ADRIANA BASTOS CONFORTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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bookPart 0 Citação(ões) na Scopus Non-invasive brain stimulation in post-stroke Aphasia rehabilitationand language research(2021) MENDONçA, L. I. Z. de; CONFORTO, A. B.Aphasia is significant impairment of stroke that has a major impact on quality of life. The results of speech and language therapy are often limited. Non-invasive brain stimulation (NIBS) has been proposed as an add-on intervention to aphasia treatment. This chapter focuses on the use of NIBS in language research as well as in post-stroke aphasia research and rehabilitation. © 2021 Nova Science Publishers, Inc.- Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients (vol 11, 1048, 2020)(2021) MIOTTO, Eliane C.; BAZAN, Paulo R.; BATISTA, Alana X.; CONFORTO, Adriana B.; FIGUEIREDO, Eberval G.; MARTIN, Maria da Graca M.; AVOLIO, Isabella B.; AMARO, Edson; TEIXEIRA, Manoel J.
conferenceObject PRESERVATION OF QUALITY OF ACUTE STROKE CARE DURING THE COVID-19 PANDEMIC IN THE LARGEST SOUTH AMERICAN HOSPITAL(2021) ANDRADE, J.; FONSECA, B.; MORAES JR., A. A.; CONFORTO, A.conferenceObject REPETITIVE PERIPHERAL SENSORY STIMULATION AS AN ADD-ON INTERVENTION FOR UPPER LIMB REHABILITATION IN STROKE: A RANDOMIZED TRIAL(2021) CONFORTO, A.; MACHADO, A.; RIBEIRO, N.; PLOW, E.; LIEW, S-L; LEITE, C. Da Costa; ZAVALIANGOS-PETROPULU, A.; MENEZES, I.; ANJOS, S. Dos; LUCCAS, R.; PECKHAM, P.; COHEN, L.conferenceObject NEUROMODULATION IN ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS(2021) PELLEGRINO, M.; SALLES, I.; SHINOSAKI, J.; REIS, S.; NOGUEIRA, R.; CONFORTO, A.- 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.
- Repetitive Peripheral Sensory Stimulation as an Add-On Intervention for Upper Limb Rehabilitation in Stroke: A Randomized Trial(2021) CONFORTO, Adriana B.; MACHADO, Andre G.; RIBEIRO, Nathalia H. V.; PLOW, Ela B.; LIEW, Sook-Lei; LEITE, Claudia da Costa; ZAVALIANGOS-PETROPULU, Artemis; MENEZES, Isabella; ANJOS, Sarah M. dos; LUCCAS, Rafael; PECKHAM, Paul Hunter; COHEN, Leonardo G.Introduction Repetitive peripheral sensory stimulation (RPSS) followed by 4-hour task-specific training (TST) improves upper limb motor function in subjects with stroke who experience moderate to severe motor upper limb impairments. Here, we compared effects of RPSS vs sham followed by a shorter duration of training in subjects with moderate to severe motor impairments in the chronic phase after stroke. Methods This single-center, randomized, placebo-controlled, parallel-group clinical trial compared effects of 18 sessions of either 1.5 h of active RPSS or sham followed by a supervised session that included 45 min of TST of the paretic upper limb. In both groups, subjects were instructed to perform functional tasks at home, without supervision. The primary outcome measure was the Wolf Motor Function Test (WMFT) after 6 weeks of treatment. Grasp and pinch strength were secondary outcomes. Results In intention-to-treat analysis, WMFT improved significantly in both active and sham groups at 3 and 6 weeks of treatment. Grasp strength improved significantly in the active, but not in the sham group, at 3 and 6 weeks. Pinch strength improved significantly in both groups at 3 weeks, and only in the active group at 6 weeks. Conclusions The between-group difference in changes in WMFT was not statistically significant. Despite the short duration of supervised treatment, WMFT improved significantly in subjects treated with RPSS or sham. These findings are relevant to settings that impose constraints in duration of direct contact between therapists and patients. In addition, RPSS led to significant gains in hand strength. Trial Registry Name: Peripheral Nerve Stimulation and Motor Training in Stroke Clinical Trials.gov identifier: NCT0265878
- Smaller spared subcortical nuclei are associated with worse post-stroke sensorimotor outcomes in 28 cohorts worldwide(2021) LIEW, Sook-Lei; ZAVALIANGOS-PETROPULU, Artemis; SCHWEIGHOFER, Nicolas; JAHANSHAD, Neda; LANG, Catherine E.; LOHSE, Keith R.; BANAJ, Nerisa; BARISANO, Giuseppe; BAUGH, Lee A.; BHATTACHARYA, Anup K.; BIGJAHAN, Bavrina; BORICH, Michael R.; BOYD, Lara A.; BRODTMANN, Amy; BUETEFISCH, Cathrin M.; BYBLOW, Winston D.; CASSIDY, Jessica M.; CHARALAMBOUS, Charalambos C.; CIULLO, Valentina; CONFORTO, Adriana B.; CRADDOCK, Richard C.; DULA, Adrienne N.; EGOROVA, Natalia; FENG, Wuwei; FERCHO, Kelene A.; GREGORY, Chris M.; HANLON, Colleen A.; HAYWARD, Kathryn S.; HOLGUIN, Jess A.; HORDACRE, Brenton; HWANG, Darryl H.; KAUTZ, Steven A.; KHLIF, Mohamed Salah; KIM, Bokkyu; KIM, Hosung; KUCEYESKI, Amy; LO, Bethany; LIU, Jingchun; LIN, David; LOTZE, Martin; MACINTOSH, Bradley J.; MARGETIS, John L.; MOHAMED, Feroze B.; NORDVIK, Jan Egil; PETOE, Matthew A.; PIRAS, Fabrizio; RAJU, Sharmila; RAMOS-MURGUIALDAY, Ander; REVILL, Kate P.; ROBERTS, Pamela; ROBERTSON, Andrew D.; SCHAMBRA, Heidi M.; SEO, Na Jin; SHIROISHI, Mark S.; SOEKADAR, Surjo R.; SPALLETTA, Gianfranco; STINEAR, Cathy M.; SURI, Anisha; TANG, Wai Kwong; THIELMAN, Gregory T.; THIJS, Vincent N.; VECCHIO, Daniela; WARD, Nick S.; WESTLYE, Lars T.; WINSTEIN, Carolee J.; WITTENBERG, George F.; WONG, Kristin A.; YU, Chunshui; WOLF, Steven L.; CRAMER, Steven C.; THOMPSON, Paul M.Liew et al. report the first large-scale examination using high-resolution neuroimaging of subcortical nuclei and sensorimotor behaviour in 828 stroke patients from 28 cohorts worldwide. They discovered novel associations between post-stroke sensorimotor behaviour and specific subcortical nuclei, providing new insight for stroke rehabilitation. Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of spared subcortical nuclei and sensorimotor behaviour at different timepoints after stroke. We pooled high-resolution T-1-weighted MRI brain scans and behavioural data in 828 individuals with unilateral stroke from 28 cohorts worldwide. Cross-sectional analyses using linear mixed-effects models related post-stroke sensorimotor behaviour to non-lesioned subcortical volumes (Bonferroni-corrected, P < 0.004). We tested subacute (<= 90 days) and chronic (>= 180 days) stroke subgroups separately, with exploratory analyses in early stroke (<= 21 days) and across all time. Sub-analyses in chronic stroke were also performed based on class of sensorimotor deficits (impairment, activity limitations) and side of lesioned hemisphere. Worse sensorimotor behaviour was associated with a smaller ipsilesional thalamic volume in both early (n = 179; d = 0.68) and subacute (n = 274, d = 0.46) stroke. In chronic stroke (n = 404), worse sensorimotor behaviour was associated with smaller ipsilesional putamen (d = 0.52) and nucleus accumbens (d = 0.39) volumes, and a larger ipsilesional lateral ventricle (d = -0.42). Worse chronic sensorimotor impairment specifically (measured by the Fugl-Meyer Assessment; n = 256) was associated with smaller ipsilesional putamen (d = 0.72) and larger lateral ventricle (d = -0.41) volumes, while several measures of activity limitations (n = 116) showed no significant relationships. In the full cohort across all time (n = 828), sensorimotor behaviour was associated with the volumes of the ipsilesional nucleus accumbens (d = 0.23), putamen (d = 0.33), thalamus (d = 0.33) and lateral ventricle (d = -0.23). We demonstrate significant relationships between post-stroke sensorimotor behaviour and reduced volumes of deep grey matter structures that were spared by stroke, which differ by time and class of sensorimotor measure. These findings provide additional insight into how different cortico-thalamo-striatal circuits support post-stroke sensorimotor outcomes.
conferenceObject Topic: AS33 Uncommon Stroke Disorders and Challenging Cases CHARACTERIZATION OF HEADACHE IN THE LATE PHASE DO CEREBRAL VENOUS THROMBOSIS(2021) BOSSONI, A.; CONFORTO, A.; PERES, M.- Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology(2021) BRUCKI, Sonia Maria Dozzi; ADONI, Tarso; ALMEIDA, Carlos Mauricio Oliveira; ANDRADE, Daniel Ciampi de; ANGHINAH, Renato; BARBOSA, Luciana Mendonca; BAZAN, Rodrigo; CARVALHO, Alzira Alves de Siqueira; CARVALHO, William; CHRISTO, Paulo Pereira; COLETTA, Marcus Della; CONFORTO, Adriana Bastos; CORREA-NETO, Ylmar; ENGELHARDT, Eliasz; FRANCA JUNIOR, Marcondes Cavalcante; FRANCO, Clelia; GLEHN, Felipe Von; GOMES, Helio Rodrigues; HOULY, Caroline Gomes de Barros; KAUP, Alexandre Ottoni; KOWACS, Fernando; KANASHIRO, Aline; LOPES, Victor Goncalves; MAIA, Debora; MANREZA, Maria; MARTINEZ, Alberto Rolim Muro; MARTINEZ, Sandra Cristina Goncalves; NADER, Saulo Nardy; NEVES, Luciana de Oliveira; OKAMOTO, Ivan Hideyo; OLIVEIRA, Rogerio Adas Ayres de; PEIXOTO, Fabiano de Melo; PEREIRA, Cristiana Borges; SABA, Roberta Arb; SAMPAIO, Leticia Pereira de Brito; SCHILLING, Lucas Porcello; SILVA, Marcus Tulius Teixeira; SILVA, Emanuelle Roberta; SMID, Jerusa; SOARES, Cristiane Nascimento; SOBREIRA-NETO, Manoel; SOUSA, Nise Alessandra de Carvalho; SOUZA, Leonardo Cruz de; TEIVE, Helio Afonso Ghizoni; TERRA, Vera Cristina; VALE, Matheus; VIEIRA, Vitor Mendes Grise; ZANOTELI, Edmar; PRADO, GilmarCannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.