Neurofeedback na reabilitação dos sintomas cognitivos pôs lesões cerebrais traumáticas em paciente submetido à remoção cirúrgica / Neurofeedback in the rehabilitation of cognitive symptoms caused traumatic brain injuries in a patient submitted to surgical removal

Introdução: Como em todos os procedimentos cirúrgicos a cirurgia do cérebro pode apresentar riscos e complicações potenciais. Dependendo da localização do tumor a Visão, audição, olfato, fala, equilíbrio, força e coordenação motora, pensamento e memória podem ser afetados. Os efeitos colaterais podem aparecer tardiamente e podem, também, ser confundidos com sintomas do tumor. Objetivo: Demonstrar os efeitos do tratamento de Neurofeedback dos sintomas causados por lesões cerebrais traumáticas em um paciente sumetido a remoção cirurgica de tumor cerebral da região do terceiro ventrículo. Método: Estudo descritivo transversal, realizado sob a perspectiva dos pressupostos epistemológicos positivista de natureza qualitativa. Paciente recém-saído de cirurgia cerebral para retirada de tumor ventricular. As medidas de avaliação incluíram análise de avalição de neurofeedback TQ7 e Avaliação Neuropsicologica pré e pós treinamento e as mesmos foram utizadas para direcionar os protocolos de tratamento, juntamente com o julgamento clínico do autor. Os sinais de EEG foram coletados e colocados de acordo com o sistema International 10-20. Resultados: Foi demonstrado os efeitos clínicos do treinamento de Neurofeedback aplicado a reabilitação de sintomas pós retirada de tumor cerebral. Os dados do TQ7 para o indivíduo aumentaram as alterações de theta, alfa e de coerência. O paciente mostrou delta aumentada sobre o córtex. Apresentou falhas acadêmicas, comportamento impulsivo e muitos problemas de atenção, concentração, memória e habilidades sociais. Os resultados evidenciaram mudanças no padrão de ondas cerebrais do paciente avaliado antes e após a realização das intervenções com neurofeedback, diminuido ondas cerebrais lentas e aumentando ondas cerebrais rápidas e médias e mostram melhorias de nos estados psicopatologicos, incluindo bem-estar psicológico, competência emocional e traços de comportamento Social, bem como em todos os domínios da cognição, dor, sono, fadiga e humor / emoção. No entanto, nossos dados devem ser interpretados com cautela porque este é um estudo de caso único. Considerações Finais: Estes resultados documenta a praticabilidade do método de neurofeedback como complemento de tratamento em transtornos pós-cirurgicos do ponto de vista clínico. Embora o uso de neurofeedback no tratamento   dos sintomas de transtornos pós-cirurgicos seja recomendado na literatura, ainda faltam estudos empíricos. São necessários ensaios controlados aleatórios para avaliar os efeitos a curto e a longo prazo do neurofeedback

Electrophysiological Correlates of Long-Term Soto Zen Meditation

This study aimed to verify the electrophysiological correlates of the changes in long-term regular meditators. We use modern techniques of high-resolution electroencephalography applied to slow potentials, power spectra, and potencies related to the events. To obtain encephalographic records, we use an assembly of 128 channels in 31 subjects (17 Soto Zen Buddhist meditators). The motivation of this study was to determine whether the induced beta power would present an increase in meditators as well as a decrease in induced theta/beta ratio in absolute and relative values. However, opposite to what we expected, no significant change was found in the beta frequency. In contrast, the main findings of the study were correlations between the frequency of weekly meditation practice and the increased theta induced relative power, increase of induced power ratio (ratio theta/beta), and increase of the ratio of induced relative powers (theta/beta ratio) during our task that featured an "adapted meditation, " suggesting that the meditative state of "mindfulness" is much more related to the permittivity of "distractions" by the meditators, with a deliberate reduction of attention

Therapeutic applications of repetitive transcranial magnetic stimulation in clinical neurorehabilitation

Transcranial magnetic stimulation (TMS) was introduced nearly 20 years ago and has since been developed as a sophisticated tool for neuroscience research. It is an excellent technique that complements other non-invasive methods for studying human brain physiology. The aim of the present study was to review the basic concepts and principles of the repetitive TMS (rTMS) technique, gathering evidence of its applications in neurorehabilitation. Several clinical studies have reported that sessions of rTMS can improve some or all of the motor symptoms associated with Parkinson’s disease, dystonia and stroke. However, since these changes are transient, it is premature to propose these applications as realistic therapeutic options, even though the rTMS technique has shown itself to be, potentially, a modulator of sensorimotor integration and neurogenesis. Future work in this area promises to advance our understanding of the pathophysiology of a wide range of neurological conditions, generate widely applicable diagnostic tools for clinical neurophysiology, and perhaps establish neuromodulation as a viable therapeutic option in neurorehabilitatio

Comparative analysis of the electroencephalogram in patients with Alzheimer's disease, diffuse axonal injury patients and healthy controls using LORETA analysis

ABSTRACT Alzheimer's disease (AD) is a dementia that affects a large contingent of the elderly population characterized by the presence of neurofibrillary tangles and senile plaques. Traumatic brain injury (TBI) is a non-degenerative injury caused by an external mechanical force. One of the main causes of TBI is diffuse axonal injury (DAI), promoted by acceleration-deceleration mechanisms. Objective: To understand the electroencephalographic differences in functional mechanisms between AD and DAI groups. Methods: The study included 20 subjects with AD, 19 with DAI and 17 healthy adults submitted to high resolution EEG with 128 channels. Cortical sources of EEG rhythms were estimated by exact low-resolution electromagnetic tomography (eLORETA) analysis. Results: The eLORETA analysis showed that, in comparison to the control (CTL) group, the AD group had increased theta activity in the parietal and frontal lobes and decreased alpha 2 activity in the parietal, frontal, limbic and occipital lobes. In comparison to the CTL group, the DAI group had increased theta activity in the limbic, occipital sublobar and temporal areas. Conclusion: The results suggest that individuals with AD and DAI have impairment of electrical activity in areas important for memory and learning

BPSD following traumatic brain injury

ABSTRACT Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. Objective: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. Methods: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. Results: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. Conclusion: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery

Sport-related concussions

ABSTRACT Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness), behavioral changes (depression, anxiety, irritability) and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence

Cognitive rehabilitation following traumatic brain injury

Abstract Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols

Alzheimer's disease qEEG: spectral analysis versus coherence. which is the best measurement?

There is evidence in electroencephalography that alpha, theta and delta band oscillations reflect cognitive and memory performances and that quantitative techniques can improve the electroencephalogram (EEG) sensitivity. This paper presents the results of comparative analysis of qEEG variables as reliable markers for Alzheimer's disease (AD). We compared the sensitivity and specificity between spectral analysis (spectA) and coherence (Coh) within the same group of AD patients. SpectA and Coh were calculated from EEGs of 40 patients with mild to moderate AD and 40 healthy elderly controls. The peak of spectA was smaller in the AD group than in controls. AD group showed predominance of slow spectA in theta and delta bands and a significant reduction of inter-hemispheric Coh for occipital alpha 2 and beta 1 and for frontal delta sub-band. ROC curve supported that alpha band spectA was more sensitive than coherence to differentiate controls from AD