Le Syndrome de l’X Fragile (SXF) est la forme héréditaire de retard mental la plus fréquente et la cause la mieux caractérisée de troubles du spectre autistique (TSA). Elle est causée par une mutation causant l’inactivation du gène Fmr1 (codant pour la protéine FMRP). La sensibilité accrue aux stimuli sensoriels est une caractéristique importante du SXF et des TSA, mais les mécanismes sous-jacents sont encore mal compris. Nous avons constaté que la suppression du gène Fmr1 entrainait une hyperexcitabilité sensorielle dans le modèle murin du SXF. Les souris Fmr1KO nécessitaient significativement moins d'informations tactiles pour l'exploration haptique, et les représentations évoquées par les informations tactiles provenant des vibrisses dans le cortex somatosensoriel primaire (S1) se propageaient à une vitesse plus élevée chez les souris Fmr1KO par rapport aux souris témoins sauvages.Au niveau cellulaire, il a été montré que les ARNm de plusieurs sous-unités de canaux ioniques (par exemple HCN1, KCNMA1) jouant un rôle clé dans le traitement de l'information dendritique / neuronale étaient des cibles de la protéine FMRP (Liao et al, 2008; Darnell et al, 2011). Sur la base de ces observations, nous avons étudié les canalopathies comme une caractéristique importante du SXF. Nous avons testé de possibles dysfonctionnement des canaux ioniques, et leurs conséquences sur le traitement de l'information dendritique dans les neurones pyramidaux du néocortex de la couche 5 chez les souris Fmr1KO, en utilisant une combinaison d’approches électrophysiologiques et d’imagerie calcique bi-photonique. Nos résultats ont montré que les dendrites des neurones pyramidaux du S1 étaient hyperexcitables, facilitant ainsi le couplage des entrées d’information synaptique à la génération de potentiel d'action en sortie dans les neurones. Cette altération était, au moins en partie, attribuable à un dysfonctionnement des canaux Ih et BKCa et a été partiellement restaurée par l'activation pharmacologique des canaux BKCa. Ces résultats plaident en faveur d'un rôle nouveau et crucial des canalopathies dans l'expression de l'hyperexcitabilité sensorielle dans le SXF. / Fragile X Syndrome (FXS) is the most common form of inherited mental retardation syndrome and most well characterized cause of Autism Spectrum Disorders (ASD), and it is caused by a silencing mutation of the gene Fmr1 (encoding the protein FMRP). Increased sensitivity to sensory stimuli is a prominent feature of FXS and ASD, but its underlying mechanisms are poorly understood. We found that deletion of the Fmr1 gene results in somatosensory hyper-excitability in a mouse model for FXS. Fmr1 knockout (Fmr1KO) mice required significantly less tactile information for haptic exploration, and touch-evoked whisker representations in the primary somatosensory cortex (S1) spread with increased velocity in Fmr1KO mice compared to wild-type control. At the cellular level, it has been shown that the mRNAs of several ion channel subunits (e.g. HCN1, KCNMA1) playing key roles in dendritic/neuronal information processing are regulated by FMRP (Liao et al., 2008; Darnell et al., 2011). Based on these observations, we investigated channelopathies as a prominent feature of FXS. We probed ion channel dysfunction, and its consequence for dendritic information processing in neocortical pyramidal neurons of layer 5 in Fmr1KO mice, using a combination of electrophysiological and 2-photon calcium imaging approaches. Our results showed that dendrites of S1 pyramidal neurons were hyper-excitable, facilitating the coupling of synaptic input to the generation of action potential output in these neurons. This defect was, at least in part, attributable to a dysfunction of Ih channels and BKCa channels and was partially rescued by pharmacological activation of BKCa channels. These findings argue for a novel and critical role for channelopathies in the expression of sensory hyper-excitability in FXS.

Cortical and subcortical microcircuits are continuously modified throughout life. Despite ongoing changes these networks stubbornly maintain their functions, which persist although destabilizing synaptic and nonsynaptic mechanisms should ostensibly propel them towards runaway excitation or quiescence. What dynamical phenomena exist to act together to balance such learning with information processing? What types of activity patterns do they underpin, and how do these patterns relate to our perceptual experiences? What enables learning and memory operations to occur despite such massive and constant neural reorganization? Progress towards answering many of these questions can be pursued through large-scale neuronal simulations.    In this thesis, a Hebbian learning rule for spiking neurons inspired by statistical inference is introduced. The spike-based version of the Bayesian Confidence Propagation Neural Network (BCPNN) learning rule involves changes in both synaptic strengths and intrinsic neuronal currents. The model is motivated by molecular cascades whose functional outcomes are mapped onto biological mechanisms such as Hebbian and homeostatic plasticity, neuromodulation, and intrinsic excitability. Temporally interacting memory traces enable spike-timing dependence, a stable learning regime that remains competitive, postsynaptic activity regulation, spike-based reinforcement learning and intrinsic graded persistent firing levels.    The thesis seeks to demonstrate how multiple interacting plasticity mechanisms can coordinate reinforcement, auto- and hetero-associative learning within large-scale, spiking, plastic neuronal networks. Spiking neural networks can represent information in the form of probability distributions, and a biophysical realization of Bayesian computation can help reconcile disparate experimental observations. / <p>QC 20170421</p>

L’optique non linéaire traite les modifications des propriétés optiques d'un matériau induites par la propagation de la lumière. Depuis ses débuts, il y a cinquante ans, des nombreuses applications ont été démontrées dans presque tous les domaines de la science. Dans le domaine de la micro et nano-photonique, les phénomènes non linéaires sont à la fois au cœur d’une physique fondamentale fascinante et des applications intéressantes: ils permettent d'adapter et de contrôler le flux de lumière à une échelle spatiale inferieure à la longueur d'onde. En effet, les effets non linéaires peuvent être amplifiés dans des systèmes qui confinent la lumière dans des espaces restreints et avec de faibles pertes optiques. Des bons candidats pour ce confinement sont les nanocavités à cristaux photoniques (CPs), qui ont été largement étudiées ces dernières années. Parmi la grande diversité des processus non linéaires en optique, les phénomènes dynamiques tels que la bistabilité et l'excitabilité font l’objet de nombreuses études. La bistabilité est bien connue pour ces applications potentielles pour les mémoires et les commutateurs optiques et pour les portes logiques. Une réponse excitable typique est celle subjacente dans le déclanchement du potentiel d'action dans les neurones. En optique, l'excitabilité a été observée il y a une quinzaine d’années. Dans ce travail, nous avons étudié les régimes bistables, auto-oscillants et excitables dans des nanocavités semiconductrices III-V à CP. Afin de coupler efficacement la lumière dans les nanocavités, nous avons développé une technique de couplage par onde évanescente en utilisant une microfibre optique étirée. Grâce à cette technique, nous avons démontré pour la première fois l’excitabilité dans une nanocavité à CP. En parallèle, nous avons accompli la première étape vers la dynamique non linéaire dans un réseau de cavités couplées en démontrant le couplage optique linéaire entre nanocavitités adjacentes. Ceci a été réalisé en utilisant de mesures de photoluminescence en champ lointain. Un ensemble de résonateurs non linéaires couplés ouvre la voie à une famille de phénomènes dynamiques non linéaires très riches, basés sur la rupture spontanée de symétrie. Nous avons démontré théoriquement ce phénomène dans deux cavités couplées par onde évanescente. Les premières études expérimentales de ce régime ont été menées, établissant ainsi les bases pour une future démonstration de la rupture spontanée de symétrie dans un réseau de nanocavités non linéaires couplées. / Nonlinear optics concerns the modifications of the optical properties of a material induced by the propagation of light. Since its beginnings, fifty years ago, it has already found applications in almost any field of science. In micro and nano-photonics, nonlinear phenomena are at the heart of both fascinating fundamental physics and interesting potential applications: they give a handle to tailor and control the flow of light within a sub-wavelength spatial scale. Indeed, the nonlinear effects can be enhanced in systems allowing tight light confinement and low optical loses. Good candidates for this are the Photonic Crystal (PhC) nanocavities, which have been extensively studied in recent years. Among the great diversity of nonlinear processes in optics, nonlinear dynamical phenomena such as bistability and excitability have recently received considerable attention. While bistability is well known as a building block for all-optical memories, switching and logic gates, excitability has been demonstrated in optics about fifteen years ago: coming from neuroscience, it is the mechanism underlying action potential firing in neurons. In this work, we have studied bistable, self-pulsing and excitable regimes in InP-based PhC nanocavities. In order to achieve efficient light coupling into the nanocavities, we have developed an evanescent coupling technique using tapered optical microfibers. As a result, we have demonstrated for the first time excitability in a PhC nanocavity. In addition, we have accomplished the first step towards nonlinear dynamics in arrays of coupled cavities by demonstrating optical linear coupling between adjacent nanocavitites. This was achieved using far field measurements of photoluminescence. A set of coupled nonlinear resonators opens the door to a rich family of nonlinear dynamical phenomena based on spontaneous symmetry breaking. We have theoretically demonstrated this phenomenon in two evanescently coupled cavities. The first experimental studies on this regime were carried out, which establish a basis for a future demonstration of spontaneous symmetry breaking in arrays of nonlinear coupled PhC nanocavities.

O desenvolvimento da estimulação magnética transcraniana (EMT) permitiu o estudo de potenciais evocados motores eliciados pela estimulação direta do córtex cerebral de forma não-invasiva. Foi observado que diferentes paradigmas de estimulação cortical por EMT apresentam diferentes padrões de resposta, que posteriormente foram associados ao funcionamento de circuitos corticais GABAérgicos e glutamatérgicos do córtex motor, compondo assim índices de excitabilidade cortical motora (ECM). Ademais, desvios da normalidade de tais índices foram encontrados em diversas condições clínicas, incluindo transtornos mentais como a esquizofrenia. O uso dessas medidas também auxiliou o desenvolvimento da estimulação transcraniana por corrente contínua (ETCC), técnica que se mostrou capaz de produzir efeitos neuromodulatórios no sistema nervoso central de forma segura e com mínimos efeitos adversos. Tal técnica vem apresentando possibilidades terapêuticas promissoras, como por exemplo, tendo sido observado sua eficácia no alívio de alucinações auditivas de indivíduos com esquizofrenia. O uso de ETCC para tratamento de sintomas negativos da esquizofrenia também pode vir a se mostrar uma abordagem eficaz, e a análise da ECM pode auxiliar no entendimento dos seus mecanismos de ação e atuar como possível preditor de resposta terapêutica. O objetivo do presente estudo é avaliar o perfil de ECM em um grupo de indivíduos com esquizofrenia, e as possíveis influências de um protocolo terapêutico utilizando ETCC sobre essas medidas. Com esse objetivo, foi selecionada uma coorte de sujeitos com esquizofrenia que participou em ensaio clínico randomizado e controlado com placebo (estimulação sham), tendo a ETCC como intervenção ativa alvo. A ECM foi mensurada na avaliação inicial dos sujeitos, assim como após a primeira sessão de ETCC, e quando da avaliação de desfecho primário. O protocolo terapêutico de ETCC envolveu a colocação de 2 eletrodos de área 5x7 cm, pólo anódico aplicado sobre região correspondente ao córtex pré-frontal dorsolateral esquerdo e pólo catódico aplicado sobre córtex de transição temporoparietal esquerdo; com intensidade de corrente de 2 mA, aplicada por 20 minutos. Cada sujeito foi submetido a 10 sessões no total. Encontramos que idade se correlacionou com diminuição da inibição intracortical, reproduzindo resultado previamente encontrado em indivíduos saudáveis. Acerca da modulação da ECM após sessão de ETCC, observamos que sujeitos submetidos à intervenção ativa apresentaram aumento da inibição intracortical no hemisfério estimulado, em oposição à ausência de mudança significativa da ECM nos sujeitos que receberam estimulação placebo. Os resultados sugerem que sessão de ETCC, utilizando os parâmetros aplicados neste estudo, levou ao aumento da inibição intracortical. Devido a evidências prévias de déficit de inibição intracortical em pessoas com esquizofrenia, é possível que o fenômeno observado represente mecanismo terapêutico da ETCC. É necessário verificar se tal efeito sobre a ECM acompanha medidas objetivas de resposta clinica. Caso isto se comprove, a ECM pode se tornar um valioso marcador de resposta terapêutica e evolução clinica em pacientes com esquizofrenia / The development of transcranial magnetic stimulation allowed the study of motor evoked potentials by applying direct stimuli to the brain cortex in a non-invasive fashion. Different stimulation protocols were observed to yield different response patterns, which were later associated with the functioning of cortical GABAergic and glutamatergic circuits, assembled as motor cortex excitability indices. Also, deviations from normality of such indices were observed in several clinical conditions, including mental disorders such as schizophrenia. The use of these measurements also helped the development of transcranial direct current stimulation (tDCS), a technique which was shown to promote neuromodulatory effects in central nervous system, with potential treatment applications. This technique has been used with success in the treatment of auditory hallucinations in patients with schizophrenia. The use of tDCS might also be effective in the treatment of negative symptoms of schizophrenia, and motor cortex excitability analysis might be used to clarify its physiological effects and act as a possible treatment response predictor. The aim of the present study is to evaluate the motor cortical excitability profile of individuals with schizophrenia, as well as possible influences of tDCS over these measurements. With this aim, we selected a cohort of subjects with schizophrenia who participated in a randomized placebo controlled clinical trial using transcranial direct current stimulation (and sham stimulation for placebo), and measuring motor cortical excitability during baseline evaluation, after the first stimulation session, and at the time of the primary outcome evaluation. The transcranial direct current stimulation protocol used in the present study involved the use of 2 electrodes of area 5x7 cm, anode placed over the region corresponding to the left dorsolateral prefrontal cortex, and cathode over the left cortical temporoparietal juntion. A current of 2 mA intensity was applied for 20 minutes. Each subject underwent a total of 10 sessions. We found that age was correlated to reduced intracortical inhibition, as has been previously found in healthy subjects. Regarding changes of motor cortical excitability following a transcranial direct current stimulation session, we observed that subjects that received the active stimulation displayed an increase in intracortical inhibition, as opposed to those who received sham stimulation, which did not present with any significant change. Results suggest that transcranial direct current stimulation session, using the parameters described in this study, led to an increase in intracortical inhibition. Given previous evidence of intracortical inhibition deficit in individuals with schizophrenia, it is possible that the observed phenomenon corresponds to a treatment mechanism of the electrical stimulation in this population. This need to be confirmed by comparing such changes in cortical excitability to objective measurements of clinical improvement. In case that is confirmed, measurement of motor cortical excitability may have a valuable application as a marker of treatment response and clinical outcome for patients with schizophrenia

In dieser Arbeit werden zwei intrazelluläre Signalwege, betreffend den Tumorsuppressor p53 und das Signalmolekül Ca2+ , diskutiert und modelliert. Einzelzellmessungen des Tumorsuppressors p53 zeigen pulsatile Antwor- ten nach Zufügung von DNA Doppelstrangbrüchen (DSBs). Außer für sehr hohe Schadensdosen, ist das zeitliche auftreten dieser Pulse unregelmäßig. Mithilfe eines Wavelet basierten Pulsdetektors werden die einzelzell Trajek- torien untersucht und die inter-Puls Intervall (IPI) Verteilungen extrahiert. Diese weisen auf nicht-oszillatorische Regime in den Daten hin. Die Theorie der anregbaren Systeme angewendet auf regulatorische Netzwerke ermöglicht dieses komplexe Verhalten mathematisch zu beschreiben. Die Kopplung von Schadens-Sensor-Kinase Dynamik mit dem kanonischen p53 negativen feedback loop, ergibt ein anregbares p53 Modell. Detaillier- te Bifurkationsanalysen zeigen ein robustes anregbares Regime, welches durch ein starkes Schadenssignal auch in Oszillationen überführt werden kann. Treibt man das p53 Modell mit einem stochastischen DNA-Schadens-Prozess, kann sowohl das oszillatorische Verhalten nach hohem Schaden, als auch das unregelmäßige pulsatile Verhalten ohne äußere Stimulation reproduziert werden. Intrazelluläre Ca 2+ Spikes entstehen durch eine hierarchische Kaskade stochastischer prozesse. Die Anwendung einer semi-markovschen Beschreibung führt zu praktischen analytischen Lösungen des erstpassagezeiten Problems. Eine hierbei entdeckte Zeitskalenseparation ermöglicht ein neues allgemeines Ca2+ -Modell. Dieses erklärt auf äußerst prägnante Weise viele wesentliche experimentelle Ergebnisse, insbesondere die Momentenbeziehungen der inter-Spike Intervall Verteilungen. Schließlich erlaubt die hier vorgestellte Theorie Berechnungen der Stimulus-Enkodierung, also die Adaption des Ca 2+ Signals auf veränderliche extrazelluläre Stimuli. Die Vorhersage einer fold change Enkodierung kann durch Experimente gestützt werden. / In this work two signaling pathways, involving the tumor suppressor p53 and the second messenger Ca2+ , are to be discussed and modelled. The tumor suppressor p53 shows a pulsatile response in single cells after induction of DNA double strand breaks (DSBs). Except for very high amounts of damage, these pulses appear at irregular times. The concept of excitable systems is employed as a convenient way to model such observed dynamics. An application to biomolecular reaction networks shows the need for a positive feedback within the p53 regulatory network. Exploiting the reported ultrasensitive dynamics of the upstream damage sensor kinases, leads to a simplified excitable kinase-phosphatase model. Coupling that to the canonical negative feedback p53 regulatory loop, is the core idea behind the construction of the excitable p53 model. A detailed bifurcation analysis of the model establishes a robust excitable regime, which can be switched to oscillatory dynamics via a strong DNA damage signal. Driving the p53 model with a stochastic DSB process yields pulsatile dynamics which reflect different experimental scenarios. Intracellular Ca 2+ concentration spikes arise from a hierarchic cascade of stochastic events. An analytical solution strategy, employing a semi-Markovian description and involving Laplace transformations, is devised and successfully applied to a specific Ca2+ model. The new gained insights are then used, to construct a new generic Ca2+ model, which elegantly captures many known features of Ca2+ signaling. In particular the experimentally observed relations between the average and the standard deviation of the inter spike intervals (ISIs) can be explained in a concise way. Finally, the theoretical considerations allow to calculate the stimulus encoding relation, which governs the adaption of the Ca 2+ signals to varying extracellular stimuli. This is predicted to be a fold change response and new experimental results display a strong support of this idea.

Les Troubles Obsessionnels et Compulsifs (TOC) sont un trouble mental sévère et fréquemment résistant. La physiopathologie du trouble se caractérise par des anomalies au sein des boucle cortico-striato-thalamo-cortical entrainant une hyper-activité du cortex orbito-frontal, du cortex cingulaire antérieur, du putamen. Au cours des dernières années, des anomalies structurales et fonctionnelles du cervelet ont de plus été mise en évidence dans les TOC venant compléter le modèle existant.Nous avons mise au point un protocole de traitement par tDCS ciblant le cortex orbito-frontal gauche et le cervelet droit pour les TOC résistants. Dans une première étude, nous avons étudié la faisabilité de ce protocole de traitement dans une étude ouverte. Cette étude a mis en évidence une réduction significative des symptômes dans une population de patient à haut niveau de résistance. Dans une deuxième étude, nous avons évaluer l’effet de ce traitement dans un protocole randomisé, contrôlé et parallèle contre placebo. Cette étude n’a pas confirmé l’efficacité de ce protocole de traitement. Dans cette même population, nous avons au cours du protocole mesuré les paramètres d’excitabilité corticale au niveau du cortex moteur par stimulation magnétique transrânienne. Nous avons ainsi mis en évidence que la tDCS provoquait une augmentation significative des processus d’inhibition (Short Interval Cortical Inhibition : SICI ) et une diminution non significative des processus de facilitation (Intra Cortical Facilitation : ICF). L’étude des effets cliniques et électro-physiologiques de cette approche thérapeutique novatrice dans les TOC résistants n’a pas permis de confirmer son intérêt clinique malgré un impact de ce protocole sur les modifications de l’excitabilité corticale inhérentes aux troubles. Ces données ont été mise en relation avec la littérature afin de proposer des perspectives d’évolution dans l’utilisation de la tDCS dans les TOC résistants / Obsessive-compulsive disorder (OCD) is a severe mental illness. OCD symptoms are often resistant to available treatments. Neurobiological models of OCD are based on an imbalance between the direct (excitatory) and indirect (inhibitory) pathway within this cortico-striato-thalamo-cortical loops, which causes hyperactivation in the orbito-frontal cortex, the cingular anterior cortex, the putamen. More recently, the role of cerebellum in the OCD physiopathology has been brought to light by studies showing structural and functional abnormalities. We proposed to use tDCS as a therapeutic tool for resistant OCD by targeting the hyperactive left orbito-frontal cortex with cathodal tDCS (assumed to decrease cortical excitability) coupled with anodal cerebellar tDCS. In a first study, we studied the feasibility of this treatment protocol in an open-trial. This study found a significant reduction in symptoms in a population with a high level of resistance. In a second study, we evaluated the effect of this treatment in a randomized-controlled trial. This study did not confirm the effectiveness of this intervention. We have assessed motor cortex cortical excitability parameters by transcranial magnetic stimulation. We thus demonstrated that the tDCS caused a significant increase of inhibition processes (Short Interval Cortical Inhibition: SICI) and a nonsignificant decrease in the facilitation processes (Intra Cortical Facilitation (ICF)). In addition, clinical improvement assessed by Clinical Global Impression at the end of the follow-up period (3 months) was positively correlated with SICI at baseline.tDCS with the cathode placed over the left OFC combined with the anode placed over the right cerebellum decreased hyper-excitability in the motor cortex but was not significantly effective in SSRI- resistant OCD patients. These works were discussed in light of the available literature to create future prospect in the field of tDCS treatment for OCD resistant patients

A recuperação motora da mão é importante para a independência funcional de pacientes com acidente vascular cerebral (AVC). A estimulação magnética transcraniana (EMT) é uma técnica não invasiva que pode ser usada para avaliar a excitabilidade do córtex motor. O objetivo principal deste estudo foi avaliar a correlação entre as medidas de EMT (inibição intracortical, IIC; facilitação intracortical, FIC; período silente ipsilateral, Psil) e o desempenho motor em atividades relevantes para as atividades de vida diária, em indivíduos com AVC (grupo AVC) e boa recuperação motora, assim como em sujeitos sem AVC (grupo controle). As medidas foram realizadas no hemisfério afetado (HA) dos indivíduos com AVC e no hemisfério homólogo dos sujeitos do grupo controle. Os objetivos secundários foram: confirmar que a as medidas de EMT do grupo AVC seriam comparáveis às do grupo controle; investigar a relação entre as medidas de IIC ou FIC e o Psil nos dois grupos. Após avaliação de elegibilidade de 2298 sujeitos, 12 pacientes (seis homens) foram incluídos no grupo AVC com média (+- desvio-padrão) de idade 52,9 (+- 11,8) anos, pontuações na escala de AVC do National Institutes of Health de 2,6 (+- 1,8) e na subescala de avaliação do membro superior de Fugl-Meyer de 57,5 (+- 4,6). No grupo controle foram incluídos 10 indivíduos (seis homens) com média de idade 53,3 (+- 12,0) anos. Nos dois grupos, foram avaliados: desempenho no teste de Jebsen Taylor, força de preensão, limiar motor, IIC, FIC e Psil. O coeficiente de correlação de Spearman foi utilizado para avaliar a correlação entre medidas de desempenho motor e medidas de EMT, assim como para associações entre medidas de excitabilidade intracortical e Psil. Para comparação das medidas entre o grupo AVC e o grupo controle, foi utilizado o teste de Mann-Whitney. Foi encontrada uma correlação significativa (r = 0,68; p = 0,014) entre a força de preensão e a IIC no Grupo AVC, mas não no grupo controle (r= 0,16; p= 0,47). Não foram encontradas correlações estatisticamente significativas entre o desempenho no teste de Jebsen-Taylor e qualquer outra medida de excitabilidade nos dois grupos. Não houve diferenças estatisticamente significativas entre as medidas de EMT nos dois grupos (p > 0,05). Não houve correlação significativa entre as medidas de excitabilidade intracortical e o Psil no grupo AVC, mas houve correlação significativa entre aumento da IIC e maior duração do Psil no grupo controle (r=-0,8; p= 0,008). A FIC não teve correlação significativa com o Psil em quaisquer dos grupos. Esses resultados sugerem que a atividade gabaérgica no córtex motor primário do HA seja relevante para a força da mão parética em indivíduos com AVC. Além disso, confirmam a hipótese de que pacientes com boa recuperação motora apresentem padrões de excitabilidade cortical semelhante aos de indivíduos saudáveis. Finalmente, os resultados não corroboram a hipótese de que um mesmo grupo de interneurônios medeie a IIC do HA e a inibição inter hemisférica do hemisfério afetado para o hemisfério não afetado em indivíduos com AVC e bom desempenho motor, na fase crônica / Recovery of hand motor function is important for the functional independence of patients with stroke. Transcranial magnetic stimulation (TMS) is a non-invasive technique for assessment of motor cortex excitability. The main objective of this study was to evaluate the correlation between TMS measures (short-interval intracortical inhibition, SICI; intracortical facilitation, ICF and ipsilateral silent period, ISP) and motor performance in subjects with stroke and good motor recovery (stroke group) as well as in subjects without stroke (control group). Measurements were performed in the affected hemisphere of stroke subjects and in the homologous hemisphere of subjects in the control group. The secondary objectives were: to confirm that the SICI, ICF and ISP of the stroke group would be comparable to those of the control group; to investigate the relation between SICI or ICF and the ISP in the two groups. After assessment of eligibility in 2298 subjects, 12 patients (six men) were included in the stroke group. Mean (+- standard deviation) age was 52.9 (+- 11.8) years, National Institutes of Health Stroke Scale score was 2.6 (+- 1.8) and Fugl-Meyer upper limb subscale score was 57.5 (+- 4.6) in the stroke group. In the control group, 10 subjects (six men) were included with a mean age of 53.3 (+- 12.0) years. In the two groups, the Jebsen-Taylor test, grip strength, motor threshold, SICI or ICF and ISP were evaluated. The Spearman\'s correlation coefficient was used to assess the correlation between motor performance measures and TMS measures, as well as the associations between intracortical excitability measures and the ISP. The Mann-Whitney test was used to compare the measures between the stroke group and the control group. A significant correlation (r = 0.68, p = 0.014) was found between grip strength and SICI in the stroke group, but not in the control group (r = 0.16, p = 0.47). No statistically significant correlations were found between performance in the Jebsen-Taylor test and any other measures of excitability in the two groups. There were no statistically significant differences between the TMS measurements between the two groups (p > 0.05). There was no significant correlation between the SICI measures and the ISP in the stroke group, but there was a significant correlation between increased SICI and longer duration of the ISP in the control group (r=-0.8; p=0.008). ICF had no significant correlation with the ISP in any of the groups. These results suggest that increased gabergic activity in the motor cortex of the affected hemisphere is relevant for strength of the paretic hand in patients with stroke. Also, they confirm the hypothesis that patients with good motor recovery present patterns of cortical excitability similar to those of healthy subjects. Finally, the results do not support the hypothesis that the same group of interneurons mediate intracortical inhibition and interhemispheric inhibition of the unaffected hemisphere by the affected hemisphere in subjects with stroke and good motor performance in the chronic phase

INTRODUÇÃO: A obtenção de medidas de excitabilidade cortical mediante a estimulação magnética transcraniana tem surgido nos últimos anos como método de avaliação da integridade funcional do trato cortico-spinal e rede interneuronal no córtex primário motor, abrindo perspectiva de utilizá-la na prática clínica. Alterações nos parâmetros de excitabilidade cortical tem sido relatados na síndrome fibromiálgica e outras síndromes dolorosas, se correlacionando com a gravidade de diferentes componentes dessas síndromes e mudando conforme o tratamento. Entretanto, apesar do seu potencial benefício, existe uma pequena quantidade de estudos disponíveis na literatura que tenham proposto a obtenção de dados de normalidade para esses parâmetros, com casuísticas pequenas, não pareadas por fatores que potencialmente alteraram seus valores. O presente estudo procurou montar uma curva de normalidade de parâmetros de excitabilidade cortical com cálculo de amostra, pareamento por idade e sexo, com estudo dos efeitos da lateralidade hemisférica e dominância, fase do ciclo menstrual e variabilidade inter e intraexaminador. MÉTODOS: Após cálculo amostral, foram convocados voluntários saudáveis do sexo masculino e feminino, pareados por idade. No total, 216 voluntários completaram o estudo. O potencial evocado motor, inibição intracortical e facilitação intracortical foram medidas no músculo primeiro interósseo dorsal após estímulo dos córtices motor primário bilateral. O grupo de 15 mulheres fez a primeira medição do uso de anticoncepcional oral e a segunda medição na fase de descanso do mesmo. A variabilidade interexaminador e intraexaminador foi aferida em 20 voluntários para cada uma das situações. RESULTADOS: A comparação entre os parâmetros de voluntários menores que 50 anos e maiores que 50 anos mostrou diferenças significativas. Foram obtidos os valores de normalidade para menores de 50 anos e maiores de 50 anos (média e desvio padrão): 1.Menores ou igual que 50 anos: LMR: 49 ± 9,39%; PEM 120%: 587,63±779,52 V; MEP 140%: 1413,08±1343,18 V; MEP 120/140%: 3,83±5,39 V; IIC 2ms: 0,40 ±0,44 V; IIC 4ms: 0,61± 0,84 V; IIC: 0,56± 0,63 V; FIC 10ms: 1,95 ±1,82 V; FIC 15ms: 1,80±1,73 V; FIC: 1,87±1,64 V. 2. Maiores de 50 anos: LMR: 49,1 ± 9.58%; PEM 120%:467,71±650,61 V; PEM 140%:1172,43±1158,47 V; PEM 120/140%: 4,04±4,27 V; IIC2ms: 0,73± 1,26 V; IIC 4ms: 1,04±1,67 V; IIC:0,81±1,03 V; FIC 10ms:2,46±3,85 V; FIC 15ms: 2,12±3,05 V; FIC: 2,28±3,32 V. Houve semelhança entre homens e mulheres( p>0,3). Os córtices motores direito e esquerdo apresentaram parâmetros semelhantes de excitabilidade cortical (p>0,25) para todas as análises. Assim, os valores para o hemisfério direito e esquerdo e os dados de homens e mulheres foram agrupados. Não houve diferença estatística significativa entre destros e sinistros (p>0,20). A variabilidade inter e intraexaminador é alta para a maior parte dos parâmetros, porém, com alta correlação para o limiar motor em repouso e potenciais evocados motores. A inibição e facilitação cortical tiveram baixa correlação, mas confiabilidade aceitável. Não houve diferença importante entre a quantidade de medidas anormais obtidas entre as fases do ciclo menstrual com ou sem o uso do anticoncepcional oral. CONCLUSÕES: Foram levantados os parâmetros de normalidade para adultos saudáveis acima e abaixo de 50 anos. A idade não tem um efeito linear sobre a excitabilidade cortical. Não há diferenças significativas entre sexo, lateralidade de hemisfério ou dominância sobre parâmetros de excitabilidade cortical. Não há correlação significativa entre as fases de uso de anticoncepcional oral e do seu descanso (período menstrual) com as medidas de excitabilidade cortical / BACKGROUND AND AIMS: Measures of cortical excitability parameters by transcranial magnetic stimulation have gained increasing interest as a way to obtain information on the functional integrity of the cortico-spinal tract and interneuronal networks within the primary motor cortex. Changes in cortical excitability parameters have been reported in fibromyalgia and neuropathic pain syndromes showing correlation with the severity of different symptoms of these pain syndromes, and seeming to change during treatment. Despite its potential use, there is a paucity of normative data for cortical excitability parameters. We aimed to obtain normative data for cortical excitability in healthy volunteers. METHODS: A sample size of men and women were matched according to age. In total 216 healthy volunteers completed the study. Rest motor threshold (RMT), motor evoked potentials (MEP), intracortical inhibition (ICI) and facilitation (ICF) were measured in the first dorsal interosseous muscle for both primary motor cortex A group of 15 women were measured twice, first during use of oral contraceptive and a second measure was obtained when not in use of it (menstruations phase). The inter and intrainvestigator variability was assessed in a sample of 20 healthy volunteers. RESULTS: The comparison between the cortical excitability parameters from volunteers younger than 50 years old and volunteers older than 50 years showed significant differences. Normative data for younger than 50 years and older than 50 years were obtained (mean and standard deviation): 1. Age of 50 years or younger: RMT: 49 ±9.39%; MEP120%: 587.63±779.52 V; MEP140%: 1413.08±1343.18 V; MEP120/140%: 3.83±5.39 V; ICI2ms: 0.40 ±0.44; ICI4ms: 0.61 ±0.84 V; ICI: 0.56±0.63 V; ICF10ms: 1.95 ±1.82 V; ICF15ms: 1.80±1.73 V; ICF: 1.87±1.64 V. 2. Older than 50 years: RMT: 49.1±9.58%; MEP120%: 467.71±650.61 V; MEP140%: 1172.43±1158.47 V; MEP120/140%: 4.04±4.27V; ICI2ms: 0.73± 1.26 V; ICI4ms: 1.04±1.67 V; ICI: 0.81±1.03 V; ICF10ms:2.46±3.85 V; ICF15ms: 2.12±3.05 V; ICF: 2.28±3.32 V. There was similarity between genders (p>0,3.) There was no difference between left and right hemispheres (p>0,25). Consequently data from both hemispheres and genders were grouped. There was no significant statistical difference between handedness. We found a good inter/intrainvestigator correlation for RMT and MEP. ICI and ICF had low correlations but an acceptable reliability. CONCLUSIONS: We reported normative data for cortical excitability in adult individuals younger and older than 50 years old. Age has a non-linear effect on cortical excitability. We found no left-right cortex asymmetries or differences related to gender or handedness. We found no correlation between the phases of contraceptive use and the menstruation phase and the cortical excitability parameters

O desenvolvimento da estimulação magnética transcraniana (EMT) permitiu o estudo de potenciais evocados motores eliciados pela estimulação direta do córtex cerebral de forma não-invasiva. Foi observado que diferentes paradigmas de estimulação cortical por EMT apresentam diferentes padrões de resposta, que posteriormente foram associados ao funcionamento de circuitos corticais GABAérgicos e glutamatérgicos do córtex motor, compondo assim índices de excitabilidade cortical motora (ECM). Ademais, desvios da normalidade de tais índices foram encontrados em diversas condições clínicas, incluindo transtornos mentais como a esquizofrenia. O uso dessas medidas também auxiliou o desenvolvimento da estimulação transcraniana por corrente contínua (ETCC), técnica que se mostrou capaz de produzir efeitos neuromodulatórios no sistema nervoso central de forma segura e com mínimos efeitos adversos. Tal técnica vem apresentando possibilidades terapêuticas promissoras, como por exemplo, tendo sido observado sua eficácia no alívio de alucinações auditivas de indivíduos com esquizofrenia. O uso de ETCC para tratamento de sintomas negativos da esquizofrenia também pode vir a se mostrar uma abordagem eficaz, e a análise da ECM pode auxiliar no entendimento dos seus mecanismos de ação e atuar como possível preditor de resposta terapêutica. O objetivo do presente estudo é avaliar o perfil de ECM em um grupo de indivíduos com esquizofrenia, e as possíveis influências de um protocolo terapêutico utilizando ETCC sobre essas medidas. Com esse objetivo, foi selecionada uma coorte de sujeitos com esquizofrenia que participou em ensaio clínico randomizado e controlado com placebo (estimulação sham), tendo a ETCC como intervenção ativa alvo. A ECM foi mensurada na avaliação inicial dos sujeitos, assim como após a primeira sessão de ETCC, e quando da avaliação de desfecho primário. O protocolo terapêutico de ETCC envolveu a colocação de 2 eletrodos de área 5x7 cm, pólo anódico aplicado sobre região correspondente ao córtex pré-frontal dorsolateral esquerdo e pólo catódico aplicado sobre córtex de transição temporoparietal esquerdo; com intensidade de corrente de 2 mA, aplicada por 20 minutos. Cada sujeito foi submetido a 10 sessões no total. Encontramos que idade se correlacionou com diminuição da inibição intracortical, reproduzindo resultado previamente encontrado em indivíduos saudáveis. Acerca da modulação da ECM após sessão de ETCC, observamos que sujeitos submetidos à intervenção ativa apresentaram aumento da inibição intracortical no hemisfério estimulado, em oposição à ausência de mudança significativa da ECM nos sujeitos que receberam estimulação placebo. Os resultados sugerem que sessão de ETCC, utilizando os parâmetros aplicados neste estudo, levou ao aumento da inibição intracortical. Devido a evidências prévias de déficit de inibição intracortical em pessoas com esquizofrenia, é possível que o fenômeno observado represente mecanismo terapêutico da ETCC. É necessário verificar se tal efeito sobre a ECM acompanha medidas objetivas de resposta clinica. Caso isto se comprove, a ECM pode se tornar um valioso marcador de resposta terapêutica e evolução clinica em pacientes com esquizofrenia / The development of transcranial magnetic stimulation allowed the study of motor evoked potentials by applying direct stimuli to the brain cortex in a non-invasive fashion. Different stimulation protocols were observed to yield different response patterns, which were later associated with the functioning of cortical GABAergic and glutamatergic circuits, assembled as motor cortex excitability indices. Also, deviations from normality of such indices were observed in several clinical conditions, including mental disorders such as schizophrenia. The use of these measurements also helped the development of transcranial direct current stimulation (tDCS), a technique which was shown to promote neuromodulatory effects in central nervous system, with potential treatment applications. This technique has been used with success in the treatment of auditory hallucinations in patients with schizophrenia. The use of tDCS might also be effective in the treatment of negative symptoms of schizophrenia, and motor cortex excitability analysis might be used to clarify its physiological effects and act as a possible treatment response predictor. The aim of the present study is to evaluate the motor cortical excitability profile of individuals with schizophrenia, as well as possible influences of tDCS over these measurements. With this aim, we selected a cohort of subjects with schizophrenia who participated in a randomized placebo controlled clinical trial using transcranial direct current stimulation (and sham stimulation for placebo), and measuring motor cortical excitability during baseline evaluation, after the first stimulation session, and at the time of the primary outcome evaluation. The transcranial direct current stimulation protocol used in the present study involved the use of 2 electrodes of area 5x7 cm, anode placed over the region corresponding to the left dorsolateral prefrontal cortex, and cathode over the left cortical temporoparietal juntion. A current of 2 mA intensity was applied for 20 minutes. Each subject underwent a total of 10 sessions. We found that age was correlated to reduced intracortical inhibition, as has been previously found in healthy subjects. Regarding changes of motor cortical excitability following a transcranial direct current stimulation session, we observed that subjects that received the active stimulation displayed an increase in intracortical inhibition, as opposed to those who received sham stimulation, which did not present with any significant change. Results suggest that transcranial direct current stimulation session, using the parameters described in this study, led to an increase in intracortical inhibition. Given previous evidence of intracortical inhibition deficit in individuals with schizophrenia, it is possible that the observed phenomenon corresponds to a treatment mechanism of the electrical stimulation in this population. This need to be confirmed by comparing such changes in cortical excitability to objective measurements of clinical improvement. In case that is confirmed, measurement of motor cortical excitability may have a valuable application as a marker of treatment response and clinical outcome for patients with schizophrenia

La recherche de méthodes permettant de lutter contre le déconditionnement neuromusculaire à la suite par exemple d’une opération chirurgicale ou d’une immobilisation prolongée intéresse la communauté scientifique depuis de nombreuses années. Ce projet visait à proposer la technique de vibration locale (LV) comme une méthode alternative aux méthodes classiquement utilisées (e.g. vibration corps entier, stimulation électrique neuromusculaire) pour lutter contre ce déconditionnement neuromusculaire. Le premier objectif de ce travail de thèse était de déterminer les effets d’une application aigüe de LV sur la fonction neuromusculaire des muscles fléchisseurs dorsaux et extenseurs du genou de sujets sains. Nos résultats montrent une modulation de l’excitabilité du système nerveux central en réponse à l’application aigüe de LV, ce qui nous a permis d’envisager de potentielles adaptations si cette technique était utilisée de façon répétée sur plusieurs semaines. Ainsi, la seconde orientation de ce travail était d’évaluer les effets d’une application chronique (entraînement) de LV sur les propriétés fonctionnelles (force, hauteur de saut) et nerveuses (mesurées par stimulation magnétique transcrânienne) de sujets sains, jeunes et âgés. Nos résultats ont montré qu’un entraînement par LV était efficace pour améliorer les capacités fonctionnelles de ces deux populations, ces gains s’accompagnant d’adaptations nerveuses. Ces travaux nous ont alors conduits à la mise en place d’une dernière étude (en cours) à visée clinique, qui évaluait l’efficacité de LV en rééducation post-ligamentoplastie du ligament croisé antérieur du genou. / There is a need to find new methods to limit neuromuscular deconditioning that occurs after a surgery or prolonged immobilization. This thesis aimed to assess local vibration (LV) training as an alternative to methods classically used (e.g. whole body vibration, neuromuscular electrical stimulation) to fight against neuromuscular deconditioning. The first aim of this project was to determine the effects of a 30-min acute exposure to LV on the neuromuscular function of dorsiflexor and knee extensor muscles in a healthy population. Our results showed that acute LV intervention changed central nervous system excitability, allowing us to consider long-term adaptations to prolonged LV. Thus, the second aim of this thesis was to assess the effects of a chronic application (training) of LV on functional (maximal strength, squat jump performance) and neural (assessed with transcranial magnetic stimulation) properties of healthy young and old subjects. Our results showed that 4 to 8 weeks of LV increase functional capacities that were due to neural adaptations. Based on these results, an on-going study assessing the effectiveness of LV during a rehabilitation program for subjects who suffered from anterior cruciate ligament lesion has been proposed.