CINTYA YUKIE HAYASHI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, 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
13 resultados
Resultados de Busca
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- Repetitive TMS does not improve cognition in patients with TBI(2019) NEVILLE, Iuri Santana; ZANINOTTO, Ana Luiza; HAYASHI, Cintya Yukie; RODRIGUES, Priscila Aparecida; GALHARDONI, Ricardo; ANDRADE, Daniel Ciampi de; BRUNONI, Andre Russowsky; AMORIM, Robson L. Oliveira; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaObjective To determine whether high-frequency repetitive transcranial magnetic stimulation (rTMS) improves cognition in patients with severe traumatic brain injury. Methods A single-center, randomized, double-blind, placebo-controlled study of rTMS was conducted in patients aged 18-60 years with chronic (> 12 months postinjury) diffuse axonal injury (DAI). Patients were randomized to either a sham or real group in a 1:1 ratio. A 10-session rTMS protocol was used with 10-Hz stimulation over the left dorsolateral prefrontal cortex (DLPFC). Neuropsychological assessments were performed at 3 time points: at baseline, after the 10th rTMS session, and 90 days after intervention. The primary outcome was change in executive function evaluated using the Trail Making Test Part B. Results Thirty patients with chronic DAI met the study criteria. Between-group comparisons of performance on TMT Part B at baseline and after the 10th rTMS session did not differ between groups (p = 0.680 and p = 0.341, respectively). No significant differences were observed on other neuropsychological tests. No differences in adverse events between treatment groups were observed. Conclusions Cognitive function in individuals with chronic DAI is not improved by high-frequency rTMS over the left DLPFC, though it appears safe and well-tolerated in this population.
- Evaluation of Changes in Preoperative Cortical Excitability by Navigated Transcranial Magnetic Stimulation in Patients With Brain Tumor(2021) NEVILLE, Iuri Santana; SANTOS, Alexandra Gomes dos; ALMEIDA, Cesar Cimonari; HAYASHI, Cintya Yukie; SOLLA, Davi Jorge Fontoura; GALHARDONI, Ricardo; ANDRADE, Daniel Ciampi de; BRUNONI, Andre Russowsky; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: This prospective study aimed to evaluate the cortical excitability (CE) of patients with brain tumors surrounding or directly involving the corticospinal tract (CST) using navigated transcranial magnetic stimulation (nTMS). Methods: We recruited 40 patients with a single brain tumor surrounding or directly involving the CST as well as 82 age- and sex-matched healthy controls. The patients underwent standard nTMS and CE evaluations. Single and paired pulses were applied to the primary motor area (M1) of both affected and unaffected cerebral hemispheres 1 week before surgery. The CE parameters included resting motor threshold (RMT), motor evoked potential (MEP) ratio for 140 and 120% stimulus (MEP 140/120 ratio), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Motor outcome was evaluated on hospital discharge and on 30-day and 90-day postoperative follow-up. Results: In the affected hemispheres of patients, SICI and ICF were significantly higher than in the unaffected hemispheres (p=0.002 and p=0.009, respectively). The 140/120 MEP ratio of patients' unaffected hemispheres was lower than that in controls (p=0.001). Patients with glioblastomas (GBM) had a higher interhemispheric RMT ratio than patients with grade II and III gliomas (p = 0.018). A weak correlation was observed among the RMT ratio and the preoperative motor score (R-2 = 0.118, p = 0.017) and the 90-day follow-up (R-2 = 0.227, p = 0.016). Conclusion: Using preoperative nTMS, we found that brain hemispheres affected by tumors had abnormal CE and that patients with GBM had a distinct pattern of CE. These findings suggest that tumor biological behavior might play a role in CE changes.
- Immersive virtual reality in patients with moderate and severe traumatic brain injury: a feasibility study(2021) MORAES, Thiago Mazzoli; ZANINOTTO, Ana Luiza; NEVILLE, Iuri Santana; HAYASHI, Cintya Yukie; PAIVA, Wellingson SilvaBackground Traumatic brain injury (TBI) remains a global health problem with cognitive impairments that can affect an individual's life. Although there is still no effective treatment for TBI sequelae, virtual reality (VR) technology shows promising results as a training tool to improve cognitive functions. Nonetheless, using a head-mounted display (HMD) device can induce cybersickness. Objective. To assess the feasibility of immersive VR cognitive training on EF and provide insights for a definitive trial. We aimed to assess the tolerability of TBI patients after prolonged use of a HMD. Also, as an exploratory analysis, we evaluated changes in cognition, including executive function, memory, and processing speed after the intervention. Methods. A prospective, single-arm, quasi-experimental study was performed to analyze the feasibility of twelve 20-min sessions of immersive VR over four weeks in patients with sustained TBI. Neuropsychological assessment was applied at baseline (T1), post-intervention (T2), and a three-months follow-up (T3). The Simulator Sickness Questionnaire (SSQ) was administered at the end of each session to evaluate the safety of the intervention. Results. Thirteen participants of mean age 34.86 (11.12), with moderate to severe TBI and average of 305.23 (51.23) days post-trauma were included. Patients showed improvements in EF between T1 and T3 (p = 0.02) and low scores in the SSQ (mean score = 4.33, SD = 4.06). Conclusions. The present VR intervention showed to be feasible and safe for patients with TBI to use a HMD. We also observed positive effects on EF and future studies should consider a home-based approach.
- Altered Intracortical Inhibition in Chronic Traumatic Diffuse Axonal Injury(2018) HAYASHI, Cintya Yukie; NEVILLE, Iuri Santana; RODRIGUES, Priscila Aparecida; GALHARDONI, Ricardo; BRUNONI, Andre Russowsky; ZANINOTTO, Ana Luiza; GUIRADO, Vinicius Monteiro de Paula; CUEVA, Ana Sofia; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: Overactivation of NMDA-mediated excitatory processes and excess of GABA-mediated inhibition are attributed to the acute and subacute phases, respectively, after a traumatic brain injury (TBI). However, there are few studies regarding the circuitry during the chronic phase of brain injury. Objective: To evaluate the cortical excitability (CE) during the chronic phase of TBI in victims diagnosed with diffuse axonal injury (DAI). Methods: The 22 adult subjects were evaluated after a minimum of 1 year from the onset of moderate or severe TBI. Each of the subjects first had a comprehensive neuropsychological assessment to evaluate executive functions-attention, memory, verbal fluency, and information processing speed. Then, CE assessment was performed with a circular coil applying single-pulse and paired-pulse transcranial magnetic stimulation over the cortical representation of the abductor pollicis brevis muscle on M1 of both hemispheres. The CE parameters measured were resting motor threshold (RMT), motor-evoked potentials (MEPs), short-interval intracortical inhibition (SIICI), and intracortical facilitation (ICF). All data were compared with that of a control group that consisted of the healthy age-matched individuals. Results: No significant differences between the left and right hemispheres were detected in the DAI subjects. Therefore, parameters were analyzed as pooled data. Values of RMT, MEPs, and ICF from DAI patients were within normal limits. However, SIICI values were higher in the DAI group-DAI SIICI = 1.28 (1.01; 1.87) versus the control value = 0.56 (0.33; 0.69)-suggesting that they had a disarranged inhibitory system (p < 0.001). By contrast, the neuropsychological findings had weak correlation with the CE data. Conclusion: As inhibition processes involve GABA-mediated circuitry, it is likely that the DAI pathophysiology itself (disruption of axons) may deplete GABA and contribute to ongoing disinhibition of these neural circuits of the cerebrum during the chronic phase of DAI.
- Brazilian version of the Rivermead Post-Concussion Symptoms Questionnaire(2021) NAGUMO, Marcia Mitie; FERRETTI-REBUSTINI, Renata Eloah de Lucena; BALBINOTTI, Marcos Alencar Abaide; SILVA, Daniele Vieira da; HAYASHI, Cintya Yukie; PAIVA, Wellingson Silva; TEIXEIRA, Manoel Jacobsen; AMORIM, Robson Luis Oliveira deBackground: After a traumatic brain injury, post-concussion symptoms are commonly reported by patients. Although common, these symptoms are difficult to diagnose and recognize. To date, no instruments evaluating post-concussion symptoms have been culturally translated or adapted to the Brazilian context. Objective: To culturally adapt the Rivermead Post-Concussion Symptoms Questionnaire for use in Brazilian Portuguese. Methods: Cross-cultural adaptation was done in five steps: translation, synthesis of translations, back-translation, evaluation by two expert committees and two pretests among adults in a target population. Results: The semantic, idiomatic, cultural and experimental aspects of the adaptation were considered adequate. The content validity coefficient of the items regarding language clarity, pratical pertinence, relevance and dimensionality were considered adequate for evaluating the desired latent variable. Both pretests demonstrated that the instrument had satisfactory acceptability. Conclusion: The Brazilian version, named Questionario Rivermead de Sintomas pos Concussionais (RPQ-Br), has been adapted, and is ready for use in the Brazilian context.
- Letter: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading(2021) SANTOS, Alexandra Gomes dos; HAYASHI, Cintya Yukie; ALMEIDA, Cesar Cimonari de; PAIVA, Wellingson Silva; ANDRADE, Daniel Ciampi de; GALHARDONI, Ricardo; BRUNONI, Andre Russowsky; TEIXEIRA, Manoel Jacobsen; NEVILLE, Iuri Santana
- Quantification of tumor induced motor cortical plasticity using navigated transcranial magnetic stimulation in patients with adult-type diffuse gliomas(2023) ALMEIDA, Cesar Cimonari de; NEVILLE, Iuri Santana; HAYASHI, Cintya Yukie; SANTOS, Alexandra Gomes dos; BRUNONI, Andre Russowsky; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaIntroductionThe evaluation of brain plasticity can provide relevant information for the surgical planning of patients with brain tumors, especially when it comes to intrinsic lesions such as gliomas. Neuronavigated transcranial magnetic stimulation (nTMS) is a non-invasive tool capable of providing information about the functional map of the cerebral cortex. Although nTMS presents a good correlation with invasive intraoperative techniques, the measurement of plasticity still needs standardization. The present study evaluated objective and graphic parameters in the quantification and qualification of brain plasticity in adult patients with gliomas in the vicinity of the motor area. MethodsThis is a prospective observational study that included 35 patients with a radiological diagnosis of glioma who underwent standard surgical treatment. nTMS was performed with a focus on the motor area of the upper limbs in both the affected and healthy cerebral hemispheres in all patients to obtain data on motor thresholds (MT) and graphical evaluation by three-dimensional reconstruction and mathematical analysis of parameters related to the location and displacement of the motor centers of gravity (Delta L), dispersion (SDpc) and variability (VCpc) of the points where there was a positive motor response. Data were compared according to the ratios between the hemispheres of each patient and stratified according to the final pathology diagnosis. ResultsThe final sample consisted of 14 patients with a radiological diagnosis of low-grade glioma (LGG), of which 11 were consistent with the final pathology diagnosis. The normalized interhemispheric ratios of Delta L, SDpc, VCpc, and MT were significantly relevant for the quantification of plasticity (p < 0.001). The graphic reconstruction allows the qualitative evaluation of this plasticity. ConclusionThe nTMS was able to quantitatively and qualitatively demonstrate the occurrence of brain plasticity induced by an intrinsic brain tumor. The graphic evaluation allowed the observation of useful characteristics for the operative planning, while the mathematical analysis made it possible to quantify the magnitude of the plasticity.
- Repetitive Transcranial Magnetic Stimulation (rTMS) for the cognitive rehabilitation of traumatic brain injury (TBI) victims: study protocol for a randomized controlled trial(2015) NEVILLE, Iuri Santana; HAYASHI, Cintya Yukie; HAJJ, Simone Alves El; ZANINOTTO, Ana Luiza Costa; SABINO, Juliana Perez; SOUSA JR., Leonardo Moura; NAGUMO, Marcia Mitie; BRUNONI, Andre Russowsky; SHIEH, Barbara Dal Forno Silva; AMORIM, Robson Luis Oliveira; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: Repetitive Transcranial Magnetic Stimulation (rTMS) has been proposed as a new tool in neurological rehabilitation of victims of traumatic brain injury (TBI). However, its usefulness to treat this condition has never been tested rigorously. The primary goal is to conduct a study protocol to determine whether rTMS used to cognitive rehabilitation of victims of TBI with diffuse axonal injury (DAI) is a safe instrument and if it enhances cognitive function recovery. Methods: Double-blind randomized controlled trial of patients with diffuse axonal injury. Thirty-six patients will be randomized to either an active coil group or sham group in a 1: 1 ratio. rTMS protocol: 10 sessions of high-frequency rTMS (10 Hz) over the left dorsolateral prefrontal cortex (DLPFC). Cortical Excitability measures will be obtained. Neuropsychological evaluations will be performed 1 week before, 1 week and 3 months after rTMS. There are 2 study hypotheses: (1) rTMS over the left DLPFC in patients with DAI will improve cognitive function and (2) whether rTMS is safe in TBI patients. Discussion: This study evaluates the immediate and delayed effects of rTMS over the DLPFC on the cognitive domain of patients with DAI following TBI. rTMS has shown good results in treating major depression and may be promising for patients with TBI. As such, the results of this study can greatly modify the cognitive rehabilitation strategies.
- Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review(2022) SCHIAVA, Lucas Jose Vaz; RIBEIRO, Iuri Neville; HAYASHI, Cintya Yukie; FIGUEIREDO, Eberval Gadelha; BRUNONI, Andre Russowsky; TEIXEIRA, Manoel Jacobsen; POKORNY, Gabriel; PAIVA, Wellingson SilvaIntroduction: The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post -operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker. Methods: Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: ((""Evoked Potentials, Motor""[Mesh]) AND ""Neoplasms""[Mesh]) AND ""Transcranial Magnetic Stimulation""[Mesh] AND ""Brain Tumor""[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese. Results: A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex. Conclusion: Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.
- Clinical outcome assessments of motor status in patients undergoing brain tumor surgery(2021) CORREIA, Mayla Santana; NEVILLE, Iuri Santana; ALMEIDA, Cesar Cimonari de; HAYASHI, Cintya Yukie; FERREIRA, Luana Talita Diniz; QUADROS, Danilo Gomes; SANTOS, Alexandra Gomes dos; SOLLA, Davi Jorge Fontoura; MARTA, Gustavo Nader; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaIntroduction: Clinical outcome assessment (COA) is an important instrument for testing the effectiveness of treatments and for supporting healthcare professionals on decision-making. This review aims to assess the use of COAs, and the evaluation time points of motor status in patients with brain tumor (BT) undergoing surgery. Methods: We performed a scoping review through MEDLINE, EMBASE, and LILACS databases, looking for original studies in primary or secondary BT, having motor function status as the primary outcome. Exclusion criteria: mixed sample, BT recurrence, and an unspecific description of motor deficits evaluation. Results: Nine studies met the eligibility criteria. There were 449 patients assessed. A total of 18 scales evaluated these BT patients, 12 performance outcomes measures (PerfO) tested motor function. Four scales were the clinician-reported outcome measures (ClinRO) found in this review, two assessed performance status, and two rated ambulation. Two patient-reported outcome measures (PRO) appraised functionality. Conclusions: A variety of instruments were used to assess BT patients. Rehabilitation studies are more likely to associate the use of PerfO and PRO concerning motor and functional status. The use of specific validated scales to the BT population was rare. The lack of a standardized approach hampers the quality of BT patient's assessment.