VALQUIRIA APARECIDA DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Effects of cerebellar neuromodulation in movement disorders: A systematic review(2018) FRANCA, Carina; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen; GALHARDONI, Ricardo; SILVA, Valquiria; BARBOSA, Egberto Reis; CURY, Rubens GisbertBackground: The cerebellum is involved in the pathophysiology of many movement disorders and its importance in the field of neuromodulation is growing. Objectives: To review the current evidence for cerebellar modulation in movement disorders and its safety profile. Methods: Eligible studies were identified after a systematic literature review of the effects of cerebellar modulation in cerebellar ataxia, Parkinson's disease (PD), essential tremor (ET), dystonia and progressive supranuclear palsy (PSP). Neuromodulation techniques included transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). The changes in motor scores and the incidence of adverse events after the stimulation were reviewed. Results: Thirty-four studies were included in the systematic review, comprising 431 patients. The evaluation after stimulation ranged from immediately after to 12 months after. Neuromodulation techniques improved cerebellar ataxia due to vascular or degenerative etiologies (TMS, tDCS and DBS), dyskinesias in PD patients (TMS), gross upper limb movement in PD patients (tDCS), tremor in ET (TMS and tDCS), cervical dystonia (TMS and tDCS) and dysarthria in PSP patients (TMS). All the neuromodulation techniques were safe, since only three studies reported the existence of side effects (slight headache after TMS, local skin erythema after tDCS and infectious complication after DBS). Eleven studies did not mention if adverse events occurred. Conclusions: Cerebellar modulation can improve specific symptoms in some movement disorders and is a safe and well-tolerated procedure. Further studies are needed to lay the groundwork for new researches in this promising target.
conferenceObject Effects of Cerebellar Neuromodulation in Movement Disorders: A Systematic Review(2018) FRANCA, Carina; ANDRADE, Daniel De; TEIXEIRA, Manoel; GALHARDONI, Ricardo; SILVA, Valquiria; BARBOSA, Egberto; CURY, Rubens- Beyond weakness: Characterization of pain, sensory profile and conditioned pain modulation in patients with motor neuron disease: A controlled study(2018) LOPES, L. C. G.; GALHARDONI, R.; SILVA, V.; JORGE, F. M. H.; YENG, L. T.; CALLEGARO, D.; CHADI, G.; TEIXEIRA, M. J.; ANDRADE, D. Ciampi deBackgroundMotor neuron diseases (MND) represent a group of disorders that evolve with inexorable muscle weakness and medical management is based on symptom control. However, deeper characterization of non-motor symptoms in these patients have been rarely reported. MethodsThis cross-sectional study aimed to describe non-motor symptoms in MND and their impact on quality of life and functional status, with a focus on pain and sensory changes. Eighty patients (31 females, 55.712.9years old) with MND underwent a neurological examination, pain, mood, catastrophizing and psychophysics assessments [quantitative sensory testing (QST) and conditioned pain modulation (CPM)], and were compared to sex- and age-matched healthy controls (HC). ResultsChronic pain was present in 46% of patients (VAS=5.182.0). Pain of musculoskeletal origin occurred in 40.5% and was mainly located in the head/neck (51%) and lower back (35%). Neuropathic pain was not present in this sample. Compared to HC, MND patients had a lower cold detection threshold (p<0.002), and significantly lower CPM scores (4.9 +/- 0.2% vs. 22.1 +/- 0.2%, p=0.012). QST/CPM results did not differ between MND patients with and without pain. Pain intensity was statistically correlated with anxiety, depression and catastrophism, and spasticity scores were inversely correlated with CPM (=-0.30, p=0.026). ConclusionsPain is frequently reported by patients with MNDs. Somatosensory and CPM changes exist in MNDs and may be related to the neurodegenerative nature of the disease. Further studies should investigate the most appropriate treatment strategies for these patients. SignificanceWe report a comprehensive evaluation of pain and sensory abnormalities in motor neuron disease (MND) patients. We assessed the different pain syndromes present in MND with validated tools, and described the QST and conditioned pain modulation profiles in a controlled design.
- Not just a matter of pain intensity: Effects or of three different conditioning stimuli on conditioned pain modulation effects(2018) SILVA, Valquiria Aparecida da; GALHARDONI, Ricardo; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi deIntroduction. - Heterotopic conditioned pain modulation (CPM) has provided potentially use-ful clinical information such as response to medication in neuropathic pain or the prediction of pain after surgical procedures. Despite these advances, several methodological aspects of CPM remain to be determined, such as the impact of the conditioning stimulus (CS) type upon CPM, if its evoked-pain intensity is controlled for [measured on a visual analogue scale (VAS: 0-100mm)]. Objectives. -To explore potential differential effects of CPM using three distinct CS (having similar evoked-pain intensity) in the same individuals. Methods. - We conducted a cross-over randomized study in healthy volunteers (HV) and looked for differences in the CPM effect evoked by three differing CS [cuff-pressure pain stimulation (CuPS), cold pressor test (COPT), and thermode-based cold painful stimulation (TCPS)] on the same test stimulus [(TS)-supra-threshold heat pain stimulation with a contact-heat thermode). CPM was calculated as a ratio: [conditioned TS VAS - unconditioned TS VAS]/[unconditioned TS VAS]. Importantly, the range of pain evoked by the unconditioned-TS and by the CS was controlled for. Also, the unpleasantness evoked by the CS [visual analogue scale (VAS: 0-100 mm)] was measured before the initiation of the conditioned-TS. Results. - Pain intensity VAS of the three unconditioned-TSs were similar between the three sessions. CPM was significantly different between the three types of CS (CoPT= -0.43 +/- 0.29; CuPS = -0.25 +/- 0.24; and TCPS = -0.23 +/- 0.35; P= .005): CoPT induced significantly more robust CPM compared to CuPS (P= .004) and TCPS (P= .005). Conclusions. -Significantly different intensities of CPM can be evoked on the same individual according to the nature of the CS, even when controlling for the intensity of the unconditioned-TS, and the pain evoked by the CS. This may have implications for the design of future recommendations and may impact the translation of CPM from the laboratory to clinical practice.