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Impacto de novas formas de reabilitação em doentes com avc: análise de dados de fmri após terapia com estimulação magnética transcraniana
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Abstract(s)
O presente estudo aborda o impacto da Estimulação Magnética Transcraniana (TMS) na
recuperação de pacientes com Acidente Vascular Cerebral (AVC). A TMS é uma técnica não
invasiva de estimulação cerebral que tem se mostrado promissora na reabilitação pós-AVC,
particularmente na modulação da conectividade funcional e na promoção da plasticidade
cerebral.
O estudo utiliza dados de ressonância magnética funcional (fMRI) em estado de repouso
(resting-state) de 13 pacientes com AVC, divididos em dois grupos: pacientes que realizaram
terapia com TMS (pacientes on), neste caso TMS inibitória no lado contralateral à lesão, e
pacientes que não realizaram a terapia (pacientes off). A análise foca-se na Default Mode
Network (DMN), uma rede de regiões cerebrais crucial para a função cognitiva.
Através da técnica de Modelagem Dinâmica Causal (DCM), especificamente o DCM espectral
(spDCM), a conectividade efetiva (CE) entre as regiões da DMN e do Sulco Intraparietal (IPS) -
devido ao seu papel na atenção visuoespacial e na modulação da conectividade entre áreas
cerebrais - foi investigada.
Os resultados indicam alterações significativas na CE entre as regiões da DMN e o IPS em
pacientes on comparados com os pacientes off. Observou-se um aumento da conectividade do
IPS direito com o córtex parietal inferior ipsilateral (RIPC) e uma diminuição da conectividade
com o contralateral (LIPC) em pacientes on, sugerindo uma reorganização da rede neuronal
após a aplicação da TMS inibitória.
Este estudo contribui para a compreensão do papel da TMS na recuperação pós-AVC,
demonstrando a sua capacidade de modular a conectividade funcional e promover a
plasticidade cerebral. No entanto, são necessários estudos com amostras maiores para
confirmar estes resultados e investigar os efeitos a longo prazo da TMS na recuperação
funcional.
The present study addresses the impact of Transcranial Magnetic Stimulation (TMS) on the recovery of stroke patients. TMS is a non-invasive brain stimulation technique that has shown promise in post-stroke rehabilitation, particularly in modulating functional connectivity and promoting brain plasticity. The study uses resting-state functional magnetic resonance imaging (fMRI) data from 13 stroke patients, divided into two groups: patients who underwent TMS therapy (on group) — in this case, inhibitory TMS on the side contralateral to the lesion — and patients who did not undergo therapy (off group). The analysis focuses on the Default Mode Network (DMN), a network of brain regions crucial for cognitive function. Using the Dynamic Causal Modeling (DCM) technique, specifically spectral DCM (spDCM), the effective connectivity (EC) between DMN regions and the Intraparietal Sulcus (IPS) -, given its role in visuospatial attention and the modulation of connectivity between brain areas - was investigated. The results indicate significant changes in EC between DMN regions and the IPS in on patients compared to off patients. An increase in the connectivity of the right IPS with the ipsilateral inferior parietal cortex (RIPC) and a decrease in connectivity with the contralateral (LIPC) were observed in on patients, suggesting a reorganization of the neural network following inhibitory TMS application. This study contributes to understanding the role of TMS in post-stroke recovery, demonstrating its ability to modulate functional connectivity and promote brain plasticity. However, studies with larger samples are needed to confirm these findings and investigate the long-term effects of TMS on functional recovery.
The present study addresses the impact of Transcranial Magnetic Stimulation (TMS) on the recovery of stroke patients. TMS is a non-invasive brain stimulation technique that has shown promise in post-stroke rehabilitation, particularly in modulating functional connectivity and promoting brain plasticity. The study uses resting-state functional magnetic resonance imaging (fMRI) data from 13 stroke patients, divided into two groups: patients who underwent TMS therapy (on group) — in this case, inhibitory TMS on the side contralateral to the lesion — and patients who did not undergo therapy (off group). The analysis focuses on the Default Mode Network (DMN), a network of brain regions crucial for cognitive function. Using the Dynamic Causal Modeling (DCM) technique, specifically spectral DCM (spDCM), the effective connectivity (EC) between DMN regions and the Intraparietal Sulcus (IPS) -, given its role in visuospatial attention and the modulation of connectivity between brain areas - was investigated. The results indicate significant changes in EC between DMN regions and the IPS in on patients compared to off patients. An increase in the connectivity of the right IPS with the ipsilateral inferior parietal cortex (RIPC) and a decrease in connectivity with the contralateral (LIPC) were observed in on patients, suggesting a reorganization of the neural network following inhibitory TMS application. This study contributes to understanding the role of TMS in post-stroke recovery, demonstrating its ability to modulate functional connectivity and promote brain plasticity. However, studies with larger samples are needed to confirm these findings and investigate the long-term effects of TMS on functional recovery.
Description
Keywords
AVC TMS fMRI DMC cTBS Resting-state