Previous research has established that observing another in pain activates both affective and sensorimotor cortical activity that is also present during the first-hand experience of pain. Some researchers have taken this “mirroring” response as indicative of empathic processing. However, very little work has explored the downstream behavioral effects of empathic pain observation. The aim of this dissertation is to begin to fill this gap in the literature by exploring the relationship between empathic pain observation, overt motor behaviours, and sensorimotor activity. In chapters 2-4, I provide robust evidence that observing pain inflicted on another person leads to faster reaction time responses. This effect is shown to be temporally extended (by at least 500ms after pain observation), effector-general (affecting both finger and foot responses), influenced by top-down (i.e., instructions to explicitly empathize) but not bottom-up (i.e., the perceived level of pain) factors, and is not influenced by adaptive (approach/withdraw) behaviours. In chapter 5, I show that sensorimotor activity, measured via TMS-induced Motor Evoked Potentials, increases while observing another in pain regardless whether the observer is preparing to make an action vs. passively observing the stimuli. These results run counter to the literature, and I provide several explanations for why these results were found. Lastly, in chapter 6, I show that sensorimotor activity, measured via Mu and Beta suppression, also increases while observing another in pain regardless whether the observer is preparing to make an action vs. passively observing the stimuli. Interestingly, I do not find significant correlations between sensorimotor activity during pain observation and faster reaction times after pain observation. I embed these findings in relation to the wider social neuroscience of empathy literature and discuss several limitations and challenges in empirically measuring “empathy” as a psychological construct. Overall, this dissertation furthers our understanding of empathy for pain by highlighting the behavioural consequences of pain observation and its connection (or rather, lack thereof) to sensorimotor activity during pain observation. / Thesis / Doctor of Philosophy (PhD) / Past research suggests that overlapping brain activity during the first-hand experience of pain and pain observation may be indicative of empathy. However, very little work has been done to explore how pain observation influences overt behaviours. This thesis investigates this issue by having participants complete a reaction time task while watching videos of needles stabbing a person’s hand. The findings reported in this thesis suggests that observing another in pain facilitates motor behaviours (i.e., faster reaction times); this facilitation extends 500ms after pain observation, affects both the hand and feet, is accentuated by instructing participants to explicitly empathize, and is not influenced by approach vs. withdraw movements. Brain activity in the motor system was also found to increase during pain observation. Overall, this thesis begins the discussion of how empathic pain observation influences explicit motor behaviours, and how such behaviours may be related to brain activity.

No / The right temporoparietal cortex plays a critical role in body representation. Here, we applied repetitive transcranial magnetic stimulation (rTMS) over right extrastriate body area (EBA) and temporoparietal junction (TPJ) to investigate their causative roles in perceptual representations of one's own and others' body. Healthy women adjusted size-distorted pictures of their own body or of the body of another person according to how they perceived the body (subjective task) or how others perceived it (intersubjective task). In keeping with previous reports, at baseline, we found an overall underestimation of body size. Crucially, EBA-rTMS increased the underestimation bias when participants adjusted the images according to how others perceived their own or the other woman's body, suggesting a specific role of EBA in allocentric body representations. Conversely, TPJ-rTMS increased the underestimation bias when participants adjusted the body of another person, either a familiar other or a close friend, in both subjective and intersubjective tasks, suggesting an involvement of TPJ in representing others' bodies. These effects were body-specific, since no TMS-induced modulation was observed when participants judged a familiar object. The results suggest that right EBA and TPJ play active and complementary roles in the complex interaction between the perceptions of one's own and other people's body.

No description available.

This thesis describes a series of experiments in human observers using neurophysiological and behavioural approaches to investigate the effects of varying haptic stimuli, attentional demand and age on motor control and perception during haptic sensing (i.e., using the hand to seek sensory information by touch). In Experiments I-IV, transcranial magnetic stimulation (TMS) was used to explore changes in corticomotor excitability when participants were actively engaged in haptic sensing tasks. These studies showed that corticospinal excitability, as reflected in motor evoked potential (MEP) amplitude, was greatly enhanced when participants were engaged in different forms of haptic sensing. Interestingly, this extra corticomotor facilitation was absent when participants performed finger movements without haptic sensing or when attention was diverted away from haptic input by a concurrent cognitive task (Exp I). This provided strong evidence that the observed corticomotor facilitation was likely central in origin and related to haptic attention. Neuroimaging has shown activation of the parieto-frontal network likely subserves this aspect of haptic perception. Further, this haptic-specific corticomotor facilitation was finely modulated depending on whether participants focused attention on identifying material (texture) as opposed to geometric properties of scanned surfaces (Exp II). With regards to aging effects, haptic-related corticomotor facilitation was associated with higher recognition accuracy in seniors (Exp III). In line with this, seniors exhibited similar levels of haptic-related corticomotor facilitation to young adults when task demands were adjusted for age (Exp IV). Interestingly, both young and senior adults also showed substantial corticomotor facilitation in the ‘resting’ hand when the ipsilateral hand was engaged in haptic sensing (Exp IV). Simply touching the stimulus without being required to identify its properties (no attentional task demands) produced no extra corticomotor facilitation in either hand or age group, attesting again to the specificity of the effects with regards to haptic attention. In Experiments V-VI, the ability to recognise 2-D letters by touch was investigated using kinematic and psychophysical measures. In Experiment V, we characterized how age affected contact forces deployed at the fingertip. This investigation showed that older adults exhibited lower normal force and increased letter-to-letter variability in normal force when compared to young adults. This difference in contact force likely contributed to longer contact times and lower recognition accuracy in older adults, suggesting a central contribution to age-related declines in haptic perception. Consistent with this interpretation, Experiment VI showed that haptic letter recognition in older adults was characterized not only by lower recognition accuracy but also by substantial increases in response times and specific patterns of confusion between letters. All in all, these investigations highlight the critical interaction of central factors such as attentional demand with aging effects on motor and perceptual aspects of haptic sensing. Of particular significance is the clear demonstration that corticomotor excitability is greatly enhanced when a haptic sensing component (i.e., attending to specific haptic features) is added to simple finger movements performed at minimal voluntary effort levels (typically <15 % of the maximal effort). These observations underline the therapeutic potential of active sensory training strategies based on haptic sensing tasks for the re-education of motor and perceptual deficits in hand function (e.g., subsequent to a stroke). The importance of adjusting attentional demands and stimuli is highlighted, particularly with regards to special considerations in the aging population.

No description available.

Résumé : INTRODUCTION : Le rappel de douleurs passées est souvent inexact. Ce phénomène, connu sous le nom de biais mnémonique, pourrait être lié au développement de certaines douleurs chroniques. Dans une étude précédente, notre laboratoire a montré, grâce à l’électroencéphalographie, que l’activité du gyrus temporal supérieur (GTS) était positivement corrélée à l’exagération des rappels douloureux. L’objectif de cette étude était de confirmer si l’activité cérébrale du GTS est impliquée causalement dans le phénomène du biais mnémonique. MÉTHODES : Dans cette étude randomisée à double insu, la stimulation magnétique transcrânienne (TMS) fut utilisée pour perturber temporairement l’activité du GTS (paradigme de lésion virtuelle). Les participants étaient assignés aléatoirement au groupe contrôle (TMS simulée, n = 21) ou au groupe expérimental (TMS réelle, n = 21). L’intensité et l’aspect désagréable de la douleur ont été évalués grâce à des échelles visuelles analogues (ÉVA; 0 à 10) immédiatement après l’événement douloureux (stimulations électriques du nerf sural droit) et au rappel, 2 mois plus tard. L’exactitude du rappel douloureux fut calculée en soustrayant l’ÉVA au rappel de l’ÉVA initiale. RÉSULTATS : Le biais mnémonique de l’intensité de la douleur était similaire dans les deux groupes (contrôle = -0,3, expérimental = 0,0; p = 0,83) alors que le biais mnémonique de l’aspect désagréable de la douleur était significativement inférieur dans le groupe expérimental (contrôle = 1.0, expérimental = -0,4; p < 0,05). CONCLUSION : Nos résultats suggèrent que le GTS affecte spécifiquement nos souvenirs liés à l’aspect motivo-affectif de la douleur. Étant donné le lien entre l’exagération des souvenirs douloureux et la persistance de la douleur, l’inhibition du GTS pourrait être une avenue intéressante pour prévenir le développement de douleur chronique. / Abstract : INTRODUCTION: Pain memories are often inaccurate. This phenomenon, known as the mnemonic pain bias, could be related to the development of chronic pain. In a past study, our research team showed, using electroencephalography, that the activity of the superior temporal gyrus (STG) was positively correlated to the exaggeration of pain recall. The aim of this study was to confirm that the STG is causally involved in the pain mnemonic bias. METHODS: In this randomised double-blind study, single-pulse transcranial magnetic stimulation (TMS) was used to transiently disrupt (virtual lesion paradigm) the activity of the STG. Participants were either assigned to the control (sham TMS, n = 21) or experimental (real TMS, n = 21) group. Pain intensity and unpleasantness were assessed using visual analog scales (VAS; 0-10) immediately after the painful event (electric stimulations of the right sural nerve) and at recall, 2 months later. The accuracy of the pain recall was determined by calculating the difference between the VAS at recall and the initial VAS. RESULTS: The mnemonic pain intensity bias was similar in both groups (control = -0.3, experimental = 0.0; p = 0.83). However, the mnemonic pain unpleasantness bias was significantly lower in the experimental group (control = 1.0, experimental = -0.4; p < 0.05). CONCLUSION: Our results suggest that the STG affects specifically our memories of the affective component of pain. Given the link between exaggerated pain memories and the development of persistent pain, this study suggests that the inhibition of the STG could be a promising avenue for individuals at risk of developing chronic pain.

Introdução e objetivos: A estimulação magnética transcraniana (EMT) é um método exclusivo para estimulação cerebral não-invasiva. A diferença fundamental entre EMT e as outras técnicas disponíveis de mapeamento por imagem do cérebro é que se estabelece haver uma relação de causa e efeito entre a resposta fisiológica evocada e o estímulo magnético. A relação entre estrutura e função como a principal característica, constitui uma modalidade de mapeamento cerebral ainda não estabelecido. Os recentes avanços no processamento de imagem permitiram refinar EMT através de sua combinação com a ressonância magnética utilizando-se do sistema de neuronavegação para orientar o posicionamento da bobina em relação ao córtex. Assim a posição da bobina sobre o couro cabeludo pode ser mantida constante conforme verificado pela orientação de navegação em tempo real com registro visual. O objetivo deste estudo foi avaliar a utilidade da EMT no mapeamento cortical motor em comparação com o mapeamento cirúrgico com estimulação cortical direta. Métodos: O estudo foi conduzido com 30 mapeamentos consecutivos em pacientes com programação de cirurgia para tumores adjacentes ao córtex motor. O mapeamento pré-operatório foi realizado com o sistema de estimulação magnética transcraniana navegada. Esta estimulação gera um pulso magnético através de uma bobina. Este método permite estimulação diretamente no córtex cerebral. Eletródios de superfície foram anexados ao abdutor curto do polegar. Em seguida, o limiar motor em repouso (LM) foi determinado através da aplicação de estimulação para região cortical da mão presumida. Mapeamento peritumoral foi realizado na intensidade de 120% do LM. O mapeamento foi realizando com definição de coordenadas vetoriais. Estas coordenadas foram ponderadas previamente por potencial evocado motor. O mapeamento intra-operatório foi realizado pelo cirurgião antes da ressecção do tumor também com neuronavegação. Os locais de estimulação intraoperatória foram selecionados de forma independente dos resultados da EMT. Resultados: Os pontos obtidos na ECD foram comparados ao mapa da EMT segundo coordenadas vetoriais dos centros geométricos da nuvem de pontos obtidos. Verificamos que a distância dos pontos vetoriais médios (centro geométrico) dos pontos obtidos nos dois métodos de mapeamentos diferiu em 4,85 +/- 1,89 mm. A análise de correlação intraclasse revelou uma correlação de 0,901 com p<0,001. As distâncias dos pontos obtidos para o tumor, identificamos uma alta correlação entre estas variáveis com r=0,87, p=0,001. O Limiar motor na EMT é maior no córtex motor do adjacente ao tumor, comparado ao córtex normal. Não há correlação entre os limiares motores de repouso na EMT e na estimulação elétrica. A exatidão do mapeamento com EMT é mantida em pacientes com déficits motores. A condição clínica dos pacientes melhorou significativamente em 3 meses após a cirurgia. Conclusões: A estimulação magnética transcraniana navegada é uma ferramenta confiável e precisa com congruência de pontos obtidos comparados com o mapeamento intraoperatório. EMT navegada é um método promissor para o mapeamento funcional pré-operatória em cirurgia de tumor adjacente ao motor córtex / Introduction and aims: Transcranial magnetic stimulation (TMS) is a unique method for non-invasive brain stimulation. The fundamental difference between TMS and other available non-invasive brain imaging techniques is that when a physiological response is evoked by stimulation of a cortical area, that specific cortical area is causally related to the response. The relationship between structure and function as the major feature constituting a brain mapping modality can therefore not be established. Recent advances in image processing allowed us to refine TMS by combining magnetic resonance imaging modalities with TMS using a neuronavigation system to measure the position of the stimulating coil and map this position onto a MRI data set. This technique has several advantages over recent TMS mapping strategies. The position of the coil on the scalp can be held constant as verified by real time visual guidance. The aim of this study was to evaluate the usefulness of navigayed TMS for cortical mapping compared with surgical mapping with direct cirtical stimulation. Methods: The study was performed with 30 neurosurgeries for tumors in or near precentral gyrus. Preoperative mapping was performed with the navigated transcranial brain stimulation system. The TMS system calculates the strength, location, and direction of the stimulating electric field in cortical tissue. It allows online targeting of stimulation directly to peritumoral córtex. The coordinates of TMS mapping were weighted by motor evoked potential. Surface electromyography electrodes were attached to abductor pollicis brevis. Next, the resting motor threshold was determined. The motor threshold was then defined traditionally as the lowest stimulation intensity capable of eliciting motor evoked potentials in at least 5 of 10 trials. The motor threshold was reported both as the percentage of the maximum stimulator intensity. Peritumoral mapping was performed at 120% motor threshold. The intraoperative mapping was performed by the surgeon performing the tumor resection. The Intraoperative direct cortical stimulation locations were chosen independently of the TMS results. The direct electric cortical stimulation points were compared with TMS responses according to original distances of vectorial modules. Results: There is a similarity of the points performed in two mapping methods. We found the distances between geometric centers of TMS and DCS 4,85 +/- 1,89. We identified a strong correlation between these vectorial points (r = 0.901 and p < 0.001). The motor threshold in TMS is the largest in the motor cortex near to the tumor compared to normal cortex (p<0,001). Patients with deficits presented excellent accuracy in two methods. The clinical performance of the patient improved significantly 3 months after surgery. Conclusion: TMS allowed for reliable, precise application in brain mapping and the peritumoral somatotopy corresponded well between the 2 modalities. Navigated TMS is a promising method for preoperative functional mapping in motor cortex tumor surgery

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-04-27T14:32:14Z No. of bitstreams: 1 Lívia Andreza de Macêdo Bezerra Alcântara.pdf: 5262105 bytes, checksum: b083f301b37714d6c62fbc8f1960632a (MD5) / Made available in DSpace on 2017-04-27T14:32:14Z (GMT). No. of bitstreams: 1 Lívia Andreza de Macêdo Bezerra Alcântara.pdf: 5262105 bytes, checksum: b083f301b37714d6c62fbc8f1960632a (MD5) Previous issue date: 2017-03-14 / This dissertation is composed of an article that is submitted to the Brazilian Journal of Physical Therapy (BJPT), entitled "Effects of Transcranial Magnetic Stimulation and Functional Electrical Stimulation on Quality of Life and Functional Independence of People with Spinal Cord Injury." This is a longitudinal and observational study with the objective of evaluating the effects of transcranial magnetic estimation (rTMS) and functional electrical estimation (FES) on quality of life (QoL) and functional capacity of adult patients with LM spinal cord injury. A sample initially composed of a group of individuals who complete a research with a clinical diagnosis of LM. The study was done for two treatment periods. In the first period, patients were followed up in the outpatient rehabilitation process for 30 days prior to initiation of rTMS therapy. In the second treatment period, patients continued the therapies that they already did in the first period and were inserted in a therapy by the rTMS / FES. Participants had 20 daily sessions of rTMS and FES associated with traditional therapy. As the evaluations were carried out before the first survey, before the first treatment period, between the first and the second period at the end of the second treatment period. The following instruments were used: Sociodemographic and Clinical Profile Sheet; Scale of the American Spinal Injury Association (ASIA); Functional Independence Measurement Scale (MIF); Barthel Index; And the Medical Outcomes Study Questionnaire 36v2 - Short Item - Form Health Survey (SF-36v2). The analysis of the nine individuals of both sexes obtained an average age of 33.55 (± 10.78) years. It was not observed between a first and second evaluation. But, between the second and third evaluation, there was improvement in the Barthel Index (p = 0.02); In the mobility and transfer domain (p = 0.02), in its total score (p = 0.01) of MIF; And it has no SF-36v2 functional processing capability (p = 0.02). It can be concluded that rTMS and FES improve QoL and the functional independence of patients with LM. / Esta dissertação é composta por um artigo que será submetido ao Brazilian Journal of Physical Therapy (BJPT), intitulado “Efeitos da Estimulação Magnética Transcraniana Repetitiva e da Estimulação Elétrica Funcional na qualidade de vida e independência funcional de pessoas com lesão medular”. Trata-se de um estudo do tipo longitudinal e observacional, com o objetivo de avaliar os efeitos da estimulação magnética transcraniana (EMTr) e estimulação elétrica funcional (FES) na qualidade de vida (QV) e capacidade funcional de pacientes adultos com lesão medular (LM). A amostra inicialmente foi composta por vinte e sete indivíduos, finalizando a pesquisa nove pacientes com diagnóstico clínico de LM. O estudo foi composto por dois períodos de tratamento. No primeiro período, os pacientes foram acompanhados no processo de reabilitação ambulatorial por 30 dias antes do início da terapia pela EMTr. No segundo período de tratamento os pacientes deram continuidade às terapias que já faziam no primeiro período e a ele foi inserido a terapia pela EMTr/FES. Os participantes tiveram 20 sessões diárias de EMTr e FES associada a terapia tradicional. As avaliações foram realizadas três vezes pela pesquisadora, antes do primeiro período de tratamento, entre o primeiro e o segundo período e ao término do segundo período de tratamento. Foram utilizados os instrumentos: Ficha de Perfil Sociodemográfico e Clínico; escala da American Spinal Injury Association (ASIA); escala de Medida de Independência Funcional (MIF); Índice de Barthel; e o questionário Medical Outcomes Study 36v2 - Item Short - Form Health Survey (SF-36v2). Na análise dos nove indivíduos, de ambos os sexos, obteve-se média de idade de 33,55 (±10,78) anos. Não foi observada entre a primeira e a segunda avaliação diferença significativa. Mas, entre a segunda e a terceira avaliação, houve melhora no Índice de Barthel (p=0,02); no domínio mobilidade e transferência (p=0,02), na sua pontuação total (p=0,01) da MIF; e no domínio capacidade funcional do SF-36v2 (p=0,02). Pode-se concluir que EMTr e FES melhoram a QV e a independência funcional de pacientes com LM.

A depressão pós-parto (DPP), tal como o episódio depressivo maior, é uma manifestação psiquiátrica comum, caracterizada pela presença de alterações de humor, cognitivas, comportamentais, psicomotoras e vegetativas. Afeta a qualidade da interação mãe-bebê prejudicando a responsividade materna o que pode repercurtir negativamente na manutenção salutar do desenvolvimento da criança. Esta manifestação apresenta prevalência estimada entre 10 e 20%, considerando as mulheres que desenvolvem sintomas nas primeiras semanas depois do parto. As opções de tratamento incluem drogas antidepressivas e eletroconvulsoterapia (com anestesia). Porém, como ambas terapêuticas envolvem abordagens farmacológicas, há contra-indicação devido à toxidade que impediria a amamentação. Entretanto, existe uma preocupação sobre como garantir a eficácia do tratamento sem prejudicar o bebê. A Estimulação Magnética Transcraniana Repetitiva (EMTr), por ser uma técnica já consagrada quanto a eficácia antidepressiva, não toxicológica, indolor, não invasiva e bem tolerada para estimular o cérebro, parece ser uma boa alternativa de tratamento. Nos quadros depressivos em geral, são observados prejuízos substanciais a várias funções cognitivas cujas alterações cognitivas apresentadas são, em grande parte, semelhantes àquelas relacionadas a alterações do funcionamento do córtex pré-frontal. A função executiva é um dos principais domínios cognitivos afetados nos transtornos depressivos, geralmente avaliada por testes como Trail Making e o teste de Stroop. A presença de depressão em pacientes puerperais parece intensificar as alterações cognitivas, especialmente as funções associadas ao lobo frontal, além do que, também prejudicam o comportamento causando danos no funcionamento social global. No presente estudo, randomizado, controlado e duplo-cego, investigaram-se os possíveis efeitos da EMTr no funcionamento cognitivo e sua repercussão comportamental: Estimulação Magnética Transcraniana de repetição (EMTr) aplicada ao córtex prefrontal dorsolateral esquerdo (CPFDLE). Uma amostra inicial de dez pacientes com DPP foram distribuídos em dois grupos. Sete participantes de um dos grupos receberam EMTr ativa e três, do grupo controle, EMTr placebo. Os parâmetros utilizados na EMTr foram: freqüência de 5 Hz, intensidade de 120% do limiar motor, em intervalos de 10 segundos ligado e 20 segundos desligado, com 25 séries por dia (2500 pulsos), durante 20 dias (quatro semanas) com dois dias de pausa semanal. Os pacientes e os avaliadores eram cegos ao tipo de tratamento de cada grupo. A avaliação neuropsicológica se deu através de testes cognitivos relacionados às funções prejudicadas em quadros depressivos e com a área estimulada (CPFDLE). Foram também aplicadas as escalas de Adequação Social (EAS) de Weissmann e Bothwell para avaliar o comportamento funcional social global, de depressão de Hamilton, 17 itens, e de depressão pós-parto de Edinburgh. As avaliações foram realizadas em três momentos: antes do início do tratamento (T0), após 4 semanas (T2) e após 6 semanas (T3). Como principais resultados foram observadas: melhora significativa no quadro depressivo ao longo do tratamento e um melhor ajustamento comportamental no funcionamento social global geral, especialmente no contexto das relações familiares; ausência de efeitos negativos em todos os testes cognitivos após o tratamento com EMTr; desempenho superior do grupo EMTr ativa em comparação com o grupo EMTr placebo, principalmente no teste de Rey auditory Verbal Learning (RAVLT) evocação pós-interferência e tardia pós-trinta minutos, no teste Trail Making Parte A e no teste de Stroop Cores. Além disso, o melhor desempenho cognitivo observado no grupo EMTr ativa viii comparado ao grupo EMTr placebo, entre T0 e T4, foi mantido na semana 6 (T6) e por vezes até melhorou sutilmente, indicando que o efeito da estimulação mantém-se estável por, pelo menos 2 semanas após o término do tratamento. Discutem-se como possíveis fatores para esses resultados: ação local da EMTr, alteração dos níveis de alguns neurotransmissores como dopamina e serotonina, relação com a melhoria do quadro depressivo e possível efeito de aprendizado pela repetição em curto período de tempo entre as testagens. Concluí-se que, baseados em uma amostra de apenas 10 pacientes, a EMTr, no que diz respeito aos efeitos antidepressivos, no comportamento frente ao funcionamento social global e às funções cognitivas, não produziu efeitos negativos e sim, produziu alguns efeitos positivos. Esta melhora é de fundamental importância, para o bem estar da mãe e conseqüentemente para o desenvolvimento neuropsicomotor, afetivo e comportamental do bebê. Isto trará desdobramentos que poderão perdurar por toda uma vida para esta criança. Além disto, a segurança da EMT, já amplamente comprovada em outros estudos, poderá, em um futuro próximo, torná-la terapêutica de primeira escolha para este grupo de pacientes. / The postpartum depression (PPD) as the major depressive episode is a common psychiatric manifestation, characterized by the presence of mood, cognitive, behavioral, psychomotor and vegetative changes. It affects the quality of mother-infant interaction jeopardizing the maternal responsiveness, which may adversely affect the maintenance of a healthy development of children. This event presents the estimated dominance between 10 and 20%, taking into account women who develop symptoms in the first weeks after delivery. Treatment options include antidepressant drugs and electroconvulsive therapy (with anesthetic). However, as both treatments involve pharmacological approaches, there is counter-indication because of toxicity that would preclude breastfeeding. Nevertheless, there is concern about the efficiency of the treatment without causing any harm to the baby. The repetitive Transcranial Magnetic Stimulation (rTMS), as it is a technique already established for antidepressant efficacy, non-toxic, painless, non-invasive and well-tolerated to stimulate the brain, it seems to be a good alternative for treatment. For general depressive conditions, substantial damages have been noticed to several cognitive functions, in which the presented cognitive changes are, in large part, similar to those related to changes in the functioning of the pre-frontal cortex (PFC). The executive function is one of the major cognitive domains affected in depressive disorders, usually assessed by tests such as Trail Making and Stroop test. The presence of depression in puerperal patients seems to strengthen cognitive changes; especially those associated to frontal lobe functions, in addition to that, it also affects the behavior causing harm to the overall social functioning. In this study, randomized, controlled and double-blind, possible effects of rTMS in the cognitive functioning and its behavioral effect were assessed: Repetitive Transcranial Magnetic Stimulation (rTMS) applied to left-dorsum-lateral-prefrontal-cortex (LDLPC). An initial sample of ten patients with PPD was divided into two groups. Firstly, seven participants in one of the groups received active rTMS and, three, of the control group, placebo rTMS. The parameters used in rTMS were: frequency of 5 Hz, intensity of 120% of the motor threshold, at intervals of 10 seconds on and 20 seconds off, with 25 sets per day (2500 pulses), during 20 days (four weeks) with two days of rest per week. Patients and evaluators were blinded to the type of treatment for each group. The neuropsychological assessment was carried out by means of cognitive tests related to impaired functions in depressive conditions and with the stimulated area (LDLPC). Social Adjustment Scal (SAS-SR) of Weissmann & Bothwell was also applied to assess the overall social functional behavior, of Hamilton depression, 17 items, and Edinburg postpartum depression. Evaluations were performed on three occasions: before starting the treatment (T0), after 4 weeks (T2) and after 6 weeks (T3). The main results were: significant improvement regarding the depression condition throughout the treatment and a better behavioral adjustment in the general overall social functioning, especially in the context of family relationships, lack of negative effects on all cognitive tests after treatment with rTMS; superior performance of the active rTMS group compared to the placebo rTMS group, especially in the Rey Auditory Verbal Learning Test (RAVLT) post-interference and late evocation after thirty minutes in the Trail Making Test - Part A and the Colors - Stroop Test. Further, the best cognitive performance was observed in the active rTMS group compared to placebo rTMS group, between T0 and T4, was maintained at week 6 (T6) and sometimes even improved slightly, indicating that the effect of the stimulation remains stable by at least 2 x weeks after the end of the treatment. It has been discussed as possible factors for these results: local rTMS action, change in the levels of some neurotransmitters such as dopamine and serotonin, relationship with the improvement of the depressive condition and possible learning effect by repetition within a short period of time between tests. Ergo, based on a sample of only 10 patients, the rTMS, regarding antidepressant effects, the behavior compared to the overall social functioning and cognitive functions, it did not yield negative effects, however it rendered some positive effects. This improvement is of primary importance for the welfare of the mother hence to the babys neuro-psychomotor, emotional and behavioral development. This will bring further outcomes that may last for the whole life for this child. In addition, the safety of TMS, which has been already proven in other researches, may, in the near future, make it a first-choice therapy for this group of patients

[pt] A estimulação magnética transcraniana (EMT) é uma técnica não-invasiva utilizada no tratamento de distúrbios de origem neuropsiquiátrica, como transtornos de humor e alucinações auditivas. Por meio de uma técnica conhecida como neuromodulação, a atividade bioelétrica cerebral é estimulada a partir de correntes elétricas induzidas pela emissão de campo magnético alternado, em região anatômica cerebral previamente estabelecida segundo protocolos terapêuticos definidos, utilizando bobinas eletromagnéticas acopladas ao EMT, com modelos em forma de anel (ring), forma de oito (figure-of-eight), duplo cone (double cone), entre outros. A garantia da eficácia do tratamento e da segurança tanto dos pacientes quanto dos operadores do dispositivo depende da distribuição espacial da densidade de fluxo magnético emitida nas proximidades do equipamento de EMT, de acordo com o projeto da bobina de indução empregada. Um sistema multicanal de medição magnética (SMM) foi desenvolvido para avaliar a configuração da densidade de fluxo magnético gerada por dispositivos de estimulação magnética e em suas proximidades. Com o SMM é realizado o mapeamento magnético ao longo de um plano XY, sob as bobinas de modelos figure-of-eight e double cone, que inclui estudo de respostas, quando estimuladas com diferentes intensidades de saída e distâncias. Os resultados permitem caracterizar o decaimento da magnitude do campo, para os modelos de bobina figure-of-eight e double cone, em direção à região mais próxima da posição da mão do operador; e identificar, de forma preliminar, a distribuição da densidade de fluxo magnético em regiões mais superfíciais e o alcançe da penetração do estímulo destinado ao efeito terapêutico. / [en] Transcranial magnetic stimulation (TMS) is a noninvasive technique used in the treatment of disorders of neuropsychiatric origin, such as mood disorders and auditory hallucinations. By means of a technique known as neuromodulation, cerebral bioelectrical activity is stimulated from electrical currents induced by the emission of an alternating magnetic field, in an anatomical region previously established according to defined therapeutic protocols, using electromagnetic coils coupled to EMT, with models in the form of ring, figure-of-eight, double cone, among others. The assurance of treatment and safety efficacy for both the patients and the device operators depends on the spatial distribution of the magnetic flux density emitted in the vicinity of the EMT equipment, according to the design of the induction coil employed. A multichannel magnetic measurement system (SMM) has been developed in order to evaluate the configuration of magnetic flux density generated by and around magnetic stimulation devices. With the SMM the magnetic mapping along an XY plane was performed under the coils of figure-of-eight and double cone models, which includes study of responses, when stimulated with varying output intensities and distances. The results allow to characterize the decay of the magnitude of the field for the figure-of-eight and double cone coil models towards the region closest to the position of the operator s hand and to identify, in a preliminary way, the distribution of the flux density magnetic properties in more superficial regions and the extent of penetration of the stimulus intended for the therapeutic effect.