ADRIANA BASTOS CONFORTO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 23 Citação(ões) na Scopus
    Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial
    (2019) MACHLINE-CARRION, M. Julia; SANTUCCI, Eliana Vieira; DAMIANI, Lucas Petri; BAHIT, M. Cecilia; MALAGA, German; PONTES-NETO, Octavio Marques; MARTINS, Sheila Cristina Ouriques; ZETOLA, Viviane Flumignan; NORMILIO-SILVA, Karina; FREITAS, Gabriel Rodrigues de; GORGULHO, Alessandra; CUNHA, Ricardo Santos; SANTOS, Aparecida Bernardes dos; FERREIRA, Luis Ley Gabriel; SAAD, Michele de Nardi; MACHADO, Michel Ferreira; LUNARDI, Camila; FERRAZ, Jamana Barbosa P.; OLIVEIRA, Pablo Nascimento; VICENTE, Suellen Mariane Rios; BETTGER, Janet Prvu; PAULA, Monica de; JEREMIAS, Maria da Conceicao; ROCHA, Fernanda Mota; IBIAPINA, Viviane de Sobral; ESMANHOTTO, Bruno Bertoli; KONDO, Erika; GOMES, Denilsen Carvalho; OLIVEIRA, Wellington Gondim de; LACERDA, Nair Gomes Soares; SILVA, Priscila Rodrigues e; ANDRADE, Marianna; FERREIRA, Natalia Cristina; LOPES, Renato D.; PEDREIRA, Arthur; ARAVENA, Tania Mariela Martinez; HASSELMANN, Rafaela Souza; SANTOS, Natalia Oliveira; GOES, Fernanda; PASSOS, Tissiana; PIRAS, Claudio; TALIULE, Aparecida; ZURRU, Maria Cristina; VALE, Solene Sousa; ALONZO, Claudia; PETERSON, Eric D.; BRESCACIN, Laura; GUIDO, Bibiana; CILENTI, Luciana; SENA, Luiz Rogerio; MOREIRA, Priscila Santos; GUSMAO, Rizia; CAVALCANTE, Liane; OLIVEIRA, Geane Borge de; KENNERLY, Silvia Eduara; OLIVEIRA, Andrea Guedes de; BACKSMANN, Alessandra; BERWANGER, Otavio; THEOTONIO, Joao Manoel; OSUGUE, Raphael Kazuo; GUERRA, Silvio; SILVA, Adriana Cruz Sarde da; CARVALHO, Paula Cristina Gonzaga; SANTOS, Edval Gomes dos; FARIAS, Tarsis Leonardo Almeida; AVELAR, Wagner Mauab; SANTOS, Anne Adrielle Oliveira; ALMEIDA FILHO, Alberto Cezar Santos; SOUZA, Felipe Ferreira Ribeiro de; MACHLINE-CARRION, Maria Julia; NUNES, Renata; CARVALHO, Mariana; GARCIA, Maria del Pilar Pozo; LIMA, Gonzalo; IOLI, Pablo Leonardo; GINEL, Malena; KOSLIK, Jessika Luana Alves; KLEIN, Francisco Ricardo; CLAVERIE, Carlos Santiago; CUOTO, Juan Blas Marcos; FRASQUETE, Analia; BERWANGER, Otavio; FERREIRA, Lis Campos; ALMEIDA, Andreza S.; SANTOS, Aline; ROCHA, Marcela; JURE, Lorena Vanina; KATSURAYAMA, Marilise; ESCHOYEZ, Maria Soledad; PEREIRA, Luiz Rogerio Sena; GUSMAO, Rizia Rocha Menezes; MOREIRA, Prisicla Santos; KUSTER, Gustavo Wruck; SANTUCCI, Eliana Vieira; MARTINS, Siderleny; MARTINS, Eliana Vieira do Nascimento; MALAGA, German; SORIANO, Victor Manuel Ortiz; SOUSA, Alessandro Augusto Viana e; ANGHINAH, Renato; NAKAJIMA, Karina; RUGGERO, Laisa Maia; RITT, Luiz Eduardo Fonteles; OLIVEIRA, Queila Borges de; CARRION, Mario Husek; DAMIANI, Lucas Petri; PAESE, Mari Ines; COSTA, Samanta da; GIACOMAZZI, Juliana; DONATTI, Amanda; NEUENSCHWANDER, Fernando Carvalho; MATOS, Arlete Pereira; NEUENSCHWANDER, Cristina; NETO, Ernesto Lippi; COSTA, Elisiany Mello; CASTILHO JUNIOR, Marco Antonio Mendes; TELES, Jose Mario Meira; BAHIT, Cecilia M.; ENDRIGO, Katia; COSTA, Ludmila Teodoro da; PAVANI, Pricila; MALAGA, German; NETO, Octavio Marques Pontes; ZETOLA, Viviane Flumignan; NORMILIO-SILVA, Karina; BETTGER, Janet Prvu; XIAN, Ying; LOPES, Renato Delascio; PETERSON, Eric; MACHLINE-CARRION, Maria Julia; BERWANGER, Otavio; SALLES, Antonio De; BAHIT, M. Cecilia; MALAGA, German; MARTINS, Sheila Cristina Ouriques; NETO, Octavio Marques Pontes; ZETOLA, Viviane Flumignan; GUIMARAES, Helio Penna; CAVALCANTI, Alexandre Biasi; FREITAS, Gabriel Rodrigues de; SALLES, Antonio De; GORGULHO, Alessandra; CONFORTO, Adriana; XIAN, Ying; BETTGER, Janet Prvu; LOPES, Renato Delascio; PETERSON, Eric; MACHLINE-CARRION, Maria Julia; BERWANGER, Otavio; GUIMARAES, Helio Penna; CAVALCANTI, Alexandre Biasi; MACHLINE-CARRION, Maria Julia; BAHIT, Cecilia M.; CALDERARO, Marcelo; MALAGA, German; MACHLINE-CARRION, Maria Julia; BERWANGER, Otavio; CAVALCANTI, Alexandre Biasi; LARANJEIRA, Ligia Nasi; SOARES, Rafael Marques; SILVA, Karina Normilio; BUENO, Priscila Regina; SANTUCCI, Eliana; CAMPOS, Viviane Bezerra; BULLA, Marina Lucia; RIBEIRO, Gisele Fialho Mota; GONZALES, Beatriz Pacheco; YAMASHITA, Juliana; KODAMA, Alessandra; SAMPAIO, Bruna; BARROS, Gabriel de Melo; CANDIDO, Carolina Trovarelli; JESUINO, Isabella de Andrade; ARBAIT, Tamiris; PINHEIRO, Samara; PARISOTO, Jaynne; BUSTA, Patricia; TEJADA, Virgina; DAMIANI, Lucas Petri; NAKAGAWA, Renato Hideo; BAHIT, Cecilia; ESNAOLA, Maria Marta; MALAGA, German; CABAJAL, Andre; BUSTA, Patricia; BAREA, Liselotte Menke; ANDRADE, Karina Nocelo Ferreiro de; SANTIM, Ricardo; DAMES, Jerusa; PARANHOS, Jorge Luiz da Rocha; LIMA, Gerluce Nery; MELO, Leonardo Vaz de; MARTINS, Sheila Cristina Ouriques; FLECK, Natacha; CAMARGO, Daiane Piccolotto Carvalho; OLIVEIRA, Fabiani Santos de; BRAGA, Gabriel Pereira; FREITAS, Paloma Fontes de; BAZAN, Rodrigo; ARANTES, Juliana; VIANA, Lorena Souza; ALQUERES, Rafaela; TRENTIN, Sheila; MORALES, Diego; SILVA, Beatriz Gonzales Pacheco da; FERNANDES, Maristela Thalheimer; VOIGT, Camila; MARTINS, Gladys Lentz; PAULI, Carla; ZETOLA, Viviane Flumignan; RASO, Larissa; RUBERT, Mauren Carneiro; SARAIVA, Sonia Batista; NOGUEIRA, Marcia Aparecida Camacho Kauffmann; MONTENARO, Kamilla Machado Paschoal; SANTOS, Juliana Yamashita; VELOSO, Cabo; MARTIN, Jose Fernando Vilela; BATTAGLINI, Mariana; PARISE, Viviane; BUTINHAO, Fernanda; MARTINELLI, Debora; ZANATTA, Joao Marcos de Menezes; RIBEIRO, Suzilene; TUNUCCI, Cileia Cristina Goncalves; CASTRO, Edna Donizete Rossi; JESUINO, Isabella de Andrade; DALL'ORTO, Frederico Toledo Campo; BERGO, Ricardo Reinaldo; RIBEIRO, Gislayne Rogante; SILVA, Gisele Sampaio; ALVES, Maramelia Araujo de Miranda; REGIS, Dalva; SILVA, Ilana Izidoro; SADALA, Danyelle; ROCHA, Felipe; ROCHA, Emilia Eva; BUENO, Priscila Regina Torres; ROUANET, Carolina; GALIARDI, Vivian; NARDOTO, Luiz Felipe; MERIDA, Kristel; BRAINER, Joao; RISCO, Eduardo Javier Tapia; TAHUA, Andre Aquiles Carbajal; BUSTA, Patricia; REYS, Michael; VELASQUEZ, Rafael Francisco; CAVALCANTI, Alexandre Biasi; CAHUARUPAY, Celia; CASTILLO, Diana; MONTES, Gerson Escobar; BARBOSA, Luiz Carlos Viana; VASCONCELOS, Jose Eduardo Gomes; CRUZ, Erica Maria Brandao; GONZALEZ, Leonardo Adrian; LEPERA, Sandra; PAEZ, Mauricio; MATIAS, Alet; GUIMARAES, Helio Penna; ALVA, Edwin Javier Pretell; ESNAOLA, Maria Martha; SCHIAVA, Marianela; TAGLIANI, Paula; REITERI, Romanela Carolina; GIARDINO, Daniela; EVARISTO, Eli; SANTOS, Edgar Ferreira dos; TAMBURIM, Barbara Reis; PEREIRA, Nathalia C. A.; XIAN, Ying; ROSA, Geiza Cristina Lozano Gomes da
    Key PointsQuestionCan a multifaceted quality improvement intervention increase the adherence to 10 evidence-based performance measures for patients with acute ischemic stroke and transient ischemic attack in Latin America? FindingsIn this cluster randomized clinical trial that included 1624 patients from 36 hospitals in 3 countries, hospitals in the intervention group had a composite adherence score of 85.3% for the evidence-based performance measures, and those in the control group had a score of 77.8%, a difference that was not statistically significant. In a planned secondary analysis, improvement in adherence to all 10 performance measures was greater in the intervention group than in the control group using an all-or-none approach for the outcome. MeaningIn this cohort of patients with acute ischemic stroke and transient ischemic attack, a multifaceted intervention did not demonstrate an overall improvement in adherence to evidence-based performance measures compared with standard of care, yet individual care elements improved. This cluster randomized clinical trial assesses the effect of a multifaceted quality improvement intervention compared with routine care on adherence to evidence-based therapy among patients with acute ischemic stroke and transient ischemic attack. ImportanceTranslating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. ObjectiveTo assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. Design, Setting and ParticipantsThis 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. InterventionsThe multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. Main Outcomes and MeasuresThe primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). ResultsA total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P=.01). Conclusions and RelevanceA multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. Trial RegistrationClinicalTrials.gov identifier: NCT02223273
  • article 36 Citação(ões) na Scopus
    Association among depression, cognitive impairment and executive dysfunction after stroke
    (2012) TERRONI, Luisa; SOBREIRO, Matildes F.M.; CONFORTO, Adriana B.; ADDA, Carla C.; GUAJARDO, Valeri D.; LUCIA, Mara Cristina S. de; FRÁGUAS, Renério
    ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.
  • article 4 Citação(ões) na Scopus
    Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients
    (2020) MIOTTO, Eliane C.; BAZAN, Paulo R.; BATISTA, Alana X.; CONFORTO, Adriana B.; FIGUEIREDO, Eberval G.; MARTIN, Maria Graca M.; AVOLIO, Isabella B.; JR, Edson Amaro; TEIXEIRA, Manoel J.
    Stroke lesions are frequently followed by cognitive impairments. Cognitive training is a non-pharmacological intervention that can promote neural compensation mechanisms and strategies to remediate cognitive impairments. The aims of this study were: (1) To investigate the cognitive performance, generalization effects, and neural correlates of semantic organization strategy training (SOST) in patients with chronic left frontoparietal stroke and healthy controls (HC); and (2) to compare the behavioral effects and neural correlates of SOST with an active control psychoeducation intervention (PI). In this randomized controlled study, all participants were randomly allocated into two groups, one group received SOST, and the other received PI intervention. Participants underwent two fMRI sessions, one prior and the other, after intervention. In each fMRI session, images were obtained during memory encoding task using a list of semantically related words. We found improved post-intervention memory performance in participants that received SOST (both patients and controls), indicated by number of words recalled, word clustering scores, and performance in a generalization task. The fMRI analysis revealed negative correlation between task performance and regions of the default-mode network. These results suggest that cognitive training using semantic organization strategy can improve episodic memory performance and promote potential functional neuroplasticity in patients with ischemic stroke lesions.
  • article 35 Citação(ões) na Scopus
    Safety of Pregnancy After Cerebral Venous Thrombosis Results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY Study
    (2017) SOUSA, Diana Aguiar de; CANHAO, Patricia; CRASSARD, Isabelle; COUTINHO, Jonathan; ARAUZ, Antonio; CONFORTO, Adriana; BEJOT, Yannick; GIROUD, Maurice; FERRO, Jose M.
    Background and Purpose-Pregnancy is associated with increased risk of venous thrombotic events, including cerebral venous thrombosis. We aimed to study the complications and outcome of subsequent pregnancies in women with previous cerebral venous thrombosis. Methods-Follow-up study of women with acute cerebral venous thrombosis at childbearing age included in a previously described cohort (International Study of Cerebral Vein and Dural Sinus Thrombosis). Patients were interviewed by local neurologists to assess rate of venous thrombotic events, pregnancy outcomes, and antithrombotic prophylaxis during subsequent pregnancies. Results-A total of 119 women were included, with a median follow-up of 14 years. Eighty-two new pregnancies occurred in 47 women. In 83% (68 of 82), some form of antithrombotic prophylaxis was given during at least 1 trimester of pregnancy or puerperium. Venous thrombotic events occurred in 3 pregnancies, including 1 recurrent cerebral venous thrombosis. Two of the 3 women were on prophylactic low-molecular-weight heparin at the time of the event. Outcomes of pregnancies were 51 full-term newborns, 9 preterm births, 2 stillbirths, and 20 abortions (14 spontaneous). Conclusions-In women with prior cerebral venous thrombosis, recurrent venous thrombotic events during subsequent pregnancies are infrequent.
  • article 2 Citação(ões) na Scopus
    Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients
    (2023) BARBOSA, Luciana Mendonca; VALERIO, Fernanda; SILVA, Valquiria Aparecida da; RODRIGUES, Antonia Lilian de Lima; GALHARDONI, Ricardo; YENG, Lin Tchia; JUNIR, Jefferson Rosi; CONFORTO, Adriana Bastos; LUCATO, Leandro Tavares; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi de
    Objectives: Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP.Methods: We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location.Results: We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non-neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 mu V +/- 464 mu V) than non-neuro-pathic (478 +/- 489) and no-pain (765 mu V +/- 880 mu V) patients, p < 0.001. Short-interval intracorti-cal inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6 +/- 11.6) compared to no-pain (0.80.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allo-dynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses.Discussion: CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to pro-vide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.(c) 2023 The Author(s).
  • article 3 Citação(ões) na Scopus
    Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A ""Real-world"" Study in a Developing Country
    (2020) SCHULZ, Victor C.; MAGALHAES, Pedro S. C. de; CAMEIRO, Camila C.; SILVA, Julia I. T. da; SILVA, Vivian N.; GUESSER, Vanessa V.; SAFANELLI, Juliana; DIEGOLI, Henrique; LIBERATO, Rafaela B.; LOPES, Cristiane C. C.; SOUZA, Aline de; FRANCA, Paulo H. C. de; CONFORTO, Adriana B.; CABRAL, Norberto L.
    Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the ""real world"" scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (EAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the EAT group. Compared to the NCRT group, IVT patients had a 28% higher (I IR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.
  • article 5 Citação(ões) na Scopus
    Repetitive Transcranial Magnetic Stimulation of the Contralesional Dorsal Premotor Cortex for Upper Extremity Motor Improvement in Severe Stroke: Study Protocol for a Pilot Randomized Clinical Trial
    (2022) LI, Xin; LIN, Yin-Liang; CUNNINGHAM, David A.; WOLF, Steven L.; SAKAIE, Ken; CONFORTO, Adriana B.; MACHADO, Andre G.; MOHAN, Akhil; O'LAUGHLIN, Kyle; WANG, Xiaofeng; WIDINA, Morgan; PLOW, Ela B.
    Up to 50% of stroke survivors have persistent, severe upper extremity paresis even after receiving rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can augment the effects of rehabilitation by modulating corticomotor excitability, but the conventional approach of facilitating excitability of the ipsilesional primary motor cortex (iM1) fails to produce motor improvement in stroke survivors with severe loss of ipsilesional substrate. Instead, the undamaged, contralesional dorsal premotor cortex (cPMd) may be a more suitable target. CPMd can offer alternate, bi-hemispheric and ipsilateral connections in support of paretic limb movement. This pilot, randomized clinical trial seeks to investigate whether rTMS delivered to facilitate cPMd in conjunction with rehabilitation produces greater gains in motor function than conventional rTMS delivered to facilitate iM1 in conjunction with rehabilitation in severely impaired stroke survivors. Twenty- four chronic (>= 6 months) stroke survivors with severe loss of ipsilesional substrate (defined by the absence of physiologic evidence of excitable residual pathways tested using TMS) will be included. Participants will be randomized to receive rTMS to facilitate cPMd or iM1 in conjunction with task-oriented upper limb rehabilitation given for 2 sessions/week for 6 weeks. Assessments of primary outcome related to motor impairment (upper extremity FuglMeyer [UEFM]), motor function, neurophysiology, and functional neuroimaging will be made at baseline and at 6-week end-of-treatment. An additional assessment of motor outcomes will be repeated at 3-month follow-up to evaluate retention. The primary endpoint is 6-week change in UEFM. This pilot trial will provide preliminary evidence on the effects and mechanisms associated with facilitating intact cPMd in chronic severe stroke survivors. The trial is registered on clinicaltrials.gov, NCT03868410. (c) 2022 S. Karger AG, Basel
  • article 7 Citação(ões) na Scopus
    Contralesional Cathodal Transcranial Direct Current Stimulation Does Not Enhance Upper Limb Function in Subacute Stroke: A Pilot Randomized Clinical Trial
    (2021) BOASQUEVISQUE, Danielle De S.; SERVINSCKINS, Larissa; PAIVA, Joselisa P. Q. de; SANTOS, Daniel G. Dos; SOARES, Priscila; PIRES, Danielle S.; MELTZER, Jed A.; PLOW, Ela B.; FREITAS, Paloma F. de; SPECIALI, Danielli S.; LOPES, Priscila; PERES, Mario F. P.; SILVA, Gisele S.; LACERDA, Shirley; CONFORTO, Adriana B.
    Transcranial direct current stimulation (tDCS) has the potential to improve upper limb motor outcomes after stroke. According to the assumption of interhemispheric inhibition, excessive inhibition from the motor cortex of the unaffected hemisphere to the motor cortex of the affected hemisphere may worsen upper limb motor recovery after stroke. We evaluated the effects of active cathodal tDCS of the primary motor cortex of the unaffected hemisphere (ctDCSM1(UH)) compared to sham, in subjects within 72 hours to 6 weeks post ischemic stroke. Cathodal tDCS was intended to inhibit the motor cortex of the unaffected hemisphere and hence decrease the inhibition from the unaffected to the affected hemisphere and enhance motor recovery. We hypothesized that motor recovery would be greater in the active than in the sham group. In addition, greater motor recovery in the active group might be associated with bigger improvements in measures in activity and participation in the active than in the sham group. We also explored, for the first time, changes in cognition and sleep after ctDCSM1(UH). Thirty subjects were randomized to six sessions of either active or sham ctDCSM1(UH) as add-on interventions to rehabilitation. The NIH Stroke Scale (NIHSS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Barthel Index (BI), Stroke Impact Scale (SIS), and Montreal Cognitive Assessment (MoCA) were assessed before, after treatment, and three months later. In the intent-to-treat (ITT) analysis, there were significant GROUP*TIME interactions reflecting stronger gains in the sham group for scores in NIHSS, FMA, BI, MoCA, and four SIS domains. At three months post intervention, the sham group improved significantly compared to posttreatment in FMA, NIHSS, BI, and three SIS domains while no significant changes occurred in the active group. Also at three months, NIHSS improved significantly in the sham group and worsened significantly in the active group. FMA scores at baseline were higher in the active than in the sham group. After adjustment of analysis according to baseline scores, the between-group differences in FMA changes were no longer statistically significant. Finally, none of the between-group differences in changes in outcomes after treatment were considered clinically relevant. In conclusion, active CtDCSM1(UH) did not have beneficial effects, compared to sham. These results were consistent with other studies that applied comparable tDCS intensities/current densities or treated subjects with severe upper limb motor impairments during the first weeks post stroke. Dose-finding studies early after stroke are necessary before planning larger clinical trials.
  • article 2 Citação(ões) na Scopus
    White Matter Integrity and Chronic Poststroke Upper Limb Function: An ENIGMA Stroke Recovery Analysis
    (2023) DOMIN, Martin; HORDACRE, Brenton; HOK, Pavel; BOYD, Lara A.; CONFORTO, Adriana B.; ANDRUSHKO, Justin W.; BORICH, Michael R.; CRADDOCK, Richard C.; DONNELLY, Miranda R.; DULA, Adrienne N.; WARACH, Steven J.; KAUTZ, Steven A.; LO, Bethany P.; SCHRANZ, Christian; SEO, Na Jin; SRIVASTAVA, Shraddha; WONG, Kristin A.; ZAVALIANGOS-PETROPULU, Artemis; THOMPSON, Paul M.; LIEW, Sook-Lei; LOTZE, Martin
    BACKGROUND:Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function.METHODS:We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy & GE;0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity).RESULTS:From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (r[21]=0.49; P=0.025) and superior longitudinal fascicle (r[21]=0.51; P=0.018) with Fugl-Meyer upper extremity.CONCLUSIONS:Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.
  • article 24 Citação(ões) na Scopus
    Combined Brain and Peripheral Nerve Stimulation in Chronic Stroke Patients With Moderate to Severe Motor Impairment
    (2018) MENEZES, Isabella S.; COHEN, Leonardo G.; MELLO, Eduardo A.; MACHADO, Andre G.; PECKHAM, Paul Hunter; ANJOS, Sarah M.; SIQUEIRA, Inara L.; CONTI, Juliana; PLOW, Ela B.; CONFORTO, Adriana B.
    ObjectivesTo evaluate effects of somatosensory stimulation in the form of repetitive peripheral nerve sensory stimulation (RPSS) in combination with transcranial direct current stimulation (tDCS), tDCS alone, RPSS alone, or sham RPSS+tDCS as add-on interventions to training of wrist extension with functional electrical stimulation (FES), in chronic stroke patients with moderate to severe upper limb impairments in a crossover design. We hypothesized that the combination of RPSS and tDCS would enhance the effects of FES on active range of movement (ROM) of the paretic wrist to a greater extent than RPSS alone, tDCS alone or sham RPSS+tDCS. Materials and MethodsThe primary outcome was the active ROM of extension of the paretic wrist. Secondary outcomes were ROM of wrist flexion, grasp, and pinch strength of the paretic and nonparetic upper limbs, and ROM of wrist extension of the nonparetic wrist. Outcomes were blindly evaluated before and after each intervention. Analysis of variance with repeated measures with factors session and time was performed. ResultsAfter screening 2499 subjects, 22 were included. Data from 20 subjects were analyzed. There were significant effects of time for grasp force of the paretic limb and for ROM of wrist extension of the nonparetic limb, but no effects of session or interaction session x time. There were no significant effects of session, time, or interaction session x time regarding other outcomes. ConclusionsSingle sessions of PSS+tDCS, tDCS alone, or RPSS alone did not improve training effects in chronic stroke patients with moderate to severe impairment.