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Yes / Energy consumption (EC) of consumers primarily depends on comfort level (CL) affirmed by brain sensations of the central nervous system. Environmental parameters such as surroundings, relative humidity, air temperature, solar irradiance, air pressure, and cloud cover directly influence consumer body temperature that in return affect blood dynamics perturbing brain comfort sensations. This CL (either in summer, winter, autumn, or spring season) is a function of external environment and internal body variations that force a consumer toward EC. To develop a new concept of consumer's EC, first the authors described environment parameters in detail with relation to surroundings and EC. Considering this, they tabulated a generic relation of consumer's CL with EC and environment temperature. Second, to build an inter-related bond between the environmental effects on consumer body dynamics, they analysed theoretically and mathematically above mutual relations between medical and environmental sciences. Finally, they present their conceptual EC model based on a closed-loop feedback system. This model is a complex non-linear adaptive system with environmental and surrounding parameters as input to the system resulting in an optimised EC, considering consumer CL as a key parameter for the system.

It was hypothesized that 192 IgG-saporin lesions of the basal forebrain cholinergic system (BFCS) would disrupt differential reinforcement of low rate (DRL) learning in an uncued DRL task, but would not impair acquisition and performance in the cued version of the task. Results suggest that BFCS lesions impair vigilance to the external cues despite continued practice in the cued DRL, whereas continuous attention to internally produced cues recovers with extended practice in the uncued DRL.

Autism spectrum disorders (ASD) are neurodevelopmental disorders with multiple neurobiological aetiologies, which could be genetic, structural, metabolic or immune-mediated. ASDs are diagnosed with deficits in social communication and restricted and repetitive behaviours, and are associated with sensorial atypicalities. 30% of cases have co-existing epilepsy. A series of in vitro, in vivo and post-mortem investigations were undertaken to examine sensory atypicalities in ASD. In vitro characterisation of hippocampal neuronal cultures using immunofluorescence demonstrated the presence of multiple cell types including neurons, astrocytes and microglia. The distribution of ion channels of the Shaker family and tumour necrosis factor α receptors in astrocytes and neurons were identified but not explored further. Neuroanatomical and neuropathological investigations of primary olfactory cortex, using post-mortem stereology, demonstrated a specific increase in glial cell densities in layer II, which was negatively associated with age in ASD. Increases in glia were also associated with symptom severity and often co-localised with the presence of corpora amylacea in layer I. Qualitative analysis of the olfactory tubercle demonstrated that corpora amylacea did not extend to this neighbouring region of the primary olfactory cortex in ASD. These changes were independent of co-existing epilepsy and not observed in epilepsy without ASD. Preliminary pilot studies of the hippocampus provided a stereological sampling strategy to quantify cell densities in future investigations of this area in ASD. Neurophysiological investigations using collected magnetoencephalography data demonstrated diminished occipital gamma oscillatory synchrony in ASD in a visual time perception task. This did not always predict behavioural outcome but was specific to ASD and could not be explained simply in terms of changes in task performance. Moreover, changes in oscillatory synchrony were associated with symptom severity. These observations in primary sensory domains in post-mortem tissue and in patients suggest possible novel mechanisms in ASD and extend knowledge of the neurobiological bases of these disorders.

De nouveaux enjeux émergent dans le domaine de la Santé en raison du vieillissement de la population et du développement inquiétant de la Maladie d’Alzheimer (MA). Chez le sujet sain ou pathologique, peu d’études ont porté sur le vieillissement du contrôle nerveux de la respiration, en dépit de son rôle crucial pour l’oxygénation du cerveau. Cette thèse présente des recherches translationnelles, réalisées chez la souris, pour étudier le vieillissement physiologique et pathologique du contrôle nerveux de la respiration. Chez des souris transgéniques, modèles reconnus de la MA et du syndrome de Rett, nous décrivons le développement de neuropathologies respiratoires graves, conduisant à un décès prématuré. Nous montrons pour la première fois qu’une tauopathie du tronc cérébral altère le fonctionnement des voies aériennes supérieures, la vocalisation et la respiration. De plus, nos travaux suggèrent un rôle délétère de l’anesthésie pour la MA et identifient des pistes thérapeutiques nouvelles. En conclusion, nos travaux chez la souris peuvent avoir des retombées particulièrement intéressantes notamment pour la MA. / New issues are emerging in the field of Health care due to ageing of the population and the alarming development of Alzheimer’s Disease (AD). In healthy or pathological living being, very few studies are dealing with the ageing of the respiratory nervous control, in spite of the crucial role of respiration for brain oxygenation. This thesis presents translational research performed in mice to examine the physiological and pathological ageing of the respiratory nervous control. In mice from two transgenic strains, recognized models for AD and Rett syndrome, we describe the development of drastic respiratory neuropathologies leading to premature death. In the AD mouse model, we show for the first time that brainstem tauopathy triggers dysfunctions of the upper airways, impairs vocalization and alters respiration and respiratory control. In addition, our work suggests a deleterious effect of anaesthesia for AD and identifies new therapeutic strategies. This mouse research could well contribute to significant improvements in AD care.

L’objectif de cette thèse a été de développer des outils d’exploration des modifications perceptuelles lors de l’écoute de sons complexes dans la schizophrénie et de confronter les résultats de ces outils à des données neurophysiologiques. Le premier résultat de notre thèse est d’avoir confirmé dans la modalité auditive des modifications de l’organisation perceptuelle lors de l’écoute de sons complexes. En effet, nous avons montré, chez les patients souffrant de schizophrénie comparativement aux témoins, d’une part une difficulté de catégorisation des sons environnementaux de type son d’impact, et d’autre part, une modification de la perception de la familiarité et de la bizarrerie pour des sons environnementaux et abstraits, indiquant une modification d’organisation des données de l’audition dans une forme univoque et consensuelle.Le deuxième résultat de notre thèse est d’avoir confirmé, par une méthode d’induction perceptuelle consistant à présenter des stimuli plus ou moins envahissants, la présence d’un sentiment d’envahissement perceptuel plus important chez les patients souffrants de schizophrénie comparativement aux témoins. Cet envahissement perceptuel était corrélé significativement avec une mesure neurophysiologique du filtrage sensoriel par potentiels évoqués dans le paradigme des doubles clics audio (diminution d’amplitude de la composante P50 au deuxième stimulus comparativement au premier stimulus). Nous avons également traduit et validé en langue française un auto-questionnaire appelé Sensory Gating Inventory (SGI) permettant de compléter l’évaluation psychophysiologique des modifications perceptuelles reliées aux anomalies du filtrage sensoriel. / The aim of this PhD was to develop tools for analyzing perceptual modifications induced by complex sounds in schizophrenia and to relate these changes to neurophysiological data. The first result of our work enabled to confirm that complex sounds modify the auditory perceptual organization. Indeed, we first showed a deficit of categorization of environmental sounds (impact sounds) in patients with schizophrenia compared with controls, and secondly a difference in the perception of familiarity and strangeness for environmental and abstract sounds, indicating a modification of data organization of hearing in a unique and consensual form.The second result of our work revealed, by a perceptual induction method, the presence of a larger perceptual sense of inundation in patients suffering from schizophrenia compared with controls when submitted to more or less invasive stimuli. This perceptual inundation was significantly correlated with a neurophysiological measurement of sensory gating with evoked responses in the paradigm of double audio clicks (decrease in amplitude of the P50 component after the second stimulus as compared to the first stimulus). We have also translated a self-administered questionnaire called “Sensory Gating Inventory” (SGI) to French and validated it in order to complete the psychophysiological assessment of perceptual changes related to abnormal sensory gating.

Introdução: Ativação exacerbada de processos excitatórios mediados por NMDA e excesso de inibição mediada por GABA são descritos, respectivamente, nas fases agudas e subagudas após o traumatismo cranioencefálico (TCE). No entanto, existem poucos estudos a respeito do funcionamento desses circuitos na fase crônica do TCE. Objetivo: Avaliar a excitabilidade cortical (EC) de pacientes em fase crônica que sofreram TCE, especificamente diagnosticados com lesão axonial difusa (LAD). Métodos: Todos os 31 pacientes adultos foram avaliados após 1 ano, pelo menos, do TCE moderado ou grave. Inicialmente, os pacientes foram submetidos à avaliação de funções executivas - atenção, memória, fluência verbal e velocidade de processamento de informação - por meio de bateria neuropsicológica. Em seguida, a avaliação da EC foi realizada utilizando-se uma bobina circular para aplicar pulsos simples e pareados de estimulação magnética transcraniana na região cortical representativa do abdutor curto do polegar (pollicis brevis) na área M1 de ambos hemisférios. Os parâmetros de EC medidos foram: Limiar Motor de Repouso (LMR), Potenciais Evocados Motores (PEM), Inibição Intracortical de Intervalo Curto (IICIC) e Facilitação Intracortical (FIC). Todos os dados foram comparados aos dados normativos de EC já descritos na literatura e também aos de um grupo controle de pessoas saudáveis. Resultados: Não houve diferença significativa entre os hemisférios direto e esquerdo. Desta forma, os dados foram analisados de forma agrupada (\"pooled data\"). Os valores de LMR e FIC dos pacientes com LAD estavam dentro dos valores de normalidade. No entanto, os valores de PEMs a 120% do LMR, a 140% do LMR e IICIC estavam aumentados (respectivamente p=0,013; p=0,012; p < 0,001): PEM-120% LAD 524,95 [365,42 ; 616,66] versus Controles 303,50 [241,49 ; 399,19]; PEM-140% LAD 1150,00 [960,56 ; 1700,00] vs Controles 670,5 [575,43 ; 1122,78] e IICIC LAD 1,09 [0,82 ; 1,35] vs Controles 0,34 [0,28 ; 0,51]; pp02-Rel LAD 0,85 [0,64 ; 1,36] vs Controles 0,28 [0,20 ; 0,37]; pp04-Rel LAD 1,03 [0,88 ; 1,34] vs Controles 0,38 [0,29 ; 0,62] - sugerindo um possível desarranjo no sistema inibitório (p < 0.001). Os achados neuropsicológicos mostraram alterações na memória, atenção e velocidade de processamento de informação, mas possuíam correlação fraca com os dados de EC. Conclusão: Como os processos inibitórios envolvem circuitos mediados por GABA, além de outros, existe a possível inferência de que a própria fisiopatologia do LAD (rompimento de axônios) possa depletar GABA contribuindo com a desinibição do sistema neural na fase crônica do LAD / Background: Overactivation of NMDA-mediated excitatory processes and excess of GABA-mediated inhibition are described after a brain injury on the acute and subacute phases, respectively. Nevertheless, there are few studies regarding the circuitry on the chronic phase of brain injury. Objective: To evaluate the cortical excitability (CE) on the chronic phase of Traumatic Brain Injury (TBI) victims, specifically diagnosed with Diffuse Axonal Injury (DAI). Method: All 31 adult patients were evaluated after one year, at least, from the moderate and severe TBI. First, all patients underwent a broad neuropsychological assessment to evaluate executive functions - attention, memory, verbal fluency and information processing speed. Then, subsequently, the 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 (MEP), Short Interval Intracortical Inhibition (SIICI), and Intracortical Facilitation (ICF). All data were compared to normative data previously described on literature and to a control group that consisted of healthy subjects. Results: No significant difference between Left and Right hemispheres were found on these DAI patients. Therefore, parameters were analyzed as pooled data. Values of RMT and ICF from DAI patients were found within the normality. However, MEPs and SIICI values were higher on DAI patients (respectively p=0,013; p=0,012; p < 0,001): MEP-120% DAI 524,95 [365,42 ; 616,66] versus Control 303,50 [241,49 ; 399,19]; MEP-140% DAI 1150,00 [960,56 ; 1700,00] vs Control 670,5 [575,43 ; 1122,78] and SIICI DAI 1,09 [0,82 ; 1,35] vs Control 0,34 [0,28 ; 0,51]; pp02-Rel DAI 0,85 [0,64 ; 1,36] vs Control 0,28 [0,20 ; 0,37]; pp04-Rel DAI 1,03 [0,88 ; 1,34] vs Control 0,38 [0,29 ; 0,62] - suggesting a disarranged inhibitory system (p < 0.001). The neuropsychological findings had weak correlation with CE data. Conclusion: As inhibition processes also involve GABA-mediated circuitry, it is likely to infer that DAI pathophysiology itself (disruption of axons) may deplete GABA contributing to a disinhibition of the neural system on the chronic phase of DAI

A estimulação transcortical com corrente contínua (ETCC) é uma técnica de estimulação não-invasiva do córtex cerebral que tem mostrado efeitos positivos no controle da dor crônica. A hipótese principal deste estudo foi verificar se a associação da ETCC ao tratamento multidisciplinar de pacientes com fibromialgia aumentaria os resultados no controle da dor e melhora da qualidade de vida. O desenho do estudo foi um ensaio clínico controlado, aleatorizado, duplo-cego e de braços paralelos. Vinte e três mulheres com fibromialgia receberam o tratamento habitual de reabilitação com a intervenção multidisciplinar e medicamentos e foram divididas aleatoriamente em um grupo com ETCC anódica sobre o córtex motor esquerdo e catódica na região supra-orbital direita, com corrente contínua de 2mA, por 20 minutos. O outro grupo recebeu estimulação sham, na qual a mesma disposição de eletrodos foi usada sobre o couro cabeludo, porém a corrente foi interrompida após 1 minuto, permanecendo desligada nos 19 minutos restantes. As sessões ocorreram uma vez por semana por 10 semanas consecutivas, sempre antes de terapia multidisciplinar. A dor foi quantificada ao início e ao final do tratamento pela escala pela visual analógica (EVA) e pela dolorimetria de pressão sobre os pontos dolorosos da fibromialgia. A qualidade de vida foi avaliada pelo Questionário de impacto da fibromialgia (FIQ) e SF-36. Como possíveis fatores de confusão, foram avaliados o humor e a capacidade funcional por meio do Índice de depressão de Beck (IDB), Escala de Hamilton (HAM) e questionário HAQ. Não foram descritos efeitos adversos graves. Houve melhora significativa da pontuação do domínio Dor do questionário SF-36, com efeito significante apenas no grupo sob estimulação ativa (de 26,6 ± 12,9 para 45,6 ± 15,1 ao final do tratamento, p=0,006). Nenhum dos demais desfechos apresentou melhora estatisticamente significativa, exceto FIQ que teve evolução marginalmente significativa no grupo ativo (62,1 ± 11,5 para 49,2 ± 21,2; p=0,056) e HAQ que evoluiu de 1,51 ± 0,47 para 1,24 ± 0,4 (p=0,0005), todavia sem diferença entre os grupos. Estes resultados reproduzem parcialmente os achados anteriores de melhora da dor com estímulo nãoinvasivo sobre o córtex motor, mas com dimensões menores, em virtude, talvez, da baixa freqüência de estímulos. A falta de ganhos diferenciados nos grupo ativo em outras dimensões da funcionalidade sugere que a estimulação realizada tem efeito específico sobre a dor. Conclui-se que a associação da ETCC à intervenção multidisciplinar pode trazer ganhos somatórios no controle das queixas clínicas da fibromialgia / Transcranial direct current stimulation (tDCS) is a non-invasive technique of cortical brain stimulation which has shown some positive effects on chronic pain control. The main hypothesis of this study was to verify if the association of tDCS to the multidisciplinary approach in patients with fibromyalgia would increase the results for the control of pain and improve quality of life. The study design was a randomized, double-blinded, shamcontrolled clinical Trial of parallel arms. Twenty tree women with fibromyalgia received the usual treatment with the multidisciplinary approach and drugs, and were randomly allocated in a group with 2mA anodic tDCS for 20 minutes over the left primary motor cortex and the cathode was positioned over the right supra-orbital region. Another group with sham stimulation, with the same electrode positioning, had the electric current interrupted within 1 minute from of stimulation and remained off during the remaining 19 minutes. Stimulations occurred weekly for 10 weeks, always before the multidisciplinary intervention. Pain was rated at the begging of the treatment and after its end by the visual analogue scale (VAS) e pressure dolorimetry on fibromyalgia tender points. Quality of life was evaluated with the Fibromyalgia impact questionnaire (FIQ) and SF-36. As possible confounders, humor and functional capacity were evaluated with Beck depression index (BDI), Hamilton scale (HAM) and HAQ. There were no serious adverse effects. There was a significant improvement in the Pain domain of SF-36, with significant effect only in the group under active tDCS (from 26.6 ± 12.9 to 45.6 ± 15.1 in the end of the treatment, p=0.006). Any of the other outcomes showed statistically significant improvement, except for FIQ, which presented with a marginally significant improvement in the active group (62.1 ± 11.5 to 49.2 ± 21.2; p=0.056) and HAQ (1.51 ± 0.47 to 1.24 ± 0.4; p=0.0005), without any difference in both groups. These results partially reproduce previous findings of pain improvement with non-invasive stimulation of the motor cortex, however with smaller effects, maybe due to the use of a reduced weekly frequency of stimuli. The lack of differential gains in the active group in other dimensions of functioning suggests the used stimulation be specifically effective for pain. The conclusion is that the association of tDCS to the multidisciplinary approach may bring additional improvement in the control of pain in fibromyalgia

La perception visuelle des visages est une fonction importante du cerveau humain, essentielle pour les interactions sociales. L’étude des bases neurales de la perception des visages a débuté il y a plusieurs décennies et les découvertes servent de modèle pour la compréhension de la perception visuelle en général. L’imagerie structurelle des patients présentant un déficit de reconnaissance des visages à la suite d’une lésion cérébrale a montré l’importance d’un vaste territoire au sein du cortex ventral occipito-temporal (VOTC), du lobe occipital jusqu’au lobe temporal antérieur (LTA), avec une prédominance droite. L’imagerie par résonnance magnétique fonctionnelle (IRMf) a montré l’existence de zones cérébrales circonscrites qui répondent plus fortement aux visages qu’aux autres objets visuels (organisation en « cluster ») principalement dans le VOTC postérieur. Cependant l’IRMf a été limitée dans sa capacité à retrouver de telles régions dans le lobe temporal antérieur à cause d’artefacts méthodologiques. Les études d’électro-encéphalographie intracrânienne (iEEG) réalisées chez les patients épileptiques sont une opportunité unique d’enregistrer l’activité neuronale directe avec un très haut rapport signal/bruit. Les études iEEG ont enregistré des réponses sélectives aux visages largement distribuées dans le VOTC, sans organisation en « clusters ». Malgré des années de recherches, plusieurs questions cruciales restent sans réponse : (1) quelle est l’organisation spatiale des régions sélectives aux visages (organisation distribuée vs. en « clusters ») ? ; (2) quelles sont les bases neurales de la perception des visages dans le LTA ? ; (3) quelles sont les régions critiques pour la perception des visages ? Afin de répondre à ces questions, nous avons utilisé les enregistrements et les stimulations électriques intracérébraux. Dans une 1ère étude (Jonas et al., sous presse), nous avons combiné les enregistrements iEEG avec la stimulation visuelle périodique rapide (FPVS). La méthode FPVS est basée sur le principe suivant : présenter des stimuli visuels à une fréquence fixe va générer une réponse EEG périodique à la même fréquence. Nous avons utilisé cette approche pour réaliser une cartographie complète des réponses sélectives aux visages dans le VOTC (28 participants). Nous leur avons montré des séquences d’images d’objets présentées à une fréquence fixe et rapide (6 Hz), avec un visage présenté tous les 5 objets (1,2 Hz). Les réponses sélectives aux visages ont été identifiées objectivement (à la fréquence de stimulation) et quantifiées dans tout le VOTC. Bien que ces réponses aient été enregistrées de manière largement distribuée, nous avons identifié plusieurs régions dans les lesquelles les réponses les plus fortes se regroupent spatialement (en « clusters »). De plus, nous avons enregistré la plus forte réponse dans le gyrus fusiforme droit. Enfin, nous avons enregistré des réponses sélectives aux visages dans 3 régions distinctes du LTA. Dans 3 autres études, nous rapportons de très rares cas de stimulations électriques de régions sélectives aux visages, testant leur rôle critique dans la perception des visages. Nous rapportons un cas de déficit transitoire de la perception des visages après stimulation du gyrus occipital inférieur droit, la région sélective au visage la plus postérieure (Jonas et al., 2012, 2014) et un cas similaire après stimulation du LTA (Jonas et al., 2015). Dans l’ensemble, ces études montrent que : (1) les régions impliquées dans la perception des visages sont largement distribuées le long du VOTC et certaines sont marquées par un regroupement spatial de leurs réponses les plus fortes ; (2) plusieurs régions distinctes sont sélectives aux visages dans le LTA; (3) des régions spécifiques dans le VOTC postérieur et le LTA sont critiques pour la perception des visages. Ces études montrent l’intérêt des enregistrements intracérébraux pour la compréhension des mécanismes de perception visuelle / Visual perception of faces is a primary function of the human brain, critical for social interactions. The neural basis of face perception in humans has been investigated extensively for decades as a primary research goal, whose findings may serve as a rich model for understanding perceptual recognition. Structural imaging of individuals with face recognition impairment following brain damage point to a large territory of the human ventral occipito-temporal cortex (VOTC), from the occipital lobe to the anterior temporal lobe (ATL), with a right hemispheric advantage. Functional magnetic resonance imaging studies (fMRI) have reported face-selective responses (larger responses to faces than other visual objects) in circumscribed regions (clustered organization) of the posterior VOTC. However, they failed to report genuine responses in the ATL because of methodological artefacts. Intracranial electroencephalographic (iEEG) recordings performed in epileptic patients offer a unique opportunity to measure direct local neural activity with a very high signal-to-noise ratio. In contrast to fMRI studies, iEEG studies recorded face-selective responses in widely distributed regions of the VOTC without any evidence of a clustered organization. Despite decades of research, several outstanding questions are still unanswered: (1) what is the spatial organization of brain regions supporting face perception (clustered vs. distributed)?; (2) what are the neural basis of face perception in the ATL?; (3) which are the critical regions for face perception? To address these gaps in knowledge, we used human iEEG recordings and electrical intracerebral stimulations. In a first study (Jonas et al., in press), we combined iEEG recordings with the Fast Periodic Visual Stimulation (FPVS), a powerful approach providing objective and high signal-to-noise brain responses. FPVS is based on the simple principle: presenting visual stimuli at a fixed rate generates a periodic EEG response at exactly the same frequency. We use this approach to report a comprehensive map of face-selective responses across the VOTC in a large group of participants (N=28). They were presented with natural images of objects at a rapid fixed rate (6 images per second: 6 Hz), with face stimuli interleaved as every 5th stimulus (i.e., 1.2 Hz). Face-selective responses were objectively (i.e., exactly at the face stimulation frequency) identified and quantified throughout the whole VOTC. Although face-selective responses were widely distributed, specific regions displayed a clustered spatial organization of their most face-selective responses. Among these regions, the right fusiform gyrus showed the largest face-selective response. In addition, we recorded face-selective responses in 3 distinct regions of the ATL. In 3 others studies, we reported very rare cases of intracerebral electrical stimulation of face-selective brain regions, testing the critical role of these regions in face perception. We reported a case of transient inability to recognize faces following the stimulation of the right inferior occipital gyrus, the most posterior face-selective region (Jonas et al., 2012, 2014) and one similar case following the stimulation of the right ATL (Jonas et al., 2015). Overall, these studies show that: (1) face-selective responses are widely distributed but some specific regions displayed a clustered spatial organization of their most face-selective responses; (2) several distinct regions are face-selective in the ATL; (3) specific brain regions in the posterior VOTC and in the ATL are critical for face perception. These finding also illustrate the diagnostic value of intracerebral electrophysiological recordings in understanding visual recognition processes

A estimulação transcortical com corrente contínua (ETCC) é uma técnica de estimulação não-invasiva do córtex cerebral que tem mostrado efeitos positivos no controle da dor crônica. A hipótese principal deste estudo foi verificar se a associação da ETCC ao tratamento multidisciplinar de pacientes com fibromialgia aumentaria os resultados no controle da dor e melhora da qualidade de vida. O desenho do estudo foi um ensaio clínico controlado, aleatorizado, duplo-cego e de braços paralelos. Vinte e três mulheres com fibromialgia receberam o tratamento habitual de reabilitação com a intervenção multidisciplinar e medicamentos e foram divididas aleatoriamente em um grupo com ETCC anódica sobre o córtex motor esquerdo e catódica na região supra-orbital direita, com corrente contínua de 2mA, por 20 minutos. O outro grupo recebeu estimulação sham, na qual a mesma disposição de eletrodos foi usada sobre o couro cabeludo, porém a corrente foi interrompida após 1 minuto, permanecendo desligada nos 19 minutos restantes. As sessões ocorreram uma vez por semana por 10 semanas consecutivas, sempre antes de terapia multidisciplinar. A dor foi quantificada ao início e ao final do tratamento pela escala pela visual analógica (EVA) e pela dolorimetria de pressão sobre os pontos dolorosos da fibromialgia. A qualidade de vida foi avaliada pelo Questionário de impacto da fibromialgia (FIQ) e SF-36. Como possíveis fatores de confusão, foram avaliados o humor e a capacidade funcional por meio do Índice de depressão de Beck (IDB), Escala de Hamilton (HAM) e questionário HAQ. Não foram descritos efeitos adversos graves. Houve melhora significativa da pontuação do domínio Dor do questionário SF-36, com efeito significante apenas no grupo sob estimulação ativa (de 26,6 ± 12,9 para 45,6 ± 15,1 ao final do tratamento, p=0,006). Nenhum dos demais desfechos apresentou melhora estatisticamente significativa, exceto FIQ que teve evolução marginalmente significativa no grupo ativo (62,1 ± 11,5 para 49,2 ± 21,2; p=0,056) e HAQ que evoluiu de 1,51 ± 0,47 para 1,24 ± 0,4 (p=0,0005), todavia sem diferença entre os grupos. Estes resultados reproduzem parcialmente os achados anteriores de melhora da dor com estímulo nãoinvasivo sobre o córtex motor, mas com dimensões menores, em virtude, talvez, da baixa freqüência de estímulos. A falta de ganhos diferenciados nos grupo ativo em outras dimensões da funcionalidade sugere que a estimulação realizada tem efeito específico sobre a dor. Conclui-se que a associação da ETCC à intervenção multidisciplinar pode trazer ganhos somatórios no controle das queixas clínicas da fibromialgia / Transcranial direct current stimulation (tDCS) is a non-invasive technique of cortical brain stimulation which has shown some positive effects on chronic pain control. The main hypothesis of this study was to verify if the association of tDCS to the multidisciplinary approach in patients with fibromyalgia would increase the results for the control of pain and improve quality of life. The study design was a randomized, double-blinded, shamcontrolled clinical Trial of parallel arms. Twenty tree women with fibromyalgia received the usual treatment with the multidisciplinary approach and drugs, and were randomly allocated in a group with 2mA anodic tDCS for 20 minutes over the left primary motor cortex and the cathode was positioned over the right supra-orbital region. Another group with sham stimulation, with the same electrode positioning, had the electric current interrupted within 1 minute from of stimulation and remained off during the remaining 19 minutes. Stimulations occurred weekly for 10 weeks, always before the multidisciplinary intervention. Pain was rated at the begging of the treatment and after its end by the visual analogue scale (VAS) e pressure dolorimetry on fibromyalgia tender points. Quality of life was evaluated with the Fibromyalgia impact questionnaire (FIQ) and SF-36. As possible confounders, humor and functional capacity were evaluated with Beck depression index (BDI), Hamilton scale (HAM) and HAQ. There were no serious adverse effects. There was a significant improvement in the Pain domain of SF-36, with significant effect only in the group under active tDCS (from 26.6 ± 12.9 to 45.6 ± 15.1 in the end of the treatment, p=0.006). Any of the other outcomes showed statistically significant improvement, except for FIQ, which presented with a marginally significant improvement in the active group (62.1 ± 11.5 to 49.2 ± 21.2; p=0.056) and HAQ (1.51 ± 0.47 to 1.24 ± 0.4; p=0.0005), without any difference in both groups. These results partially reproduce previous findings of pain improvement with non-invasive stimulation of the motor cortex, however with smaller effects, maybe due to the use of a reduced weekly frequency of stimuli. The lack of differential gains in the active group in other dimensions of functioning suggests the used stimulation be specifically effective for pain. The conclusion is that the association of tDCS to the multidisciplinary approach may bring additional improvement in the control of pain in fibromyalgia