Predictors of Treatment Response of Motor Sequels After a Stroke
Predictors of Treatment Response of Motor Sequels After a Stroke
The cerebrovascular accident (CVA) is currently the leading cause of death in Brazil and it
 is estimated that there are about 62 million stroke survivors worldwide. Thus, the stroke
 sequels are a major public health problem not only in Brazil but in the world, with existing
 treatments often insufficient for complete recovery. Thus this study aims to identify
 predictors of different responses from rehabilitation therapy through the evaluation of
 clinical and neurophysiological data performed before and after treatment. For the
 neurophysiological study will be used the association of electroencephalogram (EEG) and
 transcranial magnetic stimulation (TMS). This last one will be performed in the baseline and
 after a single Transcranial direct current stimulation (tDCS) session, aiming to leverage the
 ability of those technics to analyze the cerebral plasticity. As a secondary objective: 1)
 Identify specific features of brain plasticity involved in recovery from stroke and discuss
 the possible implications of these findings in the therapeutic approach; 2) Search possible
 electrophysiological markers that can be used as surrogate outcome of stroke of motor sequel.
The cerebrovascular accident (CVA) is currently the leading cause of death in Brazil and it
 is estimated that there are about 62 million stroke survivors worldwide. Thus, the stroke
 sequels are a major public health problem not only in Brazil but in the world, with existing
 treatments often insufficient for complete recovery. Thus, the search for new treatments is
 necessary, as well as the need to optimize and individualize the existing treatments. Several
 approaches are being used in order to find predictors of the recovery of patients after the
 stroke, highlighting the most recent studies using magnetic resonance imaging (MRI) with
 tractography. However these studies have important limitations such as high cost, but mainly
 the low capacity of this technique to quantify brain plasticity known to play an important
 role in the recovery of stroke sequelae. Thus, techniques to measure brain plasticity theory
 offer the best potential to predict the resilience of post stroke injury, among which stands
 out transcranial magnetic stimulation (TMS).

 TMS is a noninvasive brain stimulation techniques suitable for measuring the motor cortex
 excitability which in turn is used as an indirect measure of brain plasticity. Another
 interesting approach is the combination of TMS with the study of neuronal function through
 the electroencephalogram (EEG). The EEG under the stroke, has also been suggested as sequelae
 recovery predictor, however in this scenario the association of these findings with TMS has
 not yet been explored. Thus this study aims to identify predictors of different responses
 from rehabilitation therapy through the evaluation of clinical and neurophysiological data
 performed before and after treatment. For the neurophysiological study will be used the
 association of electroencephalogram (EEG) and transcranial magnetic stimulation (TMS). This
 last one will be performed in the baseline and after a single Transcranial direct current
 stimulation (tDCS) session, aiming to leverage the ability of those technics to analyze the
 cerebral plasticity.
Inclusion Criteria:

 -  Clinical and radiological diagnosis (Functional magnetic Resonance (FMR) and/or
 Computerized tomography (TC) ) of the stroke;

 -  More than one month from the date of the stroke;

 -  Clinical stability;

 -  Signed and dated informed consent form.

 Exclusion Criteria:

 -  Disturbs that forbid the adherence in treatment;

 -  Subjects already undergoing in other researches;

 -  Pregnant women;

 -  Lesions that could affect the proposed therapy;

 -  The occurence of lesion or muscle,joint pain that could forbid the therapy;

 -  Destabilization of the clinical comorbidities.