This thesis investigated the development of an EEG-based brain controlled switch and the design of a software for nerve conduction study. For EEG-based brain controlled switch, we proposed a novel paradigm for an online brain-controlled switch based on Event-Related Synchronizations (ERDs) following external sync signals. Furthermore, the ERD feature was enhanced by 3 event-related moving averages and the performance was tested online. Subjects were instructed to perform an intended motor task following an external sync signal in order to turn on a virtual switch. Meanwhile, the beta-band (16-20Hz) relative ERD power (ERD in reverse value order) of a single EEG Laplacian channel from primary motor area was calculated and filtered by 3 event-related moving average in real-time. The computer continuously monitored the filtered relative ERD power level until it exceeded a pre-set threshold selected based on the observations of ERD power range to turn on the virtual switch. Four right handed healthy volunteers participated in this study. The false positive rates encountered among the four subjects during the operation of the virtual switch were 0.8±0.4%, whereby the response time delay was 36.9±13.0s and the subjects required approximately 12.3±4.4 s of active urging time to perform repeated attempts in order to turn on the switch in the online experiments. The aim of nerve conduction simulator software design is to create software that can be used by nerve conduction simulator to serve as a medical simulator or education tool to train novice physicians for nerve conduction study test. The real response waveform of 10 different upper limb nerves in conduction studies were obtained from the equipment used in real patient studies. A waveform generation model was built to generalize the response waveform near the standard stimulus site within study interest region based on the extracted waveforms and normal reference parameters of each study and stimulus site coordinates. Finally, based on the model, a software interface was created to simulate 10 different nerve conduction studies of the upper limb with 9 pathological conditions.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas. / Leprosy, a disease known for its characteristic insensitive skin patches, is the main cause of peripheral neuropathy in endemic countries. Leprosy reactions are well-known for promoting nerve function impairment by neuritis which range from asymptomatic to exuberant clinical pictures. These neuropathy characteristics make early diagnosis exceptionally challenging as the need to intervene in order to prevent permanent nerve damage. This prospective clinical study was done selecting leprosy patients regardless their clinical form, who had presented leprosy reaction at the Souza Araújo Out-patient clinic, FIOCRUZ, Rio de Janeiro. The objective was to study the neurologic, the neurophysiological, and the nerve image pattern before and after the treatment of leprosy reactions.Twenty five patients at the time of leprosy reactions and one year after the reaction treatment had been evaluated by means of neurologic examination, physiotherapyc examination, nerve conduction study, evaluation of thickness and echogenicity of the committed nerves through the use of ultrasound, Laser Doppler fluxometry, and also by the quantitative sensory test. The patients were divided in three groups: eight patients had acute neuritis, nine had silent neuritis, and eight had skin reaction without neuritis.This study was approved by the ethics committee of the Oswaldo Cruz Foundation.In the evaluated patients presenting reactional episodes there had been a male predominance (60%), a multibacillary group predominance (80%) and a borderline-lepromatosus (36%) clinic form predominance. The isolated neuritis was the most frequent leprosy reaction, followed by neuritis associated with type 1 reaction, and by neuritis associated with type 2 reaction. The most common motor nerve affected by neuritis was peroneal, followed by ulnar nerve whereas most common sensory nerve affected was sural.The characteristic electroneuromyography pattern of leprosy reactions was multiplex mononeuropathy. The ultrasound, Laser Doppler fluxometry, and the quantitative sensory test together with the clinical examination and with the nerve conduction study were helpful exams for initial evaluation and follow-up treatment of leprosy reaction. A motor function improvement had been observed after the treatment but the same didnt occur regarding the sensory function.Throughout these studies it had been observed a need of a multidiscipline follow up for leprosy patients with specialized exams in order to have reaction diagnoses and early treatment avoiding neurological sequelae

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas. / Leprosy, a disease known for its characteristic insensitive skin patches, is the main cause of peripheral neuropathy in endemic countries. Leprosy reactions are well-known for promoting nerve function impairment by neuritis which range from asymptomatic to exuberant clinical pictures. These neuropathy characteristics make early diagnosis exceptionally challenging as the need to intervene in order to prevent permanent nerve damage. This prospective clinical study was done selecting leprosy patients regardless their clinical form, who had presented leprosy reaction at the Souza Araújo Out-patient clinic, FIOCRUZ, Rio de Janeiro. The objective was to study the neurologic, the neurophysiological, and the nerve image pattern before and after the treatment of leprosy reactions.Twenty five patients at the time of leprosy reactions and one year after the reaction treatment had been evaluated by means of neurologic examination, physiotherapyc examination, nerve conduction study, evaluation of thickness and echogenicity of the committed nerves through the use of ultrasound, Laser Doppler fluxometry, and also by the quantitative sensory test. The patients were divided in three groups: eight patients had acute neuritis, nine had silent neuritis, and eight had skin reaction without neuritis.This study was approved by the ethics committee of the Oswaldo Cruz Foundation.In the evaluated patients presenting reactional episodes there had been a male predominance (60%), a multibacillary group predominance (80%) and a borderline-lepromatosus (36%) clinic form predominance. The isolated neuritis was the most frequent leprosy reaction, followed by neuritis associated with type 1 reaction, and by neuritis associated with type 2 reaction. The most common motor nerve affected by neuritis was peroneal, followed by ulnar nerve whereas most common sensory nerve affected was sural.The characteristic electroneuromyography pattern of leprosy reactions was multiplex mononeuropathy. The ultrasound, Laser Doppler fluxometry, and the quantitative sensory test together with the clinical examination and with the nerve conduction study were helpful exams for initial evaluation and follow-up treatment of leprosy reaction. A motor function improvement had been observed after the treatment but the same didnt occur regarding the sensory function.Throughout these studies it had been observed a need of a multidiscipline follow up for leprosy patients with specialized exams in order to have reaction diagnoses and early treatment avoiding neurological sequelae