive Virtual Reality Environment.

Even though reciprocal inhibitory vestibular interactions following visual stimulation have been understood as sensory-reweighting mechanisms to stabilize motion perception; this hypothesis has not been thoroughly investigated with temporal dynamic measurements. Recently, virtual reality technology has been implemented in different medical domains. However, exposure in virtual reality environments can cause discomfort, including nausea or headache, due to visual-vestibular conflicts. We speculated that self-motion perception could be altered by accelerative visual motion stimulation in the virtual reality situation because of the absence of vestibular signals (visual-vestibular sensory conflict), which could result in the sickness. The current study investigated spatio-temporal profiles for motion perception using immersive virtual reality. We demonstrated alterations in neural dynamics under the sensory mismatch condition (accelerative visual motion stimulation) and in participants with high levels of sickness after driving simulation. Additionally, an event-related potentials study revealed that the high-sickness group presented with higher P3 amplitudes in sensory mismatch conditions, suggesting that it would be a substantial demand of cognitive resources for motion perception on sensory mismatch conditions.

A Sensorimotor Numerosity System.

Incoming sensory input provides information for the planning and execution of actions, which yield motor outcomes that are themselves sensory inputs. One dimension where action and perception strongly interact is numerosity perception. Many non-human animals can estimate approximately the number of external elements as well as their own actions, and neurons have been identified that respond to both. Recent psychophysical adaptation studies on humans also provide evidence for neural mechanisms responding to both the number of externally generated events and self-produced actions. Here we advance the idea that these strong connections may arise from dedicated sensorimotor mechanisms in the brain, part of a more generalized system interfacing action with the processing of other quantitative magnitudes such as space and time.

Cybersickness in Head-Mounted Displays Is Caused by Differences in the User's Virtual and Physical Head Pose

Sensory conflict, eye-movement, and postural instability theories each have difficulty accounting for the motion sickness experienced during head-mounted display based virtual reality (HMD VR). In this paper we review the limitations of existing theories in explaining cybersickness and propose a practical alternative approach. We start by providing a clear operational definition of provocative motion stimulation during active HMD VR. In this situation, whenever the user makes a head movement, his/her virtual head will tend to trail its true position and orientation due to the display lag (or motion to photon latency). Importantly, these differences in virtual and physical head pose (DVP) will vary over time. Based on our own research findings, we propose that cybersickness in HMD VR is triggered by large magnitude, time-varying patterns of DVP. We then show how this hypothesis can be tested by: 1) systematically manipulating display lag magnitudes and head movement speeds across HMD VR conditions; and 2) comparing the user’s estimates of DVP and cybersickness produced in each of these conditions. We believe that this approach will allow researchers to precisely predict which situations will (and will not) be provocative for cybersickness in HMD VR..

Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome.

Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.

Intervenção da fisioterapia na síndrome de Menkes

Objetivo: Descrever a intervenção da fisioterapia motora e respiratória no caso de uma criança com Síndrome de Menkes. Método: Relato de caso, com base em registros retrospectivos, no qual são apresentados dados referentes ao acompanhamento fisioterapêutico de uma criança com o diagnóstico de Síndrome de Menkes. Os dados foram obtidos por meio do prontuário, entrevista com familiares e informações dos profissionais envolvidos. O referido paciente foi encaminhado para assistência fisioterapêutica aos 5 meses de vida, devido ao quadro de pneumonia com presença de atelectasia, associado as manifestações típicas da Síndrome, sendo então acompanhado por um período de 04 meses. Foram realizados 76 atendimentos, de um total de 91 agendamentos, os quais incluíram fisioterapia motora e respiratória, sendo aplicados métodos, técnicas, manuseios e posturas, para estimulação do desenvolvimento neuropsicomotor, e realizadas técnicas e recursos fisioterapêuticos para desobstrução e reexpansão pulmonar. Resultados: A cada sessão, a criança apresentou evidente melhora imediata no padrão e tipo respiratório, na frequência respiratória, na ausculta pulmonar e nos sinais de desconforto respiratório. Além disso, a estimulação motora e manutenção do quadro músculo esquelético, impediram agravos e deformidades. Segundo relato da mãe, a criança mostrava-se menos agitada após as sessões, com melhora no padrão e conforto respiratório, o que impactou de forma positiva na sua qualidade de vida. Conclusão: A fisioterapia motora e respiratória se apresentam como terapêuticas favoráveis para condição de saúde geral de pacientes com Síndrome de Menkes e novos estudos devem ser conduzidos no sentido de elucidar essa intervenção, com amostras maiores.