Effect of neuromodulation on pain and functional mobility in people with HTLV-1: randomized clinical trial protocol
DOI:
https://doi.org/10.17267/2675-021Xevidence.2022.e4193Keywords:
Neuromodulation , Pain, Functional mobility, Tropical Spastic Paraparesis, Human T-Linphotropic Virus type 1Abstract
BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion. Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions. OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP. METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients. Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included. Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded. The protocol will be applied for 10 consecutive days with eight months of follow-up. Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect. CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life.
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References
Gessain A, Cassar O. Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbio, 2012;3:388. https://doi.org/10.3389/fmicb.2012.00388
Roman GC, Osame M. Identify of HLTV-1 associated tropical spastic paraparesis and HTLV-1 associated myelopathy (Letter). Lancet. 1988; 1:651.
Ribas JG, Melo GC. Mielopatia associada ao vírus linfotrópico humanode células T do tipo 1 (HTLV-1). Rev Soc Bras Med Trop. 2002;35(4):377-84. https://doi.org/10.1590/S0037-86822002000400015
Lannes P, Neves MAO, Machado DCD, Miana LC, Silva JG, Bastos VHV. Paraparesia Espástica Tropical - Mielopatia associada ao vírus HTLV- I: possíveis estratégias cinesioterapêuticas para a melhora dos padrões de marcha em portadores sintomáticos. Rev Neurocienc. 2006;14(3):153-160. https://doi.org/10.34024/rnc.2006.v14.8752
Netto EC, Brites C. Characteristics of chronic pain and its impact on quality of life of patients with htlv-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Clin J Pain. 2011;27(2): 131-5. https://doi.org/10.1097/AJP.0b013e3181f195d3
Mendes SMD, Baptista AF, Sá KN, Andrade DCA, Otero GG, Cavalcanti JZ, et al. Pain is highly prevalent in individuals with tropical spastic paraparesis. HC. 2013;1(3):47-53. https://doi.org/10.12966/hc.11.01.2013
Caiafa RC, Orsini M, Felicio LR, Puccioni-Sohler M. Muscular weakness represents the main limiting factor of walk, functional Independence and quality of life of myelopathy patients associeted to HTLV-1. Arq Neuropsiquiatr. 2016;74(4):280-6. https://doi.org/10.1590/0004-282X20160019
Martins JVP, Baptista AF, Araújo AQC. Quality of life in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis. Arq Neuro-Psiquiatr. 2012. 70(4):257-261. https://doi.org/10.1590/S0004-282X2012005000006
Corti M, Patten C, Triggs W. Repetitive transcranial magnetic stimulation of motor córtex after stroke: a focused review. Am J Phys Med Rehabil. 2012;91(3):254-270. https://doi.org/10.1097/PHM.0b013e318228bf0c
Baliki MN, Schnitzer TJ, Bauer WR, Apkarian AV. Brain morphological signatures for chronic pain. PLoS One. 2011;6(10):e2610. https://doi.org/10.1371/journal.pone.0026010
Franzoi AC, Araújo AQ. Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP). Spinal Cord. 2007;45(1): 64-8. https://doi.org/10.1038/sj.sc.3101919
Yamano Y, Sato T. Clinical pathophysiology of human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis. 2012. Front. Microbiol. 3:389. https://doi.org/10.3389/fmicb.2012.00389
Facchinetti LD, Araújo AQ, Chequer GL, Azevedo MF, Oliveira RV, Lima MA. Falls in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Spinal Cord. 2013;51(3):222-5. https://doi.org/10.1038/sc.2012.134
Fonseca EP, Sá KN, Nunes RFR, Ribeiro Junior AC, Lira SFB, Pinto EB. Balance, functional mobility, and fall occurrence in patients with human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis: a cross-sectional study. Rev Soc Bras Med Trop. 2018;51(2):162-167. https://doi.org/10.1590/0037-8682-0375-2017
Croda MG, Oliveira AC, Vergara MP, Bonasser F, Smid J, Duarte AJ, et al. Corticosteroid therapy in TSP/HAM patients: the results from a 10 years open cohort. J Neurol Sci. 2008;269(1-2):133–7. https://doi.org/10.1016/j.jns.2008.01.004
Borges J, Baptista AF, Santana N, Souza I, Kruschewsky RA, Galvão-Castro B, et al. Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: A randomized crossover clinical trial. J. Bodyw Mov Ther. 2014;18(1):68-74. https://doi.org/10.0.3.248/j.jbmt.2013.05.010
Figueiredo Neto I, Mendonça RP, Nascimento CA, Mendes SMD, Sá KN. Muscle strengthening in patients with HTLV-I and its influence on functional performance: a pilot study. Rev Pesq em Fisio. 2012;2(2):143-155. https://doi.org/10.17267/2238-2704rpf.v2i2.96
Britto VLS, Correa R, Vincent MB. Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis. Rev. Soc. Bras. Med. Trop. 2014;47(1):24-29. http://dx.doi.org/10.1590/0037-8682-0245-2013
Souto G, Borges IC, Goes BT, Mendonça ME, Gonçalves RG, Garcia LB, et al. Effects of tDCS-induced Motor Cortex Modulation on Pain in HTLV-1 A Blind Randomized Clinical Trial. Clin J Pain 2014;30(9):809-15. https://doi.org/10.1097/AJP.0000000000000037
Amiri M, Nafissi S, Jamal-Omidi S, Fatehi F. Effect of Repetitive Transcranial Magnetic Stimulation on Reducing Spasticity in Patients Suffering From HTLV-1–Associated Myelopathy. Jour of Clin Neurophy. 2014;31(6):547-551. https://doi.org/10.1097/WNP.0000000000000102
Kim YH, You SH, Ko MH, Park JW, Lee KH, Jang SH, et al. Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke. Stroke. 2006;37(6):1471-1776. https://doi.org/10.1161/01.STR.0000221233.55497.51
Hiscock A, Miller S, Rothwell J, Tallis RC, Pomeroy VM. Informing dose-finding studies of repetitive transcranial magnetic stimulation to enhance motor function: a qualitative systematic review. Neurorehabil Neural Repair. 2008;22(3):228-49. https://doi.org/10.1177/1545968307307115
Stein RB, Everaert DG, Roy FD, Chong S, Soleimani M. Facilitation of corticospinal connections in able-bodied people and people with central nervous system disorders using eight interventions. J Clin Neurophysiol. 2013;30(1):66-78. https://doi.org/10.1097/WNP.0b013e31827ed6bd
Thirugnanasambandam N, Sparing R, Dafotakis M, Meister IG, Paulus W, Nitsche MA, et al. Isometric contraction interferes with transcranial direct current stimulation (tDCS) induced plasticity: evidence of state-dependent neuromodulation in human motor cortex. Restor Neurol Neurosci. 2011;29(5):311-20. https://doi.org/10.3233/RNN-2011-0601
Araújo HA, Iglesio RF, Correia GSC, Fernandes DTRM, Galhardoni R, Marcolin MA, et al. Transcranial magnetic stimulation and clinical applicability: perspectives in neuropsychiatric therapeutics. Rev Med. 2011;90(1):3-14. https://doi.org/10.11606/issn.1679-9836.v90i1p3-14
Diéguez-Varela C, Lión-Vázquez S, Fraga-Bau A, Rodríguez-Acevedo B, Rodríguez-Sánchez L, Collazo-Diéguez M, et al. Intermittent theta-burst transcranial magnetic stimulation for the treatment of spasticity in patients with recurring multiple sclerosis: the results of a double-blind randomised clinical trial. Rev. neurol. 2019;69(2):45-52. https://doi.org/10.33588/rn.6902.2018275
Passard A, Attal N, Benadhira R, Brasseur L, Saba G, Sichere P, et al. Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia. Brain. 2007;130: 2661-70. https://doi.org/10.1093/brain/awm189
Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, et al. Neuromodulation approaches for the treatment of major depression Challenges and recommendations from a working group meeting. Arq Neuro-psiquiatr. 2010;68(3):433-51. https://doi.org/10.1590/S0004-282X2010000300021
Helmich RC, Siebner HR, Bakker M, Münchau A, Bloem BR. Repetitive Transcranial magnetic stimulation to improve mood and motor function in Parkinson’s disease. J Neurol Sci. 2006;248(1-2):84-96. https://doi.org/10.1016/j.jns.2006.05.009
O’Connell NE, Wand BM, Marston L, Spencer S, Desouza LH. Non-invasive brain stimulation techniques for chronic pain. A report of a Cochrane systematic review and meta-analysis. Eur J Phys Rehab Med. 2011;47(2) :309-26. PMID: 21494222.
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Copyright (c) 2022 Lucynara Gomes Lima Tambon, Cleber Luz Santos , Erika Pedreira da Fonseca , Dislene Nascimento dos Santos , Iago de Oliveira Gomes , Abrahão Fontes Baptista , Katia Nunes Sá
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The authors retain copyrights, transferring to the Journal of Evidence-Based Healthcare only the right of first publication. This work is licensed under a Creative Commons Attribution 4.0 International License.
